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5. EULAR/eumusc.net standards of care for rheumatoid arthritis: cross-sectional analyses of importance, level of implementation and care gaps experienced by patients and rheumatologists across 35 European countries

Author

Meisters, R, Putrik, P, Ramiro, S, Hifinger, M, Keszei, A, Van Eijk-Hustings, Y, Woolf, A, Smolen, J, Stamm, T, Stoffer-Marx, M, Uhlig, T, Moe, R, De Wit, M, Tafaj, A, Mukuchyan, V, Studenic, P, Verschueren, P, Shumnalieva, R, Charalambous, P, Vencovsky, J, Varvouni, M, Kull, M, Puolakka, K, Gossec, L, Gobejishvili, N, Detert, J, Sidiropoulos, P, Pentek, M, Kane, D, Scire, C, Arad, U, Andersone, D, Van De Laar, M, Van Der Helm-Van Mil, A, Gluszko, P, Cunha-Miranda, L, Berghea, F, Damjanov, N, Tomsic, M, Carmona, L, Turesson, C, Ciurea, A, Shukurova, S, Inanc, N, Verstappen, S, Boonen, A, Meisters R., Putrik P., Ramiro S., Hifinger M., Keszei A. P., Van Eijk-Hustings Y., Woolf A. D., Smolen J. S., Stamm T. A., Stoffer-Marx M., Uhlig T., Moe R. H., De Wit M., Tafaj A., Mukuchyan V., Studenic P., Verschueren P., Shumnalieva R., Charalambous P., Vencovsky J., Varvouni M., Kull M., Puolakka K., Gossec L., Gobejishvili N., Detert J., Sidiropoulos P., Pentek M., Kane D., Scire C. A., Arad U., Andersone D., Van De Laar M., Van Der Helm-Van Mil A., Gluszko P., Cunha-Miranda L., Berghea F., Damjanov N. S., Tomsic M., Carmona L., Turesson C., Ciurea A., Shukurova S., Inanc N., Verstappen S. M. M., Boonen A., Meisters, R, Putrik, P, Ramiro, S, Hifinger, M, Keszei, A, Van Eijk-Hustings, Y, Woolf, A, Smolen, J, Stamm, T, Stoffer-Marx, M, Uhlig, T, Moe, R, De Wit, M, Tafaj, A, Mukuchyan, V, Studenic, P, Verschueren, P, Shumnalieva, R, Charalambous, P, Vencovsky, J, Varvouni, M, Kull, M, Puolakka, K, Gossec, L, Gobejishvili, N, Detert, J, Sidiropoulos, P, Pentek, M, Kane, D, Scire, C, Arad, U, Andersone, D, Van De Laar, M, Van Der Helm-Van Mil, A, Gluszko, P, Cunha-Miranda, L, Berghea, F, Damjanov, N, Tomsic, M, Carmona, L, Turesson, C, Ciurea, A, Shukurova, S, Inanc, N, Verstappen, S, Boonen, A, Meisters R., Putrik P., Ramiro S., Hifinger M., Keszei A. P., Van Eijk-Hustings Y., Woolf A. D., Smolen J. S., Stamm T. A., Stoffer-Marx M., Uhlig T., Moe R. H., De Wit M., Tafaj A., Mukuchyan V., Studenic P., Verschueren P., Shumnalieva R., Charalambous P., Vencovsky J., Varvouni M., Kull M., Puolakka K., Gossec L., Gobejishvili N., Detert J., Sidiropoulos P., Pentek M., Kane D., Scire C. A., Arad U., Andersone D., Van De Laar M., Van Der Helm-Van Mil A., Gluszko P., Cunha-Miranda L., Berghea F., Damjanov N. S., Tomsic M., Carmona L., Turesson C., Ciurea A., Shukurova S., Inanc N., Verstappen S. M. M., and Boonen A.

Abstract

Objective As part of European League against Rheumatism (EULAR)/European Musculoskeletal Conditions Surveillance and Information Network, 20 user-focused standards of care (SoCs) for rheumatoid arthritis (RA) addressing 16 domains of care were developed. This study aimed to explore gaps in implementation of these SoCs across Europe. Methods Two cross-sectional surveys on the importance, level of and barriers (patients only) to implementation of each SoC (0-10, 10 highest) were designed to be conducted among patients and rheumatologists in 50 European countries. Care gaps were calculated as the difference between the actual and maximum possible score for implementation (ie, 10) multiplied by the care importance score, resulting in care gaps (0-100, maximal gap). Factors associated with the problematic care gaps (ie, gap≥30 and importance≥6 and implementation<6) and strong barriers (≥6) were further analysed in multilevel logistic regression models. Results Overall, 26 and 31 countries provided data from 1873 patients and 1131 rheumatologists, respectively. 19 out of 20 SoCs were problematic from the perspectives of more than 20% of patients, while this was true for only 10 SoCs for rheumatologists. Rheumatologists in countries with lower gross domestic product and non-European Union countries were more likely to report problematic gaps in 15 of 20 SoCs, while virtually no differences were observed among patients. Lack of relevance of some SoCs (71%) and limited time of professionals (66%) were the most frequent implementation barriers identified by patients. Conclusions Many problematic gaps were reported across several essential aspects of RA care. More efforts need to be devoted to implementation of EULAR SoCs.

