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Hirsch S, Hoeper K, Meyer-Olson D, Schwarting A, Gente K, Dreher M, Hoeper J, Witte T, Thiele T. [The subanalysis of Rheuma-VOR demonstrates a considerable need for rheumatological care]. Z Rheumatol 2024:10.1007/s00393-024-01490-2. [PMID: 38456907 DOI: 10.1007/s00393-024-01490-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/24/2024] [Indexed: 03/09/2024]
Abstract
BACKGROUND Early diagnosis and treatment of inflammatory rheumatic diseases can prevent consequential damage such as permanently limited mobility and joint or organ damage. Simultaneously, there is an increasing deficit in medical care owing to the lack of rheumatological capacity. Rural regions are particularly affected. OBJECTIVES The available unconfirmed diagnoses of the study Rheuma-VOR were analysed regarding another definitive inflammatory rheumatic disease. MATERIALS AND METHODS The returned questionnaires of the rheumatologists participating in Rheuma-VOR were screened for definitive inflammatory rheumatic diseases other than the required diagnosis of rheumatoid arthritis, psoriatic arthritis or spondyloarthritis. RESULTS Of 910 unconfirmed diagnoses, in 245 patients another definitive diagnosis could be confirmed. A total of 29.8% of the diagnoses corresponded to degenerative joint changes or chronic pain syndrome, whereas 26.1% involved different forms of inflammatory arthritis. The majority of diagnoses (40.5%) were collagenosis or vasculitis, DISCUSSION: The available data show that a rheumatological presentation was indicated for the majority of patients. Owing to the increasing deficits in medical care a prior selection of the patients is crucial to make optimal use of restricted rheumatological capacities.
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Affiliation(s)
- Stefanie Hirsch
- Klinik für Rheumatologie und Immunologie, Medizinische Hochschule Hannover, Carl-Neuberg-Straße 1, 30625, Hannover, Deutschland.
| | - K Hoeper
- Regionales Kooperatives Rheumazentrum Niedersachsen e. V., Hannover, Deutschland
| | - D Meyer-Olson
- Klinik für Rheumatologie und Immunologie, Medizinische Hochschule Hannover, Carl-Neuberg-Straße 1, 30625, Hannover, Deutschland
- m&i Fachklinik Bad Pyrmont und MVZ Weserbergland, Bad Pyrmont, Deutschland
| | - A Schwarting
- Schwerpunkt Rheumatologie und klinische Immunologie, Universitätsmedizin der Johannes Gutenberg Universität Mainz, Mainz, Deutschland
| | - K Gente
- Innere Medizin V- Sektion Rheumatologie, Universitätsklinikum Heidelberg, Heidelberg, Deutschland
| | - M Dreher
- Schwerpunkt Rheumatologie und klinische Immunologie, Universitätsmedizin der Johannes Gutenberg Universität Mainz, Mainz, Deutschland
| | - J Hoeper
- Klinik für Rheumatologie und Immunologie, Medizinische Hochschule Hannover, Carl-Neuberg-Straße 1, 30625, Hannover, Deutschland
- Center for Health Economics Research Hannover (CHERH), Leibniz University Hannover, Hannover, Deutschland
| | - T Witte
- Klinik für Rheumatologie und Immunologie, Medizinische Hochschule Hannover, Carl-Neuberg-Straße 1, 30625, Hannover, Deutschland
| | - T Thiele
- Klinik für Rheumatologie und Immunologie, Medizinische Hochschule Hannover, Carl-Neuberg-Straße 1, 30625, Hannover, Deutschland
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Klemm P, Schulz N, Boettger P, Lange U. Heat therapy in rheumatic and musculoskeletal diseases - an overview of clinical and molecular effects. Int J Hyperthermia 2024; 41:2322667. [PMID: 38439192 DOI: 10.1080/02656736.2024.2322667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Accepted: 02/20/2024] [Indexed: 03/06/2024] Open
Abstract
Rheumatic and musculoskeletal diseases (RMDs) usually lead to morphological and functional deficits of various extend, increased morbidity and a considerable loss of quality of life. Modern pharmacological treatment has become effective and can stop disease progression. Nonetheless, disease progression is often only slowed down. Moreover, pharmacological treatment does not improve functionality per se. Therefore, multimodal treatment of rheumatic disorders with physical therapy being a key element is of central importance for best outcomes. In recent years, research into physical medicine shifted from a sole investigation of its clinical effects to a combined investigation of clinical effects and potential changes in the molecular level (e.g., inflammatory cytokines and the cellular autoimmune system), thus offering new explanations of clinical effects of physical therapy. In this review we provide an overview of studies investigating different heat applications in RMDs, their effect on disease activity, pain and their influence on the molecular level.
