Periodontal disease and the oral microbiota in new‐onset rheumatoid arthritis

Objective

To profile the abundance and diversity of subgingival oral microbiota in patients with never‐treated, new‐onset rheumatoid arthritis (RA).

Methods

Periodontal disease (PD) status, clinical activity, and sociodemographic factors were determined in patients with new‐onset RA, patients with chronic RA, and healthy subjects. Multiplexed‐454 pyrosequencing was used to compare the composition of subgingival microbiota and establish correlations between the presence/abundance of bacteria and disease phenotypes. Anti–Porphyromonas gingivalis antibody testing was performed to assess prior exposure to the bacterial pathogen P gingivalis.

Results

The more advanced forms of periodontitis were already present at disease onset in patients with new‐onset RA. The subgingival microbiota observed in patients with new‐onset RA was distinct from that found in healthy controls. In most cases, however, these microbial differences could be attributed to the severity of PD and were not inherent to RA. The presence and abundance of P gingivalis were also directly associated with the severity of PD and were not unique to RA. The presence of P gingivalis was not correlated with anti–citrullinated protein antibody (ACPA) titers. Overall exposure to P gingivalis was similar between patients with new‐onset RA and controls, observed in 78% of patients and 83% of controls. The presence and abundance of Anaeroglobus geminatus correlated with the presence of ACPAs/rheumatoid factor. Prevotella and Leptotrichia species were the only characteristic taxa observed in patients with new‐onset RA irrespective of PD status.

Conclusion

Patients with new‐onset RA exhibited a high prevalence of PD at disease onset, despite their young age and paucity of smoking history. The subgingival microbiota profile in patients with new‐onset RA was similar to that in patients with chronic RA and healthy subjects whose PD was of comparable severity. Although colonization with P gingivalis correlated with the severity of PD, overall exposure to P gingivalis was similar among the groups. The role of A geminatus and Prevotella/Leptotrichia species in this process merits further study.

     

Impact of fatigue on health‐related quality of life in rheumatoid arthritis

Objective

To multidimensionally assess fatigue in rheumatoid arthritis (RA) and to evaluate the impact of fatigue on health‐related quality of life (HRQOL).

Methods

The study was conducted in 1999 among 490 RA patients with varying disease duration. Fatigue was measured with the Multidimensional Fatigue Inventory (MFI‐20) and HRQOL with a validated Dutch version of the RAND 36‐Item Health Survey. We evaluated the impact of fatigue on HRQOL by multiple linear regression analyses taking into account RA‐related pain and depressive symptoms.

Results

Different aspects of fatigue selectively explained different dimensions of HRQOL. The MFI‐20 was entered last to the linear regression models, resulting in an additional increase of explained variance of 1% (mental health) to 14% (vitality).

Conclusion

The multidimensional portrayal of RA‐related fatigue can be used to develop intervention strategies targeted to specific aspects of fatigue. Fatigue, supplementary to RA‐related pain and depressive symptoms, appears to be a feasible and treatable target in the clinical management of RA to increase HRQOL.

     

PAN–DR‐Binding Hsp60 self epitopes induce an interleukin‐10–mediated immune response in rheumatoid arthritis

Objective

Human Hsp60 is expressed in the joints of patients with rheumatoid arthritis (RA) and can elicit a regulatory T cell response in the peripheral blood and synovial fluid. However, Hsp60 can also trigger strong proinflammatory pathways. Thus, to understand the nature of these Hsp60‐directed responses in RA, it is necessary to study such responses at the molecular, epitope‐specific level. This study was undertaken to characterize the disease specificity and function of pan–DR‐binding Hsp60–derived epitopes as possible modulators of autoimmune inflammation in RA.

Methods

Lymphocyte proliferation assays (using ³H‐thymidine incorporation and carboxyfluorescein diacetate succinimidyl ester [CFSE] staining) and measurement of cytokine production (using multiplex immunoassay and intracellular staining) were performed after in vitro activation of peripheral blood mononuclear cells from patients with RA, compared with healthy controls.

