scholarly journals Factors associated with COVID-19-related death in people with rheumatic diseases: results from the COVID-19 Global Rheumatology Alliance physician-reported registry

2021 ◽  
pp. annrheumdis-2020-219498 ◽  
Author(s):  
Anja Strangfeld ◽  
Martin Schäfer ◽  
Milena A Gianfrancesco ◽  
Saskia Lawson-Tovey ◽  
Jean W Liew ◽  
...  
Keyword(s):  
Rheumatic Disease ◽  
Disease Activity ◽  
Rheumatic Diseases ◽  
Smoking Status ◽  
Disease Diagnosis ◽  
High Disease Activity ◽  
Disease Category ◽  
Logistic Regression Models ◽  
Factors Associated ◽  
Male Sex

ObjectivesTo determine factors associated with COVID-19-related death in people with rheumatic diseases.MethodsPhysician-reported registry of adults with rheumatic disease and confirmed or presumptive COVID-19 (from 24 March to 1 July 2020). The primary outcome was COVID-19-related death. Age, sex, smoking status, comorbidities, rheumatic disease diagnosis, disease activity and medications were included as covariates in multivariable logistic regression models. Analyses were further stratified according to rheumatic disease category.ResultsOf 3729 patients (mean age 57 years, 68% female), 390 (10.5%) died. Independent factors associated with COVID-19-related death were age (66–75 years: OR 3.00, 95% CI 2.13 to 4.22; >75 years: 6.18, 4.47 to 8.53; both vs ≤65 years), male sex (1.46, 1.11 to 1.91), hypertension combined with cardiovascular disease (1.89, 1.31 to 2.73), chronic lung disease (1.68, 1.26 to 2.25) and prednisolone-equivalent dosage >10 mg/day (1.69, 1.18 to 2.41; vs no glucocorticoid intake). Moderate/high disease activity (vs remission/low disease activity) was associated with higher odds of death (1.87, 1.27 to 2.77). Rituximab (4.04, 2.32 to 7.03), sulfasalazine (3.60, 1.66 to 7.78), immunosuppressants (azathioprine, cyclophosphamide, ciclosporin, mycophenolate or tacrolimus: 2.22, 1.43 to 3.46) and not receiving any disease-modifying anti-rheumatic drug (DMARD) (2.11, 1.48 to 3.01) were associated with higher odds of death, compared with methotrexate monotherapy. Other synthetic/biological DMARDs were not associated with COVID-19-related death.ConclusionAmong people with rheumatic disease, COVID-19-related death was associated with known general factors (older age, male sex and specific comorbidities) and disease-specific factors (disease activity and specific medications). The association with moderate/high disease activity highlights the importance of adequate disease control with DMARDs, preferably without increasing glucocorticoid dosages. Caution may be required with rituximab, sulfasalazine and some immunosuppressants.

scholarly journals POS0540 SEXUAL DYSFUNCTION IN MALE PATIENTS WITH RHEUMATIC DISEASES

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 504.1-504
Author(s):  
A. P. Stanciu ◽  
L. Groseanu ◽  
A. Balanescu ◽  
D. Predeteanu ◽  
D. Opris-Belinski ◽  
...  
Keyword(s):  
Sexual Dysfunction ◽  
Rheumatic Disease ◽  
Sexual Function ◽  
Disease Activity ◽  
Rheumatic Diseases ◽  
Disease Diagnosis ◽  
Sexual Life ◽  
Control Group ◽  
Healthy Controls ◽  
Male Patients

