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Sharpe L, Richmond B, Todd J, Dudeney J, Dear BF, Szabo M, Sesel AL, Forrester M, Menzies RE. A cross-sectional study of existential concerns and fear of progression in people with Rheumatoid Arthritis. J Psychosom Res 2023; 175:111514. [PMID: 37883892 DOI: 10.1016/j.jpsychores.2023.111514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 09/20/2023] [Accepted: 10/01/2023] [Indexed: 10/28/2023]
Abstract
OBJECTIVES People with rheumatoid arthritis (RA) have higher levels of fear of disease progression (FOP) than cancer survivors. In cancer, FOP is inextricably linked with existential concerns. However, this has not been investigated in people with RA. METHODS We recruited 165 people with RA (96%F) who volunteered for a treatment trial of psychological intervention. Participants completed the Existential Concerns Questionnaire (ECQ) and questionnaires measuring constructs associated with FOP in cancer. We created groups of people with RA, with and without clinically significant levels of FOP (clinical and control groups) and compared their existential concerns. We hypothesized that existential concerns would add to the variance in FOP over and above pain, psychopathology, and disability. RESULTS Nearly two-thirds of people with RA scored in the clinical range for FOP. The clinical group had higher levels of all existential concerns than the control group. When subscales of the ECQ were entered into a multiple regression with FOP as the dependent variable, death anxiety, meaninglessness and guilt domains accounted for significant variance in FOP. Moreover, when added to a regression equation controlling all other variables, existential concerns continued to account for unique variance in FOP (t = 2.712, p = 0.007). CONCLUSION Existential concerns were strongly associated with FOP. While this cross-sectional study cannot determine whether existential concerns underlie FOP in RA, these results show robust relationships that warrant future investigation.
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Affiliation(s)
- Louise Sharpe
- The School of Psychology, Faculty of Science, The University of Sydney, Australia.
| | - Bethany Richmond
- The School of Psychology, Faculty of Science, The University of Sydney, Australia
| | - Jemma Todd
- The School of Psychology, Faculty of Science, The University of Sydney, Australia
| | - Joanne Dudeney
- The eCentreClinic, School of Psychological Sciences, Macquarie University, Australia
| | - Blake F Dear
- The eCentreClinic, School of Psychological Sciences, Macquarie University, Australia
| | - Marianna Szabo
- The School of Psychology, Faculty of Science, The University of Sydney, Australia
| | - Amy-Lee Sesel
- The School of Psychology, Faculty of Science, The University of Sydney, Australia
| | - Madeline Forrester
- The School of Psychology, Faculty of Science, The University of Sydney, Australia
| | - Rachel E Menzies
- The School of Psychology, Faculty of Science, The University of Sydney, Australia
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Kirkeskov L, Bray K. Employment of patients with rheumatoid arthritis - a systematic review and meta-analysis. BMC Rheumatol 2023; 7:41. [PMID: 37964371 PMCID: PMC10644429 DOI: 10.1186/s41927-023-00365-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 10/20/2023] [Indexed: 11/16/2023] Open
Abstract
BACKGROUND Patients with rheumatoid arthritis (RA) have difficulties maintaining employment due to the impact of the disease on their work ability. This review aims to investigate the employment rates at different stages of disease and to identify predictors of employment among individuals with RA. METHODS The study was carried out according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines focusing on studies reporting employment rate in adults with diagnosed RA. The literature review included cross-sectional and cohort studies published in the English language between January 1966 and January 2023 in the PubMed, Embase and Cochrane Library databases. Data encompassing employment rates, study demographics (age, gender, educational level), disease-related parameters (disease activity, disease duration, treatment), occupational factors, and comorbidities were extracted. Quality assessment was performed employing Newcastle-Ottawa Scale. Meta-analysis was conducted to ascertain predictors for employment with odds ratios and confidence intervals, and test for heterogeneity, using chi-square and I2-statistics were calculated. This review was registered with PROSPERO (CRD42020189057). RESULTS Ninety-one studies, comprising of a total of 101,831 participants, were included in the analyses. The mean age of participants was 51 years and 75.9% were women. Disease duration varied between less than one year to more than 18 years on average. Employment rates were 78.8% (weighted mean, range 45.4-100) at disease onset; 47.0% (range 18.5-100) at study entry, and 40.0% (range 4-88.2) at follow-up. Employment rates showed limited variations across continents and over time. Predictors for sustained employment included younger age, male gender, higher education, low disease activity, shorter disease duration, absence of medical treatment, and the absence of comorbidities. Notably, only some of the studies in this review met the requirements for high quality studies. Both older and newer studies had methodological deficiencies in the study design, analysis, and results reporting. CONCLUSIONS The findings in this review highlight the prevalence of low employment rates among patients with RA, which increases with prolonged disease duration and higher disease activity. A comprehensive approach combining clinical and social interventions is imperative, particularly in early stages of the disease, to facilitate sustained employment among this patient cohort.
