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Cummins JA, Zhou G, Nambudiri VE. Natural Language Processing for Large-Scale Analysis of Eczema and Psoriasis Social Media Comments. JID INNOVATIONS 2023; 3:100210. [PMID: 37564106 PMCID: PMC10410170 DOI: 10.1016/j.xjidi.2023.100210] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 02/19/2023] [Accepted: 02/27/2023] [Indexed: 08/12/2023] Open
Abstract
Social media tools are widely used by dermatologic patients. Eczema and psoriasis, two of the most common inflammatory skin diseases, are well-represented on the social media site Reddit. We used natural language processing tools to examine comments in subreddits r/psoriasis and r/eczema (combined user base >187,000), tracking commenters' interest levels and sentiments related to common treatments for psoriasis and eczema as well as discussions of adverse drug reactions. All comments from 2014-2020 from the subreddits r/eczema (n = 196,571) and r/psoriasis (n = 123,144) were retrieved and processed using natural language processing tools. Comment volume in r/eczema related to antibacterial therapies, lifestyle changes, and prednisone decreased from 2014-2020, whereas phototherapy comments remained stable, and dupilumab comment volume increased. Comment volume in r/psoriasis for newer therapeutics (including biologics and apremilast) increased after Food and Drug Administration approval, whereas older therapies such as etanercept, adalimumab, and methotrexate decreased over time. Sentiment scores tended to decrease in the years after Food and Drug Administration approval. Among psoriasis treatments, calcipotriene and branded calcipotriene/betamethasone foam had the highest sentiment, whereas apremilast had the lowest overall sentiment score. These analyses also identified changes in patient interest levels and sentiment related to eczema and psoriasis treatments, suggesting an area for additional research.
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Affiliation(s)
| | - Guohai Zhou
- Department of Dermatology, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA
| | - Vinod E. Nambudiri
- Department of Dermatology, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA
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2
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Tahami Monfared AA, Stern Y, Doogan S, Irizarry M, Zhang Q. Understanding Barriers Along the Patient Journey in Alzheimer's Disease Using Social Media Data. Neurol Ther 2023; 12:899-918. [PMID: 37060417 PMCID: PMC10195971 DOI: 10.1007/s40120-023-00472-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 03/21/2023] [Indexed: 04/16/2023] Open
Abstract
INTRODUCTION We speculated that social media data from Alzheimer's disease (AD) stakeholders (patients, caregivers, and clinicians) could identify barriers along the patient journey in AD, and that insights gained may help devise strategies to remove barriers, and ultimately improve the patient journey. METHODS Our sample was drawn from a repository of social media posts extracted from 112 public sources between January 1998 and December 2021 using natural language processing text-mining algorithms. The patient journey was classified into three phases: (1) early signs/experiences (Early Signs); (2) screening/assessment/diagnosis (Screening); and (3) treatment/management (Treatment). In the Early Signs phase, issues/challenges derived from a conceptual AD identification framework (ADIF) were examined. In subsequent phases, behavioral/psychiatric challenges, access/barriers to health care, screening/diagnostic methods, and symptomatic treatments for AD were identified. Posts were classified by AD stakeholder type or disease stage, if possible. RESULTS We identified 225,977 AD patient journey-related social media posts. Anxiety was a predominant issue/challenge in all patient journey phases. In the Screening and Treatment phases combined, access/barriers to care were described in 16% of posts; unwillingness/resistance to seeking care was a major barrier (≥ 75% of access-related posts across all stakeholders). Commonly identified structural barriers (e.g., affordability/cost, geography/transportation/distance) were more common in patient/caregiver posts than clinician posts. Among Screening-related posts, imaging/scans were commonly mentioned by all stakeholders; biomarkers were more commonly mentioned by patients than clinicians. Treatment-related concerns were identified in 17% of stakeholder-specified posts that named pharmacological agents/classes for the symptomatic management of AD. CONCLUSION This descriptive analysis of out-of-clinic experiences reflected in AD social media posts found that unwillingness/resistance to seeking care was a key barrier, followed by structural barriers to health care, such as affordability/cost. Insights from the lived experiences of AD stakeholders are valuable and highlight the need to improve the patient journey in AD and ease patient and caregiver burden.
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Affiliation(s)
- Amir Abbas Tahami Monfared
- Eisai, Inc., 200 Metro Blvd, Nutley, NJ, 07110, USA.
- Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada.
| | - Yaakov Stern
- Cognitive Neuroscience Division, Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, USA
| | | | | | - Quanwu Zhang
- Eisai, Inc., 200 Metro Blvd, Nutley, NJ, 07110, USA
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Alhomood I, Fatani M, Bedaiwi M, Al Natour S, Erdogan A, Alsharafi A, Attar S. The Psoriatic Arthritis Experience in Saudi Arabia from the Rheumatologist and Patient Perspectives. Curr Rheumatol Rev 2023; 19:470-478. [PMID: 37194936 PMCID: PMC10523353 DOI: 10.2174/1573397119666230516162221] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Revised: 02/13/2023] [Accepted: 03/20/2023] [Indexed: 05/18/2023]
Abstract
BACKGROUND Psoriatic arthritis (PsA) is a musculoskeletal disease that adversely affects physical mobility and quality of life. It is challenging to manage because of the heterogeneous nature of the symptoms and the current treatment options. PURPOSE To explore the patient and rheumatologist perspectives of PsA to help improve understanding of the disease experience and improve disease management. METHODS A descriptive, observational cross-sectional study of Saudi Arabian dermatologists and rheumatologists and patients with psoriasis or PsA was conducted. Questionnaire data were collected from 31 dermatologists, 34 rheumatologists, 90 patients with psoriasis, and 98 patients with PsA and analysed using descriptive statistics. Here, data from rheumatologists and patients with PsA are presented. RESULTS The results revealed similarities and differences in the rheumatologist and patient perspectives of PsA. Rheumatologists and patients agreed on the impact that PsA had on patients' quality of life and that more education was needed. However, they differed on several aspects of disease management. Rheumatologists estimated the time to diagnosis as four times shorter than what patients experienced. Patients accepted their diagnosis more than rheumatologists perceived them to; rheumatologists perceived patients to be worried or fearful. Patients perceived joint pain as their most severe symptom, in contrast to rheumatologists, who presumed skin appearance was the most severe symptom. Reported input into PsA treatment goals differed significantly. More than half of the rheumatologists reported equal patient-physician input into goal development as opposed to <10% of patients reporting the same. Almost half of patients reported no input into the development of their treatment goals. CONCLUSION The management of PsA could benefit from enhanced screening and re-evaluation of what PsA outcomes have the most value to patients and rheumatologists. A multidisciplinary approach is recommended with increased patient involvement in disease management and individualized treatment options.
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Affiliation(s)
- Ibrahim Alhomood
- Medical Specialities Department, King Fahad Medical City (KFMC), P.O. Box 59046, Riyadh, 11525, Kingdom of Saudi Arabia
| | - Mohamed Fatani
- Department of Dermatology, Heraa Hospital, Al Madinah Al Munawarah Rd, Mecca, Makkah, 24227, Kingdom of Saudi Arabia
| | - Mohamed Bedaiwi
- Department of Medicine, Rheumatology Unit, College of Medicine, King Saud University, P.O. Box 14511, Riyadh, 11451, Kingdom of Saudi Arabia
| | - Sahar Al Natour
- Department of Dermatology, Imam Abdulrahman Bin Faisal University, P.O. Box 1982, Dammam, 34212, Kingdom of Saudi Arabia
| | - Alper Erdogan
- Department of Medical Neurology, Eli Lilly and Company, Ulaya Dist., Riyadh, Riyadh Province, Kingdom of Saudi Arabia
| | - Aya Alsharafi
- Department of Medical Neurology, Eli Lilly and Company, Ulaya Dist., Riyadh, Riyadh Province, Kingdom of Saudi Arabia
| | - Suzan Attar
- Department of Rheumatology, King Abdulaziz University, P.O. Box 80200, Jeddah, 21589, Kingdom of Saudi Arabia
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Kleinert S, Schuch F, Rapp P, Ronneberger M, Wendler J, Sternad P, Popp F, Bartz-Bazzanella P, von der Decken C, Karberg K, Gauler G, Wurth P, Späthling-Mestekemper S, Kuhn C, Englbrecht M, Vorbrüggen W, Adler G, Welcker M. Impairment in cognitive function in patients with axial spondyloarthritis and psoriatic arthritis. Rheumatol Int 2023; 43:89-97. [PMID: 36441274 DOI: 10.1007/s00296-022-05248-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 11/09/2022] [Indexed: 11/29/2022]
Abstract
