Adwoa Dansoa Tabi-Amponsah, Sarah Stewart, Greg Gamble, Anthony J. Doyle, Karen Billington, Chang-Nam Son, Kieran Latto, Lisa K. Stamp, William J. Taylor, Anne Horne, Nicola Dalbeth
Objective
This study aimed to identify variables that predict gout remission in people with erosive gout receiving urate-lowering therapy.
Methods
We analyzed data from a two-year, double-masked randomized-controlled trial of people with erosive gout, randomized to a serum urate target of <0.20 mmol/L or <0.30 mmol/L using oral urate-lowering therapies. All participants had dual-energy computed tomography (DECT) scans of the feet and ankles at baseline. The proportion of participants achieving gout remission according to the 2016 preliminary gout remission criteria and simplified gout remission criteria (without the patient reported outcomes) was analyzed. Logistic regression models were used to evaluate predictors of gout remission in year 2.
Results
The preliminary gout remission criteria were fulfilled in 11 of 97 participants (11%) at year 1 and 21 of 92 participants (23%) at year 2. The simplified criteria were fulfilled in 26 of 97 participants (27%) in year 1 and 40 of 92 participants (44%) in year 2. In multivariable regression models, baseline DECT monosodium urate crystal volume was the only significant independent predictor of gout remission at year 2, using either criteria. Each 1-cm3 increase in the baseline DECT monosodium urate crystal volume decreased the odds of fulfilling the 2016 preliminary gout remission criteria (odds ratio [OR] 0.65, 95% confidence interval [CI] 0.46–0.93; P = 0.02) and the simplified gout remission criteria (OR 0.57, 95% CI 0.41–0.78; P < 0.001).
Conclusion
In people with erosive gout on urate-lowering therapy, higher baseline DECT monosodium urate crystal volume is associated with lower odds of gout remission after two years of treatment, defined by either the preliminary gout remission criteria or simplified gout remission criteria.
研究目的本研究旨在确定可预测接受降尿酸治疗的侵蚀性痛风患者痛风缓解的变量：我们分析了一项为期两年的侵蚀性痛风患者双盲随机对照试验的数据：第一年有 11/97 人（11%）符合痛风缓解初步标准，第二年有 21/92 人（23%）符合标准。第一年有 26/97 人（27%）符合简化标准，第二年有 40/92 人（44%）符合简化标准。在多变量回归模型中，无论采用哪种标准，基线 DECT 尿酸单钠晶体体积都是第二年痛风缓解的唯一重要独立预测因素。基线DECT单钠尿酸盐晶体体积每增加1立方厘米，符合2016年初步痛风缓解标准（0.65 [95% CI 0.46-0.93]，p=0.02）和简化痛风缓解标准（0.57 [95% CI 0.41-0.78]，p结论：在接受降尿酸治疗的侵蚀性痛风患者中，根据初步痛风缓解标准或简化痛风缓解标准，基线DECT单钠尿酸盐晶体体积越大，治疗两年后痛风缓解的几率越低。
{"title":"Baseline Dual-Energy Computed Tomography Urate Volume Predicts Fulfillment of Gout Remission After Two Years of Urate-Lowering Therapy","authors":"Adwoa Dansoa Tabi-Amponsah, Sarah Stewart, Greg Gamble, Anthony J. Doyle, Karen Billington, Chang-Nam Son, Kieran Latto, Lisa K. Stamp, William J. Taylor, Anne Horne, Nicola Dalbeth","doi":"10.1002/acr.25414","DOIUrl":"10.1002/acr.25414","url":null,"abstract":"<div>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>This study aimed to identify variables that predict gout remission in people with erosive gout receiving urate-lowering therapy.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We analyzed data from a two-year, double-masked randomized-controlled trial of people with erosive gout, randomized to a serum urate target of <0.20 mmol/L or <0.30 mmol/L using oral urate-lowering therapies. All participants had dual-energy computed tomography (DECT) scans of the feet and ankles at baseline. The proportion of participants achieving gout remission according to the 2016 preliminary gout remission criteria and simplified gout remission criteria (without the patient reported outcomes) was analyzed. Logistic regression models were used to evaluate predictors of gout remission in year 2.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The preliminary gout remission criteria were fulfilled in 11 of 97 participants (11%) at year 1 and 21 of 92 participants (23%) at year 2. The simplified criteria were fulfilled in 26 of 97 participants (27%) in year 1 and 40 of 92 participants (44%) in year 2. In multivariable regression models, baseline DECT monosodium urate crystal volume was the only significant independent predictor of gout remission at year 2, using either criteria. Each 1-cm<sup>3</sup> increase in the baseline DECT monosodium urate crystal volume decreased the odds of fulfilling the 2016 preliminary gout remission criteria (odds ratio [OR] 0.65, 95% confidence interval [CI] 0.46–0.93; <i>P</i> = 0.02) and the simplified gout remission criteria (OR 0.57, 95% CI 0.41–0.78; <i>P</i> < 0.001).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>In people with erosive gout on urate-lowering therapy, higher baseline DECT monosodium urate crystal volume is associated with lower odds of gout remission after two years of treatment, defined by either the preliminary gout remission criteria or simplified gout remission criteria.</p>\u0000 </section>\u0000 </div>","PeriodicalId":8406,"journal":{"name":"Arthritis Care & Research","volume":"76 12","pages":"1657-1665"},"PeriodicalIF":3.7,"publicationDate":"2024-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/acr.25414","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141970529","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Maria Paula Alvarez-Hernandez, Brittany Adler, Jamie Perin, Michael Hughes, Zsuzsanna H. McMahan
Objective
Our objective was to identify patients with systemic sclerosis (SSc) with a high burden of autonomic symptoms and to determine whether they have a distinct clinical phenotype, gastrointestinal (GI) transit, or extraintestinal features.
