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Kirkeskov L, Bray K. Employment of patients with rheumatoid arthritis - a systematic review and meta-analysis. BMC Rheumatol 2023; 7:41. [PMID: 37964371 PMCID: PMC10644429 DOI: 10.1186/s41927-023-00365-4] [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: 06/07/2023] [Accepted: 10/20/2023] [Indexed: 11/16/2023] Open
Abstract
BACKGROUND Patients with rheumatoid arthritis (RA) have difficulties maintaining employment due to the impact of the disease on their work ability. This review aims to investigate the employment rates at different stages of disease and to identify predictors of employment among individuals with RA. METHODS The study was carried out according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines focusing on studies reporting employment rate in adults with diagnosed RA. The literature review included cross-sectional and cohort studies published in the English language between January 1966 and January 2023 in the PubMed, Embase and Cochrane Library databases. Data encompassing employment rates, study demographics (age, gender, educational level), disease-related parameters (disease activity, disease duration, treatment), occupational factors, and comorbidities were extracted. Quality assessment was performed employing Newcastle-Ottawa Scale. Meta-analysis was conducted to ascertain predictors for employment with odds ratios and confidence intervals, and test for heterogeneity, using chi-square and I2-statistics were calculated. This review was registered with PROSPERO (CRD42020189057). RESULTS Ninety-one studies, comprising of a total of 101,831 participants, were included in the analyses. The mean age of participants was 51 years and 75.9% were women. Disease duration varied between less than one year to more than 18 years on average. Employment rates were 78.8% (weighted mean, range 45.4-100) at disease onset; 47.0% (range 18.5-100) at study entry, and 40.0% (range 4-88.2) at follow-up. Employment rates showed limited variations across continents and over time. Predictors for sustained employment included younger age, male gender, higher education, low disease activity, shorter disease duration, absence of medical treatment, and the absence of comorbidities. Notably, only some of the studies in this review met the requirements for high quality studies. Both older and newer studies had methodological deficiencies in the study design, analysis, and results reporting. CONCLUSIONS The findings in this review highlight the prevalence of low employment rates among patients with RA, which increases with prolonged disease duration and higher disease activity. A comprehensive approach combining clinical and social interventions is imperative, particularly in early stages of the disease, to facilitate sustained employment among this patient cohort.
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Affiliation(s)
- Lilli Kirkeskov
- Department of Social Medicine, University Hospital Bispebjerg-Frederiksberg, Copenhagen, Denmark.
- Department of Social Medicine, University Hospital Bispebjerg-Frederiksberg, Nordre Fasanvej 57, Vej 8, Opgang 2.2., 2000, Frederiksberg, Denmark.
| | - Katerina Bray
- Department of Social Medicine, University Hospital Bispebjerg-Frederiksberg, Copenhagen, Denmark
- Department of Occupational and Social Medicine, Holbaek Hospital, Holbaek, Denmark
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Bokhari SFH, Mushtaq A. Psychosocial Aspects of Rheumatic Disease Management: Addressing Mental Health and Well-Being. Cureus 2023; 15:e49267. [PMID: 38143643 PMCID: PMC10746866 DOI: 10.7759/cureus.49267] [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: 11/22/2023] [Indexed: 12/26/2023] Open
Abstract
Rheumatic disease imposes a substantial emotional burden on individuals, leading to chronic pain, discomfort, anxiety, and depression. Coping with unpredictability and physical limitations can create a detrimental feedback loop, exacerbating mental and physical symptoms. Poor mental health can hinder treatment adherence and worsen disease progression. Addressing the emotional impact of rheumatic disease is crucial for comprehensive management. Healthcare providers play a critical role in recognizing psychosocial concerns through attentive listening and standardized screenings. Open communication and a collaborative approach lead to more effective care. Support systems involving family, friends, and support groups provide emotional help and reduce isolation. Coping strategies and self-management techniques empower patients to navigate their conditions. The stigma associated with mental health is a challenge that requires education, awareness, and patient advocacy. A multidisciplinary approach integrating mental health services is pivotal for addressing the psychosocial aspects of rheumatic disease, offering a holistic perspective. Ongoing research explores the interplay between mental health and physical symptoms, aiming for innovative therapies and improved patient care. Collaborative care models and patient advocacy are essential to reducing barriers and improving patient outcomes. The future of rheumatic disease management lies in a patient-centered, multidisciplinary approach that addresses both physical and mental aspects.
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Affiliation(s)
| | - Aqsa Mushtaq
- Psychology, Quaid-i-Azam University, Islamabad, PAK
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Obel N, Dessau RB, Krogfelt KA, Bodilsen J, Andersen NS, Møller JK, Roed C, Omland LH, Christiansen CB, Ellermann-Eriksen S, Bangsborg JM, Hansen K, Benfield TL, Rothman KJ, Sørensen HT, Andersen CØ, Lebech AM. Long term survival, health, social functioning, and education in patients with European Lyme neuroborreliosis: nationwide population based cohort study. BMJ 2018; 361:k1998. [PMID: 29848547 PMCID: PMC5974636 DOI: 10.1136/bmj.k1998] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To estimate long term survival, health, and educational/social functioning in patients with Lyme neuroborreliosis compared with the general population. DESIGN Nationwide population based cohort study using national registers. SETTING Denmark. PARTICIPANTS All Danish residents diagnosed during 1986-2016 as having Lyme neuroborreliosis (n=2067), defined as a positive Borrelia burgdorferi intrathecal antibody test and a clinical diagnosis of Lyme borreliosis, and a comparison cohort from the general population matched on sex and date of birth (n=20 670). MAIN OUTCOME MEASURES Mortality rate ratios, incidence rate ratios of comorbidities, and differences in educational and social outcomes. RESULTS Mortality among patients with Lyme neuroborreliosis was not higher than in the general population (mortality rate ratio 0.90, 95% confidence interval 0.79 to 1.03). Lyme neuroborreliosis patients had increased risk of haematological (incidence rate ratio 3.07, 2.03 to 4.66) and non-melanoma skin cancers (1.49, 1.18 to 1.88). At diagnosis, Lyme neuroborreliosis patients had slightly higher employment and lower disability pension rates. After five years, patients and comparison cohort members had similar numbers of hospital contacts (difference -0.22, 95% confidence interval -0.45 to 0.02, in-hospital days/year; 0.37, -0.10 to 0.83, outpatient visits/year), employment rates (difference 1.5%, -2.1% to 5.1%), income (difference -1000, -20 000 to 18 000, Danish kroner), days of sick leave (difference -0.3, -3.5 to 3.0, per year), rates of receipt of a disability pension (difference -0.9%, -3.2% to 1.3%), and number of children (difference -0.10, -0.27 to 0.08). More patients were married (difference 4.8%, 2.2% to 7.4%) and had completed high school education (difference 7%, 1% to 12%). CONCLUSION A verified diagnosis of Lyme neuroborreliosis had no substantial effect on long term survival, health, or educational/social functioning. Nevertheless, the diagnosis decreased labour market involvement marginally and was associated with increased risk of haematological and non-melanoma skin cancers.
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Affiliation(s)
- Niels Obel
- Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet, DK-2100, Copenhagen, Denmark
| | - Ram B Dessau
- Department of Clinical Microbiology, Slagelse Hospital, Slagelse, Denmark
| | - Karen A Krogfelt
- Bacteria, Parasites and Fungi Department, Statens Serum Institute, Copenhagen, Denmark
| | - Jacob Bodilsen
- Department of Clinical Microbiology and Infectious Diseases, Aalborg University hospital, Aalborg, Denmark
| | - Nanna S Andersen
- Clinical Center for Emerging and Vector-borne Infections, Odense University Hospital, Odense, Denmark
| | - Jens K Møller
- Department of Clinical Microbiology, Vejle Hospital, Vejle, Denmark
| | - Casper Roed
- Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet, DK-2100, Copenhagen, Denmark
| | - Lars H Omland
- Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet, DK-2100, Copenhagen, Denmark
| | - Claus B Christiansen
- Department of Clinical Microbiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | | | - Jette M Bangsborg
- Department of Clinical Microbiology, Herlev University Hospital, Copenhagen, Denmark
| | - Klaus Hansen
- Department of Neurology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Thomas L Benfield
- Department of Infectious Diseases, Hvidovre University Hospital, Copenhagen, Denmark
| | - Kenneth J Rothman
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
- Department of Epidemiology, Boston University, Boston, MA, USA
| | - Henrik T Sørensen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - Christian Ø Andersen
- Department of Clinical Microbiology, Hvidovre University Hospital, Copenhagen, Denmark
| | - Anne-Mette Lebech
- Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet, DK-2100, Copenhagen, Denmark
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Camilleri JP, Jessop AM, Davis S, Jessop JD, Hall M. A survey of factors affecting the capacity to work in patients with rheumatoid arthritis in South Wales. Clin Rehabil 2016. [DOI: 10.1177/026921559500900312] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
A survey was undertaken during 1992-93 to identify factors associated with the severity of rheumatoid arthritis and its management which might be modified to improve the patient's ability to continue to work. Two hundred and twenty patients taking part in a trial of second-line therapy were sent a postal questionnaire. Seventy-four per cent returned valid forms and these patients were subsequently medically examined. The unemployment rate in males was 71 % and in females 69%, compared to the average for the whole of Wales of 27% and 42% respectively in the same age range for the year in question. The data obtained suggested that improvements could be made with respect to disease control, organization of medical care and better use of rehabilitation services to optimize ability to work.
