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Healey EL, Haywood KL, Jordan KP, Garratt AM, Ryan S, Packham JC. Ankylosing spondylitis and its impact on sexual relationships. Rheumatology (Oxford) 2009; 48:1378-81. [DOI: 10.1093/rheumatology/kep143] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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102
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de Avila Lima Souza L, Gallinaro AL, Abdo CHN, Kowalski SC, Suehiro RM, da Silva CAA, Goldenstein-Schainberg C. Effect of musculoskeletal pain on sexuality of male adolescents and adults with juvenile idiopathic arthritis. J Rheumatol 2009; 36:1337-42. [PMID: 19411396 DOI: 10.3899/jrheum.080867] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To develop a questionnaire for the evaluation of sexuality of male patients with juvenile idiopathic arthritis (JIA). METHODS A cohort of male patients with rheumatoid factor (RF)-negative polyarticular JIA according to the 2004 revised ILAR criteria and inactive disease was studied. The Health Assessment Questionnaire (HAQ) was applied to all patients. As a control group, 120 age-matched males of the same socioeconomic status were evaluated. A self-administered structured instrument, the Male Sexual Evaluation Questionnaire (MSEQ), was developed by multiprofessional experts to assess sexual life, including satisfaction, practice, and related functional aspects. RESULTS Thirty-two male patients with RF-negative polyarticular JIA [mean age 20.8+/-3.8 yrs (range 16-26), mean disease duration 15.4+/-3.6 yrs (range 13-20)] were studied. Mean HAQ score was 1.25+/-0.67 (range 0.1-2.1). Masturbation was practiced similarly by patients and controls (87.5% vs 91%; p>0.999), although joint pain was observed in only 2 (7%) patients. Regular sexual intercourse (>or=once/week) was reported by 78% of patients and 62% of controls (p=0.86). Joint pain during intercourse was more frequent in patients (48% vs 3% in controls; p<0.001). The mean HAQ score was higher in the 12 patients with joint pain (hips=3, knees=5, and hips+knees=4) during intercourse compared to the 13 patients without joint pain (1.82+/-0.27 vs 1.43+/-0.32; p<0.05). Preserved desire and satisfaction were universal findings for all JIA patients and controls. CONCLUSION The MSEQ was applicable to this cohort of male patients with RF-negative polyarticular JIA and showed that sexual life is preserved despite longterm disease, morbidity/functional dysfunction, and joint pain.
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Affiliation(s)
- Lilian de Avila Lima Souza
- Faculdade de Medicina, Disciplina de Reumatologia, Universidade de São Paulo, Av. Dr. Arnaldo 455, sala 3133, São Paulo, SP, Brzsil 01246-903
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103
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The impact of rheumatic diseases on sexual function. Rheumatol Int 2009; 29:853-60. [PMID: 19152092 DOI: 10.1007/s00296-009-0850-6] [Citation(s) in RCA: 81] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2008] [Accepted: 01/05/2009] [Indexed: 12/13/2022]
Abstract
Sexuality is a complex aspect of the human being's life and is more than of only the sexual act. Normal sexual functioning consists of sexual activity with transition through the phases from arousal to relaxation with no problems, and with a feeling of pleasure, fulfillment and satisfaction. Rheumatic diseases may affect all aspects of life including sexual functioning. The reasons for disturbing sexual functioning are multifactorial and comprise disease-related factors as well as therapy. In rheumatoid arthritis and ankylosing spondylitis patients, pain and depression could be the principal factors contributing to sexual dysfunction. On the other hand, in women with Sjögren's syndrome, systemic lupus erythematosus and systemic sclerosis sexual dysfunction is apparently most associated to vaginal discomfort or pain during intercourse. Finally, sexual dysfunction in patients with fibromyalgia could be principally associated with depression, but the characteristic symptoms of fibromyalgia (generalized pain, stiffness, fatigue and poor sleep) may contribute to the occurrence of sexual dysfunction. The treatment of sexual dysfunction will depend on the specific patient's symptoms, however, there are some general recommendations including: exploring different positions, using analgesics drug, heat and muscle relaxants before sexual activity and exploring alternative methods of sexual expression. This is a systemic review about the impact of several rheumatic diseases on sexual functioning. There are no previous overviews about this topic so far.
