Exploring remission concept in axial spondyloarthritis through the perception of rheumatologists using vignettes and priority ratings.

OBJECTIVES: The optimal treatment target in axial spondyloarthritis (axSpA) is remission; however, a consensual definition of remission is lacking. Our objective was to explore rheumatologists' perception of remission using vignette cases and a priority exercise. METHODS: A cross-sectional survey of rheumatologists' perceptions of remission in axSpA was performed in 2020 using (i) 36 vignette cases, with a single clinical picture and three varying parameters [axial pain (ranging from 2 to 5 on a 0-10 scale)], fatigue (2-8), and morning stiffness (<15 min, 30 min or 1 h), assessed as remission yes/no; and (ii) prioritization of elements to consider for remission from a list of 12 items: BASDAI, ASDAS, elements of BASDAI and ASDAS including CRP, NSAID use, extra-articular manifestations (EAMs), and other explanations of symptoms, e.g. fibromyalgia. Analyses were descriptive. RESULTS: Overall, 200 French rheumatologists participated in 2400 vignette evaluations. Of these, 463 (19%) were classified as remission. The six vignette cases representing 56% of all remission cases had <15 min duration of morning stiffness and axial pain ≤3/10, regardless of fatigue levels. Prioritized items for remission were: morning stiffness (75%), EAMs (75%), NSAID use (71%), axial pain (68%) and CRP (66%). CONCLUSIONS: When conceptualizing remission in axSpA, rheumatologists took into account morning stiffness and axial pain as expected; the link between remission and fatigue was much weaker. Furthermore, rheumatologists also included EAMs and NSAID use in the concept of remission. Consensus is needed for definition of remission in axSpA.

Adherence to and patient's knowledge of self-management of subcutaneous biologic therapy in chronic inflammatory rheumatic diseases: results of a multicentre cross-sectional study.

OBJECTIVES: Non-adherence to biologic therapy is an issue in chronic inflammatory rheumatic diseases (CIRDs) and might be related to poor patient knowledge of the risk of these therapies. Our aim here was to evaluate the level of patient adherence to and knowledge of self-care safety skills for biologic therapy. METHODS: This was a multicentre, cross-sectional study in which out-patients visited an office- or hospital-based rheumatologist. All the patients received subcutaneous biologic therapy for CIRDs. We collected data on: 1. the level of CIRD patient adherence to current subcutaneous biologic therapy using both the self-administered Compliance Questionnaire Rheumatology 5 items (CQR5) and a simple adherence question; 2. patients' knowledge of self-management of biologic therapy by the self-administered BIOSECURE questionnaire; 3. sources of information related to biologic therapy. RESULTS: In all, 285 patients (rheumatoid arthritis, n=103; spondyloarthritis, n=153; psoriatic arthritis, n=25) were enrolled by 19 rheumatologists. The mean (SD) biologic therapy duration was 5.9 (4.9) years. Adherence to the current biologic therapy was high (79.3% and 57.5% according to the CQR5 questionnaire and the adherence question, respectively). Level of knowledge of self-care safety skills (median BIOSECURE score 71) was in the acceptable range. Level of adherence and level of knowledge of self-care safety skills for biologic therapy were not associated. Patients declared that the main sources of information were their rheumatologist (92.6%) and the rheumatology team (30.5%). CONCLUSIONS: According to the patients' estimation, adherence to biologic therapy and the level of knowledge of self-care safety skills related to biologic therapy are acceptable, and these domains are not related (e.g. level of adherence and level of knowledge of risks).

Influence of perceived barriers and facilitators for physical activity on physical activity levels in patients with rheumatoid arthritis or spondyloarthritis: a cross-sectional study of 150 patients.

