Patient experiences of physical activity and exercise in rheumatoid arthritis

Lay Summary: What does this mean for patients? Physical activity and exercise have been shown to have many benefits for people living with RA. These include improvements in symptoms associated with RA, such as pain, stiffness and fatigue. Participating in physical activity and exercise has also been shown to improve cardiovascular health and overall quality of life and is therefore an important part of disease management. Despite this, physical activity levels in people with RA are notably lower than those seen in people without RA, meaning that many RA patients do not experience the associated health benefits. By listening to the experiences of those with RA, researchers have been able to identify many of the reasons or barriers that make it harder for people with RA to exercise regularly. These include lack of professional support, feeling embarrassed or worrying about making symptoms worse. These important patient insights have also allowed researchers to understand other factors that support physical activity and exercise among people with RA, such as encouragement from family and friends and enjoying the feeling of achieving exercise-related goals. This paper includes the personal accounts of three patients with RA and their experiences with physical activity and exercise at different times: during childhood, during a flare and during a pandemic. Exploring the experiences of a wide range of patients is crucial in guiding the development of appropriate exercise-related advice and programmes that will support physically active lifestyles in this group of patients

AVALIAÇÃO DE RUIDO AMBIENTAL E POEIRA OCUPACIONAL EM UMA PEDREIRA NA CIDADE DE MIRABELA – MINAS GERAIS

A mineração é um setor que apesar de muito importante, apresenta impactos relevantes ao meio ambiente e ao trabalhador, causando degradações ambientais e perigos a saúde e proteção dos funcionários. A poeira de sílica e os ruídos são riscos frequentes na mineração. Dessa maneira medidas com a saúde, o conforto e a segurança dos trabalhadores vem se tornando prioridade nas indústrias e nos negócios em geral, visto que os acidentes podem levar danos na saúde como também o óbito. Diante dessas preocupações, este presente estudo tem por finalidade avaliar se a poeira ocupacional e o ruído ambiental gerados numa empresa de mineração situada no município de Mirabela – MG estão de acordo com os níveis permitidos pelas normas. Para este estudo foi utilizado o decibelímetro para medição do ruído ambiental e uma bomba gravimétrica para coleta de poeira da pedreira. Os resultados encontrados mostraram satisfatórios para a quantidade de poeira respirável, porém no quesito ruído ambiental nas proximidades do britador não estava dentro dos limites permitidos pelas normas vigentes, notando a necessidade de uma medida de proteção maior em relação aos funcionários. A sugestão para controle do ruído ambiental foi a utilização de protetores individuais, máquinas com cabines fechadas para isolamento acústico. Quanto à poeira, fazer-se de uso de protetores respiratórios, umidificação dos processos. Além disso, é importante que tenha programas de educação ambiental oferecido pelo empreendimento para os funcionários da empresa

Patient involvement in the development of a handbook for moderate rheumatoid arthritis

Self-management is a key recommendation for people with rheumatoid arthritis (RA). Educational materials may support self-management, and increasingly patients are becoming involved with the development of these materials. The TITRATE trial compares the effectiveness of intensive management to standard care in patients with moderate RA across England. As part of the intensive management intervention, participants are given a handbook.Aim and objectivesThe aim of this study was to develop a handbook to support the intensive management. The objectives were to: (i) involve patients in the identification of relevant information for inclusion in the TITRATE handbook; (ii) ensure the content of the handbook is acceptable and accessible.DesignWe held an audio-taped workshop with RA patients. The transcript of the workshop was analysed using thematic content analysis.ResultsFive main themes were identified as follows: ‘rheumatoid arthritis treatment, perceptions of rheumatoid arthritis, the importance of individualized goals, benefits of self-management and the patient handbook’. Feedback from the workshop was incorporated into the handbook, and patients’ anonymous testimonies were added.ConclusionThis study demonstrates that patient contribution to the development of educational material to support intensive management of RA is both feasible and valuable. A qualitative evaluation of the use and impact of the handbook with patients and practitioners is planned on completion of the TITRATE trial

