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Mohamed M, El-Maboud A, Salem HF, Salem MN, Elmaaty MA, Eissa N, Said ASA, Hussein RRS. Predictors of methotrexate adherence and patient's awareness of it in rheumatoid arthritis and its effect on quality of life. J Pharm Policy Pract 2024; 17:2365933. [PMID: 39035456 PMCID: PMC11259066 DOI: 10.1080/20523211.2024.2365933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Accepted: 06/04/2024] [Indexed: 07/23/2024] Open
Abstract
Introduction Adherence studies among rheumatoid arthritis (RA) patients, in Egypt and throughout the Middle East region, are lacking. This study aimed to evaluate methotrexate (MTX) adherence in Rheumatoid arthritis (RA) patients and to identify specific non-adherence predictors. Methods A cross-sectional observational study included 300 RA patients who were administered MTX for at least one year. The survey was completed through direct interviews. The demographic patient data were collected (age, education, sex, work status, disease duration, duration of MTX administration and current dose). Patients' adherence to MTX predictors for non-adherence, MTX side effects and functional disability were assessed in the study. Results Majority of respondents showed good MTX adherence, and more than 50% of patient's experienced MTX side effects. A large percentage of participants showed low knowledge about MTX nature and side effects. Most participants reported no or some difficulty in quality of life-related activities and functional disability. Conclusion MTX adherence and awareness were positively correlated to many variables, including, age, educational level and disease duration, which in turn has its positive impact on the patient's quality of life. Still, more research is needed to determine the impact of non-adherence on the patient's health outcomes.
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Affiliation(s)
- Marwa Mohamed
- Clinical Pharmacist at Medical Administration, Fayoum University, Egypt
| | - Abd El-Maboud
- Department of Clinical Pharmacy, Faculty of Pharmacy, Beni-Suef University, Cairo, Egypt
| | - Heba F. Salem
- Department of Pharmaceutics & Industrial Pharmacy, Faculty of Pharmacy, Beni-Suef University, Cairo, Egypt
| | - Mohamed N. Salem
- Department of Internal Medicine, Faculty of Medicine, Beni-Suef University, Cairo, Egypt
| | - Mahmoud Abo Elmaaty
- Senior Clinical Pharmacist at the Children Cancer Hospital in Egypt, Beni-Suef University, Cairo, Egypt
| | - Nermin Eissa
- Department of Biomedical Sciences, College of Health Sciences, Abu Dhabi University, Abu Dhabi, United Arab Emirates
| | - Amira S. A. Said
- Department of Clinical Pharmacy, Faculty of Pharmacy, Beni-Suef University, Cairo, Egypt
- Department of Clinical Pharmacy, College of Pharmacy, Al Ain University, Abu Dhabi, United Arab Emirates
| | - Raghda R. S. Hussein
- Department of Clinical Pharmacy, Faculty of Pharmacy, Beni-Suef University, Cairo, Egypt
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2
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Seet D, Yeo SI, Aw MH, Dhanasekaran P, Mui-San Lim R, Koh LW, Lahiri M. Smoking, but not use of complementary and alternative medicine predicts residual functional disability in patients with inflammatory arthritis on biologic disease-modifying anti-rheumatic drugs: Results from the Singapore National Biologics Register. Int J Rheum Dis 2023; 26:510-518. [PMID: 36737417 DOI: 10.1111/1756-185x.14590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Revised: 12/09/2022] [Accepted: 01/16/2023] [Indexed: 02/05/2023]
Abstract
AIMS To describe inflammatory arthritis (IA) patients initiating biologic disease-modifying anti-rheumatic drugs (bDMARDs) who use complementary and alternative medicine (CAM), and determine the impact of CAM on predicting modified Health Assessment Questionnaire (mHAQ) at 6 months. METHODS This was a prospective inception cohort study of patients ≥21 years old initiating a bDMARD for IA after July 2016. Data were obtained via questionnaires and abstraction from medical records. Baseline characteristics between ever-CAM and CAM non-users were compared. CAM as a predictor of mHAQ ≥1 at 6 months after bDMARD initiation was analyzed using multivariate logistic regression, adjusting for other baseline characteristics. RESULTS We recruited 299 patients (36.2% male, mean age 49.0 years). There were 45.8% who had rheumatoid arthritis, 54.2% had a spondyloarthropathy, median disease duration of 1.1 years and median mHAQ of 0.4. Compared to CAM non-users, ever-CAM users had a lower mean body mass index, were less likely to speak English, and more likely to smoke and drink alcohol. There was no association of CAM use with high mHAQ and no interaction with smoking. Smoking (odds ratio [OR] 938.9; 95% CI 3.20-275 884.1), baseline mHAQ (OR 252.2; 95% CI 5.34-11 899.2) and Charlson's Comorbidity Index score ≥4 (OR 237.4; 95% CI 1.22-46 184.4) independently predicted high mHAQ at 6 months. CONCLUSIONS CAM use was not associated with high mHAQ at 6 months. Smoking was an independent predictor of residual functional disability at 6 months, even after adjusting for age, comorbidity and baseline mHAQ. Greater emphasis on smoking cessation may improve long-term functional outcomes in IA patients on bDMARDs.