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Vinet E, Pineau C, Gordon C, Clarke AE, Bernatsky S. Systemic lupus erythematosus in women: impact on family size. ACTA ACUST UNITED AC 2009; 59:1656-60. [PMID: 18975353 DOI: 10.1002/art.24203] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Evelyne Vinet
- Montreal General Hospital, McGill University Health Center, Montreal, Quebec, Canada.
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105
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106
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[Perception of sexuality in women with rheumatic disease: case-control pilot study]. ACTA ACUST UNITED AC 2008; 1:20-4. [PMID: 21794232 DOI: 10.1016/s1699-258x(05)72708-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2005] [Accepted: 03/20/2005] [Indexed: 11/22/2022]
Abstract
INTRODUCTION Rheumatic diseases are characterized by chronic inflammation with systemic involvement and are often accompanied by functional limitation and depression. Their effect on sexual response has been little studied. The objective of the present study was to evaluate perception of sexuality in women with rheumatic disease. PATIENTS AND METHODS We administered a questionnaire that included general data, socioeconomic aspects, disease characteristics, serum markers of inflammation and measured perception of sexuality, depression traits and self-esteem. RESULTS Sixteen patients were interviewed, of which nine had rheumatoid arthritis, six had systemic lupus erythematosus and one had psoriatic arthritis. Twentyfive women were selected as controls. All patients were receiving treatment and had a functional class that allowed them to be self-dependent. Patients presented a worse perception of sexuality than controls (p=0.001) with a trend to more depressive traits and lower self-esteem. CONCLUSIONS Patients with rheumatic disease gain benefits from treatment in terms of quality of life and functionality. Perception of sexuality is affected by chronic inflammatory disease but is independent of the patient's functional class.
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107
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Schneider M, Manabile E, Tikly M. Social aspects of living with rheumatoid arthritis: a qualitative descriptive study in Soweto, South Africa - a low resource context. Health Qual Life Outcomes 2008; 6:54. [PMID: 18651986 PMCID: PMC2499996 DOI: 10.1186/1477-7525-6-54] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2008] [Accepted: 07/24/2008] [Indexed: 11/12/2022] Open
Abstract
Background Rheumatoid Arthritis (RA) is a chronic illness with important functional, social and employment consequences. We therefore undertook a cross-sectional study, using the International Classification of Functioning, Disability and Health framework, to investigate the personal and social consequences of RA in women, living under largely impoverished conditions. Methods A qualitative case study design was used with a convenience sample of 60 women with RA living in Soweto, South Africa. Semi-structured in-depth interviews were conducted to cover a range of experiences including onset of disease, treatment, environmental barriers and facilitators, employment, and social inclusion in family and community life. The outcomes are described according the International Classification of Functioning, Health and Disability framework at the body, person and societal levels and looking at both personal and environmental factors. Results The main features of living with RA were pain, muscle stiffness at the body level, difficulties in doing various activities such as mobility, washing, dressing, domestic activities, using transport and obtaining and maintaining employment at the person level. At the societal level the participants described difficulties moving around, interacting socially and taking part in community activities, fulfilling social roles and earning a living. Environmental facilitators such as assistive devices and health care services improved functioning. Barriers such as physical environments, lack of transport and basic services, such as electricity, and attitudes of others lead to social exclusion, loss of a sense of self and independence. Low income, lack of sufficient public transport, and sparse basic services were poverty features that exacerbated negative experiences. Conclusion The experiences of living with RA in a low resource context are similar to those in mid- and high resource contexts, but are exacerbated by poverty and the lack of basic services. Pain and social exclusion are some of the key experiences of women with RA living in Soweto. The ICF provides a useful framework for describing and understanding the complexity of these experiences.
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Affiliation(s)
- Marguerite Schneider
- Child, Youth, Family and Social Development, Human Sciences Research Council, Pretoria.
