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Alberti C, Dreher M, Triantafyllias K, Schwarting A. [Current patient care of systematic lupus erythematosus in Rhineland-Palatinate and Saarland]. Z Rheumatol 2024:10.1007/s00393-024-01491-1. [PMID: 38509358 DOI: 10.1007/s00393-024-01491-1] [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: 02/04/2024] [Indexed: 03/22/2024]
Abstract
BACKGROUND Systemic lupus erythematosus (SLE) is a clinically heterogeneous autoimmune disease that is associated with great suffering for those affected, as well as high socioeconomic costs. Early diagnosis and adequate medical care are essential for a mild course of the disease. However, there is a lack of current figures and data on the care situation of patients in the area. METHODOLOGY A total of 1546 general practitioners, rheumatologists, neurologists, nephrologists and dermatologists in Rhineland-Palatinate and Saarland were interviewed by fax or mail using a questionnaire regarding epidemiology, symptoms, therapy and therapy success. In addition, there was the possibility of making suggestions for improvement. RESULTS Five out of six of the 635 reported SLE patients were female. The most common main symptoms were arthralgia, fatigue, myalgia, and skin changes. Of the patients, 68% received antimalarials (AMs), whereas 46% were treated with glucocorticoids (GCs) and 50% with an immunosuppressant (IS), mainly methotrexate. In terms of comorbidities, patients suffered mainly from cardiovascular disease, fibromyalgia syndrome and depression. Rheumatologists also frequently described anaemia, diabetes mellitus and osteoporosis. DISCUSSION Compared with guideline recommendations, the low rate of AMs in therapy was particularly striking in patients not treated by rheumatologists (35% on average compared with 81% for rheumatologists). Additionally, (sustained) high doses of GCs are not in line with literature recommendations. In the free text field, the main requests were for more rheumatologists in private practice and faster appointment scheduling, as well as better communication and networking. In addition, the desire for more training and education was frequently expressed..
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Affiliation(s)
- Ciaran Alberti
- Schwerpunkt Rheumatologie und klinische Immunologie, Universitätsmedizin, Johannes Gutenberg-Universität Mainz, Langenbeckstraße 1, 55131, Mainz, Deutschland
| | - Matthias Dreher
- Schwerpunkt Rheumatologie und klinische Immunologie, Universitätsmedizin, Johannes Gutenberg-Universität Mainz, Langenbeckstraße 1, 55131, Mainz, Deutschland
- Universitäres Centrum für Autoimmunität, Universitätsmedizin, Johannes Gutenberg-Universität Mainz, Mainz, Deutschland
| | - Konstantinos Triantafyllias
- Schwerpunkt Rheumatologie und klinische Immunologie, Universitätsmedizin, Johannes Gutenberg-Universität Mainz, Langenbeckstraße 1, 55131, Mainz, Deutschland
- RZ Rheumakliniken Rheinland-Pfalz GmbH, Bad Kreuznach, Deutschland
| | - Andreas Schwarting
- Schwerpunkt Rheumatologie und klinische Immunologie, Universitätsmedizin, Johannes Gutenberg-Universität Mainz, Langenbeckstraße 1, 55131, Mainz, Deutschland.
- RZ Rheumakliniken Rheinland-Pfalz GmbH, Bad Kreuznach, Deutschland.
- Universitäres Centrum für Autoimmunität, Universitätsmedizin, Johannes Gutenberg-Universität Mainz, Mainz, Deutschland.
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2
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Henes J, Richter JG, Thiele K, Kiltz U, Callhoff J, Albrecht K. Trends in health care of patients with vasculitides, including giant cell arteritis, Takayasu arteritis, ANCA-associated vasculitis and Behçet's disease: cross-sectional data of the German National Database 2007-2021. Rheumatol Int 2024; 44:497-507. [PMID: 38180499 PMCID: PMC10866751 DOI: 10.1007/s00296-023-05508-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Accepted: 11/08/2023] [Indexed: 01/06/2024]
Abstract
The aim of this study is to present the current care situation of patients with giant cell arteritis (GCA), Takayasu arteritis (TAK), ANCA-associated vasculitis (AAV) and Behçet's disease (BD). Trends over the last 15 years will reflect improvements and remaining deficits in the management of vasculitides. Consecutive cross-sectional data from patients with vasculitides from the German National Database (NDB) of the Collaborative Arthritis Centres between 2007 and 2021 were included. Medication, physician- and patient-reported outcomes on disease activity and disease burden, inpatient stays and occupational participation are compared for different vasculitis entities and over time. Employment rates were compared to German population rates. Between 502 and 854 vasculitis patients were annually documented. GCA and AAV were the most common vasculitides. Median disease duration ranged from 2 to 16 years. Over the years, glucocorticoids decreased in proportion and dose, most markedly in GCA and TAK, while biologic therapies increased up to 27%. Physicians rated disease activity as low for the vast majority of patients, while patients-reported moderate outcomes in many dimensions. PROs remained largely unchanged. The proportion of employed patients (< 65 years) increased from 47 to 57%. In recent years, biologics are increasingly used in patients with vasculitides, while glucocorticoids decreased significantly. PRO's have not improved. Work participation increased but remains lower than that in the German population.
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Affiliation(s)
- Jörg Henes
- Centre for Interdisciplinary Clinical Immunology, Rheumatology and Autoimmune Diseases and Internal Medicine II, University Hospital Tübingen, Tübingen, Germany
| | - Jutta G Richter
- Department of Rheumatology, Faculty of Medicine, University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
- Faculty of Medicine, Hiller Research Centre Rheumatology, University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Katja Thiele
- Programme Area Epidemiology and Health Services Research, German Rheumatism Research Centre Berlin, Berlin, Germany
| | - Uta Kiltz
- Ruhr Universität Bochum, Rheumazentrum Ruhrgebiet, Herne, Germany
| | - Johanna Callhoff
- Programme Area Epidemiology and Health Services Research, German Rheumatism Research Centre Berlin, Berlin, Germany
- Institute of Social Medicine, Epidemiology and Health Economics, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Katinka Albrecht
- Programme Area Epidemiology and Health Services Research, German Rheumatism Research Centre Berlin, Berlin, Germany.
