1
|
Ramonda R, Lorenzin M, Chimenti MS, Atzeni F, Semeraro A, D'Angelo S, Selmi C, Ortolan A, Marchesoni A, Manara M, Luchetti Gentiloni MM, Santo L, Salvarani C, Cauli A, Rossini M, Amato G, Cozzi G, Scagnellato L, Ferraioli M, Carriero A, Fracassi E, Giorgio F, Doria A, Foti R, Carletto A. Four-year effectiveness, safety and drug retention rate of secukinumab in psoriatic arthritis: a real-life Italian multicenter cohort. Arthritis Res Ther 2024; 26:172. [PMID: 39342310 PMCID: PMC11438205 DOI: 10.1186/s13075-024-03401-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2024] [Accepted: 09/15/2024] [Indexed: 10/01/2024] Open
Abstract
OBJECTIVES to evaluate over a 48-month follow-up period the: 1) long-term effectiveness and safety; 2) drug retention rate (DRR); 3) impact of comorbidities and bDMARDs line on MDA and DAPSA remission/low disease activity (LDA) of secukinumab in a multicenter Italian cohort of PsA patients. METHODS Consecutive PsA patients receiving secukinumab were followed prospectively in Italian centers between 2016 and 2023. Disease characteristics, previous/ongoing treatments, comorbidities and follow-up duration were recorded. Treatment response was evaluated at 6 and 12 months after initiation, and every year up to 48 months (T48). DRR was assessed according to clinical and demographic features, comorbidities and bDMARDs line. Adverse events (AE) were recorded. RESULTS Six hundred eighty-five patients [42.5% male] were enrolled; 32.9% naïve received secukinumab; 74.2% had ≥ 1 comorbidity. Overall, secukinumab yielded improved outcomes at T48: naïve maintained lower disease activity vs. non-naïve [DAPSA 4.0 (1.4-8.1) vs. 6.0 (2.2-10.4);p = 0.04]; 76.9% naïve and 66.2% non-naïve achieved MDA; MDA no comorbidities vs. 1-3 comorbidities 78.8% vs. 73.3% (p < 0.05), and MDA no comorbidities vs. > 3 comorbidities 78.8% vs. 48.7% (p < 0.001). DAPSA-REM and DAPSA-LDA rates were higher in naïve patients, albeit similar between those without comorbidities vs. 1-3 comorbidities, and slightly lower in those with > 3 comorbidities. Treatment was discontinued in 233 patients due to loss of effectiveness, and in 41 due to AE. The overall DRR at T48 was 66%, with differences according to bDMARDs line (p < 0.001), use of combined csDMARDs (p = 0.016), BMI (p = 0.037) and mono/oligoarthritis vs. polyarthritis (p = 0.012). CONCLUSIONS Secukinumab proved safe and effective, and patients achieved sustained remission with a notable drug retention rate at 4 years.
Collapse
Affiliation(s)
- Roberta Ramonda
- Department of Medicine DIMED, Rheumatology Unit, University of Padova, Padova, Veneto, Italy.
- Rheumatology Unit, Department of Medicine-DIMED, Padova University Hospital, Via Giustiniani, 2, 35128, Padova, Italy.
| | - Mariagrazia Lorenzin
- Department of Medicine DIMED, Rheumatology Unit, University of Padova, Padova, Veneto, Italy
| | - Maria Sole Chimenti
- Department of Systems Medicine, Rheumatology, Allergology and Clinical Immunology, University of Rome Tor Vergata, Rome, Lazio, Italy
| | - Fabiola Atzeni
- Rheumatology Unit, University of Messina, Messina, Sicilia, Italy
| | - Angelo Semeraro
- Rheumatology Unit, Martina Franca-ASL Taranto, Martina Franca Hospital, Martina Franca, Taranto, Puglia, Italy
| | - Salvatore D'Angelo
- Department of Health Sciences, University of Basilicata, Potenza, Basilicata, Italy
| | - Carlo Selmi
- Rheumatology and Clinical Immunology IRCCS, Humanitas Research Hospital, Milan, Lombardia, Italy
- Department of Biomedical Sciences, Humanitas University, Milan, Lombardia, Italy
| | - Augusta Ortolan
- Rheumatology Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCSS, Rome, Lazio, Italy
| | | | - Maria Manara
- Department of Rheumatology, ASST Gaetano Pini-CTO, Milan, Lombardia, Italy
| | | | - Leonardo Santo
- Rheumatology Unit, ASL BT Andria - DSS4 Barletta, Italy, Barletta-Andria-Trani, Puglia, Italy
| | - Carlo Salvarani
- Rheumatology Unit, Department of Internal Medicine, Azienda USL-IRCCS, University of Modena and Reggio Emilia, Emilia Romagna, Italy
| | - Alberto Cauli
- Rheumatology Unit, Department of Medical Sciences, AOU and University of Cagliari, Monserrato, Sardegna, Italy
| | - Maurizio Rossini
- Rheumatology Unit, Department of Medicine, AOUI University of Verona, Verona, Veneto, Italy
| | - Giorgio Amato
- Rheumatology Unit, A.O.U. Policlinico S. Marco, Catania, Sicilia, Catania, Italy
| | - Giacomo Cozzi
- Department of Medicine DIMED, Rheumatology Unit, University of Padova, Padova, Veneto, Italy
| | - Laura Scagnellato
- Department of Medicine DIMED, Rheumatology Unit, University of Padova, Padova, Veneto, Italy
| | - Mario Ferraioli
- Department of Systems Medicine, Rheumatology, Allergology and Clinical Immunology, University of Rome Tor Vergata, Rome, Lazio, Italy
| | - Antonio Carriero
- Rheumatology Institute of Lucania (IReL), San Carlo Hospital of Potenza and Madonna delle Grazie Hospital of Matera, Potenza, Basilicata, Italy
| | - Elena Fracassi
- Rheumatology Unit, Department of Medicine, AOUI University of Verona, Verona, Veneto, Italy
| | - Francesco Giorgio
- Rheumatology Unit, Department of Medicine, AOUI University of Verona, Verona, Veneto, Italy
| | - Andrea Doria
- Department of Medicine DIMED, Rheumatology Unit, University of Padova, Padova, Veneto, Italy
| | - Rosario Foti
- Rheumatology Unit, A.O.U. Policlinico S. Marco, Catania, Sicilia, Catania, Italy
| | - Antonio Carletto
- Rheumatology Unit, Department of Medicine, AOUI University of Verona, Verona, Veneto, Italy
| |
Collapse
|
2
|
Vassilakis KD, Papagoras C, Fytanidis N, Gazi S, Mole E, Krikelis M, Voulgari PV, Kaltsonoudis E, Koletsos N, Boumpas D, Katsimpri P, Katsifis-Nezis D, Dimitroulas T, Kougkas N, Boutel M, Sfikakis PP, Tektonidou MG, Gialouri C, Bogdanos D, Simopoulou T, Koutsianas C, Mavrea E, Katsifis G, Kottas K, Konsta M, Tziafalia M, Kataxaki E, Kalavri E, Klavdianou K, Grika EP, Sfontouris C, Daoussis D, Iliopoulos G, Bournazos I, Karokis D, Georganas K, Patrikos D, Vassilopoulos D, Fragoulis GE. Identification and characteristics of patients with potential difficult-to-treat psoriatic arthritis: exploratory analyses of the Greek PsA registry. Rheumatology (Oxford) 2024; 63:2427-2432. [PMID: 38759119 PMCID: PMC11371370 DOI: 10.1093/rheumatology/keae263] [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: 02/13/2024] [Revised: 04/11/2024] [Accepted: 04/22/2024] [Indexed: 05/19/2024] Open
Abstract
OBJECTIVE To present the characteristics of patients with potential difficult-to-treat (D2T) PsA. METHODS We used data from the Greek multicentre registry of PsA patients. D2T PsA was defined as follows: patients with at least 6 months' disease duration, who have failed to at least one conventional synthetic DMARD and at least two biologic DMARDs/targeted synthetic DMARDs with a different mechanism of action and have either at least moderate disease activity (MODA) defined as DAPSA (Disease Activity index in PSoriatic Arthritis) >14, and/or are not at minimal disease activity (MDA). Demographic and clinical characteristics were compared between D2T and non-D2T PsA patients. In two sensitivity analyses, patients classified as D2T solely according to the MODA or MDA criterion were examined separately. RESULTS Among 467 patients included, 77 (16.5%) were considered D2T and 390 non-D2T PsA. Compared with non-D2T, patients with D2T PsA presented more commonly with extensive psoriasis (P < 0.0001) and were more likely to have higher BMI (P = 0.023) and a history of IBD (P = 0.026). In the MODA and MDA sensitivity analyses, 7.5% and 12.5% of patients were considered D2T, respectively. In both sensitivity analyses, extensive psoriasis was again identified as an independent variable for D2T PsA (P = 0.001 and P = 0.008, respectively). Moreover, female gender (P = 0.034) in the MODA analysis and axial disease (P = 0.040) in the MDA analysis were independent variables for D2T PsA. CONCLUSION Despite the availability of therapies, D2T PsA is common in real-life cohorts of patients with PsA and extensive psoriasis. High BMI, female gender, axial disease and history of IBD were also associated with D2T PsA.
