Long-term trends in rheumatology care

Albrecht, Katinka; Callhoff, Johanna; Zink, Angela

doi:10.1007/s00393-019-0680-1

Cited by 23 publications

(17 citation statements)

References 25 publications

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“…In 846 patients with a physician-reported SLE diagnosis in 2016, 64% received HCQ. 6 The National Database only covers patients in rheumatological care. In the incident SLE cohort in this manuscript, only 56% of the patients had contact with a rheumatologist.…”

Section: Discussionmentioning

confidence: 99%

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Comorbidity and healthcare utilisation in persons with incident systemic lupus erythematosus followed for 3 years after diagnosis: analysis of a claims data cohort

et al. 2021

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ObjectiveTo analyse comorbidity and healthcare utilisation in individuals with SLE.MethodsA cohort of individuals with incident SLE diagnosis in 2016 were investigated using claims data from a German statutory health insurance fund. Concomitant diagnoses, medical prescriptions, hospitalisation and sick leave were analysed in the year prior to diagnosis and during a 3-year follow-up in comparison with age-matched and sex-matched controls (1) without autoimmune diseases and (2) with incident diabetes mellitus. Sensitivity analyses were performed excluding cases with additional autoimmune diagnoses and without prescription of antimalarials.ResultsAmong 571 individuals with SLE, hypertension (48%), depression (30%), hyperlipidaemia (25%), osteoarthritis (25%) and osteoporosis (20%) were the most frequent comorbidities in 2016. Cerebrovascular disease was documented in 9.6%. The number of drugs (mean 9.6, ∆+6.2), hospitalisation (40%, ∆+27%) and days on sick leave (median 46 days, ∆+27 days) increased significantly in the first year with SLE diagnosis. Individuals with SLE were more frequently hospitalised and had more medications compared with both control groups (all p<0.001). The increase in comorbidity diagnoses was low in controls without autoimmune diseases, while controls with diabetes showed a more pronounced increase in cardiovascular risk factors, but less in osteoporosis and cerebrovascular disease. Sensitivity analyses showed comparable results.ConclusionComorbidities are frequently detected at the time of diagnosis of SLE. High numbers of drug prescriptions and hospitalisation following SLE diagnosis reflect the comprehensive disease burden. The comparison with incident diabetes shows that differences with controls without autoimmune disease are overestimated by detection bias.

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Section: Discussionmentioning

confidence: 99%

“…National Database 6 ; however, majority of patients have long-standing disease and numbers on incident SLE cases are small. 7 8 The German LuLa study, the second relevant cohort in Germany, focuses on self-reported outcomes instead.…”

Section: Lupus Science and Medicinementioning

confidence: 99%

Comorbidity and healthcare utilisation in persons with incident systemic lupus erythematosus followed for 3 years after diagnosis: analysis of a claims data cohort

et al. 2021

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“…Opioids are most commonly prescribed to patients reporting severe pain in axSpA. Overall, NSAID prescriptions for RA, AS and PsA have decreased in the 2000s coinciding with the increase in biologic therapies within the NDB [30]. In contrast, other nonopioid analgesics are prescribed more frequently than before.…”

Section: Discussionmentioning

confidence: 99%

Prescription of analgesics in patients with rheumatic diseases in Germany

2021

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Zusammenfassung Zielsetzung Mithilfe von Abrechnungsdaten wird die Verordnungshäufigkeit von Analgetika bei Patienten mit Diagnose einer rheumatoiden Arthritis (RA), axialen Spondyloarthritis (axSpA), Psoriasisarthritis (PsA) bzw. eines systemischen Lupus erythematodes (SLE) im Jahr 2019 untersucht. Methodik Eingeschlossen wurden Versicherte der Barmer ≥ 18 Jahre im Jahr 2019 mit Diagnose einer RA (M05, M06), axSpA (M45), PsA (M07.0–3) oder eines SLE (M32.1, 8, 9). Analgetika wurden über die ATC(Anatomisch-Therapeutisch-Chemisches Klassifikationssystem)-Codes identifiziert. Berichtet wird der Anteil an Personen mit ≥ 1 Analgetikaverordnung für die jeweiligen Krankheitsbilder im Jahr 2019 sowie für Opioide altersstandardisiert in jedem der Jahre 2005 bis 2019. Zusätzlich wird der Anteil an Opioidlangzeitverordnungen (Rezepte in ≥ 3 aufeinanderfolgenden Quartalen) im Jahr 2006 und 2019 verglichen. Ergebnisse Metamizol (29–33 %) war das am häufigsten verordnete Analgetikum. NSAR(nichtsteroidale Antirheumatika)/Coxibe wurden zu 35 % (SLE) bis 50 % (axSpA) verordnet; 11–13 % der Versicherten wurden schwach wirksame und 6–8 % stark wirksame Opioide verordnet. Von 2005 bis 2019 blieb der Anteil an Personen mit ≥ 1 Opioidverordnung stabil bei gleichbleibend bzw. leicht rückläufiger Verordnung schwach wirksamer Opioide und häufigerer Verordnung stark wirksamer Opioide. Der Anteil an Langzeitopioidverordnungen stieg von 2006 bis 2019 von 8,9 % auf 11,0 % (RA), von 6,9 % auf 9,1 % (axSpA), von 7,8 % auf 9,5 % (PsA) und von 7,5 % auf 8,8 % (SLE), entsprechend einer Zunahme um 17–24 %. Schlussfolgerung Die Verordnung von Opioiden bei Versicherten mit entzündlich rheumatischen Diagnosen ist in Deutschland nicht so hoch wie in anderen Ländern, allerdings ist der Anteil an Langzeitverordnungen deutlich angestiegen. Auffällig ist die häufige Verordnung von Metamizol.

