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Research ArticleRheumatoid Arthritis

Patient-reported Outcomes, Resource Use, and Social Participation of Patients with Rheumatoid Arthritis Treated with Biologics in Alberta: Experience of Indigenous and Non-indigenous Patients

Cheryl Barnabe, Louise Crane, Tyler White, Brenda Hemmelgarn, Gilaad G. Kaplan, Liam Martin and Walter P. Maksymowych
The Journal of Rheumatology June 2018, 45 (6) 760-765; DOI: https://doi.org/10.3899/jrheum.170778
Cheryl Barnabe
From the Department of Medicine and Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary; Canadian Arthritis Patient Alliance; Siksika Health and Wellness, Siksika Nation; Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada.
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  • For correspondence: ccbarnab{at}ucalgary.ca
Louise Crane
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Tyler White
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Brenda Hemmelgarn
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Gilaad G. Kaplan
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Liam Martin
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Walter P. Maksymowych
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Article Figures & Data

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    Table 1.

    Baseline patient-reported outcomes of ABioPharm patients, comparing self-identified indigenous to non-indigenous participants. Reported as n (%) or mean (SD) as appropriate, and p value reported only for significantly different values between groups.

    Indigenous, n = 90Non-indigenous, n = 1400p
    PtGA, 0–107.1 (2.2)6.6 (2.2)0.05
    Pain, 0–107.6 (2.2)6.7 (2.2)< 0.0001
    Fatigue, 0–107.1 (2.4)6.6 (2.6)
    Sleep, 0–107.2 (2.9)6.0 (3.0)< 0.0001
    HAQ, 0–31.7 (0.6)1.6 (0.6)0.002
    Stiffness, min120 (173)93 (144)0.0022
    EQ-5D0.3 (0.3)0.4 (0.3)0.001
    SF-36 physical health, standardized25.3 (9.2)26.9 (9.0)0.05
    SF-36 mental health, standardized40.1 (12.1)45.3 (11.9)0.0002
    • ABioPharm: Alberta Biologics Pharmacosurveillance Program; PtGA: patient’s global assessment; HAQ: Health Assessment Questionnaire; SF-36: Medical Outcomes Study Short Form-36.

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    Table 2.

    Adjusted* baseline patient-reported outcomes and rate of change (per 12 mos) during treatment with first biologic agent.

    Adjusted Rate of Change for Indigenous Patients, Slope (95% CI)Adjusted Rate of Change for Non-indigenous Patients, Slope (95% CI)Difference in Rate of Change, Mean (95% CI)
    PtGA−0.19 (−0.26 to −0.11), p < 0.001−0.25 (−0.27 to −0.22), p < 0.0010.06 (−0.02 to 0.14), p = 0.125
    Pain−0.14 (−0.22 to −0.07), p < 0.001−0.23 (−0.25 to −0.21), p < 0.0010.09 (0.01–0.16), p = 0.029
    Fatigue−0.12 (−0.19 to −0.05), p < 0.001−0.19 (−0.22 to −0.17), p < 0.0010.07 (0–0.15), p = 0.065
    Sleep−0.11 (−0.19 to −0.04), p = 0.004−0.20 (−0.23 to −0.17), p < 0.0010.08 (0.00–0.17), p = 0.043
    HAQ−0.04 (−0.06 to −0.03), p < 0.001−0.05 (−0.06 to −0.05), p < 0.0010.01 (−0.01 to 0.03), p = 0.238
    Stiffness−6.1 (−9.0 to −3.3), p < 0.001−5.4 (−6.4 to −4.4), p < 0.001−0.71 (−3.72 to 2.30), p = 0.643
    EQ-5D0.03 (0.02–0.03), p < 0.0010.02 (0.02–0.03), p < 0.0010.00 (−0.01 to 0.01), p = 0.476
    SF-36 Physical Health (standardized)0.53 (0.23–0.83), p < 0.0010.88 (0.78–0.98), p < 0.001−0.35 (−0.66 to −0.03), p = 0.03
    SF-36 Mental Health (standardized)0.40 (0.14–0.65), p = 0.0020.56 (0.47–0.65), p < 0.001−0.16 (−0.43 to 0.10), p = 0.232
    • ↵* Adjusted for baseline DAS28, age, sex, disease duration at index date, current smoking status, and baseline health assessment questionnaire (HAQ) score. PtGA: patient’s global assessment; SF-36: Medical Outcomes Study Short Form-36; DAS28: Disease Activity Score at 28 joints.

