Life satisfaction in early rheumatoid arthritis: a prospective study

The aim of this study was to describe life satisfaction prospectively in patients with early rheumatoid arthritis (RA) and to investigate its correlation with disease activity. The early RA group was compared with RA patients with longstanding disease and with a reference group. Gender differences were also compared. Patients with early RA, treated by a multidisciplinary team, reported their life satisfaction by completing a questionnaire. Disease activity score, patient global assessment, and pain were scored at onset of disease and after two years. The patients with early RA were less satisfied with life as a whole at disease onset compared with the reference group, as was a cohort of patients with longstanding disease. Patients with early RA also reported low levels of satisfaction with self-care activities, work, and sexual life. The women reported themselves more satisfied than men. After two years, a slight increase in the reported levels of satisfaction could be seen for life as a whole and for five of the eight domains. No correlation was found between disease activity variables and satisfaction with life as a whole. There were, however, positive correlations between disease activity and satisfaction both with partnership and with family life after two years, i.e. the higher disease activity the higher satisfaction with partnership relation and family life. In contrast, patients with greater disease activity were less satisfied with self-care activities. The results of this study indicate that greater effort is needed to assist patients with early RA to cope with problems concerning self-care activities, sexual life, and work.     

Changes in psychopathology following functional restoration of chronic low back pain patients: A prospective study

Past research has consistently demonstrated high rates of psychopathology in patients disabled with chronic low back pain. The purpose of the present study was to evaluate whether functional restoration treatment of these patients would lead to significant changes in psychopathology. Fifty-six patients were evaluated for current psychiatric disorders, using a structured clinical interview for DSM-III-R disorders, upon admission to a comprehensive 3 week functional restoration program, and again at 6 months following their rehabilitation. Results clearly documented significant decreases in prevalence rates of psychiatric disorders, particularly somatoform pain disorder and major depression. Such findings demonstrate that effective rehabilitation can significantly decrease the high rates of psychopathology commonly found in chronic low back pain patients.     

A case-control study of rheumatoid arthritis in Lebanon

A case-control study was conducted to investigate the risk factors contributing to the development of rheumatoid arthritis (RA) in Lebanon. One hundred cases of classical and definite RA were identified from various care facilities in Beirut. Each case was matched with another patient of the same age and sex and free from any arthritic problem. Data on demographic, socioeconomic, genetic and psychosocial factors were collected. Histories obtained from both case and control groups showed a significant difference as to their family history of RA (odds ratio = 2), their past history of trauma (OR = 4) and their history of tonsillitis (OR = 2.2). A significantly higher proportion of cases reported the occurrence of major life events prior to the onset of their disease (OR = 2.5). The perception of the nuclear family environment was compared in both case and control groups. More RA patients were brought up in a family of high conflict (OR = 5), low cohesion (OR = 2) and low expressiveness (OR = 3.5).     

Isokinetic strength testing in monitoring progress in a multidisciplinary work reentry program: A case study

The purpose of this paper is to present a case study of a patient with a history of low back pain and the use of isokinetic testing in tracking that patient through a work-reentry program. A 44-year-old male with a diagnosis of low back pain underwent a functional capacity evaluation and began a work-reentry program. Initial isokinetic testing revealed low torque outputs in both the trunk and knee flexion and extension tests as well as limited active range of motion. Coefficient of variation appeared to be relatively high and the patient seemed guarded in his movements during the testing. Psychological testing revealed a high fear of reinjury which may have influenced the initial test. Subsequent isokinetic testing performed on the tenth and twenty-fourth days of program and at 1 month post-program exhibited greater than expected increases in torque output. This could be due in part to a reduction in the fear of reinjury, a learning effect with repeated exposure to testing, and the patient's increased confidence in the use of unguarded movements. His trunk range of motion remained essentially the same throughout the serial testing. Pain in the back and left leg was slightly diminished despite an increase in strength and function.     

