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Chen HH, Wu PY, Lin CH, Wu CL, Chao WC. Factors associated with mental illness in patients with rheumatoid arthritis initiating b/ts DMARDs: A population-based study. Int J Rheum Dis 2024; 27:e14992. [PMID: 38061767 DOI: 10.1111/1756-185x.14992] [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: 09/19/2023] [Revised: 11/09/2023] [Accepted: 11/23/2023] [Indexed: 01/31/2024]
Abstract
AIM Mental health is an essential issue in patients with rheumatoid arthritis (RA) but remains unclear among those receiving biological and targeted synthetic disease-modifying antirheumatic drugs (b/tsDMARDs). We aim to assess the incidence and factors associated with mental illness among patients with RA who underwent b/tsDMARD therapy. METHOD We used Taiwan's National Health Insurance Research Database for the period 2001-2020 to identify patients with RA receiving b/tsDMARDs. The primary outcome was newly developed mental illness, including anxiety and mood disorders. We performed a Cox regression analysis to determine factors associated with mental illness and presented as hazard ratios (HR) with 95% confidence interval (CI). RESULTS We enrolled 10 852 patients, with 7854 patients receiving tumor necrosis factors inhibitors (TNFi), 1693 patients receiving non-TNFi bDMARDs, and 1305 patients treated with tsDMARD. We found that 13.62% of enrolled patients developed mental illness, with an incidence rate of 4054 per 100 000 person-year. Those receiving tocilizumab (aHR 0.64, 95% CI: 0.51-0.82), abatacept (aHR 0.69, 95% CI: 0.55-0.86), or tsDMARDs (aHR 0.58, 95% CI: 0.47-0.73) had a lower risk of mental illness compared with those receiving TNFi. We also found that old age, low income, diabetes mellitus, use of cyclosporine, and use of steroids were associated with incident mental illness. CONCLUSION This population-based study investigated the incidence and factors associated with mental illness among patients with RA receiving b/tsDMARDs. Our findings highlight the need for vigilance with respect to the possibility of mental illness in patients with RA.
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Affiliation(s)
- Hsin-Hua Chen
- Division of General Medicine, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
- Institute of Biomedical Science and Rong Hsing Research Centre for Translational Medicine, Chung Hsing University, Taichung, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Big Data Center, Chung Hsing University, Taichung, Taiwan
- Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung, Taiwan
- Department of Industrial Engineering and Enterprise Information, Tunghai University, Taichung, Taiwan
| | - Peng-Yen Wu
- Department of Critical Care Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Ching-Heng Lin
- Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung, Taiwan
- Department of Industrial Engineering and Enterprise Information, Tunghai University, Taichung, Taiwan
- Department of Medical Research, Taichung Veterans General Hospital, Taichung, Taiwan
- Department of Healthcare Management, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan
- Department of Public Health, College of Medicine, Fu Jen Catholic University, New Taipei City, Taiwan
| | - Chieh-Liang Wu
- Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung, Taiwan
- Department of Industrial Engineering and Enterprise Information, Tunghai University, Taichung, Taiwan
- Department of Critical Care Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Wen-Cheng Chao
- Big Data Center, Chung Hsing University, Taichung, Taiwan
- Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung, Taiwan
- Department of Critical Care Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
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Duarte C, Spilker RLF, Paiva C, Ferreira RJO, da Silva JAP, Pinto AM. MITIG.RA: study protocol of a tailored psychological intervention for managing fatigue in rheumatoid arthritis randomized controlled trial. Trials 2023; 24:651. [PMID: 37803467 PMCID: PMC10559483 DOI: 10.1186/s13063-023-07692-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 09/29/2023] [Indexed: 10/08/2023] Open
Abstract
BACKGROUND Despite remarkable medical advances in the treatment of rheumatoid arthritis (RA), a subset of patients fails to achieve complete clinical remission, as the Patient Global Assessment (PGA) of disease activity remains above 1, even after the inflammatory process is brought under control. This so-called state of 'PGA-near-remission' negatively impacts individuals' functioning and potentiates inadequate care. Fatigue is a distressing and disabling symptom frequently reported by patients in PGA-near-remission, and its management remains challenging. While classic cognitive-behavioural interventions show some benefits in managing fatigue, there is potential for improvement. Recently, contextual-cognitive behavioural therapies (CCBT), like mindfulness, acceptance, and compassion-based interventions, have shown promising results in fatigue-associated disorders and their determinants. This study primarily aims to examine the efficacy of the Compassion and Mindfulness Intervention for RA (MITIG.RA), a novel intervention combining different components of CCBT, compared to treatment-as-usual (TAU) in the management of RA-associated fatigue. Secondary aims involve exploring whether MITIG.RA produces changes in the perceived impact of disease, satisfaction with disease status, levels of depression, and emotion-regulation skills. METHODS This is a single center, two-arm parallel randomized controlled trial. Patients will be screened for eligibility and willingness to participate and will be assessed and randomized to the experimental (MITIG.RA + TAU) or control condition (TAU) using computer randomization. MITIG.RA will be delivered by a certified psychologist and comprises eight sessions of 2 h, followed by two booster sessions. Outcomes will be assessed through validated self-report measures, including fatigue (primary outcome), perceived impact of disease, depressive symptoms, mindfulness, self-compassion, safety, and satisfaction (secondary outcomes). Assessment will take place at baseline, post-intervention, before the first and second booster sessions (weeks 12 and 20, respectively), and at 32 and 44 weeks after the interventions' beginning. DISCUSSION We expect MITIG.RA to be effective in reducing levels of RA-associated fatigue. Secondarily, we hypothesize that the experimental group will show improvements in the overall perceived impact of disease, emotional distress, and emotion regulation skills. Our findings will contribute to determine the benefits of combining CCBT approaches for managing fatigue and associated distress in RA. TRIAL REGISTRATION ClinicalTrials.gov NCT05389189. Registered on May 25, 2022.
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Affiliation(s)
- Cátia Duarte
- Rheumatology Department, Centro Hospitalar E Universitário de Coimbra, Coimbra, Portugal.
- Faculty of Medicine, Coimbra Institute for Clinical and Biomedical Research (iCBR), University of Coimbra, Coimbra, Portugal.
| | | | - Cláudia Paiva
- Rheumatology Department, Centro Hospitalar E Universitário de Coimbra, Coimbra, Portugal
| | - Ricardo J O Ferreira
- Nursing Research, Innovation and Development Centre of Lisbon (CIDNUR), Nursing School of Lisbon (ESEL), Lisbon, Portugal
| | - José A Pereira da Silva
- Rheumatology Department, Centro Hospitalar E Universitário de Coimbra, Coimbra, Portugal
- Faculty of Medicine, Coimbra Institute for Clinical and Biomedical Research (iCBR), University of Coimbra, Coimbra, Portugal
| | - Ana M Pinto
- Centre for Research in Neuropsychology and Cognitive and Behavioural Intervention (CINEICC), Faculty of Psychology and Educational Sciences, University of Coimbra, Coimbra, Portugal
- Institute of Psychological Medicine, Faculty of Medicine, University of Coimbra, Coimbra, Portugal
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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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Suardi I, Posio C, Luconi E, Boracchi P, Caporali R, Ingegnoli F. Disease activity and disease-related factors are drivers of patient global assessment in rheumatoid arthritis: a real-life cross-sectional study. Rheumatol Int 2023; 43:1885-1895. [PMID: 37454308 PMCID: PMC10435653 DOI: 10.1007/s00296-023-05383-6] [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: 05/17/2023] [Accepted: 06/26/2023] [Indexed: 07/18/2023]
Abstract
Despite that the Patient Global Assessment (PGA) is widely used for measuring Rheumatoid Arthritis (RA) disease activity to define the remission state of the disease, the primary contributors influencing patients' ratings are still debated. This study aims to determine which clinical, sociodemographic and lifestyle-related contextual factors might be key drivers of PGA in RA. This single-center cross-sectional study recruited 393 consecutive adult RA patients. Median age 60 years, females 306 (77.9%). Data related to disease activity were assessed by using Simplified Disease Activity Index (SDAI), severity by Health Assessment Questionnaire (HAQ), and impact by RA Impact of Disease (RAID). Sociodemographic/lifestyle features were collected. Disease remission was calculated using Boolean-based criteria 1.0 and 2.0. Quantile regression models were used for univariate and multivariate analysis. The remission rate progressively increased from 15% by using SDAI with a Boolean 1.0-based definition to 43.5% using a Boolean 2.0-based remission. Among factors related to disease activity, the use of low-dose corticosteroids, the RAID items pain and sleep difficulties were predictive for worse PGA scores (p = 0.01). Among factors related to disease severity HAQ score and RAID total were independent factors associated with higher median PGA (p = 0.02 and p < 0.001). RAID's physical well-being was related to PGA scores (p = 0.01). An increasing trend in PGA was observed in longstanding diseases (> 15 years). Our results confirmed that there is no unambiguous interpretation of the PGA score. It is a measure related to some disease activity parameters, but it is also influenced by contextual factors related to disease severity and impact. These data highlighted that PGA should have a broad interpretation, thus supporting the proposal of a dual targets (biological and impact) approach to obtain a more accurate estimate of disease activity.
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Affiliation(s)
- Ilaria Suardi
- Rheumatology Clinic, Department of Clinical Sciences and Community Health, ASST Gaetano Pini-CTO, Università degli Studi di Milano, Milan, Italy
| | - Cristina Posio
- Rheumatology Clinic, Department of Clinical Sciences and Community Health, ASST Gaetano Pini-CTO, Università degli Studi di Milano, Milan, Italy
| | - Ester Luconi
- Università degli Studi di Milano, Department of Biomedical and Clinical Sciences “L. Sacco”, Milan, Italy
| | - Patrizia Boracchi
- Università degli Studi di Milano, Department of Biomedical and Clinical Sciences “L. Sacco”, Milan, Italy
| | - Roberto Caporali
- Rheumatology Clinic, Department of Clinical Sciences and Community Health, ASST Gaetano Pini-CTO, Università degli Studi di Milano, Milan, Italy
| | - Francesca Ingegnoli
- Rheumatology Clinic, Department of Clinical Sciences and Community Health, ASST Gaetano Pini-CTO, Università degli Studi di Milano, Milan, Italy
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Ramiro S, Landewé R, van der Heijde D, Sepriano A, FitzGerald O, Østergaard M, Homik J, Elkayam O, Thorne JC, Larché MJ, Ferraccioli G, Backhaus M, Boire G, Combe B, Schaeverbeke T, Saraux A, Dougados M, Rossini M, Govoni M, Sinigaglia L, Cantagrel AG, Allaart CF, Barnabe C, Bingham CO, van Schaardenburg D, Hammer HB, Dadashova R, Hutchings E, Paschke J, Maksymowych WP. Stricter treat-to-target in RA does not result in less radiographic progression: a longitudinal analysis in RA BIODAM. Rheumatology (Oxford) 2023; 62:2989-2997. [PMID: 36645243 DOI: 10.1093/rheumatology/kead021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 12/02/2022] [Accepted: 01/06/2023] [Indexed: 01/17/2023] Open
Abstract
OBJECTIVES To investigate whether meticulously following a treat-to-target (T2T)-strategy in daily clinical practice will lead to less radiographic progression in patients with active RA who start (new) DMARD-therapy. METHODS Patients with RA from 10 countries starting/changing conventional synthetic or biologic DMARDs because of active RA, and in whom treatment intensification according to the T2T principle was pursued, were assessed for disease activity every 3 months for 2 years (RA-BIODAM cohort). The primary outcome was the change in Sharp-van der Heijde (SvdH) score, assessed every 6 months. Per 3-month interval DAS44-T2T could be followed zero, one or two times (in a total of two visits). The relation between T2T intensity and change in SvdH-score was modelled by generalized estimating equations. RESULTS In total, 511 patients were included [mean (s.d.) age: 56 (13) years; 76% female]. Mean 2-year SvdH progression was 2.2 (4.1) units (median: 1 unit). A stricter application of T2T in a 3-month interval did not reduce progression in the same 6-month interval [parameter estimates (for yes vs no): +0.15 units (95% CI: -0.04, 0.33) for 2 vs 0 visits; and +0.08 units (-0.06; 0.22) for 1 vs 0 visits] nor did it reduce progression in the subsequent 6-month interval. CONCLUSIONS In this daily practice cohort, following T2T principles more meticulously did not result in less radiographic progression than a somewhat more lenient attitude towards T2T. One possible interpretation of these results is that the intention to apply T2T already suffices and that a more stringent approach does not further improve outcome.
