Rheumatology & clinical immunology, Amsterdam Rheumatology Center, Amsterdam, The Netherlands.
Rheumatology, Zuyderland Medical Center, Heerlen, The Netherlands.
Ann Rheum Dis. 2018 Oct;77(10):1394-1396. doi: 10.1136/annrheumdis-2018-213700. Epub 2018 Jul 4.
Overdiagnosis is a term coined by experts in cancer screening to point to indolent cancers detected by screening that would have never led to manifest health problems. Overdiagnosis leads to unnecessary medical care (overtreatment), anxiety and cost. In rheumatology overdiagnosis and overtreatment are hardly discussed but likely present. This viewpoint examines how our prevailing views on the management of inflammatory rheumatic diseases may relate to overdiagnosis and overtreatment. Six paradigms of modern rheumatology will be discussed: early diagnosis, intensive treatment, remission, prognosis and risk stratification, evidence-based rheumatology, and precision medicine. It is concluded that, in spite of the enormous progress that they have brought, all paradigms bear the intrinsic dangers of overdiagnosis and overtreatment. So a little caution is in order.
过度诊断是癌症筛查专家创造的一个术语，用于指出通过筛查检测到的惰性癌症，这些癌症永远不会导致明显的健康问题。过度诊断会导致不必要的医疗护理（过度治疗）、焦虑和成本。在风湿病学中，过度诊断和过度治疗几乎没有被讨论，但可能存在。本文观点探讨了我们对炎症性风湿病管理的现有观点如何与过度诊断和过度治疗相关。将讨论现代风湿病学的六个范式：早期诊断、强化治疗、缓解、预后和风险分层、循证风湿病学和精准医学。结论是，尽管它们带来了巨大的进步，但所有范式都存在过度诊断和过度治疗的内在危险。因此，需要谨慎一点。
