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Villalobos-Sánchez L, Blanco-Cáceres B, Bachiller-Corral J, Rodríguez-Serrano MT, Vázquez-Díaz M, Lázaro Y de Mercado P. Quality of life of patients with rheumatic diseases. REUMATOLOGIA CLINICA 2024; 20:59-66. [PMID: 38395496 DOI: 10.1016/j.reumae.2023.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 06/29/2023] [Indexed: 02/25/2024]
Abstract
OBJECTIVE Health-related quality of life (HRQoL) is an important indicator of population health and can measure the impact of medical actions. The main objective of this study was to determine the HRQoL of patients with rheumatic diseases (RD) and compare it with that of the general population. METHODS Observational, cross-sectional, single-center study, with consecutive inclusion of outpatients over 18 years of age seen at a Rheumatology hospital-based outpatient clinic in Madrid. Sociodemographic, clinical variables and HRQoL were recorded. HRQoL was measured with the 5-dimension, 5-level EuroQoL (EQ-5D-5L), which includes the EQ-Index (0-1 scale) and a visual analog scale (VAS, 0-100 scale). A descriptive analysis and a comparison with the HRQoL of the Spanish general population were performed. RESULTS 1144 patients were included, 820 (71.68%) women, with a mean age of 56.1 years (range 18-95), of whom 241 (25.44%) were new patients. In patients with RD, the HRQoL measured with the EQ-Index and with the VAS, was 0.186 and 12 points lower, respectively, than in the general population. The decrease in HRQoL affected the 5 health dimensions, especially "pain/discomfort", followed by "daily activities" and "mobility". This reduction in HRQoL was observed in both men and women, and in all age ranges, although it was greater between 18 and 65 years of age. The reduction in HRQoL affected all RD subtypes, especially the "peripheral and axial mechanical pathology" and the "soft tissue pathology" group. CONCLUSIONS Patients with rheumatic diseases report worse HRQoL when compared to the general population in all dimensions of HRQoL.
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Affiliation(s)
| | - Boris Blanco-Cáceres
- Department of Rheumatology, Ramón y Cajal University Hospital, Madrid, Spain; Universidad de Alcalá, Facultad de Medicina, Madrid, Spain
| | - Javier Bachiller-Corral
- Department of Rheumatology, Ramón y Cajal University Hospital, Madrid, Spain; Universidad de Alcalá, Facultad de Medicina, Madrid, Spain
| | | | - Mónica Vázquez-Díaz
- Department of Rheumatology, Ramón y Cajal University Hospital, Madrid, Spain
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Dey M, Busby A, Elwell H, Pratt A, Young A, Isaacs J, Nikiphorou E. The use and context of the term 'multimorbidity' in rheumatoid arthritis: a systematic literature review. Rheumatology (Oxford) 2021; 60:3058-3071. [PMID: 33682885 DOI: 10.1093/rheumatology/keab214] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 02/14/2021] [Accepted: 02/20/2021] [Indexed: 11/14/2022] Open
Abstract
This systematic literature review aimed to analyse terms describing coexisting conditions in the RA literature, informing the need for an operationalized definition of multimorbidity. Articles discussing RA with multimorbidity, published 1946 until August 2020, were identified. The primary outcome was the use and/or definition of 'multimorbidity' in RA. Information extracted included terms defining coexisting conditions, the use of a comorbidity/multimorbidity score and the use of 'index disease' to describe RA (more applicable to comorbidity than multimorbidity). Thirty-nine articles were included. Eight articles used the term 'multimorbidity', 18 used 'comorbidity' and 12 used both terms, 7 synonymously. One used no term. Fourteen articles fully defined the term. The number of co-existing conditions described in included studies was one-121. Twelve articles used a comorbidity/multimorbidity score. Four articles described RA as the 'index disease'. Our results demonstrate inconsistent use of the term multimorbidity. Improved assessment of multimorbidity is indicated in RA patients, including an operationalized use and definition.
