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Buckley BJ, Ali U, Kelso MJ, Ranson M. The Urokinase Plasminogen Activation System in Rheumatoid Arthritis: Pathophysiological Roles and Prospective Therapeutic Targets. Curr Drug Targets 2020; 20:970-981. [PMID: 30516104 PMCID: PMC6700755 DOI: 10.2174/1389450120666181204164140] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2018] [Revised: 11/12/2018] [Accepted: 11/28/2018] [Indexed: 01/09/2023]
Abstract
Rheumatoid Arthritis (RA) is a chronic and progressive inflammatory disease characterized in its early stages by synovial hyperplasia and inflammatory cell infiltration and later by irreversible joint tissue destruction. The Plasminogen Activation System (PAS) is associated with a wide range of physiological and pathophysiological states involving fibrinolysis, inflammation and tissue remodeling. Various components of the PAS are implicated in the pathophysiology of RA. Urokinase Plasminogen Activator (uPA) in particular is a pro-inflammatory mediator that appears to play an important role in the bone and cartilage destruction associated with RA. Clinical studies have shown that uPA and its receptor uPAR are overexpressed in synovia of patients with rheumatoid arthritis. Further, genetic knockdown and antibody-mediated neutralization of uPA have been shown to be protective against induction or progression of arthritis in animal models. The pro-arthritic role of uPA is differentiated from its haemodynamic counterpart, tissue plasminogen activator (tPA), which appears to play a protective role in RA animal models. This review summarises available evidence supporting the PAS as a critical determinant of RA pathogenesis and highlights opportunities for the development of novel uPAS-targeting therapeutics.
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Affiliation(s)
- Benjamin J Buckley
- School of Chemistry and Molecular Bioscience, University of Wollongong, NSW 2522, Australia.,Illawarra Health & Medical Research Institute, Wollongong, NSW 2522, Australia
| | - Umar Ali
- School of Chemistry and Molecular Bioscience, University of Wollongong, NSW 2522, Australia.,Illawarra Health & Medical Research Institute, Wollongong, NSW 2522, Australia
| | - Michael J Kelso
- School of Chemistry and Molecular Bioscience, University of Wollongong, NSW 2522, Australia.,Illawarra Health & Medical Research Institute, Wollongong, NSW 2522, Australia
| | - Marie Ranson
- School of Chemistry and Molecular Bioscience, University of Wollongong, NSW 2522, Australia.,Illawarra Health & Medical Research Institute, Wollongong, NSW 2522, Australia
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Xavier RM, Zerbini CAF, Pollak DF, Morales-Torres JLA, Chalem P, Restrepo JFM, Duhau JA, Amado JR, Abello M, de la Vega MC, Dávila AP, Biegun PM, Arruda MS, Ramos-Remus C. Burden of rheumatoid arthritis on patients' work productivity and quality of life. Adv Rheumatol 2019; 59:47. [PMID: 31706348 DOI: 10.1186/s42358-019-0090-8] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Accepted: 10/21/2019] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND To determine the burden of Rheumatoid Arthritis (RA) on patients' work productivity and health related quality of life (HRQoL), and examine the influence of several exposure variables; to analyze the progression of RA over 1 year and its impact on work productivity and HRQoL. METHODS International multicenter prospective survey including patients in 18 centers in Argentina, Brazil, Colombia and Mexico with diagnosis of RA and aged between 21-55 years. The following standard questionnaires were completed at baseline and throughout a 1-year follow-up: WPAI:RA, WALS, WLQ-25, EQ-5D-3 L and SF-36. Clinical and demographic variables were also collected through interview. RESULTS The study enrolled 290 patients on baseline visit. Overall mean scores at baseline visit were: WPAI:RA (presenteeism) = 29.5% (SD = 28.8%); WPAI:RA (absenteeism) = 9.0% (SD = 23.2%); WPAI:RA (absenteeism and presenteeism) = 8.6% (SD = 22.6%); WALS = 9.0 (SD = 6.1); WLQ-25 = 7.0% (SD = 5.1%); SF-36 Physical Scale = 39.1 (SD = 10.3) and Mental Scale = 45.4 (SD = 11.3); EQ-5D-3 L VAS = 69.8 (SD = 20.4) and EQ-5D-3 L index = 0.67 (SD = 0.23). Higher educational levels were associated with better results in WLQ-25, while previous orthopedic surgeries reduced absenteeism results of WPAI:RA and work limitations in WLQ-25. Higher disease duration was associated with decreased HRQoL. Intensification of disease activity was associated with decreased work productivity and HRQoL, except in WLQ-25. In the longitudinal analysis, worsening in disease activity was associated with a decrease in both work productivity and HRQoL. CONCLUSIONS RA patients are dealing with workplace disabilities and limitations and loss in HRQoL, and multiple factors seems to be associated with this. Worsening of disease activity further decreased work productivity and HRQoL, stressing the importance of disease tight control.
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Affiliation(s)
- Ricardo Machado Xavier
- Universidade Federal do Rio Grande do Sul, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil.
| | | | | | | | - Philippe Chalem
- Fundación Instituto de Reumatología Fernando Chalem, Bogotá, Colombia
| | | | - Javier Arnaldo Duhau
- Centro de Investigaciones en Enfermedades Reumáticas (CIER), Buenos Aires, Argentina
| | | | | | | | | | | | | | - Cesar Ramos-Remus
- Unidad de Investigación en Enf. Crónico-Degenerativas, Guadalajara, Mexico
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Zhou Y, Wang X, An Y, Zhang X, Han S, Li X, Wang L, Wang C, Wang Y, Yang R, Wang G, Lu X, Zhu P, Chen L, Liu J, Jin H, Liu X, Sun L, Wei P, Wang J, Chen H, Cui L, Shu R, Zhang Z, Li G, Li Z, Yang J, Li J, Jia B, Zhang F, Tao J, Lin J, Wei Q, Liu X, Ke D, Hu S, Ye C, Yang X, Li H, Huang C, Gao M, Li X, Song L, Wang Y, Wang X, Mu R, Su Y, Li Z. Disability and health-related quality of life in Chinese patients with rheumatoid arthritis: A cross-sectional study. Int J Rheum Dis 2019; 21:1709-1715. [PMID: 30345647 DOI: 10.1111/1756-185x.13345] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
AIM The objective of this study was to evaluate the impact of rheumatoid arthritis (RA) on physical function and health-related quality of life (HRQoL) in China. METHOD A cross-section survey was conducted in 21 general hospitals in China. Eight hundred and seven patients were recruited. Data on demographics, clinical data, physical function (Stanford Health Assessment Questionnaire Disability Index, HAQ-DI) and HRQoL (Study Short Form 36 Health Survey, SF-36) were collected on site. RESULTS In our cohort, physical function was impaired in 77.6% of patients (HAQ-DI >0). The median (interquartile range, IQR) of HAQ-DI was 0.750 (0.125, 1.500). Rated by HAQ-DI 0-1, >1-2, and >2-3, percentage of patients with mild, moderate and severe disability was 61.0%, 25.4%, and 13.6%, respectively. Older age, long disease duration, presence of extra-articular manifestations, tender joint count (TJC), overall status (assessed by patient Global Visual Analogue Scale [G-VAS] and physician G-VAS) and lacking disease-modifying anti-rheumatic drugs were identified as predictive factors for worse physical function (P < .05). The composite scores of SF-36 in the observed patients were: physical component summary 40.4 (IQR 27.4, 60.3), and mental component summary 49.0 (IQR 33.6, 70.9). Impaired physical health may be predicted by low income, presence of extra-articular manifestations, TJC, patient G-VAS and high HAQ-DI. Predictors for suboptimal mental health were low income, physical labor, married status, increased swollen joint count (SJC), physician G-VAS and high HAQ-DI. CONCLUSION Rheumatoid arthritis has profound effects on physical function and HRQoL in Chinese patients. Patients with identified predictive factors for poor outcome should be closely monitored.
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Affiliation(s)
- Yunshan Zhou
- Department of Rheumatology and Immunology, Peking University People's Hospital, Beijing, China
| | - Xiuru Wang
- Duoding Street Community Health Center, Peking University Shougang Hospital, Beijing, China
| | - Yuan An
- Department of Rheumatology and Immunology, Peking University People's Hospital, Beijing, China
| | - Xiaoying Zhang
- Department of Rheumatology and Immunology, Peking University People's Hospital, Beijing, China
| | - Shuling Han
- Department of Rheumatology and Immunology, Peking University Shougang Hospital, Beijing, China
| | - Xiaofeng Li
- Department of Rheumatology and Immunology, Second Hospital of Shanxi Medical University, Taiyuan, China
| | - Lizhi Wang
- Department of Rheumatology and Immunology, Second Hospital of Shanxi Medical University, Taiyuan, China
| | - Caihong Wang
- Department of Rheumatology and Immunology, Second Hospital of Shanxi Medical University, Taiyuan, China
| | - Yongfu Wang
- Department of Rheumatology and Immunology, The First Affiliated Hospital, Baotou Medical College, Baotou, China
| | - Rong Yang
- Department of Rheumatology and Immunology, The First Affiliated Hospital, Baotou Medical College, Baotou, China
| | - Guochun Wang
- Department of Rheumatology, China-Japan Friendship Hospital, Beijing, China
| | - Xin Lu
- Department of Rheumatology, China-Japan Friendship Hospital, Beijing, China
| | - Ping Zhu
- Department of Clinical Immunology, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Lina Chen
- Department of Clinical Immunology, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Jinting Liu
- Department of Rheumatology and Immunology, Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Hongtao Jin
- Department of Rheumatology and Immunology, Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Xiangyuan Liu
- Department of Rheumatology and Immunology, Peking University Third Hospital, Beijing, China
| | - Lin Sun
- Department of Rheumatology and Immunology, Peking University Third Hospital, Beijing, China
| | - Ping Wei
- Department of Rheumatology and Immunology, The Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Junxiang Wang
- Department of Rheumatology and Immunology, The Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Haiying Chen
- Department of Rheumatology and Immunology, The Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Liufu Cui
- Department of Rheumatology and Immunology, The Affiliated Kailuan Hospital of North China Coal Medical University, Tangshan, China
| | - Rong Shu
- Department of Rheumatology and Immunology, The Affiliated Kailuan Hospital of North China Coal Medical University, Tangshan, China
| | - Zhuoli Zhang
- Department of Rheumatology and Clinical Immunology, Peking University First Hospital, Beijing, China
| | - Guangtao Li
- Department of Rheumatology and Clinical Immunology, Peking University First Hospital, Beijing, China
| | - Zhenbin Li
- Department of Rheumatology and Immunology, Bethune International Peace Hospital of PLA, Shijiazhuang, China
| | - Jing Yang
- Department of Rheumatology and Immunology, Bethune International Peace Hospital of PLA, Shijiazhuang, China
| | - Junfang Li
- Department of Rheumatology and Immunology, Handan Central Hospital, Handan, China
| | - Bin Jia
- Department of Rheumatology and Immunology, Handan Central Hospital, Handan, China
| | - Fengxiao Zhang
- Department of Rheumatology and Immunology, The People's Hospital of Hebei Province, Shijiazhuang, China
| | - Jiemei Tao
- Department of Rheumatology and Immunology, The People's Hospital of Hebei Province, Shijiazhuang, China
| | - Jinying Lin
- Department of Rheumatology, the People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, China
| | - Qiumei Wei
- Department of Rheumatology, the People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, China
| | - Xiaomin Liu
- Department of Rheumatology and Immunology, Beijing Shunyi Hospital, Beijing, China
| | - Dan Ke
- Department of Rheumatology and Immunology, Beijing Shunyi Hospital, Beijing, China
| | - Shaoxian Hu
- Department of Rheumatology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Cong Ye
- Department of Rheumatology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xiuyan Yang
- Department of Rheumatology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Hao Li
- Department of Rheumatology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Cibo Huang
- Department of Rheumatology and Immunology, Beijing Hospital, Beijing, China
| | - Ming Gao
- Department of Rheumatology and Immunology, Beijing Hospital, Beijing, China
| | - Xingfu Li
- Department of Rheumatology, Shandong University Qilu Hospital, Jinan, China
| | - Lijun Song
- Department of Rheumatology, Shandong University Qilu Hospital, Jinan, China
| | - Yi Wang
- Department of Rheumatology, Second Hospital of Lanzhou University, Lanzhou, China
| | - Xiaoyuan Wang
- Department of Rheumatology, Second Hospital of Lanzhou University, Lanzhou, China
| | - Rong Mu
- Department of Rheumatology and Immunology, Peking University People's Hospital, Beijing, China
| | - Yin Su
- Department of Rheumatology and Immunology, Peking University People's Hospital, Beijing, China
| | - Zhanguo Li
- Department of Rheumatology and Immunology, Peking University People's Hospital, Beijing, China
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Hung YM, Lin L, Wang YH, Wei JCC, Wang PYP, Chiou JY. Combination effect of anti-rheumatic medications for coronary artery diseases risk in rheumatoid arthritis: a nationwide population-based cohort study. Curr Med Res Opin 2019; 35:313-320. [PMID: 29939099 DOI: 10.1080/03007995.2018.1492910] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
OBJECTIVES To determine whether a combination of anti-rheumatic drugs is associated with the risk of coronary artery diseases (CAD) in incident rheumatoid arthritis (RA) patients. METHODS This population-based cohort study used administrative data to identify 6260 newly-diagnosed patients with RA (age ≥20 years) as the study group. The study end-point was occurrence of CAD according to the ICD-9-CM codes. Exposure to different combinations of drugs and the risk of CAD was assessed. These included different combinatiosn of celecoxib (Cx), hydroxychloroquine (HCQ), methotrexate (MTX), and sulfasalazine (SSZ). Patients who never used Cx, HCQ, MTX, or SSZ were used as a reference group. A Cox proportional hazards model was used to estimate the hazard ratio (HR) of disease after controlling for demographic and other co-morbidities. When the proportionality assumption was violated, the spline curve of the Scaled Schoenfeld residuals was fitted to demonstrate the estimated effect on CAD over time for drug usage. RESULTS Among RA patients, the adjusted HR (95% confidence interval) of CAD for "Cx only", "Cx and HCQ ever", and "Cx, HCQ, MTX, and SSZ ever", were 0.29 (0.19-0.44), 0.46 (0.24-0.88), and 0.42 (0.24- 0.75), respectively, during the first period of 0-3, 4, or 7 years. However, they became 1.04 (0.78-1.38), 1.16 (0.62-2.19), and 0.59 (0.32-1.08), respectively, during the second time period of 3, 4, or 7-10 years. The adjusted HR (95% CI) of CAD for "Cx, MTX, and SSZ ever" remains constant at 0.12 (0.02-0.89). CONCLUSIONS Celecoxib-DMARDs drug combinations were associated with reduced CAD risk on incident RA patients, and some of them exhibited the time-varying drug effect.
