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Xiang L, Graves N, Low AHL, Leung YY, Fong W, Gan WH, Gandhi M, Thumboo J. Cost of lost productivity in inflammatory arthritis and osteoarthritis in the year before and after diagnosis: An inception cohort study. Int J Rheum Dis 2024; 27:e15252. [PMID: 38982887 DOI: 10.1111/1756-185x.15252] [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: 06/02/2023] [Revised: 11/17/2023] [Accepted: 06/21/2024] [Indexed: 07/11/2024]
Abstract
AIM Existing studies on the cost of inflammatory arthritis (IA) and osteoarthritis (OA) are often cross-sectional and/or involve patients with various disease durations, thus not providing a comprehensive perspective on the cost of illness from the time of diagnosis. In this study, we therefore assessed the cost of lost productivity in an inception cohort of patients with IA and OA in the year before and after diagnosis. METHODS Employment status, monthly income, days absent from work, and presenteeism were collected at diagnosis and 1 year later to estimate the annual costs of unemployment, absenteeism, and presenteeism using human capital approach. Non-parametric bootstrapping was performed to account for the uncertainty of the estimated costs. RESULTS Compared to patients with OA (n = 64), patients with IA (n = 102, including 48 rheumatoid arthritis, 19 spondyloarthritis, 23 psoriatic arthritis, and 12 seronegative IA patients) were younger (mean age: 52.3 vs. 59.5 years) with a greater proportion receiving treatment (99.0% vs. 67.2%) and a greater decrease in presenteeism score (median: 15% vs 10%) 1 year after diagnosis. Annual costs of absenteeism and presenteeism were lower in patients with IA than those with OA both in the year before (USD566 vs. USD733 and USD8,472 vs. USD10,684, respectively) and after diagnosis (USD636 vs. USD1,035 and USD6,866 vs. USD9,362, respectively). CONCLUSION Both IA and OA impose substantial cost of lost productivity in the year before and after diagnosis. The greater improvement in productivity seen in patients with IA suggests that treatment for IA improves work productivity.
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Affiliation(s)
- Ling Xiang
- Department of Rheumatology and Immunology, Singapore General Hospital, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Nicholas Graves
- Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore
| | - Andrea H L Low
- Department of Rheumatology and Immunology, Singapore General Hospital, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Duke-NUS Medical School, Singapore, Singapore
| | - Ying-Ying Leung
- Department of Rheumatology and Immunology, Singapore General Hospital, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Duke-NUS Medical School, Singapore, Singapore
| | - Warren Fong
- Department of Rheumatology and Immunology, Singapore General Hospital, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Duke-NUS Medical School, Singapore, Singapore
| | - Wee-Hoe Gan
- Duke-NUS Medical School, Singapore, Singapore
- Department of Occupational and Environmental Medicine, Singapore General Hospital, Singapore, Singapore
| | - Mihir Gandhi
- Biostatistics, Singapore Clinical Research Institute, Singapore, Singapore
- Centre of Quantitative Medicine, Duke-NUS Medical School, Singapore, Singapore
- Tampere Center for Child Health Research, Tampere University, Tampere, Finland
| | - Julian Thumboo
- Department of Rheumatology and Immunology, Singapore General Hospital, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Duke-NUS Medical School, Singapore, Singapore
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Zhou T, Wang X, Kong J, Yu L, Xie H, Wang F, Xu S, Shuai Z, Zhou Q, Pan F. PRICKLE1 gene methylation and abnormal transcription in Chinese patients with ankylosing spondylitis. Immunobiology 2023; 228:152742. [PMID: 37742487 DOI: 10.1016/j.imbio.2023.152742] [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: 05/18/2023] [Revised: 08/21/2023] [Accepted: 09/11/2023] [Indexed: 09/26/2023]
Abstract
BACKGROUND Ankylosing spondylitis (AS) is a common inflammatory arthritis without a reliable biomarker. The role of methylation and mRNA expression of PRICKLE1 promoter in the pathogenesis of ankylosing spondylitis remains unclear. METHODS A two-stage case-control design was used to detect the characteristics of methyl group and transcriptome of PRICKLE1 gene in Ankylosing spondylitis. The methylation degree of PRICKLE1 gene promoter region was tested by phosphate-sequencing, and further analyzed whether there was significant difference in methylation level of PRICKLE1 gene. The expression levels of PRICKLE1 mRNA in 50 AS patients and 50 healthy controls were detected by real-time quantitative PCR (RT-qPCR). RESULTS Compared with healthy control group, the intensity of methylation in 4 ponds of PRICKLE1 in patients with Ankylosing spondylitis was low, and the mRNA levels were overexpressed (P = 0.017). ROC results showed that the sensitivity of PRICKLE1 was 68.67% and specificity was 71.43%. CONCLUSION There is a significant change in the concentration of serum PRICKLE1 mRNAin patients with Ankylosing spondylitis, and the degree of gene methylation is significantly reduced, suggesting that PRICKLE1 gene maybe involved in the pathogenesis of Ankylosing spondylitis, which may be useful for predicting the occurrence of AS and finding new early screening indicators.
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Affiliation(s)
- Tingting Zhou
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, 81 Meishan Road, Hefei, Anhui 230032, China; The Key Laboratory of Major Autoimmune Diseases, Anhui Medical University, 81 Meishan Road, Hefei, Anhui 230032, China
| | - Xinqi Wang
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, 81 Meishan Road, Hefei, Anhui 230032, China; The Key Laboratory of Major Autoimmune Diseases, Anhui Medical University, 81 Meishan Road, Hefei, Anhui 230032, China
| | - Jiangping Kong
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, 81 Meishan Road, Hefei, Anhui 230032, China; The Key Laboratory of Major Autoimmune Diseases, Anhui Medical University, 81 Meishan Road, Hefei, Anhui 230032, China
| | - Lingxiang Yu
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, 81 Meishan Road, Hefei, Anhui 230032, China; The Key Laboratory of Major Autoimmune Diseases, Anhui Medical University, 81 Meishan Road, Hefei, Anhui 230032, China
| | - Huimin Xie
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, 81 Meishan Road, Hefei, Anhui 230032, China; The Key Laboratory of Major Autoimmune Diseases, Anhui Medical University, 81 Meishan Road, Hefei, Anhui 230032, China
| | - Feier Wang
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, 81 Meishan Road, Hefei, Anhui 230032, China; The Key Laboratory of Major Autoimmune Diseases, Anhui Medical University, 81 Meishan Road, Hefei, Anhui 230032, China
| | - Shenqian Xu
- Department of Hospital Management Research, The First Affiliated Hospital of Anhui Medical University, Hefei 230022, Anhui, China
| | - Zongwen Shuai
- Department of Hospital Management Research, The First Affiliated Hospital of Anhui Medical University, Hefei 230022, Anhui, China
| | - Qiang Zhou
- Department of Clinical Laboratory, The Second Hospital of Anhui Medical University, No. 678#, Furong Road, 230601 Hefei, Anhui Province, China
| | - Faming Pan
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, 81 Meishan Road, Hefei, Anhui 230032, China; The Key Laboratory of Major Autoimmune Diseases, Anhui Medical University, 81 Meishan Road, Hefei, Anhui 230032, China.
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Beauvais C, Pereira B, Pham T, Sordet C, Claudepierre P, Fayet F, Wendling D, Costantino F, Carton L, Grange L, Soubrier M, Legoupil N, Perdriger A, Tavares I, Dernis E, Gossec L, Rodère M. Development and Validation of a Self-Administered Questionnaire Measuring Essential Knowledge in Patients With Axial Spondyloarthritis. J Rheumatol Suppl 2023; 50:56-65. [PMID: 35840152 DOI: 10.3899/jrheum.211314] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/06/2022] [Indexed: 02/08/2023]
Abstract
OBJECTIVE To develop and validate a patient knowledge questionnaire regarding axial spondyloarthritis (axSpA). METHODS Knowledge considered essential for patients with axSpA was identified through Delphi rounds among rheumatologists, healthcare professionals (HCPs), and patients, then reformulated to develop the knowledge questionnaire. Cross-sectional validation was performed in 14 rheumatology departments to assess internal validity (Kuder-Richardson coefficient), external validity, acceptability, reproducibility (Lin concordance correlation coefficient), and sensitivity to change (knowledge score before vs after patient education sessions and effect size). RESULTS The Spondyloarthritis Knowledge Questionnaire (SPAKE) is a self-administered 42-item questionnaire with a 32-item short form, both scored 0 to 100, assessing knowledge of disease, comorbidities, pharmacological treatments, nonpharmacological treatments, self-care, and adaptive skills. In the validation study (130 patients; 67 [51.5%] male, mean age 43.5 [SD 12.9] yrs), the mean (SD) score of the long-form questionnaire was 71.6 (15.4), with higher scores (better knowledge) in nonpharmacological treatments and adaptive skills and lower scores in cardiovascular comorbidity and pharmacological treatments. Acceptability was good, with no missing data; the internal validity coefficient was 0.85. Reproducibility was good (0.81, 95% CI 0.72-0.89). SPAKE showed good sensitivity to change; scores were 69.2 (15.3) then 82.7 (14.0) after patient education sessions (Hedges effect size = 0.92, 95% CI 0.52-1.31). CONCLUSION SPAKE is a knowledge questionnaire for patients with axSpA, developed with the involvement of HCPs and patients and reflecting current recommendations for the management of axSpA. SPAKE will be useful in assessing knowledge acquisition and self-management strategies in routine care and research.
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Affiliation(s)
- Catherine Beauvais
- C. Beauvais, MD, Service de Rhumatologie Centre Hospitalier Universitaire Saint Antoine, Sorbonne Université, AP-HP, Paris;
| | - Bruno Pereira
- B. Pereira, PhD, Département de Biostatistique Centre Hospitalier Universitaire Gabriel-Montpied, Clermont-Ferrand
| | - Thao Pham
- T. Pham, MD, PhD, Service de Rhumatologie, Centre Hospitalier Universitaire Sainte Marguerite, Université Aix Marseille, Marseille
| | - Christelle Sordet
- C. Sordet, MD, PhD, Service de Rhumatologie, Hôpitaux Universitaires Strasbourg, Strasbourg
| | - Pascal Claudepierre
- P. Claudepierre, MD, PhD, Service de Rhumatologie, Centre Hospitalier Universitaire Henri Mondor, AP-HP, Université Créteil, Paris
| | - Françoise Fayet
- F. Fayet, BSc, M. Soubrier, MD, PhD, M. Rodère, BSc, Service de Rhumatologie, Centre Hospitalier Universitaire Gabriel-Montpied, Clermont-Ferrand
| | - Daniel Wendling
- D. Wendling, MD, PhD, Service de Rhumatologie, Centre Hospitalier Régional Universitaire de Besançon, and EA 4266 EPILAB, Université Bourgogne Franche-Comté, Besançon
| | - Félicie Costantino
- F. Costantino, MD, PhD, Service de Rhumatologie, Hôpital Universitaire Ambroise Paré, AP-HP, Université Paris Saclay, Boulogne-Billancourt
| | - Laurence Carton
- L. Carton, Association AFLAR (Association Française de Lutte Anti-Rhumatismale), Paris
| | - Laurent Grange
- L. Grange, MD, PhD, Service de Rhumatologie, Centre Hospitalier Universitaire Grenoble Alpes, Echirolles
| | - Martin Soubrier
- F. Fayet, BSc, M. Soubrier, MD, PhD, M. Rodère, BSc, Service de Rhumatologie, Centre Hospitalier Universitaire Gabriel-Montpied, Clermont-Ferrand
| | - Nathalie Legoupil
- N. Legoupil, MD, Service de Rhumatologie, Centre Hospitalier Universitaire Cochin, AP-HP, Paris
| | - Aleth Perdriger
- A. Perdriger, MD, PhD, Service de Rhumatologie, Centre Hospitalier Universitaire, Rennes
| | - Isabel Tavares
- I. Tavares, Service de Rééducation, Hôpital Universitaire Montpellier, Montpellier
| | - Emmanuelle Dernis
- E. Dernis, MD, MSc, Service de Rhumatologie, Hôpital Le Mans, Le Mans
| | - Laure Gossec
- L. Gossec, Sorbonne Université, Institut Pierre Louis d'Epidémiologie et de Santé Publique, INSERM, and Service de Rhumatologie, Centre Hospitalier Universitaire Pitié Salpétrière, Sorbonne Université AP-HP, Paris France
| | - Malory Rodère
- F. Fayet, BSc, M. Soubrier, MD, PhD, M. Rodère, BSc, Service de Rhumatologie, Centre Hospitalier Universitaire Gabriel-Montpied, Clermont-Ferrand
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Correlates of physical activity in adults with spondyloarthritis and rheumatoid arthritis: a systematic review. Rheumatol Int 2022; 42:1693-1713. [PMID: 35672508 PMCID: PMC9439989 DOI: 10.1007/s00296-022-05142-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 04/30/2022] [Indexed: 11/25/2022]
Abstract
Physical activity (PA) is a primary non-pharmacological treatment option for those living with rheumatoid arthritis (RA) and spondyloarthritis (SpA). The aim of this systematic literature review was to summarize and present an updated synthesis of the factors associated with PA in the RA and SpA populations. A tailored search of PubMed (inc. Medline), Web of Science, Embase, APA PsycNET, and Scopus was conducted for research published between 2004 and June 2019. Methodological quality was assessed using The National Institutes of Health (NIH) Quality Assessment Tools for Observational Cohort and Cross-sectional Studies, Case–Control Studies, and Controlled Intervention Studies. Forty RA and eleven SpA articles met the inclusion criteria. Methodological quality was generally fair to good, with two RA studies rated as poor. Correlates are discussed in the sociodemographic, physical, psychological, social, and environmental categories. Environmental factors were not measured in any RA study. In individuals living with RA, consistent positive associations were found between PA and high-density lipoprotein, self-efficacy, and motivation. Consistent negative associations were found for functional disability and fatigue. In individuals with SpA, consistent positive associations were found between PA and quality of life, and consistent negative associations with functional disability. Physical and psychological factors are most consistently related with PA parameters in those living with RA and SpA. Many variables were inconsistently studied and showed indeterminant associations. Studies with prospective designs are needed to further understand the factors associated with PA in these populations, especially in those living with SpA.
