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1.
Curr Opin Rheumatol ; 33(3): 262-269, 2021 05 01.
Artigo em Inglês | MEDLINE | ID: mdl-33741808

RESUMO

PURPOSE OF REVIEW: In early 2020, the COVID-19 global pandemic shifted most healthcare to remote delivery methods to protect patients, clinicians, and hospital staff. Such remote care delivery methods include the use of telehealth technologies including clinical video telehealth or telephone visits. Prior to this, research on the acceptability, feasibility, and efficacy of telehealth applied to rheumatology, or telerheumatology, has been limited. RECENT FINDINGS: Telerheumatology visits were found to be noninferior to in-person visits and are often more time and cost effective for patients. Clinicians and patients both noted the lack of a physical exam in telehealth visits and patients missed the opportunity to have lab work done or other diagnostic tests they are afforded with in-person visits. Overall, patients and clinicians had positive attitudes toward the use of telerheumatology and agreed on its usefulness, even beyond the pandemic. SUMMARY: Although telerheumatology has the potential to expand the reach of rheumatology practice, some of the most vulnerable patients still lack the most basic resources required for a telehealth visit. As the literature on telerheumatology continues to expand, attention should be paid to health equity, the digital divide, as well as patient preferences in order to foster true shared decision-making over telehealth.


Assuntos
/epidemiologia , Pandemias , Doenças Reumáticas/terapia , Reumatologia/métodos , Telemedicina/tendências , Comorbidade , Humanos , Preferência do Paciente , Doenças Reumáticas/epidemiologia
2.
Med Clin North Am ; 105(2): 325-339, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33589106

RESUMO

Spondyloarthritis is a common rheumatologic disease, present in up to 2% of the population, characterized by inflammatory arthritis, often with enthesitis, dactylitis, spondylitis, and skin disease. It has historically been characterized as ankylosing spondylitis, psoriatic arthritis, arthritis associated with inflammatory bowel disease, reactive arthritis, and undifferentiated spondyloarthritis. These subsets are now classified as axial-predominant and peripheral-predominant spondyloarthritis. This article provides an updated understanding of disease classification and practical advice about diagnosis to aid in the determination of which patients should be referred to rheumatology. It is important to provide patients the opportunity to have early and effective therapy.


Assuntos
Administração dos Cuidados ao Paciente/métodos , Espondilartrite , Diagnóstico Diferencial , Intervenção Médica Precoce , Humanos , Encaminhamento e Consulta , Reumatologia/métodos , Espondilartrite/diagnóstico , Espondilartrite/fisiopatologia , Espondilartrite/terapia
3.
Rheumatol Int ; 41(3): 565-573, 2021 03.
Artigo em Inglês | MEDLINE | ID: mdl-33449162

RESUMO

To describe the delivery of care for patients with rheumatic and musculoskeletal diseases (RMDs) from the perspective of rheumatologists in the Netherlands during the first months of the COVID-19 pandemic. A mixed methods design was used with quantitative and qualitative data from a cross-sectional survey sent to all members of the Dutch Rheumatology Society in May 2020. The survey contained questions on demographics, the current way of care delivery, and also on usage, acceptance, facilitators and barriers of telemedicine. Quantitative data were analyzed descriptively. The answers to the open questions were categorized into themes. Seventy-five respondents completed the survey. During the COVID-19 pandemic, continuity of care was guaranteed through telephone and video consultations by 99% and 9% of the respondents, respectively. More than 80% of the total number of outpatient visits were performed exclusively via telephone with in-person visits only on indication. One-quarter of the respondents used patient reported outcomes to guide telephone consultations. The top three facilitators for telemedicine were less travel time for patients, ease of use of the system and shorter waiting period for patients. The top three barriers were impossibility to perform physical examination, difficulty estimating how the patient is doing and difficulty in reaching patients. During the COVID-19 epidemic, care for patients with RMDs in the Netherlands continued uninterrupted by the aid of telemedicine. On average, respondents were content with current solutions, although some felt insecure mainly because of the inability to perform physical examination and missing nonverbal communication with their patients.


