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Weman L, Salo H, Kuusalo L, Huhtakangas J, Vähäsalo P, Backström M, Kärki J, Sokka-Isler T. Intense symptoms of pain are associated with poor sleep, fibromyalgia, depression and sleep apnea in patients with rheumatoid arthritis and psoriatic arthritis. A register-based study. Joint Bone Spine 2024; 91:105744. [PMID: 38795765 DOI: 10.1016/j.jbspin.2024.105744] [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: 12/03/2023] [Revised: 04/26/2024] [Accepted: 05/07/2024] [Indexed: 05/28/2024]
Abstract
OBJECTIVES To study whether poor sleep and comorbidities are associated with high symptom levels of patient-reported outcomes (PROs) pain, patient global assessment and fatigue in patients with rheumatoid arthritis (RA) and psoriatic arthritis (PsA), in a nation-wide cross-sectional setting. METHODS Clinical data were extracted from The Finnish Rheumatology Quality Register between 1.2021 and 9.2022. Self-reported sleep was categorized as "good" (little/no difficulties) or "poor" (great difficulties/can't) sleep. Data concerning comorbidities were collected from national registers. Descriptive statistics were used. Regression analyses were applied to analyze independent associations of sleep status, comorbidities and disease activity with pain in RA and PsA, adjusting for age and sex. RESULTS Among 13,512 patients with RA, 6052 [mean (SD) age 62 (13), 71% female] had sleep status reported; in PsA 1861/3636 [age 55 (13), 48% female]. In RA, 5072 (84%) reported good and 980 (16%) poor sleep; the corresponding numbers in PsA were 1460 (78%) and 401 (22%). Median values for objective disease activity were low and similar in patients with poor sleep and good sleep in both diseases. Among patients with no swollen joints, the median values for PROs were approximately three times higher for patients with poor sleep vs. good sleep in both diagnoses (P<0.001). In regression analyses, "poor" sleep was independently associated with higher symptoms in pain [B (95%CI) 20 (18,22) in RA and 23 (19, 26) in PsA], followed by comorbid fibromyalgia, as well as depression in RA and sleep apnea in PsA. CONCLUSION "Poor" sleep quality and comorbidities are independently associated with pain. Patient's sleep status is important to know especially in patients with severe symptoms without objective disease activity.
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Affiliation(s)
- Lauri Weman
- University of Eastern Finland, Kuopio, Finland.
| | - Henri Salo
- Data and Analytics, Finnish institute for health and welfare (THL), Helsinki, Finland
| | - Laura Kuusalo
- Centre for Rheumatology and Clinical Immunology, University of Turku and Turku University Hospital, Turku, Finland
| | | | - Paula Vähäsalo
- Research Unit of Clinical Medicine, University of Oulu, Department of Children and Adolescents, Oulu University Hospital, Medical Research Center, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Maria Backström
- Department of Pediatrics, Wellbeing Services County of Ostrobothnia, Vaasa, Finland, Research Unit of Clinical Medicine, University of Oulu, Oulu, Finland
| | - Johanna Kärki
- Department of Children and Adolescents, Kanta-Häme Central Hospital, Hämeenlinna, Finland
| | - Tuulikki Sokka-Isler
- University of Eastern Finland, Kuopio, Finland; University of Eastern Finland and Rheumatology, Hospital Nova of Central Finland, Jyväskylä, Finland
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Bessette L, Mysler E, Kinch CD, Kwok K, Lukic T, On PV, van Vollenhoven RF. Impact of Tofacitinib on Components of the ACR Response Criteria: Posthoc Analysis of Phase III and Phase IIIb/IV Trials. J Rheumatol 2022; 49:566-576. [DOI: 10.3899/jrheum.210707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/09/2022] [Indexed: 11/22/2022]
Abstract
Objective Evaluate the impact of tofacitinib on American College of Rheumatology (ACR) response criteria components in patients with rheumatoid arthritis (RA). Methods This posthoc analysis pooled data from RA phase III randomized controlled trials (RCTs) assessing tofacitinib 5 or 10 mg twice daily (BID), adalimumab, or placebo, with conventional synthetic disease-modifying antirheumatic drugs, and a phase IIIb/IV RCT assessing tofacitinib 5 mg BID monotherapy, tofacitinib 5 mg BID with methotrexate, or adalimumab with methotrexate. Outcomes included: proportions of patients achieving ACR20/50/70 responses and ≥20/50/70% improvement rates in ACR components at Week 2 and Months 1, 3, and 6; mean percent improvement in ACR components and Clinical or Simplified Disease Activity Index (CDAI or SDAI) low disease activity or remission rates, at Month 3, for ACR20/50/70 responders. Results Across treatment groups, ≥20/50/70% improvement rates were numerically higher for most physician- versus patient-reported measures. In phase III RCTs, at earlier timepoints, ≥50/70% improvements in Patient Global Assessment of Disease Activity, Pain and Clinician Global Assessment were similar. Among ACR20 responders receiving tofacitinib, mean percent improvements for tender and swollen joint counts were >70% at Month 3. CDAI/SDAI remission was achieved by 27.8–45.0% of ACR70 responders receiving tofacitinib at Month 3. Conclusion Among ACR20 responders treated with tofacitinib, physician-reported components particularly exceeded 20% response improvement. At Month 3, disease state generally did not corroborate ACR70 response criteria. Divergences between physician- and patient-reported measures highlight the importance of identifying appropriate patient-reported outcome targets to manage RA symptoms in clinical practice.