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Gregory WJ, Kaur J, Bamford S, Tahir H. A Survey of Diagnostic Delay in Axial Spondyloarthritis Across Two National Health Service (NHS) Rheumatology Services. Cureus 2022; 14:e23670. [PMID: 35510018 PMCID: PMC9060761 DOI: 10.7759/cureus.23670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/30/2022] [Indexed: 11/05/2022] Open
Abstract
Introduction Diagnostic delay is an ongoing challenge in axial spondyloarthritis (axial SpA). A recent, comprehensive literature review has found a mean average of 8.7 years of delay between symptom onset and formal diagnosis in the United Kingdom (UK). The primary aim of this study was to identify delays to diagnosis experienced by patients with axial SpA under the ongoing care of two urban National Health Service (NHS) rheumatology services. The secondary aims were (a) to count healthcare professional (HCP) interactions after symptom onset but prior to the diagnosis, (b) to compare our data to published delay to diagnosis research and (c) to explore contributing factors locally and the variation between the two UK rheumatology services. Methods A 14-question survey was created to identify the delay to diagnosis and contributing factors across two urban NHS axial SpA services, from the onset of symptoms to diagnosis and commencement of treatment. Participants were recruited from clinic visits between August and November 2021 and completed the survey either on paper or via online survey software, both with HCP support. Results Those completing the survey formed a cohort of 106 participants with an established diagnosis of axial SpA who attended the axial SpA services at either Royal Free NHS Foundation Trust or Salford Care Organisation, Northern Care Alliance NHS Foundation Trust. The mean time from the onset of symptoms to the diagnosis of axial SpA was similar across centres despite the differences in demographics, with Royal Free at 5.72 years and Salford Royal at 5.96 years. When reviewing via median diagnostic delay, there was a notable difference with Royal Free at 6.09 years and Salford Royal at 4.27 years. Across the two sites, between the onset of symptoms and the diagnosis of axial SpA, 90% of the participants saw a general practitioner (GP), of which 63% of the patients saw a GP 1-5 times, 23% saw 5-10 times and 14% saw more than 10 times. Many participants also saw other HCPs, including physiotherapists, other manual therapists and hospital specialists prior to diagnosis. In addition, 32% saw one other HCP, 18% two other HCPs, 9% three, 7% four and 2.7% five other HCPs prior to diagnosis. Close to 80% of the patients stated that they had received adequate axial SpA education at diagnosis, and 76% of the patients were aware of who to contact in the event of a flare. Conclusions These data highlight that the mean average time to diagnosis for both trusts was between five and six years, somewhat lower than the 8.7-year national UK average. However, despite being specialist centres, these data are a long way from the National Axial Spondyloarthritis Society (NASS) “Gold Standard” of one year time to diagnosis. The contributors to this include lack of HCP and community awareness about axial SpA, its recognition and appropriate onwards referral. There is a need for concerted ways of working for the development of patient pathways and public and HCP education to reduce this delay to allow the ambitious NASS Gold Standard of one year time to diagnosis to be achieved.
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Garrido-Cumbrera M, Collantes-Estevez E, Navarro-Compán V, Zarco-Montejo P, Sastre C, Correa-Fernández J, Sanz-Gómez S, Plazuelo-Ramos P, Gratacos J. Understanding the Disease Burden of Unemployed Patients with Axial Spondyloarthritis. Results of the Spanish Atlas 2017. J Rheumatol 2021; 49:373-379. [PMID: 34911802 DOI: 10.3899/jrheum.210655] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/26/2021] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To evaluate differences in sociodemographic factors and patient-reported outcomes (PROs) between unemployed and employed axSpA patients and to explore work-related issues. METHODS Data through online survey from 680 unselected patients of the Spanish Atlas of Axial Spondyloarthritis were analysed in 2017. Active workforce participants were divided into employed and unemployed according to International Labour Organization standards. Sociodemographic characteristics, PROs [BASDAI (0-10), spinal stiffness (3- 12), functional limitation (0-54), and psychological distress through General Health Questionnaire GHQ-12 (0-12)] were assessed. Logistic regression analysis was used to evaluate the association with unemployment status. RESULTS 415 (63.6%) patients were categorised in the active population, of which 325 (78.3%) were employed and 90 (21.7%) unemployed. 62.8% (N = 54) of unemployed declared that their joblessness was due to axSpA. Of the employed, 170 (54.3%) reported work-related issues in the year prior to the survey, being the most frequent "difficulty fulfilling working hours" (44.1%), "missing work for doctor appointments" (42.9%), and "taking sick leave" (37.1%). Being unemployed was associated with lower educational level (OR= 2.92), disease activity (OR= 1.37), spinal stiffness (OR= 1.21), functional limitation (OR= 1.05), worse mental health (OR= 1.15), anxiety (OR= 2.02) and depression (OR= 2.69) in the univariable models; and only with lower educational level (OR= 2.76) and worse mental health (OR= 1.15) in the multivariable. CONCLUSION Results show significant differences between employed and unemployed axSpA patients. Employed axSpA patients endure many problems at work related to their condition, though unemployed patients present worse disease outcomes associated with greater psychological distress.
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Affiliation(s)
- Marco Garrido-Cumbrera
- Conflict of interest: Marco Garrido-Cumbrera has no conflict of interest to disclose. Eduardo Collantes-Estévez has received unrelated honoraria or research grants from Abbvie, BMS, Lilly, MSD, Novartis, Pfizer, Roche, and UCB lower than $10,000. Victoria Navarro-Compán has received unrelated honoraria or research grants from Abbvie, BMS, Lilly, MSD, Novartis, Pfizer, Roche, and UCB lower than $10,000. Pedro Zarco- Montejo has no conflict of interest to disclose. Carlos Sastre is an employee of Novartis Farmacéutica SA. José Correa-Fernández has no conflict of interest to disclose. Sergio Sanz-Gómez has no conflct of interest to disclose. Pedro Plazuelo-Ramos has no conflict of interest to disclose. Jordi Gratacós has received unrelated honoraria or research grants from Abbvie, BMS, Lilly, MSD, Novartis, Pfizer, Roche, and UCB lower than $10,000. Funding: This study was funded by Novartis Farmacéutica SA. Corresponding author: Marco Garrido Cumbrera, Centro Internacional. Av de la Ciudad Jardín, 20, 22, 41005 Sevilla (Spain); phone number +34 955 420 796;
| | - Eduardo Collantes-Estevez
- Conflict of interest: Marco Garrido-Cumbrera has no conflict of interest to disclose. Eduardo Collantes-Estévez has received unrelated honoraria or research grants from Abbvie, BMS, Lilly, MSD, Novartis, Pfizer, Roche, and UCB lower than $10,000. Victoria Navarro-Compán has received unrelated honoraria or research grants from Abbvie, BMS, Lilly, MSD, Novartis, Pfizer, Roche, and UCB lower than $10,000. Pedro Zarco- Montejo has no conflict of interest to disclose. Carlos Sastre is an employee of Novartis Farmacéutica SA. José Correa-Fernández has no conflict of interest to disclose. Sergio Sanz-Gómez has no conflct of interest to disclose. Pedro Plazuelo-Ramos has no conflict of interest to disclose. Jordi Gratacós has received unrelated honoraria or research grants from Abbvie, BMS, Lilly, MSD, Novartis, Pfizer, Roche, and UCB lower than $10,000. Funding: This study was funded by Novartis Farmacéutica SA. Corresponding author: Marco Garrido Cumbrera, Centro Internacional. Av de la Ciudad Jardín, 20, 22, 41005 Sevilla (Spain); phone number +34 955 420 796;
| | - Victoria Navarro-Compán
- Conflict of interest: Marco Garrido-Cumbrera has no conflict of interest to disclose. Eduardo Collantes-Estévez has received unrelated honoraria or research grants from Abbvie, BMS, Lilly, MSD, Novartis, Pfizer, Roche, and UCB lower than $10,000. Victoria Navarro-Compán has received unrelated honoraria or research grants from Abbvie, BMS, Lilly, MSD, Novartis, Pfizer, Roche, and UCB lower than $10,000. Pedro Zarco- Montejo has no conflict of interest to disclose. Carlos Sastre is an employee of Novartis Farmacéutica SA. José Correa-Fernández has no conflict of interest to disclose. Sergio Sanz-Gómez has no conflct of interest to disclose. Pedro Plazuelo-Ramos has no conflict of interest to disclose. Jordi Gratacós has received unrelated honoraria or research grants from Abbvie, BMS, Lilly, MSD, Novartis, Pfizer, Roche, and UCB lower than $10,000. Funding: This study was funded by Novartis Farmacéutica SA. Corresponding author: Marco Garrido Cumbrera, Centro Internacional. Av de la Ciudad Jardín, 20, 22, 41005 Sevilla (Spain); phone number +34 955 420 796;
| | - Pedro Zarco-Montejo
- Conflict of interest: Marco Garrido-Cumbrera has no conflict of interest to disclose. Eduardo Collantes-Estévez has received unrelated honoraria or research grants from Abbvie, BMS, Lilly, MSD, Novartis, Pfizer, Roche, and UCB lower than $10,000. Victoria Navarro-Compán has received unrelated honoraria or research grants from Abbvie, BMS, Lilly, MSD, Novartis, Pfizer, Roche, and UCB lower than $10,000. Pedro Zarco- Montejo has no conflict of interest to disclose. Carlos Sastre is an employee of Novartis Farmacéutica SA. José Correa-Fernández has no conflict of interest to disclose. Sergio Sanz-Gómez has no conflct of interest to disclose. Pedro Plazuelo-Ramos has no conflict of interest to disclose. Jordi Gratacós has received unrelated honoraria or research grants from Abbvie, BMS, Lilly, MSD, Novartis, Pfizer, Roche, and UCB lower than $10,000. Funding: This study was funded by Novartis Farmacéutica SA. Corresponding author: Marco Garrido Cumbrera, Centro Internacional. Av de la Ciudad Jardín, 20, 22, 41005 Sevilla (Spain); phone number +34 955 420 796;
| | - Carlos Sastre
- Conflict of interest: Marco Garrido-Cumbrera has no conflict of interest to disclose. Eduardo Collantes-Estévez has received unrelated honoraria or research grants from Abbvie, BMS, Lilly, MSD, Novartis, Pfizer, Roche, and UCB lower than $10,000. Victoria Navarro-Compán has received unrelated honoraria or research grants from Abbvie, BMS, Lilly, MSD, Novartis, Pfizer, Roche, and UCB lower than $10,000. Pedro Zarco- Montejo has no conflict of interest to disclose. Carlos Sastre is an employee of Novartis Farmacéutica SA. José Correa-Fernández has no conflict of interest to disclose. Sergio Sanz-Gómez has no conflct of interest to disclose. Pedro Plazuelo-Ramos has no conflict of interest to disclose. Jordi Gratacós has received unrelated honoraria or research grants from Abbvie, BMS, Lilly, MSD, Novartis, Pfizer, Roche, and UCB lower than $10,000. Funding: This study was funded by Novartis Farmacéutica SA. Corresponding author: Marco Garrido Cumbrera, Centro Internacional. Av de la Ciudad Jardín, 20, 22, 41005 Sevilla (Spain); phone number +34 955 420 796;
| | - José Correa-Fernández
- Conflict of interest: Marco Garrido-Cumbrera has no conflict of interest to disclose. Eduardo Collantes-Estévez has received unrelated honoraria or research grants from Abbvie, BMS, Lilly, MSD, Novartis, Pfizer, Roche, and UCB lower than $10,000. Victoria Navarro-Compán has received unrelated honoraria or research grants from Abbvie, BMS, Lilly, MSD, Novartis, Pfizer, Roche, and UCB lower than $10,000. Pedro Zarco- Montejo has no conflict of interest to disclose. Carlos Sastre is an employee of Novartis Farmacéutica SA. José Correa-Fernández has no conflict of interest to disclose. Sergio Sanz-Gómez has no conflct of interest to disclose. Pedro Plazuelo-Ramos has no conflict of interest to disclose. Jordi Gratacós has received unrelated honoraria or research grants from Abbvie, BMS, Lilly, MSD, Novartis, Pfizer, Roche, and UCB lower than $10,000. Funding: This study was funded by Novartis Farmacéutica SA. Corresponding author: Marco Garrido Cumbrera, Centro Internacional. Av de la Ciudad Jardín, 20, 22, 41005 Sevilla (Spain); phone number +34 955 420 796;
| | - Sergio Sanz-Gómez
- Conflict of interest: Marco Garrido-Cumbrera has no conflict of interest to disclose. Eduardo Collantes-Estévez has received unrelated honoraria or research grants from Abbvie, BMS, Lilly, MSD, Novartis, Pfizer, Roche, and UCB lower than $10,000. Victoria Navarro-Compán has received unrelated honoraria or research grants from Abbvie, BMS, Lilly, MSD, Novartis, Pfizer, Roche, and UCB lower than $10,000. Pedro Zarco- Montejo has no conflict of interest to disclose. Carlos Sastre is an employee of Novartis Farmacéutica SA. José Correa-Fernández has no conflict of interest to disclose. Sergio Sanz-Gómez has no conflct of interest to disclose. Pedro Plazuelo-Ramos has no conflict of interest to disclose. Jordi Gratacós has received unrelated honoraria or research grants from Abbvie, BMS, Lilly, MSD, Novartis, Pfizer, Roche, and UCB lower than $10,000. Funding: This study was funded by Novartis Farmacéutica SA. Corresponding author: Marco Garrido Cumbrera, Centro Internacional. Av de la Ciudad Jardín, 20, 22, 41005 Sevilla (Spain); phone number +34 955 420 796;
| | - Pedro Plazuelo-Ramos
- Conflict of interest: Marco Garrido-Cumbrera has no conflict of interest to disclose. Eduardo Collantes-Estévez has received unrelated honoraria or research grants from Abbvie, BMS, Lilly, MSD, Novartis, Pfizer, Roche, and UCB lower than $10,000. Victoria Navarro-Compán has received unrelated honoraria or research grants from Abbvie, BMS, Lilly, MSD, Novartis, Pfizer, Roche, and UCB lower than $10,000. Pedro Zarco- Montejo has no conflict of interest to disclose. Carlos Sastre is an employee of Novartis Farmacéutica SA. José Correa-Fernández has no conflict of interest to disclose. Sergio Sanz-Gómez has no conflct of interest to disclose. Pedro Plazuelo-Ramos has no conflict of interest to disclose. Jordi Gratacós has received unrelated honoraria or research grants from Abbvie, BMS, Lilly, MSD, Novartis, Pfizer, Roche, and UCB lower than $10,000. Funding: This study was funded by Novartis Farmacéutica SA. Corresponding author: Marco Garrido Cumbrera, Centro Internacional. Av de la Ciudad Jardín, 20, 22, 41005 Sevilla (Spain); phone number +34 955 420 796;
| | - Jordi Gratacos
- Conflict of interest: Marco Garrido-Cumbrera has no conflict of interest to disclose. Eduardo Collantes-Estévez has received unrelated honoraria or research grants from Abbvie, BMS, Lilly, MSD, Novartis, Pfizer, Roche, and UCB lower than $10,000. Victoria Navarro-Compán has received unrelated honoraria or research grants from Abbvie, BMS, Lilly, MSD, Novartis, Pfizer, Roche, and UCB lower than $10,000. Pedro Zarco- Montejo has no conflict of interest to disclose. Carlos Sastre is an employee of Novartis Farmacéutica SA. José Correa-Fernández has no conflict of interest to disclose. Sergio Sanz-Gómez has no conflct of interest to disclose. Pedro Plazuelo-Ramos has no conflict of interest to disclose. Jordi Gratacós has received unrelated honoraria or research grants from Abbvie, BMS, Lilly, MSD, Novartis, Pfizer, Roche, and UCB lower than $10,000. Funding: This study was funded by Novartis Farmacéutica SA. Corresponding author: Marco Garrido Cumbrera, Centro Internacional. Av de la Ciudad Jardín, 20, 22, 41005 Sevilla (Spain); phone number +34 955 420 796;
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7
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Crossfield SSR, Marzo-Ortega H, Kingsbury SR, Pujades-Rodriguez M, Conaghan PG. Changes in ankylosing spondylitis incidence, prevalence and time to diagnosis over two decades. RMD Open 2021; 7:rmdopen-2021-001888. [PMID: 34887345 PMCID: PMC8663075 DOI: 10.1136/rmdopen-2021-001888] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Accepted: 11/16/2021] [Indexed: 12/17/2022] Open
Abstract
Objectives To assess changes in ankylosing spondylitis (AS) incidence, prevalence and time to diagnosis, between 1998 and 2017. Methods Using UK GP data from the Clinical Practice Research Datalink, we identified patients diagnosed with AS between 1998 and 2017. We estimated the annual AS incidence, prevalence and length of time from first recorded symptom of back pain to rheumatology referral and diagnosis. Results We identified 12 333 patients with AS. The incidence declined from 0.72 (±0.14) per 10 000 patient-years in 1998 to 0.39 (±0.06) in 2007, with this decline significant only in men, then incidence rose to 0.57 (±0.11) in 2017. By contrast, prevalence increased between 1998 and 2017 (from 0.13%±0.006 to 0.18%±0.006), rising steeply among women (from 0.06%±0.05 to 0.10%±0.06) and patients aged ≥60 (from 0.14%±0.01 to 0.26%±0.01). The overall median time from first symptom to rheumatology referral was 4.87 years (IQR=1.42–10.23). The median time from first symptom to diagnosis rose between 1998 and 2017 (from 3.62 years (IQR=1.14–7.07) to 8.31 (IQR=3.77–15.89)) and was longer in women (6.71 (IQR=2.30–12.36)) than men (5.65 (IQR=1.66–11.20)). Conclusion AS incidence declined significantly between 1998 and 2007, with an increase between 2007 and 2017 that may be explained by an improvement in the recognition of AS or confidence in diagnosing AS over time, stemming from increased awareness of inflammatory back pain and the importance of early treatment. The rising AS prevalence may indicate improved patient survival. The persisting delay in rheumatology referral and diagnosis remains of concern, particularly in women.