BACKGROUND: Barriers and facilitators to physical activity in inflammatory arthritis can be assessed through the Inflammatory arthritis FAcilitators and Barriers (IFAB) questionnaire. The objective was to measure the correlation between IFAB and self-reported physical activity levels. METHODS: This was an international, multicentric, cross-sectional study in 2019-20. Consecutive spondyloarthritis (axSpA), rheumatoid arthritis (RA) or psoriatic arthritis (PsA) patients completed the 10-item IFAB, which ranges from - 70 to 70 with lower scores indicating more barriers. Physical activity was measured by the IPAQ-S questionnaire, steps per day collected by smartphone, and psychological readiness to change by stages of behaviour change. Spearman correlations and multivariable linear regression were calculated. RESULTS: Of 245 patients included, 150 were analysed: 69 (46%) axSpA, 63 (42%) RA, 18 (12%) PsA. Mean age was 48.6 years (standard deviation, SD 17.1), mean disease duration 11.7 (10.1) years and 60% were women. Barriers to physical activity were moderate: mean IFAB, 6 (SD 19.2); 39 (26%) patients scored less than - 5, corresponding to significant barriers. The mean physical activity was 2837 (SD 2668, median 1784) MET-minutes per week. The IPAQ-S questionnaire was correlated with the IFAB (rho 0.28, p < 0.001), as well as the stage of behaviour change (rho 0.35, p < 0.001) though not with steps per day. Multivariable analyses were confirmatory. CONCLUSION: Perceived barriers and facilitators to physical activity were correlated with physical activity, indicating that targeting patients with high barriers and low facilitators to physical activity could be an effective option to improve physical activity levels. TRIAL REGISTRATION: ClinicalTrial NCT04426747 . Registered 11 June 2020 - Retrospectively registered.

Primary inefficacy of TNF inhibitors in patients with axial spondyloarthritis: a long-term follow-up of 25 patients.

Objectives: Primary inefficacy of TNF inhibitors (TNFi) for axial spondyloarthritis (axSpA) is infrequent. The objective of this study was to assess the long-term evolution and final diagnosis of patients with primary inefficacy of TNFi for axSpA. Methods: This was a systematic retrospective study of all patients receiving a TNFi for axSpA in one tertiary referral centre. Patients had axSpA confirmed by a rheumatologist and were started on a first course of TNFi according to usual practice. If the rheumatologist interrupted treatment at 3 months for inefficacy, this was defined as primary inefficacy. Five to 10 years later, these patients were re-evaluated. Results: Of 222 patients receiving a first TNFi for axSpA, 27 (12%) were considered as having primary inefficacy. These patients were more often females (48 vs 27%, P = 0.04), had higher functional impairment [BASDAI (0-100) 68 vs 42, P = 0.001] and less increased CRP (50 vs 78%, P = 0.008.) At the follow-up, 25 (92%) patients were re-evaluated: the diagnosis of axSpA was confirmed for 21/25 (84%) patients according to the Assessment of SpondyloArthritis criteria and 20/25 (80%) patients according to the rheumatologist; but 18/25 (72%) had at least one other cause of their symptoms from among OA, widespread pain syndrome or depression. A second TNFi was prescribed for 16 patients and was efficacious for 9 (56%). Conclusion: Most patients with primary inefficacy had a confirmed diagnosis of axSpA, but they often had other causes of pain. We suggest that patients with primary inefficacy to TNFi should be screened for comorbidities that may interfere with axSpA activity assessment.

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

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 at-work productivity are not interchangeable between languages.

Safety and Clinical Effectiveness of Percutaneous Vertebroplasty in the Elderly (≥80 years).

PURPOSE: To evaluate the safety and clinical effectiveness of percutaneous vertebroplasty (PVP) in patients aged 80 and over. METHODS: One hundred and seventy-three patients (127 women, 46 men; mean age = 84.2y) underwent 201 PVP procedures (391 vertebrae) in our institution from June 2008 to March 2012. One hundred and twenty-six patients (73 %) had osteoporotic vertebral compression fractures (VCF), 36 (20.5 %) were treated for tumour lesions, and the remaining 11 (6.5 %) for lesions from another cause. Comorbidities and American Society of Anesthesiologists (ASA) scores were assessed before treatment. Periprocedural and delayed complications were systematically recorded. A qualitative scale was used to evaluate pain relief at 1-month follow-up, ranging from significant pain worsening to marked improvement or disappearance. New fracture occurrence was assessed on follow-up imaging. RESULTS: Forty-five percent of patients had pretreatment ASA class scores ≥3. No major complication occurred. Pain was unchanged in 16.9 % of cases, mildly improved in 31.5 %, and disappeared in 47.8 %. We identified 27 (11 %) symptomatic new VCFs in patients with osteoporosis on follow-up imaging. The mean delay in diagnosis of new fractures was 5 ± 8.7 months. CONCLUSIONS: Even in the elderly, PVP remains a safe and effective technique for pain relief, independently of the underlying disease. KEY POINTS: • Post-PVP pain improvement was observed in 79.3 % of elderly patients. • PVP remains a safe technique in elderly patients. • No decompensation of comorbidity was observed in our series.

