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Batko B, Stajszczyk M, Świerkot J, Urbański K, Raciborski F, Jędrzejewski M, Wiland P. Prevalence and clinical characteristics of rheumatoid arthritis in Poland: a nationwide study. Arch Med Sci 2019; 15:134-140. [PMID: 30697263 PMCID: PMC6348369 DOI: 10.5114/aoms.2017.71371] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Accepted: 10/13/2017] [Indexed: 12/26/2022] Open
Abstract
INTRODUCTION There are no reliable data regarding the prevalence of rheumatoid arthritis (RA) in Poland. MATERIAL AND METHODS The first stage was a face-to-face survey on a nationwide representative sample of 3000 people, which identified respondents with a physician-confirmed diagnosis of RA. The second stage was a survey of RA patients, which characterized the disease course and treatment. It was evaluated by analysis of a representative group of 1957 RA patients in routine clinical practice. RESULTS The overall RA prevalence in Poland was 0.9% (95% CI: 0.6-1.2%), 1.06% for women, 0.74% for men. Seventy-eight percent were female, mean age was 56 and mean disease duration 7 years. Younger patients (< 50) remained professionally active in 90% of cases. Thirty percent of patients were diagnosed within 3 months of the first RA symptoms, while for 17% it took more than 1 year. Fifty-six percent of newly diagnosed patients were characterized by high disease activity (DAS-28 > 5.1). Presently, low disease activity (DAS-28 < 3.2) was found in 38.5% of patients. In Poland, 94% of patients have been treated with non-steroid anti-inflammatory drugs, almost 80% with glucocorticoids. Meanwhile, methotrexate, as an anchor drug in Poland, has been used by 80% of patients, biological agents by 2.94% of patients. CONCLUSIONS This is the first cross-sectional population-based epidemiological study regarding prevalence of RA in the adult Polish population. The results demonstrate a high prevalence, falling within the upper boundary estimates for Europe. Despite ongoing treatment, the majority still have moderate to high disease activity, and the use of biological therapies is low.
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Affiliation(s)
- Bogdan Batko
- Department of Rheumatology, J. Dietl Specialist Hospital, Krakow, Poland
| | - Marcin Stajszczyk
- Rheumatology and Autoimmune Diseases Department, Silesian Rheumatology Center, Ustron, Poland
| | - Jerzy Świerkot
- Department of Rheumatology and Internal Medicine, Wroclaw Medical University, Wroclaw, Poland
| | - Karol Urbański
- Department of Internal and Agricultural Medicine, Jagiellonian University School of Medicine, Krakow, Poland
| | - Filip Raciborski
- Department of Prevention of Environmental Hazards and Allergology, Medical University of Warsaw, Poland
| | | | - Piotr Wiland
- Department of Rheumatology and Internal Medicine, Wroclaw Medical University, Wroclaw, Poland
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van der Zee-Neuen A, Putrik P, Ramiro S, Keszei AP, Hmamouchi I, Dougados M, Boonen A. Large country differences in work outcomes in patients with RA - an analysis in the multinational study COMORA. Arthritis Res Ther 2017; 19:216. [PMID: 28962581 PMCID: PMC5622486 DOI: 10.1186/s13075-017-1421-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Accepted: 09/05/2017] [Indexed: 11/10/2022] Open
Abstract
Background We aimed to explore whether country of residence or specific country characteristics are associated with work outcomes in rheumatoid arthritis (RA). Methods Data from the 17 countries participating in the Comorbidities in RA (COMORA) study were used. Work outcomes were measured by the Work Productivity and Activity Impairment Questionnaire, addressing employment (yes/no), absenteeism (percentage of time; 3 categories) and presenteeism (percentage of at-work productivity restrictions; 4 categories). Contribution of country of residence, gross domestic product (GDP), Human Development Index (HDI), unemployment rate, social protection expenditures (SPE) or world region to work outcomes was investigated in adjusted (ordered) logistic regressions. Results The patients (n = 2395) were younger than 60 years; mean age 48 (SD 9.2) years, 1972 (84%) female and 1065 (45%) employed. Large country differences were found. Taking the country with the best work outcome as reference, Moroccan patients had the lowest odds of being employed (OR 0.2 (95% CI 0.1; 0.3) vs. Germany) and highest odds of absenteeism (OR 13.2 (3.6; 48.3) vs. Japan). Patients in Taiwan had the highest odds of presenteeism (OR 13.0 (5.5; 30.9) vs. Venezuela). All country indices except SPE were associated with work outcomes. For example, patients in low-GDP countries had lower odds of employment (OR 0.6 (0.5; 0.8)), higher odds of absenteeism (OR 2.8 (2.0; 4.1)), but lower odds of presenteeism (OR 0.5 (0.4; 0.7)) compared to higher-GDP countries. Conclusion Substantial differences in work outcomes among patients with RA were observed between countries. Lower economic wealth and human development of countries were associated with worse employment and higher absenteeism, but lower presenteeism. Electronic supplementary material The online version of this article (doi:10.1186/s13075-017-1421-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Antje van der Zee-Neuen
- CAPHRI, Maastricht University, Maastricht, The Netherlands. .,Department of Rheumatology, Maastricht University Medical Centre, P/O 5800, NL-6202, AZ, Maastricht, The Netherlands.
