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Santos-Moreno P, Rodríguez-Vargas GS, Rodríguez-Florido F, Rubio-Rubio JA, Rodríguez PA, Rojas-Villarraga A. Comparison and Influence of a Multicomponent Educational Program on the Patient-Reported Outcomes of a Group of Patients With Rheumatoid Arthritis. J Clin Rheumatol 2024; 30:200-207. [PMID: 38809130 DOI: 10.1097/rhu.0000000000002105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2024]
Abstract
BACKGROUND Rheumatoid arthritis (RA) is a chronic disease that affects different areas of the patient's body. Patient education and health literacy is essential for them to participate actively in follow-up. OBJECTIVES The aim of this study was to assess differences between clinimetric measurements done by a medical team and patient-reported outcome measures (PROMs) in RA and understand the impact of patient education strategies in order to identify differences between RA assessment methods. METHODS This is a longitudinal cohort study. It included adult patients with RA and access to digital tools. These were divided into 3 groups by type of education. Group 1 included patients who participated in a multicomponent RA educational program. Group 2 did not have this multicomponent RA education. Group 3 did not receive any education. The 3 groups performed PROMs. Disease activity scales, functional class, and quality of life were measured. Univariate and bivariate analysis (χ 2 and Wilcoxon for paired data) were done. RESULTS Twenty-eight patients were included in group 1, 26 in group 2, and 37 in group 3. All were women. In group 1, there were no significant differences in clinimetrics between the medical team and patient's PROMs except for fatigue. In group 2 and group 3, significant differences were found. The RAPID3 and PAS variables did not show significant differences when analyzed by intervention subgroups. CONCLUSIONS This study shows no differences between clinimetrics/PROMs for patients with a high-level education on RA and physicians. On the other hand, when patient did not have any RA education, the clinimetric results differed from physician measurement.
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Castrejón I, Cano L, Cuadrado MJ, Borrás J, Galindo M, Salman-Monte TC, Amorós C, San Román C, Cabezas I, Comellas M, Muñoz A. Patient-reported outcome measures for systemic lupus erythematosus: an expert Delphi consensus to guide implementation in routine care. BMC Rheumatol 2024; 8:31. [PMID: 39010239 PMCID: PMC11251319 DOI: 10.1186/s41927-024-00401-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Accepted: 07/09/2024] [Indexed: 07/17/2024] Open
Abstract
BACKGROUND Systemic lupus erythematosus (SLE) may result in great impact on patients' quality of life, social relationships, and work productivity. The use of patient-reported outcome measures (PROMs) in routine care could help capture disease burden to guide SLE management and optimize disease control. We aimed to explore the current situation, appropriateness, and feasibility of PROMs to monitor patients with SLE in routine care, from healthcare professionals' and patients' perspectives. METHODS A scientific committee developed a Delphi questionnaire, based on a focus group with patients and a literature review, including 22 statements concerning: 1) Use of PROMs in routine care (n = 2); 2) PROMs in SLE management (n = 13); 3) Multidisciplinary management of patients with SLE (n = 4), and 4) Aspects on patient empowerment (n = 3). Statements included in Sects. 2-4 were assessed from three perspectives: current use, appropriateness, and feasibility (with currently available resources). For each statement, panellists specified their level of agreement using a 7-point Likert scale. A consensus was reached when ≥ 70% of the panellists agreed (6,7) or disagreed (1,2) on each statement. RESULTS Fifty-nine healthcare professionals and 16 patients with SLE participated in the Delphi-rounds. A consensus was reached on the value of PROMs to improve SLE management (83%) and the key role of healthcare professionals (77%) and the need for a digital tool connected to the electronic medical record (85%) to promote and facilitate PROMs collection. PROMs most frequently used in clinical practice are pain (56%), patient's global assessment (44%) and fatigue (39%), all on visual analogue scales. Panellists agreed on the need to implement multidisciplinary consultation (79%), unify complementary tests (88%), incorporate pharmacists into the healthcare team (70%), and develop home medication dispensing and informed telepharmacy programmes (72%) to improve quality of care in patients with SLE. According to panellists, patient associations (82%) and nurses (80%) are critical to educate and train patients on PROMs to enhance patient empowerment. CONCLUSIONS Although pain, fatigue, and global assessment were identified as the most feasible, PROMs are not widely used in routine care in Spain. The present Delphi consensus can provide a road map for their implementation being key for SLE management.
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Affiliation(s)
- Isabel Castrejón
- Departamento de Medicina, Servicio de Reumatología, Hospital General Universitario Gregorio MarañónInstituto de Investigación Sanitaria Gregorio MarañónUniversidad Complutense de Madrid, C. del Dr. Esquerdo, 46, 28007, Madrid, Spain.
| | - Laura Cano
- Enfermería Reumatología, H. Regional de Málaga, Málaga, Spain
| | - María José Cuadrado
- Servicio de Reumatología, H. Clínica Universitaria de Navarra, Madrid, Spain
| | | | - Maria Galindo
- Servicio de Reumatología, H. 12 de Octubre, Madrid, Spain
| | | | | | | | | | | | - Alejandro Muñoz
- Servicio de Reumatología, H. Universitario Virgen del Rocío, Sevilla, Spain
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Cholerzyńska H, Zasada W, Tselios K, Grygiel-Górniak B. Sleep Disorders in Connective Tissue Diseases-Coexisting Diseases or Disease Components? J Clin Med 2024; 13:3656. [PMID: 38999222 PMCID: PMC11242285 DOI: 10.3390/jcm13133656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2024] [Revised: 06/17/2024] [Accepted: 06/20/2024] [Indexed: 07/14/2024] Open
Abstract
This comprehensive review examines the complex relationship between sleep disorders and rheumatic diseases, supported by findings from the latest research articles. It encompasses various rheumatic conditions, including rheumatoid arthritis, systemic lupus erythematosus, and systemic sclerosis. The review reveals the bidirectional relationship between sleep disorders and these diseases, emphasizing their impact on disease progression and quality of life. Conventional and alternative therapeutic interventions for connective tissue diseases are presented, focusing on improving sleep quality and alleviating rheumatic symptoms. The role of pro-inflammatory cytokines and their potential modulation through pharmacological agents is also discussed. In the treatment of sleep disorders, various options are proposed, such as cognitive behavioral therapy for insomnia, physical activity, dietary modifications, and alternative approaches like reflexology and acupuncture. Thus, this review offers a nuanced understanding of the connection between sleep disorders and rheumatic diseases, supported by evidence from diverse studies. Such an approach is particularly important because it enhances sleep quality for overall patient well-being in the holistic management of rheumatic conditions.
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Affiliation(s)
- Hanna Cholerzyńska
- Department of Rheumatology, Rehabilitation and Internal Diseases, Poznan University of Medical Sciences, 61-701 Poznan, Poland
| | - Wiktoria Zasada
- Department of Rheumatology, Rehabilitation and Internal Diseases, Poznan University of Medical Sciences, 61-701 Poznan, Poland
| | | | - Bogna Grygiel-Górniak
- Department of Rheumatology, Rehabilitation and Internal Diseases, Poznan University of Medical Sciences, 61-701 Poznan, Poland
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Henes J, Richter JG, Thiele K, Kiltz U, Callhoff J, Albrecht K. Trends in health care of patients with vasculitides, including giant cell arteritis, Takayasu arteritis, ANCA-associated vasculitis and Behçet's disease: cross-sectional data of the German National Database 2007-2021. Rheumatol Int 2024; 44:497-507. [PMID: 38180499 PMCID: PMC10866751 DOI: 10.1007/s00296-023-05508-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Accepted: 11/08/2023] [Indexed: 01/06/2024]
Abstract
The aim of this study is to present the current care situation of patients with giant cell arteritis (GCA), Takayasu arteritis (TAK), ANCA-associated vasculitis (AAV) and Behçet's disease (BD). Trends over the last 15 years will reflect improvements and remaining deficits in the management of vasculitides. Consecutive cross-sectional data from patients with vasculitides from the German National Database (NDB) of the Collaborative Arthritis Centres between 2007 and 2021 were included. Medication, physician- and patient-reported outcomes on disease activity and disease burden, inpatient stays and occupational participation are compared for different vasculitis entities and over time. Employment rates were compared to German population rates. Between 502 and 854 vasculitis patients were annually documented. GCA and AAV were the most common vasculitides. Median disease duration ranged from 2 to 16 years. Over the years, glucocorticoids decreased in proportion and dose, most markedly in GCA and TAK, while biologic therapies increased up to 27%. Physicians rated disease activity as low for the vast majority of patients, while patients-reported moderate outcomes in many dimensions. PROs remained largely unchanged. The proportion of employed patients (< 65 years) increased from 47 to 57%. In recent years, biologics are increasingly used in patients with vasculitides, while glucocorticoids decreased significantly. PRO's have not improved. Work participation increased but remains lower than that in the German population.
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Affiliation(s)
- Jörg Henes
- Centre for Interdisciplinary Clinical Immunology, Rheumatology and Autoimmune Diseases and Internal Medicine II, University Hospital Tübingen, Tübingen, Germany
| | - Jutta G Richter
- Department of Rheumatology, Faculty of Medicine, University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
- Faculty of Medicine, Hiller Research Centre Rheumatology, University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Katja Thiele
- Programme Area Epidemiology and Health Services Research, German Rheumatism Research Centre Berlin, Berlin, Germany
| | - Uta Kiltz
- Ruhr Universität Bochum, Rheumazentrum Ruhrgebiet, Herne, Germany
| | - Johanna Callhoff
- Programme Area Epidemiology and Health Services Research, German Rheumatism Research Centre Berlin, Berlin, Germany
- Institute of Social Medicine, Epidemiology and Health Economics, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Katinka Albrecht
- Programme Area Epidemiology and Health Services Research, German Rheumatism Research Centre Berlin, Berlin, Germany.
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Rodwell N, Hassett G, Bird P, Pincus T, Descallar J, Gibson KA. RheuMetric Quantitative 0 to 10 Physician Estimates of Inflammation, Damage, and Distress in Rheumatoid Arthritis: Validation Against Reference Measures. ACR Open Rheumatol 2023; 5:511-521. [PMID: 37608509 PMCID: PMC10570671 DOI: 10.1002/acr2.11574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 04/23/2023] [Accepted: 04/26/2023] [Indexed: 08/24/2023] Open
Abstract
OBJECTIVE To analyze a RheuMetric checklist, which includes four feasible physician 0 to 10 scores for DOCGL, inflammation (DOCINF), damage (DOCDAM), and distress (DOCSTR) for criterion and discriminant validity against standard reference measures. METHODS A prospective, cross-sectional assessment was performed at one routine care visit at Liverpool Hospital, Sydney, Australia. Rheumatologists recorded DOCGL, DOCINF, DOCDAM, DOCSTR, and 28 joint counts for swelling (SJC), tenderness (TJC), and limited motion/deformity (DJC). Patients completed a multidimensional health assessment questionnaire (MDHAQ), which includes routine assessment of patient index data (RAPID3), fibromyalgia assessment screening tool (FAST4), and MDHAQ depression screen (MDS2). Laboratory tests and radiographic scores were recorded. RheuMetric estimates of inflammation, damage, and distress were compared with reference and other measures using correlations and linear regressions. RESULTS In 173 patients with RA, variation in RheuMetric DOCINF was explained significantly by SJC and inversely by disease duration; variation in DOCDAM was explained significantly by DJC, radiographic scores, and physical function; and variation in DOCSTR was explained significantly by fibromyalgia and depression. CONCLUSION RheuMetric DOCINF, DOCDAM, and DOCSTR estimates were correlated significantly and specifically with reference measures of inflammation, damage, and distress, documenting criterion and discriminant validity.