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Affiliation(s)
- Philipp Klemm
- Department of Rheumatology, Clinical Immunology, Osteology and Physical Medicine, Campus Kerckhoff, Justus-Liebig-University Gießen, Bad Nauheim, Germany
| | - Nils Schulz
- Department of Rheumatology, Clinical Immunology, Osteology and Physical Medicine, Campus Kerckhoff, Justus-Liebig-University Gießen, Bad Nauheim, Germany
| | - Priyanka Boettger
- Department of Rheumatology, Clinical Immunology, Osteology and Physical Medicine, Campus Kerckhoff, Justus-Liebig-University Gießen, Bad Nauheim, Germany
| | - Uwe Lange
- Department of Rheumatology, Clinical Immunology, Osteology and Physical Medicine, Campus Kerckhoff, Justus-Liebig-University Gießen, Bad Nauheim, Germany
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3
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Kernder A, Düsing C, Richter J, Brinks R, Fischer-Betz R, Winkler-Rohlfing B, Aringer M, Schneider M, Chehab G. Factors detrimental to work productivity and daily activities in systemic lupus erythematosus patients - Analysis of the German LuLa study. Lupus 2021; 30:1931-1937. [PMID: 34739350 DOI: 10.1177/09612033211045063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE The aim of this study was to identify factors associated with impaired work productivity and impaired daily activities in patients with systemic lupus erythematosus (SLE). METHODS The LuLa study is a longitudinal patient-reported study. Beyond sociodemographic data, work productivity, daily activities and fatigue, several other clinical outcome parameters (e.g. mental health-related quality of life and physical functioning, disease activity, damage and pain) were surveyed with validated questionnaires. The effects of confounders on work productivity (WPAI 2) and daily activity domains (WPAI 4) were studied by multivariate regression analysis. RESULTS A total of 585 patients completed the questionnaire of whom 259 were employed and analysed. The median impairment in work productivity (WPAI 2) was 20% (Q1-3 0-40), and the median impairment in daily activities (WPAI 4) was 30% (Q1-3 10-50%). Multivariate regression analysis revealed that fatigue, pain, disease activity and health-related quality of life affected WPAI 2 and 4. Furthermore, we observed distinct synergistic effects of fatigue, disease activity and pain on both work productivity and daily activities: a higher impact of fatigue was associated with the reported extent of pain or disease activity. CONCLUSION In employed patients with SLE, impaired work productivity and impaired daily activities were frequently reported. Fatigue, pain, disease activity and health-related quality of life demonstrated a detrimental impact, with a synergistic effect of fatigue, disease activity and pain. Hence, both optimized pain management and targeted immunomodulatory therapy are important for preserving active participation in life among patients with fatigue.
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Affiliation(s)
- Anna Kernder
- Department of Rheumatology and Hiller-Research Unit Rheumatolog y, Heinrich-Heine-University Düsseldorf, Medical Faculty, Düsseldorf, Germany
| | - Christina Düsing
- Department of Rheumatology and Hiller-Research Unit Rheumatolog y, Heinrich-Heine-University Düsseldorf, Medical Faculty, Düsseldorf, Germany
| | - Jutta Richter
- Department of Rheumatology and Hiller-Research Unit Rheumatolog y, Heinrich-Heine-University Düsseldorf, Medical Faculty, Düsseldorf, Germany
| | - Ralph Brinks
- Department of Rheumatology and Hiller-Research Unit Rheumatolog y, Heinrich-Heine-University Düsseldorf, Medical Faculty, Düsseldorf, Germany
| | - Rebecca Fischer-Betz
- Department of Rheumatology and Hiller-Research Unit Rheumatolog y, Heinrich-Heine-University Düsseldorf, Medical Faculty, Düsseldorf, Germany
| | | | - Martin Aringer
- Department of Medicine III, Division of Rheumatology, University Medical Center and Faculty of Medicine, Dresden, Germany
| | - Matthias Schneider
- Department of Rheumatology and Hiller-Research Unit Rheumatolog y, Heinrich-Heine-University Düsseldorf, Medical Faculty, Düsseldorf, Germany
| | - Gamal Chehab
- Department of Rheumatology and Hiller-Research Unit Rheumatolog y, Heinrich-Heine-University Düsseldorf, Medical Faculty, Düsseldorf, Germany
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Meyer-Olson D, Hoeper K. [Rehabilitation in Rheumatoid Arthritis]. REHABILITATION 2021; 60:339-354. [PMID: 34655068 DOI: 10.1055/a-1275-2657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Die rheumatoide Arthritis stellt unter den Erkrankungen des Bewegungssystems eine
besondere Herausforderung für die Rehabilitationsmedizin dar 1. Eine genaue Kenntnis der Erkrankung,
inklusive der medikamentösen und der nicht medikamentösen
Behandlungsoptionen, ist die wesentliche Voraussetzung für einen
nachhaltigen Rehabilitationserfolg und um den berechtigen Anspruch der
Erkrankten auf berufliche und soziale Partizipation umzusetzen.