| | - Polina Putrik
- Department of Internal Medicine, Division of Rheumatology, Maastricht University Medical Centre, Maastricht, The Netherlands.,CAPHRI, Maastricht University, Maastricht, The Netherlands
| | - Sofia Ramiro
- Rheumatology, Leiden University Medical Center, Leiden, Netherlands
| | - Andras P Keszei
- Medical Informatics, Uniklinik RWTH Aachen University, Aachen, Germany
| | - Ihsane Hmamouchi
- Biostatistics Epidemiology LBRCE, Université Mohamed-V Souissi, Rabat, Morocco
| | - Maxime Dougados
- Paris Descartes University, Department of Rheumatology - Hôpital Cochin. Assistance Publique-Hôpitaux de Paris INSERM (U1153): Clinical epidemiology and biostatistics, PRES Sorbonne Paris-Cité, Paris, France
| | - Annelies Boonen
- Department of Internal Medicine, Division of Rheumatology, Maastricht University Medical Centre, Maastricht, The Netherlands.,CAPHRI, Maastricht University, Maastricht, The Netherlands
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Castillo-Ortiz JD, Ramiro S, Landewé R, van der Heijde D, Dougados M, van den Bosch F, Boonen A. Work Outcome in Patients With Ankylosing Spondylitis: Results From a 12-Year Followup of an International Study. Arthritis Care Res (Hoboken) 2016; 68:544-52. [PMID: 26414460 DOI: 10.1002/acr.22730] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2014] [Revised: 08/11/2015] [Accepted: 09/08/2015] [Indexed: 12/19/2022]
Abstract
OBJECTIVE To understand the impact of ankylosing spondylitis (AS) on work disability (WD) over 12 years compared with the general population, and explore factors predicting adverse work outcome, defined as new partial WD or reduction in working hours. METHODS Source of data was the Outcome Assessments in Ankylosing Spondylitis International Study, which includes patients from The Netherlands, France, and Belgium. Standardized WD rates over time compared to the general population were calculated using indirect standardization (Dutch patients only). Cox survival analyses identified baseline predictors as well as time-varying factors influencing adverse work outcome over 12 years. RESULTS Of 215 patients, 55 (26%) were full WD at baseline and 139 (65%) were at risk for adverse work outcome during followup. When compared to the general population, WD over 12 years continued to be increased in Dutch men (incidence rate [IR] 2.9 [95% confidence interval (95% CI) 1.2, 4.6]), but less clearly for women (IR 1.2 [95% CI -0.4, 2.9]). Within the entire sample, baseline predictors of adverse work outcome over 12 years were residence in The Netherlands (versus France or Belgium) (hazard ratio [HR] 3.4 [95% CI 1.4, 8.4]) and worse Bath Ankylosing Spondylitis Functional Index (BASFI) (HR 1.2 [95% CI 1.0, 1.4]). Time-varying predictors over 12 years were residence in The Netherlands, uveitis, and either BASFI or Bath Ankylosing Spondylitis Disease Activity Index with age and inflammatory bowel disease. CONCLUSION Although WD was already prevalent at inclusion in the cohort, a substantial proportion of patients incurred further adverse work outcome over 12 years. In addition to country of residence, uveitis, age, and self-reported physical function or disease activity predicted long-term adverse work outcome.