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Affiliation(s)
- Nicholas Rodwell
- Liverpool Hospital and Ingham Institute for Applied Medical Research, Liverpool, New South Wales, Australia, and University of New South WalesMedicine and HealthSydneyNew South WalesAustralia
| | - Geraldine Hassett
- Liverpool Hospital and Ingham Institute for Applied Medical Research, Liverpool, New South Wales, Australia, and University of New South WalesMedicine and HealthSydneyNew South WalesAustralia
| | - Paul Bird
- University of New South Wales, Medicine and HealthKensingtonSydneyNew South WalesAustralia
| | | | - Joseph Descallar
- Ingham Institute for Applied Medical Research, Liverpool, New South Wales, Australia, and University of New South WalesMedicine and HealthSydneyNew South WalesAustralia
| | - Kathryn A. Gibson
- Liverpool Hospital and Ingham Institute for Applied Medical Research, Liverpool, New South Wales, Australia, and University of New South WalesMedicine and HealthSydneyNew South WalesAustralia
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Hayashi K, Miki K, Shi K, Yukioka M, Hirayama T, Tsujimoto K, Takeuchi T, Hayaishi Y, Hayaishi M. Discordance of global assessment between the patients and physicians predicts 9-year pain-related outcomes in rheumatoid arthritis patients. Front Med (Lausanne) 2023; 10:1189748. [PMID: 37404806 PMCID: PMC10315535 DOI: 10.3389/fmed.2023.1189748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 05/26/2023] [Indexed: 07/06/2023] Open
Abstract
Introduction Perspectives regarding the disease state often differ between patients with rheumatoid arthritis (RA) and physicians. The aim of the present longitudinal cohort study was to investigate the impact of the discordance in global assessments between patients and physicians on 9-year pain-related outcomes in patients with rheumatoid arthritis. Method Sixty-eight consecutive outpatients with rheumatoid arthritis on their first visit to a tertiary center were included. Baseline measurements included demographic data, drugs used, disease activity, and a modified Health Assessment Questionnaire (mHAQ). Discordance in global assessment between patients and physicians at baseline was defined as 10 mm higher in the patient global assessment (PGA) than in the physician global assessment. A 9-year follow-up assessment included pain intensity, the European Quality of Life 5 Dimensions 3 Level (EQ-5D-3L) scale, Pain Catastrophizing Scale (PCS), Hospital Anxiety and Depression Scale (HADS), Pain Disability Assessment Scale (PDAS), and Pain Self-Efficacy Questionnaire (PSEQ). Results The number of patients with discordance was 26 (38%) in 68 patients. Patients with a 10 mm higher PGA than the physician global assessment at baseline measurements had significantly worse pain intensity, PCS score, PSEQ score, and EQ-5D-3L score measurements at the 9-year follow-up than those with concordance. A higher mHAQ score and 10 mm higher PGA at baseline were significantly independently associated with the EQ-5D-3L scale score and pain intensity at the 9-year follow-up. Conclusion This longitudinal cohort study suggested that discordance in global assessment between patients and physicians modestly predicted worse 9-year pain-related outcomes in patients with rheumatoid arthritis.
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Affiliation(s)
- Kazuhiro Hayashi
- Department of Physical Therapy and Rehabilitation Science, University of Iowa, Iowa City, IA, United States
| | - Kenji Miki
- Center for Pain Management, Hayaishi Hospital, Osaka, Japan
- Faculty of Health Science, Osaka Yukioka College of Health Science, Ibaraki, Japan
- Japan Pain Foundation, Tokyo, Japan
| | | | - Masao Yukioka
- Faculty of Health Science, Osaka Yukioka College of Health Science, Ibaraki, Japan
- Department of Rheumatology, Tenjin Orthopaedics and Rheumatology, Osaka, Japan
| | | | | | - Takao Takeuchi
- Department of Respiratory Medicine and Clinical Immunology, Graduate School of Medicine, Osaka University, Suita, Japan
| | - Yasuhisa Hayaishi
- Department of Respiratory Medicine and Clinical Immunology, Graduate School of Medicine, Osaka University, Suita, Japan
| | - Masahiro Hayaishi
- Department of Respiratory Medicine and Clinical Immunology, Graduate School of Medicine, Osaka University, Suita, Japan
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Bell CF, Huang SP, Yu LH, DerSarkissian M, Germain G, Concoff AL, Averell CM, Rubin B, Gu YM, Duh MS, Wallace DJ. A 5-Year Retrospective, Observational Study Assessing Rheumatoid Arthritis Disease Outcome Measures to Characterize Systemic Lupus Erythematosus Burden in the USA. Rheumatol Ther 2023; 10:261-274. [PMID: 36471198 PMCID: PMC9931978 DOI: 10.1007/s40744-022-00509-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 11/03/2022] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION We evaluated the use of rheumatoid arthritis (RA) disease measures in patients with systemic lupus erythematosus (SLE) in a US community-based rheumatology physician network over 5 years. METHODS This retrospective, observational cohort study (GSK Study 213818) of patients with SLE utilized electronic medical records (01 January 2010-31 December 2019) from the United Rheumatology Normalized Integrated Community Evidence database. The index was the date of first SLE diagnosis recorded in the database; the observation period was 5 years post-index. RA disease measures evaluated were: Pain Index, Multi-Dimensional Health Assessment Questionnaire (MD-HAQ), Patient Global Assessment (PtGA), Physician Global Assessment (PGA), Swollen Joint Count (SJC), Tender Joint Count (TJC), Routine Assessment of Patient Index Data 3 (RAPID3), Clinical Disease Activity Index (CDAI), Simplified Disease Activity Index (SDAI), and Disease Activity Score 28 (DAS-28). The number of patients with measures utilized, the score on each measure, and proportion of patients per disease activity category were assessed. RESULTS Overall, 5990 patients with SLE were included. The most frequently used measures were Pain Index, SJC, TJC, MD-HAQ, PtGA, RAPID3, and PGA (cumulative use over Years 1-5: 23.9-71.3%). For all measures, frequency of use was lowest in Year 1, followed by a general increase from Year 1 to Year 5. Scores remained relatively stable for most measures, and the proportion of patients in remission or with low/moderate disease activity per RAPID3 increased. CONCLUSION RA disease measure utilization in SLE was generally infrequent but increased over time. Pain Index and MD-HAQ were the most commonly applied cumulatively across 5 years of follow-up. The rationale for the increased use of these measures in SLE over time requires further exploration. In the absence of a clinically applicable SLE-specific measure, the use of RA measures, for example in conjunction with SLE measures, may provide an alternative approach for measuring disease activity, representing an opportunity to improve patient outcomes.
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Affiliation(s)
- Christopher F Bell
- GSK, US Value, Evidence and Outcomes, 410 Blackwell Street, Durham, NC, 27701, USA.
| | - Shirley P Huang
- GSK, US Value, Evidence and Outcomes, 410 Blackwell Street, Durham, NC, 27701, USA
| | | | | | | | | | - Carlyne M Averell
- GSK, US Value, Evidence and Outcomes, 410 Blackwell Street, Durham, NC, 27701, USA
| | - Bernard Rubin
- GSK, US Value, Evidence and Outcomes, 410 Blackwell Street, Durham, NC, 27701, USA
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Louthrenoo W, Kasitanon N, Morand E, Kandane-Rathnayake R. Associations between physicians' global assessment of disease activity and patient-reported outcomes in patients with systemic lupus erythematosus: A longitudinal study. Lupus 2021; 30:1586-1595. [PMID: 34192957 DOI: 10.1177/09612033211027943] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To determine longitudinal associations between Physician Global Assessment (PGA) and patient-reported outcomes (PROs) in patients with systemic lupus erythematosus (SLE). METHODS Patients attending a rheumatology clinic between 2013 and 2017 completed specific (SLEQOL) and generic (SF36) health-related quality of life (HRQoL) surveys and rated their global rating of change (GRC) at each visit. PGA, SLEDAI-2K and SLE Flare Index (SFI) were also captured on all visits. Generalised estimating equations (GEE) methods were used to examine longitudinal associations of PGA with PROs and clinical indicators. RESULTS 337 patients were followed for a median [IQR] of 3.2 [1.6, 3.4] years (2,059 visits). High PGA (>1) was strongly associated with high SLEDAI-2K scores, the presence of flares and poor PROs. Odd ratios (OR) [95% CI] of PGA > 1 in patients with SLEDAI-2K >4 & <10 and SLEDAI-2K ≥10, compared to SLEDAI-2K ≤ 4, were 3.46 [2.36, 5.08], p < 0.001 and 6.39 [4.30, 9.49], p < 0.001, respectively. OR [95% CI] of PGA > 1 in patients with mild-to-moderate or severe flares were 2.09 [1.62, 2.71], p < 0.001 and 4.42 [3.21, 6.07], p < 0.001, respectively. Mental components of both SLEQOL (mood, self-image) and SF36 (MCS) surveys demonstrated significant associations with high PGA. After adjusting for SLEDAI-2K, one-point increase in PGA was associated with reductions in SLEQOL total score and SF36-MCS by 2.33 (regression coefficient (RC) [95% CI] = -2.33 [-3.77, -0.88], p = 0.002), and 4.16 (RC [95% CI] = -4.16 [-5.19, -3.13], p < 0.001) points, respectively. Associations of some physical components (SLEQOL-symptoms, and SF36-PCS) with PGA attenuated when adjusted for SLEDAI-2K. Patients who rated low scores of GRC, which indicate health deterioration, were twice as likely to have PGA > 1 (OR [95%CI] 1.99 [1.25, 3.16], p = 0.004). CONCLUSION High PGA was strongly associated with poor mental health, high disease activity and flares. This study confirms the value of PGA as an efficient assessment tool for SLE.
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Affiliation(s)
- Worawit Louthrenoo
- Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Nuntana Kasitanon
- Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Eric Morand
- School of Clinical Sciences at Monash Health, Monash University, Melbourne, Australia
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Validation of a Quality of Life Instrument in Spanish Patients With Rheumatic Diseases: The Rosser Classification System. J Clin Rheumatol 2019; 25:78-84. [PMID: 29561466 DOI: 10.1097/rhu.0000000000000774] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The aim of this study was to assess the reliability and validity of the Spanish version of the Rosser classification system for disease states in patients with musculoskeletal disorders. METHODS Our study was based on a questionnaire validation design. Patients were attended at an outpatient rheumatology clinic at Hospital Clínico San Carlos, Madrid, Spain. The Rosser classification system was completed by the physician from the research team (PMQ) and by the patient (HMQ). Criterion standards: The EuroQol-5D for the HMQ and the physician global estimate (DOCGL) for the PMQ. Internal consistency reliability was assessed using Cronbach α. Test-retest reliability and interobserver reliability were analyzed using the intraclass correlation coefficient. The criterion validity between HMQ and EuroQol-5D and between PMQ and DOCGL was assessed using the Spearman correlation coefficient. RESULTS The full analysis was based on 4 samples of patients (104 to 266 patients), most of whom were middle-aged women. For HMQ, Cronbach α was 0.70. Test-retest reproducibility was 0.7. With respect to criterion validity, significant correlations in the expected direction were observed. For PMQ, Cronbach α was 0.70, indicating excellent intraobserver and interobserver reliability. With respect to criterion validity, strong correlations were observed between the PMQ and the DOCGL. CONCLUSIONS The Rosser classification system showed satisfactory reliability and suitable criterion validity for patients with musculoskeletal disorders. The instrument seems to be suitable for clinical decision making and research.
