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Bakker NF, van Weely SFE, Boonen A, Vliet Vlieland TPM, Knoop J. Work-related support for employed and self-employed people with rheumatoid arthritis or axial spondyloarthritis: a cross-sectional online survey of patients. Rheumatol Int 2024; 44:1553-1565. [PMID: 38898306 PMCID: PMC11222234 DOI: 10.1007/s00296-024-05643-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2024] [Accepted: 06/05/2024] [Indexed: 06/21/2024]
Abstract
BACKGROUND Little is known about the provision of work-related support for (self-)employed people with rheumatoid arthritis (RA) or axial spondyloarthritis (axSpA) by healthcare providers (HCPs) or employers. OBJECTIVE This study aims to explore the experiences of (self-)employed people with RA or axSpA regarding work-related support from HCPs and employers in the Netherlands. METHODS This cross-sectional study concerned an online survey for (self-)employed people, aged ≥ 16 years and diagnosed with RA or axSpA. The survey focused on experiences with HCPs and employers' work-related support and included questions on sociodemographic factors, health and work characteristics and work-related problems. RESULTS The survey was completed by 884 participants, 56% with RA and 44% with axSpA, of whom 65% were employed, 8% self-employed and 27% not employed. In total, 95% (589/617) of (self-)employed participants reported work-related problems. Sixty-five percent of employed and 56% of self-employed participants had discussed these work-related problems with rheumatologists and/or other HCPs. Whereas 69% of employees with their employer. Both employed and self-employed participants reported that work-related advices or actions were more often provided by other HCPs (53%) than rheumatologists (29%). Fifty-six percent of employees reported this work-related support by the employer. CONCLUSION This survey among (self-)employed people with RA or axSpA found that the majority reported work-related problems, but only half of them received any work-related support for these problems. Discussion of work-related problems with HCPs was more often reported by employed than self-employed participants. More attention from especially rheumatologists and other HCPs is important to identify and address work-related problems promptly.
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Affiliation(s)
- N F Bakker
- Department of Orthopedics, Rehabilitation and Physical Therapy, Leiden University Medical Center, Albinusdreef 2, P.O.Box 9600, 2300 RC, Leiden, the Netherlands.
| | - S F E van Weely
- Department of Orthopedics, Rehabilitation and Physical Therapy, Leiden University Medical Center, Albinusdreef 2, P.O.Box 9600, 2300 RC, Leiden, the Netherlands
- Institute of Allied Health Professions, HU University of Applied Sciences, Utrecht, the Netherlands
| | - A Boonen
- Division of Rheumatology, Department of Internal Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
- Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
| | - T P M Vliet Vlieland
- Department of Orthopedics, Rehabilitation and Physical Therapy, Leiden University Medical Center, Albinusdreef 2, P.O.Box 9600, 2300 RC, Leiden, the Netherlands
| | - J Knoop
- Musculoskeletal Rehabilitation Research Group, HAN University of Applied Sciences, Nijmegen, the Netherlands
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Mulligan K, Harris K, Rixon L, Burls A. A systematic mapping review of clinical guidelines for the management of fatigue in long-term physical health conditions. Disabil Rehabil 2024:1-18. [PMID: 38832888 DOI: 10.1080/09638288.2024.2353855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Accepted: 05/04/2024] [Indexed: 06/06/2024]
Abstract
PURPOSE Despite a high prevalence of fatigue and its importance to patients, many people with long-term conditions do not receive fatigue management as part of their treatment. This review is aimed to identify clinical guidance for the management of fatigue in long-term physical health conditions. METHODS A systematic mapping review was conducted in accordance with Social Care Institute for Excellence systematic review guidance. Bibliographic databases and guideline repositories were searched for clinical guidelines for long-term conditions, published between January 2008 and July 2018, with a search for updates conducted in May 2023. Data were extracted on the recommendations made for managing fatigue and, where cited, the underlying research evidence used to support these recommendations was also extracted. RESULTS The review included 221 guidelines on 67 different long-term conditions. Only 30 (13.6%) of the guidelines contained recommendations for managing fatigue. These were categorised as clinical (e.g. conduct further investigations), pharmacological, behavioural (e.g. physical activity), psychological, nutritional, complementary, environmental, and multicomponent. The guidelines rated much of the evidence for fatigue management as fairly low quality, highlighting the need to develop and test fatigue-management strategies in high-quality trials. CONCLUSION This review highlights that management of fatigue is a very important neglected area in the clinical guidelines for managing long-term conditions.
