在风湿性疾病中使用DMARDs进行外科手术管理:临床指南的范围审查
Alice Terrett1,2,3, Athena Chin4,5, Mihye Kwon6
1Rheumatology Unit, The Queen Elizabeth Hospital, Woodville South, South Australia, Australia. alice.terrett@sa.gov.au.
BMC rheumatology
|July 3, 2025
概括
在手术期间管理疾病修饰性抗风湿药物 (DMARDs) 的临床实践指南有很大差异. 这是由于低质量的证据,特别是非选择性手术,影响了患者的护理.
科学领域:
- 类风湿病学 类风湿病学
- 手术管理的手术管理.
- 基于证据的医学基于证据的医学.
背景情况:
- 患有自身免疫性类风湿性疾病的患者通常需要手术,包括关节置换.
- 在这些患者中,通常使用疾病修饰性抗风湿药物 (DMARDs).
- 对DMARDs的术后管理对于患者安全和外科手术结果至关重要.
研究的目的:
- 进行临床实践指南的范围审查.
- 为了比较DMARDs在自身免疫性类风湿性疾病的术后管理的建议.
- 识别当前指导方针建议中的变化和差距.
主要方法:
- 在Medline和EMBASE数据库中搜索了自2014年以来发布的指南.
- 包括来自国家/国际风湿病学会的指导方针.
- 专注于类风湿性关节炎,性脊柱炎,牛皮性关节炎,青少年异常性关节炎和全身性红斑狼.
- 执行重复数据提取.
主要成果:
- 包括12条指导方针,其中10条包含术后的DMARD建议.
- 类风湿性关节炎是最常见的疾病 (50%的指导方针).
- 建议基于低到中等质量的证据,主要来自选择性骨科手术研究.
- 在指导方针的制定,格式,证据系统和对生物DMARDs (bDMARDs) 和手术时间的建议中发现了显著的差异.
结论:
- 术后DMARD管理的指导方针可用,但在开发和建议方面显示出相当大的差异.
- 对非选择性和非骨科手术场景缺乏高质量的证据.
- 对bDMARDs的不同建议可能导致不一致的临床实践.
- 需要进一步的证据生成和审查,以加强外科手术期间的管理准则.
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