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108
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Vazirinejad R, Lilley J, Ward C. A health profile of adults with multiple sclerosis living in the community. Mult Scler 2008; 14:1099-105. [DOI: 10.1177/1352458508092264] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective To describe the frequency of impairments, disabilities, and related services used in a community sample of adults with multiple sclerosis (MS) to estimate the service needs of this population. Methods A community-based postal survey conducted using a self-completion questionnaire consisting of MSQOL-54 questionnaire, Nottingham Extended Activities of Daily Living (NEADL) and some demographic items as well as items to ask about MS-related symptoms and/or problems and using available services. Adults with a diagnosis of MS confirmed by a neurologist were recruited via primary care services in Southern Derbyshire, UK. Results Questionnaires were sent to 310 adults with MS and 201 completed questionnaires were returned – a response rate of 65%. The most commonly reported symptoms and/or problems were fatigue, sexual problems, urinary problems, and painful muscle spasms. Most respondents reported at least one contact with their general practitioner (GP) during the previous 12 months. However, contacts with other services potentially able to alleviate specific symptoms and/or problems were low. Conclusions The findings suggest under-use of existing health care services by those who experience potentially treatable symptoms and/or problems associated with MS. More needs to be done to raise awareness among people with MS and their carers about the services available to them. Given the very high proportion of people with MS known to make contact with primary care services, GPs have a vital role in providing this information.
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Affiliation(s)
- R Vazirinejad
- Department of Social Medicine, Medical School, Rafsanjan University of Medical Sciences, Rafsanjan, Iran
| | - J Lilley
- Division of Rehabilitation and Ageing, Queens Medical Centre, Medical School, Nottingham University, Nottingham, UK
| | - C Ward
- Division of Rehabilitation and Ageing, Queens Medical Centre, Medical School, Nottingham University, Nottingham, UK
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109
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Mitton DL, Treharne GJ, Hale ED, Williams RA, Kitas GD. The health and life experiences of mothers with rheumatoid arthritis: a phenomenological study. Musculoskeletal Care 2007; 5:191-205. [PMID: 17893844 DOI: 10.1002/msc.116] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
BACKGROUND In our varied roles as health care professionals and researchers, many women with rheumatoid arthritis (RA) have commented to us about their feelings of inability to cope with everyday tasks, especially within their role as mothers. AIMS This study explored the health and life experiences of mothers with RA in order to increase knowledge about this group of women and inform health care professionals who provide them with support before and after becoming a mother. METHODS A phenomenological approach was adopted, and individual face-to-face semi-structured interviews were carried out with a sample of seven women, aged 21-41 years, who had lived with RA for 3-11 years and had one or more children under five years of age (total range of ages being 1-7 years). The data were analysed using Colaizzi's procedural steps. RESULTS The five major themes that emerged were inner strength, depression, labelling, failure, and pre- and post-natal education. Sub-themes included issues such as putting on a brave face, spirituality, guilt, burden, feeling 'robbed of motherhood', isolation, coping methods and lack of information. CONCLUSIONS This in-depth study informs health care professionals for their role as support provider for mothers with RA. Further research needs to be carried out to include multicultural experiences, which may or may not differ. As a step forward, we have implemented a local support group for mothers with RA, which will hopefully add benefit to existing rheumatology, midwifery and health visiting services.
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Affiliation(s)
- Debbie L Mitton
- Department of Rheumatology, Dudley Group of Hospitals NHS Trust, UK.
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110
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Edwards J. An exploration of patients' experiences of anti-TNF therapy. Musculoskeletal Care 2007; 2:40-50. [PMID: 17041967 DOI: 10.1002/msc.55] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To explore the experience of rheumatoid arthritis patients receiving anti-tumour necrosis factor (anti-TNF) therapy on physical, psychological and social well-being. METHOD Seven patients with rheumatoid arthritis (RA) who received six months of infliximab were interviewed in depth by one researcher to identify their experiences of this treatment. The interviews were tape-recorded and analysed using Colaizzi's procedural steps. RESULTS Four main categories were identified from the interview relating to the patient's experience of anti-TNF therapy. These included: The impact of living with RA on physical, psychological and social function. The influence of anti-TNF therapy on physical, psychological and social function. The experience of attending for treatment. The impact of discontinuing anti-TNF treatment. CONCLUSION All seven patients experienced benefits from receiving anti-TNF therapy. These benefits were not maintained once the treatment period was completed.
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Affiliation(s)
- Jill Edwards
- Ashfield Health Care Ltd, Ashby de la Zouch, Leicestershire.
