Quality Of Life In Rheumatoid Arthritis Research Articles

Medication Adherence and its Association with Socioeconomic Factors and Quality of Life in Patients with Rheumatoid Arthritis

Abstract Background: Medication adherence to prescribed medications in chronic diseases like rheumatoid arthritis (RA) is influenced by social and economic factors, health-care team/system factors, characteristic of the disease, disease therapies, and physician-related and patient-related factors. Socioeconomic factors of the patients play a major role in adherence to long-term therapies. In view of lack of consistent findings and limited studies, this study aimed to study the socioeconomic factors and quality of life (QOL) and their association with medication adherence in RA. Materials and Methods: This is a prospective observational study carried out in a tertiary care hospital from February 2021 to June 2021. The Compliance-Questionnaire-Rheumatology 19 was used to assess adherence with scores ≥80% considered adherent and others nonadherent. QOL was assessed by the WHOQOL-BREF Questionnaire, and socioeconomic factors were determined using the Modified Kuppuswamy’s Socioeconomic Status scale 2020. Results: Of the 135 patients (108 females and 27 males) in the study, adherence was observed only in 19.3% (26) and the remaining 80.7% (109) were nonadherent. There was a significant difference (P = 0.013) in the number of medications used among both the groups. Among the socioeconomic factors, though there is difference in occupation of both the groups, it was found be not significant (P = 0.058). There was no association of adherence with any of the four domains of QOL. Conclusion: There was no association of medication adherence with socioeconomic factors and QOL in RA.

Workplace activity limitation and quality of life: A study on rheumatoid arthritis patients.

Rheumatoid arthritis (RA) causes disabilities that affect people in working age and can impair their working activity and quality of life (QoL). To assess work activity limitation and QoL among RA patients and to explore the associated risk factors. A cross-sectional study on 344 RA patients was conducted at the outpatient clinic using a number of standardized questionnaires including the Health Assessment Questionnaire Disability Index, Workplace Activity Limitation Scale, and RA QoL. Clinical examinations were also performed including the measurement of pain intensity, assessment of disease activity, and the Rheumatoid Arthritis Severity Scale. Most of the employed participants (87%) experienced high work activity limitations. Increasing work limitations were significantly associated with a decrease in QoL domains scores. The most significant risk factors affecting work limitation by logistic regression were high disease activity, the severity of the disease, married females, and a high health assessment disability index among RA patients. RA patients experience limitations that affect their productivity at work and their QoL. Paying more attention to early management to prevent the upcoming unfavorable health and economic consequences for RA patients is significantly important.

Quality of life assessment and its correlation with disease activity in rheumatoid arthritis patients

Background: Rheumatoid arthritis (RA) is a chronic autoimmune disease of unknown etiology that leads to synovial membrane inflammation & destruction of the synovial joints. Quality of life (QoL) is a multidimensional concept that is used to describe the individuals’ perceptions, satisfaction, and evaluation of different areas of their own lives. Objective: to assess the impact of rheumatoid arthritis on the quality of life of the patients & its correlation with disease activity & functional impairment. Materials and methods: The study was carried out on 60 RA patients. All patients were subjected to complete clinical examination & laboratory assessment. Disease activity had been assessed through Disease Activity Score 28 (DAS 28). Functional assessment by HAQ-DI (Health Assessment Questionnaire - Disability Index) was done. Quality of life assessment by: World Health Organization Quality of Life BREF (WHO QoL BREF) and Rheumatoid Arthritis Quality of Life (RAQoL). Sleep quality was assessed by PSQI. Results: There was significant negative correlation between QoL assessed by (WHO QoL BREF) & DAS. There was significant positive correlation between QoL assessed by RAQoL & DAS (P < 0.001), quality of sleep assessed by (PSQI) & DAS.

