Patient-physician discrepancy in the perception of immune-mediated inflammatory diseases: rheumatoid arthritis, psoriatic arthritis and psoriasis. A qualitative systematic review of the literature

Features and management of osteoarthritis from the perspective of individuals with osteoarthritis: A systematic review of qualitative studies

Objective

To enable person-centered care, considering beliefs, needs, and priorities of individuals with osteoarthritis (OA) is crucial. Nevertheless, concepts that they consider important are not fully recapitulated in assessment and care. The aim of this study was to clarify how individuals with OA conceive, experience, and manage their OA and pain.

Design

A systematic literature review was conducted including qualitative studies (interviews, focus groups, open questionnaires) regardless of OA joint location. Verbatim quotations relating to OA and OA-related pain were collected and merged in codes. Themes and categories relating to these codes were defined.

Results

The seven databases yielded a total of 9585 studies of which 79 qualitative studies were selected. Analysis of 667 verbatim quotations of 2009 participants led to 117 codes and 24 themes. Themes were grouped into 2 categories, 'features' and 'management'. 'Features' encompassed experiences ranging from common challenges (e.g., adjust to reduced function) to high impact outcomes needing therapeutic attention (e.g., devastating pain). The 'management' category captured positive and negative conceptions associated with pharmacological and cognitive-behavioral self-management, psychoeducation, and interventions. Themes from both categories were classified into four domains: symptoms, functioning, psychological, and social. A fifth domain 'disease' was also used to categorize the themes under 'features'.

Conclusions

Several themes reported by OA individuals are hardly represented in current assessment and recommendations, e.g., fatigue, sleep disturbance, psychosocial impact, and effects on family and caregivers. The reviewed beliefs, needs, and priorities may support individualized screening, complement existing assessment instruments, and can help refine interventions and psychoeducational materials.

Examining the Relationship Between Physical Function and Anxiety/Depression in Parkinson's

BACKGROUND

Parkinson's disease (PD) is a complex neurological disorder characterized by both motor and nonmotor symptoms, including tremor, muscle stiffness, anxiety, and depression.

OBJECTIVES

The primary aim of this study was to examine the relationship between physical function and psychological symptoms, specifically anxiety and depression, in people with Parkinson's (PwP). The secondary aim was to explore whether any discrepancies between participant-reported and clinician-rated measures of physical function exist.

METHODS

This study utilized the Parkinson's Progression Markers Initiative (PPMI) dataset, analyzing data from 1065 individuals with PD. Correlational analyses assessed relationships between clinician-rated and participant-reported motor outcomes alongside psychological symptoms. Multiple linear regression (MLR) was employed to identify predictors of anxiety and depression.

RESULTS

In PwP, significant correlations were found between depression/anxiety and participant-reported motor function (via MDS-UPDRS Part II: r = 0.313 for depression, r = 0.284 for anxiety, p < 0.05). In contrast, correlations with clinician-rated motor function (via MDS-UPDRS Part III) were weaker (r = 0.079 for depression, p < 0.05; r = 0.054 for anxiety, p = 0.08). MLR analysis indicated that in PwP, age, cognition, and participant-reported motor function explained 11.2% of the variance in depression and 10.5% in anxiety.

CONCLUSIONS

This study highlights a discrepancy between psychological symptoms and their relationship with clinician-rated versus participant-reported motor function in PwP. Our findings suggest that factors such as age, cognitive level, and perceived physical function significantly influence this relationship. Consequently, it is crucial to consider psychological factors and participant-reported motor function when conducting clinical assessments and treatment planning for individuals with PD.

Discordance between patient and physician global assessments of psoriatic arthritis activity: an observational study in 13 Arab countries

Discordance between physicians and patients in assessing psoriatic arthritis (PsA) activity is common and might impact treatment adherence and decision-making. Cultural and belief systems may influence this discordance. This study aimed to assess the extent of patient-physician discordance in PsA in Arab countries and its association with demographic and disease characteristics.The TACTIC study was a cross-sectional observational study across 13 Arab countries in 2022. Patient and physician global assessments (PGA, PhGA) of disease activity (0-10 scale) were collected, along with demographic and disease data, Disease Activity in Psoriatic Arthritis (DAPSA), and Psoriatic Arthritis Impact of Disease (PsAID). Discordance was defined as an absolute difference of |PGA-PhGA|> 2. Its association with patient characteristics was analyzed through multivariable multinomial logistic regression. In 538 patients (317 females, 58.9%), with a mean age of 45.5 ± 13.2 years and PsA duration of 8.8 ± 7.3 years, the disease was moderately active (mean DAPSA 19.3 ± 16.1; mean PsAID 3.86 ± 2.33). Mean PGA was higher than mean PhGA (4.7 ± 2.5 versus 4.0 ± 2.4, p < 0.001) with an absolute difference of 1.30 ± 1.41 and a high correlation between global assessments (r = 0.74). Discordance was infrequent, occurring in 84 patients (15.6%), and was mostly due to higher PGA (70/84, 83.3%). Discordance (one-point increase) was associated with a lower PhGA (Odds ratio (OR) 3.03 [95%CI 2.18-4.22]), positive fibromyalgia screening (OR 1.28 [95%CI 1.03-1.58]), higher DAPSA (OR 1.16 [95%CI 1.03-1.09]), and higher PsAID scores (OR 2.63 [95%CI 1.96-3.54]). Discordance was primarily identified in patients with moderate disease activity. Discordance between PGA and PhGA was infrequent in Arab countries, suggesting strong patient-physician alignment. Expectations and disease perceptions may play a role in this discordance.

