The relationship between work, mental health, physical health, and fatigue in patients with rheumatoid arthritis: A cross-sectional study.

To evaluate the relationship between work, mental health, physical health, and fatigue in patients with rheumatoid arthritis, the data of 282 participants were drawn from baseline. The results of structural equation modeling showed that among rheumatoid arthritis patients, those who were engaged in occupational activity had lower levels of fatigue compared to those who did not work and that this relationship was mediated by better mental health, not by physical health.

Complex rehabilitation and the clinical condition of working rheumatoid arthritis patients: does cryotherapy always overtop traditional rehabilitation?

AIM: Rehabilitation slows the progress of rheumatoid arthritis (RA) and prevents progression of disability. This study aimed to compare the impact of two rehabilitation programmes on pain, disease activity, locomotor function, global health and work ability forecast in RA patients. MATERIALS AND METHODS: Sixty-four employed women aged 24-65 years participated in the study. All patients underwent individual and instrumental kinesiotherapy. Thirty-two patients underwent cryogenic chamber therapy and local cryotherapy as well as non-weight-bearing, instrumental and individual kinesiotherapy. The remaining 32 patients received traditional rehabilitation in the form of electromagnetic and instrumental therapy, individual and pool-based non-weight-bearing kinesiotherapy. Rehabilitation lasted 3 weeks. Patients were examined three times: prior to rehabilitation, after 3 weeks of therapy and 3 months after completion of rehabilitation. The following study instruments were used: to assess disease activity: DAS-28; functional impairment: HAQ-DI; pain severity: VAS; patients' overall well-being: a scale from 0 to 100 (Global Health Index); and patients' own prognosis of fitness for work: the 6th question from Work Ability Index (WAI). Statistical analysis of data was performed using the STATISTICA 8.0 package. Mixed-design two-way analysis of variance was used for hypothesis testing. RESULTS: All patients improved after rehabilitation. The group of patients those who underwent cryotherapy had improved DAS-28, HAQ-DI, VAS and global health scores immediately following the 3-week rehabilitation programme (p < 0.001, p = 0.001, p = 0.007 and p < 0.001, respectively), as well as at the 3-month follow-up (p < 0.001, p < 0.001, p = 0.009 and p < 0.001, respectively). Rehabilitation using cryotherapy resulted in greater improvement in disease activity DAS-28 [F(2,105) = 5.700; p = 0.007; η(2) = 0.084] and HAQ-DI locomotor function scores [F(2,109) = 6.771; p = 0.003; η(2) = 0.098] compared to traditional rehabilitation. The impact of both forms of rehabilitation on patients' own prognosis of work ability in the next 2 years was not significant. Results of patients who underwent traditional approach showed decreased disease activity following the initial 3-week period; however, this improvement did not sustain to the end of follow-up, 3 months later. CONCLUSIONS: Complex rehabilitation in RA has a positive effect on patients' clinical condition. The rehabilitation programme that includes cryotherapy overtops traditional rehabilitation, particularly as regards improvement in locomotor function, disease activity and sustaining willingness to continue working and exerts long-lasting effect. IMPLICATIONS FOR REHABILITATION: Rehabilitation using cryotherapy is more effective in improving locomotor function, decreasing disease activity and sustaining willingness to continue working compared to traditional rehabilitation. Rehabilitation using cryotherapy significantly reduces the intensity of pain experienced by patients with RA, and this positive effect is maintained at 3 months post-rehabilitation. Complex rehabilitation, particularly treatment using cryotherapy, improves patients' subjective assessment of their overall well-being and perception of their disease. Complex rehabilitation in rheumatoid arthritis has a positive effect on patients' clinical condition.

Treat-to-target in systemic lupus erythematosus: recommendations from an international task force.

The principle of treating-to-target has been successfully applied to many diseases outside rheumatology and more recently to rheumatoid arthritis. Identifying appropriate therapeutic targets and pursuing these systematically has led to improved care for patients with these diseases and useful guidance for healthcare providers and administrators. Thus, an initiative to evaluate possible therapeutic targets and develop treat-to-target guidance was believed to be highly appropriate in the management of systemic lupus erythematosus (SLE) patients as well. Specialists in rheumatology, nephrology, dermatology, internal medicine and clinical immunology, and a patient representative, contributed to this initiative. The majority convened on three occasions in 2012-2013. Twelve topics of critical importance were identified and a systematic literature review was performed. The results were condensed and reformulated as recommendations, discussed, modified and voted upon. The finalised bullet points were analysed for degree of agreement among the task force. The Oxford Centre level of evidence (LoE, corresponding to the research questions) and grade of recommendation (GoR) were determined for each recommendation. The 12 systematic literature searches and their summaries led to 11 recommendations. Prominent features of these recommendations are targeting remission, preventing damage and improving quality of life. LoE and GoR of the recommendations were variable but agreement was >0.9 in each case. An extensive research agenda was identified, and four overarching principles were also agreed upon. Treat-to-target-in-SLE (T2T/SLE) recommendations were developed by a large task force of multispecialty experts and a patient representative. It is anticipated that 'treating-to-target' can and will be applicable to the care of patients with SLE.

