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Al-Homood IA, Al Ghanim N, Fatani MIA, Hussein AH, Alolaiwi AM, Abualiat A, Alqurtas E, Alomari BAA, Khardaly AM, Alenzi KAO, Albarakati RG, Almudaiheem HY, Al-Jedai A, Eshmawi MTY. The Saudi consensus recommendations for the management of psoriatic arthritis (2023). Clin Rheumatol 2024; 43:879-894. [PMID: 38217738 PMCID: PMC10876726 DOI: 10.1007/s10067-024-06867-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Revised: 12/25/2023] [Accepted: 01/02/2024] [Indexed: 01/15/2024]
Abstract
Psoriatic arthritis (PsA) is a complex inflammatory disease characterized by musculoskeletal and non-musculoskeletal manifestations. It is a distinct disease entity at the interface between rheumatology and dermatology, making it challenging to manage. The diverse clinical presentation and severity of PsA require a multidisciplinary approach for optimal care. Early diagnosis and management are necessary to improving quality of life for patients. In Saudi Arabia, there is currently no unified national consensus on the best practices for managing PsA. This lack of consensus leads to debate and uncertainty in the treatment of the disease, resulting in over or under prescribing of biological agents. To address this issue, a multidisciplinary work group was formed by the Saudi Ministry of Health. This group, consisting of dermatologists, rheumatologists, and pharmacists, aimed to develop evidence-based consensus recommendations for he use and monitoring of biological therapy in PsA management. The work group conducted five consensus workshops between December 2021 to March 2022. Using the nominal group technique, they discussed various aspects of PsA management, including eligibility criteria for biological treatment, monitoring of disease activity, treatment goals, screening, precautions, and management of PsA with biologic therapies. The group also considered special considerations for patients with comorbidities, pregnant and lactating women, as well as pediatric and adolescent populations. The resulting consensus document provides recommendations that are applicable to the Saudi setting, taking into account international guidelines and the specific needs of PsA patients in the country. The consensus document will be regularly updated to incorporate new data and therapeutic agents as they become available. Key Points • In Saudi Arabia, there is a lack of unified national consensus on the optimal management of PsA, therefore, this article aims to provide up-to-date evidence-based consensus recommendations for the optimal use and monitoring of biologic therapy in the management of PsA in Saudi Arabia. • The consensus development process was undertaken by a multidisciplinary work group of 13 experts, including two dermatologists, six rheumatologists, and five pharmacists. • There is more than one disease activity tool used in PsA disease, depending on the disease domain - peripheral arthritis Disease Activity Index in Psoriatic Arthritis (DAPSA) or Minimal Disease Activity (MDA), axial PsA Ankylosing Spondylitis Disease Activity Score (ASDAS), and dactylitis and enthesitis MDA. • The main goal of therapy in all patients with PsA is to achieve the target of remission, or alternatively, low disease activity in all disease domains and improve quality of life (QoL).
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Affiliation(s)
- Ibrahim Abdulrazag Al-Homood
- Medical Specialties Department, Rheumatology Section, King Fahad Medical City, Riyadh, Saudi Arabia.
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia.
| | - Nayef Al Ghanim
- Department of Internal Medicine, Rheumatology Unit, King Saud Medical City, Riyadh, Saudi Arabia
| | | | - Albader Hamza Hussein
- Department of Rheumatology, King Fahad General Hospital, Ministry of Health, Madinah, Saudi Arabia
| | - Abdulaziz Mohammed Alolaiwi
- Department of Rheumatology, King Saud Medical City, Riyadh, Saudi Arabia
- Deputyship of Therapeutic Affairs, Ministry of Health, Riyadh, Saudi Arabia
| | - Abdullah Abualiat
- Department of Dermatology and Venereology, Armed Forces Hospitals-Southern Region (AFHSR), Khamis Mushait, Saudi Arabia
| | - Eman Alqurtas
- Department of Medicine, College of Medicine, Rheumatology Unit, King Saud University, Riyadh, Saudi Arabia
| | | | | | | | - Rayan G Albarakati
- Department of Obstetrics and Gynecology, Majmaah University, Al-Majmaah, 11952, Saudi Arabia
| | | | - Ahmed Al-Jedai
- Deputyship of Therapeutic Affairs, Ministry of Health, Riyadh, Saudi Arabia
- College of Medicine and College of Pharmacy, Alfaisal University, Riyadh, Saudi Arabia
| | - Maysa Tariq Yousef Eshmawi
- Department of Dermatology, King Abdullah Medical Complex, Jeddah, Saudi Arabia
- College of Medicine, Imam Mohammad Ibn Saud Islamic University, Riyadh, Saudi Arabia
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Farrer C, Thib S, Eder L, Jerome D, Gakhal N. Use of Coordinator Role Improves Access to Rheumatologic Advanced Therapy. J Rheumatol 2024; 51:197-202. [PMID: 37914217 DOI: 10.3899/jrheum.2023-0402] [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] [Accepted: 09/29/2023] [Indexed: 11/03/2023]
Abstract
OBJECTIVE Delays in initiation of advanced therapies, which include biologics and targeted synthetic disease-modifying antirheumatic drugs, contribute to poor patient outcomes. The objective of this quality improvement project was to identify factors that lead to a delay in the initiation of advanced therapy and to perform plan-do-study-act cycles to decrease the time to start advanced therapy. METHODS A retrospective chart review identified factors involved in delay to start advanced therapy. The primary outcome of the study was the number of days to advanced therapy start as measured by the date of rheumatologist recommendation to the date advanced therapy was initiated by the patient. An Advanced Therapy Coordinator role was created to standardize the workflow, optimize communication, and ensure a safety checklist was instituted. RESULTS A total of 125 patients were reviewed for the study with 18 excluded. Preintervention median wait time was 82.0 (IQR 46.0-80.5) days. Median wait time during the intervention improved to 49.5 (IQR 34.0-69.5) days (April 2021 to January 2022), with nonrandom variation post intervention. Nonrandom variation was also noted in the latter baseline data (March 2020 to March 2021). CONCLUSION This study demonstrates improved wait time to advanced therapy initiation through the role of an Advanced Therapy Coordinator to facilitate communication pathways.
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Affiliation(s)
- Chandra Farrer
- C. Farrer, MSc, Department of Physical Therapy, University of Toronto;
| | | | - Lihi Eder
- L. Eder, MD, PhD, D. Jerome, MD, MEd, N. Gakhal, MD, MSc, Women's College Hospital, and Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Dana Jerome
- L. Eder, MD, PhD, D. Jerome, MD, MEd, N. Gakhal, MD, MSc, Women's College Hospital, and Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Natasha Gakhal
- L. Eder, MD, PhD, D. Jerome, MD, MEd, N. Gakhal, MD, MSc, Women's College Hospital, and Department of Medicine, University of Toronto, Toronto, Ontario, Canada
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Seo MR, Yeo J, Park JW, Lee YA, Lee JH, Kang EH, Ji SM, Kwon SR, Kim SK, Kim TJ, Kim TH, Kim HW, Park MC, Shin K, Lee SH, Lee EY, Cha HS, Shim SC, Yoon Y, Lee SH, Lim JH, Baek HJ. Korean treatment recommendations for patients with axial spondyloarthritis. Korean J Intern Med 2023; 38:620-640. [PMID: 37482652 PMCID: PMC10493447 DOI: 10.3904/kjim.2023.194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 06/13/2023] [Accepted: 06/16/2023] [Indexed: 07/25/2023] Open
Abstract
We aimed to develop evidence-based recommendations for treating axial spondylarthritis (axSpA) in Korea. The development committee was constructed, key clinical questions were determined, and the evidence was searched through online databases including MEDLINE, Embase, Cochrane, KoreaMed, and Kmbase. Systematic literature reviews were conducted, quality of evidence was determined, and draft recommendations were formulated according to the Grading of Recommendations Assessment, Development, and Evaluations methodology. Recommendations that reached 80% consensus among a voting panel were finalized. Three principles and 21 recommendations were determined. Recommendations 1 and 2 pertain to treatment strategies, regular disease status assessment, and rheumatologist-steered multidisciplinary management. Recommendations 3 and 4 strongly recommend patient education, exercise, and smoking cessation. Recommendations 5-12 address pharmacological treatment of active disease using nonsteroidal anti-inflammatory drugs, glucocorticoids, sulfasalazine, biologics, and Janus kinase inhibitors. Recommendations 13-16 address treatment in stable disease. We suggest against spa and acupuncture as therapies (Recommendation 17). Recommendations 18 and 19 pertain to total hip arthroplasty and spinal surgery. Monitoring of comorbidities and drug toxicities are recommended (Recommendations 20 and 21). Recommendations for axSpA treatment in a Korean context were developed based on comprehensive clinical questions and evidence. These are intended to guide best practice in the treatment of axSpA.
