Division of Epidemiology and Public Health, University of Nottingham, Nottingham, UK.
Department of Rheumatology, Ipswich Hospital, Ipswich, UK.
QJM. 2018 Jan 1;111(1):39-45. doi: 10.1093/qjmed/hcx194.
People with granulomatosis with polyangiitis (GPA) commonly described long delays before diagnosis.
To study the natural history of GPA prior to diagnosis using primary care data, and determine whether clinical features could be identified to help earlier diagnosis.
Case-control study using the Clinical Practice Research Datalink.
We compared primary care activity and clinical features between cases and 10 matched controls.
We identified 757 cases and matched 7546 controls. Compared to controls, cases had more GP consultations and overall healthcare activity in the 5 years prior to their diagnosis, with a marked increase in the year before diagnosis, and particularly in the last 3 months. However, consultations were mostly for symptoms that were not specifically related to GPA. In the year prior to diagnosis, the most frequent and strongly predictive clinical features of GPA were Ear Nose and Throat (ENT) symptoms [34.5% of cases, odds ratio (OR) 10.5, 95% confidence intervals (CI) 8.6-12.7], and general (constitutional) symptoms (21.5% of cases, OR 9.0, 95% CI 7.1-11.3). In the year before diagnosis a larger number of cases attended secondary care (382, 50.5%) than had records of clinical features of GPA.
After discussing our findings, we conclude that it would be difficult to identify cases of GPA earlier in primary care. Our results support a need for heightened awareness of this condition among secondary care clinicians, especially those assessing emergency admissions, and in the clinics which were most frequently attended by cases 3-12 months prior to diagnosis.
肉芽肿性多血管炎（GPA）患者在确诊前常描述存在较长的延误。
使用初级保健数据研究 GPA 在确诊前的自然病史，并确定是否可以识别出临床特征以帮助更早诊断。
使用临床实践研究数据链接进行病例对照研究。
我们比较了病例和 10 名匹配对照者的初级保健活动和临床特征。
我们确定了 757 例病例，并匹配了 7546 名对照者。与对照组相比，病例在确诊前的 5 年内有更多的全科医生就诊和整体医疗保健活动，在确诊前 1 年，尤其是在最后 3 个月，有明显增加。然而，就诊主要是针对与 GPA 无关的症状。在确诊前 1 年，GPA 的最常见且具有强烈预测性的临床特征是耳鼻喉（ENT）症状[34.5%的病例，比值比（OR）为 10.5，95%置信区间（CI）为 8.6-12.7]和全身（一般）症状（21.5%的病例，OR 为 9.0，95% CI 为 7.1-11.3）。在确诊前 1 年，更多的病例就诊于二级保健（382 例，50.5%），而有 GPA 临床特征记录的病例则较少。
在讨论了我们的发现后，我们得出结论，很难在初级保健中更早地识别 GPA 病例。我们的结果支持二级保健临床医生，尤其是评估急诊入院的临床医生以及在确诊前 3-12 个月就诊最多的诊所，需要提高对这种疾病的认识。