Examining the Relationship Between Rheumatoid Arthritis, Multimorbidity, and Adverse Health‐Related Outcomes: A Systematic Review

Multimorbidity (the coexistence of two or more long-term conditions) is highly prevalent in people who have rheumatoid arthritis (RA). The present work systematically reviewed the literature to determine the effect of multimorbidity on all-cause mortality, functional status, and quality of life in RA. Six electronic databases were searched: CINAHL, The Cochrane Library, Embase, Medline, PsycINFO, and Scopus. Full-text longitudinal observational studies in English were selected. Quality appraisal of studies was undertaken using the Cochrane-developed QUIPS tool and a narrative synthesis of findings conducted. The search strategy identified 5,343 articles, with 19 studies meeting the inclusion criteria. Nine studies had mortality as an outcome, 9 reported functional status and/or quality of life, and 1 study reported both mortality and functional status. The number of participants ranged from 183 to 18,485, with studies conducted between 1985 and 2018. The mean age of participants ranged from 52.0 to 66.6 years, and 60.0-88.0% were female. Nine studies showed a significant association between multimorbidity and higher risk of mortality in people with RA. Ten studies reported significant associations between multimorbidity and reduced functional status in RA. Three studies also showed a further association with reduced quality of life. Only one study investigated the influence of mental health comorbidities on outcomes. Our review findings indicate that multimorbidity is a significant predictor for higher mortality and poorer functional status/quality of life in people with RA and should be considered in clinical management plans.

Effectiveness of Muscle Energy Technique with Free Exercises on Quality of Life in Chronic Rheumatoid Arthritis

Background: Rheumatoid arthritis (RA) is a chronic inflammatory, symmetrical involvement polyarthritis disease. It affects many tissues in the body. The prevalence of RA in women varies from 0.5 to 3.8% and in men 0.15 to 1.37% with peak incidence in fourth decade of life. Objectives: The objectives of the study were to determine the effect of muscle energy technique (MET) with free exercise on quality of life (QOL) in chronic RA. Materials and Methods: An experimental study was carried out using simple random sampling method during 1 year in Krishna Hospital. Pre- and post-design was used for assessing the study. SPSS software was used for analysis. Result: A total of 30 subjects were involved as per inclusion and exclusion criteria and assessed with numerical rating scale (NRS) and health assessment questionnaire (HAQ). There was only one group. There is statistically significant difference with respect to mean value of NRS is (at rest) 1.30 ± 0.46, (on activity) 3.26 ± 0.58 with P < 0.0001, and HAQ 1.19 ± 0.25 with P < 0.0001. Conclusion: This study concluded that MET with free exercises on QOL in chronic RA has shown significant improvement clinically and statistically on QOL and pain.

Impact of rheumatoid arthritis on sexuality: adaptation and validation of the Qualisex questionnaire for use in Spain.

Patients with rheumatoid arthritis (RA) have a significantly increased risk of sexual dysfunction. However, it is not properly included in commonly used questionnaires to assess health-related quality of life in RA. Qualisex is a questionnaire developed in France to assess the impact of RA on patients´ sexual function. Our aim was to adapt and validate this questionnaire for use with Spanish RA patients. Two independent translations and a backward translation were obtained. The final version was tested in a pilot study with 10 RA patients to detect any aspects that could hinder interpretation. The validity and reliability of the linguistically validated questionnaire were studied in a multicenter cross-sectional study, with a longitudinal component for reliability estimation. 125 RA patients were included. The response process, discrimination, internal consistency, internal structure, convergent validity (correlation with MGH-SFQ questionnaire, DAS-28, physician global assessment, patient global health assessment, RAID, HAQ, HADS and SF-12©) and reliability were analyzed. The inclusion of two extra items was proposed in the pilot study. The validity analysis detected responses for item 10 that were not coherent with responses for the rest of items. The Cronbach alpha coefficient was 0.971. The highest correlation (0.665) was obtained with MGH-SFQ (questionnaire measuring sexual functioning), followed by RAID (0.516). The intra-class correlation was 0.880 (95% CI 0.815; 0.923), higher than 0.85, which indicates excellent reliability. All parameters used to assess this questionnaire show highly acceptable values. Qualisex allows for a global score of RA patients' sexual functioning and can be self-administered.

Lower Urinary Tract Symptoms Among Females with Rheumatoid Arthritis: A Prospective Cross-Sectional Study.