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Affiliation(s)
- J D Castillo-Ortiz
- Maastricht University, Maastricht, The Netherlands, and Unidad de Investigacion en Enfermedades Cronico Degenerativas, Guadalajara, Jalisco, Mexico
| | - S Ramiro
- Amsterdam Rheumatology Center, Amsterdam, The Netherlands, and Hospital Garcia de Orta, Almada, Portugal
| | - R Landewé
- Hospital Garcia de Orta, Almada, Portugal, and Atrium Medical Center, Heerlen, The Netherlands
| | | | | | | | - A Boonen
- Maastricht University, Maastricht, The Netherlands
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Su B, Ma Q, Edwards CJ, Williams M, Adams J. Characteristics of hand involvement in a comparative study of two early RA cohorts from the UK and China. Int J Rheum Dis 2015; 20:1426-1436. [DOI: 10.1111/1756-185x.12573] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Bowen Su
- Faculty of Health Sciences; University of Southampton; Southampton UK
| | - Qing Ma
- Yueyang Hospital of Integrated Traditional Chinese and Western Medicine; Shanghai University of Traditional Chinese Medicine; Shanghai China
| | - Christopher J. Edwards
- NIHR Wellcome Trust Clinical Research Facility; University Hospital Southampton NHS Foundation Trust; Southampton & Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS); UK
| | - Mark Williams
- Nuffield Department of Orthopaedics; Rheumatology and Musculoskeletal Sciences (NDORMS); University of Oxford; Oxford UK
| | - Jo Adams
- Faculty of Health Sciences; University of Southampton; Southampton UK
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Abstract
Rheumatoid arthritis (RA) is a chronic inflammatory disease which, if left untreated, leads to functional disability, pain, reduced health-related quality of life and premature mortality. Between 0.5% and 1% of the population are affected worldwide, and between 25 and 50 new cases evolve in a population of 100,000. Practically all patients with RA require initiation with disease-modifying antirheumatic treatment to retard or stop progression, control disease manifestations and reduce the disease burden. If disease course is monitored with adjustment of medication, lifestyle factors, and exercise, as well as physical activity levels, co-morbidities may be prevented in the course of RA. During the last decade, major progress has been made in treating RA through early identification and treatment of the disease. Many patients still experience premature work disability and co-morbidities. For societies, the economic burden of RA is high in terms of direct and indirect costs, including modern drug treatment.
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Affiliation(s)
- Till Uhlig
- National Advisory Unit on Rehabilitation in Rheumatology, Department of Rheumatology, Diakonhjemmet Hospital, Box 23 Vinderen, 0319, Oslo, Norway,
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Clinical assessment and health status in standard care in Indian and Iranian patients suffering from rheumatoid arthritis (RA). INDIAN JOURNAL OF RHEUMATOLOGY 2014. [DOI: 10.1016/j.injr.2014.02.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Sokka T, Envalds M, Pincus T. Treatment of rheumatoid arthritis: a global perspective on the use of antirheumatic drugs. Mod Rheumatol 2014. [DOI: 10.3109/s10165-008-0056-x] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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HLA-DRB1 and HLA-DQB1 allele associations in an Albanian patient population with rheumatoid arthritis: correlations with the specific autoantibody markers and inter-population DRB1 allele frequency variability. Rheumatol Int 2014; 34:1065-71. [DOI: 10.1007/s00296-013-2932-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2013] [Accepted: 12/18/2013] [Indexed: 10/25/2022]
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Woolf AD, Erwin J, March L. The need to address the burden of musculoskeletal conditions. Best Pract Res Clin Rheumatol 2013; 26:183-224. [PMID: 22794094 DOI: 10.1016/j.berh.2012.03.005] [Citation(s) in RCA: 181] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2012] [Accepted: 02/12/2012] [Indexed: 10/28/2022]
Abstract
Musculoskeletal conditions are common in men and women of all ages across all socio-demographic strata of society. They are the most common cause of severe long-term pain and physical disability and affect hundreds of millions of people around the world. They impact on all aspects of life through pain and by limiting activities of daily living typically by affecting dexterity and mobility. They affect one in four adults across Europe [1]. Musculoskeletal conditions have an enormous economic impact on society through both direct health expenditure related to treating the sequelae of the conditions and indirectly through loss of productivity. The prevalence of many of these conditions increases markedly with age, and many are affected by lifestyle factors, such as obesity and lack of physical activity. The burden of these conditions is therefore predicted to increase, in particular in developing countries. The impact on individuals and society of the major musculoskeletal conditions is reviewed and effective prevention, treatment and rehabilitation considered. The need to recognise musculoskeletal conditions as a global public health priority is discussed.
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Affiliation(s)
- Anthony D Woolf
- Department of Rheumatology, Royal Cornwall Hospital, Truro, UK.
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Kingsley G, Scott IC, Scott DL. Quality of life and the outcome of established rheumatoid arthritis. Best Pract Res Clin Rheumatol 2012; 25:585-606. [PMID: 22137926 DOI: 10.1016/j.berh.2011.10.003] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2011] [Accepted: 10/11/2011] [Indexed: 02/01/2023]
Abstract
Rheumatoid arthritis (RA) is a long-term condition causing joint pain and swelling and sometimes systemic involvement. The aims of treatment are, first, to reduce the impact the disease has on a patient and, second, to halt progression of disease. The advent of intensive therapy, including biologics, has led to a major improvement in outcome. To assess treatment impact, formal outcome measures have been developed. Traditionally, these focussed on the clinical aspects such as disease activity and joint damage. More recently, there has been an increased focus on patient-related outcome measures including quality-of-life measures. These enable illness evaluation from patients' perspectives, examination of care quality and comparison of the effectiveness and cost-effectiveness of treatment. This article examines advantages and disadvantages of the various outcome measures which are generally used in RA, with a focus on quality of life and patient-related measures.
