1
|
Bakker MM, Putrik P, Rademakers J, van de Laar M, Vonkeman H, Kok MR, Voorneveld-Nieuwenhuis H, Ramiro S, de Wit M, Buchbinder R, Batterham R, Osborne RH, Boonen A. Addressing Health Literacy Needs in Rheumatology: Which Patient Health Literacy Profiles Need the Attention of Health Professionals? Arthritis Care Res (Hoboken) 2021; 73:100-109. [PMID: 33026713 PMCID: PMC7839720 DOI: 10.1002/acr.24480] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [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: 04/29/2020] [Accepted: 10/01/2020] [Indexed: 12/16/2022]
Abstract
Objective To identify and describe health literacy profiles of patients with rheumatic diseases and explore whether the identified health literacy profiles can be generalized to a broader rheumatology context. Methods Patients with rheumatoid arthritis, spondyloarthritis, and gout from 3 hospitals in different regions in The Netherlands completed the Health Literacy Questionnaire (HLQ). Hierarchical cluster analysis was used to identify patients’ health literacy profiles based on 9 HLQ domains. A multinomial regression model with the identified health literacy profiles as the dependent variable was fitted to assess whether patients with a given disease type or attending a given hospital were more likely to belong to a specific profile. Results Among 895 participating patients, the lowest mean HLQ domain scores (indicating most difficulty) were found for “critical appraisal,” “navigating the health system,” and “finding good health information.” The 10 identified profiles revealed substantial diversity in combinations of strengths and weaknesses. While 42% of patients scored moderate to high on all 9 domains (profiles 1 and 3), another 42% of patients (profiles 2, 4, 5, and 6) clearly struggled with 1 or several aspects of health literacy. Notably, 16% (profiles 7–10) exhibited difficulty across a majority of health literacy domains. The probability of belonging to one of the profiles was independent of the hospital where the patient was treated or the type of rheumatic disease. Conclusion Ten distinct health literacy profiles were identified among patients with rheumatic diseases, independent of disease type and treating hospital. These profiles can be used to facilitate the development of health literacy interventions in rheumatology.
Collapse
Affiliation(s)
- Mark M Bakker
- Maastricht UMC+ and Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
| | - Polina Putrik
- Maastricht UMC+ and Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
| | - Jany Rademakers
- Nivel Netherlands Institute for Health Services Research, Utrecht, and Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
| | - Mart van de Laar
- Medisch Spectrum Twente, Arthritis Center Twente and University of Twente, Enschede, The Netherlands
| | - Harald Vonkeman
- Medisch Spectrum Twente, Arthritis Center Twente and University of Twente, Enschede, The Netherlands
| | - Marc R Kok
- Maasstad Hospital, Rotterdam, The Netherlands
| | | | - Sofia Ramiro
- Leiden University Medical Center, Leiden, and Zuyderland Medical Center, Heerlen, The Netherlands
| | - Maarten de Wit
- Tools2use patient association, Amsterdam, The Netherlands
| | | | - Roy Batterham
- Swinburne University of Technology, Centre for Global Health and Equity, Melbourne, Victoria, Australia, and Thammasat University, Bangkok, Thailand
| | - Richard H Osborne
- Swinburne University of Technology, Centre for Global Health and Equity, Melbourne, Victoria, Australia
| | - Annelies Boonen
- Maastricht UMC+ and Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
| |
Collapse
|
2
|
Burmester GR, Álvaro-Gracia JM, Betteridge N, Calvo Alén J, Combe B, Durez P, Fautrel B, Ferreira RJO, Gabay C, Iagnocco A, Montecucco C, Østergaard M, Ramiro S, Rubbert-Roth A, Stamm T, Szekanecz Z, Taylor PC, van de Laar M. Evolving the comprehensive management of rheumatoid arthritis: identification of unmet needs and development of practical and educational tools. Clin Exp Rheumatol 2020; 38:1056-1067. [PMID: 33253107] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Accepted: 10/28/2020] [Indexed: 06/12/2023]
Abstract
OBJECTIVES Despite availability of efficacious treatments, unmet needs still exist, preventing optimal and comprehensive management of rheumatoid arthritis (RA). Evolving the management of RA (eRA) is a European-wide educational initiative aiming to support improved patient care through practical and educational tools addressing specific unmet needs. METHODS A multidisciplinary Steering Committee (17 members, 12 countries) identified unmet needs within the management of RA and prioritised those with the greatest impact on patient outcomes. Practical educational tools addressing priority needs were then developed for dissemination and implementation by the rheumatology community across Europe. RESULTS Five areas of priority need were identified: increasing early recognition of RA and treatment initiation; treating RA to target; optimal, holistic approach to selection of treatment strategy, including shared decision-making; improving identification and management of comorbidities; and non-pharmacological patient management. A suite of 14 eRA tools included educational slides, best-practice guidance, self‑assessment questionnaires, clinical checklists, a multidisciplinary team training exercise, an interactive patient infographic, and case scenarios. By April 2020, rheumatology professionals in 17 countries had been actively engaged in the eRA programme; in 11 countries, eRA tools were selected by national leaders in rheumatology and translated for local dissemination. A web platform, with country-specific pages, was developed to support access to the translated tools (https://www.evolvingthemanagementofra.com/). CONCLUSIONS The eRA programme supports comprehensive management of RA across Europe through development and dissemination of practical educational tools. The eRA tools address priority needs and are available free of charge to the rheumatology community.
Collapse
Affiliation(s)
- Gerd-Rüdiger Burmester
- Department of Rheumatology and Clinical Immunology, Charité - University Medicine Berlin, Free University and Humboldt University Berlin, Germany.
| | - José María Álvaro-Gracia
- Rheumatology Department, Hospital General Universitario Gregorio Marañón, Universidad Complutense de Madrid, Spain
| | | | - Jaime Calvo Alén
- Jefe de Servicio de Reumatología del Hospital Universitario Araba, Vitoria-Gasteiz, Álava, Spain
| | - Bernard Combe
- Departement de Rhumatologie, CHU Montpellier, Université Montpellier, France
| | - Patrick Durez
- Rheumatology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Institut de Recherche Expérimentale et Clinique (IREC), Brussels, Belgium
| | - Bruno Fautrel
- Rheumatology, Pitié-Salpêtrière University Hospital, Sorbonne Université/Assistance Publique, Hôpitaux de Paris, France
| | | | - Cem Gabay
- Department of Medicine and Department of Pathology and Immunology, Faculty of Medicine, University of Geneva, Switzerland
| | | | | | - Mikkel Østergaard
- Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, Glostrup, and Department of Clinical Medicine, University of Copenhagen, Denmark
| | - Sofia Ramiro
- Leiden University Medical Center, Leiden, and Zuyderland Medical Center, Heerlen, The Netherlands
| | | | - Tanja Stamm
- Section for Outcomes Research, Center for Medical Statistics, Informatics and Intelligent Systems, Medical University of Vienna, Austria
| | - Zoltán Szekanecz
- Division of Rheumatology, Faculty of Medicine, University of Debrecen, Hungary
| | - Peter C Taylor
- Botnar Research Centre, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, UK
| | - Mart van de Laar
- University of Twente, Faculty of Behavioural, Management and Social Sciences, Enschede, The Netherlands
| |
Collapse
|
3
|
Meisters R, Putrik P, Ramiro S, Hifinger M, Keszei AP, van Eijk-Hustings Y, Woolf AD, Smolen JS, Stamm TA, Stoffer-Marx M, Uhlig T, Moe RH, de Wit M, Tafaj A, Mukuchyan V, Studenic P, Verschueren P, Shumnalieva R, Charalambous P, Vencovský J, Varvouni M, Kull M, Puolakka K, Gossec L, Gobejishvili N, Detert J, Sidiropoulos P, Péntek M, Kane D, Scirè CA, Arad U, Andersone D, van de Laar M, van der Helm-van Mil A, Głuszko P, Cunha-Miranda L, Berghea F, Damjanov NS, Tomšič M, Carmona L, Turesson C, Ciurea A, Shukurova S, Inanc N, Verstappen SMM, Boonen A. EULAR/eumusc.net standards of care for rheumatoid arthritis: cross-sectional analyses of importance, level of implementation and care gaps experienced by patients and rheumatologists across 35 European countries. Ann Rheum Dis 2020; 79:1423-1431. [DOI: 10.1136/annrheumdis-2020-217520] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 06/10/2020] [Accepted: 07/28/2020] [Indexed: 11/03/2022]
Abstract
ObjectiveAs part of European League against Rheumatism (EULAR)/European Musculoskeletal Conditions Surveillance and Information Network, 20 user-focused standards of care (SoCs) for rheumatoid arthritis (RA) addressing 16 domains of care were developed. This study aimed to explore gaps in implementation of these SoCs across Europe.MethodsTwo cross-sectional surveys on the importance, level of and barriers (patients only) to implementation of each SoC (0–10, 10 highest) were designed to be conducted among patients and rheumatologists in 50 European countries. Care gaps were calculated as the difference between the actual and maximum possible score for implementation (ie, 10) multiplied by the care importance score, resulting in care gaps (0–100, maximal gap). Factors associated with the problematic care gaps (ie, gap≥30 and importance≥6 and implementation<6) and strong barriers (≥6) were further analysed in multilevel logistic regression models.ResultsOverall, 26 and 31 countries provided data from 1873 patients and 1131 rheumatologists, respectively. 19 out of 20 SoCs were problematic from the perspectives of more than 20% of patients, while this was true for only 10 SoCs for rheumatologists. Rheumatologists in countries with lower gross domestic product and non-European Union countries were more likely to report problematic gaps in 15 of 20 SoCs, while virtually no differences were observed among patients. Lack of relevance of some SoCs (71%) and limited time of professionals (66%) were the most frequent implementation barriers identified by patients.ConclusionsMany problematic gaps were reported across several essential aspects of RA care. More efforts need to be devoted to implementation of EULAR SoCs.
Collapse
|
4
|
Michaud K, Pope J, van de Laar M, Curtis JR, Kannowski C, Mitchell S, Bell J, Workman J, Paik J, Cardoso A, Taylor PC. Systematic Literature Review of Residual Symptoms and an Unmet Need in Patients With Rheumatoid Arthritis. Arthritis Care Res (Hoboken) 2020; 73:1606-1616. [PMID: 32619340 PMCID: PMC8596735 DOI: 10.1002/acr.24369] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [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: 10/30/2019] [Accepted: 06/25/2020] [Indexed: 12/11/2022]
Abstract
Objective To evaluate the nature and burden of residual disease in rheumatoid arthritis (RA) in patients who meet treatment targets. Second, for those who did not meet targets, to evaluate how much is due to patient symptoms. Methods Prospective and retrospective studies were searched in Medline, Embase, and Cochrane Library in the English language from January 1, 2008 to April 18, 2018; conference abstracts (from January 2016 to April 2018) and reference lists of relevant studies were also screened. Results Of 8,339 records identified, 55 were included in the review; 53 were unique studies, including 10 randomized controlled trials. Of these, 48 reported on patients who achieved low disease activity (LDA) or remission. Studies varied in population, treatment goals, and outcome reporting. The proportions of patients with residual symptoms in these studies varied by the definitions used for LDA or remission and were more often reported in patients with LDA than those in remission. The most commonly reported outcome measures were functional disability (n = 34 studies), tender or swollen joints (n = 18), pain (n = 17), patient global assessment (n = 15), and fatigue (n = 14). However, few studies reported the percentage of patients achieving a specific threshold, which could then be used to easily define the presence of residual symptoms. Conclusion Residual symptoms are present in some patients despite their achieving LDA or remission, highlighting an unmet need, especially with respect to improving pain, fatigue, and function. Standardized reporting in future observational studies would facilitate better understanding of this issue in defined RA populations.
