摩洛哥社区风湿病学家对非放射学轴性脊柱关节炎管理的知识、态度和实践:一项全国性横断面研究。
Knowledge, Attitudes, and Practices of Moroccan Community Rheumatologists' Regarding the Management of Non-radiographic Axial Spondyloarthritis: A National Cross-Sectional Study.
作者信息
Kronbi Fatine, Rkain Hanan, Benzine Nada, Ez-Zaoui Samya, Abouqal Radouane, Belayachi Jihane, Hajjaj-Hassouni Najia, Tahiri Latifa, Allali Fadoua
机构信息
Rheumatology, Ayachi Hospital, Ibn Sina Hospital Center, Faculty of Medicine and Pharmacy, Mohammed V University, Rabat, MAR.
Exercise Physiology and Autonomous Nervous System Team, Physiology Laboratory, Faculty of Medicine and Pharmacy, Mohammed V University, Rabat, MAR.
出版信息
Cureus. 2024 May 27;16(5):e61162. doi: 10.7759/cureus.61162. eCollection 2024 May.
Introduction Non-radiographic axial spondyloarthritis (nr-axSpA) is within the spectrum of axial spondyloarthritis (axSpA). The emergence of the nr-axSpA concept, defined by the absence of significant erosive damage to the sacroiliac joints, has prompted numerous initiatives aimed at enhancing the early detection and management of this condition. The aim of the study was to assess the knowledge, attitudes, and practices related to the diagnosis and management of nr-axSpA by rheumatologists in Morocco. Methods We conducted a cross-sectional online survey among the rheumatologist community in Morocco. Rheumatologists received via e-mail a structured Google Forms (Google Inc., Mountainview, CA) questionnaire divided into four sections: sociodemographic data of rheumatologists, knowledge, attitudes, and practices related to the diagnosis and treatment management of nr-axSpA. Results A total of 110 rheumatologists (mean age of 44±13 years, 77.3% females, median professional experience of 12 years (4, 75; 26.25 years)) participated in the survey (response rate of 25%). Most responders reported a diagnosis delay issue in spondyloarthritis (SpA) (93.6%); 70.9% of rheumatologists incorrectly regarded the 2009 Assessment of Spondyloarthritis International Society (ASAS) classification criteria for axSpA as diagnostic criteria. Rheumatologists' awareness of recommended magnetic resonance imaging (MRI) sequences for detecting sacroiliac joint inflammation and structural changes in SpA varied significantly, from 69.1% to 14.5%. Their knowledge of additional subchondral edema cases in these joints, beyond SpA, ranged from 48.2% to 87.3%. Almost all rheumatologists believed that the use of sacroiliac MRI would contribute to the early diagnosis of axSpA (97.3%) but could also lead to false positive diagnoses, according to 47.3% of rheumatologists; 73.6% believed that incorrectly using the 2009 ASAS classification criteria as diagnostic criteria in nr-axSpA could also result in false-positive diagnoses. In their practice, 2009 ASAS classification criteria were used as diagnostic criteria in axSpA by 39.1% of rheumatologists. Of the total participants, 91.8% indicated that they approach nr-axSpA similarly to radiographic axial spondyloarthritis, with disparities in recommendations of biological therapies. Conclusion Our survey provides insight into the current status of nr-axSpA management among Moroccan rheumatologists. It also addresses concerns regarding the risk of false positive diagnoses when using the 2009 ASAS classification criteria for axSpA as diagnostic criteria by rheumatologists and the potential risk of misdiagnosis associated with excessive reliance on MRI, despite its utility for early diagnosis.
引言 非放射学中轴型脊柱关节炎(nr-axSpA)属于轴型脊柱关节炎(axSpA)范畴。nr-axSpA这一概念的出现,其定义为骶髂关节无明显侵蚀性损害,促使了众多旨在加强对该疾病早期检测和管理的举措。本研究的目的是评估摩洛哥风湿病学家对nr-axSpA诊断和管理的知识、态度及实践。方法 我们在摩洛哥的风湿病学家群体中进行了一项横断面在线调查。风湿病学家通过电子邮件收到一份结构化的谷歌表单(谷歌公司,加利福尼亚州山景城)问卷,该问卷分为四个部分:风湿病学家的社会人口统计学数据、与nr-axSpA诊断和治疗管理相关的知识、态度及实践。结果 共有110名风湿病学家(平均年龄44±13岁,77.3%为女性,中位专业经验12年(4,75;26.25年))参与了调查(回复率为25%)。大多数受访者报告了脊柱关节炎(SpA)的诊断延迟问题(93.6%);70.9%的风湿病学家错误地将2009年国际脊柱关节炎评估协会(ASAS)的axSpA分类标准视为诊断标准。风湿病学家对用于检测SpA骶髂关节炎症和结构变化的推荐磁共振成像(MRI)序列的知晓率差异很大,从69.1%到14.5%不等。他们对这些关节中除SpA外其他软骨下水肿病例的了解范围在48.2%至87.3%之间。几乎所有风湿病学家都认为使用骶髂关节MRI有助于axSpA的早期诊断(97.3%),但根据47.3%的风湿病学家的说法,这也可能导致假阳性诊断;73.6%的人认为在nr-axSpA中错误地将2009年ASAS分类标准用作诊断标准也可能导致假阳性诊断。在他们的实践中,39.1%的风湿病学家将2009年ASAS分类标准用作axSpA的诊断标准。在所有参与者中,91.8%表示他们对nr-axSpA的处理方式与放射学中轴型脊柱关节炎类似,在生物治疗推荐方面存在差异。结论 我们的调查提供了对摩洛哥风湿病学家对nr-axSpA管理现状的见解。它还解决了风湿病学家将2009年ASAS的axSpA分类标准用作诊断标准时出现假阳性诊断风险的问题,以及尽管MRI对早期诊断有用,但过度依赖MRI可能导致误诊的潜在风险。