Stuart R Gray, Alexander H K Montoye, Joseph D Vondrasek, Sylvia Neph, Stefan Siebert, Lorna Paul, Eva M Bachmair, Neil Basu
{"title":"Associations of physical activity levels with fatigue in people with inflammatory rheumatic diseases in the LIFT trial.","authors":"Stuart R Gray, Alexander H K Montoye, Joseph D Vondrasek, Sylvia Neph, Stefan Siebert, Lorna Paul, Eva M Bachmair, Neil Basu","doi":"10.1093/rap/rkae106","DOIUrl":"https://doi.org/10.1093/rap/rkae106","url":null,"abstract":"<p><strong>Objectives: </strong>The overall aim of the current study was to quantify physical activity levels in inflammatory rheumatic diseases (IRDs) and to explore their role in fatigue.</p><p><strong>Methods: </strong>We conducted a secondary analysis of data from the Lessening the Impact of Fatigue in IRDs (LIFT) trial of the personalized exercise program (PEP) intervention for fatigue. Participants with IRDs were recruited from 2017 to 2019 and the current analysis used fatigue, measured by the Chalder Fatigue Scale (CFS) and the Fatigue Severity Scale (FSS), and accelerometer measured physical activity data collected at baseline and at the 6-month follow-up. Physical activity levels were quantified and associations with fatigue and effects of PEP investigated.</p><p><strong>Results: </strong>Of the 337 included participants, 195 (68.4%) did not meet the current recommendations for moderate-vigorous physical activity (MVPA). In baseline cross-sectional analysis, many dimensions of physical activity were associated with fatigue. After mutual adjustment, overall physical activity (vector magnitude) was associated with CFS [-0.88 (95% CI -0.12, -1.64)] and distribution of time spent at different activity intensities was associated with FSS [-1.16 (95% CI -2.01, -0.31)]. Relative to usual care, PEP resulted in an increase in upright time, with trends for increases in step count and overall physical activity. People who increased overall physical activity (vector magnitude) more had greater improvements in CFS and FSS, while those who increased step count and MVPA more had greater improvements in FSS.</p><p><strong>Conclusion: </strong>Increasing physical activity is important for fatigue management in people with IRDs and further work is needed to optimize PEPs to target the symptoms and impact of fatigue.</p><p><strong>Trial registration: </strong>ClinicalTrials.gov (http://clinicaltrials.gov), NCT03248518.</p>","PeriodicalId":21350,"journal":{"name":"Rheumatology Advances in Practice","volume":"8 3","pages":"rkae106"},"PeriodicalIF":2.1,"publicationDate":"2024-08-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11384110/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142294338","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Is it possible to use avacopan alone in the induction of remission in ANCA-associated vasculitis?","authors":"Soichiro Kubota, Shunichiro Hanai, Nakako Tanaka-Mabuchi, Ryosuke Ito, Daiki Nakagomi","doi":"10.1093/rap/rkae100","DOIUrl":"10.1093/rap/rkae100","url":null,"abstract":"","PeriodicalId":21350,"journal":{"name":"Rheumatology Advances in Practice","volume":"8 3","pages":"rkae100"},"PeriodicalIF":2.1,"publicationDate":"2024-08-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11374021/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142133610","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Antoni Chan, Kathryn Rigler, Nadia Ahmad, Tanguy Lafont
{"title":"Progressive improvement in time to diagnosis in axial spondyloarthritis through an integrated referral and education system.","authors":"Antoni Chan, Kathryn Rigler, Nadia Ahmad, Tanguy Lafont","doi":"10.1093/rap/rkae102","DOIUrl":"https://doi.org/10.1093/rap/rkae102","url":null,"abstract":"<p><strong>Objectives: </strong>To assess the delay in the diagnosis of axial SpA (axSpA) in a real-world cohort over a 16-year period and to evaluate factors associated with this delay. We implemented a service improvement project and evaluated its effectiveness in improving time to diagnosis of axSpA.</p><p><strong>Methods: </strong>A cohort of axSpA patients newly diagnosed between January 2008 and December 2023 were studied. Surveys were carried out in 2013, 2017, 2019 and 2023 to assess time to diagnosis, which was divided into four periods from onset of inflammatory back pain to year of axSpA diagnosis. The time to diagnosis over the study period was analysed using a statistical process control chart.