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Lescop J, Pennes B, Epaulard O. Mind the gap: Concordance between perceptions regarding vaccination as declared by patients and their evaluation by their general practitioner. Vaccine 2024; 42:310-314. [PMID: 38065770 DOI: 10.1016/j.vaccine.2023.11.065] [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: 08/23/2023] [Revised: 11/29/2023] [Accepted: 11/30/2023] [Indexed: 01/01/2024]
Abstract
BACKGROUND The high level of vaccine hesitancy reported in the French population may lead general practitioners to anticipate difficult discussions on this topic. We aimed to assess the extent to which general practitioners' evaluation of their patients' vaccine hesitancy was correlated with the real vaccine hesitancy expressed by these patients. METHODS The study was based on two brief paper questionnaires completed in private by the general practitioner and the patient at the beginning of a medical appointment: one for the physician to evaluate on three quantitative and non-graduated visual scales (then analysed as a 0-100 scale) their patients' perceptions regarding vaccine safety, vaccine efficacy and 'being in favour of vaccination'; and one for the patient to express their perceptions for the same three axes using the same scales. RESULTS Overall, 31 physicians participated in the study, with 540 physician-patient pairs being included. The physicians' evaluation of patient perceptions was more positive when the physician was male (vs female), when the patient was male (vs female) and when both were males (vs both females). The median differences (in absolute values) between the physician evaluations and the patient perceptions were between 9 and 11 (on the 0-100 scale) for the three axes (vaccine safety, vaccine efficacy and 'being in favour'). A correlation was observed between the physicians' evaluation and the patients' declaration (Kendall test: vaccine efficacy: tau = 0.199, p < 0.001; vaccine safety: tau = 0.234, p < 0.001; being in favour of vaccination: tau = 0.365, p < 0.001). Physicians correctly classified 83.4 % of the patients with high perceptions of vaccine safety and efficacy (>75/100 for both scales) but only 54.5 % of those with low perceptions (<75/100 for both scales). CONCLUSION Physicians tend to correctly identify patients with the most favourable perceptions about vaccination but not those with the least favourable perceptions.
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Affiliation(s)
- Juliette Lescop
- Université Grenoble Alpes, Centre Hospitalier Universitaire Grenoble Alpes, Service des Maladies Infectieuses, Grenoble, France; Groupe de Recherche en Infectiologie Clinique, CIC-1406 Inserm-CHUGA-UGA, Grenoble, France
| | - Bertille Pennes
- Université Grenoble Alpes, Centre Hospitalier Universitaire Grenoble Alpes, Service des Maladies Infectieuses, Grenoble, France; Groupe de Recherche en Infectiologie Clinique, CIC-1406 Inserm-CHUGA-UGA, Grenoble, France
| | - Olivier Epaulard
- Université Grenoble Alpes, Centre Hospitalier Universitaire Grenoble Alpes, Service des Maladies Infectieuses, Grenoble, France; Groupe de Recherche en Infectiologie Clinique, CIC-1406 Inserm-CHUGA-UGA, Grenoble, France.
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2
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Zamani B, Moradi Hasan-Abad A, Piroozmand A, Dehghani M, Arfaatabar M, Motedayyen H. Immunogenicity and safety of the BBIBP-CorV vaccine in patients with autoimmune inflammatory rheumatic diseases undergoing immunosuppressive therapy in a monocentric cohort. Immun Inflamm Dis 2023; 11:e858. [PMID: 37249277 DOI: 10.1002/iid3.858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 03/24/2023] [Accepted: 04/21/2023] [Indexed: 05/31/2023] Open
Abstract
INTRODUCTION Vaccination plays a fundamental role in mastering the COVID-19 pandemic and protecting vulnerable groups. Persons with autoimmune inflammatory rheumatic diseases (AIIRD) requiring immunosuppressive therapies are prioritized for vaccination. However, data concerning immunogenicity and safety of the BBIBP-CorV vaccine in immunosuppressed patients are not found. This study presents data on the efficacy and safety of the BBIBP-CorV vaccine in immunosuppressed patients compared to healthy controls. METHODS Study population consisted of 100 healthy controls and 100 patients with AIIRD. Vaccination was performed according to national guidelines with the BBIBP-CorV vaccine. SARS-CoV-2 neutralizing antibody titers were quantified by enzyme-linked immunosorbent assay before initial vaccination and 1-3 months after secondary vaccination. Adverse events were assessed before study initiation and 7 days after the second dose. Disease activity was studied before entering the study and 3-8 weeks after the second dose. RESULTS Vaccination-induced positive immunogenic response rates and SARS-CoV-2 neutralizing antibody titers were significantly lower in the AIIRD patients than healthy subjects (p < .05). There are significant differences in neutralizing antibody titers among patients suffering from rheumatoid arthritis (RA), systemic lupus erythematosus (SLE), systemic sclerosis, and ankylosing spondylitis (p < .01-.05). The rates of seropositive vaccine responses were similarly distributed across all diseases. Healthy and AIIRD individuals had a similar profile in adverse events. No significant difference was observed in SARS-CoV-2 antibody titers between subjects suffering from side effects and those who did not have. SARS-CoV-2 neutralizing antibody levels were significantly higher in subjects with a history of COVID-19 infection than seronegative individuals (p < .01-0.05). Seropositive subjects had a significant increase in the percentage of vaccine-related adverse events compared to seronegative persons (p < .05). Despite a minor change in the disease activity of patients with RA and SLE, disease activity indices were overall stable in the AIIRD patients. CONCLUSION These findings revealed that the BBIBP-CorV vaccine is effective in the development of neutralizing antibodies in immunosuppressed patients without considerable reactogenicity or induction of disease flares.