Expectations of new treatment in rheumatoid arthritis: developing a patient‐generated questionnaire

Background

Service‐user partnerships in research exist in mental health, but there have been few advances in other disciplines, apart from cancer.

Objectives

To develop a patient‐generated expectancy measure for new treatments in rheumatoid arthritis (RA), using a participatory method.

Method

Stage 1: three repeated focus groups and two expert panels with patients with RA conducted by a patient researcher to generate items for the draft questionnaire. Stage 2: feasibility study of draft scale with consecutive outpatient attendees.

Results

Patients identified 21 dimensions of new treatment expectations, grouped into (i) physical, (ii) psycho‐social and (iii) expectations relating to the impact of treatment. This resulted in a draft instrument assessed in a feasibility study.

Discussion and Conclusion

The participatory research method was useful in involving patients actively in research and to produce collaboratively a feasible, valid and acceptable measure in RA. The scale will be included in a longitudinal observational study, with newly diagnosed patients, to assess (i) whether the new scale demonstrates sensitivity to change for expectations when receiving new treatment and (ii) participants' completion rate of the new scale compared with five instruments included in the future study.     

Stressful life events and disability in early rheumatoid arthritis

The objective was to investigate the relationship of stressfullife events and disability in early rheumatoid arthritis (RA),taking into account a possible stress-buffering effect of thesocial network. As part of a European study (EURIDISS), 337early RA patients in France and The Netherlands (mean diseaseduration = 2.3 years) were interviewed for life events whichhad occurred in the past year. The social network compositionwas assessed using a standardized interview schedule and describedby network density and proximity characteristics. Disabilitywas assessed with the Health Assessment Questionnaire (HAQ)cross-culturally adapted to the French and Dutch languages.Subjects reported a median of 2 significant life events overthe past year. On average they had 20 persons in their socialnetwork. The disability was significantly higher when the numberof life events experienced was higher (r = 0.11; p<0.05)and when the number of social network members in monthly contactwith the subjects was lower (r = –0.13; p<0.05). Controllingfor country, the HAQ score increased significantly with thedisease duration, disease activity variables, number of lifeevents related to RA or to another health problem and decreasedwith the number of social network members. A significant (numberof health-related life events)x(number of social network members)cross-product term entered the model which fitted the data better(R² =0.51). Factors associated with disability are disease duration,disease activity, number of health-related life events and numberof social network members in monthly contact. The results suggesta stress-buffering effect of the social network in coping withstressful life events in early RA.     

Combined ergonomic exposures and development of musculoskeletal pain in the general working population: A prospective cohort study

Objective:This study aimed to investigate the importance of combined ergonomic exposures at work for the development of musculoskeletal pain.Methods:Through four rounds (2012–2018) of the Work Environment and Health in Denmark Study, 18 905 employees of the general working population replied to a baseline and 2-year follow-up questionnaire. First, a k-means cluster analysis of seven ergonomic factors (back bending, arm above shoulders, lifting etc., from ‘never’ to ‘almost all the time’) identified nine naturally occurring clusters. Second, using a weighted survey regression model controlling for age, gender, survey year, education, lifestyle, influence at work, and pain intensity at baseline, we estimated development of pain intensity (0–10) in the neck-shoulder and low-back in these clusters. The largest cluster served as reference to the other clusters and was characterized by low ergonomic exposures.Results:Clusters characterized by multiple combined ergonomic exposures for a relatively high percentage of the working time showed the largest increase in neck-shoulder as well as low-back pain intensity from baseline to follow-up. However, clusters characterized by high exposure to a few specific ergonomic factors also increased pain significantly, eg, standing/walking combined with lifting/carrying or twisted/bent back for the majority of the working time increased low-back pain, whereas repetitive arm movements for the majority of the working time with or without standing/walking increased neck-shoulder pain.Conclusion:Combined occupational ergonomic exposures play an important role in the development of musculoskeletal pain. Workplace preventive approaches should consider this in risk assessments and organization of the work.     

