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Dahir KM, Ing SW, Deal C, Messali A, Bates T, Rush ET. Improvement in quality of life after asfotase alfa treatment in adults with pediatric-onset hypophosphatasia: data from 5 patient-reported outcome measures. JBMR Plus 2024; 8:ziae062. [PMID: 39006866 PMCID: PMC11245646 DOI: 10.1093/jbmrpl/ziae062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Revised: 04/09/2024] [Accepted: 05/02/2024] [Indexed: 07/16/2024] Open
Abstract
Hypophosphatasia (HPP) is a rare, inherited metabolic disorder caused by deficient tissue-nonspecific alkaline phosphatase activity. This study assessed the impact of treatment with asfotase alfa on patient-reported outcomes (PROs) in adults with pediatric-onset HPP. A longitudinal, telephone-based survey was administered to eligible individuals enrolled in a patient support program. Interviews were conducted at study entry (prior to asfotase alfa initiation) and after 3, 6, and 12 mo. PROs-Patient Health Questionnaire-9 [PHQ-9], Work Productivity and Activity Impairment Questionnaire: Specific Health Problem [WPAI:SHP], Patient-Reported Outcomes Measurement Information System 29 [PROMIS-29], and Routine Assessment of Patient Index Data 3 [RAPID3]-were assessed at each time point. Appropriate statistical tests were performed to assess score changes. Among 50 enrolled patients (mean age: 46 yr [SD: 15.4]; 80% female; 94% White), 49 were evaluable at 3 mo, 44 at 6 mo, and 29 at 12 mo. By month 3, statistically significant improvements from baseline were detected in PHQ-9 scores (10.6 vs 5.8 [P < .0001]), PROMIS-29 domain scores (overall physical function: 38.0 vs 43.0 [P = .001]; anxiety: 57.5 vs 51.5 [P = .0011]; fatigue: 63.3 vs 55.3 [P < .0001]; sleep disturbances: 58.8 vs 54.3 [P = .0099]; ability to participate in social roles and activities: 42.6 vs 47.7 [P = .0012]; and pain interference: 63.8 vs 58.4 [P = .001]), and RAPID3 domain scores (functional status: 2.7 vs 1.1 [P < .0001]; pain tolerance: 6.0 vs 3.2 [P < .0001]; and global health estimate: 5.1 vs 2.7 [P < .0001]). Improvements persisted at month 12. Patients also showed improvements in WPAI:SHP domain scores at month 6 (presenteeism: 39.6% vs 14.1% [P < .0001] and work productivity loss: 41.9% vs 14.1% [P < .0001]). Treatment with asfotase alfa was associated with improved quality of life across several domains.
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Affiliation(s)
- Kathryn M Dahir
- Endocrinology and Diabetes, Vanderbilt University Medical Center, Nashville, TN 37232, United States
| | - Steven W Ing
- Division of Endocrinology, Diabetes, and Metabolism, Wexner Medical Center, Ohio State University, Columbus, OH 43210, United States
| | - Chad Deal
- Department of Rheumatology, Center for Osteoporosis and Metabolic Bone Disease, Cleveland Clinic, Cleveland, OH 44195, United States
| | - Andrew Messali
- Health Economics and Outcomes Research (AM) and Medical Affairs (CD), Alexion, AstraZeneca Rare Disease, Boston, MA 02210, United States
| | - Toby Bates
- Health Economics and Outcomes Research (AM) and Medical Affairs (CD), Alexion, AstraZeneca Rare Disease, Boston, MA 02210, United States
| | - Eric T Rush
- Division of Clinical Genetics, Children's Mercy Kansas City, Kansas City, MO 64108, United States
- Department of Pediatrics, University of Missouri - Kansas City School of Medicine, Kansas City, MO 64108, United States
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Al-Abdulkarim H, Sharma Y, Attar SM, Husain W, Al-Homood I, Al Omari B, Mohamed O, Alsaqa'aby M, Jaheen AM, Anwar A, Hamad TM, Alzahrani Z. Cost-effectiveness analysis of upadacitinib as a treatment option for patients with rheumatoid arthritis in the Kingdom of Saudi Arabia. J Med Econ 2024; 27:134-144. [PMID: 38163926 DOI: 10.1080/13696998.2023.2299176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 12/21/2023] [Indexed: 01/03/2024]
Abstract
AIM To evaluate cost-effectiveness of upadacitinib (targeted synthetic-disease modifying anti-rheumatic drug [ts-DMARD]) as first-line (1 L) treatment versus current treatment among patients with rheumatoid arthritis (RA) in the Kingdom of Saudi Arabia (KSA), who had an inadequate response to prior conventional-synthetic (csDMARDs) and/or biologic-DMARDs (bDMARDs). METHODS This Excel-based model included patients with moderate (Disease Activity Score [DAS28]: >3.2 to ≤5.1) or severe RA (DAS28 > 5.1). Cost-effectiveness of current treatment (1 L: adalimumab-originator/biosimilar; second-line (2 L): other bDMARDs/tofacitinib) was compared against a new treatment involving two scenarios (1 L: upadacitinib, 2 L: adalimumab-biosimilar [scenario-1]/adalimumab-originator [scenario-2]) for a 10-year time-horizon from societal perspective. Model outcomes included direct and indirect costs, quality-adjusted life-years (QALYs), hospitalization days, number of orthopedic surgeries, and incremental cost-utility ratio (ICUR) per QALY. RESULTS With the current pathway, estimated total societal costs for 100 RA patients over 10-year period were Saudi Riyal (SAR) 50,450,354 (United States dollars [USD] 13,453,428) (moderate RA) and SAR50,013,945 (USD13,337,052) (severe RA). New pathway (scenario-1) showed that in patients with moderate-to-severe RA, upadacitinib led to higher QALY gain (+8.99 and +15.63) at lower societal cost (cost difference: -SAR2,023,522 [-USD539,606] and -SAR3,373,029 [-USD899,474], respectively). Thus, as 1 L, upadacitinib projects "dominant" ICUR per QALY over current pathway. Moreover, in alternate pathway (scenario-2), upadacitinib also projects "dominant" ICUR per QALY for patient with severe RA (QALY gain: +15.63; cost difference: -SAR 164,536 [-USD43,876]). However, moderate RA was associated with additional cost of SAR1,255,696 (USD334,852) for improved QALY (+8.99) over current pathway (ICUR per QALY: SAR139,742 [USD37,264]). Both scenarios resulted in reduced hospitalization days (scenario-1: -14.83 days; scenario-2: -11.41 days) and number of orthopedic surgeries (scenario-1: -8.36; scenario-2: -6.54) for moderate-to-severe RA over the current treatment pathway. CONCLUSION Upadacitinib as 1 L treatment in moderate-to-severe RA can considerably reduce healthcare resource burden in KSA, majorly due to reduced drug administration/monitoring/hospitalization/surgical and indirect costs.