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Affiliation(s)
- Batool Zamani
- Autoimmune Diseases Research Center, Kashan University of Medical Sciences, Kashan, Iran
| | - Amin Moradi Hasan-Abad
- Autoimmune Diseases Research Center, Kashan University of Medical Sciences, Kashan, Iran
| | - Ahmad Piroozmand
- Autoimmune Diseases Research Center, Kashan University of Medical Sciences, Kashan, Iran
| | - Mahsa Dehghani
- Autoimmune Diseases Research Center, Kashan University of Medical Sciences, Kashan, Iran
| | - Maryam Arfaatabar
- Department of Medical Laboratory Sciences, Kashan Branch, Islamic Azad University, Kashan, Iran
| | - Hossein Motedayyen
- Autoimmune Diseases Research Center, Kashan University of Medical Sciences, Kashan, Iran
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3
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Valero M, Bachiller-Corral FJ, Boris AB, Blázquez MA, Díaz-Miguel MC, García-Villanueva MJ, Larena MC, Morell JL, De la Puente C, Rodríguez-García A, Vázquez-Díaz M, Moltó A. Evaluating remission and low disease activity from the perspective of the patient with axial spondyloarthritis: The cross-sectional ConREspAx study. Joint Bone Spine 2023; 90:105505. [PMID: 36493989 DOI: 10.1016/j.jbspin.2022.105505] [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: 07/21/2022] [Revised: 11/16/2022] [Accepted: 11/24/2022] [Indexed: 12/12/2022]
Abstract
OBJECTIVES To evaluate the properties of a single question to determine patient perception of remission and disease activity; to compare this with existing definitions for remission and low disease activity (LDA). METHODS Single-center, cross-sectional study in a tertiary care hospital. Patients with axSpA (fulfilling ASAS criteria) were consecutively included. Both the patient's perception of remission and LDA and that of the physician were evaluated with a single question. Agreement between the patients' perception and other current definitions was tested using the prevalence-adjusted and bias-adjusted kappa (PABAK). The sensitivity (S) and specificity (Sp) of current definitions of disease states were tested against the patient's perception as the gold standard. RESULTS The study population included 105 axSpA patients (63.8% males; 67.6% with radiographic sacroiliitis). Patients considered themselves to be in remission in 21% of cases and in LDA in 51.4%; physicians considered patients to be in remission in 45.7% of cases and in LDA in 35.2%. The poorest agreement was recorded for the patient's and the physician's perception of remission. The best agreement for patients' perception of remission was for a BASDAI < 2 and normal C-reactive protein values. This definition was also the most sensitive (S=72.7%) and specific (Sp=83.1%) when the patient's perception was taken as the gold standard. CONCLUSION In a real-life setting, the evaluation of remission by the patient through a single question was the hardest criterion to achieve, although it did prove to be a feasible, valid, and specific way to assess remission.
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Affiliation(s)
- Marta Valero
- Rheumatology Department, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | | | | | | | | | | | - María Carmen Larena
- Rheumatology Department, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Jose Luis Morell
- Rheumatology Department, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Carlos De la Puente
- Rheumatology Department, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | | | - Mónica Vázquez-Díaz
- Rheumatology Department, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Anna Moltó
- Rheumatology Department, Hôpital Cochin, AP-HP, Paris, France; Inserm U-1153, Université Paris-Cité, Paris, France.
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Kirren Q, Daste C, Foissac F, Abdoul H, Alami S, Carrier ME, Kwakkenbos L, Lefèvre-Colau MM, Rannou F, Papelard A, Roren A, Thombs BD, Mouthon L, Nguyen C. Differences in Disability Perception in Systemic Sclerosis: A Mirror Survey of Patients and Health Care Providers. J Clin Med 2023; 12:jcm12041359. [PMID: 36835895 PMCID: PMC9959687 DOI: 10.3390/jcm12041359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 01/31/2023] [Accepted: 02/06/2023] [Indexed: 02/11/2023] Open
Abstract
Differences in disability perception between patients and care providers may impact outcomes. We aimed to explore differences in disability perception between patients and care providers in systemic sclerosis (SSc). We conducted a cross-sectional internet-based mirror survey. SSc patients participating in the online SPIN Cohort and care providers affiliated with 15 scientific societies were surveyed using the Cochin Scleroderma International Classification of Functioning, Disability and Health (ICF)-65 questionnaire, including 65 items (from 0 to 10), representing 9 domains of disability. Mean differences between patients and care providers were calculated. Care providers' characteristics associated with a mean difference ≥ 2 of 10 points were assessed in multivariate analysis. Answers were analyzed for 109 patients and 105 care providers. The mean age of patients was 55.9 (14.7) years and the disease duration was 10.1 (7.5) years. For all domains of the ICF-65, care providers' rates were higher than those of patients. The mean difference was 2.4 (1.0) of 10 points. Care providers' characteristics associated with this difference were organ-based specialty (OR = 7.0 [2.3-21.2]), younger age (OR = 2.7 [1.0-7.1]) and following patients with disease duration ≥5 years (OR = 3.0 [1.1-8.7]). We found systematic differences in disability perception between patients and care providers in SSc.
