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  • 1
    Online Resource
    Online Resource
    AB0506 GIANT CELL ARTERITIS: IS ROUTINE CLINICAL PRACTICE COMPREHENSIVE ENOUGH?
    BMJ ; 2020
    In:  Annals of the Rheumatic Diseases Vol. 79, No. Suppl 1 ( 2020-06), p. 1551.2-1551
    Details
    In: Annals of the Rheumatic Diseases, BMJ, Vol. 79, No. Suppl 1 ( 2020-06), p. 1551.2-1551
    Abstract: Recommendations to collect the most relevant information on disease course, treatment and outcomes in giant cell arteritis (GCA) has been proposed by EULAR to facilitate clinical research and to improve clinical care. Objectives: To assess the quality of data collection in routine clinical practice according to EULAR recommendations and to describe baseline and follow-up characteristics of a retrospective cohort of patients with GCA. Methods: We reviewed medical records of patients diagnosed with GCA in a tertiary academic center between 2004-2018. We included patients with available data at diagnosis and one year of follow-up. Data extraction included: demographics, diagnosis, GCA-related signs and symptoms, laboratory, imaging modalities, comorbidities and treatment. Data in the chart was then compared with the core set of parameters proposed for GCA registries and databases by EULAR. Major relapse, according to the EULAR 2018 definition, was independently assessed by two rheumatologists. Results: 58 patients were identified, 39 met predefined inclusion criteria with 151 visits during first-year follow-up. Headache (100%; 80.4%), ocular symptoms (89.7%; 81.2%), constitutional symptoms (89.7%; 80.4%), polymyalgia rheumatica (89.7%; 82%) and jaw claudication (87%; 81.2%) were the most frequently collected items at baseline and follow-up. Weight and height (2.6%; 2.6%), peripheral pulses (8%; 4.5%), smoking status (41%; 21%), and blood pressure (61.5%; 4.5%) were the less frequently collected. Most patients lacked differential pressure measurement. Myocardial infarction, malignancy, serious infections, arterial hypertension, diabetes and osteoporosis were collected in every patient (39, 100%). Only 2 mayor relapses were identified (5%). Two (2) patients died during the one-year follow-up period. Table 1 provides information on GCA-related signs and symptoms, laboratory and therapeutic data. Table 1. GCA-related signs and symptoms, laboratory and therapeutic data. Item Performed Baseline Baseline n=39 Performed Follow-up Follow-up n=112 Ocular symptoms 35/39 (89.7%) 15/35 (42.9%) 91/112 (81.2%) 29/91 (31.9%) Permanent ocular symptoms 34/39 (87%) 9/34 (26.5%) 92/112 (82%) 28/92 (30.4%) Headache 39 (100%) 30/39 (77%) 90/112 (80.4%) 13/90 (14.4%) Scalp tenderness 31/39 (79.5%) 9/31 (29.8%) 88/112 (78.6%) 4/88 (4.5%) Jaw claudication 34/39 (87%) 19/34 (55.85) 91/112 (81.2%) 6/91 (6.6%) Cranial artery abnormality 27/39 (69.2%) 17/27 (63%) 69/112 (61.6%) 3/69 (4.3%) Constitutional symptoms 35/39 (89.7%) 19/35 (54.3%) 90/112 (80.4%) 11/90 (12.2%) PMR 35/39 (89.7%) 18/35 (51.4%) 92/112 (82%) 9/92 (9.8%) ESR mean (SD ) 33/39 (84.6%) 58.7 (32.1) 83/112 (74%) 14.6 (18.8) CRP mean (SD ) 31/39 (79.5%) 8.4 (7.9) 70/112 (62.5%) 1.3 (3.3) Haemoglobin mean (SD ) 38/39 (97.4%) 12.0 (1.7) 90/112 (80.4%) 12.9 (1.5) Peripheral pulses 9/39 (8%) 3/9 (33.3%) 5/112 (4.5%) 2/5 (40%) Large vessel involvement 8/39 (20.5%) 5/8 (62.5%) 7/112 (6.25%) 3/7 (42.8%) Glucocorticoids median (IQR ) 39 (100%) 102.5 (50-250) 112 (100%) 10.0 (5-15) Synthetic DMARD 39 (100%) 8/39 (20.5%) 111/112 (99%) 17/39 (43.6%) Biological DMARD 39 (100%) 0/39 (0%) 111/112 (99%) 3/39 (7.7%) Antiplatelet agents 39 (100%) 6/39 (15.4%) 110/112 (98%) 25/110 (22.7%) PMR: polymyalgia rheumatica, ESR: erythrocyte sedimentation rate, CRP: C-reactive protein, SD: standard deviation, IQR: interquartile range, DMARD: disease modifying antirheumatic drugs Conclusion: Although data collection in routine care is usually comprehensive enough according to EULAR proposed data set, key components in physical exam mostly those aiming to detect large vessel involvement, should be addressed more carefully. References: [1]Ehlers L, et al. Ann Rheum Dis. 2019;78(9):1160–6. [2]Hellmich B, et al. Ann Rheum Dis. 2019;1–12. Disclosure of Interests: Julia Martínez-Barrio Consultant of: UCB Pharma, Belén Serrano Benavente: None declared, Tamara Del Río Blasco: None declared, Alfonso Ariza: None declared, Juan Ovalles: None declared, Juan Molina Collada: None declared, Teresa González: None declared, Carlos Gonzalez Consultant of: Gilead, Janssen, Novartis,, Speakers bureau: Abbvie, Celgene, Gilead, Janssen, Novartis, Pfizer, Roche, Isabel Castrejon: None declared, Jose Maria Alvaro Gracia: None declared
    Type of Medium: Online Resource
    ISSN: 0003-4967 , 1468-2060
    URL: Article
