Arthritis Care & Research最新文献_第9页

When Usual Care Is Not So Usual: Protocol Violations and Generalizability in a Treat-to-Target Strategy Trial in Patients With Axial Spondyloarthritis 当常规护理不那么常规时：轴性脊柱关节炎靶向治疗策略试验中的方案违规和可推广性。

IF 3.7 2区医学 Q1 RHEUMATOLOGY

Arthritis Care & Research

Pub Date : 2024-06-24 DOI: 10.1002/acr.25387

Clementina López-Medina, Filip van den Bosch, Désirée van der Heijde, Maxime Dougados, Anna Molto

Objective

The objective of this study was to evaluate the impact of protocol violations in the treat-to-target group in the Tight Control in Spondyloarthritis (TICOSPA) trial and to compare the proportion of patients optimally treated according to the Assessment of Spondyloarthritis International Society (ASAS)/EULAR 2016 recommendations for patients with axial spondyloarthritis (axSpA) between the treat-to-target versus usual care (UC) arms.

Methods

This study was a cluster-randomized, controlled 48-week trial including patients with axSpA who fulfilled the ASAS criteria, had an Axial Spondyloarthritis Disease Activity Score >2.1, and were biologic disease-modifying antirheumatic drug naive. Eighteen axSpA expert centers were randomly allocated to one treatment arm: (a) treat-to-target prespecified management strategy (four-week visits), and (b) UC treatment decisions at the rheumatologist's discretion (12-week visits). Protocol violations in the treat-to-target arm and the fulfillment of the 2016 ASAS/EULAR recommendations in both arms were evaluated at every visit. ASAS Health Index (ASAS-HI) and disease activity outcomes at 48 weeks were compared between treat-to-target violators versus nonviolators. Patients treated according to the ASAS/EULAR recommendations were compared between both arms.

Results

A total of 160 patients initiated the trial (80 patients with treat to target; 80 patients with UC). In the treat-to-target arm, 51.2% patients violated the protocol at least once (62.2% of violations resulting in maintenance/reduction of treatment against protocol). After 48 weeks, treat-to-target violators versus nonviolators showed similar ratios of ASAS-HI improvement. The proportion of patients managed according to the ASAS/EULAR recommendations after the first 12 weeks were 63.9% versus 61.8% for the treat-to-target and UC arms, respectively.

Conclusion

Protocol violations in the treat-to-target arm in the TICOSPA trial were frequent, although they did not have an impact on the rate of the primary outcome. The groups with UC was optimally treated, partly explaining the nonachievement of the primary objective in the TICOSPA trial.

目的目的是评估TICOSPA试验中靶向治疗（T2T）组违反协议的影响，并比较T2T组与常规护理（UC）组之间根据ASAS/EULAR 2016年轴向脊柱关节炎（axSpA）建议进行最佳治疗的患者比例：分组随机对照 48 周（48W）试验，包括符合 ASAS 标准、ASDAS>2.1 和 bDMARD-naïve 的 axSpA 患者。18个axSpA专家中心被随机分配到一个治疗组：a)T2T：预先指定的管理策略（4W次就诊）；b)UC：由风湿免疫科医生决定治疗方案（12W次就诊）。每次就诊时都会评估 T2T 组违反协议的情况，以及两组是否符合 2016 ASAS/EULAR 建议。在48W时，比较了T2T违规者与非违规者的ASAS-HI和疾病活动性结果。根据ASAS/EULAR建议治疗的患者在两组之间进行比较：160名患者参加了试验（80名T2T患者；80名UC患者）。在 T2T 治疗组中，51.2% 的患者至少违反过一次治疗方案（62.2% 的违反方案导致维持/减少治疗方案）。48 W后，T2T违规者与非违规者的ASAS-HI改善比例相似。头12周后，T2T组和UC组按照ASAS/EULAR建议进行治疗的患者比例分别为63.9%和61.8%：结论：在TICOSPA试验中，T2T组经常违反协议，但对主要结果的发生率没有影响。UC 组得到了最佳治疗，这在一定程度上解释了 TICOSPA 试验未达到主要目标的原因。

{"title":"When Usual Care Is Not So Usual: Protocol Violations and Generalizability in a Treat-to-Target Strategy Trial in Patients With Axial Spondyloarthritis","authors":"Clementina López-Medina, Filip van den Bosch, Désirée van der Heijde, Maxime Dougados, Anna Molto","doi":"10.1002/acr.25387","DOIUrl":"10.1002/acr.25387","url":null,"abstract":"<div>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>The objective of this study was to evaluate the impact of protocol violations in the treat-to-target group in the Tight Control in Spondyloarthritis (TICOSPA) trial and to compare the proportion of patients optimally treated according to the Assessment of Spondyloarthritis International Society (ASAS)/EULAR 2016 recommendations for patients with axial spondyloarthritis (axSpA) between the treat-to-target versus usual care (UC) arms.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This study was a cluster-randomized, controlled 48-week trial including patients with axSpA who fulfilled the ASAS criteria, had an Axial Spondyloarthritis Disease Activity Score >2.1, and were biologic disease-modifying antirheumatic drug naive. Eighteen axSpA expert centers were randomly allocated to one treatment arm: (a) treat-to-target prespecified management strategy (four-week visits), and (b) UC treatment decisions at the rheumatologist's discretion (12-week visits). Protocol violations in the treat-to-target arm and the fulfillment of the 2016 ASAS/EULAR recommendations in both arms were evaluated at every visit. ASAS Health Index (ASAS-HI) and disease activity outcomes at 48 weeks were compared between treat-to-target violators versus nonviolators. Patients treated according to the ASAS/EULAR recommendations were compared between both arms.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 160 patients initiated the trial (80 patients with treat to target; 80 patients with UC). In the treat-to-target arm, 51.2% patients violated the protocol at least once (62.2% of violations resulting in maintenance/reduction of treatment against protocol). After 48 weeks, treat-to-target violators versus nonviolators showed similar ratios of ASAS-HI improvement. The proportion of patients managed according to the ASAS/EULAR recommendations after the first 12 weeks were 63.9% versus 61.8% for the treat-to-target and UC arms, respectively.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Protocol violations in the treat-to-target arm in the TICOSPA trial were frequent, although they did not have an impact on the rate of the primary outcome. The groups with UC was optimally treated, partly explaining the nonachievement of the primary objective in the TICOSPA trial.</p>\u0000 </section>\u0000 </div>","PeriodicalId":8406,"journal":{"name":"Arthritis Care & Research","volume":null,"pages":null},"PeriodicalIF":3.7,"publicationDate":"2024-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/acr.25387","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141454941","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Adherence and Treat-to-Target Benchmarks in Older Adults With Gout Initiating Urate-Lowering Therapy in Ontario, Canada: A Population-Based Study 加拿大安大略省接受尿酸盐降压疗法的痛风老年患者的依从性和治疗目标基准：基于人群的研究

