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Drouet J, López-Medina C, Granger B, Fautrel B, Landewe RBM, Molto A, Gaujoux-Viala C, Kiltz U, Dougados M, Gossec L. Disease activity and widespread pain are main contributors to patient-reported global health in axial spondyloarthritis: an analysis of 6064 patients. Rheumatol Int 2024:10.1007/s00296-024-05576-7. [PMID: 38597981 DOI: 10.1007/s00296-024-05576-7] [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: 01/30/2024] [Accepted: 03/02/2024] [Indexed: 04/11/2024]
Abstract
Global health (GH) and health-related quality of life are patient priorities in axial spondyloarthritis (axSpA). Our objective was to assess the relative importance of disease-related factors including disease activity, and patient-related factors including comorbidities, to explain GH in axSpA. Post hoc cross-sectional analyses of 4 sets (COMOSPA, PERSPA, COMEDSPA, and DESIR) of patients fulfilling ASAS criteria for axSpA. GH was assessed through the ASAS Health Index (ASAS-HI) or the EuroQoL-5D-3L (EQ-5D). Disease-related factors included disease activity (ASDAS, psoriasis, arthritis, enthesitis, and CRP), disease duration, diagnostic delay, bamboo spine, and treatment. Non-disease-related factors included sociodemographic characteristics, comorbidities and chronic widespread pain. Multivariable logistic and linear regressions and partial variances (R2) were applied to identify independent determinants of GH. In 6064 patients (range 284-2756 across datasets), mean age ranged 38.9-45.8 years, 51-68% were male. GH was generally moderate: median ASAS-HI ranged 5.0-7.0. GH was explained by ASDAS (range of odds ratios, OR, 2.60-4.48) and chronic widespread pain (range of OR 2.19-8.39); other determinants included comorbidities and sociodemographic characteristics. Only 47-57% of the total variance in GH could be explained by the models; disease activity (partial variance, 16-26%) and chronic widespread pain (partial variance 12-15%) were the key contributing variables. A wide range of disease and non-disease-related variables usually collected in studies could only explain 47-57% of the variability in GH. Among these, disease activity and chronic widespread pain were most relevant and of similar magnitude of importance. These findings will be helpful for shared decision-making.
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Affiliation(s)
- Juliette Drouet
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Paris, France.
| | | | - Benjamin Granger
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Paris, France
- Public Health Department, AP-HP, Pitié-Salpêtrière Hospital, Paris, France
| | - Bruno Fautrel
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Paris, France
- Rheumatology Department, AP-HP, Pitié-Salpêtrière Hospital, Paris, France
| | - Robert B M Landewe
- Division of Clinical Immunology and Rheumatology, Amsterdam University Medical Center and Zuyderland Medical Center Heerlen, Heerlen, The Netherlands
| | - Anna Molto
- Rheumatology Department, Hôpital Cochin, Paris, France
- INSERM U-1183, CRESS, Université Paris Cité, Paris, France
| | - Cécile Gaujoux-Viala
- IDESP Univ Montpellier, INSERM, Rheumatology Department, CHU Nîmes, Montpellier, France
| | - Uta Kiltz
- Ruhr Universität Bochum, and Rheumazentrum Ruhrgebiet, Herne, Germany
| | - Maxime Dougados
- Rheumatology Department, Hôpital Cochin, Paris, France
- INSERM U-1183, CRESS, Université Paris Cité, Paris, France
| | - Laure Gossec
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Paris, France
- Rheumatology Department, AP-HP, Pitié-Salpêtrière Hospital, Paris, France
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Bolt JW, Aalbers CJ, Walet L, van Mens LJJ, van Denderen C, van der Horst-Bruinsma I, van Baarsen LGM, Landewé R, van de Sande MGH. Treatment decisions in axial spondyloarthritis daily clinical practice are more than treat-to-target. Rheumatology (Oxford) 2024; 63:34-40. [PMID: 37021937 PMCID: PMC10765143 DOI: 10.1093/rheumatology/kead155] [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: 12/06/2022] [Revised: 03/06/2023] [Accepted: 03/24/2023] [Indexed: 04/07/2023] Open
Abstract
OBJECTIVE 'Treat-to-target principles' are advised for axial spondyloarthritis (axSpA), although a clear target is not yet defined and targets do not always reflect inflammation. Treat-to-target use and motives for treatment choices in clinics are unknown. Therefore, we studied the presence of residual disease activity according physician's opinion, patient's opinion and composite indices and compared them to the subsequent treatment decisions. METHODS This cross-sectional multicentre study included 249 patients with a clinical diagnosis of axSpA ≥6 months. Remission and low disease activity according to the BASDAI (<1.9 and <3.5, respectively) and physician's and patient's opinion were assessed. Questionnaires included patient-reported outcomes and patients and physicians completed questions regarding treatment decisions. RESULTS A total of 115/249 (46%) patients were in remission according to the physician and 37% (n = 43) of these patients reached remission according to the BASDAI. In 51/83 (60%) of the patients with residual disease activity according to the physician and a BASDAI >3.5 the treatment was left unchanged, either because of low disease activity as rated by the physician [n = 15 (29%)] or because of a combination of low disease activity with non-inflammatory complaints or comorbidities [n = 11 (25%)]. Retrospective treat-to-target evaluations showed that treatments were most frequently intensified in patients with arthritis or inflammatory back pain and less often in patients with other (non-inflammatory) musculoskeletal comorbidities. CONCLUSION This study shows that physicians do not always strictly apply treat-to-target in case of residual disease activity in axSpA. Usually, they accept low disease activity as satisfactory.
