Pain rather than self-reported sedentary time explains variation in perceived health and activity limitation in persons with rheumatoid arthritis: a cross sectional study in Sweden

Physical activity and sleep differences between osteoarthritis, rheumatoid arthritis and non-arthritic people in China: objective versus self report comparisons

BACKGROUND

Objectively measured differences in physical activity (PA) and sleep have been documented among people with osteoarthritis (OA) and rheumatoid arthritis (RA) compared to non-arthritic controls. However, it is not clear whether OA and RA subgroups also differ on these indexes or the extent to which distinct arthritis subgroups versus controls can be accurately identified on the basis of objective PA and sleep indexes compared to self-report responses on questionnaires. This study addressed these gaps.

METHODS

This case-control study comprised Chinese adults with OA (N = 40) or RA (N = 40) diagnoses based on physician assessments as well as a control group of adults without chronic pain (N = 40). All participants wore a Sensewear Armband (SWA) for consecutive 7 days and completed the International Physical Activity Questionnaire Short Form-Chinese as well as Pittsburgh Sleep Diary to obtain objective and subjective PA and sleep data, respectively.

RESULTS

There were no differences between the three groups on any self-report indexes of PA or sleep. Conversely, OA and RA subgroups displayed significantly lower PA levels and more sleep problems than controls did on a majority of SWA indexes, though arthritis subgroups were not differentiated from one another on these measures. Logistic regression analyses indicated four non-multicollinear SWA indexes (i.e., steps, active energy expenditure, vigorous activity, time awake after sleep onset) correctly identified the subgroup membership of 75.0-82.5% of participants with RA or OA while classification accuracy results were attenuated for controls.

CONCLUSIONS

Where possible, objective measures should be used to assess PA and sleep of adults with OA and RA while particular self-report PA questionnaires should be used sparingly.

Patient perceptions of co-morbidities in inflammatory arthritis

Objective

Longer life expectancy has resulted in people living with an increasing number of co-morbidities. The average individual with inflammatory arthritis has two co-morbidities, which contribute to higher mortality, poorer functional outcomes and increased health-care utilization and cost. A number of studies have investigated the prevalence of co-morbidities, whereas this study was designed to look at patient perspectives.

Methods

The study comprised two parts: a patient questionnaire and an interview. Individuals with physician-verified inflammatory arthritis along with one or more Charlson co-morbidities were invited to participate. In-depth data were obtained by interviews with 12 willing participants.

Results

One hundred and forty-six individuals were recruited; 50 (35%) had one co-morbidity, 69 (48%) had two and 25 (17%) had more than four co-morbidities. Seventy-seven individuals (53%) reported that co-morbidities affected their health as much as their arthritis, and 82 (56%) reported dependence on others for activities of daily living. Lack of education was highlighted by 106 (73%) participants. Qualitative data provided further support for the challenges, with participants highlighting the lack of time to discuss complex or multiple problems, with no-one coordinating their care. This, in turn, led to polypharmacy and insufficient discussion around drug and disease interactions, complications and self-help measures.

Conclusion

This study highlights the challenges for individuals with inflammatory arthritis who suffer with multiple co-morbidities. The challenges result from limited resources or support within the current health-care environments. Individuals highlighted the poor quality of life, which is multifactorial, and the need for better educational strategies and coordination of care to improve outcomes.

Physical activity in established rheumatoid arthritis and variables associated with maintenance of physical activity over a seven-year period - a longitudinal observational study

Background

A large number of patients with RA do not adhere to the recommended levels of physical activity to enhance health. According to EULAR recommendations, physical activity should be part of standard care in people with rheumatic diseases. There have been few larger studies on maintenance of physical activity over longer periods of time. The aim was to study self-reported physical activity levels over 7 years in patients with established rheumatoid arthritis (RA). In addition, to determine variables associated with maintenance or change of physical activity behavior.

