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Patients with SSc may benefit from 2-day care pathway
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About 85% of patients with systemic sclerosis who enrolled in a standardized, comprehensive, 2-day care pathway including visits with a rheumatologist, cardiologist, pulmonologist, occupational therapist, nurse and social worker, had a treatment intervention identified, according to recently published data.
Researchers studied 226 patients with systemic sclerosis (SSc) over 44 months who attended the Leiden University Medical Center between April 2009 and December 2012. Patients were evaluated with high-resolution CT (HRCT) of the thorax, given pulmonary function tests including analyses of vital capacity (VC) and diffusing capacity for carbon monoxide (DLCO), cardiopulmonary exercise test, including analyses of maximum heart rate, maximum wattage, maximum oxygen consumption
(VO2) and maximum ventilation), echocardiography, ECG and 24-hour heart rhythm (Holter)
registration. A diagnosis of interstitial lung disease (ILD) was determined based on the presence of a non-specific interstitial pneumonia pattern, or usual interstitial pneumonia pattern on HRCT thorax as reported by the radiologist. The systolic pulmonary artery pressure (SPAP) was estimated using echocardiography by a cardiologist, and elevated pulmonary pressure was defined using a threshold of 35-mm Hg. Other patient evaluations included questionnaires, nailfold videocapillaroscopy and other evaluations.
A maximum of two patients weekly were evaluated at the initiation of the care pathway, which was eventually increased to four patients weekly in 2012. Two weeks following the care pathway evaluation, characteristics for each particular patient were thoroughly evaluated by a multidisciplinary conference team attended by at least two rheumatologists, one pulmonologist and one specialized nurse with knowledge of data collected by the occupational therapist, the physical therapist and the social worker involved with each patient.
One or more medical interventions, defined as the need for additional diagnostic follow-up, and/or referral to medical specialists, and/or referral to other health care professionals and/or initiation of immunosuppressive treatment and change of supportive medications were initiated in 191 (85%) of patients following utilization of the care pathway.
Statistical analyses showed patients with medical interventions tended to have a higher erythrocyte sedimentation rate and were more likely to have telangiectasias than patients who did not require any medical intervention.
“In general, adherence to the care pathway was very high, and resulted in medical interventions
in the majority of patients, independent of SSc subtype and disease duration” the researchers wrote. “Future evaluations are needed to evaluate impact on disease outcome.”
Disclosure: The researchers report support from an unrestricted educational grant by Actelion Pharmaceuticals Nederland BV.
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