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3
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Braun J, Krause A, Schulze-Koops H, Haase I, Kötter I, Hoyer BF, Aringer M, Krusche M, Voormann AJ, Wagner U, Schwarting A, Specker C. [Discipline-specific assessment of the report of the German Society of Internal Medicine e.V. (DGIM) on depiction of the treatment landscape in the field of internal medicine in Germany by the German Society for Rheumatology e.V. (DGRh)]. Z Rheumatol 2023; 82:798-813. [PMID: 37493709 DOI: 10.1007/s00393-023-01375-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/27/2023]
Affiliation(s)
- Jürgen Braun
- Deutsche Gesellschaft für Rheumatologie, Wilhelmine-Gemberg-Weg 6, 10179, Berlin, Deutschland
- c/o Praxis Dr. Karberg, Schlossstr. 110, 12163, Berlin, Deutschland
- Ruhr Universität Bochum, Bochum, Deutschland
| | - Andreas Krause
- Deutsche Gesellschaft für Rheumatologie, Wilhelmine-Gemberg-Weg 6, 10179, Berlin, Deutschland
- Abteilung Rheumatologie, Klinische Immunologie und Osteologie, Immanuel Krankenhaus Berlin, Berlin, Deutschland
| | - Hendrik Schulze-Koops
- Deutsche Gesellschaft für Rheumatologie, Wilhelmine-Gemberg-Weg 6, 10179, Berlin, Deutschland
- Sektion Rheumatologie und Klinische Immunologie, Medizinische Klinik und Poliklinik IV, Klinikum der Universität München, LMU München, München, Deutschland
| | - Isabell Haase
- Deutsche Gesellschaft für Rheumatologie, Wilhelmine-Gemberg-Weg 6, 10179, Berlin, Deutschland
- Klinik für Rheumatologie und Hiller Forschungszentrum, Universitätsklinikum Düsseldorf, Düsseldorf, Deutschland
| | - Ina Kötter
- Deutsche Gesellschaft für Rheumatologie, Wilhelmine-Gemberg-Weg 6, 10179, Berlin, Deutschland
- Klinik für Rheumatologie und Immunologie am Klinikum Bad Bramstedt und Sektion für Rheumatologie und Entzündliche Systemerkrankungen in der III. Medizin des Universitätsklinikum Eppendorf (UKE), Hamburg, Deutschland
| | - Bimba Franziska Hoyer
- Deutsche Gesellschaft für Rheumatologie, Wilhelmine-Gemberg-Weg 6, 10179, Berlin, Deutschland
- Sektion Rheumatologie und Exzellenzzentrum für Entzündungsmedizin des Universitätsklinikum Schleswig-Holstein, Christian-Albrechts-Universität zu Kiel, Kiel, Deutschland
| | - Martin Aringer
- Deutsche Gesellschaft für Rheumatologie, Wilhelmine-Gemberg-Weg 6, 10179, Berlin, Deutschland
- Abteilung Rheumatologie, Medizinische Klinik und Poliklinik III, Universitätsklinikum Carl Gustav Carus Dresden, Dresden, Deutschland
| | - Martin Krusche
- Deutsche Gesellschaft für Rheumatologie, Wilhelmine-Gemberg-Weg 6, 10179, Berlin, Deutschland
- Klinik für Rheumatologie und Immunologie am Klinikum Bad Bramstedt und Sektion für Rheumatologie und Entzündliche Systemerkrankungen in der III. Medizin des Universitätsklinikum Eppendorf (UKE), Hamburg, Deutschland
| | - Anna Julia Voormann
- Deutsche Gesellschaft für Rheumatologie, Wilhelmine-Gemberg-Weg 6, 10179, Berlin, Deutschland.