Mental health, quality of life and self-management behaviours:online evaluation of inflammatory arthritis patients over 1 year of COVID-19 lockdowns

Objective: Patients with inflammatory arthritis were especially vulnerable to the psychosocial and health impacts of coronavirus disease 2019 (COVID-19) and the lockdowns. This study investigated the impact of these changes on mental health, physical health and quality of life for inflammatory arthritis patients over 1 year following the initial lockdown in the UK. Methods: Three hundred and thirty-eight participants with inflammatory arthritis completed an ambidirectional study consisting of online questionnaires at four time points for 1 year. The questionnaires assessed demographic information, inflammatory arthritis condition, mental health, physical symptoms, self-management behaviours, COVID-19 status and impacts. Means, linear regressions and structural equation modelling for mediations were conducted over 12 months. Results: Physical health concerns peaked during June 2020, then declined, but did not return to baseline. Depression was associated with worse quality of life at baseline, as shown by the beta coefficient, (β= 0.94, P &lt; 0.01), September (β = 0.92, P &lt; 0.01), November (β= 0.77, P &lt; 0.01) and 1 year (β = 0.77, P &lt; 0.01). Likewise, anxiety was associated with worse quality of life at baseline (β = 1.92, P &lt; 0.01), September (β = 2.06, P &lt; 0.01), November (β = 1.66, P = 0.03) and 1 year (β = 1.51, P = 0.02). The association between depression and quality of life was mediated by physical activity (β= 0.13, P &lt; 0.01) at baseline. The association between anxiety and quality of life was also mediated by physical activity (β = 0.25, P = 0.04) at baseline. Conclusion: Physical health continued to be worse 1 year later compared with before the COVID-19 lockdowns in patients with inflammatory arthritis. Mental health showed long-Term effects on quality of life, with an impact for ≥12 months. Lastly, physical activity mediated between mental health and quality of life in the short term.</p

Effects of diet on the outcomes of rheumatic and musculoskeletal diseases (RMDs): systematic review and meta-analyses informing the 2021 EULAR recommendations for lifestyle improvements in people with RMDs

BackgroundA EULAR taskforce was convened to develop recommendations for lifestyle behaviours in rheumatic and musculoskeletal diseases (RMDs). In this paper, the literature on the effect of diet on the progression of RMDs is reviewed.MethodsSystematic reviews and meta-analyses were performed of studies related to diet and disease outcomes in seven RMDs: osteoarthritis (OA), rheumatoid arthritis (RA), systemic lupus erythematosus, axial spondyloarthritis, psoriatic arthritis, systemic sclerosis and gout. In the first phase, existing relevant systematic reviews and meta-analyses, published from 2013 to 2018, were identified. In the second phase, the review was expanded to include published original studies on diet in RMDs, with no restriction on publication date. Systematic reviews or original studies were included if they assessed a dietary exposure in one of the above RMDs, and reported results regarding progression of disease (eg, pain, function, joint damage).ResultsIn total, 24 systematic reviews and 150 original articles were included. Many dietary exposures have been studied (n=83), although the majority of studies addressed people with OA and RA. Most dietary exposures were assessed by relatively few studies. Exposures that have been assessed by multiple, well conducted studies (eg, OA: vitamin D, chondroitin, glucosamine; RA: omega-3) were classified as moderate evidence of small effects on disease progression.ConclusionThe current literature suggests that there is moderate evidence for a small benefit for certain dietary components. High-level evidence of clinically meaningful effect sizes from individual dietary exposures on outcomes in RMDs is missing

