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Suzuki M, Kojima T, Terabe K, Ohashi Y, Sato R, Kosugiyama H, Hasegawa J, Ohno Y, Nagai K, Ohnishi C, Sugiura H, Fujita H, Nagayoshi M, Kojima M, Asai S, Imagama S. Association between laughter, frailty, and depression in rheumatoid arthritis patients. Int J Rheum Dis 2024; 27:e15034. [PMID: 38287545 DOI: 10.1111/1756-185x.15034] [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: 09/28/2023] [Revised: 11/27/2023] [Accepted: 12/26/2023] [Indexed: 01/31/2024]
Abstract
OBJECTIVE This study aimed to determine whether there are associations between laughter, disease activity, frailty, and depression in rheumatoid arthritis (RA) patients. METHODS A total of 240 patients were included in this prospective cohort study on frailty in RA patients between March 2021 and June 2022. Patients were divided into the following four groups according to the frequency of laughter: "almost every day," "1-5 days per week," "1-3 days per month," and "never or almost never." Patient characteristics were compared among the four groups by analysis of variance. Factors associated with laughter were identified by multivariable logistic analysis. RESULTS The mean 28-joint Disease Activity Score using CRP was 1.91, with 70.7% of patients in remission and 12.6% in low disease activity. For the "almost every day" (42.5% of patients), "1-5 days per week" (40.0%), "1-3 days per month" (11.3%), and "never or almost never" (6.3%) groups, scores of the Kihon Checklist (KCL) for assessing frailty status were 3.5, 4.6, 7.3, and 8.1 (p < .001), respectively, and scores of the Beck Depression Inventory (BDI-II) were 8.4, 10.7, 15.1, and 16.5 (p < .001), respectively. Multivariable analysis revealed that KCL (OR: 0.81, 95% CI: 0.73-0.90) and BDI-II (OR: 0.91, 95% CI: 0.86-0.95) scores were independently associated with the frequency of laughter. CONCLUSION Frailty and depression were associated with laughter in RA patients with controlled disease activity. Interventions aimed at not only disease activity control but also frailty prevention may lead to a life filled with laughter.
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Affiliation(s)
- Mochihito Suzuki
- Department of Orthopedic Surgery and Rheumatology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Toshihisa Kojima
- Department of Orthopedic Surgery and Rheumatology, Nagoya University Graduate School of Medicine, Nagoya, Japan
- Department of Orthopedic Surgery, National Hospital Organization, Nagoya Medical Center, Nagoya, Japan
| | - Kenya Terabe
- Department of Orthopedic Surgery and Rheumatology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yoshifumi Ohashi
- Department of Orthopedic Surgery and Rheumatology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Ryo Sato
- Department of Orthopedic Surgery and Rheumatology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Hironobu Kosugiyama
- Department of Orthopedic Surgery and Rheumatology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Junya Hasegawa
- Department of Orthopedic Surgery and Rheumatology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yusuke Ohno
- Department of Orthopedic Surgery and Rheumatology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | | | - Chinami Ohnishi
- Department of Integrated Health Sciences, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Hideshi Sugiura
- Department of Integrated Health Sciences, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Hitomi Fujita
- Faculty of Health Sciences, Department of Rehabilitation, Nihon Fukushi University, Handa, Japan
| | - Mako Nagayoshi
- Department of Preventive Medicine, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Masayo Kojima
- Department of Frailty Research, Research Institute, National Center for Geriatrics and Gerontology, Obu, Japan
- Nagoya City University, Graduate School of Medicine, Nagoya, Japan
| | - Shuji Asai
- Department of Orthopedic Surgery and Rheumatology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Shiro Imagama
- Department of Orthopedic Surgery and Rheumatology, Nagoya University Graduate School of Medicine, Nagoya, Japan
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2
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Thiele K, Albrecht K, Zink A, Aringer M, Karberg K, Späthling-Mestekemper S, von Hinüber U, Callhoff J. Is the Rheumatoid Arthritis Impact of Disease (RAID) score a meaningful instrument for other inflammatory rheumatic diseases? A cross-sectional analysis of data from the German National Database. RMD Open 2022; 8:rmdopen-2022-002342. [PMID: 35793877 PMCID: PMC9260848 DOI: 10.1136/rmdopen-2022-002342] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Accepted: 06/09/2022] [Indexed: 11/12/2022] Open
Abstract
To analyse the performance of the rheumatoid arthritis impact of disease (RAID) score in patients with ankylosing spondylitis, polymyalgia rheumatica, systemic lupus erythematosus, primary Sjögren’s syndrome, idiopathic inflammatory myositis and systemic sclerosis, as compared with rheumatoid arthritis (RA).
Methods
A total of 12 398 patients from the German National Database were included. For each diagnosis, we calculated age-adjusted/sex-adjusted partial correlation coefficients between RAID and patient global (PtGl) health, PtGl disease activity, physician global (PhGl) disease activity, Well-Being Index (WHO-5) and EuroQoL-5 Dimensions (EQ-5D). As a measure of agreement, the mean differences between the RAID and other outcomes were compared with the respective differences for RA. The effect of each diagnosis on the difference between RAID and the other scores was assessed with linear regression, with RA as the reference.
Results
Across all diagnoses, RAID correlated strongly with PtGl health (0.71–0.83), moderately to strongly with PtGl disease activity (0.59–0.79), WHO-5 (0.65–0.81) and EQ-5D (0.68–0.73) and weakly with PhGl disease activity (0.23–0.38). Mean differences were calculated for RAID and PtGl disease activity (0 to −0.6), PtGl health (−0.4 to −0.9), WHO-5 (−0.7 to −1.3), EQ-5D (1.1 to 1.7) and PhGl disease activity (1.4 to 2.2). Discrepancies between other scores and RAID were comparable to RA. Linear regression revealed no clinically relevant effect of any of the diagnoses on the difference between RAID and the other outcomes.
Conclusion
The RAID score performs comparably across all diagnoses investigated. This supports the use of RAID for measuring the impact also of other rheumatic diseases.
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Affiliation(s)
- Katja Thiele
- Epidemiology and Health Services Research, German Rheumatism Research Center Berlin, Berlin, Germany
| | - Katinka Albrecht
- Epidemiology and Health Services Research, German Rheumatism Research Center Berlin, Berlin, Germany
| | - Angela Zink
- Epidemiology and Health Services Research, German Rheumatism Research Center Berlin, Berlin, Germany
| | - Martin Aringer
- Devision of Rheumatology, Department of Medicine III, University Medical Center and Faculty of Medicine Carl Gustav Carus at the TU Dresden, Dresden, Germany
| | - Kirsten Karberg
- Rheumatology and Internal Medicine, Practice Berlin, Berlin, Germany
| | | | | | - Johanna Callhoff
- Epidemiology and Health Services Research, German Rheumatism Research Center Berlin, Berlin, Germany.,Institute for Social Medicine, Epidemiology and Health Economics, Charité-Universitätsmedizin Berlin, Berlin, Germany
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3
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Duarte C, Ferreira RJO, Santos EJF, da Silva JAP. Treating-to-target in rheumatology: Theory and practice. Best Pract Res Clin Rheumatol 2021; 36:101735. [PMID: 34980566 DOI: 10.1016/j.berh.2021.101735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Despite its inclusion in current treatment recommendations, adherence to the treat-to-target strategy (T2T) is still poor. Among the issues are the definition(s) of target, especially the caveats of the patient global assessment (PGA), included in all recommended definitions of remission. The PGA is poorly related to inflammation, especially at low levels of disease activity, rather being a measure of the disease impact. Up to 60% of all patients otherwise in remission still score PGA at >1 and as high as 10. These patients (PGA-near-remission) are exposed to overtreatment if current recommendations are strictly followed and will continue to endure significant impact, unless adjuvant measures are implemented. A proposed method to overcome both these risks is to systematically pursue two targets: one focused on the disease process (the biological target) and another focused on the symptoms and impact (the impact target), the dual-target strategy. Candidate instruments to define each of these targets are discussed.
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Affiliation(s)
- Cátia Duarte
- Rheumatology Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal; Coimbra Institute for Clinical and Biomedical Research, Faculty of Medicine, University of Coimbra, Portugal
| | - Ricardo J O Ferreira
- Rheumatology Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal; Health Sciences Research Unit: Nursing (UICSA:E), Nursing School of Coimbra (ESEnfC), Coimbra, Portugal
| | - Eduardo J F Santos
- Health Sciences Research Unit: Nursing (UICSA:E), Nursing School of Coimbra (ESEnfC), Coimbra, Portugal; Viseu Higher School of Health, Viseu, Portugal
| | - José A P da Silva
- Rheumatology Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal; Coimbra Institute for Clinical and Biomedical Research, Faculty of Medicine, University of Coimbra, Portugal.
