1
|
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.
Collapse
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
| |
Collapse
|
2
|
Wilson N, Liu J, Adamjee Q, Di Giorgio S, Steer S, Hutton J, Lempp H. Exploring the emotional impact of axial Spondyloarthritis: a systematic review and thematic synthesis of qualitative studies and a review of social media. BMC Rheumatol 2023; 7:26. [PMID: 37608395 PMCID: PMC10464274 DOI: 10.1186/s41927-023-00351-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 08/07/2023] [Indexed: 08/24/2023] Open
Abstract
BACKGROUND The psychological burden in people with inflammatory arthritis is substantial, yet little is known about the disease-related affect experienced by individuals with axial Spondyloarthritis (axial SpA). The aim of this study was to conduct a qualitative evidence synthesis and a review of social media to explore the emotional impact of living with axial SpA. METHODS We searched nine databases for studies reporting qualitative data about participants' emotional experience of living with axial SpA. In addition, we searched social media platforms for posts from people with axial SpA based in the UK that offered insights into emotional responses to living with the condition. We employed a thematic approach to synthesise the data. RESULTS We included 27 studies (1314 participants; 72% men) in our qualitative evidence synthesis and developed seven descriptive themes from the data: 1) delayed diagnosis: a barrier to emotional wellbeing; 2) disruptive symptoms: a source of mood swings; 3) work disability: a loss of self-esteem; 4) obstacles in interpersonal relationships: a trigger of distress; 5) taking up exercise: personal pride or unwelcomed reminders; 6) anti-TNF therapy: hope reignited despite concerns and 7) a journey of acceptance: worry mixed with hope. Posts extracted from social media fora (537; 48% from women) for the most part supported the seven themes. One additional theme-COVID-19, uncertainty and anxiety during the pandemic, was developed, reflecting common emotions expressed during the UK's first wave of the coronavirus pandemic. CONCLUSION This study highlights a preponderance of negative affect experienced by people living with axial SpA, conditioned through existing and anticipated symptoms, failed expectations, and lost sense of self. Given the bidirectional relationships between negative emotions and inflammation, negative emotions and perceptions of pain, and the influence of affect in self-care behaviours, this finding has important implications for treatment and management of people with axial SpA.
Collapse
Affiliation(s)
- Nicky Wilson
- Department of Rheumatology, King's College Hospital NHS Foundation Trust, London, UK.
| | - Jia Liu
- Centre for Education, Faculty of Life Sciences & Medicine, King's College London, London, UK
| | - Qainat Adamjee
- GKT School of Medical Education, King's College London, London, UK
| | - Sonya Di Giorgio
- King's College London Libraries & Collections, King's College London, London, UK
| | - Sophia Steer
- Department of Rheumatology, King's College Hospital NHS Foundation Trust, London, UK
| | - Jane Hutton
- Department of Clinical Health Psychology, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Heidi Lempp
- Department of Inflammation Biology, Centre for Rheumatic Diseases, School of Immunology and Microbial Sciences, Faculty of Life Sciences & Medicine, King's College London, London, UK
| |
Collapse
|
3
|
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.
Collapse
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
| | | |
Collapse
|
4
|
Aicha BT, Lobna BA, Yosra Z, Siwar BD, Ines C, Selma B, Leila R, Rawdha T, Olfa S, Ines M, Leila A. Assessment of self-esteem and community integration in spondyloarthritis. REUMATOLOGIA CLINICA 2023; 19:299-305. [PMID: 37286265 DOI: 10.1016/j.reumae.2022.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Accepted: 11/17/2022] [Indexed: 06/09/2023]
Abstract
INTRODUCTION The aim of this study was to identify the associated factors with lower self-esteem and restriction in community reintegration in SpA patients. METHODS This study was a cross-sectional study including SpA patients (ASAS criteria) aged 18-50 years. The level of self-esteem was assessed using the Rosenberg Self-Esteem Scale (RSES). The Reintegration to Normal Living Index (RNLI) evaluated the degree of reintegration to normal social activities. Anxiety, depression, and fibromyalgia were screened by the Hospital Anxiety and Depression Scale (HADS)-A, HADS-D, and FiRST, respectively. Statistical analysis was performed. RESULTS A total of 72 patients were enrolled (sex-ratio=1.88), with median (IQR) age of 39 years (28.25-46). Median (IQR) disease duration was 10 (6-14) years. Median (IQR) BASDAI and ASDAS were 3 (2.1-4.7) and 2.7 (1.9-3.48), respectively. Anxiety symptoms were screened in 10% of SpA patients, depression in 11%; and fibromyalgia in 10%. Median (IQR) RSES and RNLI scores were 30 (23.25-34), and 83 (53.25-93.25), respectively. Multivariate regression analysis identified the domain (work) of pain interference, VAS pain, HAD anxiety, PGA, marital status, and morning stiffness as factors associated with lower self-esteem. Restriction in the reintegration community was predicted by the presence of IBD, VAS pain, FIRST, deformity, enjoyment of life, and HAD depression. CONCLUSION Pain intensity and interference, deformities, extra-articular manifestations, and deterioration of mental health were associated with low self-esteem and severe restriction in community reintegration among patients with SpA rather than inflammatory parameters.
Collapse
Affiliation(s)
- Ben Tekaya Aicha
- Department of Rheumatology, Charles Nicolle Hospital, Tunis, Tunisia; Faculty of Medicine of Tunis, University Tunis El Manar, Tunis, Tunisia.
| | - Ben Ammar Lobna
- Department of Rheumatology, Military Hospital, Tunis, Tunisia; Faculty of Medicine of Tunis, University Tunis El Manar, Tunis, Tunisia
| | - Zgueb Yosra
- Department of Psychiatry A, Razi Hospital, La Manouba, Tunisia; Faculty of Medicine of Tunis, University Tunis El Manar, Tunis, Tunisia
| | - Ben Dhia Siwar
- Department of Rheumatology, Charles Nicolle Hospital, Tunis, Tunisia; Faculty of Medicine of Tunis, University Tunis El Manar, Tunis, Tunisia
| | - Cherif Ines
- Department of Rheumatology, Charles Nicolle Hospital, Tunis, Tunisia; Faculty of Medicine of Tunis, University Tunis El Manar, Tunis, Tunisia
| | - Bouden Selma
- Department of Rheumatology, Charles Nicolle Hospital, Tunis, Tunisia; Faculty of Medicine of Tunis, University Tunis El Manar, Tunis, Tunisia
| | - Rouached Leila
- Department of Rheumatology, Charles Nicolle Hospital, Tunis, Tunisia; Faculty of Medicine of Tunis, University Tunis El Manar, Tunis, Tunisia
| | - Tekaya Rawdha
- Department of Rheumatology, Charles Nicolle Hospital, Tunis, Tunisia; Faculty of Medicine of Tunis, University Tunis El Manar, Tunis, Tunisia
| | - Saidane Olfa
- Department of Rheumatology, Charles Nicolle Hospital, Tunis, Tunisia; Faculty of Medicine of Tunis, University Tunis El Manar, Tunis, Tunisia
| | - Mahmoud Ines
- Department of Rheumatology, Charles Nicolle Hospital, Tunis, Tunisia; Faculty of Medicine of Tunis, University Tunis El Manar, Tunis, Tunisia
| | - Abdelmoula Leila
- Department of Rheumatology, Charles Nicolle Hospital, Tunis, Tunisia; Faculty of Medicine of Tunis, University Tunis El Manar, Tunis, Tunisia
| |
Collapse
|
5
|
Hokkanen AM, Aaltonen K, Relas H, Rutanen J, Kononoff A, Taimen K, Kauppi M, Puolakka K, Trokovic N, Nordström D. Impact of TNF inhibitor medication on working ability in axial spondyloarthritis: an observational national registry-based cohort study. Rheumatol Adv Pract 2023; 7:rkad050. [PMID: 37332300 PMCID: PMC10272299 DOI: 10.1093/rap/rkad050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Accepted: 05/03/2023] [Indexed: 06/20/2023] Open
Abstract
Objective The aim was to investigate the effect of TNF inhibitor (TNFi) initiation on working ability and health-care resource utilization among axial SpA patients in a real-life setting. Methods Patients with a clinical diagnosis of non-radiographic (nr-axSpA) or radiographic axial SpA initiating their first TNFi were identified from the National Register for Antirheumatic and Biologic Treatment in Finland. Sickness absences, including sick leave and disability pension, in- and outpatient days and rehabilitation rates, 1 year before and after initiating the medication were retrieved from national registries. Factors affecting result variables were studied using multivariate regression analysis. Results Overall, 787 patients were identified. Rates of work disability days per year were 55.6 the year before treatment onset and 55.2 the year after, with significant differences between patient subgroups. The rate of sick leave decreased after starting TNFi treatment. However, the rate of disability pension continued to rise. Patients with a diagnosis of nr-axSpA experienced a decrease in overall work disability and, especially, fewer sick leaves. No sex differences were detected. Conclusion TNFi interrupts the increase in work disabled days evident during the year before its initiation. However, the overall work disability remains high. Treating patients earlier in the nr-axSpA phase, regardless of sex, appears important in maintaining the ability to work.
Collapse
Affiliation(s)
- Anna-Mari Hokkanen
- Correspondence to: Anna-Mari Hokkanen, ROB-FIN Register, Division of Rheumatology, Helsinki University Hospital, Keskussairaalankatu 7, 15850 Lahti, Finland. E-mail:
| | - Kalle Aaltonen
- Pharmaceuticals Pricing Board, Ministry of Social Affairs and Health, Helsinki, Finland
| | - Heikki Relas
- Division of Rheumatology, Helsinki University Hospital, Helsinki University, Helsinki, Finland
| | - Jarno Rutanen
- Unit of Health Sciences, Faculty of Social Sciences, Tampere University, Tampere, Finland
- Centre for Rheumatic Diseases, Tampere University Hospital, Tampere, Finland
| | | | - Kirsi Taimen
- Division of Medicine, Turku University Hospital, Turku, Finland
| | - Markku Kauppi
- Division of Rheumatology, Päijät-Häme Central Hospital, Lahti, Finland
- Division of Rheumatology, Helsinki University, Helsinki, Finland
| | - Kari Puolakka
- Helsinki Rheumatic Diseases and Inflammation Research Group, University of Helsinki, Helsinki, Finland
| | - Nina Trokovic
- ROB-FIN Register, Division of Rheumatology, Helsinki University Hospital, Helsinki, Finland
| | - Dan Nordström
- ROB-FIN Register, Division of Rheumatology, Helsinki University Hospital, Helsinki, Finland
| |
Collapse
|
6
|
Boussaid S, Ben Majdouba M, Rekik S, Jammali S, Cheour E, Sahli H, Elleuch M. Poor work outcomes in patients with spondyloarthritis: causes, consequences, and solutions. Clin Rheumatol 2021; 41:463-470. [PMID: 34618257 DOI: 10.1007/s10067-021-05904-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 08/27/2021] [Accepted: 09/01/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Spondyloarthritis (SpA) affects patients in the prime of their economic productivity and can cause loss of work productivity and unemployment. We aim to identify factors associated with poor work outcomes in patients with SpA. METHODS A cross-sectional study was performed in 100 patients with SpA who were employed, retired, or off work because of SpA. Data on sociodemographic and professional characteristics were collected as well as specific indices: BASDAI, ASDAS-CRP, BASFI, and BASMI. Work productivity in employed patients was assessed by the Work Productivity and Activity Impairment scale (WPAI:SpA). RESULTS Patients were divided into 73 men and 27 women; the mean age was 43.68 ± 10.3 years. Fifty-nine percent of patients were employed and 26% were off work. The average disease duration was 12.24 ± 8.73 years. The mean BASDAI score was 4.4 ± 2.4, the average BASFI score was 4.6 ± 2.7, and the average ASDAS-CRP score was 2.77 ± 1.18. The mean BASMI was 4.4 ± 2.8. Among employed patients, the mean of absenteeism, presenteeism, and work productivity loss was 21.8 ± 33.13%, 42 ± 32%, and 46.5 ± 35.31%, respectively. In multivariable analysis, absenteeism was associated with ASDAS ≥ 2.1 (β = 20.14), peripheral joint involvement (β = 15.6), manual work (β = 14.31), low level of education (β = 7.92), and BASFI ≥ 4 (β = 6.39). Presenteeism and work productivity loss were associated with manual work, BASFI ≥ , body mass index ≥ 25 kg/m2, smoking, the use of symptomatic treatment, and ASDAS-CRP ≥ 2.1. CONCLUSION Spondyloarthritis affects work productivity. Screening for predictive factors should be considered by the clinician in the overall management of the disease. Key Points • SpA occurs among young and active patients; it could affect their professional lives and thus lead to loss of work productivity and unemployment. • The management of patients with SpA must be multidisciplinary; this includes assessing contextual factors in order to act on modifiable factors such as smoking and BMI, optimal management of the disease to maintain at least a low disease activity, and to ensure workstation layout and elimination of professional constraints that can affect work outcomes in patients with SpA.