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Affiliation(s)
- Janne W Bolt
- Department of Rheumatology and Clinical Immunology and Department of Experimental Immunology, Amsterdam Institute for Infection and Immunity, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Rheumatology and Immunology Center, Amsterdam, The Netherlands
| | - Caroline J Aalbers
- Department of Rheumatology and Clinical Immunology and Department of Experimental Immunology, Amsterdam Institute for Infection and Immunity, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Rheumatology and Immunology Center, Amsterdam, The Netherlands
| | - Laura Walet
- Department of Rheumatology and Clinical Immunology and Department of Experimental Immunology, Amsterdam Institute for Infection and Immunity, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Rheumatology and Immunology Center, Amsterdam, The Netherlands
| | - Leonieke J J van Mens
- Department of Rheumatology and Clinical Immunology and Department of Experimental Immunology, Amsterdam Institute for Infection and Immunity, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Rheumatology and Immunology Center, Amsterdam, The Netherlands
| | - Christiaan van Denderen
- Amsterdam Rheumatology and Immunology Center, Amsterdam, The Netherlands
- Department of Rheumatology, Reade, Amsterdam, The Netherlands
| | | | - Lisa G M van Baarsen
- Department of Rheumatology and Clinical Immunology and Department of Experimental Immunology, Amsterdam Institute for Infection and Immunity, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Rheumatology and Immunology Center, Amsterdam, The Netherlands
| | - Robert Landewé
- Department of Rheumatology and Clinical Immunology and Department of Experimental Immunology, Amsterdam Institute for Infection and Immunity, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Rheumatology and Immunology Center, Amsterdam, The Netherlands
| | - Marleen G H van de Sande
- Department of Rheumatology and Clinical Immunology and Department of Experimental Immunology, Amsterdam Institute for Infection and Immunity, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Rheumatology and Immunology Center, Amsterdam, The Netherlands
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Reich A, Weiß A, Lindner L, Baraliakos X, Poddubnyy D, Zinke S, Stille C, Strangfeld A, Regierer AC. Depressive symptoms are associated with fatigue, poorer functional status and less engagement in sports in axSpA and PsA: an analysis from the RABBIT-SpA cohort. Arthritis Res Ther 2023; 25:136. [PMID: 37533077 PMCID: PMC10394807 DOI: 10.1186/s13075-023-03127-2] [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: 03/02/2023] [Accepted: 07/26/2023] [Indexed: 08/04/2023] Open
Abstract
BACKGROUND In patients with axial spondyloarthritis (axSpA) or psoriatic arthritis (PsA), concomitant depression might have a negative impact on the course of disease and treatment outcomes. The aims of this analysis are to determine the prevalence of depressive symptoms in axSpA and PsA patients in a real-world cohort study and to identify sociodemographic and clinical associated factors for moderate or severe depressive symptoms in both diseases. METHODS Patients from the RABBIT-SpA cohort with an axSpA or PsA diagnosis and a valid WHO-5 Well-Being Index score at baseline were included. A descriptive analysis of baseline and outcome parameters by category of depressive symptoms was performed and factors associated with the presence of depressive symptoms (moderate or severe) were examined in a logistic regression. RESULTS Two thousand four hundred seventy patients (1,245 axSpA; 1,225 PsA) were included in the analysis. In both diagnoses, the proportion of patients with moderate depressive symptoms was 8% and 21% with severe symptoms. Patients with moderate or severe depressive symptoms were less likely to engage in sports than those with no or mild depressive symptoms, had more comorbidities and higher scores for disease activity, functional limitations, fatigue, and pain and took more analgesics. In axSpA, patients with a higher disease activity, a greater functional impairment and more severe fatigue were more likely to experience depressive symptoms, while patients with more years in education and engaging in sports for at least 1 h/week were less likely to experience depressive symptoms. PsA patients with a greater functional impairment and more severe fatigue were more likely to experience depressive symptoms while those engaging in sports for at least 1 h/week were less likely to experience depressive symptoms. CONCLUSION We confirmed a high prevalence of depressive symptoms in both PsA and axSpA. Factors negatively associated with the presence of depressive symptoms were fatigue, not engaging in sports, and greater functional limitations. Depressive symptoms may affect the perception of disease activity / severity by patients. Thus, depressive symptoms are an important condition in axSpA and PsA that should be considered when evaluating disease activity and treatment outcomes.
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Affiliation(s)
- Andreas Reich
- German Rheumatism Research Center (DRFZ Berlin), Epidemiology and Health Services Research, Berlin, Germany
| | - Anja Weiß
- German Rheumatism Research Center (DRFZ Berlin), Epidemiology and Health Services Research, Berlin, Germany
| | - Lisa Lindner
- German Rheumatism Research Center (DRFZ Berlin), Epidemiology and Health Services Research, Berlin, Germany
| | - Xenofon Baraliakos
- Ruhr University Bochum, Bochum, Germany
- Rheumazentrum Ruhrgebiet, Herne, Germany
| | - Denis Poddubnyy
- German Rheumatism Research Center (DRFZ Berlin), Epidemiology and Health Services Research, Berlin, Germany
- Charité – Universitätsmedizin Berlin, Department of Gastroenterology, Infectiology and Rheumatology, Berlin, Germany
| | | | | | - Anja Strangfeld
- German Rheumatism Research Center (DRFZ Berlin), Epidemiology and Health Services Research, Berlin, Germany
- Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Anne C. Regierer
- German Rheumatism Research Center (DRFZ Berlin), Epidemiology and Health Services Research, Berlin, Germany
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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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Yamamoto Y, Sawada T, Nishiyama S, Tahara K, Hayashi H, Mori H, Kato E, Tago M, Matsui T, Tohma S. Clinical variables, including novel joint index, associated with future patient-physician discordance in global assessment of rheumatoid arthritis (RA) disease activity based on a large RA database in Japan. Int J Rheum Dis 2022; 25:1020-1028. [PMID: 35754383 DOI: 10.1111/1756-185x.14374] [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: 01/23/2022] [Revised: 06/04/2022] [Accepted: 06/11/2022] [Indexed: 12/31/2022]
Abstract
BACKGROUND Discordance between patient global assessment (PGA) and physician global assessment (PhGA) of rheumatoid arthritis (RA) disease activity is mainly determined by pain and functional disabilities. This study aimed to investigate the shift in PGA-PhGA discordance and the variables associated with future positive discordance (PGA > PhGA) based on the NinJa database in Japan. METHODS We examined 7557 adults with RA registered in both NinJa 2014 and 2018, with a discordance cutoff of 3 on a 10-cm scale. The affected joint distribution was investigated using the joint indices x, y, and z, which were calculated as indices for the upper joint, lower joint, and large joint involvement, respectively. The variables in NinJa 2014 that were associated with positive discordance in NinJa 2018 were examined using binary stepwise logistic regression analysis. RESULTS Due to the small number of patients with RA categorized as having negative discordance (PGA < PhGA), we focused on patients with RA categorized as having either concordance or positive discordance. Logistic regression analysis revealed that positive discordance in NinJa 2018 was associated with age, pain, modified Health Assessment Questionnaire (mHAQ) score, corticosteroid use, and existent positive discordance and was inversely associated with C-reactive protein (CRP) and x at baseline (NinJa 2014). The same findings were observed when patients with RA were divided based on the discordance status at baseline. Persistence (positive discordance to positive discordance) was associated with pain and mHAQ scores but inversely associated with CRP. CONCLUSIONS Positive discordance may persist. Circumventing this requires adequate management of pain and functional impairment.
