Physical activity in rheumatoid arthritis: a systematic review

Background: Physical activity is associated with improved health outcomes in many populations. It is assumed that physical activity levels in the rheumatoid arthritis (RA) population may be reduced as a result of symptoms of the disease. The objective of this review is to establish the current evidence base for levels of physical activity in the RA population. Methods: A systematic review was performed of 7 databases (Emabase, MEDLINE, AMED, Biomedical Reference Collection Expanded, CINAHL, Nursing and Allied Health Collection, and SportsDiscus) up to February 2011 to examine the evidence in the area. Results: One hundred and thirty-six studies were identified through electronic searching. One hundred and six were excluded based on title and/or abstract analysis and a further 14 were excluded based on full text analysis. Sixteen studies meeting the criteria were deemed suitable for inclusion. The results of the included studies indicate that the level of physical activity may be lower among individuals with RA when compared with healthy controls or normative data. Conclusions: There are a number of methodological considerations at play within the studies reviewed which prohibits definitive conclusion on the physical activity levels of this population group. Given the known health benefits of physical activity, further research in this area appears indicated

Knitting the threads of silk through time: Behçet’s disease—past, present, and future

Behçet’s disease (BD) is a chronic relapsing vasculitis that affects vessels of all types and sizes with a broad spectrum of phenotypic heterogeneity and complex immunopathogenesis. Efforts by the scientific community to resolve the unmet needs of BD and gaps in our knowledge have been hampered by considerable challenges that primarily relate to the rare nature of the disease in many parts of the world and its heterogeneity. Controversies remain in many aspects of the disease including the diagnostic criteria, immunopathogenesis and biomarker discovery, geographical variation, and therapeutic considerations. In this review, we highlight recent advances in our scientific understanding of BD, shed new insights into diagnostic and treatment strategies, and discuss residual gaps in our knowledge that will serve as the basis for current and future research

"It might hurt, but still it's good': People with rheumatoid arthritis beliefs and expectations about physical activity interventions

Many people who have rheumatoid arthritis report low levels of physical activity. We conducted 17 interviews with people who have rheumatoid arthritis to gain insight into how they view physical activity and to explore how their levels of activity may be increased. Interviews were transcribed verbatim and analysed using thematic analysis. Four main themes were generated: being active, barriers and facilitators, information and advice, and supporting physical activity. A lack of information about being active fostered negative emotions limiting physical activity participation. Improved provision of physical activity advice is warranted to promote physical activity in people who have rheumatoid arthritis

Community-based intervention to promote physical activity in rheumatoid arthritis (CIPPA-RA): a study protocol for a pilot randomised control trial

Rheumatoid arthritis (RA) is a chronic, inflammatory condition which may cause pain, stiffness and fatigue. People who have RA have reduced levels of physical activity due to these symptoms. Interventions targeting physical activity behaviour in this population have had limited efficacy. This paper describes a protocol for a pilot randomised controlled trial (RCT) of a theory-based intervention delivered in a community setting designed to promote physical activity in people who have RA. The aim of the pilot study is to assess the impact of the intervention on moderate-intensity physical activity in people with RA. The objectives are to obtain reliable estimates regarding recruitment rates; participant retention, protocol adherence and generate potential effect size estimates to inform sample size calculations for a main trial on physical activity participation. Semi-structured interviews will be conducted with a selected sample of participants to explore their experiences. Participants will be recruited from direct referrals from the rheumatology clinics in a public hospital. Participants meeting inclusion criteria will be randomised into a 6 week physical activity intervention (four sessions delivered over a 6-week period by a trained physiotherapist) or a control group (physical activity information leaflet). Results of the pilot study will provide data to determine if a larger RCT is feasible. Qualitative data will inform intervention design and delivery. The findings will be disseminated to health professionals, in peer-reviewed journals and conference presentations

Relationship between, self-efficacy, beliefs, and physical activity in inflammatory arthritis