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Affiliation(s)
- Samantha S R Crossfield
- Leeds Institute for Data Analytics, University of Leeds, Leeds, UK .,Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
| | - Helena Marzo-Ortega
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK.,NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Sarah R Kingsbury
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK.,NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | | | - Philip G Conaghan
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK.,NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK
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8
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Maguire S, Wilson F, Gallagher P, O'Shea F. The toll of unemployment in axial spondyloarthropathy: high prevalence and negative impact on outcomes captured in a national registry. Scand J Rheumatol 2021; 51:300-303. [PMID: 34788188 DOI: 10.1080/03009742.2021.1992861] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE Axial spondyloarthropathy (axSpA) is an inflammatory arthritis of the axial skeleton. Persistent disease activity can result in significant disability and affect the ability to maintain employment. This study aimed to determine the prevalence of unemployment in axSpA and the impact on patient outcomes. METHOD Data from the Ankylosing Spondylitis Registry of Ireland (ASRI) were cleaned, and information on employment, demographics, and disease characteristics was extracted. Patients were analysed on the basis of employment and categorized as employed or unemployed. RESULTS Of the 759 participants included in the analysis, 23.5% (178) were unemployed, higher than national averages of 6.2-13.1% during the study period. Unemployed participants reported significantly worse Bath Ankylosing Spondylitis Disease Activity Index (BASDAI; 5.1 vs 3.6), Metrology Index (BASMI; 4.8 vs 3.4), Functional Index (BASFI; 5.2 vs 3.0), Health Assessment Questionnaire (HAQ; 0.82 vs 0.40), and Ankylosing Spondylitis Quality of Life (ASQoL; 9.4 vs 5.4) scores compared to employed (all p < 0.01). Male gender (odds ratio, 95% confidence interval: 2.65, 1.46-4.83), worse BASMI (1.16, 1.02-1.33), and worse HAQ scores (2.18, 1.13-4.19) were significantly associated with unemployment. CONCLUSION The prevalence of unemployment in axSpA patients is higher than in the general population, and is associated with worse quality of life, poorer levels of function, and higher levels of disease activity. Predictors of unemployment in axSpA were male gender, worse spinal mobility, and poorer level of function. Recognition of patients at risk of unemployment will improve opportunities for intervention and maintain participation in the workforce.
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Affiliation(s)
- S Maguire
- Department of Rheumatology, St James' Hospital, Dublin, Ireland.,School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - F Wilson
- Discipline of Physiotherapy, Trinity College Dublin, Dublin, Ireland
| | - P Gallagher
- Department of Rheumatology, St Vincent's University Hospital, Dublin, Ireland
| | - F O'Shea
- Department of Rheumatology, St James' Hospital, Dublin, Ireland.,School of Medicine, Trinity College Dublin, Dublin, Ireland
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9
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Deodhar A, Mease P, Marzo-Ortega H, Hunter T, Sandoval D, Kronbergs A, Lauzon S, Leung A, Navarro-Compán V. Ixekizumab improves sleep and work productivity in patients with non-radiographic axial spondyloarthritis: results from the COAST-X trial at 52 weeks. BMC Rheumatol 2021; 5:50. [PMID: 34560906 PMCID: PMC8464085 DOI: 10.1186/s41927-021-00218-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Accepted: 06/25/2021] [Indexed: 01/16/2023] Open
Abstract
Background Patients with non-radiographic axial spondyloarthritis experience negative impacts on sleep, work productivity, and activity impairment. Ixekizumab, a monoclonal antibody selectively targeting interleukin-17A, has shown efficacy in treating the signs and symptoms of non-radiographic axial spondyloarthritis. This analysis evaluated the effect of ixekizumab treatment on sleep, work productivity, and activity impairment in patients with non-radiographic axial spondyloarthritis. Methods COAST-X (NCT02757352) was a 52-week, phase 3, multicenter, randomised placebo-controlled trial evaluating 80-mg ixekizumab every 2 weeks and every 4 weeks in patients with active non-radiographic axial spondyloarthritis. Sleep disturbance was measured with the Jenkins Sleep Evaluation Questionnaire (JSEQ) and analysed using mixed-effects models for repeated measures. Work productivity and activity impairment were measured using the Work Productivity and Activity Impairment Questionnaire for Spondyloarthritis and analysed using analysis of covariance. Absenteeism, presenteeism, and overall work impairment were assessed for patients reporting paid work; activity impairment was assessed regardless of work status. Results Overall, patients treated with both dosing regimens of ixekizumab reported numerically greater improvements in sleep than placebo through Week 52. At Weeks 16 and 52, patients treated with ixekizumab every 4 weeks had significantly greater improvements in presenteeism (p = 0.007 and p = 0.003, respectively) and overall work impairment (p = 0.014 and p = 0.005, respectively) and numeric improvements in absenteeism than placebo. Patients treated with ixekizumab every 2 weeks had numerically greater improvements in absenteeism, presenteeism, and overall work impairment than placebo. Both dosing regimens of ixekizumab were associated with significantly greater improvements in activity impairment than placebo (ixekizumab every 4 weeks: p = 0.003 at Week 16 and p = 0.004 at Week 52; ixekizumab every 2 weeks: p = 0.007 at Week 16 and p = 0.006 at Week 52). Conclusions Treatment with ixekizumab improved sleep, work productivity, and activity impairment in patients with nr-axSpA. Improvements in presenteeism and overall work impairment were sustained and consistent in the patients treated with ixekizumab every 4 weeks from Week 16 to Week 52. Improvements in activity impairment were sustained and consistent in both ixekizumab-treated groups from Week 16 to Week 52. Trial registration NCT02757352, May 2, 2016.
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Affiliation(s)
- Atul Deodhar
- Division of Arthritis and Rheumatic Diseases, Oregon Health & Science University, 3181 Sam Jackson Park Rd, Portland, OR, 97239, USA.
| | - Philip Mease
- Swedish Medical Center/Providence St. Joseph Health and University of Washington, Seattle, WA, USA
| | - Helena Marzo-Ortega
- NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals Trust and LIRMM, University of Leeds, West Yorkshire, Leeds, UK
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10
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Steen E, McCrum C, Cairns M. Physiotherapists' awareness, knowledge and confidence in screening and referral of suspected axial spondyloarthritis: A survey of UK clinical practice. Musculoskeletal Care 2021; 19:306-318. [PMID: 33547709 DOI: 10.1002/msc.1537] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 01/06/2021] [Accepted: 01/07/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND Axial spondyloarthritis (axSpA) is an inflammatory disease associated with significant diagnostic delays and is commonly missed in assessments of persistent back pain. OBJECTIVE To explore musculoskeletal physiotherapists' awareness, knowledge and confidence in screening for signs, symptoms and risk factors of suspected axSpA and criteria for rheumatology referral. DESIGN An online UK survey was undertaken combining back pain vignettes (reflecting axSpA, non-specific back pain and radicular syndrome) and questioning on features of suspected axSpA. Recruitment utilised online professional forums and social media. Data analysis included descriptive statistics and conceptual content analysis for free text responses. RESULTS 132 survey responses were analysed. Only 67% (88/132) of respondents identified inflammatory pathologies as a possible cause of persistent back pain. Only 60% (79/132) recognised the axSpA vignette compared to non-specific low back pain (94%) and radicular syndrome (80%). Most suspecting axSpA would refer for specialist assessment (77/79; 92%). Awareness of national referral guidance was evident in only 50% of 'clinical reasoning' and 20% of 'further subjective screening' responses. There was misplaced confidence in recognising clinical features of axSpA (≥7/10) compared to knowledge levels shown, including high importance given to inflammatory markers and human leucocyte antigen B27 (median = 8/10). CONCLUSIONS Musculoskeletal physiotherapists may not be giving adequate consideration to axSpA in back pain assessments. Awareness of national referral guidance was also limited. Professional education on screening and referral for suspected axSpA is needed to make axSpA screening and referral criteria core knowledge in musculoskeletal clinical practice, supporting earlier diagnosis and better outcomes.
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Affiliation(s)
- Eliza Steen
- Physiotherapy Department, Kings College Hospital NHS Foundation Trust, London, UK
- Department of Allied Health Professions and Midwifery School of Health and Social Work, University of Hertfordshire, Hatfield, UK
| | - Carol McCrum
- Physiotherapy Department, East Sussex Healthcare NHS Trust, Eastbourne, UK
- Clinical Research Centre for Health Professions, University of Brighton, Eastbourne, UK
| | - Melinda Cairns
- Department of Allied Health Professions and Midwifery School of Health and Social Work, University of Hertfordshire, Hatfield, UK
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11
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Harrison SR, Marzo-Ortega H. Ixekizumab: an IL-17A inhibitor for the treatment of axial Spondylarthritis. Expert Rev Clin Immunol 2021; 17:1059-1071. [PMID: 34407705 DOI: 10.1080/1744666x.2021.1970534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Axial spondyloarthritis (axSpA) is an inflammatory arthritis which affects primarily the entheses of the spine and sacroiliac joints with peripheral joint synovitis and extra-articular manifestations. In 2017, the first IL-17A inhibitor (IL-17Ai) secukinumab was approved for the treatment of radiographic axSpA not responding adequately to conventional therapies, and this was followed in 2019 by a second IL-17Ai, ixekizumab. These agents represent the first alternative class of biological treatments after the TNF inhibitor which dominated the therapeutic landscape of axSpA for over a decade. AREAS COVERED This review discusses the role of IL-17Ais in the treatment in axSpA focusing on the newest IL-17Ai ixekizumab. It provides a detailed overview of the drug pharmacodynamic, pharmacokinetics, and clinical trial data, including areas of future research needed in the post-marketing era. EXPERT OPINION Early trials of ixekizumab for axSpA have shown encouraging results and an acceptable safety profile. Future phase IV trials should focus on direct head-to-head comparisons between ixekizumab and other biologic drugs, and stratify patients according to important disease characteristics known to affect treatment response including sex, HLA-B27 status, presence of MRI bone marrow edema at baseline, disease duration and any extra-articular manifestations.
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Affiliation(s)
- Stephanie R Harrison
- NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals Trust, Leeds, UK.,Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
| | - Helena Marzo-Ortega
- NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals Trust, Leeds, UK.,Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
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12
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Lau IS, Gun SC, Yeap SS, Mohd Zain M, Mohd Yusoof H, Sargunan S, Yahya F. Algorithm for the referral of patients with inflammatory back pain from primary care in Malaysia. MALAYSIAN FAMILY PHYSICIAN : THE OFFICIAL JOURNAL OF THE ACADEMY OF FAMILY PHYSICIANS OF MALAYSIA 2021; 16:2-6. [PMID: 34386157 PMCID: PMC8346753 DOI: 10.51866/rv1206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Chronic low back pain, defined as back pain lasting for more than three months, can be divided into mechanical or inflammatory back pain (IBP). IBP typically starts in patients below the age of 40, is improved with activity and worsens with rest. IBP is strongly associated with axial spondyloarthritis. Early recognition of IBP among primary care physicians is essential for timely diagnosis and intervention to ensure the best outcomes for patients with axial spondyloarthritis. This paper describes the Malaysian Society of Rheumatology's recently developed Inflammatory Back Pain Referral Algorithm for primary care physicians, which aims to facilitate the early identification and referral of IBP patients to rheumatologists.
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Affiliation(s)
| | | | | | | | | | | | - Fariz Yahya
- University Malaya Medical Centre, Kuala Lumpur, Malaysia
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13
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Wang M, Fu W, Meng L, Liu J, Wu L, Peng Y, Li Z. SWE and SMI ultrasound techniques for monitoring needling treatment of ankylosing spondylitis: study protocol for a single-blinded randomized controlled trial. Trials 2021; 22:385. [PMID: 34099023 PMCID: PMC8182945 DOI: 10.1186/s13063-021-05344-z] [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: 01/13/2021] [Accepted: 05/29/2021] [Indexed: 12/05/2022] Open
Abstract
Background Ankylosing spondylitis (AS) is a high-incidence disease in young men that interferes with patients’ physical and mental wellbeing and overall quality of life (QoL). It is often accompanied by arthralgia, stiffness, and limited lumbar flexibility. Acupuncture is safe and effective for reducing the symptoms of AS, but the underlying mechanisms by which it does so are not fully understood. Therefore, to objectively assess acupuncture efficacy, which is critical for patients making informed decisions about appropriate treatments, we will use shear-wave elastography (SWE) and superb microvascular imaging (SMI) ultrasound techniques to evaluate elasticity of lumbar paraspinal muscles and blood flow to the sacroiliac joint (SIJ) in AS. Methods We will recruit a total of 60 participants diagnosed with AS and 30 healthy subjects. Participants will be randomly allocated 1:1 to either an acupuncture group or a sham control acupuncture group. Primary-outcome measures will be musculoskeletal ultrasound, Ankylosing Spondylitis Quality of Life Scale (ASQoL), Bath Ankylosing Spondylitis Metrology Index (BASMI), and the Visual Analogue Scale (VAS) for pain. Secondary outcome measures will be the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Bath Ankylosing Spondylitis Function Index (BASFI), and Fatigue Scale-14 (FS-14). We will monitor the effect of acupuncture or sham acupuncture on blood flow and SIJ inflammation using SMI, lumbar-muscle stiffness using SWE and the lumbar paraspinal-muscle cross-sectional area (CSA) using a two-dimensional (2D) grayscale imaging. QoL, physical function, and fatigue will be assessed using an evaluation scale or questionnaire developed for this study, with outcomes measured by the ASQoL, BASMI, BASDAI, BASFI, and FS-14. Healthy subjects will not receive acupuncture but undergo only musculoskeletal ultrasound at baseline. Acupuncture and sham control acupuncture interventions will be conducted for 30 min, 2–3 times/week for 12 weeks. Musculoskeletal ultrasound will be conducted at baseline and post-intervention, while other outcomes will be measured at baseline, 6 weeks, and post-intervention. The statistician, outcome assessor, and participants will be blinded to treatment allocation. Discussion The results of this single-blinded, randomized trial with sham controls could help demonstrate the efficacy of acupuncture and clarify whether musculoskeletal ultrasound could be used to evaluate AS. Trial registration ClinicalTrials.gov ChiCTR2000031476. Registered 3 April 2020.