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Affiliation(s)
- Sofia Ramiro
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
- Department of Rheumatology, Zuyderland Medical Center, Heerlen, The Netherlands
| | - Robert Landewé
- Department of Rheumatology, Zuyderland Medical Center, Heerlen, The Netherlands
- Department of Rheumatology, Amsterdam Rheumatology Center, Amsterdam, The Netherlands
| | | | - Alexandre Sepriano
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
- NOVA Medical School, Universidade Nova de Lisboa, Portugal
| | - Oliver FitzGerald
- Conway Institute for Biomolecular Research, School of Medicine, University College Dublin, Ireland
| | - Mikkel Østergaard
- Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, Glostrup and Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Joanne Homik
- Department of Medicine, University of Alberta, Edmonton, Canada
| | - Ori Elkayam
- Tel Aviv Sourasky Medical Center and the "Sackler" Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - J Carter Thorne
- The Arthritis Program Research Group, University of Toronto, Toronto, Canada
| | - Maggie J Larché
- Departments of Medicine and Pediatrics, Divisions of Rheumatology, Clinical Immunology and Allergy, McMaster University, Hamilton, Canada
| | | | - Marina Backhaus
- Park-Klinik Weissensee, Academic Hospital of the Charité, Berlin, Germany
| | - Gilles Boire
- Department of Medicine/Division of Rheumatology, Centre Intégré Universitaire de Santé et de Services Sociaux de l'Estrie-Centre Hospitalier Universitaire de Sherbrooke (CIUSSS de l'Estrie-CHUS), University of Sherbrooke, Sherbrooke, Canada
| | - Bernard Combe
- Department of Rheumatology, Montpellier University, Montpellier, France
| | - Thierry Schaeverbeke
- Department of Rheumatology, FHU ACRONIM, University Hospital of Bordeaux, University of Bordeaux, France
| | - Alain Saraux
- LBAI, U1227, Université Brest, Inserm, CHU Brest, Brest, France
| | - Maxime Dougados
- Rheumatology Department, Paris Cité University, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, INSERM (U1153): Clinical Epidemiology and Biostatistics, PRES Sorbonne Paris-Cité, Paris, France
| | - Maurizio Rossini
- Rheumatology Unit, Department of Medicine, University of Verona, Verona, Italy
| | - Marcello Govoni
- Rheumatology Unit, S. Anna Hospital and University of Ferrara, Ferrara, Italy
| | - Luigi Sinigaglia
- Department of Rheumatology, Gaetano Pini Institute, Milan, Italy
| | - Alain G Cantagrel
- Department of Rheumatology, CHU Toulouse, Paul Sabatier University, Toulouse, France
| | - Cornelia F Allaart
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
| | - Cheryl Barnabe
- Departments of Medicine and Community Health Sciences, University of Calgary, Alberta, Canada
| | | | | | - Hilde B Hammer
- Department of Rheumatology, Diakonhjemmet Hospital and Faculty of Medicine, University of Oslo, Oslo, Norway
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Smolen JS, Landewé RBM, Bergstra SA, Kerschbaumer A, Sepriano A, Aletaha D, Caporali R, Edwards CJ, Hyrich KL, Pope JE, de Souza S, Stamm TA, Takeuchi T, Verschueren P, Winthrop KL, Balsa A, Bathon JM, Buch MH, Burmester GR, Buttgereit F, Cardiel MH, Chatzidionysiou K, Codreanu C, Cutolo M, den Broeder AA, El Aoufy K, Finckh A, Fonseca JE, Gottenberg JE, Haavardsholm EA, Iagnocco A, Lauper K, Li Z, McInnes IB, Mysler EF, Nash P, Poor G, Ristic GG, Rivellese F, Rubbert-Roth A, Schulze-Koops H, Stoilov N, Strangfeld A, van der Helm-van Mil A, van Duuren E, Vliet Vlieland TPM, Westhovens R, van der Heijde D. EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs: 2022 update. Ann Rheum Dis 2023; 82:3-18. [PMID: 36357155 DOI: 10.1136/ard-2022-223356] [Citation(s) in RCA: 356] [Impact Index Per Article: 356.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Accepted: 10/21/2022] [Indexed: 11/12/2022]
Abstract
OBJECTIVES To provide an update of the EULAR rheumatoid arthritis (RA) management recommendations addressing the most recent developments in the field. METHODS An international task force was formed and solicited three systematic literature research activities on safety and efficacy of disease-modifying antirheumatic drugs (DMARDs) and glucocorticoids (GCs). The new evidence was discussed in light of the last update from 2019. A predefined voting process was applied to each overarching principle and recommendation. Levels of evidence and strengths of recommendation were assigned to and participants finally voted on the level of agreement with each item. RESULTS The task force agreed on 5 overarching principles and 11 recommendations concerning use of conventional synthetic (cs) DMARDs (methotrexate (MTX), leflunomide, sulfasalazine); GCs; biological (b) DMARDs (tumour necrosis factor inhibitors (adalimumab, certolizumab pegol, etanercept, golimumab, infliximab including biosimilars), abatacept, rituximab, tocilizumab, sarilumab and targeted synthetic (ts) DMARDs, namely the Janus kinase inhibitors tofacitinib, baricitinib, filgotinib, upadacitinib. Guidance on monotherapy, combination therapy, treatment strategies (treat-to-target) and tapering in sustained clinical remission is provided. Safety aspects, including risk of major cardiovascular events (MACEs) and malignancies, costs and sequencing of b/tsDMARDs were all considered. Initially, MTX plus GCs is recommended and on insufficient response to this therapy within 3-6 months, treatment should be based on stratification according to risk factors; With poor prognostic factors (presence of autoantibodies, high disease activity, early erosions or failure of two csDMARDs), any bDMARD should be added to the csDMARD; after careful consideration of risks of MACEs, malignancies and/or thromboembolic events tsDMARDs may also be considered in this phase. If the first bDMARD (or tsDMARD) fails, any other bDMARD (from another or the same class) or tsDMARD (considering risks) is recommended. With sustained remission, DMARDs may be tapered but should not be stopped. Levels of evidence and levels of agreement were high for most recommendations. CONCLUSIONS These updated EULAR recommendations provide consensus on RA management including safety, effectiveness and cost.
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Affiliation(s)
- Josef S Smolen
- Division of Rheumatology, Department of Medicine 3, Medical University of Vienna, Vienna, Austria
| | - Robert B M Landewé
- Division of Clinical Immunology and Rheumatology, Amsterdam University Medical Center & Zuyderland Medical Center Heerlen, Heerlen, The Netherlands
| | - Sytske Anne Bergstra
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
| | - Andreas Kerschbaumer
- Division of Rheumatology, Department of Medicine 3, Medical University of Vienna, Vienna, Austria
| | | | - Daniel Aletaha
- Division of Rheumatology, Department of Medicine 3, Medical University of Vienna, Vienna, Austria
| | - Roberto Caporali
- Milan & Department of Rheumatology, ASST PINI-CTO, University of Milan, Milan, Italy
| | - Christopher John Edwards
- MSK Research Unit, NIHR Southampton Clinical Research Facility, University Hospital Southampton, Southampton, UK
| | - Kimme L Hyrich
- Centre for Epidemiology Versus Arthritis, Manchester Academic Health Science Centre and NIHR Manchester Biomedical Research Centre. Manchester University NHS Trust, University of Manchester, Manchester, UK
| | - Janet E Pope
- Western University, Schulich School of Medicine & Dentistry, London, Ontario, Canada
| | - Savia de Souza
- EULAR Patient Research Partner Network, Zurich, Switzerland
| | - Tanja A Stamm
- Section for Outcomes Research, Center for Medical Statistics, Informatics, and Intelligent Systems, Medical University of Vienna, Vienna, Austria
| | - Tsutomu Takeuchi
- Keio University School of Medicine, Tokyo and Saitama Medical University, Saitama, Japan
| | | | | | - Alejandro Balsa
- Servicio de Reumatologia, Hospital Universitario La Paz, Universidad Autonoma de Madrid, Madrid, Spain
| | - Joan M Bathon
- Columbia University Irving Medical Center/New York Presbyterian Hospital, New York, NY, USA
| | - Maya H Buch
- Centre for Musculoskeletal Research, Division of Musculoskeletal & Dermatological Sciences, Faculty of Biology, Medicine & Health and NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester, UK
| | - Gerd R Burmester
- Department of Rheumatology and Clinical Immunology, Charité University Hospital, Berlin, Germany
| | - Frank Buttgereit
- Department of Rheumatology and Clinical Immunology, Charité University Hospital, Berlin, Germany
| | | | - Katerina Chatzidionysiou
- Department of Medicine Solna, Karolinska Institutet, Rheumatology Division, Karolinska University Hospital, Stockholm, Sweden
| | - Catalin Codreanu
- Center for Rheumatic Diseases, University of Medicine and Pharmacy, Bucharest, Romania
| | - Maurizio Cutolo
- Laboratory of Experimental Rheumatology and Division of Rheumatology DiMI, Department of Internal Medicine and Medical Specialties, University of Genova IRCCS, San Martino Polyclinic Hospital, Genoa, Italy
| | | | - Khadija El Aoufy
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Axel Finckh
- Division of Rheumatology, Department of Medicine, Geneva University Hospitals & Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - João Eurico Fonseca
- Rheumatology Department, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Lisbon Academic Medical Center, and Instituto de Medicina Molecular João Lobo Antunes, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
| | | | - Espen A Haavardsholm
- Center for treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital and University of Oslo, Oslo, Norway
| | - Annamaria Iagnocco
- Academic Rheumatology Centre - AO Mauriziano Torino, Cattedra di Reumatologia - Dipartimento Scienze Cliniche e Biologiche, Università degli Studi di Torino, Turin, Italy
| | - Kim Lauper
- Division of Rheumatology, Department of Medicine, Geneva University Hospitals & Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Zhanguo Li
- Department of Rheumatology and Immunology, Peking University People's Hospital, Beijing, China
| | - Iain B McInnes
- College of Medical Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | | | - Peter Nash
- School of Medicine, Griffith University, Brisbane, Queensland, Australia
| | - Gyula Poor
- National Institute of Musculoskeletal Disorders, Semmelweis University Medical School, Budapest, Hungary
| | - Gorica G Ristic
- Department of Rheumatology and Clinical Immunology and Medical Faculty of the Military Medical Academy, The University of Defense in Belgrade, Belgrade, Serbia
| | - Felice Rivellese
- Centre for Experimental Medicine and Rheumatology, William Harvey Research Institute, London, UK
| | - Andrea Rubbert-Roth
- Division of Rheumatology and Clinical Immunology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | - Hendrik Schulze-Koops
- Division of Rheumatology and Clinical Immunology, Department of Internal Medicine IV, Ludwig Maximilians University of Munich, Munich, Germany
| | - Nikolay Stoilov
- Department of Rheumatology, Faculty of Medicine, University Hospital "St. Ivan Rilski", Medical University of Sofia, Sofia, Bulgaria
| | - Anja Strangfeld
- Department of Medicine Solna, Karolinska Institutet, Rheumatology Division, Karolinska University Hospital, Stockholm, Sweden.,Programme Area of Epidemiology and Health Services Research, German Rheumatism Research Centre, Berlin, Germany
| | | | - Elsa van Duuren
- The Sefako Makgatho Health Science University, Pretoria, South Africa
| | - Theodora P M Vliet Vlieland
- Department of Orthopaedics, Rehabilitation and Physical Therapy, Leiden University Medical Center, Leiden, The Netherlands
| | - René Westhovens
- Department of Rheumatology, University Hospitals Leuven, Leuven, Belgium
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7
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Duarte C, Kvien TK, Sexton J, Santos E, de Wit M, Gossec L, da Silva JAP. Patient Experienced Symptom State in rheumatoid arthritis: sensitivity to change in disease activity and impact. Rheumatology (Oxford) 2022; 62:98-107. [PMID: 35482485 DOI: 10.1093/rheumatology/keac257] [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: 01/22/2022] [Revised: 04/19/2022] [Accepted: 04/19/2022] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVES The Patient Experienced Symptom State (PESS) is a single-question, patient-reported outcome that is validated to assess global disease impact in RA. This study addresses its sensitivity to change, and reliability. METHODS Disease activity, disease impact in the seven domains of RA Impact of Disease (RAID) and PESS were assessed in patients with RA from the NOR-DMARD registry, at two visits, 6 months apart. The PESS over the last week was scored at five levels, from 'very bad' to 'very good'. Disease impact and disease activity were compared between patients who improved, maintained or worsened PESS over time, through one-way analysis of variance, with post hoc Bonferroni correction. Correlations between changes in these parameters were assessed through Spearman's correlation coefficient. Sensitivity to change was assessed by standardized response mean (SRM) between the two visits. Reliability was analysed through intraclass correlation coefficient (ICC) between the two visits in patients with stable disease activity and impact. RESULTS In 353 patients [76.8% females, mean (s.d.) 9.9 (9.6) years disease duration], improvement in PESS level was associated with substantial improvements in mean impact in all domains as well as disease activity (P <0.02). PESS change was moderately to strongly correlated with RAID domains and disease activity (rho: 0.4-0.7). PESS was responsive to change (SRM: 0.65, 95% CI: 0.54, 0.76), particularly among RAID responders (SRM: 1.79, 95% CI: 1.54, 1.99). PESS was moderately reliable in patients with stable condition (ICC: 0.72, 95% CI: 0.52, 0.83). CONCLUSION PESS is valid, feasible, reliable and responsive, representing an opportunity to improve the assessment of disease impact with minimal questionnaire burden.
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Affiliation(s)
- Catiá Duarte
- Department of Rheumatology, Centro Hospitalar e Universitário de Coimbra.,Coimbra Institute for Clinical and Biomedical Research, Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - Tore K Kvien
- Department of Rheumatology, Diakonhjemmet Hospital.,Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Joe Sexton
- Department of Rheumatology, Diakonhjemmet Hospital
| | - Eduardo Santos
- Viseu Higher School of Health, Viseu.,Health Sciences Research Unit: Nursing, Nursing School of Coimbra, Coimbra, Portugal
| | | | - Laure Gossec
- Institut Pierre Louis d'Epidémiologie et de Santé Publique, Sorbonne Université, INSERM.,Rheumatology Department, Pitié Salpêtrière Hospital, AP-HP, Paris, France
| | - Jose A P da Silva
- Department of Rheumatology, Centro Hospitalar e Universitário de Coimbra.,Coimbra Institute for Clinical and Biomedical Research, Faculty of Medicine, University of Coimbra, Coimbra, Portugal
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8
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Pazmino S, Lovik A, Boonen A, De Cock D, Stouten V, Joly J, Doumen M, Bertrand D, Westhovens R, Verschueren P. New indicator for discordance between patient-reported and traditional disease activity outcomes in patients with early rheumatoid arthritis. Rheumatology (Oxford) 2022; 62:108-115. [PMID: 35416951 DOI: 10.1093/rheumatology/keac213] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 03/23/2022] [Accepted: 03/23/2022] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVE To unravel disease impact in early RA by separately quantifying patient-reported (PRF), clinical (CF) and laboratory (LF) factors. We propose a new indicator, the discordance score (DS), for early identification and prediction of patient's unmet needs and of future achievement of sustained remission (SR) and RA-related quality of life (QoL). METHODS Factor-scores obtained by factor analysis in the CareRA trial, allowed to compute DS, reflecting the difference between PRF and the mean of CF and LF. Improvement from baseline to week 104 (%) and area-under-the-curve (AUC) across time points per factor-score were calculated and compared between patients achieving/not achieving sustained (week 16-104) remission (DAS28CRP < 2.6) with ANOVA. Logistic and linear regressions were used to predict SR based on previous factor and discordance scores, and QoL at year 1 and 2 based on DS at week 16. RESULTS PRF, CF and LF scores improved rapidly within 8 weeks. PRF improved 57%, CF 90% and LF 27%, in those achieving SR, compared with 32% (PRF: P = 0.13), 77% (CF: P < 0.001) and 9% (LF: P = 0.36) in patients not achieving SR. Patients achieving SR had an AUC of 15.7, 3.4 and 4.8 for PRF, CF and LF, respectively, compared with 33.2, 10.1 and 7.2 in participants not achieving SR (P < 0.001 for all). Early discordance was associated with later factor scores, QoL and self-efficacy. CONCLUSIONS All factor scores improved rapidly, especially in patients achieving sustained remission. Patient-reported burden improved less. Discordance scores could help predicting the need for additional non-pharmacological interventions to achieve sustained remission and decrease disease impact.
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Affiliation(s)
- Sofia Pazmino
- Department of Development and Regeneration, Skeletal Biology and Engineering Research Centre
| | - Anikó Lovik
- I-BioStat, Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
| | - Annelies Boonen
- Department of Internal Medicine, Division of Rheumatology, Maastricht University Medical Centre.,Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
| | - Diederik De Cock
- Department of Development and Regeneration, Skeletal Biology and Engineering Research Centre.,Laboratory of Clinical and Experimental Endocrinology, University of Leuven
| | - Veerle Stouten
- Department of Development and Regeneration, Skeletal Biology and Engineering Research Centre
| | - Johan Joly
- Division of Rheumatology, University Hospitals Leuven, Leuven, Belgium
| | - Michaël Doumen
- Department of Development and Regeneration, Skeletal Biology and Engineering Research Centre
| | - Delphine Bertrand
- Department of Development and Regeneration, Skeletal Biology and Engineering Research Centre
| | - René Westhovens
- Department of Development and Regeneration, Skeletal Biology and Engineering Research Centre.,Division of Rheumatology, University Hospitals Leuven, Leuven, Belgium
| | - Patrick Verschueren
- Department of Development and Regeneration, Skeletal Biology and Engineering Research Centre.,Division of Rheumatology, University Hospitals Leuven, Leuven, Belgium
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9
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Pisaniello HL, Whittle SL, Lester S, Menz F, Metcalf R, McWilliams L, Hill CL, Proudman S. Using the derived 28-joint disease activity score patient-reported components (DAS28-P) index as a discriminatory measure of response to disease-modifying anti-rheumatic drug therapy in early rheumatoid arthritis. BMC Rheumatol 2022; 6:67. [PMCID: PMC9664777 DOI: 10.1186/s41927-022-00299-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 07/07/2022] [Indexed: 11/16/2022] Open
Abstract
Abstract
Background
The 28-joint disease activity score (DAS28) is a widely used measure to assess disease activity in rheumatoid arthritis (RA). The DAS28-P index, a derived proportion of the patient-reported components (joint tenderness and patient global assessment) within the DAS28, has been utilized as a discriminatory measure of non-inflammatory pain mechanisms in RA. This study aimed to evaluate the use of the DAS28-P index as a predictor of treatment response in early RA.
