背景:滑膜炎,血友病的一个共同特征,是由关节中的血液触发的,代表了慢性关节病发展的第一步。滑膜炎可以通过超声或磁共振成像扫描早期检测;在这种情况下,临床关节评分不太敏感。定期使用凝血因子浓缩物进行长期预防,作为初级预防,并根据个人需求量身定制,在预防滑膜炎方面有很高的疗效。总的来说,较高的因子水平降低出血风险,但是因子水平与滑膜炎发生率之间没有直接相关性。
目的:本研究旨在就该定义达成专家共识,病理生理学,诊断,预防,滑膜炎的随访和治疗,认识到其与关节健康的相关性,并考虑到现有的知识差距。
方法:设计并进行了Delphi共识研究。一个专家组根据现有文献编写了22份声明;一个更广泛的专家小组随后对这些进行了投票。
结果:小组成员的保留率很高。经过三轮表决,需要对四项声明进行修正,并就所有声明达成共识。
结论:这项e-Delphi共识研究探讨了滑膜炎在血友病患者关节健康中的重要性,并强调了该领域的知识差距。缺乏对滑膜炎自然过程的研究,并且该过程的生物学机制尚未完全阐明。虽然基础和临床研究在这一领域进行,专家共识可以帮助指导临床医生的常规临床实践,德尔菲方法通常用于产生最佳实践指南。
BACKGROUND: Synovitis, a common feature in haemophilia, is triggered by the presence of blood in joints, and represents the first step towards the development of chronic arthropathy. Synovitis may be detected early by means of ultrasound or magnetic resonance imaging scan; clinical joint scores are less sensitive in this setting. Regular long-term prophylaxis with clotting factor concentrates, as primary prophylaxis and tailored to individual needs, has high efficacy in preventing synovitis. In general, higher factor levels lower bleeding risk, but no direct correlation between factor levels and synovitis incidence has been demonstrated.
OBJECTIVE: This study aimed to develop an expert consensus relating to the definition, pathophysiology, diagnosis, prevention, follow-up and treatment of synovitis, recognising its relevance for joint health and taking into account existing knowledge gaps.
METHODS: A Delphi
consensus study was designed and performed. An expert group prepared 22 statements based on existing literature; a wider expert panel subsequently voted on these.
RESULTS: Retention of panellists was high. Four statements required amending and
consensus on all statements was achieved after three rounds of voting.
CONCLUSIONS: This e-Delphi
consensus study addressed the importance of synovitis in joint health of people with haemophilia and highlighted knowledge gaps in this field. Studies on the natural course of synovitis are lacking and the biological mechanisms underlying this process are not yet fully elucidated. While basic and clinical research proceeds in this field, expert
consensus can help guide clinicians in their routine clinical practice, and Delphi methodology is often used to produce best-practice
guidelines.