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Affiliation(s)
- Dominic Seet
- Department of General Medicine, Sengkang General Hospital, Singapore City, Singapore
| | - Siaw Ing Yeo
- Department of Rheumatology and Immunology, Singapore General Hospital, Singapore City, Singapore
| | - Man Hua Aw
- Department of Rheumatology and Immunology, Singapore General Hospital, Singapore City, Singapore
| | - Preeti Dhanasekaran
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore City, Singapore
| | - Rosa Mui-San Lim
- Department of Rheumatology, Allergy and Immunology, Tan Tock Seng Hospital, Singapore City, Singapore
| | - Li Wearn Koh
- Department of Rheumatology, Allergy and Immunology, Tan Tock Seng Hospital, Singapore City, Singapore
| | - Manjari Lahiri
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore City, Singapore.,Division of Rheumatology, Department of Medicine, National University Hospital, Singapore City, Singapore
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3
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Sigurdardottir V, Engstrom A, Berling P, Olofsson T, Oldsberg L, Sadler S, Parra-Padilla D, Melis L, Willems D. Cost-effectiveness analysis of bimekizumab for the treatment of active psoriatic arthritis in Sweden. J Med Econ 2023; 26:1190-1200. [PMID: 37712618 DOI: 10.1080/13696998.2023.2259609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 09/07/2023] [Accepted: 09/12/2023] [Indexed: 09/16/2023]
Abstract
AIMS To evaluate the cost-effectiveness of bimekizumab, an inhibitor of IL-17F and IL-17A, against biologic and targeted synthetic disease-modifying antirheumatic drugs (DMARD) for psoriatic arthritis (PsA) from the Swedish healthcare system perspective. MATERIALS AND METHODS A Markov model was developed to simulate the clinical pathway of biologic [b] DMARD-naïve or tumor necrosis factor inhibitor experienced [TNFi-exp] PsA patients over a lifetime horizon. Treatment response was incorporated as achievement of the American College of Rheumatology 50% (ACR50) and Psoriasis Area and Severity Index 75% (PASI75) response, and changes in the Health Assessment Questionnaire-Disability Index (HAQ-DI) score. The efficacy of bimekizumab was obtained from the BE OPTIMAL (bDMARD-naïve) and BE COMPLETE (TNFi-experienced) trials while a network meta-analysis (NMA) informed the efficacy of the comparators. Resource use and drug costs were obtained from published studies and databases of drug retail prices in Sweden. A willingness-to-pay threshold of €50,000 per quality-adjusted life year (QALY) was applied. RESULTS In bDMARD-naïve patients, bimekizumab achieved greater QALYs (14.08) than with all comparators except infliximab (14.22), dominated guselkumab every 4 and 8 weeks, ixekizumab, secukinumab 300 mg, ustekinumab 45 mg and 90 mg, and was cost-effective against risankizumab, tofacitinib, upadacitinib and TNFis, except adalimumab biosimilar. In TNFi-experienced patients, bimekizumab led to greater QALYs (13.56) than all comparators except certolizumab pegol (13.84), and dominated ixekizumab and secukinumab 300 mg while being cost-effective against all other IL-17A-, IL-23- and JAK inhibitors. LIMITATIONS An NMA informed the comparative effectiveness estimates. Given gaps in evidence of disease management and indirect costs specific to HAQ-DI scores, and sequential clinical trial evidence in PsA, non-PsA cost data from similar joint conditions were used, and one line of active treatment followed by best supportive care was assumed. CONCLUSIONS Bimekizumab was cost-effective against most available treatments for PsA in Sweden, irrespective of prior TNFi exposure.
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Affiliation(s)
- Valgerdur Sigurdardottir
- Department of Rheumatology, Falun Hospital, Centre for Clinical Research, Dalarna, Uppsala University, Falun, Sweden
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4
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Gwinnutt JM, Norton S, Hyrich KL, Lunt M, Combe B, Rincheval N, Ruyssen-Witrand A, Fautrel B, McWilliams DF, Walsh DA, Nikiphorou E, Kiely PDW, Young A, Chipping JR, MacGregor A, Verstappen SMM. Exploring the disparity between inflammation and disability in the 10-year outcomes of people with rheumatoid arthritis. Rheumatology (Oxford) 2022; 61:4687-4701. [PMID: 35274696 PMCID: PMC9707289 DOI: 10.1093/rheumatology/keac137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Accepted: 02/25/2022] [Indexed: 01/10/2023] Open
Abstract
OBJECTIVES To identify groups of people with RA with different disability trajectories over 10 years, despite comparable levels of inflammation. METHODS Data for this analysis came from three European prospective cohort studies of people with RA [Norfolk Arthritis Register (NOAR), Early RA Network (ERAN), Étude et Suivi des Polyarthrites Indifférenciées Récentes (ESPOIR)]. Participants were assessed regularly over 8 (ERAN) to 10 (NOAR/ESPOIR) years. Inclusion criteria were: recruited after 1 January 2000, <24 months baseline symptom duration, and disability (HAQ) and inflammation [two-component DAS28 (DAS28-2C)] recorded at baseline and at one other follow-up. People in each cohort also completed patient-reported outcome measures at each assessment (pain, fatigue, depressive symptoms). Group-based trajectory models were used to identify distinct groups of people with similar HAQ and DAS28-2C trajectories over follow-up. RESULTS This analysis included 2500 people with RA (NOAR: 1000, ESPOIR: 766, ERAN: 734). ESPOIR included more women and the participants were younger [mean (standard deviation) age: NOAR: 57.1 (14.6), ESPOIR: 47.6 (12.5), ERAN: 56.8 (13.8); women: NOAR: 63.9%, ESPOIR: 76.9%, ERAN: 69.1%). Within each cohort, two pairs of trajectories following the hypothesized pattern (comparable DAS28-2Cs but different HAQs) were identified. Higher pain, fatigue and depressive symptoms were associated with increased odds of being in the high HAQ trajectories. CONCLUSION Excess disability is persistent in RA. Controlling inflammation may not be sufficient to alleviate disability in all people with RA, and effective pain, fatigue and mood management may be needed in some groups to improve long-term function.