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111
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Hewlett S, Hehir M, Kirwan JR. Measuring fatigue in rheumatoid arthritis: a systematic review of scales in use. ACTA ACUST UNITED AC 2007; 57:429-39. [PMID: 17394228 DOI: 10.1002/art.22611] [Citation(s) in RCA: 161] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
OBJECTIVE Fatigue is an important outcome for patients with rheumatoid arthritis (RA). The purpose of this study was to identify the scales being used to measure RA fatigue, and to systematically examine the evidence for their validation. METHODS Articles measuring fatigue in RA were sought using the terms RA and fatigue, and RA and tiredness, plus scale, questionnaire, inventory, and checklist. Index articles reporting identifiable RA fatigue data were examined for the fatigue scale used. Index and validation articles for each scale were reviewed for evidence supporting scale validation to measure RA fatigue using a standardized checklist of content, face, criterion, and construct validity, reliability, and sensitivity to change. RESULTS A total of 61 index articles used 23 different fatigue scales to measure RA fatigue on 71 occasions. Seventeen scales had either no data on validation in RA or limited evidence. Reasonable evidence of validation was identified for 6 scales, each also having some evidence of sensitivity to change: ordinal scales, the Short Form 36 vitality subscale, the Functional Assessment of Chronic Illness Therapy Fatigue Scale, visual analog scales (VAS), the Profile of Mood States, and the RA-specific Multidimensional Assessment of Fatigue scale (MAF). However, the 4 generic scales would benefit from further validation in patients with RA, the VAS requires standardization, and the MAF would benefit from further sensitivity data. CONCLUSION It was possible to identify evidence of reasonable validation for 6 of 23 scales being used to measure RA fatigue. Researchers and clinicians should select scales to measure RA fatigue carefully.
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Affiliation(s)
- S Hewlett
- University of the West of England, Bristol, UK.
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112
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Rkain H, Allali F, Bentalha A, Lazrak N, Abouqal R, Hajjaj-Hassouni N. Socioeconomic impact of ankylosing spondylitis in Morocco. Clin Rheumatol 2007; 26:2081-2088. [PMID: 17457657 DOI: 10.1007/s10067-007-0622-1] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2007] [Revised: 03/22/2007] [Accepted: 03/24/2007] [Indexed: 11/26/2022]
Abstract
The goal of this study was to determine the impact of ankylosing spondylitis (AS) on the socioeconomic well-being of Moroccan patients. One hundred (100) consecutive AS patients (71 men, 29 women) were included. The socioeconomic consequences were studied by measuring direct costs, indirect costs (consequences on work capacity), and intangible costs (social impact) of AS. The mean age at AS onset was 26.85 years +/- 11.71 (7-64). The mean disease duration of AS was 12.05 years +/- 8.32 (0.5-39). Financial difficulties due to AS were observed in 82% of the patients. In 28% of them, these conditions explained a bad observance to treatments. In 14% of the cases, they led children to leave school to support their handicapped parents. Work disability occurred in 22.9% of initially employed patients. Withdrawal from work was correlated to bad social conditions at work, higher scores of Bath ankylosing spondylitis functional index (BASFI), and absence of adherence to a social security system. Sexual problems were present in 64.2% of the patients and were correlated to higher scores of BASFI. There were also disturbances in housekeeping (65.8%) and in leisure time activities (72.2%). Patients received a financial and a psychological familial support in, respectively, 66 and 87% of the cases. Despite the great familial support, Moroccan AS patients suffer from important socioeconomic consequences because of the illness, the bad socioeconomic conditions, the insufficiency of state help, and the social security problems.
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Affiliation(s)
- Hanan Rkain
- Rheumatology Department, El Ayachi Hospital, Universitary Rabat-Salé Medical School, P.O. Box: 10000, Salé, Morocco.
- Universitary Rabat-Salé Medical School, Rabat, Morocco.
