1.
Bergsten, Ulrika, et al.
(författare)
Patterns of background factors related to early RA patients' conceptions of the causes of their disease
2011
Ingår i: Clinical Rheumatology. - London : Springer Science and Business Media LLC. - 0770-3198 .- 1434-9949. ; 30:3, s. 347-352
Tidskriftsartikel (refereegranskat) abstract
The aim of the present study was to identify patterns of background factors related to the early RA patients' conceptions of the cause of the disease. Conceptions from a qualitative study formed the basis for the stratification of 785 patients from the Swedish EIRA study answering a question about their own thoughts about the cause to RA. Logistic regression analyses were used to explore the associations between patients' conceptions and relevant background factors: sex, age, civil status, educational level, anti-cyclic citrullinated peptide antibody (anti-CCP) and smoking habits. The results were presented as odds ratios (OR) with 95% confidence intervals (CI). A conception of family-related strain was strongly associated with being young (OR 0.50; 95% CI 0.33-0.78 for age 58-70 vs. 17-46), female (OR 0.38; 95% CI 0.25-0.60 for male vs. female) and having a high level of education (OR 2.15; 95% CI 1.54-3.01 for university degree vs. no degree). A conception of being exposed to climate changes was associated with being male (OR 1.99; 95% CI 1.24-3.22 for male vs. female), having a low level of education (OR 0.33; 95% CI 0.18-0.58 for university degree vs. no degree) and positive Anti-CCP (OR 1.72; 95% CI 1.03-2.87 for positive vs. negative Anti-CCP). Linking patients' conceptions of the cause of their RA to background factors potentially could create new opportunities for understanding the complexity of the aetiology in RA. Furthermore, this information is important and relevant in the care of patients with early RA.
2.
Feldhusen, Caroline, et al.
(författare)
I am so tired of being tired : – a focus group study of fatigue in RA
2011
Konferensbidrag (övrigt vetenskapligt/konstnärligt) abstract
BakgrundFatigue is a prominent symptom in persons with Rheumatoid Arthritis (RA)and has great impact of daily life. The knowledge about how persons with RA in working age are affected by fatigue is limited. The aim of this study was to describe how persons with RA in working age experience and handle their fatigue in everyday life.MetodSix focus group discussions were conducted in 25 persons with RA (19 women/ 6 men) age 20-60 years. The discussions were recorded, transcribed verbatim and analyzed according to qualitative content analysis which resulted in four categories: The nature of fatigue in RA, limitations due to the fatigue, communicating the fatigue and strategies to handle the fatigue.ResultatThe participants experienced their fatigue as a major symptom. Because of its persistence and unpredictable nature it caused feelings of frustration, helplessness and anger. The increased need for rest and sleep caused an imbalance in daily life when valued life activities were forced to be omitted in favor of work. They were feeling limited in everyday life when the fatigue made it impossible to fulfill their roles as expected by themselves and by others. The participants expressed difficulties in communicating about the fatigue and to gain acceptance from the social environment including family, friends and health professionals. They adjusted to whom they were talking to about their fatigue to avoid being seen as lazy, boring or whining. To handle the fatigue in everyday life, planning and prioritizing to find balance was essential. The respondents also used mental strategies to handle the fatigue such as accepting the fatigue and focusing on the possibilities.SammanfattningFatigue causes considerable consequences in persons with RA in working age, living an active life and rating a low general disability. The responsibility for managing fatigue and the struggle of finding balance between important parts in life was taken by the participants themselves because fatigue was not perceived to be a factor given much consideration during medical consultation. This draws attention to the importance for health professionals to address the fatigue and its complexity and unpredictability, even in working persons with low disability.
3.
Feldthusen, Caroline, et al.