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Affiliation(s)
- Hana Al-Abdulkarim
- National Guard Health Affairs, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center (KAIMRC), Riyadh, Saudi Arabia
- Doctoral School of Applied Informatics and Applied Mathematics, Óbuda University, Budapest, Hungary
| | | | - Suzan M Attar
- Rheumatology & Internal Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | | | - Ibrahim Al-Homood
- Internal Medicine Department, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Bedor Al Omari
- Pharmaceutical Care Department, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Omneya Mohamed
- Real-World Evidence (RWE), IQVIA AG, Dubai, United Arab Emirates
| | - Mai Alsaqa'aby
- Real-World Evidence (RWE), IQVIA Solutions, Riyadh, Saudi Arabia
| | - Ahmed M Jaheen
- Branch of AbbVie Biopharmaceuticals GmbH, Scientific Office, Riyadh, Saudi Arabia
| | - Ali Anwar
- Branch of AbbVie Biopharmaceuticals GmbH, Scientific Office, Riyadh, Saudi Arabia
| | - Tharwat M Hamad
- Branch of AbbVie Biopharmaceuticals GmbH, Scientific Office, Riyadh, Saudi Arabia
| | - Zeyad Alzahrani
- Department of Surgery, King Abdulaziz Medical City, Jeddah, Saudi Arabia
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3
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Sakai R, Tanaka E, Inoue E, Sato M, Tanaka M, Ikari K, Yamanaka H, Harigai M. Association between patient-reported outcomes and impairments in work and activity in patients with rheumatoid arthritis in clinical remission: A retrospective analysis using the IORRA database. Mod Rheumatol 2023; 33:899-905. [PMID: 36094815 DOI: 10.1093/mr/roac105] [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: 04/22/2022] [Revised: 08/02/2022] [Accepted: 08/30/2022] [Indexed: 11/13/2022]
Abstract
OBJECTIVES To explore the patient-reported outcomes (PROs) associated with work productivity and activity impairment (WPAI) in patients with rheumatoid arthritis (RA) in clinical remission. METHODS We enrolled patients with RA ≥18 years and with a simplified disease activity index ≤3.3 from the Institute of Rheumatology, Rheumatoid Arthritis data set collected in October 2017. The pain-visual analogue scale, patients' global assessment visual analogue scale (VAS), Japanese version of the Healthcare Assessment Questionnaire (J-HAQ) Disability Index, and duration of morning joint stiffness were selected as the PROs. To evaluate work productivity and activity, the WPAI for RA instrument (WPAI-RA) was used. To assess the contribution of each PRO to the WPAI-RA score, an analysis of variance model was constructed. RESULTS The mean age of the 2614 patients was 62.4 years; 85.1% were female. Median values of the WPAI-RA score were 1.1% for absenteeism, 6.5% for presenteeism, 7.4% for work impairment, and 10.2% for activity impairment. Morning joint stiffness contributed the most to absenteeism (18.0%), while pain-VAS contributed the most to presenteeism (57.4%), work productivity loss (51.1%), and daily activity impairment (53.7%). J-HAQ was the second most contributing factor to presenteeism (17.4%), work productivity loss (16.3%), and daily activity impairment (26.0%). CONCLUSIONS The pain-VAS and J-HAQ highly contributed to WPAI in patients with RA in clinical remission.
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Affiliation(s)
- Ryoko Sakai
- Department of Rheumatology, Institute of Rheumatology, Tokyo Women's Medical University Hospital, Tokyo, Japan
- Division of Rheumatology, Department of Internal Medicine, Tokyo Women's Medical University School of Medicine, Tokyo, Japan
- Division of Multidisciplinary Management of Rheumatic Diseases, Tokyo Women's Medical University School of Medicine, Tokyo, Japan
| | - Eiichi Tanaka
- Department of Rheumatology, Institute of Rheumatology, Tokyo Women's Medical University Hospital, Tokyo, Japan
- Division of Rheumatology, Department of Internal Medicine, Tokyo Women's Medical University School of Medicine, Tokyo, Japan
| | - Eisuke Inoue
- Showa University Research Administration Center, Showa University Tokyo, Japan
| | - Minako Sato
- Japan Drug Development and Medical Affairs, Eli Lilly Japan K.K., Kobe, Japan
| | - Masaru Tanaka
- Japan Drug Development and Medical Affairs, Eli Lilly Japan K.K., Kobe, Japan
| | - Katsunori Ikari
- Department of Rheumatology, Institute of Rheumatology, Tokyo Women's Medical University Hospital, Tokyo, Japan
- Division of Multidisciplinary Management of Rheumatic Diseases, Tokyo Women's Medical University School of Medicine, Tokyo, Japan
- Department of Orthopedic Surgery, Tokyo Women's Medical University School of Medicine, Tokyo, Japan
| | - Hisashi Yamanaka
- Division of Rheumatology, Department of Internal Medicine, Tokyo Women's Medical University School of Medicine, Tokyo, Japan
- Rheumatology, Sanno Medical Center, Tokyo, Japan
| | - Masayoshi Harigai
- Department of Rheumatology, Institute of Rheumatology, Tokyo Women's Medical University Hospital, Tokyo, Japan
- Division of Rheumatology, Department of Internal Medicine, Tokyo Women's Medical University School of Medicine, Tokyo, Japan
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Yekini A, Grace JM. Effects of Exercise on Body Composition and Physical Function in Rheumatoid Arthritis Patients: Scoping Review. Open Access Rheumatol 2023; 15:113-123. [PMID: 37521003 PMCID: PMC10378614 DOI: 10.2147/oarrr.s412942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 05/25/2023] [Indexed: 08/01/2023] Open
Abstract
Background In rheumatoid arthritis (RA) patients, an adverse change in body composition, which usually results in muscle wasting and increased fat mass, is high, contributing to increased functional disability. There are indications that resistance and dynamic exercise interventions could improve body composition and functional capacity in RA patients and should be recommended to manage RA. Purpose The scoping literature review aimed to analyze available literature about the effects of exercise on body composition in RA patients. Secondly to identify the contribution of exercise to improve physical function in RA patients, thirdly to identify gaps in the literature about physical exercises and health outcomes in RA patients, and make recommendations for future research. Methods A scoping literature review design was employed following the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) guidelines. A systematic search of three databases (PubMed, CINAHL, and Scopus) for studies published from 2012 to 2022 was conducted. The words searched include "exercise intervention" AND "body fat" OR "muscle wasting" OR "lean body mass" AND "functional ability" OR "health assessments". The search strategy was limited to studies published in English on RA patients and exercise interventions. Results This search yielded 2693 studies, of which 11 met the inclusion criteria and were selected for review. The findings showed significant, positive effects of exercise interventions on RA patients' body composition and functional capacity, with exercise being highly beneficial. It is evident that high-intensity resistance exercise, as a stand-alone intervention, is feasible and safe for managing RA conditions. Conclusion Physical exercises, following scientific guidelines, should be included as an integrated approach to managing RA conditions.
