Elizabeth Salt

Adherence to disease-modifying antirheumatic drugs in patients with rheumatoid arthritis: a narrative review of the literature.

AIM: This paper synthesizes findings from available research about medication adherence to disease-modifying antirheumatic drugs (DMARDs) in the population with rheumatoid arthritis (RA). RESULTS: This review of literature included 35 articles. Medication adherence to DMARDs ranged from 30% to 107%. Adherence rates of more than 100% indicated that patients took more than the prescribed amount of medication. There were no consistent risk factors for nonadherence to DMARD prescriptions identified, but some evidence was provided for self-efficacy, patient–healthcare provider relationships, social support, patient beliefs about medications, and age as factors affecting medication adherence. Support for educational interventions focused on medication adherence was equivocal. CONCLUSION Further research is necessary to develop a comprehensive, theoretically based understanding of medication adherence in RA patients.

Predictors of medication adherence in patients with rheumatoid arthritis

Medication adherence is a significant problem in patients with rheumatoid arthritis (RA), a prevalent autoimmune disease. Because of the equivocal results reported in the research, consistent predictors of medication adherence in patients with RA are undetermined. A cross‐sectional descriptive, predictive study of 108 patients with RA was used to: (1) describe self‐reported medication adherence to disease‐modifying anti‐rheumatic drugs (DMARDs); (2) compare demographic (age, residence, marital status, employment status, years of education, and ethnicity) and clinical (duration of disease and number of medications) factors of adherent and nonadherent individuals; and (3) determine the predictive power of demographic and clinical factors for DMARD adherence using various cut‐points (research‐based, mean, and median) on a validated, self‐report scale measuring medication adherence. Independent samples t‐tests, Chi‐square analyses, and logistic regression modeling were used to analyze these data. Approximately 90% of the individuals with RA reported adherence with their prescribed DMARD prescriptions. The only demographic and clinical difference between the adherent and nonadherent group was ethnicity (P = 0.04); non‐Caucasian individuals reported significantly less adherence with their prescribed DMARDs when compared with Caucasian individuals. Logistic regression models identified ethnicity (OR = 3.34–10.1; P<0.05) and the number of medications taken (OR = 1.7; P<0.05) as predictors of medication nonadherence. These data provide evidence that ethnicity and taking an increased number of prescribed medications are independent predictors of medication adherence in patients with RA. These findings confirm the presence of a health disparity and an area in which further research is needed to optimize patient outcomes. Drug Dev Res 72:756–763, 2011.

Rheumatoid arthritis: new treatments, better outcomes.

There have been numerous changes regarding evidence-based care of patients with rheumatoid arthritis, a costly, chronic, autoimmune disease. This article provides an update on the factors that affect the safe use of biologic medications in this patient population.

Risk Factors for Targeted Fungal and Mycobacterial Infections in Patients Taking Tumor Necrosis Factor Inhibitors

To identify predictors of the receipt of medical care, including the receipt of pre‐drug screening, for diagnostically targeted fungal or mycobacterial infections among patients prescribed a tumor necrosis factor inhibitor (TNFi).

Risk Factors for Targeted Fungal and Mycobacterial Infections in Patients Taking TNF‐alpha Inhibitors

To identify predictors of the receipt of medical care, including the receipt of pre‐drug screening, for diagnostically targeted fungal or mycobacterial infections among patients prescribed a tumor necrosis factor inhibitor (TNFi).

Role of Stress and Smoking as Modifiable Risk Factors for Nonpersistent and Persistent Back Pain in Women.

Objective:The purpose of this study was to examine the association between smoking and stress with nonpersistent and persistent back pain. Materials and Methods:Participants included 3703 women who took part in the Kentucky Women’s Health Registry in 2008 and 2011. Multivariate logistic regression modeling was used to examine whether smoking status and stress levels were predictive of nonpersistent and persistent back pain, controlling for sociodemographic characteristics. Results:Stress level was associated with both nonpersistent and persistent back pain, whereas smoking was associated with only persistent back pain. Current smokers were 1.5 times more likely to report persistent back pain compared with never smokers, controlling for age, race, body mass index, educational attainment, and employment status. Women experiencing large or overwhelming amounts of stress were 1.8 times more likely to have nonpersistent back pain and 1.6 times more likely to report persistent back pain, compared with women experiencing small amounts of stress. Discussion:This study further substantiates the findings of prior research that describes a significant relationship between back pain, stress, and smoking. Understanding the role of modifiable risk factors (ie, smoking and stress) and their impact on back pain provides an opportunity to offer a comprehensive and tailored treatment plan.