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4
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Melikoglu MA, Ataman S, Bodur H, Cay HF, Capkin E, Akgul O, Cevik R, Gogus F, Kamanli A, Yurdakul FG, Gurer G, Yagci I, Rezvani A, Duruoz MT, Sunar I. Clinical performance of rheumatoid arthritis impact of disease score: a real-life evidence from the multicenter nationwide registry BioStaR. Rheumatol Int 2021; 41:1971-1978. [PMID: 34559275 DOI: 10.1007/s00296-021-04992-3] [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] [Received: 07/19/2021] [Accepted: 09/08/2021] [Indexed: 10/20/2022]
Abstract
The rheumatoid arthritis impact of disease (RAID) score was developed as a patient-derived composite response index for the evaluation of the disease impact on cases with rheumatoid arthritis (RA). The aim of this study was to evaluate the psychometric properties and performance of RAID score in the real-life settings. Cases with RA from our multi-center, nationwide registry called Biologic and targeted Synthetic antirheumatic drugs Registry RA (BioStaR RA) were included in this cross-sectional observational study. Demographic data, disease duration, pain, patient's global assessment (PGA) and physician's global assessment (PhyGA) were recorded. DAS28-ESR, DAS28-CRP, the simplified disease activity index (SDAI) and the clinical disease activity index (CDAI) were assessed as disease activity evaluations. The health assessment questionnaire-disability index (HAQ-DI) and RAID were completed by all the participants. The construct validity was tested by the analysis of correlations between RAID score and scores of PGA, disease activity indexes and HAQ-DI. We also evaluated the discriminatory ability of RAID to distinguish patients with different levels of disease activity and disability and the cut-off values were calculated by ROC analysis. 585 cases with RA were included in this investigation. The RAID score was significantly positively correlated with PGA, all disease activity indexes and HAQ-DI (p < 0.001). The discriminatory ability of RAID score in different disease activity and disability groups was also demonstrated (p < 0.001). To estimate DAS28-ESR (remission/low + moderate + high), RAID score cut-off points were 2.88 (sensitivity 73%, specificity 62%), 3.23 (sensitivity 75%, specificity 60%) and 3.79 (sensitivity 74%, specificity 58%), respectively. Our study indicated that RAID was a reliable tool in daily clinical practice by presenting its correlations with disease activity and disability assessments and by showing its discriminatory ability in these parameters in the real-life experiences.
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Affiliation(s)
- Meltem Alkan Melikoglu
- Division of Rheumatology, Department of Physical Medicine and Rehabilitation, Ataturk University School of Medicine, Erzurum, Turkey.
| | - Sebnem Ataman
- Division of Rheumatology, Department of Physical Medicine and Rehabilitaton, Faculty of Medicine, Ankara University, Ankara, Turkey
| | - Hatice Bodur
- Department of Physical Medicine and Rehabilitation, Ankara City Hospital, Cankaya, Ankara, Turkey
| | - Hasan Fatih Cay
- Department of Rheumatology, Antalya Education and Research Hospital, Saglik Bilimleri University, Antalya, Turkey
| | - Erhan Capkin
- Department of Physical Medicine and Rehabilitation, Karadeniz Technical University School of Medicine, Trabzon, Turkey
| | - Ozgur Akgul
- Division of Rheumatology, Department of Physical Medicine and Rehabilitation, Manisa Celal Bayar University School of Medicine, Manisa, Turkey
| | - Remzi Cevik
- Department of Physical Medicine and Rehabilitation, Dicle University School of Medicine, Diyarbakir, Turkey
| | - Feride Gogus
- Division of Rheumatology, Department of Physical Medicine and Rehabilitation, Gazi University School of Medicine, Ankara, Turkey
| | - Ayhan Kamanli
- Division of Rheumatology, Department of Physical Medicine and Rehabilitation, Sakarya University School of Medicine, Sakarya, Turkey
| | - Fatma Gul Yurdakul
- Department of Physical Medicine and Rehabilitation, Ankara City Hospital, Cankaya, Ankara, Turkey
| | - Gulcan Gurer
- Division of Rheumatology, Department of Physical Medicine and Rehabilitation, Adnan Menderes University School of Medicine, Aydın, Turkey
| | - Ilker Yagci
- Department of Physical Medicine and Rehabilitation, Marmara University School of Medicine, Istanbul, Turkey
| | - Aylin Rezvani
- Department of Physical Medicine and Rehabilitation, İstanbul Medipol University School of Medicine, Istanbul, Turkey
| | - Mehmet Tuncay Duruoz
- Division of Rheumatology, Department of Physical Medicine and Rehabilitation, Marmara University School of Medicine, Istanbul, Turkey
| | - Ismihan Sunar
- Rheumatology Clinic, Aydin State Hospital, Aydın, Turkey
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5
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Salaffi F, Di Carlo M, Farah S, Marotto D, Atzeni F, Sarzi-Puttini P. Rheumatoid Arthritis disease activity assessment in routine care: performance of the most widely used composite disease activity indices and patient-reported outcome measures. ACTA BIO-MEDICA : ATENEI PARMENSIS 2021; 92:e2021238. [PMID: 34487094 PMCID: PMC8477094 DOI: 10.23750/abm.v92i4.10831] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Accepted: 11/30/2020] [Indexed: 11/23/2022]
Abstract
Background and aim: To evaluate the convergent and discriminative validity of many continuous composite disease activity indices and patient-reported outcome measures (PROMs) in rheumatoid arthritis (RA). Methods: In consecutive RA patients in moderate or high disease activity, according to the Simplified Disease Activity Index (SDAI) definition, were computed four additional composite disease activity indices, the 28-joint Disease Activity Score – erythrocyte sedimentation rate (DAS28-ESR), the Clinical Disease Activity Index (CDAI), the Chronic Arthritis Systemic Index (CASI), and the Mean Overall Index for RA (MOI-RA), and five PROMs, the Patients’ Activity Scale (PAS), the Rheumatoid Arthritis Impact of Disease (RAID), the 5-item RA Disease Activity Index (RADAI-5), the Routine Assessment of Patient Index Data (RAPID3), and the Clinical Arthritis Activity (PRO-CLARA). Spearman’s rho correlation coefficients were determined to assess their convergent validity, and discriminative performance was calculated by the area under the receiver-operating curve (AUC-ROC). The patients’ opinion of their symptomatic status (PASS) was used as the external criterion. Results: 246 RA patients with moderate (29.3%) or high disease activity (70.7%) have been assessed. The indices all showed a significant correlation (p <0.0001 for all). Among the composite disease activity indices, the CDAI was the one that showed the best discriminating ability compared to the PASS (AUC = 0.962), while among the PROMs the RAID was the most performing (AUC = 0.879). Conclusions: CDAI as composite index of disease activity, and RAID as PROM, are the two instruments with the best performances in relation to PASS. The use of validated disease activity measures can help in clinical practice to adopt treat-to-target strategies in RA patients. (www.actabiomedica.it)
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Affiliation(s)
- Fausto Salaffi
- Rheumatology Clinic, Ospedale "Carlo Urbani", Università Politecnica delle Marche, Jesi (Ancona), Italy.
| | - Marco Di Carlo
- Rheumatology Clinic, Ospedale "Carlo Urbani", Università Politecnica delle Marche, Jesi (Ancona), Italy .
| | - Sonia Farah
- Rheumatology Clinic, Ospedale "Carlo Urbani", Università Politecnica delle Marche, Jesi (Ancona), Italy .
| | - Daniela Marotto
- Rheumatology Unit, ATS Sardegna, P. Dettori Hospital, Tempio Pausania, Italy .
| | - Fabiola Atzeni
- Rheumatology Unit, Department of Internal and Experimental Medicine, University of Messina, Messina, Italy.
| | - Piercarlo Sarzi-Puttini
- Rheumatology Unit, Internal Medicine Department, ASST Fatebenefratelli-Sacco, Milan University School of Medicine, Milan, Italy.
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6
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Duarte C, Santos EJF, Ferreira RJO, Kvien TK, Dougados M, de Wit M, da Silva JAP, Gossec L. Validity and reliability of the EULAR instrument RAID.7 as a tool to assess individual domains of impact of disease in rheumatoid arthritis: a cross-sectional study of 671 patients. RMD Open 2021; 7:rmdopen-2020-001539. [PMID: 33547229 PMCID: PMC7871340 DOI: 10.1136/rmdopen-2020-001539] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 01/17/2021] [Accepted: 01/22/2021] [Indexed: 12/22/2022] Open
Abstract
Objective The rheumatoid arthritis impact of disease (RAID) questionnaire comprises seven patient-important domains of disease impact (pain, function, fatigue, sleep disturbance, emotional well-being, physical well-being, coping). RAID was validated as a pooled-weighted score. Its seven individual items separately could provide a valuable tool in clinical practice to guide interventions targeting the patient’s experience of the disease. The aim was to separately assess the psychometric properties of each of the seven numeric rating scale (NRS) of the RAID (RAID.7). Material and methods Post hoc analyses of data from the cross-sectional RAID study and from the Rainbow study, an open-label 12-week trial of etanercept in patients with RA. Construct validity of each NRS was assessed cross-sectionally in the RAID data set by Spearman’s correlation with the respective external instrument of reference. Using the rainbow data set, we assessed reliability through intraclass correlation coefficient between the screening and the baseline visits and responsiveness (sensitivity to change) by standardised response mean between baseline and 12 weeks. Results A total of 671 patients with RA with features of established disease were analysed, 563 and 108 from RAID and Rainbow, respectively. The NRS correlated moderately to strongly with the respective external instrument of reference (r=0.62–0.81). Reliability ranged from 0.64 (0.51–0.74) (pain) to 0.83 (0.76–0.88) (sleep disturbance) and responsiveness from 0.93 (0.73–1.13) (sleep disturbance) to 1.34 (1.01–1.64) (pain). Conclusion The separate use of the individual NRS of RAID (RAID.7) is valid, feasible, reliable and sensitive to change, representing an opportunity to improve the assessment and treatment of disease impact with minimal questionnaire burden. Trial registration number NCT00768053.