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Affiliation(s)
- Amidu Yekini
- Discipline of Biokinetics, Exercise and Leisure science, College of Health Sciences, University of Kwazulu-Natal, Durban, South Africa
| | - Jeanne Martin Grace
- Discipline of Biokinetics, Exercise and Leisure science, College of Health Sciences, University of Kwazulu-Natal, Durban, South Africa
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Jabłonowska O, Woźniacka A, Szkarłat S, Żebrowska A. Female genital lichen sclerosus is connected with a higher depression rate, decreased sexual quality of life and diminished work productivity. PLoS One 2023; 18:e0284948. [PMID: 37098076 PMCID: PMC10128971 DOI: 10.1371/journal.pone.0284948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Accepted: 04/13/2023] [Indexed: 04/26/2023] Open
Abstract
Female genital lichen sclerosus is an underdiagnosed, distressing, chronic dermatosis affecting the well-being of women. The aim of this retrospective case-control study was to assess whether the disease is connected with work productivity and activity impairment, depression and decreased sexual quality of life. Fifty-one female patients with genital lichen sclerosus and forty-five healthy women were enrolled to the study and filled out an online survey including: Work Productivity and Activity Impairment: General Health (WPAI:GH), Patient Health Questionnaire-9 (PHQ-9) and The Sexual Quality of Life-Female (SQOL-F) questionnaires. The results showed that women with genital lichen sclerosus are at risk of having a diminished work productivity, are more often screened for depression and have a decreased sexual quality of life. The study highlights the importance of a multidisciplinary approach to treating female genital lichen sclerosus.
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Affiliation(s)
- Olga Jabłonowska
- Dermatology and Venereology Clinic of the Medical University of Lodz, Lodz, Poland
| | - Anna Woźniacka
- Dermatology and Venereology Clinic of the Medical University of Lodz, Lodz, Poland
| | - Simona Szkarłat
- Department of Urology, Hospital of the Ministry of Interior and Administration in Lodz, Lodz, Poland
| | - Agnieszka Żebrowska
- Dermatology and Venereology Clinic of the Medical University of Lodz, Lodz, Poland
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Gwinnutt JM, Leggett S, Lunt M, Barton A, Hyrich KL, Walker-Bone K, Verstappen SMM. Predictors of presenteeism, absenteeism and job loss in patients commencing methotrexate or biologic therapy for rheumatoid arthritis. Rheumatology (Oxford) 2021; 59:2908-2919. [PMID: 32097471 PMCID: PMC7516097 DOI: 10.1093/rheumatology/keaa027] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Revised: 01/02/2020] [Indexed: 12/20/2022] Open
Abstract
Objectives Work is an important health outcome. This study aimed to identify predictors of work loss, absenteeism and presenteeism over 1 year in RA patients commencing treatment with MTX or biologics. Methods Patients aged 18–65 years in full/part-time employment from two UK prospective cohorts were included: MTX-starters = Rheumatoid Arthritis Medication Study; and biologic-starters = Biologics in Rheumatoid Arthritis Genetics and Genomics Study Syndicate. Presenteeism and absenteeism were assessed using the RA-specific Work Productivity Survey at baseline, and 6 and 12 months. Potential predictors including baseline age, gender, clinical measures (e.g. disability, pain, fatigue), psychological distress, occupation and EULAR response from baseline to 6 months were investigated. Results A total of 51/463 MTX-starters and 30/260 biologic-starters left work over 12 months. Higher baseline psychological distress in MTX-starters [odds ratio (OR) 1.1 (95% CI: 1.0, 1.1)] and higher disability in biologic-starters [OR 3.5 (95% CI: 1.4, 8.6)] predicted work loss. Some 16.1% of patients reported sick-leave, which was predicted by disability [OR (95% CI): MTX-starters: 1.5 (0.9, 2.3); biologic-starters: 2.4 (1.1, 5.2)]. Median presenteeism scores were very low (minimal interference) in both cohorts. Higher fatigue for MTX starters [incidence rate ratio 1.2 (95% CI: 1.0, 1.4)] and higher disability in biologic-starters (incidence rate ratio 1.4 (95% CI: 1.1, 1.7)] predicted presenteeism. Good EULAR response was associated with lower absenteeism and presenteeism in both cohorts. Conclusion Patients with RA still face significant limitations regarding their ability to work. Disability and EULAR response were the main predictors of work outcomes, emphasizing the need to control the disease and the importance of function in enabling work participation.
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Affiliation(s)
- James M Gwinnutt
- Centre for Epidemiology Versus Arthritis, Centre for Musculoskeletal Research, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester
| | - Sarah Leggett
- Centre for Epidemiology Versus Arthritis, Centre for Musculoskeletal Research, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester
| | - Mark Lunt
- Centre for Epidemiology Versus Arthritis, Centre for Musculoskeletal Research, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester
| | - Anne Barton
- Centre for Genetics and Genomics Versus Arthritis, Centre for Musculoskeletal Research, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester.,NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester
| | - Kimme L Hyrich
- Centre for Epidemiology Versus Arthritis, Centre for Musculoskeletal Research, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester.,NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester
| | - Karen Walker-Bone
- MRC Versus Arthritis Centre for Musculoskeletal Health and Work, University of Southampton, Southampton, UK
| | - Suzanne M M Verstappen
- Centre for Epidemiology Versus Arthritis, Centre for Musculoskeletal Research, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester.,NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester.,MRC Versus Arthritis Centre for Musculoskeletal Health and Work, University of Southampton, Southampton, UK
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Himmler S, Mueller M, Sherif B, Ostwald D. A case study applying a novel approach to estimate the social impact of a medical innovation - the use of secukinumab for psoriatic arthritis in Germany. Expert Rev Pharmacoecon Outcomes Res 2019; 20:369-378. [DOI: 10.1080/14737167.2019.1644169] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
| | | | - Bintu Sherif
- Biostatistics, RTI Health Solutions, Research Triangle Park, NC, USA
| | - Dennis Ostwald
- Health Economics, WifOR GmbH, Darmstadt, Germany
- School of International Business and Entrepreneurship (SIBE), Steinbeis University Berlin, Berlin, Germany
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Le Berre C, Peyrin-Biroulet L, Buisson A, Olympie A, Ravel MH, Bienenfeld C, Gonzalez F. Impact of inflammatory bowel diseases on working life: A French nationwide survey. Dig Liver Dis 2019; 51:961-966. [PMID: 30826278 DOI: 10.1016/j.dld.2019.01.024] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Revised: 01/10/2019] [Accepted: 01/26/2019] [Indexed: 12/11/2022]
Abstract
BACKGROUND Inflammatory bowel diseases (IBD) affect working-age patients. Data was lacking concerning the impact on working life. AIMS The French IBD patient association conducted a nationwide survey to assess the burden of IBD at work. METHODS An online survey was performed in 2016, targeting IBD patients working or having worked previously. The results were compared to those observed in the general population. RESULTS Data from 1410 IBD patients were analyzed (62% Crohn's disease, 35% ulcerative colitis). Four-fifth of respondents were actively employed. Half of them stated that working with IBD was a problem. Compared to the general population, IBD employees had higher rates of permanent contracts, public employment but also of part-time contracts, and highly graduated patients were less likely to reach high qualified jobs. Among the disabling symptoms at work, fatigue was the most frequent (41%) followed by diarrhea (25%) and fecal incontinence (18%). Despite these difficulties, 76% were satisfied with their job. Most patients shared their IBD diagnosis with their colleagues, but 25% of them regretted it. CONCLUSION IBD has a strong negative impact on working life. While work satisfaction remains high, IBD affects career plans, highlighting the need for supporting measures to improve patients' work experience.