| | - Fadoua Allali
- Rheumatology Department, El Ayachi Hospital, Universitary Rabat-Salé Medical School, P.O. Box: 10000, Salé, Morocco
- Universitary Rabat-Salé Medical School, Rabat, Morocco
| | - Aziza Bentalha
- Rheumatology Department, El Ayachi Hospital, Universitary Rabat-Salé Medical School, P.O. Box: 10000, Salé, Morocco
| | - Noufissa Lazrak
- Rheumatology Department, El Ayachi Hospital, Universitary Rabat-Salé Medical School, P.O. Box: 10000, Salé, Morocco
| | | | - Najia Hajjaj-Hassouni
- Rheumatology Department, El Ayachi Hospital, Universitary Rabat-Salé Medical School, P.O. Box: 10000, Salé, Morocco
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Cakar E, Dincer U, Kiralp MZ, Taskaynatan MA, Yasar E, Bayman EO, Ozgul A, Dursun H. Sexual problems in male ankylosing spondylitis patients: relationship with functionality, disease activity, quality of life, and emotional status. Clin Rheumatol 2007; 26:1607-13. [PMID: 17285222 DOI: 10.1007/s10067-007-0545-x] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2006] [Revised: 01/09/2007] [Accepted: 01/11/2007] [Indexed: 10/23/2022]
Abstract
This study has focused on sexual problems of male ankylosing spondylitis (AS) patients. Initially, patients' perceptions about the effects of disease on sexual intercourse were assessed. Secondly, we investigated the factors that relate to the disease and affect sexual intercourse negatively. Thirdly, we compared data from the patients whose sexual intercourse were affected negatively with of those whose sexual intercourse were unaffected. This is a cross-sectional and double-centered study. A total of 53 married or sexually active male patients, who were certainly diagnosed with AS according to modified New York criteria, were assessed. Twenty seven patients (50.94%) expressed that their sexual life was affected negatively by the AS in general (affected patients), and 26 patients (49.06%) expressed no negative effect (unaffected patients). Both affected and unaffected patients were compared with each other with regard to educational level, joint involvement, functionality, disease activity, quality of life, and depression status. Mean BASFI, BASDAI scores were worse in the affected group, and the difference was statistically significant (p = 0.012, p = 0.039, respectively). There were statistically significant differences between the groups with regard to lumbar column and hip involvement (p = 0.035, p = 0.021; respectively). The physical functioning, role limitations due to physical problems, vitality/energy/fatigue, general mental health, and general health perception subscale scores of SF-36 were worse in the affected group, and the differences were statistically significant (p = 0.027, p = 0.023, p = 0,013, p = 0.005, p = 0.045, respectively). Affected patients' Beck Depression Inventory scores were worse than those of unaffected patients, and the difference between the groups was statistically significant (p = 0.039). Sexual problems are common in AS patients and might usually be associated with joint involvement, decreased functionality, increased disease activity, decreased health quality, and depression. Therefore, while examining AS patients and managing their treatments, special attention must be given to all domains of life instead of only physical problems.
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Affiliation(s)
- Engin Cakar
- Department of Physical Medicine and Rehabilitation, Gulhane Military Medical Academy Haydarpasa Training Hospital, GATA HEH FTR Servisi, 34668, Kadikoy, Istanbul, Turkey.
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114
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Kjeken I, Dagfinrud H, Mowinckel P, Uhlig T, Kvien TK, Finset A. Rheumatology care: Involvement in medical decisions, received information, satisfaction with care, and unmet health care needs in patients with rheumatoid arthritis and ankylosing spondylitis. ACTA ACUST UNITED AC 2006; 55:394-401. [PMID: 16739186 DOI: 10.1002/art.21985] [Citation(s) in RCA: 114] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To examine levels of received information, involvement in medical decisions, and satisfaction with care, to explore factors related to current involvement in medical decisions, and to assess patients' unmet health care needs related to their disease. METHODS A total of 1,193 patients with rheumatoid arthritis and ankylosing spondylitis completed self-reported health status questionnaires, including registration of sociodemographic data and questions about rheumatology care. Separate questions addressed information received, involvement in decisions, and satisfaction with care. Aspects of unmet health were assessed by an open-ended question. RESULTS The majority of patients reported medium to high levels of received information, involvement in medical decisions, and satisfaction with care. High involvement in medical decisions was univariately associated with high levels of perceived information and satisfaction, as well as with lower age and a good health status. In the multivariate analyses, patient satisfaction (odds ratio [OR] 4.21) and a high level of received information (OR 7.85), age (OR 0.99), and >12 years of formal education (OR 1.46) remained as significant predictors to current involvement. Nearly one-third reported a variety of unmet health care needs, and this report was associated with poor health. CONCLUSION The results indicate a need for a more flexible and patient centered care model, in which patients to a larger degree can decide which services they need and how these services should be delivered.