PurposeTo assess the presence of lower urinary tract symptoms (LUTS) in rheumatoid arthritis (RA) female patients with assessment of LUTS and its impact on quality of life (QoL).Patients and MethodsA prospective, cross-sectional study of female patients with RA was conducted. Demographics and clinical data, Bristol Female Lower Urinary Tract Symptoms questionnaire (BFLUTS), and the RA Disease Activity Score 28 (DAS28) were all collected. A correlation has been made between all variables to assess the factors that induce LUTS in RA and the impact on QoL.ResultsEighty-nine patients were enrolled. About 94.4% of RA patients had at least one symptom of LUTS. Concerning DAS28, 55.1% had moderate disease activity and 16.9% had high disease activity, which was not significantly associated with BFLUTS or QoL. The prevalence of overactive bladder syndrome symptoms (OAB: frequency, urgency, nocturia, and urgency incontinence) were found to be 65.2%, 59.6%, 56.2%, and 30.3%, respectively. Stress incontinence was prevalent in 40.4% of patients. The overall interference with life was evident in 27 (30.3%) patients secondary to LUTS. Body mass index (BMI) was positively and significantly correlated with the presence of storage symptoms (r = 0.306, p = 0.004) and with the total BFLUTS (r = 0.251, p = 0.018). BFLUTS subdomains and total scores were significantly correlated to poor QoL. The correlation of the BFLUTS QoL was found to be r = 0.584, p < 0.001 with storage symptoms, r = 0.399, p < 0.001 with voiding symptoms, and r = 0.757, p < 0.001 with incontinence.ConclusionLUTS is a prominent and significant disability that directly affects QoL in RA. BMI is an independent factor that is linked to LUTS in RA patients.

A novel approach utilizing laser acupuncture teletherapy for management of elderly-onset rheumatoid arthritis: A randomized clinical trial

Introduction Rheumatoid arthritis (RA) disease is a systemic progressive inflammatory autoimmune disorder. Elderly-onset RA can be assumed as a benign form of RA. Until recently, face-to-face therapeutic sessions between health professionals and patients are usually the method of its treatment. However, during pandemics, including coronavirus disease 2019 (COVID-19), teletherapeutic sessions can extensively increase the patient safety especially in elderly patients who are more vulnerable to these infections. Thus, the aim of this randomized clinical trial was to evaluate a novel teletherapy approach for management of elderly patients suffering from RA by utilizing laser acupuncture. Methods A teletherapy system was used for management of elderly patients suffering from RA. Sixty participants were allocated randomly into two groups and the ratio was 1:1. Patients in the first group were treated with laser acupuncture and telerehabilitation sessions, which consisted of aerobic exercise and virtual reality training. Patients in the second group received telerehabilitation sessions, which consisted of aerobic exercise and virtual reality training. Evaluation of patients was done by using the Health Assessment questionnaire (HAQ), the Rheumatoid Arthritis Quality of Life (RAQoL) questionnaire, and the analysis of interleukin-6 (IL-6), serum C-reactive protein (CRP), plasma adenosine triphosphate (ATP) concentration and plasma malondialdehyde (MDA). Results A statistically significant difference was found in CRP, RAQoL, IL-6 and MDA between the pre- and post-treatments in the first group (p < 0.05) favouring the post-treatment group, while the HAQ showed a statistically significant difference between pre- and post-treatments (p < 0.05) in both groups. Statistically significant post-treatment differences were also observed between the two groups (p < 0.05) in RAQoL, CRP, ATP and MDA, favouring the first group. Discussion Laser acupuncture teletherapy could be suggested as a reliable treatment method for elderly patients suffering from RA, as it can provide a safe and effective therapeutic approach. Teletherapy provided safer access to health professionals and patients while giving a high patient satisfaction value with a relatively lower cost (ClinicalTrials.gov Identifier: NCT04684693).