Spondyloarthritis may contribute to deficits in cognition. The objective of this study was to compare cognitive abilities in patients with axial spondyloarthritis (axSpA) or psoriatic arthritis (PsA) with matched reference groups. This investigator-initiated, cross-sectional, exploratory study of adults with axSpA or PsA was conducted at two German rheumatology centres (November 2018-September 2019). All data on patient and disease characteristics and cognitive abilities were collected at a single visit. Cognitive function was assessed by the previously validated Memory and Attention Test subscores of selective attention, episodic working memory, and episodic short-term memory and compared with subscores from healthy age-, sex-, and education-matched reference subjects. The mean patient age was 51.1 and 55.8 years in the axSpA (n = 101) and PsA (n = 117) groups, respectively, and mean symptom duration was 13.7 and 10.3 years. Compared with matched reference subjects, axSpA and PsA patients showed significant impairments in selective attention (mean difference of -6.5 and -4.5, respectively, on a 45-point scale; P < 0.001 for both) and no significant differences in episodic working memory. The PsA cohort, but not the axSpA cohort, had significantly better episodic short-term memory subscores compared with matched reference subjects (mean change of 2.0 on a 15-point scale; P < 0.001). Explorative subgroup analyses were unable to identify factors influencing cognitive changes, including disease activity, pain, and function, but may have been underpowered. We conclude that impairments in selective attention may impact the ability of axSpA and PsA patients to process information. These findings warrant additional studies, including longitudinal analyses, in patients with spondyloarthritis.
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Affiliation(s)
- Stefan Kleinert
- Praxisgemeinschaft Rheumatologie-Nephrologie (PGRN), Möhrendorferstr 1C, Erlangen, Germany.
- Universitätsklinik Würzburg, Med. Klinik 3, Rheumatologie/Klinische Immunologie, Würzburg, Germany.
| | - Florian Schuch
- Praxisgemeinschaft Rheumatologie-Nephrologie (PGRN), Möhrendorferstr 1C, Erlangen, Germany
| | - Praxedis Rapp
- Praxisgemeinschaft Rheumatologie-Nephrologie (PGRN), Möhrendorferstr 1C, Erlangen, Germany
| | - Monika Ronneberger
- Praxisgemeinschaft Rheumatologie-Nephrologie (PGRN), Möhrendorferstr 1C, Erlangen, Germany
| | - Joerg Wendler
- Praxisgemeinschaft Rheumatologie-Nephrologie (PGRN), Möhrendorferstr 1C, Erlangen, Germany
| | - Patrizia Sternad
- Medizinisches Versorgungszentrum für Rheumatologie Dr. M. Welcker GmbH, Planeg, Germany
| | - Florian Popp
- Medizinisches Versorgungszentrum für Rheumatologie Dr. M. Welcker GmbH, Planeg, Germany
| | | | | | - Kirsten Karberg
- Praxis Für Rheumatologie und Innere Medizin, Berlin, Germany
| | - Georg Gauler
- Rheumatologische Schwerpunktpraxis, Osnabrück, Germany
| | - Patrick Wurth
- Rheumatologische Schwerpunktpraxis, Osnabrück, Germany
| | | | | | | | | | - Georg Adler
- Institut für Studien zur Psychischen Gesundheit (ISPG), Mannheim, Germany
| | - Martin Welcker
- Medizinisches Versorgungszentrum für Rheumatologie Dr. M. Welcker GmbH, Planeg, Germany
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Tahami Monfared AA, Stern Y, Doogan S, Irizarry M, Zhang Q. Stakeholder Insights in Alzheimer's Disease: Natural Language Processing of Social Media Conversations. J Alzheimers Dis 2022; 89:695-708. [PMID: 35938254 DOI: 10.3233/jad-220422] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Social media data may be especially effective for studying diseases associated with high stigma, such as Alzheimer's disease (AD). OBJECTIVE We primarily aimed to identify issues/challenges experienced by patients with AD using natural language processing (NLP) of social media posts. METHODS We searched 130 public social media sources between January 1998 and December 2021 for AD stakeholder social media posts using NLP to identify issues/challenges experienced by patients with AD. Issues/challenges identified by ≥10% of any AD stakeholder type were described. Illustrative posts were selected for qualitative review. Secondarily, issues/challenges were organized into a conceptual AD identification framework (ADIF) and representation of ADIF categories within clinical instruments was assessed. RESULTS We analyzed 1,859,077 social media posts from 30,341 AD stakeholders (21,011 caregivers; 7,440 clinicians; 1,890 patients). The most common issues/challenges were Worry/anxiety (34.2%), Pain (33%), Malaise (28.7%), Confusional state (27.1%), and Falls (23.9%). Patients reported a markedly higher volume of issues/challenges than other stakeholders. Patient posts reflected the broader scope of patient burden, caregiver posts captured both patient and caregiver burden, and clinician posts tended to be targeted. Less than 5% of the high frequency issues/challenges were in the "function and independence" and "social and relational well-being" categories of the ADIF, suggesting these issues/challenges may be difficult to capture. No single clinical instrument covered all ADIF categories; "social and relational well-being" was least represented. CONCLUSION NLP of AD stakeholder social media data revealed a broad spectrum of real-world insights regarding patient burden.