Methods
Patients with early RA enrolled in a supplemental fish oil clinical trial received a combination of disease-modifying anti-rheumatic drugs (DMARDs) according to a ‘treat-to-target’ protocol. First, consecutive measures of the DAS28-P index, derived from the DAS28-erythrocyte sedimentation rate (DAS28-ESR), at each visit over a 1-year period were estimated for each patient. Then, distinct subgroups of treatment responders based on the trajectories of the DAS28-P indices were identified using bivariate k-means cluster analysis. Data on baseline predictors as well as longitudinal outcomes of disease impact and DMARD use over a 1-year period and radiographic progression over a 3-year period were collected and analyzed using a random intercept, population-averaged generalized estimating equation model.
Results
121 patients were included (74% female; mean age of 57; median of 16 weeks of active disease) and a 3-cluster model was identified—the ‘Responders’ group (n = 58; 48%), the ‘Partial Responders’ group (n = 32; 26%), and the ‘Non-Responders’ group (n = 31; 26%). The ‘Partial Responders’ group had consistently higher proportions of the DAS28-P index throughout the study period and had minimal radiographic progression over time, with the lowest joint erosion score of 0.9 [95% confidence interval (CI) 0.2, 1.6], observed at the 3-year follow-up. At 52 weeks, the methotrexate dose was higher for both ‘Partial Responders’ and ‘Non-Responders’ groups (18.5 mg [95% CI 15.5, 21.5] and 18.6 mg [95% CI 15.3, 21.8] respectively), when compared with the ‘Responders’ group (12.8 mg [95% CI 14.7, 20.9]).
Conclusions
Persistently high DAS28-P index scores are useful to distinguish poor patient global assessment and excessive treatment escalation in early RA, suggestive of underlying non-inflammatory pain contributing to higher disease activity score. Early identification of patients with discordant subjective and objective components of composite disease activity measures may allow better tailoring of treatment in RA.
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10
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Kiltz U, Buschhorn-Milberger V, Albrecht K, Lakomek HJ, Lorenz HM, Rudwaleit M, Schneider M, Schulze-Koops H, Aringer M, Hasenbring MI, Herzer P, von Hinüber U, Krüger K, Lauterbach A, Manger B, Oltman R, Schuch F, Schmale-Grede R, Späthling-Mestekemper S, Zinke S, Braun J. [Development of quality standards for patients with rheumatoid arthritis for use in Germany]. Z Rheumatol 2022; 81:744-759. [PMID: 34652486 PMCID: PMC9646547 DOI: 10.1007/s00393-021-01093-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/17/2021] [Indexed: 10/20/2022]
Abstract
Despite a qualitatively and structurally good care of patients with rheumatoid arthritis (RA) in Germany, there are still potentially amendable deficits in the quality of care. For this reason, the German Society for Rheumatology (DGRh) has therefore decided to ask a group of experts including various stakeholders to develop quality standards (QS) for the care of patients with RA in order to improve the quality of care. The QS are used to determine and quantitatively measure the quality of care, subject to relevance and feasibility. The recently published NICE and ASAS standards and a systematic literature search were used as the basis for development. A total of 8 QS, now published for the first time, were approved with the intention to measure and further optimize the quality of care for patients with RA in Germany.
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Affiliation(s)
- U Kiltz
- Rheumazentrum Ruhrgebiet, Claudiusstr. 45, 44649, Herne, Deutschland.
- Ruhr-Universität Bochum, Bochum, Deutschland.
| | | | - K Albrecht
- Programmbereich Epidemiologie, Deutsches Rheuma-Forschungszentrum (DRFZ), Berlin, Deutschland
| | - H-J Lakomek
- Johannes-Wesling-Klinikum Minden, Universitätsklinik für Geriatrie, Minden, Deutschland
| | - H-M Lorenz
- Sektion Rheumatologie, Medizinische Klinik V, Universitätsklinikum Heidelberg, Universität Heidelberg, Heidelberg, Deutschland
| | - M Rudwaleit
- Universitätsklinik für Innere Medizin und Rheumatologie, Klinikum Bielefeld Rosenhöhe, Universität Bielefeld, Bielefeld, Deutschland
| | - M Schneider
- Poliklinik, Funktionsbereich und Hiller Forschungszentrum für Rheumatologie, Universitätsklinikum Düsseldorf, Heinrich-Heine-Universität Düsseldorf, Düsseldorf, Deutschland
| | - H Schulze-Koops
- Sektion Rheumatologie und Klinische Immunologie, Medizinische Klinik und Poliklinik IV, LMU-Klinikum München, Ludwig-Maximilians-Universität München, München, Deutschland
| | - M Aringer
- Medizinische Klinik und Poliklinik III, Rheumatologie, Universitätsklinikum Carl Gustav Carus, Technische Universität Dresden, Dresden, Deutschland
| | - M I Hasenbring
- Abteilung für Medizinische Psychologie und Medizinische Soziologie, Ruhr-Universität Bochum, Bochum, Deutschland
| | - P Herzer
- Medicover München MVZ, München, Deutschland
| | - U von Hinüber
- Praxis für Rheumatologie und Osteologie, Hildesheim, Deutschland
| | - K Krüger
- Rheumatologisches Praxiszentrum St. Bonifatius, München, Deutschland
| | - A Lauterbach
- Physiotherapieschule Friedrichsheim, Friedrichsheim, Deutschland
| | - B Manger
- Medizinische Klinik 3 Rheumatologie und Immunologie, Universitätsklinikum, Friedrich-Alexander-Universität Erlangen/Nürnberg, Erlangen, Deutschland
| | - R Oltman
- Hochschule für Gesundheit Bochum, Bochum, Deutschland
| | - F Schuch
- Rheumatologische Schwerpunktpraxis Erlangen, Erlangen, Deutschland
| | | | | | - S Zinke
- Rheumatologische Schwerpunktpraxis Zinke, Berlin, Deutschland
- Bundesverband Deutscher Rheumatologen e. V. (BDRh), Grünwald, Deutschland
| | - J Braun
- Rheumazentrum Ruhrgebiet, Claudiusstr. 45, 44649, Herne, Deutschland
- Ruhr-Universität Bochum, Bochum, Deutschland
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11
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Li Z, Wang J, Lin Y, Fang J, Xie K, Guan Z, Ma H, Yuan L. Newly discovered circRNAs in rheumatoid arthritis, with special emphasis on functional roles in inflammatory immunity. Front Pharmacol 2022; 13:983744. [PMID: 36278188 PMCID: PMC9585171 DOI: 10.3389/fphar.2022.983744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 09/22/2022] [Indexed: 11/15/2022] Open
Abstract
Circular RNA (circRNA) is a unique type of endogenous RNA. It does not have free 3 ′or 5′ ends, but forms covalently closed continuous rings. Rheumatoid arthritis (RA) is a common chronic autoimmune joint disease, characterized by chronic inflammation of the joint synovial membrane, joint destruction, and the formation of pannus. Although the pathogenesis of rheumatoid arthritis remains incompletely understood, a growing amount of research shows that circRNA has a close relationship with RA. Researchers have found that abnormally expressed circRNAs may be associated with the occurrence and development of RA. This article reviews the inflammatory immune, functions, mechanisms, and values of the circRNAs in RA to provide new ideas and novel biomarkers for the diagnosis and treatment of RA.
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Affiliation(s)
| | - Jianpeng Wang
- The First Affiliated Hospital of Anhui Medical University, Anhui Medical University, Hefei, China
| | - Yudong Lin
- Department of Pediatric Orthopedics, Anhui Provincial Children’s Hospital, Hefei, China
| | - Jihong Fang
- Department of Pediatric Orthopedics, Anhui Provincial Children’s Hospital, Hefei, China
| | - Kang Xie
- Department of Pediatric Orthopedics, Anhui Provincial Children’s Hospital, Hefei, China
| | - Zhiye Guan
- Department of Pediatric Orthopedics, Anhui Provincial Children’s Hospital, Hefei, China
| | - Hailong Ma
- Department of Pediatric Orthopedics, Anhui Provincial Children’s Hospital, Hefei, China
| | - Liang Yuan
- Department of Pediatric Orthopedics, Anhui Provincial Children’s Hospital, Hefei, China
- *Correspondence: Liang Yuan,
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12
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Li W, Bi S, Liang Y, Zhu H. Construction of Rheumatoid Arthritis Risk Prediction and Medical Image Applications from Rheumatoid Factor Levels. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2022; 2022:8617467. [PMID: 36238489 PMCID: PMC9553335 DOI: 10.1155/2022/8617467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/03/2022] [Revised: 09/16/2022] [Accepted: 09/21/2022] [Indexed: 11/24/2022]
Abstract
Objective To study the value of rheumatoid factor (RF) levels in the risk assessment of rheumatoid arthritis (RA) and combined hypertension and diabetes mellitus (DM) and construct RA risk prediction and medical image applications from rheumatoid factor levels. Methods A total of 249 RA patients who were treated in the First People's Hospital of Yunnan Province, and another 149 non-RA people were selected as the controls. The clinical data and the detection results of serum circulating RF_IgA, RF_IgG, and RF_IgM were collected. The receiver operating curve (ROC) and logistic regression were used to analyze the value of RF levels in the risk assessment of RA and combined hypertension and DM. Results After adjusting for age, BMI, smoking, drinking, hypertension, and diabetes, logistic regression analysis showed that RF_IgA positive, RF_IgG positive, and RF_IgM positive were all independent risk factors for RA (P < 0.05). The area under the curve (AUC) of circulating RF_IgA, RF_IgG, and RF_IgM levels in predicting RA was 0.79 (95% CI: 0.74-0.83, P < 0.001), 0.73 (95% CI: 0.68-0.78, P < 0.001), and 0.87 (95% CI: 0.84-0.91, P < 0.001), respectively. The AUC for predicting RA was 0.88 (95% CI: 0.85-0.92, P < 0.001) when combined detection of circulating RF_IgA, RF_IgG, and RF_IgM levels in peripheral blood. After adjusting for age and sex, logistic regression analysis showed that RF_IgA positive, RF_IgG positive, and RF_IgM positive were not independent risk factors for DM in RA patients (P > 0.05). Conclusion The levels of serum circulating RF_IgA, RF_IgG, and RF_IgM are valuable indicators for predicting the risk of RA, but not for the risk of RA complicated with hypertension and DM.
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Affiliation(s)
- Wenrun Li
- Department of Medical Laboratory, The First People's Hospital of Yunnan Province, The Affiliated Hospital of Kunming University of Science and Technology, Kunming, Yunnan, China
| | - Sheng Bi
- Department of Medical Laboratory, The First People's Hospital of Yunnan Province, The Affiliated Hospital of Kunming University of Science and Technology, Kunming, Yunnan, China
| | - Yu Liang
- Department of Medical Laboratory, The First People's Hospital of Yunnan Province, The Affiliated Hospital of Kunming University of Science and Technology, Kunming, Yunnan, China
| | - Hongyan Zhu
- Department of Medical Laboratory, The First People's Hospital of Yunnan Province, The Affiliated Hospital of Kunming University of Science and Technology, Kunming, Yunnan, China
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13
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Bugatti S, De Stefano L, D'Onofrio B, Nicrosini A, Mauric E, di Lernia M, Sakellariou G, Favalli EG, Manzo A, Caporali R, Montecucco C. Inflammatory correlates of the Patient Global Assessment of Disease Activity vary in relation to disease duration and autoantibody status in patients with rheumatoid arthritis. Ann Rheum Dis 2022; 81:1206-1213. [PMID: 35623639 DOI: 10.1136/annrheumdis-2022-222436] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Accepted: 05/16/2022] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To investigate the associations between the Patient Global Assessment (PGA) and measures of disease activity in patients with rheumatoid arthritis (RA) in relation to disease duration and autoantibody status. METHODS 1412 patients from three independent cohorts were studied: a prospective cohort of 810 patients with early RA followed up for 24 months; a cross-sectional cohort of 210 patients with established RA in low disease activity; a cross-sectional cohort of 401 patients with established RA in moderate-to-high disease activity. Correlations of the PGA were analysed by Pearson's coefficients and multivariable linear regression at baseline and at months 6, 12 and 24 in the overall populations and after stratification for autoantibody subgroup and remission status (Boolean remission, PGA near remission and non-remission). RESULTS In patients with early RA in non-remission, swollen joints correlated independently with the PGA; the correlation became progressively weaker but persisted at all time points in autoantibody-positive patients (adjusted r=0.30-0.12) but lost significance after month 12 in autoantibody-negative patients. Swollen joints independently correlated with the PGA also in near remission until month 12 (adjusted r=0.18-0.16) in autoantibody-positive patients. No independent correlations of inflammatory variables were instead found in patients with established RA irrespective of disease activity and autoantibody status. CONCLUSIONS In the early phases of RA, particularly in autoantibody-positive patients, inflammatory variables directly correlate with the PGA across different disease activity states. The optimal cut-off values of the PGA capable of identifying absence of disease should be better explored in relation to disease duration and autoantibody status.
