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1.
F1000Res ; 92020.
Artigo em Inglês | MEDLINE | ID: mdl-32704350

RESUMO

Axial spondyloarthritis (axSpA) is a chronic inflammatory rheumatic disease that predominantly affects the axial skeleton. The advent of biologic drugs has transformed the management of patients with axSpA. However, non-steroidal anti-inflammatory drugs remain the first-line drug treatment for axSpA. The optimal management of patients with axSpA requires a combination of pharmacological and non-pharmacological treatment modalities, namely exercise and physical therapy. This review looks at novel therapeutic options in patients with axSpA. It also summarises current evidence regarding radiographic progression and treat-to-target in axSpA.


Assuntos
Espondilartrite , Espondilite Anquilosante , Progressão da Doença , Humanos , Espondilartrite/terapia
2.
Nat Rev Rheumatol ; 16(8): 415-433, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32661321

RESUMO

Gut inflammation is strongly associated with spondyloarthritis (SpA), as exemplified by the high prevalence of inflammatory bowel disease (IBD) and the even higher occurrence of subclinical gut inflammation in patients with SpA. The gut-joint axis of inflammation in SpA is further reinforced by similarities in immunopathogenesis at both anatomical sites and by the clinical success of therapies blocking TNF and IL-23 in IBD and in some forms of SpA. Many genetic risk factors are shared between SpA and IBD, and changes in the composition of gut microbiota are seen in both diseases. Current dogma is that inflammation in SpA initiates in the gut and leads to joint inflammation; however, although conceptually attractive, some research does not support this causal relationship. For example, therapies targeting IL-17A are efficacious in the joint but not the gut, and interfering with gut trafficking by targeting molecules such as α4ß7 in IBD can lead to onset or flares of SpA. Several important knowledge gaps remain that must be addressed in future studies. Determining the true nature of the gut-joint axis has real-world implications for the treatment of patients with co-incident IBD and SpA and for the repurposing of therapeutics from one disease to the other.


Assuntos
Microbioma Gastrointestinal , Doenças Inflamatórias Intestinais/complicações , Espondilartrite/etiologia , Animais , Predisposição Genética para Doença , Estudo de Associação Genômica Ampla , Humanos , Espondilartrite/sangue , Espondilartrite/epidemiologia , Espondilartrite/terapia
3.
Phys Ther ; 100(8): 1323-1332, 2020 08 12.
Artigo em Inglês | MEDLINE | ID: mdl-32367124

RESUMO

OBJECTIVE: Although exercise is recommended in the treatment of axial spondyloarthritis (axSpa), the focus has been on flexibility, and the effect of high-intensity exercises is unknown. The purpose of this study was to investigate the effect of high-intensity exercises on fatigue, sleep, and mood in patients with axSpA. METHODS: In this secondary analysis of a randomized controlled trial, participants were recruited from outpatient clinics at 4 hospitals in Scandinavia. A total of 100 patients with axSpA were randomized to either an exercise group (n = 50) or a control group (n = 50). High-intensity exercise was provided 3 times per week for 3 months and supervised by a physical therapist. The controls received no intervention. Measurements were self-reported at baseline, 3 months, and 12 months: fatigue, using the Fatigue Severity Scale (range = 0-7, 7 = worst, ≥5 = severe); vitality, using the RAND 36-item short-form health survey (SF-36, range = 0-100, 100 = best); sleep, using the Pittsburgh Sleep Quality Index (range = 0-21, 21 = worst, >5 = poor quality); mood, using the General Health Questionnaire 12 (range = 0-36, 36 = worst); and general health, using the EUROQoL (range = 0-100, 100 = best). RESULTS: A total of 38 participants (76%) in the exercise group followed ≥80% of the exercise protocol. At 3 months, there was a significant beneficial effect on fatigue (mean group differences = -0.4, 95% CI = -0.7 to -0.1), vitality (5.0, 95% CI = 1.1 to 10.5), mood (-2, 95% CI = -3.7 to -0.04), and general health (9.0, 95% CI = 3.3 to 14.7) but no effect on sleep (-1.1, 95% CI = -2.1 to 0.2). Compared with the control group, the exercise group had a reduced rate of severe fatigue and poor sleep. No differences were seen between the groups at 12 months. CONCLUSIONS: A 3-month exercise program had a beneficial effect on fatigue, sleep, mood, and general health in patients with axSpA at the end of the intervention; however, no long-term effects were seen. IMPACT: High-intensity cardiorespiratory and strength exercises should be considered as important in exercise programs for patients with axSpA.


