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Witkam R, Gwinnutt JM, Humphreys J, Verstappen SMM. Is the relationship between deprivation and outcomes in rheumatoid arthritis mediated by body mass index? A longitudinal cohort study. Rheumatology (Oxford) 2023; 62:2394-2401. [PMID: 36440889 PMCID: PMC10321122 DOI: 10.1093/rheumatology/keac662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Accepted: 11/13/2022] [Indexed: 07/20/2023] Open
Abstract
OBJECTIVES To understand the relationships between deprivation and obesity with self-reported disability and disease activity in people with RA, and to determine whether BMI mediates the relationship between area-level deprivation and these outcomes. METHODS Data came from the Rheumatoid Arthritis Medication Study (RAMS), a 1-year multicentre prospective observational cohort of people with RA recruited from rheumatology centres across England commencing MTX for the first time. A total of 1529 and 1626 people were included who had a baseline and at least one follow-up measurement at 6 or 12 months of HAQ-Disability Index (HAQ-DI) and DAS in 28 joints (DAS28), respectively. Linear mixed models estimated the associations of deprivation and obesity with repeated measures HAQ-DI and DAS28. Causal mediation analyses estimated the mediating effect of BMI on the relationship between deprivation and RA outcomes. RESULTS Higher deprivation and obesity were associated with higher disability [adjusted regression coefficients highest vs lowest deprivation fifths 0.32 (95% CI 0.19, 0.45); obesity vs no obesity 0.13 (95% CI 0.06, 0.20)] and higher disease activity [adjusted regression coefficients highest vs lowest deprivation fifths 0.34 (95% CI 0.11, 0.58); obesity vs no obesity 0.17 (95% CI 0.04, 0.31)]. BMI mediated part of the association between higher deprivation and self-reported disability (14.24%) and DAS (17.26%). CONCLUSIONS People with RA living in deprived areas have a higher burden of disease, which is partly mediated through obesity. Weight-loss strategies in RA could be better targeted towards those living in deprived areas.
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Affiliation(s)
- Rozemarijn Witkam
- Centre for Epidemiology Versus Arthritis, Division of Musculoskeletal and Dermatological Sciences, The University of Manchester, Manchester, UK
| | - James M Gwinnutt
- Centre for Epidemiology Versus Arthritis, Division of Musculoskeletal and Dermatological Sciences, The University of Manchester, Manchester, UK
| | - Jennifer Humphreys
- Centre for Epidemiology Versus Arthritis, Division of Musculoskeletal and Dermatological Sciences, The University of Manchester, Manchester, UK
- NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - Suzanne M M Verstappen
- Correspondence to: Suzanne M. M. Verstappen, 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, Oxford Rd, Manchester M13 9PL, UK. E-mail:
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Direskeneli H, Karadag O, Ates A, Tufan A, Inanc N, Koca SS, Cetin GY, Akar S, Cinar M, Yilmaz S, Yilmaz N, Dalkilic E, Bes C, Yilmazer B, Sahin A, Ersözlü D, Tezcan ME, Sen N, Keser G, Kalyoncu U, Armagan B, Hacibedel B, Helvacioglu K, Cesur TY, Basibuyuk CS, Alkan S, Gunay LM. Quality of life, disease activity and preferences for administration routes in rheumatoid arthritis: a multicentre, prospective, observational study. Rheumatol Adv Pract 2022; 6:rkac071. [PMID: 36133962 PMCID: PMC9486987 DOI: 10.1093/rap/rkac071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 07/10/2022] [Indexed: 11/22/2022] Open
Abstract
Objective We aimed to evaluate quality of life (QoL), disease activity, compliance to treatment, patient and physician preferences for route of administration (RoA), status of health and pain in RA patients starting advanced treatments or needing a switch, and the factors associated with patient preferences. Methods A multicentre, prospective, observational and 1-year follow-up study was conducted, between 2015 and 2020, in adult RA patients using advanced treatments for the first time or needing a switch in their current treatments. All the data collected were entered into electronic case report forms. DAS in 28 joints with ESR [DAS28-4(ESR)], EuroQol 5-Dimensional Questionnaire (EQ-5D), HAQ Disability Index (HAQ-DI), Compliance Questionnaire for Rheumatology (CQR-19), Work Productivity and Activity Impairment Instrument (WPAI) and Patient Global Assessment-Visual Analogue Scale (PGA-VAS) questionnaires were used for longitudinal assessments. Results Four hundred and fifty-nine patients were enrolled. Three hundred and eight patients (67.1%) attended the final study visit at 12 months and were included for comparative