The national database of the German Collaborative Arthritis Centres: I. Structure, aims, and patients

Objective-To describe the aims, principles, and content of the German rheum atological database and to present data on patient mix and healthcare provi sion for the year 1998. Methods-The German rheumatological database contains clinical and patient d erived data of the outpatients with inflammatory rheumatic diseases seen at one of the 24 collaborative arthritis centres. The case mix, institutional context, and demographic features of 25 653 patients from the year 1998 we re analysed. Results-51% of the patients had rheumatoid arthritis, 23% seronegative spon dyloarthropathies, including ankylosing spondylitis, psoriatic arthritis, a nd reactive arthritis, and 19% had vasculitis, including SLE (5%). The dist ribution of the age at onset of patients with RA with less than or equal to 2 years' disease duration was comparable with recent incidence data from po pulation studies. The case mix differed between university departments and rheumatology hospitals as well as individual practices. 65% of the male and 46% of the female patients at ages 18-60 were still in gainful employment, the rates of employment were 14% below the population rates for women, and 11% below those for men. 62% of all patients had seen a rheumatologist wit hin the first year of disease, 73% within the first two years. Ankylosing s pondylitis was seen in rheumatological care much later than all other disea ses (only 39% within the first year). The mean number of contacts with a rh eumatologist was five a year; rheumatologists in individual practices saw t heir patients seven times a year on the average. Together with visits to th e non-specialist doctor mainly treating the patient, the mean number of vis its to the doctor for a rheumatic condition was 20 a year. Conclusion-Large databases like this one give information about the patient case mix in different healthcare settings, about treatment practice, and a bout the consequences of disease. Patients treated in specialised rheumatol ogy units in Germany are referred earlier than in the past, which probably reflects better regional cooperation due to the implementation of arthritis centres. University departments and outpatient clinics of rheumatology hos pitals contribute considerably to the specialised care of patients with art hritis and connective tissue diseases.