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Kaerts M, Swinnen TW, Dankaerts W, de Vlam K, Neerinckx B. High-quality research on physical therapy in psoriatic arthritis is needed: a systematic review. Rheumatol Adv Pract 2024; 8:rkae107. [PMID: 39247389 PMCID: PMC11379465 DOI: 10.1093/rap/rkae107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2024] [Accepted: 08/22/2024] [Indexed: 09/10/2024] Open
Abstract
Objectives Although physical therapy is recommended as part of the non-pharmacological management of patients with psoriatic arthritis (PsA), the evidence is still unclear. Therefore, this study aimed to systematically review and appraise the quality of research on physical therapy in the management of patients with PsA. Methods In June 2024, a systematic literature search using four different databases (Medline, Embase, Web of Science and the Cochrane Library) was performed to include interventional and observational studies examining physical therapy in patients with PsA (PROSPERO ID 255501). A risk of bias assessment was conducted. Due to the wide variety of interventions and outcomes, a narrative synthesis was used. Results Of 9442 abstracts, 15 papers examining physical therapy uptake in clinical practice (N = 2) and different physical therapy interventions (N = 13) were included: cardiorespiratory exercises (N = 5), resistance exercises (N = 2), therapeutic modalities (N = 4) and mixed rehabilitation programs (N = 2). A low risk of bias was scored in only one RCT assessing cardiorespiratory exercises. The well-tolerated 11-week high-intensity interval training resulted in a long-term increase in peak oxygen uptake and a short-term decrease in truncal fat percentage in patients with low disease activity. Resistance training in patients with active disease did not increase muscle strength, but improved functional capacity, disease activity, pain and general health after the intervention. Evidence for other modalities was inconclusive. Conclusion High-quality evidence on physical therapy in PsA was scarce. Cardiorespiratory and resistance exercises demonstrated promising results to positively influence cardiometabolic risk as well as disease-related outcomes. Future research on physical therapy in PsA with adequate methodological quality is needed.
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Affiliation(s)
- Marlies Kaerts
- Department of Development and Regeneration, Skeletal Biology and Engineering Research Center, KU Leuven, Leuven, Belgium
| | - Thijs W Swinnen
- Department of Development and Regeneration, Skeletal Biology and Engineering Research Center, KU Leuven, Leuven, Belgium
- Department of Rehabilitation Sciences, Research Group for Musculoskeletal Rehabilitation, KU Leuven, Leuven, Belgium
- Division of Rheumatology, University Hospitals Leuven, Leuven, Belgium
| | - Wim Dankaerts
- Department of Rehabilitation Sciences, Research Group for Musculoskeletal Rehabilitation, KU Leuven, Leuven, Belgium
| | - Kurt de Vlam
- Department of Development and Regeneration, Skeletal Biology and Engineering Research Center, KU Leuven, Leuven, Belgium
- Division of Rheumatology, University Hospitals Leuven, Leuven, Belgium
| | - Barbara Neerinckx
- Department of Development and Regeneration, Skeletal Biology and Engineering Research Center, KU Leuven, Leuven, Belgium
- Division of Rheumatology, University Hospitals Leuven, Leuven, Belgium
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2
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Biedroń G, Wilk M, Nowakowski J, Kuszmiersz P, Guła Z, Strach M, Brkic A, Haugeberg G, Korkosz M. Impact of comorbidities on patient-reported outcomes in psoriatic arthritis: a single centre cohort study. Rheumatol Int 2024; 44:1435-1443. [PMID: 38914774 PMCID: PMC11222239 DOI: 10.1007/s00296-024-05632-2] [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: 04/30/2024] [Accepted: 05/28/2024] [Indexed: 06/26/2024]
Abstract
BACKGROUND Comorbidities are frequent in psoriatic arthritis (PsA) and may contribute to worse health-related outcomes. Patient-reported outcomes (PROs) are used to evaluate the burden of the assessed disease. The aim of this study is to evaluate the impact of comorbidities on selected PROs in PsA. METHODS Adult patients, diagnosed with PsA, based on CASPAR criteria, were included in this cross-sectional, observational study. Collected data encompassed the comorbidities and PROs (Health Assessment Questionnaire [HAQ], Multi-Dimensional Health Assessment Questionnaire [MDHAQ], 36-Item Short Form Health Survey [SF-36]). Standard statistic methods were performed for data assessment. RESULTS There were 267 participants included in the study (54.7% females). The most prevalent comorbidities were cardiovascular diseases (CVD) (29.2 %). Multimorbidity was observed in 50.2% cases and was associated with poorer results of SF-36 questionnaire, regarding bodily pain (34.7 [30.1, 39.3] vs. 47.5 [43.1, 52.0]; p<0.01), physical functioning (52.1 [47.3, 56.9] vs. 63.1 [58.9, 67.4]; p<0.01) and role physical (28.5 [21.2, 35.9] vs. 42.8 [35.2, 50.4]; p<0.01). CVD were associated with poorer MDHAQFn score (β=0.17, p<0.01), while mental disorders negatively influenced mental health (β= -0.35, p<0.01), vitality (β= -0.22, p<0.01), general health (β= -0.19, p<0.01), social functioning (β= -0.15, p=0.04) and role emotional (β= -0.30, p<0.01) dimensions of SF-36. CONCLUSIONS Multimorbidity exerts significant impact on physical aspects of quality of life (QoL) in PsA. CVD and mental disorders adversely influence functional capacity as well as mental and social dimensions of QoL, respectively. The impact of comorbidities should be taken into account by clinicians and researchers assessing PROs.
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Affiliation(s)
- Grzegorz Biedroń
- Department of Rheumatology and Immunology, Jagiellonian University Medical College, Jakubowskiego 2, Kraków, Poland.
- Department of Rheumatology, Clinical Immunology and Internal Medicine, University Hospital in Cracow, Kraków, Poland.
| | - Mateusz Wilk
- Department of Rheumatology, Clinical Immunology and Internal Medicine, University Hospital in Cracow, Kraków, Poland
| | - Jarosław Nowakowski
- Department of Rheumatology and Immunology, Jagiellonian University Medical College, Jakubowskiego 2, Kraków, Poland
- Department of Rheumatology, Clinical Immunology and Internal Medicine, University Hospital in Cracow, Kraków, Poland
| | - Piotr Kuszmiersz
- Department of Rheumatology and Immunology, Jagiellonian University Medical College, Jakubowskiego 2, Kraków, Poland
- Department of Rheumatology, Clinical Immunology and Internal Medicine, University Hospital in Cracow, Kraków, Poland
| | - Zofia Guła
- Department of Rheumatology and Immunology, Jagiellonian University Medical College, Jakubowskiego 2, Kraków, Poland
- Department of Rheumatology, Clinical Immunology and Internal Medicine, University Hospital in Cracow, Kraków, Poland
| | - Magdalena Strach
- Department of Rheumatology and Immunology, Jagiellonian University Medical College, Jakubowskiego 2, Kraków, Poland
- Department of Rheumatology, Clinical Immunology and Internal Medicine, University Hospital in Cracow, Kraków, Poland
| | - Alen Brkic
- Division of Rheumatology, Department of Internal Medicine, Sørlandet Hospital, Kristiansand, Norway
| | - 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
- Department of Rheumatology and Immunology, Jagiellonian University Medical College, Jakubowskiego 2, Kraków, Poland
- Department of Rheumatology, Clinical Immunology and Internal Medicine, University Hospital in Cracow, Kraków, Poland
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3
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Wu KA, Kugelman DN, Seidelman JL, Seyler TM. Native Joint Septic Arthritis. Antibiotics (Basel) 2024; 13:596. [PMID: 39061278 PMCID: PMC11274354 DOI: 10.3390/antibiotics13070596] [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: 05/30/2024] [Revised: 06/20/2024] [Accepted: 06/26/2024] [Indexed: 07/28/2024] Open
Abstract
Native joint septic arthritis (NJSA) is a severe and rapidly progressing joint infection, predominantly bacterial but also potentially fungal or viral, characterized by synovial membrane inflammation and joint damage, necessitating urgent and multidisciplinary management to prevent permanent joint damage and systemic sepsis. Common in large joints like knees, hips, shoulders, and elbows, NJSA's incidence is elevated in individuals with conditions like rheumatoid arthritis, diabetes, immunosuppression, joint replacement history, or intravenous drug use. This review provides a comprehensive overview of NJSA, encompassing its diagnosis, treatment, antibiotic therapy duration, and surgical interventions, as well as the comparison between arthroscopic and open debridement approaches. Additionally, it explores the unique challenges of managing NJSA in patients who have undergone graft anterior cruciate ligament (ACL) reconstruction. The epidemiology, risk factors, pathogenesis, microbiology, clinical manifestations, diagnosis, differential diagnosis, antibiotic treatment, surgical intervention, prevention, and prophylaxis of NJSA are discussed, highlighting the need for prompt diagnosis, aggressive treatment, and ongoing research to enhance patient outcomes.
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Affiliation(s)
- Kevin A. Wu
- Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, NC 27701, USA; (K.A.W.)
| | - David N. Kugelman
- Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, NC 27701, USA; (K.A.W.)
| | - Jessica L. Seidelman
- Division of Infectious Diseases, Duke University School of Medicine, Durham, NC 27710, USA
| | - Thorsten M. Seyler
- Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, NC 27701, USA; (K.A.W.)
