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Trends in treatment and outcomes of ankylosing spondylitis in outpatient rheumatological care in Germany between 2000 and 2012.

Huscher D, Thiele K, Rudwaleit M, Albrecht KC, Bischoff S, Krause A, Karberg K, Wassenberg S, Zink A - RMD Open (2015)

Bottom Line: 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.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.

View Article: PubMed Central - PubMed

Affiliation: Epidemiology Unit , German Rheumatism Research Centre, A Leibniz Institute , Berlin , Germany ; Department of Rheumatology and Clinical Immunology , Charité University Hospital Berlin , Berlin , Germany.

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.

No MeSH data available.


Related in: MedlinePlus

Development of the employment rate ratio relative to the general population by sex and age groups; weighted trend over all age groups is shown as a dashed line. For illustration, in years with case numbers ≤20 calculated values were replaced with moving averages and identification marks were omitted.
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RMDOPEN2014000033F2: Development of the employment rate ratio relative to the general population by sex and age groups; weighted trend over all age groups is shown as a dashed line. For illustration, in years with case numbers ≤20 calculated values were replaced with moving averages and identification marks were omitted.

Mentions: Fifty-three per cent of the patients aged 18–64 years were employed in 2000 and 65% in 2012 (data not shown). At the same time, early retirement among those <65 years of age declined from 19% to 14%, predominantly in men (21% to 12%, table 2). The proportion of gainfully employed patients increased slightly in women (from 51% to 56%) but significantly in men (54% to 71%). Moreover, a substantial increase was seen in patients aged 41–50 (+16%) and in those aged 51–60 (+17%). Slightly higher employment rates were also seen in the age-group ≤40 years (+7%) and in patients aged ≥60 (+6%). Accounting for a coincidental increase of employment rates in the general population, we calculated employment rate ratios: in women with AS aged 30–60 years, employment rates in the three 10-year age groups were lower in 2000 (rate ratio 0.88–0.91) and approximated the population rate in later years (2011: rate ratio 0.90–0.98) but receded in 2012 (figure 2). A similar tendency was also seen for women aged ≥60 with a low ratio of 0.31 in 2000 improving to 0.55 in 2012. For male patients with AS aged 50–60, the ratio increased from 0.62 in 2000 to 0.78 in 2012. In male patients aged 30–50, the ratios of 0.78 and 0.89 in 2000 improved to 0.96 and 1.01 in 2012.


Trends in treatment and outcomes of ankylosing spondylitis in outpatient rheumatological care in Germany between 2000 and 2012.

Huscher D, Thiele K, Rudwaleit M, Albrecht KC, Bischoff S, Krause A, Karberg K, Wassenberg S, Zink A - RMD Open (2015)

Development of the employment rate ratio relative to the general population by sex and age groups; weighted trend over all age groups is shown as a dashed line. For illustration, in years with case numbers ≤20 calculated values were replaced with moving averages and identification marks were omitted.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4612682&req=5

RMDOPEN2014000033F2: Development of the employment rate ratio relative to the general population by sex and age groups; weighted trend over all age groups is shown as a dashed line. For illustration, in years with case numbers ≤20 calculated values were replaced with moving averages and identification marks were omitted.
Mentions: Fifty-three per cent of the patients aged 18–64 years were employed in 2000 and 65% in 2012 (data not shown). At the same time, early retirement among those <65 years of age declined from 19% to 14%, predominantly in men (21% to 12%, table 2). The proportion of gainfully employed patients increased slightly in women (from 51% to 56%) but significantly in men (54% to 71%). Moreover, a substantial increase was seen in patients aged 41–50 (+16%) and in those aged 51–60 (+17%). Slightly higher employment rates were also seen in the age-group ≤40 years (+7%) and in patients aged ≥60 (+6%). Accounting for a coincidental increase of employment rates in the general population, we calculated employment rate ratios: in women with AS aged 30–60 years, employment rates in the three 10-year age groups were lower in 2000 (rate ratio 0.88–0.91) and approximated the population rate in later years (2011: rate ratio 0.90–0.98) but receded in 2012 (figure 2). A similar tendency was also seen for women aged ≥60 with a low ratio of 0.31 in 2000 improving to 0.55 in 2012. For male patients with AS aged 50–60, the ratio increased from 0.62 in 2000 to 0.78 in 2012. In male patients aged 30–50, the ratios of 0.78 and 0.89 in 2000 improved to 0.96 and 1.01 in 2012.

Bottom Line: 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.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.

View Article: PubMed Central - PubMed

Affiliation: Epidemiology Unit , German Rheumatism Research Centre, A Leibniz Institute , Berlin , Germany ; Department of Rheumatology and Clinical Immunology , Charité University Hospital Berlin , Berlin , Germany.

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.

No MeSH data available.


Related in: MedlinePlus