Ade Adebajo

Effect of the early use of the anti–tumor necrosis factor adalimumab on the prevention of job loss in patients with early rheumatoid arthritis

OBJECTIVE To compare work disability and job loss in early rheumatoid arthritis (RA) patients receiving adalimumab plus methotrexate (adalimumab + MTX) versus MTX alone. METHODS In this multicenter, randomized, controlled trial, patients with RA for <2 years who had never taken MTX and who self-reported work impairment were randomized to adalimumab + MTX or placebo + MTX for 56 weeks. Primary outcome was job loss of any cause and/or imminent job loss at or after week 16. Secondary outcomes included disease activity, function (Health Assessment Questionnaire [HAQ] score), and RA quality of life (RAQoL) questionnaire score. Work was evaluated with work diaries and the RA Work Instability Scale. RESULTS Although job loss during the 56-week study was significantly lower with adalimumab + MTX (14 of 75 patients) compared with MTX alone (29 of 73 patients; P=0.005), the primary end point was not met (12 of 75 versus 20 of 73 patients; P=0.092), likely owing to early drop out in the MTX group. There were significant improvements in American College of Rheumatology 20% response criteria, 28-joint Disease Activity Score, DeltaHAQ, DeltaRAQoL, and working time lost in the adalimumab + MTX group. Twenty-four serious adverse events were reported in 17 participants, with no differences between groups. CONCLUSION Adalimumab + MTX reduced job loss and improved productivity in early RA when compared with MTX alone, which supports the early use of anti-tumor necrosis factor therapy and suggests its cost efficacy.

Developing the evidence base of patient and public involvement in health and social care research: the case for measuring impact

While patient and public involvement (PPI) in health and social care research has progressed successfully in the last decade, a range of difficulties with the evidence base exist, including poor understanding of the concept of impact, limited theorization and an absence of quantitative impact measurement. In this paper, we argue that a paradigm change towards robust measurement of the impact of involvement in research is needed to complement qualitative explorations. We argue that service users should be collaboratively involved in the conceptualization, theorization and development of instruments to measure PPI impact. We consider the key advantages measurement would bring in strengthening the PPI evidence base through a greater understanding of what works, for whom, in what circumstances and why.

Reaching those most in need: a scoping review of interventions to improve health care quality for disadvantaged populations with osteoarthritis.

To conduct a systematic review to identify and describe the scope and nature of the research evidence on the effectiveness of interventions to improve health care quality or reduce disparities in the care of disadvantaged populations with osteoarthritis (OA) as an example of a common chronic disease.

Patient Involvement in Outcome Measures for Psoriatic Arthritis

Psoriatic arthritis (PsA) is a heterogeneous inflammatory arthritis with a varied clinical phenotype. There has been considerable international collaboration over recent years to develop and prioritise appropriate disease domains and outcome measures to capture all aspects of this complex disease. It has been recognised that patient-reported measures and physician assessments are complementary and, when used together, allow an improved reflection of disease burden. Taking this concept one step further, the experience in rheumatoid arthritis has demonstrated benefits of incorporating the patient perspective in the development of outcome measures. We report a systematic review demonstrating (1) that there has been little incorporation of the patient perspective in the development of outcome measures and domains in PsA, (2) the proceedings from the preliminary patient involvement in outcome measures for PsA (PIOMPSA) meetings, and (3) a proposed roadmap for improving patient involvement.

Development of Preliminary Remission Criteria for Gout Using Delphi and 1000Minds Consensus Exercises

To establish consensus for potential remission criteria to use in clinical trials of gout.

Addressing musculoskeletal health inequity in Africa.

Following the recent World Health Organization (WHO) report (1), the issue of health inequity and health care disparities is gaining greater global recognition together with an increasing international will and commitment to address these inequalities. Nowhere are these inequalities starker than on the African continent, where the disparity between the developed and developing world is at its greatest. Currently, 21 out of the 30 poorest nations of the world, and 33 out of the 41 most heavily indebted nations worldwide, are in Africa (2). In addition, there are also huge health disparities within the countries of Africa. Musculoskeletal health has been almost completely neglected for most of sub-Saharan Africa principally due to the fierce competition for scarce resources. As a result, rheumatology remains very much a Cinderella specialty in Africa. We consider this unfortunate, not only because there is a huge burden of musculoskeletal disease in Africa, but chiefly because we believe that this gap can be narrowed. The health care challenges faced by Africa are many and include political instabilities, wars, low income, and unemployment. These in turn contribute to poor nutrition, housing, sanitation, and education. Communicable diseases such as malaria, tuberculosis, and more recently human immunodeficiency virus (HIV) are endemic and put a huge strain on health resources in Africa. These matters are further compounded by the woefully inadequate availability of health care personnel. In the different regions of the world, the density of the health workforce per 1,000 population is 24.8 for the Americas, 18.9 for Europe, 5.8 for Western Pacific, 4.3 for South East Asia, 4.0 for Eastern Mediterranean, yet only 2.3 for Africa (3). The WHO has recommended that there should be at least one rheumatologist per 100,000 people. However, in sub-Saharan Africa (excluding South Africa) there are less than 20 rheumatologists serving 800 million people; that is one rheumatologist per 40 million people (2). These various issues are hugely detrimental in tackling what we believe to be a significant burden of musculoskeletal disorders on the African continent. According to a report, musculoskeletal disorders contributed 3.4% and 1.7% of the total disease burden in the developed and developing world, respectively, with osteoarthritis (OA) being the single largest contributor (4). However, the burden on musculoskeletal disorders in terms of disabilityadjusted life years (DALYs) on the developing world (21,076,000 DALYs) was estimated to be almost 2.5 times that of the developed world (8,723,000 DALYs). The lack of data from the developing world suggests that this figure may even be an underestimate (3,4). Using the WHO/ International League of Associations for Rheumatology Community Oriented Programme for Control of Rheumatic Diseases, a study from Egypt suggested that 16.2% of adults had musculoskeletal pain (3). There is also a remarkable range and variety of rheumatic disorders in Africa, which adds to the overall burden of disability, as well as mortality. Not only are there specific tropical arthropathies to contend with in Africa, but there are also varying and often atypical expressions of the more universal musculoskeletal diseases such as rheumatoid arthritis (RA). Additionally, there is evidence of an increasing prevalence of conditions such as RA, lupus, and gout in Africa (2), concomitant with evidence of an increasing severity of these conditions. For example, in West Africa where RA and lupus were previously considered uncommon and mild, there is evidence to indicate an increasing prevalence and severity of these diseases (5). Lupus is a case in point. It is well recognized that there is a higher risk of systemic lupus erythematosus in persons of African origin in North America (6). Recent reports suggest that the severity of lupus in Africa is now of a similar level, with associated morbidity and mortality (2,5,7). This raises the need for at least the same urgency as that required for tackling lupus and addressing health inequalities as among persons of African origin in North America (8). A recent community-based study in West Africa highlights the high burden of disease from knee OA (9). A total of 1,044 adults over the age of 40 years were randomly selected and, using the American College of Rheumatology (ACR) clinical criteria for knee OA (10), a point prevalence Ade Adebajo, FMCP, FWACP, FRCP, FACP: University of Sheffield, Sheffield, UK; Sherine E. Gabriel, MD, MSc: Mayo Clinic, Rochester, Minnesota. Address correspondence to Ade Adebajo, FMCP, FWACP, FRCP, FACP, Academic Rheumatology Group, University of Sheffield Medical School, Beech Hill Road, Sheffield S10 2RX, UK. E-mail: A.O.Adebajo@sheffield.ac.uk. Submitted for publication March 24, 2009; accepted in revised form December 9, 2009. Arthritis Care & Research Vol. 62, No. 4, April 2010, pp 439–441 DOI 10.1002/acr.20032

