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Feng J, Zhang K, Dou L, Shi Z, Chen G, Li S. Health state utility values in patients with Ankylosing Spondylitis: a systematic review and meta-analysis. Qual Life Res 2024; 33:2321-2334. [PMID: 38824212 DOI: 10.1007/s11136-024-03670-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/19/2024] [Indexed: 06/03/2024]
Abstract
INTRODUCTION Ankylosing spondylitis (AS) is a chronic condition that requires lifelong treatment and results in a serious disease burden. Health state utility values (HSUVs) are a valuable tool for quantifying this burden and conducting cost-utility analysis. OBJECTIVE We conducted a systematic review and meta-analysis to obtain estimates of HSUVs in patients with AS, explored potential sources of heterogeneity, and compared pooled patient HSUVs with population norms. METHOD We searched PubMed, Embase, Web of science, Cochrane database and Scopus until July, 2023 to obtain eligible studies. The methodological quality of the included studies was assessed using the ROBINS-I checklist. RESULTS Forty-two publications involving 11,354 participants were included in this systematic review. The most commonly used instrument is the EQ-5D (38 studies). The estimated HSUVs for patients with AS from all available studies was pooled as 0.62 (95% CI 0.59 to 0.65). The pooled mean utility estimates from the random effects meta-analysis for SF-6D, EQ-5D-3L, EQ-5D-5L, and HUI3 were 0.65 (95% CI 0.62,0.68), 0.63 (95% CI 0.59,0.66), 0.60 (95% CI 0.42,0.79), and 0.48 (95% CI 0.43,0.53), respectively. For the EQ-5D-3L we conducted stratified meta-analyses and meta-regression based on key subgroups. The pooled estimates of EQ-5D-3L were lower for patients published before 2010, with high disease activity, long duration of disease, and in developed countries. CONCLUSION Pooled estimates of HSUVs for people with AS were substantially lower than population norms. These estimates provide robust evidence that can inform the economic evaluation of new therapies for individuals with AS.
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Affiliation(s)
- JunChao Feng
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, 250012, China
- NHC Key Lab of Health Economics and Policy Research, Shandong University, Jinan, 250012, China
- Center for Health Preference Research, Shandong University, Jinan, 250012, China
| | | | - Lei Dou
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, 250012, China
- NHC Key Lab of Health Economics and Policy Research, Shandong University, Jinan, 250012, China
- Center for Health Preference Research, Shandong University, Jinan, 250012, China
| | - Zhao Shi
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, 250012, China
- NHC Key Lab of Health Economics and Policy Research, Shandong University, Jinan, 250012, China
- Center for Health Preference Research, Shandong University, Jinan, 250012, China
| | - Gang Chen
- Centre for Health Economics, Monash University, Melbourne, VIC, 3145, Australia
| | - Shunping Li
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, 250012, China.
- NHC Key Lab of Health Economics and Policy Research, Shandong University, Jinan, 250012, China.
- Center for Health Preference Research, Shandong University, Jinan, 250012, China.
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Marcon T, Lorenzon G, Zanotti R, Danielis M. Anxiety and Work Disability in Patients With Immune-Mediated Inflammatory Diseases: A Cross-Sectional Study From a Single Center. Gastroenterol Nurs 2024:00001610-990000000-00103. [PMID: 39179283 DOI: 10.1097/sga.0000000000000819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Accepted: 04/02/2024] [Indexed: 08/26/2024] Open
Abstract
Immune-mediated inflammatory diseases (IMIDs) are chronic diseases that are associated with an inflammatory process with unclear etiology and occur in genetically predisposed individuals. In this study, inflammatory bowel disease (IBD) and rheumatic disease (RD) were examined. The aim of the research is to evaluate the relationship between IMID and state anxiety and work impairment in patients. A cross-sectional study was conducted in an outpatient clinic for rheumatology and gastroenterology at an Italian university hospital. A total of 476 patients (261 IBD and 215 RD) were considered. Patients diagnosed with IBD demonstrated significantly higher levels of anxiety, encompassing both trait and state anxiety, compared to those with RD (p < .001). While trait anxiety exhibited a modest positive correlation with work productivity loss (r = .163; p = .046), activity impairment showed a positive correlation with both state anxiety (r = .243; p < .001) and trait anxiety (r = .206; p = .002). The impact of anxiety on job performance and daily activities should not be underestimated, as it may elevate the risk of unemployment and absenteeism and lead to increased societal costs.
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Affiliation(s)
- Thomas Marcon
- Thomas Marcon, MSN, RN, is a clinical nurse, Analysis of Health and Social-health Care Activities, Azienda Zero (Veneto Region), Padua, Italy. Greta Lorenzon, MSN, RN, is a clinical nurse, Department of Surgery, Oncology and Gastroenterology (DISCOG), University Hospital of Padua, Padua, Italy. Renzo Zanotti, PhD, MSN, RN, is an Associate Professor, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy. Matteo Danielis, PhD, MSN, RN, is an Assistant Professor, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
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Kang KY, Park SY, Chung TH. Long-term association between physical activity and global functioning in patients with axial spondyloarthritis: results of a two-year prospective study. Scand J Rheumatol 2024:1-8. [PMID: 39045679 DOI: 10.1080/03009742.2024.2376810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2024] [Accepted: 07/03/2024] [Indexed: 07/25/2024]
Abstract
OBJECTIVES To assess the longitudinal association between physical activity and global functioning in patients with axial spondyloarthritis (axSpA), and to identify the subtype of physical activity that is longitudinally related to global functioning. METHOD Physical activity was measured using Global Physical Activity Questionnaire. Global functioning was assessed using the Assessment of SpondyloArthritis international Society Health Index (ASAS HI). The amount and subtype (work, transport, and recreation) of physical activity, disease activity, and ASAS HI were assessed at baseline, and at 1 and 2 year follow-up. Physical activity levels were categorized as low, moderate, or high. The longitudinal association between physical activity and ASAS HI scores was analysed using a generalized estimating equation. RESULTS The study evaluated 160 patients. Univariate analysis identified physical activity at moderate level and higher, Ankylosing Spondylitis Disease Activity Score (ASDAS), and syndesmophyte number as being longitudinally associated with ASAS HI over 2 years. Multivariate analysis identified physical activity at moderate level and higher as being longitudinally associated with ASAS HI. Physical activity above moderate levels was associated independently with good global functioning. In the analysis stratified by radiographic axSpA and non-radiographic axSpA, a positive association between physical activity and global functioning was observed in both groups. Only recreational activity, but not work- and transport-related activity, showed an independent longitudinal relationship with the ASAS HI score. CONCLUSIONS Physical activity at moderate level and higher was associated independently with global functioning in axSpA. Therefore, patients should maintain physical activity above moderate levels to preserve global function.
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Affiliation(s)
- K Y Kang
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University, Baltimore, MD, USA
- Department of Internal Medicine, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - S Y Park
- Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - T H Chung
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University, Baltimore, MD, USA
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Rouse PC, Ingram T, Standage M, Sengupta R. Fear of movement and competence frustration mediate the relationship between pain catastrophising and physical function in people living with axSpA: an online cross-sectional survey. Rheumatol Int 2024; 44:933-941. [PMID: 38506923 PMCID: PMC10980646 DOI: 10.1007/s00296-024-05557-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Accepted: 02/09/2024] [Indexed: 03/22/2024]
Abstract
The objective of this study is to examine the contribution of pain catastrophising to Axial Spondyloarthritis (axSpA) patient's physical function and to test the mediating role of fear of movement, and uniquely, the contribution of competence frustration to the fear-avoidance model. Participants (N = 98, 70% female, M age = 45.62, SD 12.16) completed an online survey (December 2020-May 2021) distributed in the United Kingdom via the National Axial Spondyloarthritis Society (n ≈ 3500; NASS, 2019). The PROCESS SPSS macro was used to test three mediation models using percentile bootstrap 95% confidence intervals (PBCI). A significant indirect effect on the relationship between pain and physical function via fear of movement (β = 0.10, 95% PBCI = 0.030-0.183) was observed (Model 1). Model 2 showed the relationship between pain catastrophising and physical function to be significantly mediated by fear of movement (β = 0.16, 95% PBCI = 0.005-0.322). Finally, Model 3 showed a significant indirect effect on the relationship between pain catastrophising and physical function via competence frustration (β = 0.15, 95% PBCI = 0.014-0.309) but not through fear of movement (β = 0.062, 95% PBCI = - 0.134 to 0.248). To our knowledge, this is the first study to examine and demonstrate the unique contribution of competence need frustration to the Fear-avoidance model in people that live with axSpA. Identifying modifiable factors that contribute to disease outcomes such as physical function can improve the care and quality of life for people living with a disease currently without a cure.
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Affiliation(s)
- Peter C Rouse
- Centre for Motivation and Health Behaviour Change, Department for Health, University of Bath, Bath, BA2 7AY, UK.
| | - Thomas Ingram
- Centre for Motivation and Health Behaviour Change, Department for Health, University of Bath, Bath, BA2 7AY, UK
| | - Martyn Standage
- Centre for Motivation and Health Behaviour Change, Department for Health, University of Bath, Bath, BA2 7AY, UK
| | - Raj Sengupta
- Royal National Hospital for Rheumatic Diseases, Royal United Hospitals NHS Foundation Trust, Combe Park, Bath, Avon, BA1 3NG, UK
- Department of Pharmacy and Pharmacology, University of Bath, Bath, BA2 7AY, UK
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Gossec L, Humphries B, Rutherford M, Taieb V, Willems D, Tillett W. Improvement in work productivity among psoriatic arthritis patients treated with biologic or targeted synthetic drugs: a systematic literature review and meta-analysis. Arthritis Res Ther 2024; 26:50. [PMID: 38360699 PMCID: PMC10868000 DOI: 10.1186/s13075-024-03282-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 01/30/2024] [Indexed: 02/17/2024] Open
Abstract
BACKGROUND Capacity to work is impacted by psoriatic arthritis (PsA). Our objective was to describe the course of work productivity and leisure activity in patients with PsA treated with biologic (b) and targeted synthetic (ts) disease-modifying antirheumatic drugs (DMARDs). METHODS A systematic literature review identified all trials and observational studies published January 1, 2010-October 22, 2021, reporting work productivity using the Work Productivity and Activity Impairment Questionnaire (WPAI) in patients with PsA treated with b/tsDMARDs. Outcomes for WPAI domains (absenteeism, presenteeism, total work productivity, and activity impairment) were collected at baseline and time point closest to 24 weeks of treatment. A random effects meta-analysis of single means was conducted to calculate an overall absolute mean change from baseline for each WPAI domain. RESULTS Twelve studies (ten randomized controlled and two observational) assessing patients treated with adalimumab, bimekizumab, guselkumab, ixekizumab, risankizumab, secukinumab, or upadacitinib were analysed. Among 3741 employed patients, overall mean baseline scores were 11.4%, 38.7%, 42.7%, and 48.9% for absenteeism, presenteeism, total work productivity impairment, and activity impairment, respectively. Estimated absolute mean improvements (95% confidence interval) to week 24 were 2.4 percentage points (%p) (0.6, 4.1), 17.8%p (16.2,19.3), 17.6%p (15.9,19.4), and 19.3%p (17.6, 21.0) respectively, leading to a mean relative improvement of 41% for total work productivity. The change in work outcomes in the b/tsDMARDs appeared similar. CONCLUSIONS This systematic literature review and meta-analysis confirmed that patients with active PsA have a substantially reduced capacity to work and participate in leisure activities. Substantial improvements across various WPAI domains were noted after 24 weeks of b/tsDMARD treatment, especially in presenteeism, total work productivity, and activity impairment. These findings may be useful for reimbursement purposes and in the context of shared decision-making. This systematic literature review (SLR) of randomized clinical trials and observational studies of biologic (b) and targeted synthetic (ts) disease-modifying antirheumatic drugs b/tsDMARDs in patients with PsA found that at treatment introduction, patients presented with a 42.7% mean productivity loss per week as assessed by the Work Productivity and Activity Impairment (WPAI) Questionnaire. Through a meta-analysis comparing before/after values without adjustment for placebo response, we found that after 24 weeks of treatment with b/tsDMARDs, there was a mean absolute improvement of 17.6 percentage points and a mean relative improvement of 41% in total work productivity, with similar magnitudes of improvement in time spent at work and regular activities outside of work. These results provide clinical-, regulatory- and reimbursement decision-makers with data on the potential societal and socio-economic benefits of b/tsDMARDs in PsA.
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Affiliation(s)
- Laure Gossec
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Paris, France.