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Affiliation(s)
- Yusuke Yamamoto
- Department of Rheumatology, Tokyo Medical University Hospital, Tokyo, Japan
| | - Tetsuji Sawada
- Department of Rheumatology, Tokyo Medical University Hospital, Tokyo, Japan
| | - Susumu Nishiyama
- Rheumatic Disease Center, Kurashiki Medical Center, Okayama, Japan
| | - Koichiro Tahara
- Department of Rheumatology, Tokyo Medical University Hospital, Tokyo, Japan
| | - Haeru Hayashi
- Department of Rheumatology, Tokyo Medical University Hospital, Tokyo, Japan
| | - Hiroaki Mori
- Department of Rheumatology, Tokyo Medical University Hospital, Tokyo, Japan
| | - Eri Kato
- Department of Rheumatology, Tokyo Medical University Hospital, Tokyo, Japan
| | - Mayu Tago
- Department of Rheumatology, Tokyo Medical University Hospital, Tokyo, Japan
| | - Toshihiro Matsui
- Department of Rheumatology, Clinical Research Center for Allergy and Rheumatology, National Hospital Organization Sagamihara National Hospital, Sagamihara, Japan
| | - Shigeto Tohma
- Department of Rheumatology, National Hospital Organization Tokyo National Hospital, Tokyo, Japan
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Abstract
PURPOSE OF REVIEW Flares correspond to fluctuations in disease activity or symptoms. They should be avoided in chronic inflammatory diseases. In axial spondyloarthritis (axSpA), work is ongoing to better conceptualise and treat flares. This review highlights recent data on the definition and management of flares in axSpA. RECENT FINDINGS Many definitions of flares have been used in clinical trials, limiting the interpretation and comparison of studies. The expert group Assessment of SpondyloArthritis International Society (ASAS) developed a data-driven definition of flares/disease worsening: an increase in Ankylosing Spondylitis Disease Activity Score-C-reactive protein (ASDAS-CRP) of at least 0.9 points, for use in axSpA clinical trials. Flares are more challenging to define in clinical practice because of their multifaceted nature. Qualitative studies have shown that flares from the patient's perspective are related not only to disease activity, but also to fatigue, mood, sleep and general well-being. The management of axSpA relies on a treat-to-target (T2T) strategy and aims at reaching clinical remission while monitoring closely disease activity to prevent and shorten flares. SUMMARY The concept of flares has been clarified, and definitions have been developed for use in trials. The T2T approach aims at minimising flares in axSpA. The early recognition of flares and their severity may lead to better management.
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Affiliation(s)
- Krystel Aouad
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Paris, France
- Saint George Hospital University Medical Center, University of Balamand, Beirut, Lebanon
| | - Laure Gossec
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Paris, France
- Pitié-Salpêtrière hospital, AP-HP, Rheumatology Department, Paris, France
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Correspondence between patient-reported flare and disease activity score variation in axial spondyloarthritis: a 12-months web-based study. Joint Bone Spine 2022; 89:105422. [PMID: 35714831 DOI: 10.1016/j.jbspin.2022.105422] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 04/23/2022] [Accepted: 06/01/2022] [Indexed: 11/21/2022]
Abstract
OBJECTIVE The aims of this study were to determine thresholds of variations of BASDAI and pain associated with patient-reported outbreak or resolution of flare and to test performance of ASAS preliminary definitions of flare. METHODS SpA patients registered on the Spondy+ platform were invited to fill BASDAI and global pain on numeric rating scales every week during one year and to tell if they experienced flare since last week. Performance of BASDAI and pain variations (ΔBASDAI and Δpain) to detect occurrence and resolution of flare was determined with receiver operator characteristic (ROC) curves. RESULTS Ninety-one of the 99 axSpA patients included reported at least one episode of flare. Area under the ROC curve was significantly higher for ΔBASDAI than for Δpain to predict outbreak of flare (0.81 vs. 0.77, p<0.05) without statiscally significant difference to predict flare resolution (0.78 vs. 0.80). Best sensitivity/specificity compromise was obtained for ΔBASDAI of 0.2 and 0.4 points to predict flare outbreak or resolution, respectively. All the ASAS definitions obtained a specificity higher than 95% whereas sensitivity was lower than 40%. CONCLUSION ΔBASDAI appeared as a suitable variable to monitor occurrence and resolution of patient-reported flare in axSpA.
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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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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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Pina Vegas L, Sbidian E, Wendling D, Goupille P, Ferkal S, Le Corvoisier P, Ghaleh B, Luciani A, Claudepierre P. Factors associated with remission at 5-year follow-up in recent onset axial spondyloarthritis: results from the DESIR cohort. Rheumatology (Oxford) 2021; 61:1487-1495. [PMID: 34270707 PMCID: PMC8996779 DOI: 10.1093/rheumatology/keab565] [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: 03/12/2021] [Revised: 07/05/2021] [Indexed: 11/30/2022] Open
Abstract
Objective The factors contributing to long-term remission in axial SpA (axSpA) are unclear. We aimed to characterize individuals with axSpA at the 5-year follow-up to identify baseline factors associated with remission. Methods We included all patients from the DESIR cohort (with recent-onset axSpA) with an available Ankylosing Spondylitis Disease Activity Score–CRP (ASDAS-CRP) at 5-year follow-up. Patients in remission (ASDAS-CRP < 1.3) were compared with those with active disease by demographic, clinical, biological and imaging characteristics. A logistic model stratified on TNF inhibitor (TNFi) exposure was used. Results Overall, 111/449 patients (25%) were in remission after 5 years. Among those never exposed to TNFi, 31% (77/247) were in remission compared with 17% (34/202) of those exposed to TNFi. Patients in remission after 5 years were more likely to be male, HLA-B27+, have a lower BMI, and a higher education level. Baseline factors associated with 5-year remission in patients never exposed to TNFi included lower BASDAI [adjusted odds ratio (ORa) 0.9, 95% CI: 0.8, 0.9) and history of peripheral arthritis (ORa 2.1, 95% CI: 1.2, 5.3). In those exposed to TNFi, remission was associated with higher education level (ORa 2.9, 95% CI: 1.6, 5.1), lower enthesitis index (ORa 0.8, 95% CI: 0.7, 0.9), lower BASDAI (ORa 0.9, 95% CI: 0.9, 0.9) and lower BMI (ORa 0.8, 95% CI: 0.7, 0.9). Conclusion This study highlights the difficulty in achieving 5-year remission in those with recent-onset axSpA, especially for the more active cases, despite the use of TNFi. Socio-economic factors and BMI are implicated in the outcome at 5 years.