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Deodhar A, Blauvelt A, Lebwohl M, Feely M, Kronbergs A, Eberhart N, Zhu D, Inman E, Grace E, Holzkaemper T, Rahman P, Marzo-Ortega H, Papp KA, Merola JF, Gottlieb AB, Schwartzman S. Long-term safety of Ixekizumab in adults with psoriasis, psoriatic arthritis, or axial spondyloarthritis: a post-hoc analysis of final safety data from 25 randomized clinical trials. Arthritis Res Ther 2024; 26:49. [PMID: 38347650 PMCID: PMC10860236 DOI: 10.1186/s13075-023-03257-7] [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: 09/25/2023] [Accepted: 12/27/2023] [Indexed: 02/15/2024] Open
Abstract
BACKGROUND We report long-term, end-of-study program safety outcomes from 25 randomized clinical trials (RCTs) in adult patients with psoriasis (PsO), psoriatic arthritis (PsA), or axial spondyloarthritis (axSpA) [including ankylosing spondylitis (AS) and non-radiographic axial spondyloarthritis (nr-axSpA)] who received ≥ 1 dose of Ixekizumab (IXE) over 5 years (PsO) or up to 3 years (PsA, axSpA). METHODS This integrated safety analysis consists of data from patients who received any dose of IXE, across 25 RCTs (17 PsO, 4 PsA, 4 axSpA). Rates of treatment-emergent adverse events (TEAEs), serious adverse events (SAEs) and selected adverse events (AEs) of interest were analyzed for all pooled studies by years of therapy and overall, through March 2022. Results were reported as exposure-adjusted incidence rates (IRs) per 100 patient-years (PY) overall and at successive year intervals. RESULTS Six thousand eight hundred ninety two adult patients with PsO, 1401 with PsA, and 932 with axSpA (including AS and nr-axSpA), with a cumulative IXE exposure of 22,371.1 PY were included. The most commonly reported TEAE across indications was nasopharyngitis (IRs per 100 PY: 8.8 (PsO), 9.0 (PsA), 8.4 (axSpA)). SAEs were reported by 969 patients with PsO (IR 5.4), 134 patients with PsA (IR 6.0), and 101 patients with axSpA (IR 4.8). Forty-five deaths were reported (PsO, n = 36, IR 0.2; PsA, n = 6, IR 0.3; axSpA, n = 3, IR 0.1). TEAEs did not increase during IXE exposure: IRs per 100 PY, PsO: 88.9 to 63.2 (year 0-1 to 4-5), PsA: 87 to 67.3 (year 0-1 to 2-3), axSpA: 82.1 to 55.4 (year 0-1 to > = 2). IRs per 100 PY of discontinuation from IXE due to AE were 2.9 (PsO), 5.1 (PsA), and 3.1 (axSpA). IRs per 100 PY of injection site reactions were 5.9 (PsO), 11.6 (PsA) and 7.4 (axSpA); Candida: 1.9 (PsO), 2.0 (PsA), and 1.2 (axSpA); depression, major adverse cerebro-cardiovascular events and malignancies: ≤ 1.6 across all indications. Adjudicated IRs per 100 PY of inflammatory bowel disease were ≤ 0.8 across indications (0.1 [PsO]; 0.1 [PsA]; 0.8 [axSpA]). CONCLUSIONS In this integrated safety analysis, consisting of over 22,000 PY of exposure, the long-term safety profile of IXE was found to be consistent with previous, earlier reports, with no new safety signals identified. TRIAL REGISTRATION NCT registration numbers for RCTs included in this integrated analysis can be found in Additional File 1.
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Affiliation(s)
- Atul Deodhar
- Oregon Health & Science University, Portland, OR, USA
| | | | | | - Meghan Feely
- Mount Sinai Hospital, New York, NY, USA
- Eli Lilly and Company, Indianapolis, IN, USA
- Mount Sinai West and Mount Sinai Morningside, New York, NY, USA
| | | | | | - Danting Zhu
- Eli Lilly and Company, Indianapolis, IN, USA
| | - Elsa Inman
- Eli Lilly and Company, Indianapolis, IN, USA
| | - Elsie Grace
- Eli Lilly and Company, Indianapolis, IN, USA
| | | | - Proton Rahman
- Memorial University of Newfoundland, St. John's, NL, Canada
| | - Helena Marzo-Ortega
- NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals Trust, Leeds Institute for Rheumatic and Musculoskeletal Medicine, The University of Leeds, Leeds, UK
| | - Kim A Papp
- Probity Medical Research and Alliance Clinical Trials, Waterloo, ON, Canada
- Division of Dermatology, Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Joseph F Merola
- The University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Alice B Gottlieb
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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5
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Zhong Y, Chen Y, Zhang X, Cai W, Zhao C, Zhao W. No evidence of a causal relationship between ankylosing spondylitis and cardiovascular disease: a two-sample Mendelian randomization study. Front Cardiovasc Med 2023; 10:1243867. [PMID: 37900560 PMCID: PMC10600491 DOI: 10.3389/fcvm.2023.1243867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Accepted: 10/02/2023] [Indexed: 10/31/2023] Open
Abstract
Objective Observational studies have suggested an increased risk of cardiovascular disease in individuals with ankylosing spondylitis. However, these studies are prone to confounding factors and reverse causality. To address these limitations, we conducted a Mendelian randomization study to assess the causal relationship between AS and CVD. Methods The study population comprises 9,069 individuals with ankylosing spondylitis and 509,093 individuals with either of six common cardiovascular diseases and a related indicator. Causal analysis using summary effect estimates and inverse variance weighting were employed as the main methods. Results The CAUSE analysis showed no evidence of a causal relationship between AS and CVD. The odds ratios for total CVD, heart failure, myocardial infarction, valvular heart disease, ischemic heart disease, and venous thromboembolism, Arterial stiffness index, were as follows: OR, 1.01; 95% confidence interval, 0.96-1.05; P = 0.91; OR, 1.03; 95% CI, 0.99-1.08; P = 0.50; OR, 0.94; 95% CI, 0.86-1.03; P = 0.53; OR, 0.99; 95% CI, 0.94-1.04; P = 0.99; OR, 0.98; 95% CI, 0.91-1.04; P = 0.94; OR, 0.98; 95% CI, 0.91-1.04; P = 0.99; β, -0.0019; 95% CI, 0.97-1.01; P = 0.99. The IVW and weighted median methods also yielded consistent results, and no heterogeneity or pleiotropy was found. Likewise, a reverse Mendelian randomization analysis did not uncover a heritable causal relationship between AS and CVD. Conclusion This Mendelian randomization study does not support a causal relationship between AS and CVD. Further research is needed to confirm this association.
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Affiliation(s)
- Yan Zhong
- College of Traditional Chinese Medicine, Changchun University of Chinese Medicine, Changchun, China
| | - YingWen Chen
- College of Traditional Chinese Medicine, Tianjin University of Chinese Medicine, Tianjin, China
| | - XinYue Zhang
- College of Integrated Chinese and Western Medicine, Changchun University of Chinese Medicine, Changchun, China
| | - WenJun Cai
- Department of Orthopedics, The Third Affiliated Clinical Hospital of Changchun University of Chinese Medicine, Changchun, China
| | - ChangWei Zhao
- Department of Orthopedics, Affiliated Hospital of Changchun University of Chinese Medicine, Changchun, China
| | - WenHai Zhao
- Department of Orthopedics, Affiliated Hospital of Changchun University of Chinese Medicine, Changchun, China
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6
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Gezer HH, Acer Kasman S, Duruöz MT. Autonomic dysfunction and cardiovascular risk in psoriatic arthritis. Clin Rheumatol 2023; 42:2635-2649. [PMID: 36542174 DOI: 10.1007/s10067-022-06484-6] [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: 10/07/2022] [Revised: 12/08/2022] [Accepted: 12/11/2022] [Indexed: 12/24/2022]
Abstract
Psoriatic arthritis (PsA) is an inflammatory disease with a high prevalence of cardiovascular (CV) events due to traditional cardiovascular risk factors and increased systemic inflammation. In this review, our objectives were to (i) evaluate the cardiovascular events and risk factors and (ii) investigate the relationship between autonomic dysfunction and CV diseases in PsA. A systematic review of the literature was done on the Medline/PubMed, Scopus, and the Directory of Open Access Journals databases between January 2017 and July 2022. After screening and exclusions, 73 studies were included for the final review. Patients with PsA have a greater risk of CV diseases and increased traditional CV risk factors, including hypertension, diabetes mellitus, obesity, metabolic syndrome, and dyslipidemia. Although autonomic dysfunction is more common in PsA than in the general population, its relationship with increased CV diseases in these patients is still unclear. Limitations in explaining CV risk in these patient groups complicate patient assessment as cardiovascular risk factors are linked to the morbidity and mortality of PsA, and it is essential to improve an optimal screening and management strategy for CV disease. All CV risk scoring systems cannot fully assess the CV risk in these patients, so in addition to scoring systems, carotid ultrasound evaluation may be a part of the CV evaluation.
