Background For patients with ankylosing spondylitis (AS), new treatment options have changed the therapeutic landscape tremendously during the past decade. In Germany, the first biologic agent was approved for AS in May 2003.
Objectives To describe changes in treatment and outcome of AS during the past ten years.
Methods The national database of the German collaborative arthritis centres collects clinical and patient-derived data from unselected outpatients with inflammatory rheumatic diseases. Each patient is recorded once a year. Cross-sectional data from nine years were compared with regard to clinical presentation and quality of life indicators. Due to changes in the documentation routine, the data from 2005 and 2006 are not representative and therefore omitted from the table. Data on BASDAI, BASFI, BASMI and EuroQoL are available from 2007 onwards.
Results In the individual years, between 33 and 42% of the patients were female. Their mean age was about 49 years, and the mean disease duration about 15 years. From 2007 onwards, nearly half of all patients with AS received biologic agents. The use of synthetic DMARDs decreased significantly (Table), steroids were given to 21% of the patients in 2000 and only 11% in 2010. NSAIDs and Coxibs remain important therapeutic options with 55% of the patients receiving nonselective NSAIDs and 24% Coxibs in 2010.The proportion of patients whose disease was rated severe or very severe by the treating physician decreased from 20% to 12% between 2000 and 2010. The disease specific indices BASDAI, BASFI and BASMI indicate a further improvement during the past years. The proportion of patients reporting no limitations in daily activities and walking in the EuroQoL increased by about 5% since 2007, while almost no patients reported severe physical restrictions (≤2.5%). Significant changes occurred in the working situation: 54% of the patients in the working age were employed in 2000 and 65% in 2010, while early retirement declined to 16%. During this time period the percentage of patients with sick leave during the last 12 months fell from 43% to 33%.
Conclusions Routine care of patients with AS has changed tremendously during the past decade. Increasingly, these better treatment options are reflected in better clinical outcomes, quality of life and participation in the labor market.
Disclosure of Interest D. Huscher Grant/Research support from: The database was funded by the German Federal Minister of Research from 1999 to 2007 (grant #01 GI 0344/3). Since 2007 a consortium of 10 pharmaceutical companies has been funding the National Database by an unconditional grant to the German Rheumatological Society., M. Rudwaleit: None Declared, K. Thiele: None Declared, S. Bischoff: None Declared, I. Kötter: None Declared, K. Fischer: None Declared, A. Zink: None Declared