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Dures E, Farisoğulları B, Santos EJF, Molto A, Feldthusen C, Harris C, Elling-Audersch C, Connolly D, Elefante E, Estévez-López F, Bini I, Primdahl J, Hoeper K, Urban M, van de Laar MAFJ, Redondo M, Böhm P, Amarnani R, Hayward R, Geenen R, Rednic S, Pettersson S, Thomsen T, Uhlig T, Ritschl V, Machado PM. 2023 EULAR recommendations for the management of fatigue in people with inflammatory rheumatic and musculoskeletal diseases. Ann Rheum Dis 2023:ard-2023-224514. [PMID: 38050029 DOI: 10.1136/ard-2023-224514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 11/01/2023] [Indexed: 12/06/2023]
Abstract
OBJECTIVES Fatigue is prevalent in people with inflammatory rheumatic and musculoskeletal diseases (I-RMDs) and recognised as one of the most challenging symptoms to manage. The existence of multiple factors associated with driving and maintaining fatigue, and the evidence about what improves fatigue has led to a multifaceted approach to its management. However, there are no recommendations for fatigue management in people with I-RMDs. This lack of guidance is challenging for those living with fatigue and health professionals delivering clinical care. Therefore, our aim was to develop EULAR recommendations for the management of fatigue in people with I-RMDs. METHODS A multidisciplinary taskforce comprising 26 members from 14 European countries was convened, and two systematic reviews were conducted. The taskforce developed the recommendations based on the systematic review of evidence supplemented with taskforce members' experience of fatigue in I-RMDs. RESULTS Four overarching principles (OAPs) and four recommendations were developed. OAPs include health professionals' awareness that fatigue encompasses multiple biological, psychological and social factors which should inform clinical care. Fatigue should be monitored and assessed, and people with I-RMDs should be offered management options. Recommendations include offering tailored physical activity and/or tailored psychoeducational interventions and/or, if clinically indicated, immunomodulatory treatment initiation or change. Patient-centred fatigue management should consider the individual's needs and preferences, their clinical disease activity, comorbidities and other psychosocial and contextual factors through shared decision-making. CONCLUSIONS These 2023 EULAR recommendations provide consensus and up-to-date guidance on fatigue management in people with I-RMDs.
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Affiliation(s)
- Emma Dures
- School of Health and Social Wellbeing at the University of the West of England (UWE) Bristol and Academic Rheumatology, Bristol Royal Infirmary, Bristol, UK
| | | | - Eduardo José Ferreira Santos
- Department of Rheumatology, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
- Health Sciences Research Unit: Nursing (UICiSA:E), Coimbra, Portugal
| | - Anna Molto
- Department of Rheumatology, Hospital Cochin, Paris, France
- Université Paris-Cité, INSERM U1153, Paris, France
| | | | - Claire Harris
- Department of Rheumatology, London North West University Healthcare NHS Trust, Harrow, UK
| | | | - Deirdre Connolly
- Discipline of Occupational Therapy, Trinity College Dublin, Dublin, Ireland
| | - Elena Elefante
- Rheumatology Unit, Department of Clinical and Experimental Medicine, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - Fernando Estévez-López
- Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA
- Department of Education, Faculty of Education Sciences, SPORT Research Group and CERNEP Research Center, University of Almería, Almería, Spain
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC University Medical Centre, Rotterdam, The Netherlands
| | - Ilaria Bini
- Anmar Young, Rome, Italy
- EULAR Young PARE, Zürich, Switzerland
| | - Jette Primdahl
- University Hospital of Southern Denmark, Danish Hospital for Rheumatic Diseases, Sønderborg, Denmark
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Kirsten Hoeper
- Department of Rheumatology and Immunology, Medizinische Hochschule Hannover Klinikum, Hannover, Germany
| | - Marie Urban
- Department of Rheumatology, Bristol Royal Infirmary, Bristol, UK
| | - Mart A F J van de Laar
- Department of Psychology, Health & Technology, University of Twente, Enschede, The Netherlands
- Arthritis Center Twente, Medical Spectrum Twente, Enschede, The Netherlands
| | - Marta Redondo
- School of Psychology, Universidad Camilo José Cela, Madrid, Spain
| | - Peter Böhm
- Forschungspartner, Deutsche Rheuma-Liga Bundesverband e.V, Bonn, Germany
- Beratung und Begleitung, Deutsche Rheuma-Liga Berlin e.V, Berlin, Germany
| | - Raj Amarnani
- Department of Rheumatology, University College Hospital, London, UK
| | - Rhys Hayward
- Department of Rheumatology, London North West University Healthcare NHS Trust, Harrow, UK
| | - Rinie Geenen
- Department of Psychology, Utrecht University, Utrecht, The Netherlands
| | - Simona Rednic
- Clinica Reumatologie, University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Susanne Pettersson
- Theme Inflammation and Infection, Karolinska University Hospital, Stockholm, Sweden
- Department of Neurobiology, Karolinska Institutet, Stockholm, Sweden
| | - Tanja Thomsen
- Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Centre for Head and Orthopaedics, Rigshospitalet, Glostrup, Denmark
| | - Till Uhlig
- Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
| | - Valentin Ritschl
- Institute for Outcomes Research, Center for Medical Data Science, Medical University of Vienna, Wien, Austria
- Ludwig Boltzmann Institute for Arthritis and Rehabilitation, Vienna, Austria
| | - Pedro M Machado
- MRC Centre for Neuromuscular Diseases, University College London, London, UK
- Department of Rheumatology, University College London Centre for Rheumatology, London, UK
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Fautrel B, Wu J, Wang D, Haladyj E, van de Laar MAFJ, Takeuchi T. Relative Impact of Pain and Disease Activity on Improvements in Fatigue: Results From 2 Baricitinib Phase 3 Clinical Trials. J Clin Rheumatol 2023; 29:139-144. [PMID: 36473106 PMCID: PMC10045960 DOI: 10.1097/rhu.0000000000001924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND/OBJECTIVE Fatigue is common in patients with rheumatoid arthritis (RA). We assessed the relative impact of pain and disease activity on improvements in fatigue in 2 phase 3 baricitinib clinical trials. METHODS RA-BEAM (NCT01710358) and RA-BEACON (NCT01721044) were randomized, double-blind, placebo-controlled studies in adults with moderate to severe RA. RA-BEAM assessed baricitinib + methotrexate (MTX) and adalimumab + MTX in patients with prior inadequate response/intolerance (IR) to MTX (MTX-IR). RA-BEACON assessed patients with IR to ≥1 biologic disease-modifying antirheumatic drug (bDMARD-IR). Measures included the Functional Assessment of Chronic Illness Therapy-Fatigue scale, Clinical Disease Activity Index (CDAI) for RA, and pain visual analog scale (VAS). Analyses were implemented separately for each study. RESULTS Significant improvements were seen in disease activity and pain, which were greater with baricitinib versus adalimumab. A statistically significant improvement was seen in fatigue with both active treatments versus placebo. Moderate correlations were observed between improvements in disease activity and fatigue and between improvements in pain and fatigue in both MTX-IR and bDMARD-IR patients. Reductions in pain (≥50%) and remission or low disease activity (CDAI ≤10) had significant associations with fatigue improvement at week 24. In mediation analysis, improvements in fatigue attributable to CDAI and pain VAS in MTX-IR patients were 31% and 52%, respectively, for baricitinib, and 30% and 47%, respectively, for adalimumab. In bDMARD-IR patients, improvement in fatigue was attributed 48% to CDAI and 48% to pain VAS. CONCLUSIONS In both MTX-IR and bDMARD-IR patients, a large proportion of improvements in fatigue across treatment arms were accounted for by improvements in pain and disease activity.
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Affiliation(s)
- Bruno Fautrel
- From the Department of Rheumatology, Sorbonne University-Assistance Publique Hôpitaux de Paris, Paris, France
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3
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van de Laar MAFJ, Schöfl R, Prevoo M, Jastorff J. Predictive value of gastrointestinal symptoms and patient risk factors for NSAID-associated gastrointestinal ulcers defined by endoscopy? Insights from a pooled analysis of two naproxen clinical trials. PLoS One 2023; 18:e0284358. [PMID: 37053160 PMCID: PMC10101403 DOI: 10.1371/journal.pone.0284358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Accepted: 03/28/2023] [Indexed: 04/14/2023] Open
Abstract
OBJECTIVE Nonsteroidal anti-inflammatory drugs (NSAIDs) are widely used to treat pain and rheumatic conditions. To facilitate patient management, we determined the predictive value of gastrointestinal (GI) symptoms and risk factors for the development of NSAID-associated GI injuries. METHODS Post-hoc analysis of pooled data from naproxen treatment arms of two identical, randomized, double-blind, controlled phase 3 trials in arthritis patients at risk of GI adverse events. Endoscopic incidence of GI ulcers at baseline, and 1, 3, and 6 months was employed as a surrogate parameter for GI injury. For GI symptom analysis, Severity of Dyspepsia Assessment questionnaire was used. For GI risk factor analysis, the high risk factors: previous GI injury, concomitant selective serotonin reuptake inhibitors or corticosteroids, ulcer history, concomitant low-dose aspirin, and age >65 years were employed. RESULTS Data of 426 naproxen patients were analyzed. Distribution of GI symptoms between patients with and without ulcer was similar; about one third of patients developing an ulcer reported no GI pain symptoms. GI symptoms experienced under naproxen treatment were thus not indicative of GI injury. The proportion of patients developing an ulcer increased with the number of risk factors present, however, about a quarter of patients without any of the analyzed risk factors still developed an ulcer. CONCLUSION GI symptoms and the number of risk factors are not reliable predictors of NSAID-induced GI injury to decide which patients need gastroprotection and will lead to a large group of patients with GI injuries. A preventive rather than reactive approach should be taken.
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Affiliation(s)
- Mart A F J van de Laar
- Department of Psychology, Health and Technology, University of Twente, Enschede, The Netherlands
| | - Rainer Schöfl
- Department of Internal Medicine IV, Ordensklinikum Barmherzige Schwestern, Linz, Austria
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van de Laar CJ, Janssen CA, Janssen M, Oude Voshaar MAH, AL MJ, van de Laar MAFJ. Model-based cost-effectiveness analyses comparing combinations of urate lowering therapy and anti-inflammatory treatment in gout patients. PLoS One 2022; 17:e0261940. [PMID: 35089941 PMCID: PMC8797232 DOI: 10.1371/journal.pone.0261940] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Accepted: 12/14/2021] [Indexed: 11/18/2022] Open
Abstract
Objectives
To assess the cost-effectiveness of various combinations of urate lowering therapy (ULT) and anti-inflammatory treatment in the management of newly diagnosed gout patients, from the Dutch societal perspective.
Methods
A probabilistic patient-level simulation estimating costs and quality-adjusted life years (QALYs) comparing gout and hyperuricemia treatment strategies was performed. ULT options febuxostat, allopurinol and no ULT were considered. Flare treatments naproxen, colchicine, prednisone, and anakinra were considered. A Markov Model was constructed to simulate gout disease. Health states were no flare, and severe pain, mild pain, moderate pain, or no pain in the presence of a flare. Model input was derived from patient level clinical trial data, meta-analyses or from previously published health-economic evaluations. The results of probabilistic sensitivity analyses were presented using incremental cost-effectiveness ratios (ICERs), and summarized using cost-effectiveness acceptability curves (CEACs). Scenario analyses were performed.
Results
The ICER for allopurinol versus no ULT was €1,381, when combined with naproxen. Febuxostat yielded the highest utility, but also the highest costs (€4,385 vs. €4,063 for allopurinol), resulting in an ICER of €25,173 when compared to allopurinol. No ULT was not cost-effective, yielding the lowest utility. For the gout flare medications, comparable effects on utility were achieved. Combined with febuxostat, naproxen was the cheapest option (€4,404), and anakinra the most expensive (€4,651). The ICER of anakinra compared to naproxen was €818,504. Colchicine and prednisone were dominated by naproxen.
Conclusion
Allopurinol and febuxostat were both cost-effective compared to No ULT. Febuxostat was cost-effective in comparison with allopurinol at higher willingness-to-pay thresholds. For treating gout flares, colchicine, naproxen and prednisone offered comparable health economic implications, although naproxen was the favoured option.
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Affiliation(s)
| | - Carly A. Janssen
- Transparency in Healthcare BV, Hengelo, the Netherlands
- Department of Psychology, Health & Technology, University of Twente, Enschede, The Netherlands
| | - Matthijs Janssen
- Department of Rheumatology, VieCuri Medical Center, Venlo, The Netherlands
| | - Martijn A. H. Oude Voshaar
- Transparency in Healthcare BV, Hengelo, the Netherlands
- Department of Psychology, Health & Technology, University of Twente, Enschede, The Netherlands
| | - Maiwenn J. AL
- Institute for Medical Technology Assessment, Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Mart A. F. J. van de Laar
- Transparency in Healthcare BV, Hengelo, the Netherlands
- Department of Psychology, Health & Technology, University of Twente, Enschede, The Netherlands
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5
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Versteeg GA, Ten Klooster PM, van de Laar MAFJ. Fatigue is associated with disease activity in some, but not all, patients living with rheumatoid arthritis: disentangling "between-person" and "within-person" associations. BMC Rheumatol 2022; 6:3. [PMID: 34991729 PMCID: PMC8739670 DOI: 10.1186/s41927-021-00230-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Accepted: 08/18/2021] [Indexed: 11/24/2022] Open
Abstract
Background Previous research has shown an unclear and inconsistent association between fatigue and disease activity in patients with rheumatoid arthritis (RA). The aim of this study was to explore differences in “between-person” and “within-person” associations between disease activity parameters and fatigue severity in patients with established RA. Methods Baseline and 3-monthly follow-up data up to one-year were used from 531 patients with established RA randomized to stopping (versus continuing) tumor necrosis factor inhibitor treatment enrolled in a large pragmatic trial. Between- and within-patient associations between different indicators of disease activity (C-reactive protein [CRP], erythrocyte sedimentation rate [ESR], swollen and tender joint count [ SJC and TJC], visual analog scale general health [VAS-GH]) and patient-reported fatigue severity (Bristol RA Fatigue Numerical Rating Scale) were disaggregated and estimated using person-mean centering in combination with repeated measures linear mixed modelling. Results Overall, different indices of disease activity were weakly to moderately associated with fatigue severity over time (β’s from 0.121 for SJC to 0.352 for VAS-GH, all p’s < 0.0001). Objective markers of inflammation (CRP, ESR and SJC) were associated weakly with fatigue within patients over time (β’s: 0.104–0.142, p’s < 0.0001), but not between patients. The subjective TJC and VAS-GH were significantly associated with fatigue both within and between patients, but with substantially stronger associations at the between-patient level (β’s: 0.217–0.515, p’s < 0.0001). Within-person associations varied widely for individual patients for all components of disease activity. Conclusion Associations between fatigue and disease activity vary largely for different patients and the pattern of between-person versus within-person associations appears different for objective versus subjective components of disease activity. The current findings explain the inconsistent results of previous research, illustrates the relevance of statistically distinguishing between different types of association in research on the relation between disease activity and fatigue and additionally suggest a need for a more personalized approach to fatigue in RA patients. Trial registration Netherlands trial register, Number NTR3112.
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Affiliation(s)
- Grada A Versteeg
- Department of Psychology, Health and Technology, Faculty of Behavioural, Management and Social Sciences, University of Twente, P.O. box. 217, 7500 AE, Enschede, The Netherlands.
| | - Peter M Ten Klooster
- Department of Psychology, Health and Technology, Faculty of Behavioural, Management and Social Sciences, University of Twente, P.O. box. 217, 7500 AE, Enschede, The Netherlands
| | - Mart A F J van de Laar
- Department of Psychology, Health and Technology, Faculty of Behavioural, Management and Social Sciences, University of Twente, P.O. box. 217, 7500 AE, Enschede, The Netherlands
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6
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Spijk-de Jonge MJ, Manders SHM, Huis AMP, Elwyn G, van de Laar MAFJ, van Riel PLCM, Hulscher MEJL. Co-Design of a Disease Activity Based Self-Management Approach for Patients with Rheumatoid Arthritis. Mediterr J Rheumatol 2021; 32:21-30. [PMID: 34386699 PMCID: PMC8314884 DOI: 10.31138/mjr.32.1.21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Revised: 01/10/2021] [Indexed: 11/13/2022] Open
Abstract
Objective: The systematic development of an intervention to improve disease activity-based management of rheumatoid arthritis (RA) in daily clinical practice that is based on patient-level barriers. Methods: The self-management strategy was developed through a step-wise approach, in a process of co-design with all stakeholders and by addressing patient level barriers to RA management based on disease activity. Results: The resulting DAS-pass strategy consists of decision supportive information and guidance by a specialised rheumatology nurse. It aims to increase patients’ knowledge on DAS28, to empower patients to be involved in disease management, and to improve patients’ medication beliefs. The decision supportive information includes an informational leaflet and a patient held record. The nurse individualises the information, stimulates patients to communicate about disease activity, and offers the opportunity for questions or additional support. Conclusion: The DAS-pass strategy was found helpful by stakeholders. It can be used to improve RA daily clinical practice. Our systematic approach can be used to improve patient knowledge and self-management on other RA related topics. Also, it can be used to improve the management of other chronic conditions. We therefore provide a detailed description of our methodology to assist those interested in developing an evidence-based strategy for educating and empowering patients.
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Affiliation(s)
- Marieke J Spijk-de Jonge
- Radboud University Medical Centre, Radboud Institute for Health Sciences, IQ Healthcare, Nijmegen, The Netherlands
| | | | - Anita M P Huis
- Radboud University Medical Centre, Radboud Institute for Health Sciences, IQ Healthcare, Nijmegen, The Netherlands
| | - Glyn Elwyn
- Radboud University Medical Centre, Radboud Institute for Health Sciences, IQ Healthcare, Nijmegen, The Netherlands.,The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon (NH), United States of America
| | - Mart A F J van de Laar
- University of Twente, Department of Psychology, Health and Technology, Enschede, The Netherlands
| | - Piet L C M van Riel
- Radboud University Medical Centre, Radboud Institute for Health Sciences, IQ Healthcare, Nijmegen, The Netherlands.,Bernhoven, Department of Rheumatology, Uden, The Netherlands
| | - Marlies E J L Hulscher
- Radboud University Medical Centre, Radboud Institute for Health Sciences, IQ Healthcare, Nijmegen, The Netherlands
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7
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Spijk-de Jonge MJ, Oude Voshaar MAH, Renskers L, Huis AMP, van de Laar MAFJ, Hulscher MEJL, van Riel PLCM. Two parallel short forms to measure disease- and treatment-associated knowledge in rheumatoid arthritis: application of item response theory. Rheumatol Adv Pract 2020; 4:rkaa012. [PMID: 32704614 PMCID: PMC7368341 DOI: 10.1093/rap/rkaa012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Revised: 04/16/2020] [Indexed: 11/14/2022] Open
Abstract
Abstract
Objective
The aim was to develop two disease- and treatment-related knowledge about RA (DataK-RA) short forms using item response theory-based linear optimal test design.
Methods
We used the open source Excel add-in solver to program a linear optimization algorithm to develop two short forms from the DataK-RA item bank. The algorithm was instructed to optimize precision (i.e. reliability) of the scores for both short forms, subject to a number of constraints that served to ensure that each short form would include unique items and that the short forms would have similar psychometric properties. Agreement among item response theory scores obtained from the different short forms was assessed using the Bland–Altman method and Student’s paired t-test. Construct validity and relative efficiency of the short forms was evaluated by relating the score to age, sex and educational attainment.
Results
Two short forms were derived from the DataK-RA item bank that satisfied all content constraints. Both short forms included 15 unique items and yielded reliable scores (r > 0.70), with low ceiling and floor effects. The short forms yielded statistically indistinguishable mean scores according to Student’s paired t-test and Bland–Altman analysis. Scores on short forms 1 and 2 were associated with age, sex and educational attainment to a similar extent.
Conclusion
In this study, we developed two DataK-RA short forms with unique items, yet similar psychometric properties, that can be used to assess patients pre- and post-test interventions aimed at improving disease-related knowledge in RA patients.