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Affiliation(s)
- Halise Hande Gezer
- Department of Rheumatology, Ümraniye Training and Research Hospital, İstanbul, Turkey.
| | - Sevtap Acer Kasman
- Department of Rheumatology, Kartal Lütfi Kırdar City Hospital, İstanbul, Turkey
| | - Mehmet Tuncay Duruöz
- Rheumatology Division, PMR Department, Marmara University School of Medicine, Istanbul, Turkey
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7
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Gaffney K, Gullick N, MacKay K, Patel Y, Sengupta R, Sheeran T, Hemmings L, Pamies P. Real-world evidence for secukinumab in UK patients with psoriatic arthritis or radiographic axial spondyloarthritis: interim 2-year analysis from SERENA. Rheumatol Adv Pract 2023; 7:rkad055. [PMID: 37663578 PMCID: PMC10472087 DOI: 10.1093/rap/rkad055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 06/27/2023] [Indexed: 09/05/2023] Open
Abstract
Objectives The aim was to evaluate retention rates for secukinumab in patients with active PsA or radiographic axial spondyloarthritis (r-axSpA) treated in routine UK clinical practice. Methods SERENA (CAIN457A3403) is an ongoing, non-interventional, international study of patients with moderate-to-severe chronic plaque psoriasis, active PsA or active r-axSpA, who had received secukinumab for ≥16 weeks before enrolment. The primary objective of this interim analysis was to assess treatment retention rates in patients with PsA or r-axSpA who were enrolled and followed for ≥2 years at centres in the UK. The safety analysis set includes all patients who received at least one dose of secukinumab. The target population set includes all patients who fulfilled the patient selection criteria. Results The safety set comprised 189 patients (PsA, n = 81; r-axSpA, n = 108), and the target population set comprised 183 patients (PsA, n = 78; r-axSpA, n = 105). In the safety set, 107 patients (45 of 81 with PsA and 62 of 108 with r-axSpA) had previously received a biologic agent. Retention rates were similar between patients with PsA and r-axSpA after 1 year (PsA 91.0%, 95% CI: 84.0, 98.0; r-axSpA 89.2%, 95% CI: 82.7, 95.7) and 2 years (PsA 77.6%, 95% CI: 67.6, 87.7; r-axSpA 76.2%, 95% CI: 67.4, 85.0) of observation. Overall, 17.5% of patients (33 of 189) experienced at least one treatment-related adverse event, and 12.7% of patients (24 of 189) discontinued secukinumab because of adverse events. Conclusion This analysis of real-world data from the UK demonstrates high retention rates for secukinumab over 2 years in patients with PsA or r-axSpA, with a favourable safety profile.
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Affiliation(s)
- Karl Gaffney
- Department of Rheumatology, Norfolk and Norwich University Hospitals, NHS Foundation Trust, Norwich, UK
| | - Nicola Gullick
- University Hospital Coventry & Warwickshire, Warwick Medical School, University of Warwick, Coventry, UK
| | - Kirsten MacKay
- Rheumatology, Torbay and South Devon NHS Foundation Trust, Torquay, UK
| | - Yusuf Patel
- Hull University Teaching Hospitals NHS Trust, Hull, UK
| | - Raj Sengupta
- Royal National Hospital for Rheumatic Diseases, Royal United Hospitals, Bath, UK
| | - Tom Sheeran
- University of Wolverhampton, Royal Wolverhampton NHS Trust, Wolverhampton, UK
| | | | - Paula Pamies
- Immunology, Novartis Pharmaceuticals UK Ltd, London, UK
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8
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Almodóvar R, Cañete JD, Collantes E, de Miguel E, Fernández Carballido C, Gratacós J, Juanola X, Pinto JA, Queiro R, Zarco P. Strategies and resources to optimise the management of Psoriatic Arthritis patients: The CREA Project. REUMATOLOGIA CLINICA 2023; 19:159-167. [PMID: 36068162 DOI: 10.1016/j.reumae.2022.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 01/27/2022] [Indexed: 11/24/2022]
Abstract
BACKGROUND AND AIM Psoriatic arthritis (PsA) is a chronic immune-mediated inflammatory disease that affects the musculoskeletal system and skin, and manifests heterogeneously, with a variable course. In current clinical practice, variability and limitations in its follow-up have been observed. The aim of the CREA project was to agree on strategies to improve the initial assessment and follow-up of patients with PsA in Spain. MATERIALS AND METHODS A survey was conducted among a representative sample of expert rheumatologists in Spain, containing 33 questions on current clinical practice, available resources, and current limitations in the follow-up of patients with PsA. The results were discussed in regional meetings and 105 strategies were proposed and finally evaluated by 85 experts in a Delphi consensus. RESULTS The most important limitations in the follow-up of PsA were lack of consultation time, lack of nursing staff, and delays in performing imaging tests. A total of 108 strategies were proposed related to the assessment of quality of life and disease-impact indices; comorbidities and extra-articular manifestations; laboratory tests; imaging tests; physical examination and metrology; and activity and function indices. Of the total, 53 were considered highly advisable, with no regional differences in consensus values. DISCUSSION AND CONCLUSIONS The proposals offered in the current study are applicable to the entire country, respond to the unmet needs detected in the initial survey, form a minimum action framework, and ensure optimal follow-up of patients with PsA.
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Affiliation(s)
- Raquel Almodóvar
- Hospital Universitario Fundación Alcorcón, Alcorcón, Madrid, Spain.
| | | | - Eduardo Collantes
- Hospital Universitario Reina Sofía, Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Universidad de Córdoba, Córdoba, Spain
| | | | | | - Jordi Gratacós
- Hospital Universitario Parc Taulí, Sabadell, Spain; Grupo investigación A8G2 del I3PT, Departamento de Medicina de la UAB, Barcelona, Spain
| | | | - José A Pinto
- Complejo Hospitalario Universitario, de A Coruña, INIBIC, A Coruña, Spain
| | - Rubén Queiro
- Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain
| | - Pedro Zarco
- Hospital Universitario Fundación Alcorcón, Alcorcón, Madrid, Spain
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9
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Dubinina TV, Korotayeva TV, Lila AM. Features of medical and social expertise in ankylosing spondylitis and psoriatic arthritis. MODERN RHEUMATOLOGY JOURNAL 2023. [DOI: 10.14412/1996-7012-2023-1-16-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
Abstract
Ankylosing spondylitis (AS) and psoriatic arthritis (PsA) are the two most common diseases from the group of spondyloarthritis (SpA), which are often accompanied by permanent disability. Maintaining an acceptable quality of life, preventing the development and progression of structural changes in the musculoskeletal system, maintaining/normalizing functional and social activity are the main goals of their therapy. Over the past decades, the introduction of biological disease modifying antirheumatic drugs has made it possible to achieve significant success in the sustainable control of AS and PsA activity. However, the high cost of treatment significantly limits access to innovative drugs. Specifics of drug supply call for prescription of these drugs in the presence of the status of "disabled", which is assigned on the basis of the results of the medical and social examination (MSE). Execution of the necessary medical documentation for the implementation of the MSE is one of the functions of a rheumatologist.The lecture analyzes the main regulatory legal acts of the Russian Federation regulating the issues of establishing disability and discusses peculiarities of medical reports processing when referring patients with AS and PsA to the MSE.
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Affiliation(s)
| | | | - A. M. Lila
- V.A. Nasonova Research Institute of Rheumatology;
Department of Rheumatology Russian Medical Academy of Continuing Professional Education
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10
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Feng KM, Chien WC, Chen YH, Sun CA, Chung CH, Chen JT, Chen CL. Increased Risk of Acute Coronary Syndrome in Ankylosing Spondylitis Patients With Uveitis: A Population-Based Cohort Study. Front Immunol 2022; 13:890543. [PMID: 35757729 PMCID: PMC9226308 DOI: 10.3389/fimmu.2022.890543] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Accepted: 05/18/2022] [Indexed: 11/13/2022] Open
Abstract
Background Uveitis, a sight-threatening ocular inflammatory state, is associated with autoimmune diseases and systemic inflammation. This prolonged systemic inflammation may cause plaque formation in coronary arteries, subsequently resulting in acute coronary syndrome (ACS). Methods This retrospective, population-based study (15-year period) used the Longitudinal Health Insurance Database based on the National Health Insurance Research Database in Taiwan. Chi-square and Student's t-tests were used to examine differences between the study and comparison cohorts for categorical and continuous variables, respectively. Fine and Gray's competing risk model was used to determine the hazard ratio of the risk of ACS. Furthermore, the cumulative risk of ACS was determined using Kaplan-Meier analysis. Results A total of 1,111 patients with AS and uveitis were enrolled in this study cohort, and 4,444 patients with AS without uveitis were enrolled in the comparison cohort. After adjustment for age, sex, and comorbidities, patients with AS and uveitis demonstrated an increased risk of ACS compared to those without uveitis (adjusted hazard ratio: 1.675, p<0.001). In addition, Kaplan-Meier analysis revealed that patients with AS and uveitis had a significantly higher risk of ACS than those without uveitis (p<0.001). Age, diabetes mellitus, hypertension, hyperlipidemia, chronic obstructive pulmonary disease, asthma, and systemic steroids were significant risk factors for ACS. Both anterior uveitis and posterior segment involvement were associated with an increased risk of ACS in patients with AS. All-cause mortality was higher in the uveitis group (9.81%) than in the non-uveitis group (8.10%) (p=0.015). Conclusion Our analysis revealed that uveitis could potentially be a predictor of ACS in patients with AS. However, further prospective controlled studies are required to assess the association between uveitis and ACS in patients with AS.