Collapse
Affiliation(s)
- Soumaya Boussaid
- Rheumatology Department, Rabta Hospital, Tunis, Tunisia.
- Faculty of Medicine of Tunis, University Tunis El Manar, Tunis, Tunisia.
- Research Unit LR 05 SP 01, La Rabta Hospital, Tunis, Tunisia.
| | - Marouene Ben Majdouba
- Rheumatology Department, Rabta Hospital, Tunis, Tunisia
- Faculty of Medicine of Tunis, University Tunis El Manar, Tunis, Tunisia
| | - Sonia Rekik
- Rheumatology Department, Rabta Hospital, Tunis, Tunisia
- Faculty of Medicine of Tunis, University Tunis El Manar, Tunis, Tunisia
- Research Unit LR 05 SP 01, La Rabta Hospital, Tunis, Tunisia
| | - Samia Jammali
- Rheumatology Department, Rabta Hospital, Tunis, Tunisia
- Faculty of Medicine of Tunis, University Tunis El Manar, Tunis, Tunisia
- Research Unit LR 05 SP 01, La Rabta Hospital, Tunis, Tunisia
| | - Elhem Cheour
- Rheumatology Department, Rabta Hospital, Tunis, Tunisia
- Faculty of Medicine of Tunis, University Tunis El Manar, Tunis, Tunisia
- Research Unit LR 05 SP 01, La Rabta Hospital, Tunis, Tunisia
| | - Hela Sahli
- Rheumatology Department, Rabta Hospital, Tunis, Tunisia
- Faculty of Medicine of Tunis, University Tunis El Manar, Tunis, Tunisia
- Research Unit LR 05 SP 01, La Rabta Hospital, Tunis, Tunisia
| | - Mohamed Elleuch
- Rheumatology Department, Rabta Hospital, Tunis, Tunisia
- Faculty of Medicine of Tunis, University Tunis El Manar, Tunis, Tunisia
| |
Collapse
|
7
|
|
8
|
Akaltun MS, Altindag O, Gur A. The effect of Pulmonary Rehabilitation Programme on work productivity and clinical parameters in patients with ankylosing spondylitis. Int J Clin Pract 2021; 75:e14279. [PMID: 33914378 DOI: 10.1111/ijcp.14279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Accepted: 04/26/2021] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE The objective of the present study was to investigate the effect of the Pulmonary Rehabilitation Programme on work productivity, disease activity, functional status, quality of life, respiratory function tests (RFTs), physical capacity and depression in ankylosing spondylitis (AS) patients. METHOD Twenty-five patients diagnosed with AS were included in this study. The disease severity was evaluated with Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), functional status was evaluated with Bath Ankylosing Spondylitis Functional Index (BASFI), quality of life was evaluated with AS-Related Quality of Life Scale (ASQOL), physical capacity was evaluated with the 6-min walking test (6MWT), depression level was evaluated with Beck Depression Scale (BDS) and work productivity was evaluated with Spondyloartropathy Work Productivity and Activity Impairment (WPAI-SpA) Survey. Finally, RFT was evaluated with spirometry measurement. The patients were included in the Pulmonary Rehabilitation Programme for 8 weeks. RESULTS A total of 30% of the patients who were included in this study were unemployed, 35% of them were on and below the hunger limit, 25% were on and below the poverty line, and 40% were on the normal income line. No significant changes were detected in the RFTs after the exercise programme in AS patients (P > .05), but significant improvements were detected in the BASDAI, BASFI, WPAI, 6MWT, ASQOL and BDS (P < .001). CONCLUSION Pulmonary Rehabilitation Programme was found to be an effective method of improving work productivity in AS patients. Also, the Pulmonary Rehabilitation Programme has positive effects on disease activity, functional status, physical capacity, depression level, and quality of life.
Collapse
Affiliation(s)
- Mazlum Serdar Akaltun
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Gaziantep University, Gaziantep, Turkey
| | - Ozlem Altindag
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Gaziantep University, Gaziantep, Turkey
| | - Ali Gur
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Gaziantep University, Gaziantep, Turkey
| |
Collapse
|
9
|
Cooksey R, Rahman MA, Kennedy J, Brophy S, Choy E. Biologic use in psoriatic arthritis and ankylosing spondylitis patients: a descriptive epidemiological study using linked, routine data in Wales, UK. Rheumatol Adv Pract 2021; 5:rkab042. [PMID: 34632260 PMCID: PMC8496109 DOI: 10.1093/rap/rkab042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 06/11/2021] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES PsA and AS are chronic diseases associated with significant morbidities. National and international management guidelines include treatment with biologic therapies to improve outcomes and quality of life. There are limited real-world data on the patients' journey from symptom onset to diagnosis and treatment in the UK. We use real-life, linked health data to explore patient pathways and the impact of biologics on patient outcomes. METHODS Data from the Secure Anonymised Information Linkage databank in Wales were used to assess diagnosis and treatment of patients ≥18 years of age with at least one International Classification of Diseases, Tenth Revision code present for PsA/AS in rheumatology clinic data and at least one Read code present in primary care records. We investigated the use of biologics while exploring demographics, comorbidities and surgical procedures of 641 AS patients and 1312 PsA patients. RESULTS AS patients were significantly younger at diagnosis and were predominantly male. The average time from presenting symptoms to diagnosis of AS and PsA was 7.9 (s.d. 5.5) and 9.3 (s.d. 5.5) years, respectively. The proportion of patients receiving biologic treatment was significantly higher in AS (46%) compared with PsA patients (28.8%); of these, 23.1% of AS and 22.2% of PsA patients stopped/switched a biologic. There was a significant reduction in primary care involvement, sick notes and disability living allowance for both AS and PsA patients following biologic initiation. CONCLUSION This real-world descriptive study confirms that patients treated with biologics have reduced disability and time off work despite being initiated ∼13 years after the first symptoms and 6 years after diagnosis.
Collapse
Affiliation(s)
- Roxanne Cooksey
- Division of Infection and Immunity, CREATE Centre, Section of
Rheumatology, School of Medicine, Cardiff University,
Cardiff
- Health Data Research UK, Swansea University Medical
School, Swansea
- National Centre for Population Health and Wellbeing
Research, Swansea, UK
| | | | - Jonathan Kennedy
- Health Data Research UK, Swansea University Medical
School, Swansea
| | - Sinead Brophy
- Health Data Research UK, Swansea University Medical
School, Swansea
- National Centre for Population Health and Wellbeing
Research, Swansea, UK
| | - Ernest Choy
- Division of Infection and Immunity, CREATE Centre, Section of
Rheumatology, School of Medicine, Cardiff University,
Cardiff
- National Centre for Population Health and Wellbeing
Research, Swansea, UK
| |
Collapse
|
10
|
Yu K, Lo L, Lin M, Cheung Y, Wong S. A preliminary study of an online pain management programme for patients with ankylosing spondylitis. COUNSELLING & PSYCHOTHERAPY RESEARCH 2021. [DOI: 10.1002/capr.12314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Kai‐Ching Yu
- Department of Counselling and Psychology Hong Kong Shue Yan University North Point Hong Kong
| | - Lap‐Yan Lo
- Department of Counselling and Psychology Hong Kong Shue Yan University North Point Hong Kong
| | - Muriel Lin
- Department of Counselling and Psychology Hong Kong Shue Yan University North Point Hong Kong
| | - Yim Cheung
- Department of Counselling and Psychology Hong Kong Shue Yan University North Point Hong Kong
| | - Siu‐Sing Wong
- Department of Counselling and Psychology Hong Kong Shue Yan University North Point Hong Kong
| |
Collapse
|
11
|
Singh J, Tekur P, Metri KG, Mohanty S, Singh A, Nagaratna R. Potential Role of Yoga in the Management of Ankylosing Spondylitis: A Retrospective Study. Ann Neurosci 2021; 28:74-78. [PMID: 34733057 PMCID: PMC8558989 DOI: 10.1177/09727531211035335] [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: 04/14/2021] [Accepted: 06/25/2021] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Ankylosing spondylitis (AS) is a chronic autoimmune inflammatory spondyloarthropathy with unclear pathogenesis. The inflammatory pain in AS leads to restricted spinal mobility and significant disability. Yoga is a nonpharmacological intervention that has positive effects on various musculoskeletal-related problems. However, its role in AS is unknown. OBJECTIVE The present retrospective study assessed the efficacy of a two-week residential yoga intervention on spinal flexibility among AS patients. METHODS The records for 24 male AS patients within the age range 30 to 50 years (average age 38.3 ± 10.5 years) who underwent a two-week residential yoga retreat between 2015 and 2020 were obtained from a yoga center located in South India. Yoga intervention consisted of yoga postures, breathing practices, meditation, a healthy diet, and devotional sessions. Pre and Post data of the sit-and-reach test, blood pressure, heart rate, and symptom score were analyzed using Statistical Package for Social Sciences (SPSS). RESULTS Compared to the baseline, the post scores of the sit-and-reach test, systolic blood pressure and heart rate were found to be significantly (P < .05) lower. The symptom score and analgesic medication score also showed significant improvement after two-weeks compared to the baseline. CONCLUSION This retrospective study indicates the positive impact of on and analgesic use among AS patients. However, additional studies using robust research designs are warranted.
Collapse
Affiliation(s)
- Jyoti Singh
- Division of Yoga and Life Sciences, Swami
Vivekananda Yoga Anusandhan Samsthan (SVYASA University), Bengaluru, India
| | - Padmini Tekur
- Department of Yoga, Central University of
Rajasthan, Ajmer, Rajasthan, India
| | - Kashinath G. Metri
- Department of Yoga, Central University of
Rajasthan, Ajmer, Rajasthan, India
| | - Sriloy Mohanty
- Center for Integrative Medicine and Research
(CIMR), AlIMS, New Delhi, India
| | - Amit Singh
- Division of Yoga and Life Sciences, Swami
Vivekananda Yoga Anusandhan Samsthan (SVYASA University), Bengaluru, India
| | - Raghuram Nagaratna
- Division of Yoga and Life Sciences, Swami
Vivekananda Yoga Anusandhan Samsthan (SVYASA University), Bengaluru, India
| |
Collapse
|
12
|
Cucos I, Dadoun S, Jacquemin C, Kreis S, Fabre S, Hudry C, Pertuiset E, Fautrel B, Gossec L. Prediction of Work Impact in Axial Spondyloarthritis by the Work Instability Scale: A Prospective Cohort Study of 101 Patients. J Rheumatol 2020; 48:1002-1006. [PMID: 32934129 DOI: 10.3899/jrheum.191397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/27/2020] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Axial spondyloarthritis (axSpA) may have an effect on work. The Ankylosing Spondylitis Work Instability Scale (AS-WIS) assesses difficulties at work. The objective of this study was to evaluate the predictive value of the AS-WIS on work impact. METHODS This is a prospective cohort study with 2 timepoints (at baseline and after 1.5 yrs) that included patients with axSpA who had paid employment. Patients completed the AS-WIS at baseline and work instability was scored as moderate/high if ≥ 11 (0-20 scale). At follow-up, adverse work outcomes (AWO) were grouped as moderate (short-term sick leave) or severe AWO (long-term sick leave, disability, unemployment). Univariable and multivariable logistic regression analyses were performed to explain AWO. RESULTS Of 101 patients, mean age 45 (SD 9) years, 52% male, disease duration was 14 (SD 8) years. The Bath AS Disease Activity Index and the Bath AS Functional Index were 34 (SD 21) and 23 (SD 23), respectively, and 69 (68%) received a tumor necrosis factor inhibitor. At baseline, 46 (46%) patients had moderate/high AS-WIS. At 1.5 years of follow-up, 37 patients (36%) had AWO: 25 patients (25%) a short-term sick leave, and 12 patients (12%, 7/100 patient-years) a severe AWO. Independent baseline factors associated with AWO were a moderate/high AS-WIS score (OR 2.71, 95% CI 1.04-7.22) and shorter disease duration (OR 0.94, 95% CI 0.89-0.99). CONCLUSION In patients with axSpA, a moderate/high AS-WIS score was predictive of AWO in this population with well-controlled axSpA. This short questionnaire can be helpful to screen for future difficulties at work.