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Affiliation(s)
- Marieke J Spijk-de Jonge
- Radboud University Medical Center, Radboud Institute for Health Sciences, IQ Healthcare, Nijmegen
| | - Martijn A H Oude Voshaar
- Department of Psychology, Health and Technology, University of Twente, Enschede, The Netherlands
| | - Lisanne Renskers
- Radboud University Medical Center, Radboud Institute for Health Sciences, IQ Healthcare, Nijmegen
| | - Anita M P Huis
- Radboud University Medical Center, Radboud Institute for Health Sciences, IQ Healthcare, Nijmegen
| | - Mart A F J van de Laar
- Department of Psychology, Health and Technology, University of Twente, Enschede, The Netherlands
| | - Marlies E J L Hulscher
- Radboud University Medical Center, Radboud Institute for Health Sciences, IQ Healthcare, Nijmegen
| | - Piet L C M van Riel
- Radboud University Medical Center, Radboud Institute for Health Sciences, IQ Healthcare, Nijmegen
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8
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Oude Voshaar MAH, Das Gupta Z, Bijlsma JWJ, Boonen A, Chau J, Courvoisier DS, Curtis JR, Ellis B, Ernestam S, Gossec L, Hale C, Hornjeff J, Leung KYY, Lidar M, Mease P, Michaud K, Mody GM, Ndosi M, Opava CH, Pinheiro GRC, Salt M, Soriano ER, Taylor WJ, Voshaar MJH, Weel AEAM, de Wit M, Wulffraat N, van de Laar MAFJ, Vonkeman HE. International Consortium for Health Outcome Measurement Set of Outcomes That Matter to People Living With Inflammatory Arthritis: Consensus From an International Working Group. Arthritis Care Res (Hoboken) 2020; 71:1556-1565. [PMID: 30358135 PMCID: PMC6900179 DOI: 10.1002/acr.23799] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Accepted: 10/16/2018] [Indexed: 01/22/2023]
Abstract
Objective The implementation of value‐based health care in inflammatory arthritis requires a standardized set of modifiable outcomes and risk‐adjustment variables that is feasible to implement worldwide. Methods The International Consortium for Health Outcomes Measurement (ICHOM) assembled a multidisciplinary working group that consisted of 24 experts from 6 continents, including 6 patient representatives, to develop a standard set of outcomes for inflammatory arthritis. The process followed a structured approach, using a modified Delphi process to reach consensus on the following decision areas: conditions covered by the set, outcome domains, outcome measures, and risk‐adjustment variables. Consensus in areas 2 to 4 were supported by systematic literature reviews and consultation of experts. Results The ICHOM Inflammatory Arthritis Standard Set covers patients with rheumatoid arthritis (RA), axial spondyloarthritis, psoriatic arthritis, and juvenile idiopathic arthritis (JIA). We recommend that outcomes regarding pain, fatigue, activity limitations, overall physical and mental health impact, work/school/housework ability and productivity, disease activity, and serious adverse events be collected at least annually. Validated measures for patient‐reported outcomes were endorsed and linked to common reporting metrics. Age, sex at birth, education level, smoking status, comorbidities, time since diagnosis, and rheumatoid factor and anti‐citrullinated protein antibody lab testing for RA and JIA should be collected as risk‐adjustment variables. Conclusion We present the ICHOM inflammatory arthritis Standard Set of outcomes, which enables health care providers to implement the value‐based health care framework and compare outcomes that are important to patients with inflammatory arthritis.
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Affiliation(s)
| | - Zofia Das Gupta
- International Consortium for Health Outcomes Measurement, London, UK
| | | | - Annelies Boonen
- Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Jeffrey Chau
- Hong Kong Psoriatic Arthritis Association, Hong Kong, China
| | | | | | | | | | - Laure Gossec
- Sorbonne Université and Pitié Salpêtrière Hospital, AP-HP, Paris, France
| | | | | | - Katy Y Y Leung
- Singapore General Hospital, Duke-NUS Medical School, Singapore
| | | | - Phillip Mease
- Providence St. Joseph Health System, University of Washington, Seattle
| | - Kaleb Michaud
- University of Nebraska Medical Center Omaha, and the National Databank for Rheumatic Diseases, Wichita, Kansas
| | | | | | | | | | - Matthew Salt
- International Consortium for Health Outcomes Measurement, London, UK
| | - Enrique R Soriano
- Instituto Universitario Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | | | | | | | - Maarten de Wit
- VU University Medical Centre, Amsterdam Public Health, Amsterdam, The Netherlands
| | - Nico Wulffraat
- Wilhelmina Children's Hospital, Utrecht, The Netherlands
| | - Mart A F J van de Laar
- University of Twente, Enschede, The Netherlands, and International Consortium for Health Outcomes Measurement, London, UK
| | - Harald E Vonkeman
- University of Twente, Enschede, The Netherlands, and International Consortium for Health Outcomes Measurement, London, UK
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9
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Janssen CA, Oude Voshaar MAH, Ten Klooster PM, Vonkeman HE, van de Laar MAFJ. Development and validation of a patient-reported gout attack intensity score for use in gout clinical studies. Rheumatology (Oxford) 2019; 58:1928-1934. [PMID: 30859221 PMCID: PMC6812713 DOI: 10.1093/rheumatology/kez064] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Revised: 02/04/2019] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE Inflammation-related symptoms such as pain, swelling and tenderness of the affected joint are frequently assessed using 5-point diary rating scales in gout clinical trials. Combining these into a single gout attack symptom intensity score may be a useful summary measure for these data, which is potentially more responsive to change compared with the individual components. The objective of this study was to develop a patient-reported gout flare intensity score, the Gout Attack Intensity Score (GAIS), for use in clinical studies, that includes components for gout-related pain, swelling and tenderness. METHODS Data from a randomized controlled trial comparing anakinra to standard of care for the treatment of acute gout attacks were used for this study. A 7-day flare diary was completed by patients, including questions relating to intensity of pain, swelling and tenderness (5-point rating scales). Scalability of these items was assessed using Mokken Scale Analysis, and reliability using greatest lower bound reliability coefficients. Known-groups validity was evaluated, as well as the responsiveness to change and the presence of floor and ceiling effects. RESULTS Scalability of the single items was supported, and GAIS scores were reliable (greatest lower bound >0.80). GAIS scores demonstrated responsiveness to change with high effect sizes (>0.8), and discriminated better between responders and non-responders compared with its single-item components. No floor and ceiling effects were found. CONCLUSION The GAIS seems to be a reliable and responsive instrument for assessing patient-reported gout attack intensity that may be used in gout clinical studies.
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Affiliation(s)
- Carly A Janssen
- Arthritis Center Twente, Department of Psychology, Health and Technology, University of Twente, Enschede, The Netherlands
| | - Martijn A H Oude Voshaar
- Arthritis Center Twente, Department of Psychology, Health and Technology, University of Twente, Enschede, The Netherlands
| | - Peter M Ten Klooster
- Arthritis Center Twente, Department of Psychology, Health and Technology, University of Twente, Enschede, The Netherlands
| | - Harald E Vonkeman
- Arthritis Center Twente, Department of Psychology, Health and Technology, University of Twente, Enschede, The Netherlands.,Department of Rheumatology and Clinical Immunology, Medisch Spectrum Twente, Enschede, The Netherlands
| | - Mart A F J van de Laar
- Arthritis Center Twente, Department of Psychology, Health and Technology, University of Twente, Enschede, The Netherlands.,Department of Rheumatology and Clinical Immunology, Medisch Spectrum Twente, Enschede, The Netherlands
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10
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Oude Voshaar MAH, van de Laar MAFJ. Taking the patient and the patient's perspective into account to improve outcomes of care of patients with musculoskeletal diseases. Best Pract Res Clin Rheumatol 2019; 33:101436. [PMID: 31703794 DOI: 10.1016/j.berh.2019.101436] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Patient-reported outcome measures are commonly used in the assessment of patients with musculoskeletal diseases. The present review provides an overview of historic and recent developments, including core set recommendations for assessing patient-reported outcomes in patients with fibromyalgia, osteoarthritis, rheumatoid arthritis, ankylosing spondylitis, and psoriatic arthritis. The evidence supporting commonly used patient-reported outcomes measures is reviewed. Furthermore, various methodological approaches that can be utilized to evaluate validity and measurement precision of patient reported outcomes are introduced. Commonly used methods based on the classical test theory as well as modern approaches based on item response theory will be discussed. The review finally describes the increasing use of item response theory-based approaches used in patient-reported outcomes assessment in the musculoskeletal diseases.
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Affiliation(s)
- Martijn A H Oude Voshaar
- Department of Psychology, Health & Technology, University of Twente, the Netherlands; Transparency in Healthcare, University of Twente, Hengelo, the Netherlands.
| | - Mart A F J van de Laar
- Department of Psychology, Health & Technology, University of Twente, the Netherlands; Transparency in Healthcare, University of Twente, Hengelo, the Netherlands
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11
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van de Laar MAFJ, Hoentjen F, Thio HB. [The next step in the treatment of immune diseases: jakinibs, inhibitors of the intracellular Janus kinase]. Ned Tijdschr Geneeskd 2019; 163:D3569. [PMID: 31433146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
The next step in the treatment of immune diseases: jakinibs, inhibitors of the intracellular Janus kinase The intracellular Janus kinase (JAK) and the signal transduction and activator of transcription (STAT) proteins are involved in the whole spectrum of immune-mediated diseases. Currently, agents are developed that influence the JAK-STAT mechanism. JAK inhibitors (jakinibs) have only recently made their way into clinical practice. These agents exhibit both similarities and differences in terms of effectiveness and safety. In the coming years, results from basic and clinical research will improve our knowledge of these agents. For patients who suffer from immune-mediated diseases, their introduction appears to be a breakthrough that will offer new treatment options. One advantage over biologicals is that jakinibs can be taken orally. As with all new innovative medicines, with jakinibs one cannot escape a discussion over costs as well. The balance between the added value of jakinibs compared to biologicals, and the actual purchase prices for each of these treatment modalities, will influence the eventual positioning of jakinibs.
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Affiliation(s)
- Mart A F J van de Laar
- Universiteit Twente, faculteit Behavioural, Management and Socialsciences, Enschede
- Contact: M.A.F.J. van de Laar
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12
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Ten Klooster PM, Oude Voshaar MAH, Fakhouri W, de la Torre I, Nicolay C, van de Laar MAFJ. Long-term clinical, functional, and cost outcomes for early rheumatoid arthritis patients who did or did not achieve early remission in a real-world treat-to-target strategy. Clin Rheumatol 2019; 38:2727-2736. [PMID: 31161488 DOI: 10.1007/s10067-019-04600-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Revised: 05/02/2019] [Accepted: 05/12/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVE To retrospectively compare the long-term clinical, functional, and cost outcomes for early RA patients (symptoms < 1 year) who did or did not achieve early remission in a treat-to-target strategy. METHOD Five-year data of 471 patients included in the DREAM remission induction cohort were used. Patients were treated according to a pre-specified 28-joint Disease Activity Score (DAS28) remission driven step-up treatment strategy starting with methotrexate, addition of sulfasalazine, and exchange of sulfasalazine for biological medication in case of failure. Two- and 3-year healthcare costs were available for selected subsamples of patients only. RESULTS DAS28 remission was achieved in 27.7%, 38.2%, and 51.6% of patients at 2, 3, and 6 months, respectively. Achieving DAS28 remission at 2, 3, or 6 months was consistently associated with significantly lower DAS28 and Health Assessment Questionnaire-Disability scores at 1, 3, and 5 years of follow-up (all P values < 0.02). Patients in remission at 2, 3, or 6 months also had significantly lower medication costs per patient over the first 2 and 3 years of treatment, mainly due to lower biologic use, but differences in total healthcare resource costs (hospital admissions plus consultations) were less pronounced. Mean total medication and total healthcare resource costs at 3 years were €1131 and €1757 for patients in remission at 6 months vs. €7533 (P < 0.01) and €2202 (P = 0.09) for those not in remission. CONCLUSION Achieving early remission was associated with beneficial clinical outcomes for early RA patients and lower costs in the long term. Key Points • Previous studies in rheumatoid arthritis patients have demonstrated that early good response is associated with sustained remission and better long-term clinical outcomes. • This study extents these findings by examining the long-term benefits of achieving early remission on clinical, patient-reported, and economic outcomes in a real-world cohort of patients with very early rheumatoid arthritis treated according to treat-to-target principles. • The findings of this study clearly demonstrate that aiming for early remission in rheumatoid arthritis patients is beneficial in the long-term in terms of better clinical and functional outcomes and lower healthcare costs.
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Affiliation(s)
- Peter M Ten Klooster
- Transparency in Healthcare, Hengelo, The Netherlands. .,Arthritis Centre Twente, University of Twente, Enschede, The Netherlands. .,Department of Psychology, Health and Technology, University of Twente, PO Box 217, 7500 AE, Enschede, The Netherlands.
| | - Martijn A H Oude Voshaar
- Transparency in Healthcare, Hengelo, The Netherlands.,Arthritis Centre Twente, University of Twente, Enschede, The Netherlands
| | | | | | - Claudia Nicolay
- Lilly Deutschland GmbH, Eli Lilly and Company, Bad Homburg, Germany
| | - Mart A F J van de Laar
- Transparency in Healthcare, Hengelo, The Netherlands.,Arthritis Centre Twente, University of Twente, Enschede, The Netherlands.,Arthritis Centre Twente, Medisch Spectrum Twente, Enschede, The Netherlands
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13
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Oude Voshaar MAH, Bode C, Hewlett S, Kirwan J, Gossec L, van de Laar MAFJ. Psychometric properties and cross-language equivalence of the revised Bristol Rheumatoid Arthritis Fatigue and the Rheumatoid Arthritis Impact of Disease scales in rheumatoid arthritis. Qual Life Res 2019; 28:2543-2552. [PMID: 31028510 PMCID: PMC6698264 DOI: 10.1007/s11136-019-02188-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/19/2019] [Indexed: 11/26/2022]
Abstract
Objective To assess psychometric properties and cross-language measurement equivalence of six versions of the Bristol Rheumatoid Arthritis Fatigue Scale (BRAF-MDQ) and the Rheumatoid Arthritis Impact of Disease Score (RAID in rheumatoid arthritis (RA). Methods Both questionnaires were completed by French (n = 206), German (n = 206), Dutch (n = 317), Spanish (n = 157), Swedish (n = 170) and UK (n = 210) RA patients. The presence of cross-language differential item functioning (DIF) was examined using the generalized partial credit model. The impact of DIF on the item and total scores was examined by comparing DIF unadjusted and DIF adjusted expected item and scale scores. IRT-based methods were used to assess psychometric properties of the instruments. Results 11 of the 20 BRAF-MDQ (55%) and 4 of the 7 RAID items (57%) exhibited significant DIF in at least one of the six countries. The mean number of items with DIF per country was 2.6 for BRAF-MDQ and 1.1 for RAID. However, the impact of DIF on the total RAID and BRAF-MDQ scores, as well as the BRAF subscales, was found to be negligible at the group level. Only for the BRAF physical subscale was there evidence of minor DIF. Marginal reliabilities of BRAF-MDQ (0.93) and RAID (0.89) were excellent, and precise scores could be obtained across the spectrum of disease impact and fatigue scores measured by these PROMs. Conclusion This study supports the cross-language measurement equivalence of BRAF-MDQ and RAID and provides further support for the psychometric properties of these measures in RA. Electronic supplementary material The online version of this article (10.1007/s11136-019-02188-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Martijn A H Oude Voshaar
- Department of Psychology, Health and Technology, University of Twente, PO BOX 50 000, 7500 KA, Enschede, The Netherlands.
| | - Christina Bode
- Department of Psychology, Health and Technology, University of Twente, PO BOX 50 000, 7500 KA, Enschede, The Netherlands
| | | | | | - Laure Gossec
- Sorbonne Université, Paris, France
- Rheumatology Department, Pitié Salpêtrière Hospital, APHP, Paris, France
| | - Mart A F J van de Laar
- Department of Psychology, Health and Technology, University of Twente, PO BOX 50 000, 7500 KA, Enschede, The Netherlands
- Department for Rheumatology, Arthritis Centre Twente, Medisch Spectrum Twente, Enschede, The Netherlands
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14
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Janssen CA, Oude Voshaar MAH, Ten Klooster PM, Jansen TLTA, Vonkeman HE, van de Laar MAFJ. A systematic literature review of patient-reported outcome measures used in gout: an evaluation of their content and measurement properties. Health Qual Life Outcomes 2019; 17:63. [PMID: 30975212 PMCID: PMC6460780 DOI: 10.1186/s12955-019-1125-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Accepted: 03/26/2019] [Indexed: 01/01/2023] Open
Abstract
Background Gout is a common, monosodium urate crystal-driven inflammatory arthritis. Besides its clinical manifestations, patients often also suffer from pain, physical impairment, emotional distress and work productivity loss, as a result of the disease. Patient-reported outcome measures (PROMs) are commonly used to assess these consequences of the disease. However, current instrument endorsements for measuring such outcomes in acute and chronic gout clinical settings are based on limited psychometric evidence. The objective of this systematic literature review was to identify currently available PROMs for gout, and to critically evaluate their content and psychometric properties, in order to evaluate the current status regarding PROMs for use in gout patients. Methods Systematic literature searches were performed in the PubMed and EMBASE databases. The methodological quality of included papers was appraised using the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) checklist, and evaluation of measurement properties (reliability, responsiveness, construct validity, floor and ceiling effects) was done in accordance with published quality criteria. Item content was appraised by linking health concepts to the International Classification of Functioning Disability and Health (ICF) framework. Results In total, 13 PROMs were identified, of which three were targeted specifically at gout patients. The majority of the PROMs were rated positively for content validity. For most instruments, limited evidence was available for construct validity and reliability. Instruments to assess pain scored well on responsiveness and floor and ceiling effects, but not much is known about their reliability in gout. Conclusions The physical functioning subscale of the SF-36v2 (Short Form-36 item version 2) is the only PROM that had sufficient supporting evidence for all its psychometric properties. Many of the commonly used PROMs in gout are currently not yet well supported and more studies on their measurement properties are needed among both acute and chronic gout populations. Electronic supplementary material The online version of this article (10.1186/s12955-019-1125-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Carly A Janssen
- Department of Psychology, Health and Technology, University of Twente, PO BOX 217, 7500 AE, Enschede, the Netherlands.
| | - Martijn A H Oude Voshaar
- Department of Psychology, Health and Technology, University of Twente, PO BOX 217, 7500 AE, Enschede, the Netherlands
| | - Peter M Ten Klooster
- Department of Psychology, Health and Technology, University of Twente, PO BOX 217, 7500 AE, Enschede, the Netherlands
| | - Tim L Th A Jansen
- Department of Rheumatology, VieCuri Medical Center, Venlo, The Netherlands
| | - Harald E Vonkeman
- Department of Psychology, Health and Technology, University of Twente, PO BOX 217, 7500 AE, Enschede, the Netherlands.,Department of Rheumatology and Clinical Immunology, Medisch Spectrum Twente, Enschede, The Netherlands
| | - Mart A F J van de Laar
- Department of Psychology, Health and Technology, University of Twente, PO BOX 217, 7500 AE, Enschede, the Netherlands.,Department of Rheumatology and Clinical Immunology, Medisch Spectrum Twente, Enschede, The Netherlands
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Ghiti Moghadam M, Ten Klooster PM, Vonkeman HE, Kneepkens EL, Klaasen R, Stolk JN, Tchetverikov I, Vreugdenhil SA, van Woerkom JM, Goekoop-Ruiterman YPM, Landewé RBM, van Riel PLCM, van de Laar MAFJ, Jansen TL. Impact of Stopping Tumor Necrosis Factor Inhibitors on Rheumatoid Arthritis Patients' Burden of Disease. Arthritis Care Res (Hoboken) 2019; 70:516-524. [PMID: 28692770 DOI: 10.1002/acr.23315] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Accepted: 07/06/2017] [Indexed: 12/19/2022]
Abstract
OBJECTIVE To determine the impact of stopping tumor necrosis factor inhibitor (TNFi) treatment on patient-reported outcomes (PROs) of physical and mental health status, health utility, pain, disability, and fatigue in patients with established rheumatoid arthritis (RA). METHODS In the pragmatic, 12-month POET trial, 817 RA patients with ≥6 months of remission or stable low disease activity were randomized 2:1 to stopping or continuing TNFi. In case of flare, TNFi was restarted at the discretion of the rheumatologist. PROs were assessed every 3 months. RESULTS TNFi was restarted within 12 months in 252 of 531 patients (47.5%) in the stop group. At 3 months, mean PRO scores were significantly worse in the stop group, and a larger proportion of patients experienced a minimum clinically important difference (MCID) on all PROs. Effect sizes (ES) were strongest for health utility (ES -0.24) and pain (ES -0.30). Mean scores improved again after this point, but disability scores remained significantly different at 12 months. After 12 months, the relative risk of experiencing an MCID ranged from 1.16 for mental health status to 1.58 for fatigue. Mean PRO scores for patients restarting TNFi within 6 months were no longer significantly different from those that did not restart TNFi at 12 months. CONCLUSION Stopping TNFi had a significant negative short-term impact on a broad range of PROs. Long-term negative consequences appeared to be limited, and outcomes in patients needing to restart TNFi within the first 6 months tended to be restored at 12 months.
