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Hyland ME, Masoli M, Lanario JW, Jones RC. A Possible Explanation for Non-responders, Responders and Super-responders to Biologics in Severe Asthma. EXPLORATORY RESEARCH AND HYPOTHESIS IN MEDICINE 2019; X:1-4. [DOI: 10.14218/erhm.2019.00008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Matcham F, Hotopf M, Roberts E, Galloway J, Scott IC, Steer S, Norton S. Reply. Arthritis Rheumatol 2019; 71:1025-1026. [DOI: 10.1002/art.40843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
| | | | | | - James Galloway
- King's College London and King's College Hospital NHS Foundation Trust London UK
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Hyland ME, Masoli M, Lanario JW, Jones RC. A Possible Explanation for Non-responders, Responders and Super-responders to Biologics in Severe Asthma. EXPLORATORY RESEARCH AND HYPOTHESIS IN MEDICINE 2019; X:1-4. [DOI: 10.14218/erhm.20019.00008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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54
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Nasonov EL, Lila AM. [Rheumatoid arthritis: achievements and unresolved issues]. TERAPEVT ARKH 2019; 91:4-7. [PMID: 32598670 DOI: 10.26442/00403660.2019.05.000259] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Indexed: 11/22/2022]
Abstract
Success in a treatment of rheumatoid arthritis (RA), associated with a development of new medications and improving treatment strategies, allows to achieve remission in many patients. Despite this a lot of theoretical and clinical issues remain, including a definition of the term "remission", its characteristics and types as well as approaches to optimal tactics of "symptomatic" and "pathogenetic" drug therapy at different stages of the disease. Use of a such tactics will allow to induce quickly a state of remission and maintain it for a long term. Further research is needed which should be directed to investigation of a heterogeneity of RA pathogenetic mechanisms and to elaboration of approaches to its early diagnosis as well as to improving methods for monitoring a disease activity, biomarkers of efficacy and resistance to therapy, and finally, to developing of a differentiated therapy, including a search for new "therapeutic" targets.
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Affiliation(s)
- E L Nasonov
- V.A. Nasonova Scientific and Research Institute of Rheumatology.,I.M. Sechenov First Moscow State Medical University of Ministry of Health of the Russian Federation (Sechenov University)
| | - A M Lila
- V.A. Nasonova Scientific and Research Institute of Rheumatology
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Ng KJ, Huang KY, Tung CH, Hsu BB, Wu CH, Koo M, Hsu CW, Lu MC, Lai NS. Modified rheumatoid arthritis impact of disease (RAID) score, a potential tool for depression and anxiety screening for rheumatoid arthritis. Joint Bone Spine 2019; 86:805-807. [PMID: 31067501 DOI: 10.1016/j.jbspin.2019.04.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2019] [Accepted: 04/23/2019] [Indexed: 02/04/2023]
Affiliation(s)
- Khai-Jing Ng
- Division of Allergy, Immunology and Rheumatology, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi, Taiwan
| | - Kuang-Yung Huang
- Division of Allergy, Immunology and Rheumatology, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi, Taiwan; School of Medicine, Tzu Chi University, Hualien, Taiwan
| | - Chien-Hsueh Tung
- Division of Allergy, Immunology and Rheumatology, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi, Taiwan; School of Medicine, Tzu Chi University, Hualien, Taiwan
| | - Bao-Bao Hsu
- Division of Allergy, Immunology and Rheumatology, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi, Taiwan
| | - Cheng-Han Wu
- Division of Allergy, Immunology and Rheumatology, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi, Taiwan
| | - Malcolm Koo
- Graduate Institute of Long-term Care, Tzu Chi University of Science and Technology, Hualien, Taiwan; Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Chia-Wen Hsu
- Department of Medical Research, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi, Taiwan
| | - Ming-Chi Lu
- Division of Allergy, Immunology and Rheumatology, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi, Taiwan; School of Medicine, Tzu Chi University, Hualien, Taiwan.
| | - Ning-Sheng Lai
- Division of Allergy, Immunology and Rheumatology, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi, Taiwan; School of Medicine, Tzu Chi University, Hualien, Taiwan.