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Andreasen RA, Kristensen LE, Egstrup K, Baraliakos X, Strand V, Horn HC, Hansen IMJ, Christensen R, Ellingsen T. The impact of sex and disease classification on patient-reported outcome measures in axial spondyloarthritis: a descriptive prospective cross-sectional study. Arthritis Res Ther 2019; 21:221. [PMID: 31665083 PMCID: PMC6819525 DOI: 10.1186/s13075-019-2012-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Accepted: 09/21/2019] [Indexed: 12/02/2022] Open
Abstract
Background The aim of this study was to explore the impact of sex and disease classification on outcomes in axial spondyloarthritis (axSpA) patients, including both radiographic (r-) axSpA and non-radiographic (nr-) axSpA, in males and females, respectively. Methods AxSpA patients were consecutively recruited from two rheumatology outpatient university clinics. We explored how sex and axSpA disease classification affected patient-reported outcome measures (PROMs). General linear models were used to investigate if there was an association between the continuous variables and each of the main effects of interest (sex and axSpA classification), as well as the possible interaction between them. Categorical outcome measures were analyzed with the use of logistic regression with the same fixed effects. We analyzed the relationship between tender point count (TPC) and the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI). The prevalence of extra-articular manifestations (EAMs) and the Charlson Comorbidity Index (CCI) were determined. Results According to the protocol, a total of 100 outpatients with axSpA were enrolled (r-axSpA males 30, r-axSpA females 10, nr-axSpA males 25, nr-axSpA females 35). The BASDAI scores appeared higher among nr-axSpA females (median [Q1; Q3], 47 [21; 60]) compared with the combined median for the 3 other subgroups 25 [12; 25]. Female sex was associated with a higher number of tender point count (TPC, P < 0.001). TPC and BASDAI were correlated for female nr-axSpA patients (r = 0.44, P = 0.008) and male nr-axSpA patients (r = 0.56, P = 0.003). Being classified as nr-axSpA was associated with a lower SF-36 Mental Component Summary (median for the 4 subgroups: nr-axSpa females 46.7, nr-axSpA males 52.3 vs. r-axSpA males 56.9 and r-axSpA females 50.4). EAMs were frequent (up to 50%). The CCI was low in all 4 subgroups, and no difference in the CCI between the subgroups was observed (P = 0.14). However, male sex had a significant impact on the CCI (P = 0.03). Conclusions In summary, patients with r-axSpA, regardless of sex, appeared less affected on most PROMs compared with nr-axSpA patients. However, female sex was associated with a higher number of TPC. TPC could possibly confound disease activity outcomes such as BASDAI, and one can consider different thresholds for defining high disease activity depending on the patient’s sex. Trial registration The trial is registered and approved by the Region of Southern Denmark’s Ethics Committee (S-20150219). Registered 19 February 2015.
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Affiliation(s)
- Rikke A Andreasen
- Department of Medicine, Section of Rheumatology, Odense University Hospital, Svendborg and University of Southern Denmark, Baagøes Allé 15, DK-5700, Svendborg, Denmark. .,Musculoskeletal Statistics Unit, The Parker Institute, Copenhagen University Hospital, Bispebjerg and Frederiksberg Hospital, Copenhagen F, Denmark.
| | - Lars E Kristensen
- Musculoskeletal Statistics Unit, The Parker Institute, Copenhagen University Hospital, Bispebjerg and Frederiksberg Hospital, Copenhagen F, Denmark.,The DANBIO Registry, Centre for Rheumatology and Spine Diseases, Copenhagen, Denmark
| | - Kenneth Egstrup
- Cardiovascular Research Unit, Odense University Hospital, Svendborg, Denmark
| | | | - Vibeke Strand
- Division of Immunology/Rheumatology, Stanford University, Palo Alto, CA, USA
| | - Hans Christian Horn
- Research Unit of Rheumatology, Department of Clinical Research, Odense University Hospital, University of Southern Denmark, Odense, Denmark
| | - Inger M J Hansen
- Department of Medicine, Section of Rheumatology, Odense University Hospital, Svendborg and University of Southern Denmark, Baagøes Allé 15, DK-5700, Svendborg, Denmark
| | - Robin Christensen
- Musculoskeletal Statistics Unit, The Parker Institute, Copenhagen University Hospital, Bispebjerg and Frederiksberg Hospital, Copenhagen F, Denmark.,Research Unit of Rheumatology, Department of Clinical Research, Odense University Hospital, University of Southern Denmark, Odense, Denmark
| | - Torkell Ellingsen
- Research Unit of Rheumatology, Department of Clinical Research, Odense University Hospital, University of Southern Denmark, Odense, Denmark.,OPEN, Odense Patient Data Explorative Network, Odense University Hospital, Odense, Denmark
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12
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Pope JE, Michaud K. Is It Time to Banish Composite Measures for Remission in Rheumatoid Arthritis? Arthritis Care Res (Hoboken) 2019; 71:1300-1303. [DOI: 10.1002/acr.23862] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Accepted: 02/26/2019] [Indexed: 12/19/2022]
Affiliation(s)
- Janet E. Pope
- Schulich School of Medicine and Dentistry University of Western Ontario, and St. Joseph's Health Care London Ontario Canada
| | - Kaleb Michaud
- University of Nebraska Medical Center, Omaha, and FORWARD, The National Databank for Rheumatic Diseases Wichita Kansas
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Challa DNV, Kvrgic Z, Crowson CS, Matteson EL, Mason TG, Michet CJ, Schaffer DE, Wright KA, Davis JM. Longitudinal Occurrence and Predictors of Patient-Provider Discordance Between Global Assessments of Disease Activity in Rheumatoid Arthritis: A Case-Control Study. Arthritis Care Res (Hoboken) 2018; 72:18-26. [PMID: 30506552 DOI: 10.1002/acr.23819] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Accepted: 11/27/2018] [Indexed: 11/10/2022]
Abstract
OBJECTIVE To identify longitudinal predictors of discordance between patients with rheumatoid arthritis (RA) and their health care providers, where patient global assessment of disease activity is substantially higher than provider global assessment. METHODS This retrospective case-control study included 102 cases with positive discordance (i.e., ≥25 mm between patient and provider global assessments) and 102 controls without discordance who were matched for age, sex, RA duration, and Clinical Disease Activity Index (CDAI) score. Data were collected at the baseline visit (date of diagnosis or earliest available visit), the index visit (participation in a previous cross-sectional study), and at up to 11 additional visits before the index visit. Data included patient characteristics, disease activity measures, Disease Activity Score in 28 joints (3-variable) using the C-reactive protein level (DAS28-CRP), and medications. Data were analyzed by using linear and logistic regression models with smoothing splines for nonlinear trends. RESULTS Overall, the mean age was 63 years, 75% of patients were female, and the mean RA duration was 10 years. Compared with controls, cases had higher rates of discordant visits during the 4 years before the index visit, and they had a higher CDAI score and DAS28-CRP earlier in the disease course. Cases more frequently had antinuclear antibodies, nonerosive disease, prior depression, or prior use of antidepressants or fibromyalgia medications. Disease-modifying medication use was not different between cases and controls. CONCLUSION The findings inform new hypotheses about the relationships of disease activity and antinuclear antibodies to the later occurrence of positive discordance among patients with RA.
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Dima A, Caraiola S, Delcea C, Ionescu RA, Jurcut C, Badea C. Self-reported disease severity in women with systemic lupus erythematosus. Rheumatol Int 2018; 39:533-539. [PMID: 30415452 DOI: 10.1007/s00296-018-4203-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Accepted: 11/06/2018] [Indexed: 01/08/2023]
Abstract
Systemic lupus erythematosus (SLE), pathology with net feminine predominance, is one of the most complex autoimmune diseases and has major impact on patients' life. The aim is to identify patient and disease-related factors associated with self-perceived disease severity in female SLE patients. This cross-sectional study enrolled 73 women fulfilling the 2012 Systemic Lupus International Collaborating Clinic (SLICC) criteria. SLE disease activity was assessed by the Systemic Lupus Activity Measure (SLAM) score and overall damage by the SLICC/American College of Rheumatology (ACR) index. Patients' general characteristics, associated conditions as well as SLE specific clinical involvements and therapeutic principles were also noted. Fatigue was assessed by FACIT-fatigue scale. Self-perceived disease severity was assessed using numerical rating scales (1-10 NRSs), to evaluate the disease severity at inclusion (1-10 NRS now) and worst severity anytime during disease history (1-10 NRS worst ever). In regard to worst ever lupus severity, 54.8% of patients responded with 9 or 10, while none with 1 or 2 even if only 22.9% of the patients responded with 7 or more for disease severity at inclusion (1-10 NRS now). Women with higher 1-10 NRS now answers had also higher 1-10 NRS worst ever, SLAM, SLICC, and FACIT-fatigue scores. They associated more frequently anxiety/depression diagnosis, antiphospholipid syndrome, joint involvement as well as treatments with corticosteroids. Self-reported disease severity worst ever, anxiety/depression diagnosis, fatigue, and the daily dose of corticosteroids were independently associated with patients' perception on lupus severity at inclusion: OR (95% CI), 2.13 (1.15-3.94) p = 0.017, 6.67 (1.11-39.97) p = 0.038, 1.10 (1.02-1.19) p = 0.018, and 1.11 (1.02-1.21) p = 0.020, respectively. The vast majority of patients identified severe and very severe events during their disease history, results that raise awareness of burden concerning lupus occurrence in women's life. Self-perceived lupus severity is multifactorial, influenced also by factors less considered in the SLE management like fatigue and the depression/anxiety disorders, but also by the previous patient's experience.
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Affiliation(s)
- A Dima
- Internal Medicine Department, Carol Davila UMF, Dionisie Lupu Street 37, 020022, Bucharest S2, Romania.
- Internal Medicine Department, Colentina Clinical Hospital, Bucharest, Romania.
| | - S Caraiola
- Internal Medicine Department, Carol Davila UMF, Dionisie Lupu Street 37, 020022, Bucharest S2, Romania
- Internal Medicine Department, Colentina Clinical Hospital, Bucharest, Romania
| | - C Delcea
- Internal Medicine Department, Carol Davila UMF, Dionisie Lupu Street 37, 020022, Bucharest S2, Romania
- Internal Medicine Department, Colentina Clinical Hospital, Bucharest, Romania
| | - R A Ionescu
- Internal Medicine Department, Carol Davila UMF, Dionisie Lupu Street 37, 020022, Bucharest S2, Romania
- Internal Medicine Department, Colentina Clinical Hospital, Bucharest, Romania
| | - C Jurcut
- Dr Carol Davila Central University Emergency Military Hospital, Bucharest, Romania
| | - C Badea
- Internal Medicine Department, Carol Davila UMF, Dionisie Lupu Street 37, 020022, Bucharest S2, Romania
- Internal Medicine Department, Colentina Clinical Hospital, Bucharest, Romania
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15
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Inamo J, Kaneko Y, Sakata K, Takeuchi T. Impact of subclinical synovitis in ankles and feet detected by ultrasonography in patients with rheumatoid arthritis. Int J Rheum Dis 2018; 22:62-67. [PMID: 30338640 DOI: 10.1111/1756-185x.13399] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2018] [Revised: 08/01/2018] [Accepted: 08/28/2018] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To investigate the impact of subclinical synovitis detected by ultrasonography (US) on the ankles and feet of patients with rheumatoid arthritis. METHODS We retrospectively reviewed the data of patients (n = 59) who underwent US. RESULTS The functional ability and quality of life (QoL) of patients in the subclinical group were impaired. While the physician visual analog scale (VAS) scores significantly decreased in the subclinical group, patient and pain VAS scores significantly decreased only in patients without synovitis. CONCLUSION US-detected subclinical foot and ankle synovitis considerably affected patient functional status and QoL; however, it was often unnoticed by physicians.