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Affiliation(s)
- James M Gwinnutt
- Correspondence to: James M Gwinnutt, Centre for Epidemiology Versus Arthritis, Centre for Musculoskeletal Research, Division of Musculoskeletal and Dermatological Sciences, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester M13 9PT, UK. E-mail:
| | - Sam Norton
- Health Psychology Section, Institute of Psychiatry, Psychology and Neuroscience,Centre for Rheumatic Diseases, Department of Inflammation Biology, Faculty of Life Sciences and Medicine, King’s College London, London
| | - Kimme L Hyrich
- Centre for Epidemiology Versus Arthritis, Division of Musculoskeletal and Dermatological Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester,NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - Mark Lunt
- Centre for Epidemiology Versus Arthritis, Division of Musculoskeletal and Dermatological Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester
| | | | - Nathalie Rincheval
- Laboratory of Biostatistics and Epidemiology, University of Montpellier, Montpellier
| | - Adeline Ruyssen-Witrand
- Centre de Rhumatologie, Hôpital Purpan,Faculté de Médecine, Université Toulouse III, Paul Sabatier University, Inserm UMR1027, Toulouse
| | - Bruno Fautrel
- Department of Rheumatology, Sorbonne University—Assistance Publique Hôpitaux de Paris, Pitie Salpetriere Hospital,PEPITES team, Pierre Louis Institute of Epidemiology and Public Health, INSERM UMRS 1136, Paris, France
| | - Daniel F McWilliams
- Pain Centre Versus Arthritis, University of Nottingham,NIHR Nottingham Biomedical Research Centre, Nottingham
| | - David A Walsh
- Pain Centre Versus Arthritis, University of Nottingham,NIHR Nottingham Biomedical Research Centre, Nottingham,Department of Rheumatology, Sherwood Forest Hospitals NHS Foundation Trust, Sutton in Ashfield
| | - Elena Nikiphorou
- Centre for Rheumatic Diseases, Department of Inflammation Biology, Faculty of Life Sciences and Medicine, King’s College London, London,Rheumatology Department, King’s College Hospital
| | - Patrick D W Kiely
- Department of Rheumatology, St George’s University Hospitals NHS Foundation Trust,Institute of Medical and Biomedical Education, St George’s University of London, London
| | - Adam Young
- Centre for Health Services and Clinical Research, Life and Medical Sciences, University of Hertfordshire, Hatfield
| | - Jacqueline R Chipping
- Norwich Medical School, University of East Anglia,Rheumatology Department, Norfolk and Norwich University Hospitals NHS Trust, Norwich, UK
| | - Alex MacGregor
- Norwich Medical School, University of East Anglia,Rheumatology Department, Norfolk and Norwich University Hospitals NHS Trust, Norwich, UK
| | - Suzanne M M Verstappen
- Centre for Epidemiology Versus Arthritis, Division of Musculoskeletal and Dermatological Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester,NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
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5
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Hedenstierna L, Hedström AK, Klareskog L, Di Giuseppe D, Alfredsson L, Askling J, Ernestam S, Saevarsdottir S, Ljung L. Neither low social support nor low decision latitude at work is associated with disease remission among patients with rheumatoid arthritis: results from the Swedish EIRA study. Arthritis Res Ther 2022; 24:203. [PMID: 35999588 PMCID: PMC9396875 DOI: 10.1186/s13075-022-02892-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 08/05/2022] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVES To investigate the association between psychosocial vulnerability, defined as either low social support or low decision latitude at work, and disease remission at 3, 12, and 60 months in patients with rheumatoid arthritis (RA). METHODS This cohort study included all patients enrolled in both the Swedish Epidemiological Investigation of Rheumatoid Arthritis (EIRA) 1996-2015 and the Swedish Rheumatology Quality Register (SRQ, n = 2820). Information on social support and decision latitude at work at RA diagnosis were identified from the EIRA questionnaire. Indexes for levels of social support and decision latitude at work, respectively, were calculated based on the questionnaire. Low social support and low decision latitude at work, respectively, were identified by a score in the lowest quartile and compared with the three other quartiles (not low). Disease-activity parameters were retrieved from SRQ at 3, 12, and 60 months. The associations between social support or decision latitude at work, respectively, and Disease Activity Score 28 joint count with C-reactive protein (DAS28-CRP) remission were analysed using logistic regression models adjusted for age, sex, smoking habits, alcohol habits, symptom duration, and educational level. RESULTS Having low social support (n = 591) was not associated with DAS28-CRP remission at 3 (OR 0.93, 95% CI 0.74-1.16), 12 (OR 0.96, 95%CI 0.75-1.23), or 60 (OR 0.89, 95%CI 0.72-1.10) months compared to not low social support (n = 2209). No association was observed for low (n = 212) versus not low (n = 635) decision latitude at work and DAS28-CRP remission at 3 (OR 0.84, 95%CI 0.54-1.31), 12 (OR 0.81, 95%CI 0.56-1.16), or 60 (OR 1.37, 95%CI 0.94-2.01) months. CONCLUSION In a country with general access to healthcare, psychosocial vulnerability does not influence the likelihood of achieving remission in early RA.
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Affiliation(s)
- Louise Hedenstierna
- grid.4714.60000 0004 1937 0626Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden ,Academic Specialist Center, Stockholm Health Services, Stockholm, Sweden ,grid.4714.60000 0004 1937 0626Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden ,grid.4714.60000 0004 1937 0626Center for Rheumatology, Karolinska Institutet, Solnavägen 1E, 102 35 Stockholm, Sweden
| | - Anna Karin Hedström
- grid.4714.60000 0004 1937 0626Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Lars Klareskog
- grid.4714.60000 0004 1937 0626Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden ,Academic Specialist Center, Stockholm Health Services, Stockholm, Sweden
| | - Daniela Di Giuseppe
- grid.4714.60000 0004 1937 0626Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden
| | - Lars Alfredsson
- grid.4714.60000 0004 1937 0626Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden ,Center for Occupational and Environmental Medicine, Region Stockholm, Stockholm, Sweden
| | - Johan Askling
- grid.4714.60000 0004 1937 0626Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden ,grid.24381.3c0000 0000 9241 5705Rheumatology, Theme Inflammation & Ageing, Karolinska University Hospital, Stockholm, Sweden
| | - Sofia Ernestam
- Academic Specialist Center, Stockholm Health Services, Stockholm, Sweden
| | - Saedis Saevarsdottir
- grid.4714.60000 0004 1937 0626Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden ,grid.14013.370000 0004 0640 0021Faculty of Medicine, School of Health Sciences, University of Iceland, Reykjavik, Iceland
| | - Lotta Ljung
- grid.4714.60000 0004 1937 0626Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden ,Academic Specialist Center, Stockholm Health Services, Stockholm, Sweden ,grid.12650.300000 0001 1034 3451Department for Public Health and Clinical Medicine/Rheumatology, Umeå University, Umeå, Sweden
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6
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Marques ML, Alunno A, Boonen A, Ter Wee MM, Falzon L, Ramiro S, Putrik P. Methodological aspects of design, analysis and reporting of studies with work participation as an outcome domain in patients with inflammatory arthritis: results of two systematic literature reviews informing EULAR points to consider. RMD Open 2021; 7:rmdopen-2020-001522. [PMID: 33542048 PMCID: PMC7868290 DOI: 10.1136/rmdopen-2020-001522] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 01/06/2021] [Accepted: 01/14/2021] [Indexed: 12/12/2022] Open
Abstract
Objective To summarise the methodological aspects in studies with work participation (WP) as outcome domain in inflammatory arthritis (IA) and other chronic diseases. Methods Two systematic literature reviews (SLRs) were conducted in key electronic databases (2014–2019): search 1 focused on longitudinal prospective studies in IA and search 2 on SLRs in other chronic diseases. Two reviewers independently identified eligible studies and extracted data covering pre-defined methodological areas. Results In total, 58 studies in IA (22 randomised controlled trials, 36 longitudinal observational studies) and 24 SLRs in other chronic diseases were included. WP was the primary outcome in 26/58 (45%) studies. The methodological aspects least accounted for in IA studies were as follows (proportions of studies positively adhering to the topic are shown): aligning the studied population (16/58 (28%)) and sample size calculation (8/58 (14%)) with the work-related study objective; attribution of WP to overall health (28/58 (48%)); accounting for skewness of presenteeism/sick leave (10/52 (19%)); accounting for work-related contextual factors (25/58 (43%)); reporting attrition and its reasons (1/58 (2%)); reporting both aggregated results and proportions of individuals reaching predefined meaningful change or state (11/58 (16%)). SLRs in other chronic diseases confirmed heterogeneity and methodological flaws identified in IA studies without identifying new issues. Conclusion High methodological heterogeneity was observed in studies with WP as outcome domain. Consensus around various methodological aspects specific to WP studies is needed to improve quality of future studies. This review informs the EULAR Points to Consider for conducting and reporting studies with WP as an outcome in IA.
