K. Albrecht

Versorgung der rheumatoiden Arthritis 2014

BACKGROUNDnSince the introduction of biologic treatment in rheumatoid arthritis (RA), disease activity and treatment modalities have changed substantially. The current provision and developments in recent years are analyzed with annual data from the National Database of the Collaborative Arthritis Centers in Germany.nnnMETHODSnTo analyze disease activity, diagnostics and treatment in RA patients in 2014 with regard to seropositivity and disease duration. Time trends from 2007-2014 are reported for disease activity (DAS28) distribution and biologic treatment.nnnRESULTSnIn 2014, axa0total of 8,084 RA patients were analyzed: 72u2009% were rheumatoid factor and/or ACPA positive, the mean age was 62xa0years and the mean disease duration 12xa0years. According to DAS28, 35.9u2009% were in remission, 19.2u2009% had low, 37.1u2009% moderate and 7.8u2009% high disease activity. An increase since 2007 was only observed in patients withxa0a disease duration >2xa0years. Synthetic DMARDS were used for treatment in 78u2009%. Biologic treatment increased from 16u2009% (2007) to 27u2009% (2014). Especially those patients with a disease duration >5xa0years were treated more frequently with biologics. Seronegative patients had slightly less severe mean disease activity parameters. They were treated equally frequent with DMARDS but only half as often with biologics compared to seropositive patients.nnnCONCLUSIONnThe use of biologics in RA patients has increased since 2007; however this was not observed in patients with short disease duration. Early intensive treatment adaption seems justified to improve disease activity in the large portion of patients who do not reach low disease activity under conventional DMARDs.ZusammenfassungHintergrundSeit der Einführung der Biologika haben sich Therapie und Folgen der rheumatoiden Arthritis (RA) deutlich verändert. Die jährlich erhobenen Daten der Kerndokumentation ermöglichen es, diese Entwicklung abzubilden.MethodikDaten von Patienten mit RA aus dem Jahr 2014 wurden zu Krankheitsaktivität, Diagnostik und Therapie unter Berücksichtigung der Serologie und der Krankheitsdauer deskriptiv ausgewertet. Die Veränderungen in der Krankheitsaktivität (DAS28) und der Biologikatherapie werden von 2007 bis 2014 dargestellt.ErgebnisseIm Jahr 2014 wurden 8084 RA-Patienten erfasst. 72u2009% waren Rheumafaktor und/oder ACPA-positiv, das mittlere Alter lag bei 62xa0Jahren und die mittlere Krankheitsdauer bei 12xa0Jahren. Nach dem DAS28 waren 35,9u2009% in Remission, weitere 19,2u2009% hatten eine niedrige, 37,1u2009% eine moderate und 7,8u2009% eine hohe Krankheitsaktivität. Die Remissionsrate stieg von 2007 bis 2014 nur bei Patienten mit langer Krankheitsdauer um 8–10u2009%, während sie bei Patienten mit <2-jähriger Krankheitsdauer unverändert blieb. 78u2009% aller Patienten wurden mit einem konventionell synthetischen DMARD behandelt. Der Anteil an Patienten mit Biologika stieg von 16u2009% (2007) auf 27u2009% (2014). Vor allem bei Patienten mit >5-jähriger Krankheitsdauer wurden Biologika 2014 häufiger eingesetzt. Seronegative Patienten hatten im Mittel eine etwas geringere Krankheitsaktivität und wurden vergleichbar häufig mit DMARDs, aber nur halb so oft mit Biologika therapiert wie seropositive Patienten.SchlussfolgerungDie Versorgung der RA-Kranken mit Biologika ist seit 2007 weiter gestiegen, allerdings nicht bei Patienten mit kurzer Krankheitsdauer. Eine frühe Intensivierung der Therapie erscheint gerechtfertigt, um die Krankheitsaktivität bei dem Anteil an Patienten, die keine Remission erreichen, weiter zu reduzieren.AbstractBackgroundSince the introduction of biologic treatment in rheumatoid arthritis (RA), disease activity and treatment modalities have changed substantially. The current provision and developments in recent years are analyzed with annual data from the National Database of the Collaborative Arthritis Centers in Germany.MethodsTo analyze disease activity, diagnostics and treatment in RA patients in 2014 with regard to seropositivity and disease duration. Time trends from 2007–2014 are reported for disease activity (DAS28) distribution and biologic treatment.ResultsIn 2014, axa0total of 8,084 RA patients were analyzed: 72u2009% were rheumatoid factor and/or ACPA positive, the mean age was 62xa0years and the mean disease duration 12xa0years. According to DAS28, 35.9u2009% were in remission, 19.2u2009% had low, 37.1u2009% moderate and 7.8u2009% high disease activity. An increase since 2007 was only observed in patients withxa0a disease duration >2xa0years. Synthetic DMARDS were used for treatment in 78u2009%. Biologic treatment increased from 16u2009% (2007) to 27u2009% (2014). Especially those patients with a disease duration >5xa0years were treated more frequently with biologics. Seronegative patients had slightly less severe mean disease activity parameters. They were treated equally frequent with DMARDS but only half as often with biologics compared to seropositive patients.ConclusionThe use of biologics in RA patients has increased since 2007; however this was not observed in patients with short disease duration. Early intensive treatment adaption seems justified to improve disease activity in the large portion of patients who do not reach low disease activity under conventional DMARDs.