Methods
In a prospective cohort of patients with SSc with GI disease, clinical data were systematically obtained at routine visits. Dysautonomia was identified by the Composite Autonomic Symptom Score (COMPASS)-31questionnaire. GI transit was measured by whole-gut scintigraphy. Associations between total COMPASS-31 scores and clinical features, GI symptoms, and transit were evaluated. Comparisons between patients with global autonomic dysfunction (GAD; ≥5 positive COMPASS-31 subdomains) and those with limited autonomic dysfunction (LAD; <5 positive subdomains) were also studied.
Results
A total of 91 patients with SSc and GI involvement were included (mean age 57 years, 90% female, 74% limited cutaneous disease, 83% significant GI disease [Medsger score ≥2]). The mean COMPASS-31 score in patients with SSc was higher than controls (38.8 vs 7.2); 33% had GAD, and 67% had LAD. Patients with GAD were more likely to have limited SSc (93% vs 65%; P < 0.01) and have sicca symptoms (100% vs 77%; P = 0.01). Gastric and colonic transit were faster in patients with GAD (P < 0.05). Upper GI involvement (Medsger GI score of 1 or 2) was associated with higher total COMPASS-31 scores (P = 0.02).
Conclusion
Symptoms of global dysautonomia are seen in up to one-third of patients with SSc and GI involvement. Identifying specific clinical characteristics associated with GAD in SSc will help to identify a population that may benefit from therapies that modulate the autonomic nervous system.
{"title":"Evaluating the Associations Among Dysautonomia, Gastrointestinal Transit, and Clinical Phenotype in Patients With Systemic Sclerosis","authors":"Maria Paula Alvarez-Hernandez, Brittany Adler, Jamie Perin, Michael Hughes, Zsuzsanna H. McMahan","doi":"10.1002/acr.25411","DOIUrl":"10.1002/acr.25411","url":null,"abstract":"<div>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>Our objective was to identify patients with systemic sclerosis (SSc) with a high burden of autonomic symptoms and to determine whether they have a distinct clinical phenotype, gastrointestinal (GI) transit, or extraintestinal features.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>In a prospective cohort of patients with SSc with GI disease, clinical data were systematically obtained at routine visits. Dysautonomia was identified by the Composite Autonomic Symptom Score (COMPASS)-31questionnaire. GI transit was measured by whole-gut scintigraphy. Associations between total COMPASS-31 scores and clinical features, GI symptoms, and transit were evaluated. Comparisons between patients with global autonomic dysfunction (GAD; ≥5 positive COMPASS-31 subdomains) and those with limited autonomic dysfunction (LAD; <5 positive subdomains) were also studied.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 91 patients with SSc and GI involvement were included (mean age 57 years, 90% female, 74% limited cutaneous disease, 83% significant GI disease [Medsger score ≥2]). The mean COMPASS-31 score in patients with SSc was higher than controls (38.8 vs 7.2); 33% had GAD, and 67% had LAD. Patients with GAD were more likely to have limited SSc (93% vs 65%; <i>P</i> < 0.01) and have sicca symptoms (100% vs 77%; <i>P</i> = 0.01). Gastric and colonic transit were faster in patients with GAD (<i>P</i> < 0.05). Upper GI involvement (Medsger GI score of 1 or 2) was associated with higher total COMPASS-31 scores (<i>P</i> = 0.02).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Symptoms of global dysautonomia are seen in up to one-third of patients with SSc and GI involvement. Identifying specific clinical characteristics associated with GAD in SSc will help to identify a population that may benefit from therapies that modulate the autonomic nervous system.</p>\u0000 \u0000 <div>\u0000 <figure>\u0000 <div><picture>\u0000 <source></source></picture><p></p>\u0000 </div>\u0000 </figure>\u0000 </div>\u0000 </section>\u0000 </div>","PeriodicalId":8406,"journal":{"name":"Arthritis Care & Research","volume":"76 12","pages":"1675-1685"},"PeriodicalIF":3.7,"publicationDate":"2024-08-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141942058","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
We aimed to examine whether lower-limb muscle quantity and quality assessed by bioelectric impedance analysis (BIA) were associated with knee extension strength and whether the association differed with knee osteoarthritis (OA) severity.
Methods
We included 1,525 participants (63.6% women; mean ± SD age 68.0 ± 5.3 years) from the Nagahama Prospective Cohort. Knee extension strength was measured during maximum voluntary isometric contraction. Lower-limb muscle mass and the extracellular water (ECW)–to–intracellular water (ICW) ratio were used as indicators of muscle quantity and quality, respectively, and assessed via a BIA device. We executed multiple linear regression analyses to investigate the association of muscle quantity and quality with knee extension strength. Additionally, participants were classified into three groups with respect to OA severity and symptoms: control, early OA, and advanced OA groups; subgroup analyses were also executed.
