Rheumatoid arthritis—management

2013 ◽  
Author(s):  
Chris Deighton
Keyword(s):  
Rheumatoid Arthritis ◽  
Disease Activity ◽  
Occupational Therapists ◽  
Established Disease ◽  
Minimal Disease ◽  
Specialist Nurses ◽  
The Impact ◽  
Informed Patient

Influential guidelines on rheumatoid arthritis (RA) management agree on most key recommendations. Early diagnosis of persistent synovitis, and identification of poor prognostic markers, is essential. Rapid intervention is vital with drugs to suppress inflammation, slow down damaging disease components, and prevent disability. The label of RA covers a broad spectrum of disease severity, and there is controversy on: • whether the same interventions are needed for all patients • whether monotherapy or combination treatment is appropriate • the role of steroids in RA • the appropriate introduction of biological therapies. Treating to specified targets is optimal evidence-based practice, where patients are reviewed regularly for disease activity assessments, and inadequate control rectified. Aiming for remission is the ultimate goal, though for some patients minimal disease activity may be appropriate. Patient education addressing self-management is important, and the multidisciplinary team (MDT: specialist nurses, physiotherapists, occupational therapists, podiatrists, psychologists) needs to be involved from the start to minimize the impact on quality of life of the patient. For established disease, rapid access is important for flares, and to consider whether disease management could be improved. An intermittent overview of established disease is important with access to the MDT, and assessments for comorbidities such as ischaemic heart disease, osteoporosis, and depression, as well as complications of the disease itself such as cervical spine disease, vasculitis, and lung and eye complications. An informed patient needs to be central to all decision making.

Rheumatoid arthritis—management

2013 ◽  
pp. 867-876
Author(s):  
Chris Deighton
Keyword(s):  
Rheumatoid Arthritis ◽  
Disease Activity ◽  
Occupational Therapists ◽  
Established Disease ◽  
Minimal Disease ◽  
Specialist Nurses ◽  
The Impact ◽  
Informed Patient

Influential guidelines on rheumatoid arthritis (RA) management agree on most key recommendations. Early diagnosis of persistent synovitis, and identification of poor prognostic markers, is essential. Rapid intervention is vital with drugs to suppress inflammation, slow down damaging disease components, and prevent disability. The label of RA covers a broad spectrum of disease severity, and there is controversy about: • whether the same interventions are needed for all patients • whether monotherapy or combination treatment is appropriate • the role of steroids in RA • the appropriate introduction of biological therapies. Treating to specified targets is optimal evidence-based practice, where patients are reviewed regularly for disease activity assessments, and inadequate control rectified. Aiming for remission is the ultimate goal, though for some patients minimal disease activity may be appropriate. Patient education addressing self-management is important, and the multidisciplinary team (MDT: specialist nurses, physiotherapists, occupational therapists, podiatrists, psychologists) needs to be involved from the start to minimize the impact on quality of life of the patient. For established disease, rapid access is important for flares, and to consider whether disease management could be improved. An intermittent overview of established disease is important with access to the MDT, and assessments for comorbidities such as ischaemic heart disease, osteoporosis, and depression, as well as complications of the disease itself such as cervical spine disease, vasculitis, and lung and eye complications. An informed patient needs to be central to all decision making.

AB0229 SHORT-TERM EXPOSURE TO OUTDOOR AIR POLLUTANTS AND RHEUMATOID ARTHRITIS ACTIVITY IN METROPOLITAN AREAS IN THE NORTH OF ITALY

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 1415.1-1415
Author(s):  
F. Ingegnoli ◽  
T. Ubiali ◽  
T. Schioppo ◽  
V. Longo ◽  
S. Iodice ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Air Pollution ◽  
Disease Activity ◽  
Air Pollutants ◽  
Positive Trend ◽  
Inverse Association ◽  
Short Term ◽  
Short Term Exposure ◽  
The Impact