Background:Sexual health is an essential element of overall health and well-being. Rheumatic diseases may affect sexual functioning in many ways related to pain, fatigue, stiffness, functional impairment, depression, anxiety, negative body image, reduced libido, hormonal imbalance and drug treatment. However, these issues are rarely addressed in clinical practice.Objectives:The aim of this study was to evaluate sexual function in a cohort of men with rheumatic disease compared to healthy controls.Methods:This was an observational, single-center, cohort study conducted between august 2019 and march 2020 in the Rheumatology department of “Saint Mary” Clinical Hospital in Bucharest which included 120 men with ages between 18 and 60 years - 60 patients with rheumatic diseases and 60 healthy controls. The study tools were the Sexual Health Inventory for Men (SHIM) questionnaire and one questionnaire referring to personal data, history of the rheumatic disease, comorbidities, treatment and sexual impairment. Also, the disease activity was assessed using specific scores for each condition.Results:In this cohort of 60 patients, the mean age was 45.26 (7.8) years and the diagnoses wereankylosing spondylitis (AS) - 37%,psoriatic arthritis (PsA) - 18%, rheumatoid arthritis (RA) - 17%, systemic sclerosis (SS) - 15% and gout - 13%. More than half of the patients (62%) had active disease based on specific scores (ASDAS for AS, DAS28-CRP for RA, EScSG disease activity indices for SS, DAPSA for PsA). Regarding sexual life, this study showed a significant decrease in sexual life quality after rheumatic disease diagnosis(before diagnosis: 71,67% - satisfying and 16,67% - not satisfyingversus after diagnosis: 21,67% - satisfying and 68,33% - not satisfying). Most patients (90%) reported impairment of their sexual life after diagnosis. In terms of sexual dysfunction (SD), a significantly higher proportion of patients (40%) mentioned reduced libido compared to the control group (18,33%) (p=0.043). Also, 21,66% of the patients reported erectile dysfunction (ED) in comparison with only 8,33% in the control group (p=0.009). Most patients with AS, RA, PsA and gout had mild ED while most patients with SS presented with mild to moderate ED. Also, the SHIM score mean value was significantly lower in the study group (17,65)compared to the control group (20,15) (p=0.009). The importance of SD in this cohort is emphasized by the fact that only one patient conceived after rheumatic disease diagnosis. Concerning treatment, more than half of the patients (55%) reported no effect of the therapy on their sexual life while 38.33% mentioned that medication improved their sexual life and very few (7%) reported a worsening.Conclusion:This study revealed a higher prevalence of sexual dysfunction in male patients with rheumatic disease in comparison with healthy controls. Considering the importance of sexual and reproductive health, rheumatologists should approach this topic with their patients and offer them guidance.References:[1]AG Tristano, “The impact of rheumatic diseases on sexual function”, Rheumatol Int 2009 Jun;29(8):853-60Disclosure of Interests:None declared

scholarly journals POS1260 FACTORS ASSOCIATED WITH SEVERE SARS-COV-2 INFECTION IN PATIENTS WITH INFLAMMATORY RHEUMATIC DISEASES IN MADRID: RESULTS FROM REUMA-COVID SORCOM REGISTRY

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 914-914
Author(s):  
A. Boteanu ◽  
A. García Fernández ◽  
N. De la Torre ◽  
M. Pavia Pascual ◽  
O. Sanchez Pernaute ◽  
...  
Keyword(s):  
High Risk ◽  
Rheumatic Diseases ◽  
Connective Tissue Diseases ◽  
Severe Infection ◽  
Pulmonary Involvement ◽  
Inflammatory Rheumatic Diseases ◽  
Factors Associated ◽  
Risk Of Death ◽  
Cardiovascular Comorbidities ◽  
Male Sex