[Medical treatment of rheumatoid arthritis in 2014 : Current data from the German Collaborative Arthritis Centers].

BACKGROUNDnSince the introduction of biologic treatment in rheumatoid arthritis (RA), disease activity and treatment modalities have changed substantially. The current provision and developments in recent years are analyzed with annual data from the National Database of the Collaborative Arthritis Centers in Germany.nnnMETHODSnTo analyze disease activity, diagnostics and treatment in RA patients in 2014 with regard to seropositivity and disease duration. Time trends from 2007-2014 are reported for disease activity (DAS28) distribution and biologic treatment.nnnRESULTSnIn 2014, axa0total of 8,084 RA patients were analyzed: 72u2009% were rheumatoid factor and/or ACPA positive, the mean age was 62xa0years and the mean disease duration 12xa0years. According to DAS28, 35.9u2009% were in remission, 19.2u2009% had low, 37.1u2009% moderate and 7.8u2009% high disease activity. An increase since 2007 was only observed in patients withxa0a disease duration >2xa0years. Synthetic DMARDS were used for treatment in 78u2009%. Biologic treatment increased from 16u2009% (2007) to 27u2009% (2014). Especially those patients with a disease duration >5xa0years were treated more frequently with biologics. Seronegative patients had slightly less severe mean disease activity parameters. They were treated equally frequent with DMARDS but only half as often with biologics compared to seropositive patients.nnnCONCLUSIONnThe use of biologics in RA patients has increased since 2007; however this was not observed in patients with short disease duration. Early intensive treatment adaption seems justified to improve disease activity in the large portion of patients who do not reach low disease activity under conventional DMARDs.ZusammenfassungHintergrundSeit der Einführung der Biologika haben sich Therapie und Folgen der rheumatoiden Arthritis (RA) deutlich verändert. Die jährlich erhobenen Daten der Kerndokumentation ermöglichen es, diese Entwicklung abzubilden.MethodikDaten von Patienten mit RA aus dem Jahr 2014 wurden zu Krankheitsaktivität, Diagnostik und Therapie unter Berücksichtigung der Serologie und der Krankheitsdauer deskriptiv ausgewertet. Die Veränderungen in der Krankheitsaktivität (DAS28) und der Biologikatherapie werden von 2007 bis 2014 dargestellt.ErgebnisseIm Jahr 2014 wurden 8084 RA-Patienten erfasst. 72u2009% waren Rheumafaktor und/oder ACPA-positiv, das mittlere Alter lag bei 62xa0Jahren und die mittlere Krankheitsdauer bei 12xa0Jahren. Nach dem DAS28 waren 35,9u2009% in Remission, weitere 19,2u2009% hatten eine niedrige, 37,1u2009% eine moderate und 7,8u2009% eine hohe Krankheitsaktivität. Die Remissionsrate stieg von 2007 bis 2014 nur bei Patienten mit langer Krankheitsdauer um 8–10u2009%, während sie bei Patienten mit <2-jähriger Krankheitsdauer unverändert blieb. 78u2009% aller Patienten wurden mit einem konventionell synthetischen DMARD behandelt. Der Anteil an Patienten mit Biologika stieg von 16u2009% (2007) auf 27u2009% (2014). Vor allem bei Patienten mit >5-jähriger Krankheitsdauer wurden Biologika 2014 häufiger eingesetzt. Seronegative Patienten hatten im Mittel eine etwas geringere Krankheitsaktivität und wurden vergleichbar häufig mit DMARDs, aber nur halb so oft mit Biologika therapiert wie seropositive Patienten.SchlussfolgerungDie Versorgung der RA-Kranken mit Biologika ist seit 2007 weiter gestiegen, allerdings nicht bei Patienten mit kurzer Krankheitsdauer. Eine frühe Intensivierung der Therapie erscheint gerechtfertigt, um die Krankheitsaktivität bei dem Anteil an Patienten, die keine Remission erreichen, weiter zu reduzieren.AbstractBackgroundSince the introduction of biologic treatment in rheumatoid arthritis (RA), disease activity and treatment modalities have changed substantially. The current provision and developments in recent years are analyzed with annual data from the National Database of the Collaborative Arthritis Centers in Germany.MethodsTo analyze disease activity, diagnostics and treatment in RA patients in 2014 with regard to seropositivity and disease duration. Time trends from 2007–2014 are reported for disease activity (DAS28) distribution and biologic treatment.ResultsIn 2014, axa0total of 8,084 RA patients were analyzed: 72u2009% were rheumatoid factor and/or ACPA positive, the mean age was 62xa0years and the mean disease duration 12xa0years. According to DAS28, 35.9u2009% were in remission, 19.2u2009% had low, 37.1u2009% moderate and 7.8u2009% high disease activity. An increase since 2007 was only observed in patients withxa0a disease duration >2xa0years. Synthetic DMARDS were used for treatment in 78u2009%. Biologic treatment increased from 16u2009% (2007) to 27u2009% (2014). Especially those patients with a disease duration >5xa0years were treated more frequently with biologics. Seronegative patients had slightly less severe mean disease activity parameters. They were treated equally frequent with DMARDS but only half as often with biologics compared to seropositive patients.ConclusionThe use of biologics in RA patients has increased since 2007; however this was not observed in patients with short disease duration. Early intensive treatment adaption seems justified to improve disease activity in the large portion of patients who do not reach low disease activity under conventional DMARDs.

High variability in glucocorticoid starting doses in patients with rheumatoid arthritis: observational data from an early arthritis cohort.

