Journal of Rheumatology最新文献

Objective: We aimed to identify threshold values of presenteeism measurement instruments that reflect unacceptable work state in employed patients with rheumatoid arthritis (RA) and whether those thresholds can predict future adverse work outcomes (AWOs). Additionally, we assessed the performance of presenteeism thresholds previously established in axial spondyloarthritis (axSpA) among patients with RA for the same instruments.

Methods: Data from the multinational Patient-Reported Outcomes in Employment Study in Rheumatoid Arthritis (RA-PROSE) study were used. Thresholds to determine when patients consider themselves in an "unacceptable work state" were calculated at baseline for 4 instruments assessing presenteeism and for the patient global assessment of RA-related pain. Different approaches derived from the receiver-operating characteristic methodology were used. Accuracy of thresholds to predict AWO throughout 12 months was assessed and previously developed presenteeism thresholds for axSpA were also tested.

Results: A total of 104 employed patients were included: 15% of the patients considered themselves in an unacceptable work state, of which 7 (7%) had at least 1 AWO over 12 months. Thresholds of all instruments specifically developed in RA showed good performance vs the external criterion (area under the curve [AUC] > 0.75), except for the Quantity and Quality (QQ) method (AUC 0.62). The available axSpA thresholds were more accurate by reducing overestimation. The final optimal thresholds were Work Productivity and Activity Impairment Questionnaire (WPAI)-presenteeism ≥ 40, QQ method < 97, Workplace Activity Limitations Scale ≥ 0.75, 25-item Work Limitations Questionnaire with modified physical demands scale ≥ 29, and pain intensity ≥ 4. For AWO over 12 months, pain and WPAI performed best in predicting AWO.

Conclusion: The final thresholds to assess unacceptable presenteeism for axSpA were also chosen as most accurate for use in RA. In addition, accurate thresholds of pain reflecting unacceptable work state are available.

Objective: We aimed to (1) evaluate the cardiac involvement, with a focus on myocarditis, in patients with Still disease included in the multicenter Autoinflammatory Disease Alliance (AIDA) Network Still disease registry; and (2) assess the predictive factors for myocarditis by deriving a clinical risk patient profile for this severe manifestation.

Methods: A multicenter observational study was established, in which consecutive patients with Still disease in the AIDA Network Still disease registry were characterized by cardiac involvement. Cardiac involvement was defined according to the presence of pericarditis, tamponade, myocarditis, and/or aseptic endocarditis.

Results: In total, 73 patients with Still disease and cardiac involvement were assessed (mean age 36.3 [SD 19.9] years; male sex, 42.5%), out of which 21.9% were children. The most common cardiac manifestation was pericarditis, occurring in 90.4% of patients; patients also presented with myocarditis (26%), and less frequently endocarditis (2.7%) and tamponade (1.4%). In comparing clinical features of patients with myocarditis to those without, significantly increased frequencies of skin rash and pleuritis, as well as higher systemic scores, were seen. Further, a higher mortality rate was shown in patients with myocarditis. In regression models, skin rash and the systemic score independently predicted the myocarditis.

Conclusion: The characteristics of patients with Still disease and cardiac involvement were assessed in the AIDA Network. The most common feature was the pericarditis, but a more severe clinical picture was also reported in patients with myocarditis. The latter was associated with increased mortality rate and higher systemic score, identifying patients who should be carefully managed.

Objective: To assess the longer-term effect of bimekizumab up to 1 year on patient-reported symptoms, health-related quality of life (HRQOL), and work productivity in patients with active PsA who were biologic disease-modifying antirheumatic drug (bDMARD)-naïve or had inadequate response/intolerance to tumor necrosis factor inhibitors (TNFi-IR).

Methods: BE OPTIMAL (ClinicalTrials.gov: NCT03895203; bDMARD-naïve patients) and BE COMPLETE (NCT03896581; TNFi-IR patients) are phase III studies of subcutaneous bimekizumab 160 mg every 4 weeks. Both studies were double-blind and placebo-controlled to 16 weeks. Patients who completed week 52 of BE OPTIMAL or week 16 of BE COMPLETE were eligible for the open-label extension, BE VITAL (NCT04009499), during which all patients received bimekizumab. Patient-reported pain, fatigue, physical function, HRQOL, and work productivity are reported to week 52 or 40 (52/40) using individual study data for bimekizumab and placebo treatment arms.

Results: Bimekizumab-randomized patients demonstrated sustained mean improvements from baseline in patient-reported outcomes to week 52/40, including pain (visual analog scale [0-100 mm]: bDMARD-naïve -30.5; TNFi-IR -31.8), fatigue (Functional Assessment of Chronic Illness Therapy-Fatigue scale [0-52]: bDMARD-naïve 5.3; TNFi-IR 6.0), physical function (Health Assessment Questionnaire-Disability Index [0-3]: bDMARD-naïve -0.34; TNFi-IR -0.39), and HRQOL (36-item Short Form Health Survey, physical component summary: bDMARD-naïve 8.1; TNFi-IR 8.4); placebo patients who switched to bimekizumab at week 16 demonstrated comparable levels of improvement from week 16 to week 52/40. Improvements in overall work impairment were sustained among bimekizumab-randomized patients to week 52. Similar trends were observed for absenteeism, presenteeism, and activity impairment.

Conclusion: Bimekizumab treatment resulted in sustained improvements in patient-reported symptoms, HRQOL, and work productivity up to 1 year in bDMARD-naïve and TNFi-IR patients with active PsA.

Objective: Following Health Canada's knowledge translation framework, we report the results of a clinical audit from 2012 to 2015 followed by a multidisciplinary, nurse-led gout care protocol with a treat-to-target (T2T) strategy implemented in April 2018.

Methods: A clinical audit with chart reviewing was completed for adults with gout and urate-lowering therapy (ULT) indication at the Centre Hospitalier Universitaire de Sherbrooke. A nurse-led treatment algorithm using allopurinol was then developed. Titration of ULT by a nurse every 4 weeks was done until serum uric acid (SUA) target. In the postprotocol implementation, adults with gout and ULT indication were retrospectively recruited through a billing agency until December 2020. The main outcome was SUA target achievement at 6 months.

Results: Of 50 patients identified in the audit, 31% reached SUA target at 6 months and 16% were lost to follow-up. A 74-patient postprotocol implementation cohort was recruited, with 43 in the protocol group and 31 under usual care. Most prevalent ULT indication was ≥ 2 gout attacks per year (n = 52) at 70%. Target SUA was reached in 65% (n = 28) in the protocol group at 6 months compared to 19% (n = 6) in the usual care group (P < 0.001). Failing to titrate medication in the usual care group was the leading cause for nonachievement of SUA target at 6 months. Five percent of patients were lost to follow-up, all in the usual care group.

Conclusion: A multidisciplinary, nurse-led protocol with a T2T strategy implemented after a clinical audit significantly improved gout care. Such protocol could be replicated elsewhere in Canada.