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Affiliation(s)
- Lilli Kirkeskov
- Department of Social Medicine, University Hospital Bispebjerg-Frederiksberg, Copenhagen, Denmark.
- Department of Social Medicine, University Hospital Bispebjerg-Frederiksberg, Nordre Fasanvej 57, Vej 8, Opgang 2.2., 2000, Frederiksberg, Denmark.
| | - Katerina Bray
- Department of Social Medicine, University Hospital Bispebjerg-Frederiksberg, Copenhagen, Denmark
- Department of Occupational and Social Medicine, Holbaek Hospital, Holbaek, Denmark
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Guymer EK, Littlejohn GO, Brand CK, Kwiatek RA. Fibromyalgia onset has a high impact on work ability in Australians. Intern Med J 2017; 46:1069-74. [PMID: 27242134 DOI: 10.1111/imj.13135] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2016] [Revised: 05/16/2016] [Accepted: 05/26/2016] [Indexed: 01/30/2023]
Abstract
BACKGROUND Although the disabling effects of fibromyalgia (FM) are well recognised, there are no published data regarding the impact of FM on work ability in Australians. The impact of the development of FM symptoms on ability to work in Australians was explored in a pilot survey project. METHOD Members of the Fibromyalgia Support Network of Western Australia were invited to undertake an anonymous online survey. Information was gathered regarding demographics, symptom onset, the timing of diagnosis, employment status and changes in the ability to work. RESULTS Two hundred and eighty-seven responses were analysed. Of the respondents, 90.6% were female, with a mean age of 51.1 ± 10.6 years and had experienced symptoms between 2 and 20 years; 52.8% were diagnosed less than 5 years previously. Of the participants, 54.2% were working full time and 21.5% working part time at symptom onset; however, only 15.6% were currently working full time, with 44.8% not currently working at all. Because of FM, 24.3% stopped and 32.6% reduced paid work directly within 5 years of symptom development, with 15.3% ceasing and an additional 17.4% reducing work because of symptoms before diagnosis. Due to FM symptoms, 35.1% currently received financial support because they were unable to work. While 24.3% reported FM medication increased their ability to work, 20.8% reported it reduced their ability to work. CONCLUSION A community pilot survey of Australians with FM indicates a high impact on work ability. This occurs from symptom onset and often before diagnosis. Early diagnosis and intervention may provide a window of opportunity to prevent work disability in FM.
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Affiliation(s)
- E K Guymer
- Department of Medicine, Monash University, Melbourne, Victoria, Australia. .,Department of Rheumatology, Monash Health, Melbourne, Victoria, Australia.
| | - G O Littlejohn
- Department of Medicine, Monash University, Melbourne, Victoria, Australia.,Department of Rheumatology, Monash Health, Melbourne, Victoria, Australia
| | - C K Brand
- Fibromyalgia Support Network of Western Australia, Perth, Western Australia, Australia
| | - R A Kwiatek
- Northern Adelaide Local Health Network, Adelaide, South Australia, Australia
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Wabe N, Wiese MD. Treating rheumatoid arthritis to target: physician and patient adherence issues in contemporary rheumatoid arthritis therapy. J Eval Clin Pract 2017; 23:486-493. [PMID: 27650675 DOI: 10.1111/jep.12620] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Revised: 07/10/2016] [Accepted: 07/11/2016] [Indexed: 11/29/2022]
Abstract
Development of the treat-to-target (T2T) strategy, the process whereby drug therapy is adjusted until the therapeutic goal is achieved, has revolutionized how rheumatoid arthritis (RA) patients are treated. With the advent of T2T, the management of RA is more effective than ever, with the possibility of remission and other favorable clinical and patient-reported outcomes. Effective implementation of a T2T strategy in routine clinical practice mainly depends on the long-term commitment of physician and patient to T2T treatment recommendations. However, as T2T is a complex process involving aggressive early management with several steps of therapy modifications requiring frequent close monitoring of disease activity and drug toxicities, it may be more liable to suboptimal adherence in real-life clinical practice. The aim of the review is to present key issues related to patient medication adherence and physician adherence to the current RA treatment recommendations and their importance in optimizing the outcome of treatment in RA treated according to T2T strategy.
