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Min HK, Kim SH, Lee SH, Kim HR. Baseline bony erosions and time-averaged DAS28 predict discontinuation of TNF inhibitors in rheumatoid arthritis. Sci Rep 2022; 12:19951. [PMID: 36402804 PMCID: PMC9675786 DOI: 10.1038/s41598-022-24027-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Accepted: 11/09/2022] [Indexed: 11/21/2022] Open
Abstract
The present study evaluated the predictive role of baseline radiographic change and disease activity on drug retention and clinical response in patients with rheumatoid arthritis (RA) treated with tumor necrosis factor inhibitor (TNFi). Korean Observational Study Network for Arthritis (KORONA) registry was evaluated to identify RA patients treated with a TNFi. Disease activity score-28 (DAS28) was evaluated at baseline and 1 year after TNFi initiation or at termination of TNFi due to inefficacy (within 1 year). The retention rate of TNFi was compared in patients with and without bony erosions. The hazard ratio (HR) for drug retention was evaluated by Cox regression analysis, as was the odds ratio (OR) for achieving remission (DAS28 < 2.6). This study included 109 RA patients, including 97 (89%) women and 30 (27.5%) with erosions, who were treated with a TNFi. Higher baseline DAS28 was negatively associated with achievement of remission (OR = 0.56, 95% CI 0.35-0.88). The TNFi retention rate was significantly lower in RA patients with than in those without erosions (p = 0.04). Factors significantly associated with drug discontinuation included the presence of erosions (HR = 2.45, 95% CI 1.08-5.51) and higher time-averaged DAS28 (HR = 2.17, 95% CI 1.47-3.20), whereas concomitant methotrexate was associated with lack of drug discontinuation (HR = 0.40, 95% CI 0.17-0.95). The presence of erosions and high time-averaged disease activity could predict poor retention of TNFi by RA patients. Higher baseline DAS28 was associated with a reduced clinical response in patients with RA.Trial registration Clinical Research Information Service of South Korea https://cris.nih.go.kr : KCT0000086, registered May 26, 2009.
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Affiliation(s)
- Hong Ki Min
- grid.411120.70000 0004 0371 843XDivision of Rheumatology, Department of Internal Medicine, Konkuk University Medical Center, 120-1 Neungdong-Ro, Gwangjin-Gu, Seoul, Republic of Korea
| | - Se Hee Kim
- grid.411120.70000 0004 0371 843XDivision of Rheumatology, Department of Internal Medicine, Konkuk University Medical Center, 120-1 Neungdong-Ro, Gwangjin-Gu, Seoul, Republic of Korea
| | - Sang-Heon Lee
- grid.411120.70000 0004 0371 843XDivision of Rheumatology, Department of Internal Medicine, Research Institute of Medical Science, Konkuk University Medical Center, Konkuk University School of Medicine, 120-1 Neungdong-Ro, Gwangjin-Gu, Seoul, Republic of Korea
| | - Hae-Rim Kim
- grid.411120.70000 0004 0371 843XDivision of Rheumatology, Department of Internal Medicine, Research Institute of Medical Science, Konkuk University Medical Center, Konkuk University School of Medicine, 120-1 Neungdong-Ro, Gwangjin-Gu, Seoul, Republic of Korea
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Therapeutic Utility and Adverse Effects of Biologic Disease-Modifying Anti-Rheumatic Drugs in Inflammatory Arthritis. Int J Mol Sci 2022; 23:ijms232213913. [PMID: 36430392 PMCID: PMC9692587 DOI: 10.3390/ijms232213913] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 11/03/2022] [Accepted: 11/09/2022] [Indexed: 11/16/2022] Open
Abstract
Targeting specific pathologic pro-inflammatory cytokines or related molecules leads to excellent therapeutic effects in inflammatory arthritis, including rheumatoid arthritis, ankylosing spondylitis, and psoriatic arthritis. Most of these agents, known as biologic disease-modifying anti-rheumatic drugs (bDMARDs), are produced in live cell lines and are usually monoclonal antibodies. Several types of monoclonal antibodies target different pro-inflammatory cytokines, such as tumor necrosis factor-α, interleukin (IL)-17A, IL-6, and IL-23/12. Some bDMARDs, such as rituximab and abatacept, target specific cell-surface molecules to control the inflammatory response. The therapeutic effects of these bDMARDs differ in different forms of inflammatory arthritis and are associated with different adverse events. In this article, we summarize the therapeutic utility and adverse effects of bDMARDs and suggest future research directions for developing bDMARDs.
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Direskeneli H, Karadag O, Ates A, Tufan A, Inanc N, Koca SS, Cetin GY, Akar S, Cinar M, Yilmaz S, Yilmaz N, Dalkilic E, Bes C, Yilmazer B, Sahin A, Ersözlü D, Tezcan ME, Sen N, Keser G, Kalyoncu U, Armagan B, Hacibedel B, Helvacioglu K, Cesur TY, Basibuyuk CS, Alkan S, Gunay LM. Quality of life, disease activity and preferences for administration routes in rheumatoid arthritis: a multicentre, prospective, observational study. Rheumatol Adv Pract 2022; 6:rkac071. [PMID: 36133962 PMCID: PMC9486987 DOI: 10.1093/rap/rkac071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 07/10/2022] [Indexed: 11/22/2022] Open
Abstract
Objective We aimed to evaluate quality of life (QoL), disease activity, compliance to treatment, patient and physician preferences for route of administration (RoA), status of health and pain in RA patients starting advanced treatments or needing a switch, and the factors associated with patient preferences. Methods A multicentre, prospective, observational and 1-year follow-up study was conducted, between 2015 and 2020, in adult RA patients using advanced treatments for the first time or needing a switch in their current treatments. All the data collected were entered into electronic case report forms. DAS in 28 joints with ESR [DAS28-4(ESR)], EuroQol 5-Dimensional Questionnaire (EQ-5D), HAQ Disability Index (HAQ-DI), Compliance Questionnaire for Rheumatology (CQR-19), Work Productivity and Activity Impairment Instrument (WPAI) and Patient Global Assessment-Visual Analogue Scale (PGA-VAS) questionnaires were used for longitudinal assessments. Results Four hundred and fifty-nine patients were enrolled. Three hundred and eight patients (67.1%) attended the final study visit at 12 months and were included for comparative analyses. Irrespective of RoA, the disease activity and QoL improved significantly at 12 months, whereas compliance worsened. At baseline and 12 months, EQ-5D and DAS28-4(ESR) scores were significantly correlated (P < 0.001). The WPAI scores changed significantly in favour of better outcomes over 12 months after initiation of advanced treatment or switching (P < 0.001). A higher proportion of patients preferred an oral RoA, in comparison to physicians (53.6% vs 31.4%; P < 0.001). Patient and physician RoA preferences were independent of gender, age, disease duration, advanced treatment type and the EQ-5D-3L, DAS28-4(ESR), HAQ-DI, PGA-VAS and CQR-19 scores at baseline. Conclusion The oral route was more frequently preferred by patients compared with physicians, although patients’ preference rates showed a slight increase towards the end of the treatment, which might be an important factor for RA outcomes. Better control of disease activity and QoL were achieved at 12 months, regardless of RoA.
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Affiliation(s)
- Haner Direskeneli
- Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Marmara University , Istanbul, Turkey
| | - Omer Karadag
- Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Hacettepe University , Ankara, Turkey
| | - Askin Ates
- Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Ankara University , Ankara, Turkey
| | - Abdurrahman Tufan
- Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Gazi University , Ankara, Turkey
| | - Nevsun Inanc
- Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Marmara University , Istanbul, Turkey
| | - Serdar S Koca
- Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Fırat University , Elazıg, Turkey
| | - Gozde Y Cetin
- Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Kahramanmaras Sutcu Imam University , Kahramanmaras, Turkey
| | - Servet Akar
- Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Izmir Katip Celebi University , Izmir, Turkey
| | - Muhammet Cinar
- Clinic of Rheumatology, Gulhane Faculty of Medicine, Gulhane Training and Research Hospital, Health Science University , Ankara, Turkey
| | - Sedat Yilmaz
- Clinic of Rheumatology, Gulhane Faculty of Medicine, Gulhane Training and Research Hospital, Health Science University , Ankara, Turkey
| | - Neslihan Yilmaz
- Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, TC Demiroglu Bilim University , Istanbul, Turkey
| | - Ediz Dalkilic
- Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Uludag University , Bursa, Turkey
| | - Cemal Bes
- Clinic of Rheumatology, Department of Internal Medicine, Istanbul Provincial Health Directorate, Basaksehir Cam and Sakura City Hospital , Istanbul, Turkey
| | - Baris Yilmazer
- Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Trakya University , Edirne, Turkey
| | - Ali Sahin
- Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Cumhuriyet University , Sivas, Turkey
| | - Duygu Ersözlü
- Clinic of Rheumatology, Department of Internal Medicine, SBU Adana City Training and Research Hospital , Adana, Turkey
| | - Mehmet E Tezcan
- Division of Rheumatology, Department of Internal Medicine, Istanbul Provincial Health Directorate, Istanbul Kartal Dr. Lutfi Kırdar Training and Research Hospital , Istanbul, Turkey
| | - Nesrin Sen
- Division of Rheumatology, Department of Internal Medicine, Istanbul Provincial Health Directorate, Istanbul Kartal Dr. Lutfi Kırdar Training and Research Hospital , Istanbul, Turkey
| | - Gokhan Keser
- Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Ege University , Izmir, Turkey
| | - Umut Kalyoncu
- Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Hacettepe University , Ankara, Turkey
| | - Berkan Armagan
- Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Hacettepe University , Ankara, Turkey
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Zhao JL, Liu X, Nan Li J, Ru Liu M, Rottier E, Zhao Y, Zeng XF. Implementation of the treat-to-target approach and treatment satisfaction in patients with rheumatoid arthritis: perspectives of Chinese rheumatologists. Clin Rheumatol 2022; 41:2659-2668. [PMID: 35579773 DOI: 10.1007/s10067-022-06187-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 03/30/2022] [Accepted: 04/24/2022] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To investigate the implementation of treat-to-target (T2T) and treatment satisfaction from Chinese rheumatologists' perspectives. METHODS This retrospective analysis of a cross-sectional database collected from rheumatologists and their adult patients with RA in China using Adelphi Real World Disease Specific Programme™ methodology. Multivariate logistic regression models were used to evaluate factors associated with T2T use, achievement of T2T goals, and physician treatment satisfaction. RESULTS Sixty physicians provided data for 600 patients, of whom 39.0% (234/600) were being treated using T2T, and 64.9% (366/564) had achieved their T2T goal. Physicians were satisfied with treatment in 74.3% (445/599) of patients. Patients with a higher pain score were more likely to be managed using T2T (odds ratio (OR) 1.25; p = 0.017), but less likely to have achieved the T2T goal (OR 0.76; p = 0.004). T2T use was more likely if patients had a longer time since diagnosis (> 2 vs ≤ 2 years; OR 1.61; p = 0.031) or received targeted synthetic or biologic disease-modifying antirheumatic drugs (tsDMARDs or bDMARDs; OR 6.90; p < 0.001). T2T goal achievement was more likely for patients with higher body mass index (≥ 24 vs < 24 kg/m2; OR 2.73; p = 0.001) or full-time employment (OR 2.11; p = 0.005). Physician treatment satisfaction was more likely if the T2T goal was achieved (OR 4.78; p < 0.001) or tsDMARDs or bDMARDs were used (OR 2.58; p = 0.017), and less likely if pain scores were higher (OR 0.79; p = 0.019). CONCLUSIONS T2T implementation in China is suboptimal. Our findings provide insight into T2T implementation and physician treatment satisfaction, supporting T2T use in Chinese RA clinical practice. Key Points • T2T implementation in China is currently suboptimal. • Patients with greater pain were more likely to be managed using T2T but were less likely to have achieved their T2T goals. • Physician treatment satisfaction was associated with T2T goal achievement.
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Affiliation(s)
- Jiu Liang Zhao
- Department of Rheumatology and Clinical Immunology, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China. .,National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Ministry of Science & Technology, Beijing, China. .,State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital (PUMCH), Beijing, China. .,Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing, China.
| | - Xin Liu
- Lilly China Drug Development and Medical Affairs Center, Eli Lilly and Company, Shanghai, China
| | - Jin Nan Li
- Lilly China Drug Development and Medical Affairs Center, Eli Lilly and Company, Shanghai, China
| | - Meng Ru Liu
- Lilly China Drug Development and Medical Affairs Center, Eli Lilly and Company, Shanghai, China
| | - Elke Rottier
- Autoimmune Franchise, Adelphi Real World, Bollington, Cheshire, UK
| | - Yan Zhao
- Department of Rheumatology and Clinical Immunology, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China.,National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Ministry of Science & Technology, Beijing, China.,State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital (PUMCH), Beijing, China.,Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing, China
| | - Xiao Feng Zeng
- Department of Rheumatology and Clinical Immunology, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China.,National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Ministry of Science & Technology, Beijing, China.,State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital (PUMCH), Beijing, China.,Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing, China
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Liu J, Huang Y, Zeng J, Chen C, Li P, Ning Q, Guan X, Li L. SLAMF8 promotes the proliferation and migration of synovial fibroblasts by regulating the ERK/MMPs signalling pathway. Autoimmunity 2022; 55:294-300. [PMID: 35506438 DOI: 10.1080/08916934.2022.2070742] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
Rheumatoid arthritis is troublesome to treat effectively and often requires concomitant long-term treatment. Meanwhile, synovial fibroblasts could induce inflammation response and lead to joint erosion, finally causing progressive joint destruction, disability, and increased mortality. This study focussed on the role of SLAM family member 8 (SLAMF8) in mediating cell function from rheumatoid arthritis synovial fibroblasts stimulated with TNF-α. Cell Counting Kit-8 (CCK-8) and colony-forming unit assay were used to evaluate cell proliferation. SLAMF8 expression was analysed by reverse transcription-quantitative PCR (RT-qPCR) and western blot. Annexin V-FITC/PI double staining was used to measure the apoptosis rate. The cell migration and invasion in TNF-α-stimulated MH7A (human rheumatoid arthritis synovial cell line) and HFLS-RA cells (human fibroblast-like synoviocytes: rheumatoid arthritis) were tested via wound healing assay and transwell migration assay. In the present study, after TNF-α treatments, the SLAMF8 mRNA and protein expression in both MH7A and HFLS-RA cell lines have a time-dependent increase. The attenuation of SLAMF8 ameliorated TNF-α-induced proliferation, invasion and migration in MH7A and HFLS-RA cells. Simultaneously, when SLAMF8 was silenced, the expression of p-ERK, MMP-1, and MMP-13 was suppressed significantly. In summary, these results indicated that the knockdown of the SLAMF8 significantly attenuated TNF-α-induced proinflammatory responses in MH7A and HFLS-RA cells. Therefore, SLAMF8 exhibits therapeutic potential for the management of inflammation in rheumatoid arthritis.
