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Ohta R, Sano C. Factors affecting the duration of initial medical care seeking among older rural patients diagnosed with rheumatoid arthritis: a retrospective cohort study. BMC Rheumatol 2024; 8:23. [PMID: 38840174 PMCID: PMC11155024 DOI: 10.1186/s41927-024-00392-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Accepted: 05/24/2024] [Indexed: 06/07/2024] Open
Abstract
BACKGROUND Early diagnosis and treatment of rheumatoid arthritis (RA) are essential to prevent progressive joint destruction and improve the quality of life (QOL) of patients. This study aimed to identify the factors associated with the duration from symptom onset to seeking initial medical care among older rural patients diagnosed with RA. METHODS This retrospective cohort study was conducted in Unnan City, Japan, using electronic patient records. Data from patients aged > 65 years, who were admitted to the Unnan City Hospital between April 2016 and March 2021, were analyzed. The primary outcome was the duration from symptom onset to the initial visit to the medical institution. Demographic factors, laboratory data, and data on symptoms were collected and analyzed using statistical tests and regression models. RESULTS In total, 221 participants were included in this study. The longer duration from symptom onset to medical care usage was significantly associated with age (adjusted odds ratio [OR]: 1.09, 95% confidence interval [CI]: 1.03-1.15), isolated conditions (adjusted OR: 4.45, 95% CI: 1.85-10.70), and wrist symptoms (adjusted OR: 3.22, 95% CI: 1.44-7.17). Higher education level and alcohol consumption were also associated with the duration from symptom onset to medical care usage. CONCLUSIONS Older age, isolated conditions, and specific joint symptoms were significant factors influencing delays in seeking medical care among older rural patients with RA. Interventions to improve health literacy, increase social support, and raise awareness of RA symptoms are essential for expediting diagnosis and improving patient QOL. Further research is needed to explore additional psychosocial factors and beliefs that affect health-seeking behaviors in patients with RA.
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Affiliation(s)
- Ryuichi Ohta
- Community Care, Unnan City Hospital, Unnan, 699-1221, Japan.
| | - Chiaki Sano
- Department of Community Medicine Management, Faculty of Medicine, Shimane University, Izumo, 690-0823, Japan
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Raittio E, Baelum V, Nascimento GG, Lopez R. Dental service use among adults with incident type 2 diabetes, rheumatoid arthritis or inflammatory bowel disease. Community Dent Oral Epidemiol 2024. [PMID: 38778569 DOI: 10.1111/cdoe.12976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Revised: 04/19/2024] [Accepted: 05/09/2024] [Indexed: 05/25/2024]
Abstract
OBJECTIVES It is not clear if or how the incidence of systemic conditions like type 2 diabetes mellitus (DM2), rheumatoid arthritis (RA) or inflammatory bowel disease (IBD) affects dental service utilization. Using nationwide Danish register data, the aim of this study was to analyse the use of dental services 7 years before and after being diagnosed with DM2, RA or IBD between 1997 and 2011. METHODS Information about incident DM2 was obtained from the National Diabetes Register, and incident RA and IBD were defined based on diagnosis codes of hospital contacts identified through the National Patient Register. Separately, for each of the three conditions, each individual with the incident condition was matched to one control individual based on age, gender, country of origin, municipality of residence, highest completed education, the main source of income and income using coarsened exact matching in the year of incidence. The use of dental services and treatments received within each calendar year from 7 years before to 7 years after getting the condition were analysed with generalized estimating equations. RESULTS People with incident DM2 were less likely (by seven percentage points) to be dental service users within a year than people without incident DM2 for a period extending from up to 7 years prior to 7 years after the diagnosis. This difference even slightly increased after the diagnosis. Those with incident IBD exhibited a consistently but modestly higher proportion of dental service use (three percentage points) than those without incident IBD before and after the diagnosis. Differences in the use of services between those with or without incident RA were minor. For all three systemic diseases, detected differences mainly mirrored differences in the provision of supragingival scaling and restorative treatment. CONCLUSIONS The findings suggest that the impact of these three systemic conditions on dental service use was minor.
