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Renouprez T, Gillibert A, Gerard B, Pouplin S, Marcelli C, Lequerre T, Schuers M, Vittecoq O. Determinants associated with the prescription of a first biologic therapy in patients with axial spondyloarthritis and concomitant fibromyalgia in daily practice. Joint Bone Spine 2024; 91:105773. [PMID: 39271050 DOI: 10.1016/j.jbspin.2024.105773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Revised: 08/01/2024] [Accepted: 09/02/2024] [Indexed: 09/15/2024]
Abstract
OBJECTIVES There is no consensus on the therapeutic strategy of rheumatologists for patients with spondyloarthritis (SpA) and concomitant fibromyalgia (FM). The main aim of this study was to identify, in a population of rheumatologists practicing in Normandy, France, the determinants associated with their decision to prescribe a first biologic DMARD (bDMARD) in patients with Spa/FM. Specific objectives were to evaluate professional prescribing practices to identify a set of criteria likely to contribute to the therapeutic decision of rheumatologists, and to validate the relevance of these criteria. METHOD This is a cross-sectional survey-based study using a mixed (qualitative and quantitative) method. The quantitative approach was web-based and conducted among rheumatologists in Normandy. RESULTS The qualitative study allowed us to identify a set of criteria likely to contribute to the therapeutic decision of rheumatologists. In the quantitative study, 54/113 rheumatologists filled the questionnaire. Four criteria were considered by all respondents to contribute to their decision to prescribe a first bDMARD: arthritis on physical examination, extra-articular manifestations, systemic inflammation and structural damage on imaging. CONCLUSIONS The determinants associated with the decision of rheumatologists to prescribe a first bDMARD in patients with SpA/FM were mostly objective, in line with the recommendations in the literature. Most criteria were more related to an approach aimed at ensuring the diagnosis of SpA than evaluating its activity or severity.
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Affiliation(s)
- Thibaut Renouprez
- Rouen Université, UNIROUEN, CHU de Rouen, Department of Rheumatology, CIC-CRB 1404, 76000 Rouen, France
| | - André Gillibert
- Rouen Université, UNIROUEN, CHU de Rouen, Department of Biometry and Biostatistics, 76000 Rouen, France
| | - Baptiste Gerard
- Rouen Université, UNIROUEN, CHU de Rouen, Department of Rheumatology, CIC-CRB 1404, 76000 Rouen, France
| | - Sophie Pouplin
- Rouen Université, UNIROUEN, CHU de Rouen, Department of Rheumatology, CIC-CRB 1404, 76000 Rouen, France
| | - Christian Marcelli
- Normandie Université, UNICAEN, CHU de Caen, Department of Rheumatology, 14000 Caen, France
| | - Thierry Lequerre
- Rouen Université, UNIROUEN, CHU de Rouen, Department of Rheumatology, CIC-CRB 1404, 76000 Rouen, France
| | - Matthieu Schuers
- Rouen Université, UNIROUEN, CHU de Rouen, Department of General Medicine, 76000 Rouen, France
| | - Olivier Vittecoq
- Rouen Université, UNIROUEN, CHU de Rouen, Department of Rheumatology, CIC-CRB 1404, 76000 Rouen, France.
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Panagiotopoulos A, Fragoulis GE. Comorbidities in Psoriatic Arthritis: A Narrative Review. Clin Ther 2023; 45:177-189. [PMID: 36737317 DOI: 10.1016/j.clinthera.2023.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 01/03/2023] [Accepted: 01/12/2023] [Indexed: 02/05/2023]
Abstract
PURPOSE Psoriatic arthritis (PsA) is a common type of inflammatory arthritis. Patients with PsA present with certain extra-articular manifestations and comorbidities (often collectively called psoriatic disease). The purpose of the present review was to highlight the main comorbidities in the setting of PsA. METHODS A narrative review was performed using data from articles found in a search of PubMed and Scopus using the terms psoriatic arthritis and comorbidities. FINDINGS Cardiovascular disease (CVD), as well as metabolic and mental health disorders, are the most common comorbidities in patients with PsA. In most cases, underlying inflammation seems to be involved in the increased risk for CVD in PsA, while a bidirectional relationship seems to operate between mental health disorders and psoriatic disease. The treatment of patients with PsA, especially with biologic disease-modifying antirheumatic drugs, has been shown to lead to favorable outcomes regarding the CVD risk. However, it is debatable whether specific drug classes are more effective than others or should be avoided in patients with CVD risk factors. Comorbidity of mental health disorders is even more complex, given the difficulties in measuring and reporting these comorbidities in clinical trials and in clinical practice. IMPLICATIONS Future studies are needed for a better understanding of the pathogenic mechanisms of, and the development of better protocols for the identification and treatment of patients with, comorbidities in patients with PsA. The education of clinicians, health care professionals in rheumatology, and patients could be useful in achieving this goal.
