Arthritis Care & Research最新文献

Objective: Gout flares are the most important clinical feature of the disease. A hypothetical maximum flare occurrence in the preceding six months has been suggested to be no flares for a patient-acceptable symptom state (PASS) and only one flare for low disease activity (LDA). The aim of this analysis was to determine the relationship between gout flare states (PASS, LDA, and not in LDA or PASS [non-LDA/PASS]) and patient-reported outcomes.

Methods: Post hoc analyses of variance were undertaken using data from a 12-month randomized controlled trial involving 172 people with gout, which compared low-dose colchicine to placebo for the first 6 months while starting allopurinol with a further 6-month follow-up. Self-reported gout flares were collected monthly. Health Assessment Questionnaire (HAQ) and EuroQol 5-domain (EQ-5D-3L) were completed at 0, 3, 6 ,9, and 12 months, and the gout-specific brief illness perception questionnaire (BIPQ) was collected at months 0, 6, and 12.

Results: In the final six months of the study, 68 participants (38%) were classified as being in PASS, 34 (19%) as in LDA, and 77 (43%) as non-LDA/PASS. There was no association between gout flare states and EQ-5D-3L or HAQ. There was a statistically significant association between three of eight BIPQ items with increasing consequences, identity, and concern scores across the three states of PASS, LDA, and non-LDA/PASS.

Conclusion: The majority of people were able to achieve gout flare PASS or LDA in the second six months after commencing allopurinol. As flare burden increases, so does the impact of gout on the patient. These findings highlight the importance of flare prevention in the management of gout.

Objective: This study examined the lived employment experiences of young adults with childhood- and adult-onset systemic lupus erythematosus (SLE).

Methods: Participants were recruited from three Canadian lupus clinics and asked to complete semistructured, qualitative video/phone interviews. Interviews were transcribed verbatim and analyzed using thematic analysis. Participants were recruited until consolidated thematic saturation.

Results: Twenty-one participants (median age: 27 years)-14 woman, 5 men, and 2 gender-nonconforming individuals-were included. Thirty-eight percent had childhood-onset SLE. Seventy-one percent of the participants were employed, 19% were looking for work, and 10% were not working and not looking for work. Qualitative analysis revealed two themes. 1) "Maintaining control internally and externally": Participants described how the ability to exercise control over their symptoms (internally) and their job (externally) allowed them to gain and maintain employment. 2) "Tough choices: Health, then work and everything else": Participants described challenges in maintaining a balance among their health, other social responsibilities, and work because of their SLE-related limitations. Within this theme, participants also offered advice on how others could best manage the conflicting demands on their time and energy, which was summarized in a subtheme called "Recommendations for others-'take care of yourself first.'" CONCLUSION: When faced with the competing demands of their health (managing their SLE) and work, many young adults with SLE choose to prioritize their health, sacrificing their work or social responsibilities. Efforts aimed at promoting the employment success of young adults with SLE should inform individuals of these challenges and offer potential coping strategies.

Objective: Estimate the budget impact of funding a standardized education and exercise therapy program (GLA:D®) for people with hip and knee OA waiting for total joint replacement (TJR) consultation in a universal publicly insured healthcare system in Canada.

Methods: We built a budget impact analysis (BIA) model to estimate the annual cost of providing GLA:D® program to people waiting for TJR consultation and then forecasted a three-year budget cycle. The base case assumes 40% attend GLA:D®, 11% avoid surgery, uniform care delivery, training costs are incurred separately, and the healthcare system has enough trained staff to meet demand. The population of people with hip and knee OA waiting for TJR consultation was estimated with government statistics, peer-reviewed evidence and routinely collected data from five orthopaedic centralized intake clinics (serving 80% of people seeking TJR). Patient-level costs were collected prospectively. International published evidence-informed estimates of TJR avoidance. One-way sensitivity analysis of key parameters evaluated model robustness. Four scenarios were analysed: public-funding for everyone (base case), low-income, rural, or uninsured persons.

Results: Funding GLA:D® would cost $4.3 million, serve 12,500 people, and save $8.5 million by avoiding 1,300 TJRs in year one. Savings grow to $8.8 and $8.7 million in year two and three. The number of TJR's performed annually produced the most uncertainty in budget impact (-$15.3, -$1.8 million). The most cautious parameter estimates still produce cost-savings.

Conclusions: Publicly funding standardized education and exercise therapy programs for everyone waiting for TJR consultation would avoid surgeries, improve access to evidence-based treatments and save more than the program costs.

Objective: Despite knowledge that health outcomes vary according to patient characteristics, identity, and geography, including underrepresented populations in arthritis research remains a challenge. We conducted interviews to explore how researchers in arthritis have used equity, diversity, and inclusion (EDI) principles to inform their research.

Methods: Semistructured interviews were conducted with individuals who 1) have experience conducting arthritis research studies, 2) reside in and/or conduct their research in Canada, and 3) speak English or French. Participants were recruited using purposive and respondent-driven sampling. Interviews were conducted over video call and audio recordings were transcribed. Template analysis was applied to interview transcripts to explore participant experiences and perceptions of EDI in arthritis research.