Results
The muscle mass (P < 0.001) and ECW-to-ICW ratio (P = 0.009) were significantly associated with knee extension strength. In the subgroup analysis, the muscle mass was significantly associated with knee extension strength (P < 0.001), but there was no association between ECW-to-ICW ratio and knee extension strength (P = 0.731) in the control group. In the early OA and advanced OA groups, the muscle mass (both P < 0.001) and ECW-to-ICW ratio (early OA, P = 0.034; advanced OA, P = 0.015) were significantly associated with knee extension strength.
Conclusion
Lower-limb muscle quality was associated with knee extension strength, and the association was stronger in patients with knee OA. These findings suggest that both muscle quantity and quality should be assessed to better understand muscle function in patients with knee OA.
目的：我们旨在研究通过生物电阻抗分析（BIA）评估的下肢肌肉数量和质量是否与膝关节伸展力量有关，以及这种关联是否与膝关节骨性关节炎（OA）的严重程度有关：我们纳入了来自长滨前瞻性队列的1525名参与者（63.6%为女性；平均年龄为68.0±5.3岁）。测量最大自主等长收缩时的伸膝力量。下肢肌肉质量和细胞外水/细胞内水（ECW/ICW）比率分别作为肌肉数量和质量的指标，并通过 BIA 设备进行评估。我们采用多元线性回归分析来研究肌肉数量和质量与膝关节伸展力量的关系。此外，我们还根据 OA 严重程度和症状将参与者分为三组：对照组、早期 OA 组和晚期 OA 组；并进行了分组分析：结果：肌肉质量（p结论：下肢肌肉质量与膝关节伸展力量相关，膝关节OA患者的相关性更强。这些研究结果表明，为了更好地了解膝关节OA患者的肌肉功能，应同时评估肌肉的数量和质量。
{"title":"Association of Muscle Quantity and Quality With Knee Extension Strength in Knee Osteoarthritis: The Nagahama Study","authors":"Shogo Okada, Masashi Taniguchi, Tome Ikezoe, Tadao Tsuboyama, Hiromu Ito, Shuichi Matsuda, Fumihiko Matsuda, Noriaki Ichihashi","doi":"10.1002/acr.25412","DOIUrl":"10.1002/acr.25412","url":null,"abstract":"<div>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>We aimed to examine whether lower-limb muscle quantity and quality assessed by bioelectric impedance analysis (BIA) were associated with knee extension strength and whether the association differed with knee osteoarthritis (OA) severity.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We included 1,525 participants (63.6% women; mean ± SD age 68.0 ± 5.3 years) from the Nagahama Prospective Cohort. Knee extension strength was measured during maximum voluntary isometric contraction. Lower-limb muscle mass and the extracellular water (ECW)–to–intracellular water (ICW) ratio were used as indicators of muscle quantity and quality, respectively, and assessed via a BIA device. We executed multiple linear regression analyses to investigate the association of muscle quantity and quality with knee extension strength. Additionally, participants were classified into three groups with respect to OA severity and symptoms: control, early OA, and advanced OA groups; subgroup analyses were also executed.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The muscle mass (<i>P</i> < 0.001) and ECW-to-ICW ratio (<i>P</i> = 0.009) were significantly associated with knee extension strength. In the subgroup analysis, the muscle mass was significantly associated with knee extension strength (<i>P</i> < 0.001), but there was no association between ECW-to-ICW ratio and knee extension strength (<i>P</i> = 0.731) in the control group. In the early OA and advanced OA groups, the muscle mass (both <i>P</i> < 0.001) and ECW-to-ICW ratio (early OA, <i>P</i> = 0.034; advanced OA, <i>P</i> = 0.015) were significantly associated with knee extension strength.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Lower-limb muscle quality was associated with knee extension strength, and the association was stronger in patients with knee OA. These findings suggest that both muscle quantity and quality should be assessed to better understand muscle function in patients with knee OA.</p>\u0000 </section>\u0000 </div>","PeriodicalId":8406,"journal":{"name":"Arthritis Care & Research","volume":"76 12","pages":"1696-1702"},"PeriodicalIF":3.7,"publicationDate":"2024-08-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141905727","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Motahareh Karimijashni, Forough Abtahi, Shokoofih Abbasalipour, Parisa Ranjbar, Armaghan Dabbagh, Marie Westby, Tim Ramsay, Paul E. Beaulé, Stéphane Poitras
Objective
This systematic review aimed to identify the existing patient-reported outcome measures (PROMs) used in hip or knee arthroplasty for adults with osteoarthritis and assess their content validity using the modified International Classification of Functioning, Disability, and Health (ICF) core set for osteoarthritis (OA).
Methods
Four databases were systematically searched to identify disease or joint-specific PROMs evaluating function after hip or knee arthroplasty. Two reviewers independently evaluated the content of PROMs based on established ICF linking rules.
Results
From 449 studies included in this review, 50 PROMs were identified. The mobility chapter of activities and participation was the most common component, followed by the sensory function and pain chapter of body function and structure. The most frequent ICF activity and participation categories were d451 going up and down stairs, d4701 using private motorized transportation, d4104 standing, and d4154 maintaining a standing position. However, 11 ICF categories of the modified OA core set were not captured in any PROMs. This ICF-based content analysis of PROMs revealed that included activity and participation categories vary widely, with little overlap among PROMs. The Knee Injury and Osteoarthritis Outcome Score and the Hip Disability and Osteoarthritis Outcome Score had the most coverage for activity and participation (36.7%).
