“Don’t Rock the Boat”: A Qualitative Narrative Study Exploring Rheumatoid Arthritis Patients’ Experience of Illness and Biologics

To date, we know little about the relationship between the experiences of rheumatoid arthritis (RA) and experiences of Biologic treatment, and what these medications mean to people. This study sought to examine this relationship. Through narrative analysis, using the boat as a metaphor to illustrate the storylines within which 8 participants accounts of illness and medication experiences were emplotted and embedded, two story typologies were defined. ‘Biologics as Life Preservers’ represented Biologics as something that can be donned when needed. ‘Biologics as Life Boats’ represented Biologics as rescuing participants from an identity-damaging illness. These stories illuminate what it is like to be on boat that has metaphorically capsized, to be saved from the rough waters of disease, to have that ‘rescue’ jeopardized by others, to be at the mercy of those who control access to care. The study findings hold implications for adherence research, clinician-patient interactions, and drug reimbursement policies.M.Sc

LA VISIÓN EN PANDEMIA

En los últimos años, se ha incrementado el uso de dispositivos digitales pero la pandemia de COVID-19 lo ha potenciado aún más. La situación por la que la población mundial debió aislarse o confinarse en sus hogares ha obligado a modificar muchas de las tareas habituales. Se impuso el teletrabajo para poder continuar con las tareas laborales, lo que implicó interminables jornadas delante de pantallas de todo tipo. A estas se le sumaron las tareas educativas y de recreación que, de igual forma, quedaron dentro del hogar y se desarrollaron en gran medida a través de elementos tecnológicos también

Sustained low functional impairment in axial spondyloarthritis (axSpA): which are the primary outcomes that should be targeted to achieve this?

Abstract Objectives To (i) determine whether sustained disease activity states, as measured by Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) and Ankylosing Spondylitis Disease Activity Score (ASDAS), impact function, and (ii) evaluate characteristics predicting sustained low functional impairment in a prospective axial spondyloarthritis (axSpA) cohort. Methods Biologic Treatment Registry Across Canada (BioTRAC) was a multi-center, prospective registry that collected real-world data on axSpA patients receiving infliximab or golimumab between 2006 and 2017. Generalized estimating equations (GEE) were used to test baseline characteristics, treatment, and duration (at 6 and 12 months vs. only at 6 or 12 months vs. neither) of low BASDAI (< 3), ASDAS-inactive disease (ID)(< 1.3), and ASDAS-low disease activity (LDA) in predicting sustained low Bath Ankylosing Spondylitis Functional Index (BASFI)(< 3) between 12 and 18 months. The adjusted impact of achieving low disease state at 6 and/or 12 months on BASFI at 18 months was analyzed by generalized linear models. Results Eight hundred ten patients were enrolled. 33.7%, 13.4%, and 24.7% achieved sustained low BASDAI, ASDAS-ID, and ASDAS-LDA, respectively. In univariable GEE of baseline variables, age and baseline BASDAI, BASFI, and ASDAS significantly predicted sustained low BASFI. In multivariable GEE, sustained low BASDAI (p < 0.001), low BASDAI only at 6 or 12 months (p = 0.001), and baseline BASFI (p < 0.001) were the only predictors of sustained low BASFI. Sustained ASDAS-ID (p = 0.040) and ASDAS-LDA (p < 0.001) were also predictors when forced into the model. Similar results were obtained when evaluating the BASFI score at 18 months. Conclusion Sustained BASDAI < 3 may be a valid and feasible target for a treat-to-target strategy in axSpA having function as treatment goal

Additional file 1 of Sustained low functional impairment in axial spondyloarthritis (axSpA): which are the primary outcomes that should be targeted to achieve this?

Additional file 1: Supplementary Table 1. Predictors of Sustained Low BASFI (<3) Between 12 and 18 Months Using Non-Responder Imputation (Sensitivity Analysis). BASFI=Bath Ankylosing Spondylitis Functional Index; OR=Odds Ratio; CI=Confidence Interval; M=Month; BASDAI= Bath Ankylosing Spondylitis Disease Activity Index; ASDAS=Ankylosing Spondylitis Disease Activity Score; ID=Inactive Disease; LDA=Low Disease Activity. Bold P-values denote statistical significance. Multivariable Analysis 1: primary analysis; Multivariable Analysis 2: secondary analysis including ASDAS-LDA instead of ASDAS-ID