Results

A disease (RA)–specific immune recognition, characterized by T cell proliferation as well as increased production of tumor necrosis factor α (TNFα), interleukin‐1β (IL‐1β), and IL‐10, was found for 3 of the 8 selected peptides in patients with RA as compared with healthy controls (P < 0.05). Intracellular cytokine staining and CFSE labeling showed that CD4+ T cells were the subset primarily responsible for both the T cell proliferation and the cytokine production in RA. Interestingly, the human peptides had a remarkably different phenotype, with a 5–10‐fold higher IL‐10:TNFα ratio, compared with that of the microbial peptides.

Conclusion

These results suggest a disease‐specific immune‐modulatory role of epitope‐specific T cells in the inflammatory processes of RA. Therefore, these pan–DR‐binding epitopes could be used as a tool to study the autoreactive T cell response in RA and might be suitable candidates for use in immunotherapy.

     

Exploring perceptions of a rheumatoid arthritis‐specific smoking cessation programme

Aim

Smoking cessation is an important consideration in the management of rheumatoid arthritis (RA). The aim of the present study was to determine which aspects of a novel three‐month smoking cessation intervention were most useful for people with RA, and to identify areas for improvement.

Method

Thirty‐eight current smokers with RA (19 intervention and 19 control) enrolled in a previous randomized controlled trial (RCT) of smoking cessation and two arthritis educators who had provided the intervention were interviewed. The data were analysed thematically using a combination of deductive and inductive approaches to identify themes.

Results

Intervention participants and the educators identified individualized support and advice as the two most important components of the smoking cessation intervention. The generic smoking cessation components and education about the links between smoking and RA were also identified as important. Nicotine replacement therapy was provided to all participants and was the most commonly reported facilitator of smoking cessation. People with RA who reported being ready to quit smoking had more success at smoking cessation. The educators were positive about ongoing provision of the smoking cessation intervention.

Conclusion

The novel RA‐specific smoking cessation intervention that had formed the basis of the previous RCT provided useful and varied options to assist quitting smoking in RA. Successful quitters were ready and motivated to quit smoking regardless of their randomization status, with nicotine replacement therapy an effective aid to quitting. Support offered by the educators was critical in the participants' perspective.     

Training Physical Therapists in Person‐Centered Practice for People With Osteoarthritis: A Qualitative Case Study

Objective

To explore physical therapists’ experiences with, and the impacts of, a training program in person‐centered practice to support exercise adherence in people with knee osteoarthritis.

Methods

This was a qualitative case study using semi‐structured interviews, nested within a clinical trial. Eight Australian physical therapists were interviewed before, and after, training in person‐centered practice for people with knee osteoarthritis. Training involved a 2‐day workshop, skills practice, and audit of 8 consultations with 4 patients (per therapist), and a final single‐day workshop for audit feedback and consolidation. Semi‐structured interviews were audio‐recorded and transcribed verbatim. Data were thematically analyzed.

Results

Three pretraining themes arose regarding usual communication style, definitions of person‐centered care, and sharing exercise adherence responsibility. Three themes related to the training experience emerged: learning a new language, challenging conceptions of practice, and putting it into practice. Post‐training, 3 themes arose regarding new knowledge deepening understanding of person‐centered care, changing beliefs about sharing responsibilities, and changed conceptions of role.

Conclusion

Although physical therapists found training overwhelming initially as they realized the limitations of their current knowledge and clinical practice, they felt more confident and able to provide person‐centered care to people with knee osteoarthritis by the end of training. Training in structured person‐centered methodology that provides opportunity for skills practice with patients using a restructured consultation framework can change physical therapists’ beliefs about their roles when managing patients with osteoarthritis and positively impact their clinical practice.

     

Addressing rural and remote access disparities for patients with inflammatory arthritis through video‐conferencing and innovative inter‐professional care models

Objective

The aim of the present study was to evaluate whether rheumatoid arthritis (RA) patients followed longitudinally using video‐conferencing and inter‐professional care support have comparable disease control to those followed in traditional in‐person rheumatology clinics.

