BSR guidelines on standards of care for persons with rheumatoid arthritis

Kennedy, Tom D.; McCabe, Candy; Struthers, G R; Sinclair, Hamish; Chakravaty, K.; Bax, D. E.; Shipley, Michael; Abernethy, Rikki; Palferman, T G; Hull, Richard

doi:10.1093/rheumatology/keh554

Cited by 68 publications

(48 citation statements)

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“…Current UK guidelines for the management of RA [62][63][64] recommend that access to physiotherapists and occupational therapists should be offered to all people with RA to assess the impact and treat the consequences of the condition. Specifically, the stated aims of therapy include: l facilitating ADLs (e.g.…”

Section: Clinical Guidelinesmentioning

confidence: 99%

Strengthening And stretching for Rheumatoid Arthritis of the Hand (SARAH). A randomised controlled trial and economic evaluation

Williams

Williamson

Heine

et al. 2015

Health Technology Assessment

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BackgroundThe effectiveness of exercise for improving hand and wrist function in people with rheumatoid arthritis (RA) is uncertain.ObjectivesThe study aims were (1) to estimate the clinical effectiveness and cost-effectiveness of adding an optimised exercise programme for hands and upper limbs to standard care for patients with RA; and (2) to qualitatively describe the experience of participants in the trial with a particular emphasis on acceptability of the intervention, exercise behaviours and reasons for adherence/non-adherence.DesignA pragmatic, multicentred, individually randomised controlled trial with an embedded qualitative study. Outcome assessors were blind to group assignment and independent of treatment delivery.SettingSeventeen NHS trusts in England comprising 21 rheumatology and therapy departments.ParticipantsAdults with RA who had pain and dysfunction of the hands and/or wrists and had been on stable medication for at least 3 months. Patients were excluded if they were under 18 years old, had undergone upper limb surgery/fracture in the last 6 months, were on a waiting list for upper limb surgery or were pregnant.InterventionsUsual care or usual care plus an individualised exercise programme. Usual care consisted of joint protection education, general exercise advice and functional splinting if required. The exercise programme consisted of six sessions of strengthening and stretching exercises with a hand therapist, daily home exercises and strategies to maximise adherence.Main outcome measuresThe primary outcome was the Michigan Hand Outcome Questionnaire (MHQ) overall hand function subscale score at 12 months. Secondary outcome measures included the full MHQ, pain, health-related quality of life (Short Form questionnaire-12 items), impairment (grip strength, dexterity and range of motion) and self-efficacy. European Quality of Life-5 Dimensions, medication and health-care use were collected for the health economics evaluation. Follow-up was at 4 and 12 months post randomisation. Analysis was performed on an intention-to-treat basis.ResultsWe randomised 490 patients (244 to usual care, 246 to exercise programme). Compliance with the treatments was very good (93% of usual care participants and 75% of exercise programme participants completed treatment). Outcomes were obtained for 89% of participants at 12 months (222 for usual care, 216 for exercise programme). There was a statistically significant difference in favour of the exercise programme for the primary outcome at 4 and 12 months [mean difference 4.6 points, 95% confidence interval (CI) 2.2 to 7.0 points; and mean difference 4.4 points, 95% CI 1.6 to 7.1 points, respectively]. There were no significant differences in pain scores or adverse events. The estimated difference in mean quality-adjusted life-years (QALYs) accrued over 12 months was 0.01 greater (95% CI –0.03 to 0.05) in the exercise programme group. Imputed analysis produced incremental cost-effectiveness ratio estimates of £17,941 (0.59 probability of cost-effectiveness at willingness-to-pay threshold of £30,000 per QALY). The qualitative study found the exercise programme to be acceptable and highlighted the importance of the therapist in enabling patients to establish a routine and incorporate the exercises into their lives.ConclusionsThe results of the Strengthening And stretching for Rheumatoid Arthritis of the Hand trial suggest that the addition of an exercise programme for RA hands/wrists to usual care is clinically effective and cost-effective when compared with usual care alone. No adverse effects were associated with the exercise programme. The economic analysis suggests that the intervention is likely to be cost-effective.Study registrationCurrent Controlled Trials ISRCTN 89936343.Funding detailsThis project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full inHealth Technology Assessment; Vol. 19, No. 19. See the NIHR Journals Library website for further project information. This report has been developed in association with the NIHR Collaboration for Leadership in Applied Health Research and Care Oxford and the NIHR Biomedical Research Unit Funding Scheme. This project benefited from facilities funded through Birmingham Science City Translational Medicine Clinical Research and Infrastructure Trials Platform, with support from Advantage West Midlands.

