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Gaboury I, Dobkin PL, Gendron F, Roberge P, Beaulieu MC, Carrier N, Dagenais P, Roux S, Boire G. Mindfulness-based stress reduction to improve depression, pain and high patient global assessment in controlled rheumatoid arthritis. Rheumatol Adv Pract 2022; 6:rkac074. [PMID: 36157617 PMCID: PMC9492233 DOI: 10.1093/rap/rkac074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 08/08/2022] [Indexed: 11/16/2022] Open
Abstract
Objective The aim was to improve distressing patient-reported outcomes (PROs) that persisted in RA patients with clinically controlled inflammation (controlled RA). Methods In a pragmatic pilot study, we offered mindfulness-based stress reduction (MBSR), a group intervention, to controlled RA patients who had high (≥16) Centre for Evaluation Studies depression (CES-D) scores and/or patient general assessment of disease activity (PGA) at least 2/10 larger than evaluator general assessment (EGA) (PGA-EGA: Delta). Evaluations before, 6 and 12 months after MBSR included CES-D, PGA, modified HAQ, simple disease activity index (SDAI), anxiety (general anxiety disorder 7; GAD-7), coping strategies (coping with health injuries and problems; CHIP), sleep disturbance and pain. Facilitators and obstacles to recruitment and participation were identified. A subset of patients was interviewed for qualitative analysis of their experience. Results Out of 306 screened patients, 65 were referred, 39 (60%) agreed and 28 (43%) completed MBSR. Anticipated burden, timing and frequency of group meetings, commuting issues, age extremes and co-morbidities were barriers to participation. Up to 12 months after MBSR, anxiety, depression, emotion-oriented coping, sleep and function significantly improved. Nonetheless, no significant impact was observed on pain, PGA, Delta or SDAI. The interviews revealed that benefits, including integration of effective coping strategies, were maintained. Conclusion We addressed MBSR feasibility issues and selection of outcomes in controlled RA patients with distressing PROs. For patients who chose to participate in MBSR, lasting benefits were evident for anxiety, depression, sleep and function. Larger studies are required to evaluate the weaker impact of MBSR on RA-related pain and PGA.
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Affiliation(s)
- Isabelle Gaboury
- Department of Family Medicine, Faculty of Medicine and Health Sciences, Université de Sherbrooke , Sherbrooke, Québec, Canada
| | - Patricia L Dobkin
- Whole Person Programme, Department of Medicine, Faculty of Medicine and Health Sciences, McGill University , Montréal, Québec, Canada
| | - Françoise Gendron
- Centre Intégré Universitaire de Santé et de Services Sociaux de l’Estrie—Centre Hospitalier Universitaire de Sherbrooke (CIUSSSE-CHUS) , Sherbrooke, Québec, Canada
| | - Pasquale Roberge
- Department of Family Medicine, Faculty of Medicine and Health Sciences, Université de Sherbrooke , Sherbrooke, Québec, Canada
| | - Marie-Claude Beaulieu
- Department of Family Medicine, Faculty of Medicine and Health Sciences, Université de Sherbrooke , Sherbrooke, Québec, Canada
| | - Nathalie Carrier
- Centre Intégré Universitaire de Santé et de Services Sociaux de l’Estrie—Centre Hospitalier Universitaire de Sherbrooke (CIUSSSE-CHUS) , Sherbrooke, Québec, Canada
| | - Pierre Dagenais
- Centre Intégré Universitaire de Santé et de Services Sociaux de l’Estrie—Centre Hospitalier Universitaire de Sherbrooke (CIUSSSE-CHUS) , Sherbrooke, Québec, Canada
- Department of Medicine, Faculty of Medicine and Health Sciences, Université de Sherbrooke , Sherbrooke, Canada
| | - Sophie Roux
- Centre Intégré Universitaire de Santé et de Services Sociaux de l’Estrie—Centre Hospitalier Universitaire de Sherbrooke (CIUSSSE-CHUS) , Sherbrooke, Québec, Canada
- Department of Medicine, Faculty of Medicine and Health Sciences, Université de Sherbrooke , Sherbrooke, Canada
| | - Gilles Boire
- Centre Intégré Universitaire de Santé et de Services Sociaux de l’Estrie—Centre Hospitalier Universitaire de Sherbrooke (CIUSSSE-CHUS) , Sherbrooke, Québec, Canada
- Department of Medicine, Faculty of Medicine and Health Sciences, Université de Sherbrooke , Sherbrooke, Canada
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Ferreira RJO, Welsing PMJ, Jacobs JWG, Gossec L, Ndosi M, Machado PM, van der Heijde D, da Silva JAP. Correspondence on "Re-examining remission definitions in rheumatoid arthritis: considering the 28-Joint Disease Activity Score, C-reactive protein level and patient global assessment" by Felson et al. Arthritis Care Res (Hoboken) 2021; 74:501-502. [PMID: 34931481 DOI: 10.1002/acr.24843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Accepted: 12/14/2021] [Indexed: 11/09/2022]
Affiliation(s)
- Ricardo J O Ferreira
- Rheumatology department - Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal.,Health Sciences Research Unit: Nursing (UICISA: E), Nursing School of Coimbra, Coimbra, Portugal
| | - Paco M J Welsing
- Department of Rheumatology & Clinical Immunology, University Medical Center, Utrecht, The Netherlands
| | - Johannes W G Jacobs
- Department of Rheumatology & Clinical Immunology, University Medical Center, Utrecht, The Netherlands
| | - Laure Gossec
- Sorbonne Université - Institut Pierre Louis d'Epidémiologie et de Santé Publique, INSERM, Paris, France.,Rheumatology department - Pitié Salpêtrière hospital, AP-, HP, Paris, France
| | - Mwidimi Ndosi
- School of Health and Social Wellbeing - University of the West of England, Bristol, UK
| | - Pedro M Machado
- Centre for Rheumatology & Department of Neuromuscular Diseases - University College London, London, UK.,Department of Rheumatology, University College London Hospitals NHS Foundation Trust, London, UK.,Department of Rheumatology - Northwick Park Hospital, London North West University Healthcare NHS Trust, London, UK
| | | | - José A P da Silva
- Rheumatology department - Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal.,Clínica Universitária de Reumatologia, and i-CBR Coimbra Institute for Clinical and Biological Research, Faculty of Medicine - University of Coimbra, Portugal
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