Objective. Regular physical activity is associated with decreased morbidity and mortality. Traditionally, patients with rheumatoid arthritis (RA) have been advised to limit physical exercise. We studied the prevalence of physical activity and associations with demographic and disease-related variables in patients with RA from 21 countries. patients from 58 sites in 21 countries were enrolled in QUEST-RA: 79% were women, >90% were white, mean age was 57 years, and mean disease duration was 11.6 years. Only 13.8% of all patients reported physical exercise >3 times weekly. The majority of the patients were physically inactive with no regular weekly exercise: >80% in 7 countries, 60 -80% in 12 countries, and 45% and 29% in 2 countries, respectively. Physical inactivity was associated with female sex, older age, lower education, obesity, comorbidity, low functional capacity, and higher levels of disease activity, pain, and fatigue. Conclusion. In many countries, a low proportion of patients with RA exercise. These data may alert rheumatologists to motivate their patients to increase physical activity levels.

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ObjectiveOur study aims to understand the psychological impact of the COVID-19 pandemic among healthcare workers (HCWs) at acute hospital settings in the South-East of Ireland, as a crucial step in guiding policies and interventions to maintain their psychological well-being.DesignObservational cohort study.Participants and setting472 HCWs participated from two distinct acute hospital settings, A and B, in the South-East of Ireland.Primary and secondary outcome measuresMeasures of psychological distress—depression, anxiety, acute and post-traumatic stress disorder (PTSD)—as dictated by the Depression, Anxiety and Stress Scale (DASS-21) and Impact of Event Scale-Revised (IES-R). An independent sample t-test and a Mann-Whitney U test was used to determine significance of difference in continuous variables between groups. Categorical variables were assessed for significance with a χ2 test for independence.ResultsThe DASS-21 provided independent measures of depression (mean 4.57, IQR 2–7), anxiety (mean 3.87, IQR 1–6) and stress (mean 7.41, IQR 4–10). Positive scores were reflected in 201 workers (42.6%) for depression and 213 (45.1%) for both anxiety and stress. The IES-R measured subjective distress on three subscales: intrusion (mean 1.085, IQR 0.375–1.72), avoidance (mean 1.008, IQR 0.375–1.5) and hyperarousal (mean 1.084, IQR 0.5–1.667). Overall, 195 cases (41.3%) were concerning for PTSD. Site B scored significantly higher across all parameters of depression (5.24 vs 4.08, p<0.01), anxiety (4.66 vs 3.3, p<0.01), stress (8.91 vs 6.33, p<0.01) and PTSD (0.058 vs 0.043, p<0.01). Worse outcomes were also noted in HCWs with underlying medical ailments.ConclusionPsychological distress is prevalent among HCWs during the COVID-19 pandemic; screening for adverse mental and emotional outcomes and developing timely tailored preventative measures with effective feedback are vital to protect their psychological well-being, both in the immediate and long-term.

Current initiatives to treat rheumatoid arthritis (RA) to target remission have resulted in the widespread use of composite outcome measures to quantify disease activity. Simplified Disease Activity Index (SDAI) ≤3.3 is the gold standard of remission. Previous work has suggested that the remission threshold of DAS28-ESR or DAS28-CRP ≤2.6 is known to be not strict enough and should be revised. There is no previous study that looks at the equivalent DAS28-CRP value that best reflects SDAI remission in a real-life cohort. Consecutive cases fulfilling ACR/EULAR classification criteria for RA from one centre were included if they had an optimum number of visits with recording of all raw data to calculate DAS28-ESR, DAS28-CRP and SDAI. Data from seven visits each of 76 patients, providing 532 data points was examined. Spearman's correlation between DAS28-ESR, DAS28-CRP and SDAI was 0.91-0.97 (p < 0.001). A Bland-Altman plot demonstrated a mean difference of 0.37 units between DAS28-ESR and DAS28-CRP (p < 0.001). ROC and kappa analysis provided values of 2.58 and 2.55 for DAS28-ESR4V and 2.09 and 2.05 for DAS28-CRP4V for SDAI value of 3.3, respectively. The two versions of DAS28 using ESR and CRP and SDAI correlate but are not equivalent or interchangeable for an individual patient. The DAS28-CRP overestimates remission and should be revised downwards to a proposed value of 2.1.

Hand grip testing and subsequent conversion to z scores corrected for age and gender correlate with disease activity in early RA. We have shown that the grip strength z scores can discriminate between various disease states, and the strength seems to return to near normative data when the disease is in remission.