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Affiliation(s)
- Amir Abbas Tahami Monfared
- Eisai, Inc., Nutley, NJ, USA.,McGill University, Epidemiology, Biostatistics and Occupational Health, Montreal (QC), Canada
| | - Yaakov Stern
- Cognitive Neuroscience Division, Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, NY, USA
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Ogdie A, Myers K, Mansfield C, Tillett W, Nash P, Leach C, Nowell WB, Gavigan K, Zueger P, McDearmon-Blondell E, Walsh J. Experiences and Treatment Preferences in Patients With Psoriatic Arthritis: A Cross-Sectional Study in the ArthritisPower Registry. Rheumatol Ther 2022; 9:735-751. [PMID: 35279798 PMCID: PMC8964868 DOI: 10.1007/s40744-022-00436-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 02/25/2022] [Indexed: 11/28/2022] Open
Abstract
Introduction Despite recent advances in treatment for psoriatic arthritis (PsA), many patients experience inadequate response or intolerance to therapy, indicating that unmet treatment-related needs remain. To further characterize these unmet needs, we evaluated patients’ experiences regarding the burden of PsA symptoms and disease impacts, and patients’ preferences for treatment. Methods Patients from ArthritisPower, a rheumatology research registry, completed a web-based survey. Object case best–worst scaling (BWS) was used to evaluate the relative burden of 11 PsA-related symptoms and the relative importance of improvement in nine PsA-related disease impacts. BWS data were analyzed using a random-parameters logit model. Patient demographics, preferences for mode and frequency of therapy, and preferences for methotrexate were analyzed descriptively. Results Among the 332 participants, most were White (94%), female (80%), with mean age of 54 years (SD 11.4). In the BWS, joint pain was the most bothersome symptom, followed by other musculoskeletal pain and fatigue. The BWS for disease impacts found that improvements in the ability to perform physical activities were most important, followed by improvements in the ability to function independently, sleep quality, and the ability to perform daily activities. The most burdensome symptoms and desired disease impact improvements were similar in patients regardless of their experience with biologic disease-modifying antirheumatic drugs. The most preferred mode and frequency of treatment administration was oral, once-daily medication (preferred by 38% of respondents), and 74% prioritized therapies that significantly improved joint-related symptoms versus psoriasis-related symptoms. The majority of respondents (65%) preferred PsA treatment regimens that did not include methotrexate. Conclusions Patients with PsA from a rheumatology registry found musculoskeletal pain symptoms to be the most bothersome and prioritized improvements to functional impacts of their disease. These findings can better inform development of new therapies and guide shared patient-provider treatment decision-making. Supplementary Information The online version contains supplementary material available at 10.1007/s40744-022-00436-x.
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Affiliation(s)
- Alexis Ogdie
- Division of Rheumatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Kelley Myers
- RTI Health Solutions, 3040 East Cornwallis Road, Post Office Box 12194, Research Triangle Park, NC, 27709-2194, USA.
