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2.
Z Rheumatol ; 78(Suppl 2): 65-72, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31407089

RESUMO

BACKGROUND: Since 1993, data on the care and quality of life of patients with inflammatory rheumatic diseases have been collected in the German National Database (NDB) of the regional collaborative rheumatology centers. OBJECTIVE: In this review long-term trends on treatment, disease activity and gainful employment of the most common inflammatory rheumatic diseases are presented and the most important analyses from 25 years of the NDB are summarized. METHODS: Between 15 and 17 rheumatological institutions take part in the NDB and once a year collect data from a total of more than 10,000 patients. The rheumatologists document the disease status and care, the patients report on their state of health and the effects of the disease. RESULTS: The biologics era at the beginning of the twenty-first century has led to changes in the therapeutic spectrum of most inflammatory rheumatic diseases, especially in rheumatoid arthritis and ankylosing spondylitis. Some basic therapies formerly used are hardly used anymore and glucocorticoids are used less frequently. Methotrexate has remained the standard therapy for rheumatoid arthritis over the years. Nowadays, nearly 30% of patients with rheumatoid arthritis receive treatment with biologics. Disease activity, functional and social restrictions have decreased across all diseases. CONCLUSION: The improved health status of many patients with rheumatic diseases confirms the high level of care provided by the rheumatism centers involved in the NDB. The increasing specification of measuring instruments and the standardization of documentation systems are major challenges that the NDB will have to face in the coming years if it is to remain in the digital age.


Assuntos
Produtos Biológicos/uso terapêutico , Emprego/estatística & dados numéricos , Qualidade de Vida , Doenças Reumáticas , Artrite Reumatoide , Humanos , Doenças Reumáticas/terapia , Reumatologia/tendências , Espondilite Anquilosante
3.
Z Rheumatol ; 78(8): 703-712, 2019 Oct.
Artigo em Alemão | MEDLINE | ID: mdl-31297603

RESUMO

BACKGROUND: Since 1993, data on the care and quality of life of patients with inflammatory rheumatic diseases have been collected in the German National Database (NDB) of the regional collaborative rheumatology centers. OBJECTIVE: In this review long-term trends on treatment, disease activity and gainful employment of the most common inflammatory rheumatic diseases are presented and the most important analyses from 25 years of the NDB are summarized. METHODS: Between 15 and 17 rheumatological institutions take part in the core documentation and once a year collect data from a total of more than 10,000 patients. The rheumatologists document the disease status and care, the patients report on their state of health and the effects of the disease. RESULTS: The biologics era at the beginning of the twenty-first century has led to changes in the therapeutic spectrum of most inflammatory rheumatic diseases, especially in rheumatoid arthritis and ankylosing spondylitis. Some basic therapies formerly used are hardly used anymore and glucocorticoids are used less frequently. Methotrexate has remained the standard therapy for rheumatoid arthritis over the years. Nowadays, nearly 30% of patients with rheumatoid arthritis receive treatment with biologics. Disease activity, functional and social restrictions have decreased across all diseases. CONCLUSION: The improved health status of many patients with rheumatic diseases confirms the high level of care provided by the rheumatism centers involved in the NDB. The increasing specification of measuring instruments and the standardization of documentation systems are major challenges that the NDB will have to face in the coming years if it is to remain in the digital age.


Assuntos
Produtos Biológicos/uso terapêutico , Qualidade da Assistência à Saúde , Doenças Reumáticas , Reumatologia , Artrite Reumatoide , Humanos , Qualidade de Vida , Doenças Reumáticas/terapia , Reumatologia/tendências , Espondilite Anquilosante
4.
Lancet ; 393(10188): 2344-2358, 2019 Jun 08.
Artigo em Inglês | MEDLINE | ID: mdl-31180031

RESUMO

The heterogeneity of systemic lupus erythematosus (SLE), long recognised by clinicians, is now challenging the entire lupus community, from geneticists to clinical investigators. Although the outlook for patients with SLE has greatly improved, many unmet needs remain, chief of which is the development of safer and more efficacious therapies. To develop innovative therapies, a far better understanding of SLE pathogenesis as it relates to the array of clinical phenotypes is needed. Additionally, to efficiently achieve these goals, the lupus community needs to refine existing clinical research tools and better adapt them to overcome the obstacles created by the heterogeneity of manifestations. Here, we review progress towards the ultimate goal of safely reducing disease activity and preventing damage accrual and death. We discuss the new classification criteria from the European League Against Rheumatism and American College of Rheumatology, novel definitions of remission and low lupus disease activity, and new proposals for the histological classification of lupus nephritis. Recommendations for the treatment of SLE and novel approaches to drug development hold much promise to further enhance SLE outcomes.


