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3.
Emerg Microbes Infect ; 9(1): 830-832, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-32338155

RESUMO

The current pandemic coronavirus disease 2019 (COVID-19) caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) calls urgently for effective therapies. Anti-malarial medicine chloroquine (CQ) and particularly its chemical analogue hydroxychloroquine (HCQ) have been recommended as promising candidate therapeutics that are now under either compassionate off-label use or clinical trials for the treatment of COVID-19 patients. However, there are public concerns and disputes about both the safety and efficacy of CQ and HCQ for this new application. Given the fact that for decades HCQ has been approved as an immunomodulatory drug for the long term treatment of chronic rheumatic diseases, as experienced rheumatologists, we would like to share our thoughts in this regard and trigger a brainstorm among clinical care providers for exchanging their diverse opinions on this urgent topic.


Assuntos
Antimaláricos , Antirreumáticos , Antivirais , Betacoronavirus/efeitos dos fármacos , Infecções por Coronavirus/tratamento farmacológico , Hidroxicloroquina , Pneumonia Viral/tratamento farmacológico , Antimaláricos/administração & dosagem , Antimaláricos/efeitos adversos , Antimaláricos/uso terapêutico , Antirreumáticos/administração & dosagem , Antirreumáticos/efeitos adversos , Antirreumáticos/uso terapêutico , Antivirais/administração & dosagem , Antivirais/efeitos adversos , Antivirais/uso terapêutico , Ensaios Clínicos como Assunto , Infecções por Coronavirus/epidemiologia , Humanos , Hidroxicloroquina/administração & dosagem , Hidroxicloroquina/efeitos adversos , Hidroxicloroquina/uso terapêutico , Comunicação Interdisciplinar , Pandemias , Pneumonia Viral/epidemiologia , Reumatologistas
4.
Pediatr Rheumatol Online J ; 18(1): 35, 2020 Apr 22.
Artigo em Inglês | MEDLINE | ID: mdl-32321540

RESUMO

On March 11th, 2020 the World Health Organization declared COVID-19 a global pandemic. The infection, transmitted by 2019 novel coronavirus (2019-nCov), was first discovered in December 2019, in Wuhan, Hubei Province, and then rapidly spread worldwide. Italy was early and severely involved, with a critical spread of the infection and a very high number of victims. Person-to-person spread mainly occurs via respiratory droplets and contact. The median incubation period is 5 days. The spectrum of respiratory symptoms may range from mild to severe, strictly depending on the age of the patient and the underlying comorbidities.In children COVID-19 related disease is less frequent and less aggressive. In Italy 1% of positive cases are under 18 years of age, and no deaths have been recorded before 29 years of age. For patients affected by rheumatic disease, despite the concerns related to the imbalance of their immune response and the effect of immunosuppressive treatments, there are still few data to understand the real consequences of this infection. Major scientific societies have issued recommendations to help rheumatologists in caring their patients. Interestingly, some of the drugs mostly used by rheumatologists appear to be promising in critical COVID-19 infected patients, where the hyperinflammation and cytokine storm seem to drive to the multiorgan failure.Pediatric rheumatologists are expected to play a supporting role in this new front of COVID-19 pandemic, both as general pediatricians treating infected children, and as rheumatologists taking care of their rheumatic patients, as well as offering their experience in the possible alternative use of immunomodulatory drugs.


Assuntos
Antirreumáticos/uso terapêutico , Infecções por Coronavirus/complicações , Infecções por Coronavirus/tratamento farmacológico , Pediatras , Pneumonia Viral/complicações , Pneumonia Viral/tratamento farmacológico , Doenças Reumáticas/complicações , Doenças Reumáticas/virologia , Reumatologistas , Adolescente , Anti-Inflamatórios não Esteroides/efeitos adversos , Anti-Inflamatórios não Esteroides/uso terapêutico , Artrite Juvenil/complicações , Artrite Juvenil/virologia , Betacoronavirus , Criança , Pré-Escolar , Cloroquina/uso terapêutico , Ensaios Clínicos como Assunto , Infecções por Coronavirus/epidemiologia , Síndrome da Liberação de Citocina/tratamento farmacológico , Síndrome da Liberação de Citocina/virologia , Humanos , Hidroxicloroquina/uso terapêutico , Lactente , Interleucina-6/antagonistas & inibidores , Itália/epidemiologia , Pandemias , Pneumonia Viral/epidemiologia
7.
Medicine (Baltimore) ; 98(48): e18114, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31770236

