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Measuring the Effects of Medication Use on Health-Related Quality of Life in Patients with Rheumatoid Arthritis

A Review

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Abstract

As the treatment of rheumatoid arthritis (RA) moves towards earlier and more consistently maintained therapy, often with highly toxic medications, the importance of assessing patients’ health-related quality of life (HR-QOL) is of increasing concern to healthcare providers, insurers and policy-makers. As the course of RA can extend 20 years or more, and as patient involvement in their care and evaluation increases, the goal of therapy should be to work towards the HR-QOL desired by the patient. The challenge in HR-QOL measurement is its multidimensional nature, which takes into account not only how a person functions physically, mentally and socially, but also incorporates the individual’s perceived well-being in their physical, mental and social aspects of daily life. This review focuses on measuring the HR-QOL outcomes of drug therapy in RA in clinical settings as well as in clinical drug trials. The most commonly used instruments in RAHR-QOL measurement are presented, with particular attention to those that have been used to assess the impacts of drug therapy.

Traditionally, RA treatment outcomes assessment has focused on physical functioning and activities of daily living. As a result, there is an abundance of instruments that have been used in RAthat measure physical functioning. Social and mental functioning are being assessed more frequently as clinicians and researchers recognise the added value of assessing these dimensions in addition to physical functioning. Patient perceived well-being (especially as it relates to physical, mental and social aspects of their lives), however, is still rarely measured.

We conclude that there are few validated instruments which truly assess the impact of drug therapy on HR-QOL in RA; most are intended as measures of functional or health status. In addition, fewstudies have been conducted in natural clinical practice settings (as opposed to controlled clinical trial settings). Further, our review reveals that the psychological and social dimensions of HR-QOL are often lacking from some of the most popular RA instruments currently in use.

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References

  1. Bendtsen P, Akerlind I, Hornquist JO. Assessment of quality of life in rheumatoid arthritis: methods and implications. Pharmacoeconomics 1994; 5 (4): 286–98

    Article  PubMed  CAS  Google Scholar 

  2. Cella DF, Tulsky DS. Measuring quality of life today: methodological aspects. Oncology 1990; 4 (5): 29–38

    PubMed  CAS  Google Scholar 

  3. Pincus T, Callahan LF, Sale WG, et al. Severe functional declines, work disability and increased mortality in seventy five rheumatoid arthritis patients studied over nine years. Arthritis Rheum 1984; 27: 864–72

    Article  PubMed  CAS  Google Scholar 

  4. Pocock SJ. A perspective on the role of quality-of-life assessment in clinical trials. Control Clin Trials 1991; 12 (4 Suppl.): 257S-65S

    Article  Google Scholar 

  5. Alarcon GS. Epidemiology of rheumatoid arthritis. Rheum Dis Clin North Am 1995; 21 (2): 589–604

    PubMed  CAS  Google Scholar 

  6. Fries JF. Quality-of-life considerations with respect to arthritis and nonsteroidal anti-inflammatory drugs. Am J Med 1998; 104 (3A): 14S-220S

    Article  Google Scholar 

  7. Paulus HE, Bulpitt KJ. Outcome measures. Rheum Dis Clin North Am 1995; 21 (2): 605–18

    PubMed  CAS  Google Scholar 

  8. Group for the Respect of Ethics and Excellence in Science (GREES): Rheumatoid Arthritis Section. Recommendation for the registration of drugs used in the treatment of rheumatoid arthritis. Br J Rheumatol 1998; 37: 211–5

    Article  Google Scholar 

  9. Young A, Van der Heijde DMFM. Can we predict aggressive disease? Baillieres Clin Rheumatol 1997; 11: 27–48

    Article  PubMed  CAS  Google Scholar 

  10. Pincus T, Callahan LF. Quantitative measures to assess, monitor and predict morbidity and mortality in rheumatoid arthritis. Baillieres Clin Rheumatol 1992; 6: 161–91

    Article  PubMed  CAS  Google Scholar 

  11. Lawrence RC, Helmick CG, Arnett FC, et al. Estimates of the prevalence of arthritis and selected musculoskeletal disorders in the United States. Arthritis Rheumatism 1998; 41 (5): 778–99

    Article  PubMed  CAS  Google Scholar 

  12. Scott DL, Shipley M, Dawson A, et al. The clinical management of rheumatoid arthritis an osteoarthritis: strategies for improving clinical effectiveness. Br J Rheumatol 1998; 37: 546–54