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Affiliation(s)
- Catia Duarte
- Rheumatology Department, Centro Hospitalar e Universitario de Coimbra EPE, Coimbra, Portugal .,iCBR-Coimbra Institute for Clinical and Biomedical Research, University of Coimbra Faculty of Medicine, Coimbra, Portugal
| | - Eduardo José Ferreira Santos
- Rheumatology Department, Centro Hospitalar e Universitario de Coimbra EPE, Coimbra, Portugal.,Health Sciences Research Unit Nursing, Higher School of Nursing of Coimbra, Coimbra, Coimbra, Portugal.,Abel Salazar Institute of Biomedical Sciences, University of Porto, Porto, Portugal
| | - Ricardo J O Ferreira
- Rheumatology Department, Centro Hospitalar e Universitario de Coimbra EPE, Coimbra, Portugal.,Health Sciences Research Unit Nursing, Higher School of Nursing of Coimbra, Coimbra, Coimbra, Portugal
| | - Tore K Kvien
- Rheumatology Department, Diakonhjemmet Hospital, Oslo, Norway
| | - Maxime Dougados
- Université de Paris, Paris, France.,Rheumatology Department, Hôpital Cochin, AP-HP, Paris, France.,INSERM (U1153): Clinical Epidemiology and biostatistics, PRES Sorbonne Paris-Cité, Paris, France
| | - Maarten de Wit
- Patient Research Partner, EULAR, Amsterdam, The Netherlands
| | - Jose Antonio Pereira da Silva
- Rheumatology Department, Centro Hospitalar e Universitario de Coimbra EPE, Coimbra, Portugal.,iCBR-Coimbra Institute for Clinical and Biomedical Research, University of Coimbra Faculty of Medicine, Coimbra, Portugal
| | - Laure Gossec
- INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, INSERM, Sorbonne Université, Paris, France.,Rheumatology Department, Hopital Universitaire Pitie Salpetriere, AP-HP, Paris, France
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7
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Physical activity and rheumatoid arthritis: need for practical, precise, and personalized support - Results from an online survey. Joint Bone Spine 2021; 89:105255. [PMID: 34325048 DOI: 10.1016/j.jbspin.2021.105255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Accepted: 06/30/2021] [Indexed: 11/23/2022]
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8
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Tran F, Schirmer JH, Ratjen I, Lieb W, Helliwell P, Burisch J, Schulz J, Schrinner F, Jaeckel C, Müller-Ladner U, Schreiber S, Hoyer BF. Patient Reported Outcomes in Chronic Inflammatory Diseases: Current State, Limitations and Perspectives. Front Immunol 2021; 12:614653. [PMID: 33815372 PMCID: PMC8012677 DOI: 10.3389/fimmu.2021.614653] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 03/02/2021] [Indexed: 01/20/2023] Open
Abstract
Chronic inflammatory diseases (CID) are emerging disorders which do not only affect specific organs with respective clinical symptoms but can also affect various aspects of life, such as emotional distress, anxiety, fatigue and quality of life. These facets of chronic disease are often not recognized in the therapy of CID patients. Furthermore, the symptoms and patient-reported outcomes often do not correlate well with the actual inflammatory burden. The discrepancy between patient-reported symptoms and objectively assessed disease activity can indeed be instructive for the treating physician to draw an integrative picture of an individual's disease course. This poses a challenge for the design of novel, more comprehensive disease assessments. In this mini-review, we report on the currently available patient-reported outcomes, the unmet needs in the field of chronic inflammatory diseases and the challenges of addressing these.
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Affiliation(s)
- Florian Tran
- Institute of Clinical Molecular Biology, Christian-Albrechts-University Kiel, Kiel, Germany
- Department of Internal Medicine I, University Medical Center Schleswig-Holstein, Kiel, Germany
| | - Jan Henrik Schirmer
- Department of Internal Medicine I, University Medical Center Schleswig-Holstein, Kiel, Germany
| | - Ilka Ratjen
- Institute of Epidemiology and Biobank PopGen, Christian-Albrechts-University of Kiel, Kiel, Germany
| | - Wolfgang Lieb
- Institute of Epidemiology and Biobank PopGen, Christian-Albrechts-University of Kiel, Kiel, Germany
| | - Philip Helliwell
- UK and Leeds Musculoskeletal Biomedical Research Unit, Leeds Teaching Hospitals NHS Trust, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, United Kingdom
| | - Johan Burisch
- Gastrounit, Medical Section, Hvidovre University Hospital, Hvidovre, Denmark
| | - Juliane Schulz
- Department of Internal Medicine I, University Medical Center Schleswig-Holstein, Kiel, Germany
- Department of Oral and Maxillofacial Surgery, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Florian Schrinner
- Institute of Clinical Molecular Biology, Christian-Albrechts-University Kiel, Kiel, Germany
| | - Charlot Jaeckel
- Institute of Clinical Molecular Biology, Christian-Albrechts-University Kiel, Kiel, Germany
| | - Ulf Müller-Ladner
- Department of Rheumatology and Clinical Immunology, Justus-Liebig-University Giessen, Kerckhoff-Klinik GmbH, Giessen, Germany
| | - Stefan Schreiber
- Department of Internal Medicine I, University Medical Center Schleswig-Holstein, Kiel, Germany
| | - Bimba F. Hoyer
- Department of Internal Medicine I, University Medical Center Schleswig-Holstein, Kiel, Germany
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9
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Salaffi F, Di Carlo M, Bazzichi L, Atzeni F, Govoni M, Biasi G, Di Franco M, Mozzani F, Gremese E, Dagna L, Batticciotto A, Fischetti F, Giacomelli R, Guiducci S, Guggino G, Bentivegna M, Gerli R, Salvarani C, Bajocchi G, Ghini M, Iannone F, Giorgi V, Farah S, Cirillo M, Bonazza S, Barbagli S, Gioia C, Santilli D, Capacci A, Cavalli G, Carubbi F, Nacci F, Riccucci I, Sinigaglia L, Masullo M, Polizzi BM, Cutolo M, Sarzi-Puttini P. Definition of fibromyalgia severity: findings from a cross-sectional survey of 2339 Italian patients. Rheumatology (Oxford) 2021; 60:728-736. [PMID: 32793982 DOI: 10.1093/rheumatology/keaa355] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Revised: 05/20/2020] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVE To establish optimal cut-off values for the scores of the revised Fibromyalgia Impact Questionnaire (FIQR), the modified Fibromialgia Assessment Scale (FAS 2019mod), and the Polysymptomatic Distress Scale (PDS) in order to distinguish five levels of FM disease severity. METHODS Consecutive FM patients were evaluated with the three clinimetric indices, and each patient was required to answer the anchor question: 'In general, would you say your health is 1 = very good, 2 = good, 3 = fair, 4 = poor, or 5 = very poor?'-which represented the external criterion. Cut-off points were established through the interquartile reconciliation approach. RESULTS The study sample consisted of 2181 women (93.2%) and 158 men (6.8%), with a mean age of 51.9 (11.5) years, and mean disease duration was 7.3 (6.9) years. The overall median FIQR, FAS 2019 mod and PDS scores (25th-75th percentiles) were respectively 61.16 (41.16-77.00), 27.00 (19.00-32.00) and 19.0 (13.00-24.00). Reconciliation of the mean 75th and 25th percentiles of adjacent categories defined the severity states for FIQR: 0-23 for remission, 24-40 for mild disease, 41-63 for moderate disease, 64-82 for severe disease and >83 for very severe disease; FAS 2019 mod: 0-12 for remission, 13-20 for mild disease, 21-28 for moderate disease, 29-33 for severe disease and >33 for very severe disease; PDS: 0-5 for remission, 6-15 for mild disease, 16-20 for moderate disease, 21-25 for severe disease and >25 for very severe disease. CONCLUSIONS Disease severity cut-offs can represent an important improvement in interpreting FM.