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Affiliation(s)
- Nasir Wabe
- School of Pharmacy and Medical Sciences and Sansom Institute for Health Research, University of South Australia, Adelaide, South Australia, Australia
| | - Michael D Wiese
- School of Pharmacy and Medical Sciences and Sansom Institute for Health Research, University of South Australia, Adelaide, South Australia, Australia
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Lowe DB, Taylor MJ, Hill SJ. Associations between multimorbidity and additional burden for working-age adults with specific forms of musculoskeletal conditions: a cross-sectional study. BMC Musculoskelet Disord 2017; 18:135. [PMID: 28376838 PMCID: PMC5379740 DOI: 10.1186/s12891-017-1496-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2016] [Accepted: 03/20/2017] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Multiple health conditions are increasingly a problem for adults with musculoskeletal conditions. However, multimorbidity research has focused primarily on the elderly and those with a limited subset of musculoskeletal disorders. We sought to determine whether associations between multimorbidity and additional burden differ with specific forms of musculoskeletal conditions among working-age adults. METHODS Data were sourced from a nationally representative Australian survey. Specific musculoskeletal conditions examined were osteoarthritis; inflammatory arthritis; other forms of arthritis or arthropathies; musculoskeletal conditions not elsewhere specified; gout; back pain; soft tissue disorders; or osteoporosis. Multimorbidity was defined as the additional presence of one or more of the Australian National Health Priority Area conditions. Burden was assessed by self-reported measures of: (i) self-rated health (ii) musculoskeletal-related healthcare and medicines utilisation and, (iii) general healthcare utilisation. Associations between multimorbidity and additional health or healthcare utilisation burden among working-age adults (aged 18 - 64 years of age) with specific musculoskeletal conditions were estimated using logistic regression, adjusting for confounders. Interaction terms were fitted to identify whether there were specific musculoskeletal conditions where multimorbidity was more strongly associated with poorer health or greater healthcare utilisation than in the remaining musculoskeletal group. RESULTS Among working-age adults, for each of the specified musculoskeletal conditions, multimorbidity was associated with similar, increased likelihood of additional self-rated health burden and certain types of healthcare utilisation. While there were differences in the relationships between multimorbidity and burden for each of the specific musculoskeletal conditions, no one specific musculoskeletal condition appeared to be consistently associated with greater additional health burden in the presence of multimorbidity across the majority of self-rated health burden and healthcare use measures. CONCLUSIONS For working-age people with any musculoskeletal conditions examined here, multimorbidity increases self-reported health and healthcare utilisation burden. As no one musculoskeletal condition appears consistently worse off in the presence of multimorbidity, there is a need to better understand and identify strategies that acknowledge and address the additional burden of concomitant conditions for working-age adults with a range of musculoskeletal conditions.