| | - Ulf Wagner
- Deutsche Gesellschaft für Rheumatologie, Wilhelmine-Gemberg-Weg 6, 10179, Berlin, Deutschland
- Bereich Rheumatologie an der Klinik für Endokrinologie, Nephrologie und Rheumatologie, Universitätsklinikum Leipzig, Leipzig, Deutschland
| | - Andreas Schwarting
- Abteilung Rheumatologie und klinische Immunologie, I. Medizinische Klinik der Universität Mainz, Mainz, Deutschland
| | - Christof Specker
- Deutsche Gesellschaft für Rheumatologie, Wilhelmine-Gemberg-Weg 6, 10179, Berlin, Deutschland
- Klinik für Rheumatologie und Klinische Immunologie, KEM | Evangelische Kliniken Essen-Mitte gGmbH, Essen, Deutschland
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4
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Braun J, Specker C, Schulze-Koops H, Haase I, Kötter I, Hoyer B, Aringer M, Krusche M, Voormann A, Wagner U, Krause A. [Position paper of the German Society of Rheumatology e.V. (DGRh) regarding the situation of advanced training in the discipline of rheumatology in Germany]. Z Rheumatol 2023; 82:615-620. [PMID: 37335384 DOI: 10.1007/s00393-023-01349-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/27/2023] [Indexed: 06/21/2023]
Affiliation(s)
- J Braun
- Deutschen Gesellschaft für Rheumatologie e. V., Wilhelmine-Gemberg-Weg 6, 10179, Berlin, Deutschland
- c/o Praxis Dr. Karberg, Schlossstr. 110, 12163, Berlin, Deutschland
- Ruhr Universität Bochum, Bochum, Deutschland
| | - C Specker
- Deutschen Gesellschaft für Rheumatologie e. V., Wilhelmine-Gemberg-Weg 6, 10179, Berlin, Deutschland
- Klinik für Rheumatologie und Klinische Immunologie, KEM | Evangelische Kliniken Essen-Mitte gGmbH, Essen, Deutschland
| | - H Schulze-Koops
- Deutschen Gesellschaft für Rheumatologie e. V., Wilhelmine-Gemberg-Weg 6, 10179, Berlin, Deutschland
- Sektion Rheumatologie und Klinische Immunologie, Medizinische Klinik und Poliklinik IV, Klinikum der Universität München, LMU München, München, Deutschland
| | - I Haase
- Deutschen Gesellschaft für Rheumatologie e. V., Wilhelmine-Gemberg-Weg 6, 10179, Berlin, Deutschland
- Klinik für Rheumatologie und Hiller Forschungszentrum, Universitätsklinikum Düsseldorf, Düsseldorf, Deutschland
| | - I Kötter
- Deutschen Gesellschaft für Rheumatologie e. V., Wilhelmine-Gemberg-Weg 6, 10179, Berlin, Deutschland
- Klinik für Rheumatologie und Immunologie am Klinikum Bad Bramstedt und Sektion für Rheumatologie und Entzündliche Systemerkrankungen in der III. Medizin des Universitätsklinikum Eppendorf (UKE), Hamburg, Deutschland
| | - B Hoyer
- Deutschen Gesellschaft für Rheumatologie e. V., Wilhelmine-Gemberg-Weg 6, 10179, Berlin, Deutschland
- Sektion Rheumatologie und Exzellenzzentrum für Entzündungsmedizin, Universitätsklinikum Schleswig-Holstein, Christian-Albrechts-Universität, Kiel, Deutschland
| | - M Aringer
- Deutschen Gesellschaft für Rheumatologie e. V., Wilhelmine-Gemberg-Weg 6, 10179, Berlin, Deutschland
- Abteilung Rheumatologie, Medizinische Klinik und Poliklinik III, Universitätsklinikum Carl Gustav Carus Dresden, Dresden, Deutschland
| | - M Krusche
- Deutschen Gesellschaft für Rheumatologie e. V., Wilhelmine-Gemberg-Weg 6, 10179, Berlin, Deutschland
- Klinik für Rheumatologie und Immunologie am Klinikum Bad Bramstedt und Sektion für Rheumatologie und Entzündliche Systemerkrankungen in der III. Medizin des Universitätsklinikum Eppendorf (UKE), Hamburg, Deutschland
| | - A Voormann
- Deutschen Gesellschaft für Rheumatologie e. V., Wilhelmine-Gemberg-Weg 6, 10179, Berlin, Deutschland.
| | - U Wagner
- Deutschen Gesellschaft für Rheumatologie e. V., Wilhelmine-Gemberg-Weg 6, 10179, Berlin, Deutschland
- Bereich Rheumatologie an der Klinik für Endokrinologie, Nephrologie und Rheumatologie, Universitätsklinikum Leipzig, Leipzig, Deutschland
| | - A Krause
- Deutschen Gesellschaft für Rheumatologie e. V., Wilhelmine-Gemberg-Weg 6, 10179, Berlin, Deutschland
- Abteilung Rheumatologie, Klinische Immunologie und Osteologie, Immanuel Krankenhaus Berlin, Berlin, Deutschland
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Kernder A, Thiele K, Chehab G, Schneider M, Callhoff J. Time interval between the onset of connective tissue disease symptoms and first contact with a rheumatologist: results from the German National Database of collaborative arthritis centers. Rheumatol Int 2023; 43:1453-1458. [PMID: 37258745 PMCID: PMC10261230 DOI: 10.1007/s00296-023-05335-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Accepted: 04/20/2023] [Indexed: 06/02/2023]
Abstract
The long-term outcome of connective tissue diseases is associated with the time from symptom onset to diagnosis. To understand gaps in care, we determine whether the length of time between symptom onset and first presentation to a rheumatologist has changed in Germany in recent decades. We analyzed data on patients diagnosed with connective tissue diseases (n = 19,662) collected from the German National Database of the Regional Cooperative Rheumatology Centers. We reviewed the onset of relevant symptoms listed at first presentations from 1993 to 2018 and performed a quantitative analysis of the intervals until first presentation to a rheumatologist. We compared time intervals and performed a linear mixed regression model with random effects to identify associated factors. Although the interval between the onset of symptoms and first presentation to a rheumatologist has diminished since 1980 for all connective tissue diseases, there has been no relevant improvement during the past 2 decades. The interval between symptoms and presentation increases with patients age for all connective tissue diseases (e.g., Systemic sclerosis; for each 10-year-increment of patients age: β 0.41, CI 0.38; 0.44). Among those diagnosed with systemic sclerosis, the mean interval was 1.5 years (95% CI 1.1; 1.8) for male patients and 2.6 years (95% CI 2.4; 2.8) for females. Patients presenting with different degrees of disease severity on their first visits and with different educational levels had similar mean intervals between symptoms and first presentation regardless of their final diagnoses. Over the past 2 decades, the time to first consultation with a rheumatologist has not continued to improve in Germany, but has stagnated at the same level. Selected patient subgroups, such as older patients with suspected connective tissue diseases and female patients with suspected systemic sclerosis, are at risk to present late and may in particular benefit from an earlier referral to a rheumatologist.
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Affiliation(s)
- Anna Kernder
- Department of Rheumatology, University Hospital Düsseldorf, Medical Faculty of Heinrich Heine University, Düsseldorf, Germany
- Hiller Research Center, University Hospital Düsseldorf, Medical Faculty of Heinrich Heine University, 40224, Düsseldorf, Germany
| | - Katja Thiele
- German Rheumatism Research Centre Berlin (DRFZ), Charitéplatz 1, 10117, Berlin (Mitte), Germany
| | - Gamal Chehab
- Department of Rheumatology, University Hospital Düsseldorf, Medical Faculty of Heinrich Heine University, Düsseldorf, Germany.