Published
2020

21. Predictors and outcomes of sustained, intermittent or never achieving remission in patients with recent onset inflammatory polyarthritis: results from the Norfolk Arthritis Register

Author

Cook M. J., Diffin J., Scire C. A., Lunt M., MacGregor A. J., Symmons D. P. M., Verstappen S. M. M., Cook, M, Diffin, J, Scire, C, Lunt, M, Macgregor, A, Symmons, D, and Verstappen, S

Subjects
Male, rheumatoid arthritis, Inflammatory polyarthriti, Remission Induction, Middle Aged, Clinical Science, Arthritis, Rheumatoid, inflammatory polyarthritis, remission, predictors, disease progression, England, Antirheumatic Agents, Humans, Female, Age of Onset, Rheumatoid arthriti, Predictor
Abstract

Objectives. Early remission is the current treatment strategy for patients with inflammatory polyarthritis (IP) and RA. Our objective was to identify baseline factors associated with achieving remission: sustained (SR), intermittent (IR) or never (NR) over a 5-year period in patients with early IP. Methods. Clinical and demographic data of patients with IP recruited to the Norfolk Arthritis Register (NOAR) were obtained at baseline and years 1, 2, 3 and 5. Remission was defined as no tender or swollen joints (out of 51). Patients were classified as NR or PR, respectively, if they were in remission at: no assessment or ⩾3 consecutive assessments after baseline, and IR otherwise. Ordinal regression and a random effects model, respectively, were used to examine the association between baseline factors, remission group and HAQ scores over time. Results. A total of 868 patients (66% female) were included. Of these, 54%, 34% and 12% achieved NR, IR and SR, respectively. In multivariate analysis, female sex (odds ratio, OR 0.47, 95% CI: 0.35, 0.63), higher tender joint count (OR = 0.94, 95% CI: 0.93, 0.96), higher HAQ (OR = 0.59, 95% CI: 0.48, 0.74), being obese (OR = 0.70, 95% CI: 0.50, 0.99), hypertensive (OR = 0.67, 95% CI: 0.50, 0.90) or depressed (OR = 0.74, 95% CI: 0.55, 1.00) at baseline were independent predictors of being in a lower remission group. IR and SR were associated with lower HAQ scores over time and lower DAS28 at year 5. Conclusion. Women with higher tender joint count and disability at baseline, depression, obesity and hypertension were less likely to achieve remission. This information could help when stratifying patients for more aggressive therapy.

Published
2015

22. Test-retest reliability and correlations of 5 global measures addressing at-work productivity loss in patients with rheumatic diseases

Author

Leggett, S, Van Der Zee-Neuen, A, Boonen, A, Beaton, D, Bojinca, M, Bosworth, A, Dadoun, S, Fautrel, B, Hagel, S, Hofstetter, C, Lacaille, D, Linton, D, Mihai, C, Petersson, I, Rogers, P, Sergeant, J, Scire, C, Verstappen, S, Leggett S., Van Der Zee-Neuen A., Boonen A., Beaton D. E., Bojinca M., Bosworth A., Dadoun S., Fautrel B., Hagel S., Hofstetter C., Lacaille D., Linton D., Mihai C., Petersson I. F., Rogers P., Sergeant J. C., Scire CA., Verstappen S. M. M., Leggett, S, Van Der Zee-Neuen, A, Boonen, A, Beaton, D, Bojinca, M, Bosworth, A, Dadoun, S, Fautrel, B, Hagel, S, Hofstetter, C, Lacaille, D, Linton, D, Mihai, C, Petersson, I, Rogers, P, Sergeant, J, Scire, C, Verstappen, S, Leggett S., Van Der Zee-Neuen A., Boonen A., Beaton D. E., Bojinca M., Bosworth A., Dadoun S., Fautrel B., Hagel S., Hofstetter C., Lacaille D., Linton D., Mihai C., Petersson I. F., Rogers P., Sergeant J. C., Scire CA., and Verstappen S. M. M.