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Affiliation(s)
- Kathy Ming Feng
- Department of Ophthalmology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Wu-Chien Chien
- Department of Medical Research, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.,School of Public Health, National Defense Medical Center, Taipei, Taiwan.,Taiwanese Injury Prevention and Safety Promotion Association, Taipei, Taiwan.,Graduate Institute of Life Sciences, National Defense Medical Center, Taipei, Taiwan
| | - Yi-Hao Chen
- Department of Ophthalmology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Chien-An Sun
- Department of Public Health, College of Medicine, Fu-Jen Catholic University, New Taipei City, Taiwan.,Big Data Research Center, College of Medicine, Fu-Jen Catholic University, New Taipei City, Taiwan
| | - Chi-Hsiang Chung
- Department of Medical Research, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.,School of Public Health, National Defense Medical Center, Taipei, Taiwan.,Taiwanese Injury Prevention and Safety Promotion Association, Taipei, Taiwan
| | - Jiann-Torng Chen
- Department of Ophthalmology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Ching-Long Chen
- Department of Ophthalmology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
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11
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Validity and psychometric characteristics of the self-administered comorbidity questionnaire in patients with psoriatic arthritis. Rheumatol Int 2022; 42:2061-2067. [PMID: 35648189 DOI: 10.1007/s00296-022-05150-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 05/12/2022] [Indexed: 10/18/2022]
Abstract
The study aimed to translate and cross-culturally adapt the self-comorbidity questionnaire (SCQ) into Turkish and investigate the validity and reliability of SCQ and its modified version (mSCQ) in psoriatic arthritis (PsA). Psoriatic arthritis quality of life (PsAQoL) and short form 36 (SF-36) were used to assess the quality of life. The physical disability was evaluated with the health assessment questionnaire (HAQ). The reliability of the SCQ scale was assessed by test-retest reliability. For construct validity, the correlations of SCQ with the HAQ, SF-36, PsAQoL, age, body mass index (BMI), disease duration, disease activity in psa (DAPSA), Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Psoriasis Area and Severity Index (PASI), dactylitis and enthesitis were evaluated. The mSCQ was also used by removing the items related to rheumatic conditions. For the test-retest reliability of the Turkish version of SCQ, the intraclass correlation coefficient was 0.965, p < 0.001. The SCQ and mSCQ had significant correlations with HAQ, PsAQoL, some subscales of SF-36, and age (p < 0.05), but not with disease duration, BASDAI, PASI and dactylitis (p > 0.05). Although SCQ had a low correlation with DAPSA (rho = 0.262, p = 0.031), mSCQ was not correlated with DAPSA (p > 0.05). mSCQ was significantly correlated with BMI (rho = 0.233, p = 0.016), but SCQ was not (p > 0.05). The Turkish version of SCQ had adequate reliability and validity, and the mSCQ improved the validity of the scale in patients with PsA.
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12
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Spagnuolo R, Iaquinta FS, Mauro D, Pantano I, Dastoli S, Naty S, Cosco C, Mancina RM, Iacono D, Gaggiano E, Ruggiero A, Nisticò SP, Ciccia F, Grembiale RD, Patrizia D. Satisfaction in Social Roles and Physical Function in Immune-mediated Inflammatory Diseases: A Cross-Sectional Study. Rev Recent Clin Trials 2022; 17:RRCT-EPUB-124098. [PMID: 35642115 DOI: 10.2174/1574887117666220531162104] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2022] [Revised: 03/18/2022] [Accepted: 04/05/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Although mood disorders have been well characterized in Immune-mediated inflammatory diseases, physical function and satisfaction in social roles have not yet been defined as independent domains. OBJECTIVE The study aims to assess satisfaction in social roles and physical function alterations in an Immune-mediated inflammatory diseases population and identify associated characteristics. METHODS Physical function and social roles satisfaction were evaluated through the Patient-Reported Outcomes Measurement System. Besides comparisons between groups, univariate and multivariable logistic regression were performed to identify independent predictors. RESULTS Two hundred sixty-five Immune-mediated Inflammatory Diseases patients and 206 controls were recruited. Compared with controls, Inflammatory Bowel Diseases patients had impaired physical function (p<0.001), while Inflammatory Arthritis patients reported impairment in both domains (p<0.001, each). In the univariate logistic regression, gender, high school educational level, physical activity and occupation were positively associated with physical function and social role satisfaction (p<0.001; p=0.001; p<0.001; p=0.001 and p<0.001; p=0.012; p=0.008; p=0.004, respectively). Active disease and steroids were inversely associated with physical function and social roles satisfaction (p=0.033; p=0.022 and p=0.002; p=0.038, respectively). Further associations were found between age and physical function (p=0.002); biological treatment and ESR with social roles satisfaction (p<0.001; p=0.043; respectively). In the multivariable regression, gender remained associated with physical function (p<0.001) and social roles satisfaction (p=0.003). Negatively associated factors were biological treatment for satisfaction in social roles (p<0.001) and steroids for physical function (p=0.021) and social roles satisfaction (p=0.018). CONCLUSION Immune-mediated Inflammatory diseases determine alterations in physical function and social life satisfaction. Gender and treatment are independent associated factors. Patient-Reported Outcomes should be considered in clinical management to define patients' real needs.
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Affiliation(s)
- Rocco Spagnuolo
- Department of Clinical and Experimental Medicine, Magna Graecia University of Catanzaro, Calabria, Catanzaro, Italy
| | | | - Daniele Mauro
- Dipartimento di Medicina di Precisione, Università della Campania L. Vanvitelli, Naples, Italy
| | - Ilenia Pantano
- Dipartimento di Medicina di Precisione, Università della Campania L. Vanvitelli, Naples, Italy
| | - Stefano Dastoli
- Department of Health Sciences Magna Graecia University of Catanzaro, Calabria, Catanzaro, Italy
| | - Saverio Naty
- Department of Health Sciences Magna Graecia University of Catanzaro, Calabria, Catanzaro, Italy
| | - Cristina Cosco
- Department of Clinical and Experimental Medicine, Magna Graecia University of Catanzaro, Calabria, Catanzaro, Italy
| | - Rosellina Margherita Mancina
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, Wallenberg Laboratory, University of Gothenburg, Gothenburg, Sweden
| | - Daniela Iacono
- Dipartimento di Medicina di Precisione, Università della Campania L. Vanvitelli, Naples, Italy
| | - Emanuela Gaggiano
- Dipartimento di Medicina di Precisione, Università della Campania L. Vanvitelli, Naples, Italy
| | - Annarita Ruggiero
- Dipartimento di Medicina di Precisione, Università della Campania L. Vanvitelli, Naples, Italy
| | - Steven Paul Nisticò
- Department of Health Sciences Magna Graecia University of Catanzaro, Calabria, Catanzaro
| | - Francesco Ciccia
- Department of Health Sciences Magna Graecia University of Catanzaro, Calabria, Catanzaro
| | - Rosa Daniela Grembiale
- Department of Health Sciences Magna Graecia University of Catanzaro, Calabria, Catanzaro
| | - Doldo Patrizia
- Department of Clinical and Experimental Medicine, Magna Graecia University of Catanzaro, Calabria, Catanzaro, Italy
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13
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Deodhar AA, Combe B, Accioly AP, Bolce R, Zhu D, Gellett AM, Sprabery AT, Burmester GRR. Safety of ixekizumab in patients with psoriatic arthritis: data from four clinical trials with over 2000 patient-years of exposure. Ann Rheum Dis 2022; 81:944-950. [PMID: 35393269 PMCID: PMC9209663 DOI: 10.1136/annrheumdis-2021-222027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 03/15/2022] [Indexed: 11/12/2022]
Abstract
Objectives Ixekizumab, a high-affinity monoclonal antibody that selectively targets interleukin 17A (IL-17A), has shown significant efficacy in the treatment of psoriatic arthritis (PsA) and sustained long-term clinical response without unexpected new safety outcome for an IL-17A inhibitor. Here, we report the updated safety profile of ixekizumab up to 3 years in patients with PsA. Methods This is an integrated safety analysis from four clinical trials in patients with PsA who received at least one dose of ixekizumab. Treatment-emergent adverse events (TEAEs) and selected adverse events (AEs) exposure-adjusted incidence rates (EAIRs) per 100 patient-years up to 3 years of exposure are reported. Results A total of 1401 patients with a cumulative ixekizumab exposure of 2247.7 patient-years were included in this analysis. The EAIR of patients with ≥1 TEAE was 50.3 per 100 patient-years and most TEAEs were mild to moderate in severity. Serious AEs were reported by 134 patients (EAIR=6.0). The most reported TEAEs were nasopharyngitis (EAIR=9.0) and upper respiratory tract infection (EAIR=8.3). Infections in general and injection site reactions were the most common TEAEs; the incidence rates of serious cases were low (EAIR ≤1.2). The EAIRs of malignancies (EAIR=0.7), inflammatory bowel disease (EAIR=0.1) including ulcerative colitis and Crohn’s disease, depression (EAIR=1.6), and major adverse cerebro-cardiovascular events (EAIR=0.5) were low. As assessed, based on year of exposure, incidence rates were decreasing or constant over time. Conclusions In this analysis, the overall safety profile and tolerability of ixekizumab are consistent with the known safety profile in patients with PsA. No new or unexpected safety events were detected. Trial registration number NCT01695239, NCT02349295, NCT02584855, NCT03151551.