To evaluate initial glucocorticoid (GC) therapy in patients with rheumatoid arthritis (RA). Six hundred sixty-nine patients with early RA were followed for 2xa0years in the multicenter “Course And Prognosis of Early Arthritis” cohort. Treatment was applied according to routine care. Assessments included disease activity (DAS28), disability Hannover Functional Status Questionnaire (FFbH), and treatment details. Mixed models, ANCOVA, and logistic regression models were used for statistical analysis. In total, 518 patients (77xa0%) received oral GCs at baseline; 20xa0% received a low dose (<7.5xa0mg prednisolone/day), 22xa0% received a moderate (7.5–19xa0mg), and 35xa0% received a high dose (≥20xa0mg). In a multivariate logistic regression analysis, higher DAS28 values (OR 1.3) were associated with the use of higher GC doses at baseline (pxa0<xa00.001). After adjusting for age, sex, and baseline DAS28 and DMARDs, the patients who started with high-dose GCs had a greater improvement in DAS28 (month 3) and FFbH (month 6, pxa0<xa00.001 each). At 2xa0years, the mean DAS28 remission rates and FFbH values were similar. In all GC groups, the mean dose was tapered to 4xa0mg/day within 6xa0months. The reported comorbidities were not increased in patients with high-dose GC therapy. Starting treatment with high-dose GCs led to a better clinical response within 3 to 6xa0months compared to starting patients on lower dosages. Irrespective of the starting approach, rheumatologists tapered GCs down to a low dose within 6xa0months. With this strategy, clinical outcomes at 2xa0years did not differ relevantly.

