系统性硬化症患者手部手术转诊的筛查工具开发。
Screening tool development for hand surgery referrals in systemic sclerosis.
机构信息
Department of Orthopedics, Rheumatology and Traumatology, Faculdade de Ciências Médicas, Universidade Estadual de Campinas (UNICAMP), Campinas, São Paulo, Brazil.
Occupational Therapy School, Faculty of Psychology, Universidad de Talca, Talca, Chile.
出版信息
Clinics (Sao Paulo). 2023 Aug 17;78:100270. doi: 10.1016/j.clinsp.2023.100270. eCollection 2023.
BACKGROUND
Systemic Sclerosis (SSc) patients may need hand surgery.
OBJECTIVE
To develop a screening tool for rheumatologists to identify potential candidates with systemic sclerosis for hand surgery, optimizing referrals.
METHODS
A pilot cross-sectional study from January 2015 to December 2016.
SAMPLE SIZE
51 participants.
INCLUSION CRITERIA
≥ 18 years old, meeting the 2013 American College of Rheumatology/European League Against Rheumatism (ACR/EULAR) classification criteria for SSc and hand impairment.
DATA COLLECTED
age, sex, race, disease duration, SSc subtypes, vasodilator use, skin thickness, finger stiffness, presence of Digital Ulcers (DU) and/or calcinosis, presence of Raynaud's Phenomenon (RP) attacks, health status and disability, disease status, pain intensity and functional status of the hands. Data were analyzed by a multivariate logistic regression model.
RESULTS
Fulfillment of surgical criteria: 68.8%. The surgical group had higher scores on the HAQ-DI (1.39 vs. 0.96, p = 0.032) and CHFS (25.0 vs. 12.0, p = 0.005) questionnaires, and a higher frequency of DU (91.43% vs. 18.75%, p < 0.0010), calcinosis (60.0% vs. 0.0%, p < 0.001), use of vasodilators (100.0% vs. 75.0%, p = 0.007) and digital stiffness (28.57% vs. 0.0%, p = 0.017). The presence of DU increased the chance of surgical indication by 46.2 times (ORIC 95% = 8.23 to 259.49). The statistical model showed good accuracy (86.3%, p < 0.001), sensitivity (91.4%), and specificity (81.2%).
CONCLUSION
The presence of DU in SSc could be used as a screening feature for early identification and referral of potential candidates for hand surgery.
背景
系统性硬化症（SSc）患者可能需要手部手术。
目的
为风湿病学家开发一种筛选工具，以识别有手部手术适应证的系统性硬化症患者，从而优化转诊。
方法
这是一项 2015 年 1 月至 2016 年 12 月的前瞻性横断面研究。
样本量
51 名参与者。
纳入标准
年龄≥ 18 岁，符合 2013 年美国风湿病学会/欧洲抗风湿病联盟（ACR/EULAR）系统性硬化症分类标准，且存在手部功能障碍。
数据收集
年龄、性别、种族、疾病持续时间、SSc 亚型、血管扩张剂使用情况、皮肤厚度、手指僵硬、存在指溃疡（DU）和/或钙沉积、存在雷诺现象（RP）发作、健康状况和残疾、疾病状况、手部疼痛强度和功能状态。采用多变量逻辑回归模型进行数据分析。
结果
符合手术标准的患者占 68.8%。手术组的 HAQ-DI（1.39 比 0.96，p=0.032）和 CHFS（25.0 比 12.0，p=0.005）评分更高，且 DU（91.43%比 18.75%，p<0.0010）、钙沉积（60.0%比 0.0%，p<0.001）、血管扩张剂使用（100.0%比 75.0%，p=0.007）和手指僵硬（28.57%比 0.0%，p=0.017）的发生率更高。DU 的存在使手术指征的可能性增加了 46.2 倍（ORIC 95%CI：8.23 至 259.49）。该统计模型具有良好的准确性（86.3%，p<0.001）、敏感性（91.4%）和特异性（81.2%）。
结论
SSc 患者存在 DU 可作为早期识别和转诊手部手术潜在候选者的筛查特征。
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