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Affiliation(s)
- Jun Inamo
- Division of Rheumatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Yuko Kaneko
- Division of Rheumatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Komei Sakata
- Division of Rheumatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Tsutomu Takeuchi
- Division of Rheumatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
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16
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Castrejon I, Shakoor N, Chua JR, Block JA. Discordance of global assessment by patients and physicians is higher in osteoarthritis than in rheumatoid arthritis: a cross-sectional study from routine care. Rheumatol Int 2018; 38:2137-2145. [PMID: 30293155 DOI: 10.1007/s00296-018-4166-2] [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: 08/23/2018] [Accepted: 09/25/2018] [Indexed: 11/24/2022]
Abstract
The study compares patient-physician discordance in global assessment in patients with osteoarthritis (OA) versus patients with rheumatoid arthritis (RA) seen in routine care. This is a cross-sectional study conducted at an academic rheumatology center at which all patients are asked to complete a Multi-Dimensional Health Assessment Questionnaire (MDHAQ), which includes a patient global assessment (PATGL). Rheumatologists are encouraged to complete a physician questionnaire, which includes a physician global assessment (DOCGL). Patients with either OA or RA were identified using ICD9 codes and classified as positive discordance (PATGL-DOCGL ≥ 2), negative discordance (PATGL-DOCGL≤ - 2), and concordance (absolute difference between the two assessments < 2). Discordance was assessed by diagnosis. Agreement between patient and physician global assessments was evaluated using intraclass correlations. Logistic regression was performed to identify explanatory variables for positive discordance. The analysis included 243 OA and 216 RA patients. Mean PATGL was higher in OA versus RA (5.4 versus 4.2, p = 0.005), while mean DOCGL was similar (4.0 versus 3.8, p = 0.23) leading to a higher patient-physician discordance in OA (1.35 versus 0.43, p < 0.001). Positive discordance occurred in 34% of OA versus 18% of RA patients (p < 0.001). Intraclass correlation coefficients were 0.43 in OA versus 0.60 in RA patients. In logistic regressions, pain was the only statistically significant explanatory variable for discordance in both OA (OR 1.34, 95% CI 1.12-1.78) and RA (OR 1.47 95% CI 1.04-2.07). Patients with OA are more likely to be discordant with their rheumatologists than patients with RA because of a higher PATGL. Similarly to RA, the most important explanatory variable for discordance was higher pain.
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Affiliation(s)
- Isabel Castrejon
- Division of Rheumatology, Rush University Medical Center, 1161 West Harrison Street, Suite 510, Chicago, IL, 60612, USA.
| | - Najia Shakoor
- Division of Rheumatology, Rush University Medical Center, 1161 West Harrison Street, Suite 510, Chicago, IL, 60612, USA
| | - Jacquelin R Chua
- Division of Rheumatology, Rush University Medical Center, 1161 West Harrison Street, Suite 510, Chicago, IL, 60612, USA
| | - Joel A Block
- Division of Rheumatology, Rush University Medical Center, 1161 West Harrison Street, Suite 510, Chicago, IL, 60612, USA
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17
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Turk SA, Rasch LA, van Schaardenburg D, Lems WF, Sanberg M, van Tuyl LHD, ter Wee MM. Pain, sleep and emotional well-being explain the lack of agreement between physician- and patient-perceived remission in early rheumatoid arthritis. BMC Rheumatol 2018; 2:16. [PMID: 30886967 PMCID: PMC6390551 DOI: 10.1186/s41927-018-0024-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Accepted: 05/24/2018] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Clinical response and remission are defined in multiple ways and measured with different instruments, resulting in substantial variation of the proportion of patients classified as being in remission. Therefore, the agreement between patient-perceived, physician-perceived remission and clinical response and remission definitions was determined in early rheumatoid arthritis (RA) patients. And secondly, differences in clinical and patient-reported outcomes, in patients in physician-perceived remission, between patients in and not in self-perceived remission were assessed. METHODS In 84 early RA patients, who received methotrexate and glucocorticoids, DAS44, ACR/EULAR Boolean-based remission, EULAR good and ACR70 response were determined after 12 weeks. Agreement between patient-perceived (phrased: "Would you say that, at this moment, your disease activity is as good as gone?"), physician-perceived remission (based on a visual analogue scale for global disease severity) and clinical response and remission definitions were calculated with the percentage of agreement and with kappa values (which corrects for change). In patients in physician-perceived remission, improvement in clinical and patient-reported outcomes (RAID) were compared between patients in and not in self-perceived remission. RESULTS Agreement between the assessed outcome measures differed enormously. The agreement between physician-perceived and patient-perceived remission was 64% (kappa 0.25, p < 0.01). Physician-perceived remission had the best agreement with EULAR good response (79%), and patient-perceived remission with EULAR good and ACR70 response (both 69%). Patients not in self-perceived remission improved less on RAID components, especially on pain, sleep and emotional well-being. CONCLUSION One-third of the early RA patients disagreed with the physician on being in remission. Those patients had less improvement on RAID components, especially on pain, sleep and emotional well-being. Together with the variability in clinical response and remission definitions, these results highlight the need to increase patient involvement in their own health care decisions.
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Affiliation(s)
- Samina A. Turk
- Department of Rheumatology, Amsterdam Rheumatology and immunology Center | Reade, PO box 58271, 1040 HG, Amsterdam, The Netherlands
| | - Linda A. Rasch
- Department of Rheumatology, Amsterdam Rheumatology and immunology Center | VU University Medical Center, Amsterdam, Netherlands
| | - Dirkjan van Schaardenburg
- Department of Rheumatology, Amsterdam Rheumatology and immunology Center | Reade, PO box 58271, 1040 HG, Amsterdam, The Netherlands
- Department of Rheumatology, Amsterdam Rheumatology and immunology Center | Academic Medical Center, Amsterdam, Netherlands
| | - Willem F. Lems
- Department of Rheumatology, Amsterdam Rheumatology and immunology Center | Reade, PO box 58271, 1040 HG, Amsterdam, The Netherlands
- Department of Rheumatology, Amsterdam Rheumatology and immunology Center | VU University Medical Center, Amsterdam, Netherlands
| | - Marjolein Sanberg
- Department of Rheumatology, Amsterdam Rheumatology and immunology Center | Reade, PO box 58271, 1040 HG, Amsterdam, The Netherlands
| | - Lilian H. D. van Tuyl
- Department of Rheumatology, Amsterdam Rheumatology and immunology Center | VU University Medical Center, Amsterdam, Netherlands
| | - Marieke M. ter Wee
- Department of Rheumatology, Amsterdam Rheumatology and immunology Center | VU University Medical Center, Amsterdam, Netherlands
- Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, Netherlands
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Wang CTM, Fong W, Kwan YH, Phang JK, Lui NL, Leung YY, Thumboo J, Cheung PP. A cross-sectional study on factors associated with patient-physician discordance in global assessment of patients with axial spondyloarthritis: an Asian perspective. Int J Rheum Dis 2018; 21:1436-1442. [DOI: 10.1111/1756-185x.13299] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
- Charmaine Tze May Wang
- Department of Rheumatology and Immunology; Singapore General Hospital; Singapore City Singapore
| | - Warren Fong
- Department of Rheumatology and Immunology; Singapore General Hospital; Singapore City Singapore
- Duke-NUS Medical School; Singapore City Singapore
- Department of Medicine; Yong Loo Lin School of Medicine; National University Singapore; Singapore City Singapore
| | - Yu Heng Kwan
- Program in Health Services and Systems Research; Duke-NUS Medical School; Singapore City Singapore
| | - Jie Kie Phang
- Department of Rheumatology and Immunology; Singapore General Hospital; Singapore City Singapore
| | - Nai Lee Lui
- Department of Rheumatology and Immunology; Singapore General Hospital; Singapore City Singapore
| | - Ying Ying Leung
- Department of Rheumatology and Immunology; Singapore General Hospital; Singapore City Singapore
| | - Julian Thumboo
- Department of Rheumatology and Immunology; Singapore General Hospital; Singapore City Singapore
- Duke-NUS Medical School; Singapore City Singapore
- Department of Medicine; Yong Loo Lin School of Medicine; National University Singapore; Singapore City Singapore
| | - Peter P. Cheung
- Department of Medicine; Yong Loo Lin School of Medicine; National University Singapore; Singapore City Singapore
- Division of Rheumatology; National University Hospital; Singapore City Singapore
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19
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Eberly L, Richter D, Comerci G, Ocksrider J, Mercer D, Mlady G, Wascher D, Schenck R. Psychosocial and demographic factors influencing pain scores of patients with knee osteoarthritis. PLoS One 2018; 13:e0195075. [PMID: 29630676 PMCID: PMC5890979 DOI: 10.1371/journal.pone.0195075] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Accepted: 03/17/2018] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Pain levels in patients with osteoarthritis (OA) of the knee are commonly assessed by using a numeric scoring system, but results may be influenced by factors other than the patient's actual physical discomfort or disease severity, including psychosocial and demographic variables. We examined the possible relation between knee-pain scores and several psychosocial, sociodemographic, disease, and treatment variables in 355 patients with knee OA. METHODS The pain-evaluation instrument was a 0- to 10-point rating scale. Data obtained retrospectively from the patients' medical records were demographic characteristics, body mass index (BMI), concomitant disorders, illicit and prescription drug use, alcohol use, smoking, knee OA treatment, and severity of knee OA indicated by Kellgren-Lawrence (KL) radiographic grade. Univariate and multivariate analyses were performed to determine whether these variables correlated with reported pain scores. RESULTS On univariate analysis, higher pain scores were significantly associated with Native American or Hispanic ethnicity; a higher BMI; current prescription for an opioid, antidepressant, or gabapentinoid medication; depression; diabetes mellitus; fibromyalgia; illicit drug use; lack of health insurance; smoking; previous knee injection; and recommendation by the clinician that the patient undergo knee surgery. Neither the patient's sex nor the KL grade showed a correlation. On multivariate analysis, depression, current opioid prescription, and Native American or Hispanic ethnicity retained a significant association with higher pain scores. CONCLUSIONS AND IMPLICATIONS Our results in a large, ethnically diverse group of patients with knee OA suggest that psychosocial and sociodemographic factors may be important determinants of pain levels reported by patients with knee OA.
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Affiliation(s)
- Lauren Eberly
- Department of Orthopaedics & Rehabilitation, The University of New Mexico Health Sciences Center, Albuquerque, New Mexico, United States of America
| | - Dustin Richter
- Department of Orthopaedics & Rehabilitation, The University of New Mexico Health Sciences Center, Albuquerque, New Mexico, United States of America
| | - George Comerci
- Department of Internal Medicine, The University of New Mexico Health Sciences Center, Albuquerque, New Mexico, United States of America
| | - Justin Ocksrider
- Department of Orthopaedics & Rehabilitation, The University of New Mexico Health Sciences Center, Albuquerque, New Mexico, United States of America
| | - Deana Mercer
- Department of Orthopaedics & Rehabilitation, The University of New Mexico Health Sciences Center, Albuquerque, New Mexico, United States of America
| | - Gary Mlady
- Department of Radiology, The University of New Mexico Health Sciences Center, Albuquerque, New Mexico, United States of America
| | - Daniel Wascher
- Department of Orthopaedics & Rehabilitation, The University of New Mexico Health Sciences Center, Albuquerque, New Mexico, United States of America
| | - Robert Schenck
- Department of Orthopaedics & Rehabilitation, The University of New Mexico Health Sciences Center, Albuquerque, New Mexico, United States of America
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20
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Annapureddy N, Giangreco D, Devilliers H, Block JA, Jolly M. Psychometric properties of MDHAQ/RAPID3 in patients with systemic lupus erythematosus. Lupus 2018; 27:982-990. [DOI: 10.1177/0961203318758503] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- N Annapureddy
- Division of Rheumatology and Immunology, Vanderbilt University, Nashville, TN, USA
| | - D Giangreco
- Division of Rheumatology, Department of Medicine, Rush University Medical Center, Chicago, IL, USA
| | - H Devilliers
- Internal Medicine and Systemic Disease Unit, Dijon University Hospital, Dijon, France
| | - J A Block
- Division of Rheumatology, Department of Medicine, Rush University Medical Center, Chicago, IL, USA
| | - M Jolly
- Division of Rheumatology, Department of Medicine, Rush University Medical Center, Chicago, IL, USA
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Karpouzas GA, Ramadan SN, Cost CE, Draper TL, Hernandez E, Strand V, Ormseth SR. Discordant patient-physician assessments of disease activity and its persistence adversely impact quality of life and work productivity in US Hispanics with rheumatoid arthritis. RMD Open 2017; 3:e000551. [PMID: 29119008 PMCID: PMC5663273 DOI: 10.1136/rmdopen-2017-000551] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Revised: 10/04/2017] [Accepted: 10/09/2017] [Indexed: 12/22/2022] Open
Abstract
Objective This study was designed to evaluate the determinants of patient and physician global assessments (PtGA and MDGA, respectively) of disease activity, their discordance and change over 2 years in Hispanics with rheumatoid arthritis (RA). We further examined the impact of discordance and its persistence on health-related quality of life (HRQOL) and work productivity on final visit. Methods We studied 536 Hispanics with established RA from a single centre. PtGA and MDGA were measured annually on 10 cm visual analogue scales and discordance was defined as absolute difference between them ≥3 cm. Associations between predictors and outcomes of interest were evaluated using multivariable regression and analysis of covariance for cross-sectional and longitudinal data, respectively. Results Independent predictors of baseline PtGA were pain, fatigue, depression, general health perceptions and tender joint count. MDGA was predicted by swollen joint count, tender joint count, erythrocyte sedimentation rate, fatigue and depression. Both PtGA and MDGA improved over time (all p<0.001). Discordance was observed in 43% at baseline, with fair stability over 2 years. Higher (worse) patient ratings were most prevalent; their presence at any time and increasing persistence predicted lower physical and mental HRQOL, decreased work productivity and more activity impairment at 2-year follow-up (all p<0.001). Conclusions Determinants of PtGA, MDGA and changes over 2 years were disparate in Hispanics with RA yielding significant discordance. Higher patient ratings at any time contributed to worse HRQOL, work productivity and activity impairment on final visit.