| | - Carol Mansfield
- RTI Health Solutions, 3040 East Cornwallis Road, Post Office Box 12194, Research Triangle Park, NC, 27709-2194, USA
| | - William Tillett
- Department of Rheumatology, Royal National Hospital for Rheumatic Diseases, Bath, UK
- Department of Pharmacy and Pharmacology, University of Bath, Bath, UK
| | - Peter Nash
- Department of Medicine, Griffith University, Brisbane, QLD, Australia
| | - Colton Leach
- RTI Health Solutions, 3040 East Cornwallis Road, Post Office Box 12194, Research Triangle Park, NC, 27709-2194, USA
| | | | - Kelly Gavigan
- Global Healthy Living Foundation, Upper Nyack, NY, USA
| | | | | | - Jessica Walsh
- Division of Rheumatology, University of Utah School of Medicine, Salt Lake City, UT, USA
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Lucía Schmidt A, Rodriguez-Esteban R, Gottowik J, Leddin M. Applications of quantitative social media listening to patient-centric drug development. Drug Discov Today 2022; 27:1523-1530. [PMID: 35114364 DOI: 10.1016/j.drudis.2022.01.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 08/13/2021] [Accepted: 01/26/2022] [Indexed: 11/27/2022]
Abstract
Social media listening has been increasingly acknowledged as a tool with applications in many stages of the drug development process. These applications were created to meet the need for patient-centric therapies that are fit-for-purpose and meaningful to patients. Such applications, however, require the leverage of new quantitative approaches and analytical methods that draw from developments in artificial intelligence and real-world data (RWD) analysis. Here, we review the state-of-the-art in quantitative social media listening (QSML) methods applied to drug discovery from the perspective of the pharmaceutical industry.
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Affiliation(s)
- Ana Lucía Schmidt
- Roche Innovation Center Basel, F. Hoffmann-La Roche Ltd, Grenzacherstrasse 124, 4070 Basel, Switzerland
| | - Raul Rodriguez-Esteban
- Roche Innovation Center Basel, F. Hoffmann-La Roche Ltd, Grenzacherstrasse 124, 4070 Basel, Switzerland.
| | - Juergen Gottowik
- Roche Innovation Center Basel, F. Hoffmann-La Roche Ltd, Grenzacherstrasse 124, 4070 Basel, Switzerland
| | - Mathias Leddin
- Roche Innovation Center Basel, F. Hoffmann-La Roche Ltd, Grenzacherstrasse 124, 4070 Basel, Switzerland
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Strand V, Van den Bosch F, Ranza R, Leung YY, Drescher E, Zueger P, Saffore CD, Lertratanakul A, Lippe R, Nash P. Patient-Reported Outcomes in Psoriatic Arthritis Patients with an Inadequate Response to Biologic Disease-Modifying Antirheumatic Drugs: SELECT-PsA 2. Rheumatol Ther 2021; 8:1827-1844. [PMID: 34661885 PMCID: PMC8572272 DOI: 10.1007/s40744-021-00377-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 09/17/2021] [Indexed: 11/05/2022] Open
Abstract
Introduction Psoriatic arthritis (PsA) has a major impact on health-related quality of life (HRQOL) and other patient-reported outcomes (PROs), important components in the assessment of therapeutic efficacy. We evaluated the impact of upadacitinib on PROs in PsA patients with inadequate responses or intolerance to biologic disease-modifying anti-rheumatic drugs (bDMARD-IR). Methods Patients enrolled in the phase 3 SELECT-PsA 2 randomized controlled trial (RCT) received 56 weeks of oral upadacitinib 15 mg QD, upadacitinib 30 mg QD, or placebo switched to either dose of upadacitinib at week 24. PROs included patient global assessment of disease activity (PtGA), pain, physical function (HAQ-DI), health-related quality of life (SF-36 physical (PCS) and mental (MCS) component summary and domain scores), fatigue (FACIT-F), psoriasis symptom severity (SAPS), and work productivity (WPAI). Mean changes from baseline in PROs, improvements ≥ minimum clinically important differences (MCID) and scores ≥ normative values, and maintenance of improvements were assessed. Results At weeks 12 and 24, patients treated with either upadacitinib dose reported statistically and nominally significant improvements from baseline across all PROs versus placebo (p ≤ 0.05), except the WPAI absenteeism domain, which were maintained or further improved to week 56. A significantly greater proportion of patients receiving either upadacitinib dose reported improvements ≥ MCID and scores ≥ normative values versus placebo (nominal p ≤ 0.01) in most PROs at weeks 12 and 24, with clinically meaningful improvements continuing to week 56. Improvements ≥ MCID were reported as early as week 2 in PtGA, pain, and HAQ-DI. Conclusions Upadacitinib provides rapid, clinically meaningful, and sustained improvements in PROs reported by bDMARD-IR PsA patients. SELECT-PsA 2 ClinicalTrials.gov number, NCT03104374. Supplementary Information The online version contains supplementary material available at 10.1007/s40744-021-00377-x.