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Affiliation(s)
- Fausto Salaffi
- Rheumatology Clinic, Dipartimento di Scienze Cliniche e Molecolari, Università Politecnica delle Marche, Jesi (Ancona), Italy
| | - Marco Di Carlo
- Rheumatology Clinic, Dipartimento di Scienze Cliniche e Molecolari, Università Politecnica delle Marche, Jesi (Ancona), Italy
| | | | - Fabiola Atzeni
- Rheumatology Unit, Department of Internal Medicine, University of Messina, Messina, Italy
| | - Marcello Govoni
- Rheumatology, Department of Medical Sciences, University of Ferrara and Azienda Ospedaliera-Universitaria di Ferrara, Ferrara, Italy
| | - Giovanni Biasi
- Rheumatology Unit, Department of Medical Sciences, Surgery and Neurosciences, University of Siena, Siena, Italy
| | - Manuela Di Franco
- Department of Clinical Internal, Anesthesiological and Cardiovascular Sciences Rheumatology Unit- Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Flavio Mozzani
- Internal Medicine and Rheumatology Unit, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
| | - Elisa Gremese
- UOC Reumatologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Lorenzo Dagna
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases (UnIRAR), IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Alberto Batticciotto
- Rheumatology Unit, Internal Medicine Department, ASST Settelaghi, Ospedale Di Circolo - Fondazione Macchi, Varese, Italy
| | - Fabio Fischetti
- Department of Medical Sciences, University of Trieste, UCO Medicina Clinica (SSD Reumatologia), Trieste, Italy
| | - Roberto Giacomelli
- Clinical Unit of Rheumatology, School of Medicine, University of L'Aquila, L'Aquila, Italy
| | - Serena Guiducci
- Department of Experimental and Clinical Medicine, Divisions of Internal Medicine and Rheumatology AOUC, University of Florence, Florence, Italy
| | - Giuliana Guggino
- Department of Health Promotion Sciences, Maternal and Infant Care, Internal Medicine and Medical Specialties, University of Palermo, Palermo, Italy
| | - Mario Bentivegna
- Integrated Reference Center of Rheumatology, ASP 7, Scicli Hospital, Ragusa, Italy
| | - Roberto Gerli
- Rheumatology Unit, Department of Medicine, University of Perugia, Perugia, Italy
| | - Carlo Salvarani
- University of Modena and Reggio Emilia, Azienda USL-IRCCS di Reggio Emilia, Modena, Italy
| | - Gianluigi Bajocchi
- Rheumatology Unit, S. Maria Hospital-USL, IRCCS Institute, Reggio Emilia, Italy
| | - Marco Ghini
- Rheumatology Unit, Azienda USL di Modena, Modena, Italy
| | - Florenzo Iannone
- Rheumatology Unit, Department of Emergency and Organ Transpantations, University of Bari, Bari, Italy
| | - Valeria Giorgi
- Rheumatology Unit, Internal Medicine Department, ASST Fatebenefratelli-Sacco, Milan State University School of Medicine, Milan, Italy
| | - Sonia Farah
- Rheumatology Clinic, Dipartimento di Scienze Cliniche e Molecolari, Università Politecnica delle Marche, Jesi (Ancona), Italy
| | - Mariateresa Cirillo
- Rheumatology Unit, Department of Internal Medicine, University of Messina, Messina, Italy
| | - Sara Bonazza
- Rheumatology, Department of Medical Sciences, University of Ferrara and Azienda Ospedaliera-Universitaria di Ferrara, Ferrara, Italy
| | - Stefano Barbagli
- Rheumatology Unit, Department of Medical Sciences, Surgery and Neurosciences, University of Siena, Siena, Italy
| | - Chiara Gioia
- Department of Clinical Internal, Anesthesiological and Cardiovascular Sciences Rheumatology Unit- Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Daniele Santilli
- Internal Medicine and Rheumatology Unit, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
| | - Annunziata Capacci
- UOC Reumatologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Giulio Cavalli
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases (UnIRAR), IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Francesco Carubbi
- Clinical Unit of Rheumatology, School of Medicine, University of L'Aquila, L'Aquila, Italy
| | - Francesca Nacci
- Department of Experimental and Clinical Medicine, Divisions of Internal Medicine and Rheumatology AOUC, University of Florence, Florence, Italy
| | - Ilenia Riccucci
- Rheumatology Unit, Department of Medicine, University of Perugia, Perugia, Italy
| | | | - Maurizio Masullo
- Ministry of Health, General Directorate of Health Care, Rome, Italy
| | | | - Maurizio Cutolo
- Research Laboratory and Division of Clinical Rheumatology, Department of Internal Medicine, IRCCS San Martino, University of Genova, Genova, Italy
| | - Piercarlo Sarzi-Puttini
- Rheumatology Unit, Internal Medicine Department, ASST Fatebenefratelli-Sacco, Milan State University School of Medicine, Milan, Italy
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Abstract
PURPOSE OF REVIEW Severe acute respiratory syndrome-related coronavirus 2 (SARS-CoV-2) emerged in December 2019, rapidly reaching global pandemic proportions. Coronavirus disease 2019 (COVID-19) has presented unique challenges to the rheumatology community. It is known that many individuals with rheumatic disease are at increased risk of severe disease from other infections, sparking a similar fear for COVID-19. In addition, medications routinely used in rheumatology practice are being trialled as treatments, with the potential for drug shortages for rheumatology patients. RECENT FINDINGS Underlying comorbidities and active disease are associated with worse COVID-19 outcomes in patients with rheumatic disease. Tocilizumab and hydroxychloroquine have not proven to be effective treatments in the management of COVID-19. Telehealth has become an essential tool for the rheumatology community to monitor patients during the pandemic. In this article, we summarise the available COVID-19 evidence that is of relevance to the rheumatology community. We discuss the risk of contracting COVID-19 in individuals with rheumatic disease, along with presenting features and clinical outcomes. We provide an overview of the treatments for COVID-19 which have significance for rheumatology. We highlight published recommendations which can guide our management of rheumatic disease populations during this pandemic. Finally, we discuss the challenges in delivering effective care virtually and present methods and tools which could be adapted for use.
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Affiliation(s)
| | - Sinead Maguire
- Department of Rheumatology, St James' Hospital, Dublin, Ireland
| | - Nigil Haroon
- Medicine and Rheumatology, University of Toronto, Toronto, Ontario, Canada
- University Health Network and Mount Sinai Hospital, Scientist, Krembil Research Institute, Toronto, Ontario, Canada
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11
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Nikiphorou E, Jacklin H, Bosworth A, Jacklin C, Kiely P. Disease impact of rheumatoid arthritis in patients not treated with advanced therapies; survey findings from the National Rheumatoid Arthritis Society. Rheumatol Adv Pract 2021; 5:rkaa080. [PMID: 34322656 PMCID: PMC8314206 DOI: 10.1093/rap/rkaa080] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Revised: 12/03/2020] [Indexed: 11/21/2022] Open
Abstract
Objective The aim was to reveal the everyday impact of living with RA in people not treated with advanced therapies (i.e. biologic or targeted synthetic DMARDs). Methods People with RA, with disease duration >2 years, not currently treated with advanced therapies, completed an online survey promoted by the National Rheumatoid Arthritis Society. Items covered demographics, current treatment, RA flare frequency, the Rheumatoid Arthritis Impact of Disease (RAID) tool and questions reflecting work status and ability. Descriptive and multivariable regression analyses were performed. Results There were 612 responses from patients having a mean age of 59 years, 88% female, 37.7% with disease duration 2–5 years and 27.9% with disease duration 5–10 years. In the last year, 90% reported an RA flare, with more than six flares in 23%. A RAID patient acceptable state was recorded in 12.4%. Each of the seven domains was scored in the high range by >50% respondents; 74.3% scored sleep problems and 72% fatigue in the high range. A need to change working hours was reported by 70%. Multivariable analyses revealed that increasing difficulties with daily physical activities, reduced emotional and physical well-being in the past week were all significantly associated with pain, number of flares and ability to cope (P < 0.005). The RAID score was significantly predictive of the number of flares. Conclusion Patients not currently treated with advanced therapies experience profound difficulties in everyday living with RA, across a broad range of measures. We advocate that patient-reported measures be used to facilitate holistic care, addressing inflammation and other consequences of RA on everyday life.
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Affiliation(s)
- Elena Nikiphorou
- Department of Inflammation Biology, Centre for Rheumatic Diseases, School of Immunology and Microbial Sciences, Faculty of Life Sciences & Medicine
| | | | | | | | - Patrick Kiely
- Department of Rheumatology, St George's University Hospitals NHS Foundation Trust
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12
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Risk factors associated with fatigue in patients with rheumatoid arthritis. Joint Bone Spine 2020; 87:501-502. [DOI: 10.1016/j.jbspin.2020.03.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Accepted: 03/18/2020] [Indexed: 11/19/2022]
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13
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Renskers L, Rongen-van Dartel SA, Huis AM, van Riel PL. Patients' experiences regarding self-monitoring of the disease course: an observational pilot study in patients with inflammatory rheumatic diseases at a rheumatology outpatient clinic in The Netherlands. BMJ Open 2020; 10:e033321. [PMID: 32819925 PMCID: PMC7440711 DOI: 10.1136/bmjopen-2019-033321] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVES Self-monitoring the disease course is a relatively new concept in the management of patients with inflammatory rheumatic diseases (IRDs). The aims of this pilot study were to obtain patients' experiences with online self-monitoring, to assess information about the agreement between the disease course assessed with patient-reported outcome measures (PROMs) and an objectively measured Disease Activity Score 28 (DAS28) by the rheumatologist, and to assess adherence to predetermined PROM frequency intervals. DESIGN Observational study using qualitative and quantitative methods. SETTING The rheumatology outpatient clinic of a teaching hospital in The Netherlands (secondary care). PARTICIPANTS 47 patients with an IRD who regularly attended the outpatient clinic. METHODS Patients completed PROMs by using an online self-monitoring program. Their experiences regarding self-monitoring were qualitatively assessed through a focus group discussion and telephone interviews using a thematic analysis approach. Adherence to the predefined PROM frequency (completed PROM assessments within the predetermined frequency) and the agreement between the DAS28 course and PROM values (Rheumatoid Arthritis Disease Activity Index-5 and the Rheumatoid Arthritis Impact of Disease (RAID)) were quantitatively assessed using descriptives. RESULTS Forty-seven patients participated, most of them diagnosed with rheumatoid arthritis (n=38, 80.9%). Three themes were identified: knowledge about and insight into the disease (activity), patient-professional interaction and functionality of the program. Mean adherence to the predetermined PROM frequency was 68.1%. The RAID showed the best agreement with the DAS28 course. Mean participation time was 350 days. CONCLUSION Patients were predominantly positive about online self-monitoring. They indicated that they gained more knowledge about their disease, felt less dependent on the healthcare professional and valued the insight into their long-term disease course. Barriers were mostly related to technical factors. Patients were able to and willing to self-monitor their disease, which could contribute to a more efficient allocation of outpatient consultations in the future.
