1
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Meade T, Joyce C, Perich T, Manolios N, Conaghan PG, Katz P. Prevalence, Severity, and Measures of Anxiety in Rheumatoid Arthritis: A Systematic Review. Arthritis Care Res (Hoboken) 2024; 76:171-180. [PMID: 37779491 DOI: 10.1002/acr.25245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 08/07/2023] [Accepted: 09/22/2023] [Indexed: 10/03/2023]
Abstract
OBJECTIVE Many studies have reported high rates of anxiety in adults with rheumatoid arthritis (RA). The aim of this systematic review was to examine those findings and determine the overall prevalence, severity, and commonly used measures of anxiety in individuals with RA. METHODS Six databases were searched from January 2000 without restrictions on language/location, study design, or gray literature. All identified studies that examined anxiety prevalence and severity in adults with RA, as assessed with clinical diagnostic interview and/or standardized self-report measures, were considered for inclusion. Quality assessment of included studies was conducted using a modified Newcastle-Ottawa Evaluation Scale, and the findings were synthesized via a narrative approach. RESULTS Across the 47 studies (n = 11,085 participants), the sample size ranged from 60 to 1,321 participants with seven studies including healthy controls or groups with other health conditions. The studies were conducted across 23 countries, and anxiety prevalence ranged from 2.4% to 77%, predominantly determined with standardized self-report measures, of which Hospital Anxiety and Depression scale was used most frequently; only eight studies used a clinical diagnostic interview to confirm a specific anxiety diagnosis. Notable associations with anxiety in RA were physical disability, pain, disease activity, depression, and quality of life. CONCLUSION The reported prevalence of anxiety in RA varied widely potentially because of use of different self-report measures and cutoff points. Such cutoff points will need to be standardized to clinical thresholds to inform appropriate interventions for anxiety comorbidity in RA.
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Affiliation(s)
- Tanya Meade
- Western Sydney University, Sydney, New South Wales, Australia
| | - Caroline Joyce
- Western Sydney University, Sydney, New South Wales, Australia
| | - Tania Perich
- Western Sydney University, Sydney, New South Wales, Australia
| | - Nicholas Manolios
- The University of Sydney, Westmead Hospital, Sydney, New South Wales, Australia
| | - Phillip G Conaghan
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, and NIHR Leeds Biomedical Research Centre, Leeds, UK
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2
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Yoshii I, Chijiwa T, Sawada N. The impact of time length to Boolean remission for tight disease activity control after acquisition in rheumatoid arthritis patients. Sci Rep 2023; 13:13908. [PMID: 37626142 PMCID: PMC10457332 DOI: 10.1038/s41598-023-39711-4] [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: 04/17/2021] [Accepted: 07/29/2023] [Indexed: 08/27/2023] Open
Abstract
Clinical importance of time length from initiation under treat-to-target (T2T) strategy to acquisition of clinical remission (TL) in treating patients with rheumatoid arthritis (RA) on disease activity control, daily activities, and quality of life maintenance was investigated. In patients who achieved Boolean remission once or more, relationship between TL and patients' background data at initiation, and relationship between TL and mean simplified disease activity score (SDAI), Health Assessment Questionnaire Disability Index (HAQ-DI) score, pain score with visual analog scale (PS-VAS), Sharp/van der Heijde Score (SHS) and quality of life score (QOLS) at the first remission and thereafter were evaluated statistically. Patients were divided into two groups whether TL was within 6 months or longer (G ≤ 6 and G > 6). Change of the parameters and Boolean remission rate (BRR) after the first remission between the two groups were compared statistically. In 465 patients, TL correlated significantly with the SDAI score, the HAQ score, PS-VAS, SHS, and the QOLS after the remission. The SDAI score and the BRR after the remission were significantly better in the G ≤ 6 than in the G > 6. TL is an important key to guarantee good and stable clinical course in treating under T2T.
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Affiliation(s)
- Ichiro Yoshii
- Department of Rheumatology and Musculoskeletal Medicine, Yoshii Hospital, 6-7-5 Nakamura-Ohashidori, Shimanto, Kochi, 787-0033, Japan.
| | - Tatsumi Chijiwa
- Department of Rheumatology, Kochi Memorial Hospital, 4-13 Shiromi-Cho, Kochi, Kochi, 780-0824, Japan
| | - Naoya Sawada
- Department of Rheumatology, Dohgo Onsen Hospital, 21-21 Himetsuka-Otsu, Matsuyama, Ehime, 790-0858, Japan
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3
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Brkic A, Łosińska K, Pripp AH, Korkosz M, Haugeberg G. Remission or Not Remission, That's the Question: Shedding Light on Remission and the Impact of Objective and Subjective Measures Reflecting Disease Activity in Rheumatoid Arthritis. Rheumatol Ther 2022; 9:1531-1547. [PMID: 36129667 PMCID: PMC9561477 DOI: 10.1007/s40744-022-00490-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2022] [Accepted: 08/26/2022] [Indexed: 11/28/2022] Open
Abstract
Introduction The inclusion of certain variables in remission formulas for rheumatoid arthritis (RA) may give rise to discrepancies. An increase in patient global assessment (PGA), a variable showing the patient's self-evaluation of their disease activity, may alone tilt a patient out of remission when using certain remission-assessing methods. This study aimed to explore differences in remission rates among various formulas and the impact of PGA and other clinical variables on the calculation of remission. Methods Data were collected from RA patients monitored during the years 2015–2019 at an outpatient clinic in southern Norway. Linear and logistic regression assessed associations between PGA, other RA-related variables, and remission-assessing methods. Results Remission rates were 23%, 65%, and 73% in 2019 when assessing the same 502 RA patients using Boolean remission, Boolean remission without PGA, and the disease activity score (DAS) with C-reactive peptide [DAS28(3)-CRP] method, respectively. Among the same population that year, 27% reported PGA ≤ 10, 74% had a tender joint count of ≤ 1, 85% had a swollen joint count of ≤ 1, and 86% had CRP ≤ 10. Pain (standardized coefficient β = 0.7, p < 0.001) was most strongly associated with PGA. Pain, fatigue, and morning stiffness were substantially associated with the remission-assessing methods that incorporated PGA. Conclusions Since PGA is strongly associated with the patient’s perception of pain and may not reflect the inflammatory process, our study challenges the application of remission-assessing methods containing PGA when monitoring RA patients in the outpatient clinic. We recommend using measures that are less likely to be associated with noninflammatory pain and psychosocial factors. Supplementary Information The online version contains supplementary material available at 10.1007/s40744-022-00490-5.
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Affiliation(s)
- Alen Brkic
- Research Department, Sorlandet Hospital, Kristiansand, Norway. .,Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Sciences, NTNU, Norwegian University of Science and Technology, Trondheim, Norway.
| | - Katarzyna Łosińska
- Division of Rheumatology and Immunology, University Hospital, Krakow, Poland
| | - Are Hugo Pripp
- Oslo Centre of Biostatistics and Epidemiology, Oslo University Hospital, Oslo, Norway
| | - Mariusz Korkosz
- Division of Rheumatology and Immunology, University Hospital, Krakow, Poland.,Department of Rheumatology and Immunology, Jagiellonian University Medical College, Krakow, Poland
| | - Glenn Haugeberg
- Research Department, Sorlandet Hospital, Kristiansand, Norway.,Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Sciences, NTNU, Norwegian University of Science and Technology, Trondheim, Norway.,Division of Rheumatology, Department of Internal Medicine, Sorlandet Hospital, Kristiansand, Norway
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4
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Paulshus Sundlisæter N, Sundin U, Aga AB, Sexton J, Hammer HB, Uhlig T, Kvien TK, Haavardsholm EA, Lillegraven S. Inflammation and biologic therapy in patients with rheumatoid arthritis achieving versus not achieving ACR/EULAR Boolean remission in a treat-to-target study. RMD Open 2022; 8:rmdopen-2021-002013. [PMID: 35091463 PMCID: PMC8804675 DOI: 10.1136/rmdopen-2021-002013] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Accepted: 01/08/2022] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To investigate limiting factors of American College of Rheumatology (ACR)/EULAR Boolean remission in rheumatoid arthritis (RA), and compare patients who fulfil the criteria to patients who only partly fulfil the criteria, with respect to imaging inflammation and biologic disease modifying anti-rheumatic drug (DMARD) usage. METHODS Patients with DMARD-naïve RA were treated according to current recommendations in the the ARCTIC trial (Aiming for Remission in rheumatoid arthritis: a randomised trial examining the benefit of ultrasound in a Clinical TIght Control regimen). Limiting factors of reaching ACR/EULAR Boolean remission at 2 years were assessed. Imaging inflammation (ultrasound and MRI) in patients in remission was compared with patients failing to fulfil different components of the criteria. The OR of biologic therapy was calculated using logistic regression. RESULTS Of 203 patients, 112 (55%) reached ACR/EULAR Boolean remission; 49 (24%) fulfilled three of four criteria. The main limiting factors were patient global assessment (PGA) (59%) and tender joints (22%). Imaging inflammation was not significantly different for patients in remission and patients not fulfilling the criteria due to elevated PGA and/or tender joints, but higher odds of using biologics (OR 3.63, 95% CI 1.73 to 7.61) were observed. CONCLUSIONS PGA and tender joints were the factors most often limiting achievement of ACR/EULAR Boolean remission. The level of imaging inflammation was not elevated in these patients compared with patients in remission, but the odds of using biologic DMARDs were higher.
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Affiliation(s)
| | - Ulf Sundin
- Division of Rheumatology and Research, Diakonhjemmet Hospital, Oslo, Norway
| | - Anna-Birgitte Aga
- Division of Rheumatology and Research, Diakonhjemmet Hospital, Oslo, Norway
| | - Joseph Sexton
- Division of Rheumatology and Research, Diakonhjemmet Hospital, Oslo, Norway
| | - Hilde Berner Hammer
- Division of Rheumatology and Research, Diakonhjemmet Hospital, Oslo, Norway.,Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Till Uhlig
- Division of Rheumatology and Research, Diakonhjemmet Hospital, Oslo, Norway.,Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Tore K Kvien
- Division of Rheumatology and Research, Diakonhjemmet Hospital, Oslo, Norway.,Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Espen A Haavardsholm
- Division of Rheumatology and Research, Diakonhjemmet Hospital, Oslo, Norway.,Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Siri Lillegraven
- Division of Rheumatology and Research, Diakonhjemmet Hospital, Oslo, Norway
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5
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Liu M, Shi B. Nursing intervention reduces depression for patients with rheumatoid arthritis: A randomized controlled trial protocol. Medicine (Baltimore) 2020; 99:e23268. [PMID: 33217854 PMCID: PMC7676538 DOI: 10.1097/md.0000000000023268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Rheumatoid arthritis (RA) is a kind of chronic disease of inflammatory joint, which can lead to the damage and disability of bone and cartilage. Psychiatric comorbidity is related to the adverse results of RA. Symptoms of depression is associated with the increased disease activity and decreased response to the treatments. Therefore, the depression may be an effective intervention target to improve the life quality and subjective health of the patients with RA. The objective of this experiment is to evaluate the effectiveness of nursing intervention for reducing depression for patients with RA. METHOD It is a single-center randomized controlled study to be conducted from January 2021 to December 2021. It was admitted via the Ethics Committee of Tianjin Medical University (202018384). One hundred patients are included in the study. The inclusion criteria contains:The exclusion criteria contains:All the patients participating in this study are randomly divided into control group and study group, with 50 patients in each group. The primary result is the severity of depression in the patients with RA, based on the generally utilized questionnaires (Hospital Anxiety and Depression Scale). The secondary outcome is the patients life quality, which is evaluated with the short form 36 questionnaire. The analysis of all the data are conducted with the software of IBM SPSS Statistics for Windows, version 20. RESULTS Table will show the clinical outcomes after various interventions. CONCLUSION This paper instructs the nurses to develop protocol based on evidence to improve the clinical efficacy for the RA patients. TRIAL REGISTRATION NUMBER researchregistry6114.