Collapse
Affiliation(s)
- Irina Cucos
- I. Cucos, MD, Rheumatology Department, Pitié-Salpêtrière Hospital, AP-HP, Paris;
| | | | - Charlotte Jacquemin
- C. Jacquemin, MD, Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Paris, and Rheumatology Department, Rene Dubos Hospital, Pontoise
| | - Sarah Kreis
- S. Kreis MD, S. Fabre, MD, Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Paris
| | - Stephanie Fabre
- S. Kreis MD, S. Fabre, MD, Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Paris
| | | | - Eduard Pertuiset
- E. Pertuiset, PhD, Rheumatology Department, Rene Dubos Hospital, Pontoise
| | - Bruno Fautrel
- B. Fautrel, PhD, L. Gossec, PhD, Rheumatology Department, Pitié-Salpêtrière Hospital, AP-HP, and Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Paris, France
| | - Laure Gossec
- B. Fautrel, PhD, L. Gossec, PhD, Rheumatology Department, Pitié-Salpêtrière Hospital, AP-HP, and Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Paris, France
| |
Collapse
|
13
|
Hollick RJ, Stelfox K, Dean LE, Shim J, Walker-Bone K, Macfarlane GJ. Outcomes and treatment responses, including work productivity, among people with axial spondyloarthritis living in urban and rural areas: a mixed-methods study within a national register. Ann Rheum Dis 2020; 79:1055-1062. [PMID: 32522742 PMCID: PMC7392479 DOI: 10.1136/annrheumdis-2020-216988] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 05/08/2020] [Accepted: 05/12/2020] [Indexed: 11/26/2022]
Abstract
Objective To examine differences in clinical and patient-reported outcomes, including work, in individuals with axial spondyloarthritis (axSpA) living in rural and urban settings. Methods Using a sequential, explanatory mixed-method design, data from the British Society for Rheumatology Biologics Register for Ankylosing Spondylitis were used to (1) characterise participants with axSpA living in rural and urban areas and (b) assess any differences in outcome after commencement of biologic therapy (phase 1). Semistructured interviews (phase 2) further explored the results from phase 1. Results Patients with axSpA living in rural areas were older and more likely to work in a physical job. Among patients prescribed biologics, there were no differences in response to biologics, but after adjustment for age, sex and local area deprivation rural dwellers reported more presenteeism and overall work impairment. Work effects could be explained by accounting for individual differences in disease activity, fatigue, physical function and job type. Interviews highlighted the complex relationship between clinical factors, contextual factors (work environment, job demands) and work disability. The ability to work and flexibility in terms of what, when and how tasks are undertaken were important. Support from employers was variable and healthcare professionals were often perceived as unsupportive. Conclusions Patients with axSpA living in rural areas report a greater impact of their disease on work productivity. New measures are needed to capture important contextual factors and comprehensively determine the impact of long-term conditions on work. Future European League Against Rheumatism axSpA recommendations should include support to work as a target to optimise quality of life in patients with axSpA.
Collapse
Affiliation(s)
- Rosemary J Hollick
- Aberdeen Centre for Arthritis and Musculoskeletal Health, Epidemiology Group, University of Aberdeen, Aberdeen, UK
- MRC Versus Arthritis Centre for Musculoskeletal Health and Work, University of Aberdeen, Aberdeen, UK
- Epidemiology Group, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK
| | - Kevin Stelfox
- Aberdeen Centre for Arthritis and Musculoskeletal Health, Epidemiology Group, University of Aberdeen, Aberdeen, UK
- MRC Versus Arthritis Centre for Musculoskeletal Health and Work, University of Aberdeen, Aberdeen, UK
- Epidemiology Group, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK
| | - Linda E Dean
- Aberdeen Centre for Arthritis and Musculoskeletal Health, Epidemiology Group, University of Aberdeen, Aberdeen, UK
- MRC Versus Arthritis Centre for Musculoskeletal Health and Work, University of Aberdeen, Aberdeen, UK
- Epidemiology Group, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK
| | - Joanna Shim
- Aberdeen Centre for Arthritis and Musculoskeletal Health, Epidemiology Group, University of Aberdeen, Aberdeen, UK
- MRC Versus Arthritis Centre for Musculoskeletal Health and Work, University of Aberdeen, Aberdeen, UK
- Epidemiology Group, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK
| | - Karen Walker-Bone
- MRC Versus Arthritis Centre for Musculoskeletal Health and Work, University of Southampton, Southampton, UK
| | - Gary J Macfarlane
- Aberdeen Centre for Arthritis and Musculoskeletal Health, Epidemiology Group, University of Aberdeen, Aberdeen, UK
- MRC Versus Arthritis Centre for Musculoskeletal Health and Work, University of Aberdeen, Aberdeen, UK
- Epidemiology Group, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK
| |
Collapse
|
14
|
Park JY, Howren AM, Zusman EZ, Esdaile JM, De Vera MA. The incidence of depression and anxiety in patients with ankylosing spondylitis: a systematic review and meta-analysis. BMC Rheumatol 2020; 4:12. [PMID: 32159073 PMCID: PMC7050143 DOI: 10.1186/s41927-019-0111-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Accepted: 12/30/2019] [Indexed: 02/07/2023] Open
Abstract
Background As awareness for the importance of mental health continues to expand in rheumatology, it is important to understand the epidemiology of psychiatric complications in ankylosing spondylitis (AS) with the ultimate goal of future prevention and improved quality of care. This study aims to review evidence on the incidence and determinants of depression and/or anxiety among patients with AS. Methods We searched Medline, Embase, Cochrane Database of Systematic Reviews, CINAHL Complete, and PsycINFO for full-length observational studies that involved a sample or population of patients with AS and assessed depression and/or anxiety. Primary outcomes extracted were: 1) risk estimates for depression and/or anxiety (e.g., relative risk [RR]); and 2) determinants or factors identified as independent predictors of depression and/or anxiety using multivariable regression approaches and corresponding estimates (e.g., odds ratios [OR]). Where relevant, we pooled estimates using random effects models. Results Out of 783 titles from our search strategy, we reviewed 39 manuscripts. Four studies assessed the incidence of depression and meta-analyzing reported estimates from three of these studies yielded a pooled RR of 1.51 (95% CI 1.28 to 1.79). Differences in risk of depression among men and women with AS were inconclusive, suggesting need for further study. The incidence of anxiety was comparatively less studied with only one included study reporting a hazard ratio of 1.85 (95% CI 1.37 to 2.49). Education level was a key determinant, with lower levels associated with higher odds of depression (OR 6.65; 9% CI 1.36 to 32.51) and anxiety (OR 9.31; 9% CI 1.39 to 62.19) among AS patients. Conclusions Our systematic review and meta-analysis shows an increased risk of depression and anxiety among patients with AS. These findings suggest the importance of monitoring and care for psychiatric conditions in AS.
Collapse
Affiliation(s)
- Jamie Ye Park
- 1Faculty of Pharmaceutical Sciences, University of British Columbia, 2405 Wesbrook Mall, Vancouver, BC V6T 1Z3 Canada.,Collaboration for Outcomes Research and Evaluation, Vancouver, BC Canada.,Arthritis Research Canada, Vancouver, BC Canada
| | - Alyssa M Howren
- 1Faculty of Pharmaceutical Sciences, University of British Columbia, 2405 Wesbrook Mall, Vancouver, BC V6T 1Z3 Canada.,Collaboration for Outcomes Research and Evaluation, Vancouver, BC Canada.,Arthritis Research Canada, Vancouver, BC Canada
| | - Enav Z Zusman
- 1Faculty of Pharmaceutical Sciences, University of British Columbia, 2405 Wesbrook Mall, Vancouver, BC V6T 1Z3 Canada.,Collaboration for Outcomes Research and Evaluation, Vancouver, BC Canada.,Arthritis Research Canada, Vancouver, BC Canada
| | | | - Mary A De Vera
- 1Faculty of Pharmaceutical Sciences, University of British Columbia, 2405 Wesbrook Mall, Vancouver, BC V6T 1Z3 Canada.,Collaboration for Outcomes Research and Evaluation, Vancouver, BC Canada.,Arthritis Research Canada, Vancouver, BC Canada
| |
Collapse
|
15
|
Phang JK, Kwan YH, Fong W, Tan CS, Lui NL, Thumboo J, Leung YY. Validity and reliability of Work Productivity and Activity Impairment among patients with axial spondyloarthritis in Singapore. Int J Rheum Dis 2020; 23:520-525. [PMID: 32020752 DOI: 10.1111/1756-185x.13801] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Revised: 11/08/2019] [Accepted: 12/21/2019] [Indexed: 01/01/2023]
Abstract
OBJECTIVES To assess the validity and reliability of the Work Productivity and Activity Impairment (WPAI) questionnaire in patients with axSpA. METHODS English-speaking patients seen at a dedicated axSpA clinic in a Singapore tertiary referral hospital were recruited from 2017 to 2019. Content validity of the WPAI was assessed through cognitive debriefing interviews (CDIs). Construct validity was assessed by a priori hypotheses regarding the correlations of the WPAI outcomes (absenteeism, presenteeism, overall work productivity loss, and activity impairment) with Bath Ankylosing Spondylitis Functional Index (BASFI), Bath Ankylosing Spondylitis Patient Global Score (BAS-G), patient global assessment (PGA) and pain scores. Known group validity was assessed relative to disease activity. Test-retest reliability was assessed by intraclass correlation coefficients (ICC) in patients without treatment change 2 weeks apart. RESULTS Cognitive debriefing interviews conducted with 10 patients (22-46 years old, 50% male) supported the content validity of the WPAI. We analyzed cross-sectional data from 168 patients (mean [SD] age 41.0 [14.4], 79.8% male). Construct validity was established by meeting 100% of the hypotheses. Presenteeism, overall work productivity loss, and activity impairment demonstrated strong correlations with BASFI, BAS-G, PGA, and pain (rs > .6). The WPAI was able to distinguish patients grouped by disease activity. Test-retest reliability conducted with 50 patients ranged from moderate to good for all the four outcomes (absenteeism: ICC = 0.54; presenteeism: ICC = 0.76; activity impairment: ICC = 0.79; overall work productivity loss: ICC = 0.83; all P < .01). CONCLUSIONS This study supports the content validity, construct validity, and test-retest reliability of the WPAI in patients with axSpA.