Collapse
Affiliation(s)
- Kaleb Michaud
- University of Nebraska Medical Center, Omaha, and FORWARD, The National Databank for Rheumatic Diseases, Wichita, Kansas
| | - Janet Pope
- University of Western Ontario, London, Ontario, Canada
| | | | | | | | | | | | | | - Jim Paik
- Eli Lilly and Company, Indianapolis, Indiana
| | | | - Peter C Taylor
- Botnar Research Centre, University of Oxford, Oxford, UK
| |
Collapse
|
5
|
Alten R, van de Laar M, De Leonardis F, Tietz N, Guerreiro M, van Vollenhoven R. Physical and Emotional Burden of Rheumatoid Arthritis: Data from RA Matters, a Web-Based Survey of Patients and Healthcare Professionals. Rheumatol Ther 2019; 6:587-597. [PMID: 31659680 PMCID: PMC6858420 DOI: 10.1007/s40744-019-00179-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Indexed: 12/20/2022] Open
Abstract
INTRODUCTION This survey assessed the impact of rheumatoid arthritis (RA) on the lives of patients based on the perceptions of both patients and healthcare professionals (HCPs). METHODS This is a cross-sectional survey of patients with RA. Data were collected from patients and HCPs who manage RA using a structured, closed-ended questionnaire in their local language. Respondents for the survey were recruited from survey panels of verified unique responses. The survey focused on the impact of disease on four domains: daily activities, relationships, work and aspirations. RESULTS Overall, 1231 adult patients with RA and 270 rheumatologists or other HCPs were surveyed between November 2016 and February 2017. Almost one in three patients believed that the impact of RA is not well understood by people without the disease. Fifty-eight percent [95% confidence interval (CI) 55-61%] of patients felt frustrated when they were unable to undertake or complete daily activities because of their disease. Fifty-seven percent (95% CI 54-60%) of patients wished to be able to accept their life with RA. Forty-three percent (95% CI 40-46%) of patients hoped that the physical impact of RA will be better understood in future. Forty percent (95% CI 37-43%) of patients were forced to take long-term leave/retirement or experienced slow career progression since being diagnosed with RA. Twenty-three percent (95% CI 21-25%) of patients had difficulties in taking care of personal grooming, whereas 8% (95% CI 6-10%) of patients reported that RA ruined their life. Similar responses were observed among HCPs. CONCLUSION Patients and HCPs feel that the physical and emotional impact of RA is not well understood by people without the disease. In RA treatment decisions, patients' personal goals and patient-reported outcomes should be taken into consideration along with clinical targets. FUNDING Eli Lilly and Company (Indianapolis, IN, USA).
Collapse
Affiliation(s)
- Rieke Alten
- Schlosspark-Klinik University Medicine, Berlin, Germany.
| | - Mart van de Laar
- Arthritis Centre Twente, Medisch Spectrum Twente, Enschede, The Netherlands
| | | | | | | | | |
Collapse
|
6
|
Ten Klooster PM, Versteeg LGA, Oude Voshaar MAH, de la Torre I, De Leonardis F, Fakhouri W, Zaremba-Pechmann L, van de Laar M. Radiographic progression can still occur in individual patients with low or moderate disease activity in the current treat-to-target paradigm: real-world data from the Dutch Rheumatoid Arthritis Monitoring (DREAM) registry. Arthritis Res Ther 2019; 21:237. [PMID: 31718678 PMCID: PMC6852758 DOI: 10.1186/s13075-019-2030-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [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: 06/07/2019] [Accepted: 10/09/2019] [Indexed: 11/26/2022] Open
Abstract
Background The aim of this retrospective study was to examine the longitudinal association between disease activity and radiographic damage in a cohort of patients with early RA (symptom onset < 1 year) treated according to treat-to-target (T2T) therapy. Methods Baseline to 3-year follow-up data were used from patients included in the DREAM remission induction cohort. Patients received protocolized T2T treatment, aimed at 28-joint disease activity score-erythrocyte sedimentation rate (DAS28-ESR) remission. Disease activity (DAS28-ESR and C-reactive protein, CRP) were assessed at least every 3 months; X-rays of the hand and feet at inclusion, 6 months, and 1, 2, and 3 years were scored using modified Sharp/van der Heijde scoring (SHS). Between and within-person associations between time-integrated disease activity and radiographic progression over time were examined. Results A subset of 229 out of 534 included patients were available for analysis. At the between-patient level, time-integrated DAS28-ESR scores were not significantly correlated with progression at the 6 month and 2-year follow-up and only weakly at the 1-year (Pearson’s correlation coefficient r = 0.17, P < 0.05) and 3-year follow-up (r = 0.21, P < 0.05). Individual slopes of the relationship between DAS28-ESR and progression scores in each time interval were significantly correlated over time and the slope of the first 6 months was moderately associated with this slope at later time points (r between 0.39 and 0.59; P values < 0.001). Between 15.9 to 22.7% and 16.7 to 38.5% of patients with low and moderate time-integrated disease activity, respectively, experienced relevant (ΔSHS ≥ 3) radiographic progression at the different time intervals. Analyses using CRP showed similar results. Conclusions In early RA patients treated according to T2T, radiographic progression appears to be an individually determined disease process, driven by factors other than consistent high disease activity. For individual patients, the intra-patient relation between disease activity and cumulative radiographic damage during the first 6 months is a good indicator for this relation in later years. Trial registration Netherlands Trial Register NTR578, 12 January 2006.
Collapse
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 & Technology, University of Twente, PO BOX 217, 7500 AE, Enschede, the Netherlands.
| | - Letty G A Versteeg
- Arthritis Centre Twente, University of Twente, Enschede, the Netherlands.,Arthritis Centre Twente, Medisch Spectrum Twente, Enschede, the Netherlands
| | - Martijn A H Oude Voshaar
- Transparency in Healthcare, Hengelo, the Netherlands.,Arthritis Centre Twente, University of Twente, Enschede, the Netherlands
| | | | | | | | | | - Mart 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
| |
Collapse
|
7
|
Webers C, Beckers E, Boonen A, van Eijk-Hustings Y, Vonkeman H, van de Laar M, van Tubergen A. Development, usability and acceptability of an integrated eHealth system for spondyloarthritis in the Netherlands (SpA-Net). RMD Open 2019; 5:e000860. [PMID: 31168405 PMCID: PMC6525608 DOI: 10.1136/rmdopen-2018-000860] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Revised: 03/18/2019] [Accepted: 03/21/2019] [Indexed: 12/14/2022] Open
Abstract
Objective To develop and test the usability and acceptability of a disease-specific integrated electronic health (eHealth) system for spondyloarthritis (SpA) in the Netherlands (‘SpA-Net’). Methods SpA-Net was developed in four phases. First, content and design were discussed with experts on SpA and patients. Second, the database, electronic medical record (EMR) and quality management system were developed. Third, multiple rounds of testing were performed. Fourth, the eHealth system was implemented in practice and feasibility was tested among patients through semistructured focus interviews (n=16 patients) and among care providers through feedback meetings (n=11 rheumatologists/fellows and 5 nurses). Results After completion of the first three steps of development in 2015, SpA-Net was implemented in 2016. All patients included have a clinical diagnosis of SpA. Information on domains relevant to clinical record-keeping is prospectively collected at routine outpatient consultations and readily available to care providers, presented in a clear dashboard. Patients complete online questionnaires prior to outpatient visits. In February 2019, 1069 patients were enrolled (mean [SD] age 54.9 [14.1] years, 52.4% men). Patients interviewed (n=16) considered SpA-Net an accessible system that was beneficial to disease insight and patient–physician communication, and had additional value to current care. Care providers appreciated the additional information for (preparing) consultations. Barriers were the initial time required to adopt the EMR and the quantity of data entry. Conclusion SpA-Net enables monitoring of patients with SpA and real-life data collection, and could help improve knowledge and optimise communication between patients and care providers. Both considered SpA-Net a valuable addition to current care. Trial registration number NTR6740.
Collapse
Affiliation(s)
- Casper Webers
- Department of Medicine, Division of Rheumatology, Maastricht University Medical Center, Maastricht, The Netherlands.,Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
| | - Esther Beckers
- Department of Medicine, Division of Rheumatology, Maastricht University Medical Center, Maastricht, The Netherlands.,Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
| | - Annelies Boonen
- Department of Medicine, Division of Rheumatology, Maastricht University Medical Center, Maastricht, The Netherlands.,Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
| | - Yvonne van Eijk-Hustings
- Department of Medicine, Division of Rheumatology, Maastricht University Medical Center, Maastricht, The Netherlands.,Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
| | - Harald Vonkeman
- Department of Rheumatology, Arthritis Center Twente, Medisch Spectrum Twente Hospital and University of Twente, Enschede, The Netherlands
| | - Mart van de Laar
- Department of Rheumatology, Arthritis Center Twente, Medisch Spectrum Twente Hospital and University of Twente, Enschede, The Netherlands
| | - Astrid van Tubergen
- Department of Medicine, Division of Rheumatology, Maastricht University Medical Center, Maastricht, The Netherlands.,Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
| |
Collapse
|
8
|
Webers C, Vanhoof L, van Genderen S, Heuft L, van de Laar M, Luime J, van der Heijde D, van Gaalen FA, Spoorenberg A, Boonen A. Employment and the role of personal factors among patients with ankylosing spondylitis: a Dutch cross-sectional case-control study. RMD Open 2018; 4:e000680. [PMID: 30018801 PMCID: PMC6045712 DOI: 10.1136/rmdopen-2018-000680] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [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: 03/13/2018] [Revised: 05/28/2018] [Accepted: 05/29/2018] [Indexed: 12/22/2022] Open
Abstract
Objectives To update the knowledge on employment and the role of mastery, a personal factor reflecting the level of control over life and disease, among Dutch patients with ankylosing spondylitis (AS) compared to general population subjects. Methods Data of persons ≤65 years participating in a Dutch cross-sectional multicentre study on social participation in AS were used. Being employed was the main outcome. Standardised employment ratios (SERs) were calculated using indirect standardisation after adjusting for age, gender and education and repeated after stratification by symptom duration tertiles. Modified Poisson regressions were performed to understand the role of mastery (Pearlin’s scale) independent of sociodemographic and health-related factors. Results 214 patients and 470 controls (127 (59.3%) and 323 (68.7%) males; mean age 48.3 (SD 10.4) and 39.3 (SD 12.7) years, respectively) completed an online questionnaire. SER (95%CI) in patients was 0.83 (0.69–0.98); 0.84 (0.67–1.04) in males; 0.83 (0.59–1.07) in females. Adjusted absolute employment of patients compared to controls was 69% versus 84%; 73% versus 86% for males; 62% versus 78% for females. In multivariable analyses stratified for patients and controls, mastery was associated with being employed in patients, but only in those with low education. In controls, not mastery but higher education was associated with being employed. Conclusion Our study reveals that patients suffering from AS compared to population controls are less likely to be employed. Mastery is an important personal factor associated with employment in patients but not in controls. Interventions aimed at improving employment of patients with AS should likely account for mastery.