What Matters in Psoriatic Arthritis: A Comparison of Patient and Clinician Perspectives

OBJECTIVE

This study aimed to expand the understanding of the patient with psoriatic arthritis (PsA) experience and to compare/contrast patient and clinician prioritization of PsA dimensions.

METHODS

We conducted four patients with PsA focus groups across three US rheumatology practices using mixed methods to identify attributes of PsA important to patients. Combination with extant attributes of PsA identified by a steering committee created a comprehensive list of attributes. In separate patient and physician Delphi exercises, participants distributed 100 points across items on the list according to importance as a dimension of PsA.

RESULTS

Fifty-one items describing PsA were generated. Thirty-eight patients and 13 clinicians completed the last Delphi rating exercise. Patients distributed points across a wider range of items than physicians. Using group mean score per item, prioritization was compared between groups. Items with the top 10 mean scores for both groups included arthritis, disease activity, pain, fatigue, physical function, and spine symptoms. Other prioritized domains showed disparity: access to care, daily activities, stiffness, future health uncertainty, and sleep quality for patients versus specific disease skin and joint manifestations, comorbidities, structural damage, and disease management goals for clinicians.

CONCLUSION

Although concordance between patient and clinician perspectives regarding "what matters" in PsA was seen, significant areas of discordance were uncovered. Patients highlighted concerns about care access and uncertainty about the future and impact on aspects of life beyond physical symptoms, issues not usually discussed in a clinical visit. These differential prioritizations highlight opportunities for improvement in patient-clinician communications and delineate the need for more patient-centered research.

The relationship between multimorbidity and cognitive function in older Chinese adults: based on propensity score matching

Objective

The goal of this study was to further validate the effect of multimorbidity on cognitive performance in older adults after controlling for confounders using propensity score matching (PSM).

Methods

A cross-sectional survey of older adult people aged 60 years or older selected by convenience sampling was conducted in seven medical institutions, three communities, and five nursing homes in Zunyi City, Guizhou Province. The data collected included general information, health-related information, and Mini-Mental State Examination (MMSE) scores. Variables were controlled for confounders by PSM to analyze differences in cognitive ability between multimorbidity and nonmultimorbidity older adults. Logistic regression and multivariate-adjusted restricted cubic spline (RCS) curves for matched samples were used to assess the relationship between multimorbidity and cognitive decline.

Results

A total of 14,175 respondents were enrolled, and the mean age of the participants included in this study was 71.26 ± 7.1 years, including 7,170 (50. 58%) of the participants were males, 7,005 (49.42%) were females, and 5,482 participants (38.67%) were screened for cognitive decline. After PSM, logistic regression analysis revealed that multimorbidity was a risk factor for cognitive decline (OR = 1.392, 95% CI = 1.271-1.525, p < 0.001). The RCS show that the risk of cognitive decline is always greater in older adults with multimorbidity than in older adults without multimorbidity at the same age. Age, sex, marital status, educational level, monthly income, drinking status, participation in social activities, and exercise were influential factors for cognitive decline in older adults (p < 0.05). The incidence of cognitive decline in older adults with multimorbidity was also greater than that in older adults with one chronic disease (p < 0.001).

Conclusion

The risk of cognitive decline in older adults with multimorbidity is greater than that in older adults without multimorbidity; therefore, the government should strengthen the prevention and treatment of multimorbidity in older adults to further protect their cognitive abilities.

Treatment satisfaction, unmet needs, and new treatment expectations for vasomotor symptoms due to menopause: women's and physicians' opinions

OBJECTIVE

To assess treatment satisfaction, unmet treatment needs, and new vasomotor symptom (VMS) treatment expectations among women with moderate to severe VMS and physicians treating women with VMS.

METHODS

This noninterventional, nonrandomized survey included qualitative interviews and quantitative surveys of women and physicians in the US. Participating women had moderate to severe VMS in the past year and received ≥1 hormone therapy (HT), non-HT, or over-the-counter (OTC) treatment for VMS in the past 3 months. Participating physicians were obstetrician-gynecologists (OB-GYNs) and primary care physicians (PCPs) who treated ≥15 women with VMS in the past 3 months. Two online survey questionnaires were developed using insights from literature, qualitative interviews, and clinical experts. Menopause Symptoms Treatment Satisfaction Questionnaire (MS-TSQ) measured treatment satisfaction. Results were summarized descriptively.

