Riemekasten Gabriela, Schmelz Renate, Schäkel Knut, Thaci Diamant, Schreiber Stefan, Röcken Marit, Bartz Holger, Ploner Tina, Liao Ximing, Weber Valeria, Manz Karina C, Burkhardt Harald, Leipe Jan
Klinik für Rheumatologie und klinische Immunologie, Universitätsklinikum Schleswig-Holstein, Lübeck, Deutschland.
Medizinische Klinik und Poliklinik I, Universitätsklinikum Carl Gustav Carus Dresden, Fetscherstr. 74, 01307, Dresden, Deutschland.
Z Rheumatol. 2024 Sep;83(7):578-586. doi: 10.1007/s00393-023-01459-7. Epub 2023 Dec 9.
Chronic inflammatory diseases (immune-mediated inflammatory diseases, IMID) can overlap or occur simultaneously due to clinical similarities. The resulting utilization of heathcare structures has not yet been investigated across disciplines but is of potential importance for optimizing the treatment of patients with IMID.
Analysis of epidemiological data including utilization of care services in patients with selected IMIDs: psoriasis, psoriatic arthritis (PsA), rheumatoid arthritis (RA), ankylosing spondylitis, ulcerative colitis, Crohn's disease and connective tissue disease.
In a retrospective cross-sectional analysis based on health insurances accounting data with a sample of approximately 4 million insured persons, the prevalence of the abovementioned IMID and the frequency of IMID combinations were analyzed based on documented diagnoses (ICD-10 GM). The frequency of hospitalizations and utilization of outpatient physician contacts was recorded in predefined specialist disciplines (general medicine, dermatology, gastroenterology, rheumatology) and compared with an age-adjusted and gender-adjusted reference population.
A total of 188,440 patients had at least 1 of the IMID diagnoses analyzed (4.7%), with an age peak of 61-70 years. The highest prevalence was observed for psoriasis (1.85%), followed by rheumatoid arthritis (1.38%). Combinations with at least one other IMID were relatively common (29%), with this being most common in patients with psoriatic arthritis (82.9%, of which 68.2% had psoriasis), followed by ankylosing spondylitis (27.5%) and Crohn's disease (21.6%). Compared to the reference population, patients with IMID were hospitalized more often and more frequently utilized the outpatient disciplines.
The study results describe that IMIDs occur in combination and that the patients make comparatively more use of care structures of different disciplines. A multidisciplinary approach could increase the efficiency of care; an evaluation is still pending.
慢性炎症性疾病（免疫介导的炎症性疾病，IMID）由于临床相似性可能会重叠或同时发生。目前尚未跨学科研究由此导致的医疗保健结构利用情况，但这对于优化IMID患者的治疗具有潜在重要性。
分析包括选定IMID患者的护理服务利用情况在内的流行病学数据，这些IMID包括银屑病、银屑病关节炎（PsA）、类风湿关节炎（RA）、强直性脊柱炎、溃疡性结肠炎、克罗恩病和结缔组织病。
在一项基于医疗保险核算数据的回顾性横断面分析中，以约400万参保人员为样本，根据记录的诊断（ICD-10 GM）分析上述IMID的患病率和IMID组合的频率。记录在预定义专科领域（普通内科、皮肤科、胃肠病学、风湿病学）的住院频率和门诊医生就诊利用情况，并与年龄和性别调整后的参考人群进行比较。
共有188440名患者至少有1项所分析的IMID诊断（4.7%），年龄峰值为61至70岁。银屑病的患病率最高（1.85%），其次是类风湿关节炎（1.38%）。与至少一种其他IMID的组合相对常见（29%），在银屑病关节炎患者中最为常见（82.9%，其中68.2%患有银屑病），其次是强直性脊柱炎（27.5%）和克罗恩病（21.6%）。与参考人群相比，IMID患者住院更频繁，门诊专科就诊也更频繁。
研究结果表明IMID会合并发生，且患者相对更多地利用不同学科的护理结构。多学科方法可能会提高护理效率；仍有待评估。