Assuntos
Afeto , Terapia por Exercício/métodos , Fadiga/terapia , Transtornos do Sono-Vigília/terapia , Espondilartrite/terapia , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Avaliação de Resultados em Cuidados de Saúde , Autorrelato , Método Simples-Cego , Adulto Jovem
4.
Gastroenterol. hepatol. (Ed. impr.) ; 43(5): 273-283, mayo 2020.
Artigo em Espanhol | IBECS | ID: ibc-193008

RESUMO

Las manifestaciones extraintestinales en general, y entre ellas las articulares en particular, suponen un problema frecuente en los pacientes con enfermedad inflamatoria intestinal. De hecho, la relación entre ambas entidades parece estrecha y cada vez hay más datos que sugieren que el intestino desempeña un importante papel en la patogenia de las espondiloartritis. La asociación de la enfermedad inflamatoria intestinal con algún tipo de espondiloartritis supone un escenario clínico complejo. Es necesario, por tanto, que gastroenterólogos y reumatólogos puedan trabajar juntos y establecer una comunicación fluida que permita a cada paciente recibir el tratamiento más adecuado para cada situación concreta. El objetivo de esta revisión es el de establecer unas recomendaciones sobre el tratamiento de los pacientes con enfermedad inflamatoria intestinal y espondiloartritis asociada, en cada uno de los distintos escenarios clínicos


Extraintestinal manifestations, in general, and in particular arthropathies, are a common problem in patients with inflammatory bowel disease. In fact, the relationship between those 2entities is close and there are increasingly more data which suggest that the bowel plays a significant role in the aetiopathogenesis of spondyloarthritis. The association of inflammatory bowel disease with any kind of spondyloarthritis represents a challenging clinical scenario. It is therefore necessary that both gastroenterologists and rheumatologists work together and establish a fluent communication that enables the patient to receive the most appropriate treatment for each specific situation. The aim of this review is to make some recommendations about the treatment of patients with inflammatory bowel disease and associated spondyloarthritis, in each different clinical scenario


Assuntos
Humanos , Espondilartrite/complicações , Espondilartrite/terapia , Espondiloartropatias/diagnóstico , Espondilartrite/epidemiologia , Espanha , Doenças Inflamatórias Intestinais/complicações , Doenças Inflamatórias Intestinais/epidemiologia , Reumatologia/normas
5.
Arthritis Rheumatol ; 72(5): 733-749, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-31960614

