Rheum Round-up: Here’s What Rheumatologists and Patients Value in Rheumatoid Arthritis Treatment, Plus How Kidney Injury Affects Surgery Complications

Here are the top stories recently covered by DocWire News in the Rheumatology section. In this edition, read about what rheumatologists and patients believe is the most important in rheumatoid arthritis treatment, the effects of acute kidney injury on hip arthroplasty complications, the best technique for traumatic finger amputation, and seasonal effects on symptoms including fatigue on primary Sjögren’s syndrome.

A new study assessed the preferences of patients and rheumatologists regarding treatment attributes for rheumatoid arthritis (RA) as well as their feelings regarding shared decision-making. Three steps were taken: literature review, RA patient focus group discussion, and rheumatologist focus group discussion. A total of 90 rheumatologists (mean years of experience, 18.1 years; 52.2% were female; average RA patients per week, 24.4) and 137 RA patients (mean age, 47.5 years; 84.0% were female; mean time since RA diagnosis, 14.2 years; mean time in treatment, 13.2 years) were included in the study. Although the top three attributes were the same between patients and rheumatologists, the order in which they were ranked differed, with patients placing the highest value on time with optimal quality of life (QoL) followed by mode of administration and time to onset of treatment action, compared to rheumatologists, who ranked the top three attributes as mode of administration, time with optimal QoL, and time to onset of treatment action.

A new study highlighted the effects of acute kidney injury (AKI) on complication risk in total hip arthroplasty (THA) patients. The study authors concluded that AKI significantly increases postoperative complication risks, including mortality, and recommend that increased focus be placed on reducing AKI risk. A total of 4.1 million primary THAs were performed during the study period, of which 61,077 (1.5%) included AKI during hospitalization. Unadjusted analyses unearthed a correlation between AKI and higher rate of complications and healthcare utilization. When adjusting for age, gender, race, income, underlying diagnosis, medical comorbidity, and insurance payer, AKI presenting in primary THA was significantly increased risks for implant infection, transfusion, revision, death, total hospital discharges above the median, discharge to a rehabilitation facility, and hospital length of stay longer than three days.

A new study examined whether season has an impact on symptoms of fatigue, pain, and dryness in primary Sjögren’s syndrome. The present study evaluated patient data from the French nationwide multicenter pSS cohort Assessment of Systemic Signs and Evolution in Sjögren’s Syndrome (ASSESS) (n=395). ASSESS was created in 2006 and houses five-year prospective follow-up data as well as data from three randomized, placebo-controlled trials of infliximab, rituximab, and hydroxychloroquine. In each study, visits included data collection on visual analog scale (VAS) scores for pain, fatigue, and dryness. Data were assessed by the day, month of the year, and season. VASs did not largely differ among the seasonal groups. The EULAR Sjögren’s Syndrome Patient Reported Index scores did not significantly differ by season: spring, 57.7; summer, 59.5; fall, 55.9; and winter, 57.2.

A study questioned which is the best strategy to employ in traumatic finger amputations and concluded that the target technique will depend on the patient. The researchers reviewed data from a retrospective cohort study who underwent revision amputation or replantation at 19 U.S.- and Asia-based centers between Aug. 1, 2016, and April 12, 2018. The present analysis included data on 185 patients. The primary outcomes were hand strength, dexterity, hand-related quality of life, and pain, and the study authors employed a tree-based statistical learning method to obtain clinical decision rules for traumatic finger amputation treatment. Implementation of the tree-based statistical learning estimates found that different strategies were associated with different outcomes. Maximal hand dexterity or minimal patient-reported pain was obtained through replantation. Maximal hand strength was obtained through revision amputation in the case of a single-finger amputation; in all other cases, replantation was the best approach. Maximal patient-reported quality of life was obtained through revision amputation in patients with dominant hand injuries, and replantation was favorable in the case of nondominant hand injuries.