What Factors Affect Treatment Effectiveness in Rheumatoid Arthritis: A Multidimensional Measurement

Abstract

Purpose: The aim of the study was to examine the effects of socio-demographic characteristics, disease-related characteristics and health care use related-characteristics on the treatment effectiveness of rheumatoid arthritis patients, both separately and together. Methods: The sample of the study consisted of 440 rheumatoid arthritis patients for 99% confidence level, and this sample was reached based on the convenience sampling method. Patients who received at least one anti-TNF therapy were included in the study. Treatment effectiveness levels of rheumatoid arthritis patients were measured with a questionnaire. In the analysis of the study, four different regression models were established. In the first model, socio-demographic characteristics; in the second model, disease characteristics; in the third model, health care use characteristics: in the fourth model, the effect of all these variables on treatment effectiveness was examined. Results: In the study, smoking status, age (socio-demographic characteristics), drug regimen complexity, comorbidity status, education about the disease, disease duration (disease characteristics), and a number of admissions (health care use characteristics), were found to have a significant effect on treatment effectiveness. Conclusion: In the study, the factors affecting the treatment effectiveness were determined. Therefore, it is important to consider these factors revealed in this study in order to increase the treatment effectiveness in patients with rheumatoid arthritis.

Keywords

• Rheumatoid arthritis
• treatment effectiveness
• Anti-TNF therapy

References

1. Bloom D E, Chisholm D. Jané-Llopis E, Prettner K, Stein A, Feigl A. From burden to" best buys": reducing the economic impact of non-communicable disease in low-and middle-income countries (No. 7511). Geneva, Switzerland, World Economic Forum, 2011.
2. Horton R. The neglected epidemic of chronic disease. Lancet. 2005;366(9496):1514-1514.
3. Dent MM, Mathis MW, Outland M, Thomas M, Industrious D. Chronic disease management: teaching medical students to incorporate community. Fam Med. 2010;42(10):736-40.
4. Bruin SR, Versnel N, Lemmens LC, Molema C, Schellevis FG, Nijpels G, Baan CA. Comprehensive care programs for patients with multiple chronic conditions: a systematic literature review. Health Policy. 2012;107(2):108-145.
5. Centers for Disease Control and Prevention (CDC). 2020 https://www.cdc.gov/chronicdisease/about/index.htm, 27.02.2021.
6. Haugeberg G, Uhlig T, Falch JA, Halse JI. Kvien TK. Bone mineral density and frequency of osteoporosis in female patients with rheumatoid arthritis: results from 394 patients in the Oslo County Rheumatoid Arthritis register. Arthritis & Rheumatism: Official Journal of the American College of Rheumatology. 2000;43(3):522-530.
7. Haugeberg G, Uhlig T, Falch JA, Halse JI, Kvien TK. Reduced bone mineral density in male rheumatoid arthritis patients: frequencies and associations with demographic and disease variables in ninety‐four patients in the Oslo County Rheumatoid Arthritis Register. Arthritis & Rheumatism. 2000;43(12):2776-2784.
8. Lodder MC, de Jong Z, Kostense PJ, Molenaar ETH, Staal K, Voskuyl AE et al. Bone mineral density in patients with rheumatoid arthritis: relation between disease severity and low bone mineral density. Annals of The Rheumatic Diseases. 2004;63(12):1576-1580.