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Affiliation(s)
- Eero Raittio
- Department of Dentistry and Oral Health, Aarhus University, Aarhus, Denmark
- Institute of Dentistry, University of Eastern Finland, Kuopio, Finland
| | - Vibeke Baelum
- Department of Dentistry and Oral Health, Aarhus University, Aarhus, Denmark
| | - Gustavo G Nascimento
- National Dental Research Institute Singapore, National Dental Centre Singapore, Singapore, Singapore
- Oral Health Academic Programme, Duke-NUS Medical School, Singapore, Singapore
| | - Rodrigo Lopez
- Department of Dentistry and Oral Health, Aarhus University, Aarhus, Denmark
- School of Dentistry, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
- Center for Translational Oral Research (TOR) - Periodontology, Department of Clinical Dentistry, University of Bergen, Bergen, Norway
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Song L, Wang J, Zhang Y, Yan X, He J, Nie J, Zhang F, Han R, Yin H, Li J, Liu H, Huang L, Li Y. Association Between Human Metabolomics and Rheumatoid Arthritis: A Systematic Review and Meta-analysis. Arch Med Res 2024; 55:102907. [PMID: 38029644 DOI: 10.1016/j.arcmed.2023.102907] [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: 04/25/2023] [Revised: 09/23/2023] [Accepted: 10/24/2023] [Indexed: 12/01/2023]
Abstract
OBJECTIVE The underdiagnosis and inadequate treatment of rheumatoid arthritis (RA) can be attributed to the various clinical manifestations presented by patients. To address this concern, we conducted an extensive review and meta-analysis, focusing on RA-related metabolites. METHODS A comprehensive literature search was conducted in PubMed, the Cochrane Library, Web of Science, and Embase to identify relevant studies published up to October 5, 2022. The quality of the included articles was evaluated and, subsequently, a meta-analysis was conducted using Review Manager software to analyze the association between metabolites and RA. RESULTS Forty nine studies met the inclusion criteria for the systematic review, and six of these studies were meta-analyzed to evaluate the association between 28 reproducible metabolites and RA. The results indicated that, compared to controls, the levels of histidine (RoM = 0.83, 95% CI = 0.79-0.88, I2 = 0%), asparagine (RoM = 0.83, 95% CI = 0.75-0.91, I2 = 0%), methionine (RoM = 0.82, 95% CI = 0.69-0.98, I2 = 85%), and glycine (RoM = 0.81, 95% CI = 0.67-0.97, I2 = 68%) were significantly lower in RA patients, while hypoxanthine levels (RoM = 1.14, 95% CI = 1.09-1.19, I2 = 0%) were significantly higher. CONCLUSION This study identified histidine, methionine, asparagine, hypoxanthine, and glycine as significantly correlated with RA, thus offering the potential for the advancement of biomarker discovery and the elucidation of disease mechanisms in RA.
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Affiliation(s)
- Lili Song
- Tianjin University of Traditional Chinese Medicine, No.10, Poyang Lake Road, West zone, Tuanbo New-City, Jinghai-District, Tianjin, China
| | - Jiayi Wang
- Tianjin University of Traditional Chinese Medicine, No.10, Poyang Lake Road, West zone, Tuanbo New-City, Jinghai-District, Tianjin, China
| | - Yue Zhang
- Tianjin University of Traditional Chinese Medicine, No.10, Poyang Lake Road, West zone, Tuanbo New-City, Jinghai-District, Tianjin, China
| | - Xingxu Yan
- Tianjin University of Traditional Chinese Medicine, No.10, Poyang Lake Road, West zone, Tuanbo New-City, Jinghai-District, Tianjin, China
| | - Junjie He
- Tianjin University of Traditional Chinese Medicine, No.10, Poyang Lake Road, West zone, Tuanbo New-City, Jinghai-District, Tianjin, China
| | - Jiaxuan Nie
- Tianjin University of Traditional Chinese Medicine, No.10, Poyang Lake Road, West zone, Tuanbo New-City, Jinghai-District, Tianjin, China
| | - Fangfang Zhang
- Tianjin University of Traditional Chinese Medicine, No.10, Poyang Lake Road, West zone, Tuanbo New-City, Jinghai-District, Tianjin, China
| | - Rui Han
- Tianjin University of Traditional Chinese Medicine, No.10, Poyang Lake Road, West zone, Tuanbo New-City, Jinghai-District, Tianjin, China
| | - Hongqing Yin
- Tianjin University of Traditional Chinese Medicine, No.10, Poyang Lake Road, West zone, Tuanbo New-City, Jinghai-District, Tianjin, China
| | - Jingfang Li
- Tianjin University of Traditional Chinese Medicine, No.10, Poyang Lake Road, West zone, Tuanbo New-City, Jinghai-District, Tianjin, China
| | - Huimin Liu
- Tianjin University of Traditional Chinese Medicine, No.10, Poyang Lake Road, West zone, Tuanbo New-City, Jinghai-District, Tianjin, China
| | - Liping Huang
- Tianjin University of Traditional Chinese Medicine, No.10, Poyang Lake Road, West zone, Tuanbo New-City, Jinghai-District, Tianjin, China
| | - Yubo Li
- Tianjin University of Traditional Chinese Medicine, No.10, Poyang Lake Road, West zone, Tuanbo New-City, Jinghai-District, Tianjin, China.