Foot Disorders in Rheumatoid Arthritis Patients and their Impact on Functional Ability and Quality of Life

Foot Disorders in Rheumatoid Arthritis Patients and their Impact on Functional Ability and Quality of Life AbstractAim of the work:This study aimed to determine frequency of foot disorders in RA patients , find relation between RA disease activity and foot disorders and find out their impact on functional ability and quality of life. Patients and methods: This study included a total of 300 RA patients. All patients were subjected to the following; full history taking, clinical and laboratory examination, disease activity assessment by modified DAS28, Manchester Foot Pain and Disability Index (MFPDI, Foot and Ankle Ability Measure (FAAM), and Rheumatoid Arthritis Quality of Life (RAQoL). Results: We found that178 patients (59.3%) had foot complaint. Among the studied RA patients, there were 122 patients (46.7%) had ankle affected, 91 patients (30.3%) had subtalar affected, 73 patients (24.3%) had interphalangeal affected, 70 patients (23.3%) had midtarsal affected and 64 patients (21.3%) had metatarsophalangeal affected. There were high significant differences between RA patients with foot disorders and those without foot disorders regarding physical function and quality of life. Patients with high disease activity had more foot pain and disability, also they had more impairment of physical function and quality of life.Conclusion: Significant high frequency of foot disorders among RA patients. RA patients with high risk of developing foot disorders had high BMI , high disease activity and longer disease duration. Foot disorders had great impact on functional ability and quality of life in RA patients.

Kinesiophobia in rheumatoid arthritis patients: Relationship with quadriceps muscle strength, fear of falling, functional status, disease activity, and quality of life.

Objectives This study aims to determine the frequency of kinesiophobia in rheumatoid arthritis (RA) patients and to evaluate the relation of kinesiophobia with the knee range of motion (ROM), quadriceps muscle strength, fear of falling, functional status, disease activity, depression, and quality of life.Patients and methods Between September 2018 and September 2019, a total of 100 RA patients (25 males, 75 females; mean age: 56.1±9.3 years; range, 32 to 69 years) and 50 healthy controls (14 males, 36 females; mean age: 54.6±9.8 years; range, 30 to 69 years) were included. Disease activity was evaluated using the Disease Activity Score 28 (DAS28), and functional status using the Health Assessment Questionnaire (HAQ). Pain severity was measured using the Visual Analog Scale (VAS). Tampa Kinesiophobia Scale (TKS) was used to evaluate kinesiophobia. Quadriceps muscle strength and knee ROM measurements of two extremities were recorded. Depression was evaluated using the Beck Depression Inventory (BDI), fear of falling by Falls Efficacy Scale (FES) and quality of life using the Short Form-36 (SF-36).Results The rate of kinesiophobia was 70% in RA patients and 12% in controls, indicating a higher rate in RA patients, compared to controls (odds ratio [OR] = 44.861, 95% confidence interval [CI]: 42.571-49.052; p<0.05). This rate was 76% in females and 52% in males. Regression analysis revealed that the number of swollen and tender joints, DAS28, VAS-pain, and HAQ scores were positively associated with the TKS scores (p<0.05). Quadriceps muscle strength and knee flexion were negatively associated with the TKS scores (p<0.05). The TKS was significantly correlated with FES and BDI (p<0.05). The TKS was negatively correlated with SF-36 subscales (p<0.05).Conclusion Kinesiophobia is common in RA patients. Our study is the first to evaluate the frequency of kinesiophobia in RA patients and to show pain level, disease activity, functional status, knee flexion ROM, and quadriceps muscle strength are effective on kinesiophobia. Kinesiophobia is also associated with fear of falling and depression, negatively affecting the quality of life in terms of physical, emotional, social and mental functions. Therefore, evaluating kinesiophobia and developing targeted treatment approaches seem to be useful in increasing the quality of life in RA.

Assessment of psychometric characteristics and quality of life in adult and elderly patients with rheumatoid arthritis