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Affiliation(s)
- Alexandros Panagiotopoulos
- Joint Academic Rheumatology Program, First Department of Propedeutic Internal Medicine, University of Athens, Athens, Greece
| | - George E Fragoulis
- Joint Academic Rheumatology Program, First Department of Propedeutic Internal Medicine, University of Athens, Athens, Greece; Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow, United Kingdom.
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López-Medina C, Puche-Larrubia MÁ, Granados R, Ladehesa-Pineda L, Ruiz-Vilchez D, Ábalos-Aguilera MC, Font-Ugalde P, Collantes-Estévez E. Achilles enthesitis on physical examination leads to worse outcomes after 2 years of follow up in patients with ankylosing spondylitis from REGISPONSER-AS registry. Arthritis Res Ther 2023; 25:8. [PMID: 36639793 PMCID: PMC9837894 DOI: 10.1186/s13075-023-02988-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Accepted: 01/01/2023] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Enthesitis represents one of the most important peripheral musculoskeletal manifestations in patients with axial spondyloarthritis (axSpA). However, studies specifically evaluating Achilles tendon enthesitis and its impact over time are scarce. The objectives of this study were to evaluate the impact of Achilles' tendon enthesitis found at baseline during physical examination on the outcome measures after 2 years of follow-up in patients with ankylosing spondylitis (AS). METHODS This was an observational and prospective study conducted during 2 years of follow-up in the REGISPONSER-AS registry. Linear regression models adjusted for age, body mass index (BMI), and anti-TNF intake were conducted to evaluate the association between the presence of Achilles enthesitis at baseline and the patient-reported outcome (PRO) scores at baseline. The impact of this feature on PROs over 2 years of follow-up was evaluated using mixed models for repeated measures adjusted for age, BMI, and anti-TNF intake. RESULTS Among the 749 patients included, 46 patients (6.1%) showed Achilles' tendon enthesitis during physical examination at the baseline study visit. Patients with Achilles enthesitis had an increase in the global VAS score, BASDAI, mBASDAI, ASDAS-CRP, and BASFI scores in comparison with patients without this feature. In addition, the mean global VAS, BASDAI, and ASDAS-CRP scores were significantly higher among patients with Achilles enthesitis over the 2 years of follow-up after adjusting for age, BMI, and current anti-TNF intake. The percentage of patients achieving ASDAS low disease activity (ASDAS < 2.1) after 2 years of follow-up was 15.9% and 31.5% for patients with and without Achilles enthesitis, respectively (p = 0.030). CONCLUSIONS In patients with AS, the presence of Achilles' tendon enthesitis was associated with worse scores on the outcome measures after 2 years of follow-up, leading to a lower probability of achieving low disease activity.
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Affiliation(s)
- Clementina López-Medina
- Department of Rheumatology, Reina Sofia University Hospital, Avda. Menendez Pidal, S/N. 14004, Cordoba, Spain. .,Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Cordoba, Spain. .,Medical and Surgical Sciences Department, University of Cordoba, Cordoba, Spain.