analyses. Irrespective of RoA, the disease activity and QoL improved significantly at 12 months, whereas compliance worsened. At baseline and 12 months, EQ-5D and DAS28-4(ESR) scores were significantly correlated (P < 0.001). The WPAI scores changed significantly in favour of better outcomes over 12 months after initiation of advanced treatment or switching (P < 0.001). A higher proportion of patients preferred an oral RoA, in comparison to physicians (53.6% vs 31.4%; P < 0.001). Patient and physician RoA preferences were independent of gender, age, disease duration, advanced treatment type and the EQ-5D-3L, DAS28-4(ESR), HAQ-DI, PGA-VAS and CQR-19 scores at baseline. Conclusion The oral route was more frequently preferred by patients compared with physicians, although patients’ preference rates showed a slight increase towards the end of the treatment, which might be an important factor for RA outcomes. Better control of disease activity and QoL were achieved at 12 months, regardless of RoA.
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Affiliation(s)
- Haner Direskeneli
- Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Marmara University , Istanbul, Turkey
| | - Omer Karadag
- Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Hacettepe University , Ankara, Turkey
| | - Askin Ates
- Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Ankara University , Ankara, Turkey
| | - Abdurrahman Tufan
- Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Gazi University , Ankara, Turkey
| | - Nevsun Inanc
- Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Marmara University , Istanbul, Turkey
| | - Serdar S Koca
- Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Fırat University , Elazıg, Turkey
| | - Gozde Y Cetin
- Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Kahramanmaras Sutcu Imam University , Kahramanmaras, Turkey
| | - Servet Akar
- Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Izmir Katip Celebi University , Izmir, Turkey
| | - Muhammet Cinar
- Clinic of Rheumatology, Gulhane Faculty of Medicine, Gulhane Training and Research Hospital, Health Science University , Ankara, Turkey
| | - Sedat Yilmaz
- Clinic of Rheumatology, Gulhane Faculty of Medicine, Gulhane Training and Research Hospital, Health Science University , Ankara, Turkey
| | - Neslihan Yilmaz
- Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, TC Demiroglu Bilim University , Istanbul, Turkey
| | - Ediz Dalkilic
- Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Uludag University , Bursa, Turkey
| | - Cemal Bes
- Clinic of Rheumatology, Department of Internal Medicine, Istanbul Provincial Health Directorate, Basaksehir Cam and Sakura City Hospital , Istanbul, Turkey
| | - Baris Yilmazer
- Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Trakya University , Edirne, Turkey
| | - Ali Sahin
- Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Cumhuriyet University , Sivas, Turkey
| | - Duygu Ersözlü
- Clinic of Rheumatology, Department of Internal Medicine, SBU Adana City Training and Research Hospital , Adana, Turkey
| | - Mehmet E Tezcan
- Division of Rheumatology, Department of Internal Medicine, Istanbul Provincial Health Directorate, Istanbul Kartal Dr. Lutfi Kırdar Training and Research Hospital , Istanbul, Turkey
| | - Nesrin Sen
- Division of Rheumatology, Department of Internal Medicine, Istanbul Provincial Health Directorate, Istanbul Kartal Dr. Lutfi Kırdar Training and Research Hospital , Istanbul, Turkey
| | - Gokhan Keser
- Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Ege University , Izmir, Turkey
| | - Umut Kalyoncu
- Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Hacettepe University , Ankara, Turkey
| | - Berkan Armagan
- Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Hacettepe University , Ankara, Turkey
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Bosworth A, Dubey S, Adebajo A, Moorthy A, Arora S, Salim A, Reehal J, Paudyal V, Gupta M, Kumar K. Patient Empowerment: Apni Jung (Our Fight) against Rheumatoid Arthritis for South Asian Population. Mediterr J Rheumatol 2021; 32:93-95. [PMID: 34447903 PMCID: PMC8369277 DOI: 10.31138/mjr.32.2.93] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 04/26/2021] [Accepted: 04/30/2021] [Indexed: 12/19/2022] Open
Abstract
Covid-19 has affected many populations in the UK, and ethnic minority communities in particular. People from ethnic minority communities living with long-term chronic diseases have shown to be less engaging with self-management and report having poor medication adherence. The main reason to this problem is the way information is delivered to non-English speaking patients. This editorial discusses an innovation to over this barriers in rheumatology practice.
