Rheumatoid arthritis prevention in arthralgia: fantasy or reality?

The concept of a 'window of opportunity' in treating a disease assumes the existence of a time frame during which the trajectory of the disease can be effectively and permanently modified. In rheumatoid arthritis (RA), optimal timing of this period is presumed to be during the phase before arthritis is clinically apparent and disease is diagnosed. Several proof-of-concept trials of treatment during the 'arthralgia' phase of RA have been completed in the past 4 years, with the underlying notion that temporary treatment at this stage could prevent the development of RA or induce a sustained reduction in the burden of disease. This Review summarizes the results of these trials and reflects on the outcomes in relation to the patients' perspectives. Overall, the majority of symptomatic at-risk individuals could benefit from a fixed period treatment, even if RA does not develop. Various factors must be taken into consideration when translating these findings into clinical practice. More evidence is needed to target the individuals at highest risk, and additional tools are needed to monitor treatment and guide decisions about whether treatment can be discontinued. Without these tools, there is a paradoxical risk of seemingly increasing the incidence of the disease and prolonging disease duration, which is the opposite of what the concept of intervening in the window of opportunity entails.

Defining Pain That Does Not Interfere With Activities Among Rheumatoid Arthritis Patients.

OBJECTIVE: The objectives of this study were to: 1) characterize the distribution of noninterfering pain (defined as the pain intensity level at which individuals can function without interference) across different aspects of life among patients with rheumatoid arthritis (RA), and 2) identify clinical characteristics associated with differing levels of noninterfering pain. METHODS: Patients with RA in FORWARD, The National Databank for Rheumatic Diseases completed 8 items from the Patient-Reported Outcomes Measurement Information System (PROMIS) pain interference item bank that asked about interference with activities. If subjects reported pain interference, they were asked, "At what level would pain no longer interfere with this activity?" on a scale of 0 to 10. Subjects were also asked, "At what level of pain would you be able to do everything you want to do?" Multiple linear regression analyses examined associations between clinical characteristics and noninterfering pain. RESULTS: A total of 3,949 patients with RA completed the questionnaires. Pain interference was most common for daily activities and least common for ability to concentrate. The mean ± SD level at which pain no longer interfered with activities ranged from 2.7 ± 2.1 for ability to fall/stay asleep to 3.1 ± 2.0 for social activities. Overall, the mean ± SD threshold for noninterfering pain was 2.8 ± 1.9. The mean ± SD level of pain at which patients could do everything they wanted to do was 2.3 ± 1.9. More severe pain intensity was associated with higher noninterfering pain. CONCLUSION: The mean pain level that did not interfere with activities was 3. High pain intensity was associated with high self-reported noninterfering pain.

Risk of rheumatoid arthritis in patients with hepatitis C virus infection receiving interferon-based therapy: a retrospective cohort study using the Taiwanese national claims database.

OBJECTIVES: To illuminate the association between interferon-based therapy (IBT) and the risk of rheumatoid arthritis (RA) in patients infected with hepatitis C virus (HCV). DESIGN, SETTING, PARTICIPANTS AND INTERVENTIONS: This retrospective cohort study used Taiwan's Longitudinal Health Insurance Database 2005 that included 18 971 patients with HCV infection between 1 January 1997 and 31 December 2012. We identified 1966 patients with HCV infection who received IBT (treated cohort) and used 1:4 propensity score-matching to select 7864 counterpart controls who did not receive IBT (untreated cohort). OUTCOME MEASURES: All study participants were followed until the end of 2012 to calculate the incidence rate and risk of incident RA. RESULTS: During the study period, 305 RA events (3.1%) occurred. The incidence rate of RA was significantly lower in the treated cohort than the untreated cohort (4.0 compared with 5.5 per 1000 person-years, p<0.018), and the adjusted HR remained significant at 0.63 (95% CI 0.43 to 0.94, p=0.023) in a Cox proportional hazards regression model. Multivariate stratified analyses revealed that the attenuation in RA risk was greater in men (0.35; 0.15 to 0.81, p=0.014) and men<60 years (0.29; 0.09 to 0.93, p=0.036). CONCLUSIONS: This study demonstrates that IBT may reduce the risk of RA and contributes to growing evidence that HCV infection may lead to development of RA.

Inflammatory Arthritis Prevalence and Health Services Use in the First Nations and Non-First Nations Populations of Alberta, Canada.

