The most responsive measure of inflammation when evaluating anti-TNFalpha medication was a composite measure comprising MRI synovitis, tenosynovitis and bone marrow oedema, and this may be a promising outcome measure in clinical studies.

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This article aims to identify the strategies for coping with health and daily-life stressors of Mexican patients with chronic rheumatic disease.We analyzed the baseline data of a cohort of patients with rheumatoid arthritis (RA), ankylosing spondylitis (AS), and gout. Their strategies for coping were identified with a validated questionnaire. Comparisons between health and daily-life stressors and between the 3 clinical conditions were made. With regression analyses, we determined the contribution of individual, socioeconomic, educational, and health-related quality-of-life variables to health status and coping strategy.We identified several predominant coping strategies in response to daily-life and health stressors in 261 patients with RA, 226 with AS, and 206 with gout. Evasive and reappraisal strategies were predominant when patients cope with health stressors; emotional/negative and evasive strategies predominated when coping with daily-life stressors. There was a significant association between the evasive pattern and the low short-form health survey (SF-36) scores and health stressors across the 3 diseases. Besides some differences between diagnoses, the most important finding was the predominance of the evasive strategy and its association with low SF-36 score and high level of pain in patients with gout.Patients with rheumatic diseases cope in different ways when confronted with health and daily-life stressors. The strategy of coping differs across diagnoses; emotional/negative and evasive strategies are associated with poor health-related quality of life. The identification of the coping strategies could result in the design of psychosocial interventions to improve self-management.

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The aim of this study was to compare the socioeconomic consequences of early and late rheumatoid arthritis in Belgium and to assess the patient out-of-pocket contributions. This multicentre longitudinal study in Belgium evaluated patients with rheumatoid arthritis. Early disease was defined as diagnosis since less than 1 year. At baseline sociodemographic and disease characteristics were assessed and during the following year patients recorded all healthcare- and non-healthcare-related direct costs and out-of-pocket contributions. The study included 48 patients with early and 85 patients with late rheumatoid arthritis. Mean disease duration was 0.5 vs 12.5 years in patients with early and late rheumatoid arthritis, respectively. The disease activity score (DAS28) was comparable between both groups (4.1 vs 4.5, p = 0.14), but physical function (Health Assessment Questionnaire, HAQ) was more impaired in patients with long-standing disease (1.0 vs 1.7, p < 0.001). Work disability had increased from 2% in patients with early to 18% in patients with late disease. The annual societal direct costs per patient were 3055 Euros (median: 1518 Euros) opposed to 9946 Euros (median: 4017 Euros) for early and late rheumatoid arthritis, respectively. The higher direct cost for patients with long-standing disease was seen for all categories, but especially for physiotherapy and need for devices and adaptations. Patients with early as well as late disease contribute out of pocket about one-third to the direct healthcare costs. Within each group, HAQ was a strong determinant of costs. In Belgium, patients with long-standing rheumatoid arthritis are nine times more likely to be work disabled than patients with less than 1 year disease duration and have a threefold increase in costs. Differences in healthcare consumption between patients could be mainly explained by differences in physical function (HAQ).

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BackgroundEconomic considerations and patient preferences are increasingly important when choosing treatments. It is not known to what extent rheumatologists across Europe account for these factors when changing drug therapies in patients with active rheumatoid arthritis (RA).ObjectivesTo evaluate the extent to which rheumatologists across Europe consider costs, cost-effectiveness and patient preferences in addition to efficacy and safety in treatment decisions in RA.MethodsIn a discrete choice experiment, rheumatologists were asked to choose iteratively between two unlabelled drug treatment options for a hypothetical RA patient with moderate disease activity who failed two synthetic DMARDs. The treatment options were characterized by five attributes further specified by three levels; efficacy (level of improvement and achieved state on DAS28), safety (probability of a serious adverse event), patient preference (level of agreement with proposed treatment), medication costs and cost-effectiveness (incremental cost-effectiveness ratio (ICER)). Attributes and levels were selected based on literature data and expert consensus. An efficient experimental design was used to construct 14 treatment choices and a mixed logit model was used to estimate the relative importance of attributes.Results452 rheumatologists from 11 European countries contributed to the analysis (51% females, mean age 49 years). In all countries, drug-efficacy had the strongest influence on the rheumatologists' preferred drug choice. In addition, patient preferences were taken into account, especially when patients did not favour the drug. With regard to economic attributes of the drug, medication costs influenced the treatment choice more than ICER (table 1). However relative importance of ICER differed across countries (2-13%).ConclusionsThis study suggests that efficacy had the highest impact on treatment decisions. But for rheumatologists also patient preferences were relevant. Among the economic considerations, overall medication costs primarily influenced treatment decisions in RA, while ICER played a more limited role, especially in some countries.Disclosure of InterestM. Hifinger Employee of: Hexal AG, Holzkirchen, Germany (maternity leave), M. Hiligsmann: None declared, S. Ramiro: None declared, H. Severens: None declared, B. Fautrel: None declared, V. Watson: None declared, T. Uhlig: None declared, R. van Vollenhoven: None declared, P. Jacques: None declared, J. Detert: None declared, C. Scirè: None declared, J. Canas da Silva: None declared, F. Berghea: None declared, L. Carmona: None declared, M. Péntek: None declared, A. Boonen: None declared