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Affiliation(s)
- Jun Liu
- Department of Rheumatology and Immunology, The Affiliated Hospital of Guizhou Medical University, Guiyang, Guizhou, China
| | - Ying Huang
- Department of Rheumatology and Immunology, The Affiliated Hospital of Guizhou Medical University, Guiyang, Guizhou, China.,Department of Rheumatology and Immunology, The 2nd Hospital Affiliated to Guizhou University of Chinese Traditional Medicine, Guiyang, Guizhou Province, China
| | - Jiashun Zeng
- Department of Rheumatology and Immunology, The Affiliated Hospital of Guizhou Medical University, Guiyang, Guizhou, China
| | - Changming Chen
- Department of Rheumatology and Immunology, The 2nd Hospital Affiliated to Guizhou University of Chinese Traditional Medicine, Guiyang, Guizhou Province, China
| | - Peiting Li
- Department of Rheumatology and Immunology, The Affiliated Hospital of Guizhou Medical University, Guiyang, Guizhou, China
| | - Qiaoyi Ning
- Department of Rheumatology and Immunology, The 2nd Hospital Affiliated to Guizhou University of Chinese Traditional Medicine, Guiyang, Guizhou Province, China
| | - Xianyue Guan
- Department of Rheumatology and Immunology, The 2nd Hospital Affiliated to Guizhou University of Chinese Traditional Medicine, Guiyang, Guizhou Province, China
| | - Long Li
- Department of Rheumatology and Immunology, The Affiliated Hospital of Guizhou Medical University, Guiyang, Guizhou, China
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Gaino JZ, Bértolo MB, Nunes CS, Sachetto Z, Landim SF, Magalhães EDP. The Structural Index Score and its relation to foot function, disability and physical performance tests in rheumatoid arthritis (RA) - A cross-sectional study. Foot (Edinb) 2022; 51:101876. [PMID: 35462089 DOI: 10.1016/j.foot.2021.101876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 07/15/2021] [Accepted: 10/18/2021] [Indexed: 02/04/2023]
Abstract
OBJECTIVES To evaluate the Structural Index Score (SIS) - a clinical foot deformity assessment index developed for RA, and to compare its results with foot function, disability and physical performance tests. METHODS In this cross-sectional study, 104 patients with foot pain were evaluated according to SIS score, subscales (Forefoot SIS and Rearfoot SIS) and items. Results were compared with the Foot Function Index (FFI), the Health Assessment Questionnaire Disability Index (using lower limbs items: LL-HAQ), and physical performance tests: Berg Balance Scale (BBS), the Timed Up and Go test (TUG) and the 5-Time Sit down-to-Stand up Test (SST5). RESULTS There was a weak correlation of SIS score with FFI and LL-HAQ. Rearfoot SIS was correlated with FFI, LL-HAQ and worse performance in BBS, TUG and SST5. Regarding Rearfoot SIS items, the ankle ROM was correlated to all studied outcomes, the calcaneus varus/valgus was correlated with FFI (total, pain and disability subscales) and the planus/cavus deformity with FFI-pain, HAQ-DI and LL-HAQ. Forefoot SIS did not correlate with any outcome measures. In relation to Forefoot SIS items, hallux valgus was associated with foot function (FFI-total, pain and disability subscales), the MTPs joints subluxation was correlated with FFI-disability subscale, and the 5th MTP exostosis was associated with FFI-pain. CONCLUSION SIS score was correlated to impaired foot function (FFI) and disability (LL-HAQ). Rearfoot SIS was correlated to worse performance on FFI, LL-HAQ, BBS, TUG and SST5. SIS score index can be a useful tool to evaluate the rheumatoid foot deformities, but a better graduation of foot deformities should add sensitivity to this method.
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Affiliation(s)
- Juliana Zonzini Gaino
- Department of Internal Medicine, Rheumatology, Faculty of Medical Sciences, State University of Campinas - Unicamp, Campinas, SP, Brazil.
| | - Manoel Barros Bértolo
- Department of Internal Medicine, Rheumatology, Faculty of Medical Sciences, State University of Campinas - Unicamp, Campinas, SP, Brazil
| | - Caroline Silva Nunes
- Orthoses and Prostheses Unit, Clinical Hospital, State University of Campinas - Unicamp, Campinas, SP, Brazil
| | - Zoraida Sachetto
- Department of Internal Medicine, Rheumatology, Faculty of Medical Sciences, State University of Campinas - Unicamp, Campinas, SP, Brazil
| | - Síbila Floriano Landim
- Orthoses and Prostheses Unit, Clinical Hospital, State University of Campinas - Unicamp, Campinas, SP, Brazil
| | - Eduardo de Paiva Magalhães
- Department of Internal Medicine, Rheumatology, Faculty of Medical Sciences, State University of Campinas - Unicamp, Campinas, SP, Brazil; Orthoses and Prostheses Unit, Clinical Hospital, State University of Campinas - Unicamp, Campinas, SP, Brazil
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van der Heijde D, Kartman CE, Xie L, Beattie S, Schlichting D, Mo D, Durez P, Tanaka Y, Fleischmann R. Radiographic Progression of Structural Joint Damage Over 5 Years of Baricitinib Treatment in Patients With Rheumatoid Arthritis: Results From RA-BEYOND. J Rheumatol 2021; 49:133-141. [PMID: 34526397 DOI: 10.3899/jrheum.210346] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/02/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To evaluate the effect of baricitinib on inhibiting radiographic progression of structural joint damage over 5 years in patients with active rheumatoid arthritis (RA). METHODS Patients completed 1 of 3 phase III baricitinib trials (ClinicalTrials.gov: NCT01711359, NCT01710358, or NCT01721057) and entered the long-term extension RA-BEYOND (NCT01885078), in which patients received once-daily 4 mg or 2 mg baricitinib. Across these trials, patients initially receiving methotrexate (MTX) or adalimumab (ADA) switched to baricitinib 4 mg at Week 52. Patients initially receiving placebo (PBO) switched to baricitinib 4 mg at Week 24. Radiographs were scored at baseline and Years 2, 3, 4, and 5. Change from baseline in van der Heijde modified total Sharp score (ΔmTSS) was computed. RESULTS Overall, 2125 of 2573 (82.6%) randomized patients entered RA-BEYOND; 1837 of 2125 (86.4%) entered this analysis. From Years 3 to 5, higher proportions of disease-modifying antirheumatic drug (DMARD)-naïve patients on initial baricitinib (monotherapy or with MTX) had no progression vs initial MTX (ΔmTSS ≤ 0 at Year 5: 59.6% baricitinib 4 mg; 66.2% baricitinib 4 mg + MTX; 40.7% MTX). Higher proportions of patients with inadequate response (IR) to MTX on initial baricitinib or ADA vs PBO had no progression (ΔmTSS ≤ 0 at Year 5: 54.8% baricitinib 4 mg; 55.0% ADA; 50.3% PBO). Higher proportions of patients with conventional synthetic DMARD-IR on initial baricitinib 4 mg had less progression vs initial PBO or baricitinib 2 mg (ΔmTSS ≤ 0 at Year 5: 66.7% baricitinib 4 mg; 58.2% baricitinib 2 mg; 60.0% PBO). CONCLUSION Oral baricitinib maintained lower levels of radiographic progression than initial conventional synthetic DMARD or PBO through 5 years in patients with active RA.
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Affiliation(s)
- Désirée van der Heijde
- Financial support for the studies was provided by Eli Lilly and Company, which developed baricitinib, under license from Incyte Corporation. All costs associated with the development of this manuscript, including article processing charges and medical writing and editing services, were funded by Eli Lilly and Company. D. van der Heijde, MD, PhD, Department of Rheumatology, Leiden University Medical Center, Leiden, the Netherlands; C.E. Kartman, RN, S. Beattie, PhD, D. Mo, MD, PhD, Eli Lilly and Company, Indianapolis, Indiana, USA; L. Xie, MS, Eli Lilly and Company, Indianapolis, Indiana, now with EQRx, Cambridge, Massachusetts, USA; D. Schlichting, RN, PhD, Eli Lilly and Company, Indianapolis, Indiana, now with Janssen Pharmaceuticals, Spring House, Pennsylvania, USA; P. Durez, MD, PhD, Université Catholique de Louvain-Saint Luc, Brussels, Belgium; Y. Tanaka, MD, PhD, The First Department of Internal Medicine, University of Occupational and Environmental Health, Japan, Kitakyushu, Japan; R. Fleischmann, MD, MACR, Metroplex Clinical Research Center/ University of Texas Southwestern Medical Center, Dallas, Texas, USA. DvdH has received consulting fees from AbbVie, Astellas, Bayer, BMS, Cyxone, Eisai, Galapagos, Gilead, GSK, Eli Lilly, Novartis, Pfizer, and UCB Pharma; and is the Director of Imaging at Rheumatology BV. PD has received speaker's fees from BMS, Celltrion, Eli Lilly and Company, and Sanofi. YT has received speaker's fees from AbbVie, Asahi-kasei, Astellas, BMS, Chugai, Daiichi-Sankyo, Eisai, Eli Lilly, GSK, Gilead, Janssen, Mitsubishi-Tanabe, Novartis, Pfizer, Sanofi, YL Biologics; and grant/research support from AbbVie, Asahi-Kasei, Chugai, Daiichi-Sankyo, Eisai, Mitsubishi-Tanabe, and Takeda. RF has received consultancy fees and research/grant support from AbbVie, Amgen, Eli Lilly, GSK, Gilead, Novartis, Pfizer, Regeneron, Samumed, Sanofi, Selecta, TEVA, UCB, and Viela. CEK, SB, and DM are employees and shareholders of Eli Lilly. LX and DS are previous employees of Eli Lilly and hold stocks in the company. Address correspondence to C.E. Kartman, Eli Lilly and Company, Lilly Corporate Center, Indianapolis, IN 46225, USA. . Accepted for publication September 2, 2021
| | - Cynthia E Kartman
- Financial support for the studies was provided by Eli Lilly and Company, which developed baricitinib, under license from Incyte Corporation. All costs associated with the development of this manuscript, including article processing charges and medical writing and editing services, were funded by Eli Lilly and Company. D. van der Heijde, MD, PhD, Department of Rheumatology, Leiden University Medical Center, Leiden, the Netherlands; C.E. Kartman, RN, S. Beattie, PhD, D. Mo, MD, PhD, Eli Lilly and Company, Indianapolis, Indiana, USA; L. Xie, MS, Eli Lilly and Company, Indianapolis, Indiana, now with EQRx, Cambridge, Massachusetts, USA; D. Schlichting, RN, PhD, Eli Lilly and Company, Indianapolis, Indiana, now with Janssen Pharmaceuticals, Spring House, Pennsylvania, USA; P. Durez, MD, PhD, Université Catholique de Louvain-Saint Luc, Brussels, Belgium; Y. Tanaka, MD, PhD, The First Department of Internal Medicine, University of Occupational and Environmental Health, Japan, Kitakyushu, Japan; R. Fleischmann, MD, MACR, Metroplex Clinical Research Center/ University of Texas Southwestern Medical Center, Dallas, Texas, USA. DvdH has received consulting fees from AbbVie, Astellas, Bayer, BMS, Cyxone, Eisai, Galapagos, Gilead, GSK, Eli Lilly, Novartis, Pfizer, and UCB Pharma; and is the Director of Imaging at Rheumatology BV. PD has received speaker's fees from BMS, Celltrion, Eli Lilly and Company, and Sanofi. YT has received speaker's fees from AbbVie, Asahi-kasei, Astellas, BMS, Chugai, Daiichi-Sankyo, Eisai, Eli Lilly, GSK, Gilead, Janssen, Mitsubishi-Tanabe, Novartis, Pfizer, Sanofi, YL Biologics; and grant/research support from AbbVie, Asahi-Kasei, Chugai, Daiichi-Sankyo, Eisai, Mitsubishi-Tanabe, and Takeda. RF has received consultancy fees and research/grant support from AbbVie, Amgen, Eli Lilly, GSK, Gilead, Novartis, Pfizer, Regeneron, Samumed, Sanofi, Selecta, TEVA, UCB, and Viela. CEK, SB, and DM are employees and shareholders of Eli Lilly. LX and DS are previous employees of Eli Lilly and hold stocks in the company. Address correspondence to C.E. Kartman, Eli Lilly and Company, Lilly Corporate Center, Indianapolis, IN 46225, USA. . Accepted for publication September 2, 2021
| | - Li Xie
- Financial support for the studies was provided by Eli Lilly and Company, which developed baricitinib, under license from Incyte Corporation. All costs associated with the development of this manuscript, including article processing charges and medical writing and editing services, were funded by Eli Lilly and Company. D. van der Heijde, MD, PhD, Department of Rheumatology, Leiden University Medical Center, Leiden, the Netherlands; C.E. Kartman, RN, S. Beattie, PhD, D. Mo, MD, PhD, Eli Lilly and Company, Indianapolis, Indiana, USA; L. Xie, MS, Eli Lilly and Company, Indianapolis, Indiana, now with EQRx, Cambridge, Massachusetts, USA; D. Schlichting, RN, PhD, Eli Lilly and Company, Indianapolis, Indiana, now with Janssen Pharmaceuticals, Spring House, Pennsylvania, USA; P. Durez, MD, PhD, Université Catholique de Louvain-Saint Luc, Brussels, Belgium; Y. Tanaka, MD, PhD, The First Department of Internal Medicine, University of Occupational and Environmental Health, Japan, Kitakyushu, Japan; R. Fleischmann, MD, MACR, Metroplex Clinical Research Center/ University of Texas Southwestern Medical Center, Dallas, Texas, USA. DvdH has received consulting fees from AbbVie, Astellas, Bayer, BMS, Cyxone, Eisai, Galapagos, Gilead, GSK, Eli Lilly, Novartis, Pfizer, and UCB Pharma; and is the Director of Imaging at Rheumatology BV. PD has received speaker's fees from BMS, Celltrion, Eli Lilly and Company, and Sanofi. YT has received speaker's fees from AbbVie, Asahi-kasei, Astellas, BMS, Chugai, Daiichi-Sankyo, Eisai, Eli Lilly, GSK, Gilead, Janssen, Mitsubishi-Tanabe, Novartis, Pfizer, Sanofi, YL Biologics; and grant/research support from AbbVie, Asahi-Kasei, Chugai, Daiichi-Sankyo, Eisai, Mitsubishi-Tanabe, and Takeda. RF has received consultancy fees and research/grant support from AbbVie, Amgen, Eli Lilly, GSK, Gilead, Novartis, Pfizer, Regeneron, Samumed, Sanofi, Selecta, TEVA, UCB, and Viela. CEK, SB, and DM are employees and shareholders of Eli Lilly. LX and DS are previous employees of Eli Lilly and hold stocks in the company. Address correspondence to C.E. Kartman, Eli Lilly and Company, Lilly Corporate Center, Indianapolis, IN 46225, USA. . Accepted for publication September 2, 2021
| | - Scott Beattie
- Financial support for the studies was provided by Eli Lilly and Company, which developed baricitinib, under license from Incyte Corporation. All costs associated with the development of this manuscript, including article processing charges and medical writing and editing services, were funded by Eli Lilly and Company. D. van der Heijde, MD, PhD, Department of Rheumatology, Leiden University Medical Center, Leiden, the Netherlands; C.E. Kartman, RN, S. Beattie, PhD, D. Mo, MD, PhD, Eli Lilly and Company, Indianapolis, Indiana, USA; L. Xie, MS, Eli Lilly and Company, Indianapolis, Indiana, now with EQRx, Cambridge, Massachusetts, USA; D. Schlichting, RN, PhD, Eli Lilly and Company, Indianapolis, Indiana, now with Janssen Pharmaceuticals, Spring House, Pennsylvania, USA; P. Durez, MD, PhD, Université Catholique de Louvain-Saint Luc, Brussels, Belgium; Y. Tanaka, MD, PhD, The First Department of Internal Medicine, University of Occupational and Environmental Health, Japan, Kitakyushu, Japan; R. Fleischmann, MD, MACR, Metroplex Clinical Research Center/ University of Texas Southwestern Medical Center, Dallas, Texas, USA. DvdH has received consulting fees from AbbVie, Astellas, Bayer, BMS, Cyxone, Eisai, Galapagos, Gilead, GSK, Eli Lilly, Novartis, Pfizer, and UCB Pharma; and is the Director of Imaging at Rheumatology BV. PD has received speaker's fees from BMS, Celltrion, Eli Lilly and Company, and Sanofi. YT has received speaker's fees from AbbVie, Asahi-kasei, Astellas, BMS, Chugai, Daiichi-Sankyo, Eisai, Eli Lilly, GSK, Gilead, Janssen, Mitsubishi-Tanabe, Novartis, Pfizer, Sanofi, YL Biologics; and grant/research support from AbbVie, Asahi-Kasei, Chugai, Daiichi-Sankyo, Eisai, Mitsubishi-Tanabe, and Takeda. RF has received consultancy fees and research/grant support from AbbVie, Amgen, Eli Lilly, GSK, Gilead, Novartis, Pfizer, Regeneron, Samumed, Sanofi, Selecta, TEVA, UCB, and Viela. CEK, SB, and DM are employees and shareholders of Eli Lilly. LX and DS are previous employees of Eli Lilly and hold stocks in the company. Address correspondence to C.E. Kartman, Eli Lilly and Company, Lilly Corporate Center, Indianapolis, IN 46225, USA. . Accepted for publication September 2, 2021
