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Michelsen B, Sexton J, Kvien TK, Provan SA, Hammer HB. Ultrasound evaluation contrasts clinical disease activity evaluation in rheumatoid arthritis patients with concomitant anxiety or depression. Semin Arthritis Rheum 2024; 68:152502. [PMID: 38972287 DOI: 10.1016/j.semarthrit.2024.152502] [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: 01/17/2024] [Revised: 05/22/2024] [Accepted: 06/11/2024] [Indexed: 07/09/2024]
Abstract
OBJECTIVES To compare disease activity as assessed by ultrasonography (US) between rheumatoid arthritis (RA) patients with and without anxiety or depression, and to compare clinical disease activity and sociodemographic measures between these patient groups. METHODS Anxious or depressed patients were identified by EuroQoL-5D-3L question "I am not/moderately/extremely anxious or depressed." US assessments of 36 joints and 4 tendons were performed and power Doppler (PD) and grey scale (GS) sum scores calculated (both range 0-120). Comparisons between anxious/depressed and not anxious/depressed patients were performed in unadjusted analyses, adjusted logistic regression, and sensitivity analyses. RESULTS A total of 201 RA patients starting biological disease-modifying antirheumatic drugs were included (82 % women, mean age 52 years, disease duration 10 years). Hundred-and-nine patients (54.2 %) were moderately or extremely anxious/depressed. Median (IQR) PD (13 (4, 21) vs. 10 (3, 20), p = 0.53) and GS (28 (18, 42) vs. 25 (14, 41), p = 0.51) sum scores were similar between anxious/depressed and not anxious/depressed patients, respectively, whereas composite scores of disease activity were significantly worse in the anxious/depressed patients (p < 0.001), as were also patient-reported outcomes, ESR, CRP and plasma calprotectin (all p ≤ 0.02). Sensitivity analyses confirmed these findings, except for CRP. Self-reported economy and sleep difficulties were also worse in the anxious/depressed patients and a higher proportion were not working (all p < 0.001). CONCLUSION This study highlights the negative impact of anxiety and depression on RA patients in standard care, and underscores the challenges in disease activity assessment. US examination may be a valuable objective tool in the evaluation of these patients.
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Affiliation(s)
- Brigitte Michelsen
- Center for Treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Oslo, Norway; Research Unit, Sørlandet Hospital, Kristiansand, Norway.
| | - Joseph Sexton
- Center for Treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Oslo, Norway
| | - Tore K Kvien
- Center for Treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Oslo, Norway; Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Sella Aarestad Provan
- Center for Treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Oslo, Norway; Section for Public Health, Inland Norway University of Applied Sciences, Hamar, Norway
| | - Hilde Berner Hammer
- Center for Treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Oslo, Norway; Faculty of Medicine, University of Oslo, Oslo, Norway
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Wilk M, Zimba O, Haugeberg G, Korkosz M. Pain catastrophizing in rheumatic diseases: prevalence, origin, and implications. Rheumatol Int 2024; 44:985-1002. [PMID: 38609656 PMCID: PMC11108955 DOI: 10.1007/s00296-024-05583-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Accepted: 03/12/2024] [Indexed: 04/14/2024]
Abstract
Pain is a crucial factor in rheumatic disorders, and reducing it is a primary goal of successful treatment. Adaptive pain-coping strategies can enhance this improvement, but maladaptive approaches such as pain catastrophizing may worsen overall patient well-being. This narrative review aims to provide a concise overview of the existing knowledge on pain catastrophizing in the most prevalent specific rheumatic disorders. The objective of this study was to improve understanding of this phenomenon and its implications, as well as to pinpoint potential directions for future research. We conducted searches in the MEDLINE/PubMed, SCOPUS, and DOAJ bibliography databases to identify articles related to pain catastrophizing in rheumatoid arthritis, psoriatic arthritis, axial spondylarthritis, systemic sclerosis, systemic lupus erythematosus, Sjögren's syndrome, juvenile idiopathic arthritis, and osteoarthritis (non-surgical treatment). Data extraction was performed on November 1, 2023. The investigators screened the identified articles to determine their relevance and whether they met the inclusion criteria. Following a bibliography search, which was further expanded by screening of citations and references, we included 156 records in the current review. The full-text analysis centred on pain catastrophizing, encompassing its prevalence, pathogenesis, and impact. The review established the role of catastrophizing in amplifying pain and diminishing various aspects of general well-being. Also, potential treatment approaches were discussed and summarised across the examined disorders. Pain catastrophizing is as a significant factor in rheumatic disorders. Its impact warrants further exploration through prospective controlled trials to enhance global patient outcomes.
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Affiliation(s)
- Mateusz Wilk
- Division of Rheumatology, Immunology and Internal Medicine, University Hospital in Krakow, Krakow, Poland
| | - Olena Zimba
- Division of Rheumatology, Immunology and Internal Medicine, University Hospital in Krakow, Krakow, Poland
- National Institute of Geriatrics, Rheumatology and Rehabilitation, Warsaw, Poland
- Department of Internal Medicine N2, Danylo Halytsky Lviv National Medical University, Lviv, Ukraine
| | - Glenn Haugeberg
- Division of Rheumatology, Department of Internal Medicine, Sørlandet Hospital, Kristiansand, Norway
- Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Sciences, NTNU, Norwegian University of Science and Technology, Trondheim, Norway
| | - Mariusz Korkosz
- Division of Rheumatology, Immunology and Internal Medicine, University Hospital in Krakow, Krakow, Poland.
- Department of Rheumatology and Immunology, Jagiellonian University Medical College, Świętej Anny 12 St., 31-008, Kraków, Poland.
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3
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Rutter‐Locher Z, Esterine T, Williams R, Taams LS, Bannister K, Kirkham BW, Lempp H. Comparative analysis of centrally mediated and inflammatory pain experiences amongst patients diagnosed with rheumatoid arthritis: A multimethods study. Health Expect 2024; 27:e14090. [PMID: 38838095 PMCID: PMC11150858 DOI: 10.1111/hex.14090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Revised: 05/09/2024] [Accepted: 05/11/2024] [Indexed: 06/07/2024] Open
Abstract
BACKGROUND The identification of pain originating from distinct biological processes may lead to individualised pain treatment. In this study, we aimed to explore the pain experiences of patients with rheumatoid arthritis (RA), differentiating between those predominantly exhibiting features of peripheral inflammatory versus centrally mediated pain. METHODS Through a multimethods approach we (i) quantitatively analysed the differences in pain descriptors between patients diagnosed with RA experiencing peripheral inflammatory and centrally mediated pain, utilising the Short Form-McGill Pain Questionnaire which includes the pain visual analogue scale (VAS) and (ii) qualitatively explored their subjective pain experiences grounded in the biopsychosocial model, commonly applied in chronic pain. RESULTS Participants with centrally mediated pain reported higher pain scores on the VAS, used a wider range of pain descriptors, and a higher proportion selected each descriptor compared to those with inflammatory pain (p < .001). The qualitative analysis revealed the centrally mediated pain group's experiences were overwhelming and relentless, struggling to precisely articulate the nature of their pain. In contrast, individuals with inflammatory pain expressed their pain in more tangible terms and shared their adaptive and coping strategies. Importantly, both groups revealed the substantial psychological, functional and social impacts of their pain, highlighting the often 'invisible' and misunderstood nature of their symptoms. CONCLUSION This study has gained a deeper insight into the pain experiences of patients living with RA, particularly in differentiating between centrally mediated and inflammatory types of pain, potentially facilitating a more individualised approach to pain treatment. PATIENT CONTRIBUTION Patients actively participated in the study conception and design. This engagement includes collaboration with key stakeholders, such as members of the National Rheumatoid Arthritis Society and Patient Research Partners (PRPs), who provided continuous feedback and guidance throughout the research process. Specifically, the qualitative element was coproduced with two PRPs, who were involved in co-leading the focus groups and data analysis.
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Affiliation(s)
- Zoe Rutter‐Locher
- Rheumatology DepartmentGuy's and St Thomas' NHS TrustLondonUK
- Department of Inflammation Biology, Centre for Inflammation Biology and Cancer Immunology, Faculty of Life Sciences and Medicine, School of Immunology and Microbial SciencesKing's College LondonLondonUK
| | - Tom Esterine
- Department of Inflammation Biology, Centre for Rheumatic Diseases, Faculty of Life Sciences and Medicine, School of Immunology and Microbial SciencesKing's College LondonLondonUK
| | - Ruth Williams
- Department of Inflammation Biology, Centre for Rheumatic Diseases, Faculty of Life Sciences and Medicine, School of Immunology and Microbial SciencesKing's College LondonLondonUK
| | - Leonie S. Taams
- Department of Inflammation Biology, Centre for Inflammation Biology and Cancer Immunology, Faculty of Life Sciences and Medicine, School of Immunology and Microbial SciencesKing's College LondonLondonUK
| | - Kirsty Bannister
- Central modulation of pain group, Wolfson Centre for Age‐Related Diseases, Guy's CampusKing's College LondonLondonUK
| | | | - Heidi Lempp
- Department of Inflammation Biology, Centre for Rheumatic Diseases, Faculty of Life Sciences and Medicine, School of Immunology and Microbial SciencesKing's College LondonLondonUK
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Allegretti JR, Brady JH, Wicker A, Latymer M, Wells A. Relevance of Adalimumab Product Attributes to Patient Experience in the Biosimilar Era: A Narrative Review. Adv Ther 2024; 41:1775-1794. [PMID: 38466559 PMCID: PMC11052875 DOI: 10.1007/s12325-024-02818-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Accepted: 02/07/2024] [Indexed: 03/13/2024]
Abstract
Adalimumab (ADL, Humira®, reference product), an anti-TNF-α biologic, has transformed the treatment of chronic, immune-mediated inflammatory diseases. However, the high cost of ADL therapy has driven the development of more affordable ADL biosimilars, agents with no clinically meaningful differences from the reference product. This review summarizes the product attributes of reference ADL and the nine ADL biosimilars approved and available in the USA in relation to patient experience of injection-site pain (ISP). Product formulation, delivery volume and device features (e.g., type and needle gauge size) influence patient experience of ISP with potential clinical consequences. Citrate-free formulations generally cause less ISP; injection volumes of > 1.5 ml may be associated with increased ISP. Reference ADL and all ADL biosimilars offer a citrate-free formulation, and reference ADL and four ADL biosimilars offer a high-concentration solution that allows a smaller injection volume. All available ADL products are injected subcutaneously using either a pre-filled pen (PFP) or pre-filled syringe (PFS). Patients prefer the PFP, but the PFS permits better control over the speed and duration of injection. Smaller (29-gauge) needle outer diameter is associated with less ISP; reference ADL and seven ADL biosimilars offer a device with a 29-gauge needle. In the USA, an approved biosimilar can be designated "interchangeable," allowing pharmacy-level substitution, where state law permits. In the USA, two ADL biosimilars have received interchangeability designation; others are seeking interchangeability designation from the Food and Drug Administration (n = 2), are being evaluated in clinical studies to support interchangeability (n = 2), or do not have/are not seeking interchangeability designation (n = 3). Product-related attributes influence patient experience of ISP caused by subcutaneous ADL injection. Reference ADL and ADL biosimilar products differ in their attributes, so discussion with patients about treatment options is essential to optimize adherence and outcomes.
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Affiliation(s)
- Jessica R Allegretti
- Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA.
| | | | | | | | - Alvin Wells
- Department of Rheumatology, Advocate Health Medical Group, Franklin, WI, USA
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Zhang W, Sun J, Li J, Wang Y, Liu W, Xue W, Yuan Y, Wang X. Comparison of Angio PLanewave UltraSensitive and Power Doppler Ultrasound in Detecting Synovial Blood Flow in Wrist and Finger Joints of Rheumatoid Arthritis Patients. Acad Radiol 2024; 31:1528-1537. [PMID: 37777427 DOI: 10.1016/j.acra.2023.09.006] [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: 07/23/2023] [Revised: 08/19/2023] [Accepted: 09/03/2023] [Indexed: 10/02/2023]
Abstract
RATIONALE AND OBJECTIVES The purpose of this study is to conduct a comparison between the newly introduced Angio PLanewave UltraSensitive (AngioPLUS) method and the power Doppler ultrasound (PDUS) technique, evaluating the efficacy of these two methods in detecting synovial blood flow in wrist and finger joints of rheumatoid arthritis (RA) patients. Furthermore, the study aimed to investigate the potential associations between the observed blood flow patterns and various symptoms and indicators associated with RA. MATERIALS AND METHODS A cohort of 101 patients diagnosed with RA was included and subsequently categorized into two groups: 20 male participants (19.80%) and 81 female participants (80.20%). Their grayscale ultrasound, PDUS, and AngioPLUS were utilized to acquire data, and subsequent scoring was conducted. Serological tests of the patients were also performed, and DAS28 scores were calculated. The McNemar and Wilcoxon tests were used to compare the blood flow display rate and grading of PDUS as well as AngioPLUS, respectively. RESULTS AngioPLUS blood was significantly improved compared to PDUS. In all joints, the proportion of slight and significant improvement in wrist joints was the highest (14.11% and 1.98%, respectively). AngioPLUS was moderately correlated with C-reactive Protein (CRP), Disease Activity Score that includes 28-joint counts, and swollen joint counts and weakly correlated with platelet, hemoglobin, tender joint counts, and CRP before and after treatment. CONCLUSION Compared to PDUS, AngioPLUS has a better auxiliary diagnostic role in evaluating disease activity and can provide a reference to improve the management of RA further.
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Affiliation(s)
- Wuyue Zhang
- In-Patient Ultrasound Department, The Second Affiliated Hospital of Harbin Medical University, 246 Xuefu Road, NanGang District, Harbin, 150086, China (W.Z., J.S., J.L., Y.W., W.L., W.X., X.W.)
| | - Jiawei Sun
- In-Patient Ultrasound Department, The Second Affiliated Hospital of Harbin Medical University, 246 Xuefu Road, NanGang District, Harbin, 150086, China (W.Z., J.S., J.L., Y.W., W.L., W.X., X.W.)
| | - Jinyao Li
- In-Patient Ultrasound Department, The Second Affiliated Hospital of Harbin Medical University, 246 Xuefu Road, NanGang District, Harbin, 150086, China (W.Z., J.S., J.L., Y.W., W.L., W.X., X.W.)
| | - Yanyan Wang
- In-Patient Ultrasound Department, The Second Affiliated Hospital of Harbin Medical University, 246 Xuefu Road, NanGang District, Harbin, 150086, China (W.Z., J.S., J.L., Y.W., W.L., W.X., X.W.)
| | - Weiyao Liu
- In-Patient Ultrasound Department, The Second Affiliated Hospital of Harbin Medical University, 246 Xuefu Road, NanGang District, Harbin, 150086, China (W.Z., J.S., J.L., Y.W., W.L., W.X., X.W.)
| | - Weili Xue
- In-Patient Ultrasound Department, The Second Affiliated Hospital of Harbin Medical University, 246 Xuefu Road, NanGang District, Harbin, 150086, China (W.Z., J.S., J.L., Y.W., W.L., W.X., X.W.)
| | - Yan Yuan
- Ultrasound Department, Heilongjiang Red Cross Sengong General Hospital, Harbin, China (Y.Y.)
| | - Xiaolei Wang
- In-Patient Ultrasound Department, The Second Affiliated Hospital of Harbin Medical University, 246 Xuefu Road, NanGang District, Harbin, 150086, China (W.Z., J.S., J.L., Y.W., W.L., W.X., X.W.).
