'More than just chitchat': a qualitative study concerning the need and potential format of a peer mentor programme for patients with early rheumatoid arthritis

Viewpoint: Supporting mental health in the current management of rheumatoid arthritis: time to act!

Although clinical outcomes of RA have vastly improved in recent years, the disease's mental health impact has seemingly not decreased to the same extent. Even today, learning to live with RA is an active process involving several psychological, cognitive, behavioural and emotional pathways. Consequently, mental health disorders are more common in the context of RA than in the general population, and can be particularly detrimental both to patients' quality of life and to clinical outcomes. However, mental health is a spectrum and represents more than the absence of psychological comorbidity, and supporting patients' psychological wellbeing should thus involve a more holistic perspective than the mere exclusion or specific treatment of mental health disorders. In this viewpoint article, we build on mechanistic and historical insights regarding the relationship between RA and mental health, before proposing a practical stepwise approach to supporting patients' mental health in daily clinical practice.

Peer Support in Rheumatic Diseases: A Narrative Literature Review

Rheumatic diseases are a group of chronic conditions that are associated with significant morbidity, impaired physical function, psychosocial stress, and cost to the healthcare system. Peer support interventions have been shown to have a positive impact on health outcomes in several chronic conditions, but no review has specifically assessed the impact of peer support on rheumatic conditions. The aim of this narrative literature review was to understand how peer support has been applied in the field of rheumatology, with a specific focus on the impact of observational and randomized studies of direct peer support interventions on various outcome measures across rheumatic conditions. We also examined studies exploring patient attitudes and preferences toward peer support. The majority of studies included focused on peer support in rheumatoid arthritis and systemic lupus erythematosus. Generally, patients across the spectrum of rheumatic disease perceive peer support as a useful tool. Peer support interventions, while highly variable, were generally associated with positive impacts on health-related quality of life metrics (both perceived and measured), although these differences were not always statistically significant. Important limitations include variability in study design, selection bias among study participants, and short follow-up periods across most peer support interventions.

The Effect of Coaching Programs on Physical Activity and Pain in Patients with Rheumatoid Arthritis: A Systematic Review and Meta-analysis of Randomized Controlled Trials

OBJECTIVES

Coaching programs are used to achieve continuity in physical activity and reduce pain severity in patients with rheumatoid arthritis. Our aim was to examine the effects of coaching programs on physical activity and pain in patients with rheumatoid arthritis through randomized controlled trials.

DESIGN

Systematic review and meta-analysis.

DATA SOURCES

Scopus, PubMed, Web of Science, Cochrane Library, Science Direct, EBSCOhost/CINAHL Complete, Springer Link, ProQuest, and Ovid databases were searched without year limitations in English until May 2023.

REVIEW/ANALYSIS METHODS

PRISMA guideline was employed. Comprehensive Meta-Analysis 3 software was used to analyze the meta-analysis data. Two researchers independently assessed the quality of the included studies using the Cochrane Collaboration tool.

RESULTS

This study included six randomized controlled trials with a total of 983 participants. It was determined that the coaching programs were effective in improving physical activity levels (95% CI = 0.14-0.39, Hedge's g = 0.27, p < .001) and reducing pain (95% CI = 0.07-0.39, Hedge's g = 0.23, p = .006) in the intervention groups compared with the control groups. It was determined that the application of coaching programs in the form of face-to-face sessions and phone calls at 7-10 sessions per year in patients diagnosed with rheumatoid arthritis was beneficial in pain management and improving physical activity levels.

CONCLUSIONS

Face-to-face sessions and telephone interviews are recommended as part of a coaching program for the maintenance of physical activity and pain management in patients with rheumatoid arthritis. Coaching programs can improve patients' functional status. There is a need to determine effective strategies by increasing awareness of the coaching programs implemented by nurses.

