Functional disability associated with disease and quality-of-life parameters in Chinese patients with rheumatoid arthritis

Economic and Humanistic Burden of Rheumatoid Arthritis: Results From the US National Survey Data 2018-2020

OBJECTIVE

Our objective was to estimate the economic and humanistic burden among US adults with rheumatoid arthritis (RA).

METHODS

This study analyzed results from the Medical Expenditure Panel Survey from 2018 to 2020. Adults (aged ≥18 years) self-reporting with RA or with the presence of the International Classification of Disease, 10th Revision clinical modification codes were identified. Healthcare expenditures (inpatient care, outpatient care, emergency department, office visits, prescription medications, home health, and others) were measured. The Short Form 12 Health Survey physical component summary (PCS), mental component summary (MCS), activities of daily living (ADL), and instrumental ADL (IADL) were measured. Two-part models assessed the incremental increase in the health care expenditures for the RA group compared to the non-RA group. In addition, the multivariable linear regression was used to evaluate the marginal difference in PCS and MCS between those with RA and those without RA, whereas the multivariable logistic regression models were used to evaluate the association between ADL and IADL by RA status.

RESULTS

Annually, 4.27 million adults with RA were identified. The two-part model showed significantly higher total annual healthcare expenditures in the RA group than non-RA group (mean $3,382.971 [95% confidence interval (CI) $1,816.50-$4,949.44]). Compared to the non-RA group, the RA group was associated with lower PCS scores (mean 4.78 [95% CI 3.47-6.09]) and similarly lower MCS scores (mean -0.84 [95% CI -2.18 to 0.50]), as well as increased odds of requesting ADL (adjusted odds ratio [aOR] 2.02 [95% CI 1.59-2.56]) and IADL assistance (aOR 2.11 [95% CI 1.57-2.84]).

CONCLUSION

RA was associated with higher health care expenditures, particularly prescription medication costs, and was associated with suboptimal quality of life.

Depressive symptoms and associated factors among older patients with arthritis: evidence from a community-based study in eastern China

Introduction

Depressive symptoms are often experienced by patients with arthritis and are correlated with poor health outcomes. However, the association between depressive symptoms and multidimensional factors (sociodemographic characteristics, health conditions, health behaviors, and social support) among older patients with arthritis in China remains poorly understood. This study aimed to explore the prevalence of depressive symptoms in older patients with arthritis in eastern China and identify the associated factors.

Methods

We analyzed data of 1,081 older patients with arthritis using secondary data from 2014 to 2020 from a community-based ongoing study initiated in 2014 in eastern China. The prevalence of depressive symptoms was calculated, and univariate and multilevel logistic regression analyses were used to identify the associated factors.

Results

The mean age of older patients with arthritis was 69.16 ± 7.13 years; 42.92% were men and 57.08% were women. The prevalence of depressive symptoms in older patients with arthritis was 14.99% (95% confidence interval: 12.91-17.26%), about 1.8 times higher than that in older adults without arthritis (8.49%, p < 0.001). Multilevel logistic regression identified perception of poor economic status (odds ratio [OR] = 5.52, p < 0.001), multimorbidity (OR = 1.96, p = 0.001), limitations in activities of daily living (OR = 2.36, p = 0.004), and living alone (OR = 3.13, p = 0.026) as factors positively associated with depressive symptoms. Patients diagnosed with arthritis at an older age had lower odds of experiencing depressive symptoms (OR = 0.67, p = 0.046).

Conclusion

Screening for depressive symptoms is essential among older patients with arthritis, especially those who perceive themselves as having a poor economic status, are diagnosed at an earlier age, have multimorbidity, have limitations in activities of daily living, and live alone. The associations of age at arthritis diagnosis and dietary behaviors with depressive symptoms require further research.

Correlation between disease activity and patient-reported health-related quality of life in rheumatoid arthritis: a cross-sectional study

OBJECTIVE

We aimed to provide a comprehensive assessment of health-related quality of life (HRQoL) in patients with rheumatoid arthritis (RA) of different activities and to evaluate the correlation between clinical activity measures and HRQoL instruments. This research also analysed the extent to which different aspects of HRQoL (physical, psychological and social) were affected.

DESIGN

Cross-sectional, observational, non-interventional study.

SETTING

The study was conducted at the Department of Rheumatology and Immunology, Qilu Hospital, Shandong University.

METHODS

From December 2019 to October 2020, a total of 340 RA patients participated in the survey using convenient sampling. Three generic instruments, EQ-5D-5L,SF-12 and the AQoL-4D, as well as an RA-specific instrument,the Stanford Health Assessment Questionnaire Disability Index (HAQ-DI), were administered to assess patients' HRQoL. The Disease Activity Score 28-Erythrocyte Sedimentation Rate (DAS28-ESR) was used by doctors to measure patients' clinical activity. Multivariable linear regression was used to compare patients' HRQoL across different levels of activity. Spearman's correlation was used to assess the correlation between doctor-reported clinical activity and HRQoL.

RESULTS

A total of 314 patients with RA participated in this study. The mean score of HAQ-DI was 0.87 (SD: 0.91). Using patients in the clinical remission group as a reference, patients in the moderate and high disease activity groups showed significantly reduced health state utility values and HRQoL scores (all p<0.05). On the contrary, there was an increase in HAQ-DI scores, indicating more impairment (p<0.05). All instruments included in the study tended to differentiate disease activity based on multiple criteria, with scores showing a moderate to strong correlation with RA activity (|rs|=0.50 to 0.65). Among them, the disease-specific instrument had the highest correlation.

CONCLUSIONS

RA can have considerable impairment on patients' HRQoL, both in terms of physical and psychosocial functioning. Given the strong correlation between clinical activity and HRQoL scores, and the fact that HRQoL can be an important clinical supplement. The EQ-5D-5L is probably the most appropriate generic measurement instrument for measuring HRQoL in RA patients.

Network analysis of depression and anxiety symptoms in Chinese rheumatoid arthritis patients

Background

Rheumatoid arthritis (RA) patients are susceptible to comorbid anxiety and depression. From the network model perspective, comorbidity is due to direct interactions between depression and anxiety symptoms. The objective of this study was to assess the network structure of depression and anxiety symptoms in Chinese RA patients and identify the central and bridge symptoms as well as how depression and anxiety symptoms are related to quality of life (QoL) in the network.

Methods

A total of 402 Chinese RA patients were included in this study. Depression and anxiety symptoms were measured by the Hospital Anxiety and Depression Scale (HADS). R software was used to estimate the network. Specifically, we computed the predictability, expected influence (EI) and bridge expected influence (BEI) for each symptom and showed a flow network of "QoL".

Results

Our network revealed that the strongest edge was D2 "See the bad side of things" and D3 "Not feeling cheerful" across the whole network. For centrality indices, D3 "Not feeling cheerful" and D6 "Feeling down" had the highest EI values in the network, while A4 "Trouble relaxing" and D6 "Feeling down" had the highest BEI values of their respective community. As to "QoL", the strongest direct edge related to it was A1 "Nervousness".

Conclusions

"Feeling down" and "Not feeling cheerful" emerged as the strongest central symptoms, while "Trouble relaxing" and "Feeling down" were bridge symptoms in the anxiety-depression network of RA patients. Intervention on depression and anxiety symptoms in nurses should prioritize these symptoms.

'Making every contact count' with patients with musculoskeletal conditions: a qualitative exploration of acceptability to physiotherapists

AIM

To qualitatively explore physiotherapists' experiences and acceptability of implementing 'Making Every Contact Count Healthy Conversation Skills' (MECC HCS) in routine practice with patients with musculoskeletal (MSK) conditions.

METHODS

This article reports the second phase of a mixed method, sequential explanatory study. Physiotherapists trained in and delivering MECC HCS in their practice were invited to take part in semi-structured interviews. We hoped to develop a rich, in-depth understanding of their use and perceptions of the brief intervention and to contextualise findings from the first phase of the study. Qualitative data were analysed using Reflexive Thematic Analysis.

RESULTS

Physiotherapists valued MECC HCS as being integral to their practice, promoting a person-centred approach to supporting behaviour change and enhancing self-management in patients with MSK conditions and pain. It was believed that this brief intervention could reduce workload pressure for physiotherapists and have significant wider benefits for health services. Time limitations associated with appointments did, however, pose as a challenge to MECC HCS delivery, and it was felt that more organisational-level support was needed to sustain it.