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Affiliation(s)
- Atul A Deodhar
- Division of Arthritis/Rheumatic Diseases (OPO9), Oregon Health and Science University, Portland, Oregon, USA
| | | | | | - Rebecca Bolce
- Medical Affairs, Eli Lilly and Company, Cincinnati, Ohio, USA
| | - Danting Zhu
- Eli Lilly and Company, Indianapolis, Indiana, USA
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14
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Juanola X, Ramos MJM, Belzunegui JM, Fernández-Carballido C, Gratacós J. Treatment Failure in Axial Spondyloarthritis: Insights for a Standardized Definition. Adv Ther 2022; 39:1490-1501. [PMID: 35201604 PMCID: PMC8990961 DOI: 10.1007/s12325-022-02064-x] [Citation(s) in RCA: 8] [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: 12/07/2021] [Accepted: 01/26/2022] [Indexed: 12/17/2022]
Abstract
Axial spondyloarthritis is a chronic inflammatory rheumatic disease that affects the axial skeleton and causes severe pain and disability. It may be also associated with extra-articular manifestations. Early diagnosis and appropriate treatment can reduce the severity of the disease and the risk of progression. The biological disease-modifying antirheumatic drugs (bDMARDs) tumor necrosis factor alpha (TNFα) inhibitors (TNFi) and the anti-interleukin (IL)-17A antibodies secukinumab and ixekizumab are effective agents to reduce disease activity and minimize the inflammation that damages the joints. New alternatives such as Janus kinase (JAK) inhibitors are also available. Unfortunately, response rates to bDMARDs are far from optimal, and many patients experience so-called treatment failure. The definition of treatment failure definition is often vague and may depend on the rigorousness of the therapeutic goal, the inclusion or not of peripheral symptoms/extra-articular manifestations, or patients' overall health. After an exhaustive bibliographic review, we propose a definition based on loss of the following status: low disease activity assessed by Ankylosing Spondylitis Disease Activity Score (ASDAS)-CRP, absence of extra-articular manifestations, and low disease impact on the patients' general health. Apart from discontinuing the therapy because of safety or intolerance reasons, two types of treatment failure can be differentiated depending on when it occurs: primary failure (no response within 6 months after treatment initiation, or lack of efficacy) and secondary failure (response within 6 months but lost thereafter, or loss of efficacy over time). Physicians should carefully consider the moment and the reason for the treatment failure to decide the next therapeutic step. In the case of primary failure on a first TNFi, it seems reasonable to switch to another class of drugs, i.e., an anti-IL-17 agent, as phase III trials showed that the response to IL-17 blockade was higher than to placebo in patients previously exposed to TNFi. When secondary failure occurs, and loss of efficacy is suspected to be caused by antidrug antibodies (ADAs), it is advisable to analyze serum TNFi and ADAs concentrations, if possible; in the presence of ADAs and low TNFi levels, changing the TNFi is rational as it may restore the TNFα blocking capacity. If ADAs are absent/low with adequate drug therapeutic levels, switching to another target might be the best strategy.
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Affiliation(s)
- Xavier Juanola
- Rheumatology Service, University Hospital Bellvitge, IDIBELL, Barcelona, Spain
| | | | | | | | - Jordi Gratacós
- Rheumatology Service, Medicine Department UAB, I3PT, University Hospital Parc Taulí Sabadell, Barcelona, Spain.
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15
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Castañeda S, González C, Villaverde V, Lajas Petisco C, Castro MC, Jirout F, Obaya JC, Hermosa JC, Suárez C, García S, Rodero M, León L, López Esteban A, Gobbo M, Alcaide L, Torre-Alonso JC. Development and feasibility of 4 checklists for the evaluation of comorbidity in patients with rheumatoid arthritis, axial spondyloarthritis and psoriatic arthritis: GECOAI Project. REUMATOLOGIA CLINICA 2022; 18:114-123. [PMID: 35153034 DOI: 10.1016/j.reumae.2020.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Accepted: 09/03/2020] [Indexed: 06/14/2023]
Abstract
OBJECTIVE To develop and assess the feasibility in daily practice of four comorbidity checklists, for common use in rheumatoid arthritis (RA), axial spondyloarthritis (axSpA) and psoriatic arthritis (PsA). METHODS A multidisciplinary panel of experts on comorbidity was established. Data from the GECOAR, GECOAX and GECOAP projects were analysed and a narrative literature review in Medline on RA, axSpA and PsA comorbidity was performed in order to select the most relevant and common comorbidities across the three diseases. With these results and those obtained from a focus group of patients, in a nominal group meeting, the experts generated preliminary checklists. These were afterwards modified by an external evaluation by two associations, a patients' association and an association of health professionals related to rheumatology. As a result, the final checklists were generated. A cross-sectional study was conducted to test the feasibility of three of the checklists in daily practice, in which eight health professionals evaluated the checklists in five patients with RA, five with axSpA and five with SpA. RESULTS Four comorbidity checklists were designed, three for health professionals (one to assess current comorbidity, one on prevention/health promotion and one with the referral criteria to other health professionals), and another for patients. The feasibility study showed them to be simple, clear, and useful for use in routine clinical practice. CONCLUSIONS The use of specific and common checklists for patients with RA, axSpA and PsA is feasible and might contribute favorably to their prognosis as well as in daily practice.
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Affiliation(s)
- Santos Castañeda
- Servicio de Reumatología, Hospital Universitario de la Princesa, IIS-Princesa, Cátedra UAM-ROCHE, EPID-Futuro, Universidad Autónoma de Madrid (UAM), Madrid, Spain.
| | - Carlos González
- Servicio de Reumatología, Hospital Universitario Gregorio Marañón, Madrid, Spain
| | | | - Cristina Lajas Petisco
- Servicio de Reumatología, IDISSC, Hospital Universitario Clínico de San Carlos, Madrid, Spain
| | - María Carmen Castro
- Servicio de Reumatología, Hospital Universitario Reina Sofía, Córdoba, Spain
| | - Fernando Jirout
- Servicio de Reumatología, Hospital Monte Naranco, Oviedo, Spain
| | | | | | - Carmen Suárez
- Servicio de Medicina Interna, Hospital Universitario de La Princesa, IIS-Princesa, Madrid, Spain
| | - Silvia García
- Servicio de Reumatología, Hospital Moises Broggi, Sant Joan Despí, Barcelona, Spain
| | - María Rodero
- Servicio de Reumatología, IDISSC, Hospital Universitario Clínico de San Carlos, Madrid, Spain
| | - Leticia León
- Servicio de Reumatología, IDISSC, Hospital Universitario Clínico de San Carlos, Madrid, Spain
| | - Amparo López Esteban
- Servicio de Reumatología, Hospital Universitario Gregorio Marañón, Madrid, Spain
| | - Milena Gobbo
- Positivamente Centro de Psicología, Madrid, Spain
| | - Laly Alcaide
- Coordinadora Nacional de Artritis, Madrid, Spain
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16
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Puche-Larrubia MÁ, Ladehesa-Pineda L, Gómez-García I, Font-Ugalde P, Escudero-Contreras A, Collantes-Estévez E, López-Medina C. Impact of the number of comorbidities on the outcome measures and on the retention rate of the first anti-TNF in patients with Ankylosing Spondylitis. Two-year follow-up in REGISPONSER-AS. Semin Arthritis Rheum 2021; 52:151938. [PMID: 35027249 DOI: 10.1016/j.semarthrit.2021.12.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 11/07/2021] [Accepted: 12/06/2021] [Indexed: 10/19/2022]
Abstract
OBJECTIVES To evaluate the impact of the number of comorbidities on the outcome measures after two years of follow-up in patients with Ankylosing Spondylitis (AS) and to determine whether the number of comorbidities influences the retention rate of the first anti-TNF. METHODS This was an observational and prospective study conducted during 2 years of follow-up in the REGISPONSER-AS registry. The patients were divided into three groups according to the number of comorbidities at baseline (0, 1 or ≥2). Linear regression models adjusted for disease duration, age, sex and smoking were constructed to evaluate the association between the number of comorbidities and the Patient Reported Outcomes (PRO) scores. The impact of the number of comorbidities on PROs over two years of follow-up was evaluated using mixed models for repeated measures adjusted for disease duration, age, sex and smoking. Finally, the retention rate of the first anti-TNF antibody across the three groups was evaluated using a log-rank test. RESULTS Patients with two or more comorbidities showed higher scores at baseline and during the two years of follow-up for the Global VAS, BASDAI, ASDAS, and BASFI and worse scores for the physical component of the SF12. A higher probability of discontinuation of the first anti-TNF was found in patients with 2 or more comorbidities compared with the patients in the other groups (38.2% vs. 26.6% vs. 25.4% for ≥2 comorbidities, 0 and 1 comorbidity, respectively), although these differences were not significant (log-rank test: p-value = 0.180). CONCLUSION In patients with AS, the presence of 2 or more comorbidities was associated with worse scores on the outcome measures test after two years of follow-up and a greater tendency of discontinuation for the first anti-TNF.
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Affiliation(s)
- M Ángeles Puche-Larrubia
- Department of Rheumatology, Reina Sofia University Hospital/Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Avda. Menendez Pidal, s/n, Cordoba 14004, Spain; University of Cordoba, Cordoba, Spain
| | - Lourdes Ladehesa-Pineda
- Department of Rheumatology, Reina Sofia University Hospital/Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Avda. Menendez Pidal, s/n, Cordoba 14004, Spain; University of Cordoba, Cordoba, Spain
| | - Ignacio Gómez-García
- Department of Rheumatology, Reina Sofia University Hospital/Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Avda. Menendez Pidal, s/n, Cordoba 14004, Spain; University of Cordoba, Cordoba, Spain
| | | | - Alejandro Escudero-Contreras
- Department of Rheumatology, Reina Sofia University Hospital/Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Avda. Menendez Pidal, s/n, Cordoba 14004, Spain; University of Cordoba, Cordoba, Spain
| | - Eduardo Collantes-Estévez
- Department of Rheumatology, Reina Sofia University Hospital/Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Avda. Menendez Pidal, s/n, Cordoba 14004, Spain; University of Cordoba, Cordoba, Spain
| | - Clementina López-Medina
- Department of Rheumatology, Reina Sofia University Hospital/Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Avda. Menendez Pidal, s/n, Cordoba 14004, Spain; University of Cordoba, Cordoba, Spain; Rheumatology Department, Cochin Hospital, Paris, France.
