Impact of Symptoms on Daily Life in People at Risk of Rheumatoid Arthritis

Objectives: To explore the impact on daily life of symptoms experienced by those with systemic autoimmunity associated with rheumatoid arthritis (RA). Methods: Fifteen people took part in focus groups to explore the impact of symptoms on daily life. Results: Core themes included: 1) physical impact of limited hand function and mobility; 2) psychological distress experienced included a fear of symptoms progressing into RA, uncertainty about the future, feelings of despair, shame and frustration. Conclusion: People with arthralgia at risk of developing RA experienced considerable physical and psychological impact of symptoms. Greater consideration should be given to the needs of people at risk of developing RA

A biopsychosocial network model of fatigue in rheumatoid arthritis: A systematic review

Fatigue in RA is prevalent, intrusive and disabling. We propose a network model of fatigue encompassing multiple and mutually interacting biological, psychological and social factors. Guided by this model, we reviewed the literature to offer a comprehensive overview of factors that have been associated with fatigue in RA. Six categories of variables were found: physical functioning, psychological functioning, medical status, comorbidities and symptoms, biographical variables and miscellaneous variables. We then systematically reviewed associations between fatigue and factors commonly addressed by rheumatology health professionals. Correlations of fatigue with physical disability, poor mental well-being, pain, sleep disturbance and depression and anxiety were ∼0.50. Mostly these correlations remained significant in multivariate analyses, suggesting partly independent influences on fatigue and differences between individuals. These findings indicate the importance of research into individual-specific networks of biopsychosocial factors that maintain fatigue and tailored interventions that target the influencing factors most relevant to that person

Fatigue in rheumatoid arthritis

This is an editorial and does not contain an abstract

Training and delivery of a novel fatigue intervention: a qualitative study of rheumatology health-care professionals’ experiences

ObjectivesSuccessful, non-pharmacological research interventions are challenging to implement in clinical practice. The aim of the study was to understand the experiences of rheumatology nurses and occupational therapists (tutors) delivering a novel fatigue intervention in a trial setting, and their views on requirements for clinical implementation. After training, tutors delivered courses of a manualized group cognitive-behavioural intervention to patients with RA in a seven-centre randomized controlled trial [Reducing Arthritis Fatigue by clinical Teams using cognitive-behavioural approaches (RAFT)], which demonstrated reduced fatigue impact at 2 years.MethodsFourteen tutors participated in interviews, and eight tutors also participated in a focus group. Data were audio-recorded, transcribed and analysed using inductive thematic analysis.ResultsThe following five main themes were identified: ‘exciting but daunting’ reflected the mixture of excitement and anxiety in intervention training and delivery; ‘skills practice and demonstrations were essential’ captured the value of learning and practising together, even though the process could be uncomfortable; ‘an individual approach to a standardized intervention’ showed how tutors negotiated adherence to the manual with delivery using their own words; ‘becoming a better practitioner’ described how participation enhanced tutors’ wider clinical practice; and ‘pragmatic and flexible’ highlighted practical adaptations to facilitate training and intervention roll out.ConclusionThese insights inform strategies for clinical implementation of an evidence-based intervention that addresses a patient priority, with implications for other successful research interventions. Tutors believed that the skills acquired during RAFT enhanced their wider clinical practice, which highlights the benefits of upskilling members of clinical teams to provide self-management support to patients

Efficacy of non-pharmacological interventions: a systematic review informing the 2023 EULAR recommendations for the management of fatigue in people with inflammatory rheumatic and musculoskeletal diseases