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Affiliation(s)
- Laura Pina Vegas
- EpiDermE, Université Paris Est Créteil, Créteil, France.,Service de Rhumatologie, AP-HP, Hôpital Henri Mondor, Créteil, France
| | - Emilie Sbidian
- EpiDermE, Université Paris Est Créteil, Créteil, France.,Service de Dermatologie, AP-HP, Hôpital Henri Mondor, Créteil, France.,INSERM, Centre d'Investigation Clinique 1430, Créteil, France
| | - Daniel Wendling
- Service de rhumatologie, CHRU de Besançon, Besançon, France.,EA 4266 « agents pathogènes et inflammation », université de Franche-Comté, Besançon, France
| | - Philippe Goupille
- Service de Rhumatologie, CHU de Tours, Tours, France.,EA 7501, GICC, Université de Tours, Tours, France
| | - Salah Ferkal
- Service de Dermatologie, AP-HP, Hôpital Henri Mondor, Créteil, France.,INSERM, Centre d'Investigation Clinique 1430, Créteil, France
| | - Philippe Le Corvoisier
- INSERM, Centre d'Investigation Clinique 1430, Créteil, France.,Inserm, U955-IMRB, Équipe 03, UPEC, Ecole Nationale Vétérinaire d'Alfort, Créteil, France
| | - Bijan Ghaleh
- Plateforme de Ressources Biologiques, AP-HP, Hôpital Henri Mondor, Créteil, France
| | - Alain Luciani
- Inserm U955 équipe 18, Université Paris Est Créteil, Créteil, France
| | - Pascal Claudepierre
- EpiDermE, Université Paris Est Créteil, Créteil, France.,Service de Rhumatologie, AP-HP, Hôpital Henri Mondor, Créteil, France
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11
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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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12
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Abstract
PURPOSE OF REVIEW Patients with ankylosing spondylitis (AS) warrant a comprehensive clinical assessment because of the lack of biomarkers of disease activity, prognosis and response to biologic therapy. Multiple AS-related questionnaires have been developed to assess the disease status accurately, but feasibility remains a problem in clinical practice. The purpose of this review is to assess the pearls and pitfalls of AS-related outcome measures. RECENT FINDINGS Single-item questionnaires to measure pain, stiffness and fatigue in patients with AS are easily administrable but may lack a sufficient degree of responsiveness on an individual patient level. The Bath Ankylosing Disease Activity Index remains the gold standard for assessing disease activity in a routine practice, despite poor correlation with C-reactive protein (CRP) levels and MRI inflammation. The Ankylosing Spondylitis Disease Activity Score, a validated and highly discriminatory tool for assessing disease activity in AS, has been developed but lacks feasibility as erythrocytic sedimentation rate and CRP values are often not available during a clinic visit. RAPID-3 appears feasible to assess patients with AS quantitatively over time in busy clinical settings. SUMMARY The assessment of disease status in AS is complex and is impacted by multiple factors. The biggest challenge in AS is to incorporate the disease-specific indices into a routine practice. VIDEO ABSTRACT: http://links.lww.com/COR/A42.
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13
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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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14
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Wang CTM, Fong W, Kwan YH, Phang JK, Lui NL, Leung YY, Thumboo J, Cheung PP. A cross-sectional study on factors associated with patient-physician discordance in global assessment of patients with axial spondyloarthritis: an Asian perspective. Int J Rheum Dis 2018; 21:1436-1442. [DOI: 10.1111/1756-185x.13299] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
- Charmaine Tze May Wang
- Department of Rheumatology and Immunology; Singapore General Hospital; Singapore City Singapore
| | - Warren Fong
- Department of Rheumatology and Immunology; Singapore General Hospital; Singapore City Singapore
- Duke-NUS Medical School; Singapore City Singapore
- Department of Medicine; Yong Loo Lin School of Medicine; National University Singapore; Singapore City Singapore
| | - Yu Heng Kwan
- Program in Health Services and Systems Research; Duke-NUS Medical School; Singapore City Singapore
| | - Jie Kie Phang
- Department of Rheumatology and Immunology; Singapore General Hospital; Singapore City Singapore
| | - Nai Lee Lui
- Department of Rheumatology and Immunology; Singapore General Hospital; Singapore City Singapore
| | - Ying Ying Leung
- Department of Rheumatology and Immunology; Singapore General Hospital; Singapore City Singapore
| | - Julian Thumboo
- Department of Rheumatology and Immunology; Singapore General Hospital; Singapore City Singapore
- Duke-NUS Medical School; Singapore City Singapore
- Department of Medicine; Yong Loo Lin School of Medicine; National University Singapore; Singapore City Singapore
| | - Peter P. Cheung
- Department of Medicine; Yong Loo Lin School of Medicine; National University Singapore; Singapore City Singapore
- Division of Rheumatology; National University Hospital; Singapore City Singapore
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15
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Kiltz U, van der Heijde D, Boonen A, Akkoc N, Bautista-Molano W, Burgos-Vargas R, Wei JCC, Chiowchanwisawakit P, Dougados M, Duruoz MT, Elzorkany BK, Gaydukova I, Gensler LS, Gilio M, Grazio S, Gu J, Inman RD, Kim TJ, Navarro-Compan V, Marzo-Ortega H, Ozgocmen S, Pimentel Dos Santos F, Schirmer M, Stebbings S, Van den Bosch FE, van Tubergen A, Braun J. Measurement properties of the ASAS Health Index: results of a global study in patients with axial and peripheral spondyloarthritis. Ann Rheum Dis 2018; 77:1311-1317. [PMID: 29858176 DOI: 10.1136/annrheumdis-2017-212076] [Citation(s) in RCA: 74] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2017] [Revised: 04/12/2018] [Accepted: 04/20/2018] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To evaluate construct validity, interpretability, reliability and responsiveness as well as determination of cut-off points for good and poor health within the original English version and the 18 translations of the disease-specific Assessment of Spondyloarthritis international Society Health Index (ASAS HI) in 23 countries worldwide in patients with spondyloarthritis (SpA). METHODS A representative sample of patients with SpA fulfilling the ASAS classification criteria for axial (axSpA) or peripheral SpA was used. The construct validity of the ASAS HI was tested using Spearman correlation with several standard health outcomes for axSpA. Test-retest reliability was assessed by intraclass correlation coefficients (ICCs) in patients with stable disease (interval 4-7 days). In patients who required an escalation of therapy because of high disease activity, responsiveness was tested after 2-24weeks using standardised response mean (SRM). RESULTS Among the 1548 patients, 64.9% were men, with a mean (SD) age 42.0 (13.4) years. Construct validity ranged from low (age: 0.10) to high (Bath AnkylosingSpondylitisFunctioning Index: 0.71). Internal consistency was high (Cronbach's α of 0.93). The reliability among 578 patients was good (ICC=0.87 (95% CI 0.84 to 0.89)). Responsiveness among 246 patients was moderate-large (SRM=-0.44 for non-steroidal anti-inflammatory drugs, -0.69 for conventional synthetic disease-modifying antirheumatic drug and -0.85 for tumour necrosis factor inhibitor). The smallest detectable change was 3.0. Values ≤5.0 have balanced specificity to distinguish good health as opposed to moderate health, and values ≥12.0 are specific to represent poor health as opposed to moderate health. CONCLUSIONS The ASAS HI proved to be valid, reliable and responsive. It can be used to evaluate the impact of SpA and its treatment on functioning and health. Furthermore, comparison of disease impact between populations is possible.