Introduction: Rheumatoid arthritis (RA) is characterised by persistent joint inflammation and cartilage and bone damage with significant activity limitation, reduction in the Quality of Life (QoL), and often systemic complications. In recent years, there have been many advances in diagnostic and treatment modalities available for RA with better access to tertiary care centres in our country. The study aimed to analyse the present-day clinical profile of patients of RA reporting to a tertiary care centre in this part of India. Material and methods: This prospective observational, hospital-based study was carried out in a tertiary care teaching Mahavir Institute of Medical Sciences, Vikarabad over a period of six months. All diagnosed consecutive cases of RA visiting our OPD or admitted inwards were examined. The patients were diagnosed for RA based on the American College of Rheumatology Criteria-201. Detailed clinical history and examination along with inflammatory markers were analysed. The following instruments were used: The tools include the Medical Outcomes Study Short Form-36 (SF-36), The Western Ontario and McMaster (WOMAC) index, a disease-specific measure, was used to assess functional disability. Mini-International Neuropsychiatric Interview (MINI): The Mini-International Neuropsychiatric Interview (MINI) is a short diagnostic structured interview as per the Diagnostic and Statistical Manual (DSM-IVTR) diagnostic criteria. Results: The results indicated that there was a statistical difference in the QoL between subjects with RA and healthy population according to SF-36 Croatian norms. Also, the results showed that severe pain experience was significantly associated with poorer social functioning assessment. The RA group had significantly lower QoL scores in the psychological and environmental domains of QoL; life satisfaction scores were also significantly lower in the RA group when compared to control subjects. Conclusion: QoL and functional capacity in RA were affected in adults and the elderly. However, the results showed a significant difference between groups. There were significant proportions of patients who presented with high disease activity.

Comparison of the effectiveness of pilates exercises, aerobic exercises, and pilates with aerobic exercises in patients with rheumatoid arthritis.

Rheumatoid arthritis (RA) is a rheumatic disease characterized by erosive synovitis and polyarthritis. Exercise is known to improve many symptoms in RA patients. This study was designed to compare the effects of pilates exercises, aerobic exercises, and combined training including pilates with aerobic exercises on fatigue, depression, aerobic capacity, pain, sleep quality, and quality of life. Thirty voluntary RA patients were included in this study. Patients were divided into three groups equally, and treatment was applied to each group for 8weeks. Pilates exercises were practiced to the first group, aerobic exercises were practiced to the second group, and combined training was performed to the third group. Fatigue, depression, aerobic capacity, pain, sleep quality, and quality of life were evaluated using Fatigue Severity Scale (FSS), Beck Depression Inventory (BDI), 6-minute walk test (6MWT), McGill Pain Questionnaire- Short Form (MPQ-SF), Pittsburg Sleep Quality Index (PSQI), and Rheumatoid Arthritis Quality of Life (RAQoL), respectively. The results of the present study showed significant improvements for the first group on fatigue, depression, aerobic capacity, and quality of life (p < 0.05). Improvements in all parameters except for pain were obtained for the second and third groups (p < 0.05). In addition, there was no statistically significant difference among the treatment groups in assessments (p > 0.05). Pilates exercises may have similar effects to aerobic exercises in patients with RA. Addition of clinical pilates exercises to the routine treatment of RA may enhance the success of rehabilitation. Trial registration NCT03836820.

Accessibility to biologics and its impact on disease activity and quality of life in patients with rheumatoid arthritis in Kuwait

ObjectiveBiologics are indicated in rheumatoid arthritis (RA) in case of persistent high disease activity despite conventional disease-modifying anti-rheumatic drugs (cDMARDs) or patients with contraindications to cDMARDs or poor prognostic factors. The purpose of this study was to compare the prescription rates of biologics in Kuwaiti and non-Kuwaiti patients and to assess whether this had an impact on disease activity and quality of life in RA patients.MethodsData were extracted from the Kuwait Registry for Rheumatic Diseases. Adult patients who satisfied the ACR classification criteria for RA from four major hospitals in Kuwait were evaluated from February 2013 through May 2018. The treatment agents, disease activity, and quality of life of Kuwaiti patients were compared with non-Kuwaiti patients.ResultsA total of 1651 RA patients were included; 806 (48.8%) were Kuwaiti patients. Among Kuwaiti patients, 62.5% were on biologic drugs in comparison with 14% of non-Kuwaiti patients. In comparison with non-Kuwaiti patients, Kuwaiti patients had significantly lower numbers of swollen joints (p < 0.001) and disease activity score-28 scores (p = 0.02) and less steroid use (p < 0.001) yet a significantly higher health assessment questionnaire-disability index (p < 0.001). Regression analysis showed that DAS-28 scores were significantly associated with the treatment type (p < 0.001) and that nationality was significantly predictive of the treatment type (p < 0.001).ConclusionIn the setting of easy accessibility to treatment for Kuwaiti patients, biologics were prescribed by rheumatologists at a higher rate than for non-Kuwaitis. This may explain the lower disease activity and the lower rate of steroid use in Kuwaiti patients than non-Kuwaitis.Key points• Significant discrepancies in the rates of prescribing biologic therapies between KP and NKP in Kuwait were observed.• Several treatment outcomes were significantly better in the KP group than in the NKP group even after adjustment of confounding factors.• The poor access to biologic therapies was suggested to limit the effectiveness of RA treatments in the NKP group.