Physical activity in patients with axial spondyloarthritis: a cross-sectional study of 203 patients.

Physical activity is recommended in axial spondyloarthritis (axSpA) but may be insufficiently performed. The objective of this study was to assess physical activity in axial spondyloarthritis and to explore its explanatory factors. This was a cross-sectional study of patients with definite axSpA. The level of physical activity (International Physical Activity Questionnaire-Long form, IPAQ-L), type of aerobic exercise and the Exercise Benefits and Barriers Score were collected. Multivariate logistic regression analyses were performed to explain levels of exercise at least as recommended by the World Health Organization. In all, 203 patients were included: mean age 46.0 ± 11.6 years, 108 (53.2 %) males, mean Bath Ankylosing Spondylitis Activity Index (0-100) 37.8 ± 19.9; 137 (68.8 %) were treated with TNF-inhibitors. In all, 111 patients (54.7 %) were exercising at least as recommended; 96 (47.2 %) were in the 'high physical activity' category. Aerobic exercise >30 min was performed at least once a week by 61 (30.0 %) patients; the most frequent activities were energetic walking (31.0 %) and swimming (21.2 %). Main perceived benefits of exercising were improving physical fitness and functioning of the cardiovascular system, and the main barrier was physical exertion. Patients with paid employment had lower levels of physical activity whereas other demographic variables, disease activity/severity or TNF-inhibitor treatment were not predictive. One half of these patients performed enough physical activity according to the recommendations, similarly to the French population. Levels of physical activity did not appear to be explained by disease-related variables. Physical activity should be encouraged in axSpA.

Relationship between optimism and quality of life in patients with two chronic rheumatic diseases: axial spondyloarthritis and chronic low back pain: a cross sectional study of 288 patients.

BACKGROUND: Axial Spondyloarthritis (AxSpA) and chronic low back pain are rheumatic diseases that impact patients' health-related quality of life (HRQoL). In other chronic conditions, HRQoL was positively associated with dispositional optimism, a personality trait. The objective was to explore the relationship between optimism and HRQoL in these two diseases. METHOD: A cross-sectional study was performed in 2 tertiary care hospitals and 2 private practices in France. Patients had definite AxSpA or chronic low back pain according to the rheumatologist. A generic HRQoL questionnaire (Short Form, SF-12) with physical and mental composite scores (PCS and MCS respectively) and an optimism questionnaire (the Life Orientation Test-revised, LOT-R) were collected. Analyses included non-parametric correlations and multiple regression analyses to study the effect of optimism on PCS and MCS. RESULTS: In all, 288 (199 AxSpA and 89 low back pain) patients were included: mean age, 47.3 ± 11.9 years, 48.6 % were males. Pain levels (0-10) were 4.5 ± 2.4 and 4.3 ± 2.4 in AxSpA and LOW BACK PAIN patients, respectively. HRQoL was similarly altered in both diseases, for both physical and mental composite scores (mean PCS: 43.7 ± 8.2 vs. 41.9 ± 7.1; mean MCS: 45.9 ± 7.8 vs. 46.7 ± 8.1 for AxSpA and low back pain respectively). Optimism was moderate and similar in both populations. Optimism was positively correlated to MCS in both diseases (rho = 0.54 and 0.58, respectively, both p <0.01) and these relations persisted in multivariate analyses (beta = 1.03 and 1.40, both p <0.0001). CONCLUSIONS: Optimism was similar in these 2 chronic diseases and was an explanatory factor of the mental component of HRQoL, but not physical HRQoL. Physical HRQoL may reflect more the disease process than character traits.