- Rheumatology Department, Pitié-Salpêtrière Hospital, AP-HP, 47-83 Bd de l'Hôpital, Paris, 75013, France.
| | - Brittany Humphries
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Canada
- Cytel Inc, Ottawa, Canada
| | | | | | | | - William Tillett
- Department of Life Sciences, Royal National Hospital for Rheumatic Diseases, Centre for Therapeutic Innovation University of Bath, Bath, UK
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Hervieux V, Biron C, Dima J. Investigating Associations Between Physical Activity and Presenteeism - A Scoping Review. Am J Health Promot 2023; 37:1147-1161. [PMID: 37542375 PMCID: PMC10631278 DOI: 10.1177/08901171231193781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/06/2023]
Abstract
OBJECTIVE The aim of this study is to scope the literature on what is currently known between physical activity and presenteeism. DATA SOURCE A search strategy was conducting in six scientific databases. STUDY INCLUSION AND EXCLUSION CRITERIA Studies written in English about the relation between physical activity and presenteeism were considered for inclusion. DATA EXTRACTION Data on definitions and measurement of presenteeism and physical activity were extracted. DATA SYNTHESIS The data is categorized according to the understanding of presenteeism of the studies to give a better idea of how this phenomenon is studied in relation to physical activity. RESULTS After screening 9773 titles and abstracts and 269 full-text articles, 57 unique articles fulfilled our eligibility criteria. The majority of the articles were published since 2010 and originated predominantly in the United States. Most studies (70%) define presenteeism as lost productivity due to health problems, according to the American line of research, whereas 19% of the studies define it as "working while ill" which refers to the European line of research. The studies that reflected the American school of thought tends to report more results that supported their hypothesis (i.e., that more physical activity is associated with less presenteeism). CONCLUSION This review has highlighted the homogeneity in how presenteeism is conceptualized and measured in studies included in our sample. Research on physical activity and presenteeism should be expanded across various disciplines in social sciences to respond to the needs that many researchers have expressed to promote healthier organizations.
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Affiliation(s)
- Valérie Hervieux
- Département de Management, Université Laval, Québec, QC, Canada
- Centre d’expertise en gestion de la santé organisationnelle et sécurité du travail, Université Laval, Québec, QC, Canada
- VITAM - Centre de recherche en santé durable de l’Université Laval, Québec, QC, Canada
| | - Caroline Biron
- Département de Management, Université Laval, Québec, QC, Canada
- Centre d’expertise en gestion de la santé organisationnelle et sécurité du travail, Université Laval, Québec, QC, Canada
- VITAM - Centre de recherche en santé durable de l’Université Laval, Québec, QC, Canada
| | - Justine Dima
- Département HEG, HES-SO, Haute école d’ingénierie et de gestion du canton de Vaud, Suisse
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Madsen CMT, Primdahl J, Bremander A, Eggen L, Christensen JR. Developing a complex vocational rehabilitation intervention for patients with inflammatory arthritis: the WORK-ON study. BMC Health Serv Res 2023; 23:739. [PMID: 37422649 DOI: 10.1186/s12913-023-09780-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 07/03/2023] [Indexed: 07/10/2023] Open
Abstract
BACKGROUND People with inflammatory arthritis often experience challenges at work and balancing paid work and energy in everyday life. Low work ability is common, and people with inflammatory arthritis face high risks of losing their jobs and permanent exclusion from the labour market. Context-specific tailored rehabilitation targeting persons with inflammatory arthritis is limited. The aim of this study is to describe the development of WORK-ON - a vocational rehabilitation for people with inflammatory arthritis. METHODS Following the Medical Research Council's framework for complex interventions, WORK-ON was developed based on existing evidence, interviews with patients and rehabilitation clinicians, a workshop, and an iterative process. RESULTS The six-month vocational rehabilitation, WORK-ON, consists of 1) an initial assessment and goal setting by an occupational therapist experienced in rheumatology rehabilitation, 2) coordination by the same occupational therapist and individual support, including navigating across the primary and secondary health sectors, as well as social care, 3) group sessions for peer support, and 4) optionally individually tailored consultations with physiotherapists, nurses, or social workers. CONCLUSION WORK-ON is ready to be tested in a feasibility study. TRIAL REGISTRATION The Regional Committees on Health Ethics for Southern Denmark stated that no formal ethical approval was necessary in this study (20,192,000-105).
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Affiliation(s)
- Christina Merete Tvede Madsen
- Danish Hospital for Rheumatic Diseases, University Hospital of Southern Denmark, Engelshøjgade 9A, 6400, Sønderborg, Denmark.
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark.
| | - Jette Primdahl
- Danish Hospital for Rheumatic Diseases, University Hospital of Southern Denmark, Engelshøjgade 9A, 6400, Sønderborg, Denmark
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
- Sygehus Sønderjylland, University Hospital of Southern Denmark, Aabenraa, Denmark
| | - Ann Bremander
- Danish Hospital for Rheumatic Diseases, University Hospital of Southern Denmark, Engelshøjgade 9A, 6400, Sønderborg, Denmark
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
- Section of Rheumatology, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
| | - Linda Eggen
- Danish Hospital for Rheumatic Diseases, University Hospital of Southern Denmark, Engelshøjgade 9A, 6400, Sønderborg, Denmark
| | - Jeanette Reffstrup Christensen
- Department of Public Health, Research Unit of General Practice, University of Southern Denmark, Odense, Denmark
- Department of Public Health, User Perspectives and Community-Based Interventions, University of Southern Denmark, Odense, Denmark
- Research Unit of General Practice, Aarhus University, Aarhus, Denmark
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Hokkanen AM, Aaltonen K, Relas H, Rutanen J, Kononoff A, Taimen K, Kauppi M, Puolakka K, Trokovic N, Nordström D. Impact of TNF inhibitor medication on working ability in axial spondyloarthritis: an observational national registry-based cohort study. Rheumatol Adv Pract 2023; 7:rkad050. [PMID: 37332300 PMCID: PMC10272299 DOI: 10.1093/rap/rkad050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Accepted: 05/03/2023] [Indexed: 06/20/2023] Open
Abstract
Objective The aim was to investigate the effect of TNF inhibitor (TNFi) initiation on working ability and health-care resource utilization among axial SpA patients in a real-life setting. Methods Patients with a clinical diagnosis of non-radiographic (nr-axSpA) or radiographic axial SpA initiating their first TNFi were identified from the National Register for Antirheumatic and Biologic Treatment in Finland. Sickness absences, including sick leave and disability pension, in- and outpatient days and rehabilitation rates, 1 year before and after initiating the medication were retrieved from national registries. Factors affecting result variables were studied using multivariate regression analysis. Results Overall, 787 patients were identified. Rates of work disability days per year were 55.6 the year before treatment onset and 55.2 the year after, with significant differences between patient subgroups. The rate of sick leave decreased after starting TNFi treatment. However, the rate of disability pension continued to rise. Patients with a diagnosis of nr-axSpA experienced a decrease in overall work disability and, especially, fewer sick leaves. No sex differences were detected. Conclusion TNFi interrupts the increase in work disabled days evident during the year before its initiation. However, the overall work disability remains high. Treating patients earlier in the nr-axSpA phase, regardless of sex, appears important in maintaining the ability to work.
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Affiliation(s)
- Anna-Mari Hokkanen
- Correspondence to: Anna-Mari Hokkanen, ROB-FIN Register, Division of Rheumatology, Helsinki University Hospital, Keskussairaalankatu 7, 15850 Lahti, Finland. E-mail:
| | - Kalle Aaltonen
- Pharmaceuticals Pricing Board, Ministry of Social Affairs and Health, Helsinki, Finland
| | - Heikki Relas
- Division of Rheumatology, Helsinki University Hospital, Helsinki University, Helsinki, Finland
| | - Jarno Rutanen
- Unit of Health Sciences, Faculty of Social Sciences, Tampere University, Tampere, Finland
- Centre for Rheumatic Diseases, Tampere University Hospital, Tampere, Finland
| | | | - Kirsi Taimen
- Division of Medicine, Turku University Hospital, Turku, Finland
| | - Markku Kauppi
- Division of Rheumatology, Päijät-Häme Central Hospital, Lahti, Finland
- Division of Rheumatology, Helsinki University, Helsinki, Finland
| | - Kari Puolakka
- Helsinki Rheumatic Diseases and Inflammation Research Group, University of Helsinki, Helsinki, Finland
| | - Nina Trokovic
- ROB-FIN Register, Division of Rheumatology, Helsinki University Hospital, Helsinki, Finland
| | - Dan Nordström
- ROB-FIN Register, Division of Rheumatology, Helsinki University Hospital, Helsinki, Finland
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Lee S, Kim Y, Lee S, Lee SH, Kim Y, Jeon J, Jo J, Yoo H, Lee J, Kim T. Treatment pattern, satisfaction, and productivity loss of patients with ankylosing spondylitis treated with tumor necrosis factor inhibitors in Korea: A multicenter cross‐sectional observational study. Int J Rheum Dis 2022; 25:523-531. [PMID: 35187866 PMCID: PMC9303183 DOI: 10.1111/1756-185x.14304] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Revised: 01/21/2022] [Accepted: 01/22/2022] [Indexed: 12/17/2022]
Affiliation(s)
- Sang‐Hoon Lee
- Department of Rheumatology, Hospital at Gangdong Kyung Hee University Seoul Korea
| | - Yong‐Gil Kim
- Department of Rheumatology Asan Medical Center University of Ulsan College of Medicine Seoul Korea
| | - Seung‐Geun Lee
- Department of Rheumatology Pusan National University Hospital Pusan Korea
| | - Soo Hyun Lee
- Division of Medical Pfizer Biopharmaceuticals Group Pfizer Pharmaceuticals Korea Limited Seoul Korea
| | - Young‐Joo Kim
- Division of Medical Pfizer Biopharmaceuticals Group Pfizer Pharmaceuticals Korea Limited Seoul Korea
| | - Ja‐Young Jeon
- Division of Medical Pfizer Biopharmaceuticals Group Pfizer Pharmaceuticals Korea Limited Seoul Korea
| | - Joo‐Young Jo
- Division of Medical Pfizer Biopharmaceuticals Group Pfizer Pharmaceuticals Korea Limited Seoul Korea
| | - Hyun‐Jeong Yoo
- Division of Medical Pfizer Biopharmaceuticals Group Pfizer Pharmaceuticals Korea Limited Seoul Korea
| | - Juneyoung Lee
- Department of Biostatistics College of Medicine Korea University Seoul Korea
| | - Tae‐Hwan Kim
- Department of Rheumatology Hanyang University Hospital for Rheumatic Diseases Seoul Korea
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Madsen CMT, Christensen JR, Bremander A, Primdahl J. Perceived challenges at work and need for professional support among people with inflammatory arthritis - a qualitative interview study. Scand J Occup Ther 2021:1-10. [PMID: 34644224 DOI: 10.1080/11038128.2021.1989483] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND People with inflammatory arthritis (IA) often experience low work ability, and up to 38% lose their jobs during the initial years after the diagnosis of IA. AIM We explore the perceived challenges at work and identify the need for professional support among Danish people with IA. MATERIALS/METHODS Individual explorative interviews based on a hermeneutic approach. We used Graneheim and Lundman's qualitative content analysis. RESULTS Eleven women and four men with IA (aged 36-68 years) who worked full or part time, or were on short-term sick leave, participated. The analysis revealed one main theme, Balancing work as part of everyday life, and four sub-themes: 1) Working despite challenges, 2) Prioritising energy for work, 3) Fatigue leading to lack of control, and 4) Need for flexibility and recognition. CONCLUSIONS People with IA prioritise staying at work despite experiencing challenges with fatigue and balancing their work and energy in everyday life. They need recognition, support and flexibility at work to be able to continue in their jobs. SIGNIFICANCE The study highlights the need to be aware of occupational balance and, thus, to include other aspects in life apart from just work. It points at occupational therapists as relevant partners in vocational rehabilitation.