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Affiliation(s)
- Mi Ryoung Seo
- Division of Rheumatology, Department of Internal Medicine, Gil Medical Center, Gachon University College of Medicine, Incheon,
Korea
| | - Jina Yeo
- Division of Rheumatology, Department of Internal Medicine, Gil Medical Center, Gachon University College of Medicine, Incheon,
Korea
| | - Jun Won Park
- Division of Rheumatology, Department of Internal Medicine, Seoul National University College of Medicine, Seoul,
Korea
| | - Yeon-Ah Lee
- Division of Rheumatology, Department of Internal Medicine, Kyung Hee University College of Medicine, Seoul,
Korea
| | - Ju Ho Lee
- Division of Rheumatology, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam,
Korea
| | - Eun Ha Kang
- Division of Rheumatology, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam,
Korea
| | - Seon Mi Ji
- National Health Insurance Service, Wonju,
Korea
| | - Seong-Ryul Kwon
- Division of Rheumatology, Department of Internal Medicine, Inha University College of Medicine. Incheon,
Korea
| | - Seong-Kyu Kim
- Division of Rheumatology, Department of Internal Medicine, Daegu Catholic University School of Medicine, Daegu,
Korea
| | - Tae-Jong Kim
- Division of Rheumatology, Department of Internal Medicine, Chonnam National University Medical School and Hospital, Gwangju,
Korea
| | - Tae-Hwan Kim
- Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul,
Korea
| | - Hye Won Kim
- Division of General Internal Medicine, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam,
Korea
| | - Min-Chan Park
- Division of Rheumatology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul,
Korea
| | - Kichul Shin
- Division of Rheumatology, Department of Internal Medicine, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul,
Korea
| | - Sang-Hoon Lee
- Department of Rheumatology, Kyung Hee University Hospital at Gangdong, Kyung Hee University College of Medicine, Seoul,
Korea
| | - Eun Young Lee
- Division of Rheumatology, Department of Internal Medicine, Seoul National University College of Medicine, Seoul,
Korea
| | - Hoon Suk Cha
- Division of Rheumatology, Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul,
Korea
| | - Seung Cheol Shim
- Division of Rheumatology, Daejeon Rheumatoid & Degenerative Arthritis Center, Chungnam National University Hospital. Daejeon,
Korea
| | - Youngim Yoon
- Division of Rheumatology, Department of Internal Medicine, Seoul National University College of Medicine, Seoul,
Korea
| | - Seung Ho Lee
- Korea Ankylosing Spondylitis Society, Seoul,
Korea
| | - Jun Hong Lim
- Korea Ankylosing Spondylitis Corporation, Daejeon,
Korea
| | - Han Joo Baek
- Division of Rheumatology, Department of Internal Medicine, Gil Medical Center, Gachon University College of Medicine, Incheon,
Korea
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Seo MR, Yeo J, Park JW, Lee YA, Lee JH, Kang EH, Ji SM, Kwon SR, Kim SK, Kim TJ, Kim TH, Kim HW, Park MC, Shin K, Lee SH, Lee EY, Cha HS, Shim SC, Yoon Y, Lee SH, Lim JH, Baek HJ. Korean treatment recommendations for patients with axial spondyloarthritis. JOURNAL OF RHEUMATIC DISEASES 2023; 30:151-169. [PMID: 37476674 PMCID: PMC10351367 DOI: 10.4078/jrd.2023.0025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 06/13/2023] [Accepted: 06/15/2023] [Indexed: 07/22/2023]
Abstract
We aimed to develop evidence-based recommendations for treating axial spondylarthritis (axSpA) in Korea. The development committee was constructed, key clinical questions were determined, and the evidence was searched through online databases including MEDLINE, Embase, Cochrane, KoreaMed, and KMbase. Systematic literature reviews were conducted, quality of evidence was determined, and draft recommendations were formulated according to the Grading of Recommendations Assessment, Development, and Evaluations methodology. Recommendations that reached 80% consensus among a voting panel were finalized. Three principles and 21 recommendations were determined. Recommendations 1 and 2 pertain to treatment strategies, regular disease status assessment, and rheumatologist-steered multidisciplinary management. Recommendations 3 and 4 strongly recommend patient education, exercise, and smoking cessation. Recommendations 5~12 address pharmacological treatment of active disease using nonsteroidal anti-inflammatory drugs, glucocorticoids, sulfasalazine, biologics, and Janus kinase inhibitors. Recommendations 13~16 address treatment in stable disease. We suggest against spa and acupuncture as therapies (Recommendation 17). Recommendations 18 and 19 pertain to total hip arthroplasty and spinal surgery. Monitoring of comorbidities and drug toxicities are recommended (Recommendations 20 and 21). Recommendations for axSpA treatment in a Korean context were developed based on comprehensive clinical questions and evidence. These are intended to guide best practice in the treatment of axSpA.
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Affiliation(s)
- Mi Ryoung Seo
- Division of Rheumatology, Department of Internal Medicine, Gil Medical Center, Gachon University College of Medicine, Incheon, Korea
| | - Jina Yeo
- Division of Rheumatology, Department of Internal Medicine, Gil Medical Center, Gachon University College of Medicine, Incheon, Korea
| | - Jun Won Park
- Division of Rheumatology, Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Yeon-Ah Lee
- Division of Rheumatology, Department of Internal Medicine, Kyung Hee University College of Medicine, Seoul, Korea
| | - Ju Ho Lee
- Division of Rheumatology, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Eun Ha Kang
- Division of Rheumatology, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Seon Mi Ji
- National Health Insurance Service, Wonju, Korea
| | - Seong-Ryul Kwon
- Division of Rheumatology, Department of Internal Medicine, Inha University College of Medicine, Incheon, Korea
| | - Seong-Kyu Kim
- Division of Rheumatology, Department of Internal Medicine, Daegu Catholic University School of Medicine, Daegu, Korea
| | - Tae-Jong Kim
- Division of Rheumatology, Department of Internal Medicine, Chonnam National University Medical School and Hospital, Gwangju, Korea
| | - Tae-Hwan Kim
- Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, Korea
| | - Hye Won Kim
- Division of General Internal Medicine, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Min-Chan Park
- Division of Rheumatology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Kichul Shin
- Division of Rheumatology, Department of Internal Medicine, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Korea
| | - Sang-Hoon Lee
- Department of Rheumatology, Kyung Hee University Hospital at Gangdong, Kyung Hee University College of Medicine, Seoul, Korea
| | - Eun Young Lee
- Division of Rheumatology, Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Hoon Suk Cha
- Division of Rheumatology, Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Seung Cheol Shim
- Division of Rheumatology, Daejeon Rheumatoid & Degenerative Arthritis Center, Chungnam National University Hospital, Daejeon, Korea
| | - Youngim Yoon
- Division of Rheumatology, Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Seung Ho Lee
- Korea Ankylosing Spondylitis Society, Seoul, Korea
| | - Jun Hong Lim
- Korea Ankylosing Spondylitis Corporation, Daejeon, Korea
| | - Han Joo Baek
- Division of Rheumatology, Department of Internal Medicine, Gil Medical Center, Gachon University College of Medicine, Incheon, Korea
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Inman RD, Choquette D, Khraishi M, Gladman DD, Hussein S, Neish D, Leclerc P. Real-World Retention and Clinical Effectiveness of Secukinumab for Axial Spondyloarthritis: Results From the Canadian Spondyloarthritis Research Network. J Rheumatol 2023; 50:634-640. [PMID: 36642434 DOI: 10.3899/jrheum.220824] [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] [Accepted: 11/17/2022] [Indexed: 01/16/2023]
Abstract
OBJECTIVE Axial spondyloarthritis (axSpA) is a chronic, immune-mediated, inflammatory condition consisting of 2 clinical subsets: nonradiographic axSpA and ankylosing spondylitis, the latter having an estimated prevalence of 0.2% to 1% in Canada. Secukinumab (SEC) received Health Canada approval in 2016 for the treatment of adults with axSpA who have responded inadequately to conventional treatment, and has demonstrated efficacy and safety through extensive clinical trials. However, there is limited evidence on its real-world use in Canada. The objective of this study was to use the Canadian Spondyloarthritis (CanSpA) Research Network to describe real-world retention and effectiveness of SEC in the Canadian axSpA population. METHODS This was an observational cohort study of Canadian patients with axSpA aged 18 to 65 years within the CanSpA network who had received treatment with SEC. Patients were indexed on the first date of SEC initiation. Retention and clinical effectiveness were assessed at 12 months postindex. Clinical effectiveness was measured as the proportion in remission and change in disease activity using multiple clinical indices. RESULTS A total of 146 patients were included. Overall retention was estimated at 62.9%. Low disease activity (ie, Bath Ankylosing Spondylitis Disease Activity Index < 4) was achieved in 29.2% of patients, and 2% had achieved remission based on the Ankylosing Spondylitis Disease Activity Score. Bath Ankylosing Spondylitis Metrology Index scores improved by more than 60% from baseline to 12 months. CONCLUSION The results of this real-world study of Canadian patients with axSpA, one of the first of its kind, support the effectiveness of SEC for treatment of axSpA. The CanSpA network presents an opportunity to continue building and improving the real-world evidence base for treatment of Canadian patients with spondyloarthritis.
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Affiliation(s)
- Robert D Inman
- R.D. Inman, MD, D.D. Gladman, MD, Schroeder Arthritis Institute, Krembil Research Institute, University Health Network, University of Toronto, Toronto, Ontario;
| | - Denis Choquette
- D. Choquette, MD, Institut de recherche en rhumatologie de Montréal, CHUM, Montréal, Quebec
| | - Majed Khraishi
- M. Khraishi, MD, Nexus Clinical Research, Memorial University of Newfoundland, St. John's, Newfoundland
| | - Dafna D Gladman
- R.D. Inman, MD, D.D. Gladman, MD, Schroeder Arthritis Institute, Krembil Research Institute, University Health Network, University of Toronto, Toronto, Ontario
| | - Shamiza Hussein
- S. Hussein, MSc, P. Leclerc, PhD, Novartis Pharmaceuticals Canada Inc., Dorval, Quebec
| | - Drew Neish
- D. Neish, MSc, IQVIA Canada, Kirkland, Quebec, Canada
| | - Patrick Leclerc
- S. Hussein, MSc, P. Leclerc, PhD, Novartis Pharmaceuticals Canada Inc., Dorval, Quebec
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Usage and Adherence of Seven Advanced Therapies with Differing Mechanisms of Action for Inflammatory Arthritis in Canada. Rheumatol Ther 2022; 9:1399-1420. [PMID: 36045308 PMCID: PMC9510085 DOI: 10.1007/s40744-022-00485-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 08/14/2022] [Indexed: 11/20/2022] Open
Abstract
Introduction This retrospective, observational study aimed to analyze and assess adherence, persistence, dosing, and use of concomitant medications of seven self-administered target drugs (abatacept, golimumab, secukinumab, tocilizumab, ustekinumab, apremilast, and tofacitinib) that are currently available in Canada for the treatment of inflammatory arthritis (IA). Methods We used IQVIA’s longitudinal claims databases, which include private drug plans and public plans. Patients with IA identified using a proprietary indication algorithm who initiated treatment with any of the target drugs between January 2015 and February 2019 were selected and followed for 12 months. Results Golimumab and apremilast had the highest proportion of patients (~ 75%) who were bio-naïve and secukinumab had the fewest bio-naïve patients (~ 43%). The oral therapies, apremilast and tofacitinib, had the lowest percentage of adherent patients (73% and 71%) followed by abatacept (83%), while the remaining drugs had adherence around 90%. Secukinumab and tofacitinib had the highest 12-month persistence rate (63% and 61%), while abatacept and apremilast had the lowest persistence rate (52% and 47%). Oral corticosteroid (OCS) use was not significantly associated with adherence. Tocilizumab, secukinumab, and ustekinumab had the highest proportion of patients (> 20%) with dose escalation at 3–4 months from index. OCS and conventional disease-modifying antirheumatic drugs (cDMARD) use decreased in post-index period across all target drugs. Conclusion This study identified substantial differences in patient baseline characteristics. Patients on injectable biologics were more likely to be adherent compared with those on oral drugs, possibly owing to longer dosing intervals. Other outcomes at 12 months appeared similar as evidenced by tapering of concomitant medications, although differences in persistence and dose escalation were noted.