Background:Patients with inflammatory rheumatic diseases (IRD) infected with SARS-CoV-2 may be at risk to develop a severe course of COVID-19 due to the immune dysregulation or the influence of immunomodulating drugs on the course of the infection. For a better understanding of SARS-CoV-2 infections in patients with IRD and due to the high incidence of COVID-19 in Madrid from the beginning of this pandemic infection in Spain, the Society of Rheumatology from Madrid (SORCOM) established a registry (REUMA-COVID SORCOM) shortly after the beginning of the pandemic in Spain.Objectives:To determine factors associated with severity of infection with SARS-CoV-2 in patients with inflammatory rheumatic diseases in MadridMethods:The REUMA-COVID SORCOM registry is a multicenter, retrospective, observational cohort study conducted in Madrid, a SORCOM initiative. All rheumatology departments from Madrid were invited to participate. The study includes patients with IRD presenting with a confirmed or highly suspected diagnosis of COVID-19 between March 1, 2020, and November 10, 2020. We consider severe infection death or need of hospitalization. Inclusion criteria was having an IRD and at least 1 of the following 4 criteria: (1) a biologically confirmed COVID-19 diagnosis based on a positive result of a SARS-CoV-2 polymerase chain reaction (PCR) test on a nasopharyngeal swab; (2) Detection of IgM or IgG anti SARS-CoV2 in a symptomatic or asymptomatic patients (3)typical thoracic computed tomography (CT) abnormalities (ground-glass opacities) in epidemic areas; (4) COVID19–typical symptoms in an epidemic zone of COVID-19.Results:As of November 10, 2020, 417 patients with IRD were included in the REUMA-COVID SORCOM registry. 5 patients were discharged for incomplete data. Of 412 patients (mean age 57 years, 87.4% Caucasian race, 66.3% female) 174 need hospitalization (42.2%) and 33 patients died (18.4% mortality in hospitalized patients). 82.3% had comorbidities. 234 (56.8%) patients were classified as inflammatory arthropathy, 133 (32.3%) had connective tissue diseases (CTD). 41.1% of the patients had a large history of IRD (> 10 years). 10.4% of patients had previously pulmonary involvement. The study includes 143 patients taking Methotrexate, 89 patients taking anti-TNFα therapy and 27 Rituximab. In the univariant analysis, no differences were seen in the severity of COVID-19 infection in patients taking methotrexate. 63% of the all patients taking Rituximab included in the registry need hospitalization and 22% of them died. Hypertension, COPD or cardiovascular disease was associated with hospitalization.Independent factors associated with COVID-19 hospitalization in the multivariate analysis was: age (>62 years), male sex, IMC >30, previous cardiovascular comorbidities and the IRD disease duration (> 10 years). Independent factors associated with COVID-19 related death was: age (> 62 years), having a CTD diagnose, pulmonary involvement before infection and chronical GC treatment.Conclusion:Patients with IRD represent a population of particular interest in the pandemic context because the baseline immunological alteration and the treated with immunosuppressants agents they receive, comorbidities and the well-known risk of severe infection. Older age, male sex, cardiovascular comorbidities were factors associated with high risk of hospitalization in IRD patients. CTD diseases, previously pulmonary involvement and chronical GC treatment with more than 10mg/day were associated with high risk of death. Neither anti TNF-α treatment nor Methotrexate were risk factor for hospitalization or death COVID-19 related in IRD patients.Disclosure of Interests:None declared

scholarly journals Effectiveness of Rituximab for the Treatment of Rheumatoid Arthritis in Patients with Prior Exposure to Anti-TNF: Results from the CORRONA Registry

2015 ◽  
Vol 42 (7) ◽  
pp. 1090-1098 ◽  
Author(s):  
Leslie R. Harrold ◽  
George W. Reed ◽  
Ashwini Shewade ◽  
Robert Magner ◽  
Katherine C. Saunders ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Disease Activity ◽  
Activity Index ◽  
Disease Activity Index ◽  
Clinical Effectiveness ◽  
High Disease Activity ◽  
Low Disease Activity ◽  
Logistic Regression Models ◽  
Lower Baseline ◽  
Previously Treated