Tick-borne encephalitis (TBE) vaccine to medically immunosuppressed patients with rheumatoid arthritis: A prospective,open-label,multi-centre study

BackgroundTick-borne Encephalitis (TBE) is endemic in south-eastern Sweden as well as in the Baltic regions, Central Europe and Russia. Ageing and immunosuppressed individuals are more prone to severe disease and neurological complications. We assessed the immunogenicity of TBE-vaccine in rheumatoid arthritis (RA) patients treated with tumor necrosis factor-inhibitors (TNFi) and/or methotrexate (MTX).MethodsTBE vaccine, FSME-Immune^® or Encepur^®, was administered to non-immune RA patients as well as age and gender matched healthy controls. Individuals <60 years of age were given three doses at month 0, 1, 12. Individuals ≥60 years old were given an additional priming dose at month 3, i.e. a total of four doses. Tick-borne encephalitis neutralizing antibodies were assessed by a rapid fluorescent focus inhibition test.ResultsThe study population consisted of 66 patients and 56 age and gender matched healthy controls. Median age was 58.5 years. The patients were either treated with TNFi (n = 16), TNFi + MTX (n = 36) or MTX (n = 14). After the last TBE-vaccine dose, given one year after the first, 39% of the patients compared to 79% of the healthy controls had seroprotective levels (p = <0.05).ConclusionsStandard TBE-vaccine schedule does not confer enough immunogenicity in this group of immunosuppressed patients, who should be carefully informed about a higher risk for vaccination failure and risk of infection when exposed in high-endemic areas.     

益赛普联合甲氨蝶呤治疗早期类风湿关节炎的临床研究

[目的]评价益赛普(rh TNFR:Fc重组人Ⅱ型肿瘤坏死因子受体-抗体融合蛋白)联合甲氨蝶呤(MTX)治疗早期类风湿关节炎(RA)的有效性和安全性。[方法]将32例早期活动性RA患者(病程≤2年)随机分为两组,试验组22例在给予MTX每周7.5～15 mg治疗同时予以益赛普皮下注射治疗,每周2次,每次25 mg。对照组10例单用MTX每周7.5～15 mg治疗,疗程共为24周。在0、4、8、12、24周观察两组患者的休息痛、晨僵持续时间、关节肿胀压痛、健康评价(HAQ)、病人对疾病的评估、医生对病情的评估、红细胞沉降率(ESR)、C反应蛋白(CRP)、类风湿因子(RF),采用ACR20、ACR50、ACR70标准来评价疗效,并记录治疗过程中的任何不良事件。[结果]30例完成了试验。在第4、8、12、24周两组疗效比较差异均有统计学意义(P<0.05或P<0.01),在第24周末,试验组有77.27%(17/20)的患者达到ACR70标准,明显优于对照组。24周末两组的ESR、CRP及RF较0周时均有明显改善(P<0.05),但两组间比较无统计学差异(P>0.05)。试验组脱落2例,不良反应主要是感染,无严重不良反应。[结论]益赛普联用MTX的治疗方案对早期活动性RA疗效确切,治疗RA的短期疗效明显优于单用MTX,而不良反应以感染为多见。     

Comparison of three methods for measuring height in rehabilitation inpatients and the impact on body mass index classification: An open prospective study

Aim

To compare standing height, estimated current height and demi‐span estimated height and examine their impact on body mass index (BMI) classification.

Methods

Cross‐sectional data was collected on 104 patients admitted to an adult rehabilitation ward and seen by the dietitian. Patient's standing, estimated current height and demi‐span estimated height were collected and grouped by age: 19–64 and ≥65 years.

Results

The limits of agreement (95% confidence interval) for estimated current height compared with standing height were +9.9 cm and ?7.9 cm, in contrast to +8.7 cm and ?14.3 cm for demi‐span estimated height. Demi‐span underestimated height when compared with standing height in both age groups, 19–64 years: (mean ± SD) 3.0 ± 6.5 cm (P = 0.001, n = 68) and ≥ 65 year age group 4.0 ± 6.0 cm (P < 0.001, n = 36), resulting in a significantly greater mean BMI (analysis of variance P < 0.001, P = 0.02). In the 19‐64 and ≥65 year age groups, 3% (2/68) and 10% (4/36) of patients, respectively, had a different BMI classification using demi‐span estimated height compared with standing height.