IF 3.7 2区医学 Q1 RHEUMATOLOGY

Arthritis Care & Research

Pub Date : 2024-06-03 DOI: 10.1002/acr.25380

Timothy S. H. Kwok, Bindee Kuriya, Gillian Hawker, Lihi Eder, Ping Li, Gregory Choy, Jessica Widdifield

Objective

We sought to evaluate urate-lowering therapy (ULT) adherence and treatment-to-target (T2T) serum uric acid (SUA) levels among older adults with gout starting ULT.

Methods

We performed a population-based retrospective cohort study in Ontario, Canada in patients with gout aged ≥66 years newly dispensed ULT between 2010 and 2019. We defined successful T2T as patients having SUA levels <360 μmol/L (6 mg/dL) within 12 months after ULT dispensation. We also assessed adherence to ULT. Multilevel logistic regression clustered by ULT prescriber evaluated patient, physician, and prescription factors associated with reaching target SUA levels.

Results

Among 44,438 patients (mean ± SD age 76.0 ± 7.3 years; 64.4% male), 30,057 (67.6%) patients had ≥1 SUA test completed. Overall, 52.3% patients reached SUA target within 12 months, improving from 45.2% in 2010 to 61.2% in 2019 (P < 0.0001). ULT adherence was 55.3% overall and improved annually. Key factors associated with achieving T2T included febuxostat treatment (odds ratio [OR] 11.40, 95% confidence interval [95% CI] 5.10–25.43) (was only dispensed in 88 patients), ULT adherence (OR 5.17, 95% CI 4.89–5.47), allopurinol starting doses >50 mg (OR 2.53, 95% CI 2.14–2.99), colchicine/oral glucocorticoids co-prescription (OR 1.24, 95% CI 1.14–1.34), and ULT prescription from a rheumatologist.

Conclusion

Only 52.3% of patients achieved an optimal SUA level within 1 year of ULT initiation. ULT adherence was suboptimal, although improving over time. ULT adherence and higher allopurinol starting doses had the strongest associations of achieving a target SUA level. This study highlights room for improvement in gout management and potential strategies to address care gaps.

目标：我们试图评估开始使用 ULT 的老年痛风患者的降尿酸治疗（ULT）依从性和治疗目标（T2T）血清尿酸（SUA）水平：我们在加拿大安大略省开展了一项基于人群的回顾性队列研究，研究对象是 2010 年至 2019 年间新配发 ULT 的年龄≥66 岁的痛风患者。我们将成功进行 T2T 的患者定义为达到 SUA 水平的患者：在 44,438 名患者（平均（标清）年龄为 76.0±7.3 岁；64.4% 为男性）中，30,057 名患者（67.6%）完成了≥1 次 SUA 测试。总体而言，52.3%的患者在12个月内达到了SUA目标，从2010年的45.2%提高到2019年的61.2%（p < 0.0001）。超短波治疗依从性总体为 55.3%，并逐年提高。与实现 T2T 相关的关键因素包括非布司他的使用（OR 11.40，95% CI 5.10-25.43）（仅有 88 名患者获得配药）、超短波治疗的依从性（OR 5.17，95% CI 4.89-5.47）、开始使用别嘌醇（OR 5.17，95% CI 4.89-5.47）。47）、别嘌呤醇起始剂量大于 50 毫克（OR 2.53，95% CI：2.14-2.99）、秋水仙碱/口服皮质类固醇联合处方（OR 1.24，95% CI：1.14-1.34）以及风湿免疫科医生开具的 ULT 处方：结论：只有 52.3% 的患者在开始使用超短波治疗一年内达到了最佳 SUA 水平。超短波治疗的依从性不理想，但随着时间的推移有所改善。坚持超短波治疗和较高的别嘌呤醇起始剂量与达到目标 SUA 水平的关系最为密切。这项研究强调了痛风治疗中有待改进的地方，以及解决治疗差距的潜在策略。

{"title":"Adherence and Treat-to-Target Benchmarks in Older Adults With Gout Initiating Urate-Lowering Therapy in Ontario, Canada: A Population-Based Study","authors":"Timothy S. H. Kwok, Bindee Kuriya, Gillian Hawker, Lihi Eder, Ping Li, Gregory Choy, Jessica Widdifield","doi":"10.1002/acr.25380","DOIUrl":"10.1002/acr.25380","url":null,"abstract":"<div>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>We sought to evaluate urate-lowering therapy (ULT) adherence and treatment-to-target (T2T) serum uric acid (SUA) levels among older adults with gout starting ULT.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We performed a population-based retrospective cohort study in Ontario, Canada in patients with gout aged ≥66 years newly dispensed ULT between 2010 and 2019. We defined successful T2T as patients having SUA levels <360 μmol/L (6 mg/dL) within 12 months after ULT dispensation. We also assessed adherence to ULT. Multilevel logistic regression clustered by ULT prescriber evaluated patient, physician, and prescription factors associated with reaching target SUA levels.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Among 44,438 patients (mean ± SD age 76.0 ± 7.3 years; 64.4% male), 30,057 (67.6%) patients had ≥1 SUA test completed. Overall, 52.3% patients reached SUA target within 12 months, improving from 45.2% in 2010 to 61.2% in 2019 (<i>P</i> < 0.0001). ULT adherence was 55.3% overall and improved annually. Key factors associated with achieving T2T included febuxostat treatment (odds ratio [OR] 11.40, 95% confidence interval [95% CI] 5.10–25.43) (was only dispensed in 88 patients), ULT adherence (OR 5.17, 95% CI 4.89–5.47), allopurinol starting doses >50 mg (OR 2.53, 95% CI 2.14–2.99), colchicine/oral glucocorticoids co-prescription (OR 1.24, 95% CI 1.14–1.34), and ULT prescription from a rheumatologist.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Only 52.3% of patients achieved an optimal SUA level within 1 year of ULT initiation. ULT adherence was suboptimal, although improving over time. ULT adherence and higher allopurinol starting doses had the strongest associations of achieving a target SUA level. This study highlights room for improvement in gout management and potential strategies to address care gaps.</p>\u0000 </section>\u0000 </div>","PeriodicalId":8406,"journal":{"name":"Arthritis Care & Research","volume":null,"pages":null},"PeriodicalIF":3.7,"publicationDate":"2024-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/acr.25380","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141236877","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Hydroxychloroquine Improves Low Complement Levels 羟氯喹可改善低补体水平。

