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1.
Isr Med Assoc J ; 22(3): 185-190, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32147985

RESUMO

BACKGROUND: We describe the features of nocebo, and its impact in studies of transition from the originator to the respective biosimilar in inflammatory rheumatic diseases. Investigations in healthy volunteers as well as in the neurology and anesthesiology fields demonstrated the involved cerebral areas and the neurotransmitter pathways responsible for the nocebo response. Whether these findings are applicable to patients with inflammatory rheumatic diseases remains to be demonstrated. Nocebo may account for part of the after-switching biosimilar failures. However, in the absence of validated classification or diagnostic criteria, specific neurochemical and neuroimaging studies, the lack of data on serum tumor necrosis factor and drug levels, and the disease improvement after the switching back to the originator biologic observed in some patients, the nocebo diagnosis remains the role of the individual clinician. Investigations on nocebo pathophysiology and diagnosis are required to address its impact in after-transition biosimilar studies in rheumatology.


Assuntos
Antirreumáticos/uso terapêutico , Efeito Nocebo , Doenças Reumáticas/tratamento farmacológico , Reumatologia/métodos , Humanos
2.
Ann Ist Super Sanita ; 55(3): 246-248, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31553317

RESUMO

Patients with inflammatory bowel disease (IBD) may develop rheumatic diseases, particularly enterophatic spondyloarthritis (ESpA). Similarly, an IBD may develop in patients with SpA. Management of these patients in a dedicated ambulatory could be advantageous. We pioneered an integrated "GastroReumatology" ambulatory where a gastroenterologist and a rheumatologist with a long-lasting expertise in IBD and spondyloarthritis, respectively, simultaneously visit those patients referred for a suspected ESpA. A total of 101 different patients with suspected or known IBD and/or a rheumatic disease were visited. A new diagnosis of ESpA was eventually achieved in 13 (12.9%) patients, and further 12 patients with an already known ESpA were referred for an appropriate management. No cases of IBD in those patients with an established rheumatic disease were observed. Early diagnosis of ESpA is possible in a "GastroReumatology" ambulatory.


Assuntos
Assistência Ambulatorial/métodos , Gastroenterologia/métodos , Reumatologia/métodos , Espondilartrite/diagnóstico , Instituições de Assistência Ambulatorial , Prestação Integrada de Cuidados de Saúde , Diagnóstico Precoce , Humanos , Doenças Inflamatórias Intestinais/complicações , Espondilartrite/etiologia
4.
Z Rheumatol ; 78(8): 722-742, 2019 Oct.
Artigo em Alemão | MEDLINE | ID: mdl-31468170

RESUMO

In order to reduce the prognostically relevant time interval between the initial manifestation of a rheumatic and musculoskeletal disease and diagnosis as well as the consecutive initiation of an appropriate treatment, several rheumatological centers in Germany have improved the access to initial rheumatologic evaluation by establishing early recognition/screening clinics at their respective sites. Corresponding models located at Altoetting·Burghausen, Bad Pyrmont, Berlin Buch, Duesseldorf, Heidelberg, Herne, Mannheim as well as supraregional/multicenter initiatives Rheuma Rapid, RhePort and Rheuma-VOR are presented in this overview along with the respective characteristics, potential advantages and disadvantages, but also first evaluation results of several models. The aim of this publication is to promote early detection of rheumatic and musculoskeletal diseases as one of the most important challenges in current rheumatology by encouraging further rheumatologic centers and practices to launch their own early recognition/screening consultation model on the basis of aspects presented herein.