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Affiliation(s)
- Ingvild Kjeken
- National Resource Centre for Rehabilitation in Rheumatology, Diakonhjemmet Hospital, boks 23 Vinderen, 0319 Oslo, Norway.
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Rkain H, Allali F, Jroundi I, Hajjaj-Hassouni N. Socioeconomic impact of rheumatoid arthritis in Morocco. Joint Bone Spine 2006; 73:278-83. [PMID: 16376598 DOI: 10.1016/j.jbspin.2005.03.021] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2004] [Accepted: 03/31/2005] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To estimate the socioeconomic impact of rheumatoid arthritis (RA) in Morocco. MATERIALS AND METHODS We identified 100 consecutive patients (88 women and 12 men) with RA receiving follow-up either at a teaching hospital or from office-based physicians. For each patient, we recorded direct costs, indirect costs (productivity losses), and intangible costs (deterioration in the social domain of quality of life). RESULTS Mean age at symptom onset was 31+/- 13.6 years and mean disease duration was 12.8 +/- 7.8 years. RA-related expenses caused financial difficulties for 90% of patients, resulting in poor treatment compliance (61% of cases) and school absenteeism in the children (19% of cases). Of the 34 patients who had paid jobs at symptom onset, 65% stopped working, 6.9 years on average after the diagnosis. Older age, male gender, and a physically strenuous job were associated with stopping work. Six women (10% of married patients) divorced because of their disease. Sexual problems were reported by 67% of patients. The ability to perform domestic chores was affected in 84% of cases and participation in leisure activities in 46% of cases. CONCLUSION RA has a major socioeconomic impact on affected families. In addition to the disease itself, the low socioeconomic status of many patients and the inadequate social welfare and health insurance systems contribute to the burden.
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Affiliation(s)
- Hanan Rkain
- Rheumatology B Department, El Ayachi Hospital, Rabat-Salé Teaching Hospital, Salé, Morocco.
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116
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Hale C, Hill J. Locating the evidence base for musculoskeletal nursing: An overview of the rheumatology nursing literature. Int J Nurs Stud 2006; 43:507-18. [PMID: 16157337 DOI: 10.1016/j.ijnurstu.2005.06.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2004] [Revised: 05/17/2005] [Accepted: 06/28/2005] [Indexed: 10/25/2022]
Abstract
The main aim of this study was to locate and classify publications, particularly research publications, produced by nurses working and/or researching in the area of rheumatology in order to develop a research strategy for a newly established academic and clinical nursing unit. Database searches were undertaken to identify journal articles. Theses, dissertations, research reports, conference abstracts and books were also included in the study. The publications once located were entered into a Reference Manager electronic database and the facilities of this package were used to analyse and classify the data. The findings of the study demonstrated that over the past 40 years nurses have been steadily increasing the publication output in this area and in the last 10 years there has been a substantial increase in all publications, but particularly research and investigative articles. However there is a lack of clinical research in this area and this needs to be addressed in future as nurses develop more advanced roles in this speciality. The main limitations was the difficulty in accurately identifying nursing publications because of inadequate details of authorship.
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Affiliation(s)
- Claire Hale
- Academic and Clinical Unit for Musculoskeletal Nursing, School of Healthcare, University of Leeds, Baines Wing, P.O. Box 214, Leeds LS2 9 UT, UK.
