scholarly journals Call for action: incorporating wellness practices into a holistic management plan for rheumatoid arthritis—going beyond treat to target

RMD Open ◽  
2021 ◽  
Vol 7 (3) ◽  
pp. e001959
Author(s):  
Peter C. Taylor ◽  
Mart Van de Laar ◽  
Andrew Laster ◽  
Walid Fakhouri ◽  
Amanda Quebe ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Pain Control ◽  
Social Connectedness ◽  
Management Plan ◽  
Treat To Target ◽  
Pharmacological Agents ◽  
Holistic Management ◽  
Patient Reported ◽  
The Individual ◽  
Busy Clinical Setting

This expert opinion article explores the strategy of adopting a holistic approach to the management of rheumatoid arthritis (RA) by incorporating the wellness practices of exercise, optimised sleep, optimised nutrition, mindfulness, social connectedness and positive emotions into the management plan. The aim is to attain optimal health for each patient beyond that achievable by limiting disease management to pharmacological treatment to attain the lowest achievable composite scores of disease activity, as recommended with the current treat-to-target approach, and addressing the recent recognition of pain control as a key patient-reported outcome. Incorporating wellness practices into a busy clinical setting requires creativity and customisation based on the individual practice setting and the individual needs of each patient. Such practices can help people living with RA to achieve optimum wellness through the introduction of measures—according to individual need—designed to improve the aspects of life most impacted for that person, thereby complementing treat-to-target and pain control strategies with pharmacological agents. Clinicians must consider wellness practices in addition to treat-to-target pharmacological agents for the holistic management of people with RA.

Early Remission Is a Realistic Target in a Majority of Patients with DMARD-naive Rheumatoid Arthritis

2016 ◽  
Vol 43 (4) ◽  
pp. 699-706 ◽  
Author(s):  
Tuomas Rannio ◽  
Juha Asikainen ◽  
Arto Kokko ◽  
Pekka Hannonen ◽  
Tuulikki Sokka
Keyword(s):  
Rheumatoid Arthritis ◽  
Disease Activity ◽  
Joint Disease ◽  
Treat To Target ◽  
Sustained Remission ◽  
Duration Of Symptoms ◽  
Erosive Disease ◽  
Rheumatology Clinic ◽  
Patient Reported ◽  
Remission Rates

Objective.We analyzed remission rates at 3 and 12 months in patients with rheumatoid arthritis (RA) who were naive for disease-modifying antirheumatic drugs (DMARD) and who were treated in a Finnish rheumatology clinic from 2008 to 2011. We compared remission rates and drug treatments between patients with RA and patients with undifferentiated arthritis (UA).Methods.Data from all DMARD-naive RA and UA patients from the healthcare district were collected using software that includes demographic and clinical characteristics, disease activity, medications, and patient-reported outcomes. Our rheumatology clinic applies the treat-to-target principle, electronic monitoring of patients, and multidisciplinary care.Results.Out of 409 patients, 406 had data for classification by the 2010 RA criteria of the American College of Rheumatology/European League Against Rheumatism. A total of 68% were female, and mean age (SD) was 58 (16) years. Respectively, 56%, 60%, and 68% were positive for anticyclic citrullinated peptide antibodies (anti-CCP), rheumatoid factor (RF), and RF/anti-CCP, and 19% had erosive disease. The median (interquartile range) duration of symptoms was 6 (4–12) months. A total of 310 were classified as RA and 96 as UA. The patients with UA were younger, had better functional status and lower disease activity, and were more often seronegative than the patients with RA. The 28-joint Disease Activity Score (3 variables) remission rates of RA and UA patients at 3 months were 67% and 58% (p = 0.13), and at 12 months, 71% and 79%, respectively (p = 0.16). Sustained remission was observed in 57%/56% of RA/UA patients. Patients with RA used more conventional synthetic DMARD combinations than did patients with UA. None used biological DMARD at 3 months, and only 2.7%/1.1% of the patients (RA/UA) used them at 12 months (p = 0.36).Conclusion.Remarkably high remission rates are achievable in real-world DMARD-naive patients with RA or UA.