Results: Participants (n = 22) identified that a lack of representation in arthritis research translates to the inability to provide comprehensive care. Participants emphasized considering EDI early in all arthritis research to effectively affect a study. Themes were categorized as benefits, barriers, and facilitators. The perceived benefits were the ability to generate knowledge and reduce health disparities. Barriers included mistrust from historically exploited populations, unintended consequences, lack of access to research opportunities, and logistical challenges. Facilitators included building community partnerships, curating diverse research teams, incentivizing researchers and funder support, and fostering humility in research environments.

Conclusion: Improving representation in research is needed to improve health outcomes for diverse groups of people living with arthritis. Identified barriers to EDI in research must be addressed and partnerships and supports must be facilitated to achieve more representation in arthritis research within Canada.

Objective: The Paediatric Rheumatology International Trials Organisation (PRINTO) recently undertook an effort to better harmonize the pediatric and adult arthritis criteria. These provisional criteria are being refined for optimal performance. We aimed to investigate differences between patients who did and did not fulfill these PRINTO criteria among youth diagnosed with juvenile spondyloarthritis (SpA) that met axial juvenile SpA (axJSpA) classification criteria.

Methods: This was a retrospective cross-sectional sample of youth diagnosed with juvenile SpA who met the axJSpA classification criteria. Demographics, clinical manifestations, and physician and patient-reported outcomes were abstracted from medical records. Magnetic resonance imaging (MRI) scans underwent central imaging review by at least two central raters. Differences between groups were compared using Wilcoxon signed-rank test or chi-square test, as appropriate.

Results: Of 158 patients who met axJSpA criteria, 107 patients (68%) met the PRINTO provisional criteria for enthesitis/spondylitis-related arthritis. A total of 41 patients (26%) did not fulfill any of the three major PRINTO criteria due to lack of peripheral disease manifestations. Demographics, prevalence of inflammatory or structural lesions on MRI, family history of SpA, and duration of pain were not statistically different between those who did and did not meet PRINTO criteria. Those who fulfilled the PRINTO criteria had significantly more peripheral arthritis, enthesitis, and HLA-B27 positivity but reported less sacral/buttock pain.

Conclusion: Phenotypic differences of children with axJSpA between those who were and were not classified by the PRINTO criteria were primarily due to peripheral disease manifestations and HLA-B27 positivity. Modification of the PRINTO provisional criteria may facilitate capture of youth with primarily axial disease.

Objective: This study investigated whether changes in circulating biomarkers predict progressive pulmonary fibrosis (PPF) in patients with systemic sclerosis-associated interstitial lung disease (SSc-ILD) receiving treatment.

Methods: Participants of the Scleroderma Lung Study II, which compared receiving mycophenolate mofetil (MMF) versus cyclophosphamide (CYC) for treating SSc-ILD, who had blood samples at baseline and 12 months were included. Levels for C-reactive protein (CRP), interleukin-6, C-X-C motif chemokine ligand (CXCL) 4, CCL18, and Krebs von den Lungen (KL)-6 were measured, and a logistic regression model evaluated relationships between changes in these biomarkers and the development of PPF by 24 months.

Results: A total of 92 of the 142 randomized participants had longitudinal biomarker measurements and the required clinical outcome data, with 19 participants (21%) meeting criteria for PPF. In the whole cohort, changes in KL-6 levels were significantly correlated with PPF. KL-6 increased in patients who developed PPF and decreased in patients who did not (mean change ± SD 365.68 ± 434.41 vs -207.45 ± 670.26; P < 0.001). In the arm of participants who received MMF alone, changes in CRP and CXCL4 levels were also significantly correlated with PPF. When added to an existing prediction model based on baseline factors associated with PPF in this cohort (sex, baseline reflux severity, and CXCL4 levels), the change in KL-6 remained significantly associated with PPF (odds ratio 1.4; P = 0.0002).

Conclusion: Changes in the circulating levels of KL-6 after treatment with MMF or CYC predicted PPF, even after adjusting for baseline factors associated with PPF. Measuring longitudinal KL-6 in patients with SSc-ILD may improve how we personalize therapy in patients with SSc-ILD.

Objective: Habitual movement compensations, such as decreased surgical peak knee extension moments (pKEM), persist years after total knee arthroplasty (TKA), are linked to poorer recovery, and may influence contralateral osteoarthritis progression. The purpose of this randomized clinical trial was to determine if a movement training program (MOVE) improves movement quality and recovery after TKA compared to a standardized rehabilitation program without movement training (CONTROL).

Methods: One hundred thirty-eight individuals were randomized to either MOVE or CONTROL groups after TKA. Participants were assessed preoperatively, 10 weeks after (end of intervention), and six months after (primary endpoint) TKA. Outcomes assessed were pKEM during walking, six-minute walk test, stair climb test, 30-second sit to stand test (30STS), timed up and go test (TUG), physical activity level, strength, range of motion, and self-reported outcomes.

Results: At six months, there were no between-group differences in surgical pKEM during walking (primary outcome). The MOVE group exhibited less contralateral pKEM compared to CONTROL during self-selected gait speed (d = 0.44, P = 0.01). CONTROL performed better on TUG and 30STS at 10 weeks (P < 0.05), but differences attenuated at six months.

Conclusion: The MOVE intervention did not lead to improved surgical pKEM during walking after TKA compared to CONTROL. However, the MOVE group did demonstrate less contralateral pKEM during walking. The CONTROL group demonstrated faster recovery on the TUG and 30STS, but it is unknown if this is due to improved recovery in the surgical knee or increased movement compensation relying on contralateral knee function.