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Affiliation(s)
- Mary Lucy Marques
- Rheumatology, Leiden University Medical Center, Leiden, Zuid-Holland, The Netherlands .,Rheumatology, Centro Hospitalar e Universitario de Coimbra EPE, Coimbra, Portugal
| | - Alessia Alunno
- Rheumatology Unit, University of Perugia Department of Medicine, Perugia, Umbria, Italy
| | - Annelies Boonen
- Department of Internal Medicine, Maastricht University Medical Centre, Maastricht, Limburg, The Netherlands.,Department of Health Services Research, Universiteit Maastricht Care and Public Health Research Institute, Maastricht, Limburg, The Netherlands
| | - Marieke M Ter Wee
- Department of Epidemiology and Data Science, Amsterdam Public Health, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,Department of Rheumatology and immunology, AI&I, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Louise Falzon
- Center for Personalized Health, Feinstein Institutes for Medical Research, Northwell Health, New York, New York, USA
| | - Sofia Ramiro
- Rheumatology, Leiden University Medical Center, Leiden, Zuid-Holland, The Netherlands.,Rheumatology, Zuyderland Medical Centre Heerlen, Heerlen, Limburg, The Netherlands
| | - Polina Putrik
- Department of Internal Medicine, Maastricht University Medical Centre, Maastricht, Limburg, The Netherlands.,Department of Health Services Research, Universiteit Maastricht Care and Public Health Research Institute, Maastricht, Limburg, The Netherlands
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7
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Chopra A, Lin HY, Navarra SV, Saeed MA, Sockalingam S, Thongpooswan S, Jois R, Salim B, Gavin Lee KW, Lau TC, Wee J. Rheumatoid arthritis management in the APLAR region: Perspectives from an expert panel of rheumatologists, patients and community oriented program for control of rheumatic diseases. Int J Rheum Dis 2021; 24:1106-1111. [PMID: 34375036 DOI: 10.1111/1756-185x.14185] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Revised: 07/07/2021] [Accepted: 07/12/2021] [Indexed: 12/29/2022]
Abstract
Rheumatoid arthritis (RA) is a major health burden in Asia Pacific affecting the quality of life of patients and consuming healthcare resources. According to recent estimates from the World Health Organization-International League Against Rheumatism-Community Oriented Program for Control of Rheumatic Diseases, prevalence is around 0.3%-0.5%. Management guidelines have helped to improve treatment across this diverse region. To gain better insight into current real-world management applications in view of these guidelines, virtual meetings were conducted in mid-2020 to explore perspectives of rheumatologists and patients, as well as discuss the impact of coronavirus disease 2019 on RA management. Patients and rheumatologists from Hong Kong, Malaysia, Singapore, the Philippines, Thailand, India, Pakistan, and Taiwan were included, representing a diverse mix of healthcare systems, wealth, ethnicity and culture. Despite many countries having prospered in recent years, similar challenges in RA diagnosis and treatment were identified. The daily impact and patient experience of RA were also similar across countries, marked by "silent" pain and disability, and universal misunderstanding of the disease. Late diagnosis and treatment, and barriers to access to appropriate treatment, remain problematic. The experience shared by Taiwan offers a glimmer of hope, however, wherein patient advocacy groups have succeeded in being included in policy-making decisions and securing access to advanced treatment. Real-world solutions that pay heed to the unique local needs and diversity of Asia Pacific are required to improve RA management, which will take time. In the interim, help can be sought from the trained, non-rheumatologist community to reduce some of the disease burden.
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Affiliation(s)
| | - Hsiao-Yi Lin
- Clinical Research Center and Division of Allergy, Immunology and Rheumatology, Department of Medicine, Cheng Hsin General Hospital, Taipei, Taiwan
| | - Sandra V Navarra
- Rheumatology Center, University of Santo Tomas Hospital, Manila, Philippines
| | | | - Sargunan Sockalingam
- Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | | | - Ramesh Jois
- Department of Rheumatology & Clinical Immunology, Vikram Hospital, Bangalore, India
| | - Babur Salim
- Fauji Foundation Hospital Rawapindi Pakistan, Rawapindi, Pakistan
| | | | - Tang Ching Lau
- Division of Rheumatology, Department of Medicine, National University Hospital, Singapore, Singapore
| | - James Wee
- Pfizer Inc., Makati City, Philippines
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8
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Treatment satisfaction with rheumatoid arthritis in patients with different disease severity and financial burden: A subgroup analysis of a nationwide survey in China. Chin Med J (Engl) 2021; 133:892-898. [PMID: 32187053 PMCID: PMC7176451 DOI: 10.1097/cm9.0000000000000749] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Despite the recent advances in treatments for rheumatoid arthritis (RA), there are still unmet needs in disease outcomes. This study aimed to analyze the satisfaction with drug therapies for RA according to the levels of disease severity (patient-assessed) and proportions of treatment cost to household income. METHODS This was a subgroup study of a cross-sectional study in patients with RA and their physicians. The patients were subdivided into different subgroups based on their self-assessed severity of RA and on the proportions of treatment cost to household income (<10%, 10-30%, 31-50%, and >50%). The Treatment Satisfaction Questionnaire for Medication version II was used to assess patients' treatment satisfaction. RESULTS When considering all medications, effectiveness, convenience, and global satisfaction scores were lower in the severe and moderate RA subgroups than those in the mild and extremely mild RA subgroups (all P < 0.001). Effectiveness, side effects, and convenience scores were higher in the <10% subgroup compared to those in the >50% subgroup (all P < 0.05). Global satisfaction score was higher in the <10% subgroup than that in the 31% to 50% subgroup (F = 13.183, P = 0.004). For biological disease-modifying anti-rheumatic drugs, effectiveness and convenience scores were lower in the severe RA subgroup than those in the extremely mild RA subgroup (both P < 0.05). Convenience score was higher in the <10% subgroup compared to that in the 31% to 50% and >50% subgroups (F = 12.646, P = 0.005). Global satisfaction score was higher in the <10% subgroup than that in the 31% to 50% subgroup (F = 8.794, P = 0.032). CONCLUSION Higher disease severity and higher financial burden were associated with lower patient satisfaction.
