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首页> 外文期刊>Internal medicine journal >Scleroderma lung disease, variation in screening, diagnosis and treatment practices between rheumatologists and respiratory physicians.
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Scleroderma lung disease, variation in screening, diagnosis and treatment practices between rheumatologists and respiratory physicians.

机译：硬皮病肺病，风湿病学家和呼吸内科医师之间筛查，诊断和治疗方法的差异。

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BACKGROUND: Interstitial lung disease (ILD) and pulmonary arterial hypertension (PAH) represent the leading causes of death in systemic sclerosis (SSc). Screening for these complications has assumed greater importance, but is not universal. The aim of this study is to determine the self-reported screening, diagnosis and treatment practices of rheumatologists and respiratory physicians for SSc-related lung disease. METHODS: Email survey of 270 rheumatologists and 600 respiratory physicians. RESULTS: Responses were received from 42 (16%) rheumatologists and 68 (11%) respiratory physicians. Of SSc patients seen by rheumatologists, 17% had ILD and 7.5% had a diagnosis of PAH compared with 31% and 21% for respiratory physicians. Forty per cent of all physicians screened asymptomatic SSc patients without a known diagnosis of ILD or PAH less than annually or not at all. The most commonly used screening investigations were pulmonary function tests (PFT) (95%) and transthoracic echocardiogram (TTE) (78%). In suspected ILD, both groups used high-resolution computed tomography scans and PFT in >90% of patients. In suspected PAH, both used TTE and PFT (>90%); right heart catheterisation was used by only 50% of physicians. In treatment of ILD, rheumatologists used intravenous (IV) cyclophosphamide more often (CYC) (59% vs 28%, P= 0.003) and more respiratory physicians used oral CYC (44% vs 28%, P= 0.012). In PAH, more respiratory physicians used warfarin (68% vs 40%, P= 0.006). Only approximately 65% of physicians had used specific PAH therapy, which may reflect lack of access to a designated PAH treatment centre. CONCLUSION: The heterogeneity of responses revealed in this study raises the importance of screening, diagnosis and treatment algorithms in the management of this potentially life-threatening disease.
机译：背景：间质性肺疾病（ILD）和肺动脉高压（PAH）代表系统性硬化症（SSc）的主要死亡原因。筛查这些并发症的重要性更高，但并不普遍。这项研究的目的是确定风湿病学家和呼吸科医师针对SSc相关性肺部疾病的自我报告的筛查，诊断和治疗方法。方法：对270位风湿病学家和600位呼吸内科医生的电子邮件调查。结果：收到来自42位（16％）风湿病学家和68位（11％）呼吸内科医师的回应。由风湿病医师看过的SSc患者中，有ILD的占17％，诊断为PAH的占7.5％，而呼吸内科医师为31％和21％。所有医生中有40％筛查了无症状的SSc患者，而这些患者没有已知的ILD或PAH诊断少于每年一次或根本没有。最常用的筛查方法是肺功能检查（PFT）（95％）和经胸超声心动图（TTE）（78％）。在怀疑的ILD中，两组均在90％以上的患者中使用了高分辨率计算机断层扫描和PFT。在怀疑的PAH中，均使用了TTE和PFT（> 90％）;仅有50％的医生使用了右心导管检查。在ILD的治疗中，风湿病学家更频繁地使用静脉内（IV）环磷酰胺（CYC）（59％vs 28％，P = 0.003），更多的呼吸内科医师使用口服CYC（44％vs 28％，P = 0.012）。在PAH中，更多的呼吸内科医师使用了华法林（68％vs 40％，P = 0.006）。只有大约65％的医生使用了特定的PAH治疗，这可能反映出缺乏进入指定PAH治疗中心的机会。结论：本研究揭示的反应的异质性提高了筛查，诊断和治疗算法在治疗这种可能威胁生命的疾病方面的重要性。

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