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Affiliation(s)
- Serena Bugatti
- Division of Rheumatology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
- Department of Internal Medicine and Therapeutics, Università di Pavia, Pavia, Italy
| | - Ludovico De Stefano
- Division of Rheumatology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
- Department of Internal Medicine and Therapeutics, Università di Pavia, Pavia, Italy
| | - Bernardo D'Onofrio
- Division of Rheumatology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
- Department of Internal Medicine and Therapeutics, Università di Pavia, Pavia, Italy
| | - Andrea Nicrosini
- Division of Rheumatology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
- Department of Internal Medicine and Therapeutics, Università di Pavia, Pavia, Italy
| | - Eleonora Mauric
- Division of Rheumatology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
- Department of Internal Medicine and Therapeutics, Università di Pavia, Pavia, Italy
| | - Michele di Lernia
- Division of Rheumatology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
- Department of Internal Medicine and Therapeutics, Università di Pavia, Pavia, Italy
| | - Garifallia Sakellariou
- Department of Internal Medicine and Therapeutics, Università di Pavia, Pavia, Italy
- Maugeri Clinical Research Institutes IRCCS Pavia, Pavia, Italy
| | - Ennio Giulio Favalli
- Department of Rheumatology, Gaetano Pini-CTO, Milano, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Milano, Italy
| | - Antonio Manzo
- Division of Rheumatology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
- Department of Internal Medicine and Therapeutics, Università di Pavia, Pavia, Italy
| | - Roberto Caporali
- Department of Rheumatology, Gaetano Pini-CTO, Milano, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Milano, Italy
| | - Carlomaurizio Montecucco
- Division of Rheumatology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
- Department of Internal Medicine and Therapeutics, Università di Pavia, Pavia, Italy
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14
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Ferreira RJO, Gossec L, da Silva JAP. Overtreatment in rheumatoid arthritis: are there reasons for concern? RMD Open 2022; 8:rmdopen-2022-002212. [PMID: 36180100 PMCID: PMC9528607 DOI: 10.1136/rmdopen-2022-002212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 09/18/2022] [Indexed: 11/04/2022] Open
Affiliation(s)
- Ricardo J O Ferreira
- Nursing Research, Innovation and Development Centre of Lisbon (CIDNUR), Higher School of Nursing of Lisbon, Lisboa, Portugal .,Rheumatology, Centro Hospitalar e Universitario de Coimbra EPE, Coimbra, Portugal.,Health Sciences Research Unit: Nursing (UICISA: E), Nursing School of Coimbra, Coimbra, Portugal
| | - Laure Gossec
- Sorbonne Université, Institut Pierre Louis d'Epidémiologie et de Santé Publique, INSERM, Paris, France.,Rheumatology, Pitié Salpêtrière hospital, AP-HP, Paris, France
| | - Jose Antonio Pereira da Silva
- Rheumatology, Centro Hospitalar e Universitario de Coimbra EPE, Coimbra, Portugal.,Clínica Universitária de Reumatologia, and i-CBR Coimbra Institute for Clinical and Biological Research, Faculty of Medicine, University of Coimbra, Coimbra, Portugal
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15
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Ferreira RJO, Welsing PMJ, Jacobs JW, Gossec L, Ndosi M, Machado PM, van der Heijde D, Da Silva JA. Correspondence on 'Re-examining remission definitions in rheumatoid arthritis: considering the 28-joint Disease Activity Score, C reactive protein level and patient global assessment' by Felson et al. Ann Rheum Dis 2022:annrheumdis-2021-221917. [PMID: 35177410 DOI: 10.1136/annrheumdis-2021-221917] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Accepted: 11/28/2021] [Indexed: 01/23/2023]
Affiliation(s)
- Ricardo J O Ferreira
- Rheumatology Department, Centro Hospitalar e Universitário de Coimbra EPE, Coimbra, Coimbra, Portugal.,Health Sciences Research Unit: Nursing (UICISA: E), Higher School of Nursing of Coimbra, Coimbra, Coimbra, Portugal
| | - Paco M J Welsing
- Department of Rheumatology & Clinical Immunology, UMC Utrecht, Utrecht, Utrecht, The Netherlands
| | - Johannes Wg Jacobs
- Rheumatology and Clinical Immunology F02.127, UMC Utrecht, Utrecht, The Netherlands
| | - Laure Gossec
- INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, INSERM, Sorbonne Universite, Paris, France.,APHP, Rheumatology Department, Hopital Universitaire Pitie Salpetriere, Paris, France
| | - Mwidimi Ndosi
- School of Health and Social Wellbeing, University of the West of England, Bristol, UK
| | - Pedro M Machado
- Centre for Rheumatology & Department of Neuromuscular Diseases, University College London, London, UK.,Department of Rheumatology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Désirée van der Heijde
- Rheumatology Department, Leiden University Medical Center, Leiden, Zuid-Holland, The Netherlands
| | - Jose Ap Da Silva
- Rheumatology Department, Centro Hospitalar e Universitário de Coimbra EPE, Coimbra, Coimbra, Portugal .,Clínica Universitária de Reumatologia and i-CBR Coimbra Institute for Clinical and Biological Research, Faculty of Medicine, University of Coimbra, Coimbra, Coimbra, Portugal
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16
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Ferreira RJO, Welsing PMJ, Jacobs JWG, Gossec L, Ndosi M, Machado PM, van der Heijde D, da Silva JAP. Correspondence on "Re-examining remission definitions in rheumatoid arthritis: considering the 28-Joint Disease Activity Score, C-reactive protein level and patient global assessment" by Felson et al. ACR Open Rheumatol 2022; 4:271-272. [PMID: 35089652 PMCID: PMC8916548 DOI: 10.1002/acr2.11402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Accepted: 12/15/2021] [Indexed: 12/04/2022] Open
Affiliation(s)
- Ricardo J O Ferreira
- Centro Hospitalar e Universitário de Coimbra and Health Sciences Research Unit: Nursing, Coimbra, Portugal
| | | | | | - Laure Gossec
- Sorbonne Université - Institut Pierre Louis d'Epidémiologie, et de Santé Publique, Institut National de la Santé et de la Recherche Médicale and Pitié Salpêtrière Hospital, Assistance Publique - Hôpitaux de Paris, Paris, France
| | | | - Pedro M Machado
- University College London, University College London Hospitals NHS Foundation Trust, and Northwick Park Hospital, London North West, University Healthcare National Health Service Trust, London, UK
| | | | - José A P da Silva
- Centro Hospitalar e Universitário de Coimbra, and University of Coimbra, Coimbra, Portugal
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17
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Duarte C, Ferreira RJO, Santos EJF, da Silva JAP. Treating-to-target in rheumatology: Theory and practice. Best Pract Res Clin Rheumatol 2021; 36:101735. [PMID: 34980566 DOI: 10.1016/j.berh.2021.101735] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Despite its inclusion in current treatment recommendations, adherence to the treat-to-target strategy (T2T) is still poor. Among the issues are the definition(s) of target, especially the caveats of the patient global assessment (PGA), included in all recommended definitions of remission. The PGA is poorly related to inflammation, especially at low levels of disease activity, rather being a measure of the disease impact. Up to 60% of all patients otherwise in remission still score PGA at >1 and as high as 10. These patients (PGA-near-remission) are exposed to overtreatment if current recommendations are strictly followed and will continue to endure significant impact, unless adjuvant measures are implemented. A proposed method to overcome both these risks is to systematically pursue two targets: one focused on the disease process (the biological target) and another focused on the symptoms and impact (the impact target), the dual-target strategy. Candidate instruments to define each of these targets are discussed.
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Affiliation(s)
- Cátia Duarte
- Rheumatology Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal; Coimbra Institute for Clinical and Biomedical Research, Faculty of Medicine, University of Coimbra, Portugal
| | - Ricardo J O Ferreira
- Rheumatology Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal; Health Sciences Research Unit: Nursing (UICSA:E), Nursing School of Coimbra (ESEnfC), Coimbra, Portugal
| | - Eduardo J F Santos
- Health Sciences Research Unit: Nursing (UICSA:E), Nursing School of Coimbra (ESEnfC), Coimbra, Portugal; Viseu Higher School of Health, Viseu, Portugal
| | - José A P da Silva
- Rheumatology Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal; Coimbra Institute for Clinical and Biomedical Research, Faculty of Medicine, University of Coimbra, Portugal.
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18
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Ferreira RJO, Welsing PMJ, Jacobs JWG, Gossec L, Ndosi M, Machado PM, van der Heijde D, da Silva JAP. Correspondence on "Re-examining remission definitions in rheumatoid arthritis: considering the 28-Joint Disease Activity Score, C-reactive protein level and patient global assessment" by Felson et al. Arthritis Care Res (Hoboken) 2021; 74:501-502. [PMID: 34931481 DOI: 10.1002/acr.24843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Accepted: 12/14/2021] [Indexed: 11/09/2022]
Affiliation(s)
- Ricardo J O Ferreira
- Rheumatology department - Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal.,Health Sciences Research Unit: Nursing (UICISA: E), Nursing School of Coimbra, Coimbra, Portugal
| | - Paco M J Welsing
- Department of Rheumatology & Clinical Immunology, University Medical Center, Utrecht, The Netherlands
| | - Johannes W G Jacobs
- Department of Rheumatology & Clinical Immunology, University Medical Center, Utrecht, The Netherlands
| | - Laure Gossec
- Sorbonne Université - Institut Pierre Louis d'Epidémiologie et de Santé Publique, INSERM, Paris, France.,Rheumatology department - Pitié Salpêtrière hospital, AP-, HP, Paris, France
| | - Mwidimi Ndosi
- School of Health and Social Wellbeing - University of the West of England, Bristol, UK
| | - Pedro M Machado
- Centre for Rheumatology & Department of Neuromuscular Diseases - University College London, London, UK.,Department of Rheumatology, University College London Hospitals NHS Foundation Trust, London, UK.,Department of Rheumatology - Northwick Park Hospital, London North West University Healthcare NHS Trust, London, UK
| | | | - José A P da Silva
- Rheumatology department - Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal.,Clínica Universitária de Reumatologia, and i-CBR Coimbra Institute for Clinical and Biological Research, Faculty of Medicine - University of Coimbra, Portugal
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19
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Duarte C, Santos EJF, Ferreira RJO, Kvien TK, Dougados M, de Wit M, da Silva JAP, Gossec L. Validity and reliability of the EULAR instrument RAID.7 as a tool to assess individual domains of impact of disease in rheumatoid arthritis: a cross-sectional study of 671 patients. RMD Open 2021; 7:rmdopen-2020-001539. [PMID: 33547229 PMCID: PMC7871340 DOI: 10.1136/rmdopen-2020-001539] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 01/17/2021] [Accepted: 01/22/2021] [Indexed: 12/22/2022] Open
Abstract
Objective The rheumatoid arthritis impact of disease (RAID) questionnaire comprises seven patient-important domains of disease impact (pain, function, fatigue, sleep disturbance, emotional well-being, physical well-being, coping). RAID was validated as a pooled-weighted score. Its seven individual items separately could provide a valuable tool in clinical practice to guide interventions targeting the patient’s experience of the disease. The aim was to separately assess the psychometric properties of each of the seven numeric rating scale (NRS) of the RAID (RAID.7). Material and methods Post hoc analyses of data from the cross-sectional RAID study and from the Rainbow study, an open-label 12-week trial of etanercept in patients with RA. Construct validity of each NRS was assessed cross-sectionally in the RAID data set by Spearman’s correlation with the respective external instrument of reference. Using the rainbow data set, we assessed reliability through intraclass correlation coefficient between the screening and the baseline visits and responsiveness (sensitivity to change) by standardised response mean between baseline and 12 weeks. Results A total of 671 patients with RA with features of established disease were analysed, 563 and 108 from RAID and Rainbow, respectively. The NRS correlated moderately to strongly with the respective external instrument of reference (r=0.62–0.81). Reliability ranged from 0.64 (0.51–0.74) (pain) to 0.83 (0.76–0.88) (sleep disturbance) and responsiveness from 0.93 (0.73–1.13) (sleep disturbance) to 1.34 (1.01–1.64) (pain). Conclusion The separate use of the individual NRS of RAID (RAID.7) is valid, feasible, reliable and sensitive to change, representing an opportunity to improve the assessment and treatment of disease impact with minimal questionnaire burden. Trial registration number NCT00768053.
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Affiliation(s)
- Catia Duarte
- Rheumatology Department, Centro Hospitalar e Universitario de Coimbra EPE, Coimbra, Portugal .,iCBR-Coimbra Institute for Clinical and Biomedical Research, University of Coimbra Faculty of Medicine, Coimbra, Portugal
| | - Eduardo José Ferreira Santos
- Rheumatology Department, Centro Hospitalar e Universitario de Coimbra EPE, Coimbra, Portugal.,Health Sciences Research Unit Nursing, Higher School of Nursing of Coimbra, Coimbra, Coimbra, Portugal.,Abel Salazar Institute of Biomedical Sciences, University of Porto, Porto, Portugal
| | - Ricardo J O Ferreira
- Rheumatology Department, Centro Hospitalar e Universitario de Coimbra EPE, Coimbra, Portugal.,Health Sciences Research Unit Nursing, Higher School of Nursing of Coimbra, Coimbra, Coimbra, Portugal
| | - Tore K Kvien
- Rheumatology Department, Diakonhjemmet Hospital, Oslo, Norway
| | - Maxime Dougados
- Université de Paris, Paris, France.,Rheumatology Department, Hôpital Cochin, AP-HP, Paris, France.,INSERM (U1153): Clinical Epidemiology and biostatistics, PRES Sorbonne Paris-Cité, Paris, France
| | - Maarten de Wit
- Patient Research Partner, EULAR, Amsterdam, The Netherlands
| | - Jose Antonio Pereira da Silva
- Rheumatology Department, Centro Hospitalar e Universitario de Coimbra EPE, Coimbra, Portugal.,iCBR-Coimbra Institute for Clinical and Biomedical Research, University of Coimbra Faculty of Medicine, Coimbra, Portugal
| | - Laure Gossec
- INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, INSERM, Sorbonne Université, Paris, France.,Rheumatology Department, Hopital Universitaire Pitie Salpetriere, AP-HP, Paris, France
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20
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Scott DL, Ibrahim F, Hill H, Tom B, Prothero L, Baggott RR, Bosworth A, Galloway JB, Georgopoulou S, Martin N, Neatrour I, Nikiphorou E, Sturt J, Wailoo A, Williams FMK, Williams R, Lempp H. Intensive therapy for moderate established rheumatoid arthritis: the TITRATE research programme. PROGRAMME GRANTS FOR APPLIED RESEARCH 2021. [DOI: 10.3310/pgfar09080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Background
Rheumatoid arthritis is a major inflammatory disorder and causes substantial disability. Treatment goals span minimising disease activity, achieving remission and decreasing disability. In active rheumatoid arthritis, intensive management achieves these goals. As many patients with established rheumatoid arthritis have moderate disease activity, the TITRATE (Treatment Intensities and Targets in Rheumatoid Arthritis ThErapy) programme assessed the benefits of intensive management.
Objectives
To (1) define how to deliver intensive therapy in moderate established rheumatoid arthritis; (2) establish its clinical effectiveness and cost-effectiveness in a trial; and (3) evaluate evidence supporting intensive management in observational studies and completed trials.
Design
Observational studies, secondary analyses of completed trials and systematic reviews assessed existing evidence about intensive management. Qualitative research, patient workshops and systematic reviews defined how to deliver it. The trial assessed its clinical effectiveness and cost-effectiveness in moderate established rheumatoid arthritis.
Setting
Observational studies (in three London centres) involved 3167 patients. These were supplemented by secondary analyses of three previously completed trials (in centres across all English regions), involving 668 patients. Qualitative studies assessed expectations (nine patients in four London centres) and experiences of intensive management (15 patients in 10 centres across England). The main clinical trial enrolled 335 patients with diverse socioeconomic deprivation and ethnicity (in 39 centres across all English regions).
Participants
Patients with established moderately active rheumatoid arthritis receiving conventional disease-modifying drugs.
Interventions
Intensive management used combinations of conventional disease-modifying drugs, biologics (particularly tumour necrosis factor inhibitors) and depot steroid injections; nurses saw patients monthly, adjusted treatment and provided supportive person-centred psychoeducation. Control patients received standard care.