Methodological issues when measuring paid productivity loss in patients with arthritis using biologic therapies: an overview of the literature.

Many patients with RA, AS and PsA experience restrictions in participating in the labour force. This reduces quality of life but also affects social insertion and economic autonomy of a patient. During the past decade, treatment strategies have been intensified and, additionally, a number of biologic therapies have been introduced for the treatment of these diseases. Treatment with biologic therapies has proved to be clinically effective and retard radiographic damage. Although less frequently investigated, a number of studies also determined the impact of biologic therapy on employment. However, the results in these studies are conflicting, which may partly be explained by the variation in methods used to assess the association between biologic therapy and employment/productivity loss. The aim of this overview is to critically appraise the different methodological approaches used in studies that evaluated the effect of biologic therapies on employment/productivity loss outcomes in inflammatory arthritis. The specific aims are to compare and discuss: (i) differences in population characteristics and study design including the use of a control group; and (ii) differences in methods used to assess and quantify productivity loss.

Switching between tumour necrosis factor blockers in spondyloarthritis: a retrospective monocentre study of 222 patients.

OBJECTIVES: To assess the frequency and effectiveness of switching TNF blockers in spondyloarthritis, and the predisposing factors of this effectiveness. METHODS: This was a retrospective systematic monocentre study; inclusion criteria were definite spondyloarthritis (Amor's criteria) and introduction of a first TNF blocker after January 2004. The retention rate of the first and second TNF blocker (if applicable) was evaluated (Kaplan-Meier technique). Patients' characteristics were compared with regard to requirement for switching. Predisposing factors of retention of the second TNF blocker were analysed (log-rank, Cox). RESULTS: A total of 222 patients started a first TNF blocker; 79% fulfilled the New York modified criteria, with increased CRP (75%) and median BASDAI of 50 (35-61). Mean follow up was 29±20 months (i.e. a total of 538 patient-years). By the end of follow-up, 72 patients (32%) had switched to a second TNF blocker. Patients who switched had more peripheral enthesitic symptoms (p=0.01) and a tendency for more peripheral involvement (p=0.06). Retention of the first and second TNF blocker was similar (p=0.32). No predictive factors were found for retention of the second TNF blocker; including no difference between TNF blockers and between reasons for stopping the first. CONCLUSIONS: The effectiveness of switching TNF blocker in spondyloarthritis appears clinically relevant; no predictive factors of this effectiveness were evidenced.

Risk of infections in bronchiectasis during disease-modifying treatment and biologics for rheumatic diseases.

BACKGROUND: Bronchiectasis is frequently associated (up to 30%) with chronic inflammatory rheumatic diseases and leads to lower respiratory tract infections. Data are lacking on the risk of lower respiratory tract infections in patients treated with biologic agents. METHODS: Monocenter, retrospective systematic study of all patients with a chronic inflammatory rheumatic disease and concomitant bronchiectasis, seen between 2000 and 2009. Univariate and multivariate analyses were performed to evidence predictive factors of the number of infectious respiratory events. RESULTS: 47 patients were included (mean age 64.1±9.1 years, 33 (70.2%) women), with a mean follow-up per patient of 4.3±3.1 years. Rheumatoid arthritis was the main rheumatic disease (90.1%). The mean number of infectious events was 0.8±1.0 event per patient-year. The factors predicting infections were the type of treatment (biologic vs. non biologic disease-modifying treatments), with an odds ratio of 8.7 (95% confidence interval: 1.7-43.4) and sputum colonization by any bacteria (odds ratio 7.4, 2.0-26.8). In multivariate analysis, both factors were independently predictive of infections. CONCLUSION: Lower respiratory tract infectious events are frequent among patients receiving biologics for chronic inflammatory rheumatic disease associated with bronchiectasis. Biologic treatment and pre-existing sputum colonization are independent risk factors of infection occurrence.

Prediction of Work Impact in Axial Spondyloarthritis by the Work Instability Scale: A Prospective Cohort Study of 101 Patients.