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Lindner L, Callhoff J, Alten R, Krause A, Ochs W, Zink A, Albrecht K. Osteoporosis in patients with rheumatoid arthritis: trends in the German National Database 2007-2017. Rheumatol Int 2020; 40:2005-2012. [PMID: 32377959 PMCID: PMC7591406 DOI: 10.1007/s00296-020-04593-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Accepted: 04/18/2020] [Indexed: 11/22/2022]
Abstract
Osteoporosis is a frequent comorbidity in rheumatoid arthritis (RA). Due to the improved treatment options for RA, we expect a long-term decrease in osteoporosis as an accompanying disease. Data from the German National Database (NDB) were used to investigate whether the frequency of osteoporosis has changed in the last 10 years. From 2007 to 2017, approximately 4000 patients were documented annually with data on therapy and comorbidity. The cross-sectional data were summarised descriptively. Age, sex, disease duration, disease activity and glucocorticoids were considered as influencing factors. The Cochrane-Armitage test for trend was used to test whether the frequency of osteoporosis at the first visit changed from 2007 to 2017. Osteoporosis frequency in RA patients (mean age 63 years, 75% female) decreased from 20% in 2007 to 6% in 2017 (p < 0.001). The decrease affected women (22% to 17%) and men (14% to 8%) in all age groups and both short-term (≤ 2-year disease duration: 9% to 3%) and long-term RA patients (> 10-year disease duration: 28% to 20%). Patients with high disease activity and patients who took glucocorticoids (GC) were more often affected by osteoporosis than patients in remission or without GC. Drug prophylaxis in patients without osteoporosis increased (20% to 41% without GC, 48% to 55% with GC). Men with GC received less prophylactic treatment than women (48% vs. 57% in 2017). In this cohort, osteoporosis in patients with RA is less frequently observed compared to former years. RA-specific risk factors for osteoporosis such as disease activity and GC therapy have declined but long-term GC use is still present. Assessment of osteoporosis in RA patients should be investigated more consistently by bone density measurement. Male RA patients still need to be given greater consideration regarding osteoporosis drug prophylaxis, especially when GC therapy is needed.
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Affiliation(s)
- Lisa Lindner
- Epidemiology Division, German Rheumatism Research Center (DRFZ), Charitéplatz 1, 10117 Berlin, Germany
| | - Johanna Callhoff
- Epidemiology Division, German Rheumatism Research Center (DRFZ), Charitéplatz 1, 10117 Berlin, Germany
| | - Rieke Alten
- Schlosspark Klinik, Internal Medicine 2, Rheumatology, Clinical Immunology and Osteology, Berlin, Germany
| | - Andreas Krause
- Immanuel Hospital, Rheumatology and Clinical Immunology, Berlin, Germany
| | | | - Angela Zink
- Epidemiology Division, German Rheumatism Research Center (DRFZ), Charitéplatz 1, 10117 Berlin, Germany
- Medical Clinic with Focus on Rheumatology and Clinical Immunology, Charité – Universitätsmedizin, Berlin, Germany
| | - Katinka Albrecht
- Epidemiology Division, German Rheumatism Research Center (DRFZ), Charitéplatz 1, 10117 Berlin, Germany
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6
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Himmler S, Branner JC, Ostwald DA. The societal impact of a biologic treatment of ankylosing spondylitis: a case study based on secukinumab. J Comp Eff Res 2020; 10:143-155. [PMID: 33252266 DOI: 10.2217/cer-2020-0077] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Aim: This study estimates the societal benefits of using biologics like secukinumab (SEC) instead of nonsteroidal anti-inflammatory drugs for treating patients with ankylosing spondylitis in Germany. Materials & methods: A Markov and a population model were used to predict the functional impairment of German ankylosing spondylitis patients using SEC or nonsteroidal anti-inflammatory drugs. This was translated into avoided productivity losses, which were valued according to gross value added. Results: The productivity impairment of SEC users was predicted to decrease by 20 percentage points, corresponding to 12.8 and 32.7 million hours in paid and unpaid work and a monetary value of €1.6 billion from 2016 to 2030. Accounting for economic spillover effects increases the societal value to € 3.3 billion. Conclusion: The improvements in functional impairment due to biologics could lead to sizable productivity effects.