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Affiliation(s)
- JP Camilleri
- Rheumatology Department, University Hospital of Wales, Cardiff
| | - AM Jessop
- Rheumatology Department, University Hospital of Wales, Cardiff
| | - S. Davis
- Rheumatology Department, University Hospital of Wales, Cardiff
| | - JD Jessop
- Rheumatology Department, University Hospital of Wales, Cardiff
| | - M. Hall
- Rheumatology Department, University Hospital of Wales, Cardiff
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Lumley MA, Kelley JE, Leisen JC. Predicting Pain and Adjustment in Rheumatoid Arthritis. J Health Psychol 2016; 2:255-64. [DOI: 10.1177/135910539700200221] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The role of disclosure and emotional processing of stressful life events has not been studied in chronically ill populations. We attempted to predict the pain, physical dysfunction, and affective disturbance of 82 patients with rheumatoid arthritis (RA) from their life stress and from various measures of emotional processing: disclosure to others and thought frequency about stressful events, positive and negative emotional expression, ambivalence about emotional expression and secrecy. After controlling for demographics (gender, race, education, disability status), disease measures (duration of diagnosis, objective disease activity), and life stress, we found that pain was related to an increased expression of negative emotion; physical dysfunction was related to an increased frequency of thinking about stressful events; and affective disturbance was related to both increased ambivalence about emotional expression and increased thought frequency. We conclude that RA pain and adjustment are better predicted by emotional processing of stressful life events—including disclosure to others and emotional expression—than by the experience of stressful events, per se.
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Abstract
This article reports changes over 2 years in physical, activities of daily living (ADL), and instrumental activities of daily living (IADL) disabilities for older U.S. adults with arthritis, compared to those without arthritis. The data source is the 1986 Longitudinal Study on Aging, a follow-up survey of community-dwelling persons ages 70 and over when first interviewed in 1984 (N = 4,717). Disability is defined as difficulty doing an activity on one's own and without special equipment. Transitions from tO status (1984: No Difficulty, Yes Difficulty) to ti status (1986: No Difficulty-Community Dwelling, Yes Difficulty-Community Dwelling, Institutional Residence, Dead) are studied. (a) Among nondisabled persons at to, people with arthritis are more likely to incur all types of disability over a 2-year period. (b) Among disabled persons at tO, those with arthritis regain ADL, IADL, and walking abilities more readily than do their nonarthritis peers, but they are less likely to regain physical functions requiring endurance, strength, and dexterity. (c) Regardless of initial disability status, nonarthritis people are more likely to be institutionalized or die in 2 years than are arthritis persons. (These results are clear but vary in statistical strength: Most comparisons for [a] are significant at p ≤ .01; one third are significant at p≤ .05 for [b]; most comparisons for institutional outcome are nonsignificant due to small cell sizes; one third for dead outcome are significant at p ≤ .01.) The results reflect the medical nature of arthritis (musculoskeletal locale, moderate impact, nonfatal) and also people's successful accommodations to it. In sum, disability is an especially dynamic experience for persons with arthritis. Clinical and public health efforts to prevent disability onset and to aid restoration of function for this common disease can have high payoff, benefiting many persons for relatively low cost.
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The Employee Absenteeism Costs of Rheumatoid Arthritis: Evidence From US National Survey Data. J Occup Environ Med 2016; 57:635-42. [PMID: 26053366 DOI: 10.1097/jom.0000000000000461] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
OBJECTIVE To estimate indirect costs associated with rheumatoid arthritis (RA). METHODS This was a retrospective study using 1996-2006 US Medical Expenditure Panel Survey data. Employed individuals were aged 18 to 65 years. A two-part model estimated the probability of time lost from work and annual number of workdays missed due to illness. RESULTS Sixty-seven percent (209/312) of RA individuals missed work versus 58% (52,046/89,734) of those without RA (P = 0.0007). Among individuals who missed work, those with RA missed more workdays annually than those without RA ((Equation is included in full-text article.)= 13.659, 9.879, respectively; P = 0.008). Incremental per capita costs in annual lost workdays between those with and without RA were $596. Estimated national indirect costs of RA-related absenteeism were $252 million annually. CONCLUSIONS Individuals with RA have higher probabilities of missing work and missing workdays than those without RA.
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Lumley MA, Keefe FJ, Mosley-Williams A, Rice JR, McKee D, Waters SJ, Partridge RT, Carty JN, Coltri AM, Kalaj A, Cohen JL, Neely LC, Pahssen JK, Connelly MA, Bouaziz YB, Riordan PA. The effects of written emotional disclosure and coping skills training in rheumatoid arthritis: a randomized clinical trial. J Consult Clin Psychol 2014; 82:644-58. [PMID: 24865870 DOI: 10.1037/a0036958] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Two psychological interventions for rheumatoid arthritis (RA) are cognitive-behavioral coping skills training (CST) and written emotional disclosure (WED). These approaches have developed independently, and their combination may be more effective than either one alone. Furthermore, most studies of each intervention have methodological limitations, and each needs further testing. METHOD We randomized 264 adults with RA in a 2 × 2 factorial design to 1 of 2 writing conditions (WED vs. control writing) followed by 1 of 2 training conditions (CST vs. arthritis education control training). Patient-reported pain and functioning, blinded evaluations of disease activity and walking speed, and an inflammatory marker (C-reactive protein) were assessed at baseline and 1-, 4-, and 12-month follow-ups. RESULTS Completion of each intervention was high (>90% of patients), and attrition was low (10.2% at 12-month follow-up). Hierarchical linear modeling of treatment effects over the follow-up period, and analyses of covariance at each assessment point, revealed no interactions between writing and training; however, both interventions had main effects on outcomes, with small effect sizes. Compared with control training, CST decreased pain and psychological symptoms through 12 months. The effects of WED were mixed: Compared with control writing, WED reduced disease activity and physical disability at 1 month only, but WED had more pain than control writing on 1 of 2 measures at 4 and 12 months. CONCLUSIONS The combination of WED and CST does not improve outcomes, perhaps because each intervention has unique effects at different time points. CST improves health status in RA and is recommended for patients, whereas WED has limited benefits and needs strengthening or better targeting to appropriate patients.
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Affiliation(s)
| | - Francis J Keefe
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center
| | | | - John R Rice
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center
| | - Daphne McKee
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center
| | - Sandra J Waters
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center
| | | | | | | | | | | | | | | | - Mark A Connelly
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center
| | - Yelena B Bouaziz
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center
| | - Paul A Riordan
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center
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Naidoo P. The Impact of Life-Long Illness on Women: A Qualitative Study of Low Socio-Economic Rheumatoid Arthritis (RA) Patients. JOURNAL OF PSYCHOLOGY IN AFRICA 2014. [DOI: 10.1080/14330237.2007.10820152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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10
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Fusama M, Nakahara H, Hamano Y, Nishide M, Kawamoto K, Hosokawa T, Nozato S, Higa S, Igarashi T, Takeuchi E, Kuroiwa T, Shimaoka Y, Yukioka M, Miura Y, Higashi K, Kuritani T, Maeda K. Improvement of health status evaluated by Arthritis Impact Measurement Scale 2 (AIMS-2) and Short Form-36 (SF-36) in patients with rheumatoid arthritis treated with tocilizumab. Mod Rheumatol 2014. [DOI: 10.3109/s10165-012-0674-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Barlow J, Wright C, Kroll T. Overcoming perceived barriers to employment among people with arthritis. J Health Psychol 2012; 6:205-16. [PMID: 22049322 DOI: 10.1177/135910530100600201] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Work disability is a major problem for people with arthritis. The INTO WORK Personal Development (IWPD) programme aims to prevent work disability by addressing the internal and external barriers faced by people with arthritis seeking to fulfil their employment potential. The effectiveness of the programme was examined in a pretest-post-test study with an intervention group (n = 37) and a comparison control group (n = 42). Data were collected through self-administered questionnaires and focus groups. Significant decreases on anxiety (p = .0002), depression (p = .009) and negative mood (p = .029), and significant improvements on positive mood (p = .011), self-esteem (p = .002) and satisfaction with life (p = .010) were found for the intervention group only. The IWPD programme appears to promote self-determination, psychological well-being and strategies for overcoming perceived barriers to employment among people with arthritis.