2022 update

Funding Information: This study was funded by European League Against Rheumatism. Publisher Copyright: © Author(s) (or their employer(s)) 2022. No commercial re-use. See rights and permissions. Published by BMJ.Objectives: To provide an update of the EULAR rheumatoid arthritis (RA) management recommendations addressing the most recent developments in the field. Methods: An international task force was formed and solicited three systematic literature research activities on safety and efficacy of disease-modifying antirheumatic drugs (DMARDs) and glucocorticoids (GCs). The new evidence was discussed in light of the last update from 2019. A predefined voting process was applied to each overarching principle and recommendation. Levels of evidence and strengths of recommendation were assigned to and participants finally voted on the level of agreement with each item. Results: The task force agreed on 5 overarching principles and 11 recommendations concerning use of conventional synthetic (cs) DMARDs (methotrexate (MTX), leflunomide, sulfasalazine); GCs; biological (b) DMARDs (tumour necrosis factor inhibitors (adalimumab, certolizumab pegol, etanercept, golimumab, infliximab including biosimilars), abatacept, rituximab, tocilizumab, sarilumab and targeted synthetic (ts) DMARDs, namely the Janus kinase inhibitors tofacitinib, baricitinib, filgotinib, upadacitinib. Guidance on monotherapy, combination therapy, treatment strategies (treat-to-target) and tapering in sustained clinical remission is provided. Safety aspects, including risk of major cardiovascular events (MACEs) and malignancies, costs and sequencing of b/tsDMARDs were all considered. Initially, MTX plus GCs is recommended and on insufficient response to this therapy within 3-6 months, treatment should be based on stratification according to risk factors; With poor prognostic factors (presence of autoantibodies, high disease activity, early erosions or failure of two csDMARDs), any bDMARD should be added to the csDMARD; after careful consideration of risks of MACEs, malignancies and/or thromboembolic events tsDMARDs may also be considered in this phase. If the first bDMARD (or tsDMARD) fails, any other bDMARD (from another or the same class) or tsDMARD (considering risks) is recommended. With sustained remission, DMARDs may be tapered but should not be stopped. Levels of evidence and levels of agreement were high for most recommendations. Conclusions: These updated EULAR recommendations provide consensus on RA management including safety, effectiveness and cost.publishersversionepub_ahead_of_prin

A JUSTIÇA DE TRANSIÇÃO BRASILEIRA: LEI 6.683/79 E A LUTA CONTRA UMA POLÍTICA DE ESQUECIMENTO

Com base em um conceito internacionalizado e crítico da justiça de transição, derivado de normas e práticas internacionais, buscou-se, neste trabalho, analisar as medidas tomadas pelo Estado brasileiro no intuito de lidar com as graves violações de direitos humanos cometidas durante o regime militar de 1964 a 1985. Considerando a justiça de transição brasileira um processo em aberto, que tem início na Lei de Anistia de 1979 (Lei 6.683), dedicou-se em traçar um panorama sobre os principais momentos e os atuais desafios desse processo. Ao longo da análise, a luta entre uma política pública de esquecimento e a memória de um passado ausente permeia o debate e promove o desenvolvimento, através de avanços e retrocessos, da justiça de transição no país.Based on an internationalized and critical concept of transitional justice, deriving from international norms and practices, this dissertation proposed to analyze the Brazilian State’s actions taken in order to investigate the accountability of the serious human rights violations committed during the military regime from 1964 to 1985. Considering the Brazilian transitional justice as an open process, that started with the 1979 Amnesty Law (Law 6.683), this work is dedicated to give an overview of the key moments and the current challenges of this process. Throughout the analysis, the struggle between a public policy of forgetting and the memory of an absent past permeates the debate and promotes the development, through ups and downs, of transitional justice in Brazil

Rheumatoid Arthritis Portrayal by UK National Newspapers 2011–2016:A Service User - Led Thematic Analysis of Language Used