Prävalenz der rheumatoiden Arthritis in Deutschland auf Basis von Kassendaten

BACKGROUNDnRheumatoid arthritis (RA) is the most common chronic inflammatory joint disease with a prevalence of up to 1u2009% in the adult population.nnnOBJECTIVEnThis study describes the prevalence of RA diagnoses in outpatient health insurance claims data, based on different case definitions and stratified by age, sex and region of residence.nnnMETHODSnBased on data from a nationwide statutory health insurance fund (BARMER GEK) from the year 2013, a cross-sectional study of insurants aged 18 years or older was conducted. The following case definitions were applied: A) a diagnosis of seropositive rheumatoid arthritis (M05) or other rheumatoid arthritis (M06) according to the international classification of diseases 10 German modification (ICD-10-GM) in at least two quarterly periods of the year 2013, B) case definition A plus determination of C‑reactive protein (CRP) or erythrocyte sedimentation rate (ESR) at least once, C) case definition B plus specific drug therapy and D) case definition A plus treatment by a rheumatologist. Raw as well as age and sex-standardized prevalences were calculated and stratified according to the federal state.nnnRESULTSnThe study population consisted of 7,155,315 insurants of whom 60.2u2009% were female. Overall, RA prevalences for the respective case definitions were 1.62u2009% (A), 1.11u2009% (B), 0.94u2009% (C) and 0.64u2009% (D). When standardized to the German population the prevalences were 1.38u2009% (A), 0.95u2009% (B), 0.81u2009% (C) and 0.55u2009% (D). The proportion of women was approximately 80u2009% for all case definitions. Prevalences increased with age, peaking in the age group 70-79 years old and showing the highest values in eastern and the lowest in southern Germany for raw as well as standardized measures.nnnCONCLUSIONnRegional differences in the prevalence of RA diagnoses in health insurance claims data were observed independent of age, sex and case definition. The expected prevalence according to the results of international studies was best achieved when case definitions with CRP or ESR were considered.ZusammenfassungHintergrundDie rheumatoide Arthritis (RA) ist die häufigste chronisch entzündliche Gelenkerkrankung mit einer Prävalenz von bis zu 1u2009% in der erwachsenen Bevölkerung.ZielsetzungBeschreibung der RA-Prävalenz in Krankenkassendaten anhand verschiedener Falldefinitionen, stratifiziert nach Alter, Geschlecht und Wohnregion.MethodenBasierend auf ambulanten Abrechnungsdaten der BARMER GEK des Jahres 2013 wurde eine Querschnittstudie bei Versicherten ab 18xa0Jahren durchgeführt. Folgende Falldefinitionen wurden vergleichend angewandt: A) Diagnose M05x oder M06x (ICD-10-GM) in mindestens 2xa0Quartalen im Jahr 2013, B) Falldefinitionxa0A plus CRP- oder BSG-Bestimmung mindestens 1‑mal pro Jahr, C) Falldefinitionxa0B plus spezifische Medikation, D) Falldefinitionxa0A plus Behandlung durch Rheumatologen. Rohe sowie alters- und geschlechtsstandardisierte Prävalenzen wurden berechnet und nach Bundesländern stratifiziert.ErgebnisseDie Studienpopulation bestand aus 7.155.315 Versicherten, davon 