Patient education and disease activity: A study among rheumatoid arthritis patients

Objective: To determine whether patients experiencing high disease activity derive more benefit from patient education than those experiencing low disease activity. - \ud Methods: Data from a randomized study on the effects of a program of patient education were analyzed retrospectively. Four subgroups were studied: the high disease activity subgroup of patients who had participated in the educational program, the complementary low disease activity subgroup, the high disease activity subgroup of controls, and its low disease activity complement. Patients with erythrocyte sedimentation rate >28 mm/first hour were classified as having high disease activity. Effects on frequency of physical exercises, endurance exercises, and relaxation exercises and effects on health status (Modified Health Assessment Questionnaire, Dutch Arthritis Impact Measurement Scales [AIMS]) were measured. - \ud Results: There were no significant differences between the adherence parameters of the various pairs of groups. Four months after the educational program began, anxiety and depression scores on the Dutch-AIMS had increased among participating patients who were experiencing high disease activity and decreased among those who were experiencing low disease activity. - \ud Conclusions: Patients experiencing high disease activity did not derive more benefit from patient education than those experiencing low disease activity. On the contrary, an increase of anxiety and depression is found in these patients. Further study is needed to confirm our findings

Development of a brief observation method for measuring joint protective behaviors: Reliability

Ergonomic measures (joint protection, energy conservation and the use of devices) are part of basic treatment in rheumatoid arthritis (RA). It is of increasing importance that Health Care is based on evidence. Therefore, attention should be paid to the assessment of ergonomic performance in clinical practice and in studies on the effects of formal patient education. We describe a first step in developing a practical test for joint protection performance. The inter- and intraobserver reliability of this test was high in a preliminary study among 15 RA patients. The presented test is reliable and easy to perform. There is a need to determine the validity of the test

Determinants Associated with Work Participation in Patients with Established Rheumatoid Arthritis Taking Tumor Necrosis Factor Inhibitors

Objective. Reduced work participation (WP) is a common problem for patients with rheumatoid arthritis (RA) and generates high costs for society. Therefore, it is important to explore determinants of WP at the start of tumor necrosis factor inhibitor (TNFi) treatment, and for changes in WP after 2 years of TNFi treatment. Methods. Within the Dutch Rheumatoid Arthritis Monitoring (DREAM) biologic register, WP data were available from 508 patients with RA younger than 65 years and without an (early) retirement pension. WP was registered at start of TNFi treatment and after 2 years of followup and was measured by single patient-reported binary questions whether they had work, paid or voluntary, or had a disability allowance or a retirement pension. Determinants measured at baseline were age, sex, disease duration, functional status [through Health Assessment Questionnaire-Disability Index (HAQ-DI)], 28-joint Disease Activity Score (DAS28), rheumatoid factor, presence of erosions, number of previous disease-modifying antirheumatic drugs, and number of comorbidities. During the 2 years of followup, HAQ-DI response and European League Against Rheumatism response were measured. Univariate analyses (excluded if p value was > 0.2) and multivariate (excluded if p value was > 0.1) logistic regression analyses were used. Results. Determinants associated with WP at baseline were having a better HAQ-DI (OR 0.32, p = 0.000) and male sex (OR 0.65, p = 0.065). After 2 years of TNFi therapy, 11.8% (n = 60) started to work and 13.6% (n = 69) stopped working. Determinants associated with starting to work were better baseline HAQ-DI (OR 0.58), positive RF (OR 2.73), and young age (OR 0.96); and for stopping work, worse baseline HAQ-DI (OR 2.74), low HAQ-DI response (OR 0.31), and comorbidity (OR 2.67), all with p < 0.1. Conclusion. Young patients with RA and a high functional status without any comorbidity will have a better chance of working. This supports the main goal in the management of RA: to suppress disease activity as soon and as completely as possible to prevent irreversible destruction of the joints, and thus maintain a good functional status of the patient. Because of the low proportion of variance explained by the models in this study, other factors besides the ones studied are associated with W

Effectiveness of Switch to a Second Anti-TNF-α in Primary Nonresponders, Secondary Nonresponders and Failure Due to Adverse Events

Purpose: It is known from previous studies that switching to a second antiTNFα may be effective after failure to the first. However, it is unclear whether switching is as effective for patients who did not show any response to their first treatment (primary nonresponders), as compared to patients who had initial response but failed later (secondary nonresponders) and patients who failed due to adverse events. Methods: Patients with RA who switched to a second antiTNFα before January 2006 after failure to a first were selected from a Dutch antiTNFα register. DAS28 scores were available at start, 3 months and stop of both treatments. For each treatment the best DAS28 was selected. Based on the reason of failure to the first antiTNFα 3 groups were defined: primary nonresponders, secondary nonresponders and adverse events. Response was defined as good or moderate EULAR response based on the best DAS28. Groups were compared using ANOVA for continuous data, Pearson Chi-squared test for categorical data and nonparametric tests for data without normal distribution. Results: A total of 126 patients were included: 35 primary nonresponders; 41 secondary nonresponders; and 50 patients who failed due to adverse events. Patientcharacteristics and baseline DAS28 were comparable at start of first treatment. After switch, all groups including the primary nonresponders showed significant improvement of the best DAS28 compared to baseline: -1,77 for primary nonresponders, -1,18 for secondary nonresponders and -1,54 for patients failed due to adverse events (p = 0,189). The percentage of responders was 70,6% for primary nonresponders, 65% for secondary nonresponders and 64,2% for patients failed due to adverse events (p = 0,142). However, the absolute DAS28 scores during the second treatment were significantly higher for primary nonresponders compared to the other groups and lowest for patients who failed due to adverse events (shown in figure). Conclusion: In patients who were primary nonresponder to their first antiTNFα treatment, a switch to a second antiTNFα may be beneficial. However, a second treatment is more successful in patients who showed an initial response to the first antiTNFα