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Affiliation(s)
- Dianne B. Lowe
- Centre for Health Communication and Participation, School of Psychology and Public Health, College of Science, Health and Engineering, La Trobe University, Melbourne, Australia
- Cochrane Consumers and Communication Review Group, School of Psychology and Public Health, College of Science, Health and Engineering, La Trobe University, Melbourne, Australia
| | - Michael J. Taylor
- School of Allied Health, Australian Catholic University, Fitzroy, Australia
- Cochrane Consumers and Communication Review Group, School of Psychology and Public Health, College of Science, Health and Engineering, La Trobe University, Melbourne, Australia
| | - Sophie J. Hill
- Centre for Health Communication and Participation, School of Psychology and Public Health, College of Science, Health and Engineering, La Trobe University, Melbourne, Australia
- Cochrane Consumers and Communication Review Group, School of Psychology and Public Health, College of Science, Health and Engineering, La Trobe University, Melbourne, Australia
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A Treat-to-Target Strategy Preserves Work Capacity in a Rheumatoid Arthritis Inception Cohort Treated With Combination Conventional DMARD Therapy. J Clin Rheumatol 2017; 23:131-137. [DOI: 10.1097/rhu.0000000000000506] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Lowe DB, Taylor MJ, Hill SJ. Cross-sectional examination of musculoskeletal conditions and multimorbidity: influence of different thresholds and definitions on prevalence and association estimates. BMC Res Notes 2017; 10:51. [PMID: 28100264 PMCID: PMC5242059 DOI: 10.1186/s13104-017-2376-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2015] [Accepted: 01/04/2017] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Multimorbidity and musculoskeletal conditions create substantial burden for people and health systems. Quantifying the extent of co-occurring conditions is hampered by conceptual heterogeneity, imprecision and/or indecision about how multimorbidity is defined. The purpose of this study is to examine the influence of different ways of operationalising multimorbidity on multimorbidity prevalence rates with a focus on working-age adults with musculoskeletal conditions. Weighted population prevalence rates of multimorbidity among working-age Australians were estimated using data from the National Health Survey. Two nominal thresholds (2+ or 3+ co-occurring conditions) and three operational definitions of multimorbidity (survey-, policy- and research-based) were examined. Using logistic regression, we estimated the association between the prevalence of multimorbidity among persons with musculoskeletal conditions compared to persons with non-musculoskeletal conditions for each definition and threshold combination. RESULTS As few as 7.9% of working-age Australians have 2+ conditions using the research-based definition (95% CI 7.4-8.5%), compared to estimates of 15.3% (95% CI 14.3-16.2%) and 61.5% (95% CI 60.3-62.7%). with the policy- and survey-based definitions, respectively. Depending on definition, with the 3+ threshold multimorbidity prevalence ranged from 2.1% (research) to 41.9% (survey). Among the sub-sample with musculoskeletal conditions, multimorbidity with the 2+ threshold ranged from 20.2 to 92.2%; and with 3+ threshold from 5.9 to 75.4%, again lowest with the research-definition and highest with the survey-definition. When compared to any other condition (i.e. non-musculoskeletal conditions), all musculoskeletal conditions were positively associated with multimorbidity, regardless of definition or threshold. CONCLUSIONS Depending on definition and threshold, multimorbidity is either rare or endemic in working-age Australians. Irrespective of definition, musculoskeletal conditions are a near-ubiquitous feature of multimorbidity.
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Affiliation(s)
- Dianne B. Lowe
- Centre for Health Communication and Participation, School of Psychology and Public Health, College of Science, Health and Engineering, La Trobe University, Melbourne, Australia
- Cochrane Consumers and Communication Review Group, School of Psychology and Public Health, College of Science, Health and Engineering, La Trobe University, Melbourne, Australia
| | - Michael J. Taylor
- School of Allied Health, Australian Catholic University, Fitzroy, Australia
- Cochrane Consumers and Communication Review Group, School of Psychology and Public Health, College of Science, Health and Engineering, La Trobe University, Melbourne, Australia
| | - Sophie J. Hill
- Centre for Health Communication and Participation, School of Psychology and Public Health, College of Science, Health and Engineering, La Trobe University, Melbourne, Australia
- Cochrane Consumers and Communication Review Group, School of Psychology and Public Health, College of Science, Health and Engineering, La Trobe University, Melbourne, Australia
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Osteoimmunology: Major and Costimulatory Pathway Expression Associated with Chronic Inflammatory Induced Bone Loss. J Immunol Res 2015; 2015:281287. [PMID: 26064999 PMCID: PMC4433696 DOI: 10.1155/2015/281287] [Citation(s) in RCA: 86] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2014] [Accepted: 12/10/2014] [Indexed: 12/28/2022] Open
Abstract
The field of osteoimmunology has emerged in response to the range of evidences demonstrating the close interrelationship between the immune system and bone metabolism. This is pertinent to immune-mediated diseases, such as rheumatoid arthritis and periodontal disease, where there are chronic inflammation and local bone erosion. Periprosthetic osteolysis is another example of chronic inflammation with associated osteolysis. This may also involve immune mediation when occurring in a patient with rheumatoid arthritis (RA). Similarities in the regulation and mechanisms of bone loss are likely to be related to the inflammatory cytokines expressed in these diseases. This review highlights the role of immune-related factors influencing bone loss particularly in diseases of chronic inflammation where there is associated localized bone loss. The importance of the balance of the RANKL-RANK-OPG axis is discussed as well as the more recently appreciated role that receptors and adaptor proteins involved in the immunoreceptor tyrosine-based activation motif (ITAM) signaling pathway play. Although animal models are briefly discussed, the focus of this review is on the expression of ITAM associated molecules in relation to inflammation induced localized bone loss in RA, chronic periodontitis, and periprosthetic osteolysis, with an emphasis on the soluble and membrane bound factor osteoclast-associated receptor (OSCAR).
