Background/Purpose: Compared to rheumatoid arthritis and other arthritis-associated rheumatic diseases, autoimmune connective tissue disorders and vasculitides are still in the early stages of biological therapies. The study investigated whether health care and treatment with disease specific immunosuppressive drugs have changed in these indications. Furthermore, disease activity and outcomes of patients with autoimmune connective tissue diseases and vasculitides have been examined.

Methods: On average, a total of 3,900 patients with systemic lupus erythematodes (SLE), systemic sclerosis (SSc), primary Sjögren`s syndrome (PSS), poly- and dermatomyositis (PM/DM), mixed connective tissue disease (MCTD), other connective tissue diseases (other CTD), polymyalgia rheumatica (PMR), primary systemic vasculitis, and other primary vasculitides (ICD10: I67.7, I77.6, L13.1, L95.0/8/9, M31.0/1/8/9, M35.2/6) were documented in the National Database of the German Collaborative Arthritis Centers in each of the years 1995 to 2011. Cross-sectional data of these years were analyzed to detect time trends.

Results: Between 1995 and 2011, the number of patients consulting a rheumatologist within six months after symptom onset increased from about 50% to 60%, especially patients with SLE and systemic sclerosis were seen earlier in specialized rheumatologic care. The overall percentage of patients receiving immunosuppressive drugs increased from 52.7% to 62.3%. High dose steroid use (>7.5 mg/d) decreased from 26.1% to 13.4%. In 2011, 3.5% of all patients received a biologic therapy, the most frequent use was seen in patients with other primary vasculitides (9.2%). Since 2005, the mean disease activity assessed by the physician (NRS 0-10) decreased from 3.0 to 2.2 and the percentage of patients with a high disease activity (7-10) from 7.6% to 1.8%. Overall, work participation (patients <65 years) remained stable (46.2% 1995, 49.4% 2011), but increased considerably in female patients with PSS, SSc and PMR (see Table 1).

 

	N		Mean age		Female		Immunosuppressive therapy		Mean  disease activity   (NRS 0-10)		Work participation (only patients <65 years)#
											female		male
	1995	2011	1995	2011	1995	2011	1995	2011	1995	2011	1995	2011	1995	2011
SLE	1,432	946	43.1	46.3	89%	89%	69.6%	81.4%	3.0	2.2	45.6%	46.4%	55.3%	52.4%
SSc	317	317	55.7	57.5	86%	84%	42.9%	48.5%	3.8	3.1	36.5%	44.0%	–	–
PSS	320	200	53.1	57.9	93%	94%	43.7%	51.0%	3.2	2.5	44.2%	64.8%	–	–
DM/PM	143	94	50.7	54.9	76%	65%	65.9%	86.0%	3.1	2.4	43.2%	(41.7%)	–	–
MCTD/ overlap	329	165	47.4	50.0	89%	90%	68.8%	71.7%	3.4	2.4	47.0%	47.5%	–	–
other CTD	343	261	48.1	53.5	85%	86%	52.5%	54.5%	2.6	2.2	50.5%	63.0%	–	–
PMR	862	855	68.7	71.4	77%	67%	15.2%	28.6%	3.1	1.7	25.8%	40.0%	59.6%	60.0%
primary systemic vasculitis	292	435	50.6	60.3	52%	61%	72.0%	78.5%	3.1	2.3	31.1%	29.0%	63.0%	52.9%
other primary vasculitides	202	256	47.0	45.9	64%	45%	46.0%	57.6%	3.3	2.5	41.9%	(50.0%)	69.2%	(76.1%)

 ^#For case numbers <50, percentages are given in brackets, for male patients with SSc, PSS, DM/PM, MCTD and other CTD case numbers were to low in both years for valid comparison.

Conclusion: Early rheumatologic care and immunosuppressive therapy have increased in patients with autoimmune connective tissue diseases and vasculitides during the past 15 years. Advancement in disease control and employment status in these rather infrequent chronic autoimmune diseases encourages to further improve disease outcomes and work participation.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/earlier-admission-to-specialized-care-intensified-treatment-and-improved-outcome-in-patients-with-autoimmune-connective-tissue-disorders-and-vasculitides-in-germany-2011-compared-to-1995/