Background:Air pollution is believed to cause oxidative stress and systemic inflammation, that could trigger autoimmunity in rheumatoid arthritis (RA). Several epidemiological studies investigated the possible role of air pollution in the outbreak of RA with controversial results. As far as we know, studies on the effects on disease activity of short-term exposure have not been published.Objectives:To evaluate the impact of short-term exposure to air pollutants (daily mean PM10, PM2.5, NO2and O3) on disease activity in patients with RA.Methods:Consecutive patients with RA (ACR/EULAR Criteria 2010) resident in Lombardy (Italy) were enrolled. In each patient Disease Activity Score on 28 joints (DAS28), Simple Disease Activity Index (SDAI) were assessed. Daily PM10, PM2.5, NO2and O3concentrations, estimated by Regional Environmental Protection Agency at municipality resolution, were used to assign short-term exposure from day of visit back to 14 days. Multivariable linear regression models were performed to identify the day of the pollutants independently associated with disease activity indices, adjusting for the variables significant at the univariate analysis. β coefficients were reported for 1 μg/m3increments of pollutants’ concentrations.Results:422 RA patients were enrolled in the study between January and June 2018: 81.5% females, mean age 58.2±13.3 years, mean disease duration 16.1±11.5 years, 27.3% current smokers, 59.5% RF positivity, 54.5% ACPA positivity. Sparse punctual statistically significant negative associations emerged at the multivariate analysis between PM10, PM2.5, NO2and the outcomes, although with very low estimates, whereas positive associations resulted for O3.Afterwards patients were stratified in 3 subgroups according to their ongoing treatment (no therapy, n=25, conventional synthetic Disease Modifying anti-Rheumatic Drugs -DMARDs-, n=108 and biological or targeted synthetic DMARDs, n=289). A statistical significance was found by analysing the influence of therapy on the interaction between PM2.5and DAS28 (Figure below): a positive trend between PM2.5and DAS28 appeared in the first two groups (no therapy, 0.013±0.007, p=0.06 and csDMARDs, 0.006±0.004, p=0.17), whereas a statistically significant inverse association was seen in the b/tsDMARDs group (-0.005±0.002, p=0.01). Therapy interaction was particularly evident in several days before the visit also for O3.Conclusion:The changes of the outcome measures related to the increase of the pollutants’ levels did not reach the minimal clinically important difference, therefore air pollution seems barely relevant on disease activity once the loss of tolerance is established in RA. O3and PM/NO2always exhibit an opposite performance having inversely proportional atmospheric concentrations, whereas the biological role of this substance is still matter of debate and will need further understanding. Therapy seems to be able to interact with the relation between air pollutants and the parameters considered.Disclosure of Interests:Francesca Ingegnoli: None declared, Tania Ubiali: None declared, Tommaso Schioppo: None declared, Valentina Longo: None declared, Simona Iodice: None declared, Ennio Giulio Favalli Consultant of: Consultant and/or speaker for BMS, Eli-Lilly, MSD, UCB, Pfizer, Sanofi-Genzyme, Novartis, and Abbvie, Speakers bureau: Consultant and/or speaker for BMS, Eli-Lilly, MSD, UCB, Pfizer, Sanofi-Genzyme, Novartis, and Abbvie, Orazio De Lucia: None declared, Antonella Murgo: None declared, Valentina Bollati: None declared, Roberto Caporali Consultant of: AbbVie; Gilead Sciences, Inc.; Lilly; Merck Sharp & Dohme; Celgene; Bristol-Myers Squibb; Pfizer; UCB, Speakers bureau: Abbvie; Bristol-Myers Squibb; Celgene; Lilly; Gilead Sciences, Inc; MSD; Pfizer; Roche; UCB

scholarly journals AB0064 EVALUATION OF QUALITY OF LIFE IN RHEUMATOID ARTHRITIS USING SF-36 AND HAQ SCALES

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 1063.1-1063
Author(s):  
M. Brahem ◽  
M. Hassayoun ◽  
H. Hachfi ◽  
R. Sarraj ◽  
M. Ardhaoui ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Rheumatoid Arthritis ◽  
Disease Activity ◽  
Short Form ◽  
Bodily Pain ◽  
Global Score ◽  
Sf 36 ◽  
The Mean ◽  
The Impact