RESULTS

Questionnaires were completed by 401 women with VMS and 207 physicians treating VMS. Among women, mean total MS-TSQ score ranges were 62.8-67.3 for HT, 59.8-69.7 for non-HT, and 58.0-64.9 for OTC treatments. Among physicians, mean total MS-TSQ scores were considerably higher for HT than for non-HT and OTC treatments (HT: 73.4-75.6; non-HT: 55.6-62.1; OTC: 49.2-54.7). Women reported "lack of effectiveness" (41.2%), and physicians reported "long-term safety concerns" (56.5%) as main features that do not meet their current treatment expectations. The majority of women and physicians would consider trying a new non-HT treatment for VMS (75.8 and 75.9%, respectively).

CONCLUSIONS

Treatment satisfaction and new treatment expectations were similar but with some differences between women and physicians; the need for additional treatments for VMS was identified.

Elevating the Standard of Care for Patients with Psoriatic Arthritis: 'Calls to Action' from a Multistakeholder Pan-European Initiative

INTRODUCTION

Psoriatic arthritis (PsA) is a complex, progressive, and often debilitating disease. Despite recent advances in treatment, numerous unmet needs in patient care persist. Rheumacensus is a multistakeholder, pan-European initiative designed to identify ways to elevate the standard of care (SoC) and treatment ambition for patients with PsA, using the perspectives of three key stakeholder groups: patients, healthcare professionals (HCPs) and payors.

METHODS

Rheumacensus followed three phases: an insights-gathering workshop to identify current unmet needs in PsA and an area of focus for the project, a modified Delphi process to gain consensus on improvements within the agreed area of focus, and a Consensus Council (CC) meeting which used consensus statements as inspiration to generate 'Calls to Action' (CTA)-practical measures which, if implemented, could elevate the SoC for patients with PsA.

RESULTS

The Rheumacensus CC consisted of four patient representatives, four HCPs and four payors. All 12 members completed all three Delphi e-consultations. The shared area of focus that informed the Delphi process was "patient empowerment through education on the disease and treatment options available, to enable patient involvement in management". Four key themes emerged from the Delphi process: patient empowerment, patient knowledge and sources of education, patient-HCP consultations, and optimal initial treatment. Statements within these themes informed 12 overarching CTA, which focus on the need for a multistakeholder approach to implementing a paradigm shift towards patient-centred care and improved outcomes for patients with PsA.

CONCLUSION

Rheumacensus has identified shortcomings in the current SoC for patients with PsA and provides a foundation for change through practical CTA. It is hoped that all stakeholders will now take practical steps towards implementing these CTA across Europe to elevate the SoC for patients with PsA.

Opinions of Health Care Providers About Neuromodulation for Pain: Results of an Online Survey at the 2nd Joint Congress of the International Neuromodulation Society European Chapters

INTRODUCTION

Neuromodulation for pain has been successfully applied for decades, in that the goals and expectations that patients aim to achieve are clearly described. Nevertheless, the point of view of health care providers is less clear. Therefore, this study aimed to explore the goals, expectations, and definition of success for neuromodulation for pain according to health care providers.

MATERIALS AND METHODS

An online survey was developed and spread at the 2nd Joint Congress of the International Neuromodulation Society (INS) European Chapters in September 2021 in Paris. Respondents were asked 1) to select the goals to treat patients with neuromodulation for pain, 2) to indicate factors that they expect to change according to neuromodulation for pain, and 3) to provide their definition of success of neuromodulation for pain.

RESULTS

We approached 101 respondents, of whom 88 health care providers at least partly completed the survey. Increasing mobility/functionality (26.7%), decreasing pain intensity (24.5%), and decreasing medication use (16.6%) were the most frequently reported goals of neuromodulation. The same top three variables were selected as factors that health care providers expected to change. For the definition of success, quality of life of patients outranked other definitions. Other highly ranked definitions, in descending order, were obtaining pain relief, increasing functionality, and increasing patient satisfaction.

DISCUSSION

Goals and expectations of health care providers are not completely in line with previously explored goals of patients that are related to pain relief and improving walking abilities. Health care providers seem to put a high emphasis on the quality of life of the patient when evaluating the success of neuromodulation, which is not completely aligned with the currently used reimbursement rules that are mainly focusing on pain relief instead of incorporating health-related quality of life.

CLINICAL TRIAL REGISTRATION

The Clinicaltrials.gov registration number for the study is NCT05013840.

How is the patient perspective captured in ANCA-associated vasculitis research? An integrative review

Objective

The aim was to describe how the patient perspective is captured in clinical research on ANCA-associated vasculitis (AAV).

Methods

This integrative review included 2149 publications found in four different databases and manual searches. After screening, 156 articles remained. All articles were sorted and categorized, and 77 original articles were analysed further.

Results

The patient perspective was captured with patient-reported outcome measures (PROMs), single-item questionnaires, project-specific questionnaires and interviews. The most common aspects measured were health-related quality of life, anxiety and depression, and fatigue, and the least common were lifestyle habits, relationships and self-management.

Conclusion

The patient perspective was captured predominantly with generic PROMs and occasionally with a qualitative approach. AVV is a lifelong disease, and the results from this review show that not all aspects of importance to patients are covered with the PROMs used in research. Future studies should include the areas that are the most important for patients.