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9
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Roodenrijs NMT, Welsing PMJ, van der Goes MC, Tekstra J, Lafeber FPJG, Jacobs JWG, van Laar JM. Healthcare utilization and economic burden of difficult-to-treat rheumatoid arthritis: a cost-of-illness study. Rheumatology (Oxford) 2021; 60:4681-4690. [PMID: 33502493 DOI: 10.1093/rheumatology/keab078] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Accepted: 12/21/2020] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES To determine the impact of difficult-to-treat rheumatoid arthritis (D2T RA) on (costs related to) healthcare utilization, other resource use and work productivity. METHODS Data regarding healthcare utilization, other resource use and work productivity of 52 D2T (according to the EULAR definition) and 100 non-D2T RA patients were collected via a questionnaire and an electronic patient record review during a study visit. Annual costs were calculated and compared between groups. Multivariable linear regression analysis was performed to assess whether having D2T RA was associated with higher costs. RESULTS Mean (95% CI) annual total costs were €37 605 (€27 689 - €50 378) for D2T and €19 217 (€15 647 - €22 945) for non-D2T RA patients (P<0.001). D2T RA patients visited their rheumatologist more frequently, were more often admitted to day-care facilities, underwent more laboratory tests and used more drugs (specifically targeted synthetic DMARDs), compared with non-D2T RA patients (P<0.01). In D2T RA patients, the main contributors to total costs were informal help of family and friends (28%), drugs (26%) and loss of work productivity (16%). After adjustment for physical functioning (HAQ), having D2T RA was no longer statistically significantly associated with higher total costs. HAQ was the only independent determinant of higher costs in multivariable analysis. CONCLUSIONS The economic burden of D2T RA is significantly higher than that of non-D2T RA, indicated by higher healthcare utilization and higher annual total costs. Functional disability is a key determinant of higher costs in RA.
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Affiliation(s)
- Nadia M T Roodenrijs
- Department of Rheumatology & Clinical Immunology, University Medical Center Utrecht, Utrecht University, Utrecht
| | - Paco M J Welsing
- Department of Rheumatology & Clinical Immunology, University Medical Center Utrecht, Utrecht University, Utrecht
| | - Marlies C van der Goes
- Department of Rheumatology & Clinical Immunology, University Medical Center Utrecht, Utrecht University, Utrecht.,Department of Rheumatology, Meander Medical Center, Amersfoort, The Netherlands
| | - Janneke Tekstra
- Department of Rheumatology & Clinical Immunology, University Medical Center Utrecht, Utrecht University, Utrecht
| | - Floris P J G Lafeber
- Department of Rheumatology & Clinical Immunology, University Medical Center Utrecht, Utrecht University, Utrecht
| | - Johannes W G Jacobs
- Department of Rheumatology & Clinical Immunology, University Medical Center Utrecht, Utrecht University, Utrecht
| | - Jacob M van Laar
- Department of Rheumatology & Clinical Immunology, University Medical Center Utrecht, Utrecht University, Utrecht
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10
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Leng YF, He J, Li C, Chen B, Wang DW, Chen FQ, Xie T, Xu X, Sun ZL. Urinary metabolomics reveals the therapeutic mechanism of moxibustion on collagen-induced arthritis in rats. Eur J Integr Med 2020. [DOI: 10.1016/j.eujim.2020.101160] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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11
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Disease course and healthcare costs of a cohort of rheumatoid arthritis patients from Turkey. Rheumatol Int 2020; 40:1037-1044. [PMID: 32253500 DOI: 10.1007/s00296-020-04574-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Accepted: 03/27/2020] [Indexed: 10/24/2022]
Abstract
The objective of the study is to assess the disease course and associated healthcare costs in a cohort of established rheumatoid arthritis (RA) patients in Turkey. The study cohort consisted of 75 RA patients from our outpatient clinic who took part in a previous multicenter study assessing RA-related healthcare costs 6 years ago. In March 2018, we attempted to re-evaluate these patients with the same questionnaire of the previous study enabling us to get information on medication use, comorbidities, and RA-related healthcare costs. We used RAPID-3 for assessing disease activity, HAQ-DI for functional status and EQ-5D for quality of life. Sixty-two (83%) patients were re-evaluated, seven (9.3%) had died and three (4%) were receiving palliative care following major cardiovascular events. Forty-seven (76%) patients had used at least one biologic agent during 79.1 ± 3.3 months after the previous study. At the last evaluation, 34 patients (55%) were on biologics, 22 (35%) were on csDMARDs and 6 (9.6%) were off RA treatment. The mean RAPID3 score (4.3 ± 1.6 SD) was similar to that of the previous study. HAQ-DI (0.69 ± 0.57 SD) and EQ-5D (0.68 ± 0.21 SD) scores showed significant improvement over time. Median direct costs (€2998) were higher than indirect costs (€304). Medication costs were high (€2958). Disease activity remained stable, while functional status and QoL had improved over time. Serious infections and cardiovascular disability are a concern. Medication costs are still the main determinant of RA-related healthcare costs.
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12
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Abstract
A treat-to-target approach to psoriatic arthritis has emerged as a topic of interest following successful application of this treatment paradigm to rheumatoid arthritis. In psoriatic arthritis, this has been examined in one randomized trial to date showing benefits of a tight control treatment strategy over standard care. Nonetheless, international treatment recommendations have called for clinicians to aim for a target of remission or low disease activity, although little or no consensus exists on how to measure these targets. An ideal measure to define a treatment target should be able to address all the disease domains and preferences pertinent to an individual patient.
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Affiliation(s)
- Amy D Zhang
- University of California, San Diego, 9500 Gilman Drive, La Jolla, CA 92093-0943, USA
| | - Arthur Kavanaugh
- University of California, San Diego, 9500 Gilman Drive, La Jolla, CA 92093-0943, USA.