RESUMO

OBJECTIVE: To investigate the effect of therapies on radiographic progression in patients with axial spondyloarthritis (SpA). METHODS: A comprehensive database search for studies assessing radiographic progression in axial SpA (particular treatment versus no treatment of interest) was performed. Study-specific standardized mean differences in treatment outcomes at 2 and ≥4 years were estimated and combined using random-effects models. RESULTS: Twenty-four studies in patients with axial SpA were identified, of which 18 involved tumor necrosis factor inhibitors (TNFi), 8 involved nonsteroidal antiinflammatory drugs (NSAIDs), and 1 involved secukinumab. Spinal radiographic progression, as measured by the modified Stoke Ankylosing Spondylitis Spine Score (mSASSS), was not significantly different between TNFi-treated and biologics-naive patients at 2 years (mSASSS difference -0.73 [95% confidence interval (95% CI) -1.52, 0.12], I2 = 28%) and ≥4 years (mSASSS difference -2.03 [95% CI -4.63, 0.72], I2 = 63%). Sensitivity analyses restricted to studies with a low risk of bias showed a significant difference in spinal radiographic progression between TNFi-treated and biologics-naive patients at ≥4 years (mSASSS difference -2.17 [95% CI -4.19, -0.15]). No significant difference in spinal radiographic progression was observed between NSAID-treated and control patients (mSASSS difference -0.30 [95% CI -2.62, 1.31], I2 = 71%) or between secukinumab-treated and biologics-naive patients (mSASSS difference -0.34 [95% CI -0.85, 0.17]). With regard to treatment differences in patients with nonradiographic axial SpA or in patients with radiographic progression measured using the sacroiliac joint score, an insufficient number of studies were available for analysis. CONCLUSION: Although no significant protective effect of TNFi treatment on spinal radiographic progression was seen over the course of 2 years or ≥4 years in patients with axial SpA, our analysis restricted to studies with a low risk of bias showed a protective effect of TNFi after ≥4 years. Therefore, long-term TNFi exposure might confer beneficial effects on spinal radiographic progression in axial SpA. No difference in radiographic progression at 2 years was seen in either the NSAID or secukinumab treatment groups compared to their controls. Future studies should explore the effects of biologic treatment on radiographic progression, as well as the effects of long-term biologics exposure, in patients with early axial SpA or those with nonradiographic axial SpA.


Assuntos
Espondilartrite/diagnóstico por imagem , Espondilartrite/terapia , Progressão da Doença , Humanos , Radiografia , Resultado do Tratamento
6.
Z Rheumatol ; 79(1): 74-77, 2020 Feb.
Artigo em Alemão | MEDLINE | ID: mdl-31754787

RESUMO

In two research projects, rheumatological patient education programmes were updated. The first step was to develop an expert consented framework for all rheumatological patient education programmes. From this, curricula and working materials for rheumatoid arthritis (RA) and axial spondyloarthritis (AS) were derived and two exemplary patient education manuals developed. A randomized controlled trail was designed for the five-hour RA basic education program. Finally, existing train-the-trainer training courses were adapted for these patient education programmes.


Assuntos
Artrite Reumatoide , Educação de Pacientes como Assunto , Reumatologia , Espondilartrite , Artrite Reumatoide/terapia , Currículo , Humanos , Educação de Pacientes como Assunto/métodos , Ensaios Clínicos Controlados Aleatórios como Assunto , Espondilartrite/terapia
7.
Autoimmun Rev ; 19(2): 102457, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31838160

RESUMO

INTRODUCTION: Spondyloarthrits (SpA) share clinical, genetic and immunological features with Inflammatory Bowel Diseases (IBD), and enteropathic SpA (eSpA) represent the clinical evidence of the association between gut and joint diseases. This cross-sectional study aimed to report data of eSpA patients collected from the first Italian database. PATIENTS AND METHODS: A specific web-based interface has been created to insert and collect the main clinical, serologic and imaging data from patients with eSpA, as well as disease activity, comorbidities and treatment, in a real-life scenario. RESULTS: Data were collected in 14 Italian centers (7 rheumatology and 7 gastroenterology units). A total of 347 eSpA patients were enrolled in the study. Type 1 peripheral eSpA was the most frequent form. Crohn' Disease (CD) was the most represented IBD. CD activity was similar among eSpA, whereas UC activity was slightly higher in the axial and mixed form than in the peripheral eSpA. The disease was active in less than half of axial eSpA patients and in only 18% of patients with peripheral eSpA. Furthermore, most of the patients had an inactive IBD. Nineteen percent of the total eSpA patients were free of therapy at the time of the enrollment and 61% of the patients were receiving biotechnological agents. CONCLUSIONS: The multidisciplinary management of eSpA patients, favored by this ad hoc created web-based platform, allowed to obtain data from the largest eSpA cohort. The information coming of this database might advance knowledge of eSpA and improve their standard of care.