RESUMO

There is a paucity of succinct measures of physician satisfaction. As part of a Performance Improvement Project, we developed and piloted a simple questionnaire to determine rheumatologists satisfaction.Thirty 5 rheumatologists in the academic or private setting were sent opened-ended questions to determine the factors that made them satisfied or dissatisfied with respect to their rheumatology practice. From the responses we formed 14 questions 1 to 10 scale centering on satisfaction and dissatisfaction that was piloted in 30 rheumatologists and subsequently validated in 173 rheumatologists within the US and Latin America.Our combined sample included 173 rheumatologists (55 English and 118 Spanish-speaking respondents). The mean satisfaction for the combined sample was 6.92 (standard deviation=1.1, range 4.08-9.62). The strongest contributors to physician satisfaction were "Seeing interesting and challenging cases" (8.6 ±â€Š1.5) and "The ability to make a difference in patient's life" as well as "Establishing long term relationship with patients" (8.39 ±â€Š1.5). The strongest contributors to physician dissatisfaction were "Getting inappropriate referrals not in the scope of practice" (4.3 ±â€Š2.13) and "Time spent on documentation" (4.5 ±â€Š2.59). The scale had good reliability, relatively normal distribution, and little or no redundancy among items.A simple and practical questionnaire to measure physician satisfaction, in particular rheumatologists satisfaction, was developed, piloted and successfully validated on a predominately academic sample of rheumatologists within the US and Latin America. This scale will serve as a means to identifying potential barriers to the implementation of performance improvement projects in the practice of Rheumatology.


Assuntos
Satisfação no Emprego , Prática Profissional , Reumatologistas/psicologia , Reumatologia/normas , Inquéritos e Questionários/normas , Adulto , Feminino , Humanos , América Latina , Masculino , Pessoa de Meia-Idade , Reprodutibilidade dos Testes , Estados Unidos
8.
BMC Health Serv Res ; 19(1): 783, 2019 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-31675957

RESUMO

BACKGROUND: Systemic lupus erythematosus (SLE) is a heterogeneous autoimmune disease with significant potential morbidity and mortality. Substantial gaps have been documented between the development and dissemination of clinical practice guidelines (CPG) and their implementation in practice. The aim of this study is to assess the effectiveness and cost-effectiveness of a multi-component knowledge transfer intervention to implement a CPG for the management of SLE (CPG-SLE). METHODS: The study is an open, multicentre, controlled trial with random allocation by clusters to intervention or control. Clusters are four public university hospitals of the Canary Islands Health Service where rheumatologists are invited to participate. Patients diagnosed with SLE at least one year prior to recruitment are selected. Rheumatologists in intervention group receive a short educational group programme to both update their knowledge about SLE management according to CPG-SLE recommendations and to acquire knowledge and training on use of the patient-centred approach, a decision support tool embedded in the electronic clinical record and a quarterly feedback report containing information on management of SLE patients. Primary endpoint is change in self-perceived disease activity. Secondary endpoints are adherence of professionals to CPG-SLE recommendations, health-related quality of life, patient perception of their participation in decision making, attitudes of professionals towards shared decision making, knowledge of professionals about SLE and use of healthcare resources. Calculated sample size is 412 patients. Data will be collected from questionnaires and clinical records. Length of follow-up will be 18 months. Multilevel mixed models with repeated time measurements will be used to analyze changes in outcomes over time. Cost-effectiveness, from both social and healthcare services perspectives, will be analyzed by measuring effectiveness in terms of quality-adjusted life years gained. Deterministic and probabilistic sensitivity analyses are planned. DISCUSSION: Impact of CPGs in clinical practice could be improved by applying proven value interventions to implement them. The results of this ongoing trial are expected to generate important scientifically valid and reproducible information not only on clinical effectiveness but also on cost-effectiveness of a multi-component intervention for implementation of a CPG based on communication technologies for chronic patients in the hospital setting. TRIAL REGISTRATION: ClinicalTrial.gov NCT03537638 . Registered on 25 May 2018.


