ObjectiveTo compare the efficacy of embedded nurse-led versus conventional physician-led follow-up on disease activity in patients with rheumatoid arthritis (RA).MethodsIn a systematic literature search, we identified randomised controlled trials (RCTs) reporting on the efficacy of nurse-led follow-up on disease control in patients with RA compared with physician-led follow-up. Primary outcome was disease activity indicated by Disease Activity Score (DAS)-28. Secondary outcomes were: patient satisfaction, physical disability, fatigue, self-efficacy and quality of life. Outcomes were assessed after 1-year and 2 year follow-ups.ResultsSeven studies representing five RCTs, including a total of 723 participants, were included. All but one study included stable patients in low disease activity or remission at baseline. No difference in DAS-28 was found after 1 year (mean difference (MD) −0.07 (95% CI −0.23 to 0.09)). After 2 years, a statistically significant difference was seen in favour of nurse-led follow-up (MD −0.28 (95% CI −0.53 to −0.04)). However, the difference did not reach a clinically relevant level.No difference was found in patient satisfaction after 1 year (standard mean difference (SMD) −0.17 (95 % CI −1.0 to 0.67), whereas a statistical significant difference in favour of nurse-led follow-up was seen after 2 years (SMD: 0.6 (95% CI –0.00 to 1.20)).ConclusionAfter 1 year no difference in disease activity, indicated by DAS-28, were found between embedded nurse-led follow-up compared with conventional physician-led follow-up, in RA patients with low disease activity or remission.
Objectives Smoking is a major risk factor for the development of both cardiovascular disease (CVD) and RA and may cause attenuated responses to anti-rheumatic treatments. Our aim was to compare disease activity, CVD risk factors and CVD event rates across smoking status in RA patients. Methods Disease characteristics, CVD risk factors and relevant medications were recorded in RA patients without prior CVD from 10 countries (Norway, UK, Netherlands, USA, Sweden, Greece, South Africa, Spain, Canada and Mexico). Information on CVD events was collected. Adjusted analysis of variance, logistic regression and Cox models were applied to compare RA disease activity (DAS28), CVD risk factors and event rates across categories of smoking status. Results Of the 3311 RA patients (1012 former, 887 current and 1412 never smokers), 235 experienced CVD events during a median follow-up of 3.5 years (interquartile range 2.5–6.1). At enrolment, current smokers were more likely to have moderate or high disease activity compared with former and never smokers (P < 0.001 for both). There was a gradient of worsening CVD risk factor profiles (lipoproteins and blood pressure) from never to former to current smokers. Furthermore, former and never smokers had significantly lower CVD event rates compared with current smokers [hazard ratio 0.70 (95% CI 0.51, 0.95), P = 0.02 and 0.48 (0.34, 0.69), P < 0.001, respectively]. The CVD event rates for former and never smokers were comparable. Conclusion Smoking cessation in patients with RA was associated with lower disease activity and improved lipid profiles and was a predictor of reduced rates of CVD events.
BackgroundRheumatoid arthritis (RA) is a chronic, inflammatory rheumatic disease with the potential to induce significant disability. Patients with RA are at increased risk of cardiovascular diseases (CVD). Smokers with RA tend to experience more pain and fatigue, higher disease activity, more erosive joint destruction and a lower health-related quality of life (HR-QoL) than non-smokers. It remains to be determined whether these effects can be reduced by smoking cessation.This randomised controlled trial (RCT) in patients with RA aims to examine the effect of intensive smoking cessation intervention (motivational counselling combined with tailored nicotine replacement therapy) versus standard care on smoking cessation, and consequently on disease activity. Secondary objectives are to explore the effect on flare, risk factors for CVD, lung function, physical function, HR-QoL, pain and fatigue in patients with RA.MethodsThis will be a multicentre, open label, two arm, parallel group, RCT, including 150 daily smokers with RA, being in remission or having low-moderate disease activity (DAS28 ≤ 5.1). The intervention group (n = 75) will receive five counselling sessions with a trained smoking cessation counsellor based on the principles of motivational counselling. Furthermore, intervention patients will be offered nicotine replacement therapy tailored to individual needs. Participants randomised to the control group will receive standard care. The co-primary outcome is a hierarchical endpoint, which will be evaluated at 3 months follow-up and will include (1) self-reported smoking cessation biochemically validated by exhaled carbon monoxide and (2) achievement of EULAR clinical response (an improvement in DAS28 of > 0.6). Follow-up visits will be performed at 3, 6 and 12 months post-intervention.DiscussionThis trial will reveal whether intensive smoking cessation counselling helps smokers with RA to achieve continuous smoking cessation and whether, as a concomitant benefit, it will reduce their RA disease activity. The trial aims to generate high quality evidence for the feasibility of a health promotion intervention for smokers with RA.Trial registrationClinicalTrials.gov, identifier: NCT02901886. Registered on 10 September 2016. Recruitment status updated on 10th October 2016.Electronic supplementary materialThe online version of this article (doi:10.1186/s13063-017-2309-5) contains supplementary material, which is available to authorized users.
Smoking cessation intervention for reducing disease activity in chronic autoimmune inflammatory joint diseases.