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Affiliation(s)
- Vibeke Strand
- Division of Immunology/Rheumatology, Stanford University, Palo Alto, CA, USA
| | | | - Roberto Ranza
- Rheumatology Unit, Hospital de Clinicas, Universidade Federal de Uberlândia, Uberlândia, Brazil
| | - Ying-Ying Leung
- Department of Rheumatology and Immunology, Singapore General Hospital, Singapore, Singapore
| | - Edit Drescher
- Department of Rheumatology, Csolnoky Ferenc County Hospital/Vital Medical Center Private Clinic, Veszprém, Hungary
| | | | | | | | - Ralph Lippe
- AbbVie Deutschland GmbH & Co. KG, Wiesbaden, Germany
| | - Peter Nash
- Department of Medicine, Griffith University, Brisbane, QLD, Australia
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Ogdie A, Michaud K, Nowak M, Bruce R, Cantor S, Hintzen C, Mease PJ. Patient's experience of psoriatic arthritis: a conceptual model based on qualitative interviews. RMD Open 2021; 6:rmdopen-2020-001321. [PMID: 33115768 PMCID: PMC7722387 DOI: 10.1136/rmdopen-2020-001321] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 08/28/2020] [Accepted: 09/29/2020] [Indexed: 12/20/2022] Open
Abstract
Introduction Psoriatic arthritis (PsA) is a heterogeneous chronic inflammatory musculoskeletal disorder that manifests as peripheral arthritis, dactylitis, enthesitis and spondylitis. PsA results in significant burden that impacts quality of life of patients. We examined the signs, symptoms and impacts reported by patients with PsA, to characterise the patient experience of PsA and develop a conceptual model representing this patient experience. Methods Semi-structured interviews were conducted with patients with PsA recruited through the FORWARD databank. Spontaneous and probed signs, symptoms and impacts of PsA were assessed. Patients rated the disturbance of these concepts on their lives using a scale from 0 (‘does not disturb’) to 10 (‘greatly disturbs’). Signs, symptoms and impacts reported by >80% of patients with a disturbance rating of ≥5 were defined as salient concepts. Recruitment continued until concept saturation was achieved. Results 19 patients with PsA were interviewed. The interviews elicited 42 symptoms of which 8 had not been identified in a previous literature review encompassing 15 relevant articles. The most salient signs and symptoms elicited in the interviews were joint pain, skin symptoms, stiffness, swollen/inflamed joints and fatigue all with moderate to high disturbance ratings (range: 5.5–7.8). The most salient impacts were sleep disturbance, physical disability, effects on daily activities and feelings of frustration with also moderate to high disturbance ratings (range: 6.1–7.4). Conclusions The interviews highlighted the adverse impact PsA has on the patient’s life and may inform on outcome variables or areas suitable to be assessed in PsA studies.
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Affiliation(s)
- Alexis Ogdie
- University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Kaleb Michaud
- National Data Bank for Rheumatic Diseases, Wichita, Kansas, USA.,University of Nebraska Medical Center, Omaha, Nebraska, USA
| | | | | | | | | | - Philip J Mease
- School of Medicine, Swedish Medical Center and University of Washington, Seattle, Washington, USA
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Di Carlo M, Becciolini A, Incorvaia A, Beci G, Smerilli G, Biggioggero M, Tardella M, De Angelis R, Salaffi F. Mild cognitive impairment in psoriatic arthritis: Prevalence and associated factors. Medicine (Baltimore) 2021; 100:e24833. [PMID: 33725953 PMCID: PMC7982208 DOI: 10.1097/md.0000000000024833] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 01/25/2021] [Indexed: 01/08/2023] Open
Abstract
To assess the prevalence and factors associated with mild cognitive impairment (MCI) in patients suffering from psoriatic arthritis (PsA).A cross-sectional evaluation was conducted in consecutive PsA patients. Sociodemographic data and the clinimetric variables related to PsA and psoriasis were collected for each patient. MCI was assessed through the Montreal Cognitive Assessment (MoCA). The cognitive performance of PsA patients was compared to healthy subjects using one-way analysis of variance (ANOVA). The correlations among variables were studied by the Spearman rank correlation coefficient. A multivariate logistic regression analysis was carried out to establish the predictors of MCI.The study involved 96 PsA patients and 48 healthy subjects. MCI (defined as a MoCA score < 26/30) was detected in 47 (48.9%) PsA patients. Compared to healthy subjects, the MoCA score resulted significantly lower in PsA patients (P = .015). The main differences involved the denomination and language domains. MoCA was negatively correlated with age (r = -0.354; P < .0001), HAQ-DI (r = -0.227; P = .026), and fatigue (r = -0.222; P = .029), and positively correlated with psoriasis duration (r = 0.316; P = .001) and DLQI (r = 0.226; P = .008).The multivariate logistic regression analysis revealed the duration of psoriasis (P = .0005), age (P = .0038), PASI (P = .0050), and HAQ-DI (P = .0193) as predictors of the MoCA score.MCI is present in a significant proportion of PsA patients, and is mainly determined by age, cutaneous variables, and disability.