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Section: Clinical Guidelinesmentioning

confidence: 99%

Strengthening And stretching for Rheumatoid Arthritis of the Hand (SARAH). A randomised controlled trial and economic evaluation

Williams

Williamson

Heine

et al. 2015

Health Technology Assessment

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“…Though educational input has been recognized as one of the keys to improving medication adherence in RA 8,9 , constraints on time remain a barrier. It would be very interesting to know whether the patients in the study by Harrold, et al had received any RA disease education and whether the authors consider lack of such education (if applicable) a potential confounder.…”

Section: To the Editormentioning

confidence: 99%

The Effect of Rheumatoid Arthritis Disease Education on Adherence to Medications and Followup in Kerala, India

Ravindran¹,

Jadhav²

2013

J Rheumatol

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“…Key aspects of these changes include early start of treatment, use of drugs that can prevent joint destruction (that is, proven to prevent or delay structural damage) and disease flares, and the importance of regular monitoring of disease activity and structural changes to ensure tight control of the disease [15][16][17][18][19][20] . For this reason, several expert groups and professional societies have issued guidelines on this topic in recent years [21][22][23][24] .…”

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confidence: 99%

The Gap Between Practice and Guidelines in the Choice of First-line Disease Modifying Antirheumatic Drug in Early Rheumatoid Arthritis: Results from the ESPOIR Cohort

Benhamou¹,

Rincheval²,

Roy³

et al. 2009

J Rheumatol

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ABSTRACT. Objective. To compare rheumatologists' prescription for first disease modifying antirheumatic drug (DMARD) . "Definite" and "probable" RA were defined according to ACR criteria and the level of diagnostic certainty. The objectives were to assess conformity between the observed first-line DMARD prescribed for those patients and the DMARD recommended in the guidelines; and to conduct a mail survey of patients' usual rheumatologists to investigate the reasons for their nonconformity with guidelines. Results. In total 627 patients with definite or probable RA were identified. Conformity rates were 58% for STPR guidelines and 54% for EULAR guidelines. At 6 months, 83 (34%) patients with early RA did not receive any DMARD. Main determinants associated with conformity to guidelines were disease activity and presence of severity-predictive factors. The main reason leading to a discrepancy between guidelines and daily practice appeared to be diagnostic uncertainty, i.e., the difficulty to reliably assess RA diagnosis as early as the first visits to the rheumatologist. Conclusion.There is a substantial gap between CPG and rheumatologists' daily practice concerning the first DMARD to prescribe in early RA. This is explained mainly by diagnostic uncertainty. More attention should be paid in future guidelines to the diagnostic difficulties of early

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BSR guidelines on standards of care for persons with rheumatoid arthritis

Cited by 68 publications

References 1 publication

Strengthening And stretching for Rheumatoid Arthritis of the Hand (SARAH). A randomised controlled trial and economic evaluation

Strengthening And stretching for Rheumatoid Arthritis of the Hand (SARAH). A randomised controlled trial and economic evaluation

The Effect of Rheumatoid Arthritis Disease Education on Adherence to Medications and Followup in Kerala, India

The Gap Between Practice and Guidelines in the Choice of First-line Disease Modifying Antirheumatic Drug in Early Rheumatoid Arthritis: Results from the ESPOIR Cohort

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