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Affiliation(s)
- Mengyu Wang
- The Second Clinical College of Guangzhou University of Chinese Medicine, 111 Dade Rd, Guangzhou, 510120, Guangdong Province, China
| | - Wen Fu
- The First Affiliated Hospital of Henan University of Chinese Medicine, 19 Renmin Rd, Zhengzhou, 450004, Henan Province, China
| | - Lingcui Meng
- The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, 111 Dade Rd, Guangzhou, 510120, Guangdong Province, China
| | - Jia Liu
- The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, 111 Dade Rd, Guangzhou, 510120, Guangdong Province, China
| | - Lihua Wu
- Shenzhen Bao'an Traditional Chinese Medicine Hospital, Guangzhou University of Chinese Medicine, 25 Yu'an 2nd Rd, Shenzhen, 518000, Guangdong Province, China
| | - Yingjun Peng
- The Second Clinical College of Guangzhou University of Chinese Medicine, 111 Dade Rd, Guangzhou, 510120, Guangdong Province, China
| | - Ziping Li
- The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, 111 Dade Rd, Guangzhou, 510120, Guangdong Province, China.
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14
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Gender differences in factors associated with low quality of life and depression in Korean patients with ankylosing spondylitis. Qual Life Res 2021; 30:2299-2310. [PMID: 33689133 DOI: 10.1007/s11136-021-02800-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/13/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE To identify predictors of low health-related quality of life (HRQoL) and depression in ankylosing spondylitis (AS) patients with a focus on gender differences. METHODS We conducted a cross-sectional cohort study. Both AS-related clinical data and contextual factors were obtained. HRQoL and depressive mood were assessed by EuroQol-5 dimension (EQ-5D) and the Center for Epidemiological Studies Depression Scale (CES-D), respectively. Gender-stratified multivariable logistic regression analyses were performed. RESULTS Among 211 patients, 161 were males. Males had similar disease activity and higher radiographic damage compared with females. There was no significant difference in EQ-5D index score between genders. CES-D score was higher in females. Higher ASDAS-C-reactive protein (CRP) was associated with low HRQoL in both males (Odds ratio [OR] 4.25, 95% confidence interval [CI] 2.42-7.46) and females (OR 2.94, 95% CI 1.02-8.48). Being employed was associated with decreased possibility of having low HRQoL in males (OR 0.39, 95% CI 0.16-0.95). Regarding depression, higher ASDAS-CRP (OR 1.87, 95% CI 1.03-3.40), current smoking (OR 2.98, 95% CI 1.09-8.15), and being employed (OR 0.17, 95% CI 0.06-0.46) were associated with depression in males. For females, living with a partner was related to depression (OR 0.08, 95% CI 0.01-0.93). CONCLUSION AS patients with high disease activity are likely to be suffering from low HRQoL. Both disease-related factors and contextual factors were associated with depression, and predictors showed some differences between genders. Awareness of gender differences in comprehensive assessment can lead us to better personalized management in AS patients.
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15
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Zhao SS, Pittam B, Harrison NL, Ahmed AE, Goodson NJ, Hughes DM. Diagnostic delay in axial spondyloarthritis: a systematic review and meta-analysis. Rheumatology (Oxford) 2021; 60:1620-1628. [DOI: 10.1093/rheumatology/keaa807] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 10/09/2020] [Accepted: 11/03/2020] [Indexed: 01/20/2023] Open
Abstract
Abstract
Background
Delay to diagnosis in axial SpA (axSpA) is longer than in many other rheumatic diseases. Prolonged delay is associate with poorer outcomes, including functional impairment and quality of life. Our aims were to describe global variation in delay to diagnosis, factors associated with delay, and delay compared with PsA.
Methods
We searched MEDLINE, PubMed, Embase and Web of Science using a predefined protocol. Diagnostic delay was defined as years between the age at symptom onset and at diagnosis. We pooled the mean delay using random effects inverse variance meta-analysis. We examined variations in pooled estimates using prespecified subgroup analyses and sources of heterogeneity using meta-regression.
Results
A total of 64 studies reported the mean diagnostic delay in axSpA patients. The pooled mean delay was 6.7 years (95% CI 6.2, 7.2) with high levels of heterogeneity. Delay to diagnosis did not improve over time when stratifying results by year of publication. Studies from high-income countries (defined by the World Bank) reported longer delays than those from middle-income countries. Factors consistently reported to be associated with longer delays were lower education levels, younger age at symptom onset and absence of extra-articular manifestations (EAMs). The pooled estimate for diagnostic delay from 8 PsA studies was significantly shorter, at 2.6 years (95% CI 1.6, 3.6).
Conclusion
For axSpA patients, delay to diagnosis remains unacceptably prolonged in many parts of the world. Patient factors (e.g. education) and disease presentation (onset age and EAMs) should inform campaigns to improve delay.
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Affiliation(s)
- Sizheng Steven Zhao
- Institute of Life Course and Medical Sciences, University of Liverpool, , Liverpool, UK
- Department of Rheumatology, Liverpool University Hospitals, , Liverpool, UK
| | - Bradley Pittam
- School of Medicine, University of Liverpool, Liverpool, UK
| | | | - Ashar E Ahmed
- Department of Rheumatology, Southport & Ormskirk Hospital, Southport, UK
| | - Nicola J Goodson
- Department of Rheumatology, Liverpool University Hospitals, , Liverpool, UK
| | - David M Hughes
- Department of Biostatistics, Institute of Translational Medicine, University of Liverpool, Liverpool, UK
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Song Y, Chen H. Predictors of Health-Related Quality of Life in Patients with Ankylosing Spondylitis in Southwest China. Patient Prefer Adherence 2021; 15:1887-1894. [PMID: 34483655 PMCID: PMC8409598 DOI: 10.2147/ppa.s324097] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Accepted: 08/22/2021] [Indexed: 02/05/2023] Open
Abstract
PURPOSE The purpose of this study was to evaluate health-related quality of life (QoL) and explore its predictors in patients with ankylosing spondylitis (AS) in Southwest China. PATIENTS AND METHODS We recruited AS patients from a tertiary hospital in Chengdu, China. Data were collected by self-reported questionnaires, including sociodemographic and disease-related variables, the Medical Outcomes Study 36-Item Short Form (SF-36), Beck Depression Inventory-Second Edition (BDI-II), Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Bath Ankylosing Spondylitis Functional Index (BASFI), and Bath Ankylosing Spondylitis Global score (BAS-G). Stepwise multiple linear regression analysis was used to determine the factors affecting physical component summary (PCS) and mental component summary (MCS) of SF-36. RESULTS A total of 125 patients with AS were included in the current study. The PCS, MCS scores of SF-36 were 41.06±9.12, 47.82±9.84, respectively. Stepwise multiple linear regression analysis showed that higher educational level (β=0.237, P<0.001) and income (β=0.141, P=0.017), lower BASDAI (β=-0.195, P=0.006), BASFI (β=-0.317, P<0.001) and BAS-G (β=-0.288, P<0.001) scores were associated with higher PCS scores of SF-36. Higher BDI-II (β=-0.444, P<0.001) and fatigue (β=-0.293, P<0.001) scores were associated with worse MCS scores of SF-36. CONCLUSION AS patients in Southwest China had impaired health-related QoL. Healthcare providers should take effective strategies to modify the factors affecting health-related QoL, which may prompt disease management and increase QoL.
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Affiliation(s)
- Yuqing Song
- West China School of Nursing/West China Hospital, Sichuan University, Chengdu, Sichuan, 610041, People’s Republic of China
| | - Hong Chen
- West China School of Nursing/West China Hospital, Sichuan University, Chengdu, Sichuan, 610041, People’s Republic of China
- Correspondence: Hong Chen West China School of Nursing/West China Hospital Sichuan University, No. 37, Guoxuexiang, Wuhou District, Chengdu, Sichuan, 610041, People’s Republic of ChinaTel +86 28 8542 2684 Email
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Tu L, Xie Y, Liao Z, Jiang Y, Lv Q, Cao S, Wei Q, Gu J. Cost of Illness, Quality of Life, and Work Outcomes in Active Ankylosing Spondylitis Patients Treated With Adalimumab in China. Front Public Health 2020; 8:602334. [PMID: 33330342 PMCID: PMC7732412 DOI: 10.3389/fpubh.2020.602334] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Accepted: 10/26/2020] [Indexed: 01/31/2023] Open
Abstract
Objectives: To access the cost of illness, quality of life and work limitation in active ankylosing spondylitis (AS) patients using adalimumab in China. Methods: A prospective study was performed in 91 patients with active AS in China. Adult patients (aged ≥ 18 years) fulfilled the 1984 New York modified criteria of AS with the Bath Ankylosing Spondylitis Disease Activity Index ≥ 4 were enrolled. All participants received adalimumab (40 mg per 2 weeks) therapy and completed questionnaires about disease characteristics, quality of life and cost. Only patients with pay-work completed the Work Limitation Questionnaire and Work productivity and activity impairment questionnaire in AS. Factors associated with work outcomes were evaluated. Results: A total of 91 patients with mean age of 30 years old (87.8% males) and mean disease duration of 10 years received adalimumab treatment for 24 weeks. The annual estimated cost of each patient was $37581.41 while the direct cost accounted for 84.6%. Seventy-eight percent of patients have a paid job with average work productivity loss of 0.28 measured by work limitation questionnaire, absenteeism and presenteeism were 10.22 and 43.86%, respectively, with a mean work productivity loss of 47.92% measured by Work productivity and activity impairment questionnaire in AS. Patients experienced significantly greater improvements after adalimumab treatment in presenteeism, absenteeism, work productivity, and quality of life. Conclusions: The cost of AS patients with adalimumab therapy was high in China. Disease activity, physical function, quality of life, and work outcomes improved significantly after therapy.
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Affiliation(s)
- Liudan Tu
- Department of Rheumatology, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Ya Xie
- Department of Rheumatology, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Zetao Liao
- Department of Rheumatology, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Yutong Jiang
- Department of Rheumatology, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Qing Lv
- Department of Rheumatology, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Shuangyan Cao
- Department of Rheumatology, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Qiujing Wei
- Department of Rheumatology, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Jieruo Gu
- Department of Rheumatology, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
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Marzo-Ortega H, Mease PJ, Rahman P, Navarro-Compán V, Strand V, Dougados M, Combe B, Wei JCC, Baraliakos X, Hunter T, Sandoval D, Li X, Zhu B, Bessette L, Deodhar A. Impact of Ixekizumab on Work Productivity in Patients with Ankylosing Spondylitis: Results from the COAST-V and COAST-W Trials at 52 Weeks. Rheumatol Ther 2020; 7:759-774. [PMID: 32814997 PMCID: PMC7695773 DOI: 10.1007/s40744-020-00225-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION Patients with ankylosing spondylitis (AS) are burdened with symptoms impacting work productivity measured by presenteeism, absenteeism, overall work impairment, and activity impairment. Ixekizumab, a high-affinity monoclonal antibody selectively targeting interleukin-17A, has been demonstrated to improve disease signs and symptoms in two phase 3 trials of AS. This study investigated for 52 weeks the effect of ixekizumab treatment on work productivity in patients with active AS. METHODS COAST-V (NCT02696785) and COAST-W (NCT02696798) were phase 3, multicenter, randomized, controlled trials investigating the efficacy of ixekizumab 80 mg every 4 weeks (Q4W) and every 2 weeks (Q2W) in patients with AS naïve to biologic disease-modifying antirheumatic drugs (bDMARDs; COAST-V) or who were inadequate responders or intolerant to tumor necrosis factor inhibitors (TNFi; COAST-W). Work productivity was measured with the Work Productivity and Activity Impairment Questionnaire for Spondyloarthritis at weeks 16 and 52. Absenteeism, presenteeism, and overall work impairment were assessed for patients reporting paid work. Activity impairment was assessed regardless of work status. RESULTS At baseline, 66.2% (434/656) of patients reported paid work. At week 16, bDMARD-naïve patients treated with both ixekizumab dose regimens and TNFi-experienced patients treated with ixekizumab Q2W reported significant improvements in activity impairment (p < 0.01 and p < 0.05, respectively). TNFi-experienced patients treated with ixekizumab showed significant improvements versus placebo in presenteeism and overall work impairment (p < 0.05); bDMARD-naïve patients had numeric improvements. After week 16, patients initially on placebo switched to ixekizumab and patients already treated with ixekizumab continued treatment. Improvements in work productivity and daily activity were sustained through week 52 for both bDMARD-experienced and -naïve patients. CONCLUSION Both bDMARD-naïve and TNFi-experienced patients with AS had greater improvements in work productivity and activity impairment when receiving ixekizumab compared to placebo at week 16. Improvements in work productivity and activity impairment achieved at week 16 were sustained through week 52 with ixekizumab treatment.