</p><p><strong>Results: </strong>Over the study period, 988 referrals were received and 366 (37%) had axSpA. There was a progressive increase in the number of females with axSpA. The mean time to diagnosis significantly decreased from 9.8 years (s.d. 1.2) in 2008 to 1.0 years (s.d. 1.0) in 2023. The greatest delay was from the onset of back pain to first seeing their general practitioners (GPs; mean 3.2 years). There was a significant improvement in the mean time to diagnosis across the time periods through the service improvement interventions.</p><p><strong>Conclusion: </strong>Structural and organizational change in triage, referral and clinic pathways has led to earlier recognition of axSpA. This is further enhanced through an integrated education program and awareness campaign for the public, GPs and healthcare professionals, including physiotherapists. With continuous quality improvement cycles, we achieved our aim of reducing the mean time to diagnosis to 1 year.</p>","PeriodicalId":21350,"journal":{"name":"Rheumatology Advances in Practice","volume":"8 4","pages":"rkae102"},"PeriodicalIF":2.1,"publicationDate":"2024-08-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11398972/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142294342","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Recurrence of Kikuchi-Fujimoto Disease following influenza vaccination, diagnosis aided using ultrasound examination.","authors":"Simran Grewal, Ali S Jawad","doi":"10.1093/rap/rkae104","DOIUrl":"10.1093/rap/rkae104","url":null,"abstract":"","PeriodicalId":21350,"journal":{"name":"Rheumatology Advances in Practice","volume":"8 3","pages":"rkae104"},"PeriodicalIF":2.1,"publicationDate":"2024-08-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11374019/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142133612","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Madeleine J Bryant, Rachel J Black, Susan Lester, Vibhasha Chand, Claire Barrett, Rachelle Buchbinder, Marissa Lassere, Lyn March, Catherine L Hill
{"title":"Australian adaptation and external validation of Commissioning for Quality in Rheumatoid Arthritis-RA-Patient Reported Experience Measure (CQRA-RA-PREM).","authors":"Madeleine J Bryant, Rachel J Black, Susan Lester, Vibhasha Chand, Claire Barrett, Rachelle Buchbinder, Marissa Lassere, Lyn March, Catherine L Hill","doi":"10.1093/rap/rkae099","DOIUrl":"https://doi.org/10.1093/rap/rkae099","url":null,"abstract":"<p><strong>Objectives: </strong>To evaluate the reliability and validity of an adapted Commissioning for Quality in Rheumatoid Arthritis-RA-Patient-Reported Experience Measure (CQRA-RA-PREM) for assessing care experience in an Australian rheumatology outpatient cohort.</p><p><strong>Methods: </strong>Individual patient interviews were performed to check the language and completion time of the CQRA-RA-PREM before modification. Australian Rheumatology Association Database (ARAD) participants completed the CQRA-PREM-Australian version (CQRA-PREM-AU) (22 items, 5 domains), disease activity measure (RAPID-3, BASDAI) and Assessment of Quality of Life (AQOL-6D) index. Exploratory factor analysis (EFA) assessed item correlation. Cronbach's α assessed internal consistency.</p><p><strong>Results: </strong>Individual patient interviews (<i>n</i> = 8, 62% male, mean age 50 years, mean disease duration 4.5 years) informed CQRA-RA-PREM modification. The ARAD survey response rate was 707/1124 (63%); 459 (65%) RA, 134 (19%) PsA, 114 (16%) AS; 67% female, mean age 62 years, mean disease duration 22 years. The median instrument completion time was 299 s (interquartile range 284-414). Scoring of responses allowed an averaged overall score. EFA extracted five factors: all items loading similarly onto factor 1, indicating validity of the overall score. The CQRA-PREM-AU score correlated with the AQOL-6D score (ρ = 0.23, <i>P</i> < 0.01); partial correlation with disease activity was not significant (ρ = 0.03, <i>P</i> = 0.45), indicating divergent validity. Reliability was comparable across disease subgroups (Cronbach's α >0.94). The mean overall score did not differ by disease subgroup [4.1 (s.d. 0.6, <i>P</i> = 0.73) and there was no floor/ceiling effect.</p><p><strong>Conclusion: </strong>CQRA-PREM-AU is a valid and reliable instrument to measure self-reported care experience in Australian rheumatology patients and may be interpreted as an average overall numerical score.