Background:The assessment of health-related quality-of-life (HRQoL) in rheumatoid arthritis (RA) is becoming a common tool in clinical practice. The medical outcomes survey short form 36 (SF- 36) is one of the most widely used tools for measuring HRQoL in RA as well as the HAQ scale.Objectives:The aim of our study is to evaluate the impact of the RA in the quality of life (QoL) of our patients using the SF-36 and the HAQ questionnaires.Methods:This is a cross-sectional study during a period of the year 2020, including 70 patients followed in the department of Rheumatology in Mahdia, Tunisia. All patients were diagnosed with RA based in ACR 1987/EULAR 2010. We evaluated for each patient, the mean global scale and the eight domains of SF-36 (physical functioning (PF), role physical (RP), bodily pain (BP), general health (GH), vitality (VT), a social functioning (SF), role emotional (RE) and mental health (MH)), scored from 0 (worst) to 100 (best).Results:Our study included 70 patients (59 females/11males) with an age ranged from 21 to 76 years. The mean age was 54 ± 12 years. The mean duration of the disease was 11 ± 10 years [1-40]. The mean number of tender joints was 9.7 ±9.4 and swollen joints were 4.2 ±6.1. The mean disease activity score (DAS28) was 4.6 ±1.9 [1.2-8.4]. The mean HAQ score was 1.5±1.3, 47.1% of patients had specific joint deformations, 82.9% had radiologic involvement and 31.4% had osteoporosis. The biologic analysis showed that the mean ESR was 46.7 ± 30.5 and the CRP was 15.8 ±23.3. Rheumatoid factors were positive in 42.9% of cases, the ACPA were positive in 50% of cases. 84.3% of RA patients were treated by methotrexate, 4.3% were treated by salazopyrin and 11.4% were treated by biologic treatments.The SF-36 global score was 50.4 ± 26.3 [15.3-92.8]. 46 patients (65.7% of cases) had impaired QoL (SF-36<66.7). The means of different domains (PF, RP, BP, GH, VT, SF, RE, MH) were respectively 51; 41.4; 51.4; 50; 51.2; 57.7; 41.9; 59.2. The most severely impacted domains were the RP and RE.Our study showed a significant correlation between the SF-36 global score and the number of tender joints (p=0.002), the DAS28 (p=0.017) and the HAQ(p=0.000).Conclusion:Our study showed that 65.7% of RA patients presented impaired QoL (SF-36<66.7), which is associated with high disease activity. So it’s important to jugulate the disease, in order to ameliorate the quality of life of our patients.References:[1]Matcham, F., Scott, IC, Rayner, L., Hotopf, M., Kingsley, GH, Norton, S.,… Steer, S. (2014). L’impact de la polyarthrite rhumatoïde sur la qualité de vie évalué à l’aide du SF-36: une revue systématique et une méta-analyse. Séminaires sur l’arthrite et les rhumatismes, 44 (2), 123-130. doi: 10.1016 / j.semarthrit.2014.05.001.Disclosure of Interests:None declared

scholarly journals The Impact of Time Length to Boolean Remission for Tight Disease Activity Control After Acquisition in Rheumatoid Arthritis Patients

2021 ◽  
Author(s):  
Ichiro Yoshii ◽  
Tatsumi Chijiwa ◽  
Naoya Sawada
Keyword(s):  
Quality Of Life ◽  
Rheumatoid Arthritis ◽  
Disease Activity ◽  
Remission Rate ◽  
Health Assessment ◽  
Time Length ◽  
First Remission ◽  
The Impact ◽  
Questionnaire Disability

Abstract Importance of time length to achieving clinical remission on disease activity control, daily activities (ADL) and quality of life (QOL) maintenance after the remission was investigated for patients with rheumatoid arthritis (RA).In patients who achieved remission once or more, relationship between time length from initiation to achieve remission (TL) and patients’ background data at baseline, and relationship between TL and mean simplified disease activity score (SDAI), modified Health Assessment Questionnaire Disability Index (HAQ-DI) score, pain score with visual analog scale (PS-VAS), Sharp/van der Heijde Score (SHS) and quality of life score (QOLS) at the first remission and thereafter were evaluated statistically. Patients were divided into two groups whether TL was within 6 months or longer (G≤6 and G>6). Change of the parameters and Boolean remission rate (BRR) after the first remission between the two groups were compared statistically.In 465 patients, TL correlated significantly with the SDAI score, the HAQ score, PS-VAS, SHS, and the QOLS after the remission. The SDAI score and the BRR after the first remission were significantly better in the G≤6 than in the G>6.TL is an important key to guarantee good disease activity control, ADL and QOL.

scholarly journals Improving the quality of life of patients with rheumatoid arthritis after rehabilitation irrespective of the level of disease activity

2020 ◽  
Author(s):  
Daniel Szewczyk ◽  
Teresa Sadura-Sieklucka ◽  
Beata Sokołowska ◽  
Krystyna Księżopolska-Orłowska
Keyword(s):  
Quality Of Life ◽  
Rheumatoid Arthritis ◽  
Disease Activity ◽  
Rehabilitation Program ◽  
Activity Level ◽  
Subjective Perception ◽  
Das28 Score ◽  
Comprehensive Rehabilitation ◽  
The Impact