| | - Douglas Schlichting
- Financial support for the studies was provided by Eli Lilly and Company, which developed baricitinib, under license from Incyte Corporation. All costs associated with the development of this manuscript, including article processing charges and medical writing and editing services, were funded by Eli Lilly and Company. D. van der Heijde, MD, PhD, Department of Rheumatology, Leiden University Medical Center, Leiden, the Netherlands; C.E. Kartman, RN, S. Beattie, PhD, D. Mo, MD, PhD, Eli Lilly and Company, Indianapolis, Indiana, USA; L. Xie, MS, Eli Lilly and Company, Indianapolis, Indiana, now with EQRx, Cambridge, Massachusetts, USA; D. Schlichting, RN, PhD, Eli Lilly and Company, Indianapolis, Indiana, now with Janssen Pharmaceuticals, Spring House, Pennsylvania, USA; P. Durez, MD, PhD, Université Catholique de Louvain-Saint Luc, Brussels, Belgium; Y. Tanaka, MD, PhD, The First Department of Internal Medicine, University of Occupational and Environmental Health, Japan, Kitakyushu, Japan; R. Fleischmann, MD, MACR, Metroplex Clinical Research Center/ University of Texas Southwestern Medical Center, Dallas, Texas, USA. DvdH has received consulting fees from AbbVie, Astellas, Bayer, BMS, Cyxone, Eisai, Galapagos, Gilead, GSK, Eli Lilly, Novartis, Pfizer, and UCB Pharma; and is the Director of Imaging at Rheumatology BV. PD has received speaker's fees from BMS, Celltrion, Eli Lilly and Company, and Sanofi. YT has received speaker's fees from AbbVie, Asahi-kasei, Astellas, BMS, Chugai, Daiichi-Sankyo, Eisai, Eli Lilly, GSK, Gilead, Janssen, Mitsubishi-Tanabe, Novartis, Pfizer, Sanofi, YL Biologics; and grant/research support from AbbVie, Asahi-Kasei, Chugai, Daiichi-Sankyo, Eisai, Mitsubishi-Tanabe, and Takeda. RF has received consultancy fees and research/grant support from AbbVie, Amgen, Eli Lilly, GSK, Gilead, Novartis, Pfizer, Regeneron, Samumed, Sanofi, Selecta, TEVA, UCB, and Viela. CEK, SB, and DM are employees and shareholders of Eli Lilly. LX and DS are previous employees of Eli Lilly and hold stocks in the company. Address correspondence to C.E. Kartman, Eli Lilly and Company, Lilly Corporate Center, Indianapolis, IN 46225, USA. . Accepted for publication September 2, 2021
| | - Daojun Mo
- Financial support for the studies was provided by Eli Lilly and Company, which developed baricitinib, under license from Incyte Corporation. All costs associated with the development of this manuscript, including article processing charges and medical writing and editing services, were funded by Eli Lilly and Company. D. van der Heijde, MD, PhD, Department of Rheumatology, Leiden University Medical Center, Leiden, the Netherlands; C.E. Kartman, RN, S. Beattie, PhD, D. Mo, MD, PhD, Eli Lilly and Company, Indianapolis, Indiana, USA; L. Xie, MS, Eli Lilly and Company, Indianapolis, Indiana, now with EQRx, Cambridge, Massachusetts, USA; D. Schlichting, RN, PhD, Eli Lilly and Company, Indianapolis, Indiana, now with Janssen Pharmaceuticals, Spring House, Pennsylvania, USA; P. Durez, MD, PhD, Université Catholique de Louvain-Saint Luc, Brussels, Belgium; Y. Tanaka, MD, PhD, The First Department of Internal Medicine, University of Occupational and Environmental Health, Japan, Kitakyushu, Japan; R. Fleischmann, MD, MACR, Metroplex Clinical Research Center/ University of Texas Southwestern Medical Center, Dallas, Texas, USA. DvdH has received consulting fees from AbbVie, Astellas, Bayer, BMS, Cyxone, Eisai, Galapagos, Gilead, GSK, Eli Lilly, Novartis, Pfizer, and UCB Pharma; and is the Director of Imaging at Rheumatology BV. PD has received speaker's fees from BMS, Celltrion, Eli Lilly and Company, and Sanofi. YT has received speaker's fees from AbbVie, Asahi-kasei, Astellas, BMS, Chugai, Daiichi-Sankyo, Eisai, Eli Lilly, GSK, Gilead, Janssen, Mitsubishi-Tanabe, Novartis, Pfizer, Sanofi, YL Biologics; and grant/research support from AbbVie, Asahi-Kasei, Chugai, Daiichi-Sankyo, Eisai, Mitsubishi-Tanabe, and Takeda. RF has received consultancy fees and research/grant support from AbbVie, Amgen, Eli Lilly, GSK, Gilead, Novartis, Pfizer, Regeneron, Samumed, Sanofi, Selecta, TEVA, UCB, and Viela. CEK, SB, and DM are employees and shareholders of Eli Lilly. LX and DS are previous employees of Eli Lilly and hold stocks in the company. Address correspondence to C.E. Kartman, Eli Lilly and Company, Lilly Corporate Center, Indianapolis, IN 46225, USA. . Accepted for publication September 2, 2021
| | - Patrick Durez
- Financial support for the studies was provided by Eli Lilly and Company, which developed baricitinib, under license from Incyte Corporation. All costs associated with the development of this manuscript, including article processing charges and medical writing and editing services, were funded by Eli Lilly and Company. D. van der Heijde, MD, PhD, Department of Rheumatology, Leiden University Medical Center, Leiden, the Netherlands; C.E. Kartman, RN, S. Beattie, PhD, D. Mo, MD, PhD, Eli Lilly and Company, Indianapolis, Indiana, USA; L. Xie, MS, Eli Lilly and Company, Indianapolis, Indiana, now with EQRx, Cambridge, Massachusetts, USA; D. Schlichting, RN, PhD, Eli Lilly and Company, Indianapolis, Indiana, now with Janssen Pharmaceuticals, Spring House, Pennsylvania, USA; P. Durez, MD, PhD, Université Catholique de Louvain-Saint Luc, Brussels, Belgium; Y. Tanaka, MD, PhD, The First Department of Internal Medicine, University of Occupational and Environmental Health, Japan, Kitakyushu, Japan; R. Fleischmann, MD, MACR, Metroplex Clinical Research Center/ University of Texas Southwestern Medical Center, Dallas, Texas, USA. DvdH has received consulting fees from AbbVie, Astellas, Bayer, BMS, Cyxone, Eisai, Galapagos, Gilead, GSK, Eli Lilly, Novartis, Pfizer, and UCB Pharma; and is the Director of Imaging at Rheumatology BV. PD has received speaker's fees from BMS, Celltrion, Eli Lilly and Company, and Sanofi. YT has received speaker's fees from AbbVie, Asahi-kasei, Astellas, BMS, Chugai, Daiichi-Sankyo, Eisai, Eli Lilly, GSK, Gilead, Janssen, Mitsubishi-Tanabe, Novartis, Pfizer, Sanofi, YL Biologics; and grant/research support from AbbVie, Asahi-Kasei, Chugai, Daiichi-Sankyo, Eisai, Mitsubishi-Tanabe, and Takeda. RF has received consultancy fees and research/grant support from AbbVie, Amgen, Eli Lilly, GSK, Gilead, Novartis, Pfizer, Regeneron, Samumed, Sanofi, Selecta, TEVA, UCB, and Viela. CEK, SB, and DM are employees and shareholders of Eli Lilly. LX and DS are previous employees of Eli Lilly and hold stocks in the company. Address correspondence to C.E. Kartman, Eli Lilly and Company, Lilly Corporate Center, Indianapolis, IN 46225, USA. . Accepted for publication September 2, 2021
| | - Yoshiya Tanaka
- Financial support for the studies was provided by Eli Lilly and Company, which developed baricitinib, under license from Incyte Corporation. All costs associated with the development of this manuscript, including article processing charges and medical writing and editing services, were funded by Eli Lilly and Company. D. van der Heijde, MD, PhD, Department of Rheumatology, Leiden University Medical Center, Leiden, the Netherlands; C.E. Kartman, RN, S. Beattie, PhD, D. Mo, MD, PhD, Eli Lilly and Company, Indianapolis, Indiana, USA; L. Xie, MS, Eli Lilly and Company, Indianapolis, Indiana, now with EQRx, Cambridge, Massachusetts, USA; D. Schlichting, RN, PhD, Eli Lilly and Company, Indianapolis, Indiana, now with Janssen Pharmaceuticals, Spring House, Pennsylvania, USA; P. Durez, MD, PhD, Université Catholique de Louvain-Saint Luc, Brussels, Belgium; Y. Tanaka, MD, PhD, The First Department of Internal Medicine, University of Occupational and Environmental Health, Japan, Kitakyushu, Japan; R. Fleischmann, MD, MACR, Metroplex Clinical Research Center/ University of Texas Southwestern Medical Center, Dallas, Texas, USA. DvdH has received consulting fees from AbbVie, Astellas, Bayer, BMS, Cyxone, Eisai, Galapagos, Gilead, GSK, Eli Lilly, Novartis, Pfizer, and UCB Pharma; and is the Director of Imaging at Rheumatology BV. PD has received speaker's fees from BMS, Celltrion, Eli Lilly and Company, and Sanofi. YT has received speaker's fees from AbbVie, Asahi-kasei, Astellas, BMS, Chugai, Daiichi-Sankyo, Eisai, Eli Lilly, GSK, Gilead, Janssen, Mitsubishi-Tanabe, Novartis, Pfizer, Sanofi, YL Biologics; and grant/research support from AbbVie, Asahi-Kasei, Chugai, Daiichi-Sankyo, Eisai, Mitsubishi-Tanabe, and Takeda. RF has received consultancy fees and research/grant support from AbbVie, Amgen, Eli Lilly, GSK, Gilead, Novartis, Pfizer, Regeneron, Samumed, Sanofi, Selecta, TEVA, UCB, and Viela. CEK, SB, and DM are employees and shareholders of Eli Lilly. LX and DS are previous employees of Eli Lilly and hold stocks in the company. Address correspondence to C.E. Kartman, Eli Lilly and Company, Lilly Corporate Center, Indianapolis, IN 46225, USA. . Accepted for publication September 2, 2021
| | - Roy Fleischmann
- Financial support for the studies was provided by Eli Lilly and Company, which developed baricitinib, under license from Incyte Corporation. All costs associated with the development of this manuscript, including article processing charges and medical writing and editing services, were funded by Eli Lilly and Company. D. van der Heijde, MD, PhD, Department of Rheumatology, Leiden University Medical Center, Leiden, the Netherlands; C.E. Kartman, RN, S. Beattie, PhD, D. Mo, MD, PhD, Eli Lilly and Company, Indianapolis, Indiana, USA; L. Xie, MS, Eli Lilly and Company, Indianapolis, Indiana, now with EQRx, Cambridge, Massachusetts, USA; D. Schlichting, RN, PhD, Eli Lilly and Company, Indianapolis, Indiana, now with Janssen Pharmaceuticals, Spring House, Pennsylvania, USA; P. Durez, MD, PhD, Université Catholique de Louvain-Saint Luc, Brussels, Belgium; Y. Tanaka, MD, PhD, The First Department of Internal Medicine, University of Occupational and Environmental Health, Japan, Kitakyushu, Japan; R. Fleischmann, MD, MACR, Metroplex Clinical Research Center/ University of Texas Southwestern Medical Center, Dallas, Texas, USA. DvdH has received consulting fees from AbbVie, Astellas, Bayer, BMS, Cyxone, Eisai, Galapagos, Gilead, GSK, Eli Lilly, Novartis, Pfizer, and UCB Pharma; and is the Director of Imaging at Rheumatology BV. PD has received speaker's fees from BMS, Celltrion, Eli Lilly and Company, and Sanofi. YT has received speaker's fees from AbbVie, Asahi-kasei, Astellas, BMS, Chugai, Daiichi-Sankyo, Eisai, Eli Lilly, GSK, Gilead, Janssen, Mitsubishi-Tanabe, Novartis, Pfizer, Sanofi, YL Biologics; and grant/research support from AbbVie, Asahi-Kasei, Chugai, Daiichi-Sankyo, Eisai, Mitsubishi-Tanabe, and Takeda. RF has received consultancy fees and research/grant support from AbbVie, Amgen, Eli Lilly, GSK, Gilead, Novartis, Pfizer, Regeneron, Samumed, Sanofi, Selecta, TEVA, UCB, and Viela. CEK, SB, and DM are employees and shareholders of Eli Lilly. LX and DS are previous employees of Eli Lilly and hold stocks in the company. Address correspondence to C.E. Kartman, Eli Lilly and Company, Lilly Corporate Center, Indianapolis, IN 46225, USA. . Accepted for publication September 2, 2021
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Grekhov RA, Suleimanova GP, Trofimenko AS, Shilova LN. Psychosomatic Features, Compliance and Complementary Therapies in Rheumatoid Arthritis. Curr Rheumatol Rev 2021; 16:215-223. [PMID: 31830886 DOI: 10.2174/1573397115666191212114758] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Revised: 11/05/2019] [Accepted: 11/08/2019] [Indexed: 11/22/2022]
Abstract
This review highlights the issue of psychosomatic conditions in rheumatoid arthritis, paying special attention to new researches and trends in this field. Emerging concepts in all the major parts of the problem are covered consecutively, from the impact of chronic musculoskeletal pain on the emotional state to disease influence over quality of life, socio-psychological, and interpersonal relationships. Chronic pain is closely related to emotional responses and coping ability, with a pronounced positive effect of psychotherapeutic interventions, family and social support on it. Psychosexual disorders, anxiety, depression also commonly coexist with rheumatoid arthritis, leading to further decrease in quality of life, low compliance, and high suicide risk. Influence of psychosomatic conditions on the overall treatment effect is usually underestimated by rheumatologists and general practitioners. Psychosomatic considerations are of great importance for up-to-date management of rheumatoid arthritis, as they strongly influence the quality of life, compliance, and thereby disease outcomes. Two major approaches of psychological rehabilitation exist, both coping with pain through the regulation of emotion and psychotherapeutic intervention, which not only helps patients in coping with the disease, but also aimed at improving the overall adaptation of the patient. It includes techniques of relaxation, cognitive-behavioral therapy, and biofeedback therapy. Current data about the efficacy of the additional correcting therapies for patients with rheumatoid arthritis, both emerging and common ones, are discussed in the review.
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Affiliation(s)
- Rostislav A Grekhov
- Research Institute for Clinical and Experimental Rheumatology, Volgograd, Russian Federation
| | - Galina P Suleimanova
- Research Institute for Clinical and Experimental Rheumatology, Volgograd, Russian Federation
| | - Andrei S Trofimenko
- Research Institute for Clinical and Experimental Rheumatology, Volgograd, Russian Federation
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de Vlam K, Ogdie A, Bushmakin AG, Cappelleri JC, Fleischmann R, Taylor PC, Azevedo V, Fallon L, Woolcott J, Mease PJ. Median time to pain improvement and the impact of baseline pain severity on pain response in patients with psoriatic arthritis treated with tofacitinib. RMD Open 2021; 7:e001609. [PMID: 34226183 PMCID: PMC8258668 DOI: 10.1136/rmdopen-2021-001609] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 05/22/2021] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Pain is a core domain of psoriatic arthritis (PsA). This post hoc analysis evaluated time to pain improvement and the impact of baseline pain severity on pain response in patients with PsA receiving tofacitinib. METHODS Data from two trials (NCT01877668; NCT01882439) in patients receiving tofacitinib 5 mg twice daily, placebo switching to tofacitinib 5 mg twice daily at month 3 (placebo-to-tofacitinib) or adalimumab (NCT01877668 only) were included. Improvement in pain (≥30%/≥50% decrease from baseline in Visual Analogue Scale pain score) was assessed; median time to initial (first post-baseline visit)/continued (first two consecutive post-baseline visits) pain improvement was estimated (Kaplan-Meier) for all treatment arms. A parametric model was used to determine the relationship between baseline pain severity and time to pain response in patients receiving tofacitinib. RESULTS At month 3, more patients experienced pain improvements with tofacitinib/adalimumab versus placebo. Median days (95% CI) to initial/continued pain improvements of ≥30% and ≥50%, respectively, were 55 (29-57)/60 (57-85) and 85 (57-92)/171 (90-not estimable (NE)) for tofacitinib, versus 106 (64-115)/126 (113-173) and 169 (120-189)/NE (247-NE) for placebo-to-tofacitinib. Pain improvements were also experienced more quickly for adalimumab versus placebo. Predicted time to ≥30%/≥50% pain improvement was shorter in patients with higher baseline pain versus lower baseline pain (tofacitinib arm only). CONCLUSIONS In patients with PsA, pain improvements were experienced by more patients, and more rapidly, with tofacitinib and adalimumab versus placebo. In those receiving tofacitinib, higher baseline pain was associated with faster pain improvements.