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Affiliation(s)
- Yao-Min Hung
- a Department of Emergency Medicine , Kaohsiung Veterans General Hospital , Kaohsiung , Taiwan
- b Institute of Public Health, School of Medicine , National Yang Ming University , Taipei , Taiwan
- c Yuhing Junior College of Health Care and Management , Kaohsiung , Taiwan
| | - Lichi Lin
- d Department of Statistics , Oklahoma State University , OK , USA
- e Division of Allergy, Immunology and Rheumatology , Chung Shan Medical University Hospital , Taichung , Taiwan
| | - Yu-Hsun Wang
- f Department of Medical Research , Chung Shan Medical University , Taichung , Taiwan
| | - James Cheng-Chung Wei
- e Division of Allergy, Immunology and Rheumatology , Chung Shan Medical University Hospital , Taichung , Taiwan
| | - Paul Yung-Pou Wang
- g Division of Nephrology , Kaiser Permanente Baldwin Park Medical Center , Baldwin Park , CA , USA
| | - Jeng-Yuan Chiou
- h School of Health Policy and Management , Chung Shan Medical University , Taichung , Taiwan
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Contribution of the bone and cartilage/soft tissue components of the joint damage to the level of disability in rheumatoid arthritis patients: a longitudinal study. Clin Rheumatol 2018; 38:691-700. [PMID: 30328025 DOI: 10.1007/s10067-018-4335-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2018] [Revised: 09/24/2018] [Accepted: 10/10/2018] [Indexed: 10/28/2022]
Abstract
The study aims to analyze the association between the bone and cartilage/periarticular components of the radiographic joint damage and disability over the course of disease, in a cohort of rheumatoid arthritis (RA) patients from a day-to-day clinical practice. The secondary aim is to study the role of demographic and disease-related variables in this association. We performed a retrospective longitudinal study including 736 RA patients. Disability was assessed with the health assessment questionnaire (HAQ), and radiographic joint damage of hands and wrists with the Sharp van-der-Heijde score (total (SHS), erosion (ES), and narrowing/(sub)luxation (NSLS) components]. Generalized estimating equations models, adjusted by disease activity, demographic and disease-related variables, were used to test the relationship between SHS and medium-term (median value of the HAQs performed in the following year after each radiograph) and long-term (set of HAQ measures performed during follow-up, at least 1 year apart from the first x-ray) disability. Interaction terms between the SHS and demographic and disease-related variables were introduced in the models. To account for multiple testing, Bonferroni correction was applied. NSLS was independently associated with medium-term disability, even after Bonferroni correction. We observed significant and positive interactions between NSLS and age at x-ray, and with the ES. SHS showed no association with long-term disability. The cartilage/soft tissue component of the radiographic joint damage seems to exert a much more important role in medium-term disability than the erosive component. This association could be modulated by the age at the x-ray and by the magnitude of the erosive damage.
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Bartoli F, Bae S, Cometi L, Matucci Cerinic M, Furst DE. Sirukumab for the treatment of rheumatoid arthritis: update on sirukumab, 2018. Expert Rev Clin Immunol 2018; 14:539-547. [PMID: 29925278 DOI: 10.1080/1744666x.2018.1487291] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Interleukin-6 (IL-6) is well-known for its pro-inflammatory properties, has been proven to target a wide range of cells in the joint, and has been implicated in extra-articular and articular manifestations in rheumatoid arthritis (RA). Tocilizumab (TCZ) is now widely used in patients with active RA and a number of additional agents that target the IL-6 pathways are under development, including sirukumab (SRK). Areas covered: SRK is an IgG1κ human anti-IL-6 monoclonal antibody which binds to IL-6 and prevents IL-6-mediated downstream effects. Initial trial results in phase-III studies in patients with RA seemed promising, showing improved results in patients with moderate-to-severe RA. Data derive from the phase-II study and the various SIRROUND studies (phase III). Expert commentary: The available data show that SRK50 mg every 4 weeks or 100 mg every 2 weeks will be effective in treating the RA population, with clinical improvements as early as week 2 and sustained over time. The adverse-event profile seems to be similar to TCZ, except for an increased mortality post open-label studies due to infections and cardiovascular events, our knowledge of which will be deepened with post-marketing surveillance and registry data.
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Affiliation(s)
- Francesca Bartoli
- a Department of Experimental and Clinical Medicine , University of Florence & Department of Geriatric Medicine, Division of Rheumatology, AOUC , Florence , Italy
| | - Sangmee Bae
- b Division of Rheumatology Fellow , Geffen School of Medicine at the University of California in Los Angeles , Los Angeles , California, USA
| | - Laura Cometi
- a Department of Experimental and Clinical Medicine , University of Florence & Department of Geriatric Medicine, Division of Rheumatology, AOUC , Florence , Italy
| | - Marco Matucci Cerinic
- a Department of Experimental and Clinical Medicine , University of Florence & Department of Geriatric Medicine, Division of Rheumatology, AOUC , Florence , Italy
| | - Daniel E Furst
- c Geffen School of Medicine at the University of California in Los Angeles (Emeritus), California, USA.,d Department of Experimental and Clinical Medicine , University of Florence , Florence , Italy.,e University of Washington , Seattle , Washington DC , USA.,f Pacific Arthritis , Los Angeles , California , USA.,g Seattle Rheumatology Associates , Seattle , Washington, DC, USA
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Hammad M, Eissa M, Dawa GA. Factors contributing to disability in rheumatoid arthritis patients: An Egyptian multicenter study. ACTA ACUST UNITED AC 2018; 16:103-109. [PMID: 29724488 DOI: 10.1016/j.reuma.2018.03.006] [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: 01/17/2018] [Revised: 03/07/2018] [Accepted: 03/21/2018] [Indexed: 10/17/2022]
Abstract
OBJECTIVE Minimizing disability and enhancing physical function to its optimal levels is still a challenge in management of rheumatoid arthritis (RA). The aim is to identify factors leading to disability in RA. METHODS This is a cross-sectional Egyptian multicenter study carried out on 215 RA patients attending to our inpatient and outpatient rheumatology clinics during 4 months starting from April to July 2017 who agreed to participate in the study; 170 patients were from Cairo University hospitals and 45 from Zagazig University hospitals. We recorded a number of possible risk factors including demographic, clinical, serological and therapeutic factors. The assessment of patients' disability was done using Modified HAQ (MHAQ). RESULTS A significant positive correlation was found between MHAQ and different markers of activity in addition to age and depression score (P<0.001). Illiteracy accounted for higher MHAQ scores (P=0.001). A higher MHAQ was found in patients with ischemic heart disease (P<0.05). Patients with erosions on X-rays had significantly higher MHAQ scores. Subluxations also accounted for higher MHAQ scores (P=0.000). CONCLUSION Aging, illiteracy, disease activity, erosions, subluxations, depression and ischemic heart disease were all related to higher disability. Good control of disease activity which in turn reduces erosions and subluxations is mandatory. Screening for depression and proper use of anti-depressants is of great value. Proper screening and prophylaxis is recommended against ischemic heart disease by controlling modifiable risk factors like obesity, dyslipidaemia, hypertension, smoking and sedentary lifestyle.
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Affiliation(s)
- Marwa Hammad
- Rheumatology & Rehabilitation Department, Zagazig University, Zagazig, Egypt
| | - Mervat Eissa
- Rheumatology and Rehabilitation Department, Cairo University, Cairo, Egypt.
| | - Ghada A Dawa
- Rheumatology & Rehabilitation Department, Zagazig University, Zagazig, Egypt
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Kanbe K, Sekine C. Long-Term Efficacy of Rehabilitation Following Arthroscopic Synovectomy in Patients With Rheumatoid Arthritis Treated With Biologic Agents. Ann Rehabil Med 2017; 41:998-1004. [PMID: 29354576 PMCID: PMC5773443 DOI: 10.5535/arm.2017.41.6.998] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Accepted: 04/25/2017] [Indexed: 11/09/2022] Open
Abstract
Objective To investigate the long-term efficacy of rehabilitation following arthroscopic synovectomy in patients with rheumatoid arthritis treated with biologic agents. Methods Arthroscopic synovectomy was performed in 29 joints of 17 patients, which were divided into two groups. Group 1 included arthroscopic synovectomy plus rehabilitation for 19 joints in 10 patients, and group 2 included arthroscopic synovectomy without rehabilitation for 10 joints in 7 patients. The Disease Activity Score C-reactive protein (DAS28-CRP), Health Assessment Questionnaire-Disability Index (HAQ-DI), and Functional Independence Measure (FIM) values (motor subscale) at 9.7 years after arthroscopic synovectomy were evaluated to identify the clinical factors related to outcomes. Results The increase in FIM score was significant in group 1 (p=0.05). HAQ-DI at 9 years was significantly decreased in group 1 (p=0.02). Therefore, arthroscopic synovectomy with rehabilitation was significant in improving FIM and HAQ-DI scores over a long period. Multiple regression analysis of FIM scores at 9 years indicated that rehabilitation (p=0.03) and disease duration (p=0.02) were significantly related to outcomes. FIM score at 9 years was significantly negatively correlated with disease duration (p=0.01, r=−0.58, Y=88.89–0.21X). Conclusion Rehabilitation following arthroscopic synovectomy was effective in achieving high FIM scores over time in patients with rheumatoid arthritis.