Assuntos
Conhecimentos, Atitudes e Prática em Saúde , Lúpus Eritematoso Sistêmico/terapia , Guias de Prática Clínica como Assunto , Reumatologistas/educação , Análise Custo-Benefício , Hospitais Públicos , Humanos , Avaliação de Programas e Projetos de Saúde , Projetos de Pesquisa , Espanha , Resultado do Tratamento
9.
Z Rheumatol ; 78(10): 967-978, 2019 Dec.
Artigo em Alemão | MEDLINE | ID: mdl-31712897

RESUMO

Raynaud's phenomenon (RP) is a frequent and painful vasospasm of small arteries localized in acral body regions (most frequently the fingers). The more frequent so-called primary RP is caused merely by a functional dysregulation of the tonus of vascular walls. In contrast, the rarer secondary RP is additionally associated with structural abnormalities of blood vessels. Knowledge of RP is important for rheumatologists because secondary RP can be associated with the presence or development of severe underlying diseases, especially with systemic sclerosis. Thus, the rheumatologist has to be aware of this condition. In this article the diagnostic procedures and the most important treatment approaches are summarized.


Assuntos
Doença de Raynaud , Escleroderma Sistêmico , Humanos , Doença de Raynaud/complicações , Doença de Raynaud/terapia , Reumatologistas , Escleroderma Sistêmico/complicações
10.
Orthopade ; 48(11): 942-948, 2019 Nov.
Artigo em Alemão | MEDLINE | ID: mdl-31538207

RESUMO

BACKGROUND: Due to the broad range of diagnostic and therapeutic aspects with an increased risk of mortality, lung manifestations of rheumatic diseases are an exciting and important field in the clinical routine of pulmonologists and rheumatologists. OBJECTIVE: Discussion of different presentations in the lung, diagnostics and management of lung manifestation associated with rheumatic diseases. MATERIAL AND METHODS: Analysis and presentation of current literature on the subject. RESULTS: The manuscript presents forms of lung involvement associated with rheumatic diseases, in particular the connective tissue disease-associated interstitial lung disease. Considering the negative impact on survival, rapid and adequate diagnosis is of great importance. In the case of a known underlying rheumatic disease, histological confirmation of interstitial changes is not always necessary. In addition to the patient's history, pulmonary function testing and diagnostic imaging with high-resolution CT-scan (HR-CT) are cornerstones of the diagnostic process. The final diagnosis and therapeutic approach should be determined by a multidisciplinary discussion process. The basis of the treatment is immunosuppressants, however the use antifibrotic drugs is currently under investigation in clinical trials. In the case of advanced lung disease, lung transplantation should be evaluated promptly. CONCLUSION: In the case of pulmonary involvement with rheumatic disease, the teamwork of pulmonologists, rheumatologists and radiologists is of particular importance.


Assuntos
Doenças do Tecido Conjuntivo , Doenças Pulmonares Intersticiais , Doenças Reumáticas , Humanos , Imunossupressores/uso terapêutico , Pneumologia , Reumatologistas
11.
Orthop Clin North Am ; 50(4): 471-488, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31466663

RESUMO

Juvenile idiopathic arthritis includes conditions characterized by joint inflammation of unknown etiology lasting longer than 6 weeks in patients younger than 16 years. Diagnosis and medical management are complex and best coordinated by a pediatric rheumatologist. The mainstay of therapy is anti-inflammatory and biologic medications to control pain and joint inflammation. Orthopedic surgical treatment may be indicated for deformity, limb length inequality, or end-stage arthritis. Evaluation of the cervical spine and appropriate medication management in consultation with a patient's rheumatologist are essential in perioperative care. Preoperative planning should take into account patient deformity, contracture, small size, osteopenia, and medical comorbidities.