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Khan A, Salim B, Perveen S, Samreen S, Gul H, Nasim A. Overcoming rheumatoid arthritis challenges: Ensuring timely referral to rheumatologists in resource-scarce countries. RHEUMATOLOGY AND IMMUNOLOGY RESEARCH 2023; 4:222-224. [PMID: 38125644 PMCID: PMC10729589 DOI: 10.2478/rir-2023-0033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Accepted: 08/18/2023] [Indexed: 12/23/2023]
Affiliation(s)
- Anum Khan
- Rheumatology Department, Fauji Foundation Hospital, Rawalpindi, Pakistan
| | - Babur Salim
- Rheumatology Department, Fauji Foundation Hospital, Rawalpindi, Pakistan
| | - Shahida Perveen
- Foundation University School of Health Sciences (FUSH), Rawalpindi, Pakistan
| | - Saba Samreen
- Foundation University School of Health Sciences (FUSH), Rawalpindi, Pakistan
| | - Haris Gul
- Rheumatology Department, Fauji Foundation Hospital, Rawalpindi, Pakistan
| | - Amjad Nasim
- Rheumatology Department, Fauji Foundation Hospital, Rawalpindi, Pakistan
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Albuquerque CP, Reis APMG, Vargas Santos AB, Bértolo MB, Júnior PL, Neubarth Giorgi RD, Radominski SC, Guimarães MFBR, Bonfiglioli KR, L Cunha Sauma MDF, Pereira IA, Brenol CV, Henrique Mota LM, Santos-Neto L, Castelar Pinheiro GR. Do it fast! Early access to specialized care improved long-term outcomes in rheumatoid arthritis: data from the REAL multicenter observational study. Adv Rheumatol 2023; 63:17. [PMID: 37095556 DOI: 10.1186/s42358-023-00301-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 04/12/2023] [Indexed: 04/26/2023] Open
Abstract
BACKGROUND Early rheumatoid arthritis (RA) offers an opportunity for better treatment outcomes. In real-life settings, grasping this opportunity might depend on access to specialized care. We evaluated the effects of early versus late assessment by the rheumatologist on the diagnosis, treatment initiation and long-term outcomes of RA under real-life conditions. METHODS Adults meeting the ACR/EULAR (2010) or ARA (1987) criteria for RA were included. Structured interviews were conducted. The specialized assessment was deemed "early" when the rheumatologist was the first or second physician consulted after symptoms onset, and "late" when performed afterwards. Delays in RA diagnosis and treatment were inquired. Disease activity (DAS28-CRP) and physical function (HAQ-DI) were evaluated. Student's t, Mann-Whitney U, chi-squared and correlation tests, and multiple linear regression were performed. For sensitivity analysis, a propensity score-matched subsample of early- vs. late-assessed participants was derived based on logistic regression. The study received ethical approval; all participants signed informed consent. RESULTS We included 1057 participants (89.4% female, 56.5% white); mean (SD) age: 56.9 (11.5) years; disease duration: 173.1 (114.5) months. Median (IQR) delays from symptoms onset to both RA diagnosis and initial treatment coincided: 12 (6-36) months, with no significant delay between diagnosis and treatment. Most participants (64.6%) first sought a general practitioner. Notwithstanding, 80.7% had the diagnosis established only by the rheumatologist. Only a minority (28.7%) attained early RA treatment (≤ 6 months of symptoms). Diagnostic and treatment delays were strongly correlated (rho 0.816; p < 0.001). The chances of missing early treatment more than doubled when the assessment by the rheumatologist was belated (OR 2.77; 95% CI: 1.93, 3.97). After long disease duration, late-assessed participants still presented lower chances of remission/low disease activity (OR 0.74; 95% CI: 0.55, 0.99), while the early-assessed ones showed better DAS28-CRP and HAQ-DI scores (difference in means [95% CI]: -0.25 [-0.46, -0.04] and - 0.196 [-0.306, -0.087] respectively). The results in the propensity-score matched subsample confirmed those observed in the original (whole) sample. CONCLUSIONS Early diagnosis and treatment initiation in patients with RA was critically dependent on early access to the rheumatologist; late specialized assessment was associated with worse long-term clinical outcomes.