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17
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García EI, Martin-Delgado J, Queiro R, Pérez Venegas JJ, Gratacos J, Sanz J, Torrés A, Mira JJ. Quality certification standard proposal "SpACE" for axial spondyloarthritis treatment units. ACTA ACUST UNITED AC 2021; 18:299-303. [PMID: 34736873 DOI: 10.1016/j.reumae.2021.04.005] [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: 11/09/2020] [Accepted: 04/05/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND AND OBJECTIVE Axial spondyloarthritis is an immune-mediated disease with a high cost, diagnostic delay and associated complications that makes it a particularly important condition. This work aims to establish a certification standard (SpACE Project) for monographic consultations in its diagnosis and treatment. MATERIALS AND METHODS Qualitative study of consensus, through the technique of the nominal group. First, a pragmatic review of the literature was carried out. Second, professionals involved throughout the care process (rheumatology, ophthalmology, gastroenterology, traumatology, family medicine, physical therapy, and nursing) were included. RESULTS Thirty-seven possible standards were extracted from the pragmatic review of the literature. During the consensus phase only those standards with high feasibility and importance in the care process were prioritized. Finally, the group of 26 experts agreed on the inclusion of 14 standards. DISCUSSION AND CONCLUSIONS SpACE is a consensus-based certification standard that seeks to improve health outcomes and more integrated care.
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Affiliation(s)
| | - Jimmy Martin-Delgado
- Grupo de Investigación Atenea, Fundación para el Fomento de la Investigación Sanitaria y Biomédica (FISABIO), Sant Joan d'Alacant, Alicante, Spain.
| | - Ruben Queiro
- Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain
| | | | - Jordi Gratacos
- Consorci Corporació Sanitària Parc Taulí, Sabadell, Barcelona, Spain
| | - Jesús Sanz
- Hospital Puerta de Hierro, Majadahonda, Madrid, Spain
| | | | - José Joaquín Mira
- Departamento de Salud Alicante-Sant Joan d'Alacant, Sant Joan d'Alacant, Alicante, Spain; Universidad Miguel Hernández, Elche, Alicante, Spain; Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Alicante, Spain
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18
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Madsen CMT, Christensen JR, Bremander A, Primdahl J. Perceived challenges at work and need for professional support among people with inflammatory arthritis - a qualitative interview study. Scand J Occup Ther 2021:1-10. [PMID: 34644224 DOI: 10.1080/11038128.2021.1989483] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND People with inflammatory arthritis (IA) often experience low work ability, and up to 38% lose their jobs during the initial years after the diagnosis of IA. AIM We explore the perceived challenges at work and identify the need for professional support among Danish people with IA. MATERIALS/METHODS Individual explorative interviews based on a hermeneutic approach. We used Graneheim and Lundman's qualitative content analysis. RESULTS Eleven women and four men with IA (aged 36-68 years) who worked full or part time, or were on short-term sick leave, participated. The analysis revealed one main theme, Balancing work as part of everyday life, and four sub-themes: 1) Working despite challenges, 2) Prioritising energy for work, 3) Fatigue leading to lack of control, and 4) Need for flexibility and recognition. CONCLUSIONS People with IA prioritise staying at work despite experiencing challenges with fatigue and balancing their work and energy in everyday life. They need recognition, support and flexibility at work to be able to continue in their jobs. SIGNIFICANCE The study highlights the need to be aware of occupational balance and, thus, to include other aspects in life apart from just work. It points at occupational therapists as relevant partners in vocational rehabilitation.
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Affiliation(s)
- Christina Merete Tvede Madsen
- Danish Hospital for Rheumatic Diseases, University Hospital of Southern Denmark, Sønderborg, Denmark.,Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Jeanette Reffstrup Christensen
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark.,Research unit of User Perspectives and Community-based Interventions, Department of Public Health, University of Southern Denmark mark, Odense, Denmark
| | - Ann Bremander
- Danish Hospital for Rheumatic Diseases, University Hospital of Southern Denmark, Sønderborg, Denmark.,Department of Regional Health Research, University of Southern Denmark, Odense, Denmark.,Section of Rheumatology, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
| | - 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.,Hospital of Southern Jutland, University Hospital of Southern Denmark, Aabenraa, Denmark
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19
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Braun J, Baraliakos X, Kiltz U. Treat-to-target in axial spondyloarthritis - what about physical function and activity? Nat Rev Rheumatol 2021; 17:565-576. [PMID: 34312518 DOI: 10.1038/s41584-021-00656-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/25/2021] [Indexed: 02/07/2023]
Abstract
In patients with axial spondyloarthritis (axSpA), pain, functional and structural impairments, reduced mobility and potential deformity of the axial skeleton are the most prominent health concerns. Limitations in physical function and spinal mobility are caused by both inflammation and structural damage, and therefore restrictions to physical function must be monitored throughout a patient's life. Consequently, the assessment of physical function is recommended as a key domain in the Assessment of Spondyloarthritis International Society-OMERACT Core Outcome Set. However, in comparison with disease activity, physical function seems to be a relatively neglected target of intervention in patients with axSpA, even though physical function is a major contributor to costs and disability in this disease. This Review aims to reacquaint rheumatologists with the targets for physical function, physical activity and performance by giving guidance on determinants of physical function and how physical function can be examined in patients with axSpA.
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Affiliation(s)
- Jürgen Braun
- Rheumazentrum Ruhrgebiet, Herne, Ruhr Universität Bochum, Bochum, Germany.
| | - Xenofon Baraliakos
- Rheumazentrum Ruhrgebiet, Herne, Ruhr Universität Bochum, Bochum, Germany
| | - Uta Kiltz
- Rheumazentrum Ruhrgebiet, Herne, Ruhr Universität Bochum, Bochum, Germany
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20
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Kaplan DL, Ung BL, Pelletier C, Udeze C, Khilfeh I, Tian M. Switch rates and total cost associated with apremilast and biologics in biologic-naive patients with psoriatic arthritis. J Comp Eff Res 2021; 10:989-998. [PMID: 34187202 DOI: 10.2217/cer-2020-0285] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aim: Real-world treatment data for psoriatic arthritis are limited. We evaluated switch rates, adherence, and costs for patients initiating apremilast versus tumor necrosis factor inhibitor (TNFi) and interleukin inhibitor (ILi) among biologic-naive psoriatic arthritis patients. Materials & methods: This retrospective analysis used IBM MarketScan claims data to assess treatment switches, adherence and costs. Results: Twelve-month switch rates were significantly lower for apremilast versus TNFi (15.5% vs 26.6%; p < 0.0001) and similar to ILi (15.5% vs 14.0%; p = 0.71). Apremilast initiators had lower total costs versus TNFi and ILi (US$39,854 vs US$57,243 and US$65,687; p < 0.05) and adherence was slightly lower versus TNFi and higher versus ILi. Conclusion: Biologic-naive apremilast initiators had lower switch rates versus TNFi initiators and lower total costs versus TNFi or ILi initiators.
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Affiliation(s)
- David L Kaplan
- Adult & Pediatric Dermatology, 4601 W 109th Street, Building Number 116, Overland Park, KS 66211, USA
| | - Brian L Ung
- US HEOR, Bristol-Myers Squibb, 86 Morris Avenue, Summit, NJ 07901, USA
| | - Corey Pelletier
- US HEOR, Bristol-Myers Squibb, 86 Morris Avenue, Summit, NJ 07901, USA
| | - Chuka Udeze
- US HEOR, Celgene Corporation, 86 Morris Avenue, Summit, NJ 07901, USA
| | - Ibrahim Khilfeh
- Global Health Economics, Amgen Inc., 1 Amgen Center Drive, Thousand Oaks, CA 91320, USA
| | - Marc Tian
- US HEOR, Bristol-Myers Squibb, 86 Morris Avenue, Summit, NJ 07901, USA
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21
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García EI, Martin-Delgado J, Queiro R, Pérez Venegas JJ, Gratacos J, Sanz J, Torrés A, Mira JJ. Quality Certification Standard Proposal "SpACE" for Axial Spondyloarthritis Treatment Units. REUMATOLOGIA CLINICA 2021; 18:S1699-258X(21)00126-1. [PMID: 34148827 DOI: 10.1016/j.reuma.2021.04.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Revised: 03/15/2021] [Accepted: 04/05/2021] [Indexed: 01/15/2023]
Abstract
BACKGROUND AND OBJECTIVE Axial spondyloarthritis is an immune-mediated disease with a high cost, diagnostic delay and associated complications that makes it a particularly important condition. This work aims to establish a certification standard (SpACE Project) for monographic consultations in its diagnosis and treatment. MATERIALS AND METHODS Qualitative study of consensus, through the technique of the nominal group. First, a pragmatic review of the literature was carried out. Second, professionals involved throughout the care process (rheumatology, ophthalmology, gastroenterology, traumatology, family medicine, physical therapy, and nursing) were included. RESULTS Thirty-seven possible standards were extracted from the pragmatic review of the literature. During the consensus phase only those standards with high feasibility and importance in the care process were prioritized. Finally, the group of 26 experts agreed on the inclusion of 14 standards. DISCUSSION AND CONCLUSIONS SpaCE is a consensus-based certification standard that seeks to improve health outcomes and more integrated care.