Collapse
Affiliation(s)
- Casper Webers
- Department of Rheumatology, Maastricht University Medical Center, Maastricht, The Netherlands.,Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
| | - Laura Vanhoof
- Department of Rheumatology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Simon van Genderen
- Department of Rheumatology, Maastricht University Medical Center, Maastricht, The Netherlands.,Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
| | - Liesbeth Heuft
- Department of Rheumatology, Sint Laurentius Hospital, Roermond, The Netherlands
| | - Mart van de Laar
- Department of Rheumatology and Clinical Immunology, Arthritis Center Twente and University of Twente, Enschede, The Netherlands
| | - Jolanda Luime
- Department of Rheumatology, Erasmus Medical Center, Rotterdam, The Netherlands
| | | | - Floris A van Gaalen
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
| | - Anneke Spoorenberg
- Department of Rheumatology and Clinical Immunology, University Medical Center Groningen, Groningen, The Netherlands
| | - Annelies Boonen
- Department of Rheumatology, Maastricht University Medical Center, Maastricht, The Netherlands.,Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
| |
Collapse
|
9
|
Hifinger M, Ramiro S, Putrik P, van Eijk-Hustings Y, Woolf A, Smolen JS, Stoffer-Marx M, Uhlig T, Moe RH, Saritas M, Janson M, van der Helm-van Mil A, van de Laar M, Vonkeman H, de Wit M, Boonen A. The eumusc.net standards of care for rheumatoid arthritis: importance and current implementation according to patients and healthcare providers in the Netherlands. Clin Exp Rheumatol 2018; 36:275-283. [PMID: 29303700] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2017] [Accepted: 07/11/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVES The eumusc.net standards of care (SOCs) for rheumatoid arthritis (RA) aimed to improve quality of care across Europe. This study investigated importance and implementation of each standard according to patients and health care professionals (HCPs) in the Netherlands and identified barriers towards implementation. METHODS Dutch patients, rheumatologists and rheumatology nurses rated importance and implementation (0-10 numeric rating scale (NRS); 10=most important/best implemented) for each of the 20 SOCs. A care gap, adjusted for importance, was calculated: (100=highest gap). Statistical differences between a) patients and HCPs and b) subgroups of patients (demographics, health) were tested. Additionally, patients indicated agreement (0-10) with 6 implementation barriers. RESULTS 386 patients and 91 HCPs were included. Both ranked adequate disease modifying anti-rheumatic drug treatment (9.3(SD1.2), 9.2(SD0.8)), access to care in emergencies (9.2(SD1.2), 9.2(SD1.0)) and regular re-appraisal when treatment fails (9.2(SD1.3), 9.0(SD1.0)) the most important SOCs, and these were among the best implemented (NRS≥8.5) SOCs. After accounting for applicability, patients and HCP identified care gaps for early diagnosis (25.5(SD32.0), 22.3(SD16.3)), availability of a treatment plan (25.1(SD22.7), 25.7(SD18.5)) and patients also for a regular schedule of assessment of disease (28.6(SD25.5)).Patients with poorer health or higher education scored systematically lower on care received while sharing similar priorities. Patients and HCPs considered limited reimbursement of specific health services a main barrier for implementation and patients additionally identified limited time of physicians. CONCLUSIONS Dutch patients and HCPs overall agreed on priorities in care and found relevant SOCs well implemented. However, suggestions for improvement were raised especially by patients with poorer health and/or higher education.
Collapse
Affiliation(s)
- Monika Hifinger
- Department of Internal Medicine, Division of Rheumatology, Maastricht University Medical Centre; and CAPHRI Research Institute, Maastricht University, The Netherlands.
| | - Sofia Ramiro
- Department of Rheumatology, Leiden University Medical Centre, The Netherlands
| | - Polina Putrik
- Department of Internal Medicine, Division of Rheumatology, Maastricht University Medical Centre; and CAPHRI Research Institute, Maastricht University, The Netherlands
| | - Yvonne van Eijk-Hustings
- Department of Internal Medicine, Division of Rheumatology, Maastricht University Medical Centre, The Netherlands
| | - Anthony Woolf
- Bone and Joint Research Group, Royal Cornwall Hospital, Cornwall, UK
| | - Josef S Smolen
- Division of Rheumatology, Department of Medicine, Medical University of Vienna, Austria
| | - Michaela Stoffer-Marx
- Division of Rheumatology, Department of Medicine, Medical University of Vienna, Austria
| | - Tillman Uhlig
- National Advisory Unit for Rehabilitation in Rheumatology, Diakonhjemmet Hospital Oslo, Norway
| | - Rikke Helene Moe
- National Advisory Unit for Rehabilitation in Rheumatology, Diakonhjemmet Hospital Oslo, Norway
| | - Merdan Saritas
- Department of Rheumatology, Laurentius Hospital, Roermond, The Netherlands
| | - Marian Janson
- Department of Rheumatology, Leiden University Medical Centre, The Netherlands
| | | | - Mart van de Laar
- Department of Rheumatology, University of Twente, Enschede, The Netherlands
| | - Harald Vonkeman
- Department of Rheumatology, University of Twente, Enschede, The Netherlands
| | - Maarten de Wit
- Department of Rheumatology, VU Medical Centre Amsterdam, The Netherlands
| | - Annelies Boonen
- Department of Internal Medicine, Division of Rheumatology, Maastricht University Medical Centre; and CAPHRI Research Institute, Maastricht University, The Netherlands
| |
Collapse
|
10
|
Crowson CS, Rollefstad S, Ikdahl E, Kitas GD, van Riel PLCM, Gabriel SE, Matteson EL, Kvien TK, Douglas K, Sandoo A, Arts E, Wållberg-Jonsson S, Innala L, Karpouzas G, Dessein PH, Tsang L, El-Gabalawy H, Hitchon C, Ramos VP, Yáñez IC, Sfikakis PP, Zampeli E, Gonzalez-Gay MA, Corrales A, Laar MVD, Vonkeman HE, Meek I, Semb AG. Impact of risk factors associated with cardiovascular outcomes in patients with rheumatoid arthritis. Ann Rheum Dis 2017; 77:48-54. [PMID: 28877868 DOI: 10.1136/annrheumdis-2017-211735] [Citation(s) in RCA: 167] [Impact Index Per Article: 23.9] [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: 05/04/2017] [Revised: 06/30/2017] [Accepted: 08/04/2017] [Indexed: 01/06/2023]
Abstract
OBJECTIVES Patients with rheumatoid arthritis (RA) have an excess risk of cardiovascular disease (CVD). We aimed to assess the impact of CVD risk factors, including potential sex differences, and RA-specific variables on CVD outcome in a large, international cohort of patients with RA. METHODS In 13 rheumatology centres, data on CVD risk factors and RA characteristics were collected at baseline. CVD outcomes (myocardial infarction, angina, revascularisation, stroke, peripheral vascular disease and CVD death) were collected using standardised definitions. RESULTS 5638 patients with RA and no prior CVD were included (mean age: 55.3 (SD: 14.0) years, 76% women). During mean follow-up of 5.8 (SD: 4.4) years, 148 men and 241 women developed a CVD event (10-year cumulative incidence 20.9% and 11.1%, respectively). Men had a higher burden of CVD risk factors, including increased blood pressure, higher total cholesterol and smoking prevalence than women (all p<0.001). Among the traditional CVD risk factors, smoking and hypertension had the highest population attributable risk (PAR) overall and among both sexes, followed by total cholesterol. The PAR for Disease Activity Score and for seropositivity were comparable in magnitude to the PAR for lipids. A total of 70% of CVD events were attributable to all CVD risk factors and RA characteristics combined (separately 49% CVD risk factors and 30% RA characteristics). CONCLUSIONS In a large, international cohort of patients with RA, 30% of CVD events were attributable to RA characteristics. This finding indicates that RA characteristics play an important role in efforts to reduce CVD risk among patients with RA.
Collapse
Affiliation(s)
- Cynthia S Crowson
- Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota, USA.,Division of Rheumatology, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Silvia Rollefstad
- Preventive Cardio-Rheuma Clinic, Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
| | - Eirik Ikdahl
- Preventive Cardio-Rheuma Clinic, Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
| | - George D Kitas
- Department of Rheumatology, Dudley Group NHS Foundation Trust, West Midlands, UK
| | - Piet L C M van Riel
- Department of Rheumatic Diseases, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - Sherine E Gabriel
- Division of Rheumatology, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA.,Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
| | - Eric L Matteson
- Division of Rheumatology, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Tore K Kvien
- Preventive Cardio-Rheuma Clinic, Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
| | - Karen Douglas
- Department of Rheumatology, Dudley Group NHS Foundation Trust, West Midlands, UK
| | - Aamer Sandoo
- Department of Rheumatology, Dudley Group NHS Foundation Trust, West Midlands, UK.,School of Sport, Health and Exercise Sciences, Bangor University, Bangor, Wales, UK
| | - Elke Arts
- Department of Rheumatic Diseases, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - Solveig Wållberg-Jonsson
- Department of Public Health and Clinical Medicine/Rheumatology, University of Umeå, Umeå, Sweden
| | - Lena Innala
- Department of Public Health and Clinical Medicine/Rheumatology, University of Umeå, Umeå, Sweden
| | - George Karpouzas
- Division of Rheumatology, Harbor UCLA Medical Center RHU, Torrance, California, USA
| | - Patrick H Dessein
- Cardiovascular Pathophysiology and Genomics Research Unit, School of Physiology, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa.,Rheumatology Division, UniversitairZiekenhuis and Vrije Universiteit, Brussel, Belgium
| | - Linda Tsang
- Rheumatology Division, UniversitairZiekenhuis and Vrije Universiteit, Brussel, Belgium
| | - Hani El-Gabalawy
- Institute of Musculoskeletal Health and Arthritis, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Carol Hitchon
- Institute of Musculoskeletal Health and Arthritis, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Virginia Pascual Ramos
- Department of Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Irazú Contreras Yáñez
- Department of Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Petros P Sfikakis
- First Department of Propedeutic Medicine, University of Athens, Athens, Greece
| | - Evangelia Zampeli
- First Department of Propedeutic Medicine, University of Athens, Athens, Greece
| | - Miguel A Gonzalez-Gay
- Division of Rheumatology, Hospital Universitario Marques de Valdecilla, Santander (Cantabria), Spain
| | - Alfonso Corrales
- Division of Rheumatology, Hospital Universitario Marques de Valdecilla, Santander (Cantabria), Spain
| | - Mart van de Laar
- Department of Rheumatology and Clinical Immunology, Hospital Medisch Spectrum Twente, Enschede, The Netherlands
| | - Harald E Vonkeman
- Department of Rheumatology and Clinical Immunology, Hospital Medisch Spectrum Twente, Enschede, The Netherlands
| | - Inger Meek
- Department of Rheumatology and Clinical Immunology, Hospital Medisch Spectrum Twente, Enschede, The Netherlands
| | - Anne Grete Semb
- Preventive Cardio-Rheuma Clinic, Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
| | | |
Collapse
|
11
|
de Lautour H, Taylor WJ, Adebajo A, Alten R, Burgos-Vargas R, Chapman P, Cimmino MA, da Rocha Castelar Pinheiro G, Day R, Harrold LR, Helliwell P, Janssen M, Kerr G, Kavanaugh A, Khanna D, Khanna PP, Lin C, Louthrenoo W, McCarthy G, Vazquez-Mellado J, Mikuls TR, Neogi T, Ogdie A, Perez-Ruiz F, Schlesinger N, Ralph Schumacher H, Scirè CA, Singh JA, Sivera F, Slot O, Stamp LK, Tausche AK, Terkeltaub R, Uhlig T, van de Laar M, White D, Yamanaka H, Zeng X, Dalbeth N. Development of Preliminary Remission Criteria for Gout Using Delphi and 1000Minds Consensus Exercises. Arthritis Care Res (Hoboken) 2017; 68:667-72. [PMID: 26414176 DOI: 10.1002/acr.22741] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2015] [Revised: 09/09/2015] [Accepted: 09/22/2015] [Indexed: 12/21/2022]
Abstract
OBJECTIVE To establish consensus for potential remission criteria to use in clinical trials of gout. METHODS Experts (n = 88) in gout from multiple countries were invited to participate in a web-based questionnaire study. Three rounds of Delphi consensus exercises were conducted using SurveyMonkey, followed by a discrete-choice experiment using 1000Minds software. The exercises focused on identifying domains, definitions for each domain, and the timeframe over which remission should be defined. RESULTS There were 49 respondents (56% response) to the initial survey, with subsequent response rates ranging from 57% to 90%. Consensus was reached for the inclusion of serum urate (98% agreement), flares (96%), tophi (92%), pain (83%), and patient global assessment of disease activity (93%) as measurement domains in remission criteria. Consensus was also reached for domain definitions, including serum urate (<0.36 mm), pain (<2 on a 10-point scale), and patient global assessment (<2 on a 10-point scale), all of which should be measured at least twice over a set time interval. Consensus was not achieved in the Delphi exercise for the timeframe for remission, with equal responses for 6 months (51%) and 1 year (49%). In the discrete-choice experiment, there was a preference towards 12 months as a timeframe for remission. CONCLUSION These consensus exercises have identified domains and provisional definitions for gout remission criteria. Based on the results of these exercises, preliminary remission criteria are proposed with domains of serum urate, acute flares, tophus, pain, and patient global assessment. These preliminary criteria now require testing in clinical data sets.