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Affiliation(s)
- Ailsa Bosworth
- National Rheumatoid Arthritis Society, Maidenhead, United Kingdom
| | - Shirish Dubey
- Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Foundation Trust, Headington, United Kingdom
| | - Ade Adebajo
- Faculty of Medicine, Dentistry and Health, University of Sheffield, United Kingdom
| | - Arumugam Moorthy
- Department of Rheumatology, University Hospitals of Leicester, Leicestershire, United Kingdom
| | - Shivam Arora
- National Rheumatoid Arthritis Society, Maidenhead, United Kingdom
| | - Afshan Salim
- Bellevue Medical Centre, Birmingham, United Kingdom
| | - Joti Reehal
- National Rheumatoid Arthritis Society, Maidenhead, United Kingdom
| | - Vibhu Paudyal
- Institute of Clinical Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Monica Gupta
- Gartnavel General Hospital and Queen Elizabeth University Hospital, Glasgow, United Kingdom
| | - Kanta Kumar
- Institute of Clinical Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom
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Taylor PC, Betteridge N, Brown TM, Woolcott J, Kivitz AJ, Zerbini C, Whalley D, Olayinka-Amao O, Chen C, Dahl P, Ponce de Leon D, Gruben D, Fallon L. Treatment Mode Preferences in Rheumatoid Arthritis: Moving Toward Shared Decision-Making. Patient Prefer Adherence 2020; 14:119-131. [PMID: 32021123 PMCID: PMC6980841 DOI: 10.2147/ppa.s220714] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Accepted: 12/03/2019] [Indexed: 01/02/2023] Open
Abstract
PURPOSE Current knowledge of the reasons for patients' preference for rheumatoid arthritis (RA) treatment modes is limited. This study was designed to identify preferences for four treatment modes, and to obtain in-depth information on the reasons for these preferences. PATIENTS AND METHODS In this multi-national, cross-sectional, qualitative study, in-depth interviews were conducted with adult patients with RA in the United States, France, Germany, Italy, Spain, Switzerland, the United Kingdom, and Brazil. Patients' strength of preference was evaluated using a 100-point allocation task (0-100; 100=strongest) across four treatment modes: oral, self-injection, clinic-injection, and infusion. Qualitative descriptive analysis methods were used to identify, characterize, and summarize patterns found in the interview data relating to reasons for these preferences. RESULTS 100 patients were interviewed (female, 75.0%; mean age, 53.9 years; mean 11.6 years since diagnosis). Among the four treatment modes, oral administration was allocated the highest mean (standard deviation) preference points (47.3 [33.1]) and was ranked first choice by the greatest percentage of patients (57.0%), followed by self-injection (29.7 [27.7]; 29.0%), infusion (15.4 [24.6]; 16.0%), and clinic-injection (7.5 [14.1]; 2.0%). Overall, 56.0% of patients had a "strong" first-choice preference (ie, point allocation ≥70); most of these patients chose oral (62.5%) vs self-injection (23.2%), infusion (10.7%), or clinic-injection (3.6%). Speed and/or ease of administration were the most commonly reported reasons for patients choosing oral (52.6%) or self-injection (55.2%). The most common reasons for patients not choosing oral or self-injection were not wanting to take another pill (37.2%) and avoiding pain due to needles (46.5%), respectively. CONCLUSION These data report factors important to patients regarding preferences for RA treatment modes. Patients may benefit from discussions with their healthcare professionals and/or patient support groups, regarding RA treatment modes, to facilitate shared decision-making.
