Prevalence and risk factors for falls in patients with spondyloarthritis: A systematic review.

OBJECTIVE: Patients with spondyloarthritis (SpA) may have a greater risk of falling due to poor postural balance and decreased mobility. To our best knowledge, there are no published reviews that study falls in patients with SpA. Therefore, we aim to systematically review the literature and identify the prevalence and risk factors of falls in patients with SpA. METHODS: We conducted a systematic review using 5 electronic databases: PubMed, EMBASE, Scopus, Web of Science and Google Scholar using controlled vocabulary terms (eg MeSH terms) in the search strategy for the concepts: falls, fall risk, SpA and its subtypes. RESULTS: We identified 7279 articles, of which 3 studies with a total of 441 patients were included. Prevalence of falls ranged from 13% to 25%. We identified 16 main factors across 5 categories. Under socio-demographic factors, functional limitation, decreased quality of life, advanced age and job loss were associated with an increased risk of falls. Poor balance and mobility and fear of falling were associated with increased risk of falls. Active disease and symptoms of SpA were medical factors that were associated with increased risk of falls. Medication factors including polypharmacy, myorelaxants and antidepressants were not associated with increased fall risk. CONCLUSION: We identified potentially modifiable risk factors associated with increased risk of falls in patients with SpA, including functional limitation, poor balance and mobility, fear of falling and active disease. Clinicians should recognize these factors and address them in the holistic management of patients with SpA, thereby reducing falls and their complications.

TCM nonpharmacological interventions for ankylosing spondylitis: A protocol for systematic review and network meta-analysis.

BACKGROUND: Ankylosing spondylitis (AS) is a common infammatory rheumatic disease that affects the axial skeleton. Traditional Chinese medicine (TCM) nonpharmacological interventions are gaining an increasing popularity for AS. Nevertheless, the evidence of efficacy and safety of random controlled trials (RCTs) remains controversial. This study aims to evaluate the efficacy and acceptability of different TCM nonpharmacological therapies by systematic review and network meta-analysis. METHODS: According to the strategy, the authors will retrieve a total of 7 electronic databases by December 2020, including PubMed, the Cochrane Library, EMbase, China National Knowledge Infrastructure, China Biological Medicine, Chongqing VIP, and Wan-fang databases After a series of screening, 2 researchers will use Aggregate Data Drug Information System and Stata software to analyze the data extracted from the randomized controlled trials of TCM nonpharmacological interventions for AS. The primary outcome will be the improvement of Pain intensity and functional status/disability and the secondary outcomes will include lobal improvement, health-related quality of life, satisfaction with treatment, and adverse events. Both classical meta-analysis and network meta-analysis will be implemented to investigate direct and indirect evidences on this topic. The quality of the evidence will be evaluated using the Grading of Recommendations Assessment, Development and Evaluation instrument. RESULTS: This study will provide a reliable evidence for the selection of TCM nonpharmacological therapies in the treatment of AS. CONCLUSION: This study will generate evidence for different TCM nonpharmacological therapies for AS and provide a decision-making reference for clinical research. ETHICS AND DISSEMINATION: This study does not require ethical approval. The results will be disseminated through a peer-reviewed publication. OSF REGISTRATION NUMBER: DOI 10.17605/OSF.IO/FHD2U.

Understanding Fatigue-Related Disability in Rheumatoid Arthritis and Ankylosing Spondylitis: The Importance of Daily Correlates.

OBJECTIVE: Fatigue is common among people with inflammatory arthritis but is hard to manage. The aim of this study was to investigate how daily fluctuations in psychological variables correspond with changes in fatigue-related disability in the daily lives of people with inflammatory arthritis and to identify factors to target in psychological interventions and routine clinical practice. METHODS: A cohort of 143 patients with rheumatoid arthritis (n = 97) or ankylosing spondylitis (n = 46) participated in a 10-day online diary study. Each evening participants completed a diary questionnaire assessing their fatigue, pain, fatigue-related disability, and 4 components of psychological flexibility (valued activity, mindfulness, cognitive fusion, and fatigue avoidance). RESULTS: On days when participants were more engaged in valued activities or more mindful, they reported less disability due to fatigue, even when controlling for levels of fatigue and pain that day. The daily psychological flexibility variables explained a total of 15.6% of the variance in daily fatigue-related disability. CONCLUSION: Psychological flexibility variables are directly associated with fatigue-related disability in the daily lives of inflammatory arthritis patients. Further research is needed to investigate whether interventions that target psychological flexibility are effective at reducing fatigue-related disability.