    Article  PubMed  CAS  Google Scholar 

  13. Linos A, Worthington JW, O’Fallon WM, et al. The epidemiology of rheumatoid arthritis in Rochester, Minnesota: a study of incidence, prevalence and mortality. Am J Epidemiol 1980; 111: 87–98

    PubMed  CAS  Google Scholar 

  14. Allaire SH, Prashker MJ, Meenan RF. The costs of rheumatoid arthritis. Pharmacoeconomics 1994; 6 (6): 513–22

    Article  PubMed  CAS  Google Scholar 

  15. Bowling A. Measuring health: a review of quality of life measurement scales. 2nd ed. Buckingham: Open University Press, 1997

    Google Scholar 

  16. Ganz PA. Methods of assessing the effect of drug therapy on quality of life. Drug Saf 1990; 5 (4): 233–42

    Article  PubMed  CAS  Google Scholar 

  17. McDowell I, Newell C. Measuring health. a guide to rating scales and questionnaires. 2nd ed. New York: Oxford University Press, 1996

    Google Scholar 

  18. Ware Jr JE. Conceptualizing disease impact and treatment outcome. Cancer 1984; 53 Suppl. 10: 2316–26

    PubMed  Google Scholar 

  19. Chambers LW, MacDonald LA, Tugwell P, et al. The McMaster Health Index Questionnaire as a measure of quality of life for patients with rheumatoid disease. J Rheumatol 1982; 9 (5): 780–4

    PubMed  CAS  Google Scholar 

  20. Pincus T, Summey JA, Soraci Jr SA, et al. Assessment of patient satisfaction in activities of daily living using a modified Stanford Health Assessment Questionnaire. Arthritis Rheum 1983; 26: 1346–53

    Article  PubMed  CAS  Google Scholar 

  21. Fries JF. The hierarchy of quality-of-life assessment, the Health Assessment Questionnaire (HAQ), and issues mandating development of a toxicity index. Control Clin Trials 1991; 12 (4 Suppl.): 106S-17S

    Article  Google Scholar 

  22. Fries JF, Williams CA, Bloch DA. The relative toxicity of nonsteroidal antinflammatory drugs. Arthritis Rheum 1991; 34: 1353–60

    Article  PubMed  CAS  Google Scholar 

  23. Fries JF, Williams CA, Ramey D, et al. The relative toxicity of disease-modifying antirheumatic drugs. Arthritis Rheum 1993; 36: 297–306

    Article  PubMed  CAS  Google Scholar 

  24. Felson DT, Anderson JJ, Boers M, et al. The American College of Rheumatology preliminary core set of disease activity measures for rheumatoid arthritis clinical trials. Arthritis Rheum 1993; 36: 729–40

    Article  PubMed  CAS  Google Scholar 

  25. de Jong Z, van der Heijde D, McKenna SP, et al. The reliability and construct validity of the RAQoL: a rheumatoid arthritis specific quality of life instrument. Br J Rheumatol 1997; 36 (8): 878–83

    Article  PubMed  Google Scholar 

  26. Guyatt G, Walter S, Norman G. Measuring change over time: assessing the usefulness of evaluative instruments. J Chronic Dis 1987; 40 (2): 171–8

    Article  PubMed  CAS  Google Scholar 

  27. Derogatis LR. Symptom Checklist-90-R (SCL-90-R) administration, scoring, and procedures manual, 3rd ed. Minneapolis (MN): National Computer Systems, 1994

    Google Scholar 

  28. Smith VL. Symptom Checklist-90-Revised (SCL-90-R) and the Brief Symptom Inventory (BSI). In: Sederer LI, Dickey B, editors. Outcomes assessment in clinical practice. Baltimore (MD): Williams & Wilkins, 1996: 89–91

    Google Scholar 

  29. Hurst NP, Kind P, Ruta D, et al. Measuring health-related quality of life in rheumatoid arthritis: validity, responsiveness and reliability of EuroQol (EQ-5D). Br J Rheumatol 1997; 36 (5): 551–9

    Article  PubMed  CAS  Google Scholar 

  30. Ware JE, Sherbourne CD. The MOS 36-Item Short Form Health Survey (SF-36). Med Care 1992; 30: 474–83

    Google Scholar 

  31. Ruta DA, Hurst NP, Kind P, et al. Measuring health status in British patients with rheumatoid arthritis: reliability, validity and responsiveness of the Short Form 36-Item Health Survey (SF-36). Br J Rheumatol 1998; 37: 425–36