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Affiliation(s)
- J Barlow
- Psychosocial Rheumatology Research Centre, School of Health and Social Sciences, Coventry University, UK
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12
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Fusama M, Nakahara H, Hamano Y, Nishide M, Kawamoto K, Hosokawa T, Nozato S, Higa S, Igarashi T, Takeuchi E, Kuroiwa T, Shimaoka Y, Yukioka M, Miura Y, Higashi K, Kuritani T, Maeda K. Improvement of health status evaluated by Arthritis Impact Measurement Scale 2 (AIMS-2) and Short Form-36 (SF-36) in patients with rheumatoid arthritis treated with tocilizumab. Mod Rheumatol 2012; 23:276-83. [PMID: 22669600 DOI: 10.1007/s10165-012-0674-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2012] [Accepted: 04/16/2012] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To evaluate the improvement of health status in patients with rheumatoid arthritis (RA) treated with tocilizumab. METHODS Thirty-nine patients were treated with 8 mg/kg tocilizumab every 4 weeks for 24 weeks. Disease activity was assessed by Clinical Disease Activity Index (CDAI) and Simplified Disease Activity Index (SDAI). Improvement of health status was assessed by Arthritis Impact Measurement Scale 2 (AIMS-2) and Short Form-36 (SF-36). RESULTS Tocilizumab improved CDAI and SDAI significantly at week 4 compared with at baseline. In the components of AIMS-2, "physical score", "symptom" and "affect" improved significantly at week 4 compared with at baseline, while "social interaction" did not improve significantly during 24 weeks of tocilizumab therapy. Similarly in SF-36, "bodily pain", "general health", "vitality" and "mental health" improved significantly at week 4. The most correlative component of AIMS-2 with CDAI was "symptom", while "social interaction" did not correlate with CDAI during tocilizumab treatment. CONCLUSION The time-course diversity in improvement of health status should be considered to provide proper healthcare when treated with tocilizumab.
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Affiliation(s)
- Mie Fusama
- Division of Nursing, NTT West Osaka Hospital, Osaka, Japan
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Pfleger CCH, Flachs EM, Koch-Henriksen N. Social consequences of multiple sclerosis. Part 2. Divorce and separation: a historical prospective cohort study. Mult Scler 2010; 16:878-82. [DOI: 10.1177/1352458510370978] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background: There is a need for follow-up studies of the familial situation of multiple sclerosis (MS) patients. Objectives: To evaluate the probability of MS patients to remain in marriage or relationship with the same partner after onset of MS in comparison with the population. Patients and methods: All 2538 Danes with onset of MS 1980—1989, retrieved from the Danish MS-Registry, and 50,760 matched and randomly drawn control persons were included. Information on family status was retrieved from Statistics Denmark. Cox analyses were used with onset as starting point. Results: Five years after onset, the cumulative probability of remaining in the same relationship was 86% in patients vs. 89% in controls. The probabilities continued to deviate, and at 24 years, the probability was 33% in patients vs. 53% in the control persons ( p < 0.001). Among patients with young onset (< 36 years of age), those with no children had a higher risk of divorce than those having children less than 7 years (Hazard Ratio 1.51; p < 0.0001), and men had a higher risk of divorce than women (Hazard Ratio 1.33; p < 0.01). Conclusion: MS significantly affects the probability of remaining in the same relationship compared with the background population.
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Affiliation(s)
- CCH Pfleger
- Department of Neurology, Århus University Hospital in Aalborg, Denmark,
| | - EM Flachs
- The Danish Multiple Sclerosis Registry, Rigshospitalet, Copenhagen, Denmark, The National Institute of Public Health, University of Southern Denmark, Denmark
| | - Nils Koch-Henriksen
- Department of Neurology, Århus University Hospital in Aalborg, Denmark, The Danish Multiple Sclerosis Registry, Rigshospitalet, Copenhagen, Denmark
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Birnbaum H, Pike C, Kaufman R, Marynchenko M, Kidolezi Y, Cifaldi M. Societal cost of rheumatoid arthritis patients in the US. Curr Med Res Opin 2010; 26:77-90. [PMID: 19908947 DOI: 10.1185/03007990903422307] [Citation(s) in RCA: 161] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To estimate comprehensive cost of rheumatoid arthritis (RA) patients to society and individual stakeholders, including patients/employees, employers, family members/caregivers, and government. RESEARCH DESIGN AND METHODS Administrative claims databases covering privately insured and Medicare and Medicaid beneficiaries in the US were used to compute the excess payer and beneficiary-paid costs per patient with RA compared with matched controls. Similarly, per-person excess costs for caregivers and uninsured patients with RA were estimated. Costs were estimated for other burdens, including costs of work-loss to employers, adaptations to home and work environments, lost on-the-job productivity, informal and hired care/household help, and job turnover costs. Intangible costs associated with quality-of-life deterioration were estimated based on legal system jury awards, whereas costs for premature mortality were based on lifetime earnings data. Per-capita cost estimates were weighted by the relevant population to estimate societal costs. Because data were incomplete, several assumptions were required; these assumptions could lead to an over- or under-estimation of cost burdens. RESULTS Annual excess health care costs of RA patients were $8.4 billion, and costs of other RA consequences were $10.9 billion. These costs translate to a total annual cost of $19.3 billion. From a stakeholder perspective, 33% of the total cost was allocated to employers, 28% to patients, 20% to the government, and 19% to caregivers. Adding intangible costs of quality-of-life deterioration ($10.3 billion) and premature mortality ($9.6 billion), total annual societal costs of RA (direct, indirect, and intangible) increased to $39.2 billion. CONCLUSIONS Societal costs of RA in the US are $19.3 billion and $39.2 billion (in 2005 dollars) without and with intangible costs, respectively. This study was one of the first to attempt to quantify the comprehensive burdens of RA. Despite several assumptions made in areas in which few data exist, the findings generate useful insights into the full burden of RA.
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Time-course of health status in patients with rheumatoid arthritis during the first year of treatment with infliximab. Biomed Pharmacother 2009; 64:107-12. [PMID: 19944558 DOI: 10.1016/j.biopha.2009.04.035] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2009] [Accepted: 04/15/2009] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVES A longitudinal study was performed to examine changes in health status in comparison with rheumatoid arthritis (RA) inflammation in patients with RA during the first 54 weeks of infliximab (IFX) treatment. METHODS Health status in active RA patients (n=13) was assessed monthly using the Arthritis Impact Measurement Scale 2 (AIMS2) and the VAS-GH during the first year of IFX treatment. Simultaneously, RA activity was assessed using inflammation markers, MMP-3 and the Disease Activity Score in 28 joints (DAS-28) based on CRP [DAS-28(CRP)] and ESR[DAS-28(ESR)]. RESULTS Serum CRP and ESR decreased significantly from 2.14+/-0.52mg/dL and 56.9+/-6.96mm/h, respectively, at baseline to 0.24+/-0.11mg/dL and 31.6+/-4.39mm/h, respectively, at 2 weeks after initiation of IFX. Other inflammatory markers and MMP-3 were also suppressed significantly after 2 weeks of IFX treatment. DAS-28(CRP) and DAS-28(ESR) were also significantly decreased after 2 weeks and suppression of both DAS values remained significant until 54 weeks of IFX treatment. After initiation of IFX, patient-reported general health also showed a significant improvement based on the changes in the six summary component scores on the AIMS2 (physical, affect, symptom, role, social interaction, and patient satisfaction). These scores all improved progressively until 14-18 weeks after initiation of IFX treatment, and then exhibited a temporary but insignificant exacerbation. The six components of the physical score also improved in a time-dependent manner until 14-18 weeks, but the scores for walking and bending, hand and finger function, arm function, self-care, and household tasks showed significant exacerbation at 22-30 weeks. The score for mobility level did not show this change. CONCLUSION IFX treatment significantly improved both RA disease activity and health status in active RA patients. Time-dependent improvement of ADL until 14-18 weeks after initiation of IFX treatment, as reflected in the six components of the physical score, might have contributed to the temporary exacerbation of health status thereafter in these patients.