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Affiliation(s)
- Kathleen Mulligan
- School of Health and Psychological Sciences, City, University of London, London, United Kingdom
- East London NHS Foundation Trust, London, United Kingdom
| | - Katherine Harris
- Centre for Genomics and Child Health, the Blizard Institute, Queen Mary University of London, London, United Kingdom
| | - Lorna Rixon
- School of Health and Psychological Sciences, City, University of London, London, United Kingdom
| | - Amanda Burls
- School of Health and Psychological Sciences, City, University of London, London, United Kingdom
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3
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Duarte C, Spilker RLF, Paiva C, Ferreira RJO, da Silva JAP, Pinto AM. MITIG.RA: study protocol of a tailored psychological intervention for managing fatigue in rheumatoid arthritis randomized controlled trial. Trials 2023; 24:651. [PMID: 37803467 PMCID: PMC10559483 DOI: 10.1186/s13063-023-07692-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 09/29/2023] [Indexed: 10/08/2023] Open
Abstract
BACKGROUND Despite remarkable medical advances in the treatment of rheumatoid arthritis (RA), a subset of patients fails to achieve complete clinical remission, as the Patient Global Assessment (PGA) of disease activity remains above 1, even after the inflammatory process is brought under control. This so-called state of 'PGA-near-remission' negatively impacts individuals' functioning and potentiates inadequate care. Fatigue is a distressing and disabling symptom frequently reported by patients in PGA-near-remission, and its management remains challenging. While classic cognitive-behavioural interventions show some benefits in managing fatigue, there is potential for improvement. Recently, contextual-cognitive behavioural therapies (CCBT), like mindfulness, acceptance, and compassion-based interventions, have shown promising results in fatigue-associated disorders and their determinants. This study primarily aims to examine the efficacy of the Compassion and Mindfulness Intervention for RA (MITIG.RA), a novel intervention combining different components of CCBT, compared to treatment-as-usual (TAU) in the management of RA-associated fatigue. Secondary aims involve exploring whether MITIG.RA produces changes in the perceived impact of disease, satisfaction with disease status, levels of depression, and emotion-regulation skills. METHODS This is a single center, two-arm parallel randomized controlled trial. Patients will be screened for eligibility and willingness to participate and will be assessed and randomized to the experimental (MITIG.RA + TAU) or control condition (TAU) using computer randomization. MITIG.RA will be delivered by a certified psychologist and comprises eight sessions of 2 h, followed by two booster sessions. Outcomes will be assessed through validated self-report measures, including fatigue (primary outcome), perceived impact of disease, depressive symptoms, mindfulness, self-compassion, safety, and satisfaction (secondary outcomes). Assessment will take place at baseline, post-intervention, before the first and second booster sessions (weeks 12 and 20, respectively), and at 32 and 44 weeks after the interventions' beginning. DISCUSSION We expect MITIG.RA to be effective in reducing levels of RA-associated fatigue. Secondarily, we hypothesize that the experimental group will show improvements in the overall perceived impact of disease, emotional distress, and emotion regulation skills. Our findings will contribute to determine the benefits of combining CCBT approaches for managing fatigue and associated distress in RA. TRIAL REGISTRATION ClinicalTrials.gov NCT05389189. Registered on May 25, 2022.
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Affiliation(s)
- Cátia Duarte
- Rheumatology Department, Centro Hospitalar E Universitário de Coimbra, Coimbra, Portugal.
- Faculty of Medicine, Coimbra Institute for Clinical and Biomedical Research (iCBR), University of Coimbra, Coimbra, Portugal.
| | | | - Cláudia Paiva
- Rheumatology Department, Centro Hospitalar E Universitário de Coimbra, Coimbra, Portugal
| | - Ricardo J O Ferreira
- Nursing Research, Innovation and Development Centre of Lisbon (CIDNUR), Nursing School of Lisbon (ESEL), Lisbon, Portugal
| | - José A Pereira da Silva
- Rheumatology Department, Centro Hospitalar E Universitário de Coimbra, Coimbra, Portugal
- Faculty of Medicine, Coimbra Institute for Clinical and Biomedical Research (iCBR), University of Coimbra, Coimbra, Portugal
| | - Ana M Pinto
- Centre for Research in Neuropsychology and Cognitive and Behavioural Intervention (CINEICC), Faculty of Psychology and Educational Sciences, University of Coimbra, Coimbra, Portugal
- Institute of Psychological Medicine, Faculty of Medicine, University of Coimbra, Coimbra, Portugal
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4
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Stefanov K, Al-Wasity S, Parkinson JT, Waiter GD, Cavanagh J, Basu N. Brain mapping inflammatory-arthritis-related fatigue in the pursuit of novel therapeutics. THE LANCET. RHEUMATOLOGY 2023; 5:e99-e109. [PMID: 38251542 DOI: 10.1016/s2665-9913(23)00007-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 11/28/2022] [Accepted: 11/29/2022] [Indexed: 01/26/2023]
Abstract
Despite developments in pharmacological treatments, chronic fatigue is an unresolved issue for most people with inflammatory arthritis that severely disrupts their personal and working lives. Fatigue in these patients is not strongly linked with peripheral disease activity but is associated with CNS-derived symptoms such as chronic pain, sleep disturbance, and depression. Therefore, a neurobiological basis should be considered when pursuing novel fatigue-specific therapeutics. In this Review, we focus on clinical imaging biomarkers that map candidate brain regions and are crucial in fatigue pathophysiology. We then evaluate neuromodulation techniques that could affect these candidate brain regions and are potential treatment strategies for fatigue in patients with inflammatory arthritis. We delineate work that is still required for neuroimaging and neuromodulation to eventually become part of a clinical pathway to treat and manage fatigue.
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Affiliation(s)
- Kristian Stefanov
- School of Infection and Immunity, University of Glasgow, Glasgow, UK.
| | - Salim Al-Wasity
- School of Infection and Immunity, University of Glasgow, Glasgow, UK; College of Engineering, University of Wasit, Al Kūt, Iraq
| | - Joel T Parkinson
- School of Infection and Immunity, University of Glasgow, Glasgow, UK
| | - Gordon D Waiter
- Institute of Medical Sciences, University of Aberdeen, Aberdeen, UK
| | - Jonathan Cavanagh
- School of Infection and Immunity, University of Glasgow, Glasgow, UK
| | - Neil Basu
- School of Infection and Immunity, University of Glasgow, Glasgow, UK
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Curtis JR, Strand V, Golombek S, Zhang L, Wong A, Zielinski MC, Akmaev VR, Saleh A, Asgarian S, Withers JB. Patient outcomes improve when a molecular signature test guides treatment decision-making in rheumatoid arthritis. Expert Rev Mol Diagn 2022; 22:1-10. [PMID: 36305319 DOI: 10.1080/14737159.2022.2140586] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Accepted: 10/24/2022] [Indexed: 11/04/2022]
Abstract
BACKGROUND The molecular signature response classifier (MSRC) predicts tumor necrosis factor-ɑ inhibitor (TNFi) non-response in rheumatoid arthritis. This study evaluates decision-making, validity, and utility of MSRC testing. METHODS This comparative cohort study compared an MSRC-tested arm (N = 627) from the Study to Accelerate Information of Molecular Signatures (AIMS) with an external control arm (N = 2721) from US electronic health records. Propensity score matching was applied to balance baseline characteristics. Patients initiated a biologic/targeted synthetic disease-modifying antirheumatic drug, or continued TNFi therapy. Odds ratios (ORs) for six-month response were calculated based on clinical disease activity index (CDAI) scores for low disease activity/remission (CDAI-LDA/REM), remission (CDAI-REM), and minimally important differences (CDAI-MID) . RESULTS In MSRC-tested patients, 59% had a non-response signature and 70% received MSRC-aligned therapy . In TNFi-treated patients, the MSRC had an 88% PPV and 54% sensitivity. MSRC-guided patients were significantly (p < 0.0001) more likely to respond to b/tsDMARDs than those treated according to standard care (CDAI-LDA/REM: 36.0% vs 21.9%, OR 2.01[1.55-2.60]; CDAI-REM: 10.4% vs 3.6%, OR 3.14 [1.94-5.08]; CDAI-MID: 49.5% vs 32.8%, OR 2.01[1.58-2.55]). CONCLUSION MSRC clinical validity supports high clinical utility: guided treatment selection resulted in significantly superior outcomes relative to standard care; nearly three times more patients reached CDAI remission.