IF 3.7 2区医学 Q1 RHEUMATOLOGY

Arthritis Care & Research

Pub Date : 2024-06-03 DOI: 10.1002/acr.25381

Rebecca Jacobson, Daniel Goldman, Andrea Fava, Laurence Magder, Michelle Petri

Objective

Having a low complement level is associated with clinical systemic lupus erythematosus (SLE) disease activity and future organ damage. We studied the association of hydroxychloroquine (HCQ) whole blood levels with changes in complement level.

Methods

We performed two analyses on data prospectively collected from an SLE cohort. In the first (a “new starts on HCQ” analysis), we compared changes in complement level between those starting HCQ and those not starting it. The second analysis evaluated the association between HCQ whole blood levels and low complement level in all cohort visits using conditional logistic regression.

Results

In the “new starts on HCQ” analysis, a higher percentage of patients starting HCQ (as reflected in HCQ blood levels >50) experienced a normalization of C4 level compared to those not starting HCQ (23 of 57 [40%] vs. 9 of 56 [13%]; P = 0.011), as well as a significantly greater increase in both C3 and C4 level (P = 0.048 and P = 0.017, respectively). In the “all cohort visits” analysis, there was a statistically significant higher probability of having normal C4 levels in visits with higher HCQ whole blood levels (odds ratio 1.8–2.6 depending on the levels). This relationship was most pronounced for whole blood HCQ levels of 200 ng/mL or more.

Conclusion

We observed significant improvement in complement levels when HCQ was started and among those with higher whole blood levels of HCQ, particularly with respect to C4. Modulating the pathogenic mechanisms that lead to complement consumption may be one mode by which HCQ prevents poor outcomes in SLE.

目的：低补体与系统性红斑狼疮（SLE）的临床疾病活动和未来的器官损伤有关。我们研究了羟氯喹（HCQ）全血水平与补体变化的关系：我们对从一个系统性红斑狼疮队列中收集的前瞻性数据进行了两项分析。在第一项分析（"新开始使用 HCQ "分析）中，我们比较了开始使用羟氯喹者和未开始使用羟氯喹者的补体变化。第二项分析采用条件逻辑回归法评估了羟氯喹全血水平与所有队列中低补体之间的关联：在 "新开始使用 HCQ "分析中，与未开始使用羟氯喹的患者相比，有更高比例的患者（反映在 HCQ 血液水平>50）C4 恢复正常（23/57 (40%) vs. 9/56 (13%)，p=0.011），C3 和 C4 也显著增加（分别为 p=0.048 和 p=0.017）。在 "所有队列就诊 "分析中，在羟氯喹全血水平较高的就诊者中，C4水平正常的概率具有显著的统计学意义（OR 1.8 至 2.6，视水平而定）。这种关系在全血羟氯喹水平达到或超过 200ng/ml 时最为明显：我们观察到，在开始使用羟氯喹时，以及在羟氯喹全血水平较高的人群中，补体水平有明显改善，尤其是在 C4 方面。调节导致补体消耗的致病机制可能是羟氯喹预防系统性红斑狼疮不良预后的一种模式。

{"title":"Hydroxychloroquine Improves Low Complement Levels","authors":"Rebecca Jacobson, Daniel Goldman, Andrea Fava, Laurence Magder, Michelle Petri","doi":"10.1002/acr.25381","DOIUrl":"10.1002/acr.25381","url":null,"abstract":"<div>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>Having a low complement level is associated with clinical systemic lupus erythematosus (SLE) disease activity and future organ damage. We studied the association of hydroxychloroquine (HCQ) whole blood levels with changes in complement level.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We performed two analyses on data prospectively collected from an SLE cohort. In the first (a “new starts on HCQ” analysis), we compared changes in complement level between those starting HCQ and those not starting it. The second analysis evaluated the association between HCQ whole blood levels and low complement level in all cohort visits using conditional logistic regression.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>In the “new starts on HCQ” analysis, a higher percentage of patients starting HCQ (as reflected in HCQ blood levels >50) experienced a normalization of C4 level compared to those not starting HCQ (23 of 57 [40%] vs. 9 of 56 [13%]; <i>P</i> = 0.011), as well as a significantly greater increase in both C3 and C4 level (<i>P</i> = 0.048 and <i>P</i> = 0.017, respectively). In the “all cohort visits” analysis, there was a statistically significant higher probability of having normal C4 levels in visits with higher HCQ whole blood levels (odds ratio 1.8–2.6 depending on the levels). This relationship was most pronounced for whole blood HCQ levels of 200 ng/mL or more.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>We observed significant improvement in complement levels when HCQ was started and among those with higher whole blood levels of HCQ, particularly with respect to C4. Modulating the pathogenic mechanisms that lead to complement consumption may be one mode by which HCQ prevents poor outcomes in SLE.</p>\u0000 </section>\u0000 </div>","PeriodicalId":8406,"journal":{"name":"Arthritis Care & Research","volume":null,"pages":null},"PeriodicalIF":3.7,"publicationDate":"2024-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/acr.25381","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141236837","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Calculation of the effect of pain sensitization on opioid-induced hyperalgesia in knee osteoarthritis: comment on the article by Aoyagi et al 计算痛敏化对阿片类药物诱发膝骨关节炎痛觉减退的影响

