University of Washington School of Medicine, Seattle, Washington.
Department of Pediatrics, Division of Rheumatology, Seattle Children's Hospital, Seattle, Washington.
Pediatr Dermatol. 2020 Mar;37(2):278-283. doi: 10.1111/pde.14074. Epub 2020 Jan 22.
Morphea is an inflammatory and fibrosing condition that affects the skin and subcutaneous structures. Morphea is managed by dermatologists, rheumatologists, or both. Prior studies have suggested there is significant variability in approach to treatment. In 2012, the Childhood Arthritis and Rheumatology Research Alliance (CARRA) published consensus treatment plans (CTPs) for pediatric morphea to develop more standardized treatment plans for patients requiring systemic therapy. We aimed to assess whether the publication of CTPs has impacted care of patients with morphea at our institution.
Data were collected via a retrospective review of medical records of 61 pediatric patients diagnosed with morphea at Seattle Children's Hospital (SCH) from January 1, 2005, to December 12,2017.
Prior to the publication of CTPs, 2 out of 24 patients (8.3%) were treated with a regimen that matched a subsequent CTP. After publication of CTPs, 29 out of 37 patients (78.4%) were treated with a regimen that matched a CTP (P < 0.001). A subanalysis was performed to assess the number of patients who needed second- or third-line therapies. Of those who followed a CTP therapy plan (n = 26), 3 patients (11.5%) needed a second-line therapy compared with 11 patients (44%) in the no-CTP followed group (n = 25), (P = 0.012).
The publication of CTPs led to a significant change in treatment approach for patients with morphea requiring systemic therapy at SCH. Patients treated with one of the treatment plans recommended by the CTPs were less likely to need second-line systemic therapy.
硬斑病是一种影响皮肤和皮下组织的炎症性和纤维化疾病。硬斑病由皮肤科医生、风湿病医生或两者共同管理。先前的研究表明，治疗方法存在显著差异。2012 年，儿童关节炎和风湿病研究联盟（CARRA）发布了儿科硬斑病的共识治疗方案（CTP），以制定更标准化的治疗方案，为需要系统治疗的患者提供治疗。我们旨在评估 CTP 的发表是否影响了我们机构硬斑病患者的治疗。
通过对 2005 年 1 月 1 日至 2017 年 12 月 12 日在西雅图儿童医院（SCH）诊断为硬斑病的 61 名儿科患者的病历进行回顾性分析，收集数据。
在 CTP 发表之前，24 名患者中有 2 名（8.3%）接受了与随后的 CTP 相匹配的方案治疗。在 CTP 发表后，37 名患者中有 29 名（78.4%）接受了与 CTP 相匹配的方案治疗（P<0.001）。进行了一项亚分析，以评估需要二线或三线治疗的患者人数。在遵循 CTP 治疗方案的患者中（n=26），3 名患者（11.5%）需要二线治疗，而在未遵循 CTP 治疗方案的患者中（n=25），11 名患者（44%）需要二线治疗（P=0.012）。
CTP 的发表导致 SCH 接受系统治疗的硬斑病患者的治疗方法发生了重大变化。接受 CTP 推荐治疗方案之一治疗的患者不太可能需要二线系统治疗。