Psychological factors at work and musculoskeletal disorders: a one year prospective study.

The etiology of musculoskeletal disorders is complex, with physical and psychosocial working conditions playing an important role. This study aimed to determine the relationship between psychosocial work conditions, such as psychological job demands, decision latitude, social support and job insecurity and musculoskeletal complains (MSCs) and (repetitive strain injuries (RSIs) in a 1-year prospective study. The job content questionnaire, the Nordic musculoskeletal questionnaire and provocation tests were used to study 725 employees aged 20-70 years. Pain in the lower back (58 % of subjects), neck (57 %), wrists/hands (47 %) and upper back (44 %) was most frequent. The carpal tunnel syndrome (CTS) (33.6 %), rotator cuff tendinitis (15.4 %), Guyon's canal syndrome (13.4 %), lateral epicondylitis (7.6 %), medial epicondylitis (5.3 %), tendinitis of forearm-wrist extensors (7.8 %) and tendinitis of forearm-wrist flexors (7.3 %) were the most frequent RSIs. Logistic analysis showed that increased psychological job demands statistically significantly increased the probability of lateral and medial epicondylitis, and increased control (decision latitude) statistically significantly decreased the risk of CTS. There was no relationship between job insecurity, social support and the studied RSIs. Psychosocial factors at work predict prevalence of MSCs and RSIs, irrespectively of demographic factors, e.g., age or gender, and organizational and physical factors.

Analysis of conditions and organization of work of notebook computer users.

AIM: The aim of this study was to evaluate working conditions with a notebook computer (notebook) as a potential cause of musculoskeletal disorders. MATERIAL AND METHODS: The study had 2 stages. The first one was a questionnaire survey among 300 notebook users. The next stage was an expert analysis of 53 randomly selected workstations. The questionnaire survey included questions about the participants, their working conditions, work organization and also duration of work with a notebook. RESULTS AND CONCLUSIONS: The results of the research showed that most examined operators used a notebook as a basic working tool. The most important irregularities included an unadjustable working surface, unadjustable height of the seat pan and backrest, unadjustable height and distance between the armrests and no additional ergonomic devices (external keyboard, docking station, notebook stand or footstool).

[Acquired musculoskeletal dysfunction syndromes in workers in the light of epidemiological studies]. / Nabyte zespoly dysfunkcji ukladu miesniowo-szkieletowego u pracowników w swietle badan epidemiologicznych.

Acquired musculoskeletal dysfunction syndromes (overload syndromes) that cause limitation of the system efficiency belong nowadays to the most serious problems in the medical care of workers. The etiology of overload syndromes is multifactorial, which means that occupational factors constitute only one of many causes fostering the development of those disorders. Occupational factors which increase the risk of musculoskeletal disorders include physical factors related to the work environment or the way the work is performed, such as body posture, value of exerted forces, movement repetitiveness, load handling, mechanical vibration or microclimate as well as psychosocial factors, such as quantitative and qualitative overload, lack of control, lack of social support or work insecurity. The consequence of musculoskeletal overload syndromes is the progressing reduction of its efficiency causing limitation or even loss of work ability, which results in premature exclusion from social and occupational activities. This article presents etiological factors of musculoskeletal complains and overload syndromes and their prevalence in workers.

Job strain, overtime, life style, and cardiovascular risk in managers and physical workers.

The purpose of the study was to determine the relation between overtime, job strain and life style, and cardiovascular risk (CVR) in 97 managers and 98 physical workers. CVR was measured with the Framingham method. Information about job strain, overtime, life style and extra-occupational activities was obtained with a self-administered questionnaire. The results showed that both groups had a similar, medium-level job stress. Being a manager and having extra-occupational activities (self-education) were significantly related with CVR (p = .000, p = .035, respectively), whereas other factors that were analysed (i.e., physical work and overtime) were not. The managers were older than the physical workers; that may be why the factor of being a manager was significantly related to CVR. The extra-occupational activities connected with improving workers' skills may play an important role in the development of workers' overload and an increase in CVR.