CONCLUSIONS

These findings support our quantitative data, collected in the first phase of this study. MECC HCS is a highly acceptable brief intervention that can be delivered in physiotherapy care to support behaviour change in patients with MSK conditions. Future roll-out may be optimised within organisations by providing regular refresher training and adopting a MECC champion.

Life satisfaction, generalized sense of self-efficacy and acceptance of illness in rheumatoid arthritis patients depending on age and severity of the disease

Introduction

Rheumatoid arthritis (RA) is a chronic autoimmune condition characterized by periods of exacerbation (physical limitations, depressed mood, depressive states and decreased life satisfaction) and remission (hope of health improvement). Our objective was to present social functioning of RA patients taking into consideration their age and employing selected determinants: satisfaction with life, generalized sense of self-efficacy and acceptance of illness.

Material and methods

Standardized tools were employed: the Satisfaction with Life Scale, Generalized Self Efficacy Scale and Acceptance of Illness Scale. The study group included 46 RA patients aged 18-45 years and 54 RA patients aged over 60 years. The control group consisted of 24 non-RA subjects in every group.

Results

Rheumatoid arthritis patients in the period of disease exacerbation reported low and moderate levels of satisfaction with life, in the patients in remission period the score was moderate, while the control group subjects described their level of satisfaction with life as high and moderate. The level of acceptance of illness was described by the RA patients in the period of disease exacerbation as 20.4/40 points; the patients in remission defined their level of acceptance of illness as 29.38/40 points. The patients with RA exacerbation showed a low sense of self-efficacy, yet a large group of such patients also presented high self-efficacy levels and the majority of the RA subjects in remission reported a high sense of self-efficacy.

Conclusions

In the RA patients, satisfaction with life, generalized sense of self-efficacy and acceptance of illness were closely related and affected their general psychosocial functioning.

Expression of Nrf2 protein in serum of patients with rheumatoid arthritis: A novel indicator for disease activity and disease prognosis

OBJECTIVE

This study aimed to detect the expression level of nuclear factor erythroid 2-related factor 2 (Nrf2) in the serum of patients with rheumatoid arthritis (RA) to clarify the correlation between Nrf2 levels and medical parameters, such as disease activity, pro-inflammatory factor, clinical characteristics, as well as changes after treatment.

METHODS

Serum samples were collected from 100 patients with RA and 42 normal controls (NCs). Serum levels of Nrf2 protein, tumor necrosis factor-alpha (TNF-α), interleukin-6 (IL-6), interleukin-17A, and malondialdehyde (MDA) were analyzed. The receiver operating characteristic (ROC) curve was adopted to assess the potential of Nrf2 to predict different levels of disease activity in patients with RA. The relationship between clinical variables and parameters were evaluated.

RESULTS

For the first time, it was reported that Nrf2 levels were significantly elevated in the serum of patients with RA compared to those of NCs, as were the MDA levels. The levels of Nrf2 were positively correlated with the disease activity and pro-inflammatory factor levels. The significant cut-off points for Nrf2 to determine RA disease activity were 0.69 ng/mL, 0.69 ng/mL and 1.18 ng/mL. Levels of Nrf2 were higher in RA patients with wrist joint involvement and interstitial lung disease. Moreover, Nrf2 levels decreased after treatment.

CONCLUSIONS

Serum Nrf2 protein level is potentially a novel indicator to monitor disease activity and prognosis in patients with RA.

Smoking, but not use of complementary and alternative medicine predicts residual functional disability in patients with inflammatory arthritis on biologic disease-modifying anti-rheumatic drugs: Results from the Singapore National Biologics Register

AIMS

To describe inflammatory arthritis (IA) patients initiating biologic disease-modifying anti-rheumatic drugs (bDMARDs) who use complementary and alternative medicine (CAM), and determine the impact of CAM on predicting modified Health Assessment Questionnaire (mHAQ) at 6 months.

METHODS

This was a prospective inception cohort study of patients ≥21 years old initiating a bDMARD for IA after July 2016. Data were obtained via questionnaires and abstraction from medical records. Baseline characteristics between ever-CAM and CAM non-users were compared. CAM as a predictor of mHAQ ≥1 at 6 months after bDMARD initiation was analyzed using multivariate logistic regression, adjusting for other baseline characteristics.

RESULTS

We recruited 299 patients (36.2% male, mean age 49.0 years). There were 45.8% who had rheumatoid arthritis, 54.2% had a spondyloarthropathy, median disease duration of 1.1 years and median mHAQ of 0.4. Compared to CAM non-users, ever-CAM users had a lower mean body mass index, were less likely to speak English, and more likely to smoke and drink alcohol. There was no association of CAM use with high mHAQ and no interaction with smoking. Smoking (odds ratio [OR] 938.9; 95% CI 3.20-275 884.1), baseline mHAQ (OR 252.2; 95% CI 5.34-11 899.2) and Charlson's Comorbidity Index score ≥4 (OR 237.4; 95% CI 1.22-46 184.4) independently predicted high mHAQ at 6 months.

CONCLUSIONS

CAM use was not associated with high mHAQ at 6 months. Smoking was an independent predictor of residual functional disability at 6 months, even after adjusting for age, comorbidity and baseline mHAQ. Greater emphasis on smoking cessation may improve long-term functional outcomes in IA patients on bDMARDs.

Utility of Opportunistic Infections, Joints' Involvement and Accuracy of Various Screening Tests to Diagnose Rheumatoid Arthritis Patients

Background and Objectives: Rheumatoid Arthritis (RA) is an auto-immune disease in which the body mistakenly considers some parts of its own system as pathogens and attacks them. Prevalence is approximately 0.75% in India. About 40% of the diseased become work disabled within 5 years from the onset of symptoms. The objective of this paper is to assess the sign/symptoms, joints' involvement, difficulties in daily activities and screening accuracy of serology tests of clinically suspected RA patients. Material and Methods: A cross-sectional cohort study design was conducted on two hundred ninety clinically suspected subjects who were referred by different OPDs of hospitals for screening. The profiles of study subjects were carried through a semi-structured, pre-tested schedule method. About 2 mL of blood samples were collected in a plain vial from each patient and tested for diagnostic tests RF, CRP and AntiCCP by using RF-Latex, CRP Latex and ELISA method, respectively, by the laboratory persons. Results: Joint pain shows to be a leading problem in RA as compared to other signs and symptoms. The majority of the study subjects suffer from knee problems (62%). Approximately equal numbers of RA-positive cases were screened by RF and AntiCCP tests. The CRP test screened about one-third of cases. CRP+ AntiCCP, RF+ AntiCCP and RF + CRP all have good sensitivity, and RF+ AntiCCP + CRP has a very high sensitivity for diagnosing RA. Conclusions: This study found that a substantiation of a major proportion of clinically suspected RA patients were suffering from knee pain. Predication of AntiCCP increased the possibility for the diagnosis of RA. However, RF was also moderately related to the diagnosis of RA, and the combination of both tests was more valuable.

Projecting direct medical costs and productivity benefits of improving access to advanced therapy for rheumatoid arthritis: a projection modelling study

INTRODUCTION

To ensure the sustainability of the AT access improvement, it is important that health system stakeholders have timely, analyzed information accessible for reference and decision-making support. In this study, we projected the direct costs required as well as the expected direct medical cost-offset and productivity benefits resulting from improving the disease control.

METHODS

We implemented a deterministic, prevalence-based mathematical model to project the annual cost of rheumatoid arthritis (RA) management within the public healthcare system in Malaysia. We also calculated the annual productivity loss due to uncontrolled RA in monetary value. Using the projection model, we compared the projected costs of the status quo scenario vs. several scenarios of improved advanced therapy (AT) access over a 5-year period.

RESULTS

We projected that between 10,765 and 11,024 RA patients in Malaysia over the period of 2020-2024 will need access to AT due to treatment failure with conventional synthetic disease modifying antirheumatic drugs (DMARDs). The projected net total medical cost under the status quo scenario were 163.5 million annually on average (approximately MYR 15,000 per patient per year). Cost related to health service utilization represented the heaviest component, amounting to 71.8% followed by drug cost (24.7%). Under the access improvement scenarios, drug cost constituted a higher proportion of the total medical, ranging from 25.6% to 30.4%. In contrast, the cost of health service utilization shown a reverse pattern (reducing to between 66.3% and 70.1%). Productivity costs were also expected to reduce as AT access improved leading to better outcomes. Treatment shifts to targeted synthetic DMARDs in anticipation of price adjustment appeared to have a cost saving advantage to the health system if all other parameters remain unchanged.