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Affiliation(s)
- Helena Marzo-Ortega
- National Institute for Health Research-Leeds Biomedical Research Centre (NIHR-LBRC), Leeds Teaching Hospitals Trust and Leeds Institute of Rheumatic and Musculoskeletal Medicine (LIRMM), University of Leeds, Leeds, West Yorkshire, UK.
| | - Philip J Mease
- Swedish Medical Center-Providence St. Joseph Health and University of Washington, Seattle, WA, USA
- University of Washington School of Medicine, Seattle, WA, USA
| | - Proton Rahman
- Memorial University of Newfoundland, St. John's, NL, Canada
| | | | - Vibeke Strand
- Division Immunology/Rheumatology, Stanford University School of Medicine, Palo Alto, CA, USA
| | | | - Bernard Combe
- Department of Rheumatology, CHU Montpellier and Montpellier University, Montpellier, France
| | - James Cheng-Chung Wei
- Graduate Institute of Integrated Medicine, Chung Shan Medical University, China Medical University, Taichung City, Taiwan
| | | | | | | | - Xiaoqi Li
- Eli Lilly and Company, Indianapolis, IN, USA
| | - Baojin Zhu
- Eli Lilly and Company, Indianapolis, IN, USA
| | - Louis Bessette
- Centre hospitalier universitaire de Québec-Laval University, Quebec City, QC, Canada
| | - Atul Deodhar
- Division of Arthritis and Rheumatic Diseases, Oregon Health and Science University, Portland, OR, USA
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19
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Saeed MA, Ahmed H, Faiq M, Aslam Z, Elaine Anwer Khan S, Batool S, Farman S, Ahmad NM. Prevalence of inflammatory back pain and radiographic axial spondyloarthritis in a semi-urban community of Lahore, Pakistan. Int J Rheum Dis 2020; 24:207-215. [PMID: 33244897 DOI: 10.1111/1756-185x.14030] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 11/06/2020] [Accepted: 11/07/2020] [Indexed: 02/06/2023]
Abstract
AIMS To determine the prevalence of inflammatory back pain (IBP) and radiographic axial spondyloarthritis (SpA) in a semi-urban community of Lahore, Pakistan. METHODS This cross-sectional household survey was designed as per the Community Oriented Program for the Control of Rheumatic Diseases (COPCORD) model. In Phase 1, the subjects were interviewed for musculoskeletal (MSK) pain in the last 7 days by clinical assistants. In Phase 2, physiotherapists identified subjects with spinal/back pain and interviewed for Assessment in Spondyloarthritis International Working Group (ASAS) criteria for IBP. In Phase 3 subjects having IBP or chronic back pain (CBP) with an age at onset ≤45 years, were assessed and further investigated. RESULTS A total of 4922 subjects with a mean age of 35.3 ± 14.5 years, including 2770 (56%) women were surveyed in Phase 1. MSK pain in last 7 days was reported by 1407 (28.6%) of whom 1034 (21%) had spinal pain. The ASAS criteria for IBP were met in 329 (6.7%, 95% CI 6.0-7.0). In Phase 3, 222 with IBP and 83 having CBP with age at onset ≤45 years were evaluated. Out of this total of 305, 144 (2.9%) were confirmed to have IBP by rheumatologists as per at least 1 of the 3 criteria. ASAS criteria were met in 107 (2.2%, 95% CI 1.8-2.6). ASAS criteria for radiographic axial SpA were met in 47 (1%, 95% CI 0.7-1.3) of the surveyed population. CONCLUSION Inflammatory back pain was reported in 6.7% by physiotherapists, confirmed in 3% by rheumatologists. The prevalence of radiographic axial SpA was 1%.
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Affiliation(s)
- Muhammad Ahmed Saeed
- Rheumatology, Al-Aleem Medical College, Lahore, Pakistan.,Department of Rheumatology, Gulab Devi Teaching Hospital, Al-Aleem Medical College, Lahore, Pakistan.,Department of Rheumatology, National Hospital and Medical Center, Lahore, Pakistan.,Adjunct Faculty Fatima, Jinnah Medical University, Lahore, Pakistan.,Arthritis Care Foundation, Lahore, Pakistan
| | - Hina Ahmed
- Department of Community Health Sciences, FMH College of Medicine and Dentistry, Lahore, Pakistan
| | - Muhammad Faiq
- Department of Rheumatology, FMH College of Medicine and Dentistry, Lahore, Pakistan
| | - Zeeshan Aslam
- Department of Rheumatology, FMH College of Medicine and Dentistry, Lahore, Pakistan
| | - Saira Elaine Anwer Khan
- Department of Rheumatology, FMH College of Medicine and Dentistry, Lahore, Pakistan.,Arthritis Care Foundation, Lahore, Pakistan
| | - Shabnam Batool
- Department of Rheumatology, FMH College of Medicine and Dentistry, Lahore, Pakistan
| | - Sumaira Farman
- Department of Rheumatology, National Hospital and Medical Center, Lahore, Pakistan.,Adjunct Faculty Fatima, Jinnah Medical University, Lahore, Pakistan.,Arthritis Care Foundation, Lahore, Pakistan
| | - Nighat Mir Ahmad
- Department of Rheumatology, Gulab Devi Teaching Hospital, Al-Aleem Medical College, Lahore, Pakistan.,Department of Rheumatology, National Hospital and Medical Center, Lahore, Pakistan.,Adjunct Faculty Fatima, Jinnah Medical University, Lahore, Pakistan.,Arthritis Care Foundation, Lahore, Pakistan
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20
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Allado E, Moussu A, Bigna JJ, Hamroun S, Camier A, Chenuel B, Hamroun A. Global prevalence of spondyloarthritis in low-income and middle-income countries: a systematic review and meta-analysis protocol. BMJ Open 2020; 10:e041180. [PMID: 33122325 PMCID: PMC7597522 DOI: 10.1136/bmjopen-2020-041180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 08/26/2020] [Accepted: 09/23/2020] [Indexed: 12/03/2022] Open
Abstract
INTRODUCTION In the past decade, the definition of spondyloarthritis (SpA) has undergone major modifications with respect to new diagnostic tools and classifications. With the advent of biotherapies, treatment possibilities in patients with SpA have substantially improved in the last few years. There is great interest in obtaining accurate data on the disease prevalence, especially in regions where data remains scarce such as low-income and middle-income countries (LMICs), in order to measure and understand the needs of their healthcare systems. Therefore, through a global systematic review and meta-analysis, the current study aims to investigate the prevalence of SpA and human leucocyte antigen B27 (HLAB27) and its association with the risk of SpA in the LMIC population. METHODS AND ANALYSIS We will include cohort, case-control and cross-sectional studies performed among adults (>15 years) living in LMICs. EMBASE, Medline, Global Index Medicus and Web of Knowledge will be searched for relevant records published until 30 April 2020, without any language restriction. The review will be reported according to the Meta-analysis Of Observational Studies in Epidemiology (MOOSE) guidelines. After screening of titles and abstracts, study selection, data extraction and risk of bias assessment by two independent reviewers, we shall assess the studies individually for clinical and statistical heterogeneity. Random-effect meta-analysis will be used to pool studies judged to be clinically homogeneous. Egger's test and visual inspection of funnel plots will be used to assess publication bias. Results will be presented by WHO subregions. ETHICS AND DISSEMINATION Since primary data is not collected in this study, ethical approval is not required. This review is expected to provide relevant data on the epidemiology of SpA, HLAB27 and their association in the global population of LMICs. The final report will be published in a peer-reviewed journal. PROSPERO REGISTRATION NUMBER CRD42020163898.
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Affiliation(s)
- Edem Allado
- University Center of Sports Medicine and Adapted Physical Activity, Nancy Regional University Hospital Center, Nancy, France
- EA 3450 DevAH, Development, Adaptation and Disadvantage, Cardiorespiratory Regulations and Motor Control, Lorraine European University Centre, Nancy, France
| | - Anthony Moussu
- University Center of Sports Medicine and Adapted Physical Activity, Nancy Regional University Hospital Center, Nancy, France
| | - Jean Joel Bigna
- Department of Epidemiology and Public Health, Centre Pasteur of Cameroon, Yaoundé, Cameroon
| | - Sabrina Hamroun
- Rheumatology, Paris University, AP-HP, Cochin Hospital, Paris, Île-de-France, France
| | - Aurore Camier
- Center for Research in Epidemiology and StatisticS (CRESS), Université de Paris, INSERM, INRA, Sorbonne université, Paris, Île-de-France, France
| | - Bruno Chenuel
- University Center of Sports Medicine and Adapted Physical Activity, Nancy Regional University Hospital Center, Nancy, France
- EA 3450 DevAH, Development, Adaptation and Disadvantage, Cardiorespiratory Regulations and Motor Control, Lorraine European University Centre, Nancy, France
| | - Aghiles Hamroun
- Center for Research in Epidemiology and Population Health (CESP), Clinical Epidemiology Team, National Institute of Health and Medical Research (INSERM), Villejuif, Île-de-France, France
- Nephrology Dialysis and Kidney Transplantation Department, Lille University Hospital Center, Lille, Hauts-de-France, France
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21
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Ogdie A, Duarte-García A, Hwang M, Navarro-Compán V, van der Heijde D, Mease P. Measuring Outcomes in Axial Spondyloarthritis. Arthritis Care Res (Hoboken) 2020; 72 Suppl 10:47-71. [PMID: 33091248 DOI: 10.1002/acr.24266] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 05/12/2020] [Indexed: 12/22/2022]
Affiliation(s)
- Alexis Ogdie
- Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | | | - Mark Hwang
- University of Texas Health Science Center at Houston
| | | | | | - Philip Mease
- Swedish Medical Center, Providence St. Joseph Health, and University of Washington School of Medicine, Seattle
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22
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Krüger K, Burmester GR, Wassenberg S, Thomas MH. Golimumab improves socio economic and health economic parameters in patients with rheumatoid arthritis, psoriatic arthritis, and ankylosing spondylitis. Curr Med Res Opin 2020; 36:1559-1567. [PMID: 32609555 DOI: 10.1080/03007995.2020.1790347] [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] [Indexed: 10/23/2022]
Abstract
BACKGROUND Golimumab (GLM) has shown its efficacy and safety in various clinical trials. We aimed to assess the effect of GLM on socio economic and health economic parameters in daily clinical practice. SETTING Rheumatology offices in Germany. METHOD Analysis of socio economic and health economic parameters of the non-interventional, multicentre, prospective study GO-NICE. Analyses were performed in an exploratory manner using descriptive statistical methods. Further, p-values on socio economic variables were calculated based on one-sample t-test on the differences between baseline and follow-up visits. RESULTS A total of 1458 patients were evaluable, of whom a total of 664 patients completed the 24-month observation period. The proportions of hospitalizations decreased statistically significantly (p ≤ .05) from 10.4/7.6/14.0% at baseline (BL) to 1.7/2.2/0.8%, and the in-patient rehabilitations decreased from 3.3/3.7/7.5% at BL to 0.6/1.8/2.1% at month 24 in patients with RA, PsA, and AS. When considering a 30-day period, the mean number of sick leave days decreased statistically significantly (p ≤ .005) from 4.0 at BL to 0.9 at month 24 (greatest improvement in RA), and the mean number of days with impaired capability decreased statistically significantly (p ≤ .001) from 14.9 at BL to 4.5 at month 24 (greatest improvement in patients with AS). There was also a reduction in the number of consultations and remedies. CONCLUSION This evaluation shows improvements in socio economic and health economic parameters on GLM treatment.
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Affiliation(s)
- Klaus Krüger
- Praxiszentrum St. Bonifatius München, Munich, Germany
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23
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Goh Y, Kwan YH, Leung YY, Fong W, Cheung PP. A cross‐sectional study on factors associated with poor work outcomes in patients with axial spondyloarthritis in Singapore. Int J Rheum Dis 2019; 22:2001-2008. [DOI: 10.1111/1756-185x.13696] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Revised: 08/12/2019] [Accepted: 08/17/2019] [Indexed: 11/28/2022]
Affiliation(s)
- Yihui Goh
- Department of Rheumatology and Immunology Singapore General Hospital Singapore City Singapore
- Division of Rheumatology National University Hospital Singapore City Singapore
| | - Yu Heng Kwan
- Program in Health Services and Systems Research Duke‐NUS Medical School Singapore City Singapore
| | - Ying Ying Leung
- Department of Rheumatology and Immunology Singapore General Hospital Singapore City Singapore
- Duke‐NUS Medical School Singapore City Singapore
- Department of Medicine Yong Loo Lin School of Medicine National University of Singapore Singapore City Singapore
| | - Warren Fong
- Department of Rheumatology and Immunology Singapore General Hospital Singapore City Singapore
- Duke‐NUS Medical School Singapore City Singapore
- Department of Medicine Yong Loo Lin School of Medicine National University of Singapore Singapore City Singapore
| | - Peter P. Cheung
- Division of Rheumatology National University Hospital Singapore City Singapore
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24
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van der Heijde D, Baraliakos X, Gensler LS, Maksymowych WP, Tseluyko V, Nadashkevich O, Abi-Saab W, Tasset C, Meuleners L, Besuyen R, Hendrikx T, Mozaffarian N, Liu K, Greer JM, Deodhar A, Landewé R. Efficacy and safety of filgotinib, a selective Janus kinase 1 inhibitor, in patients with active ankylosing spondylitis (TORTUGA): results from a randomised, placebo-controlled, phase 2 trial. Lancet 2018; 392:2378-2387. [PMID: 30360970 DOI: 10.1016/s0140-6736(18)32463-2] [Citation(s) in RCA: 183] [Impact Index Per Article: 30.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Revised: 09/24/2018] [Accepted: 09/28/2018] [Indexed: 12/17/2022]
Abstract
BACKGROUND At present, biological disease-modifying anti-rheumatic drugs (DMARDs) are the only treatment recommended for patients with ankylosing spondylitis who have not responded to first-line treatment with non-steroidal anti-inflammatory drugs (NSAIDs). The TORTUGA trial investigated the efficacy and safety of filgotinib, an oral selective Janus kinase 1 (JAK1) inhibitor, for the treatment of patients with active ankylosing spondylitis. METHODS In this completed, randomised, double-blind, placebo-controlled, phase 2 trial, we enrolled adult patients from 30 sites in seven countries (Belgium, Bulgaria, Czech Republic, Estonia, Poland, Spain, and Ukraine). Eligible patients had active ankylosing spondylitis and an inadequate response or intolerance to two or more NSAIDs. Patients were randomly assigned (1:1) with an interactive web-based response system to receive filgotinib 200 mg or placebo orally once daily for 12 weeks. Randomisation was stratified by current use of conventional synthetic DMARDs and previous receipt of anti-tumour necrosis factor therapy. The patients, study team, and study sponsor were masked to treatment assignment. The primary endpoint was the change from baseline in ankylosing spondylitis disease activity score (ASDAS) at week 12, which was assessed in the full analysis set (ie, all randomised patients who received at least one dose of study drug). Safety was assessed according to actual treatment received. This trial is registered with ClinicalTrials.gov, number NCT03117270. FINDINGS Between March 7, 2017, and July 2, 2018, 263 patients were screened and 116 randomly assigned to filgotinib (n=58) or placebo (n=58). 55 (95%) patients in the filgotinib group and 52 (90%) in the placebo group completed the study; three (5%) patients in the filgotinib group and six (10%) in the placebo group discontinued treatment. The mean ASDAS change from baseline to week 12 was -1·47 (SD 1·04) in the filgotinib group and -0·57 (0·82) in the placebo group, with a least squares mean difference between groups of -0·85 (95% CI -1·17 to -0·53; p<0·0001). Treatment-emergent adverse events were reported in 18 patients in each group, the most common being nasopharyngitis (in two patients in the filgotinib group and in four patients in the placebo group). Treatment-emergent adverse events led to permanent treatment discontinuation in two patients (a case of grade 3 pneumonia in the filgotinib group and of high creatine kinase in the placebo group). No deaths were reported during the study. INTERPRETATION Filgotinib is efficacious and safe for the treatment of patients with active ankylosing spondylitis who have not responded to first-line pharmacological therapy with NSAIDs. Further investigation of filgotinib for ankylosing spondylitis is warranted. FUNDING Galapagos and Gilead Sciences.