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Affiliation(s)
- Christina Merete Tvede Madsen
- Danish Hospital for Rheumatic Diseases, University Hospital of Southern Denmark, Sønderborg, Denmark.,Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Jeanette Reffstrup Christensen
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark.,Research unit of User Perspectives and Community-based Interventions, Department of Public Health, University of Southern Denmark mark, Odense, Denmark
| | - Ann Bremander
- Danish Hospital for Rheumatic Diseases, University Hospital of Southern Denmark, Sønderborg, Denmark.,Department of Regional Health Research, University of Southern Denmark, Odense, Denmark.,Section of Rheumatology, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
| | - Jette Primdahl
- Danish Hospital for Rheumatic Diseases, University Hospital of Southern Denmark, Sønderborg, Denmark.,Department of Regional Health Research, University of Southern Denmark, Odense, Denmark.,Hospital of Southern Jutland, University Hospital of Southern Denmark, Aabenraa, Denmark
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Boussaid S, Ben Majdouba M, Rekik S, Jammali S, Cheour E, Sahli H, Elleuch M. Poor work outcomes in patients with spondyloarthritis: causes, consequences, and solutions. Clin Rheumatol 2021; 41:463-470. [PMID: 34618257 DOI: 10.1007/s10067-021-05904-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 08/27/2021] [Accepted: 09/01/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Spondyloarthritis (SpA) affects patients in the prime of their economic productivity and can cause loss of work productivity and unemployment. We aim to identify factors associated with poor work outcomes in patients with SpA. METHODS A cross-sectional study was performed in 100 patients with SpA who were employed, retired, or off work because of SpA. Data on sociodemographic and professional characteristics were collected as well as specific indices: BASDAI, ASDAS-CRP, BASFI, and BASMI. Work productivity in employed patients was assessed by the Work Productivity and Activity Impairment scale (WPAI:SpA). RESULTS Patients were divided into 73 men and 27 women; the mean age was 43.68 ± 10.3 years. Fifty-nine percent of patients were employed and 26% were off work. The average disease duration was 12.24 ± 8.73 years. The mean BASDAI score was 4.4 ± 2.4, the average BASFI score was 4.6 ± 2.7, and the average ASDAS-CRP score was 2.77 ± 1.18. The mean BASMI was 4.4 ± 2.8. Among employed patients, the mean of absenteeism, presenteeism, and work productivity loss was 21.8 ± 33.13%, 42 ± 32%, and 46.5 ± 35.31%, respectively. In multivariable analysis, absenteeism was associated with ASDAS ≥ 2.1 (β = 20.14), peripheral joint involvement (β = 15.6), manual work (β = 14.31), low level of education (β = 7.92), and BASFI ≥ 4 (β = 6.39). Presenteeism and work productivity loss were associated with manual work, BASFI ≥ , body mass index ≥ 25 kg/m2, smoking, the use of symptomatic treatment, and ASDAS-CRP ≥ 2.1. CONCLUSION Spondyloarthritis affects work productivity. Screening for predictive factors should be considered by the clinician in the overall management of the disease. Key Points • SpA occurs among young and active patients; it could affect their professional lives and thus lead to loss of work productivity and unemployment. • The management of patients with SpA must be multidisciplinary; this includes assessing contextual factors in order to act on modifiable factors such as smoking and BMI, optimal management of the disease to maintain at least a low disease activity, and to ensure workstation layout and elimination of professional constraints that can affect work outcomes in patients with SpA.
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Affiliation(s)
- Soumaya Boussaid
- Rheumatology Department, Rabta Hospital, Tunis, Tunisia.
- Faculty of Medicine of Tunis, University Tunis El Manar, Tunis, Tunisia.
- Research Unit LR 05 SP 01, La Rabta Hospital, Tunis, Tunisia.
| | - Marouene Ben Majdouba
- Rheumatology Department, Rabta Hospital, Tunis, Tunisia
- Faculty of Medicine of Tunis, University Tunis El Manar, Tunis, Tunisia
| | - Sonia Rekik
- Rheumatology Department, Rabta Hospital, Tunis, Tunisia
- Faculty of Medicine of Tunis, University Tunis El Manar, Tunis, Tunisia
- Research Unit LR 05 SP 01, La Rabta Hospital, Tunis, Tunisia
| | - Samia Jammali
- Rheumatology Department, Rabta Hospital, Tunis, Tunisia
- Faculty of Medicine of Tunis, University Tunis El Manar, Tunis, Tunisia
- Research Unit LR 05 SP 01, La Rabta Hospital, Tunis, Tunisia
| | - Elhem Cheour
- Rheumatology Department, Rabta Hospital, Tunis, Tunisia
- Faculty of Medicine of Tunis, University Tunis El Manar, Tunis, Tunisia
- Research Unit LR 05 SP 01, La Rabta Hospital, Tunis, Tunisia
| | - Hela Sahli
- Rheumatology Department, Rabta Hospital, Tunis, Tunisia
- Faculty of Medicine of Tunis, University Tunis El Manar, Tunis, Tunisia
- Research Unit LR 05 SP 01, La Rabta Hospital, Tunis, Tunisia
| | - Mohamed Elleuch
- Rheumatology Department, Rabta Hospital, Tunis, Tunisia
- Faculty of Medicine of Tunis, University Tunis El Manar, Tunis, Tunisia
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12
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Nikiphorou E, Carvalho PD, Boonen A, Fautrel B, Richette P, Machado PM, van der Heijde D, Landewé R, Ramiro S. Sick leave in early axial spondyloarthritis: the role of clinical and socioeconomic factors. Five-year data from the DESIR cohort. RMD Open 2021; 7:rmdopen-2021-001685. [PMID: 34172511 PMCID: PMC8237733 DOI: 10.1136/rmdopen-2021-001685] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 06/07/2021] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES To investigate the occurrence of sick leave (SL) and the impact of clinical and socioeconomic factors on SL in early axial spondyloarthritis (axSpA). METHODS Patients with a clinical diagnosis of axSpA from the DEvenir des Spondyloarthrites Indifférenciées Récentes (DESIR) cohort with work-related data and up to 5-year follow-up were studied. Incidence, time to first SL and potential role of baseline and time-varying clinical and socioeconomic factors (age, gender, ethnicity, education, job type, marital and parental status) were analysed. Univariable analyses, followed by collinearity and interaction tests, guided subsequent multivariable time-varying Cox survival model building. RESULTS In total, 704 axSpA patients were included (mean (SD) age 33.8 (8.6); 46% men). At baseline, 80% of patients were employed; of these, 5.7% reported being on SL. The incidence of SL among those at risk during the study period (n=620, 88%) was 0.05 (95% CI 0.03 to 0.06) per 1000 days of follow-up. Mean (SD) time to first SL was 806 (595) days (range: 175-2021 days). In multivariable models, male gender (HR 0.41 (95% CI 0.20 to 0.86)) and higher education (HR 0.48 (95% CI 0.24 to 0.95)) were associated with lower hazard of SL, while higher disease activity (HR 1.49 (95% CI 1.04 to 2.13)), older age, smoking and use of tumour necrosis factor inhibitors were associated with higher hazard of SL. CONCLUSIONS In this early axSpA cohort of young, working-age individuals, male gender and higher education were independently associated with a lower hazard of SL, whereas older age and higher disease activity were associated with higher hazard of SL. The findings suggest a role of socioeconomic factors in adverse work outcomes, alongside active disease.
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Affiliation(s)
- Elena Nikiphorou
- Leiden University Medical Center (LUMC), Department of Rheumatology, Leiden, The Netherlands .,Centre for Rheumatic Diseases, King's College London, London, UK.,Department of Rheumatology, King's College Hospital, London, UK
| | - Pedro D Carvalho
- Department of Rheumatology, Centro Hospitalar Universitário do Algarve, Faro, Portugal.,Lisbon Academic Medical Centre, Lisbon, Portugal
| | - Annelies Boonen
- Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands.,Maastricht University Medical Center, Department of Internal Medicine, Division of Rheumatology, Maastricht, The Netherlands
| | - Bruno Fautrel
- Sorbonne University - Assistance Publique Hopitaux de Paris, Pitie Salpetriere Hospital, Dept of Rheumatology. Pierre Louis Institute for Epidemiology and Public Health, INSERM UMRS 1136, PEPITES Teams, Paris, France
| | - Pascal Richette
- Université de Paris, Hopital Lariboisière, Department of Rheumatology, INSERM U1132, Paris, France
| | - Pedro M Machado
- Centre for Rheumatology & Department of Neuromuscular Diseases, University College London, London, UK.,National Institute for Health Research (NIHR) Biomedical Research Centre, University College London Hospitals NHS Foundation Trust, London, UK.,Department of Rheumatology, Northwick Park Hospital, London North West University Healthcare NHS Trust, London, UK
| | - Desirée van der Heijde
- Leiden University Medical Center (LUMC), Department of Rheumatology, Leiden, The Netherlands
| | - Robert Landewé
- Zuyderland Medical Center, Department of Rheumatology, Heerlen, The Netherlands.,Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Sofia Ramiro
- Leiden University Medical Center (LUMC), Department of Rheumatology, Leiden, The Netherlands.,Zuyderland Medical Center, Department of Rheumatology, Heerlen, The Netherlands
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13
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Nikiphorou E, Boonen A, Fautrel B, Richette P, Landewé R, van der Heijde D, Ramiro S. How do clinical and socioeconomic factors impact on work disability in early axial spondyloarthritis? Five-year data from the DESIR cohort. Rheumatology (Oxford) 2021; 61:2034-2042. [PMID: 34320627 PMCID: PMC9071517 DOI: 10.1093/rheumatology/keab607] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2021] [Revised: 07/26/2021] [Indexed: 11/12/2022] Open
Abstract
Objectives To investigate the impact of clinical and socioeconomic factors on work disability (WD) in early axial spondyloarthritis (axSpA). Methods Patients from the DESIR cohort with a clinical diagnosis of axSpA were studied over 5 years. Time to WD and potential baseline and time-varying predictors were explored, with a focus on socioeconomic (including ethnicity, education, job-type, marital/parental status) and clinical (including disease activity, function, mobility) factors. Univariable analyses, collinearity and interaction tests guided subsequent multivariable time-varying Cox survival analyses. Results From 704 patients eligible for this study, the estimated incidence of WD among those identified as at risk (n = 663, 94%), and across the five years of DESIR, was 0.05 (95% CI 0.03, 0.06) per 1000 person-days. Significant differences in baseline socioeconomic factors, including lower educational status and clinical measures, including worse disease activity, were seen in patients developing WD over follow-up, compared with those who never did. In the main multivariable model, educational status was no longer predictive of WD, whereas the AS disease activity score (ASDAS) and the BASFI were significantly and independently associated with a higher hazard of WD [HR (95%CI) 1.79 (1.27, 2.54) and 1.42 (1.22, 1.65), respectively]. Conclusion WD was an infrequent event in this early axSpA cohort. Nevertheless, clinical factors were among the strongest predictors of WD, over socioeconomic factors, with worse disease activity and function independently associated with a higher hazard of WD. Disease severity remains a strong predictor of adverse work outcome even in early disease, despite substantial advances in therapeutic strategies in axSpA.
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Affiliation(s)
- Elena Nikiphorou
- Department of Rheumatology, Leiden University Medical Center (LUMC), Leiden, Netherlands.,Centre for Rheumatic diseases, King's College London, London, United Kingdom.,Department of Rheumatology, King's College Hospital, London, United Kingdom
| | - Annelies Boonen
- Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, the Netherlands.,Division of Rheumatology, Department of Internal Medicine, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Bruno Fautrel
- Dept of Rheumatology, Pitie Salpetriere Hospital, Pierre Louis Institute for Epidemiology and Public Health, Sorbonne University-Assistance Publique Hopitaux de Paris, INSERM UMRS 1136, PEPITES Teams, Paris, France
| | - Pascal Richette
- Department of Rheumatology, Hopital Lariboisière, Université de Paris, Paris, INSERM U1132, France
| | - Robert Landewé
- Department of Rheumatology, Zuyderland Medical Center, Heerlen, the Netherlands.,Amsterdam University Medical Center, Amsterdam, Netherlands
| | - Désirée van der Heijde
- Department of Rheumatology, Leiden University Medical Center (LUMC), Leiden, Netherlands
| | - Sofia Ramiro
- Department of Rheumatology, Leiden University Medical Center (LUMC), Leiden, Netherlands.,Department of Rheumatology, Zuyderland Medical Center, Heerlen, the Netherlands
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14
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Passalent L, Sundararajan K, Perruccio AV, Hawke C, Coyte PC, Bombardier C, Bloom JA, Haroon N, Inman RD, Rampersaud YR. Bridging the Gap between Symptom Onset and Diagnosis in Axial Spondyloarthritis. Arthritis Care Res (Hoboken) 2021; 74:997-1005. [PMID: 34268914 DOI: 10.1002/acr.24751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Accepted: 07/13/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To evaluate a stratified screening process for early identification of axial spondyloarthritis (axSpA) considering: 1) wait times from primary care to rheumatology screen; 2) incremental precision and accuracy from primary care to rheumatology screen; and 3) diagnostic delay. METHODS Adults with low back pain (LBP) attending primary care LBP clinics prospectively underwent a primary standardized clinical screen. Patients with LBP >3 months and onset age <50 years were referred for a comprehensive secondary screen by a physiotherapist with advanced rheumatology training. At secondary screening, patients with inflammatory features were deemed to have a low, medium, or high risk of axSpA vs. no risk. Precision and accuracy of this screening strata were measured against a rheumatologist with axSpA expertise. RESULTS In all, 405 patients underwent primary and secondary screening. Mean age was 36.9 years (±9.9); 55% were female. HLA-B27 was present in 14.4%. Median wait time from primary to secondary screen was 15 days. AxSpA risk assignment by rheumatologist was: 64.9% (none or low risk axSpA) and 35.1% (medium or high risk axSpA). The best combination of sensitivity (68%), specificity (90%), positive (80%) and negative (84%) predictive values was evident with the secondary screen. 15.6% of patients received a final diagnosis of axSpA. Median LBP duration from onset to diagnosis was: 2 years (non-radiographic axSpA) and 7 years (ankylosing spondylitis). CONCLUSION A stratified interprofessional screening process can facilitate rapid diagnosis of persistent LBP, with high precision and accuracy, in patients with axSpA.