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Prodinger B, Shaw L, Laliberte Rudman D, Stamm T. Negotiating disability in everyday life: ethnographical accounts of women with rheumatoid arthritis. Disabil Rehabil 2013; 36:497-503. [DOI: 10.3109/09638288.2013.800594] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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TANG KENNETH, ESCORPIZO REUBEN, BEATON DORCASE, BOMBARDIER CLAIRE, LACAILLE DIANE, ZHANG WEI, ANIS ASLAMH, BOONEN ANNELIES, VERSTAPPEN SUZANNEM, BUCHBINDER RACHELLE, OSBORNE RICHARDH, FAUTREL BRUNO, GIGNAC MONIQUEA, TUGWELL PETERS. Measuring the Impact of Arthritis on Worker Productivity: Perspectives, Methodologic Issues, and Contextual Factors. J Rheumatol 2011; 38:1776-90. [DOI: 10.3899/jrheum.110405] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Leading up to the Outcome Measures in Rheumatology (OMERACT) 10 meeting, the goal of the Worker Productivity Special Interest Group (WP-SIG) was to make progress on 3 key issues that relate to the application and interpretation of worker productivity outcomes in arthritis: (1) to review existing conceptual frameworks to help consolidate our intended target and scope of measurement; (2) to examine the methodologic issues associated with our goal of combining multiple indicators of worker productivity loss (e.g., absenteeism <—> presenteeism) into a single comprehensive outcome; and (3) to examine the relevant contextual factors of work and potential implications for the interpretation of scores derived from existing outcome measures. Progress was made on all 3 issues at OMERACT 10. We identified 3 theoretical frameworks that offered unique but converging perspectives on worker productivity loss and/or work disability to provide guidance with classification, selection, and future recommendation of outcomes. Several measurement and analytic approaches to combine absenteeism and presenteeism outcomes were proposed, and the need for further validation of such approaches was also recognized. Finally, participants at the WP-SIG were engaged to brainstorm and provide preliminary endorsements to support key contextual factors of worker productivity through an anonymous “dot voting” exercise. A total of 24 specific factors were identified, with 16 receiving ≥ 1 vote among members, reflecting highly diverse views on specific factors that were considered most important. Moving forward, further progress on these issues remains a priority to help inform the best application of worker productivity outcomes in arthritis research.
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Arvidsson S, Arvidsson B, Fridlund B, Bergman S. Factors promoting health-related quality of life in people with rheumatic diseases: a 12 month longitudinal study. BMC Musculoskelet Disord 2011; 12:102. [PMID: 21599884 PMCID: PMC3141606 DOI: 10.1186/1471-2474-12-102] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2010] [Accepted: 05/20/2011] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Rheumatic diseases have a significant adverse impact on the individual from physical, mental and social aspects, resulting in a low health-related quality of life (HRQL). There is a lack of longitudinal studies on HRQL in people with rheumatic diseases that focus on factors promoting HRQL instead of risk factors. The aim of this study was to investigate the associations between suggested health promoting factors at baseline and outcome in HRQL at a 12 month follow-up in people with rheumatic diseases. METHODS A longitudinal cohort study was conducted in 185 individuals with rheumatic diseases with questionnaires one week and 12 months after rehabilitation in a Swedish rheumatology clinic. HRQL was assessed by SF-36 together with suggested health factors. The associations between SF-36 subscales and the health factors were analysed by multivariable logistic regressions. RESULTS Factors predicting better outcome in HRQL in one or several SF-36 subscales were being younger or middle-aged, feeling painless, having good sleep structure, feeling rested after sleep, performing low effort of exercise more than twice per week, having strong sense of coherence (SOC), emotional support and practical assistance, higher educational level and work capacity. The most important factors were having strong SOC, feeling rested after sleep, having work capacity, being younger or middle-aged, and having good sleep structure. CONCLUSIONS This study identified several factors that promoted a good outcome in HRQL to people with rheumatic diseases. These health factors could be important to address in clinical work with rheumatic diseases in order to optimise treatment strategies.
