ABSTRACT
To assess the hypothesis if tocilizumab (TCZ) is effective on disease activity, and also its effect in fatigue and other clinical and psychological disease-related factors in patients with rheumatoid arthritis (RA) treated with TCZ.A 24-week, multicenter, prospective, observational study in patients with moderate to severe RA receiving TCZ after failure or intolerance to disease-modifying antirheumatic drugs or tumor necrosis factor-alpha was conducted.Of the 122 patients included, 85 were evaluable for effectiveness (85% female, 51.9â±â12.5 years, disease duration 8.7â±â7.4 years). Mean change in C-reactive protein level from baseline to week 12 was -11.2â±â4.0 (Pâ<â.001). Mean Disease Activity Index score (DAS28) decreased from 5.5â±â1.0 at baseline to 2.7â±â1.3 (Pâ<â.001) at week 24. Mean change in Functional Assessment of Chronic Illness Therapy score was -5.4â±â11.2 points at week 24. Multiple regression analysis showed that the improvement in DAS28, sleep, and depression explained 56% and 47% of fatigue variance at week 12 and 24, respectively.Tocilizumab is effective in reducing disease activity and results in a clinically significant improvement in fatigue, pain, swollen joint count, morning stiffness, sleepiness, depression, and DAS28; the last 3 were specifically identified as factors explaining fatigue variance with the use of TCZ in RA patients.
Subject(s)
Antibodies, Monoclonal, Humanized/therapeutic use , Arthritis, Rheumatoid/psychology , Arthritis, Rheumatoid/therapy , Fatigue/psychology , Fatigue/therapy , Antirheumatic Agents/therapeutic use , Arthritis, Rheumatoid/physiopathology , Biomarkers/metabolism , C-Reactive Protein/metabolism , Depression/physiopathology , Depression/therapy , Fatigue/etiology , Fatigue/physiopathology , Female , Humans , Male , Middle Aged , Prospective Studies , Retreatment , Sleep , Treatment Outcome , Tumor Necrosis Factor-alpha/therapeutic useABSTRACT
To define and give priority to standards of care and quality indicators of multidisciplinary care for patients with psoriatic arthritis (PsA). A systematic literature review on PsA standards of care and quality indicators was performed. An expert panel of rheumatologists and dermatologists who provide multidisciplinary care was established. In a consensus meeting group, the experts discussed and developed the standards of care and quality indicators and graded their priority, agreement and also the feasibility (only for quality indicators) following qualitative methodology and a Delphi process. Afterwards, these results were discussed with 2 focus groups, 1 with patients, another with health managers. A descriptive analysis is presented. We obtained 25 standards of care (9 of structure, 9 of process, 7 of results) and 24 quality indicators (2 of structure, 5 of process, 17 of results). Standards of care include relevant aspects in the multidisciplinary care of PsA patients like an appropriate physical infrastructure and technical equipment, the access to nursing care, labs and imaging techniques, other health professionals and treatments, or the development of care plans. Regarding quality indicators, the definition of multidisciplinary care model objectives and referral criteria, the establishment of responsibilities and coordination among professionals and the active evaluation of patients and data collection were given a high priority. Patients considered all of them as important. This set of standards of care and quality indicators for the multidisciplinary care of patients with PsA should help improve quality of care in these patients.