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117
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Abdel-Nasser AM, Ali EI. Determinants of sexual disability and dissatisfaction in female patients with rheumatoid arthritis. Clin Rheumatol 2006; 25:822-30. [PMID: 16521053 DOI: 10.1007/s10067-005-0175-0] [Citation(s) in RCA: 74] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2005] [Revised: 11/19/2005] [Accepted: 12/03/2005] [Indexed: 12/16/2022]
Abstract
Previous research has identified two main problems of sexuality in female rheumatoid arthritis (RA) patients: difficulties in sexual performance and diminution of sexual desire and satisfaction. This study attempts to determine the clinical and psychological factors significantly contributing to sexual disability and dissatisfaction in female RA patients. Ninety consecutive female RA outpatients were assessed by a gynecologist. After excluding patients who were not sexually active and those with genital tract abnormalities, 52 patients were examined and investigated rheumatologically and given questionnaires assessing sexual performance, desire, and satisfaction, as well as demographic variables, pain, disability, anxiety, and depression. Following a correlation analysis, the contributions of demographic, disease, and psychological variables to sexual disability and dissatisfaction were explored by hierarchical and stepwise regression. Thirty-two patients (62%) had difficulties in sexual performance including nine patients (17%) who were totally unable to engage in sexual intercourse because of arthritis. Sexual desire or satisfaction were diminished in 24 patients (46%) and completely lost in 24 patients (46%). Sexual disability was not significantly correlated with any psychodemographic variables, but with parameters of disease activity (p<0.001), Health Assessment Questionnaire (HAQ)-disability (p<0.001), hip (p<0.001) but not knee joint disease, seropositivity (p<0.05), and diminished desire (p<0.05). However, HAQ-disability and hip joint disease were the only independent and significant determinants of sexual disability in the regression model after controlling for the effects of age and disease duration. These variables together explained 64% of the variance of sexual disability. On the other hand, pain (p<0.001), age (p<0.05), and depression (p<0.05) were the significant determinants in the regression model for sexual dissatisfaction, all together contributing 36% of its variance. More than 60% of female RA patients experience variable degrees of sexual disability and diminished sexual desire and satisfaction. Difficulties in sexual performance are related more to overall disability and hip involvement, while diminished desire and satisfaction are influenced more by perceived pain, age, and depression.
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Affiliation(s)
- Ahmed M Abdel-Nasser
- Department of Rheumatology and Rehabilitation, Minia University, 13 Botros Ghally St., 11341, Heliopolis, Cairo, Egypt.
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van Berlo WTM, van de Wiel HBM, Taal E, Rasker JJ, Weijmar Schultz WCM, van Rijswijk MH. Sexual functioning of people with rheumatoid arthritis: a multicenter study. Clin Rheumatol 2006; 26:30-8. [PMID: 16508697 DOI: 10.1007/s10067-006-0216-3] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2005] [Revised: 01/12/2006] [Accepted: 01/12/2006] [Indexed: 12/23/2022]
Abstract
The objective of this study is to compare men and women with rheumatoid arthritis (RA) to controls regarding sexual motivation, activity, satisfaction, and specific sexual problems, and to determine the correlation of physical aspects of the disease with sexual functioning. Questionnaire for screening sexual dysfunctions (QSD), self-constructed questionnaire on experienced distress with joints during sexual activities, arthritis impact measurements scales 2 (AIMS2), and the modified disease activity score 28 (DAS 28) were the methods used. RA patients were recruited from a registration base in three Dutch hospitals. Controls were age and sex matched healthy volunteers. A completed questionnaire was sent back by 271 patients (response 23%). Forty-seven men and 93 women were clinically examined to obtain the DAS 28. Male patients felt less sexual desire, and female patients masturbated and fantasized less than controls. Differences in satisfaction were not found. Male and female patients did not experience more sexual problems than controls. Among the women, correlations were predominantly found between age and sexual motivation and activities, among the men between physical health and sexual problems. Up to 41% of the men (4-41 depending on the joints), and up to 51% of the women (10-51 depending on the joints) have troubles with several joints during sexual activities. Medications influencing ejaculation in men correlated with distress with orgasm. Conclusions are that patients are less sexually active than controls and a considerable number of both male and female patients have trouble with their joints during sexual activities. However, patients do not differ from controls regarding sexual satisfaction. Physiological changes due to RA are apparently independent from those on psychological level. It is argued that sexual satisfaction also depends on personal and social factors. In men, physical health and disease activity are more related with sexual problems than in women.