Collapse
Affiliation(s)
- Jie Kie Phang
- Department of Rheumatology and Immunology, Singapore General Hospital, Singapore
| | - Yu Heng Kwan
- Department of Rheumatology and Immunology, Singapore General Hospital, Singapore.,Program in Health Services and Systems Research, Duke-NUS Medical School Singapore, Singapore
| | - Warren Fong
- Department of Rheumatology and Immunology, Singapore General Hospital, Singapore.,Duke-NUS Medical School, Singapore.,NUS Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Chuen Seng Tan
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Nai Lee Lui
- LUI Centre for Arthritis & Rheumatology, Singapore
| | - Julian Thumboo
- Department of Rheumatology and Immunology, Singapore General Hospital, Singapore.,Program in Health Services and Systems Research, Duke-NUS Medical School Singapore, Singapore.,NUS Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Ying Ying Leung
- Department of Rheumatology and Immunology, Singapore General Hospital, Singapore.,Duke-NUS Medical School, Singapore.,NUS Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| |
Collapse
|
16
|
Goh Y, Kwan YH, Leung YY, Fong W, Cheung PP. A cross‐sectional study on factors associated with poor work outcomes in patients with axial spondyloarthritis in Singapore. Int J Rheum Dis 2019; 22:2001-2008. [DOI: 10.1111/1756-185x.13696] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Revised: 08/12/2019] [Accepted: 08/17/2019] [Indexed: 11/28/2022]
Affiliation(s)
- Yihui Goh
- Department of Rheumatology and Immunology Singapore General Hospital Singapore City Singapore
- Division of Rheumatology National University Hospital Singapore City Singapore
| | - Yu Heng Kwan
- Program in Health Services and Systems Research Duke‐NUS Medical School Singapore City Singapore
| | - Ying Ying Leung
- Department of Rheumatology and Immunology Singapore General Hospital Singapore City Singapore
- Duke‐NUS Medical School Singapore City Singapore
- Department of Medicine Yong Loo Lin School of Medicine National University of Singapore Singapore City Singapore
| | - Warren Fong
- Department of Rheumatology and Immunology Singapore General Hospital Singapore City Singapore
- Duke‐NUS Medical School Singapore City Singapore
- Department of Medicine Yong Loo Lin School of Medicine National University of Singapore Singapore City Singapore
| | - Peter P. Cheung
- Division of Rheumatology National University Hospital Singapore City Singapore
| |
Collapse
|
17
|
Yong CY, Hamilton J, Benepal J, Griffiths K, Clark ZE, Rush A, Sengupta R, Martindale J, Gaffney K. Awareness of axial spondyloarthritis among chiropractors and osteopaths: findings from a UK Web-based survey. Rheumatol Adv Pract 2019; 3:rkz034. [PMID: 31616854 PMCID: PMC6785804 DOI: 10.1093/rap/rkz034] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Revised: 06/23/2019] [Indexed: 12/28/2022] Open
Abstract
Objective Chiropractors and osteopaths are important professional partners in the management of axial spondyloarthritis (axSpA). In view of recent advances in diagnosis and treatment, we sought to understand their current knowledge and working practices. Methods A Web-based survey was advertised to chiropractors and osteopaths via the Royal College of Chiropractors and the Institute of Osteopathy. Results Of 382 completed responses [237 chiropractors (62%) and 145 osteopaths (38%)], all were familiar with AS, but only 63 and 25% were familiar with the terms axSpA and non-radiographic axSpA, respectively. Seventy-seven per cent were confident with inflammatory back pain. Respondents routinely asked about IBD (91%), psoriasis (81%), acute anterior uveitis (49%), peripheral arthritis (71%), genitourinary/gut infection (56%), enthesitis (30%) and dactylitis (20%). Eighty-seven per cent were aware of the association between axSpA and HLA-B27. Only 29% recognized that axSpA was common in women. Forty per cent recommend an X-ray (pelvic in 80%) and, if normal, 27% would recommend MRI of the sacroiliac joints and whole spine. Forty-four per cent were aware of biologic therapies. Forty-three per cent were confident with the process of onward referral to rheumatology via the general practitioner (GP). The principal perceived barrier to onward referral was reluctance by the GP to accept their professional opinion. Conclusion Overall knowledge of ankylosing spondylitis is good, but the term axSpA is poorly understood. Specific learning needs include gender preponderance, awareness of acute anterior uveitis and the availability of biological therapies. There is lack of confidence in the onward referral process to rheumatology via the GP.
Collapse
Affiliation(s)
- Cee Y Yong
- Department of Rheumatology, North West Anglia NHS Foundation Trust, Huntingdon
| | - Jill Hamilton
- National Ankylosing Spondylitis Society, Hammersmith, London
| | | | | | - Zoë E Clark
- Howe Osteopaths and Diss Osteopathy & Natural Health Clinic, Diss
| | | | - Raj Sengupta
- Department of Rheumatology, Royal National Hospital for Rheumatic Diseases, Bath
| | - Jane Martindale
- Department of Physiotherapy, Wrightington, Wigan and Leigh NHS Foundation Trust, Lancaster
| | - Karl Gaffney
- Department of Rheumatology, Norfolk & Norwich University Hospital NHS Trust, Norwich, UK
| |
Collapse
|
18
|
Milutinovic S, Veljkovic K, Zlatanovic M, Radunovic G, Damjanov N. Depression/anxiety symptoms in axial spondyloarthritis and psoriatic arthritis patients in Serbia: a pilot study. Rheumatol Int 2019; 39:1595-1605. [PMID: 31309294 DOI: 10.1007/s00296-019-04376-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Accepted: 07/09/2019] [Indexed: 12/24/2022]
Abstract
To assess prevalence and change of depression/anxiety symptoms in spondyloarthritis patients and feasibility of depression/anxiety questionnaires. 43 Patients with axial spondyloarthritis (axSpA) and 27 patients with psoriatic arthritis (PsA) were consecutively recruited. There were 34 patients on biologics and 36 patients on nonbiologics. Patients were not previously treated for depression. The demographic variables, pain, patient global assessment, laboratory, clinical findings, diseases activity scores, Beck Depression Inventory (BDI) and Depression Anxiety and Stress Scale-short version (DASS-21) were collected. The study visits were at the beginning, after 1 month, after 3 and after 6 months. In axSpA and PsA patients on biologics, BDI and DASS-21 were significantly lower compared to nonbiologics group during time. The axSpA patients on biologics had significantly lower BDI and depression severity by BDI at each time point and lower DASS-21 after 1, 3 and 6 months. BDI in PsA patients who received biological therapy was significantly lower after 3 and 6 months. In biologics groups, BDI significantly decreased after 3 months in axSpA patients and after 1 month in PsA patients. In axSpA patients, there was a medium correlation between BDI and axial pain, patient global assessment and disease activity scores. The biological therapy significantly affected the depression/anxiety symptoms in axSpA and PsA during time. BDI moderately correlated with pain and disease activity in axSpA. BDI and DASS-21 are easy to use in daily practice.
Collapse
Affiliation(s)
- Sanja Milutinovic
- Institute of Rheumatology, University of Belgrade Medical School, Belgrade, Serbia
| | - Kristina Veljkovic
- Department of Probability and Statistics, Faculty of Mathematics, University of Belgrade, Belgrade, Serbia.
| | - Maja Zlatanovic
- Institute of Rheumatology, University of Belgrade Medical School, Belgrade, Serbia
| | - Goran Radunovic
- Institute of Rheumatology, University of Belgrade Medical School, Belgrade, Serbia
| | - Nemanja Damjanov
- Institute of Rheumatology, University of Belgrade Medical School, Belgrade, Serbia
| |
Collapse
|
19
|
Hunter T, Schroeder K, Sandoval D, Deodhar A. Persistence, Discontinuation, and Switching Patterns of Newly Initiated TNF Inhibitor Therapy in Ankylosing Spondylitis Patients in the United States. Rheumatol Ther 2019; 6:207-215. [PMID: 30835086 PMCID: PMC6514032 DOI: 10.1007/s40744-019-0148-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Indexed: 01/18/2023] Open
Abstract
INTRODUCTION The primary goals of treating ankylosing spondylitis (AS) patients are to maximize long-term health-related quality of life through control of symptoms and inflammation, prevention of progressive structural damage, and preservation of function. The objective of this study was to describe treatment patterns (persistence, discontinuations, and switch) in the 2 years following the initiation of tumor necrosis factor inhibitors (TNFi) therapy in AS patients. METHODS Adult patients with ≥ 2 AS diagnostic codes (ICD-9: 720.0 and/or ICD-10:M45.x) by a healthcare provider were included in this retrospective analysis of data from the IBM MarketScan Commercial Claims database. Patients who newly initiated a TNFi from 01/01/2009 to 12/31/2013 were indexed on their first TNFi. Patients were required to have a 1-year pre-index period free of TNFi and continuous enrollment 1-year pre-index and 2-year post-index. Patients were excluded if they had ≥ 2 diagnostic codes for any of the following conditions: rheumatoid arthritis, juvenile idiopathic arthritis, psoriatic arthritis, Crohn's disease, ulcerative colitis, plaque psoriasis, hidradenitis suppurativa, or uveitis. Demographic, clinical, and treatment patterns were analyzed. Treatment patterns included switching to a new TNFi, discontinuation (≥ 90-day gap in therapy without starting a new TNFi), or persistence (no gaps in therapy ≥ 90 days) during the 2-year follow-up period. Logistic regression analyses predicting persistent vs. non-persistent and switching vs. discontinuation were conducted. RESULTS A total of 1372 AS patients (846 males/526 females) met the inclusion criteria for this study. Males had a mean age of 44.3 years, while females had a mean age of 42.3 years. Adalimumab was the first biologic for the majority of patients (44.6% males/43.3% females), followed by etanercept (40.4% males/41.6% females), infliximab (10.4% males/10.8% females), golimumab (4.6% males/3.8% females), and certolizumab pegol (0.0% males/0.4% females). During the follow-up period, 33.1% of patients (n = 454) were persistent on their index TNFi, 40.7% (n = 559) discontinued their index TNFi and did not restart a TNFi, and 26.1% (n = 359) switched to a second TNFi. Patients prescribed cDMARDs were more likely to be persistent, while females and opioid users were less likely to be persistent on their first TNFi. Among those that discontinued their first TNFi, 32.8% (n = 187) of males and 43.6% (n = 177) of females switched to a second TNFi. CONCLUSIONS This study suggests that approximately 67% of male AS patients and 77% of female AS patients newly initiating a TNFi do not remain on the index therapy 2 year post initiation. FUNDING Eli Lilly and Company.
Collapse
Affiliation(s)
| | | | | | - Atul Deodhar
- Oregon Health and Science University, Portland, OR, USA
| |
Collapse
|
20
|
Claudepierre P, Van den Bosch F, Sarzi-Puttini P, Vastesaeger N, Govoni M, Kachroo S. Treatment with golimumab or infliximab reduces health resource utilization and increases work productivity in patients with ankylosing spondylitis in the QUO-VADIS study, a large, prospective real-life cohort. Int J Rheum Dis 2019; 22:995-1001. [PMID: 30989813 DOI: 10.1111/1756-185x.13526] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Revised: 01/17/2019] [Accepted: 02/04/2019] [Indexed: 02/06/2023]
Abstract
AIM We evaluated the effects of anti-tumor necrosis factor (TNF) agents on health economics in ankylosing spondylitis (AS) patients. METHODS QUality of Life as Outcomes and its VAriation with DIsease States (QUO-VADIS) was a prospective observational study following bio-naïve AS patients (modified New York criteria) newly treated with golimumab (GLM) or infliximab (IFX; originator) in a clinical practice setting over 6 months. We evaluated use of concomitant medications, hospitalizations (in-patient care or acute care) and visits in day care and out-patient settings for the assessment of healthcare resource utilization (HCRU). Work productivity and activity impairment (WPAI) was assessed by the number of work days missed and quantifying absenteeism, presenteeism, work impairment, and activity using the WPAI instrument adapted to spondyloarthritis (WPAI-SpA). RESULTS Nine hundred and sixty-three patients received ≥1 dose of medication (78%, n = 751 GLM; 22%, n = 221 IFX). Mean age was 42.7 years; 61.4% were male. At baseline, the percentage of patients who reported hospitalizations (in-patient care) was 13.6%, which decreased to 3.1% at 6 months, while out-patient care at baseline was reported by 39.4% of patients, which decreased to 19.0% at 6 months. The percentage of patients receiving acute emergency at baseline reduced from 1.6% to 0.3% at 6 months. The mean (SD) number of days of work missed due to AS, was reduced from 6.3 (31.1) days at baseline to 2.7 (12.3) days at 6 months. CONCLUSION In patients with AS newly treated with GLM or IFX for 6 months, HCRU was reduced and work productivity and activity increased.
Collapse
Affiliation(s)
- Pascal Claudepierre
- Department of Rheumatology, Henri Mondor Hospital, APHP, and Université Paris Est Créteil, Créteil, France
| | | | | | | | | | | |
Collapse
|
21
|
Ulus Y, Akyol Y, Bilgici A, Kuru O. Association of work instability with fatigue and emotional status in patients with ankylosing spondylitis: comparison with healthy controls. Clin Rheumatol 2018; 38:1017-1024. [DOI: 10.1007/s10067-018-4366-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Revised: 10/30/2018] [Accepted: 11/12/2018] [Indexed: 11/30/2022]
|
22
|
Shim J, Jones GT, Pathan EMI, Macfarlane GJ. Impact of biological therapy on work outcomes in patients with axial spondyloarthritis: results from the British Society for Rheumatology Biologics Register (BSRBR-AS) and meta-analysis. Ann Rheum Dis 2018; 77:1578-1584. [PMID: 30076155 PMCID: PMC6225801 DOI: 10.1136/annrheumdis-2018-213590] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Revised: 07/09/2018] [Accepted: 07/18/2018] [Indexed: 01/25/2023]
Abstract
OBJECTIVES To quantify, among patients with axial spondyloarthritis (axSpA), the benefit on work outcomes associated with commencing biologic therapy. METHODS The British Society for Rheumatology Biologics Register in Axial Spondyloarthritis (BSRBRAS) recruited patients meeting Assessment of SpondyloArthritis International Society criteria for axSpA naïve to biological therapy across 83 centres in Great Britain. Work outcomes (measured using the Work Productivity and Activity Impairment Index) were compared between those starting biological therapy at the time of recruitment and those not. Differences between treatment groups were adjusted using propensity score matching. Results from BSRBR-AS were combined with other studies in a meta-analysis to calculate pooled estimates. RESULTS Of the 577 participants in this analysis who were in employment, 27.9% were starting biological therapy at the time of recruitment. After propensity score adjustment, patients undergoing biological therapy, at 12-month follow-up, experienced significantly greater improvements (relative to non-biological therapy) in presenteeism (-9.4%, 95% CI -15.3% to -3.5%), overall work impairment (-13.9%, 95% CI -21.1% to -6.7%) and overall activity impairment (-19.2%, 95% CI -26.3% to -12.2%). There was no difference in absenteeism (-1.5%, 95% CI -8.0 to 4.9). Despite these improvements, impact on work was still greater in the biological treated cohort at follow-up. In the meta-analysis including 1109 subjects across observational studies and trials, treatment with biological therapy was associated with significantly greater improvements in presenteeism, work impairment and activity impairment, but there was no difference in absenteeism. CONCLUSIONS There is consistent evidence that treatment with biological therapy significantly improves work productivity and activity impairment in people with axSpA. However, there remain substantial unmet needs in relation to work.
