Zeitschrift fur Rheumatologie · 2026
[Survey of care situation for patients with systemic lupus erythematosus and systemic sclerosis with pulmonary involvement in Rhineland-Palatinate and Saarland].
Аннотация на английскомСтатьяНазвание и аннотация: Перевод в очереди
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Haßdenteufel Lennart, Jahns Kai, Alberti Ciaran, Schwarting Andreas, Dreher Matthias
Аннотация
BACKGROUND: Connective tissue diseases such as systemic lupus erythematosus (SLE) and systemic sclerosis (SSc) require interdisciplinary management due to their multisystem involvement. Pulmonary manifestations (CTD-ILD) are of particular prognostic relevance. However, real-world data on current healthcare provision remain limited.
METHODS: A cross-sectional survey (14 modules) was conducted between September 2024 and March 2025, targeting 2173 practices across various specialties in Rhineland-Palatinate and Saarland. Data on healthcare structures, patient numbers, pulmonary involvement, and pharmacological treatment were collected. Analysis was performed descriptively at the provider level.
RESULTS: A total of 67 institutions reported on 1569 patients (SLE: n = 859; SSc: n = 421), of whom 286 (≈18%) had pulmonary involvement. Care was predominantly delivered in specialized centers, but with substantial contribution from office-based physicians. Marked differences in treatment strategies were observed: office-based settings more frequently relied on higher-dose glucocorticoids (up to ≈28% > 10 mg/day), whereas specialized centers achieved significant glucocorticoid reduction (≈1.5% > 10 mg/day) through increased use of biologics and disease-modifying therapies, particularly mycophenolate mofetil (MMF). MMF was notably more frequently used in rheumatology-based care compared to other specialties.
CONCLUSION: The findings reveal relevant deficiencies in care, particularly an overreliance on glucocorticoids and underutilization of evidence-based disease-modifying antirheumatic drugs (DMARDs) such as MMF in nonspecialized settings. Contributing factors likely include limited rheumatology expertise and insufficient interdisciplinary coordination. Improving care requires expansion of rheumatologic capacity, earlier specialist referral, and broader implementation of guideline-based, steroid-sparing treatment strategies.
METHODS: A cross-sectional survey (14 modules) was conducted between September 2024 and March 2025, targeting 2173 practices across various specialties in Rhineland-Palatinate and Saarland. Data on healthcare structures, patient numbers, pulmonary involvement, and pharmacological treatment were collected. Analysis was performed descriptively at the provider level.
RESULTS: A total of 67 institutions reported on 1569 patients (SLE: n = 859; SSc: n = 421), of whom 286 (≈18%) had pulmonary involvement. Care was predominantly delivered in specialized centers, but with substantial contribution from office-based physicians. Marked differences in treatment strategies were observed: office-based settings more frequently relied on higher-dose glucocorticoids (up to ≈28% > 10 mg/day), whereas specialized centers achieved significant glucocorticoid reduction (≈1.5% > 10 mg/day) through increased use of biologics and disease-modifying therapies, particularly mycophenolate mofetil (MMF). MMF was notably more frequently used in rheumatology-based care compared to other specialties.
CONCLUSION: The findings reveal relevant deficiencies in care, particularly an overreliance on glucocorticoids and underutilization of evidence-based disease-modifying antirheumatic drugs (DMARDs) such as MMF in nonspecialized settings. Contributing factors likely include limited rheumatology expertise and insufficient interdisciplinary coordination. Improving care requires expansion of rheumatologic capacity, earlier specialist referral, and broader implementation of guideline-based, steroid-sparing treatment strategies.