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Regierer AC, Kiefer D, Schett G, Krause A, Weiß A, Sewerin P, Strangfeld A. No difference in clinical parameters and drug retention in PsA patients receiving b/tsDMARD monotherapy versus combination with methotrexate: data from the RABBIT-SpA registry. RMD Open 2024; 10:e004389. [PMID: 39043613 PMCID: PMC11268072 DOI: 10.1136/rmdopen-2024-004389] [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: 04/04/2024] [Accepted: 07/04/2024] [Indexed: 07/25/2024] Open
Abstract
BACKGROUND The potential benefit of methotrexate (MTX) in combination with biologic (b) and targeted synthetic (ts) disease modifying anti-rheumatic drugs (DMARDs) in psoriatic arthritis (PsA) is still a matter of debate. OBJECTIVES To compare clinical and patient reported characteristics as well as drug retention rates in PsA patients receiving b/tsDMARD monotherapy or in combination with MTX. METHODS RABBIT-SpA is a prospective longitudinal cohort study including axSpA and PsA patients. In this analysis, PsA patients were stratified into two groups: starting b/tsDMARD as monotherapy or in combination with MTX. Treatment retention was compared by drug survival analysis. RESULTS 69% of the patients (n=900) started b/tsDMARD as monotherapy while 31% were treated in combination with MTX (n=405). At baseline, clinical domains like skin, nail and joint affection, dactylitis, enthesitis and axial involvement were similar between the groups. Only the patients' satisfaction concerning tolerability of the previous treatment was significantly better in the combination group at treatment start. Drug retention rates did not differ between the groups (p=0.4). At 6/12 months, 66%/48% of patients in monotherapy and 67%/48% in the combination group were still on their original treatment. CONCLUSIONS We did not identify any clinical parameters with notable influence on the choice of b/tsDMARD mono or MTX-combination therapy in PsA. Drug retention rates are similar between mono and combination therapy. It seems that the decision to continue MTX at initiation of b/tsDMARDs is mostly based on the subjective tolerability of MTX treatment.
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Affiliation(s)
| | - David Kiefer
- Rheumazentrum Ruhrgebiet, Herne, Germany
- Ruhr-Universität Bochum Medizinische Fakultät, Bochum, Germany
| | - Georg Schett
- Department of Internal Medicine 3, University of Erlangen-Nuremberg, Erlangen, Germany
- Deutsches Zentrum Immuntherapie, Universitätsklinikum Erlangen, Erlangen, Germany
| | - Andreas Krause
- Department of Rheumatology, Clinical Immunology and Osteology, Immanuel Hospital Berlin-Wannsee Branch, Berlin, Germany
| | - Anja Weiß
- Epidemiology Unit, German Rheumatism Research Center Berlin, Berlin, Germany
| | - Philipp Sewerin
- Ruhr University Bochum, Bochum, Germany
- Hiller Research Center, University Hospital of Düsseldorf, Dusseldorf, Germany
| | - Anja Strangfeld
- Epidemiology Unit, German Rheumatism Research Center Berlin, Berlin, Germany
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Sloan M, Wincup C, Harwood R, Pollak TA, Massou E, Bosley M, Pitkanen M, Zandi MS, Leschziner G, Barrere C, Ubhi M, Andreoli L, Brimicombe J, Diment W, Jayne D, Gordon C, Naughton F, D’Cruz D. Prevalence and identification of neuropsychiatric symptoms in systemic autoimmune rheumatic diseases: an international mixed methods study. Rheumatology (Oxford) 2024; 63:1259-1272. [PMID: 37491699 PMCID: PMC11065444 DOI: 10.1093/rheumatology/kead369] [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: 05/04/2023] [Revised: 06/16/2023] [Accepted: 07/14/2023] [Indexed: 07/27/2023] Open
Abstract
OBJECTIVE A limited range of neuropsychiatric symptoms have been reported in systemic autoimmune rheumatic diseases (SARDs), with varied symptom prevalence. This study aimed to investigate a wider range of potential symptoms than previous studies, compare patient self-reports with clinician estimates, and explore barriers to symptom identification. METHODS Mixed methods were used. Data from SARDs patients (n = 1853) were compared with controls (n = 463) and clinicians (n = 289). In-depth interviews (n = 113) were analysed thematically. Statistical tests compared means of survey items between patients and controls, 8 different SARD groups, and clinician specialities. RESULTS Self-reported lifetime prevalences of all 30 neuropsychiatric symptoms investigated (including cognitive, sensorimotor and psychiatric) were significantly higher in SARDs than controls. Validated instruments assessed 55% of SARDs patients as currently having depression and 57% anxiety. Barriers to identifying neuropsychiatric symptoms included: (i) limits to knowledge, guidelines, objective tests and inter-speciality cooperation; (ii) subjectivity, invisibility and believability of symptoms; and (iii) under-eliciting, under-reporting and under-documenting. A lower proportion of clinicians (4%) reported never/rarely asking patients about mental health symptoms than the 74% of patients who reported never/rarely being asked in clinic (P < 0.001). Over 50% of SARDs patients had never/rarely reported their mental health symptoms to clinicians, a proportion underestimated at <10% by clinicians (P < 0.001). CONCLUSION Neuropsychiatric symptom self-reported prevalences are significantly higher in SARDs than controls, and are greatly underestimated by most clinicians. Research relying on medical records and current guidelines is unlikely to accurately reflect patients' experiences of neuropsychiatric symptoms. Improved inter-speciality communication and greater patient involvement is needed in SARD care and research.
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Affiliation(s)
- Melanie Sloan
- Department of Public Health and Primary Care Unit, University of Cambridge, Cambridge, UK
| | - Chris Wincup
- Department of Rheumatology, King’s College Hospital London, London, UK
| | - Rupert Harwood
- Swansea University Medical School, Swansea University, Swansea, UK
| | - Thomas A Pollak
- Institute of Psychiatry, Psychology and Neuroscience, King’s College London, and SLAM NHS Foundation Trust, London, UK
| | - Efhalia Massou
- Department of Public Health and Primary Care Unit, University of Cambridge, Cambridge, UK
| | | | - Mervi Pitkanen
- Institute of Psychiatry, Psychology and Neuroscience, King’s College London, and SLAM NHS Foundation Trust, London, UK
| | - Michael S Zandi
- Department of Neuroinflammation, UCL Queen Square Institute of Neurology, University College London, London, UK
| | - Guy Leschziner
- Department of Neurology, Guy’s and St Thomas’ Hospitals NHS Foundation Trust, London, UK
| | | | - Mandeep Ubhi
- Rheumatology Research Group, Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Laura Andreoli
- Unit of Rheumatology and Clinical Immunology, ASST Spedali Civili, Brescia, Italy
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - James Brimicombe
- Department of Public Health and Primary Care Unit, University of Cambridge, Cambridge, UK
| | | | - David Jayne
- Department of Medicine, University of Cambridge, Cambridge, UK
| | - Caroline Gordon
- Rheumatology Research Group, Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Felix Naughton
- Behavioural and Implementation Science Group, School of Health Sciences, University of East Anglia, Norwich, UK
| | - David D’Cruz
- The Louise Coote Lupus Unit, Guy’s and St Thomas’ Hospitals NHS Foundation Trust, London, UK
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Sloan M, Andreoli L, Zandi MS, Harwood R, Pitkanen M, Sloan S, Barrere C, Massou E, Wincup C, Bosley M, Naughton F, Ubhi M, Jayne D, Leschziner G, Brimicombe J, Diment W, Middleton K, Gordon C, D'Cruz D, Pollak TA. Attribution of neuropsychiatric symptoms and prioritisation of evidence in the diagnosis of neuropsychiatric lupus: mixed methods analysis of patient and clinician perspectives from the international INSPIRE study. Rheumatology (Oxford) 2023:kead685. [PMID: 38105443 DOI: 10.1093/rheumatology/kead685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 11/20/2023] [Accepted: 12/04/2023] [Indexed: 12/19/2023] Open
Abstract
OBJECTIVE Neuropsychiatric lupus (NPSLE) is challenging to diagnose. Many neuropsychiatric symptoms, such as headache and hallucinations, cannot be verified by tests or clinician assessment. We investigated prioritisations of methods for diagnosing NPSLE and attributional views. METHODS Thematic and comparative analyses were used to investigate how clinicians prioritise sources of evidence from a 13-item list, and explore discordances in clinician and patient perspectives on attribution. RESULTS We identified high levels of variability and uncertainty in clinicians' assessments of neuropsychiatric symptoms in SLE patients. In attributional decisions, clinicians (surveys n = 400, interviews n = 50) ranked clinicians' assessments above diagnostic tests (many of which they reported were often unenlightening in NPSLE). Clinicians ranked patient opinion of disease activity last, and 46% of patients reported never/rarely having been asked if their SLE was flaring, despite experienced patients often having "attributional insight". SLE Patients (surveys n = 676, interviews n = 27) estimated higher attributability of neuropsychiatric symptoms to the direct effects of SLE on the nervous system than clinicians (p < 0.001 for all symptoms excluding mania), and 24% reported that their self-assessment of disease activity was never/rarely concordant with their clinicians. Reports of misattributions were common, particularly of non-verifiable diffuse symptoms. Terminology differed between clinicians and influenced attribution estimates. CONCLUSION NPSLE diagnostic tests and clinician assessments have numerous limitations, particularly in detecting diffuse neuropsychiatric symptoms that can be directly attributable and benefit from immunosuppression. Our findings suggest that incorporating patient attributional insights-although also subject to limitations-may improve attribution decision-making. Consensus regarding terminology and interpretations of "direct attributability" is required.
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Affiliation(s)
- Melanie Sloan
- Department of Public Health and Primary Care Unit, University of Cambridge, Cambridge, UK
| | - Laura Andreoli
- Unit of Rheumatology and Clinical Immunology, ASST Spedali Civili; Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Michael S Zandi
- Department of Neuroinflammation, UCL Queen Square Institute of Neurology, University College London, London, UK
| | | | - Mervi Pitkanen
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, and South London and Maudsley NHS Foundation trust, London, UK
| | - Sam Sloan
- Brighton and Sussex Medical school, University of Sussex, Brighton, UK
| | | | - Efthalia Massou
- Department of Public Health and Primary Care Unit, University of Cambridge, Cambridge, UK
| | - Chris Wincup
- Department of Rheumatology, Kings College Hospital London, London, UK
| | | | - Felix Naughton
- Behavioural and Implementation Science Group, School of Health Sciences, University of East Anglia, Norwich, UK
| | - Mandeep Ubhi
- Rheumatology Research Group, Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - David Jayne
- Department of Medicine, University of Cambridge, Cambridge, UK
| | - Guy Leschziner
- Department of Neurology, Guy's and St Thomas' Hospitals NHS Foundation Trust, London, UK
| | - James Brimicombe
- Department of Public Health and Primary Care Unit, University of Cambridge, Cambridge, UK
| | | | | | - Caroline Gordon
- Rheumatology Research Group, Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - David D'Cruz
- The Louise Coote Lupus Unit, Guy's and St Thomas' Hospitals NHS Foundation Trust, London, UK
| | - Thomas A Pollak
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, and South London and Maudsley NHS Foundation trust, London, UK
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Dures E, Farisoğulları B, Santos EJF, Molto A, Feldthusen C, Harris C, Elling-Audersch C, Connolly D, Elefante E, Estévez-López F, Bini I, Primdahl J, Hoeper K, Urban M, van de Laar MAFJ, Redondo M, Böhm P, Amarnani R, Hayward R, Geenen R, Rednic S, Pettersson S, Thomsen T, Uhlig T, Ritschl V, Machado PM. 2023 EULAR recommendations for the management of fatigue in people with inflammatory rheumatic and musculoskeletal diseases. Ann Rheum Dis 2023:ard-2023-224514. [PMID: 38050029 DOI: 10.1136/ard-2023-224514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 11/01/2023] [Indexed: 12/06/2023]
Abstract
OBJECTIVES Fatigue is prevalent in people with inflammatory rheumatic and musculoskeletal diseases (I-RMDs) and recognised as one of the most challenging symptoms to manage. The existence of multiple factors associated with driving and maintaining fatigue, and the evidence about what improves fatigue has led to a multifaceted approach to its management. However, there are no recommendations for fatigue management in people with I-RMDs. This lack of guidance is challenging for those living with fatigue and health professionals delivering clinical care. Therefore, our aim was to develop EULAR recommendations for the management of fatigue in people with I-RMDs. METHODS A multidisciplinary taskforce comprising 26 members from 14 European countries was convened, and two systematic reviews were conducted. The taskforce developed the recommendations based on the systematic review of evidence supplemented with taskforce members' experience of fatigue in I-RMDs. RESULTS Four overarching principles (OAPs) and four recommendations were developed. OAPs include health professionals' awareness that fatigue encompasses multiple biological, psychological and social factors which should inform clinical care. Fatigue should be monitored and assessed, and people with I-RMDs should be offered management options. Recommendations include offering tailored physical activity and/or tailored psychoeducational interventions and/or, if clinically indicated, immunomodulatory treatment initiation or change. Patient-centred fatigue management should consider the individual's needs and preferences, their clinical disease activity, comorbidities and other psychosocial and contextual factors through shared decision-making. CONCLUSIONS These 2023 EULAR recommendations provide consensus and up-to-date guidance on fatigue management in people with I-RMDs.