Collapse
Affiliation(s)
| | | | | | - Rieke Alten
- Schlosspark-Klinik, Charité, University Medicine Berlin, Berlin, Germany
| | | | | | | | | | - Ric Day
- University of New South Wales and St Vincent's Hospital, Sydney, Australia
| | - Leslie R Harrold
- University of Massachusetts Medical School, Worcester, and Corrona, LLC, Southborough
| | - Philip Helliwell
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, Leeds, UK
| | | | - Gail Kerr
- Veterans Affairs Medical Center, Georgetown and Howard University Hospitals, Washington, DC
| | | | | | - Puja P Khanna
- University of Michigan and Ann Arbor VA Medical Center, Ann Arbor
| | - Chingtsai Lin
- Taichung Veteran's General Hospital, Taichung, Taiwan
| | | | - Geraldine McCarthy
- Mater Misericordiae University Hospital and University College, Dublin, Ireland
| | | | - Ted R Mikuls
- Nebraska-Western Iowa Health Care System and University of Nebraska Medical Center, Omaha
| | - Tuhina Neogi
- Boston University School of Medicine, Boston, Massachusetts
| | | | - Fernando Perez-Ruiz
- Hospital Universitario Cruces, OSI-EEC, and Biocruces Health Research Institute, Biscay, Spain
| | - Naomi Schlesinger
- Rutgers University Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | | | - Carlo A Scirè
- IRCCS Policlinico San Matteo Foundation, University of Pavia, Pavia, Italy
| | - Jasvinder A Singh
- University of Alabama at Birmingham and the Birmingham VA Medical Center, Birmingham
| | | | - Ole Slot
- Copenhagen University Hospital Glostrup, Glostrup, Denmark
| | | | | | | | - Till Uhlig
- National Advisory Unit on Rehabilitation in Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
| | | | - Douglas White
- Waikato DHB and Waikato Clinical School, University of Auckland, Hamilton, New Zealand
| | | | - Xuejun Zeng
- Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, and Peking Union Medical College, Beijing, China
| | - Nicola Dalbeth
- University of Auckland and Auckland District Health Board, Auckland, New Zealand
| |
Collapse
|
12
|
Voshaar M, Vriezekolk J, van Dulmen S, van den Bemt B, van de Laar M. Barriers and facilitators to disease-modifying antirheumatic drug use in patients with inflammatory rheumatic diseases: a qualitative theory-based study. BMC Musculoskelet Disord 2016; 17:442. [PMID: 27769224 PMCID: PMC5075197 DOI: 10.1186/s12891-016-1289-z] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2016] [Accepted: 10/08/2016] [Indexed: 01/23/2023] Open
Abstract
Background Although disease-modifying anti-rheumatic drugs (DMARDs) are the cornerstone of treatment for inflammatory rheumatic diseases, medication adherence to DMARDs is often suboptimal. Effective interventions to improve adherence to DMARDs are lacking, and new targets are needed to improve adherence. The aim of the present study was to explore patients’ barriers and facilitators of optimal DMARD use. These factors might be used as targets for adherence interventions. Methods In a mixed method study design, patients (n = 120) with inflammatory arthritis (IA) completed a questionnaire based on an existing adapted Theoretical Domains Framework (TDF) to identify facilitators and barriers of DMARD use. A subgroup of these patients (n = 21) participated in focus groups to provide insights into their facilitators and barriers. The answers to the questionnaires and responses of the focus groups were thematically coded by three researchers independently and subsequently categorized. Results The barriers and facilitators that were reported by IA patients presented large inter-individual variations. The identified barriers and facilitators could be captured in the following domains based on an adapted TDF: (i) knowledge, (ii) emotions, (iii) attention, memory, and decision processes, (iv) social influences, (v) beliefs about capability, (vi) beliefs about consequences, (vii) motivation and goals, (viii) goal conflict, (ix) environmental context and resources, and (x) skills. Conclusions Patients with IA have a variety of barriers and facilitators with regard to their DMARD use. All of these barriers and facilitators could be categorized into adapted domains of the TDF. Interventions that address individual facilitators and barriers, based on capability, opportunity, and motivation, are needed to develop strategies for medication adherence that are tailored to individual patient needs. Electronic supplementary material The online version of this article (doi:10.1186/s12891-016-1289-z) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Marieke Voshaar
- Department Psychology, Health and Technology, University of Twente, Enschede, The Netherlands.
| | - Johanna Vriezekolk
- Department of Rheumatology, Sint Maartenskliniek, Nijmegen, The Netherlands
| | - Sandra van Dulmen
- NIVEL (Netherlands Institute for Health Services Research), Utrecht, The Netherlands.,Department of Primary and Community Care, Radboud University Medical Centre, Nijmegen, The Netherlands.,Faculty of Health Sciences, University College of Southeast Norway, Drammen, Norway
| | - Bart van den Bemt
- Department of Pharmacy, Sint Maartenskliniek, Nijmegen, The Netherlands.,Department of Pharmacy, Radboudumc, Nijmegen, The Netherlands.,Department of Clinical Pharmacy and Toxicology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Mart van de Laar
- Arthritis Center Twente, Medisch Spectrum Twente and University of Twente, Enschede, The Netherlands
| |
Collapse
|
13
|
Kviatkovsky MJ, Ramiro S, Landewé R, Dougados M, Tubach F, Bellamy N, Hochberg M, Ravaud P, Martin-Mola E, Awada H, Bombardier C, Felson D, Hajjaj-Hassouni N, Logeart I, Matucci-Cerinic M, van de Laar M, van der Heijde D. The Minimum Clinically Important Improvement and Patient-acceptable Symptom State in the BASDAI and BASFI for Patients with Ankylosing Spondylitis. J Rheumatol 2016; 43:1680-6. [DOI: 10.3899/jrheum.151244] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/17/2016] [Indexed: 01/22/2023]
Abstract
Objective.To establish cutoffs for the minimum clinically important improvement (MCII) and the patient-acceptable symptom state (PASS) for the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) and the Bath Ankylosing Spondylitis Functional Index (BASFI) in patients with ankylosing spondylitis (AS).Methods.Patients with AS who started nonsteroidal antiinflammatory drugs were included. After 4 weeks, the PASS and the MCII were defined using external anchor questions (for the PASS, patients considering their condition of AS over the prior 48 h as “acceptable” forever; and for the MCII, those reporting moderate or slightly important improvement). Consistency of the MCII and PASS were tested according to HLA-B27 status, presence/absence of SpA extraarticular manifestations, age, sex, disease duration, and baseline BASDAI/BASFI score. The 75th percentile of the cumulative distribution was used to determine the MCII and PASS.Results.In total, 283 patients from a multinational cohort were included. Overall cutoffs for the PASS were 4.1 in the BASDAI and 3.8 in the BASFI. Cutoffs for the MCII were 0.7 and 0.4 for the BASDAI and BASFI, respectively. Subgroup analyses revealed that disease duration and baseline BASDAI/BASFI were significantly associated with the PASS and MCII. In a subanalysis limited to patients with active disease (baseline BASDAI ≥ 4), the MCII was 1.1 for the BASDAI and 0.6 for the BASFI.Conclusion.The conceptual viability of the PASS for the BASDAI is questionable because levels approach those required for the start of biological therapy. Because the MCII is less variable than the PASS, we propose its exclusive use, with cutoffs of 1.1/0.6 for the BASDAI/BASFI in patients with active disease. Because these values are based on a subset of the study population, we recommend confirmation in larger studies focused on patients with baseline BASDAI ≥ 4.
Collapse
|
14
|
Oude Voshaar M, van Onna M, van Genderen S, van de Laar M, van der Heijde D, Heuft L, Spoorenberg A, Luime J, Gignac M, Boonen A. Development and Validation of a Short Form of the Social Role Participation Questionnaire in Patients with Ankylosing Spondylitis. J Rheumatol 2016; 43:1386-92. [PMID: 27182067 DOI: 10.3899/jrheum.151013] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/31/2016] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The Social Role Participation Questionnaire (SRPQ) assesses the influence of health on 11 specific roles and 1 general role along 4 dimensions. In this study, a shortened version of the SRPQ (s-SRPQ) was developed in patients with ankylosing spondylitis (AS) to facilitate data collection in clinical studies and practice. METHODS Using data from 246 patients with AS and population controls, the fit of each role to the different participation dimensions, the contribution of each role to the measurement precision, and the correlation between dimensions were evaluated using item response theory. Representation of the 3 participation chapters of the International Classification of Functioning, Disability, and Health was ensured. Reliability of each dimension of both versions of the SRPQ was compared by correlating scores to the Medical Outcomes Study Short Form-36 (SF-36) and the Satisfaction With Life Scale (SWLS), and by comparing ability to discriminate between patients and controls and between patients with low and high disease activity (Bath Ankylosing Spondylitis Disease Activity Index ≥ 4). RESULTS The s-SRPQ, which assesses participation across 6 social roles along 2 dimensions (physical difficulty and satisfaction with performance), was proposed. Both dimensions of the s-SRPQ were highly reliable (r ≥ 0.86) and were shown to have construct validity as indicated by a similar pattern of correlations with the SF-36 and SWLS as the original SRPQ dimensions. Both versions discriminated well between patients and controls and between patients with high versus low disease activity (relative validity ≥ 0.72). CONCLUSION The s-SRPQ retains the measurement properties of the original SRPQ and seems useful for measuring the effect of AS on participation.
