Average HAQ Research Articles

Are the Goals of Therapy Achievable in Patients with Rheumatoid Arthritis Receiving Upadacitinib in Real Clinical Practice?

The aim of the study was to evaluate the effectiveness of UPA in RA patients in real clinical practice after 3 and 6 months of therapy. The study included 63 RA patients with high activity of the disease. Activity was assessed according to the DAS28(ESR), DAS28(CRP), SDAI, CDAI; functional ability to HAQ; quality of life to the EQ-5D; disease activity according to the patient’s RAPID-3 index; the level of depression and anxiety to the HADS scale. The effectiveness of therapy was evaluated after 3 (n = 45) and 6 (n = 31) months of UPA therapy. Remission or low activity of the disease by 3 months of therapy was achieved by most patients: remission of 69.8% of patients, low activity of the disease—16.3% of patients. Moderate or high activity persisted in 13.9% of patients. By the 6th month of UPA therapy, the number of remissions reached 90%, low activity 3.3%, moderate activity persisted in 6.7% of patients, high activity of the disease was not in any patient. 20% improvement in function was achieved in 71.8% of patients by the 3rd month of therapy and in 77.8% by the 6th month of treatment; the difference in average HAQ values by the 3rd month of therapy was 0.38 points, by the 6th month—0.58 points. After 3 months of follow—up, 31.1% of patients continued taking GC, by 6 months—24.2%. The dose of GC was reduced from an average of 7.23 to 5.6 mg/s. The percentage of patients requiring NSAIDs decreased from 95.2 to 35.6% and 33.3%, respectively. DMARDs continued to be received by 75.6% of patients by 3 months and 69.7% by 6 months of follow-up. Achieving remission or low activity of the disease in patients with RA receiving UPA in real clinical practice is possible in most patients. A rapid decrease in inflammatory activity is accompanied by a significant improvement in the functional state and quality of life of patients. UPA therapy reduces the need for the use of NSAIDs and reduces the dose of GC in a third of patients.

Are the goals of therapy achievable in patients with rheumatoid arthritis receiving upadacitinib in real clinical practice?

The aim of the study was to evaluate the effectiveness of UPA in RA patients in real clinical practice after 3 and 6 months of therapy.Material and methods. The study included 63 RA patients with high activity of the disease. Activity was assessed according to the DAS28 (ESR), DAS28 (CR P), SDAI, CDAI; functional ability to HAQ; quality of life to the EQ-5D; disease activity according to the patient’s RAPID-3 index; the level of depression and anxiety to the HADS scale. The effectiveness of therapy was evaluated after 3 (n=45) and 6 (n=31) months of UPA therapy.Results. Remission or low activity of the disease by 3 months of therapy was achieved by most patients: remission of 69.8% of patients, low activity of the disease – 16.3% of patients. Moderate or high activity persisted in 13.9% of patients. By the 6th month of UPA therapy, the number of remissions reached 90% , low activity – 3.3%, moderate activity persisted in 6.7% of patients, high activity of the disease was not in any patient. 20% improvement in function was achieved in 71.8% of patients by the 3rd month of therapy and in 77.8% – by the 6th month of treatment; the difference in average HAQ values by the 3rd month of therapy was 0.38 points, by the 6th month – 0.58 points. After 3 months of follow-up, 31.1% of patients continued taking GC, by 6 months – 24.2%. The dose of GC was reduced from an average of 7.23 mg/d to 5.6 mg/d. The percentage of patients requiring NSAIDs decreased from 95.2% to 35.6% and 33.3%, respectively. DMARDs continued to be received by 75.6% of patients by 3 months and 69.7% by 6 months of follow-up.Conclusion. Achieving remission or low activity of the disease in patients with RA receiving UPA in real clinical practice is possible in most patients. A rapid decrease in inflammatory activity is accompanied by a significant improvement in the functional state and quality of life of patients. UPA therapy reduces the need for the use of NSAIDs and reduces the dose of GC in a third of patients.

