This study demonstrates that physical activity in patients with rheumatoid arthritis may be understood as a resource to resist disability and to feel and stay healthy while creating and sustaining meaningfulness in life.

BackgroundThe everyday life of patients with RA is periodically influenced by increased disease activity (flares) which often leads to severe limitations in physical functioning and potential progressive joint destruction. Intervention studies in patients with RA have documented a positive effect of exercise on pain and physical functioning. However, studies have also demonstrated that exercise and increased activity levels are difficult to maintain over time [1]. Pain has been identified as a main barrier against adaptation and maintenance of a physically active lifestyle in patients with RA [2]. Sedentary behavior (SB) has become increasingly prevalent in modern society. SB has been recognized as a distinct and independent risk factor for cardiovascular morbidity and mortality, independent of moderate or vigorous physical activity during leisure time [3]. Recent research in healthy population has shown that SB can be reduced through behavioral intervention. At present time there exists few intervention studies investigating health effects of reducing SB. Reducing SB rather than solely increasing physical activity may be suitable in patients with RA.AimThis presentation focus on some available experiences from an intervention study (Randomized Controlled Trial, RCT) which aimed to investigate the efficacy of an individually tailored, theory-based motivational counseling intervention on reducing daily sitting time in patients with RA.Methods/DesignIn total 150 patients with RA were recruited from a rheumatology outpatient clinic with at least 5 hours of sitting time per day. Block-randomized was to the intervention group (N=75) or the control group (N=75) receiving usual care. The intervention included: 1) Individual motivational counseling (in total 3 sessions) on reducing daily sitting time in combination with 2) Individual Short Text Message Service (SMS) reminders over a 16 week intervention period. Primary outcome was a change in daily sitting time (minutes) from baseline to 16 weeks measured objectively using an ActivPAL® Activity Monitor. Secondary outcomes included fatigue, pain, physical function, health-related quality of life, self-efficacy, costs and cost-effectiveness. Furthermore, anthropometric measures were included as well as measurement of blood pressure and serum lipids.ResultsRecruitment and sample characteristicsRecruitment process commenced from April 2013 to August 2014. A project manager consecutively screened medical journals of patients with RA regarding criteria about RA diagnosis and HAQ-score <2.5.Adherence to the interventionIn total, 75 patients with RA completed all three individual Motivational Intervention (MI) sessions. The participants generally responded well to the part about setting goals to reduce daily SB, which is how each motivational session ended. Examples of SMS text messages will be presented. Frequency of SMS-reminders ranged from 1-4 per week and they were mostly sent out in the afternoon.Experiences of the interventionEvaluation of the participant experience was un...

BackgroundThe prevalence for rheumatoid arthritis (RA) is 0,5 - 1,0% [1], rises with age and occurs more frequently in women with the ratio 3: 1 [2]. It is probably the reason why research has been focusing on women and knowledge about men is scarce. RA is strongly associated with patients experiences of physical, emotional, and social restrictions and quality of life is poor compared to the general population [3]. What is missing from the literature is how men with RA perceive, interpret and understand to live with a chronic illness.ObjectivesThe aim of this study was to to develop an understanding of how men live with RA and their coping strategies to live with a chronic disease like RA.MethodsA qualitative interview study was conducted based on individual semi-structured interviews. A purposive sample of 17 men with RA, (average age 58 (range 33-70)), diagnosed with RA on average 15 years previously (min. 5, max 34 years) were recruited from the rheumatology outpatient department, Glostrup Hospital. Semi-structured interviews were conducted to understand men's experiences living with RA. The recorded interviews were transcribed verbatim, and analysed using Interpretive Description as described by Thorne [4] and by use of the Nvivo software. An interpretive description of the men's experiences was established.ResultsThe analysis revealed that men with RA are affected in several dimensions of their every daily life. Seven categories influencing men with RA were extracted: (1) Frame time of diagnosis, (2) Loss of bodily capacity, (3) Adapting to life with medicine, (4) Connecting to job situation, (5) Health literacy, (6) To navigate as a social individual and (7) The challenged to masculine rationality.ConclusionsStudy participants from a wide range of age and disease duration described their experience of living with RA as being related to essential issues about masculinity, social network and strategies to handle consequences of RA in everyday life. These findings demonstrate that RA has an impact on how men define themselves as partner and their masculine identity. Physical activity was highlighted as an important part of being a man. Knowledge from this study will be used in the planning of our subsequent intervention study targeted men with RA.ReferencesScott, D.L., F. Wolfe, and T.W.J. Huizinga, Rheumatoid arthritis. The Lancet, 2010. 376(9746): p. 1094-1108.Alamanos, Y. and A.A. Drosos, Epidemiology of adult rheumatoid arthritis. Autoimmun Rev, 2005. 4(3): p. 130-6.Ovayolu, N., O. Ovayolu, and G. Karadag, Health-related quality of life in ankylosing spondylitis, fibromyalgia syndrome, and rheumatoid arthritis: a comparison with a selected sample of healthy individuals. Clin Rheumatol, 2011. 30(5): p. 655-64.Thorne, S., Interpretive Description 2008, Walnut Creek, CA: Left Coast Press.Disclosure of InterestNone declared

