Abstract：
BACKGROUND: Glucocorticoids (GCs) play a crucial role in the treatment of many rheumatic diseases regarding their anti-inflammatory and immunosuppressive effects. Inappropriate use of GCs can exacerbate GC-related problems besides complex treatment regimens and miscellaneous well-established adverse events. Although several guidelines exist for managing these problems, there is lack of real-life studies evaluating the problems at the patient level. This study aims to identify GC-related problems among patients with rheumatic diseases and address how they have been solved.
METHODS: This prospective follow-up study was conducted between January 2021 and June 2022 at a university rheumatology outpatient clinic and included patients using GCs. A clinical pharmacist assessed patients for possible GC-related problems at baseline, 3 months, and 6 months. Identified problems, their causes, interventions to address these problems, and their outcomes were categorized using the Pharmaceutical Care Network Europe (PCNE v9.1) classification system. The resolution of the problems was evaluated at the patient\'s next follow-up visit.
RESULTS: A total of 156 patients were included, and 236 GC-related problems were identified in 66% of the patients. Adverse drug events (possible) accounted for the highest proportion of GC-related problems (94.1%), and the most common causes were lack of laboratory monitoring of GC-related adverse events (41.5%) and lack of drug treatment despite existing indications (39.8%). The median cumulative prednisolone dose was higher in patients with GC-related problems (3115 vs. 5455 mg, p = 0.007). The clinical pharmacist suggested 381 interventions: 47.7% (n = 182) at the \'prescriber level\', 31.8% (n = 121) at the \'patient level\', and 20.5% (n = 78) at the \'drug level\'. Of those interventions, 98% were accepted, and 80.1% of the problems were solved.
CONCLUSIONS: This study showed that the prevalence of GC-related problems is high in patients with rheumatic diseases. Integrating clinical pharmacists into the multidisciplinary rheumatology team provides an advantage in effectively identifying and managing GC-related problems at an early stage.
METHODS: This prospective follow-up study was conducted between January 2021 and June 2022 at a university rheumatology outpatient clinic and included patients using GCs. A clinical pharmacist assessed patients for possible GC-related problems at baseline, 3 months, and 6 months. Identified problems, their causes, interventions to address these problems, and their outcomes were categorized using the Pharmaceutical Care Network Europe (PCNE v9.1) classification system. The resolution of the problems was evaluated at the patient\'s next follow-up visit.
RESULTS: A total of 156 patients were included, and 236 GC-related problems were identified in 66% of the patients. Adverse drug events (possible) accounted for the highest proportion of GC-related problems (94.1%), and the most common causes were lack of laboratory monitoring of GC-related adverse events (41.5%) and lack of drug treatment despite existing indications (39.8%). The median cumulative prednisolone dose was higher in patients with GC-related problems (3115 vs. 5455 mg, p = 0.007). The clinical pharmacist suggested 381 interventions: 47.7% (n = 182) at the \'prescriber level\', 31.8% (n = 121) at the \'patient level\', and 20.5% (n = 78) at the \'drug level\'. Of those interventions, 98% were accepted, and 80.1% of the problems were solved.
CONCLUSIONS: This study showed that the prevalence of GC-related problems is high in patients with rheumatic diseases. Integrating clinical pharmacists into the multidisciplinary rheumatology team provides an advantage in effectively identifying and managing GC-related problems at an early stage.
摘要：
背景：糖皮质激素（GC）在许多风湿性疾病的治疗中起着至关重要的作用，因为它们具有抗炎和免疫抑制作用。除了复杂的治疗方案和其他公认的不良事件外，不适当使用GC还会加剧GC相关问题。尽管存在一些管理这些问题的准则，缺乏在患者层面评估问题的真实研究。这项研究旨在确定风湿性疾病患者中与GC相关的问题，并解决如何解决这些问题。
方法：这项前瞻性随访研究于2021年1月至2022年6月在一所大学风湿病门诊进行，包括使用GC的患者。临床药师在基线时评估患者可能的GC相关问题，3个月,和6个月。发现的问题，他们的原因,解决这些问题的干预措施，他们的结果使用欧洲药学监护网络（PCNEv9.1）分类系统进行分类。在患者的下一次随访中评估问题的解决。
结果：共纳入156例患者，在66%的患者中发现了236例GC相关问题。药物不良事件(可能)占GC相关问题的比例最高(94.1%),最常见的原因是缺乏GC相关不良事件的实验室监测(41.5%),以及尽管存在适应症(39.8%),但仍缺乏药物治疗.患有GC相关问题的患者的中位累积泼尼松龙剂量较高（3115vs.5455毫克，p=0.007)。临床药师建议381项干预措施：47.7％（n=182）在“处方水平”，31.8%(n=121)在“患者水平”，和20.5%(n=78)在“药物水平”。在这些干预措施中，98%被接受，80.1%的问题得到解决。
结论：这项研究表明，风湿性疾病患者中GC相关问题的患病率较高。将临床药剂师整合到多学科风湿病学团队中，可以在早期阶段有效识别和管理GC相关问题。
方法：这项前瞻性随访研究于2021年1月至2022年6月在一所大学风湿病门诊进行，包括使用GC的患者。临床药师在基线时评估患者可能的GC相关问题，3个月,和6个月。发现的问题，他们的原因,解决这些问题的干预措施，他们的结果使用欧洲药学监护网络（PCNEv9.1）分类系统进行分类。在患者的下一次随访中评估问题的解决。
结果：共纳入156例患者，在66%的患者中发现了236例GC相关问题。药物不良事件(可能)占GC相关问题的比例最高(94.1%),最常见的原因是缺乏GC相关不良事件的实验室监测(41.5%),以及尽管存在适应症(39.8%),但仍缺乏药物治疗.患有GC相关问题的患者的中位累积泼尼松龙剂量较高（3115vs.5455毫克，p=0.007)。临床药师建议381项干预措施：47.7％（n=182）在“处方水平”，31.8%(n=121)在“患者水平”，和20.5%(n=78)在“药物水平”。在这些干预措施中，98%被接受，80.1%的问题得到解决。
结论：这项研究表明，风湿性疾病患者中GC相关问题的患病率较高。将临床药剂师整合到多学科风湿病学团队中，可以在早期阶段有效识别和管理GC相关问题。