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Liff MH, Hoff M, Wisloff U, Videm V. Reduced cardiorespiratory fitness is a mediator of excess all-cause mortality in rheumatoid arthritis: the Trøndelag Health Study. RMD Open 2021; 7:rmdopen-2020-001545. [PMID: 33685930 PMCID: PMC7942264 DOI: 10.1136/rmdopen-2020-001545] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 02/08/2021] [Accepted: 02/17/2021] [Indexed: 11/30/2022] Open
Abstract
Objectives Investigate if low cardiorespiratory fitness (CRF) was associated with and acted as a mediator of excess all-cause mortality rate in persons suffering from rheumatoid arthritis (RA) compared with the general population. Methods All-cause mortality was analysed using Cox regression modelling in patients with RA (n=348) and controls (n=60 938) who took part in the second (1995–1997) and third (2006–2008) waves of the longitudinal population-based Trøndelag Health Study in Norway. A mediation analysis was performed to investigate if excess relative risk of mortality in RA was mediated by low estimated CRF (eCRF). Results During the follow-up until 31 December 2018 (mean 19.3 years), the mortality rate among patients with RA (n=127, 36.5%) was higher than among controls (n=12 942, 21.2%) (p<0.001). Among controls and patients with RA, 51% and 26%, respectively, had eCRF above the median for their age and sex (p<0.001). The final Cox model included RA status and eCRF, adjusted for hypertension, body mass index, smoking, cholesterol, diabetes and creatinine. eCRF below median for sex and age category was associated with increased mortality (p<0.001). The total excess relative risk of mortality in patients with RA was 28% (95% CI 2% to 55%, p=0.035), in which RA itself contributed 5% and the direct and indirect contributions of low eCRF accounted for 23%. Conclusions Low eCRF was an important mediator of the increased all-cause mortality rate found in RA. Our data indicate that patients with RA should be given advice to perform physical activity that increases CRF, along with optimised treatment with antirheumatic drugs, from the time of diagnosis.
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Affiliation(s)
- Marthe Halsan Liff
- Clinic of Orthopaedics, Rheumatology and Dermatology, St Olavs University Hospital, Trondheim, Norway.,Department of Clinical and Molecular Medicine, NTNU - Norwegian University of Science and Technology, Trondheim, Norway
| | - Mari Hoff
- Department of Neuromedicine and Movement Science, NTNU - Norwegian University of Science and Technology, Trondheim, Norway.,Department of Rheumatology, St Olavs University Hospital, Trondheim, Norway
| | - Ulrik Wisloff
- Department of Circulation and Medical Imaging, NTNU - Norwegian University of Science and Technology, Trondheim, Norway.,School of Human Movement & Nutrition Sciences, The University of Queensland, Saint Lucia, Queensland, Australia
| | - Vibeke Videm
- Department of Clinical and Molecular Medicine, NTNU - Norwegian University of Science and Technology, Trondheim, Norway .,Department of Immunology and Transfusion Medicine, St Olavs University Hospital, Trondheim, Norway
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Validation of a Quality of Life Instrument in Spanish Patients With Rheumatic Diseases: The Rosser Classification System. J Clin Rheumatol 2019; 25:78-84. [PMID: 29561466 DOI: 10.1097/rhu.0000000000000774] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The aim of this study was to assess the reliability and validity of the Spanish version of the Rosser classification system for disease states in patients with musculoskeletal disorders. METHODS Our study was based on a questionnaire validation design. Patients were attended at an outpatient rheumatology clinic at Hospital Clínico San Carlos, Madrid, Spain. The Rosser classification system was completed by the physician from the research team (PMQ) and by the patient (HMQ). Criterion standards: The EuroQol-5D for the HMQ and the physician global estimate (DOCGL) for the PMQ. Internal consistency reliability was assessed using Cronbach α. Test-retest reliability and interobserver reliability were analyzed using the intraclass correlation coefficient. The criterion validity between HMQ and EuroQol-5D and between PMQ and DOCGL was assessed using the Spearman correlation coefficient. RESULTS The full analysis was based on 4 samples of patients (104 to 266 patients), most of whom were middle-aged women. For HMQ, Cronbach α was 0.70. Test-retest reproducibility was 0.7. With respect to criterion validity, significant correlations in the expected direction were observed. For PMQ, Cronbach α was 0.70, indicating excellent intraobserver and interobserver reliability. With respect to criterion validity, strong correlations were observed between the PMQ and the DOCGL. CONCLUSIONS The Rosser classification system showed satisfactory reliability and suitable criterion validity for patients with musculoskeletal disorders. The instrument seems to be suitable for clinical decision making and research.
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Muñoz JGB, Giraldo RB, Santos AM, Bello-Gualteros JM, Rueda JC, Saldarriaga EL, Angarita JI, Arias-Correal S, Vasquez AY, Londono J. Correlation between rapid-3, DAS28, CDAI and SDAI as a measure of disease activity in a cohort of Colombian patients with rheumatoid arthritis. Clin Rheumatol 2016; 36:1143-1148. [PMID: 28013433 DOI: 10.1007/s10067-016-3521-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2016] [Revised: 12/15/2016] [Accepted: 12/16/2016] [Indexed: 11/25/2022]
Abstract
The objective of this study is to correlate the patient-driven tool Routine Assessment of Patient Index Data 3 (RAPID-3) with other common tools used in daily practice to measure disease activity in rheumatoid arthritis (RA).One hundred nineteen RA patients according to 1987 American College of Rheumatology criteria who consecutively attended a RA outpatient clinic between August and December 2015 were evaluated. Data was stored in an electronic form that included demographic information, comorbidities, concomitant medication, and laboratory results. The disease activity was determined by tender and swollen joint count, pain and disease activity visual analog scales (VAS), disease activity score 28 (DAS28), Clinical Disease Activity Index (CDAI), Simplified Disease Activity Index (SDAI), and multidimensional health assessment questionnaire (MDHAQ). Correlations between RAPID-3 and other disease activity tools were assessed. Mean age was 61 ± 13.8 years with a median disease duration of 14 years (IQR 5-21), 77% were females. Median scores were MDHAQ 0.5 (IQR 0.1-1.2), DAS 28 3.8 (IQR 2.7-5.1), and RAPID-3 12.3 (IQR 6-19). A strong correlation was obtained between RAPID-3 and DAS 28 (r 0.719, p < 0.001), CDAI (r 0.752, p < 0.001), and SDAI (r 0.758, p < 0.001). RAPID-3 had a high correlation with tools regularly used for disease activity assessment of RA patients in daily practice. The ease of its application favors routine use as it does not require laboratory results and joint counts.