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56
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Krüger K, Kneitz C. Komorbiditäten – ihre Rolle im Treat-to-Target-Konzept für die rheumatoide Arthritis. Z Rheumatol 2019; 78:422-428. [DOI: 10.1007/s00393-019-0637-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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Matcham F, Ali S, Irving K, Chalder T. Psychological Predictors of Fatigue, Work and Social Adjustment, and Psychological Distress in Rheumatology Outpatients. EUROPEAN JOURNAL OF HEALTH PSYCHOLOGY 2019. [DOI: 10.1027/2512-8442/a000024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Abstract. This study aims to investigate the longitudinal relationships between psychological variables and follow-up levels of fatigue, work and social adjustment, and psychological distress in people with rheumatic diseases. The study is a prospective observational study. Patients attending rheumatology outpatient appointments completed a questionnaire during their hospital visit and were mailed a follow-up questionnaire either at their next appointment or via postal questionnaire. Multivariate linear regression models examined the association between baseline cognitive behavioral responses, personality, social support and acceptance and follow-up levels of fatigue, work and social adjustment, and psychological distress, adjusting for age, gender, disease duration, and the length of time between baseline and follow-up. A total of 108 patients completed the follow-up questionnaires. The biggest predictors of having high levels of fatigue at follow-up were increased baseline damage beliefs and behavioral avoidance. Behavioral avoidance at baseline also had a strong relationship with worsened work and social adjustment at follow-up. The biggest predictor of psychological distress at follow-up was a lack of fatigue acceptance at baseline.
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Affiliation(s)
- Faith Matcham
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, United Kingdom
| | - Sheila Ali
- Chronic Fatigue Research and Treatment Unit, South London and Maudsley NHS Foundation Trust, London, United Kingdom
| | - Katherine Irving
- King’s College Hospital NHS Foundation Trust, London, United Kingdom
| | - Trudie Chalder
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, United Kingdom
- Chronic Fatigue Research and Treatment Unit, South London and Maudsley NHS Foundation Trust, London, United Kingdom
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58
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Rheumatoid arthritis and depression: an inflammatory perspective. Lancet Psychiatry 2019; 6:164-173. [PMID: 30366684 DOI: 10.1016/s2215-0366(18)30255-4] [Citation(s) in RCA: 207] [Impact Index Per Article: 41.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Revised: 06/11/2018] [Accepted: 06/20/2018] [Indexed: 12/13/2022]
Abstract
The coexistence of immune-mediated inflammatory diseases with depression has long been recognised. Data that illustrate the intimate associations between peripheral and brain immune responses raise the possibility of shared pathophysiological mechanisms. These associations include the negative effects of proinflammatory cytokines on monoaminergic neurotransmission, neurotrophic factors, and measures of synaptic plasticity. The evidence supporting this association is accumulating and includes findings from clinical trials of immunomodulatory therapy, indicating that these interventions can provide benefits to mental health independent of improvements in physical disease scores. In this Review, we assess this evidence in relation to rheumatoid arthritis and depression, with a focus on innate immune and molecular responses to inflammation, and discuss the challenges of assessing causation in this population, acknowledging the difficulty of assessing the confounding and contributory effects of pain and fatigue. We also discuss how future clinical and preclinical research might improve diagnosis of depression in people with rheumatoid arthritis and shed light on mechanisms that could be substrates for therapeutic interventions.