Collapse
Affiliation(s)
- Konstantinos D Vassilakis
- Joint Academic Rheumatology Program, First Department of Propedeutic and Internal Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Charalampos Papagoras
- First Department of Internal Medicine, University Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece
| | - Nikolaos Fytanidis
- First Department of Internal Medicine, University Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece
| | - Sousana Gazi
- Department of Rheumatology, KAT Hospital, Athens, Greece
| | - Evangelia Mole
- Department of Rheumatology, KAT Hospital, Athens, Greece
| | | | - Paraskevi V Voulgari
- Department of Rheumatology, School of Health Sciences, Faculty of Medicine, University of Ioannina, Ioannina, Greece
| | - Evripidis Kaltsonoudis
- Department of Rheumatology, School of Health Sciences, Faculty of Medicine, University of Ioannina, Ioannina, Greece
| | - Nikolaos Koletsos
- Department of Rheumatology, School of Health Sciences, Faculty of Medicine, University of Ioannina, Ioannina, Greece
| | - Dimitrios Boumpas
- Joint Academic Rheumatology Program, 4th Department of Internal Medicine, Attikon University Hospital, National and Kapodistrian University of Athens Medical School, Athens, Greece
| | - Pelagia Katsimpri
- Joint Academic Rheumatology Program, 4th Department of Internal Medicine, Attikon University Hospital, National and Kapodistrian University of Athens Medical School, Athens, Greece
| | - Dimitrios Katsifis-Nezis
- Joint Academic Rheumatology Program, 4th Department of Internal Medicine, Attikon University Hospital, National and Kapodistrian University of Athens Medical School, Athens, Greece
| | | | - Nikolaos Kougkas
- 4th Department of Medicine, Aristotle University, Thessaloniki, Greece
| | - Maria Boutel
- 4th Department of Medicine, Aristotle University, Thessaloniki, Greece
| | - Petros P Sfikakis
- Joint Academic Rheumatology Program, First Department of Propedeutic and Internal Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Maria G Tektonidou
- Joint Academic Rheumatology Program, First Department of Propedeutic and Internal Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Chrysoula Gialouri
- Joint Academic Rheumatology Program, First Department of Propedeutic and Internal Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Dimitrios Bogdanos
- Department of Rheumatology and Clinical Immunology, University of Thessaly, Larissa, Greece
| | - Theodora Simopoulou
- Department of Rheumatology and Clinical Immunology, University of Thessaly, Larissa, Greece
| | - Christos Koutsianas
- Joint Academic Rheumatology Program, Clinical Immunology, Rheumatology unit, 2nd Department of Medicine and Laboratory, National and Kapodistrian University of Athens Medical School, General Hospital of Athens “Hippokration”, Athens, Greece
| | - Evgenia Mavrea
- Joint Academic Rheumatology Program, Clinical Immunology, Rheumatology unit, 2nd Department of Medicine and Laboratory, National and Kapodistrian University of Athens Medical School, General Hospital of Athens “Hippokration”, Athens, Greece
| | - Gkikas Katsifis
- Rheumatology Clinic, Naval Hospital of Athens, Athens, Greece
| | | | - Maria Konsta
- Rheumatology Unit, Sismanoglio Hospital, Athens, Greece
| | | | - Evangelia Kataxaki
- Rheumatology Department, General Hospital Elefsinas Thriaseio, Athens, Greece
| | - Eleni Kalavri
- Department of Rheumatology, “Asklepieion” General Hospital, Athens, Greece
| | | | - Eleftheria P Grika
- Department of Rheumatology, Evaggelismos Athens General Hospital, Athens, Greece
| | | | - Dimitrios Daoussis
- Department of Rheumatology, Patras University Hospital, University of Patras Medical School, Patras, Greece
| | - George Iliopoulos
- Department of Rheumatology, Patras University Hospital, University of Patras Medical School, Patras, Greece
| | | | | | | | | | - Dimitrios Vassilopoulos
- Joint Academic Rheumatology Program, Clinical Immunology, Rheumatology unit, 2nd Department of Medicine and Laboratory, National and Kapodistrian University of Athens Medical School, General Hospital of Athens “Hippokration”, Athens, Greece
| | - George E Fragoulis
- Joint Academic Rheumatology Program, First Department of Propedeutic and Internal Medicine, National and Kapodistrian University of Athens, Athens, Greece
- School of Infection and Immunity, University of Glasgow, Glasgow, UK
| |
Collapse
|
3
|
Kaerts M, Swinnen TW, Dankaerts W, de Vlam K, Neerinckx B. High-quality research on physical therapy in psoriatic arthritis is needed: a systematic review. Rheumatol Adv Pract 2024; 8:rkae107. [PMID: 39247389 PMCID: PMC11379465 DOI: 10.1093/rap/rkae107] [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: 04/25/2024] [Accepted: 08/22/2024] [Indexed: 09/10/2024] Open
Abstract
Objectives Although physical therapy is recommended as part of the non-pharmacological management of patients with psoriatic arthritis (PsA), the evidence is still unclear. Therefore, this study aimed to systematically review and appraise the quality of research on physical therapy in the management of patients with PsA. Methods In June 2024, a systematic literature search using four different databases (Medline, Embase, Web of Science and the Cochrane Library) was performed to include interventional and observational studies examining physical therapy in patients with PsA (PROSPERO ID 255501). A risk of bias assessment was conducted. Due to the wide variety of interventions and outcomes, a narrative synthesis was used. Results Of 9442 abstracts, 15 papers examining physical therapy uptake in clinical practice (N = 2) and different physical therapy interventions (N = 13) were included: cardiorespiratory exercises (N = 5), resistance exercises (N = 2), therapeutic modalities (N = 4) and mixed rehabilitation programs (N = 2). A low risk of bias was scored in only one RCT assessing cardiorespiratory exercises. The well-tolerated 11-week high-intensity interval training resulted in a long-term increase in peak oxygen uptake and a short-term decrease in truncal fat percentage in patients with low disease activity. Resistance training in patients with active disease did not increase muscle strength, but improved functional capacity, disease activity, pain and general health after the intervention. Evidence for other modalities was inconclusive. Conclusion High-quality evidence on physical therapy in PsA was scarce. Cardiorespiratory and resistance exercises demonstrated promising results to positively influence cardiometabolic risk as well as disease-related outcomes. Future research on physical therapy in PsA with adequate methodological quality is needed.