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Affiliation(s)
- Quentin Kirren
- UFR de Médecine, Faculté de Santé, Université Paris Cité, 75006 Paris, France
- Service de Rééducation et de Réadaptation de l’Appareil Locomoteur et des Pathologies du Rachis, Hôpital Cochin, AP-HP, Centre-Université Paris Cité, 75014 Paris, France
| | - Camille Daste
- UFR de Médecine, Faculté de Santé, Université Paris Cité, 75006 Paris, France
- Service de Rééducation et de Réadaptation de l’Appareil Locomoteur et des Pathologies du Rachis, Hôpital Cochin, AP-HP, Centre-Université Paris Cité, 75014 Paris, France
- INSERM UMR-S 1153, Centre de Recherche Épidémiologie et Statistique Sorbonne Paris Cité, Université Paris Cité, 75004 Paris, France
| | - Frantz Foissac
- Unité de Recherche Clinique—Centre d’Investigation Clinique Paris Descartes Necker/Cochin, Hôpital Tarnier, 75014 Paris, France
- EA 7323, Évaluation des Thérapeutiques et Pharmacologie Périnatale et Pédiatrique, Université Paris Cité, 75014 Paris, France
| | - Hendy Abdoul
- Unité de Recherche Clinique—Centre d’Investigation Clinique Paris Descartes Necker/Cochin, Hôpital Tarnier, 75014 Paris, France
| | - Sophie Alami
- Cabinet d’Études Sociologiques Interlis, 75006 Paris, France
| | - Marie-Eve Carrier
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, QC H3T 1E2, Canada
| | - Linda Kwakkenbos
- Behavioural Science Institute, Clinical Psychology, Radboud University Nijmegen, 6525 XZ Nijmegen, The Netherlands
| | - Marie-Martine Lefèvre-Colau
- UFR de Médecine, Faculté de Santé, Université Paris Cité, 75006 Paris, France
- Service de Rééducation et de Réadaptation de l’Appareil Locomoteur et des Pathologies du Rachis, Hôpital Cochin, AP-HP, Centre-Université Paris Cité, 75014 Paris, France
- INSERM UMR-S 1153, Centre de Recherche Épidémiologie et Statistique Sorbonne Paris Cité, Université Paris Cité, 75004 Paris, France
| | - François Rannou
- UFR de Médecine, Faculté de Santé, Université Paris Cité, 75006 Paris, France
- Service de Rééducation et de Réadaptation de l’Appareil Locomoteur et des Pathologies du Rachis, Hôpital Cochin, AP-HP, Centre-Université Paris Cité, 75014 Paris, France
- INSERM UMR-S 1124, Toxicité Environnementale, Cibles Thérapeutiques, Signalisation Cellulaire et Biomarqueurs (T3S), Campus Saint-Germain-des-Prés, Université Paris Cité, 75006 Paris, France
| | - Agathe Papelard
- Service de Rééducation et de Réadaptation de l’Appareil Locomoteur et des Pathologies du Rachis, Hôpital Cochin, AP-HP, Centre-Université Paris Cité, 75014 Paris, France
| | - Alexandra Roren
- Service de Rééducation et de Réadaptation de l’Appareil Locomoteur et des Pathologies du Rachis, Hôpital Cochin, AP-HP, Centre-Université Paris Cité, 75014 Paris, France
- INSERM UMR-S 1153, Centre de Recherche Épidémiologie et Statistique Sorbonne Paris Cité, Université Paris Cité, 75004 Paris, France
- Département Universitaire des Sciences de la Rééducation et de la Réadaptation, Faculté de Santé, Université Paris Cité, 75006 Paris, France
| | - Brett D. Thombs
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, QC H3T 1E2, Canada
- Departments of Psychiatry, McGill University, Montreal, QC H3A 1G1, Canada
- Departments of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, QC H3A 1G1, Canada
- Departments of Medicine, McGill University, Montreal, QC H3A 1G1, Canada
- Departments of Psychology, McGill University, Montreal, QC H3A 1G1, Canada
- Departments of Educational and Counselling Psychology, McGill University, Montreal, QC H3A 1G1, Canada
- Biomedical Ethics Unit, McGill University, Montreal, QC H3A 1G1, Canada
| | - Luc Mouthon
- UFR de Médecine, Faculté de Santé, Université Paris Cité, 75006 Paris, France
- Service de Médecine Interne, Hôpital Cochin, AP-HP, Centre-Université de Paris, 75014 Paris, France
| | - Christelle Nguyen
- UFR de Médecine, Faculté de Santé, Université Paris Cité, 75006 Paris, France
- Service de Rééducation et de Réadaptation de l’Appareil Locomoteur et des Pathologies du Rachis, Hôpital Cochin, AP-HP, Centre-Université Paris Cité, 75014 Paris, France
- INSERM UMR-S 1124, Toxicité Environnementale, Cibles Thérapeutiques, Signalisation Cellulaire et Biomarqueurs (T3S), Campus Saint-Germain-des-Prés, Université Paris Cité, 75006 Paris, France
- Correspondence: ; Tel.: +33-158-412-945
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Strand V, Deodhar A, Alten R, Sullivan E, Blackburn S, Tian H, Gandhi KK, Jugl SM, Conaghan PG. Pain and Fatigue in Patients With Ankylosing Spondylitis Treated With Tumor Necrosis Factor Inhibitors: Multinational Real-World Findings. J Clin Rheumatol 2021; 27:e446-e455. [PMID: 32826654 PMCID: PMC8612885 DOI: 10.1097/rhu.0000000000001544] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND/OBJECTIVE Patients with ankylosing spondylitis (AS) experience symptoms and comorbidities that impact their health-related quality of life (HRQoL) and ability to work. This real-world, global survey was conducted among AS patients receiving tumor necrosis factor inhibitors (TNFis) to evaluate both the frequency and severity of persistent symptoms, and the impact of pain and fatigue on HRQoL, employment status, and work activity. METHODS Patients with AS and their treating physicians from 13 countries across 5 continents completed questionnaires capturing demographics, patient symptoms, current disease status, HRQoL, current therapy, employment status, and Work Productivity and Activity Impairment. RESULTS Seven hundred five patients who had been receiving a TNFi for 3 months or more and completed both Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) pain and fatigue domains were included in the analysis; of these, 37.6% reported high BASDAI pain scores and 41.3% high BASDAI fatigue scores. Medical Outcomes Study-Short Form, 36-item version 2 domain, 5-dimensional EuroQoL Questionnaire, and 5-dimensional EuroQoL visual analog scale scores were significantly lower (p < 0.0001), and Work Productivity and Activity Impairment scores significantly higher (p < 0.0001), in patients with high levels of pain or fatigue than low levels. CONCLUSIONS Globally, levels of pain and fatigue remained high in AS patients receiving TNFi treatment, which were significantly associated with reduced HRQoL and work productivity. Such persistent symptoms in usual care suggest a substantial unmet need in AS pharmacologic and nonpharmacologic therapeutic pathways.