- Hiller Research Center, University Hospital Düsseldorf, Medical Faculty of Heinrich Heine University, 40224, Düsseldorf, Germany.
| | - Matthias Schneider
- Department of Rheumatology, University Hospital Düsseldorf, Medical Faculty of Heinrich Heine University, Düsseldorf, Germany
- Hiller Research Center, University Hospital Düsseldorf, Medical Faculty of Heinrich Heine University, 40224, Düsseldorf, Germany
| | - Johanna Callhoff
- German Rheumatism Research Centre Berlin (DRFZ), Charitéplatz 1, 10117, Berlin (Mitte), Germany
- Institute of Social Medicine, Epidemiology and Health Economics, Charité-Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany
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Callhoff J, Feuchtenberger M, Karberg K, Kiltz U, Aringer M, Baraliakos X, Muth T, Regierer AC, Richter JG, Thiele K, Zinke S, Albrecht K. [With RheMIT rheumatology centers can participate in the German national database-Expansion of the long-term rheumatological documentation]. Z Rheumatol 2023:10.1007/s00393-023-01373-y. [PMID: 37280334 PMCID: PMC10382348 DOI: 10.1007/s00393-023-01373-y] [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: 04/18/2023] [Indexed: 06/08/2023]
Abstract
The national database (NDB) of the German regional collaborative rheumatology centers was switched to the RheMIT documentation software last year. Rheumatology centers that already use RheMIT for care contracts or other research projects can therefore use the software to also participate in the NDB. Experiences from a hospital, a medical care center and a specialist practice show how the changeover to RheMIT from an existing documentation system or a new participation in the NDB with RheMIT can be implemented. The NDB team at the German Rheumatism Research Center in Berlin (DRFZ) welcomes new participating rheumatology centers.
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Affiliation(s)
- Johanna Callhoff
- Programmbereich Epidemiologie und Versorgungsforschung, Deutsches Rheuma-Forschungszentrum Berlin, Charitéplatz 1, 10117, Berlin, Deutschland.
- Institut für Sozialmedizin, Epidemiologie und Gesundheitsökonomie, Charité - Universitätsmedizin Berlin, Berlin, Deutschland.
| | - Martin Feuchtenberger
- Med. Versorgungszentren Burghausen - Altötting, MED BAYERN OST GmbH, Burghausen, Deutschland
| | | | - Uta Kiltz
- Ruhr-Universität Bochum, Rheumazentrum Ruhrgebiet, Herne, Deutschland
| | - Martin Aringer
- Rheumatologie, Medizinische Klinik und Poliklinik III, Universitätsklinikum und Medizinische Fakultät Carl Gustav Carus, Technische Universität Dresden, Dresden, Deutschland
| | | | - Theresia Muth
- BDRh Service-GmbH, Grünwald bei München, Deutschland
| | - Anne C Regierer
- Programmbereich Epidemiologie und Versorgungsforschung, Deutsches Rheuma-Forschungszentrum Berlin, Charitéplatz 1, 10117, Berlin, Deutschland
| | - Jutta G Richter
- Klinik für Rheumatologie, Medizinische Fakultät, Universitätsklinikum Düsseldorf, Heinrich-Heine-Universität Düsseldorf, Düsseldorf, Deutschland
- Hiller Forschungszentrum Rheumatologie, Medizinische Fakultät, Universitätsklinikum Düsseldorf, Heinrich-Heine-Universität Düsseldorf, Düsseldorf, Deutschland
| | - Katja Thiele
- Programmbereich Epidemiologie und Versorgungsforschung, Deutsches Rheuma-Forschungszentrum Berlin, Charitéplatz 1, 10117, Berlin, Deutschland
| | - Silke Zinke
- Rheumatologische Praxis Berlin, Berlin, Deutschland
| | - Katinka Albrecht
- Programmbereich Epidemiologie und Versorgungsforschung, Deutsches Rheuma-Forschungszentrum Berlin, Charitéplatz 1, 10117, Berlin, Deutschland
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Henry K, Nepal D, Valley E, Pedersen C, Duarte-García A, Putman M. Comparative Efficacy Randomized Controlled Trials in Rheumatology Guidelines. ACR Open Rheumatol 2022; 4:897-902. [PMID: 35892138 PMCID: PMC9555191 DOI: 10.1002/acr2.11484] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Revised: 06/06/2022] [Accepted: 06/10/2022] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND Comparative efficacy randomized controlled trials (RCTs) compare two active interventions in a head-to-head design. They are useful for informing clinical practice guidelines, but the degree to which such trials inform clinical practice guidelines in rheumatology is unknown. METHODS The American College of Rheumatology (ACR) and European Alliance of Associations for Rheumatology (EULAR) websites were searched from January 1, 2017, to June 12, 2021, for clinical practice guidelines. RCTs referenced by each guideline were identified, and information regarding design and outcomes were extracted. Clinical practice recommendations from each guideline were also analyzed. RESULTS Fifteen ACR- and nine EULAR-endorsed guidelines were included, which cited 609 RCTs and provided 481 recommendations. Referenced RCTs enrolled an average of 418 patients (SD 985), most commonly evaluated biologic/targeted synthetic disease-modifying antirheumatic drugs (70.1%), and infrequently used a head-to-head design (28%). A minority of recommendations received a high level of evidence (LOE) by the Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) methodology (2.9%) or an "A" grade by the Oxford Centre for Evidence based Medicine Standards (OCEBM) methodology (28.9%). LOE was higher for recommendations informed by RCTs (P < 0.001) or head-to-head RCTs (P = 0.008). Many recommendations received a strong recommendation despite low (8 [2.6%]) or very low (25 [8.3%]) LOE. CONCLUSION Less than one in six rheumatology guideline recommendations are informed by head-to-head RCTs. Recommendations that were informed by head-to-head RCTs were more likely to have a high LOE by both GRADE and OCEBM. Efforts to introduce more comparative efficacy RCTs should be undertaken.