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Affiliation(s)
- Laura Passalent
- Division of Rheumatology, Schroeder Arthritis Institute, Krembil Research Institute, University Health Network, Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Kala Sundararajan
- Division of Orthopaedics, Schroeder Arthritis Institute, Krembil Research Institute, University Health Network Toronto, Toronto, Canada
| | - Anthony V Perruccio
- Schroeder Arthritis Institute, Krembil Research Institute, Arthritis Community Research and Evaluation Unit, University Health Network, Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Christopher Hawke
- Division of Orthopaedics, Schroeder Arthritis Institute, University Health Network, Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Peter C Coyte
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Claire Bombardier
- Toronto General Hospital Research Institute, Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Jeff A Bloom
- Family and Community Medicine, University Health Network, Toronto, Canada
| | - Nigil Haroon
- Division of Rheumatology, Schroeder Arthritis Institute, Krembil Research Institute, University Health Network, Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Robert D Inman
- Division of Rheumatology, Schroeder Arthritis Institute, Krembil Research Institute, University Health Network, Departments of Medicine and Immunology, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Y Raja Rampersaud
- Division of Orthopaedics, Schroeder Arthritis Institute, Krembil Research Institute, University Health Network, Department of Surgery, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
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15
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Blasco-Blasco M, Castrejón I, Jovaní V, Pascual E, Ruiz-Cantero MT. Reviewing Disease Activity Indices in Spondyloarthritis From the Sex Perspective: A Systematic Review and Metaanalysis. J Rheumatol 2021; 48:1395-1404. [PMID: 33795327 DOI: 10.3899/jrheum.200967] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/16/2021] [Indexed: 12/29/2022]
Abstract
OBJECTIVE To determine whether the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) and the Ankylosing Spondylitis Disease Activity Score (ASDAS) exhibited differences between women and men. METHODS We systematically searched MEDLINE, Embase, Web of Science, and other sources in English or Spanish from January 1, 1995, to July 31, 2020, to assess the differences according to sex in BASDAI and ASDAS. We performed a comparative analysis by sex using t test and mean difference by sex metaanalyses for BASDAI and ASDAS, as well as a random-effects model using the inverse-variance method. RESULTS Forty-one studies included BASDAI (6785 women, 12,929 men) and 16 of them included ASDAS (2046 women, 4403 men). Disease activity detected using BASDAI was significantly higher in women than in men (mean 4.9 vs 4.2, P = 0.02), whereas ASDAS did not detect differences between sexes (mean 2.8 women vs 2.8 men). In the metaanalyses, BASDAI detected significant differences between women and men (mean difference = 0.55 [95% CI 0.46-0.65], P < 0.00001), but ASDAS did not identify significant mean difference between sexes (0.04, 95% CI -0.05 to 0.12], P = 0.38). CONCLUSION The 2 most widely used indices of disease activity in spondyloarthritis (SpA) discriminate differently according to sex by their different evaluations of peripheral disease. The different components and weights in BASDAI and ASDAS influence their values. BASDAI may be affected by fatigue, and in predominantly peripheral manifestations such as enthesitis, ASDAS may not be sensitive enough to detect activity. This may represent a sex bias unfavorable to women, because peripheral SpA is more common in women than in men.
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Affiliation(s)
- Mar Blasco-Blasco
- M. Blasco-Blasco, PhD, Public Health Research Group, University of Alicante, Alicante, Spain;
| | - Isabel Castrejón
- I. Castrejón, MD, PhD, Division of Rheumatology, Rush University Medical Center, Chicago, Illinois, USA
| | - Vega Jovaní
- V. Jovaní, MD, PhD, Department of Rheumatology, Alicante University General Hospital, Alicante, Spain
| | - Eliseo Pascual
- E. Pascual, MD, PhD, Department of Clinical Medicine, Miguel Hernández University, Alicante, Spain
| | - María Teresa Ruiz-Cantero
- M.T. Ruiz-Cantero, MD, PhD, Public Health Research Group, University of Alicante, and CIBERESP (Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública), Alicante, Spain
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16
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Franco L, Sengupta R, Wade L, Cazzola D. A novel IMU-based clinical assessment protocol for Axial Spondyloarthritis: a protocol validation study. PeerJ 2021; 9:e10623. [PMID: 33569248 PMCID: PMC7845531 DOI: 10.7717/peerj.10623] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Accepted: 11/30/2020] [Indexed: 01/31/2023] Open
Abstract
Clinical assessment of spinal impairment in Axial Spondyloarthritis is currently performed using the Bath Ankylosing Spondylitis Metrological Index (BASMI). Despite being appreciated for its simplicity, the BASMI index lacks sensitivity and specificity of spinal changes, demonstrating poor association with radiographical range of motion (ROM). Inertial measurement units (IMUs) have shown promising results as a cost-effective method to quantitatively examine movement of the human body, however errors due to sensor angular drift have limited their application to a clinical space. Therefore, this article presents a wearable sensor protocol that facilitates unrestrained orientation measurements in space while limiting sensor angular drift through a novel constraint-based approach. Eleven healthy male participants performed five BASMI-inspired functional movements where spinal ROM and continuous kinematics were calculated for five spine segments and four spinal joint levels (lumbar, lower thoracic, upper thoracic and cervical). A Bland-Altman analysis was used to assess the level of agreement on range of motion measurements, whilst intraclass correlation coefficient (ICC), standardised error measurement, and minimum detectable change (MDC) to assess relative and absolute reliability. Continuous kinematics error was investigated through root mean square error (RMSE), maximum absolute error (MAE) and Spearman correlation coefficient (ρ). The overall error in the measurement of continuous kinematic measures was low in both the sagittal (RMSE = 2.1°), and frontal plane (RMSE = 2.3°). ROM limits of agreement (LoA) and minimum detectable change were excellent for the sagittal plane (maximum value LoA 1.9° and MDC 2.4°) and fair for lateral flexion (overall value LoA 4.8° and MDC 5.7°). The reliability analysis showed excellent level of agreement (ICC > 0.9) for both segment and joint ROM across all movements. The results from this study demonstrated better or equivalent accuracy than previous studies and were considered acceptable for application in a clinical setting. The protocol has shown to be a valuable tool for the assessment of spinal ROM and kinematics, but a clinical validation study on Axial Spondyloarthritis patients is required for the development and testing of a novel mobility index.
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Affiliation(s)
- Luca Franco
- Department for Health, University of Bath, Bath, UK
- Centre for Analysis of Motion, Entertainment Research and Application, Bath, UK
| | - Raj Sengupta
- Royal National Hospital for Rheumatic Diseases, Bath, UK
- Department of Pharmacy and Pharmacology, University of Bath, Bath, UK
| | - Logan Wade
- Department for Health, University of Bath, Bath, UK
- Centre for Analysis of Motion, Entertainment Research and Application, Bath, UK
| | - Dario Cazzola
- Department for Health, University of Bath, Bath, UK
- Centre for Analysis of Motion, Entertainment Research and Application, Bath, UK
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Abstract
PURPOSE OF REVIEW Axial spondyloarthritis (axSpA) is a chronic inflammatory disease that typically affects people of working age. Work-related outcomes are therefore important to study, both from an individual but also a societal perspective. Through this review of the literature, we explore the impact of axSpA on key work outcomes including work and productivity loss and predictors for these. RECENT FINDINGS Recent evidence confirms that axSpA is associated with substantial consequences on the ability to work. Reassuringly, early treatment and use of biologics have been associated with improved wok outcomes highlighting the importance of prompt diagnosis and management. High disease activity, labour-intensive jobs, poor physical function and impaired spinal mobility are among identified predictors of adverse work outcomes in axSpA. The impact of axSpA on work outcomes is considerable and necessitates optimal intervention, including suppression of disease activity, to enhance people's chances of remaining in work.
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Affiliation(s)
- Elena Nikiphorou
- Leiden University Medical Center, Leiden, The Netherlands.
- King's College London, London, UK.
| | - Sofia Ramiro
- Leiden University Medical Center, Leiden, The Netherlands
- Zuyderland Medical Center, Heerlen, The Netherlands
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18
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Cañete JD, Tasende JAP, Laserna FJR, Castro SG, Queiro R. The Impact of Comorbidity on Patient-Reported Outcomes in Psoriatic Arthritis: A Systematic Literature Review. Rheumatol Ther 2020; 7:237-257. [PMID: 32270447 PMCID: PMC7211228 DOI: 10.1007/s40744-020-00202-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Indexed: 01/25/2023] Open
Abstract
INTRODUCTION A systematic literature review was conducted with the aim to analyse the impact of comorbidity on patient-reported outcomes (PROs) in patients with psoriatic arthritis (PsA). METHODS A sensitive search strategy of the Medline, Embase and the Cochrane Library (up to March 2019) was applied to retrieve studies for inclusion in this systematic literature review. Abstracts of the ACR and EULAR scientific meetings were also searched. The selection criteria were: (1) patients with PsA (population) with a comorbidity (intervention) and (2) report of any impact of the comorbidity on PROs. Systematic literature reviews, randomized controlled trials and observational were included in this systematic literature review. Two of the authors selected the articles and collected the data. RESULTS Eighteen articles were included in this systematic literature review, with most being cross-sectional studies that included more than 9000 patients with PsA. Some studies analysed the impact of an individual comorbidity, such as fibromyalgia (FM), and in others the analysis was according to the number of comorbidities. The most frequently analysed PROs were function, quality of life and fatigue. Analysis of the studies included in the review showed that patients with a higher number of comorbidities and/or more severe comorbidities reported worse impacts of their disease on function, patient's global assessment (PGA), pain, fatigue, work disability and quality of life. Specifically, FM had a negative impact on the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), function, quality of sleep and quality of life; anxiety and depression had a negative impact on function and fatigue; metabolic syndrome had a negative impact on BASDAI, function, PGA and quality of life; obesity had a negative impact on function and pain; smoking (current and ex-smokers) had a negative impact on pain, function, fatigue, quality of life and overall health; alcohol intake had a negative impact on pain, function, fatigue, quality of life and overall health. CONCLUSIONS The prevalence and impact of medical comorbidity on PROs are very high in patients with PsA.
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Affiliation(s)
- Juan D Cañete
- Arthritis Unit, Rheumatology Department, Hospital Clínic-IDIBAPS, Barcelona, Spain
| | | | | | | | - Rubén Queiro
- Rheumatology Department, Hospital Universitario Central de Asturias, Oviedo, Spain.
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19
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Phang JK, Kwan YH, Fong W, Tan CS, Lui NL, Thumboo J, Leung YY. Validity and reliability of Work Productivity and Activity Impairment among patients with axial spondyloarthritis in Singapore. Int J Rheum Dis 2020; 23:520-525. [PMID: 32020752 DOI: 10.1111/1756-185x.13801] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Revised: 11/08/2019] [Accepted: 12/21/2019] [Indexed: 01/01/2023]
Abstract
OBJECTIVES To assess the validity and reliability of the Work Productivity and Activity Impairment (WPAI) questionnaire in patients with axSpA. METHODS English-speaking patients seen at a dedicated axSpA clinic in a Singapore tertiary referral hospital were recruited from 2017 to 2019. Content validity of the WPAI was assessed through cognitive debriefing interviews (CDIs). Construct validity was assessed by a priori hypotheses regarding the correlations of the WPAI outcomes (absenteeism, presenteeism, overall work productivity loss, and activity impairment) with Bath Ankylosing Spondylitis Functional Index (BASFI), Bath Ankylosing Spondylitis Patient Global Score (BAS-G), patient global assessment (PGA) and pain scores. Known group validity was assessed relative to disease activity. Test-retest reliability was assessed by intraclass correlation coefficients (ICC) in patients without treatment change 2 weeks apart. RESULTS Cognitive debriefing interviews conducted with 10 patients (22-46 years old, 50% male) supported the content validity of the WPAI. We analyzed cross-sectional data from 168 patients (mean [SD] age 41.0 [14.4], 79.8% male). Construct validity was established by meeting 100% of the hypotheses. Presenteeism, overall work productivity loss, and activity impairment demonstrated strong correlations with BASFI, BAS-G, PGA, and pain (rs > .6). The WPAI was able to distinguish patients grouped by disease activity. Test-retest reliability conducted with 50 patients ranged from moderate to good for all the four outcomes (absenteeism: ICC = 0.54; presenteeism: ICC = 0.76; activity impairment: ICC = 0.79; overall work productivity loss: ICC = 0.83; all P < .01). CONCLUSIONS This study supports the content validity, construct validity, and test-retest reliability of the WPAI in patients with axSpA.