IF 3.7 2区医学 Q1 RHEUMATOLOGY

Arthritis Care & Research

Pub Date : 2024-05-23 DOI: 10.1002/acr.25379

Michael R. Bubb

引用次数: 0

Relationship of Fatigue, Pain Interference, and Physical Disability in Children Newly Diagnosed With Juvenile Idiopathic Arthritis 新诊断为幼年特发性关节炎的儿童疲劳、疼痛干扰和身体残疾之间的关系。

IF 3.7 2区医学 Q1 RHEUMATOLOGY

Arthritis Care & Research

Pub Date : 2024-05-20 DOI: 10.1002/acr.25377

Naomi Choong, Michelle Batthish, Roberta A. Berard, Gaëlle Chédeville, Brian M. Feldman, Kristin M. Houghton, Adam M. Huber, Sarah James, Jean-Philippe Proulx-Gauthier, Dax G. Rumsey, Heinrike Schmeling, Karine Toupin-April, Jaime Guzman, for the CAPRI Registry Investigators

Objective

Our objectives were to quantify the relationships among fatigue, pain interference, and physical disability in children with juvenile idiopathic arthritis (JIA) and to test whether fatigue mediates the relationship between pain interference and physical disability in JIA.

Methods

Patients enrolled within three months of JIA diagnosis in the Canadian Alliance of Pediatric Rheumatology Investigators (CAPRI) Registry between February 2017 and May 2023 were included. Their parents completed the Patient-Reported Outcomes Measurement Information System fatigue and pain interference short proxy questionnaires and the Childhood Health Assessment Questionnaire disability index at registry enrollment. Associations were assessed using Pearson correlations and multiple linear regression. Structural equation modeling (SEM) was used to test if fatigue mediates the relationship between pain interference and physical disability.

Results

Among 855 patients (61.4% female, 44.1% with oligoarthritis), most reported fatigue and pain interference scores similar to those in the reference population, but 15.6% reported severe fatigue and 7.3% reported severe pain interference, with wide variation across JIA categories. Fatigue was strongly correlated with pain interference (r = 0.72, P < 0.001) and with physical disability (r = 0.60, P < 0.001). Pain interference (β = 0.027, P < 0.001) and fatigue (β = 0.013, P < 0.001) were both associated with physical disability after controlling for each other and potential confounders. SEM supported our hypothesis that fatigue partially mediates the relationship between pain interference and physical disability.

Conclusion

Our findings suggest both fatigue and pain interference are independently associated with physical disability in children newly diagnosed with JIA, and the effect of pain interference may be partly mediated by fatigue.

目标：我们的目标是量化 JIA 儿童疲劳、疼痛干扰和身体残疾之间的关系，并检验疲劳是否介导了 JIA 儿童疼痛干扰和身体残疾之间的关系：我们的目标是量化JIA患儿疲劳、疼痛干扰和肢体残疾之间的关系，并检验疲劳是否介导了JIA疼痛干扰和肢体残疾之间的关系：方法：纳入2017年2月至2023年5月期间在加拿大儿童风湿病学研究者联盟（CAPRI）登记处确诊JIA后3个月内登记的患者。他们的父母在注册登记时填写了PROMIS疲劳和疼痛干扰简易代理问卷以及CHAQ残疾指数。采用皮尔逊相关性和多元线性回归评估两者之间的关联。结构方程模型（SEM）用于检验疲劳是否介导了疼痛干扰和身体残疾之间的关系：在 855 名患者（61.4% 为女性，44.1% 患有少关节炎）中，大多数人的疲劳和疼痛干扰评分与参照人群相似，但有 15.6% 的人报告有严重疲劳，7.3% 的人报告有严重疼痛干扰，而且不同 JIA 类别之间的差异很大。疲劳与疼痛干扰（r = 0.72，p < 0.001）和身体残疾（r = 0.60，p < 0.001）密切相关。疼痛干扰（b = 0.027，p < 0.001）和疲劳（b = 0.013，p < 0.001）在控制了彼此和潜在的混杂因素后，均与身体残疾相关。SEM 支持我们的假设，即疲劳在一定程度上介导了疼痛干扰与身体残疾之间的关系：我们的研究结果表明，在新诊断为JIA的儿童中，疲劳和疼痛干扰均与肢体残疾独立相关，疼痛干扰的影响可能部分由疲劳介导。

{"title":"Relationship of Fatigue, Pain Interference, and Physical Disability in Children Newly Diagnosed With Juvenile Idiopathic Arthritis","authors":"Naomi Choong, Michelle Batthish, Roberta A. Berard, Gaëlle Chédeville, Brian M. Feldman, Kristin M. Houghton, Adam M. Huber, Sarah James, Jean-Philippe Proulx-Gauthier, Dax G. Rumsey, Heinrike Schmeling, Karine Toupin-April, Jaime Guzman, for the CAPRI Registry Investigators","doi":"10.1002/acr.25377","DOIUrl":"10.1002/acr.25377","url":null,"abstract":"<div>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>Our objectives were to quantify the relationships among fatigue, pain interference, and physical disability in children with juvenile idiopathic arthritis (JIA) and to test whether fatigue mediates the relationship between pain interference and physical disability in JIA.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Patients enrolled within three months of JIA diagnosis in the Canadian Alliance of Pediatric Rheumatology Investigators (CAPRI) Registry between February 2017 and May 2023 were included. Their parents completed the Patient-Reported Outcomes Measurement Information System fatigue and pain interference short proxy questionnaires and the Childhood Health Assessment Questionnaire disability index at registry enrollment. Associations were assessed using Pearson correlations and multiple linear regression. Structural equation modeling (SEM) was used to test if fatigue mediates the relationship between pain interference and physical disability.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Among 855 patients (61.4% female, 44.1% with oligoarthritis), most reported fatigue and pain interference scores similar to those in the reference population, but 15.6% reported severe fatigue and 7.3% reported severe pain interference, with wide variation across JIA categories. Fatigue was strongly correlated with pain interference (r = 0.72, <i>P</i> < 0.001) and with physical disability (<i>r</i> = 0.60, <i>P</i> < 0.001). Pain interference (β = 0.027, <i>P</i> < 0.001) and fatigue (β = 0.013, <i>P</i> < 0.001) were both associated with physical disability after controlling for each other and potential confounders. SEM supported our hypothesis that fatigue partially mediates the relationship between pain interference and physical disability.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Our findings suggest both fatigue and pain interference are independently associated with physical disability in children newly diagnosed with JIA, and the effect of pain interference may be partly mediated by fatigue.</p>\u0000 </section>\u0000 </div>","PeriodicalId":8406,"journal":{"name":"Arthritis Care & Research","volume":null,"pages":null},"PeriodicalIF":3.7,"publicationDate":"2024-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/acr.25377","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141070408","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Predicting Gout Flares in People Starting Allopurinol Using the Start-Low Go-Slow Dose Escalation Strategy 使用 "开始-低剂量-继续-低剂量 "的剂量递增策略预测别嘌醇新用药者的痛风复发。

