[Use of clinical scores for rheumatoid arthritis and inflammatory rheumatic diseases in routine care]. / Utilité des scores pour le suivi de la polyarthrite rhumatoïde et autres arthropathies inflammatoires.

Many clinical scores have been developed in research to measure rheumatoid arthritis (RA), spondyloarthritis (SpA) and psoriatic arthritis (PsA) activity. In routine care, they may be used as part of a treat to target (T2T) strategy consisting of a systematic evaluation of disease activity followed by an adaptation of the treatment in order to reach a predefined therapeutic target, generally remission. The benefits of this strategy have been showed in RA and its use is recommended for this condition. The added value of the T2T strategy for SpA and PsA remains debated, requiring further studies. Scores may be used for the follow-up of patients, but their limitations should be taken in consideration.

De nombreux scores cliniques ont été développés en recherche pour mesurer l'activité de la polyarthrite rhumatoïde (PR), de la spondylarthrite (SpA) et de l'arthrite psoriasique (PsA). Ils peuvent être utilisés en pratique dans l'application de la stratégie « Treat to Target ¼ (T2T) consistant en une évaluation systé matique de l'activité de la maladie suivie d'une adaptation du traitement afin d'atteindre un objectif thérapeutique prédéfini, généralement la rémission. Les bénéfices de cette stratégie étant démontrés dans la PR, son utilisation est recommandée pour cette pathologie. L'apport de la stratégie T2T pour la SpA et la PsA reste débattu, nécessitant des études complémentaires. L'utilisation d'un score dans le suivi individuel d'un patient peut être utile mais doit se faire avec discernement en connaissance des limites du score.

Can Early Introduction of Palliative Care Limit Intensive Care, Emergency and Hospital Admissions in Patients with Severe Chronic Obstructive Pulmonary Disease? A Pilot Randomized Study.

BACKGROUND: Despite their poor prognosis, patients with severe chronic obstructive pulmonary disease (COPD) have little access to palliative care and tend to have a high rate of hospital and intensive care unit (ICU) admissions during their last year of life. OBJECTIVES: To determine the feasibility of a home palliative care intervention during 1 year versus usual care, and the possible impact of this intervention on emergency, hospital and ICU admissions, survival, mood, and health-related quality of life (HRQL). METHODS: Prospective controlled study of patients with severe COPD (GOLD stage III or IV) and long-term oxygen therapy and/or home noninvasive ventilation and/or one or more hospital admissions in the previous year for acute exacerbation, randomized to usual care versus usual care with add-on monthly intervention by palliative care specialists at home for 12 months. RESULTS: Of 315 patients screened, 49 (15.5%) were randomized (26 to early palliative care; 23 to the control group); aged (mean ± SD) 71 ± 8 years; FEV1 was 37 ± 14% predicted; 88% with a COPD assessment test score > 10; 69% on long-term oxygen therapy or home noninvasive ventilation. The patients accepted the intervention and completed the assessment scales. After 1 year, there was no difference between groups in symptoms, HRQL and mood, and there was a nonsignificant trend for higher admission rates to hospital and emergency wards in the intervention group. CONCLUSION: Although this pilot study was underpowered to formally exclude a benefit from palliative care in severe COPD, it raises several questions as to patient selection, reluctance to palliative care in this group, and modalities of future trials.