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Affiliation(s)
- Catherine Le Berre
- Department of Gastroenterology, Nantes University Hospital, Nantes, France; Inserm U954 and Department of Gastroenterology, Nancy University Hospital, Lorraine University, Vandoeuvre-lès-Nancy, France
| | - Laurent Peyrin-Biroulet
- Inserm U954 and Department of Gastroenterology, Nancy University Hospital, Lorraine University, Vandoeuvre-lès-Nancy, France.
| | | | | | | | | | - Florent Gonzalez
- Department of Gastroenterology, Grand-Sud Polyclinic, Nîmes, France
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9
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Almoallim H, Janoudi N, Alokaily F, Alzahrani Z, Algohary S, Alosaimi H, Attar S. Achieving comprehensive remission or low disease activity in rheumatoid patients and its impact on workability - Saudi Rheumatoid Arthritis Registry. Open Access Rheumatol 2019; 11:89-95. [PMID: 31118842 PMCID: PMC6475091 DOI: 10.2147/oarrr.s191111] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Purpose Ability to work is an important endpoint in rheumatoid arthritis (RA). It is not clear what outcome measures should be used to guide treatment in order to maximize workability. This study addressed the impact of RA on workability in a Saudi population and examined the correlation between objective measures of disease activity and reduced workability. This will allow better understanding of treatment targets that will translate into improved workability. Patients and methods Data were collected through a digital patient record keeper: The Rheumatoid Arthritis Saudi Database. Male and female patients, ≥18 years of age, that met the American College for Rheumatology criteria for diagnosis of RA, were recruited, regardless of treatment. Demographic and disease-specific data were collected. Disease Activity Score-28 (DAS-28) was used to define patients as low (DAS-28 ≤3.2) vs high (DAS-28 >3.2) disease activity. Health assessment questionnaire (HAQ) score, visual analog scale (VAS) score, and musculoskeletal ultrasound 7 joint score were documented also. The work productivity and activity impairment (WPAI) score was used to measure absenteeism, presenteeism, overall work impairment, and activity impairment. DAS-28 score was correlated with WPAI score and linear regression used to identify the demographic and measures of treatment response that predict improvement in WPAI score. Results Higher absenteeism and more activity impairment were seen for patients with persistent DAS-28 >3.2 (non-achievers). HAQ and VAS scores correlated with presenteeism, overall work impairment, and activity impairment. Conclusion Disease activity, as defined by DAS-28 score, correlates with absenteeism and work impairment in a Saudi population. However, on linear regression analysis, HAQ and VAS scores were the only measures predictive of work impairment. These scores should be used to monitor response to treatment regimens that aim to maximize work potential for Saudi individuals.
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Affiliation(s)
- Hani Almoallim
- Department of Medicine, Faculty of Medicine, Umm Alqura University, Makkah, Saudi Arabia, .,Department of Medicine, Dr. Soliman Fakeeh Hospital, Jeddah, Saudi Arabia, .,Alzaidi Chair of Research in Rheumatic Diseases, Umm Alqura University, Makkah, Saudi Arabia,
| | - Nahid Janoudi
- Department of Medicine, Dr. Soliman Fakeeh Hospital, Jeddah, Saudi Arabia,
| | - Fahdah Alokaily
- Division of Rheumatology, Department of Medicine, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Zeyad Alzahrani
- Department of Medicine, Faculty of King Saud bin Abdulaziz for Health Sciences, Jeddah, Saudi Arabia
| | - Shereen Algohary
- Alzaidi Chair of Research in Rheumatic Diseases, Umm Alqura University, Makkah, Saudi Arabia,
| | - Hanan Alosaimi
- Alzaidi Chair of Research in Rheumatic Diseases, Umm Alqura University, Makkah, Saudi Arabia, .,Department of Medicine, King Fahd Armed Forces Hospital, Jeddah, Saudi Arabia
| | - Suzan Attar
- Alzaidi Chair of Research in Rheumatic Diseases, Umm Alqura University, Makkah, Saudi Arabia, .,Department of Medicine, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
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Abstract
AIMS Depression is the most frequent comorbidity reported among patients with rheumatoid arthritis (RA). Comorbid depression negatively impacts RA patients' health-related quality-of-life, physical function, mental function, mortality, and experience of pain and symptom severity. The objective of this study was to assess healthcare utilization, expenditures, and work productivity among patients with RA with or without depression. MATERIALS AND METHODS Data from adult patients who had at least two visits each related to RA and depression over a 1-year period were extracted from the Truven Health MarketScan research databases. Outcomes comprised healthcare resource utilization, work productivity loss, and direct healthcare costs comparing patients with RA with depression (n = 3,478) vs patients with RA without depression (n = 43,222). RESULTS Patients with RA and depression had a significantly greater relative risk of hospitalization and number of all-cause and RA-related hospitalizations, utilization of emergency services, days spent in the hospital, physician visits, and RA-related surgeries compared with RA patients without depression. Patients with RA and depression had a higher risk of and experienced more events and days of short-term disability compared with patients without depression. The incremental adjusted annual all-cause and RA-related direct costs were $8,488 (95% CI = $6,793-$10,223) and $578 (95% CI = -$98-$1,243), respectively, when comparing patients with RA and depression vs RA only. LIMITATIONS The current analysis is subject to the known limitations of retrospective studies based on administrative claims data. CONCLUSIONS This study suggested increased healthcare utilization, work productivity loss, and economic burden among RA patients due to comorbid depression. These findings emphasize the importance of managing depression and including depression as a factor when devising treatment algorithms for patients with RA.