Assuntos
Lúpus Eritematoso Sistêmico/tratamento farmacológico , Feminino , Humanos , Lúpus Eritematoso Sistêmico/classificação , Lúpus Eritematoso Sistêmico/fisiopatologia , Masculino , Indução de Remissão , Reumatologia/métodos , Reumatologia/tendências , Índice de Gravidade de Doença
5.
Clin Rheumatol ; 38(6): 1785-1789, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31093788

RESUMO

Social media has become a key component of contemporary medicine, and the rheumatology subspecialty is not an exemption. We found that just six of the 40 key peer-reviewed rheumatology journals have found it sensible to incorporate the new appointment of a Social Media Editor-or a similar designation-into their Editorial Boards. We propose that the role of a social media editor is a trinomial: not only a technological work to promote digital engagement but also an activity of ethical guidance and a cultural challenge dealing with worldwide cultural and mindset diversity.


Assuntos
Políticas Editoriais , Editoração/tendências , Mídias Sociais/tendências , Humanos , Disseminação de Informação/métodos , Publicações Periódicas como Assunto , Reumatologia/tendências
6.
Int J Rheum Dis ; 22(5): 880-889, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30950207

RESUMO

AIM: This study aims to measure current situation with regard to access and financial protection towards healthcare for rheumatic diseases (RDs) in India. METHOD: The first part of this study is quantitative, and uses the data generated by the 71st Round of National Sample Survey 2014, which measured self-reported morbidity, choice of provider and utilization of services and out of pocket expenditure (OOPE) incurred on healthcare services in a sample of 65 932 households and 333 104 individuals from all across India. The second qualitative part of the study was done in one sample district to understand the barriers to access and financial protection. RESULTS: 3.5% of all hospitalizations in the preceding one year and 9.9% of all ambulatory care in the preceding 15 days of this study period were due to RDs. Cost of care for RDs was three times higher in private sector. Cost on medicines comprised the largest share in both sectors. 54% of the households faced catastrophic health expenditure at 10% threshold (CHE-10) and this was nine times higher in private provisioning (OR: 8.8, CI: 6.8-11.4). 24% of the households had to borrow or sell household assets to meet the hospitalization expenditure. Insurance had marginal impact and it did not help in preventing household from facing CHE-10 for the lowermost three economic quintiles. There was significant unmet health care needs and lack of continuity of care of RDs in India. CONCLUSION: Addressing the gaps in access and financial protection for patients with RDs need greater emphasis in policy as well as implementation, if the country has to achieve Universal Health Coverage.


Assuntos
Custos de Cuidados de Saúde , Gastos em Saúde , Acesso aos Serviços de Saúde/economia , Doenças Reumáticas/economia , Doenças Reumáticas/terapia , Reumatologia/economia , Cobertura Universal do Seguro de Saúde/economia , Adolescente , Adulto , Criança , Pré-Escolar , Continuidade da Assistência ao Paciente/economia , Continuidade da Assistência ao Paciente/tendências , Feminino , Custos de Cuidados de Saúde/tendências , Pesquisas sobre Serviços de Saúde , Gastos em Saúde/tendências , Acesso aos Serviços de Saúde/tendências , Disparidades em Assistência à Saúde/economia , Disparidades em Assistência à Saúde/tendências , Humanos , Índia/epidemiologia , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Pesquisa Qualitativa , Doenças Reumáticas/epidemiologia , Reumatologia/tendências , Cobertura Universal do Seguro de Saúde/tendências , Adulto Jovem
7.
Rheum Dis Clin North Am ; 45(2): 173-186, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30952391

RESUMO

This article aims to describe key issues, processes, and outcomes related to development of a patient registry for rheumatology research using a digital platform where patients track useful data about their condition for their own use while contributing to research. Digital interventions are effective to build a patient research registry for people with rheumatoid arthritis and other rheumatic and musculoskeletal diseases. ArthritisPower provides evidence of the value of digital interventions to build community support for research and to transform patient engagement and patient-generated data capture.