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Thiele K, Albrecht K, Zink A, Aringer M, Karberg K, Späthling-Mestekemper S, von Hinüber U, Callhoff J. Is the Rheumatoid Arthritis Impact of Disease (RAID) score a meaningful instrument for other inflammatory rheumatic diseases? A cross-sectional analysis of data from the German National Database. RMD Open 2022; 8:rmdopen-2022-002342. [PMID: 35793877 PMCID: PMC9260848 DOI: 10.1136/rmdopen-2022-002342] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Accepted: 06/09/2022] [Indexed: 11/12/2022] Open
Abstract
To analyse the performance of the rheumatoid arthritis impact of disease (RAID) score in patients with ankylosing spondylitis, polymyalgia rheumatica, systemic lupus erythematosus, primary Sjögren’s syndrome, idiopathic inflammatory myositis and systemic sclerosis, as compared with rheumatoid arthritis (RA).
Methods
A total of 12 398 patients from the German National Database were included. For each diagnosis, we calculated age-adjusted/sex-adjusted partial correlation coefficients between RAID and patient global (PtGl) health, PtGl disease activity, physician global (PhGl) disease activity, Well-Being Index (WHO-5) and EuroQoL-5 Dimensions (EQ-5D). As a measure of agreement, the mean differences between the RAID and other outcomes were compared with the respective differences for RA. The effect of each diagnosis on the difference between RAID and the other scores was assessed with linear regression, with RA as the reference.
Results
Across all diagnoses, RAID correlated strongly with PtGl health (0.71–0.83), moderately to strongly with PtGl disease activity (0.59–0.79), WHO-5 (0.65–0.81) and EQ-5D (0.68–0.73) and weakly with PhGl disease activity (0.23–0.38). Mean differences were calculated for RAID and PtGl disease activity (0 to −0.6), PtGl health (−0.4 to −0.9), WHO-5 (−0.7 to −1.3), EQ-5D (1.1 to 1.7) and PhGl disease activity (1.4 to 2.2). Discrepancies between other scores and RAID were comparable to RA. Linear regression revealed no clinically relevant effect of any of the diagnoses on the difference between RAID and the other outcomes.
Conclusion
The RAID score performs comparably across all diagnoses investigated. This supports the use of RAID for measuring the impact also of other rheumatic diseases.
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Affiliation(s)
- Katja Thiele
- Epidemiology and Health Services Research, German Rheumatism Research Center Berlin, Berlin, Germany
| | - Katinka Albrecht
- Epidemiology and Health Services Research, German Rheumatism Research Center Berlin, Berlin, Germany
| | - Angela Zink
- Epidemiology and Health Services Research, German Rheumatism Research Center Berlin, Berlin, Germany
| | - Martin Aringer
- Devision of Rheumatology, Department of Medicine III, University Medical Center and Faculty of Medicine Carl Gustav Carus at the TU Dresden, Dresden, Germany
| | - Kirsten Karberg
- Rheumatology and Internal Medicine, Practice Berlin, Berlin, Germany
| | | | | | - Johanna Callhoff
- Epidemiology and Health Services Research, German Rheumatism Research Center Berlin, Berlin, Germany.,Institute for Social Medicine, Epidemiology and Health Economics, Charité-Universitätsmedizin Berlin, Berlin, Germany
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9
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Strangfeld A, Albrecht K, Regierer A, Callhoff J, Zink A, Minden K. [Celebrating 33 years of the DRFZ: Epidemiology and Health Services Research]. Z Rheumatol 2022; 81:642-651. [PMID: 35380251 PMCID: PMC8980768 DOI: 10.1007/s00393-022-01187-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/25/2021] [Indexed: 11/18/2022]
Abstract
Der wissenschaftliche Fokus des Programmbereichs Epidemiologie und Versorgungsforschung des DRFZ liegt einerseits auf der Erforschung der Versorgungssituation rheumakranker Menschen in Deutschland einschließlich ihrer Defizite, Fortschritte und zeitlichen Trends. Andererseits ist ein wesentliches Ziel, durch die langfristige Beobachtung von Krankheitsverläufen in großen Kohorten Risikofaktoren für ungünstige Krankheitsverläufe, aber auch protektive Faktoren aufzudecken. Mit der Zulassung innovativer, zielgerichteter Therapien zu Beginn dieses Jahrtausends wurde die Thematik der Sicherheit und Wirksamkeit der verschiedenen antirheumatischen Therapien unter Alltagsbedingungen zu einer für Ärzte und Patienten vorrangigen Frage. Die Biologika-Register entwickelten sich zu zentralen Instrumenten des Programmbereichs, mit denen Fragen zur vergleichenden Therapiesicherheit, aber auch zur Therapiewirksamkeit und Reduktion von Risiken durch wirksame Therapie, belastbar beantwortet werden können. Im vorliegenden Artikel werden ausgewählte Ergebnisse epidemiologischer Forschung am DRFZ dargestellt. Das übergreifende Ziel der Forschung war und ist es, zur Verbesserung der Lebensqualität rheumakranker Kinder und Erwachsener beizutragen. Dem dient die klinisch-evaluative Versorgungsforschung ebenso wie die Gewinnung von Erkenntnissen, die eine wirksame, individualisierte Therapie unterstützen. Als unverzichtbare Instrumente haben sich große, langfristige Patientenkohorten und ein stabiles Netzwerk mit den klinisch tätigen Rheumatologen und Betroffenen erwiesen.
