Objective

To identify the patterns of healthcare resource utilization and unmet needs of persistent disease activity, pain, and physical disability in rheumatoid arthritis (RA) by cluster analysis.

Method

Patients attending the Jyväskylä Central Hospital rheumatology unit, Finland, were, from 2007, prospectively enrolled in a clinical database. We identified all RA patients in 2010–2014 and combined their individual-level data with well-recorded administrative data on all public healthcare contacts in fiscal year 2014. We ran agglomerative hierarchical clustering (Ward’s method), with 28-joint Disease Activity Score with three variables, Health Assessment Questionnaire index, pain (visual analogue scale 0–100), and total annual health service-related direct costs (€) as clustering variables.

Results

Complete-case analysis of 939 patients derived four clusters. Cluster C1 (remission and low costs, 550 patients) comprised relatively young patients with low costs, low disease activity, and minimal disability. C2 (chronic pain, disability, and fatigue, 269 patients) included those with the highest pain and fatigue levels, and disability was fairly common. C3 (inflammation, 97 patients) had rather high mean costs and the highest average disease activity, but lower average levels of pain and less disability than C2, highlighting the impact of effective treatment. C4 (comorbidities and high costs, 23 patients) was characterized by exceptionally high costs incurred by comorbidities.

Conclusions

The majority of RA patients had favourable outcomes and low costs. However, a large group of patients was distinguished by chronic pain, disability, and fatigue not unambiguously linked to disease activity. The highest healthcare costs were linked to high disease activity or comorbidities.

中文翻译：

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聚类分析确定类风湿关节炎患者未满足的医疗保健需求

客观的

通过聚类分析确定类风湿关节炎 (RA) 的医疗资源利用模式和持续疾病活动、疼痛和身体残疾的未满足需求。

方法

从 2007 年起，芬兰于韦斯屈莱中央医院风湿病科的患者被前瞻性地纳入临床数据库。我们确定了 2010-2014 年的所有 RA 患者，并将他们的个人水平数据与 2014 财年所有公共医疗保健联系人的记录良好的管理数据相结合。我们进行了凝聚层次聚类（Ward 方法），使用 28 个关节疾病活动评分与三个变量，健康评估问卷指数、疼痛（视觉模拟量表 0-100）和年度卫生服务相关直接成本总额（€）作为聚类变量。

结果

对 939 名患者的完整病例分析得出四个聚类。C1 组（缓解和低成本，550 名患者）包括相对年轻的患者，费用低、疾病活动度低和残疾最小。C2（慢性疼痛、残疾和疲劳，269 名患者）包括疼痛和疲劳程度最高的患者，残疾相当普遍。C3（炎症，97 名患者）具有较高的平均成本和最高的平均疾病活动度，但与 C2 相比，疼痛的平均水平较低且残疾较少，突出了有效治疗的影响。C4（合并症和高成本，23 名患者）的特点是合并症导致的成本异常高。

结论

大多数 RA 患者预后良好且成本低。然而，一大群患者以慢性疼痛、残疾和疲劳为特征，但与疾病活动没有明确的联系。最高的医疗保健费用与高疾病活动或合并症有关。