Evaluation of efficacy and safety of long-term use of amtolmetin guacil in rheumatic diseases: results of a 9-month observational AURORA study (Amtolmetin guacil: allRussian Register for Osteoarthritis, Rheumatoid arthritis and Ankylosing spondylitis)

Non-steroidal anti-inflammatory drugs (NSAIDs) are widely used for the treatment of rheumatic diseases (RD). In some cases, their long-term use is advisable: NSAIDs slow the progression of spondylarthritis, are an important element in the control of chronic pain in osteoarthritis (OA) and rheumatoid arthritis (RA). However, the risk of serious adverse events (AE) should be considered. A good choice for long-term therapy may be amtolmetin guacil (AMG), which rarely induce gastrointestinal AE.The aimof the study was to assess the effect and safety of long-term use of AMG in RD.Material and methods.An open observational study was conducted in which AMG (Nayzilat) was assigned to 442 patients with OA (mean age 60.6±10.2 years, women 88.7%), 126 patients with RA (55.0±14.0 years, women 84.2%) and 73 with ankylosing spondylitis (AS, 47.0±12.0 years, women 30.0%). The dose of AMG depended on the clinical situation and was determined by the attending physician: from 1800 to 600 mg/day. The main criterion of the effect was the changes of pain by numeric rating scale (NRS), additional measures of efficacy were pain on the WOMAC and HAQ for OA, DAS28 for RA, BASDAI, BASFI and ASDAS-CRP for AS. The result of treatment was evaluated during three consecutive visits every 3 months (9 months of follow-up).Results and discussion.At the end of follow-up 65.2% of patients with OA, 75.3% of patients with RA and 82.2% of patients with AS continued treatment with AMG. The reasons for discontinuation of treatment were significant reduction or absence of pain (70.3%), the patient's decision (26.6%) or AE (3.1%). At the end of follow-up, there was a significant decrease in pain intensity compared to the baseline: in OA, the median pain decreased from 5.6 [4.1; 6.9] to 3.4 [1.7; 5.1], in RA from 5.8 [4.0; 7.5] to 3.4 [2.0; 4.8], in AS from 5.8 [4.2; 7.5] to 3.1 [1.5; 5.0] according to NRS, the difference was significant in all groups (p<0.001). In OA, the median WOMAC pain decreased from 127 [24; 159] to 13.7 [14; 40] (p<0.001), the average HAQ value – from 0.54±0.44 to 0.34±0.26 (p<0.001). In RA, the average value of DAS28 decreased from 4.81±1.18 to 4.30±1.24 (p<0.05). The number of painful and swollen joints, ESR and C-reactive protein also significantly decreased. In AS, the median BASDAI index decreased from 4.5 [1.0; 8.0] to 3.0 [0; 8.0] (p<0.001). The number of patients with high activity according to ASDAS-CRP (>3.5) decreased from 76.9 to 25.8% (p<0.001). The BASFI index did not changed. 77.9% of patients with OA, 77.0% with RA and 74.5% with AS were satisfied with the results of AMG treatment. AMG tolerance was good. Mild dyspepsia was observed in 15–25% of patients. AE, which caused the discontinuation of therapy, were observed only in 6 (0.93%) patients. There was no development or deterioration of hypertension, as well as other cardiovascular complications.Conclusion.AMG is an effective NSAID with good tolerability, which is advisable to use for long-term treatment of RD. Limitations are the open nature of the study and the absence of a control group.

EQ-5D utility, response and drug survival in rheumatoid arthritis patients on biologic monotherapy: A prospective observational study of patients registered in the south Swedish SSATG registry.