Assuntos
Atitude do Pessoal de Saúde , Doenças Reumáticas/terapia , Reumatologia/métodos , Telemedicina/métodos , Adulto , Idoso , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Países Baixos/epidemiologia , Pandemias , Relações Médico-Paciente , Pesquisa Qualitativa , Inquéritos e Questionários
4.
Clin Rheumatol ; 40(4): 1233-1244, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33389315

RESUMO

Primary and secondary haemophagocytic lymphohistiocytosis (HLH) are hyperferritinaemic hyperinflammatory syndromes with a common terminal pathway triggered by different etiopathogenetic factors. HLH is characterised by a decreased capacity of interferon gamma production with an activated NK phenotype profile similar to other hyperinflammatory syndromes. Viruses are closely linked to the development of HLH as infectious triggers, and the break of tolerance to self-antigens is considered a critical mechanism involved in the development of immune-mediated conditions triggered by viral infections. Emerging studies in patients with COVID-19 are suggesting a key role of monocytes/macrophages in the pathogenesis of this viral infection, and there is a significant overlap between several features reported in severe COVID-19 and the features included in the HLH-2004 diagnostic criteria. Therefore, SARS-Cov-2, as other respiratory viruses, may also be considered a potential etiological trigger of HLH. The frequency of HLH in adult patients with severe COVID-19 is lower than 5%, although this figure could be underestimated considering that most reported cases lacked information about some specific criteria (mainly the histopathological criteria and the measurement of NK cell function and sCD25 levels). Because HLH is a multi-organ syndrome, the diagnostic approach in a patient with severe COVID-19 in whom HLH is suspected must be carried out in a syndromic and holistic way, and not in the light of isolated clinical or laboratory features. In COVID-19 patients presenting with persistent high fever, progressive pancytopenia, and hepatosplenic involvement, together with the characteristic triad of laboratory abnormalities (hyperferritinaemia, hypertriglyceridaemia, and hypofibrinogenaemia), the suspicion of HLH is high, and the diagnostic workup must be completed with specific immunological and histopathological studies.


Assuntos
Síndrome da Liberação de Citocina/diagnóstico , Linfo-Histiocitose Hemofagocítica/diagnóstico , Síndrome de Ativação Macrofágica/diagnóstico , Adulto , /diagnóstico , Criança , Síndrome da Liberação de Citocina/etiologia , Síndrome da Liberação de Citocina/fisiopatologia , Diagnóstico Diferencial , Humanos , Linfo-Histiocitose Hemofagocítica/complicações , Linfo-Histiocitose Hemofagocítica/fisiopatologia , Síndrome de Ativação Macrofágica/fisiopatologia , Pandemias , Reumatologia/métodos
6.
Ann Acad Med Singap ; 49(11): 905-908, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-33381785

RESUMO

The ongoing pandemic in Singapore is part of a global pandemic caused by the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). To control the spread of COVID-19 and prevent the healthcare system from being overwhelmed, 'circuit breaker' measures were introduced between 7 April and 1 June 2020 in Singapore. There is thus a crucial need for innovative approaches to the provision and delivery of healthcare in the context of safe-distancing by harnessing telemedicine, especially for patients with chronic diseases who have traditionally been managed in tertiary institutions. We present a summary of how the Virtual Monitoring Clinic has benefited the practice of our outpatient rheumatology service during the COVID-19 pandemic. The virtual consultations address the need for safe-distancing by limiting face-to-face appointments and unnecessary exposure of patients to the hospital where feasible. This approach ensures that the patients are monitored appropriately for drug toxicities and side-effects, maintained on good disease control, and provided with patient education.


Assuntos
Antirreumáticos/uso terapêutico , Doenças Reumáticas/tratamento farmacológico , Reumatologia/métodos , Telemedicina/métodos , Assistência Ambulatorial/métodos , Assistência à Saúde , Humanos , Profissionais de Enfermagem , Farmacêuticos , Singapura , Telemedicina/organização & administração , Centros de Atenção Terciária
7.
Pediatr Rheumatol Online J ; 18(1): 85, 2020 Oct 31.
Artigo em Inglês | MEDLINE | ID: mdl-33129319

RESUMO

BACKGROUND: The use of telemedicine in pediatric rheumatology has been historically low. The current COVID 19 global pandemic has forced a paradigm shift with many centers rapidly adopting virtual visits to conduct care resulting in rapid expansion of use of telemedicine amongst practices. BODY: This commentary discusses practical tips for physicians including guidance around administrative and governance issues, preparation for telemedicine, involving the multidisciplinary care team, and teaching considerations. We also outline a standard proforma and smart phrases for the electronic health record. A proposed variation of the validated pediatric gait arms legs spine examination (pGALS) called the video pGALS (VpGALS) as a means of conducting virtual pediatric rheumatology physical examination is presented. CONCLUSION: This commentary provides a starting framework for telemedicine use in pediatric rheumatology and further work on validation and acceptability is needed.