Collapse
Affiliation(s)
- Marlies Kaerts
- Department of Development and Regeneration, Skeletal Biology and Engineering Research Center, KU Leuven, Leuven, Belgium
| | - Thijs W Swinnen
- Department of Development and Regeneration, Skeletal Biology and Engineering Research Center, KU Leuven, Leuven, Belgium
- Department of Rehabilitation Sciences, Research Group for Musculoskeletal Rehabilitation, KU Leuven, Leuven, Belgium
- Division of Rheumatology, University Hospitals Leuven, Leuven, Belgium
| | - Wim Dankaerts
- Department of Rehabilitation Sciences, Research Group for Musculoskeletal Rehabilitation, KU Leuven, Leuven, Belgium
| | - Kurt de Vlam
- Department of Development and Regeneration, Skeletal Biology and Engineering Research Center, KU Leuven, Leuven, Belgium
- Division of Rheumatology, University Hospitals Leuven, Leuven, Belgium
| | - Barbara Neerinckx
- Department of Development and Regeneration, Skeletal Biology and Engineering Research Center, KU Leuven, Leuven, Belgium
- Division of Rheumatology, University Hospitals Leuven, Leuven, Belgium
| |
Collapse
|
4
|
Biedroń G, Wilk M, Nowakowski J, Kuszmiersz P, Guła Z, Strach M, Brkic A, Haugeberg G, Korkosz M. Impact of comorbidities on patient-reported outcomes in psoriatic arthritis: a single centre cohort study. Rheumatol Int 2024; 44:1435-1443. [PMID: 38914774 PMCID: PMC11222239 DOI: 10.1007/s00296-024-05632-2] [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: 04/30/2024] [Accepted: 05/28/2024] [Indexed: 06/26/2024]
Abstract
BACKGROUND Comorbidities are frequent in psoriatic arthritis (PsA) and may contribute to worse health-related outcomes. Patient-reported outcomes (PROs) are used to evaluate the burden of the assessed disease. The aim of this study is to evaluate the impact of comorbidities on selected PROs in PsA. METHODS Adult patients, diagnosed with PsA, based on CASPAR criteria, were included in this cross-sectional, observational study. Collected data encompassed the comorbidities and PROs (Health Assessment Questionnaire [HAQ], Multi-Dimensional Health Assessment Questionnaire [MDHAQ], 36-Item Short Form Health Survey [SF-36]). Standard statistic methods were performed for data assessment. RESULTS There were 267 participants included in the study (54.7% females). The most prevalent comorbidities were cardiovascular diseases (CVD) (29.2 %). Multimorbidity was observed in 50.2% cases and was associated with poorer results of SF-36 questionnaire, regarding bodily pain (34.7 [30.1, 39.3] vs. 47.5 [43.1, 52.0]; p<0.01), physical functioning (52.1 [47.3, 56.9] vs. 63.1 [58.9, 67.4]; p<0.01) and role physical (28.5 [21.2, 35.9] vs. 42.8 [35.2, 50.4]; p<0.01). CVD were associated with poorer MDHAQFn score (β=0.17, p<0.01), while mental disorders negatively influenced mental health (β= -0.35, p<0.01), vitality (β= -0.22, p<0.01), general health (β= -0.19, p<0.01), social functioning (β= -0.15, p=0.04) and role emotional (β= -0.30, p<0.01) dimensions of SF-36. CONCLUSIONS Multimorbidity exerts significant impact on physical aspects of quality of life (QoL) in PsA. CVD and mental disorders adversely influence functional capacity as well as mental and social dimensions of QoL, respectively. The impact of comorbidities should be taken into account by clinicians and researchers assessing PROs.
Collapse
Affiliation(s)
- Grzegorz Biedroń
- Department of Rheumatology and Immunology, Jagiellonian University Medical College, Jakubowskiego 2, Kraków, Poland.
- Department of Rheumatology, Clinical Immunology and Internal Medicine, University Hospital in Cracow, Kraków, Poland.
| | - Mateusz Wilk
- Department of Rheumatology, Clinical Immunology and Internal Medicine, University Hospital in Cracow, Kraków, Poland
| | - Jarosław Nowakowski
- Department of Rheumatology and Immunology, Jagiellonian University Medical College, Jakubowskiego 2, Kraków, Poland
- Department of Rheumatology, Clinical Immunology and Internal Medicine, University Hospital in Cracow, Kraków, Poland
| | - Piotr Kuszmiersz
- Department of Rheumatology and Immunology, Jagiellonian University Medical College, Jakubowskiego 2, Kraków, Poland
- Department of Rheumatology, Clinical Immunology and Internal Medicine, University Hospital in Cracow, Kraków, Poland
| | - Zofia Guła
- Department of Rheumatology and Immunology, Jagiellonian University Medical College, Jakubowskiego 2, Kraków, Poland
- Department of Rheumatology, Clinical Immunology and Internal Medicine, University Hospital in Cracow, Kraków, Poland
| | - Magdalena Strach
- Department of Rheumatology and Immunology, Jagiellonian University Medical College, Jakubowskiego 2, Kraków, Poland
- Department of Rheumatology, Clinical Immunology and Internal Medicine, University Hospital in Cracow, Kraków, Poland
| | - Alen Brkic
- Division of Rheumatology, Department of Internal Medicine, Sørlandet Hospital, Kristiansand, Norway
| | - Glenn Haugeberg
- Division of Rheumatology, Department of Internal Medicine, Sørlandet Hospital, Kristiansand, Norway
- Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Sciences, NTNU, Norwegian University of Science and Technology, Trondheim, Norway
| | - Mariusz Korkosz
- Department of Rheumatology and Immunology, Jagiellonian University Medical College, Jakubowskiego 2, Kraków, Poland
- Department of Rheumatology, Clinical Immunology and Internal Medicine, University Hospital in Cracow, Kraków, Poland
| |
Collapse
|
5
|
Bautista-Molano W, Ibatá L, Martínez S, Chacón A. Burden of Disease in Psoriatic Arthritis in Latin America: a Systematic Literature Review. Clin Rheumatol 2024; 43:677-693. [PMID: 38114817 DOI: 10.1007/s10067-023-06838-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 11/02/2023] [Accepted: 11/21/2023] [Indexed: 12/21/2023]
Abstract
INTRODUCTION Psoriatic arthritis is a chronic inflammatory pathology that generates a substantial and progressive deterioration of functionality and quality of life. It is associated with comorbidities (cardiovascular and metabolic) and involvement of mental health. In Latin America, information regarding the disease is limited. This study reviews the burden of disease (disease activity, functional involvement, clinical manifestations, comorbidities, patient-reported outcomes, quality of life, and use of health resources) in PsA patients in Latin America. METHODS Systematic literature review of publications in PUBMED, EMBASE, Cochrane Database of Systematic Reviews-CDSR/Database of Abstracts of Reviews of Effects, LILACS, Scielo, Redalyc, conference abstracts, and grey literature. Two independent assessors selected studies and extracted information. Quality was assessed according to the type of study. RESULTS We identified 692 references, selecting 50 studies: 41 cross-sectional, four economic-studies, four cohort studies and one systematic review. The information comes mainly from Brazil, Argentina, and Mexico. The estimated disease prevalence for Latin America ranges from 0.004 to 0.08% (95% CI 0.02-0.20). Measurements with validated instruments suggest suboptimal assessment of disease domains, significant functional compromise, loss of productivity, and high frequency of comorbidities, including mental health. Methodological and population considerations limit the generalizability of the findings. CONCLUSIONS The available information reports a considerable burden of disease in patients with PsA in Latin America, with involvement of quality of life associated with disability in relation to disease activity and its various manifestations. Future research and funding efforts should be aimed at generating more standardized information about the impact of PsA in the region. Key Points •The functional involvement related to disease activity, the impact on the quality of life, and the frequency of cardiometabolic and psychological comorbidities are remarkable in Latin American patients with PsA. •The current synthesis offers an overview of the burden of disease (disease activity, functional involvement, clinical manifestations, comorbidities, patient-reported outcomes, quality of life, and use of health resources) in PsA patients in Latin America. •Future research efforts and clinical strategies are required in order to generate standardized data on the patients and better estimate the burden of disease in the region.
Collapse
Affiliation(s)
- Wilson Bautista-Molano
- Rheumatologist University Hospital Fundación Santa Fe de Bogotá, School of Medicine Universidad El Bosque, School of Medicine Universidad Militar Nueva Granada, Bogotá, Colombia.