DISCUSSION

Improving AT access for RA patients towards the aspirational target appeared to be feasible given the current health budget in Malaysia. Broader socio-economic consequences of productivity and income loss should be included as an important part of the policy consideration. The financial implication of different AT utilization mixes and the anticipated price adjustment will likely result in some cost saving to the health system.

A comprehensive review of COVID-19 symptoms and treatments in the setting of autoimmune diseases

After the first reporting of the index case of Severe Acute Respiratory Syndrome (SARS)-CoV-2-associated disease at the end of December 2019, the virus spread quickly throughout the world, prompting the WHO on 11 March 2020 to declare the disease a global pandemic. The coronavirus disease 2019 (COVID-19) pandemic, raises concerns for all people, mainly for susceptible population. People with pre-existing diseases, especially individuals with autoimmune disorders, are more at the risk of SARS-CoV-2 infection because of compromised immune system due to frequent use of immunosuppressive drugs and steroids. Patients with autoimmune diseases and their physicians have concerns about these patients' healthcare, since they are at a higher risk for COVID-19 infection, may show severe complications of COVID-19, and may experience probable flares of their pre-existing disease. Even though there have been several studies discussing the relation between COVID-19 and various types of autoimmune diseases, it cannot be ascertained that all patients with autoimmune diseases experience more severe complications of COVID-19 and have more hospitalization or mortality rate. The situation depends on each patient's condition, such as the type and the severity of the underlying autoimmune disease and the kind of treatment they receive. In the present review, we have discussed the effects of COVID-19 pandemic on patients with different autoimmune diseases and their relative concerns about their treatments. As a result, we have reviewed further considerations that should be taken into account for these patients during the pandemic or when they are infected with COVID-19.

A comprehensive review of COVID-19 symptoms and treatments in the setting of autoimmune diseases

After the first reporting of the index case of Severe Acute Respiratory Syndrome (SARS)-CoV-2-associated disease at the end of December 2019, the virus spread quickly throughout the world, prompting the WHO on 11 March 2020 to declare the disease a global pandemic. The coronavirus disease 2019 (COVID-19) pandemic, raises concerns for all people, mainly for susceptible population. People with pre-existing diseases, especially individuals with autoimmune disorders, are more at the risk of SARS-CoV-2 infection because of compromised immune system due to frequent use of immunosuppressive drugs and steroids. Patients with autoimmune diseases and their physicians have concerns about these patients' healthcare, since they are at a higher risk for COVID-19 infection, may show severe complications of COVID-19, and may experience probable flares of their pre-existing disease. Even though there have been several studies discussing the relation between COVID-19 and various types of autoimmune diseases, it cannot be ascertained that all patients with autoimmune diseases experience more severe complications of COVID-19 and have more hospitalization or mortality rate. The situation depends on each patient's condition, such as the type and the severity of the underlying autoimmune disease and the kind of treatment they receive. In the present review, we have discussed the effects of COVID-19 pandemic on patients with different autoimmune diseases and their relative concerns about their treatments. As a result, we have reviewed further considerations that should be taken into account for these patients during the pandemic or when they are infected with COVID-19.

How to measure multidimensional quality of life of persons with disabilities in public policies - a case of Poland

Background

The aim of this paper is to construct a tool that can be used to measure multidimensional quality of life of persons with disabilities in comparison with population without disabilities for the purpose of monitoring of the UN Convention on the Rights of Persons with Disabilities (UNCRPD) in Poland.

Methods

The Sen’s capability approach was applied to conceptualize the quality of life in various life domains. We followed guidelines of The Quality of Life Framework developed within the European Statistical System on choosing the life domains in which the QoL should be measured. The QoL scores in each domain (covered by the UNCRPD) were constructed using multiply indicators and multiple causes model (MIMIC). All analysis were based on 2018 EU-SILC data for Poland. We constructed quality of life indicators for population with and without disabilities and compared the differences.

Results

Persons without disability experienced higher QoL as compared to population with disabilities, overall and in various domains. Lower average QoL of persons with disabilities is a result of a lower share of those who experience high QoL. The biggest difference is observed for health and for productive and main activity domains. For material conditions and economic security and physical safety there was a moderate difference recorded. For the leisure and social relations domain there is almost no difference observed. Additionally, we identified diversified associations between such factors as age, gender, household situation, education, partner status, urbanization, health on the QoL across domains and analysed populations.

Conclusions

A tool developed in this paper can be calibrated to enable cross-country and in time comparisons between different populations and support evidenced-based social policy.

Patients' and clinicians' perspectives on the clinical utility of the Rheumatoid Arthritis Foot Disease Activity Index

Although patient-reported outcome measures (PROMs) are recommended in clinical practice, their application in routine care is limited. The Rheumatoid Arthritis Foot Disease Activity Index (RADAI-F5) is a validated PROM for assessing foot disease in rheumatoid arthritis (RA). To explore patient and clinician opinions and perceptions of the clinical utility of the Rheumatoid Arthritis Foot Disease Activity Index (RADAI-F5), eight RA patients and eight clinicians routinely involved in the management of RA patients participated in one semi-structured remote video-based interview. They provided their perspectives on the barriers and facilitators to clinical implementation of the RADAI-F5. Three global themes were identified; 'Feet are a priority' as the impact of RA on the feet negatively impacted upon patient quality of life. The second theme was 'Need for a clinically feasible foot PROM' as participants recognised the current lack of a clinically feasible tool to determine RA foot disease. The third global theme of 'Implementation' was drawn together to form two subordinate themes: 'Facilitators to RADAI-F5 implementation' as the tool can promote communication, guide management, help screen foot symptoms, monitor foot disease status and treatments, and promote patient education and; 'Barriers to RADAI-F5 implementation' as there were associated practical difficulties, including lack of appointment time, administrative burdens, IT barriers and preference for further RADAI-F5 validation using imaging. The RADAI-F5 has significant potential as a clinical tool to aid foot disease management. However, implementation challenges must be overcome before broad adoption in rheumatology clinics.

Poststroke activity engagement in community dwellers: Association with illness perceptions and perceived environment

OBJECTIVES

To investigate whether individuals' poststroke activity engagement is associated with their perceptions of stroke, as well as their perceptions of physical and social environment.

DESIGN

Cross-sectional study.

SETTING

Participants were recruited from eight rehabilitation settings in Beijing, China.

PARTICIPANTS

A total of 202 dyads of community dwellers with stroke and their primary caregivers.

MAIN MEASURES

Activity engagement measured by the Assessment of Life Habits; stroke individuals' and caregivers' illness perceptions measured by the Stroke-Specific Illness Perceptions Questionnaire - Revised; and stroke individuals' perceived social and physical environment measured by the Social Support Survey and abbreviated Neighborhood Environment Walkability Scale.

RESULTS

A total of 202 dyads of individuals with stroke and their caregivers participated in the study with mean ages of 61.3 (8.3) and 52.6 (11.6), respectively. On average, stroke individuals scored 7.61 (1.42) on the daily activities subscale, indicating that they completed personal level activities without assistance but with some difficulty. They scored 6.21 (2.21) on the social roles subscale, suggesting that individuals completed societal level activities with assistive devices and with some difficulty. Illness perceptions correlated significantly with personal level activity engagement (change in R-squared = 0.029; p = 0.049), and perceived accessibility and heterogeneity correlated significantly with societal level activity engagement (change in R-squared = 0.025; p = 0.011).

CONCLUSIONS

Poststroke activity engagement is associated not only with stroke individuals' performance skills but also with their perceptions of stroke, and how they perceive their physical environment. The findings may assist clinicians' decision making when developing comprehensive, targeted interventions for improving activity engagement and maximizing recovery after stroke.