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Affiliation(s)
- Nan Li
- a Janssen Global Services , Horsham , PA , USA
| | - Edmond Chan
- a Janssen Global Services , Horsham , PA , USA
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Chen J, Taylor B, Palmer AJ, Kirk-Brown A, van Dijk P, Simpson S, Blizzard L, van der Mei I. Estimating MS-related work productivity loss and factors associated with work productivity loss in a representative Australian sample of people with multiple sclerosis. Mult Scler 2018; 25:994-1004. [DOI: 10.1177/1352458518781971] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: Little is known about the work productivity loss in multiple sclerosis (MS). Objectives: To quantify the MS-related work productivity loss and to compare factors associated with labour force participation and work productivity loss. Methods: Participants were from the Australian MS Longitudinal Study. MS-related work productivity loss included absenteeism (time missed from work) and presenteeism (reduced productivity while working). Data were analysed using log-binomial and Cragg hurdle regression. Results: Among 740 MS employees, 56% experienced any work productivity loss due to MS in the past 4 weeks. The mean total work productivity loss was 2.5 days (14.2% lost productive time), absenteeism 0.6 days (3.4%) and presenteeism 1.9 days (10.8%)), leading to AU$6767 (US$4985, EURO€4578) loss per person annually. Multivariable analyses showed that work productivity was determined most strongly by symptoms, particularly ‘fatigue and cognitive symptoms’ and ‘pain and sensory symptoms’, while older age, and lower education level were also predictive of not being in the labour force. Conclusion: MS-related presenteeism was three times higher than absenteeism, highlighting the importance of presenteeism being included in employment outcomes. The dominance of symptom severity as predictors of both work participation and productivity loss emphasises the need for improved management of symptoms.
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Affiliation(s)
- Jing Chen
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia
| | - Bruce Taylor
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia
| | - Andrew J Palmer
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia
| | - Andrea Kirk-Brown
- Department of Management, Monash University, Narre Warren, VIC, Australia
| | - Pieter van Dijk
- Department of Management, Monash University, Narre Warren, VIC, Australia
| | - Steve Simpson
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia; Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
| | - Leigh Blizzard
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia
| | - Ingrid van der Mei
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia
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Boot CR, de Wind A, van Vilsteren M, van der Beek AJ, van Schaardenburg D, Anema JR. One-year Predictors of Presenteeism in Workers with Rheumatoid Arthritis: Disease-related Factors and Characteristics of General Health and Work. J Rheumatol 2018; 45:766-770. [DOI: 10.3899/jrheum.170586] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/07/2017] [Indexed: 01/20/2023]
Abstract
Objective.Rheumatoid arthritis (RA) affects adults of working age and leads to productivity losses because of presenteeism that results from limitations while at work. The aim of our study was to gain insight into disease-related factors, general health, and work characteristics as predictors of presenteeism in workers with RA.Methods.Workers with RA (n = 150) recruited by rheumatologists completed questionnaires at baseline and after 1 year. Medical information was retrieved from patient records. Presenteeism was measured by the Work Limitations Questionnaire. Disease [28-joint Disease Activity Score (DAS28), Health Assessment Questionnaire (HAQ), pain, fatigue], general health (mental, physical, deterioration of health), and work characteristics (work instability, social support, workload) were assessed as predictors of presenteeism after 1 year using linear regression analyses.Results.Presenteeism was 4.0 h over a 2-week period based on an average work week of 28.7 hours. More RA-related disability (HAQ; B = −1.20, 95% CI −2.12 to −0.28), poorer mental health (B = −0.04, 95% CI −0.08 to −0.01), and health deterioration over a 1-year period (B: −0.02, 95% CI −0.04 to −0.01) were associated with more presenteeism. Work characteristics were not associated with presenteeism.Conclusion.Disease-related factors and general health characteristics were significantly associated with presenteeism at 1-year followup, although the effects of the general health characteristics were considered not to be relevant. To reduce presenteeism and improve functioning at work, it is important to pay attention to reducing RA-related disability in addition to reducing disease activity. A broader perspective is needed and should also take into account the level of RA-related disability.
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Fleischmann R, Weinblatt ME, Schiff M, Khanna D, Maldonado MA, Nadkarni A, Furst DE. Patient-Reported Outcomes From a Two-Year Head-to-Head Comparison of Subcutaneous Abatacept and Adalimumab for Rheumatoid Arthritis. Arthritis Care Res (Hoboken) 2017; 68:907-13. [PMID: 26473625 PMCID: PMC5094537 DOI: 10.1002/acr.22763] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2015] [Revised: 09/29/2015] [Accepted: 10/13/2015] [Indexed: 12/12/2022]
Abstract
Objective To report 2‐year patient‐reported outcomes (PROs) from the head‐to‐head Abatacept versus Adalimumab Comparison in Biologic‐Naive RA Subjects with Background Methotrexate (MTX) (AMPLE) trial. Methods AMPLE was a phase IIIb, randomized, investigator‐blinded trial. Biologic‐naive patients with rheumatoid arthritis (RA) and an inadequate response to MTX were randomized to subcutaneous (SC) abatacept (125 mg/week) or adalimumab (40 mg every 2 weeks) with background MTX. PROs (pain, fatigue, ability to perform work, and ability to perform daily activities) were compared up to year 2 for patients in each treatment group, as well as those who achieved low disease activity at both years 1 and 2 (responders) and those who did not (nonresponders). Results A total of 646 patients were randomized and treated with SC abatacept (n = 318) or adalimumab (n = 328). Baseline characteristics were balanced between the 2 treatment arms. Comparable improvements in PROs were observed in the abatacept and adalimumab groups over 2 years, with both groups achieving clinically meaningful improvements in PROs from baseline. At year 2, fatigue improved by 23.4 mm and 21.5 mm on a 100‐mm visual analog scale with abatacept and adalimumab, respectively. Clinical responders achieved greater improvements in PROs than nonresponders. Conclusion In biologic‐naive patients with active RA, despite prior MTX, treatment with SC abatacept or adalimumab with background MTX resulted in comparable improvements in PROs, which were highly correlated with physician‐reported clinical response end points.
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Affiliation(s)
| | | | | | - Dinesh Khanna
- Dinesh Khanna, MD: University of Michigan, Ann Arbor
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14
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Miller PSJ, Hill H, Andersson FL. Nocturia Work Productivity and Activity Impairment Compared with Other Common Chronic Diseases. PHARMACOECONOMICS 2016; 34:1277-1297. [PMID: 27581788 DOI: 10.1007/s40273-016-0441-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
OBJECTIVES The International Continence Society defines nocturia as the need to void one or more times during the night, with each of the voids preceded and followed by sleep. The chronic sleep disturbance and sleep deprivation experienced by patients with nocturia affects quality of life, compromising both mental and physical well-being. This paper aims to characterise the burden of nocturia by comparing published data from patients with nocturia with data from patients with any of 12 other common chronic conditions, specifically focusing on its impact on work productivity and activity impairment, as measured by the instrument of the same name (WPAI). METHODS A systematic literature review of multiple data sources identified evaluable studies for inclusion in the analysis. Study eligibility criteria included use of the WPAI instrument in patients with one of a predefined list of chronic conditions. We assessed the quality of each included study using the Newcastle-Ottawa scale and extracted basic study information, work and activity impairment data. To assess how work and activity impairment from nocturia compares with impairment from other common chronic diseases, we conducted two data syntheses (pooled and unpooled). RESULTS The number of evaluable studies and the range of overall work productivity impairment reported, respectively, were as follows: nocturia (3; 14-39 %), overactive bladder (5; 11-41 %), irritable bowel syndrome/constipation (14; 21-51 %), gastroesophageal reflux disease (GERD) (13; 6-42 %), asthma/allergies (11; 6-40 %), chronic obstructive pulmonary disease (COPD) (7; 19-42 %), sleep problems (3; 12-37 %), arthritis (13; 21-69 %), pain (9; 29-64 %), depression (4; 15-43 %) and gout (2; 20-37 %). CONCLUSIONS The overall work productivity impairment as a result of nocturia is substantial and was found to be similar to impairment observed as a result of several other more frequently researched common chronic diseases. Greater awareness of the burden of nocturia, a highly bothersome and prevalent condition, will help policy makers and healthcare decision makers provide appropriate management of nocturia.