Main outcome measures
Disease Activity Score for 28 joints based on the erythrocyte sedimentation rate (DAS28-ESR)-categorised patients (active to remission). Remission (DAS28-ESR < 2.60) was the treatment target. Other outcomes included fatigue (measured on a 100-mm visual analogue scale), disability (as measured on the Health Assessment Questionnaire), harms and resource use for economic assessments.
Results
Evaluation of existing evidence for intensive rheumatoid arthritis management showed the following. First, in observational studies, DAS28-ESR scores decreased over 10–20 years, whereas remissions and treatment intensities increased. Second, in systematic reviews of published trials, all intensive management strategies increased remissions. Finally, patients with high disability scores had fewer remissions. Qualitative studies of rheumatoid arthritis patients, workshops and systematic reviews helped develop an intensive management pathway. A 2-day training session for rheumatology practitioners explained its use, including motivational interviewing techniques and patient handbooks. The trial screened 459 patients and randomised 335 patients (168 patients received intensive management and 167 patients received standard care). A total of 303 patients provided 12-month outcome data. Intention-to-treat analysis showed intensive management increased DAS28-ESR 12-month remissions, compared with standard care (32% vs. 18%, odds ratio 2.17, 95% confidence interval 1.28 to 3.68; p = 0.004), and reduced fatigue [mean difference –18, 95% confidence interval –24 to –11 (scale 0–100); p < 0.001]. Disability (as measured on the Health Assessment Questionnaire) decreased when intensive management patients achieved remission (difference –0.40, 95% confidence interval –0.57 to –0.22) and these differences were considered clinically relevant. However, in all intensive management patients reductions in the Health Assessment Questionnaire scores were less marked (difference –0.1, 95% confidence interval –0.2 to 0.0). The numbers of serious adverse events (intensive management n = 15 vs. standard care n = 11) and other adverse events (intensive management n = 114 vs. standard care n = 151) were similar. Economic analysis showed that the base-case incremental cost-effectiveness ratio was £43,972 from NHS and Personal Social Services cost perspectives. The probability of meeting a willingness-to-pay threshold of £30,000 was 17%. The incremental cost-effectiveness ratio decreased to £29,363 after including patients’ personal costs and lost working time, corresponding to a 50% probability that intensive management is cost-effective at English willingness-to-pay thresholds. Analysing trial baseline predictors showed that remission predictors comprised baseline DAS28-ESR, disability scores and body mass index. A 6-month extension study (involving 95 intensive management patients) showed fewer remissions by 18 months, although more sustained remissions were more likley to persist. Qualitative research in trial completers showed that intensive management was acceptable and treatment support from specialist nurses was beneficial.
Limitations
The main limitations comprised (1) using single time point remissions rather than sustained responses, (2) uncertainty about benefits of different aspects of intensive management and differences in its delivery across centres, (3) doubts about optimal treatment of patients unresponsive to intensive management and (4) the lack of formal international definitions of ‘intensive management’.
Conclusion
The benefits of intensive management need to be set against its additional costs. These were relatively high. Not all patients benefited. Patients with high pretreatment physical disability or who were substantially overweight usually did not achieve remission.
Future work
Further research should (1) identify the most effective components of the intervention, (2) consider its most cost-effective delivery and (3) identify alternative strategies for patients not responding to intensive management.
Trial registration
Current Controlled Trials ISRCTN70160382.
Funding
This project was funded by the National Institute for Health Research (NIHR) Programme Grants for Applied Research programme and will be published in full in Programme Grants for Applied Research; Vol. 9, No. 8. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- David L Scott
- Centre for Rheumatic Diseases, Department of Inflammation Biology, School of Immunology and Microbial Sciences, King’s College London, London, UK
| | - Fowzia Ibrahim
- Centre for Rheumatic Diseases, Department of Inflammation Biology, School of Immunology and Microbial Sciences, King’s College London, London, UK
| | - Harry Hill
- ScHARR Health Economics and Decision Science, The University of Sheffield, Sheffield, UK
| | - Brian Tom
- MRC Biostatistics Unit, University of Cambridge, Cambridge, UK
| | - Louise Prothero
- Centre for Rheumatic Diseases, Department of Inflammation Biology, School of Immunology and Microbial Sciences, King’s College London, London, UK
| | - Rhiannon R Baggott
- Centre for Rheumatic Diseases, Department of Inflammation Biology, School of Immunology and Microbial Sciences, King’s College London, London, UK
| | | | - James B Galloway
- Centre for Rheumatic Diseases, Department of Inflammation Biology, School of Immunology and Microbial Sciences, King’s College London, London, UK
| | - Sofia Georgopoulou
- Centre for Rheumatic Diseases, Department of Inflammation Biology, School of Immunology and Microbial Sciences, King’s College London, London, UK
| | - Naomi Martin
- Centre for Rheumatic Diseases, Department of Inflammation Biology, School of Immunology and Microbial Sciences, King’s College London, London, UK
| | - Isabel Neatrour
- Centre for Rheumatic Diseases, Department of Inflammation Biology, School of Immunology and Microbial Sciences, King’s College London, London, UK
| | - Elena Nikiphorou
- Centre for Rheumatic Diseases, Department of Inflammation Biology, School of Immunology and Microbial Sciences, King’s College London, London, UK
| | - Jackie Sturt
- Department of Adult Nursing, Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King’s College London, London, UK
| | - Allan Wailoo
- ScHARR Health Economics and Decision Science, The University of Sheffield, Sheffield, UK
| | - Frances MK Williams
- Twin Research and Genetic Epidemiology, School of Life Course Sciences, King’s College London, St Thomas’ Hospital, London, UK
| | - Ruth Williams
- Centre for Rheumatic Diseases, Department of Inflammation Biology, School of Immunology and Microbial Sciences, King’s College London, London, UK
| | - Heidi Lempp
- Centre for Rheumatic Diseases, Department of Inflammation Biology, School of Immunology and Microbial Sciences, King’s College London, London, UK
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21
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Ferreira RJO, Fautrel B, Saraux A, Gaujoux‐Viala C, Rat A, Guillemin F, Silva JAP, Dougados M, Gossec L. Patient Global Assessment of Disease Activity and Radiographic Progression in Early Arthritis: Three‐Year Results From the ESPOIR Cohort. Arthritis Care Res (Hoboken) 2021; 73:1300-1305. [DOI: 10.1002/acr.24237] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Accepted: 04/21/2020] [Indexed: 01/17/2023]
Affiliation(s)
- Ricardo J. O. Ferreira
- Centro Hospitalar e Universitário de Coimbra and Nursing School of Coimbra (ESEnfC) Coimbra Portugal
| | - Bruno Fautrel
- Institut Pierre Louis d’Epidémiologie et de Santé Publique INSERM Sorbonne Université and AP‐HP Pitié Salpêtrière Hospital, and CRI IMIDIATE Clinical Research Network Paris France
| | - Alain Saraux
- CHU Brest and UMR1227, Lymphocytes B et Autoimmunité INSERM Université de Bretagne occidentale Brest France
| | | | - Anne‐Christine Rat
- EA 4360 APEMAC Université de Lorraine, Nancy, France, and CHU Caen Caen France
| | - Francis Guillemin
- EA 4360 APEMAC Université de Lorraine, and Inserm CIC 1433 Epidémiologie clinique CHRU de Brabois Nancy France
| | - José A. P. Silva
- Centro Hospitalar e Universitário de Coimbra and University of Coimbra Coimbra Portugal
| | - Maxime Dougados
- Paris Descartes University Hôpital Cochin Assistance Publique Hôpitaux de Paris, and INSERM (U1153), Paris, France: Clinical epidemiology and biostatistics PRES Sorbonne Paris‐Cité Paris France
| | - Laure Gossec
- Institut Pierre Louis d’Epidémiologie et de Santé Publique INSERM Sorbonne Université, and AP‐HP Pitié Salpêtrière Hospital Paris France
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22
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Brites L, Rovisco J, Costa F, Freitas JPDD, Jesus D, Eugénio G, Serra S, Duarte C, Ferreira RJO, da Silva JAPD. High patient global assessment scores in patients with rheumatoid arthritis otherwise in remission do not reflect subclinical inflammation. Joint Bone Spine 2021; 88:105242. [PMID: 34166795 DOI: 10.1016/j.jbspin.2021.105242] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Accepted: 06/01/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVES To assess whether high patient global assessment (PGA) scores by patients with rheumatoid arthritis (RA) otherwise in remission reflect subclinical inflammation. METHODS Cross-sectional, single-center study, including consecutive RA patients. Remission states were defined based on the ACR/EULAR Boolean definition: 4V-remission (tender and swollen 28-joint counts (TJC28/SJC28), C-reactive protein (CRP), and PGA all≤1), PGA-near-remission (the same, except PGA>1), and non-remission (any of TJC28, SJC28, CRP>1). A blinded expert musculoskeletal ultrasonographer scanned 44 joints, 38 tendon sheaths, 4 bursae on the same day of the clinical evaluation. Each structure was assessed for the presence of Grey Scale synovial hypertrophy (GS) and Power Doppler (PD), both scored using a semi-quantitative scale (0-3 points). The Global OMERACT-EULAR Synovitis Score (GLOESS, 0-132, primary outcome), and a global tenosynovitis/bursitis score (GTBS) were compared between remission states, using non-parametric tests. Different sensitivity analyses comparing GS and PD subscores were performed. RESULTS In total, 130 patients (mean age 63 years, 86% female, average disease duration 14 years) were included 40 being in 4V-remission, 40 in PGA-near-remission, 50 in non-remission. 4v-remission and PGA-near-remission presented similar median (IQR) GLOESS, [6 (5-11) and 4 (1-7), P>0.05, respectively] and GTBS [0 (0-1) and 0 (0-2), P>0.05, respectively]. The same was observed in GS, PD scores, and in global synovitis score considering only the 16 joints not included in 28-joint counts. These observations were confirmed in patients with≤5 years disease duration. CONCLUSIONS Subclinical inflammation is not present among persons with elevated PGA who are otherwise in remission. PGA-near-remission patients would be exposed to the risk of overtreatment if current treatment recommendations were strictly followed. This study supports the need to reconsider the role of PGA in definitions used to target immunosuppressive therapy and to provide a separate and enhanced focus to the patient's experience of the disease.
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Affiliation(s)
- Luisa Brites
- Rheumatology Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - João Rovisco
- Rheumatology Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal; Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - Flávio Costa
- Rheumatology Department, Centro Hospitalar Vila, Nova de Gaia, Portugal
| | | | - Diogo Jesus
- Rheumatology Department, Centro Hospitalar de Leiria, Leiria, Portugal
| | - Gisela Eugénio
- Rheumatology Department, Centro Hospitalar do Baixo-Vouga, Aveiro, Portugal
| | - Sara Serra
- Rheumatology Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Cátia Duarte
- Rheumatology Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal; Faculty of Medicine, Coimbra Institute for Clinical and Biomedical Research (i.CIBR), University of Coimbra, Coimbra, Portugal
| | - Ricardo J O Ferreira
- Rheumatology Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal; Health Sciences Research Unit: Nursing, Nursing School of Coimbra, Coimbra, Portugal
| | - José António Pereira da da Silva
- Rheumatology Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal; Faculty of Medicine, Coimbra Institute for Clinical and Biomedical Research (i.CIBR), University of Coimbra, Coimbra, Portugal.
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23
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Jain S, Dhir V, Aggarwal A, Gupta R, Leishangthem B, Naidu S, Khullar A, Maurya S, Dhawan V, Sharma SK, Sharma A, Jain S. Comparison of two dose escalation strategies of methotrexate in active rheumatoid arthritis: a multicentre, parallel group, randomised controlled trial. Ann Rheum Dis 2021; 80:1376-1384. [PMID: 34112656 DOI: 10.1136/annrheumdis-2021-220512] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Accepted: 05/25/2021] [Indexed: 11/04/2022]
Abstract
OBJECTIVES There are no head-to-head trials of different dose escalation strategies of methotrexate (MTX) in RA. We compared the efficacy, safety and tolerability of 'usual' (5 mg every 4 weeks) versus 'fast' (5 mg every 2 weeks) escalation of oral MTX. METHODS This multicentre, open-label (assessor blinded) RCT included patients 18-55 years of age having active RA with disease duration <5 years, and not on DMARDs. Patients were randomized 1:1 into usual or fast escalation groups, both groups starting MTX at 15 mg/week till a maximum of 25 mg/week. Primary outcome was EULAR good response at 16 weeks, secondary outcomes were ΔDAS28 and adverse effects (AE). Analyses were intention-to-treat. RESULTS 178 patients with mean DAS28-CRP of 5.4(1.1) were randomized to usual (n=89) or fast escalation groups (n=89). At 16 weeks, there was no difference in good EULAR response in the usual (28.1%) or fast escalation (22.5%) groups (p=0.8). There was no difference in mean ΔDAS28-CRP at 8 weeks (-0.9, -0.8, p=0.72) or 16 weeks (-1.3, -1.3, p=0.98). Even at 24 weeks (extended follow-up), responses were similar. There were no inter-group differences in ΔHAQ, or MTX-polyglutamates 1-3 levels at 8 or 16 weeks. Gastrointestinal AE were higher in the fast escalation group over initial 8 weeks (27%, 40%, p=0.048), but not over 16 weeks. There was no difference in cytopenias, transaminitis, or drug discontinuation/dose reduction between the groups. No serious AE were seen. CONCLUSION A faster MTX escalation strategy in RA was not more efficacious over 16-24 weeks, and did not significantly increase AE, except higher gastrointestinal AE initially. TRIAL REGISTRATION NUMBER CTRI/2018/12/016549.
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Affiliation(s)
- Siddharth Jain
- Division of Clinical Immunology and Rheumatology, Department of Internal Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Varun Dhir
- Division of Clinical Immunology and Rheumatology, Department of Internal Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Amita Aggarwal
- Department of Clinical Immunology and Rheumatology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Ranjan Gupta
- Department of Rheumatology, All India Institute of Medical Sciences, New Delhi, India
| | - Bidyalaxmi Leishangthem
- Division of Clinical Immunology and Rheumatology, Department of Internal Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Shankar Naidu
- Division of Clinical Immunology and Rheumatology, Department of Internal Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Aastha Khullar
- Division of Clinical Immunology and Rheumatology, Department of Internal Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Supriya Maurya
- Department of Clinical Immunology and Rheumatology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Veena Dhawan
- Department of Experimental Medicine and Biotechnology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Shefali Khanna Sharma
- Division of Clinical Immunology and Rheumatology, Department of Internal Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Aman Sharma
- Division of Clinical Immunology and Rheumatology, Department of Internal Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Sanjay Jain
- Division of Clinical Immunology and Rheumatology, Department of Internal Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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24
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Ferreira RJO, Landewé RBM, da Silva JAP. Definition of Treatment Targets in Rheumatoid Arthritis: Is It Time for Reappraisal? J Rheumatol 2021; 48:1763-1766. [PMID: 34074683 DOI: 10.3899/jrheum.210050] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
In the current issue of The Journal of Rheumatology, Kremer and colleagues1 compare the Clinical Disease Activity Index (CDAI) with a slightly modified Corrona Routine Assessment of Patient Index Data 3 (cRAPID3) in terms of correlation and disease activity categorization, using 2 large US registries of patients with rheumatoid arthritis (RA). Overall, a low concordance between these 2 composite indices (κ = 0.29) was found in terms of disease activity categories, despite a moderate correlation between their numerical global scores (rs = 0.58 and 0.72, for the BRASS and CORRONA registries, respectively).