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Investigation into the wait time for consultation in the psoriatic arthritis program. Clin Rheumatol 2022; 41:3753-3757. [DOI: 10.1007/s10067-022-06288-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 07/07/2022] [Accepted: 07/07/2022] [Indexed: 11/25/2022]
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Dhir V, Mishra D, Samanta J. Glucocorticoids in spondyloarthritis-systematic review and real-world analysis. Rheumatology (Oxford) 2021; 60:4463-4475. [PMID: 33748829 DOI: 10.1093/rheumatology/keab275] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 02/20/2021] [Accepted: 03/10/2021] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVE The objective of this study was to identify and summarize the efficacy and safety of systemic glucocorticoids (GCs) and local injections of GC in SpA. METHODS PubMed (Medline) and EMBASE were searched with pre-defined keywords for relevant articles in English reporting randomized controlled trials (RCTs), non-randomized interventional studies and non-randomized observational studies of the efficacy of GC in SpA, with five or more patients, for inclusion in a systematic literature review. Local injections of GC included IA and entheseal injections, but excluded SI joint injections. RESULTS Out of 9657 records identified, there were 14 studies on the use of systemic GCs in SpA (364 patients), including two RCTs of oral prednisolone. On pooling data from two placebo-controlled RCTs (≤24 weeks), BASDAI 50 was 4.2 times more likely (95% CI: 1.5, 11.5) and Ankylosing Spondylitis Assessment Group (ASAS) 20 was twice more likely (95% CI: 1.1, 3.64) to occur in patients on high-dose oral prednisolone (± taper). Pulsed GCs led to dramatic improvements that lasted a few weeks to a few months. There were no deaths or major adverse events. There were 10 studies (560 patients) on local GCs in SpA. IA injection was effective in achieving a sustained response in 51.5-90% of joints at 6 months. Entheseal injections led to reduced pain and improved US parameters. CONCLUSION There were limited studies on either systemic or local injections of GCs in SpA. However, there was good evidence of efficacy with the use of high-dose systemic GCs in the short term (≤6 months) in SpA. Both IA and entheseal injections seemed safe and effective.
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Affiliation(s)
- Varun Dhir
- Division of Rheumatology and Clinical Immunology, Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Debasish Mishra
- Division of Rheumatology and Clinical Immunology, Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Joydeep Samanta
- Division of Rheumatology and Clinical Immunology, Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Beckers E, Been M, Webers C, Boonen A, Ten Klooster PM, Vonkeman HE, van Tubergen A. Performance of three composite measures for disease activity in peripheral spondyloarthritis. J Rheumatol 2021; 49:256-264. [PMID: 34470791 DOI: 10.3899/jrheum.210075] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/13/2021] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To investigate concurrent validity and discrimination of the Disease Activity Psoriatic Arthritis score (DAPSA), Psoriatic Arthritis Disease Activity Score (PASDAS) and Ankylosing Spondylitis Disease Activity Score (ASDAS) in peripheral spondyloarthritis (pSpA) in clinical practice. METHODS Data from a Dutch registry for SpA (SpA-Net) were used. Predefined hypotheses on concurrent validity of the composite measures with 15 other outcome measures of disease activity, physical function and health-related quality of life were tested. Concurrent validity was considered acceptable if ≥75% of the hypotheses were confirmed. Discrimination was assessed by stratifying patients in DAPSA, PASDAS and ASDAS predefined disease activity states and studying mean differences in health outcomes by one-way ANOVA. Furthermore, the concordance in disease activity states was determined. All analyses were repeated in subgroups with and without psoriasis. RESULTS DAPSA, PASDAS and ASDAS scores were available for 191, 139 and 279 patients with pSpA, respectively. The concurrent validity and discrimination of all composite measures were acceptable as the strength of correlations were as hypothesized in ≥75% of the studied correlations. With increasing disease activity states, scores in nearly all outcome measures worsened significantly. The DAPSA, PASDAS and ASDAS classified 22%, 56% and 48% of the patients, respectively, in the two highest disease activity states. Stratified analyses for concomitant psoriasis revealed no relevant subgroup differences. CONCLUSION The performance of DAPSA, PASDAS and ASDAS in pSpA was acceptable, and independent of concomitant psoriasis. Due to discrepancy in classification, the validity of existing thresholds for disease activity states warrants further study in pSpA.
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Affiliation(s)
- Esther Beckers
- Department of Medicine, Division of Rheumatology, Maastricht University Medical Center, Maastricht, the Netherlands; Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, the Netherlands; Department of Psychology, Health & Technology, University of Twente, Enschede, the Netherlands; Department of Rheumatology, Medisch Spectrum Twente, Enschede, the Netherlands. The authors declare that they have no conflict of interest. Funding declaration: SpA-Net was financially supported by grants from The Netherlands Organisation for Health Research and Development (ZonMw; project number 836042001) and Dutch Arthritis Society, and was additionally sponsored by Abbvie, Biogen, Celgene, Janssen-Cilag, MSD, Novartis, Pfizer and UCB. Data availability statement: The data underlying this article will be shared on reasonable request to the corresponding author. Address correspondence to Esther Beckers, Department of Internal Medicine, Division of Rheumatology, Maastricht University Medical Center, P Debyelaan 25, 6229 HX, Maastricht, The Netherlands.
| | - Marin Been
- Department of Medicine, Division of Rheumatology, Maastricht University Medical Center, Maastricht, the Netherlands; Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, the Netherlands; Department of Psychology, Health & Technology, University of Twente, Enschede, the Netherlands; Department of Rheumatology, Medisch Spectrum Twente, Enschede, the Netherlands. The authors declare that they have no conflict of interest. Funding declaration: SpA-Net was financially supported by grants from The Netherlands Organisation for Health Research and Development (ZonMw; project number 836042001) and Dutch Arthritis Society, and was additionally sponsored by Abbvie, Biogen, Celgene, Janssen-Cilag, MSD, Novartis, Pfizer and UCB. Data availability statement: The data underlying this article will be shared on reasonable request to the corresponding author. Address correspondence to Esther Beckers, Department of Internal Medicine, Division of Rheumatology, Maastricht University Medical Center, P Debyelaan 25, 6229 HX, Maastricht, The Netherlands.
| | - Casper Webers
- Department of Medicine, Division of Rheumatology, Maastricht University Medical Center, Maastricht, the Netherlands; Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, the Netherlands; Department of Psychology, Health & Technology, University of Twente, Enschede, the Netherlands; Department of Rheumatology, Medisch Spectrum Twente, Enschede, the Netherlands. The authors declare that they have no conflict of interest. Funding declaration: SpA-Net was financially supported by grants from The Netherlands Organisation for Health Research and Development (ZonMw; project number 836042001) and Dutch Arthritis Society, and was additionally sponsored by Abbvie, Biogen, Celgene, Janssen-Cilag, MSD, Novartis, Pfizer and UCB. Data availability statement: The data underlying this article will be shared on reasonable request to the corresponding author. Address correspondence to Esther Beckers, Department of Internal Medicine, Division of Rheumatology, Maastricht University Medical Center, P Debyelaan 25, 6229 HX, Maastricht, The Netherlands.
| | - Annelies Boonen
- Department of Medicine, Division of Rheumatology, Maastricht University Medical Center, Maastricht, the Netherlands; Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, the Netherlands; Department of Psychology, Health & Technology, University of Twente, Enschede, the Netherlands; Department of Rheumatology, Medisch Spectrum Twente, Enschede, the Netherlands. The authors declare that they have no conflict of interest. Funding declaration: SpA-Net was financially supported by grants from The Netherlands Organisation for Health Research and Development (ZonMw; project number 836042001) and Dutch Arthritis Society, and was additionally sponsored by Abbvie, Biogen, Celgene, Janssen-Cilag, MSD, Novartis, Pfizer and UCB. Data availability statement: The data underlying this article will be shared on reasonable request to the corresponding author. Address correspondence to Esther Beckers, Department of Internal Medicine, Division of Rheumatology, Maastricht University Medical Center, P Debyelaan 25, 6229 HX, Maastricht, The Netherlands.
| | - Peter M Ten Klooster
- Department of Medicine, Division of Rheumatology, Maastricht University Medical Center, Maastricht, the Netherlands; Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, the Netherlands; Department of Psychology, Health & Technology, University of Twente, Enschede, the Netherlands; Department of Rheumatology, Medisch Spectrum Twente, Enschede, the Netherlands. The authors declare that they have no conflict of interest. Funding declaration: SpA-Net was financially supported by grants from The Netherlands Organisation for Health Research and Development (ZonMw; project number 836042001) and Dutch Arthritis Society, and was additionally sponsored by Abbvie, Biogen, Celgene, Janssen-Cilag, MSD, Novartis, Pfizer and UCB. Data availability statement: The data underlying this article will be shared on reasonable request to the corresponding author. Address correspondence to Esther Beckers, Department of Internal Medicine, Division of Rheumatology, Maastricht University Medical Center, P Debyelaan 25, 6229 HX, Maastricht, The Netherlands.
| | - Harald E Vonkeman
- Department of Medicine, Division of Rheumatology, Maastricht University Medical Center, Maastricht, the Netherlands; Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, the Netherlands; Department of Psychology, Health & Technology, University of Twente, Enschede, the Netherlands; Department of Rheumatology, Medisch Spectrum Twente, Enschede, the Netherlands. The authors declare that they have no conflict of interest. Funding declaration: SpA-Net was financially supported by grants from The Netherlands Organisation for Health Research and Development (ZonMw; project number 836042001) and Dutch Arthritis Society, and was additionally sponsored by Abbvie, Biogen, Celgene, Janssen-Cilag, MSD, Novartis, Pfizer and UCB. Data availability statement: The data underlying this article will be shared on reasonable request to the corresponding author. Address correspondence to Esther Beckers, Department of Internal Medicine, Division of Rheumatology, Maastricht University Medical Center, P Debyelaan 25, 6229 HX, Maastricht, The Netherlands.
| | - Astrid van Tubergen
- Department of Medicine, Division of Rheumatology, Maastricht University Medical Center, Maastricht, the Netherlands; Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, the Netherlands; Department of Psychology, Health & Technology, University of Twente, Enschede, the Netherlands; Department of Rheumatology, Medisch Spectrum Twente, Enschede, the Netherlands. The authors declare that they have no conflict of interest. Funding declaration: SpA-Net was financially supported by grants from The Netherlands Organisation for Health Research and Development (ZonMw; project number 836042001) and Dutch Arthritis Society, and was additionally sponsored by Abbvie, Biogen, Celgene, Janssen-Cilag, MSD, Novartis, Pfizer and UCB. Data availability statement: The data underlying this article will be shared on reasonable request to the corresponding author. Address correspondence to Esther Beckers, Department of Internal Medicine, Division of Rheumatology, Maastricht University Medical Center, P Debyelaan 25, 6229 HX, Maastricht, The Netherlands.