Conclusion
Even though our search identified 50 specific PROMs, there remain gaps in content related to activity and participation coverage. By providing a content analysis of the PROMs used after hip or knee arthroplasty, this study may help clinicians select PROMs based on covered categories and relevant clinical objectives.
{"title":"Functional Patient-Reported Outcome Measures After Hip or Knee Arthroplasty: A Systematic Review and Content Analysis Using the International Classification of Functioning, Disability, and Health","authors":"Motahareh Karimijashni, Forough Abtahi, Shokoofih Abbasalipour, Parisa Ranjbar, Armaghan Dabbagh, Marie Westby, Tim Ramsay, Paul E. Beaulé, Stéphane Poitras","doi":"10.1002/acr.25413","DOIUrl":"10.1002/acr.25413","url":null,"abstract":"<div>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>This systematic review aimed to identify the existing patient-reported outcome measures (PROMs) used in hip or knee arthroplasty for adults with osteoarthritis and assess their content validity using the modified International Classification of Functioning, Disability, and Health (ICF) core set for osteoarthritis (OA).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Four databases were systematically searched to identify disease or joint-specific PROMs evaluating function after hip or knee arthroplasty. Two reviewers independently evaluated the content of PROMs based on established ICF linking rules.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>From 449 studies included in this review, 50 PROMs were identified. The mobility chapter of activities and participation was the most common component, followed by the sensory function and pain chapter of body function and structure. The most frequent ICF activity and participation categories were d451 going up and down stairs, d4701 using private motorized transportation, d4104 standing, and d4154 maintaining a standing position. However, 11 ICF categories of the modified OA core set were not captured in any PROMs. This ICF-based content analysis of PROMs revealed that included activity and participation categories vary widely, with little overlap among PROMs. The Knee Injury and Osteoarthritis Outcome Score and the Hip Disability and Osteoarthritis Outcome Score had the most coverage for activity and participation (36.7%).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Even though our search identified 50 specific PROMs, there remain gaps in content related to activity and participation coverage. By providing a content analysis of the PROMs used after hip or knee arthroplasty, this study may help clinicians select PROMs based on covered categories and relevant clinical objectives.</p>\u0000 </section>\u0000 </div>","PeriodicalId":8406,"journal":{"name":"Arthritis Care & Research","volume":"76 12","pages":"1703-1722"},"PeriodicalIF":3.7,"publicationDate":"2024-08-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/acr.25413","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141905728","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Few studies have explored whether the involvement of patients in shared decision-making (SDM) is beneficial to the management of systemic lupus erythematosus (SLE). Therefore, this study investigated the relationship between patient participation in SDM and their trust in physicians using data from the Trust Measurement in Physicians and Patients With SLE (TRUMP2-SLE) study.
Methods
Data regarding the nine-item Japanese version of the Shared Decision-Making Questionnaire (SDM-Q-9) scores, Trust in Physician Scale (TIPS) scores, and Abbreviated Wake Forest Physician Trust Scale (A-WFPTS) scores for interpersonal trust in a physician and trust in the medical profession were collected from patients with SLE who visited the outpatient clinics of five facilities in Japan through a self-administered questionnaire. The relationships among these scores were analyzed by general linear models with cluster-robust variance.
Results
This study included 433 patients with SLE. The median baseline TIPS and A-WFPTS (attending physician version) scores were 82 (73–93) and 80 (70–95), respectively. A higher baseline SDM-Q-9 score was correlated with an increase in the TIPS score at one year (coefficient per 10-point [pt] increase, 0.94 pts, 95% confidence interval [CI] 0.16–1.72). A higher baseline SDM-Q-9 score was correlated with a higher A-WFPTS score for interpersonal trust (coefficient per 10-pt increase, 2.20 pts, 95% CI 1.44–2.96). The baseline SDM-Q-9 score was also correlated with an increase in the general physician version of the A-WFPTS score at one year (coefficient per 10-pt increase, 1.29 pts, 95% CI 0.41–2.18).
Conclusion
Engagement of patients with SLE in SDM elevates their trust in the attending physicians and health care providers, potentially enhancing doctor–patient relationships and overall health care trust.