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Affiliation(s)
| | | | - Dennis A Ostwald
- WifOR Institute, Darmstadt 64283, Germany.,School of International Business & Entrepreneurship (SIBE) Steinbeis University, Herrenberg 71083, Germany
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Krüger K, Burmester GR, Wassenberg S, Thomas MH. Golimumab improves socio economic and health economic parameters in patients with rheumatoid arthritis, psoriatic arthritis, and ankylosing spondylitis. Curr Med Res Opin 2020; 36:1559-1567. [PMID: 32609555 DOI: 10.1080/03007995.2020.1790347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Golimumab (GLM) has shown its efficacy and safety in various clinical trials. We aimed to assess the effect of GLM on socio economic and health economic parameters in daily clinical practice. SETTING Rheumatology offices in Germany. METHOD Analysis of socio economic and health economic parameters of the non-interventional, multicentre, prospective study GO-NICE. Analyses were performed in an exploratory manner using descriptive statistical methods. Further, p-values on socio economic variables were calculated based on one-sample t-test on the differences between baseline and follow-up visits. RESULTS A total of 1458 patients were evaluable, of whom a total of 664 patients completed the 24-month observation period. The proportions of hospitalizations decreased statistically significantly (p ≤ .05) from 10.4/7.6/14.0% at baseline (BL) to 1.7/2.2/0.8%, and the in-patient rehabilitations decreased from 3.3/3.7/7.5% at BL to 0.6/1.8/2.1% at month 24 in patients with RA, PsA, and AS. When considering a 30-day period, the mean number of sick leave days decreased statistically significantly (p ≤ .005) from 4.0 at BL to 0.9 at month 24 (greatest improvement in RA), and the mean number of days with impaired capability decreased statistically significantly (p ≤ .001) from 14.9 at BL to 4.5 at month 24 (greatest improvement in patients with AS). There was also a reduction in the number of consultations and remedies. CONCLUSION This evaluation shows improvements in socio economic and health economic parameters on GLM treatment.
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Affiliation(s)
- Klaus Krüger
- Praxiszentrum St. Bonifatius München, Munich, Germany
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8
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Long-term trends in rheumatology care : Achievements and deficits in 25 years of the German national rheumatology database. Z Rheumatol 2019; 78:65-72. [PMID: 31407089 DOI: 10.1007/s00393-019-0680-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND Since 1993, data on the care and quality of life of patients with inflammatory rheumatic diseases have been collected in the German National Database (NDB) of the regional collaborative rheumatology centers. OBJECTIVE In this review long-term trends on treatment, disease activity and gainful employment of the most common inflammatory rheumatic diseases are presented and the most important analyses from 25 years of the NDB are summarized. METHODS Between 15 and 17 rheumatological institutions take part in the NDB and once a year collect data from a total of more than 10,000 patients. The rheumatologists document the disease status and care, the patients report on their state of health and the effects of the disease. RESULTS The biologics era at the beginning of the twenty-first century has led to changes in the therapeutic spectrum of most inflammatory rheumatic diseases, especially in rheumatoid arthritis and ankylosing spondylitis. Some basic therapies formerly used are hardly used anymore and glucocorticoids are used less frequently. Methotrexate has remained the standard therapy for rheumatoid arthritis over the years. Nowadays, nearly 30% of patients with rheumatoid arthritis receive treatment with biologics. Disease activity, functional and social restrictions have decreased across all diseases. CONCLUSION The improved health status of many patients with rheumatic diseases confirms the high level of care provided by the rheumatism centers involved in the NDB. The increasing specification of measuring instruments and the standardization of documentation systems are major challenges that the NDB will have to face in the coming years if it is to remain in the digital age.
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9
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Himmler S, Mueller M, Sherif B, Ostwald D. A case study applying a novel approach to estimate the social impact of a medical innovation - the use of secukinumab for psoriatic arthritis in Germany. Expert Rev Pharmacoecon Outcomes Res 2019; 20:369-378. [DOI: 10.1080/14737167.2019.1644169] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
| | | | - Bintu Sherif
- Biostatistics, RTI Health Solutions, Research Triangle Park, NC, USA
| | - Dennis Ostwald
- Health Economics, WifOR GmbH, Darmstadt, Germany
- School of International Business and Entrepreneurship (SIBE), Steinbeis University Berlin, Berlin, Germany
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11
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Abstract
Rheumatic diseases usually progress towards morphological and functional deficits and thus cause impairment of physical health and function. Based on this fact, physiotherapeutic options are elementary and indispensable. This article focuses on the significance and importance of physiotherapy in inflammatory and degenerative rheumatic diseases. Furthermore, an overview is presented on the consequences of rheumatic diseases, the reality of supply of physiotherapy, the principles and therapeutic options, and the evidence.
