Fonseca João Eurico, Pereira da Silva José António, Bernardes Miguel, Cernadas Rui, Canas da Silva José, Costa Lúcia, Videira Taciana, C Miranda Luís, Barcelos Anabela, Laires Pedro A, Dezerto Raquel, D Pereira Marília, Vidal Filomena, Cunha Esmeralda, Morais Ana, Martins Carla, Mesquita Rui
Acta Reumatol Port. 2018 Jan-Mar;43(1):40-51.
Early diagnosis and treatment of Rheumatoid Arthritis (RA) and axial Spondylarthritis (axial SpA) can limit the impact of disease outcomes. This study evaluated the effectiveness of a referral program on the identification of patients with RA and axial SpA.
This was an observational, prospective, randomized (by clusters) study conducted in Portugal to evaluate the impact of the implementation of a set of referral support actions (RSA). The study was divided in two sub-studies, the RA sub-study and the axial SpA sub-study. 28 participating primary care units were randomly (by clusters) assigned to RSA or control group (with no intervention). Both RSA and control groups identified and referred patients with suspected RA or axial SpA to the rheumatology unit of the reference hospital. The primary objective was to evaluate the correct diagnosis of RA or axial SpA cases confirmed by the rheumatologist of the reference hospital.
RA-Substudy: A total of 340 patients were recruited (144 in the RSA-exposed group; 196 in the control). RA diagnosis confirmation was 7.3% (95%CI, 2.1-12.5%) in RSA group versus 2.7% (95%CI, 0.0-5.7%) in control group RSA effect was positive but moderate (4.6%) and not statistically significant (95% CI, 0.0%-11.8%; p=0.222, adjusted for clustering effect). Rate of confirmed arthritis of any type was 16.9% (n=14/83) in the RSA group and 6.0% (n=5/83) in the control group. This difference was statistically significant and favorable to RSA group (OR=3.2; 95% CI 1.1-9.2; p=0.028). Axial SpA-Substudy: A total of 231 patients were recruited (108 in the RSA-exposed group; 123 in the control). Axial SpA diagnosis confirmation was 8.7% (95% CI, 2.1-15.4%) in RSA group versus 5.6% (95% CI, 0.0-11.73%) in control group. RSA effect was positive (3.1%) but not statistically significant (95% CI, -7.5- 12.9%; p=0.568, adjusted for clustering effect).
This study showed a positive tendency for the RSA program, most relevantly on the diagnosis of patients with any type of arthritis in the RA sub-study. It is possible that a referral program more comprehensive than the one herein tested might improve early diagnosis of RA and SpA.
类风湿关节炎（RA）和中轴型脊柱关节炎（axial SpA）的早期诊断和治疗可限制疾病结局的影响。本研究评估了一项转诊计划对识别RA和axial SpA患者的有效性。
这是一项在葡萄牙进行的观察性、前瞻性、（整群）随机研究，以评估一系列转诊支持行动（RSA）实施的影响。该研究分为两个子研究，即RA子研究和axial SpA子研究。28个参与的初级保健单位被随机（整群）分配到RSA组或对照组（无干预）。RSA组和对照组均识别并将疑似RA或axial SpA的患者转诊至参考医院的风湿病科。主要目的是评估参考医院的风湿病科医生确诊的RA或axial SpA病例的正确诊断情况。
RA子研究：共招募了340例患者（RSA暴露组144例；对照组196例）。RSA组的RA诊断确诊率为7.3%（95%CI，2.1 - 12.5%），而对照组为2.7%（95%CI，0.0 - 5.7%）。RSA的效果为阳性但中等（4.6%），且无统计学意义（95%CI，0.0% - 11.8%；p = 0.222，校正了聚类效应）。RSA组任何类型关节炎的确诊率为16.9%（n = 14/83），对照组为6.0%（n = 5/83）。这一差异具有统计学意义且有利于RSA组（OR = 3.2；95%CI 1.1 - 9.2；p = 0.028）。axial SpA子研究：共招募了231例患者（RSA暴露组108例；对照组123例）。RSA组的axial SpA诊断确诊率为8.7%（95%CI，2.1 - 15.4%），对照组为5.6%（95%CI，0.0 - 11.73%）。RSA的效果为阳性（3.1%）但无统计学意义（95%CI， - 7.5 - 12.9%；p = 0.568，校正了聚类效应）。
本研究显示RSA计划有积极趋势，在RA子研究中对任何类型关节炎患者的诊断方面最为明显。可能比本研究中测试的更全面的转诊计划可能会改善RA和SpA的早期诊断。