60,2u2009% Frauen. Die RA-Prävalenz für die jeweiligen Falldefinitionen betrug 1,62u2009% (A), 1,11u2009% (B), 0,94u2009% (C) und 0,64u2009% (D). Die auf die deutsche Bevölkerung standardisierten Prävalenzen lagen bei 1,38u2009% (A), 0,95u2009% (B), 0,81u2009% (C) und 0,55u2009% (D). Der Frauenanteil betrug in allen Falldefinitionen rund 80u2009%. Die Prävalenz stieg mit dem Alter an, mit einem Peak in der Altersgruppe der 70- bis 79-Jährigen und war in Ostdeutschland am höchsten und in Süddeutschland am niedrigsten. Dies galt sowohl für rohe als auch für standardisierte Maße.SchlussfolgerungUnabhängig von Alter, Geschlecht und Falldefinition zeigten sich regionale Unterschiede bei der RA-Diagnosehäufigkeit in Krankenkassendaten. Die nach internationalen Studien zu erwartende Prävalenz wird am besten bei den Falldefinitionen mit CRP- oder BSG-Bestimmung erreicht.AbstractBackgroundRheumatoid arthritis (RA) is the most common chronic inflammatory joint disease with a prevalence of up to 1u2009% in the adult population.ObjectiveThis study describes the prevalence of RA diagnoses in outpatient health insurance claims data, based on different case definitions and stratified by age, sex and region of residence.MethodsBased on data from a nationwide statutory health insurance fund (BARMER GEK) from the year 2013, a cross-sectional study of insurants aged 18 years or older was conducted. The following case definitions were applied: A) a diagnosis of seropositive rheumatoid arthritis (M05) or other rheumatoid arthritis (M06) according to the international classification of diseases 10 German modification (ICD-10-GM) in at least two quarterly periods of the year 2013, B) case definition A plus determination of C‑reactive protein (CRP) or erythrocyte sedimentation rate (ESR) at least once, C) case definition B plus specific drug therapy and D) case definition A plus treatment by a rheumatologist. Raw as well as age and sex-standardized prevalences were calculated and stratified according to the federal state.ResultsThe study population consisted of 7,155,315 insurants of whom 60.2u2009% were female. Overall, RA prevalences for the respective case definitions were 1.62u2009% (A), 1.11u2009% (B), 0.94u2009% (C) and 0.64u2009% (D). When standardized to the German population the prevalences were 1.38u2009% (A), 0.95u2009% (B), 0.81u2009% (C) and 0.55u2009% (D). The proportion of women was approximately 80u2009% for all case definitions. Prevalences increased with age, peaking in the age group 70-79 years old and showing the highest values in eastern and the lowest in southern Germany for raw as well as standardized measures.ConclusionRegional differences in the prevalence of RA diagnoses in health insurance claims data were observed independent of age, sex and case definition. The expected prevalence according to the results of international studies was best achieved when case definitions with CRP or ESR were considered.

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

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.

Body mass index distribution in rheumatoid arthritis: a collaborative analysis from three large German rheumatoid arthritis databases

