6ER-027 Improvement in self-management of biological DMARDS for patients with chronic inflammatory arthritis when a pharmacist participates in a multidisciplinary consultation

Abstract Purpose of the review Pain in chronic inflammatory joint diseases is a common symptom reported by patients. Pain becomes of absolute clinical relevance especially when it becomes chronic, i.e., when it persists beyond normal healing times. As an operational definition, pain is defined chronic when it lasts for more than 3 months. This article aims to provide a review of the main mechanisms underlying pain in patients with chronic inflammatory joint diseases, discussing in particular their overlap. Recent findings While it may be intuitive how synovial inflammation or enthesitis are responsible for nociceptive pain, in clinical practice, it is common to find patients who continue to complain of symptoms despite optimal control of inflammation. In this kind of patients at the genesis of pain, there may be neuropathic or nociplastic mechanisms. Summary In the context of chronic inflammatory joint diseases, multiple mechanisms generally coexist behind chronic pain. It is the rheumatologist’s task to identify the mechanisms of pain that go beyond the nociceptive mechanisms, to adopt appropriate therapeutic strategies, including avoiding overtreatment of patients with immunosuppressive drugs. In this sense, future research will have to be oriented to search for biomarkers of non-inflammatory pain in patients with chronic inflammatory joint diseases.

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Methotrexate and glucocorticoids, but not anticytokine therapy, impair the immunogenicity of a single dose of the BNT162b2 mRNA COVID-19 vaccine in patients with chronic inflammatory arthritis

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2021-220862 ◽

2021 ◽

pp. annrheumdis-2021-220862

Author(s):

Serena Bugatti ◽

Ludovico De Stefano ◽

Silvia Balduzzi ◽

Maria Immacolata Greco ◽

Terenzj Luvaro ◽

...

Keyword(s):

Single Dose ◽

Inflammatory Arthritis ◽

Chronic Inflammatory Arthritis ◽

Anticytokine Therapy

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Effectiveness of self-management interventions in inflammatory arthritis: a systematic review informing the 2021 EULAR recommendations for the implementation of self-management strategies in patients with inflammatory arthritis

RMD Open ◽

10.1136/rmdopen-2021-001647 ◽

2021 ◽

Vol 7 (2) ◽

pp. e001647

Author(s):

Andréa Marques ◽

Eduardo Santos ◽

Elena Nikiphorou ◽

Ailsa Bosworth ◽

Loreto Carmona

Keyword(s):

Systematic Review ◽

Full Text ◽

Inflammatory Arthritis ◽

Data Extraction ◽

Management Strategies ◽

Psychosocial Interventions ◽

Behavioural Therapy ◽

Self Management ◽

Cochrane Library ◽

Management Interventions

ObjectiveTo perform a systematic review (SR) on the effectiveness of self-management interventions, in order to inform the European League Against Rheumatism Recommendations for its implementation in patients with inflammatory arthritis (IA).MethodsThe SR was conducted according to the Cochrane Handbook and included adults (≥18 years) with IA. The search strategy was run in Medline through PubMed, Embase, Cochrane Library, CINAHL Plus with Full Text, and PEDro. The assessment of risk of bias, data extraction and synthesis were performed by two reviewers independently. A narrative Summary of Findings was provided according to the Grading of Recommendations, Assessment, Development and Evaluation.ResultsFrom a total 1577 references, 57 were selected for a full-text review, and 32 studies fulfilled the inclusion criteria (19 randomised controlled trials (RCTs) and 13 SRs). The most studied self-management components were specific interactive disease education in ten RCTs, problem solving in nine RCTs, cognitive–behavioural therapy in eight RCTs, goal setting in six RCTs, patient education in five RCTs and response training in two RCTs. The most studied interventions were multicomponent or single exercise/physical activity in six SRs, psychosocial interventions in five SRs and education in two SRs. Overall, all these specific components and interventions of self-management have beneficial effects on IAs-related outcomes.ConclusionsThe findings confirm the beneficial effect of the self-management interventions in IA and the importance of their implementation. Further research should focus on the understanding that self-management is a complex intervention to allow the isolation of the effectiveness of its different components.

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