Collapse
Affiliation(s)
- Joanna Shim
- Epidemiology Group, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK,Arthritis Research UK/Medical Research Council Centre for Musculoskeletal Health and Work, Aberdeen, UK,Aberdeen Centre for Arthritis and Musculoskeletal Health, University of Aberdeen, Aberdeen, UK
| | - Gareth T Jones
- Epidemiology Group, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK,Arthritis Research UK/Medical Research Council Centre for Musculoskeletal Health and Work, Aberdeen, UK,Aberdeen Centre for Arthritis and Musculoskeletal Health, University of Aberdeen, Aberdeen, UK
| | - Ejaz M I Pathan
- Spondylitis Program, Department of Rheumatology, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
| | - Gary J Macfarlane
- Epidemiology Group, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK,Arthritis Research UK/Medical Research Council Centre for Musculoskeletal Health and Work, Aberdeen, UK,Aberdeen Centre for Arthritis and Musculoskeletal Health, University of Aberdeen, Aberdeen, UK
| |
Collapse
|
23
|
Sağ S, Nas K, Sağ MS, Tekeoğlu İ, Kamanlı A. Relationship of work disability between the disease activity, depression and quality of life in patients with ankylosing spondylitis. J Back Musculoskelet Rehabil 2018; 31:499-505. [PMID: 29504521 DOI: 10.3233/bmr-169657] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVES In this study, our objective was to determine the work productivity and work disability of the patients with ankylosing spondylitis (AS) and to investigate the relation of these parameters with disease activity, anxiety, depression and quality of life. PATIENTS AND METHODS Fifty patients with the diagnosis of AS and 30 healthy control were included in the study. In patients with AS, Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) was used to evaluate the disease activity; Bath Ankylosing Spondylitis Metrology Index (BASMI) was used to evaluate the spinal mobility and Bath Ankylosing Spondylitis Functional Index (BASFI) was used to determine the functional status. In addition, the Ankylosing Spondylitis Quality of Life (ASQoL) questionnaire and The Short Form (SF-36) Health Survey was used to evaluate the health status, Hospital Anxiety and Depression Scale (HADS) was used for the evaluation of depression and anxiety and Work Productivity and Activity Impairment Questionnaire: Specific Health Problem v2.0 (WPAI:SHP) was used to evaluate the work productivity. RESULTS In AS patients duration of disease at the diagnosis was 7.24 ± 6.23 years. The time lost at work due to the disease, decrease in the work productivity and impairment in the time off daily activities were worse in the patient group compared with the control group (p< 0.05). The impairment in the work productivity was correlated with BASDAI and depression; difficulty in time-off activities was correlated with BASFI and anxiety and depression was correlated with BASDAI (p< 0.05). While the impairment in work productivity was correlated with the subparameter vitality in SF-36, difficulty in time off activities was correlated with general health status, social functions, vitality and mental health (p< 0.05). CONCLUSION In this study, we determined that AS had a significant influence on the working conditions and the factors related to the disease had a significant correlation with work productivity. Factors related to the psychology and the disease were also correlated with the working conditions.
Collapse
|
24
|
McCormack RC, O'Shea F, Doran M, Connolly D. Impact of a fatigue management in work programme on meeting work demands of individuals with rheumatic diseases: A pilot study. Musculoskeletal Care 2018; 16:398-404. [PMID: 29575485 DOI: 10.1002/msc.1237] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2018] [Revised: 01/17/2018] [Accepted: 01/19/2018] [Indexed: 06/08/2023]
Abstract
INTRODUCTION Work disability and job loss are serious consequences of rheumatic diseases (RDs), and fatigue is a symptom of RDs commonly reported to have an impact on work performance. A FAtigue ManagEment in Work (FAME-W) programme was developed to facilitate the self-management of fatigue in work. The present pilot study explored if FAME-W could facilitate individuals with RDs to manage fatigue in work and improve their ability to meet work demands. METHODS Twenty-seven individuals with a variety of rheumatic diagnoses completed a 4-week, 2-h occupational therapy-led self-management programme. Each week focused on fatigue-related topics, including fatigue and activity management, pain management and joint protection, mental well-being, effective communication with employers and work colleagues, and employment legislation. Individual workplace ergonomic assessments were also offered. Study measures (work function, fatigue, pain, mood and self-efficacy) were completed prior to starting FAME-W, immediately post-intervention and 12 weeks post-intervention. RESULTS Participants (56% male) had a mean age of 43 years. No significant improvements were observed immediately post-programme. However, at the 12-week follow-up, significant improvements were reported in meeting work demands (scheduling [p = 0.046], output [p = 0.002], physical [p = 0.003], mental [p = 0.016]), fatigue [p = 0.001], pain [p = 0.01], anxiety [p = 0.001], depression [p < 0.001], self-efficacy [p < 0.001] and Arthritis Impact Measurement Scales 2-Short Form (physical: p = 0.005; symptoms: p = 0.010; affect: p = 0.010; social: p = 0.001). CONCLUSIONS Significant improvements were reported in participants' ability to meet various demands of their work 3 months post-FAME-W. These findings suggest that FAME-W has the potential to assist individuals with RDs to meet the demands of their work, although further research is required to test the effectiveness of this intervention.
Collapse
Affiliation(s)
- Róisín C McCormack
- Discipline of Occupational Therapy, Trinity Centre for Health Sciences, St James' Hospital, Dublin, Ireland
| | - Finbar O'Shea
- Rheumatology Department, St James' Hospital, Dublin, Ireland
| | - Michele Doran
- Rheumatology Department, St James' Hospital, Dublin, Ireland
| | - Deirdre Connolly
- Discipline of Occupational Therapy, Trinity Centre for Health Sciences, St. James' Hospital, Dublin, Ireland
| |
Collapse
|
25
|
Saidane O, Mahmoud I, Gafsi L, Houda A, Tekaya R, Abdelmoula L. Factors leading to work absenteeism in Tunisian ankylosing spondylitis patients. THE EGYPTIAN RHEUMATOLOGIST 2018. [DOI: 10.1016/j.ejr.2017.06.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
|
26
|
Druce KL, Aikman L, Dilleen M, Burden A, Szczypa P, Basu N. Fatigue independently predicts different work disability dimensions in etanercept-treated rheumatoid arthritis and ankylosing spondylitis patients. Arthritis Res Ther 2018; 20:96. [PMID: 29843776 PMCID: PMC5972438 DOI: 10.1186/s13075-018-1598-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2017] [Accepted: 04/18/2018] [Indexed: 11/29/2022] Open
Abstract
Background Work disability remains a significant problem in ankylosing spondylitis (AS) and rheumatoid arthritis (RA), despite biological therapy. This study aimed to test the hypothesis that the prevalent symptom of fatigue longitudinally predicts work disability among RA and AS patients commencing etanercept. Methods Two observational studies, comprising RA and AS etanercept commencers, respectively, were analysed. Both provided data on work disability over 1 year and a comprehensive set of putative predictors, including fatigue. A series of repeated measures models were conducted, including baseline variables, visit (6/12 months), and the interaction between visit and each of the explanatory variables. Results A total of 1003 AS and 1747 RA patients were assessed. For AS, fatigue was significantly associated with presenteeism (linear mixed model coefficient 3.75, 95% confidence interval (CI) 2.14 to 5.36) and activity impairment (2.62, 1.26 to 3.98), but not with work productivity loss (1.81, −0.40 to 4.02) or absenteeism (generalised linear mixed model odds ratio (OR) 1.18, 95% CI 0.92 to 1.51). In RA, fatigue was associated with presenteeism (coefficient 3.44, 95% CI 2.17 to 4.70), activity impairment (1.52, 0.79 to 2.26), work productivity loss (4.16, 2.47 to 5.85), and absenteeism (OR 1.23, 95% CI 1.02 to 1.49). The lack of significant interactions between fatigue and visit supported a consistent effect of baseline fatigue over time. Conclusions Among patients beginning etanercept therapy, fatigue has a significant and independent effect on absenteeism, presenteeism, productivity loss, and activity impairment for RA patients and a significant but dimension-selective effect on work disability among AS patients. Trial registration ClinicalTrials.gov, NCT00544557. Registered on 16 October 2007. ClinicalTrials.gov, NCT00488475. Registered on 20 June 2006.
Collapse
Affiliation(s)
- Katie L Druce
- Arthritis Research UK Centre for Epidemiology, Faculty of Biology Medicine and Health, the University of Manchester, Manchester, M13 9PT, UK
| | | | - Maria Dilleen
- Statistics, Global Product Development, Pfizer, Sandwich, UK
| | | | | | - Neil Basu
- Epidemiology Group, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK. .,Aberdeen Centre for Arthritis and Musculoskeletal Health, University of Aberdeen, Aberdeen, UK. .,Arthritis Research UK/MRC Centre for Musculoskeletal Health and Work, University of Aberdeen, Aberdeen, UK.
| |
Collapse
|
27
|
Park JS, Hong JY, Park YS, Han K, Suh SW. Trends in the prevalence and incidence of ankylosing spondylitis in South Korea, 2010-2015 and estimated differences according to income status. Sci Rep 2018; 8:7694. [PMID: 29769560 PMCID: PMC5955990 DOI: 10.1038/s41598-018-25933-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Accepted: 04/30/2018] [Indexed: 01/13/2023] Open
Abstract
The aim of this study is to determine the prevalence and incidence of ankylosing spondylitis (AS) in South Korea, 2010–2015. This study was conducted using the Health Insurance Review Agency (HIRA) database, which includes information on every patient diagnosed with AS. The incidence and prevalence of AS were evaluated by age, sex, and income status. The prevalence increased linearly by 7.7% annually, i.e., 31.62 in 2010 to 52.30 in 2015 (per 100,000 persons). During the study period, the incidence was 6.34 per 100,000 person-years. The prevalence peaked for both men and women in the age range 30–39 years. Incidence peaked for men in the age range 20–29 years, but peaked for women between ages 70 and 89. AS was 3.6 times more prevalent in men than in women, and the incidence in men was 2.1 times greater than in women. With respect to income status, the prevalence and incidence of AS were 3 times greater and 5 times greater, respectively, in medical aid recipients compared to individuals with other income levels. The trend of increasing AS prevalence and the observation that 14.3% of all patients newly diagnosed with AS are medical aid recipients have significant implications for healthcare planning.