OBJECTIVE: To estimate prevalence of rheumatoid arthritis (RA), ankylosing spondylitis (AS), psoriatic disease (PsD), and crystal-related arthritis and health care use for inflammatory arthritis in First Nations and non-First Nations patients in Alberta, Canada. METHODS: Population-based cohorts of adults with RA, AS, PsD, and crystal-related arthritis were defined, with First Nations determination by premium payer status, to estimate prevalence rates. Rates of outpatient primary care, specialist visits, and hospitalizations (all-cause, inflammatory-arthritis specific) were estimated. RESULTS: RA affected 3 times as many First Nations residents compared to non-First Nations residents (standardized rate ratio [SRR] 3.2, 95% confidence interval [95% CI] 2.9-3.4). AS and PsD were more prevalent in First Nations (AS 0.6 per 100 residents; SRR 2.7, 95% CI 2.3-3.2 and PsD 0.3 per 100 residents; SRR 1.5, 95% CI 1.3-1.9), whereas crystal-related arthritis was less prevalent (SRR 0.7, 95% CI 0.6-0.7). First Nations patients were more likely to have primary care visits (SRR 1.7, 95% CI 1.6-1.8) and less likely to have specialist visits (SRR 0.6, 95% CI 0.6-0.7) for RA relative to non-First Nations individuals. In PsD and crystal-related arthritis, First Nations people had higher rates of cause-specific hospitalizations. CONCLUSION: The estimated prevalence of RA, AS, and PsD was higher in the First Nations population, while crystal-related arthritis was less prevalent compared to the non-First Nations population. First Nations people were more likely to see primary care physicians and were less likely to see specialists for inflammatory arthritis care.

Development and reliability of a Turkish version of the Short Form-Joint Protection Behavior Assessment (JPBA-S).

STUDY DESIGN: Clinical measurement. PURPOSE: To adapt the original JPBA-S to a Turkish version (TUR-JPBA-S) and to investigate its reliability in assessing patients with rheumatoid arthritis (RA). METHODS: Twenty-two participants with RA and 21 healthy people were videotaped while performing tasks listed in the TUR-JPBA-S. Two raters scored the video recordings for to evaluate inter-rater reliability. One rater re-analyzed the recordings at a different time point for intra-rater reliability. Participants with RA were asked to perform the same tasks after three to four weeks which was also recorded to evaluate test-retest reliability. RESULTS: Internal consistency (Cronbach's α value) was found to be high (0.89) for participants with RA. Our results demonstrate excellent intra-rater (ICC: 0.99, SEM 1.2) inter-rater (ICC: 0.99, SEM 1.7) reliability, apart from excellent test-retest reliability (ICC: 0.96). CONCLUSION: The TUR-JPBA-S is a valid and reliable instrument for assessing JP behavior in patients with RA in Turkey. LEVEL OF EVIDENCE: Level 2.

Protocolo Clínico e Diretrizes Terapêuticas: artrite reumatóide / Clinical Protocol and Therapeutic Guidelines: rheumatoid arthritis

