Here are the top stories recently covered by DocWire News in the Rheumatology section. In this edition, read an interview with two researchers behind a study on factors that patients with rheumatoid arthritis (RA) think affect their provider’s treatment decisions, healthcare utilization among psoriatic arthritis patients in the years leading up to their diagnosis, factors that influence discharge disposition after hip fracture surgery, and the risk of respiratory diseases in women with RA.
A recent DocWire News article highlighted a new study on factors that patients with rheumatoid arthritis (RA) think affect their provider’s treatment decisions. We recently interviewed W. Benjamin Nowell, PhD, director of Patient-Centered Research at CreakyJoints and ArthritisPower principal investigator, and lead study author Kelly Gavigan, MPH, manager, Research and Data Science at CreakyJoints, to discuss the findings of the study. Click here to see what they had to say, including the study’s key takeaways as well as what took the authors by surprise.
Psoriatic arthritis (PsA) patients are significantly more likely to have medical visits than other patients during the time period leading up to their diagnosis, going back as far as five years. The analysis included 462 PsA patients and 2,310 controls (mean [SD] age, 54.2 [13.8] years; 55.6% were female). PsA patients were significantly more likely to visit a primary care physician for nonspecific musculoskeletal issues in the year leading up to the index date (odds ratio [OR]=2.14; 95% confidence interval [CI], 1.73–2.64); this trend was also observed in the five years leading up to the index date (OR=1.76; 95% CI, 1.43–2.18). PsA patients were also more likely than the controls to require musculoskeletal-related specialty care, diagnostic imaging and procedures prior to the index date. PsA patients were more likely to be assessed by nonrheumatologist musculoskeletal specialists (OR range, 1.59–2.03), visit an emergency department for musculoskeletal-related issues (OR range, 1.33–2.69), and have joint imaging (OR range, 3.20–6.26) and joint injections (OR range, 4.63–9.26).
While recovery rate and hospital length of stay (LOS) are predictors of discharge disposition following hip arthroscopy, daily time in therapy plays an insignificant role in outcomes. Final analysis included 150 patients (mean [SD] age, 82.0 [7.3] years; 101 [67.3%] were female; 148 [98.6%] were white). Upon rehabilitation admission, all patients had similar functional levels, regardless of gain and therapy minutes per LOS day (mean [SD] mobility, 16.2 [3.2]; F8,141=1.26; P=0.27), but significant differences emerged at discharge (mean [SD] mobility, 23.9 [5.2]; F8,141=14.34; P<0.001). At time of discharge, high-gain patients presented mobility independence, but low-gain patients required assistance for almost all mobility tasks. Mobility independence in the medium-gain group varied by LOS: those with a mean LOS of 27 days were independently mobile at discharge, while those whose mean LOS was less than 21 days required toilet transfer supervision and assistance with stairs. Regarding therapy minutes per LOS, “medium– and high–therapy minutes per LOS day groups were statistically significant in the regression model (β = 6.99; P = .001; and β = 11.46; P = .007, respectively), [but] they explained only 1% of the variance in discharge outcome,” the researchers observed.
A study evaluated the correlation between elevated levels of anti-citrullinated protein antibodies (ACPA) prior to an RA diagnosis and chronic obstructive pulmonary disease (COPD) and/or asthma. Final analysis included 283 pre-RA women and 842 control patients. For women who were eventually diagnosed with RA, blood draw was performed a mean 9.7 (SD=5.8) years prior to diagnosis. About one in five women (n=59, 20.8%) were pre-RA ACPA+. Over 21,489 person-years of follow-up, 107 cases of incident COPD and 105 incident cases of asthma were reported. When adjusting for covariates, including smoking pack-years, women with pre-RA ACPA+ were significantly more likely to develop COPD (hazard ratio [HR]=3.04; 95% confidence interval [CI], 1.33–7.00). Pre-RA ACPA+ was also correlated with a greater risk for asthma (HR=1.74; multivariable 95% CI, 0.72–4.24), as was pre-RA ACPA- (HR=1.65; 95% CI, 1.11–2.46).