Methods

This was a randomized controlled trial for 85 RA patients allocated to either traditional in‐person rheumatology follow‐up or video‐conferenced follow‐up with urban‐based rheumatologists and rural in‐person physical therapist examiners. Follow‐up was every 3 months for 9 months. Outcome measures included disease activity metrics (disease activity in 28 joints with CRP measure score [DAS28‐CRP], and RA disease activity index [RADAI]), modified health assessment questionnaire (mHAQ), quality of life (EuroQOL five dimensions questionnaire [EQ5D]) and patient satisfaction (nine‐item visit‐specific satisfaction questionnaire [VSQ9]).

Results

Of 85 participants, 54 were randomized to the video‐conferencing team model and 31 to the traditional clinic (control group). Dropout rates were high, with only 31 (57%) from the video‐conferencing and 23 (74%) from the control group completing the study. The mean age for study participants was 56 years; 20% were male. Mean RA disease duration was 13.9 years. There were no significant between‐group differences in DAS28‐CRP, RADAI, mHAQ or EQ5D scores at baseline or over the study period. Satisfaction rates were high in both groups.

Conclusions

We found no evidence of a difference in effectiveness between inter‐professional video‐conferencing and traditional rheumatology clinic for both the provision of effective follow‐up care and patient satisfaction for established RA patients. High dropout rates reinforce the need for consultation with patients' needs and preferences in developing models of care. While use of video‐conferencing/telehealth technologies may be a distinct advantage for some patients, there may be loss of travel‐related auxiliary benefits for others.     

Soluble VE‐cadherin in rheumatoid arthritis patients correlates with disease activity: Evidence for tumor necrosis factor α–induced VE‐cadherin cleavage

Objective

Rheumatoid arthritis (RA) is a chronic, systemic inflammatory disorder that principally attacks synovial joints. However, accelerated atherosclerosis and increased cardiovascular morbidity and mortality are major clinical consequences of endothelial dysfunction in RA patients. Tumor necrosis factor α (TNFα) is the major mediator of inflammation in RA, related to vascular injury by targeting VE‐cadherin, an endothelium‐specific adhesion molecule of vital importance for endothelium integrity and angiogenesis. We undertook this study to examine the mechanisms regulating VE‐cadherin processing by TNFα and their occurrence in RA.

Methods

Human umbilical vein endothelial cells were used in primary culture and treated with recombinant TNFα to study VE‐cadherin cleavage. Cell lysates and conditioned media were analyzed by Western blotting for VE‐cadherin cytoplasmic domain and extracellular domain (VE‐90) generation, respectively. VE‐90 was analyzed at baseline and at the 1‐year followup in sera from 63 RA patients (from the Very Early Rheumatoid Arthritis cohort) with disease duration of <6 months.

Results

TNFα induced a time‐dependent shedding of VE‐90 in cell media. This effect was prevented by tyrosine kinase inhibitors (genistein and PP2) or by knocking down Src kinase. In contrast, tyrosine phosphatase blockade enhanced VE‐cadherin cleavage, confirming the requirement of tyrosine phosphorylation processes. In addition, using the matrix metalloproteinase (MMP) activator APMA and the MMP inhibitor GM6001, we demonstrated that MMPs are involved in TNFα‐induced VE‐cadherin cleavage. Of major importance, VE‐90 was detected in sera from the 63 RA patients and was positively correlated with the Disease Activity Score at baseline and after 1‐year followup.

Conclusion

These findings provide the first evidence of VE‐cadherin proteolysis upon TNFα stimulation and suggest potential clinical relevance of soluble VE‐cadherin in management of RA.

     

Foot‐related health care use in patients with rheumatoid arthritis in an outpatient secondary care center for rheumatology and rehabilitation in The Netherlands: A cohort study with a maximum of fifteen years of followup

Objective

To describe foot‐related health care use over time in a cohort of rheumatoid arthritis (RA) patients in an outpatient secondary care center for rheumatology and rehabilitation in The Netherlands.

Methods

A total of 1,087 patients with recent‐onset RA from 1995 to September 2010 were included in the study. All foot‐related visits to the podiatrist, rehabilitation physician, orthopedic surgeon, and the multidisciplinary foot‐care clinic were registered and described. Logistic regression techniques for longitudinal data were used to analyze the course of foot‐related health care use.