Assuntos
Infecções por Coronavirus , Pandemias , Pediatria/métodos , Exame Físico/métodos , Pneumonia Viral , Reumatologia/métodos , Telemedicina/métodos , Comunicação por Videoconferência , Betacoronavirus , Assistência à Saúde , Europa (Continente) , Humanos , Seleção de Pacientes , Pediatria/educação , Pediatria/organização & administração , Reumatologia/educação , Reumatologia/organização & administração , Telemedicina/legislação & jurisprudência , Telemedicina/organização & administração , Estados Unidos
9.
Z Rheumatol ; 79(7): 679-685, 2020 Sep.
Artigo em Alemão | MEDLINE | ID: mdl-32757030

RESUMO

A few days after the SARS-CoV-2 infection was declared a pandemic, the German Society for Rheumatology (DGRh) compiled first recommendations for the care of patients with inflammatory rheumatic diseases (IRD). These first recommendations were based on an expert consensus and were largely non-evidence-based. Now that the first scientific data from registers, cross-sectional studies, case reports and case series are available, the present update is intended to update the previous recommendations and to add new findings. The current recommendations are based on a literature search of publications available up to 15 June 2020 and address preventive measures (such as hygiene measures or vaccinations) and the use of immunomodulatory/immunosuppressive drugs. An important goal of the current recommendations is also to prevent harm to patients with IRD through unjustified restriction of care. The DGRh will continue to update its recommendations in the case of new aspects and will publish them as well as further information on the COVID-19 pandemic on its homepage ( www.dgrh.de ) in an ongoing process.


Assuntos
Infecções por Coronavirus/epidemiologia , Inflamação/terapia , Pneumonia Viral/epidemiologia , Doenças Reumáticas/terapia , Reumatologia/métodos , Betacoronavirus , Alemanha , Humanos , Pandemias , Sociedades Médicas
10.
Clin Rheumatol ; 39(9): 2817-2821, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32712743

RESUMO

COVID-19 has significantly affected healthcare systems around the world. To prepare for this unprecedented emergency, elective patient care was put on hold across the National Health Service (NHS). Rheumatology service had to be reorganised with a cancellation of elective clinics and clinical reconfiguration to continue to deliver care to patients, support frontline, and prevent viral transmission. The rheumatology community's responsibility of providing a continuity of care for patients had to be balanced with measures to reduce the risk of viral transmission and also protection of both the patients and staff. We describe our experience of delivering rheumatology service as recommended by the National Institute for Health and Care Excellence (NICE NG167) guidelines at a district general hospital during the current pandemic. Key Points • Prepare to deliver a rapid mass communication; ensure email and mobile phones registered in patients' records; enable access to text and video messaging. • To ensure wider access to innovative digital technology in clinical practice; implement telephone and video consultations where appropriate. • To consider setting up community OP clinics, for example, mobile and satellite clinics.


Assuntos
Infecções por Coronavirus/epidemiologia , Assistência à Saúde/métodos , Pneumonia Viral/epidemiologia , Doenças Reumáticas/terapia , Reumatologia/métodos , Telemedicina , Administração Intravenosa , Assistência Ambulatorial , Antirreumáticos/uso terapêutico , Betacoronavirus , Continuidade da Assistência ao Paciente , Infecções por Coronavirus/prevenção & controle , Infecções por Coronavirus/transmissão , Substituição de Medicamentos , Hospitais de Distrito , Hospitais Gerais , Humanos , Infusões Subcutâneas , Enfermeiras e Enfermeiros , Pandemias/prevenção & controle , Admissão e Escalonamento de Pessoal , Pneumonia Viral/prevenção & controle , Pneumonia Viral/transmissão , Reumatologistas , Medição de Risco , Medicina Estatal , Reino Unido
11.
Z Rheumatol ; 79(6): 562-569, 2020 Aug.
Artigo em Alemão | MEDLINE | ID: mdl-32651681

RESUMO

Digitalization in the healthcare system is a great challenge for rheumatology as for other medical disciplines. The German Society for Rheumatology (DGRh) wants to actively participate in this process and benefit from it. By founding the commission on digital rheumatology, the DGRh has created a committee that deals with the associated tasks, advises the DGRh on questions and positions associated with digital health. For the DGRh, this affects the most diverse areas of digitalization in medicine and rheumatology. This position paper presents the topics and developments currently handled by the commission and the tasks identified.