Background:Treatment of Rheumatoid Arthritis (RA) has improved significantly based on early treat-to-target (T2T) strategies. Still, decreased health related quality of life (QoL), restricted ability to work and other unmet needs are reported by RA patients even in the absence of disease activity. We previously identified 3 factors representing the broader impact of RA using exploratory factor analysis: a patient-reported factor (patients global health, pain, fatigue and HAQ), a clinical factor (physician’s global health, tender and swollen joint count), and a laboratory factor (ESR and CRP)1.Objectives:To test whether the discordance between patient-reported (PRF) and clinical(CF)/laboratory(LF) measures can predict QoL, or has a mediating effect in predicting future disease burden based on disease activity (DAS28CRP).Methods:This is a post-hoc analysis of the 2-year CareRA trial. PRF, CF and LF scores were calculated as weighted (by factor loading) sum of their components at week 16, 52 and 104 after treatment initiation. A discordance score (DS) between PRF and the mean of the other two scores was also computed.Mediation analyses were fitted to test the hypothesis (Figure 1) that DS could be a mediator for predicting PRF, CF and LF at a future time point (week 16, 52 and 104) using DAS28CRP at a previous time point (baseline and week 16). Confidence intervals were estimated via 10 000 bootstraps. Finally, a linear regression was fitted for DS to predict future QoL (RAQoL questionnaire; range 0-30; higher values indicating worse QoL).Results:Patients with early RA (n=379) were included with a mean (SD) age of 53.9 (13.0), 77% seropositive and 69% women.The DS was shown to be mediating the effect of DAS28CRP on any future PRF (Table1). On the other hand, there was no mediation effect of the DS in the prediction of the CF and an inconsistent mediation effect when predicting the LF.Moreover, the DS at week 16 significantly predicted (p<0.0001) RAQoL scores at year 1 with an effect of β 19.05 (SE 1.58) and an R2 of 0.30 (CI 0.22-0.38). Similarly, it predicted RAQoL (p<0.0001) at year 2 with a β 19.74 (SE 1.56) and R2 of 0.32 (CI 0.24-0.40).Table 1.Results of mediation analyses for prediction of future burden based on previous DAS28CRP and mediated by discordance.TimepointPredictor variablesDirect Effect95% CIsR2Mediation effect Patient-reported factorW16DAS28CRP at BL-0.0091-0.0240, 0.00580.1450PresentDS at BL0.0246*0.0169, 0.03310.1784W52DAS28CRP at W160.0215*0.0010, 0.04190.3394PartialDS at W160.0580*0.0442, 0.07390.2749W104DAS28CRP at W160.0101-0.0102, 0.03050.2798PresentDS at W160.0528*0.0396, 0.06860.2749Clinical factorW16DAS28CRP at BL0.0153*0.0074, 0.02320.0599AbsentDS at BL0.0019-0.0010, 0.00480.1784W52DAS28CRP at W160.0365*0.0267, 0.04630.1944AbsentDS at W160.0034-0.0031, 0.00950.2749W104DAS28CRP at W160.0115*0.0024, 0.02070.0409AbsentDS at W160.0033-0.0019, 0.00890.2749Laboratory factorW16DAS28CRP at BL0.0063*0.0015, 0.01110.0634PartialDS at BL0.0030*0.0012, 0.00500.1784W52DAS28CRP at W160.0003-0.0063, 0.00680.0305PresentDS at W160.0051*0.0012, 0.00960.2749W104DAS28CRP at W16-0.0007-0.0079, 0.00640.0014AbsentDS at W160.0013-0.0019, 0.00460.2749W: week BL: baseline DS: discordance scoreDAS28CRP: disease activity score in 28 joints with C-reactive protein*p<0.01Conclusion:Early discordance between patient-reported and biological/clinical factors mediates the effect of disease activity on future patient-reported outcomes, but also predicts QoL. Paying attention to this early discordance might provide opportunities to prevent patient’s unmet needs by additional non-pharmacological interventions, hence broadening the scope of T2T.References:[1]Pazmino S, et al. Does Including Pain, Fatigue, and Physical Function When Assessing Patients with Early Rheumatoid Arthritis Provide a Comprehensive Picture of Disease Burden? J Rheumatol. 2020 Nov 15:jrheum.200758. doi: 10.3899/jrheum.200758. Ahead of print.Disclosure of Interests:None declared