A pilot investigation of the prevalence of US-detectable forefoot joint pathology and reported foot-related disability in participants with systemic lupus erythematosus

The main aim of this study was to determine the prevalence of US-detectable forefoot bursae, metatarsophalangeal (MTP) joint and metacarpophalangeal (MCP) joint synovial hypertrophy (SH), Power Doppler (PD) signal or erosion in participants with systemic lupus erythematosus (SLE). A secondary aim was to determine the strength of potential association between patient reported foot-related disability and US-detected forefoot bursae, MTP joint SH, PD signal or erosion in participants with SLE.A cross-sectional observational study of 20 participants with SLE was completed to determine the prevalence of US-detected forefoot bursal, MTP and MCP joint pathology. Patient-reported foot-related impairment and activity limitation (accumulatively referred to as disability) were also recorded. Spearmans' Rank Correlation analyses were completed to determine the potential strength of association between US-detected pathology and patient report disability.The prevalence of MTP joint SH and PD was 80 % (16/20) and 10 % (2/20), respectively. The prevalence of MCP joint SH and PD was 60 % (12/20) and 30 % (6/20) respectively. A significant association was noted between PD scores for the MTP joints and MCP joints (r = 0.556; p = 0.011) although this was not demonstrated for SH scores (r = 0.176; p = 0.459). Significant associations between forefoot bursal prevalence and MTP joint PD were noted (r = 0.467; p = 0.038). The prevalence of bursae and bursal PD (grade 2 or above) was 100 % (20/20) and 10 % (2/20), respectively. Moderate foot-related impairment and activity limitation was reported by 95 and 85 % of participants respectively.This pilot study suggests that US-detected MTP, MCP joint and forefoot bursal abnormalities may be prevalent in participants with SLE and they may experience a moderate level of foot-related disability. Further research is required to substantiate these preliminary findings

Biologic dose reduction in rheumatoid arthritis: what do patients think? Results from a patient and public involvement event

Abstract: Background: Biological therapies are well established and effective treatments for rheumatoid arthritis (RA). Although it seems impossible to stop biological therapies for the majority of RA patients with established disease it appears that dose reduction can be successful in some patients in remission or with low disease activity. Stratified medicine approaches may identify individuals who are most likely to maintain low levels of disease activity on a reduced biological therapy dose while achieving the same clinical benefit. Dose reduction may allow a reduced risk of adverse events and also produce economic benefits that may allow greater numbers of patients to use biological therapies. Despite an increased interest in biological therapy dose reduction in recent years, the perspectives of patients have not yet been reported. Engagement of patients in shared decision-making about their disease management is vital to improving health outcomes and a stated aim of many treatment guidelines. We aimed to investigate the views of patients with regard to biological therapies and dose reduction.Methods: We arranged a patient and public involvement (PPI) event with 9 patients (8 female, mean age 49y, mean disease duration 17y) with RA. Eight patients were on a biological therapy with 2 patients on a reduced dose. Discussion was facilitated and recorded by two PPI experts and a consultant rheumatologist. Participants (1) discussed biological therapy in general, (2) listed the top 10 concerns about biological therapy and (3) explored attitudes towards dose reduction.Results: The most common issues arising during group discussion about biological therapies in general were: impact of disease on health, delays in accessing treatment, need for education about biological therapies, adverse effects, inefficacy of previous treatments, impact of disease on family and work and patient autonomy. When exploring attitudes towards dose reduction, the most common concerns were loss of disease control, delay in access to the previous dose and potential loss of efficacy of a previously successful treatment. Perceived benefits were a lower risk of adverse effects and reduced frequency of injection.Conclusion: Patients were generally prepared to consider dose reduction but need reassurance about rapid access to higher doses should their disease flare. The data provide insight into patients’ beliefs and attitudes towards biological therapies and dose reduction and will be used to generate a questionnaire to be distributed to a larger group of patients