Assuntos
Artrite Juvenil/tratamento farmacológico , Artrite Juvenil/cirurgia , Terapia Combinada/métodos , Assistência Centrada no Paciente/métodos , Adolescente , Criança , Pré-Escolar , Feminino , Humanos , Cirurgiões Ortopédicos , Planejamento de Assistência ao Paciente , Assistência Perioperatória , Reumatologistas
12.
Muscle Nerve ; 60(4): 361-366, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31335971

RESUMO

Neuromuscular ultrasound has become an essential tool in the diagnostic evaluation of various neuromuscular disorders, and, as such, there is growing interest in neuromuscular ultrasound training. Effective training is critical in mastering this modality. Our aim was to develop consensus-based guidelines for neuromuscular ultrasound training courses. A total of 18 experts participated. Expert opinion was sought through the Delphi method using 4 consecutive electronic surveys. A high degree of consensus was achieved with regard to the general structure of neuromuscular ultrasound training; the categorization of training into basic, intermediate, and advanced levels; the learning objectives; and the curriculum for each level. In this study, a group of neuromuscular ultrasound experts established consensus-based guidelines for neuromuscular ultrasound training. These guidelines can be used in the development of the specialty and the standardization of neuromuscular ultrasound training courses and workshops.


Assuntos
Competência Clínica , Currículo , Guias como Assunto , Neurologistas/educação , Doenças Neuromusculares/diagnóstico por imagem , Ultrassonografia/normas , Técnica Delfos , Humanos , Fisiatras/educação , Radiologistas/educação , Reumatologistas/educação
13.
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
14.
Int J Rheum Dis ; 22(9): 1695-1705, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31322831

RESUMO

BACKGROUND: Medication non-adherence is prevalent among patients with rheumatoid arthritis (RA). Rheumatologists are specialists in medication prescribing and counselling for RA, but their insights regarding medication adherence have not been studied. OBJECTIVE: To explore rheumatologists' insights into medication adherence in patients with RA. METHODS: A qualitative study using semi-structured interviews with 10 rheumatologists in Iran was undertaken. Thematic analysis was conducted to identify how rheumatologists assess medication adherence and their perceived determinants of adherence. The identified determinants of adherence were mapped according to the Andersen's Behavioral Model of Health Service Use. RESULTS: Six participants were male, and the mean age was 47 years. The mean years of experience as a rheumatologist was 8.6 (SD = 7.1) years. Rheumatologists did not use a validated tool for medication adherence assessment. They assessed medication adherence either by asking their patients simple questions or using laboratory test results. The identified determinants of adherence were divided into 3 groups: patient-, rheumatologist- and healthcare organization-related determinants. The proposed suggestions to improve adherence were: (a) to understand a patient's financial situation before prescribing more expensive medications; (b) to employ a dose-reducing strategy; (c) to give hope to patients regarding remission; and (d) to arrange a session with the nurse educator. CONCLUSION: The findings of this study provide insight into rheumatologists' perspectives on medication adherence of patients with RA. The identified determinants of adherence could be considered when developing initiatives to improve medication adherence in this group of patients.


