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      Economic and Humanistic Burden of Rheumatoid Arthritis: Results From the US National Survey Data 2018–2020

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      1 , , 2 , 3
      ACR Open Rheumatology
      Wiley Periodicals, Inc.

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          Abstract

          Objective

          Our objective was to estimate the economic and humanistic burden among US adults with rheumatoid arthritis (RA).

          Methods

          This study analyzed results from the Medical Expenditure Panel Survey from 2018 to 2020. Adults (aged ≥18 years) self‐reporting with RA or with the presence of the International Classification of Disease, 10th Revision clinical modification codes were identified. Healthcare expenditures (inpatient care, outpatient care, emergency department, office visits, prescription medications, home health, and others) were measured. The Short Form 12 Health Survey physical component summary (PCS), mental component summary (MCS), activities of daily living (ADL), and instrumental ADL (IADL) were measured. Two‐part models assessed the incremental increase in the health care expenditures for the RA group compared to the non‐RA group. In addition, the multivariable linear regression was used to evaluate the marginal difference in PCS and MCS between those with RA and those without RA, whereas the multivariable logistic regression models were used to evaluate the association between ADL and IADL by RA status.

          Results

          Annually, 4.27 million adults with RA were identified. The two‐part model showed significantly higher total annual healthcare expenditures in the RA group than non‐RA group (mean $3,382.971 [95% confidence interval (CI) $1,816.50–$4,949.44]). Compared to the non‐RA group, the RA group was associated with lower PCS scores (mean 4.78 [95% CI 3.47–6.09]) and similarly lower MCS scores (mean −0.84 [95% CI −2.18 to 0.50]), as well as increased odds of requesting ADL (adjusted odds ratio [aOR] 2.02 [95% CI 1.59–2.56]) and IADL assistance (aOR 2.11 [95% CI 1.57–2.84]).

          Conclusion

          RA was associated with higher health care expenditures, particularly prescription medication costs, and was associated with suboptimal quality of life.

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          Most cited references55

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          Rheumatoid arthritis

          Rheumatoid arthritis (RA) is a chronic, inflammatory, autoimmune disease that primarily affects the joints and is associated with autoantibodies that target various molecules including modified self-epitopes. The identification of novel autoantibodies has improved diagnostic accuracy, and newly developed classification criteria facilitate the recognition and study of the disease early in its course. New clinical assessment tools are able to better characterize disease activity states, which are correlated with progression of damage and disability, and permit improved follow-up. In addition, better understanding of the pathogenesis of RA through recognition of key cells and cytokines has led to the development of targeted disease-modifying antirheumatic drugs. Altogether, the improved understanding of the pathogenetic processes involved, rational use of established drugs and development of new drugs and reliable assessment tools have drastically altered the lives of individuals with RA over the past 2 decades. Current strategies strive for early referral, early diagnosis and early start of effective therapy aimed at remission or, at the least, low disease activity, with rapid adaptation of treatment if this target is not reached. This treat-to-target approach prevents progression of joint damage and optimizes physical functioning, work and social participation. In this Primer, we discuss the epidemiology, pathophysiology, diagnosis and management of RA.
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            Diagnosis and Management of Rheumatoid Arthritis

            Rheumatoid arthritis (RA) occurs in about 5 per 1000 people and can lead to severe joint damage and disability. Significant progress has been made over the past 2 decades regarding understanding of disease pathophysiology, optimal outcome measures, and effective treatment strategies, including the recognition of the importance of diagnosing and treating RA early.
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              EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs: 2022 update

              Objectives To provide an update of the EULAR rheumatoid arthritis (RA) management recommendations addressing the most recent developments in the field. Methods An international task force was formed and solicited three systematic literature research activities on safety and efficacy of disease-modifying antirheumatic drugs (DMARDs) and glucocorticoids (GCs). The new evidence was discussed in light of the last update from 2019. A predefined voting process was applied to each overarching principle and recommendation. Levels of evidence and strengths of recommendation were assigned to and participants finally voted on the level of agreement with each item. Results The task force agreed on 5 overarching principles and 11 recommendations concerning use of conventional synthetic (cs) DMARDs (methotrexate (MTX), leflunomide, sulfasalazine); GCs; biological (b) DMARDs (tumour necrosis factor inhibitors (adalimumab, certolizumab pegol, etanercept, golimumab, infliximab including biosimilars), abatacept, rituximab, tocilizumab, sarilumab and targeted synthetic (ts) DMARDs, namely the Janus kinase inhibitors tofacitinib, baricitinib, filgotinib, upadacitinib. Guidance on monotherapy, combination therapy, treatment strategies (treat-to-target) and tapering in sustained clinical remission is provided. Safety aspects, including risk of major cardiovascular events (MACEs) and malignancies, costs and sequencing of b/tsDMARDs were all considered. Initially, MTX plus GCs is recommended and on insufficient response to this therapy within 3–6 months, treatment should be based on stratification according to risk factors; With poor prognostic factors (presence of autoantibodies, high disease activity, early erosions or failure of two csDMARDs), any bDMARD should be added to the csDMARD; after careful consideration of risks of MACEs, malignancies and/or thromboembolic events tsDMARDs may also be considered in this phase. If the first bDMARD (or tsDMARD) fails, any other bDMARD (from another or the same class) or tsDMARD (considering risks) is recommended. With sustained remission, DMARDs may be tapered but should not be stopped. Levels of evidence and levels of agreement were high for most recommendations. Conclusions These updated EULAR recommendations provide consensus on RA management including safety, effectiveness and cost.
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                Author and article information

                Contributors
                yhuang9@olemiss.edu
                Journal
                ACR Open Rheumatol
                ACR Open Rheumatol
                10.1002/(ISSN)2578-5745
                ACR2
                ACR Open Rheumatology
                Wiley Periodicals, Inc. (Boston, USA )
                2578-5745
                06 August 2024
                November 2024
                : 6
                : 11 ( doiID: 10.1002/acr2.v6.11 )
                : 746-754
                Affiliations
                [ 1 ] School of Pharmacy University of Mississippi University Mississippi
                [ 2 ] College of Pharmacy University of Houston Houston Texas
                [ 3 ] Baylor College of Medicine Houston Texas
                Author notes
                [*] [* ] Address correspondence via email to Yinan Huang, MS, PhD, at yhuang9@ 123456olemiss.edu .

                1Yinan Huang, MS, PhD: School of Pharmacy, University of Mississippi, University, Mississippi; 2Jieni Li, MPH, PhD: College of Pharmacy, University of Houston, Houston, Texas; 3Sandeep Krishna Agarwal, MD, PhD: Baylor College of Medicine, Houston, Texas.

                Author information
                https://orcid.org/0009-0008-8107-8606
                https://orcid.org/0000-0002-8386-4116
                Article
                ACR211728
                10.1002/acr2.11728
                11557984
                39105293
                aeb6d9e0-d1b4-4d53-8340-fbd6f31f8bc6
                © 2024 The Author(s). ACR Open Rheumatology published by Wiley Periodicals LLC on behalf of American College of Rheumatology.

                This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc/4.0/ License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.

                History
                : 07 May 2024
                : 03 October 2023
                : 03 July 2024
                Page count
                Figures: 0, Tables: 5, Pages: 9, Words: 7300
                Categories
                Original Article
                Original Article
                Custom metadata
                2.0
                November 2024
                Converter:WILEY_ML3GV2_TO_JATSPMC version:6.5.1 mode:remove_FC converted:13.11.2024

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