Collapse
Affiliation(s)
- Martijn Oude Voshaar
- From the Arthritis Centre Twente; Department of Psychology, Health and Technology, University of Twente, Enschede; Department of Medicine, Division of Rheumatology, Maastricht University Medical Centre; School for Public Health and Primary Care (CAPHRI), Maastricht University, Maastricht; Rheumatology, Leiden University Medical Center; Department of Rheumatology, Sint Laurentius hospital Roermond, Roermond; Sint Jans Gasthuis Weert, Weert; Department of Rheumatology, University Medical Center Groningen, Groningen; Department of Rheumatology, Medical Center Leeuwarden, Leeuwarden; Department of Rheumatology, Erasmus Medical Center Rotterdam, Rotterdam, the Netherlands; Institute for Work and Health; Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.M. Oude Voshaar*, PhD, Arthritis Centre Twente, and Department of Psychology, Health and Technology, University of Twente; M. van Onna*, MD, Department of Medicine, Division of Rheumatology, Maastricht University Medical Centre, CAPHRI, Maastricht University; S. van Genderen, MSc, Department of Medicine, Division of Rheumatology, Maastricht University Medical Centre, and CAPHRI, Maastricht University; M. van de Laar, MD, PhD, Arthritis Centre Twente, and University of Twente; D. van der Heijde, MD, PhD, Professor of Rheumatology, Rheumatology, Leiden University Medical Center; L. Heuft, MD, PhD, Department of Rheumatology, Sint Laurentius Hospital Roermond, and Sint Jans Gasthuis Weert; A. Spoorenberg, MD, PhD, Department of Rheumatology, University Medical Center Groningen, and Department of Rheumatology, Medical Center Leeuwarden; J. Luime, PhD, Department of Rheumatology, Erasmus Medical Center Rotterdam; M. Gignac, PhD, Institute for Work and Health, and the Dalla Lana School of Public Health, University of Toronto; A. Boonen, MD, PhD, Department of Medicine, Division of Rheumatology, Maastricht University Medical Centre, and CAPHRI, Maastricht University. *Equal contribution. a.h.oude
| | - Marloes van Onna
- From the Arthritis Centre Twente; Department of Psychology, Health and Technology, University of Twente, Enschede; Department of Medicine, Division of Rheumatology, Maastricht University Medical Centre; School for Public Health and Primary Care (CAPHRI), Maastricht University, Maastricht; Rheumatology, Leiden University Medical Center; Department of Rheumatology, Sint Laurentius hospital Roermond, Roermond; Sint Jans Gasthuis Weert, Weert; Department of Rheumatology, University Medical Center Groningen, Groningen; Department of Rheumatology, Medical Center Leeuwarden, Leeuwarden; Department of Rheumatology, Erasmus Medical Center Rotterdam, Rotterdam, the Netherlands; Institute for Work and Health; Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.M. Oude Voshaar*, PhD, Arthritis Centre Twente, and Department of Psychology, Health and Technology, University of Twente; M. van Onna*, MD, Department of Medicine, Division of Rheumatology, Maastricht University Medical Centre, CAPHRI, Maastricht University; S. van Genderen, MSc, Department of Medicine, Division of Rheumatology, Maastricht University Medical Centre, and CAPHRI, Maastricht University; M. van de Laar, MD, PhD, Arthritis Centre Twente, and University of Twente; D. van der Heijde, MD, PhD, Professor of Rheumatology, Rheumatology, Leiden University Medical Center; L. Heuft, MD, PhD, Department of Rheumatology, Sint Laurentius Hospital Roermond, and Sint Jans Gasthuis Weert; A. Spoorenberg, MD, PhD, Department of Rheumatology, University Medical Center Groningen, and Department of Rheumatology, Medical Center Leeuwarden; J. Luime, PhD, Department of Rheumatology, Erasmus Medical Center Rotterdam; M. Gignac, PhD, Institute for Work and Health, and the Dalla Lana School of Public Health, University of Toronto; A. Boonen, MD, PhD, Department of Medicine, Division of Rheumatology, Maastricht University Medical Centre, and CAPHRI, Maastricht University. *Equal contribution
| | - Simon van Genderen
- From the Arthritis Centre Twente; Department of Psychology, Health and Technology, University of Twente, Enschede; Department of Medicine, Division of Rheumatology, Maastricht University Medical Centre; School for Public Health and Primary Care (CAPHRI), Maastricht University, Maastricht; Rheumatology, Leiden University Medical Center; Department of Rheumatology, Sint Laurentius hospital Roermond, Roermond; Sint Jans Gasthuis Weert, Weert; Department of Rheumatology, University Medical Center Groningen, Groningen; Department of Rheumatology, Medical Center Leeuwarden, Leeuwarden; Department of Rheumatology, Erasmus Medical Center Rotterdam, Rotterdam, the Netherlands; Institute for Work and Health; Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.M. Oude Voshaar*, PhD, Arthritis Centre Twente, and Department of Psychology, Health and Technology, University of Twente; M. van Onna*, MD, Department of Medicine, Division of Rheumatology, Maastricht University Medical Centre, CAPHRI, Maastricht University; S. van Genderen, MSc, Department of Medicine, Division of Rheumatology, Maastricht University Medical Centre, and CAPHRI, Maastricht University; M. van de Laar, MD, PhD, Arthritis Centre Twente, and University of Twente; D. van der Heijde, MD, PhD, Professor of Rheumatology, Rheumatology, Leiden University Medical Center; L. Heuft, MD, PhD, Department of Rheumatology, Sint Laurentius Hospital Roermond, and Sint Jans Gasthuis Weert; A. Spoorenberg, MD, PhD, Department of Rheumatology, University Medical Center Groningen, and Department of Rheumatology, Medical Center Leeuwarden; J. Luime, PhD, Department of Rheumatology, Erasmus Medical Center Rotterdam; M. Gignac, PhD, Institute for Work and Health, and the Dalla Lana School of Public Health, University of Toronto; A. Boonen, MD, PhD, Department of Medicine, Division of Rheumatology, Maastricht University Medical Centre, and CAPHRI, Maastricht University. *Equal contribution
| | - Mart van de Laar
- From the Arthritis Centre Twente; Department of Psychology, Health and Technology, University of Twente, Enschede; Department of Medicine, Division of Rheumatology, Maastricht University Medical Centre; School for Public Health and Primary Care (CAPHRI), Maastricht University, Maastricht; Rheumatology, Leiden University Medical Center; Department of Rheumatology, Sint Laurentius hospital Roermond, Roermond; Sint Jans Gasthuis Weert, Weert; Department of Rheumatology, University Medical Center Groningen, Groningen; Department of Rheumatology, Medical Center Leeuwarden, Leeuwarden; Department of Rheumatology, Erasmus Medical Center Rotterdam, Rotterdam, the Netherlands; Institute for Work and Health; Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.M. Oude Voshaar*, PhD, Arthritis Centre Twente, and Department of Psychology, Health and Technology, University of Twente; M. van Onna*, MD, Department of Medicine, Division of Rheumatology, Maastricht University Medical Centre, CAPHRI, Maastricht University; S. van Genderen, MSc, Department of Medicine, Division of Rheumatology, Maastricht University Medical Centre, and CAPHRI, Maastricht University; M. van de Laar, MD, PhD, Arthritis Centre Twente, and University of Twente; D. van der Heijde, MD, PhD, Professor of Rheumatology, Rheumatology, Leiden University Medical Center; L. Heuft, MD, PhD, Department of Rheumatology, Sint Laurentius Hospital Roermond, and Sint Jans Gasthuis Weert; A. Spoorenberg, MD, PhD, Department of Rheumatology, University Medical Center Groningen, and Department of Rheumatology, Medical Center Leeuwarden; J. Luime, PhD, Department of Rheumatology, Erasmus Medical Center Rotterdam; M. Gignac, PhD, Institute for Work and Health, and the Dalla Lana School of Public Health, University of Toronto; A. Boonen, MD, PhD, Department of Medicine, Division of Rheumatology, Maastricht University Medical Centre, and CAPHRI, Maastricht University. *Equal contribution
| | - Désirée van der Heijde
- From the Arthritis Centre Twente; Department of Psychology, Health and Technology, University of Twente, Enschede; Department of Medicine, Division of Rheumatology, Maastricht University Medical Centre; School for Public Health and Primary Care (CAPHRI), Maastricht University, Maastricht; Rheumatology, Leiden University Medical Center; Department of Rheumatology, Sint Laurentius hospital Roermond, Roermond; Sint Jans Gasthuis Weert, Weert; Department of Rheumatology, University Medical Center Groningen, Groningen; Department of Rheumatology, Medical Center Leeuwarden, Leeuwarden; Department of Rheumatology, Erasmus Medical Center Rotterdam, Rotterdam, the Netherlands; Institute for Work and Health; Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.M. Oude Voshaar*, PhD, Arthritis Centre Twente, and Department of Psychology, Health and Technology, University of Twente; M. van Onna*, MD, Department of Medicine, Division of Rheumatology, Maastricht University Medical Centre, CAPHRI, Maastricht University; S. van Genderen, MSc, Department of Medicine, Division of Rheumatology, Maastricht University Medical Centre, and CAPHRI, Maastricht University; M. van de Laar, MD, PhD, Arthritis Centre Twente, and University of Twente; D. van der Heijde, MD, PhD, Professor of Rheumatology, Rheumatology, Leiden University Medical Center; L. Heuft, MD, PhD, Department of Rheumatology, Sint Laurentius Hospital Roermond, and Sint Jans Gasthuis Weert; A. Spoorenberg, MD, PhD, Department of Rheumatology, University Medical Center Groningen, and Department of Rheumatology, Medical Center Leeuwarden; J. Luime, PhD, Department of Rheumatology, Erasmus Medical Center Rotterdam; M. Gignac, PhD, Institute for Work and Health, and the Dalla Lana School of Public Health, University of Toronto; A. Boonen, MD, PhD, Department of Medicine, Division of Rheumatology, Maastricht University Medical Centre, and CAPHRI, Maastricht University. *Equal contribution
| | - Liesbeth Heuft
- From the Arthritis Centre Twente; Department of Psychology, Health and Technology, University of Twente, Enschede; Department of Medicine, Division of Rheumatology, Maastricht University Medical Centre; School for Public Health and Primary Care (CAPHRI), Maastricht University, Maastricht; Rheumatology, Leiden University Medical Center; Department of Rheumatology, Sint Laurentius hospital Roermond, Roermond; Sint Jans Gasthuis Weert, Weert; Department of Rheumatology, University Medical Center Groningen, Groningen; Department of Rheumatology, Medical Center Leeuwarden, Leeuwarden; Department of Rheumatology, Erasmus Medical Center Rotterdam, Rotterdam, the Netherlands; Institute for Work and Health; Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.M. Oude Voshaar*, PhD, Arthritis Centre Twente, and Department of Psychology, Health and Technology, University of Twente; M. van Onna*, MD, Department of Medicine, Division of Rheumatology, Maastricht University Medical Centre, CAPHRI, Maastricht University; S. van Genderen, MSc, Department of Medicine, Division of Rheumatology, Maastricht University Medical Centre, and CAPHRI, Maastricht University; M. van de Laar, MD, PhD, Arthritis Centre Twente, and University of Twente; D. van der Heijde, MD, PhD, Professor of Rheumatology, Rheumatology, Leiden University Medical Center; L. Heuft, MD, PhD, Department of Rheumatology, Sint Laurentius Hospital Roermond, and Sint Jans Gasthuis Weert; A. Spoorenberg, MD, PhD, Department of Rheumatology, University Medical Center Groningen, and Department of Rheumatology, Medical Center Leeuwarden; J. Luime, PhD, Department of Rheumatology, Erasmus Medical Center Rotterdam; M. Gignac, PhD, Institute for Work and Health, and the Dalla Lana School of Public Health, University of Toronto; A. Boonen, MD, PhD, Department of Medicine, Division of Rheumatology, Maastricht University Medical Centre, and CAPHRI, Maastricht University. *Equal contribution
| | - Anneke Spoorenberg