ObjectivesBiologic agents have dramatically changed treatment of rheumatoid arthritis (RA). To date only scarce head-to-head data exist especially when the biological therapies are given as monotherapy without concomitant disease modifying drugs (DMARDs). Thus the objective of the current study is to evaluate treatment response of all available biological therapies with special focus on utility (EQ-5D-3L) and drug survival of biologic DMARDs (bDMARDs) prescribed as monotherapy in RA patients in southern Sweden.Materials and methodsAll RA patients registered in a regional database as initiating bDMARD as monotherapy, i.e. without concomitant conventional synthetic DMARDs (csDMARDs), from 1st of January 2006 through 31st of December 2012, were included. Patients were followed from initiation of the first dose of bDMARD monotherapy treatment until withdrawal from treatment, loss of follow-up or 31st of December 2012. Descriptive statistics for utility (EQ-5D-3L), effectiveness, and drug survival of bDMARD monotherapy were calculated.ResultsDuring the study period, a total of 554 patients were registered in SSATG as initiating bDMARD monotherapy. Most of the patients were women (81%), with a mean age of 57 years. The average disease duration was more than 12 years, and on average the patients had previously been treated with approximately four different csDMARDs. Fifty-five percent of the patients were initiating their first bDMARD, 26% their second, and 19% their third or more. At baseline the average EQ-5D-3L was 0.34. Most patients had moderate to high disease activity, with a mean DAS28 of 5.0, and were substantially disabled, with an average HAQ score of 1.4. At 6 months´ follow-up, the EQ-5D-3L in patients still on the biologic drug had increased by mean 0.23 (SD 0.4) with no differences between type of bDMARD (p = 0.49). The mean change in EQ-5D-3L ranged from 0.11 (rituximab and infliximab) to 0.42 (tocilizumab). Although the changes were numerically different, no distinct pattern favored any particular bDMARD for EQ-5D-3L (p = 0.49) or other clinical outcomes. Overall, DAS28 defined remission and low disease activity were achieved in 20% and 43% of patients, respectively. Drug survival rates were statistically significantly different between bDMARDs (p = 0.01), with the highest rates observed for rituximab, followed by etanercept. After failing first course of anti-TNF, patients switching to another mode of action had significantly higher drug survival than those switching to a second course of anti-TNF therapy (p = 0.02).ConclusionsUtility (EQ-5D-3L) increased after 6 months of all bDMARD treatments in monotherapy, indicating improvement of patients’ quality of life. After failure of anti-TNF treatment in monotherapy, switching to another mode of action may be associated with better drug survival than starting a second TNF-inhibitor.

AB1177-HPR Occupational Characterization in A Cohort of Rheumatoid Arthritis Patients – Correlation with Disease Activity and Functional Status

BackgroundRheumatoid arthritis (RA) is a disease that in most cases is associated with disability and loss of earning capacity. There is a lack of information about occupation of rheumatoid arthritis...

AB0220 Disability and Health-Related Quality of Life of Filipino Patients with Rheumatoid Arthritis

BackgroundRheumatoid arthritis is associated with physical disability as the disease progresses. Disability, in turn, exerts a significant impact on general health satisfaction and mortality of the RA patient. High disease...

AB0846-HPR Independence in daily life activities in patients with rheumatoid arthritis and correlation with personal causation, disease activity and functionality

BackgroundIndependence in daily life activities (DLA) is the capability to perform every procedure in adequate time and without any help. In rheumatoid arthritis (RA) patients functionality is reduced and usually...

AB0845-HPR Impact of occupational therapy treatment in daily life activities dependence in a cohort of rheumatoid arthritis patients

BackgroundOccupational Therapy’s (OT) intervention has as a principal objective to get or to maintain independence and functionality in patients with Rheumatoid arthritis (RA). Independence in daily life activities (DLA) is...

SAT0582-HPR Occupational Characterization and Relation between Working Condition and Disease Activity or Functionality in Patients with Rheumatoid Arthritis

BackgroundRheumatoid arthritis (RA) is a disease that in most cases is associated with disability and loss of earning capacity. There is a lack of information about occupation of rheumatoid arthritis...

FRI0483-HPR Occupational characterization and relation between working condition and disease activity or functionality in patients with rheumatoid arthritis

BackgroundRheumatoid arthritis (RA) is a disease that in most cases is associated with disability and loss of earning capacity. There is a lack of information about occupation of rheumatoid arthritis...