scholarly journals Comparative analyses of responsiveness between the Rheumatoid Arthritis Impact of Disease score, other patient-reported outcomes and disease activity measures: secondary analyses from the ARCTIC study

RMD Open ◽  
2018 ◽  
Vol 4 (2) ◽  
pp. e000754 ◽  
Author(s):  
Karen Holten ◽  
Joseph Sexton ◽  
Tore K Kvien ◽  
Anna-Birgitte Aga ◽  
Espen A Haavardsholm
Keyword(s):  
Rheumatoid Arthritis ◽  
Disease Activity ◽  
Inflammatory Markers ◽  
Disease Duration ◽  
Treat To Target ◽  
Patient Reported ◽  
Short Disease Duration ◽  
Activity Measures ◽  
The Mean ◽  
Disease Activity Measures

ObjectiveTo evaluate the responsiveness of the Rheumatoid Arthritis Impact of Disease (RAID) score compared with other patient-reported outcome measures (PROMs), inflammatory markers and clinical disease activity measures in patients with early rheumatoid arthritis (RA).MethodsDisease-modifying antirheumatic drug–naïve patients with RA with short disease duration were included in the treat-to-target ARCTIC trial and followed for 24 months. The responsiveness of the RAID score was evaluated using standardised response mean (SRM) and relative efficiency (RE) with respect to tender joints by Ritchie Articular Index (RAI). SRMs and REs were also calculated for other PROMs, inflammatory markers and clinical outcome measures. An SRM with value above 0.80 was considered high.Results230 patients with RA were included. The mean±SD symptom duration was 7.1±5.4 months and the baseline mean±SD  RAID score was 4.49±2.14. At 3 months of follow-up, the mean±SD change score for RAID was −2.25±1.98  and the SRM (95%  CI) −1.13 (−1.33 to −0.96). The RAID score showed high responsiveness both at 3 and 6 months (SRM≥0.80) and was more sensitive in detecting change than the reference, tender joints assessed by RAI.ConclusionsThe RAID score proved to be highly responsive to change in patients with RA with short disease duration who followed a treat-to-target strategy. The RAID score was more efficient in detecting change than the reference (RAI) as well as most other PROMs.

scholarly journals Barriers to treatment optimization and achievement of patients’ goals: perspectives from people living with rheumatoid arthritis enrolled in the ArthritisPower registry

2020 ◽  
Vol 22 (1) ◽  
Author(s):  
Kelly Gavigan ◽  
W. Benjamin Nowell ◽  
Mylene S. Serna ◽  
Jeffrey L. Stark ◽  
Mohamed Yassine ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Disease Activity ◽  
Online Survey ◽  
Treatment Decisions ◽  
Treat To Target ◽  
Measurement Information ◽  
Treatment Goals ◽  
Barriers To Treatment ◽  
Treatment Optimization ◽  
Patient Reported

Abstract Background Few studies have investigated patients’ own treatment goals in rheumatoid arthritis (RA). The objective of this real-world, cross-sectional study of US patients with RA was to identify factors that patients believed influenced their physician’s treatment decisions. Secondary objectives included reasons patients tolerated sub-optimal disease control and their perceived barriers to treatment optimization. Methods Eligible participants were enrolled in the ArthritisPower registry, ≥ 19 years, had physician-diagnosed RA, unchanged treatment within 3 months of baseline, prior/current disease-modifying antirheumatic drug treatment (DMARDs), and computer/smartphone access. In December 2017, participants completed Patient-Reported Outcomes Measurement Information System-Computerized Adaptive Tests (PROMIS-CAT) for pain interference, fatigue, sleep disturbance, and physical function. Routine Assessment of Patient Index Data 3 (RAPID3) provided disease activity scores (0–30). Participants completed an online survey on barriers to treatment optimization, including self-perception of disease compared to RAPID3/PROMIS scores. Results A total of 249 participants met inclusion criteria and completed the survey. Mean age (SD) was 52 (11) years, and the majority were female (92%) with high RAPID3 disease activity (175/249 [70%]; median score 18). The main reason participants did not change treatment was their physician’s recommendation (66%; n = 32). Of participants with high RAPID3 disease activity, 66 (38%) were offered a treatment change; 19 (29%) of whom declined the change. Most participants who intensified treatment did so because their symptoms had remained severe or worsened (51%; n = 33); only 16 (25%) participants intensified because they had not reached a specified treatment goal. Among participants who self-reported their disease activity as “none/low” or “medium” (n = 202; 81% of cohort), most still had RAPID3 high disease activity (137/202 [68%]; score > 12). Most PROMIS scores showed moderate agreement with participants’ self-assessment of health status, in contrast to RAPID3 (weighted kappa: 0.05 [95% CI − 0.01, 0.11]). Conclusions Most participants trusted their rheumatologist’s treatment decisions and prioritized their physician’s treatment goals over their own. Patients should be encouraged to share their treatment goals/expectations with their rheumatologist, in line with the treat-to-target approach. RAPID3 may be inappropriate for setting patient-centric treatment goals given the poor agreement with self-reported disease activity; most PROMIS scores showed better alignment with patients’ own assessments.