Assuntos
Doenças Musculoesqueléticas , Doenças Reumáticas , Reumatologia , Diagnóstico Precoce , Alemanha , Humanos , Doenças Musculoesqueléticas/diagnóstico , Doenças Musculoesqueléticas/terapia , Encaminhamento e Consulta , Doenças Reumáticas/diagnóstico , Doenças Reumáticas/terapia , Reumatologia/métodos
5.
JMIR Mhealth Uhealth ; 7(7): e12952, 2019 07 02.
Artigo em Inglês | MEDLINE | ID: mdl-31267979

RESUMO

BACKGROUND: In contrast to the use of traditional unidimensional paper-based scales, a mobile health (mHealth) assessment of pain in children and young people (CYP) with juvenile idiopathic arthritis (JIA) enables comprehensive and complex multidimensional pain data to be captured remotely by individuals. However, how professionals use multidimensional pain data to interpret and synthesize pain reports gathered using mHealth tools is not yet known. OBJECTIVE: The aim of this study was to explore the salience and prioritization of different mHealth pain features as interpreted by key stakeholders involved in research and management of pain in CYP with JIA. METHODS: Pain and rheumatology specialists were purposively recruited via professional organizations. Face-to-face focus groups were conducted for each specialist group. Participants were asked to rank order 9 static vignette scenarios created from real patient mHealth multidimensional pain data. These data had been collected by a researcher in a separate study using My Pain Tracker, a valid and acceptable mHealth iPad pain communication tool that collects information about intensity, severity, location, emotion, and pictorial pain qualities. In the focus groups, specialists discussed their decision-making processes behind each rank order in the focus groups. The total group rank ordering of vignette scenarios was calculated. Qualitative data from discussions were analyzed using latent thematic analysis. RESULTS: A total of 9 pain specialists took part in 1 focus group and 10 rheumatology specialists in another. In pain specialists, the consensus for the highest pain experience (44%) was poorer than their ranking of the lowest pain experiences (55%). Conversely, in rheumatology specialists, the consensus for the highest pain experience (70%) was stronger than their ranking of the lowest pain experience (50%). Pain intensity was a high priority for pain specialists, but rheumatology specialists gave high priority to intensity and severity taken together. Pain spread was highly prioritized, with the number of pain locations (particular areas or joints) being a high priority for both groups; radiating pain was a high priority for pain specialists only. Pain emotion was challenging for both groups and was only perceived to be a high priority when specialists had additional confirmatory evidence (such as information about pain interference or clinical observations) to validate the pain emotion report. Pain qualities such as particular word descriptors, use of the color red, and fire symbols were seen to be high priority by both groups in interpretation of CYP pain reports. CONCLUSIONS: Pain interpretation is complex. Findings from this study of specialists' decision-making processes indicate which aspects of pain are prioritized and weighted more heavily than others by those interpreting mHealth data. Findings are useful for developing electronic graphical summaries which assist specialists in interpreting patient-reported mHealth pain data more efficiently in clinical and research settings.


Assuntos
Manejo da Dor/instrumentação , Dor/classificação , Reumatologistas/psicologia , Adulto , Artrite Juvenil/complicações , Artrite Juvenil/psicologia , Feminino , Grupos Focais/métodos , Humanos , Masculino , Pessoa de Meia-Idade , Dor/psicologia , Manejo da Dor/psicologia , Manejo da Dor/normas , Medição da Dor/métodos , Pesquisa Qualitativa , Reumatologistas/estatística & dados numéricos , Reumatologia/instrumentação , Reumatologia/métodos , Telemedicina/tendências
7.
Lancet ; 393(10188): 2344-2358, 2019 Jun 08.
Artigo em Inglês | MEDLINE | ID: mdl-31180031

RESUMO

The heterogeneity of systemic lupus erythematosus (SLE), long recognised by clinicians, is now challenging the entire lupus community, from geneticists to clinical investigators. Although the outlook for patients with SLE has greatly improved, many unmet needs remain, chief of which is the development of safer and more efficacious therapies. To develop innovative therapies, a far better understanding of SLE pathogenesis as it relates to the array of clinical phenotypes is needed. Additionally, to efficiently achieve these goals, the lupus community needs to refine existing clinical research tools and better adapt them to overcome the obstacles created by the heterogeneity of manifestations. Here, we review progress towards the ultimate goal of safely reducing disease activity and preventing damage accrual and death. We discuss the new classification criteria from the European League Against Rheumatism and American College of Rheumatology, novel definitions of remission and low lupus disease activity, and new proposals for the histological classification of lupus nephritis. Recommendations for the treatment of SLE and novel approaches to drug development hold much promise to further enhance SLE outcomes.


