Background/Purpose: Rheumatoid arthritis (RA) is associated with high healthcare costs, but little is known about how the costs compare to other chronic rheumatic diseases. We combined a large, population-based clinical dataset on patients at a rheumatology clinic with an administrative database in order to compare healthcare utilization in patients with rheumatoid arthritis, psoriatic arthritis, juvenile idiopathic arthritis, and axial spondyloarthritis.

Methods: The data is on the adult population of the City of Jyväskylä, Finland (population 135 000). Their primary care is delivered at the local healthcare centers, which rely on the Jyväskylä Central Hospital (JCH) when specialist treatment is needed. The rheumatic specialist care is served in the JCH rheumatology unit, where clinical data is systematically recorded in a structured digital database. Well-recorded administrative data with costs data in euros (€) from fiscal year 2014 includes information on all public healthcare visits to physicians and allied healthcare professionals, both in primary and specialty care. Also inpatient care is included. With the Kruskal-Wallis test, we compared costs associated with healthcare utilization for adult patients with RA, psoriatic arthritis (PsA), juvenile idiopatic arthritis (JIA), and patients with axial spondyloarthritis or spondyloarthropathies (AS+SpA). We recognized high healthcare utilizing proportions in each and explored their clinical characteristics.

Results: The cost distribution was similar in all studied diseases (p = 0.62), and the distribution was widest in RA. The cost distribution was similar also in women (p = 0.31) and in men (p = 0.59). In RA (n = 967), 9% utilizes as much as the remaining 91%. Corresponding figures are 9% and 91% for PsA (n = 190), 10% and 90% for AS+SpA (n = 257), and 16% and 84% for JIA (n = 102). The high healthcare utilizing proportions were characterized by lower functional capacity measured with HAQ index (0-3) and higher pain (VAS 0-100), as well as higher disease activity, measured with DAS28. In addition, a larger proportion of these patients had at some point received biologics compared to patients with lower utilization. Mental health disorders were common multimorbidities in all studied diseases, particularly in young adults, as cardiovascular multimorbidities were particularly prevalent in older age groups.

Conclusion: Healthcare utilization is similar for RA, PsA, JIA, and AS+SpA. Approximately one tenth of patients utilizes as much as the remaining 90%. Higher healthcare utilization is characterized by patient perceived health measures. To limit the costs caused by healthcare utilization, disease activity should be minimized, improving functional capacity with reducing HAQ and pain. Moreover, costs of active treatment might be saved by reducing the healthcare utilization.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/a-minority-of-patients-utilize-most-of-healthcare-resources-in-rheumatoid-arthritis-psoriatic-arthritis-juvenile-idiopathic-arthritis-and-axial-spondyloarthritis/