- From the Arthritis Centre Twente; Department of Psychology, Health and Technology, University of Twente, Enschede; Department of Medicine, Division of Rheumatology, Maastricht University Medical Centre; School for Public Health and Primary Care (CAPHRI), Maastricht University, Maastricht; Rheumatology, Leiden University Medical Center; Department of Rheumatology, Sint Laurentius hospital Roermond, Roermond; Sint Jans Gasthuis Weert, Weert; Department of Rheumatology, University Medical Center Groningen, Groningen; Department of Rheumatology, Medical Center Leeuwarden, Leeuwarden; Department of Rheumatology, Erasmus Medical Center Rotterdam, Rotterdam, the Netherlands; Institute for Work and Health; Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.M. Oude Voshaar*, PhD, Arthritis Centre Twente, and Department of Psychology, Health and Technology, University of Twente; M. van Onna*, MD, Department of Medicine, Division of Rheumatology, Maastricht University Medical Centre, CAPHRI, Maastricht University; S. van Genderen, MSc, Department of Medicine, Division of Rheumatology, Maastricht University Medical Centre, and CAPHRI, Maastricht University; M. van de Laar, MD, PhD, Arthritis Centre Twente, and University of Twente; D. van der Heijde, MD, PhD, Professor of Rheumatology, Rheumatology, Leiden University Medical Center; L. Heuft, MD, PhD, Department of Rheumatology, Sint Laurentius Hospital Roermond, and Sint Jans Gasthuis Weert; A. Spoorenberg, MD, PhD, Department of Rheumatology, University Medical Center Groningen, and Department of Rheumatology, Medical Center Leeuwarden; J. Luime, PhD, Department of Rheumatology, Erasmus Medical Center Rotterdam; M. Gignac, PhD, Institute for Work and Health, and the Dalla Lana School of Public Health, University of Toronto; A. Boonen, MD, PhD, Department of Medicine, Division of Rheumatology, Maastricht University Medical Centre, and CAPHRI, Maastricht University. *Equal contribution
| | - Jolanda Luime
- From the Arthritis Centre Twente; Department of Psychology, Health and Technology, University of Twente, Enschede; Department of Medicine, Division of Rheumatology, Maastricht University Medical Centre; School for Public Health and Primary Care (CAPHRI), Maastricht University, Maastricht; Rheumatology, Leiden University Medical Center; Department of Rheumatology, Sint Laurentius hospital Roermond, Roermond; Sint Jans Gasthuis Weert, Weert; Department of Rheumatology, University Medical Center Groningen, Groningen; Department of Rheumatology, Medical Center Leeuwarden, Leeuwarden; Department of Rheumatology, Erasmus Medical Center Rotterdam, Rotterdam, the Netherlands; Institute for Work and Health; Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.M. Oude Voshaar*, PhD, Arthritis Centre Twente, and Department of Psychology, Health and Technology, University of Twente; M. van Onna*, MD, Department of Medicine, Division of Rheumatology, Maastricht University Medical Centre, CAPHRI, Maastricht University; S. van Genderen, MSc, Department of Medicine, Division of Rheumatology, Maastricht University Medical Centre, and CAPHRI, Maastricht University; M. van de Laar, MD, PhD, Arthritis Centre Twente, and University of Twente; D. van der Heijde, MD, PhD, Professor of Rheumatology, Rheumatology, Leiden University Medical Center; L. Heuft, MD, PhD, Department of Rheumatology, Sint Laurentius Hospital Roermond, and Sint Jans Gasthuis Weert; A. Spoorenberg, MD, PhD, Department of Rheumatology, University Medical Center Groningen, and Department of Rheumatology, Medical Center Leeuwarden; J. Luime, PhD, Department of Rheumatology, Erasmus Medical Center Rotterdam; M. Gignac, PhD, Institute for Work and Health, and the Dalla Lana School of Public Health, University of Toronto; A. Boonen, MD, PhD, Department of Medicine, Division of Rheumatology, Maastricht University Medical Centre, and CAPHRI, Maastricht University. *Equal contribution
| | - Monique Gignac
- From the Arthritis Centre Twente; Department of Psychology, Health and Technology, University of Twente, Enschede; Department of Medicine, Division of Rheumatology, Maastricht University Medical Centre; School for Public Health and Primary Care (CAPHRI), Maastricht University, Maastricht; Rheumatology, Leiden University Medical Center; Department of Rheumatology, Sint Laurentius hospital Roermond, Roermond; Sint Jans Gasthuis Weert, Weert; Department of Rheumatology, University Medical Center Groningen, Groningen; Department of Rheumatology, Medical Center Leeuwarden, Leeuwarden; Department of Rheumatology, Erasmus Medical Center Rotterdam, Rotterdam, the Netherlands; Institute for Work and Health; Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.M. Oude Voshaar*, PhD, Arthritis Centre Twente, and Department of Psychology, Health and Technology, University of Twente; M. van Onna*, MD, Department of Medicine, Division of Rheumatology, Maastricht University Medical Centre, CAPHRI, Maastricht University; S. van Genderen, MSc, Department of Medicine, Division of Rheumatology, Maastricht University Medical Centre, and CAPHRI, Maastricht University; M. van de Laar, MD, PhD, Arthritis Centre Twente, and University of Twente; D. van der Heijde, MD, PhD, Professor of Rheumatology, Rheumatology, Leiden University Medical Center; L. Heuft, MD, PhD, Department of Rheumatology, Sint Laurentius Hospital Roermond, and Sint Jans Gasthuis Weert; A. Spoorenberg, MD, PhD, Department of Rheumatology, University Medical Center Groningen, and Department of Rheumatology, Medical Center Leeuwarden; J. Luime, PhD, Department of Rheumatology, Erasmus Medical Center Rotterdam; M. Gignac, PhD, Institute for Work and Health, and the Dalla Lana School of Public Health, University of Toronto; A. Boonen, MD, PhD, Department of Medicine, Division of Rheumatology, Maastricht University Medical Centre, and CAPHRI, Maastricht University. *Equal contribution
| | - Annlies Boonen
- From the Arthritis Centre Twente; Department of Psychology, Health and Technology, University of Twente, Enschede; Department of Medicine, Division of Rheumatology, Maastricht University Medical Centre; School for Public Health and Primary Care (CAPHRI), Maastricht University, Maastricht; Rheumatology, Leiden University Medical Center; Department of Rheumatology, Sint Laurentius hospital Roermond, Roermond; Sint Jans Gasthuis Weert, Weert; Department of Rheumatology, University Medical Center Groningen, Groningen; Department of Rheumatology, Medical Center Leeuwarden, Leeuwarden; Department of Rheumatology, Erasmus Medical Center Rotterdam, Rotterdam, the Netherlands; Institute for Work and Health; Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.M. Oude Voshaar*, PhD, Arthritis Centre Twente, and Department of Psychology, Health and Technology, University of Twente; M. van Onna*, MD, Department of Medicine, Division of Rheumatology, Maastricht University Medical Centre, CAPHRI, Maastricht University; S. van Genderen, MSc, Department of Medicine, Division of Rheumatology, Maastricht University Medical Centre, and CAPHRI, Maastricht University; M. van de Laar, MD, PhD, Arthritis Centre Twente, and University of Twente; D. van der Heijde, MD, PhD, Professor of Rheumatology, Rheumatology, Leiden University Medical Center; L. Heuft, MD, PhD, Department of Rheumatology, Sint Laurentius Hospital Roermond, and Sint Jans Gasthuis Weert; A. Spoorenberg, MD, PhD, Department of Rheumatology, University Medical Center Groningen, and Department of Rheumatology, Medical Center Leeuwarden; J. Luime, PhD, Department of Rheumatology, Erasmus Medical Center Rotterdam; M. Gignac, PhD, Institute for Work and Health, and the Dalla Lana School of Public Health, University of Toronto; A. Boonen, MD, PhD, Department of Medicine, Division of Rheumatology, Maastricht University Medical Centre, and CAPHRI, Maastricht University. *Equal contribution
| |
Collapse
|
15
|
Bellamy N, Hochberg M, Tubach F, Martin-Mola E, Awada H, Bombardier C, Hajjaj-Hassouni N, Logeart I, Matucci-Cerinic M, van de Laar M, van der Heijde D, Dougados M. Development of multinational definitions of minimal clinically important improvement and patient acceptable symptomatic state in osteoarthritis. Arthritis Care Res (Hoboken) 2015; 67:972-80. [PMID: 25581339 DOI: 10.1002/acr.22538] [Citation(s) in RCA: 74] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2014] [Revised: 11/03/2014] [Accepted: 12/16/2014] [Indexed: 01/22/2023]
Abstract
OBJECTIVE The ability to interpret scores from patient-reported outcome measures at the individual patient level depends on the availability of valid, clinically meaningful benchmarks of response and state attainment. The goal was to develop multinational estimates for minimal clinically important improvement (MCII) and patient acceptable symptomatic state (PASS). METHODS A multinational sample of patients with osteoarthritis (OA) was evaluated before and 4 weeks after treatment with nonsteroidal antiinflammatory drugs. Patients completed either the Western Ontario and McMaster Osteoarthritis Index (WOMAC) numerical rating scale 3.1 (hip and knee OA) or the Australian/Canadian Index (AUSCAN) numerical rating scale 3.1 (hand OA) before and after treatment. Patients rated the clinical importance of their response to treatment and their satisfaction with the health state achieved, from which multinational MCII and PASS estimates were calculated for both the WOMAC and AUSCAN indices. RESULTS A total of 609 patients from 7 countries participated in the study. MCII and PASS estimates varied slightly by instrument and subscale. Absolute (percentage) change for MCII ranged 6-9 (10% to 17%) for WOMAC and 4-9 (8% to 15%) for AUSCAN. PASS estimates ranged 39-48 for WOMAC and 38-45 for AUSCAN. Some between-country variation was observed in MCII and PASS. CONCLUSION Preliminary multinational estimates for MCII and PASS have been developed for several countries. Further research is required to evaluate the robustness, temporal consistency, and age- and sex-dependency of the preliminary estimates as well as their generalizability to other countries, languages, cultures, regions, and other condition-specific outcome measures.
Collapse
Affiliation(s)
- Nicholas Bellamy
- University of Queensland School of Medicine, Brisbane, Queensland, Australia, and Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
| | - Marc Hochberg
- University of Maryland School of Medicine, Baltimore
| | - Florence Tubach
- Université Paris Diderot, Sorbonne Paris Cité, INSERM, UMR-S 1123, INSERM, CIC 1425-EC, UMR-S 1123, and AP-HP Hôpital Bichat, Paris, France
| | - Emilio Martin-Mola
- Hospital Universitario La Paz and Universidad Autónoma Madrid, Madrid, Spain
| | - Hassane Awada
- Saint Joseph University Hôtel-Dieu de France, Beirut, Lebanon
| | - Claire Bombardier
- University of Toronto, Toronto General Research Institute, Institute for Work and Health, and Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Najia Hajjaj-Hassouni
- Mohammed Vth Souissi University, CNRST, and Laboratory of Information and Research on Bone Diseases (LIRPOS-URAC 30), Rabat, Morocco, and El Ayachi Hospital and University Hospital, Salé, Morocco
| | | | | | - Mart van de Laar
- Arthritis Center Twente, Medisch Spectrum Twente, and University Twente, Enschede, The Netherlands
| | | | - Maxime Dougados
- Paris Descartes University, Cochin Hospital, AP-HP, INSERM (U1153), PRES Sorbonne Paris-Cité, Paris, France
| |
Collapse
|
16
|
ter Keurs D, Bulthuis Y, Zeegers E, van de Laar M. Patients with impairment of multiple joints after a total joint replacement benefit from three weeks’ intensive exercise training directly following hospital discharge. Cureus 2013. [DOI: 10.7759/cureus.122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
|
17
|
Morón Merchante I, Pergolizzi JV, van de Laar M, Mellinghoff HU, Nalamachu S, O'Brien J, Perrot S, Raffa RB. Tramadol/Paracetamol fixed-dose combination for chronic pain management in family practice: a clinical review. ISRN Family Med 2013; 2013:638469. [PMID: 24959571 PMCID: PMC4041254 DOI: 10.5402/2013/638469] [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] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/30/2013] [Accepted: 02/19/2013] [Indexed: 01/17/2023]
Abstract
The family practitioner plays an important role in the prevention, diagnosis, and early management of chronic pain. He/she is generally the first to be consulted, the one most familiar with the patients and their medical history, and is likely the first to be alerted in case of inadequate pain control or safety and tolerability issues. The family practitioner should therefore be at the center of the multidisciplinary team involved in a patient's pain management. The most frequent indications associated with chronic pain in family practice are of musculoskeletal origin, and the pain is often multimechanistic. Fixed-dose combination analgesics combine compounds with different mechanisms of action; their broader analgesic spectrum and potentially synergistic analgesic efficacy and improved benefit/risk ratio might thus be useful. A pain specialist meeting held in November 2010 agreed that the fixed-dose combination tramadol/paracetamol might be a useful pharmacological option for chronic pain management in family practice. The combination is effective in a variety of pain conditions with generally good tolerability. Particularly in elderly patients, it might be considered as an alternative to conventional analgesics such as NSAIDs, which should be used rarely with caution in this population.
