Tailored Therapist-guided Internet-based Cognitive-behavioural Treatment for Psoriasis and Rheumatoid Arthritis: Two Case Reports

Chronic somatic conditions, such as psoriasis, arthritis psoriatica and rheumatoid arthritis, have a large impact on patients’ lives. Tailored therapist-guided internet-based cognitive-behavioural therapy (ICBT) has been shown to be effective in improving physical and psychological well-being in these patients. Two cases are presented here, in order to provide an in-depth illustration of the course and content of this novel treatment and to investigate the therapeutic alliance in an online treatment. After face-to-face intakes, both patients received therapist-guided ICBT tailored to their specific problems and treatment goals. The treatment resulted in improved physical and psychological well-being and these clinically significant improvements were maintained at 6-month follow-up. In addition, the therapeutic relationship was evaluated positively by both patients and increased further during treatment, indicating an adequate therapeutic working alliance in this online treatment. These case reports show that tailored ICBT may contribute to improved care for patients with chronic somatic conditions

Caspase-12 and the inflammatory response to Yersinia pestis

Background: Caspase-12 functions as an antiinflammatory enzyme inhibiting caspase-1 and the NOD2/RIP2 pathways. Due to increased susceptibility to sepsis in individuals with functional caspase-12, an early-stop mutation leading to the loss of caspase-12 has replaced the ancient genotype in Eurasia and a significant proportion of individuals from African populations. In African-Americans, it has been shown that caspase-12 inhibits the pro-inflammatory cytokine production. Methodology/Principal Findings: We assessed whether similar mechanisms are present in African individuals, and whether evolutionary pressures due to plague may have led to the present caspase-12 genotype population frequencies. No difference in cytokine induction through the caspase-1 and/or NOD2/RIP2 pathways was observed in two independent African populations, among individuals with either an intact or absent caspase-12. In addition, stimulations with Yersinia pestis and two other species of Yersinia were preformed to investigate whether caspase-12 modulates the inflammatory reaction induced by Yersinia. We found that caspase-12 did not modulate cytokine production induced by Yersinia spp. Conclusions: Our experiments demonstrate for the first time the involvement of the NOD2/RIP2 pathway for recognition of Yersinia. However, caspase-12 does not modulate innate host defense against Y. pestis and alternative explanations for the geographical distribution of caspase-12 should be sought

What patients think about E-health: patients' perspective on internet-based cognitive behavioral treatment for patients with rheumatoid arthritis and psoriasis

Item does not contain fulltextIn the past decade, the use of internet-based cognitive behavioral treatments (internet-based CBT) for a wide range of patients has grown intensively. Incorporating the patients' opinions and perspective into new health care innovations might improve the quality and applicability of these innovations, as high dropout rates and low attrition are the often-reported concerns in E-health research. Most studies to date have examined patient perspectives on specific internet-based interventions that patients had participated in, and not the views of the general public. The current paper explores the perspective of patients with rheumatoid arthritis and psoriasis on internet-based CBT for these patient groups. In total, 100 patients (55 % male) participated in a semi-structured telephone interview about internet-based CBT, including questions about possible advantages and disadvantages and the readiness to participate in this kind of treatment. Most patients (78 %) were prepared to participate in internet-based CBT. Patients endorsed the advantages (57 %) more often than the disadvantages (34 %). The ease of internet-based CBT and the time saved were especially appealing to patients. Main disadvantages according to patients are that not all patients will be reached due to computer illiteracy and the lack of face-to-face interaction with the therapist. The results suggest that, from the patients' perspective, internet-based CBT is a promising health care development. Further research into aspects such as therapist interaction and enhancing computer literacy might contribute to an effective way of E-health care delivery in the future

In-vitro cytokine measurements after whole blood LPS and Pam3Cys stimulation between the caspase-12 genotypes from the volunteers enrolled in 2006.

<p>Stimulation was performed with 1, 10 and 100 ng/ml LPS (<i>E. coli</i>) and 10 µg/ml Pam3Cys. TNF (A), IL-1β (B) and IL-10 (C) were measured by ELISA in the supernatant after 24 hour stimulation. Volunteers were grouped as homozygous bearing the nonfunctional caspase-12 genotype (S/S), heterozygous bearing the nonfunctional and functional caspase-12 (S/L), and homozygous bearing the functional caspase-12 (L/L). Numbers of volunteers included for each cytokine are S/S = 33, S/L = 16 and L/L = 1. Values represent mean + SD for each group of volunteers. P-values for differences between caspase-12 genotype were calculated with the Mann-Whitney test. *P<0.05.</p

In-vitro cytokine measurements after PBMC stimulation with <i>Yersinia enterocolitica</i>, <i>Yersinia pseudotuberculosis</i> and <i>Yersinia pestis</i>.

<p>Caucasian individuals bearing a normal (NOD2 wt, N = 10) or homozygous for the 3020insC NOD2 mutation (NOD2 del, N = 5) were stimulated with the various <i>Yersinia spp</i>. TNF (A) and IL-1β (B) were measured by ELISA after 24-hour stimulation. Values represent mean + SD for each group of volunteers. P-values for differences between caspase-12 genotype were calculated with the Mann-Whitney test. *P<0.05, **P≤0.01.</p

Caspase-12 genotypes and allele frequency in two cohorts of Mali volunteers, one collected in 2006 and one in 2007.

a<p>Population do not violate Hardy-Weinberg equilibrium.</p>b<p>Distribution of Caspase-12 genotypes between 2006 and 2007 populations did not differ (χ²-test).</p