INTRODUÇÃO: A Artrite reumatoide (AR) é uma doença autoimune, inflamatória, sistêmica e crônica, caracterizada por sinovite periférica e por diversas manifestações extra-articulares. No Brasil, um estudo de 2004 mostrou prevalência de 0,46%, representando quase um milhão de pessoas com essa doença, o que confirma o achado do estudo multicêntrico, realizado em 1993, que verificou uma prevalência de AR em adultos variando de 0,2% - 1%, nas macrorregiões brasileiras, ocorrendo predominantemente em mulheres entre a quarta e sexta décadas de vida. DIAGNÓSTICO: O diagnóstico de AR é estabelecido com base em achados clínicos e exames complementares. Nenhum exame isoladamente, seja laboratorial, de imagem ou histopatológico, estabelece o diagnóstico. Sem tratamento adequado, o curso da doença é progressivo, determinando deformidades decorrentes da lassidão ou ruptura dos tendões e das erosões articulares. Entre os achados tardios, podem-se identificar desvio ulnar dos dedos ou "dedos em ventania", deformidades em "pescoço de cisne" (hiperextensão das articulações IFP e flexão das interfalangianas distais -IFD), deformidades em "botoeira" (flexão das IFP e hiperextensão das IFD), "mãos em dorso de camelo" (aumento de volume do punho e das articulações MCF com atrofia interóssea dorsal), joelhos valgos (desvio medial), tornozelos valgos (eversão da articulação subtalar), hálux valgo (desvio lateral do hálux), "dedos em martelo" (hiperextensão das articulações metatarsofalangianas - MTF e extensão das IFD), "dedos em crista de galo" (deslocamento dorsal das falanges proximais com exposição da cabeça dos metatarsianos) e pés planos (arco longitudinal achatado). CRITÉRIOS DE INCLUSÃO: erão incluídos neste Protocolo os pacientes que preencherem os critérios ACR de 1987 ou os critérios ACR/EULAR de 2010 para classificação de AR. CRITÉRIOS DE EXCLUSÃO: Serão excluídos do uso de medicamento preconizado neste Protocolo os pacientes que apresentarem contraindicação absoluta ao seu respectivo uso. CASOS ESPECIAIS: Serão considerados casos especiais os pacientes com os seguintes diagnósticos: doença reumatoide do pulmão, vasculite reumatoide (diagnosticadas em indivíduos com AR e manifestações compatíveis) e ARJ. TRATAMENTO: O tratamento de AR deve ser iniciado o mais breve possível, uma vez que a terapia medicamentosa intensiva instituída precocemente previne danos estruturais (erosões), melhorando a capacidade funcional (1,10,51,52). O período inicial da doença, principalmente os doze primeiros meses (AR inicial), configura uma janela de oportunidade terapêutica, isto é, um momento em que a intervenção farmacológica efetiva pode mudar o curso da doença. Em alguns países, o acompanhamento por reumatologista é uma política assistencial custo-efetiva (54), devendo ser o preferencial. Intervenções educacionais podem ser úteis na implementação de protocolos clínicos para essa doença. BENEFÍCIOS ESPERADOS: O tratamento de AR tem como benefícios esperados reversão da limitação funcional, melhora da qualidade de vida e aumento da sobrevida por meio do controle da atividade de doença, da prevenção das complicações agudas e crônicas e da inibição da progressão dos danos estruturais causados pela doença. MONITORIZAÇÃO: Revisões periódicas para avaliação de eficácia e segurança do tratamento devem fazer parte do tratamento dos pacientes com AR. Inicialmente, os pacientes devem ser avaliados a intervalos menores (1 a 3 meses). Uma vez atingido o objetivo do tratamento (remissão para AR mais recente e atividade leve de doença para AR de anos de evolução), intervalos maiores podem ser considerados (6 a 12 meses). No entanto, mesmo sem a necessidade de visitas mais frequentes para avaliação de eficácia, a monitorização de segurança deve ser observada, ou seja, os intervalos dos exames laboratoriais para monitorização dos possíveis efeitos adversos de medicamentos devem ser respeitados. ACOMPANHAMENTO PÓS TRATAMENTO: O tratamento de AR deve ser realizado enquanto o paciente dele se beneficiar. Nos raros casos de remissão após interrupção de tratamento, revisões anuais podem ser adotadas. Nessas consultas, além da história e do exame físico, exames como velocidade de hemossedimentação e proteína C reativa podem ser solicitados. Na confirmação de reativação da doença, devem-se as recomendações deste Protocolo voltam a ser aplicáveis.

Determinants of MSK health and disability--social determinants of inequities in MSK health.

Even in most egalitarian societies, disparities in care exist to the disadvantage of some people with chronic musculoskeletal (MSK) disorders and related disability. These situations translate into inequality in health and health outcomes. The goal of this chapter is to review concepts and determinants associated with health inequity, and the effect of interventions to minimize their impact. Health inequities are avoidable, unnecessary, unfair and unjust. Inequities can occur across the health care continuum, from primary and secondary prevention to diagnosis and treatment. There are many ways to define and identify inequities, according for instance to ethical, philosophical, epidemiological, sociological, economic, or public health points of view. These complementary views can be applied to set a framework of analysis, identify determinants and suggest targets of action against inequity. Most determinants of inequity in MSK disorders are similar to those in the general population and other chronic diseases. People may be exposed to inequity as a result of policies and rules set by the health care system, individuals' demographic characteristics (e.g., education level), or some behavior of health professionals and of patients. Osteoarthritis (OA) represents a typical chronic MSK condition. The PROGRESS-Plus framework is useful for identifying the important role that place of residence, race and ethnicity, occupation, gender, education, socioeconomic status, social capital and networks, age, disability and sexual orientation may have in creating or maintaining inequities in this disease. In rheumatoid arthritis (RA), a consideration of international data led to the conclusion that not all RA patients who needed biologic therapy had access to it. The disparity in care was due partly to policies of a country and a health care system, or economic conditions. We conclude this chapter by discussing examples of interventions designed for reducing health inequity.