Difficult to Treat and Refractory to Treatment in Psoriatic Arthritis

Psoriatic arthritis (PsA) is a complex and chronic inflammatory condition in which the achievement of the best possible disease control has been proposed as the treatment target, which includes the possibility of reaching remission in all disease domains. However, due to the complexity of this multidomain disease, some patients may still have high disease activity in one or more domain and a high burden of disease, potentially leading to various treatment changes and to difficulty with the overall management. In this paper, we overview the concept of patients with difficult-to-treat PsA and the concept of patients with refractory-to-treatment PsA by providing a distinction between these two concepts and the possible implication for the management of patients with PsA.

Internet search analysis on the treatment of rheumatoid arthritis: What do people ask and read online?

OBJECTIVES

This study aimed to characterize the content of frequently asked questions about the treatment of rheumatoid arthritis (RA) on the internet in Japan and to evaluate the quality of websites related to the questions.

METHODS

We searched terms on the treatment of RA on Google and extracted frequently asked questions generated by the Google "people also ask" function. The website that answered each question was also obtained. We categorized the questions based on the content. The quality of the websites was evaluated using the brief DISCERN, Journal of American Medical Association benchmark criteria, and Clear Communication Index.

RESULTS

Our search yielded 83 questions and the corresponding websites. The most frequently asked questions were regarding the timeline of treatment (n = 17, 23%) and those on the timeline of the clinical course (n = 13, 16%). The median score of brief DISCERN was 11 points, with only 7 (8%) websites having sufficient quality. Websites having sufficient quality based on the Journal of American Medical Association benchmark criteria and Clear Communication Index were absent.

CONCLUSIONS

The questions were most frequently related to the timeline of treatment and clinical course. Physicians should provide such information to patients with RA in the counseling and education materials.

Drug-related problems reported by patients with rheumatic diseases: an observational study

BACKGROUND

Drug-related problems can negatively influence treatment outcome and well-being for patients with rheumatic diseases. Thus, it is important to support patients in preventing or resolving drug-related problems as quickly as possible. To effectively develop interventions for this purpose, knowledge on the frequency and character of drug-related problems is needed. Therefore, this study aims to quantify and characterize drug-related problems reported by patients with inflammatory rheumatic diseases along their treatment process.

METHODS

A prospective observational study was conducted in a Dutch outpatient pharmacy. Adult patients with rheumatic diseases that were prescribed medication by a rheumatologist were questioned about experienced DRPs by telephone 4 times in 8 weeks using a structured interview-guide. Patient-reported DRPs were scored on uniqueness (i.e., if a specific DRP was reported in multiple interviews by one individual, this was counted as one unique DRP) and were categorized using a classification for patient-reported DRPs and analysed descriptively.

RESULTS

In total, 52 participants (median age 68 years (interquartile range (IQR) 62-74), 52% male) completed 192 interviews with 45 (87%) participants completing all 4 interviews. The majority of patients (65%) were diagnosed with rheumatoid arthritis. Patients reported a median number of 3 (IQR 2-5) unique DRPs during interview 1. In subsequent interviews, patients reported median numbers of 1 (IQR 0-2), 1 (IQR 0-2) and 0 (IQR 0-1) unique DRPs for interviews 2-4 respectively. Participants reported a median number of 5 (IQR 3-9) unique DRPs over all completed interviews. Unique patient-reported DRPs were most frequently categorized into (suspected) side effects (28%), medication management (e.g., medication administering or adherence) (26%), medication concerns (e.g., concerns regarding long-term side-effects or effectiveness) (19%) and medication effectiveness (17%).

CONCLUSIONS

Patients with rheumatic diseases report various unique DRPs with intervals as short as two weeks. These patients might therefore benefit from more continuous support in-between contact moments with their healthcare provider.

Shared decision-making practices and patient values in pharmacist outpatient care for rheumatic disease: A multiple correspondence analysis

Purpose: To investigate the value-to-value relationships, relationship between values and patient background, continuation rate of treatment after shared decision-making (SDM), and disease status in order to clarify the values involved in drug therapy decisions for patients with rheumatic disease. Methods: We investigated patient values (efficacy of drug therapy [effectiveness], safety, economics, daily life, and other) and the continuance rate and disease status of treatment after 6 months in 94 patients with rheumatic disease aged ≥18 years who made decisions with pharmacists and physicians in the pharmacy outpatient clinic between September 2019 and April 2021. Multiple correspondence and K-means cluster analyses were performed to show the relationship between values and basic patient information. Results: Among the selected patients, 87% and 47% selected effectiveness for multiple selections and single selection, respectively. Effectiveness was at the center of the graph; three clusters containing other values were placed around it. History of allergy or side effects caused by biologics or Janus kinase inhibitors were in the safety cluster. The non-usage history of biologics or Janus kinase inhibitors was in the economic cluster. Conclusion: Effectiveness was the most important factor for patients with rheumatic disease; the values that patients consider important may shift from effectiveness to other values based on each patient's subjective experience with the treatment and/or the stage of life in which they were treated. It is important to positively link patient values and information about the treatment plan in shared decision-making while establishing rapport with the patient.

Practices among General Practitioners in Rheumatoid Arthritis (GEPRA-I): results of a region-wide online survey

Background

To assess current practice regarding the management of rheumatoid arthritis patients among general practitioners of a French region, and their perception about the deployment of a multidisciplinary collaboration.