Phenotypes of body composition, physical performance and quality of life in women with rheumatoid arthritis

Aim. To evaluate the frequency of different body composition phenotypes, physical performance (PP) and their relationship with quality of life in women with rheumatoid arthritis (RA). Materials and methods. The study included 157 women (average age 58.68.8 years) with RA. Clinical and laboratory examination, dual-energy X-ray absorptiometry, quality of life assessment according to the questionnaires EQ-5D (European Quality of Life Questionnaire), HADS (Hospital Anxiety and Depression Scale) and RAID (Rheumatoid Arthritis Impact of Disease), determination of muscle strength and the PP of skeletal muscles were carried out. Results. Osteoporotic, sarcopenic and osteosarcopenic phenotypes of body composition were identified in 27 (17%), 16 (10%) and 16 (10%) patients, respectively; 139 (88.5%) people had low muscle strength, and 96 (61.1%) had reduced PP. Quality of life according to the EQ-5D index and RAID, the severity of depression according to HADS in women with different phenotypes of body composition did not differ. Women with osteosarcopenic phenotype had worse indicators for EQ-5D-VAS (VAS visual analog scale), and patients with sarcopenic phenotype had more severe anxiety according to the HADS questionnaire compared to those with normal phenotype (p=0.014 and p=0.027, respectively). The quality of life according to all questionnaires was significantly worse in patients with reduced PP. Conclusion. Pathological phenotypes of body composition were found in 37% of RA patients. A decrease in muscle strength was revealed in 88.5%, and a low PP in 61.1% of patients. The relationship between quality of life and body composition has not been established, at the same time quality of life associated with the PP of skeletal muscles.

Pharmacokinetics and Safety of Single and Multiple Doses of Peficitinib (ASP015K) in Healthy Chinese Subjects

Objective

To investigate the pharmacokinetics and safety of peficitinib (Janus kinase inhibitor for the treatment of rheumatoid arthritis) in healthy Chinese subjects following single and multiple doses.

Methods

This open-label, randomized study was conducted at one site in China. Subjects received peficitinib 50, 100 or 150 mg as a single dose on Day 1 (fasted) and once daily from Days 8 to 13 in the multiple-dose period (fed). Blood samples were collected before administration each day, and up to 72h post administration. Pharmacokinetic assessments included area under the concentration curve (AUC), half-life (t_1/2), maximum concentration (C_max), and time to maximum concentration (t_max) of peficitinib and its metabolites (H1, H2 and H4). Treatment-emergent adverse events (TEAEs) were evaluated.

Results

Thirty-six subjects were enrolled (12 per dose group). After a single dose of peficitinib, median t_max was 1.0–1.5h and mean t_1/2 was 7.4–13.0h for all doses. In the multiple-dose period, median t_max was 1.5–2.0h. Dose-proportional increases in C_max and AUC_24h were observed for peficitinib and its metabolites following single and multiple doses, with minimal drug accumulation. The major metabolite was H2, with a systemic exposure of >150% of the parent AUC. Drug-related TEAEs were experienced by 5 (13.9%) and 12 (33.3%) subjects in the single- and multiple-dose periods, respectively. Following multiple doses of peficitinib, TEAEs were more frequent in higher than lower dose groups but were mild in severity with no related discontinuation or death.

Conclusion

Following single and multiple doses of peficitinib in healthy Chinese subjects, peficitinib demonstrated rapid absorption and was well tolerated at all doses.

Clinicaltrials.gov Identifier

NCT04143477.

Health-related quality of life and treatment satisfaction in Palestinians with rheumatoid arthritis: a cross-sectional study

BACKGROUND

Studying health-related quality of life (HRQoL) and treatment satisfaction have helped in understanding how to optimize rheumatoid arthritis (RA) treatment outcomes and find ways to alleviate signs and symptoms among patients.

OBJECTIVE

In this study, our objective was to evaluate the association between satisfaction with care and HRQoL among RA patients from northern Palestine. In addition, this study also aimed to determine the associations between the clinical characteristics of patients with RA with treatment satisfaction and HRQoL.

METHODS

This was a multicenter cross-sectional study conducted between July and October 2018. Patients with RA diagnosis who presented at rheumatology clinics were interviewed. The SF-36 short questionnaire was used to assess HRQoL and Treatment Satisfaction Questionnaire for Medication (TSQM) version 1.4 to assess treatment satisfaction among study groups. We use descriptive and comparative statistics to present the results.

RESULTS

A total of 283 patients were included. Several sociodemographic and clinical characteristics were found to be associated with poor HRQoL scores and low treatment satisfaction. The physical component summary (PCS) was negatively associated with age, patients' self-reported disease activity, duration of the disease, and the total number of medications taken by the patient, and was positively associated with educational background, employment, and household income. The mental component summary (MCS) was negatively associated with patients' self-reported disease activity and the patient's total number of comorbid diseases. The number of comorbid diseases was negatively associated with effectiveness. All HRQoL subscales were significantly correlated with treatment satisfaction. The range of correlation with PCS was between 0.272 for convenience and 0.425 for side effects (p < 0.001). Similarly, the highest correlation with MCS was 0.458 for side effects, and the lowest was 0.337 for convenience (p < 0.001).

CONCLUSIONS

The current study found that HRQoL was significantly correlated with treatment satisfaction. Furthermore, the results of this study showed that HRQoL and treatment satisfaction are likely to be affected by sociodemographic and clinical characteristics. These results may be beneficial in clinical practice, mainly in the early treatment of patients with RA, at a stage where it is still possible to increase treatment satisfaction.

Psychosocial and clinical impact of COVID-19 pandemic and its relationship to the quality of life in patients with rheumatoid arthritis: a cross-sectional study, Egypt

Background

Data have been pouring on the impact of the COVID-19 pandemic on patients with chronic diseases. This study aimed to address the relationship between the perceived fears of COVID-19 virus (FCV), psychological status, and quality of life (QoL) among patients with rheumatoid arthritis (RA) during the pandemic. This study included 100 patients with RA and an equal number of control subjects, who were recruited from Zagazig University rheumatology outpatient clinics, Egypt. All subjects were interviewed using the fear of COVID-19 scale (FCV-19S), Symptom Checklist-90 scale (SCL-90), and World Health Organization Quality of Life Scale (WHOQOL-BREF). Patients were additionally assessed using the Disease Activity Score 28 (DAS28) and Modified Health Assessment Questionnaire (MHAQ).

Results

There were significant differences between both groups in all QoL domains and most psychological dimensions. Most patients with RA experienced moderate-to-high disease activity and mild-to-moderate functional impairment (85% and 80%, respectively). FCV was correlated with the number of family members (P-value 0.020), and obsessive-compulsive (P-value 0.006), interpersonal sensitivity (P-value 0.035), hostility (P-value 0.017), phobia (P-value 0.010), and psychoticism (P-value 0.034) symptoms. Moderate-to-high disease activity was associated with reduced psychological QoL. Patients with moderate-to-severe functional impairment had worse QoL in all domains (except social). Prolonged illness duration was associated with worse social QoL.

Conclusions

QoL was adversely affected in patients with RA during the pandemic. There was a robust relationship between FCV and the emergence of psychological symptoms. RA-related clinical factors like illness duration, disease activity, and functional disability were associated with reduced QoL in those patients.

Prevalence of depressive symptoms in patients with rheumatoid arthritis at a regional hospital in KwaZulu-Natal, South Africa

Background

Depression affects 14.8% – 38.8% of patients with rheumatoid arthritis (RA) in developed countries. The prevalence and risk factors for depression in patients with RA in sub-Saharan Africa is not well established.

Aim

To determine the prevalence of depressive symptoms in patients with RA.

Setting

Public sector regional hospital in South Africa.

Methods

A cross-sectional descriptive study was undertaken with 110 adult RA patients. A structured socio-demographic and clinical questionnaire, the modified health assessment questionnaire (mHAQ), the simplified disease activity index (SDAI) for RA, the patient health questionnaire (PHQ-9), and the Household Food Insecurity Access scale (HFIAS) for nutritional status, were used. Correlates of depressive symptomatology in participants with RA were identified using t-tests and regression analyses.

Results

Most of the participants were women (90.9%), 67% had moderate to severe RA disease on the SDAI score, 92.7% reported functional disability (HAQ score of ≥ 1), and 87.2% reported mild to severe depressive symptoms. Unemployment (p < 0.01), severe food insecurity (p < 0.01) and functional disability (p = 0.02), were significantly associated with the depressive symptoms, but not with disease activity (p = 0.8) or inflammatory markers (p = 0.63). Unemployment (adjusted β = −5.07, p < 0.01) and severe food insecurity (adjusted β = −4.47, p < 0.01) were significantly associated with depressive symptoms, based on the adjusted regression model.