| | - Linda Ibatá
- Epidemióloga, MPH, InValue Health Solutions, Bogotá, Colombia
| | - Susan Martínez
- Epidemióloga, MPH, InValue Health Solutions, Bogotá, Colombia
| | - Andrea Chacón
- Chemistry Pharmaceutical Epidemiologist, InValue Health Solutions, Bogotá, Colombia
| |
Collapse
|
6
|
Frede N, Hiestand S, Schauer F, Endres D, Tebartz van Elst L, Zeisbrich M, Craig-Mueller N, Finzel S, Thiel J, Voll RE, Schempp C, Venhoff N. Psoriasis and Psoriatic Arthritis Have a Major Impact on Quality of Life and Depressive Symptoms: A Cross-Sectional Study of 300 Patients. Rheumatol Ther 2023; 10:1655-1668. [PMID: 37843747 PMCID: PMC10654309 DOI: 10.1007/s40744-023-00602-9] [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: 07/17/2023] [Accepted: 09/20/2023] [Indexed: 10/17/2023] Open
Abstract
INTRODUCTION Psoriasis (Pso) and psoriatic arthritis (PsA) can reduce the quality of life (QoL) and are known to be associated with depression. Within this study, we aimed to assess the burden of disease, functional capacity, quality of life, and depressive symptoms and identify factors predicting functional impairment and depression in patients with psoriatic disease. METHODS A cross-sectional survey was conducted in a cohort of 300 patients with psoriatic disease including 150 patients from a university hospital dermatology outpatient clinic and 150 patients from a university hospital rheumatology outpatient clinic. Questionnaire-based assessment of signs of arthritis (Psoriasis Epidemiology Screening Tool; PEST), functional status (Functional Questionnaire Hannover; FFbH), quality of life (World Health Organization Quality of Life Brief Version; WHOQOL-BREF), and depressive symptoms (Patient health questionnaire 9; PHQ-9) and retrospective medical chart analysis were performed. RESULTS Despite treatment, burden of disease was high. Joint pain was reported in multiple regions in patients with Pso (n = 111) and patients with PsA (n = 189), but with differences in frequency and distribution patterns of symptoms. Functional impairment in everyday life was independently associated with diagnosis of PsA (odds ratio [OR] 9.56, p = 0.005), depressive symptoms (OR 5.44, p < 0.001) and age (OR 1.04, p = 0.033). At least mild depressive symptoms were demonstrated in 54% and 69% of patients with Pso and PsA, respectively. In a logistic regression model, depressive symptoms were independently associated with functional impairment (OR 4.50, p = 0.003), axial complaints (OR 2.80, p = 0.030), diagnosis of psoriatic arthritis (OR 2.69, p = 0.046), and number of joint regions with complaints (OR 1.10, p = 0.032). CONCLUSION Functional impairment, QoL, and depressive symptoms are mutually interdependent. Early diagnosis of PsA and initiation of anti-inflammatory therapy are essential to avoid long-term damage, disability, and mental health complications. However, despite therapy many patients with PsA, and especially female patients, report a substantial residual disease burden due to their psoriatic disease which will need to be addressed by a more patient-centered approach.
Collapse
Affiliation(s)
- Natalie Frede
- Department of Rheumatology and Clinical Immunology, Faculty of Medicine, Medical Center-University of Freiburg, University of Freiburg, Hugstetter Straße 55, 79106, Freiburg, Germany.
| | - Sonja Hiestand
- Department of Rheumatology and Clinical Immunology, Faculty of Medicine, Medical Center-University of Freiburg, University of Freiburg, Hugstetter Straße 55, 79106, Freiburg, Germany
| | - Franziska Schauer
- Department of Dermatology, Faculty of Medicine, Medical Center-University of Freiburg, University of Freiburg, Freiburg, Germany
| | - Dominique Endres
- Department of Psychiatry and Psychotherapy, Faculty of Medicine, Medical Center-University of Freiburg, University of Freiburg, Freiburg, Germany
| | - Ludger Tebartz van Elst
- Department of Psychiatry and Psychotherapy, Faculty of Medicine, Medical Center-University of Freiburg, University of Freiburg, Freiburg, Germany
| | - Markus Zeisbrich
- Department of Rheumatology and Clinical Immunology, Faculty of Medicine, Medical Center-University of Freiburg, University of Freiburg, Hugstetter Straße 55, 79106, Freiburg, Germany
| | - Nils Craig-Mueller
- Department of Rheumatology and Clinical Immunology, Faculty of Medicine, Medical Center-University of Freiburg, University of Freiburg, Hugstetter Straße 55, 79106, Freiburg, Germany
| | - Stephanie Finzel
- Department of Rheumatology and Clinical Immunology, Faculty of Medicine, Medical Center-University of Freiburg, University of Freiburg, Hugstetter Straße 55, 79106, Freiburg, Germany
| | - Jens Thiel
- Department of Rheumatology and Clinical Immunology, Faculty of Medicine, Medical Center-University of Freiburg, University of Freiburg, Hugstetter Straße 55, 79106, Freiburg, Germany
- Division of Rheumatology and Clinical Immunology, Medical University Graz, Graz, Austria
| | - Reinhard E Voll
- Department of Rheumatology and Clinical Immunology, Faculty of Medicine, Medical Center-University of Freiburg, University of Freiburg, Hugstetter Straße 55, 79106, Freiburg, Germany
| | - Christoph Schempp
- Department of Dermatology, Faculty of Medicine, Medical Center-University of Freiburg, University of Freiburg, Freiburg, Germany
| | - Nils Venhoff
- Department of Rheumatology and Clinical Immunology, Faculty of Medicine, Medical Center-University of Freiburg, University of Freiburg, Hugstetter Straße 55, 79106, Freiburg, Germany
| |
Collapse
|
7
|
Larsen P, Rathleff MS, Roos EM, Elsoe R. National population-based reference data for the Hip Disability and Osteoarthritis Outcome Score (HOOS). Arch Orthop Trauma Surg 2023; 143:6865-6874. [PMID: 37277643 PMCID: PMC10542294 DOI: 10.1007/s00402-023-04915-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Accepted: 05/21/2023] [Indexed: 06/07/2023]
Abstract
INTRODUCTION Interpretation of patient-reported outcome scores such as the Hip Disability and Osteoarthritis Outcome Score (HOOS) can be improved with use of reference values. The aim of the study was to establish population-based reference values for the HOOS' five subscales and its short-form HOOS-12. MATERIALS AND METHODS A representative sample of 9997 Danish citizens 18 years and older were identified. The population record-based sample was based on seven predefined age groups and an equal sex distribution within each age group. A national secure electronic system was used to send the HOOS questionnaire and one supplementary question regarding previous hip complaints to all participants. RESULTS 2277 participants completed the HOOS, 947 women (42%) and 1330 men (58%). The mean HOOS subscale scores were: pain 86.9 (95% CI 86.1-87.7), symptoms 83.7 (95% CI 82.9-84.5), ADL 88.2 (95% CI 87.5-89.0), sport and recreation function 83.1 (95% CI 82.0-84.1), QOL 82.7 (95% CI 81.8-83.6). The youngest age group reported better mean scores in four subscales compared to the oldest age group (pain 91.7 vs. 84.5, mean difference 7.2 95% CI 0.4-14.0), (ADL 94.6 points vs. 83.2, mean difference 11.4 95% CI 4.9-17.8), (sport and recreation function 91.5 points vs. 73.8 points, mean difference 17.7 95% CI 9.0-26.4), (QOL 88.9 points vs. 78.8, mean difference 10.1 points 95% CI 2.0-18.2). Participants with a self-reported hip complaint had worse HOOS scores across all subscales (mean difference range 22.1-34.6). Super obese patients (BMI > 40) had > 12.5 points worse scores across the five HOOS subscales. Results were similar for the HOOS-12. CONCLUSION This study provides reference values for the HOOS and its short form HOOS-12. Results show that older patients and patients with a BMI over 40 have worse HOOS and HOOS-12 scores that may be of clinical importance in the interpretation of scores both when evaluating potential for improvement and post-treatment results.
Collapse
Affiliation(s)
- Peter Larsen
- Department of Occupational Therapy and Physiotherapy, Aalborg University Hospital, Aalborg, Denmark
- Department of Orthopaedic Surgery, Aalborg University Hospital, Aalborg University, 18-22 Hobrovej, 9000, Aalborg, Denmark
| | - Michael S Rathleff
- Department of Occupational Therapy and Physiotherapy, Aalborg University Hospital, Aalborg, Denmark
| | - Ewa M Roos
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Rasmus Elsoe
- Department of Orthopaedic Surgery, Aalborg University Hospital, Aalborg University, 18-22 Hobrovej, 9000, Aalborg, Denmark.