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Affiliation(s)
- Marjan Ghiti Moghadam
- Arthritis Centre Twente, University of Twente, and Medisch Spectrum Twente, Enschede, The Netherlands
| | - Peter M Ten Klooster
- Arthritis Centre Twente, University of Twente, and Medisch Spectrum Twente, Enschede, The Netherlands
| | - Harald E Vonkeman
- Arthritis Centre Twente, University of Twente, and Medisch Spectrum Twente, Enschede, The Netherlands
| | | | - Ruth Klaasen
- Meander Medical Centre, Amersfoort, The Netherlands
| | - Jan N Stolk
- Gelderse Vallei Hospital, Ede, The Netherlands
| | | | | | | | | | | | | | - Mart A F J van de Laar
- Arthritis Centre Twente, University of Twente, and Medisch Spectrum Twente, Enschede, The Netherlands
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16
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Janssen CA, Oude Voshaar MAH, Vonkeman HE, Jansen TLTA, Janssen M, Kok MR, Radovits B, van Durme C, Baan H, van de Laar MAFJ. Anakinra for the treatment of acute gout flares: a randomized, double-blind, placebo-controlled, active-comparator, non-inferiority trial. Rheumatology (Oxford) 2019; 58:5270863. [PMID: 30602035 DOI: 10.1093/rheumatology/key402] [Citation(s) in RCA: 58] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVES To evaluate the efficacy and safety of anakinra in treating acute gout flares in a randomized, double-blind, placebo-controlled, active comparator, non-inferiority (NI) trial. METHODS Patients with a crystal-proven acute gout flare were randomized (1: 1) to treatment with anakinra or treatment as usual (free choice: either colchicine, naproxen or prednisone). The primary end point was the change in pain between baseline and the averaged pain score on days 2-4 measured on a five-point rating scale. NI of anakinra would be established if the upper bound of the 95% CI of the numeric difference in changed pain scores between treatment groups did not exceed the NI limit of 0.4 in favour of treatment as usual, in the per-protocol (PP) and intention-to-treat (ITT) populations, assessed in an analysis of covariance model. Secondary outcomes included safety assessments, improvement in pain, swelling, tenderness and treatment response after 5 days, assessed using linear mixed models and binary logistic regression models. RESULTS Forty-three patients received anakinra and 45 treatment as usual. Anakinra was non-inferior (mean difference; 95% CI) to treatment as usual in both the PP (-0.13; -0.44, 0.18) and ITT (-0.18; -0.44, 0.08) populations. No unexpected or uncommon (serious) adverse events were observed in either treatment arm. Analyses of secondary outcomes showed that patients in both groups reported similar significant reductions in their gout symptoms. CONCLUSION Efficacy of anakinra was shown to be non-inferior to treatment as usual for the treatment of acute gout flares, suggesting that anakinra is an effective treatment alternative for acute gout flares. TRIAL REGISTRATION Het Nederlands Trial Register, www.trialregister.nl, NTR5234.
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Affiliation(s)
- Carly A Janssen
- Arthritis Center Twente, Department of Psychology, Health and Technology, University of Twente, The Netherlands
| | - Martijn A H Oude Voshaar
- Arthritis Center Twente, Department of Psychology, Health and Technology, University of Twente, The Netherlands
| | - Harald E Vonkeman
- Arthritis Center Twente, Department of Psychology, Health and Technology, University of Twente, The Netherlands
- Department of Rheumatology and Clinical Immunology, Medisch Spectrum Twente, Ensche, The Netherlands
| | - Tim L Th A Jansen
- Department of Rheumatology, VieCuri Medical Center, Venlo, The Netherlands
| | - Matthijs Janssen
- Department of Rheumatology, VieCuri Medical Center, Venlo, The Netherlands
- Department of Rheumatology, Rijnstate Hospital, Arnhem, The Netherlands
| | - Marc R Kok
- Department of Rheumatology and Clinical Immunology, Maasstad Hospital, Rotterdam, The Netherlands
| | - Bea Radovits
- Department of Rheumatology, Bernhoven Hospital, Uden, The Netherlands
| | - Caroline van Durme
- Department of Rheumatology, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Hetty Baan
- Department of Rheumatology and Clinical Immunology, ZiekenhuisGroep Twente, Almelo, The Netherlands
| | - Mart A F J van de Laar
- Arthritis Center Twente, Department of Psychology, Health and Technology, University of Twente, The Netherlands
- Department of Rheumatology and Clinical Immunology, Medisch Spectrum Twente, Ensche, The Netherlands
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17
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Oude Voshaar MAH, Ten Klooster P, Vonkeman HE, van de Laar MAFJ. Rasch measurement in rheumatoid arthritis: deriving psychometrically optimal measures from the Rasch Everyday Activity Limitation item bank. Rheumatology (Oxford) 2018; 57:1761-1768. [PMID: 29939313 DOI: 10.1093/rheumatology/key154] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Indexed: 11/14/2022] Open
Abstract
Objective Recently we developed the Rasch Everyday Activity Limitations (REAL) generic item bank for measuring physical function. In this study we evaluate the REAL item bank in 209 RA patients and demonstrate how computerized adaptive testing (CAT) and Optimal Test Assembly methods can be used to derive measures from the REAL item bank with superior measurement performance compared with the HAQ Disability Index (HAQ-DI). Methods Structural validity of the item bank was assessed using confirmatory factor analysis. The validity of the REAL score metric in RA was evaluated by examining differential item functioning against the general population calibration sample. Besides the REAL-CAT, a 6-item short form (REAL-6) was developed using Optimal Test Assembly that was optimized with respect to common disability levels in RA, content and reading ease. Measurement precision of the different instruments was examined using item response theory methods. Construct validity was evaluated by testing hypothesized correlations with external measures. Results Good model-data fit was observed for a one-dimensional model and only two items showed differential item functioning of substantial magnitude. The REAL-CAT had superior measurement precision compared with HAQ-DI and REAL-6. REAL-6 outperformed HAQ-DI across all but the very lowest level of physical function. All three instruments demonstrated good construct validity (>75% of hypotheses affirmed) and only HAQ-DI had a ceiling effect (23.9%). Conclusion This study supports the validity of the REAL item bank and illustrates the potential of CAT and OTA applications based on the REAL item bank for assessing physical function in RA.
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Affiliation(s)
- Martijn A H Oude Voshaar
- Arthritis Center Twente, Department of Psychology, Health and Technology, University of Twente, Enschede, The Netherlands
| | - Peter Ten Klooster
- Arthritis Center Twente, Department of Psychology, Health and Technology, University of Twente, Enschede, The Netherlands
| | - Harald E Vonkeman
- Arthritis Center Twente, Department of Psychology, Health and Technology, University of Twente, Enschede, The Netherlands.,Arthritis Center Twente, Department of Rheumatology and Clinical Immunology, Medisch Spectrum Twente, Enschede, The Netherlands
| | - Mart A F J van de Laar
- Arthritis Center Twente, Department of Rheumatology and Clinical Immunology, Medisch Spectrum Twente, Enschede, The Netherlands
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18
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Tran-Duy A, Ghiti Moghadam M, Oude Voshaar MAH, Vonkeman HE, Boonen A, Clarke P, McColl G, Ten Klooster PM, Zijlstra TR, Lems WF, Riyazi N, Griep EN, Hazes JMW, Landewé R, Bernelot Moens HJ, van Riel PLCM, van de Laar MAFJ, Jansen TL. An Economic Evaluation of Stopping Versus Continuing Tumor Necrosis Factor Inhibitor Treatment in Rheumatoid Arthritis Patients With Disease Remission or Low Disease Activity: Results From a Pragmatic Open-Label Trial. Arthritis Rheumatol 2018; 70:1557-1564. [PMID: 29745059 DOI: 10.1002/art.40546] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Accepted: 04/24/2018] [Indexed: 02/01/2023]
Abstract
OBJECTIVE To evaluate, from a societal perspective, the incremental cost-effectiveness of withdrawing tumor necrosis factor inhibitor (TNFi) treatment compared to continuation of these drugs within a 1-year, randomized trial among rheumatoid arthritis patients with longstanding, stable disease activity or remission. METHODS Data were collected from a pragmatic, open-label trial. Cost-utility analysis was performed using the nonparametric bootstrapping method, and a cost-effectiveness acceptability curve was constructed using the net-monetary benefit framework, where a willingness-to-accept threshold (WTA) was defined as the minimal cost saved that a patient accepted for each quality-adjusted life year (QALY) lost. RESULTS A total of 531 patients were randomized to the stop group and 286 patients to the continuation group. Withdrawal of TNFi treatment resulted in a >60% reduction of the total drug cost, but led to an increase of ∼30% in other health care expenditures. Compared to continuation, stopping TNFi resulted in a mean yearly cost saving of €7,133 (95% confidence interval [95% CI] €6,071, €8,234]) and was associated with a mean loss of QALYs of 0.02 (95% CI 0.002, 0.040). Mean saved cost per QALY lost and per extra flare incurred in the stop group compared to the continuation group was €368,269 (95% CI €155,132, €1,675,909) and €17,670 (95% CI €13,650, €22,721), respectively. At a WTA of €98,438 per QALY lost, the probability that stopping TNFi treatment is cost-effective was 100%. CONCLUSION Although an official WTA is not defined, the mean saved cost of €368,269 per QALY lost seems acceptable in The Netherlands, given existing data on willingness to pay.
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Affiliation(s)
- An Tran-Duy
- Arthritis Center Twente, Medisch Spectrum Twente, and University of Twente, Enschede, The Netherlands
| | - Marjan Ghiti Moghadam
- Arthritis Center Twente, Medisch Spectrum Twente, and University of Twente, Enschede, The Netherlands
| | - Martijn A H Oude Voshaar
- Arthritis Center Twente, Medisch Spectrum Twente, and University of Twente, Enschede, The Netherlands
| | - Harald E Vonkeman
- Arthritis Center Twente, Medisch Spectrum Twente, and University of Twente, Enschede, The Netherlands
| | - Annelies Boonen
- Maastricht University Medical Center and Maastricht University, Maastricht, The Netherlands
| | - Philip Clarke
- University of Melbourne, Melbourne, Victoria, Australia
| | - Geoff McColl
- University of Melbourne, Melbourne, Victoria, Australia
| | - Peter M Ten Klooster
- Arthritis Center Twente, Medisch Spectrum Twente, and University of Twente, Enschede, The Netherlands
| | | | - Willem F Lems
- VU University Medical Center and Reade Medical Center, Amsterdam, The Netherlands
| | - N Riyazi
- Haga Medical Center, The Hague, The Netherlands
| | - E N Griep
- Antonius Medical Center, Sneek, The Netherlands
| | - J M W Hazes
- Erasmus University Medical Center, Rotterdam, The Netherlands
| | | | | | | | - Mart A F J van de Laar
- Arthritis Center Twente, Medisch Spectrum Twente, and University of Twente, Enschede, The Netherlands
| | - T L Jansen
- Viecurie Medical Center, Venlo, The Netherlands
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19
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Ghiti Moghadam M, Lamers-Karnebeek FBG, Vonkeman HE, ten Klooster PM, Tekstra J, Schilder AM, Visser H, Sasso EH, Chernoff D, Lems WF, van Schaardenburg DJ, Landewe R, Bernelot Moens HJ, Radstake TRDJ, van Riel PLCM, van de Laar MAFJ, Jansen TL. Multi-biomarker disease activity score as a predictor of disease relapse in patients with rheumatoid arthritis stopping TNF inhibitor treatment. PLoS One 2018; 13:e0192425. [PMID: 29791439 PMCID: PMC5965880 DOI: 10.1371/journal.pone.0192425] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Accepted: 01/09/2018] [Indexed: 01/04/2023] Open
Abstract
Objective Successfully stopping or reducing treatment for patients with rheumatoid arthritis (RA) in low disease activity (LDA) may improve cost-effectiveness of care. We evaluated the multi-biomarker disease activity (MBDA) score as a predictor of disease relapse after discontinuation of TNF inhibitor (TNFi) treatment. Methods 439 RA patients who were randomized to stop TNFi treatment in the POET study were analyzed post-hoc. Three indicators of disease relapse were assessed over 12 months: 1) restarting TNFi treatment, 2) escalation of any DMARD therapy and 3) physician-reported flare. MBDA score was assessed at baseline. Associations between MBDA score and disease relapse were examined using univariate analysis and multivariate logistic regression. Results At baseline, 50.1%, 35.3% and 14.6% of patients had low (<30), moderate (30−44) or high (>44) MBDA scores. Within 12 months, 49.9% of patients had restarted TNFi medication, 59.0% had escalation of any DMARD and 57.2% had ≥1 physician-reported flare. MBDA score was associated with each indicator of relapse. At least one indicator of relapse was observed in 59.5%, 68.4% and 81.3% of patients with low, moderate or high MBDA scores, respectively (P = 0.004). Adjusted for baseline DAS28-ESR, disease duration, BMI and erosions, high MBDA scores were associated with increased risk for restarting TNFi treatment (OR = 1.85, 95% CI 1.00–3.40), DMARD escalation (OR = 1.99, 95% CI 1.01–3.94) and physician-reported flare (OR = 2.00, 95% 1.06–3.77). Conclusion For RA patients with stable LDA who stopped TNFi, a high baseline MBDA score was independently predictive of disease relapse within 12 months. The MBDA score may be useful for identifying patients at risk of relapse after TNFi discontinuation.
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Affiliation(s)
- Marjan Ghiti Moghadam
- Department of Rheumatology, Medisch Spectrum Twente, Enschede, The Netherlands
- Department of Psychology, Health & Technology, University of Twente, Enschede, The Netherlands
- * E-mail:
| | | | - Harald E. Vonkeman
- Department of Rheumatology, Medisch Spectrum Twente, Enschede, The Netherlands
- Department of Psychology, Health & Technology, University of Twente, Enschede, The Netherlands
| | - Peter M. ten Klooster
- Department of Psychology, Health & Technology, University of Twente, Enschede, The Netherlands
| | - Janneke Tekstra
- Department of Rheumatology, University Medical Center Utrecht, Utrecht, The Netherlands
| | | | - Henk Visser
- Department of Rheumatology, Rijnstate, Arnhem, The Netherlands
| | - Eric H. Sasso
- Crescendo Bioscience, Inc., South San Francisco, CA, United States of America
| | - David Chernoff
- Crescendo Bioscience, Inc., South San Francisco, CA, United States of America
| | - Willem F. Lems
- Department of Rheumatology, VU University Medical Center, Amsterdam, The Netherlands
| | | | - Robert Landewe
- Department of Rheumatology, AMC Amsterdam, Amsterdam, the Netherlands
| | | | | | - Piet L. C. M. van Riel
- Department of IQ Healthcare, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Mart A. F. J. van de Laar
- Department of Rheumatology, Medisch Spectrum Twente, Enschede, The Netherlands
- Department of Psychology, Health & Technology, University of Twente, Enschede, The Netherlands
| | - Tim L. Jansen
- Department of Rheumatology, VieCuri Medical Center, Venlo, The Netherlands
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Steunebrink LMM, Versteeg LGA, Vonkeman HE, Ten Klooster PM, Hoekstra M, van de Laar MAFJ. Radiographic progression in early rheumatoid arthritis patients following initial combination versus step-up treat-to-target therapy in daily clinical practice: results from the DREAM registry. BMC Rheumatol 2018; 2:1. [PMID: 30886952 PMCID: PMC6390778 DOI: 10.1186/s41927-018-0009-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2017] [Accepted: 01/07/2018] [Indexed: 02/08/2023] Open
Abstract
Background Early and intensive targeted treatment with disease modifying anti-rheumatic drugs (DMARDs) has been shown to lead to substantial reductions in disease activity and radiograph damage in patients with early rheumatoid arthritis (RA). The aim of this quasi-experimental study was to compare the first-year radiographic progression rates between a treat-to-target (T2 T) strategy with initial combination therapy (strategy II, started in 2012) versus an initial step-up monotherapy (strategy I, started in 2006). Methods A total of 128 patients from strategy II was individually matched with 128 patients from strategy I on sex, age (± 5 yrs.) and baseline disease activity (± 0.5 on the DAS28). Differences in radiographic progression (Sharp/van der Heijde) scores (SHS) and the number of patients experiencing a minimal clinically important difference (MCID; ≥ 5 SHS points) between both strategies were tested with Mann Whitney U and chi-square tests. Next, linear and logistic regression analyses were performed to examine which baseline variables were associated with radiographic progression scores and the probability of experiencing an MCID within 1 year. Results Patients with initial combination therapy had slightly higher baseline disease activity scores and pain scores, but better mental health scores. Patients with initial monotherapy had significantly more, and more frequently clinically relevant, radiographic progression after 1 year. Experiencing a MCID was independently associated with fewer tender joints (p = 0.050) and higher erythrocyte sedimentation rate (p = 0.015) at baseline. Conclusion Treating early RA patients with initial combination therapy results in better radiographic outcomes than initial monotherapy in daily clinical practice. Trial registration Netherlands Trial Register NTR578, 12 January 2006.
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Affiliation(s)
- Laura M M Steunebrink
- 1Arthritis Center Twente, Department of Rheumatology, Medisch Spectrum Twente, PO BOX 50 000, 7500 KA Enschede, The Netherlands.,2Department of Psychology, Health & Technology, University of Twente, Enschede, The Netherlands
| | - Letty G A Versteeg
- 1Arthritis Center Twente, Department of Rheumatology, Medisch Spectrum Twente, PO BOX 50 000, 7500 KA Enschede, The Netherlands.,2Department of Psychology, Health & Technology, University of Twente, Enschede, The Netherlands
| | - Harald E Vonkeman
- 1Arthritis Center Twente, Department of Rheumatology, Medisch Spectrum Twente, PO BOX 50 000, 7500 KA Enschede, The Netherlands.,2Department of Psychology, Health & Technology, University of Twente, Enschede, The Netherlands
| | - Peter M Ten Klooster
- 2Department of Psychology, Health & Technology, University of Twente, Enschede, The Netherlands
| | | | - Mart A F J van de Laar
- 1Arthritis Center Twente, Department of Rheumatology, Medisch Spectrum Twente, PO BOX 50 000, 7500 KA Enschede, The Netherlands.,2Department of Psychology, Health & Technology, University of Twente, Enschede, The Netherlands
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21
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de Jonge MJ, Oude Voshaar MAH, Huis AMP, van de Laar MAFJ, Hulscher MEJL, van Riel PLCM. Development of an item bank to measure factual disease and treatment related knowledge of rheumatoid arthritis patients in the treat to target era. Patient Educ Couns 2018; 101:67-73. [PMID: 28811047 DOI: 10.1016/j.pec.2017.07.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/23/2016] [Revised: 04/21/2017] [Accepted: 07/17/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVE To develop a Disease and treatment associated Knowledge in RA item bank (DataK-RA) based on item response theory. METHODS Initial items were developed from a systematic review. Rheumatology professionals identified relevant content trough a RAND modified Delphi scoring procedure and consensus meeting. RA patients provided additional content trough a focus group. Patients and professionals rated readability, feasibility and comprehensiveness of resulting items. Cross-sectional data were collected to evaluate psychometric properties of the items. RESULTS Data of 473 patients were used for item reduction and calibration. Twenty items were discarded based on corrected item-total point biserial correlation <0.30. Confirmatory factor analysis with weighted least squares estimation on the polychoric correlation matrix suggested good fit for a unidimensional model for the remaining 42 items (CFI 0.97 TLI=0.97, RMSEA=0.02, WRMR=0.97), supporting the proposed scoring procedure. Scores were highly reliable and normally distributed with minimal ceiling (1.8%) and no floor effects. 75% of tested hypotheses about the association of DataK-RA scores with related constructs were supported, indicating good construct validity. CONCLUSION DataK-RA is a psychometrically sound item bank. PRACTICE IMPLICATIONS DataK-RA provides health professionals and researchers with a tool to identify and target patients' information needs or to assess effects of educational efforts.
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Affiliation(s)
- Marieke J de Jonge
- Radboud university medical center, Radboud Institute for Health Sciences, IQ healthcare, Nijmegen, The Netherlands.
| | - Martijn A H Oude Voshaar
- University of Twente, Department of Psychology, Health and Technology, Enschede, The Netherlands.
| | - Anita M P Huis
- Radboud university medical center, Radboud Institute for Health Sciences, IQ healthcare, Nijmegen, The Netherlands.
| | - Mart A F J van de Laar
- University of Twente, Department of Psychology, Health and Technology, Enschede, The Netherlands.
| | - Marlies E J L Hulscher
- Radboud university medical center, Radboud Institute for Health Sciences, IQ healthcare, Nijmegen, The Netherlands.
| | - Piet L C M van Riel
- Radboud university medical center, Radboud Institute for Health Sciences, IQ healthcare, Nijmegen, The Netherlands; Bernhoven, Department of Rheumatology, Uden, The Netherlands.