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Affiliation(s)
- Peter C Taylor
- Botnar Research Centre, University of Oxford, Oxford, UK
- Correspondence: Peter C Taylor Botnar Research Centre, University of Oxford, Windmill Road, Headington, OxfordOX3 7LD, UKTel +441865 227323 Email
| | | | - T Michelle Brown
- Patient-Centered Outcomes Assessment Group, RTI Health Solutions, Research Triangle Park, NC, USA
| | - John Woolcott
- Patient and Health Impact, Health Economics and Outcomes Research, Pfizer Inc, Collegeville, PA, USA
| | - Alan J Kivitz
- Altoona Center for Clinical Research, Duncansville, PA, USA
| | - Cristiano Zerbini
- Department of Rheumatology, Centro Paulista De Investigação Clinica, São Paulo, Brazil
| | - Diane Whalley
- Patient-Centered Outcomes Assessment Group, RTI Health Solutions, Manchester, UK
| | - Oyebimpe Olayinka-Amao
- Patient-Centered Outcomes Assessment Group, RTI Health Solutions, Research Triangle Park, NC, USA
| | - Connie Chen
- Xeljanz, Rheumatology, Inflammation & Immunology Medical Affairs, Pfizer Inc, New York, NY, USA
| | - Palle Dahl
- Medical Affairs, International Developed Markets, Inflammation & Immunology, Pfizer Inc, Ballerup, Denmark
| | | | - David Gruben
- Statistical Research and Data Science Center, Pfizer Inc, Groton, CT, USA
| | - Lara Fallon
- Global Medical Affairs, Pfizer Inc, Montreal, QC, Canada
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Kumar K, Stack RJ, Adebajo A, Adams J. Health-care professionals' perceptions of interacting with patients of South Asian origin attending early inflammatory arthritis clinics. Rheumatol Adv Pract 2019; 3:rkz042. [PMID: 31768498 PMCID: PMC6862933 DOI: 10.1093/rap/rkz042] [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: 06/20/2019] [Revised: 10/06/2019] [Indexed: 11/13/2022] Open
Abstract
Objective The aim was to explore the perceptions of rheumatology health-care professionals (HCPs) of interacting with patients of South Asian origin attending early inflammatory arthritis clinics. Methods We used face-to-face semi-structured interviews, designed in partnership with a clinician partner, to interview 10 HCPs involved in the running of early inflammatory arthritis clinics across seven centres in the UK. Data were recorded, transcribed by an independent company and analysed using inductive thematic analysis. Results Three emerging themes were identified that characterized consulting experiences of HCPs: varied approaches were used in early inflammatory arthritis clinic; the challenges for rheumatology HCPs in managing and delivering information to patients of South Asian origin in early inflammatory arthritis clinics; and moving towards good practice, the views on managing future patients of South Asian origin in early inflammatory arthritis clinics. Overall, HCPs found that they required additional skills to support the engagement and management for patients of South Asian origin living with inflammatory arthritis. The HCPs felt that they were less effective in addressing self-management issues for this patient group, and they found it difficult to determine adherence to medication. In such consultations, HCPs perceived that their own limitation of inadequate training contributed towards poor consultations. Conclusion For the first time, our data demonstrate that the management of patients of South Asian origin in early inflammatory arthritis clinics is under-served. To address this, HCPs have identified training needs to improve knowledge and skills in engaging with and supporting patients of South Asian origin. These findings provide a good direction for future research.
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Affiliation(s)
- Kanta Kumar
- Institute of Clinical Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham
| | - Rebecca J Stack
- Department of Psychology, Nottingham Trent University, Nottingham
| | - Ade Adebajo
- Faculty of Medicine, Dentistry and Health, University of Sheffield, Sheffield
| | - Jo Adams
- School of Health Sciences, Faculty of Environment and Life Sciences, University of Southampton, Southampton, UK
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