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Affiliation(s)
- Cleandro Pires Albuquerque
- Rheumatology Service, Universidade de Brasília (UnB), Brasília, DF, Brazil.
- Universidade de Brasília / UnB, Campus Darcy Ribeiro, Brasília, CEP 70910-900, Federal District, Brazil.
| | | | - Ana Beatriz Vargas Santos
- Department of Rheumatology, Universidade do Estado do Rio de Janeiro (UERJ), Rio de Janeiro, RJ, Brazil
| | | | - Paulo Louzada Júnior
- School of Medicine, Universidade de Ribeirão Preto, Universidade de São Paulo (USP), Ribeirão Preto, SP, Brazil
| | - Rina Dalva Neubarth Giorgi
- Instituto de Assistência Médica ao Servidor Público Estadual, Hospital do Servidor Público Estadual de São Paulo (IAMSPE), São Paulo, SP, Brazil
| | | | | | | | | | - Ivânio Alves Pereira
- Rheumatology, Universidade Federal de Santa Catarina (UFSC), Florianópolis, SC, Brazil
| | - Claiton Viegas Brenol
- Department of Internal Medicine, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
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Jain A, Joseph S, James J, James TS, Kumar K, Raza K, Greenfield S, Shenoy P. Delay in diagnosis of rheumatoid arthritis: reasons and trends over a decade. Rheumatol Int 2023; 43:503-508. [PMID: 35996027 DOI: 10.1007/s00296-022-05187-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Accepted: 08/10/2022] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Delay in diagnosis and treatment initiation often lead to poorer outcomes in rheumatoid arthritis (RA). Most of the data on delay in diagnosis and management are from western population with no data from India. Additionally, with improved health care services, whether the delay has changed over years is not known. In this longitudinal observational study, we investigated delay to diagnosis and disease-modifying antirheumatic drugs (DMARDs) initiation over past 9 years. METHODS Patients aged ≥ 18 years having RA fulfilling 2010 ACR/EULAR criteria were enrolled from January to June in years 2012, 2017 and 2021. Diagnoses received before presenting to clinic, socioeconomic status, educational level and other demographic variables were recorded. RESULTS Each year, 323 patients (mean age 49.5-52.01 years) were enrolled. There was a significant reduction in delay in diagnosis from a median (IQR) of 36 (12-84, range 1-288) months in 2012 to 12 (4-36, range 1-180) months in 2017 and 10 (5-24, range 1-120) months) in 2021 (p < 0.0001). A significant improvement in time to initiating DMARDs from 2012 [48 (24-96) months] to 2017 [12 (6-36) months] (p < 0.0001) and from 2017 to 2021 [12 (5-24) months] (p = 0.03) was seen. Higher education, more patients opting for treatment from rheumatologists, and urbanisation contributed significantly to improvement in delay. There was no impact of age or gender on delay. CONCLUSION Delay in diagnosis has improved significantly between 2012 and 2021. However, delay still remains long as most patients miss the 3-month therapeutic window. Future work focussing on reasons for delays in the patient pathway could help improve consultation pathways in India.