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Affiliation(s)
- Katsuaki Kanbe
- Department of Rehabilitation, Tokyo Women's Medical University, Medical Center East, Tokyo, Japan.,Department of Orthopaedic Surgery, Tokyo Women's Medical University, Medical Center East, Tokyo, Japan
| | - Chiaki Sekine
- Department of Rehabilitation, Tokyo Women's Medical University, Medical Center East, Tokyo, Japan.,Department of Orthopaedic Surgery, Tokyo Women's Medical University, Medical Center East, Tokyo, Japan
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Kawata M, Sasabuchi Y, Inui H, Taketomi S, Matsui H, Fushimi K, Chikuda H, Yasunaga H, Tanaka S. Annual trends in knee arthroplasty and tibial osteotomy: Analysis of a national database in Japan. Knee 2017; 24:1198-1205. [PMID: 28797877 DOI: 10.1016/j.knee.2017.06.005] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Revised: 04/29/2017] [Accepted: 06/08/2017] [Indexed: 02/02/2023]
Abstract
BACKGROUND Various nationwide studies have reported differing annual trends in utilization of knee arthroplasty and tibial osteotomy. Using the Diagnosis Procedure Combination database in Japan, the present series examined annual trends and demographics in total knee arthroplasty (TKA), unicompartmental knee arthroplasty (UKA) and tibial osteotomy. METHODS All patients were identified who underwent TKA, UKA or tibial osteotomy for osteoarthritis, osteonecrosis or rheumatoid arthritis of the knee between July 2007 and March 2015. RESULTS A total of 170,433 cases of TKA, 13,209 cases of UKA and 8760 cases of tibial osteotomy were identified. The proportion of patients undergoing UKA rose from 4.0% in 2007 to 8.1% in 2014 (P<0.001), and that of tibial osteotomy from 2.6% in 2007 to 5.5% in 2014 (P<0.001); the proportion undergoing TKA fell from 93.4% in 2007 to 86.3% in 2014 (P<0.001). Between 2007 and 2014 the proportions of patients with osteonecrosis who underwent UKA and tibial osteotomy increased from 34.7% and 11.6% to 38.6% and 16.2%, respectively (P=0.001 for UKA and P=0.004 for tibial osteotomy). The proportions of patients with osteonecrosis undergoing UKA or tibial osteotomy were significantly greater than those with other diagnoses (P<0.001 for both). CONCLUSIONS The popularity of UKA and tibial osteotomy in Japan increased during the period 2007-2014 at the expense of TKA. The proportions of UKA and tibial osteotomy in patients with osteonecrosis also increased, and were larger than those in patients with other causative diseases.
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Affiliation(s)
- Manabu Kawata
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Yusuke Sasabuchi
- Department of Health Services Research, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Hiroshi Inui
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan.
| | - Shuji Taketomi
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Hiroki Matsui
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
| | - Kiyohide Fushimi
- Department of Health Informatics and Policy, Graduate School of Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Hirotaka Chikuda
- Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, Gunma, Japan
| | - Hideo Yasunaga
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
| | - Sakae Tanaka
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
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Time trends in the incidence, prevalence, and severity of rheumatoid arthritis: A systematic literature review. Joint Bone Spine 2016; 83:625-630. [DOI: 10.1016/j.jbspin.2016.07.007] [Citation(s) in RCA: 82] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/17/2016] [Indexed: 01/15/2023]
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Nikiphorou E, Norton S, Carpenter L, Dixey J, Andrew Walsh D, Kiely P, Young A. Secular Changes in Clinical Features at Presentation of Rheumatoid Arthritis: Increase in Comorbidity But Improved Inflammatory States. Arthritis Care Res (Hoboken) 2016; 69:21-27. [PMID: 27564223 DOI: 10.1002/acr.23014] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Revised: 07/08/2016] [Accepted: 08/09/2016] [Indexed: 12/31/2022]
Abstract
OBJECTIVE To examine secular trends in demographics, clinical manifestations, and comorbidity on first presentation of rheumatoid arthritis (RA) prior to disease-modifying antirheumatic drug treatment. METHODS A total of 2,701 patients were recruited over 25 years to 2 UK-based RA inception cohorts: the Early Rheumatoid Arthritis Study (9 centers; 1986-2001) and the Early Rheumatoid Arthritis Network (23 centers; 2002-2012). Trends in demographic and baseline clinical/laboratory and radiographic variables and comorbidities were estimated using mixed-effects models, including random effects for recruitment center. RESULTS Age at onset increased from 53.2 to 57.7 years in 1990 and 2010, respectively (2.6 months/year; 95% confidence interval [95% CI] 1.2, 4.1). Sex ratio, the proportion living in deprived areas, and smoking status were unchanged (P > 0.05) and there were no changes in the proportion seropositive or erosive at baseline (P > 0.05). After controlling for treatment at the time of assessment, erythrocyte sedimentation rate decreased and hemoglobin increased over time (P > 0.05); however, the Health Assessment Questionnaire (HAQ), the Disease Activity Score (DAS), the DAS in 28 joints, and joint counts were unchanged (P > 0.05). The overall prevalence of comorbidity increased from 29.0% in 1990 to 50.7% in 2010, mainly due to cardiovascular and non-cardiac vascular conditions, including hypertension. There was a significant increase in body mass index (0.15 units/year; 95% CI 0.11, 0.18), resulting in an increase in the prevalence of obesity from 13.3% in 1990 to 33.6% in 2010. CONCLUSION Age at onset and comorbidity burden, especially obesity, have increased at RA presentation over 25 years, reflecting wider demographic trends at the population level. In contrast, there were no accompanying changes in disease severity assessed by composite markers of disease activity, radiographic erosions, seropositivity, or HAQ at presentation. Treatment strategies in early RA should take greater account of the impact of comorbidity on outcomes.
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Affiliation(s)
- Elena Nikiphorou
- Whittington Hospital NHS Trust, London, UK, and Early Rheumatoid Arthritis Study, St. Albans City Hospital, St. Albans, UK
| | - Sam Norton
- Institute of Psychiatry, Psychology and Neuroscience, and Faculty of Life and Medical Science, King's College London, London, UK
| | - Lewis Carpenter
- Centre for Lifespan and Chronic Illness Research, University of Hertfordshire, Hatfield, UK
| | | | | | - Patrick Kiely
- St. Georges University Hospitals NHS Foundation Trust, London, UK
| | - Adam Young
- Early Rheumatoid Arthritis Study, St. Albans City Hospital, St. Albans, UK
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Zuidema RM, van Gaal BG, van Dulmen S, Repping-Wuts H, Schoonhoven L. An Online Tailored Self-Management Program for Patients With Rheumatoid Arthritis: A Developmental Study. JMIR Res Protoc 2015; 4:e140. [PMID: 26706653 PMCID: PMC4706640 DOI: 10.2196/resprot.4571] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2015] [Revised: 07/22/2015] [Accepted: 07/24/2015] [Indexed: 11/15/2022] Open
Abstract
Background Every day rheumatoid arthritis (RA) patients make many decisions about managing their disease. An online, computer-tailored, self-management program can support this decision making, but development of such a program requires the active participation of patients. Objective To develop an online, computer-tailored, self-management program integrated with the nursing care, as nurses have an important role in supporting self-management behavior. Methods The intervention mapping framework was used to develop the program. Development was a multistep process: (1) needs assessment; (2) developing program and change objectives in a matrix; (3) selecting theory-based intervention methods and practical application strategies; (4) producing program components; (5) planning and adoption, implementation, and sustainability; and (6) planning for evaluation. Results After conducting the needs assessment (step 1), nine health-related problems were identified: (1) balancing rest and activity, (2) setting boundaries, (3) asking for help and support, (4) use of medicines, (5) communicating with health professionals, (6) use of assistive devices, (7) performing physical exercises, (8) coping with worries, and (9) coping with RA. After defining performance and change objectives (step 2), we identified a number of methods which could be used to achieve them (step 3), such as provision of general information about health-related behavior, self-monitoring of behavior, persuasive communication, modeling, and self-persuasion and tailoring. We described and operationalized these methods in texts, videos, exercises, and a medication intake schedule. The resulting program (step 4) consisted of an introduction module and nine modules dealing with health-related problems. The content of these modules is tailored to the user’s self-efficacy, and patients can use the online program as often as they want, working through a module or modules at their own speed. After implementation (step 5), the program will be evaluated in a two-center pilot trial involving 200 RA patients. Log-in data and qualitative interviews will used for a process evaluation. Conclusions The intervention mapping framework was used to guide development of an online computer-tailored self-management program via a process which could serve as a model for the development of other interventions. A pilot randomized controlled trial (RCT) will provide insight into the important outcome measures in preparation for a larger RCT. The process evaluation will provide insight into how RA patients use the program and the attrition rate. Trial Registration Netherlands Trial Register (NTR): NTR4871; http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=4871 [accessed 13-NOV-15]
http://www.webcitation.org/6d1ZyIoEy
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Affiliation(s)
- Rixt M Zuidema
- Radboud University Medical Center, Radboud Institute for Health Sciences, Scientific Institute for Quality of Healthcare, Nijmegen, Netherlands.
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13
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Revicki D, Ganguli A, Kimel M, Roy S, Chen N, Safikhani S, Cifaldi M. Reliability and Validity of the Work Instability Scale for Rheumatoid Arthritis. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2015; 18:1008-1015. [PMID: 26686785 DOI: 10.1016/j.jval.2015.09.2941] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/18/2014] [Revised: 08/13/2015] [Accepted: 09/18/2015] [Indexed: 06/05/2023]
Abstract
OBJECTIVE The objective was to evaluate the psychometric properties of the Rheumatoid Arthritis-Work Instability Scale (RA-WIS) in a clinical trial setting. METHODS Secondary analyses were conducted using data from a 56-week, randomized controlled trial of patients with early rheumatoid arthritis (RA). Patient-reported outcome measures included the RA-WIS, the Health Assessment Questionnaire (HAQ), the Rheumatoid Arthritis Quality of Life Questionnaire, and the Global Assessment of Disease Activity and Pain, data for which were collected at baseline and at weeks 12, 16, 24, and 56. Data were analyzed for reliability, validity, and responsiveness. RESULTS Among 148 patients whose data were analyzed, more than half were women (56.1%) with a mean age of 46.8 years. On average, patients experienced RA symptoms for 8.7 months; the mean 28-Joint Disease Activity Score (DAS28) was 5.9, and the mean HAQ - Disability Index was 1.3. The RA-WIS demonstrated excellent internal consistency and test-retest reliability (α = 0.89 and intraclass correlation coefficient = 0.91, respectively). At baseline and week 24, moderate to strong correlations were seen between RA-WIS total scores and the HAQ, the Global Assessment of Disease Activity, and the Pain Rheumatoid Arthritis Quality of Life Questionnaire, ranging from 0.47 to 0.81 (all P < 0.0001). Mean RA-WIS total scores and work disability risk levels discriminated between clinical severity scores on the DAS28, the HAQ - Disability Index, and the Physician Global Assessment of Disease Activity (all P < 0.05). Mean baseline to week 24 RA-WIS total change scores were significantly different among American College of Rheumatology responder groups (P ≤ 0.0001) and between DAS28 remission status groups (P < 0.001). CONCLUSIONS These findings provide evidence supporting the reliability, validity, and responsiveness of the RA-WIS for evaluating work disability in patients with RA in a clinical trial setting.
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Zuidema RM, Repping-Wuts H, Evers AWM, Van Gaal BGI, Van Achterberg T. What do we know about rheumatoid arthritis patients' support needs for self-management? A scoping review. Int J Nurs Stud 2015; 52:1617-24. [PMID: 26117711 DOI: 10.1016/j.ijnurstu.2015.05.008] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2014] [Revised: 05/28/2015] [Accepted: 05/30/2015] [Indexed: 01/15/2023]
Abstract
BACKGROUND Self-management support is essential to perform self-management behavior. To provide this support in an effective way, insight in the needs for self-management support is necessary. OBJECTIVE To give an overview of self-management support needs from the perspective of rheumatoid arthritis patients to help nurses to improve self-management. DESIGN We conducted a scoping review for the period of January 2002 to May 2013 using the following inclusion criteria: (1) studies on adult patients aged 18 years and older, (2) studies from the perspective of rheumatoid arthritis patients, (3) studies reporting results on support needs, and (4) empirical studies using any design. DATA SOURCES We searched in PubMed, CINAHL, and PsycINFO. REVIEW METHODS Following the steps of a scoping review, we (1) identified the research question, (2) identified relevant studies, (3) selected studies, (4) charted the data, and (5) collated, summarized, and reported results. We incorporated the optional sixth step of consultation of a multidisciplinary panel of professionals and patients to validate our findings. RESULTS Seventeen articles were included. Our review shows that rheumatoid arthritis patients have informational, emotional, social and practical support needs. We found an information need for various topics, e.g. exercises and medication. Patients express a need for emotional support in daily life, given through other RA patients, colleagues and supervisors and nurses. For information needs, emotional and social support it is important that it is tailored to the individual needs of the patient. CONCLUSION The most important support needs for self-management mentioned by rheumatoid arthritis patients are more informational, social and practical support and emotional support. Considering patients' perspective as a starting point for delivering support for self-management can lead to the development of nursing interventions tailored to the needs of rheumatoid arthritis patients.