Results

A total of 32.9% of patients visited a podiatrist in secondary care during the course of their disease. For most patients, a visit to the podiatrist took place during the first year after diagnosis. This was followed by a significant decrease in visits in the ensuing years. Nine percent of patients visited the rehabilitation physician with foot symptoms, with peak prevalences between year 10 and 11 and during year 14 of followup. The orthopedic surgeon was visited by 5.3% of patients with foot symptoms, with a significant increase in visits over time. The multidisciplinary foot‐care clinic was visited by 7.5% of patients. This was significantly associated with visits to the rehabilitation physician.

Conclusion

In an outpatient secondary care center in The Netherlands, RA patients with foot symptoms visited the podiatrist in an early stage of the disease. When foot symptoms worsened, patients visited the rehabilitation physician, who subsequently referred patients to the multidisciplinary foot‐care clinic for therapeutic footwear. The orthopedic surgeon was the final step in the management of foot symptoms.     

Discovery of new rheumatoid arthritis biomarkers using the surface‐enhanced laser desorption/ionization time‐of‐flight mass spectrometry ProteinChip approach

Objective

To identify serum protein biomarkers specific for rheumatoid arthritis (RA), using surface‐enhanced laser desorption/ionization time‐of‐flight mass spectrometry (SELDI‐TOF‐MS) technology.

Methods

A total of 103 serum samples from patients and healthy controls were analyzed. Thirty‐four of the patients had a diagnosis of RA, based on the American College of Rheumatology criteria. The inflammation control group comprised 20 patients with psoriatic arthritis (PsA), 9 with asthma, and 10 with Crohn's disease. The noninflammation control group comprised 14 patients with knee osteoarthritis and 16 healthy control subjects. Serum protein profiles were obtained by SELDI‐TOF‐MS and compared in order to identify new biomarkers specific for RA. Data were analyzed by a machine learning algorithm called decision tree boosting, according to different preprocessing steps.

Results

The most discriminative mass/charge (m/z) values serving as potential biomarkers for RA were identified on arrays for both patients with RA versus controls and patients with RA versus patients with PsA. From among several candidates, the following peaks were highlighted: m/z values of 2,924 (RA versus controls on H4 arrays), 10,832 and 11,632 (RA versus controls on CM10 arrays), 4,824 (RA versus PsA on H4 arrays), and 4,666 (RA versus PsA on CM10 arrays). Positive results of proteomic analysis were associated with positive results of the anti–cyclic citrullinated peptide test. Our observations suggested that the 10,832 peak could represent myeloid‐related protein 8.

Conclusion

SELDI‐TOF‐MS technology allows rapid analysis of many serum samples, and use of decision tree boosting analysis as the main statistical method allowed us to propose a pattern of protein peaks specific for RA.

     

Targeting interleukin‐15 in patients with rheumatoid arthritis: A proof‐of‐concept study

Objective

Interleukin‐15 (IL‐15) is a proinflammatory, innate response cytokine that mediates pleiotropic effector function in rheumatoid arthritis (RA) inflammatory synovitis. Our objective was to study the ability of HuMax‐IL15, a human IgG1 anti–IL‐15 monoclonal antibody, to neutralize exogenous and endogenous IL‐15 activity in vitro and to perform a phase I–II dose‐escalation trial with HuMax‐IL15 in patients with active RA.

Methods

Mononuclear cells from blood and synovial fluid (SF) of RA patients were isolated and cultured in vitro under experimental conditions involving the addition of HuMax‐IL15. HuMax‐IL15 was administered to 30 RA patients who received no other disease‐modifying antirheumatic drugs in a 12‐week, dose‐ascending, placebo‐controlled, double‐blind, phase I–II proof‐of‐concept study.