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Oude Voshaar MAH, Ten Klooster PM, Vonkeman HE, van de Laar MAFJ. Measuring everyday functional competence using the Rasch assessment of everyday activity limitations (REAL) item bank. Qual Life Res 2017; 26:2949-2959. [PMID: 28638966 PMCID: PMC5655561 DOI: 10.1007/s11136-017-1627-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/15/2017] [Indexed: 11/23/2022]
Abstract
OBJECTIVE Traditional patient-reported physical function instruments often poorly differentiate patients with mild-to-moderate disability. We describe the development and psychometric evaluation of a generic item bank for measuring everyday activity limitations in outpatient populations. STUDY DESIGN AND SETTING Seventy-two items generated from patient interviews and mapped to the International Classification of Functioning, Disability and Health (ICF) domestic life chapter were administered to 1128 adults representative of the Dutch population. The partial credit model was fitted to the item responses and evaluated with respect to its assumptions, model fit, and differential item functioning (DIF). Measurement performance of a computerized adaptive testing (CAT) algorithm was compared with the SF-36 physical functioning scale (PF-10). RESULTS A final bank of 41 items was developed. All items demonstrated acceptable fit to the partial credit model and measurement invariance across age, sex, and educational level. Five- and ten-item CAT simulations were shown to have high measurement precision, which exceeded that of SF-36 physical functioning scale across the physical function continuum. Floor effects were absent for a 10-item empirical CAT simulation, and ceiling effects were low (13.5%) compared with SF-36 physical functioning (38.1%). CAT also discriminated better than SF-36 physical functioning between age groups, number of chronic conditions, and respondents with or without rheumatic conditions. CONCLUSION The Rasch assessment of everyday activity limitations (REAL) item bank will hopefully prove a useful instrument for assessing everyday activity limitations. T-scores obtained using derived measures can be used to benchmark physical function outcomes against the general Dutch adult population.
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Affiliation(s)
- Martijn A H Oude Voshaar
- Arthritis Center Twente, Department of Psychology, Health and Technology, University of Twente, PO Box 217, 7500 AE, Enschede, The Netherlands.
| | - Peter M Ten Klooster
- Arthritis Center Twente, Department of Psychology, Health and Technology, University of Twente, PO Box 217, 7500 AE, Enschede, The Netherlands
| | - Harald E Vonkeman
- Arthritis Center Twente, Department of Psychology, Health and Technology, University of Twente, PO Box 217, 7500 AE, Enschede, The Netherlands
- Arthritis Center Twente, Department of Rheumatology and Clinical Immunology, Medical Spectrum Twente, Enschede, The Netherlands
| | - Mart A F J van de Laar
- Arthritis Center Twente, Department of Psychology, Health and Technology, University of Twente, PO Box 217, 7500 AE, Enschede, The Netherlands
- Arthritis Center Twente, Department of Rheumatology and Clinical Immunology, Medical Spectrum Twente, Enschede, The Netherlands
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23
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Janssen CA, Jansen TLTA, Oude Voshaar MAH, Vonkeman HE, van de Laar MAFJ. Quality of care in gout: a clinical audit on treating to the target with urate lowering therapy in real-world gout patients. Rheumatol Int 2017; 37:1435-1440. [PMID: 28748426 PMCID: PMC5570767 DOI: 10.1007/s00296-017-3777-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Accepted: 07/18/2017] [Indexed: 12/01/2022]
Abstract
The current paper aimed to describe the quality of care for gout patients by showing the clinical outcomes achieved in two patient cohorts in which differing targeted urate lowering therapy (ULT) treatment approaches were employed, both aiming to reach the European League Against Rheumatism recommended serum urate (sUA) targets. A retrospective medical chart review study was conducted. Data from the medical records of gout patients from two clinical centers in The Netherlands, both applying targeted ULT treatments (albeit using different approaches), were reviewed. Patients in cohort A were given a combination of xanthine oxidase inhibitors with uricosurics if treatment with allopurinol monotherapy failed to reach sUA target levels, whereas patients in cohort B were treated with sequential monotherapy. Data on patient characteristics and clinical outcomes were collected. A total of 177 patient dossiers were included: 99 from cohort A and 78 from cohort B. The great majority (n = 146, 82.5%) of the patients in both cohorts had a current sUA level <360 µmol/L. In addition, more than half (n = 104, 58.8%) of the patients met the stringent sUA target level of <300 µmol/L. The largest reductions in mean sUA levels were observed for patients who were treated with combination therapy. This clinical audit of two cohorts of gout patients provides initial—yet promising—results regarding the proportion of real-world gout patients in whom recommended that sUA target levels can be achieved, and demonstrates the added value that a targeted treatment approach may have in reaching these goals.
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Affiliation(s)
- Carly A Janssen
- Department of Psychology, Health and Technology, Arthritis Center Twente, University of Twente, PO BOX 217, 7500 AE, Enschede, The Netherlands.
| | - Tim L Th A Jansen
- Department of Rheumatology, Viecuri Medical Center, Venlo, The Netherlands
| | - Martijn A H Oude Voshaar
- Department of Psychology, Health and Technology, Arthritis Center Twente, University of Twente, PO BOX 217, 7500 AE, Enschede, The Netherlands
| | - Harald E Vonkeman
- Department of Psychology, Health and Technology, Arthritis Center Twente, University of Twente, PO BOX 217, 7500 AE, Enschede, The Netherlands.,Department of Rheumatology and Clinical Immunology, Medisch Spectrum Twente, Enschede, The Netherlands
| | - Mart A F J van de Laar
- Department of Psychology, Health and Technology, Arthritis Center Twente, University of Twente, PO BOX 217, 7500 AE, Enschede, The Netherlands.,Department of Rheumatology and Clinical Immunology, Medisch Spectrum Twente, Enschede, The Netherlands
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Ghiti Moghadam M, Vonkeman HE, Ten Klooster PM, Tekstra J, van Schaardenburg D, Starmans-Kool M, Brouwer E, Bos R, Lems WF, Colin EM, Allaart CF, Meek IL, Landewé R, Bernelot Moens HJ, van Riel PLCM, van de Laar MAFJ, Jansen TL. Stopping Tumor Necrosis Factor Inhibitor Treatment in Patients With Established Rheumatoid Arthritis in Remission or With Stable Low Disease Activity: A Pragmatic Multicenter, Open-Label Randomized Controlled Trial. Arthritis Rheumatol 2017; 68:1810-7. [PMID: 26866428 DOI: 10.1002/art.39626] [Citation(s) in RCA: 67] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2015] [Accepted: 02/02/2016] [Indexed: 12/18/2022]
Abstract
OBJECTIVE Tumor necrosis factor inhibitor (TNFi) biologic agents are an effective treatment for rheumatoid arthritis (RA). It is unclear whether patients whose disease is in remission or who have stable low disease activity need to continue use of TNFi or can stop this treatment. This study was undertaken to assess whether patients with established RA who are in remission or have stable low disease activity can effectively and safely stop their TNFi therapy. METHODS The study was designed as a pragmatic multicenter, open-label randomized controlled trial. Inclusion criteria were a diagnosis of RA according to the American College of Rheumatology 1987 classification criteria, as well as use of a TNFi for at least 1 year along with a stable dose of disease-modifying antirheumatic drugs and a Disease Activity Score in 28 joints (DAS28) of <3.2 over the 6 months preceding trial inclusion. Patients were randomized in a 2:1 ratio to either stop or continue treatment with their current TNFi. Flare was defined as a DAS28 of ≥3.2 during the 12-month follow-up period and an increase in score of ≥0.6 compared to the baseline DAS28. RESULTS In total, 531 patients were allocated to the stop group and 286 to the TNFi continuation group. At 12 months, more patients had experienced a flare in the stop group (272 [51.2%] of 531) than in the continuation group (52 [18.2%] of 286; P < 0.001). The hazard ratio for occurrence of a flare after stopping TNFi was 3.50 (95% confidence interval [95% CI] 2.60-4.72). The mean DAS28 in the stop group was significantly higher during the follow-up period compared to that in the continuation group (P < 0.001). Of the 195 patients who restarted TNFi treatment after experiencing a flare and within 26 weeks after stopping, 165 (84.6%) had regained a DAS28 of <3.2 by 6 months later, and the median time to a regained DAS28 of <3.2 was 12 weeks (95% Cl 10.7-13.3). There were more hospitalizations in the stop group than in the continuation group (6.4% versus 2.4%). CONCLUSION Stopping TNFi treatment results in substantially more flares than does continuation of TNFi in patients with established RA in remission or with stable low disease activity.
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Affiliation(s)
- Marjan Ghiti Moghadam
- Arthritis Center Twente Medical Spectrum Twente and University of Twente, Enschede, The Netherlands
| | - Harald E Vonkeman
- Arthritis Center Twente Medical Spectrum Twente and University of Twente, Enschede, The Netherlands
| | - Peter M Ten Klooster
- Arthritis Center Twente Medical Spectrum Twente and University of Twente, Enschede, The Netherlands
| | | | | | - Mirian Starmans-Kool
- Atrium Medical Center, Heerlen, The Netherlands, and Orbis Medical Center, Sittard-Geleen, The Netherlands
| | | | - Reinhard Bos
- Medical Center Leeuwarden, Leeuwarden, The Netherlands
| | - Willem F Lems
- VU University Medical Center and Reade Medical Center, Amsterdam, The Netherlands
| | - Edgar M Colin
- Hospital Group Almelo, Almelo, The Netherlands, and Hengelo Twente Hospital Group, Hengelo, The Netherlands
| | | | - Inger L Meek
- Radboud University Medical Center, Nijmegen, The Netherlands
| | - Robert Landewé
- Academic Medical Center Amsterdam, Amsterdam, The Netherlands
| | - Hein J Bernelot Moens
- Hospital Group Almelo, Almelo, The Netherlands, and Hengelo Twente Hospital Group, Hengelo, The Netherlands
| | | | - Mart A F J van de Laar
- Arthritis Center Twente Medical Spectrum Twente and University of Twente, Enschede, The Netherlands
| | - Tim L Jansen
- VieCuri Medical Center, Rheumatology, Venlo, The Netherlands
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25
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Voshaar MAHO, Moghadam MG, Vonkeman HE, Ten Klooster PM, van Schaardenburg D, Tekstra J, Visser H, van de Laar MAFJ, Jansen TL. Measuring Disease Exacerbation and Flares in Rheumatoid Arthritis: Comparison of Commonly Used Disease Activity Indices and Individual Measures. J Rheumatol 2017; 44:1118-1124. [PMID: 28507187 DOI: 10.3899/jrheum.160915] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/07/2017] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To evaluate and compare the utility of commonly used outcome measures for assessing disease exacerbation or flare in patients with rheumatoid arthritis (RA). METHODS Data from the Dutch Potential Optimalisation of (Expediency) and Effectiveness of Tumor necrosis factor-α blockers (POET) study, in which 462 patients discontinued their tumor necrosis factor-α inhibitor, were used. The ability of different measures to discriminate between those with and without physician-reported flare or medication escalation at the 3-month visit (T2) was evaluated by calculating effect size (ES) statistics. Responsiveness to increased disease activity was compared between measures by standardizing change scores (SCS) from baseline to the 3-month visit. Finally, the incremental validity of individual outcome measures beyond the Simplified Disease Activity Score was evaluated using logistic regression analysis. RESULTS The SCS were greater for disease activity indices than for any of the individual measures. The 28-joint Disease Activity Score, Clinical Disease Activity Index, and Simplified Disease Activity Index performed similarly. Pain and physician's (PGA) and patient's global assessment (PtGA) of disease activity were the most responsive individual measures. Similar results were obtained for discriminative ability, with greatest ES for disease activity indices followed by pain, PGA, and PtGA. Pain was the only measure to demonstrate incremental validity beyond SDAI in predicting 3-month flare status. CONCLUSION These results support the use of composite disease activity indices, patient-reported pain and disease activity, and physician-reported disease activity for measuring disease exacerbation or identifying flares of RA. Physical function, acute-phase response, and the auxiliary measures fatigue, participation, and emotional well-being performed poorly.
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Affiliation(s)
- Martijn A H Oude Voshaar
- From the Arthritis Center Twente, Department of Psychology, Health and Technology, University of Twente; Arthritis Center Twente, Department of Rheumatology and Clinical Immunology, Medical Spectrum Twente, Enschede; Department of Rheumatology, VU University Medical Center and Reade Medical Center, Amsterdam; Department of Rheumatology, University Medical Center Utrecht, Utrecht; Department of Rheumatology, Rijnstate Medical Center, Arnhem; Department of Rheumatology, Viecuri Medical Center, Venlo, the Netherlands; Department of Rheumatology, University Hospital Leuven, Leuven, Belgium.,M.A. Oude Voshaar, PhD, Arthritis Center Twente, Department of Psychology, Health and Technology, University of Twente; M. Ghiti Moghadam, MD, Arthritis Center Twente, Department of Psychology, Health and Technology, University of Twente, and Department of Rheumatology, University Hospital Leuven, and Arthritis Center Twente, Department of Rheumatology and Clinical Immunology, Medical Spectrum Twente; H.E. Vonkeman, MD, PhD, Arthritis Center Twente, Department of Psychology, Health and Technology, University of Twente, and Arthritis Center Twente, Department of Rheumatology and Clinical Immunology, Medical Spectrum Twente; P.M. ten Klooster, PhD, Arthritis Center Twente, Department of Psychology, Health and Technology, University of Twente; D. van Schaardenburg, MD, PhD, Department of Rheumatology, VU University Medical Center and Reade Medical Center; J. Tekstra, MD, PhD, Department of Rheumatology, University Medical Center Utrecht; H. Visser, MD, PhD, Department of Rheumatology, Rijnstate Medical Center; M.A. van de Laar, MD, PhD, Arthritis Center Twente, Department of Psychology, Health and Technology, University of Twente, and Arthritis Center Twente, Department of Rheumatology and Clinical Immunology, Medical Spectrum Twente; T.L. Jansen, MD, PhD, Department of Rheumatology, Viecuri Medical Center
| | - Marjan Ghiti Moghadam
- From the Arthritis Center Twente, Department of Psychology, Health and Technology, University of Twente; Arthritis Center Twente, Department of Rheumatology and Clinical Immunology, Medical Spectrum Twente, Enschede; Department of Rheumatology, VU University Medical Center and Reade Medical Center, Amsterdam; Department of Rheumatology, University Medical Center Utrecht, Utrecht; Department of Rheumatology, Rijnstate Medical Center, Arnhem; Department of Rheumatology, Viecuri Medical Center, Venlo, the Netherlands; Department of Rheumatology, University Hospital Leuven, Leuven, Belgium. .,M.A. Oude Voshaar, PhD, Arthritis Center Twente, Department of Psychology, Health and Technology, University of Twente; M. Ghiti Moghadam, MD, Arthritis Center Twente, Department of Psychology, Health and Technology, University of Twente, and Department of Rheumatology, University Hospital Leuven, and Arthritis Center Twente, Department of Rheumatology and Clinical Immunology, Medical Spectrum Twente; H.E. Vonkeman, MD, PhD, Arthritis Center Twente, Department of Psychology, Health and Technology, University of Twente, and Arthritis Center Twente, Department of Rheumatology and Clinical Immunology, Medical Spectrum Twente; P.M. ten Klooster, PhD, Arthritis Center Twente, Department of Psychology, Health and Technology, University of Twente; D. van Schaardenburg, MD, PhD, Department of Rheumatology, VU University Medical Center and Reade Medical Center; J. Tekstra, MD, PhD, Department of Rheumatology, University Medical Center Utrecht; H. Visser, MD, PhD, Department of Rheumatology, Rijnstate Medical Center; M.A. van de Laar, MD, PhD, Arthritis Center Twente, Department of Psychology, Health and Technology, University of Twente, and Arthritis Center Twente, Department of Rheumatology and Clinical Immunology, Medical Spectrum Twente; T.L. Jansen, MD, PhD, Department of Rheumatology, Viecuri Medical Center.