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Affiliation(s)
- R M Zuidema
- Radboud university medical center, Radboud Institute for Health Science, Scientific Institute for Quality of Healthcare (IQ healthcare), Nijmegen, The Netherlands.
| | - H Repping-Wuts
- Radboud university medical center, Department of Rheumatology, Radboud Institute for Health Science, Nijmegen, The Netherlands
| | - A W M Evers
- University of Leiden, Department of Health, Medical and Neuropsychology, The Netherlands; Radboud university medical center, Department of Medical Psychology, Nijmegen, The Netherlands
| | - B G I Van Gaal
- Radboud university medical center, Radboud Institute for Health Science, Scientific Institute for Quality of Healthcare (IQ healthcare), Nijmegen, The Netherlands
| | - T Van Achterberg
- KU Leuven, Centre for Health Services and Nursing Research, Leuven, Belgium; Radboud university medical center, Radboud Institute for Health Science, Scientific Institute for Quality of Healthcare (IQ healthcare), Nijmegen, The Netherlands
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Nakashita T, Ando K, Kaneko N, Takahashi K, Motojima S. Potential risk of TNF inhibitors on the progression of interstitial lung disease in patients with rheumatoid arthritis. BMJ Open 2014; 4:e005615. [PMID: 25125479 PMCID: PMC4139628 DOI: 10.1136/bmjopen-2014-005615] [Citation(s) in RCA: 65] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVES Biological therapy represents important advances in alleviating rheumatoid arthritis (RA), but the effect on interstitial lung disease (ILD) has been controversial. The objective of this study was to assess the risk of such treatment for patients with ILD. DESIGN Case-control cohorts. SETTING Single centre in Japan. PARTICIPANTS This study included 163 patients with RA who underwent biological therapy. OUTCOME MEASURED We assessed chest CT before initiation of biological therapy and grouped 163 patients according to the presence of ILD (with (n=58) and without pre-existing ILD (n=105)). Next, we evaluated serial changes of chest CT after treatment and visually assessed the emergence of ILD or its progression, which was referred to as an 'ILD event'. Then, we also classified the patients according to the presence of ILD events and analysed their characteristics. RESULTS Tumour necrosis factor (TNF) inhibitors were administered to more patients with ILD events than those without ILD events (88% vs 60%, p<0.05), but recipients of tocilizumab or abatacept did not differ in this respect. Of 58 patients with pre-existing ILD, 14 had ILD events, and that proportion was greater than for those without pre-existing ILD (24% vs 3%, p<0.001). Of these 14 patients, all were treated with TNF inhibitors. Four patients developed generalised lung disease and two died from ILD progression. Baseline levels of KL-6 were similar in both groups, but increased in patients with ILD events. CONCLUSIONS TNF inhibitors have the potential risk of ILD events, particularly for patients with pre-existing ILD, and KL-6 is a valuable surrogate marker for detecting ILD events. Our data suggest that non-TNF inhibitors are a better treatment option for these patients.
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MESH Headings
- Abatacept
- Adalimumab
- Aged
- Antibodies, Monoclonal/adverse effects
- Antibodies, Monoclonal, Humanized/adverse effects
- Antirheumatic Agents/adverse effects
- Arthritis, Rheumatoid/complications
- Arthritis, Rheumatoid/drug therapy
- Case-Control Studies
- Disease Progression
- Etanercept
- Female
- Humans
- Immunoconjugates/adverse effects
- Immunoglobulin G/adverse effects
- Infliximab
- Lung/diagnostic imaging
- Lung Diseases, Interstitial/chemically induced
- Lung Diseases, Interstitial/complications
- Lung Diseases, Interstitial/diagnosis
- Male
- Middle Aged
- Mucin-1/blood
- Receptors, Tumor Necrosis Factor
- Retrospective Studies
- Tomography, X-Ray Computed
- Tumor Necrosis Factor-alpha/antagonists & inhibitors
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Affiliation(s)
- Tamao Nakashita
- Department of Rheumatology, Kameda Medical Center, Kamogawa City, Chiba, Japan
| | - Katsutoshi Ando
- Division of Respiratory Medicine, Juntendo University Faculty of Medicine and Graduate School of Medicine, Bunkyo-Ku, Tokyo, Japan
| | - Norihiro Kaneko
- Department of Respiratory Internal Medicine, Kameda Medical Center, Kamogawa City, Chiba, Japan
| | - Kazuhisa Takahashi
- Division of Respiratory Medicine, Juntendo University Faculty of Medicine and Graduate School of Medicine, Bunkyo-Ku, Tokyo, Japan
| | - Shinji Motojima
- Department of Rheumatology, Kameda Medical Center, Kamogawa City, Chiba, Japan
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Diffin JG, Lunt M, Marshall T, Chipping JR, Symmons DPM, Verstappen SMM. Has the severity of rheumatoid arthritis at presentation diminished over time? J Rheumatol 2014; 41:1590-9. [PMID: 24986850 DOI: 10.3899/jrheum.131136] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVE To examine the pattern of disease severity in patients with rheumatoid arthritis (RA) at presentation to the Norfolk Arthritis Register (NOAR) over 20 years. METHODS NOAR is a primary-care-based cohort of patients with recent-onset inflammatory polyarthritis. At baseline, subjects are assessed and examined by a research nurse. The Health Assessment Questionnaire (HAQ) is administered and the DAS28 (28-joint Disease Activity Score) is calculated. Information is collected on disease-modifying antirheumatic drug exposure. In this study, patients (symptom duration of < 2 years at baseline) were grouped into 4 cohorts (Cohort 1: 1990-1994; Cohort 2: 1995-1999; Cohort 3: 2000-2004; Cohort 4: 2005-2008). The American College of Rheumatology/European League Against Rheumatism (ACR/EULAR) 2010 criteria for RA were applied retrospectively at baseline. Regression analyses were used to examine whether calendar year of presentation to NOAR was associated with baseline HAQ and DAS28 scores. Potential confounders included age at symptom onset, sex, rheumatoid factor, and anticyclic citrullinated peptide antibody positivity. RESULTS A total of 1724 patients met the ACR/EULAR 2010 RA criteria at baseline. Unadjusted mean DAS28 scores decreased over time. Calendar year of presentation to NOAR was significantly associated with lower DAS28 scores over time [Y = 4.51 + (-0.56 × year) + (0.44 × year(2))]. Although unadjusted median HAQ scores increased over time, calendar year of presentation to NOAR was not significantly associated with HAQ scores [Y = (1.1) + (0.023 × year) + (0.05 × year(2))]. Similar results were observed in each subpopulation of patients. CONCLUSION While baseline disease activity has lessened slightly over time, there has been no improvement in baseline levels of functional disability.
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Affiliation(s)
- Janet G Diffin
- From the Arthritis Research UK Centre for Epidemiology, Manchester Academic Health Science Centre, and The School of Nursing, Midwifery, and Social Work, University of Manchester, Manchester; Department of Rheumatology, Norfolk and Norwich University Hospital, Norwich; Norfolk Arthritis Register (NOAR), School of Medicine, Health Policy, and Practice, University of East Anglia, Norwich; UK National Institute for Health Research (NIHR) Manchester Musculoskeletal Biomedical Research Unit, Central Manchester University Hospitals National Health Service (NHS) Foundation Trust and University of Manchester Partnership, Manchester, UK.J.G. Diffin, PhD, Research Associate, Arthritis Research UK Centre for Epidemiology, Manchester Academic Health Science Centre, and The School of Nursing, Midwifery, and Social Work, University of Manchester; M. Lunt, PhD, Reader in Medical Statistics, Arthritis Research UK Centre for Epidemiology, Manchester Academic Health Science Centre, University of Manchester; T. Marshall, MD, Consultant Rheumatologist, Department of Rheumatology, Norfolk and Norwich University Hospital; J.R. Chipping, NOAR Deputy Clinical Manager, School of Medicine, Health Policy, and Practice, University of East Anglia; D.P.M. Symmons, MD, FRCP, FFPH, Arthritis Research UK Centre for Epidemiology, Manchester Academic Health Science Centre, University of Manchester, and NIHR Manchester Musculoskeletal Biomedical Research Unit, Central Manchester University Hospitals NHS Foundation Trust and University of Manchester Partnership; S.M.M. Verstappen, PhD, Senior Research Fellow, Arthritis Research UK Centre for Epidemiology, Manchester Academic Health Science Centre, University of Manchester
| | - Mark Lunt
- From the Arthritis Research UK Centre for Epidemiology, Manchester Academic Health Science Centre, and The School of Nursing, Midwifery, and Social Work, University of Manchester, Manchester; Department of Rheumatology, Norfolk and Norwich University Hospital, Norwich; Norfolk Arthritis Register (NOAR), School of Medicine, Health Policy, and Practice, University of East Anglia, Norwich; UK National Institute for Health Research (NIHR) Manchester Musculoskeletal Biomedical Research Unit, Central Manchester University Hospitals National Health Service (NHS) Foundation Trust and University of Manchester Partnership, Manchester, UK.J.G. Diffin, PhD, Research Associate, Arthritis Research UK Centre for Epidemiology, Manchester Academic Health Science Centre, and The School of Nursing, Midwifery, and Social Work, University of Manchester; M. Lunt, PhD, Reader in Medical Statistics, Arthritis Research UK Centre for Epidemiology, Manchester Academic Health Science Centre, University of Manchester; T. Marshall, MD, Consultant Rheumatologist, Department of Rheumatology, Norfolk and Norwich University Hospital; J.R. Chipping, NOAR Deputy Clinical Manager, School of Medicine, Health Policy, and Practice, University of East Anglia; D.P.M. Symmons, MD, FRCP, FFPH, Arthritis Research UK Centre for Epidemiology, Manchester Academic Health Science Centre, University of Manchester, and NIHR Manchester Musculoskeletal Biomedical Research Unit, Central Manchester University Hospitals NHS Foundation Trust and University of Manchester Partnership; S.M.M. Verstappen, PhD, Senior Research Fellow, Arthritis Research UK Centre for Epidemiology, Manchester Academic Health Science Centre, University of Manchester
| | - Tarnya Marshall
- From the Arthritis Research UK Centre for Epidemiology, Manchester Academic Health Science Centre, and The School of Nursing, Midwifery, and Social Work, University of Manchester, Manchester; Department of Rheumatology, Norfolk and Norwich University Hospital, Norwich; Norfolk Arthritis Register (NOAR), School of Medicine, Health Policy, and Practice, University of East Anglia, Norwich; UK National Institute for Health Research (NIHR) Manchester Musculoskeletal Biomedical Research Unit, Central Manchester University Hospitals National Health Service (NHS) Foundation Trust and University of Manchester Partnership, Manchester, UK.J.G. Diffin, PhD, Research Associate, Arthritis Research UK Centre for Epidemiology, Manchester Academic Health Science Centre, and The School of Nursing, Midwifery, and Social Work, University of Manchester; M. Lunt, PhD, Reader in Medical Statistics, Arthritis Research UK Centre for Epidemiology, Manchester Academic Health Science Centre, University of Manchester; T. Marshall, MD, Consultant Rheumatologist, Department of Rheumatology, Norfolk and Norwich University Hospital; J.R. Chipping, NOAR Deputy Clinical Manager, School of Medicine, Health Policy, and Practice, University of East Anglia; D.P.M. Symmons, MD, FRCP, FFPH, Arthritis Research UK Centre for Epidemiology, Manchester Academic Health Science Centre, University of Manchester, and NIHR Manchester Musculoskeletal Biomedical Research Unit, Central Manchester University Hospitals NHS Foundation Trust and University of Manchester Partnership; S.M.M. Verstappen, PhD, Senior Research Fellow, Arthritis Research UK Centre for Epidemiology, Manchester Academic Health Science Centre, University of Manchester
| | - Jacqueline R Chipping
- From the Arthritis Research UK Centre for Epidemiology, Manchester Academic Health Science Centre, and The School of Nursing, Midwifery, and Social Work, University of Manchester, Manchester; Department of Rheumatology, Norfolk and Norwich University Hospital, Norwich; Norfolk Arthritis Register (NOAR), School of Medicine, Health Policy, and Practice, University of East Anglia, Norwich; UK National Institute for Health Research (NIHR) Manchester Musculoskeletal Biomedical Research Unit, Central Manchester University Hospitals National Health Service (NHS) Foundation Trust and University of Manchester Partnership, Manchester, UK.J.G. Diffin, PhD, Research Associate, Arthritis Research UK Centre for Epidemiology, Manchester Academic Health Science Centre, and The School of Nursing, Midwifery, and Social Work, University of Manchester; M. Lunt, PhD, Reader in Medical Statistics, Arthritis Research UK Centre for Epidemiology, Manchester Academic Health Science Centre, University of Manchester; T. Marshall, MD, Consultant Rheumatologist, Department of Rheumatology, Norfolk and Norwich University Hospital; J.R. Chipping, NOAR Deputy Clinical Manager, School of Medicine, Health Policy, and Practice, University of East Anglia; D.P.M. Symmons, MD, FRCP, FFPH, Arthritis Research UK Centre for Epidemiology, Manchester Academic Health Science Centre, University of Manchester, and NIHR Manchester Musculoskeletal Biomedical Research Unit, Central Manchester University Hospitals NHS Foundation Trust and University of Manchester Partnership; S.M.M. Verstappen, PhD, Senior Research Fellow, Arthritis Research UK Centre for Epidemiology, Manchester Academic Health Science Centre, University of Manchester