Effect of Music Therapy Intervention on Physical Functions and Mental Health of Patients with Ankylosing Spondylitis.

BACKGROUND: This study aims to investigate the influence of traditional Chinese music on the physical and psychological functions of hospitalized patients with ankylosing spondylitis (AS). SUBJECTS AND METHODS: A total of 120 patients with AS admitted to the People's Hospital of Anhui Province between March 2018 and March 2019 were randomly divided into experiment and control groups. The experiment group was a traditional music group composed of 56 patients, namely, 50 males and 6 females. The control group was further divided into a painting group and a routine treatment group with a total of 64 patients, namely, 48 males and 16 females. The physical and psychological functions of each group of patients before and after the intervention were assessed in terms of physical and psychological function dimensions obtained before and after the intervention. RESULTS: After 8 weeks of treatment, the score in terms of physical functions is the highest in the music group (P<0.05), and the difference in eating functions is statistically significant (P<0.001). This finding suggests that the music group is better than the painting group and the routine treatment group (P<0.05). In terms of the score in sexual functions, the following trend is observed: music group>painting group>routine treatment group. The difference in their psychological functions is statistically significant (P<0.001). In terms of the score in psychological functions, the following trend is obtained: music group>painting group>routine treatment group. The three groups significantly differ in their scores in mental tension, negative emotion, positive emotion, cognitive functions, and self-esteem. All of these dimensions show the following pattern: music group>painting group>routine treatment group. Cross-group comparisons between the three groups are also statistically significant (P<0.05). CONCLUSIONS: Traditional Chinese music therapy and painting therapy can promote the recovery of patients' physical and psychological functions. Traditional Chinese music intervention therapy is better than painting therapy and routine hospitalization in promoting the recovery of physical and psychological functions of hospitalized patients.

Predicting response to anti-TNFα therapy among patients with axial spondyloarthritis (axSpA): results from BSRBR-AS.

OBJECTIVES: While many axSpA patients, eligible to receive anti-TNFα therapy, derive benefit when prescribed them, some patients do not. The current study aims to identify modifiable targets to improve outcome as well as non-modifiable targets that identify groups less likely to derive benefit. METHODS: The BSRBR-AS is a prospective cohort study of axSpA patients who, at recruitment, were naïve to biologic therapy. Those in the 'biologic' sub-cohort commenced their first anti-TNFα therapy at recruitment or during follow-up. Prior to commencement, information was collected on socio-economic, clinical and patient-reported factors. Outcome was assessed according to ASAS20, ASAS40, ASDAS reduction and achieving a moderate/inactive ASDAS disease state. RESULTS: 335 participants commenced their first anti-TNFα therapy and were followed up at a median of 14 (inter-quartile range 12-17) weeks. Response varied between 33% and 52% according to criteria used. Adverse socio-economic factors, fewer years in education predicted lower likelihood of response across outcome measures as did not working full-time. Co-morbidities and poor mental health were clinical and patient-reported factors, respectively, associated with lack of response. The models, particularly those using ASDAS, were good at predicting those who did not respond (negative predictive value (NPV) 77%). CONCLUSION: Some factors predicting non-response (such as mental health) are modifiable but many (such as social/economic factors) are not modifiable in clinic. They do, however, identify patients who are unlikely to benefit from biologic therapy alone. Priority should focus on how these patients receive the benefits that many derive from such therapies.

Patient Concerns and Perceptions Regarding Biologic Therapies in Ankylosing Spondylitis: Insights From a Large-Scale Survey of Social Media Platforms.