Objective.To characterize the real-world effectiveness of rituximab (RTX) in patients with rheumatoid arthritis.Methods.Clinical effectiveness at 12 months was assessed in patients who were prescribed RTX based on the Clinical Disease Activity Index (CDAI). Change in CDAI was calculated (CDAI at 12 mos minus at initiation). Achievement of remission or low disease activity (LDA; CDAI ≤ 10) among those with moderate/high disease activity at the time of RTX initiation was compared based on prior anti-tumor necrosis factor agent (anti-TNF) use (1 vs ≥ 2) using logistic regression models.Results.Patients (n = 265) were followed for 12 months with a mean change in CDAI of −8.1 (95% CI −9.8 – −6.4). Of the 218 patients with moderate/high disease activity at baseline, patients with 1 prior anti-TNF (baseline CDAI 25.0) demonstrated a mean change in CDAI of −10.1 (95% CI −13.2 – −7.0); patients with ≥ 2 prior anti-TNF (baseline CDAI 30.0) demonstrated a mean change of −10.5 (95% CI −12.9 – −8.0). The unadjusted OR for achieving LDA/remission in patients with moderate/high disease activity at baseline exposed to ≥ 2 versus 1 prior anti-TNF was 0.40 (95% CI 0.22–0.73), which was robust to 4 different adjusted models (OR range 0.38–0.44).Conclusion.A good clinical response was observed in all patients; however, patients previously treated with 1 anti-TNF, who had lower baseline CDAI and a greater opportunity for clinical improvement compared with patients previously treated with ≥ 2 anti-TNF, were more likely to achieve LDA/remission.

scholarly journals Awareness and interest in IQOS heated tobacco products among youth in Canada, England and the USA

2019 ◽  
Vol 29 (1) ◽  
pp. 89-95 ◽  
Author(s):  
Christine D Czoli ◽  
Christine M White ◽  
Jessica L Reid ◽  
Richard J OConnor ◽  
David Hammond
Keyword(s):  
Smoking Status ◽  
International Markets ◽  
Tobacco Products ◽  
Web Based ◽  
Logistic Regression Models ◽  
The Usa ◽  
History Of ◽  
Male Sex ◽  
Current Tobacco ◽  
Very High

IntroductionHeated tobacco products (HTPs), such as IQOS, have been introduced in a growing number of international markets. However, little is known about perceptions of HTP products among youth.MethodsData are from wave 1 of the International Tobacco Control Youth Tobacco and E-cigarette Survey (2017), a web-based cohort survey of people aged 16–19 years from Canada, England and the USA. Respondents (n=12 064) were shown an image of IQOS and asked about their awareness, interest in trying and susceptibility to trying the product. Youth awareness, interest in trying and susceptibility to trying IQOS were analysed using descriptive statistics, and logistic regression models were used to examine correlates of these outcomes.ResultsOverall, 7.0% of youth reported awareness of IQOS (England=5.6%, Canada=6.4% and USA=9.1%) and 38.6% expressed interest in trying the product (England=41.8%, Canada=33.0% and USA=40.9%). Within each country, all key outcomes varied by smoking status: greater proportions of youth who were currently smoking or had a history of smoking reported being aware of, interested in trying and susceptible to trying IQOS. Interest and susceptibility to trying IQOS were associated with male sex, current tobacco use and current e-cigarette use. Across all countries, susceptibility to trying IQOS (25.1%) was higher than for tobacco cigarettes (19.3%), but lower than for e-cigarettes (29.1%).ConclusionsAwareness of HTPs, such as IQOS, is emerging among youth in Canada, England and the USA. Interest in trying these products is very high among smokers, but also present among non-smokers.

scholarly journals Role of targeted therapies in rheumatic patients on COVID-19 outcomes: results from the COVIDSER study

RMD Open ◽  
2021 ◽  
Vol 7 (3) ◽  
pp. e001925
Author(s):  
Jose María Álvaro Gracia ◽  
Carlos Sanchez-Piedra ◽  
Javier Manero ◽  
María Ester Ruiz-Lucea ◽  
Laura López-Vives ◽  
...  
Keyword(s):  
Rheumatic Disease ◽  
Rheumatic Diseases ◽  
Targeted Therapies ◽  
Disease Diagnosis ◽  
Sociodemographic Factors ◽  
Inflammatory Rheumatic Diseases ◽  
Increased Risk ◽  
Related Hospitalisation ◽  
Observational Cohort ◽  
Synthetic Dmards

