Therapeutic education improves rheumatoid arthritis patients' knowledge about methotrexate: a single center retrospective study.

To assess, by means of a questionnaire, the effectiveness of a therapeutic education session on rheumatoid arthritis patients' knowledge about methotrexate. Retrospective study of data collected in routine care. STROBE guidelines were used. Rheumatoid arthritis patients treated with methotrexate had a therapeutic education session conducted by a rheumatology nurse at time 0 and 6 months after. They completed a questionnaire to assess their knowledge about methotrexate before the first therapeutic education session and 6 and 12 months after. A score from 0 to 100 was calculated based on 20 questions. A total of 66 patients were enrolled (50 women), with a mean age of 57 years, median disease duration of 4 years, and methotrexate treatment duration of 2 years. The knowledge score improved 6 months after the first therapeutic education session and was unchanged at 12 months. Significant improvement was observed in knowledge about the need for contraception, the contraindication of trimethoprim, the maximum dose not to be exceeded, reduction in alcohol consumption, and the value of combining folic acid with methotrexate. Knowledge about the risk of hypersensitivity pneumonitis did not improve. Skills related to the need for and timing of laboratory testing and contraception were evaluated using two role-playing situations. None of the skills improved. A therapeutic education session improves patients' knowledge about methotrexate at 6 months.

Performance of Fibromyalgia Rapid Screening Tool (FiRST) to detect fibromyalgia syndrome in rheumatic diseases.

OBJECTIVE: To evaluate the performance of the Fibromyalgia Rapid Screening Tool (FiRST) self-questionnaire for the detection of FM associated with inflammatory rheumatic diseases. METHODS: This cross-sectional, French single-centre study was carried out between September 2014 and April 2015 in all patients who consulted for RA, SpA or CTD. Diagnosis of FM was based on ACR 90 criteria and rheumatologist opinion. RESULTS: The self-questionnaire was completed by 605 patients (279 RA, 271 SpA, 57 CTD). It detected 143 concomitant FMs (24.4%). When assessed against ACR 90 criteria, FiRST had a sensitivity of 74.5%, a specificity of 80.4%, a positive predictive value of 26.6% and a negative predictive value (NPV) of 97.1%. Specificity was lower in the CTD group (RA: 84.4%, SpA: 80.2%, CTD: 59.6%) (P = 0.001). When assessed against the rheumatologist's opinion, FiRST had a sensitivity of 75.8%, a specificity of 85.1%, a positive predictive value of 48.3% and an NPV of 95%. Sensitivity was lower in the SpA group than in the CTD group (66% vs 94.4%) (P = 0.004). Performance varied according to self-questionnaire items. CONCLUSION: Although it performs less well in inflammatory rheumatic disease, FiRST's opinion is close to that of the rheumatologist. It can be used by the rheumatologist in clinical practice for patients facing an apparent treatment failure and to rule out a potential FM diagnosis which could interfere with the treatment response.

Effect of Argentine tango sessions on total physical activity time in patients with chronic inflammatory rheumatism: randomized, controlled, pilot study.

OBJECTIVE: The aim of this study was to evaluate the effect of an Argentine Tango (AT) program on total physical activity (PA) time in patients with rheumatoid arthritis (RA) and spondyloarthritis (SpA). METHODS: Prospective randomized controlled pilot study with two parallel groups. Participants were randomized 1:1 to attend a 24-week AT program from baseline to month 6 for the immediate tango group (ITG) and a 12-week AT program from month 3 to month 6 for the wait-list control group (WLCG). Total PA time was measured at baseline, month 3, and month 6 using the Global Physical Activity Questionnaire-ONAPS and an accelerometer. RESULTS: Twenty-seven participants (15 RA and 12 SpA) were enrolled in the study. Thirteen participants in the WLCG and 14 in the ITG. At month 3, there was no significant difference in the total PA time between the two groups. Longitudinal analyses revealed no significant difference between the two groups regarding PA, sedentary, fatigue, anxiety, depression, balance, physical performance, pain, and stress. However, body appreciation improved significantly in the ITG compared with the WLCG. Both groups showed improved physical abilities at 6 month, including improvements in the 6-min walk test and timed up and go test. The ITG also reported reduced pain at months 3 and 6, while the WLCG exhibited improved balance at month 6. CONCLUSION: Although the AT program did not significantly increase total PA time in patients with CIR, it positively impacted body appreciation and physical abilities suggesting its potential as a complementary therapy. Key Points • Body appreciation significantly improved after a 24-week AT program, emphasizing the positive impact of dance on self-perception. • Both groups exhibited improved physical abilities at month 6, indicating a positive influence on participants' overall mobility and functional capacity. • The 24-week AT group reported reduced pain at months 3 and 6, and the 12-week AT group exhibited improved balance at month 6.

