53 research outputs found
Aspects of health services research for inflammatory rheumatic diseases in Germany
No full textDiese Habilitationsschrift beleuchtet verschiedene Aspekte der Versorgung entzündlich-rheumatischer Erkrankungen in Deutschland
The impact of biologic and conventional therapy on physical function in rheumatoid arthritis and ankylosing spondylitis
No full textZielstellung: Der Erhalt der Funktionsfähigkeit spielt für Patienten mit
entzündlich-rheumatischen Erkrankungen eine große Rolle. Ziel der ersten
beiden Arbeiten war es deshalb, eine vergleichende Bewertung der Wirkung
neuerer gentechnisch hergestellter Medikamente, sog. Biologika, auf die
Funktionsfähigkeit von Patienten mit rheumatoider Arthritis (RA) oder
ankylosierender Spondylitis (AS)/axialer Spondyloarthritis (axSpA)
vorzunehmen. Mit der dritten Arbeit wurde die Wirksamkeit einer Therapie mit
oralem Prednisolon bei AS untersucht. Methoden: Zur Untersuchung der Wirkung
von Biologika bzw. TNFα-Blockern bei RA bzw. axSpA wurden zwei Metaanalysen
durchgeführt. Diese fassen jeweils die Ergebnisse von randomisierten
kontrollierten Studien (RCTs) mit einer Mindestdauer von 12 Wochen zusammen,
deren Patienten mit einem Biologikum bzw. einem TNFα-Blocker in einer
zugelassenen Dosierung behandelt wurden. Zur Untersuchung der Wirksamkeit von
oralem Prednisolon bei AS-Patienten wurde ein RCT mit einer Studiendauer von
zwei Wochen durchgeführt, bei dem ein Teil der Patienten mit 50mg Prednisolon
täglich, ein Teil mit 20mg und ein Teil mit Plazebo behandelt wurde.
Ergebnisse: Für Patienten mit RA konnte gezeigt werden, dass mehr als 50% der
Patienten eine klinisch relevante Verbesserung der Funktion durch Biologika
erfahren. Dabei gab es keine signifikanten Unterschiede in der Wirksamkeit
einzelner Biologika. Bei Patienten, die bisher noch kein synthetisches
disease-modifying anti-rheumatic drug (sDMARD) erhalten hatten, war die
Überlegenheit der Biologika gegenüber einer Behandlung mit sDMARDs kleiner als
bei Patienten mit ungenügendem Ansprechen auf sDMARDs (meist Methotrexat
(MTX)). Patienten mit nicht radiographischer axSpA (nr-axSpA) und AS
profitieren gleichermaßen von der Behandlung mit TNFα-Blockern, die mittlere
Verbesserung im Bath AS Functional Index (BASFI) lag bei 1,3 bzw. 1,4.
Erstmals konnte auch in einer randomisierten Studie gezeigt werden, dass
Patienten mit AS von einer Therapie mit 50mg Prednisolon profitieren: In
dieser Studie war allerdings die Fallzahl mit insgesamt 36 Patienten sehr
klein. Schlussfolgerung: In Hinblick auf die Verbesserung der
Funktionskapazität stellen TNFα-Blocker bei RA und SpA, sowie bei RA auch
andere Biologika, wirksame Therapieoptionen dar, die bei vielen Patienten
klinisch relevante Verbesserungen der Funktion bewirken. Es gibt außerdem
Hinweise auf einen Nutzen einer initialen Therapie der AS mit hochdosiertem
oralen Prednisolon.Objective: For patients with inflammatory rheumatic diseases, preservation of
functional capacity is an important issue. This work investigates the effect
on physical function of biologics in rheumatoid arthritis (RA) patients, the
effect of TNFα inhibitors on patients with axial spondyloarthritis (axSpA) and
that of oral prednisolone in ankylosing spondylitis (AS). Methods: Two meta-
analyses were conducted to assess the efficacy of biologics resp. TNFα
inhibitors in RA and axSpA. These combine the results of randomised controlled
trials (RCTs) with a duration of at least 12 weeks, with biologic treatment in
an approved dosage. To investigate the efficacy of oral prednisolone in AS an
RCT with two weeks study duration was conducted, in which one part of the
patients was treated with 50mg oral prednisolone daily, one with 20mg and one
with placebo. Results: For patients with RA it could be shown that more than
50% of the patients have a clinically relevant improvement of their function
with biologics. There were no significant differences in the efficacy of