scholarly journals POS1434 WHICH PROGNOSTIC FACTORS MIGHT PREDICT THE NEED FOR TREATMENT ADAPTATION IN EARLY RHEUMATOID ARTHRITIS? A COMPARISON OF MACHINE LEARNING, SURVIVAL ANALYSIS AND REGRESSION METHODS

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 1001.2-1002
Author(s):  
G. Verhavert ◽  
T. Verdonck ◽  
S. Pazmino ◽  
V. Stouten ◽  
D. Bertrand ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Statistical Model ◽  
Proportional Hazards ◽  
Predictive Performance ◽  
Cox Proportional Hazards ◽  
Data Driven ◽  
Treat To Target ◽  
Clinical Factors ◽  
Patient Reported ◽  
Random Survival Forest

Background:Current EULAR guidelines recommend treating RA early, intensively and to-target. A data-driven tool for planning the optimal moment for subsequent visits might adapt visit schedules more to the patient’s needs, without losing treatment quality.Objectives:To determine the optimal statistical model and clinical factors to predict the time to a treatment adaptation in early RA patients.Methods:This study included 379 patients from the treat-to-target Care in Rheumatoid Arthritis (CareRA) trial. The CareRA protocol included 2 predefined treatment adaptation steps for patients not reaching low disease activity (DAS28CRP<3.2). The 1st adaptation was an MTX dose increase and the second one was adding/increasing the dose of a 2nd csDMARD. Three predictive models (Cox Proportional Hazards, Linear Multi-Task Regression and Random Survival Forest) were trained and validated to predicting time until these 2 adaptations. Factor selection for these models was performed by applying Cox Proportional Hazards with LASSO penalty to each set of demographic and clinical variables recorded at baseline, w4 and w8. Models used these factors at these 3 time points to predict future treatment adaptations. Model performance was estimated by the Uno Concordance Index with five-fold cross-validation. Missing data were imputed by interpolation or mean score.Results:Factors selected to predict the first per protocol change included TJC, SJC, HAQ, CRP, pain and morning stiffness>15min. Factors selected to predict the second per protocol change included TJC, SJC, PGA, PhGA. Uno Concordance indices showed similar scores per different statistical model but higher scores at w4 and w8 compared to baseline indicating a better predictive performance (Table 1. next page).Table 1.Uno Concordance Scores. Format ‘mean (min-max)’.BaselineWeek 4Week 8Cox Proportional HazardsChange 10.63 (0.59-0.69)0.72 (0.68-0.80)0.75 (0.69-0.82)Change 20.58 (0.50-0.66)0.75 (0.65-0.87)0.78 (0.65-0.93)Linear Multi-Task RegressionChange 10.65 (0.62-0.68)0.72 (0.68-0.78)0.75 (0.69-0.79)Change 20.58 (0.51-0.68)0.72 (0.67-0.82)0.77 (0.68-0.89)Random Survival ForestChange 10.64 (0.58-0.67)0.71 (0.66-0.78)0.76 (0.68-0.80)Change 20.56 (0.50-0.68)0.72 (0.60-0.82)0.77 (0.64-0.92)Conclusion:Our data-driven approach identified predictive clinical factors with a high face validity including joint counts, functionality scores and global health indicators. The different model approaches did not seem to increase the predictive capacity performance. However, our results underline that not so much the baseline disease status but rather the early response to initial treatment reflected in the selected predictive factors can be used for prediction of the need for further treatment adaptation. These models will have to be enriched with patient reported outcomes to further improve predictive performance.Disclosure of Interests:None declared