Comparison of group versus individual patient education for promoting safety skills of patients with autoimmune rheumatic diseases treated with biologics: a multicentre randomised controlled trial.

OBJECTIVE: To evaluate the effectiveness of a nurse-led intervention combining face-to-face and group education sessions for the acquisition of safety skills by patients with autoimmune rheumatic diseases treated with biologics. METHODS: This multicentre randomised controlled trial compared two individual patient education sessions against a combination of an individual session at baseline and a group session 3 months later. The primary outcome was a validated questionnaire (BioSecure) scored at 6 and 12 months that assessed competencies and problem-solving abilities to deal with fever, infection, vaccination, and daily situations. Secondary outcomes were fear of disease, anxiety, depression, and arthritis helplessness. RESULTS: A total of 120 patients with rheumatoid arthritis and spondyloarthritis were included (60 in each arm) from 7 French rheumatology departments; 99 patients completed the study at 6 months and 83 at 12 months. The BioSecure score improved at 6 months in both arms (delta from baseline 14.9 ± 16.3 in face-to-face education and 16.0 ± 17.9 in combined education) and was maintained for 12 months but no significant difference was found between arms at 6 and 12 months (p = 0.35 and p = 0.13, respectively). Fear of disease, arthritis helplessness, and anxiety were improved at 6 and 12 months with no difference between arms. CONCLUSION: Educating patients using individual nurse-led sessions or a combination of individual and group sessions increased their safety skills on biologics, with no superiority shown for the combined format. Given the time and resources required to educate patients, these results could lead to potential cost savings. TRIAL REGISTRATION: Clinical Trials: NCT03838939. Key Points • Face-to-face patient education has been shown effective in promoting safety skills of patients treated with biologics compared to information provided by the rheumatologist in usual care. • This randomised controlled trial showed that a patient education format combining one individual and one group session was not superior to two individual sessions regarding safety skills assessed at 6 and 12 months • Safety skills, fear of disease, arthritis helplessness, and anxiety were improved in both arms. • As the most common barriers to the implementation of patient education are constraints in time and resources, these results could lead to potential cost savings.

Post-traumatic stress disorder prior to diagnosis is as rare in spondyloarthritis as in non-inflammatory rheumatic conditions and rheumatoid arthritis.

OBJECTIVE: Post-traumatic stress disorder (PTSD) may be a risk factor for the development of rheumatoid arthritis (RA). No data are available in spondyloarthritis (SpA). The aim of the present study was to investigate the frequency of traumatic events and PTSD in patients with SpA and its different phenotypes and to compare the results to patients with non inflammatory rheumatic disease and RA patients. METHODS: This was an observational, cross-sectional and bi-centric study. Participants were patients diagnosed with SpA, non-inflammatory rheumatic or autoimmune disease (controls), or RA. Traumatic events were identified by the brief trauma questionnaire (BTQ). PTSD was defined as the presence of a traumatic event and ≥4 symptoms on the short PTSD checklist scale. RESULTS: Among 1389 participants, 510 patients were diagnosed with SpA (167 ankylosing spondylitis, 140 psoriatic arthritis, 130 non-radiographic-axial SpA, and 51 peripheral SpA), 365 with non-inflammatory rheumatic disease and 514 patients with RA. The frequency of trauma in SPA patients was 33.7%, of which 30.5% in AS, 30.7% in PsA, 37.7% in nr-axSpA and 41.2% in peripheral SpA (P=NS). The prevalence of PTSD in SPA patients was 4.9%, (of which 3.6% in AS, 2.9% in PsA, 6.2% in nr-axSpA and 7.8% in peripheral SpA [P=NS]) and was not significantly different from the controls (after IPTW 4.8% vs. 6.7%). The frequency of trauma and PTSD was also comparable between RA and controls and between SPA and RA. CONCLUSION: Traumatic events and PTSD occurring prior to diagnosis is as rare in SpA as in non-inflammatory rheumatic diseases and RA.