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12
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Throm S, Hömke R. [New antirheumatics : Advances for patients and society]. Z Rheumatol 2018; 77:290-296. [PMID: 29728806 DOI: 10.1007/s00393-018-0453-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The current repertoire of conventional, biological and targeted synthetic disease-modifying antirheumatic drugs (DMARDs) presents wide-ranging options to help patients with inflammatory rheumatic diseases. These therapeutic possibilities have improved quality of life for many patients and also had a positive impact at the societal level. Among these positive effects are a reduction in short-term inability to work and early retirement; for paediatric patients they represent an opportunity for an almost normal school life including physical education. The development of formulations adapted to patients' needs has greatly facilitated the long-term treatment of these chronic diseases. Further additions to the therapeutic spectrum can be expected in the years to come, including new oral synthetic DMARDs. Even for rare inflammatory rheumatic diseases, various therapeutic options should be available soon, thus increasing these patients' chances of a life with significantly fewer impairments. As German trial sites are participating in many clinical trials on inflammatory rheumatic diseases, there are many opportunities to mediate patients to a trial if the approved treatment options do not prove satisfactory.
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Affiliation(s)
- S Throm
- Verband Forschender Arzneimittelhersteller e. V. (vfa), Hausvogteiplatz 13, 10117, Berlin, Deutschland
| | - R Hömke
- Verband Forschender Arzneimittelhersteller e. V. (vfa), Hausvogteiplatz 13, 10117, Berlin, Deutschland.
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13
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Richter JG, Muth T, Li J, Brinks R, Chehab G, Koch T, Siegrist J, Angerer P, Huscher D, Schneider M. Elevated Psychosocial Stress at Work in Patients with Systemic Lupus Erythematosus and Rheumatoid Arthritis. J Rheumatol 2017; 45:227-234. [DOI: 10.3899/jrheum.170233] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/24/2017] [Indexed: 01/03/2023]
Abstract
Objective.Psychosocial stress at work not only affects the healthy working population, but also workers with chronic diseases. We aimed to investigate the psychosocial work stress levels in patients with systemic lupus erythematosus (SLE) and rheumatoid arthritis (RA).Methods.A cross-sectional study applied the Effort-Reward Imbalance (ERI) questionnaire — an internationally established instrument that measures work stress — to patients with SLE and RA who were capable of work and to a group of controls without these diseases. Participants were recruited through rheumatologists in private practices, hospitals, and from self-help groups by personal communication, paper-based flyers, and online advertisements. Because very few studies tested the ERI’s applicability in patient groups, with a lack of evidence in patients with inflammatory rheumatic diseases, internal consistency and construct validity of the ERI measure were evaluated.Results.Data came from 270 patients with RA and 247 with SLE, and 178 controls. Patients showed elevated psychosocial stress at work compared to controls. Across the total sample and all groups, satisfactory internal consistencies of the scales effort, reward, and overcommitment were obtained (Cronbach’s alpha coefficients > 0.70), and confirmatory factor analysis replicated the theoretical structure of the ERI model (goodness-of-fit index > 0.80).Conclusion.We found elevated psychosocial stress at work in patients with SLE and RA compared to controls by applying the ERI model. Despite some heterogeneity in the sample, we achieved satisfactory psychometric properties of the ERI questionnaire. Our results suggest that the ERI questionnaire is a psychometrically useful tool to be implemented in epidemiological studies of employed patients with SLE and RA.
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Zink A, Braun J, Gromnica-Ihle E, Krause D, Lakomek HJ, Mau W, Müller-Ladner U, Rautenstrauch J, Specker C, Schneider M. [Memorandum of the German Society for Rheumatology on the quality of treatment in rheumatology - Update 2016]. Z Rheumatol 2017; 76:195-207. [PMID: 28364218 DOI: 10.1007/s00393-017-0297-1] [Citation(s) in RCA: 58] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
On behalf of the Steering Committee of the German Society for Rheumatology, in 2016 the Interdisciplinary Commission on Healthcare Quality updated the 2008 memorandum on rheumatological healthcare in Germany. The update considers changes in therapeutic strategies, treatment targets as well as current structures in healthcare and the political framework. It concentrates on examination of the need for rheumatologists with a background in internal medicine and determines the gap between needs and supply. The internist rheumatologist is responsible for the care of patients with inflammatory rheumatic diseases and contributes to the care of patients with severe forms of other musculoskeletal diseases. At least 2 internist rheumatologists are needed for the outpatient care of 100,000 adult inhabitants, equivalent to 1350 rheumatologists in Germany. With currently 776 rheumatologists, we have little more than half of what we need. The German Society for Rheumatology calls for specific requirements planning for rheumatologists in outpatient care in order to decrease the deficit. In acute inpatient care we need specialized hospitals and wards that ensure a high quality of treatment for patients with complex diseases. We need up to 50 beds per 1 million inhabitants. At least 2 full-time internist rheumatologists and 3 further physicians are needed per 30 beds. In inpatient and outpatient rehabilitation we need 40 beds or outpatient places per 1 million inhabitants with at least 1 full-time rheumatologist and 1 further physician. In order to reduce the existing deficits and to cover the increasing future need for rheumatologists, more emphasis has to be laid on primary and secondary education. Chairs for internal rheumatology are needed at each medical university and more positions for postgraduate training in rheumatology should be provided. In all segments of healthcare the treatment aims should be jointly defined between patients and physicians. The patients should be treated in an interdisciplinary network, comprising other medical specialties, health professionals as well as patient organizations.