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Affiliation(s)
- Paul S J Miller
- Miller Economics Ltd., BioHub Alderley Edge, Alderley Park, SK10 4TG, UK.
| | - Harry Hill
- Centre for Health Economics, Institute of Population Health/School of Dentistry, University of Manchester, 4.306, Jean McFarlane Building, Oxford Road, Manchester, M13 9PL, UK
| | - Fredrik L Andersson
- Global Health Economics and Outcomes Research, Ferring Pharmaceuticals A/S, Kay Fiskers Plads 11, 2300, Copenhagen, Denmark
- Center for Medical Technology Assessment (CMT), Linköping University, 581 83, Linköping, Sweden
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15
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Discordance between patient and physician assessments of global disease activity in rheumatoid arthritis and association with work productivity. Arthritis Res Ther 2016; 18:114. [PMID: 27209012 PMCID: PMC4875609 DOI: 10.1186/s13075-016-1004-3] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2016] [Accepted: 04/26/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Discordance between patient and physician ratings of rheumatoid arthritis (RA) severity occurs in clinical practice and correlates with pain scores and measurements of joint disease. However, information is lacking on whether discordance impacts patients' ability to work. We evaluated the discordance between patient and physician ratings of RA disease activity before and after treatment with etanercept and investigated the associations between discordance, clinical outcomes, and work productivity. METHODS In the PRESERVE clinical trial, patients with moderate RA received open-label etanercept 50 mg once weekly plus methotrexate for 36 weeks. Baseline and week-36 disease characteristics and clinical and work productivity outcomes were categorized according to week-36 concordance category, defined as positive discordance (patient global assessment - physician global assessment ≥2), negative discordance (patient global assessment - physician global assessment ≤ -2), and concordance (absolute difference between the two disease activity assessments = 0 or 1). Correlations between discordance, clinical outcomes, and predictors of discordance were determined. RESULTS At baseline, 520/762 (68.2 %) patient and physician global assessment scores were concordant, 194 (25.5 %) were positively discordant, and 48 (6.3 %) were negatively discordant. After 36 weeks of therapy, 556/763 (72.9 %) scores were concordant, 189 (24.8 %) were positively discordant, and 18 (2.4 %) were negatively discordant. Patients with week-36 concordance had the best 36-week clinical and patient-reported outcomes, and overall, the greatest improvement between baseline and week 36. Baseline pain, swollen joint count, duration of morning stiffness, fatigue, and patient general health significantly correlated with week-36 discordance, p < 0.0001 to p < 0.05. Additionally, baseline pain, patient general health, and C-reactive protein were predictors of week-36 discordance (odds ratios 1.22, 1.02, and 0.98, respectively). For the employed patients, percent impairment while working and percent overall work impairment were highest (greatest impairment) at baseline and 36 weeks in the group with positive discordance. CONCLUSIONS The percentage of patients with concordance increased after 36 weeks of treatment with etanercept, with concordant patients demonstrating the greatest improvement in clinical and patient-reported outcomes. Discordance correlated with several measures of disease activity and was associated with decreased work productivity. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT00565409 . Registered 28/11/2007.
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Wang BCM, Hsu PN, Furnback W, Ney J, Yang YW, Fang CH, Tang CH. Estimating the Economic Burden of Rheumatoid Arthritis in Taiwan Using the National Health Insurance Database. Drugs Real World Outcomes 2016; 3:107-114. [PMID: 27747810 PMCID: PMC4819475 DOI: 10.1007/s40801-016-0063-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Rheumatoid arthritis (RA) is a chronic autoimmune disease characterized by inflammation and destruction of the joints. OBJECTIVES This research aims to estimate the economic burden of RA in Taiwan. METHODS The National Health Insurance Research Database (NHIRD), a claims-based dataset encompassing 99 % of Taiwan's population, was applied. We used a micro-costing approach for direct healthcare costs and indirect social costs by estimating the quantities and prices of cost categories. Direct costs included surgeries, hospitalizations, medical devices and materials, laboratory tests, and drugs. The costs and quantities of the direct economic burden were calculated based on 2011 data of NHIRD. We identified RA patients and a control cohort matched 1:4 on demographic and clinical covariates to calculate the incremental cost related to RA. Indirect costs were evaluated by missed work (absenteeism) and worker productivity (presenteeism). For the indirect burden, we estimated the rate of absenteeism and presenteeism from a patient survey. Costs were presented in US dollars (US$1 = 30 TWD). RESULTS A total of 41,269 RA patients were included in the database with incremental total direct cost of US$86,413,971 and indirect cost of US$138,492,987. This resulted in an average incremental direct cost of US$2050 per RA patient. Within direct costs, the largest burdens were associated with drugs (US$73,028,944), laboratory tests (US$6,132,395), and hospitalizations (US$3,208,559). For indirect costs, absenteeism costs and presenteeism costs were US$16,059,681 and US$114,291,687, respectively. CONCLUSIONS The economic burden of RA in Taiwan is driven by indirect healthcare costs, most notably presenteeism.
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Affiliation(s)
- Bruce C M Wang
- Elysia Group Ltd., Floor 2, No. 17-1, Lane 113, Xiamen Street, Taipei, Taiwan
| | - Ping-Ning Hsu
- National Taiwan University, No. 1, Changde St., Zhongzheng Dist., Taipei, 10048, Taiwan
| | - Wesley Furnback
- Elysia Group Ltd., Floor 2, No. 17-1, Lane 113, Xiamen Street, Taipei, Taiwan
| | - John Ney
- University of Washington, 1410 NE Campus Parkway, Seattle, WA, 98195, USA
| | - Ya-Wen Yang
- Pfizer Limited, 177 Chung Cheng East Road, sec. 2, Tansui, New Taipei City, 251, Taiwan
| | - Chi-Hui Fang
- Pfizer Limited, 177 Chung Cheng East Road, sec. 2, Tansui, New Taipei City, 251, Taiwan
| | - Chao-Hsiun Tang
- Taipei Medical University, 250 Wuxing Street, Taipei, 110, Taiwan.