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Affiliation(s)
| | - Rodrigo B Giraldo
- Department of Rheumatology, Universidad de La Sabana, Hospital Militar Central, Km 7, Autopista Norte de Bogota, Bogotá, Colombia
| | - Ana M Santos
- Department of Rheumatology, Universidad de La Sabana, Hospital Militar Central, Km 7, Autopista Norte de Bogota, Bogotá, Colombia
| | - Juan Manuel Bello-Gualteros
- Department of Rheumatology, Universidad de La Sabana, Hospital Militar Central, Km 7, Autopista Norte de Bogota, Bogotá, Colombia
| | - Juan C Rueda
- Department of Rheumatology, Universidad de La Sabana, Hospital Militar Central, Km 7, Autopista Norte de Bogota, Bogotá, Colombia
| | - Eugenia-Lucia Saldarriaga
- Department of Rheumatology, Universidad de La Sabana, Hospital Militar Central, Km 7, Autopista Norte de Bogota, Bogotá, Colombia
| | - Jose-Ignacio Angarita
- Department of Rheumatology, Universidad de La Sabana, Hospital Militar Central, Km 7, Autopista Norte de Bogota, Bogotá, Colombia
| | - Sofia Arias-Correal
- Department of Rheumatology, Universidad de La Sabana, Hospital Militar Central, Km 7, Autopista Norte de Bogota, Bogotá, Colombia
| | - Andres Y Vasquez
- Department of Rheumatology, Universidad de La Sabana, Hospital Militar Central, Km 7, Autopista Norte de Bogota, Bogotá, Colombia
| | - John Londono
- Department of Rheumatology, Universidad de La Sabana, Hospital Militar Central, Km 7, Autopista Norte de Bogota, Bogotá, Colombia.
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Redondo M, Leon L, Povedano FJ, Abasolo L, Perez-Nieto MA, López-Muñoz F. A bibliometric study of the scientific publications on patient-reported outcomes in rheumatology. Semin Arthritis Rheum 2016; 46:828-833. [PMID: 28087065 DOI: 10.1016/j.semarthrit.2016.12.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2016] [Revised: 11/25/2016] [Accepted: 12/07/2016] [Indexed: 10/20/2022]
Abstract
INTRODUCTION We have conducted a bibliometric study of the scientific publications on patient-reported outcomes in the field of rheumatology. METHODS SCOPUS was the database used in this bibliometric study. We performed two searches. The main search involved selecting the documents published between 2000 and 2014 limited to top-tier journals addressing rheumatic and musculoskeletal diseases, using specific descriptors together with the operator and main descriptor "patient-reported outcomes" (PROs), and we performed a secondary search, with the following specific descriptors: "pain," "functional capacity," and "fatigue." We used bibliometric indicators for articles distribution (Price's law for the increase of scientific literature and Bradford's law for dispersion of articles). We also calculated the participation index of the different countries. RESULTS A total of 983 original articles were published between 2000 and 2014. Our results confirmed the fulfilment of Price's law (correlation coefficient r = 0.9385 after linear adjustment). The average number of articles per Bradford Zone was 327.6. A total of 30 different journals were published. The type of growth for the descriptors "pain" (r2 = 0.5417 compared to r2 = 0.4839) and "fatigue" (r2 = 06276 compared to r2 = 0.5544) is exponential, whereas it is linear for the descriptor "functional capacity" (r2 = 0.6769 compared to r2 = 0.3779). DISCUSSION This study revealed significant linear growth of patient-related outcomes in global terms, as well as upward trends for most of the citation-based bibliometric indices, especially significant from 2010 to 2014. Pain and fatigue have greater growth as PRO concepts.
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Affiliation(s)
- Marta Redondo
- Health Sciences Faculty, Camilo José Cela University, Madrid, Spain
| | - Leticia Leon
- Health Sciences Faculty, Camilo José Cela University, Madrid, Spain; Department of Rheumatology, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IDISSC), Hospital Clinico San Carlos, Madrid, Spain.