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Affiliation(s)
- Uta Kiltz
- Rheumazentrum Ruhrgebiet, Herne, Germany
| | | | - Annelies Boonen
- Division of Rheumatology, Maastricht University Medical Center, Maastricht, The Netherlands
| | | | - Wilson Bautista-Molano
- School of Medicine, Universidad Militar Nueva Granada and Rheumatology Department, Hospital Militar, Bogotà, Colombia
| | | | - James Cheng-Chung Wei
- Division of Allergy, Immunology and Rheumatology, Chung Shan Medical University Hospital, Institute of Medicine, Graduate Institute of Integrated Medicine, China Medical University, Taichung, Taiwan
| | | | - Maxime Dougados
- Department of Rheumatology, Servicio de Reumatologia, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris INSERM (U1153): Clinical Epidemiology and Biostatistics, PRES Sorbonne Paris-Cité, H, Paris, France
| | - M Tuncay Duruoz
- PMR Department, Rheumatology Division, Marmara University School of Medicine, Istanbul, Turkey
| | | | - Inna Gaydukova
- North-Western State Medical University named after I I Mechnikov, St. Petersburg, Russian Federation
| | - Lianne S Gensler
- Division of Rheumatology, University of California, San Francisco, San Francisco, California, USA
| | - Michele Gilio
- Department of Lucania, San Carlo Hospital of Potenza and Madonna delle Grazie Hospital of Matera, Potenza and Matera and PhD Scholarship in Life Sciences, Department of Health Sciences, University of Catanzaro 'Magna Graecia', Catanzaro, Italy
| | - Simeon Grazio
- Sestre Milosrdnice University Hospital Center, Zagreb, Croatia
| | - Jieruo Gu
- University of Guangzhou, Guangzhou, China
| | - Robert D Inman
- Spondylitis, University of Toronto, Toronto, Ontario, Canada
| | - Tae-Jong Kim
- Chonnam National University Medical School and Hospital, South Korea
| | | | - Helena Marzo-Ortega
- NIHR Leeds Biomedical Research Centre, Chapel Allerton Hospital, Leeds, and Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
| | - Salih Ozgocmen
- Department of Rheumatology, Medicalpark Gaziosmanpasa Hospital, Istanbul, Turkey
| | | | - Michael Schirmer
- Department of Internal Medicine, Innsbruck Medical University, Clinic II, Innsbruck, Austria
| | - Simon Stebbings
- Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Filip E Van den Bosch
- VIB Center for Inflammation Research, Unit for Molecular Immunology and Inflammation, Department of Internal Medicine, Ghent University, Ghent, Belgium.,Department of Rheumatology, Ghent University Hospital, Ghent, Belgium
| | - Astrid van Tubergen
- Division of Rheumatology, Maastricht University Medical Center, Maastricht, The Netherlands
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16
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Karpouzas GA, Ramadan SN, Cost CE, Draper TL, Hernandez E, Strand V, Ormseth SR. Discordant patient-physician assessments of disease activity and its persistence adversely impact quality of life and work productivity in US Hispanics with rheumatoid arthritis. RMD Open 2017; 3:e000551. [PMID: 29119008 PMCID: PMC5663273 DOI: 10.1136/rmdopen-2017-000551] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Revised: 10/04/2017] [Accepted: 10/09/2017] [Indexed: 12/22/2022] Open
Abstract
Objective This study was designed to evaluate the determinants of patient and physician global assessments (PtGA and MDGA, respectively) of disease activity, their discordance and change over 2 years in Hispanics with rheumatoid arthritis (RA). We further examined the impact of discordance and its persistence on health-related quality of life (HRQOL) and work productivity on final visit. Methods We studied 536 Hispanics with established RA from a single centre. PtGA and MDGA were measured annually on 10 cm visual analogue scales and discordance was defined as absolute difference between them ≥3 cm. Associations between predictors and outcomes of interest were evaluated using multivariable regression and analysis of covariance for cross-sectional and longitudinal data, respectively. Results Independent predictors of baseline PtGA were pain, fatigue, depression, general health perceptions and tender joint count. MDGA was predicted by swollen joint count, tender joint count, erythrocyte sedimentation rate, fatigue and depression. Both PtGA and MDGA improved over time (all p<0.001). Discordance was observed in 43% at baseline, with fair stability over 2 years. Higher (worse) patient ratings were most prevalent; their presence at any time and increasing persistence predicted lower physical and mental HRQOL, decreased work productivity and more activity impairment at 2-year follow-up (all p<0.001). Conclusions Determinants of PtGA, MDGA and changes over 2 years were disparate in Hispanics with RA yielding significant discordance. Higher patient ratings at any time contributed to worse HRQOL, work productivity and activity impairment on final visit.
