Frequency and Characteristic of Concomitant Fibromyalgia in Patients with Rheumatoid Arthritis

Fibromyalgia (FM) is a confounding factor for diagnosing and assessing rheumatic disease activity. This study sought to assess the extent of this syndrome in rheumatoid arthritis (RA) patients at our rheumatology department. The RA patients were divided into 2 groups (RA with FM and RA without FM) according to the score of the FiRST questionnaire and modified 2016 criteria for FM. We compared the clinical data and disease activities of RA patients with and without FM. As a result, RA patients with FM showed higher levels of CRP, ESR, DAS28-ESR compared with RA patients without FM in both FiRST questionnaires and questionnaires developed to diagnose FM(2016 criteria).Furthermore, RA patients with FM showed higher levels of IgA compared to without FM. For the blood cells count, RA patients with FM showed higher levels of white blood cells, platelets and lower levels of hemoglobin compared with RA patients without FM. Only by FiRST Questionnaires, RA patients with FM showed higher levels of RF compared to without FM. However, all groups showed a similar pattern in anti-CCP and IgG, IgM. RA patients with FM showed lower levels of vitamin D (VD) and higher levels of interleukin (IL)-6 compared with RA patients without FM.In conclusion,FM is a common feature in RA, more associated with high values of disease activity such as ESR, CRP and DAS28-ESR.

Storage Conditions of Immunobiologicals and their Influence on the Efficacy and Safety in the Treatment of Autoimmune Rheumatic Diseases

Objective: The study aimed to evaluate the influence of storage temperature on immunobiological efficacy and safety in autoimmune rheumatic disease treatment. Methods: This observational study included adult patients with autoimmune rheumatic diseases who used immunobiologicals stored at home and were followed up at the rheumatology outpatient clinic of the General University Hospital of Cuiabá, Mato Grosso, Brazil, in 2017/2018. Patients were evaluated regarding disease activity and occurrence of adverse events, and a household survey of the temperature of the storage environment of these drugs was conducted. Results: Sixty patients with a mean age of 50.4 years were evaluated. Of these, 39 patients (65%) stored their biological drugs outside the recommended temperature range. Storage of the immunobiological at the incorrect temperature was 76% higher among patients with moderate/high rheumatic disease activity (p=0.003). Conclusion: Most patients stored their immunobiologicals outside the temperature range recommended in the package insert, and there was an association between incorrect storage temperature and moderate/high autoimmune rheumatic disease activity.

Usability and Workflow Evaluation of “RhEumAtic Disease activitY” (READY)

SummaryBackground RhEumAtic Disease activitY (READY) is a mobile health (mHealth) application that aims to create a shared platform integrating data from both patients and physicians, with a particular emphasis on arthritis disease activity.Methods We made READY available on an iPad and pilot implemented it at a rheumatology outpatient clinic. We conducted 1) a usability evaluation study to explore patients’ and physicians’ interactions with READY, and 2) a time motion study (TMS) to observe the clinical workflow before and after the implementation.Results A total of 33 patients and 15 physicians participated in the usability evaluation. We found usability problems in navigation, data entry, pain assessment, documentation, and instructions along with error messages. Despite these issues, 25 (75,76%) patients reported they liked READY. Physicians provided mixed feedback because they were concerned about the impact of READY on clinical workflow. Six physicians participated in the TMS. We observed 47 patient visits (44.72 hours) in the pre-implementation phase, and 42 patient visits (37.82 hours) in the post-implementation phase. We found that patients spent more time on READY than paper (4.39mins vs. 2.26mins), but overall, READY did not delay the workflow (pre = 52.08 mins vs. post = 45.46 mins). This time difference may be compensated with READY eliminating a workflow step for the staff.Conclusion Patients preferred READY to paper documents. Many found it easier to input information because of the larger font size and the ease of ‘tapping’ rather than writing-out or circling answers. Even though patients spent more time on READY than using paper documents, the longer usage of READY was mainly due to when troubleshooting was needed. Most patients did not have problems after receiving initial support from the staff. This study not only enabled improvements to the software but also serves as good reference for other researchers or institutional decision makers who are interested in implementing such a technology.Citation: Yen P, Lara B, Lopetegui M, Bharat A, Ardoin S, Johnson B, Mathur P, Embi P, Curtis J. Usability and workflow evaluation of “RhEumAtic Disease activitY” (READY).