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Affiliation(s)
- Avinash Jain
- Department of Clinical Immunology & Rheumatology, SMS Medical College and Hospital, Jaipur, India
| | - Sanjana Joseph
- Department of Clinical Immunology & Rheumatology, Centre for Arthritis and Rheumatism Excellence (CARE), 16/554-2, NH 47, Nettoor, Cochin, Kerala, 682040, India
| | - Jeenamol James
- Department of Clinical Immunology & Rheumatology, Centre for Arthritis and Rheumatism Excellence (CARE), 16/554-2, NH 47, Nettoor, Cochin, Kerala, 682040, India
| | - Tintus Sara James
- Department of Clinical Immunology & Rheumatology, Centre for Arthritis and Rheumatism Excellence (CARE), 16/554-2, NH 47, Nettoor, Cochin, Kerala, 682040, India
| | - Kanta Kumar
- Institute of Clinical Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, B15 2TT, UK
| | - Karim Raza
- Rheumatology Research Group, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK.,NIHR Birmingham Biomedical Research Centre, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.,Department of Rheumatology, Sandwell and West Birmingham NHS Trust, Birmingham, UK
| | - Sheila Greenfield
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, B15 2TT, UK
| | - Padmanabha Shenoy
- Department of Clinical Immunology & Rheumatology, Centre for Arthritis and Rheumatism Excellence (CARE), 16/554-2, NH 47, Nettoor, Cochin, Kerala, 682040, India.
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A Novel Ensemble-Based Technique for the Preemptive Diagnosis of Rheumatoid Arthritis Disease in the Eastern Province of Saudi Arabia Using Clinical Data. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2022; 2022:2339546. [PMID: 36158117 PMCID: PMC9492338 DOI: 10.1155/2022/2339546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Revised: 07/20/2022] [Accepted: 08/02/2022] [Indexed: 11/17/2022]
Abstract
Rheumatoid arthritis (RA) is a chronic inflammatory disease caused by numerous genetic and environmental factors leading to musculoskeletal system pain. RA may damage other tissues and organs, causing complications that severely reduce patients' quality of life. According to the World Health Organization (WHO), over 1.71 billion individuals worldwide had musculoskeletal problems in 2021. Rheumatologists face challenges in the early detection of RA since its symptoms are similar to other illnesses, and there is no definitive test to diagnose the disease. Accordingly, it is preferable to profit from the power of computational intelligence techniques that can identify hidden patterns to diagnose RA early. Although multiple studies were conducted to diagnose RA early, they showed unsatisfactory performance, with the highest accuracy of 87.5% using imaging data. Yet, imaging data requires diagnostic tools that are challenging to collect and examine and are more costly. Recent studies indicated that neither a blood test nor a physical finding could early confirm the diagnosis. Therefore, this study proposes a novel ensemble technique for the preemptive prediction of RA and investigates the possibility of diagnosing the disease using clinical data before the symptoms appear. Two datasets were obtained from King Fahad University Hospital (KFUH), Dammam, Saudi Arabia, including 446 patients, with 251 positive cases of RA and 195 negative cases of RA. Two experiments were conducted where the former was developed without upsampling the dataset, and the latter was carried out using an upsampled dataset. Multiple machine learning (ML) algorithms were utilized to assemble the novel voting ensemble, including support vector machine (SVM), logistic regression (LR), and adaptive boosting (Adaboost). The results indicated that clinical laboratory tests fed to the proposed voting ensemble technique could accurately diagnose RA preemptively with an accuracy, recall, and precision of 94.03%, 96.00%, and 93.51%, respectively, with 30 clinical features when utilizing the original data and sequential forward feature selection (SFFS) technique. It is concluded that deploying the proposed model in local hospitals can contribute to introducing a method that aids medical specialists in preemptively diagnosing RA and stopping or delaying the course using clinical laboratory tests.
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Abstract
Rheumatoid arthritis (RA) is currently diagnosed and treated once an individual displays the clinical findings of inflammatory arthritis (IA). However, growing evidence supports that there is a 'pre-RA' stage that can be identified through factors such as autoantibodies in absence of clinically apparent IA. In particular, biomarkers, including antibodies to citrullinated protein antigens (ACPA), demonstrate a high risk for future IA/RA, and multiple clinical trials have been developed to intervene in individuals in pre-RA to prevent or delay clinically apparent disease. Herein, we will discuss in more depth what is currently known about the natural history of RA, and the emerging possibility that early 'diagnosis' of RA-related autoimmunity followed by an intervention can lead to the delay or prevention of the first onset of clinically apparent RA.
