Change of psychological distress and physical disability in patients with rheumatoid arthritis over the last two decades

OBJECTIVE: During the past decades, a more cautious approach with respect to prescribing medication and physical exercise progressed toward evidence-based guidelines regarding the management of rheumatoid arthritis (RA). Currently, physical activity and other means to improve well-being and functioning are encouraged, and the disease is targeted earlier with more intensive and aggressive pharmacologic treatment. The current study examined whether psychological distress and physical disability in patients with RA reduced over the last 2 decades and whether this is explained by a reduction of disease activity. METHODS: From 1990-2011, consecutive patients with RA (n = 1,151, age range 17-86 years, 68% female, 62% rheumatoid factor positive) were monitored at diagnosis and after 3-5 years of treatment (followup). Depressed mood, anxiety, and physical disability were predicted in multiple linear regression analyses by year of assessment, disease activity, and patient demographics. RESULTS: Over the decades, depressed mood (P = 0.01), anxiety (P = 0.001), and physical disability (P = 0.02) reduced at diagnosis and within-treatment improvement of anxiety (P = 0.04) and physical disability (P < 0.001) increased. Percentages of patients with depressed mood, anxiety, and physical disability at followup changed from 25%, 23%, and 53%, respectively, 2 decades ago to 14%, 12%, and 31%, respectively, currently. After taking account of reduction in disease activity, the decrease in physical disability remained significant (P < 0.001). CONCLUSION: Over the last 2 decades, psychological distress and physical disability decreased. This favorable trend might partly be due to reduced disease activity. The results indicate that patients with RA have a better opportunity to live a valued life currently than 20 years ago

Physical activity and physical activity cognitions are potential factors maintaining fatigue in patients with primary Sjogren's syndrome

Background Fatigue is a prevalent and debilitating problem in Sjogren's syndrome. It has been suggested that physical activity and cognitions about physical activity can influence fatigue. Objective The aim of this study was to examine fatigue and physical activity levels in patients with Sjogren's syndrome and the associations of physical activity and physical activity cognitions with fatigue. Methods In 300 patients with primary Sjogren's syndrome and 100 demographically matched people from the general population (mean age 57 years, 93% female), fatigue (five dimensions of the multidimensional fatigue inventory) and physical activity (three dimensions of the international physical activity questionnaire) were assessed. The physical activity cognitions 'activity avoidance' and 'somatic focus' of the Tampa scale of kinesiophobia were assessed in the Sjogren's group only. Results Sjogren's patients had higher scores on all five fatigue dimensions (p Conclusions The results suggest that fatigue in patients with Sjogren's syndrome might be reduced by targeting both physical activity and physical activity cognitions. This suggestion requires verification in clinical experimental studies

Psychoeducation for Patients With a Psychotic Disorder: Effects on Knowledge and Coping

Objective: Psychoeducation is an essential and promising element in the nonpharmacologic treatment of patients with a psychotic disorder. This study examined the effects of patient-directed psychoeducation on knowledge and coping