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Affiliation(s)
- Lisanne Renskers
- IQ Healthcare, Radboudumc, Nijmegen, Gelderland, The Netherlands
| | - Sanne Aa Rongen-van Dartel
- IQ Healthcare, Radboudumc, Nijmegen, Gelderland, The Netherlands
- Rheumatology, Bernhoven Hospital Location Uden, Uden, Noord-Brabant, The Netherlands
| | - Anita Mp Huis
- IQ Healthcare, Radboudumc, Nijmegen, Gelderland, The Netherlands
| | - Piet Lcm van Riel
- IQ Healthcare, Radboudumc, Nijmegen, Gelderland, The Netherlands
- Rheumatology, Bernhoven Hospital Location Uden, Uden, Noord-Brabant, The Netherlands
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14
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Latocha KM, Løppenthin KB, Østergaard M, Jennum PJ, Christensen R, Hetland M, Røgind H, Lundbak T, Midtgaard J, Esbensen BA. Cognitive behavioural therapy for insomnia in patients with rheumatoid arthritis: protocol for the randomised, single-blinded, parallel-group Sleep-RA trial. Trials 2020; 21:440. [PMID: 32471477 PMCID: PMC7257190 DOI: 10.1186/s13063-020-04282-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2020] [Accepted: 03/26/2020] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND More than half of patients with rheumatoid arthritis complain of insomnia, which is predominantly treated with hypnotic drugs. However, cognitive behavioural therapy for insomnia is recommended as the first-line treatment in international guidelines on sleep. Patients with rheumatoid arthritis suffer from debilitating symptoms, such as fatigue and pain, which can also be linked to sleep disturbance. It remains to be determined whether cognitive behavioural therapy for insomnia can be effective in patients with rheumatoid arthritis. The aim of the Sleep-RA trial is to investigate the efficacy of cognitive behavioural therapy for insomnia on sleep and disease-related symptoms in patients with rheumatoid arthritis. The primary objective is to compare the effect of cognitive behavioural therapy for insomnia relative to usual care on changes in sleep efficiency from baseline to week 7 in patients with rheumatoid arthritis. The key secondary objectives are to compare the effect of cognitive behavioural therapy for insomnia relative to usual care on changes in sleep onset latency, wake after sleep onset, total sleep time, insomnia, sleep quality, fatigue, impact of rheumatoid arthritis and depressive symptoms from baseline to week 26 in patients with rheumatoid arthritis. METHODS The Sleep-RA trial is a randomised controlled trial with a two-group parallel design. Sixty patients with rheumatoid arthritis, insomnia and low-to-moderate disease activity will be allocated 1:1 to treatment with cognitive behavioural therapy for insomnia or usual care. Patients in the intervention group will receive nurse-led, group-based cognitive behavioural therapy for insomnia once a week for 6 weeks. Outcome assessments will be carried out at baseline, after treatment (week 7) and at follow-up (week 26). DISCUSSION Data on treatment of insomnia in patients with rheumatoid arthritis are sparse. The Sleep-RA trial is the first randomised controlled trial to investigate the efficacy of cognitive behavioural therapy for insomnia in patients with rheumatoid arthritis. Because symptoms of rheumatoid arthritis and insomnia have many similarities, we also find it relevant to investigate the secondary effects of cognitive behavioural therapy for insomnia on fatigue, impact of rheumatoid arthritis, depressive symptoms, pain, functional status, health-related quality of life and disease activity. If we find cognitive behavioural therapy for insomnia to be effective in patients with rheumatoid arthritis this will add weight to the argument that evidence-based non-pharmacological treatment for insomnia in rheumatological outpatient clinics is eligible in accordance with the existing international guidelines on sleep. TRIAL REGISTRATION ClinicalTrials.gov: NCT03766100. Registered on 30 November 2018.
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Affiliation(s)
- K M Latocha
- Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Rigshospitalet, Glostrup, Denmark.
| | - K B Løppenthin
- Department of Oncology, Research unit for Cancer Late Effect, CASTLE, Rigshospitalet, Copenhagen, Denmark
| | - M Østergaard
- Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Rigshospitalet, Glostrup, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - P J Jennum
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Danish Center for Sleep Medicine, Department of Clinical Neurophysiology, Rigshospitalet, Glostrup, Denmark
| | - R Christensen
- Musculoskeletal Statistics Unit, The Parker Institute, Bispebjerg and Frederiksberg Hospital, Frederiksberg, Denmark
- Research Unit of Rheumatology, Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - M Hetland
- Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Rigshospitalet, Glostrup, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - H Røgind
- Center for Rheumatology and Spine Diseases, Rigshospitalet, Glostrup, Denmark
| | - T Lundbak
- Center for Rheumatology and Spine Diseases, Rigshospitalet, Glostrup, Denmark
| | - J Midtgaard
- The University Hospitals Centre for Health Research, Rigshospitalet, Copenhagen, Denmark
- Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - B A Esbensen
- Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Rigshospitalet, Glostrup, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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15
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Mistry J, Sharif M, Prideaux A, Smith C, Sumbwanyambe M, Sibley M, Carpenter L, Sweeney M, Kiely P. Use of rheumatoid arthritis impact of disease (RAID) in routine care; identification of DAS28 remission and unmet patient-reported outcomes. Rheumatol Adv Pract 2020; 4:rkaa013. [PMID: 32685911 PMCID: PMC7359769 DOI: 10.1093/rap/rkaa013] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Accepted: 04/16/2020] [Indexed: 02/02/2023] Open
Abstract
Objective The aim was to assess how the patient-reported outcome RA impact of disease (RAID) relates to DAS28 categories in routine care, its utility in identifying patients in DAS28 remission (RDAS) or low disease activity (LDAS) and the burden of unmet patient-reported needs in those achieving RDAS/LDAS. Methods DAS28 and RAID scores were collected from patients with established RA attending for routine review. The relationship between RAID and DAS28 was assessed with univariate pairwise correlation and mixed-effects linear regression analyses. RAID <2 was defined as a patient-acceptable state. Results One hundred and ninety-eight patients were assessed, with 220 observations, using DAS28-CRP categories: 47.5% RDAS, 14.1% LDAS, 31.8% moderate DAS (MDAS) and 6.6% high DAS (HDAS). Both patient visual analog scale score and tender joint count exhibited a high statistical association with RAID using linear regression (P < 0.0001). The mean RAID score per DAS28-CRP category was RDAS 1.84, LDAS 4.78, MDAS 5.60 and HDAS 7.68, with a statistically significant increase in RAID per unit increase in DAS-CRP or DAS28-ESR on linear regression (P < 0.001). Of 66 patients with RAID <2, 64 (97%) were in RDAS and 65 (98.5%) in RDAS/LDAS. Of 134 patients in RDAS/LDAS, RAID was ≥2 in 69 (51.5%), with fatigue and sleep being the worst-scoring domains. Conclusion RAID functions well as a patient-reported outcome in routine care. Patients with RAID <2 have a high likelihood of being in RDAS/LDAS and, if pre-screened, could avoid a clinic visit. Analysis of RAID domains provides individualized targets for holistic care in RA management, with fatigue and sleep problems dominating unmet needs in those in RDAS/LDAS.