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Affiliation(s)
- Kurt de Vlam
- Department of Rheumatology, UZ Leuven, Leuven, Belgium
| | - Alexis Ogdie
- Division of Rheumatology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | | | | | - Roy Fleischmann
- Department of Internal Medicine, University of Texas Southwestern Medical Center and Metroplex Clinical Research Center, Dallas, Texas, USA
| | - Peter C Taylor
- Botnar Research Centre, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, Oxfordshire, UK
| | - Valderilio Azevedo
- Departamento de Clínica Médica, Universidade Federal do Paraná, Curitiba, Brazil
| | - Lara Fallon
- Global Medical Affairs, Rheumatology, Pfizer Inc, Kirkland, Quebec, Canada
| | - John Woolcott
- Global Medical Affairs, Gastroenterology, Inflammation and Immunology, Pfizer Inc, Collegeville, Pennsylvania, USA
| | - Philip J Mease
- Swedish Medical Center/Providence St. Joseph Health and University of Washington, Seattle, Washington, USA
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Abramkin AA, Lisitsyna TA, Veltishchev DY, Seravina OF, Kovalevskaya OB, Glukhova SI, Nasonov EL. [Depression and severity of articular destruction in patients with rheumatoid arthritis]. TERAPEVT ARKH 2020; 92:22-32. [PMID: 32598772 DOI: 10.26442/00403660.2020.05.000624] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Indexed: 11/22/2022]
Abstract
AIM To assess the influence of anxiety and depressive disorders on joint destruction in patients with rheumatoid arthritis (RA). MATERIALS AND METHODS 128 RA-patients were included, 87% were women with a mean age of 47.411.3 years and a median of RA duration 96 [48; 228] months. At the inclusion most patients had moderate (n=56, 43.7%) and severe (n=48, 37.5%) disease activity according to DAS28. Joint destruction was classified as maximal in patients with radiographic stage III, IV and/or osteonecrosis) and minimal in patients with stage I, II and no osteonecrosis. Pain intensity was measured with the BPI (Brief Pain Inventory) scale, severity of fatigue with fatigue severity scale (FSS), clinically important fatigue was diagnosed in patients with FSS4. Anxiety and depressive disorders (ADD) were diagnosed by a licensed psychiatrist in 123 (96.1%) of RA-patients in accordance with ICD-10 in semi-structured interview. Severity of depression and anxiety was evaluated with Montgomery-Asberg Depression Rating Scale (MADRS) and Hamilton Anxiety Rating Scale (HAM-A). RA-patients with ADD were divided into the following treatment groups: 1 сDMARDs (n=39), 2 сDMARDs+PPT (sertraline or mianserine), n=43, 3 сDMARDs+bDMARDs (n=32), 4 сDMARDs+bDMARDs+PPT (sertraline or mianserine), n=9. Biologics treatment duration varied from 1 to 6 years, antidepressants from 6 to 96 weeks. 83 (67.5%) RA patients were assessed at five-years follow-up. Linear regression analysis was conducted to determine factors associated with maximal join destruction. RESULTS According to linear regression analysis, maximal joint destruction at 5 years follow-up was associated with higher baseline BPImax, longer RA and ADD duration, clinically important fatigue at baseline, baseline extraarticular RA manifestations, recurrent depressive disorder at 5-years follow-up and treatment with cDMARDs only. CONCLUSION Recurrent depressive disorder without antidepressant treatment is an important predictor of progression of joint destruction in patients with rheumatoid arthritis.
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Affiliation(s)
| | | | - D Y Veltishchev
- Moscow Research Institute of Psychiatry - branch of the Serbskiy National Medical Research Center of Psychiatry and Narcology.,Pirogov Russian National Research Medical University
| | - O F Seravina
- Moscow Research Institute of Psychiatry - branch of the Serbskiy National Medical Research Center of Psychiatry and Narcology
| | - O B Kovalevskaya
- Moscow Research Institute of Psychiatry - branch of the Serbskiy National Medical Research Center of Psychiatry and Narcology
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Opioid use in rheumatoid arthritis: trends, efficacy, safety, and best practices. Curr Opin Rheumatol 2019; 31:264-270. [DOI: 10.1097/bor.0000000000000602] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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Qorolli M, Rexhepi B, Rexhepi S, Mustapić M, Doko I, Grazio S. Association between disease activity measured by RAPID3 and health-related quality of life in patients with rheumatoid arthritis. Rheumatol Int 2019; 39:827-834. [PMID: 30847560 DOI: 10.1007/s00296-019-04258-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Accepted: 02/14/2019] [Indexed: 12/26/2022]
Abstract
Routine assessment of patient index data 3 (RAPID3) is a simple, valid and reliable tool designed to measure disease activity in patients with rheumatoid arthritis (RA). RA causes significant disability and diminishes health-related quality of life (HR-QoL). The aim of this study was to investigate how RAPID3 is related to HR-QoL in patients with RA. In this cross-sectional study performed at the tertiary outpatient clinic 68 consecutive patients (58 females, and 10 males) with established RA were enrolled. RAPID3 and EuroQoL-5D-3L (EQ-5D-3L) were used to measure disease activity and quality of life, respectively. Alongside, demographic and clinical data were obtained, as well as HAQ-DI as a measure of physical function, and Steinbrocker's score for radiographic damage. To test the relationships among RAPID3 and study variables we used the Pearson product-moment correlation coefficient, with the significance was set at P < 0.05. Linear and forward stepwise regression was used to show how variables of interest contributed to RAPID3. The mean value of RAPID3 (standard deviation, SD) was 14.12 (± 5.21), while the median (IQR) value of EQ-5D-3L was 0.51 (0.62-0.23). There was a high significant correlation (r = - 0.73) between RAPID3 scores and EQ-5D-3L. Among the other variables of interest, the strongest correlation was found between RAPID3 and intensity of pain (r = 0.88), while the EQ-5D-3L and pain were moderately correlated (r = - 0.68). In evaluating the influence of variables of interest on RAPID3, a forward stepwise regression model was constructed to evaluate whether VAS pain, EQ-5D-3L and EQ-VAS predicted RAPID3. The given variables significantly explained approximately 81% of the variation in RAPID3. Based on the results of this study RAPID3, a simple and practical tool to assess disease activity, reflects well HR-QoL in patients with established RA.
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Affiliation(s)
- Merita Qorolli
- Clinic of Physical Medicine and Rehabilitation, University Clinical Centre of Kosovo, Pristina, Kosovo
| | - Blerta Rexhepi
- Rheumatology Clinic, University Clinical Centre of Kosovo, Pristina, Kosovo
| | - Sylejman Rexhepi
- Rheumatology Clinic, University Clinical Centre of Kosovo, Pristina, Kosovo
| | - Matej Mustapić
- Department of Radiology, Southern Älvsborg Hospital, Borås, Sweden
| | - Ines Doko
- University Department for Rheumatology, Physical and Rehabilitation Medicine, University Hospital Centre Sestre Milosrdnice, Vinogradska c. 29, 10000, Zagreb, Croatia
| | - Simeon Grazio
- University Department for Rheumatology, Physical and Rehabilitation Medicine, University Hospital Centre Sestre Milosrdnice, Vinogradska c. 29, 10000, Zagreb, Croatia.
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van Bemmel PF, Voshaar MAO, Klooster PMT, Vonkeman HE, van de Laar MA. Development and preliminary evaluation of a short self-report measure of generalized pain hypersensitivity. J Pain Res 2019; 12:395-404. [PMID: 30705605 PMCID: PMC6342225 DOI: 10.2147/jpr.s182287] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Purpose Generalized pain hypersensitivity is frequently observed in chronic pain conditions. Currently, identification is based on expert clinical opinion, and in very few cases combined with quantitative sensory testing. The objectives of this study were to develop and evaluate a short self-report measure of generalized pain hypersensitivity: a generalized pain questionnaire (GPQ). Methods Items for the GPQ were developed based on a literature review, followed by an interview study with ten rheumatic patients with suspected pain hypersensitivity. We examined the psychometric properties of the preliminary items in a sample of 212 outpatients suffering from either fibromyalgia (FM; n=98) or rheumatoid arthritis (n=114). Additionally, self-reported data were gathered on sociodemographics, fibromyalgia-survey criteria, health status, and neuropathic-like pain features. Results Mokken-scale analyses demonstrated a unidimensional seven-item scale with strong homogeneity (H=0.65) and high reliability (r=0.90). Correlations between total GPQ scores and relevant external measures, such as the FM-survey criteria and neuropathic-like pain features, were consistent with a priori expectations, supporting its external construct validity. Furthermore, the GPQ had good accuracy in distinguishing between patients with FM (generally assumed to be the result of central nervous system hypersensitization) and patients with RA (assumed to result mostly in local nociceptive or inflammatory pain), with an area under the receiver-operating characteristic curve of 0.89. A cutoff value >10 had the highest combination of sensitivity (82.7%) and specificity (77.2%). Conclusion The GPQ is psychometrically sound and appears promising for measuring the presence and severity of generalized pain hypersensitivity in chronic pain patients.
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Affiliation(s)
- Peter F van Bemmel
- Department of Rheumatology, Medisch Spectrum Twente, Enschede, Netherlands
| | - Martijn Ah Oude Voshaar
- Department of Psychology, Health, and Technology, University of Twente, Enschede, Netherlands,
| | - Peter M Ten Klooster
- Department of Psychology, Health, and Technology, University of Twente, Enschede, Netherlands,
| | - Harald E Vonkeman
- Department of Rheumatology, Medisch Spectrum Twente, Enschede, Netherlands.,Department of Psychology, Health, and Technology, University of Twente, Enschede, Netherlands,
| | - Mart Afj van de Laar
- Department of Rheumatology, Medisch Spectrum Twente, Enschede, Netherlands.,Department of Psychology, Health, and Technology, University of Twente, Enschede, Netherlands,
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Causal Relationships Between Modifiable Risk Factors of Cognitive Impairment, Cognitive Function, Self-Management, and Quality of Life in Patients With Rheumatic Diseases. Orthop Nurs 2018; 37:305-315. [PMID: 30247414 DOI: 10.1097/nor.0000000000000481] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Rheumatic diseases are one of the most common types of chronic conditions that affect cognitive functions. PURPOSE To develop and verify a hypothetical model of causal relationships between modifiable risk factors for cognitive impairment, cognitive function, self-management, and quality of life in patients with rheumatic diseases. METHODS A hypothetical model was developed on the basis of empirical evidence. The fitness of the model was verified on 210 patients with rheumatic diseases. RESULTS The prevalence of cognitive impairment was 49.0%. Smoking, underlying diseases, pain, and fatigue had a significant direct effect on cognitive impairment. Only cognitive impairment had a significant direct effect on self-management. Fatigue, anxiety, depression, and cognitive function had a significant direct effect on quality of life. CONCLUSIONS The importance of proper management of symptoms and health habits should be emphasized to prevent and delay the progression of cognitive impairment and improve adherence to self-management regimens and quality of life.
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Bączyk G, Kozłowska K. The role of demographic and clinical variables in assessing the quality of life of outpatients with rheumatoid arthritis. Arch Med Sci 2018; 14:1070-1079. [PMID: 30154890 PMCID: PMC6111345 DOI: 10.5114/aoms.2018.77254] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2016] [Accepted: 04/06/2017] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION The aim of this study was to assess quality of life among patients with rheumatoid arthritis (RA) treated as outpatients. The specific question was: does the quality of life of RA patients depend on demographic variables and clinical variables? MATERIAL AND METHODS The study included 240 patients with RA recruited from outpatients. To assess quality of life, the Arthritis Impact Measurement Scales 2 was applied. Clinical tests: VAS, Morning Stiffness, Grip Strength, Richie Articular Index. RESULTS The analysis of life quality for the total group was carried out in the particular AIMS2 of the mean scores for arthritis pain - 7.37; walking and bending - 6.62; social activity - 5.52; level of tension - 5.17; satisfaction - 5.17; hand and finger function - 4.28; mood - 4.03; physical activity - 3.27; arm function - 3.16; household tasks - 2.67; self-care - 2.18; and support from family and friends - 1.75. The arthritis impact score was 6.01. The analysis of the correlation between clinical variables and individual AIMS2 subscales showed a statistically significant relationship between the VAS Pain, Grip Strength Measurement, Morning Stiffness and quality of life subscales (p < 0.01). VAS Pain, Morning Stiffness, and Grip Strength Measurement were the most important predictors among clinical variables of physical component, affect and symptoms (p < 0.001). Among demographic variables: age over 60 years and low education were the most important predictors of physical component (p < 0.01). CONCLUSIONS The study results may be helpful for further health-related studies on quality of life among RA studies and in making therapeutic decisions concerning quality of life improvement.
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Affiliation(s)
- Grażyna Bączyk
- Department of Nursing Practice, Faculty of Health Sciences, Poznan University of Medical Sciences, Poznan, Poland
| | - Katarzyna Kozłowska
- Department of Nursing Practice, Faculty of Health Sciences, Poznan University of Medical Sciences, Poznan, Poland
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Abstract
BACKGROUND/OBJECTIVE Recent studies have indicated that cardiac autonomic dysfunction is an early sign of cardiovascular impairment in rheumatoid arthritis (RA). Previous studies have mainly focused on resting assessments; however, analysis of heart rate (HR) responses to exercise might provide additional information on cardiac autonomic dysfunction in this disease. Thus, we aimed to assess the HR responses during and after a maximal graded exercise test in patients with RA and healthy controls (CONs). METHODS This was a cross-sectional study in which 27 female RA patients and 14 female CONs frequency matched by physical activity, age, and body mass index were compared for HR responses during and after a maximal graded exercise test. RESULTS Rheumatoid arthritis patients showed reduced chronotropic response (94.3% ± 16.3% vs. 106.1% ± 10.3%, p = 0.02) and lower HR recovery (HRR) at 30 seconds (8.6 ± 6.7 vs. 13.4 ± 5.2 beats/min [bpm], p = 0.02), 60 seconds (16.5 ± 7.8 vs. 24.0 ± 9.9 bpm, p = 0.01), 120 seconds (32.6 ± 9.9 vs. 40.7 ± 12.3 bpm, p = 0.03), and 180 seconds (46.5 ± 12.6 vs. 55.5 ± 13.4 bpm, p = 0.05) post-maximal exercise test when compared with CONs. Moreover, the prevalence of chronotropic incompetence (i.e., failure to reach 80% of the HR-predicted response) and abnormal HRR (i.e., HRR ≤12 bpm) were, respectively, 22.2% and 37.1% in RA patients. CONCLUSIONS Patients with RA showed reduced chronotropic response to exercise and slower postexercise HRR. These abnormal autonomic responses to exercise indicate the presence of cardiac autonomic dysfunction and increased cardiovascular risk in this population.
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Salaffi F, Giacobazzi G, Di Carlo M. Chronic Pain in Inflammatory Arthritis: Mechanisms, Metrology, and Emerging Targets-A Focus on the JAK-STAT Pathway. Pain Res Manag 2018; 2018:8564215. [PMID: 29623147 PMCID: PMC5829432 DOI: 10.1155/2018/8564215] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Accepted: 12/13/2017] [Indexed: 12/14/2022]
Abstract
Chronic pain is nowadays considered not only the mainstay symptom of rheumatic diseases but also "a disease itself." Pain is a multidimensional phenomenon, and in inflammatory arthritis, it derives from multiple mechanisms, involving both synovitis (release of a great number of cytokines) and peripheral and central pain-processing mechanisms (sensitization). In the last years, the JAK-STAT pathway has been recognized as a pivotal component both in the inflammatory process and in pain amplification in the central nervous system. This paper provides a summary on pain in inflammatory arthritis, from pathogenesis to clinimetric instruments and treatment, with a focus on the JAK-STAT pathway.