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Affiliation(s)
- Mrinalini Dey
- Institute of Life Course and Medical Sciences, University of Liverpool
- Department of Rheumatology, Aintree Hospital, Liverpool University Hospitals NHS Foundation Trust, Liverpool
| | - Amanda Busby
- Centre for Health Services and Clinical Research, Life and Medical Sciences, University of Hertfordshire, Hatfield
| | - Helen Elwell
- British Medical Association Library, BMA House, Tavistock Square, London
| | - Arthur Pratt
- Faculty of Medical Sciences, Newcastle University Translational and Clinical Research Institute
- Musculoskeletal Unit, Newcastle upon Tyne Hospitals NHS Foundation Trust, Freeman Hospital, Newcastle upon Tyne
| | - Adam Young
- Centre for Health Services and Clinical Research, Life and Medical Sciences, University of Hertfordshire, Hatfield
| | - John Isaacs
- Faculty of Medical Sciences, Newcastle University Translational and Clinical Research Institute
- Musculoskeletal Unit, Newcastle upon Tyne Hospitals NHS Foundation Trust, Freeman Hospital, Newcastle upon Tyne
| | - Elena Nikiphorou
- Centre for Rheumatic Diseases, King's College London, London, UK
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Beers-Tas MV, Nielen MM, Twisk JWR, Korevaar J, van Schaardenburg D. Increased primary care use for musculoskeletal symptoms, infections and comorbidities in the years before the diagnosis of inflammatory arthritis. RMD Open 2020; 6:rmdopen-2019-001163. [PMID: 32641448 PMCID: PMC7425115 DOI: 10.1136/rmdopen-2019-001163] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2019] [Revised: 03/10/2020] [Accepted: 04/09/2020] [Indexed: 01/10/2023] Open
Abstract
Objectives Little is known about relevant events in the at-risk phase of rheumatoid arthritis before the development of clinically apparent inflammatory arthritis (IA). The present study assessed musculoskeletal symptoms, infections and comorbidity in future IA patients. Methods In a nested case–control study using electronic health records of general practitioners, the frequency and timing of 192 symptoms or diseases were evaluated before a diagnosis of IA, using the International Classification of Primary Care coding system. Cases were 2314 adults with a new diagnosis IA between 2012 and 2016; controls were matched 1:2. The frequency of primary care visits was compared using logistic regression. Results The frequency of visits for musculoskeletal symptoms (mostly of shoulders, wrists, fingers and knees) and carpal tunnel syndrome was significantly higher in IA patients vs controls within the final 1.5 years before diagnosis, with ORs of 3.2 (95% CI 2.8 to 3.5), 2.8 (95% CI 2.5 to 3.1) and 2.5 (95% CI 2.2 to 2.8) at 6, 12 and 18 months before diagnosis, respectively. Also, infections (notably of the genital and urinary tracts), IA-comorbidities and chronic diseases were more prevalent in cases than controls, but more evenly spread out over the whole 6-year period before IA. A decision tree was created including all symptoms and diseases. Conclusion There was an increased frequency of primary care visits for musculoskeletal symptoms, infections and comorbidities prior to the diagnosis of IA. This diverging trend is present for 4–6 years, but becomes statistically significant 1.5 years before the diagnosis. Validation of these results is warranted.