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Affiliation(s)
- Jeffrey R Curtis
- Division of Clinical Immunology and Rheumatology, The University of Alabama at Birmingham, Birmingham, AL, USA
| | - Vibeke Strand
- Division of Immunology/Rheumatology, Stanford University, Palo Alto, CA, USA
| | - Steven Golombek
- Allergy, Asthma & Arthritis Associates, St. Clare's Health, Denville, NJ, USA
| | - Lixia Zhang
- Scipher Medicine Corporation, Waltham, MA, USA
| | - Angus Wong
- Scipher Medicine Corporation, Waltham, MA, USA
| | | | | | - Alif Saleh
- Scipher Medicine Corporation, Waltham, MA, USA
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Adamowicz JL, Vélez-Bermúdez M, Thomas EB. Fatigue severity and avoidance among individuals with chronic disease: A meta-analysis. J Psychosom Res 2022; 159:110951. [PMID: 35665612 PMCID: PMC9629285 DOI: 10.1016/j.jpsychores.2022.110951] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 05/23/2022] [Accepted: 05/23/2022] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Fatigue is a common, debilitating symptom experienced by individuals with chronic disease. Avoidance, or the act of evading unwanted experiences, is associated with fatigue across chronic disease samples. The current study sought to determine the strength of association between fatigue severity and avoidance in individuals with chronic disease. METHODS PubMed, PsycINFO, CINAHL, and ProQuest Dissertations and Theses databases were searched. Eligible studies measured fatigue and avoidance in chronic disease samples. Sixty-six studies were included. Data analyses were conducted in Rstudio. A random effects model was employed, and a weighted mean effect size was computed for fatigue severity and avoidance. Mixed-effects meta-regression analyses were conducted to examine moderating variables, including patient, clinical, and measurement characteristics. Publication bias was examined using funnel plot, trim-and-fill, and p-curve. RESULTS The meta-analysis comprised of 71 unique patient samples from 66 studies. The total number of included participants was 13,024. A small, positive association was found between fatigue severity and avoidance, r(71) = 0.22, p < .001, 95% CI [0.18-0.27], SE = 0.02. There was also significant heterogeneity, Q(70) = 349.96, p < .001. Moderator analyses examining age, sex, illness duration, avoidance type, and disease sample were all non-significant. Regarding publication bias, trim-and-fill resulted in a modified weighted mean effect size (r(83) = 0.18, p < .001) and a p-curve analysis supported the evidential value of the current analysis. CONCLUSION Findings support that among individuals with chronic disease, fatigue severity and avoidance are positively associated, which has implications for behavioral interventions in this population.
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Affiliation(s)
| | - Miriam Vélez-Bermúdez
- University of Iowa, Department of Psychological and Brain Sciences, United States of America.
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7
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Immunological Changes in Peripheral Blood of Ankylosing Spondylitis Patients during Anti-TNF- α Therapy and Their Correlations with Treatment Outcomes. J Immunol Res 2021; 2021:1017938. [PMID: 34692850 PMCID: PMC8536454 DOI: 10.1155/2021/1017938] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 09/11/2021] [Indexed: 01/21/2023] Open
Abstract
Tumor necrosis factor-α (TNF-α) inhibitors are the main types of biological conventional synthetic disease-modifying antirheumatic drugs and have efficacy in treating ankylosing spondylitis (AS) which is not sensitive for nonsteroidal anti-inflammatory drug. However, the impact of TNF-α inhibitors on immune cells in patients with AS is still clearly undefined, and the impact of immune cells on treatment response is also largely elusive. This study is aimed at evaluating the longitudinal changes of circulating immune cells after anti-TNF-α therapy and their associations with treatment response in AS patients. Thirty-five AS patients receiving the treatment of anti-TNF-α therapy were included into this prospective observational study. The frequencies of immune cells including Th1, Th2, Th17, regulatory T cell (Treg), T follicular helper cell (Tfh), and regulatory B cell (Breg) in the peripheral blood were measured by flow cytometry at baseline and 4 time points after therapy. The difference in the circulating immune cells between responders and nonresponders was compared. This study suggested that anti-TNF-α therapy could significantly reduce circulating proinflammatory immune cells such as Th17 and Tfh, but significantly increased the percentages of circulating Treg and Breg. Moreover, circulating Breg may be a promising predictor of response to anti-TNF-α therapy in AS patients.
