Radboud University Medical Center, Radboud Institute for Health Sciences, IQ Healthcare, PO box 9101 (114), 6500 HB, Nijmegen, The Netherlands.
, Populierstraat 31, Oss, 5342 VA, The Netherlands.
Clin Rheumatol. 2020 Apr;39(4):1131-1139. doi: 10.1007/s10067-019-04913-7. Epub 2020 Jan 29.
To re-evaluate the adherence to clinical practice guidelines recommended disease activity-based management of rheumatoid arthritis (RA) in daily clinical practice, among Dutch rheumatologists in the past decade. In 2007, disease activity was measured in only 16% of outpatient visits. All rheumatologists that participated in the 2007 study were invited to re-enter our study in 2016/2017. If necessary, data were supplemented with data from other rheumatologists. For all 26 rheumatologists who agreed to participate in our study, data were collected from 30 consecutive patients that visited the outpatient clinic. Per patient, data from four consecutive rheumatologist outpatient visits were collected. Since 2007, disease activity was measured more frequently in Dutch daily clinical practice, increasing from 16 to 79% of visits (2440/3081 visits). In addition, intensification of medication based on disease activity scores increased from 33 to 50% of visits (260/525 visits). DAS/DAS28 was the most frequently used disease activity measure (1596/2440 visits). There was a wide variation among rheumatologists in measuring disease activity and intensification of medication, 20-100% and 0-75% respectively. Over the past years, there has been a large improvement in disease activity assessment in daily clinical practice. Disease activity-based medication intensifications, also called tight control or treat to target, increased to a lesser extent. Large variation between different rheumatologists and clinics indicates that there is still room for improvement. Key Points • Following guideline dissemination disease activity is assessed more frequently (79%). • There is large variation between rheumatologists, indicating room for improvement. • Finding factors that explain variation is necessary to improve tight control in daily practice.
重新评估荷兰风湿病学家在过去十年中遵循基于疾病活动的类风湿关节炎（RA）临床实践指南进行疾病管理的情况。2007 年，只有 16％的门诊就诊时测量疾病活动。所有参与 2007 年研究的风湿病学家均受邀于 2016/2017 年重新参与我们的研究。如果有必要，从其他风湿病学家处补充数据。对于所有同意参与我们研究的 26 名风湿病学家，从 30 名连续就诊的门诊患者中收集数据。每位患者均从连续 4 次风湿病学家门诊就诊中收集数据。自 2007 年以来，荷兰日常临床实践中更频繁地测量疾病活动，就诊时的测量比例从 16％增加到 79％（2440/3081 次就诊）。此外，基于疾病活动评分的药物强化治疗的比例从 33％增加到 50％（260/525 次就诊）。DAS/DAS28 是最常使用的疾病活动测量方法（1596/2440 次就诊）。风湿病学家在测量疾病活动和强化药物治疗方面存在很大差异，分别为 20-100％和 0-75％。在过去的几年中，日常临床实践中疾病活动评估得到了很大改善。基于疾病活动的药物强化治疗（也称为严格控制或靶向治疗）的比例有所增加，但程度较小。不同风湿病学家和诊所之间存在很大差异，表明仍有改进的空间。要点 • 遵循指南传播后，疾病活动评估更频繁（79％）。 • 风湿病学家之间存在很大差异，表明仍有改进的空间。 • 找到解释差异的因素对于改善日常实践中的严格控制是必要的。