| |
Collapse
|
8
|
Heriseanu AI, Karin E, Walker J, Scott AJ, Bisby MA, Gandy M, Dudeney J, Fisher A, Titov N, Dear BF. The impact of obesity and overweight on response to internet-delivered cognitive behavioural therapy for adults with chronic health conditions. Int J Obes (Lond) 2023; 47:487-495. [PMID: 36869151 PMCID: PMC10212763 DOI: 10.1038/s41366-023-01285-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Revised: 02/16/2023] [Accepted: 02/17/2023] [Indexed: 03/05/2023]
Abstract
BACKGROUND There is growing evidence that internet-delivered cognitive behavioural therapy (iCBT) can improve functioning and reduce psychological distress in people with chronic health conditions. Obesity frequently co-occurs with chronic health conditions, yet its impact on response to psychological interventions in this population is not known. The current study examined associations between BMI and clinical outcomes (depression, anxiety, disability, and satisfaction with life) following a transdiagnostic iCBT program targeting adjustment to chronic illness. METHODS Participants from a large randomised controlled trial, who provided information on height and weight, were included (N = 234; mean age= 48.32, SD = 13.80; mean BMI = 30.43, SD = 8.30, range 16.18-67.52; 86.8% female). The influence of baseline BMI range on treatment outcomes at post-treatment and 3-month follow-up was examined using generalized estimating equations. We also examined changes in BMI and in participants' perceived impact of weight on their health. RESULTS Improvement in all outcomes occurred across BMI ranges; additionally, persons with obesity or overweight generally experienced greater symptom reductions than those within a healthy weight range. A greater proportion of participants with obesity achieved clinically significant change on key outcomes (e.g., depression: 32% [95% CI: 25%, 39%]) than participants with a healthy weight (21% [95% CI: 15%, 26%]) or overweight (24% [95% CI: 18%, 29%], p = 0.016). There were no significant changes in BMI from pre-treatment to 3-month follow-up, however there were significant reductions on the self-rated impact of weight on health. CONCLUSIONS Persons with chronic health conditions and with obesity or overweight benefit at least as much as those with a healthy BMI from iCBT programs targeting psychological adjustment to chronic illness, even without changes in BMI. iCBT programs may be an important component in the self-management of this population, and may address barriers implicated in health behaviour change.
Collapse
Affiliation(s)
- Andreea I Heriseanu
- eCentreClinic, School of Psychological Sciences, Macquarie University, Sydney, NSW, Australia.
| | - Eyal Karin
- School of Psychological Sciences, Macquarie University, Sydney, NSW, Australia
| | - Jennie Walker
- eCentreClinic, School of Psychological Sciences, Macquarie University, Sydney, NSW, Australia
- MindSpot Clinic, MQ Health, Macquarie University, Sydney, NSW, Australia
| | - Amelia J Scott
- eCentreClinic, School of Psychological Sciences, Macquarie University, Sydney, NSW, Australia
| | - Madelyne A Bisby
- eCentreClinic, School of Psychological Sciences, Macquarie University, Sydney, NSW, Australia
| | - Milena Gandy
- eCentreClinic, School of Psychological Sciences, Macquarie University, Sydney, NSW, Australia
| | - Joanne Dudeney
- eCentreClinic, School of Psychological Sciences, Macquarie University, Sydney, NSW, Australia
| | - Alana Fisher
- eCentreClinic, School of Psychological Sciences, Macquarie University, Sydney, NSW, Australia
| | - Nickolai Titov
- eCentreClinic, School of Psychological Sciences, Macquarie University, Sydney, NSW, Australia
- MindSpot Clinic, MQ Health, Macquarie University, Sydney, NSW, Australia
| | - Blake F Dear
- eCentreClinic, School of Psychological Sciences, Macquarie University, Sydney, NSW, Australia
| |
Collapse
|
9
|
Panagiotopoulos A, Fragoulis GE. Comorbidities in Psoriatic Arthritis: A Narrative Review. Clin Ther 2023; 45:177-189. [PMID: 36737317 DOI: 10.1016/j.clinthera.2023.01.006] [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: 10/12/2022] [Revised: 01/03/2023] [Accepted: 01/12/2023] [Indexed: 02/05/2023]
Abstract
PURPOSE Psoriatic arthritis (PsA) is a common type of inflammatory arthritis. Patients with PsA present with certain extra-articular manifestations and comorbidities (often collectively called psoriatic disease). The purpose of the present review was to highlight the main comorbidities in the setting of PsA. METHODS A narrative review was performed using data from articles found in a search of PubMed and Scopus using the terms psoriatic arthritis and comorbidities. FINDINGS Cardiovascular disease (CVD), as well as metabolic and mental health disorders, are the most common comorbidities in patients with PsA. In most cases, underlying inflammation seems to be involved in the increased risk for CVD in PsA, while a bidirectional relationship seems to operate between mental health disorders and psoriatic disease. The treatment of patients with PsA, especially with biologic disease-modifying antirheumatic drugs, has been shown to lead to favorable outcomes regarding the CVD risk. However, it is debatable whether specific drug classes are more effective than others or should be avoided in patients with CVD risk factors. Comorbidity of mental health disorders is even more complex, given the difficulties in measuring and reporting these comorbidities in clinical trials and in clinical practice. IMPLICATIONS Future studies are needed for a better understanding of the pathogenic mechanisms of, and the development of better protocols for the identification and treatment of patients with, comorbidities in patients with PsA. The education of clinicians, health care professionals in rheumatology, and patients could be useful in achieving this goal.
Collapse
Affiliation(s)
- Alexandros Panagiotopoulos
- Joint Academic Rheumatology Program, First Department of Propedeutic Internal Medicine, University of Athens, Athens, Greece
| | - George E Fragoulis
- Joint Academic Rheumatology Program, First Department of Propedeutic Internal Medicine, University of Athens, Athens, Greece; Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow, United Kingdom.
| |
Collapse
|
10
|
Queiro R, Alonso S, Morante I, Alperi M. Non-Physical Disease Facets in Spondyloarthritis: An ASAS Health Index-Based Analysis between Psoriatic Arthritis and Axial Spondyloarthritis. J Clin Med 2022; 11:jcm11206094. [PMID: 36294416 PMCID: PMC9605564 DOI: 10.3390/jcm11206094] [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: 09/08/2022] [Revised: 10/08/2022] [Accepted: 10/13/2022] [Indexed: 11/10/2022] Open
Abstract
Background: Psychosocial health is a key driver of quality of life (QoL) in axial spondyloarthritis (axSpA) and psoriatic arthritis (PsA), but it is often overlooked in clinical practice. We aimed to analyze this aspect of QoL by using the Assessment of SpA International Society−Health Index (ASAS HI) in both SpA phenotypes. Patients and methods: One hundred and eleven patients with axSpA and 90 with PsA were consecutively recruited from two rheumatology centers. In both populations, the categories of stress handling (ASAS HI items #11 and 17) and emotional functions (ASAS HI item #13) were analyzed based on the International Classification of Functioning, Disability, and Health (ICF). A multivariate regression model was used to analyze the explanatory factors associated with positive responses to these items. Results: Thirty-four of the 90 PsA patients (37.8%) and 37/111 of the patients (33.3%) with axSpA reported a positive response to at least one of the stress-handling items. Compared to the patients with PsA, patients with axSpA were less likely to report stress-handling issues (OR 0.48, p < 0.05). Thirty-one of the 90 PsA patients (34.4%) and 44/111 of the patients (39.6%) with axSpA reported positive responses to item #13. In both groups of SpA patients, disease activity and severity (OR 6.6, p < 0.001) were independently associated with alterations in psychosocial health. Compared with those in the axSpA group, the psychosocial health items were better correlated with each other and with the ASAS HI sum score in the PsA group. Conclusions: Psychosocial health is frequently altered in SpA. Both disease activity and severity are associated with this issue. However, psychosocial factors seem to have a greater impact on QoL in PsA than in axSpA.