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10
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Reyes-Cordero G, Enríquez-Sosa F, Gomez-Ruiz C, Gonzalez-Diaz V, Castillo-Ortiz JD, Duran-Barragán S, Duran-Ortiz JS, Espinosa-Morales R, Gamez-Nava JI, Gonzalez-Lopez L, Julian-Martínez B, Mendoza-Fuentes A, Ramos-Remus C, Pacheco-Tena C, Burgos-Vargas R. Recommendations of the Mexican College of Rheumatology for the Management of Spondyloarthritis. REUMATOLOGIA CLINICA 2021; 17:37-45. [PMID: 31285162 DOI: 10.1016/j.reuma.2019.03.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Accepted: 03/31/2019] [Indexed: 06/09/2023]
Abstract
OBJECTIVES To update the recommendations for the management of patients with Spondyloarthritis (SpA) in the Mexican population, and identify which variables could influence patient management. MATERIAL AND METHODS A group of 15 experts in SpA translated, analyzed and modified the recommendations of the Mexican College of Rheumatology (CMR) and the International Society for the Assessment of Spondyloarthritis (ASAS)/European League Against Rheumatism (EULAR) 2016 group through a systematic review of the literature by two external reviewers during the period from 2015 to 2018 using the grade of recommendation, Oxford levels of evidence, percentage of concordance (Delphi). RESULTS Compared to previous recommendations, there were no significant changes from the year 2015. However, we modified the five fundamental principles and reduced the number of recommendations to ten by incorporating the first item in the text and combining five recommendations into two and adding a further recommendation. We confirmed the tendency to use glucocorticoids for patients with inflammatory activity and scarce access to biologicals. We identified the sociodemographic and clinical characteristics of patients with SpA and their influence on the application of the recommendations. CONCLUSIONS The ten recommendations of the CMR and the analysis of the characteristics of the Mexican patients with SpA focussed on step therapy, including pharmacological and non-pharmacological therapies, in a spectrum from easily accessible to high-tech substances available to a small percentage of the population.
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Affiliation(s)
- Greta Reyes-Cordero
- Hospital Ángeles Chihuahua, Facultad de Medicina y Ciencias Biomédicas, Universidad Autónoma de Chihuahua, Chihuahua, México
| | - Favio Enríquez-Sosa
- Hospital Regional «General Ignacio Zaragoza», ISSSTE, Ciudad de México, México
| | | | - Verónica Gonzalez-Diaz
- Antiguo Hospital Civil de Guadalajara «Fray Antonio Alcalde», Guadalajara, Jalisco, México
| | | | - Sergio Duran-Barragán
- Clínica de Investigación en Reumatología y Obesidad S.C. Instituto de Investigación en Reumatología y del Sistema Musculoesquelético, Departamento de Clínicas Médicas, Universidad de Guadalajara, Guadalajara, Jalisco, México
| | - J Santos Duran-Ortiz
- Servicio de Reumatología, Hospital General de Zona N.(o) 1, Instituto Mexicano del Seguro Social, Tepic, Nayarit, México
| | - Rolando Espinosa-Morales
- Servicio de Reumatología, Instituto Nacional de Rehabilitación Luis Guillermo Ibarra Ibarra, Ciudad de México, México
| | - Jorge I Gamez-Nava
- Unidad de Investigación Biomédica 02, UMAE, Hospital de Especialidades Centro Médico Nacional de Occidente, IMSS, Guadalajara, Jalisco, México; Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara, Jalisco, México
| | - Laura Gonzalez-Lopez
- Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara, Jalisco, México
| | - Bernardo Julian-Martínez
- Servicio de Reumatología, Hospital General de Zona N.(o) 1, Instituto Mexicano del Seguro Social Delegación Hidalgo, Pachuca, Hidalgo, México
| | | | - Cesar Ramos-Remus
- Unidad de Investigación en Enfermedades Crónico-Degenerativas, Guadalajara, Jalisco, México
| | - Cesar Pacheco-Tena
- Facultad de Medicina y Ciencias Biomédicas, Universidad Autónoma de Chihuahua, Chihuahua, México
| | - Ruben Burgos-Vargas
- Hospital General de México «Dr. Eduardo Liceaga», Universidad Nacional Autónoma de México, Ciudad de México, México.
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11
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Feld J, Ye JY, Chandran V, Inman RD, Haroon N, Cook R, Gladman DD. Is axial psoriatic arthritis distinct from ankylosing spondylitis with and without concomitant psoriasis? Rheumatology (Oxford) 2020; 59:1340-1346. [PMID: 31593590 DOI: 10.1093/rheumatology/kez457] [Citation(s) in RCA: 72] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Revised: 09/02/2019] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVE The aim of this study was to compare patients with ankylosing spondylitis with psoriasis (ASP) and without psoriasis (AS), to axial PsA (axPsA) patients. METHODS Two adult cohorts were recruited from the AS clinic: ASP and AS. These two cohorts were compared with two adult cohorts recruited from the PsA clinic: axPsA (radiographic sacroiliitis: ⩾bilateral grade 2 or unilateral grade 3 or 4); and Peripheral PsA. All patients were followed prospectively according to the same protocol. The demographic, clinical and radiographic variables were compared. Adjusted means were used to account for varying intervals between visits. A logistic regression was performed and adjusted for follow-up duration. RESULTS There were 477 axPsA patients, 826 peripheral PsA, 675 AS and 91 ASP patients included. AS patients were younger (P < 0.001), more male and HLA-B*27 positive (76%, 72% vs 64%, P ⩽ 0.001, 82%, 75%, vs 19%, P = 0.001). They had more back pain at presentation (90%, 92% vs 19%, P = 0.001), worse axial disease activity scores (bath ankylosing spondylitis disease activity index: 4.1, 3.9 vs 3.5 P = 0.017), worse back metrology (bath ankylosing spondylitis metrology index: 2.9, 2.2 vs 1.8, P < 0.001), worse physician global assessments (2.4, 2.2 vs 2.1, P < 0.001), were treated more with biologics (29%, 21% vs 7%, P = 0.001) and had a higher grade of sacroiliitis (90%, 84% vs 51%, P < 0.001). Similar differences were detected in the comparison of ASP to axPsA and in a regression model. CONCLUSION AS patients, with or without psoriasis, seem to be different demographically, genetically, clinically and radiographically from axPsA patients. axPsA seems to be a distinct entity.
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Affiliation(s)
- Joy Feld
- Krembil Research Institute, Toronto Western Hospital, University Health Network.,Institute of Medical Science, University of Toronto, Toronto
| | - Justine Yang Ye
- Krembil Research Institute, Toronto Western Hospital, University Health Network
| | - Vinod Chandran
- Krembil Research Institute, Toronto Western Hospital, University Health Network.,Institute of Medical Science, University of Toronto, Toronto.,Division of Rheumatology, Department of Medicine, University of Toronto, Toronto.,Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto
| | - Robert D Inman
- Krembil Research Institute, Toronto Western Hospital, University Health Network.,Institute of Medical Science, University of Toronto, Toronto.,Department of Immunology, Medical Sciences Building, University of Toronto, Toronto
| | - Nigil Haroon
- Krembil Research Institute, Toronto Western Hospital, University Health Network.,Institute of Medical Science, University of Toronto, Toronto.,Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto
| | - Richard Cook
- Department of Statistics and Actuarial Science, University of Waterloo, Waterloo, ON, Canada
| | - Dafna D Gladman
- Krembil Research Institute, Toronto Western Hospital, University Health Network.,Institute of Medical Science, University of Toronto, Toronto.,Division of Rheumatology, Department of Medicine, University of Toronto, Toronto
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12
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Ali Y, Abutiban F, Alawadhi A, AlDei A, Alenizi A, Alhajeri H, Al-Herz A, Alkandari W, Dehrab A, Hasan E, Hayat S, Ghanem A, Saleh K, Baraliakos X. Recommendation for the Management of Spondyloarthritis Patients in Kuwait. Open Access Rheumatol 2020; 12:147-165. [PMID: 32903931 PMCID: PMC7445633 DOI: 10.2147/oarrr.s246246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Accepted: 05/29/2020] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE In 2016, ASAS and EULAR made joint recommendations for the management of patients with spondyloarthritis. Although Global and European perspectives are important, they cannot accurately reflect the situation for all patients in all countries and regions. As such, the group worked to tailor the existing international recommendations to suit the specific demographic needs of local populations in the Gulf region, with a specific focus on Kuwait. METHODS Recommendations drafted following a PubMed search for relevant literature were reviewed and then underwent Delphi vote to reach consensus on those to be included. Advice for newly approved agents, including targeted synthetic disease-modifying anti-rheumatic drugs, was included based on the group's clinical experience. RESULTS The resulting 41 recommendations are grouped into five categories covering key definitions and principles for the management and treatment of both axial and peripheral forms of spondyloarthritis. CONCLUSION Through adaptation of existing guidelines and incorporating the current evidence and clinical experience of the members of the group, these recommendations have been developed to reflect the unique situation in Kuwait with regard to differing patient profiles, local culture and approved therapeutic approaches, and are designed to aid in clinical decision-making.
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Affiliation(s)
- Yaser Ali
- Mubarak Al-Kabeer Hospital, Jabriya, Kuwait
| | | | - Adel Alawadhi
- Faculty of Medicine, Kuwait University, Kuwait City, Kuwait
| | - Ali AlDei
- Al-Amiri Hospital, Kuwait City, Kuwait
| | | | | | | | | | | | - Eman Hasan
- Faculty of Medicine, Kuwait University, Kuwait City, Kuwait
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13
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Hilberdink B, van der Giesen F, Vliet Vlieland T, Nijkamp M, van Weely S. How to optimize exercise behavior in axial spondyloarthritis? Results of an intervention mapping study. PATIENT EDUCATION AND COUNSELING 2020; 103:952-959. [PMID: 31926668 DOI: 10.1016/j.pec.2019.12.017] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Revised: 11/23/2019] [Accepted: 12/30/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVE Many individuals with axial spondyloarthritis (axSpA) do not engage in adequate exercise, despite its proven health benefits. This study aimed to identify the intervention components needed to optimize exercise behavior in people with axSpA. METHODS The first three steps of the Intervention Mapping protocol were used: 1) needs assessment; 2) identification of axSpA-specific exercise barriers and facilitators (´determinants'); 3) selection of effective intervention components addressing potentially modifiable determinants. All three steps included scoping reviews and semi-structured interviews with patients (n = 2) and physical therapists (n = 2). RESULTS The scoping reviews included 28, 23 and 15 papers, respectively. Step 1 showed that only one third of axSpA patients exercise regularly, demonstrating especially a lack of strengthening and cardiorespiratory exercises. Based on eight determinants identified in Step 2, 10 intervention components were selected in Step 3: education, motivational interviewing, goal setting, action planning, monitoring, feedback, tailoring, guided practice, therapists' training and group exercise encouragement. CONCLUSION Using the Intervention Mapping method, 10 intervention components for optimizing exercise behavior in people with axSpA were identified and an intervention with behavior change guidance and a training for health professionals is proposed. PRACTICE IMPLICATIONS This study provides a foundation for the development of an axSpA-specific exercise intervention.
