Academic journal article British Journal of Occupational Therapy

A Narrative Literature Review of the Impact of Anti-TNF[alpha] Treatment on the Occupational Performance of People with Rheumatoid Arthritis or Ankylosing Spondylitis

Academic journal article British Journal of Occupational Therapy

A Narrative Literature Review of the Impact of Anti-TNF[alpha] Treatment on the Occupational Performance of People with Rheumatoid Arthritis or Ankylosing Spondylitis

Article excerpt

Introduction

Rheumatoid arthritis (RA) is a chronic, progressive inflammatory disease with the potential to cause cartilage destruction and bone erosions (Bresnihan 1999) and affects around 387,000 adults in the United Kingdom (UK), with approximately 12,000 new cases diagnosed each year (Arthritis Research Campaign [ARC] 2002). Within two years of diagnosis, 60% of people with RA experience problems with leisure, household and social activities (Young et al 2000); about a third of people with RA will leave employment prematurely (Backman 2004); hand function in women is 40% of normal function within six months of diagnosis (Hammond et al 2000) and up to 70% of people experience fatigue (Hewlett et al 2011).

Ankylosing spondylitis (AS) affects the sacroiliac joints (at the junction of the spine and the pelvis), axial skeleton (the skull, spinal column ribs), entheses (points at which a tendon or ligament or muscle inserts into bone) and, occasionally, peripheral (upper and lower limb) joints; it predominantly affects younger adults (Braun et al 2005). Approximately 70 per 100,000 men and 14 per 100,000 women have AS (Parsons et al 2011). Failure to prevent disease progression leads to the development of severe spinal restriction (Marzo-Ortega et al 2005). People with AS experience pain, fatigue, poor sleep (Ward 1998) and difficulties with family relationships, sexual function and work (Ozgul et al 2006). Withdrawal from work is three times more common than in the general population (ARC 2002). People with AS have been shown to experience levels of disability and pain similar to people with RA (Zink et al 2000).

The focus of clinical interventions in RA and AS is on controlling pain and inflammation, reducing joint damage and maintaining or improving physical function and quality of life (QoL). Tumour necrosis factor (TNF[alpha]) plays a crucial role in the development of inflammatory arthritis, promoting inflammation and joint damage (Taylor et al 2000). Evidence has been growing since the mid 1990s that anti-TNF[alpha] blocks proinflammatory cytokines, damping down physiological factors but also potentially ameliorating the psychological impact of having a chronic illness (de Ridder et al 2008), thereby reducing disease activity and improving function and quality of life (Baraliakos et al 2005, Weinblatt et al 2006). In 2002, the National Institute for Health and Care Excellence (NICE) recommended the use of these therapies in people with RA who had not responded well to at least two disease-modifying anti-rheumatic drugs (NICE 2002). In 2008, similar guidance was issued for people with AS (NICE 2008). In 2006, approximately 10,000 people with RA were using anti-TNF[alpha] therapies in the UK at an estimated annual cost of approximately 100 million (Chen et al 2006). This number will continue to increase as more people become eligible for anti-TNF[alpha] treatment.

This literature review was conducted to explore the current evidence on the impact of anti-TNF[alpha] treatment on occupational performance in people with RA and AS. It was undertaken to inform a wider United Kingdom Occupational Therapy Research Foundation-funded (UKOTRF) project looking at the experiences of occupational gain in people with RA and AS on anti-TNF[alpha] medication.

Method

This literature review was undertaken in phases, informed by the framework of the Evidence for Policy and Practice Information and Co-ordinating Centre (EPPI-Centre) (EPPICentre 2007) (see Table 1).

Phase 1: defining the parameters

The ASSIA, CINAHL, Web of Science, PubMed (medline) and

Cochrane reviews databases were searched from 2000 to 2011. Subsequently, a manual search of both reference lists in studies which met the review's inclusion criteria and key rheumatology journals was performed. These journals were: Rheumatology, Annals of Rheumatic Disease, Arthritis Care and Research and Journal of Rheumatology. …

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