在现实世界实践中未分化的外周炎性关节炎的结果. 一个纵向队列研究
Mahsa Mashayekhi1, Amirreza Khalaji1, Aida Malek Mahdavi2,3
1Connective Tissue Diseases Research Center, Tabriz University of Medical Sciences, Golgasht St., P.O Box 5166614756, Tabriz, Iran.
Clinical rheumatology
|July 5, 2023
概括
不分化的外周炎性关节炎 (UPIA) 在11%的病例中可以演变为类风湿性关节炎 (RA). 预测因素包括ACPA阳性和缺乏持续缓解,而无药物缓解与缺乏并发症和早期持续缓解有关.
科学领域:
- 类风湿病学 类风湿病学
- 炎症性关节炎研究
- 临床流行病学临床流行病学
背景情况:
- 不分化的外周炎性关节炎 (UPIA) 呈现出各种临床轨迹,包括进展到定义的类风湿性疾病.
- 了解UPIA结果的预测因素对于及时有效的患者管理至关重要.
- 对UPIA过程和影响因素的纵向数据对于基于证据的治疗策略至关重要.
研究的目的:
- 确定UPIA患者不同结果的预测因子.
- 在纵向队列中提供关于疾病过程和缓解的真实世界的证据.
- 分析与进展为类风湿性关节炎和无药物缓解相关的因素.
主要方法:
- 建立了一组203名UPIA患者的纵向队列,满足针对突炎和疾病活性的特定纳入标准.
- 患者从2004年至2023年进行了跟踪,收集了有关疾病进展,治疗坚持和并发症的数据.
- 进行了统计分析,以确定无药缓解,转发为类风湿性关节炎和关节损伤的预测因素.
主要成果:
- 在20.7%的患者中实现了无药可治疗的缓解,预计没有并发症,早期持续缓解 (≤6个月),并且没有疾病爆发.
- 11.8%的患者进展为其他类风湿性疾病,最常见的是类风湿性关节炎 (RA),由抗素抗体 (ACPA) 阳性,不坚持,缺乏持续缓解和爆发预测.
- 关节损伤发生在16.3%的病例中,治疗延迟 (>3个月) 和ACPA阳性是关键预测因素.
结论:
- 虽然大多数用DMARDs治疗的UPIA病例不会进展为RA,但持续治疗通常是必要的,无药物缓解是不常见的.
- 预测RA进展的预测因素包括ACPA阳性,不坚持和疾病爆发,这突显了持续管理的重要性.
- 在"机会窗口"中的早期干预可能会改善共同的结果,强调及时诊断和治疗启动.
相关概念视频
01:22Rheumatic Heart Disease II: Clinical Manifestations and Diagnostic Studies
38
The key clinical manifestations of Rheumatic heart disease (RHD) include several distinct cardiac symptoms.Carditis, a hallmark of acute rheumatic fever, involves inflammation of the heart's endocardium, myocardium, and pericardium. Chronic RHD often results from recurrent episodes of carditis. Its symptoms include the following:Murmurs are caused by valvular damage, especially to the mitral and aortic valves. Mitral stenosis or regurgitation is common, with characteristic heart murmurs...
38
01:27Peripheral Artery Disease III: Interprofessional Care
11
Peripheral Artery Disease (PAD) is characterized by narrowed arteries that diminish blood flow to the extremities. Effective management of PAD requires an interprofessional approach involving various healthcare professionals. The critical aspects of interprofessional care for PAD patients focus on risk factor modification, drug therapy, exercise therapy, nutrition therapy, critical limb ischemia care, and interventional radiology and surgical procedures.The primary treatment goal for PAD...
11
01:17Pericarditis III: Medical Management
15
The primary objectives of managing pericarditis are to determine the underlying cause, provide effective therapy for treatment and symptom relief, and promptly detect signs and symptoms of cardiac tamponade. The following outlines the essential aspects of medical management for pericarditis:ObjectivesDetermine the Cause: Identifying the underlying cause of pericarditis is crucial for targeted treatment. Causes include viral infections, autoimmune diseases, post-cardiac injury syndrome, and...
15
01:21Rheumatic Heart Disease III: Medical Management
22
Rheumatic heart disease (RHD) management can be divided into two main strategies: prevention and long-term management.Primary PreventionPrimary prevention focuses on timely diagnosis and management of group A streptococcal pharyngitis to prevent acute rheumatic fever. The most widely used antibiotic for treating this condition is intramuscular benzathine penicillin G.Acute Rheumatic Fever TreatmentThe primary treatment goal for a patient diagnosed with acute rheumatic fever is to suppress the...
22
01:11Guidelines for Writing Outcome
2.8K
When developing expected outcomes for a patient care plan, the nurse should adhere to the following recommendations:
Patient outcomes reflect the patient's response to the goal rather than what the nurse aims to achieve. Terminology should be observable and measurable to avoid the reader's interpretation. The desired outcome should be realistic and achievable in the designated care timeframe. Expected outcomes should align with adjunctive therapies. The outcome should enhance care...
Patient outcomes reflect the patient's response to the goal rather than what the nurse aims to achieve. Terminology should be observable and measurable to avoid the reader's interpretation. The desired outcome should be realistic and achievable in the designated care timeframe. Expected outcomes should align with adjunctive therapies. The outcome should enhance care...
2.8K
01:23Rheumatic Heart Disease I: Introduction
17
Rheumatic heart disease or RHD is a chronic condition that results from rheumatic fever, causing permanent damage to the heart valves.Etiology and Risk FactorsIt primarily arises from rheumatic fever, an inflammatory disease that can develop after untreated or inadequately treated group A streptococcal (GAS) pharyngitis. Streptococcus spreads through direct contact with oral or respiratory secretions. While the bacteria are the causative agents, factors like malnutrition, overcrowding, poor...
17