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Affiliation(s)
- George A Karpouzas
- Division of Rheumatology, Harbor-UCLA Medical Center and Los Angeles Biomedical Research Institute, Torrance, California, USA
| | - Sera N Ramadan
- Division of Rheumatology, Harbor-UCLA Medical Center and Los Angeles Biomedical Research Institute, Torrance, California, USA
| | - Chelsie E Cost
- David Geffen School of Medicine, Department of Psychology, University of California, Cousins Center for Psychoneuroimmunology, Los Angeles, California, USA
| | - Taylor L Draper
- David Geffen School of Medicine, Department of Psychology, University of California, Cousins Center for Psychoneuroimmunology, Los Angeles, California, USA
| | - Elizabeth Hernandez
- Division of Rheumatology, Harbor-UCLA Medical Center and Los Angeles Biomedical Research Institute, Torrance, California, USA
| | - Vibeke Strand
- Division of Immunology/Rheumatology, Stanford University School of Medicine, Palo Alto, California, USA
| | - Sarah R Ormseth
- Division of Rheumatology, Harbor-UCLA Medical Center and Los Angeles Biomedical Research Institute, Torrance, California, USA
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El-Haddad C, Castrejon I, Gibson KA, Yazici Y, Bergman MJ, Pincus T. MDHAQ/RAPID3 scores in patients with osteoarthritis are similar to or higher than in patients with rheumatoid arthritis: a cross-sectional study from current routine rheumatology care at four sites. RMD Open 2017; 3:e000391. [PMID: 29225915 PMCID: PMC5708309 DOI: 10.1136/rmdopen-2016-000391] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2016] [Revised: 04/17/2017] [Accepted: 05/12/2017] [Indexed: 11/25/2022] Open
Abstract
Objective To compare patients with a primary diagnosis of osteoarthritis (OA) versus rheumatoid arthritis (RA) for scores on a patient self-report MDHAQ/RAPID3 (Multidimensional Health Assessment Questionnaire/Routine Assessment of Patient Index Data 3), and for physician global assessment (DOCGL). Methods All patients with all diagnoses complete an MDHAQ/RAPID3 at all routine rheumatology visits in the waiting area before seeing a rheumatologist at four sites, one in Australia and three in the USA. The two-page MDHAQ includes 0–10 scores for physical function (in 10 activities), pain and patient global assessment [on 0–10 visual analogue scales (VAS)], compiled into a 0–30 RAPID3, as well as fatigue and self-report painful joint count scales. Rheumatologists estimate a 0–10 DOCGL VAS. Demographic, MDHAQ/RAPID3 and DOCGL data from a random visit were compared in patients with RA versus patients with OA using multivariate analysis of variance, adjusted for age, disease duration and formal education level. Results Median RAPID3 was higher in OA versus RA at all four sites (11.7–16.8 vs 6.2–11.8) (p<0.001 at three sites). Median DOCGL in OA versus RA was 5 vs 4, 4 vs 3.7, 2.2 vs 2.5 and 2 vs 1. Patterns were similar for individual RAPID3 items, fatigue and painful joint scales, and in stratified analyses of patients aged 55–70. Conclusion Patient MDHAQ/RAPID3 and physician DOCGL indicate similar or higher disease burden in OA versus RA. Routine MDHAQ/RAPID3 allows direct comparisons of the two diseases. The findings suggest possible revision of current clinical and public policy views concerning OA.
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Affiliation(s)
- Carlos El-Haddad
- Department of Rheumatology, Liverpool Hospital, Liverpool, Australia
| | - Isabel Castrejon
- Division of Rheumatology, Department of Internal Medicine, Rush University Medical Center, Chicago, Illinois, USA
| | - Kathryn A Gibson
- Department of Rheumatology, Liverpool Hospital, Liverpool, Australia.,Ingham Research Institute, Liverpool, Australia.,Rheumatology, University of New South Wales, Sydney, NSW, Australia
| | - Yusuf Yazici
- NYU Hospital for Joint Diseases, New York University School of Medicine, New York, New York, USA
| | - Martin J Bergman
- Department of Arthritis and Rheumatology, Taylor Hospital, Ridley Park, Pennsylvania, USA
| | - Theodore Pincus
- Division of Rheumatology, Department of Internal Medicine, Rush University Medical Center, Chicago, Illinois, USA
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LoCasale RJ, Datto C, Wilson H, Yeomans K, Coyne KS. The Burden of Opioid-Induced Constipation: Discordance Between Patient and Health Care Provider Reports. J Manag Care Spec Pharm 2016; 22:236-45. [PMID: 27003553 PMCID: PMC10397844 DOI: 10.18553/jmcp.2016.22.3.236] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Opioid-induced constipation (OIC), a common side effect of opioid treatment for chronic pain, affects patient health-related quality of life (HRQL) and may prompt some patients to lower the dose or alter adherence to their opioid medication, compromising pain relief. Although health care providers (HCPs) are aware of the potential for OIC, patients may not inform their HCPs of their OIC symptoms, and HCPs may not initiate conversation regarding OIC if their patients' pain is controlled. Patients often try to address OIC symptoms on their own by using natural approaches or over-the-counter options. When OIC is discussed in an office visit, HCPs typically recommend conventional laxatives to relieve symptoms, but the efficacy of this approach is unproven and often suboptimal. In many areas of medicine, HCP perceptions of the impact of adverse effects of treatment on a patient's HRQL do not align with the patient's experience. OBJECTIVES To (a) describe HCP-reported understanding of his or her patients' experiences with OIC and (b) evaluate the level of agreement or discordance in perception between patients and their HCPs of OIC's impact on clinical outcomes. METHODS This was a prospective, longitudinal, observational cohort study conducted in the United States, Canada, Germany, and the United Kingdom (NCT01928953) in patients aged 18 to 85 years who had been receiving daily opioid therapy for ≥ 4 weeks for chronic noncancer pain with presence of OIC in the past 2 weeks. Data were collected from retrospective chart reviews, HCP questionnaires, and web-based patient surveys. Eligible patients enrolled online and completed the Patient Assessment of Constipation-Symptoms, the Work Productivity and Activity Impairment Questionnaire-Specific Health Problem, the EuroQOL 5 Dimensions, and the Global Assessment of Treatment Benefit, Satisfaction, and Willingness to Continue standardized questionnaires. The patient-reported component included 1 baseline survey and 8 follow-up surveys over 24 weeks. HCPs completed a web-based survey at baseline and at week 24 to assess their perceptions of OIC burden, treatment patterns, laxative use, and overall treatment satisfaction. The correspondence of patient- and HCP-reported data was evaluated for all similar outcomes from these 2 databases. RESULTS Patients (N = 489) reported a mean (SD) number of bowel movements (BMs) per week and spontaneous BMs per week of 3.7 (2.9) and 1.4 (2.3), respectively, at baseline. Most (87%) reported chronic pain of ≥ 2 years duration; 65% had used opioids for ≥ 2 years; and the mean pain score at baseline was 6.3, consistent with a moderate-to-severe pain population. Most (97%) patients at baseline reported any gastrointestinal-related symptom of at least moderate intensity, with 82% reporting the same intensity of any symptom at week 24. Of the 405 patients who had seen their HCPs in the past month, 63% reported that they had spoken to their HCPs about constipation, and 62% reported that their HCPs had asked them if they had constipation in the past month. The proportion of agreement between HCPs and their patients on the presence of constipation at baseline was 61%. Similar average pain ratings between HCPs and patients (5.9 vs. 6.0) at week 24 suggested clear communication regarding the level of pain experienced by the patient; however, OIC symptoms, laxative use and effectiveness, and impact of OIC on pain management and HRQL were not fully appreciated by HCPs. CONCLUSIONS The importance and severity of OIC are perceived differently by patients and their HCPs, a discordance that complicates pain management and demonstrates a need for greater communication. These disparate perceptions indicate a need for clinical education and coordination of care by HCPs to improve understanding and proactively manage OIC in patients with chronic noncancer pain.
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Affiliation(s)
- Robert J LoCasale
- 1 Group Director of Quality, Design & Analytics, Global Medicines Development, Payer & Real World Evidence, AstraZeneca Pharmaceuticals, Gaithersburg, Maryland
| | - Catherine Datto
- 2 U.S. Medical Affairs Medical Lead, AstraZeneca Pharmaceuticals, Wilmington, Delaware
| | - Hilary Wilson
- 3 Research Scientist, Research, Evidera, Bethesda, Maryland
| | - Karen Yeomans
- 4 Senior Manager and Senior Research Scientist, United BioSource Corporation, Montreal, QC, Canada
| | - Karin S Coyne
- 5 Vice President, Research, Evidera, Bethesda, Maryland
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Scharbatke EC, Behrens F, Schmalzing M, Koehm M, Greger G, Gnann H, Burkhardt H, Tony HP. Association of Improvement in Pain With Therapeutic Response as Determined by Individual Improvement Criteria in Patients With Rheumatoid Arthritis. Arthritis Care Res (Hoboken) 2016; 68:1607-1615. [PMID: 26990995 PMCID: PMC5129502 DOI: 10.1002/acr.22884] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2015] [Revised: 02/24/2016] [Accepted: 03/08/2016] [Indexed: 12/24/2022]
Abstract
Objective To use statistical methods to establish a threshold for individual response in patient‐reported outcomes (PROs) in patients with rheumatoid arthritis. Methods We used an analysis of variance model in patients on stable therapy (discovery cohort) to establish critical differences (dcrit) for the minimum change associated with a significant individual patient response (beyond normal variation) in the PRO measures of pain (0–10), fatigue (0–10), and function (Funktionsfragebogen Hannover questionnaire; 0–100). We then evaluated PRO responses in patients initiating adalimumab in a noninterventional study (treatment cohort). Results In the discovery cohort (n = 700), PROs showed excellent long‐term retest reliability. The minimum change that exceeded random fluctuation was conservatively determined to be 3 points for pain, 4 points for fatigue, and 16 points for function. In the treatment cohort (n = 2,788), 1,483 patients (53.2%) achieved a significant individual therapeutic response as assessed by Disease Activity Score in 28 joints (DAS28)–dcrit (≥1.8 points) after 12 months of adalimumab treatment; 68.5% of patients with a DAS28‐dcrit response achieved a significant improvement in pain, whereas approximately 40% achieved significant improvements in fatigue or function. Significant improvements in all 3 PROs occurred in 22.7% of patients; 22.8% did not have any significant PRO responses. In contrast, significant improvements in all 3 PROs occurred in only 4.4% of 1,305 patients who did not achieve a DAS28‐dcrit response at month 12, and 59.1% did not achieve any significant PRO responses. Conclusion The establishment of critical differences in PROs distinguishes true responses from random variation and provides insights into appropriate patient management.