Conclusions

Estimated current height is a simple and practical alternative if standing height is unable to be obtained when performing a nutrition assessment. Demi‐span estimated height should be used with caution when calculating BMI to assess nutritional status, particularly in the elderly.     

Performance in leisure-time physical activities and self-efficacy in females with rheumatoid arthritis

Abstract

The purpose of this study was to examine leisure-time physical activities (LTPAs) and their association with self-efficacy in females with rheumatoid arthritis (RA) (n = 238). Their self-reported performance in LTPAs was measured by the Interest Checklist and efficacy beliefs by using the Arthritis Self-Efficacy Scales (ASES). LTPAs were classified as active or less active according to how many LTPAs they performed. The participants had reduced their participation in LTPAs by almost one-third during the last year. Active individuals performed the vigorous activities more often, they had a higher level of education, were working to a significantly greater extent, and reported better function, higher scores on the self-efficacy scales, and lower joint pain and fatigue. Multivariate analyses demonstrated that a high level of LTPAs was independently related to less fatigue (OR 0.98, p = 0.004), positive self-efficacy in coping with RA functions (OR 1.03, p = 0.015), and higher employment level (OR 0.42, p = 0.039). Only a quarter of the responders were physically active in their leisure time in the present study. Less active individuals reduced their performance in LTPAs to a much higher degree than active individuals during the last year. Partaking in a high amount of LTPAs was related to less fatigue and higher efficacy beliefs.     

Barriers to patient information provision in primary care: patients' and general practitioners' experiences and expectations of information for low back pain

Background As patient involvement in health‐care increases, the role of information is crucial, especially in conditions where self‐management is considered an integral part of care. However, the suitability and applicability of much patient information has not been appraised in terms of how far it meets patients' information needs. Aims To ascertain patients' and clinicians' experiences and expectations of information in low back pain in order to suggest a suitable ‘patient‐centred’ content for a patient information pack to be used in a primary care setting. Methods A qualitative study using semi‐structured interviews with General Practitioners (GPs) (n = 15) and focus groups comprising patients with low back pain (n = 37). Results Barriers to information‐giving for low back pain in primary care exist. Patients are dissatisfied with the information they receive from their GPs, especially regarding diagnosis and treatment. Patients tend to access information from a variety of other sources, which is often contradictory, conflicts with research evidence and leads to unreasonable expectations. GPs have varying views regarding the value of patient information and are equivocal about their roles as information providers. Although The Back Book is generally acceptable as a patient information leaflet for low back pain, attention to the tone of the text is required. Conclusions Barriers exist to patient information provision, both generally and for low back pain, which need to be addressed in order to close the gap between strategy and implementation. Improving clinician communication skills and involving patients in developing information materials which meet their needs are crucial to this process.     

Life satisfaction of women in early stages of fertility treatment

As many women perceive motherhood to be a central component of identity that enhances life satisfaction, difficulties conceiving may lead to stress. This study examined women in the early stages of fertility treatment to ascertain the relations of perceived stress, cognitive appraisal, and self-mastery to the life satisfaction of women embarking on fertility treatment and whether the associations were the same for women who were already mothers versus those who were not. Women were recruited for the study over a period of 18 months, from January 2013 to June 2014. The final sample was composed of 145 women; of these, 67 had 1 or 2 children and 78 had no children. No significant differences were found in perceived stress and life satisfaction between women with and without children. However, in the sample as a whole, higher levels of self-mastery and lower levels of stress were associated with greater life satisfaction. Moreover, the associations between self-mastery and cognitive appraisals of threat and self-efficacy were mediated by perceived stress. The findings highlight the importance of developing interventions at fertility clinics that begin at the very first point of contact to promote the psychological well-being of women being treated for infertility.