Methods

A cross-sectional online survey was sent to the general practitioners of a French region. The questionnaire comprised of 3 sections to collect data regarding 1/demographics, 2/practice and knowledge in rheumatoid arthritis, and 3/perception about the deployment of a multidisciplinary collaboration.

Results

1/A total of 247 general practitioners (M/F ratio: 1.4; mean age: 46.7 years) completed the survey. 2/More than half of general practitioners believed that their role was very or extremely important in disease diagnosis (72.5%), and management of comorbidities (67.2%). Among respondents, 6.1% considered that they did not face any difficulty concerning the patient management and 61.5% had already identified causes of non-adherence. 3/A total of 151 (61.1%) general practitioners were willing to participate in a multidisciplinary programme to improve medication adherence in rheumatoid arthritis.

Conclusions

General practitioners are motivated to contribute to an overall management of rheumatoid arthritis patients. Nevertheless, they need professional education about rheumatoid arthritis treatment and training in motivational interviews before getting involved in a multidisciplinary collaboration.

Juvenile Dermatomyositis: what comes next? Long-term outcomes in childhood myositis from a patient perspective

BACKGROUND

To describe long-term outcomes in JDM using patient questionnaires and link to longitudinal, prospectively collected data for each patient within the Juvenile Dermatomyositis Cohort and Biomarker Study, UK and Ireland (JDCBS) to determine outcome predictors.  METHODS: JDCBS participants aged ≥ 16y completed the SF36, HAQ and a questionnaire regarding current disease features, medications, education and employment. Data collected from the JDCBS included disease subtype, demographics, clinical and laboratory features. Intensity indices were calculated for physician VAS, modified skin DAS, CMAS and MMT8 by dividing area under the curve (AUC) from longitudinal score trajectories by duration of study follow-up (y). Relationships between questionnaire and JDCBS clinical / laboratory data were investigated fitting statistical models appropriate for cross sectional and longitudinal data.

RESULTS

Of 190 questionnaires sent, 84 (44%) were returned. Average age of respondents was 20.6 years (SD 3.9), time since diagnosis was 12.4 years (SD 5.0), age at onset was 9.2 years (SD 4.3), female to male ratio 4.25:1. Forty-nine (59%) self-reported persistently active disease, 54 (65%) were still taking immunosuppressive medication. 14/32 at school/higher education reported myositis adversely affecting academic results. 18-24 year-olds were twice as likely to be unemployed compared the UK population (OR = 0.456, 95% CI 0.24, 0.84, p = 0.001). Participants ≥ 18 years were three times as likely to be living with a parent/guardian (OR = 3.39, p < 0.001). SF36 MCS and MMT8 intensity index scores were significantly correlated (ρ = 0.328, p = 0.007).

CONCLUSIONS

After 12.4 years, questionnaire responders reported self-perceived high rates of persistently active disease and medication use, reduced rates of employment and were more likely to live with a parent/guardian. Perceived persistently active muscle disease appeared to affect quality of life in these patients and was the most significant contributor to long-term outcomes. Our findings highlight the importance of including the patient perspective in the assessment of long term outcomes, so that that we can start to target initial management strategies more effectively based on a combination of clinical and patient-reported data.

Illness Perception Regarding Early-stage Mycosis Fungoides among Dermatologists: A Multi-centre Cross-sectional Study

Early-stage mycosis fungoides is a rare cutaneous T-cell lymphoma with a good prognosis. Data regarding patients’ illness perception of mycosis fungoides are accumulating. However, investigating the dermatologists’ viewpoint is also essential, as it shapes the therapeutic relationship and doctor–patient communication. The aim of this study was to investigate the aspects of dermatologists’ illness perception towards early-stage mycosis fungoides and the way they present it to patients. Twenty-five dermatology residents and 55 attending physicians from all Israeli dermatology departments and the community completed the study questionnaires online. Dermatologists viewed mycosis fungoides as a chronic disease, causing a moderate emotional burden. In contrast to previously published data regarding patients’ illness perception, dermatologists demonstrated dominancy in the notion that patients were able to control their disease. Most dermatologists thought that patients perceived mycosis fungoides as an indolent lymphoma that causes anxiety. Dermatologists used a high diversity of themes when presenting mycosis fungoides to patients. The differences between the residents’ and attending physicians’ perceptions were minimal. Dermatologists have a kaleidoscope of views regarding the way they perceive mycosis fungoides, the way they think patients perceive it, and the way they communicate with patients. Maintaining patient-centred communication enables dermatologists to identify these gaps and view mycosis fungoides from their patients’ perspective.

Clinical variables, including novel joint index, associated with future patient-physician discordance in global assessment of rheumatoid arthritis (RA) disease activity based on a large RA database in Japan

BACKGROUND

Discordance between patient global assessment (PGA) and physician global assessment (PhGA) of rheumatoid arthritis (RA) disease activity is mainly determined by pain and functional disabilities. This study aimed to investigate the shift in PGA-PhGA discordance and the variables associated with future positive discordance (PGA > PhGA) based on the NinJa database in Japan.