IF 3.7 2区医学 Q1 RHEUMATOLOGY

Arthritis Care & Research

Pub Date : 2024-05-20 DOI: 10.1002/acr.25376

Lisa K. Stamp, Anne Horne, Borislav Mihov, Jill Drake, Janine Haslett, Peter Chapman, Christopher Frampton, Nicola Dalbeth

Objective

The study objective was to determine predictors of gout flare when commencing allopurinol using the “start-low go-slow” dose escalation strategy.

Methods

A post hoc analysis of a 12-month double-blind placebo-controlled noninferiority trial with participants randomized 1:1 to colchicine 0.5 mg daily or placebo for the first six months was undertaken. Multivariate logistic regression models were used to identify independent predictors of gout flares in the first and last six months of the trial.

Results

Multivariable analysis revealed a significant association between risk of a gout flare in the first six months and flare in the month before starting allopurinol (odds ratio [OR] 2.65, 95% confidence interval [CI] 1.36–5.17) and allopurinol 100 mg starting dose (OR 3.21, 95% CI 1.41–7.27). The predictors of any gout flares in the last six months of the trial, after stopping colchicine or placebo, were having received colchicine (OR 2.95, 95% CI 1.48–5.86), at least one flare in the month before stopping study drug (OR 5.39, 95% CI 2.21–13.15), and serum urate ≥0.36 mmol/L at month 6 (OR 2.85, 95% CI 1.14–7.12).

Conclusion

Anti-inflammatory prophylaxis when starting allopurinol using the “start-low go-slow” dose escalation strategy may be best targeted at those who have had a gout flare in the month before starting allopurinol and are commencing allopurinol 100 mg daily. For those with ongoing gout flares during the first six months of starting allopurinol who have not yet achieved serum urate target, a longer period of prophylaxis may be required.

目的采用 "起点低、进展慢 "的剂量递增策略，确定开始服用别嘌醇时痛风复发的预测因素：我们对一项为期 12 个月的双盲安慰剂对照非劣效性试验进行了事后分析，试验参与者在最初 6 个月中被按 1:1 随机分配到每日服用 0.5 毫克秋水仙碱或安慰剂。试验采用多变量逻辑回归模型来确定试验前六个月和后六个月痛风发作的独立预测因素：多变量分析表明，头六个月痛风复发的风险与开始服用别嘌醇前一个月痛风复发（几率比（OR）（95% 置信区间（CI））2.65（1.36-5.17））和别嘌醇 100 毫克起始剂量（OR（95% 置信区间（CI））3.21（1.41-7.27））之间存在显著关联。停用秋水仙碱或安慰剂后，在试验的最后6个月中痛风复发的预测因素包括：曾服用秋水仙碱（OR (95% CI) 2.95 (1.48-5.86)）、停药前一个月至少复发一次（OR (95% CI) 5.39 (2.21-13.15)）、第6个月时血清尿酸盐≥0.36mmol/L（OR (95% CI) 2.85 (1.14-7.12)）：在开始使用别嘌呤醇时，采用 "起始低、进展慢 "的剂量递增策略进行抗炎预防，可能最适合那些在开始使用别嘌呤醇前一个月内痛风复发且开始每天使用100毫克别嘌呤醇的患者。对于那些在开始服用别嘌醇的前 6 个月中痛风持续发作且尚未达到血清尿酸目标值的患者，可能需要更长的预防期。

{"title":"Predicting Gout Flares in People Starting Allopurinol Using the Start-Low Go-Slow Dose Escalation Strategy","authors":"Lisa K. Stamp, Anne Horne, Borislav Mihov, Jill Drake, Janine Haslett, Peter Chapman, Christopher Frampton, Nicola Dalbeth","doi":"10.1002/acr.25376","DOIUrl":"10.1002/acr.25376","url":null,"abstract":"<div>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>The study objective was to determine predictors of gout flare when commencing allopurinol using the “start-low go-slow” dose escalation strategy.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A post hoc analysis of a 12-month double-blind placebo-controlled noninferiority trial with participants randomized 1:1 to colchicine 0.5 mg daily or placebo for the first six months was undertaken. Multivariate logistic regression models were used to identify independent predictors of gout flares in the first and last six months of the trial.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Multivariable analysis revealed a significant association between risk of a gout flare in the first six months and flare in the month before starting allopurinol (odds ratio [OR] 2.65, 95% confidence interval [CI] 1.36–5.17) and allopurinol 100 mg starting dose (OR 3.21, 95% CI 1.41–7.27). The predictors of any gout flares in the last six months of the trial, after stopping colchicine or placebo, were having received colchicine (OR 2.95, 95% CI 1.48–5.86), at least one flare in the month before stopping study drug (OR 5.39, 95% CI 2.21–13.15), and serum urate ≥0.36 mmol/L at month 6 (OR 2.85, 95% CI 1.14–7.12).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Anti-inflammatory prophylaxis when starting allopurinol using the “start-low go-slow” dose escalation strategy may be best targeted at those who have had a gout flare in the month before starting allopurinol and are commencing allopurinol 100 mg daily. For those with ongoing gout flares during the first six months of starting allopurinol who have not yet achieved serum urate target, a longer period of prophylaxis may be required.</p>\u0000 </section>\u0000 </div>","PeriodicalId":8406,"journal":{"name":"Arthritis Care & Research","volume":null,"pages":null},"PeriodicalIF":3.7,"publicationDate":"2024-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/acr.25376","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141065299","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Opioid Treatment for Adults With and Without Systemic Autoimmune/Inflammatory Rheumatic Diseases: Analysis of 2006–2019 United States National Data 患有和未患有系统性自身免疫/炎症性风湿病的成年人使用阿片类药物的情况：2006-2019年美国全国数据分析》。