Assuntos
Lúpus Eritematoso Sistêmico/tratamento farmacológico , Feminino , Humanos , Lúpus Eritematoso Sistêmico/classificação , Lúpus Eritematoso Sistêmico/fisiopatologia , Masculino , Indução de Remissão , Reumatologia/métodos , Reumatologia/tendências , Índice de Gravidade de Doença
8.
Z Rheumatol ; 78(5): 429-438, 2019 Jun.
Artigo em Alemão | MEDLINE | ID: mdl-31161316

RESUMO

In the last 4 years selective contracts according to §140a of the German Social Code Book V (SGB V) with three different health insurers were signed by the Professional Association of German Rheumatologists (BDRh) and from the beginning of the year 2018 by the management company of the association. The contracts were rolled out in five regions of Germany (Bavaria, Hesse, Mecklenburg-Western Pomerania, North Rhine and Saxony). Up to the end of 2018, 12,000 patients with chronic inflammatory rheumatic diseases were treated within the managed care of these contracts. The interface and the treatment pathways were initially consented with the associations of rheumatologists and general practitioners. The aim of the managed care was to provide the optimal quality in diagnostics and treatment and to improve management of rheumatic diseases. Quality indicators, such as treat-to-target principles, tight control, delegation to specially trained assistance personnel, patient education in rheumatoid arthritis (StruPi) and early arthritis consultation, are part of the managed care and are successfully promoted with incentive payments. Thus approximately 20% of the patients were enrolled for the first time in rheumatological care. The BDRh wants to promote the nationwide roll-out of this managed care in Germany with more participating health insurance funds.


Assuntos
Artrite Reumatoide , Qualidade da Assistência à Saúde , Doenças Reumáticas , Reumatologia , Artrite Reumatoide/terapia , Alemanha , Humanos , Doenças Reumáticas/terapia , Reumatologistas , Reumatologia/economia , Reumatologia/métodos
9.
Clin Rheumatol ; 38(8): 2029-2038, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31102085

RESUMO

Given the plethora of studies today on the same topic, clinicians in rheumatology as well as others increasingly rely on systematic reviews, with or without meta-analysis, to aid in their evidence-based decision-making. However, given time constraints, staying up-to-date on current methods for conducting systematic reviews and meta-analyses as well as interpreting the results of these reviews for application in clinical practice can be challenging. The purpose of this paper is to try and address this gap. In this paper, a description of the different types of systematic reviews and meta-analyses is provided as well as a description of the major elements, including methodology and interpretation of systematic reviews with meta-analyses. Included is a broad, five-question checklist to aid clinicians in rheumatology for making decisions about the utility of a systematic review. It is the hopes that this paper will aid clinicians in rheumatology as well as other consumers of systematic reviews and meta-analyses with the information necessary for judging the utility of systematic reviews and meta-analyses in their own work.


Assuntos
Metanálise como Assunto , Reumatologia/normas , Revisão Sistemática como Assunto , Tomada de Decisões , Medicina Baseada em Evidências , Humanos , Publicações , Reumatologia/métodos
11.
Rheum Dis Clin North Am ; 45(2): 173-186, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30952391

RESUMO

This article aims to describe key issues, processes, and outcomes related to development of a patient registry for rheumatology research using a digital platform where patients track useful data about their condition for their own use while contributing to research. Digital interventions are effective to build a patient research registry for people with rheumatoid arthritis and other rheumatic and musculoskeletal diseases. ArthritisPower provides evidence of the value of digital interventions to build community support for research and to transform patient engagement and patient-generated data capture.