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Affiliation(s)
- Anja Strangfeld
- Programmbereich Epidemiologie und Versorgungsforschung, Deutsches Rheuma-Forschungszentrum Berlin, Charitéplatz 1, 10117, Berlin, Deutschland. .,Medizinische Klinik mit Schwerpunkt Rheumatologie und Klinische Immunologie, Charité - Universitätsmedizin Berlin, Berlin, Deutschland.
| | - Katinka Albrecht
- Programmbereich Epidemiologie und Versorgungsforschung, Deutsches Rheuma-Forschungszentrum Berlin, Charitéplatz 1, 10117, Berlin, Deutschland
| | - Anne Regierer
- Programmbereich Epidemiologie und Versorgungsforschung, Deutsches Rheuma-Forschungszentrum Berlin, Charitéplatz 1, 10117, Berlin, Deutschland
| | - Johanna Callhoff
- Programmbereich Epidemiologie und Versorgungsforschung, Deutsches Rheuma-Forschungszentrum Berlin, Charitéplatz 1, 10117, Berlin, Deutschland
| | - Angela Zink
- Programmbereich Epidemiologie und Versorgungsforschung, Deutsches Rheuma-Forschungszentrum Berlin, Charitéplatz 1, 10117, Berlin, Deutschland
| | - Kirsten Minden
- Programmbereich Epidemiologie und Versorgungsforschung, Deutsches Rheuma-Forschungszentrum Berlin, Charitéplatz 1, 10117, Berlin, Deutschland.,Medizinische Klinik mit Schwerpunkt Rheumatologie und Klinische Immunologie, Charité - Universitätsmedizin Berlin, Berlin, Deutschland
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10
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Abstract
Biologics are an integral part of modern strategies for treatment of rheumatoid arthritis (RA) and spondylarthritis (SpA), including psoriatic arthritis (PsA). Biologics are biotechnologically produced proteins that have inhibiting effects on humoral and cellular components of rheumatic inflammation. Substance classes used in rheumatology are tumor necrosis factor (TNF)-alpha, interleukin (IL)-1, IL‑6, IL-12, IL-17 and IL-23 inhibitors effective against cytokines as well as the T lymphocyte activation inhibitor abatacept and the B lymphocyte-depleting rituximab. There are clear recommendations for the use of biologics for RA patients inadequately responding to one or more conventional synthetic disease-modifying antirheumatic drugs and for ankylosing spondylitis (AS) and nonradiographical axial SpA patients with an inadequate response to at least two nonsteroidal antirheumatic drugs. For PsA the recommended use depends on the most prominent manifestations in each case. Treatment with biologics should follow the treat to target principle, with a defined and validated treatment target. Treatment in cases of RA and SpA should target remission or at least a low or minimum disease activity. The safety of treatment with biologics has been intensively investigated. There are very specific contraindications for individual substance classes with a focus on an increased risk of infections. The standard procedure before starting treatment with biologics includes the exclusion of latent tuberculosis and hepatitis B. The TNF-alpha inhibitors have a protective effect with respect to myocardial infarction, stroke and venous thromboembolism.
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11
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Richter JG, Weiß A, Bungartz C, Fischer-Betz R, Zink A, Schneider M, Strangfeld A. Mobile Responsive App-A Useful Additional Tool for Data Collection in the German Pregnancy Register Rhekiss? Front Med (Lausanne) 2022; 8:773836. [PMID: 34977074 PMCID: PMC8718637 DOI: 10.3389/fmed.2021.773836] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Accepted: 11/15/2021] [Indexed: 12/21/2022] Open
Abstract
Background: The German pregnancy register Rhekiss is designed as a nationwide, web-based longitudinal observational cohort established in 2015. The register follows women with inflammatory rheumatic disease prospectively from child wish or early pregnancy until 2 years post-partum. Information on clinical and laboratory parameters, drug treatment, and (adverse) pregnancy outcomes are documented in pre-specified intervals. Physicians and patients report data for the same time periods via separated accounts and forms into a web-based application (app). As data entry on mobile devices might improve response rates of patients, a responsive app as a further convenient documentation option was developed. Methods: The Rhekiss-app is available for self-reported data retrieval since August 2017 from the App stores. For the current analysis, Rhekiss register data were used from the start of the register until 30 September 2020. The analyses were performed for forms containing information on devices. Outcome parameters were compared for mobile and desktop users for the quantity and quality of filled forms. Results: In total, 5,048 forms were received and submitted by 966 patients. About 57% of forms were sent from mobile devices with the highest numbers in patients with child wishes (63%). Users of mobile devices were slightly younger and often had less high-education level (62 vs. 79%) compared with desktop users. The proportion of forms submitted via mobile devices increased steadily from 48% in the fourth quarter of 2018 to 64% in the third quarter of 2020. The proportion of forms received before and after the Rhekiss-app implementation increased with the highest increase of 12% for forms filled at time point 12 months post-partum. Mobile users submitted significantly more forms than desktop users (2.9 vs. 2.1), data sent via desktops were more often complete (88 vs. 86%). Conclusion: The responsive app is a valuable additional tool for data collection and is well-accepted by patients as indicated by its increasing use in Rhekiss. Apart from desktop/browser developments, the technological adoptions within observational cohorts and registries should take smartphone requirements and developments into account, especially when patient-reported data in young, mobile patients are collected, bearing in mind that data quality could be compromised and concepts for improving data quality should be implemented.