Adherence to Subcutaneous Anti-TNF Treatment in Chronic Inflammatory Rheumatism and Therapeutic Patient Education.

OBJECTIVE: Poor patient adherence to anti-TNF treatment has proven to be a major roadblock to effective management. Therapeutic patient education (TPE) is now recognized as a crucial tool in managing conditions like chronic inflammatory rheumatism and in improving treatment adherence. This study aimed to assess whether different TPE programs might improve adherence to subcutaneous anti-tumor necrosis factor (anti-TNF) treatment in patients with rheumatoid arthritis (RA), ankylosing spondyloarthritis (AS), and psoriatic arthritis (PsA). METHODS: This was a retrospective, observational, monocentric study of current care practices. We included 193 patients (124 women; mean age 53.3 ± 14.8 years). All patients received subcutaneous anti-TNF treatment and one of three TPE models, delivered by a nurse, from 2009 to 2013. The cohort was grouped according to different educational models: M1: information (N=92); M2: individual TPE (N=80); and M3: individual and group TPE sessions (N=21). Adherence was assessed with the Morisky Medication Adherence Scale (MMAS-4™). Scores were rated as follows: good adherence (MMAS-4 = 4), moderate adherence (MMAS-4 = 2-3), and poor adherence (MMAS-4 = 0-1). RESULTS: The mean disease duration was 10 years [95% CI: 5 to 18]. The cohort comprised 113 patients with RA, 73 with AS, and seven with PsA. Overall, 146 (75.7%) patients displayed good adherence, 34 (17.6%) displayed moderate adherence, and 13 (6.7%) displayed poor adherence. The M3 group displayed less adherence than the M1 and M2 groups. Old age was the only factor correlated with good adherence (p=0.005). The level of knowledge had no significant impact on adherence. CONCLUSION: This study demonstrated good adherence to anti-TNF treatment in patients that received TPE, particularly when it was delivered in individual sessions.

Retention rates of adalimumab, etanercept and infliximab as first-line biotherapy agent for rheumatoid arthritis patients in daily practice - Auvergne experience.

OBJECTIVE: To compare, in real-life conditions, the retention rates of anti-tumor necrosis factor (anti-TNF) treatment (etanercept [ETN], adalimumab [ADA] and infliximab [IFX]) initiated as first-line biotherapy for rheumatoid arthritis (RA) and to evaluate, in case of failure, the switch to another anti-TNF or a non-anti-TNF biological. METHODS: Monocentric retrospective cohort including all patients with RA starting a first anti-TNF between 2001 and 2015. RESULTS: Among the 346 patients analyzed, 201 received ETN, 82 ADA and 63 IFX. The first anti-TNF was interrupted in 151 cases. The retention rates were 82.8%, 67.6%, 46.5%, 28.1% and 22.5% at 1, 2, 5, 10 and 15 years, respectively, with a median retention duration of 52.8 (18.9-136.2) months (ETN: 59.3 [19.1-NA), ADA: 79.9 [19.3-136.2] and IFX: 37.2 [17.5-134.5], P = 0.49). The predictive factors of discontinuation were active RA (Disease Activity Score of 28 joints - C-reactive protein [DAS28-CRP] hazards ratio [HR]: 1.22 [1.03-1.45]), inflammatory syndrome (erythrocyte sedimentation rate HR: 1.01 [1.0-1.02]; CRP HR: 1.00 [1.00-1.01]), absence of methotrexate treatment (HR: 0.60 [0.43-0.83]), and corticosteroid use (HR: 1.91 [1.31-2.78]). The patients who switched to another anti-TNF treatment had an inferior retention than those who switched to a non-anti-TNF treatment (HR: 0.39 [0.17-0.87], P = 0.02). CONCLUSION: In real life, there was no difference in retention among the three anti-TNF agents, and 25% of patients continued them at 15 years. After failure of an anti-TNF, the switch to a non-anti-TNF biotherapy showed better retention.