Abstract Background An important source of knowledge, beliefs, and attitudes about illness is the mass media. Research has established the often negative and emotive language utilised by journalists to report on physical and mental long-term illnesses. The limited amount of research on rheumatological conditions has largely focused on the extent of, and/or accuracy of media coverage. This is the first published study to examine systematically the language used by the United Kingdom (UK) popular press to specifically describe rheumatoid arthritis (RA). Methods A patient and public involvement (PPI) approach, involving academics and service users with RA, was used to conduct the research. LexisNexis online repository of print media was searched for articles within a defined five year time frame, which included RA in the headline and/or lead paragraph of 15 UK national non-specialist newspapers. Resultant articles were uploaded to NVivo, and a realist perspective aided a thematic analysis of the data set. Results A search of LexisNexis produced 413 newspaper articles, of which 147 met the inclusion criteria. Three themes emerged: (1) language used to describe RA; (2) language used to refer to those who live with RA and; (3) language used to report on potential new treatments for RA. Negative and emotive terms such as ‘attack’, ‘painful’, ‘crippling’, and ‘agony’ were the most frequently used to describe the experience of RA. People diagnosed with RA were often portrayed as ‘sufferers’ or ‘victims’, though neutral language was also deployed. ‘Hope’ and ‘breakthrough’ were the most reported terms for potential new treatments for RA. Across the three themes, tabloid and middle market newspaper articles applied more sensationalised language with attention grabbing headlines and news stories. By contrast, such emotive terminology was less apparent in broadsheets. Conclusions The media is a source of information about RA for the general population, but the quality of newspaper journalism about the condition requires improvement. The findings may act as a stimulus for a national public awareness initiative and/or social marketing campaign. How the language currently constructed to describe RA in the press is received by people with RA would be an important area for future research

Clinician and patient views on janus kinase inhibitors in the treatment of inflammatory arthritis:a mixed methods study

BACKGROUND: Janus kinase inhibitors (JAKi) are new targeted synthetic disease-modifying antirheumatic drugs (DMARDs) licenced in the UK to treat rheumatoid and psoriatic arthritides. Unlike currently often prescribed biological DMARDs, they target a different part of the inflammatory pathway and are taken orally. The aim of this study was to explore what UK-based rheumatology clinicians and inflammatory arthritis (IA) patients think about the awareness, prescription and use of JAKi; how they compare with biologics; and how the COVID-19 pandemic has affected how JAKi are viewed and prescribed.METHODS: Rheumatology clinicians and IA patients completed online surveys and participated in interviews/focus groups between September 2021 and January 2022. Survey data were analysed descriptively, and interview/focus group data underwent an inductive thematic analysis.RESULTS: 66.6% of patients had at least some awareness of JAKi, 73.0% from their rheumatology team. Problems getting earlier access to these drugs were raised by some patients, with many being prescribed JAKi after multiple other therapies had failed. 91.5% of clinicians prescribed JAKi in keeping with their local guidelines, with 72.3% prescribing them frequently as a monotherapy. Some clinicians had lingering safety concerns over JAKi use. Despite experiencing side effects and knowing of possible long-term risks, patients felt overall the benefits of JAKi outweighed the risks. 39.3% of patients were 'very satisfied' on JAKi, compared with 25.0% on biologics. Patients on JAKi appreciated their short half-life when it comes to infections, and their convenience as an oral therapy. When JAKi were discontinued in patients, it was predominantly due to inefficacy and non-cardiovascular adverse events. The COVID-19 pandemic resulted in increased prescription of JAKi as an alternative to injections and infusions, primarily to avoid potentially exposing patients to the coronavirus. Some patients believed their JAKi may confer some protection against developing severe COVID-19.CONCLUSION: JAKi are an effective treatment option for IA and are liked by patients. The COVID-19 pandemic appears to have impacted their prescription favourably. However, clinicians have safety concerns over JAKi use. Any decision to go on a JAKi should be informed and take into account individual patient risk factors, circumstances and preferences.</p

Patient and clinician views on the quality of foot health care for rheumatoid arthritis outpatients:A mixed methods service evaluation

Foot health patient information leaflet. (PDF 443 kb