single biologics. In patients who had not been treated with a synthetic
disease-modifying anti-rheumatic drug (sDMARD) before, the efficacy of
biologics in comparison to sDMARDs was smaller than in those patients who had
shown inadequate response to sDMARDs before. Patients with non radiographic
axSpA (nr-axSpA) and AS equally profit from treatment with TNF inhibitors, the
mean change of the Bath AS Functional Index (BASFI) was 1.3 in nr-axSpA and
1.4 in AS patients. For the first time it could be shown in a randomised
trial, that AS patients profit from a therapy with 50mg oral prednisolone, but
this trial included only 36 patients in total. Conclusion: Considering the
improvement of funtional capacity, in SpA and RA TNF inhibitors, and in RA
also other biologics, are an efficacious treatment option. These medications
lead to a clinically relevant impovement of function in many patients. There
is evidence for a benefit of an initial therapy with highly dosed oral
prednisolone in AS
Interstitial lung disease in rheumatoid arthritis: incidence, prevalence and related drug prescriptions between 2007 and 2020
No full textOBJECTIVE: To investigate prevalence, incidence and medication of interstitial lung disease (ILD) among German individuals with rheumatoid arthritis (RA). METHODS: Nationwide BARMER claims data from 2007 to 2020 were used. RA-ILD was identified by diagnosis codes, prescription of disease-modifying antirheumatic drugs (DMARDs) and lung diagnostics. ILD was assigned as incident or prevalent relative to the year of the first diagnosis. We identified prescriptions of glucocorticoids, conventional synthetic (cs), biological (b) and targeted synthetic (ts)DMARDs, antifibrotics and rheumatology and/or pulmonology care. RESULTS: Among all persons with RA (40 686 in 2007 to 85 175 in 2020), 1.7%–2.2%/year had ILD with a slight decline since 2013. Incident ILD was 0.13%–0.21% per year and remained stable over time. ILD was more common in seropositive RA, in men and in the elderly (mean age 72 years in 2020). Glucocorticoids (84% to 68%), csDMARD (83% to 55%) and non-steroidal anti-inflammatory drug use (62% to 38%) declined, while bDMARDs (16% to 24%) rose. In 2020, 7% received tsDMARDs, 3% antifibrotics, 44% analgesics and 30% opioids. DMARD therapy was more common if a rheumatologist was involved and antifibrotics if a pulmonologist was involved. Opioid use was highest if no specialist was involved (39%) but also common in rheumatology care (32%) and less frequent in pulmonology care (21%). CONCLUSIONS: RA-ILD is rare and mainly affects elderly persons. No trend in incidence was observed but treatment strategies have enlarged. Specialist care is necessary to provide disease-specific therapies. The continuing high analgesic and opioid demand shows unmet needs in these patients
Depression is a stronger predictor of the risk to consider work disability in early arthritis than disease activity or response to therapy
No full textObjectives: To evaluate the factors that influence patients with early inflammatory arthritis to consider a disability pension.
Methods: A total of 528 patients aged 63 or younger from an early arthritis cohort with a mean symptom duration of 3 months at inclusion were asked at 12 and 24 months whether they were considering applying for, had applied for or were receiving a disability pension because of arthritis. Possible predictors were analysed with univariate and multivariate logistic regression.
Results: 69 patients (13%) were considering, had applied for or were receiving a disability pension. Univariate predictors were older age, disease activity, several patient-reported outcomes and depression. In a multivariate analysis, age, days on sick leave, impairment of physical function and depression were predictive for considering a disability pension (OR for severe vs no depression: 3.85, 95% CI 1.43 to 10.4).