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17
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Tsai CL, Lin CF, Lin HT, Liu MF, Chiu HY, Hsu HY, Kuo LC. How kinematic disturbance in the deformed rheumatoid thumb impacts on hand function: a biomechanical and functional perspective. Disabil Rehabil 2016; 39:338-345. [PMID: 26883482 DOI: 10.3109/09638288.2016.1141244] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Purpose This study investigates the effects of kinematic disturbances in rheumatoid thumb on patient's hand functions via objective and patient-perceived measurements. Method Twenty-one patients with rheumatoid arthritis (RA) and 21 healthy age- and gender-matched individuals were recruited to receive the objective evaluations, including the Purdue Pegboard Test, Jamar dynamometer, pinch-meter, Permanent Impairment Scale and self-administrated measurements, including the Health Assessment Questionnaire (HAQ) and Manual Ability Measure-36 (MAM-36). An electromagnetic tracking system was used to measure thumb kinematics. The differences in the measures between the RA and control groups and the dominant and non-dominant hands of the RA group were examined. The relationships between the thumb kinematics and hand functional capabilities, as well as impairment levels, were also explored. Results The RA group showed significantly smaller thumb movement capabilities and hand strength, as well as worse scores in hand dexterity, MAM-36 and HAQ than healthy controls. The movement workspace of the RA thumb showed moderate correlations with the factors of hand strength, dexterity, impairment scale, MAM-36 and HAQ scores. Conclusions The findings indicate deficits related to the movement capability of the RA thumb may negatively influence hand dexterity and functional hand performance, as well as life quality, for the patients with RA. Implications for Rehabilitation A deformed rheumatoid thumb might limit the movement workspace of the thumb and consequently impair the hand performance as well as the life quality. The dominant thumb of the RA patients might have greater structural and functional deterioration than the non-dominant side. Suitable joint protection strategies, exercises and orthotics should be early applied to the RA patients for preserving hand functions.
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Affiliation(s)
- Chin-Liang Tsai
- a Department of Physical Medicine and Rehabilitation , National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University , Tainan , Taiwan
| | - Cheng-Feng Lin
- b Department of Physical Therapy , College of Medicine, National Cheng Kung University , Tainan , Taiwan
| | - Hwai-Ting Lin
- c Department of Sports Medicine , College of Medicine, Kaohsiung Medical University , Kaohsiung , Taiwan
| | - Ming-Fei Liu
- d Department of Rheumatology , College of Medicine, National Cheng Kung University , Tainan , Taiwan
| | - Haw-Yen Chiu
- e Section of Plastic Surgery, Department of Surgery , Chi-Mei Medical Center , Tainan , Taiwan
| | - Hsiu-Yun Hsu
- a Department of Physical Medicine and Rehabilitation , National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University , Tainan , Taiwan.,f Department of Occupational Therapy , College of Medicine, National Cheng Kung University , Tainan , Taiwan
| | - Li-Chieh Kuo
- f Department of Occupational Therapy , College of Medicine, National Cheng Kung University , Tainan , Taiwan.,g Medical Device Innovation Center, National Cheng Kung University , Tainan , Taiwan
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Strand V, Jones TV, Li W, Koenig AS, Kotak S. The impact of rheumatoid arthritis on work and predictors of overall work impairment from three therapeutic scenarios. ACTA ACUST UNITED AC 2015. [DOI: 10.2217/ijr.15.40] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Kavanaugh A, Gladman D, van der Heijde D, Purcaru O, Mease P. Improvements in productivity at paid work and within the household, and increased participation in daily activities after 24 weeks of certolizumab pegol treatment of patients with psoriatic arthritis: results of a phase 3 double-blind randomised placebo-controlled study. Ann Rheum Dis 2015; 74:44-51. [PMID: 24942382 PMCID: PMC4283690 DOI: 10.1136/annrheumdis-2014-205198] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2014] [Revised: 04/15/2014] [Accepted: 05/24/2014] [Indexed: 11/03/2022]
Abstract
OBJECTIVES To evaluate the effect of certolizumab pegol (CZP) on productivity outside and within the home, and on participation in family, social and leisure activities in adult patients with psoriatic arthritis (PsA). METHODS RAPID-PsA (NCT01087788) is a phase 3, double-blind, placebo-controlled trial. 409 patients with active PsA were randomised 1:1:1 to placebo, CZP 200 mg every 2 weeks (Q2W) or CZP 400 mg every 4 weeks (Q4W). The arthritis-specific Work Productivity Survey (WPS) assessed the impact of PsA on paid work and household productivity, and participation in social activities during the preceding month. WPS responses were compared between treatment arms using a non-parametric bootstrap-t method. RESULTS At baseline, 56.6%, 60.1% and 61.5% of placebo, CZP 200 mg Q2W and CZP 400 mg Q4W patients were employed. By week 24, employed CZP patients reported an average of 1.0-1.8 and 3.0-3.9 fewer days of absenteeism and presenteeism, respectively, per month compared with 1.0 and 0.3 fewer days for placebo patients (p<0.05). Within the home, by week 24, CZP patients reported an average of 3.0-3.5 household work days gained per month versus 1.0 day for placebo (p<0.05). CZP patients also reported fewer days with reduced household productivity or days lost for participation in family, social and leisure activities. Improvements with CZP were seen as early as week 4 and continued to week 24. CONCLUSIONS CZP treatment significantly improved productivity at paid work and within the home, and resulted in greater participation in social activities for PsA patients. TRIAL REGISTRATION NUMBER NCT01087788.