BackgroundMETARTHROS (Metabolic impact on joint and bone disease) is a nationwide German network to investigate the overlap between inflammatory and metabolic diseases. The objective of this study was to compare the body mass index (BMI) distribution in patients with early and established rheumatoid arthritis (RA) with data from the general population, and to evaluate the association of BMI with patient characteristics and clinical markers.MethodsThe BMI distribution was examined with data collected at inclusion of patients in the early arthritis cohort CAPEA, the biologics register RABBIT, and the National database of the German Collaborative Arthritis Centers. A data source with a representative sample of the German population (German Ageing Survey) was used as a comparator. BMI categories of <18.5xa0kg/m2 (underweight), 18.5 to <25xa0kg/m2 (normal weight), 25 to <30xa0kg/m2 (overweight), and ≥30xa0kg/m2 (obese) were used. Patients were stratified by age and sex, and compared to controls from the German Ageing Survey. Associations between BMI and markers of disease activity were analysed with non-parametric tests and linear models.ResultsData from 1207 (CAPEA), 12,230 (RABBIT), and 3424 (National database) RA patients and 6202 population controls were evaluated. The mean age was 56, 56, 62, and 62xa0years, respectively, the mean disease duration was 13xa0weeks, 9.9xa0years, and 13.5xa0years, respectively, and the mean disease activity score (DAS28) was 5.1, 5.2, and 3.1, respectively. In all RA cohorts, obesity was more frequent (23.8xa0%, 23.4xa0%, 21.4xa0%, respectively) than in controls (18.2xa0%). This applied to all age groups <70xa0years, was independent of disease duration, and was more pronounced in females. In all cohorts, the age at RA onset was associated with BMI, being higher in overweight/obese patients compared to normal-weight patients. Current smoking was negatively associated with BMI. Linear analyses revealed increased erythrocyte sedimentation rate (ESR) values in underweight and obese females, and an increasing disparity between tender joint counts (TJCs) and swollen joint counts (SJCs) in higher BMI categories.ConclusionsCompared to the general population, a higher prevalence of obesity was observed in all RA cohorts. The dominance of obesity in females and the different behaviour of disease activity markers in relation to the BMI in females indicate that additional parameters need to be considered when analysing the impact of obesity on inflammation in RA.

Changes in referral, treatment and outcomes in patients with systemic lupus erythematosus in Germany in the 1990s and the 2000s

Objective To evaluate trends in the referral, treatment and outcome of patients with systemic lupus erythematosus (SLE) in Germany over two decades. Methods From 1993 to 2012, ∼1200 patients with SLE were recorded annually in the national database of the German Collaborative Arthritis Centres. Treatment patterns, healthcare use and outcomes, such as disease activity, function and work participation, were evaluated over time. Furthermore, two distinct cohorts of patients (enrolment 1994–1998, n=467; and 2004–2008, n=376) observed over 5u2005years were assessed for changes in outcomes. Results The mean disease duration at the first visit to a rheumatologist decreased from 2.6 (1994) to 1.5 (2012) years. Glucocorticoids (69%), antimalarials (56%), azathioprine (22%), non-steroidal anti-inflammatory drugs (23%) and mycophenolate mofetil (15%) were the most frequently used treatments in 2012. A significant increase was observed in the use of antimalarials and mycophenolate mofetil. The use of glucocorticoids at >7.5u2005mg/day decreased from 27% (1994) to 10% (2012). The average length of sick leave taken due to SLE declined from 9u2005weeks (1997) to 6u2005weeks (2012). When comparing the two longitudinal cohorts, in the cohort from the 2000s, the intraindividual decline of disease activity was significantly stronger (p<0.001), and fewer patients retired early (36% vs 46%). Conclusions The disease activity and resource use declined considerably over the observation period, and more patients remained in the labour force. Earlier treatment onset, faster modification of the treatment regimen and more intensive use of anti-inflammatory therapy may account for the improved outcomes in patients with SLE across the years.