Collapse
Affiliation(s)
- Jin-Sung Park
- Department of Orthopedics, Korea University Ansan Hospital, Ansan-si, South Korea
| | - Jae-Young Hong
- Department of Orthopedics, Korea University Ansan Hospital, Ansan-si, South Korea.
| | - Ye-Soo Park
- Department of Orthopedics, Hanyang University Guri Hospital, Guri-si, South Korea
| | - Kyungdo Han
- Department of Biostatistics, Biomedicine & Health Sciences, Catholic University, Seoul, South Korea
| | - Seung-Woo Suh
- Scoliosis Research Institute, Department of Orthopedics, Korea University Guro Hospital, Seoul, South Korea
| |
Collapse
|
28
|
Schofield D, Shrestha R, Cunich M. The economic impacts of using adalimumab (Humira ® ) for reducing pain in people with ankylosing spondylitis: A microsimulation study for Australia. Int J Rheum Dis 2018; 21:1106-1113. [PMID: 29611342 DOI: 10.1111/1756-185x.13277] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
AIM The onset and progression of ankylosing spondylitis (AS) usually occurs during the life stage when individuals are more likely to be working and receiving an income, but little is known about the effects of interventions that reduce pain and improve the economic circumstances of patients out of the labour force due to AS. This study evaluates the economic benefits of pain reduction among people aged 19-64 with AS using adalimumab (Humira® ) from the patient and governmental perspectives. METHODS We estimated the benefits of adalimumab for reducing pain in people aged 19-64 with AS in terms of labor force participation and earnings, and to the Australian Government in terms of income tax revenue and welfare payments using economic simulation. The simulation model integrated data from the Adalimumab Trial Evaluating Long-Term Safety and Efficacy for Ankylosing Spondylitis (ATLAS), the Household Income and Labour Dynamics in Australia (HILDA) Survey - Wave 10, and Static Incomes Model (STINMOD). All benefits are expressed in 2014 real Australian dollars. RESULTS We estimated an additional 131 people aged 19-64 with AS (111 males, 20 females) would be in the labour force after using adalimumab for 24 weeks. National benefits consisted of an increase in annual earnings of AU$7.4 million for patients through increased labour force participation, savings of $2 million in annual welfare payments, and an increase of $1.3 million in income tax revenue in 2014 (after 24 weeks). CONCLUSION Adalimumab therapy generates substantial economic benefits in addition to health benefits for individuals, and savings for government.
Collapse
Affiliation(s)
- Deborah Schofield
- Faculty of Pharmacy, Charles Perkins Centre, The University of Sydney, New South Wales, Australia.,Murdoch Childrens Research Institute, Royal Children's Hospital, Melbourne, Victoria, Australia.,Garvan Institute of Medical Research, Sydney, New South Wales, Australia
| | - Rupendra Shrestha
- Faculty of Pharmacy, Charles Perkins Centre, The University of Sydney, New South Wales, Australia
| | - Michelle Cunich
- Faculty of Pharmacy, Charles Perkins Centre, The University of Sydney, New South Wales, Australia
| |
Collapse
|
29
|
Redeker I, Hoffmann F, Callhoff J, Haibel H, Sieper J, Zink A, Poddubnyy D. Determinants of psychological well-being in axial spondyloarthritis: an analysis based on linked claims and patient-reported survey data. Ann Rheum Dis 2018. [PMID: 29525776 PMCID: PMC6029638 DOI: 10.1136/annrheumdis-2017-212629] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVES The aim of this study was to assess the psychological well-being and to analyse factors associated with depressive symptoms in axial spondyloarthritis (axSpA). METHODS A stratified random sample of subjects with a diagnosis of axSpA (International Classification of Diseases, Tenth Revision, German Modification M45) was drawn from health insurance data in Germany. These persons received a postal questionnaire on disease-related, psychological and lifestyle factors as well as socioeconomic status. Additional information to verify the axSpA diagnosis was also collected. The psychological well-being was assessed by means of the 5-item WHO Well-Being Index (WHO-5), which is considered a screening tool for depression. The following established cut-offs on the WHO-5 were applied: >50: good well-being, no depressive symptoms; 29-50: mild depressive symptoms; ≤28: moderate-to-severe depressive symptoms. Information on comorbidities, drug prescriptions and non-pharmacological treatment was retrieved from claims data and linked to the questionnaire data. RESULTS A total of 1736 persons with a confirmed axSpA diagnosis were included. Using the cut-offs on the WHO-5, 533 persons (31%) were found to have moderate-to-severe depressive symptoms, 479 (28%) had mild depressive symptoms and 724 (42%) had a good well-being. Multivariable logistic regression revealed that higher disease activity, higher level of functional impairment, lower income, self-reported stress and lack of exercise, and younger age represent factors associated with moderate-to-severe depressive symptoms. CONCLUSIONS The prevalence of depressive symptoms in axSpA subjects is high and associated with disease-related parameters, socioeconomic status and lifestyle factors. These findings highlight the need for the careful evaluation of depressive symptoms as a part of the management strategy for axSpA.
Collapse
Affiliation(s)
- Imke Redeker
- Epidemiology Unit, German Rheumatism Research Centre, Berlin, Germany
| | - Falk Hoffmann
- Department of Health Services Research, Carl von Ossietzky University, Oldenburg, Germany
| | - Johanna Callhoff
- Epidemiology Unit, German Rheumatism Research Centre, Berlin, Germany
| | - Hildrun Haibel
- Department of Gastroenterology, Infectiology and Rheumatology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Joachim Sieper
- Department of Gastroenterology, Infectiology and Rheumatology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Angela Zink
- Epidemiology Unit, German Rheumatism Research Centre, Berlin, Germany.,Department of Rheumatology and Clinical Immunology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Denis Poddubnyy
- Epidemiology Unit, German Rheumatism Research Centre, Berlin, Germany.,Department of Gastroenterology, Infectiology and Rheumatology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| |
Collapse
|
30
|
Walsh JA, Shao Y, Leng J, He T, Teng CC, Redd D, Treitler Zeng Q, Burningham Z, Clegg DO, Sauer BC. Identifying Axial Spondyloarthritis in Electronic Medical Records of US Veterans. Arthritis Care Res (Hoboken) 2017; 69:1414-1420. [PMID: 27813310 DOI: 10.1002/acr.23140] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Revised: 10/19/2016] [Accepted: 11/01/2016] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Large database research in axial spondyloarthritis (SpA) is limited by a lack of methods for identifying most types of axial SpA. Our objective was to develop methods for identifying axial SpA concepts in the free text of documents from electronic medical records. METHODS Veterans with documents in the national Veterans Health Administration Corporate Data Warehouse between January 1, 2005 and June 30, 2015 were included. Methods were developed for exploring, selecting, and extracting meaningful terms that were likely to represent axial SpA concepts. With annotation, clinical experts reviewed sections of text containing the meaningful terms (snippets) and classified the snippets according to whether or not they represented the intended axial SpA concept. With natural language processing (NLP) tools, computers were trained to replicate the clinical experts' snippet classifications. RESULTS Three axial SpA concepts were selected by clinical experts, including sacroiliitis, terms including the prefix spond*, and HLA-B27 positivity (HLA-B27+). With supervised machine learning on annotated snippets, NLP models were developed with accuracies of 91.1% for sacroiliitis, 93.5% for spond*, and 97.2% for HLA-B27+. With independent validation, the accuracies were 92.0% for sacroiliitis, 91.0% for spond*, and 99.0% for HLA-B27+. CONCLUSION We developed feasible and accurate methods for identifying axial SpA concepts in the free text of clinical notes. Additional research is required to determine combinations of concepts that will accurately identify axial SpA phenotypes. These novel methods will facilitate previously impractical observational research in axial SpA and may be applied to research with other diseases.
Collapse
Affiliation(s)
- Jessica A Walsh
- George E. Wahlen Veterans Affairs Medical Center and University of Utah, Salt Lake City
| | - Yijun Shao
- George E. Wahlen Veterans Affairs Medical Center, Salt Lake City, Utah, and George Washington University, Washington, DC
| | - Jianwei Leng
- George E. Wahlen Veterans Affairs Medical Center and University of Utah, Salt Lake City
| | - Tao He
- George E. Wahlen Veterans Affairs Medical Center and University of Utah, Salt Lake City
| | - Chia-Chen Teng
- George E. Wahlen Veterans Affairs Medical Center and University of Utah, Salt Lake City
| | - Doug Redd
- George E. Wahlen Veterans Affairs Medical Center, Salt Lake City, Utah, and George Washington University, Washington, DC
| | - Qing Treitler Zeng
- George E. Wahlen Veterans Affairs Medical Center, Salt Lake City, Utah, and George Washington University, Washington, DC
| | | | - Daniel O Clegg
- George E. Wahlen Veterans Affairs Medical Center and University of Utah, Salt Lake City
| | - Brian C Sauer
- George E. Wahlen Veterans Affairs Medical Center and University of Utah, Salt Lake City
| |
Collapse
|
31
|
The health-related quality of life of ankylosing spondylitis patients assessed by SF-36: a systematic review and meta-analysis. Qual Life Res 2016; 25:2711-2723. [PMID: 27324038 DOI: 10.1007/s11136-016-1345-z] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/14/2016] [Indexed: 12/26/2022]
Abstract
PURPOSE The main purpose of this meta-analysis was to evaluate the impact of ankylosing spondylitis on the health-related quality of life assessed by the Medical Outcomes Short-Form-36 questionnaire (SF-36). METHODS A systematic literature search was performed on PubMed and Web of Science until January 22, 2016 to obtain eligible studies. Random effect model was performed to summarize the scores of each domain. The radar chart was used to compare the scores of AS patients with other health conditions. Spearman's correlation analysis and meta-regression were used to explore the related factors. STATA (version 11.0) and SPSS (version 13.0) were adopted in this meta-analysis. RESULTS Thirty-eight studies were included in this study, which were all reliable to summarize the scores of the SF-36. Pooled mean scores of the physical health domains ranged from 45.93 to 58.17, with the RP and PF domains being the lowest and the highest, respectively. Pooled mean scores of the mental health domains ranged from 47.49 to 62.52, with the VT and SF domains being the lowest and the highest, respectively. Besides, the physical component summary was lower than the mental component summary. BASDAI and BASFI were negatively associated with some domains of the SF-36 significantly. Patients with AS had a substantial impaired HRQoL in comparison with the general population. CONCLUSIONS AS could adversely affect the HRQoL of patients. Measuring HRQoL should be considered as an essential part of the overall assessment of health status of AS patients, which would provide valuable clues for improving the management of disease and making decisions regarding treatment.
Collapse
|
32
|
Rahman P, Choquette D, Bensen WG, Khraishi M, Chow A, Zummer M, Shaikh S, Sheriff M, Dixit S, Sholter D, Psaradellis E, Sampalis JS, Letourneau V, Lehman AJ, Nantel F, Rampakakis E, Otawa S, Shawi M. Biologic Treatment Registry Across Canada (BioTRAC): a multicentre, prospective, observational study of patients treated with infliximab for ankylosing spondylitis. BMJ Open 2016; 6:e009661. [PMID: 27048632 PMCID: PMC4823435 DOI: 10.1136/bmjopen-2015-009661] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVES To describe the profile of patients with ankylosing spondylitis (AS) treated with infliximab in Canadian routine care and to assess the effectiveness and safety of infliximab in real world. SETTING 46 primary care rheumatology practices across Canada. PARTICIPANTS 303 biological-naïve patients with AS or patients previously treated with a biological for <6 months and who were eligible for infliximab treatment as per routine care within the Biologic Treatment Registry Across Canada (BioTRAC). INTERVENTION Not applicable (non-interventional study). PRIMARY AND SECONDARY OUTCOMES Effectiveness was assessed with changes in disease parameters (AS Disease Activity Score (ASDAS), Bath AS Disease Activity Index (BASDAI), Bath AS Functional Index (BASFI), Health Assessment Questionnaire Disease Index (HAQ-DI), physician global assessment of disease activity (MDGA), patient global disease activity (PtGA), back pain, C-reactive protein, erythrocyte sedimentation rate (ESR), morning stiffness). Safety was assessed with the incidence of adverse events (AEs). RESULTS Of the 303 patients included, 44.6% were enrolled in 2005-2007 and 55.4% in 2008-2013. Patients enrolled in 2005-2007 had significantly higher MDGA and ESR at baseline while all other disease parameters examined were numerically higher with the exception of PtGA. Treatment with infliximab significantly (p<0.001) improved all disease parameters over time in both groups. At 6 months, 56% and 31% of patients achieved clinically important (change≥1.1) and major (change≥2.0) improvement in ASDAS, respectively; at 48 months, these proportions increased to 75% and 50%, respectively. Among patients unemployed due to disability at baseline, 12.1% returned to work (mean Kaplan-Meier (KM)-based time=38.8 months). The estimated retention rate at 12 and 24 months was 78.3% and 60.1%, respectively. The profile and incidence of AEs were comparable to data previously reported for tumour necrosis factor-α inhibitors. CONCLUSIONS Characteristics of patients with AS at infliximab initiation changed over time towards lower disease activity and shorter disease duration. Infliximab treatment significantly reduced disease activity independent of treatment initiation year, although patients enrolled in recent years achieved lower disease activity over 48 months. TRIAL REGISTRATION NUMBER NCT00741793.