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Affiliation(s)
- George A Karpouzas
- Division of Rheumatology, Harbor-UCLA Medical Center and Los Angeles Biomedical Research Institute, Torrance, California, USA
| | - Sera N Ramadan
- Division of Rheumatology, Harbor-UCLA Medical Center and Los Angeles Biomedical Research Institute, Torrance, California, USA
| | - Chelsie E Cost
- David Geffen School of Medicine, Department of Psychology, University of California, Cousins Center for Psychoneuroimmunology, Los Angeles, California, USA
| | - Taylor L Draper
- David Geffen School of Medicine, Department of Psychology, University of California, Cousins Center for Psychoneuroimmunology, Los Angeles, California, USA
| | - Elizabeth Hernandez
- Division of Rheumatology, Harbor-UCLA Medical Center and Los Angeles Biomedical Research Institute, Torrance, California, USA
| | - Vibeke Strand
- Division of Immunology/Rheumatology, Stanford University School of Medicine, Palo Alto, California, USA
| | - Sarah R Ormseth
- Division of Rheumatology, Harbor-UCLA Medical Center and Los Angeles Biomedical Research Institute, Torrance, California, USA
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17
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Molto A, Gossec L, Meghnathi B, Landewé RBM, van der Heijde D, Atagunduz P, Elzorkany BK, Akkoc N, Kiltz U, Gu J, Wei JCC, Dougados M. An Assessment in SpondyloArthritis International Society (ASAS)-endorsed definition of clinically important worsening in axial spondyloarthritis based on ASDAS. Ann Rheum Dis 2017; 77:124-127. [DOI: 10.1136/annrheumdis-2017-212178] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Revised: 09/12/2017] [Accepted: 10/06/2017] [Indexed: 01/17/2023]
Abstract
IntroductionIn a previous phase, 12 draft definitions for clinically important worsening in axial spondyloarthritis (axSpA) were selected, of which 3 were based on absolute changes in Ankylosing Spondylitis Disease Activity Score (ASDAS)-CRP (ASDAS). The objective here was to select the best cut-off for ASDAS for clinically important worsening in axSpA for use in clinical trials and observational studies.MethodsAn international longitudinal prospective study evaluating stable patients with axSpA was conducted. Data necessary to calculate ASDAS were collected at two consecutive visits (spaced 7 days to 6 months). Sensitivity and specificity of the three cut-offs for change in ASDAS were tested against the patient’s subjective assessment of worsening as the external standard (ie, the patient reporting that he had worsened and felt a need for treatment intensification). Final selection was made by a consensus and voting procedure among Assessment of SpondyloArthritis International Society (ASAS) members.ResultsIn total, 1169 patients with axSpA were analysed: 64.8% were male and had a mean age of 41.7 (SD 12.4) years. At the second visit, 127 (10.9%) patients judged their situation as worsened.Sensitivity and specificity for an increase of at least 0.6, 0.9 and 1.1 ASDAS points to detect patient-reported worsening were 0.55 (Se) and 0.91 (Sp), 0.38 (Se) and 0.96 (Sp), and 0.33 (Se) and 0.98 (Sp), respectively. The ASAS consensus was to define clinically important worsening as an increase in ASDAS of at least 0.9 points.ConclusionThis data-driven ASAS consensus process resulted in an ASDAS-based cut-off value defining clinically important worsening in axSpA for use in trials.
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18
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Harvard S, Guh D, Bansback N, Richette P, Saraux A, Fautrel B, Anis A. Access criteria for anti-TNF agents in spondyloarthritis: influence on comparative 1-year cost-effectiveness estimates. COST EFFECTIVENESS AND RESOURCE ALLOCATION 2017; 15:20. [PMID: 28904528 PMCID: PMC5590198 DOI: 10.1186/s12962-017-0081-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2016] [Accepted: 08/23/2017] [Indexed: 12/17/2022] Open
Abstract
Background Anti-tumor necrosis factor (anti-TNF) agents are an effective, but costly, treatment for spondyloarthritis (SpA). Worldwide, multiple sets of access criteria aim to restrict anti-TNF therapy to patients with specific clinical characteristics, yet the influence of access criteria on anti-TNF cost-effectiveness is unknown. Our objective was to use data from the DESIR cohort, a prospective study of early SpA patients in France, to determine whether the French anti-TNF access criteria are the most cost-effective in that setting relative to other potential restrictions. Methods We used data from the DESIR cohort to create five study populations of patients meeting anti-TNF access criteria from Canada, France, Germany, United Kingdom, and Hong Kong, respectively. For each study population, we calculated the costs and quality-adjusted life years (QALYs) over 1 year of patients treated and not treated with anti-TNF therapy. To control for differences between anti-TNF users and non-users, we used linear regression models to derive adjusted mean costs and QALYs. We calculated incremental cost-effectiveness ratios (ICERs) representing the incremental cost per additional QALY gained by treating with an anti-TNF within each of the five study populations, using bootstrapping to explore the range of uncertainty in costs and QALYs. A series of sensitivity analyses was conducted, including one to simulate the effect of a 24-week stopping rule for anti-TNF non-responders. Results Anti-TNF access criteria from France were satisfied by the largest proportion of DESIR patients (27.8%), followed by Germany (25.1%), Canada (23.8%), the UK (12.1%) and Hong Kong (8.6%). Confidence intervals around incremental costs and QALYs in the basecase analysis were overlapping, indicating that anti-TNF cost-effectiveness estimates derived from each subset were similar. In the sensitivity analysis that examined the effect of excluding costs accumulated past 24 weeks by anti-TNF non-responders, the incremental cost per QALY was reduced by approximately 25% relative to the basecase analysis (France: €857,992 vs. €1,105,859; Canada: € 626,459 vs. €818,186; Germany: € 422,568 vs. €545,808); UK €578,899 vs. €766,217; Hong Kong €335,418 vs. €456,850). Conclusions Anti-TNF cost-effectiveness is strongly affected by treatment continuation among non-responders. Access criteria could improve anti-TNF cost-effectiveness by defining patients likely to respond. Electronic supplementary material The online version of this article (doi:10.1186/s12962-017-0081-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Stephanie Harvard
- University of British Columbia, Vancouver, Canada.,Centre for Health Evaluation and Outcome Sciences, 588-1081, Burrard Street, Vancouver, BC V6Z 1Y6 Canada.,Sorbonne Universités, UPMC-GRC08, Pierre Louis Institute for Epidemiology and Public Health, Paris, France
| | - Daphne Guh
- Centre for Health Evaluation and Outcome Sciences, 588-1081, Burrard Street, Vancouver, BC V6Z 1Y6 Canada
| | - Nick Bansback
- University of British Columbia, Vancouver, Canada.,Centre for Health Evaluation and Outcome Sciences, 588-1081, Burrard Street, Vancouver, BC V6Z 1Y6 Canada
| | - Pascal Richette
- University Paris Diderot, Faculty of Medicine, Paris 07, Paris, France.,AP-HP, Rheumatology Department, Lariboisiere University Hospital, Paris, France
| | - Alain Saraux
- Rheumatology Unit, Hôpital de la Cavale Blanche, 29609 Brest, France.,EA2216, INSERM ESPRI ERI29 Université de Brest LabEx IGO, Brest, France
| | - Bruno Fautrel
- Sorbonne Universités, UPMC-GRC08, Pierre Louis Institute for Epidemiology and Public Health, Paris, France.,AP-HP, Rheumatology Department, Pitié Salpétrière University Hospital, Paris, France