Assuntos
Antirreumáticos/uso terapêutico , Artrite Reumatoide/tratamento farmacológico , Atitude do Pessoal de Saúde , Conhecimentos, Atitudes e Prática em Saúde , Adesão à Medicação , Reumatologistas/psicologia , Adulto , Antirreumáticos/efeitos adversos , Antirreumáticos/economia , Artrite Reumatoide/diagnóstico , Artrite Reumatoide/economia , Artrite Reumatoide/psicologia , Aconselhamento , Custos de Medicamentos , Feminino , Gastos em Saúde , Humanos , Entrevistas como Assunto , Irã (Geográfico) , Masculino , Pessoa de Meia-Idade , Educação de Pacientes como Assunto , Padrões de Prática Médica , Pesquisa Qualitativa , Indução de Remissão
15.
Medicine (Baltimore) ; 98(26): e16086, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31261523

RESUMO

Pleuroparenchymal fibroelastosis (PPFE) is a rare new interstitial lung disease (ILD) characterized by the fibrotic thickening of the visceral pleura and subadjacent parenchymal areas of the upper lobes This study reveals that patients with ILD-SSc associated with chest HRCT evidence of PPFE require close and recurrent follow-up with periodic evaluation of lung function parameters, DLCO and chest HRCT. Rheumatologists should be aware of this new radiological finding which is accompanied by a negative prognosis, especially when associated with a progressive course. Patients with this radiological pattern need to be monitored with particular attention.


Assuntos
Doenças Pulmonares Intersticiais/complicações , Doenças Pulmonares Intersticiais/diagnóstico por imagem , Doenças Pleurais/complicações , Doenças Pleurais/diagnóstico por imagem , Escleroderma Sistêmico/complicações , Escleroderma Sistêmico/diagnóstico por imagem , Idoso , Feminino , Seguimentos , Humanos , Pulmão/diagnóstico por imagem , Doenças Pulmonares Intersticiais/terapia , Masculino , Doenças Pleurais/terapia , Prognóstico , Fibrose Pulmonar/complicações , Fibrose Pulmonar/diagnóstico por imagem , Fibrose Pulmonar/terapia , Estudos Retrospectivos , Reumatologistas , Escleroderma Sistêmico/terapia
16.
Pediatr Rheumatol Online J ; 17(1): 32, 2019 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-31262324

RESUMO

BACKGROUND: Childhood-onset systemic erythematosus lupus (cSLE) is characterized by more severe disease, widespread organ involvement and higher mortality compared to adult-onset SLE. However, cSLE is largely underfunded to carry out necessary research to advance the field. Few commonly used SLE medications have been studied in children, and important knowledge gaps exist concerning epidemiology, genetics, pathophysiology and optimal treatments for cSLE. METHODS: In order to assess highest cSLE research priority areas, the Lupus Foundation of America (LFA) and Childhood Arthritis and Rheumatology Research Alliance (CARRA) administered a cSLE research prioritization survey to pediatric rheumatologists, dermatologists and nephrologists with expertise in lupus. Members of LFA and CARRA's SLE Committee identified a list of cSLE research domains and developed a 17-item tiered, web-based survey asking respondents to categorize the research domains into high, medium, or low priority areas. For domains identified as high priority, respondents ranked research topics within that category. For example, for the domain of nephritis, respondents ranked importance of: epidemiology, biomarkers, long-term outcomes, quality improvement, etc. The survey was distributed to members of CARRA, Midwestern Pediatric Nephrology Consortium (MWPNC) and Pediatric Dermatology Research Alliance (PeDRA) Connective Tissue Disease group. RESULTS: The overall response rate was 256/752 (34%). The highest prioritized research domains were: nephritis, clinical trials, biomarkers, neuropsychiatric disease and refractory skin disease. Notably, nephritis, clinical trials and biomarkers were ranked in the top five by all groups. Within each research domain, all groups showed agreement in identifying the following as important focus areas: determining best treatments, biomarkers/pathophysiology, drug discovery/novel treatments, understanding long term outcomes, and refining provider reported quality measures. CONCLUSION: This survey identified the highest cSLE research priorities among leading rheumatology, dermatology and nephrology clinicians and investigators engaged in care of children with lupus. There is a strong need for multidisciplinary collaboration moving forward, which was indicated as highly important among stakeholders involved in the survey. These survey results should be used as a roadmap to guide funding and specific research programs in cSLE to address urgent, unmet needs among this population.