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Affiliation(s)
| | - Jimmy Martin-Delgado
- Grupo de Investigación Atenea, Fundación para el Fomento de la Investigación Sanitaria y Biomédica (FISABIO), Sant Joan d'Alacant, Alicante, España.
| | - Ruben Queiro
- Hospital Universitario Central de Asturias, Oviedo, Asturias, España
| | | | - Jordi Gratacos
- Consorci Corporació Sanitària Parc Taulí, Sabadell, Barcelona, España
| | - Jesús Sanz
- Hospital Puerta de Hierro, Majadahonda, Madrid, España
| | - Antonio Torrés
- Sociedad Española de Calidad Asistencial, Oviedo, España
| | - José Joaquín Mira
- Departamento de Salud Alicante-Sant Joan d'Alacant, Sant Joan d'Alacant, Alicante, España; Universidad Miguel Hernández, Elche, Alicante, España; Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Alicante, España
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22
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Vivekanantham A, McGagh D, Coates LC. Current treatments and recommendations for Psoriatic Arthritis. Best Pract Res Clin Rheumatol 2021; 35:101680. [DOI: 10.1016/j.berh.2021.101680] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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23
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Mistegård J, Gudbjornsson B, Lindqvist U, Laasonen L, Ejstrup L, Ståhle M, Iversen L. Comorbidities in a Cohort of 66 Patients With Psoriatic Arthritis Mutilans-Results From the Nordic PAM Study. Front Med (Lausanne) 2021; 8:629741. [PMID: 33614686 PMCID: PMC7889950 DOI: 10.3389/fmed.2021.629741] [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: 11/17/2020] [Accepted: 01/12/2021] [Indexed: 01/05/2023] Open
Abstract
Objective: Psoriatic arthritis mutilans (PAM) is the most severe phenotype of psoriatic arthritis due to excessive bone erosion causing joint destruction and decreased functional capacity. The aim of this study was to investigate the prevalence of comorbidities among patients with PAM and the association between comorbidities and joint involvement. Methods: A total of 66 patients aged ≥18 years from the Nordic countries with past or present psoriasis along with at least one mutilated joint were included in the present study. Results: The median number of comorbid conditions per patient was 1 [interquartile range (IQR) 0-2] and 16.7% reported three or more comorbidities. The most frequent comorbidity was hypertension (36.4%). The median number of mutilated joints per patient was 3 (IQR 1-8.3; range 1-38). Conclusion: Two thirds of the patients with PAM reported comorbid conditions and the most frequent was hypertension which affected more than a third of the patients. However, this study was unable to detect any association between comorbidities and the severity of PAM.
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Affiliation(s)
| | - Bjorn Gudbjornsson
- Faculty of Medicine, Centre for Rheumatology Research, Landspitali University Hospital, University of Iceland, Reykjavik, Iceland
| | - Ulla Lindqvist
- Department of Medical Sciences, Rheumatology, Uppsala University, Uppsala, Sweden
| | - Leena Laasonen
- Helsinki Medical Imaging Center, Helsinki University Central Hospital, Helsinki, Finland
| | - Leif Ejstrup
- Department of Rheumatology, Odense University Hospital, Odense, Denmark
| | - Mona Ståhle
- Dermatology Division, Department of Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Lars Iversen
- Department of Dermatology, Aarhus University Hospital, Aarhus, Denmark
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24
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Gupta S, Syrimi Z, Hughes DM, Zhao SS. Comorbidities in psoriatic arthritis: a systematic review and meta-analysis. Rheumatol Int 2021; 41:275-284. [PMID: 33423070 PMCID: PMC7835184 DOI: 10.1007/s00296-020-04775-2] [Citation(s) in RCA: 57] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Accepted: 12/21/2020] [Indexed: 12/19/2022]
Abstract
The aims of this systematic review and meta-analysis were to: (1) describe the prevalence of commonly reported comorbidities in psoriatic arthritis (PsA), (2) compare the incidence and/or prevalence of comorbidities between PsA and control populations; and (3) examine the impact of comorbidities on PsA outcomes. We systematically searched Medline, PubMed, Scopus, and Web of Science using a predefined protocol in accordance with PRISMA guidelines. Studies reporting only one comorbidity, or a few closely related diseases within one organ system, were excluded. Where possible, meta-analysis was performed using random-effects models. We included 39 studies amounting to over 152 thousand PsA patients. We performed meta-analysis for the prevalence of 21 commonly reported comorbidities. The most prevalent comorbidities were hypertension (pooled prevalence 34%), metabolic syndrome (29%), obesity (27%), hyperlipidaemia (24%) and any cardiovascular diseases (19%). Eleven studies consistently showed higher prevalence of comorbidities in PsA than controls. Five studies showed that comorbid patients had more severe disease, poorer quality of life, and increased discontinuation of treatment. Comorbidities, particularly cardiometabolic disorders, were highly prevalent in PsA and more common than in healthy controls. Comorbidities were associated with adverse disease features, but more research is needed on their impact on longitudinal outcomes such as treatment response, work productivity and mortality.
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Affiliation(s)
- Sonal Gupta
- School of Medicine, University of Liverpool, Liverpool, UK
| | - Zoe Syrimi
- Department of Medicine, Liverpool University Hospitals, Liverpool, UK
| | - David M Hughes
- Department of Health Data Science, Institute of Population Health, University of Liverpool, Liverpool, UK
| | - Sizheng Steven Zhao
- Musculoskeletal Biology, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, L69 3GA, UK.
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25
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Castañeda S, González C, Villaverde V, Lajas Petisco C, Castro MC, Jirout F, Obaya JC, Hermosa JC, Suárez C, García S, Rodero M, León L, López Esteban A, Gobbo M, Alcaide L, Torre-Alonso JC. Development and feasibility of 4 checklists for the evaluation of comorbidity in patients with rheumatoid arthritis, axial spondyloarthritis and psoriatic arthritis: GECOAI Project. REUMATOLOGIA CLINICA 2020; 18:S1699-258X(20)30225-4. [PMID: 33293243 DOI: 10.1016/j.reuma.2020.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Revised: 07/28/2020] [Accepted: 09/03/2020] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To develop and assess the feasibility in daily practice of four comorbidity checklists, for common use in rheumatoid arthritis (RA), axial spondyloarthritis (axSpA) and psoriatic arthritis (PsA). METHODS A multidisciplinary panel of experts on comorbidity was established. Data from the GECOAR, GECOAX and GECOAP projects were analysed and a narrative literature review in Medline on RA, axSpA and PsA comorbidity was performed in order to select the most relevant and common comorbidities across the three diseases. With these results and those obtained from a focus group of patients, in a nominal group meeting, the experts generated preliminary checklists. These were afterwards modified by an external evaluation by two associations, a patients' association and an association of health professionals related to rheumatology. As a result, the final checklists were generated. A cross-sectional study was conducted to test the feasibility of three of the checklists in daily practice, in which eight health professionals evaluated the checklists in five patients with RA, five with axSpA and five with SpA. RESULTS Four comorbidity checklists were designed, three for health professionals (one to assess current comorbidity, one on prevention/health promotion and one with the referral criteria to other health professionals), and another for patients. The feasibility study showed them to be simple, clear, and useful for use in routine clinical practice. CONCLUSIONS The use of specific and common checklists for patients with RA, axSpA and PsA is feasible and might contribute favorably to their prognosis as well as in daily practice.
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Affiliation(s)
- Santos Castañeda
- Servicio de Reumatología, Hospital Universitario de la Princesa, IIS-Princesa, Cátedra UAM-ROCHE, EPID-Futuro, Universidad Autónoma de Madrid (UAM), Madrid, España.
| | - Carlos González
- Servicio de Reumatología, Hospital Universitario Gregorio Marañón, Madrid, España
| | - Virginia Villaverde
- Servicio de Reumatología, Hospital Universitario de Móstoles, Madrid, España
| | - Cristina Lajas Petisco
- Servicio de Reumatología, IDISSC, Hospital Universitario Clínico de San Carlos, Madrid, España
| | - María Carmen Castro
- Servicio de Reumatología, Hospital Universitario Reina Sofía, Córdoba, España
| | - Fernando Jirout
- Servicio de Reumatología, Hospital Monte Naranco, Oviedo, España
| | | | | | - Carmen Suárez
- Servicio de Medicina Interna, Hospital Universitario de La Princesa, IIS-Princesa, Madrid, España
| | - Silvia García
- Servicio de Reumatología, Hospital Moises Broggi, Sant Joan Despí, Barcelona, España
| | - María Rodero
- Servicio de Reumatología, IDISSC, Hospital Universitario Clínico de San Carlos, Madrid, España
| | - Leticia León
- Servicio de Reumatología, IDISSC, Hospital Universitario Clínico de San Carlos, Madrid, España
| | - Amparo López Esteban
- Servicio de Reumatología, Hospital Universitario Gregorio Marañón, Madrid, España
| | - Milena Gobbo
- Positivamente Centro de Psicología, Madrid, España
| | - Laly Alcaide
- Coordinadora Nacional de Artritis, Madrid, España
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26
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Lubrano E, Scriffignano S, Perrotta FM. Multimorbidity and comorbidity in psoriatic arthritis - a perspective. Expert Rev Clin Immunol 2020; 16:963-972. [PMID: 32940114 DOI: 10.1080/1744666x.2021.1825941] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Psoriatic Arthritis (PsA) is a multifaceted disease in which various musculoskeletal and skin manifestations are involved. Beyond these features, PsA is associated with comorbidities that might increase the burden of the disease. AREAS COVERED In the last years a growing interest has come out for the concept of multimorbidity in rheumatology. Multimorbidity was defined as the 'co-existence of two or more chronic diseases in the same individual.' In the multimorbidity concept, the patient is of central concern and all coexisting diseases are of equal importance. Comorbidity was defined as the 'occurrence of any distinct additional entity during the clinical course of patient who has the index disease under study.' In PsA, comorbidity and multimorbidity have often been confusingly used interchangeably, showing that there is an unmet need on this topic. EXPERT OPINION This perspective article dealt with these different visions of the co-existence of other diseases in PsA, providing a distinction between them, not only for the impact on the treatment decision but also in how this concept might be incorporated into clinical trials design, choosing the right outcome measures for the patient-centric concept of multimorbidity. For this perspective, the authors searched PubMed and the Cochrane library for articles published.