| | | | - Lydia Abasolo
- Department of Rheumatology, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IDISSC), Hospital Clinico San Carlos, Madrid, Spain
| | | | - Francisco López-Muñoz
- Health Sciences Faculty, Camilo José Cela University, Madrid, Spain; Neuropsychopharmacology Unit, Hospital 12 de Octubre Research Institute (i+12), Madrid, Spain
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Lopez-Gonzalez R, Seoane-Mato D, Perez-Vicente S, Martin-Martinez MA, Sanchez-Alonso F, Silva-Fernandez L. Variability in the frequency of rheumatology consultations in patients with rheumatoid arthritis in Spain. Rheumatol Int 2016; 36:1525-1534. [PMID: 27538838 DOI: 10.1007/s00296-016-3547-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2016] [Accepted: 08/02/2016] [Indexed: 11/30/2022]
Abstract
The aim of this work was to assess the variability in the use of health-care resources, based on the number of visits to rheumatology departments by rheumatoid arthritis patients, in Spain, and its association with patient, physician and center characteristics. The sample consisted of patient records of men and women (aged 16 or older), with a clinical diagnosis of RA, who met the American Rheumatism Association 1987 revised criteria and who had been treated in a rheumatology department at a Spanish hospital with at least one visit to a rheumatologist during the two years preceding the date of the study. To analyze which variables were independently associated with the number of consultations, those with a statistically significant result in the bivariate analysis, or which were clinically relevant or deemed confounders, were used in the construction of a linear regression model. The records of 1188 RA patients were studied. The linear regression model explained the 26.67 % of the variability in the number of visits. The number of csDMARDs prescribed, the administration of biological therapy, corticoid prescription, the presence of nursing consultation, mean time to first visit in the department and attended population showed a positive significant association, while the presence of telephone consultation, distance from the hospital to the patient´s residence (≥20 km) and drug monitoring by rheumatology department + primary care physician or by other specialists were negatively associated with the number of consultations. We observed a high variability in the number of visits, which remains partially unexplained even after taking into account individual, physician and center characteristics.
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Affiliation(s)
- R Lopez-Gonzalez
- Rheumatology Unit, Rheumatology Department, Complejo Hospitalario de Zamora, Avenida Requejo 35, 49022, Zamora, Spain.
| | - D Seoane-Mato
- Research Unit, Spanish Society of Rheumatology, Madrid, Spain
| | - S Perez-Vicente
- Research Unit, Spanish Society of Rheumatology, Madrid, Spain
| | | | | | - L Silva-Fernandez
- Rheumatology Department, Complexo Hospitalario Universitario de Ferrol, Ferrol, A Coruña, Spain
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Pincus T, Chua JR, Gibson KA. Evidence from a Multidimensional Health Assessment Questionnaire (MDHAQ) of the Value of a Biopsychosocial Model to Complement a Traditional Biomedical Model in Care of Patients with Rheumatoid Arthritis. JOURNAL OF RHEUMATIC DISEASES 2016. [DOI: 10.4078/jrd.2016.23.4.212] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Affiliation(s)
- Theodore Pincus
- Division of Rheumatology, Department of Internal Medicine, Rush University Medical Center, Chicago, IL, USA
| | - Jacquelin R Chua
- Division of Rheumatology, Department of Internal Medicine, Rush University Medical Center, Chicago, IL, USA
| | - Kathryn A Gibson
- Rheumatology Department, Liverpool Hospital, University of New South Wales, and Ingham Research Institute, Liverpool, NSW, Australia
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Ferraz-Amaro I, Seoane-Mato D, Sánchez-Alonso F, Martín-Martínez MA. Synthetic disease-modifying antirheumatic drug prescribing variability in rheumatoid arthritis: a multilevel analysis of a cross-sectional national study. Rheumatol Int 2015; 35:1825-36. [DOI: 10.1007/s00296-015-3363-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2015] [Accepted: 09/16/2015] [Indexed: 12/19/2022]
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Ogdie A, Pang WG, Forde KA, Samir BD, Mulugeta L, Chang KM, Kaplan DE, Amorosa VK, Kostman JR, Reddy RK, Schumacher RH, Lo Re V. Prevalence and risk factors for patient-reported joint pain among patients with HIV/hepatitis C coinfection, hepatitis C monoinfection, and HIV monoinfection. BMC Musculoskelet Disord 2015; 16:93. [PMID: 25896674 PMCID: PMC4404567 DOI: 10.1186/s12891-015-0552-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2014] [Accepted: 04/13/2015] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND To determine the prevalence of patient-reported joint pain among patients with human immunodeficiency virus (HIV)/chronic hepatitis C virus (HCV) coinfection, chronic HCV monoinfection, and HIV monoinfection followed in hepatology and infectious disease outpatient practices. METHODS Standardized interviews were performed among 79 HIV/HCV-coinfected, 93 HCV-monoinfected, and 30 HIV-monoinfected patients in a cross-sectional study within hepatology and infectious disease clinics at three centers. The Multi-Dimensional Health Assessment Questionnaire was used to ascertain joint pain and associated symptoms. Information on potential risk factors for joint pain was obtained during the interview and by chart review. Logistic regression was used to determine adjusted odds ratios (aORs) with 95% confidence intervals (CIs) of joint pain associated with risk factors of interest among chronic HCV-infected and HIV-infected patients. RESULTS Joint pain was more commonly reported in HCV-monoinfected than HIV/HCV-coinfected (71% versus 56%; p = 0.038) and HIV-monoinfected (71% versus 50%; p = 0.035) patients. A previous diagnosis of arthritis and current smoking were risk factors for joint pain among HCV-infected patients (arthritis: aOR, 4.25; 95% CI, 1.84-9.81; smoking: aOR, 5.02; 95% CI, 2.15-11.74) and HIV-infected (arthritis: aOR, 5.36; 95% CI, 2.01-14.25; smoking: aOR, 6.07; 95% CI, 2.30-16.00) patients. CONCLUSION Patient-reported joint pain was prevalent among all three groups, but more common among chronic HCV-monoinfected than either HIV/HCV-coinfected or HIV-monoinfected patients. A prior diagnosis of arthritis and current smoking were risk factors for patient-reported joint pain among both HCV-infected and HIV-infected patients.