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Affiliation(s)
- Gabrielle Kingsley
- Department of Rheumatology, King's College London School of Medicine, Weston Education Centre, UK.
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11
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Kim YJ, Shim JS, Choi CB, Bae SC. Mortality and incidence of malignancy in Korean patients with rheumatoid arthritis. J Rheumatol 2011; 39:226-32. [PMID: 22174211 DOI: 10.3899/jrheum.110704] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVE To determine the standardized mortality ratio (SMR) and standardized incidence ratio (SIR) for malignancy in Korean patients with rheumatoid arthritis (RA). METHODS We enrolled 1534 patients with RA who fulfilled the American College of Rheumatology criteria, from October 2001 to December 2007. Baseline assessment included sociodemographic variables, laboratory findings including rheumatoid factor, anticitrullinated protein antibody, functional class, radiological stage, medication, and the Korean version of the Health Assessment Questionnaire. We used the national mortality rate from 2001 to 2007 from the Korean National Statistical Office (KNSO) and the incidence rate from the Korean Central Cancer Registry (KCCR) from 2001 to 2007 as comparison data for estimates of SMR and SIR. Confidence intervals were calculated based on the Poisson distribution. RESULTS There were 57 deaths in 6683 person-years of followup. The number of expected deaths (derived from the KNSO) was 42.33 and the SMR for patients with RA was 1.35 (95% CI 1.02-1.74). The main causes of death were malignancy, cardiovascular disease, and respiratory disease. In the cause-specific SMR, deaths from respiratory disease, especially from interstitial lung disease (ILD) and pneumonia, were significantly higher than expected: 4.66 (95% CI 2.13-8.85) for all respiratory disease, 18.18 (95% CI 2.20-65.64) for ILD, and 10.26 (95% CI 2.79-26.26) for pneumonia. Thirty malignancies had occurred in 1501 patients. The number of expected malignancies derived from the KCCR was 34.91, yielding a SIR for cancer of 0.86 (95% CI 0.58-1.23). CONCLUSION Our study demonstrates that the SMR was slightly higher in patients with RA, but the incidence rates of malignancies were not significantly different from the general population. But deaths from respiratory diseases were significantly higher.
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Affiliation(s)
- Yun Jung Kim
- Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Hanyang University, Seoul, Republic of Korea
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Alishiri GH, Bayat N, Salimzadeh A, Salari A, Hosseini SM, Rahimzadeh S, Assari S. Health-related quality of life and disease activity in rheumatoid arthritis. JOURNAL OF RESEARCH IN MEDICAL SCIENCES : THE OFFICIAL JOURNAL OF ISFAHAN UNIVERSITY OF MEDICAL SCIENCES 2011; 16:897-903. [PMID: 22279457 PMCID: PMC3263102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/06/2010] [Accepted: 07/21/2010] [Indexed: 10/27/2022]
Abstract
BACKGROUND The present study sought to 1) investigate the degrees of correlations between different disease activity scores (DASs) and health-related quality of life (HRQoL), and 2) determine if DASs correlate with either physical or mental HRQoL. METHODS Eighty patients with rheumatoid arthritis (RA) were assessed for different DASs, measured with erythrocyte sedimentation rate (ESR) or C-reactive protein (CRP), namely DAS4-ESR, DAS-3 ESR, DAS4-CRP, DAS3-CRP, DAS4-28 ESR, DAS3-28 ESR, DAS4-28 CRP, and DAS3-28 CRP, and Simplified Disease Activity Indexes namely SDAI-ESR, and SDAI-CRP. Physical and mental HRQoL were measured using the SF-36. The Pearson correlation test was employed to examine the correlations between HRQoL and different DAS indices. PASS 2000 (Power Analysis and Sample Size) software was utilized to find significant differences between the correlations. RESULTS SF-36 total score showed a significant inverse correlation with the DAS4-ESR, DAS-3 ESR, DAS4-CRP, DAS3-CRP, DAS4-28 ESR, DAS3-28 ESR, DAS4-28 CRP, and DAS3-28 CRP, with correlation coefficients of -0.320, -0.314, -0.330, -0.323, -0.327, -0.318, -0.360 and -0.348, respectively (P < 0.01 for all). The correlation coefficients between different DAS indices and the HRQoL score were not significantly different. In addition, all DASs showed significant correlations with physical HRQoL, but not with mental HRQoL. CONCLUSIONS Among patients with RA, disease severity indices are associated with physical, but not mental HRQoL. However this study failed to show any differences between various DASs in their clinical use.
