Hysa Elvis, Ghorbannia Ali, Emamifar Amir, Milchert Marcin, Manzo Ciro
Laboratory of Experimental Rheumatology and Academic Division of Clinical Rheumatology, Department of Internal Medicine, University of Genoa, Italy.
Private rheumatologist, Aaalborg, Denmark.
Reumatologia. 2021;59(5):323-329. doi: 10.5114/reum.2021.110600. Epub 2021 Nov 7.
Fast-track clinics (FTC) have been introduced in different fields and have been reporting significant outcomes in terms of reducing mortality, morbidity, and financial costs. To date, scarce evidence is available for FTC specific for patients suspected of polymyalgia rheumatica (PMR). The primary aim of our paper is to provide an overview of the clinical impact of PMR on patients and the healthcare system by analysing multiple aspects: the median time from onset of symptoms to diagnosis and the burden of the disease both on the healthcare system costs and on patients' quality of life (QoL). Secondarily, based on these data, we aim to discuss the potential advantages and feasibility of a PMR FTC in everyday clinical practice.
We performed a narrative non-systematic review (PRISMA protocol not followed) of PubMed and Medline (OVID interface) with the following MeSH terms: [polymyalgia rheumatica AND diagnosis OR diagnosis, delayed OR patient care OR early diagnosis OR length of stay OR costs OR healthcare system OR quality of life] or [polymyalgia rheumatica AND glucocorticoids AND side effects]. We decided to exclude every paper that did not report raw data in terms of diagnostic time or delay, hospitalization rate, socio-economic costs on the healthcare system, patients' QoL, and glucocorticoids-related events in PMR patients. Papers focused primarily on giant cell arteritis patients with overlapping PMR were also excluded. Abstract archives of the European League Against Rheumatism (EULAR) and the American College of Rheumatology (ACR) congresses of the last 10 years were screened and included in the search if raw data were available. Each paper's reference list was scanned for additional publications meeting this study's aims. When papers reported data partially presented in previous articles, we opted to use the most recently published data.
According to our literature review, a PMR FTC might lighten the burden of the disease. Nevertheless, its feasibility depends mostly on the resources of the national health system and of the territorial health district, which are heterogeneously limited. The usefulness of PMR FTCs depends on closer collaboration with the general practitioner because he/she is the first clinician to visit patients with PMR.
Polymyalgia rheumatica fast-track clinics might lighten the burden of the disease. However, it has some limits that should carefully assessed in planning health policies.
快速通道诊所（FTC）已在不同领域推行，并在降低死亡率、发病率和经济成本方面取得了显著成效。迄今为止，针对疑似风湿性多肌痛（PMR）患者的FTC的证据尚少。本文的主要目的是通过分析多个方面，概述PMR对患者及医疗保健系统的临床影响：从症状出现到诊断的中位时间，以及该疾病对医疗保健系统成本和患者生活质量（QoL）的负担。其次，基于这些数据，我们旨在探讨PMR快速通道诊所在日常临床实践中的潜在优势和可行性。
我们对PubMed和Medline（OVID界面）进行了叙述性非系统性综述（未遵循PRISMA方案），使用了以下医学主题词：[风湿性多肌痛与诊断或诊断、延迟或患者护理或早期诊断或住院时间或成本或医疗保健系统或生活质量]或[风湿性多肌痛与糖皮质激素与副作用]。我们决定排除所有未报告诊断时间或延迟、住院率、医疗保健系统的社会经济成本、患者QoL以及PMR患者糖皮质激素相关事件的原始数据的论文。主要关注重叠PMR的巨细胞动脉炎患者的论文也被排除。对欧洲抗风湿病联盟（EULAR）和美国风湿病学会（ACR）过去10年大会的摘要档案进行了筛选，若有原始数据则纳入搜索范围。扫描每篇论文的参考文献列表以查找符合本研究目的的其他出版物。当论文报告的数据部分已在先前文章中呈现时，我们选择使用最新发表的数据。
根据我们的文献综述，PMR快速通道诊所可能减轻疾病负担。然而，其可行性主要取决于国家卫生系统和地区卫生区的资源，而这些资源存在不同程度的限制。PMR快速通道诊所的实用性取决于与全科医生更密切的合作，因为全科医生是首位诊治PMR患者的临床医生。
风湿性多肌痛快速通道诊所可能减轻疾病负担。然而，它存在一些局限性，在制定卫生政策时应仔细评估。