| | - Aslam Anis
- University of British Columbia, Vancouver, Canada.,Centre for Health Evaluation and Outcome Sciences, 588-1081, Burrard Street, Vancouver, BC V6Z 1Y6 Canada
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19
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Desthieux C, Granger B, Balanescu AR, Balint P, Braun J, Canete JD, Heiberg T, Helliwell PS, Kalyoncu U, Kvien TK, Kiltz U, Niedermayer D, Otsa K, Scrivo R, Smolen J, Stamm TA, Veale DJ, de Vlam K, de Wit M, Gossec L. Determinants of Patient-Physician Discordance in Global Assessment in Psoriatic Arthritis: A Multicenter European Study. Arthritis Care Res (Hoboken) 2017; 69:1606-1611. [DOI: 10.1002/acr.23172] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Revised: 11/22/2016] [Accepted: 12/13/2016] [Indexed: 01/18/2023]
Affiliation(s)
- Carole Desthieux
- Sorbonne Universités, UPMC University Paris 06, Institut Pierre Louis d'Epidémiologie et de Santé Publique, GRC-UPMC 08 (EEMOIS), AP-HP, Hôpital Pitié Salpêtrière; Paris France
| | - Benjamin Granger
- Sorbonne Universités, UPMC University Paris 06, Institut Pierre Louis d'Epidémiologie et de Santé Publique, GRC-UPMC 08 (EEMOIS), AP-HP, Hôpital Pitié Salpêtrière; Paris France
| | - Andra Rodica Balanescu
- University of Medicine and Pharmacy Carol Davila and St Maria Hospital; Bucharest Romania
| | - Peter Balint
- National Institute of Rheumatology and Physiotherapy; Budapest Hungary
| | - Jürgen Braun
- Ruhrgebiet, Herne and Ruhr-Universität Bochum; Herne Germany
| | | | - Turid Heiberg
- Østfold University College, Halden, and Regional Research Support, Oslo University Hospital; Oslo Norway
| | | | | | | | - Uta Kiltz
- Ruhrgebiet, Herne and Ruhr-Universität Bochum; Herne Germany
| | - Dora Niedermayer
- National Institute of Rheumatology and Physiotherapy; Budapest Hungary
| | - Kati Otsa
- Tallinn Central Hospital; Tallinn Estonia
| | | | - Josef Smolen
- III Medical University of Vienna; Vienna Austria
| | | | - Douglas J. Veale
- Dublin Academic Medical Centre and St Vincent's University Hospital; Dublin Ireland
| | | | - Maarten de Wit
- Patient Research Partner, People with Arthritis/Rheumatism in Europe; Zurich Switzerland
| | - Laure Gossec
- Sorbonne Universités, UPMC University Paris 06, Institut Pierre Louis d'Epidémiologie et de Santé Publique, GRC-UPMC 08 (EEMOIS), AP-HP, Hôpital Pitié Salpêtrière; Paris France
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Abstract
PURPOSE OF REVIEW Incorporation of the patients' perspective in clinical research is critical to ensure that outcomes measured reflect those, which matter most to patients. This review summarizes recent efforts to include the patients' perspective in the development of outcome measures and the importance of encouraging patient participation in decision-making and self-management. RECENT FINDINGS Since the inclusion of fatigue as a patient-endorsed core outcome measure in rheumatoid arthritis (RA) trials, OMERACT has been instrumental in advocating for patient involvement in the development of core domains and instruments; current endeavors include cultivating an understanding of remission through the eyes of patients and gaining a sense of how to measure features of pain and 'stiffness' deemed as important to patients. The concept of remission was further explored in RA patients, highlighting a common goal of returning to normality; additionally, various tools have been developed to assess for unmet needs in rheumatology patients. Advances have also been made in the development and revision of patient-centered core measures in rheumatologic diagnoses outside of RA. SUMMARY Incorporating the patients' perspective is now considered an essential feature in outcomes research. Future research should focus on how best to involve patients in specific research activities.
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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: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [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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Abstract
PURPOSE OF REVIEW Incorporation of the patients' perspective in clinical research is critical to ensure that outcomes measured reflect those, which matter most to patients. This review summarizes recent efforts to include the patients' perspective in the development of outcome measures and the importance of encouraging patient participation in decision-making and self-management. RECENT FINDINGS Since the inclusion of fatigue as a patient-endorsed core outcome measure in rheumatoid arthritis (RA) trials, OMERACT has been instrumental in advocating for patient involvement in the development of core domains and instruments; current endeavors include cultivating an understanding of remission through the eyes of patients and gaining a sense of how to measure features of pain and 'stiffness' deemed as important to patients. The concept of remission was further explored in RA patients, highlighting a common goal of returning to normality; additionally, various tools have been developed to assess for unmet needs in rheumatology patients. Advances have also been made in the development and revision of patient-centered core measures in rheumatologic diagnoses outside of RA. SUMMARY Incorporating the patients' perspective is now considered an essential feature in outcomes research. Future research should focus on how best to involve patients in specific research activities.
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Jacquemin C, Maksymowych WP, Boonen A, Gossec L. Patient-reported Flares in Ankylosing Spondylitis: A Cross-sectional Analysis of 234 Patients. J Rheumatol 2016; 44:425-430. [PMID: 27980007 DOI: 10.3899/jrheum.160838] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/16/2016] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Ankylosing spondylitis (AS) is characterized by periodic flares. The objective of this study was to assess the frequency of patient-reported flares and their related factors. METHODS This cross-sectional study analyzed the 2004 data of a Canadian cohort. Participants had AS according to the modified New York criteria. Current flare status ("Are you experiencing a current flare"?), number of flares over the past 3 months, their average duration, the Bath Ankylosing Spondylitis Disease Activity and Functional Index (BASDAI and BASFI, respectively), and the AS Quality of Life questionnaire were assessed by self-report. Univariate and multivariate regressions analyzed the factors associated with current flare. RESULTS Among 234 analyzed patients, 169 (73.5%) were men, mean age was 45.5 (± 11.8) years, mean disease duration of 21.7 (± 11.7) years, and mean BASDAI and BASFI (0-10) of 4.4 (± 2.3) and 3.4 (± 2.6), respectively; 18 (7.7%) received antitumor necrosis factor (anti-TNF). Overall, 175 patients (74.8%) reported flares and 117 (50%) were currently in flare. Patients reporting flares had a median of 3 flares in 3 months, with a median duration of 2 weeks. Overall, the 234 patients spent a median of 25% of their time in flare. In multivariate analyses, current flare was significantly associated with higher BASDAI (OR 2.01, p = 0.01), worse quality of life (OR 1.37, p = 0.004), shorter AS duration (OR 1.19, p = 0.04), and less anti-TNF (OR 7.14, p = 0.03). CONCLUSION In this population, before the wide use of biologics, flares were frequent and long. As expected, flare was associated with higher disease activity, suggesting the validity of the concept of patient-reported flares.