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Affiliation(s)
| | - Noushin Bayat
- Baqiyatallah University of Medical Sciences, Tehran, Iran
| | | | | | | | - Shadi Rahimzadeh
- Clinical Research Unit, Baqiyatallah University of Medical Sciences, Tehran, Iran., Universal Network for Health Information Dissemination and Exchange (UNHIDE)
| | - Shervin Assari
- Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, MI, United States
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Bugajska J, Brzosko M, Jędryka-Góral A, Głuszko P, Żołnierczyk-Zreda D, Sagan A, Konarska M, Rell-Bakalarska M, Pazdur J, Zeidler H, Rihl M. Psychological stress in rheumatoid arthritis patients: a comparative Polish–German study. Autoimmun Rev 2010; 9:211-5. [DOI: 10.1016/j.autrev.2009.08.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2009] [Accepted: 08/11/2009] [Indexed: 01/21/2023]
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Vetti N, Alsing R, Kråkenes J, Rørvik J, Gilhus NE, Brun JG, Espeland A. MRI of the transverse and alar ligaments in rheumatoid arthritis: feasibility and relations to atlantoaxial subluxation and disease activity. Neuroradiology 2010; 52:215-23. [DOI: 10.1007/s00234-009-0650-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2009] [Accepted: 12/10/2009] [Indexed: 11/24/2022]
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Louie GH, Reveille JD, Ward MM. Challenges comparing functional limitations in rheumatoid arthritis and ankylosing spondylitis. Clin Exp Rheumatol 2009; 27:S83-S91. [PMID: 19822052 PMCID: PMC2953760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Whether physical functioning in patients with rheumatoid arthritis (RA) differs from that in patients with ankylosing spondylitis (AS) is presently uncertain. Such a comparison poses challenges, not only because the two diseases differ in the domains of functioning affected, but also because of the different instruments used to measure functional limitations. Limiting our analysis to studies using similar self-report questionnaires, we examined published observational studies of unselected cohorts of patients with RA and patients with AS to compare and contrast the severity of functional limitations. Available studies from a few direct comparisons, and mostly indirect comparisons, suggested that patients with RA are generally more severely limited in physical functioning throughout the disease course than patients with AS. Since most studies did not adjust adequately for potentially important confounders, such as age, gender, comorbidity, and disease duration, reported differences in functional disability between patients with RA and patients with AS must be interpreted cautiously.
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Affiliation(s)
- G H Louie
- Intramural Research Program, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Department of Health and Human Services, Bethesda, Maryland 20892-1468, USA
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Kim YJ, Choi CB, Sung YK, Lee H, Bae SC. Characteristics of Korean Patients with RA: A Single Center Cohort Study. ACTA ACUST UNITED AC 2009. [DOI: 10.4078/jkra.2009.16.3.204] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
- Yun Jung Kim
- Department of Rheumatology, Hospital for Rheumatic Diseases, Hanyang University, College of Medicine, Seoul, Korea
| | - Chan-Bum Choi
- Department of Rheumatology, Hospital for Rheumatic Diseases, Hanyang University, College of Medicine, Seoul, Korea
| | - Yoon-Kyoung Sung
- Department of Rheumatology, Hospital for Rheumatic Diseases, Hanyang University, College of Medicine, Seoul, Korea
| | - Hyeseon Lee
- Department of Rheumatology, Hospital for Rheumatic Diseases, Hanyang University, College of Medicine, Seoul, Korea
| | - Sang-Cheol Bae
- Department of Rheumatology, Hospital for Rheumatic Diseases, Hanyang University, College of Medicine, Seoul, Korea
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Schneider M, Manabile E, Tikly M. Social aspects of living with rheumatoid arthritis: a qualitative descriptive study in Soweto, South Africa - a low resource context. Health Qual Life Outcomes 2008; 6:54. [PMID: 18651986 PMCID: PMC2499996 DOI: 10.1186/1477-7525-6-54] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2008] [Accepted: 07/24/2008] [Indexed: 11/12/2022] Open
Abstract
Background Rheumatoid Arthritis (RA) is a chronic illness with important functional, social and employment consequences. We therefore undertook a cross-sectional study, using the International Classification of Functioning, Disability and Health framework, to investigate the personal and social consequences of RA in women, living under largely impoverished conditions. Methods A qualitative case study design was used with a convenience sample of 60 women with RA living in Soweto, South Africa. Semi-structured in-depth interviews were conducted to cover a range of experiences including onset of disease, treatment, environmental barriers and facilitators, employment, and social inclusion in family and community life. The outcomes are described according the International Classification of Functioning, Health and Disability framework at the body, person and societal levels and looking at both personal and environmental factors. Results The main features of living with RA were pain, muscle stiffness at the body level, difficulties in doing various activities such as mobility, washing, dressing, domestic activities, using transport and obtaining and maintaining employment at the person level. At the societal level the participants described difficulties moving around, interacting socially and taking part in community activities, fulfilling social roles and earning a living. Environmental facilitators such as assistive devices and health care services improved functioning. Barriers such as physical environments, lack of transport and basic services, such as electricity, and attitudes of others lead to social exclusion, loss of a sense of self and independence. Low income, lack of sufficient public transport, and sparse basic services were poverty features that exacerbated negative experiences. Conclusion The experiences of living with RA in a low resource context are similar to those in mid- and high resource contexts, but are exacerbated by poverty and the lack of basic services. Pain and social exclusion are some of the key experiences of women with RA living in Soweto. The ICF provides a useful framework for describing and understanding the complexity of these experiences.