Assuntos
Bases de Dados Factuais , Doenças Inflamatórias Intestinais/epidemiologia , Espondilartrite/epidemiologia , Espondilartrite/terapia , Comorbidade , Doença de Crohn/epidemiologia , Estudos Transversais , Feminino , Humanos , Internet , Itália , Masculino , Pessoa de Meia-Idade
8.
Z Rheumatol ; 79(1): 5-12, 2020 Feb.
Artigo em Alemão | MEDLINE | ID: mdl-31506791

RESUMO

Although the pathogenesis of spondylarthritis (SpA) has been the subject of intensive research in recent years, the consequences for treatment are relatively minor. Basic research studies indicated a potentially important role of the cytokines tumor necrosis factor (TNF) alpha and interleukin (IL)-17 for the pathogenesis of SpA but their outstanding role could then only be demonstrated by their inhibition in clinical studies, while other promising targets, such as IL­23 and IL­6 could not be shown to be relevant (at least against axial manifestations) in clinical studies. The intestinal microbiota probably plays an important role in the pathogenesis but not yet for the treatment of SpA. Ultimately, early effective and long-term suppression of inflammation is currently the best method to prevent ankylosis in the long run.


Assuntos
Espondilartrite , Citocinas , Humanos , Inflamação , Espondilartrite/patologia , Espondilartrite/terapia , Fator de Necrose Tumoral alfa
11.
PLoS One ; 14(12): e0225749, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31790484

RESUMO

OBJECTIVES: The primary objective of this trial was to assess safety and anti-inflammatory effects of an add-on training program involving breathing exercises, cold exposure, and meditation in patients with axial spondyloarthritis. METHODS: This study was an open-label, randomised, one-way crossover clinical proof-of-concept trial. Twenty-four patients with moderately active axial spondyloarthritis(ASDAS >2.1) and hs-CRP ≥5mg/L were included and randomised to an intervention (n = 13) and control group (n = 11) group that additionally received the intervention after the control period. The intervention period lasted for 8 weeks. The primary endpoint was safety, secondary endpoints were change in hs-CRP, serum calprotectin levels and ESR over the 8-week period. Exploratory endpoints included disease activity measured by ASDAS-CRP and BASDAI, quality of life (SF-36, EQ-5D, EQ-5D VAS), and hospital anxiety and depression (HADS). RESULTS: We found no significant differences in adverse events between groups, with one serious adverse event occurring 8 weeks after end of the intervention and judged 'unrelated'. During the 8-week intervention period, there was a significant decline of ESR from (median [interquartile range] to 16 [9-26.5] to 9 [5-23] mm/hr, p = 0.040, whereas no effect was found in the control group (from 14 [8.3-27.3] to 16 [5-37] m/hr, p = 0.406). ASDAS-CRP declined from 3.1 [2.5-3.6] to 2.3 [1.9-3.2] in the intervention group (p = 0.044). A similar trend was observed for serum calprotectin (p = 0.064 in the intervention group versus p = 0.182 in the control group), but not for hs-CRP. CONCLUSIONS: This proof-of-concept study in axial spondyloarthritis met its primary endpoint with no safety signals during the intervention. There was a significant decrease in ESR levels and ASDAS-CRP upon the add-on training program in the intervention group. These findings warrant full-scale randomised controlled trials of this novel therapeutic approach in patients with inflammatory conditions. TRIAL REGISTRATION: ClinicalTrials.gov; NCT02744014.


