Scandinavian journal of rheumatology. Supplement最新文献

Morning stiffness has been recognized in traditional approaches to assessment of disease activity in rheumatoid arthritis (RA). Although morning stiffness is not specific to RA, changes in morning stiffness for an individual patient are helpful when monitoring health status. Health professionals can ask about morning stiffness but the most accurate and consistent approach to assessment from one visit to the next appears to be a patient self-report questionnaire. However, quantitative measures of patient-reported data are not an integral part of clinical monitoring in most clinics. No single measure is adequate for all individual patients, so quantitative measurement of patient-reported data should include many elements such as pain, functional status, fatigue, sleep, morning stiffness, work capacity, and physical and emotional well-being. In daily clinical practice, patient-reported outcomes can be collected easily using a standard questionnaire that patients can complete with pencil and paper or electronically on a touch screen in the waiting room. The results are then immediately available to the rheumatologists, to facilitate doctor-patient communication to improve the quality of patient care, leading to better patient outcomes.

Morning joint stiffness and pain are prominent features in patients suffering from rheumatoid arthritis (RA) and contribute to impaired function. A survey was conducted across 11 European countries to assess the impact of impaired morning function on patients' quality of life. A total of 518 rheumatologists, and 750 patients aged 18-75 years with RA for ≥ 6 months and impaired morning function at least three times a week, completed the structured questionnaires. Impaired morning function was defined as 'stiffness and pain in the joints first thing in the morning that results in difficulty to function or perform tasks'. The mean duration of morning stiffness and pain was 83 min according to patients, slightly longer than that estimated by rheumatologists (70 min). Impaired morning function lasting more than 30 min/day was reported by 75% of patients, with 76% of rheumatologists estimating this duration for their patients. Most respondents (82% of patients and 96% of rheumatologists) considered that impaired morning function had a significant effect on patient quality of life. Around two-thirds of patients reported changes in how they carry out usual morning activities. Patients who were unable to function normally in the morning reported feeling frustrated (58%) and angry (32%). Almost one in five patients in the survey (18%) was unable to work as a direct result of their RA. Of the 274 patients included in the survey who were in paid work, 73% reported that impaired morning function had a significant impact on their job; 40% missed time from work in the past 6 months due to impairment in morning function, resulting in a mean of 4.5 days lost from work/employed person. In conclusion, the survey shows that impaired morning function has a considerable impact on the lives and well-being of patients with RA.

Patients with rheumatoid arthritis (RA) commonly experience morning symptoms of joint stiffness and pain that result in impaired function. However, current treatment options are limited. The management of impaired morning function is based primarily on non-pharmacological approaches, including simple or short exercises, application of heat or a hot shower or bath, and delaying activities until later in the day. Although it seems that the majority of patients follow the management advice they are given by rheumatologists, symptoms persist. In recent years, only a minority of clinical studies have assessed the impact on morning symptoms of pharmacological treatments for RA. The paucity of data makes it difficult to evaluate systematically the ability of current treatments to improve morning function. However, treatment seems to be suboptimal; in a pan-European survey of 518 rheumatologists, 61% considered that current treatment options do not address impaired morning function specifically, and 68% considered there is a need for new treatment options. Understanding the pathophysiology of circadian symptoms may provide the key to improving treatment of impaired morning function. In patients with morning symptoms of RA, there may be insufficient endogenous cortisol released during the night to counter elevated levels of the pro-inflammatory cytokine, interleukin (IL)-6. Delivering exogenous glucocorticoid during the night was found to reduce IL-6 levels and reduce morning stiffness, but was inconvenient for patients. However, this chronotherapeutic approach has now been facilitated by the development of modified-release prednisone tablets. Taken at bedtime (approximately 10:00 pm), these tablets give programmed delivery of prednisone around 4 h later, at the optimal time to suppress IL-6. Clinical studies suggest that morning stiffness in patients with RA could be treated successfully with the use of low-dose modified-release prednisone.

Objective: The aim of this study was to determine the monetary equivalent of the emotional and functional impact of morning stiffness (MS) in patients with rheumatoid arthritis (RA), using alternative valuing methods.

Methods: Telephone interviews were conducted among 166 patients with RA to assess utility and clinical symptoms, including MS. Three standard economic methods were used: the human capital approach (HCA), marginal value of time (MVT), and willingness-to-pay (WTP).

Results: The monetary equivalent of the impact of MS varied with the method used (from EUR 5.74 to EUR 17.87 per patient per day) and severity of MS (5-8-fold higher in patients with severe MS compared with mild MS). Patients placed considerable value on a reduction in duration and severity of MS. Patients with MS lasting an hour or more were willing to pay EUR 21.74/day to stop the symptom and EUR 10.63/day to halve the duration. Patients with severe MS were willing to pay EUR 47.86/day to stop the symptom and EUR 21.68/day to halve the severity.

Conclusions: The observed variation in the monetary equivalent of the impact of MS obtained with the three estimation methods indicates that the findings of studies using different valuing methods should not be compared directly. The study demonstrates that a reduction in MS is worth a considerable amount to patients with RA, particularly those with severe or prolonged MS. These findings suggest that clinical treatment decisions to improve patients' quality of life should also incorporate therapy that reduces MS.

In patients with rheumatoid arthritis (RA), symptoms of joint stiffness and pain may be most severe in the morning, resulting in impaired ability to carry out normal morning functions. Although morning stiffness was included in the criteria for classification and remission of RA, defined by the American College of Rheumatology (ACR) in 1987, the approach to assessment of this circadian symptom has not been standardized, and other circadian aspects of the disease (i.e. pain, functional ability) were not included. A bibliographic study of papers published in English in the period January 2007 to January 2010 and reporting morning stiffness, pain or function was undertaken to investigate methods of assessing circadian aspects of RA. A total of 73 studies were identified using Medline, including 62 clinical trials. Full papers were obtained for 52 reports of clinical studies (84%), most of which (44/52, 85%) assessed duration of morning stiffness. Only two studies (4%) specified that severity of morning stiffness was assessed, only three (6%) assessed pain in the morning, and none assessed morning functional ability. These findings suggest the need for consistent reporting of a measure to reflect the impaired morning function, arising from joint stiffness and pain that is commonly experienced by patients.