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Affiliation(s)
- Eva C Scharbatke
- Schwerpunkt Rheumatologie/Klinische Immunologie Medizinische Klinik und Poliklinik II, Universität Würzburg, Würzburg, Germany
| | - Frank Behrens
- University Hospital Frankfurt, Goethe University, and Fraunhofer Institute for Molecular Biology and Applied Ecology IME, Project Group Translational Medicine & Pharmacology TMP, Frankfurt am Main, Germany
| | - Marc Schmalzing
- Schwerpunkt Rheumatologie/Klinische Immunologie Medizinische Klinik und Poliklinik II, Universität Würzburg, Würzburg, Germany
| | - Michaela Koehm
- University Hospital Frankfurt, Goethe University, and Fraunhofer Institute for Molecular Biology and Applied Ecology IME, Project Group Translational Medicine & Pharmacology TMP, Frankfurt am Main, Germany
| | - Gerd Greger
- AbbVie Deutschland GmbH & Co. KG, Wiesbaden, Germany
| | - Holger Gnann
- Abteilung Biostatistik, GKM Gesellschaft für Therapieforschung mbH, München, Germany
| | - Harald Burkhardt
- University Hospital Frankfurt, Goethe University, and Fraunhofer Institute for Molecular Biology and Applied Ecology IME, Project Group Translational Medicine & Pharmacology TMP, Frankfurt am Main, Germany
| | - Hans-Peter Tony
- Schwerpunkt Rheumatologie/Klinische Immunologie Medizinische Klinik und Poliklinik II, Universität Würzburg, Würzburg, Germany.
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Castrejón I, Yazici Y, Celik S, Pincus T. Pragmatic assessment of exercise in routine care using an MDHAQ: associations with changes in RAPID3 and other clinical variables. Arthritis Res Ther 2016; 18:199. [PMID: 27600736 PMCID: PMC5013578 DOI: 10.1186/s13075-016-1095-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2016] [Accepted: 08/17/2016] [Indexed: 11/15/2022] Open
Abstract
Background Exercise is associated with major benefits in patients with rheumatic diseases for both cardiovascular and rheumatic status. However, information about exercise generally is not collected systematically in routine rheumatology care. A multidimensional health assessment questionnaire (MDHAQ), which was designed for busy clinical settings, includes a query about exercise status. We analyzed possible associations between change in MDHAQ exercise scores and other MDHAQ measures in patients with various rheumatic diseases over one year. Methods In one rheumatology clinical setting, all patients, regardless of diagnosis, complete an MDHAQ before seeing a rheumatologist. The MDHAQ includes scores for physical function, pain, and patient global estimate, compiled into an index, routine assessment of patient index data (RAPID3), as well as a self-report joint count and a query about exercise. Patients were classified into four groups according to their exercise status at baseline and one year later as: EXER-Yes (regular exercise), EXER-Yes; EXER-No (no regular exercise), EXER-Yes; EXER-Yes, EXER-No; and EXER-No, EXER-No. These groups were compared using the chi square and Kruskal-Wallis tests and analysis of variance (ANOVA). Results Patients who reported regular exercise at baseline were younger, had higher formal education, and better clinical status than other patients. The EXER-No, EXER-Yes group had greater improvement in other MDHAQ variables than patients in the other three groups. By contrast, the EXER-Yes, EXER-No group was the only group with poorer status one year later. Conclusions The MDHAQ exercise query indicates that regular exercise is associated with better clinical status. Patients in the EXER-No, EXER-Yes group reported the best clinical improvement, although it is not known whether exercise preceded or followed the improved clinical status.
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Affiliation(s)
- Isabel Castrejón
- Department of Medicine, Division of Rheumatology, Rush University Medical Center, 1611 West Harrison Street, Suite 510, Chicago, IL, 60612, USA
| | - Yusuf Yazici
- Department of Medicine, Division of Rheumatology, New York University School of Medicine and NYU Hospital for Joint Diseases, New York, NY, USA
| | - Selda Celik
- Department of Medicine, Division of Rheumatology, New York University School of Medicine and NYU Hospital for Joint Diseases, New York, NY, USA
| | - Theodore Pincus
- Department of Medicine, Division of Rheumatology, Rush University Medical Center, 1611 West Harrison Street, Suite 510, Chicago, IL, 60612, USA.
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Discordance between patient and physician assessments of global disease activity in rheumatoid arthritis and association with work productivity. Arthritis Res Ther 2016; 18:114. [PMID: 27209012 PMCID: PMC4875609 DOI: 10.1186/s13075-016-1004-3] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2016] [Accepted: 04/26/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Discordance between patient and physician ratings of rheumatoid arthritis (RA) severity occurs in clinical practice and correlates with pain scores and measurements of joint disease. However, information is lacking on whether discordance impacts patients' ability to work. We evaluated the discordance between patient and physician ratings of RA disease activity before and after treatment with etanercept and investigated the associations between discordance, clinical outcomes, and work productivity. METHODS In the PRESERVE clinical trial, patients with moderate RA received open-label etanercept 50 mg once weekly plus methotrexate for 36 weeks. Baseline and week-36 disease characteristics and clinical and work productivity outcomes were categorized according to week-36 concordance category, defined as positive discordance (patient global assessment - physician global assessment ≥2), negative discordance (patient global assessment - physician global assessment ≤ -2), and concordance (absolute difference between the two disease activity assessments = 0 or 1). Correlations between discordance, clinical outcomes, and predictors of discordance were determined. RESULTS At baseline, 520/762 (68.2 %) patient and physician global assessment scores were concordant, 194 (25.5 %) were positively discordant, and 48 (6.3 %) were negatively discordant. After 36 weeks of therapy, 556/763 (72.9 %) scores were concordant, 189 (24.8 %) were positively discordant, and 18 (2.4 %) were negatively discordant. Patients with week-36 concordance had the best 36-week clinical and patient-reported outcomes, and overall, the greatest improvement between baseline and week 36. Baseline pain, swollen joint count, duration of morning stiffness, fatigue, and patient general health significantly correlated with week-36 discordance, p < 0.0001 to p < 0.05. Additionally, baseline pain, patient general health, and C-reactive protein were predictors of week-36 discordance (odds ratios 1.22, 1.02, and 0.98, respectively). For the employed patients, percent impairment while working and percent overall work impairment were highest (greatest impairment) at baseline and 36 weeks in the group with positive discordance. CONCLUSIONS The percentage of patients with concordance increased after 36 weeks of treatment with etanercept, with concordant patients demonstrating the greatest improvement in clinical and patient-reported outcomes. Discordance correlated with several measures of disease activity and was associated with decreased work productivity. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT00565409 . Registered 28/11/2007.
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Cho SK, Sung YK, Choi CB, Bang SY, Cha HS, Choe JY, Chung WT, Hong SJ, Jun JB, Kim J, Kim TH, Kim TJ, Koh EM, Lee HS, Lee J, Lee SH, Lee SS, Lee SW, Park SH, Yoo DH, Yoon BY, Bae SC. What factors affect discordance between physicians and patients in the global assessment of disease activity in rheumatoid arthritis? Mod Rheumatol 2016; 27:35-41. [PMID: 27143194 DOI: 10.1080/14397595.2016.1176310] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To identify the level of agreement between patients with rheumatoid arthritis (RA) and physicians in the global assessment of disease activity and to explore factors influencing their discordance. METHODS A total of 4368 patients with RA were analyzed from the KORean Observational study Network for Arthritis (KORONA) database. Patients were divided into four subgroups according to difference from their physicians in the assessment of disease activity by substracting physician's visual analog scale (VAS) from patient's VAS as follows: positive discordance group I (10 mm ≤ discordance <25 mm), positive discordance group II (≥25 mm), concordance (<|10| mm), and negative discordance (≤ -10mm). Multinomial logistic regression analysis was performed to identify factors associated with discordance. RESULTS Only 1350 (29.2%) patients were classified in the concordance group. Positive discordance was found in 52.3% of the patients (n = 2425), with 33.7% (n = 1563) showing marked discordance (≥25 mm). The high disease activity (OR =1.41), gastrointestinal (GI) disease (OR =1.28), pain (OR =1.12), fatigue (OR =1.07) were consistently associated with positive discordance. CONCLUSION More than half of patients with RA thought their disease more severe than their physicians. In addition to high disease activity, pain, fatigue, and sleep disturbance or GI disease were associated with the discordance between physicians and patients with RA.
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Affiliation(s)
- Soo-Kyung Cho
- a Hanyang University Hospital for Rheumatic Diseases , Seoul , South Korea.,b Clinical Research Center for Rheumatoid Arthritis (CRCRA) , Seoul , South Korea
| | - Yoon-Kyoung Sung
- a Hanyang University Hospital for Rheumatic Diseases , Seoul , South Korea.,b Clinical Research Center for Rheumatoid Arthritis (CRCRA) , Seoul , South Korea
| | - Chan-Bum Choi
- a Hanyang University Hospital for Rheumatic Diseases , Seoul , South Korea.,b Clinical Research Center for Rheumatoid Arthritis (CRCRA) , Seoul , South Korea
| | - So-Young Bang
- c Hanyang University Guri Hospital , Guri , South Korea
| | - Hoon-Suk Cha
- d Sungkyunkwan University School of Medicine, Samsung Medical Center , Seoul , South Korea
| | - Jung-Yoon Choe
- e Catholic University of Daegu School of Medicine , Daegu , South Korea
| | | | | | - Jae-Bum Jun
- a Hanyang University Hospital for Rheumatic Diseases , Seoul , South Korea
| | - Jinseok Kim
- h Jeju National University Hospital , Jeju , South Korea
| | - Tae-Hwan Kim
- a Hanyang University Hospital for Rheumatic Diseases , Seoul , South Korea
| | - Tae-Jong Kim
- i Chonnam National University Hospital , Gwangju , South Korea
| | - Eun-Mi Koh
- d Sungkyunkwan University School of Medicine, Samsung Medical Center , Seoul , South Korea
| | - Hye-Soon Lee
- c Hanyang University Guri Hospital , Guri , South Korea
| | - Jisoo Lee
- j Ewha Women's University Mokdong Hospital , Seoul , South Korea
| | - Sang-Heon Lee
- k Konkuk University Medical Center , Seoul , South Korea , and
| | - Shin-Seok Lee
- i Chonnam National University Hospital , Gwangju , South Korea
| | - Sung Won Lee
- f Dong-A University Hospital , Busan , South Korea
| | - Sung-Hoon Park
- e Catholic University of Daegu School of Medicine , Daegu , South Korea
| | - Dae-Hyun Yoo
- a Hanyang University Hospital for Rheumatic Diseases , Seoul , South Korea
| | - Bo Young Yoon
- l Inje University Ilsan Paik Hospital , Goyang , South Korea
| | - Sang-Cheol Bae
- a Hanyang University Hospital for Rheumatic Diseases , Seoul , South Korea.,b Clinical Research Center for Rheumatoid Arthritis (CRCRA) , Seoul , South Korea
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- b Clinical Research Center for Rheumatoid Arthritis (CRCRA) , Seoul , South Korea
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Lindström Egholm C, Krogh NS, Pincus T, Dreyer L, Ellingsen T, Glintborg B, Kowalski MR, Lorenzen T, Madsen OR, Nordin H, Rasmussen C, Hetland ML. Discordance of Global Assessments by Patient and Physician Is Higher in Female than in Male Patients Regardless of the Physician's Sex: Data on Patients with Rheumatoid Arthritis, Axial Spondyloarthritis, and Psoriatic Arthritis from the DANBIO Registry. J Rheumatol 2015; 42:1781-5. [PMID: 26233511 DOI: 10.3899/jrheum.150007] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/04/2015] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To assess the frequency of discordance in patient's (PtGA) and physician's (PGA) global assessment, and to investigate whether higher discordance in female patients compared with male patients is associated with the physician's sex in patients with rheumatoid arthritis (RA), axial spondyloarthritis (axSpA), and psoriatic arthritis (PsA). METHODS PtGA, PGA, and other patient-related variables were retrieved from the Danish DANBIO registry, used nationwide to monitor patients with RA, axSpA, and PsA. A questionnaire was sent to all physicians registering in DANBIO (n = 265) regarding individual physician characteristics including sex and age. Discordance was defined as PtGA > 20 mm higher (or lower) than PGA. First encounters between patients and physicians were analyzed using descriptive statistics and mixed model regression analysis. RESULTS Ninety physicians (34%) returned the questionnaire and were pairwise matched with 10,282 first patient encounters (8300 patients with RA, 524 axSpA, and 1458 PsA). The frequency of discordant (PtGA > PGA) encounters (not including PGA > PtGA seen in < 2%) in RA, axSpA, and PsA was 49.0%, 48.3%, and 56.5%, respectively. Discordance was more common in female patients with high scores on functional disability, pain, and fatigue across the 3 diseases, whereas it was independent of the physician's sex. CONCLUSION In this study on Danish patients with RA, axSpA, and PsA, the PtGA was > 20 mm higher than the PGA in about half of the encounters, and more common in female patients of both female and male physicians. This finding highlights one of the challenges in shared decision making.