Assuntos
Exercícios Respiratórios , Temperatura Baixa , Inflamação/terapia , Meditação , Espondilartrite/terapia , Adulto , Biomarcadores/metabolismo , Determinação de Ponto Final , Feminino , Humanos , Masculino , Estudo de Prova de Conceito
13.
N Z Med J ; 132(1505): 38-47, 2019 11 08.
Artigo em Inglês | MEDLINE | ID: mdl-31697662

RESUMO

AIMS: To evaluate costs associated with a diagnosis of spondyloarthritis (SpA) in an Aotearoa/New Zealand cohort. METHODS: Patients with SpA attending specialist SpA clinics in Auckland and Hamilton completed a series of questionnaires on costs associated with ankylosing spondylitis, disease parameters (BASDAI), work productivity (WPAI, WLQ) and quality of life measures (EQ-5D, ASAS-HI). RESULTS: Eighty-one patients (median age 43 years) completed the study. All fulfilled the ASAS criteria for axial spondyloarthritis and 44 (58%) fulfilled the Modified New York Criteria for ankylosing spondylitis. The mean (SD) score on the EQ-VAS was 69mm (24.1). More than half reported difficulties with usual activities and more than 80% had moderate pain or discomfort despite current treatment. Sixty-six (82%) were in the workforce, and the mean work productivity loss was 4.8%. The mean (SD) annual cost was NZ$15,677 (NZ$11,269) with NZ$12,189 direct cost and NZ$3,488 productivity loss. The largest cost driver was use of biologic medications, which were used by 48% patients. CONCLUSIONS: This study has quantified the direct and indirect costs of spondyloarthritis (SpA) in Aotearoa/New Zealand, and demonstrates meaningful reduction in quality of life and work productivity in patients with SpA. The major driver of direct costs in SpA are biologic medications.


Assuntos
Custos e Análise de Custo , Qualidade de Vida , Espondilartrite/economia , Espondilite Anquilosante/economia , Adolescente , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Nova Zelândia , Índice de Gravidade de Doença , Espondilartrite/terapia , Espondilite Anquilosante/terapia , Inquéritos e Questionários , Adulto Jovem
15.
Rheum Dis Clin North Am ; 45(4): 519-535, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31564294

RESUMO

This article discusses treat-to-target strategies in axial spondyloarthritis and current status. Treatment ranging from nonsteroidal anti-inflammatory drugs to biologic and other disease-modifying drugs is discussed in the context of treat-to-target. The article explores evidence from landmark randomized, controlled trials and observational studies focusing on both radiographic and nonradiographic axial spondyloarthritis. The feasibility of treat-to-target, as well as predictors of remission are addressed in line with existing evidence. Finally, issues around management principles and challenges, as well as unmet need in the field, are highlighted.


Assuntos
Produtos Biológicos/farmacologia , Coluna Vertebral/diagnóstico por imagem , Espondilartrite , Inibidores do Fator de Necrose Tumoral/farmacologia , Gerenciamento Clínico , Humanos , Planejamento de Assistência ao Paciente , Radiografia/métodos , Espondilartrite/diagnóstico , Espondilartrite/terapia
16.
Nat Rev Rheumatol ; 15(12): 747-757, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31551538

RESUMO

The cytokines IL-23 and IL-17 have an important role in the pathogenesis of, and as a therapeutic target in, both animal models of chronic inflammation and some human chronic inflammatory diseases. The traditional view is that a main source of IL-17 is T cells and that IL-17 production is under the control of IL-23. IL-17 inhibition has shown good efficacy in clinical trials for ankylosing spondylitis (AS), a subtype of axial spondyloarthritis (axSpA) characterized by radiographic evidence of sacroiliitis. On the basis of data from animal models, genetic studies and the investigation of tissue and blood samples from patients with AS, IL-23 had also been predicted to be important in the pathogenesis of this disease and was therefore considered a potential therapeutic target for axSpA. However, two placebo-controlled, double-blind clinical trials in axSpA of monoclonal antibodies directed against either the p40 protein or the p19 protein of the IL-23 molecule had clear negative results. These findings indicate that IL-23 and IL-17 are at least partly uncoupled in axSpA. Reasons as to why, when and how such an uncoupling might occur are discussed in this Review, with special reference to the unique microenvironment of the subchondral bone marrow in axSpA.


