The influence of social support, financial status and lifestyle on the disparity between inflammation and disability in rheumatoid arthritis

ObjectivesTo investigate how social support, financial status and lifestyle influence the development of excess disability in rheumatoid arthritis (RA).MethodsData came from the Étude et Suivi des Polyarthrites Indifférenciées Récentes (ESPOIR) cohort study of people with RA. A previous analysis identified groups with similar inflammation trajectories but markedly different disability over 10 years; those in the higher disability trajectory groups were defined as having “excess disability”. Participants self-reported data on contextual factors (social support, financial situation, lifestyle) and completed patient reported outcome measures (PROMs; pain, fatigue, anxiety, depression) at baseline. The direct effect of the contextual factors on excess disability and the effect mediated by PROMs was assessed using structural equation models. Findings were validated within two independent datasets (Norfolk Arthritis Register [NOAR], Early Rheumatoid Arthritis Network [ERAN]).ResultsOf 538 included ESPOIR participants (mean age [standard deviation (SD)]: 48.3 [12.2] years, 79.2% women), 200 (37.2%) were in the excess disability group. Less social support (β 0.17 [95% CI 0.08, 0.26]), worse financial situation (β 0.24 [95% CI 0.14, 0.34]), less exercise (β 0.17 [95% CI 0.09, 0.25]) and less education (β 0.15 [95% CI 0.06, 0.23]) were associated with excess disability group membership; smoking, alcohol consumption and body mass index were not. Fatigue and depression mediated a small proportion of these effects. Similar results were seen in NOAR and ERAN.ConclusionsGreater emphasis is needed on the economic and social context of people with RA at presentation; these factors might influence disability over the following decade

EULAR points to consider for therapeutic drug monitoring of biopharmaceuticals in inflammatory rheumatic and musculoskeletal diseases

OBJECTIVE: To develop EULAR points-to-consider for therapeutic drug monitoring (TDM) of biopharmaceuticals in inflammatory rheumatic and musculoskeletal diseases (RMDs). METHODS: The points-to-consider were developed in accordance with EULAR standardised operation procedures by a multidisciplinary task force from eight European countries, based on a systematic literature review and expert consensus. Level of evidence and strength of the points-to-consider were determined, and mean levels of agreement among the task force were calculated using a 10-point rating scale. RESULTS: Six overarching principles and 13 points-to-consider were formulated. The level of agreement among the task force for the overarching principles and points-to-consider ranged from 8.4 to 9.9.The overarching principles define TDM and its subtypes, and reinforce the underlying pharmacokinetic/pharmacodynamic principles, which are relevant to all biopharmaceutical classes. The points-to-consider highlight the clinical utility of the measurement and interpretation of biopharmaceutical blood concentrations and antidrug antibodies in specific clinical scenarios, including factors that influence these parameters. In general, proactive use of TDM is not recommended but reactive TDM could be considered in certain clinical situations. An important factor limiting wider adoption of TDM is the lack of both high quality trials addressing effectiveness and safety of TDM and robust economic evaluation in patients with RMDs. Future research should focus on providing this evidence, as well as on further understanding of pharmacokinetic and pharmacodynamic characteristics of biopharmaceuticals. CONCLUSION: These points-to-consider are evidence-based and consensus-based statements for the use of TDM of biopharmaceuticals in inflammatory RMDs, addressing the clinical utility of TDM