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Affiliation(s)
- Jatin Mistry
- Rheumatology, St George's University Hospitals NHS Foundation Trust, London
| | - Mohammed Sharif
- Rheumatology, St George's University Hospitals NHS Foundation Trust, London
| | - Amy Prideaux
- School of Medicine, University of Cardiff, Cardiff
| | - Catherine Smith
- Rheumatology, St George's University Hospitals NHS Foundation Trust, London
| | | | - Margaret Sibley
- Rheumatology, St George's University Hospitals NHS Foundation Trust, London
| | - Lewis Carpenter
- Department of Inflammation Biology, Institute for Psychiatry, Psychology and Neuroscience, King's College, London
| | - Melissa Sweeney
- Department of Inflammation Biology, Institute for Psychiatry, Psychology and Neuroscience, King's College, London
| | - Patrick Kiely
- Rheumatology, St George's University Hospitals NHS Foundation Trust, London.,Institute of Medical and Biomedical Education, St George's University of London, London, UK
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Salaffi F, Carotti M, Di Carlo M, Sessa F, Malavolta N, Polonara G, Giovagnoni A. Craniocervical junction involvement in musculoskeletal diseases: an area of close collaboration between rheumatologists and radiologists. Radiol Med 2020; 125:654-667. [DOI: 10.1007/s11547-020-01156-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Accepted: 02/10/2020] [Indexed: 02/07/2023]
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17
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Radawski C, Genovese MC, Hauber B, Nowell WB, Hollis K, Gaich CL, DeLozier AM, Gavigan K, Reynolds M, Cardoso A, Curtis JR. Patient Perceptions of Unmet Medical Need in Rheumatoid Arthritis: A Cross-Sectional Survey in the USA. Rheumatol Ther 2019; 6:461-471. [PMID: 31385264 PMCID: PMC6702617 DOI: 10.1007/s40744-019-00168-5] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Indexed: 12/22/2022] Open
Abstract
INTRODUCTION Many rheumatoid arthritis (RA) patients do not achieve their treatment goals and experience symptoms that affect psychosocial outcomes and daily activities. This study aimed to identify and quantify the unmet needs perceived by US patients with RA currently taking a disease-modifying antirheumatic drug (DMARD). METHODS A cross-sectional, web-based survey was conducted with RA patients recruited through CreakyJoints, an online patient support community, and ArthritisPower®, an online patient research registry, from December 2017 to January 2018. Participant patients were aged ≥ 21 years, failed ≥ 1 DMARDs, and were receiving their current DMARD(s) for ≥ 6 months; they answered 50 questions about treatment history, RA symptoms, and flares and completed the Rheumatoid Arthritis Impact of Disease (RAID) questionnaire and the Treatment Satisfaction Questionnaire for Medication (TSQM). Treatment satisfaction was defined by a TSQM global satisfaction score ≥ 80. RESULTS Of 415 patients screened, 258 (62%) were eligible and completed the survey; 87% were women, and 87% white, with mean (SD) age of 54.5 (11.4) years. A total of 232 patients (90%) had current or past biologic DMARD (bDMARD) use, with 67% currently on a bDMARD, 65% on ≥ 1 conventional synthetic DMARD, and 40% on methotrexate. Forty-three percent of patients reported daily/almost daily use of prescription pain medications, and 44% reported a current flare. Mean (SD) TSQM scores were 59 [20] for effectiveness, 59 [26] for side effects, 72 [18] for convenience, and 65 [21] for global satisfaction. The mean (SD) RAID overall score was 5.1 (2.0) on a 0-10 scale. Only 26% (67 patients) were satisfied with their RA treatment. Patients not satisfied with treatment reported higher RAID scores overall and by domain, and approximately half reported a current flare. CONCLUSIONS Results from this real-world survey suggest that three-fourths of RA patients are not satisfied with treatments, which include bDMARDs. Patients continued to experience bothersome symptoms that impacted their daily activities and life. There remains a need for improved disease management among currently treated RA patients. FUNDING Eli Lilly and Company (Indianapolis, IN, USA).
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Affiliation(s)
| | | | - Brett Hauber
- RTI Health Solutions, Research Triangle Park, NC, USA
| | | | - Kelly Hollis
- RTI Health Solutions, Research Triangle Park, NC, USA
| | | | | | - Kelly Gavigan
- Global Healthy Living Foundation, Upper Nyack, NY, USA
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18
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Ng KJ, Huang KY, Tung CH, Hsu BB, Wu CH, Koo M, Hsu CW, Lu MC, Lai NS. Modified rheumatoid arthritis impact of disease (RAID) score, a potential tool for depression and anxiety screening for rheumatoid arthritis. Joint Bone Spine 2019; 86:805-807. [PMID: 31067501 DOI: 10.1016/j.jbspin.2019.04.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2019] [Accepted: 04/23/2019] [Indexed: 02/04/2023]
Affiliation(s)
- Khai-Jing Ng
- Division of Allergy, Immunology and Rheumatology, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi, Taiwan
| | - Kuang-Yung Huang
- Division of Allergy, Immunology and Rheumatology, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi, Taiwan; School of Medicine, Tzu Chi University, Hualien, Taiwan
| | - Chien-Hsueh Tung
- Division of Allergy, Immunology and Rheumatology, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi, Taiwan; School of Medicine, Tzu Chi University, Hualien, Taiwan
| | - Bao-Bao Hsu
- Division of Allergy, Immunology and Rheumatology, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi, Taiwan
| | - Cheng-Han Wu
- Division of Allergy, Immunology and Rheumatology, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi, Taiwan
| | - Malcolm Koo
- Graduate Institute of Long-term Care, Tzu Chi University of Science and Technology, Hualien, Taiwan; Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Chia-Wen Hsu
- Department of Medical Research, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi, Taiwan
| | - Ming-Chi Lu
- Division of Allergy, Immunology and Rheumatology, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi, Taiwan; School of Medicine, Tzu Chi University, Hualien, Taiwan.
| | - Ning-Sheng Lai
- Division of Allergy, Immunology and Rheumatology, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi, Taiwan; School of Medicine, Tzu Chi University, Hualien, Taiwan.
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19
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Gossec L, Strand V, Proudfoot C, Chen CI, Guillonneau S, Kimura T, van Hoogstraten H, Mangan E, Reaney M. Effects of Sarilumab on Rheumatoid Arthritis as Reported by Patients Using the Rheumatoid Arthritis Impact of Disease Scale. J Rheumatol 2019; 46:1259-1267. [PMID: 30877216 DOI: 10.3899/jrheum.180904] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/06/2019] [Indexed: 01/20/2023]
Abstract
OBJECTIVE We evaluated the effect of sarilumab on patient-perceived impact of rheumatoid arthritis (RA) using the 7-domain RA Impact of Disease (RAID) scale. METHODS Two phase III, randomized, controlled trials of sarilumab in patients with active, longstanding RA were analyzed: (1) sarilumab 150 mg and 200 mg every 2 weeks plus conventional synthetic disease-modifying antirheumatic drugs (+csDMARD) versus placebo + csDMARD [TARGET (NCT01709578)]; and (2) sarilumab 200 mg versus adalimumab (ADA) 40 mg monotherapy [MONARCH (NCT02332590)]. Least-squares mean (LSM) differences in RAID total score (range 0-10) and 7 key RA symptoms, including pain and fatigue (baseline to Weeks 12 and 24), were compared. "Responders" by RAID total score were defined by improvements from baseline ≥ minimal clinically important difference (MCID), and ≥ patient-acceptable symptom-state (PASS) at endpoint. RESULTS Sarilumab 150 mg and 200 mg + csDMARD were nominally superior (p < 0.05) versus placebo + csDMARD and 200 mg sarilumab versus ADA 40 mg in LSM differences for RAID total score at weeks 12 (-0.93 and -1.13; -0.49, respectively) and 24 (-0.75 and -1.01; -0.78), and all effects of RA (except functional impairment in MONARCH Week 12). Effects were greater in physical domains (e.g., pain) than mental domains (e.g., emotional well-being). More patients receiving sarilumab versus placebo or ADA reported improvements ≥ MCID and PASS in total RAID scores at both assessments. CONCLUSION Based on the RAID, sarilumab + csDMARD or as monotherapy reduced the effect of RA on patients' lives to a greater extent than placebo + csDMARD or ADA monotherapy. (ClinicalTrials.gov: NCT01709578 and NCT02332590).