Assuntos
Antirreumáticos/uso terapêutico , Fatores Biológicos/uso terapêutico , Imunossupressores/uso terapêutico , Imunoterapia/métodos , Interleucina-17/metabolismo , Interleucina-23/metabolismo , Espondilartrite , Humanos , Interleucina-17/antagonistas & inibidores , Interleucina-23/antagonistas & inibidores , Espondilartrite/imunologia , Espondilartrite/metabolismo , Espondilartrite/terapia
17.
Arthritis Care Res (Hoboken) ; 71(10): 1285-1299, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31436026

RESUMO

OBJECTIVE: To update evidence-based recommendations for the treatment of patients with ankylosing spondylitis (AS) and nonradiographic axial spondyloarthritis (SpA). METHODS: We conducted updated systematic literature reviews for 20 clinical questions on pharmacologic treatment addressed in the 2015 guidelines, and for 26 new questions on pharmacologic treatment, treat-to-target strategy, and use of imaging. New questions addressed the use of secukinumab, ixekizumab, tofacitinib, tumor necrosis factor inhibitor (TNFi) biosimilars, and biologic tapering/discontinuation, among others. We used the Grading of Recommendations, Assessment, Development and Evaluation methodology to assess the quality of evidence and formulate recommendations and required at least 70% agreement among the voting panel. RESULTS: Recommendations for AS and nonradiographic axial SpA are similar. TNFi are recommended over secukinumab or ixekizumab as the first biologic to be used. Secukinumab or ixekizumab is recommended over the use of a second TNFi in patients with primary nonresponse to the first TNFi. TNFi, secukinumab, and ixekizumab are favored over tofacitinib. Co-administration of low-dose methotrexate with TNFi is not recommended, nor is a strict treat-to-target strategy or discontinuation or tapering of biologics in patients with stable disease. Sulfasalazine is recommended only for persistent peripheral arthritis when TNFi are contraindicated. For patients with unclear disease activity, spine or pelvis magnetic resonance imaging could aid assessment. Routine monitoring of radiographic changes with serial spine radiographs is not recommended. CONCLUSION: These recommendations provide updated guidance regarding use of new medications and imaging of the axial skeleton in the management of AS and nonradiographic axial SpA.


Assuntos
Pesquisa Biomédica/normas , Reumatologia/normas , Espondilartrite/diagnóstico por imagem , Espondilite Anquilosante/diagnóstico por imagem , Antirreumáticos/uso terapêutico , Pesquisa Biomédica/métodos , Ensaios Clínicos como Assunto/métodos , Ensaios Clínicos como Assunto/normas , Humanos , Reumatologia/métodos , Espondilartrite/epidemiologia , Espondilartrite/terapia , Espondilite Anquilosante/epidemiologia , Espondilite Anquilosante/terapia , Resultado do Tratamento , Estados Unidos/epidemiologia
19.
Z Rheumatol ; 78(10): 979-986, 2019 Dec.
Artigo em Alemão | MEDLINE | ID: mdl-31346705