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Linde L, Ørnbjerg LM, Georgiadis S, H. Rasmussen S, Lindström U, Askling J, Michelsen B, Di Giuseppe D, Wallman JK, Gudbjornsson B, Love TJ, Nordström DC, Yli-Kerttula T, Nekvindová L, Vencovský J, Iannone F, Cauli A, Loft AG, Glintborg B, Laas K, Rotar Z, Tomšič M, Macfarlane GJ, Möller B, van de Sande M, Codreanu C, Nissen MJ, Birlik M, Erten S, Santos MJ, Vieira-Sousa E, Hetland ML, Østergaard M. Predictors of DAPSA28 remission in patients with psoriatic arthritis initiating a first TNF inhibitor: results from 13 European registries. Rheumatology (Oxford) 2024; 63:751-764. [PMID: 37314967 PMCID: PMC10907817 DOI: 10.1093/rheumatology/kead284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 05/17/2023] [Accepted: 05/26/2023] [Indexed: 06/16/2023] Open
Abstract
OBJECTIVES In bio-naïve patients with PsA initiating a TNF inhibitor (TNFi), we aimed to identify baseline predictors of Disease Activity index for PsA in 28 joints (DAPSA28) remission (primary objective) and DAPSA28 moderate response at 6 months, as well as drug retention at 12 months across 13 European registries. METHODS Baseline demographic and clinical characteristics were retrieved and the three outcomes investigated per registry and in pooled data, using logistic regression analyses on multiply imputed data. In the pooled cohort, selected predictors that were either consistently positive or negative across all three outcomes were defined as common predictors. RESULTS In the pooled cohort (n = 13 369), 6-month proportions of remission, moderate response and 12-month drug retention were 25%, 34% and 63% in patients with available data (n = 6954, n = 5275 and n = 13 369, respectively). Five common baseline predictors of remission, moderate response and 12-month drug retention were identified across all three outcomes. The odds ratios (95% CIs) for DAPSA28 remission were: age, per year: 0.97 (0.96-0.98); disease duration, years (<2 years as reference): 2-3 years: 1.20 (0.89-1.60), 4-9 years: 1.42 (1.09-1.84), ≥10 years: 1.66 (1.26-2.20); men vs women: 1.85 (1.54-2.23); CRP of >10 vs ≤10 mg/l: 1.52 (1.22-1.89) and 1 mm increase in patient fatigue score: 0.99 (0.98-0.99). CONCLUSION Baseline predictors of remission, response and adherence to TNFi therapy were identified, of which five were common for all three outcomes, indicating that the predictors emerging from our pooled cohort may be considered generalizable from country level to disease level.
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Affiliation(s)
- Louise Linde
- Center for Rheumatology and Spine Diseases, Copenhagen Center for Arthritis Research (COPECARE), Denmark
- DANBIO Registry, Rigshospitalet, Glostrup, Denmark
| | - Lykke M Ørnbjerg
- Center for Rheumatology and Spine Diseases, Copenhagen Center for Arthritis Research (COPECARE), Denmark
- DANBIO Registry, Rigshospitalet, Glostrup, Denmark
| | - Stylianos Georgiadis
- Center for Rheumatology and Spine Diseases, Copenhagen Center for Arthritis Research (COPECARE), Denmark
- DANBIO Registry, Rigshospitalet, Glostrup, Denmark
| | - Simon H. Rasmussen
- Center for Rheumatology and Spine Diseases, Copenhagen Center for Arthritis Research (COPECARE), Denmark
| | - Ulf Lindström
- Department of Rheumatology and Inflammation Research, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Johan Askling
- Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Brigitte Michelsen
- Center for Rheumatology and Spine Diseases, Copenhagen Center for Arthritis Research (COPECARE), Denmark
- Center for Treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Oslo, Norway
- Research Unit, Sørlandet Hospital, Kristiansand, Norway
| | - Daniela Di Giuseppe
- Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Johan K Wallman
- Department of Clinical Sciences Lund, Rheumatology, Skåne University Hospital, Lund University, Lund, Sweden
| | - Bjorn Gudbjornsson
- Centre for Rheumatology Research, Landspitali, University Hospital, Reykjavik, Iceland
- Faculty of Medicine, University of Iceland, Reykjavik, Iceland
| | - Thorvardur Jon Love
- Faculty of Medicine, University of Iceland, Reykjavik, Iceland
- Department for Science and Research, Landspitali University Hospital, Reykjavik, Iceland
| | - Dan C Nordström
- Departments of Medicine and Rheumatology, Helsinki University Hospital, Helsinki, Finland
| | - Timo Yli-Kerttula
- Department of Rheumatology, Satakunta Central Hospital, Rauma, Finland
| | - Lucie Nekvindová
- Institute of Rheumatology, Prague, Czech Republic
- Department of Rheumatology, First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Jiří Vencovský
- Institute of Rheumatology, Prague, Czech Republic
- Department of Rheumatology, First Faculty of Medicine, Charles University, Prague, Czech Republic
| | | | - Alberto Cauli
- Rheumatology Unit, Department of Medical Sciences and Public Health, AOU and University of Cagliari, Monserrato, Italy
| | - Anne Gitte Loft
- Department of Rheumatology, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Bente Glintborg
- Center for Rheumatology and Spine Diseases, Copenhagen Center for Arthritis Research (COPECARE), Denmark
- DANBIO Registry, Rigshospitalet, Glostrup, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Karin Laas
- Department of Rheumatology, East-Tallinn Central Hospital, Tallinn, Estonia
| | - Ziga Rotar
- Department of Rheumatology, University Medical Centre Ljubljana, Ljubljana, Slovenia
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Matija Tomšič
- Department of Rheumatology, University Medical Centre Ljubljana, Ljubljana, Slovenia
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Gary J Macfarlane
- Aberdeen Centre for Arthritis and Musculoskeletal Health (Epidemiology Group), University of Aberdeen, Aberdeen, UK
| | - Burkhard Möller
- Department for Rheumatology and Immunology, Inselspital, University Hospital Bern, on behalf of the Swiss Clinical Quality Management for Rheumatic Diseases, SCQM, Zürich, Switzerland
| | - Marleen van de Sande
- Amsterdam UMC, University of Amsterdam, Department of Rheumatology & Clinical Immunology and Department of Experimental Immunology, Amsterdam Institute for Infection & Immunity, Amsterdam, The Netherlands
- Amsterdam Rheumatology and Immunology Center (ARC), Amsterdam, The Netherlands
| | - Catalin Codreanu
- Center for Rheumatic Diseases, University of Medicine and Pharmacy, Romanian Registry of Rheumatic Diseases, Bucharest, Romania
| | - Michael J Nissen
- Department of Rheumatology, Geneva University Hospital, Geneva, Switzerland
| | - Merih Birlik
- Division of Rheumatology, Department of Internal Medicine, Dokuz Eylul University School of Medicine, Izmir, Turkey
| | - Sukran Erten
- Department of Rheumatology, Ankara Yıldırım Beyazıt University Ankara City Hospital, Ankara, Turkey
| | - Maria J Santos
- Serviço de Reumatologia, Hospital Garcia de Orta, Almada, Portugal
- Reuma.pt, Sociedade Portuguesa de Reumatologia, Lisbon, Portugal
| | - Elsa Vieira-Sousa
- Department of Rheumatology, Hospital de Santa Maria, CHULN, Instituto Medicina Molecular, Faculdade de Medicina da Universidade de Lisboa, Centro Académico de Medicina de Lisboa, Lisbon, Portugal
| | - Merete L Hetland
- Center for Rheumatology and Spine Diseases, Copenhagen Center for Arthritis Research (COPECARE), Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Mikkel Østergaard
- Center for Rheumatology and Spine Diseases, Copenhagen Center for Arthritis Research (COPECARE), Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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Antalfy A, Berman K, Everitt C, Alten R, Latymer M, Godfrey CM. The Adherence and Outcomes Benefits of Using a Connected, Reusable Auto-Injector for Self-Injecting Biologics: A Narrative Review. Adv Ther 2023; 40:4758-4776. [PMID: 37733212 PMCID: PMC10567963 DOI: 10.1007/s12325-023-02671-2] [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: 06/09/2023] [Accepted: 08/30/2023] [Indexed: 09/22/2023]
Abstract
Many biologics are now self-administered by patients at home. A variety of self-injection devices are available, including vials and syringes, prefilled syringes, and spring-driven prefilled pens or auto-injectors. Each has advantages and drawbacks, and different devices suit different patients. For example, some patients have difficulty achieving consistent and successful self-injection due to poor manual dexterity, or experience anxiety at the prospect of self-injection or injection-site pain. These factors can reduce patients' medication adherence and overall experience. Furthermore, while self-injection brings patients many benefits, the proliferation of single-use injection devices has implications for environmental sustainability, including the reliance on single-use plastics, repeated freighting requirements, and need for incineration as hazardous waste. Recently developed, innovative electromechanical auto-injector devices offer technological enhancements over existing devices to overcome some of these issues. Features include customisable injection speeds or durations, consistent rate of injection, electronic injection logs and reminders, and step-by-step, real-time instructions. Indeed, a growing body of evidence points to higher adherence rates among patients using electromechanical devices compared with other devices. Further, with time, the reusability of electromechanical devices may prove to lighten the environmental impact compared with disposable devices, especially as research continues to optimise their sustainability, driven by increased consumer demands for environmental responsibility. This narrative review discusses the differences between prefilled syringes, spring-driven prefilled pens, and electromechanical devices. It also explores how these features may help reduce injection-associated pain and anxiety, improve patient experience, connectivity and adherence, and drive sustainability of biologic drugs in future.
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Affiliation(s)
| | | | | | | | - Mark Latymer
- Inflammation and Immunology Global Medical Affairs, Pfizer Biopharmaceuticals Group, Ramsgate Road, Sandwich, CT13 9NJ, UK.
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Doumen M, Pazmino S, Verschueren P, Westhovens R. Viewpoint: Supporting mental health in the current management of rheumatoid arthritis: time to act! Rheumatology (Oxford) 2023; 62:SI274-SI281. [PMID: 37871921 DOI: 10.1093/rheumatology/kead248] [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: 02/22/2023] [Accepted: 05/23/2023] [Indexed: 10/25/2023] Open
Abstract
Although clinical outcomes of RA have vastly improved in recent years, the disease's mental health impact has seemingly not decreased to the same extent. Even today, learning to live with RA is an active process involving several psychological, cognitive, behavioural and emotional pathways. Consequently, mental health disorders are more common in the context of RA than in the general population, and can be particularly detrimental both to patients' quality of life and to clinical outcomes. However, mental health is a spectrum and represents more than the absence of psychological comorbidity, and supporting patients' psychological wellbeing should thus involve a more holistic perspective than the mere exclusion or specific treatment of mental health disorders. In this viewpoint article, we build on mechanistic and historical insights regarding the relationship between RA and mental health, before proposing a practical stepwise approach to supporting patients' mental health in daily clinical practice.
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Affiliation(s)
- Michaël Doumen
- Department of Development and Regeneration, Skeletal Biology and Engineering Research Centre, KU Leuven, Leuven, Belgium
- Rheumatology, University Hospitals Leuven, Belgium, Leuven
| | - Sofia Pazmino
- Department of Development and Regeneration, Skeletal Biology and Engineering Research Centre, KU Leuven, Leuven, Belgium
| | - Patrick Verschueren
- Department of Development and Regeneration, Skeletal Biology and Engineering Research Centre, KU Leuven, Leuven, Belgium
- Rheumatology, University Hospitals Leuven, Belgium, Leuven
| | - René Westhovens
- Department of Development and Regeneration, Skeletal Biology and Engineering Research Centre, KU Leuven, Leuven, Belgium
- Rheumatology, University Hospitals Leuven, Belgium, Leuven
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9
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Abe T, Tamura M, Azuma N, Matsui K. The role of pain catastrophizing in pain perception among patients with rheumatoid arthritis without clinical signs of inflammation. Musculoskeletal Care 2023; 21:694-701. [PMID: 36748978 DOI: 10.1002/msc.1740] [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: 01/12/2023] [Revised: 01/20/2023] [Accepted: 01/25/2023] [Indexed: 06/18/2023]
Abstract
OBJECTIVE Pain in rheumatoid arthritis (RA) is considered to be associated with non-inflammatory factors, including physical disabilities, psychiatric disorders, and pain catastrophizing (PC). PC is reportedly a key driver in the development of pain in patients with RA without clinical signs of inflammation; however, previous studies enroled patients with RA who were potentially in an inflammatory state. Hence, our aim was to investigate the role of PC as the possible link between pain, physical disabilities, and psychiatric disorders in patients with RA without clinical signs of inflammation. MATERIALS AND METHODS In this cross-sectional study, 81 patients with RA without clinical signs of inflammation were included; all patients had serum C-reactive protein levels <0.5 mg/dL, without any inflammatory joints. We examined the demographic and clinical data and administered the pain visual analogue scale (VAS), pain catastrophizing scale (PCS), Health Assessment Questionnaire Disability Index (HAQ-DI), and patient version of the Brief Scale for Psychiatric Problems in Orthopaedic Patients (pBS-POP). A series of multivariate-adjusted multiple regression analyses were performed to examine the associations between PC and pain intensity, physical disabilities, and psychiatric disorders. RESULTS We found associations between all the above-mentioned variables in separate models with HAQ-DI, pBS-POP, and PCS scores. However, in the model associated with pain VAS, the PCS score (β = 0.34, p = 0.0073) emerged as the only variable showing a statistically significant association. CONCLUSIONS PC is associated with pain in patients with RA without clinical signs of inflammation, and this association may be mediated through pathways involving physical disabilities and psychiatric disorders.