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6
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Gilani SS, Nair N, Plant D, Hyrich K, Morgan AW, Morris AP, Wilson AG, Isaacs JD, Barton A, Bluett J. Pharmacogenetics of TNF inhibitor response in rheumatoid arthritis utilizing the two-component disease activity score. Pharmacogenomics 2020; 21:1151-1156. [PMID: 33124499 PMCID: PMC7649675 DOI: 10.2217/pgs-2020-0043] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aim: TNF inhibitor drugs are a treatment option for rheumatoid arthritis, but response is not universal. Response is typically measured using the composite 4-component (4C) disease activity score 28 (DAS28) which contains more subjective measures. This study used a validated 2-component (2C) DAS28 score to determine whether SNPs associated with response were replicated in the UK population. Materials & methods: A literature review identified TNF inhibitor response SNPs. Linear regression was conducted to replicate associations with 4C or 2C-DAS28 response. Results: Eighteen independent SNPs were analyzed in 1828 patients. One and four associations with 4C and 2C-DAS28 response respectively were identified (p ≤ 0.05). Conclusion: Further genetic associations were replicated using the 2C-DAS28 which may reflect the objective nature of 2C-AS28.
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Affiliation(s)
- Syed Sa Gilani
- School of Medicine, University of Manchester, Manchester, M13 9PT, UK
| | - Nisha Nair
- NIHR Manchester Biomedical Research Center, Central Manchester NHS Foundation Trust, Manchester Academic Health Science Center, Manchester, M13 9WL, UK.,Versus Arthritis Centre for Genetics & Genomics, Centre for Musculoskeletal Research, The University of Manchester, Manchester, M13 9PL, UK
| | - Darren Plant
- NIHR Manchester Biomedical Research Center, Central Manchester NHS Foundation Trust, Manchester Academic Health Science Center, Manchester, M13 9WL, UK.,Versus Arthritis Centre for Genetics & Genomics, Centre for Musculoskeletal Research, The University of Manchester, Manchester, M13 9PL, UK
| | - Kimme Hyrich
- NIHR Manchester Biomedical Research Center, Central Manchester NHS Foundation Trust, Manchester Academic Health Science Center, Manchester, M13 9WL, UK.,Versus Arthritis Center for Epidemiology, Center for Musculoskeletal Research, The University of Manchester, Manchester, M13 9PL, UK
| | - Ann W Morgan
- School of Medicine, University of Leeds & NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds, LS2 9JT, UK
| | - Andrew P Morris
- Versus Arthritis Centre for Genetics & Genomics, Centre for Musculoskeletal Research, The University of Manchester, Manchester, M13 9PL, UK
| | - Anthony G Wilson
- School of Medicine & Medical Science, Conway Institute, University College Dublin, Dublin, Dublin 4, Ireland
| | - John D Isaacs
- Institute of Translational & Clinical Research, Newcastle University & Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, NE1 7RU, UK
| | - Anne Barton
- NIHR Manchester Biomedical Research Center, Central Manchester NHS Foundation Trust, Manchester Academic Health Science Center, Manchester, M13 9WL, UK.,Versus Arthritis Centre for Genetics & Genomics, Centre for Musculoskeletal Research, The University of Manchester, Manchester, M13 9PL, UK
| | - James Bluett
- NIHR Manchester Biomedical Research Center, Central Manchester NHS Foundation Trust, Manchester Academic Health Science Center, Manchester, M13 9WL, UK.,Versus Arthritis Centre for Genetics & Genomics, Centre for Musculoskeletal Research, The University of Manchester, Manchester, M13 9PL, UK
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7
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Ferreira RJO, de Wit M, Henriques M, Pinto AF, Duarte C, Mateus E, Mendes G, da Silva JAP, Ndosi M. 'It can't be zero!' Difficulties in completing patient global assessment in rheumatoid arthritis: a mixed methods study. Rheumatology (Oxford) 2020; 59:1137-1147. [PMID: 31600398 DOI: 10.1093/rheumatology/kez467] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Revised: 08/20/2019] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVES Patient global assessment (PGA) is purported to add the patient's perspective in the composite measures of RA. However, PGA is not standardized and it is not known whether patients' interpretation of the measure is consistent with its intended purpose. This study aimed to explore difficulties experienced by patients with RA in completing PGA, and to assess the impact of a structured explanation in improving its validity and reliability. METHODS This was a mixed methods study, using interviews, focus groups and PGA data. During interviews, patients (convenience sample, n = 33) completed three often-used PGA formulations. Then a nurse provided structured explanation about what PGA is and why it is used. After further discussion, patients completed one PGA version again. Interviews were recorded, transcribed and analysed using inductive thematic analysis. We compared PGA scores pre- and post-explanation (Wilcoxon signed-ranks) and the proportion of patients achieving RA remission with PGA ⩽1 (McNemar's tests). RESULTS Three themes emerged: understanding the meaning of PGA, the purpose of PGA and measurement difficulties. The difficulties caused systematic errors in PGA completion such as marking higher when feeling well, marking near the centre or away from zero. The structured explanation was helpful. Following the explanation, the median PGA score decreased from 3.0 to 2.1 cm, and the proportion of non-remission solely due to PGA >1 from 52% to 41%; none of these changes was statistically significant. CONCLUSION Many patients have difficulties in completing PGA. Standardization of PGA and a structured explanation may improve its clarity, validity and reliability.
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Affiliation(s)
- Ricardo J O Ferreira
- Rheumatology Department, Centro Hospitalar e Universitário de Coimbra, Coimbra.,Health Sciences Research Unit: Nursing (UICiSA: E), Nursing School of Coimbra (ESEnfC), Coimbra, Portugal
| | - Maarten de Wit
- Department of Medical Humanities, Amsterdam University Medical Centre, Amsterdam, The Netherlands.,Patient Research Partner, EULAR standing committee of People with Arthritis/Rheumatism in Europe (PARE), Zurich, Switzerland
| | | | - Ana F Pinto
- Faculty of Medicine, University of Coimbra, Coimbra
| | - Cátia 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
| | - Elsa Mateus
- Patient Research Partner, EULAR standing committee of People with Arthritis/Rheumatism in Europe (PARE), Zurich, Switzerland.,Portuguese League Against Rheumatic Diseases (LPCDR), Lisbon
| | - Gabriel Mendes
- Department of National Team, Portuguese Cycling Federation, Lisbon
| | - José A P da Silva
- Coimbra Institute for Clinical and Biomedical Research (iCBR), Faculty of Medicine -University of Coimbra, Coimbra.,Rheumatology Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Mwidimi Ndosi
- Department of Nursing and Midwifery, University of the West of England, Bristol, UK
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8
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Coskun Benlidayi I. Fibromyalgia interferes with disease activity and biological therapy response in inflammatory rheumatic diseases. Rheumatol Int 2020; 40:849-858. [PMID: 31900502 DOI: 10.1007/s00296-019-04506-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Accepted: 12/20/2019] [Indexed: 12/17/2022]
Abstract
Fibromyalgia is one of the numerous comorbidities that may accompany inflammatory rheumatic diseases. Concomitant fibromyalgia in inflammatory rheumatic conditions can interfere with symptomatology, disease activity and overall management plan. The aim of the present narrative review article was to discuss the current evidence on (i) the prevalence/frequency of comorbid fibromyalgia in inflammatory rheumatic conditions, (ii) the role of fibromyalgia on disease activity, (iii) the impact of concomitant fibromyalgia on biological disease-modifying antirheumatic treatment outcomes and (iv) potential effectiveness of biological disease-modifying antirheumatic drugs on fibromyalgia-related symptoms among patients with inflammatory rheumatic diseases. A literature search was conducted through PubMed/MEDLINE Cochrane and Web of Science databases by using relevant keywords and their combinations. Studies representing different geographical areas of the world revealed that frequency rates of fibromyalgia are higher in inflammatory rheumatic diseases than those in the general population. Comorbid fibromyalgia interferes not only with the disease activity scores but also with the treatment outcomes and management plan. Further evidence is warranted in order to determine the potential benefits of biological disease-modifying antirheumatic drugs on fibromyalgia-related symptoms in patients with inflammatory rheumatic diseases.
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Affiliation(s)
- Ilke Coskun Benlidayi
- Department of Physical Medicine and Rehabilitation, Cukurova University Faculty of Medicine, Adana, Turkey.
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9
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Studenic P, Felson D, de Wit M, Alasti F, Stamm TA, Smolen JS, Aletaha D. Testing different thresholds for patient global assessment in defining remission for rheumatoid arthritis: are the current ACR/EULAR Boolean criteria optimal? Ann Rheum Dis 2020; 79:445-452. [PMID: 32024651 PMCID: PMC10564460 DOI: 10.1136/annrheumdis-2019-216529] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Revised: 12/21/2019] [Accepted: 01/22/2020] [Indexed: 12/21/2022]
Abstract
OBJECTIVES This study aimed to evaluate different patient global assessment (PGA) cut-offs required in the American College of Rheumatology/European League Against Rheumatism (ACR/EULAR) Boolean remission definition for their utility in rheumatoid arthritis (RA). METHODS We used data from six randomised controlled trials in early and established RA. We increased the threshold for the 0-10 score for PGA gradually from 1 to 3 in steps of 0.5 (Boolean1.5 to Boolean3.0) and omitted PGA completely (BooleanX) at 6 and 12 months. Agreement with the index-based (Simplified Disease Activity Index (SDAI)) remission definition was analysed using kappa, recursive partitioning (classification and regression tree (CART)) and receiver operating characteristics. The impact of achieving each definition on functional and radiographic outcomes after 1 year was explored. RESULTS Data from 1680 patients with early RA and 920 patients with established RA were included. The proportion of patients achieving Boolean remission increased with higher thresholds for PGA from 12.4% to 19.7% in early and 5.9% to 12.3% in established RA at 6 months. Best agreement with SDAI remission occurred at PGA cut-offs of 1.5 and 2.0, while agreement decreased with higher PGA (CART: optimal agreement at PGA≤1.6 cm; sensitivity of PGA≤1.5 95%). Changing PGA thresholds at 6 months did not affect radiographic progression at 12 months (mean ꙙsmTSS for Boolean, 1.5, 2.0, 2.5, 3.0, BooleanX: 0.35±5.4, 0.38±5.14, 0.41±5.1, 0.37±4.9, 0.34±4.9, 0.27±4.7). However, the proportion attaining HAQ≤0.5 was 90.2%, 87.9%, 85.2%, 81.1%, 80.7% and 73.1% for the respective Boolean definitions. CONCLUSION Increasing the PGA cut-off to 1.5 cm would provide high consistency between Boolean with the index-based remission; the integer cut-off of 2.0 cm performed similarly.
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Affiliation(s)
- Paul Studenic
- Department of Internal Medicine 3, Division of Rheumatology, Medical University of Vienna, Wien, Austria
| | - David Felson
- Section of Rheumatology, Boston University School of Medicine, Boston, Massachusetts, USA
- Centre for Epidemiology, The University of Manchester, Manchester, UK
| | - Maarten de Wit
- Standing Committee of People with Arthritis/Rheumatism in Europe (PARE), EULAR, Zurich, Switzerland
| | - Farideh Alasti
- Department of Internal Medicine 3, Division of Rheumatology, Medical University of Vienna, Wien, Austria
| | - Tanja A Stamm
- Center for Medical Statistics, Informatics, and Intelligent Systems, Section for Outcomes Research, Medical University of Vienna, Wien, Austria
| | - Josef S Smolen
- Department of Internal Medicine 3, Division of Rheumatology, Medical University of Vienna, Wien, Austria
| | - Daniel Aletaha
- Department of Internal Medicine 3, Division of Rheumatology, Medical University of Vienna, Wien, Austria
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10
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Craig ET, Perin J, Zeger S, Curtis JR, Bykerk VP, Bingham CO, Bartlett SJ. What Does the Patient Global Health Assessment in Rheumatoid Arthritis Really Tell Us? Contribution of Specific Dimensions of Health-Related Quality of Life. Arthritis Care Res (Hoboken) 2019; 72:1571-1578. [PMID: 31549772 DOI: 10.1002/acr.24073] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Accepted: 09/17/2019] [Indexed: 01/09/2023]
Abstract
OBJECTIVE To estimate the contributions of health-related quality of life domains to the patient global assessment of disease activity (PtGA) in rheumatoid arthritis (RA). METHODS Data are drawn from baseline visits of 2 observational RA cohorts. Participants completed forms for patient-reported outcome measures, including PtGA and measures from the Patient-Reported Outcomes Measurement Information System, and clinical data were collected. Factor analysis was used to identify latent variables, and multivariable linear regression was used to estimate determinants of the PtGA. RESULTS Patients were mostly female (81%), white (78%), and had established disease (mean ± SD 12.3 ± 10.7 years), with 62% in remission or having low disease activity. In cohort 1 (n = 196), the following 2 factors emerged: 1) daily function (moderate-to-strong [i.e., >|0.65|] loadings of physical function, pain interference, social participation, and fatigue, and weak [>0.35] loadings of sleep disturbance); and 2) emotional distress (strong loadings of depression and anxiety). In crude analysis, daily function explained up to 53% and emotional distress up to 20% of the variance in PtGA. In both cohorts, in adjusted analyses, daily function and, to a much lesser extent, swollen joint count independently predicted PtGA; age was inversely related to PtGA in cohort 1 only. CONCLUSION These findings suggest that in patients with RA, PtGA ratings largely reflect the extent to which patients feel they can function in everyday roles and are not impacted by mood. This suggests that higher than expected PtGA scores may offer an opportunity to discuss patient expectations regarding roles and activities and the impact of their RA symptoms on daily function.