Background: Self-rated health (SRH) has been shown to be a strong predictor of mortality from a number of major chronic diseases, however, the association with cancer remains unclear. The aim of this study was to investigate a possible association between change in SRH and cancer incidence. Materials and methods: SRH and information on lifestyle and other risk factors were obtained for 13-636 women in the Danish Nurse Cohort. Cancers that developed during 12 years of follow-up were identified in the National Patient Registry. An association between SRH and cancer was examined in a Cox proportional hazards model with adjustment for age, smoking, alcohol, marital status, physical activity, body mass index and estrogen replacement therapy. Results: No significant association was found between SRH and overall cancer incidence in the ageadjusted Cox proportional hazards model (1.04; 95% CI 0.93-1.16), even after adjustment for potential confounding factors (HR 1.08; 95% CI 0.96-1.21). Likewise, there was no significant association between SRH and breast cancer (HR 1.09; 95% CI 0.89-1.33), lung cancer (HR 1.03; 95% CI 0.71-1.49) or colon cancer (HR 1.08; 95% CI 0.75-1.54). Conclusion: SRH is not significantly associated with the incidence of all cancers or breast, lung or colon cancer among Danish female nurses. Women who reported a decrease in SRH between 1993 and 1999 had the same risk for cancer as those who reported unchanged or improved SRH.
Purpose: The aim of this study was to gain more knowledge on how people with rheumatoid arthritis (RA) experienced participation in a randomized controlled trial (RCT) testing the effect of a smoking cessation intervention since this intervention have not been tested on an RA population before Methods: We conducted a qualitative study with semi-structured individual interviews with 12 participants from the intervention group in the RCT. Results: Through thematic analysis we identified four themes: Instilling hope for smoking cessation, referring to the initial invitation to participate in the RCT; Various components of importance in the intervention, referring to cooperation with the smoking cessation counsellor, improved carbon monoxide levels, fear of becoming addicted to nicotine replacement therapy, and suggestions for additional components in the intervention which could promote motivation; Breaking habits, referring to ongoing reflection on quitting smoking; and Increased awareness of health, arthritis and smoking, referring to the lack of information on smoking and RA from health professionals, and the impact of smoking on RA symptoms and overall health. Conclusion: The results reflect the participants' perspective on what is meaningful to them when trying to quit smoking and adds important knowledge to future smoking cessation studies in this patient group.
Smokers with an inflammatory joint disease (IJD) experience poorer health-related quality of life compared to non-smokers with IJD (1). Smoking may exacerbate the symptoms of the disease and cause a reduced response to antirheumatic treatment (2-4). Smoking cessation interventions have traditionally been designed for people without chronic diseases (5). The literature on smoking cessation interventions to people with IJDs is limited.Initially, this lecture will focus on “state of the art” regarding smoking cessation interventions to people with IJD.Firstly, results from a systematic review will be presented. Randomised controlled trials (RCT) were included if they tested any form of smoking cessation intervention for adult daily smokers diagnosed with an IJD (6).Secondly, the lecture will focus on various interventions for smoking cessation e.g. brief advice, behavioural interventions, motivational interviewing and nicotine replacement therapy.Finally, principles for an ongoing RCTs where daily smokers with rheumatoid arthritis (RA) are randomised to either an intervention group or to a control group will be presented (7). The intervention consists of motivational counselling combined with nicotine replacement therapy. One patient research partner with RA (former smoker) has been involved with all phases of the study.The above indicate that smoking cessation may positively impact not only clinical outcomes but also patient reported outcomes. However, a limited number of studies on smoking cessation interventions and the effect of smoking cessation on clinical and patient reported outcomes to people with IJD have been published. The knowledge is therefore limited, and health professionals should focus on this subject to proactively support people with IJDs who wish to quit smoking.References:[1] Bremander A, Jacobsson LT, Bergman S, Haglund E, Lofvendahl S, Petersson IF. Smoking is associated with a worse self-reported health status in patients with psoriatic arthritis: data from a Swedish population-based cohort. Clinical rheumatology. 2015;34(3):579-83.[2] Chang K, Yang SM, Kim SH, Han KH, Park SJ, Shin JI. Smoking and rheumatoid arthritis. International journal of molecular sciences. 2014;15(12):22279-95.[3] Abhishek A, Butt S, Gadsby K, Zhang W, Deighton CM. Anti-TNF-alpha agents are less effective for the treatment of rheumatoid arthritis in current smokers. Journal of clinical rheumatology : practical reports on rheumatic & musculoskeletal diseases. 2010;16(1):15-8.[4] Soderlin MK, Petersson IF, Geborek P. The effect of smoking on response and drug survival in rheumatoid arthritis patients treated with their first anti-TNF drug. Scandinavian journal of rheumatology. 2012;41(1):1-9.[5] Gritz ER, Vidrine DJ, Fingeret MC. Smoking cessation a critical component of medical management in chronic disease populations. American journal of preventive medicine. 2007;33(6 Suppl):S414-22.[6] Roelsgaard IK, Esbensen BA, Østergaard M, Rollefstad S, Semb AG, Christensen R, et al. Smoking cessation intervention for reducing d...
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