OBJECTIVE: Axial spondyloarthritis (axSpA) may have an effect on work. The Ankylosing Spondylitis Work Instability Scale (AS-WIS) assesses difficulties at work. The objective of this study was to evaluate the predictive value of the AS-WIS on work impact. METHODS: This is a prospective cohort study with 2 timepoints (at baseline and after 1.5 yrs) that included patients with axSpA who had paid employment. Patients completed the AS-WIS at baseline and work instability was scored as moderate/high if ≥ 11 (0-20 scale). At follow-up, adverse work outcomes (AWO) were grouped as moderate (short-term sick leave) or severe AWO (long-term sick leave, disability, unemployment). Univariable and multivariable logistic regression analyses were performed to explain AWO. RESULTS: Of 101 patients, mean age 45 (SD 9) years, 52% male, disease duration was 14 (SD 8) years. The Bath AS Disease Activity Index and the Bath AS Functional Index were 34 (SD 21) and 23 (SD 23), respectively, and 69 (68%) received a tumor necrosis factor inhibitor. At baseline, 46 (46%) patients had moderate/high AS-WIS. At 1.5 years of follow-up, 37 patients (36%) had AWO: 25 patients (25%) a short-term sick leave, and 12 patients (12%, 7/100 patient-years) a severe AWO. Independent baseline factors associated with AWO were a moderate/high AS-WIS score (OR 2.71, 95% CI 1.04-7.22) and shorter disease duration (OR 0.94, 95% CI 0.89-0.99). CONCLUSION: In patients with axSpA, a moderate/high AS-WIS score was predictive of AWO in this population with well-controlled axSpA. This short questionnaire can be helpful to screen for future difficulties at work.

Clinical guidelines and care pathway for management of low back pain with or without radicular pain.

OBJECTIVE: To develop guidelines for low back pain management according to previous international guidelines and the updated literature. METHODS: A report was compiled from a review of systematic reviews of guidelines published between 2013 and 2018 and meta-analysis of the management of low back pain published between 2015 and 2018. This report summarized the state-of-the-art scientific knowledge for each predefined area of the guidelines from a critical review of selected literature. A multidisciplinary panel of experts including 17 health professionals involved in low back pain management and 2 patient representatives formulated preliminary guidelines based on the compilation report and a care pathway. The compilation report and preliminary guidelines were submitted to 25 academic institutions and stakeholders for the consultation phase. From responses of academic institutions and stakeholders, the final guidelines were developed. For each area of the guidelines, agreement between experts was assessed by the RAND/UCLA method. RESULTS: The expert panel drafted 32 preliminary recommendations including a care pathway, which was amended after academic institution and stakeholder consultation. The consensus of the multidisciplinary expert panel was assessed for each final guideline: 32 recommendations were assessed as appropriate; none was assessed as uncertain or inappropriate. Strong approval was obtained for 27 recommendations and weak for 5. CONCLUSION: These new guidelines introduce several concepts, including the need to early identify low back pain at risk of chronicity to provide quicker intensive and multidisciplinary management if necessary.

Diagnostic delay in axial spondyloarthritis: A cross-sectional study of 432 patients.

OBJECTIVES: The diagnostic delay of axial spondyloarthritis (axSpA) is usually reported to be more than seven years but may have decreased recently. The objective was to quantify the diagnostic delay in patients with axSpA in France and to explore its associated factors. METHODS: Two cross-sectional observational studies included consecutively patients with axSpA (according to both ASAS criteria and rheumatologist expert opinion). Diagnostic delay was defined as the time interval from the date of first symptoms to the date of diagnosis. Potential predictive factors of diagnostic delay analyzed by multiple linear regression were demographic factors, HLA B27 status, year of diagnosis, clinical presentation and sacroiliitis on MRI or radiography. RESULTS: In all, 432 patients were analyzed: the mean age at diagnosis was 34.2 (standard deviation, 12.5) years, the mean disease duration at the time of the assessment was 11.4 (10.4) years. In all, 66.7% were HLA B27 positive, and 70.2% had radiographic sacroiliitis. The mean diagnostic delay was 4.9 (6.3) years, with a median of 2.0 years (interquartile range, 1-7; range: 0-43). In multivariable analysis, factors independently associated with a longer diagnostic delay were: higher age at diagnosis (beta=0.13; P<0.001), less frequent peripheral arthritis or dactylitis (beta=-1.69; P=0.005), and more frequent entheseal pain (beta=1.46; P=0.015). CONCLUSION: The median diagnostic delay was 2 years indicating diagnostic delay may be for most patients shorter than previously reported. A more "typical" SpA clinical presentation was associated with a shorter diagnostic delay, whereas sacroiliitis and HLA B27 positivity were not associated with this delay.