| | - Harald E Vonkeman
- From the Arthritis Center Twente, Department of Psychology, Health and Technology, University of Twente; Arthritis Center Twente, Department of Rheumatology and Clinical Immunology, Medical Spectrum Twente, Enschede; Department of Rheumatology, VU University Medical Center and Reade Medical Center, Amsterdam; Department of Rheumatology, University Medical Center Utrecht, Utrecht; Department of Rheumatology, Rijnstate Medical Center, Arnhem; Department of Rheumatology, Viecuri Medical Center, Venlo, the Netherlands; Department of Rheumatology, University Hospital Leuven, Leuven, Belgium.,M.A. Oude Voshaar, PhD, Arthritis Center Twente, Department of Psychology, Health and Technology, University of Twente; M. Ghiti Moghadam, MD, Arthritis Center Twente, Department of Psychology, Health and Technology, University of Twente, and Department of Rheumatology, University Hospital Leuven, and Arthritis Center Twente, Department of Rheumatology and Clinical Immunology, Medical Spectrum Twente; H.E. Vonkeman, MD, PhD, Arthritis Center Twente, Department of Psychology, Health and Technology, University of Twente, and Arthritis Center Twente, Department of Rheumatology and Clinical Immunology, Medical Spectrum Twente; P.M. ten Klooster, PhD, Arthritis Center Twente, Department of Psychology, Health and Technology, University of Twente; D. van Schaardenburg, MD, PhD, Department of Rheumatology, VU University Medical Center and Reade Medical Center; J. Tekstra, MD, PhD, Department of Rheumatology, University Medical Center Utrecht; H. Visser, MD, PhD, Department of Rheumatology, Rijnstate Medical Center; M.A. van de Laar, MD, PhD, Arthritis Center Twente, Department of Psychology, Health and Technology, University of Twente, and Arthritis Center Twente, Department of Rheumatology and Clinical Immunology, Medical Spectrum Twente; T.L. Jansen, MD, PhD, Department of Rheumatology, Viecuri Medical Center
| | - Peter M Ten Klooster
- From the Arthritis Center Twente, Department of Psychology, Health and Technology, University of Twente; Arthritis Center Twente, Department of Rheumatology and Clinical Immunology, Medical Spectrum Twente, Enschede; Department of Rheumatology, VU University Medical Center and Reade Medical Center, Amsterdam; Department of Rheumatology, University Medical Center Utrecht, Utrecht; Department of Rheumatology, Rijnstate Medical Center, Arnhem; Department of Rheumatology, Viecuri Medical Center, Venlo, the Netherlands; Department of Rheumatology, University Hospital Leuven, Leuven, Belgium.,M.A. Oude Voshaar, PhD, Arthritis Center Twente, Department of Psychology, Health and Technology, University of Twente; M. Ghiti Moghadam, MD, Arthritis Center Twente, Department of Psychology, Health and Technology, University of Twente, and Department of Rheumatology, University Hospital Leuven, and Arthritis Center Twente, Department of Rheumatology and Clinical Immunology, Medical Spectrum Twente; H.E. Vonkeman, MD, PhD, Arthritis Center Twente, Department of Psychology, Health and Technology, University of Twente, and Arthritis Center Twente, Department of Rheumatology and Clinical Immunology, Medical Spectrum Twente; P.M. ten Klooster, PhD, Arthritis Center Twente, Department of Psychology, Health and Technology, University of Twente; D. van Schaardenburg, MD, PhD, Department of Rheumatology, VU University Medical Center and Reade Medical Center; J. Tekstra, MD, PhD, Department of Rheumatology, University Medical Center Utrecht; H. Visser, MD, PhD, Department of Rheumatology, Rijnstate Medical Center; M.A. van de Laar, MD, PhD, Arthritis Center Twente, Department of Psychology, Health and Technology, University of Twente, and Arthritis Center Twente, Department of Rheumatology and Clinical Immunology, Medical Spectrum Twente; T.L. Jansen, MD, PhD, Department of Rheumatology, Viecuri Medical Center
| | - Dirkjan van Schaardenburg
- From the Arthritis Center Twente, Department of Psychology, Health and Technology, University of Twente; Arthritis Center Twente, Department of Rheumatology and Clinical Immunology, Medical Spectrum Twente, Enschede; Department of Rheumatology, VU University Medical Center and Reade Medical Center, Amsterdam; Department of Rheumatology, University Medical Center Utrecht, Utrecht; Department of Rheumatology, Rijnstate Medical Center, Arnhem; Department of Rheumatology, Viecuri Medical Center, Venlo, the Netherlands; Department of Rheumatology, University Hospital Leuven, Leuven, Belgium.,M.A. Oude Voshaar, PhD, Arthritis Center Twente, Department of Psychology, Health and Technology, University of Twente; M. Ghiti Moghadam, MD, Arthritis Center Twente, Department of Psychology, Health and Technology, University of Twente, and Department of Rheumatology, University Hospital Leuven, and Arthritis Center Twente, Department of Rheumatology and Clinical Immunology, Medical Spectrum Twente; H.E. Vonkeman, MD, PhD, Arthritis Center Twente, Department of Psychology, Health and Technology, University of Twente, and Arthritis Center Twente, Department of Rheumatology and Clinical Immunology, Medical Spectrum Twente; P.M. ten Klooster, PhD, Arthritis Center Twente, Department of Psychology, Health and Technology, University of Twente; D. van Schaardenburg, MD, PhD, Department of Rheumatology, VU University Medical Center and Reade Medical Center; J. Tekstra, MD, PhD, Department of Rheumatology, University Medical Center Utrecht; H. Visser, MD, PhD, Department of Rheumatology, Rijnstate Medical Center; M.A. van de Laar, MD, PhD, Arthritis Center Twente, Department of Psychology, Health and Technology, University of Twente, and Arthritis Center Twente, Department of Rheumatology and Clinical Immunology, Medical Spectrum Twente; T.L. Jansen, MD, PhD, Department of Rheumatology, Viecuri Medical Center
| | - Janneke Tekstra
- From the Arthritis Center Twente, Department of Psychology, Health and Technology, University of Twente; Arthritis Center Twente, Department of Rheumatology and Clinical Immunology, Medical Spectrum Twente, Enschede; Department of Rheumatology, VU University Medical Center and Reade Medical Center, Amsterdam; Department of Rheumatology, University Medical Center Utrecht, Utrecht; Department of Rheumatology, Rijnstate Medical Center, Arnhem; Department of Rheumatology, Viecuri Medical Center, Venlo, the Netherlands; Department of Rheumatology, University Hospital Leuven, Leuven, Belgium.,M.A. Oude Voshaar, PhD, Arthritis Center Twente, Department of Psychology, Health and Technology, University of Twente; M. Ghiti Moghadam, MD, Arthritis Center Twente, Department of Psychology, Health and Technology, University of Twente, and Department of Rheumatology, University Hospital Leuven, and Arthritis Center Twente, Department of Rheumatology and Clinical Immunology, Medical Spectrum Twente; H.E. Vonkeman, MD, PhD, Arthritis Center Twente, Department of Psychology, Health and Technology, University of Twente, and Arthritis Center Twente, Department of Rheumatology and Clinical Immunology, Medical Spectrum Twente; P.M. ten Klooster, PhD, Arthritis Center Twente, Department of Psychology, Health and Technology, University of Twente; D. van Schaardenburg, MD, PhD, Department of Rheumatology, VU University Medical Center and Reade Medical Center; J. Tekstra, MD, PhD, Department of Rheumatology, University Medical Center Utrecht; H. Visser, MD, PhD, Department of Rheumatology, Rijnstate Medical Center; M.A. van de Laar, MD, PhD, Arthritis Center Twente, Department of Psychology, Health and Technology, University of Twente, and Arthritis Center Twente, Department of Rheumatology and Clinical Immunology, Medical Spectrum Twente; T.L. Jansen, MD, PhD, Department of Rheumatology, Viecuri Medical Center
| | - Henk Visser
- From the Arthritis Center Twente, Department of Psychology, Health and Technology, University of Twente; Arthritis Center Twente, Department of Rheumatology and Clinical Immunology, Medical Spectrum Twente, Enschede; Department of Rheumatology, VU University Medical Center and Reade Medical Center, Amsterdam; Department of Rheumatology, University Medical Center Utrecht, Utrecht; Department of Rheumatology, Rijnstate Medical Center, Arnhem; Department of Rheumatology, Viecuri Medical Center, Venlo, the Netherlands; Department of Rheumatology, University Hospital Leuven, Leuven, Belgium.,M.A. Oude Voshaar, PhD, Arthritis Center Twente, Department of Psychology, Health and Technology, University of Twente; M. Ghiti Moghadam, MD, Arthritis Center Twente, Department of Psychology, Health and Technology, University of Twente, and Department of Rheumatology, University Hospital Leuven, and Arthritis Center Twente, Department of Rheumatology and Clinical Immunology, Medical Spectrum Twente; H.E. Vonkeman, MD, PhD, Arthritis Center Twente, Department of Psychology, Health and Technology, University of Twente, and Arthritis Center Twente, Department of Rheumatology and Clinical Immunology, Medical Spectrum Twente; P.M. ten Klooster, PhD, Arthritis Center Twente, Department of Psychology, Health and Technology, University of Twente; D. van Schaardenburg, MD, PhD, Department of Rheumatology, VU University Medical Center and Reade Medical Center; J. Tekstra, MD, PhD, Department of Rheumatology, University Medical Center Utrecht; H. Visser, MD, PhD, Department of Rheumatology, Rijnstate Medical Center; M.A. van de Laar, MD, PhD, Arthritis Center Twente, Department of Psychology, Health and Technology, University of Twente, and Arthritis Center Twente, Department of Rheumatology and Clinical Immunology, Medical Spectrum Twente; T.L. Jansen, MD, PhD, Department of Rheumatology, Viecuri Medical Center
| | - Mart A F J van de Laar
- From the Arthritis Center Twente, Department of Psychology, Health and Technology, University of Twente; Arthritis Center Twente, Department of Rheumatology and Clinical Immunology, Medical Spectrum Twente, Enschede; Department of Rheumatology, VU University Medical Center and Reade Medical Center, Amsterdam; Department of Rheumatology, University Medical Center Utrecht, Utrecht; Department of Rheumatology, Rijnstate Medical Center, Arnhem; Department of Rheumatology, Viecuri Medical Center, Venlo, the Netherlands; Department of Rheumatology, University Hospital Leuven, Leuven, Belgium.,M.A. Oude Voshaar, PhD, Arthritis Center Twente, Department of Psychology, Health and Technology, University of Twente; M. Ghiti Moghadam, MD, Arthritis Center Twente, Department of Psychology, Health and Technology, University of Twente, and Department of Rheumatology, University Hospital Leuven, and Arthritis Center Twente, Department of Rheumatology and Clinical Immunology, Medical Spectrum Twente; H.E. Vonkeman, MD, PhD, Arthritis Center Twente, Department of Psychology, Health and Technology, University of Twente, and Arthritis Center Twente, Department of Rheumatology and Clinical Immunology, Medical Spectrum Twente; P.M. ten Klooster, PhD, Arthritis Center Twente, Department of Psychology, Health and Technology, University of Twente; D. van Schaardenburg, MD, PhD, Department of Rheumatology, VU University Medical Center and Reade Medical Center; J. Tekstra, MD, PhD, Department of Rheumatology, University Medical Center Utrecht; H. Visser, MD, PhD, Department of Rheumatology, Rijnstate Medical Center; M.A. van de Laar, MD, PhD, Arthritis Center Twente, Department of Psychology, Health and Technology, University of Twente, and Arthritis Center Twente, Department of Rheumatology and Clinical Immunology, Medical Spectrum Twente; T.L. Jansen, MD, PhD, Department of Rheumatology, Viecuri Medical Center
| | - Tim L Jansen
- From the Arthritis Center Twente, Department of Psychology, Health and Technology, University of Twente; Arthritis Center Twente, Department of Rheumatology and Clinical Immunology, Medical Spectrum Twente, Enschede; Department of Rheumatology, VU University Medical Center and Reade Medical Center, Amsterdam; Department of Rheumatology, University Medical Center Utrecht, Utrecht; Department of Rheumatology, Rijnstate Medical Center, Arnhem; Department of Rheumatology, Viecuri Medical Center, Venlo, the Netherlands; Department of Rheumatology, University Hospital Leuven, Leuven, Belgium.,M.A. Oude Voshaar, PhD, Arthritis Center Twente, Department of Psychology, Health and Technology, University of Twente; M. Ghiti Moghadam, MD, Arthritis Center Twente, Department of Psychology, Health and Technology, University of Twente, and Department of Rheumatology, University Hospital Leuven, and Arthritis Center Twente, Department of Rheumatology and Clinical Immunology, Medical Spectrum Twente; H.E. Vonkeman, MD, PhD, Arthritis Center Twente, Department of Psychology, Health and Technology, University of Twente, and Arthritis Center Twente, Department of Rheumatology and Clinical Immunology, Medical Spectrum Twente; P.M. ten Klooster, PhD, Arthritis Center Twente, Department of Psychology, Health and Technology, University of Twente; D. van Schaardenburg, MD, PhD, Department of Rheumatology, VU University Medical Center and Reade Medical Center; J. Tekstra, MD, PhD, Department of Rheumatology, University Medical Center Utrecht; H. Visser, MD, PhD, Department of Rheumatology, Rijnstate Medical Center; M.A. van de Laar, MD, PhD, Arthritis Center Twente, Department of Psychology, Health and Technology, University of Twente, and Arthritis Center Twente, Department of Rheumatology and Clinical Immunology, Medical Spectrum Twente; T.L. Jansen, MD, PhD, Department of Rheumatology, Viecuri Medical Center
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Nota I, Drossaert CHC, Melissant HC, Taal E, Vonkeman HE, Haagsma CJ, van de Laar MAFJ. Development of a web-based patient decision aid for initiating disease modifying anti-rheumatic drugs using user-centred design methods. BMC Med Inform Decis Mak 2017; 17:51. [PMID: 28441950 PMCID: PMC5405550 DOI: 10.1186/s12911-017-0433-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2016] [Accepted: 03/29/2017] [Indexed: 04/05/2023] Open
Abstract
Background A main element of patient-centred care, Patient Decision Aids (PtDAs) facilitate shared decision-making (SDM). A recent update of the International Patient Decision Aids Standards (IPDAS) emphasised patient involvement during PtDA development, but omitted a methodology for doing so. This article reports on the value of user-centred design (UCD) methods for the development of a PtDA that aims to support inflammatory arthritis patients in their choice between disease modifying anti-rheumatic drugs (DMARDs). Methods The IPDAS development process model in combination with UCD methods were applied. The process was overseen by an eight-member multidisciplinary steering group. Patients and health professionals were iteratively consulted. Qualitative in-depth interviews combined with rapid prototyping were conducted with patients to assess their needs for specific functionality, content and design of the PtDA. Group meetings with health professionals were organized to assess patients’ needs and to determine how the PtDA should be integrated into patient pathways. The current literature was reviewed to determine the clinical evidence to include in the PtDA. To evaluate usability among patients, they were observed using the PtDA while thinking aloud and then interviewed. Results The combination of patient interviews with rapid prototyping revealed that patients wanted to compare multiple DMARDs both for their clinical aspects and implications for daily life. Health professionals mainly wanted to refer patients to a reliable, easily adjustable source of information about DMARDs. A web-based PtDA was constructed consisting of four parts: 1) general information about SDM, inflammatory arthritis and DMARDs; 2) an application to compare particular DMARDs; 3) value clarification exercises; and 4) a printed summary of patients’ notes, preferences, worries and questions that they could bring to discuss with their rheumatologist. Conclusions The study demonstrated that UCD methods can be of great value for the development of PtDAs. The early, iterative involvement of patients and health professionals was helpful in developing a novel user-friendly PtDA that allowed patients to choose between DMARDs. The PtDA fits the values of all stakeholders and easily integrates with the patient pathway and daily workflow of health professionals. This collaborative designed PtDA may improve SDM and patient participation in arthritis care. Electronic supplementary material The online version of this article (doi:10.1186/s12911-017-0433-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Ingrid Nota
- Department of Psychology, Health and Technology, University of Twente, PO Box 217, 7500AE, Enschede, The Netherlands.
| | - Constance H C Drossaert
- Department of Psychology, Health and Technology, University of Twente, PO Box 217, 7500AE, Enschede, The Netherlands
| | - Heleen C Melissant
- Department of Clinical Psychology, VU University Amsterdam, Van der Boechorststraat 1, 1081 BT, Amsterdam, The Netherlands
| | - Erik Taal
- Department of Psychology, Health and Technology, University of Twente, PO Box 217, 7500AE, Enschede, The Netherlands
| | - Harald E Vonkeman
- Department of Rheumatology and Clinical Immunology, Medisch Spectrum Twente, PO Box 50 000, 7500 KA, Enschede, The Netherlands
| | - Cees J Haagsma
- Department of Rheumatology, Ziekenhuisgroep Twente, PO Box 7600, 7600 SZ, Almelo, The Netherlands
| | - Mart A F J van de Laar
- Department of Rheumatology and Clinical Immunology, Medisch Spectrum Twente, PO Box 50 000, 7500 KA, Enschede, The Netherlands
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Nota I, Drossaert CHC, Taal E, Vonkeman HE, Haagsma CJ, van de Laar MAFJ. Evaluation of a patient decision aid for initiating disease modifying anti-rheumatic drugs. Arthritis Res Ther 2016; 18:252. [PMID: 27793171 PMCID: PMC5086044 DOI: 10.1186/s13075-016-1138-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2016] [Accepted: 09/27/2016] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND According to international guidelines, treatment of inflammatory arthritis should be based on a shared decision between patient and rheumatologist. Furthermore, patients with inflammatory arthritis have high need of information and want to be more actively involved in medical decision-making. To facilitate shared decision-making and support patients in choosing between disease modifying anti-rheumatic drugs (DMARDs), a web-based patient decision aid (PtDA) was developed. This study evaluated use, appreciation and effect of this PtDA. METHODS A post-test only study with a historical comparison group was conducted. In a two-year period, all patients diagnosed with rheumatoid arthritis, psoriatic arthritis or ankylosing spondylitis, who were deciding whether to start a (different) DMARD were invited to participate. In the first year, patients received standard information (comparison group). In the second year, patients were referred to the PtDA (intervention group). In both groups, a questionnaire was sent four weeks after consulting the rheumatologist. Patient characteristics included sociodemographic, health-related and preference-related variables. Process measures were for use and appraisal of the PtDA (intervention group only). The primary outcome measure was patients' perceived role in medical decision-making. Secondary outcome measures comprised satisfaction with the decision-making process and the decision, beliefs about medication, adherence to medication and trust in the physician. RESULTS We received 158/232 questionnaires (68 %) from the comparison group and 123/200 (61 %) from the intervention group. The PtDA was used by 69/123 patients (57 %) in the intervention group. Patients who used the PtDA highly appreciated it and perceived it as easy to use and helpful. Relative to the comparison group, patients in the intervention group perceived a more active role in medical decision-making and decisions were more in line with patients' personal preferences. Other outcomes showed no significant difference between the two groups. CONCLUSION The web-based PtDA was highly appreciated and perceived as helpful for decision-making. Implementation of the PtDA in rheumatology practice was associated with a significantly larger proportion of patients perceiving an active role in medical decision-making and decisions were more in line with patients' personal preferences. The PtDA can be a valuable aid in improving patient participation in decision-making about DMARDs.
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Affiliation(s)
- Ingrid Nota
- Department of Psychology, Health and Technology, University of Twente, PO Box 217, 7500, AE, Enschede, The Netherlands.
| | - Constance H C Drossaert
- Department of Psychology, Health and Technology, University of Twente, PO Box 217, 7500, AE, Enschede, The Netherlands
| | - Erik Taal
- Department of Psychology, Health and Technology, University of Twente, PO Box 217, 7500, AE, Enschede, The Netherlands
| | - Harald E Vonkeman
- Department of Psychology, Health and Technology, University of Twente, PO Box 217, 7500, AE, Enschede, The Netherlands.,Department of Rheumatology and Clinical Immunology, Medisch Spectrum Twente, PO Box 50 000, 7500, KA, Enschede, The Netherlands
| | - Cees J Haagsma
- Department of Rheumatology, Ziekenhuisgroep Twente, PO Box 7600, 7600, SZ, Almelo, The Netherlands
| | - Mart A F J van de Laar
- Department of Psychology, Health and Technology, University of Twente, PO Box 217, 7500, AE, Enschede, The Netherlands.,Department of Rheumatology and Clinical Immunology, Medisch Spectrum Twente, PO Box 50 000, 7500, KA, Enschede, The Netherlands
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28
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Oude Voshaar MAH, Schenk O, Ten Klooster PM, Vonkeman HE, Bernelot Moens HJ, Boers M, van de Laar MAFJ. Further Simplification of the Simple Erosion Narrowing Score With Item Response Theory Methodology. Arthritis Care Res (Hoboken) 2016; 68:1206-10. [PMID: 27444101 DOI: 10.1002/acr.22793] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2015] [Revised: 11/04/2015] [Accepted: 11/17/2015] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To further simplify the simple erosion narrowing score (SENS) by removing scored areas that contribute the least to its measurement precision according to analysis based on item response theory (IRT) and to compare the measurement performance of the simplified version to the original. METHODS Baseline and 18-month data of the Combinatietherapie Bij Reumatoide Artritis (COBRA) trial were modeled using longitudinal IRT methodology. Measurement precision was evaluated across different levels of structural damage. SENS was further simplified by omitting the least reliably scored areas. Discriminant validity of SENS and its simplification were studied by comparing their ability to differentiate between the COBRA and sulfasalazine arms. Responsiveness was studied by comparing standardized change scores between versions. RESULTS SENS data showed good fit to the IRT model. Carpal and feet joints contributed the least statistical information to both erosion and joint space narrowing scores. Omitting the joints of the foot reduced measurement precision for the erosion score in cases with below-average levels of structural damage (relative efficiency compared with the original version ranged 35-59%). Omitting the carpal joints had minimal effect on precision (relative efficiency range 77-88%). Responsiveness of a simplified SENS without carpal joints closely approximated the original version (i.e., all Δ standardized change scores were ≤0.06). Discriminant validity was also similar between versions for both the erosion score (relative efficiency = 97%) and the SENS total score (relative efficiency = 84%). CONCLUSION Our results show that the carpal joints may be omitted from the SENS without notable repercussion for its measurement performance.
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Affiliation(s)
| | - Olga Schenk
- University of Twente, Enschede, The Netherlands
| | | | - Harald E Vonkeman
- University of Twente and Medisch Spectrum Twente, Enschede, The Netherlands
| | | | - Maarten Boers
- VU University Medical Center, Amsterdam, The Netherlands
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Steunebrink LMM, Vonkeman HE, ten Klooster PM, Hoekstra M, van Riel PLCM, van de Laar MAFJ. Recently diagnosed rheumatoid arthritis patients benefit from a treat-to-target strategy: results from the DREAM registry. Clin Rheumatol 2016; 35:609-15. [PMID: 26852313 PMCID: PMC4785198 DOI: 10.1007/s10067-016-3191-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2015] [Revised: 01/18/2016] [Accepted: 01/23/2016] [Indexed: 01/11/2023]
Abstract
Despite considerable evidence on the efficacy and safety of early aggressive treat-to-target (T2T) strategies in early rheumatoid arthritis (RA), a proportion of patients still fail to reach remission. The goal of this study is to examine remission rates and predictors of remission in a real life T2T cohort of consecutive patients with a recent diagnosis of RA. Baseline demographics, clinical, laboratory and patient-reported variables and 1-year follow-up disease activity data were used from patients with early RA included in the DREAM remission induction cohort II study. Survival analyses and simple and multivariable logistic regression analyses were used to examine remission rates and significant predictors of achieving remission. A total of 137 recently diagnosed consecutive RA patients were available for this study. During the first year after inclusion, DAS28 remission was achieved at least once in 77.2 % of the patients and the median time to first remission was 17 weeks. None of the examined baseline variables were robustly associated with achieving remission within 1 year and in the multivariable analysis only lower ESR (p = 0.005) remained significantly associated with achieving fast remission within 17 weeks. During the first year of their disease a high proportion of recently diagnosed RA patient achieved remission, with only a small percentage of patients needing bDMARD therapy. Combined with the absence of baseline predictors of remission, this suggests that clinicians in daily clinical practice may focus on DAS28 scores only, without needing to take other patients characteristics into account.
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Affiliation(s)
- Laura M M Steunebrink
- Arthritis Center Twente, Department of Rheumatology, Medisch Spectrum Twente, PO BOX 50 000, 7500 KA, Enschede, The Netherlands. .,Department Psychology, Health & Technology, University of Twente, Enschede, The Netherlands.
| | - Harald E Vonkeman
- Arthritis Center Twente, Department of Rheumatology, Medisch Spectrum Twente, PO BOX 50 000, 7500 KA, Enschede, The Netherlands.,Department Psychology, Health & Technology, University of Twente, Enschede, The Netherlands
| | - Peter M ten Klooster
- Department Psychology, Health & Technology, University of Twente, Enschede, The Netherlands
| | | | | | - Mart A F J van de Laar
- Arthritis Center Twente, Department of Rheumatology, Medisch Spectrum Twente, PO BOX 50 000, 7500 KA, Enschede, The Netherlands.,Department Psychology, Health & Technology, University of Twente, Enschede, The Netherlands
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Arends RY, Bode C, Taal E, van de Laar MAFJ. The longitudinal relation between patterns of goal management and psychological health in people with arthritis: The need for adaptive flexibility. Br J Health Psychol 2016; 21:469-89. [PMID: 26726041 DOI: 10.1111/bjhp.12182] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2015] [Revised: 10/26/2015] [Indexed: 11/27/2022]
Abstract
OBJECTIVES Due to their disease, patients with polyarthritis face the task of reconciling their threatened personal goals with their capabilities. Previous cross-sectional research on patients with chronic disease related higher levels of goal management strategies to lower levels of distress and higher levels of well-being. This study was the first to focus longitudinally on goal management patterns that combined strategies originating from different goal management theories. Our first study objective was to identify patterns that consisted of various strategies of goal management among patients with polyarthritis. Subsequently, the cross-sectional and longitudinal relationships between these patterns and the psychological health of the patients were studied. METHODS A longitudinal questionnaire study with three measurements of goal management and psychological health was conducted among 331 patients with polyarthritis. Stability of goal management over time was analysed with ANOVAs. Patterns were identified using cluster analysis at baseline, based on the following strategies: Goal maintenance, goal adjustment, goal disengagement, and goal reengagement. Longitudinal relationships between the patterns and psychological health (specifically: Depression, anxiety, purpose in life, positive affect, and social participation) were analysed using a generalized estimating equations analysis. RESULTS Three goal management patterns were found: 'Moderate engagement', 'Broad goal management repertoire', and 'Holding on'. Patients with the 'Broad goal management repertoire' pattern had the highest level of psychological health. The 'Holding on' pattern was identified as the most unfavourable in terms of psychological health. Over time, stable differences in levels of psychological health between the patterns were found. CONCLUSIONS This study was the first to reveal patterns of several goal management strategies and their longitudinal relationship to psychological health. Psychosocial support for arthritis patients with lower psychological health should focus on helping patients to become familiar with a broad range of goal management strategies when dealing with threatened goals. STATEMENT OF CONTRIBUTION What is already known on this subject? Polyarthritis is a collective term for a variety of disorders associated with autoimmune pathologies that may affect all aspects of a person's physical, psychological, and social functioning. Patients often experience difficulties in maintaining and achieving goals in several domains of life due to disease symptoms. The process of emotional adaptation to polyarthritis is characterized by searching equilibrium between desires and constraints and reacting constructive to stressors. Goal management strategies are ways to minimize the perceived disparity between the actual and the preferred situation with regard to personal goals and are applied both consciously and unconsciously. Cross-sectional, higher levels of goal management strategies have been related to lower levels of distress and higher levels of well-being both in patients with polyarthritis and in other patient groups. What does this study add? Contributes to our understanding of how combinations of goal management strategies relate to psychological health. Identifies patterns of goal management that are longitudinally related to psychological health. Provides clear guidance for improving psychological health of people with polyarthritis.