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59
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Baerwald C, Manger B, Hueber A. Depression als Komorbidität bei rheumatoider Arthritis. Z Rheumatol 2018; 78:243-248. [DOI: 10.1007/s00393-018-0568-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Nakagami Y, Sugihara G, Takei N, Fujii T, Hashimoto M, Murakami K, Furu M, Ito H, Uda M, Torii M, Nin K, Murai T, Mimori T. Effect of Physical State on Pain Mediated Through Emotional Health in Rheumatoid Arthritis. Arthritis Care Res (Hoboken) 2018; 71:1216-1223. [PMID: 30295427 DOI: 10.1002/acr.23779] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Accepted: 09/25/2018] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Pain is one of the main symptoms of patients with rheumatoid arthritis (RA). Pain in RA is caused by specific physical changes, such as joint destruction, and is therefore used as a disease activity marker. Although pain can also be influenced by emotional factors, neither the effect of emotional health nor the indirect effect of the physical state mediated by emotional health on pain has been quantified. METHODS A total of 548 patients with RA participated. Emotional health was assessed using the Hospital Anxiety and Depression Scale (HADS). Measures routinely used in practice were used to evaluate the physical state and pain. To quantify the effects of the physical state on emotional health, and the effects of both physical and emotional health on pain, we used structural equation modeling, with emotional health, physical state, and pain as latent variables. RESULTS The prevalence of anxiety and depression (HADS score ≥8 for each) among patients with RA was 18.7% and 29.4%, respectively. Emotional health was significantly influenced by the physical state (β = 0.21). Pain was affected by physical (β = 0.54) and emotional health (β = 0.29). The effect of the physical state on pain was mediated by emotional health, with this mediation effect (β = 0.06) accounting for 10.2% of the total effect. CONCLUSION The magnitude of pain in RA is determined by the mediation effect of emotional health as well as the direct physical state. Our findings suggest that emotional factors should be taken into account when assessing RA disease activity.
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Affiliation(s)
| | | | - Nori Takei
- Hamamatsu University School of Medicine, Kyoto, Japan, and King's College, London, UK
| | - Takao Fujii
- Wakayama Medical University, Wakayama, Japan
| | | | | | - Moritoshi Furu
- Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Hiromu Ito
- Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Miyabi Uda
- Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Mie Torii
- Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Kazuko Nin
- Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Toshiya Murai
- Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Tsuneyo Mimori
- Kyoto University Graduate School of Medicine, Kyoto, Japan
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Dual target strategy: a proposal to mitigate the risk of overtreatment
and enhance patient satisfaction in rheumatoid arthritis. Ann Rheum Dis 2018; 78:e109. [DOI: 10.1136/annrheumdis-2018-214199] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2018] [Accepted: 07/31/2018] [Indexed: 11/03/2022]
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Matcham F, Galloway J, Hotopf M, Roberts E, Scott IC, Steer S, Norton S. The Impact of Targeted Rheumatoid Arthritis Pharmacologic Treatment on Mental Health: A Systematic Review and Network Meta-Analysis. Arthritis Rheumatol 2018; 70:1377-1391. [PMID: 29873196 DOI: 10.1002/art.40565] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Accepted: 05/15/2018] [Indexed: 12/16/2022]
Abstract
Rheumatoid arthritis (RA) pharmacotherapy may impact mental health outcomes by improving pain and stiffness, potentially by targeting inflammatory processes common to RA and depression. The objectives of this review were to ascertain the frequency of mental health assessments in RA pharmacotherapy trials, quantify the efficacy of RA pharmacotherapy for mental health outcomes, and explore the clinical and demographic factors related to mental health outcomes. Effective pharmacotherapy alone is unlikely to substantially improve mental health outcomes in most patients with RA. Integrated mental health care provided within routine clinical practice is essential to optimize mental and physical health outcomes.