OBJECTIVE: Few studies have examined ankylosing spondylitis (AS) patients' concerns about and perceptions of biologic therapies, apart from traditional surveys. In this study, we used social media data to examine the knowledge, attitudes, and beliefs of AS patients regarding biologic therapies. METHODS: We collected posts published on 601 social media sites between January 1, 2016 and April 26, 2017. In each post, both an AS keyword and a biologic were mentioned. To explore themes within the collection of posts in an unsupervised manner, a latent Dirichlet allocation topic model was fit to the data set. Each discovered topic was represented as a discrete distribution over the words in the collection, similar to a word cloud. The topics were manually reviewed to identify themes, which were confirmed using thematic data analysis. RESULTS: We examined 27,416 social media posts and identified 112 themes. The majority of themes (n = 67 [60%]) focused on discussions related to AS treatment. Other themes, including the psychological impact of AS, reporting of medical literature, and AS disease consequences, accounted for the remaining 40% (n = 45). In discussions regarding AS treatment, most topics involved biologics, and most subthemes involved side effects (e.g., fatigue, allergic reactions), biologic treatment attributes (e.g., dosing, frequency), and concerns about use of biologics (e.g., increased cancer risk). Additional implicit patient needs (e.g., support) were identified using qualitative analyses. CONCLUSION: Social media revealed a dynamic range of themes governing AS patients' experience with and choice of biologic agents. The complexity of selecting biologics from among many such agents and navigating their risk/benefit profiles suggests the merit of creating online tools tailored to support patients' decision-making with regard to biologic therapies for AS.

Dose reduction of biologic therapy in inflammatory arthritis: A qualitative study of patients' perceptions and needs.

OBJECTIVE: Successful biologic disease-modifying anti-rheumatic drug (bDMARD) dose reduction appears increasingly possible from clinical trials. The present study aimed to understand the patient perspective of bDMARD dose reduction. METHODS: Patients with rheumatoid arthritis, ankylosing spondylitis or psoriatic arthritis who were self-administering subcutaneous bDMARDs therapy at two National Health Service trusts participated in semi-structured interviews. To capture multiple experiences, patients were purposefully sampled for a range of age, gender, disease duration, reducing/not reducing bDMARDs and either within 3-12 months of bDMARD initiation or ≥12 months and in remission/low disease activity. Inductive thematic analysis was utilized. RESULTS: Fifteen patients were interviewed (six on dose reduction). Five overarching themes were identified. When thinking about dose reduction, patients reflected on their difficult life before bDMARDs ("Where I was then") compared with their transformative effects ("Where I am now"). All raised concerns that a dose reduction would take them back to where they used to be ("Fears for the future") and most believed it to be a cost-cutting exercise. Most had "Hopes for the future", that a reduction would lower their risk of side effects, and release funds for other patients. They wanted a clear rationale for reduction, collaborative decision making, and control over flexible dosing ("Information needs"). CONCLUSION: Patients were fearful of reducing the dose of their bDMARDs, having previously experienced uncontrollable symptoms. However, most were willing to try, provided that there was a clear rationale and that it was in their best interests, with opportunities for collaboration and dose control. These patient perspectives will inform the provision of patient information to guide clinical discussions.

Optimizing outcomes for ankylosing spondylitis and axial spondyloarthritis patients: a holistic approach to care.

Axial SpA (axSpA) can affect diverse elements of an individual's life. The areas affected can be much more wide-ranging than the historical medical model of SpA, causing increased disease activity (pain and stiffness) and disability (reduced range of movement and physical function). A more holistic view of the individual results in the realization that many other areas of life can be adversely affected by axSpA, from the ability to work effectively and function socially, to effects on quality of life and the onset of worsening fatigue or mood disturbance. A good understanding of these areas outside the medical model allows for an improved understanding of the overall life impact of axSpA. This highlights the importance of understanding how to measure these elements of life using patient-reported outcome measures that can truly reflect an individual's experience of axSpA. These measures can then provide a better insight into the risks and benefits of interventions and medications used to treat axSpA.

An exploration of the impact of anti-TNFα medication on exercise behaviour in patients with ankylosing spondylitis.

