title: Trends in treatment and outcomes of ankylosing spondylitis in outpatient rheumatological care in Germany between 2000 and 2012.
abstract: OBJECTIVE
  To describe changes in drug treatment and clinical outcomes of ankylosing spondylitis (AS) during the past decade.
  
  
  METHODS
  The national database of the German collaborative arthritis centres collects clinical and patient-derived data from unselected outpatients with inflammatory rheumatic diseases. Cross-sectional data from 2000 to 2012 of around 1000 patients with AS per year were compared with regard to clinical presentation and quality of life indicators.
  
  
  RESULTS
  Non-steroidal anti-inflammatory drugs (NSAIDs) have been the predominant treatment choice in AS over the years with a prescription rate of 67% of patients in 2012. Currently, almost half of the patients with AS in German rheumatology centres are treated with tumour necrosis factor inhibitors (TNFi). Often, both treatments are used in combination (33%), followed by combinations of NSAIDs and synthetic disease modifying antirheumatic drugs (sDMARDs) with 23% or TNFi alone (21%). In 2012, 10% of patients each received NSAID or sDMARD monotherapy. Methotrexate, sulfasalazine, glucocorticoids and analgaesics alone or in combination with other treatments were given to 10% of patients, respectively. Over the years, we have seen remarkable improvements in disease control and patient reported outcomes. These developments are consistent with enhanced functional status, increasing employment rates and decreasing sick leave, hospitalisation and work disability.
  
  
  CONCLUSIONS
  In the German rheumatology secondary/tertiary care setting, routine care of patients with AS has changed tremendously during the past decade. Increasingly, more efficacious treatment options are reflected in improved clinical outcomes, quality of life and participation in the labour force.
authors.affiliation: Epidemiology Unit , German Rheumatism Research Centre, A Leibniz Institute , Berlin , Germany ; Department of Rheumatology and Clinical Immunology , Charité University Hospital Berlin , Berlin , Germany.
authors.forename: Dörte
authors.initials: D
authors.lastname: Huscher
authors.affiliation: Epidemiology Unit , German Rheumatism Research Centre, A Leibniz Institute , Berlin , Germany.
authors.forename: Katja
authors.initials: K
authors.lastname: Thiele
authors.affiliation: Endokrinologikum Berlin am Gendarmenmarkt , Berlin , Germany.
authors.forename: Martin
authors.initials: M
authors.lastname: Rudwaleit
authors.affiliation: Epidemiology Unit , German Rheumatism Research Centre, A Leibniz Institute , Berlin , Germany.
authors.forename: Katinka Charlotte
authors.initials: KC
authors.lastname: Albrecht
authors.affiliation: Epidemiology Unit , German Rheumatism Research Centre, A Leibniz Institute , Berlin , Germany.
authors.forename: Sascha
authors.initials: S
authors.lastname: Bischoff
authors.affiliation: Department of Rheumatology and Clinical Immunology , Immanuel Krankenhaus Berlin , Berlin , Germany.
authors.forename: Andreas
authors.initials: A
authors.lastname: Krause
authors.affiliation: Rheumapraxis Steglitz , Berlin , Germany.
authors.forename: Kirsten
authors.initials: K
authors.lastname: Karberg
authors.affiliation: Rheumazentrum Ratingen , Ratingen , Germany.
authors.forename: Siegfried
authors.initials: S
authors.lastname: Wassenberg
authors.affiliation: Epidemiology Unit , German Rheumatism Research Centre, A Leibniz Institute , Berlin , Germany ; Department of Rheumatology and Clinical Immunology , Charité University Hospital Berlin , Berlin , Germany.
authors.forename: Angela
authors.initials: A
authors.lastname: Zink
keywords: Ankylosing Spondylitis; Anti-TNF; Health services research; Outcomes research; Treatment