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Affiliation(s)
| | - James Galloway
- King's College London and King's College Hospital NHS Foundation Trust, London, UK
| | | | | | | | - Sophia Steer
- King's College Hospital NHS Foundation Trust, London, UK
| | - Sam Norton
- King's College London and King's College Hospital NHS Foundation Trust, London, UK
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Influence of Biological Therapeutics, Cytokines, and Disease Activity on Depression in Rheumatoid Arthritis. J Immunol Res 2018; 2018:5954897. [PMID: 30148175 PMCID: PMC6083532 DOI: 10.1155/2018/5954897] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2018] [Revised: 04/21/2018] [Accepted: 06/10/2018] [Indexed: 11/28/2022] Open
Abstract
Purpose Rheumatoid arthritis (RA) is an often debilitating autoinflammatory disease. Patients with rheumatoid arthritis are often troubled by co-occurring depression or other psychological manifestations. RA patients have a variety of treatment options available, including biologicals that inhibit cytokines or immune cells. If these cytokines influence the psychological symptoms, then the use of cytokine inhibitors should modulate these symptoms. Methods A cohort of 209 individuals was recruited. This group included 82 RA patients, 22 healthy subjects, 32 depressed control subjects, and 73 subjects with systemic lupus erythematosus. Of the RA patients, 51% were on a biological therapeutic. ELISA was used to measure cytokine levels. A variety of psychological assessments were used to evaluate depression, anxiety, sleep, fatigue, and relationship status. Clinical values were obtained from medical records. Results IL-10 concentration was associated with depressive symptoms in the RA patients, healthy controls, and the lupus patients. In the patients with primary depression, depressive symptoms were associated with IL-6 and TNF-alpha. In RA patients, Tocilizumab use was associated with decreased depressive symptoms. 14 RA patients who were not using biologicals began using them by a one-month follow-up. In these patients, there was no significant change to any value except for fatigue. Conclusions A variety of both biological and social factors influences depressive symptoms in RA. IL-10 and IL-6 are likely to be involved, since IL-10 concentration was associated with depression and Tocilizumab decreased depressive symptoms in the RA patients. The roles of these cytokines are different in RA and lupus, as high IL-10 in RA is associated with increased depressive symptoms, but high IL-10 in the lupus patients is associated with decreased depression. IL-6 was also associated with depressive symptoms in the patients with primary depression. These results strongly indicate that disease activity, including cytokine levels, has a strong impact on depressive symptoms.
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64
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Nasonov EL, Olyunin YA, Lila AM. RHEUMATOID ARTHRITIS: THE PROBLEMS OF REMISSION AND THERAPY RESISTANCE. ACTA ACUST UNITED AC 2018. [DOI: 10.14412/1995-4484-2018-263-271] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Rheumatoid arthritis (RA) is an immunoinflammatory (autoimmune) rheumatic disease of unknown etiology, which is characterized by chronic erosive arthritis and systemic visceral organ damage that results in early disability and shorter patient survival. Despite RA treatment advances associated with the design of novel drugs and the improvement of treatment strategies to achieve remission in many patients, there are still many theoretical and clinical problems concerning both the definition of the concept of remission, its characteristics and types and approaches to the optimum policy of symptomatic and pathogenetic drug therapy at different stages of the disease, the use of which will be able to rapidly induce and maintain remission in the long-term. Further investigations are needed to study the nature of heterogeneity of pathogenetic mechanisms of RA and approaches to early diagnosis, to improve methods for monitoring disease activity and biomarkers for the efficiency of and resistance to therapy and, finally, to develop differentiation therapy, including those related to a search for new therapeutic targets.