BACKGROUND: Exercise has traditionally been an important part of the treatment of ankylosing spondylitis (AS) in order to maintain spinal mobility. Additionally, anti-tumour necrosis factor-alpha (TNFα) medication has been proven highly effective in treating the condition. Over recent years, a few papers have shown the synergistic effect of combining anti-TNFα medication with rehabilitation. There is minimal evidence on the perceptions of AS patients on how the medication has affected their exercise behaviour. The aim of the present study was to explore the effects of anti-TNFα medication on exercise behaviour in patients with AS. METHOD: A qualitative approach was adopted to provide a holistic understanding of participants' exercise behaviour while on anti-TNFα medication. Semi-structured interviews were undertaken and transcribed verbatim. Data were analysed using thematic network analysis. Ethical approval and informed consent were obtained. RESULTS: Twenty participants (age range 26-74, disease duration 3-36 years) who had been on the medication for over a year described how their exercise behaviour had improved since being on the medication. They highlighted their motivation and incentives to continue with an exercise programme. The participants had reinstated previous sporting activities, started new ones and regularly undertook physiotherapy exercises. CONCLUSION: The present study provides evidence of the long-term effects of anti-TNFα medication on the exercise behaviour of AS patients. It shows that AS patients are able to sustain a regular exercise programme over a number of years, provides insight into what motivates them to exercise and reveals the incentives that have influenced their choice of activity.

Willingness of patients with ankylosing spondylitis to pay for inpatient treatment is influenced by the treatment environment and expectations of improvement.

OBJECTIVE: To assess the willingness to pay (WTP) for treatment in a spa resort of patients with ankylosing spondylitis (AS) and to assess if the experience of a spa influences the WTP. METHODS: 120 patients participating in a randomised trial comparing 3 weeks' treatment in a spa resort in Austria or in the Netherlands with a control group completed a WTP questionnaire before and after spa treatment. Patients indicated on a payment card the maximal co-payment they wanted to contribute for three scenarios that included (a) two levels of improvement in pain and stiffness and (b) two treatment environments: a rehabilitation hospital and a spa resort. RESULTS: At baseline, patients wanted to contribute more for the same improvement after treatment in a spa resort compared with a rehabilitation hospital (p<0.003), and were prepared to pay more when expected effects were higher (p<0.001). No differences were found between men and women, pain, or income. After the trial none of the treatment groups showed a change in their WTP. CONCLUSION: The WTP of patients with AS for inpatient treatment is influenced by the treatment environment and the expected improvement. Experiencing treatment in a spa resort does not influence the co-payment.

[Retained and discontinued conventional and unconventional measures by patients with Bechterew disease for modifying the course of illness]. / Von Patienten mit Morbus Bechterew beibehaltene und aufgegebene konventionelle und unkonventionelle Massnahmen zur Beeinflussung der Erkrankung.

BACKGROUND: Patients with chronic rheumatic disease often seek relief in unconventional treatments, but many of them do not share this information with their physician. OBJECTIVE: To explore which conventional and unconventional interventions are used by patients with ankylosing spondylitis. Which of these do they continue to use and which do they give up? PATIENTS: One-hundred fifty patients (36 female, 114 male) with ankylosing spondylitis, who presented for radon thermal treatment at the Gasteiner Heilstollen Hospital (mean age 50 +/- 11 years; disease duration 24 +/- 11 years). METHOD: A previous investigation identified 75 interventions used by patients with AS to influence their disease. In a face-to-face, structured interview all these interventions (terms used by the patients) were now presented to 150 other patients with AS. They were asked to state whether they had already used (and given up) the respective intervention or whether they intend to continue using it and intend to use it in future. RESULTS: A summary of all interventions previously and still used by patients showed conventional interventions (67%) to out-number unconventional (33%) interventions. Of the 150 patients, 20 stated that they use or have used more than 15 different unconventional interventions. In addition to health resort medicine (interview at a health resort!), massage therapy, physiotherapy and physical exercise were the most commonly used of the conventional interventions. Of the unconventional interventions warm climate, sea bathing, self-applied psychotherapy, vitamin pills, repression, showering with alternating cold and warm water, and self-help groups were named most frequently. CONCLUSION: Some patients with ankylosing spondylitis use many different (33% unconventional) interventions. In the patient's view, even rather general interventions such as warm climate or sea bathing are regarded as relevant to the disease. An open doctor-patient discussion of unconventional interventions used by the patient appears reasonable. The results confirm that most patients suffering from chronic and incurable disease seek relief in unconventional therapies.