ObjectivesTo analyse the effect of targeted therapies, either biological (b) disease-modifying antirheumatic drugs (DMARDs), targeted synthetic (ts) DMARDs and other factors (demographics, comorbidities or COVID-19 symptoms) on the risk of COVID-19 related hospitalisation in patients with inflammatory rheumatic diseases.MethodsThe COVIDSER study is an observational cohort including 7782 patients with inflammatory rheumatic diseases. Multivariable logistic regression was used to estimate ORs and 95% CIs of hospitalisation. Antirheumatic medication taken immediately prior to infection, demographic characteristics, rheumatic disease diagnosis, comorbidities and COVID-19 symptoms were analysed.ResultsA total of 426 cases of symptomatic COVID-19 from 1 March 2020 to 13 April 2021 were included in the analyses: 106 (24.9%) were hospitalised and 19 (4.4%) died. In multivariate-adjusted models, bDMARDs and tsDMARDs in combination were not associated with hospitalisation compared with conventional synthetic DMARDs (OR 0.55, 95% CI 0.24 to 1.25 of b/tsDMARDs, p=0.15). Tumour necrosis factor inhibitors (TNF-i) were associated with a reduced likelihood of hospitalisation (OR 0.32, 95% CI 0.12 to 0.82, p=0.018), whereas rituximab showed a tendency to an increased risk of hospitalisation (OR 4.85, 95% CI 0.86 to 27.2). Glucocorticoid use was not associated with hospitalisation (OR 1.69, 95% CI 0.81 to 3.55). A mix of sociodemographic factors, comorbidities and COVID-19 symptoms contribute to patients’ hospitalisation.ConclusionsThe use of targeted therapies as a group is not associated with COVID-19 severity, except for rituximab, which shows a trend towards an increased risk of hospitalisation, while TNF-i was associated with decreased odds of hospitalisation in patients with rheumatic disease. Other factors like age, male gender, comorbidities and COVID-19 symptoms do play a role.

scholarly journals Characteristics associated with hospitalisation for COVID-19 in people with rheumatic disease: data from the COVID-19 Global Rheumatology Alliance physician-reported registry

2020 ◽  
Vol 79 (7) ◽  
pp. 859-866 ◽  
Author(s):  
Milena Gianfrancesco ◽  
Kimme L Hyrich ◽  
Sarah Al-Adely ◽  
Loreto Carmona ◽  
Maria I Danila ◽  
...  
Keyword(s):  
Rheumatic Disease ◽  
Kinase Inhibitors ◽  
Smoking Status ◽  
Case Series ◽  
Disease Diagnosis ◽  
Janus Kinase ◽  
Prednisone Dose ◽  
Janus Kinase Inhibitors ◽  
Factor Inhibitor ◽  
Necrosis Factor

ObjectivesCOVID-19 outcomes in people with rheumatic diseases remain poorly understood. The aim was to examine demographic and clinical factors associated with COVID-19 hospitalisation status in people with rheumatic disease.MethodsCase series of individuals with rheumatic disease and COVID-19 from the COVID-19 Global Rheumatology Alliance registry: 24 March 2020 to 20 April 2020. Multivariable logistic regression was used to estimate ORs and 95% CIs of hospitalisation. Age, sex, smoking status, rheumatic disease diagnosis, comorbidities and rheumatic disease medications taken immediately prior to infection were analysed.ResultsA total of 600 cases from 40 countries were included. Nearly half of the cases were hospitalised (277, 46%) and 55 (9%) died. In multivariable-adjusted models, prednisone dose ≥10 mg/day was associated with higher odds of hospitalisation (OR 2.05, 95% CI 1.06 to 3.96). Use of conventional disease-modifying antirheumatic drug (DMARD) alone or in combination with biologics/Janus Kinase inhibitors was not associated with hospitalisation (OR 1.23, 95% CI 0.70 to 2.17 and OR 0.74, 95% CI 0.37 to 1.46, respectively). Non-steroidal anti-inflammatory drug (NSAID) use was not associated with hospitalisation status (OR 0.64, 95% CI 0.39 to 1.06). Tumour necrosis factor inhibitor (anti-TNF) use was associated with a reduced odds of hospitalisation (OR 0.40, 95% CI 0.19 to 0.81), while no association with antimalarial use (OR 0.94, 95% CI 0.57 to 1.57) was observed.ConclusionsWe found that glucocorticoid exposure of ≥10 mg/day is associated with a higher odds of hospitalisation and anti-TNF with a decreased odds of hospitalisation in patients with rheumatic disease. Neither exposure to DMARDs nor NSAIDs were associated with increased odds of hospitalisation.