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Deodhar A, Mease P, Marzo-Ortega H, Hunter T, Sandoval D, Kronbergs A, Lauzon S, Leung A, Navarro-Compán V. Ixekizumab improves sleep and work productivity in patients with non-radiographic axial spondyloarthritis: results from the COAST-X trial at 52 weeks. BMC Rheumatol 2021; 5:50. [PMID: 34560906 PMCID: PMC8464085 DOI: 10.1186/s41927-021-00218-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Accepted: 06/25/2021] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Patients with non-radiographic axial spondyloarthritis experience negative impacts on sleep, work productivity, and activity impairment. Ixekizumab, a monoclonal antibody selectively targeting interleukin-17A, has shown efficacy in treating the signs and symptoms of non-radiographic axial spondyloarthritis. This analysis evaluated the effect of ixekizumab treatment on sleep, work productivity, and activity impairment in patients with non-radiographic axial spondyloarthritis. METHODS COAST-X ( NCT02757352 ) was a 52-week, phase 3, multicenter, randomised placebo-controlled trial evaluating 80-mg ixekizumab every 2 weeks and every 4 weeks in patients with active non-radiographic axial spondyloarthritis. Sleep disturbance was measured with the Jenkins Sleep Evaluation Questionnaire (JSEQ) and analysed using mixed-effects models for repeated measures. Work productivity and activity impairment were measured using the Work Productivity and Activity Impairment Questionnaire for Spondyloarthritis and analysed using analysis of covariance. Absenteeism, presenteeism, and overall work impairment were assessed for patients reporting paid work; activity impairment was assessed regardless of work status. RESULTS Overall, patients treated with both dosing regimens of ixekizumab reported numerically greater improvements in sleep than placebo through Week 52. At Weeks 16 and 52, patients treated with ixekizumab every 4 weeks had significantly greater improvements in presenteeism (p = 0.007 and p = 0.003, respectively) and overall work impairment (p = 0.014 and p = 0.005, respectively) and numeric improvements in absenteeism than placebo. Patients treated with ixekizumab every 2 weeks had numerically greater improvements in absenteeism, presenteeism, and overall work impairment than placebo. Both dosing regimens of ixekizumab were associated with significantly greater improvements in activity impairment than placebo (ixekizumab every 4 weeks: p = 0.003 at Week 16 and p = 0.004 at Week 52; ixekizumab every 2 weeks: p = 0.007 at Week 16 and p = 0.006 at Week 52). CONCLUSIONS Treatment with ixekizumab improved sleep, work productivity, and activity impairment in patients with nr-axSpA. Improvements in presenteeism and overall work impairment were sustained and consistent in the patients treated with ixekizumab every 4 weeks from Week 16 to Week 52. Improvements in activity impairment were sustained and consistent in both ixekizumab-treated groups from Week 16 to Week 52. TRIAL REGISTRATION NCT02757352 , May 2, 2016.
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Affiliation(s)
- Atul Deodhar
- Division of Arthritis and Rheumatic Diseases, Oregon Health & Science University, 3181 Sam Jackson Park Rd, Portland, OR, 97239, USA.
| | - Philip Mease
- Swedish Medical Center/Providence St. Joseph Health and University of Washington, Seattle, WA, USA
| | - Helena Marzo-Ortega
- NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals Trust and LIRMM, University of Leeds, West Yorkshire, Leeds, UK
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9
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Abstract
BACKGROUND Rheumatoid arthritis is often associated with work disability, a term used to describe the inability to be or to remain employed. Work disability is a common implication of rheumatoid arthritis. OBJECTIVE This review aims to identify and analyze the predictive factors of work disability among patients with rheumatoid arthritis, as well as to group these factors into broader categories, based on the most current studies in this field. METHODS An electronic search was conducted using Google Scholar, MEDLINE and PsycINFO databases. Eighty-six international journal articles were finally selected. RESULTS The results suggest that occupational, personal, medical and societal factors are the main predictive categories of work disability for people with rheumatoid arthritis. CONCLUSIONS Medical progress has had a positive effect on the development and the rates of work disability among patients with RA. Work disability is, however, not only defined by medical factors. Occupational, personal and societal factors interact with each other and affect the development of work disability in RA. The results of this review emphasize the need for medical and vocational therapy interventions, social support and state policies that target the work status of patients with RA. Future holistic research approaches to the field are required for a complete picture and concrete solutions with the aim of keeping patients with RA employed.
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Affiliation(s)
- Doxa Papakonstantinou
- Department of Educational and Social Policy, University of Macedonia, 156 Egnatia street, 54636, Thessaloniki, Greece. Tel.: +30 2310 891403; E-mail: ; ORCID: https://orcid.org/0000-0002-3242-7629
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10
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Marques ML, Alunno A, Boonen A, Ter Wee MM, Falzon L, Ramiro S, Putrik P. Methodological aspects of design, analysis and reporting of studies with work participation as an outcome domain in patients with inflammatory arthritis: results of two systematic literature reviews informing EULAR points to consider. RMD Open 2021; 7:rmdopen-2020-001522. [PMID: 33542048 PMCID: PMC7868290 DOI: 10.1136/rmdopen-2020-001522] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 01/06/2021] [Accepted: 01/14/2021] [Indexed: 12/12/2022] Open
Abstract
Objective To summarise the methodological aspects in studies with work participation (WP) as outcome domain in inflammatory arthritis (IA) and other chronic diseases. Methods Two systematic literature reviews (SLRs) were conducted in key electronic databases (2014–2019): search 1 focused on longitudinal prospective studies in IA and search 2 on SLRs in other chronic diseases. Two reviewers independently identified eligible studies and extracted data covering pre-defined methodological areas. Results In total, 58 studies in IA (22 randomised controlled trials, 36 longitudinal observational studies) and 24 SLRs in other chronic diseases were included. WP was the primary outcome in 26/58 (45%) studies. The methodological aspects least accounted for in IA studies were as follows (proportions of studies positively adhering to the topic are shown): aligning the studied population (16/58 (28%)) and sample size calculation (8/58 (14%)) with the work-related study objective; attribution of WP to overall health (28/58 (48%)); accounting for skewness of presenteeism/sick leave (10/52 (19%)); accounting for work-related contextual factors (25/58 (43%)); reporting attrition and its reasons (1/58 (2%)); reporting both aggregated results and proportions of individuals reaching predefined meaningful change or state (11/58 (16%)). SLRs in other chronic diseases confirmed heterogeneity and methodological flaws identified in IA studies without identifying new issues. Conclusion High methodological heterogeneity was observed in studies with WP as outcome domain. Consensus around various methodological aspects specific to WP studies is needed to improve quality of future studies. This review informs the EULAR Points to Consider for conducting and reporting studies with WP as an outcome in IA.