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Affiliation(s)
- Susann Arvidsson
- Research and Development Centre Spenshult, Spenshult hospital for rheumatic diseases, SE-313 92 Oskarström, Sweden
- School of Health Sciences, Jönköping University, Jönköping, Sweden
| | - Barbro Arvidsson
- School of Social and Health Sciences, Halmstad University, Halmstad, Sweden
- Gjøvik University College, Faculty of Nursing Science, Gjøvik, Norway
| | - Bengt Fridlund
- School of Health Sciences, Jönköping University, Jönköping, Sweden
| | - Stefan Bergman
- Research and Development Centre Spenshult, Spenshult hospital for rheumatic diseases, SE-313 92 Oskarström, Sweden
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A cost-utility analysis of nonsurgical management, total wrist arthroplasty, and total wrist arthrodesis in rheumatoid arthritis. J Hand Surg Am 2010; 35:379-391.e2. [PMID: 20193858 PMCID: PMC2909683 DOI: 10.1016/j.jhsa.2009.12.013] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2009] [Revised: 11/04/2009] [Accepted: 12/07/2009] [Indexed: 02/02/2023]
Abstract
PURPOSE Management of end-stage rheumatoid wrist disease remains controversial. Total wrist arthrodesis provides reliable pain relief and stability and is the most commonly applied management strategy. Total wrist arthroplasty is a motion-preserving alternative that is gaining popularity. The purpose of this study was to perform a cost-utility analysis comparing nonsurgical management, total wrist arthroplasty, and total wrist arthrodesis for the rheumatoid wrist. METHODS A time trade-off utility survey was developed to investigate patient and physician preferences for the potential outcomes of total wrist arthroplasty and total wrist arthrodesis. The study sample consisted of rheumatoid patients (N = 49) recruited as part of an ongoing prospective study and a national random sample of hand surgeons and rheumatologists (N = 109). A decision tree was created using utility values derived from the survey, and the expected quality-adjusted life-years (QALYs) for each procedure were determined. Using the societal perspective, costs were based on the Medicare fee schedules for the Current Procedural Terminology codes associated with total wrist arthroplasty and total wrist arthrodesis and their potential complications. Costs per QALY were calculated and compared. RESULTS Patients and physicians both showed a preference for surgical management over nonsurgical management. Application of cost data indicated that the incremental cost per additional QALY gained for total wrist arthroplasty over nonsurgical management was $2,281 and the incremental cost per QALY gained with total wrist arthroplasty over total wrist arthrodesis was $2,328, which is substantially less than the national standard of $50,000/QALY deemed acceptable for adoption. CONCLUSIONS In the absence of rigorous outcome data, cost-utility analysis is a useful tool to guide treatment decisions. Total wrist arthroplasty and total wrist arthrodesis are both extremely cost-effective procedures. This study incorporated patient and physician utilities to demonstrate that total wrist arthroplasty has only a small incremental cost over the traditional total wrist arthrodesis procedure. Based on this economic model, total wrist arthroplasty may be worthy of further consideration, and cost should not be considered prohibitive. TYPE OF STUDY/LEVEL OF EVIDENCE Decision Analysis II.
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Birnbaum H, Shi L, Pike C, Kaufman R, Sun P, Cifaldi M. Workplace impacts of anti-TNF therapies in rheumatoid arthritis: review of the literature. Expert Opin Pharmacother 2009; 10:255-69. [PMID: 19236197 DOI: 10.1517/14656560802682163] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Rheumatoid arthritis (RA) causes pain and serious functional impacts and substantially affects patients' daily lives, including their ability to work. OBJECTIVE This review examines recent studies of patients with RA treated with TNF antagonists and the impacts these therapies have on the workplace. METHODS A total of 133 articles and 14 poster abstracts were reviewed that matched specific criteria. RESULTS/CONCLUSION The results of early studies of TNF antagonists varied regarding their effects on patients with RA in the workplace. However, recent studies of adalimumab showed positive impacts across a range of workplace burdens. Treatments such as adalimumab may help employees with RA to remain in the workforce and lead to reduced workplace costs to the employers and employees.
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Affiliation(s)
- Howard Birnbaum
- Analysis Group, 111 Huntington Avenue, 10th Floor, MA 02199, Boston, USA
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