{"title":"Effect of Shared Decision-Making on Trust in Physicians in the Management of Systemic Lupus Erythematosus: The Trust Measurement for Physicians and Patients With Systemic Lupus Erythematosus Prospective Cohort Study","authors":"Ryusuke Yoshimi, Nobuyuki Yajima, Chiharu Hidekawa, Natsuki Sakurai, Nao Oguro, Kenta Shidahara, Keigo Hayashi, Takanori Ichikawa, Dai Kishida, Yoshia Miyawaki, Ken-ei Sada, Yasuhiro Shimojima, Yuichi Ishikawa, Yuji Yoshioka, Yosuke Kunishita, Daiga Kishimoto, Kaoru Takase-Minegishi, Yohei Kirino, Shigeru Ohno, Noriaki Kurita, Hideaki Nakajima","doi":"10.1002/acr.25409","DOIUrl":"10.1002/acr.25409","url":null,"abstract":"<div>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>Few studies have explored whether the involvement of patients in shared decision-making (SDM) is beneficial to the management of systemic lupus erythematosus (SLE). Therefore, this study investigated the relationship between patient participation in SDM and their trust in physicians using data from the Trust Measurement in Physicians and Patients With SLE (TRUMP2-SLE) study.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Data regarding the nine-item Japanese version of the Shared Decision-Making Questionnaire (SDM-Q-9) scores, Trust in Physician Scale (TIPS) scores, and Abbreviated Wake Forest Physician Trust Scale (A-WFPTS) scores for interpersonal trust in a physician and trust in the medical profession were collected from patients with SLE who visited the outpatient clinics of five facilities in Japan through a self-administered questionnaire. The relationships among these scores were analyzed by general linear models with cluster-robust variance.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>This study included 433 patients with SLE. The median baseline TIPS and A-WFPTS (attending physician version) scores were 82 (73–93) and 80 (70–95), respectively. A higher baseline SDM-Q-9 score was correlated with an increase in the TIPS score at one year (coefficient per 10-point [pt] increase, 0.94 pts, 95% confidence interval [CI] 0.16–1.72). A higher baseline SDM-Q-9 score was correlated with a higher A-WFPTS score for interpersonal trust (coefficient per 10-pt increase, 2.20 pts, 95% CI 1.44–2.96). The baseline SDM-Q-9 score was also correlated with an increase in the general physician version of the A-WFPTS score at one year (coefficient per 10-pt increase, 1.29 pts, 95% CI 0.41–2.18).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Engagement of patients with SLE in SDM elevates their trust in the attending physicians and health care providers, potentially enhancing doctor–patient relationships and overall health care trust.</p>\u0000 </section>\u0000 </div>","PeriodicalId":8406,"journal":{"name":"Arthritis Care & Research","volume":"76 12","pages":"1597-1605"},"PeriodicalIF":3.7,"publicationDate":"2024-08-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141888349","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Catherine Nasrallah, Gabriela Schmajuk, Alicia Hamblin, Cherish Wilson, Emma Kersey, Cammie Young, Patti Katz, Puneet Bajaj, Christina Downey, Christie Bartels, JoAnn Zell, Maria I. Danila, Sancia Ferguson, Jennifer L. Barton, Kimberly DeQuattro, Jinoos Yazdany
Objective
Despite the recognized benefits of collecting rheumatoid arthritis (RA) outcomes measures, their use in routine care is inconsistent. Using the Consolidated Framework for Implementation Research (CFIR), we conducted semistructured interviews with US rheumatologists and practice personnel to assess workflows, opportunities, and challenges in collecting RA outcome measures. Using insights from interviews, we developed the RA Measures Toolkit to enhance their use in clinical practice.
Methods
We invited 138 Rheumatology Informatics System for Effectiveness (RISE) registry practices and 5 academic medical centers with ≥30 patients eligible for RA outcome measures to participate in the study. Practices were classified based on their performance in quality payment programs. Recorded interviews were transcribed verbatim and analyzed thematically using deductive and inductive techniques. The findings were used to create the RA Measures Toolkit.
Results
We conducted 20 interviews with 38 participants across 20 practices. Key themes within the CFIR domains highlighted the challenges and best practices in RA outcome measure collection and included (1) process: the variability in practices’ use of RA outcome measures and the importance of streamlined workflows; (2) intervention: challenges of integrating patient-reported outcomes into electronic health records; and (3) individual characteristics: importance of clinic culture around quality improvement. Using these data, we developed the RA Measures Toolkit, a multimedia online resource, featuring guidelines, best practices, and educational resources to improve the efficiency of current workflows and to enhance patient care.
Conclusion
This study identifies critical gaps in the collection of RA outcome measures in US rheumatology practices and provides actionable recommendations and resources to address challenges via the RA Measures Toolkit.
目的：尽管收集类风湿性关节炎（RA）结果指标的益处已得到公认，但其在常规护理中的应用却不一致。利用实施研究综合框架（CFIR），我们对美国的风湿病学家和医务人员进行了半结构化访谈，以评估收集 RA 结果指标的工作流程、机遇和挑战。利用访谈中获得的见解，我们开发了 RA 测量工具包，以提高其在临床实践中的利用率：我们邀请了 138 家 RISE 注册机构和 5 家学术医疗中心参与研究，这些机构都拥有≥ 30 名符合 RA 结果测量条件的患者。我们根据医疗机构在质量支付项目中的表现对其进行了分类。对访谈录音进行逐字转录，并采用演绎和归纳技术进行专题分析。研究结果被用于创建 RA 措施工具包：我们对 20 家医疗机构的 38 名参与者进行了 20 次访谈。CFIR 领域的关键主题突出了 RA 成果测量收集方面的挑战和最佳实践，包括1）过程：实践中使用 RA 结果测量的差异性以及简化工作流程的重要性；2）干预：将 PROs 整合到电子健康记录 (EHR) 中的挑战；以及 3）个体特征：围绕质量改进的诊所文化的重要性。利用这些数据，我们开发了 RA 工具包，这是一个多媒体在线资源，其中包括指南、最佳实践和教育资源，以提高当前工作流程的效率并加强患者护理：本研究确定了美国风湿病学实践中在收集 RA 结果指标方面存在的关键差距，并通过 RA 工具包提供了应对挑战的可行建议和资源。