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Ryan S, Wylie E. An exploratory survey of the practice of rheumatology nurses addressing the sexuality of patients with rheumatoid arthritis. Musculoskeletal Care 2005; 3:44-53. [PMID: 17041993 DOI: 10.1002/msc.25] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
BACKGROUND Rheumatoid arthritis (RA) is a chronic progressive inflammatory condition primarily affecting the joints. It is characterized by pain, stiffness and fatigue. Research has demonstrated that the symptoms of RA can negatively impact on a patient's sexuality and patients would welcome the opportunity to discuss their sexual needs with a health professional. AIMS To identify current perceived practice, skills, and knowledge of rheumatology nurses in addressing the sexuality of patients with RA. METHODS A postal questionnaire was sent to 132 rheumatology nurses identified from the British Health Professionals in Rheumatology Handbook. The questionnaire sought to identify the nurse's role in the assessment and management of RA patients' sexuality. RESULTS Seventy six questionnaires were returned (response rate of 57.5%). Sixty nine respondents stated that sexuality should be included within the nursing assessment. The main factors that influenced whether sexuality was discussed was privacy, the level of knowledge and skills and time. Nurses felt that while contraceptive advice for patients treated with cytotoxic drugs was discussed in depth, the patient's sexual relationship was not discussed at all. The majority of respondents (83%) had never received any training in this area and would undergo training if they had the opportunity. CONCLUSION While rheumatology nurses acknowledge the importance of including sexuality in the care management of patients with RA, in practice the impact of the condition on a patient's sexuality is only discussed briefly. Rheumatology nurses have identified the need for further training in this complex area.
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Affiliation(s)
- Sarah Ryan
- Haywood Hospital, High Lane, Burslem, Stoke-on-Trent, UK.
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Hill J, Hale C. Clinical skills: evidence-based nursing care of people with rheumatoid arthritis. ACTA ACUST UNITED AC 2004; 13:852-7. [PMID: 15284648 DOI: 10.12968/bjon.2004.13.14.14314] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Rheumatoid arthritis is a complex inflammatory disease with an unknown cause, uncertain prognosis and no known cure. The physical symptoms of this chronic disease can impact on the patient's psychological state and also affect the family unit and social/economic viability. Nursing patients with such a multifaceted illness is a skilled and complex task and it is imperative that the care provided is optimal, timely and underpinned by patient education. Evidence-based nursing care founded on an in-depth knowledge of the disease and its treatments will help to achieve optimal patient outcome.
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Affiliation(s)
- Jackie Hill
- Academic and Clinical Unit for Musculoskeletal Nursing (ACUMeN), University of Leeds, Chapel Allerton Hospital, Leeds
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Østensen M. New insights into sexual functioning and fertility in rheumatic diseases. Best Pract Res Clin Rheumatol 2004; 18:219-32. [PMID: 15121041 DOI: 10.1016/j.berh.2004.01.002] [Citation(s) in RCA: 92] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Sexuality is an often neglected area of quality of life in patients with rheumatic disease. Manifestations and symptoms of disease can impair sexual functioning, but this can be much improved by adequate intervention and counseling. Fertility is in general not reduced in rheumatic diseases, however, the time taken to achieve a pregnancy is often increased. An increased rate of pregnancy loss is observed in systemic lupus erythematosus and the antiphospholipid syndrome contributing to a reduced family size. Autoantibodies are present in most of the rheumatic diseases and can interfere with fertilization, implantation, embryonic development and placental function. Active disease disturbs the hypothalamic-pituitary-axis, giving rise to periods of gonadal dysfunction. Toxic effects of immunosuppressive drugs can induce transient or permanent gonadal failure in women and men.
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Affiliation(s)
- Monika Østensen
- Department of Rheumatology and Clinical Immunology/Allergology, University Hospital of Berne, CH-3010 Bern, Switzerland.
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Abstract
PURPOSE OF REVIEW Patient-physician communication is a vital element of the process of care. In numerous studies, communication behaviors during the medical interaction have been significantly associated with a variety of patient satisfaction and health outcomes. The purpose of this review is to synthesize recent findings in the area of patient-physician communication, particularly as they relate to patients with rheumatic disease. RECENT FINDINGS Although there is scant research on the medical interaction with patients with rheumatic disease specifically, there is a large body of literature examining patient-doctor communication in other chronic diseases. Because many of the findings of studies conducted in patients with other diseases can be extended to patients with rheumatic disease, this review also covers the most salient literature published in the past year on patient-doctor communication in chronic diseases in general, in addition to covering publications in the field of rheumatology. SUMMARY The literature reviewed shows that patients' expectations of medical encounters are not always fulfilled and that patients desire increased participation and information sharing. Establishing patient-centered care is a challenging goal, but fortunately, recent studies show that physicians can be trained, irrespective of the years in practice, to provide patient-centered care and increase patient participation and satisfaction with care.
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Affiliation(s)
- Maria E Suarez-Almazor
- Baylor College of Medicine and Houston Veteran Affairs Medical Center, Texas 77030, USA.
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