scholarly journals Storage Conditions of Immunobiologicals and their Influence on the Efficacy and Safety in the Treatment of Autoimmune Rheumatic Diseases

2020 ◽  
Vol 14 (1) ◽  
pp. 1-6
Author(s):  
Tássia Moraes de Assis Damasce ◽  
Vander Fernand ◽  
Cristhiane Almeida Leite da Silva ◽  
Ageo Mario Candido da Silva ◽  
Luciana Carolina Ishikawa Cezar Santo ◽  
...  
Keyword(s):  
Rheumatic Disease ◽  
Disease Activity ◽  
Rheumatic Diseases ◽  
Storage Temperature ◽  
Efficacy And Safety ◽  
Mato Grosso ◽  
Temperature Range ◽  
Autoimmune Rheumatic Diseases ◽  
Autoimmune Rheumatic Disease ◽  
Rheumatic Disease Activity

Objective: The study aimed to evaluate the influence of storage temperature on immunobiological efficacy and safety in autoimmune rheumatic disease treatment. Methods: This observational study included adult patients with autoimmune rheumatic diseases who used immunobiologicals stored at home and were followed up at the rheumatology outpatient clinic of the General University Hospital of Cuiabá, Mato Grosso, Brazil, in 2017/2018. Patients were evaluated regarding disease activity and occurrence of adverse events, and a household survey of the temperature of the storage environment of these drugs was conducted. Results: Sixty patients with a mean age of 50.4 years were evaluated. Of these, 39 patients (65%) stored their biological drugs outside the recommended temperature range. Storage of the immunobiological at the incorrect temperature was 76% higher among patients with moderate/high rheumatic disease activity (p=0.003). Conclusion: Most patients stored their immunobiologicals outside the temperature range recommended in the package insert, and there was an association between incorrect storage temperature and moderate/high autoimmune rheumatic disease activity.

scholarly journals P60 Daily fluctuations in fatigue severity and C-reactive protein in people with rheumatic diseases

Rheumatology ◽  
2020 ◽  
Vol 59 (Supplement_2) ◽  
Author(s):  
Katie L Druce ◽  
David S Gibson ◽  
Keven McEleney ◽  
Stephanie Meleck ◽  
Ben James ◽  
...  
Keyword(s):  
Rheumatic Diseases ◽  
Disease Diagnosis ◽  
Pain Severity ◽  
Ordinal Scale ◽  
C Reactive Protein ◽  
Logistic Regression Models ◽  
Reactive Protein ◽  
Ordered Logistic Regression ◽  
Fatigue Severity ◽  
Active Inflammation