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“…The results of retrospective analysis of 385 PMR patient data, made by Giollo A. et al (2019) in Italy, demonstrate "a frequent need for a protracted GC use" attending this disease and a possible protective effect of adjuvant aminobisphosphonate therapy: they were used by 60 % patients. The use of aminobisphosphonates was associated with the GC discontinuation irrespective of the age, initial Prednisone dose and osteoporosis presence (hazard ratio 0.66; 95 % CI 0.50-0.88) [38].…”

Section: Notes: Accp -Anti-cyclic Citrullinated Protein Antibodies; Ae -Adverse Effect; Ah -Arterial Hypertension; Ap -Alkaline Phosphatamentioning

confidence: 97%

“…Referring to the «treat to target» concept, i.e. treatment till the target is reached, used for PMR as a chronic condition, associated with elevated risks of various complications in the elderly people, we rely on the opinion by the Italian researchers and Mayo Clinic representatives, Camellino D. et al (2019), who consider the control of inflammatory activity, functional disorders and patient health as the treatment target, as well as maintaining the life quality in general [48].…”

Section: лекції огляди / Lectures Reviewsmentioning

confidence: 99%

Ревматическая Полимиалгия В Клинических Рекомендациях 2018–2020 Годов. Часть I. Группы Риска, Адъювантная Терапия

Puzanova¹

2021

PJS

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At the beginning of the Healthy Ageing Decade, a number of guidelines were published describing management of the rheumatic diseases of the elderly. The aim of the paper is to characterize and discuss the Italian Society of Rheumatology’s guideline for polymyalgia rheumatica (2020) and the European Association of Nuclear Medicine, the Society of Nuclear Medicine and Molecular Imaging, and the American Society of Nuclear Cardiology’s (2018) recommendation for positron-emission tomography/computed tomography imaging to diagnose the large vessel vasculitis and polymyalgia rheumatica. The following methods were used: original texts of recommedations, their content and methodology behind the development of both guidelines were studied by means of information analysis and compared with the recommendations for the management of polymyalgia rheumatica and giant cell arteritis elaborated in 2018–2020 by the European League Against Rheumatism, American College of Rheumatology; the German, Austrian, Swiss and British rheumatological societies; the European Headache Federation and their references. We’ve established the priority of consensus approach for the development of modern guidelines for polymyalgia rheumatica. The specific feature of the Italian guideline’s development is the search for prototypes restricted to the two evidence-based medicine databases and the grey literature as well as selection of three international guidelines for adaptation, one of them elaborated by the societies for nuclear medicine. The following issues were updated: the patient management in primary care (whose algorithm is proposed), including the conserted clinical decision-making and alertness to the giant cell arteritis. Out of the first-line therapy tools, only the initial doses of glucocorticoids are evidence-based, and their reduction is allowed as an alternating regimen. The ineffectiveness of hydroxichloroquine use is justified, while both azathioprine and alternative medical drugs are not subject to discussion. It is necessary to identify the risk factors for vasculitis and its relapses, longterm glucocorticoid use and their side effects. For the first time, the use of positron-emission tomography/computed tomography is recommended for detecting of vasculitis. The recommendation for adjuvant therapy with methotrexate and abstaining from the biologic agents is found the most evidence-based, strongest and consistent; referral to a rheumatologist being the least agreed-on position. Conclusion. Solving such an urgent healthcare problem as improving the quality of polymyalgia rheumatic management suggests the medical standards being raised on the most clinically important issues, the importance of at-risk patient identification and referral to rheumatologists and ophthalmologists, and consideration of the methotrexate’s benefits.

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Long-term trends in rheumatology care

Cited by 23 publications

References 25 publications

Comorbidity and healthcare utilisation in persons with incident systemic lupus erythematosus followed for 3 years after diagnosis: analysis of a claims data cohort

Comorbidity and healthcare utilisation in persons with incident systemic lupus erythematosus followed for 3 years after diagnosis: analysis of a claims data cohort

Prescription of analgesics in patients with rheumatic diseases in Germany

Ревматическая Полимиалгия В Клинических Рекомендациях 2018–2020 Годов. Часть I. Группы Риска, Адъювантная Терапия

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