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Affiliation(s)
- Marian van Beers-Tas
- Rheumatology, Amsterdam Rheumatology and Immunology Center, Reade, Amsterdam, Netherlands
| | - Markus Mj Nielen
- Netherlands Institute for Health Services Research (NIVEL), Utrecht, Netherlands
| | - Jos W R Twisk
- Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, Netherlands
| | - Joke Korevaar
- Netherlands Institute for Health Services Research (NIVEL), Utrecht, Netherlands
| | - D van Schaardenburg
- Rheumatology, Amsterdam Rheumatology and Immunology Center, Reade, Amsterdam, Netherlands.,Rheumatology, Amsterdam Rheumatology & immunology Center, Amsterdam University Medical Center location AMC, Amsterdam, The Netherlands
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Cook MJ, Bellou E, Bowes J, Sergeant JC, O'Neill TW, Barton A, Verstappen SMM. The prevalence of co-morbidities and their impact on physical activity in people with inflammatory rheumatic diseases compared with the general population: results from the UK Biobank. Rheumatology (Oxford) 2019; 57:2172-2182. [PMID: 30107595 PMCID: PMC6256331 DOI: 10.1093/rheumatology/key224] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Indexed: 11/13/2022] Open
Abstract
Objectives To compare the prevalence and incidence of chronic co-morbidities in people with inflammatory rheumatic and musculoskeletal diseases (iRMDs), and to determine whether the prevalent co-morbidities are associated with physical activity levels in people with iRMDs and in those without iRMDs. Methods Participants were recruited to the UK Biobank; a population-based cohort. Data were collected about demographics, physical activity, iRMDs (RA, PsA, AS, SLE) and other chronic conditions, including angina, myocardial infarction, stroke, hypertension, pulmonary disease, diabetes and depression. The standardized prevalence of co-morbidities in people with iRMDs was calculated. Cox regression was used to determine the relationship between the presence of an iRMD and an incident co-morbidity. The relationship between the presence (versus absence) of a (co-)morbidity and physical activity level (low, moderate, high) in people with iRMDs and in those without was assessed using multinomial logistic regression. Results A total of 488 991 participants were included. The estimated prevalence of each co-morbidity was increased in participants with an iRMD, compared with in those without, particularly for stroke in participants with SLE (standardized morbidity ratio (95% CI), 4.9 (3.6, 6.6). Compared with people with no iRMD and no morbidity, the odds ratios (95% CI) for moderate physical activity were decreased for: no iRMD and morbidity, 0.87 (0.85, 0.89); iRMD and no co-morbidity, 0.71 (0.64, 0.80); and iRMD and co-morbidity, 0.58 (0.54, 0.63). Conclusion Having a (co-)morbidity is associated with reduced physical activity in the general population, and to a greater extent in participants with an iRMD. Optimal management of both iRMDs and co-morbidities may help to reduce their impact on physical activity.
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Affiliation(s)
- Michael J Cook
- Arthritis Research UK Centre for Epidemiology, Division of Musculoskeletal & Dermatological Sciences, Manchester, UK
| | - Eftychia Bellou
- Arthritis Research UK Centre for Genetics and Genomics, Division of Musculoskeletal & Dermatological Sciences, School of Biological Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - John Bowes
- Arthritis Research UK Centre for Genetics and Genomics, Division of Musculoskeletal & Dermatological Sciences, School of Biological Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Jamie C Sergeant
- Division of Population Health, Health Services Research & Primary Care, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, UK
| | - Terence W O'Neill
- Arthritis Research UK Centre for Epidemiology, Division of Musculoskeletal & Dermatological Sciences, Manchester, UK.,NIHR Manchester Biomedical Research Centre, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - Anne Barton
- Arthritis Research UK Centre for Genetics and Genomics, Division of Musculoskeletal & Dermatological Sciences, School of Biological Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK.,NIHR Manchester Biomedical Research Centre, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - Suzanne M M Verstappen
- Arthritis Research UK Centre for Epidemiology, Division of Musculoskeletal & Dermatological Sciences, Manchester, UK.,NIHR Manchester Biomedical Research Centre, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
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Ursum J, Nielen MMJ, Twisk JWR, Peters MJL, Schellevis FG, Nurmohamed MT, Korevaar JC. Cardiovascular disease-related hospital admissions of patients with inflammatory arthritis. J Rheumatol 2014; 42:188-92. [PMID: 25512486 DOI: 10.3899/jrheum.140476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Patients with inflammatory arthritis (IA) have an increased risk of cardiovascular diseases (CVD), suggesting a high rate of CVD-related hospitalizations, but data on this topic are limited. Our study addressed hospital admissions for CVD in a primary care-based population of patients with IA and controls. METHODS All newly diagnosed patients with IA between 2001 and 2010 were selected from electronic medical records of the Netherlands Institute for Health Services Research Primary Care database, representing a national network of general practices. Two control patients matched for age, sex, and practice were selected for each patient with IA. Hospital admission data for all patients was retrieved from the Dutch Hospital Data. RESULTS There were 2615 patients with IA and 5555 controls included in our study. CVD-related hospital admissions were observed more frequently among patients with IA as compared with control patients: 48% versus 36% (p < 0.001) in a followup period of 4 years. Patients with IA were more often hospitalized because of ischemic heart disease (OR 1.7, 95% CI 1.2-2.2) and for day-care admission because of cerebrovascular disease (OR 2.2, 95% CI 1.0-4.9). CONCLUSION Increased hospital admission rates confirm the higher CVD burden among patients with IA compared with controls, and underscore the need for proper CVD risk management in patients with IA.