Collection and management of selected comorbidities and their risk factors in chronic inflammatory rheumatic diseases in daily practice in France.

INTRODUCTION: In chronic inflammatory rheumatic diseases (CIRDs), comorbidities such as cardiovascular disease and infections are sub-optimally managed. EULAR recently developed points to consider to collect and report comorbidities. The objective of this present study was to develop a pragmatic guide to collect, report and propose management recommendations for comorbidities, from a rheumatologist perspective. METHODS: The collection and reporting of comorbidities and risk factors was adapted from the EULAR points to consider. To develop management recommendations, the process comprised (1) systematic literature reviews by 3 fellows and (2) a 2-day consensus process involving 110 experts (rheumatologists and health professionals). Votes of agreement (Likert 1-5 where 5 indicates full agreement) were obtained. RESULTS: The six selected comorbidities were ischemic cardiovascular diseases, malignancies, infections, diverticulitis, osteoporosis and depression. The literature review retrieved 97 articles or websites, mostly developed for the general population. The consensus process led to reporting presence of comorbidities, current treatment, risk factors (e.g. hypertension), screening (e.g. mammography) and prevention (e.g. vaccination). Management recommendations include physical examination (e.g. blood pressure or lymph node examination), prescribing screening procedures, and interpreting results to refer in a timely manner to appropriate other health professionals. Agreement was high (mean±standard deviation, 4.37±0.33). CONCLUSIONS: Using an evidence-based approach followed by expert consensus, this initiative furthers the dissemination in France of the EULAR points to consider, and clearly defines what part of the management of comorbidities is potentially within the remit of rheumatologists. This initiative should facilitate systematic management of patients with CIRDs.

Test-retest Reliability and Correlations of 5 Global Measures Addressing At-work Productivity Loss in Patients with Rheumatic Diseases.

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.

Intra-articular injections in thumb osteoarthritis: A systematic review and meta-analysis of randomized controlled trials.

OBJECTIVES: The objective was to assess the efficacy of intra-articular injections of corticosteroids or hyaluronic acid in thumb osteoarthritis. METHODS: A systematic review of the literature was performed until August 2014. All controlled trials reporting the efficacy on pain, functional capacity and pulp pinch force of hyaluronic acid or corticosteroids in thumb osteoarthritis were selected. Pooled standardized response means (SRMs) were assessed by meta-analysis. RESULTS: Six trials were included and contributed to 3 meta-analyses (hyaluronic acid versus placebo, corticosteroids vs. placebo and hyaluronic acid vs. corticosteroids). Among the 428 patients included, 169 were treated with hyaluronic acid, 147 with corticosteroids and 74 with placebo. Versus placebo at week 12, hyaluronic acid (2 trials, 148 patients) lead to better functional capacity (SRM -1.14 [-1.69; -0.60]) with no difference on pain; corticosteroids (2 trials, 164 patients) lead to no difference on pain or function. When comparing hyaluronic acid vs. corticosteroids (4 trials, 304 patients), no difference was evidenced until week 12. At week 24, pain was significantly lower in the corticosteroids group (SRM 1.44 [0.14; 2.74]) and pulp pinch force higher in the hyaluronic acid group (SRM -0.75 [-3.87; -1.97]). CONCLUSION: This meta-analysis shows great heterogeneity. Hyaluronic acid may be useful to increase functional capacity and corticosteroids to decrease pain in thumb osteoarthritis at week 24.