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Affiliation(s)
- Alexis Ogdie
- Division of Rheumatology, Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine at the University of Pennsylvania, Penn Tower Room 1407, 1 Convention Ave, Philadelphia, PA 19104, USA.
| | - Wyki Gina Pang
- Maine Medical Center, Tufts University School of Medicine, Portland, ME, USA
| | - Kimberly A Forde
- Department of Medicine, Division of Gastroenterology, Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.
| | - Bhangle D Samir
- Seacoast Arthritis and Osteoporosis Center, 10 Members Way, Suite 403, Dover, NH 03820, USA.
| | - Lakeisha Mulugeta
- Perelman School of Medicine, the University of Pennsylvania, Philadelphia, PA, USA.
| | - Kyong-Mi Chang
- Division of Gastroenterology, Philadelphia VA Medical Center, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.
| | - David E Kaplan
- Division of Gastroenterology, Philadelphia VA Medical Center, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.
| | - Valerianna K Amorosa
- Division of Infectious Diseases, Philadelphia VA Medical Center, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.
| | - Jay R Kostman
- Division of Infectious Diseases, Philadelphia VA Medical Center, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.
| | - Rajender K Reddy
- Division of Gastroenterology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, USA.
| | - Ralph H Schumacher
- Division of Rheumatology, Philadelphia VA Medical Center, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.
| | - Vincent Lo Re
- Department of Medicine, Division of Infectious Diseases, Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.
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Palmer D, Miedany YE. Rheumatoid arthritis: recommendations for treat to target. ACTA ACUST UNITED AC 2014; 23:310-5. [DOI: 10.12968/bjon.2014.23.6.310] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Deborah Palmer
- Advanced Nurse Practitioner, North Middlesex University Hospital, London
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Scott IC, Scott DL. Spleen Tyrosine Kinase Inhibitors for Rheumatoid Arthritis: Where Are We Now? Drugs 2014; 74:415-22. [DOI: 10.1007/s40265-014-0193-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Poulsen CH, Jacobsen S, Frisch M, Frederiksen K, Johansen C. Anti-cyclic citrullinated peptide antibodies do not reflect self-reported disability and physical health in patients with rheumatoid arthritis of less than 5 years of duration. Rheumatol Int 2013; 33:2763-72. [DOI: 10.1007/s00296-013-2807-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2011] [Accepted: 06/17/2013] [Indexed: 12/19/2022]
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PROMs in inflammatory arthritis: moving from static to dynamic. Clin Rheumatol 2013; 32:735-42. [PMID: 23572036 DOI: 10.1007/s10067-013-2228-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2013] [Accepted: 02/27/2013] [Indexed: 12/19/2022]
Abstract
There are several advantages in using patient-reported outcome measures (PROMs) in standard clinical practice, particularly if a questionnaire is distributed to each patient at each visit as a standard in the infrastructure usual care. The patients, being the most knowledgeable persons concerning their pain and global estimate, do most of the work by completing a questionnaire. Completion of the questionnaire helps the patients prepare for their visit as well as improving doctor-patient communication. Recently, the role of PROMs has expanded from the static phase of capturing and measuring outcomes at a single point of time to a more dynamic role. This dynamic role is aiming at driving improvement not only in the quality of inflammatory arthritis care but also in the patients' reported experience. Therefore, in addition to its value in tailoring treatment targets adapted to the patient's needs, PROMs also have the potential of modifying the disease impact through improving the patients' adherence to therapy and allowing the patients to monitor the changes in their condition. Though more attention has been given to the use of PROMs in routine clinical care, little was published regarding what could be done with the plethora of data gained from PROMs and how dynamic it can be enhancing the "patient-centered care" approach and improving patients' experience. This article highlights the value of adopting PROMs for arthritic patients in standard clinical practice and its impact on long-term patients' management.
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Amaya-Amaya J, Botello-Corzo D, Calixto OJ, Calderón-Rojas R, Domínguez AM, Cruz-Tapias P, Montoya-Ortiz G, Mantilla RD, Anaya JM, Rojas-Villarraga A. Usefulness of patients-reported outcomes in rheumatoid arthritis focus group. ARTHRITIS 2012; 2012:935187. [PMID: 23097701 PMCID: PMC3465872 DOI: 10.1155/2012/935187] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/04/2012] [Accepted: 08/20/2012] [Indexed: 12/19/2022]
Abstract
Objective. Patient-reported outcomes (PROs) have become an essential part of the assessment of patients with rheumatoid arthritis (RA). We aimed to evaluate the agreement and correlation between PROs and the physician's measurements. Methods. This was a cross-sectional analytical study in which 135 patients with RA were clinically evaluated during two different sessions of focus group interviews. Rheumatologist recorded 28 swollen (SJCs) and tender joint counts (TJCs). The patients filled out the PROs instruments (MDHAQ, RADAI, RAPID3, 4, and 5 and self-report articular index (SAI) diagram for pain and joint swelling). DAS28 was calculated (C-reactive protein). An adjusted multiple lineal regression model was done (DAS28 as dependent variable). Results. Highly significant agreements were found between SJC and TJC registered by the physician and patient. There was moderate correlation between DAS28 with patient SJC (r = 0.52), patient TJC (r = 0.55), RADAI (r = 0.56), RAPID3 (r = 0.52), RAPID4 (r = 0.56), RAPID5 (r = 0.66), and VAS-Global (r = 0.51). Likewise, we found moderate to high correlations between CDAI and SDAI with all variable measurements done by the patients. The resulting predictive equation was DAS28(CRP) = 2.02 + 0.037 × RAPID4 + 0.042× patient SJC. Conclusion. PROs applied in focus groups interview are a useful tool for managing patients with RA regardless of gender, educational level, and duration of disease.
