Daten aus der Kerndokumentation

Dargestellt 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

Diagnostic accuracy of inflammatory back pain for axial spondyloarthritis in rheumatological care

Objective: Inflammatory back pain (IBP), the key symptom of axial spondyloarthritis (axSpA), including ankylosing spondylitis, has been proposed as a screening test for patients presenting with chronic back pain in primary care. The diagnostic accuracy of IBP in the rheumatology setting is unknown. Methods: Six rheumatology centres, representing secondary and tertiary rheumatology care, included routinely referred patients with consecutive chronic back pain with suspicion of axSpA. IBP (diagnostic test) was assessed in each centre by an independent (blinded) rheumatologist; a second (unblinded) rheumatologist made the diagnosis (axSpA or no-axSpA), which served as reference standard. Results: Of 461 routinely referred patients, 403 received a final diagnosis. IBP was present in 67.3%, and 44.6% (180/403) were diagnosed as axSpA. The sensitivity of IBP according to various definitions (global judgement, Calin, Berlin, Assessment of SpondyloArthritis international Society criteria for IBP) was 74.4%-81.1 % and comparable to published figures, whereas the specificity was unexpectedly low (25.1%-43.9%). The resulting positive likelihood ratios (LR+) were 1.1-1.4 and without major differences between sets of IBP criteria. The presence of IBP according to various definitions increased the probability of axSpA by 2.5%-8.4% only (from 44.6% to 47.1%-53.0%). Conclusions: The diagnostic utility of IBP in the rheumatology setting was smaller than expected. However, this was counterbalanced by a high prevalence of IBP among referred patients, demonstrating the effective usage of IBP in primary care as selection parameter for referral to rheumatology. Notably, this study illustrates potential shifts in specificity and LR+ of diagnostic tests if these tests are used to select patients for referral

Body mass index distribution in rheumatoid arthritis: a collaborative analysis from three large German rheumatoid arthritis databases

Background METARTHROS (Metabolic impact on joint and bone disease) is a nationwide German network to investigate the overlap between inflammatory and metabolic diseases. The objective of this study was to compare the body mass index (BMI) distribution in patients with early and established rheumatoid arthritis (RA) with data from the general population, and to evaluate the association of BMI with patient characteristics and clinical markers. Methods The BMI distribution was examined with data collected at inclusion of patients in the early arthritis cohort CAPEA, the biologics register RABBIT, and the National database of the German Collaborative Arthritis Centers. A data source with a representative sample of the German population (German Ageing Survey) was used as a comparator. BMI categories of <18.5 kg/m2 (underweight), 18.5 to <25 kg/m2 (normal weight), 25 to <30 kg/m2 (overweight), and ≥30 kg/m2 (obese) were used. Patients were stratified by age and sex, and compared to controls from the German Ageing Survey. Associations between BMI and markers of disease activity were analysed with non-parametric tests and linear models. Results Data from 1207 (CAPEA), 12,230 (RABBIT), and 3424 (National database) RA patients and 6202 population controls were evaluated. The mean age was 56, 56, 62, and 62 years, respectively, the mean disease duration was 13 weeks, 9.9 years, and 13.5 years, respectively, and the mean disease activity score (DAS28) was 5.1, 5.2, and 3.1, respectively. In all RA cohorts, obesity was more frequent (23.8 %, 23.4 %, 21.4 %, respectively) than in controls (18.2 %). This applied to all age groups <70 years, was independent of disease duration, and was more pronounced in females. In all cohorts, the age at RA onset was associated with BMI, being higher in overweight/obese patients compared to normal-weight patients. Current smoking was negatively associated with BMI. Linear analyses revealed increased erythrocyte sedimentation rate (ESR) values in underweight and obese females, and an increasing disparity between tender joint counts (TJCs) and swollen joint counts (SJCs) in higher BMI categories. Conclusions Compared to the general population, a higher prevalence of obesity was observed in all RA cohorts. The dominance of obesity in females and the different behaviour of disease activity markers in relation to the BMI in females indicate that additional parameters need to be considered when analysing the impact of obesity on inflammation in RA

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ABSTRACT. Objective. To assess the influence of income on self-reported disease and work productivity outcomes. Methods. Persons with rheumatoid arthritis (RA) diagnosis (International Classification of Diseases, 10th ed. codes M05/M06) on health insurance claims data in at least 2 quarters of 2013 were randomly selected. They were mailed questionnaires covering RA diagnosis, household income, functional capacity [Hannover functional status questionnaire (FFbH), 0-100], RA Impact of Disease questionnaire (RAID; 0-10), self-reported swollen joint count (SJC; 0-48), tender joint count (TJC; 0-50), and effect of RA on work productivity (change of work, fewer working hours, sick leave, application for disability pension, and others). Weighted multivariable linear regression models were used to assess the association between income and disease outcomes. Results. A total of 1492 persons of working age who confirmed RA diagnosis were available for analysis. The mean age was 55 years, 82% were women, and 74% were under rheumatologic care