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Affiliation(s)
- Marguerite Schneider
- Child, Youth, Family and Social Development, Human Sciences Research Council, Pretoria.
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Shergy WJ. Selective costimulation modulation with abatacept: a look at quality-of-life outcomes in patients with rheumatoid arthritis. Semin Arthritis Rheum 2008; 38:434-43. [PMID: 18538830 DOI: 10.1016/j.semarthrit.2008.03.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2007] [Revised: 02/29/2008] [Accepted: 03/24/2008] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To highlight the importance of improving quality of life (QoL) in patients with rheumatoid arthritis (RA) and to provide a summary of the QoL benefits provided by abatacept in patients who have an inadequate response to disease-modifying antirheumatic drugs (DMARDs) and/or tumor necrosis factor (TNF) antagonists. METHODS A literature search of the MEDLINE, EMBASE, and BIOSIS databases was performed using the terms "abatacept," "cytotoxic T-lymphocyte-associated antigen-4 (CTLA-4)" and "ORENCIA," with the coindexing terms: "abatacept," "CTLA-4," and "ORENCIA." Only articles presenting primary data on QoL outcomes from randomized, placebo-controlled clinical trials of abatacept were included in the review. RESULTS The literature search initially yielded 220 articles. A total of 8 articles fulfilled the inclusion criteria described above and are reviewed here. In clinical trials to date, abatacept treatment has been shown to improve QoL in patients who have an inadequate response to traditional DMARDs and TNF antagonists. CONCLUSIONS Improvements in QoL are rated by patients as 1 of the most important benefits of an effective treatment; however, inclusion of QoL measurements in clinical trials as a measure of efficacy is a relatively recent event. Abatacept has been shown to alleviate both the physical and the emotional/social burdens that RA imposes on the patient, including improvements in day-to-day activity and reducing sleep problems and fatigue in patients with RA who have an inadequate response to DMARDs and/or TNF antagonists.
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Affiliation(s)
- William J Shergy
- University of Alabama School of Medicine, Huntsville, Alabama 35801, USA.
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Baron M, Schieir O, Hudson M, Steele R, Kolahi S, Berkson L, Couture F, Fitzcharles MA, Gagné M, Garfield B, Gutkowski A, Kang H, Kapusta M, Ligier S, Mathieu JP, Ménard H, Starr M, Stein M, Zummer M. The clinimetric properties of the World Health Organization Disability Assessment Schedule II in early inflammatory arthritis. ACTA ACUST UNITED AC 2008; 59:382-90. [PMID: 18311751 DOI: 10.1002/art.23314] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
OBJECTIVE To assess the clinimetric properties of a new health-related quality of life (HRQOL) instrument, the World Health Organization Disability Assessment Schedule II (WHODAS II), in patients with early inflammatory arthritis. METHODS Internal consistency as well as criterion, construct, and discriminative validity of the WHODAS II were assessed in 172 patients with early inflammatory arthritis who completed the WHODAS II, the Medical Outcomes Study Short Form 36 (SF-36), and other measures of disease severity, functioning, pain, depression, and resource use. Test-retest reliability of the WHODAS II was assessed by having a subset of 20 patients complete the WHODAS II a second time, 1 week after the first assessment. RESULTS The WHODAS II had high internal consistency (Cronbach's alpha = 0.96 for patients working or in school and 0.93 for patients not working or in school). Test-retest intraclass correlation coefficients of the WHODAS II total score and subscales ranged from 0.82-0.96. The WHODAS II total score was strongly correlated with the SF-36 physical component score (Kendall's tau-b 0.51, P < 0.001) and moderately correlated with the SF-36 mental component score (tau-b 0.43, P < 0.001). WHODAS II correlations with disease outcomes ranged from Kendall's tau-b 0.15-0.55. The WHODAS II significantly differentiated between every aspect of disease severity assessed with the exception of measures of health resource use. CONCLUSION The WHODAS II is a valid and reliable measure of HRQOL in cross-sectional studies of patients with early inflammatory arthritis. Research is still required to investigate potential item redundancy and determine its usefulness in longitudinal studies.