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13
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Olofsson T, Söderling JK, Gülfe A, Kristensen LE, Wallman JK. Patient-Reported Outcomes Are More Important Than Objective Inflammatory Markers for Sick Leave in Biologics-Treated Patients With Rheumatoid Arthritis. Arthritis Care Res (Hoboken) 2019; 70:1712-1716. [PMID: 29885037 DOI: 10.1002/acr.23619] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Accepted: 06/05/2018] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To study the impact of common noncomposite disease activity measures on sick leave in biologics-treated patients with rheumatoid arthritis (RA). METHODS Data from study visits by biologics-treated RA patients of working age (<65 years) in the observational South Swedish Arthritis Treatment Group Register between 2005 and 2011, were included (5,118 visits by 941 patients). We performed association analyses between various noncomposite disease activity measures at each visit and the number of days of sick leave during the subsequent month; this information was retrieved from the Social Insurance Agency. Adjusted separate generalized estimating equation regression models were used, and analyses were stratified according to sick leave status for the month preceding each visit (no, partial, or full sick leave). Results are presented as standardized beta coefficients for comparability. RESULTS Among modifiable noncomposite disease activity measures, patient's assessment of pain and disease activity scored on a visual analog scale (VAS) were most strongly associated with subsequent sick leave, irrespective of baseline sick leave status. Generally, measures that were more objective (swollen joint count, erythrocyte sedimentation rate, and C-reactive protein) had less impact on sick leave compared with variables that were more subjective (patient's pain and global scores on a VAS, evaluator's global assessment of disease activity on a 5-grade Likert scale, and tender joint count). CONCLUSION Measures of disease activity that are more subjective have a greater impact on sick leave in biologics-treated patients with RA compared with variables that are more objective, suggesting a stronger focus on subjective measures when targeting work loss or intervening to reduce it.
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Affiliation(s)
- Tor Olofsson
- Lund University and Skåne University Hospital, Lund, Sweden
| | | | - Anders Gülfe
- Lund University and Skåne University Hospital, Lund, Sweden
| | - Lars-Erik Kristensen
- Lund University, Lund, Sweden, and the Parker Institute, Frederiksberg and Bispebjerg, Copenhagen, Denmark
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14
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Fautrel B, Alten R, Kirkham B, de la Torre I, Durand F, Barry J, Holzkaemper T, Fakhouri W, Taylor PC. Call for action: how to improve use of patient-reported outcomes to guide clinical decision making in rheumatoid arthritis. Rheumatol Int 2018; 38:935-947. [PMID: 29564549 PMCID: PMC5953992 DOI: 10.1007/s00296-018-4005-5] [Citation(s) in RCA: 59] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Accepted: 03/03/2018] [Indexed: 01/05/2023]
Abstract
Current guidelines for the management of rheumatoid arthritis (RA) recommend early treatment and a treat-to-target goal of remission or low disease activity. Over the past decade, this approach has been extremely successful in reducing disease activity and joint damage in patients with RA. At the same time, however, overall patient perception of well-being appears to have decreased with respect to outcome measures considered important by patients themselves, such as pain, fatigue, physical function and quality of life. The timely and effective use of patient-reported outcomes (PROs) could encourage physicians to focus more on the impact of RA on patients and how patients are feeling. This in turn would facilitate shared decision making between patients and physicians, ultimately leading to a more patient-centered approach and improved patient care. Indeed, PROs provide information about individual patients that complements information provided by physical assessment and composite scores, and can also be used to guide patient care, such as determining whether a clinic visit is needed or whether treatment modifications are necessary. This is particularly important for patients who do not achieve the aspirational target of remission or low disease activity with pharmacological treatment. A number of validated PRO questionnaires are available, but how and which PROs should be incorporated into rheumatology clinical practice as part of the decision-making process is still controversial. Combining PROs with technology, such as computer adaptive tests, electronic PRO systems, web-based platforms and patient dashboards, could further aid PRO integration into daily rheumatology clinical practice.
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Affiliation(s)
- Bruno Fautrel
- Institut Pierre Louis d'Epidémiologie et de Santé Publique, Sorbonne Universités, UPMC Universitaire Paris 06, Paris, France
- Department of Rheumatology, Pitié-Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Rieke Alten
- Schlosspark-Klinik University Medicine, 14059, Berlin, Germany
| | - Bruce Kirkham
- Department of Rheumatology, Guys and St Thomas' NHS Trust, Great Maze Pond, London, SE1 9RT, UK
| | | | | | - Jane Barry
- Eli Lilly and Company, Basingstoke, Hampshire, UK
| | | | - Walid Fakhouri
- Eli Lilly and Company, Indianapolis, IN, USA
- Eli Lilly and Company, Basingstoke, Hampshire, UK
| | - Peter C Taylor
- Botnar Research Centre, NDORMS, University of Oxford, Oxford, UK.
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15
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Ji J, Zhang L, Zhang Q, Yin R, Fu T, Li L, Gu Z. Functional disability associated with disease and quality-of-life parameters in Chinese patients with rheumatoid arthritis. Health Qual Life Outcomes 2017; 15:89. [PMID: 28464888 PMCID: PMC5414118 DOI: 10.1186/s12955-017-0659-z] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2016] [Accepted: 04/19/2017] [Indexed: 01/29/2023] Open
Abstract
Background As an important outcome measure among rheumatoid arthritis (RA) patients, functional disability may contribute to unemployment, loss of work productivity, and impaired quality of life. However, little is known about the risk factors of functional disability in Chinese RA patients. This study aimed (1) to examine the prevalence of functional disability in Chinese RA patients; (2) to explore factors associated with the health assessment questionnaire-disability index (HAQ-DI). Methods A total of 101 RA patients in this cross-sectional study underwent standardized laboratory examinations and responded to the questionnaire for demographic data, the HAQ-DI for functional disability, the Compliance Questionnaire on Rheumatology (CQR) for medication adherence, the Hospital Anxiety and Depression Scale (HADS) for psychological status, and the Short Form 36 health survey (SF-36) for quality of life. Pain, grip/pinch strength, disease activity, and large joint mobility were recorded. Independent samples t-tests, chi-square analyses, and logistic regression modeling were used to analyze the data. Results The mean ± SD age of RA patients was 54.9 ± 11.9 years. Approximately 15.8% RA patients in mainland China experience functional disability (defined as a HAQ-DI score ≥ 1). Long disease duration, pain, high disease activity, a larger number of tender and swollen joints, high C-reactive protein (CRP) level, decreased grip strength, and limitation of shoulder, elbow, wrist, knee, and ankle motion were associated with the HAQ-DI. Participants with functional disability tended to have more severe depressive symptoms and a lower quality of life compared with individuals without functional disability. Stepwise logistic regression analyses found that limitation of wrist extension (P = 0.001) and lower body pain (BP) score (P = 0.001) explained higher HAQ-DI score. Conclusions The present study reported that functional disability was common in Chinese RA patients. A low quality of life and limitation of joint mobility had great impacts on functional disability in Chinese RA patients. Targeted and culturally sensitive interventions should be strengthened to delay the onset of disabilities of this population.