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Affiliation(s)
- Jie Kie Phang
- Department of Rheumatology and Immunology, Singapore General Hospital, Singapore
| | - Yu Heng Kwan
- Department of Rheumatology and Immunology, Singapore General Hospital, Singapore.,Program in Health Services and Systems Research, Duke-NUS Medical School Singapore, Singapore
| | - Warren Fong
- Department of Rheumatology and Immunology, Singapore General Hospital, Singapore.,Duke-NUS Medical School, Singapore.,NUS Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Chuen Seng Tan
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Nai Lee Lui
- LUI Centre for Arthritis & Rheumatology, Singapore
| | - Julian Thumboo
- Department of Rheumatology and Immunology, Singapore General Hospital, Singapore.,Program in Health Services and Systems Research, Duke-NUS Medical School Singapore, Singapore.,NUS Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Ying Ying Leung
- Department of Rheumatology and Immunology, Singapore General Hospital, Singapore.,Duke-NUS Medical School, Singapore.,NUS Yong Loo Lin School of Medicine, National University of Singapore, Singapore
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20
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Kiltz U, Braun J. Assessments of Functioning in Patients With Axial Spondyloarthritis. JOURNAL OF RHEUMATIC DISEASES 2020. [DOI: 10.4078/jrd.2020.27.1.22] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Affiliation(s)
- Uta Kiltz
- Rheumazentrum Ruhrgebiet and Ruhr-University Bochum, Herne, Germany
| | - Jürgen Braun
- Rheumazentrum Ruhrgebiet and Ruhr-University Bochum, Herne, Germany
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21
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Rouse PC, Standage M, Sengupta R. Living with ankylosing spondylitis: an open response survey exploring physical activity experiences. Rheumatol Adv Pract 2019; 3:rkz016. [PMID: 31528839 PMCID: PMC6735966 DOI: 10.1093/rap/rkz016] [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] [Received: 03/11/2019] [Revised: 06/05/2019] [Indexed: 11/25/2022] Open
Abstract
Objective The aim was to gather in-depth, rich accounts of physical activity experiences of people living with AS, to include symptom management, consequences for symptoms, factors that encourage and disrupt physical activity, and motivations that underpin participation in physical activity. Methods Participants (n = 149; 60% female) completed a Bristol Online Survey that consisted of open questions to capture rich qualitative data. In total, 96% of participants self-reported having AS (1% other arthritis; 3% missing), and 51% had this diagnosis for >20 years. A content analysis was conducted to identify the key themes/factors from within the open question responses. A frequency analysis was used to ascertain the most commonly identified themes and factors. Results Fifty different physical activities were participated in over the previous month. Physical activity can improve and worsen arthritis symptoms, and fluctuations in participation exist even in the most active. Pain and fatigue were the two most frequently identified factors that stopped people with AS from being physically active. Participants reported more autonomously driven motivations than controlled motivations for participating in physical activity. Conclusion People with AS can and do participate in a diverse range of physical activities, but fluctuations in activity levels occur owing to disease- and non-disease-specific factors. Individually tailored plans and self-monitoring are important to optimize levels of physical activity and maximize benefits for people living with AS. Multiple reasons why AS patients participate in physical activity were revealed that included both adaptive (i.e. autonomous) and maladaptive (i.e. controlled) forms of motivation.
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Affiliation(s)
- Peter C Rouse
- Department for Health, Centre for Motivation and Health Behaviour Change, University of Bath, Bath, UK
| | - Martyn Standage
- Department for Health, Centre for Motivation and Health Behaviour Change, University of Bath, Bath, UK
| | - Raj Sengupta
- Rhuematology, Royal National Hospital for Rheumatic Diseases, Royal United Hospitals Bath, Bath, UK
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22
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Dehlin M, Landgren AJ, Bergsten U, Jacobsson LTH. The Validity of Gout Diagnosis in Primary Care: Results from a Patient Survey. J Rheumatol 2019; 46:1531-1534. [PMID: 30936288 DOI: 10.3899/jrheum.180989] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/22/2019] [Indexed: 12/27/2022]
Abstract
OBJECTIVE Validate primary care diagnosis of gout by the Mexico and the Netherlands classification criteria. METHODS Questionnaires on gout characteristics were sent to all individuals aged ≥ 18 with ≥ 1 International Classification of Diseases, 10th ed. diagnosis of gout at 12 primary care centers. RESULTS Positive predictive values for gout diagnosis ranged from 71% for the Netherlands criteria to 80% for the Mexico criteria. Maximum inflammation within 24 h was the most common reported symptom (86%). CONCLUSION The vast majority of gout cases in primary care fulfill classification criteria and are valid for research purposes.
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Affiliation(s)
- Mats Dehlin
- From the Department of Rheumatology and Inflammation Research, Sahlgrenska Academy, University of Gothenburg; R&D Department at Region Halland, Halmstad, Sweden. .,M. Dehlin, MD, Associate Professor, Department of Rheumatology and Inflammation Research, Sahlgrenska Academy, University of Gothenburg; A.J. Landgren, MD, PhD student, Department of Rheumatology and Inflammation Research, Sahlgrenska Academy, University of Gothenburg; U. Bergsten, PhD, R&D Department at Region Halland; L.T. Jacobsson, MD, Professor, Department of Rheumatology and Inflammation Research, Sahlgrenska Academy, University of Gothenburg.
| | - Anton J Landgren
- From the Department of Rheumatology and Inflammation Research, Sahlgrenska Academy, University of Gothenburg; R&D Department at Region Halland, Halmstad, Sweden.,M. Dehlin, MD, Associate Professor, Department of Rheumatology and Inflammation Research, Sahlgrenska Academy, University of Gothenburg; A.J. Landgren, MD, PhD student, Department of Rheumatology and Inflammation Research, Sahlgrenska Academy, University of Gothenburg; U. Bergsten, PhD, R&D Department at Region Halland; L.T. Jacobsson, MD, Professor, Department of Rheumatology and Inflammation Research, Sahlgrenska Academy, University of Gothenburg
| | - Ulrika Bergsten
- From the Department of Rheumatology and Inflammation Research, Sahlgrenska Academy, University of Gothenburg; R&D Department at Region Halland, Halmstad, Sweden.,M. Dehlin, MD, Associate Professor, Department of Rheumatology and Inflammation Research, Sahlgrenska Academy, University of Gothenburg; A.J. Landgren, MD, PhD student, Department of Rheumatology and Inflammation Research, Sahlgrenska Academy, University of Gothenburg; U. Bergsten, PhD, R&D Department at Region Halland; L.T. Jacobsson, MD, Professor, Department of Rheumatology and Inflammation Research, Sahlgrenska Academy, University of Gothenburg
| | - Lennart T H Jacobsson
- From the Department of Rheumatology and Inflammation Research, Sahlgrenska Academy, University of Gothenburg; R&D Department at Region Halland, Halmstad, Sweden.,M. Dehlin, MD, Associate Professor, Department of Rheumatology and Inflammation Research, Sahlgrenska Academy, University of Gothenburg; A.J. Landgren, MD, PhD student, Department of Rheumatology and Inflammation Research, Sahlgrenska Academy, University of Gothenburg; U. Bergsten, PhD, R&D Department at Region Halland; L.T. Jacobsson, MD, Professor, Department of Rheumatology and Inflammation Research, Sahlgrenska Academy, University of Gothenburg
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23
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Atas N, Varan O, Babaoglu H, Satis H, Bilici Salman R, Celik B, Tufan A, Haznedaroglu S, Goker B, Ozturk MA. Work productivity in patients with Behçet disease and its association with disease activity and quality of life. Br J Occup Ther 2019. [DOI: 10.1177/0308022619834184] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction Behçet disease is a chronic vasculitis that generally affects young adults in the most productive period of their life. The purpose of this study is to evaluate patients’ work productivity and daily activity impairment, and their relationship with disease activity and quality of life. Method In this study, 55 patients with Behçet disease who are currently working and 50 healthy controls were included. To evaluate quality of life, a 36-item short form health survey was used. For the evaluation of Behçet disease activity and work productivity, the Behçet Disease Current Activity Form and Work Productivity and Activity Impairment questionnaire were used, respectively. Quality of life and work productivity between patients and healthy controls were compared. Results Scores of all domains of the health survey were significantly worse in patients with Behçet disease (range, p = 0.006 to p < 0.001). The mean Work Productivity and Activity Impairment absenteeism, presenteeism and activity impairment scores were higher in patients with Behçet disease ( p = 0.005, p < 0.001 and p < 0.001, respectively). There was a significant correlation between Behçet Disease Current Activity Form score and absenteeism ( r = 0.32, p = 0.016). Moreover, there was significant correlation between Work Productivity and Activity Impairment and most domains of the health survey (range, r = −0.27 to –0.64, range, p = 0.047 to p < 0.001). Conclusion Our results showed remarkable impairment in work productivity and health-related quality of life in Behçet disease. There is a strong correlation between work productivity and quality of life. To improve work productivity, more effective therapeutic approaches and improvements in working conditions should be provided.
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Affiliation(s)
- Nuh Atas
- Division of Rheumatology, Department of Internal Medicine, Gazi University, Ankara, Turkey
| | - Ozkan Varan
- Division of Rheumatology, Department of Internal Medicine, Gazi University, Ankara, Turkey
| | - Hakan Babaoglu
- Division of Rheumatology, Department of Internal Medicine, Gazi University, Ankara, Turkey
| | - Hasan Satis
- Division of Rheumatology, Department of Internal Medicine, Gazi University, Ankara, Turkey
| | - Reyhan Bilici Salman
- Division of Rheumatology, Department of Internal Medicine, Gazi University, Ankara, Turkey
| | - Bulent Celik
- Department of Statistics, Faculty of Science, Gazi University, Ankara, Turkey
| | - Abdurrahman Tufan
- Division of Rheumatology, Department of Internal Medicine, Gazi University, Ankara, Turkey
| | - Seminur Haznedaroglu
- Division of Rheumatology, Department of Internal Medicine, Gazi University, Ankara, Turkey
| | - Berna Goker
- Division of Rheumatology, Department of Internal Medicine, Gazi University, Ankara, Turkey
| | - Mehmet Akif Ozturk
- Division of Rheumatology, Department of Internal Medicine, Gazi University, Ankara, Turkey
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24
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Mogard E, Bremander A, Lindqvist E, Bergman S. Prevalence of chronic widespread pain in a population-based cohort of patients with spondyloarthritis - a cross-sectional study. BMC Rheumatol 2019; 2:11. [PMID: 30886962 PMCID: PMC6390534 DOI: 10.1186/s41927-018-0018-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2017] [Accepted: 03/23/2018] [Indexed: 01/09/2023] Open
Abstract
Background Chronic pain, regional or widespread, is a frequent and multidimensional symptom in arthritis. There is still limited information on chronic pain in spondyloarthritis, which is important to recognize for adequate diagnosis and treatment. Our objective was to study differences in prevalence of chronic widespread pain in two spondyloarthritis subgroups: ankylosing spondylitis (AS) and undifferentiated spondyloarthritis (USpA). Methods A population-based postal survey involving questions on the duration, distribution, and intensity of pain was answered by 940 patients with AS (ICD-10 M45.9) or USpA (ICD-10 M46.1-0, M46.8-9). The patients were categorized as having chronic widespread pain, chronic regional pain, or no chronic pain, and prevalence estimates for the pain groups were calculated, including age- and sex-adjusted prevalence. Results The prevalence of chronic widespread pain was 45.3% in AS vs. 49.3% in USpA, and that of chronic regional pain was 17.7% vs. 21.9% (p = 0.033). More women than men reported having chronic widespread pain (54.1% vs. 41.2%, p ≤ 0.001), while the sex distribution for chronic regional pain was equal. Reports of pain intensity were equal in AS and USpA, with no significant difference in pain intensity between women and men who had chronic regional pain or chronic widespread pain. In the multiple logistic regression analysis, chronic widespread pain was associated to female sex, being an ever-smoker, and having a higher body mass index, controlled for SpA subgroup and disease duration. Conclusions The prevalence of chronic widespread pain in patients with AS and USpA is high, and with a female predominance, but with no difference in pain intensity between women and men. Chronic pain can complicate the clinical evaluation in patients with SpA, and highlights the need for a thorough clinical examination, including evaluation of inflammation and an accurate pain analysis, to individualize non-pharmacological and pharmacological treatment decisions.
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Affiliation(s)
- Elisabeth Mogard
- Department of Clinical Sciences Lund, Rheumatology, Lund University, Skane University Hospital, Lund, Sweden
| | - Ann Bremander
- 2Department of Clinical Sciences Lund,Rheumatology, Lund University, Faculty of Medicine, Lund, Sweden.,3School of Business, Engineering and Science, Rydberg Laboratory for Applied Science, Halmstad University, Halmstad, Sweden.,Spenshult Research and Development Center, Halmstad, Sweden
| | - Elisabet Lindqvist
- Department of Clinical Sciences Lund, Rheumatology, Lund University, Skane University Hospital, Lund, Sweden
| | - Stefan Bergman
- 2Department of Clinical Sciences Lund,Rheumatology, Lund University, Faculty of Medicine, Lund, Sweden.,Spenshult Research and Development Center, Halmstad, Sweden.,5Primary Health Care Unit, Department of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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25
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Purmonen T, Puolakka K, Mishra D, Gunda P, Martikainen J. Cost-effectiveness of secukinumab compared to other biologics in the treatment of ankylosing spondylitis in Finland. CLINICOECONOMICS AND OUTCOMES RESEARCH 2019; 11:159-168. [PMID: 30858713 PMCID: PMC6386207 DOI: 10.2147/ceor.s192235] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
AIM This study assesses the cost-effectiveness of secukinumab vs currently licensed biologics for the treatment of ankylosing spondylitis (AS) from the Finnish health care system perspective. METHODS A semi-Markov model compared secukinumab with adalimumab, adalimumab biosimilar, certolizumab pegol, etanercept, etanercept biosimilar, golimumab, and infliximab in a biologic-naïve population over a lifetime horizon. The Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) was used to assess the treatment response. Efficacy inputs were obtained from the network meta-analysis, and other model inputs were obtained from the published literature and Finnish sources. Main study outcomes included quality-adjusted life years (QALYs) gained and incremental cost-effectiveness ratio in terms of cost per QALY gained. Robustness of results was confirmed by sensitivity analyses and alternative scenario analyses. RESULTS Secukinumab achieved highest QALYs (13.1) at lowest expected lifetime cost (€279,872) vs other comparators in biologic-naïve AS patients in the base case analysis, thus it dominated other biologics. Golimumab had a second highest QALYs (12.9) at the total cost of €309,551. Results were sensitive to variation in BASDAI 50 response for secukinumab, baseline Bath Ankylosing Spondylitis Functional Index (BASFI) score across all drugs, change in BASDAI and BASFI scores, and discount rates as observed in the one-way sensitivity analyses. Secukinumab was either dominant or cost-effective treatment in different alternative scenarios. CONCLUSION Secukinumab presented itself to be the dominant (ie, less costly and more effective) treatment vs other comparators for the biologic-naïve patients with AS in Finland.