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Affiliation(s)
- Bas Hilberdink
- Leiden University Medical Center, Dept. of Orthopaedics, Rehabilitation and Physical Therapy, Leiden, the Netherlands.
| | | | - Thea Vliet Vlieland
- Leiden University Medical Center, Dept. of Orthopaedics, Rehabilitation and Physical Therapy, Leiden, the Netherlands
| | - Marjan Nijkamp
- Open University, Psychology and Educational Sciences, Heerlen, the Netherlands
| | - Salima van Weely
- Leiden University Medical Center, Dept. of Orthopaedics, Rehabilitation and Physical Therapy, Leiden, the Netherlands
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14
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Phang KF, Lahiri M, Fong WWS, Leong KH, Leung YY, Lim AYN, Lui NL, Manghani M, Tan TC, Santosa A, Sriranganathan MK, Suresh E, Teng GG, Cheung PP. Update on recommendations for eligibility of government subsidization of biologic disease‐modifying antirheumatic drugs for the treatment of axial spondyloarthritis in Singapore. Int J Rheum Dis 2019; 23:165-173. [DOI: 10.1111/1756-185x.13744] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Revised: 09/29/2019] [Accepted: 10/15/2019] [Indexed: 12/17/2022]
Affiliation(s)
- Kee Fong Phang
- Division of Rheumatology University Medicine Cluster National University Health System Singapore Singapore
| | - Manjari Lahiri
- Division of Rheumatology University Medicine Cluster National University Health System Singapore Singapore
- Department of Medicine Yong Loo Lin School of Medicine Singapore Singapore
| | - Warren Weng Seng Fong
- Department of Rheumatology and Immunology Singapore General Hospital Singapore Singapore
| | - Keng Hong Leong
- Leong Keng Hong Arthritis and Medical ClinicGleneagles Medical Centre Singapore Singapore
| | - Ying Ying Leung
- Department of Rheumatology and Immunology Singapore General Hospital Singapore Singapore
| | - Anita Yee Nah Lim
- Division of Rheumatology University Medicine Cluster National University Health System Singapore Singapore
- Department of Medicine Yong Loo Lin School of Medicine Singapore Singapore
| | - Nai Lee Lui
- Lui Centre for Arthritis & Rheumatology Gleneagles Medical Centre Singapore Singapore
| | - Mona Manghani
- Department of Rheumatology, Allergy and Immunology Tan Tock Seng Hospital Singapore Singapore
| | - Teck Choon Tan
- Department of Medicine Khoo Teck Puat Hospital Singapore Singapore
| | - Amelia Santosa
- Division of Rheumatology University Medicine Cluster National University Health System Singapore Singapore
- Department of Medicine Yong Loo Lin School of Medicine Singapore Singapore
| | | | - Ernest Suresh
- Department General Medicine and Acute Medicine Ng Teng Fong Hospital Singapore Singapore
| | - Gim Gee Teng
- Division of Rheumatology University Medicine Cluster National University Health System Singapore Singapore
- Department of Medicine Yong Loo Lin School of Medicine Singapore Singapore
| | - Peter P. Cheung
- Division of Rheumatology University Medicine Cluster National University Health System Singapore Singapore
- Department of Medicine Yong Loo Lin School of Medicine Singapore Singapore
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15
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Feld J, Chandran V, Haroon N, Inman R, Gladman D. Axial disease in psoriatic arthritis and ankylosing spondylitis: a critical comparison. Nat Rev Rheumatol 2019; 14:363-371. [PMID: 29752461 DOI: 10.1038/s41584-018-0006-8] [Citation(s) in RCA: 121] [Impact Index Per Article: 24.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Ankylosing spondylitis (AS) was first identified in the late 17th century. 250 years later, inflammatory spine disease was recognized to be one of the patterns of psoriatic arthritis (PsA). Isolated spondylitis is rare among patients with PsA, occurring in less than 5% of patients; however, many patients with PsA have axial disease that is concurrent with peripheral arthritis. At the other end of the spondyloarthritis spectrum, psoriasis is observed in 10% of patients with AS. Although axial involvement in PsA can be indistinguishable from axial disease in AS, it can also differ in several respects, raising the question of whether axial PsA and AS (with or without psoriasis) are different clinical presentations of the same disease, or whether they are separate diseases that have overlapping features. In this Review, the clinical presentation, metrology, radiographic characteristics, genetic factors, treatment options and axial prognosis of the two diseases are addressed. The aim of this Review is to capture all available comparisons made to date, to highlight the similarities and differences between AS and axial PsA and to propose a research agenda.
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Affiliation(s)
- Joy Feld
- Centre for Prognosis Studies in Rheumatic Diseases, Krembil Research Institute, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
| | - Vinod Chandran
- Centre for Prognosis Studies in Rheumatic Diseases, Krembil Research Institute, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada.,Division of Rheumatology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada.,Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada.,Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
| | - Nigil Haroon
- Centre for Prognosis Studies in Rheumatic Diseases, Krembil Research Institute, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada.,Division of Rheumatology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada.,Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
| | - Robert Inman
- Centre for Prognosis Studies in Rheumatic Diseases, Krembil Research Institute, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada.,Division of Rheumatology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada.,Department of Immunology, Medical Sciences Building, University of Toronto, Toronto, Ontario, Canada
| | - Dafna Gladman
- Centre for Prognosis Studies in Rheumatic Diseases, Krembil Research Institute, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada. .,Division of Rheumatology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada. .,Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada.
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16
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Zhu W, He X, Cheng K, Zhang L, Chen D, Wang X, Qiu G, Cao X, Weng X. Ankylosing spondylitis: etiology, pathogenesis, and treatments. Bone Res 2019; 7:22. [PMID: 31666997 PMCID: PMC6804882 DOI: 10.1038/s41413-019-0057-8] [Citation(s) in RCA: 193] [Impact Index Per Article: 38.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Revised: 05/20/2019] [Accepted: 05/23/2019] [Indexed: 02/06/2023] Open
Abstract
Ankylosing spondylitis (AS), a common type of spondyloarthropathy, is a chronic inflammatory autoimmune disease that mainly affects spine joints, causing severe, chronic pain; additionally, in more advanced cases, it can cause spine fusion. Significant progress in its pathophysiology and treatment has been achieved in the last decade. Immune cells and innate cytokines have been suggested to be crucial in the pathogenesis of AS, especially human leukocyte antigen (HLA)‑B27 and the interleukin‑23/17 axis. However, the pathogenesis of AS remains unclear. The current study reviewed the etiology and pathogenesis of AS, including genome-wide association studies and cytokine pathways. This study also summarized the current pharmaceutical and surgical treatment with a discussion of future potential therapies.
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Affiliation(s)
- Wei Zhu
- 1Department of Orthopedics, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, 100730 Beijing, China
| | - Xuxia He
- 2Department of Clinical Medicine, Chinese Academy of Medical Sciences & Peking Union Medical College, 100730 Beijing, China
| | - Kaiyuan Cheng
- 1Department of Orthopedics, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, 100730 Beijing, China
| | - Linjie Zhang
- 1Department of Orthopedics, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, 100730 Beijing, China
| | - Di Chen
- 3Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL 60612 USA
| | - Xiao Wang
- 4Department of Orthopedic Surgery, School of Medicine, Johns Hopkins University, Baltimore, MD USA
| | - Guixing Qiu
- 1Department of Orthopedics, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, 100730 Beijing, China
| | - Xu Cao
- 4Department of Orthopedic Surgery, School of Medicine, Johns Hopkins University, Baltimore, MD USA
| | - Xisheng Weng
- 1Department of Orthopedics, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, 100730 Beijing, China
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17
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Tam LS, Wei JCC, Aggarwal A, Baek HJ, Cheung PP, Chiowchanwisawakit P, Dans L, Gu J, Hagino N, Kishimoto M, Reyes HM, Soroosh S, Stebbings S, Whittle S, Yeap SS, Lau CS. 2018 APLAR axial spondyloarthritis treatment recommendations. Int J Rheum Dis 2019; 22:340-356. [PMID: 30816645 DOI: 10.1111/1756-185x.13510] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Accepted: 01/10/2019] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Despite the availability of axial spondyloarthritis (SpA) recommendations proposed by various rheumatology societies, we considered that a region-specific guideline was of substantial added value to clinicians of the Asia-Pacific region, given the wide variations in predisposition to infections and other patient factors, local practice patterns, and access to treatment across countries. MATERIALS AND METHODS Systematic reviews were undertaken of English-language articles published between 2000 and 2016, identified from MEDLINE using PubMed, EMBASE and Cochrane databases. The strength of available evidence was graded using the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) approach. Recommendations were developed through consensus using the Delphi technique. RESULTS Fourteen axial SpA treatment recommendations were developed based on evidence summaries and consensus. The first 2 recommendations cover non-pharmacological approaches to management. Recommendations 3 to 5 describe the following: the use of non-steroidal anti-inflammatory drugs as first-line symptomatic treatment; the avoidance of long-term corticosteroid use; and the utility of conventional synthetic disease-modifying anti-rheumatic drugs (csDMARDs) for peripheral or extra-articular manifestations. Recommendation 6 refers to the indications for biological DMARDs (bDMARDs). Recommendation 7 deals specifically with screening for infections endemic to Asia, prior to use of bDMARDs. Recommendations 7 to 13 cover the role of bDMARDs in the treatment of active axial SpA and include related issues such as continuing therapy and use in special populations. Recommendation 14 deals with the utility of surgical intervention in axial SpA. CONCLUSION These recommendations provide up-to-date guidance for treatment of axial SpA to help meet the needs of patients and clinicians in the Asia-Pacific region.