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Grellmann C, Dombrowsky W, Fabricius V, Suruki R, Sheahan A, Joeres L. Epidemiology and Treatment of Patients with Rheumatoid Arthritis, Psoriatic Arthritis and Psoriasis in Germany: A Real-World Evidence Study. Adv Ther 2021; 38:366-385. [PMID: 33128201 PMCID: PMC7854418 DOI: 10.1007/s12325-020-01522-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Accepted: 09/30/2020] [Indexed: 12/13/2022]
Abstract
Introduction Rheumatoid arthritis (RA), psoriatic arthritis (PsA) and psoriasis (PSO) are chronic inflammatory diseases that have a substantial impact on patients’ health. This retrospective database study aimed to assess the epidemiology, comorbidities, diagnosis and treatment patterns of RA, PsA and PSO in the German population. Methods Data were extracted from the Deutsche Forschungsdatenbank für Abrechnungsinformationen der Krankenversicherung database from 2012 to 2016 for patients aged ≥ 18 years holding full health coverage in the reporting year at least. Diagnoses were defined according to International Classification of Diseases (ICD)-10 codes. Reported outcomes included prevalence and incidence rates, pre-defined comorbidities, diagnosing and treating physicians, and treatment exposure. A subgroup analysis was performed for women of childbearing age (females aged 18–45 years). Results The prevalence rates of RA, PsA and PSO in Germany were consistent over the study period; by 2016 they were 0.4%, 0.3% and 2.1%, respectively, and in women of childbearing age they were 0.2%, 0.2% and 1.5%, respectively. RA, PsA and PSO were predominantly observed among patients aged > 45 years. RA and PsA were more prevalent in women, while PSO had an approximately equal gender distribution. Depressive episodes were the most frequently reported comorbidity in 2016 (RA: 25.7%; PsA: 25.1%; PSO: 17.8%), and this was similar in women of childbearing age (RA: 20.5%; PsA: 23.4%; PSO: 16.3%). Approximately 50% of patients with RA and PsA and 6% of patients with PSO were receiving systemic treatment in 2016, of which methotrexate (RA: 38.4%; PsA: 30.2%; PSO: 2.2%) was most common. Biologic therapies were the least frequently used treatment options (RA: 28.9%; PsA: 20.9%; PSO: 1.8%). Conclusions This analysis provides key epidemiological information for patients with RA, PsA and PSO, including in women of childbearing age, in Germany and highlights common comorbidities and that patients were likely receiving insufficient treatment for these diagnoses. Electronic Supplementary Material The online version of this article (10.1007/s12325-020-01522-8) contains supplementary material, which is available to authorized users.
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Greenblatt HK, Kim HA, Bettner LF, Deane KD. Preclinical rheumatoid arthritis and rheumatoid arthritis prevention. Curr Opin Rheumatol 2020; 32:289-296. [PMID: 32205569 PMCID: PMC7340337 DOI: 10.1097/bor.0000000000000708] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
PURPOSE OF REVIEW This review is to provide an update on the current understanding of rheumatoid arthritis (RA) development related to disease development prior to the onset clinically apparent synovitis (i.e. Pre-RA), and opportunities for disease prevention. RECENT FINDINGS A growing number of studies have demonstrated that serum elevations of autoantibodies rheumatoid factor, antibodies to citrullinated protein/peptide antigens (ACPAs) and antibodies to other posttranslationally modified proteins (e.g. carbamylated proteins) are highly predictive of future development of inflammatory arthritis/RA during a period that can be termed Pre-RA. Other factors including genetic, environmental, symptoms and imaging findings can also enhance prediction. Moreover, several novel biomarkers and changes in autoantibodies (e.g. glycosylation of variable domains) have been identified in Pre-RA. There has also been growing evidence that initiation and propagation of RA-related autoimmunity during the Pre-RA phase may be related to mucosal processes. The discovery of Pre-RA has also underpinned the development of several clinical prevention trials in RA; specifically, the PRAIRI study demonstrated that a single dose of rituximab can delay the onset of clinically apparent IA in at-risk individuals. Additional studies are evaluating the ability of drugs including abatacept, hydroxychloroquine and methotrexate to prevent or delay future RA. SUMMARY The results from ongoing natural history and prevention trials in RA should further inform several critical issues in RA prevention including identification and enrolment of individuals at high-risk of imminent RA, the efficacy, safety and cost-effectiveness of prevention, and potentially the identification of new targets for prevention.
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Affiliation(s)
| | - Hyoun-Ah Kim
- University of Colorado Anschutz Medical Campus
- Department of Rheumatology, Ajou University School of Medicine, Suwon, Republic of Korea
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