OBJECTIVE: To identify the best evidence on the efficacy of non-pharmacological interventions in reducing fatigue in people with inflammatory rheumatic and musculoskeletal diseases (I-RMDs) and to summarise their safety in the identified studies to inform European Alliance of Associations for Rheumatology recommendations for the management of fatigue in people with I-RMDs. METHODS: Systematic review of randomised controlled trials (RCTs) including adults with I-RMDs conducted according to the Cochrane Handbook. Search strategy ran in Medline, Embase, Cochrane Library, CINAHL Complete, PEDro, OTseeker and PsycINFO. Assessment of risk of bias, data extraction and synthesis were performed by two reviewers independently. Data were pooled in meta-analyses. RESULTS: From a total of 4150 records, 454 were selected for full-text review, 82 fulfilled the inclusion criteria and 55 RCTs were included in meta-analyses. Physical activity or exercise was efficacious in reducing fatigue in rheumatoid arthritis (RA) (standardised mean differences (SMD)=-0.23, 95% CI=-0.37 to -0.1), systemic lupus erythematosus (SLE) (SMD=-0.54, 95% CI=-1.07 to -0.01) and spondyloarthritis (SMD=-0.94, 95% CI=-1.23 to -0.66); reduction of fatigue was not significant in Sjögren's syndrome (SMD=-0.83, 95% CI=-2.13 to 0.47) and systemic sclerosis (SMD=-0.66, 95% CI=-1.33 to 0.02). Psychoeducational interventions were efficacious in reducing fatigue in RA (SMD=-0.32, 95% CI=-0.48 to -0.16), but not in SLE (SMD=-0.19, 95% CI=-0.46 to 0.09). Follow-up models in consultations (SMD=-0.05, 95% CI=-0.29 to 0.20) and multicomponent interventions (SMD=-0.20, 95% CI=-0.53 to 0.14) did not show significant reductions of fatigue in RA. The results of RCTs not included in the meta-analysis suggest that several other non-pharmacological interventions may provide a reduction of fatigue, with reassuring safety results. CONCLUSIONS: Physica activity or exercise and psychoeducational interventions are efficacious and safe for managing fatigue in people with I-RMDs

A Directed Acyclic Graph (DAG) Ensemble Classification Model: An Alternative Architecture for Hierarchical Classification

In this paper, a hierarchical ensemble classification approach that utilizes a Directed Acyclic Graph (DAG) structure is proposed as a solution to the multi-class classification problem. Two main DAG structures are considered: (i) rooted DAG, and (ii) non-rooted DAG. The main challenges that are considered in this paper are: (i) the successive misclassification issue associated with hierarchical classification, and (i) identification of the starting node within the non-rooted DAG approach. To address these issues the idea is to utilize Bayesian probability values to: select the best starting DAG node, and to dictate whether single or multiple paths should be followed within the DAG structure. The reported experimental results indicated that the proposed DAG structure is more effective than when using a simple binary tree structure for generating a hierarchical classification model.</p

A Cryptographic Ensemble for Secure Third Party Data Analysis: Collaborative Data Clustering Without Data Owner Participation

This paper introduces the twin concepts Cryptographic Ensembles and Global Encrypted Distance Matrices (GEDMs), designed to provide a solution to outsourced secure collaborative data clustering. The cryptographic ensemble comprises: Homomorphic Encryption (HE) to preserve raw data privacy, while supporting data analytics; and Multi-User Order Preserving Encryption (MUOPE) to preserve the privacy of the GEDM. Clustering can therefore be conducted over encrypted datasets without requiring decryption or the involvement of data owners once encryption has taken place, all with no loss of accuracy. The GEDM concept is applicable to large scale collaborative data mining applications that feature horizontal data partitioning. In the paper DBSCAN clustering is adopted for illustrative and evaluation purposes. The results demonstrate that the proposed solution is both efficient and accurate while maintaining data privacy

The experience of people with rheumatoid arthritis living with fatigue: A qualitative metasynthesis

ObjectivesTo identify, appraise and synthesise qualitative studies on the experience of living with rheumatoid arthritis (RA)-related fatigue. MethodsWe conducted a qualitative metasynthesis encompassing a systematic literature search in February 2017, for studies published in the past 15 years, in PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Embase, SveMed, PsychINFO and Web of Science. To be included, the studies had to report the experience of living with fatigue among adults with RA. The analysis and synthesis followed Malterud's systematic text condensation. ResultsEight qualitative articles were included, based on 212 people with RA (69% women) and aged between 20 and 83 years old. The synthesis resulted in the overall theme A vicious circle of an unpredictable symptom'. In addition, the synthesis derived four subthemes: being alone with fatigue'; time as a challenge'; language as a tool for increased understanding' and strategies to manage fatigue'. Fatigue affects all areas of everyday life for people with RA. They strive to plan and prioritise, pace, relax and rest. Furthermore, they try to make use of a variety of words and metaphors to explain to other people that they experience that RA-related fatigue is different from normal tiredness. Despite this, people with RA-related fatigue experience feeling alone with their symptom and they develop their own strategies to manage fatigue in their everyday life.ConclusionsThe unpredictability of RA-related fatigue is dominant, pervasive and is experienced as a vicious circle, which can be described in relation to its physical, cognitive, emotional and social impact. It is important for health professionals to acknowledge and address the impact of fatigue on the patients' everyday lives. Support from health professionals to manage fatigue and develop strategies to increase physical activity and maintain work is important for people with RA-related fatigue