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Häkkinen AH, Mälkiä EA, Sokka TM, Hannonen PJ. A physically demanding occupation predicts premature retirement among patients with erosive arthritis. Physiother Theory Pract 2009. [DOI: 10.3109/09593989809070040] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Laidmäe VI, Leppik L, Tulva T, Hääl ML. Disease-related social and family life: people coping with rheumatoid arthritis in Estonia. CRITICAL PUBLIC HEALTH 2009. [DOI: 10.1080/09581590802375871] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Ouimet JM, Pope JE, Gutmanis I, Koval J. Work disability in scleroderma is greater than in rheumatoid arthritis and is predicted by high HAQ scores. Open Rheumatol J 2008; 2:44-52. [PMID: 19088871 PMCID: PMC2588092 DOI: 10.2174/1874312900802010044] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2008] [Revised: 08/29/2008] [Accepted: 09/20/2008] [Indexed: 12/04/2022] Open
Abstract
Objectives To estimate the frequency of work disability (WD) in a cohort of patients with Systemic Sclerosis (SSc) vs an internal control group of patients with rheumatoid arthritis (RA) with a known high frequency of WD; and to investigate the association between WD and other factors including Health Assessment Questionnaire Disability Index (HAQ-DI) scores, HAQ pain, age, sex, disease duration and education level. Methods Cross-sectional data on WD status were obtained from a questionnaire sent to all SSc (n = 35 limited [lcSSc], 26 diffuse [dcSSc]) and a subset of RA patients (n=104) from a rheumatology practice. WD data, HAQ-DI scores, and demographic/clinical features (age, sex, high school education, disease duration and SSc disease subtype [dcSSc vs lcSSc]) were recorded. Results The proportion with WD was 0.56 in SSc (95% CI: 0.43-0.68) vs 0.35 in RA (95% CI: 0.25-0.44), p= 0.009. HAQ-DI scores were significantly higher in work-disabled SSc and RA patients vs those who were employed (p=0.0001, and p <0.0001). Multivariate logistic regression analysis demonstrated that higher HAQ-DI scores (β=1.78, p <0.001), disease type (dcSSc, lcSSc, RA) (β=1.32 for dcSSc, p=0.032), and self-reported disease duration (β=0.04, p=0.042) were significantly associated with WD (R2=0.311). Adding a work-related factor (self-reported physically demanding work) improved the regression model (R2=0.346) and strengthened the HAQ-DI (β=1.86, p <0.001) and lcSSc (β=1.24, p=0.024) coefficients. Conclusion The frequency of WD in SSc was high and was greater than in RA. SSc (and dcSSc) had significantly more WD than RA. The HAQ-DI was strongly associated with WD in SSc
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Affiliation(s)
- Janine M Ouimet
- Department of Epidemiology & Biostatistics, The University of Western Ontario, London, ON, Canada
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Ward MM, Reveille JD, Learch TJ, Davis JC, Weisman MH. Impact of ankylosing spondylitis on work and family life: comparisons with the US population. ACTA ACUST UNITED AC 2008; 59:497-503. [PMID: 18383414 DOI: 10.1002/art.23523] [Citation(s) in RCA: 60] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To examine the impact of ankylosing spondylitis (AS) on work disability, nonparticipation in the labor force, marriage, divorce, and childbearing. METHODS In this cross-sectional survey, we asked AS patients (n = 591, 72.8% men, mean age 48.9 years) from the Los Angeles, Houston, San Francisco, and Washington, DC metropolitan areas about work and family life. The proportion of patients who were work disabled, did not participate in the labor force, had never been married, were divorced, or had a biological child were compared with the proportions expected for each outcome based on data from population surveys. RESULTS Patients with AS were more likely to be work disabled (13.3% versus 5.7%; P < 0.0001) and somewhat more likely to not participate in the labor force compared with the proportion expected (25.1% versus 21.8%; P = 0.07). These associations were stronger among patients age > or =45 years and those with AS for > or =20 years. AS patients were more likely than expected to have never been married (22.8% versus 15.4%; P < 0.0001) or to be divorced (13.2% versus 10.0%; P = 0.02). Women with AS were less likely than expected to have had children (54.7% versus 64.9%; P = 0.02), but the proportion of men with AS who had children was not different from that of the general population. CONCLUSION Patients with AS in this study were more likely to have never been married, more likely to be divorced, and more than twice as likely to be work disabled than members of the general population. Women with AS were also less likely to have had children than women in the general population.
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Affiliation(s)
- Michael M Ward
- National Institute of Arthritis and Musculoskeletal and Skin Diseases, NIH, Bethesda, Maryland 20892, USA.
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Jönsson B. Patient access to rheumatoid arthritis treatments. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2008; 8 Suppl 2:S35-S38. [PMID: 18157679 DOI: 10.1007/s10198-007-0086-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
This paper is an introduction to the study "The Burden of Rheumatoid Arthritis and Patient Access to Treatment". The objective of the study is to compare patient access to new drugs in Europe, North America and a selection of other countries, and to analyse the determinants of differences between countries, as basis for a discussion on how patients' access to new and effective treatments can be improved. There were few treatments available that could affect the progression of the disease prior to the introduction of the first TNF inhibitors in the late 1990s. Since the cost per patient treated with these biological drugs is high compared to previously available treatments, reimbursement through private and public insurance is an important determinant for access to treatment.
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Affiliation(s)
- Bengt Jönsson
- Department of Economics, Stockholm School of Economics, Stockholm, Sweden.
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ten Klooster PM, Veehof MM, Taal E, van Riel PLCM, van de Laar MAFJ. Changes in priorities for improvement in patients with rheumatoid arthritis during 1 year of anti-tumour necrosis factor treatment. Ann Rheum Dis 2007; 66:1485-90. [PMID: 17472993 PMCID: PMC2111636 DOI: 10.1136/ard.2007.069765] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVES To examine priorities for health status improvement in patients with active rheumatoid arthritis (RA) during anti-tumour necrosis factor (TNF) treatment. METHODS Data were used from 173 patients with RA starting treatment with TNF-blocking agents. Outcome measures included assessment of health status with the Arthritis Impact Measurement Scales 2 (AIMS2) at baseline and after 3 and 12 months. The AIMS2 contains a priority list from which patients are asked to select from 12 areas of health the 3 in which they would most like to see improvement. RESULTS After 1 year of treatment, 10 out of 12 areas of health on the AIMS2 were significantly improved. The most commonly selected priorities for improvement at baseline were pain (88%), hand and finger function (57%), walking and bending (42%), mobility (33%), and work (29%). At group level, this priority ranking remained largely unchanged during treatment. After adjustment for multiple comparisons, only pain was selected significantly less often at 3 and 12 months (71% at both assessments). Within individual patients, however, priorities often changed. Changes in the priority of pain were related to the achieved level of patient-perceived pain and disease activity. CONCLUSIONS This study shows that, at the group level, patients' priorities for improvement are fairly stable during 12 months of anti-TNF therapy, despite major improvements in health status. Although pain reduction becomes somewhat less important, it remains the most commonly selected priority. In contrast, individual patient priorities are not stable over the course of treatment and appear to be associated with differences in disease state.
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Affiliation(s)
- Peter M ten Klooster
- Institute for Behavioral Research, Faculty of Behavioral Sciences, University of Twente, PO Box 217, 7500 AE Enschede, The Netherlands.
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Osiri M, Kamolratanakul P, Maetzel A, Tugwell P. Cost effectiveness analysis of disease modifying antirheumatic drugs in rheumatoid arthritis. Rheumatol Int 2007; 27:1063-9. [PMID: 17440729 DOI: 10.1007/s00296-007-0342-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2006] [Accepted: 03/04/2007] [Indexed: 10/23/2022]
Abstract
The objective was to assess the cost-effectiveness of various DMARDs compared with antimalarials (AM) for rheumatoid arthritis (RA) treatment. The data on disease activity, functional status and societal costs were collected from a 1-year cohort of 152 patients with RA receiving at least one DMARD for > or = 6 months. Incremental cost effectiveness ratio (ICER) was calculated from the societal costs of DMARD treatment compared with AM per one unit of HAQ improvement. All costs were presented in 2001 US dollars. Mean (SD) societal cost of AM treatment was US$ 2,285 (1,154) per patient per year. MTX + AM was less costly and more effective than AM, as the ICER of this combination would save US$ 834 per 1 U of HAQ improvement. MTX + SSZ, leflunomide, and triple therapy (AM + MTX + SSZ) were more effective than AM with additional costs. RA treatment with non MTX-based DMARDs was not cost-effective.