Assuntos
Medidas de Resultados Relatados pelo Paciente , Projetos de Pesquisa/tendências , Reumatologia , Telemedicina/métodos , Humanos , Seleção de Pacientes , Reumatologia/métodos , Reumatologia/tendências , Autogestão/métodos
12.
Rheum Dis Clin North Am ; 45(2): 257-273, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30952397

RESUMO

Technology can help health care providers understand their patients' experience of illness in a way that was previously impossible. Experience in using health information technology (IT) to capture this information through PROs within rheumatology suggests that careful attention to human centered design, including detailed workflow planning, consideration of patient and physician burden, integration into the health IT ecosystem, and delivering information to the right person at the right time are all important. Technology applications must be tested in diverse health systems and populations to ensure they are simple to interpret, useful for clinical decision making and effective in impacting outcomes.


Assuntos
Informática Médica/métodos , Medidas de Resultados Relatados pelo Paciente , Reumatologia , Telemedicina/métodos , Registros Eletrônicos de Saúde , Humanos , Reumatologia/métodos , Reumatologia/tendências
14.
Scand J Rheumatol ; 48(4): 259-265, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30838907

RESUMO

Objective: To develop evidence-based guidelines for the management of giant cell arteritis (GCA) as a complement to guidelines in other areas of rheumatology, issued by the Swedish Society of Rheumatology. Methods: A working group selected key areas for recommendations, reviewed the available evidence, and wrote draft guidelines. These were discussed and revised according to standard procedures within the Swedish Society of Rheumatology, including a one-day meeting open to all members. For key recommendations, the quality of evidence was assessed according to GRADE. The final guidelines were approved by the Society board in March 2018. Results: The guidelines include recommendations on diagnostic procedures, pharmacological treatment, follow-up, and adjuvant treatment. Ultrasonography is complementary to temporal artery biopsy (TAB) in the diagnostic work-up. Other imaging techniques (magnetic resonance imaging and positron emission tomography/computed tomography) are important in evaluating large-vessel involvement. Glucocorticoids (oral, or intravenous in cases with ischaemic complications) remain the first line treatment for GCA. Addition of tocilizumab is recommended for patients with relapsing disease who meet five criteria, representing active disease that has been objectively verified by TAB or imaging. Tocilizumab may also be considered in patients with newly diagnosed GCA who are at major risk of severe glucocorticoid side effects. Based on current evidence, tocilizumab treatment for > 1 year cannot be recommended. Conclusion: These guidelines are based on current evidence and consensus within Swedish rheumatology. Following major developments in diagnostics and treatment of GCA, such guidelines are important for clinical practice, and should be updated on a regular basis.


Assuntos
Anticorpos Monoclonais Humanizados , Diagnóstico por Imagem , Arterite de Células Gigantes , Glucocorticoides , Anticorpos Monoclonais Humanizados/administração & dosagem , Anticorpos Monoclonais Humanizados/efeitos adversos , Antirreumáticos/administração & dosagem , Antirreumáticos/efeitos adversos , Diagnóstico por Imagem/classificação , Diagnóstico por Imagem/métodos , Monitoramento de Medicamentos/métodos , Prática Clínica Baseada em Evidências/métodos , Arterite de Células Gigantes/diagnóstico , Arterite de Células Gigantes/tratamento farmacológico , Glucocorticoides/administração & dosagem , Glucocorticoides/efeitos adversos , Humanos , Gravidade do Paciente , Reumatologia/métodos , Suécia
15.
Med Hypotheses ; 125: 89, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30902159

RESUMO

Remission is the goal of therapy in patients with rheumatoid arthritis (RA). However, drug free remission has not been investigated adequately. Early and intensive treatment may increase the chances of successful drug free remission. Effect of long term remission while on medical therapy on the success of drug withdrawal has not been previously evaluated in RA. Long term immune suppression has been shown to have beneficial effects on relapse rates in other diseases with dysregulated immune tolerance. Therefore, drug withdrawal could be an acceptable option in RA patients in long term remission.