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Affiliation(s)
- Laure Gossec
- From the Sorbonne Université, Institut Pierre Louis d'Epidémiologie et de Santé Publique (UMRS 1136), GRC-UPMC 08 (EEMOIS); Rheumatology Department, Hôpital Pitié Salpêtrière, AP-HP, Paris, France; Stanford University, Palo Alto, California, USA; Sanofi, Guildford, UK; Regeneron Pharmaceuticals Inc., Tarrytown, New York, USA; Sanofi, Paris, France; Sanofi, Bridgewater, New Jersey, USA.,L. Gossec, MD, PhD, Sorbonne Université and Rheumatology Department, Hôpital Pitié Salpêtrière, Institut Pierre Louis d'Epidémiologie et de Santé Publique (UMRS 1136), GRC-UPMC 08 (EEMOIS); V. Strand, MD, Stanford University; C. Proudfoot, PhD, Novartis; C.I. Chen, MPH, Regeneron Pharmaceuticals Inc.; S. Guillonneau, MSc, Sanofi; T. Kimura, MSc, Regeneron Pharmaceuticals Inc.; H. van Hoogstraten, MD/PhD, Sanofi; E. Mangan, PhD, Regeneron Pharmaceuticals Inc.; M. Reaney, MSc, formerly of Sanofi
| | - Vibeke Strand
- From the Sorbonne Université, Institut Pierre Louis d'Epidémiologie et de Santé Publique (UMRS 1136), GRC-UPMC 08 (EEMOIS); Rheumatology Department, Hôpital Pitié Salpêtrière, AP-HP, Paris, France; Stanford University, Palo Alto, California, USA; Sanofi, Guildford, UK; Regeneron Pharmaceuticals Inc., Tarrytown, New York, USA; Sanofi, Paris, France; Sanofi, Bridgewater, New Jersey, USA.,L. Gossec, MD, PhD, Sorbonne Université and Rheumatology Department, Hôpital Pitié Salpêtrière, Institut Pierre Louis d'Epidémiologie et de Santé Publique (UMRS 1136), GRC-UPMC 08 (EEMOIS); V. Strand, MD, Stanford University; C. Proudfoot, PhD, Novartis; C.I. Chen, MPH, Regeneron Pharmaceuticals Inc.; S. Guillonneau, MSc, Sanofi; T. Kimura, MSc, Regeneron Pharmaceuticals Inc.; H. van Hoogstraten, MD/PhD, Sanofi; E. Mangan, PhD, Regeneron Pharmaceuticals Inc.; M. Reaney, MSc, formerly of Sanofi
| | - Clare Proudfoot
- From the Sorbonne Université, Institut Pierre Louis d'Epidémiologie et de Santé Publique (UMRS 1136), GRC-UPMC 08 (EEMOIS); Rheumatology Department, Hôpital Pitié Salpêtrière, AP-HP, Paris, France; Stanford University, Palo Alto, California, USA; Sanofi, Guildford, UK; Regeneron Pharmaceuticals Inc., Tarrytown, New York, USA; Sanofi, Paris, France; Sanofi, Bridgewater, New Jersey, USA.,L. Gossec, MD, PhD, Sorbonne Université and Rheumatology Department, Hôpital Pitié Salpêtrière, Institut Pierre Louis d'Epidémiologie et de Santé Publique (UMRS 1136), GRC-UPMC 08 (EEMOIS); V. Strand, MD, Stanford University; C. Proudfoot, PhD, Novartis; C.I. Chen, MPH, Regeneron Pharmaceuticals Inc.; S. Guillonneau, MSc, Sanofi; T. Kimura, MSc, Regeneron Pharmaceuticals Inc.; H. van Hoogstraten, MD/PhD, Sanofi; E. Mangan, PhD, Regeneron Pharmaceuticals Inc.; M. Reaney, MSc, formerly of Sanofi
| | - Chieh-I Chen
- From the Sorbonne Université, Institut Pierre Louis d'Epidémiologie et de Santé Publique (UMRS 1136), GRC-UPMC 08 (EEMOIS); Rheumatology Department, Hôpital Pitié Salpêtrière, AP-HP, Paris, France; Stanford University, Palo Alto, California, USA; Sanofi, Guildford, UK; Regeneron Pharmaceuticals Inc., Tarrytown, New York, USA; Sanofi, Paris, France; Sanofi, Bridgewater, New Jersey, USA.,L. Gossec, MD, PhD, Sorbonne Université and Rheumatology Department, Hôpital Pitié Salpêtrière, Institut Pierre Louis d'Epidémiologie et de Santé Publique (UMRS 1136), GRC-UPMC 08 (EEMOIS); V. Strand, MD, Stanford University; C. Proudfoot, PhD, Novartis; C.I. Chen, MPH, Regeneron Pharmaceuticals Inc.; S. Guillonneau, MSc, Sanofi; T. Kimura, MSc, Regeneron Pharmaceuticals Inc.; H. van Hoogstraten, MD/PhD, Sanofi; E. Mangan, PhD, Regeneron Pharmaceuticals Inc.; M. Reaney, MSc, formerly of Sanofi
| | - Sophie Guillonneau
- From the Sorbonne Université, Institut Pierre Louis d'Epidémiologie et de Santé Publique (UMRS 1136), GRC-UPMC 08 (EEMOIS); Rheumatology Department, Hôpital Pitié Salpêtrière, AP-HP, Paris, France; Stanford University, Palo Alto, California, USA; Sanofi, Guildford, UK; Regeneron Pharmaceuticals Inc., Tarrytown, New York, USA; Sanofi, Paris, France; Sanofi, Bridgewater, New Jersey, USA.,L. Gossec, MD, PhD, Sorbonne Université and Rheumatology Department, Hôpital Pitié Salpêtrière, Institut Pierre Louis d'Epidémiologie et de Santé Publique (UMRS 1136), GRC-UPMC 08 (EEMOIS); V. Strand, MD, Stanford University; C. Proudfoot, PhD, Novartis; C.I. Chen, MPH, Regeneron Pharmaceuticals Inc.; S. Guillonneau, MSc, Sanofi; T. Kimura, MSc, Regeneron Pharmaceuticals Inc.; H. van Hoogstraten, MD/PhD, Sanofi; E. Mangan, PhD, Regeneron Pharmaceuticals Inc.; M. Reaney, MSc, formerly of Sanofi
| | - Toshio Kimura
- From the Sorbonne Université, Institut Pierre Louis d'Epidémiologie et de Santé Publique (UMRS 1136), GRC-UPMC 08 (EEMOIS); Rheumatology Department, Hôpital Pitié Salpêtrière, AP-HP, Paris, France; Stanford University, Palo Alto, California, USA; Sanofi, Guildford, UK; Regeneron Pharmaceuticals Inc., Tarrytown, New York, USA; Sanofi, Paris, France; Sanofi, Bridgewater, New Jersey, USA.,L. Gossec, MD, PhD, Sorbonne Université and Rheumatology Department, Hôpital Pitié Salpêtrière, Institut Pierre Louis d'Epidémiologie et de Santé Publique (UMRS 1136), GRC-UPMC 08 (EEMOIS); V. Strand, MD, Stanford University; C. Proudfoot, PhD, Novartis; C.I. Chen, MPH, Regeneron Pharmaceuticals Inc.; S. Guillonneau, MSc, Sanofi; T. Kimura, MSc, Regeneron Pharmaceuticals Inc.; H. van Hoogstraten, MD/PhD, Sanofi; E. Mangan, PhD, Regeneron Pharmaceuticals Inc.; M. Reaney, MSc, formerly of Sanofi
| | - Hubert van Hoogstraten
- From the Sorbonne Université, Institut Pierre Louis d'Epidémiologie et de Santé Publique (UMRS 1136), GRC-UPMC 08 (EEMOIS); Rheumatology Department, Hôpital Pitié Salpêtrière, AP-HP, Paris, France; Stanford University, Palo Alto, California, USA; Sanofi, Guildford, UK; Regeneron Pharmaceuticals Inc., Tarrytown, New York, USA; Sanofi, Paris, France; Sanofi, Bridgewater, New Jersey, USA.,L. Gossec, MD, PhD, Sorbonne Université and Rheumatology Department, Hôpital Pitié Salpêtrière, Institut Pierre Louis d'Epidémiologie et de Santé Publique (UMRS 1136), GRC-UPMC 08 (EEMOIS); V. Strand, MD, Stanford University; C. Proudfoot, PhD, Novartis; C.I. Chen, MPH, Regeneron Pharmaceuticals Inc.; S. Guillonneau, MSc, Sanofi; T. Kimura, MSc, Regeneron Pharmaceuticals Inc.; H. van Hoogstraten, MD/PhD, Sanofi; E. Mangan, PhD, Regeneron Pharmaceuticals Inc.; M. Reaney, MSc, formerly of Sanofi
| | - Erin Mangan
- From the Sorbonne Université, Institut Pierre Louis d'Epidémiologie et de Santé Publique (UMRS 1136), GRC-UPMC 08 (EEMOIS); Rheumatology Department, Hôpital Pitié Salpêtrière, AP-HP, Paris, France; Stanford University, Palo Alto, California, USA; Sanofi, Guildford, UK; Regeneron Pharmaceuticals Inc., Tarrytown, New York, USA; Sanofi, Paris, France; Sanofi, Bridgewater, New Jersey, USA.,L. Gossec, MD, PhD, Sorbonne Université and Rheumatology Department, Hôpital Pitié Salpêtrière, Institut Pierre Louis d'Epidémiologie et de Santé Publique (UMRS 1136), GRC-UPMC 08 (EEMOIS); V. Strand, MD, Stanford University; C. Proudfoot, PhD, Novartis; C.I. Chen, MPH, Regeneron Pharmaceuticals Inc.; S. Guillonneau, MSc, Sanofi; T. Kimura, MSc, Regeneron Pharmaceuticals Inc.; H. van Hoogstraten, MD/PhD, Sanofi; E. Mangan, PhD, Regeneron Pharmaceuticals Inc.; M. Reaney, MSc, formerly of Sanofi
| | - Matthew Reaney
- From the Sorbonne Université, Institut Pierre Louis d'Epidémiologie et de Santé Publique (UMRS 1136), GRC-UPMC 08 (EEMOIS); Rheumatology Department, Hôpital Pitié Salpêtrière, AP-HP, Paris, France; Stanford University, Palo Alto, California, USA; Sanofi, Guildford, UK; Regeneron Pharmaceuticals Inc., Tarrytown, New York, USA; Sanofi, Paris, France; Sanofi, Bridgewater, New Jersey, USA. .,L. Gossec, MD, PhD, Sorbonne Université and Rheumatology Department, Hôpital Pitié Salpêtrière, Institut Pierre Louis d'Epidémiologie et de Santé Publique (UMRS 1136), GRC-UPMC 08 (EEMOIS); V. Strand, MD, Stanford University; C. Proudfoot, PhD, Novartis; C.I. Chen, MPH, Regeneron Pharmaceuticals Inc.; S. Guillonneau, MSc, Sanofi; T. Kimura, MSc, Regeneron Pharmaceuticals Inc.; H. van Hoogstraten, MD/PhD, Sanofi; E. Mangan, PhD, Regeneron Pharmaceuticals Inc.; M. Reaney, MSc, formerly of Sanofi.