Assuntos
Medidas de Resultados Relatados pelo Paciente , Projetos de Pesquisa/tendências , Reumatologia , Telemedicina/métodos , Humanos , Seleção de Pacientes , Reumatologia/métodos , Reumatologia/tendências , Autogestão/métodos
8.
Rheum Dis Clin North Am ; 45(2): 257-273, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30952397

RESUMO

Technology can help health care providers understand their patients' experience of illness in a way that was previously impossible. Experience in using health information technology (IT) to capture this information through PROs within rheumatology suggests that careful attention to human centered design, including detailed workflow planning, consideration of patient and physician burden, integration into the health IT ecosystem, and delivering information to the right person at the right time are all important. Technology applications must be tested in diverse health systems and populations to ensure they are simple to interpret, useful for clinical decision making and effective in impacting outcomes.


Assuntos
Informática Médica/métodos , Medidas de Resultados Relatados pelo Paciente , Reumatologia , Telemedicina/métodos , Registros Eletrônicos de Saúde , Humanos , Reumatologia/métodos , Reumatologia/tendências
11.
Z Rheumatol ; 78(5): 396-403, 2019 Jun.
Artigo em Alemão | MEDLINE | ID: mdl-30824997

RESUMO

Rheumatoid arthritis (RA) is one of the most frequent chronic inflammatory rheumatic diseases and when untreated leads to chronic tissue destruction and increased mortality. Due to innovative systemic treatment strategies established over the last 20-25 years, the prognosis has considerably improved in terms of disease and socioeconomic burdens, symptoms, long-term prognosis, ability to work and mortality; however, as a rule a prerequisite is long-term and continuous treatment. A medicinal cure of RA is still not in view. For many patients this means the long-term use of very expensive medications. In addition to hemato-oncology, rheumatology has become the second most expensive discipline in Germany in terms of cost per patient. Convincing data from many studies imply that an early start of treatment within the first few weeks after clinical onset of symptoms improves the prognosis, reduces the necessity for expensive drugs and thereby considerably decreases medical costs. This results in the requirement that every patient with symptoms of arthritis must be seen by a rheumatologist within the first 6 weeks following initial manifestation of the disease. Such an improvement in treatment can only be achieved in Germany if the numbers of rheumatologists and trained healthcare professionals in practices such as clinics are considerably increased. This is not only in the interests of patients but also in the interests of the health insurance companies because the investment in the healthcare infrastructure with internistic rheumatologists will result in substantial economic benefits for the cost bearer. It must be the common task of all players in healthcare policy, cost bearers and internistic rheumatologists to provide optimal conditions in medical as well as economical terms.


Assuntos
Artrite Reumatoide , Reumatologia , Artrite Reumatoide/terapia , Alemanha , Humanos , Prognóstico , Encaminhamento e Consulta , Reumatologia/tendências , Fatores de Tempo
13.
Int J Clin Pharmacol Ther ; 57(4): 182-187, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30738498

RESUMO

OBJECTIVE: The goal of the present study was to investigate lines of therapy with biological drugs in patients followed in dermatology, gastroenterology, and rheumatology practices in Germany. MATERIALS AND METHODS: The study included patients aged 18 years or over who had received a biological therapy in dermatology, gastroenterology, or rheumatology practices in Germany in 2017 (index date). The primary outcome of the study was the prevalence of different lines of therapy (first-, second-, third-, and at least fourth-line therapies) by type of practice, age, and gender. The second outcome was the association between basic characteristics (type of practice, age, and gender) and lines of therapy with biological drugs. RESULTS: The present study included 27,816 individuals. The mean age (SD) at index date was 50.7 years (15.4 years). Biological drugs were prescribed as first-line therapies in 60% of patients (dermatology 73%, gastroenterology 61%, and rheumatology 56%). The prevalence of first-line therapies ranged from 57% in individuals aged 41 - 50 years to 65% in those aged 18 - 30 years. Furthermore, 56% of women and 61% of men were prescribed biological drugs as first-line therapies. Finally, the likelihood of being prescribed biological drugs as second-, third-, or at least fourth-line therapies was significantly associated with being followed in a rheumatology or gastroenterology practice, older age, and female gender. CONCLUSION: Biological drugs were prescribed as first-line therapies in most cases. The type of practice as well as the patient's age and gender had a significant impact on lines of therapy with biological drugs.
.


