IBD Unit, DIMEC, University of Bologna, S Orsola-Malpighi Hospital Bologna, Bologna, Italy.
Istituto Reumatologico Lucano (IReL), Potenza, Italy.
Adv Ther. 2018 Apr;35(4):545-562. doi: 10.1007/s12325-018-0672-6. Epub 2018 Mar 7.
Immune-mediated inflammatory diseases (IMIDs) are chronic autoimmune conditions that share common pathophysiologic mechanisms. The optimal management of patients with IMIDs remains challenging because the coexistence of different conditions requires the intervention of several specialists. The aim of this study was to develop a series of statements defining overarching principles that guide the implementation of a multidisciplinary approach for the management of spondyloarthritis (SpA)-related IMIDs including SpA, psoriasis, psoriatic arthritis, Crohn's disease, ulcerative colitis and uveitis.
A Delphi consensus-based approach was used to identify a core set of statements. The process included development of initial questions by a steering committee, an exhaustive search of the literature using complementary approaches to identify potential statements and two Delphi voting rounds for finalization of the statements.
Consensus was achieved on the related nature of IMIDs, the existence of a high prevalence of multiple IMIDs in a single patient and the fact that a multidisciplinary approach can result in a more extensive evaluation and comprehensive approach to treatment. The goals of a multidisciplinary team should be to increase diagnosis of concomitant IMIDs, improve the decision-making process, and increase patient satisfaction and adherence. Early referral and diagnosis, early recognition of concomitant IMIDs and optimizing treatment to improve patient quality of life are some of the advantages of using multidisciplinary teams. To be effective, a multidisciplinary team should be equipped with the appropriate tools for diagnosis and follow-up, and at a minimum the multidisciplinary team should include a dermatologist, gastroenterologist and rheumatologist; providing psychologic support via a psychologist and involving an ophthalmologist, general practitioners and nurses in multidisciplinary care is also important.
The present Delphi consensus identified a set of overarching principles that may be useful for implementation of a multidisciplinary approach for the management of SpA-related IMIDs.
Aristea and Hippocrates.
免疫介导的炎症性疾病（IMIDs）是慢性自身免疫性疾病，具有共同的病理生理机制。由于不同疾病的共存需要多位专家的干预，因此患者的最佳管理仍然具有挑战性。本研究的目的是制定一系列陈述，定义指导多学科方法管理与脊柱关节炎（SpA）相关的免疫介导的炎症性疾病（包括 SpA、银屑病、银屑病关节炎、克罗恩病、溃疡性结肠炎和葡萄膜炎）的总体原则。
采用德尔菲共识方法确定一组核心陈述。该过程包括由指导委员会制定初始问题、使用互补方法全面搜索文献以确定潜在陈述以及进行两轮德尔菲投票以确定最终陈述。
就 IMIDs 的相关性、单个患者中多种 IMIDs 的高患病率以及多学科方法可导致更广泛的评估和综合治疗达成共识。多学科团队的目标应该是增加对并发 IMIDs 的诊断、改善决策过程、提高患者满意度和依从性。早期转诊和诊断、早期识别并发 IMIDs 以及优化治疗以提高患者生活质量是使用多学科团队的一些优势。为了有效，多学科团队应该配备适当的诊断和随访工具，并且最低限度地，多学科团队应该包括皮肤科医生、胃肠病学家和风湿病学家；通过心理学家提供心理支持，并在多学科护理中涉及眼科医生、全科医生和护士也很重要。
本德尔菲共识确定了一组总体原则，可能有助于实施多学科方法管理与 SpA 相关的 IMIDs。
阿里斯蒂亚和希波克拉底。