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Affiliation(s)
- Takeo Abe
- Division of Diabetes, Endocrinology and Clinical Immunology, Department of Internal Medicine, Hyogo Medical University, Nishinomiya, Hyogo, Japan
- Department of Rheumatology Medicine, Kobe City Medical Center West Hospital, Kobe-shi, Hyogo, Japan
| | - Masao Tamura
- Division of Diabetes, Endocrinology and Clinical Immunology, Department of Internal Medicine, Hyogo Medical University, Nishinomiya, Hyogo, Japan
- Department of Rheumatology Medicine, Kobe City Medical Center West Hospital, Kobe-shi, Hyogo, Japan
| | - Naoto Azuma
- Division of Diabetes, Endocrinology and Clinical Immunology, Department of Internal Medicine, Hyogo Medical University, Nishinomiya, Hyogo, Japan
| | - Kiyoshi Matsui
- Division of Diabetes, Endocrinology and Clinical Immunology, Department of Internal Medicine, Hyogo Medical University, Nishinomiya, Hyogo, Japan
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Kaya MN, Kılıç Ö, Doğan A, Yılmaz S, Tecer D. Effect of Central Sensitization in Patients with Familial Mediterranean Fever, Axial Spondyloarthritis, and Both Diseases. Cureus 2023; 15:e45459. [PMID: 37731687 PMCID: PMC10508709 DOI: 10.7759/cureus.45459] [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: 09/18/2023] [Indexed: 09/22/2023] Open
Abstract
OBJECTIVE Our aim in this study was to evaluate the level of central sensitization (CS) in patients having familial Mediterranean fever (FMF), axial spondyloarthritis (axSpA), and both diseases (axSpA/FMF). METHODS This study included 30 FMF, 30 axSpA, 30 axSpA/FMF patients, and 30 healthy controls (HCs). The presence of CS was investigated by the Central Sensitization Inventory (CSI) questionnaire. In order to evaluate the effect of CS on patient groups, clinical features, disease activity, quality of life, sleep quality, depression, and anxiety frequency were examined. The patients were divided into groups according to the presence and severity of CS and their results were compared. RESULTS The mean age of all participants was 28.4±5.7 years and 67 (55.8%) of them were male. The erythrocyte sedimentation rate (ESR) value was significantly higher in axSpA and axSpA/FMF groups than in FMF and HCs groups (p<0.001). ESR value was significantly higher in the FMF group than in the HCs group (p<0.001). C-reactive protein (CRP) value was significantly higher in the axSpA/FMF group than in the axSpA and HCs groups (p=0.001). CSI-Part A value was significantly higher in the axSpA, FMF, and axSpA/FMF group than in the HCs group (p<0.001). CSI-Part A value did not differ significantly between axSpA/FMF, axSpA, and FMF groups (p>0.05). The presence of chronic fatigue syndrome was found to be significantly higher in the FMF group than in the axSpA and HCs groups (p<0.05). Fibromyalgia syndrome was significantly higher in the axSpA/FMF group than in the axSpA, FMF, and HCs groups (p<0.05). CONCLUSIONS In this study, the CS score was found to be significantly higher in axSpA and FMF patients compared to the HCs group. There was no difference between the disease groups in terms of CS score.
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Affiliation(s)
- Mehmet Nur Kaya
- Rheumatology, Gülhane Training and Research Hospital, Ankara, TUR
| | - Özlem Kılıç
- Rheumatology, Gülhane Training and Research Hospital, Ankara, TUR
| | - Abdullah Doğan
- Rheumatology, Gülhane Training and Research Hospital, Ankara, TUR
| | - Sedat Yılmaz
- Rheumatology, Gülhane Training and Research Hospital, Ankara, TUR
| | - Duygu Tecer
- Rheumatology, Gülhane Training and Research Hospital, Ankara, TUR
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11
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Westerlind H, Glintborg B, Hammer HB, Saevarsdottir S, Krogh NS, Hetland ML, Hauge EM, Martinez Tejada I, Sexton J, Askling J. Remission, response, retention and persistence to treatment with disease-modifying agents in patients with rheumatoid arthritis: a study of harmonised Swedish, Danish and Norwegian cohorts. RMD Open 2023; 9:e003027. [PMID: 37673441 PMCID: PMC10496677 DOI: 10.1136/rmdopen-2023-003027] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Accepted: 07/21/2023] [Indexed: 09/08/2023] Open
Abstract
OBJECTIVE Precision medicine in rheumatoid arthritis (RA) requires a good understanding of treatment outcomes and often collaborative efforts that call for data harmonisation. We aimed to describe how harmonisation across study cohorts can be achieved and investigate how the observed proportions reaching remission vary across remission criteria, study types, disease-modifying antirheumatic drugs (DMARDs) and countries, and how they relate to other treatment outcomes. METHODS We used data from eight existing large-scale, clinical RA registers and a pragmatic trial from Sweden, Denmark and Norway. In these, we defined three types of treatment cohorts; methotrexate monotherapy (as first DMARD), tumour necrosis factor inhibitors (TNFi) (as first biological DMARD) and rituximab. We developed a harmonised study protocol defining time points during 36 months of follow-up, collected clinical visit data on treatment response, retention, persistence and six alternative definitions of remission, and investigated how these outcomes differed within and between cohorts, by treatment. RESULTS Cohort sizes ranged from ~50 to 22 000 patients with RA. The proportions reaching each outcome varied across outcome metric, but with small to modest variations within and between cohorts, countries and treatment. Retention and persistence rates were high (>50% at 1 year), yet <33% of patients starting methotrexate or TNFi, and only 10% starting rituximab, remained on drug without other DMARDs added and achieved American Congress of Rheumatology/European Alliance of Associations for Rheumatology or Simplified Disease Activity Index remission at 1 year. CONCLUSION Harmonisation of data from different RA data sources can be achieved without compromising internal validity or generalisability. The low proportions reaching remission, point to an unmet need for treatment optimisation in RA.
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Affiliation(s)
- Helga Westerlind
- Clinical Epidemiology Division, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden
| | - Bente Glintborg
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- DANBIO and Copenhagen Center for Arthritis Research (COPECARE), Centre for Rheumatology and Spine Diseases, Centre of Head and Orthopaedics, Rigshospitalet Glostrup, Glostrup, Denmark
| | - Hilde Berner Hammer
- Center for treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Oslo, Norway
- Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Saedis Saevarsdottir
- Clinical Epidemiology Division, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden
- Faculty of Medicine, School of Health Sciences, University of Iceland, Reykjavik, Iceland
| | - Niels Steen Krogh
- DANBIO and Copenhagen Center for Arthritis Research (COPECARE), Centre for Rheumatology and Spine Diseases, Centre of Head and Orthopaedics, Rigshospitalet Glostrup, Glostrup, Denmark
| | - Merete Lund Hetland
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- DANBIO and Copenhagen Center for Arthritis Research (COPECARE), Centre for Rheumatology and Spine Diseases, Centre of Head and Orthopaedics, Rigshospitalet Glostrup, Glostrup, Denmark
| | - Ellen-Margrethe Hauge
- Department of Rheumatology, Aarhus University Hospital Skejby, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Isabel Martinez Tejada
- DANBIO and Copenhagen Center for Arthritis Research (COPECARE), Centre for Rheumatology and Spine Diseases, Centre of Head and Orthopaedics, Rigshospitalet Glostrup, Glostrup, Denmark
| | - Joseph Sexton
- Center for treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Oslo, Norway
| | - Johan Askling
- Clinical Epidemiology Division, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden
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12
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Hammer HB, Pedersen SL, Jonsson MK, Mathsson-Alm L, Gehring I, Sexton J, Haavardsholm EA, Askling J. Calprotectin, a sensitive marker of inflammation, is robustly assessed in plasma from patients with early or established rheumatoid arthritis by use of different laboratory methods. Scand J Clin Lab Invest 2023; 83:330-335. [PMID: 37343245 DOI: 10.1080/00365513.2023.2225223] [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: 03/09/2023] [Revised: 05/01/2023] [Accepted: 06/11/2023] [Indexed: 06/23/2023]
Abstract
Calprotectin (S100A8/S100A9, MRP8/MRP14) is a major leukocyte protein found to be more sensitive than C-Reactive Protein (CRP) and Erythrocyte Sedimentation Rate (ESR) as a marker of inflammation in patients with rheumatoid arthritis (RA). The present objective was to explore the robustness of calprotectin assessments by comparing two different laboratory methods assessing calprotectin in plasma samples from patients with early or established RA. A total of 212 patients with early RA (mean (SD) age 52(13.3) years, disease duration 0.6(0.5) years) and 177 patients with established RA (mean (SD) age 52.9(13.0) years, disease duration 10.0(8.8) years) were assessed by clinical, laboratory, and ultrasound examinations. Frozen plasma samples (-80 °C) were analysed for calprotectin levels at baseline, 1, 2, 3, 6 and 12 months by use of either enzyme-linked immunosorbent assay (ELISA) or fluoroenzyme immunoassay (FEIA). The ELISA technique used kits from Calpro AS and the FEIA technology was assessed on an automated Thermo Fisher Scientific instrument. The results showed high correlations between the two methods at baseline and during follow-up, with Spearman correlation at baseline 0.93 (p < 0.001) in the early and 0.96 (p < 0.001) in the established RA cohorts. The correlations between each of the two calprotectin assessments and clinical examinations had similar range. Calprotectin correlated well with clinical examinations, with at least as high correlations as CRP and ESR. The present study showed similar results for the two analytical methods, supporting the robustness of calprotectin analyses, and suggest calprotectin in plasma to be included in the assessments offered by clinical routine laboratories.
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Affiliation(s)
- Hilde Berner Hammer
- Center for treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Oslo, Norway
- Faculty of Medicine, University of Oslo, Oslo, Norway
| | | | - Maria K Jonsson
- Broegelmann Research Laboratory, Department of Clinical Science, University of Bergen, Bergen, Norway
- Department of Paediatrics, Haukeland University Hospital, Bergen, Norway
| | | | | | - Joe Sexton
- Center for treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Oslo, Norway
| | - Espen A Haavardsholm
- Center for treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Oslo, Norway
- Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Johan Askling
- Department of Medicine, Karolinska Institutet, Solna, Sweden
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13
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Das D, Choy E. Non-inflammatory pain in inflammatory arthritis. Rheumatology (Oxford) 2023; 62:2360-2365. [PMID: 36478185 PMCID: PMC10321089 DOI: 10.1093/rheumatology/keac671] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 11/19/2022] [Indexed: 07/20/2023] Open
Abstract
'Non-inflammatory' pain, pain that is not associated with measures of inflammation, is common in patients with inflammatory arthritis including RA. One important cause of non-inflammatory pain is concomitant fibromyalgia. Systematic review has shown that fibromyalgia is common in inflammatory arthritis including RA affecting 1 in 5 patients and is associated with higher disease activity scores due to inflated tender joint count and patient global assessment. Consequently, many patients with RA and concomitant fibromyalgia may fail to reach treatment target and switch to alternate disease modifying drugs frequently. European Alliance of Association for Rheumatology has highlighted that concomitant fibromyalgia is an important consideration in assessing difficult-to-treat RA. The incidence and prevalence of fibromyalgia are higher in RA than the general population, raising the possibility that fibromyalgia may be 'secondary' to RA rather than a concomitant disease. The precise mechanisms whereby patients with RA develop fibromyalgia are unknown. In this review, we discussed fibromyalgia in RA, its clinical impact and epidemiology as well as data suggesting fibromyalgia might be 'secondary'. Lastly, we reviewed potential pathogenic mechanisms which included inflammatory cytokines sensitizing nociceptive neurones, temporal summation, also known as windup, from chronic pain and impaired coping from poor quality sleep and mental well-being. Deciphering the exact mechanisms may lead to treatment strategies that prevent development of secondary fibromyalgia and will address a common factor associated with difficult-to-treat RA.
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Affiliation(s)
- Dhivya Das
- Consultant Rheumatologist, Northern Care Alliance NHS Foundation Trust, University School of Medicine (Formerly with Cardiff), Cardiff, UK
| | - Ernest Choy
- Correspondence to: Ernest Choy, CREATE Centre, Section of Rheumatology, Division of Infection and Immunity, Cardiff University, Tenovus Building, Heath Park Campus, Cardiff CF14 4XN, UK. E-mail:
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14
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Berman K, Moss S, Holden-Theunissen B, Satou N, Okada K, Latymer M, Antalfy A. Design Development of the SMARTCLIC ®/CLICWISE ® Injection Device for Self-Administered Subcutaneous Therapies: Findings from Usability and Human Factor Studies. Adv Ther 2023; 40:3070-3086. [PMID: 37199860 PMCID: PMC10272234 DOI: 10.1007/s12325-023-02512-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Accepted: 03/29/2023] [Indexed: 05/19/2023]
Abstract
INTRODUCTION An easy-to-use, multiuse, single-patient, electromechanical autoinjector, the SMARTCLIC®/CLICWISE® injection device, was recently developed to improve the self-administration options available to patients with chronic inflammatory disease treated with biologic agents. An extensive series of studies were conducted to guide the design and development of this device and to ensure its safety and effectiveness. METHODS Participants in two user preference studies and three formative human factor (HF) studies evaluated evolving iterations of the autoinjector device, dose dispenser cartridge, graphical user interface, and informational materials; participants in a summative HF test subsequently assessed the final proposed commercially representative product. In the user preference studies, rheumatologists and patients with chronic inflammatory disease, interviewed online and in-person, provided feedback on the design and functionality of four prototypes. In the HF studies, the safety, effectiveness, and usability of adapted prototypes were assessed under simulated-use conditions by patients with chronic inflammatory disease, caregivers, and healthcare professionals (HCPs). The safety and effectiveness of the final refined device and system were confirmed in a summative HF test by patients and HCPs in simulated-use scenarios. RESULTS Rheumatologists (n = 204) and patients (n = 39) interviewed in the two user preference studies provided feedback on the device size, feature ergonomics, and usability that guided prototype development in the subsequent formative HF studies. Observations from patients, caregivers, and HCPs (n = 55) participating in the latter studies yielded additional critical design revisions that culminated in development of the final device and system. Of 106 injection simulations conducted in the summative HF test, all resulted in successful medication delivery, and no potential harms were associated with injection-related use events. CONCLUSION Findings from this research facilitated development of the SmartClic/ClicWise autoinjector device and demonstrated that it could be used safely and effectively by participants representative of the intended-use population of patients, lay caregivers, and HCPs.
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Affiliation(s)
| | | | | | | | | | - Mark Latymer
- Inflammation & Immunology Global Medical Affairs, Pfizer Biopharmaceuticals Group, Ramsgate Road, Sandwich, CT13 9NJ, UK.
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Wilk M, Pripp AH, Korkosz M, Haugeberg G. Exploring pain catastrophizing and its associations with low disease activity in rheumatic inflammatory disorders. Rheumatol Int 2023; 43:687-694. [PMID: 36624289 DOI: 10.1007/s00296-023-05271-z] [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: 11/23/2022] [Accepted: 01/02/2023] [Indexed: 01/11/2023]
Abstract
Pain catastrophizing is a maladaptive mechanism associated with the exaggerated experience of pain, increased rumination and feelings of helplessness. The main objective of this study was to explore whether increased pain catastrophizing is independently associated with a lower proportion of low disease activity (LDA) in rheumatoid arthritis (RA), psoriatic arthritis (PsA) and axial spondylarthritis (axSpA). Demographics, comorbidities, treatment, disease activity measures and patient-reported outcome data were recorded in RA, PsA and axSpA patients. Pain catastrophizing score (PCS) was assessed using a standardised questionnaire. For each diagnosis, composite disease activity scores with distinct cut-off values for LDA, i.e. DAS28-CRP (RA), DAPSA (PsA) and ASDAS-CRP (axSpA) were calculated and used as the dependent variable in logistic regression reflecting LDA achieved. A total of one thousand two hundred and twenty nine patients were included: 580 with RA, 394 with PsA and 255 with axSpA. In the multivariable analysis, pain catastrophizing was independently associated with LDA rates in axSpA (OR 0.33, 95% CI [0.12, 0.88]) amongst tested groups. In RA (OR 0.90, 95% CI [0.64, 1.28]) and PsA (OR 0.77, 95% CI [0.55, 1.07]), a statistically significant association was not observed. Higher PCS was independently associated with not achieving LDA in axSpA. Our data, however, indicate that pain catastrophizing, which also reflects a patient's personality traits and coping abilities, plays a less important role for the patient than general pain perception.