METHODS

We examined 7557 adults with RA registered in both NinJa 2014 and 2018, with a discordance cutoff of 3 on a 10-cm scale. The affected joint distribution was investigated using the joint indices x, y, and z, which were calculated as indices for the upper joint, lower joint, and large joint involvement, respectively. The variables in NinJa 2014 that were associated with positive discordance in NinJa 2018 were examined using binary stepwise logistic regression analysis.

RESULTS

Due to the small number of patients with RA categorized as having negative discordance (PGA < PhGA), we focused on patients with RA categorized as having either concordance or positive discordance. Logistic regression analysis revealed that positive discordance in NinJa 2018 was associated with age, pain, modified Health Assessment Questionnaire (mHAQ) score, corticosteroid use, and existent positive discordance and was inversely associated with C-reactive protein (CRP) and x at baseline (NinJa 2014). The same findings were observed when patients with RA were divided based on the discordance status at baseline. Persistence (positive discordance to positive discordance) was associated with pain and mHAQ scores but inversely associated with CRP.

CONCLUSIONS

Positive discordance may persist. Circumventing this requires adequate management of pain and functional impairment.

Qualitative interview study exploring the patient experience of living with axial spondyloarthritis and fatigue: difficult, demanding and draining

OBJECTIVE

To explore patients' lived experiences of axial spondyloarthritis (axSpA) and fatigue.

DESIGN

Interpretative phenomenological analysis (lived experience) was used as the study design. Analysis drew together codes with similar meaning to create superordinate and subordinate themes.

SETTING

Rheumatology departments in three National Health Service Foundation Trusts in the north, midlands and south of England.

PARTICIPANTS

A purposive sample of seventeen axSpA patients were recruited. The age range was 22-72 years (median age 46), nine were male and eight, female.

RESULTS

A central concept of achieving balance was identified as the active process of integrating axSpA symptoms and fatigue into daily life, working with and not against their condition to lead a fulfilled life. This was conveyed through three superordinate themes: struggling to find energy, engaging in everyday life and persevering through difficulties. Struggling to find energy was the challenge of retaining enough stamina to do things in daily life. Engaging in everyday life highlighted dedication to being active and organised, learning through experience and acceptance of a changed way of being. Persevering through difficulties identified the physical and emotional effort required to keep moving forward and the importance of feeling supported.

CONCLUSION

Achieving balance through finding energy, engaging and persevering everyday was fundamental to having the best possible life. The experience of energy emerged as a distinct but related component of fatigue. However, while energy could be maintained or replenished, fatigue was more difficult to overcome and required greater effort. Energy may be a useful indicator of an individual's current state and ability to sustain activities that supports their well-being, such as exercise. Awareness of the elements of achieving balance in axSpA may enable patients and clinicians to work together to tailor treatments to individual patient need.

Factors associated with depressive symptoms in Japanese women with rheumatoid arthritis

Objectives

It has been suggested that patients with RA are more likely to suffer from depression. Therefore, this study identified the factors associated with depressive states in female RA patients to inform future patient care.

Methods

A self-assessment questionnaire was administered to 150 female RA patients aged ≥20 years regarding their satisfaction with disease activity, pain (measured using a visual analogue scale), self-rated depression scale (SDS), stress content (illness, work, family, difficulty in daily life, appearance, treatment and other), confidence in stress management and satisfaction (treatment effect, health status and relationships with health-care professionals). The factors related to depression and the presence of depressive tendencies were investigated.

Results

Data from 145 patients were analysed. Eighteen patients (12.4%) showed depressive tendencies according to their SDS scores. Among these patients, SDS scores were positively correlated with disease activity and with scores on the modified HAQ, visual analogue scale for pain, and stress content. The SDS score was also negatively correlated with patients’ confidence in stress management and health status satisfaction.

Conclusion

Female RA patients had family problems and various stressors in their daily lives. Nurses need to conduct regular mental health assessments to monitor their self-management status and support them to improve their confidence and satisfaction in coping. To achieve this, it is important for health-care teams involving various health-care professionals to collaborate and cooperate.

Patient Preference for Biologic Treatments of Psoriasis in the Chinese Setting

OBJECTIVE

Assessments of patients' preferences can support in clinical decision-making regarding biologic therapies for psoriasis. Our objective was to investigate patient preference for biologic treatments in patients with psoriasis in China.

METHODS

From October 2020 to January 2021, psoriasis patients were recruited for a survey that included demographic and disease-related questions, as well as a discrete choice experiment to measure their preferences for biologic therapy. A discrete-choice experiment was used in which respondents selected psoriasis treatments based on benefits (ie, early onset of efficacy, long-term efficacy, sustained efficacy) and treatment costs. We analyzed choice data using conditional logit model.

RESULTS

This study included 236 patients with moderate-to-severe psoriasis. The relative importance of the cost of biologic treatments, probability of keeping PASI100 at 5 years, probability of achieving PASI100 at 3 months and time to achieve PASI50 after initiation the biologic treatment were 0.593, 0.137, 0.185 and 0.085. Over 50% of patients regarded the cost of biologic treatments as the most important attribute. High-income and low-income subgroups had higher preference weight in probability of achieving PASI100 at 3-month and monthly cost.