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Affiliation(s)
- Manathip Osiri
- Division of Rheumatology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Rama IV Road, Pathumwan, Bangkok 10330, Thailand.
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Abstract
Both the relative efficacy and inefficacy of non-steroidal antiinflammatory drugs (NSAIDs) contribute to their use in chronic rheumatic diseases. There are also sociological trends in patients, and in the population as a whole, increasing demand for treatment. In view of the risks of such treatment, the most rational approach to prescribing would be the use of a scientific risk-benefit analysis. Unfortunately, the data, especially those related to symptom relief, are inadequate for such an analysis. Until more meaningful figures are produced, good clinical practise concentrates on the responsibilities of physicians who both start and stop drugs, and makes it essential that strategies to minimize risk are produced.
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Affiliation(s)
- I Haslock
- Middlesbrough General Hospital, Cleveland, UK
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Gignac MAM, Sutton D, Badley EM. Reexamining the arthritis-employment interface: Perceptions of arthritis-work spillover among employed adults. ACTA ACUST UNITED AC 2006; 55:233-40. [PMID: 16583413 DOI: 10.1002/art.21848] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE To examine employed individuals' perceptions of arthritis-work spillover (AWS), the reciprocal influence of arthritis on work and work on arthritis, and the demographic, illness, and work context factors associated with AWS. METHODS The study group comprised 492 employed individuals with osteoarthritis or inflammatory arthritis. Participants completed an interview-administered, structured questionnaire assessing AWS, demographic (e.g., age, sex), illness (e.g., disease type, pain, activity limitations), and work context (e.g., workplace control, hours of work) variables. Principal components analysis, reliability analysis, and multiple linear regression were used to analyze the data. RESULTS A single factor solution emerged for AWS. The scale had an internal reliability of 0.88. Respondents were more likely to report that work interfered with caring for their arthritis than they were to report that their disease affected their work performance. Younger respondents, those with more fatigue and workplace activity limitations, and those working in trades and transportation reported more AWS. Individuals with more control over their work schedules reported less AWS. CONCLUSION The results of this study extend research on arthritis by reexamining the interface between arthritis and employment. This study introduces a new measure of AWS that enhances the range of tools available to researchers and clinicians examining the impact of arthritis in individuals' lives.
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Affiliation(s)
- Monique A M Gignac
- Arthritis Community Research & Evaluation Unit, Toronto Western Research Institute at the University Health Network, Main Pavilion 10th floor, Room 10-316, 399 Bathurst Street, Toronto, Ontario, Canada M5T 2S8.
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Burton W, Morrison A, Maclean R, Ruderman E. Systematic review of studies of productivity loss due to rheumatoid arthritis. Occup Med (Lond) 2005; 56:18-27. [PMID: 16286432 DOI: 10.1093/occmed/kqi171] [Citation(s) in RCA: 199] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Rheumatoid arthritis (RA) is a chronic, debilitating disease with a significant impact on workplace productivity. AIM To perform a systematic review of studies of the relationship between RA and reduced workplace productivity. METHODS Screening of 307 titles identified in bibliographic database searches resulted in 38 articles subject to systematic review. Productivity loss was expressed by three different measures: work disability, work loss (synonymous with absenteeism or short-term sick leave) and work limitation (reduction in productivity while present at work). RESULTS A median of 66% (range 36-84%) of employed RA subjects experienced work loss due to RA in the previous 12 months, for a median duration of 39 days (range 7-84 days). The times from RA diagnosis until a 50% probability of being work disabled varied from 4.5 to 22 years. In inception cohort studies, the baseline variables consistently predictive of subsequent work disability were a physically demanding work type, more severe RA and older age. CONCLUSIONS RA-related work-disability rates were similar in the USA and European countries. An apparent decrease in the prevalence of RA-related work disability since the 1970s may be related to a decrease in physically demanding work rather than to epidemiologic changes in RA. The majority of the literature addresses permanent disability and temporary work loss; none of the studies reviewed reported the effect of RA on presenteeism, i.e. work limitation from the employer perspective, and there are few published studies of the effectiveness of disease-modifying anti-rheumatic drugs in reducing work-related productivity loss.
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Affiliation(s)
- Wayne Burton
- Northwestern University Feinberg School of Medicine, Chicago, IL 60670, USA.
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de Buck PDM, le Cessie S, van den Hout WB, Peeters AJ, Ronday HK, Westedt ML, Breedveld FC, Vliet Vlieland TPM. Randomized comparison of a multidisciplinary job-retention vocational rehabilitation program with usual outpatient care in patients with chronic arthritis at risk for job loss. ACTA ACUST UNITED AC 2005; 53:682-90. [PMID: 16208658 DOI: 10.1002/art.21452] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Work disability is a major consequence of inflammatory rheumatic conditions. Evidence regarding the effectiveness of interventions aimed at the prevention or reduction of work disability in rheumatic diseases is limited. We conducted a randomized controlled trial to investigate the effectiveness of a multidisciplinary job-retention vocational rehabilitation (VR) program in patients with a rheumatic condition who were at risk for job loss. METHODS A total of 140 patients with a chronic rheumatic condition were randomly assigned to either a multidisciplinary job-retention VR program (n = 74) or usual outpatient care (UC) (n = 66). Patients in the VR group were assessed and guided by a multidisciplinary team, whereas patients in the UC group received care as initiated by their rheumatologist, supplemented with written information. The main outcome measure was the occurrence of job loss (complete work disability or unemployment); additional outcome measures included job satisfaction, pain, functional status, emotional status, and quality of life. RESULTS There was no difference between the 2 groups regarding the proportion of patients having lost their job at any time point, with 24% and 23% of the patients in the VR and UC groups, respectively, having lost their job after 24 months. Over the total period of 24 months, patients in the VR group had a significantly greater improvement of the fatigue visual analog scale and of emotional status (all P values < 0.05). CONCLUSION A job-retention VR program did not reduce the risk of job loss but improved fatigue and mental health in patients with chronic rheumatic diseases at risk for job loss.
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Rosery H, Bergemann R, Maxion-Bergemann S. International variation in resource utilisation and treatment costs for rheumatoid arthritis: a systematic literature review. PHARMACOECONOMICS 2005; 23:243-257. [PMID: 15836006 DOI: 10.2165/00019053-200523030-00005] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
Recent years have witnessed substantial progress in understanding the cost implications of rheumatoid arthritis (RA). To assess the divergent methodologies and their impact on the resulting cost analyses in RA, we conducted a systematic literature review to summarise the scientific evidence of RA-induced costs. Sixty-five reviews, models or cost analyses on the burden of illness and general costs associated with RA were identified. They covered the US, Canada, Sweden, the UK, The Netherlands, Germany and Finland. Twenty-four cost analyses provided appropriate data about direct and/or indirect costs. Each study was summarised separately. Costs were discounted to 2003 and converted to US dollars. The costs per RA-year ranged from USD 1503 to USD 16,514. However, each study has to be interpreted individually, with consideration given to the study population, indication, age of the study, database used, type of therapy, setting, level of cost differentiation and data derivation. Health technology assessment reports offer sufficient space to adequately describe the composite parts and restrictive elements of different methodological approaches and analyses.
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Allaire SH. What work changes do people with arthritis make to preserve employment, and are such changes effective? Arthritis Care Res (Hoboken) 2004; 51:871-3. [PMID: 15593234 DOI: 10.1002/art.20832] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Fifield * J, Mcquillan J, Armeli S, Tennen H, Reisine S, Affleck G. Chronic strain, daily work stress and pain among workers with rheumatoid arthritis: Does job stress make a bad day worse? WORK AND STRESS 2004. [DOI: 10.1080/02678370412331324996] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Verstappen SMM, Bijlsma JWJ, Verkleij H, Buskens E, Blaauw AAM, ter Borg EJ, Jacobs JWG. Overview of work disability in rheumatoid arthritis patients as observed in cross-sectional and longitudinal surveys. Arthritis Care Res (Hoboken) 2004; 51:488-97. [PMID: 15188338 DOI: 10.1002/art.20419] [Citation(s) in RCA: 155] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- S M M Verstappen
- Department of Rheumatology and Clinical Immunology, University Medical Center Utrecht, Utrecht, The Netherlands.