Abstract

Objective. Several global measures to assess at-work productivity loss or presenteeism in patients with rheumatic diseases have been proposed, but the comparative validity is hampered by the lack of data on test-retest reliability and comparative concurrent and construct validity. Our objective was to test-retest 5 global measures of presenteeism and to compare the association between these scales and health-related well-being. Methods. Sixty-five participants with inflammatory arthritis or osteoarthritis in paid employment were recruited from 7 countries (UK, Canada, Netherlands, France, Sweden, Romania, and Italy). At baseline and 2 weeks later, 5 global measures of presenteeism were evaluated: the Work Productivity Scale-Rheumatoid Arthritis (WPS-RA), Work Productivity and Activity Impairment Questionnaire (WPAI), Work Ability Index (WAI), Quality and Quantity questionnaire (QQ), and the WHO Health and Performance Questionnaire (HPQ). Agreement between the 2 timepoints was assessed using single-measure intraclass correlations (ICC) and correlated between each other and with visual analog scale general well-being scores at followup by Spearman correlation. Results. ICC between measures ranged from fair (HPQ 0.59) to excellent (WPS-RA 0.78). Spearman correlations between measures were moderate (Qquality vs WAI, r = 0.51) to strong (WPS-RA vs WPAI, r = 0.88). Correlations between measures and general well-being were low to moderate, ranging from-0.44 ? r ? 0.66. Conclusion. Test-retest results of 4 out of 5 global measures were good, and the correlations between these were moderate. The latter probably reflect differences in the concepts, recall periods, and references used in the measures, which implies that some measures are probably not interchangeable. The Journal of Rheumatology.

Published
2016

23. Content validity of global measures for at-work productivity in patients with rheumatic diseases: An international qualitative study

Author

Leggett, S, Van Der Zee-Neuen, A, Boonen, A, Beaton, D, Bojinca, M, Bosworth, A, Dadoun, S, Fautrel, B, Hagel, S, Hofstetter, C, Lacaille, D, Linton, D, Mihai, C, Petersson, I, Rogers, P, Scire, C, Verstappen, S, Leggett S., Van Der Zee-Neuen A., Boonen A., Beaton D., Bojinca M., Bosworth A., Dadoun S., Fautrel B., Hagel S., Hofstetter C., Lacaille D., Linton D., Mihai C., Petersson I. F., Rogers P., Scire CA., Verstappen S. M. M., Leggett, S, Van Der Zee-Neuen, A, Boonen, A, Beaton, D, Bojinca, M, Bosworth, A, Dadoun, S, Fautrel, B, Hagel, S, Hofstetter, C, Lacaille, D, Linton, D, Mihai, C, Petersson, I, Rogers, P, Scire, C, Verstappen, S, Leggett S., Van Der Zee-Neuen A., Boonen A., Beaton D., Bojinca M., Bosworth A., Dadoun S., Fautrel B., Hagel S., Hofstetter C., Lacaille D., Linton D., Mihai C., Petersson I. F., Rogers P., Scire CA., and Verstappen S. M. M.

Abstract

Objectives. To identify from a patient's perspective, difficulties and differences in the comprehension of five global presenteeism measures in patients with inflammatory arthritis and OA across seven countries. Methods. Seventy patients with a diagnosis of inflammatory arthritis or OA in paid employment were recruited from seven countries across Europe and Canada. Patients were randomly allocated to be cognitively debriefed on 3/5 global measures [Work Productivity Scale - Rheumatoid Arthritis, Work Productivity and Activity Impairment Questionnaire (WPAI), Work Ability Index, Quality and Quantity questionnaire, and WHO Health and Work Performance Questionnaire (HPQ)], with the WPAI debriefed in all patients as a standard measure of comparison between countries and patients. NVivo was used to code the data into four themes: construct and anchor, time recall, reference frame, and attribution. Results. Discrepancies were found in the interpretation of the word performance (HPQ) between countries, with Romania and Sweden relating performance to sports rather than work. Seventy percent of patients considered that a 7-day recall (WPAI) can accurately represent how their disease affects work productivity. The compared to normal reference (Quality and Quantity questionnaire) was reportedly too ambiguous, and the comparison with colleagues (HPQ), made many feel uncomfortable. Overall, 29% of patients said the WPAI was the most relevant to them, making it the most favoured measure. Conclusion. Overall, patients across countries agree that the construct of work productivity in the last 7 days can accurately reflect the impact of disease while at work. Some current constructs to assess atwork productivity are not interchangeable between languages.

Published
2016

24. Predictors and outcomes of sustained, intermittent or never achieving remission in patients with recent onset inflammatory polyarthritis: Results from the Norfolk Arthritis Register

Author

Cook, M, Diffin, J, Scire, C, Lunt, M, Macgregor, A, Symmons, D, Verstappen, S, Cook M. J., Diffin J., Scire C. A., Lunt M., MacGregor A. J., Symmons D. P. M., Verstappen S. M. M., Cook, M, Diffin, J, Scire, C, Lunt, M, Macgregor, A, Symmons, D, Verstappen, S, Cook M. J., Diffin J., Scire C. A., Lunt M., MacGregor A. J., Symmons D. P. M., and Verstappen S. M. M.