Adaptation and validation of the Rheumatoid Arthritis Quality of Life (RAQoL) questionnaire for use in Bulgaria.

Rheumatoid arthritis (RA) is a chronic disease with an enormous impact on patients' quality of life. The Rheumatoid Arthritis Quality of Life (RAQoL) questionnaire is a disease-specific measure of QoL for individuals with rheumatoid arthritis. Our aim was to adapt and validate the RAQoL for use in Bulgaria. The development of a new language version of the RAQoL consisted of three stages: translation, field testing and psychometric evaluation. The dual-panel methodology, requiring two independent panels of Bulgarian speakers, was applied to translate the UK English version of the RAQoL into Bulgarian. Face and content validity of the translated questionnaire were assessed through cognitive debriefing interviews. Lastly, the RAQoL was administered on two occasions to a random sample of RA patients to evaluate reliability and validity. At the first occasion, the SF-36 was also administered for use as a comparator scale. The RAQoL was successfully adapted into Bulgarian and considered easy to understand, acceptable and comprehensive by RA patients. A psychometric study demonstrated that the new language version has excellent internal consistency (Cronbach's alpha coefficients = 0.93 and 0.94) and test-retest reliability (a Spearman's rank correlation coefficient = 0.97). Convergent validity was established by correlating scores on the RAQoL with a comparator measure, the SF-36. A strong correlation between RAQoL scores and the physical functioning section of the SF-36 was observed. Known group validity was established by the ability of the measure to distinguish between subgroups of patients, who differed according to their perceived general health, disease severity (p < 0.001) and whether they were experiencing a flare-up (p < 0.01). The new language version is recommended for use in future research studies, clinical trials and routine practice with Bulgarian RA patients.

Serum C-Reactive Protein/Albumin Ratio in Rheumatoid Arthritis and its Relationship With Disease Activity, Physical Function, and Quality of Life

This study aims to evaluate the relationship between C-reactive protein (CRP)/albumin ratio (CAR) and disease activity, quality of life (QoL), and physical function in rheumatoid arthritis (RA). A total of 121 RA patients (22 males, 99 females; mean age 57.6±11.2 years; range, 32 to 85 years) applying to Ankara University School of Medicine Rheumatology Outpatient Clinic between January 2019 and February 2019 were included in this cross-sectional study. The inclusion criteria were fulfilling the American College of Rheumatology/European League Against Rheumatism 2010 RA classification criteria, being over 18 years and accepting to participate in the study. Demographic and clinical parameters including serum erythrocyte sedimentation rate (ESR), CRP and albumin levels were recorded. Disease activity was measured using Disease Activity Score 28 (DAS28)-ESR. General health, fatigue, and pain were questioned by means of a 100 mm visual analog scale (VAS). The QoL was assessed with the Rheumatoid Arthritis Quality of Life (RAQoL) Questionnaire. The functional status was determined using the Health Assessment Questionnaire (HAQ). Rheumatoid factor (RF) was positive in 56.2% of the patients. The median ESR was 19.0 mm/hour [interquartile range (IQR): 19.5] and median CRP was 5.6 (IQR: 9) mg/L. The median CAR was 1.3 (IQR: 2.1) and median DAS 28-ESR was 3.6 (IQR: 1.5). There was a significant but weak correlation between CAR and DAS28-ESR [p<0.001, Spearman's correlation coefficient (rs)=0.327]. Moreover, CAR was positively correlated with ESR, CRP, and VAS physician's global assessment (p<0.001, rs=0.497; p<0.001, rs=0.987, p<0.001, rs=0.401, respectively). However, no correlation was observed between CAR, HAQ, and RAQoL. In the RF positive group, there was a significant but weak correlation between CAR and RF titers (p=0.016, rs=0.292). We observed a positive but weak correlation between CAR and DAS28-ESR, ESR, and the RF titer. Further studies are warranted to investigate the role of CAR in RA.