Productividad laboral en pacientes con artritis reumatoidea: Instituto Guatemalteco de Seguridad Social, 2013 / Labor productivity in patients with rheumatoid arthritis: Guatemalan Institute of Social Security, 2013

Introducción: La artritis reumatoide está asociadacon un significativa pérdida en la productividad enel trabajo (ausentismo y presentismo). Objetivo: Determinar la productividad laboral en pacientes conartritis reumatoide que asisten a la consulta externade reumatología de la policlínica zona 1, periféricasde zona 5 y zona 11, y Autonomía, dependencias pertenecientes al Instituto Guatemalteco de Seguridad Social, ciudad de Guatemala, durante los meses de julio y agosto del año 2013. Métodos: Estudio descriptivo transversal, donde se realizó una revisión sistemática de expedientes y valoración clínica de 142 pacientes con diagnóstico de artritis reumatoide según criterios del Colegio Americano de Reumatología del año 1987. Además se aplicaron test estandarizados para valorar calidad devida (RAQoL), estado general de salud (HAQ) yel grado de actividad de la enfermedad (DAS28) ysu correlación con el impedimento de actividadesy productividad laboral (WPAI-RA). Resultados: El 84.51% de los pacientes fue de sexo femenino, el promedio de edad de 47.5 ± 11.06 años. Ciento nueve pacientes laboraban (76.76%), se obtuvosegún WPAI-RA una media 3.20 horas laborales perdidas debido a AR por paciente, en los últimos7 días. El porcentaje de ausentismo y presentismo laboral fue de 6.21% y 42.11%, respectivamente.Se obtuvo una correlación positiva débil entre elgrado de afectación de la productividad laboral y elgrado de actividad de la enfermedad (DAS28) r de Spearman de 0.347; correlación positiva moderada a fuerte con el estado general de salud (HAQ)r de Spearman de 0.602; y correlación positiva moderada a fuerte con la calidad de vida (RAQoL) r de Spearman de 0.621...

Background: Rheumatoid arthritis is associated withsignificant losses in work productivity (absenteeismand presenteeism). Objective: To determine thework productivity in patients with rheumatoid arthritis who attend at peripheral rheumatologic out-patient clinics in zone 5 and zone 11, Policlinic zone 1, and Autonomía, Guatemalan Institute of Social Security, Guatemala city, during July and August,2013. Methods: A cross-sectional study was carryout by performing a systematic review of medical records and clinical evaluation of 142 patients diagnosed with Rheumatoid Arthritis who met the American College of Rheumatology 1987 revised criteria. Standar dized tests were applied to assessquality of life (RAQoL), functional disability, Health Assessment Questionnaire (HAQ), Disease Activity Score (DAS28) and their correlations with the Work Productivity and Activity Impairment (WPAI-RA). Results: 84.51% were women, age average: 47.5+/- 11.06 years. One hundred nine patients wereworking (76.76%) and according to WPAI-RA, 3.20 hours were lost because of RA per patient in the last 7 days. The percentage of absenteeism and presenteeism was 6.21% and 42.11%, respectively. A slight positive correlation was found between the work productivity impairment and the degree of the disease activity (DAS28) r of Spearman 0.347; positive correlation from moderate to strong with the functional disability (HAQ) and quality of life (RAQoL), r of Spearman of 0.602 and 0.621, respectively...

Limited end-user knowledge of methotrexate despite patient education: an assessment of rheumatologic preventive practice and effectiveness.