Assuntos
Reumatologia , Telemedicina , Alemanha , Humanos , Reumatologia/métodos , Reumatologia/tendências , Telemedicina/métodos , Telemedicina/tendências
12.
Z Rheumatol ; 79(6): 584-589, 2020 Aug.
Artigo em Alemão | MEDLINE | ID: mdl-32661916

RESUMO

BACKGROUND: The preparations of healthcare systems to accommodate the large numbers of severely ill COVID-19 patients in March/April 2020 also had a substantial impact on rheumatological patient care. OBJECTIVE: The aim of this online survey was to assess the changes and current status of rheumatology departments and practices in Germany. MATERIAL AND METHODS: A web-based questionnaire was designed to differentiate the impact of the pandemic on inpatient and outpatient operations. Questions addressed the following issues: characteristics of the department, impact on patient care, application of recommendations, personal protective equipment (PPE), and organizational adaptations to the new framework conditions. The survey was available for 14 days and closed on 3 May 2020. RESULTS: A total of 66 complete answers were recorded and evaluated. In the first 4 weeks of the COVID-19 crisis the proportion of outpatients in the institutions decreased on average by -40.6%. The number of outpatients receiving infusions decreased by -25.6%. Of the inpatient facilities 81% reported an average decrease of hospitalized patients of -54.9% and 52% of the participants complained of a lack of PPE. Organizational adjustments are reported. CONCLUSION: The rheumatological services were significantly reduced 4 weeks after the SARS-CoV­2 pandemic had reached Germany on a large scale. The study showed that in this phase there were decisive turning points in patient care and implicated substantial organizational and ultimately also economic effects on the healthcare system, both in hospitals and private practices. As the survey cannot adapt to the daily dynamic changes in priorities it serves as a first snapshot, which requires follow-up studies.


Assuntos
Infecções por Coronavirus/epidemiologia , Pneumonia Viral/epidemiologia , Doenças Reumáticas/terapia , Reumatologia/métodos , Betacoronavirus , Alemanha , Humanos , Pandemias , Equipamento de Proteção Individual/provisão & distribução , Inquéritos e Questionários
13.
RMD Open ; 6(2)2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32584782

RESUMO

The coronavirus disease 2019 (COVID-19) pandemic has come with many challenges for healthcare providers and patients alike. In addition to the direct burden it has placed on societies and health systems, it had a significant impact in the care of patients with chronic diseases, as healthcare resources were deployed to fight the crisis, and major travel and social restrictions were adopted. In the field of rheumatology, this has required notable efforts from departments and clinicians to adapt to the novel status quo and assure the follow-up of patients with rheumatic and musculoskeletal diseases. In the present viewpoint, we provide a practical approach to tackle this reality. Key measures include setting up preventive team management strategies, optimising communication with patients and reorganising patient care in all its dimensions. We then anticipate the nuances of rheumatology practice as restrictive measures are progressively lifted, while an effective vaccine is still pending. This includes the need to reimpose the same strategy as further waves unfold. Finally, we look ahead and address the lessons we can incorporate into post-COVID-19 rheumatology.


Assuntos
Betacoronavirus/isolamento & purificação , Infecções por Coronavirus , Inovação Organizacional , Pandemias , Administração dos Cuidados ao Paciente , Pneumonia Viral , Doenças Reumáticas , Reumatologia/métodos , Técnicas de Laboratório Clínico/métodos , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/imunologia , Infecções por Coronavirus/prevenção & controle , Procedimentos Clínicos/organização & administração , Procedimentos Clínicos/tendências , Humanos , Imunidade , Pandemias/prevenção & controle , Administração dos Cuidados ao Paciente/métodos , Administração dos Cuidados ao Paciente/organização & administração , Administração dos Cuidados ao Paciente/tendências , Pneumonia Viral/epidemiologia , Pneumonia Viral/prevenção & controle , Doenças Reumáticas/epidemiologia , Doenças Reumáticas/terapia , Telemedicina/métodos
14.
Ann Rheum Dis ; 79(9): 1189-1193, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32503859