scholarly journals AB1269 REGIONAL DIFFERENCES IN THE PATIENTS’ UNDERSTANDING OF TREATMENT STRATEGY IN RHEUMATOID ARTHRITIS

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 1925.3-1926
Author(s):  
C. Cobilinschi ◽  
M. Danila ◽  
D. Opris-Belinski ◽  
I. Saulescu ◽  
L. Groseanu ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Adverse Events ◽  
Disease Control ◽  
Regional Differences ◽  
College Education ◽  
Current Therapy ◽  
Treat To Target ◽  
Patient Reported ◽  
The Us ◽  
Risk Of Cancer

Background:The treat-to target (T2T) concept is the standard for treating rheumatoid arthritis (RA) patients worldwide1. However, difficulties that patients encounter in achieving disease control may differ between regions, which may impact the type of support needed for successful T2T implementation.Objectives:To compare differences in patient-reported challenges to controlling RA-related issues between Romanian and US patients.Methods:A cross-sectional study that recruited 403 RA patients was conducted in six centers in Romania. Patients were invited to complete an RA-related questionnaire. We compared their responses to those from a previous published study that included patients with RA from the US2. The survey included items on subjective beliefs about RA treatment (e.g. adherence, cost, adverse events) and knowledge about T2T strategy. Approval for US data use was given by the study coordinator2.Results:All patients in the Romanian cohort were Caucasian, with a mean age of 58.7 years (SD 11.6). 78% were females and the mean disease duration was 11.2 years (SD 8.3). Data was concordant with results from the previously published study. More patients from US had college education (60% vs 43.9%).Among the respondents, 93.3% Romanians were on a synthetic DMARD versus 97.7% Americans and 64.01% were currently on a biologic of choice compared to 74% patients in the US. More than half of the patients in both regions had a history of biologic DMARD use.Asked to grade (0very good, 10very bad) their disease activity on the survey day, a large category of patients (37.4%, SD 14.1) marked an average state (4-6), while 19.08% (SD 11.2) were feeling poorly related to their disease.Patients were asked to define their adherence to RA treatment in the last 30 days. While the US study reported that 93% of patients were adherent2, in our study only 62.5% of the Romanian patients reported adherence (p<0.01). A significantly lower proportion of Romanian patients were aware of T2T strategy (35 %, p 0.04).Regarding patient beliefs on their disease, statements were grouped into categories such as difficulty managing pain, medication safety, adherence, lifestyle. Most European patients would agree to change treatment to lower pain. Almost 82% stated they would accept rare adverse events in order to avoid invalidity, to confirm a better future outcome. US patients were more prone to stick to current therapy than escalade to increase clinical response. However, asked about novel therapies, Romanians were reluctant to changing treatment despite insufficient benefit, if the risk of cancer was noted. There was a high agreement that a delay in treatment would be unsatisfactory for both familial and professional chores.Conclusion:There are regional differences in knowledge and perceptions about RA treatment. Romanian patients know less on T2T algorithm. Improving awareness of the T2T strategy among RA patients may need different types of support depending on the patient’s place of residence.References:[1]Smolen, J. S.et al.EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs: 2016 update.Ann. Rheum. Dis.76,960–977 (2017).[2]Owensby, J. K.et al.Patient- and Rheumatologist- Perspectives Regarding Challenges to Achieving Optimal Disease Control in Rheumatoid Arthritis.Arthritis Care Res. (Hoboken).0–2 (2019).Disclosure of Interests:CLAUDIA COBILINSCHI Speakers bureau: novartis, Maria Danila Speakers bureau: as personally stated, Daniela Opris-Belinski Speakers bureau: as declared, Ioana Saulescu Speakers bureau: Eli-Lilly, Pfizer, Laura Groseanu Speakers bureau: novartis, eli-lilly, ucb, pfizer,sandoz, Sanziana Daia-Iliescu Speakers bureau: sandoz, Catalin Codreanu Consultant of: Speaker and consulting fees from AbbVie, Accord Healthcare, Alfasigma, Egis, Eli Lilly, Ewopharma, Genesis, Mylan, Novartis, Pfizer, Roche, Sandoz, UCB, Speakers bureau: Speaker and consulting fees from AbbVie, Accord Healthcare, Alfasigma, Egis, Eli Lilly, Ewopharma, Genesis, Mylan, Novartis, Pfizer, Roche, Sandoz, UCB, Razvan Ionescu Speakers bureau: as personally stated, Magda Parvu Consultant of: Speaker fee and consultant: Pfizer, Novartis, Roche, Abbvie, UCB, Eli-Lilly, Speakers bureau: Speaker fee and consultant: Pfizer, Novartis, Roche, Abbvie, UCB, Eli-Lilly, Horatiu Popoviciu Speakers bureau: as personally stated, CODRINA ANCUTA Consultant of: AbbVie, Pfizer, Roche, Novartis, UCB, Ewopharma, Merck Sharpe and Dohme, and Eli Lilly, Speakers bureau: AbbVie, Pfizer, Roche, Novartis, UCB, Ewopharma, Merck Sharpe and Dohme, and Eli Lilly, Elena Rezus: None declared, Claudia Mihailov Speakers bureau: as personally stated, Ruxandra Ionescu Consultant of: Consulting fees from Abbvie, Eli-Lilly, Novartis, Pfizer, Roche, Sandoz, Speakers bureau: Consulting and speaker fees from Abbvie, Eli-Lilly, Novartis, Pfizer, Roche, Sandoz