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65
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Holla JFM, van Beers-Tas MH, van de Stadt LA, Landewé R, Twisk JWR, Dekker J, van Schaardenburg D. Depressive mood and low social support are not associated with arthritis development in patients with seropositive arthralgia, although they predict increased musculoskeletal symptoms. RMD Open 2018; 4:e000653. [PMID: 30018798 PMCID: PMC6045698 DOI: 10.1136/rmdopen-2018-000653] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Revised: 04/06/2018] [Accepted: 04/21/2018] [Indexed: 11/29/2022] Open
Abstract
Objective Studies on the role of psychosocial vulnerability in the development of arthritis must be performed early in the disease course to exclude the reverse explanation that arthritis leads to psychological symptoms. Therefore, the objective of this study was to investigate the longitudinal (5-year) association between depressive mood, daily stressors, avoidance coping and social support as predictors, and the development of arthritis and other clinical parameters as outcomes, in persons with seropositive arthralgia at risk of developing rheumatoid arthritis. Methods Five-year follow-up data of 231 patients from the Reade seropositive arthralgia cohort were used. Clinical and psychological data were collected using physical examinations and questionnaires. Mixed models and Cox regression analyses were used to assess the 5-year associations between depressive mood, daily stressors, avoidance coping or social support, and the development of arthritis or clinical parameters (tender joint count, Visual Analogue Scale (VAS) pain, VAS morning stiffness and erythrocyte sedimentation rate (ESR)). Results Higher scores for depressive mood and lower scores for social support were not associated with the development of arthritis nor with ESR. However, they were longitudinally associated with an increase in pain (p<0.001), morning stiffness (p<0.01) and tender joint count (p<0.001). No consistent associations were found between daily stressors, avoidance coping and the development of arthritis or other clinical parameters. Conclusion Although an effect on the development of arthritis could not be demonstrated, a strong longitudinal association was found between high depressive mood, low social support and clinical parameters. In persons with seropositive arthralgia, depressive symptoms and low social support may increase musculoskeletal symptoms.
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Affiliation(s)
- Jasmijn F M Holla
- Amsterdam Rehabilitation Research Center, Reade, Amsterdam, The Netherlands
| | | | - Lotte A van de Stadt
- Amsterdam Rheumatology and immunology Center, VU University Medical Center, Amsterdam, The Netherlands
| | - Robert Landewé
- Amsterdam Rheumatology and immunology Center, Academic Medical Center, Amsterdam, The Netherlands
| | - Jos W R Twisk
- Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, The Netherlands
| | - Joost Dekker
- Amsterdam Rehabilitation Research Center, Reade, Amsterdam, The Netherlands.,Department of Rehabilitation Medicine, VU University Medical Center, Amsterdam, The Netherlands.,Department of Psychiatry, VU University Medical Center, Amsterdam, The Netherlands.,Amsterdam Public Health research institute, VU University Medical Center, Amsterdam, The Netherlands
| | - Dirkjan van Schaardenburg
- Amsterdam Rheumatology and immunology Center, Reade, Amsterdam, The Netherlands.,Amsterdam Rheumatology and immunology Center, Academic Medical Center, Amsterdam, The Netherlands
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66
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Leon L, Redondo M, Fernández-Nebro A, Gómez S, Loza E, Montoro M, Garcia-Vicuña R, Galindo M. Expert recommendations on the psychological needs of patients with rheumatoid arthritis. Rheumatol Int 2018; 38:2167-2182. [PMID: 29808295 DOI: 10.1007/s00296-018-4057-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Accepted: 05/17/2018] [Indexed: 12/26/2022]
Abstract
OBJECTIVE To establish feasible and practical recommendations for the management of the psychological needs of patients with rheumatoid arthritis (RA) from the moment of diagnosis through the course of the disease. METHODS A nominal group meeting was held with an RA expert team including rheumatologists and psychologists, at which a guided discussion addressed the most important psychological and emotional needs in RA. Based on the comments collected, and a literature review, a matrix document of recommendations for telematics discussion was prepared, as well as a Delphi survey to test agreement with these recommendations. Agreement was defined if at least 80% of participants voted ≥ 7 (from 1, totally disagree to 10, totally agree). For each recommendation, the level of evidence and grading of recommendations was established following the Oxford criteria, and the degree of agreement through the Delphi. RESULTS Thirteen recommendations were established, addressing several key processes: (1) identification of psychological problems and needs in patients with RA, and a guideline for their management in daily practice; (2) communication with patients; (3) referral criteria to mental health professionals. CONCLUSIONS These recommendations are intended to help health care professionals openly address the psychological aspects of patients in daily practice to follow and treat them properly.