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Affiliation(s)
- Mateusz Wilk
- Division of Rheumatology and Immunology, University Hospital, Macieja Jakubowskiego 2, 30-688, Cracow, Poland.
| | - Are H Pripp
- Oslo Centre of Biostatistics and Epidemiology, Oslo University Hospital, Oslo, Norway
| | - Mariusz Korkosz
- Division of Rheumatology and Immunology, University Hospital, Macieja Jakubowskiego 2, 30-688, Cracow, Poland
- Department of Rheumatology and Immunology, Jagiellonian University Medical College, Cracow, Poland
| | - Glenn Haugeberg
- Division of Rheumatology, Department of Internal Medicine, Sørlandet Hospital, Kristiansand, Norway
- Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Sciences, NTNU, Norwegian University of Science and Technology, Trondheim, Norway
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Yousefi Afrashteh M, Abbasi M, Abbasi M. The relationship between meaning of life, perceived social support, spiritual well-being and pain catastrophizing with quality of life in migraine patients: the mediating role of pain self-efficacy. BMC Psychol 2023; 11:17. [PMID: 36691101 PMCID: PMC9869619 DOI: 10.1186/s40359-023-01053-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Accepted: 01/17/2023] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Migraine is a neurological disease that has several physical and psychological complications, which is characterized by disability and impaired quality of life. AIMS The aim of this study was to explore the mediating role of pain self-efficacy in the relationship between meaning of life, perceived social support, spiritual well-being and pain catastrophizing with quality of life in migraine sufferers. The relationship between these factors with quality of life (QOL) was not fully explored in migraine patients. METHOD This study was a correlational study of structural equations. Therefore, 300 patients with migraine who referred to one of the specialized neurological treatment centers in Zanjan in 2021 were recruited based on the inclusion criteria. Patients also completed the World Health Organization Quality of Life Scale (WHOQOL-BREF), Meaning in Life Questionnaire, Multidimensional Scale of Perceived Social Support, Spiritual Well-Being Scale, Pain Catastrophizing Scale, Pain Self-Efficacy Questionnaire. Finally, the hypotheses were then analyzed with correlation coefficient and path analysis method by using SPSS-26 and LISREL-10.2 programs. RESULTS The results of the present study showed that pain self-efficacy has a mediating role in the relationship between meaning of life and quality of life (B = 0.015), perceived social support with quality of life (B = 0.022), spiritual well-being with quality of life (B = 0.021), as well as pain catastrophizing with quality of life (B = - 0.015). CONCLUSION According to the results of this study, by considering the role of self-efficacy of pain, it is possible to develop the programs to strengthen and improve the meaning of life, perceived social support, spiritual well-being and also reduce pain catastrophizing, in order to improve the quality of life of patients with migraine.
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Affiliation(s)
| | - Mahya Abbasi
- Department of Psychology, Family Research Institute, Shahid Beheshti University, Tehran, Iran
| | - Mahsa Abbasi
- Department of Psychology, Faculty of Psychology and Educational Sciences, Shahid Beheshti University, Tehran, Iran
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van Diemen MPJ, Ziagkos D, Kruizinga MD, Bénard MR, Lambrechtse P, Jansen JAJ, Snoeker BAM, Gademan MGJ, Cohen AF, Nelissen RGHH, Groeneveld GJ. Mitochondrial function, grip strength, and activity are related to recovery of mobility after a total knee arthroplasty. Clin Transl Sci 2022; 16:224-235. [PMID: 36401590 PMCID: PMC9926084 DOI: 10.1111/cts.13441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 10/09/2022] [Accepted: 10/14/2022] [Indexed: 11/21/2022] Open
Abstract
Low muscle quality and a sedentary lifestyle are indicators for a slow recovery after a total knee arthroplasty (TKA). Mitochondrial function is an important part of muscle quality and a key driver of sarcopenia. However, it is not known whether it relates to recovery. In this pilot study, we monitored activity after TKA using a wrist mounted activity tracker and assessed the relation of mitochondrial function on the rate of recovery after TKA. Additionally, we compared the increase in activity as a way to measure recovery to traditional outcome measures. Patients were studied 2 weeks before TKA and up to 6 months after. Activity was monitored continuously. Baseline mitochondrial function (citrate synthase and complex [CP] 1-5 abundance of the electron transport chain) was determined on muscle tissue taken during TKA. Traditional outcome measures (Knee Injury and Osteoarthritis Outcome Score [KOOS], timed up-and-go [TUG] completion time, grip, and quadriceps strength) were performed 2 weeks before, 6 weeks after, and 6 months after TKA. Using a multivariate regression model with various clinical baseline parameters, the following were significantly related to recovery: CP5 abundance, grip strength, and activity (regression weights 0.13, 0.02, and 2.89, respectively). During recovery, activity correlated to the KOOS-activities of daily living (ADL) score (r = 0.55, p = 0.009) and TUG completion time (r = -0.61, p = 0.001). Mitochondrial function seems to be related to recovery, but so are activity and grip strength, all indicators of sarcopenia. Using activity trackers before and after TKA might give the surgeon valuable information on the expected recovery and the opportunity to intervene if recovery is low.
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Affiliation(s)
- Marcus P. J. van Diemen
- Centre for Human Drug ResearchLeidenThe Netherlands,Department of OrthopedicsLeiden University Medical CenterLeidenThe Netherlands
| | | | | | - Menno R. Bénard
- Department of OrthopedicsAlrijne HospitalLeidenThe Netherlands
| | | | | | | | - Maaike G. J. Gademan
- Department of OrthopedicsLeiden University Medical CenterLeidenThe Netherlands,Department of Clinical EpidemiologyLeiden University Medical CenterLeidenThe Netherlands
| | - Adam F. Cohen
- Centre for Human Drug ResearchLeidenThe Netherlands,Department of NephrologyLeiden University Medical CenterLeidenThe Netherlands
| | | | - Geert Jan Groeneveld
- Centre for Human Drug ResearchLeidenThe Netherlands,Department of AnesthesiologyLeiden University Medical CenterLeidenThe Netherlands
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Alciati A, Di Carlo M, Siragusano C, Palumbo A, Masala IF, Atzeni F. Effect of biological DMARDs and JAK inhibitors in pain of chronic inflammatory arthritis. Expert Opin Biol Ther 2022; 22:1311-1322. [PMID: 36168970 DOI: 10.1080/14712598.2022.2130243] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION The advent of biological disease-modifying anti-rheumatic drugs (bDMARDs) and, more recently, of Janus kinase inhibitors (JAKi) has had a major impact on the long-term outcomes of chronic inflammatory arthritis (IA). However, the persistence of pain, even in patients with a complete pharmacological control of peripheral inflammation, represents an important clinical challenge in the treatment of IA. AREAS COVERED In this review, we provide an overview of possible mechanisms underlying pain in IA and its assessment, as well as the effects of bDMARDs and JAKi on pain management. EXPERT OPINION The overall data showed a good effect of bDMARDs and JAKi on pain, more pronounced for JAKi. However, it is challenging to distinguish the effect on the different types of pain (nociceptive, neuropathic, and nociplastic).
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Affiliation(s)
- Alessandra Alciati
- Department of Clinical Neurosciences, Hermanas Hospitalarias, Villa San Benedetto Menni Hospital, Humanitas Clinical and Research Center, Albese con Cassano, via Roma 16, 22032 Como, Italy; Rozzano, Milan, Italy
| | - Marco Di Carlo
- Rheumatology Clinic, Department of Clinical and Molecular Sciences, Università Politecnica delle Marche, Jesi, Ancona, Italy
| | - Cesare Siragusano
- Rheumatology Unit, Department of Experimental and Internal Medicine, University of Messina, Messina, Italy
| | - Antonino Palumbo
- Rheumatology Unit, Department of Experimental and Internal Medicine, University of Messina, Messina, Italy
| | | | - Fabiola Atzeni
- Rheumatology Unit, Department of Experimental and Internal Medicine, University of Messina, Messina, Italy
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Early response to JAK inhibitors on central sensitization and pain catastrophizing in patients with active rheumatoid arthritis. Inflammopharmacology 2022; 30:1119-1128. [PMID: 35505266 PMCID: PMC9135884 DOI: 10.1007/s10787-022-00995-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 04/09/2022] [Indexed: 12/19/2022]
Abstract
Objectives To evaluate the effect of 4 weeks of treatment with Janus kinase inhibitors (JAKis) on central sensitization (CS) and pain catastrophizing, and to determine the pain-related variables predictive of disease activity improvement, in patients with active rheumatoid arthritis (RA). Methods Consecutive RA patients with active disease starting a JAKi have been enrolled in this prospective observational study. Patients have been assessed at baseline and after 4 weeks of treatment. The evaluation was comprehensive of disease activity [Simplified Disease Activity Index (SDAI) and ultrasonographic (US) score] and of questionnaires aimed at investigating primarily CS [Central Sensitization Inventory (CSI)] and pain catastrophizing [Pain Catastrophizing Scale (PCS)]. Differences (Δ values) between the final and baseline were studied with the t test, Δ values of the variables were correlated with each other using Pearson’s test, and predictor variables for improvement in SDAI were also investigated using multivariate regression analysis. Results A total of 115 patients were evaluated. Overall, all variables demonstrated significant improvement between baseline and final except the US score. In particular, CSI decreased from 36.73 to 32.57 (p < 0.0001), PCS decreased from 32.46 to 28.72 (p = 0.0001). ΔSDAI showed a significant correlation with both ΔPCS and ΔCSI (r = 0.466 and 0.386, respectively, p < 0.0001). ΔPCS was the only variable predictive of an improvement in SDAI (coefficient = 0.500, p = 0.0224). Conclusion JAKis would appear to have a positive effect on pain-related variables, particularly CS and pain catastrophizing, for the genesis of which extra-synovial mechanisms are responsible.
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Mulrooney E, Neogi T, Dagfinrud H, Hammer HB, Pettersen PS, Gaarden TL, Engedal K, Kvien TK, Magnusson K, Haugen IK. The associations of psychological symptoms and cognitive patterns with pain and pain sensitization in people with hand osteoarthritis. OSTEOARTHRITIS AND CARTILAGE OPEN 2022; 4:100267. [DOI: 10.1016/j.ocarto.2022.100267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Accepted: 04/28/2022] [Indexed: 11/16/2022] Open
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21
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Hammer HB, Caporali R. Controversies in rheumatology: Ultrasound for monitoring of RA - do we need it? Rheumatology (Oxford) 2022; 61:4245-4251. [PMID: 35394009 DOI: 10.1093/rheumatology/keac228] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 03/10/2022] [Accepted: 04/03/2022] [Indexed: 11/14/2022] Open
Abstract
Clinical joint examination is the cornerstone for evaluation of patients with rheumatoid arthritis (RA). However, since large discrepancies have been shown even between experienced rheumatologists in evaluation of joint inflammation, and tender joints may have limited value in reflecting inflammation, ultrasound has in the last decennials been introduced in the clinical assessments of RA patients. Ultrasound has high accordance with other imaging modalities and enables detection of clinically difficult pathologies and contributes to assessments of joints difficult to evaluate clinically. However, there is no general agreement on the optimal use of ultrasound in rheumatology and the prevalence of machines as well as the level of experience is highly different across the countries. In addition, standardized use of ultrasound in treat-to-target follow-up of RA patients was found not to have any added value. Thus, how to use ultrasound in monitoring of RA patients is open for debate. The present article will discuss the pros and cons for using ultrasound in the clinical setting.
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Affiliation(s)
- Hilde Berner Hammer
- Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway.,Faculty of medicine, University of Oslo, Norway
| | - Roberto Caporali
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy.,Department of Rheumatology and Medical Sciences, ASST Pini-CTO, Milan, Italy
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22
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Tesser J, Lin I, Shiff NJ, Chakravarty SD, Schmajuk G, Hammam N, Desai S. Improvement in disease activity among patients with rheumatoid arthritis who switched from intravenous infliximab to intravenous golimumab in the ACR RISE registry. Clin Rheumatol 2022; 41:2319-2327. [PMID: 35312895 PMCID: PMC9287251 DOI: 10.1007/s10067-022-06116-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 02/15/2022] [Accepted: 02/22/2022] [Indexed: 11/25/2022]
Abstract
Infliximab and golimumab are intravenously (IV) administered tumor necrosis factor inhibitors approved to treat moderate-to-severe rheumatoid arthritis (RA) with concomitant methotrexate. Owing to differences in biologic construct, patients with IV-infliximab treatment failure may benefit from switching to IV-golimumab. Utilizing the ACR’s Rheumatology Informatics System for Effectiveness (RISE), a large electronic health records registry based in the USA, we assessed RA disease activity in patients switching from IV-infliximab to IV-golimumab. This retrospective, longitudinal, single-arm study included adults (≥ 18 years) with ≥ 1 RA diagnosis code between 2014 and 2018 and ≥ 1 IV-infliximab prescription within 6 months of a new IV-golimumab order (index date). Longitudinal assessments of disease activity using the Clinical Disease Activity Index (CDAI) were calculated in patients continuing IV-golimumab for 6–9- and 9–12-months post-switch. Paired t-tests evaluated significance of mean improvements during the follow-up periods. Most RA patients with disease activity assessments during the 6-month follow-up (N = 100; mean age: 65.3 years; 81% female; 74% white) demonstrated moderate-to-high disease activity (CDAI: 73% [38/52]) at enrollment. On average, patients showed significant improvement in disease activity within 6–9 months of switching; mean CDAI scores improved from 21.3 to 14.1 (p < 0.0001) and were durable through 9–12 months of treatment. Real-world patients with moderate-to-high disease activity who switched from IV-infliximab to IV-golimumab demonstrated significant and sustained improvements post-switch as measured by the CDAI.