Assuntos
Lúpus Eritematoso Sistêmico/complicações , Pesquisa , Adolescente , Atitude do Pessoal de Saúde , Atitude Frente a Saúde , Biomarcadores/metabolismo , Criança , Pré-Escolar , Comportamento Cooperativo , Fármacos Dermatológicos/uso terapêutico , Dermatologistas , Humanos , Lactente , Recém-Nascido , Relações Interprofissionais , Lúpus Eritematoso Sistêmico/tratamento farmacológico , Transtornos Mentais/complicações , Nefrite/complicações , Nefrologistas , Doenças do Sistema Nervoso/complicações , Neurologistas , Reumatologistas , Dermatopatias/complicações , Inquéritos e Questionários
17.
Z Rheumatol ; 78(8): 753-764, 2019 Oct.
Artigo em Alemão | MEDLINE | ID: mdl-31286192

RESUMO

The Ruhrgebiet Rheumatism Center, which is highly specialized for rheumatic diseases, is the largest of its kind in Germany. For many years it has fulfilled all the requirements for structural quality required by the Association of Rheumatological Acute Clinics (VRA) including regular participation in the KOBRA benchmarking project. Therefore, the center regularly receives the VRA seal for quality of care. In 2018 more than 7500 patients were treated as inpatients. Within the framework of care according to §116b (ASV since May 2019) there were nearly 25,000 outpatient patient contacts. Furthermore, an early screening program (triage) was established 5 years ago in order to be able to identify patients with musculoskeletal complaints on a potentially inflammatory rheumatic basis. This functions in the sense of an early diagnosis and treatment in accordance with the treat-to-target concept within less than 4 weeks (initially) on an outpatient basis with respect to the required urgency, in order to subsequently provide sound diagnostic support. In the last 2 years 2017 and 2018, this deadline was met in more than 90% of cases. Within the scope of inpatient care approximately one third of patients were treated in recent years with a defined rheumatological complex therapy and 10% with pain complex therapy. Approximately 3% were treated with geriatric complex therapy and 65% were short-stay patients (<4 days), i.e. patients who received the necessary diagnostics and treatment on an inpatient basis at short notice. The overall structure of the rheumatism center, the cooperation with rheumatologists in private practice, many cooperation partners, referring physicians and patients represents a model for rheumatological care in large conurbations. The care of large numbers of patients also enables the further training of many assistants and this is essential for the future of good rheumatological medicine.


Assuntos
Garantia da Qualidade dos Cuidados de Saúde , Doenças Reumáticas , Reumatologia , Diagnóstico Precoce , Alemanha , Humanos , Doenças Reumáticas/terapia , Reumatologistas
18.
Z Rheumatol ; 78(10): 979-986, 2019 Dec.
Artigo em Alemão | MEDLINE | ID: mdl-31346705