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Affiliation(s)
- Leticia Leon
- Rheumatology Unit, IDISSC, San Carlos Clinical Hospital, Madrid, Spain.,Faculty of Heath Sciences, Camilo José Cela University, Madrid, Spain
| | - Marta Redondo
- Faculty of Heath Sciences, Camilo José Cela University, Madrid, Spain
| | - Antonio Fernández-Nebro
- Rheumatology Clinical Management Unit, Biomedical Research Institute in Malaga (IBIMA), Regional University Hospital in Malaga, University of Malaga, Malaga, Spain
| | - Susana Gómez
- Pfizer Medical Department, Alcobendas, Madrid, Spain
| | | | - María Montoro
- Pfizer Medical Department, Alcobendas, Madrid, Spain
| | | | - María Galindo
- Rheumatology Service, 12 de Octubre University Hospital, Av. Cordoba, s/n, 28041, Madrid, Spain.
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Bechman K, Sin FE, Ibrahim F, Norton S, Matcham F, Scott DL, Cope A, Galloway J. Mental health, fatigue and function are associated with increased risk of disease flare following TNF inhibitor tapering in patients with rheumatoid arthritis: an exploratory analysis of data from the Optimizing TNF Tapering in RA (OPTTIRA) trial. RMD Open 2018; 4:e000676. [PMID: 29862047 PMCID: PMC5976130 DOI: 10.1136/rmdopen-2018-000676] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Revised: 04/13/2018] [Accepted: 04/15/2018] [Indexed: 12/23/2022] Open
Abstract
Background Tapering of anti-tumour necrosis factor (TNF) therapy appears feasible, safe and effective in selected patients with rheumatoid arthritis (RA). Depression is highly prevalent in RA and may impact on flare incidence through various mechanisms. This study aims to investigate if psychological states predict flare in patients' dose tapering their anti-TNF therapy. Methods This study is a post-hoc analysis of the Optimizing TNF Tapering in RA trial, a multicentre, randomised, open-label study investigating anti-TNF tapering in RA patients with sustained low disease activity. Patient-reported outcomes (Health Assessment Questionnaire, EuroQol 5-dimension scale, Functional Assessment of Chronic Illness Therapy fatigue scale (FACIT-F), 36-Item Short Form Survey (SF-36)) were collected at baseline. The primary outcome was flare, defined as an increase in 28-joint count Disease Activity Score (DAS28) ≥0.6 and ≥1 swollen joint. Discrete-time survival models were used to identify patient-reported outcomes that predict flare. Results Ninety-seven patients were randomised to taper their anti-TNF dose by either 33% or 66%. Forty-one patients flared. Higher baseline DAS28 score was associated with flare (adjusted HR 1.96 (95% CI 1.18 to 3.24), p=0.01). Disability (SF-36 physical component score), fatigue (FACIT-F) and mental health (SF-36 mental health subscale (MH)) predicted flare in unadjusted models. In multivariate analyses, only SF-36 MH remained a statistically significant predictor of flare (adjusted HR per 10 units 0.74 (95% CI 0.60 to 0.93), p=0.01). Conclusions Baseline DAS28 and mental health status are independently associated with flare in patients who taper their anti-TNF therapy. Fatigue and function also associate with flare but the effect disappears when adjusting for confounders. Given these findings, mental health and functional status should be considered in anti-TNF tapering decisions in order to optimise the likelihood of success. Trial registration numbers EudraCT Number: 2010-020738-24; ISRCTN: 28955701; Post-results.
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Affiliation(s)
- Katie Bechman
- Academic Department of Rheumatology, King's College London, London, UK
| | - Fang En Sin
- Academic Department of Rheumatology, King's College London, London, UK
| | - Fowzia Ibrahim
- Academic Department of Rheumatology, King's College London, London, UK
| | - Sam Norton
- Academic Department of Rheumatology, King's College London, London, UK
| | - Faith Matcham
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, KCL, London, UK
| | - David Lloyd Scott
- Academic Department of Rheumatology, King's College London, London, UK
| | - Andrew Cope
- Academic Department of Rheumatology, King's College London, London, UK
| | - James Galloway
- Academic Department of Rheumatology, King's College London, London, UK
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Clinical News. Br J Hosp Med (Lond) 2018. [DOI: 10.12968/hmed.2018.79.3.128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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