    Article  PubMed  CAS  Google Scholar 

  32. Hunt SM, McKenna SP, McEwen J, et al. The Nottingham Health Profile: subjective health status and medical consultations. Soc Sci Med 1981; 15: 221–9

    Article  CAS  Google Scholar 

  33. Houssien DA, McKenna SP, Scott DL. The Nottingham Health Profile as a measure of disease activity and outcome in rheumatoid arthritis. Br J Rheumatol 1997; 36 (1): 69–73

    Article  PubMed  CAS  Google Scholar 

  34. Kaplan RM, Bush JW. Health-related quality of life measurement for evaluation research and policy analysis. Health Psychol 1982; 1: 61–80

    Article  Google Scholar 

  35. Bush JW. General health policy model: Quality of Well-Being (QWB) Scale. In: Wenger NK, Mattson ME, Furberg CD, et al., editors. Assessment of quality of life in clinical trials of cardiovascular therapies. New York: Le Jacq, 1984

    Google Scholar 

  36. Anderson JP, Bush JW, Berry CC. Classifying function for health outcome and quality-of-life evaluation: self- versus interviewer modes. Med Care 1986; 24 (5): 454–70

    Article  PubMed  CAS  Google Scholar 

  37. Read LJ, Quinn RJ, Hoefer MA. Measuring overall health: an evaluation of three important approaches. J Chronic Dis 1987; 40: 7S-21S

    Article  Google Scholar 

  38. Carter W, Bobbitt RA, Bergner M, et al. Validation of an interval scaling: the Sickness Impact Profile. Health Serv Res 1976; 11: 516–28

    PubMed  CAS  Google Scholar 

  39. Bergner M, Bobbit RA, Carter WB, et al. The Sickness Impact Profile: development and final revision of a health status measures. Med Care 1981; 19: 787–805

    Article  PubMed  CAS  Google Scholar 

  40. Nicassio PM, Wallston KA, Callahan LE, et al. The measurement of helplessness in rheumatoid arthritis: the development of the Arthritis Helplessness Index. J Rheumatol 1985; 12: 462–7

    PubMed  CAS  Google Scholar 

  41. Jette AM. The Functional Status Index: reliability and validity of a self-report functional disability measure. J Rheumatol 1987; 14 Suppl. 15: 15–9

    Google Scholar 

  42. Liang MH, Larson MG, Cullen KE, et al. Comparative measurement efficacy and sensitivity of five health status instruments for arthritis research. Arthritis Rheum 1985; 28: 542–7

    Article  PubMed  CAS  Google Scholar 

  43. Fries JF, Spitz P, Kraines RG, et al. Measurement of patient outcome in arthritis. Arthritis Rheum 1980; 23 (2): 137–45

    Article  PubMed  CAS  Google Scholar 

  44. Tugwell P, Bombardier C, Buchanan WW, et al. The MACTAR patient preference disability questionnaire: an individualized functional priority approach for assessing improvement in physical disability in clinical trials in rheumatoid arthritis. J Rheumatol 1987; 14: 446–51

    PubMed  CAS  Google Scholar 

  45. Stucki G, Stucki S, Bruhlmann P, et al. Ceiling effects of the Health Assessment Questionnaire and its modified version in some ambulatory rheumatoid arthritis patients. Ann Rheum Dis 1995; 54 (6): 461–5

    Article  PubMed  CAS  Google Scholar 

  46. Meenan RF, Mason JH, Anderson JJ, et al. AIMS2: the content and properties of a revised and expanded Arthritis Impact Measurement Scales health status questionnaire. Arthritis Rheum 1992; 35 (1): 1–10

    Article  PubMed  CAS  Google Scholar 

  47. Cheah SY, Clark C, Goldberg L, et al. Outcome measures, pooled index and quality of life instruments in rheumatoid arthritis. J Clin Pharm Ther 1996 21: 297–316

    Article  PubMed  CAS  Google Scholar 

  48. Whalley D, McKenna SP, de Jong Z, et al. Quality of life in rheumatoid arthritis. Br J Rheumatol 1997; 36 (8): 884–8

    Article  PubMed  CAS  Google Scholar 

  49. Derogatis LR, Rickels K, Rock AF. The SCL-90 and the MMPI: a step in the validation of a new self-report scale. Br J Psychiatry 1976; 128: 280–9

    Article  PubMed  CAS  Google Scholar 

  50. Ritchie DM, Boyle JA, McInnes HM, et al. Clinical studies with an articular index for the assessment of joint tenderness in patients with rheumatoid arthritis. QJ Med 1968; 37: 393–406

