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北京大学学报（医学版） ›› 2019, Vol. 51 ›› Issue (6): 1014-1018. doi: 10.19723/j.issn.1671-167X.2019.06.006

• 论著 • 上一篇    下一篇

银屑病关节炎患者就医行为及治疗现状的多中心调查

李玉慧1,苏波2,林福安3,费雅楠4,于笑霞5,范文强6,陈海英7,张学武1,贾园1,△()   

  1. 1. 北京大学人民医院风湿免疫科,北京 100044
    2. 航空总医院内分泌科,北京 100012
    3. 四川省简阳市人民医院风湿免疫科,四川简阳　641400
    4. 北京市海淀医院风湿免疫科,北京　100080
    5. 河北省沧州中西医结合医院风湿免疫科,河北沧州　006100
    6. 新乡市中心医院风湿免疫科,河南新乡　453000
    7. 河北医科大学第三医院风湿免疫科,石家庄　050051
  • 收稿日期:2019-09-09 出版日期:2019-12-18 发布日期:2019-12-19
  • 通讯作者: 贾园 E-mail:jiayuan1023@sina.com
  • 基金资助:
    国家自然科学基金(81801617);北京大学人民医院研究与发展基金(RDY2018-01);北京大学人民医院研究与发展基金(RS2018-02)

Cross-sectional study on clinic behavior and therapeutic status of patients with psoriatic arthritis in multi-center

Yu-hui LI1,Bo SU2,Fu-an LIN3,Ya-nan FEI4,Xiao-xia YU5,Wen-qiang FAN6,Hai-ying CHEN7,Xue-wu ZHANG1,Yuan JIA1,△()   

  1. 1. Department of Rheumatology & Immunology, Peking University People’s Hospital, Beijing 100044, China
    2. Department of Endocrinology, General Aerospace Hospital, Beijing 100012, China
    3. Department of Rheumatology & Immu-nology, People’s Hospital of Jianyang City, Jianyang 641400, Sichuan, China
    4. Department of Rheumatology & Immunology, Haidian Hospital of Beijing, Beijing 100080, China
    5. Department of Rheumatology & Immunology, Integrated Traditional Chinese and Western Medicine Hospital of Cangzhou City, Cangzhou 006100, Hebei, China
    6. Department of Rheumatology & Immunology, Central Hospital of Xinxiang City, Xinxiang 453000, Henan, China
    7. Department of Rheumatology & Immunology, The Third Hospital of Hebei Medical University, Shijiazhuang 050051, China
  • Received:2019-09-09 Online:2019-12-18 Published:2019-12-19
  • Contact: Yuan JIA E-mail:jiayuan1023@sina.com
  • Supported by:
    Supported by the National Natural Science Foundation of China(81801617);Research and Development Fund of Peking University People’s Hospital(RDY2018-01);Research and Development Fund of Peking University People’s Hospital(RS2018-02)

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摘要：

目的 调查并分析银屑病关节炎(psoriatic arthritis, PsA)患者就医行为特点及规范化治疗状况。方法 对2018年2月至6月在北京大学人民医院、北京市海淀医院、四川省简阳市人民医院、河南省新乡市中心医院、河北省沧州中西医结合医院、河北医科大学第三医院6家医院风湿免疫科门诊就诊的PsA患者进行现场问卷调查。调查内容包括患者的一般资料,首诊及确诊科室,就诊及确诊时间, 随诊时间间隔及传统改善病情的抗风湿药或生物制剂的应用情况。结果 参与调查的共133例PsA患者,平均年龄(47±11)岁,男女比例为1.3 ∶1,病程(16±8)年。患者首次就诊科室最多的为风湿免疫科(37.6%, 50/133),其次为骨科(24.1%, 32/133)和皮肤科(23.3%, 31/133);首诊确诊率以风湿免疫科为最高(78%,39/50),其次为皮肤科(19.4%,6/31);从患者首次就诊到确诊PsA的中位时间为7.6个月,首诊于风湿免疫科的患者确诊时间明显少于其他科室;仅有37%患者规律随诊,随诊时间间隔≤3个月,17.3%患者随诊间隔3~6个月,40.2%患者随诊时间间隔超过1年。48.8% PsA患者本次调查时段就诊前未接受规范化治疗,1/3的患者未应用改善病情抗风湿药(disease modifying anti-rheumatic drugs, DMARDs)。在治疗药物方面,PsA患者使用甲氨蝶呤者最多,占58.3%,其次为来氟米特20.5%,生物制剂19.7%,均为肿瘤坏死因子拮抗剂。结论 PsA患者首诊科室分布广泛,确诊科室以风湿免疫科为首,PsA患者首诊及确诊时间延误,约半数患者治疗及随诊不规范。

