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目的：（1）探讨延误患者从出现症状到第一次看风湿科医生的人口和临床特点；（2）比较病程早期看风湿科医生患者与晚些确诊患者的临床、影像学及报告结果。 方法：所有银屑病关节炎（PsA）患者，符合CASPAR标准、平均病程＞10年的被邀请进行详细的临床评价。总延迟时间是从出现症状到首次到风湿科就诊，研究数据从推荐信和医疗记录中提取。将患者分为早期咨询者或晚期咨询者主要取决于他们是否在出现症状6个月内或超过6个月去看风湿科医生。 结果：283例银屑病关节炎患者被纳入研究。队列中从发病到第一次行风湿科评估平均滞后时间为1年（0.5~2）。30 %（n=86），53 %（n=149）和71%（n=202）的患者从出现症状到第一次看风湿科医生的时间分别为6个月、1和2年。低教育现状 (OR 2.09, p=0.02)和身体质量指数(OR 0.92,p=0.01)更有可能使银屑病关节炎患者诊断延误＞2年。多元逐步回归分析，该模型对于预测晚期咨询者外周关节侵蚀的发展(OR 4.25,p=0.001)和糟糕的健康问卷调查得分 (OR 2.2,p=0.004)有重大意义。 结论：即使从出现症状到第一次去看风湿科医生延迟6个月也可导致外周关节侵蚀的发展及长期身体机能的恶化。
文献来源： Haroon M,et al. Ann Rheum Dis 2015;74:1045–1050. doi:10.1136/annrheumdis-2013-204858
Objectives (1) To investigate the demographic and clinical characteristics contributing to the delay fromsymptom onset to the first visit to a rheumatologist; (2) to compare clinical, radiographic and patient-reported outcome measures of those who saw a rheumatologist early in theirdisease course with those who were diagnosed later. Methods All psoriatic arthritis (PsA) patients, fulfillingCASPAR criteria, with an average disease duration of>10 years were invited for detailed clinical evaluation. Thetotal lag time from symptom onset to their firstrheumatological encounter was studied. The data wereextracted from the referral letters and medical records.Patients were classified as early consulters or late consulter sdepending on whether they were seen by a rheumatologistwithin or beyond 6 months of symptom onset. Results 283 PsA patients were studied. Median lag timefrom the disease onset to the first rheumatological assessment of the cohort was 1.00 years (IQR 0.5–2). 30%(n=86), 53% (n=149) and 71% (n=202) of the cohortwere seen by a rheumatologist within 6 months, 1 and2 years of symptom onset, respectively. PsA patients withlow education status (OR 2.09, p=0.02) and Body MassIndex (OR 0.92, p=0.01) were significantly more likely tohave a diagnostic delay of >2 years. On multiple stepwise regression analysis, the model predicted significant association of late consulters with the development ofperipheral joint erosions (OR 4.25, p=0.001) and worseHealth Assessment Questionnaire scores (OR 2.2, p=0.004). Conclusions Even a 6-month delay from symptom onsetto the first visit with a rheumatologist contributes to thedevelopment of peripheral joint erosions and worse longtermphysical function. 翻译：西临床免疫科 牛敏 |
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