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Affiliation(s)
| | - Kari Puolakka
- South Karelia Central Hospital, Lappeenranta, Finland
| | - Dinesh Mishra
- Novartis Product Lifecycle Services-NBS, Novartis Healthcare Private Limited, Hyderabad, India
| | - Praveen Gunda
- Novartis Product Lifecycle Services-NBS, Novartis Healthcare Private Limited, Hyderabad, India
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26
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Packham J. Optimizing outcomes for ankylosing spondylitis and axial spondyloarthritis patients: a holistic approach to care. Rheumatology (Oxford) 2018; 57:vi29-vi34. [PMID: 30445484 PMCID: PMC6238224 DOI: 10.1093/rheumatology/key200] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Revised: 06/05/2018] [Indexed: 01/20/2023] Open
Abstract
Axial SpA (axSpA) can affect diverse elements of an individual's life. The areas affected can be much more wide-ranging than the historical medical model of SpA, causing increased disease activity (pain and stiffness) and disability (reduced range of movement and physical function). A more holistic view of the individual results in the realization that many other areas of life can be adversely affected by axSpA, from the ability to work effectively and function socially, to effects on quality of life and the onset of worsening fatigue or mood disturbance. A good understanding of these areas outside the medical model allows for an improved understanding of the overall life impact of axSpA. This highlights the importance of understanding how to measure these elements of life using patient-reported outcome measures that can truly reflect an individual's experience of axSpA. These measures can then provide a better insight into the risks and benefits of interventions and medications used to treat axSpA.
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Affiliation(s)
- Jonathan Packham
- Research Institute for Primary Care and Health Sciences, Keele University, Keele, UK
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27
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Rodrigues Manica S, Sepriano A, Ramiro S, Pimentel Santos F, Putrik P, Nikiphorou E, Norton S, Molto A, Dougados M, van der Heijde D, Landewé RBM, van den Bosch FE, Boonen A. Work participation in spondyloarthritis across countries: analysis from the ASAS-COMOSPA study. Ann Rheum Dis 2018; 77:1303-1310. [PMID: 29860232 DOI: 10.1136/annrheumdis-2018-213464] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2018] [Revised: 05/15/2018] [Accepted: 05/15/2018] [Indexed: 01/24/2023]
Abstract
OBJECTIVES To explore the role of individual and country level socioeconomic (SE) factors on employment, absenteeism and presenteeism in patients with spondyloarthritis (SpA) across 22 countries worldwide. METHODS Patients with a clinical diagnosis of SpA fulfilling the ASAS classification criteria and in working age (≤65 years) from COMOSPA were included. Outcomes of interest were employment status, absenteeism and presenteeism, assessed by the Work Productivity and Activity Impairment Specific General Health questionnaire. Three multivariable models were built (one per outcome) using mixed-effects binomial (for work status) or ordinal regressions (for absenteeism and presenteeism), with country as random effect. The contribution of SE factors at the individual-level (eg, gender, education, marital status) and country-level (healthcare expenditure (HCE) per capita, Human Development Index (HDI) and gross domestic product per capita) SE factors, independent of clinical factors, was assessed. RESULTS In total, 3114 patients with SpA were included of which 1943 (62%) were employed. Physical function and comorbidities were related to all work outcomes in expected directions and disease activity also with absenteeism and presenteeism. Higher education (OR 4.2 (95% CI 3.1 to 5.6)) or living in a country with higher HCE (OR 2.3 (1.5 to 3.6)) or HDI (OR 1.9 (1.2 to 3.3)) was positively associated with being employed. Higher disease activity was associated with higher odds for absenteeism (OR 1.5 (1.3 to 1.7)) and presenteeism (OR 2.1 (1.8 to 2.4)). No significant association between individual-level and country-level SE factors and absenteeism or presenteeism was found. CONCLUSIONS Higher education level and higher country SE welfare are associated with a higher likelihood of keeping patients with SpA employed. Absenteeism and presenteeism are only associated with clinical but not with individual-level or country-level SE factors.
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Affiliation(s)
- Santiago Rodrigues Manica
- Department of Rheumatology, Hospital de Egas Moniz, Centro Hospitalar Lisboa Ocidental, Lisboa, Portugal.,NOVA Medical School, Universidade Nova de Lisboa, Lisboa, Portugal
| | - Alexandre Sepriano
- NOVA Medical School, Universidade Nova de Lisboa, Lisboa, Portugal.,Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
| | - Sofia Ramiro
- NOVA Medical School, Universidade Nova de Lisboa, Lisboa, Portugal.,Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
| | - Fernando Pimentel Santos
- Department of Rheumatology, Hospital de Egas Moniz, Centro Hospitalar Lisboa Ocidental, Lisboa, Portugal.,NOVA Medical School, Universidade Nova de Lisboa, Lisboa, Portugal
| | | | - Elena Nikiphorou
- Academic Rheumatology, King's College of London (KCL), London, UK
| | - Sam Norton
- Academic Rheumatology, King's College of London (KCL), London, UK.,Psychology Department, King's College of London (KCL), London, UK
| | - Anna Molto
- Rheumatology Department, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Paris Descartes University, Paris, France.,INSERM (U1153): Clinical Epidemiology and Biostatistics, PRES Sorbonne Paris-Cité, Paris, France
| | - Maxime Dougados
- Rheumatology Department, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Paris Descartes University, Paris, France.,INSERM (U1153): Clinical Epidemiology and Biostatistics, PRES Sorbonne Paris-Cité, Paris, France
| | | | | | - Filip E van den Bosch
- Department of Internal Medicine, VIB-UGent Center for Inflammation Research, Ghent University, Ghent, Belgium.,Department of Rheumatology, Ghent University Hospital, Ghent, Belgium
| | - Annelies Boonen
- Department of Internal Medicine, Division of Rheumatology, Maastricht University Medical Centre, Maastricht, The Netherlands.,Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
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28
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Garrido-Cumbrera M, Hillmann O, Mahapatra R, Trigos D, Zajc P, Weiss L, Bostynets G, Gossec L, Coates LC. Improving the Management of Psoriatic Arthritis and Axial Spondyloarthritis: Roundtable Discussions with Healthcare Professionals and Patients. Rheumatol Ther 2017; 4:219-231. [PMID: 28600789 PMCID: PMC5696278 DOI: 10.1007/s40744-017-0066-2] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Indexed: 12/17/2022] Open
Abstract
Psoriatic arthritis (PsA) and axial spondyloarthritis (AxSpA) are both chronic, inflammatory conditions that result in a substantial burden of disease and reduced quality of life for patients. Patient involvement in developing optimal disease management strategies, including defining appropriate goals, therapies, and treatment options, as well as in setting policy priorities and agendas, is key. A working group of patient organization representatives and rheumatologists explored what patients consider to be unmet needs, important treatment gaps, and future priorities in PsA and AxSpA management. Reducing pain and fatigue, and improving physical and social functioning and work productivity were identified as important treatment goals for patients. Although the major treatment target for both PsA and AxSpA is remission, with low/minimal disease activity an alternative target for patients with established or long-standing disease, the meaning of remission from the patient's perspective needs to be explored further as it may differ considerably from the physician's perspective. Key recommendations from the working group to tackle unmet needs included reducing time to diagnosis, increasing patient and physician disease awareness, focusing on patients' priorities for treatment goals, and improving patient-physician communication. By addressing these key action points moving forward, the hope is that outcomes will continue to improve for patients with PsA and AxSpA.
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Affiliation(s)
- Marco Garrido-Cumbrera
- CEADE (Coordinadora Española de Asociaciones de Pacientes de Espondiloartritis), Universidad de Sevilla, Seville, Spain
| | - Ottfrid Hillmann
- EUROPSO (European Umbrella Organisation for Psoriasis Movements), Almere, The Netherlands
| | - Raj Mahapatra
- ASIF (Ankylosing Spondylitis International Federation), London, UK
| | | | - Petra Zajc
- Slovenian Association of Rheumatic Patients, Ljubljana, Slovenia
| | - Luisa Weiss
- Schweizerische Polyarthritiker-Vereinigung, Zurich, Switzerland
| | | | - Laure Gossec
- Sorbonne Université, Paris 06 Univ, Paris, France
- Rheumatology Department, Hôpital Pitié Salpêtrière, AP-HP, Paris, France
| | - Laura C Coates
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK.
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK.
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29
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van Lunteren M, Ez-Zaitouni Z, Fongen C, Landewé R, Ramonda R, van der Heijde D, van Gaalen FA. Disease activity decrease is associated with improvement in work productivity over 1 year in early axial spondyloarthritis (SPondyloArthritis Caught Early cohort). Rheumatology (Oxford) 2017; 56:2222-2228. [DOI: 10.1093/rheumatology/kex365] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Indexed: 02/05/2023] Open
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30
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Secular trends in sickness absence among Swedish patients with ankylosing spondylitis and psoriatic arthritis. Rheumatol Int 2017; 38:275-282. [PMID: 28879599 PMCID: PMC5773654 DOI: 10.1007/s00296-017-3809-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2017] [Accepted: 08/28/2017] [Indexed: 11/23/2022]
Abstract
The aim was to investigate whether secular trends in sickness absence (SA) were present in patients with ankylosing spondylitis (AS) and psoriatic arthritis (PsA) receiving their diagnosis between 2002 and 2011. A repeated cross-sectional study design was used. Patients were identified in the Skåne Healthcare Register (SHR). A washout period of 18 months was applied. The general population seeking health care was used as a reference cohort. SA data from 2003 to 2012 were obtained from the Swedish Social Insurance Agency and converted into net days of SA per year. Within diagnosis and sex, the average number of net days of SA during the calendar year following diagnosis was calculated and plotted against calendar year together with the corresponding SA of the age-standardized reference population. Linear regression on aggregated data, within diagnosis and sex, was applied to formally investigate differences in secular trends among patients and referents. There were 3173 patients and 992,502 referents. Among men diagnosed with AS, the average amount of SA declined by 8.1 net days per year in patients as compared with 2.4 in the referents (p = 0.01). Among PsA patients, the average amount of SA declined by 11.7 net days per year in women as compared with 2.7 in the referents (p < 0.001) and by 7.6 net days per year in men as compared with 1.9 in the referents (p < 0.001). Secular trends of declining SA were present among AS and PsA patients. Trends were also present among the referents, although not at all of the same magnitude.