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Affiliation(s)
- Jennie Ursum
- From the Netherlands Institute for Health Services Research (NIVEL), Utrecht; the EMGO+ Institute for Health and Care Research, VU University; Department of Epidemiology and Biostatistics, Department of Internal Medicine, Department of General Practice and Elderly Care Medicine/EMGO Institute for Health and Care Research, and the Department of Rheumatology, VU University Medical Centre, Amsterdam, the Netherlands.J. Ursum, PhD; M.M.J. Nielen, PhD; J.C. Korevaar, PhD, NIVEL; J.W.R. Twisk, PhD, EMGO+ Institute for Health and Care Research, VU University, and the Department of Epidemiology and Biostatistics, VU University Medical Centre; M.J.L. Peters, PhD, Department of Internal Medicine, VU University Medical Centre; F.G. Schellevis, Professor, NIVEL, and the Department of General Practice and Elderly Care Medicine/EMGO Institute for Health and Care Research, VU University Medical Centre; M.T. Nurmohamed, PhD, Department of Internal Medicine, and the Department of Rheumatology, VU University Medical Centre.
| | - Mark M J Nielen
- From the Netherlands Institute for Health Services Research (NIVEL), Utrecht; the EMGO+ Institute for Health and Care Research, VU University; Department of Epidemiology and Biostatistics, Department of Internal Medicine, Department of General Practice and Elderly Care Medicine/EMGO Institute for Health and Care Research, and the Department of Rheumatology, VU University Medical Centre, Amsterdam, the Netherlands.J. Ursum, PhD; M.M.J. Nielen, PhD; J.C. Korevaar, PhD, NIVEL; J.W.R. Twisk, PhD, EMGO+ Institute for Health and Care Research, VU University, and the Department of Epidemiology and Biostatistics, VU University Medical Centre; M.J.L. Peters, PhD, Department of Internal Medicine, VU University Medical Centre; F.G. Schellevis, Professor, NIVEL, and the Department of General Practice and Elderly Care Medicine/EMGO Institute for Health and Care Research, VU University Medical Centre; M.T. Nurmohamed, PhD, Department of Internal Medicine, and the Department of Rheumatology, VU University Medical Centre
| | - Jos W R Twisk
- From the Netherlands Institute for Health Services Research (NIVEL), Utrecht; the EMGO+ Institute for Health and Care Research, VU University; Department of Epidemiology and Biostatistics, Department of Internal Medicine, Department of General Practice and Elderly Care Medicine/EMGO Institute for Health and Care Research, and the Department of Rheumatology, VU University Medical Centre, Amsterdam, the Netherlands.J. Ursum, PhD; M.M.J. Nielen, PhD; J.C. Korevaar, PhD, NIVEL; J.W.R. Twisk, PhD, EMGO+ Institute for Health and Care Research, VU University, and the Department of Epidemiology and Biostatistics, VU University Medical Centre; M.J.L. Peters, PhD, Department of Internal Medicine, VU University Medical Centre; F.G. Schellevis, Professor, NIVEL, and the Department of General Practice and Elderly Care Medicine/EMGO Institute for Health and Care Research, VU University Medical Centre; M.T. Nurmohamed, PhD, Department of Internal Medicine, and the Department of Rheumatology, VU University Medical Centre
| | - Mike J L Peters