Collapse
Affiliation(s)
| | - Joseph V Pergolizzi
- Johns Hopkins University, Baltimore, MD 21287, USA ; Association of Chronic Pain Patients, Houston, TX 77515, USA
| | - Mart van de Laar
- Arthritis Center Twente (MST & UT), P.O. Box 50.000, 7500KA Enschede, The Netherlands
| | - Hans-Ulrich Mellinghoff
- Department of Endocrinology, Diabetology and Osteology, Kantonsspital St. Gallen, 9007 St. Gallen, Switzerland
| | - Srinivas Nalamachu
- Kansas University Medical Center, Kansas City, KS 66160, USA ; International Clinic Research, Overland Park, KS 66210, USA
| | - Joanne O'Brien
- Department of Pain Medicine, Beaumont Hospital, Beaumont, Dublin 9, Ireland
| | - Serge Perrot
- Service de Médecine Interne et Consultation de la Douleur, Hôpital Dieu, 75004 Paris, France
| | - Robert B Raffa
- Department of Pharmaceutical Sciences, Temple University School of Pharmacy, Philadelphia, PA 19140, USA
| |
Collapse
|
18
|
Cui J, Stahl EA, Saevarsdottir S, Miceli C, Diogo D, Trynka G, Raj T, Mirkov MU, Canhao H, Ikari K, Terao C, Okada Y, Wedrén S, Askling J, Yamanaka H, Momohara S, Taniguchi A, Ohmura K, Matsuda F, Mimori T, Gupta N, Kuchroo M, Morgan AW, Isaacs JD, Wilson AG, Hyrich KL, Herenius M, Doorenspleet ME, Tak PP, Crusius JBA, van der Horst-Bruinsma IE, Wolbink GJ, van Riel PLCM, van de Laar M, Guchelaar HJ, Shadick NA, Allaart CF, Huizinga TWJ, Toes REM, Kimberly RP, Bridges SL, Criswell LA, Moreland LW, Fonseca JE, de Vries N, Stranger BE, De Jager PL, Raychaudhuri S, Weinblatt ME, Gregersen PK, Mariette X, Barton A, Padyukov L, Coenen MJH, Karlson EW, Plenge RM. Genome-wide association study and gene expression analysis identifies CD84 as a predictor of response to etanercept therapy in rheumatoid arthritis. PLoS Genet 2013; 9:e1003394. [PMID: 23555300 PMCID: PMC3610685 DOI: 10.1371/journal.pgen.1003394] [Citation(s) in RCA: 133] [Impact Index Per Article: 12.1] [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: 08/13/2012] [Accepted: 01/13/2013] [Indexed: 12/21/2022] Open
Abstract
Anti-tumor necrosis factor alpha (anti-TNF) biologic therapy is a widely used treatment for rheumatoid arthritis (RA). It is unknown why some RA patients fail to respond adequately to anti-TNF therapy, which limits the development of clinical biomarkers to predict response or new drugs to target refractory cases. To understand the biological basis of response to anti-TNF therapy, we conducted a genome-wide association study (GWAS) meta-analysis of more than 2 million common variants in 2,706 RA patients from 13 different collections. Patients were treated with one of three anti-TNF medications: etanercept (n = 733), infliximab (n = 894), or adalimumab (n = 1,071). We identified a SNP (rs6427528) at the 1q23 locus that was associated with change in disease activity score (ΔDAS) in the etanercept subset of patients (P = 8 × 10(-8)), but not in the infliximab or adalimumab subsets (P>0.05). The SNP is predicted to disrupt transcription factor binding site motifs in the 3' UTR of an immune-related gene, CD84, and the allele associated with better response to etanercept was associated with higher CD84 gene expression in peripheral blood mononuclear cells (P = 1 × 10(-11) in 228 non-RA patients and P = 0.004 in 132 RA patients). Consistent with the genetic findings, higher CD84 gene expression correlated with lower cross-sectional DAS (P = 0.02, n = 210) and showed a non-significant trend for better ΔDAS in a subset of RA patients with gene expression data (n = 31, etanercept-treated). A small, multi-ethnic replication showed a non-significant trend towards an association among etanercept-treated RA patients of Portuguese ancestry (n = 139, P = 0.4), but no association among patients of Japanese ancestry (n = 151, P = 0.8). Our study demonstrates that an allele associated with response to etanercept therapy is also associated with CD84 gene expression, and further that CD84 expression correlates with disease activity. These findings support a model in which CD84 genotypes and/or expression may serve as a useful biomarker for response to etanercept treatment in RA patients of European ancestry.
Collapse
Affiliation(s)
- Jing Cui
- Division of Rheumatology, Immunology, and Allergy, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Eli A. Stahl
- Division of Rheumatology, Immunology, and Allergy, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
- Division of Genetics, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
- Medical and Population Genetics Program, Chemical Biology Program, Broad Institute, Cambridge, Massachusetts, United States of America
| | - Saedis Saevarsdottir
- Rheumatology Unit, Department of Medicine, Karolinska Institutet and Karolinska University Hospital Solna, Stockholm, Sweden
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Corinne Miceli
- Université Paris-Sud, Orsay, France
- APHP–Hôpital Bicêtre, INSERM U1012, Le Kremlin Bicêtre, Paris, France
| | - Dorothee Diogo
- Division of Rheumatology, Immunology, and Allergy, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
- Division of Genetics, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
- Medical and Population Genetics Program, Chemical Biology Program, Broad Institute, Cambridge, Massachusetts, United States of America
| | - Gosia Trynka
- Division of Rheumatology, Immunology, and Allergy, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
- Division of Genetics, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
- Medical and Population Genetics Program, Chemical Biology Program, Broad Institute, Cambridge, Massachusetts, United States of America
| | - Towfique Raj
- Division of Genetics, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
- Medical and Population Genetics Program, Chemical Biology Program, Broad Institute, Cambridge, Massachusetts, United States of America
- Program in Translational NeuroPsychiatric Genomics, Institute for the Neurosciences, Department of Neurology, Brigham and Women's Hospital, Boston, Massachusetts, United States of America
| | - Maša Umiċeviċ Mirkov
- Department of Human Genetics, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - Helena Canhao
- Division of Rheumatology, Immunology, and Allergy, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
- Rheumatology Research Unit, Instituto de Medicina Molecular, Faculdade de Medicina da Universidade de Lisboa, Lisbon, Portugal
- Rheumatology Department, Santa Maria Hospital–CHLN, Lisbon, Portugal
| | - Katsunori Ikari
- Institute of Rheumatology, Tokyo Women's Medical University, Tokyo, Japan
| | - Chikashi Terao
- Department of Rheumatology and Clinical Immunology, Kyoto University Graduate School of Medicine, Kyoto, Japan
- Center for Genomic Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Yukinori Okada
- Division of Rheumatology, Immunology, and Allergy, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
- Division of Genetics, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
- Medical and Population Genetics Program, Chemical Biology Program, Broad Institute, Cambridge, Massachusetts, United States of America
| | - Sara Wedrén
- Rheumatology Unit, Department of Medicine, Karolinska Institutet and Karolinska University Hospital Solna, Stockholm, Sweden
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Johan Askling
- Rheumatology Unit, Department of Medicine, Karolinska Institutet and Karolinska University Hospital Solna, Stockholm, Sweden
- Clinical Epidemiology Unit, Department of Medicine, Karolinska Institute/Karolinska University Hospital, Stockholm, Sweden
| | - Hisashi Yamanaka
- Institute of Rheumatology, Tokyo Women's Medical University, Tokyo, Japan
| | - Shigeki Momohara
- Institute of Rheumatology, Tokyo Women's Medical University, Tokyo, Japan
| | - Atsuo Taniguchi
- Institute of Rheumatology, Tokyo Women's Medical University, Tokyo, Japan
| | - Koichiro Ohmura
- Department of Rheumatology and Clinical Immunology, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Fumihiko Matsuda
- Center for Genomic Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Tsuneyo Mimori
- Department of Rheumatology and Clinical Immunology, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Namrata Gupta
- Medical and Population Genetics Program, Chemical Biology Program, Broad Institute, Cambridge, Massachusetts, United States of America
| | - Manik Kuchroo
- Medical and Population Genetics Program, Chemical Biology Program, Broad Institute, Cambridge, Massachusetts, United States of America
- Program in Translational NeuroPsychiatric Genomics, Institute for the Neurosciences, Department of Neurology, Brigham and Women's Hospital, Boston, Massachusetts, United States of America
| | - Ann W. Morgan
- NIHR–Leeds Musculoskeletal Biomedical Research Unit and Leeds Institute of Molecular Medicine, University of Leeds, Leeds, United Kingdom
| | - John D. Isaacs
- Musculoskeletal Research Group, Institute of Cellular Medicine, Newcastle Upon Tyne, United Kingdom
| | - Anthony G. Wilson
- Rheumatology Unit, Medical School, University of Sheffield, Sheffield, United Kingdom
| | - Kimme L. Hyrich
- School of Translational Medicine, Arthritis Research UK Epidemiology Unit, University of Manchester, Manchester, United Kingdom
| | - Marieke Herenius
- Department of Clinical Immunology and Rheumatology, Academic Medical Center/University of Amsterdam, Amsterdam, The Netherlands
| | - Marieke E. Doorenspleet
- Department of Clinical Immunology and Rheumatology, Academic Medical Center/University of Amsterdam, Amsterdam, The Netherlands
| | - Paul-Peter Tak
- Department of Clinical Immunology and Rheumatology, Academic Medical Center/University of Amsterdam, Amsterdam, The Netherlands
| | - J. Bart A. Crusius
- Laboratory of Immunogenetics, Department of Pathology, Vrije Universiteit Medical Center, Amsterdam, The Netherlands
| | | | - Gert Jan Wolbink
- Sanquin Research Landsteiner Laboratory, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
- School of Medicine and Biomedical Sciences, Sheffield University, Sheffield, United Kingdom
- Jan van Breemen Institute, Amsterdam, The Netherlands
| | - Piet L. C. M. van Riel
- Department of Human Genetics, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - Mart van de Laar
- Arthritis Center Twente, University Twente and Medisch Spectrum Twente, Enschede, The Netherlands
| | - Henk-Jan Guchelaar
- Department of Clinical Pharmacy and Toxicology, Leiden University Medical Center, Leiden, The Netherlands
| | - Nancy A. Shadick
- Division of Rheumatology, Immunology, and Allergy, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Cornelia F. Allaart
- Department of Rheumatology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Tom W. J. Huizinga
- Department of Rheumatology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Rene E. M. Toes
- Department of Rheumatology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Robert P. Kimberly
- Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
| | - S. Louis Bridges
- Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
| | - Lindsey A. Criswell
- Rosalind Russell Medical Research Center for Arthritis, Division of Rheumatology, Department of Medicine, University of California San Francisco, San Francisco, California, United States of America
| | - Larry W. Moreland
- Division of Rheumatology and Clinical Immunology, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
| | - João Eurico Fonseca
- Rheumatology Research Unit, Instituto de Medicina Molecular, Faculdade de Medicina da Universidade de Lisboa, Lisbon, Portugal
- Rheumatology Department, Santa Maria Hospital–CHLN, Lisbon, Portugal
| | - Niek de Vries
- Department of Clinical Immunology and Rheumatology, Academic Medical Center/University of Amsterdam, Amsterdam, The Netherlands
| | - Barbara E. Stranger
- Division of Genetics, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
- Medical and Population Genetics Program, Chemical Biology Program, Broad Institute, Cambridge, Massachusetts, United States of America
| | - Philip L. De Jager
- Division of Genetics, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