    DOI: 10.1136/annrheumdis-2020-eular.4852
    RVK:
    XA 10000
    Language: English
    Publisher: BMJ
    Publication Date: 2020
    detail.hit.zdb_id: 1481557-6
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  • 2
    Online Resource
    Online Resource
    FRI0652-HPR DEVELOPMENT OF THE ADVANCED PRACTICE NURSING CONSULT IN RHEUMATOLOGY IN THE MULTIDISCIPLINARY APPROACH OF INFLAMMATORY DISEASES MEDIATED BY IMMUNITY
    BMJ ; 2020
    In:  Annals of the Rheumatic Diseases Vol. 79, No. Suppl 1 ( 2020-06), p. 930.1-930
    Details
    In: Annals of the Rheumatic Diseases, BMJ, Vol. 79, No. Suppl 1 ( 2020-06), p. 930.1-930
    Abstract: Patients with immunity mediated inflammatory diseases (IMID) often have clinical manifestations and comorbidity in the field of various medical specialties. A center has been created in our hospital for the comprehensive care of patients with IMID. It is an innovative healthcare model, that incorporate patients into its governance. Physicians, pharmacists and advanced practice nurses (APN), collaborates in consultation or in the day hospital (DH). Objectives: To analyze the activity of the rheumatology APN consult integrated in the multidisciplinary team, and the impact on health care and quality of life on IMID patients. Methods: Descriptive study of the rheumatology APN activity since the opening of the center for a year. The APN consultations were face-to-face (scheduled or demanded) or by telephone. Variables measured: demography, diagnosis, treatments, clinic activity and patient reported outcomes (PRO). In the face-to-face consultation, was included: integral valuation (clinic, functional and psychosocial), education for Health (information about disease and treatments, adverse effects, healthy living habits), drug administration, emotional support. In the telephone consultation, the rheumatology APN is the reference professional for monitoring, question solving and advice in case of flare or adverse event. Results: 721 patients were evaluated, mean age 54.6 years, (range, SD) (20-90, 13.9), 61.3% women, with a total of 1737 consults. Diagnosis: 324 (44.9%) RA, 221 (30.6%) SpA, 100 (13.9%) PsA and 76 (10.5%) other diseases. Treatment modality: IV 293 (40.4) SC 399 (55.3%) and oral 29 (4.0%). Rheumatology APN activities are described in Table 1. 1415 face-to-face consultation were made, 82.7% scheduled and 17.2% demanded either by the patient, the rheumatologist or another member of the multidisciplinary work-team. Among the face-to-face consultations, 62 (4.4%) patients were attended the same day in the medic consult due to disease flare or other disease problems, 38 (2.7%) patients were sent to another specialist of the work-team due to co-morbidity. The activity executed in the rheumatology APN consultation is shown in Table 2 Table 1. Educative interventions by the APN. •Information about the disease •Information about the treatment •Medicine administration •Adverse effects of the medicine •Healthy life style habits •Vaccines •Evaluation of cardiovascular risk •Signs and symptoms of alerts due to the pathology •Ongoing following of the evolution of the disease. •Support for the achievement of the treatment and possible difficulties. Table 2. Activity done in the consult. N° 1.737 Face-to-face activity N° consults 1.415 Non face-to-face activity N° consults 322 Complete valuation due to necessities 721 (51%) Valuation 58 (18.0%) Educative Interventions 1.305 (92.2%) Questions 96 (29.8%) Valuation and following 1.372 (97.0%) Test result 26 (8.1%) PRO execution 1.156 (81.7%) Articular counting’s 733 (51.8%) Valuation of the diseases activity •DAS28 PCR •ASDAS-PCR 737 (52.1%) 419 (26.6%) Process of appointment •Requested by the doctor •Requested by the patient. 105 (32.61 50 (47.0%) 55(53.0%) Cardiovascular risk valuation. 721 (51.0%) Derivative to different medical consults 37 (11.5%) Blood extraction 724 (51.2%) Solved by APN 285(88.5%) Analytics monetarization 1.171 (82.8%) Medicine monetarization 1.372 (97.0%) Day Hospital Management Conclusion: The rheumatology APN takes a vital part in the multidisciplinary team, offering a holistic approach, as well as efficient and high-quality care, offering quick response, reducing waiting time and becoming an important part of this patient-centered model. Disclosure of Interests: None declared
    Type of Medium: Online Resource
    ISSN: 0003-4967 , 1468-2060
    URL: Article
    DOI: 10.1136/annrheumdis-2020-eular.3257
    RVK:
    XA 10000
    Language: English
    Publisher: BMJ
    Publication Date: 2020
    detail.hit.zdb_id: 1481557-6
    Location Call Number Limitation Availability
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    Online Resource
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