Influenza and pneumococcal vaccination in patients with rheumatoid arthritis in comparison with age- and sex-matched controls: results of a claims data analysis

The aim of this study was to assess the vaccination status for influenza and pneumonia and the prevalence of hospitalised pneumonia in rheumatoid arthritis (RA) patients and population controls in Germany. Members of a large statutory health insurance fund in Germany who were continuously insured between 2009 and 2013 and had a diagnosis of RA in 2013 were age and sex matched 1:5 to members without RA. Pneumococcal and influenza vaccinations were evaluated with regard to age, sex and region of residence. Logistic regression models were used to determine predictors for influenza vaccination in RA patients. Prevalences of pneumonia that required hospitalisation were compared to regional vaccination rates. The data of 111,482 RA patients and 557,410 matched controls were available for analysis. Compared to controls, RA patients were vaccinated more frequently against influenza (40.8 vs. 32.2xa0%) and pneumonia (15.0 vs. 10.0xa0%). Vaccination rates increased with older age and differed between the federal states (highest in East Germany, lowest in South Germany). The region of residence, comorbidities, rheumatologic care and biologic treatment was associated with a higher probability of an influenza vaccination. Prevalences of pneumonia that required hospitalisation were 2–3 times higher in patients compared to controls and tended to be higher in regions with low vaccination rates. The increased pneumonia prevalence in RA patients confirms their status as a risk group. RA patients are vaccinated more frequently than controls, but vaccination rates are still low. The lower pneumonia prevalence in East Germany indicates that vaccination may help to reduce pneumonia in RA.

Depression is a stronger predictor of the risk to consider work disability in early arthritis than disease activity or response to therapy

Objectives To evaluate the factors that influence patients with early inflammatory arthritis to consider a disability pension. Methods A total of 528 patients aged 63 or younger from an early arthritis cohort with a mean symptom duration of 3u2005months at inclusion were asked at 12 and 24u2005months whether they were considering applying for, had applied for or were receiving a disability pension because of arthritis. Possible predictors were analysed with univariate and multivariate logistic regression. Results 69 patients (13%) were considering, had applied for or were receiving a disability pension. Univariate predictors were older age, disease activity, several patient-reported outcomes and depression. In a multivariate analysis, age, days on sick leave, impairment of physical function and depression were predictive for considering a disability pension (OR for severe vs no depression: 3.85, 95% CI 1.43 to 10.4). Conclusions In patients with early arthritis, depression appears to be a stronger predictor of the risk to consider applying for work disability pension than the features of disease activity. Patients at risk could be identified with one single depression statement. This finding should prompt physicians to react early to signs and symptoms of depression to help patients to maintain their ability to work.

Transition to adult rheumatology care is necessary to maintain DMARD therapy in young people with juvenile idiopathic arthritis

OBJECTIVEnTo evaluate the outpatient health service utilisation of young people (YP) with juvenile idiopathic arthritis (JIA) during transfer from paediatric to adult care in Germany.nnnMETHODSnBased on claims data of a large German statutory health fund (BARMER GEK) we conducted a cohort study of 2008-2014. Insured YP with diagnosis of JIA (ICD: M08 or M09.0) in two quarters at the age of 16 and continuous insurance until the age of 20 were included. Outpatient health care utilisation, prescribed antirheumatic drugs and diagnosis maintenance were analysed over four consecutive years for all YP with JIA and for the subgroup on disease-modifying antirheumatic drugs (DMARDs) at the age of 16.nnnRESULTSnA total of 256 YP with JIA (67% female) were followed during the transfer period, 115 of them received (DMARDs) at the age of 16. At the age of 20, 30% of all 256 YP utilised adult specialty care, 59% still had a JIA diagnosis and 30% were treated with DMARDs. Of those 115 YP, treated with DMARDs at the age of 16 and in need of follow-up, 49% had visited an adult rheumatologist at the age of 20, 75% had a JIA diagnosis and 56% were on DMARDs. Those 49% YP with successful transfer to adult specialty care had a JIA diagnosis in 93% and were treated with DMARDs in 80%. YP, who were only seen by general practitioners, had a JIA diagnosis in 54% and received DMARDs in 27%.nnnCONCLUSIONSnOne in two YP with JIA and a clear need for ongoing follow-up do not utilise adult rheumatologic care. The maintenance of JIA diagnosis and DMARD therapy depend on the utilisation of specialised care services.