Yelin E H, Such C L, Criswell L A, Epstein W V
Rosalind Russell Medical Research Center for Arthritis and the Institute for Health Policy Studies, University of California, San Francisco, USA.
Med Care. 1998 Apr;36(4):513-22. doi: 10.1097/00005650-199804000-00007.
The authors compared outcomes among persons with rheumatoid arthritis (RA) with a rheumatologist versus a non-rheumatologist as the main physician for this condition.
A cohort of 1,025 persons with rheumatoid arthritis were followed for as long as 11 years. The principal measures were obtained from an annual structured telephone interview conducted by a trained survey worker. All persons with rheumatoid arthritis originally were selected from a random sample of community rheumatologists, but some subsequently had migrated to the practices of non-rheumatologists. The main outcome measures included the number of painful and swollen joints, extent of morning stiffness, a global pain rating, functional status, and a measure of global improvement.
The persons with rheumatoid arthritis treated by rheumatologists reported significantly better functional status, fewer painful joints, and a lower overall pain rating, although the magnitude of these differences was small. A significantly greater proportion of the persons with rheumatoid arthritis treated by rheumatologists also reported improvement in a global measure of rheumatoid arthritis outcome and simultaneous improvement in all outcome measures. On all other outcome measures, the point estimate favored those with a rheumatologist as the main rheumatoid arthritis physician, although the differences did not reach statistical significance.
The evidence suggests an advantage for persons with a rheumatologist as the main rheumatoid arthritis physician, but on several of the measures of outcome, the magnitude of the advantage was small. Because the present study was an observational design, the possibility that the advantage among persons with a rheumatologist as the main rheumatoid arthritis physician is an artifact of selection bias cannot be ruled out.
作者比较了以风湿病专科医生而非非风湿病专科医生作为主要治疗医师的类风湿关节炎（RA）患者的治疗结果。
对1025名类风湿关节炎患者进行了长达11年的随访。主要测量指标来自一名经过培训的调查人员每年进行的结构化电话访谈。所有类风湿关节炎患者最初均从社区风湿病专科医生的随机样本中选取，但其中一些患者后来转至非风湿病专科医生处就诊。主要结局指标包括疼痛和肿胀关节的数量、晨僵程度、整体疼痛评分、功能状态以及整体改善情况的一项测量指标。
由风湿病专科医生治疗的类风湿关节炎患者报告的功能状态明显更好，疼痛关节更少，总体疼痛评分更低，尽管这些差异的幅度较小。由风湿病专科医生治疗的类风湿关节炎患者中，有显著更高比例的患者还报告在类风湿关节炎结局的整体测量指标上有所改善，且所有结局指标同时得到改善。在所有其他结局指标上，点估计值倾向于以风湿病专科医生作为主要类风湿关节炎治疗医师的患者，尽管差异未达到统计学显著性。
证据表明以风湿病专科医生作为主要类风湿关节炎治疗医师对患者有优势，但在一些结局指标上，优势幅度较小。由于本研究为观察性设计，不能排除以风湿病专科医生作为主要类风湿关节炎治疗医师的患者的优势是选择偏倚所致假象的可能性。