关键词: 银屑病关节炎, 现况调查, 随访, 慢作用抗风湿药, 生物制剂

Abstract:

Objective: To investigate and analyse the features of treatment behavior and standardized therapeutic status of patients with psoriatic arthritis (PsA).Methods: Out patients diagnosed with PsA in People’s Hospital of Peking University, Haidian Hospital, People’s Hospital of Jianyang City, Central Hospital of Xinxiang City, Integrated Traditional Chinese and Western Medicine Hospital of Cangzhou City, The Third Hospital of Hebei Medical University from February to June 2018 were enrolled in this investigation. The data including gender, age of onset, course of disease, site of first consulting department, time of the first visit and definite diagnosis, follow-up interval, and use of conventional disease modifying anti-rheumatic drugs (cDMARDs) and biological DMARDs (BioDMARDs) were collected and analyzed.Results: In the cross-sectional study, 133 PsA patients were investigated. The mean age of onset was (47±11) years, the male to female ratio was 1.3:1, and mean disease duration was (16±8) years. Rheumatology department was the most common site of first hospital visit (37.6%, 50/133). Orthopedics department and dermatological department were visited by 24.1% (32/133) and 23.3% (31/133), respectively. Ratio of definite diagnosis was the highest in rheumatology department which was 78% (39/50). The ratio of definite diagnosis of dermatological department was the second highest, which was 19.4% (6/31). The mean definite diagnosed time was 7.6 months since the first visit of PsA patients, and diagnosed time was the shortest in rheumatology department, which had statistical significance. 37% PsA patients were treated appropriately in 3 months, 17.3% PsA patients were treated in 3-6 months and 40.2% patients with PsA visited their doctor more than once a year. 48.8% patients hadn’t received standardized treatment before visit, and one third patients never received the therapy of DMARDs. Methotrexate was the most commonly used cDMARDs (58.3%), followed by leflunomide (20.5%) and BioDMARDs (19.7%), and biologicals were tumor necrosis factor antagonists.Conclusion: In this multi-center study, the first visit department of PsA patients was widely distributed, and most patients were definitely diagnosed in Rheumatology Department. The time of their first visit and definite diagnosis were delayed due to multi factors. Nearly half of the patients did not receive standardized treatment.

Key words: Psoriatic arthritis, Cross-sectional study, Follow-up, Disease modifying anti-rheumatic drugs (DMARDs), Biologics

中图分类号: 

  • R593

图1

PsA患者首诊科室及其首诊确诊比例"

表1

133例PsA患者首诊确诊时间"

Department Diagnostic time/months Inter-quartile range/months
Rheumatology 4.4 0-11.2
Orthopedics 10.4 2.1-21.3
Dermatology 10.5 1.2-22.1
General medicine 11.2 2.3-24.9

表2

127例PsA患者随诊时间间隔"

Follow-up interval/months n %
≤3 47 37.0
- 6 22 17.3
-12 7 5.5
>12 51 40.2

表3

127例PsA药物应用的构成比"

Drugs Past medication Present medication
n % n %
MTX 74 58.3 50 39.4
LEF 26 20.5 23 18.1
Biologics 25 19.7 17 13.4
TGW 13 10.2 11 8.7
SASP 11 8.7 10 7.9
IGU 3 2.4 8 6.3
CsA 3 2.4 2 1.6

表4

127例 PsA患者规范化用药情况分析"