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Affiliation(s)
- Marco Di Carlo
- Rheumatology Clinic, Università Politecnica delle Marche, “Carlo Urbani” Hospital, Jesi (Ancona)
| | - Andrea Becciolini
- Department of Rheumatology, “Gaetano Pini”-CTO Institute, Milan, Italy
| | - Antonella Incorvaia
- Rheumatology Clinic, Università Politecnica delle Marche, “Carlo Urbani” Hospital, Jesi (Ancona)
| | - Giacomo Beci
- Rheumatology Clinic, Università Politecnica delle Marche, “Carlo Urbani” Hospital, Jesi (Ancona)
| | - Gianluca Smerilli
- Rheumatology Clinic, Università Politecnica delle Marche, “Carlo Urbani” Hospital, Jesi (Ancona)
| | | | - Marika Tardella
- Rheumatology Clinic, Università Politecnica delle Marche, “Carlo Urbani” Hospital, Jesi (Ancona)
| | - Rossella De Angelis
- Rheumatology Clinic, Università Politecnica delle Marche, “Carlo Urbani” Hospital, Jesi (Ancona)
| | - Fausto Salaffi
- Rheumatology Clinic, Università Politecnica delle Marche, “Carlo Urbani” Hospital, Jesi (Ancona)
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Carter K, Tannous C, Walmsley S, Rome K, Turner DE. Linking the patient experience of foot involvement related to psoriatic arthritis to the International Classification of Functioning, Disability and Health. Rheumatol Adv Pract 2020; 4:rkaa028. [PMID: 32914051 PMCID: PMC7474858 DOI: 10.1093/rap/rkaa028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 06/16/2020] [Indexed: 01/14/2023] Open
Abstract
Objective The aim was to categorize the patient experience of PsA-related foot involvement by linking it to the International Classification of Functioning, Disability and Health (ICF) framework. Methods Concepts, obtained from a previous qualitative investigation of people with PsA and health professionals into their perspective of PsA-related foot involvement, were linked to the full version of the ICF classification. Concepts were linked to the most appropriate ICF category using established linking rules, which enable a systematic and standardized linking process. All concepts were linked independently to the ICF by two investigators, followed by a third investigator for adjudication. The professional backgrounds of the investigators included occupational therapy and podiatry. Results More than 100 distinct ICF categories were linked to the interview concepts. The most represented ICF category was body functions (35%), followed by environmental factors (31%), activities and participation (19%) and body structure (15%). Concepts that could not be linked to the ICF were related to coping, aspects of time and knowledge. Health professionals identified a greater proportion of body functions and fewer activity and participation categories compared with patients, indicating a possible mismatch of key concerns. Interdisciplinary group analysis demonstrated merit. Conclusion A list of ICF categories was generated, defining aspects of functioning important and relevant to the impact of PsA-related foot involvement. Despite the localized anatomical focus of this study, the effect of foot problems in PsA was linked to all components of the ICF, confirming the profound impact on functioning and daily life.