Key Points • This study used real-world data from the Rheumatology Informatics System for Effectiveness (RISE) registry to evaluate the efficacy of directly switching from intravenous (IV)-infliximab to IV-golimumab to control rheumatoid arthritis (RA) disease activity. • Most IV-infliximab patients had moderate-to-high disease activity at the time of the switch. • On average, IV-golimumab was effective in improving RA disease activity after switching from IV-infliximab as measured by the Clinical Disease Activity Index. • These data suggest that real-world RA patients with persistent symptoms despite treatment with IV-infliximab may realize improved disease control with a switch to IV-golimumab. |
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Affiliation(s)
- John Tesser
- Arizona Arthritis & Rheumatology Associates, 4550 E. Bell Road, Suite 172, Phoenix, AZ, 85032, USA.
| | - Iris Lin
- Janssen Scientific Affairs, LLC, Horsham, PA, USA
| | - Natalie J Shiff
- Janssen Scientific Affairs, LLC, Horsham, PA, USA
- Adjunct, Department of Community Health and Epidemiology, University of Saskatchewan, Saskatoon, SK, Canada
| | - Soumya D Chakravarty
- Janssen Scientific Affairs, LLC, Horsham, PA, USA
- Drexel University College of Medicine, Philadelphia, PA, USA
| | | | - Nevin Hammam
- University of California San Francisco, San Francisco, CA, USA
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Wilk M, Łosińska K, Pripp AH, Korkosz M, Haugeberg G. Pain catastrophizing in rheumatoid arthritis, psoriatic arthritis and axial spondyloarthritis: biopsychosocial perspective and impact on health-related quality of life. Rheumatol Int 2022; 42:669-682. [DOI: 10.1007/s00296-021-05070-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 12/13/2021] [Indexed: 12/01/2022]
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Gehin JE, Syversen SW, Warren DJ, Goll GL, Sexton J, Bolstad N, Hammer HB. Serum etanercept concentrations in relation to disease activity and treatment response assessed by ultrasound, biomarkers and clinical disease activity scores: results from a prospective observational study of patients with rheumatoid arthritis. RMD Open 2021; 7:rmdopen-2021-001985. [PMID: 34911811 PMCID: PMC8679136 DOI: 10.1136/rmdopen-2021-001985] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Accepted: 11/16/2021] [Indexed: 12/21/2022] Open
Abstract
Objectives To identify the therapeutic range for etanercept and to assess the incidence of anti-etanercept antibody formation. Methods Associations between etanercept serum concentration and disease activity as well as treatment response were examined in a longitudinal observational study of rheumatoid arthritis patients starting etanercept. Disease activity was assessed by ultrasound (grey scale and power Doppler), 28-joint Disease Activity Score (DAS28), Simplified Disease Activity Index, plasma calprotectin and C reactive protein. Etanercept concentration and anti-etanercept antibodies were analysed using automated in-house fluorescence assays. Results A total of 89 patients were included, whereof 66% were biological disease-modifying antirheumatic drug (DMARD) naïve and 91% used concomitant synthetic DMARD. At 3 months, the median etanercept concentration was 1.8 (IQR 1.1–2.5) mg/L. Longitudinal associations were found between etanercept concentration and disease activity assessed by plasma calprotectin, C reactive protein and DAS28, but not between etanercept concentration and improvement in disease activity by any of the parameters at 3, 6 or 12 months of treatment. Etanercept concentrations were not significantly different among patients who achieved response or remission, compared with non-response or non-remission. Hence, no therapeutic range could be identified. None of the patients developed anti-etanercept antibodies. Conclusion Despite the use of sensitive and objective markers of inflammation, a therapeutic range could not be identified for etanercept. Hence, this study suggests that proactive therapeutic drug monitoring is unlikely to benefit rheumatoid arthritis patients treated with etanercept, but a potential benefit in certain clinical situations cannot be excluded.
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Affiliation(s)
- Johanna Elin Gehin
- Department of Medical Biochemistry, Oslo University Hospital, Oslo, Norway .,Faculty of Medicine, University of Oslo, Oslo, Norway
| | | | - David John Warren
- Department of Medical Biochemistry, Oslo University Hospital, Oslo, Norway
| | - Guro Løvik Goll
- Division of Rheumatology and Research, Diakonhjemmet Hospital, Oslo, Norway
| | - Joseph Sexton
- Division of Rheumatology and Research, Diakonhjemmet Hospital, Oslo, Norway
| | - Nils Bolstad
- Department of Medical Biochemistry, Oslo University Hospital, Oslo, Norway
| | - Hilde Berner Hammer
- Faculty of Medicine, University of Oslo, Oslo, Norway.,Division of Rheumatology and Research, Diakonhjemmet Hospital, Oslo, Norway
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25
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Yoshida T, Hashimoto M, Horiguchi G, Murakami K, Murata K, Nishitani K, Watanabe R, Yamamoto W, Tanaka M, Morinobu A, Ito H, Matsuda S, Uehara R. Pain catastrophizing hinders Disease Activity Score 28 - erythrocyte sedimentation rate remission of rheumatoid arthritis in patients with normal C-reactive protein levels. Int J Rheum Dis 2021; 24:1520-1529. [PMID: 34698449 DOI: 10.1111/1756-185x.14231] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 09/28/2021] [Accepted: 10/17/2021] [Indexed: 10/20/2022]
Abstract
AIM This study aimed to assess the relationship between pain catastrophizing and achievement of 28-joint Disease Activity Score-defined remission of rheumatoid arthritis (RA), considering the presence or absence of systemic inflammation, and to evaluate associated factors for pain catastrophizing. METHOD This cross-sectional study included 421 RA outpatients. The relationship between pain catastrophizing and remission was analyzed by adjusting several confounding factors. Univariable and multivariable analyses were performed to determine the relationship between pain catastrophizing and RA-related factors, comorbidities, and lifestyle habits. RESULTS The prevalence of pain catastrophizing was 26%. Pain catastrophizing was negatively associated with remission (odds ratio 0.62, 95% confidence interval 0.38-1.00, P = .048). A multinomial logistic analysis showed that the presence of pain catastrophizing was an independent factor that was negatively correlated with the achievement of remission in the absence of systemic inflammation (odds ratio 0.51, 95% confidence interval 0.28-0.93, P = .029). Factors associated with elevated ratings on the Pain Catastrophizing Scale were a history of falls within the past year, a Health Assessment Questionnaire score >0.5, and smoking habit. Further, patients' subjective symptoms, including patient global assessment minus evaluator global assessment values ≥20 and high tender joint count minus swollen joint counts, were associated with elevated pain catastrophizing. CONCLUSION Pain catastrophizing is a major obstacle to achieving remission in RA patients with normal C-reactive protein levels. Advanced physical disability, smoking habit, and history of falls were associated with pain catastrophizing, in addition to patients' subjective symptoms.
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Affiliation(s)
- Tamami Yoshida
- Department of Epidemiology for Community Health and Medicine, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Motomu Hashimoto
- Department of Clinical Immunology, Graduate School of Medicine, Osaka City University, Osaka, Japan
| | - Go Horiguchi
- The Clinical and Translational Research Center, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Kosaku Murakami
- Department of Rheumatology and Clinical Immunology, Graduate School of Medicine, Kyoto University, Kyoto, Japan.,The Center for Cancer Immunotherapy and Immunobiology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Koichi Murata
- Department of Advanced Medicine for Rheumatic Diseases, Graduate School of Medicine, Kyoto University, Kyoto, Japan.,Department of Orthopedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Kohei Nishitani
- Department of Advanced Medicine for Rheumatic Diseases, Graduate School of Medicine, Kyoto University, Kyoto, Japan.,Department of Orthopedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Ryu Watanabe
- Department of Clinical Immunology, Graduate School of Medicine, Osaka City University, Osaka, Japan
| | - Wataru Yamamoto
- Department of Health Information Management, Kurashiki Sweet Hospital, Kurashiki, Japan
| | - Masao Tanaka
- Department of Advanced Medicine for Rheumatic Diseases, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Akio Morinobu
- Department of Rheumatology and Clinical Immunology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Hiromu Ito
- Department of Advanced Medicine for Rheumatic Diseases, Graduate School of Medicine, Kyoto University, Kyoto, Japan.,Department of Orthopedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Shuichi Matsuda
- Department of Orthopedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Ritei Uehara
- Department of Epidemiology for Community Health and Medicine, Kyoto Prefectural University of Medicine, Kyoto, Japan
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26
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Geng Y, Gao T, Zhang X, Wang Y, Zhang Z. The association between disease duration and mood disorders in rheumatoid arthritis patients. Clin Rheumatol 2021; 41:661-668. [PMID: 34689245 DOI: 10.1007/s10067-021-05967-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Revised: 10/08/2021] [Accepted: 10/12/2021] [Indexed: 11/29/2022]
Abstract
AIMS The mood disorders have been recognized as common comorbidities of rheumatoid arthritis (RA), however unknown in patients with different RA courses. Therefore, we aimed to investigate the status of mood disorders in early RA and non-early RA patients and further identify the associated factors for mood disorders. METHODS Self-rating anxiety scale (SAS) and self-rating depression scale (SDS) were assessed in all enrolled RA patients. Besides clinical assessments, power Doppler and greyscale (GS) ultrasound of 28 joints was performed. The frequency of mood disorders was compared between early RA and non-early RA patients. Multivariate regression was used to identify the associated factors for mood disorders. RESULTS Tow hundred one RA patients were enrolled, with 76 early RA (disease duration ≤ 2 years) and 125 non-early RA (disease duration > 2 years). Mood disorders (depression and/or anxiety) were found in 42 (20.9%) patients. Depression was more frequently observed in early RA than non-early RA patients (26.3% vs. 14.4%, P = 0.036). A similar trend for anxiety was also observed in early RA compared to non-early RA patients, although the difference was insignificant (13.2% vs. 5.6%, P = 0.062). Disease duration (OR = 0.991, 95% CI 0.985-0.998, P = 0.009), health assessment questionnaire disability index (HAQ-DI) (OR = 1.045, 95% CI 1.005-1.086, P = 0.029) and GS synovitis score (OR = 1.065, 95% CI 1.017-1.115, P = 0.007) were identified as factors associated with depression. Disease duration (OR = 0.981, 95% CI 0.967-0.995, P = 0.009), HAQ-DI (OR = 1.071, 95% CI 1.013-1.133, P = 0.017) and GS synovitis score (OR = 1.072, 95% CI 1.012-1.136, P = 0.019) were identified to be associated with anxiety. CONCLUSIONS Depression and anxiety were almost doubled in frequency in early RA than in long-standing RA patients. RA patients with short disease duration, high HAQ-DI and GS score were more likely to be in depression and anxiety. Key Points • Mood disorders were more frequent in early RA than non-early RA patients. • More attention to psychological status is needed in RA patients. • RA patients with short disease duration, poor physical function and severe synovitis were more likely to have depression and/or anxiety.
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Affiliation(s)
- Yan Geng
- Department of Rheumatology and Clinical Immunology, Peking University First Hospital, No. 8 Xishiku Street, West District, Beijing, 100034, China
| | - Tianjing Gao
- Department of Rheumatology and Clinical Immunology, Peking University First Hospital, No. 8 Xishiku Street, West District, Beijing, 100034, China
| | - Xiaohui Zhang
- Department of Rheumatology and Clinical Immunology, Peking University First Hospital, No. 8 Xishiku Street, West District, Beijing, 100034, China
| | - Yu Wang
- Department of Rheumatology and Clinical Immunology, Peking University First Hospital, No. 8 Xishiku Street, West District, Beijing, 100034, China
| | - Zhuoli Zhang
- Department of Rheumatology and Clinical Immunology, Peking University First Hospital, No. 8 Xishiku Street, West District, Beijing, 100034, China.
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Kieskamp SC, Paap D, Carbo MJG, Wink F, Bos R, Bootsma H, Arends S, Spoorenberg A. Central sensitization, illness perception and obesity should be considered when interpreting disease activity in axial spondyloarthritis. Rheumatology (Oxford) 2021; 60:4476-4485. [PMID: 33492397 PMCID: PMC8487271 DOI: 10.1093/rheumatology/keab019] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Accepted: 12/10/2020] [Indexed: 01/20/2023] Open
Abstract
OBJECTIVES Many patients with axial spondyloarthritis (axSpA) report persistent pain even when treated with anti-inflammatory agents. Our aim was to explore the presence of central sensitization (CS) and different types of illness perceptions in patients with axSpA, and to assess their associations with disease activity assessments. METHODS Consecutive outpatients from the Groningen Leeuwarden Axial Spondyloarthritis (GLAS) cohort were included. Besides standardized assessments, patients filled out the Central Sensitization Inventory (CSI), Illness Perception Questionnaire (IPQ-R) and Pain Catastrophizing Scale (PCS). Univariable and multivariable linear regression analyses were used to investigate the association between questionnaire scores, patient characteristics and disease activity assessments ASDASCRP, BASDAI and CRP. RESULTS We included 182 patients with a mean symptom duration of 21.6 years. Mean ASDASCRP was 2.1, mean BASDAI 3.9, and median CRP 2.9. Mean CSI score was 37.8 (scale 0-100) and 45% of patients scored ≥40, indicating a high probability of CS. CSI score, IPQ-R domain identity (number of symptoms the patient attributes to their illness), and IPQ-R domain treatment control (perceived treatment efficacy), and obesity were significantly and independently associated with both ASDASCRP and BASDAI, explaining a substantial proportion of variation in these disease activity scores (R2=0.35 and R2=0.47, respectively). Only obesity was also independently associated with CRP. CONCLUSION CS may be common in patients with long-term axSpA. CS, as well as specific illness perceptions and obesity were all independently associated with the widely used (partially) patient-reported disease activity assessments ASDASCRP and BASDAI. Treating physicians should take this into account in the follow-up and treatment of their patients.
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Affiliation(s)
| | - Davy Paap
- Department of Rheumatology and Clinical Immunology and Department of Rehabilitation Medicine, University Medical Centre Groningen, Groningen
| | | | - Freke Wink
- Department of Rheumatology, Medical Centre Leeuwarden, Leeuwarden, The Netherlands
| | - Reinhard Bos
- Department of Rheumatology, Medical Centre Leeuwarden, Leeuwarden, The Netherlands
| | | | - Suzanne Arends
- Department of Rheumatology and Clinical Immunology.,Department of Rheumatology, Medical Centre Leeuwarden, Leeuwarden, The Netherlands
| | - Anneke Spoorenberg
- Department of Rheumatology and Clinical Immunology.,Department of Rheumatology, Medical Centre Leeuwarden, Leeuwarden, The Netherlands
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Provan SA, Michelsen B, Sexton J, Uhlig T, Hammer HB. Trajectories of fatigue in actively treated patients with established rheumatoid arthritis starting biologic DMARD therapy. RMD Open 2021; 6:rmdopen-2020-001372. [PMID: 33214326 PMCID: PMC7856128 DOI: 10.1136/rmdopen-2020-001372] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 09/04/2020] [Accepted: 11/01/2020] [Indexed: 11/04/2022] Open
Abstract
Objectives To define fatigue trajectories in patients with rheumatoid arthritis (RA) who initiate biological DMARD (bDMARD) treatment, and explore baseline predictors for a trajectory of continued fatigue. Methods One-hundred and eighty-four patients with RA initiating bDMARDs were assessed at 0, 1, 2, 3, 6 and 12 months. Swollen and tender joint counts, patient reported outcomes (PROMs), blood samples and ultrasound examinations were collected at each time point. Fatigue was assessed by the fatigue Numeric Rating Scale (0–10) from the Rheumatoid Arthritis Impact of Disease (RAID) questionnaire. Clinically significant fatigue was predefined as fatigue ≥4. Three trajectories of interest were defined according to level of RAID fatigue: no fatigue (≤3 at 5/6 visits), improved fatigue (≥4 at start, but ≤3 at follow-up) and continued fatigue (≥4 at 5/6 visits). Baseline variables were compared between groups by bivariate analyses, and logistic regression models were used to explore baseline predictors of continued vs improved fatigue. Results The majority of patients starting bDMARD therapy followed one of three fatigue trajectories, (no fatigue; n=61, improved; n=33 and continued fatigue; n=53). Patients with continued fatigue were more likely to be anti–citrullinated protein antibody and/or rheumatoid factor positive and had higher baseline PROMs compared to the other groups, while there were no differences between the groups for variables of inflammation including. Patient global, tender joint count and anxiety were predictors for the continued fatigue trajectory. Discussion A trajectory of continued fatigue was determined by PROMs and not by inflammatory RA disease activity.