Abstract

Objectives. Early remission is the current treatment strategy for patients with inflammatory polyarthritis (IP) and RA. Our objective was to identify baseline factors associated with achieving remission: sustained (SR), intermittent (IR) or never (NR) over a 5-year period in patients with early IP.Methods. Clinical and demographic data of patients with IP recruited to the Norfolk Arthritis Register (NOAR) were obtained at baseline and years 1, 2, 3 and 5. Remission was defined as no tender or swollen joints (out of 51). Patients were classified as NR or PR, respectively, if they were in remission at: no assessment or ≥3 consecutive assessments after baseline, and IR otherwise. Ordinal regression and a random effects model, respectively, were used to examine the association between baseline factors, remission group and HAQ scores over time.Results. A total of 868 patients (66% female) were included. Of these, 54%, 34% and 12% achieved NR, IR and SR, respectively. In multivariate analysis, female sex (odds ratio, OR 0.47, 95% CI: 0.35, 0.63), higher tender joint count (OR = 0.94, 95% CI: 0.93, 0.96), higher HAQ (OR = 0.59, 95% CI: 0.48, 0.74), being obese (OR = 0.70, 95% CI: 0.50, 0.99), hypertensive (OR = 0.67, 95% CI: 0.50, 0.90) or depressed (OR = 0.74, 95% CI: 0.55, 1.00) at baseline were independent predictors of being in a lower remission group. IR and SR were associated with lower HAQ scores over time and lower DAS28 at year 5.Conclusion. Women with higher tender joint count and disability at baseline, depression, obesity and hypertension were less likely to achieve remission. This information could help when stratifying patients for more aggressive therapy.

Published
2016

25. Anticitrullinated protein antibodies and rheumatoid factor are associated with increased mortality but with different causes of death in patients with rheumatoid arthritis: a longitudinal study in three European cohorts

Author

Ajeganova, S, primary, Humphreys, J H, additional, Verheul, M K, additional, van Steenbergen, H W, additional, van Nies, J A B, additional, Hafström, I, additional, Svensson, B, additional, Huizinga, T W J, additional, Trouw, L A, additional, Verstappen, S M M, additional, and van der Helm-van Mil, A H M, additional

Published
2016
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30. Gender, body mass index and rheumatoid arthritis disease activity: results from the QUEST-RA Study

Author

Jawaheer, D, Olsen, J, Lahiff, M, Forsberg, Susanne, Lähteenmäki, J, da Silveira, I G, Rocha, F A, Magalhães Laurindo, I M, Henrique da Mota, L M, Drosos, A A, Murphy, E, Sheehy, C, Quirke, E, Cutolo, M, Rexhepi, S, Dadoniene, J, Verstappen, S M M, Sokka, T, Hetland, Merete Lund, Jawaheer, D, Olsen, J, Lahiff, M, Forsberg, Susanne, Lähteenmäki, J, da Silveira, I G, Rocha, F A, Magalhães Laurindo, I M, Henrique da Mota, L M, Drosos, A A, Murphy, E, Sheehy, C, Quirke, E, Cutolo, M, Rexhepi, S, Dadoniene, J, Verstappen, S M M, Sokka, T, and Hetland, Merete Lund

Abstract

To investigate whether body mass index (BMI), as a proxy for body fat, influences rheumatoid arthritis (RA) disease activity in a gender-specific manner.

Published
2010

41. Association of morbid obesity with disability in early inflammatory polyarthritis: Results from the Norfolk Arthritis Register.

Author

Humphreys, J. H., Verstappen, S. M. M., Mirjafari, H., Bunn, D., Lunt, M., Bruce, I. N., and Symmons, D. P. M.

Abstract

Objective Obesity has been associated with disease outcomes in inflammatory arthritis. This study aimed to investigate cross-sectionally the relationship between body mass index (BMI) and functional disability in a large inception cohort of patients with early inflammatory polyarthritis (IP). Methods Patients age ≥16 years with ≥2 swollen joints for ≥4 weeks were recruited into the Norfolk Arthritis Register. At the initial assessment, clinical and demographic data were obtained, joints were examined, and height and weight were measured. Blood samples were taken to measure inflammatory markers and autoantibodies, and patients completed the Health Assessment Questionnaire (HAQ) to assess functional disability. Univariate and multivariate ordinal regression were used to examine the cross-sectional association between BMI and the HAQ. Multiple imputation using chained equations allowed inclusion of patients with missing variables. Results A total of 1,246 patients were studied (median age 57 years). Of those patients, 782 patients (63%) were female and 303 (25%) were obese (BMI ≥30 kg/m2). Morbid obesity (BMI ≥35 kg/m2) was significantly associated with worse functional disability in the univariate and multivariate analysis with missing data imputed, adjusting for age, sex, symptom duration, smoking status, disease activity, autoantibodies, comorbidities, and treatment (multivariate odds ratio 1.87, 95% confidence interval 1.14-3.07). Conclusion Morbid obesity in patients with early IP is associated with worse HAQ scores. This should be taken into account in patient management and when interpreting the HAQ in clinical practice. [ABSTRACT FROM AUTHOR]

Published
2013
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42. Multiple adverse pregnancy outcomes before symptom onset are associated with a worse disease outcome in women with recent-onset inflammatory polyarthritis.