Abstract Background: The benefits of physical activity (PA) in inflammatory arthritis (IA) patients are well-established. However, levels of PA in the IA population are suboptimal and the psychological determinants of PA are poorly understood. Objective: The study aimed to examine the self-reported PA levels and psychological determinants of PA for the IA population. Methods: A cross-sectional study of people with rheumatoid arthritis (RA) and psoriatic arthritis (PsA) was conducted to explore the association between demographic and psychological variables such as self-efficacy and belief about PA, and levels of PA and energy expenditure (EE). PA was recorded using the Yale Physical Activity Survey (YPAS). Results: A total of 102 participants were included in the study. Participants reported low levels of PA [mean standard deviation (SD), 24.3 18.2]. Beliefs about PA, but not self-efficacy, correlated with levels of self-report PA over the past week (r Z 0.25, p Z 0.01), over the past month (r Z 0.21, p Z 0.04), and EE (r Z 0.31, p Z 0.01). Conclusion: People with IA have decreased levels of PA. Beliefs about PA are associated with levels of self-report PA and EE in this population. These data provide a useful signpost for guiding and designing interventions to improve PA levels in IA populations by altering beliefs about PA

Sleep and physical activity: a survey of people with inflammatory arthritis and their engagement by health professionals in rheumatology in Ireland

Purpose: Sleep is important in maintaining the body’s circadian rhythm and in maintaining health. Aim was to investigate sleep and physical activity among people who have Inflammatory Arthritis and their engagement with Health Professionals. Materials and Methods: Members from a national charitable organisation for patients with arthritis and a national rheumatology health professionals society were invited to participate in separate cross-sectional surveys hosted on SurveyMonkey(R)TM. Results: Ninety (90) people responded and report an average of 5.7 (SD 1.46) hours sleep per night. A majority (61%) report their sleep quality as bad, with 31% taking medications at least once a week to help sleep. There was a statistically significant association between longer years with symptoms, taking medication at least once a week and limited in their activities, when rating their sleep quality as bad. Twenty eight (65%) health professional’s responded with 53% discussing sleep with their patients. Conclusions: People with inflammatory arthritis report low sleep with those having symptoms longer, taking medications regularly and having limitations with their activities, reporting poorer sleep quality. Only half of health professionals discuss sleep. More research is needed in investigating poor sleep quality, disturbances and physical activity in order to promote health and well-being in this population

Does exercise impact on sleep for people who have rheumatoid arthritis? A systematic review

To systematically search for the availability of evidence for exercise impacting on sleep for people who have rheumatoid arthritis. Two reviewers independently searched seven electronic databases, identified and extracted relevant studies by applying eligibility criteria. Sources of bias were assessed independently by two reviewers using the Cochrane bias assessment tool for randomized controlled trials (RCTs) and Newcastle–Ottawa Quality Assessment Scale for non-RCTs. Data were synthesized using a level of evidence approach. Meta-analyses were deemed to be inappropriate due to the heterogeneity of study designs, measurement tools and interventions. Five studies were included: one RCT; two pilot RCTs and two samples of convenience. A total of 262 people with RA were included. Interventions used were difficult to assess due to the heterogeneity of study designs and the inclusion of two using different types of yoga as an intervention. Different sleep outcome measures were used thus, it was not feasible to pool results. Studies had a high risk of bias. This review could find no consistent or conclusive evidence on whether exercise impacts on sleep in people who have rheumatoid arthritis, therefore no firm conclusions can be made. However, there is some indication that exercise may have positive benefits on sleep in people who have rheumatoid arthritis. Further studies with improved study designs, using subjective and objective measures, are needed

Sleep and physical activity: a cross-sectional objective profile of people with rheumatoid arthritis