Retention rates of adalimumab, etanercept, and infliximab as first- or second-line biotherapies for spondyloarthritis patients in daily practice in Auvergne (France).

OBJECTIVE: To compare, in real-life settings, the retention rates of initial anti-tumor-necrosis factor (TNF) treatments (etanercept [ETN], adalimumab [ADA] and infliximab [IFX]) used as first-line biotherapy for axial spondyloarthritis (axSpA), and evaluate treatment switches to another anti-TNF inhibitor in the event of treatment failure. METHODS: We analyzed the medical records of all SpA patients (Assessment in Ankylosing Spondylitis International Working Group axial criteria) treated with ETN, IFX or ADA between 2001 and February 2015. Drug retention rates were calculated using the Kaplan-Meier method and compared by means of the Cox extended model. Sub-analyses were performed according to discontinuation reasons. RESULTS: Of the 249 SpA patients analyzed (135 radiographic cases, 114 non-radiographic), 102 received ETN, 62 ADA, and 85 IFX. In total, 103 discontinued treatment. The retention rates of IFX, ADA and ETN were 67%, 59% and 56% after 3 years; 62%, 42% and 47% after 5 years; 55%, 42% and 24% after 8 years; 53%, 42% and 12% after 10 years, respectively. In multivariate analyses, the predictive factors for retention were: low BASDAI score (hazard ratio [HR]: 1.02 [1.01-1.04]), high C-reactive protein levels (HR: 0.98 [0.97-0.99]), concomitant disease-modifying therapy (HR: 0.4 [0.21-0.75]), and radiographic SpA (HR: 1.5 [1.0-2.52]). In total, 61 patients switched to another anti-TNF therapy. No difference was observed among the three anti-TNF therapies regarding median retention duration, although the retention rate proved higher for treatment switches from one monoclonal antibody to another. CONCLUSION: The retention rate in SpA patients proved high, with retention for IFX superior to that of ETN.

Frequency of concomitant fibromyalgia in rheumatic diseases: Monocentric study of 691 patients.

OBJECTIVE: Fibromyalgia (FM) is a confounding factor for diagnosing and assessing rheumatic disease activity. This study sought to assess the extent of this syndrome in rheumatism patients at a French rheumatology department. METHOD: This monocentric epidemiological study enrolled all patients consulting due to rheumatoid arthritis (RA), spondyloarthritis (SpA), or connective tissue disease (CTD). FM diagnosis was confirmed or excluded according to the rheumatologist opinion and the 1990 American College of Rheumatology (ACR) criteria. RESULTS: We enrolled 691 patients, including 451 women (65.3%), with a mean age of 55.8 years (18-93). Of the enrolled patients, 325 presented with RA, 298 SpA [59 psoriatic arthritis (PsA), 137 ankylosing spondylitis (AS), 64 non-radiographic SpA (nr-SpA), and 38 peripheral SpA], and 71 CTD. The rheumatologist established FM diagnosis in 97 patients (14%), while 55 (8%) fulfilled the 1990 ACR criteria. The frequency of FM was lower in RA patients (4.9% by 1990 ACR criteria; 7.7% by expert opinion) compared to SpA (11.1% by 1990 ACR, p < 0.05; 17.5% by expert opinion, p < 0.003) and CTD (11.3% by 1990 ACR, non-significant; 28.2% by expert opinion, p < 0.001). In the SpA subgroups, FM was more common in the nr-SpA than in PsA or AS (23.9%, 9.6%, and 6.4%, by 1990 ACR, p = 0.001; 37.3%, 13.5%, and 7.2%, by expert opinion, p < 0.001). CONCLUSION: FM-like symptoms are commonly associated with rheumatic diseases. The frequency of FM is particularly high in non-radiographic axial SpA, thus raising questions about the specificity of the Assessment of SpondyloArthritis International Society (ASAS) classification criteria.