In this article, the 2010 European League against Rheumatism (EULAR) recommendations for the management of rheumatoid arthritis (RA) with synthetic and biological disease-modifying antirheumatic drugs (sDMARDs and bDMARDs, respectively) have been updated. The 2013 update has been developed by an international task force, which based its decisions mostly on evidence from three systematic literature reviews (one each on sDMARDs, including glucocorticoids, bDMARDs and safety aspects of DMARD therapy); treatment strategies were also covered by the searches. The evidence presented was discussed and summarised by the experts in the course of a consensus finding and voting process. Levels of evidence and grades of recommendations were derived and levels of agreement (strengths of recommendations) were determined. Fourteen recommendations were developed (instead of 15 in 2010). Some of the 2010 recommendations were deleted, and others were amended or split. The recommendations cover general aspects, such as attainment of remission or low disease activity using a treat-to-target approach, and the need for shared decision-making between rheumatologists and patients. The more specific items relate to starting DMARD therapy using a conventional sDMARD (csDMARD) strategy in combination with glucocorticoids, followed by the addition of a bDMARD or another csDMARD strategy (after stratification by presence or absence of adverse risk factors) if the treatment target is not reached within 6 months (or improvement not seen at

/pdf/eular-recommendations-for-the-management-of-rheumatoid-4fujp4paik.pdf

EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs: 2016 update

https://www.pae-eu.eu/wp-content/uploads/2013/12/Survey-of-chronic-pain-in-Europe.pdf

Survey of chronic pain in Europe: prevalence, impact on daily life, and treatment.

Treatment of rheumatoid arthritis (RA) may differ among rheumatologists and currently, clear and consensual international recommendations on RA treatment are not available. In this paper recommendations for the treatment of RA with synthetic and biological disease-modifying antirheumatic drugs (DMARDs) and glucocorticoids (GCs) that also account for strategic algorithms and deal with economic aspects, are described. The recommendations are based on evidence from five systematic literature reviews (SLRs) performed for synthetic DMARDs, biological DMARDs, GCs, treatment strategies and economic issues. The SLR-derived evidence was discussed and summarised as an expert opinion in the course of a Delphi-like process. Levels of evidence, strength of recommendations and levels of agreement were derived. Fifteen recommendations were developed covering an area from general aspects such as remission/low disease activity as treatment aim via the preference for methotrexate monotherapy with or without GCs vis-à-vis combination of synthetic DMARDs to the use of biological agents mainly in patients for whom synthetic DMARDs and tumour necrosis factor inhibitors had failed. Cost effectiveness of the treatments was additionally examined. These recommendations are intended to inform rheumatologists, patients and other stakeholders about a European consensus on the management of RA with DMARDs and GCs as well as strategies to reach optimal outcomes of RA, based on evidence and expert opinion.

EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs

Principles and Practice of Structural Equation Modeling (2nd ed.)

Measuring Health: A Guide to Rating Scales and Questionnaires

https://onlinelibrary.wiley.com/doi/epdf/10.1002/art.23108

The Rasch measurement model in rheumatology: what is it and why use it? When should it be applied, and what should one look for in a Rasch paper?

Objectives To demonstrate the use of Rasch analysis by assessing the appropriateness of utilizing the Hospital Anxiety and Depression Scale (HADS) total score (HADS-14) as a measure of psychological distress.

Design Cross-sectional, using Rasch analysis.

Methods The HADS was administered to 296 patients attending an out-patient musculoskeletal rehabilitation program. Rasch analysis was conducted using RUMM2020 software to assess the overall fit of the model, the response scale used, individual item fit, differential item functioning (DIF) and person separation.

Results Rasch analysis supported the viability of the HADS-14 as a measure of psychological distress. It showed good person separation, little disordering of the thresholds and no evidence of DIF. One anxiety item (item 11) showed some misfit to the model. The residuals patterned into the two subscales (anxiety and depression), but the person estimate derived from these two subscales was not statistically different to that derived from all items taken together, supporting the assumption of unidimensionality. A cut-point of 12 on the HADS-14 identified all cases that were classified as both anxious and depressed on the original individual HADS subscales.

Conclusions The results of Rasch analysis support the use of the HADS-14 as a global measure of psychological distress. The study demonstrates the usefulness of Rasch analysis in assessing the psychometric properties of a scale and suggests that further use of this technique to assess the HADS-14 in other clinical groups is warranted.

An introduction to the Rasch measurement model: An example using the Hospital Anxiety and Depression Scale (HADS)

Background
The Warwick-Edinburgh Mental Well-Being Scale (WEMWBS) was developed to meet demand for instruments to measure mental well-being. It comprises 14 positively phrased Likert-style items and fulfils classic criteria for scale development. We report here the internal construct validity of WEMWBS from the perspective of the Rasch measurement model.

https://link.springer.com/content/pdf/10.1186%2F1477-7525-7-15.pdf

Internal Construct Validity of the Warwick-Edinburgh Mental Well-Being Scale (WEMWBS): A Rasch Analysis using Data from the Scottish Health Education Population Survey

Background: Although disease-specific health status measures are available for ankylosing spondylitis (AS), no instrument exists for assessing quality of life (QoL) in the condition. 

Objective: To produce an AS-specific QoL measure that would be relevant and acceptable to respondents, valid, and reliable. 

Methods: The ASQoL employs the needs-based model of QoL and was developed in parallel in the UK and the Netherlands (NL). Content was derived from interviews with patients in each country. Face and content validity were assessed through patient field test interviews (UK and NL). A postal survey in the UK produced a more efficient version of the ASQoL, which was tested for scaling properties, reliability, internal consistency, and validity in a further postal survey in each country. 

Results: A 41 item questionnaire was derived from interview transcripts. Field testing interviews confirmed acceptability. Rasch analysis of data from the first survey (n=121) produced a 26 item questionnaire. Rasch analysis of data from the second survey (UK: n=164; NL: n=154) showed some item misfit, but showed that items formed a hierarchical order and were stable over time. Problematic items were removed giving an 18 item scale. Both language versions had excellent internal consistency (α=0.89–0.91), test-retest reliability (rs=0.92 UK and rs=0.91 NL), and validity. 

Conclusions: The ASQoL provides a valuable tool for assessing the impact of interventions for AS and for evaluating models of service delivery. It is well accepted by patients, taking about four minutes to complete, and has excellent scaling and psychometric properties.

/pdf/development-of-the-asqol-a-quality-of-life-instrument-4fcn58fy7v.pdf

Development of the ASQoL: a quality of life instrument specific to ankylosing spondylitis

https://onlinelibrary.wiley.com/doi/pdf/10.1111/j.1524-4733.2004.7s106.x

Alan Tennant

Papers

The Rasch measurement model in rheumatology: what is it and why use it? When should it be applied, and what should one look for in a Rasch paper?

An introduction to the Rasch measurement model: An example using the Hospital Anxiety and Depression Scale (HADS)

Internal Construct Validity of the Warwick-Edinburgh Mental Well-Being Scale (WEMWBS): A Rasch Analysis using Data from the Scottish Health Education Population Survey

Development of the ASQoL: a quality of life instrument specific to ankylosing spondylitis

Application of Rasch analysis in the development and application of quality of life instruments.