The emerging risk of overdiagnosis in rheumatoid arthritis and polymyalgia rheumatica.

IF 15 1区 医学 Q1 RHEUMATOLOGY Lancet Rheumatology Pub Date : 2024-09-25 DOI:10.1016/S2665-9913(24)00227-3
Elizabeth Nettleton, Kylie Carlson, Michael Putman
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Abstract

Overdiagnosis occurs when patients are diagnosed with a disease that would otherwise never have affected the quality or duration of their lives. This often happens unintentionally through well-meaning screening programmes that aim to detect diseases during so-called subclinical stages. Recently, it has been suggested that patients with polymyalgia rheumatica should be screened for giant cell arteritis to identify those at higher risk of relapse or vascular complications. Screening for interstitial lung disease for patients with rheumatoid arthritis has also been recommended to identify patients who could benefit from pulmonary interventions. These potential benefits must be weighed against foreseeable harms. Such harms include the uncovering of incidental findings that necessitate additional medical follow-up, the financial costs associated with screening initiatives, the risk of overtreatment through increased immunosuppression in patients who might not have otherwise required it, and the psychosocial burden of a new diagnosis. Randomised clinical trials and prospective cohort studies of screening interventions should be conducted to establish the risks and benefits and identify patients most likely to benefit from them. This Viewpoint covers risks that overdiagnosis presents to the field of rheumatology, with focus on rheumatoid arthritis and polymyalgia rheumatica.

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类风湿性关节炎和多发性风湿性关节炎新出现的过度诊断风险。
过度诊断是指患者被诊断出患有一种本来不会影响其生活质量或寿命的疾病。这种情况往往是通过旨在发现所谓亚临床阶段疾病的善意筛查计划无意中发生的。最近,有人建议对多发性风湿痛患者进行巨细胞动脉炎筛查,以识别复发或血管并发症风险较高的患者。还有人建议对类风湿性关节炎患者进行间质性肺病筛查,以确定哪些患者可以从肺部干预中获益。这些潜在的益处必须与可预见的危害进行权衡。这些危害包括发现需要额外医疗随访的偶然发现、与筛查措施相关的经济成本、通过增加免疫抑制对原本不需要治疗的患者进行过度治疗的风险,以及新诊断带来的社会心理负担。应该对筛查干预措施进行随机临床试验和前瞻性队列研究,以确定其风险和益处,并确定最有可能从中受益的患者。本观点涵盖了过度诊断给风湿病学领域带来的风险,重点关注类风湿性关节炎和多发性风湿痛。
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来源期刊
Lancet Rheumatology
Lancet Rheumatology RHEUMATOLOGY-
CiteScore
34.70
自引率
3.10%
发文量
279
期刊介绍: The Lancet Rheumatology, an independent journal, is dedicated to publishing content relevant to rheumatology specialists worldwide. It focuses on studies that advance clinical practice, challenge existing norms, and advocate for changes in health policy. The journal covers clinical research, particularly clinical trials, expert reviews, and thought-provoking commentary on the diagnosis, classification, management, and prevention of rheumatic diseases, including arthritis, musculoskeletal disorders, connective tissue diseases, and immune system disorders. Additionally, it publishes high-quality translational studies supported by robust clinical data, prioritizing those that identify potential new therapeutic targets, advance precision medicine efforts, or directly contribute to future clinical trials. With its strong clinical orientation, The Lancet Rheumatology serves as an independent voice for the rheumatology community, advocating strongly for the enhancement of patients' lives affected by rheumatic diseases worldwide.
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