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Salaffi F, Di Carlo M, Carotti M, Farah S. Validity and interpretability of the QuickDASH in the assessment of hand disability in rheumatoid arthritis. Rheumatol Int 2018; 39:923-932. [PMID: 30511229 DOI: 10.1007/s00296-018-4216-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Accepted: 11/30/2018] [Indexed: 10/27/2022]
Abstract
Objective of this study is to evaluate the construct validity and the interpretability of the shortened Disability of Arm, Shoulder and Hand Questionnaire (QuickDASH) in the assessment of rheumatoid arthritis (RA) hand disability. Consecutive RA patients were assessed through the QuickDASH and other function and disease activity indices, respectively, the Health Assessment Questionnaire-Disability Index (HAQ-DI) and the Recent-Onset Arthritis Disability questionnaire (ROAD). For each patient were evaluated the tender and swollen 28-joints counts. Interpretability was defined determining cut-off points of impairment in accordance to the Simplified Disease Activity Index (SDAI) definition of disease activity states. A total of 440 patients (89 men and 351 women, mean age of 57.0 ± 12.7 years) were enrolled. Following the SDAI definition, 98 patients (22.3%) resulted in REM, 115 subjects (26.1%) in LDA, 74 patients (16.8%) in MDA, and 153 subjects (34.8%) in HDA. Mean QuickDASH differed significantly between patients classified as remission (REM), low disease activity (LDA), moderate disease activity (MDA), or high disease activity (HDA) (p < 0.001). High correlations were found comparing QuickDASH to composite indices of disease activity and of physical health function: of special interest are the correlations between the comparable dimension of the QuickDASH and the ROAD Upper Extremity Function (rho = 0.876; p < 0.001). The cut-off points for functional categories (SDAI categories as external criterion) resulted: no impairment ≤ 13, 13 < low impairment ≤ 18.5, 18.5 < moderate impairment ≤ 31.5, and high impairment > 31.5. QuickDASH is useful in clinical practice, for its ease of administration, and positively correlates with the disease activity. It may be a surrogate for evaluating upper extremity impairment, disability index and disease control in RA patients.
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Affiliation(s)
- Fausto Salaffi
- Rheumatological Clinic, Ospedale "Carlo Urbani", Università Politecnica delle Marche, Via Aldo Moro, 25, Jesi, 60035, Ancona, Italy
| | - Marco Di Carlo
- Rheumatological Clinic, Ospedale "Carlo Urbani", Università Politecnica delle Marche, Via Aldo Moro, 25, Jesi, 60035, Ancona, Italy.
| | - Marina Carotti
- Department of Radiology, Ospedali Riuniti, Università Politecnica delle Marche, Ancona, Italy
| | - Sonia Farah
- Rheumatological Clinic, Ospedale "Carlo Urbani", Università Politecnica delle Marche, Via Aldo Moro, 25, Jesi, 60035, Ancona, Italy
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Holten K, Sexton J, Kvien TK, Aga AB, Haavardsholm EA. Comparative analyses of responsiveness between the Rheumatoid Arthritis Impact of Disease score, other patient-reported outcomes and disease activity measures: secondary analyses from the ARCTIC study. RMD Open 2018; 4:e000754. [PMID: 30487996 PMCID: PMC6242024 DOI: 10.1136/rmdopen-2018-000754] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Revised: 08/29/2018] [Accepted: 09/22/2018] [Indexed: 11/06/2022] Open
Abstract
Objective To evaluate the responsiveness of the Rheumatoid Arthritis Impact of Disease (RAID) score compared with other patient-reported outcome measures (PROMs), inflammatory markers and clinical disease activity measures in patients with early rheumatoid arthritis (RA). Methods Disease-modifying antirheumatic drug–naïve patients with RA with short disease duration were included in the treat-to-target ARCTIC trial and followed for 24 months. The responsiveness of the RAID score was evaluated using standardised response mean (SRM) and relative efficiency (RE) with respect to tender joints by Ritchie Articular Index (RAI). SRMs and REs were also calculated for other PROMs, inflammatory markers and clinical outcome measures. An SRM with value above 0.80 was considered high. Results 230 patients with RA were included. The mean±SD symptom duration was 7.1±5.4 months and the baseline mean±SD RAID score was 4.49±2.14. At 3 months of follow-up, the mean±SD change score for RAID was −2.25±1.98 and the SRM (95% CI) −1.13 (−1.33 to −0.96). The RAID score showed high responsiveness both at 3 and 6 months (SRM≥0.80) and was more sensitive in detecting change than the reference, tender joints assessed by RAI. Conclusions The RAID score proved to be highly responsive to change in patients with RA with short disease duration who followed a treat-to-target strategy. The RAID score was more efficient in detecting change than the reference (RAI) as well as most other PROMs.
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Affiliation(s)
- Karen Holten
- Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway.,Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Joseph Sexton
- Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
| | - Tore K Kvien
- Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway.,Faculty of Medicine, University of Oslo, Oslo, Norway
| | | | - Espen A Haavardsholm
- Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway.,Faculty of Medicine, University of Oslo, Oslo, Norway
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The Portuguese Rheumatoid Arthritis Impact of Disease (RAID) score and its measurement equivalence in three countries: validation study using Rasch Models. Qual Life Res 2018; 27:2909-2921. [PMID: 30069794 PMCID: PMC6208571 DOI: 10.1007/s11136-018-1959-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/28/2018] [Indexed: 11/10/2022]
Abstract
Purpose The Rheumatoid Arthritis Impact of Disease (RAID) score assesses seven impact domains of interest for people with RA. This study aimed to test patients’ understanding of the Portuguese RAID and evaluate its cross-cultural validity for use in Portugal. Methods This was a mixed methods study comprising two phases: (i) cognitive debriefing to determine patient’s comprehension of the Portuguese RAID and (ii) cross-cultural validation using Rasch analysis. Construct validity was determined by fit to the model, invariance culture (compared with France and UK datasets) and evidence of convergent and divergent validity. Results Patients’ input (n = 38) led to minor changes in the phrasing of two items to ensure conceptual equivalence between the Portuguese and the original RAID. In Rasch analysis (n = 288), two items ‘Sleep’ and ‘Physical well-being’ in the Portuguese dataset did not adequately fit the model specifications, suggesting multidimensionality (sleep—not necessarily associated with RA) and redundancy (physical well-being overlapping with functional disability). Despite the imperfections, the scale had high internal consistency, evidence of convergent and divergent validity and invariance to culture (compared to France n = 195 and UK n = 205 datasets). The scale was well targeted for patients with different levels of disease impact. Conclusions The RAID has been successfully adapted into Portuguese and it can be used with confidence in clinical practice. Further research will be required to ensure it captures the full range of sleep problems in RA. Meanwhile, data across the three countries (Portugal, France and the UK) are comparable except for the two items (sleep and physical well-being). Electronic supplementary material The online version of this article (10.1007/s11136-018-1959-4) contains supplementary material, which is available to authorized users.
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23
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Fautrel B, Alten R, Kirkham B, de la Torre I, Durand F, Barry J, Holzkaemper T, Fakhouri W, Taylor PC. Call for action: how to improve use of patient-reported outcomes to guide clinical decision making in rheumatoid arthritis. Rheumatol Int 2018; 38:935-947. [PMID: 29564549 PMCID: PMC5953992 DOI: 10.1007/s00296-018-4005-5] [Citation(s) in RCA: 59] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Accepted: 03/03/2018] [Indexed: 01/05/2023]
Abstract
Current guidelines for the management of rheumatoid arthritis (RA) recommend early treatment and a treat-to-target goal of remission or low disease activity. Over the past decade, this approach has been extremely successful in reducing disease activity and joint damage in patients with RA. At the same time, however, overall patient perception of well-being appears to have decreased with respect to outcome measures considered important by patients themselves, such as pain, fatigue, physical function and quality of life. The timely and effective use of patient-reported outcomes (PROs) could encourage physicians to focus more on the impact of RA on patients and how patients are feeling. This in turn would facilitate shared decision making between patients and physicians, ultimately leading to a more patient-centered approach and improved patient care. Indeed, PROs provide information about individual patients that complements information provided by physical assessment and composite scores, and can also be used to guide patient care, such as determining whether a clinic visit is needed or whether treatment modifications are necessary. This is particularly important for patients who do not achieve the aspirational target of remission or low disease activity with pharmacological treatment. A number of validated PRO questionnaires are available, but how and which PROs should be incorporated into rheumatology clinical practice as part of the decision-making process is still controversial. Combining PROs with technology, such as computer adaptive tests, electronic PRO systems, web-based platforms and patient dashboards, could further aid PRO integration into daily rheumatology clinical practice.
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Affiliation(s)
- Bruno Fautrel
- Institut Pierre Louis d'Epidémiologie et de Santé Publique, Sorbonne Universités, UPMC Universitaire Paris 06, Paris, France
- Department of Rheumatology, Pitié-Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Rieke Alten
- Schlosspark-Klinik University Medicine, 14059, Berlin, Germany
| | - Bruce Kirkham
- Department of Rheumatology, Guys and St Thomas' NHS Trust, Great Maze Pond, London, SE1 9RT, UK
| | | | | | - Jane Barry
- Eli Lilly and Company, Basingstoke, Hampshire, UK
| | | | - Walid Fakhouri
- Eli Lilly and Company, Indianapolis, IN, USA
- Eli Lilly and Company, Basingstoke, Hampshire, UK
| | - Peter C Taylor
- Botnar Research Centre, NDORMS, University of Oxford, Oxford, UK.
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