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      Elevating the Standard of Care for Patients with Axial Spondyloarthritis: ‘Calls to Action’ from Rheumacensus, a Multistakeholder Pan-European Initiative

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          Abstract

          Introduction

          Several barriers to optimal care in axial spondyloarthritis (axSpA) exist, which is detrimental to patient outcomes. The Rheumacensus programme aimed to identify how the standard of care (SoC) and treatment ambition for patients with axSpA could be elevated, from the unique perspective of three key stakeholders from across Europe: patients, healthcare professionals (HCPs) and payors.

          Methods

          Rheumacensus followed three phases: an insights-gathering workshop to identify current unmet needs in axSpA and an area of focus, a modified Delphi process to gain consensus on improvements within the agreed area of focus, and a Consensus Council (CC) meeting to generate ‘Calls to Action’ (CTA) to highlight the changes needed to elevate the SoC for patients with axSpA.

          Results

          The Rheumacensus CC consisted of four patient representatives, four HCPs and four payors. All 12 members completed all three Delphi e-consultations. The shared area of focus that informed the Delphi process was patient empowerment through education on the disease and treatment options available, to enable patient involvement in management and ultimately increase treatment adherence. Four key themes emerged from the Delphi process: patient empowerment, patient knowledge, patient–HCP consultations and optimal initial treatment. These themes informed 11 overarching CTA, which demonstrate the need for a multistakeholder approach to implement a paradigm shift towards patient-centred care to elevate health outcomes in patients with axSpA.

          Conclusion

          Rheumacensus identified CTA to help bridge the disparities observed in axSpA care. It is now imperative for all stakeholders to take practical steps towards addressing these CTA to elevate the SoC and treatment ambition in patients with axSpA.

          Supplementary Information

          The online version contains supplementary material available at 10.1007/s40744-024-00663-4.

          Plain Language Summary

          Axial spondyloarthritis (axSpA) is a long-term inflammatory disease involving the spine and other joints of the body as well as where tendons and ligaments attach to bone. AxSpA is associated with a significant burden to patients which can be worsened by delays in diagnosis and poor disease management. This report is about a programme called Rheumacensus which has the overall aim of improving the standard of care (SoC) for patients with axSpA. Rheumacensus brings together the points of view of three key groups involved in the care of people with axSpA: patients, payors and healthcare professionals (HCPs) from across Europe. Together, these three groups agreed to focus on patient empowerment through education on the disease and treatment options to effectively enhance treatment adherence, as a way to raise the SoC. Through a series of exercises—to agree on the current SoC and what needs to be improved—and group discussions, four themes were established which were used by the groups to help them suggest ‘Calls to action’ (CTA). The CTAs were ideas of how improvements could be made or what needs to be done to improve the care patients receive. The four themes were (1) patient empowerment, (2) patient knowledge, (3) patient–HCP consultation and (4) optimal initial treatment. In total, 11 CTAs were developed across these themes that provide direction and practical next steps which patients, payors and HCPs could take to drive change and make a real difference to patients by improving their care.

          Supplementary Information

          The online version contains supplementary material available at 10.1007/s40744-024-00663-4.

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          Most cited references19

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          ASAS-EULAR recommendations for the management of axial spondyloarthritis: 2022 update

          Objectives To update the Assessment of SpondyloArthritis international Society (ASAS)-EULAR recommendations for the management of axial spondyloarthritis (axSpA). Methods Following the EULAR Standardised Operating Procedures, two systematic literature reviews were conducted on non-pharmacological and pharmacological treatment of axSpA. In a task force meeting, the evidence was presented, discussed, and overarching principles and recommendations were updated, followed by voting. Results Five overarching principles and 15 recommendations with a focus on personalised medicine were agreed: eight remained unchanged from the previous recommendations; three with minor edits on nomenclature; two with relevant updates (#9, 12); two newly formulated (#10, 11). The first five recommendations focus on treatment target and monitoring, non-pharmacological management and non-steroidal anti-inflammatory drugs (NSAIDs) as first-choice pharmacological treatment. Recommendations 6–8 deal with analgesics and discourage long-term glucocorticoids and conventional synthetic disease-modifying antirheumatic drugs (DMARDs) for pure axial involvement. Recommendation 9 describes the indication of biological DMARDs (bDMARDs, that is, tumour necrosis factor inhibitors (TNFi), interleukin-17 inhibitors (IL-17i)) and targeted synthetic DMARDs (tsDMARDs, ie, Janus kinase inhibitors) for patients who have Ankylosing Spondylitis Disease Activity Score ≥2.1 and failed ≥2 NSAIDs and also have either elevated C reactive protein, MRI inflammation of sacroiliac joints or radiographic sacroiliitis. Current practice is to start a TNFi or IL-17i. Recommendation 10 addresses extramusculoskeletal manifestations with TNF monoclonal antibodies preferred for recurrent uveitis or inflammatory bowel disease, and IL-17i for significant psoriasis. Treatment failure should prompt re-evaluation of the diagnosis and consideration of the presence of comorbidities (#11). If active axSpA is confirmed, switching to another b/tsDMARD is recommended (#12). Tapering, rather than immediate discontinuation of a bDMARD, can be considered in patients in sustained remission (#13). The last recommendations (#14, 15) deal with surgery and spinal fractures. Conclusions The 2022 ASAS-EULAR recommendations provide up-to-date guidance on the management of patients with axSpA.
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            Patient empowerment: The need to consider it as a measurable patient-reported outcome for chronic conditions

