The editors ofArthritis Todaymagazine were on the scene, collecting news and information to share with readers from the American College of Rheumatology’s (ACR) Annual Meeting, November 9-13, in Atlanta. Here are a few of the many interesting and enlightening research topics they learned about.
Anti-inflammatory Diet Improves Disease
There has long been uncertainty whether diet influences disease activity in inflammatory arthritis. Two studies presented some evidence that it does. In one study, 17 patients with active rheumatoid arthritis (RA), defined as at least three tender and three swollen joints, followed an anti-inflammatory diet for two weeks. Blood tests before, during and after measured oxylipins, molecules involved in inflammation, pain and other cellular functions. The diet added turmeric, antioxidants, prebiotics and probiotics. It eliminated pro-inflammatory items, such as lactose (found in diary), gluten and red meat, and improved the ratio of omega-3 to omega-6 fatty acids. The subjects were found to have good diet adherence. After 14 days, a range of disease measures were significantly lower, and tests showed correlation with changes in blood levels of the oxylipins. The authors concluded that diet has the potential to complement medication and improve quality of life for patients with RA.–MARCY O’KOON
Depression and Resilience
炎症已被证明在抑郁症中起作用，但这是否使抑郁症成为炎症性疾病呢?不，安德鲁·米勒博士强调说，他是埃默里医学院精神科的研究员。抑郁症可能与炎症有关，而炎症是风湿性关节炎、银屑病关节炎和红斑狼疮等炎症疾病的核心，但在其他健康人群中与抑郁症无关。(用于治疗抑郁症炎症的生物制剂没有效果。)
In the same session, “Mechanisms & Mediators of Psychiatric Comorbidity in Rheumatology,” Afton Hassett, a psychologist and researcher in the University of Michigan’s Chronic Fatigue and Pain Research Center, explored the role of resilience in people with arthritis and pain. People with rheumatic diseases tend to have a more negative outlook than “healthy” people do, but positive emotions – which are key to resilience – are associated with less pain, less need for medications, earlier discharge from the hospital and other positive outcomes. The good news is that resilience can be learned. Hassett described some exercises, including these three: 1) Pick a future point, such as one or five years from now, and imagine being your best self, living to your full potential, then write about it in detail. 2) Every day write down three things for which you are grateful; as time goes on, you’ll become aware of even smaller things to appreciate. 3) Pick a day this week and do five kind things for others and one kind thing for yourself.– JILL TYRER
Patient Partner Perspective: Stacy Courtnayattended this session on pain, depression and anxiety and said it really resonated with her.
“The more connections you have with people living in a similar situation as you, the better mental and emotional health you will have. Support groups are the key to managing your overall well-being.” – Stacy Courtnay
史黛西说，“我们需要彼此的支持”，参与关节炎基金会真的帮助她建立了这些联系，因为这是使命的一个重要部分。现场是的!关节炎网络在帮助她与理解她的挣扎的人建立联系方面发挥了巨大的作用。
The Problem of Sleeplessness
对于关节炎患者来说，疼痛会影响睡眠并不奇怪;研究表明，更显著的相关性是失眠加剧疼痛。密歇根大学的Anna Kratz博士和英国阿伯丁大学的Daniel Whibley博士在一个名为“不再数羊:循证睡眠管理”的会议上讨论了睡眠不足对关节炎患者的影响和治疗方法。(惠布利说，事实上，数羊入睡要比放松想象多花20分钟。)他讨论了昼夜节律在不同人的睡眠模式中的作用(“早起鸟”vs.“夜猫子”)，以及夜间睡眠的结构(夜间醒来几次是正常的)。他还说，患有风湿病的人通常“睡眠效率”较差——他们醒着躺着的时间比其他人睡着的时间更长。睡眠不足会导致精神障碍以及疼痛和疲劳，有睡眠问题的人应该筛查其原因，比如阻塞性睡眠呼吸暂停或慢性失眠——这两种情况在关节炎患者中很常见——或阿片类药物或其他药物的副作用。
Good sleep hygiene (getting regular exercise; keeping a dark, quiet bedroom; keeping a regular sleeping schedule; shutting off blue-light electronics, etc.) helps many people, but people with rheumatic disease may need more help. The American Academy of Sleep Medicine discourages the use of sleep medications and recommends cognitive behavioral therapy for insomnia (CBTi) as a first-line treatment. In the U.S., however, it’s hard to find people qualified to practice CBTi. (Whibley and Kratz suggested rheumatology practices have someone trained in CBTi.) “The most important thing is to be regular in your sleep-waking patterns, and that includes weekends,” Whibley said. If you don’t sleep well, seek help. “Don’t assume that poor sleep in part of the condition.”–JILL TYRER
Patient Partner Perspective: Cheryl Crowattended this session on sleep, which she
stated was a very informative and engaging session. She was surprised by some of the information she learned when it comes to sleep and the rheumatic disease population. Cheryl said having a patient on this sleep panel sharing her story was powerful to witness as a patient herself.
“与普通人相比，在患风湿病的人群中，失眠和阻塞性睡眠呼吸暂停更常见，37-50%的人有某种障碍。我完全不知道。让我想去做评估。” – Cheryl Crow
She was moved to see that so many rheumatology professionals were in the room asking questions to get the patient perspective, demonstrating that patient engagement is crucial in providing better patient care.
Standard PRO Measures Miss Younger Patients
Patient-reported outcome measures (PROMs) are routinely used by doctors as well as in research, but Erika Mosor, a researcher at the Medical University of Vienna, Austria, found that the standard measures may not get a true view of younger patients. In her session, “When You Read This, You Really Feel Old: Perspectives of Young People with Inflammatory Arthritis on Patient Reported Outcome Measures from a European Qualitative Study,” she reported that patients aged 18 to 35 said the PROMs of daily functioning and other issues “seem like they’re for old people.” They don’t address technology, childcare, social life, sex, loss of friends and other issues relevant to younger patients. Because their concerns are overlooked, results may be skewed so these patients appear to be doing better than they are; some patients said they considered marking worse scores just to get their concerns recognized. PROMs should be more tailored to patients so they can be used more effectively in shared decision-making, Mosor said.– JILL TYRER