- Medical and Population Genetics Program, Chemical Biology Program, Broad Institute, Cambridge, Massachusetts, United States of America
- APHP–Hôpital Bicêtre, INSERM U1012, Le Kremlin Bicêtre, Paris, France
| | - Soumya Raychaudhuri
- Division of Rheumatology, Immunology, and Allergy, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
- Division of Genetics, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
- Medical and Population Genetics Program, Chemical Biology Program, Broad Institute, Cambridge, Massachusetts, United States of America
- NIHR Manchester Musculoskeletal Biomedical Research Unit, Central Manchester NHS Foundation Trust, Manchester Academic Health Sciences Centre, Manchester, United Kingdom
| | - Michael E. Weinblatt
- Division of Rheumatology, Immunology, and Allergy, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Peter K. Gregersen
- The Feinstein Institute for Medical Research, North Shore–Long Island Jewish Health System, Manhasset, New York, United States of America
| | - Xavier Mariette
- Université Paris-Sud, Orsay, France
- APHP–Hôpital Bicêtre, INSERM U1012, Le Kremlin Bicêtre, Paris, France
| | - Anne Barton
- Arthritis Research UK Epidemiology Unit, Musculoskeletal Research Group, University of Manchester, Manchester Academic Health Sciences Centre, Manchester, United Kingdom
| | - Leonid Padyukov
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Marieke J. H. Coenen
- Department of Human Genetics, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - Elizabeth W. Karlson
- Division of Rheumatology, Immunology, and Allergy, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Robert M. Plenge
- Division of Rheumatology, Immunology, and Allergy, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
- Division of Genetics, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
- Medical and Population Genetics Program, Chemical Biology Program, Broad Institute, Cambridge, Massachusetts, United States of America
- * E-mail:
| |
Collapse
|
19
|
Pergolizzi JV, van de Laar M, Langford R, Mellinghoff HU, Merchante IM, Nalamachu S, O'Brien J, Perrot S, Raffa RB. Tramadol/paracetamol fixed-dose combination in the treatment of moderate to severe pain. J Pain Res 2012; 5:327-46. [PMID: 23055775 PMCID: PMC3442743 DOI: 10.2147/jpr.s33112] [Citation(s) in RCA: 25] [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] [Indexed: 01/19/2023] Open
Abstract
Pain is the most common reason patients seek medical attention and pain relief has been put forward as an ethical obligation of clinicians and a fundamental human right. However, pain management is challenging because the pathophysiology of pain is complex and not completely understood. Widely used analgesics such as nonsteroidal anti-inflammatory drugs (NSAIDs) and paracetamol (acetaminophen) have been associated with adverse events. Adverse event rates are of concern, especially in long-term treatment or at high doses. Paracetamol and NSAIDs are available by prescription, over the counter, and in combination preparations. Patients may be unaware of the risk associated with high dosages or long-term use of paracetamol and NSAIDs. Clinicians should encourage patients to disclose all medications they take in a “do ask, do tell” approach that includes patient education about the risks and benefits of common pain relievers. The ideal pain reliever would have few risks and enhanced analgesic efficacy. Fixed-dose combination analgesics with two or more agents may offer additive or synergistic benefits to treat the multiple mechanisms of pain. Therefore, pain may be effectively treated while toxicity is reduced due to lower doses. One recent fixed-dose combination analgesic product combines tramadol, a centrally acting weak opioid analgesic, with low-dose paracetamol. Evidence-based guidelines recognize the potential value of combination analgesics in specific situations. The current guideline-based paradigm for pain treatment recommends NSAIDs for ongoing use with analgesics such as opioids to manage flares. However, the treatment model should evolve how to use low-dose combination products to manage pain with occasional use of NSAIDs for flares to avoid long-term and high-dose treatment with these analgesics. A next step in pain management guidelines should be targeted therapy when possible, or low-dose combination therapy or both, to achieve maximal efficacy with minimal toxicity.
Collapse
Affiliation(s)
- Joseph V Pergolizzi
- Department of Medicine, Johns Hopkins University, Baltimore, MD, USA ; Association of Chronic Pain Patients, Houston, TX, USA
| | | | | | | | | | | | | | | | | |
Collapse
|
20
|
Baan H, Drossaers-Bakker W, Dubbeldam R, van de Laar M. We should not forget the foot: relations between signs and symptoms, damage, and function in rheumatoid arthritis. Clin Rheumatol 2011; 30:1475-9. [PMID: 21614474 PMCID: PMC3203245 DOI: 10.1007/s10067-011-1780-8] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [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: 01/05/2011] [Revised: 05/10/2011] [Accepted: 05/11/2011] [Indexed: 11/29/2022]
Abstract
We studied rheumatoid arthritis (RA) patients with foot complaints to address the associations between clinical signs and symptoms, radiographic changes, and function in connection with disease duration. Secondly, we describe the contribution of several foot segments to the clinical presentation and function. In 30 RA patients with complaints of their feet, attributed to either signs of arthritis and/or radiographic damage, we compared radiographic, ultrasound, clinical, and functional parameters of the feet and ankle. Pain and swelling of the ankle were correlated weakly but statistically significantly with limitation and disability (0.273 to 0.293) as measured on the 5-Foot Function Index (FFI). The clinical signs of the forefoot joints did not influence any of the functional outcome measures. Radiographic scores for both forefeet (SvdH) and hindfeet (Larsen) were correlated with the total Health Assessment Questionnaire Disability Index (HAQ DI) and the 5-FFI limitation subscale. Pain and disease duration, more than radiographic damage, influence the total HAQ DI significantly. With the progression of time, structural damage and function of the rheumatic foot worsen in RA patients. Pain and swelling of the ankle contribute more to disability than radiographic damage of the foot and ankle.
Collapse
Affiliation(s)
- Henriëtte Baan
- Ziekenhuis Groep Twente, Almelo & Hengelo, The Netherlands.
| | | | | | | |
Collapse
|
21
|
Vonkeman H, Meek I, van de Laar M. Risk management of risk management: Combining proton pump inhibitors with low-dose aspirin. Drug Healthc Patient Saf 2010; 2:191-204. [PMID: 21701631 PMCID: PMC3108704 DOI: 10.2147/dhps.s7206] [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] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/05/2010] [Indexed: 01/16/2023]
Abstract
Low-dose aspirin is widely used in the primary and secondary prevention of cardiovascular events, but is associated with a range of upper gastrointestinal side effects. In this review, we summarize the rationale for low-dose aspirin therapy, quantify the risk for upper gastrointestinal side effects, identify the risk factors involved, and provide an overview of preventive strategies, thereby focusing on the rationale and clinical utility of combining proton-pump inhibitors with low-dose aspirin.
Collapse
Affiliation(s)
- Harald Vonkeman
- Department of Rheumatology and Clinical Immunology, Arthritis Centre Twente, Medisch Spectrum Twente and University of Twente, Enschede, The Netherlands
| | | | | |
Collapse
|
22
|
Hoekstra M, Haagsma C, Neef C, Proost J, Knuif A, van de Laar M. Splitting high-dose oral methotrexate improves bioavailability: a pharmacokinetic study in patients with rheumatoid arthritis. J Rheumatol 2006; 33:481-5. [PMID: 16463431] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
OBJECTIVE To study the bioavailability of a divided higher oral dose of methotrexate (MTX), in comparison to a single dose, in adult patients with rheumatoid arthritis (RA). METHODS A pharmacokinetic analysis was performed in 10 patients with RA taking a stable dose (25-35 mg weekly) of MTX. Separated by one week, a pharmacokinetic analysis was performed in each patient after an oral single dose, and after an equal but split dose separated by 8 hours. MTX serum concentrations were measured by a fluorescence polarization immunoassay technique. Analysis was performed by calculation of the area under the curve (AUC) by the trapezoidal rule and by means of an iterative 2-stage Bayesian population procedure, obtaining population and individual pharmacokinetic parameters. For the population analysis, data from 15 patients in our previous study comparing oral and subcutaneous administration of MTX were also used. RESULTS The median MTX dose was 30 mg weekly (range 25-35 mg). The bioavailability of the split dose was 28% higher compared to the single dose (p = 0.007). In the population pharmacokinetic modeling, a 2-compartment model best described the serum MTX concentration versus time curves. The mean bioavailability after single-dose and split-dose MTX was 0.76 and 0.90, respectively, compared to subcutaneous administration. There was a statistically significant difference in the bioavailability of the 2 oral administration regimens (p = 0.008). CONCLUSION The bioavailability of oral higher dose MTX in adult patients with RA can be improved by splitting the dose.
Collapse
Affiliation(s)
- Monique Hoekstra
- Department of Rheumatology, Medisch Spectrum Twente and University Twente, Enschede, The Netherlands.
| | | | | | | | | | | |
Collapse
|
23
|
Vonkeman H, ten Napel C, Rasker H, van de Laar M. Disseminated primary varicella infection during infliximab treatment. J Rheumatol 2004; 31:2517-8. [PMID: 15570661] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
Abstract
A young man developed a serious disseminated varicella infection, necessitating antiviral treatment, after being treated with anti-tumor necrosis factor-alpha therapy for rheumatoid arthritis.
Collapse
Affiliation(s)
- Harald Vonkeman
- Department of Rheumatology and the Department of Internal Medicine, Medisch Spectrum Twente, PO Box 50000, 7500 KA Enschede, The Netherlands.
| | | | | | | |
Collapse
|
24
|
Hoekstra M, Haagsma C, Neef C, Proost J, Knuif A, van de Laar M. Bioavailability of higher dose methotrexate comparing oral and subcutaneous administration in patients with rheumatoid arthritis. J Rheumatol 2004; 31:645-8. [PMID: 15088287] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
Abstract
OBJECTIVE To determine the bioavailability of higher oral doses of methotrexate (MTX) in adult patients with rheumatoid arthritis (RA). METHODS A pharmacokinetic analysis was performed in 15 patients with RA taking a stable dose of MTX (> or = 25 mg weekly). Separated by 2 weeks, a pharmacokinetic analysis was performed in each patient after oral and subcutaneous administration of the same dose of MTX. MTX serum concentrations were measured by a fluorescence polarization immunoassay. Pharmacokinetic analysis was performed with an iterative 2-stage Bayesian population procedure, obtaining population and individual pharmacokinetic parameters. RESULTS The median MTX dose was 30 mg weekly (range 25-40 mg). A 2-compartment model best described the serum MTX concentration versus time curves. The mean bioavailability after oral MTX was 0.64 (range 0.21-0.96) compared to subcutaneous administration. There was a statistically significant difference in the bioavailability of the 2 administration regimens. CONCLUSION Bioavailability of a higher oral dose of MTX in adult patients with RA is highly variable, and on average two-thirds that of the subcutaneous administration. To improve efficacy of MTX at dosages of 25 mg weekly or more, a change to parenteral administration should be considered.
Collapse
Affiliation(s)
- Monique Hoekstra
- Department of Rheumatology, Medisch Spectrum Twente, Enschede, The Netherlands.
| | | | | | | | | | | |
Collapse
|