Conclusions: In patients with early arthritis, depression appears to be a stronger predictor of the risk to consider applying for work disability pension than the features of disease activity. Patients at risk could be identified with one single depression statement. This finding should prompt physicians to react early to signs and symptoms of depression to help patients to maintain their ability to work
A patient-reported questionnaire developed in a German early arthritis cohort to assess periodontitis in patients with rheumatoid arthritis
No full textBackground: The aim of this study was to develop a patient-reported questionnaire that is suitable to detect periodontitis (PD) in patients with rheumatoid arthritis (RA).Methods: A self-reported questionnaire containing 12 items potentially relevant to PD and dentists’ semiquantitative assessment of PD (no/mild/moderate/severe) was obtained from 353 patients from an early arthritis cohort. Available radiographs (n = 253) and blinded assessment of 3 independent dentists were used for validation. By defining the dentists’ assessment as the reference standard, relevant questionnaire items were identified with factor analysis methods. Receiver operator characteristic (ROC) plots were used to determine sensitivities and specificities to detect PD in varying severity. Ordinal regression models were used to determine the coefficients for the final score.Results: Seventy percent had at least mild PD. The items from the questionnaire correlating best with the dentists’ assessment were selected for a final 6-item score (number of teeth, gum pockets, receding gums, loose teeth, receding jaw bone and tooth extractions and age). For the detection of any/moderate/severe PD, the bias-corrected areas under the curve (AUC) were 0.81/0.83/0.90. Sensitivity to detect mild PD was 85% and specificity 57%. Very high specificity was achieved for the detection of severe PD with 99% at the cost of low sensitivity (28%).Conclusions: This patient-reported six-item score has moderate diagnostic properties to study PD in RA patients in epidemiological settings. We propose to use the score as a measure of periodontitis without applying cut-off values.<br/
Daten aus der Kerndokumentation
No full textDargestellt sind die Ergebnisse der Kerndokumentation der regionalen kooperativen Rheumazentren des Jahres 2020. Es gibt Angaben zur Krankheitsaktivität, Medikation und nicht-medikamentöser Behandlung. Viele Patient:innen-berichtete Angaben zur Funktionskapazität, dem Krankheitseinfluss, depressiven Symptomen und weitere sind angegeben
Depression, anxiety and cognitive function in persons with inflammatory rheumatic diseases: cross-sectional results from the German National Cohort (NAKO)
No full textOBJECTIVE: To assess the presence of mental health disorders in persons with rheumatoid arthritis (RA), ankylosing spondylitis (AS), psoriatic arthritis (PsA), systemic lupus erythematosus (SLE) and Sjögren’s disease (SjD) (all: inflammatory rheumatic disease, iRMD) in a population-based cohort. METHODS: Baseline data from 101 601 participants of the German National Cohort (NAKO) were analysed. Self-reported physician’s diagnoses of depression and anxiety, the depression scale of the Patient Health Questionnaire (PHQ-9), the Generalised Anxiety Disorder Symptoms Scale (GAD-7), the depression section of the Mini-International Neuropsychiatric Interview (MINI) and cognitive tests on memory and executive functions were analysed. Results of participants with iRMD were compared with participants with osteoarthritis (OA), stratified by age and sex. Cognitive function was described for iRMD and OA using a linear regression model, adjusted for sex and education. RESULTS: n=3257 participants (3.2%) had an iRMD (2.3% RA, 0.6% AS, 0.5% PsA, 0.2% SLE, 0.1% SjD) and n=24 030 (24%) had OA. Physicians’ diagnoses of depression (26% vs 21%), anxiety (15% vs 11%), current depressive (PHQ-9 ≥10: 13% vs 9.0%) and anxiety symptoms (GAD-7 ≥10: 8.6% vs 5.8%) were more frequent in iRMDs compared with OA. In all age groups, women were more often affected than men. Linear regression models showed no differences in neuropsychological test results between iRMD and OA. CONCLUSION: Individuals with iRMD frequently experience mental disorders. The study provides an assessment of both self-report and test-based occurrences in this group. Depression and anxiety are more frequent in iRMD compared with OA, whereas levels of cognitive dysfunction were comparable