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Affiliation(s)
- Lai Shan Tam
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - James Cheng-Chung Wei
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan.,Department of Medicine, Chung Shan Medical University Hospital, Taichung, Taiwan.,Graduate Institute of Integrated Medicine, China Medical University, Taichung, Taiwan
| | - Amita Aggarwal
- Department of Clinical Immunology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Han Joo Baek
- Division of Rheumatology, Department of Internal Medicine, Gil Medical Center, Gachon University College of Medicine, Incheon, Korea
| | - Peter P Cheung
- Division of Rheumatology, National University Hospital and Yong Loo Lin School of Medicine, National University of Singapore, Singapore City, Singapore
| | | | - Leonila Dans
- Department of Pediatrics and Clinical Epidemiology, Philippine General Hospital, University of the Philippines, Manila, Philippines
| | - Jieruo Gu
- Department of Rheumatology, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Noboru Hagino
- Division of Hematology and Rheumatology, Teikyo University Chiba Medical Center, Chiba, Japan
| | - Mitsumasa Kishimoto
- Immuno-Rheumatology Center, St Luke`s International Hospital, St Luke`s International University, Tokyo, Japan
| | - Heizel Manapat Reyes
- Division of Rheumatology, Department of Medicine, Philippine General Hospital, University of the Philippines, Manila, Philippines
| | - Soosan Soroosh
- AJA University of Medical Sciences, Rheumatology Research Center, Tehran, Iran
| | - Simon Stebbings
- Department of Medicine Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Samuel Whittle
- The Queen Elizabeth Hospital, University of Adelaide, Adelaide, South Australia, Australia
| | - Swan Sim Yeap
- Department of Medicine, Subang Jaya Medical Centre, Subang Jaya, Malaysia
| | - Chak Sing Lau
- Division of Rheumatology and Clinical Immunology, Department of Medicine, The University of Hong Kong, Pokfulam, Hong Kong
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18
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Bignell K, Bender C, Lichtenstein A, McArthur B, Musselman KE, Kay T, Farrer C. Improving access in rheumatology: Evaluating the validity of a paper triage process involving an advanced practice physiotherapist through a retrospective chart review. Physiother Theory Pract 2018; 36:203-210. [PMID: 29924671 DOI: 10.1080/09593985.2018.1482978] [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: 10/28/2022]
Abstract
Objectives: This study evaluated a standardized paper triage process conducted by an advanced practice physiotherapist (APP) at a rheumatology center. The aims were to (1) determine the concordance between paper triage priority assignment and the rheumatologist's diagnosis; (2) determine the sensitivity and specificity of the paper triage process; and (3) assess reasons for incorrect priority ranking. Methods: Referrals were triaged by a formally trained APP into one of the three priorities, guided by a priority referral tool. A retrospective review of 192 charts was performed. Raw proportion of agreement between paper triage and rheumatologist's diagnosis was supplemented by a prevalence-adjusted bias-adjusted kappa (PABAK). Priority categories were collapsed to calculate sensitivity and specificity. For discordant cases, additional information was collected from the referral and chart to identify potential features leading to discrepancy. Results: Overall agreement was 76%. The PABAK was 0.80 [95% confidence interval 0.70-0.90]. Sensitivity ranged 0.64-0.92 and specificity ranged 0.81-0.94, depending on the priority category. Forty-six cases were discordant, with the APP choosing a higher priority in 37 cases. An incorrect diagnosis from the family physician with no supporting information for the paper triage led to discordance in 16 cases. Conclusion: A standardized paper triage process conducted by an APP showed substantial concordance, sensitivity, and specificity.
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Affiliation(s)
- Kristin Bignell
- Department of Physical Therapy, University of Toronto, Toronto, Canada
| | - Cassie Bender
- Department of Physical Therapy, University of Toronto, Toronto, Canada
| | | | - Brad McArthur
- Department of Physical Therapy, University of Toronto, Toronto, Canada
| | - Kristin E Musselman
- Department of Physical Therapy, University of Toronto, Toronto, Canada.,Rheumatology Department, Toronto Rehabilitation Institute - University Health Network, Toronto, ON, Canada
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Bergman M, Lundholm A. Managing morbidity and treatment-related toxicity in patients with ankylosing spondylitis. Rheumatology (Oxford) 2018; 57:419-428. [PMID: 28977661 PMCID: PMC5850804 DOI: 10.1093/rheumatology/kex292] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Indexed: 12/17/2022] Open
Abstract
AS is the prototypical member of the family of spondyloarthropathies, and is characterized by seronegativity, axial predominance and new bone formation, which underlie symptoms of inflammatory back pain, enthesopathy and extra-articular manifestations, including anterior uveitis, psoriasis and colitis. Patients with AS typically experience a wide variety of morbidities. These include both morbidities related to the disease itself—most prominently progressive, irreversible, structural damage to the axial or peripheral skeleton—and morbidities stemming from treatments for the disease, including toxicities from NSAID use, and increased risk of infections and immunogenicity concerns with biologics. AS is also associated with a number of comorbidities. We review the risks associated with AS, its comorbidities and its treatments, as well as strategies that can be used to mitigate these risks in patients with AS.
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Affiliation(s)
- Martin Bergman
- Department of Medicine, Drexel University College of Medicine, PA, USA
| | - Amy Lundholm
- Rheumatology, Lankenau Medical Center, Wynnewood, PA, USA
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20
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Kopylov U, Starr M, Watts C, Dionne S, Girardin M, Seidman EG. Detection of Crohn Disease in Patients with Spondyloarthropathy: The SpACE Capsule Study. J Rheumatol 2018; 45:498-505. [PMID: 29449505 DOI: 10.3899/jrheum.161216] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/11/2017] [Indexed: 12/22/2022]
Abstract
OBJECTIVE Inflammatory bowel disease (IBD) is generally reported to be associated with spondylarthropathies (SpA) in 5%-15% of cases. Systematic colonoscopic assessment by protocol demonstrated mucosal inflammation characteristic of Crohn disease (CD) in up to one-third of patients with SpA. Video capsule endoscopy (CE) is a superior diagnostic tool to detect small bowel mucosal disease. Our study compared the accuracy of CE to standard colonoscopy for detection of inflammatory bowel lesions in patients with SpA, and to describe predictors of small bowel inflammation (SBI) in this cohort. METHODS Prospective cross-sectional study of adult patients followed for SpA. Patients were evaluated by CE and standard colonoscopy with biopsies. SBI was quantified using the Lewis Score. Additional screening tests included fecal calprotectin (FCP), C-reactive protein (CRP), and a diagnostic panel of serologic, inflammatory and genetic tests (SGI). RESULTS There were 64 patients recruited (53% female, mean age 42 ± 13 yrs). Chronic gastrointestinal (GI) symptoms were present in 57%. CE revealed significant SBI in 27/64 (42.2%), compared to 7/64 (10.9%) by standard colonoscopy (p = 0.035). Elevated FCP was associated with small bowel CD (OR 4.5, 95% CI 1.01-19.9; p = 0.042). No correlation was observed with presence of GI symptoms, CRP, or SGI results. Finding CD led to a change in management in 65.2% of cases. CONCLUSION CE uncovered SBI consistent with CD in 42.2% of patients with SpA, with a significant incremental yield over colonoscopy of 31%. FCP levels were significantly correlated with CE results, while GI symptoms and SGI results were poor predictors of SBI.
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Affiliation(s)
- Uri Kopylov
- From the divisions of Gastroenterology and Rheumatology, Faculty of Medicine, McGill University, Montreal, Quebec, Canada
- U. Kopylov, MD, Division of Gastroenterology, Faculty of Medicine, McGill University; M. Starr, MD, Division of Rheumatology, Faculty of Medicine, McGill University; C. Watts, MD, Division of Rheumatology, Faculty of Medicine, McGill University; S. Dionne, PhD, Division of Gastroenterology, Faculty of Medicine, McGill University; M. Girardin, MD, Division of Gastroenterology, Faculty of Medicine, McGill University; E.G. Seidman, MDCM, FRCPC, FACG, Division of Gastroenterology, Faculty of Medicine, McGill University
| | - Michael Starr
- From the divisions of Gastroenterology and Rheumatology, Faculty of Medicine, McGill University, Montreal, Quebec, Canada
- U. Kopylov, MD, Division of Gastroenterology, Faculty of Medicine, McGill University; M. Starr, MD, Division of Rheumatology, Faculty of Medicine, McGill University; C. Watts, MD, Division of Rheumatology, Faculty of Medicine, McGill University; S. Dionne, PhD, Division of Gastroenterology, Faculty of Medicine, McGill University; M. Girardin, MD, Division of Gastroenterology, Faculty of Medicine, McGill University; E.G. Seidman, MDCM, FRCPC, FACG, Division of Gastroenterology, Faculty of Medicine, McGill University
| | - Craig Watts
- From the divisions of Gastroenterology and Rheumatology, Faculty of Medicine, McGill University, Montreal, Quebec, Canada
- U. Kopylov, MD, Division of Gastroenterology, Faculty of Medicine, McGill University; M. Starr, MD, Division of Rheumatology, Faculty of Medicine, McGill University; C. Watts, MD, Division of Rheumatology, Faculty of Medicine, McGill University; S. Dionne, PhD, Division of Gastroenterology, Faculty of Medicine, McGill University; M. Girardin, MD, Division of Gastroenterology, Faculty of Medicine, McGill University; E.G. Seidman, MDCM, FRCPC, FACG, Division of Gastroenterology, Faculty of Medicine, McGill University
| | - Serge Dionne
- From the divisions of Gastroenterology and Rheumatology, Faculty of Medicine, McGill University, Montreal, Quebec, Canada
- U. Kopylov, MD, Division of Gastroenterology, Faculty of Medicine, McGill University; M. Starr, MD, Division of Rheumatology, Faculty of Medicine, McGill University; C. Watts, MD, Division of Rheumatology, Faculty of Medicine, McGill University; S. Dionne, PhD, Division of Gastroenterology, Faculty of Medicine, McGill University; M. Girardin, MD, Division of Gastroenterology, Faculty of Medicine, McGill University; E.G. Seidman, MDCM, FRCPC, FACG, Division of Gastroenterology, Faculty of Medicine, McGill University
| | - Marc Girardin
- From the divisions of Gastroenterology and Rheumatology, Faculty of Medicine, McGill University, Montreal, Quebec, Canada
- U. Kopylov, MD, Division of Gastroenterology, Faculty of Medicine, McGill University; M. Starr, MD, Division of Rheumatology, Faculty of Medicine, McGill University; C. Watts, MD, Division of Rheumatology, Faculty of Medicine, McGill University; S. Dionne, PhD, Division of Gastroenterology, Faculty of Medicine, McGill University; M. Girardin, MD, Division of Gastroenterology, Faculty of Medicine, McGill University; E.G. Seidman, MDCM, FRCPC, FACG, Division of Gastroenterology, Faculty of Medicine, McGill University
| | - Ernest G Seidman
- From the divisions of Gastroenterology and Rheumatology, Faculty of Medicine, McGill University, Montreal, Quebec, Canada.
- U. Kopylov, MD, Division of Gastroenterology, Faculty of Medicine, McGill University; M. Starr, MD, Division of Rheumatology, Faculty of Medicine, McGill University; C. Watts, MD, Division of Rheumatology, Faculty of Medicine, McGill University; S. Dionne, PhD, Division of Gastroenterology, Faculty of Medicine, McGill University; M. Girardin, MD, Division of Gastroenterology, Faculty of Medicine, McGill University; E.G. Seidman, MDCM, FRCPC, FACG, Division of Gastroenterology, Faculty of Medicine, McGill University.