| | - M. Ángeles Puche-Larrubia
- grid.411349.a0000 0004 1771 4667Department of Rheumatology, Reina Sofia University Hospital, Avda. Menendez Pidal, S/N. 14004, Cordoba, Spain ,grid.428865.50000 0004 0445 6160Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Cordoba, Spain ,grid.411901.c0000 0001 2183 9102Medical and Surgical Sciences Department, University of Cordoba, Cordoba, Spain
| | - Raquel Granados
- grid.411349.a0000 0004 1771 4667Department of Rheumatology, Reina Sofia University Hospital, Avda. Menendez Pidal, S/N. 14004, Cordoba, Spain ,grid.428865.50000 0004 0445 6160Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Cordoba, Spain ,grid.411901.c0000 0001 2183 9102Medical and Surgical Sciences Department, University of Cordoba, Cordoba, Spain
| | - Lourdes Ladehesa-Pineda
- grid.411349.a0000 0004 1771 4667Department of Rheumatology, Reina Sofia University Hospital, Avda. Menendez Pidal, S/N. 14004, Cordoba, Spain ,grid.428865.50000 0004 0445 6160Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Cordoba, Spain ,grid.411901.c0000 0001 2183 9102Medical and Surgical Sciences Department, University of Cordoba, Cordoba, Spain
| | - Desirée Ruiz-Vilchez
- grid.411349.a0000 0004 1771 4667Department of Rheumatology, Reina Sofia University Hospital, Avda. Menendez Pidal, S/N. 14004, Cordoba, Spain ,grid.428865.50000 0004 0445 6160Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Cordoba, Spain ,grid.411901.c0000 0001 2183 9102Medical and Surgical Sciences Department, University of Cordoba, Cordoba, Spain
| | - M. Carmen Ábalos-Aguilera
- grid.411349.a0000 0004 1771 4667Department of Rheumatology, Reina Sofia University Hospital, Avda. Menendez Pidal, S/N. 14004, Cordoba, Spain ,grid.428865.50000 0004 0445 6160Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Cordoba, Spain ,grid.411901.c0000 0001 2183 9102Medical and Surgical Sciences Department, University of Cordoba, Cordoba, Spain
| | - Pilar Font-Ugalde
- grid.428865.50000 0004 0445 6160Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Cordoba, Spain ,grid.411901.c0000 0001 2183 9102Medical and Surgical Sciences Department, University of Cordoba, Cordoba, Spain
| | - Eduardo Collantes-Estévez
- grid.428865.50000 0004 0445 6160Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Cordoba, Spain ,grid.411901.c0000 0001 2183 9102Medical and Surgical Sciences Department, University of Cordoba, Cordoba, Spain
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Santos-Moreno P, Parra-Padilla D, Gómez-De la Rosa F, Carrasquilla-Sotomayor M, Villarreal L, Jervis-Jálabe DS, Alvis-Zakzuk NJ. Direct Medical Costs and Healthcare Resource Utilization of Treating Patients With Two Clinical Subtypes of Axial Spondyloarthritis in Colombia. Value Health Reg Issues 2022; 32:88-94. [PMID: 36152397 DOI: 10.1016/j.vhri.2022.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 06/22/2022] [Accepted: 08/09/2022] [Indexed: 11/26/2022]
Abstract
OBJECTIVES This study aimed to calculate the healthcare resource utilization and direct medical costs in patients with 2 subtypes of axial spondyloarthritis (axSpA) in a rheumatic care center in Colombia. METHODS This is a retrospective cost-of-illness study. Patients with at least 1 medical consultation associated with an axSpA diagnosis between October 2018 and October 2019 were identified. Patients were classified as having radiographic (r-axSpA) or nonradiographic axSpA (nr-axSpA). Direct medical costs were calculated in Colombian pesos and expressed in American dollars using an exchange rate of 3263 Colombian pesos = 1 US dollar ($). Predictors of total direct costs were identified using a generalized linear model with gamma distribution and log-link. RESULTS A total of 162 patients with a mean age of 49.6 years (± 13.7) were included in the study. Among these, 147 (90.7%) were considered as having r-axSpA and 15 (9.3%) nr-axSpA, with mean costs of $6600 (± 6203) and $843 (± 1135), respectively (P < .001). The total direct mean cost was calculated at $6067 (± 6144) per patient. Medication costs were the main driver of total costs (97.6%, $5921), with biologic disease-modifying antirheumatic drugs accounting for nearly 92.0% ($5582) of these costs. Rheumatologist (100%) and physiatrist (64.2%) visits were the most frequently used medical service. CONCLUSIONS The economic burden associated with axSpA in the Colombian setting is substantial. There is a significant difference in direct medical costs between the r-axSpA and the nr-axSpA. Health policies aimed at the comprehensive management of nr-axSpA would have an important role in the reduction of the associated direct medical costs.
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Affiliation(s)
| | - Devian Parra-Padilla
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom; Department of Health Technology Assessment, ALZAK Foundation, Cartagena, Colombia
| | | | | | | | | | - Nelson J Alvis-Zakzuk
- Department of Health Sciences. Universidad de la Costa, Barranquilla, Colombia; Postgraduate Program in Epidemiology, School of Public Health, University of São Paulo, São Paulo, Brazil.
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