Objective. To quantify the impact of etanercept on work and activity impairment in employed US patients with moderate to severe rheumatoid arthritis (RA). Methods. This prospective, observational, longitudinal study recruited RA patients initiating etanercept (50 mg/week) between January 2009 and March 2010. The Work Productivity and Activity Impairment Questionnaire (WPAI) and domestic productivity questionnaire were administered by telephone interviews at baseline and at 1, 2, 3, and 6 months after etanercept initiation. The human capital approach was used to estimate the costs of work impairment. Changes in WPAI measures were analyzed using Wilcoxon's signed rank test. Results. RA patients (n ‫؍‬ 204) initiating etanercept were a mean ؎ SD age of 46.6 ؎ 10.9 years and 72% were women. After 6 months, 153 patients continued treatment (continuers) and showed significant decreases in overall work impairment (41.9% at baseline versus 25.2% at 6 months; P < 0.0001), absenteeism (8.4% versus 2.3%; P ‫؍‬ 0.0001), presenteeism (38.9% versus 24.3%; P < 0.0001), and activity impairment (55.7% versus 30.9%; P < 0.0001) and a 76.4% reduction in work hours lost weekly due to RA (3.2 versus 0.8; P ‫؍‬ 0.0001). The projected 12-month gain in work productivity for continuers was 284.5 hours per patient, equating to $3,233-22,533 depending on annual income level, which partially or completely offset the annual cost of etanercept ($20,190). Domestic productivity improved from 41.5% at baseline to 69.6% at 6 months (P < 0.0001). Conclusion. In US employed moderate to severe RA patients, etanercept led to significant reductions in overall work and activity impairment; the value of increased work productivity partially or completely offset the cost of treatment.

items related to the financial aspect of caring. The objective was to test the French translation of the PSQ III and evaluate its content validity considering the local health care system. METHODS: The French version of the PSQ-III was tested on 5 patients with rheumatoid arthritis. The aim of these cognitive interviews was to test clarity and comprehension of the translation but also the relevance of the 8 financial items to the French context from the patients' point of view. RESULTS: A direct translation of the financial items didn't prove difficult as they could be rendered literally. Cognitive interviews showed that the items were also easily understood. Respondents mostly didn't consider the items, however, as relevant to their situation (e.g. "I worry sometimes about having to pay large medical bills" or "I have to pay for more of my medical care that I can afford") although they showed some concern regarding future evolution of the reimbursement process in France. After consultation, the developer of the instrument confirmed that if needed, the items related to the financial domain could be left aside. Decision was made to create two versions of the translation: one including the eight financial items and another excluding them. CONCLUSIONS: As far as health care systems are concerned, linguistic validation goes beyond understanding the text and direct translation of the relevant items. It requires knowledge of the local context in order to collect meaningful data. The target healthcare system needs to be carefully considered and adequacy of the translation can be tested through cognitive interviews and consultation with experts in the domain. OBJECTIVES:Fibromyalgia is a chronic musculoskeletal condition characterized by pain, fatigue, psychological distress, and sleep disturbances. The symptom complexity and existence of comorbid conditions such as anxiety and depression have been shown to negatively impact patient's quality of life (QoL). The study objective is to identify the most commonly used QoL instruments in fibromyalgia and to examine the instruments' psychometric properties. METHODS: A systematic search was conducted from 1990 to 2010 using PUBMED, EBSCOhost, OVID, and ScienceDirect databases. The search was limited to English language and key search terms (e.g., fibromyalgia, quality of life) were used to identify articles of interest. Articles identified were further screened to exclude clinical studies, review papers and studies that discussed development of QoL instruments. RESULTS: The search yielded 74 articles out of which 40 were included in the final review. The review identified 11 generic instruments, 6 disease-specific, and 20 condition-specific instruments that were used in fibromyalgia. Short Form 36 was the most commonly used generic instrument. Among disease-specific instruments, Fibromyalgia Impact Questionnaire (FIQ) was the most commonly used and has 10 domains (physical functioning, feeling well, work missed, job ability, pain, fatigue, morning tiredness, stiffness, anxiety,...