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Abstract
This paper reviews the evidence for mind-body therapies (eg, relaxation, meditation, imagery, cognitive-behavioral therapy) in the treatment of pain-related medical conditions and suggests directions for future research in these areas. Based on evidence from randomized controlled trials and in many cases, systematic reviews of the literature, the following recommendations can be made: 1) multi-component mind-body approaches that include some combination of stress management, coping skills training, cognitive restructuring and relaxation therapy may be an appropriate adjunctive treatment for chronic low back pain; 2) multimodal mind-body approaches such as cognitive-behavioral therapy, particularly when combined with an educational/informational component, can be an effective adjunct in the management of rheumatoid and osteoarthritis; 3) relaxation and thermal biofeedback may be considered as a treatment for recurrent migraine while relaxation and muscle biofeedback can be an effective adjunct or stand alone therapy for recurrent tension headache; 4) an array of mind-body therapies (eg, imagery, hypnosis, relaxation) when employed pre-surgically, can improve recovery time and reduce pain following surgical procedures; 5) mind-body approaches may be considered as adjunctive therapies to help ameliorate pain during invasive medical procedures.
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Affiliation(s)
- John A Astin
- California Pacific Medical Center Research Institute, San Francisco, CA, USA.
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Abstract
Rheumatoid arthritis (RA) is a chronic, generally progressive autoimmune disease that causes functional disability, significant pain and joint destruction, and leads to premature mortality. It is estimated to affect between 0.5 and 1.0% of the adult population worldwide, increases in prevalence with age and affects more women than men. The magnitude of the severe long-term economic consequences of RA has been underestimated in the past. Most patients with the disease require continuous treatment to retard or stop progression and to control disease flares. Many also require surgery, such as total hip or knee replacement. In addition to these direct costs, work disability leads to reduced productivity and early retirement, and as a result, substantial indirect costs. The individual and his or her family must cope with the feeling of loss of contribution to society combined with redefined social roles, and the effects of pain, fatigue, low self-esteem, mental distress and depression. A number of countries in North America and Europe have reported a decline in the incidence of RA in recent years, although geographical differences remain that may be associated with genetic, environmental or cultural factors. Nevertheless, patients with RA have not shared the improvements in survival rates seen with other diseases over the last 40 years, and have a mean reduction in life expectancy of between 5 and 10 years. Disease severity, activity and disability are strongly linked to premature mortality in patients with RA. The high direct and indirect costs associated with RA, together with the substantial morbidity and mortality affecting millions of people worldwide, underline the potential benefits of improved treatments for this chronic disease to patients, their families and society.
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Affiliation(s)
- Tore K Kvien
- Oslo City Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway.
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Kobelt G, Jönsson L, Young A, Eberhardt K. The cost-effectiveness of infliximab (Remicade) in the treatment of rheumatoid arthritis in Sweden and the United Kingdom based on the ATTRACT study. Rheumatology (Oxford) 2003; 42:326-35. [PMID: 12595631 DOI: 10.1093/rheumatology/keg107] [Citation(s) in RCA: 117] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE The cost per quality-adjusted life-year (QALY) of infliximab (Remicade) treatment in rheumatoid arthritis (RA) was estimated on the basis of a clinical trial comparing infliximab plus methotrexate with methotrexate alone in 428 patients with advanced disease [Anti-Tumour Necrosis Factor Trial in Rheumatoid Arthritis with Concomitant Therapy (ATTRACT)]. METHODS The effect of infliximab on disease progression and related costs and utilities was estimated using two disease progression models based on epidemiological cohorts followed for up to 15 yr in Sweden and the UK. The clinical trial data were used directly in the model and extrapolated to 10 yr using a cohort from the epidemiological studies matched for gender, age, time since onset of RA and disease severity. RESULTS One to two years of treatment with infliximab treatment reduced direct and indirect resource consumption in both countries, thereby partly offsetting the treatment cost. In the base case, including both direct and indirect costs, the cost per QALY gained was SEK 32 000 (euro 3440) in Sweden and GBP 21 600 (euro 34 800) for 1 yr of treatment. The respective QALY gains were 0.248 and 0.298. With 2 yr of treatment, the costs per QALY gained were SEK 150 000 (euro 16 100) and GBP 29 900 (euro;48 200). CONCLUSIONS Although 1-2 yr of treatment with infliximab will lead to savings in both direct and indirect costs, these will not offset the drug cost. However, the cost-effectiveness ratios remain within the usual range for treatments to be recommended for use.
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Yokoro CM, Tatsuo MAKF, Pereira LSM, Alves DLF, Francischi JN. Role of endogenous glucocorticoids in hyperalgesia and edema in old arthritic rats. Braz J Med Biol Res 2003; 36:77-83. [PMID: 12532230 DOI: 10.1590/s0100-879x2003000100011] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
We compared the intensity and frequency of arthritis in old (8-12 months, N = 12) and juvenile (2 months, N = 10) rats and determined the role played by adrenal glands in this disorder. Arthritis was induced by subcutaneous injection of Mycobacterium butyricum at the base of the tail of female Holtzman rats at day zero. Paw edema and hyperalgesia were monitored from day zero to day 21 after induction as signs of arthritis development. Some (N = 11) old animals were adrenalectomized bilaterally and treated with dexamethasone or celecoxib immediately following surgery. All bilaterally adrenalectomized old animals became susceptible to arthritis and the onset of disease was shortened from the 10th to the 5th day. Hyperalgesia and paw edema responses were less frequent in older animals (50 and 25% compared to control juvenile rats, respectively), although old responder animals showed responses of similar intensity to those of their juvenile counterparts: by the 14th day the data for hyperalgesia were juvenile = 0.8 +/- 0.07/old = 0.8 +/- 0.09, and for paw edema juvenile = 56.6 +/- 6.04/old = 32.24 +/- 12.7, reported as delta% increase in paw edema. Chronic treatment of adrenalectomized old animals with dexamethasone (0.01 or 0.1 mg/kg) but not celecoxib (3 mg/kg), once daily for 21 days by gavage, abolished the effects of adrenalectomy, in particular those related to the hyperalgesia response (old = 0.95 +/- 0.03/dexamethasone = 0 +/- 0; 14th day), thus suggesting a specific participation of circulating corticosteroids in the modulation of pain in old arthritic rats.
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Affiliation(s)
- C M Yokoro
- Departamento de Farmacologia, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brasil
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Kobelt G, Jönsson L, Lindgren P, Young A, Eberhardt K. Modeling the progression of rheumatoid arthritis: a two-country model to estimate costs and consequences of rheumatoid arthritis. ARTHRITIS AND RHEUMATISM 2002; 46:2310-9. [PMID: 12355478 DOI: 10.1002/art.10471] [Citation(s) in RCA: 93] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Two simulation models were developed to analyze the cost-effectiveness of new treatments that affect the progression of rheumatoid arthritis (RA). METHODS We used data from 2 cohorts of patients with early RA who had been followed up since disease onset (up to 15 years). In the Swedish study, 183 patients were followed up for a mean of 11.3 years. In the UK study, 916 patients were followed up for a mean of 7.8 years. Disease progression over 10 years was modeled as annual transitions between disease states, defined by Health Assessment Questionnaire (HAQ) scores. A regression model was used to estimate transition probabilities conditional on age, sex, and time since onset of disease, in order to allow simulation of different patient cohorts. Costs and utilities associated with different HAQ levels were based on data from the cohort studies and cross-sectional surveys. RESULTS Costs increase and quality of life decreases as RA progresses. In Sweden, total annual costs range from 4,900 dollars to 33,000 dollars per patient, compared with 4,900 dollars to 14,600 dollars in the UK. Cumulative costs over 10 years for patients starting in disease state 1 (HAQ < 0.6) are 54,600 dollars in Sweden and 26,600 dollars in the UK. The cumulative numbers of quality-adjusted life-years (QALYs) are 5.5 and 5.6, respectively. Both costs and QALYs were discounted at 3%. CONCLUSION The 2 models, which were based on different patient cohorts, reach a similar conclusion in terms of the effect of RA over 10 years. They appear to accurately capture disease progression and its effects and can therefore be useful in estimating the cost-effectiveness of new treatments in RA.