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Affiliation(s)
- Jenny Amaya-Amaya
- Center for Autoimmune Diseases Research (CREA), School of Medicine and Health Sciences, Universidad del Rosario, Bogota, Colombia
| | - Diana Botello-Corzo
- Center for Autoimmune Diseases Research (CREA), School of Medicine and Health Sciences, Universidad del Rosario, Bogota, Colombia
| | - Omar-Javier Calixto
- Center for Autoimmune Diseases Research (CREA), School of Medicine and Health Sciences, Universidad del Rosario, Bogota, Colombia
| | - Rolando Calderón-Rojas
- Center for Autoimmune Diseases Research (CREA), School of Medicine and Health Sciences, Universidad del Rosario, Bogota, Colombia
| | | | - Paola Cruz-Tapias
- Center for Autoimmune Diseases Research (CREA), School of Medicine and Health Sciences, Universidad del Rosario, Bogota, Colombia
- Doctoral Program in Biomedical Sciences, Universidad del Rosario, Bogota, Colombia
| | - Gladis Montoya-Ortiz
- Center for Autoimmune Diseases Research (CREA), School of Medicine and Health Sciences, Universidad del Rosario, Bogota, Colombia
| | - Ruben-Dario Mantilla
- Center for Autoimmune Diseases Research (CREA), School of Medicine and Health Sciences, Universidad del Rosario, Bogota, Colombia
- Riesgo de Fractura-Cayre IPS, Rheumatology Unit, Bogota, Colombia
| | - Juan-Manuel Anaya
- Center for Autoimmune Diseases Research (CREA), School of Medicine and Health Sciences, Universidad del Rosario, Bogota, Colombia
| | - Adriana Rojas-Villarraga
- Center for Autoimmune Diseases Research (CREA), School of Medicine and Health Sciences, Universidad del Rosario, Bogota, Colombia
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Singh H, Gupta V, Ray S, Kumar H, Talapatra P, Kaur M, Kumar S, Arya S, Mathur R, Ghangas N. Evaluation of disease activity in rheumatoid arthritis by Routine Assessment of Patient Index Data 3 (RAPID3) and its correlation to Disease Activity Score 28 (DAS28) and Clinical Disease Activity Index (CDAI): an Indian experience. Clin Rheumatol 2012; 31:1663-9. [PMID: 22983768 DOI: 10.1007/s10067-012-2070-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2012] [Revised: 06/25/2012] [Accepted: 08/10/2012] [Indexed: 12/19/2022]
Abstract
Serial objective assessment of disease activity in rheumatoid arthritis (RA) is imperative to achieve remission. Routine Assessment of Patient Index Data 3 (RAPID3), an index without formal joint counts, appears attractive for evaluation of disease activity in RA patients in a busy clinical setting. This study aims to evaluate correlation and agreement of RAPID3 with Disease Activity Score 28 (DAS28) and Clinical Disease Activity Index (CDAI) in RA patients. All patients completed a Multidimensional Health Assessment Questionnaire (MDHAQ) at each visit. A physician/assessor 28-joint count and erythrocyte sedimentation rate were completed in 200 literate patients with RA to score DAS28, CDAI, and RAPID3. RAPID3 includes the three MDHAQ patient self-report RA core dataset measures for physical function, pain, and patient global estimate. Proposed RAPID3 (range, 0-30) severity categories of high (>12), moderate (6.1-12.0), low (3.1-6.0), and near remission (≤3) were compared to DAS28 (0-10) activity categories of high (> 5.1), moderate (3.21-5.1), low (2.61-3.2), and remission (≤ 2.6), and CDAI (0-76) categories of >22, 10.1-22.0, 2.9-10.0, and ≤2.8. Statistical significance was analyzed using Spearman correlations, cross-tabulations, and kappa statistics. Comparison of RAPID3 with DAS28 and CDAI indicated Spearman rank-order correlation coefficients for DAS28 with RAPID3 of 0.910, and for CDAI with RAPID3 of 0.907, all highly significant (P < 0.001). There was substantial agreement between RAPID3 and DAS28 (kappa value = 0.634, P < 0.001) and also between RAPID3 and CDAI (kappa value = 0.690, P < 0.001). Overall, 89-94 % of patients who met DAS28 or CDAI moderate/high activity criteria met similar RAPID severity criteria and 84-88 % who met DAS28 or CDAI remission/low activity criteria also met similar RAPID criteria. RAPID3 scores provide similar quantitative information to DAS28 and CDAI, and hence, is an informative index for evaluation of disease activity in RA in busy clinical settings.
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Affiliation(s)
- H Singh
- Department of Medicine, Pt. B.D. Sharma PGIMS, DLF Colony, Rohtak, Haryana, India.
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Maese J, García De Yébenes MJ, Carmona L, Hernández-García C. Estudio sobre el manejo de la artritis reumatoide en España (emAR II). Características clínicas de los pacientes. ACTA ACUST UNITED AC 2012; 8:236-42. [DOI: 10.1016/j.reuma.2012.03.009] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2011] [Revised: 03/03/2012] [Accepted: 03/07/2012] [Indexed: 11/28/2022]
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Newman ED, Lerch V, Jones JB, Stewart W. Touchscreen questionnaire patient data collection in rheumatology practice: development of a highly successful system using process redesign. Arthritis Care Res (Hoboken) 2012; 64:589-96. [PMID: 22162301 DOI: 10.1002/acr.21560] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE While questionnaires have been developed to capture patient-reported outcomes (PROs) in rheumatology practice, these instruments are not widely used. We developed a touchscreen interface designed to provide reliable and efficient data collection. Using the touchscreen to obtain PROs, we compared 2 different workflow models implemented separately in 2 rheumatology clinics. METHODS The Plan-Do-Study-Act methodology was used in 2 cycles of workflow redesign. Cycle 1 relied on off-the-shelf questionnaire builder software, and cycle 2 relied on a custom programmed software solution. RESULTS During cycle 1, clinic 1 (private practice model, resource replete, simple flow) demonstrated a high completion rate at the start, averaging between 74% and 92% for the first 12 weeks. Clinic 2 (academic model, resource deficient, complex flow) did not achieve a consistent completion rate above 60%. The revised cycle 2 implementation protocol incorporated a 15-minute "nurse visit," an instant messaging system, and a streamlined authentication process, all of which contributed to substantial improvement in touchscreen questionnaire completion rates of ∼80% that were sustained without the need for any additional clinic staff support. CONCLUSION Process redesign techniques and touchscreen technology were used to develop a highly successful, efficient, and effective process for the routine collection of PROs in a busy, complex, and resource-depleted academic practice and in typical private practice. The successful implementation required both a touchscreen questionnaire, human behavioral redesign, and other technical solutions.