</p>","PeriodicalId":21350,"journal":{"name":"Rheumatology Advances in Practice","volume":"8 4","pages":"rkae099"},"PeriodicalIF":2.1,"publicationDate":"2024-08-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11457261/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142392928","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Comment on: Impaired health-related quality of life in idiopathic inflammatory myopathies: a cross-sectional analysis from the COVAD-2 e-survey.","authors":"Josef Finsterer","doi":"10.1093/rap/rkae097","DOIUrl":"10.1093/rap/rkae097","url":null,"abstract":"","PeriodicalId":21350,"journal":{"name":"Rheumatology Advances in Practice","volume":"8 3","pages":"rkae097"},"PeriodicalIF":2.1,"publicationDate":"2024-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11374026/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142133607","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Comment on: Impaired health-related quality of life in idiopathic inflammatory myopathies: a cross-sectional analysis from the COVAD-2 e-survey: Reply.","authors":"Akira Yoshida, Masataka Kuwana, Vikas Agarwal, Latika Gupta","doi":"10.1093/rap/rkae098","DOIUrl":"10.1093/rap/rkae098","url":null,"abstract":"","PeriodicalId":21350,"journal":{"name":"Rheumatology Advances in Practice","volume":"8 3","pages":"rkae098"},"PeriodicalIF":2.1,"publicationDate":"2024-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11374017/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142133608","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Kirsi Taimen, Ilpo Koskivirta, Laura Pirilä, Heikki Mäkisalo, Marko Seppänen, Topias Allonen
{"title":"Polyarteritis nodosa with abdominal bleeding: imaging with PET/CT and angiography on the same day.","authors":"Kirsi Taimen, Ilpo Koskivirta, Laura Pirilä, Heikki Mäkisalo, Marko Seppänen, Topias Allonen","doi":"10.1093/rap/rkae095","DOIUrl":"10.1093/rap/rkae095","url":null,"abstract":"","PeriodicalId":21350,"journal":{"name":"Rheumatology Advances in Practice","volume":"8 3","pages":"rkae095"},"PeriodicalIF":2.1,"publicationDate":"2024-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11319636/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141976522","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Lisa Uchida, Rachel B Jones, Rona M Smith, Marianna Nodale, Simon Bond, Claudia Loechel, Maria King, Raashid Luqmani, David Gray, Joe Barrett, David R W Jayne
{"title":"Long-term surveillance study of rituximab originator treated patients with granulomatosis with polyangiitis (GPA) or microscopic polyangiitis (MPA).","authors":"Lisa Uchida, Rachel B Jones, Rona M Smith, Marianna Nodale, Simon Bond, Claudia Loechel, Maria King, Raashid Luqmani, David Gray, Joe Barrett, David R W Jayne","doi":"10.1093/rap/rkae090","DOIUrl":"10.1093/rap/rkae090","url":null,"abstract":"<p><strong>Objectives: </strong>Rituximab is used for remission induction and the prevention of relapse in anti-neutrophil cytoplasmic antibody-associated vasculitis (AAV). This study evaluated the incidence of safety events and compared time to first serious adverse event (SAE) between a rituximab cohort and a cohort treated with non-rituximab therapies in a real-life setting.</p><p><strong>Methods: </strong>Rituximab surveillance study in vasculitis was a retrospective observational study of patients with AAV who received rituximab (MabThera) or other treatments between 2003 and 2017 at a specialist vasculitis clinic. The primary endpoint was time to first SAE.</p><p><strong>Results: </strong>392 patients were enrolled: 247 in the rituximab and 145 in the control cohorts with a total follow up of 2217 person-years (mean study duration 5.7 years). Mean age was 61 years, 77% had granulomatosis with polyangiitis (GPA). There were differences in baseline characteristics (disease duration and prior immunosuppressive use) between groups. 134/247 patients (54%) in the rituximab and 58/145 (40%) of controls experienced at least one SAE. Time to first SAE was shorter in the rituximab group (hazard ratio (HR) 1.55, 95% CI 1.07-2.26, <i>P </i>= 0.022). Predictors of first SAE were higher vasculitis damage index and the presence of chronic pulmonary or kidney disease. The risk of serious infection was higher in the rituximab group (relative risk (RR) 2.12, 95% CI 1.31-3.43).</p><p><strong>Conclusion: </strong>Over 40% of patients with AAV experienced at least one SAE. Although shorter time to first SAE and higher risk of infection were observed in the rituximab group, baseline imbalances necessitate a careful interpretation of these results.</p>","PeriodicalId":21350,"journal":{"name":"Rheumatology Advances in Practice","volume":"8 3","pages":"rkae090"},"PeriodicalIF":2.1,"publicationDate":"2024-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11333760/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142009336","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}