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Affiliation(s)
| | | | - Lianne S Gensler
- Division of Rheumatology, University of California, San Francisco, CA, USA
| | | | - Vira Tseluyko
- Department of Rheumatology, Kharkiv Medical Academy of Postgraduate Education, Kharkiv, Ukraine
| | | | | | | | | | | | | | | | - Ke Liu
- Gilead Sciences, Foster City, CA, USA
| | | | - Atul Deodhar
- Division of Arthritis and Rheumatic Diseases, Oregon Health & Science University, Portland, OR, USA
| | - Robert Landewé
- Department of Rheumatology & Clinical Immunology, Amsterdam University Medical Center, Amsterdam, Netherlands; Department of Rheumatology, Zuyderland Hospital, Heerlen, Netherlands
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25
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Macfarlane GJ, Shim J, Jones GT, Walker-Bone K, Pathan E, Dean LE. Identifying Persons with Axial Spondyloarthritis At Risk of Poor Work Outcome: Results from the British Society for Rheumatology Biologics Register. J Rheumatol 2018; 46:145-152. [PMID: 30385702 DOI: 10.3899/jrheum.180477] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/08/2018] [Indexed: 11/22/2022]
Abstract
OBJECTIVE First, to test the hypothesis that, among working patients with axial spondyloarthritis (axSpA), those who report issues with reduced productivity at work (presenteeism) are at higher risk of work absence (absenteeism), and patients who report absenteeism are at higher risk of subsequently leaving the workforce. Second, to identify characteristics of workers at high risk of poor work outcome. METHODS The British Society for Rheumatology Biologics Register in Ankylosing Spondylitis has recruited patients meeting Assessment of Spondyloarthritis international Society criteria for axSpA from 83 centers. Data collection involved clinical and patient-reported measures at recruitment and annually thereafter, including the Work Productivity and Activity Impairment scale. Generalized estimating equations were used to identify factors associated with poor work outcomes. RESULTS Of the 1188 participants in this analysis who were working at recruitment, 79% reported some presenteeism and 19% some absenteeism in the past week owing to their axSpA. Leaving employment was most strongly associated with previous absenteeism (RR 1.02 per % increase in absenteeism, 95% CI 1.01-1.03), which itself was most strongly associated with previous presenteeism, a labor-intensive job, and peripheral joint involvement. High disease activity, fatigue, a labor-intensive job, and poorer physical function were all independently associated with future presenteeism. CONCLUSION Clinical and patient-reported factors along with aspects of work are associated with an increased risk of axSpA patients having a poor outcome in relation to work. This study has identified modifiable factors as targets, facilitating patients with axSpA to remain productive at work.
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Affiliation(s)
- Gary J Macfarlane
- From the Epidemiology Group, School of Medicine, Medical Sciences and Nutrition, and the Aberdeen Centre for Arthritis and Musculoskeletal Health, and the Medical Research Council (MRC)/Arthritis Research UK Centre for Musculoskeletal Health and Work, University of Aberdeen, Aberdeen, UK; MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK; Spondylitis Program, Department of Rheumatology, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada. .,G.J. Macfarlane, MD, Dean of Research and Knowledge Exchange (Life Sciences and Medicine) and Chair in Epidemiology, Epidemiology Group, School of Medicine, Medical Sciences and Nutrition, and Aberdeen Centre for Arthritis and Musculoskeletal Health, and MRC/Arthritis Research UK Centre for Musculoskeletal Health and Work, University of Aberdeen; J. Shim, PhD, Research Fellow (Epidemiology), Epidemiology Group, School of Medicine, Medical Sciences and Nutrition, and Aberdeen Centre for Arthritis and Musculoskeletal Health, and MRC/Arthritis Research UK Centre for Musculoskeletal Health and Work, University of Aberdeen; G.T. Jones, PhD, Reader of Epidemiology, Epidemiology Group, School of Medicine, Medical Sciences and Nutrition, and Aberdeen Centre for Arthritis and Musculoskeletal Health, and MRC/Arthritis Research UK Centre for Musculoskeletal Health and Work, University of Aberdeen; K. Walker-Bone, PhD, Professor of Occupational Rheumatology, MRC/Arthritis Research UK Centre for Musculoskeletal Health and Work, and MRC Lifecourse Epidemiology Unit, University of Southampton; E. Pathan, PhD, Research Fellow (Rheumatology), Spondylitis Program, Department of Rheumatology, Toronto Western Hospital, University Health Network; L.E. Dean, PhD, Research Assistant, Epidemiology Group, School of Medicine, Medical Sciences and Nutrition, and Aberdeen Centre for Arthritis and Musculoskeletal Health, and MRC/Arthritis Research UK Centre for Musculoskeletal Health and Work, University of Aberdeen.
| | - Joanna Shim
- From the Epidemiology Group, School of Medicine, Medical Sciences and Nutrition, and the Aberdeen Centre for Arthritis and Musculoskeletal Health, and the Medical Research Council (MRC)/Arthritis Research UK Centre for Musculoskeletal Health and Work, University of Aberdeen, Aberdeen, UK; MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK; Spondylitis Program, Department of Rheumatology, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada.,G.J. Macfarlane, MD, Dean of Research and Knowledge Exchange (Life Sciences and Medicine) and Chair in Epidemiology, Epidemiology Group, School of Medicine, Medical Sciences and Nutrition, and Aberdeen Centre for Arthritis and Musculoskeletal Health, and MRC/Arthritis Research UK Centre for Musculoskeletal Health and Work, University of Aberdeen; J. Shim, PhD, Research Fellow (Epidemiology), Epidemiology Group, School of Medicine, Medical Sciences and Nutrition, and Aberdeen Centre for Arthritis and Musculoskeletal Health, and MRC/Arthritis Research UK Centre for Musculoskeletal Health and Work, University of Aberdeen; G.T. Jones, PhD, Reader of Epidemiology, Epidemiology Group, School of Medicine, Medical Sciences and Nutrition, and Aberdeen Centre for Arthritis and Musculoskeletal Health, and MRC/Arthritis Research UK Centre for Musculoskeletal Health and Work, University of Aberdeen; K. Walker-Bone, PhD, Professor of Occupational Rheumatology, MRC/Arthritis Research UK Centre for Musculoskeletal Health and Work, and MRC Lifecourse Epidemiology Unit, University of Southampton; E. Pathan, PhD, Research Fellow (Rheumatology), Spondylitis Program, Department of Rheumatology, Toronto Western Hospital, University Health Network; L.E. Dean, PhD, Research Assistant, Epidemiology Group, School of Medicine, Medical Sciences and Nutrition, and Aberdeen Centre for Arthritis and Musculoskeletal Health, and MRC/Arthritis Research UK Centre for Musculoskeletal Health and Work, University of Aberdeen
| | - Gareth T Jones
- From the Epidemiology Group, School of Medicine, Medical Sciences and Nutrition, and the Aberdeen Centre for Arthritis and Musculoskeletal Health, and the Medical Research Council (MRC)/Arthritis Research UK Centre for Musculoskeletal Health and Work, University of Aberdeen, Aberdeen, UK; MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK; Spondylitis Program, Department of Rheumatology, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada.,G.J. Macfarlane, MD, Dean of Research and Knowledge Exchange (Life Sciences and Medicine) and Chair in Epidemiology, Epidemiology Group, School of Medicine, Medical Sciences and Nutrition, and Aberdeen Centre for Arthritis and Musculoskeletal Health, and MRC/Arthritis Research UK Centre for Musculoskeletal Health and Work, University of Aberdeen; J. Shim, PhD, Research Fellow (Epidemiology), Epidemiology Group, School of Medicine, Medical Sciences and Nutrition, and Aberdeen Centre for Arthritis and Musculoskeletal Health, and MRC/Arthritis Research UK Centre for Musculoskeletal Health and Work, University of Aberdeen; G.T. Jones, PhD, Reader of Epidemiology, Epidemiology Group, School of Medicine, Medical Sciences and Nutrition, and Aberdeen Centre for Arthritis and Musculoskeletal Health, and MRC/Arthritis Research UK Centre for Musculoskeletal Health and Work, University of Aberdeen; K. Walker-Bone, PhD, Professor of Occupational Rheumatology, MRC/Arthritis Research UK Centre for Musculoskeletal Health and Work, and MRC Lifecourse Epidemiology Unit, University of Southampton; E. Pathan, PhD, Research Fellow (Rheumatology), Spondylitis Program, Department of Rheumatology, Toronto Western Hospital, University Health Network; L.E. Dean, PhD, Research Assistant, Epidemiology Group, School of Medicine, Medical Sciences and Nutrition, and Aberdeen Centre for Arthritis and Musculoskeletal Health, and MRC/Arthritis Research UK Centre for Musculoskeletal Health and Work, University of Aberdeen
| | - Karen Walker-Bone
- From the Epidemiology Group, School of Medicine, Medical Sciences and Nutrition, and the Aberdeen Centre for Arthritis and Musculoskeletal Health, and the Medical Research Council (MRC)/Arthritis Research UK Centre for Musculoskeletal Health and Work, University of Aberdeen, Aberdeen, UK; MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK; Spondylitis Program, Department of Rheumatology, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada.,G.J. Macfarlane, MD, Dean of Research and Knowledge Exchange (Life Sciences and Medicine) and Chair in Epidemiology, Epidemiology Group, School of Medicine, Medical Sciences and Nutrition, and Aberdeen Centre for Arthritis and Musculoskeletal Health, and MRC/Arthritis Research UK Centre for Musculoskeletal Health and Work, University of Aberdeen; J. Shim, PhD, Research Fellow (Epidemiology), Epidemiology Group, School of Medicine, Medical Sciences and Nutrition, and Aberdeen Centre for Arthritis and Musculoskeletal Health, and MRC/Arthritis Research UK Centre for Musculoskeletal Health and Work, University of Aberdeen; G.T. Jones, PhD, Reader of Epidemiology, Epidemiology Group, School of Medicine, Medical Sciences and Nutrition, and Aberdeen Centre for Arthritis and Musculoskeletal Health, and MRC/Arthritis Research UK Centre for Musculoskeletal Health and Work, University of Aberdeen; K. Walker-Bone, PhD, Professor of Occupational Rheumatology, MRC/Arthritis Research UK Centre for Musculoskeletal Health and Work, and MRC Lifecourse Epidemiology Unit, University of Southampton; E. Pathan, PhD, Research Fellow (Rheumatology), Spondylitis Program, Department of Rheumatology, Toronto Western Hospital, University Health Network; L.E. Dean, PhD, Research Assistant, Epidemiology Group, School of Medicine, Medical Sciences and Nutrition, and Aberdeen Centre for Arthritis and Musculoskeletal Health, and MRC/Arthritis Research UK Centre for Musculoskeletal Health and Work, University of Aberdeen
| | - Ejaz Pathan
- From the Epidemiology Group, School of Medicine, Medical Sciences and Nutrition, and the Aberdeen Centre for Arthritis and Musculoskeletal Health, and the Medical Research Council (MRC)/Arthritis Research UK Centre for Musculoskeletal Health and Work, University of Aberdeen, Aberdeen, UK; MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK; Spondylitis Program, Department of Rheumatology, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada.,G.J. Macfarlane, MD, Dean of Research and Knowledge Exchange (Life Sciences and Medicine) and Chair in Epidemiology, Epidemiology Group, School of Medicine, Medical Sciences and Nutrition, and Aberdeen Centre for Arthritis and Musculoskeletal Health, and MRC/Arthritis Research UK Centre for Musculoskeletal Health and Work, University of Aberdeen; J. Shim, PhD, Research Fellow (Epidemiology), Epidemiology Group, School of Medicine, Medical Sciences and Nutrition, and Aberdeen Centre for Arthritis and Musculoskeletal Health, and MRC/Arthritis Research UK Centre for Musculoskeletal Health and Work, University of Aberdeen; G.T. Jones, PhD, Reader of Epidemiology, Epidemiology Group, School of Medicine, Medical Sciences and Nutrition, and Aberdeen Centre for Arthritis and Musculoskeletal Health, and MRC/Arthritis Research UK Centre for Musculoskeletal Health and Work, University of Aberdeen; K. Walker-Bone, PhD, Professor of Occupational Rheumatology, MRC/Arthritis Research UK Centre for Musculoskeletal Health and Work, and MRC Lifecourse Epidemiology Unit, University of Southampton; E. Pathan, PhD, Research Fellow (Rheumatology), Spondylitis Program, Department of Rheumatology, Toronto Western Hospital, University Health Network; L.E. Dean, PhD, Research Assistant, Epidemiology Group, School of Medicine, Medical Sciences and Nutrition, and Aberdeen Centre for Arthritis and Musculoskeletal Health, and MRC/Arthritis Research UK Centre for Musculoskeletal Health and Work, University of Aberdeen
| | - Linda E Dean
- From the Epidemiology Group, School of Medicine, Medical Sciences and Nutrition, and the Aberdeen Centre for Arthritis and Musculoskeletal Health, and the Medical Research Council (MRC)/Arthritis Research UK Centre for Musculoskeletal Health and Work, University of Aberdeen, Aberdeen, UK; MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK; Spondylitis Program, Department of Rheumatology, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada.,G.J. Macfarlane, MD, Dean of Research and Knowledge Exchange (Life Sciences and Medicine) and Chair in Epidemiology, Epidemiology Group, School of Medicine, Medical Sciences and Nutrition, and Aberdeen Centre for Arthritis and Musculoskeletal Health, and MRC/Arthritis Research UK Centre for Musculoskeletal Health and Work, University of Aberdeen; J. Shim, PhD, Research Fellow (Epidemiology), Epidemiology Group, School of Medicine, Medical Sciences and Nutrition, and Aberdeen Centre for Arthritis and Musculoskeletal Health, and MRC/Arthritis Research UK Centre for Musculoskeletal Health and Work, University of Aberdeen; G.T. Jones, PhD, Reader of Epidemiology, Epidemiology Group, School of Medicine, Medical Sciences and Nutrition, and Aberdeen Centre for Arthritis and Musculoskeletal Health, and MRC/Arthritis Research UK Centre for Musculoskeletal Health and Work, University of Aberdeen; K. Walker-Bone, PhD, Professor of Occupational Rheumatology, MRC/Arthritis Research UK Centre for Musculoskeletal Health and Work, and MRC Lifecourse Epidemiology Unit, University of Southampton; E. Pathan, PhD, Research Fellow (Rheumatology), Spondylitis Program, Department of Rheumatology, Toronto Western Hospital, University Health Network; L.E. Dean, PhD, Research Assistant, Epidemiology Group, School of Medicine, Medical Sciences and Nutrition, and Aberdeen Centre for Arthritis and Musculoskeletal Health, and MRC/Arthritis Research UK Centre for Musculoskeletal Health and Work, University of Aberdeen