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Affiliation(s)
- Vibeke Strand
- From the Division of Rheumatology/Immunology, Stanford University, Palo Alto, CA
| | - Atul Deodhar
- Oregon Health & Science University, Portland, OR
| | - Rieke Alten
- Schlosspark-Klinik, University Medicine, Berlin, Germany
| | | | | | - Haijun Tian
- Novartis Pharmaceuticals Corporation, East Hanover, NJ
| | | | | | - Philip G. Conaghan
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds & NIHR Leeds Biomedical Research Centre Leeds, United Kingdom
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Antonacci CL, Omari AM, Zaifman J, Baig AF, Sommi CP, Medvedev G, Savoie FH, Sethi PM, Klein GR, Koerner JD, Alberta FG. Differences in Patient and Physician Perceptions of Urgency for Musculoskeletal Conditions During the COVID-19 Pandemic. Orthopedics 2021; 44:e534-e538. [PMID: 34292807 DOI: 10.3928/01477447-20210618-13] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
In 2020, the coronavirus disease 2019 (COVID-19) pandemic limited musculoskeletal care to urgent or "nonelective" office visits and procedures. No guidelines exist to inform patients or physicians what meets these criteria. The purpose of this multi-institutional study was to describe the differences in perceptions of urgency for musculoskeletal complaints between patients and providers during the COVID-19 pandemic. An anonymous survey was distributed to patients who visited the authors' orthopedic clinics in January and February 2020 and practicing orthopedic surgeons. The surveys were administered in May 2020 after COVID-19 was officially labeled a pandemic and included questions regarding demographic information and perceptions of orthopedic urgency. A total of 1491 patients and 128 physicians completed the surveys. A significantly higher percentage of physicians considered the following diagnoses an appropriate indication for an urgent visit compared with patients: fracture (P<.001), acute dislocation (P<.001), infection (P<.001), neurologic compromise (P<.001), tumor (P<.001), acute tendon injury (P<.001), weakness (P<.001), inability to bear weight (P<.001), post-surgical problem (P<.001), and painful joint effusion (P<.001). There were no significant differences in the perception of urgency for the following conditions: bursitis/tendonitis (P=1.00), joint/extremity deformity without pain (P=.113), and loss of range of motion of a joint (P=.467). Younger patients and those with higher levels of education were significantly more likely to consider their conditions urgent. Patients may require additional education to prevent delay in treatment of urgent conditions-especially time-sensitive conditions such as neurologic compromise, tumors, and infections-when access to physicians is limited. [Orthopedics. 2021;44(4):e534-e538.].
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7
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Ugarte-Gil MF, Gamboa-Cardenas RV, Reátegui-Sokolova C, Pimentel-Quiroz VR, Zeña-Huancas P, Elera-Fitzcarrald C, Garcia-Hirsh S, Gil L, Pastor-Asurza CA, Rodriguez-Bellido Z, Merrill J, Askanase AD, Alarcon G, Perich-Campos RA. Evaluation of the LFA-REAL clinician-reported outcome (ClinRO) and patient-reported outcome (PRO): data from the Peruvian Almenara Lupus Cohort. Lupus Sci Med 2021; 7:7/1/e000419. [PMID: 33046557 PMCID: PMC7552838 DOI: 10.1136/lupus-2020-000419] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Revised: 08/18/2020] [Accepted: 09/16/2020] [Indexed: 11/04/2022]
Abstract
OBJECTIVE The Lupus Foundation of America Rapid Evaluation of Activity in Lupus (LFA-REAL) clinician-reported outcome (ClinRO) and the LFA-REAL patient-reported outcome (PRO) were developed in order to capture manifestations of SLE from the perspective of both the clinician and the patient. The aim of this study is to compare the LFA-REAL ClinRO and PRO with other lupus disease activity measures. METHODS A cross-sectional analysis of patients from a single-centre cohort was performed using Spearman's correlation. Disease activity measures included were LFA-REAL ClinRO (range 0-1400), LFA-REAL PRO (range 0-1200), Systemic Lupus Erythematosus Disease Activity Index 2000 (SLEDAI-2K), clinical SLEDAI-2K and Physician Global Assessment (PGA, range 0-100). RESULTS Two hundred and twenty-seven patients with SLE were studied. The mean age was 46.3 (SD: 13.8); 212 (93.4%) were female. The mean (SD) LFA-REAL ClinRO was 25.4 (34.7), LFA-REAL PRO was 241.1 (187.6), PGA was 11.9 (15.4), SLEDAI-2K was 2.3 (3.3) and clinical SLEDAI-2K was 1.6 (2.9). The LFA-REAL ClinRO correlated with PGA (r=0.758, p<0.001), SLEDAI-2K (r=0.608, p<0.001) and clinical SLEDAI-2K (r=0.697, p<0.001); the LFA-REAL PRO correlated modestly with PGA (r=0.160, p=0.016), SLEDAI-2K (r=0.121, p=0.069), clinical SLEDAI-2K (r=0.143, p=0.031) and LFA-REAL ClinRO (r=0.161, p=0.015). CONCLUSIONS The LFA-REAL ClinRO and the LFA-REAL PRO had good and weak correlations, respectively, with several physician-based disease activity measures in a cross-sectional study, suggesting their potential usefulness in establishing disease severity. Longitudinal studies will be required to determine their value in monitoring patients with SLE.
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Affiliation(s)
- Manuel Francisco Ugarte-Gil
- Universidad Cientifica del Sur, Lima, Peru .,Rheumatology, Hospital Nacional Guillermo Almenara Irigoyen, EsSalud, Lima, Peru
| | | | - Cristina Reátegui-Sokolova
- Rheumatology, Hospital Nacional Guillermo Almenara Irigoyen, EsSalud, Lima, Peru.,Unidad de Investigación para la Generación y Síntesis de Evidencias en Salud, Universidad San Ignacio de Loyola, Lima, Peru
| | - Victor Román Pimentel-Quiroz
- Universidad Cientifica del Sur, Lima, Peru.,Rheumatology, Hospital Nacional Guillermo Almenara Irigoyen, EsSalud, Lima, Peru
| | - Paola Zeña-Huancas
- Rheumatology, Hospital Nacional Guillermo Almenara Irigoyen, EsSalud, Lima, Peru
| | - Claudia Elera-Fitzcarrald
- Universidad Cientifica del Sur, Lima, Peru.,Rheumatology, Hospital Nacional Guillermo Almenara Irigoyen, EsSalud, Lima, Peru
| | - Samira Garcia-Hirsh
- Rheumatology, Hospital Nacional Guillermo Almenara Irigoyen, EsSalud, Lima, Peru
| | - Luciana Gil
- Rheumatology, Hospital Nacional Guillermo Almenara Irigoyen, EsSalud, Lima, Peru
| | - Cesar Augusto Pastor-Asurza
- Rheumatology, Hospital Nacional Guillermo Almenara Irigoyen, EsSalud, Lima, Peru.,Universidad Nacional Mayor de San Marcos, Lima, Peru
| | - Zoila Rodriguez-Bellido
- Rheumatology, Hospital Nacional Guillermo Almenara Irigoyen, EsSalud, Lima, Peru.,Universidad Nacional Mayor de San Marcos, Lima, Peru
| | - Joan Merrill
- Oklahoma Medical Research Foundation, Oklahoma City, Oklahoma, USA
| | | | - Graciela Alarcon
- School of Medicine, The University of Alabama at Birmingham, Birmingham, Alabama, United States.,School of Medicine, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Risto Alfredo Perich-Campos
- Rheumatology, Hospital Nacional Guillermo Almenara Irigoyen, EsSalud, Lima, Peru.,Universidad Nacional Mayor de San Marcos, Lima, Peru
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8
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Alonso S, Morante I, Alperi M, Queiro R. The ASAS health index: a new era for health impact assessment in spondyloarthritis. J Rheumatol 2021; 49:8-15. [PMID: 34393105 DOI: 10.3899/jrheum.200586] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/23/2021] [Indexed: 11/22/2022]
Abstract
The concept of spondyloarthritis (SpA) encompasses a series of entities that share clinical and imaging characteristics and a common genetic basis. These diseases can affect 0.20 to 1.6% of the general population, limiting functioning and affecting the quality of life of patients. Considering the patient perspective in the management of the disease and ensuring patients are sufficiently prepared to participate in decisionmaking is critical to treatment success as well as for optimal health outcomes. The overall picture of impairments, limitations, and restrictions in activities or social participation of patients with SpA is not adequately assessed in SpA-specific instruments. Therefore, it is quite relevant to measure the broader range of impairments that can affect SpA patients and integrate these into one measure of overall functioning in daily life. The Assessment of SpondyloArthritis international Society-Health Index (ASAS HI) is a recently introduced health instrument for evaluating SpA based on the International Classification of Functioning, Disability and Health, also known as ICF, that could cover a good part of the health metric needs in SpA. This review addresses its origins, its measurement properties, its use in routine clinical practice, as well as its prospects for future use.