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Affiliation(s)
| | - Brigitte Michelsen
- Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway.,Department of Rheumatology, Hospital of Southern Norway Trust Kristiansand, Kristiansand, Norway
| | - Joseph Sexton
- Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
| | - Tillmann Uhlig
- Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
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Mathias K, Amarnani A, Pal N, Karri J, Arkfeld D, Hagedorn JM, Abd-Elsayed A. Chronic Pain in Patients with Rheumatoid Arthritis. Curr Pain Headache Rep 2021; 25:59. [PMID: 34269913 DOI: 10.1007/s11916-021-00973-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/11/2021] [Indexed: 12/27/2022]
Abstract
PURPOSE OF REVIEW Chronic pain is highly prevalent in patients with rheumatoid arthritis (RA) and can cause various physical and psychological impairments. Unfortunately, the appropriate diagnosis of chronic pain syndromes in this population can be challenging because pain may be primary to RA-specific inflammation and/or secondary to other conditions, typically osteoarthritis (OA) and fibromyalgia (FM). This disparity further poses a clinical challenge, given that chronic pain can often be discordant or undetected with standard RA-specific surveillance strategies, including serological markers and imaging studies. In this review, we provide a robust exploration of chronic pain in the RA population with emphasis on epidemiology, mechanisms, and management strategies. RECENT FINDINGS Chronic pain associated with RA typically occurs in patients with anxiety, female sex, and elevated inflammatory status. Up to 50% of these patients are thought to have chronic pain despite appropriate inflammatory suppression, typically due to peripheral and central sensitization as well as secondary OA and FM. In addition to the standard-of-care management for OA and FM, patients with RA and chronic pain benefit from behavioral and psychological treatment options. Moreover, early and multimodal therapies, including non-pharmacological, pharmacological, interventional, and surgical strategies, exist, albeit with varying efficacy, to help suppress inflammation, provide necessary analgesia, and optimize functional outcomes. Overall, chronic pain in RA is a difficult entity for both patients and providers. Early diagnosis, improved understanding of its mechanisms, and initiation of early, targeted approaches to pain control may help to improve outcomes in this population.
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Affiliation(s)
- Kristen Mathias
- Department of Internal Medicine, University of Chicago, Chicago, IL, USA
| | - Abhimanyu Amarnani
- Department of Internal Medicine, Division of Rheumatology, Los Angeles County + University of Southern California (LAC + USC) and Keck Medicine of USC, Los Angeles, CA, USA
| | - Neha Pal
- Texas A&M School of Medicine, Bryan, TX, USA
| | - Jay Karri
- Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, TX, USA
| | - Daniel Arkfeld
- Department of Internal Medicine, Division of Rheumatology, Los Angeles County + University of Southern California (LAC + USC) and Keck Medicine of USC, Los Angeles, CA, USA
| | - Jonathan M Hagedorn
- Department of Anesthesiology and Perioperative Medicine, Division of Pain Medicine, Mayo Clinic, Rochester, MN, USA
| | - Alaa Abd-Elsayed
- Department of Anesthesia, Division of Pain Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.
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30
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Terslev L, Ostergaard M. Rheumatoid Arthritis Relapse and Remission - Advancing Our Predictive Capability Using Modern Imaging. J Inflamm Res 2021; 14:2547-2555. [PMID: 34163211 PMCID: PMC8215903 DOI: 10.2147/jir.s284405] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Accepted: 05/27/2021] [Indexed: 01/18/2023] Open
Abstract
Clinical remission has become an achievable target for the majority of patients with rheumatoid arthritis, but subclinical inflammation as assessed by ultrasound and magnetic resonance imaging (MRI) has been demonstrated to be frequent in patients in clinical remission. Subclinical synovitis has been shown to be linked to both subsequent structural damage progression and a risk of flare, demonstrating that subclinical synovitis represents incomplete suppression of inflammation and questions whether it is appropriate only to use clinical composite scores as treatment target in clinical practice. Maintaining a state of remission has proven important as sustained clinical remission impacts long-term outcome regarding joint damage progression, physical function and quality of life. Treating subclinical inflammation has been attempted and has led to more frequent strict clinical remission and better physical function, but also to more adverse events. Thus, an overall benefit of incorporating imaging goals in treat-to-target strategies has not been documented. However, in patients in clinical remission on biological disease-modifying anti-rheumatic drugs, both ultrasound and MRI may aid in the clinical decision regarding whether drug tapering or even discontinuation should be attempted.
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Affiliation(s)
- Lene Terslev
- Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Glostrup, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Mikkel Ostergaard
- Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Glostrup, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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Hammer HB, Jensen Hansen IM, Järvinen P, Leirisalo-Repo M, Ziegelasch M, Agular B, Terslev L. Rheumatoid arthritis patients with predominantly tender joints rarely achieve clinical remission despite being in ultrasound remission. Rheumatol Adv Pract 2021; 5:rkab030. [PMID: 34131623 PMCID: PMC8195913 DOI: 10.1093/rap/rkab030] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 02/17/2021] [Indexed: 01/04/2023] Open
Abstract
Objectives Given that subjective variables might reduce remission by composite DAS (CDAS), the main objectives were to explore whether RA patients with mainly tender vs mainly swollen joints had differences in patient-reported outcome measures (PROMs), clinical or US assessments or in achieving remission defined by CDAS or US. Methods In a Nordic multicentre study, RA patients initiating tocilizumab were assessed by PROMs, clinical, laboratory and US assessments (36 joints and 4 tendons) at baseline, 4, 12 and 24 weeks. Remission was defined according to clinical disease activity index (CDAI)/Boolean or no Doppler activity present. Tender-swollen joint differences (TSJDs) were calculated. Statistics exploring changes over time/differences between groups included Wilcoxon, Mann-Whitney, Kruskal-Wallis and Spearman tests. Results One hundred and ten patients were included [mean (s.d.) age 55.6 (12.1) years, RA duration 8.7 (9.5) years]. All PROMs, clinical, laboratory and US scores decreased during follow-up (P < 0.001). During follow-up, tender joint counts were correlated primarily with PROMs [r = 0.24-0.56 (P < 0.05-0.001)] and swollen joint counts with US synovitis scores [r = 0.33-0.72 (P < 0.05-0.001)]. At 24 weeks, patients with TSJD > 0 had higher PROMs and CDAI (P < 0.05-0.001) but lower US synovitis scores (P < 0.05). Remission by CDAI/Boolean was seen in 26-34% and by Doppler 53%, but only 2-3% of patients with TSJD > 0 achieved CDAI/Boolean remission. Conclusion Patients with more tender than swollen joints scored higher on subjective assessments but had less US synovitis. They seldom achieved CDAS remission despite many being in Doppler remission. If patients with predominantly tender joints do not reach CDAS remission, objective assessments of inflammation should be performed. Trial registration ClinicalTrials.gov, https://clinicaltrials.gov/, NCT02046616.
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Affiliation(s)
- Hilde Berner Hammer
- Department of Rheumatology, Diakonhjemmet Hospital.,Faculty of Medicine, University of Oslo, Oslo, Norway
| | | | - Pentti Järvinen
- Department of Rheumatology, Kiljava Medical Research, Hyvinkää
| | - Marjatta Leirisalo-Repo
- Department of Rheumatology, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | | | | | - Lene Terslev
- Centre for Rheumatology and Spine Diseases, Rigshospitalet Glostrup, Copenhagen, Denmark
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Lassen J, Baron R. [Rheumatic diseases and neuropathic pain : Diagnosis and treatment]. Z Rheumatol 2020; 80:226-233. [PMID: 33355701 DOI: 10.1007/s00393-020-00950-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/21/2020] [Indexed: 11/29/2022]
Abstract
Pain is a leading symptom in inflammatory rheumatic diseases. For a long time it has been assumed that this pain is of nociceptive origin; however, in about one fifth of all patients the pain remains despite successful anti-inflammatory treatment and is not typically described as nociceptive by those affected. Recent studies indicate that some patients with rheumatoid arthritis (RA) experience pain with a neuropathic pain component. The treatment of neuropathic pain with damage to the somatosensory system differs markedly from the treatment of nociceptive pain in which the pain processing system is intact. Thus, the recognition and, above all, the more precise differentiation of the pain symptoms of affected patients make a decisive contribution to a successful treatment. With the help of a few points in the history and a physical examination, the assumption of the diagnosis neuropathic pain can often be rejected or substantiated. Pain with a neuropathic component does not adequately respond to typical analgesics. Instead, the high efficacy of co-analgesics, such as anticonvulsants and antidepressants, has been repeatedly proven.
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Affiliation(s)
- J Lassen
- Sektion Neurologische Schmerzforschung und -therapie, Klinik für Neurologie, Christian-Albrechts-Universität zu Kiel, Arnold-Heller-Str. 3, Haus D, 24105, Kiel, Deutschland
| | - R Baron
- Sektion Neurologische Schmerzforschung und -therapie, Klinik für Neurologie, Christian-Albrechts-Universität zu Kiel, Arnold-Heller-Str. 3, Haus D, 24105, Kiel, Deutschland.
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Kremer JM, Pappas DA, Kane K, Greenberg J, Harrold LR, Feathers VL, Shadick N, Weinblatt ME, Reed G. The Clinical Disease Activity Index and the Routine Assessment of Patient Index Data 3 for Achievement of Treatment Strategies. J Rheumatol 2020; 48:1776-1783. [PMID: 33323534 DOI: 10.3899/jrheum.200692] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/09/2020] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To compare the Clinical Disease Activity Index (CDAI) with the Routine Assessment of Patient Index Data 3 (RAPID3) from 2 large United States registries. METHODS Using a cross section of clinic visits within 2 registries, we determined whether the outcome of each metric would place the patient in remission (REM), low (LDA), moderate (MDA), or high disease activity (HDA) using the CDAI, with the assumption that a patient in MDA or HDA would be a candidate for acceleration of treatment. RESULTS We identified significant disparities between the 2 indices in final disease categorization using each index system. For patients identified in LDA by CDAI, RAPID3 identified 20.4% and 28.3% as LDA in Corrona and the Brigham and Women's Rheumatoid Arthritis Sequential Study (BRASS), respectively. For patients identified as MDA by CDAI, RAPID3 identified 36.2% and 31.1% as MDA in Corrona and BRASS, respectively, with the greatest disparities within each system identified for LDA and MDA activity by the CDAI (20.4% and 36.2% agreement of RAPID3 with CDAI, respectively, in Corrona and 28.3% and 31.1% agreement in BRASS). Overall comparison between CDAI and RAPID3 in the 4 disease categories resulted in estimated k = 0.285 in both. The RAPID3 scores indicated the potential for treat-to-target acceleration in 34.4% of patients in REM or LDA based on CDAI in Corrona and 27.7% in BRASS, respectively. CONCLUSION The RAPID3, based on patient-reported outcomes, shows differences with CDAI categories of disease activity. The components of CDAI are not highly correlated with RAPID3, except for patient global assessment. These differences could significantly affect the decision to advance treatment when using a treat-to-target regimen.
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Affiliation(s)
- Joel M Kremer
- This study was supported by the Corrona Research Foundation. J.M. Kremer, MD, Albany Medical College and The Center for Rheumatology, Albany, New York; D.A. Pappas, MD, MPH, Columbia University, New York, New York, and Corrona, LLC, Waltham, Massachusetts; K. Kane, MS, G. Reed, PhD, University of Massachusetts Medical School, Worcester, Massachusetts; J. Greenberg, MD, MPH, Corrona, LLC, Waltham, Massachusetts, and New York School of Medicine, New York, New York; L.R. Harrold, MD, MPH, Corrona, LLC, Waltham, and Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts; V.L. Feathers, MS, N. Shadick, MD, MPH, M.E. Weinblatt, MD, Division of Rheumatology, Inflammation, and Immunity, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA. The authors declare no conflicts of interest. Address correspondence to Dr. J.M. Kremer, 9832 Rennes Lane, Delray Beach, FL 33446, USA. . Accepted for publication December 3, 2020
| | - Dimitrios A Pappas
- This study was supported by the Corrona Research Foundation. J.M. Kremer, MD, Albany Medical College and The Center for Rheumatology, Albany, New York; D.A. Pappas, MD, MPH, Columbia University, New York, New York, and Corrona, LLC, Waltham, Massachusetts; K. Kane, MS, G. Reed, PhD, University of Massachusetts Medical School, Worcester, Massachusetts; J. Greenberg, MD, MPH, Corrona, LLC, Waltham, Massachusetts, and New York School of Medicine, New York, New York; L.R. Harrold, MD, MPH, Corrona, LLC, Waltham, and Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts; V.L. Feathers, MS, N. Shadick, MD, MPH, M.E. Weinblatt, MD, Division of Rheumatology, Inflammation, and Immunity, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA. The authors declare no conflicts of interest. Address correspondence to Dr. J.M. Kremer, 9832 Rennes Lane, Delray Beach, FL 33446, USA. . Accepted for publication December 3, 2020
| | - Kevin Kane
- This study was supported by the Corrona Research Foundation. J.M. Kremer, MD, Albany Medical College and The Center for Rheumatology, Albany, New York; D.A. Pappas, MD, MPH, Columbia University, New York, New York, and Corrona, LLC, Waltham, Massachusetts; K. Kane, MS, G. Reed, PhD, University of Massachusetts Medical School, Worcester, Massachusetts; J. Greenberg, MD, MPH, Corrona, LLC, Waltham, Massachusetts, and New York School of Medicine, New York, New York; L.R. Harrold, MD, MPH, Corrona, LLC, Waltham, and Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts; V.L. Feathers, MS, N. Shadick, MD, MPH, M.E. Weinblatt, MD, Division of Rheumatology, Inflammation, and Immunity, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA. The authors declare no conflicts of interest. Address correspondence to Dr. J.M. Kremer, 9832 Rennes Lane, Delray Beach, FL 33446, USA. . Accepted for publication December 3, 2020
| | - Jeffrey Greenberg
- This study was supported by the Corrona Research Foundation. J.M. Kremer, MD, Albany Medical College and The Center for Rheumatology, Albany, New York; D.A. Pappas, MD, MPH, Columbia University, New York, New York, and Corrona, LLC, Waltham, Massachusetts; K. Kane, MS, G. Reed, PhD, University of Massachusetts Medical School, Worcester, Massachusetts; J. Greenberg, MD, MPH, Corrona, LLC, Waltham, Massachusetts, and New York School of Medicine, New York, New York; L.R. Harrold, MD, MPH, Corrona, LLC, Waltham, and Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts; V.L. Feathers, MS, N. Shadick, MD, MPH, M.E. Weinblatt, MD, Division of Rheumatology, Inflammation, and Immunity, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA. The authors declare no conflicts of interest. Address correspondence to Dr. J.M. Kremer, 9832 Rennes Lane, Delray Beach, FL 33446, USA. . Accepted for publication December 3, 2020
