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                <title level="j">Revue du Rhumatisme</title>
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                  <biblScope unit="pp">16-25</biblScope>
                  <date type="datePub">2025-01</date>
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                <term xml:lang="en">Comorbidities</term>
                <term xml:lang="en">Education</term>
                <term xml:lang="en">Rheumatoid Arthritis</term>
                <term xml:lang="en">Spondyloarthritis</term>
                <term xml:lang="en">Chronic rheumatism</term>
                <term xml:lang="en">Holistic review</term>
                <term xml:lang="fr">Intervention multidisciplinaire</term>
                <term xml:lang="fr">Rhumatismes inflammatoires chroniques</term>
                <term xml:lang="fr">Polyarthrite rhumatoïde</term>
                <term xml:lang="fr">Spondyloarthrite</term>
                <term xml:lang="fr">Évaluation globale systématique</term>
                <term xml:lang="fr">Revue holistique</term>
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              <p>Introduction: National and international recommendations call for an annual standardized systematic holistic review in the management of chronic inflammatory rheumatism (CIR). This includes an assessment of disease activity and severity, as well as patient education on the disease, knowledge of pharmacological and non-pharmacological treatments, adherence to treatment and screening for comorbidities. Our study aims to recall the definition of a holistic review (HR), to present the evidence of their effectiveness and to give an overview of HR practices in France. Methods: A literature review was conducted in the Pubmed database to identify randomized controlled trials (RCTs) or meta-analyses reporting the efficacy of a multidisciplinary intervention in ICR or other chronic diseases. Two online surveys were sent to all rheumatology departments in France and to a sample of independent rheumatologists, with 34 and 19 questions respectively. These questionnaires were used to determine the profile of the responding center/rheumatologist, the existence of an HR and the obstacles or facilitators to its implementation. Results: Literature search yielded 872 articles, 24 of which were finally included: 16 RCTs and 8 meta-analyses. Only 3 articles concerned ICRs, including one meta-analysis of 10 RCTs in rheumatoid arthritis (RA). Of these 3 studies, 2 RCTs in systemic lupus and systemic sclerosis showed a favorable impact of a multidisciplinary approach on SLEDAI and grip strength and mouth opening respectively, while the meta-analysis in RA showed no benefit on disability or disease activity. The questionnaire was answered by 72 centers and 186 rheumatologists. A third of the centers had already implemented a HR during a day hospitalization. Seventy percent of centers estimated that they managed more than 10 patients per month, devoting an average of 35 minutes of rheumatologist time and 90 minutes of cumulative time for all other healthcare professionals (HCPs) involved in the program. Most of the HCPs involved were nurses (92%), dieticians (56%) and physiotherapists (56%). The main obstacles to setting up a HR were the lack of paramedical resources, lack of economic value and lack of support from treating rheumatologists, while patient motivation was seen as a facilitating factor. Conclusion: Although HR is recommended, there is little evidence of its effectiveness in ICR. Only 36% of responding centers have implemented such a program. This survey helps to identify the obstacles and facilitators, and to find solutions for extending this practice.</p>
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            <abstract xml:lang="fr">
              <p>Introduction &amp;gt; Les recommandations nationales et internationales proposent la réalisation d'une évaluation globale systématique standardisée (EGSS) annuelle dans la prise en charge desrhumatismes inflammatoires chroniques (RIC). Celle-ci comprend une évaluation de l'activité et la sévérité de la maladie, mais aussi l'éducation du patient sur la maladie, les connaissances destraitements pharmacologiques et non-pharmacologiques, l'adhésion aux traitements et le dépistage des comorbidités. L'objectif de cette mise au point est de rappeler la définition d'une EGSS, de présenter les preuves de leur efficacité et de faire un état des lieux des pratiques d'une EGSS en France à partir d'une enquête adressée à 72 services de rhumatologie et 186 rhumatologues libéraux. Méthodes &amp;gt; Une revue de la littérature a été menée dans la base de données Pubmed afind'identifier les essais contrôlés randomisés (ECR) ou les méta-analyses rapportant l'efficacité d'une intervention pluridisciplinaire dans les RIC ou dans d'autres maladies chroniques. Deux enquêtes en ligne ont été adressées à tous les services de rhumatologie en France et à un échantillon de rhumatologues libéraux comprenant respectivement 34 et 19 questions. Ces questionnaires permettaient de déterminer le profil du centre/rhumatologue répondeur, l'existence d'une EGSS et les freins ou les éléments facilitateurs à sa mise en place. Résultats &amp;gt; La recherche bibliographique a identifié 872 articles dont 24 ont finalement été inclus :16 ECR et 8 méta-analyses. Seuls 3 articles concernaient les RIC dont une méta-analyse combinant 10 ECR et 2 études d'extension dans la polyarthrite rhumatoïde (PR). Parmi ces 3 études, 2 ECR dans le lupus systémique et la sclérodermie systémique ont montré un impact favorable d'une approche multidisciplinaire respectivement sur le SLEDAI et la force de préhension et l'ouverture buccale tandis que la méta-analyse dans la PR n'a pas démontré de bénéfice sur l'amélioration du handicap ou sur l'activité de la maladie. Une réponse au questionnaire a été obtenue pour 72 centres et 186 rhumatologues. Un tiers des centres avaient déjà mis en place une EGSS au cours d'une HDJ. Soixante-dix pour cent des centres estimaient prendre en charge &amp;gt; 10 patients par mois en y consacrant en moyenne 35 minutes de temps-rhumatologue et 90 minutes de temps cumulé pour tous les autres professionnels de santé (PDS) participants au programme. Les PDS impliqués étaient majoritairement l'infirmier (92 %), le diététicien (56 %) et le kinésithérapeute (56 %). Les principaux freins à la mise en place d'une EGSS étaient l'absence de ressources paramédicales suffisantes, le manque de valorisation économique et l'absence d'adhésion des rhumatologues traitants tandis que la motivation des patients ressortait plutôt comme un élément facilitateur.Conclusion &amp;gt; Bien que la réalisation d'une EGSS soit recommandée par les sociétés savantes, les preuves de leur efficacité dans les RIC sont minces. De plus, seuls 36 % des centres répondeurs ont mis en place un tel programme. Cette enquête permet de soulever les freins et les éléments facilitateurs afin de trouver des solutions pour étendre cette pratique.</p>
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