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Affiliation(s)
- Fausto Salaffi
- Rheumatology Department, Università Politecnica delle Marche, Jesi, Ancona, Italy
| | | | - Marco Di Carlo
- Rheumatology Department, Università Politecnica delle Marche, Jesi, Ancona, Italy
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18
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Bae SC, Cha JH, Choe JY, Choi SJ, Cho SK, Chung WT, Joung CI, Jung YO, Kang YM, Kim DW, Kim J, Kim YJ, Lee CK, Lee HS, Lee J, Lee SH, Lee SH, Lee SS, Lee YA, Nah SS, Shim SC, Song GG, Suh CH, Won S, Yoo WH, Yoon BY. Productivity Loss of Rheumatoid Arthritis Patients according to the Their Stages of the Disease Activity Score. JOURNAL OF RHEUMATIC DISEASES 2018. [DOI: 10.4078/jrd.2018.25.2.122] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Affiliation(s)
- Sang-Cheol Bae
- Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, Korea
| | - Jin-Hye Cha
- Outcomes Research/Real World Data Team, Corporate Affairs and Health & Value Division, Pfizer Pharmaceuticals Korea Limited, Seoul, Korea
| | - Jung-Yoon Choe
- Division of Rheumatology, Department of Internal Medicine, Catholic University of Daegu School of Medicine, Daegu, Korea
| | - Sung Jae Choi
- Division of Rheumatology, Korea University Ansan Hospital, Ansan, Korea
| | - Soo-Kyung Cho
- Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, Korea
| | - Won-Tae Chung
- Department of Rheumatology, Dong-A University Hospital, Busan, Korea
| | - Chung-Il Joung
- Department of Rheumatology, Konyang University Hospital, Daejeon, Korea
| | - Young-Ok Jung
- Department of Rheumatology, Hallym University Kangnam Sacred Heart Hospital, Seoul, Korea
| | - Young Mo Kang
- Department of Rheumatology, Kyungpook National University Hospital, Daegu, Korea
| | - Dong-Wook Kim
- Department of Rheumatology, Inje University Busan Paik Hospital, Busan, Korea
| | - Jinseok Kim
- Department of Rheumatology, Jeju National University School of Medicine, Jeju, Korea
| | - Young-Joo Kim
- Outcomes Research/Real World Data Team, Corporate Affairs and Health & Value Division, Pfizer Pharmaceuticals Korea Limited, Seoul, Korea
| | - Choong-Ki Lee
- Department of Infectious Diseases and Rheumatology, Yeongnam University Hospital, Daegu, Korea
| | - Hye-Soon Lee
- Department of Rheumatology, Hangyang University Guri Hospital, Guri, Korea
| | - Jisoo Lee
- Division of Rheumatology, Ewha Womans University Mokdong Hospital, Seoul, Korea
| | - Sang-Heon Lee
- Department of Rheumatology, Konkuk University Medical Center, Seoul, Korea
| | - Sang-Hoon Lee
- Department of Rheumatology, Kyung Hee University Hospital at Gangdong, Seoul, Korea
| | - Shin-Seok Lee
- Division of Rheumatology, Chonnam National University Medical School and Hospital, Gwangju, Korea
| | - Yeon-Ah Lee
- Division of Rheumatology, Department of Internal Medicine, Kyung Hee University Hospital, Seoul, Korea
| | - Seong-Su Nah
- Department of Rheumatology, Soonchunhyang University Cheonan Hospital, Cheonan, Korea
| | - Seung Cheol Shim
- Department of Rheumatology, Chungnam National University Hospital, Daejeon, Korea
| | - Gwan-Gyu Song
- Division of Rheumatology, Korea University Guro Hospital, Seoul, Korea
| | - Chang-Hee Suh
- Department of Rheumatology, Ajou University School of Medicine, Suwon, Korea
| | - Soyoung Won
- Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, Korea
| | - Wan-Hee Yoo
- Department of Rheumatology, Chonbuk National University Hospital, Jeonju, Korea
| | - Bo Young Yoon
- Division of Rheumatology, Department of Internal Medicine, Inje University Ilsan Paik Hospital, Goyang, Korea
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Husni ME, Merola JF, Davin S. The psychosocial burden of psoriatic arthritis. Semin Arthritis Rheum 2017; 47:351-360. [DOI: 10.1016/j.semarthrit.2017.05.010] [Citation(s) in RCA: 95] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2017] [Revised: 05/09/2017] [Accepted: 05/19/2017] [Indexed: 01/01/2023]
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Kiadaliri AA, Kristensen LE, Englund M. Burden of rheumatoid arthritis in the Nordic region, 1990–2015: a comparative analysis using the Global Burden of Disease Study 2015. Scand J Rheumatol 2017; 47:1-101. [DOI: 10.1080/03009742.2017.1314002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- AA Kiadaliri
- Lund University, Faculty of Medicine, Department of Clinical Sciences-Lund, Orthopaedics, Clinical Epidemiology Unit, Lund, Sweden
| | - L-E Kristensen
- The Parker Institute, Bispebjerg and Frederiksberg Hospitals, University of Copenhagen, Copenhagen, Denmark
- Department of Rheumatology, Lund University Hospital, Lund, Sweden
| | - M Englund
- Lund University, Faculty of Medicine, Department of Clinical Sciences-Lund, Orthopaedics, Clinical Epidemiology Unit, Lund, Sweden
- Clinical Epidemiology Research and Training Unit, Boston University School of Medicine, Boston, MA, USA
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Kronisch C, McLernon DJ, Dale J, Paterson C, Ralston SH, Reid DM, Tierney A, Harvie J, McKay N, Wilson HE, Munro R, Saunders S, Richmond R, Baxter D, McMahon M, Kumar V, McLaren J, Siebert S, McInnes IB, Porter D, Macfarlane GJ, Basu N. Brief Report: Predicting Functional Disability: One-Year Results From the Scottish Early Rheumatoid Arthritis Inception Cohort. Arthritis Rheumatol 2017; 68:1596-602. [PMID: 26866516 DOI: 10.1002/art.39627] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2015] [Accepted: 01/28/2016] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To identify baseline prognostic indicators of disability at 1 year within a contemporary early inflammatory arthritis inception cohort and then develop a clinically useful tool to support early patient education and decision-making. METHODS The Scottish Early Rheumatoid Arthritis (SERA) inception cohort is a multicenter, prospective study of patients with newly presenting RA or undifferentiated arthritis. SERA data were analyzed to determine baseline predictors of disability (defined as a Health Assessment Questionnaire [HAQ] score of ≥1) at 1 year. Clinical and psychosocial baseline exposures were entered into a forward stepwise logistic regression model. The model was externally validated using newly accrued SERA data and subsequently converted into a prediction tool. RESULTS Of the 578 participants (64.5% female), 36.7% (n = 212) reported functional disability at 1 year. Functional disability was independently predicted by baseline disability (odds ratio [OR] 2.67 [95% confidence interval (95% CI) 1.98, 3.59]), depression (OR 2.52 [95% CI 1.18, 5.37]), anxiety (OR 2.37 [95% CI 1.33, 4.21]), being in paid employment with absenteeism during the last week (OR 1.19 [95% CI 0.63, 2.23]), not being in paid employment (OR 2.36 [95% CI 1.38, 4.03]), and being overweight (OR 1.61 [95% CI 1.04, 2.50]). External validation (using 113 newly acquired patients) evidenced good discriminative performance with a C statistic of 0.74, and the calibration slope showed no evidence of model overfit (P = 0.31). CONCLUSION In the context of modern early inflammatory arthritis treatment paradigms, predictors of disability at 1 year appear to be dominated by psychosocial rather than more traditional clinical measures. This indicates the potential benefit of early access to nonpharmacologic interventions targeting key psychosocial factors, such as mental health and work disability.
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Affiliation(s)
- Caroline Kronisch
- Cantonal Hospital Fribourg, Fribourg, Switzerland, and University of Aberdeen, Aberdeen, UK
| | | | | | | | | | | | | | | | | | | | | | | | | | | | - Mike McMahon
- Dumfries & Galloway Royal Infirmary, Dumfries, UK
| | | | | | | | | | | | | | - Neil Basu
- University of Aberdeen, Aberdeen, UK
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Shim EJ, Hahm BJ, Go DJ, Lee KM, Noh HL, Park SH, Song YW. Modeling quality of life in patients with rheumatic diseases: the role of pain catastrophizing, fear-avoidance beliefs, physical disability, and depression. Disabil Rehabil 2017; 40:1509-1516. [PMID: 28291952 DOI: 10.1080/09638288.2017.1300691] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
PURPOSE To examine factors in the fear-avoidance model, such as pain, pain catastrophizing, fear-avoidance beliefs, physical disability, and depression and their relationships with physical and psychological quality of life in patients with rheumatic diseases. MATERIALS AND METHODS The data were obtained from 360 patients with rheumatic diseases who completed self-report measures assessing study variables. Structural equation modeling was used to examine the hypothesized relationships among factors specified in the fear-avoidance model predicting physical and psychological quality of life. RESULTS Final models fit the data well, explaining 96% and 82% of the variance in physical and psychological quality of life, respectively. Higher pain catastrophizing was related to stronger fear-avoidance beliefs that had a direct negative association with physical disability and depression, which, in turn, negatively affected physical quality of life. Pain severity was also directly related to physical disability. Physical disability also affected physical quality of life indirectly through depression. The hypothesized relationships specified in the model were also confirmed for psychological quality of life. However, physical disability had an indirect association with psychological quality of life via depression. CONCLUSION The current results underscore the significant role of cognitive, affective, and behavioral factors in perceived physical disability and their mediated detrimental effect on physical and psychological quality of life in patients with rheumatic diseases. Implications for rehabilitation The fear-avoidance model is applicable to the prediction of quality of life in patients with rheumatic diseases. As pain-catastrophizing and fear-avoidance beliefs are important factors linked to physical disability and depression, intervening these cognitive factors is necessary to improve physical function and depression in patients with rheumatic diseases. Considering the strong association between depression and physical and psychological quality of life, the assessment and treatment of the former should be included in the rehabilitation of patients with rheumatic diseases. Interventions targeting physical function and depression are likely to be effective in terms of improving physical and psychological quality of life in patients with rheumatic diseases.
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Affiliation(s)
- Eun-Jung Shim
- a Department of Psychology , Pusan National University , Busan , Republic of Korea
| | - Bong-Jin Hahm
- b Department of Neuropsychiatry , Seoul National University Hospital , Seoul , Republic of Korea.,c Department of Psychiatry and Behavioral Science , Seoul National University College of Medicine , Seoul , Republic of Korea
| | - Dong Jin Go
- d Department of Molecular Medicine and Biopharmaceutical Sciences, Graduate School of Convergence Science and Technology, and College of Medicine , Medical Research Center, Seoul National University , Seoul , Republic of Korea.,e Department of Internal Medicine, Division of Rheumatology , Seoul National University College of Medicine , Seoul , Republic of Korea
| | - Kwang-Min Lee
- c Department of Psychiatry and Behavioral Science , Seoul National University College of Medicine , Seoul , Republic of Korea.,f Department of Psychiatry , Gyeonggi provincial Medical Center Uijeongbu Hospital , Uijeongbusi , Republic of Korea
| | - Hae Lim Noh
- a Department of Psychology , Pusan National University , Busan , Republic of Korea
| | - Seung-Hee Park
- a Department of Psychology , Pusan National University , Busan , Republic of Korea
| | - Yeong Wook Song
- d Department of Molecular Medicine and Biopharmaceutical Sciences, Graduate School of Convergence Science and Technology, and College of Medicine , Medical Research Center, Seoul National University , Seoul , Republic of Korea.,e Department of Internal Medicine, Division of Rheumatology , Seoul National University College of Medicine , Seoul , Republic of Korea
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Ormseth SR, Draper TL, Irwin MR, Weisman MH, Aréchiga AE, Hartoonian N, Bui T, Nicassio PM. Multidimensional Model of Disability and Role Functioning in Rheumatoid Arthritis. Arthritis Care Res (Hoboken) 2016. [PMID: 26212464 DOI: 10.1002/acr.22658] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVE To examine a model addressing the roles of rheumatoid arthritis (RA) disease burden, mood disturbance, and disability as determinants of impairments in role functioning. METHODS In a cross-sectional design, 103 RA patients recruited from the community to participate in a clinical trial completed assessments of self-assessed disease burden (total joint pain and disease activity), mood disturbance (Center for Epidemiological Studies Depression Scale depressed mood, somatic symptoms, lack of positive affect, and interpersonal problems), disability (Health Assessment Questionnaire disability index gross and fine motor), and role functioning (Short Form 36 health survey physical and social). Structural equation modeling (SEM) was used to examine direct and indirect mechanisms linking disease burden to role functioning. RESULTS SEM results indicated that the model had excellent fit: S-Bχ(2)(30) = 38.59, P = 0.135; comparative fit index = 0.977, standardized root mean residual = 0.062, and root mean square error of approximation = 0.053. Mediational analyses demonstrated that, while disease burden was associated with poor role functioning, its effects were jointly mediated by mood disturbance and disability. After the effects of mood disturbance and disability were taken into account, the effect of disease burden on role functioning was not significant. CONCLUSION The results indicate that mood disturbance and disability may serve as important pathways through which RA disease burden affects role functioning. Future longitudinal research is suggested to replicate these findings and further explore the mediational mechanisms examined in this study.
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Affiliation(s)
- Sarah R Ormseth
- Cousins Center for Psychoneuroimmunology, David Geffen School of Medicine, University of California, Los Angeles
| | | | - Michael R Irwin
- Cousins Center for Psychoneuroimmunology, David Geffen School of Medicine, University of California, Los Angeles
| | | | | | | | - Thuy Bui
- California School of Professional Psychology of Alliant International University, Alhambra
| | - Perry M Nicassio
- Cousins Center for Psychoneuroimmunology, David Geffen School of Medicine, University of California, Los Angeles
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Patient and clinician views on the quality of foot health care for rheumatoid arthritis outpatients: a mixed methods service evaluation. J Foot Ankle Res 2016; 9:1. [PMID: 26740821 PMCID: PMC4702354 DOI: 10.1186/s13047-015-0133-2] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2015] [Accepted: 12/18/2015] [Indexed: 11/10/2022] Open
Abstract
Background Feet are often the first site of joint involvement in rheumatoid arthritis (RA) and get progressively worse if unmanaged, leading to permanent disability and negatively impacting patients’ quality of life. Podiatrists are specialists in the assessment, diagnosis and management of foot and ankle problems, however, RA outpatients often rely on referral from rheumatology clinicians to gain access to musculoskeletal podiatry services on the UK National Health Service (NHS). Therefore, the aim of this evaluation was to identify the foot health needs of rheumatoid arthritis patients and if they are being met by rheumatology clinicians. Methods A mixed methods approach was used: collecting qualitative data from patients and quantitative data from clinicians. Two focus groups were conducted with nine RA patients from a tertiary rheumatology outpatient clinic in the UK and the data were thematically analysed to inform a clinician survey. Thirteen rheumatology clinicians, from the same centre, completed the online survey. Resultant data were analysed to produce descriptive statistics. Results Patient focus group data generated four main themes: (1) need for foot health information, (2) feet ignored during routine consultations, (3) frequency of foot examination and (4) access to podiatry. Survey data highlighted that (i) 69–85 % of clinicians provided patients with foot health information sometimes, (ii) feet were examined in 47 % of routine consultations, (iii) 54 % of clinicians did not examine feet routinely because they are not included in the disease activity score with 28 joints (DAS-28), (iv) 31 % of clinicians referred patients to podiatry upon RA diagnosis, (v) 0 % of clinicians referred patients to podiatry for periodic review, (vi) 54 % of clinicians believed patients will self-report foot problems and (vii) 62 % of clinicians felt competent in foot examination. Conclusions RA patients’ foot health needs were not being fully met by rheumatology clinicians. Patients want foot health information and easy access to podiatry services. Rheumatology outpatient consultations need to have a wider focus than the DAS-28 and incorporate foot examination as standard. Clinicians need to ensure they have sufficient training and follow current national foot health guidance to provide optimal foot health care and outcomes for their RA patients. Electronic supplementary material The online version of this article (doi:10.1186/s13047-015-0133-2) contains supplementary material, which is available to authorized users.
