Disease activity and transition outcomes in a childhood-onset systemic lupus erythematosus cohort.
Disease activity and transition outcomes in a childhood-onset systemic lupus erythematosus cohort.
复制标题
DOI：
10.1177/0961203316640913
复制
发表时间：
2016-11
期刊：
影响因子：
2.6
通讯作者：
Costenbader KH
中科院分区：
文献类型：
--
作者：
Son MB;Sergeyenko Y;Guan H;Costenbader KH
儿童期起病的系统性红斑狼疮(CSLE)的慢性化和严重性要求从儿科向成人提供有效的过渡。我们研究了CSLE队列中的过渡结果。我们确定了在一家成人狼疮诊所确诊为系统性红斑狼疮≤18年的患者，并由一位儿科风湿科医生进行了随访。从成人护理的头3年(“过渡期后”)提取的数据包括：社会人口学、抑郁、焦虑、SLE表现、SLE疾病活动指数(SLEDAI)和系统性红斑狼疮国际协作诊所/ACR SLE损害指数(SLICC)评分、未遵守的情况和护理方面的差距(在建议的时间范围内没有预约)。对以下预测因素进行了多变量Logistic回归分析：(1)儿科和成人提供者之间的时间，(2)护理差距，(3)计划外使用(急诊科就诊和住院)(4)抑郁和/或焦虑，以及错过预约次数的多变量Poisson回归分析。在50名患者中，SLEDAI评分稳定(开始时平均5.7±5.0分，第三年为4.7±4.8分，p=0.2)，但SLICC评分增加(0.46±0.84分，对0.78±1.25分，p=0.01)。抑郁和焦虑显著增加(10%比26%，p=0.02)。从最后一次儿科就诊到第一次成人就诊的平均时间为9个月(253±392天)。近75%的患者在护理方面存在≥1缺口。白人种族、低教育水平和不遵守约定与错过预约显著相关。尽管CSLE过渡队列中的疾病活动适中，但儿科和成人提供者之间的时间延长，过渡后时期的护理差距也出现了。焦虑和抑郁是经常被报道的。今后的工作应确定改进过渡的方法。
The chronicity and severity of childhood onset Systemic Lupus Erythematosus (cSLE) necessitate effective transition from pediatric to adult providers. We studied transition outcomes in a cSLE cohort. We identified patients at an adult Lupus clinic diagnosed with SLE ≤ 18 years who had been followed by a pediatric rheumatologist. Data extracted from the first 3 years in adult care (“post-transition period”) included: sociodemographics, depression, anxiety, SLE manifestations, SLE Disease Activity Index (SLEDAI) and Systemic Lupus International Collaborating Clinics/ACR Damage Index for SLE (SLICC) scores, non-adherence, and gaps in care (no appointments in the recommended time frame). Multivariable logistic regression analyses for predictors of: (1) time between pediatric and adult providers, (2) gaps in care, (3) unscheduled utilization (Emergency Department visits and admissions) (4) depression and/or anxiety were performed, as was a multivariable Poisson regression analysis for number of missed appointments. In 50 patients, SLEDAI scores were stable (mean 5.7 ± 5.0 at start vs. 4.7 ± 4.8 at year 3, p=0.2), but SLICC scores increased (0.46 ± 0.84, vs. 0.78 ± 1.25, p=0.01). Depression and anxiety increased significantly (10% vs. 26%, p=0.02). Mean time from last pediatric to first adult provider visit was almost 9 months (253 ± 392 days). Nearly 75% of patients had ≥1 gap in care. White race, low education level and non-adherence were significantly associated with missed appointments. Despite moderate disease activity in this cSLE transition cohort, prolonged time between pediatric and adult providers and gaps in care in the post-transition period occurred. Anxiety and depression were frequently reported. Future work should identify methods to improve transition.
登录
查看更多内容
影响因子：
4.7
作者：
Felsenstein, Susanna;Reiff, Andreas O.;Ramanathan, Anusha
通讯作者：
Ramanathan, Anusha
DOI：
10.1002/art.10790
发表时间：
2002-12-15
期刊：
ARTHRITIS & RHEUMATISM-ARTHRITIS CARE & RESEARCH
影响因子：
--
作者：
Mosley-Williams, A;Lumley, MA;Guice, D
通讯作者：
Guice, D
影响因子：
8
作者：
Son, Mary Beth F.;Johnson, Victor M.;Costenbader, Karen H.
通讯作者：
Costenbader, Karen H.
狼疮护理和结果的差异。
影响因子：
5.1
作者：
Demas KL;Costenbader KH
通讯作者：
Costenbader KH
影响因子：
13.3
作者：
Hanly, John G.;Su, Li;Urowitz, Murray B.;Romero-Diaz, Juanita;Gordon, Caroline;Bae, Sang-Cheol;Bernatsky, Sasha;Clarke, Ann E.;Wallace, Daniel J.;Merrill, Joan T.;Isenberg, David A.;Rahman, Anisur;Ginzler, Ellen M.;Petri, Michelle;Bruce, Ian N.;Dooley, M. A.;Fortin, Paul;Gladman, Dafna D.;Sanchez-Guerrero, Jorge;Steinsson, Kristjan;Ramsey-Goldman, Rosalind;Khamashta, Munther A.;Aranow, Cynthia;Alarcon, Graciela S.;Fessler, Barri J.;Manzi, Susan;Nived, Ola;Sturfelt, Gunnar K.;Zoma, Asad A.;van Vollenhoven, Ronald F.;Ramos-Casals, Manuel;Ruiz-Irastorza, Guillermo;Lim, S. Sam;Kalunian, Kenneth C.;Inanc, Murat;Kamen, Diane L.;Peschken, Christine A.;Jacobsen, Soren;Askanase, Anca;Theriault, Chris;Thompson, Kara;Farewell, Vernon
通讯作者：
Farewell, Vernon