Use of DMARDs n %
Appropriately used 65 51.1
1 DMARD 31 24.4
<6-month 8 6.3
≥6-month 23 18.1
≥2 DMARDs 34 26.8
<6-month 7 5.5
≥6-month 27 21.3
Inappropriately used 22 17.3
Never used 40 31.5
[1] Congi L, Roussou E . Clinical application of the CASPAR criteria for psoriatic arthritis compared to other existing critieria[J]. Clin Exp Rheumatol, 2010,28(3):304-310.
[2] Villani AP, Rouzaud M, Sevrain M , et al. Prevalence of undiagnosed psoriatic arthritis among psoriasis patients: Systematic review and meta-analysis[J]. J Am Acad Dermatol, 2015,73(2):242-248.
[3] Ogdie A, Weiss P . The epidemiology of psoriatic arthritis[J]. Rheum Dis Clin North Am, 2015,41(4):545-568.
[4] Zeng QY, Chen R, Darmawan J , et al. Rheumatic diseases in China[J]. Arthritis Res Ther, 2008,10(1):R17.
[5] Leung YY, Ho KW, Li EK , et al. Predictors of functional deterioration in Chinese patients with psoriatic arthritis: a longitudinal study[J]. BMC Musculoskelet Disord, 2014,15:284.
[6] Gossec L, Smolen JS, Ramiro S , et al. European League Against Rheumatism (EULAR) recommendations for the management of psoriatic arthritis with pharmacological therapies: 2015 update[J]. Ann Rheum Dis, 2016,75(3):499-510.
[7] Taylor W, Gladman D, Helliwell P , et al. Classification criteria for psoriatic arthritis: development of new criteria from a large international study[J]. Arthritis Rheum, 2006,54(8):2665-2673.
[8] Husted JA, Gladman DD, Farewell VT , et al. Health-related quality of life of patients with psoriatic arthritis: a comparison with patients with rheumatoid arthritis[J]. Arthritis Rheum, 2001,45(2):151-158.
[9] Adams R, Walsh C, Veale D , et al. Understanding the relationship between the EQ-5D, SF-6D, HAQ and disease activity in inflammatory arthritis[J]. Pharmacoeconomics, 2010,28(6):477-487.
[10] Singh JA, Strand V . Spondyloarthritis is associated with poor function and physical health-related quality of life[J]. J Rheumatol, 2009,36(5):1012-1020.
[11] Javitz HS, Ward MM, Farber E , et al. The direct cost of care for psoriasis and psoriatic arthritis in the United States[J]. J Am Acad Dermatol, 2002,46(6):850-860.
[12] Singh JA, Strand V . Health care utilization in patients with spondyloarthropathies[J]. Rheumatology (Oxford), 2009,48(3):272-276.
[13] Gladman DD . Mortality in psoriatic arthritis[J]. Clin Exp Rheumatol, 2008,26(5 Suppl 51):S62-S65.
[14] Gladman DD . Early psoriatic arthritis[J]. Rheum Dis Clin North Am, 2012,38(2):373-386.
[15] Singh JA, Guyatt G, Ogdie A , et al. 2018 American College of Rheumatology/national psoriasis foundation guideline for the treatment of psoriatic arthritis[J]. Arthritis Rheumatol, 2019,71(1):5-32.
[16] Coates LC, Gossec L, Ramiro S , et al. New GRAPPA and EULAR recommendations for the management of psoriatic arthritis[J]. Rheumatology, 2017,56(8):1251-1253.
[17] Smolen JS, Aletaha D, Bijlsma JW , et al. Treating rheumatoid arthritis to target: recommendations of an international task force[J]. Ann Rheum Dis, 2010,69(4):631-637.
[18] Kiltz U, Smolen J, Bardin T , et al. Treat-to-target (T2T) recommendations for gout[J]. Ann Rheum Dis, 2016,76(4):632-638.
[19] van Vollenhoven RF, Mosca M, Bertsias G , et al. Treat-to-target in systemic lupus erythematosus: recommendations from an international task force[J]. Ann Rheum Dis, 2014,73(6):958-967.
[20] Schoels M, Knevel R, Aletaha D , et al. Evidence for treating rheumatoid arthritis to target: results of a systematic literature search[J]. Ann Rheum Dis, 2010,69(4):623-643.
[21] Stoffer MA, Schoels MM, Smolen JS , et al. Evidence for treating rheumatoid arthritis to target: results of a systematic literature search update[J]. Ann Rheum Dis, 2016,75(1):16-22.
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