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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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Iaquinta M, McCrone S. An Integrative Review of Correlates and Predictors of Depression in Patients with Rheumatoid Arthritis. Arch Psychiatr Nurs 2015; 29:265-78. [PMID: 26397428 DOI: 10.1016/j.apnu.2015.04.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2014] [Revised: 04/12/2015] [Accepted: 04/15/2015] [Indexed: 01/04/2023]
Abstract
Depression creates an additional burden for adults with rheumatoid arthritis (RA), negatively affecting disease outcomes and quality of life. An integrative literature review of twenty-three quantitative studies was conducted on correlates and factors predictive of depression in adults with RA. Methodological assessment tools were used to independently evaluate the data quality by two reviewers. Prevalence rates ranged from 6.6 to 66.25%. Correlates included pain, functional status, disease duration, and RA treatment. Predictors, including sociodemographics, pain, coping ability, support, functional status, and clinical factors, varied depending upon the sample, standardized measure, and geographic location. Understanding correlates/predictors could guide the development of comprehensive care.
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Affiliation(s)
| | - Susan McCrone
- West Virginia University School of Nursing, Morgantown, WV.
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Purabdollah M, Lakdizaji S, Rahmani A, Hajalilu M, Ansarin K. Relationship between Sleep Disorders, Pain and Quality of Life in Patients with Rheumatoid Arthritis. J Caring Sci 2015; 4:233-41. [PMID: 26464840 DOI: 10.15171/jcs.2015.024] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2015] [Accepted: 07/27/2015] [Indexed: 12/14/2022] Open
Abstract
INTRODUCTION Rheumatoid arthritis as one of the most common autoimmune diseases is known to be one of the leading causes of disability. Sleep disorders have direct influence on patient's life. According to studies, sleep problems are known to have negative impact on well-being and functioning, but the exact nature of relationship between sleep disorders and Rheumatoid arthritis is not completely understood. This study aimed to investigate the relationship between sleep disorders, pain and quality of life in patients with rheumatoid arthritis patients. METHODS In a descriptive -correlative study, 210 patients with rheumatoid arthritis referred to Tabriz medical university clinics selected by convenience sampling and were assessed by Sleep Disorders Questionnaire (SDQ), Epworth Sleepiness Scale (ESS), SF-36 Quality of Life Questionnaire and Visual Analog Scale (VAS). Data were analyzed using SPSS-13 by descriptive statistics such as frequency, mean (SD) and inferential statistics including Spearman correlation analysis, linear regression, χ(2),t-test and ANOVA. RESULTS The mean age of participants was 48.41(12.92) years in which most of them (74%) were female. The mean (SD) quality of life was 40.51(22.94), sleepiness 13.14 (5.6) and pain 6.09 (2.14). There was significant negative relationship between some sleep disorders such as (naps, apnea, asphyxia,…) and pain with quality of life but pain severity had more effect on QOL compared to sleep problems. Furthermore, participants had low quality of life with more restriction in physical (mean=34.71) and general health (mean=34.42). CONCLUSION Sleep problems and pain were associated with poor quality of life in Rheumatoid Arthritis patients.
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Affiliation(s)
- Majid Purabdollah
- Department of Nursing, Nursing and Midwifery Faculty, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Sima Lakdizaji
- Department of Nursing, Nursing and Midwifery Faculty, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Azad Rahmani
- Department of Nursing, Hematology and Oncology Research Center, Tabriz University of Medical Sciences, Iran
| | - Mehrzad Hajalilu
- Department of Internal Medicine, Medicine Faculty, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Khalil Ansarin
- Department of Internal Medicine, Medicine Faculty, Tabriz University of Medical Sciences, Tabriz, Iran
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Wan SW, He HG, Mak A, Lahiri M, Luo N, Cheung PP, Wang W. Health-related quality of life and its predictors among patients with rheumatoid arthritis. Appl Nurs Res 2015; 30:176-83. [PMID: 27091275 DOI: 10.1016/j.apnr.2015.07.004] [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: 07/19/2015] [Accepted: 07/31/2015] [Indexed: 01/13/2023]
Abstract
BACKGROUND Limited studies have examined the predictors of HRQoL among patients with rheumatoid arthritis. This study helped to ascertain the predictors of HRQoL from the pool of influencing factors identified by previous studies. AIM This study investigated the health-related quality of life (HRQoL) of adult patients with rheumatoid arthritis and its predictors. METHODS Using a descriptive correlational design, this study explored the relationship between HRQoL and pain, functional disability, anxiety, depression, medication adherence and social support. Eligible outpatients (n=108) were recruited via their attending doctors who were co-investigators of this study. Informed consent forms were distributed and questionnaires administered in a teaching hub by the main researcher. RESULTS Significant correlations were found between HRQoL and all of the study variables. Pain, functional disability and depression were main predictors of HRQoL. CONCLUSIONS Future evidence-based interventions focusing on pain relief, delaying disability or improving functional ability and reducing depressive symptoms are required to enhance the HRQoL of patients with rheumatoid arthritis.
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Affiliation(s)
- Su Wei Wan
- Division of Nursing, National University Hospital, Singapore.
| | - Hong-Gu He
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
| | - Anselm Mak
- Division of Rheumatology, National University Hospital, Singapore.
| | - Manjari Lahiri
- Division of Rheumatology, National University Hospital, Singapore.
| | - Nan Luo
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore.
| | - Peter P Cheung
- Division of Rheumatology, National University Hospital, Singapore.
| | - Wenru Wang
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
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Telfer S, Woodburn J. Let me Google that for you: a time series analysis of seasonality in internet search trends for terms related to foot and ankle pain. J Foot Ankle Res 2015; 8:27. [PMID: 26146521 PMCID: PMC4490673 DOI: 10.1186/s13047-015-0074-9] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2015] [Accepted: 04/13/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The analysis of internet search traffic may present the opportunity to gain insights into general trends and patterns in information seeking behaviour related to medical conditions at a population level. For prevalent and widespread problems such as foot and ankle pain, this information has the potential to improve our understanding of seasonality and trends within these conditions and their treatments, and may act as a useful proxy for their true incidence/prevalence characteristics. This study aimed to explore seasonal effects, general trends and relative popularity of internet search terms related to foot and ankle pain over the past decade. METHODS We used the Google Trends tool to obtain relative search engine traffic for terms relating to foot and ankle pain and common treatments from Google search and affiliated pages for major northern and southern hemisphere English speaking nations. Analysis of overall trends and seasonality including summer/winter differences was carried out on these terms. RESULTS Searches relating to general foot pain were on average 3.4 times more common than those relating to ankle pain, and twice as common as searches relating to heel pain. Distinct seasonal effects were seen in the northern hemisphere, with large increases in search volumes in the summer months compared to winter for foot (p = 0.004, 95 % CI [22.2-32.1]), ankle (p = 0.0078, 95 % CI [20.9-35.5]), and heel pain (p = 0.004, 95 % CI [29.1-45.6]). These seasonal effects were reflected by data from Australia, with the exception of ankle pain. Annual seasonal effects for treatment options were limited to terms related to foot surgery and ankle orthoses (p = 0.031, 95 % CI [3.5-20.9]; p = 0.004, 95 % CI [7.6-25.2] respectively), again increasing in the summer months. CONCLUSIONS A number of general trends and annual seasonal effects were found in time series internet search data for terms relating to foot and ankle pain. This data may provide insights into these conditions at population levels.
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Affiliation(s)
- Scott Telfer
- Research Fellow, Institute of Applied Health Research, Glasgow Caledonian University, Glasgow, G4 0BA UK
| | - James Woodburn
- Professor of Rehabilitation, Institute of Applied Health Research, Glasgow Caledonian University, Glasgow, UK
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Singh JA, Noorbaloochi S, Thorne C, Hazlewood GS, Suarez-Almazor ME, Tanjong Ghogomu E, Wells GA, Tugwell P. Subcutaneous or intramuscular methotrexate for rheumatoid arthritis. Hippokratia 2015. [DOI: 10.1002/14651858.cd011730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Jasvinder A Singh
- Birmingham VA Medical Center; Department of Medicine; Faculty Office Tower 805B 510 20th Street South Birmingham AL USA 35294
| | - Shahrzad Noorbaloochi
- Minneapolis VA Medical Center and University of Minnesota; Department of Medicine; One Veterans Drive Minneapolis MN USA 55417
| | - Carter Thorne
- Southlake Regional Health Centre; 43 Lundy's Lane Newmarket ON Canada L3Y 3R7
| | - Glen S Hazlewood
- University of Toronto; Department of Health, Policy, Management and Evaluation; 60 Murray St., Suite 2-029 Toronto ON Canada M5T 3L9
| | - Maria E Suarez-Almazor
- The University of Texas, M.D. Anderson Cancer Center; Department of General Internal Medicine; 1515 Holcombe Blvd Unit 1465 Houston TX USA 77030
| | - Elizabeth Tanjong Ghogomu
- University of Ottawa; Bruyère Research Institute; 43 Bruyère St Annex E, room 302 Ottawa ON Canada K1N 5C8
| | - George A Wells
- University of Ottawa; Department of Epidemiology and Community Medicine; Room H1281 40 Ruskin Street Ottawa ON Canada K1Y 4W7
| | - Peter Tugwell
- Faculty of Medicine, University of Ottawa; Department of Medicine; Ottawa ON Canada K1H 8M5
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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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Joshi N, Khanna R, Shah RM. Relationship Between Depression and Physical Activity, Disability, Burden, and Health-Related Quality of Life Among Patients with Arthritis. Popul Health Manag 2015; 18:104-14. [DOI: 10.1089/pop.2014.0062] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Namita Joshi
- School of Pharmacy, The University of Mississippi, University, Mississippi
| | - Rahul Khanna
- School of Pharmacy, The University of Mississippi, University, Mississippi
| | - Ruchit M. Shah
- School of Pharmacy, The University of Mississippi, University, Mississippi
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Nyklíček I, Hoogwegt F, Westgeest T. Psychological distress across twelve months in patients with rheumatoid arthritis: the role of disease activity, disability, and mindfulness. J Psychosom Res 2015; 78:162-7. [PMID: 25260860 DOI: 10.1016/j.jpsychores.2014.08.004] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2014] [Revised: 08/06/2014] [Accepted: 08/12/2014] [Indexed: 01/04/2023]
Abstract
OBJECTIVE Mindfulness may diminish effects of adversities on psychological well-being in medical patients, but studies are scarce, especially in patients with rheumatoid arthritis (RA). The purpose was to examine the prospective moderating effect of mindfulness regarding psychological distress associated with disease activity and disability in patients with RA. METHODS Two-hundred-and-one patients with RA (mean age 57.4 ± 11.7, 55% women) completed questionnaires at baseline and at six and twelve month follow-up. Disease activity score was assessed by the rheumatologist. RESULTS Controlled for potential confounders, mixed linear model analyses showed a strong prospective association of higher baseline mindfulness with lower psychological distress up to the twelve month follow-up (p<.001). In addition, a mindfulness by disability by time interaction showed that higher baseline mindfulness was associated with lower disability related psychological distress at follow-up (p=.022). CONCLUSION Findings are in line with the hypothesis that mindfulness may protect against psychological distress associated with disability in RA. Potential benefits of mindfulness-based interventions for prevention should be examined in this population.
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Affiliation(s)
- Ivan Nyklíček
- Center of Research on Psychology in Somatic disease (CoRPS), Department of Medical and Clinical Psychology, Tilburg University, The Netherlands.
| | - Frans Hoogwegt
- Department of Medical Psychology, Máxima Medical Center, Eindhoven, The Netherlands
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Roma I, de Almeida ML, Mansano NDS, Viani GA, de Assis MR, Barbosa PMK. [Quality of life in adults and elderly patients with rheumatoid arthritis]. REVISTA BRASILEIRA DE REUMATOLOGIA 2015; 54:279-86. [PMID: 25627223 DOI: 10.1016/j.rbr.2014.03.025] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2013] [Accepted: 03/20/2014] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE To analyze and compare quality of life (QoL) in adults and elderly patients with rheumatoid arthritis (RA). METHODS This was a cross-sectional quantitative study. The tools include the Medical Outcomes Study Short Form-36 (SF-36), the Disease Activity Score 28 (DAS-28), the Assessment Health Questionnaire (HAQ), the Beck Depression Inventory (BDI) and the 6-Minute Walk Test (6MWT). Data analysis was done by descriptive statistics, Student's t test and linear regression test, with significance level of p <0.05. RESULTS The sample consisted of 99 patients diagnosed with RA, divided into adults and elderly. Those considered adults were 18-59 years-old and those with 60 years or older where considered elderly. In SF-36, the groups showed the pain domain as the most compromised and the emotional aspects domain as the less compromised. Both showed moderate level of disease activity and mild disability. Applying the t test, it was found that there was no significant difference between groups with respect to QoL, functional ability, depression and disease activity. The difference was significant in the 6MWT, in which the elderly achieved an average of 330.8 m, and the adults, 412.2 m (p=0.000). In linear regression, a significant correlation (r=-0.31) between the 6MWT and increasing age was noted. CONCLUSION QoL and functional capacity in RA were affected in adults and the elderly. How-ever, the results showed no significant difference between groups, with the exception of the 6MWT.
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Affiliation(s)
- Izabela Roma
- Faculdade de Medicina de Marília, Marília, SP, Brasil.
| | | | | | - Gustavo Arruda Viani
- Departamento de Radioterapia e Oncologia, Faculdade de Medicina de Marília, Marília, SP, Brasil
| | | | - Pedro Marco Karan Barbosa
- Faculdade de Medicina de Marília, Marília, SP, Brasil; Hospital das Clínicas de Marília, Faculdade de Medicina de Marília, Marília, SP, Brasil
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35
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McBain H, Mulligan K, Newman SP. Nonpharmacologic pain management. Rheumatology (Oxford) 2015. [DOI: 10.1016/b978-0-323-09138-1.00050-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Walsh DA, McWilliams DF. Mechanisms, impact and management of pain in rheumatoid arthritis. Nat Rev Rheumatol 2014; 10:581-92. [PMID: 24861185 DOI: 10.1038/nrrheum.2014.64] [Citation(s) in RCA: 177] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
People with rheumatoid arthritis (RA) identify pain as their most important symptom, one that often persists despite optimal control of inflammatory disease. RA pain arises from multiple mechanisms, involving inflammation, peripheral and central pain processing and, with disease progression, structural change within the joint. Consequently, RA pain has a wide range of characteristics-constant or intermittent, localized or widespread-and is often associated with psychological distress and fatigue. Dominant pain mechanisms in an individual are identified by critical evaluation of clinical symptoms and signs, and by laboratory and imaging tests. Understanding these mechanisms is essential for effective management, although evidence from preclinical models should be interpreted with caution. A range of pharmacological analgesic and immunomodulatory agents, psychological interventions and surgery may help manage RA pain. Pain contributes importantly to the clinical assessment of inflammatory disease activity, and noninflammatory components of RA pain should be considered when gauging eligibility for or response to biologic agents. Further randomized controlled trials are required to determine the optimal usage of analgesics in RA, and novel agents with greater efficacy and lower propensity for adverse events are urgently needed. Meanwhile, targeted use of existing treatments could reduce pain in people with RA.
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Affiliation(s)
- David A Walsh
- Arthritis Research UK Pain Centre, Academic Rheumatology, University of Nottingham, Clinical Sciences Building, City Hospital, Hucknall Road, Nottingham NG5 1PB, UK
| | - Daniel F McWilliams
- Arthritis Research UK Pain Centre, Academic Rheumatology, University of Nottingham, Clinical Sciences Building, City Hospital, Hucknall Road, Nottingham NG5 1PB, UK
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Bingham CO, Weinblatt M, Han C, Gathany TA, Kim L, Lo KH, Baker D, Mendelsohn A, Westhovens R. The effect of intravenous golimumab on health-related quality of life in rheumatoid arthritis: 24-week results of the phase III GO-FURTHER trial. J Rheumatol 2014; 41:1067-76. [PMID: 24786931 DOI: 10.3899/jrheum.130864] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To evaluate the effects of intravenous (IV) golimumab 2 mg/kg + methotrexate (MTX) on patient-reported measures of health-related quality of life (HRQOL) in patients with active rheumatoid arthritis (RA) despite prior MTX therapy. METHODS In this randomized, multicenter, double-blind, placebo-controlled, phase III trial, adults with RA were randomly assigned to receive IV placebo (n = 197) or golimumab 2 mg/kg (n = 395) infusions at Week 0, Week 4, and every 8 weeks thereafter. All patients continued stable oral MTX (15-25 mg/wk). HRQOL assessments included Health Assessment Questionnaire-Disability Index (HAQ-DI; physical function), Medical Outcomes Study Short Form-36 questionnaire physical/mental component summary (SF-36 PCS/MCS) scores, EQ-5D assessment of current health state, Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-Fatigue) questionnaire, and disease effect on productivity [10-cm visual analog scale (VAS)]. RESULTS Mean HAQ-DI improvements from baseline were significantly greater with golimumab + MTX than placebo + MTX at Week 14 and Week 24 (p < 0.001). Significantly greater improvements in all 8 individual SF-36 subscores and both the SF-36 PCS and MCS scores (p < 0.001) also accompanied golimumab + MTX therapy. Improved EQ-5D and EQ-5D VAS (p < 0.001) and FACIT-Fatigue (p < 0.001) scores were also observed for golimumab + MTX-treated patients at Week 12, Week 16, and Week 24, and greater proportions of golimumab + MTX-treated patients had clinically meaningful improvements in these measures. Greater reductions in disease effect on productivity were observed with golimumab + MTX versus placebo + MTX at Week 24 (p < 0.001). Improvements in physical function, HRQOL, fatigue, and productivity significantly correlated with disease activity improvement. CONCLUSION In active RA, IV golimumab + MTX significantly improved physical function, HRQOL, fatigue, and productivity using multiple measurement tools; all correlated with improvements in disease activity (NCT00973479, EudraCT 2008-006064-11).