BACKGROUND: Methotrexate (MTX) is a first-line disease-modifying agent and anchor drug for biologic therapy used in rheumatoid arthritis and other inflammatory rheumatic disorders. Adverse effects are a common cause of drug discontinuation and include preventable serious incidents that may result in patient harm or death. OBJECTIVES: The objective of this study was to audit adherence by health professionals to national and international guidelines for patient education and risk reduction in patients prescribed MTX for inflammatory rheumatic diseases. METHODS: A combination of interviews, case record reviews, and self-administered patient knowledge questionnaires with individual patient feedback was used. The setting was the rheumatology outpatient department of a district general hospital. RESULTS: Fifty-one patients participated in the audit. The mean age was 58.6 (SD, 13.1) years and median duration of disease was 3.7 years (interquartile range, 1.7-7.6 years). Nurse-led patient education was documented at baseline for 94.1% of participants. Despite this, only 11.8% of participants recognized the potentially lethal drug-drug interaction with trimethoprim/Septrin (co-trimoxazole), and less than 60.8% recognized possible major adverse effects related to MTX. Although lifestyle implications relating to alcohol consumption and pregnancy/breast-feeding were recognized by the majority, only 52.9% of males were aware of recommendations in relation to conception. Univariable and multivariable analyses identified male sex, not speaking English as a first language, and a longer duration of therapy as predictors of lower levels of patient knowledge. CONCLUSIONS: Despite consistent baseline patient education, end-user knowledge and awareness pertinent to MTX safety are limited. Good-quality written information in the most appropriate language, patient feedback on educational programs, follow-up testing of patient knowledge, and targeted reeducation are recommended to address individual deficiencies in core knowledge.

A public health approach to addressing arthritis in older adults: the most common cause of disability.

Arthritis is highly prevalent and is the leading cause of disability among older adults in the United States owing to the aging of the population and increases in the prevalence of risk factors (e.g., obesity). Arthritis will play a large role in the health-related quality of life, functional independence, and disability of older adults in the upcoming decades. We have emphasized the role of the public health system in reducing the impact of this large and growing public health problem, and we have presented priority public health actions.

Avaliação econômica das anticitocinas adalimumabe, etanercepte e infliximabe no tratamento da artrite reumatoide no Estado do Paraná / Economic evaluation of anticitokines adalimumab, etanercept and infliximab for treatment of rheumatoid arthritis in Paraná State, Brazil

Este estudo objetivou realizar uma avaliação econômica das anticitocinas adalimumabe (ADA), etanercepte (ETA) e infliximabe (IFX) para o tratamento da artrite reumatoide no Estado do Paraná, sob a perspectiva do SUS. Os dados de eficácia e segurança dos tratamentos foram buscados na literatura, e os custos foram calculados com valores gastos pelo SUS para cada um dos tratamentos. Foi elaborado o modelo de Markov para obter a relação custo-efetividade de cada tratamento. A relação custo-efetividade incremental (ICER) comparado ao tratamento padrão também foi calculada para cada anticitocina. Análises de sensibilidade e taxas de desconto foram aplicadas. Na avaliação custo-efetividade, encontraram-se custos por QALY de R$ 511.633,00, R$ 437.486,00 e R$ 657.593,00 para ADA, ETA e IFX, respectivamente. O ICER por QALY foi R$ 628.124,00, R$ 509.974,00 e R$ 965.927,00 para ADA, ETA e IFX, respectivamente. Nas análises de sensibilidade, o ETA e o ADA apresentaram valores próximos. Cabe aos gestores públicos e aos médicos prescritores a escolha adequada para cada paciente, entre os tratamentos disponibilizados.

This study aimed to perform an economic evaluation of anticytokines adalimumab (ADA), etanercept (ETA) and infliximab (IFX) for the treatment of rheumatoid arthritis in the State of Parana, in Brazil, in the perspective of the Brazilian Unified Health System. Data on efficacy and safety of treatment were collected in literature, and costs were calculated on the amounts spent by the Government for each treatment. A Markov model was performed to get the cost-effectiveness of each treatment. The incremental cost-effectiveness relationship (ICER) compared to a standard treatment was also calculated for each anticytokine. Sensitivity analysis and discount rates were applied. In assessing cost-effectiveness we found the following values (cost at R$ per QALY): 511,633.00, 437,486.00 and 657,593.00 (respectively for ADA, ETA and IFX). The ICER (R$ per QALY) was 628,124.00, 509,974.00 and 965,927.00 (for ADA, ETA and IFX). In the sensitivity analysis, ETA and ADA showed similar values. It is for public managers and physicians the choice for each patient, among the treatments available.

The delivery of evidence-based preventive care for older Americans with arthritis.