RESUMO

BACKGROUND: In Germany, the numbers of patients with spondylarthritides (SpA) and rheumatoid arthritis (RA) have increased. This rise was possibly promoted by the introduction of new classification criteria (CC) that enable an earlier recognition and the inclusion of less severe cases. The study explores how the new CC for axial SpA (axSpA) are incorporated into the clinical practice, compared with the CC for RA and systemic lupus erythematosus (SLE). In addition, the study investigated whether the new entity of non-radiographic axSpA (nr-axSpA) is accepted and used in Germany. MATERIAL AND METHODS: In 2016, an online survey was performed among all rheumatologists registered in the German Society of Rheumatology (DGRh). In addition, 150 rheumatologists were invited to the survey at the national meeting of the DGRh in 2016. RESULTS: Among 119 participating rheumatologists, 99% were familiar with the new CC for SpA and 82% applied them in practice (RA 99% and 80%, SLE 50% and 56%). 78% differentiated between radiographic and nr-axSpA and 80% believed that a significant proportion of patients with nr-axSpA will never develop radiographic changes. 91% agreed that the new CC facilitated an earlier treatment start and 58% that the CC enabled more patients to receive biologicals. 50% shared the opinion that the criterion "chronic back pain" could lead to the classification of too many patients as having axSpA. It deemed possible to 65% that patients with nr-axSpA would be treated with biologicals in whom the diagnosis of axSpA could not be confirmed later on. 81% voted against the initiation of TNF inhibitors in nr-axSpA patients with normal CRP levels and normal MRI. 67% interpreted the MRI themselves and 30% stated that the MRI is evaluated according to validated standards by the radiologists. Among all axSpA criteria, HLA B27 and inflammatory back pain received the highest significance and the response to NSAID the lowest. CONCLUSION: The new CC and the entity of nr-axSpA are accepted by German rheumatologists. A relevant proportion saw weaknesses of the new CC in the differentiation between nr-axSpA and non-specific chronic back pain. In practise, the interpretation of the CC with respect to the start of biologics is relatively strict, especially in cases with normal CRP and MRI. A ranking of axSpA criteria is commonly applied, although this was not initially intended in the CC.


Assuntos
Artrite Reumatoide , Lúpus Eritematoso Sistêmico , Espondilartrite , Espondilite Anquilosante , Artrite Reumatoide/diagnóstico , Artrite Reumatoide/terapia , Alemanha , Humanos , Lúpus Eritematoso Sistêmico/diagnóstico , Lúpus Eritematoso Sistêmico/terapia , Reumatologistas , Espondilartrite/diagnóstico , Espondilartrite/terapia , Espondilite Anquilosante/diagnóstico , Espondilite Anquilosante/terapia
19.
Pediatr Rheumatol Online J ; 17(1): 48, 2019 Jul 22.
Artigo em Inglês | MEDLINE | ID: mdl-31331351

RESUMO

BACKGROUND: We describe a Childhood Arthritis and Rheumatology Research Alliance (CARRA) survey of North American pediatric rheumatologists that assesses physician attitudes on withdrawal of medications in systemic juvenile idiopathic arthritis (SJIA). METHODS: A REDCap anonymous electronic survey was distributed to 100 random CARRA JIA workgroup physician-voting members. The survey had three broad sections including: A) demographic information; B) physicians' opinions on clinical inactive disease (CID) in SJIA and C) existing practices for withdrawing medications in SJIA. RESULTS: The survey had an 86% response rate. 88 and 93% of participants agreed with the current criteria for CID and clinical remission on medications (CRM) respectively. 78% thought it necessary to meet CRM before tapering medications except steroids. 76% use CARRA SJIA consensus treatment plans always or the majority of the time. All participants weaned steroids first in SJIA patients on combination therapy, 47% waited > 6 months before tapering additional medications. 35% each tapered methotrexate over > 6 months and 2-6 months; however, 39% preferred tapering anakinra, canakinumab and tocilizumab more quickly over 2-6 months and favored spacing the dosing interval for canakinumab and tocilizumab. When patients are on combination therapy with methotrexate and biologics, 58% preferred tapering methotrexate first while others considered patient/family preference and adverse effects to guide their choice. CONCLUSION: Most CARRA members surveyed use published consensus treatment plans for SJIA and agree with validated definitions of CID and CRM. There was agreement with tapering steroids first in SJIA. There was considerable variability with tapering decisions of all other medications.


Assuntos
Antirreumáticos/uso terapêutico , Artrite Juvenil/tratamento farmacológico , Atitude do Pessoal de Saúde , Desprescrições , Reumatologistas , Corticosteroides/uso terapêutico , Anticorpos Monoclonais Humanizados/uso terapêutico , Artrite Juvenil/fisiopatologia , Tomada de Decisão Clínica , Humanos , Proteína Antagonista do Receptor de Interleucina 1/uso terapêutico , Metotrexato/uso terapêutico , Inquéritos e Questionários
20.
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
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