- From the Netherlands Institute for Health Services Research (NIVEL), Utrecht; the EMGO+ Institute for Health and Care Research, VU University; Department of Epidemiology and Biostatistics, Department of Internal Medicine, Department of General Practice and Elderly Care Medicine/EMGO Institute for Health and Care Research, and the Department of Rheumatology, VU University Medical Centre, Amsterdam, the Netherlands.J. Ursum, PhD; M.M.J. Nielen, PhD; J.C. Korevaar, PhD, NIVEL; J.W.R. Twisk, PhD, EMGO+ Institute for Health and Care Research, VU University, and the Department of Epidemiology and Biostatistics, VU University Medical Centre; M.J.L. Peters, PhD, Department of Internal Medicine, VU University Medical Centre; F.G. Schellevis, Professor, NIVEL, and the Department of General Practice and Elderly Care Medicine/EMGO Institute for Health and Care Research, VU University Medical Centre; M.T. Nurmohamed, PhD, Department of Internal Medicine, and the Department of Rheumatology, VU University Medical Centre
| | - François G Schellevis
- From the Netherlands Institute for Health Services Research (NIVEL), Utrecht; the EMGO+ Institute for Health and Care Research, VU University; Department of Epidemiology and Biostatistics, Department of Internal Medicine, Department of General Practice and Elderly Care Medicine/EMGO Institute for Health and Care Research, and the Department of Rheumatology, VU University Medical Centre, Amsterdam, the Netherlands.J. Ursum, PhD; M.M.J. Nielen, PhD; J.C. Korevaar, PhD, NIVEL; J.W.R. Twisk, PhD, EMGO+ Institute for Health and Care Research, VU University, and the Department of Epidemiology and Biostatistics, VU University Medical Centre; M.J.L. Peters, PhD, Department of Internal Medicine, VU University Medical Centre; F.G. Schellevis, Professor, NIVEL, and the Department of General Practice and Elderly Care Medicine/EMGO Institute for Health and Care Research, VU University Medical Centre; M.T. Nurmohamed, PhD, Department of Internal Medicine, and the Department of Rheumatology, VU University Medical Centre
| | - Michael T Nurmohamed
- From the Netherlands Institute for Health Services Research (NIVEL), Utrecht; the EMGO+ Institute for Health and Care Research, VU University; Department of Epidemiology and Biostatistics, Department of Internal Medicine, Department of General Practice and Elderly Care Medicine/EMGO Institute for Health and Care Research, and the Department of Rheumatology, VU University Medical Centre, Amsterdam, the Netherlands.J. Ursum, PhD; M.M.J. Nielen, PhD; J.C. Korevaar, PhD, NIVEL; J.W.R. Twisk, PhD, EMGO+ Institute for Health and Care Research, VU University, and the Department of Epidemiology and Biostatistics, VU University Medical Centre; M.J.L. Peters, PhD, Department of Internal Medicine, VU University Medical Centre; F.G. Schellevis, Professor, NIVEL, and the Department of General Practice and Elderly Care Medicine/EMGO Institute for Health and Care Research, VU University Medical Centre; M.T. Nurmohamed, PhD, Department of Internal Medicine, and the Department of Rheumatology, VU University Medical Centre
| | - Joke C Korevaar
- From the Netherlands Institute for Health Services Research (NIVEL), Utrecht; the EMGO+ Institute for Health and Care Research, VU University; Department of Epidemiology and Biostatistics, Department of Internal Medicine, Department of General Practice and Elderly Care Medicine/EMGO Institute for Health and Care Research, and the Department of Rheumatology, VU University Medical Centre, Amsterdam, the Netherlands.J. Ursum, PhD; M.M.J. Nielen, PhD; J.C. Korevaar, PhD, NIVEL; J.W.R. Twisk, PhD, EMGO+ Institute for Health and Care Research, VU University, and the Department of Epidemiology and Biostatistics, VU University Medical Centre; M.J.L. Peters, PhD, Department of Internal Medicine, VU University Medical Centre; F.G. Schellevis, Professor, NIVEL, and the Department of General Practice and Elderly Care Medicine/EMGO Institute for Health and Care Research, VU University Medical Centre; M.T. Nurmohamed, PhD, Department of Internal Medicine, and the Department of Rheumatology, VU University Medical Centre
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