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Affiliation(s)
- A Zink
- Deutsches Rheuma-Forschungszentrum Berlin, Programmbereich Epidemiologie und Klinik mit Schwerpunkt Rheumatologie und Klinische Immunologie, Charité Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Deutschland.
| | - J Braun
- Rheumazentrum Ruhrgebiet, Herne, Deutschland
| | | | - D Krause
- Internistische und rheumatologische Gemeinschaftspraxis, Gladbeck, Deutschland
| | - H J Lakomek
- Klinik für Rheumatologie und Interdisziplinäre Geriatrie, Universitätszentrum Innere Medizin, Johannes Wesling Klinikum Minden, Minden, Deutschland
| | - W Mau
- Institut für Rehabilitationsmedizin, Medizinische Fakultät, Martin-Luther-Universität Halle-Wittenberg, Halle, Deutschland
| | - U Müller-Ladner
- Lehrstuhl für Innere Medizin mit Schwerpunkt Rheumatologie, Justus-Liebig-Universität Gießen, Gießen, Deutschland
- Abteilung Rheumatologie und klinische Immunologie, Kerckhoff-Klinik GmbH, Bad Nauheim, Deutschland
| | - J Rautenstrauch
- Deutsche Gesellschaft für Rheumatologie, Berlin, Deutschland
| | - C Specker
- Klinik für Rheumatologie & Klinische Immunologie, Rheumazentrum Rhein-Ruhr e.V., St. Josef Krankenhaus (Universitätsklinikum Essen), Essen, Deutschland
| | - M Schneider
- Poliklinik und Funktionsbereich für Rheumatologie, Hiller Forschungszentrum Rheumatologie, Universitätsklinikum Düsseldorf, Düsseldorf, Deutschland
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Mau W, Beyer W, Ehlebracht-König I, Engel JM, Genth E, Lange U. [Treat to participation : Position paper of the German Society for Rheumatology on sustained improvement of functional health of patients with rheumatic and musculoskeletal diseases]. Z Rheumatol 2016; 74:553-7. [PMID: 26238709 DOI: 10.1007/s00393-015-1640-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
From the perspective of patients with rheumatic diseases, the reduction of inflammatory disease activity alone is not a sufficient treatment goal. In addition the functional health and participation also have to be improved. Starting with the first symptoms the empowerment for the self-management of the disease is important for the patients; therefore, the established treat to target-strategy has to be expanded by the functional dimension to treat to participation. The position paper of the German Society for Rheumatology (GSR) summarizes the relevant fields of the multiprofessional action that is frequently necessary. This includes the acquirement of function-related competencies during training, further education and advanced training as well as implementation in the everyday practice of patient care. Furthermore, the GSR acknowledges the need for research related to functional and sociomedical consequences of rheumatic diseases and to individual and combined function-related programs in outpatient and inpatient care in rheumatology.
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Affiliation(s)
- W Mau
- Institut für Rehabilitationsmedizin, Medizinische Fakultät der Martin-Luther-Universität Halle-Wittenberg, 06097, Halle (Saale), Deutschland,
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Huscher D, Thiele K, Rudwaleit M, Albrecht KC, Bischoff S, Krause A, Karberg K, Wassenberg S, Zink A. Trends in treatment and outcomes of ankylosing spondylitis in outpatient rheumatological care in Germany between 2000 and 2012. RMD Open 2015; 1:e000033. [PMID: 26535133 PMCID: PMC4612682 DOI: 10.1136/rmdopen-2014-000033] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2014] [Revised: 04/17/2015] [Accepted: 04/29/2015] [Indexed: 12/17/2022] Open
Abstract
Objectives To describe changes in drug treatment and clinical outcomes of ankylosing spondylitis (AS) during the past decade. Methods The national database of the German collaborative arthritis centres collects clinical and patient-derived data from unselected outpatients with inflammatory rheumatic diseases. Cross-sectional data from 2000 to 2012 of around 1000 patients with AS per year were compared with regard to clinical presentation and quality of life indicators. Results Non-steroidal anti-inflammatory drugs (NSAIDs) have been the predominant treatment choice in AS over the years with a prescription rate of 67% of patients in 2012. Currently, almost half of the patients with AS in German rheumatology centres are treated with tumour necrosis factor inhibitors (TNFi). Often, both treatments are used in combination (33%), followed by combinations of NSAIDs and synthetic disease modifying antirheumatic drugs (sDMARDs) with 23% or TNFi alone (21%). In 2012, 10% of patients each received NSAID or sDMARD monotherapy. Methotrexate, sulfasalazine, glucocorticoids and analgaesics alone or in combination with other treatments were given to 10% of patients, respectively. Over the years, we have seen remarkable improvements in disease control and patient reported outcomes. These developments are consistent with enhanced functional status, increasing employment rates and decreasing sick leave, hospitalisation and work disability. Conclusions In the German rheumatology secondary/tertiary care setting, routine care of patients with AS has changed tremendously during the past decade. Increasingly, more efficacious treatment options are reflected in improved clinical outcomes, quality of life and participation in the labour force.