Conclusion

As RA effects functional status, with the impact of the resulting unemployment and food insecurity being associated with depression, affected people should be screened for depression and managed using a multidisciplinary approach, especially considering the role of social determinants in RA patients with depression.

Predicting the individualized risk of nonadherence to zoledronic acid among osteoporosis patients receiving the first infusion of zoledronic acid: development and validation of new predictive nomograms

Introduction:

Achieving optimal adherence to zoledronic acid (ZOL) among osteoporosis (OP) patients is a challenging task. Here, we aimed to develop and validate a precise and efficient prediction tool for ZOL nonadherence risk in OP patients.

Methods:

We prospectively collected and analyzed survey data from a clinical registry. A total of 1010 OP patients treated for the first time with ZOL in two separate hospitals were selected for nonadherence analysis. The evaluation included a 16-item ZOL Nonadherence Questionnaire and potential risk factors for ZOL nonadherence were assessed via univariate and multivariate analyses. We next developed and validated two distinct-stage nomograms. Discrimination, calibration, and clinical usefulness of the predicting models were assessed using the area under the curve (AUC), calibration curves, and decision curve analysis (DCA).

Results:

The total nonadherence rate was 20.30% after the first ZOL infusion. To generate a model predicting ZOL nonadherence risk, six predictors of 16 items were retained. Model 2 (AUC, 0.8486; 95% confidence interval [CI], 0.8171–0.8801) exhibited considerably more discrimination in desirable functional outcomes, relative to Model 1 (AUC, 0.7644; 95% CI, 0.7265–0.8024). The calibration curves displayed good calibration. DCA revealed that a cutoff probability of 5–54% (Model 1) and 1–85% (Model 2) indicated that the models were clinically useful. External validation also exhibited good discrimination and calibration.

Conclusions:

This study developed and validated two novel, distinct-stage prediction nomograms that precisely estimate nonadherence risk among OP patients receiving the first infusion of ZOL. However, additional evaluation and external validation are necessary prior to widespread implementation.

Associations of depressive symptoms and chronic diseases with activities of daily living among middle-aged and older population in China: A population-based cohort study

BACKGROUND

Activities of daily living (ADL) disability is a concern in the aging population and can lead to increased health service demands and lower quality of life. The aim of this longitudinal study was to assess the associations of chronic conditions and depressive symptoms with ADL disability.

METHODS

This prospective cohort study used two waves of data (2011 and 2015) from the China Health and Retirement Longitudinal Study (CHARLS). A total of 10,864 participants aged 45 and older were included for analysis. Chronic diseases were assessed by self-report and depressive symptoms were assessed using the validated 10-item of Center for Epidemiologic Studies Depression Scale at baseline. Incidents of ADL disability during follow-up were assessed using the Katz ADL scales.

RESULTS

After 4 years of follow-up, there were 704 participants incidents of ADL disability. The incident rate was 17.22 per 1,000 person-years. Having at least one chronic disease was independently associated with a 39% increased risk of incident ADL disability (adjusted HR, 1.39; 95%CI: 1.16, 1.67). The presence of depression symptoms was independently associated with a 54% increased risk of incident ADL disability (adjusted HR, 1.54; 95%CI: 1.30, 1.82). However, there was no significant additive interaction effect between chronic diseases and depressive symptoms on ADL disability.

CONCLUSION

Chronic diseases and depressive symptoms are associated with an increased risk of ADL disability in middle-aged and older Chinese adults. Improving chronic diseases and depressive symptoms can prevent ADL disability.

Impact of social support on severity of depressive symptoms by remission status in patients with rheumatoid arthritis

OBJECTIVES

We aimed to examine the psychosocial characteristics of patients with rheumatoid arthritis (RA) by remission status and determine the impacts of social support on severity of depressive symptoms.

METHODS

We enrolled RA patients aged 40-79 years who visited university hospitals' outpatient clinics. Severity of depressive symptoms (Beck Depression Inventory-II), physical disability (Health Assessment Questionnaire), and support were evaluated. Furthermore, RA disease activity was evaluated by 28-point Disease Activity Score (DAS28) calculation. The independent impacts of instrumental and emotional social support on depressive symptoms by remission status defined as DAS28 score < 2.6 were estimated by multivariable regression analysis.

RESULTS

This study included 360 RA patients. In the remission group, emotional support showed a statistically significant negative impact on depressive symptoms, whereas instrumental support had an extremely limited contribution to severity of depressive symptoms. In the non-remission group, instrumental support showed a negative tendency of impact on severity of depressive symptoms, whereas emotional support had a wide range of influence.

CONCLUSIONS

Favourable association between emotional support and depressive symptoms is confirmed only among RA patients in remission status. The influence of emotional support in non-remission patients and that of instrumental support regardless of remission status are inconclusive.

Current status and influencing factors of fatigue in patients with rheumatoid arthritis: A cross-sectional study in China

AIM

This study aimed to explore the level and influencing factors of fatigue in patients with rheumatoid arthritis.

METHODS

This cross-sectional study was conducted in 243 patients with rheumatoid arthritis from April 2016 to March 2017. The Bristol Rheumatoid Arthritis Fatigue Multi-Dimensional Questionnaire, Arthritis Self-Efficacy Scale-8, Visual Analogue Scale for pain, physical function subscale of Short Form 36-Item Health Survey, Hospital Anxiety and Depression Scale, Perceived Social Support Scale, Pittsburgh Sleep Quality Index and a self-designed demographic and disease-related information questionnaire were used to collect the data. Stepwise linear multiple regression was used to clarify the impact of statistically significant variables (P < 0.05) in the independent sample t test, one-way ANOVA and correlation analysis on the level of fatigue.

RESULTS

Stepwise linear multiple regression analyses showed that disease activity, self-efficacy, physical function, pain, depression, duration of morning stiffness and anxiety were major factors influencing fatigue in patients with rheumatoid arthritis, which explained 59.5% of the total variance.

CONCLUSION

Our study demonstrated a moderate level of fatigue in Chinese patients with rheumatoid arthritis. In clinical practice, nurses should explore individualized intervention programmes based on related predictors of fatigue to help patients relieve fatigue.

Socioeconomic inequality in patients with rheumatoid arthritis: a systematic review and meta-analysis

BACKGROUND

Rheumatoid arthritis is a chronic inflammatory and systemic autoimmune disease associated with synovial fluid inflammatory lesions and articular changes. The aim of the present study was to determine socioeconomic inequality in RA patients using a meta-analysis approach.

METHODS

A systematic search of national and international databases of SID, MagIran, Google Scholar, Cochrane, Embase, ScienceDirect, Scopus, PubMed, and Web of Science (WoS) was conducted to find articles published from 1988 to March 2020. Random effects model was used for analysis and heterogeneity of studies was investigated using I² index. Data analysis was then carried out using Comprehensive Meta-Analysis (Ver. 2).

RESULTS

A total of 51 articles with a total sample size of 48,195 individuals were included in the meta-analysis in all the components. The results showed that 18.9% (95% CI: 4.9-13.25%) of patients were single patients, 70.6% (95% CI: 63.5-76.8%) were married, 31.6% (95% CI: 24.5-39.7%) had low economic status, 52.1% (95% CI: 5.8-44.53%) had moderate economic status, level of education was below diploma in 33% (95% CI: 27.1-39.5%) of cases, 36.2% (95% CI: 27.3-46.1%) were smokers, and 8.8% (95% CI: 2.8-24.1%) of patients were unemployed.

CONCLUSION

The results of the present study indicate high socioeconomic inequality in RA patients in the main components of the study. Hence, to improve the aforementioned status and find causes and do the monitoring at all levels, appropriate solutions must be adopted by providing feedback to policy-makers.

KEY POINTS

• The results showed that 18.9% (95% CI: 4.9-13.25%) of patients were single patients. • 70.6% (95% CI: 63.5-76.8%) were married and 31.6% (95% CI: 24.5-39.7%) had low economic status. • 52.1% (95% CI: 5.8-44.53%) had moderate economic status; 36.2% (95% CI: 27.3-46.1%) were smokers.