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Affiliation(s)
- Eric D Newman
- Geisinger Health System, Danville, Pennsylvania, USA.
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Genevay S, Cedraschi C, Marty M, Rozenberg S, De Goumoëns P, Faundez A, Balagué F, Porchet F, Mannion AF. Reliability and validity of the cross-culturally adapted French version of the Core Outcome Measures Index (COMI) in patients with low back pain. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2011; 21:130-7. [PMID: 21881865 DOI: 10.1007/s00586-011-1992-2] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/18/2011] [Revised: 06/22/2011] [Accepted: 08/16/2011] [Indexed: 11/27/2022]
Abstract
PURPOSE To conduct a cross-cultural adaptation of the Core Outcome Measures Index (COMI) into French according to established guidelines. METHODS Seventy outpatients with chronic low back pain were recruited from six spine centres in Switzerland and France. They completed the newly translated COMI, and the Roland Morris disability (RMQ), Dallas Pain (DPQ), adjectival pain rating scale, WHO Quality of Life, and EuroQoL-5D questionnaires. After ~14 days RMQ and COMI were completed again to assess reproducibility; a transition question (7-point Likert scale; "very much worse" through "no change" to "very much better") indicated any change in status since the first questionnaire. RESULTS COMI whole scores displayed no floor effects and just 1.5% ceiling effects. The scores for the individual COMI items correlated with their corresponding full-length reference questionnaire with varying strengths of correlation (0.33-0.84, P < 0.05). COMI whole scores showed a very good correlation with the "multidimensional" DPQ global score (Rho = 0.71). 55 patients (79%) returned a second questionnaire with no/minimal change in their back status. The reproducibility of individual COMI 5-point items was good, with test-retest differences within one grade ranging from 89% for 'social/work disability' to 98% for 'symptom-specific well-being'. The intraclass correlation coefficient for the COMI whole score was 0.85 (95% CI 0.76-0.91). CONCLUSIONS In conclusion, the French version of this short, multidimensional questionnaire showed good psychometric properties, comparable to those reported for German and Spanish versions. The French COMI represents a valuable tool for future multicentre clinical studies and surgical registries (e.g. SSE Spine Tango) in French-speaking countries.
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Affiliation(s)
- Stéphane Genevay
- Division of Rheumatology, University Hospital of Geneva, Hôpital Beau-Séjour, 26 av. Beau-Séjour, 1211, Geneva 14, Switzerland.
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Sokka T. Morning stiffness and other patient-reported outcomes of rheumatoid arthritis in clinical practice. Scand J Rheumatol 2011; 125:23-7. [PMID: 21529307 DOI: 10.3109/03009742.2011.566437] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Morning stiffness has been recognized in traditional approaches to assessment of disease activity in rheumatoid arthritis (RA). Although morning stiffness is not specific to RA, changes in morning stiffness for an individual patient are helpful when monitoring health status. Health professionals can ask about morning stiffness but the most accurate and consistent approach to assessment from one visit to the next appears to be a patient self-report questionnaire. However, quantitative measures of patient-reported data are not an integral part of clinical monitoring in most clinics. No single measure is adequate for all individual patients, so quantitative measurement of patient-reported data should include many elements such as pain, functional status, fatigue, sleep, morning stiffness, work capacity, and physical and emotional well-being. In daily clinical practice, patient-reported outcomes can be collected easily using a standard questionnaire that patients can complete with pencil and paper or electronically on a touch screen in the waiting room. The results are then immediately available to the rheumatologists, to facilitate doctor-patient communication to improve the quality of patient care, leading to better patient outcomes.
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Affiliation(s)
- T Sokka
- Department of Medicine, Jyväskylä Central Hospital, Jyväskylä, Finland.
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22
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Taylor A, Bagga H. Measures of rheumatoid arthritis disease activity in Australian clinical practice. ISRN RHEUMATOLOGY 2011; 2011:437281. [PMID: 22389794 PMCID: PMC3263749 DOI: 10.5402/2011/437281] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/13/2011] [Accepted: 03/01/2011] [Indexed: 11/23/2022]
Abstract
Objectives. To investigate which rheumatoid arthritis (RA) disease activity measures are being collected in patients receiving glucocorticoids, non-biologic or biologic disease-modifying antirheumatic drugs (DMARDs) in Australian rheumatology practice. Methods. A retrospective audit of medical records was conducted from eight rheumatology practices around Australia. Each rheumatologist recruited 30 consecutive eligible patients into the review, 10 of whom must have been receiving a biological agent for rheumatoid arthritis. Disease activity measures and radiographic assessments were collected from each patient's last consultation. For biologic patients, disease activity measures were also collected from when the patient was first initiated on the biological agent. Results. At last consultation, the disease measures that were recorded most often were ESR (89.2%), haemoglobin (87.5%), and CRP (84.2%). DAS28 was infrequently recorded (16.3%). The rate of recording disease activity measures for patients receiving biologic DMARDs decreased over time (mean 27 months). Conclusion. This review has shown inconsistency of RA activity measures being recorded in Australian rheumatology clinical practice. An accurate assessment of the disease process is necessary to effectively target rheumatoid arthritis patients to treat in order to achieve optimal outcomes.
