Patient-reported flare frequency is associated with diminished quality of life and family role functioning in systemic lupus erythematosus.

PURPOSE: To understand the influence of the systemic lupus erythematosus (SLE)-related flares on patient's health-related quality of life (HRQoL). METHODS: An online survey included individuals with self-reported physician's diagnosis of SLE or lupus nephritis (LN). Lupus impact tracker (LIT) assessed lupus symptoms and HRQoL, SLE-Family questionnaire measured family role functioning, and Healthy Days Core Module (HDCM) measured overall mental and physical health. Chi-square and analysis of variance evaluated differences by flare frequency. Multivariable linear regression and generalized linear models evaluated the independent relationships of flare frequency to HRQoL. RESULTS: 1066 respondents with SLE or LN completed the survey. Mean (SD) duration of illness was 12.4 (10.1) years. 93.4% (n = 996) were women, 82.3% (n = 830) were White, and 49.7% (n = 530) were employed or students. More frequent flares were associated with significantly worse scores on all HRQoL measures: LIT (adjusted means: 0 flares, 31.8; 1-3 flares, 47.0; 4-6 flares, 56.1; ≥ 7 flares, 63.6; P < 0.001); SLE-Family (adjusted means: 0 flares, 3.1; 1-3 flares 3.8; 4-6 flares, 4.3; ≥ 7 flares, 4.6, P < 0.001); HDCM unhealthy days (0 flares, 8.7; 1-3 flares, 17.4; 4-6 flares, 21.5; ≥ 7 flares, 26.2 days, P < 0.001). CONCLUSION: Lupus flares contributed to impaired functional and psychological well-being, family functioning, and number of monthly healthy days. Better understanding of the burden of flare activity from the patient's perspective will support a holistic approach to lupus management.

The Association Between Yoga Use, Physical Function, and Employment in Adults With Rheumatoid Arthritis.

Mind-body exercises such as yoga offer patients with rheumatoid arthritis (RA) a symptom management strategy for improving physical and mental health. Studies have evaluated yoga to manage symptoms of RA and improve physical function; however, none has examined the relationship between yoga and work status in adults with RA. The objective was to describe differences in RA symptomatology, physical function scores, and work status between adults with RA who participate in yoga and those who do not. This cross-sectional study surveyed adults with rheumatologist-diagnosed RA regarding yoga use in the past year, symptoms, physical function, and work status. Differences between yoga and non-yoga participation groups were assessed with 2-sided t tests or Pearson χ tests. Multivariate linear regression analyses were conducted to identify significant associations between yoga participation and primary outcomes. The sample included 398 adults with RA; 88% were females, 66% were white, mean age 61.8 years, mean disease duration 24.8 years; 10.6% participated in yoga. Vinyasa, Bikram, Hatha, Iyengar, and restorative yoga styles were practiced, mostly in a group setting. Yoga participants were significantly more likely to work full-time, less likely to be unable to work due to disability, and had better physical function. These findings characterize yoga practice and practitioners among adults with RA. In adults with RA, yoga participation is associated with full-time work status and better physical function than nonparticipation. This study adds additional information to the growing body of literature about adults with RA who practice yoga.

A Qualitative Study Exploring Community Yoga Practice in Adults with Rheumatoid Arthritis.

OBJECTIVE: Yoga may improve physical function and reduce disease symptoms in adults with rheumatoid arthritis (RA). However, little is known about how patients with RA are practicing yoga in the community. The objective of this qualitative study was to explore community yoga practice characteristics and thoughts about yoga practice for adults with RA. DESIGN: Participants completed a semi-structured telephone interview with open-ended questions. Thematic analysis was used to analyze interview transcripts. PARTICIPANTS: A convenience sample of 17 adults with rheumatologist-diagnosed RA who had participated in yoga within the past year were asked about the decision to start, continue, and stop yoga; the perceived benefits of yoga; components of yoga sessions; and general thoughts about yoga as it relates to RA. RESULTS: Although eight different styles of yoga were practiced, commonalities in yoga class components (such as stretching, strengthening, deep breathing, meditation, and positive messaging from the instructor) reveal examples of preferred types of yoga for patients with RA. Three main themes emerged, each with multiple subthemes: (1) motivators (physical fitness, influence of others, reduced price), (2) barriers (cost, symptom burden, class difficulty), and (3) benefits of yoga practice (mind-body, a tool for coping, pride/achievement, social, and "yoga meets you where you are"). CONCLUSION: In this study, patients with RA described how yoga practice helped improve physical and psychosocial symptoms related to their disease. Yoga practice, a dynamic exercise, encompassing many different styles, can provide many benefits for adults with RA; however, yoga may not be beneficial for every adult with RA.