Increased risk of mental health disorders in patients with RA during the COVID-19 pandemic: a possible surge and solutions

Depression is a common co-morbidity among rheumatoid arthritis (RA) patients, which may translate into difficulty performing activities of daily living. COVID-19 is an unprecedented disaster that has disrupted lives worldwide and led to a rise in the incidence of mental health disorders. Given the widespread economic devastation due to COVID-19, many RA patients, already susceptible to mental illness, maybe at an increased risk of inaccessibility to medical care, accentuated stress, and consequent worsening of existent mental health disorders, or the onset of new mental health disorders such as anxiety, post-traumatic stress disorder, or depression. The objective of this review is to assess if there is an increased risk of mental health disorders in patients with RA during the COVID-19 pandemic. Telemedicine has bridged the transition to remote chronic care in the pandemic period, though certain accessibility and technological challenges are to be addressed. Decreased access to care amid lockdowns and a proposed triggering of disease activity in patients with autoimmune disorders may potentially herald a massive spike in incidence or flares of patients diagnosed with RA in the coming months. Such a deluge of cases may be potentially devastating to an overburdened healthcare system. Rheumatologists may need to prepare for this eventuality and explore techniques to provide adequate care during these challenging times. The authors found that there is a significant association between the adverse impact on the mental health of RA patients and the COVID-19 pandemic. However, more research is needed to highlight individual risk factors.

Effects of illness perceptions on health-related quality of life in patients with rheumatoid arthritis in China

Objectives

For patients with rheumatoid arthritis (RA) in China, little is known of how their illness perceptions affect their health-related quality of life (HRQoL). The present study investigated associations between specific illness perceptions due to RA and HRQoL features.

Methods

For 191 patients with RA, illness perceptions were measured using the Brief Illness Perceptions Questionnaire (BIPQ) comprising 8 domains. HRQoL was determined with the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36). Multivariate linear regression analyses were performed.

Results

The overall BIPQ of patients with RA was 49.09 ± 11.06. The highest and lowest scores were for concern (9.15 ± 1.81) and personal control (4.30 ± 2.52), respectively. Multivariate stepwise regression analyses showed that the overall BIPQ was significantly negatively associated with each HRQoL feature, and HRQoL total score (β = − 0.343, P < 0.001, 95% CI − 7.080 to − 4.077). Positive associations between BIPQ features and HRQoL included personal control (β = 0.119, P = 0.004, 95% CI 2.857–14.194) and treatment control (β = 0.084, P = 0.029, 95% CI 0.640–12.391). Negative associations with HRQoL were identity (β = − 0.105, P = 0.034, 95% CI − 13.159 to − 0.430) and emotional response (β = − 0.207, P < 0.001, 95% CI − 18.334 to − 6.811).

Conclusions

Patients with RA in China perceive their illness in ways that affect their HRQoL. These results suggest that strategies that target these perceptions may improve the quality of life of these patients.

Pharmacokinetics, Pharmacodynamics, and Safety of Peficitinib (ASP015K) in Healthy Male Caucasian and Japanese Subjects

BACKGROUND AND OBJECTIVE

Peficitinib pharmacokinetics and pharmacodynamics have been characterized mainly in Caucasian subjects. This study investigated the pharmacokinetics, pharmacodynamics, safety, and tolerability of peficitinib in healthy Japanese subjects compared with Caucasian subjects.

METHODS

In this single-center, randomized, double-blind, placebo-controlled study, a cohort of healthy Japanese (n = 24) and Caucasian (n = 24) men received a single oral dose of peficitinib (20, 60, or 200 mg) or placebo. Another cohort of Japanese men (n = 24) received peficitinib (10, 30, or 100 mg) or placebo twice daily for 7 days. Pharmacokinetic and pharmacodynamic parameters were assessed, and adverse events (AEs) monitored throughout.

RESULTS

Dose proportionality of maximum plasma drug concentration (C_max) and area under the plasma concentration-time curve extrapolated to infinity (AUC_inf) was demonstrated for both ethnicities. The geometric mean ratio for dose-normalized C_max was 45.7-98.8% higher and AUC_inf was 33.8-66.4% higher in Japanese versus Caucasian subjects. Mean peak inhibition of STAT5 phosphorylation was higher in Japanese than Caucasian subjects for a given peficitinib dose, but inhibition was comparable across ethnicities for a given plasma peficitinib concentration. In the multiple-dose study, plasma peficitinib concentrations were similar on day 1 and day 7. All AEs were mild, and none resulted in study discontinuation.

CONCLUSIONS

Peficitinib was well tolerated at doses up to 200 mg daily for 7 days in healthy Japanese subjects. Dose-proportional exposure was demonstrated across the single-dose range of 20-200 mg, with greater peficitinib exposure in Japanese compared with Caucasian subjects. The pharmacokinetic/pharmacodynamic relationships were considered comparable between these populations. CLINICALTRIALS.

GOV IDENTIFIER

NCT01225224.

Responsiveness of the Persian health assessment questionnaire measures in differentiating among disease activity levels in rheumatoid arthritis patients

OBJECTIVES

Evidence suggests that inflammation has a harmful effect on muscle strength as well as on functional disability. The purpose of the present study was to examine the association of objectively measured disease activity levels and functional disability among Iranian patients with Rheumatoid Arthritis (RA), and to analyse whether a Persian version of the health assessment questionnaire-disability index (PHAQ-DI) can distinguish between RA patients at different stages of the disease progression.

MATERIALS & METHODS

198 RA patients were requested to complete the PHAQ-DI. The disease activity score for each patient was evaluated using the disease activity score (DAS-28). The association analysis between the PHAQ-DI scores and the four levels of disease activity was measured using a Spearman correlation coefficient. A Kruskal-Wallis analysis was utilized to determine differences in PHAQ-DI scores among the levels of disease activity. The Receiver operating characteristic (ROC) curve was also utilized to determine the PHAQ-DI total score cut-off for predicting the level of disease activity.

RESULTS

Spearman's correlation coefficients between the PHAQ-DI and the disease activity level ranged between 0.59 and 0.75. There were significant differences in the PHAQ-DI total score among known groups with various disease activity levels (P = 0.001); However, HAQ-DI total score could not differentiate the remission phase from low disease activity levels in patients with RA (p = 0.37). The PHAQ-DI total score cut-off for distinguishing remission-low disease activity from moderate-high disease activity was 1.19, with a specificity of 0.91 and a sensitivity of 0.615.

CONCLUSION

The present findings provide evidence for the degree to which the PHAQ-DI measures identify and distinguish disease activity levels in patients with rheumatoid arthritis. The PHAQ-DI questionnaire, as a patient-administered, non-invasive, fast, inexpensive and available tool, can be used in the rheumatologist's office as a substitute for determining disease activity in patients with active RA.

The Bioequivalence of Two Peficitinib Formulations, and the Effect of Food on the Pharmacokinetics of Peficitinib: Two-Way Crossover Studies of a Single Dose of 150 mg Peficitinib in Healthy Volunteers

The marketed tablet formulation of peficitinib differs from the tablet used during the clinical trials. The bioequivalence of the marketed formulation and developmental tablet, and the food effect on the marketed formulation, were analyzed in 2 Japanese open‐label, randomized, 2‐way crossover studies in healthy male volunteers. Volunteers received a single oral dose of the marketed 150‐mg peficitinib tablet under fasted conditions (bioequivalence), and under fed or fasted conditions (food effect). Bioequivalence was compared with the developmental 150‐mg tablet. Samples for pharmacokinetic analysis were collected before dose and ≤72 hours after dose. Safety assessments included adverse events, vital signs, and laboratory variables. In total, 40 and 18 subjects were randomized to the bioequivalence and food effect studies, respectively. The 2 peficitinib formulations were bioequivalent (90% confidence intervals of the geometric mean ratios for C_max and AUC_t of peficitinib were within predefined limits of 0.8 to 1.25). The AUC_last and the C_max of the marketed tablet were 36.8% and 56.4% higher, respectively, under fed versus fasted conditions. Peficitinib was well tolerated. The marketed 150‐mg tablet formulation of peficitinib was bioequivalent to the developmental 150‐mg formulation, with no discernible safety differences. Bioavailability increased under fed conditions with the marketed tablet formulation.

Functional Disability and Its Determinants in Ecuadorian Patients with Rheumatoid Arthritis

INTRODUCTION

Disability in RA is associated with loss of workdays, greater use of health resources and a higher prevalence of depression. The purpose of this study was to determine the prevalence of functional disability and the factors associated with it.