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Affiliation(s)
- Andrew Taylor
- St. John of God Medical Centre, Suite 19/100 Murdoch Drive, Murdoch, WA 6150, Australia
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Mease PJ. Improving the routine management of rheumatoid arthritis: the value of tight control. J Rheumatol 2010; 37:1570-8. [PMID: 20595287 DOI: 10.3899/jrheum.091064] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Evidence is mounting that adopting a tight control approach to the management of patients with rheumatoid arthritis (RA) yields superior clinical outcomes including inhibition of progressive structural damage. While this approach has been successfully implemented in other chronic diseases, such as diabetes, its use in RA is less straightforward as there is not a simple "gold standard" measure for disease activity. A key component of the tight control approach is the availability of easily implemented and clinically relevant assessment measures of disease activity that allow physicians to monitor progress toward preset goals. This article summarizes the evidence from clinical trials demonstrating the benefits of achieving tight control and surveys the instruments available to assess patient progress in a consistent manner. A case study clearly demonstrates the benefits of the tight control approach in routine clinical practice.
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Affiliation(s)
- Philip J Mease
- Seattle Rheumatology Associates, Seattle, Washington 98104, USA.
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Pincus T, Yazici Y, Bergman MJ. Patient questionnaires in rheumatoid arthritis: advantages and limitations as a quantitative, standardized scientific medical history. Rheum Dis Clin North Am 2010; 35:735-43, vii. [PMID: 19962618 DOI: 10.1016/j.rdc.2009.10.009] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
In many chronic diseases, objective gold standard measures such as blood pressure, cholesterol, and bone densitometry often provide most of the information used to establish a diagnosis and guide therapy. By contrast, in inflammatory rheumatic diseases, information from a patient history usually is considerably more prominent in clinical management. Patient history data can be recorded as standardized, quantitative scientific data through use of validated self-reported questionnaires. Patient questionnaires address the primary concerns of patients and their families. Questionnaire scores distinguish active from control treatments in clinical trials at similar levels to swollen and tender joint counts or laboratory tests. Patient questionnaire data are correlated significantly with joint counts, radiographic scores, and laboratory tests, but usually are far more significant than these measures in the prognosis of severe outcomes of rheumatoid arthritis (RA), including work disability, costs, and premature death. Limitations of patient questionnaires are based on cultural features involving variation in responses among ethnic groups, and a need for translation, although translated questionnaires can be as valuable as a translator. Patient questionnaires do not replace further medical history, physical examination, laboratory tests, and imaging data, and they require interpretation in a context of these standard sources of information at any clinical encounter. Patient questionnaires are useful to monitor patient status in usual clinical care, with almost no effort on the part of the physician and staff if distributed by the receptionist in the infrastructure of office practice.
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Affiliation(s)
- Theodore Pincus
- Division of Rheumatology, Department of Medicine, New York University School of Medicine and NYU Hospital for Joint Diseases, Room 1608, 301 East 17th Street, New York, NY 10003, USA.
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Pincus T, Bergman MJ, Maclean R, Yazici Y. Complex Measures and Indices for Clinical Research Compared with Simple Patient Questionnaires to Assess Function, Pain, and Global Estimates as Rheumatology “Vital Signs” for Usual Clinical Care. Rheum Dis Clin North Am 2009; 35:779-86, ix. [DOI: 10.1016/j.rdc.2009.10.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Is a self-report RAPID3 score a reasonable alternative to a DAS28 in usual clinical care? J Clin Rheumatol 2009; 15:215-7. [PMID: 19654489 DOI: 10.1097/rhu.0b013e3181b40a9a] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Abstract
BACKGROUND Advances in the understanding of rheumatoid arthritis (RA) immunopathogenesis support the hypothesis for a 'window of opportunity' for therapeutic intervention in RA and the need for rapid and effective treatment strategies, with the ultimate goal of alleviating symptoms and halting progressive joint damage. Biologic therapies targeting pro-inflammatory cytokines have significantly improved the outlook for patients with RA; however, some patients still experience inadequate treatment responses. Recently, therapeutic agents targeting alternative pathways have been developed. One such therapy--abatacept--targets T-cell activation and is approved in the United States for treatment of moderate-to-severe RA and juvenile idiopathic arthritis. OBJECTIVE To overview the efficacy and safety of abatacept in the treatment of adult patients with active RA and an inadequate response to methotrexate (MTX) or tumor necrosis factor (TNF) antagonists. SEARCH METHODOLOGY: A comprehensive literature search was performed using the National Library of Medicine (MEDLINE), EMBASE and BIOSIS databases (restricted to articles in the English language posted between January 2000 and February 2007). The search terms 'CTLA-4Ig', 'abatacept' and 'ORENCIA' were used, and data from randomized clinical trials were summarized. RESULTS Abatacept provided clinically meaningful improvements in the signs and symptoms of RA in both MTX and TNF antagonist inadequate responders in Phase II and III studies. Health-related quality of life was also improved with abatacept, which demonstrated an acceptable safety and tolerability profile in both patient populations. Additionally, when assessed in patients with an inadequate response to MTX, abatacept inhibited structural damage progression. CONCLUSION Although longer-term data are required and differing study designs preclude direct comparisons with other RA therapies, results of clinical trials to date suggest that abatacept has an acceptable safety profile and is an effective treatment option for patients with RA, whether treating biologic-naïve patients or those who have already had an inadequate response to TNF antagonists.
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Affiliation(s)
- Yvonne Sherrer
- Center for Rheumatology, Immunology and Arthritis, Fort Lauderdale, FL 33334, USA.
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