目的：（1）探討延誤患者從出現(xiàn)癥狀到第一次看風濕科醫(yī)生的人口和臨床特點；（2）比較病程早期看風濕科醫(yī)生患者與晚些確診患者的臨床、影像學及報告結果。

方法：所有銀屑病關節(jié)炎（PsA）患者，符合CASPAR標準、平均病程＞10年的被邀請進行詳細的臨床評價。總延遲時間是從出現(xiàn)癥狀到首次到風濕科就診，研究數(shù)據(jù)從推薦信和醫(yī)療記錄中提取。將患者分為早期咨詢者或晚期咨詢者主要取決于他們是否在出現(xiàn)癥狀6個月內(nèi)或超過6個月去看風濕科醫(yī)生。

結果：283例銀屑病關節(jié)炎患者被納入研究。隊列中從發(fā)病到第一次行風濕科評估平均滯后時間為1年（0.5~2）。30 %（n=86），53 %（n=149）和71%（n=202）的患者從出現(xiàn)癥狀到第一次看風濕科醫(yī)生的時間分別為6個月、1和2年。低教育現(xiàn)狀 (OR 2.09, p=0.02)和身體質量指數(shù)(OR 0.92,p=0.01)更有可能使銀屑病關節(jié)炎患者診斷延誤＞2年。多元逐步回歸分析，該模型對于預測晚期咨詢者外周關節(jié)侵蝕的發(fā)展(OR 4.25,p=0.001)和糟糕的健康問卷調查得分 (OR 2.2,p=0.004)有重大意義。

結論：即使從出現(xiàn)癥狀到第一次去看風濕科醫(yī)生延遲6個月也可導致外周關節(jié)侵蝕的發(fā)展及長期身體機能的惡化。

文獻來源：

Haroon M,et al. Ann Rheum Dis 2015;74:1045–1050. doi:10.1136/annrheumdis-2013-204858

Objectives (1) To investigate the demographic and clinical characteristics contributing to the delay fromsymptom onset to the first visit to a rheumatologist; (2) to compare clinical, radiographic and patient-reported outcome measures of those who saw a rheumatologist early in theirdisease course with those who were diagnosed later.

Methods All psoriatic arthritis (PsA) patients, fulfillingCASPAR criteria, with an average disease duration of>10 years were invited for detailed clinical evaluation. Thetotal lag time from symptom onset to their firstrheumatological encounter was studied. The data wereextracted from the referral letters and medical records.Patients were classified as early consulters or late consulter sdepending on whether they were seen by a rheumatologistwithin or beyond 6 months of symptom onset.

Results 283 PsA patients were studied. Median lag timefrom the disease onset to the first rheumatological assessment of the cohort was 1.00 years (IQR 0.5–2). 30%(n=86), 53% (n=149) and 71% (n=202) of the cohortwere seen by a rheumatologist within 6 months, 1 and2 years of symptom onset, respectively. PsA patients withlow education status (OR 2.09, p=0.02) and Body MassIndex (OR 0.92, p=0.01) were significantly more likely tohave a diagnostic delay of >2 years. On multiple stepwise regression analysis, the model predicted significant association of late consulters with the development ofperipheral joint erosions (OR 4.25, p=0.001) and worseHealth Assessment Questionnaire scores (OR 2.2, p=0.004).

Conclusions Even a 6-month delay from symptom onsetto the first visit with a rheumatologist contributes to thedevelopment of peripheral joint erosions and worse longtermphysical function.

翻譯：西臨床免疫科 牛敏