Results

In vitro studies showed that HuMax‐IL15 suppressed proliferation and induced apoptosis in an IL‐15–dependent cell line, BDB2, and was capable of suppressing the release of interferon‐γ by synovial fluid mononuclear cell (SFMC) cultures induced by exogenous IL‐15. Furthermore, HuMax‐IL15 F(ab′)₂ fragments suppressed exogenous IL‐15–induced CD69 expression in RA peripheral blood mononuclear cells and SFMCs, which indicates that HuMax‐IL15 can specifically neutralize several biologic effects of IL‐15 in synovial tissue in vitro. In a phase I–II clinical trial, HuMax‐IL15 was well tolerated clinically, with no significant effects on T lymphocyte subset and natural killer cell numbers. Substantial improvements in disease activity were observed according to the American College of Rheumatology criteria for 20% improvement (63% of patients), 50% improvement (38%), and 70% improvement (25%).

Conclusion

These clinical data suggest for the first time that IL‐15 could represent a novel therapeutic target in RA.

     

The programmed death 1/programmed death ligand 1 inhibitory pathway is up‐regulated in rheumatoid synovium and regulates peripheral T cell responses in human and murine arthritis

Objective

T cells play a major role in the pathogenesis of rheumatoid arthritis (RA). The programmed death 1 (PD‐1)/programmed death ligand 1 (PDL‐1) pathway is involved in peripheral tolerance through inhibition of T cells at the level of synovial tissue. The aim of this study was to examine the role of PD‐1/PDL‐1 in the regulation of human and murine RA.

Methods

In synovial tissue and synovial fluid (SF) mononuclear cells from patients with RA, expression of PD‐1/PDL‐1 was examined by immunohistochemistry and flow cytometry, while PD‐1 function was assessed in RA peripheral blood (PB) T cells after stimulation of the cells with anti‐CD3 and PDL‐1.Fc to crosslink PD‐1. Collagen‐induced arthritis (CIA) was induced in PD‐1^−/− C57BL/6 mice, and recombinant PDL‐1.Fc was injected intraperitoneally to activate PD‐1 in vivo.

Results

RA synovium and RA SF were enriched with PD‐1+ T cells (mean ± SEM 24 ± 5% versus 4 ± 1% in osteoarthritis samples; P = 0.003) and enriched with PDL‐1+ monocyte/macrophages. PD‐1 crosslinking inhibited both T cell proliferation and production of interferon‐γ (IFNγ) in RA patients; PB T cells incubated with RA SF, as well as SF T cells from patients with active RA, exhibited reduced PD‐1–mediated inhibition of T cell proliferation at suboptimal, but not optimal, concentrations of PDL‐1.Fc. PD‐1^−/− mice demonstrated increased incidence of CIA (73% versus 36% in wild‐type mice; P < 0.05) and greater severity of CIA (mean maximum arthritis score 5.0 versus 2.3 in wild‐type mice; P = 0.040), and this was associated with enhanced T cell proliferation and increased production of cytokines (IFNγ and interleukin‐17) in response to type II collagen. PDL‐1.Fc treatment ameliorated the severity of CIA and reduced T cell responses.

Conclusion

The negative costimulatory PD‐1/PDL‐1 pathway regulates peripheral T cell responses in both human and murine RA. PD‐1/PDL‐1 in rheumatoid synovium may represent an additional target for immunomodulatory therapy in RA.

     

Comparison of employability outcomes among patients with early or long‐standing rheumatoid arthritis

Objective

To compare employability between patients with early and long‐standing rheumatoid arthritis (RA) and examine the relationships between improvement in employability and disease stage after adjustment for demographic characteristics, disease activity, physical functioning, and response to therapy.

Methods

We evaluated the employability data from 2 double‐blind, randomized, placebo‐controlled studies of infliximab plus methotrexate (MTX) in patients with RA. Patients were incomplete responders to MTX in 1 study and had never taken MTX in the other study. Patients age <65 years were categorized as having early RA (≤3 years disease duration) or long‐standing RA (>3 years disease duration). Physical functioning was assessed using the Health Assessment Questionnaire (HAQ) and clinical response was determined based on the American College of Rheumatology 20% improvement criteria (ACR20).

Results

Patients with early RA were more likely to be employable at baseline than those with long‐standing RA, even after adjusting for baseline HAQ scores. Among patients who were not employable at baseline but achieved an ACR20 response after 1 year of treatment, after adjusting for baseline HAQ score, the patients with early RA who had never taken MTX were 3 times more likely to become employable compared with those with long‐standing RA who had an incomplete response to MTX at baseline.

