Rheumatoid Arthritis: Piper H

Piper H, Mulherin D, Hardwick N. · No affiliation provided · Ann Rheum Dis. · Pubmed #16410533 links to  free full text

This publication has no abstract.

Treharne GJ, Douglas KM, Iwaszko J, Panoulas VF, Hale ED, Mitton DL, Piper H, Erb N, Kitas GD. · School of Psychology, University of Birmingham, Birmingham, UK. · Musculoskeletal Care. · Pubmed #17623274 No free full text.

Abstract: BACKGROUND: People with rheumatoid arthritis (RA) often have comorbidities with associated disability and complex medication regimens. Little published evidence exists about why people with RA require so many medications, although it is logical to hypothesize that this may relate to older age, longer duration of RA, more active RA, worse functional disability and a greater number of comorbidities. OBJECTIVES: We set out to quantify polypharmacy in RA and identify its predictors in an observational cohort. METHODS: The case notes of 348 people receiving secondary care for RA were reviewed to record polypharmacy. The 28-joint Disease Activity Score (DAS28) was calculated and the Health Assessment Questionnaire (HAQ) and the Self-administered Comorbidity Questionnaire (SCQ) were completed. RESULTS: The mean total number of medications was 5.39, with a maximum of 16; of these, a mean of 2.41 medications were directly for RA. A mediational relationship was identified: older age and longer RA duration were significant predictors of a greater total number of medications, but these relationships were explained by the greater number of comorbidities in older participants and those with longer RA duration. Polypharmacy was not related to RA activity or functional disability. CONCLUSIONS: Polypharmacy is common among people with RA and associates with older age and longer RA duration through a greater number of comorbidities. Regular review of the full treatment plan of individuals with RA by pharmacists and other health professionals specializing in rheumatology, to weigh the benefits and risks of each medication and their interactions in light of RA activity and comorbidities, is advocated.

Piper H, Douglas KM, Treharne GJ, Mitton DL, Haider S, Kitas GD. · Department of Rheumatology, Dudley Group of Hospitals NHS Trust, UK. · Musculoskeletal Care. · Pubmed #17457954 No free full text.

Abstract: BACKGROUND: People with rheumatoid arthritis (RA) have an increased risk for eye problems caused by associated conditions or medication side-effects. Consequent visual impairment may increase the risk of falls or difficulties self-administering medications. AIMS: The aim of the present study was to estimate the prevalence and predictors of ocular manifestations and visual impairment in a local sample of people with RA. The Visual Functioning Questionnaire (VFQ-25) was evaluated as a screening tool in people with RA. METHODS: Seventy-five participants with RA attended a visual screening clinic. Demographic, medication and disease characteristics were recorded, a full ophthalmological assessment was performed by an expert ophthalmologist and the VFQ-25, Health Assessment Questionnaire and Self-administered Comorbidity Questionnaire were completed. RESULTS: Twenty-nine participants (38.7%) had impaired visual acuity; this was correctable by appropriate refraction in 93.1%. The prevalence of cataracts was 22.7% and this was predicted by older age and steroid use. An abnormal Schirmer's test, suggesting dry eyes, was seen in 70.7% of participants but only 12.0% were using artificial tears. Answers to the VFQ-25 suggested misinterpretation of questions as relating to disability attributed to arthritis rather than caused by visual impairment. CONCLUSIONS: Visual impairment does not appear to be particularly prevalent in RA, obviating the need for a screening programme. Utilization of the VFQ-25 as a screening tool in RA requires further consideration. The high prevalence of cataracts in participants on steroids emphasizes the need to prescribe the minimum required dose. The high prevalence of dry eyes suggests that a Schirmer's test should be performed regularly, with prescription of artificial tears if required.

Sandhu RS, Treharne GJ, Douglas KM, Cassim K, Saratzis A, Piper H, Erb N, Jenkins D, Tavakoli M, Deighton C, Kitas GD. · Primary Care Musculoskeletal Research Centre, Keele University, UK. · Musculoskeletal Care. · Pubmed #17117445 No free full text.

Abstract: BACKGROUND: Anti-tumour necrosis factor (anti-TNF) therapy has been an important development for the treatment of rheumatoid arthritis (RA) but the impact of its delivery on hospital resources in still emerging.Aims: We audited the effect of starting anti-TNF on the use of other anti-rheumatic therapies and hospital resources in a routine secondary care setting. METHODS: A retrospective study of resource use before and after anti-TNF was conducted. Hospital records of 54 RA patients were studied and data taken from the time of commencing anti-TNF to 1 October 2004 and an equal time period prior to commencing anti-TNF. Identical data were collected for 54 controls not on anti-TNF. Relevant figures were extrapolated to per annum rates. Results were analysed using two-factor ANOVAs comparing the pre- versus post-anti-TNF period. Cases on intravenous (IV) versus subcutaneous (SC) anti-TNF were also compared in separate ANOVAs. RESULTS: Mean duration of anti-TNF therapy was 17.04 months (range 3.60-42.36). Mean pre- and 3-months post-anti-TNF Disease Activity Scores (DAS28) were 6.93 and 3.88, respectively. Cases were more likely than controls to be on oral prednisolone pre- and post-anti-TNF. Methylprednisolone requirement, number of disease-modifying anti-rheumatic drugs (DMARDs), telephone helpline contacts and duration as an inpatient reduced significantly post-anti-TNF. Day case admissions increased but outpatient appointments decreased only in cases on IV anti-TNF. CONCLUSIONS: In a pragmatic setting, anti-TNF therapy led to reduced need for steroid injections and other DMARDs, as well as reductions in use of several hospital resources. Wider replication of these findings will be important for planning delivery.