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Affiliation(s)
- Ricardo J O Ferreira
- R.J. Ferreira, RN, PhD, Nursing Specialist in Chronic Diseases, Invited Professor, Rheumatology Department, Centro Hospitalar e Universitário de Coimbra, and Health Sciences Research Unit: Nursing (UICiSA:E), Nursing School of Coimbra (ESEnfC), Coimbra, Portugal; R.B. Landewé, MD, PhD, Rheumatologist, Full Professor of Rheumatology, Rheumatology, Zuyderland Medical Center, Heerlen, and Amsterdam Rheumatology Center, AMC, Amsterdam, the Netherlands; J.A. da Silva, MD, PhD, Rheumatologist, Full Professor of Rheumatology, Head of Department, Rheumatology Department, Centro Hospitalar e Universitário de Coimbra, and Coimbra Institute for Clinical and Biomedical Research (iCBR), Faculty of Medicine, University of Coimbra, Portugal. The authors have no conflicts of interest. Photo for RJF courtesy of the European Alliance of Associations for Rheumatology (EULAR). Address correspondence to Dr. R.J. Ferreira, Serviço de Reumatologia, Consulta Externa, Piso 7, Centro Hospitalar e Universitário de Coimbra, EPE. Avenida Dr. Bissaya Barreto, 3000-075 Coimbra. Portugal.
| | - Robert B M Landewé
- R.J. Ferreira, RN, PhD, Nursing Specialist in Chronic Diseases, Invited Professor, Rheumatology Department, Centro Hospitalar e Universitário de Coimbra, and Health Sciences Research Unit: Nursing (UICiSA:E), Nursing School of Coimbra (ESEnfC), Coimbra, Portugal; R.B. Landewé, MD, PhD, Rheumatologist, Full Professor of Rheumatology, Rheumatology, Zuyderland Medical Center, Heerlen, and Amsterdam Rheumatology Center, AMC, Amsterdam, the Netherlands; J.A. da Silva, MD, PhD, Rheumatologist, Full Professor of Rheumatology, Head of Department, Rheumatology Department, Centro Hospitalar e Universitário de Coimbra, and Coimbra Institute for Clinical and Biomedical Research (iCBR), Faculty of Medicine, University of Coimbra, Portugal. The authors have no conflicts of interest. Photo for RJF courtesy of the European Alliance of Associations for Rheumatology (EULAR). Address correspondence to Dr. R.J. Ferreira, Serviço de Reumatologia, Consulta Externa, Piso 7, Centro Hospitalar e Universitário de Coimbra, EPE. Avenida Dr. Bissaya Barreto, 3000-075 Coimbra. Portugal.
| | - José A P da Silva
- R.J. Ferreira, RN, PhD, Nursing Specialist in Chronic Diseases, Invited Professor, Rheumatology Department, Centro Hospitalar e Universitário de Coimbra, and Health Sciences Research Unit: Nursing (UICiSA:E), Nursing School of Coimbra (ESEnfC), Coimbra, Portugal; R.B. Landewé, MD, PhD, Rheumatologist, Full Professor of Rheumatology, Rheumatology, Zuyderland Medical Center, Heerlen, and Amsterdam Rheumatology Center, AMC, Amsterdam, the Netherlands; J.A. da Silva, MD, PhD, Rheumatologist, Full Professor of Rheumatology, Head of Department, Rheumatology Department, Centro Hospitalar e Universitário de Coimbra, and Coimbra Institute for Clinical and Biomedical Research (iCBR), Faculty of Medicine, University of Coimbra, Portugal. The authors have no conflicts of interest. Photo for RJF courtesy of the European Alliance of Associations for Rheumatology (EULAR). Address correspondence to Dr. R.J. Ferreira, Serviço de Reumatologia, Consulta Externa, Piso 7, Centro Hospitalar e Universitário de Coimbra, EPE. Avenida Dr. Bissaya Barreto, 3000-075 Coimbra. Portugal.
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25
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Bugatti S, De Stefano L, Manzo A, Sakellariou G, Xoxi B, Montecucco C. Limiting factors to Boolean remission differ between autoantibody-positive and -negative patients in early rheumatoid arthritis. Ther Adv Musculoskelet Dis 2021; 13:1759720X211011826. [PMID: 34093745 PMCID: PMC8141996 DOI: 10.1177/1759720x211011826] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 03/31/2021] [Indexed: 12/14/2022] Open
Abstract
Background: The patient global assessment of disease activity (PGA) is the major limiting factor to Boolean remission in patients with established rheumatoid arthritis (RA). Here, we investigated the limiting variables to disease remission in patients with early RA treated with conventional synthetic disease modifying anti-rheumatic drugs, also in relation to autoantibody status. Methods: Data were retrieved from 535 early RA patients (<12 months of symptoms) with an observation period of 6–12 months upon initiation of therapy with methotrexate aimed at the achievement of low disease activity based on the 28-joints disease activity score. Near-remission was defined as any of the four core items of Boolean remission >1 with the remaining three all ⩽1. Reasons for missing Boolean remission and predictors of near-remission subcategories were analyzed in relation to baseline disease variables. Results: After 6 and 12 months, near-remission was two-times more frequent than Boolean remission (25.6% and 26.9% at the two time-points). A 28-swollen joint count (SJC28) >1 was responsible for the majority of near-remission (56.2% and 57.6% at 6 and 12 months, respectively), and PGA > 1 accounted for approximatively 35% of the cases. Autoantibody-positivity independently predicted the risk of missing remission because of SJC28 > 1 [adjusted odds ratio (OR) 95% confidence interval (CI) 2.81 (1.59–4.9) at 6 months and 1.73 (1.01–3.01) at 12 months], whilst autoantibody-negativity was an independent predictor of PGA near-remission [adjusted OR (95% CI) 2.45 (1.25–4.80) at 6 months and 5.71 (2.47–13.2) at 12 months]. Conclusion: In early RA, Boolean remission is more frequently missed because of persistent swollen joints. However, barriers to full-remission vary in relation to the autoantibody status. Autoantibody-positive patients more commonly experience residual swollen joints, whilst PGA more frequently impairs remission in autoantibody-negative patients. Efforts to target full-remission in early RA may thus require different strategies according to autoantibody profile.
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Affiliation(s)
- Serena Bugatti
- Division of Rheumatology, IRCCS Policlinico San Matteo Foundation University Hospital, Viale Golgi 19, Pavia, 27100, Italy
| | - Ludovico De Stefano
- Division of Rheumatology, IRCCS Policlinico San Matteo Foundation, Pavia, Italy
| | - Antonio Manzo
- Division of Rheumatology, IRCCS Policlinico San Matteo Foundation, Pavia, Italy
| | | | - Blerina Xoxi
- Division of Rheumatology, IRCCS Policlinico San Matteo Foundation, Pavia, Italy
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26
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Li J, Liu HH, Yin XD, Li CC, Wang J. COVID-19 illness and autoimmune diseases: recent insights. Inflamm Res 2021; 70:407-428. [PMID: 33640999 PMCID: PMC7914392 DOI: 10.1007/s00011-021-01446-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 01/25/2021] [Accepted: 02/18/2021] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND The aim of this review is to explore whether patients with autoimmune diseases (AIDs) were at high risk of infection during the COVID-19 epidemic and how severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic affected immune system. METHODS A systematic literature search was performed using the foreign databases (NCBI, web of science, EBSCO, ELSEVIER ScienceDirect) and Chinese databases (WanFang, CNKI (China National Knowledge Infrastructure), VIP, CBM) to locate all relevant publications (up to January 10, 2021). The search strategies used Medical Search Headings (MeSH) headings and keywords for "COVID-19" or "SARS-CoV-2" or "coronavirus" and "autoimmune disease". RESULTS This review evaluates the effect of SARS-CoV-2 on the immune system through ACE-2 receptor binding as the main pathway for cell attachment and invasion. It is speculated that SARS-COV-2 infection can activate lymphocytes and inflammatory response, which may play a role in the clinical onset of AIDs and also patients were treated with immunomodulatory drugs during COVID-19 outbreak. Preliminary studies suggested that the risk of developing severe forms of COVID-19 in patients with AIDs treated with immunomodulators or biologics might not increase. A large number of samples are needed for further verification, leading to an excessive immune response to external stimuli. CONCLUSION The relationship between autoimmune diseases and SARS-CoV-2 infection is complex. During the COVID-19 epidemic, individualized interventions for AIDs should be provided such as Internet-based service.
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Affiliation(s)
- Juan Li
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Meishan Road 81, Hefei, 230032, Anhui, People's Republic of China
- Medical Data Processing Center of School of Public Health of Anhui Medical University, Anhui Medical University, Hefei, China
| | - Hong-Hui Liu
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Meishan Road 81, Hefei, 230032, Anhui, People's Republic of China
- Medical Data Processing Center of School of Public Health of Anhui Medical University, Anhui Medical University, Hefei, China
| | - Xiao-Dong Yin
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Meishan Road 81, Hefei, 230032, Anhui, People's Republic of China
- Medical Data Processing Center of School of Public Health of Anhui Medical University, Anhui Medical University, Hefei, China
| | - Cheng-Cheng Li
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Meishan Road 81, Hefei, 230032, Anhui, People's Republic of China
- Medical Data Processing Center of School of Public Health of Anhui Medical University, Anhui Medical University, Hefei, China
| | - Jing Wang
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Meishan Road 81, Hefei, 230032, Anhui, People's Republic of China.
- Medical Data Processing Center of School of Public Health of Anhui Medical University, Anhui Medical University, Hefei, China.
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27
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Ferreira RJO, Welsing PMJ, Jacobs JWG, Gossec L, Ndosi M, Machado PM, van der Heijde D, Da Silva JAP. Revisiting the use of remission criteria for rheumatoid arthritis by excluding patient global assessment: an individual meta-analysis of 5792 patients. Ann Rheum Dis 2021; 80:293-303. [PMID: 33023964 DOI: 10.1136/annrheumdis-2020-217171] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Revised: 08/29/2020] [Accepted: 09/03/2020] [Indexed: 01/01/2023]
Abstract
OBJECTIVES To determine the impact of excluding patient global assessment (PGA) from the American College of Rheumatology (ACR)/European League Against Rheumatism (EULAR) Boolean remission criteria, on prediction of radiographic and functional outcome of rheumatoid arthritis (RA). METHODS Meta-analyses using individual patient data from randomised controlled trials testing the efficacy of biological agents on radiographic and functional outcomes at ≥2 years. Remission states were defined by 4 variants of the ACR/EULAR Boolean definition: (i) tender and swollen 28-joint counts (TJC28/SJC28), C reactive protein (CRP, mg/dL) and PGA (0-10=worst) all ≤1 (4V-remission); (ii) the same, except PGA >1 (4V-near-remission); (iii) 3V-remission (i and ii combined; similar to 4V, but without PGA); (iv) non-remission (TJC28 >1 and/or SJC28 >1 and/or CRP >1). The most stringent class achieved at 6 or 12 months was considered. Good radiographic (GRO) and functional outcome (GFO) were defined as no worsening (ie, change in modified total Sharp score (ΔmTSS) ≤0.5 units and ≤0.0 Health Assessment Questionnaire-Disability Index points, respectively, during the second year). The pooled probabilities of GRO and GFO for the different definitions of remission were estimated and compared. RESULTS Individual patient data (n=5792) from 11 trials were analysed. 4V-remission was achieved by 23% of patients and 4V-near-remission by 19%. The probability of GRO in the 4V-near-remission group was numerically, but non-significantly, lower than that in the 4V-remission (78 vs 81%) and significantly higher than that for non-remission (72%; difference=6%, 95% CI 2% to 10%). Applying 3V-remission could have prevented therapy escalation in 19% of all participants, at the cost of an additional 6.1%, 4.0% and 0.7% of patients having ΔmTSS >0.0, >0.5 and >5 units over 2 years, respectively. The probability of GFO (assessed in 8 trials) in 4V-near-remission (67%, 95% CI 63% to 71%) was significantly lower than in 4V-remission (78%, 74% to 81%) and similar to non-remission (69%, 66% to 72%). CONCLUSION 4V-near-remission and 3V-remission have similar validity as the original 4V-remission definition in predicting GRO, despite expected worse prediction of GFO, while potentially reducing the risk of overtreatment. This supports further exploration of 3V-remission as the target for immunosuppressive therapy complemented by patient-oriented targets.
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Affiliation(s)
- Ricardo J O Ferreira
- Rheumatology, Centro Hospitalar e Universitário de Coimbra EPE, Coimbra, Portugal.,Health Sciences Research Unit: Nursing (UICISA: E), Escola Superior de Enfermagem de Coimbra, Coimbra, Portugal
| | - Paco M J Welsing
- Rheumatology and Clinical Immunology, UMC Utrecht, Utrecht, The Netherlands
| | | | - Laure Gossec
- Institut Pierre Louis d'Epidémiologie et de Santé Publique, INSERM, Sorbonne Université, Paris, France.,Rheumatology, Pitié Salpêtrière Hospital, AP-HP, Paris, France
| | - Mwidimi Ndosi
- Faculty of Health and Applied Sciences, University of the West of England Bristol, Bristol, UK
| | - Pedro M Machado
- Centre for Rheumatology & Department of Neuromuscular Diseases, University College London, London, UK.,Rheumatology, University College London Hospitals NHS Foundation Trust, London, UK.,Rheumatology, Northwick Park Hospital, London North west UniversityHealthcare NHS Trust, London, UK
| | | | - Jose A P Da Silva
- Rheumatology, Centro Hospitalar e Universitário de Coimbra EPE, Coimbra, Portugal .,Clínica Universitária de Reumatologia, and i-CBR Coimbra Institute for Clinical and Biological Research, Faculty of Medicine, University of Coimbra, Coimbra, Portugal
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28
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Cui K, Movahedi M, Bombardier C, Kuriya B. Cardiovascular risk factors are negatively associated with rheumatoid arthritis disease outcomes. Ther Adv Musculoskelet Dis 2021; 13:1759720X20981217. [PMID: 33643444 PMCID: PMC7890714 DOI: 10.1177/1759720x20981217] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Accepted: 11/20/2020] [Indexed: 11/17/2022] Open
Abstract
Aims: Rheumatoid arthritis (RA) is associated with cardiovascular disease (CVD), but the influence of CVD risk factors on RA outcomes is limited. We examined if CVD risk factors alone are associated with RA disease activity and disability. Methods: We performed a cross-sectional analysis of participants in the Ontario Best Practices Research Initiative, RA registry. Patients were categorized into mutually exclusive CVD categories: (1) No established CVD and no CVD risk factors; (2) CVD risk factors only including ⩾1 of hypertension, dyslipidemia, diabetes, or smoking; or (3) history of established CVD event. Multivariable regression analyses examined the effect of CVD status on Disease Activity Score 28 (DAS28-ESR), Clinical Disease Activity Index (CDAI), and Health Assessment Questionnaire Disability Index (HAQ-DI) scores at baseline. Results: Of 2033 patients, 50% had at least 1 CVD risk factor, even in the absence of established CVD. The presence of ⩾1 CVD risk factor was independently associated with higher CDAI [β coefficient 1.59, 95% confidence interval (CI) 0.29–2.90, p = 0.02], DAS28-ESR (β coefficient 0.20, 95% CI 0.06–0.34, p = 0.01) and HAQ-DI scores (β coefficient 0.15, 95% CI 0.08–0.22, p < 0.0001). The total number of CVD risk factors displayed a dose response, as >1 CVD risk factor was associated with higher disease activity and disability, compared with having one or no CVD risk factors. Conclusion: CVD risk factors alone, or in combination, are associated with higher disease activity and disability in RA. This emphasizes the importance of risk factor recognition and management, not only to prevent CVD, but also to improve potential RA outcomes.