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Affiliation(s)
| | - Caterina Tannous
- Occupational Therapy Department, School of Health and Sciences, Western Sydney University, Sydney, NSW, Australia
| | | | - Keith Rome
- Health and Rehabilitation Research Institute, Faculty of Health and Environmental Science, AUT University, Auckland, New Zealand
| | - Deborah E Turner
- Podiatry Department.,Podiatry Department, School of Clinical Sciences, Queensland University of Technology, Queensland, Australia
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Orbai AM, Ogdie A, Gossec L, Tillett W, Leung YY, Gao J, Trivedi M, Tasset C, Meuleners L, Besuyen R, Hendrikx T, Coates LC. Effect of filgotinib on health-related quality of life in active psoriatic arthritis: a randomized phase 2 trial (EQUATOR). Rheumatology (Oxford) 2020; 59:1495-1504. [PMID: 31624837 PMCID: PMC7310097 DOI: 10.1093/rheumatology/kez408] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Revised: 08/08/2019] [Indexed: 01/20/2023] Open
Abstract
Objective To examine the effects of filgotinib, an oral, selective Janus kinase 1 inhibitor, on health-related quality of life (HRQoL) using the Psoriatic Arthritis Impact of Disease (PsAID)9 questionnaire in active PsA. Methods Patients were randomized 1 : 1 to filgotinib 200 mg or placebo once daily for 16 weeks in EQUATOR, a multicentre, double-blind, phase 2 randomized controlled trial. HRQoL was assessed with PsAID9 at Weeks 4 and 16. Change from baseline in total and individual domain scores, plus the proportions of patients achieving minimal clinically important improvement (MCII; ⩾3 points) and patient-accepted symptom status (PASS; score <4), were evaluated. Correlation with the 36-item short-form health survey (SF-36) was investigated. Results One hundred and thirty-one patients were randomized to filgotinib or placebo. Filgotinib effects on PsAID9 were observed from Week 4. At Week 16, mean (s.d.) change from baseline in PsAID9 was –2.3 (1.8) and –0.8 (2.2) for filgotinib and placebo, respectively (least-squares mean of group difference –1.48 [95% CI –2.12, –0.84], P < 0.0001), with significant improvements in all domains vs placebo. Significantly more patients on filgotinib achieved MCII (group difference 25.4% [95% CI 8.92, 39.99], P = 0.0022) and PASS (group difference 29.6% [95% CI 10.65, 45.60], P = 0.0018) at Week 16 vs placebo. Similar improvements in SF-36 were observed, with moderate to strong negative correlation between PsAID9 and SF-36. Conclusion Filgotinib significantly improved HRQoL vs placebo in patients with active PsA, as measured by PsAID9. To our knowledge, EQUATOR is the first randomized controlled trial to evaluate PsAID9. Trial registration ClinicalTrials.gov, https://clinicaltrials.gov/ct2/show, NCT03101670.
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Affiliation(s)
- Ana-Maria Orbai
- Division of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, MA
| | - Alexis Ogdie
- Division of Rheumatology and Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Laure Gossec
- Institut Pierre Louis d'Epidémiologie et de Santé Publique, Sorbonne Université.,Rheumatology Department, Pitié Salpêtrière Hospital, AP-HP, Paris, France
| | - William Tillett
- Rheumatology, Royal National Hospital for Rheumatic Diseases.,Pharmacy and Pharmacology, University of Bath, Bath, UK
| | - Ying Ying Leung
- Department of Rheumatology & Immunology, Singapore General Hospital, Duke-NUS Medical School, Singapore, Singapore
| | | | - Mona Trivedi
- Clinical Research, Gilead Sciences, Inc, Foster City, CA, USA
| | | | | | | | | | - Laura C Coates
- Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
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Pisaniello HL, Dixon WG. What does digitalization hold for the creation of real-world evidence? Rheumatology (Oxford) 2020; 59:39-45. [PMID: 31834405 PMCID: PMC6909915 DOI: 10.1093/rheumatology/kez068] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2018] [Revised: 02/07/2019] [Indexed: 12/25/2022] Open
Abstract
Health-related information is increasingly being collected and stored digitally. These data, either structured or unstructured, are becoming the ubiquitous assets that might enable us to comprehensively map out a patient's health journey from an asymptomatic state of wellness to disease onset and its trajectory. These new data could provide rich real-world evidence for better clinical care and research, if they can be accessed, linked and analyzed-all of which are possible. In this review, these opportunities will be explored through a case vignette of a patient with OA, followed by discussion on how this digitalized real-world evidence could best be utilized, as well as the challenges of data access, quality and maintaining public trust.
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Affiliation(s)
- Huai Leng Pisaniello
- Arthritis Research UK Centre for Epidemiology, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
- Department of Medicine, University of Adelaide, Adelaide, South Australia, Australia
| | - William Gregory Dixon
- Arthritis Research UK Centre for Epidemiology, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
- Correspondence to: William Gregory Dixon, Arthritis Research UK Centre for Epidemiology, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Oxford Road, Manchester M13 9PT, UK. E-mail:
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Bridging the Gaps in the Care of Psoriasis and Psoriatic Arthritis: the Role of Combined Clinics. Curr Rheumatol Rep 2018; 20:76. [DOI: 10.1007/s11926-018-0785-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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