Center for Medical Technology Assessment, Division of Health Care Analysis, Linköping University , Linköping, Sweden.
Scand J Rheumatol. 2020 Sep;49(5):379-388. doi: 10.1080/03009742.2020.1750688. Epub 2020 Jul 20.
: To analyse healthcare utilization, loss of productivity, and disease activity in relation to presence of anti-citrullinated protein antibodies (ACPAs). : In total, 447 ACPA-positive and 224 ACPA-negative patients from two early rheumatoid arthritis cohorts, recruited 1996-1998 (cohort 1) and 2006-2009 (cohort 2), were followed during 3 years. Data on disease activity were collected, and patients reported healthcare utilization and days lost from work. Disease activity, healthcare costs, and loss of productivity were compared between ACPA groups. Linear regression was performed, controlling for confounders. : Healthcare costs did not differ significantly by ACPA status (EUR 3214 for vs EUR 2174 for ACPA-positive vs ACPA-negative patients in cohort 1, ns; EUR 4150 vs EUR 3820 in cohort 2, ns). Corresponding values for loss of productivity were EUR 9148 vs EUR 7916 (ns) and EUR 5857 vs EUR 5995 (ns). Total prescription of traditional disease-modifying anti-rheumatic drugs was higher in cohort 2 than in cohort 1. Methotrexate prescription was higher in ACPA-positive patients, but biologics did not differ significantly between ACPA groups. Disease activity was significantly more improved in cohort 2, but there was no difference in achieving remission in relation to ACPA status. In cohort 1, 25% of ACPA-positive patients were in remission vs 31% of ACPA-negative (ns) and in cohort 2, 55% vs 60% (ns). : With increasing drug treatment for both ACPA-positive and ACPA-negative patients, outcome in ACPA-positive was no more severe than in ACPA-negative patients. Healthcare costs and loss of productivity were similar in the two groups.
: 分析与抗瓜氨酸蛋白抗体（ACPAs）存在相关的医疗保健利用、生产力损失和疾病活动。 : 共有来自两个早期类风湿关节炎队列的 447 名 ACPA 阳性和 224 名 ACPA 阴性患者（队列 1 招募于 1996-1998 年，队列 2 招募于 2006-2009 年）在 3 年内接受了随访。收集了疾病活动数据，患者报告了医疗保健利用和因工作缺勤的天数。比较了 ACPA 组之间的疾病活动、医疗保健费用和生产力损失。进行了线性回归，控制了混杂因素。 : ACPA 状态对医疗保健费用没有显著影响（队列 1 中 ACPA 阳性患者为 3214 欧元，而 ACPA 阴性患者为 2174 欧元，ns；队列 2 中分别为 4150 欧元和 3820 欧元，ns）。相应的生产力损失值分别为 9148 欧元和 7916 欧元（ns）和 5857 欧元和 5995 欧元（ns）。与队列 1 相比，队列 2 中传统疾病修饰抗风湿药物的总处方量更高。甲氨蝶呤处方在 ACPA 阳性患者中更高，但生物制剂在 ACPA 组之间无显著差异。队列 2 中的疾病活动显著改善，但与 ACPA 状态无关，达到缓解的比例也无差异。在队列 1 中，25%的 ACPA 阳性患者处于缓解期，而 ACPA 阴性患者为 31%（ns），在队列 2 中，55%和 60%（ns）。 : 随着 ACPA 阳性和 ACPA 阴性患者药物治疗的增加，ACPA 阳性患者的结局并不比 ACPA 阴性患者更严重。两组的医疗保健费用和生产力损失相似。