Regular physical activity (PA) is important for people with rheumatoid arthritis (RA). Poor sleep is a common complaint among people with RA, which may have an influence on their PA levels. There is a lack of objective information regarding total sleep time (TST) and PA duration in this population. A cross-sectional study design was used. SenseWear Pro3 Armband(R)TM is used to measure TST and total PA duration. Four valid days, with 95% wear time necessary for inclusion in final results. Disease activity and function were measured using the DAS-28, HAQ and VAS. Data analysis carried out using SPSS v22. Seventy-five (75) participants completed monitoring period, with 51 (68%) meeting modified PA duration guidelines. Data with 95% wear time over a minimum of 4 days were available for 32 recorded participants, with a mean TST of 5.7 (SD_1.11) hours per night and a median 1.25 (IQR_1.88) hours of daily PA. TST had a positive significant relationship with PA (p = 0.018); PA demonstrated a negative significant relationship with functional limitations (p = 0.009) and correlated with lower CRP levels; CRP levels had in turn a significant relationship to global health (p = 0.034). Total sleep time was low for people with RA. People with RA who are more physically active have longer TST. These findings provide an objective profile of TST and PA duration in people with RA and suggest a relationship between increased PA duration and longer TST. Further research is needed to confirm these novel findings

Real life switching from infliximab innovator to biosimilar in rheumatic diseases: A 6 month single-centre prospective observational study

Background: Although Inflectra, biosimilar infliximab, has been approved by the EMA since September 2013 for all licensed indications of Remicade (innovator infliximab) but there is a paucity of real-world data and guidelines regarding switching from innovator Remicade to Inflectra. Objectives: To explore efficacy, safety, and retention rate of biosimilar Inflectra when switching from Remicade, in patients with rheumatic diseases. Methods: Informed consent was sought from all patients attending our rheumatology unit to undertake a switching programme. Baseline demographics and clinical characteristics were obtained before switching to Inflectra. Disease activity and safety assessment were undertaken before and then every 12 weeks after switching. The retention rate of Inflectra switch patients was compared with a cohort of non-switch Inflectra naive (11 patients) and historic Remicade (31 patients) patients. Results: Thirty out of thirty-one patients {median (IQR) age 50 (18), 20F} with various rheumatic diseases (9 with diagnosis of AS, 6 with RA, 6 with Behçet’s disease, 3 with Enteropathic arthritis, 2 with psoriatic arthritis) agreed to the switch. There was no statistical difference noted between pre-switch and 6 months postFortune switch mean values of PGA (p=0.37), BASDAI (p=0.60), ASDAS-CRP (p=0.90), DAS28CRP (p=0.85), DAS28ESR (p=0.45), CRP (p=0.09), Behçet’s disease activity score (p=0.77) and HAQ-DI (p=0.18). The retention rate on Inflectra switch was 86.7% as compared to 90.9% in the Inflectra naive cohort and 100% for historic Remicade cohort. Conclusion: These results demonstrate that in this cohort at 6 months Inflectra is comparable to Remicade in efficacy and there are no new safety signals

High vitamin D levels may downregulate inflammation in patients with Behcet's disease

Vitamin D plays a significant role in the immune system modulation and may confer a protective role in autoimmune diseases. We conducted a case-control study to compare 25(OH)D levels in patients with BD who were managed at a regional rheumatology programme in the midwest region of Ireland compared to matched controls. Healthy controls were selected from the Irish health systemandmatched in 1 : 5 ratio for age, sex, and themonth of the year. 25(OH)Dlevels <20 nmol/Lwere classified as deficientwhile levels between 20 and 40 nmol/Lwere classified as insufficient. Differences between groupswere assessed usingMann–Whitney test and associations between cases and controls were expressed as odds ratios and 95% confidence intervals.Nineteen patients with BD were compared with 95 controls matched by age, sex, and month of blood draw. 25(OH)D levels were significantly higher in patients in BD than in matched controls (median values: 45 nmol/L versus 22 nmol/L, < 0.005) and tended to be lower in patients with active disease than in those without (median values: 35 nmol/L (IQR: 22.75–47.25 nm/L) versus 50 nmol/L (IQR: 35–67 nmol/L), = 0.11). Compared to controls, patients with BD were significantly less likely to have 25(OH)D deficiency or insufficiency (OR: 0.09, 95% CI: 0.03–0.28, < 0.001). Our findings suggest a possible role for 25(OH)D in modifying the inflammatory response in BD and uncover a potential opportunity to assess whether correction of Vit D deficiency confers protective benefits