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Affiliation(s)
- Ethan T Craig
- Johns Hopkins University School of Medicine, Baltimore, Maryland, and University of Pennsylvania and Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia
| | - Jamie Perin
- Johns Hopkins University, Baltimore, Maryland
| | - Scott Zeger
- Johns Hopkins University, Baltimore, Maryland
| | | | | | | | - Susan J Bartlett
- Johns Hopkins University School of Medicine, Baltimore, Maryland, and McGill University and Research Institute of McGill University Health Centers, Montreal, Quebec, Canada
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11
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Ishimaru T, Fujino Y, Anzai T, Matsuda S, Tanaka Y. Validity and responsiveness of the Work Functioning Impairment Scale (WFun) in rheumatoid arthritis patients: A multicenter prospective study. Mod Rheumatol 2019; 30:821-827. [PMID: 31483182 DOI: 10.1080/14397595.2019.1661593] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Objective: Previous studies have not fully evaluated the measurement properties of the Work Functioning Impairment Scale (WFun) in clinical situations and there are no data from patients with rheumatoid arthritis (RA). This study aimed to investigate the convergent validity and responsiveness of the WFun in patients with RA.Methods: This substudy was a part of the multicenter, observational, prospective FIRST ACT-SC study. In total, 322 paid workers with RA received anti-rheumatic drugs at baseline. The WFun, Disease Activity Score based on 28 joints and erythrocyte sedimentation rate (DAS28-ESR), Clinical Disease Activity Index (CDAI), Simplified Disease Activity Index (SDAI), Work Productivity and Activity Impairment Questionnaire (WPAI), and Japanese Health Assessment Questionnaire Disability Index (HAQ-DI) were administrated at baseline and weeks 12, 24, and 52. Multilevel regression analyses were performed.Results: High average WFun scores were associated with higher score categories of the DAS28-ESR, CDAI, SDAI, WPAI and HAQ-DI. Average WFun change scores linearly decreased with decreases on each instruments.Conclusion: The findings indicate that the WFun has reasonable measurement properties: the scale demonstrated validity and responsiveness with RA patients. The WFun could be useful in assessing presenteeism in patients with RA.
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Affiliation(s)
- Tomohiro Ishimaru
- Department of Health Management, Nishinihon Occupational Health Service Center, Kitakyushu, Japan.,Department of Occupational Health Practice and Management, Institute of Industrial Ecological Sciences, University of Occupational and Environmental Health, Japan, Kitakyushu, Japan
| | - Yoshihisa Fujino
- Department of Environmental Epidemiology, Institute of Industrial Ecological Sciences, University of Occupational and Environmental Health, Japan, Kitakyushu, Japan
| | - Tatsuhiko Anzai
- Statistic Analysis Department 1, EPS Corporation, Tokyo, Japan
| | - Shinya Matsuda
- Department of Public Health, School of Medicine, University of Occupational and Environmental Health, Japan, Kitakyushu, Japan
| | - Yoshiya Tanaka
- First Department of Internal Medicine, School of Medicine, University of Occupational and Environmental Health, Japan, Kitakyushu, Japan
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Lee SW, Kim SY, Chang SH. Prevalence of feet and ankle arthritis and their impact on clinical indices in patients with rheumatoid arthritis: a cross-sectional study. BMC Musculoskelet Disord 2019; 20:420. [PMID: 31506089 PMCID: PMC6737695 DOI: 10.1186/s12891-019-2773-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Accepted: 08/21/2019] [Indexed: 01/08/2023] Open
Abstract
Background We aimed to evaluate the prevalence of foot and/or ankle arthritis (FAA) and its impact on clinical indices in patients with rheumatoid arthritis (RA). Methods This cross-sectional study used data from the Korean College of Rheumatology Biologics & Targeted therapy registry to observe clinical outcomes of patients undergoing biologics therapy and conventional therapy. FAA was defined as ≥1 tender or swollen joint in the ankle and/or 1st-5th metatarsophalangeal (MTP) joints. Disease Activity Score 28 (DAS28), Routine Assessment of Patient Index Data 3 (RAPID3), Simplified Disease Activity Index (SDAI), and Clinical Disease Activity Index (CDAI) were assessed. Results Among 2046 patients, 598 had FAA. The ankle joint was the most commonly involved joint in FAA (tender joint, 71.4%; swollen joint, 59.5%), followed by the third and second MTP joints. Patients with FAA showed higher DAS28, RAPID3, SDAI, and CDAI scores. FAA presence was significantly associated with non-remission as per DAS28-ESR (odds ratio, 3.4; 95% confidence interval, 2.0–5.8), DAS28-CRP (3.6, 2.4–5.3), SDAI (6.3, 2.8–14.6), CDAI (7.6, 2.4–24.3), and RAPID3 (5.6, 2.7–11.5) indices on adjusting for age, sex, disease duration, presence of rheumatoid factor, presence of anti-cyclic citrullinated peptide antibody, lung disease, use of methotrexate, and previous use of biological disease-modifying anti-rheumatic drugs. Patients with FAA were less likely to achieve remission of SDAI (n = 6, 1.0%) and CDAI (n = 3, 0.5%) than that of DAS28-ESR (n = 21, 3.5%), DAS28-CRP (n = 38, 6.4%), and RAPID3 (n = 12, 2.0%). Conclusions FAA represents a severe disease activity and is an independent risk factor for non-remission in patients with RA. Electronic supplementary material The online version of this article (10.1186/s12891-019-2773-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Sung Won Lee
- Division of Rheumatology, Department of Internal Medicine, Soonchunhyang University Cheonan Hospital, Cheonan, Korea.,Division of Rheumatology, Department of Internal Medicine, Soonchunhyang University College of Medicine, Cheonan, Chungchungnam-do, Korea
| | - Seong-Yong Kim
- Division of Big Data and Management Engineering, Hoseo University, Asan, Korea
| | - Sung Hae Chang
- Division of Rheumatology, Department of Internal Medicine, Soonchunhyang University Cheonan Hospital, Cheonan, Korea. .,Division of Rheumatology, Department of Internal Medicine, Soonchunhyang University College of Medicine, Cheonan, Chungchungnam-do, Korea.
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13
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Noda K, Tajima M, Oto Y, Saitou M, Yoshiga M, Otani K, Yoshida K, Kurosaka D. How do neuropathic pain-like symptoms affect health-related quality of life among patients with rheumatoid arthritis?: A comparison of multiple pain-related parameters. Mod Rheumatol 2019; 30:828-834. [PMID: 31398076 DOI: 10.1080/14397595.2019.1650462] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Objectives: Rheumatoid arthritis (RA) pain is thought to be nociceptive. However, recent studies indicate that RA also involves the neuropathic pain (NP) mechanism. We examined pain features and the effect of NP-like symptoms on health-related quality of life (HRQOL) among patients with RA.Methods: The painDETECT questionnaire (PDQ) was used to evaluate NP-like symptoms among 145 outpatients with RA. Disease activity, pain quality, and HRQOL were evaluated. We compared clinical parameters between patients with and without NP-like symptoms and analyzed pain features and the effect of NP-like symptoms on HRQOL, along with multiple other pain-related parameters.Results: Thirty (20.7%) patients had NP-like symptoms (PDQ ≥13). Patient global assessment and evaluator global assessment diverged for patients with RA who had NP-like symptoms. Of the examined pain-related parameters, PDQ score (p = .038, ß = -.173) was associated with the Short-Form 36-Item Health Survey role-social component summary score, but not with the physical or mental component summary scores.Conclusion: NP-like symptoms affected HRQOL among patients with RA. There was discordance between global assessments by patients and by evaluators for patients with RA who had NP-like symptoms. Therefore, NP-like symptoms should be given somewhat more attention when treating patients with RA.
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Affiliation(s)
- Kentaro Noda
- Department of Rheumatology, Division of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan.,Laboratory of Experimental Rheumatology and Neuroendocrine Immunology, Department of Internal Medicine I, University Hospital Regensburg, Regensburg, Germany
| | - Miku Tajima
- Department of Rheumatology, Division of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan
| | - Yohsuke Oto
- Department of Rheumatology, Division of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan
| | - Moe Saitou
- Department of Rheumatology, Division of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan
| | - Masayuki Yoshiga
- Department of Rheumatology, Division of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan
| | - Kazuhiro Otani
- Department of Rheumatology, Division of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan
| | - Ken Yoshida
- Department of Rheumatology, Division of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan
| | - Daitaro Kurosaka
- Department of Rheumatology, Division of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan
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Yilmaz-Oner S, Gazel U, Can M, Atagunduz P, Direskeneli H, Inanc N. Predictors and the optimal duration of sustained remission in rheumatoid arthritis. Clin Rheumatol 2019; 38:3033-3039. [PMID: 31270696 DOI: 10.1007/s10067-019-04654-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2018] [Revised: 06/14/2019] [Accepted: 06/20/2019] [Indexed: 12/20/2022]
Abstract
OBJECTIVE To determine predictors and optimal duration of sustained remission (SR) in patients with rheumatoid arthritis (RA). METHODS A total of 428 consecutive patients with RA visiting our clinic routinely between 2012 and 2013 were evaluated. Seventy seven of these patients in DAS28 remission were enrolled and followed up for 62.2 ± 9.9 months. Patients in remission ≥ 6 months (SR) and shorter (non: N-SR) were compared in terms of demographic-clinical data and the psychosocial factors. At enrollment, 1st and 5th years, patients in DAS28, SDAI, and Boolean remission were determined. RESULTS Sixty three patients were in SR and 14 in N-SR. Lower baseline DAS28 and HAQ scores, anti-CCP were positive predictors of SR. Although the presence of anxiety, depression, fibromyalgia, and fatigue were lower in the SR group, there was no significance. Patients in DAS28 remission (100%) at baseline reduced to 64% at 1st and 42.6% at 5th years. Patients satisfying SDAI and Boolean remission at these three visits were 49%, 44%, and 32.4% vs 41%, 28%, and 20.6%, respectively. If the duration of remission is defined as 6 months, the remission rates of SDAI at inclusion and fifth years' visits were similar but Boolean remission rates differed significantly and if it is accepted as ≥ 12 months, both the SDAI and Boolean remission rates were not different. CONCLUSION Low DAS28 and HAQ scores at baseline, anti-CCP were positive predictors of SR. Instead of 6 months, remission duration for ≥ 12 months would probably help us to predict SR independently from the chosen criteria; Boolean or SDAI.