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Affiliation(s)
- Emma Dures
- School of Health and Social Wellbeing at the University of the West of England (UWE) Bristol and Academic Rheumatology, Bristol Royal Infirmary, Bristol, UK
| | | | - Eduardo José Ferreira Santos
- Department of Rheumatology, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
- Health Sciences Research Unit: Nursing (UICiSA:E), Coimbra, Portugal
| | - Anna Molto
- Department of Rheumatology, Hospital Cochin, Paris, France
- Université Paris-Cité, INSERM U1153, Paris, France
| | | | - Claire Harris
- Department of Rheumatology, London North West University Healthcare NHS Trust, Harrow, UK
| | | | - Deirdre Connolly
- Discipline of Occupational Therapy, Trinity College Dublin, Dublin, Ireland
| | - Elena Elefante
- Rheumatology Unit, Department of Clinical and Experimental Medicine, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - Fernando Estévez-López
- Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA
- Department of Education, Faculty of Education Sciences, SPORT Research Group and CERNEP Research Center, University of Almería, Almería, Spain
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC University Medical Centre, Rotterdam, The Netherlands
| | - Ilaria Bini
- Anmar Young, Rome, Italy
- EULAR Young PARE, Zürich, Switzerland
| | - Jette Primdahl
- University Hospital of Southern Denmark, Danish Hospital for Rheumatic Diseases, Sønderborg, Denmark
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Kirsten Hoeper
- Department of Rheumatology and Immunology, Medizinische Hochschule Hannover Klinikum, Hannover, Germany
| | - Marie Urban
- Department of Rheumatology, Bristol Royal Infirmary, Bristol, UK
| | - Mart A F J van de Laar
- Department of Psychology, Health & Technology, University of Twente, Enschede, The Netherlands
- Arthritis Center Twente, Medical Spectrum Twente, Enschede, The Netherlands
| | - Marta Redondo
- School of Psychology, Universidad Camilo José Cela, Madrid, Spain
| | - Peter Böhm
- Forschungspartner, Deutsche Rheuma-Liga Bundesverband e.V, Bonn, Germany
- Beratung und Begleitung, Deutsche Rheuma-Liga Berlin e.V, Berlin, Germany
| | - Raj Amarnani
- Department of Rheumatology, University College Hospital, London, UK
| | - Rhys Hayward
- Department of Rheumatology, London North West University Healthcare NHS Trust, Harrow, UK
| | - Rinie Geenen
- Department of Psychology, Utrecht University, Utrecht, The Netherlands
| | - Simona Rednic
- Clinica Reumatologie, University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Susanne Pettersson
- Theme Inflammation and Infection, Karolinska University Hospital, Stockholm, Sweden
- Department of Neurobiology, Karolinska Institutet, Stockholm, Sweden
| | - Tanja Thomsen
- Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Centre for Head and Orthopaedics, Rigshospitalet, Glostrup, Denmark
| | - Till Uhlig
- Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
| | - Valentin Ritschl
- Institute for Outcomes Research, Center for Medical Data Science, Medical University of Vienna, Wien, Austria
- Ludwig Boltzmann Institute for Arthritis and Rehabilitation, Vienna, Austria
| | - Pedro M Machado
- MRC Centre for Neuromuscular Diseases, University College London, London, UK
- Department of Rheumatology, University College London Centre for Rheumatology, London, UK
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Wang J, Tulka S, Knippschild S, Schneider M, Distler JHW, Baraliakos X, Brinks R, Sewerin P. A population-based projection of psoriatic arthritis in Germany until 2050: analysis of national statutory health insurance data of 65 million German population. Rheumatol Int 2023; 43:2037-2047. [PMID: 37597059 PMCID: PMC10495508 DOI: 10.1007/s00296-023-05422-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Accepted: 08/05/2023] [Indexed: 08/21/2023]
Abstract
The population-based prevalence of psoriatic arthritis (PsA) is still unclear and not well described globally. The aim of this study was to conduct a population-based prevalence projection and provide long-term future estimations of PsA patients in Germany until 2050, using the illness-death model and based on historical data. We analyzed the national statutory health insurance data of 65 million population in the German Institute for Medical Documentation and Information between January 2009 and December 2012. We constructed an estimation of the PsA burden among the German population using the relevant epidemiological parameters to project the numbers of patients with PsA in Germany until 2050 under five possible scenarios by varying the incidence and mortality. The overall conservatively estimated prevalence of PsA in Germany in 2019 was 0.31% (95% CI 0.28-0.36%). Women contribute a higher prevalence than men in all five scenarios. In the assumed scenarios with increased incidence, the prevalence of PsA at 60 years of age could rise from 1% in 2019 to more than 3% in 2050 for both genders, with the increase particularly pronounced for women, reaching around 3.5%. However, in the assumed scenarios with decreasing incidence, the prevalence curve may flatten and begin a decreasing trend from 2035 to 2050 for both genders, achieving a prevalence of less than 1% in 2050. Our research is to generate assumed population-based data on PsA in Germany that can serve as a reference for public health stakeholders to prepare an optional intervention. We would expect worryingly high numbers in the coming decades if preventive strategies are not implemented. In the long term, it will be necessary to implement preventive strategies to identify predictors and treat psoriasis symptoms early in order to delay or even prevent the transition of psoriasis to PsA.
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Affiliation(s)
- Jiancong Wang
- Institute of Biometry and Epidemiology, The German Diabetes Center, Heinrich Heine University Düsseldorf, 40225 Düsseldorf, Germany
| | - Sabrina Tulka
- Chair for Medical Biometry and Epidemiology, University of Witten/Herdecke, 58448 Witten, Germany
| | - Stephanie Knippschild
- Chair for Medical Biometry and Epidemiology, University of Witten/Herdecke, 58448 Witten, Germany
| | - Matthias Schneider
- Hiller Research Center, University Hospital Düsseldorf, Medical Faculty of Heinrich Heine University, 40225 Düsseldorf, Germany
| | - Jörg H. W. Distler
- Hiller Research Center, University Hospital Düsseldorf, Medical Faculty of Heinrich Heine University, 40225 Düsseldorf, Germany
- Clinic for Rheumatology, University Hospital Düsseldorf, Medical Faculty of Heinrich Heine University, 40225 Düsseldorf, Germany
| | | | - Ralph Brinks
- Institute of Biometry and Epidemiology, The German Diabetes Center, Heinrich Heine University Düsseldorf, 40225 Düsseldorf, Germany
- Chair for Medical Biometry and Epidemiology, University of Witten/Herdecke, 58448 Witten, Germany
| | - Philipp Sewerin
- Hiller Research Center, University Hospital Düsseldorf, Medical Faculty of Heinrich Heine University, 40225 Düsseldorf, Germany
- Ruhr-Universität Bochum, Rheumazentrum Ruhrgebiet, 44649 Herne, Germany
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Marzaioli V, Canavan M, Donnelly A, Wade S, Fraser A, O'Sullivan T, Harney S, Ireland A, Veale DJ, Fearon U. Knowledge of disease, diagnosis, adherence and impact of research in an Irish cohort of patients with inflammatory arthritis. HRB Open Res 2023; 4:60. [PMID: 37250112 PMCID: PMC10213824 DOI: 10.12688/hrbopenres.13274.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/10/2023] [Indexed: 05/31/2023] Open
Abstract
Background: Patient engagement with clinicians results in shared decision making and increased adherence to medication. However, in order for strong patient: clinician partnerships to be achieved, communication barriers need to be identified. Therefore, the aim of this study was to examine the level of understanding of inflammatory arthritis patients and the need for strong patient-partnership in research. Methods: An online anonymous survey was distributed to patients living with inflammatory arthritis which addressed questions about diagnosis, routine tests, medications and how they work, medication adherence, disease flare, heredity, pregnancy, and patient involvement in research. Results: There were 1,873 respondents, 1416 of which had inflammatory arthritis (IA)- rheumatoid arthritis (RA) (65.8%) and psoriatic arthritis (PsA) (34.2%). They were predominantly female (RA 86%, PsA 85 %), aged 55±13 and 50±12 years. Less than 35% of patients had an understanding of diagnostic tests, what was measured and the implication for disease, with 75.5% also concerned about heredity. There was a high level of understanding of how specific medications treat inflammatory arthritis (72.9%). Adherence was also very high (>87%), with the main reasons for stopping medication without the advice of their clinician, 'feeling better' and 'side effects' however a significant proportion of patients (69.9%) reported a disease-flare following cessation of medication. Patients (31%) were also concerned that inflammatory arthritis reduced their chances of getting pregnant, with only 8% believing arthritis medications were safe to take during pregnancy. Finally, only 9% of patients had ever been asked to participate in a research study. Conclusions: This study demonstrates a need for the development of stronger patient-partnerships with clinicians and researchers in relation to patient education and engagement with research, to create a platform where patients can have meaningful input and involvement in future research studies.
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Affiliation(s)
- Viviana Marzaioli
- Molecular Rheumatology, Trinity College Dublin, Dublin, Ireland
- EULAR Centre of Excellence, Centre for Arthritis and Rheumatic Diseases, St Vincent's University Hospital, Dublin, Dublin, Ireland
| | - Mary Canavan
- Molecular Rheumatology, Trinity College Dublin, Dublin, Ireland
- EULAR Centre of Excellence, Centre for Arthritis and Rheumatic Diseases, St Vincent's University Hospital, Dublin, Dublin, Ireland
| | | | - Siobhan Wade
- Molecular Rheumatology, Trinity College Dublin, Dublin, Ireland
- EULAR Centre of Excellence, Centre for Arthritis and Rheumatic Diseases, St Vincent's University Hospital, Dublin, Dublin, Ireland
| | | | | | - Sinead Harney
- Rheumatology Dept, Cork University Hospital, Cork, Ireland
| | | | - Douglas J. Veale
- EULAR Centre of Excellence, Centre for Arthritis and Rheumatic Diseases, St Vincent's University Hospital, Dublin, Dublin, Ireland
| | - Ursula Fearon
- Molecular Rheumatology, Trinity College Dublin, Dublin, Ireland
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Alten R, Moss S, Hahne S, Muriset AT, Gruben D, Latymer M. High Usability and Applicability Ratings for the New SmartClic ®/ClicWise ® Injection Device: Evidence from a Health Care Professional Opinion Study. Rheumatol Ther 2023; 10:477-487. [PMID: 36689125 PMCID: PMC10011277 DOI: 10.1007/s40744-022-00520-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 12/08/2022] [Indexed: 01/24/2023] Open
Abstract
INTRODUCTION The SmartClic®/ClicWise® autoinjector is a new reusable, multi-use, single-patient device for the administration of subcutaneously administered biologics in the treatment of chronic conditions, including rheumatoid arthritis. The device will be used in conjunction with a mobile application (app). The aim of this study was to collect feedback on the usability, functionality, and applicability of the device and the companion app from health care professionals (HCPs) who perform injections as part of their role and care for patients with rheumatic conditions. METHODS The study was conducted from September to October 2020 in Germany. HCPs participated in a training session for the device and gained experience by performing simulated injections with water. Following the simulations, HCPs answered questions on the ease of use, feature design, effectiveness, and injection speed of the SmartClic/ClicWise device and estimate the patient training time required. They also answered questions on the functionality of the proposed app after attending a storyboard presentation. Responses were recorded as multiple-choice answers, Likert scale ratings (seven-point scale), or open-ended comments. The mean, median, and mode scores were recorded. RESULTS Twenty-five HCPs (mean age, 38.2 years; females, n = 22 [88%]; registered nurses, n = 19 [76%]) participated in the study. HCP feedback on questions related to the SmartClic/ClicWise device was positive overall, with mean scores > 4.50 across questions; mean scores < 5.00 were reported on 2/40 questions. Twenty-four of 25 participants (96%) estimated that a training time of ≤ 20 min would suffice for patients learning to use the device. Positive feedback was also reported on questions related to the companion app, with mean scores > 5.70. CONCLUSIONS Initial feedback from HCPs on the SmartClic/ClicWise device and proposed app was generally favorable, suggesting they will provide an acceptable alternative for self-administration of biologics for patients with rheumatoid arthritis and other chronic conditions.
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Affiliation(s)
- Rieke Alten
- Department of Internal Medicine, Rheumatology, Clinical Immunology, Osteology at Schlosspark-Klinik, University Medicine Berlin, Berlin, Germany
| | | | | | | | | | - Mark Latymer
- Inflammation and Immunology Global Medical Affairs, Pfizer Biopharmaceuticals Group, Ramsgate Road, Sandwich, CT13 9NJ, UK.
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Current Utilization of Qualitative Methodologies in Dermatology: A Scoping Review. JID INNOVATIONS 2023; 3:100172. [PMID: 36891031 PMCID: PMC9986021 DOI: 10.1016/j.xjidi.2022.100172] [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: 04/30/2022] [Revised: 08/27/2022] [Accepted: 10/03/2022] [Indexed: 11/19/2022] Open
Abstract
The focus of this review was to determine how qualitative methods are used in dermatology research and whether published manuscripts meet current standards for qualitative research. A scoping review of manuscripts published in English between January 1, 2016 and September 22, 2021 was conducted. A coding document was developed to collect information on authors, methodology, participants, research theme, and the presence of quality criteria as outlined by the Standards for Reporting Qualitative Research. Manuscripts were included if they described original qualitative research about dermatologic conditions or topics of primary interest to dermatology. An adjacency search yielded 372 manuscripts, and after screening, 134 met the inclusion criteria. Most studies utilized interviews or focus groups, and researchers predominantly selected participants on the basis of disease status, including over 30 common and rare dermatologic conditions. Research themes frequently included patient experience of disease, development of patient-reported outcomes, and descriptions of provider and caregiver experiences. Although most authors explained their analysis and sampling strategy and included empirical data, few referenced qualitative data reporting standards. Missed opportunities for qualitative methods in dermatology include examination of health disparities, exploration of surgical and cosmetic dermatology experiences, and determination of the lived experience of and provider attitudes toward diverse patient populations.