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Regner EH, Ohri N, Stahly A, Gerich ME, Fennimore BP, Ir D, Jubair WK, Görg C, Siebert J, Robertson CE, Caplan L, Frank DN, Kuhn KA. Functional intraepithelial lymphocyte changes in inflammatory bowel disease and spondyloarthritis have disease specific correlations with intestinal microbiota. Arthritis Res Ther 2018; 20:149. [PMID: 30029674 PMCID: PMC6053728 DOI: 10.1186/s13075-018-1639-3] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Accepted: 06/01/2018] [Indexed: 01/13/2023] Open
Abstract
Background Dysbiosis occurs in spondyloarthritis (SpA) and inflammatory bowel disease (IBD), which is subdivided into Crohn’s disease (CD) and ulcerative colitis (UC). The immunologic consequences of alterations in microbiota, however, have not been defined. Intraepithelial lymphocytes (IELs) are T cells within the intestinal epithelium that are in close contact with bacteria and are likely to be modulated by changes in microbiota. We examined differences in human gut-associated bacteria and tested correlation with functional changes in IELs in patients with axial SpA (axSpA), CD, or UC, and in controls. Methods We conducted a case-control study to evaluate IELs from pinch biopsies of grossly normal colonic tissue from subjects with biopsy-proven CD or UC, axSpA fulfilling Assessment of SpondyloArthritis International Society (ASAS) criteria and from controls during endoscopy. IELs were harvested and characterized by flow cytometry for cell surface markers. Secreted cytokines were measured by ELISA. Microbiome analysis was by 16S rRNA gene sequencing from rectal swabs. Statistical analyses were performed with the Kruskal-Wallis and Spearman’s rank tests. Results The total number of IELs was significantly decreased in subjects with axSpA compared to those with IBD and controls, likely due to a decrease in TCRβ+ IELs. We found strong, significant negative correlation between peripheral lymphocyte count and IEL number. IELs secreted significantly increased IL-1β in patients with UC, significantly increased IL-17A and IFN-γ in patients with CD, and significantly increased TNF-α in patients with CD and axSpA as compared to other cohorts. For each disease subtype, IELs and IEL-produced cytokines were positively and negatively correlated with the relative abundance of multiple bacterial taxa. Conclusions Our data indicate differences in IEL function among subjects with axSpA, CD, and UC compared to healthy controls. We propose that the observed correlation between altered microbiota and IEL function in these populations are relevant to the pathogenesis of axSpA and IBD, and discuss possible mechanisms. Trial registration ClinicalTrials.gov, NCT02389075. Registered on 17 March 2015. Electronic supplementary material The online version of this article (10.1186/s13075-018-1639-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Emilie H Regner
- Division of Gastroenterology, Department of Medicine, University of Colorado School of Medicine, Aurora, CO, USA.,Mucosal Inflammation Program, University of Colorado School of Medicine, Aurora, CO, USA
| | - Neha Ohri
- Division of Rheumatology, Department of Medicine, University of Colorado School of Medicine, Aurora, CO, USA.,Mucosal Inflammation Program, University of Colorado School of Medicine, Aurora, CO, USA
| | - Andrew Stahly
- Division of Rheumatology, Department of Medicine, University of Colorado School of Medicine, Aurora, CO, USA
| | - Mark E Gerich
- Division of Gastroenterology, Department of Medicine, University of Colorado School of Medicine, Aurora, CO, USA.,Mucosal Inflammation Program, University of Colorado School of Medicine, Aurora, CO, USA
| | - Blair P Fennimore
- Division of Gastroenterology, Department of Medicine, University of Colorado School of Medicine, Aurora, CO, USA.,Mucosal Inflammation Program, University of Colorado School of Medicine, Aurora, CO, USA
| | - Diana Ir
- Division of Infectious Disease, Department of Medicine, University of Colorado School of Medicine, Aurora, CO, USA
| | - Widian K Jubair
- Division of Rheumatology, Department of Medicine, University of Colorado School of Medicine, Aurora, CO, USA.,Mucosal Inflammation Program, University of Colorado School of Medicine, Aurora, CO, USA
| | - Carsten Görg
- Computational Bioscience Program, University of Colorado School of Medicine, Aurora, CO, USA
| | - Janet Siebert
- Computational Bioscience Program, University of Colorado School of Medicine, Aurora, CO, USA
| | - Charles E Robertson
- Division of Infectious Disease, Department of Medicine, University of Colorado School of Medicine, Aurora, CO, USA
| | - Liron Caplan
- Division of Rheumatology, Department of Medicine, University of Colorado School of Medicine, Aurora, CO, USA.,Denver Veterans Affairs Medical Center (Denver VAMC), Denver, CO, USA
| | - Daniel N Frank
- Division of Infectious Disease, Department of Medicine, University of Colorado School of Medicine, Aurora, CO, USA
| | - Kristine A Kuhn
- Division of Rheumatology, Department of Medicine, University of Colorado School of Medicine, Aurora, CO, USA. .,Mucosal Inflammation Program, University of Colorado School of Medicine, Aurora, CO, USA.
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Zhao S, Thong D, Miller N, Duffield SJ, Hughes DM, Chadwick L, Goodson NJ. The prevalence of depression in axial spondyloarthritis and its association with disease activity: a systematic review and meta-analysis. Arthritis Res Ther 2018; 20:140. [PMID: 29996916 PMCID: PMC6042424 DOI: 10.1186/s13075-018-1644-6] [Citation(s) in RCA: 71] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Background Depression is common among patients with axial spondyloarthritis (axSpA), but reports of its prevalence are highly variable. We performed a systematic review to (i) describe the prevalence of depression in axSpA, (ii) compare its prevalence between axSpA, ankylosing spondylitis (AS) and non-radiographic axSpA (nr-axSpA) cohorts, and (iii) compare disease activity and functional impairment between those with and without depression. Methods We searched Medline, PubMed, Web of Science, PsycINFO, CINAHL Plus, the Cochrane library and conference abstracts of the European League Against Rheumatism, British Society for Rheumatology and American College of Rheumatology using a predefined protocol in accordance with Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. Meta-analysis was performed using quality-effects model. Results Fifteen original articles and one abstract were included for analysis; 14 studies described AS cohorts and two nr-axSpA. Three screening criteria and one diagnostic criterion were used to define depression. Prevalence ranged from 11 to 64% depending on criteria and thresholds used. Pooled prevalence of at least moderate depression was 15% using the Hospital Anxiety and Depression Scale (HADS) threshold of ≥ 11. The prevalence of depression was similar between axSpA, AS and nr-axSpA cohorts. Patients with depression had significantly worse disease activity, including higher BASDAI by 1.4 units (95% CI 1.0 to 1.9), ASDAS by 0.5 units (95% CI 0.3 to 0.7) and ESR by 3.5 mm/h (95% CI 0.6 to 6.4). They also had greater functional impairment with higher BASFI and BASMI by 1.2 units (95% CI 0.6 to 1.8) and 0.6 units (95% CI 0.3 to 0.8), respectively. Mean age of each study cohort inversely correlated with depression prevalence. Conclusions Depression is common among axSpA patients and is associated with more severe disease activity and functional impairment. Identifying and managing depression should form part of their holistic care. Further longitudinal studies are needed to explore the impact of depression on treatment outcomes and axSpA treatment on symptoms of depression. Electronic supplementary material The online version of this article (10.1186/s13075-018-1644-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Sizheng Zhao
- Musculoskeletal biology I, Institute of Ageing and Chronic Disease, University of Liverpool, Liverpool, UK.,Department of Academic Rheumatology, Aintree University Hospital, Liverpool, UK
| | - Daniel Thong
- Department of Academic Rheumatology, Aintree University Hospital, Liverpool, UK
| | - Natasha Miller
- Musculoskeletal biology I, Institute of Ageing and Chronic Disease, University of Liverpool, Liverpool, UK
| | - Stephen J Duffield
- Musculoskeletal biology I, Institute of Ageing and Chronic Disease, University of Liverpool, Liverpool, UK
| | - David M Hughes
- Department of Biostatistics, Institute of Translational Medicine, University of Liverpool, Liverpool, UK
| | - Laura Chadwick
- Musculoskeletal biology I, Institute of Ageing and Chronic Disease, University of Liverpool, Liverpool, UK.,Department of Academic Rheumatology, Aintree University Hospital, Liverpool, UK
| | - Nicola J Goodson
- Musculoskeletal biology I, Institute of Ageing and Chronic Disease, University of Liverpool, Liverpool, UK. .,Department of Academic Rheumatology, Aintree University Hospital, Liverpool, UK.
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Saidane O, Mahmoud I, Gafsi L, Houda A, Tekaya R, Abdelmoula L. Factors leading to work absenteeism in Tunisian ankylosing spondylitis patients. THE EGYPTIAN RHEUMATOLOGIST 2018. [DOI: 10.1016/j.ejr.2017.06.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Druce KL, Aikman L, Dilleen M, Burden A, Szczypa P, Basu N. Fatigue independently predicts different work disability dimensions in etanercept-treated rheumatoid arthritis and ankylosing spondylitis patients. Arthritis Res Ther 2018; 20:96. [PMID: 29843776 PMCID: PMC5972438 DOI: 10.1186/s13075-018-1598-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2017] [Accepted: 04/18/2018] [Indexed: 11/29/2022] Open
Abstract
Background Work disability remains a significant problem in ankylosing spondylitis (AS) and rheumatoid arthritis (RA), despite biological therapy. This study aimed to test the hypothesis that the prevalent symptom of fatigue longitudinally predicts work disability among RA and AS patients commencing etanercept. Methods Two observational studies, comprising RA and AS etanercept commencers, respectively, were analysed. Both provided data on work disability over 1 year and a comprehensive set of putative predictors, including fatigue. A series of repeated measures models were conducted, including baseline variables, visit (6/12 months), and the interaction between visit and each of the explanatory variables. Results A total of 1003 AS and 1747 RA patients were assessed. For AS, fatigue was significantly associated with presenteeism (linear mixed model coefficient 3.75, 95% confidence interval (CI) 2.14 to 5.36) and activity impairment (2.62, 1.26 to 3.98), but not with work productivity loss (1.81, −0.40 to 4.02) or absenteeism (generalised linear mixed model odds ratio (OR) 1.18, 95% CI 0.92 to 1.51). In RA, fatigue was associated with presenteeism (coefficient 3.44, 95% CI 2.17 to 4.70), activity impairment (1.52, 0.79 to 2.26), work productivity loss (4.16, 2.47 to 5.85), and absenteeism (OR 1.23, 95% CI 1.02 to 1.49). The lack of significant interactions between fatigue and visit supported a consistent effect of baseline fatigue over time. Conclusions Among patients beginning etanercept therapy, fatigue has a significant and independent effect on absenteeism, presenteeism, productivity loss, and activity impairment for RA patients and a significant but dimension-selective effect on work disability among AS patients. Trial registration ClinicalTrials.gov, NCT00544557. Registered on 16 October 2007. ClinicalTrials.gov, NCT00488475. Registered on 20 June 2006.
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Affiliation(s)
- Katie L Druce
- Arthritis Research UK Centre for Epidemiology, Faculty of Biology Medicine and Health, the University of Manchester, Manchester, M13 9PT, UK
| | | | - Maria Dilleen
- Statistics, Global Product Development, Pfizer, Sandwich, UK
| | | | | | - Neil Basu
- Epidemiology Group, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK. .,Aberdeen Centre for Arthritis and Musculoskeletal Health, University of Aberdeen, Aberdeen, UK. .,Arthritis Research UK/MRC Centre for Musculoskeletal Health and Work, University of Aberdeen, Aberdeen, UK.
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Evaluation of quality of life in patients with axial spondyloarthritis and its association with disease activity, functionality, mobility, and structural damage. Clin Rheumatol 2018; 37:1581-1588. [DOI: 10.1007/s10067-018-4112-4] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2017] [Revised: 02/07/2018] [Accepted: 04/10/2018] [Indexed: 11/25/2022]
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van der Heijde D, Braun J, Rudwaleit M, Purcaru O, Kavanaugh AF. Improvements in workplace and household productivity with certolizumab pegol treatment in axial spondyloarthritis: results to week 96 of a phase III study. RMD Open 2018; 4:e000659. [PMID: 29670761 PMCID: PMC5903272 DOI: 10.1136/rmdopen-2018-000659] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Revised: 03/13/2018] [Accepted: 03/15/2018] [Indexed: 01/21/2023] Open
Abstract
Objectives To evaluate the effect of certolizumab pegol (CZP) on work and household productivity, and on participation in family, social and leisure activities in patients with axial spondyloarthritis (axSpA), including ankylosing spondylitis (AS) and non-radiographic (nr-) axSpA. Methods RAPID-axSpA (NCT01087762) was a phase III, double-blind, placebo-controlled trial to week (Wk) 24, dose-blind to Wk48 and open-label to Wk204. A total of 325 patients were randomised 1:1:1 to placebo, CZP 200 mg Q2W or CZP 400 mg Q4W. The validated arthritis-specific Work Productivity Survey assessed the impact of axSpA on work and household productivity and participation in social activities during the preceding month. Data are shown to Wk96, with responses compared between treatment arms (placebo vs CZP 200 mg and 400 mg dose groups combined) and subpopulations using a non-parametric bootstrap-t method. Results At baseline, 63.2% of placebo and 72.0% of CZP patients were employed. By Wk24, CZP patients reported on average 1.0 fewer days of absenteeism and 2.6 fewer days of presenteeism per month, compared with 0.4 and 0.9 fewer days for placebo. At home, by Wk24, CZP patients reported on average 3.0 household work days gained per month versus 1.3 for placebo. CZP patients reported fewer days with reduced household productivity or days lost for social participation. Similar improvements were observed in AS and nr-axSpA subpopulations and improvements with CZP were maintained to Wk96. Conclusions Compared with placebo, treatment with CZP significantly improved work and household productivity and resulted in greater social participation for patients with axSpA, which could lead to considerable indirect cost gains. Trial registration number NCT01087762.
