背景:远程医疗在风湿性疾病患者中的应用迅速增长,特别是在2019年冠状病毒病大流行之后。轻松和便利似乎是这种增长的主要原因。然而,这种方法对系统性红斑狼疮(SLE)患者的疗效尚待揭示.在这项研究中,我们研究了远程医疗对SLE患者疾病活动性评估和损伤评分的影响.
方法:本病例交叉研究是在沙特阿拉伯的SLE患者的国家前瞻性队列中进行的。如果SLE患者在2020年3月至2021年3月之间符合系统性狼疮国际合作诊所分类标准,并在三个时间点进行评估,两次评估之间间隔3个月,根据该队列的标准化方案。远程医疗进行了第一次评估,在第二次和第三次访问中使用了亲自评估。主要结果是SLE疾病活动指数2000(SLEDAI-2K)评分的差异。主要分析使用重复测量模型进行,并针对潜在的混杂因素进行调整,包括人口统计,药物,和类固醇剂量的变化。进行了几项敏感性分析,以减轻选择和时变混杂因素。
结果:共有92名参与者被纳入本研究。大多数患者是女性(88%)。平均(±标准差[SD])年龄为36(±13)岁。基线时的平均(±SD)疾病活动评分如下:SLEDAI-2K,5(±5);SLE响应者指数,3.8(±3.5);系统性狼疮国际合作诊所/美国风湿病学会损伤指数,1(±1)。远程医疗和随访之间SLEDAI-2K评分的平均差异为-1.641(95%置信区间-2.773至-0.510,p=0.005*)。所有敏感性分析结果一致。
结论:我们发现远程医疗评估的疾病活动性评分比后续评估高得多,这可能表明对疾病活动的高估和后来评估的准确性。对于患有活动性疾病的SLE患者,建议谨慎采用。
BACKGROUND: The utilisation of telemedicine has been rapidly growing among patients with rheumatic diseases, especially following the corona virus disease 2019 pandemic. Ease and convenience appear to dominate the reasons for this growth. However, the effects of this approach in patients with systemic lupus erythematosus (SLE) are yet to be revealed. In this study, we examined the effect of telemedicine on disease activity assessment and damage scores in patients with SLE.
METHODS: This
case-crossover study was nested within a national prospective cohort of patients with SLE in Saudi Arabia. Patients with SLE were included if they fulfilled the Systemic Lupus International Collaborating Clinics classification criteria between March 2020 and March 2021 and were assessed at three time points with 3 months between assessments, according to the standardised protocol of this cohort. Telemedicine was conducted for the first evaluation, while in-person assessments were used at the second and third visits. The primary outcome was the difference in the SLE disease activity index 2000 (SLEDAI-2K) score. The primary analysis was conducted using the repeated measure model and adjusted for potential confounders, including demographics, medications, and changes in steroid doses. Several sensitivity analyses were conducted to mitigate selection and time-varying confounders.
RESULTS: A total of 92 participants were included in this study. Most patients were females (88%), with a mean (±standard deviation [SD]) age of 36 (±13) years. The mean (±SD) disease activity scores at baseline were as follows: SLEDAI-2K, 5 (±5); SLE responder index, 3.8 (±3.5); Systemic Lupus International Collaborating Clinics/American College of Rheumatology damage index, 1 (±1). The mean difference in SLEDAI-2K score was -1.641 (95% confidence interval -2.773 to -0.510, p = 0.005*) between telemedicine and follow-up visits. The results were consistent in all sensitivity analyses.
CONCLUSIONS: We found that telemedicine assessment was associated with a much higher disease activity score than subsequent assessments, which may suggest an overestimation of disease activity and later assessment accuracy. Cautious adoption has been suggested for SLE patients with active disease.