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Affiliation(s)
- Roos Y Arends
- Department of Psychology, Health & Technology, Arthritis Centre Twente, University of Twente, Enschede, The Netherlands
| | - Christina Bode
- Department of Psychology, Health & Technology, Arthritis Centre Twente, University of Twente, Enschede, The Netherlands
| | - Erik Taal
- Department of Psychology, Health & Technology, Arthritis Centre Twente, University of Twente, Enschede, The Netherlands
| | - Mart A F J van de Laar
- Department of Psychology, Health & Technology, Arthritis Centre Twente, University of Twente, Enschede, The Netherlands.,Department for Rheumatology and Clinical Immunology, Arthritis Centre Twente, Medisch Spectrum Twente, Enschede, The Netherlands
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Manders SHM, van de Laar MAFJ, Rongen-van Dartel SAA, Bos R, Visser H, Brus HL, Jansen T, Vonkeman HE, van Riel PLCM, Kievit W. Tapering and discontinuation of methotrexate in patients with RA treated with TNF inhibitors: data from the DREAM registry. RMD Open 2015; 1:e000147. [PMID: 26535151 PMCID: PMC4623370 DOI: 10.1136/rmdopen-2015-000147] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Revised: 08/24/2015] [Accepted: 08/31/2015] [Indexed: 11/23/2022] Open
Abstract
Objectives To study the number of patients that taper or discontinue concomitant methotrexate (MTX) in daily practice in patients with rheumatoid arthritis (RA) treated with tumour necrosis factor inhibitor (TNFi) and to analyse the effects of that adaption on disease activity and drug survival. Methods Data were collected from the Dutch Rheumatoid Arthritis Monitoring (DREAM) registry. Patients who started their first TNFi were included in the study. Treatment effectiveness after MTX tapering or discontinuation was analysed using Disease Activity Score of 28 joints (DAS28). Drug survival of the TNFi was analysed using the Cox proportional hazard model with a time-dependent covariate. Results In 458 patients (34%), MTX was tapered, 126 patients (10%) discontinued MTX and 747 patients (56%) continued MTX at the same dose. On average, DAS28 improved after tapering MTX (−0.40, −0.45) and after stopping MTX (−0.28, −0.12) at 6 and 12 months. In the taper group, 21% of the patients relapsed (DAS28 increase >0.6), and in the discontinuation group this was 21% and 24% at 6 and 12 months, respectively. Patients who taper and discontinue MTX have a similar DAS28 score over time as patients who continue MTX. Moreover, there was no influence of tapering or discontinuation of MTX on long-term drug survival of TNFi. Conclusions In daily practice, tapering or discontinuation of concomitant MTX in patients with RA treated with TNFi frequently occurs and it does not seem to influence the average DAS28 over time or the long-term TNFi drug survival. It appears that in daily clinical practice the correct patients are selected to taper or discontinue MTX.
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Affiliation(s)
- Sofie H M Manders
- Radboud Institute for Health Sciences, IQ healthcare, Radboud University Medical Center , Nijmegen , The Netherlands
| | | | - Sanne A A Rongen-van Dartel
- Radboud Institute for Health Sciences, Rheumatic diseases, Radboud university medical center , Nijmegen , The Netherlands
| | - Reinhard Bos
- Department of Rheumatology , Medical Centre Leeuwarden , Leeuwarden , The Netherlands
| | - Henk Visser
- Department of Rheumatology , Rijnstate , Arnhem , The Netherlands
| | - Herman L Brus
- Department of Rheumatology , Twee Steden Ziekenhuis , Almelo , The Netherlands
| | - Tim Jansen
- Department of Rheumatology , VieCuri Ziekenhuis , Venlo , The Netherlands
| | - Harald E Vonkeman
- Department of Rheumatology , Twente University , Enschede , The Netherlands
| | - Piet L C M van Riel
- Radboud Institute for Health Sciences, IQ healthcare, Radboud University Medical Center , Nijmegen , The Netherlands
| | - Wietske Kievit
- Radboud Institute for Health Sciences, Health Evidence, Radboud University Medical Center , Nijmegen , The Netherlands
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Tran-Duy A, Boonen A, van de Laar MAFJ, Severens JL. Impact on total population health and societal cost, and the implication on the actual cost-effectiveness of including tumour necrosis factor-α antagonists in management of ankylosing spondylitis: a dynamic population modelling study. Cost Eff Resour Alloc 2015; 13:18. [PMID: 26451133 PMCID: PMC4597433 DOI: 10.1186/s12962-015-0044-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2014] [Accepted: 09/29/2015] [Indexed: 12/30/2022] Open
Abstract
Background Sequential treatment of ankylosing spondylitis (AS) that includes tumour necrosis factor-α antagonists (anti-TNF agents) has been applied in most of the Western countries. Existing cost-effectiveness (CE) models almost exclusively presented the incremental CE of anti-TNF agents using a closed cohort while budget impact studies are mainly lacking. Notwithstanding, information on impact on total population health and societal budget as well as on actual incremental CE for a given decision time span are important for decision makers. This study aimed at quantifying, for different decision time spans starting from January 1, 2014 in the Dutch society, (1) impact of sequential drug treatment strategies without and with inclusion of anti-TNF agents (Strategies 1 and 2, respectively) on total population health and societal cost, and (2) the actual incremental CE of Strategy 2 compared to Strategy 1. Methods Dynamic population modelling was used to capture total population health and cost, and the actual incremental CE. Distinguishing the prevalent AS population on January 1, 2014 and the incident AS cohorts in the subsequent 20 years, the model tracked individually an actual number of AS patients until death or end of the simulation time. During the simulation, data on patient characteristics, history of drug use, costs and health at discrete time points were generated. In Strategy 1, five nonsteroidal anti-inflammatory drugs (NSAIDs) were available but anti-TNF agents withdrawn. In Strategy 2, five NSAIDs and two anti-TNF agents continued to be available. Results The predicted size of the prevalent AS population in the Dutch society varied within the range of 67,145–69,957 with 44–46 % of the patients receiving anti-TNF agents over the period 2014–2034. The use of anti-TNF agents resulted in an increase in the annual drug costs (168.54–205.28 million Euros), but at the same time caused a decrease in the annual productivity costs (12.58–31.21 million Euros) and in annual costs of healthcare categories other than drugs (7.23–11.90 million Euros). Incremental cost (Euros) per QALY gained in Strategy 2 compared to Strategy 1 corresponding to decision time spans of 5, 10, 15 and 20 years improved slightly from 75,379 to 67,268, 63,938 and 61,129, respectively. At willingness-to-pay thresholds of 118,656, 112,067, 110,188 and 110,512 Euros, it was 99 % certain that Strategy 2 was cost-effective for decision time spans of 5, 10, 15 and 20, respectively. Conclusions Using the dynamic population approach, the present model can project real-time data to inform a healthcare system decision that affects all actual number of AS patients eligible for anti-TNF agents within different decision time spans. The predicted total population costs of different categories in the present study can help plan the organization of the healthcare resources based on the national budget for the disease.
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Affiliation(s)
- An Tran-Duy
- Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Center, P.O. Box 5800, 6202 AZ Maastricht, The Netherlands ; Division of Rheumatology, Department of Internal Medicine, Maastricht University Medical Center, Maastricht, The Netherlands ; Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Annelies Boonen
- Division of Rheumatology, Department of Internal Medicine, Maastricht University Medical Center, Maastricht, The Netherlands ; Caphri School for Public Health and Primary Care, Maastricht UMC+, Maastricht, The Netherlands
| | - Mart A F J van de Laar
- Department of Rheumatology and Clinical Immunology, Twente University and Medisch Spectrum Twente, Enschede, The Netherlands
| | - Johan L Severens
- Institute of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
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Koop SMW, ten Klooster PM, Vonkeman HE, Steunebrink LMM, van de Laar MAFJ. Neuropathic-like pain features and cross-sectional associations in rheumatoid arthritis. Arthritis Res Ther 2015; 17:237. [PMID: 26335941 PMCID: PMC4558794 DOI: 10.1186/s13075-015-0761-8] [Citation(s) in RCA: 84] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2015] [Accepted: 08/20/2015] [Indexed: 01/07/2023] Open
Abstract
INTRODUCTION Increasing evidence indicates that features suggestive of neuropathic pain may also be present in patients with common rheumatic conditions. The objective of this study was to examine neuropathic-like pain symptoms and associated factors in patients with rheumatoid arthritis. METHODS We used the painDETECT screening tool to identify possible or likely neuropathic pain in 159 outpatients with rheumatoid arthritis. Patients additionally completed other self-reported measures, while clinical measures were assessed to calculate the 28-joint Disease Activity Score. Univariate analyses and multivariable logistic regression were used to identify factors associated with neuropathic pain features. RESULTS According to the painDETECT, 27 patients (17.0 %) were classified as having likely neuropathic pain and 34 patients (21.4 %) as having possible neuropathic pain. Besides reporting more severe pain, patients with likely or possible neuropathic pain were more likely to meet the diagnostic criteria for fibromyalgia, to use analgesics, and to have more tender joints and a worse physical and mental health status as measured by the 36-item Short-Form health survey. In multivariable analysis, physical (P < 0.001) and mental health status (P = 0.006) remained significantly associated with neuropathic pain features, even after controlling for pain severity. CONCLUSIONS These findings suggest that a sizeable proportion of patients with relatively well-controlled rheumatoid arthritis report symptoms suggestive of neuropathic pain. Neuropathic-like pain symptoms are independently associated with worse self-reported physical and mental health.
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Affiliation(s)
- Sanne M W Koop
- Department of Internal Medicine, Hospital Group Twente, Almelo, The Netherlands.
| | - Peter M ten Klooster
- Arthritis Center Twente, Department of Psychology, Health and Technology, University of Twente, Enschede, The Netherlands.
| | - Harald E Vonkeman
- Arthritis Center Twente, Department of Psychology, Health and Technology, University of Twente, Enschede, The Netherlands.
- Arthritis Center Twente, Department of Rheumatology and Clinical Immunology, Medical Spectrum Twente, Enschede, The Netherlands.
| | - Laura M M Steunebrink
- Arthritis Center Twente, Department of Psychology, Health and Technology, University of Twente, Enschede, The Netherlands.
| | - Mart A F J van de Laar
- Arthritis Center Twente, Department of Psychology, Health and Technology, University of Twente, Enschede, The Netherlands.
- Arthritis Center Twente, Department of Rheumatology and Clinical Immunology, Medical Spectrum Twente, Enschede, The Netherlands.
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Oude Voshaar MAH, Ten Klooster PM, Glas CAW, Vonkeman HE, Taal E, Krishnan E, Bernelot Moens HJ, Boers M, Terwee CB, van Riel PLCM, van de Laar MAFJ. Validity and measurement precision of the PROMIS physical function item bank and a content validity-driven 20-item short form in rheumatoid arthritis compared with traditional measures. Rheumatology (Oxford) 2015. [PMID: 26224306 DOI: 10.1093/rheumatology/kev265] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To evaluate the content validity and measurement properties of the Patient-Reported Outcome Measurement Information System (PROMIS) physical function item bank and a 20-item short form in patients with RA in comparison with the HAQ disability index (HAQ-DI) and 36-item Short Form Health Survey (SF-36) physical functioning scale (PF-10). METHODS The content validity of the instruments was evaluated by linking their items to the International Classification of Functioning, Disability and Health (ICF) core set for RA. The measures were administered to 690 RA patients enrolled in the Dutch Rheumatoid Arthritis Monitoring registry. Measurement precision was evaluated using item response theory methods and construct validity was evaluated by correlating physical function scores with other clinical and patient-reported outcome measures. RESULTS All 207 health concepts identified in the physical function measures referred to activities that are featured in the ICF. Twenty-three of 26 ICF RA core set domains are featured in the full PROMIS physical function item bank compared with 13 and 8 for the HAQ-DI and PF-10, respectively. As hypothesized, all three physical function instruments were highly intercorrelated (r 0.74-0.84), moderately correlated with disease activity measures (r 0.44-0.63) and weakly correlated with age (rs 0.07-0.14). Item response theory-based analysis revealed that a 20-item PROMIS physical function short form covered a wider range of physical function levels than the HAQ-DI or PF-10. CONCLUSION The PROMIS physical function item bank demonstrated excellent measurement properties in RA. A content-driven 20-item short form may be a useful tool for assessing physical function in RA.
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Affiliation(s)
| | - Peter M Ten Klooster
- Arthritis Center Twente, Department of Psychology, Health & Technology, Enschede
| | - Cees A W Glas
- Department of Research Methodology, Measurement and Data Analysis, University of Twente
| | - Harald E Vonkeman
- Arthritis Center Twente, Department of Psychology, Health & Technology, Enschede, Arthritis Center Twente, Department of Rheumatology and Clinical Immunology, Medisch Spectrum Twente, Enschede, The Netherlands
| | - Erik Taal
- Arthritis Center Twente, Department of Psychology, Health & Technology, Enschede
| | - Eswar Krishnan
- Stanford ARAMIS Program, Stanford University School of Medicine, Palo Alto, CA, USA
| | | | - Maarten Boers
- Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam and
| | - Caroline B Terwee
- Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam and
| | - Piet L C M van Riel
- Department of Rheumatic Diseases, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Mart A F J van de Laar
- Arthritis Center Twente, Department of Psychology, Health & Technology, Enschede, Arthritis Center Twente, Department of Rheumatology and Clinical Immunology, Medisch Spectrum Twente, Enschede, The Netherlands
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Nota I, Drossaert CHC, Taal E, van de Laar MAFJ. Patients' Considerations in the Decision-Making Process of Initiating Disease-Modifying Antirheumatic Drugs. Arthritis Care Res (Hoboken) 2015; 67:956-64. [DOI: 10.1002/acr.22531] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2014] [Revised: 11/04/2014] [Accepted: 12/02/2014] [Indexed: 01/27/2023]
Affiliation(s)
- Ingrid Nota
- University of Twente; Enschede The Netherlands
| | | | - Erik Taal
- University of Twente; Enschede The Netherlands
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Nikolaus S, Bode C, Taal E, Vonkeman HE, Glas CAW, van de Laar MAFJ. Working mechanism of a multidimensional computerized adaptive test for fatigue in rheumatoid arthritis. Health Qual Life Outcomes 2015; 13:23. [PMID: 25890307 PMCID: PMC4340497 DOI: 10.1186/s12955-015-0215-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2014] [Accepted: 01/24/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND This paper demonstrates the mechanism of a multidimensional computerized adaptive test (CAT) to measure fatigue in patients with rheumatoid arthritis (RA). A CAT can be used to precisely measure patient-reported outcomes at an individual level as items are consequentially selected based on the patient's previous answers. The item bank of the CAT Fatigue RA has been developed from the patients' perspective and consists of 196 items pertaining to three fatigue dimensions: severity, impact and variability of fatigue. METHODS The CAT Fatigue RA was completed by fifteen patients. To test the CAT's working mechanism, we applied the flowchart-check-method. The adaptive item selection procedure for each patient was checked by the researchers. The estimated fatigue levels and the measurement precision per dimension were illustrated with the selected items, answers and flowcharts. RESULTS The CAT Fatigue RA selected all items in a logical sequence and those items were selected which provided the most information about the patient's individual fatigue. Flowcharts further illustrated that the CAT reached a satisfactory measurement precision, with less than 20 items, on the dimensions severity and impact and to somewhat lesser extent also for the dimension variability. Patients' fatigue scores varied across the three dimensions; sometimes severity scored highest, other times impact or variability. The CAT's ability to display different fatigue experiences can improve communication in daily clinical practice, guide interventions, and facilitate research into possible predictors of fatigue. CONCLUSIONS The results indicate that the CAT Fatigue RA measures precise and comprehensive. Once it is examined in more detail in a consecutive, elaborate validation study, the CAT will be available for implementation in daily clinical practice and for research purposes.
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Affiliation(s)
- Stephanie Nikolaus
- Department of Psychology, Health and Technology, University of Twente, P.O. Box 217, 7500 AE, Enschede, The Netherlands. .,Expert Center for Chronic Fatigue, Radboud University Medical Center, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands.
| | - Christina Bode
- Department of Psychology, Health and Technology, University of Twente, P.O. Box 217, 7500 AE, Enschede, The Netherlands.
| | - Erik Taal
- Department of Psychology, Health and Technology, University of Twente, P.O. Box 217, 7500 AE, Enschede, The Netherlands.
| | - Harald E Vonkeman
- Department of Psychology, Health and Technology, University of Twente, P.O. Box 217, 7500 AE, Enschede, The Netherlands. .,Medical Spectrum Twente, Department of Rheumatology and Clinical Immunology, P.O. Box 50 000, 7500 KA, Enschede, The Netherlands.
| | - Cees A W Glas
- Department of Research Methodology, Measurement and Data Analysis, University of Twente, P.O. Box 217, 7500 AE, Enschede, The Netherlands.
| | - Mart A F J van de Laar
- Department of Psychology, Health and Technology, University of Twente, P.O. Box 217, 7500 AE, Enschede, The Netherlands. .,Medical Spectrum Twente, Department of Rheumatology and Clinical Immunology, P.O. Box 50 000, 7500 KA, Enschede, The Netherlands.
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Manders SHM, Kievit W, Adang E, Jansen TJ, Stolk JN, Visser H, Schilder AM, Vonkeman HE, van de Laar MAFJ, van Riel PLCM. Effectiveness of TNF inhibitor treatment with various methotrexate doses in patients with rheumatoid arthritis: results from clinical practice. Ann Rheum Dis 2014; 74:e24. [DOI: 10.1136/annrheumdis-2014-207005] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Ten Klooster PM, Vonkeman HE, Oude Voshaar MAH, Siemons L, van Riel PLCM, van de Laar MAFJ. Predictors of satisfactory improvements in pain for patients with early rheumatoid arthritis in a treat-to-target study. Rheumatology (Oxford) 2014; 54:1080-6. [PMID: 25433041 DOI: 10.1093/rheumatology/keu449] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2014] [Indexed: 01/22/2023] Open
Abstract
OBJECTIVE The aim of this study was to identify baseline predictors of achieving patient-perceived satisfactory improvement (PPSI) in pain after 6 months of treat to target in patients with early RA. METHODS Baseline and 6 month data were used from patients included in the Dutch Rheumatoid Arthritis Monitoring remission induction cohort study. Simple and multivariable logistic regression analyses were used to identify significant predictors of achieving an absolute improvement of 30 mm or a relative improvement of 50% on a visual analogue scale for pain. RESULTS At 6 months, 125 of 209 patients (59.8%) achieved an absolute PPSI and 130 patients (62.2%) achieved a relative PPSI in pain. Controlling for baseline pain, having symmetrical arthritis was the strongest independent predictor of achieving an absolute [odds ratio (OR) 3.17, P = 0.03] or relative (OR 3.44, P = 0.01) PPSI. Additionally, anti-CCP positivity (OR 2.04, P = 0.04) and having ≤12 tender joints (OR 0.29, P = 0.01) were predictive of achieving a relative PPSI. The total explained variance of baseline predictors was 30% for absolute and 18% for relative improvements, respectively. CONCLUSION Symmetrical joint involvement, anti-CCP positivity and fewer tender joints at baseline are prognostic signs for achieving satisfactory improvement in pain after 6 months of treat to target in patients with early RA.