Longitudinal trajectories of fatigue in early RA: the role of inflammation, perceived disease impact and early treatment response

OBJECTIVE

Fatigue is common in rheumatoid arthritis (RA). We aimed to explore its longitudinal course, predictors and association with disease activity in early RA.

METHODS

Data came from the 2-year treat-to-target trial CareRA (Care in early RA) and its 3-year extension. Fatigue was measured on Visual Analogue Scale, Multidimensional Fatigue Inventory and Short Form-36 (SF-36) vitality. Longitudinal fatigue trajectories were identified with multivariate growth mixture modelling. Early predictors of fatigue and the association of fatigue and its trajectories with disease activity and clinical/psychosocial outcomes were studied with linear mixed models and multilevel mediation.

RESULTS

We included 356 and 244 patients in the 2-year and 5-year analyses, respectively. Four fatigue trajectories were identified: rapid, gradual, transient improvement and early deterioration, including 10%, 14%, 56% and 20% of patients. Worse pain, mental health and emotional functioning were seen in the early deterioration group. Higher pain, patient global assessment (PGA) and disability (Health Assessment Questionnaire), lower SF-36 mental components, and fewer swollen joints at baseline predicted higher fatigue over 5 years, while early disease remission strongly improved 5-year fatigue. The association between Simple Disease Activity Index and fatigue was mediated by PGA, pain, mental health and sleep quality.

CONCLUSIONS

Although fatigue evolves dynamically over time in early RA, most patients do not achieve sustained fatigue improvement despite intensive disease-modifying antirheumatic drug therapy. Higher 5-year fatigue levels were seen in patients with more perceived disease impact and fewer swollen joints at baseline. Conversely, early inflammatory disease control strongly improved long-term fatigue, pointing towards an early window of opportunity to prevent persistent fatigue.

Disseminating and assessing implementation of the EULAR recommendations for patient education in inflammatory arthritis: a mixed-methods study with patients' perspectives

Objectives

To explore patients’ agreement and reasons for agreement or disagreement with the EULAR recommendations for patient education (PE) for people with inflammatory arthritis (IA).

Methods

This mixed-method survey collected data using snowball sampling. The survey had been translated into 20 languages by local healthcare professionals, researchers and patient research partners. It explored the degree to which patients with IA agreed with each recommendation for PE (0=do not agree at all and 10=agree completely) and their rationale for their agreement level in free text questions. Descriptive statistics summarised participants’ demographics and agreement levels. Qualitative content analysis was used to analyse the free text data. Sixteen subcategories were developed, describing the reasons for agreement or disagreement with the recommendations, which constituted the categories.

Results

The sample comprised 2779 participants (79% female), with a mean (SD) age 55.1 (13.1) years and disease duration 17.1 (13.3) years. Participants strongly agreed with most recommendations (median 10 (IQR: 9–10) for most recommendations). Reasons for agreement with the recommendations included the benefit of using PE to facilitate collaborative care and shared decision making, the value of flexible and tailored PE, and the value of gaining support from other patients. Reasons for disagreement included lack of resources for PE, not wanting information to be tailored by healthcare professionals and a reluctance to use telephone-based PE.

Conclusion

The EULAR recommendations for PE have been disseminated among patients with IA. Overall, agreement levels were very high, suggesting that they reflect patients’ preferences for engaging in collaborative clinical care and using PE to facilitate and supplement their own understanding of IA. Reasons for not completely agreeing with the recommendations can inform implementation strategies and education of healthcare professionals.

Social integration of adolescents with chronic pain: a social network analysis

RESULTS

showed that ACPs were not less popular than adolescents without chronic pain. Second, ACPs nominated each other more often as being part of the same peer group. Third, results regarding friendship quality showed that adolescents with more pain problems perceived the relationship with their friends as less positive (e.g., support) and more negative (e.g., conflict) than adolescents with less pain problems. Finally, positive and negative friendship quality moderated the relationship between pain and emotional distress.The current study contributes to the literature on the importance of ACPs' peer relationships. Clinical implications and directions for future research are discussed.