More Unnecessary Imaginary Worlds - Part 1: The Institute for Clinical and Economic Review's Evidence Report on Janus Kinase (JAK) Inhibitors in Rheumatoid Arthritis.

Previous commentaries in the Formulary Evaluation section of INNOVATIONS in Pharmacy have pointed to the lack of credibility in modeled claims for cost-effectiveness and associated recommendations for pricing by the Institute for Clinical and Economic Review (ICER). The principal objection to ICER reports has been that their modeled claims fail the standards of normal science: they are best seen as pseudoscience. The purpose of this latest commentary is to consider the recently released ICER evidence report for Janus Kinase (JAK) Inhibitors. As ICER continues, in the case of JAK Inhibitors, to apply its modeled cost utility framework with consequent recommendations for pricing adjustments, these recommendations also lack credibility. In contrast with previous ICER evidence reports, the present report adopts only a 12-month timeframe, one due, in large part, to ICER being unable to justify assumptions to drive its construction of imaginary worlds beyond 12 months. This commentary emphasizesagain, why the ICER methodology fails to meet the standards of normal science. Claims made by ICER for the competing JAK Inhibitor therapies lack credibility, are impossible to evaluate, let alone replicate across treatment settings. Even so, it is important to examine a number of key elements in the ICER invention of the 12-month JAK Inhibitor imaginary world. While this does not imply any degree of acceptance of the ICER methodology, one element that merits particular attention is thefailure of the ICER modeling to meet logically defensible measurement standards in its application of generic health related quality of life (HRQoL) ordinal metrics to create its QALY claims. The failure to meet the required standards of fundamental measurement means that the cost-per-QALY claims are invalid. This raises the issue of the application of Rasch Measurement Theory (RMT) in instrument development and the potential role of patient centric outcome (PCO) instruments that represent the patient voice in value claims. The case made here is that the ICER approach should be abandoned as an unnecessary distraction. If we are to meet standards for the discovery of new facts in therapy response then our focus must be on proposing credible, evaluable and replicable claims within disease states. Instruments, such as the Rheumatoid Arthritis Quality of Life (RAQoL)questionnaire that build on the common construct that QoL is the extent to which human needs are fulfilled should be the basis for value claims. HRQoL Instruments that are clinically focused and reflect the value calculus of providers and not patients in measuring response by symptoms and activity limitations are irrelevant. This puts to one side the belief that incremental cost-per-QALY models, the construction of imaginary worlds are, in any sense, a 'gold standard'; a meme embraced by the health technology assessment profession. Claims for incremental cost per QALY outcomes and recommendations for pricing and access driven by willingness to pay thresholds are irrelevant to formulary decisions.

Prevalence of and factors associated with depression and anxiety in patients with rheumatoid arthritis: A multicenter prospective cross‐sectional study

To investigate the prevalence of and factors associated with depression and anxiety in patients with rheumatoid arthritis (RA). This prospective cross-sectional study included patients who were consecutively enrolled in the Siriraj Rheumatoid Arthritis Registry or the Thai Army Rheumatoid Arthritis Cohort during the September 2016 to March 2018 study period. Demographic data and clinical variables, including disease activity, functional status, health-related quality of life, and cognitive function, were collected. Depression and anxiety were assessed using the Thai version of the Hospital Anxiety and Depression Scale (Thai HADS). Four hundred and sixty-four patients were included. Mean age was 59years, median disease duration was 9.9years, and 85% of patients were female. Based on the Thai HADS cutoff value of 8 or higher, 12.5% and 14.5% of patients had some degree of depression and anxiety, respectively. Multivariate analysis revealed global health score (risk ratio [RR]: 0.98, P=.001) to be the only factor independently negatively associated with depression. Regarding anxiety, functional disability (RR: 2.46, P=.004) and married status (RR: 2.43, P=.009) were significantly associated with increased risk, whereas disease duration of 10years or more (RR: 0.45, P=.007) and global health score (RR: 0.97, P<.001) were significantly associated with decreased risk of developing anxiety. Depression and anxiety are common in patients with RA. Patients' perceptions of their current health are significantly related to mood disorders. Therefore, mental health status, especially mood disturbances, should be addressed in routine practice to improve quality of life in RA.