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Affiliation(s)
- Kangping Cui
- Division of Rheumatology, University of Toronto, Toronto, Ontario, Canada
| | | | | | - Bindee Kuriya
- Division of Rheumatology, Sinai Health System, University of Toronto, 60 Murray Street, Room 2-008, Toronto, Ontario M5T 3L9, Canada
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29
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Ferreira RJO, de Wit M, Duarte C, da Silva JAP, Ndosi M. Comment on: 'It can't be zero!' difficulties in completing patient global assessment in rheumatoid arthritis: a mixed methods study: reply. Rheumatology (Oxford) 2021; 60:e30-e31. [PMID: 33020820 DOI: 10.1093/rheumatology/keaa488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Accepted: 07/09/2020] [Indexed: 11/14/2022] Open
Affiliation(s)
- Ricardo J O Ferreira
- Rheumatology Department, Centro Hospitalar e Universitário de Coimbra.,Health Sciences Research Unit: Nursing (UICiSA:E), Nursing School of Coimbra (ESEnfC), Coimbra, Portugal
| | - Maarten de Wit
- Patient Research Partner, EULAR Standing Committee of People with Arthritis/Rheumatism in Europe (PARE), Zurich, Switzerland
| | - Cátia Duarte
- Rheumatology Department, Centro Hospitalar e Universitário de Coimbra.,Coimbra Institute for Clinical and Biomedical Research (iCBR), Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - José A P da Silva
- Rheumatology Department, Centro Hospitalar e Universitário de Coimbra.,Coimbra Institute for Clinical and Biomedical Research (iCBR), Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - Mwidimi Ndosi
- Department of Nursing and Midwifery, University of the West of England, Bristol, UK
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30
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Kremer JM, Pappas DA, Kane K, Greenberg J, Harrold LR, Feathers VL, Shadick N, Weinblatt ME, Reed G. The Clinical Disease Activity Index and the Routine Assessment of Patient Index Data 3 for Achievement of Treatment Strategies. J Rheumatol 2020; 48:1776-1783. [PMID: 33323534 DOI: 10.3899/jrheum.200692] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/09/2020] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To compare the Clinical Disease Activity Index (CDAI) with the Routine Assessment of Patient Index Data 3 (RAPID3) from 2 large United States registries. METHODS Using a cross section of clinic visits within 2 registries, we determined whether the outcome of each metric would place the patient in remission (REM), low (LDA), moderate (MDA), or high disease activity (HDA) using the CDAI, with the assumption that a patient in MDA or HDA would be a candidate for acceleration of treatment. RESULTS We identified significant disparities between the 2 indices in final disease categorization using each index system. For patients identified in LDA by CDAI, RAPID3 identified 20.4% and 28.3% as LDA in Corrona and the Brigham and Women's Rheumatoid Arthritis Sequential Study (BRASS), respectively. For patients identified as MDA by CDAI, RAPID3 identified 36.2% and 31.1% as MDA in Corrona and BRASS, respectively, with the greatest disparities within each system identified for LDA and MDA activity by the CDAI (20.4% and 36.2% agreement of RAPID3 with CDAI, respectively, in Corrona and 28.3% and 31.1% agreement in BRASS). Overall comparison between CDAI and RAPID3 in the 4 disease categories resulted in estimated k = 0.285 in both. The RAPID3 scores indicated the potential for treat-to-target acceleration in 34.4% of patients in REM or LDA based on CDAI in Corrona and 27.7% in BRASS, respectively. CONCLUSION The RAPID3, based on patient-reported outcomes, shows differences with CDAI categories of disease activity. The components of CDAI are not highly correlated with RAPID3, except for patient global assessment. These differences could significantly affect the decision to advance treatment when using a treat-to-target regimen.
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Affiliation(s)
- Joel M Kremer
- This study was supported by the Corrona Research Foundation. J.M. Kremer, MD, Albany Medical College and The Center for Rheumatology, Albany, New York; D.A. Pappas, MD, MPH, Columbia University, New York, New York, and Corrona, LLC, Waltham, Massachusetts; K. Kane, MS, G. Reed, PhD, University of Massachusetts Medical School, Worcester, Massachusetts; J. Greenberg, MD, MPH, Corrona, LLC, Waltham, Massachusetts, and New York School of Medicine, New York, New York; L.R. Harrold, MD, MPH, Corrona, LLC, Waltham, and Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts; V.L. Feathers, MS, N. Shadick, MD, MPH, M.E. Weinblatt, MD, Division of Rheumatology, Inflammation, and Immunity, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA. The authors declare no conflicts of interest. Address correspondence to Dr. J.M. Kremer, 9832 Rennes Lane, Delray Beach, FL 33446, USA. . Accepted for publication December 3, 2020
| | - Dimitrios A Pappas
- This study was supported by the Corrona Research Foundation. J.M. Kremer, MD, Albany Medical College and The Center for Rheumatology, Albany, New York; D.A. Pappas, MD, MPH, Columbia University, New York, New York, and Corrona, LLC, Waltham, Massachusetts; K. Kane, MS, G. Reed, PhD, University of Massachusetts Medical School, Worcester, Massachusetts; J. Greenberg, MD, MPH, Corrona, LLC, Waltham, Massachusetts, and New York School of Medicine, New York, New York; L.R. Harrold, MD, MPH, Corrona, LLC, Waltham, and Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts; V.L. Feathers, MS, N. Shadick, MD, MPH, M.E. Weinblatt, MD, Division of Rheumatology, Inflammation, and Immunity, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA. The authors declare no conflicts of interest. Address correspondence to Dr. J.M. Kremer, 9832 Rennes Lane, Delray Beach, FL 33446, USA. . Accepted for publication December 3, 2020
| | - Kevin Kane
- This study was supported by the Corrona Research Foundation. J.M. Kremer, MD, Albany Medical College and The Center for Rheumatology, Albany, New York; D.A. Pappas, MD, MPH, Columbia University, New York, New York, and Corrona, LLC, Waltham, Massachusetts; K. Kane, MS, G. Reed, PhD, University of Massachusetts Medical School, Worcester, Massachusetts; J. Greenberg, MD, MPH, Corrona, LLC, Waltham, Massachusetts, and New York School of Medicine, New York, New York; L.R. Harrold, MD, MPH, Corrona, LLC, Waltham, and Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts; V.L. Feathers, MS, N. Shadick, MD, MPH, M.E. Weinblatt, MD, Division of Rheumatology, Inflammation, and Immunity, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA. The authors declare no conflicts of interest. Address correspondence to Dr. J.M. Kremer, 9832 Rennes Lane, Delray Beach, FL 33446, USA. . Accepted for publication December 3, 2020
| | - Jeffrey Greenberg
- This study was supported by the Corrona Research Foundation. J.M. Kremer, MD, Albany Medical College and The Center for Rheumatology, Albany, New York; D.A. Pappas, MD, MPH, Columbia University, New York, New York, and Corrona, LLC, Waltham, Massachusetts; K. Kane, MS, G. Reed, PhD, University of Massachusetts Medical School, Worcester, Massachusetts; J. Greenberg, MD, MPH, Corrona, LLC, Waltham, Massachusetts, and New York School of Medicine, New York, New York; L.R. Harrold, MD, MPH, Corrona, LLC, Waltham, and Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts; V.L. Feathers, MS, N. Shadick, MD, MPH, M.E. Weinblatt, MD, Division of Rheumatology, Inflammation, and Immunity, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA. The authors declare no conflicts of interest. Address correspondence to Dr. J.M. Kremer, 9832 Rennes Lane, Delray Beach, FL 33446, USA. . Accepted for publication December 3, 2020
| | - Leslie R Harrold
- This study was supported by the Corrona Research Foundation. J.M. Kremer, MD, Albany Medical College and The Center for Rheumatology, Albany, New York; D.A. Pappas, MD, MPH, Columbia University, New York, New York, and Corrona, LLC, Waltham, Massachusetts; K. Kane, MS, G. Reed, PhD, University of Massachusetts Medical School, Worcester, Massachusetts; J. Greenberg, MD, MPH, Corrona, LLC, Waltham, Massachusetts, and New York School of Medicine, New York, New York; L.R. Harrold, MD, MPH, Corrona, LLC, Waltham, and Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts; V.L. Feathers, MS, N. Shadick, MD, MPH, M.E. Weinblatt, MD, Division of Rheumatology, Inflammation, and Immunity, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA. The authors declare no conflicts of interest. Address correspondence to Dr. J.M. Kremer, 9832 Rennes Lane, Delray Beach, FL 33446, USA. . Accepted for publication December 3, 2020
| | - Vivi L Feathers
- This study was supported by the Corrona Research Foundation. J.M. Kremer, MD, Albany Medical College and The Center for Rheumatology, Albany, New York; D.A. Pappas, MD, MPH, Columbia University, New York, New York, and Corrona, LLC, Waltham, Massachusetts; K. Kane, MS, G. Reed, PhD, University of Massachusetts Medical School, Worcester, Massachusetts; J. Greenberg, MD, MPH, Corrona, LLC, Waltham, Massachusetts, and New York School of Medicine, New York, New York; L.R. Harrold, MD, MPH, Corrona, LLC, Waltham, and Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts; V.L. Feathers, MS, N. Shadick, MD, MPH, M.E. Weinblatt, MD, Division of Rheumatology, Inflammation, and Immunity, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA. The authors declare no conflicts of interest. Address correspondence to Dr. J.M. Kremer, 9832 Rennes Lane, Delray Beach, FL 33446, USA. . Accepted for publication December 3, 2020
| | - Nancy Shadick
- This study was supported by the Corrona Research Foundation. J.M. Kremer, MD, Albany Medical College and The Center for Rheumatology, Albany, New York; D.A. Pappas, MD, MPH, Columbia University, New York, New York, and Corrona, LLC, Waltham, Massachusetts; K. Kane, MS, G. Reed, PhD, University of Massachusetts Medical School, Worcester, Massachusetts; J. Greenberg, MD, MPH, Corrona, LLC, Waltham, Massachusetts, and New York School of Medicine, New York, New York; L.R. Harrold, MD, MPH, Corrona, LLC, Waltham, and Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts; V.L. Feathers, MS, N. Shadick, MD, MPH, M.E. Weinblatt, MD, Division of Rheumatology, Inflammation, and Immunity, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA. The authors declare no conflicts of interest. Address correspondence to Dr. J.M. Kremer, 9832 Rennes Lane, Delray Beach, FL 33446, USA. . Accepted for publication December 3, 2020
| | - Michael E Weinblatt
- This study was supported by the Corrona Research Foundation. J.M. Kremer, MD, Albany Medical College and The Center for Rheumatology, Albany, New York; D.A. Pappas, MD, MPH, Columbia University, New York, New York, and Corrona, LLC, Waltham, Massachusetts; K. Kane, MS, G. Reed, PhD, University of Massachusetts Medical School, Worcester, Massachusetts; J. Greenberg, MD, MPH, Corrona, LLC, Waltham, Massachusetts, and New York School of Medicine, New York, New York; L.R. Harrold, MD, MPH, Corrona, LLC, Waltham, and Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts; V.L. Feathers, MS, N. Shadick, MD, MPH, M.E. Weinblatt, MD, Division of Rheumatology, Inflammation, and Immunity, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA. The authors declare no conflicts of interest. Address correspondence to Dr. J.M. Kremer, 9832 Rennes Lane, Delray Beach, FL 33446, USA. . Accepted for publication December 3, 2020
| | - George Reed
- This study was supported by the Corrona Research Foundation. J.M. Kremer, MD, Albany Medical College and The Center for Rheumatology, Albany, New York; D.A. Pappas, MD, MPH, Columbia University, New York, New York, and Corrona, LLC, Waltham, Massachusetts; K. Kane, MS, G. Reed, PhD, University of Massachusetts Medical School, Worcester, Massachusetts; J. Greenberg, MD, MPH, Corrona, LLC, Waltham, Massachusetts, and New York School of Medicine, New York, New York; L.R. Harrold, MD, MPH, Corrona, LLC, Waltham, and Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts; V.L. Feathers, MS, N. Shadick, MD, MPH, M.E. Weinblatt, MD, Division of Rheumatology, Inflammation, and Immunity, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA. The authors declare no conflicts of interest. Address correspondence to Dr. J.M. Kremer, 9832 Rennes Lane, Delray Beach, FL 33446, USA. . Accepted for publication December 3, 2020
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Duarte C, Santos E, da Silva JAP, Kristianslund EK, Kvien TK, Dougados M, de Wit M, Gossec L, Heiberg T. The Patient Experienced Symptom State (PESS): a patient-reported global outcome measure that may better reflect disease remission status. Rheumatology (Oxford) 2020; 59:3458-3467. [PMID: 32375173 DOI: 10.1093/rheumatology/keaa149] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Revised: 02/28/2020] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES In RA, Patient Acceptable Symptom State assesses disease from the patient's perspective, which does not correspond either to disease remission or to full control of disease impact. This study aims to explore the properties of a novel multilevel Patient Experienced Symptom State (PESS). METHODS This was a cross-sectional analysis of two datasets of patients with RA. PESS was assessed through the question: 'Consider how your RA has affected you. If you remain in the coming months as you have been the last week, how would you rate your condition?', with five levels (from 'very bad' to 'very good'). Construct validity of PESS was assessed against validated disease activity [DAS28, Simplified Disease Activity Index (SDAI) and Clinical Disease Activity Index (CDAI)] and impact measures [RA Impact of Disease (RAID) and modified HAQ]. Multiple pairwise comparisons between groups and receiver-operating characteristic curves with Youden Index were performed. RESULTS A total of 1407 patients [74% female, mean (S.d.) age 53.5 (13.4) years, mean disease duration 14.3 (12.0) years and mean DAS28 3.0 (1.5)] were analysed. Overall, 16.3% considered themselves as being in 'very good', 21.6% in 'good' and 31.9% in 'acceptable' state. Disease activity and impact measures differed significantly across the five levels (P < 0.01). Cut-off values corresponding to 'good' and 'very good' PESS states were in the range of low disease activity/remission (for 'good' and 'very good': DAS28-ESR-4v ≤2.6/≤2.3; CDAI ≤5.0/≤3.1; SDAI ≤5.1/≤3.8, respectively) and very low disease impact (RAID domains all ≤1). CONCLUSION PESS 'very good' status corresponds to currently recommended targets for RA management and reflects full control of disease impact. PESS appears to be an easy-to-use and relevant measure in the evaluation of patients with RA.