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Affiliation(s)
- A Kavanaugh
- Division of Rheumatology, Allergy and Immunology, UCSD, San Diego, California, USA
| | - D Gladman
- Division of Health Care & Outcomes Research, Toronto Western Research Institute, Toronto Western Hospital, Toronto, Ontario, Canada
| | - D van der Heijde
- Department of Rheumatology, Leiden University Medical Centre, Leiden, Netherlands
| | | | - P Mease
- Swedish Medical Center and University of Washington, Seattle, Washington, USA
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20
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de Jong PH, Hazes JM, Han HK, Huisman M, van Zeben D, van der Lubbe PA, Gerards AH, van Schaeybroeck B, de Sonnaville PB, van Krugten MV, Luime JJ, Weel AE. Randomised comparison of initial triple DMARD therapy with methotrexate monotherapy in combination with low-dose glucocorticoid bridging therapy; 1-year data of the tREACH trial. Ann Rheum Dis 2014; 73:1331-9. [PMID: 24788619 PMCID: PMC4078755 DOI: 10.1136/annrheumdis-2013-204788] [Citation(s) in RCA: 93] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Objectives To compare 1-year clinical efficacy of (1) initial triple disease-modifying antirheumatic drug therapy (iTDT) with initial methotrexate (MTX) monotherapy (iMM) and (2) different glucocorticoid (GC) bridging therapies: oral versus a single intramuscular injection in early rheumatoid arthritis. Methods In a single-blinded randomised clinical trial patients were randomised into three arms: (A) iTDT (methotrexate+sulfasalazine+hydroxychloroquine) with GCs intramuscularly; (B) iTDT with an oral GC tapering scheme and (C) MTX with oral GCs similar to B. Primary outcomes were (1) area under the curve (AUC) of Health Assessment Questionnaire (HAQ) and Disease Activity Score (DAS) and (2) the proportion of patients with radiographic progression. Results 281 patients were randomly assigned to arms A (n=91), B (n=93) or C (n=97). The AUC DAS and HAQ were respectively −2.39 (95% CI −4.77 to −0.00) and −1.67 (95% CI −3.35 to 0.02) lower in patients receiving iTDT than in those receiving iMM. After 3 months, treatment failure occurred less often in the iTDT group, resulting in 40% fewer treatment intensifications. The difference in treatment intensifications between the arms required to maintain the predefined treatment goal remained over time. No differences were seen between the two GC bridging therapies. Respectively 21%, 24% and 23% of patients in arms A, B and C had radiographic progression after 1 year. Patients receiving iTDT had more adjustments of their medication owing to adverse events than those receiving iMM. Conclusions Treatment goals are attained more quickly and maintained with fewer treatment intensifications with iTDT than with iMM. However, no difference in radiographic progression is seen. Both GC bridging therapies are equally effective and, therefore, both can be used. Trial registration number ISRCTN26791028.
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Affiliation(s)
- P H de Jong
- Department of Rheumatology, University Medical Center, Rotterdam, The Netherlands
| | - J M Hazes
- Department of Rheumatology, University Medical Center, Rotterdam, The Netherlands
| | - H K Han
- Department of Rheumatology, Maasstad Hospital, Rotterdam, The Netherlands
| | - M Huisman
- Department of Rheumatology, Sint Francicus Gasthuis Hospital, Rotterdam, The Netherlands
| | - D van Zeben
- Department of Rheumatology, Sint Francicus Gasthuis Hospital, Rotterdam, The Netherlands
| | - P A van der Lubbe
- Department of Rheumatology, Vlietland Hospital, Schiedam, The Netherlands
| | - A H Gerards
- Department of Rheumatology, Vlietland Hospital, Schiedam, The Netherlands
| | - B van Schaeybroeck
- Department of Rheumatology, Albert Schweitzer Hospital, Dordrecht, The Netherlands
| | - P B de Sonnaville
- Department of Rheumatology, Admiraal de Ruyter Hospital, Goes & Vlissingen, The Netherlands
| | - M V van Krugten
- Department of Rheumatology, Admiraal de Ruyter Hospital, Goes & Vlissingen, The Netherlands
| | - J J Luime
- Department of Rheumatology, University Medical Center, Rotterdam, The Netherlands
| | - A E Weel
- Department of Rheumatology, University Medical Center, Rotterdam, The Netherlands Department of Rheumatology, Maasstad Hospital, Rotterdam, The Netherlands
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Radner H, Smolen JS, Aletaha D. Remission in rheumatoid arthritis: benefit over low disease activity in patient-reported outcomes and costs. Arthritis Res Ther 2014; 16:R56. [PMID: 24555808 PMCID: PMC3979137 DOI: 10.1186/ar4491] [Citation(s) in RCA: 98] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2013] [Accepted: 02/05/2014] [Indexed: 12/23/2022] Open
Abstract
Introduction Rheumatoid arthritis (RA) is a chronic inflammatory disease that causes a considerable burden for the patient and society. It is not clear yet whether aiming for remission (REM) is worthwhile, especially when compared with low disease activity (LDA). Methods In 356 consecutive RA patients, we obtained data on physical function (health assessment questionnaire (HAQ)), health-related quality of life (HRQoL: Short Form 36 (SF36), Short Form 6 dimensions (SF-6D), Euro QoL 5D (EQ-5D)), work productivity (work productivity and activity impairment questionnaire (WPAI)), as well as estimation of direct and indirect costs. Cross-sectionally, data were compared in patients within different levels of disease activity according to the simplified disease activity index (SDAI; remission (REM ≤3.3); n = 87; low disease activity (LDA: 3.3 < SDAI ≤11); n = 103; moderate to high disease activity (MDA/HDA) >11 n = 119) by using analyses of variance (ANOVA). Longitudinal investigations assessed patients who changed from LDA to REM and vice versa. Results We found differences in patients achieving REM compared with LDA for HAQ (0.39 ± 0.58 versus 0.72 ± 68), WPAI (percentage impairment while working 11.8% ± 18.7% versus 26.8% ± 23.9%; percentage of overall activity impairment, 10.8% ± 14.1% versus 29.0% ± 23.6%)), EQ-5D (0.89 ± 0.12 versus 0.78 ± 0.6) and SF-36 (physical component score (PCS): 46.0 ± 8.6 versus 38.3 ± 10.5; mental component score (MCS): 49.9 ± 11.1 versus 47.9 ± 12.3) (P < 0.01 for all, except for SF36 MCS). Regarding costs, we found significant differences of direct and indirect costs (P < 0.05) within different levels of disease activity, with higher costs in patients with higher states of disease activity. Longitudinal evaluations confirmed the main analyses. Conclusion Patients with REM show better function, HRQoL, and productivity, even when compared with another good state, such as LDA. Also from a cost perspective, REM appears superior to all other states.
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Cost Effectiveness of TNF-α Inhibitors in Rheumatoid Arthritis. Int J Inflam 2013; 2013:581409. [PMID: 24324915 PMCID: PMC3845242 DOI: 10.1155/2013/581409] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2013] [Revised: 08/29/2013] [Accepted: 09/15/2013] [Indexed: 11/18/2022] Open
Abstract
Background. TNF-α inhibitors have shown to be effective in reducing disease activity and improving the quality of life. Due to the high costs associated with acquisition of this treatment, this study was undertaken to evaluate the ICER of TNF-α antagonists (etanercept, adalimumab, and infliximab) in improving the quality of life. Methods. The HAQ and SF-36 were administered at phases 1, 2, and 3, in order to assess the improvement in the QOL. Suppression of disease activity was assessed through the DAS-28. Results. Statistically significant improvements (P < 0.05) were noted for the SF-36 and HAQ after 3 months and for the DAS-28 after 6 months of TNF-α inhibitor therapy. The mean ICER per 10% improvement in the HAQ, DAS-28, and SF-6D were €1976.5, €2086.5, and €2316.4, respectively, following 6 months of TNF-α intervention. Most favorable ICERs were reported from a patient who had to undergo surgical intervention whilst on DMARD therapy. Conclusion. Significant improvement was observed in patients' quality of life, after a short timeframe of 6 months. Such data is useful information in the light of convincing policy makers, in terms of providing access to the medications to individual patients on national health service schemes.
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