| | - Deborah P M Symmons
- From the Arthritis Research UK Centre for Epidemiology, Manchester Academic Health Science Centre, and The School of Nursing, Midwifery, and Social Work, University of Manchester, Manchester; Department of Rheumatology, Norfolk and Norwich University Hospital, Norwich; Norfolk Arthritis Register (NOAR), School of Medicine, Health Policy, and Practice, University of East Anglia, Norwich; UK National Institute for Health Research (NIHR) Manchester Musculoskeletal Biomedical Research Unit, Central Manchester University Hospitals National Health Service (NHS) Foundation Trust and University of Manchester Partnership, Manchester, UK.J.G. Diffin, PhD, Research Associate, Arthritis Research UK Centre for Epidemiology, Manchester Academic Health Science Centre, and The School of Nursing, Midwifery, and Social Work, University of Manchester; M. Lunt, PhD, Reader in Medical Statistics, Arthritis Research UK Centre for Epidemiology, Manchester Academic Health Science Centre, University of Manchester; T. Marshall, MD, Consultant Rheumatologist, Department of Rheumatology, Norfolk and Norwich University Hospital; J.R. Chipping, NOAR Deputy Clinical Manager, School of Medicine, Health Policy, and Practice, University of East Anglia; D.P.M. Symmons, MD, FRCP, FFPH, Arthritis Research UK Centre for Epidemiology, Manchester Academic Health Science Centre, University of Manchester, and NIHR Manchester Musculoskeletal Biomedical Research Unit, Central Manchester University Hospitals NHS Foundation Trust and University of Manchester Partnership; S.M.M. Verstappen, PhD, Senior Research Fellow, Arthritis Research UK Centre for Epidemiology, Manchester Academic Health Science Centre, University of Manchester
| | - Suzanne M M Verstappen
- From the Arthritis Research UK Centre for Epidemiology, Manchester Academic Health Science Centre, and The School of Nursing, Midwifery, and Social Work, University of Manchester, Manchester; Department of Rheumatology, Norfolk and Norwich University Hospital, Norwich; Norfolk Arthritis Register (NOAR), School of Medicine, Health Policy, and Practice, University of East Anglia, Norwich; UK National Institute for Health Research (NIHR) Manchester Musculoskeletal Biomedical Research Unit, Central Manchester University Hospitals National Health Service (NHS) Foundation Trust and University of Manchester Partnership, Manchester, UK.J.G. Diffin, PhD, Research Associate, Arthritis Research UK Centre for Epidemiology, Manchester Academic Health Science Centre, and The School of Nursing, Midwifery, and Social Work, University of Manchester; M. Lunt, PhD, Reader in Medical Statistics, Arthritis Research UK Centre for Epidemiology, Manchester Academic Health Science Centre, University of Manchester; T. Marshall, MD, Consultant Rheumatologist, Department of Rheumatology, Norfolk and Norwich University Hospital; J.R. Chipping, NOAR Deputy Clinical Manager, School of Medicine, Health Policy, and Practice, University of East Anglia; D.P.M. Symmons, MD, FRCP, FFPH, Arthritis Research UK Centre for Epidemiology, Manchester Academic Health Science Centre, University of Manchester, and NIHR Manchester Musculoskeletal Biomedical Research Unit, Central Manchester University Hospitals NHS Foundation Trust and University of Manchester Partnership; S.M.M. Verstappen, PhD, Senior Research Fellow, Arthritis Research UK Centre for Epidemiology, Manchester Academic Health Science Centre, University of Manchester.
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Rendas-Baum R, Bayliss M, Kosinski M, Raju A, Zwillich SH, Wallenstein GV, Koncz T. Measuring the effect of therapy in rheumatoid arthritis clinical trials from the patient's perspective. Curr Med Res Opin 2014; 30:1391-403. [PMID: 24716665 DOI: 10.1185/03007995.2014.896328] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE Health measurements used to evaluate the effectiveness of rheumatoid arthritis (RA) therapies often fail to reflect patients' priorities, despite recommendations towards more patient-centered assessments. The goals of the current review are: (1) to present guidelines, tools, and required steps for successful implementation of patient-reported outcome (PRO) measurement in RA clinical trials; and (2) to identify gaps between recommendations and current practices. METHODS The first objective was addressed by reviewing existing frameworks for assessment of health-related quality of life among patients with RA and guidelines on the evaluation of PRO instruments, with a focus on evidence required to demonstrate the adequacy of PRO-based labeling claims. The second goal was addressed by conducting an empirical investigation of the overlap between patients' perspectives and current practices regarding PROs in RA studies, elaborated from systematic literature searches. The first search identified qualitative studies that reported direct input from patients with RA, while the second identified the main health outcomes measured in RA trials, with a focus on biologic therapy. RESULTS Our review revealed a set of outcomes that have thus far not been widely used to assess treatment benefit in RA, despite evidence of their importance to patients. The psychometric properties of PRO instruments used to evaluate commonly assessed domains are presented, as are recommendations for PRO tools that assess domains less often measured in RA studies. CONCLUSIONS Although the validity of some PRO tools among patients with RA is well established, further work needs to be done in several health domains which have traditionally received insufficient attention.
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Overman CL, Jurgens MS, Bossema ER, Jacobs JWG, Bijlsma JWJ, Geenen R. Change of psychological distress and physical disability in patients with rheumatoid arthritis over the last two decades. Arthritis Care Res (Hoboken) 2014; 66:671-8. [PMID: 24302705 DOI: 10.1002/acr.22211] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2013] [Accepted: 10/15/2013] [Indexed: 11/11/2022]
Abstract
OBJECTIVE During the past decades, a more cautious approach with respect to prescribing medication and physical exercise progressed toward evidence-based guidelines regarding the management of rheumatoid arthritis (RA). Currently, physical activity and other means to improve well-being and functioning are encouraged, and the disease is targeted earlier with more intensive and aggressive pharmacologic treatment. The current study examined whether psychological distress and physical disability in patients with RA reduced over the last 2 decades and whether this is explained by a reduction of disease activity. METHODS From 1990-2011, consecutive patients with RA (n = 1,151, age range 17-86 years, 68% female, 62% rheumatoid factor positive) were monitored at diagnosis and after 3-5 years of treatment (followup). Depressed mood, anxiety, and physical disability were predicted in multiple linear regression analyses by year of assessment, disease activity, and patient demographics. RESULTS Over the decades, depressed mood (P = 0.01), anxiety (P = 0.001), and physical disability (P = 0.02) reduced at diagnosis and within-treatment improvement of anxiety (P = 0.04) and physical disability (P < 0.001) increased. Percentages of patients with depressed mood, anxiety, and physical disability at followup changed from 25%, 23%, and 53%, respectively, 2 decades ago to 14%, 12%, and 31%, respectively, currently. After taking account of reduction in disease activity, the decrease in physical disability remained significant (P < 0.001). CONCLUSION Over the last 2 decades, psychological distress and physical disability decreased. This favorable trend might partly be due to reduced disease activity. The results indicate that patients with RA have a better opportunity to live a valued life currently than 20 years ago.
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Norton S, Fu B, Scott DL, Deighton C, Symmons DPM, Wailoo AJ, Tosh J, Lunt M, Davies R, Young A, Verstappen SMM. Health Assessment Questionnaire disability progression in early rheumatoid arthritis: systematic review and analysis of two inception cohorts. Semin Arthritis Rheum 2014; 44:131-44. [PMID: 24925692 PMCID: PMC4282305 DOI: 10.1016/j.semarthrit.2014.05.003] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2013] [Revised: 03/26/2014] [Accepted: 05/02/2014] [Indexed: 11/29/2022]
Abstract
Objective The Health Assessment Questionnaire is widely used for patients with inflammatory polyarthritis (IP) and its subset, rheumatoid arthritis (RA). In this study, we evaluated the progression of HAQ scores in RA (i) by systematically reviewing the published literature on the methods used to assess changes in functional disability over time and (ii) to study in detail HAQ progression in two large prospective observational studies from the UK. Methods Data from two large inception cohorts, ERAS and NOAR, were studied to determine trajectories of HAQ progression over time by applying latent class growth models (LCGMs) to each dataset separately. Age, sex, baseline DAS28, symptom duration, rheumatoid factor, fulfilment of the 1987 ACR criteria and socio-economic status (SES) were included as potential predictors of HAQ trajectory subgroup membership. Results The literature search identified 49 studies showing that HAQ progression has mainly been based on average changes in the total study population. In the HAQ progression study, a LCGM with four HAQ trajectory subgroups was selected as providing the best fit in both cohorts. In both the cohorts, older age, female sex, longer symptom duration, fulfilment of the 1987 ACR criteria, higher DAS28 and lower SES were associated with increased likelihood of membership of subgroups with worse HAQ progression. Conclusion Four distinct HAQ trajectory subgroups were derived from the ERAS and NOAR cohorts. The fact that the subgroups identified were nearly identical supports their validity. Identifying distinct groups of patients who are at risk of poor functional outcome may help to target therapy to those who are most likely to benefit.
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Affiliation(s)
- Sam Norton
- Psychology Department, Institute of Psychiatry, King׳s College London, London, UK
| | - Bo Fu
- Centre for Biostatistics, Institute of Population Health, The University of Manchester, Manchester, UK
| | - David L Scott
- Department of Rheumatology, Kings College Hospital, London, UK
| | - Chris Deighton
- Department of Rheumatology, Medical Specialities Out-Patients, Rehabilitation Block, Royal Derby Hospital, Derby, UK
| | - Deborah P M Symmons
- Arthritis Research UK Centre for Epidemiology, Centre for Musculoskeletal Research, Institute of Inflammation and Repair, The University of Manchester, Manchester Academic Health Science Centre, Stopford Building, Oxford Rd, Manchester M13 9PT, UK; NIHR Manchester Musculoskeletal Biomedical Research Unit, Central Manchester University Hospitals NHS Foundation Trust and University of Manchester Partnership, Manchester, UK
| | - Allan J Wailoo
- School of Health and Related Research, University of Sheffield, UK
| | - Jonathan Tosh
- School of Health and Related Research, University of Sheffield, UK
| | - Mark Lunt
- Arthritis Research UK Centre for Epidemiology, Centre for Musculoskeletal Research, Institute of Inflammation and Repair, The University of Manchester, Manchester Academic Health Science Centre, Stopford Building, Oxford Rd, Manchester M13 9PT, UK
| | - Rebecca Davies
- Arthritis Research UK Centre for Epidemiology, Centre for Musculoskeletal Research, Institute of Inflammation and Repair, The University of Manchester, Manchester Academic Health Science Centre, Stopford Building, Oxford Rd, Manchester M13 9PT, UK
| | - Adam Young
- Early Rheumatoid Arthritis Study, City Hospital, St Albans, UK
| | - Suzanne M M Verstappen
- Arthritis Research UK Centre for Epidemiology, Centre for Musculoskeletal Research, Institute of Inflammation and Repair, The University of Manchester, Manchester Academic Health Science Centre, Stopford Building, Oxford Rd, Manchester M13 9PT, UK.