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Affiliation(s)
- Sara Alonso
- Rheumatology Division. Hospital Universitario Central de Asturias (HUCA). Oviedo- Asturias (Spain); Rheumatology Division. Hospital de Sierrallana. Torrelavega-Cantabria (Spain); ISPA Translational Immunology division. Oviedo (Spain). Address correspondence to Rubén Queiro. M.D., Ph.D, Associate professor. Oviedo University School of Medicine, Rheumatology Division, HUCA. Avenida de Roma s/n, 33011. Oviedo (Spain).
| | - Isla Morante
- Rheumatology Division. Hospital Universitario Central de Asturias (HUCA). Oviedo- Asturias (Spain); Rheumatology Division. Hospital de Sierrallana. Torrelavega-Cantabria (Spain); ISPA Translational Immunology division. Oviedo (Spain). Address correspondence to Rubén Queiro. M.D., Ph.D, Associate professor. Oviedo University School of Medicine, Rheumatology Division, HUCA. Avenida de Roma s/n, 33011. Oviedo (Spain).
| | - Mercedes Alperi
- Rheumatology Division. Hospital Universitario Central de Asturias (HUCA). Oviedo- Asturias (Spain); Rheumatology Division. Hospital de Sierrallana. Torrelavega-Cantabria (Spain); ISPA Translational Immunology division. Oviedo (Spain). Address correspondence to Rubén Queiro. M.D., Ph.D, Associate professor. Oviedo University School of Medicine, Rheumatology Division, HUCA. Avenida de Roma s/n, 33011. Oviedo (Spain).
| | - Rubén Queiro
- Rheumatology Division. Hospital Universitario Central de Asturias (HUCA). Oviedo- Asturias (Spain); Rheumatology Division. Hospital de Sierrallana. Torrelavega-Cantabria (Spain); ISPA Translational Immunology division. Oviedo (Spain). Address correspondence to Rubén Queiro. M.D., Ph.D, Associate professor. Oviedo University School of Medicine, Rheumatology Division, HUCA. Avenida de Roma s/n, 33011. Oviedo (Spain).
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9
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Liu V, Fong W, Kwan YH, Leung YY. Residual Disease Burden in Patients With Axial Spondyloarthritis and Psoriatic Arthritis Despite Low Disease Activity States in a Multiethnic Asian Population. J Rheumatol 2020; 48:677-684. [DOI: 10.3899/jrheum.200934] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/19/2020] [Indexed: 01/23/2023]
Abstract
ObjectivesTo evaluate the burden of residual disease in patients with axial spondyloarthritis (axSpA) or psoriatic arthritis (PsA) who achieved low disease activity (LDA) status.MethodsWe used baseline data from a clinic registry of SpA in a tertiary hospital in Singapore. For axSpA, LDA was defined as Ankylosing Spondylitis (AS) Disease Activity Score based on erythrocyte sedimentation rate (ASDAS-ESR) < 2.1 or Bath AS Disease Activity Index (BASDAI) < 3/10. For PsA, LDA was defined by achieving 5/7 cutoffs in the minimal disease activity (MDA) or Clinical Disease Activity Index for Psoriatic Arthritis (cDAPSA) ≤ 13.ResultsIn 262 cases of axSpA (21% women; mean ± standard deviation (SD) age 42 ± 14 yrs), 33% and 43% of patients achieved ASDAS-ESR and BASDAI LDA states, respectively, while in 142 cases of PsA (49% women, mean age 51 ± SD 14 yrs), 35% and 63% achieved MDA and cDAPSA LDA, respectively. Both axSpA and PsA patients with LDA had pain scores ranging from 14.0 to 21.4/100 and fatigue scores ranging from 3.1 to 3.6/10. Substantial burden in physical disability and mental well-being were observed, with low physical and mental component summary scores on the 36-item Short Form Health Survey. AxSpa patients in BASDAI LDA had higher ESR and lower disability than those in ASDAS-ESR LDA. cDAPSA classified nearly twice as many PsA patients into LDA than MDA. Compared to PsA patients in MDA LDA, those in cDAPSA LDA had higher active joint counts, dactylitis, enthesitis, pain scores, and patient global assessment.ConclusionDespite being in LDA, patients with axSpA and PsA experienced substantial residual burden in pain, poorer physical function, and mental well-being.