    CAS  Google Scholar 

  51. Chambers LW, Haight M, Norman G, et al. Sensitivity to change and the effect of mode of administration on health status measurement. Med Care 1987; 25: 470–9

    Article  PubMed  CAS  Google Scholar 

  52. Chambers LW. The McMaster Health Index Questionnaire: an update. In: Walker SR, Rosser RM, editors. Quality of life assessment: key issues in the 1990s. Dordrecht: Kluwer Academic Publishers, 1993: 131–49

    Chapter  Google Scholar 

  53. Katz JN, Larson MG, Phillips CB, et al. Comparative measurement sensitivity of short and longer health status instruments. Med Care 1992; 30 (10): 917–25

    Article  PubMed  CAS  Google Scholar 

  54. Wallston KA, Wallston BS, DeVellis R. Development of the Multidimensional Health Locus of Control (MHLC) Scales. Health Educ Monogr 1978; 6: 161–70

    Google Scholar 

  55. Tugwell P, Bombardier C, Buchanan WW, et al. Methotrexate in rheumatoid arthritis: impact on quality of life assessed by traditional standard-item and individualized patient preference health status questionnaires. Arch Intern Med 1990; 150: 59–62

    Article  PubMed  CAS  Google Scholar 

  56. Guyatt GH, Bombardier C, Tugwell PX. Measuring disease specific quality of life in clinical trials. Can Med Assoc J 1986; 134: 889–95

    CAS  Google Scholar 

  57. Ware JE, Keller SD, Hatoum HT, et al. The SF-36 Arthritis-Specific Health Index (ASHI). I: development and cross-validation of scoring algorithms. Med Care 1999; 37 (5): MS40–50

    Google Scholar 

  58. Boers M, Verhoeven AC, Markusse HM, et al. Randomised comparison of combined step-down prednisolone, methotrexate and sulphasalazine with sulphasalazine alone in early rheumatoid arthritis. Lancet 1997; 350 (9074): 309–18

    Article  PubMed  CAS  Google Scholar 

  59. Ciconelli RM, Ferraz MB, Visioni RA, et al. A randomized double-blind controlled trial of sulphasalazine combined with pulses of methylprednisolone or placebo in the treatment of rheumatoid arthritis. Br J Rheumatol 1996; 35: 150–4

    Article  PubMed  CAS  Google Scholar 

  60. Guillemin F, Coste J, Pouchot J, French Quality of Life in Rheumatology Group, et al. The AIMS2-SF: a short form of the Arthritis Impact Measurement Scales 2. Arthritis Rheum 1997; 40 (7): 1267–74

    PubMed  CAS  Google Scholar 

  61. O’Dell JR, Haire CE, Erikson N, et al. Treatment of rheumatoid arthritis with methotrexate alone, sulfasalazine and hydroxychloroquine, or a combination of all three medications. N Engl J Med 1996; 334 (20): 1287–91

    Article  PubMed  Google Scholar 

  62. Pillemer SR, Fowler SE, Tilley BC, MIRA Trial Group, et al. Meaningful improvement criteria sets in a rheumatoid arthritis clinical trial: minocycline in rheumatoid arthritis. Arthritis Rheum 1997; 40 (3): 419–25

    Article  PubMed  CAS  Google Scholar 

  63. Pouchot J, Guillemin F, Coste J, et al. Validity, reliability, and sensitivity to change of a French version of the arthritis impact measurement scales 2 (AIMS2) in patients with rheumatoid arthritis treated with methotrexate. J Rheumatol 1996; 23 (1): 52–60

    PubMed  CAS  Google Scholar 

  64. Salaffi F, Carotti M, Cervini C. Combination therapy of cyclosporine A with methotrexate or hydroxychloroquine in refractory rheumatoid arthritis. Scand J Rheumatol 1996; 25: 16–23

    Article  PubMed  CAS  Google Scholar 

  65. Stein CM, Pincus T, Yocum D, et al. Combination treatment of severe rheumatoid arthritis with cyclosporine and methotrexate for forty-eight weeks: an open-label extension study. Arthritis Rheum 1997; 40 (10): 1843–51

    Article  PubMed  CAS  Google Scholar 

  66. Tuttleman M, Pillemer SR, Tilley BC, Minocycline in Rheumatoid Arthritis Trial Group, et al. A cross sectional assessment of health status instruments in patients with rheumatoid arthritis participating in a clinical trial. J Rheumatol 1997; 24 (10): 1910–5