How Do Meaning in Life and Positive Affect Relate to Adaptation to Stress? The Case of Firefighters Following the Mount Carmel Forest Fire.

BACKGROUND: We examined how positive affect (PA) and meaning in life (MIL) conjointly regulate posttraumatic stress disorder (PTSD) symptoms and perceived coping self-efficacy. Hypotheses were guided by a recent holistic model, according to which PA and MIL should compensate for each other in relating to adaptation to high stress. METHOD: The sample included 75 Israeli firefighters who took active part in extinguishing the 2010 Mount Carmel forest fire. RESULTS: PA and MIL helped to compensate for the other, demonstrating that when one of them was low, the other related to higher adaptation. That is, under low MIL, PA related to PTSD symptoms and coping self-efficacy, and under low PA, MIL related to PTSD symptoms and coping self-efficacy. LIMITATION: The study design was cross-sectional and therefore precluded any causal inferences. CONCLUSIONS: The findings lend additional support to the holistic model and help to understand how subjective well-being and MIL correlate with adaptation to stress.

The use of complementary and alternative fertility treatment in couples seeking fertility care: data from a prospective cohort in the United States.

OBJECTIVE: To determine the prevalence of complementary and alternative medicine (CAM) use among couples seeking fertility care and to identify the predictors of CAM use in this population. DESIGN: Prospective cohort study. SETTING: Eight community and academic infertility practices. PATIENT(S): A total of 428 couples presenting for an infertility evaluation. INTERVENTION(S): Interviews and questionnaires. MAIN OUTCOME MEASURE(S): Prevalence of complementary and alternative medicine therapy. RESULT(S): After 18 months of observation, 29% of the couples had utilized a CAM modality for treatment of infertility; 22% had tried acupuncture, 17% herbal therapy, 5% a form of body work, and 1% meditation. An annual household income of > or = $200,000 (odds ratio 2.8, relative to couples earning <$100,000), not achieving a pregnancy (odds ratio 2.3), and a positive attitude toward CAM use at baseline were independently associated with CAM use. CONCLUSION(S): A substantial minority of infertile couples use CAM treatments. CAM was chosen most commonly by wealthier couples, those not achieving a pregnancy, and those with a baseline belief in the effectiveness of CAM treatments.

Racial/ethnic differences in the use of complementary and alternative medicine in patients with arthritis.

OBJECTIVE: To examine use of complementary and alternative medicine (CAM) by individuals with osteoarthritis (OA) from 4 ethnic groups, differences in CAM use among groups, and correlates of CAM use. METHODS: Data were obtained from individuals from 4 ethnic groups (African, Asian, and Hispanic Americans, and Caucasians) participating in trials assessing celecoxib efficacy. A questionnaire assessing CAMs specifically used to help arthritis was administered at screening. Use of 42 specific therapies within 7 categories-alternative medical systems, mind-body interventions, manipulation and body-based methods, energy therapies, and 3 types of biologically based therapies--was queried. RESULTS: More than 80% of subjects reported that they used some CAM for arthritis in the past month. In contrast, 50% reported the use of prescription medicines, and 52% reported the use of over-the-counter medicines. Dietary practices were the most common type of CAM (71.5%), followed by mind-body interventions (42.4%), topical agents (38.1%), use of supplements or herbs (32.9%), and manipulation and body-based methods (21.4%). African Americans were more likely to report any CAM use than other groups (89.1% versus 83.1% [Asian], 81.1% [Hispanic], 77.7% [Caucasian]). African and Asian Americans more commonly reported the use of mind-body interventions in general, and prayer in particular. African Americans were also most likely to report the use of topical agents. Asian Americans were most likely to report use of alternative medical systems, manipulation methods, and supplements. Caucasians were least likely to report use of dietary practices. CONCLUSION: Individuals with OA commonly use CAM. Use of these therapies varies by racial/ethnic group. Some CAMs may be effective for symptom relief, while others may interact with prescription medications, suggesting that routine queries by physicians concerning CAM use would be beneficial.