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Hekmat K, Jacobsson LT, Nilsson JÅ, Lindroth Y, Turesson C. Changes and sex differences in patient reported outcomes in rheumatoid factor positive RA-results from a community based study. BMC Musculoskelet Disord 2014; 15:44. [PMID: 24552546 PMCID: PMC3932728 DOI: 10.1186/1471-2474-15-44] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2013] [Accepted: 02/17/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Patient reported outcomes (PROs) are important measures in rheumatoid arthritis (RA). A register of patients with RA from all rheumatology care providers in Malmö, Sweden, was established in 1997 and has been continually updated. This register includes virtually all the RA patients in the area. The aim of this study was to analyse PROs in surveys of this population conducted between 1997 and 2009, and to assess differences in treatment and outcome in male and female patients. METHOD In 1997, 2002, 2005 and 2009, questionnaires were sent to the RA patients in the register (n = 1016 in 1997; n = 916 in 2002; n = 1625 in 2005; n = 1700 in 2009). Response rates varied between 62 % and 74 %, and 72-74 % was women. Questionnaire data included medication and measures of disability and health related quality of life. Data on rheumatoid factor (RF) tests were retrieved from the databases of the two clinical immunology laboratories in the area. In order to limit the impact of changes in the case mix over time, the study was restricted to RF positive patients. The analyses were stratified by sex. RESULTS Patients reported less severe outcomes for all measures in the later surveys compared to 1997, and patients' global disease activity assessment and self-reported pain were further improved in 2009 compared to 2005. Treatment with biologics increased over time from 1997 (none) to 2009 (29%), with no difference between men and women. Visual analogue scales (0-100) for patients' global assessment of disease activity [mean 45 (95 % CI (45-47) vs. 38 (35-40)] and pain [mean 46 (44-49) vs. 38 (36-40)] decreased from 1997 to 2009, with numerically greater improvement in male patients. The mean SF-36 physical component scores also improved, and were higher in men than in women in all surveys. CONCLUSION Pharmacologic treatment of RA became more extensive over time, and there was improvement in all PROs. Despite similar treatment, male patients reported better outcomes, in particular for pain and physical function, compared to female patients. We suggest that patient reported outcomes should be reported separately in male and female patients with RA.
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Affiliation(s)
- Korosh Hekmat
- Department of Clinical Sciences, Section of Rheumatology, Lund University, Malmö, Sweden.
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Simon JE, Docherty CL. Current health-related quality of life is lower in former Division I collegiate athletes than in non-collegiate athletes. Am J Sports Med 2014; 42:423-9. [PMID: 24318608 DOI: 10.1177/0363546513510393] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND College athletes participate in physical activity that may increase chronic stress and injury and induce overtraining. However, there is little known about how previous injuries that have occurred during college may limit current physical activity and/or decrease their subsequent health-related quality of life (HRQoL). PURPOSE To evaluate HRQoL in former United States National Collegiate Athletic Association Division I athletes and nonathletes with the Patient-Reported Outcomes Measurement Information System (PROMIS) and a demographics questionnaire. STUDY DESIGN Cohort study (prognosis); Level of evidence, 2. METHODS The study sample was recruited through alumni databases at a large Midwestern university and consisted of 2 cohorts: (1) former Division I athletes and (2) nonathletes who participated in recreational activity, club sports, or intramurals while attending college. Participants answered a survey constructed with a web-based system. All individuals contacted were between the ages of 40 and 65 years. Study participants responded to the questions on the PROMIS scales for sleep, anxiety, depression, fatigue, pain interference, physical function, and satisfaction with participation in social roles. The PROMIS was developed to fill the void of HRQoL being evaluated by multiple instruments. An additional questionnaire was constructed to record demographic and exercise information. RESULTS Initially, 1280 former Division I athletes and nonathletes were contacted; 638 surveys were returned (49.8%). Surveys eligible for analyses (71.6%) were completed by 232 former Division I athletes (mean age ± SD, 53.36 ± 7.11 years) and 225 nonathletes (mean age ± SD, 53.60 ± 6.79 years). Univariate analyses for the effect of group was significantly related to PROMIS scales for physical function, depression, fatigue, sleep disturbances, and pain interference (P < .05). The overall scores were significantly worse for the former Division I athletes than for the nonathletes on 5 of the 7 scales. In addition, the former Division I athletes reported significantly more limitations in daily activities and more major and chronic injuries than did the nonathlete controls. CONCLUSION According to these data, former Division I athletes have decreased HRQoL compared with nonathletes. CLINICAL RELEVANCE Sports encourage physical activity, which help promote a healthy lifestyle. Moderate activity and exercise should be encouraged. However, the demands of Division I athletics may result in injuries that linger into adulthood and possibly make participants incapable of staying active as they age, thereby lowering their HRQoL.
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Affiliation(s)
- Janet E Simon
- Janet E. Simon, MS, ATC, Indiana University, 1025 East Seventh Street, Bloomington, IN 47405.
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Welsing PMJ, Kievit W, Laan RFJM, Severens JL. Quality of life and costs for different treatment strategies for rheumatoid arthritis. Expert Rev Pharmacoecon Outcomes Res 2014; 5:395-410. [DOI: 10.1586/14737167.5.4.395] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Vliet Vlieland TPM. New models of care for patients with rheumatoid arthritis. Expert Rev Pharmacoecon Outcomes Res 2014; 6:159-69. [DOI: 10.1586/14737167.6.2.159] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Yamanaka H, Inoue E, Singh G, Tanaka E, Nakajima A, Taniguchi A, Hara M, Tomatsu T, Kamatani N. Improvement of disease activity of rheumatoid arthritis patients from 2000 to 2006 in a large observational cohort study IORRA in Japan. Mod Rheumatol 2014. [DOI: 10.3109/s10165-007-0587-6] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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Sokka T, Envalds M, Pincus T. Treatment of rheumatoid arthritis: a global perspective on the use of antirheumatic drugs. Mod Rheumatol 2014. [DOI: 10.3109/s10165-008-0056-x] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Austad C, Kvien TK, Olsen IC, Uhlig T. Health status has improved more in women than in men with rheumatoid arthritis from 1994 to 2009: results from the Oslo rheumatoid arthritis register. Ann Rheum Dis 2013; 74:148-55. [DOI: 10.1136/annrheumdis-2013-204014] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
ObjectiveTo examine changes in patient reported outcome measures (PROs) over 15 years in a representative population of patients with rheumatoid arthritis (RA), with a particular focus on gender differences.Patients and methodsPatients in the Oslo RA register filled in questionnaires including the Modified Health Assessment Questionnaire (MHAQ), the Short-Form 36 (SF-36) with physical (PCS) and mental component summaries and derived utility (SF-6D), visual analogue scales (VAS) for pain, patient global assessment of disease (PtGA) and fatigue, and checklists of medication commonly used in the treatment of RA. Data were collected at five time points during a 15-year period from 1994. Mixed model analyses were used to analyse longitudinal changes in PROs from 1994 to 1996, 2001, 2004 and 2009.ResultsData were available from 829–1025 RA patients at each time point. PROs were statistically significantly improved from 1994 to 2009 (MHAQ, SF-36 PCS, SF-6D, pain VAS, PtGA VAS and fatigue VAS; all p<0.001), and also with clinically important improvement. Men reported significantly better health status than women in 1994, but women improved significantly more than men over 15 years with a reduction of the gender gap in 2009. Antirheumatic medication was increasingly used over 15 years with no gender differences.ConclusionsRA patients reported statistically significantly improved health status for most PROs from 1994 to 2009. Women improved most, and although they still reported higher disease impact than men, the gender differences were small at the final data collection in 2009.
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Meesters J, Verhoef J, Tijhuis G, Vliet Vlieland T. Functional disability in patients with rheumatoid arthritis admitted for multidisciplinary rehabilitation from 1992 to 2009. Rheumatology (Oxford) 2013; 52:1879-83. [DOI: 10.1093/rheumatology/ket232] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Nair SC, Bijlsma JWJ, van der Werf JH, van der Veen MJ, Linn-Rasker SP, Vreugdenhil S, Lafeber FPJG, Welsing PMJ. Do radiographic joint damage and disease activity influence functional disability through different mechanisms? Direct and indirect effects of disease activity in established rheumatoid arthritis. J Rheumatol 2013; 40:1505-12. [PMID: 23818710 DOI: 10.3899/jrheum.121346] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
OBJECTIVE To explore the relationship between rheumatoid arthritis (RA) disease activity and functional disability over time, considering indirect (predictive) and direct (concurrent) associations as well as the influence of radiographic joint damage and treatment strategy. METHODS Functional disability [Health Assessment Questionnaire (HAQ)], disease activity [28-joint Disease Activity Score (DAS28)], and radiographic joint damage [Sharp/van der Heijde score (SHS)] were measured in 4 consecutive randomized controlled trials with increasingly intensive (tight control) treatment strategies. Average followup time for the 3 cohorts was 97, 53, and 50 months, respectively. Next to current DAS28, the previous DAS28 was used to study the predictive effect of a change in DAS28 on progression of functional disability (HAQ). Finally, it was investigated whether SHS mediated the predictive effect of DAS28. RESULTS In patients treated with intensive treatment strategies, the progression of HAQ over time was statistically significantly less (p < 0.0001). The predictive influence of DAS28 on HAQ progression increased over the duration of the disease. SHS was not found to influence HAQ progression and did not mediate the predictive effect of DAS28. In the less intensively treated patients, the direct effect of disease activity decreased with disease duration, and contrarily, SHS did influence HAQ progression, but was not found to (fully) mediate the predictive effect of DAS28. CONCLUSION In patients with RA treated with modern treatment strategies, there is less functional decline over time. Further, disease activity does predict functional decline but joint damage does not. This might indicate that factors associated with cumulative disease activity but not visible on radiographs can influence functional decline in patients with RA. This further underlines the importance of disease activity as a treatment target in early RA and in established RA.
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Affiliation(s)
- Sandhya C Nair
- From the Department of Rheumatology and Clinical Immunology, University Medical Center Utrecht, Utrecht, The Netherlands.
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Almoallim H, Kamil A. Rheumatoid arthritis: should we shift the focus from “Treat to Target” to “Treat to Work?”. Clin Rheumatol 2013; 32:285-7. [DOI: 10.1007/s10067-012-2160-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2012] [Accepted: 12/19/2012] [Indexed: 11/30/2022]
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Dafydd M, Whitaker I, Murison M, Boyce D. Change in operative workload for rheumatoid disease of the hand: 1,109 procedures over 13 years. J Plast Reconstr Aesthet Surg 2012; 65:800-3. [DOI: 10.1016/j.bjps.2011.11.050] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2011] [Revised: 10/22/2011] [Accepted: 11/25/2011] [Indexed: 10/14/2022]
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Fries J, Rose M, Krishnan E. The PROMIS of better outcome assessment: responsiveness, floor and ceiling effects, and Internet administration. J Rheumatol 2012; 38:1759-64. [PMID: 21807798 DOI: 10.3899/jrheum.110402] [Citation(s) in RCA: 113] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVE Use of item response theory (IRT) and, subsequently, computerized adaptive testing (CAT), under the umbrella of the NIH-PROMIS initiative (National Institutes of Health-Patient-Reported Outcomes Measurement Information System), to bring strong new assets to the development of more sensitive, more widely applicable, and more efficiently administered patient-reported outcome (PRO) instruments. We present data on current progress in 3 crucial areas: floor and ceiling effects, responsiveness to change, and interactive computer-based administration over the Internet. METHODS We examined nearly 1000 patients with rheumatoid arthritis and related diseases in a series of studies including a one-year longitudinal examination of detection of change; compared responsiveness of the Legacy SF-36 and HAQ-DI instruments with IRT-based instruments; performed a randomized head-to-head trial of 4 modes of item administration; and simulated the effect of lack of floor and ceiling items upon statistical power and sample sizes. RESULTS IRT-based PROMIS instruments are more sensitive to change, resulting in the potential to reduce sample size requirements substantially by up to a factor of 4. The modes of administration tested did not differ from each other in any instance by more than one-tenth of a standard deviation. Floor and ceiling effects greatly reduce the number of available subjects, particularly at the ceiling. CONCLUSION Failure to adequately address floor and ceiling effects, which determine the range of an instrument, can result in suboptimal assessment of many patients. Improved items, improved instruments, and computer-based administration improve PRO assessment and represent a fundamental advance in clinical outcomes research.
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Affiliation(s)
- James Fries
- Department of Medicine, Stanford University School of Medicine, Palo Alto, California, USA.
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Verstappen SM, Symmons DP. What is the outcome of RA in 2011 and can we predict it? Best Pract Res Clin Rheumatol 2011; 25:485-96. [DOI: 10.1016/j.berh.2011.10.008] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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Rothrock NE, Hays RD, Spritzer K, Yount SE, Riley W, Cella D. Relative to the general US population, chronic diseases are associated with poorer health-related quality of life as measured by the Patient-Reported Outcomes Measurement Information System (PROMIS). J Clin Epidemiol 2010; 63:1195-204. [PMID: 20688471 PMCID: PMC2943571 DOI: 10.1016/j.jclinepi.2010.04.012] [Citation(s) in RCA: 268] [Impact Index Per Article: 19.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2009] [Revised: 04/12/2010] [Accepted: 04/13/2010] [Indexed: 11/19/2022]
Abstract
OBJECTIVES The Patient-Reported Outcomes Measurement Information System (PROMIS) allows assessment of the impact of chronic conditions on health-related quality of life (HRQL) across diseases. We report on the HRQL impact of individual and comorbid conditions as well as conditions that are described as limiting activity. STUDY DESIGN AND SETTING Data were collected through online and clinic recruitment as part of the PROMIS item calibration sample (n=21,133). Participants reported the presence or absence of 24 chronic health conditions and whether their activity was limited by each condition. RESULTS Across health status domains, the presence of a chronic condition was associated with poorer scores than those without a diagnosis, particularly for those individuals who reported that their condition was disabling. The magnitude of detriment in HRQL was more pronounced for individuals with two or more chronic conditions and could not be explained by sociodemographic factors. Patterns of HRQL deficits varied across disease and comorbidity status. CONCLUSION The impact of chronic conditions, particularly when experienced with comorbid disease, is associated with detriments in HRQL. The negative impact on HRQL varies across symptoms and functional areas within a given condition.