Assuntos
Antirreumáticos/uso terapêutico , Artrite Reumatoide/tratamento farmacológico , Indução de Remissão , Humanos , Sistema Imunitário , Imunossupressores/uso terapêutico , Modelos Teóricos , Recidiva , Projetos de Pesquisa , Reumatologia/métodos , Reumatologia/normas , Resultado do Tratamento
16.
Rev. bras. cir. plást ; 34(1): 134-137, jan.-mar. 2019. ilus
Artigo em Inglês, Português | LILACS | ID: biblio-994618

RESUMO

Introdução: A esclerose sistêmica é uma doença rara, autoimune, com evolução progressiva, que afeta os tecidos conectivos e órgãos internos por inflamação, podendo causar calcinose de subcutâneo. Podem evoluir para quadros dolorosos e incapacitantes, podendo tornar-se infectados, principalmente quando ulceram pela pele. Objetivo: Apresentar caso de calcinose em região inguinal e sua evolução cirúrgica. Relato de Caso: Paciente feminina portadora de calcinoses em região inguinal bilateral, apresentando algia moderada/grave com falha de tratamento clínico. Realizada ressecção cirúrgica das calcinoses, que formavam cordões de fibrose com aderência na fáscia do músculo oblíquo externo. Realizado fechamento primário com nylon 2.0 pontos simples subdérmicos e ponto intradérmico continuo nylon 3.0 para fechamento estético e menor reação inflamatória. Boa evolução pós- operatório. Conclusão: O melhor tratamento da calcinoses ainda não é claro. O tratamento das complicações se torna essencial para reduzir a morbidade e aumentar a qualidade de vida do paciente.


Introduction: Systemic sclerosis is a rare, autoimmune, progressive disease that affects connective tissues and internal organs by inflammation, which can cause calcinosis cutis. It can progress to painful and disabling conditions, and can become infected, especially when skin ulceration is present. Objective: To present a case of calcinosis in the inguinal region and its surgical recovery. Case Report: A female patient with calcinosis in the bilateral inguinal region presenting with moderate/severe pain had a failed clinical treatment. We performed surgical resection of the calcinosis cutis, which had formed clusters of fibrosis with adhesion to the fascia of the external oblique muscle. We used simple nylon 2.0 sutures along the subdermal plane to perform primary closure and continuous nylon 3.0 sutures along the intradermal plane for aesthetic closure and minimal inflammatory reaction. Her postoperative recovery was positive. Conclusion: The best treatment for calcinosis cutis is still unclear. Treating complications becomes essential for reducing patients' morbidity and increasing their quality of life.


Assuntos
Humanos , Feminino , Pessoa de Meia-Idade , Reumatologia/métodos , Esclerose/cirurgia , Esclerose/complicações , Doenças Autoimunes/diagnóstico , Procedimentos Cirúrgicos Operatórios/métodos , Calcinose/diagnóstico , Calcinose/patologia , Procedimentos Cirúrgicos Reconstrutivos/métodos , /métodos , Inflamação/patologia
17.
Autoimmun Rev ; 18(4): 369-381, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30772494

RESUMO

Overt polyautoimmunity (PolyA) corresponds to the presence of more than one well-defined autoimmune disease (AD) manifested clinically in a single patient. The current study aimed to describe the main characteristics of juvenile PolyA in a pediatric rheumatology setting and analyze the chronological aspects, index cases, familial autoimmunity, and clustering pattern. This was a cross-sectional and multicenter study in which 313 children with overt PolyA were included. Patients were systematically interviewed and their medical records reviewed using a questionnaire that sought information about demographic, clinical, immunological, and familial characteristics. A hierarchical cluster analysis was done to determine similarities between autoimmune diseases based on PolyA. PolyA occurred simultaneously in 138 (44%) patients. Multiple autoimmune syndrome was observed in 62 (19.8%) patients. There were 25 index diseases of which, systemic lupus erythematosus (SLE, n = 134, 42.8%), juvenile idiopathic arthritis (JIA, n = 40, 12.7%), Hashimoto's thyroiditis (HT, n = 24, 7.66%), immune thrombocytopenic purpura (ITP n = 20, 6.39%), antiphospholipid syndrome (APS, n = 15, 4.79%), and vitiligo (VIT, n = 15, 4.79%) were the most frequent and represented 79.23% of the total number of patients. Familial autoimmunity influenced PolyA. A high aggregation of autoimmunity was observed (λr = 3.5). Three main clusters were identified, of which SLE and APS were the most similar pair of diseases (based on the Jaccard index) followed by HT and JIA, which were related to ITP and Sjögren's syndrome. The third cluster was composed of localized scleroderma and VIT. Our findings may assist physicians to make an early diagnosis of this frequent condition. Pediatric patients with ADs should be systematically assessed for PolyA.


