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. 2001 Mar;60(3):207–213. doi: 10.1136/ard.60.3.207

The national database of the German Collaborative Arthritis Centres: II. Treatment of patients with rheumatoid arthritis

A Zink 1, J Listing 1, M Niewerth 1, H Zeidler 1
PMCID: PMC1753561  PMID: 11171679

Abstract

OBJECTIVE—To describe current treatment of patients with rheumatoid arthritis (RA) in German rheumatology.
METHODS—Data from the German rheumatological database of 1998, comprising clinical and patient questionnaire data of 12 992 outpatients with RA seen at 24 collaborative arthritis centres in Germany, were analysed.
RESULTS—At the time of documentation, 88% of the patients with RA were undergoing disease modifying antirheumatic drug (DMARD) treatment. Methotrexate (MTX) was prescribed to 56% of the patients (61% with seropositive and 45% with seronegative RA). Combination treatment was used in 15%. MTX was the drug of first choice even in patients with up to one year's disease duration (49%), followed by antimalarial drugs (21%). Patients treated by non-rheumatologists within the previous year had received DMARD treatment in only 33% of the cases. In steroid treatment, low doses (⩽7.5 mg/day) were used by rheumatologists much more often (44%) than higher doses (12%). 16% of the patients had been inpatients during the previous year, with a median length of stay accumulated over the year of 21 days. Together with stays in inpatient rehabilitation, 22% of all patients had had some form of inpatient treatment. Comprehensive measures such as occupational therapy and patient education were prescribed to fewer than 12% of the patients, mostly during their hospital stay.
CONCLUSION—German rheumatologists do follow recent recommendations about early and effective treatment. However, there are still deficits in outpatient care with non-medicinal measures like occupational therapy and patient education, which may partly explain the high hospital admission rates.