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Affiliation(s)
- Sibel Yilmaz-Oner
- Medical Faculty, Department of Rheumatology, Marmara University, Pendik, 34890, Istanbul, Turkey.
| | - Ummugulsum Gazel
- Medical Faculty, Department of Rheumatology, Marmara University, Pendik, 34890, Istanbul, Turkey
| | - Meryem Can
- Medical Faculty, Department of Rheumatology, Marmara University, Pendik, 34890, Istanbul, Turkey
| | - Pamir Atagunduz
- Medical Faculty, Department of Rheumatology, Marmara University, Pendik, 34890, Istanbul, Turkey
| | - Haner Direskeneli
- Medical Faculty, Department of Rheumatology, Marmara University, Pendik, 34890, Istanbul, Turkey
| | - Nevsun Inanc
- Medical Faculty, Department of Rheumatology, Marmara University, Pendik, 34890, Istanbul, Turkey
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The Relationship Between Demographic Characteristics and Noninflammatory Complaints in Rheumatoid Arthritis Patients on Remission. J Clin Rheumatol 2019; 26:255-259. [PMID: 31136414 DOI: 10.1097/rhu.0000000000001068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES The aim of this study was to investigate the noninflammatory complaints in rheumatoid arthritis (RA) patients on remission and the relationship between these complaints and disease characteristics. METHODS This is a medical records review study of 103 RA patients who sustained a remission period for at least 6 months. Clinical features and demographic characteristics of patients, such as laboratory parameters, current number of sensitive and swollen joints, pain level and Patient Global Assessment, previously used medications, and modified Health Assessment Questionnaire, were carefully recorded. Patients were divided into 2 groups according to the presence of noninflammatory complaints as patients with or without noninflammatory complaints (group 1, n = 56; group 2, n = 47, respectively). RESULTS The most common complaints with a decreasing frequency were as follows: low back pain (n = 13 [23.2%]), degenerative knee pain (n = 11 [19.6%]), and widespread body pain due to fibromyalgia (n = 7 [12.5%]). The mean age and age at diagnosis were higher in group 1 than in those in group 2 (p = 0.039, and p = 0.014, respectively). CONCLUSIONS Noninflammatory complaints can be observed in about 50% of RA patients on remission. These complaints were more common in elderly patients with old-age disease onset. Therefore, while evaluating and treating this patient population, noninflammatory complaints and disease-specific parameters should be considered carefully in order to fully improve the clinical outcomes.
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Krüger K, Kneitz C. Komorbiditäten – ihre Rolle im Treat-to-Target-Konzept für die rheumatoide Arthritis. Z Rheumatol 2019; 78:422-428. [DOI: 10.1007/s00393-019-0637-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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Is a Fundamental Change in the Interpretation of Rheumatoid Arthritis Disease Activity Necessary? J Clin Rheumatol 2018; 25:272-277. [PMID: 30570492 DOI: 10.1097/rhu.0000000000000937] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Disease Activity Score (DAS) composite models are moderately precise and robust measures of disease severity when they are used in rheumatoid arthritis (RA) cohorts. They are less so when used for individual patients. This is because subjective components, patient global assessment of well-being and tender joint count, modified by factors other than RA biological disease activity, often obfuscate interpretation of disease activity. Comorbidities, especially distress, can disproportionately inflate these components. Fibromyalgia, essentially synonymous with distress, pain augmentation, and depression, is a common comorbidity. Its presence and severity can be determined by the Polysymptomatic Distress Scale (PSD). The differential effects of distress and fibromyalgia syndrome on the DAS can be demonstrated by manipulating information already there: the arithmetic differences or ratios of the tender joint count and swollen joint count and comparison of the modified disease activity score with 28 joints to the disease activity score with 28 joints-patient (DAS28-derived indices that measure the contribution of the relatively objective or relatively subjective components, respectively). The potentially more objective multibiomarker disease activity might also be used to test the severity of biological RA disease activity. These tools may be used to elucidate disproportionate values for subjective DAS model components, which then should facilitate identification of the underlying process factors, including depression, for potential treatment.
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The Patient-Reported Outcomes Thermometer-5-Item Scale (5T-PROs): Validation of a New Tool for the Quick Assessment of Overall Health Status in Painful Rheumatic Diseases. Pain Res Manag 2018; 2018:3496846. [PMID: 30425755 PMCID: PMC6218716 DOI: 10.1155/2018/3496846] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Accepted: 09/30/2018] [Indexed: 12/23/2022]
Abstract
Objective To investigate the construct validity, reliability (internal consistency and retest reliability), and feasibility of the patient-reported outcomes thermometer–5-item scale (5T-PROs), a new tool to measure overall health status in patients with painful chronic rheumatic diseases such as rheumatoid arthritis (RA), psoriatic arthritis (PsA), axial spondyloarthritis (axialSpA), and fibromyalgia (FM). Methods Consecutive patients have been involved in this study. The following analyses were performed to establish the validity of the 5T-PROs: (1) principal component factor analysis was used to identify the presence of a relatively small number of underlying latent factors than can be used to represent relations among sets of many variables; (2) Cronbach's alpha was calculated as an indicator of internal consistency; and (3) Pearson product-moment correlations were conducted to assess the convergent validity. The 5T-PROs was also administered a second time (two weeks after the initial administration) to a subset of sample (n = 426) to allow for calculation of test-retest reliability. We used the intraclass correlation coefficient (ICC) as an estimate of test-retest reliability. Additionally, discriminant validity was tested using analysis of variance (ANOVA) with Bonferroni post hoc multiple comparisons, in different disease conditions. Feasibility was analyzed by the time taken in completing the 5T-PROs and the proportion of patients able to complete the 5 item. Results 1,199 patients (572 with RA, 251 with axialSpA, 150 with PsA, and 226 with FM) were examined. The mean age was 55.7 (standard deviation: 13.1; range: 20 to 80) years. Factor analysis yielded two factors which accounted for 62.54% of the variance of the 5T-PROs. The first factor “Symptom Summary Score” (35.57% of the variance) revealed a good internal consistency (alpha = 0.88); the internal consistency of the second factor “Psychological Summary Score” (26.97% of the variance) was moderate (alpha = 0.69). The reliability of the whole instrument was good (alpha = 0.82). A very high correlation was obtained between Symptom Summary Score and SF-36 PCS and between pain thermometer intensity and SF-36 bodily pain. For all five items and summary scale scores of the SF-36, there was strong evidence that the mean rank of the scores differs significantly between the groups (Kruskal–Wallis tests, p < 0.001). Discriminant validity, assessed by comparing the 5T-PRO dimensions in patients with different states of disease activity, showed that the 5T-PROs show moderate association with the presence of comorbidities. It was also noted that it was inversely correlated (p=0.01) to years of formal education. Conclusion The 5T-PROs is easily administered, reliable and a valid instrument for evaluating the extensive multidimensional impact associated with chronic painful rheumatic conditions.
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19
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Zhai W, Ma Z, Wang W, Song L, Yi J. Paeoniflorin inhibits Rho kinase activation in joint synovial tissues of rats with collagen-induced rheumatoid arthritis. Biomed Pharmacother 2018; 106:255-259. [PMID: 29966968 DOI: 10.1016/j.biopha.2018.06.130] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2017] [Revised: 06/15/2018] [Accepted: 06/25/2018] [Indexed: 02/06/2023] Open
Abstract
Paeoniflorin (PF) has many effects, such as anti-inflammation, immune-regulation, abirritation, and so on. However, the protective mechanisms of PF on rheumatoid arthritis (RA) was not completely known. Thus, we explored deeply the protective mechanisms in a collagen-induced RA (CIA) rat model. CIA was induced in rats by intradermal injection of bovine type II collagen in complete Freund's adjuvant. Later, the CIA rats received oral administration of PF (50 and 100 mg/kg) once a day from the day 21, with the treatment lasting for 14 days. A variety of indicators were measured for evaluation of anti-rheumatism effect, including paw swelling, arthritis scores, and histopathological changes. And the contents of pro-inflammatory cytokines, including tumor necrosis factor alpha (TNF-α), interleukin-1 beta (IL-1β), and interleukin-6 (IL-6) in the serum, as well as p-NF-κB p65 and p-MYPT1 in the joint synovial tissues were detected to explore the possible mechanisms. The results demonstrated that PF treatment significantly ameliorated the symptoms in CIA rats, reduced the levels of pro-inflammatory cytokines and paw swelling, down-regulated the expressions of p-NF-κB p65 and p-MYPT1. The present results revealed that PF could effectively improve collagen-induced RA in rats by inhibiting Rho kinase activation in the joint synovial tissues, in turn down-regulating expression of p-NF-κB p65 and reducing contents of pro-inflammatory cytokines. Moreover, PF may be an effective agent for RA.
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Affiliation(s)
- Wenjing Zhai
- College of Chemical and Biological Engineering, Yichun University, Yichun 336000, China
| | - Zhihong Ma
- Department of Immunology and Pathobiology, Hebei University of Chinese Medicine, Shijiazhuang 050200, China
| | - Weijie Wang
- Department of Surgery, The Second Hospital of Hebei Medical University, Shijiazhuang 050000, China
| | - Lin Song
- Department of Immunology and Pathobiology, Hebei University of Chinese Medicine, Shijiazhuang 050200, China
| | - Jianfeng Yi
- Key Laboratory for Research on Active Ingredients in Natural Medicine of Jiangxi Province, Yichun University, Yichun 336000, China; The Center for Translational Medicine, Yichun University, Yichun 336000, China.
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20
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Ferreira RJO, Duarte C, Ndosi M, de Wit M, Gossec L, da Silva JAP. Suppressing Inflammation in Rheumatoid Arthritis: Does Patient Global Assessment Blur the Target? A Practice-Based Call for a Paradigm Change. Arthritis Care Res (Hoboken) 2018; 70:369-378. [PMID: 28544615 DOI: 10.1002/acr.23284] [Citation(s) in RCA: 79] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2017] [Accepted: 05/16/2017] [Indexed: 12/12/2022]
Abstract
OBJECTIVE In current management paradigms of rheumatoid arthritis (RA), patient global assessment (PGA) is crucial to decide whether a patient has attained remission (target) or needs reinforced therapy. We investigated whether the clinical and psychological determinants of PGA are appropriate to support this important role. METHODS This was a cross-sectional, single-center study including consecutive ambulatory RA patients. Data collection comprised swollen 28-joint count (SJC28), tender 28-joint count (TJC28), C-reactive protein (CRP) level, PGA, pain, fatigue, function, anxiety, depression, happiness, personality traits, and comorbidities. Remission was categorized using American College of Rheumatology/European League Against Rheumatism Boolean-based criteria: remission, near-remission (only PGA >1), and nonremission. A binary definition without PGA (3v-remission) was also studied. Univariable and multivariable analyses were used to identify explanatory variables of PGA in each remission state. RESULTS A total of 309 patients were included (remission 9.4%, near-remission 37.2%, and nonremission 53.4%). Patients in near-remission were indistinguishable from remission regarding disease activity, but described a disease impact similar to those in nonremission. In multivariable analyses, PGA in near-remission was explained (R2adjusted = 0.50) by fatigue, pain, anxiety, and function. Fatigue and pain had no relationship with disease activity measures. CONCLUSION In RA, a consensually acceptable level of disease activity (SJC28, TJC28, and CRP level ≤1) does not equate to low disease impact: a large proportion of these patients are considered in nonremission solely due to PGA. PGA mainly reflects fatigue, pain, function, and psychological domains, which are inadequate to define the target for immunosuppressive therapy. This consideration suggests that clinical practice should be guided by 2 separate remission targets: inflammation (3v-remission) and disease impact.
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Affiliation(s)
- Ricardo J O Ferreira
- Centro Hospitalar e Universitário de Coimbra and Health Sciences Research Unit: Nursing, Coimbra, Portugal
| | - Cátia Duarte
- Centro Hospitalar e Universitário de Coimbra and University of Coimbra, Coimbra, Portugal
| | | | - Maarten de Wit
- Patient research partner, EULAR Standing Committee of People with Arthritis/Rheumatism in Europe, Zurich, Switzerland, and VU University Medical Centre, Amsterdam, The Netherlands
| | - Laure Gossec
- Sorbonne Universités, UPMC University Paris 06, Institut Pierre Louis d'Epidémiologie et de Santé Publique, GRC-UPMC 08 (EEMOIS), and AP-HP, Pitié-Salpetrière Hospital, Paris, France
| | - J A P da Silva
- Centro Hospitalar e Universitário de Coimbra and University of Coimbra, Coimbra, Portugal
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Davis AM, Rubinstein TB, Rodriguez M, Knight AM. Mental health care for youth with rheumatologic diseases - bridging the gap. Pediatr Rheumatol Online J 2017; 15:85. [PMID: 29282086 PMCID: PMC5745617 DOI: 10.1186/s12969-017-0214-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Accepted: 12/14/2017] [Indexed: 12/21/2022] Open
Abstract
Youth with rheumatologic diseases have a high prevalence of comorbid mental health disorders. Individuals with comorbid mental health disorders are at increased risk for adverse outcomes related to mental health as well as their underlying rheumatologic disease. Early identification and treatment of mental health disorders has been shown to improve outcomes, but current systems of care fall short in providing adequate mental health services to those in need. Pediatric rheumatologists are uniquely positioned to provide mental health screening and intervention for youth with rheumatologic diseases due to the frequency of patient encounters and ongoing therapeutic relationship with patients and families. However, additional training is likely required for pediatric rheumatologists to provide effective mental health care, and focusing efforts on providing trainees with mental health education is key to building competency. Potential opportunities for improved mental health education include development of clinical guidelines regarding mental health screening and management within pediatric rheumatology settings and incorporation of mental health didactics, workshops, and interdisciplinary clinic experiences into pediatric rheumatology fellowship curricula. Additional steps include mental health education for patients and families and focus on system change, targeting integration of medical and mental health care. Research is needed to better define the scope of the problem, determine effective strategies for equipping pediatric rheumatologists with skills in mental health intervention, and develop and implement sustainable systems for delivery of optimal mental health care to youth with rheumatologic diseases.