METHODS

A cross-sectional study was carried out during January-June 2019 at a rheumatology clinic in the city of Guayaquil. Patients with pre-established RA were included. Functional disability was measured using the HAQ-DI. Data were analyzed using the statistical program SPSS v22. We compared characteristics between patients with and without disability using Student's t-test and chi-square. A multiple logistic regression model for functional disability was made.

RESULTS

We included 395 patients, 87.8% female and 12.2% male with a mean age of 51.4±12 years and mean duration of disease 13.8±7 years. Most patients had extra-articular manifestations (80.8%) and comorbidities (81.3%). The mean HAQ-DI was 0.8±0.9, with a prevalence of disability of 26.6%. We found a statistically significant relationship between disability and female sex (p=0.018), age (p=0.020), presence of extra-articular manifestations (p=0.008), myalgia (p<0.001) and fatigue (p<0.001). In addition, patients with disabilities had a lower employment rate (26.7%) compared to those without disability (45.5%, p=0.001). In the multivariate logistic analysis, only depression (p=0.029), diabetes (p=0.003), SJC (p=0.001) and VAS of pain (p=0.004) were significantly related to functional disability.

CONCLUSION

Disability affects a quarter of patients with RA. Among the determinants of disability, we found female sex, older age, grade of pain, inflammatory markers and the level of disease activity.

Pharmacokinetics and Safety of a Single Oral Dose of Peficitinib (ASP015K) in Japanese Subjects with Normal and Impaired Renal Function

BACKGROUND AND OBJECTIVE

This study measured and compared the exposure and safety of peficitinib (ASP015K), a novel oral Janus kinase inhibitor, in subjects with normal and impaired renal function after a single oral, clinically relevant peficitinib dose.

METHODS

This was an open-label, parallel-group study conducted at two centres in Japan. Subjects with normal and mildly, moderately, or severely impaired renal function received a single oral dose of peficitinib (one 150 mg tablet) under fasting conditions in a hospital setting. Blood samples were collected prior to administration and up to 72 h post-dose for pharmacokinetic assessment. Safety was assessed up to 7 days post-dose.

RESULTS

Peficitinib plasma concentration-time profiles were similar between those with normal and impaired renal function. In subjects with impaired renal function, area under the plasma concentration-time curve and maximum concentration were 0.8- to 1.1-fold those in subjects with no impairment. Two subjects (one in the normal group and one in the mildly impaired group) each experienced a treatment-emergent adverse event (TEAE). There were no serious TEAEs, deaths or TEAEs leading to treatment withdrawal.

CONCLUSIONS

Peficitinib exposure and TEAEs were similar in subjects with and without renal impairment after a single oral 150 mg dose. Based on these findings, it is not expected that peficitinib dose adjustment will be required in clinical practice, according to the degree of renal impairment. CLINICALTRIALS.

GOV IDENTIFIER

NCT02603497.

A drug-drug interaction study to evaluate the impact of peficitinib on OCT1- and MATE1-mediated transport of metformin in healthy volunteers

Purpose

Peficitinib is an oral pan-Janus kinase inhibitor for the treatment of rheumatoid arthritis. Co-administration of peficitinib with metformin, a type 2 diabetes therapy, can occur in clinical practice. Hepatic and renal uptake of metformin is mediated by organic cation transporter 1 (OCT1) and OCT2, respectively, and its renal excretion by multidrug and toxin extrusion 1 (MATE1) and MATE2-K. This study investigated the effect of peficitinib on metformin pharmacokinetics in vitro and in healthy volunteers.

Methods

Inhibitory effects of peficitinib and its metabolite H2 on metformin uptake into human OCT1/2- and MATE1/2-K-expressing cells were assessed in vitro. In an open-label, drug–drug interaction study, 24 healthy volunteers received a single dose of metformin 750 mg on Days 1 and 10, and a single dose of peficitinib 150 mg on Days 3 and 5–11. Blood and urine samples were collected pre-dose on Days 1 and 10, and at intervals ≤ 48 h post-dose. Metformin concentration was determined by liquid chromatography–tandem mass spectrometry and its pharmacokinetic parameters calculated.

Results

Peficitinib, but not H2, inhibited metformin uptake into OCT1- and MATE1/2-K-expressing cells. Repeated-dose administration of peficitinib reduced metformin area under the concentration–time curve from 0 h extrapolated to infinity (AUC_inf) by 17.4%, maximum plasma concentration (C_max) by 17.0%, and renal clearance (CL_R) by 12.9%. Co-administration of peficitinib with metformin was generally well tolerated.

Conclusion

Slight changes in AUC_inf, C_max and CL_R of metformin were observed when co-administered with peficitinib; however, these changes were considered not clinically relevant.

Electronic supplementary material

The online version of this article (10.1007/s00228-020-02876-2) contains supplementary material, which is available to authorized users.

Depression has an impact on disease activity and health-related quality of life in rheumatoid arthritis: A systematic review and meta-analysis

OBJECTIVE

The aim of this study was to explore the impact of depression on pain, disease activity, functional disability and quality of life in patients with rheumatoid arthritis (RA).

METHODS

English (PubMed, the Cochrane Library, Web of Science and PsycINFO) and Chinese (Wan Fang Database and Chinese National Knowledge Infrastructure) databases were systematically and independently searched from their inception until 30 September, 2019. Studies evaluating the impact of depression on pain, disease activity, functional disability and quality of life with the use of the Short Form-36 questionnaire (SF-36) scoring system were included. Statistical analyses were performed with Revman5.3. Data were pooled using a fixed or random-effects model according to heterogeneity.

RESULTS

A total of 7 identified studies matched the inclusion criteria, reporting on a total of 1078 patients with RA in the analysis. The total Disease Activity Score in 28 joints was significantly higher in patients with depression than in patients without depression [standardized mean difference (SMD) =0.47, 95% CI 0.10-0.85, P = .01]. All SF-36 dimensions (physical function, role physical function, emotional role function, vitality, mental health, social function, body pain, general health, physical component scale, mental component scale) were lower in patients with depression than in groups without depression. Interestingly, the results of this meta-analysis showed no significant difference between patients with and without depression in pain (SMD = 0.57, 95% CI - 0.03-1.17, P = .06) and functional disability (SMD = 0.48, 95% CI - 0.03-0.99, P = .43).

CONCLUSION

This meta-analysis showed that RA patients with depression tended to have higher disease activity and lower quality of life than patients without depression.

Impact of rheumatoid arthritis on work capacity impairment and its predictors

INTRODUCTION

A decline in work capacity is an important outcome of rheumatoid arthritis (RA). In a first such study from India, we evaluated the impact of RA on work capacity and its predictors.

METHODOLOGY

We included 52 RA patients meeting 2010 Rheumatoid Arthritis Classification Criteria. Clinical history, physical examination and HAQ-DI, to assess the functional capability, were done. Information on socio-demographic, working and financial conditions of the patients was collected. Disease-specific characteristics: DAS28, ESR and CRP were included. Statistical analysis was carried out using Pearson's exact chi-square analysis.

RESULTS

Among 52 RA patients, 10 patients had retired from their jobs before diagnosis, and 42 were of working age. Mean disease duration was 6.85 years (range 0.3-26 years). A total of 73% of patients suffered impaired work capacity: reduced working hours (48%), changed their job (8%) and left the labour force early (17%), while 27% had no work capacity impairment. Reduced working hours was significantly associated with lower educational level (p = 0.03), lower monthly income (p = 0.02), manual job (p = 0.01) and concerning disease-related factors: DAS-28 (p = 0.008), CRP level (p = 0.007) and HAQ-DI (p = 0.01). However, leaving the labour force early was related to no medical insurance (p = 0.04) and manual job (p = 0.02). No significant effect was seen in the group with job change.

CONCLUSION

RA impacts work capacity in Indian population. Socio-demographics (educational level, monthly income, job type) and disease-related factors (disease activity, CRP, physical function) are potential predictors for work capacity impairment in RA. Manual job and absence of medical insurance predicted leaving the labour force before official retirement age due to RA.Key Points• A decline in work capacity is an important outcome of the disease.• Attention has not been paid to this issue in India.• Potential predictors for work capacity impairment in RA include: educational level, monthly income, job type, disease activity, CRP, physical function.• Targeting the predictors may result in reducing work capacity impairment in RA.