Collapse
Affiliation(s)
- Proton Rahman
- Department of Medicine & Rheumatology, Memorial University, St. John's, Newfoundland, Canada
| | - Denis Choquette
- Institut de Rhumatologie de Montréal, Montreal, Quebec, Canada
| | - William G Bensen
- St. Joseph's Hospital, Hamilton, Ontario, Canada
- McMaster University, Hamilton, Ontario, Canada
| | - Majed Khraishi
- Memorial University of Newfoundland, St. John's, Newfoundland, Canada
| | - Andrew Chow
- Credit Valley Rheumatology, Mississauga, Ontario, Canada
| | - Michel Zummer
- Université de Montréal, Montreal, Quebec, Canada
- Maisonneuve-Rosemont Hospital, Montreal, Quebec, Canada
| | | | - Maqbool Sheriff
- Nanaimo Regional General Hospital, Nanaimo, British Columbia, Canada
| | | | | | - Eliofotisti Psaradellis
- JSS Medical Research Inc., St-Laurent, Quebec, Canada
- McGill University, Montreal, Quebec, Canada
| | - John S Sampalis
- JSS Medical Research Inc., St-Laurent, Quebec, Canada
- McGill University, Montreal, Quebec, Canada
| | | | | | | | - Emmanouil Rampakakis
- JSS Medical Research Inc., St-Laurent, Quebec, Canada
- McGill University, Montreal, Quebec, Canada
| | - Susan Otawa
- Janssen Inc. Medical Affairs, Toronto, Ontario, Canada
| | - May Shawi
- Janssen Inc. Medical Affairs, Toronto, Ontario, Canada
| |
Collapse
|
33
|
Ankylosing spondylitis self-help organisations - do members differ from non-members? Joint Bone Spine 2015; 83:295-300. [PMID: 26677993 DOI: 10.1016/j.jbspin.2015.06.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2015] [Accepted: 06/21/2015] [Indexed: 11/22/2022]
Abstract
OBJECTIVES Joining a patient self-help organisation is recommended for patients with ankylosing spondylitis (AS). The objective was to compare AS patients who are members of a self-help organisation with non-members regarding disease specific and patient personality aspects, and make inferences on potential benefits of membership. METHODS A comprehensive questionnaire regarding demographics, smoking habits, acquisition of information about the disease, disease activity, functioning, patient satisfaction, treatment, sick leave, work disability and educational level was distributed to members of the German AS self-help organisation and to non-member AS patients. RESULTS In total, 1273 patients responded. Significant differences regarding age and disease duration led us to match members 2:1 to non-members. In the matched population (n=549), members had a higher level of education, felt more often well-informed about the disease, had less often physically demanding jobs, and smoked less than non-members. Members were more often treated with NSAIDs and less often with TNF-blockers suggesting more severe disease in non-members. While the level of disease activity was similar (BASDAI 4.1 vs. 4.2), members had a better functional status (BASFI 3.5 vs. 3.9) and significantly less days on sick leave during the last year (15.1 days vs. 31.2 days). Days on sick leave increased with increasing BASFI significantly more strikingly in non-members than in members. CONCLUSION AS patients who are members of an AS self-help organisation have a higher educational level and are much better informed about the disease. Inferences on disease outcome measures, however, are hampered by potential confounders.
Collapse
|
34
|
Spencer S, Martindale JH, MacPhie E, Montgomery P. Self management programme for ankylosing spondylitis. Hippokratia 2015. [DOI: 10.1002/14651858.cd006977.pub2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
- Sally Spencer
- Edge Hill University; Faculty of Health and Social Care; St Helens Road Ormskirk Lancashire UK L39 4QP
| | - Jane H Martindale
- Wrightington, Wigan and Leigh NHS Foundation Trust; Physiotherapy; Hall Lane, Appley Bridge Wigan Lancashire UK WN6 9EP
| | - Elizabeth MacPhie
- Lancashire Care NHS Foundation Trust; Rheumatology Department; Minerva Health Centre, Lowthorpe Road Preston Lancashire UK PR1 6SB
| | - Paul Montgomery
- University of Oxford; Department of Social Policy and Social Work; Barnett House 32 Wellington Square Oxford UK OX1 2ER
| |
Collapse
|
35
|
Stolwijk C, Castillo‐Ortiz J, Gignac M, Luime J, Boonen A, Lacaille D, Fautrel B, Tang K, Verstappen S, Escorpizo R, Tugwell P, Beaton D. Importance of Contextual Factors When Measuring Work Outcome in Ankylosing Spondylitis: A Systematic Review by the OMERACT Worker Productivity Group. Arthritis Care Res (Hoboken) 2015; 67:1316-1327. [DOI: 10.1002/acr.22573] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2014] [Revised: 02/07/2015] [Accepted: 02/24/2015] [Indexed: 02/06/2023]
Affiliation(s)
- Carmen Stolwijk
- Maastricht University Medical CenterMaastricht The Netherlands
| | - José‐Dionisio Castillo‐Ortiz
- Maastricht University Medical Center, Maastricht, The Netherlands, and Unidad de Investigación en Enfermedades Cronico‐DegenerativasGuadalajara Mexico
| | - Monique Gignac
- Institute for Work and Health, University of Toronto, and University Health NetworkToronto, Ontario Canada
| | - Jolanda Luime
- Erasmus Medical Center and University Medical CenterRotterdam The Netherlands
| | - A. Boonen
- Maastricht University Medical CenterMaastricht The Netherlands
| | | | | | | | | | | | | | | | | |
Collapse
|
36
|
Haglund E, Petersson IF, Bremander A, Bergman S. Predictors of presenteeism and activity impairment outside work in patients with spondyloarthritis. JOURNAL OF OCCUPATIONAL REHABILITATION 2015; 25:288-295. [PMID: 25173795 DOI: 10.1007/s10926-014-9537-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
PURPOSES To assess predictors of presenteeism (reduced productivity at work) and activity impairment outside work in patients with spondyloarthritis (SpA). METHODS Multivariate logistic regression analysis was used to study predictors of presenteeism and activity impairment in 1,253 patients with SpA based on a 2.5 year follow-up questionnaire. The Work Productivity and Activity Impairment (WPAI) questionnaire was used as main outcome. Age, gender, lifestyle factors, subgroups, disease duration, and different patient reported outcome measures (PROMs) were studied as possible predictors. The association between presenteeism and WPAI activity impairment outside work was assessed. RESULTS Out of 1,253 patients, 757 reported being in work and of these 720 responded to the WPAI questionnaire. The mean (confidence interval, CI) reported presenteeism was 25% (23-27%) and mean activity impairment 33% (31-35%) (0-100%, 0 = no reduction). Significant predictors of presenteeism and activity impairment at follow-up (controlled for gender, age, spondyloarthritis subgroups and presenteeism at baseline) were presenteeism at baseline, poor quality of life, worse disease activity, decreased physical function, lower self-efficacy pain and symptom, higher scores of anxiety, depression, smoking and low education level, and for activity impairment also female sex. There was a strong association between presenteeism and activity impairment outside work (OR 16.7; 95% CI 11.6-24.3; p < 0.001). CONCLUSIONS Presenteeism and activity impairment were not only predicted by presenteeism at baseline, but also by several PROMs commonly used in clinical rheumatology practice. Impaired activity outside work could indicate problems also at work suggesting why both areas need to be addressed in the clinical situation.
Collapse
Affiliation(s)
- Emma Haglund
- Spenshult Research and Development Center, Bäckagårdsvägen 47, 302 74, Halmstad, Sweden,
| | | | | | | |
Collapse
|
37
|
The impact of ankylosing spondylitis/axial spondyloarthritis on work productivity. Best Pract Res Clin Rheumatol 2015; 29:512-23. [PMID: 26612245 DOI: 10.1016/j.berh.2015.04.002] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Ankylosing spondylitis (AS) is a chronic inflammatory condition that has a significant impact on the quality of life and work productivity. New classification criteria have enabled earlier diagnosis of this condition. However, work productivity is an important issue that is still often overlooked during clinical assessments and consultations. This article focusses on the relationship between axial spondyloarthritis (axial SpA) and work productivity. It summarises the impact of this condition on work productivity, and it highlights the tools available to assess this. It also highlights the increasing role and potential of employers, health professionals and new treatments for enhancing work productivity for people with this condition.
Collapse
|
38
|
Efficiency of adalimumab, etanercept and infliximab in ankylosing spondylitis in clinical practice. Int J Clin Pharm 2015; 37:808-14. [DOI: 10.1007/s11096-015-0124-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2014] [Accepted: 04/15/2015] [Indexed: 12/15/2022]
|
39
|
de Jong M, de Boer AGEM, Tamminga SJ, Frings-Dresen MHW. Quality of working life issues of employees with a chronic physical disease: a systematic review. JOURNAL OF OCCUPATIONAL REHABILITATION 2015; 25:182-96. [PMID: 24832893 DOI: 10.1007/s10926-014-9517-6] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
PURPOSE To assess issues that contribute to the Quality of Working Life (QWL) of employees with a chronic physical disease. METHODS A systematic literature search was conducted using the databases PubMed, PsycINFO and EMBASE. Experiences and perceptions during the working life of employees with a chronic physical disease were extracted and synthesized into issues that contributed to their QWL. We organized these synthesized QWL issues into higher order themes and categories with qualitative data analysis software. RESULTS From a total of 4,044 articles identified by the search, 61 articles were included. Data extraction and data synthesis resulted in an overview of 73 QWL issues that were classified into 30 themes. The following five categories of themes were identified: (1) job characteristics with issues such as job flexibility and work-site access; (2) the social structure and environment containing issues about disclosure, discrimination, misunderstanding, and awareness by employers or colleagues; (3) organizational characteristics with issues such as requesting work accommodations; (4) individual work perceptions including issues about enjoyment and evaluating work or life priorities; and (5) effect of the disease and treatment including issues about cognitive and physical health and work ability. CONCLUSION This systematic review offers an extensive overview of issues that might contribute to the QWL of employees with a chronic physical disease. This overview may function as a starting point for occupational support, such as monitoring and evaluating the QWL of employees with a chronic physical disease during return-to-work and work continuation processes.
Collapse
Affiliation(s)
- Merel de Jong
- Coronel Institute of Occupational Health, Academic Medical Center, University of Amsterdam, P.O. Box 22660, 1100 DD, Amsterdam, The Netherlands,
| | | | | | | |
Collapse
|
40
|
Boonen A, Boone C, Albert A, Mielants H. Understanding Limitations in At-work Productivity in Patients with Active Ankylosing Spondylitis: The Role of Work-related Contextual Factors. J Rheumatol 2014; 42:93-100. [DOI: 10.3899/jrheum.131287] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Objective.To explore the effect of health-related and contextual factors on presenteeism, absenteeism, and overall work productivity loss in patients with active ankylosing spondylitis (AS).Methods.Consecutive patients with AS starting their first tumor necrosis factor inhibitor and in paid employment were eligible. Patients completed the Work Productivity and Activity Impairment (WPAI) questionnaire for AS to assess presenteeism, absenteeism, and overall work productivity loss in the previous 7 days. In addition, they answered questions about work characteristics (type, characteristics of workplace, satisfaction of contacts with colleagues, and importance of work in life) and health status [Bath AS Functional Index (BASFI), AS Disease Activity Score-C-reactive protein (ASDAS-CRP)]. Physicians assessed the Bath Ankylosing Spondylitis Metrology Index, presence of articular and extraarticular manifestations, comorbidities, and laboratory indicators of inflammation. Stepwise regression models were computed to determine which work-related and health-related factors contributed to WPAI outcomes.Results.The study included 80 patients. The WPAI presenteeism, absenteeism, and overall work productivity loss scores were 49.1%, 30.2%, and 53.1%, respectively. Presenteeism was associated with higher BASFI, female sex, and poor quality of contact with colleagues. Absenteeism was associated with increasing age, current smoking status, higher ASDAS-CRP, and low importance of work for life. Overall work productivity loss was associated with female sex, higher BASFI, past adaptation of job because of illness, number of working hours, and manual profession.Conclusion.Both health-related and contextual factors contribute to work limitations in patients with AS and suggest additional opportunities for improvement by addressing the working environment.