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Affiliation(s)
- Charlotte Jacquemin
- From the UPMC Univ Paris 06, Institut Pierre Louis d'Epidémiologie et de Santé Publique, GRC-UPMC 08 (EEMOIS); APHP, Pitié-Salpêtrière Hospital, Department of Rheumatology, Paris, France; University of Alberta, Department of Medicine, Edmonton, Alberta, Canada; Maastricht University Medical Center, Department of Rheumatology, Maastricht, the Netherlands.,Dr. W.P. Maksymowych received research grants from Abbvie, Janssen, and Pfizer, and honoraria from Abbvie, Eli-Lilly, and Pfizer. Dr. L. Gossec received research grants from Pfizer France and Lilly France.,C. Jacquemin, MD, UPMC Univ Paris 06, Institut Pierre Louis d'Epidémiologie et de Santé Publique, GRC-UPMC 08 (EEMOIS), and APHP, Pitié-Salpêtrière Hospital, Department of Rheumatology; W.P. Maksymowych, FRCP(C), University of Alberta, Department of Medicine; A. Boonen, MD, PhD, Maastricht University Medical Center, Department of Rheumatology; L. Gossec, MD, PhD, Professor, UPMC Univ Paris 06, Institut Pierre Louis d'Epidémiologie et de Santé Publique, GRC-UPMC 08 (EEMOIS), and APHP, Pitié-Salpêtrière Hospital, Department of Rheumatology
| | - Walter P Maksymowych
- From the UPMC Univ Paris 06, Institut Pierre Louis d'Epidémiologie et de Santé Publique, GRC-UPMC 08 (EEMOIS); APHP, Pitié-Salpêtrière Hospital, Department of Rheumatology, Paris, France; University of Alberta, Department of Medicine, Edmonton, Alberta, Canada; Maastricht University Medical Center, Department of Rheumatology, Maastricht, the Netherlands.,Dr. W.P. Maksymowych received research grants from Abbvie, Janssen, and Pfizer, and honoraria from Abbvie, Eli-Lilly, and Pfizer. Dr. L. Gossec received research grants from Pfizer France and Lilly France.,C. Jacquemin, MD, UPMC Univ Paris 06, Institut Pierre Louis d'Epidémiologie et de Santé Publique, GRC-UPMC 08 (EEMOIS), and APHP, Pitié-Salpêtrière Hospital, Department of Rheumatology; W.P. Maksymowych, FRCP(C), University of Alberta, Department of Medicine; A. Boonen, MD, PhD, Maastricht University Medical Center, Department of Rheumatology; L. Gossec, MD, PhD, Professor, UPMC Univ Paris 06, Institut Pierre Louis d'Epidémiologie et de Santé Publique, GRC-UPMC 08 (EEMOIS), and APHP, Pitié-Salpêtrière Hospital, Department of Rheumatology
| | - Annelies Boonen
- From the UPMC Univ Paris 06, Institut Pierre Louis d'Epidémiologie et de Santé Publique, GRC-UPMC 08 (EEMOIS); APHP, Pitié-Salpêtrière Hospital, Department of Rheumatology, Paris, France; University of Alberta, Department of Medicine, Edmonton, Alberta, Canada; Maastricht University Medical Center, Department of Rheumatology, Maastricht, the Netherlands.,Dr. W.P. Maksymowych received research grants from Abbvie, Janssen, and Pfizer, and honoraria from Abbvie, Eli-Lilly, and Pfizer. Dr. L. Gossec received research grants from Pfizer France and Lilly France.,C. Jacquemin, MD, UPMC Univ Paris 06, Institut Pierre Louis d'Epidémiologie et de Santé Publique, GRC-UPMC 08 (EEMOIS), and APHP, Pitié-Salpêtrière Hospital, Department of Rheumatology; W.P. Maksymowych, FRCP(C), University of Alberta, Department of Medicine; A. Boonen, MD, PhD, Maastricht University Medical Center, Department of Rheumatology; L. Gossec, MD, PhD, Professor, UPMC Univ Paris 06, Institut Pierre Louis d'Epidémiologie et de Santé Publique, GRC-UPMC 08 (EEMOIS), and APHP, Pitié-Salpêtrière Hospital, Department of Rheumatology
| | - Laure Gossec
- From the UPMC Univ Paris 06, Institut Pierre Louis d'Epidémiologie et de Santé Publique, GRC-UPMC 08 (EEMOIS); APHP, Pitié-Salpêtrière Hospital, Department of Rheumatology, Paris, France; University of Alberta, Department of Medicine, Edmonton, Alberta, Canada; Maastricht University Medical Center, Department of Rheumatology, Maastricht, the Netherlands. .,Dr. W.P. Maksymowych received research grants from Abbvie, Janssen, and Pfizer, and honoraria from Abbvie, Eli-Lilly, and Pfizer. Dr. L. Gossec received research grants from Pfizer France and Lilly France. .,C. Jacquemin, MD, UPMC Univ Paris 06, Institut Pierre Louis d'Epidémiologie et de Santé Publique, GRC-UPMC 08 (EEMOIS), and APHP, Pitié-Salpêtrière Hospital, Department of Rheumatology; W.P. Maksymowych, FRCP(C), University of Alberta, Department of Medicine; A. Boonen, MD, PhD, Maastricht University Medical Center, Department of Rheumatology; L. Gossec, MD, PhD, Professor, UPMC Univ Paris 06, Institut Pierre Louis d'Epidémiologie et de Santé Publique, GRC-UPMC 08 (EEMOIS), and APHP, Pitié-Salpêtrière Hospital, Department of Rheumatology.
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