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Affiliation(s)
- Clifton O Bingham
- From the Division of Rheumatology and Allergy and Clinical Immunology, Johns Hopkins University, Baltimore, Maryland; Department of Clinical Rheumatology, Brigham and Women's Hospital, Boston, Massachusetts; Patient Reported Outcomes, Janssen Global Services LLC, Malvern, Pennsylvania; Biostatistics and Immunology, Janssen Research & Development LLC, Spring House, Pennsylvania, USA; Department of Rheumatology, UZ Gasthuisberg, KU Leuven, Belgium.C.O. Bingham III, MD, Division of Rheumatology and Allergy and Clinical Immunology, Johns Hopkins University; M. Weinblatt, MD, Department of Clinical Rheumatology, Brigham and Women's Hospital; C. Han, PhD; T.A. Gathany, PhD, Patient Reported Outcomes, Janssen Global Services; L. Kim, PhD; K.H. Lo, PhD, Biostatistics, Janssen Research & Development LLC; D. Baker, MD; A. Mendelsohn, MD, Immunology, Janssen Research & Development LLC; R. Westhovens, MD, Department of Rheumatology, University Hospitals Leuven; Department of Development and Regeneration, KU Leuven.
| | - Michael Weinblatt
- From the Division of Rheumatology and Allergy and Clinical Immunology, Johns Hopkins University, Baltimore, Maryland; Department of Clinical Rheumatology, Brigham and Women's Hospital, Boston, Massachusetts; Patient Reported Outcomes, Janssen Global Services LLC, Malvern, Pennsylvania; Biostatistics and Immunology, Janssen Research & Development LLC, Spring House, Pennsylvania, USA; Department of Rheumatology, UZ Gasthuisberg, KU Leuven, Belgium.C.O. Bingham III, MD, Division of Rheumatology and Allergy and Clinical Immunology, Johns Hopkins University; M. Weinblatt, MD, Department of Clinical Rheumatology, Brigham and Women's Hospital; C. Han, PhD; T.A. Gathany, PhD, Patient Reported Outcomes, Janssen Global Services; L. Kim, PhD; K.H. Lo, PhD, Biostatistics, Janssen Research & Development LLC; D. Baker, MD; A. Mendelsohn, MD, Immunology, Janssen Research & Development LLC; R. Westhovens, MD, Department of Rheumatology, University Hospitals Leuven; Department of Development and Regeneration, KU Leuven
| | - Chenglong Han
- From the Division of Rheumatology and Allergy and Clinical Immunology, Johns Hopkins University, Baltimore, Maryland; Department of Clinical Rheumatology, Brigham and Women's Hospital, Boston, Massachusetts; Patient Reported Outcomes, Janssen Global Services LLC, Malvern, Pennsylvania; Biostatistics and Immunology, Janssen Research & Development LLC, Spring House, Pennsylvania, USA; Department of Rheumatology, UZ Gasthuisberg, KU Leuven, Belgium.C.O. Bingham III, MD, Division of Rheumatology and Allergy and Clinical Immunology, Johns Hopkins University; M. Weinblatt, MD, Department of Clinical Rheumatology, Brigham and Women's Hospital; C. Han, PhD; T.A. Gathany, PhD, Patient Reported Outcomes, Janssen Global Services; L. Kim, PhD; K.H. Lo, PhD, Biostatistics, Janssen Research & Development LLC; D. Baker, MD; A. Mendelsohn, MD, Immunology, Janssen Research & Development LLC; R. Westhovens, MD, Department of Rheumatology, University Hospitals Leuven; Department of Development and Regeneration, KU Leuven
| | - Timothy A Gathany
- From the Division of Rheumatology and Allergy and Clinical Immunology, Johns Hopkins University, Baltimore, Maryland; Department of Clinical Rheumatology, Brigham and Women's Hospital, Boston, Massachusetts; Patient Reported Outcomes, Janssen Global Services LLC, Malvern, Pennsylvania; Biostatistics and Immunology, Janssen Research & Development LLC, Spring House, Pennsylvania, USA; Department of Rheumatology, UZ Gasthuisberg, KU Leuven, Belgium.C.O. Bingham III, MD, Division of Rheumatology and Allergy and Clinical Immunology, Johns Hopkins University; M. Weinblatt, MD, Department of Clinical Rheumatology, Brigham and Women's Hospital; C. Han, PhD; T.A. Gathany, PhD, Patient Reported Outcomes, Janssen Global Services; L. Kim, PhD; K.H. Lo, PhD, Biostatistics, Janssen Research & Development LLC; D. Baker, MD; A. Mendelsohn, MD, Immunology, Janssen Research & Development LLC; R. Westhovens, MD, Department of Rheumatology, University Hospitals Leuven; Department of Development and Regeneration, KU Leuven
| | - Lilianne Kim
- From the Division of Rheumatology and Allergy and Clinical Immunology, Johns Hopkins University, Baltimore, Maryland; Department of Clinical Rheumatology, Brigham and Women's Hospital, Boston, Massachusetts; Patient Reported Outcomes, Janssen Global Services LLC, Malvern, Pennsylvania; Biostatistics and Immunology, Janssen Research & Development LLC, Spring House, Pennsylvania, USA; Department of Rheumatology, UZ Gasthuisberg, KU Leuven, Belgium.C.O. Bingham III, MD, Division of Rheumatology and Allergy and Clinical Immunology, Johns Hopkins University; M. Weinblatt, MD, Department of Clinical Rheumatology, Brigham and Women's Hospital; C. Han, PhD; T.A. Gathany, PhD, Patient Reported Outcomes, Janssen Global Services; L. Kim, PhD; K.H. Lo, PhD, Biostatistics, Janssen Research & Development LLC; D. Baker, MD; A. Mendelsohn, MD, Immunology, Janssen Research & Development LLC; R. Westhovens, MD, Department of Rheumatology, University Hospitals Leuven; Department of Development and Regeneration, KU Leuven
| | - Kim Hung Lo
- From the Division of Rheumatology and Allergy and Clinical Immunology, Johns Hopkins University, Baltimore, Maryland; Department of Clinical Rheumatology, Brigham and Women's Hospital, Boston, Massachusetts; Patient Reported Outcomes, Janssen Global Services LLC, Malvern, Pennsylvania; Biostatistics and Immunology, Janssen Research & Development LLC, Spring House, Pennsylvania, USA; Department of Rheumatology, UZ Gasthuisberg, KU Leuven, Belgium.C.O. Bingham III, MD, Division of Rheumatology and Allergy and Clinical Immunology, Johns Hopkins University; M. Weinblatt, MD, Department of Clinical Rheumatology, Brigham and Women's Hospital; C. Han, PhD; T.A. Gathany, PhD, Patient Reported Outcomes, Janssen Global Services; L. Kim, PhD; K.H. Lo, PhD, Biostatistics, Janssen Research & Development LLC; D. Baker, MD; A. Mendelsohn, MD, Immunology, Janssen Research & Development LLC; R. Westhovens, MD, Department of Rheumatology, University Hospitals Leuven; Department of Development and Regeneration, KU Leuven
| | - Dan Baker
- From the Division of Rheumatology and Allergy and Clinical Immunology, Johns Hopkins University, Baltimore, Maryland; Department of Clinical Rheumatology, Brigham and Women's Hospital, Boston, Massachusetts; Patient Reported Outcomes, Janssen Global Services LLC, Malvern, Pennsylvania; Biostatistics and Immunology, Janssen Research & Development LLC, Spring House, Pennsylvania, USA; Department of Rheumatology, UZ Gasthuisberg, KU Leuven, Belgium.C.O. Bingham III, MD, Division of Rheumatology and Allergy and Clinical Immunology, Johns Hopkins University; M. Weinblatt, MD, Department of Clinical Rheumatology, Brigham and Women's Hospital; C. Han, PhD; T.A. Gathany, PhD, Patient Reported Outcomes, Janssen Global Services; L. Kim, PhD; K.H. Lo, PhD, Biostatistics, Janssen Research & Development LLC; D. Baker, MD; A. Mendelsohn, MD, Immunology, Janssen Research & Development LLC; R. Westhovens, MD, Department of Rheumatology, University Hospitals Leuven; Department of Development and Regeneration, KU Leuven
| | - Alan Mendelsohn
- From the Division of Rheumatology and Allergy and Clinical Immunology, Johns Hopkins University, Baltimore, Maryland; Department of Clinical Rheumatology, Brigham and Women's Hospital, Boston, Massachusetts; Patient Reported Outcomes, Janssen Global Services LLC, Malvern, Pennsylvania; Biostatistics and Immunology, Janssen Research & Development LLC, Spring House, Pennsylvania, USA; Department of Rheumatology, UZ Gasthuisberg, KU Leuven, Belgium.C.O. Bingham III, MD, Division of Rheumatology and Allergy and Clinical Immunology, Johns Hopkins University; M. Weinblatt, MD, Department of Clinical Rheumatology, Brigham and Women's Hospital; C. Han, PhD; T.A. Gathany, PhD, Patient Reported Outcomes, Janssen Global Services; L. Kim, PhD; K.H. Lo, PhD, Biostatistics, Janssen Research & Development LLC; D. Baker, MD; A. Mendelsohn, MD, Immunology, Janssen Research & Development LLC; R. Westhovens, MD, Department of Rheumatology, University Hospitals Leuven; Department of Development and Regeneration, KU Leuven
| | - Rene Westhovens
- From the Division of Rheumatology and Allergy and Clinical Immunology, Johns Hopkins University, Baltimore, Maryland; Department of Clinical Rheumatology, Brigham and Women's Hospital, Boston, Massachusetts; Patient Reported Outcomes, Janssen Global Services LLC, Malvern, Pennsylvania; Biostatistics and Immunology, Janssen Research & Development LLC, Spring House, Pennsylvania, USA; Department of Rheumatology, UZ Gasthuisberg, KU Leuven, Belgium.C.O. Bingham III, MD, Division of Rheumatology and Allergy and Clinical Immunology, Johns Hopkins University; M. Weinblatt, MD, Department of Clinical Rheumatology, Brigham and Women's Hospital; C. Han, PhD; T.A. Gathany, PhD, Patient Reported Outcomes, Janssen Global Services; L. Kim, PhD; K.H. Lo, PhD, Biostatistics, Janssen Research & Development LLC; D. Baker, MD; A. Mendelsohn, MD, Immunology, Janssen Research & Development LLC; R. Westhovens, MD, Department of Rheumatology, University Hospitals Leuven; Department of Development and Regeneration, KU Leuven
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Kwan YH, Koh ET, Leong KP, Wee HL. Association between helplessness, disability, and disease activity with health-related quality of life among rheumatoid arthritis patients in a multiethnic Asian population. Rheumatol Int 2014; 34:1085-93. [DOI: 10.1007/s00296-013-2938-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2013] [Accepted: 12/27/2013] [Indexed: 11/30/2022]
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Sariyildiz MA, Batmaz I, Bozkurt M, Bez Y, Cetincakmak MG, Yazmalar L, Ucar D, Celepkolu T. Sleep quality in rheumatoid arthritis: relationship between the disease severity, depression, functional status and the quality of life. J Clin Med Res 2013; 6:44-52. [PMID: 24400031 PMCID: PMC3881989 DOI: 10.4021/jocmr1648w] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/24/2013] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND The aim of this study was to evaluate sleep quality and the related variables in patients with rheumatoid arthritis (RA). METHODS Ninety-four patients diagnosed with RA and fifty two healthy controls were enrolled in the study. Disease activity was assessed through the Disease Activity Score (DAS) 28 scale. All patients were assessed using the Rheumatoid Arthritis Quality of Life and Health Assessment Questionnaire scales, together with the Beck Depression Inventory. Radiological damage was calculated with the modified Larsen method. The Pittsburgh Sleep Quality Index (PSQI) was used for the evaluation of the sleep disturbance. RESULTS The patients with RA had significantly higher scores in the subjective sleep quality, sleep latency, habitual sleep efficiency, sleep disturbance domains and the total PSQI score compared to the healthy control group. According to the results of Spearman's analysis, there was a significantly correlation between the age, disease activity, CRP, pain, fatigue, depression, functional disability, quality of life, radiological damage, menopause status, duration of morning stiffness, ESR levels and the sleep disturbance. The logistic regression analysis indicated that depression and DAS 28 scores were predictors for poor sleep quality. CONCLUSION The sleep quality is disturbed in patients with RA. The poor sleep quality is especially associated with the disease activity and depression.
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Affiliation(s)
- Mustafa Akif Sariyildiz
- Department of Physical Medicine and Rehabilitation, Dicle University Faculty of Medicine, Diyarbakir, Turkey
| | - Ibrahim Batmaz
- Department of Physical Medicine and Rehabilitation, Dicle University Faculty of Medicine, Diyarbakir, Turkey
| | - Mehtap Bozkurt
- Department of Physical Medicine and Rehabilitation, Dicle University Faculty of Medicine, Diyarbakir, Turkey
| | - Yasin Bez
- Department of Psychiatry, Dicle University Faculty of Medicine, Diyarbakir, Turkey
| | | | - Levent Yazmalar
- Department of Physical Medicine and Rehabilitation, Dicle University Faculty of Medicine, Diyarbakir, Turkey
| | - Demet Ucar
- Department of Physical Medicine and Rehabilitation, Dicle University Faculty of Medicine, Diyarbakir, Turkey
| | - Tahsin Celepkolu
- Department of Family Physician, Dicle University Faculty of Medicine, Diyarbakir, Turkey
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Tsao NW, Shojania K, Marra CA. Cost-effectiveness of abatacept for moderate-to-severe rheumatoid arthritis. Expert Rev Pharmacoecon Outcomes Res 2013; 14:9-18. [PMID: 24325566 DOI: 10.1586/14737167.2014.861742] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Abatacept, a selective T-cell costimulation modulator, has become a valuable treatment option for those with moderately to severely active rheumatoid arthritis. Given new clinical evidence, for the first time guidelines from the American College of Rheumatology and Canadian Rheumatology Association are promoting the consideration of abatacept as the first biologic added to initial traditional disease-modifying antirheumatic drugs once an inadequate response to disease-modifying antirheumatic drug monotherapy has been established, putting abatacept at the same line of treatment options as TNF-α inhibitors or rituximab. Since the advent of the subcutaneous formulation of abatacept, positive results from its clinical trials have further increased its appeal. In light of these changes, a review of the literature was conducted on the cost-effectiveness of abatacept for moderate-to-severe rheumatoid arthritis. Here we discuss current evidence, gaps in the literature and abatacept's future outlook.