Abstract Background Fluctuations in fatigue severity are common in people with inflammatory (e.g. rheumatoid arthritis (RA)) and non-inflammatory (e.g. fibromyalgia (FM) and osteoarthritis (OA)) rheumatic diseases. We tested whether fluctuations in fatigue in RA, OA and FM were explained by fluctuations in inflammation (C-reactive protein (CRP)), pain and mood. Methods Participants in the GIRAF (Gaining Insight into RheumAtic Fatigue) study used a patient co-configured app to report fatigue severity, pain severity and mood on a 5-point ordinal scale (increasing scores = worse state) twice daily for 7 days. Daily CRP (mg/L) was measured via dried blood spot sampling. Fluctuations in fatigue were calculated as within-day (morning to evening variability) and between-days (morning to morning; evening to evening variability). Multi-level mixed effects ordered logistic regression models tested the relationship between fluctuations in CRP and fatigue over 7 days. The relationships between fluctuations in fatigue, pain and mood were also examined. Models were adjusted for age, sex and disease diagnosis. Results Thirty-eight people (RA:12, OA:13, FM:13) participated and contributed data on 190 (71% of eligible) days. Participants were mostly female (81.6%), with a median age of 56 years. There were no demographic differences between disease groups. Within-day changes in fatigue severity of ≥one point were observed on 97 (51.1%) days and between-days changes were observed on 52% of mornings (92/177 eligible periods) and 49.4% of evenings (85/172 eligible). Fluctuations in pain severity and mood of ≥one point were similarly common (data not shown). Median CRP levels were low (<5mg/L) across all diseases and did not fluctuate substantially between days (change ≥1mg/L:17.5% (33/189) of days). 8 participants (21.1%: RA:4, OA:2, FM:2) had “active inflammation” (CRP>5mg/L) on a total 22 (8.3%) days in the study (range:1-8 days). Fluctuations in CRP were not associated with fluctuations in fatigue (odds-ratio:1.01, 95%CI:0.83-1.22). Fluctuations in pain severity (6.93, 4.68-10.28) and mood (4.58, 3.26-6.45) were associated with fluctuations in fatigue (Table 1). Conclusion Fluctuations in fatigue severity were common in people with rheumatic diseases. Inflammation was low and did not predict fatigue variability. Optimal management should target fatigue independently of inflammatory disease management and may benefit from modification of pain and mood. Disclosures K.L. Druce None. D.S. Gibson None. K. McEleney None. S. Meleck None. B. James None. B. Hellman None. W.G. Dixon None. J. Mcbeth None.

Patient-acceptable Symptom State as an Outcome Measure in the Daily Care of Patients with Ankylosing Spondylitis

2012 ◽  
Vol 39 (7) ◽  
pp. 1424-1432 ◽  
Author(s):  
CARLOS RODRÍGUEZ-LOZANO ◽  
MARÍA-ÁNGELES GANTES ◽  
BEATRIZ GONZÁLEZ ◽  
JOSÉ A. HERNÁNDEZ-BERIAIN ◽  
ANTONIO NARANJO ◽  
...  
Keyword(s):  
Ankylosing Spondylitis ◽  
Disease Activity ◽  
Outcome Measures ◽  
Global Assessment ◽  
Daily Practice ◽  
High Disease Activity ◽  
Anxiety And Depression ◽  
Factors Associated ◽  
Patient Reported ◽  
Patient Acceptable Symptom State

Objective.We assessed the prevalence of patients with ankylosing spondylitis (AS), rating their state as acceptable (patient-acceptable symptom state; PASS), among 190 patients with AS seen in daily practice. Factors associated with PASS status and PASS thresholds for outcome measures were also analyzed.Methods.The characteristics of patients with affirmative and negative assignment to PASS were compared. Associated factors were estimated by logistic regression models and PASS thresholds by the 75th percentile and receiver-operating characteristic curve methods.Results.A total of 77% of patients rated their state as acceptable (95% CI 62–91). These patients were taking fewer nonsteroidal antiinflammatory drugs and corticosteroids, practiced more exercise, had less anxiety and depression, and had lower values of all patient-reported outcome measures, physicians’ assessment, AS Disease Activity Score (ASDAS) and C-reactive protein. Lower values of Bath AS Disease Activity Index and physician’s global assessment were independent factors associated with acceptable symptom state. High rates of anxiety and depression were found in patients not in PASS. The thresholds with the 75th percentile approach were 4.55 for the BASDAI and 2.84 for the ASDAS. Fifty-three percent of patients in PASS had a high or very high disease activity state according to ASDAS cutoff values.Conclusion.A high percentage of patients with AS in daily practice declared that their symptom state was acceptable. PASS status correlated with physician global assessment and BASDAI. PASS thresholds for common recommended outcome measures were relatively high and many patients in PASS had unacceptably high disease activity states according to ASDAS. Other factors such as psychological problems may influence a negative PASS state.

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