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Affiliation(s)
| | | | - Martin Rudwaleit
- Department of Internal Medicine and Rheumatology, Klinikum Bielefeld Rosenhöhe, Bielefeld, Germany
| | | | - Arthur F Kavanaugh
- Division of Rheumatology, Allergy and Immunology, University of California, San Diego, San Diego, California, USA
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O'Shea F, Taylor PC, Dickie G, Yaworsky A, Banderas B, Kachroo S. Quality of Care in Rheumatoid Disease from the Clinician Perspective: A Modified Delphi Panel Approach. Rheumatol Ther 2018; 5:87-98. [PMID: 29616498 DOI: 10.1007/s40744-018-0107-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION To establish clinical consensus on important and relevant quality-of-care (QoC) attributes in rheumatic disease (RD) treatment that may improve treatment outcomes and guide best practices. METHODS Twenty-three QoC attributes were identified in a literature review. Fifteen European-based clinicians were selected based on their contributions to RD guidelines, publications, and patient care. A three-round (an interview round and two web-based rounds) modified Delphi panel was conducted to reach consensus and finalize a QoC attribute list. RESULTS In round 1 (clinician interviews), clinicians reported 52 unique QoC attributes across 14 themes, with the greatest number of attributes reported in the "treatment goals" (n = 7) and "remote monitoring" (n = 7) themes. During rounds 2 and 3, the critically important QoC attributes most frequently reported were access to care/treatment (n = 14, 93.3%), safety of treatment (round 2 n = 14, 93.3%, round 3 n = 13, 86.7%), and access to clinicians and specialists (round 2: n = 13, 86.7%, round 3: n = 14, 93.3%). The final list contained 53 QoC attributes. CONCLUSION The study demonstrates consensus across several themes of QoC. Quality of care is a complex, multidimensional, and fluid concept that can be improved by ensuring patients have access to care, open communication between patients and clinicians, and the use of novel strategies, such as remote monitoring. Utilization of the attribute list can potentially improve the lives of patients, provide clinicians with tools to provide greater QoC, and improve the healthcare system as a whole. FUNDING Merck & Co., Inc.
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Affiliation(s)
| | - Peter C Taylor
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Botnar Research Centre, University of Oxford, Oxford, UK
| | | | | | | | - Sumesh Kachroo
- Center for Observational and Real-World Evidence (CORE), Merck & Co., Inc., Kenilworth, NJ, USA
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Rademacher J, Poddubnyy D. Emerging drugs for the treatment of axial spondyloarthritis. Expert Opin Emerg Drugs 2018; 23:83-96. [DOI: 10.1080/14728214.2018.1445719] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Judith Rademacher
- Department of Gastroenterology, Infectiology and Rheumatology, Charité - Universitätsmedizin Berlin, Berlin, Germany
- Berlin Institute of Health, Berlin, Germany
| | - Denis Poddubnyy
- Department of Gastroenterology, Infectiology and Rheumatology, Charité - Universitätsmedizin Berlin, Berlin, Germany
- German Rheumatism Research Centre, Berlin, Germany
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Mennini FS, Viti R, Marcellusi A, Sciattella P, Viapiana O, Rossini M. Economic evaluation of spondyloarthritis: economic impact of diagnostic delay in Italy. CLINICOECONOMICS AND OUTCOMES RESEARCH 2018; 10:45-51. [PMID: 29391817 PMCID: PMC5768184 DOI: 10.2147/ceor.s144209] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND AND AIM Spondyloarthritis (SpA) is a disease that normally affects the axial skeleton. It progressively leads to overall stiffness up to severe postural deformity of rachis and functional impotence. The objective of the study was to quantify, through an economic model, the impact of specialized testing and pharmacological treatments carried out by the National Health Service (NHS) in normal clinical practice, before the patient is diagnosed with SpA in Italy. In line with the analysis objective, the chosen perspective is that of the NHS. METHOD The study was conducted by analyzing the Health Search Database - IMS Health Longitudinal Patient Database, from which newly diagnosed SpA patients were identified over the period 1 January 2007 to 31 December 2013. The use of specialist health care services and pharmacological treatments provided to the patients before the final SpA diagnosis were estimated. RESULTS Through a retrospective analysis of the Health Search Database, 1,084 subjects (aged 25-45 years) were identified. These patients produced an expense of approximately €153,000 in the 3 years prior to a confirmed SpA diagnosis, in terms of specialist check-ups and drugs, presumably not appropriately used due to a lack of diagnosis. If we assume that the Health Search Database is a representative sample of the Italian population, it may be estimated that, in the 3 years prior to SpA diagnosis, over €5.4 million was largely unduly spent in Italy to examine and manage 38,232 newly diagnosed SpA patients, between 2010 and 2013. CONCLUSION The costs due to the delay in SpA diagnosis were quantified for the first time in Italy. For this reason, this work represents a contribution for national and regional decision makers to understand the current clinical practice and the economic consequences of a diagnostic delay in the short and medium term.
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Affiliation(s)
- Francesco S Mennini
- Economic Evaluation and HTA (EEHTA), CEIS, Faculty of Economics, University of Rome “Tor Vergata”, Rome, Italy
- Institute of Leadership and Management in Health, Kingston University, London, UK
| | - Raffaella Viti
- Economic Evaluation and HTA (EEHTA), CEIS, Faculty of Economics, University of Rome “Tor Vergata”, Rome, Italy
| | - Andrea Marcellusi
- Economic Evaluation and HTA (EEHTA), CEIS, Faculty of Economics, University of Rome “Tor Vergata”, Rome, Italy
- Institute of Leadership and Management in Health, Kingston University, London, UK
- Consiglio Nazionale delle Ricerche (CNR), Istituto di Richerche sulla Popolazione e le Politiche Sociali (IRPPS), Rome, Italy
| | - Paolo Sciattella
- Economic Evaluation and HTA (EEHTA), CEIS, Faculty of Economics, University of Rome “Tor Vergata”, Rome, Italy
| | - Ombretta Viapiana
- Rheumatology Unit, Department of Medicine, University of Verona, Verona, Italy
| | - Maurizio Rossini
- Rheumatology Unit, Department of Medicine, University of Verona, Verona, Italy
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Xu H, Li B. Effect of Interferon-γ Polymorphisms on Ankylosing Spondylitis: A Case-Control Study. Med Sci Monit 2017; 23:4126-4131. [PMID: 28843049 PMCID: PMC5584821 DOI: 10.12659/msm.902822] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Background This research aimed to explore the effects of interferon-γ (IFN-γ) polymorphisms and expression profile on susceptibility to ankylosing spondylitis (AS) in a Chinese population. Material/Methods Blood samples were collected from 89 AS patients and 106 healthy controls. IFN-γ polymorphisms were genotyped by polymerase chain reaction (PCR) and sequencing methods. The genotype distribution of polymorphism in the control group was detected by Hardy-Weinberg equilibrium (HWE). Odds ratios (OR) with 95% confidence intervals (95%CI) were calculated using the χ2 test to evaluate the association between AS susceptibility and IFN-γ polymorphisms. Moreover, serum IFN-γ level was measured by ELISA. Results rs1861493 and rs2430561 polymorphisms were conformed to be in HWE in genotypes distribution of the control group (P>0.05 for both). However, only TT genotype and T allele of rs2430561 presented significantly higher frequencies in AS patients than in healthy controls (P=0.04 and 0.03, respectively), indicating that they obviously increased the risk of AS in a Chinese population (OR=2.54, 95%CI=1.01–6.40; OR=1.60, 95%CI=1.04–2.46). In AS patients, serum IFN-γ level was higher than in controls, and its expression patterns showed significant association with genotypes of rs2430561. Conclusions IFN-γ rs2430561 polymorphism may contribute to the risk of AS through influencing IFN-γ expression.
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Affiliation(s)
- Haitao Xu
- Department of Orthopedics, The Yongchuan Hospital of Chongqing Medical University, Chongqing, China (mainland)
| | - Bo Li
- Department of Orthopaedic, The Yongchuan Hospital of Chongqing Medical University, Chongqing, China (mainland)
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Betts KA, Griffith J, Song Y, Mittal M, Joshi A, Wu EQ, Ganguli A. Network Meta-Analysis and Cost Per Responder of Tumor Necrosis Factor-α and Interleukin Inhibitors in the Treatment of Active Ankylosing Spondylitis. Rheumatol Ther 2016; 3:323-336. [PMID: 27747581 PMCID: PMC5127962 DOI: 10.1007/s40744-016-0038-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2016] [Indexed: 12/17/2022] Open
Abstract
INTRODUCTION Biologic therapies have improved the clinical management of ankylosing spondylitis (AS). Few head-to-head studies have directly compared the efficacy of these agents. This study was conducted to indirectly compare the efficacy of biologic agents for treatment of active AS. METHODS A targeted literature review was conducted to identify randomized clinical trials for adalimumab, infliximab, golimumab, certolizumab pegol, etanercept, and secukinumab for the treatment of active AS. The clinical efficacy was evaluated using ASAS20 and ASAS40 and synthesized via a Bayesian network meta-analysis. Number needed to treat (NNT) was calculated as the reciprocal of incremental response rate of each biologic versus placebo. Comparisons were also made in terms of cost per incremental ASAS20 or ASAS40 responder. RESULTS Fifteen studies were identified, which included ASAS20 and/or ASAS40 response rates at Week 12 to Week 16. Patients with AS treated with infliximab had the lowest NNT for ASAS20 of 2.3, followed by those treated with adalimumab (2.8) and etanercept (2.9). Adalimumab had the lowest 12-week cost per additional ASAS20 responder at $26,888, followed by infliximab at $28,175 and golimumab at $28,199. Patients treated with infliximab also had the lowest NNT for ASAS40 (2.6), followed by those treated with adalimumab (2.8) and secukinumab (3.5). Adalimumab had the lowest cost per additional ASAS40 responder at $26,898, followed by infliximab at $32,508 and etanercept at $34,406. CONCLUSION Infliximab had the lowest NNT to achieve an additional ASAS20/40 response, and adalimumab had the lowest cost per ASAS20/40 responder among biologic agents for the treatment of active AS. FUNDING AbbVie.
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Affiliation(s)
| | | | - Yan Song
- Analysis Group, Inc., Boston, MA, USA
| | | | | | - Eric Q Wu
- Analysis Group, Inc., Boston, MA, USA
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de Hooge M, Ramonda R, Lorenzin M, Frallonardo P, Punzi L, Ortolan A, Doria A. Work productivity is associated with disease activity and functional ability in Italian patients with early axial spondyloarthritis: an observational study from the SPACE cohort. Arthritis Res Ther 2016; 18:265. [PMID: 27852321 PMCID: PMC5112652 DOI: 10.1186/s13075-016-1162-3] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2016] [Accepted: 10/24/2016] [Indexed: 12/20/2022] Open
Abstract
Background Spondyloarthritis often affects young people, typically in their working years. The aim of our study was to investigate work productivity and its relationship with disease activity and physical functioning in Italian patients with axial spondyloarthritis (axSpA) with chronic back pain (CBP) for ≥3 months and ≤2 years, and onset < 45 years of age. Methods Baseline absenteeism, presenteeism, work productivity loss (assessed by the Work Productivity and Activity Impairment questionnaire (WPAI)), and disease activity (assessed by the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI)/Ankylosing Spondylitis Disease Activity Score (ASDAS)) and functional ability (assessed by the Bath Ankylosing Spondylitis Disease Functional Index (BASFI)) of patients with axSpA (rheumatologist’s diagnosis) included in the Italian section of the Spondyloarthritis Caught Early (SPACE) cohort were collected. Multivariate linear regression analysis was used to evaluate the associations between work productivity and disease activity/physical functioning. Results Absenteeism in 51 patients with axSpA was low (8.3 %). A decrease in work productivity was related to an increase in disease activity. Disease activity was strongly correlated with absenteeism (p < 0.01), presenteeism (p < 0.01) and work productivity loss (p < 0.001). In addition, decreased work productivity was related to a decrease in functional ability. Physical functioning was correlated with absenteeism (p < 0.001), presenteeism (p < 0.05) and work productivity loss (p < 0.001). Conclusions Impairment of work productivity was correlated with disease activity and physical functioning in Italian patients with axSpA with CBP for ≥3 months and ≤2 years, with onset <45 years of age.
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Affiliation(s)
- Manouk de Hooge
- Rheumatology Unit, Department of Medicine -DIMED, University of Padova, Via Giustiniani 2, 35128, Padova, Italy
| | - Roberta Ramonda
- Rheumatology Unit, Department of Medicine -DIMED, University of Padova, Via Giustiniani 2, 35128, Padova, Italy.
| | - Mariagrazia Lorenzin
- Rheumatology Unit, Department of Medicine -DIMED, University of Padova, Via Giustiniani 2, 35128, Padova, Italy
| | - Paola Frallonardo
- Rheumatology Unit, Department of Medicine -DIMED, University of Padova, Via Giustiniani 2, 35128, Padova, Italy
| | - Leonardo Punzi
- Rheumatology Unit, Department of Medicine -DIMED, University of Padova, Via Giustiniani 2, 35128, Padova, Italy
| | - Augusta Ortolan
- Rheumatology Unit, Department of Medicine -DIMED, University of Padova, Via Giustiniani 2, 35128, Padova, Italy
| | - Andrea Doria
- Rheumatology Unit, Department of Medicine -DIMED, University of Padova, Via Giustiniani 2, 35128, Padova, Italy
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Zou Q, Jiang Y, Mu F, Shi Y, Fang Y. Correlation of Axial Spondyloarthritis with Anxiety and Depression. Med Sci Monit 2016; 22:3202-8. [PMID: 27611598 PMCID: PMC5021017 DOI: 10.12659/msm.897232] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Background This study compared anxiety and depression in patients with nonradiographic axial spondyloarthritis (nr-axSpA) versus patients with ankylosing spondylitis (AS), and examined the relationship between clinical characteristics and psychological status. Material/Methods Patients diagnosed with axial spondyloarthritis (axSpA) were recruited for the study. Disease status was evaluated by the bath ankylosing spondylitis disease activity index (BASDAI), the bath ankylosing spondylitis functional index, visual analog scale, and the level of inflammatory markers. Psychological status was evaluated by the self-rating anxiety scale (SAS) and the self-rating depression scale (SDS). Results Sixty patients with axSpA were enrolled in the study, including 40 patients with AS and 20 patients with nr-axSpA. Patients with AS and patients with nr-axSpA had similar disease status and psychological status. Anxiety was significantly associated with disease status and SDS score (P<0.05 for all), whereas BASDAI (odds ratio [OR]=0.28, 95% CI=0.08–0.97, P=0.045) and SDS (OR=0.90, 95% CI=0.82–0.98, P=0.014) protected against anxiety. Depression was obviously correlated with smoking history, disease status, and SAS score (P<0.05 for all). Smoking history (OR=10.18, 95% CI=1.23–84.23, P=0.031) and SAS score (OR=0.85, 95% CI=0.75–0.97, P=0.014) were negatively correlated with risk of depression. Conclusions Patients with AS and patients with nr-axSpA had similar psychological status in terms of anxiety and depression. Disease status and smoking were significantly correlated with psychological status. Patients with higher SAS scores were more likely to have depression. The results of this study may be helpful to clinically guide psychological interventions for patients with axSpA.
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Affiliation(s)
- Qinghua Zou
- Department of Rheumatology, Southwest Hospital, Third Military Medical University, Chongqing, China (mainland)
| | - Yi Jiang
- Department of Rheumatology, Southwest Hospital, Third Military Medical University, Chongqing, China (mainland)
| | - Fangxiang Mu
- Department of Rheumatology, Southwest Hospital, Third Military Medical University, Chongqing, China (mainland)
| | - Ying Shi
- Department of Rheumatology, Southwest Hospital, Third Military Medical University, Chongqing, China (mainland)
| | - Yongfei Fang
- Department of Rheumatology, Southwest Hospital, Third Military Medical University, Chongqing, China (mainland)
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