INTRODUCTION: Previous research suggests patients with rheumatoid arthritis (RA) may receive suboptimal care with respect to preventive tests and services. We evaluated the proportion of older Americans with RA, psoriatic arthritis (PsA), and osteoarthritis (OA) receiving these services and the specialty of the providers delivering this care. METHODS: Using data from 1999 to 2006 from the Medicare Chronic Conditions Warehouse, we identified persons age >/= 65 in the national 5% sample. Over the required five-year observation period, we identified tests and services recommended for older adults and the associated healthcare provider. Services of interest included dual energy x-ray absorptiometry (DXA), influenza and pneumococcal vaccination, hyperlipidemia lab testing, mammography and colonoscopy. RESULTS: After accounting for the sampling fraction, we identified 141,140 RA, 6,300 PsA, and 770,520 OA patients eligible for analysis. Over five years, a majority of RA, PsA, and OA patients were tested for hyperlipidemia (84%, 89% and 87% respectively) and received DXA (69%, 75%, and 52%). Only approximately one-third of arthritis patients received pneumococcal vaccination; 19% to 22% received influenza vaccination each year. Approximately 20% to 35% of arthritis patients never underwent mammography and colonoscopy over five years. Concomitant care from both a rheumatologist and a primary care physician was significantly associated with a greater likelihood of receiving almost all preventive tests and services. CONCLUSIONS: Among older Americans on Medicare, the absolute proportion of persons with arthritis receiving various recommended preventive services and screening tests was substantially less than 100%. Improved co-management between primary care and arthritis physicians may in part improve the delivery of preventive care for arthritis patients, but novel systematic interventions in this area are needed.

Preventing the progression from undifferentiated arthritis to rheumatoid arthritis: the clinical and economic implications.

A significant percentage of patients presenting with undifferentiated arthritis (UA) will progress to rheumatoid arthritis (RA), while others will undergo spontaneous remission. Evidence supports the use of therapeutic intervention in patients with UA to delay or halt disease progression and its long-term consequences. However, there is first a need to screen patients with UA to identify those with a high probability of progressing to RA who would benefit from antirheumatic therapy. The 2010 American College of Rheumatology/European League Against Rheumatism RA classification criteria were designed for this purpose. These criteria can aid clinicians in deciding when it is appropriate to initiate therapy in patients at risk of progressing to RA. These criteria can also have important implications in reducing the inappropriate and unnecessary use of antirheumatic agents in patients less likely to develop RA, thus reducing healthcare costs and minimizing the risk of sequelae associated with these agents. Use of disease-modifying antirheumatic drugs and biologic agents in patients with UA has been associated with delays in disease progression. However, further clinical studies are needed to fully evaluate the long-term clinical and economic outcomes of these agents in patients with UA.

Management of patients with rheumatoid arthritis.

Rheumatoid arthritis is a chronic inflammatory disease, which mainly affects the peripheral joints. Nurses are integral to the care of patients with this disease. This article discusses the role of the rheumatology nurse in the management of patients with this disabling condition.

Arthritis burden and impact are greater among U.S. women than men: intervention opportunities.

OBJECTIVES: To summarize arthritis burden and impact among women compared with men, using updated surveillance and impact measures; to describe public health approaches to arthritis; and to review effective, evidence-based arthritis self-management interventions. RESULTS: Arthritis continues to burden the U.S. population as the leading cause of physical disability and affects women disproportionately: women with arthritis report greater prevalence of activity and work limitations, psychological distress, and severe joint pain than their male counterparts. Three main public health interventions can reduce arthritis impact: self-management education, physical activity, and weight management. Self-management education programs are proven to reduce pain and depression, delay disability, improve self-efficacy, physical function, and quality of life, and reduce healthcare costs. Appropriate physical activity decreases pain, improves function, and delays disability. The American College of Rheumatology recommends maintaining a healthy weight to benefit patients with hip or knee osteoarthritis. Women appear more receptive to certain information delivery methods (i.e., physician counseling) than men, suggesting gender-specific targeting of interventions may be of use. CONCLUSIONS: Effective interventions remain underused. The Centers for Disease Control and Prevention Arthritis Program and its partners, including state arthritis programs, continue their efforts to build the arthritis public health science base, monitor burden and impact, evaluate and disseminate evidence-based interventions, and work to decrease and delay disability, and increase quality of life among those with arthritis. As new approaches are developed, women and other disproportionately impacted groups merit particular consideration in tailoring and delivering programs to reduce arthritis burden.