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Cellucci T, Guzman J, Petty RE, Batthish M, Benseler SM, Ellsworth JE, Houghton KM, LeBLANC CMA, Huber AM, Luca N, Schmeling H, Shiff NJ, Soon GS, Tse SML. Management of Juvenile Idiopathic Arthritis 2015: A Position Statement from the Pediatric Committee of the Canadian Rheumatology Association. J Rheumatol 2018; 43:1773-1776. [PMID: 27698103 DOI: 10.3899/jrheum.160074] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- Tania Cellucci
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
| | - Jaime Guzman
- Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Ross E Petty
- Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada;
| | - Michelle Batthish
- Department of Pediatrics, Western University, London, Ontario, Canada
| | - Susanne M Benseler
- Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada
| | - Janet E Ellsworth
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Kristin M Houghton
- Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Adam M Huber
- Department of Pediatrics, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Nadia Luca
- Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada
| | - Heinrike Schmeling
- Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada
| | - Natalie J Shiff
- Department of Pediatrics, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Gordon S Soon
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Shirley M L Tse
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
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22
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Turkish League Against Rheumatism Consensus Report: Recommendations For Management of Axial Spondyloarthritis. Arch Rheumatol 2018; 33:1-16. [PMID: 29900976 DOI: 10.5606/archrheumatol.2018.6833] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Accepted: 02/10/2018] [Indexed: 12/17/2022] Open
Abstract
Objectives This study aims to update 2011 Turkish League Against Rheumatism SpondyloArthritis Recommendations, and to compose a national expert opinion on management of axial spondyloArthritis under guidance of current guidelines, and implantation and dissemination of these international guidelines into our clinical practice. Patients and methods A scientific committee of 28 experts consisting of 14 rheumatologists and 14 physical medicine and rehabilitation specialists (one of them also has an immunology PhD) was formed. The recommendations, systematic reviews, and meta-analyses including pharmacologic and non-pharmacologic treatment were scrutinized paying special attention with convenient key words. The draft of Turkish League Against Rheumatism opinion whose roof consisted of international treatment recommendations, particularly the Assessment of SpondyloArthritis International Society/European League Against Rheumatism recommendations was composed. Assessment of level of agreement with opinions by task force members was established through the Delphi technique. Voting using a numerical rating scale assessed the strength of each recommendation. Results Panel compromised on five basic principles and 13 recommendations including pharmacological and nonpharmacological methods. All of the recommendations had adequate strength. Conclusion Turkish League Against Rheumatism expert opinion for the management of axial spondyloArthritis was developed based on scientific evidence. These recommendations will be updated regularly in accordance with current developments.
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Goeree R, Chiva-Razavi S, Gunda P, Graham CN, Miles L, Nikoglou E, Jugl SM, Gladman DD. Cost-effectiveness analysis of secukinumab for the treatment of active psoriatic arthritis: a Canadian perspective. J Med Econ 2018; 21:163-173. [PMID: 28945143 DOI: 10.1080/13696998.2017.1384737] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVE The study evaluates the cost-effectiveness of secukinumab, a fully human monoclonal antibody that selectively neutralizes interleukin (IL)-17A, vs currently licensed biologic treatments in patients with active psoriatic arthritis (PsA) from a Canadian healthcare system perspective. METHODS A decision analytic semi-Markov model evaluated the cost-effectiveness of secukinumab 150 mg and 300 mg compared to subcutaneous biologics adalimumab, certolizumab pegol, etanercept, golimumab, and ustekinumab, and intravenous biologics infliximab and infliximab biosimilar in biologic-naive and biologic-experienced patients over a lifetime horizon. The response to treatments was evaluated after 12 weeks by PsA Response Criteria (PsARC) response rates. Non-responders or patients discontinuing initial-line of biologic treatment were allowed to switch to subsequent-line biologics. Model input parameters (Psoriasis Area Severity Index [PASI], Health Assessment Questionnaire [HAQ], withdrawal rates, costs, and resource use) were collected from clinical trials, published literature, and other Canadian sources. Benefits were expressed as quality-adjusted life years (QALYs). An annual discount rate of 5% was applied to costs and benefits. The robustness of the study findings were evaluated via sensitivity analyses. RESULTS Biologic-naive patients treated with secukinumab achieved the highest number of QALYs (8.54) at the lowest cost (CAD 925,387) over a lifetime horizon vs all comparators. Secukinumab dominated all treatments, except for infliximab and its biosimilar, which achieved minimally more QALYs (8.58). However, infliximab and its biosimilar incurred more costs than secukinumab (infliximab: CAD 1,015,437; infliximab biosimilar: CAD 941,004), resulting in higher cost-effectiveness estimates relative to secukinumab. In the biologic-experienced population, secukinumab dominated all treatments as it generated more QALYs (8.89) at lower costs (CAD 954,692). Deterministic sensitivity analyses indicated the results were most sensitive to variation in PsARC response rates, change in HAQ, and utility values in both populations. CONCLUSIONS Secukinumab is either dominant or cost-effective vs all licensed biologics for the treatment of active PsA in biologic-naive and biologic-experienced populations in Canada.
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MESH Headings
- Adult
- Antibodies, Monoclonal/administration & dosage
- Antibodies, Monoclonal/economics
- Antibodies, Monoclonal, Humanized/administration & dosage
- Antibodies, Monoclonal, Humanized/economics
- Arthritis, Psoriatic/diagnostic imaging
- Arthritis, Psoriatic/drug therapy
- Arthritis, Psoriatic/economics
- Biological Products/administration & dosage
- Biological Products/economics
- Biological Products/pharmacology
- Biosimilar Pharmaceuticals/administration & dosage
- Biosimilar Pharmaceuticals/economics
- Canada
- Cost-Benefit Analysis
- Decision Support Techniques
- Drug Administration Schedule
- Drug Costs
- Female
- Follow-Up Studies
- Humans
- Injections, Subcutaneous
- Male
- Markov Chains
- Quality-Adjusted Life Years
- Severity of Illness Index
- Time Factors
- Treatment Outcome
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Affiliation(s)
- Ron Goeree
- a Goeree Consulting Ltd , Hamilton , Ontario , Canada
- b McMaster University , Hamilton , Ontario , Canada
| | | | - Praveen Gunda
- d Novartis Product Life Cycle Services-NBS, Novartis Healthcare Private Limited , Hyderabad , India
| | | | - LaStella Miles
- e RTI Health Solutions , Research Triangle Park , NC , USA
| | - Efthalia Nikoglou
- f Novartis Product Lifecycle Services - NBS, Novartis Global Service Center , Dublin , Ireland
| | | | - Dafna D Gladman
- h Toronto Western Hospital, University of Toronto , Toronto , Ontario , Canada
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Bhoi P, Bessette L, Bell MJ, Tkaczyk C, Nantel F, Maslova K. Adherence and dosing interval of subcutaneous antitumour necrosis factor biologics among patients with inflammatory arthritis: analysis from a Canadian administrative database. BMJ Open 2017; 7:e015872. [PMID: 28928177 PMCID: PMC5623530 DOI: 10.1136/bmjopen-2017-015872] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
OBJECTIVES Subcutaneous tumour necrosis factor alpha TNFαinhibitors (SC-TNFis) such as golimumab (GLM), adalimumab (ADA), etanercept (ETA) and certolizumab pegol (CZP) have been used for many years for the treatment of inflammatory arthritis. Non-adherence to therapy is an important modifiable factor that may compromise patient outcomes. The aim of this analysis was to compare adherence and dosing interval of SC-TNFis in the treatment of people with inflammatory arthritis. DESIGN We used the IMS Brogan database combining both Canadian private and public drug plan databases of Ontario and Quebec. Target drugs included SC-TNFis for inflammatory arthritis. The index period was from 1 January 2010 to 30 June 2012 and patients were followed for 24 months through 30 June 2014. Inclusion criteria were adult patients newly prescribed a SC-TNFis with at least three prescriptions and retained on therapy at 24 months.Dosing regimens as per the product monographs were used to compare actual versus expected drug utilisation. The mean possession ratio was used as a marker for adherence. Patients who scored >80% were considered adherent. The average days between units was estimated by taking the total days on therapy and divided by the number of units the patient received. RESULTS 4035 patients were included: 683 (16.9%), 1400 (34.7%), 1765 (43.7%) and 187 (4.6%) were treated with GLM, ADA, ETA and CZP, respectively. The proportion of adherent patients in the GLM cohort (n=595/683, 87%, p<0.0001) was greater compared with ADA (n=1044/1400, 75%), ETA (n=1285/1765, 73%) and CZP-treated patients (132/187, 71%). In addition, the number of patients receiving biological drug at a shorter dosing interval was similar between cohorts, and was 5%, 6%, 12% and 4% in GLM (≤26 days), ADA (≤12 days), ETA (≤6 days) and CZP-treated patients (≤12 days), respectively. CONCLUSIONS In this real-life administrative database, GLM had better adherence compared with other SC-TNFis.
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Affiliation(s)
- Peter Bhoi
- Medical Affairs, Janssen Inc, Toronto, Ontario, Canada
| | - Louis Bessette
- Groupe de Recherche en Rhumatologie et Maladies Osseuses, Sainte-Foy, Quebec, Canada
| | - Mary J Bell
- Department of Rheumatology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Cathy Tkaczyk
- Medical Affairs, Janssen Inc, Toronto, Ontario, Canada
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Deodhar A, Yu D. Switching tumor necrosis factor inhibitors in the treatment of axial spondyloarthritis. Semin Arthritis Rheum 2017; 47:343-350. [PMID: 28551170 DOI: 10.1016/j.semarthrit.2017.04.005] [Citation(s) in RCA: 61] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Revised: 04/11/2017] [Accepted: 04/24/2017] [Indexed: 12/17/2022]
Abstract
OBJECTIVE To assess the impact of switching tumor necrosis factor (TNF)-alpha inhibitors on patients with axial spondyloarthritis (axSpA). METHODS PubMed literature searches were conducted using combinations of search terms including ankylosing spondylitis, spondyloarthropathy, spondyloarthritis, switch/switching, drug survival, and TNF/tumor necrosis factor to identify published articles with data on outcomes related to switching biologic therapies in patients with axSpA. RESULTS Of the 134 studies screened, 21 were identified as reporting data on switching TNF inhibitors in patients carrying a diagnosis of axSpA or ankylosing spondylitis. The most common reasons for switching from the first TNF inhibitor were lack of efficacy (14-68%), loss of efficacy (13-61%), and adverse events/poor tolerability (13-57%). Switching TNF inhibitors was beneficial for a substantial proportion of patients with axSpA who failed to respond to initial or even second TNF inhibitor therapy and adverse effects were not enhanced. Drug survival rates were generally lower for the second (47-72% at 2 years) or third TNF inhibitor (49% at 2 years) than for the first TNF inhibitor (58-75% at 2 years). Predictors of responses in TNF-naïve patients included HLA-B27 positivity, absence of enthesitis, age ≤40 years, elevated C-reactive protein level, good functional status, and shorter disease duration. Predictors of drug survival included male sex and peripheral arthritis. Common characteristics of patients who switched TNF inhibitors included female sex, older age, more severe disease, greater symptom burden, higher erythrocyte sedimentation rate, complete ankyloses, and enthesitis. CONCLUSION When the first or even the second TNF inhibitor fails, switching to an alternate one is not an unreasonable clinical therapeutic decision.