Periodontal disease in Chinese patients with rheumatoid arthritis: A case-control study

OBJECTIVE

To evaluate the prevalence and severity of periodontal disease in Chinese rheumatoid arthritis patients.

SUBJECTS AND METHODS

This cross-sectional study included 128 RA and 109 healthy controls. Two dentists conducted periodontal status including Plaque index (PI), Gingival index (GI), pocket probing depths (PPDs), Clinical attachment level (CAL) and Bleeding on probing (BOP) independently. Sociodemographic, lifestyle, clinical parameters and use of medication were assessed. Data were analyzed by Student's t test, χ² test, Wilcoxin-Mann- Whitney's test, Correlational Analysis, univariate or multivariate logistic regression.

RESULTS

The periodontal status was significantly worse in RA, especially the condition of dental and gingival status. RA had 4.68-fold. After adjusted potential risk factors, RA had 10.26-fold. The independent variable related to GI was DAS28 (p = .05) negatively, to the contrary, ESR (p = .013) was positively associated; the independent variable positively and related to periodontitis was educational level (p = .021) and anti-CCP positivity (p = .002). Through multivariate logistic regression, age and swollen joint were the independent variable related to periodontitis of RA (OR 1.087, p = .044) and (OR 1.560, p = .008) respectively.

CONCLUSIONS

Chinese RA patients show higher odds of PD. It is important to take early interventions in combination with medical therapy.

Constant hypoxia inhibits osteoclast differentiation and bone resorption by regulating phosphorylation of JNK and IκBα

BACKGROUND

Osteoclasts are responsible for the bone loss in rheumatoid arthritis (RA). Hypoxia has been suggested to play key roles in pathological bone loss. However, the current understanding of the effects of hypoxia on osteoclastogenesis is controversial. Effects of hypoxia on both the formation and function of osteoclasts requires examination. In the current study, we aimed to explore the effect of hypoxia on osteoclast differentiation and the underlying mechanisms.

METHODS

RAW264.7 cells and murine bone-marrow-derived monocytes were used to induce osteoclastogenesis in the presence of macrophage colony-stimulating factor (M-CSF) and receptor activator of nuclear factor kappa B ligand (RANKL). Hypoxic conditions were maintained in a hypoxic chamber at 5% CO₂ and 1% O₂, balanced with N₂. Osteoclasts were detected by tartrate-resistant acid phosphatase (TRAP) staining. A bone resorption assay was carried out in vitro using bone slices. RT-PCR was conducted to detect osteoclast markers and transcription factors. The phosphorylation of nuclear factor-κBα (IκBα), c-Jun N-terminal kinase (JNK), extracellular regulated protein kinase (ERK), and p38 was detected by western blotting. Mann-Whitney U test or Student's t test was used to compare differences between the two groups.

RESULTS

TRAP staining and the bone resorption assay revealed that hypoxia-restrained osteoclast differentiation and bone resorption. Expression of osteoclast markers including cathepsin K, RANK, and TRAP decreased during osteoclast differentiation under hypoxic conditions (all P < 0.05). Hypoxia at 1% O₂ did not affect cell viability, whereas it dramatically abated RANKL-dependent phosphorylation of the JNK-mitogen-activated protein kinases (MAPK) and IκBα pathways. Moreover, the expression of nuclear factor of activated T-cell cytoplasmic 1 (NFATc1) was inhibited under hypoxic conditions (all P < 0.05).

CONCLUSIONS

These results suggest that constant hypoxia at 1% O₂ significantly restrains osteoclast formation and resorbing function without affecting cell viability. Constant hypoxia might inhibit RANKL-induced osteoclastogenesis by regulating NFATc1 expression via interfering the phosphorylation of JNK and IκBα.

Motion analysis of the wrist joints in Chinese rheumatoid arthritis patients: a cross-sectional study

BACKGROUND

The wrist is often severely affected in rheumatoid arthritis (RA) patients; however, little is known about the potential risk factors of the reduced wrist range of motion. In this study, we explored a broad range of possible risk factors of wrist range of motion in RA patients. We also determined whether measurements of wrist range of motion reflect Sharp score for the wrists.

METHODS

Active wrist volar flexion, dorsal flexion, radial deviation and ulnar deviation were assessed using a goniometer. RA patients underwent standardized laboratory and radiographic examinations and completed several questionnaires. A linear regression model was used to study association between the wrist range of motion and independent variables. In addition, Spearman and Pearson correlation analysis were used to compare influence factors and outcome measurements between the measurements of wrist range of motion and Sharp score for the wrists.

RESULTS

In this study, lower socioeconomic status, longer disease duration, severe pain, higher disease activity and drug treatments were associated with reduced wrist range of motion in RA patients (n = 102, 86.3% female, mean ± SD age, 55.0 ± 11.7 years, and mean ± SD disease duration, 8.4 ± 8.7 years). Furthermore, wrist range of motion was highly correlated with Sharp score for the wrists (P < 0.05).

CONCLUSIONS

Socioeconomic status and disease-specific factors were significantly associated with wrist range of motion in RA patients. The results indicated that rheumatologists and nurses should note the measurements of wrist range of motion in RA patients, especially those with a low socioeconomic status, a long disease duration, severe pain, and high disease activity to develop strategies to improve their quality of life.

Factors contributing to disability in rheumatoid arthritis patients: An Egyptian multicenter study

OBJECTIVE

Minimizing disability and enhancing physical function to its optimal levels is still a challenge in management of rheumatoid arthritis (RA). The aim is to identify factors leading to disability in RA.

METHODS

This is a cross-sectional Egyptian multicenter study carried out on 215 RA patients attending to our inpatient and outpatient rheumatology clinics during 4 months starting from April to July 2017 who agreed to participate in the study; 170 patients were from Cairo University hospitals and 45 from Zagazig University hospitals. We recorded a number of possible risk factors including demographic, clinical, serological and therapeutic factors. The assessment of patients' disability was done using Modified HAQ (MHAQ).

RESULTS

A significant positive correlation was found between MHAQ and different markers of activity in addition to age and depression score (P<0.001). Illiteracy accounted for higher MHAQ scores (P=0.001). A higher MHAQ was found in patients with ischemic heart disease (P<0.05). Patients with erosions on X-rays had significantly higher MHAQ scores. Subluxations also accounted for higher MHAQ scores (P=0.000).

CONCLUSION

Aging, illiteracy, disease activity, erosions, subluxations, depression and ischemic heart disease were all related to higher disability. Good control of disease activity which in turn reduces erosions and subluxations is mandatory. Screening for depression and proper use of anti-depressants is of great value. Proper screening and prophylaxis is recommended against ischemic heart disease by controlling modifiable risk factors like obesity, dyslipidaemia, hypertension, smoking and sedentary lifestyle.

Predicting medication nonadherence risk in a Chinese inflammatory rheumatic disease population: development and assessment of a new predictive nomogram

PURPOSE

The aim of this study was to develop and internally validate a medication nonadherence risk nomogram in a Chinese population of patients with inflammatory rheumatic diseases.

PATIENTS AND METHODS

We developed a prediction model based on a training dataset of 244 IRD patients, and data were collected from March 2016 to May 2016. Adherence was evaluated using 19-item Compliance Questionnaire Rheumatology. The least absolute shrinkage and selection operator regression model was used to optimize feature selection for the medication nonadherence risk model. Multivariable logistic regression analysis was applied to build a predicting model incorporating the feature selected in the least absolute shrinkage and selection operator regression model. Discrimination, calibration, and clinical usefulness of the predicting model were assessed using the C-index, calibration plot, and decision curve analysis. Internal validation was assessed using the bootstrapping validation.

RESULTS

Predictors contained in the prediction nomogram included use of glucocorticoid (GC), use of nonsteroidal anti-inflammatory drugs, number of medicine-related questions, education level, and the distance to hospital. The model displayed good discrimination with a C-index of 0.857 (95% confidence interval: 0.807-0.907) and good calibration. High C-index value of 0.847 could still be reached in the interval validation. Decision curve analysis showed that the nonadherence nomogram was clinically useful when intervention was decided at the nonadherence possibility threshold of 14%.

CONCLUSION

This novel nonadherence nomogram incorporating the use of GC, the use of nonsteroidal anti-inflammatory drugs, the number of medicine-related questions, education level, and distance to hospital could be conveniently used to facilitate the individual medication nonadherence risk prediction in IRD patients.