            Background Health policy in the UK and elsewhere is prioritising patient empowerment and patient evaluations of healthcare. Patient reported outcome measures now take centre-stage in implementing strategies to increase patient empowerment. This article argues for consideration of patient empowerment itself as a directly measurable patient reported outcome for chronic conditions, highlights some issues in adopting this approach, and outlines a research agenda to enable healthcare evaluation on the basis of patient empowerment. Discussion Patient empowerment is not a well-defined construct. A range of condition-specific and generic patient empowerment questionnaires have been developed; each captures a different construct e.g. personal control, self-efficacy/self-mastery, and each is informed by a different implicit or explicit theoretical framework. This makes it currently problematic to conduct comparative evaluations of healthcare services on the basis of patient empowerment. A case study (clinical genetics) is used to (1) illustrate that patient empowerment can be a valued healthcare outcome, even if patients do not obtain health status benefits, (2) provide a rationale for conducting work necessary to tighten up the patient empowerment construct (3) provide an exemplar to inform design of interventions to increase patient empowerment in chronic disease. Such initiatives could be evaluated on the basis of measurable changes in patient empowerment, if the construct were properly operationalised as a patient reported outcome measure. To facilitate this, research is needed to develop an appropriate and widely applicable generic theoretical framework of patient empowerment to inform (re)development of a generic measure. This research should include developing consensus between patients, clinicians and policymakers about the content and boundaries of the construct before operationalisation. This article also considers a number of issues for society and for healthcare providers raised by adopting the patient empowerment paradigm. Summary Healthcare policy is driving the need to consider patient empowerment as a measurable patient outcome from healthcare services. Research is needed to (1) tighten up the construct (2) develop consensus about what is important to include (3) (re)develop a generic measure of patient empowerment for use in evaluating healthcare (4) understand if/how people make trade-offs between empowerment and gain in health status.
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              Determinants of diagnostic delay in axial spondyloarthritis: an analysis based on linked claims and patient-reported survey data.

              The objective of this study was to assess the current diagnostic delay in axial SpA (axSpA) and to analyse factors associated with it.
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                Author and article information

                Contributors
                Xenofon.Baraliakos@elisabethgruppe.de
                Journal
                Rheumatol Ther
                Rheumatol Ther
                Rheumatology and Therapy
                Springer Healthcare (Cheshire )
                2198-6576
                2198-6584
                25 April 2024
                25 April 2024
                June 2024
                : 11
                : 3
                : 773-794
                Affiliations
                [1 ]Axial Spondyloarthritis International Federation, Nicosia, Cyprus
                [2 ]Department of Pharmacy, Sint Maartenskliniek, ( https://ror.org/0454gfp30) Nijmegen, The Netherlands
                [3 ]Department of Pharmacy, Radboud UMC, ( https://ror.org/05wg1m734) Nijmegen, The Netherlands
                [4 ]Academic Rheumatology Unit, Dipartimento di Medicina e Scienze Della Salute “Vincenzo Tiberio”, Università Degli Studi del Molise, ( https://ror.org/04z08z627) Campobasso, Italy
                [5 ]Department of Development and Regeneration, Skeletal Biology and Engineering Research Center, KU Leuven University, ( https://ror.org/05f950310) Leuven, Belgium
                [6 ]University Hospitals Birmingham, ( https://ror.org/00635kd98) Birmingham, UK
                [7 ]Rheumatology Department, Hospital Universitario San Juan de Alicante, ( https://ror.org/00f6kbf47) Alicante, Spain
                [8 ]Formerly Department of Medicines, Therapeutic Appliances and Remedies, DAK-Gesundheit, ( https://ror.org/05qp89973) Hamburg, Germany
                [9 ]National Axial Spondyloarthritis Society, London, UK
                [10 ]Association France Spondyloarthrites, Tulle, France
                [11 ]Ogilvy Health, Oxford, UK
                [12 ]GRID grid.476674.0, ISNI 0000 0004 0559 133X, Ruhr Universität Bochum, Rheumazentrum Ruhrgebiet, ; Herne, Germany
                Author information
                http://orcid.org/0000-0002-8560-9514
                http://orcid.org/0000-0001-6189-5328
                http://orcid.org/0000-0002-0910-4944
                http://orcid.org/0000-0002-9475-9362
                Article
                663
                10.1007/s40744-024-00663-4
                11111622
                38662146
                2289fde4-6eb2-414b-845a-cd95a2185640
                © The Author(s) 2024

                Open Access This article is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License, which permits any non-commercial use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by-nc/4.0/.

                History
                : 15 December 2023
                : 11 March 2024
                Funding
                Funded by: FundRef http://dx.doi.org/10.13039/100015661, UCB Pharma;
                Categories
                Original Research
                Custom metadata
                © Springer Healthcare Ltd., part of Springer Nature 2024

                axial spondyloarthritis,consensus,standard of care,european,multistakeholder,patient-centric care

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