Author

Camacho, E. M., Verstappen, S. M. M., Lunt, M., Bunn, D. K., and Symmons, D. P. M.

Abstract

Objective Previous evidence suggests that women with a history of adverse pregnancy outcomes (APOs) may be at greater risk of developing rheumatoid arthritis. Additionally, one study reported that female patients with rheumatoid arthritis with a history of preonset APOs showed a worse 2-year radiographic outcome than did patients with no APOs. The authors' aim was to investigate the relationship between preonset APOs (spontaneous abortion or stillbirth) and disease outcome in women with inflammatory polyarthritis (IP). Methods The Norfolk Arthritis Register (NOAR) is a primary-care-based cohort of patients with recentonset IP; 1586 gravid women who joined NOAR during 1990-2004 were included in this analysis. The authors examined the relationship between patient-reported preonset APOs and disease outcome, measured using the Health Assessment Questionnaire (HAQ) and disease activity score in 28 joints (DAS28CRP) (for a subgroup of patients), using linear random effects analysis, adjusted for age and other factors. Results In a predominantly parous cohort (99%), 397 (25%) women reported ≥1 APO before symptom onset. The rates of APOs in NOAR were comparable to the general population. On average, women with a history of ≥2 APOs had significantly higher HAQ and DAS28 scores over time than women with no APOs (mean difference in HAQ 0.13 (95% CI 0.002 to 0.26); DAS28, 0.56 (95% CI 0.01 to 1.11)). This relationship was more pronounced in women with ≥3 APOs (mean difference in HAQ 0.23 (95% CI 0.02 to 0.43); DAS28, 0.98 (95% CI 0.23 to 1.74)). Conclusion Women with two or more APOs before IP onset had a worse disease outcome than women with no APOs. [ABSTRACT FROM AUTHOR]

Published
2012
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43. Adverse events and factors associated with toxicity in patients with early rheumatoid arthritis treated with methotrexate tight control therapy: the CAMERA study.

Author

Verstappen, S M M, Bakker, M F, Heurkens, A H M, van der Veen, M J, Kruize, A A, Geurts, M A W, Bijlsma, J W J, and Jacobs, J W G

Abstract

Objective To evaluate toxicity profiles in patients with rheumatoid arthritis (RA) treated either according to an intensive or a conventional treatment strategy approach with methotrexate (MTX) and to study factors associated with MTX-related toxicity. Methods Data were used from the Computer-Assisted Management in Early Rheumatoid Arthritis (CAMERA) study, in which clinical efficacy of an intensive treatment strategy with MTX was more beneficial than a conventional treatment strategy approach. In this study, data on adverse events (AEs) were compared between the two strategy groups. Logistic regression analyses were used to identify possible associations between factors assessed at baseline and withdrawal due to MTX-related AEs or liver toxicity at follow-up. Results Although significantly more patients in the intensive strategy group experienced MTX-related AEs than in the conventional strategy group, all recorded AEs were relatively mild. A higher body mass index (BMI) was significantly associated with withdrawal due to MTX-related AEs in the multiple regression analyses (odds ratio=1.207, 95% confidence interval 1.02 to 1.44, p=0.033). There was a trend towards an association between diminished creatinine clearance and MTX withdrawal. For liver toxicity, increased serum liver enzymes at baseline were associated with liver toxicity during follow-up. Conclusion Although the occurrence of AEs in the intensive strategy group was higher than in the conventional strategy group, the previously observed clinical efficacy of an intensive treatment strategy seems to outweigh the observed toxicity profiles. When starting MTX, attention should be given to patients with a high BMI and those with increased levels of liver enzymes and decreased renal function. [ABSTRACT FROM PUBLISHER]

Published
2010
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44. Beneficial effects of a 3-week course of intramuscular glucocorticoid injections in patients with very early inflammatory polyarthritis: results of the STIVEA trial.