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Gottlieb AB, McInnes IB, Rahman P, Kollmeier AP, Xu XL, Jiang Y, Sheng S, Shawi M, Chakravarty SD, Lavie F, Mease PJ. Low rates of radiographic progression associated with clinical efficacy following up to 2 years of treatment with guselkumab: results from a phase 3, randomised, double-blind, placebo-controlled study of biologic-naïve patients with active psoriatic arthritis. RMD Open 2023; 9:rmdopen-2022-002789. [PMID: 36828643 PMCID: PMC9972414 DOI: 10.1136/rmdopen-2022-002789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 02/02/2023] [Indexed: 02/26/2023] Open
Abstract
OBJECTIVE Evaluate relationship between radiographic progression and clinical outcomes in post hoc analyses of patients with psoriatic arthritis (PsA) receiving up to 2 years of guselkumab therapy in the phase 3, placebo-controlled, randomised trial, DISCOVER-2. METHODS Biologic-naïve adults with active PsA (≥5 swollen joints /≥5 tender joints ; C reactive protein ≥0.6 mg/dL) were randomised to guselkumab 100 mg every 4 weeks (Q4W); guselkumab 100 mg at week 0, week 4, then every 8 weeks (Q8W); or placebo→guselkumab 100 mg Q4W (week 24). Radiographs (hands/feet) at week 0, week 24, week 52 and week 100 were scored via PsA-modified van der Heijde-Sharp (vdH-S) methodology. In these post hoc analyses, mean changes in vdH-S scores were summarised according to achievement of American College of Rheumatology 20/50/70 response; low disease activity (LDA) defined by Disease Activity in Psoriatic Arthritis (DAPSA) ≤14 or Psoriatic ArthritiS Disease Activity Score (PASDAS) ≤3.2, or minimal/very low disease activity (MDA/VLDA); and normalised physical function (Health Assessment Questionnaire-Disability Index (HAQ-DI) ≤0.5). Response rates for achieving MDA/VLDA and each component were determined among patients with and without radiographic progression (change in total vdH-S score >0.5). No formal hypothesis testing was performed. RESULTS 664 of 739 treated patients in DISCOVER-2 continued study treatment at week 52 and were included in these analyses. Mean changes in vdH-S scores from weeks 0 to 100 among all patients in the Q4W and Q8W groups were 1.7 and 1.5, respectively. Among all guselkumab-randomised patients, those who achieved ACR20/50/70, DAPSA LDA, PASDAS LDA, MDA, VLDA and HAQ-DI ≤0.5 (normalised physical function) had smaller mean changes in vdH-S scores than did non-responders at week 52 (0.2-1.2 vs 1.7-4.1) and week 100 (0.3-1.2 vs 2.0-4.6). Relative to patients with radiographic progression, those without progression were more likely to achieve the MDA criteria related to swollen and tender joint counts, patient-reported pain and global assessment, and normalised physical function through week 100. CONCLUSION In these post hoc analyses, the achievement of low levels of disease activity, including MDA, was associated with diminished rates of radiographic progression observed in patients receiving up to 2 years of guselkumab. Radiographic non-progressors were more likely to achieve patient-reported MDA criteria of minimal pain and normalised physical function compared with radiographic non-responders. TRIAL REGISTRATION NUMBER NCT03158285.
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Affiliation(s)
- Alice B Gottlieb
- Dermatology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Iain B McInnes
- College of Medical Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - Proton Rahman
- Rheumatology, Memorial University, St John's, Newfoundland, Canada
| | - Alexa P Kollmeier
- Immunology, Janssen Research & Development, San Diego, California, USA
| | - Xie L Xu
- Immunology, Janssen Research & Development, San Diego, California, USA
| | - Yusang Jiang
- Cytel Inc on behalf of Janssen Research & Development LLC, Spring House, Pennsylvania, USA
| | - Shihong Sheng
- Janssen Research & Development, Spring House, Pennsylvania, USA
| | - May Shawi
- Immunology Global Medical Affairs, Janssen Pharmaceutical Companies of Johnson & Johnson, Horsham, Pennsylvania, USA
| | - Soumya D Chakravarty
- Immunology, Janssen Scientific Affairs, Horsham, Pennsylvania, USA,Rheumatology, Drexel University College of Medicine, Philadelphia, Pennsylvania, USA
| | - Frederic Lavie
- Immunology Global Medical Affairs, Janssen Cilag Global Medical Affairs, Issy les Moulineaux, France
| | - Philip J Mease
- School of Medicine, Swedish Medical Center and University of Washington, Seattle, Washington, USA
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10
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Merola JF, Landewé R, McInnes IB, Mease PJ, Ritchlin CT, Tanaka Y, Asahina A, Behrens F, Gladman DD, Gossec L, Gottlieb AB, Thaçi D, Warren RB, Ink B, Assudani D, Bajracharya R, Shende V, Coarse J, Coates LC. Bimekizumab in patients with active psoriatic arthritis and previous inadequate response or intolerance to tumour necrosis factor-α inhibitors: a randomised, double-blind, placebo-controlled, phase 3 trial (BE COMPLETE). Lancet 2023; 401:38-48. [PMID: 36495881 DOI: 10.1016/s0140-6736(22)02303-0] [Citation(s) in RCA: 55] [Impact Index Per Article: 55.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 10/21/2022] [Accepted: 11/03/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND Bimekizumab is a monoclonal IgG1 antibody that selectively inhibits interleukin (IL)-17F and IL-17A. This study compared the efficacy and safety of bimekizumab with placebo over 16 weeks in patients with active psoriatic arthritis and previous inadequate response or intolerance to tumour necrosis factor-α (TNFα) inhibitors. METHODS BE COMPLETE was a phase 3, multicentre, randomised, double-blind, placebo-controlled trial conducted across 92 sites (including hospitals, clinics, and research centres) in 11 countries (Australia, Canada, Czech Republic, Germany, Hungary, Italy, Japan, Poland, Russia, the UK, and the USA). Eligible patients were aged 18 years or older with adult-onset psoriatic arthritis (meeting the Classification Criteria for Psoriatic Arthritis for at least 6 months before screening) with a history of inadequate response or intolerance to treatment with one or two TNFα inhibitors for either psoriatic arthritis or psoriasis. We stratified patients with active psoriatic arthritis by region and previous TNFα inhibitor use. Patients were randomly assigned (2:1) to receive subcutaneous bimekizumab 160 mg every 4 weeks or placebo by an interactive-voice and web-response system on the basis of a predetermined randomisation schedule. The primary endpoint was the proportion of patients with 50% or greater improvement in American College of Rheumatology criteria (ACR50) at week 16 (non-responder imputation). Efficacy analyses were done in the randomised population. The safety analysis set comprised patients who received one or more doses of study treatment. This trial was registered at ClinicalTrials.gov, NCT03896581, and is completed. FINDINGS Between March 28, 2019, and Feb 14, 2022, 556 patients were screened and 400 patients were randomly assigned to bimekizumab 160 mg every 4 weeks (n=267) or placebo (n=133). The primary and all hierarchical secondary endpoints were met at week 16. 116 (43%) of 267 patients receiving bimekizumab reached ACR50, compared with nine (7%) of 133 patients receiving placebo (adjusted odds ratio [OR] 11·1 [95% CI 5·4-23·0], p<0·0001). 121 (69%) of 176 patients with psoriasis affecting at least 3% body surface area at baseline who received bimekizumab reached 90% or greater improvement in the Psoriasis Area and Severity Index (PASI90), compared with six (7%) of 88 patients who received placebo (adjusted OR 30·2 [12·4-73·9], p<0·0001). Treatment-emergent adverse events up to week 16 were reported in 108 (40%) of 267 patients receiving bimekizumab and 44 (33%) of 132 patients receiving placebo. There were no new safety signals and no deaths. INTERPRETATION Bimekizumab treatment led to superior improvements in joint and skin efficacy outcomes at week 16 compared with placebo in patients with psoriatic arthritis and inadequate response or intolerance to TNFα inhibitors. The safety profile of bimekizumab was consistent with previous phase 3 studies in patients with plaque psoriasis, and studies of IL-17A inhibitors. FUNDING UCB Pharma.
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Affiliation(s)
- Joseph F Merola
- Harvard Medical School, Brigham and Women's Hospital, Boston, MA, USA
| | - Robert Landewé
- Amsterdam Rheumatology and Clinical Immunology Center, Amsterdam, Netherlands; Zuyderland MC, Heerlen, Netherlands
| | - Iain B McInnes
- College of Medical Veterinary and Life Sciences, University of Glasgow, Glasgow, UK.
| | - Philip J Mease
- Swedish Medical Center and Providence St Joseph Health and University of Washington, Seattle, WA, USA
| | | | - Yoshiya Tanaka
- The First Department of Internal Medicine, University of Occupational and Environmental Health, Japan, Kitakyushu, Japan
| | - Akihiko Asahina
- Department of Dermatology, The Jikei University School of Medicine, Tokyo, Japan
| | - Frank Behrens
- Division of Rheumatology, University Hospital and Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Fraunhofer Cluster of Excellence Immune-Mediated Diseases CIMD, Goethe University, Frankfurt am Main, Germany
| | - Dafna D Gladman
- Schroeder Arthritis Institute, Krembil Research Institute, University Health Network, University of Toronto, ON, Canada
| | - Laure Gossec
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Paris, France; Rheumatology Department, AP-HP, Pitié-Salpêtrière Hospital, Paris, France
| | - Alice B Gottlieb
- Department of Dermatology, The Icahn School of Medicine at Mt Sinai, New York, NY, USA
| | - Diamant Thaçi
- Institute and Comprehensive Center for Inflammation Medicine, University of Lübeck, Lübeck, Germany
| | - Richard B Warren
- Dermatology Centre, Salford Royal NHS Foundation Trust, Manchester NIHR Biomedical Research Centre, University of Manchester, Manchester, UK
| | | | | | | | | | | | - Laura C Coates
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Diseases University of Oxford, Oxford, UK; Oxford Biomedical Research Centre, Oxford University Hospitals NHS Trust, Oxford, UK
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Pavlova NT, Ramasawmy C, Picariello F, Smith C, Moss‐Morris R. ‘I don't know which is the chicken and which is the egg’: A qualitative study of weight loss‐related beliefs and behaviours among adults with psoriasis and comorbid obesity. Br J Health Psychol 2022; 28:532-551. [PMID: 36484107 DOI: 10.1111/bjhp.12639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 09/12/2022] [Accepted: 11/23/2022] [Indexed: 12/13/2022]
Abstract
OBJECTIVES Obesity is a common (30%-40%) comorbidity of psoriasis. Weight loss is shown to improve the severity of psoriasis; however, little is known about the factors that may influence successful weight loss in the context of obesity and psoriasis. The current qualitative study aimed to explore the obesity-associated beliefs, perceptions, and behaviours related to weight loss in psoriasis. Preferences for a weight loss intervention were also explored. DESIGN Qualitative in-depth semi-structured interviews were conducted with 24 adults (62.5% male) with moderate-to-severe psoriasis and obesity (mean body mass index = 35.2 kg/m2 , SD = 4.1), recruited through a patient organization website in the UK. Data were analysed using inductive thematic analysis. RESULTS Most participants viewed psoriasis as unrelated to obesity. A well-controlled psoriasis and improvements in psoriasis symptoms were considered as major motivators for engaging in a weight loss program by individuals who viewed psoriasis and obesity as related conditions. Comfort eating was perceived as an escape strategy from the psoriasis-induced negative emotions. Participants shared their dissatisfaction with current weight loss recommendations which were too generic. They suggested that a desirable weight loss program would require both emotional and behavioural support, with an emphasis on psoriasis' burden. CONCLUSION The findings accentuate the importance of (1) clinicians discussing the link between obesity and psoriasis with patients, (2) weight loss advice to include both behavioural and emotional support, and (3) a weight loss advice to consider the psoriasis burden and the perceived barriers which may potentially lead to improved outcomes to obesity management in psoriasis.