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Affiliation(s)
- Alaina M. Davis
- 0000 0004 1936 9916grid.412807.8Division of Pediatric Rheumatology, Vanderbilt University Medical Center, Monroe Carell Junior Children’s Hospital at Vanderbilt, 2200 Children’s Way, Doctor’s Office Tower 11240, Nashville, TN 37232 USA
| | - Tamar B. Rubinstein
- 0000000121791997grid.251993.5Division of Pediatric Rheumatology, Albert Einstein College of Medicine, Children’s Hospital at Montefiore/ Albert Einstein College of Medicine, 3415 Bainbridge Avenue, Bronx, NY 10467 USA
| | - Martha Rodriguez
- 0000 0000 9682 4709grid.414923.9Section of Pediatric Rheumatology, Riley Hospital for Children at Indiana University Health, 705 Riley Hospital Dr, Indianapolis, IN 46202 USA
| | - Andrea M. Knight
- 0000 0001 0680 8770grid.239552.aDivision of Rheumatology, The Children’s Hospital of Philadelphia, Roberts Center for Pediatric Research, 2716 South St, Ste 10253, Philadelphia, PA 19146 USA ,0000 0001 0680 8770grid.239552.aThe Children’s Hospital of Philadelphia, Roberts Center for Pediatric Research, Center for Pediatric Clinical Effectiveness, 2716 South St, Ste 10253, Philadelphia, PA 19146 USA ,0000 0001 0680 8770grid.239552.aThe Children’s Hospital of Philadelphia, Roberts Center for Pediatric Research, PolicyLab, 2716 South St, Ste 10253, Philadelphia, PA 19146 USA
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Abstract
PURPOSE OF REVIEW The purpose of this study was to review the current information on fatigue in rheumatoid arthritis (RA). RECENT FINDINGS Severe fatigue is common among individuals with RA and has a significant impact on quality of life (QOL). RA-related factors (e.g., inflammation, pain) are associated with greater fatigue, but other factors, such as obesity, physical inactivity, sleep disturbance, and depression, explain the majority of variation in fatigue. Medications targeting RA have little effect on fatigue. Instead, the most effective interventions seem to address non-RA-specific factors such as physical inactivity or use cognitive behavioral approaches. No recommendations have been made for tools to measure fatigue in RA, leading to potential difficulty comparing studies. Although fatigue has great impact on patients' QOL, effective interventions that are feasible for broad dissemination remain elusive. Additional multi-faceted research is needed to identify modifiable sources of fatigue. Such research would be enhanced by harmonization of fatigue measurement across studies.
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Curtis JR, Herrem C, Ndlovu 'MN, O'Brien C, Yazici Y. A somatization comorbidity phenotype impacts response to therapy in rheumatoid arthritis: post-hoc results from the certolizumab pegol phase 4 PREDICT trial. Arthritis Res Ther 2017; 19:215. [PMID: 28962590 PMCID: PMC5622491 DOI: 10.1186/s13075-017-1412-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Accepted: 08/29/2017] [Indexed: 01/09/2023] Open
Abstract
Background Comorbidities may contribute to disease activity and treatment response in rheumatoid arthritis (RA) patients. We defined a somatization comorbidity phenotype (SCP) and examined its influence on response to certolizumab pegol (CZP) using data from the PREDICT trial. Methods Patients in PREDICT were randomized to the patient-reported Routine Assessment of Patient Index Data 3 (RAPID3) or physician-based Clinical Disease Activity Index (CDAI) for treatment response assessment. Post-hoc analyses identified patients with the SCP, which included diagnosis of depression, fibromyalgia/myalgias, and/or use of medications indicated for treatment of depression, anxiety, or neuropathic pain. The effect of the SCP on RAPID3 or CDAI response at week 12 and low disease activity (LDA; Disease Activity Score in 28 joints based on erythrocyte sedimentation rate ≤ 3.2) at week 52, in week-12 responders, was analyzed using non-parametric analysis of covariance (ANCOVA). Results At baseline, 43% (313/733) of patients met the SCP classification. Patients with the SCP were 9% more likely to withdraw from the trial. American College of Rheumatology 20% (ACR20), ACR50, and ACR70 responses were 5–14% lower among those with the SCP, and 11% more patients reported adverse events (AEs). Patients without SCP in the CDAI arm were twice as likely to achieve LDA at week 52 compared with those with SCP (32% versus 16%). No differentiation by SCP was observed in the RAPID3 arm (pooled result 21.5%). Conclusions We operationalized a potentially important somatization comorbidity phenotype in a trial setting that was associated with a substantially lower likelihood of treatment response and a higher frequency of AEs. Including large numbers of patients with this phenotype in RA trials may reduce the measured clinical effectiveness of a new molecule. Trial registration ClinicalTrials.gov, NCT01255761. Registered on 6 December 2010. Electronic supplementary material The online version of this article (doi:10.1186/s13075-017-1412-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Jeffrey R Curtis
- Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham, FOT 802, 510 20th Street South, Birmingham, AL, 35294, USA.
| | | | | | - Cathy O'Brien
- UCB Pharma, Allée de la Recherche 60, 1070, Brussels, Belgium
| | - Yusuf Yazici
- NYU Hospital for Joint Diseases, New York University School of Medicine, 301 East 17th Street, New York, NY, 10003, USA
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Salaffi F, Gerardi MC, Atzeni F, Batticciotto A, Talotta R, Draghessi A, Di Carlo M, Sarzi-Puttini P. The influence of fibromyalgia on achieving remission in patients with long-standing rheumatoid arthritis. Rheumatol Int 2017; 37:2035-2042. [PMID: 28875224 DOI: 10.1007/s00296-017-3792-4] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2017] [Accepted: 08/09/2017] [Indexed: 12/19/2022]
Abstract
To investigate the influence of fibromyalgia (FM) on achieving remission defined on the basis of the Simplified Disease Activity Index (SDAI) remission criteria in patients with long-standing rheumatoid arthritis (RA). This observational longitudinal cohort consisted of long-standing RA patients being treated with conventional synthetic disease-modifying antirheumatic drugs (csDMARDs) or biological DMARDs (bDMARDs). After 6 months of follow-up, the patients fulfilling or not fulfilling the remission criteria were identified and compared with each other in terms of the presence of FM, neuropathic pain, and other comorbidities. At the end of the 6-month observation period, 24 of the 117 patients (20.4%) met the SDAI remission criteria. Logistic regression analysis showed that the modified Rheumatic Disease Comorbidity Index (mRDCI) (p = 0.0001), the FM presence (p = 0.0001), and the 36-item short-form health survey Mental Component Summary (SF-36 MCS) Score (p = 0.0088) were the strongest predictors of not being in SDAI remission. None of the patients with concomitant FM (17.1%) achieved SDAI remission. In comparison with the non-FM patients, the patients with RA and FM patients had worse scores on the SF-36 MCS (p = 0.011), on the sleep Visual Analogue Scale (VAS) (p = 0.018), on the self-counts of tender joints (p = 0.039), and on the PainDetect Questionnaire (PDQ) (p = 0.001). To avoid over treatment, an assessment of FM should be considered in RA patients who do not fulfil the remission criteria.
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Affiliation(s)
- Fausto Salaffi
- Rheumatology Department, Università Politecnica delle Marche, c/o Ospedale "Carlo Urbani", Via Aldo Moro 25, 60035, Jesi, AN, Italy.
| | - Maria Chiara Gerardi
- Rheumatology Unit, ASST Fatebenefratelli-L. Sacco University Hospital, Milan, Italy
| | - Fabiola Atzeni
- Rheumatology Unit, ASST Fatebenefratelli-L. Sacco University Hospital, Milan, Italy
| | - Alberto Batticciotto
- Rheumatology Unit, ASST Fatebenefratelli-L. Sacco University Hospital, Milan, Italy
| | - Rossella Talotta
- Rheumatology Unit, ASST Fatebenefratelli-L. Sacco University Hospital, Milan, Italy
| | - Antonella Draghessi
- Rheumatology Department, Università Politecnica delle Marche, c/o Ospedale "Carlo Urbani", Via Aldo Moro 25, 60035, Jesi, AN, Italy
| | - Marco Di Carlo
- Rheumatology Department, Università Politecnica delle Marche, c/o Ospedale "Carlo Urbani", Via Aldo Moro 25, 60035, Jesi, AN, Italy
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van Tuyl LHD, Boers M. Remission — keeping the patient experience front and centre. Nat Rev Rheumatol 2017; 13:573-574. [DOI: 10.1038/nrrheum.2017.139] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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Ward MM, Guthrie LC, Dasgupta A. Direct and Indirect Determinants of the Patient Global Assessment in Rheumatoid Arthritis: Differences by Level of Disease Activity. Arthritis Care Res (Hoboken) 2017; 69:323-329. [PMID: 27273981 DOI: 10.1002/acr.22953] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Revised: 05/18/2016] [Accepted: 05/31/2016] [Indexed: 01/16/2023]
Abstract
OBJECTIVE In rheumatoid arthritis (RA), the patient global assessment (PGA) has been strongly associated with pain severity, but less often with other measures, including disease activity measures. We tested whether RA activity and psychological measures had direct associations with the PGA or indirect associations that were mediated by pain. We also tested whether the correlates of the PGA differed with the degree of RA activity. METHODS We studied 260 patients with active RA on 2 visits in a prospective longitudinal study. We used path analysis to test direct and indirect associations of Disease Activity Score in 28 joints (DAS28), morning stiffness, Health Assessment Questionnaire (HAQ), fatigue, physical role limitations, social functioning, depressive symptoms, and health distress with the PGA. RESULTS Among the 509 visits, the median PGA score was 50 (25th-75th percentile: 24-66). Pain severity had the strongest association with the PGA, but direct associations were also found for morning stiffness severity, health distress, fatigue, and DAS28. Morning stiffness severity, DAS28, health distress, and HAQ were also indirectly associated with the PGA through pain. Among visits with DAS28 ≥5.4, pain, morning stiffness severity, and HAQ were the only determinants of the PGA. Among visits with DAS28 <4.2, health distress and age were additional determinants, and fatigue was marginally associated with the PGA. CONCLUSION Although pain was the strongest determinant of the PGA in RA, morning stiffness severity, health distress, fatigue, and DAS28 were also important. Determinants of the PGA differed with RA activity, with health distress, age, and to a lesser degree, fatigue, contributing only in patients with less active RA.