Author

Verstappen, S M M, McCoy, M J, Roberts, C, Dale, N E, Hassell, A B, and Symmons, D P M

Abstract

Objective To evaluate whether treating patients with very early inflammatory polyarthritis (IP) with a 3-week course of intramuscular (IM) methylprednisolone acetate may postpone the need for disease-modifying antirheumatic drugs (DMARDs) and prevent IP from evolving into rheumatoid arthritis (RA). Methods Patients with very early IP (4–10 weeks’ duration) were randomised to receive three injections of either 80 mg IM methylprednisolone acetate or placebo, given at weekly intervals. Assessments were monthly until 6 months after the first injection, and then concluded at 12 months. The primary outcome was the need to start DMARDs by the 6-month assessment. Secondary outcomes included disease activity and final clinical diagnosis by the rheumatologist at 12 months. Results Patients in the placebo group (76%) were more likely to need DMARDs during the first 6 months of the trial than patients in the glucocorticoid group (61%) (adjusted OR = 2.11, 95% CI 1.16 to 3.85, p = 0.015). Disease activity did not differ between the two groups at 12 months, probably because many patients in the placebo group started DMARDs early in the study. After 12 months, the arthritis had resolved without the need for DMARDs in 9.9% (11/111) of the patients in the placebo group and in 19.8% (22/111) in the glucocorticoid-treated group (adjusted OR = 0.42, 95% CI 0.18 to 0.99, p = 0.048). Conclusion Treatment of patients with very early IP with IM methylprednisolone acetate appears to postpone the prescription of DMARDs and prevent one in 10 patients from progressing into RA. [ABSTRACT FROM PUBLISHER]

Published
2010
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45. Work disability in patients with rheumatoid arthritis in 15 countries

Author

Sokka, Tuulikki, Verstappen, S. M. M., Merete Lund Hetland, Makinen, H., Naranjo, A., Belmonte, M., Baecklund, E., Henrohn, D., Herborn, G., Rau, R., Morelli, A., Ferraccioli, G. F., Combe, B., Mcclinton, C., Tunc, R., Sierakowski, S., Romanowski, W., Skakic, V., Murphy, E., Sheehy, C., Bergman, M., and Pincus, T.

46. Work disability in patients with rheumatoid arthritis in 15 countries

Author

Sokka, Tuulikki, Verstappen, S. M. M., Hetland, M. L., Makinen, H., Naranjo, A., Belmonte, M., Baecklund, E., Henrohn, D., Herborn, G., Rau, R., Morelli, A., Ferraccioli, G. F., Combe, B., Mcclinton, C., Tunc, R., Sierakowski, S., Romanowski, W., Skakic, V., Murphy, E., Sheehy, C., Bergman, M., Pincus, T., and Quest, R. A. Grp