Association Between the Use of Oral Contraceptives and Patient-Reported Outcomes in an Early Arthritis Cohort
No full textObjectiveTo evaluate the association between exposure to oral contraceptives (OCs) and clinical outcomes in an early arthritis cohort. MethodsFemale patients with early inflammatory arthritis, ages 18-60 years, who were enrolled in an early arthritis cohort and had no exposure to hormone replacement were studied (n=273). Associations between OC exposure (current/past/never) and disease activity, treatment, and patient-reported outcomes, including the Rheumatoid Arthritis Impact of Disease Score (RAID), the Rheumatoid Arthritis Disease Activity Index (RADAI), the Profile of Mood and Discomfort (PROFAD), and the Hannover Functional Assessment (FFbH), were studied over 2 years. Linear mixed models adjusted for age, body mass index, parity, smoking, and education were used. ResultsEighteen percent of patients had never used OCs, 63% had used OCs in the past, and 19% currently used OCs. After adjustment, the current/past OC use was associated with better RAID, PROFAD, RADAI, and FFbH scores at 12 months (P < 0.05 for all) compared to never use. Longitudinally over 2 years, the mean RAID scores were significantly better in women with current/past OC use (P < 0.001). Actual inflammatory markers were not associated with OC use. Glucocorticoids were used by a higher percentage of OC never users than by current/past users (P=0.08), especially in patients with impaired function (FFbH <70: odds ratio 4.2 [95% confidence interval 1.6-11]). ConclusionFor past as well as current use, OCs seem to moderate patient-reported outcomes in inflammatory arthritis. Protective effects may be induced via central nervous pathways rather than through the suppression of peripheral inflammation
Trends in idiopathic inflammatory myopathies: cross-sectional data from the German National Database
No full textObjective!#!To describe trends in outcomes among patients with idiopathic inflammatory myopathies (IIM) over two decades.!##!Methods!#!From 1997 to 2017, a total of 1079 IIM patients were documented in the National Database of the German Collaborative Arthritis Centers. Annual cross-sectional data on treatment, disease activity, patient-reported outcomes, hospitalization and employment were compared across the years. Information on phenotypes, organ manifestations and autoantibodies was collected for a subset to compare the assessment of global health, pain, fatigue and sleeping disorders.!##!Results!#!In 2017, significantly more IIM patients were assessed to be in low disease activity (94%) than in 1997 (59%), p &lt; 0.01. Pain (p = 0.001), global health (p = 0.049), fatigue (p = 0.03) and sleeping disorders (p = 0.01) also improved since recording. Glucocorticoid use decreased from 84 to 58% (p &lt; 0.01). Employment in patients &lt; 65 years remained unchanged (53%), while early retirement (23-9%), hospitalization/year (34-18%) and sick leave (52-24%) decreased. A total of 186 patients with information on subtypes were classified as polymyositis (44%), dermatomyositis (33%), anti-synthetase syndrome (10%), overlapping-myositis (8%), inclusion body myositis (2%), necrotizing myositis (0.5%) and unspecific (3%). The most frequently reported symptoms were limitations in global health (60%), fatigue (57%) and sleeping disorders (51%), and all of them were most frequent in overlap-myositis. Pulmonary hypertension and cardiomyopathy were associated with poor outcomes regarding global health, daily activities and fatigue.!##!Conclusion!#!IIM patients report better outcomes than 20 years ago, along with good physician-reported disease control. Global health, fatigue and sleeping disorders are relevant patient-reported domains in IIM
SAT0187 TRENDS IN EMPLOYMENT AND HOSPITALIZATION IN PATIENTS WITH SJÖGREN’S SYNDROME 1993–2016: RESULTS FROM THE GERMAN NATIONAL DATABASE
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