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31
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Meesters JJL, Bergman S, Haglund E, Jacobsson LTH, Petersson IF, Bremander A. Prognostic factors for change in self-reported anxiety and depression in spondyloarthritis patients: data from the population-based SpAScania cohort from southern Sweden. Scand J Rheumatol 2017; 47:185-193. [DOI: 10.1080/03009742.2017.1350744] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- JJL Meesters
- ERC Syd, Skåne University Hospital, Lund, Sweden
- Department of Orthopaedics, Rehabilitation and Physical Therapy, Leiden University Medical Center, Leiden, The Netherlands
- Research and Development, Sophia Rehabilitation Center, The Hague, The Netherlands
| | - S Bergman
- Section of Rheumatology, Department of Clinical Sciences, Lund, Lund University, Lund, Sweden
- Primary Health Care Unit, Institute of Medicine, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Spenshult Research and Development Center, Halmstad, Sweden
| | - E Haglund
- Spenshult Research and Development Center, Halmstad, Sweden
- School of Business, Engineering and Science, Halmstad University, Halmstad, Sweden
| | - LTH Jacobsson
- Department of Rheumatology and Inflammation Research, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - IF Petersson
- Section of Orthopedics, Department of Clinical Sciences, University of Lund, Lund, Sweden
| | - A Bremander
- Section of Rheumatology, Department of Clinical Sciences, Lund, Lund University, Lund, Sweden
- Spenshult Research and Development Center, Halmstad, Sweden
- School of Business, Engineering and Science, Halmstad University, Halmstad, Sweden
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32
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Haglund E, Bremander A, Bergman S, Larsson I. Educational needs in patients with spondyloarthritis in Sweden - a mixed-methods study. BMC Musculoskelet Disord 2017; 18:335. [PMID: 28768510 PMCID: PMC5541660 DOI: 10.1186/s12891-017-1689-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2017] [Accepted: 07/24/2017] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND There is a demand for a flexible and individually tailored patient education to meet patients' specific needs and priorities, but this area has seldom been studied in patients with spondyloarthritis (SpA), a family of inflammatory rheumatic diseases. The aim of the present study was to identify needs and priorities in patient education in patients with SpA. A second aim was to investigate patients' experiences and preferences of receiving patient education. METHODS Data collection included a questionnaire survey with the Educational Needs Assessment Tool (ENAT) and interviews, using a mixed-methods design. Patients were identified through a specialist clinic register. Descriptive data are presented as mean with standard deviation, or frequencies. Chi-square test and independent-samples t-test were used for group comparisons. A manifest qualitative conventional content analysis was conducted to explore patients' experiences and needs in patient education, based on two focus groups (n = 6) and five individual interviews. RESULTS Almost half (43%) of the 183 SpA patients had educational needs, particularly regarding aspects of self-help, feelings, and the disease process. More educational needs were reported by women and in patients with higher disease activity, while duration of disease did not affect the needs. The qualitative analysis highlighted the importance of obtaining a guiding, reliable, and easily available patient education for management of SpA. Individual contacts with healthcare professionals were of importance, but newer media were also requested. CONCLUSION There are considerable educational needs in patients with SpA, and education concerning self-help, feelings, and the diseases process were raised as important issues. Healthcare professionals need to consider the importance of presenting varied formats of education based on the experiences and preferences of patients with SpA.
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Affiliation(s)
- Emma Haglund
- School of Business, Engineering and Science, Halmstad University, Halmstad, Sweden
- Spenshult Research and Development Center, Bäckagårdsvägen 47, SE-30274 Halmstad, Sweden
| | - Ann Bremander
- School of Business, Engineering and Science, Halmstad University, Halmstad, Sweden
- Spenshult Research and Development Center, Bäckagårdsvägen 47, SE-30274 Halmstad, Sweden
- Department of Clinical Sciences, Lund, Section of Rheumatology, Lund University, Lund, Sweden
| | - Stefan Bergman
- Spenshult Research and Development Center, Bäckagårdsvägen 47, SE-30274 Halmstad, Sweden
- Department of Clinical Sciences, Lund, Section of Rheumatology, Lund University, Lund, Sweden
- Primary Health Care Unit, Department of Public Health and Community Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- School of Health and Welfare, Halmstad University, Halmstad, Sweden
| | - Ingrid Larsson
- Spenshult Research and Development Center, Bäckagårdsvägen 47, SE-30274 Halmstad, Sweden
- School of Health and Welfare, Halmstad University, Halmstad, Sweden
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Blasco-Blasco M, Ruiz-Cantero MT, Juárez-Herrera Y Cairo LA, Jovaní V, Pascual E. Sex and Gender Interactions in the Lives of Patients with Spondyloarthritis in Spain: A Quantitative-qualitative Study. J Rheumatol 2017; 44:1429-1435. [PMID: 28668807 DOI: 10.3899/jrheum.170128] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/12/2017] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To illustrate the experiences and contextual support perceived by men and women with spondyloarthritis (SpA) in relation to their demanding productive and reproductive roles. METHODS A quantitative-qualitative study of 96 men and 54 women with SpA was conducted at the Alicante University General Hospital, in a Spanish Mediterranean city, from March 2013 to February 2014. Descriptive and qualitative content analyses compared working lives and family/partner relationships of male and female patients. RESULTS Working life: both women (55.6%) and men (51.04%) were similarly affected, but women had worse disease activity (5.4 vs 4.0, p = 0.01) and less antitumor necrosis factor-α therapy (56.7% vs 77.6%, p < 0.05). Different patterns were found by gender: women mostly practiced presenteeism whereas men practiced absenteeism, women took antiinflammatories prior to work and men after work, employers suggested more frequently the beneficial actions for men, and some women withdrew permanently from the labor market. Family/partner relationships: women were more affected (57.4%) than men (41.7%), with worse results for diagnostic delay (11.2 vs 6.4 yrs, p = 0.02), disease activity (5.8 vs 3.6, p < 0.001), and physical function (5.2 vs 3.8, p = 0.02). Gender role conflicts emerged, with women developing strategies to face compulsory housework whereas men avoided them; women regretted neglecting their children and men not sharing leisure activities with them. CONCLUSION Our study highlights the vital complexity in which patients with SpA are immersed, especially for women in a country where a mix of new and traditional gender roles coexist. Awareness of its existence is crucial when professionals strive to provide healthcare focused on their well-being in addition to medical therapy.
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Affiliation(s)
- Mar Blasco-Blasco
- From the Public Health Department, Alicante University; Rheumatology Department, Alicante University General Hospital; Miguel Hernandez University, Alicante, Spain.,M. Blasco-Blasco, MPH, Public Health Department, University of Alicante; M.T. Ruiz-Cantero, MPH, PhD, Public Health Department, University of Alicante, and CIBERESP; L.A. Juárez-Herrera y Cairo, PhD, Public Health Department, University of Alicante; V. Jovaní, MD, Rheumatology Department, Alicante University General Hospital; E. Pascual, Professor of Medicine (Rheumatology), Miguel Hernandez University
| | - María Teresa Ruiz-Cantero
- From the Public Health Department, Alicante University; Rheumatology Department, Alicante University General Hospital; Miguel Hernandez University, Alicante, Spain. .,M. Blasco-Blasco, MPH, Public Health Department, University of Alicante; M.T. Ruiz-Cantero, MPH, PhD, Public Health Department, University of Alicante, and CIBERESP; L.A. Juárez-Herrera y Cairo, PhD, Public Health Department, University of Alicante; V. Jovaní, MD, Rheumatology Department, Alicante University General Hospital; E. Pascual, Professor of Medicine (Rheumatology), Miguel Hernandez University.
| | - Lucero Aida Juárez-Herrera Y Cairo
- From the Public Health Department, Alicante University; Rheumatology Department, Alicante University General Hospital; Miguel Hernandez University, Alicante, Spain.,M. Blasco-Blasco, MPH, Public Health Department, University of Alicante; M.T. Ruiz-Cantero, MPH, PhD, Public Health Department, University of Alicante, and CIBERESP; L.A. Juárez-Herrera y Cairo, PhD, Public Health Department, University of Alicante; V. Jovaní, MD, Rheumatology Department, Alicante University General Hospital; E. Pascual, Professor of Medicine (Rheumatology), Miguel Hernandez University
| | - Vega Jovaní
- From the Public Health Department, Alicante University; Rheumatology Department, Alicante University General Hospital; Miguel Hernandez University, Alicante, Spain.,M. Blasco-Blasco, MPH, Public Health Department, University of Alicante; M.T. Ruiz-Cantero, MPH, PhD, Public Health Department, University of Alicante, and CIBERESP; L.A. Juárez-Herrera y Cairo, PhD, Public Health Department, University of Alicante; V. Jovaní, MD, Rheumatology Department, Alicante University General Hospital; E. Pascual, Professor of Medicine (Rheumatology), Miguel Hernandez University
| | - Eliseo Pascual
- From the Public Health Department, Alicante University; Rheumatology Department, Alicante University General Hospital; Miguel Hernandez University, Alicante, Spain.,M. Blasco-Blasco, MPH, Public Health Department, University of Alicante; M.T. Ruiz-Cantero, MPH, PhD, Public Health Department, University of Alicante, and CIBERESP; L.A. Juárez-Herrera y Cairo, PhD, Public Health Department, University of Alicante; V. Jovaní, MD, Rheumatology Department, Alicante University General Hospital; E. Pascual, Professor of Medicine (Rheumatology), Miguel Hernandez University
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Work outcome in yet undiagnosed patients with non-radiographic axial spondyloarthritis and ankylosing spondylitis; results of a cross-sectional study among patients with chronic low back pain. Arthritis Res Ther 2017. [PMID: 28623950 PMCID: PMC5474026 DOI: 10.1186/s13075-017-1333-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Background To understand the impact of yet undiagnosed non-radiographic axial spondyloarthritis (nr-axSpA) and ankylosing spondylitis (AS) on work outcomes in a cohort of patients with long-lasting chronic low back pain (CLBP). Methods Data were used from a primary care CLBP cohort that was established to understand the prevalence of nr-axSpA and AS. Clinical characteristics comprised measures of back pain (visual analogue scale), inflammation (C-reactive protein) and physical functioning (Roland Morris Disability Questionnaire (RMDQ)). Worker outcomes comprised a question on employment and the Work Productivity and Activity Impairment (WPAI) questionnaire, distinguishing absenteeism, presenteeism, and overall work impairment in those employed and activity impairment in all patients. For each disease subgroup, employment ratio compared to the general population was assessed by indirect standardization. Factors associated with work productivity were explored by zero inflated negative binomial (ZINB) regression models. Results Patients with CLBP (n = 579) were included (41% male, mean age 36 years), of whom 71 (12%) were identified as having nr-axSpA and 24 (4%) as having AS. The standardized employment ratios were 0.89 (95% CI 0.84–0.94), 0.97 (95% CI 0.85–1.09) and 0.81 (95% CI 0.56–1.06) for patients with CLBP, nr-axSpA and AS, respectively. Scores for the WPAI subdomains were not significantly different between patients with CLBP, nr-axSpA or AS. The ZINB models showed significant associations between visual analog scale (VAS) score for pain and RMDQ and work productivity. Conclusion The impact of yet undiagnosed nr-axSpA and AS on patients’ work outcomes was substantial but was not significantly different from those of patients with long-standing CLBP. Variables significantly associated with reduced work productivity were VAS for pain and RMDQ score. Electronic supplementary material The online version of this article (doi:10.1186/s13075-017-1333-x) contains supplementary material, which is available to authorized users.
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de Hooge M, Ramonda R, Lorenzin M, Frallonardo P, Punzi L, Ortolan A, Doria A. Work productivity is associated with disease activity and functional ability in Italian patients with early axial spondyloarthritis: an observational study from the SPACE cohort. Arthritis Res Ther 2016; 18:265. [PMID: 27852321 PMCID: PMC5112652 DOI: 10.1186/s13075-016-1162-3] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2016] [Accepted: 10/24/2016] [Indexed: 12/20/2022] Open
Abstract
Background Spondyloarthritis often affects young people, typically in their working years. The aim of our study was to investigate work productivity and its relationship with disease activity and physical functioning in Italian patients with axial spondyloarthritis (axSpA) with chronic back pain (CBP) for ≥3 months and ≤2 years, and onset < 45 years of age. Methods Baseline absenteeism, presenteeism, work productivity loss (assessed by the Work Productivity and Activity Impairment questionnaire (WPAI)), and disease activity (assessed by the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI)/Ankylosing Spondylitis Disease Activity Score (ASDAS)) and functional ability (assessed by the Bath Ankylosing Spondylitis Disease Functional Index (BASFI)) of patients with axSpA (rheumatologist’s diagnosis) included in the Italian section of the Spondyloarthritis Caught Early (SPACE) cohort were collected. Multivariate linear regression analysis was used to evaluate the associations between work productivity and disease activity/physical functioning. Results Absenteeism in 51 patients with axSpA was low (8.3 %). A decrease in work productivity was related to an increase in disease activity. Disease activity was strongly correlated with absenteeism (p < 0.01), presenteeism (p < 0.01) and work productivity loss (p < 0.001). In addition, decreased work productivity was related to a decrease in functional ability. Physical functioning was correlated with absenteeism (p < 0.001), presenteeism (p < 0.05) and work productivity loss (p < 0.001). Conclusions Impairment of work productivity was correlated with disease activity and physical functioning in Italian patients with axSpA with CBP for ≥3 months and ≤2 years, with onset <45 years of age.