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el-Miedany YM, el-Rasheed AH. Is anxiety a more common disorder than depression in rheumatoid arthritis? Joint Bone Spine 2002; 69:300-6. [PMID: 12102277 DOI: 10.1016/s1297-319x(02)00368-8] [Citation(s) in RCA: 73] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE As most of the previous studies were done to study depressive disorders and/or symptoms in patients with rheumatoid arthritis, this study was performed to investigate whether anxiety disorder is as common as depressive disorder in these patients and to look for the socio-demographic as well as the clinical characteristics of the patients developing these disorders. METHODS A detailed physical assessment of 80 patients with rheumatoid arthritis was performed. Also psychiatric assessment was done using Research Diagnostic Criteria for the International Classification of Diseases-10 (ICD-10). In addition, patients answered a Health Assessment Questionnaire (HAQ) to assess their functional capacity. RESULTS Depression was diagnosed in 66.2% of the total sample while anxiety was diagnosed in 70%. Functional disability, social stress and morning stiffness were the factors highly associated with depression. Using multiple regression analysis, anxiety was highly associated with depression as well as Ritchie articular index. CONCLUSION Psychiatric illness is a relatively common disorder in patients with RA, with a frequency higher than that of other general medical conditions. Anxiety is a more common disorder than depression. The first step in correct management is recognition of anxiety and depression so that appropriate treatment can be tried. Particular attention has to be paid to social stress and lack of social support.
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El-Miedany Y, Rasheed AHE, Ostuni O. L’anxiété est-elle plus fréquente que la dépression au cours de la polyarthrite rhumatoïde ? ACTA ACUST UNITED AC 2002. [DOI: 10.1016/s1169-8330(02)00285-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Abstract
The rheumatic diseases continue to represent a significant healthcare burden in the 21st century. However, despite the best standard of care and recent therapeutic advances it is still not possible to consistently prevent the progressive joint destruction that leads to chronic disability. In rheumatoid arthritis and osteoarthritis this progressive cartilage and bone destruction is considered to be driven by an excess of the matrix metalloproteinase (MMP) enzymes. Consequently, a great number of potent small molecule MMP inhibitors have been examined. Several MMP inhibitors have entered clinical trials as a result of impressive data in animal models, although only one MMP inhibitor, Ro32-3555 (Trocade), a collagenase selective inhibitor, has been fully tested in the clinic, but it did not prevent progression of joint damage in patients with rheumatoid arthritis. The key stages and challenges associated with the development of an MMP inhibitor in the rheumatic diseases are presented below with particular reference to Trocade. It is concluded that the future success of MMP inhibitors necessitates a greater understanding of the joint destructive process and it is hoped that their development may be accompanied with clearer, more practical, outcome measures to test these drugs for, what remains, an unmet medical need.
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Affiliation(s)
- D R Close
- Department of Clinical Science, Roche Products Ltd, Welwyn Garden City, Hertfordshire, UK.
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Reibel DK, Greeson JM, Brainard GC, Rosenzweig S. Mindfulness-based stress reduction and health-related quality of life in a heterogeneous patient population. Gen Hosp Psychiatry 2001; 23:183-92. [PMID: 11543844 DOI: 10.1016/s0163-8343(01)00149-9] [Citation(s) in RCA: 202] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
This study examined the effects of mindfulness-based stress reduction (MBSR) on health-related quality of life and physical and psychological symptomatology in a heterogeneous patient population. Patients (n=136) participated in an 8-week MBSR program and were required to practice 20 min of meditation daily. Pre- and post-intervention data were collected by using the Short-Form Health Survey (SF-36), Medical Symptom Checklist (MSCL) and Symptom Checklist-90 Revised (SCL-90-R). Health-related quality of life was enhanced as demonstrated by improvement on all indices of the SF-36, including vitality, bodily pain, role limitations caused by physical health, and social functioning (all P<.01). Alleviation of physical symptoms was revealed by a 28% reduction on the MSCL (P<.0001). Decreased psychological distress was indicated on the SCL-90-R by a 38% reduction on the Global Severity Index, a 44% reduction on the anxiety subscale, and a 34% reduction on the depression subscale (all P<.0001). One-year follow-up revealed maintenance of initial improvements on several outcome parameters. We conclude that a group mindfulness meditation training program can enhance functional status and well-being and reduce physical symptoms and psychological distress in a heterogeneous patient population and that the intervention may have long-term beneficial effects.
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Affiliation(s)
- D K Reibel
- Center for Integrative Medicine, Thomas Jefferson University, Philadelphia, PA, USA.
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Pincus T, Sokka T. How can the risk of long-term consequences of rheumatoid arthritis be reduced? Best Pract Res Clin Rheumatol 2001; 15:139-70. [PMID: 11358420 DOI: 10.1053/berh.2000.0131] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The long-term natural history of rheumatoid arthritis includes early radiographic damage and progression, severe functional declines, work disability and increased mortality rates. Emerging evidence suggests that this natural history may be favourably affected by disease-modifying anti-rheumatic drugs (DMARDs), which slow the radiographic progression and functional decline. It is necessary to document both the efficacy of these drugs in randomized controlled clinical trials and their long-term effectiveness in clinical observational studies. Although a 20% improvement in inflammatory measures in the American College of Rheumatology Core Data Set (ACR20) distinguishes DMARDs from placebo in clinical trials, it is not clear that a control of inflammation at this level, or even at 50%, is sufficient to prevent long-term damage. There is limited financial support for long-term observational studies, which depend on data from the clinical experience of rheumatologists. Quantitative databases from clinical care, can be developed to document long-term outcomes in patients with early rheumatoid arthritis to include additional physical, radiographic, laboratory and patient questionnaire quantitative data. Patient self-report questionnaires appear to provide the least expensive and most effective measures toward this goal.
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Affiliation(s)
- T Pincus
- Division of Rheumatology and Immunology, Vanderbilt University School of Medicine, 203 Oxford House, Nashville, TN 37232, USA
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Lubeck DP. A review of the direct costs of rheumatoid arthritis: managed care versus fee-for-service settings. PHARMACOECONOMICS 2001; 19:811-818. [PMID: 11596833 DOI: 10.2165/00019053-200119080-00003] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
Rheumatoid arthritis (RA) is a prevalent condition associated with pain, joint destruction and morbidity. Direct healthcare costs are 2 to 3 times higher than average costs for individuals of similar age and gender. Furthermore, utilisation and costs rise with age and disease duration. Managed care has become an increasingly popular way to organise and finance the delivery of healthcare. Studies comparing the quality of care in health maintenance organisations and fee-for-service settings have found few differences in outcomes, although reduced costs have been attributed to lower hospitalisation rates in patients with RA. We reviewed 10 studies of the direct costs of RA. In 1996 dollars, direct costs ranged from $US 2,299 per person per year in Canada to $US 13,549 in a US study focusing on patients who have been hospitalised only. Surprisingly, the contributions to direct costs--hospital care, medications and physician visits--remained relatively stable over time and the setting of care. Hospitalisation costs were the highest component of direct costs accounting, generally, for 60% or more of costs while only approximately 10% of patients with RA were hospitalised. The only exception was a managed care setting where hospitalisation costs were 16% of total direct costs. In managed care settings, costs of medications were proportionately higher than in fee-for-service settings. We conclude that in studies of the direct costs of RA the components of costs have remained relatively stable over time. This may change with the development and growing use of new RA medications including cyclo-oxygenase 2 inhibitors, interleukins, cytokines, treatments that inhibit tumour necrosis factor, and combination therapies. The effectiveness of managed care in controlling direct costs needs to be evaluated in more targeted studies.
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Affiliation(s)
- D P Lubeck
- Department of Medicine, Stanford University, California 94304-5755, USA.
