{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T00:30:31Z","timestamp":1792024231443,"version":"4.4.0"},"reference-count":31,"publisher":"BMJ","issue":"1","license":[{"start":{"date-parts":[[2023,3,9]],"date-time":"2023-03-09T00:00:00Z","timestamp":1678320000000},"content-version":"unspecified","delay-in-days":8,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["RMD Open"],"accepted":{"date-parts":[[2023,2,24]]},"published-print":{"date-parts":[[2023,3]]},"abstract":"<jats:sec>\n                  <jats:title>Objective<\/jats:title>\n                  <jats:p>To assess polypharmacy in women and men with psoriatic arthritis (PsA).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>From the German BARMER health insurance database, 11\u2009984 persons with PsA and disease-modifying antirheumatic drug therapy in 2021 were included and compared with sex-matched and age-matched controls without inflammatory arthritis. Medications were analysed by Anatomical Therapeutic Chemical (ATC) groups. Polypharmacy (\u22655 concomitant drugs) was compared by sex, age and comorbidity using the Rheumatic Disease Comorbidity Index (RDCI) and the Elixhauser Score. The mean difference in the number of medications between persons with PsA and controls was estimated using a linear regression model.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Compared with controls, all ATC drug classes were significantly more frequent in persons with PsA, most commonly musculoskeletal (81% vs 30%), immunomodulatory (56% vs 2.6%), cardiovascular (62% vs 48%), alimentary tract\/metabolic (57% vs 31%) and nervous system (50% vs 31%) drugs. Polypharmacy was significantly higher in PsA (49%) compared with controls (17%), more frequent in women (52%) compared with men (45%) and strongly increased with age and comorbidity. For each unit increase of the RDCI, the age-adjusted number of medications increased by 0.98 (95% CI 0.95 to 1.01) units in men and 0.93 (95% CI 0.90 to 0.96) units in women. Compared with controls, the number of medications in PsA (mean 4.9 (SD 2.8)) was 2.4 (95%CI 2.34; 2.43) units higher in women and 2.3 (95% CI 2.21 to 2.35) units higher in men.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>Polypharmacy is common in PsA and is composed of PsA-specific medication as well as frequent medications for comorbidities, equally affecting women and men.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/rmdopen-2022-002960","type":"journal-article","created":{"date-parts":[[2023,3,9]],"date-time":"2023-03-09T11:10:15Z","timestamp":1678360215000},"page":"e002960","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":12,"title":["High burden of polypharmacy and comorbidity in persons with psoriatic arthritis: an analysis of claims data, stratified by age and sex"],"prefix":"10.1136","volume":"9","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0886-0294","authenticated-orcid":false,"given":"Katinka","family":"Albrecht","sequence":"first","affiliation":[{"name":"Epidemiology and Health Services Research, German Rheumatism Research Center Berlin, Berlin, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2456-4049","authenticated-orcid":false,"given":"Anne Constanze","family":"Regierer","sequence":"additional","affiliation":[{"name":"Epidemiology and Health Services Research, German Rheumatism Research Center Berlin, Berlin, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6233-022X","authenticated-orcid":false,"given":"Anja","family":"Strangfeld","sequence":"additional","affiliation":[{"name":"Epidemiology and Health Services Research, German Rheumatism Research Center Berlin, Berlin, Germany"},{"name":"Department of Rheumatology and Clinical Immunology, Charit\u00e9-Universit\u00e4tsmedizin Berlin, Berlin, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ursula","family":"Marschall","sequence":"additional","affiliation":[{"name":"Department Medicine and Health Services Research, BARMER Institute for Health System Research, Wuppertal, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3923-2728","authenticated-orcid":false,"given":"Johanna","family":"Callhoff","sequence":"additional","affiliation":[{"name":"Epidemiology and Health Services Research, German Rheumatism Research Center Berlin, Berlin, Germany"},{"name":"Institute for Social Medicine, Epidemiology and Health Economics, Charit\u00e9-Universit\u00e4tsmedizin Berlin, Berlin, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2023,3,9]]},"reference":[{"issue":"6 Suppl 1","key":"2025090312144083000_9.1.e002960.1","first-page":"52","article-title":"Grappa treatment recommendations: 2021 update","volume":"49","author":"Coates","year":"2022","journal-title":"J