[The role of psychosocial work factors in the development of musculoskeletal disorders in workers]. / Rola psychospolecznych czynników pracy w powstawaniu zaburzen miesniowo-szkieletowych u pracowników.

The aim of the study was to determine the role of psychosocial work factors in the development of musculoskeletal disorders in workers. It should be stressed that over a decade these disorders have been the subject of studies because of complaints reported not only by workers performing heavy physical work or working in awkward, forced body posture. It has also been acknowledged that stress at work caused by various psychosocial work factors can significantly influence their development. One of the models, most popular nowadays, was used in the study. It takes into account various risk factors in the etiology of cervical spine disorders. Based on this model it was shown that certain psychosocial and cultural variables (e.g., work demands and control, individual variables, individual values, work group's culture) may constitute occupational stressors and, when combined with physical load factors, may lead to stress and musculoskeletal disorders. It was also indicated that such psychosocial work factors as excessive work demands (quantitative or qualitative), inadequate control at work or lack of social support are the most frequent sources of work-related stress. The article presents the results of some prospective studies in which the role of these factors in the development of musculoskeletal disorders has been considered. Apart from work properties (factors), the role of other psychological variables was shown; these include: work involvement, perfectionism, negative affectivity or work style, which in numerous studies turned out to be important risk factors in the development of musculoskeletal disorders. Finally, potential mechanisms underlying the relationships between psychosocial factors and musculoskeletal disorders were indicated. However, it was stressed that the majority of them still require to be confirmed in future descriptive or experimental studies.

[Psychologic stress and its predictors in rheumatoid arthritis]. / Stres psychologiczny i jego predykatory u chorych na reumatoidalne zapalenie stawów.

This article presents the current conceptualization of stress with particular attention focused on psychologic stress in rheumatic diseases: its sources, pathophysiology, and techniques of coping. Predictors, i.e., factors heralding psychologic stress in a patient with rheumatoid arthritis (RA) are discussed in relation to the mechanism of the "vicious circle" as well as to the socio-economic and medico-psychologic context in which the patient functions. The author's results from a comparative Polish-German study on predictors of psychologic stress in RA patients are provided.

Coronary heart disease risk factors and cardiovascular risk in physical workers and managers.

This study aimed to assess the incidence of coronary heart disease (CHD) risk factors and cardiovascular risk in physical workers and managers in Poland. There were 232 male subjects: 123 managers (48.9 +/- 11.2 years old) and 109 physical workers (37.5 +/- 11.1 years old). The family history of CHD was recorded and anthropometric and biochemical indices, i.e., body mass index, visceral obesity index, blood pressure, glucose, total cholesterol, fibrinogen, HDL (high density lipoprotein), LDL (low density lipoprotein) and triglycerides were measured. Cardiovascular risk was assessed with the Systematic Coronary Risk Evaluation (SCORE) table system. The factors that turned out to be the most common in the managers were obesity, hypertension, and elevated levels of blood glucose and LDL, whereas cigarette smoking, premature CHD in the family and a high level of fibrinogen were more common in physical workers. Very high cardiovascular risk was found in 35% of managers and in 16% of physical workers.

Perceived work-related stress and early atherosclerotic changes in healthy employees.

OBJECTIVE: This study was conducted to investigate the relationship between perceived work-related stress and preclinical atherosclerosis. METHODS: A total of 100 managers and 50 office workers aged 35-65 participated in a questionnaire study. Individual, family and work-related stress risk factors and coping were evaluated in all the studied individuals. Serum levels of biochemical (total cholesterol, LDL, HDL, TG, glucose) and serological risk factors of atherosclerosis (anticardiolipin, anti-beta(2) GPI, anti-oxLDL, anti-HSP and anti-hsCRP antibodies) were evaluated. A computer analysis of B-mode ultrasound images was used to assess carotid artery intima-media thickness (IMT) and atherosclerotic plaque in carotid arteries. Statistical analysis was conducted with SPSS v. 11.5. RESULTS: The studied individuals showed average ranges of both the global stress level and of coping results. In 71% no changes were found in the ultrasound image and in 29% of individuals (43) the presence of plaque was shown. The mean value of the IMT measure was 0.0618 +/- 0.013 mm. IMT and plaque correlated negatively with the level of global work-related stress (r = -0.26; P < 0.01; and r = -0.28; P < 0.01; respectively). No correlation was found either between work-related stress and coping, or between coping and IMT (P > 0.05), or between work-related stress and healthy lifestyle (no smoking, no excessive use of alcohol, high physical activity), or between healthy lifestyle and IMT (P > 0.05). Positive correlation between IMT and LDL and smoking did not result from higher stress reaction in the studied individuals. CONCLUSIONS: The explanation of the negative correlation between perceived work-related stress and preclinical atherosclerosis was not confirmed either by the subjects under high stress undertaking healthy protective activities or by their escaping into unhealthy behaviour. The most probable interpretation of the results is that in individuals with a low level of perceived work-related stress, somatization of stress takes place.

