Diagnosis challenges in inception cohorts in axial spondyloarthritis: the case of the French national DESIR cohort.

IF 5.1 2区 医学 Q1 RHEUMATOLOGY
Anna Molto, Chris Serrand, Sandrine Alonso, Francis Berenbaum, Pascal Claudepierre, Bernard Combe, Laure Gossec, Adeline Ruyssen-Witrand, Alain Saraux, Daniel Wendling, Thierry Lequerre, Maxime Dougados
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引用次数: 0

Abstract

Background: Inception cohorts aim to describe chronic diseases from diagnosis and over years of follow-up. Axial spondyloarthritis (axSpA) diagnosis might be challenging during the first years of the disease. Thus, identifying the features that will be associated with a confirmed diagnosis over time is key.

Objectives: To assess the frequency and the predisposing factors for a change of an initial diagnosis in an inception axSpA cohort.

Methods: DESIR is an ongoing national multicentre inception axSpA cohort with currently 12.5 years of follow-up. At the entry visit and confirmed at each visit, the diagnosis of axSpA was based on the opinion of the treating rheumatologist. Follow-up was interrupted in case of a change in this initial diagnosis. Multiple imputation was used to estimate the probability of a change in the initial diagnosis of axSpA for each patient lost to follow-up. Factors predisposing to an unchanged diagnosis of axSpA were then assessed using a multivariate logistic regression model on the imputed data sets.

Results: Of the 708 patients included, over 10 years of follow-up, 45 (6.4%) were excluded due to a diagnosis change and 300 (42.4%) patients were lost to follow-up. Based on the imputation of these 300 patients, a change in their initial axSpA diagnosis was estimated in 42 (14.0%). Factors predisposing to an unchanged initial axSpA diagnosis during follow-up were (ORs (95% CIs)): radiographic sacroiliitis: 17.0 (4.1 to 71.0); psoriasis: 5.3 (2.0 to 14.3); CRP≥6 mg/L: 2.7 (1.3 to 5.3); good NSAID response: 2.5 (1.5 to 4.2); HLA B27+: 2.0 (1.3 to 3.3); anterior chest wall pain: 2.0 (1.2 to 3.3) and female sex: 1.9 (1.2 to 3.0).

Conclusion: These data suggest that a change in diagnosis in recent onset axSpA exists, but is not frequent, and is less likely to occur in the presence of objective features at baseline.

轴性脊柱关节炎初始队列中的诊断难题:法国国家 DESIR 队列的案例。
背景:初始队列旨在描述慢性疾病从诊断到多年随访的过程。轴性脊柱关节炎(axSpA)的诊断在发病最初几年可能具有挑战性。因此,确定与确诊相关的特征至关重要:方法:DESIR是一项正在进行中的全国性多中心研究:DESIR是一个正在进行的全国性多中心axSpA初诊队列,目前已随访12.5年。在入组时,axSpA 的诊断以主治风湿病学家的意见为基础,并在每次随访时进行确认。如果初始诊断发生变化,则中断随访。采用多重估算法估算每一位失去随访机会的患者的 axSpA 初始诊断发生变化的概率。然后,使用多变量逻辑回归模型对归因数据集进行评估,以确定导致 axSpA 诊断不变的因素:在随访 10 年的 708 例患者中,有 45 例(6.4%)因诊断变更而被排除,300 例(42.4%)患者失去了随访机会。根据对这 300 名患者的估算,估计有 42 名患者(14.0%)的最初 axSpA 诊断发生了改变。导致随访期间最初 axSpA 诊断不变的因素有(ORs (95% CIs)):放射性骶髂关节炎:17.0(4.1 至 71.0);银屑病:5.3(2.0 至 95% CIs):5.3(2.0 至 14.3);CRP≥6 mg/L:2.7(1.3 至 5.3);非甾体抗炎药反应良好:2.5(1.5 至 4.2);HLA B27+:2.0(1.3 至 3.3);前胸壁疼痛:2.0(1.2 至 3.3);女性:1.9(1.2 至 3.0):这些数据表明,新近发病的 axSpA 存在诊断改变,但并不常见,而且在基线存在客观特征的情况下发生诊断改变的可能性较小。
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来源期刊
RMD Open
RMD Open RHEUMATOLOGY-
CiteScore
7.30
自引率
6.50%
发文量
205
审稿时长
14 weeks
期刊介绍: RMD Open publishes high quality peer-reviewed original research covering the full spectrum of musculoskeletal disorders, rheumatism and connective tissue diseases, including osteoporosis, spine and rehabilitation. Clinical and epidemiological research, basic and translational medicine, interesting clinical cases, and smaller studies that add to the literature are all considered.
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