Collapse
|
41
|
Chan CYY, Tsang HHL, Lau CS, Chung HY. Prevalence of depressive and anxiety disorders and validation of the Hospital Anxiety and Depression Scale as a screening tool in axial spondyloarthritis patients. Int J Rheum Dis 2014; 20:317-325. [PMID: 25293872 DOI: 10.1111/1756-185x.12456] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To determine the prevalence of anxiety and depression in axial spondyloarthritis (SpA) patients by a psychiatrist using the Chinese-bilingual Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, fourth edition patient research version (CB-SCID-I/P), and to examine the effectiveness of the Hospital Anxiety and Depression Scale (HADS) as a screening tool. METHODS We recruited 160 Chinese axial-SpA patients to determine the prevalence of anxiety and depression using the CB-SCID-I/P. Recruited subjects were asked to complete the HADS. HADS, HADS-depression (HADS-D) subscale and HADS-anxiety (HADS-A) subscale were analyzed to determine their effectiveness in screening for depressive and anxiety disorders. RESULTS The prevalence of current major depressive disorder (MDD) and anxiety disorder were 10.6% and 15.6%, respectively. The full-scale HADS outperformed the HADS-D subscale in screening for current MDD (area under the curve [AUC] 0.889; 0.844) and all depressive disorders (AUC 0.885; 0.862) while the HADS-A subscale outperformed the full scale HADS in screening for anxiety disorders (AUC 0.894; 0.846). The optimal cut-off point of the full scale HADS for screening current MDD and all depressive disorders were 7/8 and 6/7, yielding a sensitivity of 82.4% and 83.9%, specificity of 78.7% and 74.8%, respectively. The optimal cut-off point of HADS-A subscale for screening anxiety disorders was 6/7, yielding a sensitivity of 88.0% and specificity of 74.4%. CONCLUSION The prevalence of MDD and anxiety disorder in SpA patients were 10.6% and 15.6%, respectively. We recommend using the full-scale HADS in screening for depressive disorders and HADS-A subscale for anxiety disorders.
Collapse
Affiliation(s)
- Cynthia Y Y Chan
- Department of Psychiatry, Pamela Youde Nethersole Eastern Hospital, Hong Kong, China
| | - Helen H L Tsang
- Division of Rheumatology and Clinical Immunology, Queen Mary Hospital, Hong Kong, China
| | - C S Lau
- Division of Rheumatology and Clinical Immunology, Queen Mary Hospital, Hong Kong, China.,Division of Rheumatology and Clinical Immunology, University of Hong Kong, Hong Kong, China
| | - H Y Chung
- Division of Rheumatology and Clinical Immunology, Queen Mary Hospital, Hong Kong, China
| |
Collapse
|
42
|
Lederer V, Loisel P, Rivard M, Champagne F. Exploring the diversity of conceptualizations of work (dis)ability: a scoping review of published definitions. JOURNAL OF OCCUPATIONAL REHABILITATION 2014; 24:242-67. [PMID: 23884716 DOI: 10.1007/s10926-013-9459-4] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
PURPOSE Researchers are confronted to numerous definitions of work ability/disability, influenced by their context of emergence, discipline, purpose, underlying paradigm and relationship to time. This study provides an in-depth analysis of the concept through a systematic scoping review and the development of an integrative concept map of work (dis)ability. The research questions are: How has work (dis)ability been conceptualized from the perspectives of research, practice, policy and industry in the published scientific literature? How has the conceptualization of work (dis)ability evolved over time? METHODS A search strategy was designed with a library scientist to retrieve scientific publications containing explicit definition(s) of work (dis)ability in leading-edge databases. The screening and the extraction of the definitions were achieved by duplicate assessment. The definitions were subject to a comparative analysis based on the grounded theory approach. RESULTS In total, 423 abstracts were retrieved from the bibliographic databases. After removing duplicates, 280 unique records were screened for inclusion. A final set of 115 publications containing unique original conceptual definitions served as basis for analysis. CONCLUSIONS The scientific literature does not reflect a shared, integrated vision of the exact nature and dimensions of work (dis)ability. However, except for a few definitions, there seems to be a consensus that work (dis)ability is a relational concept resulting from the interaction of multiple dimensions that influence each other through different ecological levels. The conceptualization of work (dis)ability also seems to have become more dynamic over time. The way work (dis)ability is defined has important implications for research, compensation and rehabilitation.
Collapse
Affiliation(s)
- Valérie Lederer
- University of Montreal Public Health Research Institute, Montreal, QC, Canada,
| | | | | | | |
Collapse
|
43
|
Abdul-Sattar A, Abou El Magd S. Prevalence and associated risk factors for work disability in Egyptian patients with ankylosing spondylitis from one center. Int J Rheum Dis 2014; 20:2028-2034. [PMID: 24618084 DOI: 10.1111/1756-185x.12306] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To determine the prevalence of work disability (WD) in Egyptian patients with ankylosing spondylitis (AS) and to identify the main factors associated with this. METHODS A cross-sectional survey was conducted among all patients with AS during an extended outpatient visit in the period between July, 2011 and December, 2012. Demographic data were collected and a physical examination was performed. Multivariate modeling was applied to determine the factors associated with work disability. RESULTS The questionnaire was completed by 90 patients (85 males; 94.4%). The mean age of the participants was 37.8 (SD 9.7) years, mean disease duration was 12.1 (SD 8.9) years, and the mean symptom duration was 15 (SD 2.9) years. A total of 36 (40%) patients of working age were not working due to AS. The factors that associated with work disability, after completing logistic regression models, were older age (odds ratio [OR] = 1.8, 95%, confidence interval [CI] = 1.04-1.17), longer disease duration (OR = 1.60, 95% CI = 1.12-2.8), increasing diagnostic delay (OR = 2.1, 95% CI = 1.0-3.4), lower educational level (OR = 3.5, 95% CI = 1.6-6.4), manual profession (OR = 1.80, 95% CI = 1.10-2.6), living in a rural zone (OR = 3.14, 95% CI = 1.98-5.05), peripheral arthritis (OR = 2.04, 95% CI = 1.20-3.43) and psychological symptoms (OR = 2.3, 95% CI = 1.9-4.6). CONCLUSION The prevalence of WD among Egyptian patients with AS is considerably high. Clinical and psychosocial factors, in particular, appear to be associated with WD and should therefore be prioritized in clinical practice.
Collapse
Affiliation(s)
- Amal Abdul-Sattar
- Department of Rheumatology and Rehabilitation, Zagazig University, Zagazig, Egypt
| | - Sahar Abou El Magd
- Department of Community, Environmental and Occupational Medicine, Zagazig University, Zagazig, Egypt
| |
Collapse
|
44
|
Basu N, McClean A, Harper L, Amft EN, Dhaun N, Luqmani RA, Little MA, Jayne DRW, Flossmann O, McLaren J, Kumar V, Erwig LP, Reid DM, Macfarlane GJ, Jones GT. Markers for work disability in anti-neutrophil cytoplasmic antibody-associated vasculitis. Rheumatology (Oxford) 2014; 53:953-6. [DOI: 10.1093/rheumatology/ket483] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
|
45
|
Haglund E, Bremander A, Bergman S, Jacobsson LTH, Petersson IF. Work productivity in a population-based cohort of patients with spondyloarthritis. Rheumatology (Oxford) 2013; 52:1708-14. [DOI: 10.1093/rheumatology/ket217] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
|
46
|
Frauendorf R, Medeiros Pinheiro MD, Mesquita Ciconelli R. Variáveis relacionadas com perda da produtividade no trabalho em pacientes com espondilite anquilosante. REVISTA BRASILEIRA DE REUMATOLOGIA 2013. [DOI: 10.1590/s0482-50042013000300009] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
|
47
|
Meyer K, Niedermann K, Tschopp A, Klipstein A. Is the work ability index useful to evaluate absence days in ankylosing spondylitis patients? A cross-sectional study. BMJ Open 2013; 3:bmjopen-2012-002231. [PMID: 23524041 PMCID: PMC3612752 DOI: 10.1136/bmjopen-2012-002231] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND The work incapacity of ankylosing spondylitis (AS) ranges between 3% and 50% in Europe. In many countries, work incapacity is difficult to quantify. The work ability index (WAI) is applied to measure the work ability in workers, but it is not well investigated in patients. AIMS To investigate the work incapacity in terms of absence days in patients with AS and to evaluate whether the WAI reflects the absence from work. HYPOTHESIS Absence days can be estimated based on the WAI and other variables. DESIGN Cross-sectional design. SETTING In a secondary care centre in Switzerland, the WAI and a questionnaire about work absence were administered in AS patients prior to cardiovascular training. The number of absence days was collected retrospectively. The absence days were estimated using a two-part regression model. PARTICIPANTS 92 AS patients (58 men (63%)). INCLUSION CRITERIA AS diagnosis, ability to cycle, age between 18 and 65 years. EXCLUSION CRITERIA severe heart disease. PRIMARY AND SECONDARY OUTCOME MEASURES Absence days. RESULTS Of the 92 patients, 14 received a disability pension and 78 were in the working process. The median absence days per year of the 78 patients due to AS alone and including other reasons was 0 days (IQR 0-12.3) and 2.5 days (IQR 0-19), respectively. The WAI score (regression coefficient=-4.66 (p<0.001, CI -6.1 to -3.2), 'getting a disability pension' (regression coefficient=-106.8 (p<0.001, 95% CI -141.6 to -72.0) and other not significant variables explained 70% of the variance in absence days (p<0.001), and therefore may estimate the number of absence days. CONCLUSIONS Absences in our sample of AS patients were equal to pan-European countries. In groups of AS patients, the WAI and other variables are valid to estimate absence days with the help of a two-part regression model.
Collapse
Affiliation(s)
- Katharina Meyer
- Physiotherapy Occupational Therapy, University Hospital Zurich, Zurich, Switzerland
| | - Karin Niedermann
- School of Health Professions, Zurich University of Applied Sciences, Institute of Physiotherapy, Winterthur, Switzerland
| | - Alois Tschopp
- Biostatistics Unit, Institute of Social and Preventive Medicine, University Zurich, Zurich, Switzerland
| | - Andreas Klipstein
- Physiotherapy Occupational Therapy, University Hospital Zurich, Zurich, Switzerland
- Center of Occupational Health, Zurich, Switzerland
| |
Collapse
|
48
|
Hoving JL, van Zwieten MCB, van der Meer M, Sluiter JK, Frings-Dresen MHW. Work participation and arthritis: a systematic overview of challenges, adaptations and opportunities for interventions. Rheumatology (Oxford) 2013; 52:1254-64. [DOI: 10.1093/rheumatology/ket111] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
|
49
|
Farren W, Goodacre L, Stigant M. Fatigue in ankylosing spondylitis: causes, consequences and self-management. Musculoskeletal Care 2013; 11:39-50. [PMID: 22825963 DOI: 10.1002/msc.1029] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
OBJECTIVES To explore the perceived causes, consequences and management of fatigue in ankylosing spondylitis (AS). METHODS In this single-cohort qualitative study, ten participants completed a seven-day diary and participated in a semi-structured interview exploring possible causes, consequences and self-management of fatigue. Interviews were recorded, transcribed and analysed using 'framework' analysis. Ethical approval was obtained. RESULTS Three themes emerged: patterns and causes, consequences and management of fatigue. While patients' descriptions of fatigue were similar, the patterns and perceived causes of fatigue varied between individuals. Fatigue impacted on social life, relationships and work. Two approaches to fatigue management were observed: help and support from others and self-management, with four participants having sought medical help for fatigue. CONCLUSIONS The study suggested that fatigue has a negative impact on quality of life in people with AS. Future practice should include a comprehensive fatigue assessment and the development of treatment programmes directed at enhancing self-management techniques.
Collapse
Affiliation(s)
- Wendy Farren
- North Cumbria University Hospitals NHS Trust Carlisle, UK.
| | | | | |
Collapse
|
50
|
Prince DS, McGuigan LE, McGirr EE. Working life and physical activity in ankylosing spondylitis pre and post anti-tumor necrosis factor-alpha therapy. Int J Rheum Dis 2012; 17:165-72. [DOI: 10.1111/1756-185x.12018] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Affiliation(s)
- David S. Prince
- Faculty of Medicine; University of New South Wales; Sydney New South Wales Australia
| | - Louis E. McGuigan
- Faculty of Medicine; University of New South Wales; Sydney New South Wales Australia
- Combined Rheumatology Practice; Miranda New South Wales Australia
| | | |
Collapse
|