| | - Leslie R Harrold
- This study was supported by the Corrona Research Foundation. J.M. Kremer, MD, Albany Medical College and The Center for Rheumatology, Albany, New York; D.A. Pappas, MD, MPH, Columbia University, New York, New York, and Corrona, LLC, Waltham, Massachusetts; K. Kane, MS, G. Reed, PhD, University of Massachusetts Medical School, Worcester, Massachusetts; J. Greenberg, MD, MPH, Corrona, LLC, Waltham, Massachusetts, and New York School of Medicine, New York, New York; L.R. Harrold, MD, MPH, Corrona, LLC, Waltham, and Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts; V.L. Feathers, MS, N. Shadick, MD, MPH, M.E. Weinblatt, MD, Division of Rheumatology, Inflammation, and Immunity, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA. The authors declare no conflicts of interest. Address correspondence to Dr. J.M. Kremer, 9832 Rennes Lane, Delray Beach, FL 33446, USA. . Accepted for publication December 3, 2020
| | - Vivi L Feathers
- This study was supported by the Corrona Research Foundation. J.M. Kremer, MD, Albany Medical College and The Center for Rheumatology, Albany, New York; D.A. Pappas, MD, MPH, Columbia University, New York, New York, and Corrona, LLC, Waltham, Massachusetts; K. Kane, MS, G. Reed, PhD, University of Massachusetts Medical School, Worcester, Massachusetts; J. Greenberg, MD, MPH, Corrona, LLC, Waltham, Massachusetts, and New York School of Medicine, New York, New York; L.R. Harrold, MD, MPH, Corrona, LLC, Waltham, and Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts; V.L. Feathers, MS, N. Shadick, MD, MPH, M.E. Weinblatt, MD, Division of Rheumatology, Inflammation, and Immunity, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA. The authors declare no conflicts of interest. Address correspondence to Dr. J.M. Kremer, 9832 Rennes Lane, Delray Beach, FL 33446, USA. . Accepted for publication December 3, 2020
| | - Nancy Shadick
- This study was supported by the Corrona Research Foundation. J.M. Kremer, MD, Albany Medical College and The Center for Rheumatology, Albany, New York; D.A. Pappas, MD, MPH, Columbia University, New York, New York, and Corrona, LLC, Waltham, Massachusetts; K. Kane, MS, G. Reed, PhD, University of Massachusetts Medical School, Worcester, Massachusetts; J. Greenberg, MD, MPH, Corrona, LLC, Waltham, Massachusetts, and New York School of Medicine, New York, New York; L.R. Harrold, MD, MPH, Corrona, LLC, Waltham, and Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts; V.L. Feathers, MS, N. Shadick, MD, MPH, M.E. Weinblatt, MD, Division of Rheumatology, Inflammation, and Immunity, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA. The authors declare no conflicts of interest. Address correspondence to Dr. J.M. Kremer, 9832 Rennes Lane, Delray Beach, FL 33446, USA. . Accepted for publication December 3, 2020
| | - Michael E Weinblatt
- This study was supported by the Corrona Research Foundation. J.M. Kremer, MD, Albany Medical College and The Center for Rheumatology, Albany, New York; D.A. Pappas, MD, MPH, Columbia University, New York, New York, and Corrona, LLC, Waltham, Massachusetts; K. Kane, MS, G. Reed, PhD, University of Massachusetts Medical School, Worcester, Massachusetts; J. Greenberg, MD, MPH, Corrona, LLC, Waltham, Massachusetts, and New York School of Medicine, New York, New York; L.R. Harrold, MD, MPH, Corrona, LLC, Waltham, and Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts; V.L. Feathers, MS, N. Shadick, MD, MPH, M.E. Weinblatt, MD, Division of Rheumatology, Inflammation, and Immunity, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA. The authors declare no conflicts of interest. Address correspondence to Dr. J.M. Kremer, 9832 Rennes Lane, Delray Beach, FL 33446, USA. . Accepted for publication December 3, 2020
| | - George Reed
- This study was supported by the Corrona Research Foundation. J.M. Kremer, MD, Albany Medical College and The Center for Rheumatology, Albany, New York; D.A. Pappas, MD, MPH, Columbia University, New York, New York, and Corrona, LLC, Waltham, Massachusetts; K. Kane, MS, G. Reed, PhD, University of Massachusetts Medical School, Worcester, Massachusetts; J. Greenberg, MD, MPH, Corrona, LLC, Waltham, Massachusetts, and New York School of Medicine, New York, New York; L.R. Harrold, MD, MPH, Corrona, LLC, Waltham, and Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts; V.L. Feathers, MS, N. Shadick, MD, MPH, M.E. Weinblatt, MD, Division of Rheumatology, Inflammation, and Immunity, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA. The authors declare no conflicts of interest. Address correspondence to Dr. J.M. Kremer, 9832 Rennes Lane, Delray Beach, FL 33446, USA. . Accepted for publication December 3, 2020
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St Clair-Jones A, Prignano F, Goncalves J, Paul M, Sewerin P. Understanding and Minimising Injection-Site Pain Following Subcutaneous Administration of Biologics: A Narrative Review. Rheumatol Ther 2020; 7:741-757. [PMID: 33206343 PMCID: PMC7672413 DOI: 10.1007/s40744-020-00245-0] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Accepted: 10/03/2020] [Indexed: 02/07/2023] Open
Abstract
Injection-site pain (ISP) is a subjective side effect that is commonly reported with the subcutaneous administration of biological agents, yet it may only be a concern to some. Multiple factors related to the product formulation, such as pH, volume and excipients, and/or to the injection process have the potential to contribute to ISP, while patient-related factors, such as low body weight, gender and age, can make an individual more susceptible to experiencing ISP. While total elimination of ISP remains unlikely with any subcutaneously administered agent, it can be minimised by helping the patient to develop a confident and competent injection technique via robust and effective training. Careful management of patient expectations along with open discussion regarding the potential risk of ISP may serve to minimise treatment-related anxieties and, importantly, allow the patient to remain in control of his/her treatment. Other interventions to help minimise ISP include psychological interventions, allowing biologics to reach room temperature prior to injection, using the most suitable injection device for the individual patient and selecting an alternative drug formulation, when available. Productive patient–physician communication remains important in order to support and optimise treatment experience and adherence, while also providing the opportunity for patients to discuss any ISP-related issues.
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Affiliation(s)
- Anja St Clair-Jones
- Pharmacy Department, Brighton and Sussex University Hospitals NHS Trust, Brighton, UK.
| | - Francesca Prignano
- Section of Dermatology, Department of Health Science, University of Florence, Florence, Italy
| | - Joao Goncalves
- iMed-Research Institute for Medicines, Faculdade de Farmácia, Universidade de Lisboa, Lisbon, Portugal
| | - Muriel Paul
- Department of Pharmacy, AP-HP, Henri-Mondor Hospital, Créteil, France
- University of Paris-Est Créteil, Epidemiology in Dermatology and Evaluation of Therapeutics (EpidermE), EA 7379, UPEC, Créteil, 94010, France
| | - Philipp Sewerin
- Department and Hiller Research Unit of Rheumatology, University Clinic Düsseldorf (UKD), Heinrich Heine University, Düsseldorf, Germany
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Razmjou AA, Brook J, Elashoff D, Kaeley G, Choi S, Kermani T, Ranganath VK. Ultrasound and multi-biomarker disease activity score for assessing and predicting clinical response to tofacitinib treatment in patients with rheumatoid arthritis. BMC Rheumatol 2020; 4:55. [PMID: 33089069 PMCID: PMC7569763 DOI: 10.1186/s41927-020-00153-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 08/05/2020] [Indexed: 12/15/2022] Open
Abstract
Background Musculoskeletal ultrasound (MSUS) and the multi-biomarker disease activity (MBDA) score are outcome measures that may aid in the management of rheumatoid arthritis (RA) patients. This study evaluated tofacitinib response by MSUS/MBDA scores and assessed whether baseline MSUS/MBDA scores or their early changes predict later clinical response. Methods Twenty-five RA patients treated with tofacitinib were assessed at baseline, 2, 6 and 12-weeks. Power doppler (PDUS) and gray scale (GSUS) ultrasound scores, MBDA score, clinical disease activity index (CDAI), and disease activity score (DAS28) were obtained. Pearson correlations and multiple linear regression models were used to evaluate associations and identify predictors of response to therapy. Results MSUS, MBDA scores, CDAI, and DAS28 improved significantly over 12 weeks (p < 0.0001). Baseline MSUS and MBDA score correlated with each other, and with 12-week changes in CDAI/DAS28 (r = 0.45–0.62, p < 0.05), except for GSUS with DAS28. Two-week change in MSUS correlated significantly with 12-week changes in CDAI/DAS28 (r = 0.42–0.57, p < 0.05), except for early change in PDUS with 12-week change in CDAI. Regression analysis demonstrated significant independent associations between baseline PDUS/MBDA score and 6-week change in CDAI/DAS28, with adjustment for baseline CDAI/DAS28 (all p < 0.05); and between baseline MBDA scores and 12-week change in DAS28 (p = 0.03). Conclusions RA patients treated with tofacitinib for 12 weeks demonstrated improvement by clinical, imaging, and biomarker end-points. Baseline PDUS and MBDA score were predictive of CDAI and DAS28 responses. This is the first study to evaluate early measurements of MSUS and MBDA score as predictors of clinical response in RA patients treated with tofacitinib. Trial registration ClinicalTrials.gov NCT02321930 (registered 12/22/2014).
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Affiliation(s)
- Amir A Razmjou
- Department of Medicine, UCLA-David Geffen School of Medicine, Los Angeles, USA
| | - Jenny Brook
- Department of Medicine Statistics Core, UCLA-David Geffen School of Medicine, Los Angeles, USA
| | - David Elashoff
- Department of Medicine Statistics Core, UCLA-David Geffen School of Medicine, Los Angeles, USA
| | - Gurjit Kaeley
- Department of Rheumatology, University of Florida Health, Jacksonville, USA
| | - Soo Choi
- Department of Rheumatology, University of California, San Diego, USA
| | - Tanaz Kermani
- Department of Rheumatology, UCLA-David Geffen School of Medicine, 1000 Veteran Blvd., RM 32-59, Los Angeles, CA 90095 USA
| | - Veena K Ranganath
- Department of Rheumatology, UCLA-David Geffen School of Medicine, 1000 Veteran Blvd., RM 32-59, Los Angeles, CA 90095 USA
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Fatigue is cross-sectionally not associated with objective assessments of inflammation, but changes in fatigue are associated with changes of disease activity assessments during biologic treatment of patients with established rheumatoid arthritis. Clin Rheumatol 2020; 40:1739-1749. [PMID: 33040226 PMCID: PMC8102439 DOI: 10.1007/s10067-020-05402-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Revised: 09/08/2020] [Accepted: 09/12/2020] [Indexed: 01/03/2023]
Abstract
Objective The associations between fatigue and disease activity in patients with rheumatoid arthritis (RA) have not been defined. The present objectives were to explore in RA patients the cross-sectional and longitudinal relation of fatigue with subjective as well as objective assessments of disease activity. Methods RA patients were consecutively included when initiating biologic disease-modifying anti-rheumatic drugs (DMARDs) and assessed at baseline, 1, 2, 3, 6, and 12 months with investigation of fatigue, patient-reported outcome measures (PROMs; joint pain and patient’s global disease activity, MHAQ, pain catastrophizing, Mental Health score), clinical examinations (examiner’s global disease activity, 28 tender and swollen joint counts), and laboratory variables (ESR, CRP, calprotectin). Ultrasound examinations (semi-quantitative scoring (0–3)) with grey scale and power Doppler were performed of 36 joints and 4 tendons. Statistics included one-way analysis of variance, Pearson’s correlations, and multiple linear and logistic regression analysis. Results A total of 208 RA patients (mean (SD) age 53.2 (13.2) years, disease duration 9.8 (8.5) years) were included. Fatigue levels diminished during follow-up (mean (SD) baseline/12 months; 4.8 (2.8)/3.0 (2.5) (p < 0.001)). Substantial correlations were cross-sectionally found between fatigue and PROMs (median (IQR) r=0.61 (0.52-0.71)) but not with the objective inflammatory assessments. During follow-up, baseline fatigue was associated with PROMs (p < 0.001) but not with objective inflammatory assessments. However, change of fatigue was associated with change in all variables. Higher baseline fatigue levels were associated with lower clinical composite score remission rates. Conclusion Fatigue was cross-sectionally associated to subjective but not to objective disease assessments. However, change of fatigue during treatment was associated to all assessments of disease activity. Trial registration number Anzctr.org.au identifier ACTRN12610000284066, Norwegian Regional Committee for Medical and Health Research Ethics South East reference number 2009/1254Key Points • In this longitudinal study of patients with established RA, fatigue was associated with patient reported outcome measures at each visit, but not with objective assessments of inflammation including calprotectin and comprehensive ultrasound examinations. • Changes in fatigue during biological treatment were associated with changes in patient reported outcome measures, clinical, laboratory and ultrasound assessments. • Baseline fatigue was associated with all patient reported outcome measures, but not objective assessments of inflammation at all the prospective visits. • Higher baseline fatigue levels were associated with lower remission rates as assessed by clinical composite scores. |
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Heisler AC, Song J, Dunlop DD, Wohlfahrt A, Bingham CO, Bolster MB, Clauw DJ, Marder W, Phillips K, Neogi T, Lee YC. Association of Pain Centralization and Patient-Reported Pain in Active Rheumatoid Arthritis. Arthritis Care Res (Hoboken) 2020; 72:1122-1129. [PMID: 31162824 PMCID: PMC6891118 DOI: 10.1002/acr.23994] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Accepted: 05/28/2019] [Indexed: 12/26/2022]
Abstract
OBJECTIVE Pain is a significant burden for patients with rheumatoid arthritis (RA) despite advancements in treatment. We undertook this study to examine the independent contribution of pain centralization to the pain experience of patients with active RA. METHODS A total of 263 RA patients with active disease underwent quantitative sensory testing (QST), including assessment of extraarticular pressure pain thresholds (PPTs), temporal summation (TS), and conditioned pain modulation (CPM). The pain experience was assessed by a pain intensity numeric rating scale and the Patient-Reported Outcomes Measurement Information System pain interference computerized adaptive test. We examined associations between QST measures and pain intensity and pain interference. Multiple linear regression models were adjusted for demographic and clinical variables, including swollen joint count and C-reactive protein level. RESULTS Patients with the lowest PPTs (most central dysregulation) reported higher pain intensity than patients with the highest PPTs (adjusted mean difference 1.02 [95% confidence interval (95% CI) 0.37, 1.67]). Patients with the highest TS (most central dysregulation) had higher pain intensity than those with the lowest TS (adjusted mean difference 1.19 [95% CI 0.54, 1.84]). CPM was not associated with differences in pain intensity. PPT and TS were not associated with pain interference. Patients with the lowest CPM (most centrally dysregulated) had lower pain interference than patients with the highest CPM (adjusted mean difference -2.35 [95% CI -4.25, -0.44]). CONCLUSION Pain centralization, manifested by low PPTs and high TS, was associated with more intense pain. Clinicians should consider pain centralization as a contributor to pain intensity, independent of inflammation.