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Affiliation(s)
- Manouk de Hooge
- Rheumatology Unit, Department of Medicine -DIMED, University of Padova, Via Giustiniani 2, 35128, Padova, Italy
| | - Roberta Ramonda
- Rheumatology Unit, Department of Medicine -DIMED, University of Padova, Via Giustiniani 2, 35128, Padova, Italy.
| | - Mariagrazia Lorenzin
- Rheumatology Unit, Department of Medicine -DIMED, University of Padova, Via Giustiniani 2, 35128, Padova, Italy
| | - Paola Frallonardo
- Rheumatology Unit, Department of Medicine -DIMED, University of Padova, Via Giustiniani 2, 35128, Padova, Italy
| | - Leonardo Punzi
- Rheumatology Unit, Department of Medicine -DIMED, University of Padova, Via Giustiniani 2, 35128, Padova, Italy
| | - Augusta Ortolan
- Rheumatology Unit, Department of Medicine -DIMED, University of Padova, Via Giustiniani 2, 35128, Padova, Italy
| | - Andrea Doria
- Rheumatology Unit, Department of Medicine -DIMED, University of Padova, Via Giustiniani 2, 35128, Padova, Italy
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Ramonda R, Marchesoni A, Carletto A, Bianchi G, Cutolo M, Ferraccioli G, Fusaro E, De Vita S, Galeazzi M, Gerli R, Matucci-Cerinic M, Minisola G, Montecucco C, Pellerito R, Salaffi F, Paolazzi G, Sarzi-Puttini P, Scarpa R, Bagnato G, Triolo G, Valesini G, Punzi L, Olivieri I. Patient-reported impact of spondyloarthritis on work disability and working life: the ATLANTIS survey. Arthritis Res Ther 2016; 18:78. [PMID: 27037139 PMCID: PMC4818386 DOI: 10.1186/s13075-016-0977-2] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2016] [Accepted: 03/18/2016] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND The aim was to establish how patients experience the impact of spondyloarthritis (SpA) on work disability and working life. METHODS The survey was performed in 17/20 regions in Italy (1 January to 31 March 2013). A multiple-choice questionnaire was published on the official website of the sponsor - the National Association of Rheumatic Patients (ANMAR) - and hard-copies were distributed at outpatient clinics for rheumatic patients. RESULTS Respondents (n = 770) were of both sexes (56 % men), educated (62 % at high school or more), of working age (75 % aged ≤60 years), and affected by SpA. The most common types diagnosed were ankylosing spondylitis (AS) (39 %) and psoriatic arthritis (PsA) (36 %). Respondents were working full-time (45 %), part-time (8 %) or had retired (22 %); 15 % were unemployed (for reasons linked to the disease or for other reasons, students or housewives). Patients reported disability (39 %), were receiving disability benefits (34 %), were experiencing important limitations that were hindering their professional development/career (36 %) and some had to change/leave their job or lost it because of SpA (21 %). Employed respondents (n = 383) had worked on average 32.2 h in the last 7 days. More hours of work were lost over the last 7 days due to SpA (2.39 h vs 1.67 h). The indirect costs of the disease amounted to €106/week for patients reporting well-being/good physical conditions/improvement and €216/week for those reporting permanent impairment. CONCLUSIONS Most patients were in the midst of their productive years and were experiencing considerable difficulties in carrying out their job because of the disease: half of them reported disability and one third were experiencing important limitations in their career perspective.
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Affiliation(s)
- Roberta Ramonda
- Rheumatology Unit, Department of Medicine DIMED, University of Padova, Via Giustiniani, 2, Padova, 35128, Italy.
| | - Antonio Marchesoni
- Division of Rheumatology, Day Hospital Unit, Istituto Ortopedico G. Pini, Milano, Italy
| | | | - Gerolamo Bianchi
- Department of Locomotor System, Division of Rheumatology, ASL3-Azienda Sanitaria Genovese, Arenzano, Genova, Italy
| | - Maurizio Cutolo
- Research Laboratory and Academic Division of Clinical Rheumatology, Department of Internal Medicine, IRCCS A.O.U. San Martino-IST, University of Genova, Genova, Italy
| | - Gianfranco Ferraccioli
- Division of Rheumatology, Institute of Rheumatology & Affine Sciences, Catholic University School of Medicine, Roma, Italy
| | - Enrico Fusaro
- Rheumatology Unit, Città della Salute e della Scienza, University Hospital of Torino, Torino, Italy
| | - Salvatore De Vita
- Rheumatology Clinic, Department of Medical and Biological Sciences, Azienda Ospedaliero-Universitaria S. Maria della Misericordia, Udine, Italy
| | - Mauro Galeazzi
- Research Center of Systemic Autoimmune and Autoinflammatory Diseases, University of Siena, Siena, Italy
| | - Roberto Gerli
- Rheumatology Unit, Department of Medicine, University of Perugia, Perugia, Italy
| | - Marco Matucci-Cerinic
- Department of Experimental and Clinical Medicine, Division of Rheumatology, Azienda Ospedaliero-Universitaria Careggi (AOUC), University of Firenze, Firenze, Italy
| | | | | | | | - Fausto Salaffi
- Rheumatology Department, Polytechnic University of the Marche Region, Jesi, Italy
| | | | | | - Raffaele Scarpa
- Rheumatology Research Unit, Department of Clinical and Experimental Medicine, University Federico II, Napoli, Italy
| | - Gianfilippo Bagnato
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Giovanni Triolo
- Department of Internal Medicine, Rheumatology Unit, University of Palermo, Palermo, Italy
| | - Guido Valesini
- Rheumatology Unit, La Sapienza University of Roma, Roma, Italy
| | - Leonardo Punzi
- Rheumatology Unit, Department of Medicine DIMED, University of Padova, Via Giustiniani, 2, Padova, 35128, Italy
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Mogard E, Lindqvist E, Bergman S, Bremander A. Spinal Mobility in Axial Spondyloarthritis: A Cross-Sectional Clinical Study. Musculoskeletal Care 2016; 15:36-48. [PMID: 26916253 DOI: 10.1002/msc.1138] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
OBJECTIVE Research concerning spinal mobility in axial spondyloarthritis (axSpA) has focused on ankylosing spondylitis (AS), and data on the clinical diagnosis of undifferentiated spondyloarthritis (USpA) are limited. The objective was to study differences in spinal mobility between axSpA subgroups AS and USpA, including gender differences. METHODS A total of 183 patients with axSpA from a rheumatology clinic were included in the study. The earliest recorded spinal mobility measures (cervical rotation/flexion/extension/lateral flexion, tragus-to-wall distance, vital capacity, chest expansion, thoracic flexion, thoracolumbar flexion, lateral spinal flexion, lumbar flexion and intermalleolar distance) were obtained by specialized physiotherapists. Differences between subgroups were analysed using analysis of covariance, controlled for gender and disease duration. RESULTS In the USpA group (n = 57), the mean [standard deviation (SD)] age was 41.6 (11.4) years, and disease duration was 13 (10.6) years, with 54% men. In the AS group (n = 126), the mean (SD) age was 48.4 (13.5) years, and disease duration 24.6 (13.3) years, with 77% men. Spinal mobility was less restricted in USpA versus AS patients (p ≤ 0.05), with a median (interquartile range) tragus-to-wall distance of 11 (10-12) cm versus 13 (11.3-18.5) cm; thoracolumbar flexion 9 (7-10) cm versus 6.5 (4-9) cm; lateral spinal flexion 29 (25-36) cm versus 21.3 (12-31) cm; lumbar flexion 4.5 (3.5-5.0) cm versus 3.5 (2.0-4.5) cm and intermalleolar distance 113 (102-121) cm versus 101 (86-114) cm. There were no differences between the subgroups in cervical mobility, vital capacity, chest expansion or thoracic flexion, and there were few gender differences, besides anthropometric measures. CONCLUSION Patients with USpA and AS had similar cervical and chest mobility, while thoracic and lumbar mobility were more severely restricted in AS. There were few gender differences in either subgroup. Further studies, to understand the full impact of USpA on spinal mobility, are needed. Copyright © 2016 John Wiley & Sons, Ltd.
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Affiliation(s)
- Elisabeth Mogard
- Department of Clinical Sciences, Section of Rheumatology, Lund University, Lund, Sweden.,Department of Rheumatology, Skåne University Hospital, Lund, Sweden
| | - Elisabet Lindqvist
- Department of Clinical Sciences, Section of Rheumatology, Lund University, Lund, Sweden.,Department of Rheumatology, Skåne University Hospital, Lund, Sweden
| | - Stefan Bergman
- Department of Clinical Sciences, Section of Rheumatology, Lund University, Lund, Sweden.,Spenshult Research and Development Center, Halmstad, Sweden.,Primary Health Care Unit, Department of Public Health and Community Medicine, Institute of Medicine, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Ann Bremander
- Department of Clinical Sciences, Section of Rheumatology, Lund University, Lund, Sweden.,School of Business Engineering and Science, Halmstad University, Halmstad, Sweden.,Spenshult Research and Development Center, Halmstad, Sweden
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Löfvendahl S, Petersson IF, Theander E, Svensson Å, Zhou C, Steen Carlsson K. Incremental Costs for Psoriasis and Psoriatic Arthritis in a Population-based Cohort in Southern Sweden: Is It All Psoriasis-attributable Morbidity? J Rheumatol 2016; 43:640-7. [DOI: 10.3899/jrheum.150406] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/14/2015] [Indexed: 02/08/2023]
Abstract
Objective.To estimate incremental costs for patients with psoriasis/psoriatic arthritis (PsO/PsA) compared to population-based referents free from PsO/PsA and estimate costs attributable specifically to PsO/PsA.Methods.Patients were identified by International Classification of Diseases, 10th ed., codes for PsO/PsA using information from 1998 to 2007 in the Skåne Healthcare Register, covering healthcare use for the population of the Skåne region of Sweden. For each patient, 3 population-based referents were selected. Data were retrieved from Swedish registers on healthcare, drugs, and productivity loss. The human capital method was used to value productivity losses. Mean annual costs for 2008 to 2011 were assessed from a societal perspective.Results.We identified 15,283 patients fulfilling the inclusion criteria for PsO [n = 12,562, 50% women, mean age (SD) 52 (21) yrs] or PsA [n = 2721, 56% women, mean age 54 (16) yrs] and included 45,849 referents. Mean annual cost per patient with PsO/PsA was 55% higher compared to referents: €10,500 vs €6700. The cost was 97% higher for PsA compared to PsO. Costs due to productivity losses represented the largest share of total costs, ranging from 52% for PsO to 60% for PsA. Biological drug costs represented 10% of the costs for PsA and 1.6% for PsO. The proportion of cost identified as attributable to PsO/PsA problems was greatest among the patients with PsA (drug costs 71% and healthcare costs 31%).Conclusion.Annual mean incremental societal cost per patient was highest for PsA, mainly because of productivity losses and biological treatment. A minor fraction of the costs were identified as attributable to PsO/PsA specifically, indicating an increased morbidity in these patients that needs to be further investigated.
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Haglund E, Petersson IF, Bremander A, Bergman S. Predictors of presenteeism and activity impairment outside work in patients with spondyloarthritis. JOURNAL OF OCCUPATIONAL REHABILITATION 2015; 25:288-295. [PMID: 25173795 DOI: 10.1007/s10926-014-9537-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
PURPOSES To assess predictors of presenteeism (reduced productivity at work) and activity impairment outside work in patients with spondyloarthritis (SpA). METHODS Multivariate logistic regression analysis was used to study predictors of presenteeism and activity impairment in 1,253 patients with SpA based on a 2.5 year follow-up questionnaire. The Work Productivity and Activity Impairment (WPAI) questionnaire was used as main outcome. Age, gender, lifestyle factors, subgroups, disease duration, and different patient reported outcome measures (PROMs) were studied as possible predictors. The association between presenteeism and WPAI activity impairment outside work was assessed. RESULTS Out of 1,253 patients, 757 reported being in work and of these 720 responded to the WPAI questionnaire. The mean (confidence interval, CI) reported presenteeism was 25% (23-27%) and mean activity impairment 33% (31-35%) (0-100%, 0 = no reduction). Significant predictors of presenteeism and activity impairment at follow-up (controlled for gender, age, spondyloarthritis subgroups and presenteeism at baseline) were presenteeism at baseline, poor quality of life, worse disease activity, decreased physical function, lower self-efficacy pain and symptom, higher scores of anxiety, depression, smoking and low education level, and for activity impairment also female sex. There was a strong association between presenteeism and activity impairment outside work (OR 16.7; 95% CI 11.6-24.3; p < 0.001). CONCLUSIONS Presenteeism and activity impairment were not only predicted by presenteeism at baseline, but also by several PROMs commonly used in clinical rheumatology practice. Impaired activity outside work could indicate problems also at work suggesting why both areas need to be addressed in the clinical situation.
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Affiliation(s)
- Emma Haglund
- Spenshult Research and Development Center, Bäckagårdsvägen 47, 302 74, Halmstad, Sweden,
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Physical activity in spondyloarthritis: a systematic review. Rheumatol Int 2014; 35:393-404. [DOI: 10.1007/s00296-014-3141-9] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2014] [Accepted: 09/20/2014] [Indexed: 10/24/2022]
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Meesters JJL, Petersson IF, Bergman S, Haglund E, Jacobsson LTH, Bremander A. Sociodemographic and disease-related factors are associated with patient-reported anxiety and depression in spondyloarthritis patients in the Swedish SpAScania cohort. Clin Rheumatol 2014; 33:1649-56. [DOI: 10.1007/s10067-014-2699-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2013] [Revised: 04/16/2014] [Accepted: 05/23/2014] [Indexed: 12/20/2022]
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Jöud A, Petersson IF, Jordan KP, Löfvendahl S, Grahn B, Englund M. Socioeconomic status and the risk for being diagnosed with spondyloarthritis and chronic pain: a nested case–control study. Rheumatol Int 2014; 34:1291-8. [DOI: 10.1007/s00296-014-3039-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2014] [Accepted: 05/03/2014] [Indexed: 11/24/2022]
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