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Affiliation(s)
- Dörte Huscher
- Epidemiology Unit , German Rheumatism Research Centre, A Leibniz Institute , Berlin , Germany ; Department of Rheumatology and Clinical Immunology , Charité University Hospital Berlin , Berlin , Germany
| | - Katja Thiele
- Epidemiology Unit , German Rheumatism Research Centre, A Leibniz Institute , Berlin , Germany
| | | | | | - Sascha Bischoff
- Epidemiology Unit , German Rheumatism Research Centre, A Leibniz Institute , Berlin , Germany
| | - Andreas Krause
- Department of Rheumatology and Clinical Immunology , Immanuel Krankenhaus Berlin , Berlin , Germany
| | | | | | - Angela Zink
- Epidemiology Unit , German Rheumatism Research Centre, A Leibniz Institute , Berlin , Germany ; Department of Rheumatology and Clinical Immunology , Charité University Hospital Berlin , Berlin , Germany
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Callhoff J, Albrecht K, Schett G, Zink A, Westhoff G. Depression is a stronger predictor of the risk to consider work disability in early arthritis than disease activity or response to therapy. RMD Open 2015; 1:e000020. [PMID: 26509053 PMCID: PMC4612683 DOI: 10.1136/rmdopen-2014-000020] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2014] [Revised: 01/14/2015] [Accepted: 01/18/2015] [Indexed: 11/30/2022] Open
Abstract
Objectives 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.
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Affiliation(s)
- Johanna Callhoff
- Department of Epidemiology , German Rheumatism Research Centre , Berlin , Germany
| | - Katinka Albrecht
- Department of Epidemiology , German Rheumatism Research Centre , Berlin , Germany
| | - Georg Schett
- Department of Internal Medicine , University of Erlangen-Nuremberg , Erlangen , Germany
| | - Angela Zink
- Department of Epidemiology , German Rheumatism Research Centre , Berlin , Germany ; Department of Rheumatology and Clinical Immunology , Charité University Medicine Berlin, Campus Mitte , Berlin , Germany
| | - Gisela Westhoff
- Department of Epidemiology , German Rheumatism Research Centre , Berlin , Germany
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Albrecht K, Huscher D, Richter J, Backhaus M, Bischoff S, Kötter I, Thiele K, Zink A. Changes in referral, treatment and outcomes in patients with systemic lupus erythematosus in Germany in the 1990s and the 2000s. Lupus Sci Med 2014; 1:e000059. [PMID: 25553251 PMCID: PMC4271412 DOI: 10.1136/lupus-2014-000059] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2014] [Revised: 10/22/2014] [Accepted: 11/03/2014] [Indexed: 11/28/2022]
Abstract
Objective To evaluate trends in the referral, treatment and outcome of patients with systemic lupus erythematosus (SLE) in Germany over two decades. Methods From 1993 to 2012, ∼1200 patients with SLE were recorded annually in the national database of the German Collaborative Arthritis Centres. Treatment patterns, healthcare use and outcomes, such as disease activity, function and work participation, were evaluated over time. Furthermore, two distinct cohorts of patients (enrolment 1994–1998, n=467; and 2004–2008, n=376) observed over 5 years were assessed for changes in outcomes. Results The mean disease duration at the first visit to a rheumatologist decreased from 2.6 (1994) to 1.5 (2012) years. Glucocorticoids (69%), antimalarials (56%), azathioprine (22%), non-steroidal anti-inflammatory drugs (23%) and mycophenolate mofetil (15%) were the most frequently used treatments in 2012. A significant increase was observed in the use of antimalarials and mycophenolate mofetil. The use of glucocorticoids at >7.5 mg/day decreased from 27% (1994) to 10% (2012). The average length of sick leave taken due to SLE declined from 9 weeks (1997) to 6 weeks (2012). When comparing the two longitudinal cohorts, in the cohort from the 2000s, the intraindividual decline of disease activity was significantly stronger (p<0.001), and fewer patients retired early (36% vs 46%). Conclusions The disease activity and resource use declined considerably over the observation period, and more patients remained in the labour force. Earlier treatment onset, faster modification of the treatment regimen and more intensive use of anti-inflammatory therapy may account for the improved outcomes in patients with SLE across the years.