9. Salaffi F. Sarzi-Puttini P, Girolimetti R, Atzeni F. Gasparini S. Grassi W. Health-related quality of life in fibromyalgia patients: a comparison with rheumatoid arthritis patients and the general population using the SF-36 health survey. Clinical & Experimental Rheumatology. 2009;27(5):S67.
10. Lin SC. Overview of rheumatoid arthritis: Past lessons and future paths. Curr Rheumatol Res. 2020;1(1):1-2.
11. Raterman HG, Bultink IE, Lems WF. Osteoporosis in patients with rheumatoid arthritis: an update in epidemiology, pathogenesis, and fracture prevention. Expert Opinion on Pharmacotherapy. 2020;1-13. https://doi.org/10.1080/14656566.2020.1787381.
12. Atallah Á. N. Efficacy and effectiveness of treatment. Sao Paulo Medical Journal. 1996;114(4):1195-1195.
13. Carson C, Giuliano F, Goldstein I, Hatzichristou D, Hellstrom W, Lue T et al. The ‘effectiveness’ scale—therapeutic outcome of pharmacologic therapies for ED: an international consensus panel report. International journal of impotence research. 2004;16(3):207-213.
14. Vessey MP, Villard-Mackintosh L, Yeates D. Oral contraceptives, cigarette smoking and other factors in relation to arthritis. Contraception. 1987;35(5):457-464.
15. Forslind K, Hafström I, Ahlmen M, Svensson B. Sex: a major predictor of remission in early rheumatoid arthritis?. Annals of The Rheumatic Diseases. 2007;66(1):46-52.
16. Waldburger JM. Firestein GS. Rheumatoid Arthritis Epidemiology, Pathology, and Pathogenesis. In Primer on the Rheumatic Diseases (Eds JH Klippel JH Stone, LJ. Crofford, PH White: 122-132). US, Springer, 2008.
17. Chang K, Yang SM, Kim SH, Han KH, Park SJ, Shin JI. Smoking and rheumatoid arthritis. International Journal of Molecular Sciences. 2014;15(12):22279-22295.
18. George J, Phun YT, Bailey MJ, Kong DC, Stewart K. Development and validation of the medication regimen complexity index. The Annals of Pharmacotherapy. 2004;38(9):1369–1376.
19. Okuyan B, Babi B, Sancar M, Ay P, Yücel E, Yücel A, Izzettin FV. Validation of the Turkish version of medication regimen complexity index among elderly patients. Journal of Evaluation in Clinical Practice. 2016;22(5):732-736.
20. Michaud K, Wolfe F. Comorbidities in rheumatoid arthritis. Best practice & research Clinical rheumatology 2007;21(5):885-906.
21. Michaud K, Wolfe F. The development of a rheumatic disease research comorbidity index for use in outpatients patients with RA, OA, SLE and fibromyalgia (FMS). Arthritis Rheum. 2007;56(Suppl):S596.
22. England BR, Sayles H, Mikuls TR, Johnson DS, Michaud K. Validation of the rheumatic disease comorbidity index. Arthritis care & Research. 2015;67(6):865–872.
23. Spaetgens B, Wijnands JM, van Durme C, Boonen A. Content and construct validity of the Rheumatic Diseases Comorbidity Index in patients with gout. Rheumatology 2015;54(9):1659-1663.
24. Peipert JD, Beaumont JL, Bode R, Cella D, Garcia SF. Hahn EA. Development and validation of the functional assessment of chronic illness therapy treatment satisfaction (FACIT TS) measures. Quality of Life Research: An International Journal of Quality of Life Aspects of Treatment, Care And Rehabilitation. 2014;23(3):815–824.
25. Manfredsdottir VF, Vikingsdottir T, Jonsson T, Geirsson AJ, Kjartansson O, Heimisdottir M, Sigurdardottir SL, Valdimarsson H, Vikingsson A the effects of tobacco smoking and rheumatoid factor seropositivity on disease activity and joint damage in early rheumatoid arthritis. Rheumatology (Oxford, England). 2006;45(6):734–740.
26. Carlens C, Hergens MP, Grunewald J, Ekbom A, Eklund A, Hoglund CO, Askling J. Smoking, use of moist snuff, and risk of chronic inflammatory diseases. American journal of respiratory and critical care medicine. 2010;181(11):1217-1222.
27. Abhishek A, Butt S, Gadsby K, Zhang W, Deighton CM. Anti-TNF-alpha agents are less effective for the treatment of rheumatoid arthritis in current smokers. Journal of clinical rheumatology : practical reports on rheumatic & musculoskeletal diseases. 2010;16(1):15–18.