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Affiliation(s)
- Jutta G Richter
- Policlinic for Rheumatology and Hiller Research Unit for Rheumatology, Medical Faculty, Heinrich-Heine-University Duesseldorf, University Clinic, Düsseldorf, Germany
| | - Anja Weiß
- Epidemiology Unit, German Rheumatism Research Center (DRFZ), Berlin, Germany
| | - Christina Bungartz
- Epidemiology Unit, German Rheumatism Research Center (DRFZ), Berlin, Germany
| | - Rebecca Fischer-Betz
- Policlinic for Rheumatology and Hiller Research Unit for Rheumatology, Medical Faculty, Heinrich-Heine-University Duesseldorf, University Clinic, Düsseldorf, Germany
| | - Angela Zink
- Epidemiology Unit, German Rheumatism Research Center (DRFZ), Berlin, Germany
| | - Matthias Schneider
- Policlinic for Rheumatology and Hiller Research Unit for Rheumatology, Medical Faculty, Heinrich-Heine-University Duesseldorf, University Clinic, Düsseldorf, Germany
| | - Anja Strangfeld
- Epidemiology Unit, German Rheumatism Research Center (DRFZ), Berlin, Germany
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12
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Albrecht K, Redeker I, Aringer M, Marschall U, Strangfeld A, Callhoff J. Comorbidity and healthcare utilisation in persons with incident systemic lupus erythematosus followed for 3 years after diagnosis: analysis of a claims data cohort. Lupus Sci Med 2021; 8:8/1/e000526. [PMID: 34433613 PMCID: PMC8388287 DOI: 10.1136/lupus-2021-000526] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 08/13/2021] [Indexed: 11/09/2022]
Abstract
Objective To analyse comorbidity and healthcare utilisation in individuals with SLE. Methods A 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. Results Among 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. Conclusion Comorbidities 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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Affiliation(s)
- Katinka Albrecht
- Epidemiology Unit, German Rheumatism Research Centre, Berlin, Germany
| | - Imke Redeker
- Epidemiology Unit, German Rheumatism Research Centre, Berlin, Germany
| | - Martin Aringer
- Division of Rheumatology, Department of Medicine III, University Medical Center and Faculty of Medicine Carl Gustav Carus at the TU Dresden, Dresden, Germany
| | - Ursula Marschall
- Institute for Health System Research, Barmer, Wuppertal, Germany
| | - Anja Strangfeld
- Epidemiology Unit, German Rheumatism Research Centre, Berlin, Germany
| | - Johanna Callhoff
- Epidemiology Unit, German Rheumatism Research Centre, Berlin, Germany.,Institute for Social Medicine, Epidemiology and Health Economics, Charité Universitätsmedizin, Berlin, Germany
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13
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Prescription of analgesics in patients with rheumatic diseases in Germany : A claims data analysis. Z Rheumatol 2021; 80:68-75. [PMID: 33825975 PMCID: PMC8752520 DOI: 10.1007/s00393-021-00971-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/12/2020] [Indexed: 11/15/2022]
Abstract
Objective To investigate the prescription frequency of analgesics in persons diagnosed with rheumatoid arthritis (RA), axial spondylarthritis (axSpA), psoriatic arthritis (PsA) and systemic lupus erythematosus (SLE) in 2019 using claims data. Methods Persons ≥ 18 years insured in 2019 with a diagnosis of RA (M05, M06), axSpA (M45), PsA (M07.0-3) or SLE (M32.1,8,9) were included. Analgesics were identified by the anatomic therapeutic classification (ATC) system. Reported is the percentage of individuals with ≥ 1 analgesics prescription for the respective rheumatic diagnosis in 2019 and for opioids age-standardized in each of the years 2005–2019. In addition, the proportion of long-term opioid use (prescriptions in ≥ 3 consecutive quarter years) in 2006 and 2019 is compared. Results Metamizole (29–33%) was the most commonly prescribed analgesic. Nonsteroidal anti-inflammatory drugs (NSAID)/coxibs were prescribed from 35% (SLE) to 50% (axSpA). Of the patients 11–13% were prescribed weak and 6–8% strong opioids. From 2005 to 2019, the proportion of persons with an opioid prescription remained stable, with similar or slightly decreasing proportions of weak opioids and more frequent prescriptions of strong opioids. The proportion of long-term opioid prescriptions increased from 2006 to 2019 from 8.9% to 11.0% (RA), from 6.9% to 9.1% (axSPA), from 7.8% to 9.5% (PsA), and from 7.5% to 8.8% (SLE), corresponding to a 17–24% increase. Conclusion The prescription of opioids for persons with inflammatory rheumatic diagnoses is not as high in Germany as in other countries; however, the proportion of long-term prescriptions has considerably increased. The frequent prescription of metamizole is conspicuous.
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14
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Albrecht K, Marschall U, Callhoff J. [Prescription of analgesics in patients with rheumatic diseases in Germany : A claims data analysis. German version]. Z Rheumatol 2021; 80:243-250. [PMID: 33635407 DOI: 10.1007/s00393-021-00962-z] [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: 12/12/2020] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To investigate the prescription frequency of analgesics in persons diagnosed with rheumatoid arthritis (RA), axial spondylarthritis (axSpA), psoriatic arthritis (PsA) and systemic lupus erythematosus (SLE) in 2019 using claims data. METHODS Persons ≥ 18 years insured in 2019 with a diagnosis of RA (M05, M06), axSpA (M45), PsA (M07.0-3) or SLE (M32.1,8,9) were included. Analgesics were identified by the anatomic therapeutic classification (ATC) system. Reported is the percentage of individuals with ≥ 1 analgesics prescription for the respective rheumatic diagnosis in 2019 and for opioids age-standardized in each of the years 2005-2019. In addition, the proportion of long-term opioid use (prescriptions in ≥ 3 consecutive quarter years) in 2006 and 2019 is compared. RESULTS Metamizole (29-33%) was the most commonly prescribed analgesic. Nonsteroidal anti-inflammatory drugs (NSAID)/coxibs were prescribed from 35% (SLE) to 50% (axSpA). Of the patients 11-13% were prescribed weak and 6-8% strong opioids. From 2005 to 2019, the proportion of persons with an opioid prescription remained stable, with similar or slightly decreasing proportions of weak opioids and more frequent prescriptions of strong opioids. The proportion of long-term opioid prescriptions increased from 2006 to 2019 from 8.9% to 11.0% (RA), from 6.9% to 9.1% (axSPA), from 7.8% to 9.5% (PsA), and from 7.5% to 8.8% (SLE), corresponding to a 17-24% increase. CONCLUSION The prescription of opioids for persons with inflammatory rheumatic diagnoses is not as high in Germany as in other countries; however, the proportion of long-term prescriptions has considerably increased. The frequent prescription of metamizole is conspicuous.