A nurse-led rheumatology clinic's impact on empowering patients with rheumatoid arthritis: A qualitative study.

The aim of this study was to describe a nurse-led rheumatology clinic's impact on empowering patients with rheumatoid arthritis (RA). Rheumatoid arthritis is a chronic, inflammatory disease that attacks many joints, causing considerable functional restrictions for patients. Consequently, these patients are dependent on a wide variety of health-care services. A descriptive, qualitative design inspired by phenomenography was chosen. The conceptions were collected through interviews with 16 strategically selected patients with RA. Three descriptive categories comprising eight conceptions emerged: teaching (gaining insight and receiving information), regular review (receiving security, realizing regularity, and achieving accessibility), and attention (getting a holistic assessment, receiving coordinated care, and getting sufficient time). A nurse-led rheumatology clinic can be a source for empowering patients with RA to adopt new stances to alternative actions and achieve a higher level of faith in their own abilities.

Phenomenological lived experience of patients with rheumatoid arthritis.

This phenomenological study explored (a) the lived experience of rheumatoid arthritis (RA), (b) the patient's view of the nurse's role, and (c) the patient as comanager of RA. The purposive sample consisted of 6 Caucasian women living in West Virginia. Using Colaizzi's methodology, a rich, exhaustive description of living with RA emerged. Recommendations for nursing care quality focus on providing personalized, holistic, and humanistic care, which may ultimately improve the patient's quality of life.

Lived experience of Korean women suffering from rheumatoid arthritis: a phenomenological approach.

Rheumatoid arthritis (RA) sufferers number approximately 200 million people around the world. In Korea, there is no accurate statistical information, but 1-2% of the total population have been estimated to be suffering from RA. Current research studies related to RA have been limited to quantitative approaches. In qualitative studies, most research has been focused on one aspect of the experience of patients with RA, such as pain or fatigue. In order to address the problems of patients with chronic disease, like RA, a comprehensive approach should be demanded concerning various aspects of the patient's life in terms of perspectives of the patients with RA. The purpose of this study was to explore and describe the illness experience of women with RA in Korea using a phenomenological methodology. Participants were five women who were diagnosed with RA. The transcripts were analyzed using Colaizzi's (In: Vails, R.S., King, M. (Eds.), Existential Phenomenological Alternatives for Psychology. Oxford University Press, New York, 1978) method. The results of this study identified 8 major theme clusters, which were 'severe pain', 'self-esteem', 'negative feelings', 'reflect the past life', 'concentrate on recovery from disease', 'a comfortable mind in pain', 'support of family and others', and 'new life'. These results may provide important information to establish effective interventions for women with RA, their families, and health providers through understanding various aspects of the lived experience of women with RA. The implications for nursing practice in this area of chronic illness such as RA, should be how patients can be empowered to believe they can take control of their disease and their lives.

Women and arthritis: burden, impact and prevention programs.

OBJECTIVES: To characterize the public health burden and impact of arthritis among women, document the growing interest in addressing arthritis as a public health problem, and review new national (Centers for Disease Control and Prevention [CDC]) and state arthritis programs. RESULTS: Arthritis and other rheumatic diseases are a major public health problem, affecting nearly 27 million women in 1997 and accounting for 23.9 million ambulatory medical care visits and 451,000 hospitalizations among women in that year. Arthritis is also the leading cause of disability and is associated with considerable functional limitations. The 1999 National Arthritis Action Plan: A Public Health Strategy prompted first-time congressional funding to the CDC to monitor the burden of arthritis and to establish state arthritis prevention programs through cooperative agreements. The CDC's Arthritis Program also used this funding to build the public health science base, develop national health communications campaigns, foster partnerships, and initiate health systems change. CONCLUSIONS: Arthritis in general and selected types, such as rheumatoid arthritis, systemic lupus erythmatosus (SLE), and fibromyalgia, disproportionately affect women. The CDC, state health departments, and their partners are working toward improving the quality of life for women affected by arthritis. Effective, evidence-based interventions, such as self-management education and physical activity programs, are currently available and can reduce pain, improve function, and delay disability, but they remain underused. Future research should focus on improving earlier diagnosis and increasing access to effective interventions.