Assuntos
Doenças Autoimunes , Doenças Reumáticas , Adolescente , Idade de Início , Doenças Autoimunes/classificação , Doenças Autoimunes/epidemiologia , Doenças Autoimunes/patologia , Doenças Autoimunes/terapia , Autoimunidade/imunologia , Criança , Análise por Conglomerados , Estudos Transversais , Feminino , Humanos , Masculino , Estudos Retrospectivos , Doenças Reumáticas/classificação , Doenças Reumáticas/epidemiologia , Doenças Reumáticas/patologia , Doenças Reumáticas/terapia , Reumatologia/métodos , Inquéritos e Questionários
18.
Arch Osteoporos ; 14(1): 16, 2019 02 05.
Artigo em Inglês | MEDLINE | ID: mdl-30723883

RESUMO

Glucocorticoid-induced osteoporosis (GIOP) is common in patients prescribed with long-term glucocorticoids. Guidelines suggest patients receiving moderate-dose glucocorticoid therapy receive GIOP preventive care. Previous studies have shown preventive care rates are not optimal. We look at GIOP preventive care rates in rheumatology patients and predictors of various components of care. PURPOSE: Glucocorticoid-induced osteoporosis (GIOP) is a common concern in patients prescribed with long-term glucocorticoids. Studies have shown GIOP preventive care is not provided optimally in the general population; however, little is published on GIOP preventive care among patients with rheumatic disease. The objective of this study is to determine the proportion of rheumatology patients who received GIOP preventive care. METHODS: A population-based retrospective quality assurance study of adults seen at the University of Alberta Rheumatology Clinic was performed using the electronic outpatient medical record. Records of adult patients prescribed with prednisone from January 1st to December 31st, 2016 by a rheumatologist were initially included for review. Those who had been prescribed ≥ 7.5 mg/day for ≥ 3 months were assessed for concurrent GIOP preventive care. RESULTS: A total of 745 discreet courses of prednisone were prescribed in 433 patients with 113 meeting the above inclusion criteria. Following the prednisone prescription, 79% were taking vitamin D, 86% were taking calcium, and 50% were prescribed with osteoporosis pharmacotherapy. Twenty-five percent of patients had DXA imaging ordered by the rheumatologist within the first 6 months; of these, 86% of patients completed the DXA. CONCLUSIONS: Overall, our study shows that patients under the care of rheumatologists receive better GIOP preventative care than previously reported care in the general population. However, there is still room for improvement. In particular, men, younger patients, and rural patients seem to be at the most at risk of not receiving optimal GIOP prevention.


Assuntos
Cálcio na Dieta/uso terapêutico , Glucocorticoides/efeitos adversos , Osteoporose/prevenção & controle , Vitamina D/uso terapêutico , Vitaminas/uso terapêutico , Adulto , Conservadores da Densidade Óssea/uso terapêutico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Osteoporose/induzido quimicamente , Prednisona/efeitos adversos , Estudos Retrospectivos , Reumatologia/métodos
19.
BMC Musculoskelet Disord ; 20(1): 74, 2019 Feb 13.
Artigo em Inglês | MEDLINE | ID: mdl-30760253