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Affiliation(s)
- Katinka Albrecht
- Epidemiology Unit , German Rheumatism Research Centre, A Leibniz Institute, Berlin , Germany
| | - Dörte Huscher
- Epidemiology Unit , German Rheumatism Research Centre, A Leibniz Institute, Berlin , Germany ; Department of Rheumatology and Clinical Immunology , Charité University Hospital , Berlin , Germany
| | - Jutta Richter
- Department of Rheumatology , Heinrich-Heine-University Duesseldorf , Duesseldorf , Germany
| | - Marina Backhaus
- Department of Rheumatology and Clinical Immunology , Charité University Hospital , Berlin , Germany
| | - Sascha Bischoff
- Epidemiology Unit , German Rheumatism Research Centre, A Leibniz Institute, Berlin , Germany
| | - Ina Kötter
- Department of Rheumatology , Robert-Bosch Hospital , Stuttgart , Germany
| | - Katja Thiele
- Epidemiology Unit , German Rheumatism Research Centre, A Leibniz Institute, Berlin , Germany
| | - Angela Zink
- Epidemiology Unit , German Rheumatism Research Centre, A Leibniz Institute, Berlin , Germany ; Department of Rheumatology and Clinical Immunology , Charité University Hospital , Berlin , Germany
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Mau W, Beyer W, Ehlebracht-König I, Engel JM, Genth E, Jäckel WH, Lange U, Thiele K. [Trends in rehabilitation of patients with rheumatic diseases in Germany]. Z Rheumatol 2014; 73:139-48. [PMID: 24659150 DOI: 10.1007/s00393-013-1259-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Recent Deutsche Gesellschaft für Rheumatologie (DGRh, German Society of Rheumatology) guidelines emphasized the significance of coordinated multidisciplinary care and rehabilitation of patients with inflammatory rheumatic diseases. Nationwide data from the German pension insurance funds showed that inpatient rehabilitation due to rheumatoid arthritis (RA) varied by a factor of 2.6 between the different German states. From 2000 to 2012 rehabilitation measures were reduced by one third, most significantly in men with ankylosing spondylitis (AS). Rehabilitation measures because of RA or AS were provided up to 14 times more frequently by the German statutory pension insurance scheme compared with a large compulsory health insurance which is responsible for rehabilitation measures after retirement. In rehabilitation centers with high numbers of patients with inflammatory rheumatic diseases, higher structural and process quality were demonstrated. In 2011 a total of 40 % of RA patients in the national database of the collaborative arthritis centers showed medium or severe functional limitations. Among these disabled RA patients inpatient rehabilitation was reduced by about 50 % between 1995 and 2011. Out of all RA patients from outpatient rheumatology care with severe functional limitations 38 % had no functional restoration therapy within the previous 12 months with a high variation between rheumatologists. Experiences from other European countries may inspire German rheumatologists and other involved health professionals to initiate a wider range of rehabilitative interventions in the future.
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Affiliation(s)
- W Mau
- Institut für Rehabilitationsmedizin, Medizinische Fakultät der Martin-Luther-Universität Halle-Wittenberg, 06097, Halle (Saale), Deutschland,
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Ehlebracht-König I, Dorn M. [Work-related medical rehabilitation for patients with rheumatic diseases]. Z Rheumatol 2013; 73:27-34. [PMID: 24337957 DOI: 10.1007/s00393-013-1207-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
In recent years work-related rehabilitation has been intensified. Several studies have shown the effectiveness of work-related interventions in medical rehabilitation by improving participation in the work force and reducing sick leave. The German pension insurance fund has developed standardized requirements for medical work-related rehabilitation which include diagnostic procedures to identify patients with specific occupational problems and vocation-related interventions. These requirements address patients across different indications and diagnoses. Rehabilitation centers are assigned to different levels of work-related interventions depending on the intensity and specificity of the profile. Centers providing the complete range of work-related interventions offer differentiated work-related diagnostics, job training and occupational groups in addition to general social advice. In this article four case studies with different priorities regarding vocational interventions are presented.
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Affiliation(s)
- I Ehlebracht-König
- Schwerpunktklinik für Orthopädie und Rheumatologie, Rehazentrum Bad Eilsen, Brunnenpromenade 2, 31707, Bad Eilsen, Deutschland,
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