{"title":"Leveraging the Consolidated Framework for Implementation Research to Develop the American College of Rheumatology's Toolkit for Implementation of Rheumatoid Arthritis Outcome Measures in Clinical Practice: A Qualitative Study","authors":"Catherine Nasrallah, Gabriela Schmajuk, Alicia Hamblin, Cherish Wilson, Emma Kersey, Cammie Young, Patti Katz, Puneet Bajaj, Christina Downey, Christie Bartels, JoAnn Zell, Maria I. Danila, Sancia Ferguson, Jennifer L. Barton, Kimberly DeQuattro, Jinoos Yazdany","doi":"10.1002/acr.25410","DOIUrl":"10.1002/acr.25410","url":null,"abstract":"<div>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>Despite the recognized benefits of collecting rheumatoid arthritis (RA) outcomes measures, their use in routine care is inconsistent. Using the Consolidated Framework for Implementation Research (CFIR), we conducted semistructured interviews with US rheumatologists and practice personnel to assess workflows, opportunities, and challenges in collecting RA outcome measures. Using insights from interviews, we developed the RA Measures Toolkit to enhance their use in clinical practice.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We invited 138 Rheumatology Informatics System for Effectiveness (RISE) registry practices and 5 academic medical centers with ≥30 patients eligible for RA outcome measures to participate in the study. Practices were classified based on their performance in quality payment programs. Recorded interviews were transcribed verbatim and analyzed thematically using deductive and inductive techniques. The findings were used to create the RA Measures Toolkit.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>We conducted 20 interviews with 38 participants across 20 practices. Key themes within the CFIR domains highlighted the challenges and best practices in RA outcome measure collection and included (1) process: the variability in practices’ use of RA outcome measures and the importance of streamlined workflows; (2) intervention: challenges of integrating patient-reported outcomes into electronic health records; and (3) individual characteristics: importance of clinic culture around quality improvement. Using these data, we developed the RA Measures Toolkit, a multimedia online resource, featuring guidelines, best practices, and educational resources to improve the efficiency of current workflows and to enhance patient care.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>This study identifies critical gaps in the collection of RA outcome measures in US rheumatology practices and provides actionable recommendations and resources to address challenges via the RA Measures Toolkit.</p>\u0000 </section>\u0000 </div>","PeriodicalId":8406,"journal":{"name":"Arthritis Care & Research","volume":"76 12","pages":"1647-1656"},"PeriodicalIF":3.7,"publicationDate":"2024-08-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141888350","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Laure Gossec, Louis Bessette, Ricardo M. Xavier, Ennio G. Favalli, Andrew Östör, Maya H. Buch
Objective
Treat-to-target is recommended in the management of rheumatoid arthritis (RA) but its implementation is suboptimal. We aimed to identify interventional strategies targeted at improving treat-to-target implementation in RA by systematically reviewing published evidence on barriers to, facilitators of, and interventions to support treat-to-target implementation.
Methods
Systematic and scoping literature searches in PubMed/MEDLINE, BIOSIS Previews, Derwent Drug File, Embase, EMCare, International Pharmaceutical Abstracts, and SciSearch were conducted to identify barriers/facilitators and interventions relating to treat-to-target implementation in RA. The quality of included studies was assessed using Critical Appraisal Skills Programme (CASP) checklists. Data related to barriers/facilitators and interventions were extracted, grouped, and summarized descriptively, and a narrative synthesis was generated.
Results
In total, 146 articles were analyzed, of which 123 (84%) included ≥50% of the items assessed by CASP checklists. Of the 146 studies, 76 evaluated treat-to-target barriers and facilitators, from which 329 relevant statements were identified and regrouped into 18 target areas, including health care professional (HCP) or patient knowledge or perceptions; patient-HCP communication or alignment; and time or resources. Overall, 56 interventions were identified from 70 studies across the 18 target areas; 54% addressed disease activity or patient-reported outcome assessments. Of the 56 interventions identified, 36 improved treat-to-target implementation and/or patient outcomes in RA.
Conclusion
Despite long-established treat-to-target recommendations, there remain many barriers to its implementation. Interventions to improve treat-to-target should be developed further and assessed, with a particular focus on tailoring them to individual countries, regions, and health care settings.
{"title":"Barriers to, Facilitators of, and Interventions to Support Treat-to-Target Implementation in Rheumatoid Arthritis: A Systematic Review","authors":"Laure Gossec, Louis Bessette, Ricardo M. Xavier, Ennio G. Favalli, Andrew Östör, Maya H. Buch","doi":"10.1002/acr.25408","DOIUrl":"10.1002/acr.25408","url":null,"abstract":"<div>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>Treat-to-target is recommended in the management of rheumatoid arthritis (RA) but its implementation is suboptimal. We aimed to identify interventional strategies targeted at improving treat-to-target implementation in RA by systematically reviewing published evidence on barriers to, facilitators of, and interventions to support treat-to-target implementation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Systematic and scoping literature searches in PubMed/MEDLINE, BIOSIS Previews, Derwent Drug File, Embase, EMCare, International Pharmaceutical Abstracts, and SciSearch were conducted to identify barriers/facilitators and interventions relating to treat-to-target implementation in RA. The quality of included studies was assessed using Critical Appraisal Skills Programme (CASP) checklists. Data related to barriers/facilitators and interventions were extracted, grouped, and summarized descriptively, and a narrative synthesis was generated.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>In total, 146 articles were analyzed, of which 123 (84%) included ≥50% of the items assessed by CASP checklists. Of the 146 studies, 76 evaluated treat-to-target barriers and facilitators, from which 329 relevant statements were identified and regrouped into 18 target areas, including health care professional (HCP) or patient knowledge or perceptions; patient-HCP communication or alignment; and time or resources. Overall, 56 interventions were identified from 70 studies across the 18 target areas; 54% addressed disease activity or patient-reported outcome assessments. Of the 56 interventions identified, 36 improved treat-to-target implementation and/or patient outcomes in RA.