28. Söderlin MK, Petersson IF, Geborek P. The effect of smoking on response and drug survival in rheumatoid arthritis patients treated with their first anti-TNF drug. Scandinavian journal of rheumatology. 2012;41(1):1–9.
29. Vittecoq O, Richard L, Banse C, Lequerré T. The impact of smoking on rheumatoid arthritis outcomes. Joint bone spine. 2018;85(2):135–138.
30. Smolen JS, Szumski A, Koenig AS, Jones TV, Marshall L. Predictors of remission with etanercept-methotrexate induction therapy and loss of remission with etanercept maintenance, reduction, or withdrawal in moderately active rheumatoid arthritis: results of the PRESERVE trial. Arthritis research & therapy. 2018;20(1):1-17.
31. Mu R, Li C, Li X, Ke Y, Zhao L, Chen L et al. Effectiveness and safety of iguratimod treatment in patients with active rheumatoid arthritis in Chinese: A nationwide, prospective real-world study. The Lancet Regional Health-Western Pacific. 2021;10:100128.
32. Klerk E, van der Heijde D, Landewé R, van der Tempel H, Urquhart J, van der Linden S. (2003). Patient compliance in rheumatoid arthritis, polymyalgia rheumatica, and gout. The Journal of Rheumatology. 2003;30(1):44-54.
33. Schwartzman S, Morgan GJ. Does route of administration affect the outcome of TNF antagonist therapy?. Arthritis Research & Therapy. 2004;6(2):1-5.
34. Jansà M, Hernández C, Vidal M, Nuñez M, Bertran MJ, Sanz S et al. Multidimensional analysis of treatment adherence in patients with multiple chronic conditions. A cross-sectional study in a tertiary hospital. Patient Education And Counseling. 2010;81(2):161-168.
35. Salt E, Frazier SK. Predictors of medication adherence in patients with rheumatoid arthritis. Drug Development Research. 2011;72(8):756-763.
36. Pantuzza LL, Ceccato MDGB, Silveira, MR, Junqueira LMR, Reis AMM. Association between medication regimen complexity and pharmacotherapy adherence: a systematic review. European Journal of Clinical Pharmacology. 2017;73(11):1475-1489.
37. Manzano-García M, Pérez-Guerrero C, Álvarez de Sotomayor Paz M, Robustillo-Cortés M. D. LA, Almeida-González CV, Morillo-Verdugo R. Identification of the medication regimen complexity index as an associated factor of nonadherence to antiretroviral treatment in HIV positive patients. Annals of Pharmacotherapy. 2018;52(9):862-867.
38. Pombo-Suarez M, Fernandez JRM. Gomez-Reino JJ. Adherence to Treatment in Patients with Rheumatoid Arthritis from Spain. Patient Preference And Adherence. 2021;15:111-117.
39. Krüger K, Kneitz C. Komorbiditäten – ihre Rolle im Treat-to-Target-Konzept für die rheumatoide Arthritis [Comorbidities-Their role in the treat to target concept for rheumatoid arthritis]. Zeitschrift fur Rheumatologie. 2019;78(5):422–428.
40. Curtis JR, Herrem C, O’Brien C, Yazici Y. A somatization comorbidity phenotype impacts response to therapy in rheumatoid arthritis: post-hoc results from the certolizumab pegol phase 4 PREDICT trial. Arthritis research & therapy. 2017;19(1):1-11.
41. Biggioggero M, Mesina F. Favalli EG. The Use of Rheumatic Disease Comorbidity Index for Predicting Clinical Response and Retention Rate in a Cohort of Rheumatoid Arthritis Patients Receiving Tumor Necrosis Factor Alpha Inhibitors. BioMed research international. 2019;2019:6107217.
42. Hirano PC, Laurent DD, Lorig K. Arthritis patient education studies, 1987–1991: a review of the literature. Patient Education and Counseling. 1994;24(1):9-54.
43. Capelusnik D, Aletaha D. Baseline predictors of different types of treatment success in rheumatoid arthritis. Annals of the Rheumatic Diseases. 2022;81(2):153-158.
44. Radner H, Yoshida K, Frits M, Iannaccone C, Shadick NA, Weinblatt M et al. The impact of multimorbidity status on treatment response in rheumatoid arthritis patients initiating disease-modifying anti-rheumatic drugs. Rheumatology. 2015;54(11):2076-2084.