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    Table 3.

    Allied health and community services use, mean number of visits per patient over past 3 months, comparing self-identified indigenous to non-indigenous participants. Reported as mean (SD) unless indicated.

    InceptionFinal Visit
    Indigenous, n = 90Non-indigenous, n = 1400pIndigenous, n = 79Non-indigenous, n = 1288p
    Allied health services
    Physiotherapy0.4 (1.7)0.5 (2.2)0.880.1 (0.7)0.2 (1.4)0.25
    Occupational therapy0.1 (0.4)0.1 (1.1)0.880.1 (0.5)0.0 (0.4)0.58
    Chiropractor0.0 (0.4)0.3 (1.5)0.080.0 (0.2)0.2 (1.2)0.11
    Acupuncture0.1 (0.0)0.2 (1.1)0.530.0 (0.1)0.1 (0.7)0.35
    Massage0.2 (1.2)0.3 (1.3)0.180.0 (0.1)0.3 (1.6)0.01
    Community services
    Any service used, %8.13.20.037.73.30.05
    Paid for services, %9.89.40.856.48.20.83
    Home help, hours/week0.6 (2.5), median 0 (range 0–20)0.3 (3.5), median 0 (range 0–12)0.020.1 (0.7), median 0 (range 0–6)0.3 (1.9), median 0 (range 0–40)0.78
    Childcare, hours/week0.0 (0.0), median 0 (range 0–40)0.1 (1.3), median 0 (range 0–40)0.420.0 (0.0), median 0 (range 0–0)0.0 (0.4), median 0 (range 0–10)0.67
    • View popup
    Table 4.

    Participation in activities of daily living, comparing self-identified indigenous to non-indigenous participants. Reported as mean (SD) unless indicated.

    InceptionFinal Visit
    Indigenous, n = 90Non-indigenous, n = 1400pIndigenous, n = 79Non-indigenous, n = 1288p
    Participation in normal activities (in past month)
    Unable, %70.966.20.4150.036.90.03
    No. days8.0 (9.9)6.0 (28.2)< 0.0014.0 (7.0)3.1 (7.1)0.01
    No. hours/day4.8 (8.2)3.8 (27.4)0.013.5 (6.4)2.2 (5.6)0.01
    Assistance required for normal activities (in past month)
    Required help, %61.252.50.1433.828.50.36
    No. days6.6 (9.7)5.2 (28.2)< 0.013.6 (7.6)2.6 (6.9)0.09
    No. hours/day3.2 (5.6)2.5 (27.2)< 0.011.1 (2.7)1.0 (3.1)0.29
    • View popup
    Table 5.

    Current employment status. Reported as % unless indicated.

    InceptionFinal Visit
    Indigenous, n = 90Non-indigenous, n = 1400Indigenous, n = 79Non-indigenous, n = 1288
    Employed44.346.441.343.2
      Days unable to work due to RA over past 6 months, mean (SD)6.9 (24.7)3.7 (16.4)1.6 (5.8)1.9 (11.3)
      Proportion of cohort reporting a change in work hours over last 6 months due to RA15.67.55.15.1
    Unemployed17.76.323.86.8
      If unemployed, stopped work because of arthritis64.451.081.847.9
    Disabled24.113.328.611.4
    Housework3.89.21.66.6
    Student3.81.90.01.0
    Retired6.322.94.831.0
    • RA: rheumatoid arthritis.

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The Journal of Rheumatology
Vol. 45, Issue 6
1 Jun 2018
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Patient-reported Outcomes, Resource Use, and Social Participation of Patients with Rheumatoid Arthritis Treated with Biologics in Alberta: Experience of Indigenous and Non-indigenous Patients
Cheryl Barnabe, Louise Crane, Tyler White, Brenda Hemmelgarn, Gilaad G. Kaplan, Liam Martin, Walter P. Maksymowych
The Journal of Rheumatology Jun 2018, 45 (6) 760-765; DOI: 10.3899/jrheum.170778

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Patient-reported Outcomes, Resource Use, and Social Participation of Patients with Rheumatoid Arthritis Treated with Biologics in Alberta: Experience of Indigenous and Non-indigenous Patients
Cheryl Barnabe, Louise Crane, Tyler White, Brenda Hemmelgarn, Gilaad G. Kaplan, Liam Martin, Walter P. Maksymowych
The Journal of Rheumatology Jun 2018, 45 (6) 760-765; DOI: 10.3899/jrheum.170778
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Keywords

RHEUMATOID ARTHRITIS
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