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Affiliation(s)
- Neli T. Pavlova
- Health Psychology Section, Psychology Department, Institute of Psychiatry Psychology and Neuroscience King's College London London UK
| | - Celeny Ramasawmy
- Health Psychology Section, Psychology Department, Institute of Psychiatry Psychology and Neuroscience King's College London London UK
| | - Federica Picariello
- Health Psychology Section, Psychology Department, Institute of Psychiatry Psychology and Neuroscience King's College London London UK
| | - Catherine Smith
- Health Psychology Section, Psychology Department, Institute of Psychiatry Psychology and Neuroscience King's College London London UK
- St John's Institute of Dermatology Guy's and St Thomas' NHS Foundation Trust London UK
| | - Rona Moss‐Morris
- Health Psychology Section, Psychology Department, Institute of Psychiatry Psychology and Neuroscience King's College London London UK
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12
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de Vlam K, Mease PJ, Bushmakin AG, Fleischmann R, Ogdie A, Azevedo VF, Merola JF, Woolcott J, Cappelleri JC, Fallon L, Taylor PC. Identifying and Quantifying the Role of Inflammation in Pain Reduction for Patients With Psoriatic Arthritis Treated With Tofacitinib: A Mediation Analysis. Rheumatol Ther 2022; 9:1451-1464. [PMID: 36076054 PMCID: PMC9510078 DOI: 10.1007/s40744-022-00482-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 08/01/2022] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION Pain is a multidimensional factor and core domain of psoriatic arthritis (PsA). This analysis aimed to quantify the role of potential inflammation-associated outcomes on pain reduction in patients with PsA receiving tofacitinib, using mediation modeling. METHODS Pooled data were from two phase 3 studies (OPAL Broaden and OPAL Beyond) of patients with active PsA treated with tofacitinib 5 mg twice daily or placebo. Mediation modeling was utilized to quantify the indirect effects (via Itch Severity Item [ISI], C-reactive protein [CRP] levels, swollen joint count [SJC], Psoriasis Area and Severity Index [PASI], and enthesitis [using Leeds Enthesitis Index]) and direct effects (representing all other factors) of tofacitinib treatment on pain improvement. RESULTS The initial model showed that tofacitinib treatment affects pain, primarily indirectly, via ISI, CRP, SJC, PASI, and enthesitis (overall 84.0%; P = 0.0009), with 16.0% (P = 0.5274) attributable to the direct effect. The model was respecified to exclude SJC and PASI. Analysis of the final model revealed that 29.5% (P = 0.0579) of tofacitinib treatment effect on pain was attributable to the direct effect, and 70.5% (P < 0.0001) was attributable to the indirect effect. ISI, CRP, and enthesitis mediated 37.4% (P = 0.0002), 15.3% (P = 0.0107), and 17.8% (P = 0.0157) of the tofacitinib treatment effect on pain, respectively. CONCLUSIONS The majority of the effect of tofacitinib on pain was collectively mediated by itch, CRP, and enthesitis, with itch being the primary mediator of treatment effect. TRIAL REGISTRATION NCT01877668, NCT01882439. GRAPHICAL PLS.
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Affiliation(s)
- Kurt de Vlam
- Department of Rheumatology, University Hospitals Leuven, Leuven, Belgium
| | - Philip J Mease
- Swedish Medical Center, University of Washington, Seattle, WA, USA
| | | | - Roy Fleischmann
- Metroplex Clinical Research Center, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Alexis Ogdie
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | | | - Joseph F Merola
- Division of Rheumatology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
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13
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McInnes IB, Ostor AJK, Mease PJ, Tillett W, Baraliakos X, de Vlam K, Bessette L, Lippe R, Maniccia A, Feng D, Gao T, Zueger P, Saffore C, Kato K, Song IH, Deodhar A. Effect of upadacitinib on reducing pain in patients with active psoriatic arthritis or ankylosing spondylitis: post hoc analysis of three randomised clinical trials. RMD Open 2022; 8:rmdopen-2021-002049. [PMID: 35332058 PMCID: PMC8948377 DOI: 10.1136/rmdopen-2021-002049] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Accepted: 03/03/2022] [Indexed: 11/05/2022] Open
Abstract
Objective Evaluate the effect of upadacitinib on pain outcomes in patients with active psoriatic arthritis (PsA) or ankylosing spondylitis (AS) across 3 randomised trials (SELECT-PsA 1 and 2 for PsA; SELECT-AXIS 1 for AS). Methods Patients were randomised to upadacitinib 15 mg once daily or placebo (all 3 studies), or adalimumab 40 mg every other week (SELECT-PsA 1 only). Pain outcomes included proportion of patients achieving ≥30%, ≥50% and ≥70% reduction from baseline in patient global assessment of pain and other end points. Results A higher proportion of patients receiving upadacitinib versus placebo achieved ≥30%, ≥50% and ≥70% reduction in pain end points as early as week 2; these improvements with upadacitinib were generally sustained or increased through year 1 (PsA 1/2 studies: 64%/48%, 58%/42% and 38%/22%, respectively; SELECT-AXIS 1 study: 76%, 72% and 54%). Results were similar with adalimumab in PsA 1 (59%, 49% and 32%). Patients who switched from placebo to upadacitinib 15 mg were able to reach a similar level of improvement as the continuous upadacitinib groups by year 1 (PsA 1/2 studies: 46%–60%, 35%–49% and 15%–34%; AS study: 83%, 72% and 46%). Results were similar with other pain end points. Conclusion Rapid and sustained improvements in pain outcomes across several end points were consistently shown with upadacitinib over 1 year in patients with active PsA or AS who had either inadequate response to prior non-biologic or biologic disease-modifying antirheumatic drugs (PsA studies) or were biologic-naïve with inadequate response to non-steroidal anti-inflammatory drugs (AS study).
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Affiliation(s)
- Iain B McInnes
- University of Glasgow, College of Medical, Veterinary and Life Sciences, Glasgow, UK
| | - Andrew J K Ostor
- Department of Medicine, Monash University, Melbourne, Victoria, Australia,Department of Rheumatolgy, Cabrini Medical Centre, Malvern, Victoria, Australia
| | - Philip J Mease
- Department of Rheumatology, Swedish Medical Center, Providence St Joseph Health, and School of Medicine, University of Washington, Seattle, Washington, USA
| | - William Tillett
- Department of Rheumatology, Royal National Hospital for Rheumatic Disease, Bath, UK
| | | | - Kurt de Vlam
- Department of Rheumatology, University Hospitals Leuven, Leuven, Belgium
| | - Louis Bessette
- Department of Medicine, Laval University, Quebec City, Quebec, Canada
| | - Ralph Lippe
- AbbVie Deutschland GmbH and Co KG, Wiesbaden, Germany
| | | | - Dai Feng
- AbbVie Inc, North Chicago, Illinois, USA
| | | | | | | | - Koji Kato
- AbbVie Inc, North Chicago, Illinois, USA
| | - In-Ho Song
- AbbVie Inc, North Chicago, Illinois, USA
| | - Atul Deodhar
- Division of Arthritis and Rheumatic Diseases, Oregon Health & Science University, Portland, Oregon, USA
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14
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Ogdie A, Myers K, Mansfield C, Tillett W, Nash P, Leach C, Nowell WB, Gavigan K, Zueger P, McDearmon-Blondell E, Walsh J. Experiences and Treatment Preferences in Patients With Psoriatic Arthritis: A Cross-Sectional Study in the ArthritisPower Registry. Rheumatol Ther 2022; 9:735-751. [PMID: 35279798 PMCID: PMC8964868 DOI: 10.1007/s40744-022-00436-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 02/25/2022] [Indexed: 11/28/2022] Open
Abstract
Introduction Despite recent advances in treatment for psoriatic arthritis (PsA), many patients experience inadequate response or intolerance to therapy, indicating that unmet treatment-related needs remain. To further characterize these unmet needs, we evaluated patients’ experiences regarding the burden of PsA symptoms and disease impacts, and patients’ preferences for treatment. Methods Patients from ArthritisPower, a rheumatology research registry, completed a web-based survey. Object case best–worst scaling (BWS) was used to evaluate the relative burden of 11 PsA-related symptoms and the relative importance of improvement in nine PsA-related disease impacts. BWS data were analyzed using a random-parameters logit model. Patient demographics, preferences for mode and frequency of therapy, and preferences for methotrexate were analyzed descriptively. Results Among the 332 participants, most were White (94%), female (80%), with mean age of 54 years (SD 11.4). In the BWS, joint pain was the most bothersome symptom, followed by other musculoskeletal pain and fatigue. The BWS for disease impacts found that improvements in the ability to perform physical activities were most important, followed by improvements in the ability to function independently, sleep quality, and the ability to perform daily activities. The most burdensome symptoms and desired disease impact improvements were similar in patients regardless of their experience with biologic disease-modifying antirheumatic drugs. The most preferred mode and frequency of treatment administration was oral, once-daily medication (preferred by 38% of respondents), and 74% prioritized therapies that significantly improved joint-related symptoms versus psoriasis-related symptoms. The majority of respondents (65%) preferred PsA treatment regimens that did not include methotrexate. Conclusions Patients with PsA from a rheumatology registry found musculoskeletal pain symptoms to be the most bothersome and prioritized improvements to functional impacts of their disease. These findings can better inform development of new therapies and guide shared patient-provider treatment decision-making. Supplementary Information The online version contains supplementary material available at 10.1007/s40744-022-00436-x.
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Affiliation(s)
- Alexis Ogdie
- Division of Rheumatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Kelley Myers
- RTI Health Solutions, 3040 East Cornwallis Road, Post Office Box 12194, Research Triangle Park, NC, 27709-2194, USA.
| | - Carol Mansfield
- RTI Health Solutions, 3040 East Cornwallis Road, Post Office Box 12194, Research Triangle Park, NC, 27709-2194, USA
| | - William Tillett
- Department of Rheumatology, Royal National Hospital for Rheumatic Diseases, Bath, UK
- Department of Pharmacy and Pharmacology, University of Bath, Bath, UK
| | - Peter Nash
- Department of Medicine, Griffith University, Brisbane, QLD, Australia
| | - Colton Leach
- RTI Health Solutions, 3040 East Cornwallis Road, Post Office Box 12194, Research Triangle Park, NC, 27709-2194, USA
| | | | - Kelly Gavigan
- Global Healthy Living Foundation, Upper Nyack, NY, USA
| | | | | | - Jessica Walsh
- Division of Rheumatology, University of Utah School of Medicine, Salt Lake City, UT, USA
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15
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Day J, Antony A, Tillett W, Coates LC. The state of the art-psoriatic arthritis outcome assessment in clinical trials and daily practice. THE LANCET. RHEUMATOLOGY 2022; 4:e220-e228. [PMID: 38288938 DOI: 10.1016/s2665-9913(21)00349-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 10/14/2021] [Accepted: 10/21/2021] [Indexed: 04/26/2024]
Abstract
Psoriatic arthritis is a heterogeneous condition with substantial challenges in optimising outcome measures for both clinical trials and daily practice. As with other inflammatory arthritides, there is no gold standard instrument for measuring disease activity or impact, both of which are key to evaluate therapeutic approaches in trials and monitor disease in daily practice. A wide range of domains have been highlighted in the Outcome Measures in Rheumatology (OMERACT) core domain set for psoriatic arthritis; reflecting the disease involvement in multiple tissues (joints, tendons, skin, and spine) and the heterogenous impact of the disease on individuals. This Review summarises the current evidence around outcome measure selection, considering factors such as unidimensional versus multidimensional outcomes, continuous versus binary measures, and the feasibility of these approaches in trials compared with clinical practice.
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Affiliation(s)
- Julia Day
- Royal National Hospital for Rheumatic Diseases, Royal United Hospitals, Bath, UK
| | - Anna Antony
- School of Clinical Sciences, Monash University, Melbourne, VIC, Australia
| | - William Tillett
- Royal National Hospital for Rheumatic Diseases, Royal United Hospitals, Bath, UK; Department of Pharmacy and Pharmacology, University of Bath, Bath, UK
| | - Laura C Coates
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK.
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Gladman DD, Coates LC, Wu J, Fallon L, Bacci ED, Cappelleri JC, Bushmakin AG, Helliwell PS. Time to response for clinical and patient-reported outcomes in patients with psoriatic arthritis treated with tofacitinib, adalimumab, or placebo. Arthritis Res Ther 2022; 24:40. [PMID: 35139908 PMCID: PMC8826651 DOI: 10.1186/s13075-022-02721-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 01/13/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND This study examined the time to clinically meaningful response in patients with active psoriatic arthritis treated with tofacitinib, adalimumab, or placebo switching to tofacitinib. METHODS Data were from two phase 3 studies, OPAL Broaden (12 months) and OPAL Beyond (6 months). Patients received tofacitinib 5 or 10 mg twice daily (BID), adalimumab 40 mg once every 2 weeks (OPAL Broaden only), or placebo switching to tofacitinib 5 or 10 mg BID at month 3. Baseline to initial response time was according to pre-defined clinically meaningful criteria on Health Assessment Questionnaire-Disability Index (HAQ-DI; ≥ 0.35-point improvement), Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-F; ≥ 4-point improvement), Psoriatic Arthritis Disease Activity Score (PASDAS; post-baseline score ≤ 3.2 and > 1.6-point improvement from baseline), and minimal disease activity (MDA; meeting at least 5 of 7 criteria) composite. RESULTS In OPAL Broaden, median time to initial HAQ-DI score response was 29, 53, and 30 days in patients treated with tofacitinib 5 mg BID, tofacitinib 10 mg BID, or adalimumab, compared with 162 and 112 days in patients treated with placebo switching to tofacitinib 5 or 10 mg BID at month 3, respectively. Across studies, median time to initial FACIT-F total score response was shorter in patients receiving tofacitinib 5 mg BID (31 days) vs other groups (84-92 days). Median time to initial response was approximately 11 (MDA)/6-9 months (PASDAS) in tofacitinib/adalimumab groups in OPAL Broaden. CONCLUSION This analysis demonstrates tofacitinib's efficacy on most patient-reported and clinical endpoints over time and shows a shorter time to initial, clinically meaningful response in patients receiving tofacitinib vs patients switching from placebo to tofacitinib. TRIAL REGISTRATION ClinicalTrials.gov , NCT01877668. Registered June 12, 2013. ClinicalTrials.gov , NCT01882439. Registered June 18, 2013.