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Affiliation(s)
- Juan Ji
- Department of Rheumatology, Affiliated Hospital of Nantong University, 20th Xisi Road, 226001, Nantong, People's Republic of China
| | - Lijuan Zhang
- Department of Rheumatology, Affiliated Hospital of Nantong University, 20th Xisi Road, 226001, Nantong, People's Republic of China.,School of Nursing, Nantong University, 19th Qixiu Road, 226001, Nantong, People's Republic of China
| | - Qiuxiang Zhang
- Department of Rheumatology, Affiliated Hospital of Nantong University, 20th Xisi Road, 226001, Nantong, People's Republic of China.,School of Nursing, Nantong University, 19th Qixiu Road, 226001, Nantong, People's Republic of China
| | - Rulan Yin
- Department of Rheumatology, Affiliated Hospital of Nantong University, 20th Xisi Road, 226001, Nantong, People's Republic of China.,School of Nursing, Nantong University, 19th Qixiu Road, 226001, Nantong, People's Republic of China
| | - Ting Fu
- Department of Rheumatology, Affiliated Hospital of Nantong University, 20th Xisi Road, 226001, Nantong, People's Republic of China.,School of Nursing, Nantong University, 19th Qixiu Road, 226001, Nantong, People's Republic of China
| | - Liren Li
- School of Nursing, Nantong University, 19th Qixiu Road, 226001, Nantong, People's Republic of China.
| | - Zhifeng Gu
- Department of Rheumatology, Affiliated Hospital of Nantong University, 20th Xisi Road, 226001, Nantong, People's Republic of China.
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16
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Allen PB, Olivera P, Emery P, Moulin D, Jouzeau JY, Netter P, Danese S, Feagan B, Sandborn WJ, Peyrin-Biroulet L. Review article: moving towards common therapeutic goals in Crohn's disease and rheumatoid arthritis. Aliment Pharmacol Ther 2017; 45:1058-1072. [PMID: 28247573 DOI: 10.1111/apt.13995] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2016] [Revised: 08/01/2016] [Accepted: 01/28/2017] [Indexed: 12/11/2022]
Abstract
BACKGROUND Crohn's disease (CD) and rheumatoid arthritis are chronic, progressive and disabling conditions that frequently lead to structural tissue damage. Based on strategies originally developed for rheumatoid arthritis, the treatment goal for CD has recently moved from exclusively controlling symptoms to both clinical remission and complete mucosal healing (deep remission), with the final aim of preventing bowel damage and disability. AIM To review the similarities and differences in treatment goals between CD and rheumatoid arthritis. METHODS This review examined manuscripts from 1982 to 2016 that discussed and/or proposed therapeutic goals with their supportive evidence in CD and rheumatoid arthritis. RESULTS Proposed therapeutic strategies to improve outcomes in both rheumatoid arthritis and CD include: (i) evaluation of musculoskeletal or organ damage and disability, (ii) tight control, (iii) treat-to-target, (iv) early intervention and (v) disease modification. In contrast to rheumatoid arthritis, there is a paucity of disease-modification trials in CD. CONCLUSIONS Novel therapeutic strategies in CD based on tight control of objective signs of inflammation are expected to change disease course and patients' lives by halting progression or, ideally, preventing the occurrence of bowel damage. Most of these strategies require validation in prospective studies, whereas several disease-modification trials have addressed these issues in rheumatoid arthritis over the last decade. The recent approval of new drugs in CD such as vedolizumab and ustekinumab should facilitate initiation of disease-modification trials in CD in the near future.
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Affiliation(s)
- P B Allen
- Division of Gastroenterology, Ulster Hospital, Belfast, UK
| | - P Olivera
- Gastroenterology Section, Department of Internal Medicine, Centro de Educación Médica e Investigaciones Clínicas (CEMIC), Buenos Aires, Argentina
| | - P Emery
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - D Moulin
- UMR 7365 IMoPA CNRS-Université de Lorraine, Biopôle de l'Université de Lorraine, Campus Biologie-Santé, Vandœuvre-lès-Nancy Cedex, France
| | - J-Y Jouzeau
- UMR 7365 IMoPA CNRS-Université de Lorraine, Biopôle de l'Université de Lorraine, Campus Biologie-Santé, Vandœuvre-lès-Nancy Cedex, France
| | - P Netter
- UMR 7365 IMoPA CNRS-Université de Lorraine, Biopôle de l'Université de Lorraine, Campus Biologie-Santé, Vandœuvre-lès-Nancy Cedex, France
| | - S Danese
- Department of Gastroenterology, IBD Center, Istituto Clinico Humanitas, Humanitas University, Milan, Italy
| | - B Feagan
- Western University, London, ON, Canada
| | - W J Sandborn
- Division of Gastroenterology, University of California San Diego, La Jolla, CA, USA
| | - L Peyrin-Biroulet
- Inserm U954 and Department of Hepato-Gastroenterology, University Hospital of Nancy, Lorraine University, Vandoeuvre-les-Nancy, France
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17
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Shim EJ, Hahm BJ, Go DJ, Lee KM, Noh HL, Park SH, Song YW. Modeling quality of life in patients with rheumatic diseases: the role of pain catastrophizing, fear-avoidance beliefs, physical disability, and depression. Disabil Rehabil 2017; 40:1509-1516. [PMID: 28291952 DOI: 10.1080/09638288.2017.1300691] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
PURPOSE To examine factors in the fear-avoidance model, such as pain, pain catastrophizing, fear-avoidance beliefs, physical disability, and depression and their relationships with physical and psychological quality of life in patients with rheumatic diseases. MATERIALS AND METHODS The data were obtained from 360 patients with rheumatic diseases who completed self-report measures assessing study variables. Structural equation modeling was used to examine the hypothesized relationships among factors specified in the fear-avoidance model predicting physical and psychological quality of life. RESULTS Final models fit the data well, explaining 96% and 82% of the variance in physical and psychological quality of life, respectively. Higher pain catastrophizing was related to stronger fear-avoidance beliefs that had a direct negative association with physical disability and depression, which, in turn, negatively affected physical quality of life. Pain severity was also directly related to physical disability. Physical disability also affected physical quality of life indirectly through depression. The hypothesized relationships specified in the model were also confirmed for psychological quality of life. However, physical disability had an indirect association with psychological quality of life via depression. CONCLUSION The current results underscore the significant role of cognitive, affective, and behavioral factors in perceived physical disability and their mediated detrimental effect on physical and psychological quality of life in patients with rheumatic diseases. Implications for rehabilitation The fear-avoidance model is applicable to the prediction of quality of life in patients with rheumatic diseases. As pain-catastrophizing and fear-avoidance beliefs are important factors linked to physical disability and depression, intervening these cognitive factors is necessary to improve physical function and depression in patients with rheumatic diseases. Considering the strong association between depression and physical and psychological quality of life, the assessment and treatment of the former should be included in the rehabilitation of patients with rheumatic diseases. Interventions targeting physical function and depression are likely to be effective in terms of improving physical and psychological quality of life in patients with rheumatic diseases.