Collapse
Affiliation(s)
- Rubén Queiro
- Rheumatology Division, Hospital Universitario Central de Asturias, 33011 Oviedo, Spain
- ISPA Translational Immunology Division, 33011 Oviedo, Spain
- School of Medicine, Oviedo University, 33003 Oviedo, Spain
- Correspondence: ; Tel.: +34-985-108000
| | - Sara Alonso
- Rheumatology Division, Hospital Universitario Central de Asturias, 33011 Oviedo, Spain
| | - Isla Morante
- Rheumatology Division, Hospital de Sierrallana, 39300 Torrelavega, Spain
| | - Mercedes Alperi
- Rheumatology Division, Hospital Universitario Central de Asturias, 33011 Oviedo, Spain
| |
Collapse
|
11
|
Validity and psychometric characteristics of the self-administered comorbidity questionnaire in patients with psoriatic arthritis. Rheumatol Int 2022; 42:2061-2067. [PMID: 35648189 DOI: 10.1007/s00296-022-05150-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 05/12/2022] [Indexed: 10/18/2022]
Abstract
The study aimed to translate and cross-culturally adapt the self-comorbidity questionnaire (SCQ) into Turkish and investigate the validity and reliability of SCQ and its modified version (mSCQ) in psoriatic arthritis (PsA). Psoriatic arthritis quality of life (PsAQoL) and short form 36 (SF-36) were used to assess the quality of life. The physical disability was evaluated with the health assessment questionnaire (HAQ). The reliability of the SCQ scale was assessed by test-retest reliability. For construct validity, the correlations of SCQ with the HAQ, SF-36, PsAQoL, age, body mass index (BMI), disease duration, disease activity in psa (DAPSA), Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Psoriasis Area and Severity Index (PASI), dactylitis and enthesitis were evaluated. The mSCQ was also used by removing the items related to rheumatic conditions. For the test-retest reliability of the Turkish version of SCQ, the intraclass correlation coefficient was 0.965, p < 0.001. The SCQ and mSCQ had significant correlations with HAQ, PsAQoL, some subscales of SF-36, and age (p < 0.05), but not with disease duration, BASDAI, PASI and dactylitis (p > 0.05). Although SCQ had a low correlation with DAPSA (rho = 0.262, p = 0.031), mSCQ was not correlated with DAPSA (p > 0.05). mSCQ was significantly correlated with BMI (rho = 0.233, p = 0.016), but SCQ was not (p > 0.05). The Turkish version of SCQ had adequate reliability and validity, and the mSCQ improved the validity of the scale in patients with PsA.
Collapse
|
12
|
Abstract
Psoriatic arthritis (PsA) is a type of inflammatory arthritis that is included within the spondyloarthritis, a group of rheumatological diseases characterized by different clinical manifestations and associated comorbidities, that can compromise the quality of life of patients. The diagnosis of PsA is sometimes difficult due to an enormous clinical and radiological variability, including six different domains of involvement: peripheral joint, axial skeleton, skin psoriasis, nail psoriasis, enthesitis and dactylitis. Currently, there are no biomarkers that allow the detection of PsA in patients with psoriasis, so a high level of suspicion is important, mainly by dermatologists, but also by other specialists, such as family doctors. Advances in the knowledge of new immunological mechanisms and joint management by rheumatologists and dermatologists have made it possible to improve the therapeutic approach in patients with PsA.
Collapse
|
13
|
Ritchlin CT, Mease PJ, Boehncke WH, Tesser J, Schiopu E, Chakravarty SD, Kollmeier AP, Xu XL, Shawi M, Jiang Y, Sheng S, Wang Y, Xu S, Merola JF, McInnes IB, Deodhar A. Sustained and improved guselkumab response in patients with active psoriatic arthritis regardless of baseline demographic and disease characteristics: pooled results through week 52 of two phase III, randomised, placebo-controlled studies. RMD Open 2022; 8:rmdopen-2022-002195. [PMID: 35296534 PMCID: PMC8928386 DOI: 10.1136/rmdopen-2022-002195] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Accepted: 02/11/2022] [Indexed: 01/03/2023] Open
Abstract
OBJECTIVES To evaluate the efficacy through 52 weeks of guselkumab, an interleukin 23-p19 subunit inhibitor, in subgroups of pooled psoriatic arthritis (PsA) patients from the DISCOVER-1 and DISCOVER-2 trials defined by baseline patient characteristics. METHODS Adults with active PsA despite standard therapies were enrolled in DISCOVER-1 (≥3 swollen and ≥3 tender joints, C reactive protein (CRP) level ≥0.3 mg/dL) and DISCOVER-2 (≥5 swollen and ≥5 tender joints, CRP ≥0.6 mg/dL, biological-naïve). Randomised patients received 100 mg guselkumab at weeks 0, 4, and then every 4 or 8 weeks (Q4W/Q8W) or placebo. Guselkumab effects on joint (ACR20/50/70), skin (IGA 0/1, IGA 0), patient-reported outcome (Health Assessment Questionnaire Disability Index/Functional Assessment of Chronic Illness Therapy-Fatigue) and disease severity (minimal disease activity/PsA Disease Activity Score low disease activity) endpoints were evaluated by patient sex, body mass index, PsA duration, swollen/tender joint counts, CRP level, percent body surface area with psoriasis, Psoriasis Area and Severity Index score, and conventional synthetic disease-modifying antirheumatic drug use at baseline. RESULTS Baseline patients characteristics in DISCOVER-1 (N=381) and DISCOVER-2 (N=739) were well balanced across randomised groups. At week 24, 62% (232/373) and 60% (225/375), respectively, of guselkumab Q4W-treated and Q8W-treated patients pooled across DISCOVER-1 and DISCOVER-2 achieved the primary endpoint of ACR20 response versus 29% (109/372) of placebo-treated patients. Guselkumab treatment effect at week 24 was observed across patient subgroups. Within each patient subgroup, response rates across all disease domains were sustained or increased at week 52 with both guselkumab regimens. CONCLUSIONS Guselkumab Q4W and Q8W resulted in robust and sustained improvements in PsA signs and symptoms consistently in subgroups of patients defined by diverse baseline characteristics. TRIAL REGISTRATION NUMBERS NCT03162796, NCT03158285.
Collapse
Affiliation(s)
- Christopher T Ritchlin
- Department of Medicine - Allergy/Immunology and Rheumatology, University of Rochester Medical Center, Rochester, New York, USA
| | - Philip J Mease
- Rheumatology Research, Swedish Medical Center/Providence St. Joseph Health and University of Washington, Seattle, Washington, USA
| | - Wolf-Henning Boehncke
- Division of Dermatology and Venereology, Geneva University Hospitals, Geneva, Switzerland
| | - John Tesser
- Arizona Arthritis & Rheumatology Associates, Phoenix, Arizona, USA
| | - Elena Schiopu
- Department of Rheumatology & Internal Medicine, Michigan Medicine Rheumatology Clinic, Ann Arbor, Michigan, USA
| | - Soumya D Chakravarty
- Immunology, Janssen Scientific Affairs, LLC, Horsham, Pennsylvania, USA.,Rheumatology, Drexel University College of Medicine, Philadelphia, Pennsylvania, USA
| | - Alexa P Kollmeier
- Immunology, Janssen Research and Development LLC, San Diego, California, USA
| | - Xie L Xu
- Immunology, Janssen Research and Development LLC, San Diego, California, USA
| | - May Shawi
- Immunology Global Medical Affairs, Janssen Pharmaceutical Companies of Johnson and Johnson, Horsham, Pennsylvania, USA
| | - Yusang Jiang
- Biostatistics, Janssen Research and Development LLC, Spring House, Pennsylvania, USA
| | - Shihong Sheng
- Biostatistics, Janssen Research and Development LLC, Spring House, Pennsylvania, USA
| | - Yanli Wang
- Biostatistics, Janssen Research and Development LLC, Spring House, Pennsylvania, USA
| | - Stephen Xu
- Biostatistics, Janssen Research and Development LLC, Spring House, Pennsylvania, USA
| | - Joseph F Merola
- Dermatology and Medicine, Division of Rheumatology and Immunology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Iain B McInnes
- Institute of Infection, Immunity & Inflammation, University of Glasgow, Glasgow, UK
| | - Atul Deodhar
- Division of Arthritis and Rheumatic Diseases, Oregon Health & Science University, Portland, Oregon, USA
| |
Collapse
|
14
|
Comment to “Health-related quality of life in early psoriatic arthritis compared with early rheumatoid arthritis and a general population”. Semin Arthritis Rheum 2022; 54:151983. [DOI: 10.1016/j.semarthrit.2022.151983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2021] [Accepted: 01/19/2022] [Indexed: 11/17/2022]
|
15
|
Alonso S, Morante I, Alperi M, Queiro R. The ASAS health index: a new era for health impact assessment in spondyloarthritis. J Rheumatol 2021; 49:8-15. [PMID: 34393105 DOI: 10.3899/jrheum.200586] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/23/2021] [Indexed: 11/22/2022]
Abstract
The concept of spondyloarthritis (SpA) encompasses a series of entities that share clinical and imaging characteristics and a common genetic basis. These diseases can affect 0.20 to 1.6% of the general population, limiting functioning and affecting the quality of life of patients. Considering the patient perspective in the management of the disease and ensuring patients are sufficiently prepared to participate in decisionmaking is critical to treatment success as well as for optimal health outcomes. The overall picture of impairments, limitations, and restrictions in activities or social participation of patients with SpA is not adequately assessed in SpA-specific instruments. Therefore, it is quite relevant to measure the broader range of impairments that can affect SpA patients and integrate these into one measure of overall functioning in daily life. The Assessment of SpondyloArthritis international Society-Health Index (ASAS HI) is a recently introduced health instrument for evaluating SpA based on the International Classification of Functioning, Disability and Health, also known as ICF, that could cover a good part of the health metric needs in SpA. This review addresses its origins, its measurement properties, its use in routine clinical practice, as well as its prospects for future use.