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Affiliation(s)
- Dafna D Gladman
- Department of Medicine, University of Toronto, Schroeder Arthritis Institute, Krembil Research Institute, Toronto Western Hospital, Toronto, ON, Canada.
| | | | | | | | | | | | | | - Philip S Helliwell
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
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Rombach I, Tucker L, Tillett W, Jadon D, Watson M, Francis A, Sinomati Y, Dutton SJ, Coates LC. Clinical effectiveness of symptomatic therapy compared with standard step-up care for the treatment of low-impact psoriatic oligoarthritis: the two-arm parallel group randomised POISE feasibility study. Ther Adv Musculoskelet Dis 2022; 13:1759720X211057668. [PMID: 35035537 PMCID: PMC8756359 DOI: 10.1177/1759720x211057668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Accepted: 10/15/2021] [Indexed: 11/16/2022] Open
Abstract
Introduction In psoriatic arthritis (PsA), treatment recommendations support first-line use of disease-modifying antirheumatic drugs (DMARDs). There are few treatment strategy trials, and no previous studies have investigated tailored treatment choice by disease severity. Studies in oligoarthritis (<5 inflamed joints) are limited but have suggested that some can be managed without DMARDs, preventing unnecessary side effects. This study aimed to assess the feasibility and acceptability of a study comparing standard DMARD treatment against symptomatic therapy in patients with mild psoriatic oligoarthritis. Methods This trial was embedded within the MONITOR-PsA cohort, which uses a Trials Within Cohorts (TWiCs) design. Patients with newly diagnosed psoriatic oligoarthritis, with low disease activity (PASDAS ⩽ 3.2) and the absence of poor prognostic factors [C reactive protein (CRP) < 5 mg/dL, HAQ < 1, no radiographic erosions] were randomised open-label to either standard care with 'step-up' DMARD therapy or to symptomatic therapy with nonsteroidal anti-inflammatory drugs (NSAIDs) and local corticosteroid injections to inflamed joints. Key outcomes were the proportion of eligible cohort patients, consent and study completion rate. Results Over the 15-month study period, only one eligible patient was randomised. Although oligoarthritis patients represented 45% of patients in this early PsA cohort, the majority did not have mild disease (24% raised CRP, 51% moderate disease activity, 13% radiographic damage and/or poor function). Of those meeting trial inclusion criteria, many patients refused treatment in the observational cohort prior to an invitation into the trial as they did not wish to be treated with DMARDs. Conclusion The study was not feasible as designed. Oligoarthritis represents around half of initial PsA presentations, but the majority starting therapy have high-impact disease. A small proportion have mild oligoarticular disease but many are not keen on treatment with DMARDs, given the potential side effects of these medications. Further research is needed to support evidence-based treatment in this subgroup. Trial registration number - ClinicalTrials.gov (NCT03797872) and EudraCT (2018-001085-42).
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Affiliation(s)
- Ines Rombach
- Oxford Clinical Trials Research Unit, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Laura Tucker
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - William Tillett
- Royal National Hospital for Rheumatic Diseases, Bath, UK; Department of Pharmacy & Pharmacology, University of Bath, Bath, UK
| | - Deepak Jadon
- Department of Medicine, University of Cambridge, Cambridge, UK
| | - Marion Watson
- Oxford Clinical Trials Research Unit, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Anne Francis
- Oxford Clinical Trials Research Unit, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Yvonne Sinomati
- Oxford Clinical Trials Research Unit, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Susan J Dutton
- Oxford Clinical Trials Research Unit, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Laura C Coates
- Botnar Research Centre, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Windmill Road, Oxford OX3 7LD, UK
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Ogdie A, Michaud K, Nowak M, Bruce R, Cantor S, Hintzen C, Mease PJ. Patient's experience of psoriatic arthritis: a conceptual model based on qualitative interviews. RMD Open 2021; 6:rmdopen-2020-001321. [PMID: 33115768 PMCID: PMC7722387 DOI: 10.1136/rmdopen-2020-001321] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 08/28/2020] [Accepted: 09/29/2020] [Indexed: 12/20/2022] Open
Abstract
Introduction Psoriatic arthritis (PsA) is a heterogeneous chronic inflammatory musculoskeletal disorder that manifests as peripheral arthritis, dactylitis, enthesitis and spondylitis. PsA results in significant burden that impacts quality of life of patients. We examined the signs, symptoms and impacts reported by patients with PsA, to characterise the patient experience of PsA and develop a conceptual model representing this patient experience. Methods Semi-structured interviews were conducted with patients with PsA recruited through the FORWARD databank. Spontaneous and probed signs, symptoms and impacts of PsA were assessed. Patients rated the disturbance of these concepts on their lives using a scale from 0 (‘does not disturb’) to 10 (‘greatly disturbs’). Signs, symptoms and impacts reported by >80% of patients with a disturbance rating of ≥5 were defined as salient concepts. Recruitment continued until concept saturation was achieved. Results 19 patients with PsA were interviewed. The interviews elicited 42 symptoms of which 8 had not been identified in a previous literature review encompassing 15 relevant articles. The most salient signs and symptoms elicited in the interviews were joint pain, skin symptoms, stiffness, swollen/inflamed joints and fatigue all with moderate to high disturbance ratings (range: 5.5–7.8). The most salient impacts were sleep disturbance, physical disability, effects on daily activities and feelings of frustration with also moderate to high disturbance ratings (range: 6.1–7.4). Conclusions The interviews highlighted the adverse impact PsA has on the patient’s life and may inform on outcome variables or areas suitable to be assessed in PsA studies.
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Affiliation(s)
- Alexis Ogdie
- University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Kaleb Michaud
- National Data Bank for Rheumatic Diseases, Wichita, Kansas, USA.,University of Nebraska Medical Center, Omaha, Nebraska, USA
| | | | | | | | | | - Philip J Mease
- School of Medicine, Swedish Medical Center and University of Washington, Seattle, Washington, USA
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19
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OMERACT Filter 2.1 Instrument Selection for Physical Function Domain in Psoriatic Arthritis: Provisional Endorsement for HAQ-DI and SF-36 PF. Semin Arthritis Rheum 2021; 51:1117-1124. [PMID: 34392975 PMCID: PMC8453108 DOI: 10.1016/j.semarthrit.2021.07.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 06/04/2021] [Accepted: 07/07/2021] [Indexed: 11/24/2022]
Abstract
OBJECTIVES Physical function is one of the core domains to be measured in all trials in psoriatic arthritis (PsA). We aimed to evaluate two instruments for physical function in PsA: The Health Assessment Questionnaire-disability index (HAQ-DI) and the physical functioning subscale of the Medical Outcome Survey Short-Form 36 items (SF-36 PF). METHODS We followed guidelines set out by the OMERACT Filter 2.1. A working group was formed to evaluate each instrument for domain match and feasibility to reach consensus. Two systematic literature reviews (SLRs) were conducted to identify the relevant articles supporting measurement properties of both instruments. Five additional measurement properties were appraised: construct validity, test-retest reliability, longitudinal construct validity, clinical trial discrimination, and threshold of meaning. New evidence was synthesized to fill the gap. Data were presented to the OMERACT technical advisory group (TAG) and the Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA) community for endorsement. RESULTS The results for seven measurement properties for HAQ-DI and SF-36 PF were presented in Summary of Measurement Property (SOMP) tables. The working group proposed "Provisional Endorsement" for both instruments. The body of evidence was approved by the OMERACT TAG. In two Delphi exercises among GRAPPA members, HAQ-DI received 93.9% and 97.5% endorsement votes, while that for SF-36 PF were 86.7% and 77.3%. CONCLUSION Both HAQ-DI and SF-36 PF were provisionally endorsed for the measurement of physical function in PsA trials, using the OMERACT Filter 2.1.
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20
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de Vlam K, Ogdie A, Bushmakin AG, Cappelleri JC, Fleischmann R, Taylor PC, Azevedo V, Fallon L, Woolcott J, Mease PJ. Median time to pain improvement and the impact of baseline pain severity on pain response in patients with psoriatic arthritis treated with tofacitinib. RMD Open 2021; 7:e001609. [PMID: 34226183 PMCID: PMC8258668 DOI: 10.1136/rmdopen-2021-001609] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 05/22/2021] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Pain is a core domain of psoriatic arthritis (PsA). This post hoc analysis evaluated time to pain improvement and the impact of baseline pain severity on pain response in patients with PsA receiving tofacitinib. METHODS Data from two trials (NCT01877668; NCT01882439) in patients receiving tofacitinib 5 mg twice daily, placebo switching to tofacitinib 5 mg twice daily at month 3 (placebo-to-tofacitinib) or adalimumab (NCT01877668 only) were included. Improvement in pain (≥30%/≥50% decrease from baseline in Visual Analogue Scale pain score) was assessed; median time to initial (first post-baseline visit)/continued (first two consecutive post-baseline visits) pain improvement was estimated (Kaplan-Meier) for all treatment arms. A parametric model was used to determine the relationship between baseline pain severity and time to pain response in patients receiving tofacitinib. RESULTS At month 3, more patients experienced pain improvements with tofacitinib/adalimumab versus placebo. Median days (95% CI) to initial/continued pain improvements of ≥30% and ≥50%, respectively, were 55 (29-57)/60 (57-85) and 85 (57-92)/171 (90-not estimable (NE)) for tofacitinib, versus 106 (64-115)/126 (113-173) and 169 (120-189)/NE (247-NE) for placebo-to-tofacitinib. Pain improvements were also experienced more quickly for adalimumab versus placebo. Predicted time to ≥30%/≥50% pain improvement was shorter in patients with higher baseline pain versus lower baseline pain (tofacitinib arm only). CONCLUSIONS In patients with PsA, pain improvements were experienced by more patients, and more rapidly, with tofacitinib and adalimumab versus placebo. In those receiving tofacitinib, higher baseline pain was associated with faster pain improvements.
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Affiliation(s)
- Kurt de Vlam
- Department of Rheumatology, UZ Leuven, Leuven, Belgium
| | - Alexis Ogdie
- Division of Rheumatology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | | | | | - Roy Fleischmann
- Department of Internal Medicine, University of Texas Southwestern Medical Center and Metroplex Clinical Research Center, Dallas, Texas, USA
| | - Peter C Taylor
- Botnar Research Centre, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, Oxfordshire, UK
| | - Valderilio Azevedo
- Departamento de Clínica Médica, Universidade Federal do Paraná, Curitiba, Brazil
| | - Lara Fallon
- Global Medical Affairs, Rheumatology, Pfizer Inc, Kirkland, Quebec, Canada
| | - John Woolcott
- Global Medical Affairs, Gastroenterology, Inflammation and Immunology, Pfizer Inc, Collegeville, Pennsylvania, USA
| | - Philip J Mease
- Swedish Medical Center/Providence St. Joseph Health and University of Washington, Seattle, Washington, USA
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Marzaioli V, Canavan M, Donnolly A, Wade S, Fraser A, O'Sullivan T, Harney S, Ireland A, Veale DJ, Fearon U. Knowledge of disease, diagnosis, adherence and impact of research in an Irish cohort of patients with inflammatory arthritis. HRB Open Res 2021. [DOI: 10.12688/hrbopenres.13274.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background: Patient engagement with clinicians results in shared decision making and increased adherence to medication. However, in order for strong patient: clinician partnerships to be achieved, communication barriers need to be identified. Therefore, the aim of this study was to examine the level of understanding of inflammatory arthritis patients and the need for strong patient-partnership in research. Methods: An online anonymous survey was distributed to patients living with inflammatory arthritis which addressed questions about diagnosis, routine tests, medications and how they work, medication adherence, disease flare, heredity, pregnancy, and patient involvement in research. Results: There were 1,873 respondents, 1416 of which had inflammatory arthritis (IA)- rheumatoid arthritis (RA) (65.8%) and psoriatic arthritis (PsA) (34.2%). They were predominantly female (RA 86%, PsA 85 %), aged 55±13 and 50±12 years. Less than 35% of patients had an understanding of diagnostic tests, what was measured and the implication for disease, with 75.5% also concerned about heredity. There was a high level of understanding of how specific medications treat inflammatory arthritis (72.9%). Adherence was also very high (>87%), with the main reasons for stopping medication without the advice of their clinician, ‘feeling better’ and ‘side effects’ however a significant proportion of patients (69.9%) reported a disease-flare following cessation of medication. Patients (31%) were also concerned that inflammatory arthritis reduced their chances of getting pregnant, with only 8% believing arthritis medications were safe to take during pregnancy. Finally, only 9% of patients had ever been asked to participate in a research study. Conclusions: This study demonstrates a need for the development of stronger patient-partnerships with clinicians and researchers in relation to patient education and engagement with research, to create a platform where patients can have meaningful input and involvement in future research studies.