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Affiliation(s)
- Mary Lucy Marques
- Rheumatology, Leiden University Medical Center, Leiden, Zuid-Holland, The Netherlands .,Rheumatology, Centro Hospitalar e Universitario de Coimbra EPE, Coimbra, Portugal
| | - Alessia Alunno
- Rheumatology Unit, University of Perugia Department of Medicine, Perugia, Umbria, Italy
| | - Annelies Boonen
- Department of Internal Medicine, Maastricht University Medical Centre, Maastricht, Limburg, The Netherlands.,Department of Health Services Research, Universiteit Maastricht Care and Public Health Research Institute, Maastricht, Limburg, The Netherlands
| | - Marieke M Ter Wee
- Department of Epidemiology and Data Science, Amsterdam Public Health, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,Department of Rheumatology and immunology, AI&I, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Louise Falzon
- Center for Personalized Health, Feinstein Institutes for Medical Research, Northwell Health, New York, New York, USA
| | - Sofia Ramiro
- Rheumatology, Leiden University Medical Center, Leiden, Zuid-Holland, The Netherlands.,Rheumatology, Zuyderland Medical Centre Heerlen, Heerlen, Limburg, The Netherlands
| | - Polina Putrik
- Department of Internal Medicine, Maastricht University Medical Centre, Maastricht, Limburg, The Netherlands.,Department of Health Services Research, Universiteit Maastricht Care and Public Health Research Institute, Maastricht, Limburg, The Netherlands
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11
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Wagan AA, Raheem A, Bhatti A, Zafar T. Fatigue assessment by FACIT-F scale in Pakistani cohort with Rheumatoid Arthritis (FAF-RA) study. Pak J Med Sci 2021; 37:1025-1030. [PMID: 34290777 PMCID: PMC8281179 DOI: 10.12669/pjms.37.4.3602] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Revised: 10/12/2020] [Accepted: 03/26/2021] [Indexed: 11/29/2022] Open
Abstract
Objective: To fine out fatigue frequency and severity by FACIT-F scale in Pakistani cohort with rheumatoid arthritis. Methods: This study was conducted at department of Medicine division of rheumatology CPMC Lahore. After the approval of IRB, 192 patients of RA were recruited. Written, informed consent was taken, demographic details were noted, patients filled the URDU version of FACIT-F (fatigue severity scale). 5-ml of blood was taken for fasting blood sugar, viral markers and ESR by a trained phlebotomist. Each individual’s disease activity was assessed by DAS-28 and FACIT-F score was calculated. Results: The Mean age (39.9±10.5) years, (71.9%) were females. Fatigue frequency was 62% (n=126), age, education, hypertension, DAS-28, exercise levels and HCV gives significant association with fatigue score. Linear regression analysis, results showed one unit increase in DAS-28 will gives 2.71 unit increases in fatigue scores(P <0.05). Conclusions: We have very high frequency of fatigue in RA, increases with disease activity & associated conditions.
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Affiliation(s)
- Abrar Ahmed Wagan
- Dr. Abrar Ahmed Wagan, MBBS, FCPS (Medicine), FCPS (Rheumatology), FACR. Assistant Professor, Indus Medical College, Tando Mohammad Khan, Pakistan
| | - Abdul Raheem
- Dr. Abdul Raheem, MBBS. Postgraduate Trainee, Central Park Medical College Lahore, Lahore, Pakistan
| | - Afra Bhatti
- Dr. Afra Bhatti, MBBS. Postgraduate Trainee, Central Park Medical College Lahore, Lahore, Pakistan
| | - Taimoor Zafar
- Dr. Taimoor Zafar, MBBS. Postgraduate Trainee, Central Park Medical College Lahore, Lahore, Pakistan
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12
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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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13
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Zhou W, Zhu J, Guo J, Chen H, Zhang X, Gu Z, Zhou F, Dong C. Health-related quality of life assessed by Gout Impact Scale (GIS) in Chinese patients with gout. Curr Med Res Opin 2020; 36:2071-2078. [PMID: 33085514 DOI: 10.1080/03007995.2020.1840341] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
OBJECTIVE The Gout Impact Scale (GIS) is a disease-specific health-related quality of life (HR-QoL) measurement for patients with gout. This study aimed to investigate the quality of life in Chinese patients with gout and potential risk factors for poorer HR-QoL by GIS. METHODS Adults with gout from February 2017 to February 2019 were invited to complete a questionnaire containing the GIS, social demographic characteristics, clinical information and gout-specific questions. Pearson/Spearman correlation and linear regression were used to analyze the data. RESULTS A total of 413 patients were included in the analysis (mean age, 51.85 years; 96.4% male). The mean (SD) score of GIS total was 56.79 ± 15.45. Worse gout-specific HR-QoL was associated with anxiety (p < .05), depression (p < .05) and fatigue (p < .05). The effectiveness and global satisfaction of Treatment Satisfaction Questionnaire for Medication (TSQM) were negatively related to each dimension of GIS. Age (B = -0.251, p = .013), fatigue (B = 1.850, p < .001) and depression (B = 9.068, p = .042) were independent predictors of GIS total score. CONCLUSION Gout-specific HR-QoL is impaired by social demographic and clinical characteristics, highlighting the importance of psychological factors (fatigue and depression) and patient-reported outcomes (patients' satisfaction and confidence in gout treatment). These findings suggest that more studies should focus on disease-specific HR-QoL.