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Affiliation(s)
| | - Jing Song
- Northwestern University, Chicago, Illinois
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Kuettel D, Terslev L, Weber U, Østergaard M, Primdahl J, Petersen R, Ammitzbøll-Danielsen M, Möller S, Hørslev-Petersen K. Flares in rheumatoid arthritis: do patient-reported swollen and tender joints match clinical and ultrasonography findings? Rheumatology (Oxford) 2020; 59:129-136. [PMID: 31382292 DOI: 10.1093/rheumatology/kez231] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Revised: 05/15/2019] [Indexed: 01/16/2023] Open
Abstract
OBJECTIVES To investigate how patient-reported flares in RA are related to clinical joint examination and inflammation detected by US. METHODS Eighty RA patients with DAS28-CRP <3.2 and no swollen joints at baseline were followed for 1 year. In case of patient-reported hand flare with swollen and tender joints (SJ and TJ, respectively), patients underwent clinical examination for SJ/TJ and US of bilateral wrists, MCP and PIP 1st-5th, six extensor tendon compartments and wrist flexor tendons for synovitis/tenosynovitis. Percentage agreement and kappa were calculated between patient-reported SJ and TJ, clinical examination for SJ/TJ and US findings indicative of inflammation. With US as reference, sensitivity, specificity, positive/negative predictive value and accuracy of patient-reported and clinically examined joints were determined. RESULTS Hand flare was reported by 36% (29/80) of patients. At time of flare, all clinical and ultrasonographic measures of disease activity deteriorated compared with baseline. Agreement between patient-reported SJ/TJ, clinically examined SJ/TJ and US was slight (kappa = 0.02-0.20). Patients and clinicians agreed in 79-93% of joints, more frequently on SJ than TJ. With US as reference, specificities were 86-100% and 88-100%, and sensitivities 12-34% and 4-32% for patient-reported SJ/TJ and clinically examined SJ/TJ, respectively. CONCLUSION Over 12 months of follow-up, hand flare was reported by every third RA patient. Self-reported flares were associated with increased disease activity as determined by clinical examination and US. Patient-reported joint assessment may aid in capturing flares between routine clinical visits.
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Affiliation(s)
- Dorota Kuettel
- Danish Hospital for Rheumatic Diseases, University Hospital of Southern Denmark, Sønderborg, Denmark.,Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Lene Terslev
- Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Rigshospitalet - Glostrup, Glostrup, Denmark
| | - Ulrich Weber
- Danish Hospital for Rheumatic Diseases, University Hospital of Southern Denmark, Sønderborg, Denmark.,Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Mikkel Østergaard
- Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Rigshospitalet - Glostrup, Glostrup, Denmark
| | - Jette Primdahl
- Danish Hospital for Rheumatic Diseases, University Hospital of Southern Denmark, Sønderborg, Denmark.,Department of Regional Health Research, University of Southern Denmark, Odense, Denmark.,Sygehus Sønderjylland, University Hospital of Southern Denmark, Aabenraa, Denmark
| | - Randi Petersen
- Danish Hospital for Rheumatic Diseases, University Hospital of Southern Denmark, Sønderborg, Denmark
| | - Mads Ammitzbøll-Danielsen
- Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Rigshospitalet - Glostrup, Glostrup, Denmark
| | - Sören Möller
- OPEN - Odense Patient data Explorative Network, Odense University Hospital, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Kim Hørslev-Petersen
- Danish Hospital for Rheumatic Diseases, University Hospital of Southern Denmark, Sønderborg, Denmark.,Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
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Hammer HB, Michelsen B, Provan SA, Sexton J, Lampa J, Uhlig T, Kvien TK. Tender Joint Count and Inflammatory Activity in Patients With Established Rheumatoid Arthritis: Results From a Longitudinal Study. Arthritis Care Res (Hoboken) 2019; 72:27-35. [DOI: 10.1002/acr.23815] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Accepted: 11/20/2018] [Indexed: 11/08/2022]
Affiliation(s)
| | - Brigitte Michelsen
- Diakonhjemmet Hospital, Oslo, Norway, and Hospital of Southern Norway Trust Kristiansand Norway
| | | | | | - Jon Lampa
- Karolinska InstituteKarolinska University Hospital Stockholm Sweden
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Larice S, Ghiggia A, Di Tella M, Romeo A, Gasparetto E, Fusaro E, Castelli L, Tesio V. Pain appraisal and quality of life in 108 outpatients with rheumatoid arthritis. Scand J Psychol 2019; 61:271-280. [PMID: 31674683 DOI: 10.1111/sjop.12592] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2019] [Accepted: 09/16/2019] [Indexed: 12/22/2022]
Abstract
Individual differences in emotional functioning, pain appraisal processing, and perceived social support may play a relevant role in the subjective experience of pain. Due to the paucity of data regarding individuals with Rheumatoid Arthritis (RA), the present study aimed to examine pain intensity, emotional functioning (psychological distress and alexithymia), pain appraisal (pain beliefs, pain catastrophizing, and pain-related coping strategies) and social support, and their relationships with the health-related quality of life (HRQoL) in patients with RA. Data were collected from 108 female patients diagnosed with RA. Clinically relevant levels of depressive and anxiety symptoms assessed by the HADS subscales were present in 34% and 41% of the patients, respectively, and about 24% of them exhibited the presence of alexithymia. The results of hierarchical multiple regression analyses showed that pain intensity, alexithymia, the maladaptive beliefs regarding the stability of pain and the coping strategy of guarding explained 54% of the variance in the physical component of HRQoL (p < 0.001). Depression subscale of the HADS, alexithymia, the coping strategy of resting, and the rumination factor of pain catastrophizing significantly explained 40% of the variance in the mental component of HRQoL (p < 0.001). The present findings provide evidence regarding the importance of emotional functioning and pain appraisal in the negative impact of RA on patients' quality of life. These findings provide additional evidence for the biopsychosocial model of chronic pain, further supporting the complex interaction between emotional, cognitive, and behavioral processes in patients with chronic pain.
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Affiliation(s)
- Sara Larice
- Department of Psychology, University of Turin, Turin, Italy
| | - Ada Ghiggia
- Clinical Psychology Unit, A.O.U. Città della Salute e della Scienza, Turin, Italy
| | | | - Annunziata Romeo
- Clinical Psychology Unit, A.O.U. Città della Salute e della Scienza, Turin, Italy
| | - Eleonora Gasparetto
- Clinical Psychology Unit, A.O.U. Città della Salute e della Scienza, Turin, Italy
| | - Enrico Fusaro
- Rheumatology Unit, A.O.U. Città della Salute e della Scienza, Turin, Italy
| | - Lorys Castelli
- Department of Psychology, University of Turin, Turin, Italy
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Hammer HB, Kvien TK, Terslev L. Intermetatarsal bursitis is frequent in patients with established rheumatoid arthritis and is associated with anti-cyclic citrullinated peptide and rheumatoid factor. RMD Open 2019; 5:e001076. [PMID: 31673423 PMCID: PMC6803004 DOI: 10.1136/rmdopen-2019-001076] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Revised: 09/18/2019] [Accepted: 10/02/2019] [Indexed: 12/01/2022] Open
Affiliation(s)
| | - Tore K Kvien
- Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
| | - L Terslev
- Center for Rheumatology and Spine Disease, Rigshospitalet Glostrup, Copenhagen, Denmark
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42
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Romão VC, Fonseca JE. Major Challenges in Rheumatology: Will We Ever Treat Smarter, Instead of Just Harder? Front Med (Lausanne) 2019; 6:144. [PMID: 31294026 PMCID: PMC6606708 DOI: 10.3389/fmed.2019.00144] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Accepted: 06/10/2019] [Indexed: 12/17/2022] Open
Affiliation(s)
- Vasco C Romão
- Department of Rheumatology, Centro Hospitalar Universitário Lisboa Norte, Hospital de Santa Maria, Lisbon Academic Medical Centre, Lisbon, Portugal.,Rheumatology Research Unit, Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
| | - João Eurico Fonseca
- Department of Rheumatology, Centro Hospitalar Universitário Lisboa Norte, Hospital de Santa Maria, Lisbon Academic Medical Centre, Lisbon, Portugal.,Rheumatology Research Unit, Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
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43
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Hammer HB, Michelsen B, Sexton J, Haugen IK, Provan SA, Haavardsholm EA, Uhlig T, Kvien TK. Swollen, but not tender joints, are independently associated with ultrasound synovitis: results from a longitudinal observational study of patients with established rheumatoid arthritis. Ann Rheum Dis 2019; 78:1179-1185. [DOI: 10.1136/annrheumdis-2019-215321] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Revised: 05/18/2019] [Accepted: 05/21/2019] [Indexed: 11/04/2022]
Abstract
ObjectivesJoint swelling and tenderness are considered a proxy for inflammation in patients with rheumatoid arthritis (RA). With ultrasound-detected inflammation as reference, our objectives were to explore on patient and joint level the associations between ultrasound synovitis and joint swelling, tenderness and patient-reported joint pain (PRJP).Methods209 patients with established RA were examined six times during 12 months with assessment of 32 joints in upper/lower extremities for joint swelling/tenderness and Grey scale (GS)/power Doppler (PD) synovitis. PRJP was assessed on a manikin. Correlations between different sum scores were at each examination calculated using Spearman’s rho (r), agreement at joint level was examined by Cohen’s kappa and logistic regression models were used to explore the associations between joint assessment and GS/PD scores.ResultsAt patient level, swollen joints were strongly correlated with GS/PD sum scores (r=0.64–0.88), while tender joints were primarily associated with PRJP (r=0.54–0.68). At joint level, GS/PD pathology had higher agreement with swelling (kappa 0.54–0.57) than tenderness (kappa 0.20–0.21) or PRJP (0.23–0.25). Higher percentages of joints were swollen according to increasing GS/PD scores, independently of joint tenderness. However, joints being tender, but not swollen, were not associated with GS/PD scores. Receiver operating curves showed swollen but not tender joints to be associated with GS/PD scores.ConclusionsSwollen joints were strongly associated with ultrasound detected synovitis at both patient and joint level, while this association was not found for tender joints. These results may question if tender joints reflect ongoing inflammation in established RA.
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Is a Fundamental Change in the Interpretation of Rheumatoid Arthritis Disease Activity Necessary? J Clin Rheumatol 2018; 25:272-277. [PMID: 30570492 DOI: 10.1097/rhu.0000000000000937] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Disease Activity Score (DAS) composite models are moderately precise and robust measures of disease severity when they are used in rheumatoid arthritis (RA) cohorts. They are less so when used for individual patients. This is because subjective components, patient global assessment of well-being and tender joint count, modified by factors other than RA biological disease activity, often obfuscate interpretation of disease activity. Comorbidities, especially distress, can disproportionately inflate these components. Fibromyalgia, essentially synonymous with distress, pain augmentation, and depression, is a common comorbidity. Its presence and severity can be determined by the Polysymptomatic Distress Scale (PSD). The differential effects of distress and fibromyalgia syndrome on the DAS can be demonstrated by manipulating information already there: the arithmetic differences or ratios of the tender joint count and swollen joint count and comparison of the modified disease activity score with 28 joints to the disease activity score with 28 joints-patient (DAS28-derived indices that measure the contribution of the relatively objective or relatively subjective components, respectively). The potentially more objective multibiomarker disease activity might also be used to test the severity of biological RA disease activity. These tools may be used to elucidate disproportionate values for subjective DAS model components, which then should facilitate identification of the underlying process factors, including depression, for potential treatment.
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Pukšić S, Bolton-King P, Sexton J, Michelsen B, Kvien TK, Berner Hammer H. DAPSA and ultrasound show different perspectives of psoriatic arthritis disease activity: results from a 12-month longitudinal observational study in patients starting treatment with biological disease-modifying antirheumatic drugs. RMD Open 2018; 4:e000765. [PMID: 30487999 PMCID: PMC6242028 DOI: 10.1136/rmdopen-2018-000765] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Revised: 09/17/2018] [Accepted: 09/22/2018] [Indexed: 12/19/2022] Open
Abstract
Objectives Disease Activity index for PSoriatic Arthritis (DAPSA) (sum score 68/66 tender/swollen joint counts (68TJC/66SJC), patient’s global assessment, pain and C-reactive protein (CRP)) is recommended for clinical assessment of disease activity in patients with psoriatic arthritis (PsA). Ultrasound (US) (grey scale (GS) and power Doppler (PD)) detects inflammation in joints and extra-articular structures. The present objectives were to explore the longitudinal relationships between DAPSA, clinical assessment as well as patient-reported outcome measures (PROMs) with US in patients with PsA initiating biological DMARDs and the associations between DAPSA and US remission. Methods 47 patients with PsA were examined at baseline and after 3, 6, 9 and 12 months. Assessments included 68TJC/66SJC, examiner’s global assessment (EGA), PROMs, CRP, erythrocyte sedimentation rate (ESR) and US GS and PD (48 joints, 10 flexor tendons, 14 entheses, 4 bursae). Clinical composite scores and PD sum scores (0=remission) were calculated. Longitudinal associations were explored by generalised estimating equations with linear and logistic regression. Results DAPSA was not longitudinally associated to PD. 66SJC, ESR, 28-joint Disease Activity Score, EGA and CRP were longitudinally associated with PD (p<0.001–0.03), whereas the pain-related components of DAPSA (68TJC and pain) as well as PROMs were not associated. At 6–12 months, remission was achieved in 29%–33 % of the patients for DAPSA and 59%–70 % for PD. The association between DAPSA and PD remission was not significant (p=0.33). Conclusions DAPSA was not associated with US inflammatory findings which indicates that DAPSA and US may assess different aspects of PsA activity.
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Affiliation(s)
- Silva Pukšić
- Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway.,Department of Clinical Immunology, Rheumatology and Allergology, University Hospital Dubrava, University of Zagreb School of Medicine, Zagreb, Croatia
| | | | - Joseph Sexton
- Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
| | | | - Tore K Kvien
- Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
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Is synovial hypertrophy without Doppler activity sensitive to change? Post-hoc analysis from a rheumatoid arthritis ultrasound study. Arthritis Res Ther 2018; 20:224. [PMID: 30285845 PMCID: PMC6235232 DOI: 10.1186/s13075-018-1709-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Accepted: 08/28/2018] [Indexed: 11/17/2022] Open
Abstract
Background To explore to what extent synovial hypertrophy in joints without Doppler activity is a sign of active disease, we investigated the sensitivity to change of synovial hypertrophy without Doppler activity during biological disease-modifying antirheumatic drug (bDMARD) treatment in rheumatoid arthritis (RA) patients. Method RA patients initiating or switching bDMARD treatment had ultrasound (US) performed on 36 joints at baseline, and at 3 and 6 months. Synovial hypertrophy by grayscale US and Doppler activity were graded separately from 0 to 3 at the joint level for all time points. Changes in synovial hypertrophy in joints without Doppler activity during treatment were assessed and compared with changes in synovial hypertrophy in joints with Doppler activity. Results We included 151 patients (82.8% women, 80.1% seropositive for anticyclic citrullinated peptide) with a mean ± standard deviation age of 51.4 ± 13.2 years, a disease duration of 9.9 ± 7.9 years, and baseline Disease Activity Score 28-joint count C-reactive peptide (DAS28-CRP) of 4.14 ± 1.32. At baseline, 44.8% of all joints examined (n = 5225) had synovial hypertrophy ≥ 1 and 50.7% of these had synovial hypertrophy without Doppler activity. The improvement in synovial hypertrophy was similar in joints with and without Doppler activity but, when adjusting for the baseline score of synovial hypertrophy, joints with synovial hypertrophy without Doppler had a higher tendency towards a decrease than joints with synovial hypertrophy with Doppler activity independent of grade (3 months: p < 0.0001; 6 months: p = 0.0003). Conclusion Joints with synovial hypertrophy without Doppler activity improve during treatment, independent of the grade. Thus, SH without Doppler activity is not a sign of inactive disease. These findings indicate that joints with synovial hypertrophy without Doppler activity should also be taken in to account when assessing disease activity by US.
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