Rheumatol"},{"key":"2025090312144083000_9.1.e002960.2","first-page":"1611","article-title":"Psoriatic arthritis: one year in review 2022","volume":"40","author":"Cigolini","year":"2022","journal-title":"Clin Exp Rheumatol"},{"key":"2025090312144083000_9.1.e002960.3","doi-asserted-by":"crossref","DOI":"10.1186\/s12877-017-0621-2","article-title":"What is polypharmacy? A systematic review of definitions","volume":"17","author":"Masnoon","year":"2017","journal-title":"BMC Geriatr"},{"key":"2025090312144083000_9.1.e002960.4","doi-asserted-by":"crossref","first-page":"573542","DOI":"10.3389\/fmed.2020.573542","article-title":"Polypharmacy in middle-european rheumatoid arthritis-patients: a retrospective longitudinal cohort analysis with systematic literature review","volume":"7","author":"Jack","year":"2020","journal-title":"Front Med (Lausanne)"},{"key":"2025090312144083000_9.1.e002960.5","doi-asserted-by":"crossref","first-page":"1285","DOI":"10.1007\/s13555-020-00442-3","article-title":"Psoriasis is associated with a high comedication burden: a population based register study","volume":"10","author":"Duvetorp","year":"2020","journal-title":"Dermatol Ther (Heidelb)"},{"key":"2025090312144083000_9.1.e002960.6","doi-asserted-by":"crossref","first-page":"634","DOI":"10.1111\/bjd.14754","article-title":"Increased overall drug utilization in patients with psoriasis: a case-control study based on Dutch general practitioner data","volume":"176","author":"Dowlatshahi","year":"2017","journal-title":"Br J Dermatol"},{"key":"2025090312144083000_9.1.e002960.7","first-page":"627","article-title":"Polypharmacy-an upward trend with unpredictable effects","volume":"113","author":"Mo\u00dfhammer","year":"2016","journal-title":"Dtsch Arztebl Int"},{"key":"2025090312144083000_9.1.e002960.8","doi-asserted-by":"crossref","first-page":"483","DOI":"10.1007\/s40744-021-00286-z","article-title":"Real-World treatment persistence with biologic disease-modifying antirheumatic drugs among German patients with psoriatic arthritis-a retrospective database study","volume":"8","author":"Sewerin","year":"2021","journal-title":"Rheumatol Ther"},{"key":"2025090312144083000_9.1.e002960.9","first-page":"285","article-title":"Analysis of pharmaceutical care in patients with psoriatic arthritis using statutory health insurance data","volume":"16","author":"Sondermann","year":"2018","journal-title":"J Dtsch Dermatol Ges"},{"key":"2025090312144083000_9.1.e002960.10","doi-asserted-by":"publisher","DOI":"10.1055\/s-0031-1275711"},{"key":"2025090312144083000_9.1.e002960.11","doi-asserted-by":"crossref","unstructured":"Callhoff J , Albrecht K , Marschall U , et al . Identification of rheumatoid arthritis in German claims data using different algorithms: validation by cross-sectional patient-reported survey data. Pharmacoepidemiol Drug Saf 8, 2022. doi:10.1002\/pds.5562","DOI":"10.1002\/pds.5562"},{"key":"2025090312144083000_9.1.e002960.12","doi-asserted-by":"crossref","first-page":"404","DOI":"10.1002\/pds.4950","article-title":"Validation of claims-based algorithms for psoriatic arthritis","volume":"29","author":"Lee","year":"2020","journal-title":"Pharmacoepidemiol Drug Saf"},{"key":"2025090312144083000_9.1.e002960.13","doi-asserted-by":"crossref","first-page":"465","DOI":"10.1038\/s41584-022-00798-0","article-title":"Group for research and assessment of psoriasis and psoriatic arthritis (grappa): updated treatment recommendations for psoriatic arthritis 2021","volume":"18","author":"Coates","year":"2022","journal-title":"Nat Rev Rheumatol"},{"key":"2025090312144083000_9.1.e002960.14","unstructured":"WHO Collaborating Centre for Drug Statistics Methology . Anatomical therapeutic chemical (ATC) classification. Available: www.whocc.no\/atc_ddd_index\/ [Accessed 5 Jul 2022]."},{"key":"2025090312144083000_9.1.e002960.15","unstructured":"WHO Collaborating Centre for Drug Statistics Methodology . ATC-DDD toolkit. defined daily dose (DDD). 2022. Available: www.who.int\/tools\/atc-ddd-toolkit\/about-ddd [Accessed 27 Sep 2022]."