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Affiliation(s)
- Atul Deodhar
- Oregon Health & Science University, 3181 SW Sam Jackson Park Rd, Portland, OR 97299.
| | - David Yu
- Ronald Reagan UCLA Medical Center, Los Angeles, CA
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26
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Bergman M, Lundholm A. Mitigation of disease- and treatment-related risks in patients with psoriatic arthritis. Arthritis Res Ther 2017; 19:63. [PMID: 28320454 PMCID: PMC5359960 DOI: 10.1186/s13075-017-1265-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Psoriatic arthritis is a part of the family of diseases referred to as spondyloarthropathies, a diverse group of chronic inflammatory disorders with common clinical, radiographic, and genetic features. Peripheral arthritis is the most common symptom of psoriatic arthritis and patients also frequently experience involvement of the entheses, spine, skin, and nails. Due to the diverse clinical spectrum of disease severity, tissues affected, and associated comorbidities, the treatment of psoriatic arthritis can be challenging and it is necessary to mitigate risks associated with both the disease and its treatment. These risks include disease-specific, treatment-related, and psychological risks. Disease-specific risks include those associated with disease progression that can limit functional status and be mitigated through early diagnosis and initiation of treatment. Risks also arise from comorbidities that are associated with psoriatic arthritis such as cardiovascular disease, obesity, diabetes mellitus, and gastrointestinal inflammation. Patient outcomes can be affected by the treatment strategy employed and the pharmacologic agents administered. Additionally, it is important for physicians to be aware of risks specific to each therapeutic option. The impact of psoriatic arthritis is not limited to the skin and joints and it is common for patients to experience quality-of-life impairment. Patients are also more likely to have depression, anxiety, and alcoholism. This article reviews the many risks associated with psoriatic arthritis and provides guidance on mitigating these risks.
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Affiliation(s)
- Martin Bergman
- Taylor Hospital, 8 Morton Avenue, Suite 304, Ridley Park, PA, 19078, USA.
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27
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Furst DE, Tran M, Sullivan E, Pike J, Piercy J, Herrera V, Palmer JB. Misalignment between physicians and patient satisfaction with psoriatic arthritis disease control. Clin Rheumatol 2017; 36:2045-2054. [PMID: 28238086 PMCID: PMC5554474 DOI: 10.1007/s10067-017-3578-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2016] [Revised: 02/05/2017] [Accepted: 02/08/2017] [Indexed: 02/04/2023]
Abstract
The main objective of the present study is to evaluate the misalignment between psoriatic arthritis (PsA) patient- and physician-reported satisfaction with PsA control. Data came from the Adelphi Rheumatology Disease Specific Programme, a retrospective, cross-sectional survey of US-based rheumatologists and patients. Physicians provided satisfaction and clinical characteristics on tender joint count, swollen joint count, and percent body surface area (BSA) affected by psoriasis. Patients provided data on satisfaction, the Work Productivity Activity Impairment and Health Assessment Questionnaire-Disability Index (HAQ-DI) questionnaires. Based on their satisfaction response, patient-physician pairs were classified into aligned (both satisfied or dissatisfied) or misaligned (rated satisfaction differently) groups. Multivariate analysis evaluated association of characteristics with misalignment. Among 305 paired patient-physician records analyzed, 23.6% were misaligned and 76.4% were aligned. The misaligned group had shorter disease duration (mean years, 5.2 vs. 6.4), used fewer biologic disease-modifying antirheumatic drugs (49.3 vs. 62.9%), had more swollen (mean, 3.7 vs. 1.9, P = 0.0002) and tender joints (mean, 5.6 vs. 2.9, P < 0.0001), greater proportion of patients with comorbidities (72.2 vs. 63.1%), and >3% BSA affected by psoriatic skin lesions (64.2 vs. 55.1%). Misaligned patients reported greater work impairment (mean, 38.7 vs. 21.4, P = 0.0004), daily activities (mean, 38.7 vs. 22.3, P < 0.0001), and higher disease burden (mean HAQ-DI; 0.56 vs. 0.37, P = 0.0001). Multivariate analysis found the number of swollen joints (P = 0.02) and HAQ-DI score (P = 0.03) was significantly associated with misalignment among all patients; however, not in the subgroup of employed patients. Patient-physician misalignment is associated with increased disease activity and disability among patients with PsA.
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Affiliation(s)
- Daniel E Furst
- Department of Rheumatology, University of California, Los Angeles Medical Center, Los Angeles, CA, USA
| | | | | | - James Pike
- Adelphi Real World, Adelphi Mill, Cheshire, UK
| | | | - Vivian Herrera
- Health Economics & Outcomes Research, Immunology & Dermatology Business Unit, Novartis Pharmaceuticals Corporation, East Hanover, NJ, 07936, USA
| | - Jacqueline B Palmer
- Health Economics & Outcomes Research, Immunology & Dermatology Business Unit, Novartis Pharmaceuticals Corporation, East Hanover, NJ, 07936, USA.
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28
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Chen C, Zhang X, Xiao L, Zhang X, Ma X. Comparative Effectiveness of Biologic Therapy Regimens for Ankylosing Spondylitis: A Systematic Review and a Network Meta-Analysis. Medicine (Baltimore) 2016; 95:e3060. [PMID: 26986130 PMCID: PMC4839911 DOI: 10.1097/md.0000000000003060] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
To establish the comparative effectiveness of all available biologic therapy regimens for ankylosing spondylitis, we performed a systematic review and a Bayesian network meta-analysis of randomized controlled trials. PubMed, Medline, Embase, Cochrane library, and ClinicalTrials.gov were searched from the inception of each database to June 2015. Systematic review and network meta-analysis was reported according to the Preferred Reporting Items of Systematic Reviews and Meta-Analyses Extension Statement for Reporting of Systematic Reviews Incorporating Network Meta-analyses. The primary outcome was 20% improvement of Assessments in SpondyloArthritis International Society Response Criteria (ASAS20) at Week 12 or 14; secondary outcomes were ASAS40, ASAS5/6, ASAS partial remission and 50% improvement in baseline Bath ankylosing spondylitis (AS) disease activity index. We reported relative risks and 95% confidence intervals from direct meta-analysis and 95% credible intervals from Bayesian network meta-analysis, and ranked the treatment for outcomes. We also used Grading of Recommendations Assessment, Development and Evaluation criteria to appraise quality of evidence. Fourteen RCTs comprising 2672 active AS patients were included in the network meta-analysis. Most biologic therapy regimens were more effective than placebo regarding all the outcomes assessed, except for secukinumab and tocilizumab. No differences between biologic therapies in the treatment of AS could be found, except for the finding that infliximab 5 mg was superior to tocilizumab. Infliximab 5 mg/kg had the highest probability of being ranked the best for achieving ASAS20, whereas notably, secukinumab had the highest probability of being ranked the second best. Our study suggests that no differences between biologic therapies in the treatment of AS could be found except that infliximab 5 mg was superior to tocilizumab. Infliximab 5 mg/kg seems to be the better biologic therapy regimen for AS. Secukinumab appears promising, though additional data is warranted. Nevertheless, these interpretations should be accepted very cautiously.
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Affiliation(s)
- Chao Chen
- From the Department of Spinal Surgery (CC, XLZ, XLM), Tianjin Hospital, Tianjin; Air Force Centre of Aviation Medical Evaluation and Training (LX), Hangzhou, Zhejiang; and Department of Orthopedics (XSZ), Chinese PLA General Hospital, Beijing, China
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Kabeerdoss J, Sandhya P, Danda D. Gut inflammation and microbiome in spondyloarthritis. Rheumatol Int 2015; 36:457-68. [PMID: 26719306 DOI: 10.1007/s00296-015-3414-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2015] [Accepted: 12/21/2015] [Indexed: 12/16/2022]
Abstract
Spondyloarthritis (SpA) is chronic inflammatory disease involving joints and the spine. Bowel inflammation is common in SpA, which may be classified as acute or chronic. Chronic gut inflammation is most common in SpA patients with axial involvement as compared to those presenting with peripheral involvement alone. The pathogenesis of gut inflammation in SpA could be explained by two factors-over-activation of immunological cells and altered gut microbiome. This is exemplified by SpA animal models, namely HLA-B27-expressing transgenic animals and SKG mice models. Immunological mechanisms include homing of activated T cells from gut into synovium, excess pro-inflammatory cytokines secretion by immune cells such as IL-23 and genetic variations in immunological genes. The evidence for role of gut microbiome in SpA is gradually emerging. Recently, metagenomic study of gut microbiome by sequencing of microbial nucleic acids has enabled identification of new microbial taxa and their functions in gut of patients with SpA. In SpA, the gut microbiome could emerge as diagnostic and prognostic marker of disease. Modulation of gut microbiome is slated to have therapeutic potential as well.
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Affiliation(s)
- Jayakanthan Kabeerdoss
- Department of Clinical Immunology and Rheumatology, Christian Medical College, Vellore, Tamil Nadu, 632004, India
| | - Pulukool Sandhya
- Department of Clinical Immunology and Rheumatology, Christian Medical College, Vellore, Tamil Nadu, 632004, India
| | - Debashish Danda
- Department of Clinical Immunology and Rheumatology, Christian Medical College, Vellore, Tamil Nadu, 632004, India.
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Rohekar S, Chan J, Tse SM, Haroon N, Chandran V, Bessette L, Mosher D, Flanagan C, Keen KJ, Adams K, Mallinson M, Thorne C, Rahman P, Gladman DD, Inman RD. 2014 Update of the Canadian Rheumatology Association/Spondyloarthritis Research Consortium of Canada Treatment Recommendations for the Management of Spondyloarthritis. Part II: Specific Management Recommendations. J Rheumatol 2015; 42:665-81. [DOI: 10.3899/jrheum.141001] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/22/2014] [Indexed: 01/01/2023]
Abstract
Objective.The Canadian Rheumatology Association (CRA) and the Spondyloarthritis Research Consortium of Canada (SPARCC) have collaborated to update the recommendations for the management of spondyloarthritis (SpA).Methods.A working group was assembled and consisted of the SPARCC executive committee, rheumatologist leaders from SPARCC collaborating sites, Canadian rheumatologists from across the country with an interest in SpA (both academic and community), a rheumatology trainee with an interest in SpA, an epidemiologist/health services researcher, a member of the CRA executive, a member of the CRA therapeutics committee, and a patient representative from the Canadian Spondylitis Association. An extensive review was conducted of literature published from 2007 to 2014 involving the management of SpA. The working group created draft recommendations using multiple rounds of Web-based surveys and an in-person conference.Results.Recommendations for the management of SpA were created. Part II: Specific Management Recommendations addresses management with nonpharmacologic methods, nonsteroidal anti-inflammatories and analgesics, disease-modifying antirheumatic drugs, antibiotics, tumor necrosis factor inhibitors, other biologic agents, and surgery. Also included are 10 modifications for application to juvenile SpA.Conclusion.These recommendations were developed based on current literature and applied to a Canadian healthcare context. It is hoped that implementation of these recommendations will promote best practices in the treatment of SpA.
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