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Gladman D, Nash P, Goto H, Birt JA, Lin CY, Orbai AM, Kvien TK. Fatigue numeric rating scale validity, discrimination and responder definition in patients with psoriatic arthritis. RMD Open 2021; 6:rmdopen-2019-000928. [PMID: 31958274 PMCID: PMC7046948 DOI: 10.1136/rmdopen-2019-000928] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Revised: 09/27/2019] [Accepted: 10/22/2019] [Indexed: 01/21/2023] Open
Abstract
Objectives This study assessed the psychometric properties of the fatigue numeric rating scale (NRS) and sought to establish values for clinically meaningful change (responder definition). Methods Using disease-specific clinician-reported and patient-reported data from two randomised clinical trials of patients with psoriatic arthritis (PsA), the fatigue NRS was evaluated for test–retest reliability, construct validity and responsiveness. A responder definition was also explored using anchor-based and distribution-based methods. Results Test–retest reliability analyses supported the reproducibility of the fatigue NRS in patients with PsA (intraclass correlation coefficient=0.829). Mean (SD) values at baseline and week 2 were 5.7 (2.2) and 5.7 (2.4), respectively. Supporting construct validity of the fatigue NRS, moderate-to-large correlations with other assessments measuring similar concepts as measured by Sackett’s conventions were demonstrated. Fatigue severity was reduced when the underlying disease activity was improved and reductions remained consistent at week 12 and 24. A 3-point improvement was identified as being optimal for demonstrating a level of clinically meaningful improvement in fatigue NRS after 12–24 weeks of treatment. Conclusions Fatigue NRS is a valid and responsive patient-reported outcome instrument for use in patients with PsA. The established psychometric properties from this study support the use of fatigue NRS in clinical trials and in routine clinical practice. Robust validation of reliability for use in routine clinical practice in treating patients with active PsA in less active disease states and other more diverse ethnic groups is needed.
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Affiliation(s)
- Dafna Gladman
- Medicine/Rheumatology, Krembil Research Institute, Toronto, Ontario, Canada
| | - Peter Nash
- Department of Medicine, Griffith University, Brisbane, Queensland, Australia
| | | | - Julie A Birt
- Eli Lilly and Company, Indianapolis, Indiana, USA
| | - Chen-Yen Lin
- Eli Lilly and Company, Indianapolis, Indiana, USA
| | - Ana-Maria Orbai
- Medicine Rheumatology, Johns Hopkisn University, Baltimore, Maryland, USA
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23
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Kodumudi V, Rajput K. Pain Management in Painful Psoriasis and Psoriatic Arthropathy: Challenging and Intricately Intertwined Issues Involving Several Systems. Curr Pain Headache Rep 2021; 25:36. [PMID: 33821380 DOI: 10.1007/s11916-021-00952-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/22/2021] [Indexed: 11/28/2022]
Abstract
PURPOSE OF REVIEW Psoriasis and psoriatic arthropathy are inflammatory autoimmune conditions that can lead to profound emotional distress, social stigmatization, isolation, disfigurement, pain, disability, unemployment, and decreased quality of life. Thus, this disease has immense psychological, social, and economic implications as the pain experienced is closely associated with the primary disease burden. This review focuses on discussing the primary disease burden of psoriasis and psoriatic arthropathy, as well as management of different types of pain in these patients. RECENT FINDINGS Pain affects over 40% of patients with psoriasis, ranging from neuropathic to nociceptive. Treatment of pain largely focuses on treating the underlying disease with mild topical steroids and non-steroidal medications including vitamin D analogs followed by systemic immunomodulatory agents for more severe disease. Interventional options such as corticosteroid injections are available for select cases (conditional recommendation). Psoriasis and psoriatic arthropathy have been associated with underreporting and resultant undertreatment of pain. Pain control in these conditions is complex and requires a multidisciplinary approach. More research and guidelines are needed in the areas of reporting of psoriatic disease, associated pain, psoriatic nociception, and optimal clinical management.
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Affiliation(s)
- Vijay Kodumudi
- Yale University School of Medicine, 333 Cedar St, TMP3, CT, 06510, New Haven, USA
| | - Kanishka Rajput
- Yale University School of Medicine, 333 Cedar St, TMP3, CT, 06510, New Haven, USA.
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Antony A, Holland R, D'Agostino MA, Maksymowych WP, Bertheussen H, Schick L, Goel N, Ogdie A, Orbai AM, Højgaard P, Coates LC, Strand V, Gladman DD, Christensen R, Leung YY, Mease P, Tillett W. Measurement properties of radiographic outcome measures in Psoriatic Arthritis: A systematic review from the GRAPPA-OMERACT initiative. Semin Arthritis Rheum 2021; 51:367-386. [PMID: 33601193 DOI: 10.1016/j.semarthrit.2021.01.008] [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: 09/22/2020] [Revised: 11/27/2020] [Accepted: 01/05/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND Structural damage is as an important outcome in the Psoriatic Arthritis (PsA) Core Domain Set and its assessment is recommended at least once in the development of a new drug. OBJECTIVES To conduct a systematic review (SR) to identify studies addressing the measurement properties of radiographic outcome instruments for structural damage in PsA and appraise the evidence through the Outcome Measures in Rheumatology (OMERACT) Filter 2.1 Framework Instrument Selection Algorithm (OFISA). METHODS A SR was conducted using search strategies in EMBASE and MEDLINE to identify full-text English studies which aimed to develop or assess the measurement properties of radiographic outcome instruments in PsA. Determination of eligibility and data extraction was performed independently by two reviewers with input from a third to achieve consensus. Two reviewers assessed the methodology and results of eligible studies and synthesized the evidence using OMERACT methodology. RESULTS Twelve articles evaluating radiographic instruments were included. The articles assessed nine peripheral (hands, wrists and/or feet) and six axial (spinal and/or sacroiliac joints) radiographic instruments. The peripheral radiographic instruments with some evidence for reliability, cross-sectional construct validity and longitudinal construct validity were the Ratingen and modified Sharp van der Heijde scores. No instruments had evidence for clinical trial discrimination or thresholds of meaning. There was limited evidence for the measurement properties of all identified axial instruments. CONCLUSION There are significant knowledge gaps in the responsiveness of peripheral radiographic instruments. Axial radiographic instruments require further validation, and the need to generate novel instruments and utilise other imaging modalities should be considered.
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Affiliation(s)
- Anna Antony
- School of Clinical Sciences, Department of Rheumatology, Monash Medical Centre, Monash University, 246 Clayton Road, Clayton 3168 VIC, Australia.
| | - Richard Holland
- Department of Rheumatology, Concord Repatriation General Hospital, New South Wales, Australia
| | | | | | | | | | - Niti Goel
- Patient Research Partner, Duke University School of Medicine, United States
| | - Alexis Ogdie
- Division of Rheumatology, University of Pennsylvania, Pennsylvania, United States
| | - Ana-Maria Orbai
- Division of Rheumatology, Johns Hopkins University School of Medicine, United States
| | - P Højgaard
- Centre for Rheumatology and Spine Diseases, Rigshospitalet, Denmark
| | - Laura C Coates
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, and Oxford Biomedical Research Centre, Oxford University Hospitals NHS Trust, Oxford, United Kingdom
| | - Vibeke Strand
- Division of Immunology/Rheumatology, Stanford University School of Medicine, Palo Alto CA, United States
| | - Dafna D Gladman
- Krembil Research Institute, University of Toronto, Toronto Western Hospital, Canada
| | - Robin Christensen
- Musculoskeletal Statistics Unit, the Parker Institute, Bispebjerg and Frederiksberg Hospital, Copenhagen & Research Unit of Rheumatology, Department of Clinical Research, University of Southern Denmark, Odense University Hospital, Denmark
| | - Ying Ying Leung
- Department of Rheumatology and Immunology, Singapore General Hospital, Singapore
| | - Philip Mease
- Rheumatology, Swedish Medical Center, Seattle, Washington, USA
| | - William Tillett
- Department of Pharmacy and Pharmacology, University of Bath, Bath, United Kingdom
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Goel N. Conducting research in psoriatic arthritis: the emerging role of patient research partners. Rheumatology (Oxford) 2021; 59:i47-i55. [PMID: 32159791 PMCID: PMC7065462 DOI: 10.1093/rheumatology/kez338] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2019] [Revised: 06/24/2019] [Indexed: 12/16/2022] Open
Abstract
Since 2003, patients have become increasingly involved in research endeavours related to psoriatic arthritis (PsA), progressing into a patient research partner (PRP) role. This paper reviews the general considerations related to PRP involvement in research endeavours and more specifically, the evolution of PRP contributions related to PsA research. The addition of the perspective from individuals with lived experience of PsA can bring unique insights to the research process, and increase the likelihood that the results of research are meaningful and relevant to PsA patients. There are also potential issues to address when incorporating PRPs, such as the need for additional time and effort to identify, train, and collaborate with PRPs as members of a research team. Overall, while there are challenges to overcome, and the opportunities to include PRPs are sometimes overlooked, efforts to include PRPs in PsA research should offer significant benefits to patients, researchers, and trials.
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Affiliation(s)
- Niti Goel
- Department of Medicine, Duke University School of Medicine, Durham, NC, USA
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Gudu T, Jadon DR. Multidisciplinary working in the management of axial and peripheral spondyloarthritis. Ther Adv Musculoskelet Dis 2020; 12:1759720X20975888. [PMID: 33354231 PMCID: PMC7734487 DOI: 10.1177/1759720x20975888] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2020] [Accepted: 10/14/2020] [Indexed: 12/24/2022] Open
Abstract
Multidisciplinary (MD) care is essential in the management of patients with spondyloarthritis (SpA) and is one of the main pillars of disease management and patient care. However, evidence supporting the effectiveness and benefits of this strategy in SpA is scarce. In this review we discuss the three types of MD care models: (i) combined clinics (MD units), including ‘face to face’, ‘parallel’ and ‘circuit approach’ clinics; (ii) MD team meetings; (iii) group consultations. The most frequently used model in SpA studies has been the ‘parallel’ combined clinic and usually encompasses a rheumatologist and another specialist, most commonly a dermatologist or a gastroenterologist, that work in tandem according to predefined referral criteria and treatment algorithms. MD working seems to improve the care of patients with SpA by a better identification and diagnosis of the disease, an earlier and more comprehensive treatment approach, and better outcomes for patients in terms of disease activity, physical function, quality of life and patient satisfaction. Nevertheless, challenges remain. Data on effectiveness and feasibility are scarce and are mostly derived from studies with design issues and often without a unidisciplinary care comparator arm. Although patient centricity is one of the core values of patient care and MD setting in SpA, the patient often does not play an active role in most of the MD settings studied or in common clinical practice. Further efforts should be made so that MD care reflects patients’ expectations and needs. Overcoming these limits will help to implement successfully SpA MD care in daily clinical practice and subsequently to achieve a higher quality of care for our patients.
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Affiliation(s)
- Tania Gudu
- Department of Rheumatology, Cambridge University Hospitals NHSFT, Cambridge, UK
| | - Deepak R Jadon
- Rheumatology Research Unit, Addenbrooke's Hospital, Cambridge, CB2 0QQ, UK
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27
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Meneguin S, de Godoy NA, Pollo CF, Miot HA, de Oliveira C. Quality of life of patients living with psoriasis: a qualitative study. BMC DERMATOLOGY 2020; 20:22. [PMID: 33302933 PMCID: PMC7727128 DOI: 10.1186/s12895-020-00116-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Accepted: 11/25/2020] [Indexed: 12/20/2022]
Abstract
BACKGROUND Psoriasis is a multifactorial inflammatory disease prevalent in dermatology. We aimed to understand the perceptions of patients living with psoriasis in relation to their quality of life and to identify aspects to improve it. METHODS This is qualitative research carried out in a dermatology outpatient clinic of the São Paulo State University (UNESP) medical school, Botucatu, Brazil, with 81 psoriasis patients. The interviews were transcribed and analysed using the Discourse of the Collective Subject method (DCS). RESULTS Quality of life was linked to well-being, happiness, leisure, good food and financial stability. However, disease symptoms, social and clothing restrictions, impairment of professional activities and the absence of a cure, negatively influenced their perceptions. Suggestions for improvements included an increase of public awareness, stress reduction, disease acceptance and multidisciplinary care. CONCLUSION The meanings of quality of life revealed by the participants are subjective, multidimensional, linked to moments experienced by them and to the health-disease process. Public health policies promoting reduction in social stigma and stress as well as multidisciplinary approaches towards care can contribute to improvements of QoL in psoriasis.
