Objective: To investigate and analyse the features of treatment behavior and standardized therapeutic status of patients with psoriatic arthritis (PsA).
Methods: Out patients diagnosed with PsA in People's Hospital of Peking University, Haidian Hospital, People's Hospital of Jianyang City, Central Hospital of Xinxiang City, Integrated Traditional Chinese and Western Medicine Hospital of Cangzhou City, The Third Hospital of Hebei Medical University from February to June 2018 were enrolled in this investigation. The data including gender, age of onset, course of disease, site of first consulting department, time of the first visit and definite diagnosis, follow-up interval, and use of conventional disease modifying anti-rheumatic drugs (cDMARDs) and biological DMARDs (BioDMARDs) were collected and analyzed.
Results: In the cross-sectional study, 133 PsA patients were investigated. The mean age of onset was (47±11) years, the male to female ratio was 1.3:1, and mean disease duration was (16±8) years. Rheumatology department was the most common site of first hospital visit (37.6%, 50/133). Orthopedics department and dermatological department were visited by 24.1% (32/133) and 23.3% (31/133), respectively. Ratio of definite diagnosis was the highest in rheumatology department which was 78% (39/50). The ratio of definite diagnosis of dermatological department was the second highest, which was 19.4% (6/31). The mean definite diagnosed time was 7.6 months since the first visit of PsA patients, and diagnosed time was the shortest in rheumatology department, which had statistical significance. 37% PsA patients were treated appropriately in 3 months, 17.3% PsA patients were treated in 3-6 months and 40.2% patients with PsA visited their doctor more than once a year. 48.8% patients hadn't received standardized treatment before visit, and one third patients never received the therapy of DMARDs. Methotrexate was the most commonly used cDMARDs (58.3%), followed by leflunomide (20.5%) and BioDMARDs (19.7%), and biologicals were tumor necrosis factor antagonists.
Conclusion: In this multi-center study, the first visit department of PsA patients was widely distributed, and most patients were definitely diagnosed in Rheumatology Department. The time of their first visit and definite diagnosis were delayed due to multi factors. Nearly half of the patients did not receive standardized treatment.
目的: 调查并分析银屑病关节炎(psoriatic arthritis, PsA)患者就医行为特点及规范化治疗状况。
方法: 对2018年2月至6月在北京大学人民医院、北京市海淀医院、四川省简阳市人民医院、河南省新乡市中心医院、河北省沧州中西医结合医院、河北医科大学第三医院6家医院风湿免疫科门诊就诊的PsA患者进行现场问卷调查。调查内容包括患者的一般资料,首诊及确诊科室,就诊及确诊时间, 随诊时间间隔及传统改善病情的抗风湿药或生物制剂的应用情况。
结果: 参与调查的共133例PsA患者,平均年龄(47±11)岁,男女比例为1.3 ∶1,病程(16±8)年。患者首次就诊科室最多的为风湿免疫科(37.6%, 50/133),其次为骨科(24.1%, 32/133)和皮肤科(23.3%, 31/133);首诊确诊率以风湿免疫科为最高(78%,39/50),其次为皮肤科(19.4%,6/31);从患者首次就诊到确诊PsA的中位时间为7.6个月,首诊于风湿免疫科的患者确诊时间明显少于其他科室;仅有37%患者规律随诊,随诊时间间隔≤3个月,17.3%患者随诊间隔3~6个月,40.2%患者随诊时间间隔超过1年。48.8% PsA患者本次调查时段就诊前未接受规范化治疗,1/3的患者未应用改善病情抗风湿药(disease modifying anti-rheumatic drugs, DMARDs)。在治疗药物方面,PsA患者使用甲氨蝶呤者最多,占58.3%,其次为来氟米特20.5%,生物制剂19.7%,均为肿瘤坏死因子拮抗剂。
结论: PsA患者首诊科室分布广泛,确诊科室以风湿免疫科为首,PsA患者首诊及确诊时间延误,约半数患者治疗及随诊不规范。