(författare)
I am so tired of being tired : – a focus group study of fatigue in RA
2011
Konferensbidrag (refereegranskat) abstract
Background: Fatigue is a prominent symptom in RA and most negative impact from fatigue seems to be experienced by younger persons. Even in individuals with RA who are able to successfully participate in a wide spectrum of demanding daily activities, fatigue has been shown to be significant. The knowledge about how younger persons with RA experience and handle their fatigue is limited.Objectives: The aims were to explore, by means of qualitative interviews, how fatigue is experienced by persons with RA in working age and to identify when fatigue is experienced as a limitation and how it is handled in everyday life.Methods: Six focus group interviews were conducted with 25 (19 women, 6 men) persons. Inclusion criteria: >30 mm fatigue on a 100 mm visual analogue scale, age between 20-60 years and fulfill classification criteria of rheumatoid arthritis. The persons were asked to discuss their fatigue related to RA as well as how fatigue affected everyday life and how fatigue was handled. Transcripts were systematically analyzed by content analysis identifying units, codes, sub categories, categories and a theme (1). The categories and theme were validated by an expert in the field and by a research partner with RA.Results: Fatigue was experienced by the respondents as a significant symptom. Because of its persistence and unpredictable nature it caused feelings of frustration, helplessness and anger. The respondents expressed difficulties in communicating about the fatigue and to get understanding from the social environment including family, friends and healthcare. They were feeling limited in everyday life when the fatigue made it impossible to fulfill the roles as expected by themselves and by others. Feelings of shame, being lazy and boring were common. Finding balance between important parts of life such as work, family, leisure time, social activities and rest was mentioned as difficult. To handle the fatigue in everyday life planning and prioritizing among activities was essential. The respondents also used mental strategies to handle the fatigue including trying to accept the fatigue and focus on the possibilities.Conclusions: The result showed that fatigue in persons with RA in working age was a symptom of great importance that needs to be more highlighted in the clinical care. Even if the patients did not report extremely high levels of fatigue the consequences were extensive. An understanding of the complexity of fatigue in RA could help the persons to find a better balance between important parts in life.
4.
Thyberg, Ingrid, et al.
(författare)
HAQ scores related to persistent disabilities 8 years efter diagnosis of RA despite reduction of DAS-28. : The Swedish TIRA study
2011
Konferensbidrag (refereegranskat) abstract
Background: Early instituted disease modifying anti rheumatic drugs (DMARD:s) leads to reduced disease activity. Critical levels of disease activity measured with Disease Activity Score 28 joint count (DAS-28) are widely used to identify needs and evaluate outcomes of DMARD:s. Early instituted DMARD:s also reduce disability, but some patients still have disabilities and there is a need to establish clinically useful routines to identify patients with different disabilities, and thereby possible unmet needs for rehabilitation as a complement to their medication.Objectives: To discriminate sub-groups of patients due to HAQ levels and relate these sub-groups to disease activity and more comprehensive aspects of disability.Methods: 132 patients (68% women) with recent-onset (≤1 year) RA who fulfilled ≥4/7 RA classification criteria or at least: morning stiffness ≥60 minutes, symmetrical arthritis, and arthritis of small joints, and included in the Swedish TIRA-1 cohort during 1996-1998, constituted the study group. All patients had access to rehabilitation and regular contact with a multi-professional team, but there were no standardized criteria for further assessments or interventions. Anti-CCP antibodies were analysed. Disease activity (DAS-28), Health Assessment Questionnaire (HAQ), Short Form 36 (SF-36) and ongoing DMARD:s were registered at inclusion and thereafter yearly. In the presented analysis, the study group was divided into a high-HAQ group (score≥1) and a low-HAQ group (score<1) based on the HAQ score at the 8 year follow-up (1).Results: The sub-group of 48 patients (36%) with a HAQ score ≥1 at the 8 year follow-up had a higher mean HAQ score already at inclusion and further on at all visits compared to the low-HAQ group. 32 patients (24%) had high HAQ-score both at inclusion and at Year 8. Also, more comprehensive aspects of disability reported with the 8 dimensions of SF-36 differed significantly between these sub-groups at the majority of the visits. Age and Anti-CCP did not differ between sub-groups while the high-HAQ group had a higher DAS-28 at most visits except at inclusion. In accordance with known sex differences, the majority of the patients in the high-HAQ group were women. Despite higher frequencies of DMARD:s, the HAQ-score in the high-HAQ group showed a persistent divergence in contrast to the improvement in the low-HAQ group, and in contrast to the DAS-28 that showed improvement over time in both groups. Thus, a HAQ score ≥1 at the 8 year follow-up indicated persistent and comprehensive disabilities, and supposed needs for more effective or more specific rehabilitation as a complement to the medication in 36% of the study group.Conclusions: The HAQ-score is clinically useful as a complement to DAS-28, especially to identify patients with unmet needs for further rehabilitation assessments.