Carpal tunnel syndrome in occupational medicine practice.

Work-related overload syndromes are chiefly associated with the upper limbs, where carpal tunnel syndrome (CTS) plays a leading role. This article analyses methods of diagnosing CTS, with special emphasis on those that can be used by physicians in early diagnosis of CTS in workers doing monotonous work. It also discusses occupational (e.g., assembly work, typing, playing instruments, packaging and work associated with the use of a hammer or pruning scissors) and extra-occupational factors (e.g., post-traumatic deformation of bone elements of the carpal tunnel, degenerative and inflammatory changes in tendon sheaths, connective tissue hypertrophy or formation of crystal deposits) leading to CTS; diagnostic methods (subjective symptoms, physical examination and manual provocative tests, vibration perception threshold, electrophysiological examination and imaging methods); and therapeutic and preventive management tools accessible in occupational medicine practice.

Occupational work and quality of life in osteoarthritis patients.

The ageing European population suffers from chronic diseases, including osteoarthritis (OA). The aim of this study was to investigate the work activity/ability, the quality of life and reciprocal interaction between both in OA patients. A total of 750 OA outpatients were evaluated by a questionnaire study. Work Ability Index (WAI) and General Health Questionnaire 28 (GHQ 28) were used as tools for work ability and quality of life assessment, respectively. Statistical analysis was performed by means of ANOVA tests. A total of 22.2% OA patients were still active professionally. They had decreased work ability and decreased quality of life. A worse work ability and a worse quality of life were related with a blue-collar work, multi-joint localization of OA and co-existence of other diseases. A negative correlation was found between general scores of GHQ 28 and that of WAI and five WAI components. Findings indicate a need for work ability promotion among OA working patients to maintain both, better quality of life and higher level of satisfaction with job.

Work ability in ageing workers suffering from chronic diseases.

The aim of this study was to investigate the work ability in ageing workers suffering from osteoarthritis (OA), coronary heart disease (CHD) or hypertension (H). One hundred and sixty-six OA and 355 CHD/H outpatients were evaluated. The Work Ability Index (WAI) served for work ability assessment. Patients' results were compared with the results of a control group of 225 healthy young workers. Statistical analysis was performed with ANOVA tests. WAI in female and male CHD/H patients was higher than in OA patients (p < .01), better work ability was related to better education (p < .01), white-collar work (p < .01) and better recreation (p < .01); subjective work ability was determined mostly by the objective health status. The promotion of work ability among workers suffering from advanced age-related diseases should be closely related to the promotion of health. It is indicative to improve occupational education and skills, already at an early stage of a disease.

Self-rated emotional functioning of patients with neurological or asymptomatic form of Wilson's disease.

Psychopathology was assessed in 50 patients with the neurological form of Wilson's disease (WD-N) and in 17 asymptomatic patients (WD-A) compared to matched healthy controls and to rheumatoid arthritis (RA) control patients using The Hopkins Symptom Checklist. As hypothesized, WD-N patients had significantly lower interpersonal sensitivity and aggression/hostility scores than had healthy controls, but did not differ from them either in depression or anxiety levels. Retarded depression and anxiety were higher among RA patients than in WD-N patients. This nondistressed response to the chronic disabling disease was even more salient in 19 WD patients with lesions in basal ganglia only. WD-A patients did not differ from their healthy peers, which suggests a tendency towards hypercompensation and denial in the former. WD-N patients' limited awareness of their deficits (including impaired control of affective behavior) seems to result from their brain damage implicating the basal ganglia.

Stress--where are we now? Does immunity play an intrinsic role?

The whole world experiences progress and development, however it is the human being who pays the price in stress--an inevitable part of modern life. When encountering stress, an individual reacts at the level of both the micro- and macroenvironment. Nowadays, stress is defined as a real or interpreted threat to the physiological or psychological integrity of an individual, which results in a physiological and/or behavioral response. In the article a review of the stress conceptualization, health consequences of stress (its neurophysiology and relation to autoimmune disease) as well as ways of management (exercises and psychotherapeutic intervention) is given.