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Sokka T, Envalds M, Pincus T. Treatment of rheumatoid arthritis: a global perspective on the use of antirheumatic drugs. Mod Rheumatol 2008; 18:228-39. [PMID: 18437286 PMCID: PMC2668379 DOI: 10.1007/s10165-008-0056-x] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2007] [Accepted: 01/29/2008] [Indexed: 12/13/2022]
Abstract
Modern therapy for rheumatoid arthritis (RA) is based on knowledge of the severity of the natural history of the disease. RA patients are approached with early and aggressive treatment strategies, methotrexate as an anchor drug, biological targeted therapies in those with inadequate response to methotrexate, and “tight control,” aiming for remission and low disease activity according to quantitative monitoring. This chapter presents a rationale for current treatment strategies for RA with antirheumatic drugs, a review of published reports concerning treatments in clinical cohorts outside of clinical trials, and current treatments at 61 sites in 21 countries in the QUEST-RA database.
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Affiliation(s)
- Tuulikki Sokka
- Arkisto/Tutkijat, Jyväskylä Central Hospital, Jyvaskyla, Finland.
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García-Poma A, Segami MI, Mora CS, Ugarte MF, Terrazas HN, Rhor EA, García E, Ramos MP, Alva M, Castañeda I, Chung CP. Obesity is independently associated with impaired quality of life in patients with rheumatoid arthritis. Clin Rheumatol 2007; 26:1831-5. [PMID: 17340047 DOI: 10.1007/s10067-007-0583-4] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2006] [Accepted: 01/31/2007] [Indexed: 01/22/2023]
Abstract
Obesity is a modifiable major cause of morbidity and mortality in the general population, but little is known about the association of obesity and quality of life in patients with rheumatoid arthritis (RA). Thus, we set out a study to test the hypothesis that obesity is independently associated with lower quality of life in patients with RA. Three hundred and fifty nine patients with RA underwent an interview, physical exam, and all clinical charts were reviewed. Based on body mass index (BMI), patients were classified as normal (BMI < 25 kg/m(2)), overweight (BMI = 25-29.9 kg/m(2)), and obese (BMI > or = 30 kg/m(2)). Quality of life was quantified with the Medical Outcomes Study Short Form 36 (SF-36). Data obtained included demographic variables, extra-articular disease, comorbidities, presence of X-ray erosions, rheumatoid factor, and depression. The association between obesity and quality of life was examined with the use of multiple lineal regression models. One hundred and seventy-two patients (47.9%) had normal BMI, 126 (35.1%) were overweight, and 61 patients (17%) were obese. Obese patients had lower quality of life (30.8 +/- 18.1) than overweight patients (43.3 +/- 20.1) and patients with normal weight (43.8 +/- 22.2), P < 0.001. The association between obesity and impaired quality of life was confirmed with a linear regression model (Coef = -12.9, P < 0.001) and remained significant after adjustment for age, sex, disease activity, extra-articular disease, comorbidities, X-ray erosions, presence of rheumatoid factor, depression, education, and disease duration (Coef = -5.3, P = 0.039). In conclusion, obesity is independently associated with the impaired quality of life in patients with rheumatoid arthritis.
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Abstract
Assessment of health-related quality of life (HRQoL) is relevant for the patients and is important in both clinical research and daily clinical practice. Generic and disease-specific instruments for assessment of HRQoL are reviewed. Changes in HRQoL provide important information on randomized controlled clinical trials as well as on observational studies. The floor effect is a limitation of many of the scales, especially in patients with less severe disease. Feasibility and low test-retest reproducibility limit the use of many of the instruments in clinical practice, especially when they are used for individual treatment decisions. Electronic transferral of data from patients to the health professionals by, for example, internet or a personal digital assistant (PDA), opens up new opportunities for frequent patient reports and improved access to the data.
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Affiliation(s)
- T K Kvien
- Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway.