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Affiliation(s)
- Cecilie Lindström Egholm
- From the DANBIO Registry, Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Glostrup Hospital, Glostrup; The Regional Research Unit, Region Zealand, Roskilde; Zitelab Aps, Frederiksberg; Department of Rheumatology C, Copenhagen University Hospital Gentofte, Hellerup; Department of Rheumatology, Odense University Hospital, Odense; Department of Rheumatology, Vendsyssel Hospital, Hjørring; Department of Rheumatology, Diagnostic Centre, Silkeborg Regional Hospital, Silkeborg; Department of Infectious Diseases and Rheumatology, Rigshospitalet, University Hospital of Copenhagen; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark; Division of Rheumatology, Rush University Medical Center, Chicago, Illinois, USA.C. Lindström Egholm, MPH, Research Consultant, DANBIO Registry, Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Glostrup Hospital, and The Regional Research Unit, Region Zealand; N.S. Krogh, Master of Economics, CEO, Zitelab Aps; T. Pincus, MD, Division of Rheumatology, Rush University Medical Center; L. Dreyer, PhD, Chief Physician, Department of Rheumatology C, Copenhagen University Hospital Gentofte; T. Ellingsen, MD, PhD, Professor, Chief Physician, Department of Rheumatology, Odense University Hospital; B. Glintborg, MD, PhD, Department of Rheumatology C, Copenhagen University Hospital Gentofte; M.R. Kowalski, PhD, Consultant, Department of Rheumatology, Vendsyssel Hospital; T. Lorenzen, MD, Chief Physician, Department of Rheumatology, Diagnostic Centre, Silkeborg Regional Hospital; O.R. Madsen, PhD, DrMed, Consultant, Associate Professor, Department of Rheumatology C, Copenhagen University Hospital Gentofte; H. Nordin, MD, Consultant, Department of Infectious Diseases and Rheumatology, Rigshospitalet, University Hospital of Copenhagen; C. Rasmussen, MD, Chief Physician, Department of Rheumatology
| | - Niels Steen Krogh
- From the DANBIO Registry, Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Glostrup Hospital, Glostrup; The Regional Research Unit, Region Zealand, Roskilde; Zitelab Aps, Frederiksberg; Department of Rheumatology C, Copenhagen University Hospital Gentofte, Hellerup; Department of Rheumatology, Odense University Hospital, Odense; Department of Rheumatology, Vendsyssel Hospital, Hjørring; Department of Rheumatology, Diagnostic Centre, Silkeborg Regional Hospital, Silkeborg; Department of Infectious Diseases and Rheumatology, Rigshospitalet, University Hospital of Copenhagen; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark; Division of Rheumatology, Rush University Medical Center, Chicago, Illinois, USA.C. Lindström Egholm, MPH, Research Consultant, DANBIO Registry, Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Glostrup Hospital, and The Regional Research Unit, Region Zealand; N.S. Krogh, Master of Economics, CEO, Zitelab Aps; T. Pincus, MD, Division of Rheumatology, Rush University Medical Center; L. Dreyer, PhD, Chief Physician, Department of Rheumatology C, Copenhagen University Hospital Gentofte; T. Ellingsen, MD, PhD, Professor, Chief Physician, Department of Rheumatology, Odense University Hospital; B. Glintborg, MD, PhD, Department of Rheumatology C, Copenhagen University Hospital Gentofte; M.R. Kowalski, PhD, Consultant, Department of Rheumatology, Vendsyssel Hospital; T. Lorenzen, MD, Chief Physician, Department of Rheumatology, Diagnostic Centre, Silkeborg Regional Hospital; O.R. Madsen, PhD, DrMed, Consultant, Associate Professor, Department of Rheumatology C, Copenhagen University Hospital Gentofte; H. Nordin, MD, Consultant, Department of Infectious Diseases and Rheumatology, Rigshospitalet, University Hospital of Copenhagen; C. Rasmussen, MD, Chief Physician, Department of Rheumatology
| | - Theodore Pincus
- From the DANBIO Registry, Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Glostrup Hospital, Glostrup; The Regional Research Unit, Region Zealand, Roskilde; Zitelab Aps, Frederiksberg; Department of Rheumatology C, Copenhagen University Hospital Gentofte, Hellerup; Department of Rheumatology, Odense University Hospital, Odense; Department of Rheumatology, Vendsyssel Hospital, Hjørring; Department of Rheumatology, Diagnostic Centre, Silkeborg Regional Hospital, Silkeborg; Department of Infectious Diseases and Rheumatology, Rigshospitalet, University Hospital of Copenhagen; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark; Division of Rheumatology, Rush University Medical Center, Chicago, Illinois, USA.C. Lindström Egholm, MPH, Research Consultant, DANBIO Registry, Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Glostrup Hospital, and The Regional Research Unit, Region Zealand; N.S. Krogh, Master of Economics, CEO, Zitelab Aps; T. Pincus, MD, Division of Rheumatology, Rush University Medical Center; L. Dreyer, PhD, Chief Physician, Department of Rheumatology C, Copenhagen University Hospital Gentofte; T. Ellingsen, MD, PhD, Professor, Chief Physician, Department of Rheumatology, Odense University Hospital; B. Glintborg, MD, PhD, Department of Rheumatology C, Copenhagen University Hospital Gentofte; M.R. Kowalski, PhD, Consultant, Department of Rheumatology, Vendsyssel Hospital; T. Lorenzen, MD, Chief Physician, Department of Rheumatology, Diagnostic Centre, Silkeborg Regional Hospital; O.R. Madsen, PhD, DrMed, Consultant, Associate Professor, Department of Rheumatology C, Copenhagen University Hospital Gentofte; H. Nordin, MD, Consultant, Department of Infectious Diseases and Rheumatology, Rigshospitalet, University Hospital of Copenhagen; C. Rasmussen, MD, Chief Physician, Department of Rheumatology
| | - Lene Dreyer
- From the DANBIO Registry, Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Glostrup Hospital, Glostrup; The Regional Research Unit, Region Zealand, Roskilde; Zitelab Aps, Frederiksberg; Department of Rheumatology C, Copenhagen University Hospital Gentofte, Hellerup; Department of Rheumatology, Odense University Hospital, Odense; Department of Rheumatology, Vendsyssel Hospital, Hjørring; Department of Rheumatology, Diagnostic Centre, Silkeborg Regional Hospital, Silkeborg; Department of Infectious Diseases and Rheumatology, Rigshospitalet, University Hospital of Copenhagen; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark; Division of Rheumatology, Rush University Medical Center, Chicago, Illinois, USA.C. Lindström Egholm, MPH, Research Consultant, DANBIO Registry, Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Glostrup Hospital, and The Regional Research Unit, Region Zealand; N.S. Krogh, Master of Economics, CEO, Zitelab Aps; T. Pincus, MD, Division of Rheumatology, Rush University Medical Center; L. Dreyer, PhD, Chief Physician, Department of Rheumatology C, Copenhagen University Hospital Gentofte; T. Ellingsen, MD, PhD, Professor, Chief Physician, Department of Rheumatology, Odense University Hospital; B. Glintborg, MD, PhD, Department of Rheumatology C, Copenhagen University Hospital Gentofte; M.R. Kowalski, PhD, Consultant, Department of Rheumatology, Vendsyssel Hospital; T. Lorenzen, MD, Chief Physician, Department of Rheumatology, Diagnostic Centre, Silkeborg Regional Hospital; O.R. Madsen, PhD, DrMed, Consultant, Associate Professor, Department of Rheumatology C, Copenhagen University Hospital Gentofte; H. Nordin, MD, Consultant, Department of Infectious Diseases and Rheumatology, Rigshospitalet, University Hospital of Copenhagen; C. Rasmussen, MD, Chief Physician, Department of Rheumatology
| | - Torkell Ellingsen
- From the DANBIO Registry, Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Glostrup Hospital, Glostrup; The Regional Research Unit, Region Zealand, Roskilde; Zitelab Aps, Frederiksberg; Department of Rheumatology C, Copenhagen University Hospital Gentofte, Hellerup; Department of Rheumatology, Odense University Hospital, Odense; Department of Rheumatology, Vendsyssel Hospital, Hjørring; Department of Rheumatology, Diagnostic Centre, Silkeborg Regional Hospital, Silkeborg; Department of Infectious Diseases and Rheumatology, Rigshospitalet, University Hospital of Copenhagen; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark; Division of Rheumatology, Rush University Medical Center, Chicago, Illinois, USA.C. Lindström Egholm, MPH, Research Consultant, DANBIO Registry, Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Glostrup Hospital, and The Regional Research Unit, Region Zealand; N.S. Krogh, Master of Economics, CEO, Zitelab Aps; T. Pincus, MD, Division of Rheumatology, Rush University Medical Center; L. Dreyer, PhD, Chief Physician, Department of Rheumatology C, Copenhagen University Hospital Gentofte; T. Ellingsen, MD, PhD, Professor, Chief Physician, Department of Rheumatology, Odense University Hospital; B. Glintborg, MD, PhD, Department of Rheumatology C, Copenhagen University Hospital Gentofte; M.R. Kowalski, PhD, Consultant, Department of Rheumatology, Vendsyssel Hospital; T. Lorenzen, MD, Chief Physician, Department of Rheumatology, Diagnostic Centre, Silkeborg Regional Hospital; O.R. Madsen, PhD, DrMed, Consultant, Associate Professor, Department of Rheumatology C, Copenhagen University Hospital Gentofte; H. Nordin, MD, Consultant, Department of Infectious Diseases and Rheumatology, Rigshospitalet, University Hospital of Copenhagen; C. Rasmussen, MD, Chief Physician, Department of Rheumatology
| | - Bente Glintborg
- From the DANBIO Registry, Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Glostrup Hospital, Glostrup; The Regional Research Unit, Region Zealand, Roskilde; Zitelab Aps, Frederiksberg; Department of Rheumatology C, Copenhagen University Hospital Gentofte, Hellerup; Department of Rheumatology, Odense University Hospital, Odense; Department of Rheumatology, Vendsyssel Hospital, Hjørring; Department of Rheumatology, Diagnostic Centre, Silkeborg Regional Hospital, Silkeborg; Department of Infectious Diseases and Rheumatology, Rigshospitalet, University Hospital of Copenhagen; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark; Division of Rheumatology, Rush University Medical Center, Chicago, Illinois, USA.C. Lindström Egholm, MPH, Research Consultant, DANBIO Registry, Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Glostrup Hospital, and The Regional Research Unit, Region Zealand; N.S. Krogh, Master of Economics, CEO, Zitelab Aps; T. Pincus, MD, Division of Rheumatology, Rush University Medical Center; L. Dreyer, PhD, Chief Physician, Department of Rheumatology C, Copenhagen University Hospital Gentofte; T. Ellingsen, MD, PhD, Professor, Chief Physician, Department of Rheumatology, Odense University Hospital; B. Glintborg, MD, PhD, Department of Rheumatology C, Copenhagen University Hospital Gentofte; M.R. Kowalski, PhD, Consultant, Department of Rheumatology, Vendsyssel Hospital; T. Lorenzen, MD, Chief Physician, Department of Rheumatology, Diagnostic Centre, Silkeborg Regional Hospital; O.R. Madsen, PhD, DrMed, Consultant, Associate Professor, Department of Rheumatology C, Copenhagen University Hospital Gentofte; H. Nordin, MD, Consultant, Department of Infectious Diseases and Rheumatology, Rigshospitalet, University Hospital of Copenhagen; C. Rasmussen, MD, Chief Physician, Department of Rheumatology
