Positive affect as a predictor of adherence in patients with Rheumatoid Arthritis.

The study was conducted in order to investigate adherence in patients with Rheumatoid arthritis (RA), correlating it with other variables such as affect and self-esteem. Seventy-eight patients with RA between 20 and 81 years of age were evaluated. Patients were assessed for Medical Outcomes Study (MOS) Measures of Patient Adherence, Rosenberg self-esteem scale and Short Portuguese version of the Positive and Negative Affect Schedule (PANAS). Pearson's correlation coefficient was used to assess the correlation between the therapeutic compliance and age, disease activity, disability, GPA, self-esteem, affect and inflammatory parameters. An independent T-test was used to evaluate differences in adherence within gender. The one-way analysis of variance (ANOVA) was used to determine associations between adherence and marital status, education level and employment status. A linear regression model was adjusted with stepwise data entry to determine predictors of therapeutic compliance. Patients had a mean age of 57 years and disease duration of 12.8 years. We observed higher levels of adherence in patients with higher self-esteem (r= 0.343, p<0.05) and positive affect (r= 0.345, p<0.01). The adjusted linear regression model allowed the identification of positive affect as a RA patient's adherence predictor (R = 0.347, p<0.05). In our study, high levels of self-reported adherence in RA patients were found. Positive affect seems to be an important determinant of therapeutic adherence in RA patients. These results suggest a relevant role of psychosocial aspects in therapeutic compliance and outcome, which should alert physicians to the need of an holistic approach of the patient.

Portuguese recommendations for the use of biological therapies in patients with axial spondyloarthritis - 2016 update.

OBJECTIVE: To update the recommendations for the treatment of axial spondyloarthritis (axSpA) with biological therapies, endorsed by the Portuguese Society of Rheumatology. METHODS: These treatment recommendations were formulated by Portuguese rheumatologists based on literature evidence and consensus opinion. At a national meeting, the 7 recommendations included in this document were discussed and updated. A draft of the full text of the recommendations was then circulated and suggestions were incorporated. A final version was again circulated before publication and the level of agreement among Portuguese Rheumatologists was anonymously assessed using an online survey. RESULTS: A consensus was achieved regarding the initiation, assessment of response and switching of biological therapies in patients with axSpA. In total, seven recommendations were produced. The first recommendation is a general statement indicating that biological therapy is not a first-line drug treatment option and should only be used after conventional treatment has failed. The second recommendation is also a general statement about the broad concept of axSpA adopted by these recommendations that includes both non-radiographic and radiographic axSpA. Recommendations 3 to 7 deal with the definition of active disease (including the recommended threshold of 2.1 for the Ankylosing Spondylitis Disease Activity Score [ASDAS] or the threshold of 4 [0-10 scale] for the Bath Ankylosing Spondylitis Disease Activity Index [BASDAI]), conventional treatment failure (nonsteroidal anti-inflammatory drugs being the first-line drug treatment), assessment of response to treatment (based on an ASDAS improvement  of at least 1.1 units or a BASDAI improvement of at least 2 units [0-10 scale] or at least 50%), and strategy in the presence of an inadequate response (where switching is recommended) or in the presence of long-term remission (where a process of biological therapy optimization can be considered, either a gradual increase in the interval between doses or a decrease of each dose of the biological therapy). CONCLUSION: These recommendations may be used for guidance in deciding which patients with axSpA should be treated with biological therapies. They cover a rapidly evolving area of therapeutic intervention. As more evidence becomes available and more biological therapies are licensed, these recommendations will have to be updated.