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ABSTRACT. Objective. To assess the influence of income on self-reported disease and work productivity outcomes. Methods. Persons with rheumatoid arthritis (RA) diagnosis (International Classification of Diseases, 10th ed. codes M05/M06) on health insurance claims data in at least 2 quarters of 2013 were randomly selected. They were mailed questionnaires covering RA diagnosis, household income, functional capacity [Hannover functional status questionnaire (FFbH), 0-100], RA Impact of Disease questionnaire (RAID; 0-10), self-reported swollen joint count (SJC; 0-48), tender joint count (TJC; 0-50), and effect of RA on work productivity (change of work, fewer working hours, sick leave, application for disability pension, and others). Weighted multivariable linear regression models were used to assess the association between income and disease outcomes. Results. A total of 1492 persons of working age who confirmed RA diagnosis were available for analysis. The mean age was 55 years, 82% were women, and 74% were under rheumatologic care

The Prevalence of Dental Implants and Related Factors in Patients with Sjögren Syndrome:Results from a Cohort Study

Objective.To investigate prevalence and patient-reported outcomes of dental implants in patients with Sjögren syndrome (SS).Methods.A total of 205 female patients from an observational cohort study answered oral health questionnaires about periodontal signs and symptoms, dentures, dental implants, comorbidities, and therapies that may interfere with bone remodeling. Data were compared with the reports of 87 female healthy controls.Results.The patients were older than the controls (58 ± 12 and 54 ± 14 yrs, respectively) and differed substantially in the prevalence of self-reported gingivitis (60% and 35%), self-reported periodontitis (19% and 8%), and in the numbers of remaining teeth (21 ± 7 and 24 ± 5). Patients more frequently had removable prostheses (36% compared with 23%) and dental implants (16% compared with 7%). The 32 patients with SS with dental implants had a mean number of 3.1 ± 2.0 implants. Notably, for patients with implants, their oldest existing implant survived for a mean period of 4.9 ± 5.4 years. A total of 5 of 104 (4.8%) implants in the patients and none of the 14 implants in the controls had to be removed. A total of 75% of the patients were highly satisfied with the implants and 97% would recommend them to other patients with SS.Conclusion.A substantial portion of patients with SS have dental complications and require subsequent implants. The majority were satisfied with the implants and would recommend them to other patients. The high implant survival rate may encourage patients, rheumatologists, and dentists to consider dental implants for the treatment of patients with SS.</jats:sec

The impact of biologic and conventional therapy on physical function in rheumatoid arthritis and ankylosing spondylitis

Zielstellung: 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

Factors Associated with Survey Non-Response in a Cross-Sectional Survey of Persons with an Axial Spondyloarthritis or Osteoarthritis Claims Diagnosis

Non-response in surveys can lead to bias, which is often difficult to investigate. The aim of this analysis was to compare factors available from claims data associated with survey non-response and to compare them among two samples. A stratified sample of 4471 persons with a diagnosis of axial spondyloarthritis (axSpA) and a sample of 8995 persons with an osteoarthritis (OA) diagnosis from a German statutory health insurance were randomly selected and sent a postal survey. The association of age, sex, medical prescriptions, specialist physician contact, influenza vaccination, hospitalization, and Elixhauser comorbidity index with the survey response was assessed. Multiple logistic regression models were used with response as the outcome. A total of 47% of the axSpA sample and 40% of the OA sample responded to the survey. In both samples, the response was highest in the 70&ndash;79-year-olds. Women in all age groups responded more often, except for the 70&ndash;79-year-olds. Rheumatologist/orthopedist contact, physical therapy prescription, and influenza vaccination were more frequent among responders. In the logistic regression models, rheumatologist/orthopedist treatment, influenza vaccination, and physical therapy were associated with a higher odds ratio for response in both samples. The prescription of biologic drugs was associated with higher response in axSpA. A high Elixhauser comorbidity index and opioid use were not relevantly associated with response. Being reimbursed for long-term care was associated with lower response&mdash;this was only significant in the OA sample. The number of quarters with a diagnosis in the survey year was associated with higher response. Similar factors were associated with non-response in the two samples. The results can help other investigators to plan sample sizes of their surveys in similar settings