Conclusion

In 2 clinical trials, patients with early RA were more likely to show improved employment outcomes after treatment than those with long‐standing RA, suggesting intervention as early as possible in the disease course maximizes an individual patient's employment potential.     

Effectiveness of the introduction of an International Classification of Functioning,Disability and Health–based rehabilitation tool in multidisciplinary team care in patients with rheumatoid arthritis

Objective

To investigate whether the use of an International Classification of Functioning, Disability and Health (ICF)–based instrument to structure multidisciplinary care improves clinical effectiveness and satisfaction in patients with rheumatoid arthritis (RA) admitted for multidisciplinary team care.

Methods

Consecutive patients with RA admitted to an inpatient or day patient multidisciplinary team care ward were included during a 12‐month period before (period I) and after (period II) the introduction of an ICF‐based rehabilitation tool (Rehabilitation Activities Profile [RAP]). Patients were assessed at admission, discharge, and 6 weeks thereafter. The primary outcome measure was a patient‐oriented measure of functional ability (McMaster Toronto Arthritis Patient Preference Disability Questionnaire [MACTAR]), whereas secondary outcome measures included measures of physical and mental functioning, quality of life, disease activity, and patient satisfaction. Change scores between periods were compared using analysis of covariance.

Results

A total of 80 and 85 patients were included in periods I and II, respectively. Concerning the improvement of the MACTAR score and all other secondary clinical outcome measures, there was no significant difference between the 2 periods. Patient satisfaction with care was slightly higher in period II than in period I, with the differences regarding the total score of a multidimensional satisfaction questionnaire and the domains focusing on individual problems and empathy reaching statistical significance.

Conclusion

The introduction of the RAP did not change clinical effectiveness but had a modest beneficial impact on patient satisfaction with care in patients with RA admitted for multidisciplinary team care.     

Validation of single‐factor structure and scoring protocol for the health assessment questionnaire‐disability index

Objective

The extensively used Health Assessment Questionnaire Disability Index (HAQ‐DI) has been well received by the research and clinical community, notably because of its measurement strengths including reliability and stability of scores over time, utility in observational studies and clinical trials, predictive relationship with morbidity and mortality in rheumatoid arthritis (RA), and its translation for use in different countries. However, HAQ‐DI scoring has not been validated. The purpose of this study was to examine the structural validity of the HAQ‐DI and evaluate the latent factors underlying HAQ‐DI scoring.

Methods

This study used a cross‐validation approach on a total of 278 patients with RA. Exploratory and confirmatory factor analyses were performed.

Results

Results yielded a single‐factor HAQ‐DI score, which favored the current scoring system of the HAQ‐DI. Additionally, modification indices suggested improved model fit with the secondary inclusion of correlated residual scores from a motor skills subdomain.

Conclusion

The current study provides the first validation of the HAQ‐DI scoring system as determined by its latent factor structure. In addition, the findings suggest some benefit from a secondary interpretation of the scores based on domains that measure motor skills.

     

Perspectives of Medical Specialists From Different Disciplines on the Management of Systemic Lupus Erythematosus: An Interview Study

Objective

Systemic lupus erythematosus (SLE) is a complex autoimmune disease that can affect multiple organ systems, with specialists from many disciplines often involved, which may lead to inconsistent care. We aimed to describe the attitudes and perspectives of specialists from different medical disciplines on the management of people with SLE.

Methods

Face‐to‐face semistructured interviews were conducted with rheumatologists (n = 16), nephrologists (n = 16), and immunologists (n = 11) providing care to adults with SLE from 19 centers across Australia in 2015. All interviews were transcribed and analyzed thematically.

Results

Five themes were identified: uncertainties in judgments (hampered by unknown and unclear etiology, inapplicable evidence, comprehending information dispersion), reflexive responses (anchoring to specialty training, anticipating outcomes, avoiding disaster, empathy for the vulnerable), overarching duty to patients (achieving patient priorities, maximizing adherence, controlling the disease, providing legitimate information, having adequate and relevant expertise), safeguarding professional opportunities (diversifying clinical skills, protecting colleagues’ interests), and optimizing access to treatment (capitalizing on multidisciplinary care, acquiring breakthrough therapies).