Moderating effects of immunosuppressive medications and risk factors for post-operative joint infection following total joint arthroplasty in patients with rheumatoid arthritis or osteoarthritis

OBJECTIVE Inconclusive findings about infection risks, importantly the use of immunosuppressive medications in patients who have undergone large-joint total joint arthroplasty, challenge efforts to provide evidence-based perioperative total joint arthroplasty recommendations to improve surgical outcomes. Thus, the aim of this study was to describe risk factors for developing a post-operative infection in patients undergoing TJA of a large joint (total hip arthroplasty, total knee arthroplasty, or total shoulder arthroplasty) by identifying clinical and demographic factors, including the use of high-risk medications (i.e., prednisone and immunosuppressive medications) and diagnoses [i.e., rheumatoid arthritis (RA), osteoarthritis (OA), gout, obesity, and diabetes mellitus] that are linked to infection status, controlling for length of follow-up. METHODS A retrospective, case-control study (N = 2212) using de-identified patient health claims information from a commercially insured, U.S. dataset representing 15 million patients annually (from January 1, 2007 to December 31, 2009) was conducted. Descriptive statistics, t-test, chi-square test, Fishers exact test, and multivariate logistic regression were used. RESULTS Male gender (OR = 1.42, p < 0.001), diagnosis of RA (OR = 1.47, p = 0.031), diabetes mellitus (OR = 1.38, p = 0.001), obesity (OR = 1.66, p < 0.001) or gout (OR = 1.95, p = 0.001), and a prescription for prednisone (OR = 1.59, p < 0.001) predicted a post-operative infection following total joint arthroplasty. Persons with post-operative joint infections were significantly more likely to be prescribed allopurinol (p = 0.002) and colchicine (p = 0.006); no significant difference was found for the use of specific disease-modifying anti-rheumatic drugs and TNF-α inhibitors. CONCLUSION High-risk, post-operative joint infection groups were identified allowing for precautionary clinical measures to be taken.

Factors affecting well-being in adults recently diagnosed with rheumatoid arthritis

This article examines role stress, key psychosocial variables, and well-being in adults recently diagnosed with rheumatoid arthritis. Patients recently diagnosed with rheumatoid arthritis must often learn to balance disease and role-related responsibilities. This was cross-sectional, descriptive study (N = 80). Data were analyzed using correlation coefficients and linear regression models. Participants were predominantly female (78%), married, and employed. Mean age and disease duration were 54.2 years and 24.2 months, respectively. The findings suggest that well-being is influenced by feelings of being self-efficacious and having balance in their roles and less to do with social support received from others.

Comparison of lumbo-pelvic kinematics during trunk forward bending and backward return between patients with acute low back pain and asymptomatic controls

Background: Prior studies have reported differences in lumbo‐pelvic kinematics during a trunk forward bending and backward return task between individuals with and without chronic low back pain; yet, the literature on lumbo‐pelvic kinematics of patients with acute low back pain is scant. Therefore, the purpose of this study was set to investigate lumbo‐pelvic kinematics in this cohort. Methods: A case‐control study was conducted to investigate the differences in pelvic and thoracic rotation along with lumbar flexion as well as their first and second time derivatives between females with and without acute low back pain. Participants in each group completed one experimental session wherein they performed trunk forward bending and backward return at self‐selected and fast paces. Findings: Compared to controls, individuals with acute low back pain had larger pelvic range of rotations and smaller lumbar range of flexions. Patients with acute low back pain also adopted a slower pace compared to asymptomatic controls which was reflected in smaller maximum values for angular velocity, deceleration and acceleration of lumbar flexion. Irrespective of participant group, smaller pelvic range of rotation and larger lumbar range of flexion were observed in younger vs. older participants. Interpretation: Reduced lumbar range of flexion and slower task pace, observed in patients with acute low back pain, may be the result of a neuromuscular adaptation to reduce the forces and deformation in the lower back tissues and avoid pain aggravation. HighlightsThe literature on trunk kinematics of patients with acute low back pain is scant.Trunk kinematics in patients with acute low back pain and controls were quantified.Patients had larger pelvic range of rotations and smaller lumbar range of flexions.The adopted trunk kinematics by patients might be a strategy to avoid pain.

Student Perception of Improvement in Communication and Value in 2 Interprofessional Education Delivery Formats.

A preferred format to deliver interprofessional education (IPE) has not been described. The aim of this study was to compare students’ (N = 150) perceived value and improvement in communication between an IPE activity delivered using a comprehensive versus an abbreviated format. Although both formats were perceived by students to improve their communication skills and add value to their education, students indicated the abbreviated format was more effective than the comprehensive format.