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Affiliation(s)
- Cátia Duarte
- Department of Rheumatology, Centro Hospitalar e Universitário de Coimbra, Coimbra.,Coimbra Institute for Clinical and Biomedical Research - Faculty of Medicine, University of Coimbra, Coimbra
| | - Eduardo Santos
- Department of Rheumatology, Centro Hospitalar e Universitário de Coimbra, Coimbra.,Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto, Porto.,Health Sciences Research Unit: Nursing, Nursing School of Coimbra, Coimbra, Portugal
| | - José A P da Silva
- Department of Rheumatology, Centro Hospitalar e Universitário de Coimbra, Coimbra.,Coimbra Institute for Clinical and Biomedical Research - Faculty of Medicine, University of Coimbra, Coimbra
| | | | - Tore K Kvien
- Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
| | - Maxime Dougados
- Université de Paris, Paris.,Department of Rheumatology, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, Paris.,INSERM (U1153): Clinical Epidemiology and Biostatistics, PRES Sorbonne Paris-Cité, Paris, France
| | | | - Laure Gossec
- INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Sorbonne Université, Paris.,Rheumatology Department, Pitié Salpêtrière Hospital, Sorbone Univeristé-AP-HP, Paris, France
| | - Turid Heiberg
- Faculty of Health and Welfare, Østfold University College, Halden.,Regional Research Support, Oslo University Hospital, Oslo, Norway
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Carvajal Bedoya G, Davis LA, Hirsh JM. Patient-Reported Outcomes in Rheumatology Patients With Limited English Proficiency and Limited Health Literacy. Arthritis Care Res (Hoboken) 2020; 72 Suppl 10:738-749. [PMID: 33091257 DOI: 10.1002/acr.24243] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Accepted: 04/28/2020] [Indexed: 12/13/2022]
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Bozzalla Cassione E, Zanframundo G, Biglia A, Codullo V, Montecucco C, Cavagna L. Response to: ‘Experience of telemedicine use in a big cohort of patients with rheumatoid arthritis during COVID-19 pandemic’ by Santos-Moreno et al. Ann Rheum Dis 2020; 80:e66. [DOI: 10.1136/annrheumdis-2020-218193] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Accepted: 06/08/2020] [Indexed: 11/03/2022]
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Bugatti S, De Stefano L, Favalli EG, Caporali R, Montecucco C. Increasing the threshold for patient global assessment in defining remission may have a different impact in patients with early and established rheumatoid arthritis. Ann Rheum Dis 2020; 81:e55. [PMID: 32312769 DOI: 10.1136/annrheumdis-2020-217488] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 04/03/2020] [Indexed: 11/04/2022]
Affiliation(s)
- Serena Bugatti
- Department of Internal Medicine and Therapeutics, University of Pavia, Pavia, Lombardia, Italy .,Division of Rheumatology, IRCCS S Matteo, Pavia, Lombardia, Italy
| | - Ludovico De Stefano
- Department of Internal Medicine and Therapeutics, University of Pavia, Pavia, Lombardia, Italy.,Division of Rheumatology, IRCCS S Matteo, Pavia, Lombardia, Italy
| | | | - Roberto Caporali
- Department of Rheumatology, Gaetano Pini-CTO, Milano, Lombardia, Italy.,Department of Clinical Sciences and Community Health, University of Milan, Milano, Lombardia, Italy
| | - Carlomaurizio Montecucco
- Department of Internal Medicine and Therapeutics, University of Pavia, Pavia, Lombardia, Italy.,Division of Rheumatology, IRCCS S Matteo, Pavia, Lombardia, Italy
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Studenic P, Felson D, de Wit M, Alasti F, Stamm TA, Smolen JS, Aletaha D. Testing different thresholds for patient global assessment in defining remission for rheumatoid arthritis: are the current ACR/EULAR Boolean criteria optimal? Ann Rheum Dis 2020; 79:445-452. [PMID: 32024651 PMCID: PMC10564460 DOI: 10.1136/annrheumdis-2019-216529] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Revised: 12/21/2019] [Accepted: 01/22/2020] [Indexed: 12/21/2022]
Abstract
OBJECTIVES This study aimed to evaluate different patient global assessment (PGA) cut-offs required in the American College of Rheumatology/European League Against Rheumatism (ACR/EULAR) Boolean remission definition for their utility in rheumatoid arthritis (RA). METHODS We used data from six randomised controlled trials in early and established RA. We increased the threshold for the 0-10 score for PGA gradually from 1 to 3 in steps of 0.5 (Boolean1.5 to Boolean3.0) and omitted PGA completely (BooleanX) at 6 and 12 months. Agreement with the index-based (Simplified Disease Activity Index (SDAI)) remission definition was analysed using kappa, recursive partitioning (classification and regression tree (CART)) and receiver operating characteristics. The impact of achieving each definition on functional and radiographic outcomes after 1 year was explored. RESULTS Data from 1680 patients with early RA and 920 patients with established RA were included. The proportion of patients achieving Boolean remission increased with higher thresholds for PGA from 12.4% to 19.7% in early and 5.9% to 12.3% in established RA at 6 months. Best agreement with SDAI remission occurred at PGA cut-offs of 1.5 and 2.0, while agreement decreased with higher PGA (CART: optimal agreement at PGA≤1.6 cm; sensitivity of PGA≤1.5 95%). Changing PGA thresholds at 6 months did not affect radiographic progression at 12 months (mean ꙙsmTSS for Boolean, 1.5, 2.0, 2.5, 3.0, BooleanX: 0.35±5.4, 0.38±5.14, 0.41±5.1, 0.37±4.9, 0.34±4.9, 0.27±4.7). However, the proportion attaining HAQ≤0.5 was 90.2%, 87.9%, 85.2%, 81.1%, 80.7% and 73.1% for the respective Boolean definitions. CONCLUSION Increasing the PGA cut-off to 1.5 cm would provide high consistency between Boolean with the index-based remission; the integer cut-off of 2.0 cm performed similarly.
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Affiliation(s)
- Paul Studenic
- Department of Internal Medicine 3, Division of Rheumatology, Medical University of Vienna, Wien, Austria
| | - David Felson
- Section of Rheumatology, Boston University School of Medicine, Boston, Massachusetts, USA
- Centre for Epidemiology, The University of Manchester, Manchester, UK
| | - Maarten de Wit
- Standing Committee of People with Arthritis/Rheumatism in Europe (PARE), EULAR, Zurich, Switzerland
| | - Farideh Alasti
- Department of Internal Medicine 3, Division of Rheumatology, Medical University of Vienna, Wien, Austria
| | - Tanja A Stamm
- Center for Medical Statistics, Informatics, and Intelligent Systems, Section for Outcomes Research, Medical University of Vienna, Wien, Austria
| | - Josef S Smolen
- Department of Internal Medicine 3, Division of Rheumatology, Medical University of Vienna, Wien, Austria
| | - Daniel Aletaha
- Department of Internal Medicine 3, Division of Rheumatology, Medical University of Vienna, Wien, Austria
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Ferreira RJO, Santos EJF, de Wit M, Marques A, Barbieri-Figueiredo MDC, Marques A, Ventura F, da Silva JAP, Ndosi M. Shared decision-making in people with chronic disease: Integrating the biological, social and lived experiences is a key responsibility of nurses. Musculoskeletal Care 2020; 18:84-91. [PMID: 31837252 DOI: 10.1002/msc.1443] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Revised: 10/22/2019] [Accepted: 10/23/2019] [Indexed: 06/10/2023]
Affiliation(s)
- Ricardo J O Ferreira
- Rheumatology Department, Centro Hospitalar e Universitário de Coimbra (CHUC), Coimbra, Portugal
- Health Sciences Research Unit: Nursing (UICISA: E), Nursing School of Coimbra (ESEnfC), Coimbra, Portugal
| | - Eduardo J F Santos
- Rheumatology Department, Centro Hospitalar e Universitário de Coimbra (CHUC), Coimbra, Portugal
- Health Sciences Research Unit: Nursing (UICISA: E), Nursing School of Coimbra (ESEnfC), Coimbra, Portugal
- Abel Salazar Institute of Biomedical Sciences, University of Porto, Porto, Portugal
| | - Maarten de Wit
- Patient research partner, EULAR Standing Committee of People with Arthritis/Rheumatism in Europe, Zurich, Switzerland
- Department of Medical Humanities, Amsterdam University Medical Centre, Amsterdam, The Netherlands
| | - Andréa Marques
- Rheumatology Department, Centro Hospitalar e Universitário de Coimbra (CHUC), Coimbra, Portugal
- Health Sciences Research Unit: Nursing (UICISA: E), Nursing School of Coimbra (ESEnfC), Coimbra, Portugal
- Nursing School of Coimbra, Coimbra, Portugal
| | - Maria do Céu Barbieri-Figueiredo
- Abel Salazar Institute of Biomedical Sciences, University of Porto, Porto, Portugal
- Nursing School of Porto, Porto, Portugal
- CINTESIS - Center for Health Technology and Services Research, University of Porto, Porto, Portugal
| | - António Marques
- Health Sciences Research Unit: Nursing (UICISA: E), Nursing School of Coimbra (ESEnfC), Coimbra, Portugal
- AGI médica I, Centro Hospitalar e Universitário de Coimbra (CHUC), Coimbra, Portugal
| | - Filipa Ventura
- Health Sciences Research Unit: Nursing (UICISA: E), Nursing School of Coimbra (ESEnfC), Coimbra, Portugal
| | - José A P da Silva
- Rheumatology Department, Centro Hospitalar e Universitário de Coimbra (CHUC), Coimbra, Portugal
- Coimbra Institute for Clinical and Biomedical Research (iCBR) - Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - Mwidimi Ndosi
- Department of Nursing and Midwifery, University of the West of England, Bristol, UK
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Hirsh J, Wood P, Keniston A, Boyle D, Quinzanos I, Caplan L, Davis L. Universal Health Literacy Precautions Are Associated With a Significant Increase in Medication Adherence in Vulnerable Rheumatology Patients. ACR Open Rheumatol 2020; 2:110-118. [PMID: 31957348 PMCID: PMC7011426 DOI: 10.1002/acr2.11108] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Accepted: 11/07/2019] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVE Our objective was to determine the impact of the Health Literacy Universal Precautions Toolkit, adapted for rheumatology, on medication adherence, patient satisfaction, and feasibility in all patients; its effect on the clinical disease activity index (CDAI) was studied in a rheumatoid arthritis (RA) subpopulation. METHODS Data collected during a 6-month prospective quality assurance intervention was compared with data from a prior 6-month period. Interventions included 1) encouraging questions, 2) teach-back communication, and 3) brown-bag medication review. Analysis was performed using linear regression or generalized estimating equation (GEE) regression. RESULTS During the intervention period, 46 physicians completed 1737 patient visits. Questions were encouraged, and teach-back communication was performed in more than 90% of visits. Brown-bag medication reviews were performed in 47% of visits overall and 69% of visits in a subgroup that received additional reminder calls. Visit duration and patient satisfaction were not significantly increased. Adherence for rheumatology-related medications that were prescribed both before and during the intervention increased by 22% (P ≤ 0.001; by GEE). Teach-back communication predicted a statistically significant improvement in medication adherence in this subpopulation (by linear regression). The mean CDAI did not improve; however, African American race and Hispanic ethnicity were associated with a decreased CDAI (by GEE). CONCLUSION Implementation of the Health Literacy Universal Precautions Toolkit, adapted for rheumatology, improved medication adherence in our safety-net clinic, with particularly strong effects seen with teach-back communication. In certain populations, use of the toolkit may also improve RA disease activity. This is the first study to document improved medication adherence with this intervention in a real-world setting.
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Affiliation(s)
- Joel Hirsh
- Denver Health and Hospital Authority, University of Colorado Medical School, Denver, Aurora, Colorado
| | - Patrick Wood
- Denver Veterans Affairs and Medical Center, University of Colorado Medical School, Aurora, Colorado
| | - Angela Keniston
- Denver Health and Hospital Authority, University of Colorado Medical School, Denver, Aurora, Colorado
| | - Dennis Boyle
- Denver Health and Hospital Authority, University of Colorado Medical School, Denver, Aurora, Colorado
| | - Itziar Quinzanos
- Denver Health and Hospital Authority, University of Colorado Medical School, Denver, Aurora, Colorado
| | - Liron Caplan
- Denver Veterans Affairs and Medical Center, University of Colorado Medical School, Aurora, Colorado
| | - Lisa Davis
- Denver Health and Hospital Authority, University of Colorado Medical School, Denver, Aurora, Colorado
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Craig ET, Perin J, Zeger S, Curtis JR, Bykerk VP, Bingham CO, Bartlett SJ. What Does the Patient Global Health Assessment in Rheumatoid Arthritis Really Tell Us? Contribution of Specific Dimensions of Health-Related Quality of Life. Arthritis Care Res (Hoboken) 2019; 72:1571-1578. [PMID: 31549772 DOI: 10.1002/acr.24073] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Accepted: 09/17/2019] [Indexed: 01/09/2023]
Abstract
OBJECTIVE To estimate the contributions of health-related quality of life domains to the patient global assessment of disease activity (PtGA) in rheumatoid arthritis (RA). METHODS Data are drawn from baseline visits of 2 observational RA cohorts. Participants completed forms for patient-reported outcome measures, including PtGA and measures from the Patient-Reported Outcomes Measurement Information System, and clinical data were collected. Factor analysis was used to identify latent variables, and multivariable linear regression was used to estimate determinants of the PtGA. RESULTS Patients were mostly female (81%), white (78%), and had established disease (mean ± SD 12.3 ± 10.7 years), with 62% in remission or having low disease activity. In cohort 1 (n = 196), the following 2 factors emerged: 1) daily function (moderate-to-strong [i.e., >|0.65|] loadings of physical function, pain interference, social participation, and fatigue, and weak [>0.35] loadings of sleep disturbance); and 2) emotional distress (strong loadings of depression and anxiety). In crude analysis, daily function explained up to 53% and emotional distress up to 20% of the variance in PtGA. In both cohorts, in adjusted analyses, daily function and, to a much lesser extent, swollen joint count independently predicted PtGA; age was inversely related to PtGA in cohort 1 only. CONCLUSION These findings suggest that in patients with RA, PtGA ratings largely reflect the extent to which patients feel they can function in everyday roles and are not impacted by mood. This suggests that higher than expected PtGA scores may offer an opportunity to discuss patient expectations regarding roles and activities and the impact of their RA symptoms on daily function.
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Affiliation(s)
- Ethan T Craig
- Johns Hopkins University School of Medicine, Baltimore, Maryland, and University of Pennsylvania and Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia
| | - Jamie Perin
- Johns Hopkins University, Baltimore, Maryland
| | - Scott Zeger
- Johns Hopkins University, Baltimore, Maryland
| | | | | | | | - Susan J Bartlett
- Johns Hopkins University School of Medicine, Baltimore, Maryland, and McGill University and Research Institute of McGill University Health Centers, Montreal, Quebec, Canada
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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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