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Affiliation(s)
- Wei Zhou
- Research Center of Clinical Medicine, Affiliated Hospital of Nantong University, Nantong, China
- Department of Nursing, Affiliated Hospital of Nantong University, Nantong, China
| | - Jinjin Zhu
- Department of Nursing, Affiliated Hospital of Nantong University, Nantong, China
| | - Jiaxin Guo
- Department of Nursing, Affiliated Hospital of Nantong University, Nantong, China
| | - Huamao Chen
- Department of Nursing, Affiliated Hospital of Nantong University, Nantong, China
| | - Xiaomei Zhang
- Department of Nursing, Affiliated Hospital of Nantong University, Nantong, China
| | - Zhifeng Gu
- Department of Rheumatology, Affiliated Hospital of Nantong University, Nantong, China
| | - Fengyan Zhou
- Department of Nursing, Affiliated Hospital of Nantong University, Nantong, China
| | - Chen Dong
- Research Center of Clinical Medicine, Affiliated Hospital of Nantong University, Nantong, China
- Department of Nursing, Affiliated Hospital of Nantong University, Nantong, China
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Marzo-Ortega H, Mease PJ, Rahman P, Navarro-Compán V, Strand V, Dougados M, Combe B, Wei JCC, Baraliakos X, Hunter T, Sandoval D, Li X, Zhu B, Bessette L, Deodhar A. Impact of Ixekizumab on Work Productivity in Patients with Ankylosing Spondylitis: Results from the COAST-V and COAST-W Trials at 52 Weeks. Rheumatol Ther 2020; 7:759-774. [PMID: 32814997 PMCID: PMC7695773 DOI: 10.1007/s40744-020-00225-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION Patients with ankylosing spondylitis (AS) are burdened with symptoms impacting work productivity measured by presenteeism, absenteeism, overall work impairment, and activity impairment. Ixekizumab, a high-affinity monoclonal antibody selectively targeting interleukin-17A, has been demonstrated to improve disease signs and symptoms in two phase 3 trials of AS. This study investigated for 52 weeks the effect of ixekizumab treatment on work productivity in patients with active AS. METHODS COAST-V (NCT02696785) and COAST-W (NCT02696798) were phase 3, multicenter, randomized, controlled trials investigating the efficacy of ixekizumab 80 mg every 4 weeks (Q4W) and every 2 weeks (Q2W) in patients with AS naïve to biologic disease-modifying antirheumatic drugs (bDMARDs; COAST-V) or who were inadequate responders or intolerant to tumor necrosis factor inhibitors (TNFi; COAST-W). Work productivity was measured with the Work Productivity and Activity Impairment Questionnaire for Spondyloarthritis at weeks 16 and 52. Absenteeism, presenteeism, and overall work impairment were assessed for patients reporting paid work. Activity impairment was assessed regardless of work status. RESULTS At baseline, 66.2% (434/656) of patients reported paid work. At week 16, bDMARD-naïve patients treated with both ixekizumab dose regimens and TNFi-experienced patients treated with ixekizumab Q2W reported significant improvements in activity impairment (p < 0.01 and p < 0.05, respectively). TNFi-experienced patients treated with ixekizumab showed significant improvements versus placebo in presenteeism and overall work impairment (p < 0.05); bDMARD-naïve patients had numeric improvements. After week 16, patients initially on placebo switched to ixekizumab and patients already treated with ixekizumab continued treatment. Improvements in work productivity and daily activity were sustained through week 52 for both bDMARD-experienced and -naïve patients. CONCLUSION Both bDMARD-naïve and TNFi-experienced patients with AS had greater improvements in work productivity and activity impairment when receiving ixekizumab compared to placebo at week 16. Improvements in work productivity and activity impairment achieved at week 16 were sustained through week 52 with ixekizumab treatment.
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Affiliation(s)
- Helena Marzo-Ortega
- National Institute for Health Research-Leeds Biomedical Research Centre (NIHR-LBRC), Leeds Teaching Hospitals Trust and Leeds Institute of Rheumatic and Musculoskeletal Medicine (LIRMM), University of Leeds, Leeds, West Yorkshire, UK.
| | - Philip J Mease
- Swedish Medical Center-Providence St. Joseph Health and University of Washington, Seattle, WA, USA
- University of Washington School of Medicine, Seattle, WA, USA
| | - Proton Rahman
- Memorial University of Newfoundland, St. John's, NL, Canada
| | | | - Vibeke Strand
- Division Immunology/Rheumatology, Stanford University School of Medicine, Palo Alto, CA, USA
| | | | - Bernard Combe
- Department of Rheumatology, CHU Montpellier and Montpellier University, Montpellier, France
| | - James Cheng-Chung Wei
- Graduate Institute of Integrated Medicine, Chung Shan Medical University, China Medical University, Taichung City, Taiwan
| | | | | | | | - Xiaoqi Li
- Eli Lilly and Company, Indianapolis, IN, USA
| | - Baojin Zhu
- Eli Lilly and Company, Indianapolis, IN, USA
| | - Louis Bessette
- Centre hospitalier universitaire de Québec-Laval University, Quebec City, QC, Canada
| | - Atul Deodhar
- Division of Arthritis and Rheumatic Diseases, Oregon Health and Science University, Portland, OR, USA
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Abstract
Fatigue is highly prevalent in inflammatory arthritis, and people living with the symptom have described it as overwhelming and a challenge to manage. In this article, we explore the experience, impact and non-pharmacological management of fatigue from a multi-disciplinary perspective. We start by presenting qualitative evidence from people living with fatigue, including the physical, cognitive and emotional nature of the symptom and its impact on daily life. This is followed by discussion of current conceptual models of mechanisms and factors that may cause and maintain fatigue, within and between individuals. We then address the issue of fatigue measurement and modes of assessment, which is an integral aspect of management and evaluating support provision. This leads to a review of the research evidence for non-pharmacological interventions to reduce fatigue severity and impact. Finally, we consider implementation of this evidence in clinical practice and we introduce some key practical tools and techniques.