Abstract Due to the exacerbation of the disease, the rehabilitation of patients with rheumatoid arthritis is often limited. The aim of the study was to analyze the impact of a comprehensive rehabilitation on a subjective perception of pain and quality of life in patients with rheumatoid arthritis depending on the level of disease activity. The study involved 58 women with rheumatoid arthritis aged 18–60, who underwent a 4-weeks comprehensive rehabilitation program. The assessment included the disease activity level on the DAS28 scale, pain intensity on the 10-point pain scale (VAS) and the value of the CRP protein. The HAQ-DI and KALU questionnaire were used to assess the quality of life. In both groups (group A—DAS28 < 4.2, group B—DAS28 ≥ 4.2) the statistically significant effects in decreasing the level of pain and improvement of quality of life were observed. This indicates the need and effectiveness of rehabilitation regardless of the level of activity of rheumatoid arthritis according to the DAS28 scale. There were no significant changes in the CRP protein level. In conclusion, the rehabilitation of patients with moderate to high disease activity is effective and the success of comprehensive rehabilitation is demonstrated by the decrease of the DAS28 score and the pain level reported by patients, as well as improving self-assessment of health and quality of life.

088 The impact of anxiety on quality of life and disease activity in rheumatoid arthritis: a systematic review

Rheumatology ◽  
2019 ◽  
Vol 58 (Supplement_3) ◽  
Author(s):  
Annabelle R Machin ◽  
Randula Haththotuwa ◽  
Opeyemi Babatunde ◽  
Ian Scott ◽  
Milica Bucknall ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Rheumatoid Arthritis ◽  
Systematic Review ◽  
Disease Activity ◽  
The Impact

scholarly journals FRI0062 THE USE OF A COMORBIDITY INDEX FOR PREDICTING CLINICAL RESPONSE IN RHEUMATOID ARTHRITIS PATIENTS RECEIVING THEIR FIRST BIOLOGICAL AGENT

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 607.1-608
Author(s):  
S. Garcia ◽  
B. M. Fernandes ◽  
G. Terroso ◽  
M. Bernardes ◽  
L. Costa
Keyword(s):  
Rheumatoid Arthritis ◽  
Disease Activity ◽  
Clinical Response ◽  
Multivariate Logistic Regression Model ◽  
Physician Global Assessment ◽  
Comorbidity Index ◽  
Disease Modifying ◽  
The Impact ◽  
Moderate Response

Background:Several studies in Rheumatoid arthritis (RA) have suggested that a greater number of comorbidities is associated with worse functional status and disease activity measures. However, it is useful to use a composite comorbidity index, such as Rheumatic Disease Comorbidity Index (RDCI) that is validated for the use in patients with rheumatic diseases, to better understand the overall role of comorbidities in treatment outcomes.Objectives:To evaluate the impact of comorbidities on 12-month clinical response in a cohort of patients with RA treated with a first-line biologic disease-modifying antirheumatic drug (bDMARD), by using the RDCI.Methods:Observational retrospective study was performed including consecutive patients with the diagnosis of RA followed at our Rheumatology Department. The prevalence of comorbidities was computed, and patients were stratified according to RDCI for evaluating its role in clinical response disease activity at baseline and follow up (6 and 12 months). Correlations between variables were studied using Spearman correlation analysis, comparison between groups was performed using Kruskal-Wallis and Chi-square. A multivariate logistic regression model was developed to examine the role of RDCI along with other baseline factors as potential predictor of achieving remission, low disease activity (LDA), and EULAR good/moderate response. Statistical analyses were performed using SPSS statistical software, version 23.0.Results:A total of 251 patients were included: 83.7% (n=210) females, mean age of 58 (± 11.10) years old, with a median disease duration of 16.11 years [10.79 - 23.04]. The majority exhibited a very high or high disease activity at baseline (median DAS28 3V 5.48 [4.70 – 6.19]) and 90% (n=226) of them were concomitantly using corticosteroids and/or other disease-modifying anti-rheumatic drugs (129 with methotrexate (MTX), 96 with leflunomide and 35 with sulfasalazine). The most frequently reported comorbidities were cardiovascular disorders (37.5%), osteoporosis (7.6%) and depression (6.8%). The median RDCI score was 1.0 [0.0 – 2.0] and the majority of patients (63.6%) carried at least one comorbidity. When comparing baseline demographic and clinical characteristics of the 4 subgroups, stratified according to RDCI score (RDCI=0, 1, 2, or ≥3), we found statistically significant differences in age, age at diagnosis, sex and the prescribed anti-TNF agent (p<0.05). There was a progressive increase in the mean age as the RDCI score increased between the subgroups.RDCI strongly correlates with the number of comorbidities (NC) (r=0.764, p<0.01). NC was weakly correlated with patient and physician global assessment of disease activity (pVAS and phVAS) (r=0.183, p<0.01 and r=0.196, p=0.019, respectively), DAS28 3V (r=0.192, p=0.046) and HAQ-DI (r=0.301, p<0.01) at 6 months. Moreover, RDCI poorly correlated with CRP (r=0.192, p=0.01), pVAS (r=0.183, p=0.02) and HAQ-DI (r=0.202, p<0.01). Weaker correlations were also found at 12 months: NC with pVAS (r= 0.196, p=0.02), DAS28 3V (r=0.216, p=0.01) and HAQ-DI (r=0.187, p=0.04); RDCI with phVAS (r= 0.196, p=0.04).The 12-month DAS28 remission rate was 37.8% (n=95); 6.7% (n=17) achieved EULAR good response and 54.4% (n=137) a moderate EULAR response. RDCI was not an independent predictor of DAS remission (OR 0.794, 95% CI 0.561- 1.125,p =0.194) nor it was of EULAR good/moderate response (OR 0,720, 95% CI 0.430- 1.206, p= 0.212).Conclusion:Although our data point to a weak association between morbidities, assessed by the RDCI, and response to a first bDMARD, it is important to consider this simple and useful tool in future prospective and broader studies, since information bias regarding comorbidities may have been responsible for our results.Disclosure of Interests:Salomé Garcia: None declared, Bruno Miguel Fernandes: None declared, Georgina Terroso: None declared, Miguel Bernardes Speakers bureau: Abbvie, Amgen, Biogen, Eli-Lilly, Glaxo-Smith-Kline, Pfizer, Janssen, Novartis, Lúcia Costa: None declared