RESUMO

OBJECTIVES: We have previously shown that neural network technology can be used for scoring arthritis disease activity in ultrasound images from rheumatoid arthritis (RA) patients, giving scores according to the EULAR-OMERACT grading system. We have now further developed the architecture of this neural network and can here present a new idea applying cascaded convolutional neural network (CNN) design with even better results. We evaluate the generalisability of this method on unseen data, comparing the CNN with an expert rheumatologist. METHODS: The images were graded by an expert rheumatologist according to the EULAR-OMERACT synovitis scoring system. CNNs were systematically trained to find the best configuration. The algorithms were evaluated on a separate test data set and compared with the gradings of an expert rheumatologist on a per-joint basis using a Kappa statistic, and on a per-patient basis using a Wilcoxon signed-rank test. RESULTS: With 1678 images available for training and 322 images for testing the model, it achieved an overall four-class accuracy of 83.9%. On a per-patient level, there was no significant difference between the classifications of the model and of a human expert (p=0.85). Our original CNN had a four-class accuracy of 75.0%. CONCLUSIONS: Using a new network architecture we have further enhanced the algorithm and have shown strong agreement with an expert rheumatologist on a per-joint basis and on a per-patient basis. This emphasises the potential of using CNNs with this architecture as a strong assistive tool for the objective assessment of disease activity of RA patients.


Assuntos
Artrite Reumatoide/diagnóstico por imagem , Interpretação de Imagem Assistida por Computador/métodos , Redes Neurais de Computação , Reumatologia/métodos , Índice de Gravidade de Doença , Ultrassonografia/estatística & dados numéricos , Adulto , Ensaios Clínicos como Assunto , Feminino , Humanos , Articulações/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Reprodutibilidade dos Testes , Sinovite/diagnóstico por imagem , Ultrassonografia/métodos
15.
Ann Rheum Dis ; 79(9): 1139-1140, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32527863

RESUMO

The COVID-19 pandemic forces the whole rheumatic and musculoskeletal diseases community to reassemble established treatment and research standards. Digital crowdsourcing is a key tool in this pandemic to create and distil desperately needed clinical evidence and exchange of knowledge for patients and physicians alike. This viewpoint explains the concept of digital crowdsourcing and discusses examples and opportunities in rheumatology. First experiences of digital crowdsourcing in rheumatology show transparent, accessible, accelerated research results empowering patients and rheumatologists.


Assuntos
Pesquisa Biomédica/métodos , Infecções por Coronavirus/terapia , Crowdsourcing/métodos , Pneumonia Viral/terapia , Reumatologia/métodos , Betacoronavirus , Pesquisa Biomédica/normas , Infecções por Coronavirus/virologia , Crowdsourcing/normas , Humanos , Pandemias , Pneumonia Viral/virologia , Reumatologia/normas
16.
Clin Rheumatol ; 39(9): 2757-2762, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32474883

RESUMO

The emergent COVID-19 pandemic dictates an urgent switch to teleconsultation. India has high patient to rheumatologist ratio, and patients have limited concepts about telemedicine. Thus, we attempted to find the feasibility and acceptance of patients in switching to teleconsultation. The CARE rheumatology clinic at Kerala, India, caters to average 170 (range: 140-240) patients per day. Patients with prefixed appointments had two-level screening for eligibility for teleconsultation. Those eligible were given the option for teleconsultation on the widely available WhatsApp app. Of those who completed teleconsultations, 100 were chosen at random to provide feedback. In the first 7 days, out of 1469 appointments, 975 were found eligible for teleconsultation. Of these, 723 (74%) opted for it. The average footfall in the clinic was reduced to 67 (range 29-117). The proportion of patients accepting teleconsultations increased with time. Amongst the 100 respondents, median satisfaction was 9 (IQR 8-10) and recommendation for continuing was 9.5 (IQR 8-10) on a 0-10 scale. Multivariate analysis showed the recommendation score was dependent on beliefs about social distancing, perceptions about clinical examination, and the satisfaction score of the first teleconsultation. Age, sex, availability of personal video conferencing app or of vehicles did not independently influence this score. Without teleconsultation facilities, three-fourths of the respondents would have stopped drugs or self-medicated. The switch was feasible and accepted by patients. It enabled quick reduction in the number of persons travelling to the centre. Not making the switch could have deprived approximately three-quarters of these patients of proper medical care. Key Points • Patient to rheumatologist ratios in India is heavily skewed and awareness about telemedicine is limited. • Switch to telemedicine was feasible and allowed a decrease in the number of people attending the clinic. • Not switching could have lead to disruption of care or self-medication in a majority of patients.