Rheumatoid Arthritis in the Lebanese Adults: Impact on Health-Related Quality of Life

Rheumatoid Arthritis (RA) is a chronic inflammatory disabling disease with significant impact on the Quality of Life (QOL) of patients. Information on the effects of RA on Health-related Quality of Life (HRQoL) is lacking in the Lebanese population. The objective of this study was to evaluate QOL of RA patients compared with non-RA subjects and to suggest possible predictors of their QOL in Lebanon. We conducted a case–control observational study among individuals visiting the external clinics at three hospitals and different private clinics; the QOL was measured using the SF-36 questionnaire administered face to face to the study population, applied to RA (N = 90) and non-RA (N = 180) groups. RA presented lower Physical Component Scores (PCS) and Mental Component Scores (MCS) as well as overall QOL scores. Among RA patients, MCS and QOL were significantly decreased with morning stiffness duration (β = −9.211, p = 0.013 and β = −9.190, p = 0.009, respectively). The frequency of practicing sport per week increases PCS and QOL (β = 6.692, p = 0.002 and β = 6.148, p = 0.003, respectively). Workability has a positive effect on PCS (β = 5.546, p = 0.022) and time between blood transfusion and the onset of the disease has a positive impact on MCS (β = 8.415, p = 0.007). To improve QOL of patients with RA, health professionals have to take these results into consideration while treating their patients.

Quality of life in Ecuadorian patients with established rheumatoid arthritis.

PurposeTo evaluate quality of life in patients with established rheumatoid arthritis (RA) and identify the factors that negatively affect it.MethodsThis was a cross-sectional study with patients with established RA from a rheumatology center in Ecuador. The RA Quality of Life (RAQoL) questionnaire was used to assess QoL and the Health Assessment Questionnaire — disability index (HAQ-DI) questionnaire for functional capacity. In addition, demographics, clinical characteristics, and markers of disease activity were included. Data were analyzed using SPSS 22.ResultsOf 186 patients, 89.8% were women, with a mean age of 51 years, 86.6% had symmetrical polyarticular involvement, 40.3% erosions, 46.8% morning stiffness, 46.8% xerophthalmia, and 39.2% fatigue. Depression was the most frequent comorbidity — 42.5%. The mean HAQ-DI score was 0.8, and 26.9% had functional disability. The mean RAQoL score was 7.2. Xerophthalmia, xerostomia, fatigue, morning stiffness, and depression were related to higher scores in the RAQoL (p<0.05). The mean RAQoL was higher in patients with more disease activity and comorbidities (p<0.05). Likewise, patients with functional disability had a mean RAQoL score of 15.6 versus 4.1 in patients without disability (p<0.05). There were positive correlations between RAQoL and ESR, CRP, painful-joint count, swollen-joint count, VAS of pain, and physician assessment (p<0.05).ConclusionQoL is severely affected in patients with RA. Depression, fatigue, morning stiffness, pain, high disease activity, and disability have a negative effect on QoL in RA. Likewise, patients with more comorbidities and extraarticular manifestations show worse QoL.

Lay Perspectives of Quality of Life in Rheumatoid Arthritis Patients: The Relevance of Autonomy and Psychological Distress.

The aim of this study is to increase the understanding of Quality of Life (QoL) in rheumatoid arthritis (RA) patients and explore the personal features of living with the disease. Sixty-two RA patients (MAge = 56.7; SD = 11.2; female = 83.9%) were interviewed. Assessment included topics on medical condition, functional status (HAQ-DI), and on their perceived difficulties and worries in having RA. Patients' overall definition of QoL was also inquired. Most patients lived with RA for a long period of time (M = 16.5 years; SD = 11.6) and presented moderate HAQ-DI scores (M = 1.37; SD = 0.75). Main features of QoL in RA highlight the importance given to physical health, particularly to independence and autonomy. Psychological distress emerged also as an important feature of living with RA, constraining a good QoL. Medical staff should consider the RA patients' emotional needs, expectations, and main perceived determinants of their QoL to better help them.