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Pugner KM, Scott DI, Holmes JW, Hieke K. The costs of rheumatoid arthritis: an international long-term view. Semin Arthritis Rheum 2000; 29:305-20. [PMID: 10805355 DOI: 10.1016/s0049-0172(00)80017-7] [Citation(s) in RCA: 154] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVES To review the literature on the measurable direct and indirect costs of rheumatoid arthritis (RA) in industrialized countries from a societal perspective and to develop a template for international use. METHODS A literature search using MEDLINE and other sources identified 153 relevant published articles, press releases, and so forth on the costs of RA and rheumatism from the major Organization for Economic Cooperation and Development (OECD) countries in English and other languages. Sixty-eight publications provide some economic data for analysis and are included in the bibliography. Twelve publications provide sufficiently detailed and robust information for inclusion in country overview tables. The concept of varied costs at different disease stages measured by years since diagnosis and Health Assessment Questionnaire (HAQ) scores is used to guide rational decisions in the allocation of scarce health care resources. RESULTS Direct costs increase overproportionately during the course of the disease. The most important driver of direct costs is hospitalization, especially in moderate and severe RA. Costs of medication represent a comparatively small proportion of direct costs. Indirect costs caused by work disability can be substantially higher than direct costs, particularly in working-age patients. The total costs of RA to society, and the different cost components such as direct and indirect costs, are broadly comparable in industrialized countries by their order of magnitude. Major confounding factors for international comparison are different study methodologies and patient samples. CONCLUSIONS The cost template developed in this article can be used to estimate the likely costs of RA to society for industrialized countries. It probably will underestimate indirect costs because of their incomplete coverage in the studies examined. A long-term perspective is needed for chronic diseases such as RA to assess the future effects of early interventions. Treatment in the early stages of RA that effectively reduces long-term disability has the potential to save substantial costs to society.
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Affiliation(s)
- K M Pugner
- Economists Advisory Group Ltd, London, United Kingdom.
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Mancuso CA, Paget SA, Charlson ME. Adaptations made by rheumatoid arthritis patients to continue working: A pilot study of workplace challenges and successful adaptations. ACTA ACUST UNITED AC 2000. [DOI: 10.1002/1529-0131(200004)13:2<89::aid-anr3>3.0.co;2-l] [Citation(s) in RCA: 92] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Waltz M. The disease process and utilization of health services in rheumatoid arthritis: The relative contributions of various markers of disease severity in explaining consumption patterns. ACTA ACUST UNITED AC 2000; 13:74-88. [PMID: 14635281 DOI: 10.1002/1529-0131(200004)13:2<74::aid-anr2>3.0.co;2-3] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To examine the predictive ability of a wide array of measures of disease severity in explaining Dutch and German patterns of health services utilization during a 2-year period. METHODS Slightly over 200 rheumatoid arthritis (RA) patients, 136 from a Dutch and 98 from a German outpatient clinic, supplied information on symptom and functional status, global health, and emotional and social functioning at baseline. The patients' rheumatologists provided clinical assessments of functional grade and disease activity. A questionnaire mailed twice at 12-month intervals was the source of retrospective information on physician consultations, hospitalization, and referrals for surgery and physical therapy during the previous period. Major determinants of use were studied with multivariate analyses. RESULTS German patients reported more frequent physician contacts than Dutch patients, but the volume of surgery, hospital admissions, and referrals for physical therapy did not differ between the two countries. In a hierarchical regression, the consultation rate was directly associated with pain quality and global health. Markers of RA progression were related to surgery, and the latter to volume of in-hospital care. Fatigue severity and physical disability predicted referrals for physical therapy. Patient self-management activities were only weakly associated with disease severity variables. CONCLUSION The activity and damage components of RA were related to the separate components of total health service utilization. Disease activity was the prime determinant of physician services used, and RA progression the determinant of surgical interventions and hospitalization.
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Affiliation(s)
- M Waltz
- Rheumatology Research Unit, St. Willibrord Hospital, Emmerich, Germany
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Abstract
Research over the last 20 years in Mind-Body Medicine has made significant contributions to the treatment of rheumatic disease. This approach is based on the concept that patients have the ability to influence their experience of illness through directed modification of their thoughts, emotions, and behaviors. This article finds that Mind-Body treatment results in significant, incremental symptom relief and improvement in disability status and well-being beyond that achieved through routine medical care. There is also evidence that these interventions reduce utilization of health care services, despite continuing progression of disease, a finding that has major economic implications for health policy.
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Affiliation(s)
- J E Broderick
- Department of Psychiatry and Behavioral Sciences, State University of New York at Stony Brook, USA
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46
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Abstract
Many patients with arthritis are strongly influenced by religious beliefs and often participate in religious healing activities such as prayer and worship attendance. Scientific studies demonstrate, and most patients confirm, that faith and involvement in religious healing activities can be helpful in preventing and treating illness, recovering from surgery, reducing pain, and improving quality of life. To improve the care of patients, clinicians should develop a patient-centered, spiritually sensitive form of medical practice in which religious issues are addressed gently and appropriately with dignity, respect, and integrity.
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Affiliation(s)
- D A Matthews
- Division of General Internal Medicine, Georgetown University School of Medicine, Washington, DC, USA.
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Abstract
Rheumatoid arthritis is a common cause of disability worldwide. The nature of the disability impacts on all areas of life. This chapter focuses on the nature of the disability of rheumatoid arthritis with emphasis on work disability. The various approaches for minimising the disability and rehabilitating those with disability are discussed. The tools for the assessment of disability are described and their strengths and limitations outlined.
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Affiliation(s)
- E M Shanahan
- Rheumatology Research Unit, Repatriation General Hospital, Daw Park, Australia
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Millett, Devlin, Adams, Gill. Patient participation in service improvement: the initial Measures Project experience. Health Expect 1999; 2:280-284. [PMID: 11281904 PMCID: PMC5080944 DOI: 10.1046/j.1369-6513.1999.00060.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND: 'Measures' is a 2-year, part-funded European Community project. It began in March 1998 and has, as its primary foci, the aims of continuing to improve the quality and efficiency of patient care by, (1) re-examining healthcare processes and (2) determining how best to take advantage of information technology. Central to this has been patient involvement in the project. Initially the project is focused on aspects of rheumatology, diabetes and spinal injury services based across Pinderfields and Pontefract NHS Hospitals Trust. APPROACH: Patient questionnaires, interactive cross-specialty and individual specialty focus groups have been employed. The re-enforcement of relationships with voluntary organizations has featured prominently. CONCLUSION: Initial perception from patients participating in the process is highly positive and supportive. Specific areas to be considered for change have been addressed.
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Affiliation(s)
- Millett
- Pinderfields and Pontefract NHS Trust, Wakefield, West Yorkshire, UK
| | - Devlin
- Pinderfields and Pontefract NHS Trust, Wakefield, West Yorkshire, UK
| | - Adams
- Adams Training and Advisory, Great Shefford, Hungerford UK
| | - Gill
- Pinderfields and Pontefract NHS Trust, Wakefield, West Yorkshire, UK
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De Roos AJ, Callahan LF. Differences by sex in correlates of work status in rheumatoid arthritis patients. ARTHRITIS CARE AND RESEARCH : THE OFFICIAL JOURNAL OF THE ARTHRITIS HEALTH PROFESSIONS ASSOCIATION 1999; 12:381-91. [PMID: 11081009 DOI: 10.1002/1529-0131(199912)12:6<381::aid-art6>3.0.co;2-g] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To examine differences by sex in correlates of work status in rheumatoid arthritis (RA) patients seen in rheumatology clinical settings. METHODS Associations of demographic factors, occupation, duration of RA, and scores for disease and psychological scales with work status according to sex were examined in a cross-sectional study of 960 RA patients, aged 18-64 years, of whom 451 were working and 254 were work-disabled. Comparisons of characteristics were conducted by logistic regression between working and work-disabled, and between working and not working subjects. RESULTS For both men and women, the odds of work disability increased with age, duration of RA, nonwhite race, and scores indicating high levels of functional disability, pain, and helplessness. Work-disabled women were more likely than working women to have less than a high school education or a nonprofessional occupation, compared with little association of these variables with work disability in men. Unmarried men were more likely to be work-disabled than working, while marital status was not associated with work disability in women. Differences by sex in the associations of pain and helplessness scores with work disability were also observed. Similar results were observed in associations of these characteristics when the outcome was coded as working versus not working. CONCLUSIONS These findings indicate some differences between men and women with RA in correlates of work disability that may help to more effectively target interventions. A patient's sex should be an important consideration in studies of work disability due to arthritis.
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Affiliation(s)
- A J De Roos
- Department of Epidemiology, School of Public Health, University of North Carolina at Chapel Hill 27514, USA
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Leino-Kilpi H, Maenpaa I, Katajisto J. Nursing study of the significance of rheumatoid arthritis as perceived by patients using the concept of empowerment. ACTA ACUST UNITED AC 1999. [DOI: 10.1016/s1361-3111(99)80051-x] [Citation(s) in RCA: 45] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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