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Affiliation(s)
- Silmara Meneguin
- Department of Nursing, Botucatu Medical School, Paulista State University, São Paulo, Brazil.
| | | | - Camila Fernandes Pollo
- Department of Nursing, Botucatu Medical School, Paulista State University, São Paulo, Brazil
| | - Hélio Amante Miot
- Department of Dermatology, Botucatu Medical School, Paulista State University, São Paulo, Brazil
| | - Cesar de Oliveira
- Department of Epidemiology & Public health, University College London, London, UK
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Leung YY, Holland R, Mathew AJ, Lindsay C, Goel N, Ogdie A, Orbai AM, Hojgaard P, Chau J, Coates LC, Strand V, Gladman DD, Christensen R, Tillett W, Mease P. Clinical trial discrimination of physical function instruments for psoriatic arthritis: A systematic review. Semin Arthritis Rheum 2020; 50:1158-1181. [DOI: 10.1016/j.semarthrit.2020.05.022] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 05/21/2020] [Accepted: 05/27/2020] [Indexed: 12/29/2022]
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Svoboda SA, Ghamrawi RI, Owusu DA, Feldman SR. Treatment Goals in Psoriasis: Which Outcomes Matter Most? Am J Clin Dermatol 2020; 21:505-511. [PMID: 32424692 DOI: 10.1007/s40257-020-00521-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Psoriasis is a chronic immune-mediated inflammatory disease that predominantly affects the skin and joints. Its detrimental effects on the physical, psychosocial, and emotional well-being of patients leads to a significant reduction in quality of life (QoL). The goals of treatment focus on decreasing disease severity and improving QoL for patients; accomplishing these goals requires physicians to understand both the full impact of the disease on a patient's life and the outcomes that matter most to patients. The use of outcome measures, both physician- and patient-reported, can assist clinicians in evaluating the disease burden and its effect on QoL and in identifying patient preferences for treatment, ultimately enhancing quality of care. However, current outcome measures have many limitations and do not adequately capture patients' needs and priorities. Nevertheless, physicians treating patients with psoriasis are encouraged to utilize these instruments while remaining cognizant of each of their limitations. As there is no consensus on an outcome measure that fully encompasses the complexities of psoriasis and its impact on patients, instruments that are appropriate and applicable to dermatologists and their patients should be developed.
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Affiliation(s)
- Steven A Svoboda
- Center for Dermatology Research, Department of Dermatology, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC, 27157-1071, USA.
| | - Rima I Ghamrawi
- Center for Dermatology Research, Department of Dermatology, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC, 27157-1071, USA
| | - Dorellie A Owusu
- Center for Dermatology Research, Department of Dermatology, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC, 27157-1071, USA
| | - Steven R Feldman
- Center for Dermatology Research, Department of Dermatology, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC, 27157-1071, USA
- Department of Pathology, Wake Forest School of Medicine, Winston-Salem, NC, USA
- Department of Social Sciences & Health Policy, Wake Forest School of Medicine, Winston-Salem, NC, USA
- Department of Dermatology, University of Southern Denmark, Odense, Denmark
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Orbai AM, Ogdie A, Gossec L, Tillett W, Leung YY, Gao J, Trivedi M, Tasset C, Meuleners L, Besuyen R, Hendrikx T, Coates LC. Effect of filgotinib on health-related quality of life in active psoriatic arthritis: a randomized phase 2 trial (EQUATOR). Rheumatology (Oxford) 2020; 59:1495-1504. [PMID: 31624837 PMCID: PMC7310097 DOI: 10.1093/rheumatology/kez408] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Revised: 08/08/2019] [Indexed: 01/20/2023] Open
Abstract
Objective To examine the effects of filgotinib, an oral, selective Janus kinase 1 inhibitor, on health-related quality of life (HRQoL) using the Psoriatic Arthritis Impact of Disease (PsAID)9 questionnaire in active PsA. Methods Patients were randomized 1 : 1 to filgotinib 200 mg or placebo once daily for 16 weeks in EQUATOR, a multicentre, double-blind, phase 2 randomized controlled trial. HRQoL was assessed with PsAID9 at Weeks 4 and 16. Change from baseline in total and individual domain scores, plus the proportions of patients achieving minimal clinically important improvement (MCII; ⩾3 points) and patient-accepted symptom status (PASS; score <4), were evaluated. Correlation with the 36-item short-form health survey (SF-36) was investigated. Results One hundred and thirty-one patients were randomized to filgotinib or placebo. Filgotinib effects on PsAID9 were observed from Week 4. At Week 16, mean (s.d.) change from baseline in PsAID9 was –2.3 (1.8) and –0.8 (2.2) for filgotinib and placebo, respectively (least-squares mean of group difference –1.48 [95% CI –2.12, –0.84], P < 0.0001), with significant improvements in all domains vs placebo. Significantly more patients on filgotinib achieved MCII (group difference 25.4% [95% CI 8.92, 39.99], P = 0.0022) and PASS (group difference 29.6% [95% CI 10.65, 45.60], P = 0.0018) at Week 16 vs placebo. Similar improvements in SF-36 were observed, with moderate to strong negative correlation between PsAID9 and SF-36. Conclusion Filgotinib significantly improved HRQoL vs placebo in patients with active PsA, as measured by PsAID9. To our knowledge, EQUATOR is the first randomized controlled trial to evaluate PsAID9. Trial registration ClinicalTrials.gov, https://clinicaltrials.gov/ct2/show, NCT03101670.
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Affiliation(s)
- Ana-Maria Orbai
- Division of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, MA
| | - Alexis Ogdie
- Division of Rheumatology and Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Laure Gossec
- Institut Pierre Louis d'Epidémiologie et de Santé Publique, Sorbonne Université.,Rheumatology Department, Pitié Salpêtrière Hospital, AP-HP, Paris, France
| | - William Tillett
- Rheumatology, Royal National Hospital for Rheumatic Diseases.,Pharmacy and Pharmacology, University of Bath, Bath, UK
| | - Ying Ying Leung
- Department of Rheumatology & Immunology, Singapore General Hospital, Duke-NUS Medical School, Singapore, Singapore
| | | | - Mona Trivedi
- Clinical Research, Gilead Sciences, Inc, Foster City, CA, USA
| | | | | | | | | | - Laura C Coates
- Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
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Sumpton D, Kelly A, Tunnicliffe DJ, Craig JC, Hassett G, Chessman D, Tong A. Patients’ Perspectives and Experience of Psoriasis and Psoriatic Arthritis: A Systematic Review and Thematic Synthesis of Qualitative Studies. Arthritis Care Res (Hoboken) 2020; 72:711-722. [DOI: 10.1002/acr.23896] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Accepted: 03/26/2019] [Indexed: 02/06/2023]
Affiliation(s)
- Daniel Sumpton
- Concord Repatriation General Hospital, Sydney School of Public HealthThe University of Sydney, and The Children’s Hospital Westmead Sydney New South Wales Australia
| | - Ayano Kelly
- The Children’s Hospital Westmead, Sydney, New South Wales, and Australian National University Canberra Australia
| | - David J. Tunnicliffe
- Sydney School of Public HealthThe University of Sydney, and The Children’s Hospital Westmead Sydney New South Wales Australia
| | | | | | | | - Allison Tong
- Sydney School of Public HealthThe University of Sydney, and The Children’s Hospital Westmead Sydney New South Wales Australia
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32
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Leung YY, Orbai AM, Ogdie A, Hojgaard P, Holland R, Goel N, Chau J, Coates LC, Strand V, Gladman DD, Mease PJ, Christensen R, Tillett W. Appraisal of Candidate Instruments for Assessment of the Physical Function Domain in Patients with Psoriatic Arthritis. J Rheumatol 2020; 48:58-66. [DOI: 10.3899/jrheum.191119] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/17/2020] [Indexed: 12/20/2022]
Abstract
Objective.Numerous patient-reported outcome measures (PROM) exist for the measurement of physical function for psoriatic arthritis (PsA), but only a few are validated comprehensively. The objective of this project was to prioritize PROM for measuring physical function for potential incorporation into a standardized outcome measurement set for PsA.Methods.A working group of 13 members including 2 patient research partners was formed. PROM measuring physical function in PsA were identified through a systematic literature review and recommendations by the working group. The rationale for inclusion and exclusion from the original list of existing PROM was thoroughly discussed and 2 rounds of Delphi exercises were conducted to achieve consensus.Results.Twelve PROM were reviewed and discussed. Six PROM were prioritized: Health Assessment Questionnaire (HAQ) and 4 modifications (HAQ-Disability Index, HAQ-Spondyloarthritis, modified HAQ, multidimensional HAQ), Medical Outcomes Study 36-item Short Form survey physical functioning domain, and the Patient-Reported Outcomes Measurement Information System (PROMIS) physical functioning module.Conclusion.Through discussion and Delphi exercises, we achieved consensus to prioritize 6 physical function PROM for PsA. These 6 PROM will undergo further appraisal using the Outcome Measures in Rheumatology (OMERACT) Filter 2.1.
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Dures E, Bowen C, Brooke M, Lord J, Tillett W, McHugh N, Hewlett S. Diagnosis and initial management in psoriatic arthritis: a qualitative study with patients. Rheumatol Adv Pract 2019; 3:rkz022. [PMID: 31528844 PMCID: PMC6735807 DOI: 10.1093/rap/rkz022] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Revised: 07/23/2019] [Indexed: 01/10/2023] Open
Abstract
Objectives PsA is an inflammatory condition that can cause pain, fatigue, swelling and joint stiffness. The consequences include impaired physical function, a high psychosocial burden, reduced quality of life and work disability. The presenting symptoms can be non-specific and varied, leading to delays in diagnosis or referral to specialist teams. The aim of this study was to explore patients' experiences of being diagnosed and the initial management of PsA. Methods The study used a qualitative design, with data collected in one-to-one, face-to-face semi-structured interviews. Results Fifteen newly diagnosed patients (<24 months) from three hospital sites in the southwest of England participated. Interviews were transcribed, anonymized and analysed using inductive thematic analysis. The following two main themes with sub-themes represent the data: symptom onset to specialist care: ‘it was the blind leading the blind’ (making sense of symptoms; mis-diagnosis and missed opportunities; and fast and easy access to expertise); and diagnosis as a turning point: ‘having somebody say you've got something wrong with you, I was euphoric’ (validation and reassurance; weighing up treatment options; taking on self-management; and acknowledging loss and change). Conclusion Participants were already dealing with functional limitations and were highly distressed and anxious by the time they received their diagnosis. Physical and mental outcomes could be improved by the implementation of existing psoriasis management guidelines and strategies for earlier referral from primary care to rheumatology and by the development of guidelines on educational, self-management and psychological support provision soon after diagnosis.
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Affiliation(s)
- Emma Dures
- Department of Nursing & Midwifery, University of the West of England.,Academic Rheumatology, Bristol Royal Infirmary, Bristol
| | - Clive Bowen
- The Psoriatic Arthritis Support Group (PsAZZ), Bristol
| | - Mel Brooke
- The Psoriatic Arthritis Support Group (PsAZZ), Bristol
| | - Jane Lord
- Academic Rheumatology, Bristol Royal Infirmary, Bristol
| | - William Tillett
- Royal National Hospital for Rheumatic Diseases.,Department of Pharmacy & Pharmacology, University of Bath, Bath, UK
| | - Neil McHugh
- Department of Pharmacy & Pharmacology, University of Bath, Bath, UK
| | - Sarah Hewlett
- Department of Nursing & Midwifery, University of the West of England.,Academic Rheumatology, Bristol Royal Infirmary, Bristol
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Gorlier C, Orbai AM, Puyraimond-Zemmour D, Coates LC, Kiltz U, Leung YY, Palominos P, Cañete JD, Scrivo R, Balanescu A, Dernis E, Tälli S, Ruyssen-Witrand A, Soubrier M, Aydin SZ, Eder L, Gaydukova I, Lubrano E, Kalyoncu U, Richette P, Husni ME, de Wit M, Smolen JS, Gossec L. Comparing patient-perceived and physician-perceived remission and low disease activity in psoriatic arthritis: an analysis of 410 patients from 14 countries. Ann Rheum Dis 2018; 78:201-208. [DOI: 10.1136/annrheumdis-2018-214140] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Revised: 10/15/2018] [Accepted: 10/27/2018] [Indexed: 11/03/2022]
Abstract
BackgroundThe objective was to compare different definitions of remission and low disease activity (LDA) in patients with psoriatic arthritis (PsA), based on both patients’ and physicians’ perspectives.MethodsIn ReFlap (Remission/Flare in PsA; NCT03119805), adults with physician-confirmed PsA and >2 years of disease duration in 14 countries were included. Remission was defined as very low disease activity (VLDA), Disease Activity index for PSoriatic Arthritis (DAPSA) ≤4, and physician-perceived and patient-perceived remission (specific question yes/no), and LDA as minimal disease activity (MDA), DAPSA <14, and physician-perceived and patient-perceived LDA. Frequencies of these definitions, their agreement (prevalence-adjusted kappa), and sensitivity and specificity versus patient-defined status were assessed cross-sectionally.ResultsOf 410 patients, the mean age (SD) was 53.9 (12.5) years, 50.7% were male, disease duration was 11.2 (8.2) years, 56.8% were on biologics, and remission/LDA was frequently attained: respectively, for remission from 12.4% (VLDA) to 36.1% (physician-perceived remission), and for LDA from 25.4% (MDA) to 43.9% (patient-perceived LDA). Thus, patient-perceived remission/LDA was frequent (65.4%). Agreement between patient-perceived remission/LDA and composite scores was moderate to good (kappa range, 0.12–0.65). When patient-perceived remission or LDA status is used as reference, DAPSA-defined remission/LDA and VLDA/MDA had a sensitivity of 73.1% and 51.5%, respectively, and a specificity of 76.8% and 88.0%, respectively. Physician-perceived remission/LDA using a single question was frequent (67.6%) but performed poorly against other definitions.ConclusionIn this unselected population, remission/LDA was frequently attained. VLDA/MDA was a more stringent definition than DAPSA-based remission/LDA. DAPSA-based remission/LDA performed better than VLDA/MDA to detect patient-defined remission or remission/LDA. Further studies of long-term outcomes are needed.