    PubMed  CAS  Google Scholar 

  67. van der Heide A, Jacobs JWG, Bijlsma JWJ, et al. The effectiveness of early treatment with ’second line’ anti-rheumatic drugs: a randomized controlled trial. Ann Intern Med 1996; 124: 699–707

    PubMed  Google Scholar 

  68. Vliet Vlieland TPM, Breedveld FC, Hazes JMV. The two-year follow-up of a randomized comparison of in-patient multidisciplinary team care and routine out-patient care for acute rheumatoid arthritis. Br J Rheumatol 1997; 36: 82–5

    Article  PubMed  CAS  Google Scholar 

  69. De Haes JCJM, Van Knippenberg FCE. Quality of life instruments for cancer patients: ’Babel’s tower revisited’. J Clin Epidemiol 1989; 42: 1239–41

    Article  PubMed  Google Scholar 

  70. Breslow L. Aquantitative approach to the Word Health organization definition of health: physical, mental, and social wellbeing. Int J Epidemiol 1972; 1: 347–55

    Article  PubMed  CAS  Google Scholar 

  71. Patrick DL, Erickson P. Assessing health-related quality of life for clinical decision making. In: Walker SR, Rosser RM, editors. Quality of life: assessment and application. Lancaster: MTP Press Limited, 1988: 9–49

    Google Scholar 

  72. Ward MM, Fries JF. Trends in antirheumatic medication use among patients with rheumatoid arthritis, 1981–1996. J Rheumatol 1998; 25 (3): 408–16

    PubMed  CAS  Google Scholar 

  73. Pincus T, Marcum SB, Callahan LF. Long term drug therapy for rheumatoid arthritis in seven rheumatology private practices. II: second line drugs and prednisone. J Rheumatol 1992; 19: 1885–94

    PubMed  CAS  Google Scholar 

  74. Hawkey CJ. Quality of life in users of non-steroidal anti-inflammatory drugs. Scand J Gastroenterol Suppl 1996; 221: 23–4

    Article  PubMed  CAS  Google Scholar 

  75. Pincus T. Assessment of long-term outcomes of rheumatoid arthritis: how choices of measures and study designs may lead to apparent different conclusions. Rheum Dis Clin North Am 1995; 21 (3): 619–54

    PubMed  CAS  Google Scholar 

  76. Wolfe F, Hawley DJ, Cathey MA. Termination of slow acting antirheumatic therapy in rheumatoid arthritis: a 14-year prospective evaluation of 1017 consecutive starts. J Rheumatol 1990; 17: 994–1002

    PubMed  CAS  Google Scholar 

  77. Lee P, Jasani MK, Dick WC, et al. Evaluation of a functional index in rheumatoid arthritis. Scand J Rheumatol 1973; 2 (2): 71–7

    Article  PubMed  CAS  Google Scholar 

  78. Siegert CEH, Vleming LJ, Vanderbroucke JP, et al. Measurement of disability in Dutch rheumatoid arthritis patients. Clin Rhematol 1984; 3: 305–9

    Article  CAS  Google Scholar 

  79. Fries JF, Spitz P, Williams CA, et al. A toxicity index for comparison of side effects among different drugs. Arthritis Rheum 1990; 33 (1): 121–30

    Article  PubMed  CAS  Google Scholar 

  80. Fries JF, Williams CA, Ramey DR, et al. The relative toxicity of alternative therapies for rheumatoid arthritis: implications for the therapeutic progression. Semin Arthritis Rheum 1993; 36: 68–73

    Article  Google Scholar 

  81. Felson DT, Anderson JJ, Meenan RF. Use of short-term efficacy/toxicity trade offs to select second-line drugs in rheumatoid arthritis. Arthritis Rheum 1992; 35: 1117–25

    Article  PubMed  CAS  Google Scholar 

  82. Lorig KR, Mazonson PD, Holman HR. Evidence suggesting that health education for self-management in patients with chronic arthritis has sustained health benefits while reducing health care costs. Arthritis Rheum 1993; 36: 439–46

    Article  PubMed  CAS  Google Scholar 

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  1. School of Pharmacy, University of Southern California, 1540 East Alcazar Street, CHP 140, Los Angeles, California, 90089, USA

    Michael B. Nichol

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Nichol, M.B., Harada, A.S.M. Measuring the Effects of Medication Use on Health-Related Quality of Life in Patients with Rheumatoid Arthritis. Pharmacoeconomics 16, 433–448 (1999). https://doi.org/10.2165/00019053-199916050-00002

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