Methods

Questionnaires were sent to the BARFOT cohort in 2010 (n = 1525) and in 2017 (n = 1046), and 950 patients responded to both questionnaires. Patients were dichotomized according to meeting MVPA recommendations (physically active at a moderate level ≥ 150 min/week or at an intense level ≥ 75 min/week) or not. Body mass index, smoking habits, tender joint count (TJC), swollen joint count (SJC), Patient Global Assessment (PatGA), pain intensity and distribution, fatigue, physical function (HAQ), health-related quality of life (EQ. 5D), comorbidities, and medical treatment were assessed. We used logistic regression analysis to study variables associated with maintenance and/or change of MVPA behavior.

Results

Forty-one per cent (n = 389) of the patients met MVPA recommendations on both occasions. Patients who met MVPA recommendations over 7 years were younger and a higher proportion were never-smokers. There was a negative association with being overweight or obese, having cardiovascular or pulmonary diseases, pain, fatigue, and physical function, whereas there was a positive association between QoL and maintaining MVPA recommendations. Similar factors were positively associated with a deterioration in physical activity level over time.

Conclusions

Maintenance of physical activity over a long period of time is challenging for patients with established RA. Reports of high quality of life supported maintenance of physical activity while disease related and unhealthy lifestyle factors had a negative effect. Health professionals should consider the patient's standpoint when encouraging maintenance of physical activity, preferably using coordinated lifestyle interventions.

Association between sitting time and orthopedic conditions in Korean older adults

This study aimed to identify the association between sitting time and orthopedic conditions in Korean older adults. Data from adults aged ≥65 years from the 6th Korea National Health and Nutrition Examination Survey (2014-2015) were used for analysis (n = 3,011). Sitting time ≥7.5 h/day was significantly associated with knee joint (OR = 1.41, 95% CI: 1.11, 1.79), hip joint (OR = 1.54, 95% CI: 1.17, 2.03), and low back pain (OR = 1.44, 95% CI: 1.19, 1.74) when adjusted for sex, age, obesity, housing type, family income, education, and marital status in multiple logistic regression analyses. These findings imply that appropriate pain management according to sociodemographic characteristics in orthopedic conditions are necessary to reduce excessive sitting time in Korean older adults.

Influence of pain score measured by a visual analog scale (PS-VAS) on the Health Assessment Questionnaire Disability Index and 28-joint Disease Activity Index with C-reactive protein in rheumatoid arthritis patients

BACKGROUND

Pain is a serious burden for rheumatoid arthritis (RA) patients. However, the effect on Health Assessment Questionnaire Disability Index (HAQ-DI) and 28-joint Disease Activity Score (DAS28) has not been presented. The aim of this study is to evaluate them in a case series.

METHODS

Three hundred and eighty-two RA patients who were treated for more than 5 years were studied. The parameters assessed included average value of the DAS28 with C-reactive protein (DAS28-CRP), the HAQ-DI score, the Sharp/van der Heijde Score (SvdHS), age, and the pain score measured by a visual analog scale (PS-VAS). Relationships among these factors and the relationships between the HAQ-DI score and the other factors, and the relationships between the change in HAQ-DI scores and the changes in other factors were evaluated statistically with multivariate linear regression analysis. The effect of PS-VAS on HAQ-DI was compared with that of DAS28-CRP on the overlapping data of each parameter.

RESULTS

HAQ-DI demonstrated significant positive correlations with all parameters. However, PS-VAS demonstrated a stronger effect than DAS28-CRP, also demonstrated without overlapping data. After minimizing the effects of DAS28-CRP, age and SvdHS, there was a significant correlation between HAQ-DI and PS-VAS in all analyses. The change in HAQ-DI demonstrated a significant correlation with the change in PS-VAS.

CONCLUSIONS

These results suggested that HAQ-DI is deeply influenced by PS-VAS. The effect of DAS28-CRP overlapped with the effect of PS-VAS in a major way. Pain control for RA patients is the most important factor contributing to activities of daily living, as well as disease activity control.