49. Gender, body mass index and rheumatoid arthritis disease activity: Results from the QUEST-RA study

Author

Jawaheer, D., Olsen, J., Lahiff, M., Forsberg, S., Lähteenmäki, J., Da Silveira, I. G., Rocha, F. A., Laurindo, I. M. M., Da Mota, L. M. H., Drosos, A. A., Murphy, E., Sheehy, C., Quirke, E., Cutolo, M., Rexhepi, S., Dadoniene, J., Verstappen, S. M. M., Sokka, T., Toloza, S., Aguero, S., Barrera, S. O., Retamozo, S., Alba, P., Lascano, C., Babini, A., Albiero, E., Pinheiro, G. R. C., Lazovskis, J., Hetland, M. L., Ørnbjerg, L., Hørslev-Petersen, K., Hansen, T. M., Knudsen, L. S., Hamoud, H., Sobhy, M., Fahmy, A., Magdy, M., Aly, H., Saeid, H., Nagm, A., Fathi, N. A., Abda, E., Ebraheam, Z., Müller, R., Kuuse, R., Tammaru, M., Kallikorm, R., Peets, T., Otsa, K., Laas, K., Valter, I., Mäkinen, H., Immonen, K., Luukkainen, R., Gossec, L., Dougados, M., Maillefert, J. F., Combe, B., Sibilia, J., Exarchou, S., Moutsopoulos, H. M., Tsirogianni, A., Skopouli, F. N., Mavrommati, M., Herborn, G., Rau, R., Alten, R., Pohl, C., Burmester, G. R., Marsmann, B., Géher, P., Rojkovich, B., Bresnihan, B., Minnock, P., Devlin, J., Alraqi, S., Aggarwal, A., Pandya, S., Sharma, B., Cazzato, M., Bombardieri, S., Ferraccioli, G., Morelli, A., Salaffi, F., Stancati, A., Yamanaka, H., Nakajima, A., Fukuda, W., Shono, E., Oyoo, O., Rexhepi, M., Andersone, D., Stropuviene, S., Baranauskaite, A., Najia Hajjaj-Hassouni, Benbouazza, K., Allali, F., Bahiri, R., Amine, B., Jacobs, J. W. G., Huisman, M., Hoekstra, M., Haugeberg, G., Gjelberg, H., Sierakowski, S., Majdan, M., Romanowski, W., Tlustochowicz, W., Kapolka, D., Sadkiewicz, S., Zarowny-Wierzbinska, D., Ionescu, R., Predeteanu, D., Karateev, D., Luchikhina, E., Chichasova, N., Badokin, V., Skakic, V., Dimic, A., Nedovic, J., Stankovic, A., Naranjo, A., Rodríguez-Lozano, C., Calvo-Alen, J., Belmonte, M., Baecklund, E., Henrohn, D., Oding, R., Liveborn, M., Holmqvist, A. -C, Gogus, F., Tunc, R., Celic, S., Badsha, H., Mofti, A., Taylor, P., Mcclinton, C., Woolf, A., Chorghade, G., Choy, E., Kelly, S., Pincus, T., Yazici, Y., Bergman, M., Craig-Muller, J., Kautiainen, H., Swearingen, C., University of California Los Angeles, University of California Berkeley, North Karelia Central Hospital, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Universidade Federal do Ceará, Universidade Estadual Paulista (UNESP), Hospital Universitário de Brasília, University of Ioannina Ioannina, Waterford Regional Hospital, Connolly Hospital, University of Genova, Rheumatology Department, Vilnius University, University Medical Centre Utrecht, Jyväskylä Central Hospital, Medcare Oy, Hospital Oakland Research Institute, Hospital San Juan Bautista, Hospital of Cordoba, Universidade do Estado do Rio de Janeiro (UERJ), Riverside Professional Centre, Copenhagen University Hospital at Hvidovre, King Christian the Xth Hospital, Copenhagen University Hospital at Herlev, Al-Azhar University, Assiut University Hospital, Abo Sohage University Hospital, Tartu University Hospital, East-Tallinn Central Hospital, Centre for Clinical and Basic Research, Satakunta Central Hospital, Hôpital Cochin, INSERM U887, Hôpital Lapeyronie, Hôpital Hautepierre, National University of Athens, Euroclinic Hospital, Evangelisches Fachkrankenhaus, Schlosspark-Klinik, University Medicine Berlin, Semmelweis University of Medical Sciences, Polyclinic of the Hospitaller Brothers of St. John of God in Budapest, St. Vincent University Hospital, Our Lady's Hospice, Vedanta Institiute of Medical Sciences, Jaipur Hospital, Santa Chiara Hospital, Catholic University of Sacred Heart, University of Ancona, Tokyo Women's Medical University, Kyoto First Red Cross Hospital, Shono Rheumatism Clinic, Kenyatta Hospital, Pauls Stradina Clinical University Hospital, Kaunas University Hospital, El Ayachi Hospital Mohamed Vth Souissi University, Sint Franciscus Gasthuis Hospital, Medisch Spectrum Twente, Sørlandet Hospital, Medical University in Bialystok, Medical University of Lublin, Poznan Rheumatology Centre in Srem, Military Institute of Medicine, Silesian Hospital for Rheumatology and Rehabilitation in Ustron Slaski, Szpital Wojewodzki im. Jana Biziela, Wojewodzki Zespol Reumatologiczny im. dr Jadwigi Titz-Kosko, Spitalul Clinic Sf Maria, Institute of Rheumatology of Russian Academy of Medical Sciences, Moscow Medical Academy, Russian Medical Academy of Postgraduate Education, Rheumatology Institut, Hospital de Gran Canaria Dr. Negrin, Hospital Sierrallana Ganzo, Hospital General de Castellón, Uppsala University Hospital, Centrallasarettet, Hudiksvall Medical Clinic, Gazi University Medical Faculty, Meram Medical Faculty, Cerrahpasa Medic Faculty, Dubai Bone and Joint Centre, American Hospital Dubai, Charing Cross Hospital, Royal Cornwall Hospital, Kings College Hospital, Vanderbilt University, NYU Hospital for Joint Diseases, Taylor Hospital, Centra Care Clinic, University of Arkansas for Medical Sciences, and New York University Hospital for Joint Diseases