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Affiliation(s)
- Eun-Jung Shim
- a Department of Psychology , Pusan National University , Busan , Republic of Korea
| | - Bong-Jin Hahm
- b Department of Neuropsychiatry , Seoul National University Hospital , Seoul , Republic of Korea.,c Department of Psychiatry and Behavioral Science , Seoul National University College of Medicine , Seoul , Republic of Korea
| | - Dong Jin Go
- d Department of Molecular Medicine and Biopharmaceutical Sciences, Graduate School of Convergence Science and Technology, and College of Medicine , Medical Research Center, Seoul National University , Seoul , Republic of Korea.,e Department of Internal Medicine, Division of Rheumatology , Seoul National University College of Medicine , Seoul , Republic of Korea
| | - Kwang-Min Lee
- c Department of Psychiatry and Behavioral Science , Seoul National University College of Medicine , Seoul , Republic of Korea.,f Department of Psychiatry , Gyeonggi provincial Medical Center Uijeongbu Hospital , Uijeongbusi , Republic of Korea
| | - Hae Lim Noh
- a Department of Psychology , Pusan National University , Busan , Republic of Korea
| | - Seung-Hee Park
- a Department of Psychology , Pusan National University , Busan , Republic of Korea
| | - Yeong Wook Song
- d Department of Molecular Medicine and Biopharmaceutical Sciences, Graduate School of Convergence Science and Technology, and College of Medicine , Medical Research Center, Seoul National University , Seoul , Republic of Korea.,e Department of Internal Medicine, Division of Rheumatology , Seoul National University College of Medicine , Seoul , Republic of Korea
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18
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Conigliaro P, Ciccacci C, Politi C, Triggianese P, Rufini S, Kroegler B, Perricone C, Latini A, Novelli G, Borgiani P, Perricone R. Polymorphisms in STAT4, PTPN2, PSORS1C1 and TRAF3IP2 Genes Are Associated with the Response to TNF Inhibitors in Patients with Rheumatoid Arthritis. PLoS One 2017; 12:e0169956. [PMID: 28107378 PMCID: PMC5249113 DOI: 10.1371/journal.pone.0169956] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2016] [Accepted: 12/27/2016] [Indexed: 11/29/2022] Open
Abstract
Objective Rheumatoid Arthritis (RA) is a progressive autoimmune disease characterized by chronic joint inflammation and structural damage. Remission or at least low disease activity (LDA) represent potentially desirable goals of RA treatment. Single nucleotide polymorphisms (SNPs) in several genes might be useful for prediction of response to therapy. We aimed at exploring 4 SNPs in candidate genes (STAT4, PTPN2, PSORS1C1 and TRAF3IP2) in order to investigate their potential role in the response to therapy with tumor necrosis factor inhibitors (TNF-i) in RA patients. Methods In 171 RA patients we investigated the following SNPs: rs7574865 (STAT4), rs2233945 (PSORS1C1), rs7234029 (PTPN2) and rs33980500 (TRAF3IP2). Remission, LDA, and EULAR response were registered at 6 months and 2 years after initiation of first line TNF-i [Adalimumab (ADA) and Etanercept (ETN)]. Results STAT4 variant allele was associated with the absence of a good/moderate EULAR response at 2 years of treatment in the whole RA group and in ETN treated patients. The PTPN2 SNP was associated with no good/moderate EULAR response at 6 months in ADA treated patients. Patients carrying PSORS1C1 variant allele did not reach LDA at 6 months in both the whole RA group and ETN treated patients. TRAF3IP2 variant allele was associated with the lack of LDA and remission achievement at 6 months in all RA cohort while an association with no EULAR response at 2 years of treatment occurred only in ETN treated patients. Conclusions For the first time, we reported that SNPs in STAT4, PTPN2, PSORS1C1, and TRAF3IP2 are associated with response to TNF-i treatment in RA patients; however, these findings should be validated in a larger population.
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Affiliation(s)
- Paola Conigliaro
- Clinic of Rheumatology, Allergology and Clinical Immunology, Department of “Medicina dei Sistemi”, University of Rome Tor Vergata, Rome, Italy
| | - Cinzia Ciccacci
- Department of Biomedicine and Prevention, Genetics Section, University of Rome Tor Vergata, Rome, Italy
| | - Cristina Politi
- Department of Biomedicine and Prevention, Genetics Section, University of Rome Tor Vergata, Rome, Italy
| | - Paola Triggianese
- Clinic of Rheumatology, Allergology and Clinical Immunology, Department of “Medicina dei Sistemi”, University of Rome Tor Vergata, Rome, Italy
- * E-mail:
| | - Sara Rufini
- Department of Biomedicine and Prevention, Genetics Section, University of Rome Tor Vergata, Rome, Italy
| | - Barbara Kroegler
- Clinic of Rheumatology, Allergology and Clinical Immunology, Department of “Medicina dei Sistemi”, University of Rome Tor Vergata, Rome, Italy
| | - Carlo Perricone
- Reumatologia, Dipartimento di Medicina Interna e Specialità Mediche, Sapienza Università di Roma, Rome, Italy
| | - Andrea Latini
- Department of Biomedicine and Prevention, Genetics Section, University of Rome Tor Vergata, Rome, Italy
| | - Giuseppe Novelli
- Department of Biomedicine and Prevention, Genetics Section, University of Rome Tor Vergata, Rome, Italy
| | - Paola Borgiani
- Department of Biomedicine and Prevention, Genetics Section, University of Rome Tor Vergata, Rome, Italy
| | - Roberto Perricone
- Clinic of Rheumatology, Allergology and Clinical Immunology, Department of “Medicina dei Sistemi”, University of Rome Tor Vergata, Rome, Italy
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