Assuntos
Infecções por Coronavirus/epidemiologia , Aceitação pelo Paciente de Cuidados de Saúde , Pneumonia Viral/epidemiologia , Consulta Remota/métodos , Reumatologia/métodos , Comunicação por Videoconferência , Adulto , Betacoronavirus , Assistência à Saúde , Estudos de Viabilidade , Feminino , Humanos , Índia/epidemiologia , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Pandemias , Satisfação do Paciente , Telemedicina
19.
Ann Rheum Dis ; 79(8): 1031-1036, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32424031

RESUMO

OBJECTIVES: In treat to target (T2T), the patient is treated to reach and maintain specified and sequentially measured goals, such as remission or low disease activity. T2T in psoriatic arthritis (PsA) has demonstrated improved clinical and patient-reported outcomes and is recommended in European guidelines. However, most clinicians do not use T2T in PsA. This study examined the barriers and enablers to implementation in practice. METHODS: Sequential mixed methods comprising a qualitative design (interviews and focus group) to inform a quantitative design (survey). Qualitative data were analysed thematically, and quantitative statistics were analysed descriptively. RESULTS: Nineteen rheumatology clinicians participated in telephone interviews or a face-to-face focus group. An overarching theme 'Complexity' (including 'PsA vs Rheumatoid Arthritis', 'Measurement' and 'Resources') and an underpinning theme 'Changes to current practice' (including 'Reluctance due to organisational factors' and 'Individual determination to make changes') were identified. 153 rheumatology clinicians responded to an online survey. Barriers included limited clinical appointment time to collect outcome data (54.5%) and lack of training in assessing skin disease (35%). Enablers included provision of a protocol (86.4%), a local implementation lead (80.9%), support in clinic to measure outcomes (83.3%) and training in T2T (69.8%). The importance of regular audit with feedback, specialist PsA clinics and a web-based electronic database linked to hospital/national information technology (IT) systems were also identified as enablers. CONCLUSIONS: Implementation of T2T in PsA requires an integrated approach to address the support, training and resource needs of individual clinicians, rheumatology teams, local IT systems and service providers to maximise success.


Assuntos
Artrite Psoriásica/tratamento farmacológico , Fidelidade a Diretrizes/estatística & dados numéricos , Conhecimentos, Atitudes e Prática em Saúde , Padrões de Prática Médica , Antirreumáticos/uso terapêutico , Humanos , Reumatologistas , Reumatologia/métodos , Reumatologia/normas
20.
Ann Rheum Dis ; 79(7): 935-942, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32371388

RESUMO

OBJECTIVES: The Assessment of SpondyloArthritis international Society (ASAS) MRI working group conducted a multireader exercise on MRI scans from the ASAS classification cohort to assess the spectrum and evolution of lesions in the sacroiliac joint and impact of discrepancies with local readers on numbers of patients classified as axial spondyloarthritis (axSpA). METHODS: Seven readers assessed baseline scans from 278 cases and 8 readers assessed baseline and follow-up scans from 107 cases. Agreement for detection of MRI lesions between central and local readers was assessed descriptively and by the kappa statistic. We calculated the number of patients classified as axSpA by the ASAS criteria after replacing local detection of active lesions by central readers and replacing local reader radiographic sacroiliitis by central reader structural lesions on MRI. RESULTS: Structural lesions, especially erosions, were as frequent as active lesions (≈40%), the majority of patients having both types of lesions. The ASAS definitions for active MRI lesion typical of axSpA and erosion were comparatively discriminatory between axSpA and non-axSpA. Local reader overcall for active MRI lesions was about 30% but this had a minor impact on the number of patients (6.4%) classified as axSpA. Substitution of radiography with MRI structural lesions also had little impact on classification status (1.4%). CONCLUSION: Despite substantial discrepancy between central and local readers in interpretation of both types of MRI lesion, this had a minor impact on the numbers of patients classified as axSpA supporting the robustness of the ASAS criteria for differences in assessment of imaging.


Assuntos
Imagem por Ressonância Magnética/classificação , Reumatologia/normas , Sacroileíte/classificação , Espondilartrite/classificação , Adulto , Estudos de Coortes , Diagnóstico Diferencial , Feminino , Humanos , Agências Internacionais , Masculino , Pessoa de Meia-Idade , Variações Dependentes do Observador , Reumatologia/métodos , Articulação Sacroilíaca/diagnóstico por imagem , Sacroileíte/diagnóstico por imagem , Sociedades Médicas , Espondilartrite/diagnóstico por imagem
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