Does early arthritis clinic organisation improve outcomes? What evidence is there? A systematic review.
Does early arthritis clinic organisation improve outcomes? What evidence is there? A systematic review.
复制标题
早期关节炎诊所组织是否可以改善治疗结果？
DOI：
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发表时间：
2013
影响因子：
3.7
通讯作者：
M. Padovan
中科院分区：
文献类型：
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作者：
M. Govoni;C. Scirè;M. Manara;N. Malavolta;L. Mancarella;G. Sandri;F. Mascella;P. Macchioni;G. Delsante;M. Padovan
目标
进行一项系统性综述，旨在确定建立一个名为早期关节炎诊所（EAC）的结构化组织项目的影响的研究，该项目最终确定用于管理早期关节炎（EA）或疑似早期类风湿性关节炎（ERA）患者。
方法
使用电子数据库进行文献检索，直至2012年5月。通过手动和灰色文献检索获得更多信息。已定义主要和次要结局以及合格性标准。
结果
检索共提供了3367篇引文，经过选择过程，选择了11项非随机对照试验，共包括8240名参与者。EAC在缩短转诊延迟时间和治疗时间（次要结局）方面的疗效确实明显。只有两项研究达到了主要结局：一项研究表明EAC有助于减少疾病活动和放射学进展，但不是功能残疾，而另一项研究报告在6-12个月随访期后疼痛减轻。
结论
与EAC以外的患者相比，EAC的建立是否会改善EA在主要结局（如临床、功能和放射学进展）方面的预后，这在文献中仍然是一个未得到充分解决的问题，应被风湿病学界视为一个迫切未满足的需求，以获得更多关于该主题的循证信息。
OBJECTIVES
To perform a systematic review aimed to identify studies addressing the effect of the establishment of a structured organisation programme, named early arthritis clinic (EAC), finalized to manage patients with early arthritis (EA) or suspected early rheumatoid arthritis (ERA).
METHODS
A literature search was performed until May 2012 using electronic databases. Additional information was obtained through a hand and grey literature search. Primary and secondary outcomes and eligibility criteria have been defined.
RESULTS
The search provided a total of 3367 citations and, after the selection process, 11 non randomised controlled trials were selected, including a total of 8240 participants. The efficacy of EAC did clearly emerge with regard to reduction of the referral lag time and of the time to treatment (secondary outcomes). Only two studies met the primary outcomes: one study demonstrated that the EAC contributed to reducing disease activity and radiographic progression but not functional disability, while another reported a reduction of pain after a 6-12-month period of follow-up.
CONCLUSIONS
Whether the establishment of EAC would improve the prognosis of EA in terms of primary outcomes such as clinical, functional and radiologic progression compared to patients managed outside from EAC does appear a still poorly addressed issue in the literature, which should be recognised as an urgent unmet need by the rheumatology community to gain more evidence-based information on this topic.