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Affiliation(s)
- Michael M Ward
- National Institute of Arthritis and Musculoskeletal and Skin Diseases, NIH, Washington, DC
| | - Lori C Guthrie
- National Institute of Arthritis and Musculoskeletal and Skin Diseases, NIH, Washington, DC
| | - Abhijit Dasgupta
- National Institute of Arthritis and Musculoskeletal and Skin Diseases, NIH, Washington, DC
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The Effect Size of Fibromyalgia on PG-VAS in Rheumatoid Arthritis Patients. Adjustment Proposal in DAS28-ESR: Letter to the Editor regarding Challa, D.N.V., Crowson, C.S. & Davis, J.M. Rheumatol Ther (2017) 4: 201. doi:10.1007/s40744-017-0063-5. Rheumatol Ther 2017; 4:515-517. [PMID: 28685293 PMCID: PMC5696279 DOI: 10.1007/s40744-017-0067-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2017] [Indexed: 11/20/2022] Open
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Challa DNV, Crowson CS, Davis JM. The Patient Global Assessment of Disease Activity in Rheumatoid Arthritis: Identification of Underlying Latent Factors. Rheumatol Ther 2017; 4:201-208. [PMID: 28488206 PMCID: PMC5443732 DOI: 10.1007/s40744-017-0063-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Indexed: 01/14/2023] Open
Abstract
Introduction The patient global assessment of disease activity is a crucial component of various measures of disease activity in rheumatoid arthritis (RA). Our objective was to identify underlying latent traits driving the patient global assessment using a quantitative, multivariable data reduction approach. Methods This was a prospective cross-sectional study of consecutive patients with RA. The patient sample was stratified to include 50 patients with patient-provider discordance (i.e., at least 25-mm absolute difference between the patient and provider global assessments) and 20 patients with patient-provider concordance (i.e., less than 25-mm absolute difference between the patient and provider global assessments). Data were collected from the most recent rheumatology visit, including patient characteristics, current RA medications, and comorbidities. Participants completed several validated patient-reported outcome measures. The data were evaluated using factor analysis, and then linear regression was used to determine the variability in the patient global assessment explained by the factor scores. Results The study included 70 patients with mean age of 61 years, 73% female, and with mean disease duration of 8 years. The means (SD) for the patient and provider global assessments were 44.6 (22.7) and 20.1 (17.7), respectively. Factor analysis yielded eight factors that represented measurements of pain, fatigue, depression or anxiety symptoms, prior diagnosis of depression or anxiety, advanced age and degenerative arthritis, inability to participate, fibromyalgia (clinical diagnosis and Widespread Pain Index), and undetermined. Linear regression analysis showed that fibromyalgia explained the greatest proportion of the variance in the patient global assessment followed by the other factors. Conclusion Latent factors underlying the patient global assessment include pain, depression and anxiety, inability to participate, fibromyalgia, advanced age, and degenerative arthritis.
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Affiliation(s)
- Divya N V Challa
- Division of Rheumatology, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Cynthia S Crowson
- Division of Biostatistics and Informatics, Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - John M Davis
- Division of Rheumatology, Department of Medicine, Mayo Clinic, Rochester, MN, USA.
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Jensen Hansen IM, Asmussen Andreasen R, van Bui Hansen MN, Emamifar A. The Reliability of Disease Activity Score in 28 Joints-C-Reactive Protein Might Be Overestimated in a Subgroup of Rheumatoid Arthritis Patients, When the Score Is Solely Based on Subjective Parameters: A Cross-sectional, Exploratory Study. J Clin Rheumatol 2017; 23:102-106. [PMID: 27870649 PMCID: PMC5325244 DOI: 10.1097/rhu.0000000000000469] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND Disease Activity Score in 28 Joints (DAS28) is a scoring system to evaluate disease activity and treatment response in rheumatoid arthritis (RA). A DAS28 score of greater than 3.2 is a well-described limit for treatment intensification; however, the reliability of DAS28 might be overestimated. OBJECTIVE The aim of this study was to evaluate the reliability of DAS28 in RA, especially focusing on a subgroup of patients with a DAS28 score of greater than 3.2. METHODS Data from RA patients registered in the local part of Danish DANBIO Registry were collected in May 2015. Patients were categorized into 2 groups: First, those with DAS28 >3.2 with at least one swollen joint (SJ) or elevated C-reactive protein (CRP) ("objective group"), and second, patients with a DAS28 >3.2 who had no SJ, and CRP values were within the reference range ("subjective group"). Disease Activity Score in 28 Joints, Clinical Disease Activity Index, and Health Assessment Questionnaire scores were calculated for each group. We defined new score, DAS28 subjective, to focus on subjective parameters. RESULTS Two hundred thirty patients were included; 198 (86.1%) and 32 (13.9%) patients were in the objective and subjective groups, respectively. Patients in the subjective group had lower mean values of DAS28 (P < 0.001) and Evaluator Global Assessment (P < 0.001) with less common immunoglobulin M rheumatoid factor (P < 0.001) and anti-cyclic citrullinated peptide positivity (P = 0.02) and contrarily higher mean values of tender joints (P = 0.04) and DAS28 based on subjective parameters (P = 0.003) compared with the objective group. CONCLUSIONS Rheumatoid arthritis scoring systems should be used cautiously in patients who are considered for treatment intensification. Patients with central sensitization and psychological problems and those with false-positive diagnosis of RA are at high risk of overtreatment.
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Affiliation(s)
- Inger Marie Jensen Hansen
- From the *Department of Rheumatology, Odense University Hospital, Svendborg Hospital, Svendborg; and †Faculty of Health Sciences, University of Southern Denmark, Odense; ‡DANBIO Registry, Copenhagen; and §Department of Technology and Innovation, University of Southern Denmark, Odense, Denmark
| | - Rikke Asmussen Andreasen
- From the *Department of Rheumatology, Odense University Hospital, Svendborg Hospital, Svendborg; and †Faculty of Health Sciences, University of Southern Denmark, Odense; ‡DANBIO Registry, Copenhagen; and §Department of Technology and Innovation, University of Southern Denmark, Odense, Denmark
| | - Mark Nam van Bui Hansen
- From the *Department of Rheumatology, Odense University Hospital, Svendborg Hospital, Svendborg; and †Faculty of Health Sciences, University of Southern Denmark, Odense; ‡DANBIO Registry, Copenhagen; and §Department of Technology and Innovation, University of Southern Denmark, Odense, Denmark
| | - Amir Emamifar
- From the *Department of Rheumatology, Odense University Hospital, Svendborg Hospital, Svendborg; and †Faculty of Health Sciences, University of Southern Denmark, Odense; ‡DANBIO Registry, Copenhagen; and §Department of Technology and Innovation, University of Southern Denmark, Odense, Denmark
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Absence of Association of Joint Tenderness and High-Resolution Ultrasound Findings in Established Rheumatoid Arthritis. J Clin Rheumatol 2016; 22:449-450. [DOI: 10.1097/rhu.0000000000000443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Zhou B, Li G, Zhang Y, Zhao Z. Effects of Nursing Interventions on Depression of Patients With Rheumatoid Arthritis: A Meta-Analysis of Randomized Controlled Trials. Arch Psychiatr Nurs 2016; 30:717-721. [PMID: 27888965 DOI: 10.1016/j.apnu.2016.06.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Revised: 05/12/2016] [Accepted: 06/18/2016] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Previous randomized controlled trials have led to conflicting findings regarding the effects of nursing interventions on depression of patients with rheumatoid arthritis (RA). The purpose of this study was to use the meta-analytic approach to resolve these discrepancies. METHODS We performed a systematic search of publications using MEDLINE, EMBASE, the Cochrane Library, and manual searches without language restrictions. Studies that met the following criteria were included: (1) randomized controlled trials; (2) duration of intervention≥4 weeks; (3) comparative control group; (4) adults with RA; (5) published studies in any language since reception; and (6) psychological symptoms assessed. We extracted relative risks (RRs) and 95% confidence internals (CIs) and pooled them using a random effect model. We carried out sensitivity analysis and assessed heterogeneity and publication bias. RESULTS A total of 14 studies, including 1803 patients, were eligible for inclusion in the review. Depression symptom was assessed by questionnaires. In the pooled analysis, nursing interventions, including exercise training, medication guide, health education and psychotherapy were associated with the remission of depression (RR: -0.67; 95% CI: -0.89 to -0.46; P<0.01) with significant heterogeneity between studies (P<0.01). CONCLUSION Nursing interventions may be important adjunctive therapies in the medical management of RA patients.
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Affiliation(s)
- Biyun Zhou
- Medical School of Southeast University, Nanjing, Jiangsu, China.
| | - Guohong Li
- Zhongda Hospital Affiliated to Southeast University, Nanjing, Jiangsu, China
| | - Yuqun Zhang
- Medical School of Southeast University, Nanjing, Jiangsu, China
| | - Zihan Zhao
- Medical School of Southeast University, Nanjing, Jiangsu, China
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Mian AN, Chaabo K, Wajed J, Subesinghe S, Gullick NJ, Kirkham B, Garrood T. Rheumatoid arthritis patients with fibromyalgic clinical features have significantly less synovitis as defined by power Doppler ultrasound. BMC Musculoskelet Disord 2016; 17:404. [PMID: 27659057 PMCID: PMC5034619 DOI: 10.1186/s12891-016-1258-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2016] [Accepted: 09/14/2016] [Indexed: 11/13/2022] Open
Abstract
Background In patients with rheumatoid arthritis (RA) clinical measures of disease activity may not reliably discriminate between patients with active inflammatory disease and those with concomitant fibromyalgia (FM). Recent work has shown RA patients with a 28 tender joint count (TJC) minus swollen joint count (SJC) of 7 or more (joint count criteria) are more likely to meet classification criteria for FM. This study aimed to determine whether RA patients meeting clinical criteria for FM had lower levels of joint inflammation as determined by ultrasound (US). Methods RA patients with DAS28 > 2.6 were recruited. Patients underwent clinical assessment including ultrasound examination of the hands and wrists with quantification of grey scale (GS) and power Doppler (PD) synovitis. Patients completed questionnaires to assess pain, fatigue, disability and psychological comorbidity. Results Patients meeting either of the FM criteria had higher scores for disease activity, depression, disability and fatigue. Those meeting both the joint count and classification FM criteria had significantly lower levels of GS and PD inflammation on US. Conclusions RA patients with concomitant FM, as determined by widespread soft tissue tenderness but fewer clinically inflamed joints, have higher disease activity scores but may have lower levels of synovial inflammation on US. This has implications for the identification and management of these patients who may not respond to conventional therapy and hence be more suitable for alternative approaches to treatment.
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Affiliation(s)
- Aneela N Mian
- Department of Rheumatology, Guys and St Thomas' NHS Trust, Great Maze Pond, London, SE1 9RT, UK. .,Department of Academic Rheumatology, King's College London, 10 Cutcombe Road, London, SE5 9RT, UK.
| | - Khaldoun Chaabo
- Department of Rheumatology, Guys and St Thomas' NHS Trust, Great Maze Pond, London, SE1 9RT, UK
| | - Julekha Wajed
- Department of Rheumatology, Guys and St Thomas' NHS Trust, Great Maze Pond, London, SE1 9RT, UK
| | - Sujith Subesinghe
- Department of Rheumatology, Guys and St Thomas' NHS Trust, Great Maze Pond, London, SE1 9RT, UK
| | - Nicola J Gullick
- Department of Rheumatology, King's College Hospital London, Denmark Hill, SE5 9RS, UK
| | - Bruce Kirkham
- Department of Rheumatology, Guys and St Thomas' NHS Trust, Great Maze Pond, London, SE1 9RT, UK
| | - Toby Garrood
- Department of Rheumatology, Guys and St Thomas' NHS Trust, Great Maze Pond, London, SE1 9RT, UK
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Rathbun AM, Harrold LR, Reed GW. A Prospective Evaluation of the Effects of Prevalent Depressive Symptoms on Disease Activity in Rheumatoid Arthritis Patients Treated With Biologic Response Modifiers. Clin Ther 2016; 38:1759-1772.e3. [PMID: 27368116 DOI: 10.1016/j.clinthera.2016.06.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Revised: 04/18/2016] [Accepted: 06/07/2016] [Indexed: 12/11/2022]
Abstract
PURPOSE Depressive symptoms are common in rheumatoid arthritis (RA) and may affect disease activity and treatment outcomes. The objective of this study was to determine if prevalent depressive symptoms modify biologic treatment response through their effect on RA disease activity. METHODS RA patients with depressive symptoms, initiating biologic treatment, were identified from a US RA registry sample. Patients with depression were compared with control subjects (ie, those patients with no reports of depressive symptoms at, or before, initiating therapy) in terms of clinical disease activity index (CDAI) remission and low disease activity (LDA), and the changes in the component measures that comprise this scale at 6 and 12 months of follow-up. Inverse probability weighting was used to account for differences in baseline disease severity, concomitant treatment characteristics, and other possible confounders. Logistic and linear regression models estimated differences in response rates and changes in component disease activity measures. FINDINGS Depressive symptoms were associated with a decreased likelihood of CDAI remission at 6 months (odds ratio, 0.43 [95% CI, 0.19-0.96]) but not at 12 months (odds ratio, 0.83 [95% CI, 0.43-1.60]), and there was no effect on CDAI LDA. Adjusted core component measurement changes showed smaller decreases in global assessment ratings in patients with depressive symptoms; these associations were not statistically significant. IMPLICATIONS Poorer treatment outcomes among RA patients with depressive symptoms may be a result of higher baseline disease severity. Adjusted estimates indicated symptoms of depression only affected remission at 6 months' follow-up through patient and physician global assessments. Thus, any impact of depressive symptoms during biologic treatment might not be due to a definitive impact on joint swelling and tenderness.