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Affiliation(s)
- Nan E Rothrock
- Department of Medical Social Sciences, Northwestern University, 625N. Michigan Ave., Chicago, IL 60611, USA.
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Abstract
The incidence of rheumatoid arthritis (RA) is decreasing, and rheumatologists perceive that their patients are presenting with less-disabling disease. This impression coincides with the availability of improved therapeutic options, including biologic agents. In RA, the term 'disease severity' can be defined from various perspectives: that of the patient, or by measures of disease activity and damage. This Perspectives article examines the scientific basis for a perceived decrease in RA severity over time, as determined by patient-reported outcomes and measures of disease severity and structural damage. An improved health care system and better treatment strategies with access to new therapeutic modalities are likely to have contributed to a milder RA disease course in more-recent years. The focus needs to be kept on these issues to further improve disease severity in patients with RA.
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Affiliation(s)
- Till Uhlig
- Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway.
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Sokka T, Kautiainen H, Pincus T, Toloza S, da Rocha Castelar Pinheiro G, Lazovskis J, Hetland ML, Peets T, Immonen K, Maillefert JF, Drosos AA, Alten R, Pohl C, Rojkovich B, Bresnihan B, Minnock P, Cazzato M, Bombardieri S, Rexhepi S, Rexhepi M, Andersone D, Stropuviene S, Huisman M, Sierakowski S, Karateev D, Skakic V, Naranjo A, Baecklund E, Henrohn D, Gogus F, Badsha H, Mofti A, Taylor P, McClinton C, Yazici Y. Disparities in rheumatoid arthritis disease activity according to gross domestic product in 25 countries in the QUEST-RA database. Ann Rheum Dis 2009; 68:1666-72. [PMID: 19643759 PMCID: PMC2756954 DOI: 10.1136/ard.2009.109983] [Citation(s) in RCA: 134] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To analyse associations between the clinical status of patients with rheumatoid arthritis (RA) and the gross domestic product (GDP) of their resident country. METHODS The Quantitative Standard Monitoring of Patients with Rheumatoid Arthritis (QUEST-RA) cohort includes clinical and questionnaire data from 6004 patients who were seen in usual care at 70 rheumatology clinics in 25 countries as of April 2008, including 18 European countries. Demographic variables, clinical characteristics, RA disease activity measures, including the disease activity score in 28 joints (DAS28), and treatment-related variables were analysed according to GDP per capita, including 14 "high GDP" countries with GDP per capita greater than US$24,000 and 11 "low GDP" countries with GDP per capita less than US$11,000. RESULTS Disease activity DAS28 ranged between 3.1 and 6.0 among the 25 countries and was significantly associated with GDP (r = -0.78, 95% CI -0.56 to -0.90, r(2) = 61%). Disease activity levels differed substantially between "high GDP" and "low GDP" countries at much greater levels than according to whether patients were currently taking or not taking methotrexate, prednisone and/or biological agents. CONCLUSIONS The clinical status of patients with RA was correlated significantly with GDP among 25 mostly European countries according to all disease measures, associated only modestly with the current use of antirheumatic medications. The burden of arthritis appears substantially greater in "low GDP" than in "high GDP" countries. These findings may alert healthcare professionals and designers of health policy towards improving the clinical status of patients with RA in all countries.
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Affiliation(s)
- T Sokka
- Jyväskylä Central Hospital, 40620 Jyväskylä, Finland.
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Abstract
PURPOSE OF REVIEW Rheumatoid arthritis (RA) is recognized as a disease with a natural history of severe long-term outcomes, which appear to be improving at this time, as reported from many clinics. RECENT FINDINGS Improved outcomes of many long-term consequences of inflammation such as joint deformity, functional declines, work disability, and early death have been reported in recent years. SUMMARY Therapies for RA are assessed in randomized clinical trials and in clinical care primarily according to measures of inflammatory activity, which may change considerably over days, weeks, and months. In usual clinical care, long-term consequences of the disease, which often require years of observation, can also be assessed. Data in published reports of both clinical trials and clinical care continue to include only a minority of all patients with RA. Further efforts are needed to promote collection of quantitative data in all patients with RA, at all visits in all clinical settings, to facilitate 'tight control' and better outcomes for all patients with RA.
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Rantalaiho V, Korpela M, Hannonen P, Kautiainen H, Järvenpää S, Leirisalo-Repo M, Hakala M, Puolakka K, Julkunen H, Luosujärvi R, Möttönen T. The good initial response to therapy with a combination of traditional disease-modifying antirheumatic drugs is sustained over time: the eleven-year results of the Finnish rheumatoid arthritis combination therapy trial. ACTA ACUST UNITED AC 2009; 60:1222-31. [PMID: 19404945 DOI: 10.1002/art.24447] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To evaluate the evolution of functional and clinical outcomes over 11 years in patients with early rheumatoid arthritis (RA) initially treated with a combination of 3 disease-modifying antirheumatic drugs (DMARDs) or with a single DMARD. METHODS A cohort of 199 patients with early active RA were initially randomized to receive treatment with a combination of methotrexate, sulfasalazine, and hydroxychloroquine with prednisolone or treatment with a single DMARD (initially, sulfasalazine) with or without prednisolone. After 2 years, the drug treatment strategy became unrestricted, but still targeted remission. At 11 years, function was assessed with the Health Assessment Questionnaire (HAQ), and clinical outcomes were assessed with the modified Minimal Disease Activity (MDA) measure and the American College of Rheumatology (ACR) criteria for remission. RESULTS At 11 years, 138 patients were assessed (68 in the combination-DMARD group and 70 in the single-DMARD group). The mean+/-SD HAQ scores were 0.34+/-0.54 in the combination-DMARD group and 0.38+/-0.58 in the single-DMARD group (P=0.88). Modified MDA was achieved by 63% (95% confidence interval [95% CI] 51, 77) and by 43% (95% CI 32, 55) (P=0.016) of the combination-DMARD group and the single-DMARD group, respectively, and ACR remission by 37% (95% CI 26, 49) and by 19% (95% CI 11, 29) (P=0.017), respectively. CONCLUSION Initial therapy with a combination of DMARDs in early RA results in higher rates of patients achieving modified MDA and strict ACR remission even over the long term than initial single-DMARD therapy. Targeting remission with tight clinical controls results in good functional and clinical outcomes in most RA patients.
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Affiliation(s)
- Vappu Rantalaiho
- Department of Internal Medicine, Centre for Rheumatic Diseases, Tampere University Hospital, Tampere, Finland.
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Sokka T, Mäkinen H. Drug management of early rheumatoid arthritis – 2008. Best Pract Res Clin Rheumatol 2009; 23:93-102. [DOI: 10.1016/j.berh.2008.08.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
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Sokka T, Toloza S, Cutolo M, Kautiainen H, Makinen H, Gogus F, Skakic V, Badsha H, Peets T, Baranauskaite A, Géher P, Ujfalussy I, Skopouli FN, Mavrommati M, Alten R, Pohl C, Sibilia J, Stancati A, Salaffi F, Romanowski W, Zarowny-Wierzbinska D, Henrohn D, Bresnihan B, Minnock P, Knudsen LS, Jacobs JW, Calvo-Alen J, Lazovskis J, Pinheiro GDRC, Karateev D, Andersone D, Rexhepi S, Yazici Y, Pincus T. Women, men, and rheumatoid arthritis: analyses of disease activity, disease characteristics, and treatments in the QUEST-RA study. Arthritis Res Ther 2009; 11:R7. [PMID: 19144159 PMCID: PMC2688237 DOI: 10.1186/ar2591] [Citation(s) in RCA: 149] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2008] [Revised: 10/28/2008] [Accepted: 01/14/2009] [Indexed: 11/23/2022] Open
Abstract
Introduction Gender as a predictor of outcomes of rheumatoid arthritis (RA) has evoked considerable interest over the decades. Historically, there is no consensus whether RA is worse in females or males. Recent reports suggest that females are less likely than males to achieve remission. Therefore, we aimed to study possible associations of gender and disease activity, disease characteristics, and treatments of RA in a large multinational cross-sectional cohort of patients with RA called Quantitative Standard Monitoring of Patients with RA (QUEST-RA). Methods The cohort includes clinical and questionnaire data from patients who were seen in usual care, including 6,004 patients at 70 sites in 25 countries as of April 2008. Gender differences were analyzed for American College of Rheumatology Core Data Set measures of disease activity, DAS28 (disease activity score using 28 joint counts), fatigue, the presence of rheumatoid factor, nodules and erosions, and the current use of prednisone, methotrexate, and biologic agents. Results Women had poorer scores than men in all Core Data Set measures. The mean values for females and males were swollen joint count-28 (SJC28) of 4.5 versus 3.8, tender joint count-28 of 6.9 versus 5.4, erythrocyte sedimentation rate of 30 versus 26, Health Assessment Questionnaire of 1.1 versus 0.8, visual analog scales for physician global estimate of 3.0 versus 2.5, pain of 4.3 versus 3.6, patient global status of 4.2 versus 3.7, DAS28 of 4.3 versus 3.8, and fatigue of 4.6 versus 3.7 (P < 0.001). However, effect sizes were small-medium and smallest (0.13) for SJC28. Among patients who had no or minimal disease activity (0 to 1) on SJC28, women had statistically significantly higher mean values compared with men in all other disease activity measures (P < 0.001) and met DAS28 remission less often than men. Rheumatoid factor was equally prevalent among genders. Men had nodules more often than women. Women had erosions more often than men, but the statistical significance was marginal. Similar proportions of females and males were taking different therapies. Conclusions In this large multinational cohort, RA disease activity measures appear to be worse in women than in men. However, most of the gender differences in RA disease activity may originate from the measures of disease activity rather than from RA disease activity itself.
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Affiliation(s)
- Tuulikki Sokka
- Jyväskylä Central Hospital, Keskussairaalantie 19, 40620 Jyväskylä, and Medcare Oy, Hämeentie 1, 44100 Aänekoski, Finland.
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Sokka T, Pincus T. Ascendancy of weekly low-dose methotrexate in usual care of rheumatoid arthritis from 1980 to 2004 at two sites in Finland and the United States. Rheumatology (Oxford) 2008; 47:1543-7. [PMID: 18687711 PMCID: PMC2544432 DOI: 10.1093/rheumatology/ken316] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2008] [Revised: 07/07/2008] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVES To analyse consecutive patients with RA in usual rheumatology care between 1980 and 2004 at two settings for the proportion of patients taking MTX, interval from patient presentation to MTX prescription and radiographic and functional status outcomes. METHODS Longitudinal study of all patients seen in usual care between 1980 and 2004, 1982 consecutive patients in Jyväskylä, Finland and 738 consecutive patients in Nashville, TN, USA. Clinical status was assessed as Larsen radiographic scores in Jyväskylä and modified health assessment questionnaire (MHAQ) in Nashville. RESULTS The probability of initiating MTX within 5 yrs after presentation increased from <5% in Jyväskylä before 1989 to >90% in 2000-04, and from 25% in Nashville in 1980-84 to >90% since 1995. The median interval from presentation to MTX initiation in Jyväskylä was 14 yrs in 1980-84 vs 8.6 in 1985-89, 4.5 in 1990-94, 1.8 in 1995-99 and <1 yr in 2000-05; in Nashville, median intervals were 8.6 yrs in 1980-84, 4.4 years in 1985-89, and <2 months in 1990-95, 1995-2000 and 2000-05. Patient outcomes were substantially improved in both settings: in Jyväskylä, mean 5-yr Larsen radiographic scores (0-100) were 15.7 in 1980-84 vs 4.0 in 1995-99; in Nashville, mean MHAQ scores (0-3) for physical function were 1.13 in 1980-84 vs 0.57 in 2000-04. CONCLUSION Early MTX in usual clinical care of RA increased from <5% in 1980 to >90% in 2004. Over this period, substantially improved outcomes were seen, most of which antedated biological agents.