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Despite long-established treat-to-target recommendations, there remain many barriers to its implementation. Interventions to improve treat-to-target should be developed further and assessed, with a particular focus on tailoring them to individual countries, regions, and health care settings.</p>\u0000 </section>\u0000 </div>","PeriodicalId":8406,"journal":{"name":"Arthritis Care & Research","volume":"76 12","pages":"1626-1636"},"PeriodicalIF":3.7,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/acr.25408","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141874015","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Amr H. Sawalha, Kelli D. Allen, Candace H. Feldman, S. Sam Lim, Andras Perl, Daniel H. Solomon, Edith M. Williams
{"title":"Diversity and Inclusivity in Rheumatology Publications","authors":"Amr H. Sawalha, Kelli D. Allen, Candace H. Feldman, S. Sam Lim, Andras Perl, Daniel H. Solomon, Edith M. Williams","doi":"10.1002/acr.25390","DOIUrl":"10.1002/acr.25390","url":null,"abstract":"","PeriodicalId":8406,"journal":{"name":"Arthritis Care & Research","volume":"76 10","pages":"1351-1352"},"PeriodicalIF":3.7,"publicationDate":"2024-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141854632","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
<div> <section> <h3> Objective</h3> <p>No clinical trials have been conducted to establish optimal and effective treatment in patients with immune-mediated necrotizing myopathy (IMNM), which can have a refractory course with increased morbidity from permanent muscle damage, especially in patients who experience delay in diagnosis and treatment. A subset of autoimmune necrotizing myopathy is associated with antibodies against 3-hydroxy-3-methylglutaryl-coenzyme A reductase (HMGCR). Treatment involves withdrawing statins and using a combination of immunosuppressant and immunomodulatory treatment. Our study aims to provide longitudinally collected data on outcomes of early versus late initiation of intravenous Ig (IVIG) using our myositis center cohort of patients with anti-HMGCR IMNM.</p> </section> <section> <h3> Methods</h3> <p>We conducted a retrospective chart review of 31 adult patients of the Oregon Health and Science University Myositis Center who were diagnosed with anti-HMGCR IMNM from September 2016 through October 2022 and reviewed physical examination, serologic laboratory data, and their treatment including prednisone reception as well as treatment response at 0 (the evaluation immediately before IVIG initiation), 3, 6, and 12 months on treatment. We divided this cohort into those who received IVIG at or before six months after receiving the diagnosis of anti-HMGCR IMNM and refer this as the cohort with nondelayed treatment, and those who received IVIG after six months following their diagnosis, which we referred to as the cohort with delayed treatment. Diagnosis of anti-HMGCR IMNM was defined as per the 2016 European Neuromuscular Centre criteria as having all three of elevated serum creatine kinase (CK), proximal muscle weakness, and anti-HMGCR antibodies. We evaluated the response to treatment by using a limited total improvement score (TIS) as per 2016 American College of Rheumatology/EULAR myositis response criteria.</p> </section> <section> <h3> Results</h3> <p>Among the 31 total patients, 19 were included within the cohort with nondelayed treatment, and 12 within the cohort with delayed treatment. The two cohorts had a comparable amount of time between the onset of symptoms and diagnosis; however, the cohort with delayed treatment had a significantly longer time between diagnosis and IVIG treatment (<i>P</i> < 0.001). At disease onset, cohorts had a comparable serum CK (<i>P</i> > 0.999), but patients with delayed treatment had an expected lower serum CK (<i>P</i> = 0.016) at the 0-month time point. At the 0-month time point, nine of the patients with nondelayed treatment (47%) required the use of a walker or wheelchair, whereas eight of the cohort with delayed treatment (66%) did. Patients who r
{"title":"Benefits of Early Versus Late Initiation of Intravenous Immunoglobulin in the Treatment of Patients With Anti–3-Hydroxy-3-Methylglutaryl-Coenzyme A Reductase Immune-Mediated Necrotizing Myopathy","authors":"Kyle Sharf, Toan Do, Daniela Ghetie, Dongseok Choi, Nizar Chahin","doi":"10.1002/acr.25406","DOIUrl":"10.1002/acr.25406","url":null,"abstract":"<div>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>No clinical trials have been conducted to establish optimal and effective treatment in patients with immune-mediated necrotizing myopathy (IMNM), which can have a refractory course with increased morbidity from permanent muscle damage, especially in patients who experience delay in diagnosis and treatment. A subset of autoimmune necrotizing myopathy is associated with antibodies against 3-hydroxy-3-methylglutaryl-coenzyme A reductase (HMGCR). Treatment involves withdrawing statins and using a combination of immunosuppressant and immunomodulatory treatment. Our study aims to provide longitudinally collected data on outcomes of early versus late initiation of intravenous Ig (IVIG) using our myositis center cohort of patients with anti-HMGCR IMNM.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We conducted a retrospective chart review of 31 adult patients of the Oregon Health and Science University Myositis Center who were diagnosed with anti-HMGCR IMNM from September 2016 through October 2022 and reviewed physical examination, serologic laboratory data, and their treatment including prednisone reception as well as treatment response at 0 (the evaluation immediately before IVIG initiation), 3, 6, and 12 months on treatment. We divided this cohort into those who received IVIG at or before six months after receiving the diagnosis of anti-HMGCR IMNM and refer this as the cohort with nondelayed treatment, and those who received IVIG after six months following their diagnosis, which we referred to as the cohort with delayed treatment. Diagnosis of anti-HMGCR IMNM was defined as per the 2016 European Neuromuscular Centre criteria as having all three of elevated serum creatine kinase (CK), proximal muscle weakness, and anti-HMGCR antibodies. We evaluated the response to treatment by using a limited total improvement score (TIS) as per 2016 American College of Rheumatology/EULAR myositis response criteria.