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10
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Hirano F, Landewé RBM, van Gaalen FA, van der Heijde D, Gaujoux-Viala C, Ramiro S. Determinants of the physician global assessment of disease activity and influence of contextual factors in early axial spondyloarthritis. Arthritis Care Res (Hoboken) 2020; 74:268-273. [PMID: 32986932 PMCID: PMC9303864 DOI: 10.1002/acr.24465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 08/23/2020] [Accepted: 09/22/2020] [Indexed: 11/25/2022]
Abstract
Objective To investigate determinants of the physician global assessment (PhGA) of disease activity and the influence of the contextual factors on this relationship in patients with early axial spondyloarthritis (SpA). Methods Five‐year data of DESIR, a cohort of early axial SpA, were analyzed. Univariable generalized estimating equations (GEEs) were used to investigate contributory explanatory effects of various potential determinants of PhGA. Effect modification by contextual factors (age, sex, and educational level) was tested, and if significant, models were stratified. Autoregressive GEE models (i.e., models adjusted for PhGA at the previous time point) were used to confirm a longitudinal relationship. Results A total of 708 patients were included. Higher Bath Ankylosing Spondylitis Disease Activity Index individual questions, swollen joint count in 28 joints (SJC28), tender joint count in 53 joints, Maastricht Ankylosing Spondylitis Enthesitis Score, C‐reactive protein (CRP) level, and Bath Ankylosing Spondylitis Metrology Index score were associated with a higher PhGA. Sex and age were effect modifiers of SJC28; the contributory effect of SJC28 was largest in the younger male stratum (β = 1.07 [95% confidence interval (95% CI) 0.71, 1.43]), and the smallest in the older female stratum (β = 0.13 [95% CI 0.04, 0.22]). Autoregressive GEE models revealed the same determinants as having a longitudinal association with PhGA and the same pattern of effect modification. Conclusion Patients’ subjective symptoms, peripheral arthritis and enthesitis, higher CRP level, and impaired spinal mobility contribute to explaining PhGA in patients with early axial SpA, irrespective of sex and age. Intriguingly, physicians consider the presence of swollen joints as more important in males than in females.
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Affiliation(s)
- Fumio Hirano
- Department of Rheumatology, Leiden University Medical Center, Leiden, the Netherlands
| | - Robert B M Landewé
- Department of Rheumatology, Amsterdam University Medical Center, Amsterdam, the Netherlands.,Department of Rheumatology, Zuyderland Medical Center, Heerlen, the Netherlands
| | - Floris A van Gaalen
- Department of Rheumatology, Leiden University Medical Center, Leiden, the Netherlands
| | | | - Cécile Gaujoux-Viala
- EA2415, University of Montpellier, Montpellier, France.,Department of Rheumatology, Nîmes University Hospital, Nîmes, France
| | - Sofia Ramiro
- Department of Rheumatology, Leiden University Medical Center, Leiden, the Netherlands.,Department of Rheumatology, Zuyderland Medical Center, Heerlen, the Netherlands
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11
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Seng JJB, Kwan YH, Fong W, Phang JK, Lui NL, Thumboo J, Leung YY. Validity and reliability of EQ-5D-5L among patients with axial spondyloarthritis in Singapore. Eur J Rheumatol 2020; 7:71-78. [PMID: 32644927 DOI: 10.5152/eurjrheum.2020.19043] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Accepted: 01/11/2020] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVE This study aims to evaluate the reliability and validity of EuroQOL-5 Dimensions-5 Levels (EQ-5D-5L) among patients with axial spondyloarthritis (SpA) in Singapore. METHODS A cross-sectional study was conducted involving patients with axial SpA in an Asian tertiary hospital from 2017 to 2018. This study followed the COnsensus-based Standards for selection of health Measurement Instruments framework. Construct validity was evaluated by testing 22 a priori hypotheses with other patient-reported outcomes measures. Cronbach's alpha was used to estimate the internal consistency of the EQ-5D-5L, while its test-retest reliability was assessed using weighted kappa and the intraclass correlation coefficient (ICC). The measurement error was assessed by analyzing minimal detectable change (MDC). RESULTS The median age of included patients (n=118) was 35 years (interquartile range: 28, 49). Ninety-six (81.4%) patients were male, while 112 (94.9%) patients were of Chinese ethnicity. The EQ-5D-5L demonstrated good internal consistency with a Cronbach's alpha of 0.79. The test-retest reliability of the EQ-5D-5L was good with a weighted kappa of ≥0.61 for mobility, self-care, usual activities, and anxiety/depression; the ICC was 0.92 and 0.99 for the EQ-5D-5L index and visual analog scale (VAS) scores, respectively. The weighted kappa for the EQ-5D-5L pain/discomfort was moderate [0.53, 95% confidence interval: 0.41-0.60]. The MDC for EQ-5D-5L index and VAS scores was 0.06 and 4.5, respectively. Convergent validity was supported as all hypotheses were confirmed in the results. CONCLUSION This study supports EQ-5D-5L as a valid and reliable instrument for assessing health-related quality of life among patients with axial SpA in Singapore.