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Affiliation(s)
- Nicole W Tsao
- Collaboration for Outcomes Research and Evaluation, Faculty of Pharmaceutical Sciences, University of British Columbia, 2405 Wesbrook Mall, Vancouver, Canada V6T 1Z3
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Cutolo M, Kitas GD, van Riel PLCM. Burden of disease in treated rheumatoid arthritis patients: going beyond the joint. Semin Arthritis Rheum 2013; 43:479-88. [PMID: 24080116 DOI: 10.1016/j.semarthrit.2013.08.004] [Citation(s) in RCA: 80] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2013] [Revised: 08/12/2013] [Accepted: 08/13/2013] [Indexed: 12/11/2022]
Abstract
OBJECTIVE The disease burden in rheumatoid arthritis (RA) extends beyond the joint. This article evaluates the physical and psychosocial extra-articular burden of treated RA and relationships among diverse disease manifestations. METHODS MEDLINE searches identified papers published in English from January 2003 to December 2012 that evaluated systemic complications and psychosocial aspects associated with RA. Preference was given to studies with randomized cohorts and large (>100) sample sizes. Of 378 articles identified in the initial search, 118 were selected for inclusion. RESULTS RA is associated with multiple comorbidities and psychosocial impairments, including cardiovascular disease, osteoporosis, interstitial lung disease, infection, malignancies, fatigue, depression, cognitive dysfunction, reduced work performance, work disability, and decreased health-related quality of life. The etiology of the extra-articular burden may reflect the systemic inflammation and immune system alteration associated with RA, metabolic imbalances and side effects related to treatment, or the influence of comorbidities. Strategies that may help to reduce the extra-articular disease burden include personalized medicine and the potential introduction of treatments with new mechanisms of action. CONCLUSION Despite improvements in treating joint disease, the extra-articular burden in RA remains substantial, encompassing multiple comorbidities and psychosocial impairments.
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Affiliation(s)
- Maurizio Cutolo
- Research Laboratories and Academic Division of Clinical Rheumatology, Department of Internal Medicine, University of Genoa, Viale Benedetto XV 6, Genoa 16132, Italy.
| | - George D Kitas
- Clinical Rheumatology and R&D Director, Department of Rheumatology, Dudley Group NHS Foundation Trust, Dudley, United Kingdom; and Arthritis Research UK Epidemiology Unit, University of Manchester, Manchester, UK
| | - Piet L C M van Riel
- Rheumatology, Department of Rheumatology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
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Linde L, Sørensen J, Østergaard M, Hetland ML, Merete LH. Gain in quality-adjusted life-years in patients with rheumatoid arthritis during 1 year of biological therapy: a prospective study in clinical practice. J Rheumatol 2013; 40:1479-86. [PMID: 23818719 DOI: 10.3899/jrheum.121387] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The quality-adjusted life-year (QALY) is used to measure outcome in rheumatoid arthritis (RA) studies; identification of drivers of a gain in QALY might help predict a treatment response. We investigated how changes in components of the Disease Activity Score-28 joints (DAS28) were associated with the European League Against Rheumatism (EULAR) and European Quality of Life 5 Dimensions (EQ-5D) responses; and what baseline variables predicted the change in QALY following 1 year of biological therapy. METHODS Data were collected at baseline and after 3, 6, and 12 months of biological therapy in Danish patients with RA and included bDAS28, sociodemographic data, comorbidity, Health Assessment Questionnaire (HAQ), and EQ-5D scored using the Danish algorithm. A cross-tabulation based on EULAR versus EQ-5D responses was performed, and the association of each DAS28 component across the EULAR/EQ-5D response groups was tested. Predictors of a change in QALY were assessed in a multiple regression model including baseline clinical and patient-reported data as explanatory variables. RESULTS In total, 315 patients entered the study; 77% were women, 78% IgM rheumatoid factor-positive, with mean age 55 (SD 13) years, disease duration 10 (SD 8) years, mean DAS28 4.9 (SD 1.2), HAQ score 1.22 (SD 0.70), and EQ-5D score 0.60 (SD 0.19). Sixty-eight percent of patients gained QALY; the mean gain was 0.14 (SD 0.13). The patient global score was strongly correlated with both EULAR and EQ-5D responses. The gain in QALY increased with increasing patient global score and number of swollen joints, but not with C-reactive protein (CRP). CONCLUSION The subjective patient global score was the best baseline predictor of gain in QALY following biological therapy, while the objective CRP measure had no predictive value. It seems that no sharp demarcation between objective and subjective measures could be determined.
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Affiliation(s)
- Louise Linde
- The DANBIO Registry, the Centre for Applied Health Services Research and Technology Assessment, University of Southern Denmark, Odense, Denmark.
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Ng X, Low AHL, Chew LC, Chong YY, Fong KY, Lui NL, Sim E, Tan YK, Yoong J, Thumboo J. Disease patterns of rheumatology outpatients seen in a tertiary hospital serving a multi-ethnic, urban Asian population in Singapore. Int J Rheum Dis 2012; 16:273-8. [PMID: 23981747 DOI: 10.1111/1756-185x.12016] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
AIMS To describe the spectrum of diseases seen in an outpatient setting in the Singapore General Hospital, the largest tertiary referral centre in Singapore. METHODS In this cross-sectional study, medical records of patients scheduled for an appointment at the rheumatology specialist outpatient clinics over a 4-month period (10 August 2010-31 December 2010) were reviewed. Primary diagnoses documented by the attending physician at the latest visit were recorded. RESULTS Among 4180 patients (29.5% male; mean [SD] age: 53.5 [15.1] years; 77.0% Chinese, 8.0% Malay, 8.8% Indian and 6.2% others), the spectrum of diseases seen was as follows [disease - definite n (%), probable n (%)]: Arthritis: rheumatoid arthritis - 958 (22.9%), 68 (1.6%); osteoarthritis - 452 (10.8%), 39 (0.9%); crystal arthritis - 417 (10.0%), 18 (0.4%); spondyloarthritis - 227 (5.4%), 61 (1.5%); psoriatic arthritis - 158 (3.8%), 9 (0.2%); other inflammatory arthritis - 153 (3.7%), 94 (2.2%); Connective tissues diseases: systemic lupus erythematosus - 412 (9.9%), 26 (0.6%); vasculitis - 105 (2.5%), 22 (0.5%); Sjögren's syndrome - 81 (1.9%), 32 (0.8%); overlap syndromes - 73 (1.8%); scleroderma - 50 (1.2%), 4 (0.1%); undifferentiated connective tissue diseases - 45 (1.1%), 106 (2.5%); myositis - 41 (1.0%), 12 (0.3%); antiphospholipid syndrome - 22 (0.5%), 7 (0.2%); polymyalgia rheumatica - 16 (0.4%); Others: soft tissue rheumatism - 155 (3.7%); osteoporosis - 61 (1.5%); other non-rheumatologic conditions - 189 (4.5%); other rheumatologic conditions - 67 (1.6%). CONCLUSION Rheumatoid arthritis, osteoarthritis and crystal arthritis were the three most common rheumatological diseases seen in a tertiary referral centre serving a multi-ethnic urban Asian population in Singapore.
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Affiliation(s)
- Xinyi Ng
- Department of Rheumatology and Immunology, Singapore General Hospital, Singapore
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Uhm DC, Nam ES, Lee HY, Lee EB, Yoon YI, Chai GJ. [Health-related quality of life in Korean patients with rheumatoid arthritis: association with pain, disease activity, disability in activities of daily living and depression]. J Korean Acad Nurs 2012; 42:434-42. [PMID: 22854556 DOI: 10.4040/jkan.2012.42.3.434] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
PURPOSE The purpose of this predictive study was to identify factors affecting health related quality of life (HRQoL) in patients with rheumatoid arthritis (RA). METHODS The participants in this study were 131 patients with RA who were recruited from the outpatient clinic of a university hospital in Seoul. Disease activity in rheumatoid arthritis was evaluated by calculating the Disease Activity Score 28. Disability in activities of daily living (ADL) was assessed with the Korean Health Assessment Questionnaire, and depression with The Center for Epidemiologic Studies Depression Scale. HRQoL was evaluated using The Short Form 36 Health Survey. Data were analyzed using descriptive statistics, correlation, and hierarchical multiple regression. RESULTS Pain, disability in ADL, disease activity, and depression correlated negatively with physical and mental dimensions of HRQoL. But hierachical multiple regression analysis revealed that disability in ADL and depression were the only variables negatively influencing physical and mental QoL after adjustment for influences of sociodemographic variables. CONCLUSION Results of this study suggest that disability in ADL and depression, rather than disease activity and pain have profound effects on HRQoL in patients with RA. Further studies are needed to assess the predictive ability of disease activity and pain on HRQoL in this population.
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Affiliation(s)
- Dong Choon Uhm
- Department of Emergency Medical Technician, Daejeon University, Daejeon, South Korea
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Hodkinson B, Musenge E, Ally M, Meyer PWA, Anderson R, Tikly M. Functional disability and health-related quality of life in South Africans with early rheumatoid arthritis. Scand J Rheumatol 2012; 41:366-74. [PMID: 22803639 DOI: 10.3109/03009742.2012.676065] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND The severity and predictors of functional disability and health-related quality of life (HRQoL) in a cohort of South Africans with early rheumatoid arthritis (RA) were investigated. METHODS Changes in the Health Assessment Questionnaire Disability Index (HAQ) and the 36-Item Short Form Health Survey (SF-36) following 12 months of traditional disease-modifying anti-rheumatic drugs (DMARDs) were studied in previously DMARD-naïve adults with disease duration ≤ 2 years. RESULTS The majority of the 171 patients were female (82%), Black Africans (89%) with a mean (SD) symptom duration of 11.6 (7.0) months. In the 134 patients seen at 12 months, there were significant improvements in the HAQ and all domains of the SF-36 but 92 (69%) still had substantial functional disability (HAQ > 0.5) and 89 (66%) had suboptimal mental health [SF-36 mental composite score (MCS) < 66.6]. Multivariate analysis showed that female sex (p = 0.05) and high baseline HAQ score (p < 0.01) predicted substantial functional disability at 12 months. Unemployment (p = 0.03), high baseline pain (p = 0.02), and HAQ score (p = 0.04) predicted suboptimal mental health, with a trend towards a low level of schooling being significant (p = 0.08). CONCLUSIONS Early RA has a broad impact on HRQoL in indigent South Africans, with a large proportion of patients still showing substantial functional disability and suboptimal mental health despite 12 months of DMARD therapy. Further research is needed to establish the role of interventions including psychosocial support, rehabilitation programmes, and biological therapy to improve physical function and HRQoL in this population.
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Affiliation(s)
- B Hodkinson
- Division of Rheumatology, Department of Medicine, Chris Hani Baragwanath Hospital, University of the Witwatersrand, Johannesburg, South Africa.
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Kingsley G, Scott IC, Scott DL. Quality of life and the outcome of established rheumatoid arthritis. Best Pract Res Clin Rheumatol 2012; 25:585-606. [PMID: 22137926 DOI: 10.1016/j.berh.2011.10.003] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2011] [Accepted: 10/11/2011] [Indexed: 02/01/2023]
Abstract
Rheumatoid arthritis (RA) is a long-term condition causing joint pain and swelling and sometimes systemic involvement. The aims of treatment are, first, to reduce the impact the disease has on a patient and, second, to halt progression of disease. The advent of intensive therapy, including biologics, has led to a major improvement in outcome. To assess treatment impact, formal outcome measures have been developed. Traditionally, these focussed on the clinical aspects such as disease activity and joint damage. More recently, there has been an increased focus on patient-related outcome measures including quality-of-life measures. These enable illness evaluation from patients' perspectives, examination of care quality and comparison of the effectiveness and cost-effectiveness of treatment. This article examines advantages and disadvantages of the various outcome measures which are generally used in RA, with a focus on quality of life and patient-related measures.
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Affiliation(s)
- Gabrielle Kingsley
- Department of Rheumatology, King's College London School of Medicine, Weston Education Centre, UK.
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Sahatçiu-Meka V, Rexhepi S, Manxhuka-Kërliu S, Rexhepi M. Radiographic estimation in seropositive and seronegative rheumatoid arthritis. Bosn J Basic Med Sci 2012; 11:180-4. [PMID: 21875421 DOI: 10.17305/bjbms.2011.2571] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Long since it have been suggested that a subpopulation of patients with rheumatoid arthritis, diagnosed with negative rheumatoid factor tests, represents a clinical entity quite distinct from that of seropositive rheumatoid arthritis (RA). Our aim was to establish a scientific comparative analysis between seronegative and seropositive rheumatoid arthritis, regarding some radiological and clinical parameters, applied for the first time on patients from Kosovo. Two hundred fifty patients with rheumatoid arthritis according to the American College of Rheumatology criteria were retrospectively studied by analysis the radiographic damage and clinical parameters of the disease, using a data base. All examinees were between 25-60 years of age (Xb=49.96, SD=10.37) with disease duration between 1-27 years (Xb = 6.41, SD=6.47). All patients underwent a standardised evaluation radiographs. Baseline standardised poster anterior radiographs of hands and feet and radiographs of other joints, depending on indications, were assessed. Erythrocyte sedimentation rate values correlated with the radiological damages and statistical difference was found for seronegative subset (r=0.24, p<0.01). Longer duration of the disease resulted in the increase of radiological changes in both subsets (r=0.66, p<0.01) seronegative, (r=0.49, p<0.01) seropositive. Anatomic changes of IInd and IIIrd level were nearly equally distributed in both subsets, 76 (60.8%) seronegative, 75 (60%) seropositive. Radiological damages are nearly equal in both subsets, elevate in relation to the duration of the disease and correlate with ESR values. Regarding the sero-status, differences within sex, with some exceptions, are not relevant. Although there are some definite quantitative and qualitative differences regarding sero-status, obviously there is a great deal of overlap between the two groups.
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Affiliation(s)
- Vjollca Sahatçiu-Meka
- Physical Medicine Department, Clinic for Orthopaedics, University of Prishtina, Kosovo.
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POLLARD LOUISEC, IBRAHIM FOWZIA, CHOY ERNESTH, SCOTT DAVIDL. Pain Thresholds in Rheumatoid Arthritis: The Effect of Tender Point Counts and Disease Duration. J Rheumatol 2011; 39:28-31. [DOI: 10.3899/jrheum.110668] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Objective.We evaluated the influence of demographic and clinical factors on pain thresholds in patients with rheumatoid arthritis (RA).Methods.A cross-sectional observational study (105 patients with RA) assessed pain thresholds using an algometer. Regression analysis examined the influence of demographic and clinical assessments.Results.Pain thresholds (median 289, interquartile range 89–434) correlated with assessments of disease activity (tender joint counts), disability (Health Assessment Questionnaire), fatigue, depression, and anxiety. Ordinal logistic regression showed tender point counts and disease duration were the dominant contributors.Conclusion.These findings suggest that low pain thresholds reflect “fibromyalgic” RA (many tender points) and central pain sensitization with prolonged disease duration.
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Nicassio PM, Kay MA, Custodio MK, Irwin MR, Olmstead R, Weisman MH. An evaluation of a biopsychosocial framework for health-related quality of life and disability in rheumatoid arthritis. J Psychosom Res 2011; 71:79-85. [PMID: 21767687 PMCID: PMC3139906 DOI: 10.1016/j.jpsychores.2011.01.008] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2010] [Revised: 01/07/2011] [Accepted: 01/10/2011] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To examine the relationships between physical, psychological, and social factors and health-related quality of life (HRQOL) and disability in rheumatoid arthritis (RA). METHODS A sample of 106 patients with rheumatoid arthritis (RA) completed measures of self-reported disease activity and psychosocial functioning, including coping, personal mastery, social network, perceived stress, illness beliefs, the SF-36 and Health Assessment Questionnaire Disability Index (HAQ-DI). In addition, physician-based assessment of disease activity using the Disease Activity Scale (DAS-28) was obtained. Hierarchical multiple regression analyses were used to evaluate the relationships between psychosocial factors and scores on the SF-36 and HAQ-DI. RESULTS Lower self-reported disease activity was associated with higher SF-36 physical functioning scores, while the contribution of active coping, passive coping, and helplessness was significant only as a block. Lower self-reported disease activity, higher personal mastery, and lower perceived stress contributed to higher SF-36 mental health functioning, and higher self-reported disease activity and lower helplessness were associated with greater disability, as indexed by the HAQ-DI. The DAS-28, an objective of measure of disease activity, was unrelated to any of these outcomes. CONCLUSIONS The findings highlight the importance of targeting psychological factors to enhance HRQOL and disability in the clinical management of RA patients.
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Affiliation(s)
- Perry M Nicassio
- University of California, Los Angeles, Cousins Center for Psychoneuroimmunology, Semel Institute for Neuroscience and Human Behavior, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, USA.
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