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Affiliation(s)
- Peter M Ten Klooster
- Arthritis Centre Twente, Department of Psychology, Health and Technology, University of Twente, Arthritis Centre Twente, Department of Rheumatology and Clinical Immunology, Medical Spectrum Twente, Enschede and IQ Healthcare, Radboud University Medical Centre, Nijmegen, The Netherlands.
| | - Harald E Vonkeman
- Arthritis Centre Twente, Department of Psychology, Health and Technology, University of Twente, Arthritis Centre Twente, Department of Rheumatology and Clinical Immunology, Medical Spectrum Twente, Enschede and IQ Healthcare, Radboud University Medical Centre, Nijmegen, The Netherlands. Arthritis Centre Twente, Department of Psychology, Health and Technology, University of Twente, Arthritis Centre Twente, Department of Rheumatology and Clinical Immunology, Medical Spectrum Twente, Enschede and IQ Healthcare, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Martijn A H Oude Voshaar
- Arthritis Centre Twente, Department of Psychology, Health and Technology, University of Twente, Arthritis Centre Twente, Department of Rheumatology and Clinical Immunology, Medical Spectrum Twente, Enschede and IQ Healthcare, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Liseth Siemons
- Arthritis Centre Twente, Department of Psychology, Health and Technology, University of Twente, Arthritis Centre Twente, Department of Rheumatology and Clinical Immunology, Medical Spectrum Twente, Enschede and IQ Healthcare, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Piet L C M van Riel
- Arthritis Centre Twente, Department of Psychology, Health and Technology, University of Twente, Arthritis Centre Twente, Department of Rheumatology and Clinical Immunology, Medical Spectrum Twente, Enschede and IQ Healthcare, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Mart A F J van de Laar
- Arthritis Centre Twente, Department of Psychology, Health and Technology, University of Twente, Arthritis Centre Twente, Department of Rheumatology and Clinical Immunology, Medical Spectrum Twente, Enschede and IQ Healthcare, Radboud University Medical Centre, Nijmegen, The Netherlands. Arthritis Centre Twente, Department of Psychology, Health and Technology, University of Twente, Arthritis Centre Twente, Department of Rheumatology and Clinical Immunology, Medical Spectrum Twente, Enschede and IQ Healthcare, Radboud University Medical Centre, Nijmegen, The Netherlands
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Oude Voshaar MAH, Ten Klooster PM, Glas CAW, Vonkeman HE, Krishnan E, van de Laar MAFJ. Relative performance of commonly used physical function questionnaires in rheumatoid arthritis and a patient-reported outcomes measurement information system computerized adaptive test. Arthritis Rheumatol 2014; 66:2900-8. [PMID: 24964773 DOI: 10.1002/art.38759] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2014] [Accepted: 06/19/2014] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To evaluate and compare the measurement precision and sensitivity to change of the Health Assessment Questionnaire disability index (HAQ DI), the Short Form 36 physical functioning scale (PF-10), and simulated Patient-Reported Outcomes Measurement Information System (PROMIS) physical function computer adaptive tests (CATs) with 5, 10, and 15 items, using item response theory-based simulation studies. METHODS The measurement precision of the various physical function instruments was evaluated by calculating root mean square errors (RMSEs) between true physical function levels (latent physical function score) and estimated physical function levels. Measurement precision was evaluated at 9 levels of physical function, with 5,000 simulated response patterns per level. Sensitivity to change was evaluated by the ability of a simple statistical test to detect simulated change scores of small to moderate magnitude (standardized effect sizes 0.20, 0.35, and 0.50). RESULTS RMSEs were smaller for the PROMIS physical function 15-item CAT (CAT-15) and CAT-10 than for the HAQ DI and PF-10 across all levels of the latent physical function scale. Only marginal improvement in performance was observed for the CAT-15 compared with the CAT-10, and the CAT-5 performed quite similarly to the HAQ DI and PF-10 across most levels of the latent physical function scale. Substantially improved sensitivity to change was observed for the CAT-10 compared with the HAQ DI and PF-10, particularly in detecting moderate effect sizes. CONCLUSION Clearly higher measurement precision was observed for the PROMIS CAT compared with the HAQ DI and PF-10. Higher reliability also translated into lower sample size requirements for detecting changes in clinical status.
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Oude Voshaar MAH, ten Klooster PM, Taal E, Wolfe F, Vonkeman H, Glas CAW, van de Laar MAFJ. Linking Physical Function Outcomes in Rheumatology: Performance of a Crosswalk for Converting Health Assessment Questionnaire Scores to Short Form 36 Physical Functioning Scale Scores. Arthritis Care Res (Hoboken) 2014; 66:1754-8. [DOI: 10.1002/acr.22357] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2014] [Revised: 03/20/2014] [Accepted: 04/15/2014] [Indexed: 12/26/2022]
Affiliation(s)
| | | | - Erik Taal
- University of Twente; Enschede The Netherlands
| | - Frederick Wolfe
- National Data Bank for Rheumatic Diseases and University of Kansas School of Medicine; Wichita
| | - Harald Vonkeman
- University of Twente and Medisch Spectrum Twente; Enschede The Netherlands
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Nota I, Drossaert CHC, Taal E, Vonkeman HE, van de Laar MAFJ. Patient participation in decisions about disease modifying anti-rheumatic drugs: a cross-sectional survey. BMC Musculoskelet Disord 2014; 15:333. [PMID: 25281209 PMCID: PMC4192293 DOI: 10.1186/1471-2474-15-333] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2014] [Accepted: 09/24/2014] [Indexed: 02/10/2023] Open
Abstract
BACKGROUND Involvement of patients in decision-making about medication is currently being advocated. This study examined (the concordance between) inflammatory arthritis patients' preferred and perceived involvement in decision-making in general, and in four specific decisions about Disease-Modifying Anti-Rheumatic Drugs (DMARDs). Furthermore, this study examined how patients' involvement is related to satisfaction about decision-making and which factors are related to preferred roles, perceived roles and concordance. METHODS Using a cross-sectional survey, 894 patients diagnosed with Rheumatoid Arthritis, Psoriatic Arthritis or Ankylosing Spondylitis were sent a questionnaire which focused on medical decisions in general and on four specific decisions: (a) starting with a traditional DMARD; (b) starting to inject methotrexate; (c) starting a biological DMARD; and (d) decreasing or stopping a DMARD. For each decision preferred and perceived involvement in decision-making was assessed using the Control Preference Scale. Concordance was calculated by subtracting the scores for perceived role from scores for the preferred role. Furthermore, satisfaction with the decision process and socio-demographic, health-related, patient-related and physician-related variables were assessed. RESULTS The response rate was 58%. For all decisions, most patients (59%-63%) preferred Shared Decision-Making (SDM). SDM was perceived frequently (26%-55%) and patients' preferences were met in 54% of the respondents. Yet, in some specific decisions, 26% to 54% of patients would have liked more participation. Perceiving less participation then preferred was associated with less satisfaction with the decision-process, but perceiving more participation than preferred was not. Our results did not reveal any meaningful models to predict preferred or perceived participation in decision-making in general or with reference to specific decisions about DMARDs. CONCLUSIONS Most arthritis patients prefer to be involved in decisions about their medication and SDM is perceived frequently. Yet, in some specific decisions patient participation can be further improved. Patients especially prefer more participation in decision-making regarding starting a first traditional DMARD, which occurs most commonly in newly diagnosed patients. Whereas perceiving too little participation was associated with decreased satisfaction, perceiving too much participation was not. Therefore, rheumatologists should urge patients to participate in every medical decision.
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Affiliation(s)
- Ingrid Nota
- Department of Psychology, Health and Technology, University of Twente, PO Box 217, Enschede 7500AE, The Netherlands.
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Tran-Duy A, Boonen A, Kievit W, van Riel PLCM, van de Laar MAFJ, Severens JL. Modelling outcomes of complex treatment strategies following a clinical guideline for treatment decisions in patients with rheumatoid arthritis. Pharmacoeconomics 2014; 32:1015-1028. [PMID: 24972589 DOI: 10.1007/s40273-014-0184-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
BACKGROUND Management of rheumatoid arthritis (RA) is characterised by a sequence of disease-modifying antirheumatic drugs (DMARDs) and biological response modifiers (BRMs). In most of the Western countries, the drug sequences are determined based on disease activity and treatment history of the patients. A model for realistic patient outcomes should reflect the treatment pathways relevant for patients with specific characteristics. OBJECTIVE This study aimed at developing a model that could simulate long-term patient outcomes and cost effectiveness of treatment strategies with and without inclusion of BRMs following a clinical guideline for treatment decisions. METHODS Discrete event simulation taking into account patient characteristics and treatment history was used for model development. Treatment effect on disease activity, costs, health utilities and times to events were estimated using Dutch observational studies. Long-term progression of physical functioning was quantified using a linear mixed-effects model. Costs and health utilities were estimated using two-part models. The treatment strategy recommended by the Dutch Society for Rheumatology where both DMARDs and BRMs were available (Strategy 2) was compared with the treatment strategy without BRMs (Strategy 1). Ten thousand theoretical patients were tracked individually until death. In the probabilistic sensitivity analysis, Monte Carlo simulations were performed with 1,000 sets of parameters sampled from appropriate probability distributions. RESULTS The simulated changes over time in disease activity and physical functioning were plausible. The incremental cost per quality-adjusted life-year gained of Strategy 2 compared with Strategy 1 was <euro>124,011. At a willingness-to-pay threshold higher than <euro>119,167, Strategy 2 dominated Strategy 1 in terms of cost effectiveness but the probability that the Strategy 2 is cost effective never exceeded 0.87. CONCLUSIONS It is possible to model the outcomes of complex treatment strategies based on a clinical guideline for the management of RA. Following the Dutch guideline and using real-life data, inclusion of BRMs in the treatment strategy for RA appeared to be less favourable in our model than in most of the existing models that compared drug sequences independent of patient characteristics and used data from randomised controlled clinical trials. Despite complexity and demand for extensive data, our modelling approach can help to identify the knowledge gaps in clinical guidelines for RA management and priorities for future research.
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Affiliation(s)
- An Tran-Duy
- Department of Clinical Epidemiology and Medical Technology Assessment (KEMTA), Maastricht University Medical Center, P.O. Box 5800, 6202 AZ, Maastricht, The Netherlands,
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Conaghan PG, Peloso PM, Everett SV, Rajagopalan S, Black CM, Mavros P, Arden NK, Phillips CJ, Rannou F, van de Laar MAFJ, Moore RA, Taylor SD. Inadequate pain relief and large functional loss among patients with knee osteoarthritis: evidence from a prospective multinational longitudinal study of osteoarthritis real-world therapies. Rheumatology (Oxford) 2014; 54:270-7. [PMID: 25150513 PMCID: PMC4301711 DOI: 10.1093/rheumatology/keu332] [Citation(s) in RCA: 83] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Objective. To estimate the prevalence of inadequate pain relief (IPR) among patients with symptomatic knee OA prescribed analgesic therapy and to characterize patients with IPR. Methods. Patients ≥50 years old with physician-diagnosed knee OA who had taken topical or oral pain medication for at least 14 days were recruited for this prospective non-interventional study in six European countries. Pain and function were assessed using the Brief Pain Inventory (BPI) and the WOMAC; quality of life (QoL) was assessed using the 12-item short form. IPR was defined as an average pain score of >4 out of 10 on BPI question 5. Results. Of 1187 patients enrolled, 68% were female and the mean age was 68 years (s.d. 9); 639 (54%) met the definition of IPR. Patient responses for the BPI average pain question were well correlated with responses on the WOMAC pain subscale (Spearman r = 0.64, P < 0.001). In multivariate logistic regression, patients with IPR had greater odds of being female [adjusted odds ratio (adjOR) 1.90 (95% CI 1.46, 2.48)] and having OA in both knees [adjOR 1.48 (95% CI 1.15, 1.90)], higher BMI, longer OA duration, depression or diabetes. Patients with IPR (vs non-IPR) were more likely to have worse QoL, greater function loss and greater pain interference. Conclusion. IPR is common among patients with knee OA requiring analgesics and is associated with large functional loss and impaired QoL. Patients at particular risk of IPR, as characterized in this study, may require greater attention towards their analgesic treatment options. Trial registration:https://clinicaltrials.gov/ (NCT01294696).
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Affiliation(s)
- Philip G Conaghan
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, NIHR Leeds Musculoskeletal Biomedical Research Unit, Leeds, UK, Clinical Development, MRL, Merck & Co., Kenilworth, Global Health Outcomes, Merck & Co., Whitehouse Station, MedData Analytics, East Brunswick, NJ, College of Pharmacy, St Johns University, Queens, NY, USA, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, Centre for Health Economics, Swansea University, Swansea, UK, Cochin Hospital, Rehabilitation Department, University of Paris, Paris, France, Department of Rheumatology and Clinical Immunology, University of Twente, Enschede, The Netherlands and Pain Research & Nuffield Department of Anaesthetics, Oxford University, Oxford, UK. Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, NIHR Leeds Musculoskeletal Biomedical Research Unit, Leeds, UK, Clinical Development, MRL, Merck & Co., Kenilworth, Global Health Outcomes, Merck & Co., Whitehouse Station, MedData Analytics, East Brunswick, NJ, College of Pharmacy, St Johns University, Queens, NY, USA, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, Centre for Health Economics, Swansea University, Swansea, UK, Cochin Hospital, Rehabilitation Department, University of Paris, Paris, France, Department of Rheumatology and Clinical Immunology, University of Twente, Enschede, The Netherlands and Pain Research & Nuffield Department of Anaesthetics, Oxford University, Oxford, UK
| | - Paul M Peloso
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, NIHR Leeds Musculoskeletal Biomedical Research Unit, Leeds, UK, Clinical Development, MRL, Merck & Co., Kenilworth, Global Health Outcomes, Merck & Co., Whitehouse Station, MedData Analytics, East Brunswick, NJ, College of Pharmacy, St Johns University, Queens, NY, USA, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, Centre for Health Economics, Swansea University, Swansea, UK, Cochin Hospital, Rehabilitation Department, University of Paris, Paris, France, Department of Rheumatology and Clinical Immunology, University of Twente, Enschede, The Netherlands and Pain Research & Nuffield Department of Anaesthetics, Oxford University, Oxford, UK
| | - Sharlette V Everett
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, NIHR Leeds Musculoskeletal Biomedical Research Unit, Leeds, UK, Clinical Development, MRL, Merck & Co., Kenilworth, Global Health Outcomes, Merck & Co., Whitehouse Station, MedData Analytics, East Brunswick, NJ, College of Pharmacy, St Johns University, Queens, NY, USA, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, Centre for Health Economics, Swansea University, Swansea, UK, Cochin Hospital, Rehabilitation Department, University of Paris, Paris, France, Department of Rheumatology and Clinical Immunology, University of Twente, Enschede, The Netherlands and Pain Research & Nuffield Department of Anaesthetics, Oxford University, Oxford, UK
| | - Srinivasan Rajagopalan
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, NIHR Leeds Musculoskeletal Biomedical Research Unit, Leeds, UK, Clinical Development, MRL, Merck & Co., Kenilworth, Global Health Outcomes, Merck & Co., Whitehouse Station, MedData Analytics, East Brunswick, NJ, College of Pharmacy, St Johns University, Queens, NY, USA, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, Centre for Health Economics, Swansea University, Swansea, UK, Cochin Hospital, Rehabilitation Department, University of Paris, Paris, France, Department of Rheumatology and Clinical Immunology, University of Twente, Enschede, The Netherlands and Pain Research & Nuffield Department of Anaesthetics, Oxford University, Oxford, UK
| | - Christopher M Black
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, NIHR Leeds Musculoskeletal Biomedical Research Unit, Leeds, UK, Clinical Development, MRL, Merck & Co., Kenilworth, Global Health Outcomes, Merck & Co., Whitehouse Station, MedData Analytics, East Brunswick, NJ, College of Pharmacy, St Johns University, Queens, NY, USA, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, Centre for Health Economics, Swansea University, Swansea, UK, Cochin Hospital, Rehabilitation Department, University of Paris, Paris, France, Department of Rheumatology and Clinical Immunology, University of Twente, Enschede, The Netherlands and Pain Research & Nuffield Department of Anaesthetics, Oxford University, Oxford, UK
| | - Panagiotis Mavros
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, NIHR Leeds Musculoskeletal Biomedical Research Unit, Leeds, UK, Clinical Development, MRL, Merck & Co., Kenilworth, Global Health Outcomes, Merck & Co., Whitehouse Station, MedData Analytics, East Brunswick, NJ, College of Pharmacy, St Johns University, Queens, NY, USA, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, Centre for Health Economics, Swansea University, Swansea, UK, Cochin Hospital, Rehabilitation Department, University of Paris, Paris, France, Department of Rheumatology and Clinical Immunology, University of Twente, Enschede, The Netherlands and Pain Research & Nuffield Department of Anaesthetics, Oxford University, Oxford, UK
| | - Nigel K Arden
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, NIHR Leeds Musculoskeletal Biomedical Research Unit, Leeds, UK, Clinical Development, MRL, Merck & Co., Kenilworth, Global Health Outcomes, Merck & Co., Whitehouse Station, MedData Analytics, East Brunswick, NJ, College of Pharmacy, St Johns University, Queens, NY, USA, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, Centre for Health Economics, Swansea University, Swansea, UK, Cochin Hospital, Rehabilitation Department, University of Paris, Paris, France, Department of Rheumatology and Clinical Immunology, University of Twente, Enschede, The Netherlands and Pain Research & Nuffield Department of Anaesthetics, Oxford University, Oxford, UK
| | - Ceri J Phillips
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, NIHR Leeds Musculoskeletal Biomedical Research Unit, Leeds, UK, Clinical Development, MRL, Merck & Co., Kenilworth, Global Health Outcomes, Merck & Co., Whitehouse Station, MedData Analytics, East Brunswick, NJ, College of Pharmacy, St Johns University, Queens, NY, USA, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, Centre for Health Economics, Swansea University, Swansea, UK, Cochin Hospital, Rehabilitation Department, University of Paris, Paris, France, Department of Rheumatology and Clinical Immunology, University of Twente, Enschede, The Netherlands and Pain Research & Nuffield Department of Anaesthetics, Oxford University, Oxford, UK
| | - François Rannou
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, NIHR Leeds Musculoskeletal Biomedical Research Unit, Leeds, UK, Clinical Development, MRL, Merck & Co., Kenilworth, Global Health Outcomes, Merck & Co., Whitehouse Station, MedData Analytics, East Brunswick, NJ, College of Pharmacy, St Johns University, Queens, NY, USA, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, Centre for Health Economics, Swansea University, Swansea, UK, Cochin Hospital, Rehabilitation Department, University of Paris, Paris, France, Department of Rheumatology and Clinical Immunology, University of Twente, Enschede, The Netherlands and Pain Research & Nuffield Department of Anaesthetics, Oxford University, Oxford, UK
| | - Mart A F J van de Laar
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, NIHR Leeds Musculoskeletal Biomedical Research Unit, Leeds, UK, Clinical Development, MRL, Merck & Co., Kenilworth, Global Health Outcomes, Merck & Co., Whitehouse Station, MedData Analytics, East Brunswick, NJ, College of Pharmacy, St Johns University, Queens, NY, USA, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, Centre for Health Economics, Swansea University, Swansea, UK, Cochin Hospital, Rehabilitation Department, University of Paris, Paris, France, Department of Rheumatology and Clinical Immunology, University of Twente, Enschede, The Netherlands and Pain Research & Nuffield Department of Anaesthetics, Oxford University, Oxford, UK
| | - R Andrew Moore
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, NIHR Leeds Musculoskeletal Biomedical Research Unit, Leeds, UK, Clinical Development, MRL, Merck & Co., Kenilworth, Global Health Outcomes, Merck & Co., Whitehouse Station, MedData Analytics, East Brunswick, NJ, College of Pharmacy, St Johns University, Queens, NY, USA, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, Centre for Health Economics, Swansea University, Swansea, UK, Cochin Hospital, Rehabilitation Department, University of Paris, Paris, France, Department of Rheumatology and Clinical Immunology, University of Twente, Enschede, The Netherlands and Pain Research & Nuffield Department of Anaesthetics, Oxford University, Oxford, UK
| | - Stephanie D Taylor
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, NIHR Leeds Musculoskeletal Biomedical Research Unit, Leeds, UK, Clinical Development, MRL, Merck & Co., Kenilworth, Global Health Outcomes, Merck & Co., Whitehouse Station, MedData Analytics, East Brunswick, NJ, College of Pharmacy, St Johns University, Queens, NY, USA, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, Centre for Health Economics, Swansea University, Swansea, UK, Cochin Hospital, Rehabilitation Department, University of Paris, Paris, France, Department of Rheumatology and Clinical Immunology, University of Twente, Enschede, The Netherlands and Pain Research & Nuffield Department of Anaesthetics, Oxford University, Oxford, UK.
