Considerations for improving quality of care of patients with rheumatoid arthritis and associated comorbidities.

Autor:	Kvien TK; Dept. of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway t.k.kvien@medisin.uio.no., Balsa A; Hospital Universitario La Paz, Madrid, Spain., Betteridge N; Neil Betteridge Associates, London, UK., Buch MH; Centre for Musculoskeletal Research, School of Biological Sciences, University of Manchester, Manchester, UK.; Leeds Institute of Rheumatic & Musculoskeletal Medicine, Chapel Allerton Hospital, Leeds, UK., Durez P; Cliniques Universitaires Saint Luc, UCL, Brussels, Belgium., Favalli EG; Rheumatology, Gaetano Pini Institute, Milan, Italy., Favier G; Leeds Institute of Rheumatic & Musculoskeletal Medicine, Chapel Allerton Hospital, Leeds, UK.; Global Strategy Group, KPMG LLP, London, UK., Gabay C; Department of Internal Medicine Specialties, University Hospitals of Geneva, Geneva, Switzerland., Geenen R; Utrecht University, Utrecht, Netherlands., Gouni-Berthold I; University of Cologne, Koln, Germany., van den Hoogen F; Radboud University Medical Center Nijmegen, Nijmegen, Netherlands.; Sint Maartenskliniek, Nijmegen, Netherlands., Kent A; Salisbury NHS Foundation Trust, Salisbury, UK., Klareskog L; Rheumatology, Karolinska Institutet, Stockholm, Sweden., Ostergaard M; Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, Kobenhavn, Denmark., Pavelka K; Rheumatologic Clinic, Institute of Rheumatology, Prague, Czech Republic., Polido Pereira J; Hospital De Santa Maria, Lisboa, Portugal., Semb AG; Dept. of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway., Sköld M; Respiratory Medicine Unit, Department of Medicine Solna and Center for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden.; Department of Respiratory Medicine and Allergy, Karolinska University Hospital Solna, Karolinska Institutet, Stockholm, Sweden., Dougados M; Hôpital Cochin, Rheumatology, Université Paris Descartes, Paris, France.
Jazyk:	angličtina
Zdroj:	RMD open [RMD Open] 2020 Jul; Vol. 6 (2).
DOI:	10.1136/rmdopen-2020-001211
Abstrakt:	Objective: Rheumatoid arthritis (RA) is a chronic autoimmune inflammatory disorder with a global prevalence of approximately 0.5-1%. Patients with RA are at an increased risk of developing comorbidities (eg, cardiovascular disease, pulmonary disease, diabetes and depression). Despite this, there are limited recommendations for the management and implementation of associated comorbidities. This study aimed to identify good practice interventions in the care of RA and associated comorbidities. Methods: A combination of primary research (180+ interviews with specialists across 12 European rheumatology centres) and secondary research (literature review of existing publications and guidelines/recommendations) were used to identify challenges in management and corresponding good practice interventions. Findings were prioritised and reviewed by a group of 18 rheumatology experts including rheumatologists, comorbidity experts, a patient representative and a highly specialised nurse. Results: Challenges throughout the patient pathway (including delays in diagnosis and referral, shortage of rheumatologists, limited awareness of primary care professionals) and 18 good practice interventions were identified in the study. The expert group segmented and prioritised interventions according to three distinct stages of the disease: (1) suspected RA, (2) recent diagnosis of RA and (3) established RA. Examples of good practice interventions included enabling self-management (self-monitoring and disease management support, for example, lifestyle adaptations); early arthritis clinic; rapid access to care (online referral, triage, ultrasound-guided diagnosis); dedicated comorbidity specialists; enhanced communication with primary care (hotline, education sessions); and integrating patient registries into daily clinical practice. Conclusion: Learning from implementation of good practice interventions in centres across Europe provides an opportunity to more widely improved care for patients with RA and associated comorbidities. Competing Interests: Competing interests: TKK has received fees for speaking and/or consulting from AbbVie, Biogen, Celltrion, Egis, Eli Lilly, Hikma, MSD, Mylan, Novartis, Oktal, Orion Pharma, Pfizer, Roche, Sandoz, Sanofi and UCB and received research funding to Diakonhjemmet Hospital from AbbVie, BMS, MSD, Pfizer, Roche and UCB. AB has received Grant/research support, fees for consultancies or as a speaker for Abbvie, Pfizer, Novartis, BMS, Nordic, Sanofi-Genzyme, Sandoz, Lilly, UCB and Roche. NB has received fees for speaking and/or consulting from Amgen, Eli Lilly, Grunenthal, GSK, Heart Vlavle Voice, Janssen, Roche, Sanofi Genzyme and Sanofi Regeron. MHB has received fees for speaking and/or consulting from AbbVie, AstraZeneca, Bristol-Myers-Squibb, Chugai, Eli Lilly, Merck-Serono, Pfizer, Roche, Sandoz and Sanofi, and research funding to University of Leeds from Pfizer, Roche and UCB. PD has received fees for speaking and/or consulting from Bristol-Myers-Squibb, Celltrion, Lilly and Sanofi Genzyme. EGF has received fees for speaking and/or consulting from AbbVie, BMS, Eli Lilly, Gilead, MSD, Novartis, Pfizer, Roche, Sanofi-Genzyme and UCB. CG has received fees for consulting from Roche, Sanofi Genzyme, Regeneron, Pfizer, Lilly and Ab2 Bio Ltd. RG has received fees for speaking from Sanofi Genzyme. IG-B has received fees for consulting from Amgen, Akcea, Sanofi Genzyme and Regeneron. FvdH has received fees for consulting from AbbVie, Biogen, Celltron, Roche, Sanofi Genzyme, Pfizer and Munidpharma. AK has received fees for speaking and/or consulting from UCB, Bristol-Myers-Squibb, MSD, Amgen, Abbvie, Pfizer, Novartis and Sanofi. LK has received research grants to Karolinska Institutet from Janssen, Pfizer, BMS, GSK and UCB. MØ has received fees for speaking and/or consulting from Abbvie, Bristol-Myers-Squibb, Boehringer-Ingelheim, Celgene, Eli-Lilly, Hospira, Janssen, Merk, Novartis, Novo, Orion, Pfizer, Regeneron, Roche, Sanofi and UCB. KP has received fees for speaking and/or consulting for AbbVie, Amgen, Biogen, Bristol-Myers-Squibb, Egis, MSD and UCB. JP-P has received fees for speaking and/or consulting from AbbVie, MSD, Pfizer, Roche and Tecnimede. AGS has received fees for speaking and/or consulting from AbbVie, Novartis, Sanofi and Bayer and have an unrestricted research collaboration with Eli Lilly which includes transfer of funds to Diakonhjemmet Hospital from Eli Lilly. MS has received research grants from Boehringer Ingelheim and Roche, speakers fee/consultancy from AstraZeneca, Boehringer Ingelheim, GlaxoSmithKline, Novartis, Mundipharma, Sandoz and Roche. MD has received fees for speaking and/or consulting from AbbVie, Biogen, Eli Lilly, BMS, MSD, Novartis, Pfizer, Roche, Sandoz, Sanofi and UCB and his department has received research grants from AbbVie, BMS, MSD, Pfizer, Roche, Lilly, Janssen, Novartis and UCB. (© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)
Databáze:	MEDLINE
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