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Affiliation(s)
- Alan M Rathbun
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland.
| | - Leslie R Harrold
- Department of Orthopedics, University of Massachusetts Medical School, Worcester, Massachusetts; CORRONA, Inc., Southborough, Massachusetts
| | - George W Reed
- CORRONA, Inc., Southborough, Massachusetts; Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts
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Affiliation(s)
- Lilian H D van Tuyl
- Amsterdam Rheumatology and Immunology Center, Department of Rheumatology, VU University Medical Center, PO Box 7057 1007 MB, Amsterdam, The Netherlands
| | - Kaleb Michaud
- Department of Medicine, University of Nebraska Medical Center, 986270 Nebraska Medical Center, Omaha, NE 68198-6270, USA; National Data Bank for Rheumatic Diseases, 1035 North Emporia, Suite 288, Wichita, KS 67214, USA.
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Zhu L, Chen T, Chang X, Zhou R, Luo F, Liu J, Zhang K, Wang Y, Yang Y, Long H, Liu Y, Yan T, Ma C. Salidroside ameliorates arthritis-induced brain cognition deficits by regulating Rho/ROCK/NF-κB pathway. Neuropharmacology 2015; 103:134-42. [PMID: 26690894 DOI: 10.1016/j.neuropharm.2015.12.007] [Citation(s) in RCA: 96] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2015] [Revised: 11/23/2015] [Accepted: 12/09/2015] [Indexed: 01/27/2023]
Abstract
The prevalence of cognitive impairment in rheumatoid arthritis (RA) patients was increasingly serious nowadays. The purpose of the current study was to explore whether salidroside (Sal) could alleviate arthritis-induced cognition deficits and examine the relationship between the impairment and Rho/ROCK/NF-κB pathway. Collagen-induced arthritis (CIA) was established by the injection of chicken type II collagen (CII), complete Freund's adjuvant (CFA) and incomplete Freund's adjuvant (IFA). Arthritic lesions of CIA rats were assessed by arthritis index score, swelling of paws and histological analysis. Cognitive deficits symptoms of CIA rats were monitored through Morris water maze test. The contents of pro-inflammatory cytokines tumor necrosis factor-alpha (TNF-α), interleukin-1 beta (IL-1β) and interleukin-6 (IL-6) in hippocampus and serum were significantly reduced with salidroside (20 mg/kg, 40 mg/kg) treatment compared with those in the CIA group. In parallel, we demonstrated that the expressions of RhoA, ROCK1, ROCK2, p-NF-κBp65, p-IκBα, p-IKKα and p-IKKβ were enhanced accompanying the investigation arthritis-induced cognition deficits, which were remarkably down-regulated by salidroside and confirmed by the results obtained from western blot and immunohistochemistry. LC-MS/MS results ascertained that Sal could enter into the blood and brain tissues to exhibit the protective effect on arthritis-induced cognitive dysfunction. Therefore, it was assumed that Sal might be a potential therapeutic candidate to treat arthritis-induced brain cognition deficits through the regulation of Rho/ROCK/NF-κB signaling.
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Affiliation(s)
- Lingpeng Zhu
- Department of Biochemistry, School of Life Science and Technology, China Pharmaceutical University, Nanjing 210009, China; Department of Physiology and Pharmacology, China Pharmaceutical University, Nanjing 210009, China
| | - Tong Chen
- State Key Laboratory of Natural Medicines, Department of Pharmacology, China Pharmaceutical University, Nanjing 210009, China
| | - Xiayun Chang
- Department of Physiology and Pharmacology, China Pharmaceutical University, Nanjing 210009, China
| | - Rui Zhou
- Department of Physiology and Pharmacology, China Pharmaceutical University, Nanjing 210009, China
| | - Fen Luo
- Department of Physiology and Pharmacology, China Pharmaceutical University, Nanjing 210009, China
| | - Jingyan Liu
- Department of Physiology and Pharmacology, China Pharmaceutical University, Nanjing 210009, China
| | - Kai Zhang
- Department of Pharmacology of Chinese Materia Medica, China Pharmaceutical University, Nanjing 210009, China
| | - Yue Wang
- School of Engineering, China Pharmaceutical University, Nanjing 210009, China
| | - Ying Yang
- School of Engineering, China Pharmaceutical University, Nanjing 210009, China
| | - Hongyan Long
- Nanjing Municipal Hospital of T.C.M, The Third Affiliated Hospital of Nanjing University of T.C.M, Nanjing 210001, China.
| | - Yu Liu
- Department of Biochemistry, School of Life Science and Technology, China Pharmaceutical University, Nanjing 210009, China.
| | - Tianhua Yan
- Department of Biochemistry, School of Life Science and Technology, China Pharmaceutical University, Nanjing 210009, China; Department of Physiology and Pharmacology, China Pharmaceutical University, Nanjing 210009, China.
| | - Chunhua Ma
- Department of Physiology and Pharmacology, China Pharmaceutical University, Nanjing 210009, China.
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Lee YC, Hackett J, Frits M, Iannaccone CK, Shadick NA, Weinblatt ME, Segurado OG, Sasso EH. Multibiomarker disease activity score and C-reactive protein in a cross-sectional observational study of patients with rheumatoid arthritis with and without concomitant fibromyalgia. Rheumatology (Oxford) 2015; 55:640-8. [PMID: 26608972 PMCID: PMC4795537 DOI: 10.1093/rheumatology/kev388] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2014] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVES To examine the association between a multibiomarker disease activity (MBDA) score, CRP and clinical disease activity measures among RA patients with and without concomitant FM. METHODS In an observational cohort of patients with established RA, we performed a cross-sectional analysis comparing MBDA scores with CRP by rank correlation and cross-classification. MBDA scores, CRP and clinical measures of disease activity were compared between patients with RA alone and RA with concomitant FM (RA and FM) by univariate and multivariate analyses. RESULTS CRP was ⩽1.0 mg/dl for 184 of 198 patients (93%). MBDA scores correlated with CRP (r = 0.755, P < 0.001), but were often discordant, being moderate or high for 19%, 55% and 87% of patients with CRP ⩽0.1, 0.1 to ⩽0.3, or 0.3 to ⩽1.0 mg/dl, respectively. Among patients with CRP ⩽1.0 mg/dl, swollen joint count (SJC) increased linearly across levels of MBDA score, both with (P = 0.021) and without (P = 0.004) adjustment for CRP, whereas CRP was not associated with SJC. The 28-joint-DAS-CRP, other composite measures, and their non-joint-count component measures were significantly greater for patients with RA and FM (n = 25) versus RA alone (n = 173) (all P ⩽ 0.005). MBDA scores and CRP were similar between groups. CONCLUSION MBDA scores frequently indicated RA disease activity when CRP did not. Neither one was significantly greater among patients with RA and FM versus RA alone. Thus, MBDA score may be a useful objective measure for identifying RA patients with active inflammation when CRP is low (⩽1.0 mg/dl), including RA patients with concomitant FM.
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Affiliation(s)
- Yvonne C Lee
- Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, Boston, MA,
| | | | - Michelle Frits
- Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, Boston, MA
| | - Christine K Iannaccone
- Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, Boston, MA
| | - Nancy A Shadick
- Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, Boston, MA
| | - Michael E Weinblatt
- Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, Boston, MA
| | - Oscar G Segurado
- Medical and Scientific Affairs, Crescendo Bioscience Inc., South San Francisco, CA, USA
| | - Eric H Sasso
- Medical and Scientific Affairs, Crescendo Bioscience Inc., South San Francisco, CA, USA
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Yilmaz-Oner S, Ozen G, Can M, Atagunduz P, Direskeneli H, Inanc N. Biomarkers in Remission According to Different Criteria in Patients with Rheumatoid Arthritis. J Rheumatol 2015; 42:2066-70. [PMID: 26472417 DOI: 10.3899/jrheum.150478] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/28/2015] [Indexed: 01/16/2023]
Abstract
OBJECTIVE Remission is the primary aim in the treatment of patients with rheumatoid arthritis (RA). In this study, we aimed to evaluate biomarker profiles of patients in remission by different criteria and compare these profiles with controls. METHODS Serum levels of calprotectin, interleukin 6 (IL-6), type II collagen helical peptide, C-terminal crosslinking telopeptide of type I collagen generated by matrix metalloproteinases (ICTP), matrix metalloproteinase 3 (MMP-3), resistin, and leptin were measured by ELISA in 80 patients. The patients were in Disease Activity Score at 28 joints with erythrocyte sedimentation rate (DAS28-ESR) remission, and had these characteristics: female/male 54/26, mean age 51.4 ± 12.1 years, mean disease duration 11.4 ± 8.1 years, rheumatoid factor positivity 68.7% (n = 55), anticyclic citrullinated peptide positivity 60.7% (n = 48). These patients were also evaluated for the American College of Rheumatology/European League Against Rheumatism (Boolean) and Simple Disease Activity Index (SDAI) remissions. Additionally, 80 age-, sex-, and comorbidity-matched individuals without rheumatic diseases were included in the study as controls. RESULTS At recruitment of 80 patients in DAS28 remission, 33 patients (41.2%) were found in Boolean remission and 39 patients (48.7%) were in SDAI remission. Serum MMP-3, ICTP, resistin, and IL-6 levels of the 80 patients in DAS28 remission were statistically significantly higher than the controls. Patients in Boolean and SDAI remissions had significantly higher serum ICTP, resistin, and IL-6 levels in comparison with the controls. CONCLUSION The 3 commonly used remission criteria of RA are almost similar with regard to patients' biomarker levels. Biomarker profiles of patients may provide complementary information to clinical evaluation of remission and may help to determine the patients under the risk of progression.
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Affiliation(s)
- Sibel Yilmaz-Oner
- From the Department of Rheumatology, Medical Faculty, Marmara University, Istanbul, Turkey.S. Yilmaz-Oner, MD, Marmara University, Medical Faculty, Department of Rheumatology; G. Ozen, MD, Marmara University, Medical Faculty, Department of Rheumatology; M. Can, MD, Marmara University, Medical Faculty, Department of Rheumatology; P. Atagunduz, MD, Professor, Marmara University, Medical Faculty, Department of Rheumatology; H. Direskeneli, MD, Professor, Marmara University, Medical Faculty, Department of Rheumatology; N. Inanc, MD, Professor, Marmara University, Medical Faculty, Department of Rheumatology
| | - Gulsen Ozen
- From the Department of Rheumatology, Medical Faculty, Marmara University, Istanbul, Turkey.S. Yilmaz-Oner, MD, Marmara University, Medical Faculty, Department of Rheumatology; G. Ozen, MD, Marmara University, Medical Faculty, Department of Rheumatology; M. Can, MD, Marmara University, Medical Faculty, Department of Rheumatology; P. Atagunduz, MD, Professor, Marmara University, Medical Faculty, Department of Rheumatology; H. Direskeneli, MD, Professor, Marmara University, Medical Faculty, Department of Rheumatology; N. Inanc, MD, Professor, Marmara University, Medical Faculty, Department of Rheumatology
| | - Meryem Can
- From the Department of Rheumatology, Medical Faculty, Marmara University, Istanbul, Turkey.S. Yilmaz-Oner, MD, Marmara University, Medical Faculty, Department of Rheumatology; G. Ozen, MD, Marmara University, Medical Faculty, Department of Rheumatology; M. Can, MD, Marmara University, Medical Faculty, Department of Rheumatology; P. Atagunduz, MD, Professor, Marmara University, Medical Faculty, Department of Rheumatology; H. Direskeneli, MD, Professor, Marmara University, Medical Faculty, Department of Rheumatology; N. Inanc, MD, Professor, Marmara University, Medical Faculty, Department of Rheumatology
| | - Pamir Atagunduz
- From the Department of Rheumatology, Medical Faculty, Marmara University, Istanbul, Turkey.S. Yilmaz-Oner, MD, Marmara University, Medical Faculty, Department of Rheumatology; G. Ozen, MD, Marmara University, Medical Faculty, Department of Rheumatology; M. Can, MD, Marmara University, Medical Faculty, Department of Rheumatology; P. Atagunduz, MD, Professor, Marmara University, Medical Faculty, Department of Rheumatology; H. Direskeneli, MD, Professor, Marmara University, Medical Faculty, Department of Rheumatology; N. Inanc, MD, Professor, Marmara University, Medical Faculty, Department of Rheumatology
| | - Haner Direskeneli
- From the Department of Rheumatology, Medical Faculty, Marmara University, Istanbul, Turkey.S. Yilmaz-Oner, MD, Marmara University, Medical Faculty, Department of Rheumatology; G. Ozen, MD, Marmara University, Medical Faculty, Department of Rheumatology; M. Can, MD, Marmara University, Medical Faculty, Department of Rheumatology; P. Atagunduz, MD, Professor, Marmara University, Medical Faculty, Department of Rheumatology; H. Direskeneli, MD, Professor, Marmara University, Medical Faculty, Department of Rheumatology; N. Inanc, MD, Professor, Marmara University, Medical Faculty, Department of Rheumatology
| | - Nevsun Inanc
- From the Department of Rheumatology, Medical Faculty, Marmara University, Istanbul, Turkey.S. Yilmaz-Oner, MD, Marmara University, Medical Faculty, Department of Rheumatology; G. Ozen, MD, Marmara University, Medical Faculty, Department of Rheumatology; M. Can, MD, Marmara University, Medical Faculty, Department of Rheumatology; P. Atagunduz, MD, Professor, Marmara University, Medical Faculty, Department of Rheumatology; H. Direskeneli, MD, Professor, Marmara University, Medical Faculty, Department of Rheumatology; N. Inanc, MD, Professor, Marmara University, Medical Faculty, Department of Rheumatology.