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Affiliation(s)
| | - Yu Heng Kwan
- Program in Health Services and Systems Research, Duke-NUS Medical School, 8 College Road, Singapore
| | - Warren Fong
- Department of Medicine, Duke-NUS Medical School, 8 College Road, Singapore.,Department of Rheumatology and Immunology, Singapore General Hospital, Outram Road, Singapore.,Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, 12 Science Drive 2, Singapore
| | - Jie Kie Phang
- Department of Rheumatology and Immunology, Singapore General Hospital, Outram Road, Singapore
| | - Nai Lee Lui
- Department of Rheumatology and Immunology, Singapore General Hospital, Outram Road, Singapore
| | - Julian Thumboo
- Program in Health Services and Systems Research, Duke-NUS Medical School, 8 College Road, Singapore.,Department of Rheumatology and Immunology, Singapore General Hospital, Outram Road, Singapore.,Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, 12 Science Drive 2, Singapore
| | - Ying Ying Leung
- Department of Medicine, Duke-NUS Medical School, 8 College Road, Singapore.,Department of Rheumatology and Immunology, Singapore General Hospital, Outram Road, Singapore.,Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, 12 Science Drive 2, Singapore
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12
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Phang KF, Lahiri M, Fong WWS, Leong KH, Leung YY, Lim AYN, Lui NL, Manghani M, Tan TC, Santosa A, Sriranganathan MK, Suresh E, Teng GG, Cheung PP. Update on recommendations for eligibility of government subsidization of biologic disease‐modifying antirheumatic drugs for the treatment of axial spondyloarthritis in Singapore. Int J Rheum Dis 2019; 23:165-173. [DOI: 10.1111/1756-185x.13744] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Revised: 09/29/2019] [Accepted: 10/15/2019] [Indexed: 12/17/2022]
Affiliation(s)
- Kee Fong Phang
- Division of Rheumatology University Medicine Cluster National University Health System Singapore Singapore
| | - Manjari Lahiri
- Division of Rheumatology University Medicine Cluster National University Health System Singapore Singapore
- Department of Medicine Yong Loo Lin School of Medicine Singapore Singapore
| | - Warren Weng Seng Fong
- Department of Rheumatology and Immunology Singapore General Hospital Singapore Singapore
| | - Keng Hong Leong
- Leong Keng Hong Arthritis and Medical ClinicGleneagles Medical Centre Singapore Singapore
| | - Ying Ying Leung
- Department of Rheumatology and Immunology Singapore General Hospital Singapore Singapore
| | - Anita Yee Nah Lim
- Division of Rheumatology University Medicine Cluster National University Health System Singapore Singapore
- Department of Medicine Yong Loo Lin School of Medicine Singapore Singapore
| | - Nai Lee Lui
- Lui Centre for Arthritis & Rheumatology Gleneagles Medical Centre Singapore Singapore
| | - Mona Manghani
- Department of Rheumatology, Allergy and Immunology Tan Tock Seng Hospital Singapore Singapore
| | - Teck Choon Tan
- Department of Medicine Khoo Teck Puat Hospital Singapore Singapore
| | - Amelia Santosa
- Division of Rheumatology University Medicine Cluster National University Health System Singapore Singapore
- Department of Medicine Yong Loo Lin School of Medicine Singapore Singapore
| | | | - Ernest Suresh
- Department General Medicine and Acute Medicine Ng Teng Fong Hospital Singapore Singapore
| | - Gim Gee Teng
- Division of Rheumatology University Medicine Cluster National University Health System Singapore Singapore
- Department of Medicine Yong Loo Lin School of Medicine Singapore Singapore
| | - Peter P. Cheung
- Division of Rheumatology University Medicine Cluster National University Health System Singapore Singapore
- Department of Medicine Yong Loo Lin School of Medicine Singapore Singapore
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13
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Kwan YH, Tan JJ, Phang JK, Fong W, Lim KK, Koh HL, Lui NL, Tan CS, Østbye T, Thumboo J, Leung YY. Validity and reliability of the Ankylosing Spondylitis Disease Activity Score with C-reactive protein (ASDAS-CRP) and Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) in patients with axial spondyloarthritis (axSpA) in Singapore. Int J Rheum Dis 2019; 22:2206-2212. [PMID: 31721427 DOI: 10.1111/1756-185x.13735] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Revised: 09/24/2019] [Accepted: 10/04/2019] [Indexed: 11/28/2022]
Abstract
INTRODUCTION The Ankylosing Spondylitis Disease Activity Score with C-reactive protein (ASDAS-CRP) and Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) are commonly used instruments for measuring disease activity. However, few studies have assessed their psychometric properties in patients with axial spondyloarthritis (axSpA). We aimed to assess the validity and reliability of ASDAS-CRP and BASDAI in patients with axSpA in Singapore. METHODS Cross-sectional data from 280 patients with axSpA from a dedicated axSpA clinic in a Singapore tertiary referral hospital from 2011 to 2019 were used. Internal consistency was assessed using Cronbach's alpha. Construct validity was assessed through 12 a priori hypotheses by correlation of overall ASDAS-CRP and BASDAI score with other patient-reported outcomes measures (PROMs). Structural validity was evaluated via confirmatory factor analysis using maximum-likelihood method, where Comparative Fit Index (CFI) >0.95, Tucker-Lewis Index (TLI) >0.95, Root Mean Square Error of Approximation (RMSEA) <0.06 and Standardized Root Mean Residuals (SRMR) <0.08 were indicative of good fit. RESULTS Among 280 patients (78.2% Male; 92.5% Chinese), ASDAS-CRP showed poor internal consistency of 0.33, while BASDAI showed high internal consistency of 0.87. Convergent and divergent construct validity were demonstrated by fulfillment of 11 out of 12 a priori hypotheses when ASDAS-CRP and BASDAI were compared with other PROMs. Our proposed ASDAS-CRP and BASDAI model showed good fit for a 1-factor structure respectively (CFI = 0.993, TLI = 0.984, RMSEA = 0.036, SRMR = 0.026 for ASDAS-CRP; CFI = 0.993, TLI = 0.985, RMSEA = 0.057, SRMR = 0.022 for BASDAI), demonstrating structural validity. CONCLUSION This study supports the use of both ASDAS-CRP and BASDAI in measuring disease activity in patients with axSpA in Singapore.
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Affiliation(s)
- Yu Heng Kwan
- Program in Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore
| | - Jun Jie Tan
- Department of Pharmacy, Singapore General Hospital, Singapore, Singapore
| | - Jie Kie Phang
- Department of Rheumatology and Immunology, Singapore General Hospital, Singapore, Singapore
| | - Warren Fong
- Department of Rheumatology and Immunology, Singapore General Hospital, Singapore, Singapore.,Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.,Duke-NUS Medical School, Singapore, Singapore
| | - Ka Keat Lim
- Program in Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore
| | - Hwee Ling Koh
- Department of Pharmacy, Faculty of Science, National University of Singapore, Singapore, Singapore
| | - Nai Lee Lui
- Department of Rheumatology and Immunology, Singapore General Hospital, Singapore, Singapore
| | - Chuen Seng Tan
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Truls Østbye
- Program in Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore
| | - Julian Thumboo
- Program in Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore.,Department of Rheumatology and Immunology, Singapore General Hospital, Singapore, Singapore.,Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Ying Ying Leung
- Department of Rheumatology and Immunology, Singapore General Hospital, Singapore, Singapore.,Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.,Duke-NUS Medical School, Singapore, Singapore
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14
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Wang CTM, Kwan YH, Fong W, Xiong SQ, Leung YY. Factors associated with patient-physician discordance in a prospective cohort of patients with psoriatic arthritis: An Asian perspective. Int J Rheum Dis 2019; 22:1209-1215. [PMID: 30942553 PMCID: PMC6766962 DOI: 10.1111/1756-185x.13568] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Revised: 02/22/2019] [Accepted: 03/12/2019] [Indexed: 12/22/2022]
Abstract
Objectives To evaluate factors associated with patient‐physician discordance in a multiethnic Asian cohort of psoriatic arthritis (PsA) patients. Methods We used data from a prospective cohort of consecutive patients with PsA fulfilling the Classification Criteria for Psoriatic Arthritis, recruited from a single center in Singapore. Sociodemographic, clinical data and patient‐reported outcomes were collected using a standardized protocol at baseline, 4 months, 8 months, 1 year, 2 years and 5 years. patient‐physician discordance was defined as patient global assessment minus physician global assessment (PGA‐PhGA). We evaluated variables associated with patient‐physician discordance using generalized linear regression to control for within‐subject effect. Results One hundred and fortytwo patients (51.4% male, 66.2% Chinese, mean [SD] age and duration of illness 51.1 [13.8] years and 27.5 [98.3] months) were recruited at baseline. Paired results for PGA and PhGA were available for 291 visits with median (interquartile range) follow‐up time of 11.6 (17) months. In univariable analysis, duration of illness, fatigue, pain, tender and swollen joint count, dactylitis count, and health‐related quality of life (Short Form‐36) domains were significantly correlated with patient‐physician discordance. In multivariable analysis, age, fatigue level, pain score were positively associated with patient‐physician discordance, while swollen joint count and mental health were negatively associated with patient physician discordance. Conclusions Increased age, higher fatigue levels, higher pain score and poorer mental health may explain underestimation of disease activity by physicians. Physicians’ overestimation of disease activity may be explained by higher swollen joint counts.