},{"key":"2025090312144083000_9.1.e002960.16","doi-asserted-by":"crossref","first-page":"865","DOI":"10.1002\/acr.22456","article-title":"Validation of the rheumatic disease comorbidity index","volume":"67","author":"England","year":"2015","journal-title":"Arthritis Care Res (Hoboken)"},{"key":"2025090312144083000_9.1.e002960.17","doi-asserted-by":"crossref","DOI":"10.1136\/rmdopen-2021-001671","article-title":"Comorbidity burden in the first three years after diagnosis in patients with rheumatoid arthritis, psoriatic arthritis or spondyloarthritis: a general practice registry-based study","volume":"7","author":"Stouten","year":"2021","journal-title":"RMD Open"},{"key":"2025090312144083000_9.1.e002960.18","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1111\/eci.13013","article-title":"Influence of baseline modified rheumatic disease comorbidity index (mrdci) on drug survival and effectiveness of biological treatment in patients affected with rheumatoid arthritis, spondyloarthritis and psoriatic arthritis in real-world settings","volume":"48","author":"Iannone","year":"2018","journal-title":"Eur J Clin Invest"},{"key":"2025090312144083000_9.1.e002960.19","doi-asserted-by":"publisher","DOI":"10.1097\/01.mlr.0000182534.19832.83"},{"key":"2025090312144083000_9.1.e002960.20","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pmed.1001885","article-title":"The reporting of studies conducted using observational routinely-collected health data (record) statement","volume":"12","author":"Benchimol","year":"2015","journal-title":"PLoS Med"},{"key":"2025090312144083000_9.1.e002960.21","doi-asserted-by":"publisher","DOI":"10.1111\/j.1468-3083.2009.03159.x"},{"key":"2025090312144083000_9.1.e002960.22","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2133.2008.09023.x"},{"key":"2025090312144083000_9.1.e002960.23","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0226511","article-title":"Potentially inappropriate medication in older participants of the Berlin aging study II (BASE-II)-sex differences and associations with morbidity and medication use","volume":"14","author":"Toepfer","year":"2019","journal-title":"PLoS One"},{"key":"2025090312144083000_9.1.e002960.24","doi-asserted-by":"publisher","DOI":"10.1136\/annrheumdis-2022-eular.3915"},{"key":"2025090312144083000_9.1.e002960.25","doi-asserted-by":"crossref","first-page":"1767","DOI":"10.1093\/rheumatology\/kez037","article-title":"Polypharmacy is associated with treatment response and serious adverse events: results from the British Society for rheumatology biologics register for rheumatoid arthritis","volume":"58","author":"Bechman","year":"2019","journal-title":"Rheumatology (Oxford)"},{"key":"2025090312144083000_9.1.e002960.26","doi-asserted-by":"publisher","DOI":"10.3899\/jrheum.160818"},{"key":"2025090312144083000_9.1.e002960.27","doi-asserted-by":"crossref","first-page":"245","DOI":"10.1007\/s40266-022-00922-5","article-title":"The FORTA (fit for the aged) list 2021: fourth version of a validated clinical aid for improved pharmacotherapy in older adults","volume":"39","author":"Pazan","year":"2022","journal-title":"Drugs Aging"},{"key":"2025090312144083000_9.1.e002960.28","doi-asserted-by":"crossref","first-page":"970371","DOI":"10.3389\/fimmu.2022.970371","article-title":"The cardiometabolic conditions of psoriatic disease","volume":"13","author":"Toussirot","year":"2022","journal-title":"Front Immunol"},{"key":"2025090312144083000_9.1.e002960.29","doi-asserted-by":"crossref","first-page":"595","DOI":"10.1159\/000509732","article-title":"Sex and age influence the associated risk of depression in patients with psoriasis: A retrospective population study based on diagnosis and drug-use","volume":"237","author":"Duvetorp","year":"2021","journal-title":"Dermatology"},{"key":"2025090312144083000_9.1.e002960.30","doi-asserted-by":"crossref","first-page":"766","DOI":"10.1002\/pds.4202","article-title":"Pain, depressive symptoms and medication in german patients with rheumatoid arthritis-results from the linking patient-reported outcomes with claims data for health services research in rheumatology (PROCLAIR) study","volume":"26","author":"Jobski","year":"2017","journal-title":"Pharmacoepidemiol Drug Saf"},{"key":"2025090312144083000_9.1.e002960.31","doi-asserted-by":"crossref","first-page":"27","DOI":"10.1016\/j.zefq.2016.03.004","article-title":"Assessment of polypharmacy: a question of definition and underlying data","volume":"113","author":"Hoffmann","year":"2016","journal-title":"Z Evid Fortbild Qual Gesundhwes"}],"container-title":["RMD Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/rmdopen-2022-002960","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,9,3]],"date-time":"2025-09-03T19:14:49Z","timestamp":1756926889000},"score":1,"resource":{"primary":{"URL":"https:\/\/rmdopen.bmj.com\/lookup\/doi\/10.1136\/rmdopen-2022-002960"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,3]]},"references-count":31,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2023,3,9]]},"published-print":{"date-parts":[[2023,3]]}},"alternative-id":["10.1136\/rmdopen-2022-002960"],"URL":"https:\/\/doi.org\/10.1136\/rmdopen-2022-002960","relation":{},"ISSN":["2056-5933"],"issn-type":[{"value":"2056-5933","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,3]]}}}