AB1204 Course and outcomes of systemic juvenile arthritis after 10 and more years of follow-up in adults

BackgroundAmong all arthritis in children the systemic juvenile arthritis (SoJA) is one of the most severe by its clinical implications, the most complicated in terms of differentiated diagnostics, selection of...

FRI0486-HPR Personal causation and spare time use in patients with rheumatoid arthritis and relationship with age and functionality

BackgroundPersonal causation is defined as motivation and desire to do daily life activities and it is affected by disease derived functional decline, psychological and social problems. Spare time utilization is...

FRI0591-HPR Correlates of energy expenditure in the rheumatoid arthritis (RA) population

BackgroundFew research studies have been conducted designed specifically to examine the correlates of physical activity behaviour for people with RA. Most of this work has been conducted assessing the psychosocial...

PMS17 ESTIMATION OF COSTS OF HEALTH CARE FOR PEOPLE WITH RHEUMATOID ARTHRITIS FOR VARYING DEGREES OF DISABILITY AS MEASURED BY THE HEALTH ASSESSMENT QUESTIONNAIRE IN THE UNITED KINGDOM

OBJECTIVES: Rheumatoid arthritis (RA) confers both significant short- and longterm disability, and substantial background health care costs, yet cost data are scarce. We modeled disability in RA using covariates also available in routine, primary care data from which total health care cost were estimated. METHODS: In modeling disability, biologic-naive RA cases from the UK biologics register were selected. General Linear Modeling (GLM) was used to predict HAQ score from demographics, comorbidity, polypharmacy, RA duration, BMI, smoking status and disease activity. Health care costs were estimated from similar incident cases with > = 1 year’s observation selected from the THIN database. Annual costs included prescriptions, consultations, and investigations from primary care and hospital episodes. An alternatve generalised linear model assumed a Poisson distribution, and a log-link explored the association between health care costs and predicted HAQ. RESULTS: Disability was modeled using 3,924 cases, of whom 75% were female with an average age of 58 years (sd 14) and an average baseline HAQ of 1.80 (sd 0.72). The optimal HAQ model included gender, RA duration, number prior DMARDs, number of current non- DMARD drugs, logCRP, smoking status and stroke history. The r2 value was 0.27, while mean prediction error was 0.15 (sd 0.30). Costs were assessed in 3,378 cases with similar gender balance but slightly older (mean 64 years). Their predicted HAQ scores ranged from 0.48 to 3.00, with a mean of 1.60 (sd 0.40). The mean total cost of care in this population was £1,960 per annum (sd, £1,864), with prescriptions the largest component (43%), followed by outpatient attendances (18%), GP consultations (16%), and hospital admissions (13%). Predicted total costs (GBP2007) ranging from £650 to £10,017 were calculated from EXP^(5.949+(Age*0.002)+(pHAQ*0.67 5)+(Age*pHAQ*0.003)). CONCLUSIONS: Total health care costs for RA patients increased exponentially across the range of estimated disability. Exclusion of supportservice costs suggests these values may be conservative.

Early Referral and Outcome in Rheumatoid Arthritis

In a cross-sectional study of 200 outpatients with rheumatoid arthritis (RA) we tested the hypothesis that early specialist referral within one year of disease onset reduces subsequent functional disability. Early referral was defined as being seen in a specialist unit within one year of the onset of symptoms. Functional outcome was measured using the physical functional section of the full test (NHP) and (HAQ). Additional information was collected on other factors likely to influence disability including age, sex, pain scores, and rheumatoid factor positivity. The difference in average HAQ and NHP physical function scores between late and early referrals was 0.34 and 11.0 respectively (p<0.01 in both cases) using unequal-variance t-test. After adjusting for the other risk factors, multiple regression analysis showed late referral patients had greater NHP physical function scores than early-referred patients by approximately 8 points and there was a similar trend with HAQ. We conclude that early referral for specialist advice is associated with improved health status, with reduced physical function scores on the NHP.