RESUMO

BACKGROUND: There is a pressing need to enhance osteoarthritis (OA) research to find ways of alleviating its enormous individual and societal impact due to the high prevalence, associated disability, and extensive costs. METHODS: Potential research priorities and initial rankings were pre-identified via surveys and the 1000Minds process by OA consumers and the research community. The OA Summit was held to decide key research priorities that match the strengths and expertise of the Australian OA research community and align with the needs of consumers. Facilitated breakout sessions were conducted to identify initiatives and strategies to advance OA research into agreed priority areas, and foster collaboration in OA research by forming research networks. RESULTS: From the pre-Summit activities, the three research priority areas identified were: treatment adherence and behaviour change, disease modification, and prevention of OA. Eighty-five Australian and international leading OA experts participated in the Summit, including specialists, allied health practitioners, researchers from all states of Australia representing both universities and medical research institutes; representatives from Arthritis Australia, health insurers; and persons living with OA. Through the presentations and discussions during the Summit, there was a broad consensus on the OA research priorities across stakeholders and how these can be supported across government, industry, service providers and consumers. CONCLUSION: The Australian OA Summit brought consumers, experts and opinion leaders together to identify OA research priorities, to enhance current research efforts by fostering collaboration that offer the greatest potential for alleviating the disease burden.


Assuntos
Pesquisa Biomédica/métodos , Osteoartrite , Projetos de Pesquisa , Reumatologia/métodos , Idoso , Antirreumáticos/uso terapêutico , Austrália , Consenso , Comportamento Cooperativo , Feminino , Humanos , Comunicação Interdisciplinar , Masculino , Adesão à Medicação , Pessoa de Meia-Idade , Osteoartrite/diagnóstico , Osteoartrite/epidemiologia , Osteoartrite/fisiopatologia , Osteoartrite/terapia , Serviços Preventivos de Saúde , Participação dos Interessados
20.
Scand J Rheumatol ; 48(4): 326-330, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30758242

RESUMO

Objective: The Swedish Rheumatology Quality Register has implemented an internet-based method (PER) for registering patient-recorded outcome measures. The aim of this study was to compare the agreement between visual analogue scales (VASs) reported via PER and clinic-based reporting using paper forms. Methods: In a cross-sectional study (70 patients), the results of 79 registrations of VASs for global health, pain, and fatigue from PER were compared with corresponding clinic-based paper registrations. For patients with polyarthritis, 28-joint count Disease Activity Scores (DAS28) were computed. Patients with axial disease also completed Bath Ankylosing Spondylitis Disease Activity Index and Functional Index (BASDAI and BASFI) questionnaires. Mean differences and intraclass correlation coefficients (ICCs) were calculated. Agreement was visualized using Bland-Altman plots. Results: No statistically significant differences in VASs were found comparing PER and paper forms for VAS Global, VAS Pain, and VAS Fatigue (p = 0.295, 0.463, and 0.288, respectively). ICCs for VAS Global, Pain, and Fatigue ranged from 0.889 to 0.952, indicating excellent agreement. Bland-Altman plots for VAS did not show any proportional bias. The mean difference for DAS28 calculated by VASs from paper vs PER was -0.02 (n = 65, p = 0.660), and the mean difference for BASDAI was 0.04 (n = 11, p = 0.742). ICCs for DAS28 and BASDAI were 0.962 and 0.985, respectively. Of the participating patients, 60% preferred PER. Conclusion: Internet-based reporting for patient-reported outcomes in a clinical setting resulted in similar data for VASs and corresponding disease activity scores to clinic-based reporting on paper forms.


Assuntos
Instituições de Assistência Ambulatorial , Artrite , Internet , Medidas de Resultados Relatados pelo Paciente , Artrite/diagnóstico , Artrite/epidemiologia , Estudos Transversais , Autoavaliação Diagnóstica , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , /estatística & dados numéricos , Sistema de Registros/normas , Reprodutibilidade dos Testes , Reumatologia/métodos , Índice de Gravidade de Doença , Inquéritos e Questionários/estatística & dados numéricos , Suécia/epidemiologia , Escala Visual Analógica
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