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Abraham S, Barton A, Eder L, Lim A, McGonagle D, McHugh N, Pennington S, Sengupta R, Siebert S, Bowness P, Schafer PH, Cullen E, FitzGerald O. Advancing research paradigms and pathophysiological pathways in psoriatic arthritis and ankylosing spondylitis: Proceedings of the 2017 Platform for the Exchange of Expertise and Research (PEER) meeting. Semin Arthritis Rheum 2018; 48:1005-1013. [PMID: 30415944 DOI: 10.1016/j.semarthrit.2018.10.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Revised: 09/06/2018] [Accepted: 10/09/2018] [Indexed: 10/28/2022]
Affiliation(s)
- Sonya Abraham
- NIHR/Wellcome Trust Clinical Research Facility, Imperial Centre for Translational and Experimental Medicine, Imperial College Healthcare NHS Trust, Hammersmith Hospital, Du Cane Road, London W12 0HS, UK.
| | - Anne Barton
- Centre for Musculoskeletal Research, University of Manchester and Central Manchester NHS Foundation Trust, Manchester Academic Health Sciences Centre, Manchester, UK
| | - Lihi Eder
- Women's College Research Institute, Women's College Hospital, University of Toronto, Toronto, ON, Canada
| | - Adrian Lim
- Charing Cross Hospital, Imperial College London, UK
| | - Dennis McGonagle
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Chapel Allerton Hospital, Leeds, UK
| | - Neil McHugh
- Royal National Hospital for Rheumatic Diseases and Department of Pharmacy and Pharmacology, University of Bath, Bath, UK
| | - Stephen Pennington
- St. Vincent's University Hospital and Conway Institute for Biomolecular Research, University College Dublin School of Medicine, Dublin, Ireland
| | - Raj Sengupta
- Royal National Hospital for Rheumatic Diseases, Bath, UK
| | - Stefan Siebert
- Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow, UK
| | - Paul Bowness
- Nuffield Department of Orthopaedics Rheumatology and Musculoskeletal Science, Oxford OX3 7LD, UK
| | | | | | - Oliver FitzGerald
- St. Vincent's University Hospital and Conway Institute for Biomolecular Research, University College Dublin School of Medicine, Dublin, Ireland
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Mapping Quality of Life (EQ-5D) from DAPsA, Clinical DAPsA and HAQ in Psoriatic Arthritis. PATIENT-PATIENT CENTERED OUTCOMES RESEARCH 2018; 11:329-340. [PMID: 29164493 DOI: 10.1007/s40271-017-0285-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND Clinical trials and observational studies lacking measures of health-related quality of life (QoL) are often inapplicable when conducting cost-effectiveness analyses using quality-adjusted life-years (QALYs). The only solution is to map QoL ex post from additionally collected clinical outcomes and generic QoL instruments. Nonetheless, mapping studies are absent in psoriatic arthritis (PsA). METHODS In this 2-year, prospective, multicentre, non-interventional study of PsA patients, EQ-5D and key clinical parameters such as Disease Activity in PsA (DAPsA), clinical DAPsA (cDAPsA; DAPsA without C-reactive protein [CRP]), and Health Assessment Questionnaire disability index (HAQ) were collected. We employed a linear mixed-effect regression model (ME) of the longitudinal dataset to explore the best predictors of QoL. RESULTS A total of 228 patients were followed over 873 appointments/observations. DAPsA, cDAPsA and HAQ were stable and highly significant predictors of EQ-5D utilities in both cross-sectional and longitudinal analyses. The best prediction was provided using a linear ME with HAQ and cDAPsA or DAPsA. A HAQ increase of 1 point represented a decrease in EQ-5D by -0.204 or -0.203 (p < 0.0001); a one-point increase in cDAPsA or DAPsA dropped EQ-5D equally by -0.005 (p < 0.0001). The ME revealed steeper and more accurate association compared with cross-sectional regressions or non-linear models/transformations. CONCLUSIONS This is the first mapping study conducted in PsA and we hope that our study will encourage further mapping studies in PsA. The results showed that in cases where CRP is absent, cDAPsA provides similar results to DAPsA in predicting QoL.
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Allard A, Antony A, Shaddick G, Jadon DR, Cavill C, Robinson G, Korendowych E, McHugh N, Tillett W. Trajectory of radiographic change over a decade: the effect of transition from conventional synthetic disease-modifying antirheumatic drugs to anti-tumour necrosis factor in patients with psoriatic arthritis. Rheumatology (Oxford) 2018; 58:269-273. [DOI: 10.1093/rheumatology/key297] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Indexed: 11/14/2022] Open
Affiliation(s)
- Andrew Allard
- Rheumatology, Royal National Hospital for Rheumatic Diseases, Bath, UK
| | - Anna Antony
- Rheumatology, Royal National Hospital for Rheumatic Diseases, Bath, UK
| | | | - Deepak R Jadon
- Rheumatology, Cambridge University Hospitals NHSFT, Cambridge, UK
| | - Charlotte Cavill
- Rheumatology, Royal National Hospital for Rheumatic Diseases, Bath, UK
| | | | | | - Neil McHugh
- Rheumatology, Royal National Hospital for Rheumatic Diseases, Bath, UK
- Pharmacy and Pharmacology, University of Bath, Bath, UK
| | - William Tillett
- Rheumatology, Royal National Hospital for Rheumatic Diseases, Bath, UK
- Pharmacy and Pharmacology, University of Bath, Bath, UK
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Erskine G, Dures E, McHugh N, Hewlett S. Exploring the illness representations of people with psoriatic arthritis: a secondary analysis of focus group data. Rheumatol Adv Pract 2018; 2:rky023. [PMID: 31431969 PMCID: PMC6649914 DOI: 10.1093/rap/rky023] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2018] [Revised: 06/05/2018] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND PsA is an inflammatory arthritis associated with psoriasis, affecting the joints and connective tissue. According to the common-sense model (CSM), patients develop illness beliefs when faced with new symptoms, which determine their emotional and behavioural response to the condition. The CSM includes five beliefs: identity, consequence, cause, time line and control. These are important determinants of outcomes and have been shown to influence adherence to medication. METHODS A secondary analysis of eight focus groups held across five hospital sites and including 41 participants was undertaken. Participants were sampled for a range of phenotypes and domains of disease activity: men = 20 and women = 21; mean (s.d.): age = 58 (11.4) years; disease duration = 9 (8.3) years; and HAQ = 1 (0.7). RESULTS The analysis provided evidence to support the existence of the five illness beliefs among patients with PsA and evidence that these representations affected the way patients engaged with their condition. The results showed that many participants experienced high levels of uncertainty in relationship to the illness representation. The role of external social and environmental factors was also shown to influence participants' illness representations and the way they made sense of their PsA. CONCLUSION This research highlights a new theme of uncertainty within illness representations and how this impacts on the way in which people living with PsA manage their condition. A greater understanding of the uncertainty that patients might have about their condition and its treatment could provide clinicians with an opportunity to address misinformed illness representations.
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Affiliation(s)
- George Erskine
- Academic Rheumatology, University of the West of England, Bristol Royal Infirmary, Bristol, UK,Correspondence to: George Erskine, Academic Rheumatology, University of the West of England, Bristol Royal Infirmary, Bristol, England. E-mail:
| | - Emma Dures
- Academic Rheumatology, University of the West of England, Bristol Royal Infirmary, Bristol, UK
| | - Neil McHugh
- Department of Pharmacy and Pharmacology, University of Bath, Bath, Somerset, UK
| | - Sarah Hewlett
- Academic Rheumatology, University of the West of England, Bristol Royal Infirmary, Bristol, UK
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Tillett W, Bojke L. Work Disability and the Cost-effectiveness of Drugs to Treat Rheumatic Diseases - Time for a New Dialogue? J Rheumatol 2018; 45:1075-1077. [PMID: 30068757 DOI: 10.3899/jrheum.180197] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- William Tillett
- Royal National Hospital for Rheumatic Diseases; and Department of Pharmacy and Pharmacology, University of Bath, Bath;
| | - Laura Bojke
- Centre for Health Economics, University of York, York, UK
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40
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Affiliation(s)
- Tania Gudu
- Research Center of Rheumatic Diseases, Sf Maria Hospital, University of Medicine and Pharmacy Carol Davila, Bucharest, Romania
| | - Laure Gossec
- Department of Rheumatology, Sorbonne Université, Institut Pierre Louis d’Epidémiologie et de Santé Publique; AP-HP, Pitié Salpêtrière Hospital, Paris, France
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Scalone L, Sarzi-Puttini P, Sinigaglia L, Montecucco C, Giacomelli R, Lapadula G, Olivieri I, Giardino AM, Cortesi PA, Mantovani LG, Mecchia M. Patients', physicians', nurses', and pharmacists' preferences on the characteristics of biologic agents used in the treatment of rheumatic diseases. Patient Prefer Adherence 2018; 12:2153-2168. [PMID: 30410311 PMCID: PMC6199235 DOI: 10.2147/ppa.s168458] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
OBJECTIVE To estimate preferences in relevant treatment characteristics evaluated by different groups involved in the management of patients with rheumatic diseases. SUBJECTS AND METHODS We surveyed patients with rheumatic diseases, and rheumatologists, nurses, and pharmacists with experience in treatment with/provision of biologic drugs for these patients. Through a discrete choice experiment, participants evaluated 16 possible scenarios in which pairs of similarly efficacious treatments were described with six characteristics: 1) frequency of administration; 2) mode and place of administration; 3) manner, helpfulness, efficiency, and courtesy of health personnel; 4) frequency of reactions at the site of drug administration; 5) severity of generalized undesired/allergic reactions; and 6) additional cost. The direction and strength of preferences toward each characteristic level and the relative importance of each characteristic were estimated through a random-effects conditional logistic regression model. RESULTS In total, 513 patients, 110 rheumatologists, 51 nurses, and 46 pharmacists from 30 centers in Italy participated. Characteristics 3, 4, and 6 were the most important for every subgroup; 1 was least important for patients and rheumatologists, 2 was least important for pharmacists, and 2 and 5 were least important for nurses. For characteristic 2, pharmacists preferred subcutaneous self-injection with a syringe; nurses preferred assisted infusion at an infusion center close to the patient's home; patients and rheumatologists preferred subcutaneous self-injection with a pen. CONCLUSION The different preferences for some characteristics shown by the different groups can play an important role, together with purely clinical aspects, in the choice and consequent benefit of treatments, contributing also to a more satisfactory use of resources.
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Affiliation(s)
- Luciana Scalone
- Centre of Research on Public Health, University of Milano-Bicocca, and CHARTA Foundation, Milan, Italy,
| | | | | | | | - Roberto Giacomelli
- Rheumatology Unit School of Medicine, University of L'Aquila, L'Aquila, Italy
| | | | - Ignazio Olivieri
- Rheumatology Department of Lucania, San Carlo Hospital of Potenza, Potenza, Italy
- Madonna delle Grazie Hospital of Matera, Matera, Italy
| | | | - Paolo Angelo Cortesi
- Centre of Research on Public Health, University of Milano-Bicocca, and CHARTA Foundation, Milan, Italy,
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Tillett W. Comment on: Residual disease activity in psoriatic arthritis: discordance between the rheumatologist’s opinion and minimal disease activity measurement. Rheumatology (Oxford) 2017; 57:401-402. [DOI: 10.1093/rheumatology/kex400] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2017] [Accepted: 09/28/2017] [Indexed: 11/14/2022] Open
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Tillett W, Dures E, Hewlett S, Helliwell PS, FitzGerald O, Brooke M, James J, Lord J, Bowen C, de Wit M, Orbai AM, McHugh N. A Multicenter Nominal Group Study to Rank Outcomes Important to Patients, and Their Representation in Existing Composite Outcome Measures for Psoriatic Arthritis. J Rheumatol 2017; 44:1445-1452. [DOI: 10.3899/jrheum.161459] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/18/2017] [Indexed: 01/06/2023]
Abstract
Objective.To rank outcomes identified as important to patients with psoriatic arthritis (PsA) and examine their representation in existing composite measures.Methods.Seven nominal group technique (NGT) meetings took place at 4 hospital sites. Two sorting rounds were conducted to generate a shortlist of outcomes followed by a group discussion and final ranking. In the final ranking round, patients were given 15 points each and asked to rank their top 5 outcomes from the shortlist. The totals were summed across the 7 NGT groups and were presented as a percentage of the maximum possible priority score.Results.Thirty-one patients took part: 16 men and 15 women; the mean age was 54 years (range 24–77; SD 12.2), the mean disease duration was 10.3 years (range 1–40; SD 9.2), and mean Health Assessment Questionnaire was 1.15 (range 0–2.63; SD 0.7). The highest-ranked outcomes that patients wished to see from treatment were pain with 93 points (20.0%), fatigue 62 (13.3%), physical fitness 33 (7.1%), halting/slowing damage 32 (6.9%), and quality of life/well-being 29 (6.2%). Reviewing existing composite measures for PsA demonstrated that no single measure adequately identifies all these outcomes.Conclusion.Pain and fatigue were ranked as the outcomes most important to patients receiving treatment for PsA and are not well represented within existing composite measures. Future work will focus on validating composite measures modified to identify outcomes important to patients.
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