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Affiliation(s)
- T. Sokka
- Jyväskylä Central Hospital, Jyväskylä, Finland and NYU Hospital for Joint Diseases, NY, USA
| | - T. Pincus
- Jyväskylä Central Hospital, Jyväskylä, Finland and NYU Hospital for Joint Diseases, NY, USA
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Sokka T, Hetland ML, Mäkinen H, Kautiainen H, Hørslev-Petersen K, Luukkainen RK, Combe B, Badsha H, Drosos AA, Devlin J, Ferraccioli G, Morelli A, Hoekstra M, Majdan M, Sadkiewicz S, Belmonte M, Holmqvist AC, Choy E, Burmester GR, Tunc R, Dimić A, Nedović J, Stanković A, Bergman M, Toloza S, Pincus T. Remission and rheumatoid arthritis: Data on patients receiving usual care in twenty-four countries. ACTA ACUST UNITED AC 2008; 58:2642-51. [DOI: 10.1002/art.23794] [Citation(s) in RCA: 137] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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Sokka T, Envalds M, Pincus T. Treatment of rheumatoid arthritis: a global perspective on the use of antirheumatic drugs. Mod Rheumatol 2008; 18:228-39. [PMID: 18437286 PMCID: PMC2668379 DOI: 10.1007/s10165-008-0056-x] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2007] [Accepted: 01/29/2008] [Indexed: 12/13/2022]
Abstract
Modern therapy for rheumatoid arthritis (RA) is based on knowledge of the severity of the natural history of the disease. RA patients are approached with early and aggressive treatment strategies, methotrexate as an anchor drug, biological targeted therapies in those with inadequate response to methotrexate, and “tight control,” aiming for remission and low disease activity according to quantitative monitoring. This chapter presents a rationale for current treatment strategies for RA with antirheumatic drugs, a review of published reports concerning treatments in clinical cohorts outside of clinical trials, and current treatments at 61 sites in 21 countries in the QUEST-RA database.
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Affiliation(s)
- Tuulikki Sokka
- Arkisto/Tutkijat, Jyväskylä Central Hospital, Jyvaskyla, Finland.
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Different Time Perspectives of the Doctor and the Patient Reduce Quality in Health Care. Qual Manag Health Care 2008; 17:136-9. [DOI: 10.1097/01.qmh.0000316991.56297.4d] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Kok R, Hoving JL, Verbeek JH, Schaafsma FG, Smits PBA, van Dijk FJH. Evaluation of a workshop on evidence-based medicine for social insurance physicians. Occup Med (Lond) 2008; 58:83-7. [PMID: 18204004 DOI: 10.1093/occmed/kqm151] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Evidence-based medicine (EBM), a comprehensive method to support clinical decision making by using evidence, has been instrumental in clinical specialties but not yet in insurance medicine. AIMS We developed and evaluated a workshop on EBM for Dutch social insurance physicians who perform disability evaluations. METHODS Sixty-six social insurance physicians followed a 1-day introductory workshop that focused on teaching two EBM core skills: to ask answerable questions and to search for the best evidence. All outcomes were measured before, immediately after and 3 months after the workshop by means of self-assessment. The primary outcomes were knowledge, skills, attitude and intention to apply EBM in practice. The secondary outcomes were social influence, self-efficacy and behaviour. RESULTS Immediately after the workshop, a marked and significant improvement was seen in self-assessed skills (mean difference 4.2, 95% CI 3.7-4.6) and in self-efficacy to apply EBM (mean difference 0.7, 95% CI 0.6-0.8). For attitude, knowledge and intention, the improvements were small. Three months after the workshop, the improvements in skills (mean difference 2.3, 95% CI 1.8-2.9) and self-efficacy (mean difference 0.5, 95% CI 0.3-0.6) remained significant. CONCLUSIONS The workshop improved self-assessed EBM skills and self-efficacy both in the short and long term. The workshop also resulted in limited short-term improvements in self-assessed knowledge and in the intention to apply EBM in practice. The EBM approach can be successfully taught to social insurance physicians working in the field of disability evaluation.
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Affiliation(s)
- Rob Kok
- Research Center for Insurance Medicine AMC-UWV-VUmc, Amsterdam, The Netherlands.
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Yamanaka H, Inoue E, Singh G, Tanaka E, Nakajima A, Taniguchi A, Hara M, Tomatsu T, Kamatani N. Improvement of disease activity of rheumatoid arthritis patients from 2000 to 2006 in a large observational cohort study IORRA in Japan. Mod Rheumatol 2007; 17:283-9. [PMID: 17694260 DOI: 10.1007/s10165-007-0587-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2007] [Accepted: 03/05/2007] [Indexed: 10/23/2022]
Abstract
The objective of this study was to show whether the disease activity of rheumatoid arthritis (RA) patients had improved in Japan, and whether the improvement of disease activity had resulted in a better outcome of patients. In a single-institute-based prospective observational cohort of RA patients (Institute of Rheumatology, Rheumatoid Arthritis, IORRA), a total of 7512 patients were enrolled, and their information was collected biannually. A cross-sectional data set A that included all patients in each phase was analyzed. From October 2000 to April 2006, disease activity score DAS28 significantly improved from 4.15 to 3.63, and the frequency of patients in remission (DAS28 < 2.6) increased from 8.5% to 21.5%. During this period, the frequency of methotrexate users increased from 33.9% to 58.7% and the average dosage of methotrexate also increased from 5.59 mg/week to 6.94 mg/week; on the other hand, there was no increase in any adverse reaction among the methotrexate users. To investigate the relationship between longitudinal disease control and progression of disability, a longitudinal data set B that included 712 patients who completed all phases of the study from 2000 to 2006 was selected and was analyzed. The disability index JHAQ of a poorly controlled group (average DAS > 5.1) increased (+34.8%), that of a moderately controlled group (average DAS 3.2-5.1) also increased (+14.0%), but that of a well-controlled group (average DAS < 3.2) decreased (-13.0%). In conclusion, by using a prospective observational cohort IORRA in Japan, we demonstrate that RA disease activity improved from 2000 to 2006, which correlates with an increased use of methotrexate. The suppression of disease activity resulted in a better outcome for patients.
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Affiliation(s)
- Hisashi Yamanaka
- Institute of Rheumatology, Tokyo Women's Medical University, 10-22 Kawada-cho, Shinjuku-ku, Tokyo, 162-0054, Japan.
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Wolfe F, Rasker JJ, Boers M, Wells GA, Michaud K. Minimal disease activity, remission, and the long-term outcomes of rheumatoid arthritis. ACTA ACUST UNITED AC 2007; 57:935-42. [PMID: 17665487 DOI: 10.1002/art.22895] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To determine the prevalence of minimal disease activity (MDA) and remission in patients with rheumatoid arthritis (RA), to assess the effect of anti-tumor necrosis factor (anti-TNF) therapy on MDA, and to determine the extent to which MDA status improves long-term outcomes. METHODS Using the Patient Activity Scale (PAS) as a surrogate, we assessed the prevalence of MDA and remission in 18,062 patients with RA using the newly developed Outcome Measures in Rheumatology Clinical Trials (OMERACT) criteria for MDA. RESULTS MDA was noted in 20.2% of 18,062 patients and persistent MDA, operationally defined as having MDA during >or=2 consecutive 6-month observation periods, occurred in 13.5% of 7,433 patients followed longitudinally. Disease activity at remission levels was noted in 7%. Among patients with MDA, 82% received disease-modifying antirheumatic drugs or biologic agents. Following anti-TNF initiation, the cumulative probability of achieving MDA at 2 and 6 years was 4.1% and 7.6%, respectively, and persistent MDA probabilities were 2.7% and 4.5%, respectively. Regardless of RA duration, patients with MDA had substantially better outcomes, including a 10-fold reduction in work disability and an approximately 2-fold reduction in total joint replacement and mortality. CONCLUSION Remission remains uncommon in RA, and the prevalence of new remission in community practice is substantially lower than noted in published trials of biologic therapy. On average, persons with MDA appear to have persistently mild RA. This might be the effect of milder RA and/or more effective treatment in early RA. The PAS had satisfactory levels of agreement with the full MDA criteria and appears suitable for use in clinical and epidemiologic research.
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Affiliation(s)
- Frederick Wolfe
- National Data Bank for Rheumatic Diseases, Wichita, Kansas 67214, USA.
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Sokka T, Kautiainen H, Hannonen P, Pincus T. Changes in Health Assessment Questionnaire disability scores over five years in patients with rheumatoid arthritis compared with the general population. ACTA ACUST UNITED AC 2006; 54:3113-8. [PMID: 17009231 DOI: 10.1002/art.22130] [Citation(s) in RCA: 64] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE To analyze longitudinal data over 5 years for changes in Health Assessment Questionnaire (HAQ) scores in patients with rheumatoid arthritis (RA) and age- and sex-matched controls from the general population. METHODS In 2000 and 2005, identical self-report questionnaires were mailed to a cohort of patients with RA and control cohort from the community. The questionnaire included the HAQ, which was used to assess functional status. Changes in HAQ scores over 5 years were analyzed. RESULTS In 2000, 73% of 1,495 patients with RA and 77% of 2,000 general population controls responded to the questionnaire. In 2005, 84% of 2,022 patients with RA and 77% of 1,817 controls responded. A total of 863 patients with RA and 1,176 community controls responded in both 2000 and 2005 and were included in the analyses. Mean baseline HAQ scores were significantly higher in patients with RA than in controls (0.71 versus 0.17; P < 0.001). Over 5 years, the HAQ scores increased by 0.01 units per year in both the RA cohort and the community population; in both cohorts, the net change was primarily attributable to individuals over age 70 years. Changes in HAQ scores were similar in patients and controls who had low HAQ scores at baseline. Female patients with baseline HAQ scores of >or=0.5 had less potential for improvement than did controls. Among subjects in both groups who had HAQ scores >2, death was a common outcome over the next 5 years. CONCLUSION Currently, progression of functional disability among patients with RA and among persons in the general population is largely explained by the aging process. Our results showing stable function scores over 5 years in most patients with RA who are younger than age 70 years provide further evidence of improved status of RA patients today compared with the major declines observed in previous decades.
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Sokka T, Kautiainen H, Hannonen P. Stable occurrence of knee and hip total joint replacement in Central Finland between 1986 and 2003: an indication of improved long-term outcomes of rheumatoid arthritis. Ann Rheum Dis 2006; 66:341-4. [PMID: 17068067 PMCID: PMC1855996 DOI: 10.1136/ard.2006.057067] [Citation(s) in RCA: 68] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
BACKGROUND Total joint replacement (TJR) surgery is an important severe long-term outcome of rheumatoid arthritis, but relatively little is known about changes of its incidence in patients with rheumatoid arthritis over the past two decades. METHODS A population-based, retrospective, incidence case review was conducted to analyse the frequency of primary TJR surgery of the knee and hip in all patients, and specifically in patients with rheumatoid arthritis in Central Finland between 1986 and 2003. Patients with TJR surgery of the knee and hip were identified in hospital databases over the 18-year period. Age-standardised incidence rate ratios for the primary TJR of the knee and hip were calculated, stratified to sex and diagnosis, with 1986 as the reference value. RESULTS In patients without rheumatoid arthritis the age-adjusted incidence rate ratios (with 95% CI) for TJR of the knee increased 9.8-fold from 1986 to 2003 in women and men, and for TJR of the hip 1.8-fold in women and 2-fold in men. By contrast, no meaningful change was seen over this period, in age-adjusted incidence rate ratios for TJR of the knee or hip in patients with rheumatoid arthritis, ranging from 0.7 to 1.2 in 2003 compared with 1986. CONCLUSION The prevalence of TJR surgery has increased 2-10-fold in patients without rheumatoid arthritis patients, associated with an ageing population, but has not increased in patients with rheumatoid arthritis between 1986 and 2003. These data are consistent with emerging evidence that long-term outcomes of rheumatoid arthritis have improved substantially, even before the availability of biological agents.
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Affiliation(s)
- Tuulikki Sokka
- Jyväskylä Central Hospital, Arkisto/Tutkijat, Jyväskylä 40620, Finland.
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Martínez Taboada V, Carmona L. [Not Available]. REUMATOLOGIA CLINICA 2006; 2:221-223. [PMID: 21794333 DOI: 10.1016/s1699-258x(06)73051-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/24/2006] [Accepted: 06/09/2006] [Indexed: 05/31/2023]
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