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Selected References

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  1. Anderson R. B., Needleman R. D., Gatter R. A., Andrews R. P., Scarola J. A. Patient outcome following inpatient vs outpatient treatment of rheumatoid arthritis. J Rheumatol. 1988 Apr;15(4):556–560. [PubMed] [Google Scholar]
  2. Boers M. The case for corticosteroids in the treatment of early rheumatoid arthritis. Rheumatology (Oxford) 1999 Feb;38(2):95–97. doi: 10.1093/rheumatology/38.2.95. [DOI] [PubMed] [Google Scholar]
  3. Clarke A. E., Zowall H., Levinton C., Assimakopoulos H., Sibley J. T., Haga M., Shiroky J., Neville C., Lubeck D. P., Grover S. A. Direct and indirect medical costs incurred by Canadian patients with rheumatoid arthritis: a 12 year study. J Rheumatol. 1997 Jun;24(6):1051–1060. [PubMed] [Google Scholar]
  4. Collins D., Bellamy N., Campbell J. A Canadian survey of current methotrexate prescribing practices in rheumatoid arthritis. J Rheumatol. 1994 Jul;21(7):1220–1223. [PubMed] [Google Scholar]
  5. Conaghan P. G., Crotty M., Oh E., Day R. O., Brooks P. M. Anti-rheumatic drug-prescribing behaviour of Australasian rheumatologists 1984-1994. Br J Rheumatol. 1997 Apr;36(4):487–490. doi: 10.1093/rheumatology/36.4.487. [DOI] [PubMed] [Google Scholar]
  6. Criswell L. A., Henke C. J. What explains the variation among rheumatologists in their use of prednisone and second line agents for the treatment of rheumatoid arthritis? J Rheumatol. 1995 May;22(5):829–835. [PubMed] [Google Scholar]
  7. Criswell L. A., Such C. L., Yelin E. H. Differences in the use of second-line agents and prednisone for treatment of rheumatoid arthritis by rheumatologists and non-rheumatologists. J Rheumatol. 1997 Dec;24(12):2283–2290. [PubMed] [Google Scholar]
  8. Emery P. Rheumatoid arthritis: not yet curable with early intensive therapy. Lancet. 1997 Aug 2;350(9074):304–305. doi: 10.1016/S0140-6736(97)22031-3. [DOI] [PubMed] [Google Scholar]
  9. Fries J. F. Reevaluating the therapeutic approach to rheumatoid arthritis: the "sawtooth" strategy. J Rheumatol Suppl. 1990 May;22:12–15. [PubMed] [Google Scholar]
  10. Jaffe I. A. Combination therapy of rheumatoid arthritis--rationale and overview. J Rheumatol Suppl. 1990 Nov;25:24–27. [PubMed] [Google Scholar]
  11. Kirwan J. R., Russell A. S. Systemic glucocorticoid treatment in rheumatoid arthritis--a debate. Scand J Rheumatol. 1998;27(4):247–251. doi: 10.1080/030097498442343. [DOI] [PubMed] [Google Scholar]
  12. Mikuls T. R., O'Dell J. The changing face of rheumatoid arthritis therapy: results of serial surveys. Arthritis Rheum. 2000 Feb;43(2):464–465. doi: 10.1002/1529-0131(200002)43:2<464::AID-ANR30>3.0.CO;2-U. [DOI] [PubMed] [Google Scholar]
  13. Morrison E., Capell H. A. Corticosteroids in rheumatoid arthritis--the case against. Rheumatology (Oxford) 1999 Feb;38(2):97–100. doi: 10.1093/rheumatology/38.2.97. [DOI] [PubMed] [Google Scholar]
  14. Möttönen T., Hannonen P., Leirisalo-Repo M., Nissilä M., Kautiainen H., Korpela M., Laasonen L., Julkunen H., Luukkainen R., Vuori K. Comparison of combination therapy with single-drug therapy in early rheumatoid arthritis: a randomised trial. FIN-RACo trial group. Lancet. 1999 May 8;353(9164):1568–1573. doi: 10.1016/s0140-6736(98)08513-4. [DOI] [PubMed] [Google Scholar]
  15. O'Dell J. R., Haire C. E., Erikson N., Drymalski W., Palmer W., Eckhoff P. J., Garwood V., Maloley P., Klassen L. W., Wees S. Treatment of rheumatoid arthritis with methotrexate alone, sulfasalazine and hydroxychloroquine, or a combination of all three medications. N Engl J Med. 1996 May 16;334(20):1287–1291. doi: 10.1056/NEJM199605163342002. [DOI] [PubMed] [Google Scholar]
  16. Pincus T., O'Dell J. R., Kremer J. M. Combination therapy with multiple disease-modifying antirheumatic drugs in rheumatoid arthritis: a preventive strategy. Ann Intern Med. 1999 Nov 16;131(10):768–774. doi: 10.7326/0003-4819-131-10-199911160-00009. [DOI] [PubMed] [Google Scholar]
  17. Smyth C. J. Therapy of rheumatoid arthritis. A pyramidal plan. Postgrad Med. 1972 May;51(6):31–39. doi: 10.1080/00325481.1972.11698261. [DOI] [PubMed] [Google Scholar]
  18. Suarez-Almazor M. E., Soskolne C. L., Saunders L. D., Russell A. S. Use of second line drugs for the treatment of rheumatoid arthritis in Edmonton, Alberta. Patterns of prescription and longterm effectiveness. J Rheumatol. 1995 May;22(5):836–843. [PubMed] [Google Scholar]
  19. Vliet Vlieland T. P., Breedveld F. C., Hazes J. M. The two-year follow-up of a randomized comparison of in-patient multidisciplinary team care and routine out-patient care for active rheumatoid arthritis. Br J Rheumatol. 1997 Jan;36(1):82–85. doi: 10.1093/rheumatology/36.1.82. [DOI] [PubMed] [Google Scholar]
  20. Ward M. M., Fries J. F. Trends in antirheumatic medication use among patients with rheumatoid arthritis, 1981-1996. J Rheumatol. 1998 Mar;25(3):408–416. [PubMed] [Google Scholar]
  21. Wilske K. R., Healey L. A. Remodeling the pyramid--a concept whose time has come. J Rheumatol. 1989 May;16(5):565–567. [PubMed] [Google Scholar]
  22. Wolfe F., Kleinheksel S. M., Spitz P. W., Lubeck D. P., Fries J. F., Young D. Y., Mitchell D. M., Roth S. H. A multicenter study of hospitalization in rheumatoid arthritis: effect of health care system, severity, and regional difference. J Rheumatol. 1986 Apr;13(2):277–284. [PubMed] [Google Scholar]
  23. Wolfe F., Kleinheksel S. M., Spitz P. W., Lubeck D. P., Fries J. F., Young D. Y., Mitchell D., Roth S. A multicenter study of hospitalization in rheumatoid arthritis. Frequency, medical-surgical admissions, and charges. Arthritis Rheum. 1986 May;29(5):614–619. doi: 10.1002/art.1780290505. [DOI] [PubMed] [Google Scholar]
  24. Zink A., Listing J., Klindworth C., Zeidler H., German Collaboratrive Arthritis Centres The national database of the German Collaborative Arthritis Centres: I. Structure, aims, and patients. Ann Rheum Dis. 2001 Mar;60(3):199–206. doi: 10.1136/ard.60.3.199. [DOI] [PMC free article] [PubMed] [Google Scholar]
  25. van der Heide A., Jacobs J. W., Bijlsma J. W., Heurkens A. H., van Booma-Frankfort C., van der Veen M. J., Haanen H. C., Hofman D. M., van Albada-Kuipers G. A., ter Borg E. J. The effectiveness of early treatment with "second-line" antirheumatic drugs. A randomized, controlled trial. Ann Intern Med. 1996 Apr 15;124(8):699–707. doi: 10.7326/0003-4819-124-8-199604150-00001. [DOI] [PubMed] [Google Scholar]

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