CONCLUSION

The cost of biologic treatments was found as the most important attribute for Chinese patients with psoriasis. Among efficacy attributes, the probability of achieving PASI100 at 3 months showed most sensitive. These results may be helpful to understand patient preference for biologic treatments used for psoriasis in China.

Maintained activity in ankylosing spondylitis patients treated with TNFi and/or NSAID for at least 12 weeks: a cross-sectional study in Brazil

BACKGROUND

The aim of this study was to evaluate disease activity among patients with axial spondyloarthritis (AS) treated with tumor necrosis factor inhibitors (TNFi) and/or nonsteroidal anti-inflammatory drugs (NSAIDs) for at least 12 weeks in private outpatient settings in Brazil.

METHODS

This was a cross-sectional, real-world study conducted in 17 Brazilian private health care institutes. Patients were selected if diagnosed with AS or axial radiographic spondyloarthritis (AxSpA) and treated with NSAIDs or TNFi for at least 12 weeks within the last 26 weeks prior to enrollment. The data were collected from interviewed-based and self-administered questionnaires from patients and physicians. Disease activity was defined as active (≥ 4), low /suboptimal (≥ 2 and < 4) and inactive (< 4) by Bath AS Disease Activity Index (BASDAI) and/or very high (≥ 3.5), high (≥ 2.1 to < 3.5), low (≥ 1.3 to < 2.1), and inactive (< 1.3) by AS Disease Activity Score (ASDAS-CRP). Both patients and physicians' perceptions of disease control were assessed using a numeric rating scale (NRS; 0-inactive to 10-very active disease).

RESULTS

The cohort included 378 patients with a mean age of 46 years, and the median time since diagnosis until enrollment was 5.4 years (interquartile range 2.7-10.5). Most patients were treated with TNFi alone (74%), followed by TNFi in combination with NSAID (15%), and NSAID alone (11%). About half AS patients showed active disease and 24% of patients showed low activity/suboptimal disease control despite having been treated for at least 12 weeks. Although TNFi showed better disease control than NSAID, inactive disease was experienced by few patients. The NRS (mean [standard deviation]) score for disease perception was 4.24 (3.3) and 2.85 (2.6) for patients and physicians, respectively.

CONCLUSION

This real-world study showed that most AS patients on TNFi and/or NSAID had not achieved an adequate disease control, as almost 75% of them exhibited active disease or low activity/suboptimal disease control. There remains a need for improved disease management among patients with AS.

Therapeutic goals and treatment response evaluation in moderate to severe psoriasis: an experts opinion document

OBJECTIVE

To critically analyse and define therapeutic objectives, response to treatment evaluation and related decisions in psoriasis.

METHODS

Expert consensus meetings, a systematic and narrative reviews and a collaborative Delphi procedure were carried out. A steering committee from the Spanish Group of Psoriasis was established who based on the reviews generated a set of related statements. Subsequently, a group of 40 experts tested their agreement with the statements, through 3 Delphi rounds.

RESULTS

We found a great variability in clinical guidelines regarding to the definition of treatment goal and the response. In general, treatment failure was considered if a PASI50 is not achieved. The panel of experts agreed on (1) clearly differentiate between ideal and a realistic goals when establishing the therapeutic goal in moderate to severe psoriasis; (2) treatment goals should be in general established regardless of the type of drug for psoriasis; (3) treatment failure if PASI75 response is not reached; (4) an absolute PASI is in general preferred to the rate of PASI improvement from baseline; (5) disease characteristics, patients and physicians opinions/needs and treatment adherence influence treatment goals.

CONCLUSIONS

A clear treatment decision making framework is vital to improve management of psoriasis.KEY MESSAGESPsoriasis characteristics, patients and physicians opinions/needs and treatment adherence influence treatment goals.Different disease indexes could be used to assess treatment response but absolute PASI is preferredIn general psoriasis treatment failure should be considered if PASI75 response is not reached.

How Should We Measure Peripheral Spondyloarthritis?

Spondyloarthritis (SpA) is recognized as an overarching spectrum of disease characterized by axial SpA (axSpA), peripheral arthritis, enthesitis, and dactylitis. Despite significant overlap, patients are often characterized as having predominantly peripheral or axial involvement.

Decision tree analysis for evaluating disease activity in patients with rheumatoid arthritis

Objective

Rheumatoid arthritis (RA) is a chronic inflammatory autoimmune disease characterized by inflammatory synovitis. We developed a new disease activity evaluation system using important cytokines to help doctors better evaluate disease activity in patients with RA.

Methods

Flow cytometry was used to detect the levels of seven cytokines. Then, the results were analyzed using an R language decision tree.

Results

The levels of six cytokines, namely interleukin (IL)-2, IL-4, IL-6, IL-10, tumor necrosis factor-α, and interferon-γ, were significantly different between the active disease and remission stages. Decision tree analysis of the six cytokines with statistical significance identified two judgment rules for the remission stage and three judgment rules for the active disease stage.

Conclusion

We proposed the use of the decision tree method to analyze cytokine levels in patients with RA and obtain a more intuitive and objective RA disease activity scoring system. This method revealed the relationships of IL-6 and TNF-α levels with inflammatory characteristics in patients with RA, which can help predict disease activity.