Patient education in rheumatoid arthritis: is the needs-based approach the way forward?

In recent years, the assessment of patients’ needs has become an important area of research for several reasons; expenditure on healthcare has risen faster than the cost increases reported in other sectors of the economy, and medical advances and demographic changes will continue the upward pressure on costs. At the same time, the resources available for healthcare are limited, and the rising expectations of the public have led to greater concerns about the quality of the services they receive.

Virus-induced vasculitis

There is a growing understanding of the different syndromes that have a definite, and in some cases a possible, association with viral infections. Hepatitis C virus-associated mixed cryoglobulinemias and hepatitis B virus-associated polyarteritis nodosa are examples of a vasculitis with a definite viral association. However, various types of cutaneous vasculitis are examples of a vasculitis with only a possible association with a viral infection.

Rheumatology in and from Slovenia

The central European country of Slovenia is well known for its natural beauty and tourism, but it is perhaps less well known in the field of rheumatology [1]. The ‘Rheumatology in Slovenia: Clinical practice and translational research’ Collection, demonstrates the growing strength of Slovenian rheumatology. This Collection also demonstrates the wide breadth of Slovenian clinical and scientific endeavour in rheumatology. The articles within this Collection provide insights across the major areas of rheumatology practice and research including epidemiology, connective tissue disorders, vasculitis, sero epidemiology and genomic medicine. This Slovenian Collection focuses on clinical practice and scientific communication, thereby reflecting as well as complementing several of the other publications in the field of rheumatology, emanating out of Slovenia [2, 3]. We learn from this current Collection that the incidence of rheumatoid arthritis in Slovenia is comparable to the incidence of the disorder in Southern Europe. In addition, whilst there is still more to be done, the emergence of early interventional clinics in Slovenia is already beginning to yield dividends both with achieving an early diagnosis of rheumatoid arthritis as well as with the timely commencement of disease modifying anti rheumatoid drugs for these patients. Another epidemiological study shows that in Slovenia, there is an incidence rate for the inflammatory myopathies consistent with the literature. In Slovenia, Giant Cell Arteritis (GCA) has been found to be the commonest form of vasculitis in adults over the age of 50 years with an incidence rate comparable to that of GCA in Southern Europe. Fortunately, the condition is being diagnosed and treated early through a fast track GCA service which utilises temporal artery biopsy, colour Doppler sonography and where necessary, positron emission tomography (PET) scanning. Laboratory studies of the condition are identifying serological markers as well as potential candidate biomarkers in the temporal artery biopsies of GCA patients using quantitative PCR, all of which will serve to facilitate prompt diagnosis of the condition in the future. The results of several other laboratory studies are reported in this Collection. One study demonstrates that a modified fluorescent Farr method for measuring double stranded DNA antibodies compares favourably with the traditional Farr radioimmunoassay. In other studies, antiphospholipid antibodies have been found to have potentially important associations with both cerebrovascular events as well as IgA vasculitis, whilst non criteria antiphospholipid antibodies have also been found to be important serological markers for the antiphospholipid antibody syndrome. Thus, this Collection provides information that is of national, regional and, in particular, of international interest and importance in the field of Rheumatology. We believe that the Collection points to a continuing significant contribution that Slovenia rheumatology will increasingly make to the global rheumatology community.

Epidemiology of Psoriasis and Psoriatic Arthritis

Psoriatic arthritis (PsA) is a unique type of chronic inflammatory arthritis that occurs in association with the skin manifestations of psoriasis, commonly presenting with extra articular manifestations which includes nail involvement, enthesitis and dactilitis. It is also important to note that like rheumatoid arthritis PsA has been shown to have significant cardiovascular comorbidities.