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16
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Nadin T, Wallis D, Holroyd CR, D'Angelo S, Walker-Bone K, Edwards CJ. Amongst patients taking biologic therapies for axial spondyloarthritis, which factors are associated with work non-participation? BMC Musculoskelet Disord 2020; 21:209. [PMID: 32252744 PMCID: PMC7137257 DOI: 10.1186/s12891-020-03247-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Accepted: 03/27/2020] [Indexed: 01/01/2023] Open
Abstract
Background Axial spondyloarthritis (axSpA) frequently presents during working age and therefore impacts work participation. Biologic therapies have demonstrated a positive impact on work-related outcomes in clinical trials but real world data are limited. Therefore, we investigated the prevalence and predictors of work impairment and disability among axSpA patients attending a biologic therapy clinic. Methods This was a single-centre, cross-sectional study of patients with axSpA treated with biologic therapy. Work participation was assessed with the Work Productivity and Activity Impairment (WPAI) Questionnaire. Work outcomes (presenteeism, absenteeism, health-related job loss) were compared for gender, time since diagnosis, smoking status and disease outcome measures. Results Data were available for 165 patients (mean age 47.6 years, 75% male, 21% current smokers). Mean time since diagnosis was 15.5 years and mean duration of biologic therapy 4.7 years; 19/165 (11.5%) were on a tapered-dose regimen. Occupational data were available for 144 patients amongst whom 101 (70.1%) were either currently employed or in full time education. Of those eligible to work, 17/118 (14.4%) reported inability to work due to their axSpA. Amongst those in employment, 10.8% reported absenteeism due to axSpA in the week prior to their clinic visit (mean hours missed = 13). The mean work productivity impairment was 23%. Higher disease activity (BASDAI) and markers of global health, quality of life and pain, (BAS-G, ASQoL and spinal pain VAS) were associated with axSpA related job loss, absenteeism and presenteeism. Conclusions In this group of axSpA patients on biologic therapy (mean age 47.6 years), almost 1 in 6 (14.4%) reported axSpA related job loss. Poor work outcomes: axSpA-related work disability, absenteeism and presenteeism were associated with poorer scores for patient-reported disease outcome measures. Strategies for enhancing work productivity should be directed towards those patients at risk of poor work outcomes. More data are needed including details of the types of work that are most difficult with axSpA.
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Affiliation(s)
- Tom Nadin
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Dinny Wallis
- University Hospital Southampton NHS Foundation Trust, Southampton, UK.
| | | | - Stefania D'Angelo
- MRC Versus Arthritis Centre for Musculoskeletal Health and Work, MRC Lifecourse Epidemiology Unit, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Karen Walker-Bone
- MRC Versus Arthritis Centre for Musculoskeletal Health and Work, MRC Lifecourse Epidemiology Unit, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Christopher J Edwards
- University Hospital Southampton NHS Foundation Trust, Southampton, UK.,NIHR Clinical Research Facility, University Hospital Southampton NHS Foundation Trust, Southampton, UK
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Santos EJF, Duarte C, da Silva JAP, Ferreira RJO. The impact of fatigue in rheumatoid arthritis and the challenges of its assessment. Rheumatology (Oxford) 2020; 58:v3-v9. [PMID: 31435662 PMCID: PMC6827262 DOI: 10.1093/rheumatology/kez351] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Revised: 07/16/2019] [Indexed: 01/22/2023] Open
Abstract
Fatigue is one of the most important symptoms for patients with RA, and imposes a great burden on patients’ lives, being associated with significantly reduced health-related quality of life. Although being recognized by the rheumatology community as a major gap in the current management of the disease, fatigue has not been easy to measure and conceptualize. Part of the problem seems to reside in the multidimensional causality of this phenomenon, which may warrant dedicated measures and interventions. Although there are several instruments available to measure it, no consensus has yet been reached to recommend a ‘gold-standard’. This review aims at synthesizing the role of fatigue in the global impact of RA; describing validated instruments and their psychometric properties as measures of fatigue among patients with RA; and finally proposing a clinically meaningful, valid and feasible process to measure fatigue in clinical practice.