Background:Many patients with rheumatoid arthritis (RA) live with the consequences of arthritis in everyday life. Sleep disturbances, including insomnia, are highly prevalent and a complex issue that increases existing RA-related symptoms, such as pain, fatigue, and depressed mood. To our knowledge, only two studies have qualitatively investigated the patient perspective and experiences of sleep in people with RA (1-2).Objectives:To investigate how people with RA and concomitant sleep disturbances describe their sleep and experience everyday life with poor sleep.Methods:This study is a qualitative phenomenological study. In total, 14 people with RA and sleep disturbance were recruited from an RCT study (3) from the Center for Rheumatology and Spine Diseases at Rigshospitalet in 2012. Semi-structured interviews were performed after the last follow-up in the RCT. The analysis was based on Giorgis’ descriptive phenomenological psychological analysis.Results:For the characteristics of participants, see Table 1. We identified six essences; 1) “When sleep is put into words” covered that the participants described their poor sleep experiences simultaneously to their wishes for good sleep still existed. 2) “The struggle to sleep” included participants’ descriptions of difficulties sleeping and how thoughts and worries could interfere with sleep at night. 3) “Pain is a companion day and night” included how pain affected sleep and how participants had problems with pain management. 4) “To take sleep in their own hands” described how the participants tried to create their framework for sleeping and how they also strove to reach out for help from, e.g. of professionals. 5) “Everyday life in the shadow of sleep” included the overwhelming fatigue, a need to rest during the day, and how social relationships were affected negatively. 6) “Adapt to the circumstances,” which meant that the participants tried to seek shelter behind a facade, and at the same time tried to learn to live with the consequences of poor sleep in everyday life.People with RA and sleep disturbances describe several challenges that affect their sleep, e.g., pain, thoughts at night, and many reasons for awakenings. Participants in this qualitative study were not aware of the difference between fatigue and poor sleep, both regarding reasons for occurring and management of the two highly prevalent consequences of RA. At the same time, they believed that health professionals lacked knowledge on sleep disturbances and management hereof in people with RA.Conclusion:When people with RA and concomitant sleep disturbance describe their sleep, a struggle to sleep was most often described, characterized by pain, thoughts, difficulty falling asleep, and many and early awakenings. Everyday life experience with sleep disturbances was marked by fatigue and sleep deprivation, negative impact on social skills and relationships, and failure when they reached out for help.Table 1.Characteristics of participants(N=8)Age, median (range)50 (44-60)Sex, Women, n %7 (77,8%)RA-relatedDuration of RA, median (range)14,75 (6-32)DAS28-CRP, median (range)11,9 (1,62-3,03)Physical function, HAQ, median (range)10,5 (0,000 – 2,13)SleepPSQI, median (range)29,5 (6-15)FatigueVAS fatigue, median (range)33,4 (2-65)BRAF-MDQ, median (range)325,5 (4-36)PainVAS pain, median (range)25 (0-60)Quality of LifeVAS global, median (range)45,6 (8-40)1 Disease activity score-28 C-reactive protein2Health Assessment Questionnaire, score 0-3 (Higher score indicates worse physical functioning.2 Pittsburgh Sleep Quality Index, score 0-21 (score of 5 or more indicates sleep disturbances)3 Visual Analog scale, score 0-100 (higher score is worse)4 Bristol Rheumatoid Arthritis Fatigue Multidimensional Questionnaire score 0-70(higher score indicates more fatigue)References:[1]Short V et al; Annals of the Rheumatic Diseases. 2017;76(Suppl 2):519.[2]McKenna S, et al; EULAR. 2020; OP0267-HPR (2020).[3]Løppenthin et al; BMC Musculoskeletal Disorders 2014, 15:49.Disclosure of Interests:Camilla Andersen: None declared, Kristine Marie Latocha: None declared, Bente Appel Esbensen Speakers bureau: Bente Appel Esbensen has received speaking fees from Pfizer and Eli Lilly.