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Among the 31 total patients, 19 were included within the cohort with nondelayed treatment, and 12 within the cohort with delayed treatment. The two cohorts had a comparable amount of time between the onset of symptoms and diagnosis; however, the cohort with delayed treatment had a significantly longer time between diagnosis and IVIG treatment (<i>P</i> < 0.001). At disease onset, cohorts had a comparable serum CK (<i>P</i> > 0.999), but patients with delayed treatment had an expected lower serum CK (<i>P</i> = 0.016) at the 0-month time point. At the 0-month time point, nine of the patients with nondelayed treatment (47%) required the use of a walker or wheelchair, whereas eight of the cohort with delayed treatment (66%) did. Patients who r","PeriodicalId":8406,"journal":{"name":"Arthritis Care & Research","volume":"76 11","pages":"1584-1592"},"PeriodicalIF":3.7,"publicationDate":"2024-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141756868","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Shalmali Bane, Titilola Falasinnu, Patricia Rodriguez Espinosa, Julia F. Simard
Objective
Diagnostic errors in outpatient settings lead to significant consequences, especially in rare diseases such as systemic lupus erythematosus (SLE). A recent vignette-based experimental study revealed that demographic factors influenced rheumatologists’ diagnoses of SLE, raising concerns about potential diagnostic biases. We conducted a qualitative study to contextualize these results to generate insights about diagnostic challenges and biases, and root causes.
Methods
We conducted 41 semistructured interviews among US rheumatologists. Transcripts were independently coded by at least two coders using a hybrid deductive–inductive approach and thematic analysis. A team of four researchers reviewed and defined themes collectively, and also resolved any discrepancies.
Results
Participants were 66% women, and 49% had more than10 years of postfellowship experience. Five major themes were generated, including receiving training through the lens of race or sex, the role of the documented epidemiology of SLE, pattern recognition and test-taking strategies, patient vignettes as an imperfect proxy for patient interactions, and varied consequences to patients from diagnostic bias. Participants noted that the consequences of diagnostic bias could include progressed disease from delayed diagnosis, unnecessary and inappropriate treatment due to missed diagnosis or misdiagnosis, and increased cost and harm.
Conclusion
This study underscores the unique challenges of diagnosing SLE, with complex factors contributing to diagnosis bias and delays. Interventions during medical education could prevent downstream diagnostic biases. Future research should explore interventions to mitigate diagnostic bias and refine vignettes to better mirror real-world clinical scenarios. Understanding diagnostic bias in SLE is crucial for improving patient outcomes and refining medical training practices.
{"title":"Misdiagnosis, Missed Diagnosis, and Delayed Diagnosis of Lupus: A Qualitative Study of Rheumatologists","authors":"Shalmali Bane, Titilola Falasinnu, Patricia Rodriguez Espinosa, Julia F. Simard","doi":"10.1002/acr.25405","DOIUrl":"10.1002/acr.25405","url":null,"abstract":"<div>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>Diagnostic errors in outpatient settings lead to significant consequences, especially in rare diseases such as systemic lupus erythematosus (SLE). A recent vignette-based experimental study revealed that demographic factors influenced rheumatologists’ diagnoses of SLE, raising concerns about potential diagnostic biases. We conducted a qualitative study to contextualize these results to generate insights about diagnostic challenges and biases, and root causes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We conducted 41 semistructured interviews among US rheumatologists. Transcripts were independently coded by at least two coders using a hybrid deductive–inductive approach and thematic analysis. A team of four researchers reviewed and defined themes collectively, and also resolved any discrepancies.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Participants were 66% women, and 49% had more than10 years of postfellowship experience. Five major themes were generated, including receiving training through the lens of race or sex, the role of the documented epidemiology of SLE, pattern recognition and test-taking strategies, patient vignettes as an imperfect proxy for patient interactions, and varied consequences to patients from diagnostic bias. Participants noted that the consequences of diagnostic bias could include progressed disease from delayed diagnosis, unnecessary and inappropriate treatment due to missed diagnosis or misdiagnosis, and increased cost and harm.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>This study underscores the unique challenges of diagnosing SLE, with complex factors contributing to diagnosis bias and delays. Interventions during medical education could prevent downstream diagnostic biases. Future research should explore interventions to mitigate diagnostic bias and refine vignettes to better mirror real-world clinical scenarios. Understanding diagnostic bias in SLE is crucial for improving patient outcomes and refining medical training practices.</p>\u0000 \u0000 <div>\u0000 <figure>\u0000 <div><picture>\u0000 <source></source></picture><p></p>\u0000 </div>\u0000 </figure>\u0000 </div>\u0000 </section>\u0000 </div>","PeriodicalId":8406,"journal":{"name":"Arthritis Care & Research","volume":"76 11","pages":"1566-1573"},"PeriodicalIF":3.7,"publicationDate":"2024-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/acr.25405","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141733446","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
扫码关注我们
求助内容：
应助结果提醒方式：
京公网安备 11010802042870号