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Affiliation(s)
- Charmaine Tze May Wang
- Department of Rheumatology & Immunology, Singapore General Hospital, Singapore City, Singapore
| | - Yu Heng Kwan
- Department of Rheumatology & Immunology, Singapore General Hospital, Singapore City, Singapore.,Duke-NUS Medical School, Singapore City, Singapore
| | - Warren Fong
- Department of Rheumatology & Immunology, Singapore General Hospital, Singapore City, Singapore.,Duke-NUS Medical School, Singapore City, Singapore
| | - Shu Qin Xiong
- Department of Rheumatology & Immunology, Singapore General Hospital, Singapore City, Singapore
| | - Ying Ying Leung
- Department of Rheumatology & Immunology, Singapore General Hospital, Singapore City, Singapore.,Duke-NUS Medical School, Singapore City, Singapore
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Garrido-Cumbrera M, Poddubnyy D, Gossec L, Gálvez-Ruiz D, Bundy C, Mahapatra R, Makri S, Christen L, Delgado-Domínguez CJ, Sanz-Gómez S, Plazuelo-Ramos P, Navarro-Compán V. The European Map of Axial Spondyloarthritis: Capturing the Patient Perspective-an Analysis of 2846 Patients Across 13 Countries. Curr Rheumatol Rep 2019; 21:19. [PMID: 30868287 PMCID: PMC6449283 DOI: 10.1007/s11926-019-0819-8] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
PURPOSE OF REVIEW Scientific research in axial spondyloarthritis (axSpA) has grown significantly. Nevertheless, the patient perspective remains insufficiently explored. Using a cross-sectional survey, the European Map of Axial Spondyloarthritis (EMAS) describes how patients living with self-reported axSpA experience their disease physically, psychologically, and socially. RECENT FINDINGS 2846 patients participated: mean age 43.9 ± 12.3 years, 61.3% female, mean disease duration was 17.2 ± 12.4 years, and 71.3% were HLA-B27 positive. Mean diagnostic delay was 7.4 ± 8.4 years. Mean BASDAI score was 5.5 ± 2.0 and 75.7% reported moderate/severe spinal stiffness throughout the day. Daily life was substantially impaired: 74.1% reported difficulties finding a job due to the disease, and 61.5% reported psychological distress. EMAS results showed long diagnostic delay and substantial physical and psychological burden, indicating important unmet needs for patients. Furthermore, axSpA restricted patients' ability to participate in their daily routine and lead a productive work life. Understanding the patient's perspective can improve both health outcomes and shared decision-making between patient and rheumatologist.
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Affiliation(s)
- Marco Garrido-Cumbrera
- Universidad de Sevilla, Seville, Spain.
- Health & Territory Research (HTR), Centro de Investigación, Tecnología e Innovación Manuel Losada Villasante (CITIUS), Universidad de Sevilla, C/ Dr Rafael Martínez Domínguez s/n, 41013, Seville, Spain.
- Spanish Federation of Spondyloarthritis Patient Associations (CEADE), Madrid, Spain.
| | - Denis Poddubnyy
- Charité-Universitätsmedizin Berlin, Berlin, Germany
- German Rheumatism Research Centre, Berlin, Germany
| | - Laure Gossec
- Sorbonne Université, Institut Pierre Louis d'Epidémiologie et de Santé Publique (iPLESP), Paris, France
- Rheumatology Department, Pitié Salpêtrière hospital, AP-HP, Paris, France
| | - David Gálvez-Ruiz
- Universidad de Sevilla, Seville, Spain
- Health & Territory Research (HTR), Centro de Investigación, Tecnología e Innovación Manuel Losada Villasante (CITIUS), Universidad de Sevilla, C/ Dr Rafael Martínez Domínguez s/n, 41013, Seville, Spain
| | | | - Raj Mahapatra
- Ankylosing Spondylitis International Federation (ASIF), London, UK
| | - Souzi Makri
- Cyprus League Against Rheumatism, Nicosia, Cyprus
| | - Laura Christen
- Novartis Pharma AG, Patient Advocacy, Basel, Switzerland
| | - Carlos J Delgado-Domínguez
- Health & Territory Research (HTR), Centro de Investigación, Tecnología e Innovación Manuel Losada Villasante (CITIUS), Universidad de Sevilla, C/ Dr Rafael Martínez Domínguez s/n, 41013, Seville, Spain
| | - Sergio Sanz-Gómez
- Universidad de Sevilla, Seville, Spain
- Health & Territory Research (HTR), Centro de Investigación, Tecnología e Innovación Manuel Losada Villasante (CITIUS), Universidad de Sevilla, C/ Dr Rafael Martínez Domínguez s/n, 41013, Seville, Spain
| | - Pedro Plazuelo-Ramos
- Spanish Federation of Spondyloarthritis Patient Associations (CEADE), Madrid, Spain
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