Collapse
Affiliation(s)
- Sara Alonso
- Rheumatology Division. Hospital Universitario Central de Asturias (HUCA). Oviedo- Asturias (Spain); Rheumatology Division. Hospital de Sierrallana. Torrelavega-Cantabria (Spain); ISPA Translational Immunology division. Oviedo (Spain). Address correspondence to Rubén Queiro. M.D., Ph.D, Associate professor. Oviedo University School of Medicine, Rheumatology Division, HUCA. Avenida de Roma s/n, 33011. Oviedo (Spain).
| | - Isla Morante
- Rheumatology Division. Hospital Universitario Central de Asturias (HUCA). Oviedo- Asturias (Spain); Rheumatology Division. Hospital de Sierrallana. Torrelavega-Cantabria (Spain); ISPA Translational Immunology division. Oviedo (Spain). Address correspondence to Rubén Queiro. M.D., Ph.D, Associate professor. Oviedo University School of Medicine, Rheumatology Division, HUCA. Avenida de Roma s/n, 33011. Oviedo (Spain).
| | - Mercedes Alperi
- Rheumatology Division. Hospital Universitario Central de Asturias (HUCA). Oviedo- Asturias (Spain); Rheumatology Division. Hospital de Sierrallana. Torrelavega-Cantabria (Spain); ISPA Translational Immunology division. Oviedo (Spain). Address correspondence to Rubén Queiro. M.D., Ph.D, Associate professor. Oviedo University School of Medicine, Rheumatology Division, HUCA. Avenida de Roma s/n, 33011. Oviedo (Spain).
| | - Rubén Queiro
- Rheumatology Division. Hospital Universitario Central de Asturias (HUCA). Oviedo- Asturias (Spain); Rheumatology Division. Hospital de Sierrallana. Torrelavega-Cantabria (Spain); ISPA Translational Immunology division. Oviedo (Spain). Address correspondence to Rubén Queiro. M.D., Ph.D, Associate professor. Oviedo University School of Medicine, Rheumatology Division, HUCA. Avenida de Roma s/n, 33011. Oviedo (Spain).
| |
Collapse
|
16
|
Moraes FA, da Silva MRR, Dos Santos JBR, Acurcio FA, Almeida AM, Kakehasi AM, Alvares-Teodoro J. Health-Related Quality of Life in Psoriatic Arthritis: Findings and Implications. Value Health Reg Issues 2021; 26:135-141. [PMID: 34390960 DOI: 10.1016/j.vhri.2021.06.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Revised: 05/05/2021] [Accepted: 06/14/2021] [Indexed: 01/22/2023]
Abstract
OBJECTIVES To assess the quality of life (QOL) and its associated factors in patients with psoriatic arthritis (PsA) who would start treatment with biologic drugs at the Brazilian Unified Health System. METHODS A cross-sectional study was performed at a single center pharmacy in Belo Horizonte, State of Minas Gerais, Brazil. EQ-5D was used to assess the patients' QOL. The functional status was assessed using the Health Assessment Questionnaire-Disability Index, whereas disease activity was evaluated through the Bath Ankylosing Spondylitis Disease Activity Index and the Clinical Disease Activity Index. Simple and multiple linear regression analyses were performed to assess the factors associated with QOL. RESULTS A total of 212 patients with PsA were included, of which 185 (87.3%) reported having some pain/discomfort, and 148 (69.8%) presented some level of anxiety/depression. Patients with PsA had a mean QOL score of 0.651 (SD 0.12) with a significant reduction in female patients, concomitant use of nonsteroidal anti-inflammatory drugs, comorbidity, and worse clinical and functional status. Poor QOL was associated with worse functional status by the Health Assessment Questionnaire-Disability Index, disease activity by the Bath Ankylosing Spondylitis Disease Activity Index, and with diagnoses of osteoporosis, hypothyroidism, and depression. CONCLUSION PsA and its associated comorbidities negatively affect the QOL, evidencing the need for a comprehensive and effective clinical approach.
Collapse
Affiliation(s)
- Felipe A Moraes
- Department of Social Pharmacy, College of Pharmacy, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Michael R R da Silva
- Health Assessment, Technology, and Economy Group, Center for Exact, Natural, and Health Sciences, Federal University of Espírito Santo, Alegre, Espírito Santo, Brazil
| | - Jéssica B R Dos Santos
- Health Assessment, Technology, and Economy Group, Center for Exact, Natural, and Health Sciences, Federal University of Espírito Santo, Alegre, Espírito Santo, Brazil.
| | - Francisco A Acurcio
- Department of Social Pharmacy, College of Pharmacy, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Alessandra M Almeida
- Faculty of Medical Sciences of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Adriana M Kakehasi
- Medicine School, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Juliana Alvares-Teodoro
- Department of Social Pharmacy, College of Pharmacy, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| |
Collapse
|
17
|
Menon D, Alnajjar S, Barnett C, Vijayan J, Katzberg H, Fathi D, Alcantara M, Bril V. Telephone consultation for myasthenia gravis care during the COVID-19 pandemic: Assessment of a novel virtual myasthenia gravis index. Muscle Nerve 2021; 63:831-836. [PMID: 33792967 PMCID: PMC8251129 DOI: 10.1002/mus.27243] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 03/22/2021] [Accepted: 03/28/2021] [Indexed: 12/14/2022]
Abstract
INTRODUCTION/AIMS The aim of the study was to determine the association between the virtual Myasthenia Gravis Impairment Index (vMGII) with other patient-reported outcomes (PROs) of myasthenia gravis (MG) and its usefulness in telephone consultations with MG patients. METHODS This was a retrospective case series in which vMGII score along with virtual Single Simple Question (vSSQ), virtual Patient-Acceptable Symptom State PASS (vPASS) response, and patient disease status based on Myathenia Gravis Foundation of America postintervention status were collected during telephone consultation along with the MGII, SSQ, and PASS responses during the preceding in-person clinic visits. RESULTS In 214 patients, the mean difference of vMGII between the vPASS "Yes" and "No" groups was -14.2 ± 1.4 (95% confidence interval, -16.9 to -11.3; P < .001) with mean vMGII for vPASS "Yes" group being 6.4 ± 7.7 and vPASS "No" being 20.5 ± 11.5. A vMGII of 11.5 or higher predicted vPASS "yes" response with a sensitivity of 78.7% and specificity of 81.4%. A strong negative correlation was found between the vMGII and vSSQ (r = -.667; P < .001). The mean vMGII was 0.48 ± 1.42 for patients in remission, and 9.31 ± 10.93 for improved, 9.32 ± 8.79 for stable, and 22.58 ± 14.04 for worsened groups (P < .001). These associations were the same as those obtained during the preceding in-person clinic visit and the direction of change in MGII scores also indicated change in disease status. DISCUSSION vMGII is an effective measure to assess an MG patient's disease status in telephone consultations and relates well with other PRO measures. The vMGII remains reliable for assessing MG disease status even with removal of the physical examination component.