Assuntos
Produtos Biológicos/uso terapêutico , Dermatologia/tendências , Gastroenterologia/tendências , Reumatologia/tendências , Adolescente , Adulto , Feminino , Alemanha , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem
17.
Int J Rheum Dis ; 22 Suppl 1: 21-27, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-29707909

RESUMO

The classification of the systemic vasculitides has been controversial for several decades. The Chapel Hill consensus Conference definitions originally developed in 1994, but revised and extended in 2012 are now widely accepted. The American College of Rheumatology (ACR) criteria were first published in 1990, are now generally accepted to be out of date and new criteria are needed. More recently the classical division of the ANCA vasculitides using clinical phenotype has come under scrutiny with evidence from epidemiological, genetic and outcome studies that perhaps these conditions should be classified on the basis of ANCA specificity into PR3-ANCA positive and MPO-ANCA positive groups. The traditional distinction between giant cell arteritis and Takayasu arteritis has been questioned and some recent studies of GCA have included patients with only extra-cranial disease. The Diagnostic and Classification Criteria of Vasculitis study (DCVAS) will provide new validated classification criteria for the systemic vasculitides.


Assuntos
Pesquisa Biomédica/tendências , Reumatologia/tendências , Vasculite Sistêmica/classificação , Vasculite Sistêmica/diagnóstico , Terminologia como Assunto , Consenso , Conferências de Consenso como Assunto , Previsões , Humanos , Fenótipo , Vasculite Sistêmica/genética , Vasculite Sistêmica/imunologia
18.
Rheum Dis Clin North Am ; 45(1): 13-26, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30447742

RESUMO

The United States is facing a rheumatology provider shortage over the next decade, which will negatively affect care for patients with rheumatic disease across the nation if this deficit is not thoughtfully addressed. The increasing numbers of retiring rheumatology specialists, women entering the workforce, and rheumatology graduates seeking part-time employment were identified as the most significant factors driving the projected decline in supply of providers. The major factors driving the projected increase in demand include an aging and growing population and improved treatment options, both of which increase disease prevalence and the challenge of managing chronic rheumatologic diseases.


Assuntos
Mão de Obra em Saúde/tendências , Reumatologistas/provisão & distribução , Reumatologia/tendências , Acesso aos Serviços de Saúde , Necessidades e Demandas de Serviços de Saúde , Humanos , Admissão e Escalonamento de Pessoal , Médicas , Aposentadoria , Doenças Reumáticas/epidemiologia , Doenças Reumáticas/terapia
20.
Ann Rheum Dis ; 78(3): 293-296, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30559252

RESUMO

The specialty of rheumatology takes care of people with disabling and long-term musculoskeletal conditions. For these patients, good healthcare requires the establishment of a sustainable partnership with healthcare professionals. For over two decades, rheumatology has been a frontrunner in piloting and implementing new kinds of partnerships in scientific research. In this viewpoint paper, we provide evidence for the leading role of rheumatology in developing strategies for engaging patients in research agenda setting, outcome research, developing treatment recommendations, assessing grant applications, conducting patient-centred research and transferring knowledge from research into practice. Experiences and lessons learnt in rheumatology are regularly published and are currently widely adapted and implemented in other specialties and research contexts. Challenges still exist and it is expected that rheumatology, as a leading discipline in this field, may further enhance our knowledge, expertise and understanding of the conditions for relational empowerment and meaningful patient involvement.


Assuntos
Pesquisa Biomédica/tendências , Participação do Paciente/tendências , Relações Profissional-Paciente , Pesquisadores/tendências , Reumatologia/tendências , Humanos , Doenças Musculoesqueléticas
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