Subjects
Bmi, Gender, Disease activity, Rheumatoid arthritis
Abstract

Made available in DSpace on 2022-04-28T18:56:40Z (GMT). No. of bitstreams: 0 Previous issue date: 2010-12-01 Objective: To investigate whether body mass index (BMI), as a proxy for body fat, influences rheumatoid arthritis (RA) disease activity in a gender-specific manner. Methods: Consecutive patients with RA were enrolled from 25 countries into the QUEST-RA program between 2005 and 2008. Clinical and demographic data were collected by treating rheumatologists and by patient self-report. Distributions of Disease Activity Scores (DAS28), BMI, age, and disease duration were assessed for each country and for the entire dataset; mean values between genders were compared using Student's t-tests. An association between BMI and DAS28 was investigated using linear regression, adjusting for age, disease duration and country. Results: A total of 5,161 RA patients (4,082 women and 1,079 men) were included in the analyses. Overall, women were younger, had longer disease duration, and higher DAS28 scores than men, but BMI was similar between genders. The mean DAS28 scores increased with increasing BMI from normal to overweight and obese, among women, whereas the opposite trend was observed among men. Regression results showed BMI (continuous or categorical) to be associated with DAS28. Compared to the normal BMI range, being obese was associated with a larger difference in mean DAS28 (0.23, 95% CI: 0.11, 0.34) than being overweight (0.12, 95% CI: 0.03, 0.21); being underweight was not associated with disease activity. These associations were more pronounced among women, and were not explained by any single component of the DAS28. Conclusion: BMI appears to be associated with RA disease activity in women, but not in men. © Copyright Clinical and Experimental Rheumatology 2010. University of California Los Angeles, Los Angeles, CA University of California Berkeley, Berkeley, CA North Karelia Central Hospital, Joensuu Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre Universidade Federal do Ceará, Fortaleza Universidade Estadual de São Paulo, São Paulo Hospital Universitário de Brasília, Brasilia University of Ioannina Ioannina Waterford Regional Hospital, Waterford Connolly Hospital, Dublin University of Genova, Genova Rheumatology Department, Pristine Institute of Experimental and Clinical Medicine Vilnius University, Vilnius University Medical Centre Utrecht, Utrecht Jyväskylä Central Hospital, Jyväskylä Medcare Oy, Äänekoski Hospital Oakland Research Institute, Oakland, CA Hospital San Juan Bautista, Catamarca Hospital of Cordoba, Cordoba Universidade do Estado do Rio de Janeiro, Rio de Janeiro Riverside Professional Centre, Sydney, NS Copenhagen University Hospital at Hvidovre, Hvidovre King Christian the Xth Hospital, Gråsten Copenhagen University Hospital at Herlev, Herlev Al-Azhar University, Cairo Assiut University Hospital, Assiut Abo Sohage University Hospital, Sohage Tartu University Hospital, Tartu East-Tallinn Central Hospital, Tallinn Centre for Clinical and Basic Research, Tallinn Satakunta Central Hospital, Rauma University René Descartes Hôpital Cochin, Paris Dijon University Hospital University of Burgundy INSERM U887, Dijon Hôpital Lapeyronie, Montpellier Hôpital Hautepierre, Strasbourg School of Medicine National University of Athens, Athens Euroclinic Hospital, Athens Evangelisches Fachkrankenhaus, Ratingen Schlosspark-Klinik, Berlin University Medicine Berlin, Berlin Semmelweis University of Medical Sciences, Budapest Ilona Újfalussy Polyclinic of the Hospitaller Brothers of St. John of God in Budapest, Budapest St. Vincent University Hospital, Dublin Our Lady's Hospice, Dublin Department of Immunology, Lucknow Vedanta Institiute of Medical Sciences, Ahmedabad Department of Immunology Jaipur Hospital Santa Chiara Hospital, Pisa Catholic University of Sacred Heart, Rome University of Ancona, Ancona Institute of Rheumatology Tokyo Women's Medical University, Tokyo Department of Rheumatology Kyoto First Red Cross Hospital, Kyoto Shono Rheumatism Clinic, Fukuoka Kenyatta Hospital, Nairobi Pauls Stradina Clinical University Hospital, Riga Kaunas University Hospital, Kaunas El Ayachi Hospital Mohamed Vth Souissi University, Rabat Sint Franciscus Gasthuis Hospital, Rotterdam Medisch Spectrum Twente, Enschede Sørlandet Hospital, Kristiansand Medical University in Bialystok, Bialystok Medical University of Lublin, Lublin Poznan Rheumatology Centre in Srem, Srem Military Institute of Medicine, Warsaw Silesian Hospital for Rheumatology and Rehabilitation in Ustron Slaski, Ustroñ Slaski Szpital Wojewodzki im. Jana Biziela, Bydgoszcz Wojewodzki Zespol Reumatologiczny im. dr Jadwigi Titz-Kosko, Sopot Spitalul Clinic Sf Maria, Bucharest Institute of Rheumatology of Russian Academy of Medical Sciences, Moscow Moscow Medical Academy, Moscow Russian Medical Academy of Postgraduate Education, Moscow Rheumatology Institut, Niska Banja Hospital de Gran Canaria Dr. Negrin, Las Palmas Hospital Sierrallana Ganzo, Torrelavega Hospital General de Castellón, Castellón Uppsala University Hospital, Uppsala Centrallasarettet, Västerås Hudiksvall Medical Clinic, Hudiksvall Gazi University Medical Faculty, Ankara Meram Medical Faculty, Konya Cerrahpasa Medic Faculty, Istanbul Dubai Bone and Joint Centre, Dubai American Hospital Dubai, Dubai Charing Cross Hospital, London Royal Cornwall Hospital, Truro Kings College Hospital, London Vanderbilt University, Nashville, TN NYU Hospital for Joint Diseases, New York, NY Taylor Hospital, Ridley Park, PA Centra Care Clinic, St. Cloud, MN University of Arkansas for Medical Sciences, Little Rock, AR New York University Hospital for Joint Diseases, New York, NY Universidade Estadual de São Paulo, São Paulo

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