scholarly journals Improving Quality of Care in Rheumatoid Arthritis Through Mobile Patient-Reported Outcome Measurement: Focus Group Study

10.2196/15158 ◽  
2020 ◽  
Vol 4 (3) ◽  
pp. e15158
Author(s):  
Sonali Desai ◽  
Emma Stevens ◽  
Srinivas Emani ◽  
Peter Meyers ◽  
Maura Iversen ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Decision Making ◽  
Shared Decision Making ◽  
Outcome Measurement ◽  
Advisory Council ◽  
Treat To Target ◽  
Shared Decision ◽  
Office Visits ◽  
Patient Reported ◽  
Informal Feedback

Background Patient-reported outcomes (PROs) for chronic disease management can be integrated into the routine workflow by leveraging mobile technology. Objective The objective of our study was to describe the process of our quality improvement (QI) efforts using tablets for PRO collection in a busy, academic rheumatology practice to support a treat-to-target (TTT) approach for rheumatoid arthritis (RA) management. Methods Our QI team designed a process for routine collection of PROs for RA patients at the Arthritis Center, employing information technology and an electronic medical record (EMR) system. Patients received a tablet at the clinic check-in desk to complete the Routine Assessment of Patient Index Data 3 (RAPID3) survey, a validated RA PRO. RAPID3 scores were uploaded to the EMR in real time and available for use in shared decision making during routine office visits. Weekly data were collected on RAPID3 completion rates and shared with front desk staff and medical assistants to drive improvement. Patients in our patient family advisory council and focus groups provided informal feedback on the process. Results From May 1, 2017, to January 31, 2019, a total of 4233 RAPID3 surveys were completed by 1691 patients. The mean age of patients was 63 (SD 14) years; 84.00% (1420/1691) of the patients were female, and 83.00% (1403/1691) of the patients were white. The rates of RAPID3 completion increased from 14.3% (58/405) in May 2017 to 68.00% (254/376) in September 2017 and were sustained over time through January 2019. Informal feedback from patients was positive and negative, relating to the usability of the tablet and the way rheumatologists used and explained the RAPID3 data in shared decision making during the office visit. Conclusions We designed a sustainable and reliable process for collecting PROs from patients with RA in the waiting room and integrated these data through the EMR during office visits.

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