OBJECTIVES:Epidemiology has taken on new roles in the management of health care services. In this study, we developed a non-pharmacological self-management modular program group intervention and evaluated its efficacy as an adjunct therapy in patients suffering from early rheumatoid arthritis (RA).METHODS:Patients were randomized to either participate in a non-equivalent intervention group along with the standard of care or only receive standard-of-care treatment at a community rheumatology center. The outcomes measured were a pain visual analog scale (VAS), patient general health (GH) on a VAS, and the Short Form 36 Health Survey version 2 scale measuring quality of life. These parameters were evaluated in the first week to obtain baseline values, and at 20, 32, 48, and 60 weeks to evaluate the efficacy of the intervention group.RESULTS:The patients were randomized, with 100 patients in the intervention group and 106 in the control group. The intervention and control groups were similar with regard to the percentage of women (86% vs. 89.6%), tobacco usage (25% vs. 19.8%), mean age (42.6±13.2 years vs. 46.6±10.9 years), and disease duration (15.3±6.7 months vs. 14.5±6.6 months). The mean outcomes were significantly different between the two groups, and post-hoc pairwise analysis demonstrated significant deterioration in the control group in contrast to improvement in the intervention group at the second, third, fourth, and fifth evaluations. Improvements were often seen as early as the 12-week and 24-week follow-up visits.CONCLUSIONS:Epidemiology contributes to the evaluation of how well specific therapies or other health interventions prevent or control health problems. The modular program group intervention implemented in this study appears to be a suitable and feasible method to facilitate much more comprehensive management of early RA in socioeconomically challenged communities.

Introduction:Ramadan fasting has several advantages in regards to different diseases. However, its role in chronic diseases and patients who are under treatment with specific medications remains unknown. The general objective of this study was to determine the effect of Ramadan fasting on liver function tests in patients using methotrexate attending Shahid Mohammadi Hospital in 2015.Methods: This cohort study was conducted on patients under treatment with methotrexate in the Rheumatology Center, Bandar Abbas, Iran. Fifty patients were placed in fasting group and 50 in a non-fasting group. Patients were evaluated for liver function tests, including aspartate aminotransferase, alanine aminotransferase, alkaline phosphatase, and total bilirubin before and after Ramadan fasting. For data analysis, IBM SPSS version 22.0 and descriptive tests, independent samples T-test and paired samples T-test were used. Results: Liver function tests were similar in two groups before Ramadan fasting (p>0.05). Also, liver function tests were not statistically different between two groups after Ramadan fasting (p>0.05). In the fasting and nonfasting group, there was no statistically significant difference between liver function tests before and after Ramadan fasting (p>0.05). Conclusion:The effect of Ramadan fasting on liver function tests in rheumatologic patients using methotrexate is not statistically and clinically significant. However, we recommend nutritional instructions for patients using methotrexate for Ramadan fasting.

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Objective: Rheumatoid arthritis (RA) is a crippling disease with significant affection in a patient's life. The objective of this study is to describe the role of uni-modular and multi-modular non-pharmacological community intervention effectiveness, especially pain management interventions in rheumatoid arthritis. Methods: This review built on a preliminary literature search, covering 2009 up to December 2013. Selective review of current literature was produced by searching the term nonpharmacological intervention, "self-management programme", "self-care", "rheumatoid arthritis" to capture all spectrums of rheumatoid arthritis non-pharmacological intervention. Twenty-six reviews were included in this overview. Results: A substantial and remarkable number of studies of non-drug care interventions in RA are available. Twenty-six reviews were included in the present overview indicated a beneficial effect of cognitive-behavioural therapy and psychotherapeutic intervention, self-management, physical therapy (Exercise) but a few studies indicated a beneficial effect of the multidisciplinary education programme and specific dietary interventions. The evidence of effectiveness varies among the different non-pharmacological modalities and indicates a need for further investigation into the most clinically and cost-effective strategies to deliver individual, nonpharmacological treatment modalities as well as comprehensive arthritis service delivery models for RA patients. Conclusion: This review gives a summary of the available evidence regarding the effectiveness of non-pharmacological treatment modalities are often prescribed as an adjunct to standard care in RA, but the data need scientific appraisal into the most clinically and cost-effective strategies