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Mortada M, Abdul-Sattar A, Gossec L. Fatigue in Egyptian patients with rheumatic diseases: a qualitative study. Health Qual Life Outcomes 2015; 13:134. [PMID: 26297320 PMCID: PMC4546339 DOI: 10.1186/s12955-015-0304-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2014] [Accepted: 07/14/2015] [Indexed: 01/27/2023] Open
Abstract
OBJECTIVES Fatigue is frequent in rheumatic diseases. Fatigue expression and consequences may be modified by cultural differences. Our objective was to increase the understanding of the fatigue experience and characteristics among Egyptian, Muslim patients with rheumatic diseases. METHODS Prospective monocentric qualitative study based on conventional qualitative content analysis, inductive reasoning, grounded theory. Egyptian patients with rheumatoid arthritis (RA), fibromyalgia or axial spondyloarthritis (AxSpA) were asked about fatigue, its patterns, consequences and self-management. RESULTS Of the 60 patients interviewed, 20 patients had each disease (RA, fibromyalgia and AxSpA); median ages ranged from 34 to 40 years. Patients were mainly male (N = 40, 66%), had 3 to 7 years (mean) of disease duration and had moderate disease activity. Some aspects of the patients' experience of fatigue may be specific to the Egyptian and Muslim culture such as the description of fatigue as a physical more than a mental impact of the disease, the response to the effect of fatigue on sexual function and the gender specific (women more than men) limitation of social activities due to fatigue which was more obvious in our study than other previous studies. Other aspects of patients' experience of fatigue like overlap between the patients' perception of fatigue and pain and coping strategies were similar to the findings in previous studies. CONCLUSION This study gives insights regarding fatigue in rheumatic diseases in an Arabic and Muslim culture. Similarities and differences with previous studies were noted and should be taken into account when assessing these patients.
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Affiliation(s)
- Mohamed Mortada
- Rheumatology & Rehabilitation Department, Zagazig University, Faculty of Medicine, 28 Qawmeia street, Zagazig, Egypt.
| | - Amal Abdul-Sattar
- Rheumatology & Rehabilitation Department, Zagazig University, Faculty of Medicine, 28 Qawmeia street, Zagazig, Egypt.
| | - Laure Gossec
- Department of rheumatology, Sorbonne Universités, UPMC Univ Paris 06, Institut Pierre Louis d'Epidémiologie et de Santé Publique; AP-HP, Pitié Salpêtrière Hospital, F-75013, Paris, France.
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Fusama M, Miura Y, Yukioka K, Kuroiwa T, Yukioka C, Inoue M, Nakanishi T, Murata N, Takai N, Higashi K, Kuritani T, Maeda K, Sano H, Yukioka M, Nakahara H. Psychological state is related to the remission of the Boolean-based definition of patient global assessment in patients with rheumatoid arthritis. Mod Rheumatol 2015; 25:679-82. [DOI: 10.3109/14397595.2015.1008955] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Wolfe F, Walitt BT, Rasker JJ, Katz RS, Häuser W. The Use of Polysymptomatic Distress Categories in the Evaluation of Fibromyalgia (FM) and FM Severity. J Rheumatol 2015; 42:1494-501. [PMID: 26077414 DOI: 10.3899/jrheum.141519] [Citation(s) in RCA: 67] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/01/2015] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The polysymptomatic distress (PSD) scale is derived from variables used in the 2010 American College of Rheumatology (ACR) fibromyalgia (FM) criteria modified for survey and clinical research. The scale is useful in measuring the effect of PSD over the full range of pain-related clinical symptoms, not just in those who are FM criteria-positive. However, no PSD scale categories have been defined to distinguish severity of illness in FM or in those who do not satisfy the FM criteria. We analyzed the scale and multiple covariates to develop clinical categories and to further validate the scale. METHODS FM was diagnosed according to the research criteria modification of the 2010 ACR FM criteria. We investigated categories in a large database of patients with pain (2732 with rheumatoid arthritis) and developed categories by using germane clinic variables that had been previously studied for severity groupings. By definition, FM cannot be diagnosed unless PSD is at least 12. RESULTS Based on population categories, regression analysis, and inspections of curvilinear relationships, we established PSD severity categories of none (0-3), mild (4-7), moderate (8-11), severe (12-19), and very severe (20-31). Categories were statistically distinct, and a generally linear relationship between PSD categories and covariate severity was noted. CONCLUSION PSD categories are clinically relevant and demonstrate FM type symptoms over the full range of clinical illness. Although FM criteria can be clinically useful, there is no clear-cut symptom distinction between FM (+) and FM (-), and PSD categories can aid in more effectively classifying patients.
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Affiliation(s)
- Frederick Wolfe
- From the National Data Bank for Rheumatic Diseases, and University of Kansas School of Medicine, Wichita, Kansas; Rheumatology, Washington Hospital Center, Washington, DC; Rheumatology, Rush University Medical Center, Chicago, Illinois, USA; Faculty Behavioral Sciences, Department of Psychology, Health and Technology, University of Twente, Enschede, the Netherlands; Department of Psychosomatic Medicine and Psychotherapy, Technische Universität München, Munich, Germany.F. Wolfe, MD, National Data Bank for Rheumatic Diseases, and University of Kansas School of Medicine; B.T. Walitt, MD, Rheumatology, Washington Hospital Center; J.J. Rasker, MD, Faculty Behavioral Sciences, Department of Psychology, Health and Technology, University of Twente; R.S. Katz, MD, Rheumatology, Rush University Medical Center; W. Häuser, MD, Department of Psychosomatic Medicine and Psychotherapy, Technische Universität München.
| | - Brian T Walitt
- From the National Data Bank for Rheumatic Diseases, and University of Kansas School of Medicine, Wichita, Kansas; Rheumatology, Washington Hospital Center, Washington, DC; Rheumatology, Rush University Medical Center, Chicago, Illinois, USA; Faculty Behavioral Sciences, Department of Psychology, Health and Technology, University of Twente, Enschede, the Netherlands; Department of Psychosomatic Medicine and Psychotherapy, Technische Universität München, Munich, Germany.F. Wolfe, MD, National Data Bank for Rheumatic Diseases, and University of Kansas School of Medicine; B.T. Walitt, MD, Rheumatology, Washington Hospital Center; J.J. Rasker, MD, Faculty Behavioral Sciences, Department of Psychology, Health and Technology, University of Twente; R.S. Katz, MD, Rheumatology, Rush University Medical Center; W. Häuser, MD, Department of Psychosomatic Medicine and Psychotherapy, Technische Universität München
| | - Johannes J Rasker
- From the National Data Bank for Rheumatic Diseases, and University of Kansas School of Medicine, Wichita, Kansas; Rheumatology, Washington Hospital Center, Washington, DC; Rheumatology, Rush University Medical Center, Chicago, Illinois, USA; Faculty Behavioral Sciences, Department of Psychology, Health and Technology, University of Twente, Enschede, the Netherlands; Department of Psychosomatic Medicine and Psychotherapy, Technische Universität München, Munich, Germany.F. Wolfe, MD, National Data Bank for Rheumatic Diseases, and University of Kansas School of Medicine; B.T. Walitt, MD, Rheumatology, Washington Hospital Center; J.J. Rasker, MD, Faculty Behavioral Sciences, Department of Psychology, Health and Technology, University of Twente; R.S. Katz, MD, Rheumatology, Rush University Medical Center; W. Häuser, MD, Department of Psychosomatic Medicine and Psychotherapy, Technische Universität München
| | - Robert S Katz
- From the National Data Bank for Rheumatic Diseases, and University of Kansas School of Medicine, Wichita, Kansas; Rheumatology, Washington Hospital Center, Washington, DC; Rheumatology, Rush University Medical Center, Chicago, Illinois, USA; Faculty Behavioral Sciences, Department of Psychology, Health and Technology, University of Twente, Enschede, the Netherlands; Department of Psychosomatic Medicine and Psychotherapy, Technische Universität München, Munich, Germany.F. Wolfe, MD, National Data Bank for Rheumatic Diseases, and University of Kansas School of Medicine; B.T. Walitt, MD, Rheumatology, Washington Hospital Center; J.J. Rasker, MD, Faculty Behavioral Sciences, Department of Psychology, Health and Technology, University of Twente; R.S. Katz, MD, Rheumatology, Rush University Medical Center; W. Häuser, MD, Department of Psychosomatic Medicine and Psychotherapy, Technische Universität München
| | - Winfried Häuser
- From the National Data Bank for Rheumatic Diseases, and University of Kansas School of Medicine, Wichita, Kansas; Rheumatology, Washington Hospital Center, Washington, DC; Rheumatology, Rush University Medical Center, Chicago, Illinois, USA; Faculty Behavioral Sciences, Department of Psychology, Health and Technology, University of Twente, Enschede, the Netherlands; Department of Psychosomatic Medicine and Psychotherapy, Technische Universität München, Munich, Germany.F. Wolfe, MD, National Data Bank for Rheumatic Diseases, and University of Kansas School of Medicine; B.T. Walitt, MD, Rheumatology, Washington Hospital Center; J.J. Rasker, MD, Faculty Behavioral Sciences, Department of Psychology, Health and Technology, University of Twente; R.S. Katz, MD, Rheumatology, Rush University Medical Center; W. Häuser, MD, Department of Psychosomatic Medicine and Psychotherapy, Technische Universität München
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Abstract
Patient reported outcomes (PRO) are at the core of assessing RA treatment response with patient assessments of global health or disease activity, pain, and physical function included in the calculation of American College of Rheumatology (ACR) responses. Progress has been made in assessing PROs that include additional patient-valued aspects of disease in recent RA randomized clinical trials (RCTs), particularly fatigue. Importantly, the National Institute of Health (NIH)--Patient Reported Outcomes Measurement Information System (PROMIS) development of psychometrically advanced generic health measures that span the range of symptoms potentially affected in RA, with high precision across the entire range of a symptom are undergoing additional study in RA and other rheumatologic diseases to establish their construct validity, responsiveness, and clinically meaningful cutoffs. PRO measures that are currently used and widely available can provide important perspectives not captured in composite clinical response criteria with the potential of better informing treatment decisions in clinical practice.
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Affiliation(s)
- Ana-Maria Orbai
- Divisions of Rheumatology, Johns Hopkins University, Baltimore, MD, USA,
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