IF 3.7 2区医学 Q1 RHEUMATOLOGY

Arthritis Care & Research

Pub Date : 2024-05-20 DOI: 10.1002/acr.25378

Yinan Huang, Sebastian Bruera, Sandeep Krishna Agarwal, Maria E. Suarez-Almazor, Shadi Bazzazzadehgan, Sujith Ramachandran, Kaustuv Bhattacharya, John P. Bentley, Yi Yang

Objectives

This study compared opioid prescribing among ambulatory visits with systemic autoimmune/inflammatory rheumatic diseases (SARDs) or without and assessed factors associated with opioid prescribing in SARDs.

Methods

This cross-sectional study used the National Ambulatory Medical Care Survey between 2006 and 2019. Adult (≥18 years) visits with a primary diagnosis of SARDs, including rheumatoid arthritis, ankylosing spondylitis, psoriatic arthritis, or systemic lupus erythematosus were included in the study. Opioid prescribing was compared between those with vs without SARDs using multivariable logistic regression accounting for the complex survey design and adjusting for predisposing, enabling, and need factors within Andersen's Behavioral Model of Health Services Use. Another multivariable logistic regression examined the predictors associated with opioid prescribing in SARDs.

Results

Annually, an average of 5.20 million (95% confidence interval [CI] 3.58–6.82) visits were made for SARDs, whereas 780.14 million (95% CI 747.56–812.72) visits were made for non-SARDs. The SARDs group was more likely to be prescribed opioids (22.53%) than the non-SARDs group (9.83%) (adjusted odds ratio [aOR] 2.65; 95% CI 1.68–4.18). Among the SARDs visits, patient age from 50 to 64 (aOR 1.95; 95% CI 1.05–3.65 relative to ages 18–49) and prescribing of glucocorticoids (aOR 1.75; 95% CI 1.20–2.54) were associated with an increased odd of opioid prescribing, whereas private insurance relative to Medicare (aOR 0.50; 95% CI 0.31–0.82) was associated with a decreased odds of opioid prescribing.

Conclusion

Opioid prescribing in SARDs was higher compared to non-SARDs. Concerted efforts are needed to determine the appropriateness of opioid prescribing in SARDs.

研究目的本研究比较了患有或不患有系统性自身免疫/炎症性风湿病（SARDs）的门诊患者的阿片类药物处方情况，并评估了与SARDs阿片类药物处方相关的因素：这项横断面研究使用了 2006 年至 2019 年间的全国流动医疗护理调查。研究纳入了主要诊断为 SARDs（包括类风湿性关节炎、强直性脊柱炎、银屑病关节炎或系统性红斑狼疮）的成人（≥18 岁）就诊者。使用多变量逻辑回归（MLR）对患有与未患有 SARD 的阿片类药物处方情况进行了比较，其中考虑到了复杂的调查设计，并根据 Andersen 的医疗服务使用行为模型对诱发因素、促成因素和需求因素进行了调整。另一项多重回归研究了与 SARDs 中阿片类药物处方相关的预测因素：每年，SARDs 患者平均就诊 520 万人次（95% CI 358-682 万人次），而非 SARDs 患者平均就诊 7.8014 亿人次（95% CI 7.4756-8.1272 亿人次）。与非 SARDs 组（9.83%）相比，SARDs 组更有可能获得阿片类药物处方（22.53%）（aOR 2.65 [95% CI 1.68-4.18]）。在 SARDs 就诊者中，50-64 岁的成年人（相对于 18-49 岁，aOR 为 1.95 [95% CI 为 1.05-3.65]）和使用糖皮质激素（aOR 为 1.75 [95% CI 为 1.20-2.54]）与阿片类药物处方几率增加有关，而相对于医疗保险（aOR 为 0.50 [95% CI 为 0.31-0.82]）的私人保险与阿片类药物处方几率降低有关：结论：与非 SARDs 相比，SARDs 的阿片类药物处方量更高。结论：与非 SARDs 相比，SARDs 中阿片类药物的处方量较高，需要共同努力确定 SARDs 中阿片类药物处方的适当性。