Preferences for biologic treatment in patients with psoriatic arthritis: a discrete choice experiment

OBJECTIVES

We aimed to assess patient preferences for the characteristics and outcomes of biologic and targeted synthetic DMARDs to manage psoriatic arthritis.

METHODS

We conducted a discrete choice experiment in patients with psoriatic arthritis from three rheumatology centers in Sydney, Australia. We assessed preferences for different attributes of biologic medications. The route and frequency of medications had a range of five levels and the following seven attributes had a range of three levels: the ability to attend to normal activities, improvements in joint pain, enthesitis and skin disease, chance of disease remission, risk of infection and risk of severe adverse events. Multinomial logit models including a latent class model were used to calculate preferences.

RESULTS

Of the 150 participants, 58.3% were female, with a median age of 53.5 years. The attributes in order of preference were (β coefficient in absolute values, 95% confidence interval): oral route compared to subcutaneous and intravenous routes (β coefficient 1.00, fixed-parameter), avoiding severe side effects (0.72, 0.50 to 0.95), increasing ability to attend to normal activities (0.66, 0.36 to 0.96), avoiding infections (0.38, 0.23 to 0.53), improvement in enthesitis pain (0.28, 0.20 to 0.36), improvement in psoriasis (0.28, CI 0.20 to 0.36), increasing chance of remission (0.27, 0.19 to 0.36) and improvement in joint pain (0.26, 0.00 to 0.52).

CONCLUSION

When choosing biologic medications, patients with psoriatic arthritis preferred oral medications. Patients prioritized avoiding severe complications, maintaining the ability to attend to work and normal activities and avoiding infection over clinical measures of efficacy.

Two Sides of the Same Coin? A Dual Multiple Criteria Decision Analysis of Novel Treatments Against Rheumatoid Arthritis in Physicians and Patients

PURPOSE

Available treatment options for rheumatoid arthritis (RA) differ in important aspects. In this sense, each RA treatment option is accompanied by a spectrum of characteristics that collectively constitute its comprehensive "value," as viewed from the physician's or the patient's perspective. The objective of this study was to perform a multiple criteria decision analysis of different RA treatments from the perspective of physicians and patients and to outline the respective aspects of value for each treatment METHODS: A literature review was performed for constructing a set of criteria (N = 8) for the multiple criteria decision analysis. Workshops for the elicitation of preferences occurred separately for physicians and patients. A performance matrix was populated via 2 network meta-analyses plus converged clinical opinion. Criteria were hierarchically classified by application of pairwise comparisons, and criteria weights were attributed by point allocation through convergence of opinions. Performances in both panels were scored by using a 100-point scale. A linear additive value function was used for the calculation of total value estimates.

FINDINGS

Both panels provided their consensus. The hierarchical classification of attributes from the physician perspective placed the highest values on the criteria of severe adverse events, clinical efficacy, route of administration, and cost per year for the third-party payer. From the patient perspective, the highest ranking criteria were clinical efficacy, severe adverse events, percentage of patients remaining with the same targeted immune modulator for 1 year ("drug survival"), and cost per year for the third-party payer.

IMPLICATIONS

In an era of multiple options and varying preferences, RA treatments must be evaluated by taking into consideration patients' preferences as well, as to cover the full spectrum of value elements rather than simply clinical outcomes. The results of this analysis show that physicians and patients share similarities but also marked differences in terms of the aspects of treatment that they perceive as more valuable.

Development and validation of a Patient-Reported Outcome in systemic sclerosis: the Hand scleroDerma lived Experience Scale (HAnDE Scale)

OBJECTIVES

to develop and validate a Patient Reported Outcome (PRO) scale-the HAnDE (Hand-ScleroDerma Disease lived Experience) scale-assessing the lived experience of hand involvement in patients with systemic sclerosis (SSc).

METHODS

explanatory sequential mixed-method study with two phases: 1) PRO development through an Inductive Process to analyze the Structure of lived Experience approach, involving 21 SSc patients, 2) PRO validation by assessing the psychometric properties of the scale among 105 SSc patients.

RESULTS

1) Phase-1 enabled to generate the 18-item provisional scale. 2) The mean total score of the scale was 29,16 (SD 16,15). The item reduction process retained 16 items with 5 levels of answers (range 0-64). Internal consistency of the 16-item version was excellent (Cronbach-alpha coefficient=0,946). Construct validity was very good, the Principal Component Analysis being in favour of a unidimensional instrument, with one factor explaining 56% of the variance, and concurrent validity being confirmed: Cochin Hand Function Scale r=0,66; Health Assessment Questionnaire-Disability index r=0.58; Hospital Anxiety Depression, anxiety r=0,51, depression r=0,4; Mouth Handicap in Systemic Sclerosis r=0,61; SF-36, physical component r=-0,48, mental component r=-0,46; and Kapandji score r=-0,46. The correlations were statistically significant (p<0,05).

CONCLUSION

We propose, for future trials and clinical practice in SSc, a new PRO the HAnDE scale, that assesses all the dimensions -functional, aesthetic, relational, existential, and emotional- of the lived experience of hand involvement.