Collapse
Affiliation(s)
- Deepak Menon
- Ellen & Martin Prosserman Centre for Neuromuscular Diseases, University Health NetworkUniversity of TorontoTorontoOntarioCanada
| | - Sara Alnajjar
- Ellen & Martin Prosserman Centre for Neuromuscular Diseases, University Health NetworkUniversity of TorontoTorontoOntarioCanada
| | - Carolina Barnett
- Ellen & Martin Prosserman Centre for Neuromuscular Diseases, University Health NetworkUniversity of TorontoTorontoOntarioCanada
| | - Joy Vijayan
- Ellen & Martin Prosserman Centre for Neuromuscular Diseases, University Health NetworkUniversity of TorontoTorontoOntarioCanada
| | - Hans Katzberg
- Ellen & Martin Prosserman Centre for Neuromuscular Diseases, University Health NetworkUniversity of TorontoTorontoOntarioCanada
| | - Davood Fathi
- Ellen & Martin Prosserman Centre for Neuromuscular Diseases, University Health NetworkUniversity of TorontoTorontoOntarioCanada
| | - Monica Alcantara
- Ellen & Martin Prosserman Centre for Neuromuscular Diseases, University Health NetworkUniversity of TorontoTorontoOntarioCanada
| | - Vera Bril
- Ellen & Martin Prosserman Centre for Neuromuscular Diseases, University Health NetworkUniversity of TorontoTorontoOntarioCanada
| |
Collapse
|
18
|
Alonso S, Villa I, Fernández S, Martín JL, Charca L, Pino M, Riancho L, Morante I, Santos M, Brandy A, Aurrecoechea E, Carmona L, Queiro R. Multicenter Study of Secukinumab Survival and Safety in Spondyloarthritis and Psoriatic Arthritis: SEcukinumab in Cantabria and ASTURias Study. Front Med (Lausanne) 2021; 8:679009. [PMID: 34124110 PMCID: PMC8187784 DOI: 10.3389/fmed.2021.679009] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 04/29/2021] [Indexed: 12/31/2022] Open
Abstract
Objectives: We aimed to evaluate the drug retention rate and safety of secukinumab (SEC) in patients with axial spondyloarthritis (AxSpA) and psoriatic arthritis (PsA) in a real clinical setting. Methods: This multicenter retrospective observational study included all AxSpA and PsA patients who received at least one dose of SEC. Adverse events (AE) and the drug retention rate were the main study outcomes. Drug survival was analyzed by Kaplan-Meier curves while predictive factors of discontinuation were evaluated using a Cox regression analysis. The weight of these associations was estimated by hazard ratio (HR) values. Results: We included 154 patients (59 PsA and 95 AxSpA). Mean disease duration was 6.5 years (IQR 2-8). Sixty-one percent of patients were treated with two or more biologics prior to SEC. The 1 and 2-year retention rates for SEC were 66 and 43%, respectively. The main causes of discontinuation were inefficacy (59%) and AE (36%). The factors associated with lower risk of discontinuation were male gender (HR 0.54, 95% CI 0.38-0.78 p = 0.001), obesity (HR 0.53, 95% CI 0.30-0.93 p = 0.027), hypertension (HR 0.55, 95% CI 0.30-0.93 p = 0.008), and diabetes (HR 0.42 95% CI 0.18-0.99 p = 0.047) while number of previous biologics and depression were predictors of discontinuation (HR 1.18, 95% CI 1.04-1.34 p = 0.011 and HR 2.53, 95% CI 1.61-3.96 p < 0.001). Conclusions: SEC showed a good retention rate in a population previously exposed to several biological therapies. As a novelty, cardiometabolic comorbidities were associated with better drug survival.
Collapse
Affiliation(s)
- Sara Alonso
- Rheumatology Division, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Ignacio Villa
- Rheumatology Division, Hospital Sierrallana, Torrelavega, Spain
| | - Sabela Fernández
- Rheumatology Division, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - José L Martín
- Rheumatology Division, Hospital Sierrallana, Torrelavega, Spain
| | - Lilyan Charca
- Rheumatology Division, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Marina Pino
- Rheumatology Division, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Leyre Riancho
- Rheumatology Division, Hospital Sierrallana, Torrelavega, Spain
| | - Isla Morante
- Rheumatology Division, Hospital Sierrallana, Torrelavega, Spain
| | | | - Anahy Brandy
- Rheumatology Division, Hospital Universitario de Cabueñes, Gijón, Spain
| | | | | | - Rubén Queiro
- Rheumatology Division, Hospital Universitario Central de Asturias, Oviedo, Spain.,Instituto de Investigación Sanitaria del Principado de Asturias (ISPA) Translational Immunology Division, Hospital Universitario Central de Asturias (HUCA), Oviedo, Spain
| |
Collapse
|
19
|
Management of particular clinical situations in psoriatic arthritis: an expert's recommendation document based on systematic literature review and extended Delphi process. Rheumatol Int 2021; 41:1549-1565. [PMID: 33934175 PMCID: PMC8316175 DOI: 10.1007/s00296-021-04877-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 04/23/2021] [Indexed: 02/07/2023]
Abstract
To establish practical recommendations for the management of patients with psoriatic arthritis (PsA) with particular clinical situations that might lead to doubts in the pharmacological decision-making. A group of six expert rheumatologists on PsA identified particular clinical situations in PsA. Then, a systematic literature review (SLR) was performed to analyse the efficacy and safety of csDMARDs, b/tsDMARDs in PsA. In a nominal group meeting, the results of the SLR were discussed and a set of recommendations were proposed for a Delphi process. A total of 65 rheumatologists were invited to participate in the Delphi. Agreement was defined if ≥ 70% of the participants voted ≥ 7 (from 1, totally disagree to 10, totally agree). For each recommendation, the level of evidence and grade of recommendation was established based on the Oxford Evidence-Based Medicine categorisation. Particular clinical situations included monoarthritis, axial disease, or non-musculoskeletal manifestations. The SLR finally comprised 131 articles. A total of 16 recommendations were generated, all but 1 reached consensus. According to them, it is crucial to carefully analyse the impact of individual manifestations on patients (disability, quality of life, etc.), but also to recognise the impact of each drug singularities on selected clinical phenotypes to adopt the most appropriate treatment strategy. Early diagnosis and treatment to target approach, along with a close risk management, is also necessary. These recommendations are intended to complement gaps in national and international guidelines by helping health professionals address and manage particular clinical situations in PsA.
Collapse
|
20
|
Queiro R, Charca L, Pino M. A comparison of disease impact according to the cardiometabolic risk profile in psoriatic arthritis. Arch Med Sci 2021; 17:557-560. [PMID: 33747293 PMCID: PMC7959045 DOI: 10.5114/aoms/132315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 01/10/2021] [Indexed: 11/17/2022] Open
Affiliation(s)
- Rubén Queiro
- Rheumatology Department and ISPA Translational Immunology Section, Hospital Universitario Central de Asturias (HUCA), Oviedo, Spain
| | - Lilyan Charca
- Rheumatology Department and ISPA Translational Immunology Section, Hospital Universitario Central de Asturias (HUCA), Oviedo, Spain
| | - Marina Pino
- Rheumatology Department and ISPA Translational Immunology Section, Hospital Universitario Central de Asturias (HUCA), Oviedo, Spain
| |
Collapse
|
21
|
Impact of Comorbidities on Disease Activity, Patient Global Assessment, and Function in Psoriatic Arthritis: A Cross-Sectional Study. Rheumatol Ther 2020; 7:825-836. [PMID: 32804332 PMCID: PMC7695787 DOI: 10.1007/s40744-020-00229-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Indexed: 01/18/2023] Open
Abstract
INTRODUCTION The aim of this study was to evaluate the impact of comorbidities on disease activity, patient's impact of the disease, patient global assessment, and function in psoriatic arthritis (PsA). METHODS Consecutive PsA patients were enrolled in this cross-sectional study. During the visit, the patients underwent a complete physical examination and clinical/laboratory data were collected, including type and number of comorbidities, recorded as simple comorbidity count (SCC). Disease activity was assessed using the Disease Activity Score for Psoriatic Arthritis (DAPSA) and the Minimal Disease Activity (MDA) was also evaluated. The Psoriatic Arthritis Impact of Disease (PsAID), the Health Assessment Questionnaire-Disability Index (HAQ-DI), and the Patient Global Assessment of disease activity (PtGA) were also collected. RESULTS A total of 144 patients were enrolled. At least one comorbidity was registered in 104 (72.2%) patients. The SCC was associated with DAPSA (β = 1.48, p = 0.013), PsAID (β = 0.41, p < 0.01), HAQ-DI (β = 0.11, p < 0.01) and PtGA (β = 0.50, p < 0.01). The comorbidities that showed an impact on outcome measures were anxiety and fibromyalgia (FM). Anxiety showed an impact on DAPSA (β = 14.46, p < 0.001), PsAID (β = 1.98, p = 0.039) and HAQ-DI (β = 0.54, p = 0.036). FM showed an impact on DAPSA (β = 6.46, p = 0.025), PsAID (β = 2.88, p < 0.001), HAQ-DI (β = 0.70, p < 0.001), PtGA (β = 2.00, p = 0.014), and MDA (β = - 2.79, p = 0.01). The median PtGA value was different among patients with different numbers of comorbidities. CONCLUSIONS This study showed that comorbidities, either as a simple comorbidity count number or as single comorbidity, might have an impact on the main domains affecting PsA patients in real clinical practice.
Collapse
|