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Umićević Mirkov M, Janss L, Vermeulen SH, van de Laar MAFJ, van Riel PLCM, Guchelaar HJ, Brunner HG, Albers CA, Coenen MJH. Estimation of heritability of different outcomes for genetic studies of TNFi response in patients with rheumatoid arthritis. Ann Rheum Dis 2014; 74:2183-7. [PMID: 25114059 DOI: 10.1136/annrheumdis-2014-205541] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2014] [Accepted: 07/20/2014] [Indexed: 01/03/2023]
Abstract
OBJECTIVES Pharmacogenetic studies of tumour necrosis factor inhibitors (TNFi) response in patients with rheumatoid arthritis (RA) have largely relied on the changes in complex disease scores, such as disease activity score 28 (DAS28), as a measure of treatment response. It is expected that genetic architecture of such complex score is heterogeneous and not very suitable for pharmacogenetic studies. We aimed to select the most optimal phenotype for TNFi response using heritability estimates. METHODS Using two linear mixed-modelling approaches (Bayz and GCTA), we estimated heritability, together with genomic and environmental correlations for the TNFi drug-response phenotype ΔDAS28 and its separate components: Δ swollen joint count (SJC), Δ tender joint count (TJC), Δ erythrocyte sedimentation rate (ESR) and Δ visual-analogue scale of general health (VAS-GH). For this, we used genome-wide single nucleotide polymorphism (SNP) data from 878 TNFi-treated Dutch patients with RA. Furthermore, a multivariate genome-wide association study (GWAS) approach was implemented, analysing separate DAS28 components simultaneously. RESULTS The highest heritability estimates were found for ΔSJC (h(2)gbayz=0.76 and h(2)gGCTA=0.87) and ΔTJC (h(2)gbayz=0.62 and h(2)gGCTA=0.82); lower heritability was found for ΔDAS28 (h(2)gbayz=0.59 and h(2)gGCTA=0.71) while estimates for ΔESR and ΔVASGH were near or equal to zero. The highest genomic correlations were observed for ΔSJC and ΔTJC (0.49), and the highest environmental correlation was seen between ΔTJC and ΔVASGH (0.62). The multivariate GWAS did not generate excess of low p values as compared with a univariate analysis of ΔDAS28. CONCLUSIONS Our results indicate that multiple SNPs together explain a substantial portion of the variation in change in joint counts in TNFi-treated patients with RA. In conclusion, of the outcomes studied, the joint counts are most suitable for TNFi pharmacogenetics in RA.
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Affiliation(s)
- Maša Umićević Mirkov
- Department of Human Genetics, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Luc Janss
- Faculty of Science and Technology, Department of Molecular Biology and Genetics, University of Aarhus, Tjele, Denmark
| | - Sita H Vermeulen
- Department of Human Genetics, Radboud University Medical Center, Nijmegen, The Netherlands Department for Health Evidence, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Mart A F J van de Laar
- Department of Rheumatology, University Twente&Medisch Spectrum Twente, Enschede, The Netherlands
| | - Piet L C M van Riel
- Department for Health Evidence, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Henk-Jan Guchelaar
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
| | - Han G Brunner
- Department of Human Genetics, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Cornelis A Albers
- Department of Human Genetics, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Marieke J H Coenen
- Department of Human Genetics, Radboud University Medical Center, Nijmegen, The Netherlands
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Siemons L, ten Klooster PM, Vonkeman HE, van de Laar MAFJ, Glas CAW. Further optimization of the reliability of the 28-joint disease activity score in patients with early rheumatoid arthritis. PLoS One 2014; 9:e100544. [PMID: 24955759 PMCID: PMC4067329 DOI: 10.1371/journal.pone.0100544] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2014] [Accepted: 05/28/2014] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND The 28-joint Disease Activity Score (DAS28) combines scores on a 28-tender and swollen joint count (TJC28 and SJC28), a patient-reported measure for general health (GH), and an inflammatory marker (either the erythrocyte sedimentation rate [ESR] or the C-reactive protein [CRP]) into a composite measure of disease activity in rheumatoid arthritis (RA). This study examined the reliability of the DAS28 in patients with early RA using principles from generalizability theory and evaluated whether it could be increased by adjusting individual DAS28 component weights. METHODS Patients were drawn from the DREAM registry and classified into a "fast response" group (N = 466) and "slow response" group (N = 80), depending on their pace of reaching remission. Composite reliabilities of the DAS28-ESR and DAS28-CRP were determined with the individual components' reliability, weights, variances, error variances, correlations and covariances. Weight optimization was performed by minimizing the error variance of the index. RESULTS Composite reliabilities of 0.85 and 0.86 were found for the DAS28-ESR and DAS28-CRP, respectively, and were approximately equal across patients groups. Component reliabilities, however, varied widely both within and between sub-groups, ranging from 0.614 for GH ("slow response" group) to 0.912 for ESR ("fast response" group). Weight optimization increased composite reliability even further. In the total and "fast response" groups, this was achieved mostly by decreasing the weight of the TJC28 and GH. In the "slow response" group, though, the weights of the TJC28 and SJC28 were increased, while those of the inflammatory markers and GH were substantially decreased. CONCLUSIONS The DAS28-ESR and the DAS28-CRP are reliable instruments for assessing disease activity in early RA and reliability can be increased even further by adjusting component weights. Given the low reliability and weightings of the general health component across subgroups it is recommended to explore alternative patient-reported outcome measures for inclusion in the DAS28.
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Affiliation(s)
- Liseth Siemons
- Arthritis Center Twente, Department of Psychology, Health & Technology, University of Twente, Enschede, the Netherlands
- * E-mail:
| | - Peter M. ten Klooster
- Arthritis Center Twente, Department of Psychology, Health & Technology, University of Twente, Enschede, the Netherlands
| | - Harald E. Vonkeman
- Arthritis Center Twente, Department of Psychology, Health & Technology, University of Twente, Enschede, the Netherlands
- Arthritis Center Twente, Department of Rheumatology, Medisch Spectrum Twente, Enschede, the Netherlands
| | - Mart A. F. J. van de Laar
- Arthritis Center Twente, Department of Psychology, Health & Technology, University of Twente, Enschede, the Netherlands
- Arthritis Center Twente, Department of Rheumatology, Medisch Spectrum Twente, Enschede, the Netherlands
| | - Cees A. W. Glas
- Department of Research Methodology, Measurement and Data Analysis, University of Twente, Enschede, the Netherlands
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Manders SHM, Kievit W, Braakman-Jansen ALMA, Brus HLM, Hendriks L, Fransen J, van de Laar MAFJ, van Riel PLCM. Determinants associated with work participation in patients with established rheumatoid arthritis taking tumor necrosis factor inhibitors. J Rheumatol 2014; 41:1263-9. [PMID: 24833758 DOI: 10.3899/jrheum.130878] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Reduced work participation (WP) is a common problem for patients with rheumatoid arthritis (RA) and generates high costs for society. Therefore, it is important to explore determinants of WP at the start of tumor necrosis factor inhibitor (TNFi) treatment, and for changes in WP after 2 years of TNFi treatment. METHODS Within the Dutch Rheumatoid Arthritis Monitoring (DREAM) biologic register, WP data were available from 508 patients with RA younger than 65 years and without an (early) retirement pension. WP was registered at start of TNFi treatment and after 2 years of followup and was measured by single patient-reported binary questions whether they had work, paid or voluntary, or had a disability allowance or a retirement pension. Determinants measured at baseline were age, sex, disease duration, functional status [through Health Assessment Questionnaire-Disability Index (HAQ-DI)], 28-joint Disease Activity Score (DAS28), rheumatoid factor, presence of erosions, number of previous disease-modifying antirheumatic drugs, and number of comorbidities. During the 2 years of followup, HAQ-DI response and European League Against Rheumatism response were measured. Univariate analyses (excluded if p value was > 0.2) and multivariate (excluded if p value was > 0.1) logistic regression analyses were used. RESULTS Determinants associated with WP at baseline were having a better HAQ-DI (OR 0.32, p = 0.000) and male sex (OR 0.65, p = 0.065). After 2 years of TNFi therapy, 11.8% (n = 60) started to work and 13.6% (n = 69) stopped working. Determinants associated with starting to work were better baseline HAQ-DI (OR 0.58), positive RF (OR 2.73), and young age (OR 0.96); and for stopping work, worse baseline HAQ-DI (OR 2.74), low HAQ-DI response (OR 0.31), and comorbidity (OR 2.67), all with p < 0.1. CONCLUSION Young patients with RA and a high functional status without any comorbidity will have a better chance of working. This supports the main goal in the management of RA: to suppress disease activity as soon and as completely as possible to prevent irreversible destruction of the joints, and thus maintain a good functional status of the patient. Because of the low proportion of variance explained by the models in this study, other factors besides the ones studied are associated with WP.
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Affiliation(s)
- Sofie H M Manders
- From the Radboud University Nijmegen Medical Centre, Nijmegen; University of Twente, Enschede; TweeSteden Ziekenhuis, Tilburg; and Medisch centrum Leeuwarden, Leeuwarden, the Netherlands.S.H.M. Manders, MSc; W. Kievit, PhD, Radboud University Nijmegen Medical Centre; A.L.M.A. Braakman-Jansen, PhD, University of Twente; H.L.M. Brus, PhD, TweeSteden Ziekenhuis; L. Hendriks, MSc, Medisch centrum Leeuwarden; J. Fransen, PhD, Radboud University Nijmegen Medical Centre; M.A.F.J. van de Laar, Professor, University of Twente; and P.L.C.M. van Riel, Professor, Radboud University Nijmegen Medical Centre.
| | - Wietske Kievit
- From the Radboud University Nijmegen Medical Centre, Nijmegen; University of Twente, Enschede; TweeSteden Ziekenhuis, Tilburg; and Medisch centrum Leeuwarden, Leeuwarden, the Netherlands.S.H.M. Manders, MSc; W. Kievit, PhD, Radboud University Nijmegen Medical Centre; A.L.M.A. Braakman-Jansen, PhD, University of Twente; H.L.M. Brus, PhD, TweeSteden Ziekenhuis; L. Hendriks, MSc, Medisch centrum Leeuwarden; J. Fransen, PhD, Radboud University Nijmegen Medical Centre; M.A.F.J. van de Laar, Professor, University of Twente; and P.L.C.M. van Riel, Professor, Radboud University Nijmegen Medical Centre
| | - Annemarie L M A Braakman-Jansen
- From the Radboud University Nijmegen Medical Centre, Nijmegen; University of Twente, Enschede; TweeSteden Ziekenhuis, Tilburg; and Medisch centrum Leeuwarden, Leeuwarden, the Netherlands.S.H.M. Manders, MSc; W. Kievit, PhD, Radboud University Nijmegen Medical Centre; A.L.M.A. Braakman-Jansen, PhD, University of Twente; H.L.M. Brus, PhD, TweeSteden Ziekenhuis; L. Hendriks, MSc, Medisch centrum Leeuwarden; J. Fransen, PhD, Radboud University Nijmegen Medical Centre; M.A.F.J. van de Laar, Professor, University of Twente; and P.L.C.M. van Riel, Professor, Radboud University Nijmegen Medical Centre
| | - Herman L M Brus
- From the Radboud University Nijmegen Medical Centre, Nijmegen; University of Twente, Enschede; TweeSteden Ziekenhuis, Tilburg; and Medisch centrum Leeuwarden, Leeuwarden, the Netherlands.S.H.M. Manders, MSc; W. Kievit, PhD, Radboud University Nijmegen Medical Centre; A.L.M.A. Braakman-Jansen, PhD, University of Twente; H.L.M. Brus, PhD, TweeSteden Ziekenhuis; L. Hendriks, MSc, Medisch centrum Leeuwarden; J. Fransen, PhD, Radboud University Nijmegen Medical Centre; M.A.F.J. van de Laar, Professor, University of Twente; and P.L.C.M. van Riel, Professor, Radboud University Nijmegen Medical Centre
| | - Lidy Hendriks
- From the Radboud University Nijmegen Medical Centre, Nijmegen; University of Twente, Enschede; TweeSteden Ziekenhuis, Tilburg; and Medisch centrum Leeuwarden, Leeuwarden, the Netherlands.S.H.M. Manders, MSc; W. Kievit, PhD, Radboud University Nijmegen Medical Centre; A.L.M.A. Braakman-Jansen, PhD, University of Twente; H.L.M. Brus, PhD, TweeSteden Ziekenhuis; L. Hendriks, MSc, Medisch centrum Leeuwarden; J. Fransen, PhD, Radboud University Nijmegen Medical Centre; M.A.F.J. van de Laar, Professor, University of Twente; and P.L.C.M. van Riel, Professor, Radboud University Nijmegen Medical Centre
| | - Jaap Fransen
- From the Radboud University Nijmegen Medical Centre, Nijmegen; University of Twente, Enschede; TweeSteden Ziekenhuis, Tilburg; and Medisch centrum Leeuwarden, Leeuwarden, the Netherlands.S.H.M. Manders, MSc; W. Kievit, PhD, Radboud University Nijmegen Medical Centre; A.L.M.A. Braakman-Jansen, PhD, University of Twente; H.L.M. Brus, PhD, TweeSteden Ziekenhuis; L. Hendriks, MSc, Medisch centrum Leeuwarden; J. Fransen, PhD, Radboud University Nijmegen Medical Centre; M.A.F.J. van de Laar, Professor, University of Twente; and P.L.C.M. van Riel, Professor, Radboud University Nijmegen Medical Centre
| | - Mart A F J van de Laar
- From the Radboud University Nijmegen Medical Centre, Nijmegen; University of Twente, Enschede; TweeSteden Ziekenhuis, Tilburg; and Medisch centrum Leeuwarden, Leeuwarden, the Netherlands.S.H.M. Manders, MSc; W. Kievit, PhD, Radboud University Nijmegen Medical Centre; A.L.M.A. Braakman-Jansen, PhD, University of Twente; H.L.M. Brus, PhD, TweeSteden Ziekenhuis; L. Hendriks, MSc, Medisch centrum Leeuwarden; J. Fransen, PhD, Radboud University Nijmegen Medical Centre; M.A.F.J. van de Laar, Professor, University of Twente; and P.L.C.M. van Riel, Professor, Radboud University Nijmegen Medical Centre
| | - Piet L C M van Riel
- From the Radboud University Nijmegen Medical Centre, Nijmegen; University of Twente, Enschede; TweeSteden Ziekenhuis, Tilburg; and Medisch centrum Leeuwarden, Leeuwarden, the Netherlands.S.H.M. Manders, MSc; W. Kievit, PhD, Radboud University Nijmegen Medical Centre; A.L.M.A. Braakman-Jansen, PhD, University of Twente; H.L.M. Brus, PhD, TweeSteden Ziekenhuis; L. Hendriks, MSc, Medisch centrum Leeuwarden; J. Fransen, PhD, Radboud University Nijmegen Medical Centre; M.A.F.J. van de Laar, Professor, University of Twente; and P.L.C.M. van Riel, Professor, Radboud University Nijmegen Medical Centre
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Meek IL, Vonkeman HE, van de Laar MAFJ. Cardiovascular case fatality in rheumatoid arthritis is decreasing; first prospective analysis of a current low disease activity rheumatoid arthritis cohort and review of the literature. BMC Musculoskelet Disord 2014; 15:142. [PMID: 24779371 PMCID: PMC4046075 DOI: 10.1186/1471-2474-15-142] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2013] [Accepted: 03/17/2014] [Indexed: 02/06/2023] Open
Abstract
Background Previous studies found increased case fatality after myocardial infarction and more frequent sudden death in RA patients compared to non-RA subjects. The RA associated CV risk might be explained by the combined effects of chronic systemic inflammation and increased lifestyle associated cardiovascular risk factors, and modified by the use of medication such as non steroidal anti-inflammatory drugs, corticosteroids and disease modifying anti-rheumatic drugs. Trends in case fatality rate in RA after the introduction of potent anti-inflammatory biologic therapies and treat-to-target treatment strategies aiming at remission are not known. This study was performed to examine the cardiovascular fatality rate in current low disease activity RA, and to evaluate trends in RA associated CV case fatality over time. Methods Prospective study to determine the incidence of fatal and nonfatal CV events in 480 RA patients included in the ACT-CVD cohort between February 2009 and December 2011. Patients with prior CV disease were excluded. Cox regression analysis was performed to determine CV event risk and contributing risk factors over time. The results of the cohort analysis were put into the context of a review of the literature to evaluate trends in RA associated CV fatality rate over time. Results The study included 480 RA patients, 72.3% female with median disease duration of 4.2 years, 72.1% being in clinical remission (Disease Activity Score in 28 joints). During a mean follow up of 2.9 years 29 patients (6%) experienced a first CV event, 2 fatal and 27 non-fatal, corresponding to a 6.9% case fatality rate. Comparison with previous studies in cohorts with successive enrolment periods shows a trend towards a decrease in CV case fatality in RA from 52.9% in 1998 to 6.9% in our study. Conclusion CV case fatality in current low disease activity RA is importantly lower than in previous studies, and a trend towards decreasing CV fatality in RA is suggested.
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Affiliation(s)
- Inger L Meek
- Arthritis Center Twente, University Twente and Medisch Spectrum Twente, 7500KA Enschede, Netherlands.
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van der Vaart R, Drossaert CHC, Taal E, Drossaers-Bakker KW, Vonkeman HE, van de Laar MAFJ. Impact of patient-accessible electronic medical records in rheumatology: use, satisfaction and effects on empowerment among patients. BMC Musculoskelet Disord 2014; 15:102. [PMID: 24673997 PMCID: PMC3986693 DOI: 10.1186/1471-2474-15-102] [Citation(s) in RCA: 64] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2013] [Accepted: 03/12/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To measure the use, satisfaction and impact of a web portal which provides patients with rheumatoid arthritis home access to their electronic medical records (EMR). METHODS A pretest-posttest study was conducted among 360 patients. Questionnaires assessed socio-demographics, health literacy, Internet use, disease characteristics, patient-provider relationship and empowerment before and after launching a hospital-based patient web portal. To measure the impact of the portal, patients' satisfaction with care, trust in their rheumatologist, self-efficacy in patient-provider communication, illness perceptions, and medication adherence were assessed. The post-test included questions on portal use, satisfaction, and self-perceived impact due to portal use. RESULTS 54% of respondents with Internet access had viewed their EMR. Respondents were positive about the ease of use and usefulness of the portal and reported very few problems. Age (P = .03), amount of Internet use (P = .01) and self-perceived Internet skills (P = .03) significantly predicted portal use. Of the respondents who had logged in, 44% reported feeling more involved in their treatment and 37% felt they had more knowledge about their treatment. Significant differences over time were not found on the empowerment-related instruments. CONCLUSIONS The current portal succeeded in offering patients access to their EMR in a usable and understandable way. While its true impact is difficult to grasp, a relevant portion of the patients felt more involved in their treatment due to the web portal. Offering patients home EMR access, therefore, appears to be a valuable addition to the care process.
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Affiliation(s)
- Rosalie van der Vaart
- Department of Psychology, Health & Technology, University of Twente, Citadel H423, P,O, Box 217 7500 AE, Enschede, The Netherlands.
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van der Vaart R, Drossaert CHC, Taal E, van de Laar MAFJ. Reply. Arthritis Care Res (Hoboken) 2014; 66:334-5. [DOI: 10.1002/acr.22155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
| | | | - Erik Taal
- University of Twente; Enschede The Netherlands
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Vermeer M, Kievit W, Kuper HH, Braakman-Jansen LMA, Bernelot Moens HJ, Zijlstra TR, den Broeder AA, van Riel PLCM, Fransen J, van de Laar MAFJ. Treating to the target of remission in early rheumatoid arthritis is cost-effective: results of the DREAM registry. BMC Musculoskelet Disord 2013; 14:350. [PMID: 24330489 PMCID: PMC3884120 DOI: 10.1186/1471-2474-14-350] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2013] [Accepted: 12/03/2013] [Indexed: 11/17/2022] Open
Abstract
Background Where health economic studies are frequently performed using modelling, with input from randomized controlled trials and best guesses, we used real-life data to analyse the cost-effectiveness and cost-utility of a treatment strategy aiming to the target of remission compared to usual care in early rheumatoid arthritis (RA). Methods We used real-life data from comparable cohorts in the Dutch Rheumatoid Arthritis Monitoring (DREAM) registry: the DREAM remission induction cohort (treat-to-target, T2T) and the Nijmegen early RA inception cohort (usual care, UC). Both cohorts were followed prospectively using the DREAM registry methodology. All patients fulfilled the American College of Rheumatology criteria for RA and were included in the cohort at the time of diagnosis. The T2T cohort was treated according to a protocolised strategy aiming at remission (Disease Activity Score in 28 joints (DAS28) < 2.6). The UC cohort was treated without DAS28-guided treatment decisions. EuroQol-5D utility scores were estimated from the Health Assessment Questionnaire. A health care perspective was adopted and direct medical costs were collected. The incremental cost effectiveness ratio (ICER) per patient in remission and incremental cost utility ratio (ICUR) per quality-adjusted life year (QALY) gained were calculated over two and three years of follow-up. Results Two year data were available for 261 T2T patients and 213 UC patients; an extended follow-up of three years was available for 127 and 180 patients, respectively. T2T produced higher remission percentages and a larger gain in QALYs than UC. The ICER was € 3,591 per patient in remission after two years and T2T was dominant after three years. The ICUR was € 19,410 per QALY after two years and T2T was dominant after three years. Conclusions We can conclude that treating to the target of remission in early RA is cost-effective compared with UC. The data suggest that in the third year, T2T becomes cost-saving.
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Affiliation(s)
| | | | - Hillechiena H Kuper
- Department of Rheumatology and Clinical Immunology, Medisch Spectrum Twente, Enschede, The Netherlands.
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