2007 年至 2021 年美国新诊断的自身免疫性风湿病患者疼痛治疗方式的年度趋势：基于行政索赔的研究。

IF 15 1区医学 Q1 RHEUMATOLOGY

Lancet Rheumatology Pub Date : 2024-08-01 DOI:10.1016/S2665-9913(24)00120-6

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引用次数: 0

摘要

背景：自身免疫性风湿病具有独特的致病机制，是导致全球残疾和死亡率上升的原因之一。本研究旨在探讨自身免疫性风湿病患者疼痛治疗方式的年度趋势：我们在 Merative Marketscan 研究数据库中识别了 2007 年至 2021 年新确诊的强直性脊柱炎、银屑病关节炎、类风湿性关节炎、斯约格伦综合征、系统性硬化症或系统性红斑狼疮 (SLE) 患者。该数据库包括美国医疗保险报销的住院病人和门诊病人的身份信息。我们发现多重重叠病症的发生率极低，并且只收录了每位患者的初始诊断记录。我们确定了患者在确诊后一年内接受阿片类药物、抗惊厥药、抗抑郁药、骨骼肌松弛药、非甾体抗炎药（NSAIDs）、局部镇痛药和物理治疗的年发病率。我们使用逻辑回归法来估计日历年与结果之间的关联，并对年龄、性别和地区进行了调整：我们纳入了 141 962 名患者：研究结果：我们共纳入了 141 962 名患者：强直性脊柱炎患者 10 927 名、银屑病关节炎患者 21 438 名、类风湿性关节炎患者 71 393 名、斯约格伦综合征患者 16 718 名、系统性红斑狼疮患者 18 018 名以及系统性硬化症患者 3468 名。其中 107 475 人（75-7%）为女性，34 487 人（24-3%）为男性。总体而言，阿片类药物的使用率在2014年之前每年增加4%（调整后的几率比[aOR] 1-04 [95% CI 1-03-1-04]），2014年之后每年减少15%（0-85 [0-84-0-86]）。在 2014 年之前，物理治疗的使用率每年增加 5%（aOR 1-05 [95% CI 1-04-1-06]），2014 年之后每年略微下降 1%（0-99 [0-98-1-00]）。抗惊厥药的使用率在 2014 年前每年增加 7%（aOR 1-07 [95% CI 1-07-1-08]），2014 年后没有显著变化（1-00 [0-99-1-00]）。在 2014 年之前，非甾体抗炎药的使用率每年增加 2%（aOR 1-02 [95% CI 1-02-1-03]）；但在 2014 年之后，使用率每年下降 5%（0-95 [0-95-0-96]）。除2014年之前使用非甾体抗炎药（pinteraction=0-02）和2014年之后使用局部镇痛药（pinteraction=0-0100）外，这些趋势在性别上没有差异：自2014年以来，非阿片类止痛药的使用有所增加或趋于稳定，而阿片类止痛药和非甾体抗炎药的使用有所减少。未来的研究需要评估这些变化的有效性，以及它们对生活质量、残疾和功能等结果的影响：国家关节炎、肌肉骨骼和皮肤病研究所。

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Annual trends in pain management modalities in patients with newly diagnosed autoimmune rheumatic diseases in the USA from 2007 to 2021: an administrative claims-based study

Background

Autoimmune rheumatic diseases have distinct pathogenic mechanisms and are causes of disability and increased mortality worldwide. In this study, we aimed to examine annual trends in pain management modalities among patients with autoimmune rheumatic diseases.

Methods

We identified newly diagnosed patients with ankylosing spondylitis, psoriatic arthritis, rheumatoid arthritis, Sjögren's syndrome, systemic sclerosis, or systemic lupus erythematosus (SLE) in the Merative Marketscan Research Databases from 2007 to 2021. The database includes deidentified inpatient and outpatient health encounters with employment-sponsored health insurance claims in the USA. We found minimal occurrences of multiple overlapping conditions and included only the initial recorded diagnosis for each patient. We determined the annual incidence of patients treated with opioids, anticonvulsants, antidepressants, skeletal muscle relaxants, non-steroidal anti-inflammatory drugs (NSAIDs), topical analgesics, and physical therapy in the year following diagnosis. Logistic regression was used to estimate the association between calendar year and outcomes, adjusted for age, sex, and region.

Findings

We included 141 962 patients: 10 927 with ankylosing spondylitis, 21 438 with psoriatic arthritis, 71 393 with rheumatoid arthritis, 16 718 with Sjögren's syndrome, 18 018 with SLE, and 3468 with systemic sclerosis. 107 475 (75·7%) were women and 34 487 (24·3%) were men. Overall, the incidence of opioid use increased annually until 2014 by 4% (adjusted odds ratio [aOR] 1·04 [95% CI 1·03–1·04]) and decreased annually by 15% after 2014 (0·85 [0·84–0·86]). The incidence of physical therapy use increased annually by 5% until 2014 (aOR 1·05 [95% CI 1·04–1·06]), with a slight decrease annually by 1% after 2014 (0·99 [0·98–1·00]). The incidence of anticonvulsant use increased annually by 7% until 2014 (aOR 1·07 [95% CI 1·07–1·08]) and did not significantly change after 2014 (1·00 [0·99–1·00]). Before 2014, the incidence of NSAIDs use increased by 2% annually (aOR 1·02 [95% CI 1·02–1·03]); however, after 2014, the incidence decreased annually by 5% (0·95 [0·95–0·96]). These trends did not differ by sex except for NSAID use before 2014 (p_interaction=0·02) and topical analgesic use after 2014 (p_interaction=0·0100).

Interpretation

Since 2014, the use of non-opioid pain management modalities has increased or stabilised, whereas opioid and NSAID use has declined. Future studies are needed to evaluate the effectiveness of these changes, and the effects they have had on outcomes such as quality of life, disability, and function.

Funding

National Institute of Arthritis and Musculoskeletal and Skin Diseases.

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来源期刊

Lancet Rheumatology RHEUMATOLOGY-

CiteScore

34.70

自引率

3.10%

发文量

279

期刊介绍： The Lancet Rheumatology, an independent journal, is dedicated to publishing content relevant to rheumatology specialists worldwide. It focuses on studies that advance clinical practice, challenge existing norms, and advocate for changes in health policy. The journal covers clinical research, particularly clinical trials, expert reviews, and thought-provoking commentary on the diagnosis, classification, management, and prevention of rheumatic diseases, including arthritis, musculoskeletal disorders, connective tissue diseases, and immune system disorders. Additionally, it publishes high-quality translational studies supported by robust clinical data, prioritizing those that identify potential new therapeutic targets, advance precision medicine efforts, or directly contribute to future clinical trials. With its strong clinical orientation, The Lancet Rheumatology serves as an independent voice for the rheumatology community, advocating strongly for the enhancement of patients' lives affected by rheumatic diseases worldwide.