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Affiliation(s)
- Eduardo J F Santos
- Rheumatology Department, Centro Hospitalar e Universitário de Coimbra, Coimbra.,Abel Salazar Institute of Biomedical Sciences, University of Porto, Porto.,Health Sciences Research Unit: Nursing, Nursing School of Coimbra, University of Coimbra, Coimbra, Portugal
| | - Catia Duarte
- Rheumatology Department, Centro Hospitalar e Universitário de Coimbra, Coimbra.,Coimbra Institute for Clinical and Biomedical Research (iCBR) - Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - José A P da Silva
- Rheumatology Department, Centro Hospitalar e Universitário de Coimbra, Coimbra.,Coimbra Institute for Clinical and Biomedical Research (iCBR) - Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - Ricardo J O Ferreira
- Rheumatology Department, Centro Hospitalar e Universitário de Coimbra, Coimbra.,Health Sciences Research Unit: Nursing, Nursing School of Coimbra, University of Coimbra, Coimbra, Portugal
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Tužil J, Mlčoch T, Jirčíková J, Závada J, Nekvindová L, Svoboda M, Uher M, Křístková Z, Vencovský J, Pavelka K, Doležal T. Short-term response in new users of anti-TNF predicts long-term productivity and non-disability: analysis of Czech ATTRA ankylosing spondylitis biologic registry. Expert Opin Biol Ther 2019; 20:183-192. [PMID: 31736377 DOI: 10.1080/14712598.2020.1694900] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Objectives: To assess the role of short-term response to first anti-TNF in long-term prediction of disability.Methods: In nationwide registry ATTRA, we identified ankylosing spondylitis patients starting anti-TNF between 01/2003 and 12/2016. Full disability and work impairment (WI; WPAI questionnaire) were predicted via the Cox- and lagged-parameter mixed-effect regression.Results: 2,274 biologicals-naïve patients newly indicated to anti-TNF were prospectively followed (6,333 patient-years; median follow-up 1.9 years). Reaching BASDAI < 4 (77.4%) and ASDAS-CRP < 2.1 (61.1%) after 3 months of anti-TNF both decreased the risk of future disability by ≈2.5-fold. ASDAS-CRP < 2.1 predicted non-disability better than BASDAI < 4 & CRP < 5 mg/L (p = 0.032). BASDAI < 4 & CRP < 5 mg/L was comparable to BASDAI < 4 (p = 0.941) and to BASDAI change by >50% or by >2 points (p = 0.902). ASDAS-CRP change >1.1 and >2.0 both failed to predict non-disability. Once on anti-TNF therapy, the strongest predictor of WI was Pain (SF36). Yearly increase in indirect costs remains below €3,000 in those reaching ASDAS-CRP < 2.1.Conclusions: Low disease activity measured by ASDAS-CRP ≤ 2.1 should be used to measure the outcome of new anti-TNF therapy. Continuous WI could be decreased through pain management.
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Affiliation(s)
- Jan Tužil
- Institute of Health Economics and Technology Assessment, Prague, Czech Republic.,1st Faculty of Medicine, Charles University in Prague, Prague, Czech Republic
| | - Tomáš Mlčoch
- Institute of Health Economics and Technology Assessment, Prague, Czech Republic
| | - Jitka Jirčíková
- Institute of Health Economics and Technology Assessment, Prague, Czech Republic
| | - Jakub Závada
- 1st Faculty of Medicine, Charles University in Prague, Prague, Czech Republic.,Institute of Rheumatology, Prague, Czech Republic
| | - Lucie Nekvindová
- 1st Faculty of Medicine, Charles University in Prague, Prague, Czech Republic.,Institute of Biostatistics and Analyses, Ltd., Spinoff company of the Faculty of Medicine of the Masaryk University, Brno, Czech Republic
| | - Michal Svoboda
- Institute of Biostatistics and Analyses, Ltd., Spinoff company of the Faculty of Medicine of the Masaryk University, Brno, Czech Republic
| | - Michal Uher
- Faculty of Medicine of the Masaryk University, Institute of Biostatistics and Analyses, Brno, Czech Republic
| | - Zlatuše Křístková
- Institute of Biostatistics and Analyses, Ltd., Spinoff company of the Faculty of Medicine of the Masaryk University, Brno, Czech Republic
| | - Jiří Vencovský
- 1st Faculty of Medicine, Charles University in Prague, Prague, Czech Republic.,Institute of Rheumatology, Prague, Czech Republic
| | - Karel Pavelka
- 1st Faculty of Medicine, Charles University in Prague, Prague, Czech Republic.,Institute of Rheumatology, Prague, Czech Republic
| | - Tomáš Doležal
- Institute of Health Economics and Technology Assessment, Prague, Czech Republic.,Department of Pharmacology, Faculty of Medicine, Masaryk University, Brno, Czech Republic
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Relative Impact of Pain and Fatigue on Work Productivity in Patients with Rheumatoid Arthritis from the RA-BEAM Baricitinib Trial. Rheumatol Ther 2019; 6:409-419. [PMID: 31228100 PMCID: PMC6702585 DOI: 10.1007/s40744-019-0164-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Indexed: 01/01/2023] Open
Abstract
Introduction To explore the relationship of pain and fatigue with daily activity and work productivity in rheumatoid arthritis (RA) patients from the baricitinib clinical trial, RA-BEAM. Methods In RA-BEAM, a double-blind phase 3 study, patients were randomized 3:3:2 to placebo (n = 488), baricitinib 4 mg once daily (n = 487), or adalimumab 40 mg biweekly (n = 330) with background methotrexate. The Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-F) measured fatigue and the pain visual analog scale (0–100 mm) assessed pain. Work Productivity and Activity Impairment Questionnaire-RA measured daily activity and work productivity. At weeks 12 and 24, pain was assessed using pain reduction (< 30%, 30% to < 50%, ≥ 50%) and overall pain score; clinically relevant FACIT-F changes were assessed by values < 3.56 and ≥ 3.56 and the FACIT-F normative value score (< 40.1, ≥ 40.1). Pairwise comparisons between pain/fatigue reduction groups were assessed using ANCOVA with pooled data on daily activity and work productivity. A mediator analysis with pain, fatigue, and disease activity measured their contribution to daily activity and work productivity. Data were pooled from all patients for most analyses, and baricitinib-treated patients were assessed as a sensitivity analysis. Results Reductions in pain (≥ 50%) and fatigue (≥ 3.56) had significant (p ≤ 0.001) effects on daily activity and work productivity improvement at weeks 12 and 24. Reductions in pain, fatigue, and disease activity accounted for most of the improvements in daily activity and work productivity. At the lowest levels of remaining pain (≤ 10 mm) at weeks 12 and 24, however, fatigue did not appear to impact work productivity. Similar trends were observed with baricitinib-treated patients. Conclusions Reductions in pain and fatigue were associated with improved daily activity and work productivity for all RA patients and for baricitinib-treated patients in RA-BEAM. Trial Registration ClinicalTrials.gov identifier, NCT01710358. Funding Incyte Corporation and Eli Lilly and Company. Electronic Supplementary Material The online version of this article (10.1007/s40744-019-0164-4) contains supplementary material, which is available to authorized users.
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