RESUMO

BACKGROUND: In Germany, the numbers of patients with spondylarthritides (SpA) and rheumatoid arthritis (RA) have increased. This rise was possibly promoted by the introduction of new classification criteria (CC) that enable an earlier recognition and the inclusion of less severe cases. The study explores how the new CC for axial SpA (axSpA) are incorporated into the clinical practice, compared with the CC for RA and systemic lupus erythematosus (SLE). In addition, the study investigated whether the new entity of non-radiographic axSpA (nr-axSpA) is accepted and used in Germany. MATERIAL AND METHODS: In 2016, an online survey was performed among all rheumatologists registered in the German Society of Rheumatology (DGRh). In addition, 150 rheumatologists were invited to the survey at the national meeting of the DGRh in 2016. RESULTS: Among 119 participating rheumatologists, 99% were familiar with the new CC for SpA and 82% applied them in practice (RA 99% and 80%, SLE 50% and 56%). 78% differentiated between radiographic and nr-axSpA and 80% believed that a significant proportion of patients with nr-axSpA will never develop radiographic changes. 91% agreed that the new CC facilitated an earlier treatment start and 58% that the CC enabled more patients to receive biologicals. 50% shared the opinion that the criterion "chronic back pain" could lead to the classification of too many patients as having axSpA. It deemed possible to 65% that patients with nr-axSpA would be treated with biologicals in whom the diagnosis of axSpA could not be confirmed later on. 81% voted against the initiation of TNF inhibitors in nr-axSpA patients with normal CRP levels and normal MRI. 67% interpreted the MRI themselves and 30% stated that the MRI is evaluated according to validated standards by the radiologists. Among all axSpA criteria, HLA B27 and inflammatory back pain received the highest significance and the response to NSAID the lowest. CONCLUSION: The new CC and the entity of nr-axSpA are accepted by German rheumatologists. A relevant proportion saw weaknesses of the new CC in the differentiation between nr-axSpA and non-specific chronic back pain. In practise, the interpretation of the CC with respect to the start of biologics is relatively strict, especially in cases with normal CRP and MRI. A ranking of axSpA criteria is commonly applied, although this was not initially intended in the CC.


Assuntos
Artrite Reumatoide , Lúpus Eritematoso Sistêmico , Espondilartrite , Espondilite Anquilosante , Artrite Reumatoide/diagnóstico , Artrite Reumatoide/terapia , Alemanha , Humanos , Lúpus Eritematoso Sistêmico/diagnóstico , Lúpus Eritematoso Sistêmico/terapia , Reumatologistas , Espondilartrite/diagnóstico , Espondilartrite/terapia , Espondilite Anquilosante/diagnóstico , Espondilite Anquilosante/terapia
20.
Z Rheumatol ; 78(8): 713-721, 2019 Oct.
Artigo em Alemão | MEDLINE | ID: mdl-31273459

RESUMO

BACKGROUND: The objective of the research consortium PROCLAIR was to gain population level knowledge on the treatment of patients with rheumatoid arthritis (RA), axial spondylarthritis (axSpA) and osteoarthritis (OA) in Germany. AIMS: A main question of the consortium was whether it is possible to identify groups of people who were exposed to a particular risk of undersupply or oversupply of treatment. In addition, the study investigated the validity of claims data for these diseases as a basis for further studies. PATIENTS AND METHODS: Cross-sectional surveys were carried out among insurees of the BARMER statutory health insurance fund whose claims data included RA, axSpA and OA diagnoses. The questionnaire data were linked with the claims data of the insured persons if they agreed. RESULTS: In all three diseases risk groups for care deficits could be identified. Persons with RA who are not treated by a specialist have less access to drug treatment. Physical therapy is prescribed for all three diagnoses at a low level, even for people undergoing joint replacement surgery. A connection between depressive symptoms and disease activity or function in axSpA was shown. In addition to the results relevant to care, the PROCLAIR network has also made contributions to critically assess the quality of health insurance data. DISCUSSION: The combination of billing data with survey data enables a comprehensive description of the treatment of musculoskeletal diseases. Particularly relevant factors are the specialization of the physician, sociodemographic parameters of the patients and the region of residence. In particular, access to treatment cannot be investigated in randomized clinical trials.


Assuntos
Artrite Reumatoide , Osteoartrite , Espondilartrite , Artrite Reumatoide/diagnóstico , Artrite Reumatoide/terapia , Produtos Biológicos/uso terapêutico , Estudos Transversais , Alemanha , Humanos , Osteoartrite/diagnóstico , Osteoartrite/terapia , Modalidades de Fisioterapia , Espondilartrite/diagnóstico , Espondilartrite/terapia , Inquéritos e Questionários
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