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Affiliation(s)
- Ennio Lubrano
- Academic Rheumatology Unit, Dipartimento di Medicina e Scienze della Salute "Vincenzo Tiberio", Università degli Studi del Molise , Campobasso, Italy
| | - Silvia Scriffignano
- Academic Rheumatology Unit, Dipartimento di Medicina e Scienze della Salute "Vincenzo Tiberio", Università degli Studi del Molise , Campobasso, Italy
| | - Fabio Massimo Perrotta
- Academic Rheumatology Unit, Dipartimento di Medicina e Scienze della Salute "Vincenzo Tiberio", Università degli Studi del Molise , Campobasso, Italy
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27
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Zhao SS, Robertson S, Reich T, Harrison NL, Moots RJ, Goodson NJ. Prevalence and impact of comorbidities in axial spondyloarthritis: systematic review and meta-analysis. Rheumatology (Oxford) 2020; 59:iv47-iv57. [PMID: 33053193 PMCID: PMC7566561 DOI: 10.1093/rheumatology/keaa246] [Citation(s) in RCA: 53] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Accepted: 04/09/2020] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVES Comorbidities are common in people with axial spondyloarthritis (axSpA). In this systematic review and meta-analysis, we aimed to: (i) describe the prevalence of commonly reported comorbidities, (ii) compare comorbidities between axSpA and control populations, and (iii) examine the impact of comorbidity burden on axSpA outcomes. METHODS We systematically searched Medline, PubMed, Scopus and Web of Science using a predefined protocol in accordance with Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. We excluded studies of only one comorbid condition or a few closely related diseases within one organ system. Where possible, meta-analysis was performed using random-effects models. RESULTS A total of 40 studies were included for analysis. 36 studies reported prevalence of comorbidities, amounting to a combined sample size of 119 427 patients. The number of comorbidities studied ranged from 3 to 43. The most prevalent individual comorbidities were hypertension (pooled prevalence 23%), hyperlipidaemia (17%) and obesity (14%). Eleven studies consistently showed higher prevalence of comorbidities in axSpA than controls, particularly large differences were seen for depression [pooled odds ratio (OR) 1.80] and heart failure (OR 1.84). Comorbidities (total number of and individual conditions) were also associated with axSpA disease activity, functional impairment, quality of life, work productivity and mortality. CONCLUSIONS Comorbidities are common in axSpA, particularly cardiovascular diseases and risk factors. Most comorbidities were more prevalent in axSpA patients than in control populations. Overall comorbidity burden, and many individual conditions, were associated with axSpA outcomes including worse disease severity, work productivity and mortality.
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Affiliation(s)
- Sizheng Steven Zhao
- Musculoskeletal Biology, Institute of Lifecourse and Medical Sciences, University of Liverpool
- Department of Academic Rheumatology, Liverpool University Hospitals
| | | | - Tzvi Reich
- School of Medicine, University of Liverpool, Liverpool, UK
| | | | - Robert J Moots
- Musculoskeletal Biology, Institute of Lifecourse and Medical Sciences, University of Liverpool
- Department of Academic Rheumatology, Liverpool University Hospitals
| | - Nicola J Goodson
- Musculoskeletal Biology, Institute of Lifecourse and Medical Sciences, University of Liverpool
- Department of Academic Rheumatology, Liverpool University Hospitals
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28
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Gossec L, Baraliakos X, Kerschbaumer A, de Wit M, McInnes I, Dougados M, Primdahl J, McGonagle DG, Aletaha D, Balanescu A, Balint PV, Bertheussen H, Boehncke WH, Burmester GR, Canete JD, Damjanov NS, Kragstrup TW, Kvien TK, Landewé RBM, Lories RJU, Marzo-Ortega H, Poddubnyy D, Rodrigues Manica SA, Schett G, Veale DJ, Van den Bosch FE, van der Heijde D, Smolen JS. EULAR recommendations for the management of psoriatic arthritis with pharmacological therapies: 2019 update. Ann Rheum Dis 2020; 79:700-712. [PMID: 32434812 PMCID: PMC7286048 DOI: 10.1136/annrheumdis-2020-217159] [Citation(s) in RCA: 543] [Impact Index Per Article: 135.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Revised: 04/30/2020] [Accepted: 05/01/2020] [Indexed: 12/31/2022]
Abstract
OBJECTIVE To update the European League Against Rheumatism (EULAR) recommendations for the pharmacological treatment of psoriatic arthritis (PsA). METHODS According to the EULAR standardised operating procedures, a systematic literature review was followed by a consensus meeting to develop this update involving 28 international taskforce members in May 2019. Levels of evidence and strengths of recommendations were determined. RESULTS The updated recommendations comprise 6 overarching principles and 12 recommendations. The overarching principles address the nature of PsA and diversity of both musculoskeletal and non-musculoskeletal manifestations; the need for collaborative management and shared decision-making is highlighted. The recommendations provide a treatment strategy for pharmacological therapies. Non-steroidal anti-inflammatory drugs and local glucocorticoid injections are proposed as initial therapy; for patients with arthritis and poor prognostic factors, such as polyarthritis or monoarthritis/oligoarthritis accompanied by factors such as dactylitis or joint damage, rapid initiation of conventional synthetic disease-modifying antirheumatic drugs is recommended. If the treatment target is not achieved with this strategy, a biological disease-modifying antirheumatic drugs (bDMARDs) targeting tumour necrosis factor (TNF), interleukin (IL)-17A or IL-12/23 should be initiated, taking into account skin involvement if relevant. If axial disease predominates, a TNF inhibitor or IL-17A inhibitor should be started as first-line disease-modifying antirheumatic drug. Use of Janus kinase inhibitors is addressed primarily after bDMARD failure. Phosphodiesterase-4 inhibition is proposed for patients in whom these other drugs are inappropriate, generally in the context of mild disease. Drug switches and tapering in sustained remission are addressed. CONCLUSION These recommendations provide stakeholders with an updated consensus on the pharmacological management of PsA, based on a combination of evidence and expert opinion.
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Affiliation(s)
- Laure Gossec
- Institut Pierre Louis d'Epidémiologie et de Santé Publique, INSERM, Sorbonne Universite, Paris, France
- APHP.Sorbonne Universite, Rheumatology Department, Hopital Universitaire Pitie Salpetriere, Paris, France
| | | | - Andreas Kerschbaumer
- Division of Rheumatology, Department of Medicine 3; 2nd Department of Medicine, Hietzing Hospital, Medical University of Vienna, Vienna, Austria
| | | | - Iain McInnes
- Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow, UK
| | - Maxime Dougados
- Hopital Cochin, Rheumatology, Université Paris Descartes, Paris, France
| | - 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
| | - Dennis G McGonagle
- LTHT, Leeds NIHR Biomedical Research Centre, Leeds, UK
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
| | - Daniel Aletaha
- Division of Rheumatology, Department of Medicine 3, Medical University of Vienna, Vienna, Austria
| | - Andra Balanescu
- Research Center of Rheumatic Diseases, Sf Maria Hospital, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Peter V Balint
- 3rd Department of Rheumatology, National Institute of Rheumatology and Physiotherapy, Budapest, Hungary
| | | | | | - Gerd R Burmester
- Rheumatology and Clinical Immunology, Charite University Hospital Berlin, Berlin, Germany
| | - Juan D Canete
- Arthritis Unit, Department of Rheumatology and IDIBAPS, Hospital Clinic, Barcelona, Spain
| | - Nemanja S Damjanov
- Institute of Rheumatology, Belgrade University School of Medicine, Belgrade, Serbia
| | - Tue Wenzel Kragstrup
- Department of Biomedicine, Aarhus University, Aarhus C, Denmark
- Department of Rheumatology, Aarhus Universitetshospital, Aarhus, Denmark
| | - Tore K Kvien
- Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
| | - Robert B M Landewé
- Amsterdam Rheumatology Center, AMC, Amsterdam, The Netherlands
- Rheumatology, Zuyderland MC, Heerlen, The Netherlands
| | - Rik Jozef Urbain Lories
- Laboratory of Tissue Homeostasis and Disease, Skeletal Biology and Engineering Research Center, KU Leuven, Leuven, Flanders, Belgium
- Rheumatology, KU Leuven University Hospitals Leuven, Leuven, Flanders, Belgium
| | - Helena Marzo-Ortega
- LTHT, Leeds NIHR Biomedical Research Centre, Leeds, UK
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
| | - Denis Poddubnyy
- Department of Rheumatology, Infectious Diseases and Rheumatology, Charité Universitätsmedizin Berlin, Berlin, Germany
- Epidemiology, German Rheumatism Research Center Berlin, Berlin, Germany
| | - Santiago Andres Rodrigues Manica
- Rheumatology, Hospital de Egas Moniz, Lisboa, Portugal
- Universidade Nova de Lisboa Centro de Estudos de Doencas Cronicas, Lisboa, Portugal
| | - Georg Schett
- Internal Medicine, University of Erlangen-Nuremberg, Erlangen, Germany
| | - Douglas J Veale
- Centre for Arthritis and Rheumatic Disease, Dublin Academic Medical Centre, St Vincent's University Hospital, Dublin, Ireland
| | - Filip E Van den Bosch
- Department of Internal Medicine and Pediatrics, VIB Center for Inflammation Research, Ghent University, Gent, Belgium
| | - Désirée van der Heijde
- Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
- Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
| | - Josef S Smolen
- Division of Rheumatology, Department of Medicine 3, Medical University of Vienna, Vienna, Wien, Austria
- 2nd Department of Medicine, Hietzing Hospital, Vienna, Wien, Austria
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