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Planning health care for patients with Graves’ orbitopathy

By I.V. Sasim, T.T.J.M. Berendschot, C. van Isterdael and M.P. Mourits


Background: To describe disease parameters of patients with\ud Graves’ orbitopathy in a tertiary referral center in order to\ud plan health care resource allocations. To investigate whether\ud the clinical activity and/or the severity of the disease can be\ud used as a predictor of the duration of treatment.\ud Methods: Retrospective, observational, non-comparative case\ud series. One hundred and seventeen charts of GO-patients,\ud randomly chosen out of a pool of 1600, referred to the\ud Orbital Unit of the University Medical Centre Utrecht\ud between 1 January 1992 and 1 January 2002, were analysed.\ud Relevant parameters, such as age, gender, race, disease\ud duration, smoking habits, concomitant diseases, previous\ud treatment, symptoms and signs, number and sort of investigations,\ud severity and activity scores, number and sort of\ud treatments, treatment duration and outcome of treatment\ud were retrieved and analysed. Disease activity and severity at\ud entry were tested as possible predictors of disease duration\ud and extent of treatment.\ud Results: Clinical profile at presentation; duration of the\ud disease; extent of treatment; predictors of disease duration\ud and of number of treatment interventions were the main\ud outcome measures. Three percent of patients had Only Signs,\ud but No Symptoms (OSNS), 61% had mild, 27% had\ud moderately severe and 9% had severe GO. Fifteen percent\ud had inactive disease at presentation, 65% had borderline\ud activity and only 20% had active orbitopathy. Sixty percent\ud complained about eyelid swelling and/or proptosis. The\ud average period of eye treatment was 2.5 years (range: 0–\ud 110 months), during which patients were seen at an average\ud of 8 times. Twenty percent needed no treatment at all. Fifteen\ud percent were treated with nothing but lubricants and/or\ud prisms. Twenty-five percent were treated with immunosuppressive\ud modalities. Fifty-six percent underwent one or more\ud surgical corrections. The Clinical Activity Score (CAS) was\ud found to be significantly related to the duration of the\ud treatment (p<0.001), to the number of visits (p<0.001), and\ud to the number of surgical interventions (p<0.001).\ud Conclusions: The majority of GO patients referred to a\ud tertiary referral centre has no or borderline disease activity\ud and ‘mild’ orbitopathy, disfiguring eyelids and proptosis\ud being the most frequent complaints. The disease activity as\ud assessed with the CAS can be used to predict the duration\ud and extent of the treatment

Topics: Geneeskunde, Graves’ orbitopathy, Tertiary referral center, Health care, Clinical activity, Severity, Predictor
Year: 2008
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