| | - Marcin Ryszard Kowalski
- From the DANBIO Registry, Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Glostrup Hospital, Glostrup; The Regional Research Unit, Region Zealand, Roskilde; Zitelab Aps, Frederiksberg; Department of Rheumatology C, Copenhagen University Hospital Gentofte, Hellerup; Department of Rheumatology, Odense University Hospital, Odense; Department of Rheumatology, Vendsyssel Hospital, Hjørring; Department of Rheumatology, Diagnostic Centre, Silkeborg Regional Hospital, Silkeborg; Department of Infectious Diseases and Rheumatology, Rigshospitalet, University Hospital of Copenhagen; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark; Division of Rheumatology, Rush University Medical Center, Chicago, Illinois, USA.C. Lindström Egholm, MPH, Research Consultant, DANBIO Registry, Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Glostrup Hospital, and The Regional Research Unit, Region Zealand; N.S. Krogh, Master of Economics, CEO, Zitelab Aps; T. Pincus, MD, Division of Rheumatology, Rush University Medical Center; L. Dreyer, PhD, Chief Physician, Department of Rheumatology C, Copenhagen University Hospital Gentofte; T. Ellingsen, MD, PhD, Professor, Chief Physician, Department of Rheumatology, Odense University Hospital; B. Glintborg, MD, PhD, Department of Rheumatology C, Copenhagen University Hospital Gentofte; M.R. Kowalski, PhD, Consultant, Department of Rheumatology, Vendsyssel Hospital; T. Lorenzen, MD, Chief Physician, Department of Rheumatology, Diagnostic Centre, Silkeborg Regional Hospital; O.R. Madsen, PhD, DrMed, Consultant, Associate Professor, Department of Rheumatology C, Copenhagen University Hospital Gentofte; H. Nordin, MD, Consultant, Department of Infectious Diseases and Rheumatology, Rigshospitalet, University Hospital of Copenhagen; C. Rasmussen, MD, Chief Physician, Department of Rheumatology
| | - Tove Lorenzen
- From the DANBIO Registry, Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Glostrup Hospital, Glostrup; The Regional Research Unit, Region Zealand, Roskilde; Zitelab Aps, Frederiksberg; Department of Rheumatology C, Copenhagen University Hospital Gentofte, Hellerup; Department of Rheumatology, Odense University Hospital, Odense; Department of Rheumatology, Vendsyssel Hospital, Hjørring; Department of Rheumatology, Diagnostic Centre, Silkeborg Regional Hospital, Silkeborg; Department of Infectious Diseases and Rheumatology, Rigshospitalet, University Hospital of Copenhagen; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark; Division of Rheumatology, Rush University Medical Center, Chicago, Illinois, USA.C. Lindström Egholm, MPH, Research Consultant, DANBIO Registry, Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Glostrup Hospital, and The Regional Research Unit, Region Zealand; N.S. Krogh, Master of Economics, CEO, Zitelab Aps; T. Pincus, MD, Division of Rheumatology, Rush University Medical Center; L. Dreyer, PhD, Chief Physician, Department of Rheumatology C, Copenhagen University Hospital Gentofte; T. Ellingsen, MD, PhD, Professor, Chief Physician, Department of Rheumatology, Odense University Hospital; B. Glintborg, MD, PhD, Department of Rheumatology C, Copenhagen University Hospital Gentofte; M.R. Kowalski, PhD, Consultant, Department of Rheumatology, Vendsyssel Hospital; T. Lorenzen, MD, Chief Physician, Department of Rheumatology, Diagnostic Centre, Silkeborg Regional Hospital; O.R. Madsen, PhD, DrMed, Consultant, Associate Professor, Department of Rheumatology C, Copenhagen University Hospital Gentofte; H. Nordin, MD, Consultant, Department of Infectious Diseases and Rheumatology, Rigshospitalet, University Hospital of Copenhagen; C. Rasmussen, MD, Chief Physician, Department of Rheumatology
| | - Ole Rintek Madsen
- From the DANBIO Registry, Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Glostrup Hospital, Glostrup; The Regional Research Unit, Region Zealand, Roskilde; Zitelab Aps, Frederiksberg; Department of Rheumatology C, Copenhagen University Hospital Gentofte, Hellerup; Department of Rheumatology, Odense University Hospital, Odense; Department of Rheumatology, Vendsyssel Hospital, Hjørring; Department of Rheumatology, Diagnostic Centre, Silkeborg Regional Hospital, Silkeborg; Department of Infectious Diseases and Rheumatology, Rigshospitalet, University Hospital of Copenhagen; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark; Division of Rheumatology, Rush University Medical Center, Chicago, Illinois, USA.C. Lindström Egholm, MPH, Research Consultant, DANBIO Registry, Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Glostrup Hospital, and The Regional Research Unit, Region Zealand; N.S. Krogh, Master of Economics, CEO, Zitelab Aps; T. Pincus, MD, Division of Rheumatology, Rush University Medical Center; L. Dreyer, PhD, Chief Physician, Department of Rheumatology C, Copenhagen University Hospital Gentofte; T. Ellingsen, MD, PhD, Professor, Chief Physician, Department of Rheumatology, Odense University Hospital; B. Glintborg, MD, PhD, Department of Rheumatology C, Copenhagen University Hospital Gentofte; M.R. Kowalski, PhD, Consultant, Department of Rheumatology, Vendsyssel Hospital; T. Lorenzen, MD, Chief Physician, Department of Rheumatology, Diagnostic Centre, Silkeborg Regional Hospital; O.R. Madsen, PhD, DrMed, Consultant, Associate Professor, Department of Rheumatology C, Copenhagen University Hospital Gentofte; H. Nordin, MD, Consultant, Department of Infectious Diseases and Rheumatology, Rigshospitalet, University Hospital of Copenhagen; C. Rasmussen, MD, Chief Physician, Department of Rheumatology
| | - Henrik Nordin
- From the DANBIO Registry, Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Glostrup Hospital, Glostrup; The Regional Research Unit, Region Zealand, Roskilde; Zitelab Aps, Frederiksberg; Department of Rheumatology C, Copenhagen University Hospital Gentofte, Hellerup; Department of Rheumatology, Odense University Hospital, Odense; Department of Rheumatology, Vendsyssel Hospital, Hjørring; Department of Rheumatology, Diagnostic Centre, Silkeborg Regional Hospital, Silkeborg; Department of Infectious Diseases and Rheumatology, Rigshospitalet, University Hospital of Copenhagen; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark; Division of Rheumatology, Rush University Medical Center, Chicago, Illinois, USA.C. Lindström Egholm, MPH, Research Consultant, DANBIO Registry, Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Glostrup Hospital, and The Regional Research Unit, Region Zealand; N.S. Krogh, Master of Economics, CEO, Zitelab Aps; T. Pincus, MD, Division of Rheumatology, Rush University Medical Center; L. Dreyer, PhD, Chief Physician, Department of Rheumatology C, Copenhagen University Hospital Gentofte; T. Ellingsen, MD, PhD, Professor, Chief Physician, Department of Rheumatology, Odense University Hospital; B. Glintborg, MD, PhD, Department of Rheumatology C, Copenhagen University Hospital Gentofte; M.R. Kowalski, PhD, Consultant, Department of Rheumatology, Vendsyssel Hospital; T. Lorenzen, MD, Chief Physician, Department of Rheumatology, Diagnostic Centre, Silkeborg Regional Hospital; O.R. Madsen, PhD, DrMed, Consultant, Associate Professor, Department of Rheumatology C, Copenhagen University Hospital Gentofte; H. Nordin, MD, Consultant, Department of Infectious Diseases and Rheumatology, Rigshospitalet, University Hospital of Copenhagen; C. Rasmussen, MD, Chief Physician, Department of Rheumatology
| | - Claus Rasmussen
- From the DANBIO Registry, Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Glostrup Hospital, Glostrup; The Regional Research Unit, Region Zealand, Roskilde; Zitelab Aps, Frederiksberg; Department of Rheumatology C, Copenhagen University Hospital Gentofte, Hellerup; Department of Rheumatology, Odense University Hospital, Odense; Department of Rheumatology, Vendsyssel Hospital, Hjørring; Department of Rheumatology, Diagnostic Centre, Silkeborg Regional Hospital, Silkeborg; Department of Infectious Diseases and Rheumatology, Rigshospitalet, University Hospital of Copenhagen; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark; Division of Rheumatology, Rush University Medical Center, Chicago, Illinois, USA.C. Lindström Egholm, MPH, Research Consultant, DANBIO Registry, Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Glostrup Hospital, and The Regional Research Unit, Region Zealand; N.S. Krogh, Master of Economics, CEO, Zitelab Aps; T. Pincus, MD, Division of Rheumatology, Rush University Medical Center; L. Dreyer, PhD, Chief Physician, Department of Rheumatology C, Copenhagen University Hospital Gentofte; T. Ellingsen, MD, PhD, Professor, Chief Physician, Department of Rheumatology, Odense University Hospital; B. Glintborg, MD, PhD, Department of Rheumatology C, Copenhagen University Hospital Gentofte; M.R. Kowalski, PhD, Consultant, Department of Rheumatology, Vendsyssel Hospital; T. Lorenzen, MD, Chief Physician, Department of Rheumatology, Diagnostic Centre, Silkeborg Regional Hospital; O.R. Madsen, PhD, DrMed, Consultant, Associate Professor, Department of Rheumatology C, Copenhagen University Hospital Gentofte; H. Nordin, MD, Consultant, Department of Infectious Diseases and Rheumatology, Rigshospitalet, University Hospital of Copenhagen; C. Rasmussen, MD, Chief Physician, Department of Rheumatology
| | - Merete Lund Hetland
- From the DANBIO Registry, Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Glostrup Hospital, Glostrup; The Regional Research Unit, Region Zealand, Roskilde; Zitelab Aps, Frederiksberg; Department of Rheumatology C, Copenhagen University Hospital Gentofte, Hellerup; Department of Rheumatology, Odense University Hospital, Odense; Department of Rheumatology, Vendsyssel Hospital, Hjørring; Department of Rheumatology, Diagnostic Centre, Silkeborg Regional Hospital, Silkeborg; Department of Infectious Diseases and Rheumatology, Rigshospitalet, University Hospital of Copenhagen; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark; Division of Rheumatology, Rush University Medical Center, Chicago, Illinois, USA.C. Lindström Egholm, MPH, Research Consultant, DANBIO Registry, Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Glostrup Hospital, and The Regional Research Unit, Region Zealand; N.S. Krogh, Master of Economics, CEO, Zitelab Aps; T. Pincus, MD, Division of Rheumatology, Rush University Medical Center; L. Dreyer, PhD, Chief Physician, Department of Rheumatology C, Copenhagen University Hospital Gentofte; T. Ellingsen, MD, PhD, Professor, Chief Physician, Department of Rheumatology, Odense University Hospital; B. Glintborg, MD, PhD, Department of Rheumatology C, Copenhagen University Hospital Gentofte; M.R. Kowalski, PhD, Consultant, Department of Rheumatology, Vendsyssel Hospital; T. Lorenzen, MD, Chief Physician, Department of Rheumatology, Diagnostic Centre, Silkeborg Regional Hospital; O.R. Madsen, PhD, DrMed, Consultant, Associate Professor, Department of Rheumatology C, Copenhagen University Hospital Gentofte; H. Nordin, MD, Consultant, Department of Infectious Diseases and Rheumatology, Rigshospitalet, University Hospital of Copenhagen; C. Rasmussen, MD, Chief Physician, Department of Rheumatology
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