患者和医生的矛盾会影响早期类风湿性关节炎的结果,因为治疗到目标的实施不那么一致
Michaël Doumen1,2, Veerle Stouten1,3, Sofia Pazmino1,4
1Skeletal Biology and Engineering Research Centre, KU Leuven, Leuven, Belgium.
Rheumatology (Oxford, England)
|December 21, 2023
概括
类风湿性关节炎 (RA) 疾病活动中的患者与医生的矛盾影响治疗到目标 (T2T) 实施. 较高的不一致性与缓解程度较低和身体功能较差相关,突出显示在RA治疗中需要对患者和医疗服务提供者的认知保持一致.
科学领域:
- 类风湿病学 类风湿病学
- 临床试验分析
- 患者报告的结果
背景情况:
- 治疗到目标 (T2T) 是一种推的类风湿性关节炎 (RA) 管理策略.
- 了解影响T2T实施的因素对于优化临床结果至关重要.
研究的目的:
- 评估在疾病活动评估中的患者和医生的不一致性与在早期RA中T2T实施之间的关联.
- 确定这种异常对临床结果的影响,包括缓解,身体功能和放射性进展.
主要方法:
- 对早期RA的2年护理 (CareRA) 试验数据的分析.
- 基于疾病活动得分 (Disease Activity Score) 的T2T实施评估:C反应蛋白 (DAS28-CRP) 值的28关节计数.
- 使用不一致分数 (DS) 量化患者与医生的不一致.
- 统计建模用于分析DS,T2T遵守和结果之间的关联.
主要成果:
- 仅在49%的DAS28-CRP升高 (>3.2) 的访问中,T2T的实施发生,并在研究期间下降.
- 较高的患者-医生矛盾 (DS) 与更低的缓解率和2年后更差的身体功能有关.
- 这种关联在一定程度上是由于对T2T协议的遵守程度降低而导致的.
- 在DS和放射性进展之间没有发现显著的关联.
结论:
- 即使在试验环境中,在RA中T2T的实施也不是最佳的.
- 关于疾病活动的患者和医生的矛盾会对T2T坚持,缓解率和身体功能产生负面影响.
- 解决患者和医生的协调对于改善RA管理和患者的治疗结果至关重要.
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