Conclusion

Specialists strive to deliver evidence‐informed patient‐centered care, but recognize that they are anchored by their training. To overcome uncertainties in clinical management due to lack of high‐quality evidence and specialty silo structures, specialists translated evidence from other disease settings and collaborated with other specialists in routine care. Developing robust evidence, tools to support evidence‐informed decisions, and multidisciplinary shared‐care pathways may improve the management of people with this complex disease.

     

Better arthritis care: Patients' expectations and priorities,the competencies that community‐based health professionals need to improve their care of people with arthritis?

Objective

The aim of the present study was to identify the competencies that patients think non‐specialist community‐based nurses and allied health professionals (AHPs) need to enable them to assess, care for and manage arthritis appropriately.

Methods

Four face‐to‐face focus groups were held with a total of 16 women and nine men with arthritis, to discuss the care they received from community‐based health professionals, the skills and knowledge they expected from community‐based health professionals and what they prioritized.

Results

People with arthritis wanted health providers to have an understanding of the difference between inflammatory arthritis (IA) and osteoarthritis (OA), of how serious OA can be, and of the unpredictability of IA and flares. They emphasized the need for nurses and AHPs to understand the psychosocial impact of arthritis on individuals, family and friends, and the psychological adjustment needed when diagnosed with IA. They wanted community‐based health professionals to have some knowledge of the types of drug treatments that people with IA receive and the implications of taking immunosuppressive drugs. They also wanted them to understand the pain associated with arthritis, particularly OA, which participants felt was not taken seriously enough. They wanted nurses and AHPs in the community to be able to give basic advice on pacing and pain management, to make multidisciplinary referrals, to communicate effectively between referral points and to be able to signpost people to sources of help and good, reliable sources of education and information (especially for OA). They also wanted them to understand that patients who have had a diagnosis for a long time are the experts in their own disease. Other areas which were emphasized as being important were good communication skills and taking a holistic approach to caring for people with arthritis.

Conclusions

OA and IA differ significantly, both in their nature and their management. However, patients with arthritis want health professionals working in the community to be able to take a holistic approach to arthritis, with an understanding not just of the physical effects, but also their impact on the lives of patients, their family and their wider social circle, and on their ability to participate. People with OA want their condition to be taken seriously and to be offered appropriate management options, while people with IA want professionals to understand the unpredictability of their condition and to have a basic understanding of the drugs used for its treatment.     

Physical inactivity in patients with rheumatoid arthritis: Data from twenty‐one countries in a cross‐sectional,international study

Objective

Regular physical activity is associated with decreased morbidity and mortality. Traditionally, patients with rheumatoid arthritis (RA) have been advised to limit physical exercise. We studied the prevalence of physical activity and associations with demographic and disease‐related variables in patients with RA from 21 countries.

Methods

The Questionnaires in Standard Monitoring of Patients with Rheumatoid Arthritis (QUEST‐RA) is a cross‐sectional study that includes a self‐report questionnaire and clinical assessment of nonselected consecutive outpatients with RA who are receiving usual clinical care. Frequency of physical exercise (≥30 minutes with at least some shortness of breath, sweating) is queried with 4 response options: ≥3 times weekly, 1–2 times weekly, 1–2 times monthly, and no exercise.

Results

Between January 2005 and April 2007, a total of 5,235 patients from 58 sites in 21 countries were enrolled in QUEST‐RA: 79% were women, >90% were white, mean age was 57 years, and mean disease duration was 11.6 years. Only 13.8% of all patients reported physical exercise ≥3 times weekly. The majority of the patients were physically inactive with no regular weekly exercise: >80% in 7 countries, 60–80% in 12 countries, and 45% and 29% in 2 countries, respectively. Physical inactivity was associated with female sex, older age, lower education, obesity, comorbidity, low functional capacity, and higher levels of disease activity, pain, and fatigue.

Conclusion

In many countries, a low proportion of patients with RA exercise. These data may alert rheumatologists to motivate their patients to increase physical activity levels.