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Kalouche Khalil L, Baddoura R, Okais J, Awada H. Rheumatoid arthritis in Lebanese patients: characteristics in a tertiary referral centre in Beirut city. Ann Rheum Dis 2005; 65:684-5. [PMID: 16176993 PMCID: PMC1798138 DOI: 10.1136/ard.2005.043059] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Heiberg T, Finset A, Uhlig T, Kvien TK. Seven year changes in health status and priorities for improvement of health in patients with rheumatoid arthritis. Ann Rheum Dis 2005; 64:191-5. [PMID: 15647426 PMCID: PMC1755377 DOI: 10.1136/ard.2004.022699] [Citation(s) in RCA: 92] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To examine possible changes in priorities for improvement in health and health status from 1994 to 2001 within the setting of the Oslo Rheumatoid Arthritis (RA) Register, which provides representative data for the entire RA population in the county. METHODS All living patients in the Oslo RA Register area received a postal questionnaire in 1994 and 2001, including the Arthritis Impact Measurement Scales 2 (AIMS2), Short Form-36, the modified Health Assessment Questionnaire, and pain and fatigue visual analogue scales (VAS). Priorities for improvement in health were examined through question 60 in AIMS2, where patients are asked to indicate three of 12 areas of health where they would most like to see improvement. RESULTS The number of respondents aged 20-79 years in 1994/2001 was 932/830, with similar demographic characteristics (78.8/78.3% were female, mean age 60.6/60.8, and disease duration 12.6/13.9 years). Health status was improved in all dimensions, with statistical improvement for the physical dimension, global health and pain, from 1994 to 2001. The profile of priorities remained mostly unchanged. Improvement in pain had the highest priority in both cohorts. Both symptom modifying and disease modifying drugs were more extensively used in 2001. CONCLUSIONS Health status had improved from 1994 to 2001, probably because of access to better and more aggressive treatments. Pain remained the area of highest priority for improvement among patients with RA-despite an improved level of pain in 2001.
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Affiliation(s)
- T Heiberg
- Department of Administration, Ullevål University Hospital, N-0407 Oslo, Norway.
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Dadoniene J, Stropuviene S, Venalis A, Boonen A. High work disability rate among rheumatoid arthritis patients in Lithuania. Arthritis Care Res (Hoboken) 2004; 51:433-9. [PMID: 15188330 DOI: 10.1002/art.20415] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To evaluate labor force characteristics among patients with rheumatoid arthritis (RA) in Lithuania. To assess if Lithuania's transition from a state-planned to a free-market economy after 1990 changed the employment perspectives of patients with RA. METHODS RA patients, age 16-65 years (n = 238), were randomly selected from the RA register in Vilnius. They completed questions about sociodemographics, working status, and disease characteristics, they underwent a clinical examination, and they completed the modified Health Assessment Questionnaire and the Short Form 36. RESULTS Age- and sex-adjusted employment was 24.2% lower and work disability 51.7% higher in patients compared with the general population in Lithuania. After 10 years of disease, 48% of the patients had withdrawn from the labor force. In those with a paid job, the average sick leave in the past year was 31.9 days compared with the national average of 10.8 days. Although disease activity was not significantly different in employed compared with work-disabled patients, physical function and perceived quality of life (except general health) were worse among patients with work disability. The change in economic organization in 1990 was noted to increase the risk for work withdrawal by a factor of 2.75 (95% confidence interval 1.68-4.53). CONCLUSION In Lithuania, the impact of RA on work disability is important. Although work disability in Lithuanian patients with RA seems more pronounced compared with reports from Western societies, variables associated with work disability are comparable. The transition to a market-orientated economy in 1990 increased the risk of becoming work disabled.
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Affiliation(s)
- Jolanta Dadoniene
- Institute of Experimental adn Clinical Medicine, Vilnius University, Vilnius, Lithuania.
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Abstract
Rheumatoid arthritis (RA) is a chronic, generally progressive autoimmune disease that causes functional disability, significant pain and joint destruction, and leads to premature mortality. It is estimated to affect between 0.5 and 1.0% of the adult population worldwide, increases in prevalence with age and affects more women than men. The magnitude of the severe long-term economic consequences of RA has been underestimated in the past. Most patients with the disease require continuous treatment to retard or stop progression and to control disease flares. Many also require surgery, such as total hip or knee replacement. In addition to these direct costs, work disability leads to reduced productivity and early retirement, and as a result, substantial indirect costs. The individual and his or her family must cope with the feeling of loss of contribution to society combined with redefined social roles, and the effects of pain, fatigue, low self-esteem, mental distress and depression. A number of countries in North America and Europe have reported a decline in the incidence of RA in recent years, although geographical differences remain that may be associated with genetic, environmental or cultural factors. Nevertheless, patients with RA have not shared the improvements in survival rates seen with other diseases over the last 40 years, and have a mean reduction in life expectancy of between 5 and 10 years. Disease severity, activity and disability are strongly linked to premature mortality in patients with RA. The high direct and indirect costs associated with RA, together with the substantial morbidity and mortality affecting millions of people worldwide, underline the potential benefits of improved treatments for this chronic disease to patients, their families and society.
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Affiliation(s)
- Tore K Kvien
- Oslo City Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway.
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