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Affiliation(s)
- K Albrecht
- Programmbereich Epidemiologie und Versorgungsforschung, Deutsches Rheuma-Forschungszentrum Berlin, Charitéplatz 1, 10117, Berlin, Deutschland.
| | - U Marschall
- Abteilung Medizin und Versorgungsforschung, Barmer, Wuppertal, Deutschland
| | - J Callhoff
- Programmbereich Epidemiologie und Versorgungsforschung, Deutsches Rheuma-Forschungszentrum Berlin, Charitéplatz 1, 10117, Berlin, Deutschland
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15
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Rautenstrauch J. [Translational healthcare research : Show what is-Angela Zink, the grande dame of public health research in rheumatology]. Z Rheumatol 2020; 79:975-982. [PMID: 33258975 DOI: 10.1007/s00393-020-00904-1] [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: 06/30/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND As director of the program area epidemiology and health care research at the German Rheumatism Research Center, Angela Zink established the German National Database, a national register for the care of people with inflammatory rheumatic diseases and other important registers for public health research in rheumatology. OBJECTIVE This publication summarizes Angela Zink's life work and sheds light on the national significance of this extraordinary achievement from the background of the research results achieved. MATERIAL AND METHODS The available literature and personal memories of the author formed the basis of this summary. RESULTS The German National Database, which regularly collects data from more than 15,000 patients with inflammatory rheumatic diseases per year, shows that the prognosis has steadily improved in many areas, disease activity has decreased, the burden of illness due to pain or functional limitations has decreased, the incidence of incapacity for work and early retirement has decreased and those affected can nowadays participate to a much greater extent in social and working life; however, the data also revealed existing shortcomings, regional differences and differences between treatment by specialists or general practitioners. This made the database a central instrument of quality assurance. The biologics register RABBIT, in which side effects of biologics were registered and used for risk management, has also gained great importance. CONCLUSION The registers which were set up and systematically developed in the program area epidemiology under the leadership of Angela Zink, are a treasure trove of national importance. A continuation, even after the retirement of Angela Zink from active professional life, seems urgently necessary if the healthcare research of German rheumatology does not want to lose the international connection.
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Affiliation(s)
- Julia Rautenstrauch
- European League Against Rheumatism (EULAR), Seestr. 240, 8802, Kilchberg, Schweiz.
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16
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Yu B, Darves-Bornoz AL, Brannigan RE, Halpern JA. Acute anejaculation, hypogonadism, and fertility preservation in the setting of neurosarcoidosis: case report and literature review. F S Rep 2020; 1:317-325. [PMID: 34223263 PMCID: PMC8244293 DOI: 10.1016/j.xfre.2020.09.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2020] [Revised: 09/23/2020] [Accepted: 09/26/2020] [Indexed: 11/26/2022] Open
Abstract
Objective To examine fertility preservation techniques in the setting of neurosarcoidosis, and to review the impact of corticosteroid and methotrexate therapy on fertility. Design Case report of a patient with infertility secondary to anejaculation associated with spinal neurosarcoidosis, treated with systemic corticosteroids and methotrexate. Setting Academic tertiary-care hospital. Patient(s) A 39-year-old man presented with neurosarcoidosis complicated by acute anejaculation, erectile dysfunction, and hypogonadism. He underwent fertility consultation and sperm cryopreservation before initiating methotrexate therapy. His pretreatment total testosterone was low, at 157 ng/dL. Intervention(s) Unsuccessful pharmacologic therapy and penile vibratory stimulation (PVS) were followed by microdissection testicular sperm extraction (microTESE). Clomiphene was administered for optimization of spermatogenesis before microTESE. Main Outcome Measure(s) Vials of cryopreserved sperm, testis histopathology, and serum testosterone levels. Result(s) Eight vials of viable sperm were harvested by means of micro-TESE and cryopreserved. Despite intraoperative appearance of hypospermatogenesis, 90% of seminiferous tubules had active germ cell sloughing. Total testosterone increased to 278 ng/dL 2 months after initiating clomiphene. Conclusion(s) Conventional fertility preservation techniques may be effective in the setting of neurosarcoidosis-induced infertility owing to largely intact spermatogenesis. PVS, though not effective for this patient, should be considered along with electroejaculation, given high success rates in other patients with neurogenic anejaculation. Corticosteroid-mediated hypogonadism also must be considered in these patients, because it can negatively affect downstream spermatogenesis. In addition, evidence for the impact of paternal methotrexate exposure on fertility is limited and requires further investigation. As such, fertility consultation before initiating methotrexate is highly recommended.
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Affiliation(s)
- Benjamin Yu
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Anne L Darves-Bornoz
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Robert E Brannigan
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Joshua A Halpern
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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Trends in idiopathic inflammatory myopathies: cross-sectional data from the German National Database. Rheumatol Int 2020; 40:1639-1647. [PMID: 32594219 PMCID: PMC7452918 DOI: 10.1007/s00296-020-04634-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 06/17/2020] [Indexed: 12/15/2022]
Abstract
Objective 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 < 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 < 0.01). Employment in patients < 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.
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