{"title":"Opioid Treatment for Adults With and Without Systemic Autoimmune/Inflammatory Rheumatic Diseases: Analysis of 2006–2019 United States National Data","authors":"Yinan Huang, Sebastian Bruera, Sandeep Krishna Agarwal, Maria E. Suarez-Almazor, Shadi Bazzazzadehgan, Sujith Ramachandran, Kaustuv Bhattacharya, John P. Bentley, Yi Yang","doi":"10.1002/acr.25378","DOIUrl":"10.1002/acr.25378","url":null,"abstract":"<div>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>This study compared opioid prescribing among ambulatory visits with systemic autoimmune/inflammatory rheumatic diseases (SARDs) or without and assessed factors associated with opioid prescribing in SARDs.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This cross-sectional study used the National Ambulatory Medical Care Survey between 2006 and 2019. Adult (≥18 years) visits with a primary diagnosis of SARDs, including rheumatoid arthritis, ankylosing spondylitis, psoriatic arthritis, or systemic lupus erythematosus were included in the study. Opioid prescribing was compared between those with vs without SARDs using multivariable logistic regression accounting for the complex survey design and adjusting for predisposing, enabling, and need factors within Andersen's Behavioral Model of Health Services Use. Another multivariable logistic regression examined the predictors associated with opioid prescribing in SARDs.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Annually, an average of 5.20 million (95% confidence interval [CI] 3.58–6.82) visits were made for SARDs, whereas 780.14 million (95% CI 747.56–812.72) visits were made for non-SARDs. The SARDs group was more likely to be prescribed opioids (22.53%) than the non-SARDs group (9.83%) (adjusted odds ratio [aOR] 2.65; 95% CI 1.68–4.18). Among the SARDs visits, patient age from 50 to 64 (aOR 1.95; 95% CI 1.05–3.65 relative to ages 18–49) and prescribing of glucocorticoids (aOR 1.75; 95% CI 1.20–2.54) were associated with an increased odd of opioid prescribing, whereas private insurance relative to Medicare (aOR 0.50; 95% CI 0.31–0.82) was associated with a decreased odds of opioid prescribing.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Opioid prescribing in SARDs was higher compared to non-SARDs. Concerted efforts are needed to determine the appropriateness of opioid prescribing in SARDs.</p>\u0000 </section>\u0000 </div>","PeriodicalId":8406,"journal":{"name":"Arthritis Care & Research","volume":null,"pages":null},"PeriodicalIF":3.7,"publicationDate":"2024-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141065295","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Interpreting and Addressing Racialized Inequities in Rheumatic Disease Care and Outcomes 解读和解决风湿病治疗和结果中的种族不平等问题。

IF 3.7 2区医学 Q1 RHEUMATOLOGY

Arthritis Care & Research

Pub Date : 2024-05-15 DOI: 10.1002/acr.25375

Sherry Yang, Candace H. Feldman

引用次数: 0

Old Before Their Time? The Impact of Osteoarthritis on Younger Adults 未老先衰？骨关节炎对年轻人的影响

IF 3.7 2区医学 Q1 RHEUMATOLOGY

Arthritis Care & Research

Pub Date : 2024-05-15 DOI: 10.1002/acr.25374

Jessica M. Wilfong, Elizabeth M. Badley, Anthony V. Perruccio

Objective

Osteoarthritis (OA) is frequently perceived as a disease of the elderly and an inevitable result of aging. Because OA studies often are restricted to older adults, there is limited information on OA in younger adults. This study describes the burden of OA across a wide age range and compares younger and older adults.

Methods

Descriptive analysis of the Survey on Living with Chronic Diseases in Canada – Arthritis Component, a nationally representative survey of Canadians ≥20 years who reported an arthritis diagnosis in the Canadian Community Health Survey, a general health population survey. Analyses were restricted to those reporting OA and no other kind of arthritis (n = 1,749).

Results

In the representative group with OA, 55.4% were younger than 65 years. The mean age at diagnosis was 50 years, with 30.4% reporting being diagnosed before age 45 years. Younger adults reported similar symptom severity as their older counterparts with OA regarding the mean number of affected joint sites, severity of pain and fatigue, and activity limitations. In the youngest age group, those with OA were significantly more likely to report fair or poor overall and mental health and life dissatisfaction compared with their general counterparts; the same was not the case in the oldest age group.

Conclusion

OA is not uncommon among younger and middle-aged adults, and they experience OA impacts comparable with those for older adults. These findings suggest that younger adults with OA will live many years with symptoms and disability and highlight a need for effective OA management across ages.

目的：骨关节炎（OA）通常被认为是一种老年疾病，是衰老的必然结果。由于对 OA 的研究通常仅限于老年人，因此有关年轻人 OA 的信息非常有限。本研究描述了不同年龄段人群的 OA 负担，并对年轻人和老年人进行了比较：方法：对《加拿大慢性病患者生活调查-关节炎部分》进行描述性分析，该调查具有全国代表性，调查对象为在加拿大社区健康调查（一项普通健康人口调查）中报告确诊为关节炎的 20 岁以上加拿大人。分析仅限于报告有 OA 且无其他类型关节炎的人（n=1,749）：在具有代表性的 OA 患者群体中，55.4% 的人年龄小于 65 岁。确诊时的平均年龄为50岁，其中30.4%在45岁之前确诊。在受影响关节部位的平均数量、疼痛和疲劳的严重程度以及活动限制方面，年轻成人与患有 OA 的老年患者的症状严重程度相似。在最年轻的年龄组中，与普通人群相比，患有OA的人更有可能报告总体健康状况一般/较差、精神健康状况较差以及对生活不满意；而在最年长的年龄组中，情况并非如此：结论：OA 在中青年人中并不少见，他们受到的 OA 影响与老年人不相上下。这表明，患有 OA 的年轻人将带着症状和残疾生活很多年，并强调了跨年龄段有效管理 OA 的必要性。

{"title":"Old Before Their Time? The Impact of Osteoarthritis on Younger Adults","authors":"Jessica M. Wilfong, Elizabeth M. Badley, Anthony V. Perruccio","doi":"10.1002/acr.25374","DOIUrl":"10.1002/acr.25374","url":null,"abstract":"<div>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>Osteoarthritis (OA) is frequently perceived as a disease of the elderly and an inevitable result of aging. Because OA studies often are restricted to older adults, there is limited information on OA in younger adults. This study describes the burden of OA across a wide age range and compares younger and older adults.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Descriptive analysis of the Survey on Living with Chronic Diseases in Canada – Arthritis Component, a nationally representative survey of Canadians ≥20 years who reported an arthritis diagnosis in the Canadian Community Health Survey, a general health population survey. Analyses were restricted to those reporting OA and no other kind of arthritis (n = 1,749).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>In the representative group with OA, 55.4% were younger than 65 years. The mean age at diagnosis was 50 years, with 30.4% reporting being diagnosed before age 45 years. Younger adults reported similar symptom severity as their older counterparts with OA regarding the mean number of affected joint sites, severity of pain and fatigue, and activity limitations. In the youngest age group, those with OA were significantly more likely to report fair or poor overall and mental health and life dissatisfaction compared with their general counterparts; the same was not the case in the oldest age group.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>OA is not uncommon among younger and middle-aged adults, and they experience OA impacts comparable with those for older adults. These findings suggest that younger adults with OA will live many years with symptoms and disability and highlight a need for effective OA management across ages.</p>\u0000 </section>\u0000 </div>","PeriodicalId":8406,"journal":{"name":"Arthritis Care & Research","volume":null,"pages":null},"PeriodicalIF":3.7,"publicationDate":"2024-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/acr.25374","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140943219","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Informing Digital Programs for Lupus Self-Management Education: A Systematic Scoping Review 为红斑狼疮自我管理教育的数字程序提供信息：系统性范围审查。