scholarly journals The Reproducibility of Patient Self-reported Joint Counts in Rheumatoid Arthritis: A Closer Look at the Results of a Review

2021 ◽  
pp. jrheum.210822
Author(s):  
Salima Francis Elisabeth van Weely
Keyword(s):  
Quality Of Life ◽  
Rheumatoid Arthritis ◽  
Disease Activity ◽  
Systematic Evaluation ◽  
Treat To Target ◽  
Disease Remission ◽  
Remote Care

In the management of rheumatoid arthritis (RA), the systematic evaluation of disease activity is of paramount importance. It is the cornerstone of the "treat-to-target" approach, aiming at disease remission and optimization of quality of life.1 In times of increasing delivery of remote care, accelerated due to the coronavirus disease 2019 (COVID-19) pandemic, the role of patients in the monitoring of disease activity becomes more topical.

Role of contextual factors in health-related quality of life in ankylosing spondylitis

2009 ◽  
Vol 69 (01) ◽  
pp. 108-112 ◽  
Author(s):  
V S Gordeev ◽  
W P Maksymowych ◽  
S M A A Evers ◽  
A Ament ◽  
L Schachna ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Ankylosing Spondylitis ◽  
Disease Activity ◽  
Contextual Factors ◽  
Health Related Quality ◽  
Related Quality ◽  
Health Related ◽  
The Impact

Background:In the bio-psycho-social model of health, the role of contextual factors, either environmental or personal, is recognised.Objective:To assess the impact of a number of contextual factors on self-reported disease-specific and generic health-related quality of life in patients with ankylosing spondylitis (AS).Methods:522 patients with AS from Canada and Australia completed a postal questionnaire including sociodemographic variables, disease activity (Bath Ankylosing Spondylitis Disease Activity Index (BASDAI)) function (Bath Ankylosing Spondylitis Functional Index (BASFI)) health-related quality of life (ASQoL and EQ-5D) and Rheumatoid Attitudes Index Helplessness Subscale. The contribution of contextual factors (nationality, ethnicity, marital status, education, employment and helplessness) in addition to functioning and disability (BASDAI and BASFI) to health-related quality of life was analysed using multivariate regression analyses. Interactions between contextual variables were explored.Results:Contextual factors explained 37% and 47% of the variance in EQ-5D and ASQoL, respectively. Helplessness and employment were the most important contextual factors. Their role was independent of the strong effect of disease activity (BASDAI) and functional limitations (BASFI). When ASQoL was the outcome, an interaction was seen between employment and education and when EQ-5D was the outcome, an interaction was seen between helplessness and education.Conclusions:Of the contextual factors explored in this study, helplessness and employment had an important and independent contribution to health-related quality of life. In patients with lower education, the effect of not being employed on ASQoL and the effect of helplessness on EQ-5D were stronger. Contextual factors, especially helplessness and employment, should receive more attention when interpreting data on health-related quality of life.

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