Motta Francesca, Morandini Pierandrea, Maffia Fiore, Vecellio Matteo, Tonutti Antonio, De Santis Maria, Costanzo Antonio, Puggioni Francesca, Savevski Victor, Selmi Carlo
Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy.
Division of Rheumatology and Clinical Immunology, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy.
Front Med (Lausanne). 2023 Jun 14;10:1179240. doi: 10.3389/fmed.2023.1179240. eCollection 2023.
The impact of a multidisciplinary management of rheumatoid arthritis (RA), psoriatic arthritis (PsA), and psoriasis on systemic glucocorticoids or innovative treatments remains unknown. Rule-based natural language processing and text extraction help to manage large datasets of unstructured information and provide insights into the profile of treatment choices.
We obtained structured information from text data of outpatient visits between 2017 and 2022 using regular expressions (RegEx) to define elastic search patterns and to consider only affirmative citation of diseases or prescribed therapy by detecting negations. Care processes were described by binary flags which express the presence of RA, PsA and psoriasis and the prescription of glucocorticoids and biologics or small molecules in each cases. Logistic regression analyses were used to train the classifier to predict outcomes using the number of visits and the other specialist visits as the main variables.
We identified 1743 patients with RA, 1359 with PsA and 2,287 with psoriasis, accounting for 5,677, 4,468 and 7,770 outpatient visits, respectively. Among these, 25% of RA, 32% of PsA and 25% of psoriasis cases received biologics or small molecules, while 49% of RA, 28% of PsA, and 40% of psoriasis cases received glucocorticoids. Patients evaluated also by other specialists were treated more frequently with glucocorticoids (70% vs. 49% for RA, 60% vs. 28% for PsA, 51% vs. 40% for psoriasis; < 0.001) as well as with biologics/small molecules (49% vs. 25% for RA, 64% vs. 32% in PsA; 51% vs. 25% for psoriasis; < 0.001) compared to cases seen only by the main specialist.
Patients with RA, PsA, or psoriasis undergoing multiple evaluations are more likely to receive innovative treatments or glucocorticoids, possibly reflecting more complex cases.
类风湿性关节炎（RA）、银屑病关节炎（PsA）和银屑病的多学科管理对全身糖皮质激素或创新疗法的影响尚不清楚。基于规则的自然语言处理和文本提取有助于管理大量非结构化信息数据集，并深入了解治疗选择情况。
我们使用正则表达式（RegEx）从2017年至2022年门诊就诊的文本数据中获取结构化信息，以定义弹性搜索模式，并通过检测否定词来仅考虑对疾病或规定疗法的肯定引用。护理过程由二元标志描述，这些标志表示RA、PsA和银屑病的存在以及每种情况下糖皮质激素和生物制剂或小分子的处方情况。使用逻辑回归分析来训练分类器，以就诊次数和其他专科就诊情况作为主要变量来预测结果。
我们识别出1743例RA患者、1359例PsA患者和2287例银屑病患者，分别占门诊就诊次数5677次、4468次和7770次。其中，25%的RA病例、32%的PsA病例和25%的银屑病病例接受了生物制剂或小分子治疗，而49%的RA病例、28%的PsA病例和40%的银屑病病例接受了糖皮质激素治疗。由其他专科医生评估的患者接受糖皮质激素治疗（RA为70%对49%，PsA为60%对28%，银屑病为51%对40%；<0.001）以及生物制剂/小分子治疗（RA为49%对25%，PsA为64%对32%；银屑病为51%对25%；<0.001）的频率高于仅由主诊专科医生诊治的病例。
接受多次评估的RA、PsA或银屑病患者更有可能接受创新疗法或糖皮质激素治疗，这可能反映了病情更为复杂。