IF 3.7 2区医学 Q1 RHEUMATOLOGY

Arthritis Care & Research

Pub Date : 2024-05-12 DOI: 10.1002/acr.25357

Katherine Carpenter, Sarah Gilman, Melissa French, Yasmine Shakur, Charmayne Dunlop-Thomas, Laura Cullerton, Cristina Drenkard, Kamil E. Barbour, S. S. Lim

Objective

We describe the characteristics, content, and effectiveness of digital self-management (SM) education programs for lupus and other chronic conditions to identify gaps and inform the improvement of future programs in lupus.

Methods

Three bibliographic databases were searched for articles published between May 2012 and April 2022. The search was cast to capture the breadth of digital SM education programs in the following conditions: lupus, epilepsy, fibromyalgia, multiple sclerosis, sickle cell anemia, Sjögren syndrome, psoriatic arthritis, and rheumatoid arthritis. Title and abstract screening, as well as full-text review, was conducted by two independent reviewers. Data extraction was first completed by one author charting all studies and then, a second time, by four members of the research team charting collaboratively.

Results

Of the 1,969 articles identified through the search, 14 met inclusion criteria. Two additional articles were included following bibliography review. The 16 articles represented 12 unique digital SM education programs. Programs covered five conditions: epilepsy (n = 3), fibromyalgia (n = 2), multiple sclerosis (n = 4), lupus (n = 1), and rheumatoid arthritis (n = 2). Most programs were asynchronous and internet-based (n = 9) with a prescribed sequence of content (n = 8). Peer, technical, or specialist support was offered in seven programs. Most programs demonstrated statistically significant improvement of symptoms in the intervention group (n = 8).

Conclusion

This scoping review summarizes the current landscape for digital SM education programs in lupus and similar conditions. In lupus, further investigation will fill in the gaps around digital SM education needs, user experience, and evaluation of outcomes.

目的我们描述了针对红斑狼疮和其他慢性疾病的数字化自我管理（SM）教育项目的特点、内容和有效性，以找出差距，为改进未来的红斑狼疮项目提供参考：方法：在三个文献数据库中检索了 2012 年 5 月至 2022 年 4 月间发表的文章。搜索范围包括以下疾病的数字 SM 教育项目：红斑狼疮、癫痫、纤维肌痛、多发性硬化症、镰状细胞性贫血、Sjogren's 综合征、银屑病关节炎和类风湿性关节炎。标题和摘要筛选以及全文审阅由两位独立审稿人完成。数据提取工作首先由一位作者对所有研究进行制表，然后由研究团队的四位成员合作进行第二次制表：结果：在搜索到的 1,969 篇文章中，有 14 篇符合纳入标准。另有两篇文章在书目审查后被纳入。这 16 篇文章代表了 12 个独特的数字 SM 教育项目。项目涉及五种疾病：癫痫（3 篇）、纤维肌痛（2 篇）、多发性硬化（4 篇）、狼疮（1 篇）和类风湿性关节炎（2 篇）。大多数项目是基于互联网的异步项目（人数=9），有规定的内容顺序（人数=8）。有 7 个项目提供同伴、技术或专家支持。大多数项目都表明，干预组的症状有明显的统计学改善（8 个）：本综述总结了狼疮及类似疾病的数字 SM 教育项目的现状。在红斑狼疮方面，进一步的调查将填补数字 SM 教育需求、用户体验和结果评估方面的空白。

{"title":"Informing Digital Programs for Lupus Self-Management Education: A Systematic Scoping Review","authors":"Katherine Carpenter, Sarah Gilman, Melissa French, Yasmine Shakur, Charmayne Dunlop-Thomas, Laura Cullerton, Cristina Drenkard, Kamil E. Barbour, S. S. Lim","doi":"10.1002/acr.25357","DOIUrl":"10.1002/acr.25357","url":null,"abstract":"<div>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>We describe the characteristics, content, and effectiveness of digital self-management (SM) education programs for lupus and other chronic conditions to identify gaps and inform the improvement of future programs in lupus.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Three bibliographic databases were searched for articles published between May 2012 and April 2022. The search was cast to capture the breadth of digital SM education programs in the following conditions: lupus, epilepsy, fibromyalgia, multiple sclerosis, sickle cell anemia, Sjögren syndrome, psoriatic arthritis, and rheumatoid arthritis. Title and abstract screening, as well as full-text review, was conducted by two independent reviewers. Data extraction was first completed by one author charting all studies and then, a second time, by four members of the research team charting collaboratively.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Of the 1,969 articles identified through the search, 14 met inclusion criteria. Two additional articles were included following bibliography review. The 16 articles represented 12 unique digital SM education programs. Programs covered five conditions: epilepsy (n = 3), fibromyalgia (n = 2), multiple sclerosis (n = 4), lupus (n = 1), and rheumatoid arthritis (n = 2). Most programs were asynchronous and internet-based (n = 9) with a prescribed sequence of content (n = 8). Peer, technical, or specialist support was offered in seven programs. Most programs demonstrated statistically significant improvement of symptoms in the intervention group (n = 8).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>This scoping review summarizes the current landscape for digital SM education programs in lupus and similar conditions. In lupus, further investigation will fill in the gaps around digital SM education needs, user experience, and evaluation of outcomes.</p>\u0000 </section>\u0000 </div>","PeriodicalId":8406,"journal":{"name":"Arthritis Care & Research","volume":null,"pages":null},"PeriodicalIF":3.7,"publicationDate":"2024-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/acr.25357","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140911546","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0