Patients' conceptions of their own influence on good treatment response to biological therapy in chronic inflammatory arthritis

Impact of Biological Therapies on Quality of Life in Rheumatoid Arthritis: A Narrative Review

Rheumatoid arthritis (RA) is a chronic inflammatory disease that causes joint damage, pain, and disability, leading to significant impairments in patients' physical, mental, and social well-being. While biological disease-modifying antirheumatic drugs (bDMARDs) such as tumor necrosis factor (TNF) inhibitors, interleukin-6 (IL-6) inhibitors, and Janus kinase (JAK) inhibitors have revolutionized the treatment of RA by effectively controlling disease activity, their influence on patients' quality of life (QoL) is crucial but not fully understood. The aim of this review is to evaluate the impact of bDMARDs on QoL in RA patients, particularly focusing on domains such as physical functioning, pain, fatigue, mental health, and social participation. A comprehensive literature search was conducted in databases such as PubMed and the Cochrane Library, including randomized controlled trials, cohort studies, and surveys assessing QoL outcomes in RA patients receiving bDMARD therapy. The review includes studies that utilized the Health Assessment Questionnaire (HAQ), EuroQol-5 Dimension (EQ-5D), and Short Form-36 (SF-36), Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-F), Fatigue Severity Scale (FSS), and Patient Global Assessment (PtGA) QoL questionnaires, among others, to assess patient-reported outcomes. The findings of the current review suggest that bDMARDs significantly improve QoL in RA patients by reducing pain, fatigue, and disability while enhancing physical function and mental well-being. However, variability in patient responses, side effects, and the long-term impact of these therapies remain key concerns. Future studies with standardized QoL assessments and longer follow-up periods are needed to provide a more comprehensive understanding of the sustained effects of bDMARD therapy on RA patients' overall well-being.

Role of Platelets in Rheumatic Chronic Autoimmune Inflammatory Diseases

Platelets are essential in maintaining blood homeostasis and regulating several inflammatory processes. They constantly interact with immune cells, have immunoregulatory functions, and can affect, through immunologically active substances, endothelium, leukocytes, and other immune response components. In reverse, inflammatory and immune processes can activate platelets, which might be significant in autoimmune disease progression and arising complications. Thus, considering this interplay, targeting platelet activity may represent a new approach to treatment of autoimmune diseases. This review aims to highlight the role of platelets in the pathogenic mechanisms of the most frequent chronic autoimmune inflammatory diseases to identify gaps in current knowledge and to provide potential new targets for medical interventions.

Patients' Perceptions of Person-Centered Care in Early Rheumatoid Arthritis: A Qualitative Study

Objective

Most research on patient experiences of rheumatoid arthritis (RA) care is performed with patients who have established RA and less often with patients with early RA. Experiences of and expectations about health care may change over time, which is why the aim was to explore patients’ perceptions of person‐centered care (PCC) early in the RA disease course.

Methods

Thirty‐one patients with early RA were interviewed in this qualitative study. An abductive qualitative content analysis was conducted based on the framework of McCormack and McCance (1,2). The four constructs, prerequisites, care environment, person‐centered processes, and person‐centered outcomes, constituted the four categories in the deductive part of the study. An inductive analysis generated 11 subcategories exploring the content of PCC.

Results

For patients with early RA, PCC was described in terms of 1) prerequisites including being treated with respect, meeting dedicated health care professionals, and meeting professional competence; 2) care environment including having access to a multidisciplinary team, having access to health care, and encountering a supportive organization; 3) person‐centered processes including being listened to, being supported, and being involved in decision‐making; and 4) person‐centered outcomes including being satisfied with received health care and achieving optimal health.

Conclusion

Genuine PCC is important for patients early in the RA disease course, supporting the implementation of a person‐centered approach during all stages in the health care system. This study contributes to information about how to further develop person‐centeredness in rheumatology care.

Platelet indices in patients with chronic inflammatory arthritis: a systematic review and meta-analysis

Correlation between platelet indices and chronic inflammatory arthritis (CIA) remains a moot point today. This meta-analysis aimed to evaluate whether platelet (PLT) count, mean platelet volume (MPV) and platelet distribution width (PDW) associated with rheumatoid arthritis (RA), ankylosing spondylitis (AS) and psoriatic arthritis (PsA). A systematic literature search was performed in PubMed, EMBASE, and Web of Science up to August 2019. Pooled standardized mean differences (SMD) and 95% confidence interval (CI) were calculated using a random-effect model. As a result, 34 studies were included, encompassing 17 on RA, 12 on AS, 3 on PsA and 2 on both RA and AS. In these studies, PLT count was significantly higher in RA (SMD = 0.55, 95% CI = 0.36-0.73, P < .001), AS (SMD = 0.53, 95% CI = 0.36-0.70, P < .001) and PsA patients (SMD = 1.29, 95% CI = 0.82-1.77, P < .001) than that in healthy subjects, while MPV and PDW presented nonsignificant differences in these intergroup comparisons (P > .05), and similar results were observed in subgroup analyses. The meta-regression analysis demonstrated that there were strong positive correlations between erythrocyte sedimentation rate and PLT count, and weak correlation trend between the disease activity score and PLT count in both RA and AS subjects without statistically significant difference. The sensitivity analysis indicated that these results were not unduly influenced by any single study. In conclusion, this meta-analysis demonstrated that PLT count was elevated in CIA patients and could be suitable for evaluating the disease activity, whereas MPV and PDW were independent of CIA.