The rheumatology month in review for June 2024 addresses the critical role of psychological, socioeconomic, and lifestyle factors in the management of rheumatic diseases, particularly rheumatoid arthritis (RA) and fibromyalgia.

Psychological and Social Factors

This month’s headlines feature studies on RA that highlight the significant role of psychological and socioeconomic factors in managing the disease, particularly regarding sleep disturbances and fatigue. These findings emphasize the necessity of a holistic approach in managing RA, addressing both psychological and socioeconomic dimensions to improve patient outcomes.

Positive Personality Traits May Impact Sleep Issues in Patients with RA

New research shows disease activity itself plays a secondary role in explaining sleep disturbances in RA—with personality traits and perceived disease impact having greater influence.

Investigators, led by MJ Cadório, from Coimbra Hospital in Portugal, aimed to better understand sleep disturbances in patients with RA through a multifactorial explanatory model, examining the influence of disease activity, perceived disease impact, personality traits, and the comorbidities of depression and anxiety on sleep.

A multifactorial model explained 57% of the variance of sleep disturbances. “Positive” personality and disease activity explained 46% of the variance of the perceived impact of the disease.

High Fatigue Rates Exist in Economically Disadvantaged Patients with RA

Although the prevalence of fatigue in RA patients is well-researched, few studies have assessed the fatigue prevalence among patients with RA in South Africa. Thus, investigators sought to explore the prevalence, severity, and root causes of fatigue among indigent patients with RA in South Africa.

In total, 73.3% of patients experienced fatigue, with patients with high disease activity more likely to have severe or extreme fatigue than patients with low disease activity. Moreover, multivariate analyses demonstrated smoking, ≥ 2 comorbidities, pain severity, pain interference, anxiety, and depression were also significantly associated with fatigue.

Self-Management and Lifestyle

Recent studies emphasize the importance of lifestyle interventions and self-monitoring in managing and preventing rheumatic diseases. Increased physical activity, exemplified by higher daily step counts, has been linked to a significantly reduced risk of developing RA. Similarly, a targeted mobile app providing lifestyle counseling has proven effective in improving disease control among patients with RA, psoriatic arthritis (PsA), and spondyloarthritis (SpA), highlighting the challenges and benefits of inducing lifestyle changes in patients.

Higher Step Count Lowers Risk of Developing RA by 45%

To analyze the dose-response link between daily step count—measured by a wrist-worn accelerometer—and incident RA, investigators used data from the UK Biobank, in which subjects wore the device for 7 days.

A higher median daily step count was linked to a lower risk of incident RA, which was inverse log-linear. Patients in the highest quarter (> 11659 daily steps) had a 45% lower risk of RA compared with patients in the lowest quarter (< 6818 daily steps) (hazard ratio [HR] .55, [95% confidence interval (CI) .44 — .68]). Additionally, a 5% lower risk of developing RA was observed per each 1000-step increase per day.

Mobile App Improves Disease Control in Patients with Rheumatic Diseases

Previous research has shown common autoimmune inflammatory rheumatic diseases are impacted by nutritional patterns, exercise, and mental health. The Mediterranean Diet has been recommended for these patients due to its anti-inflammatory effects.

However, “lifestyle changes are notoriously hard to induce in patients,” wrote a team of investigators. “There are several potential obstacles to efficient lifestyle counseling, including time restrictions and insufficient reimbursement modalities or even a lack thereof, depending on the local health policy.”

Results of a single-blinded, randomized, controlled trial revealed a targeted lifestyle counseling app was shown to improve disease activity among patients with RA, PsA, and SpA.

Urate Self-Monitoring Improves Medication Adherence in Gout

Patients with gout who participated in 12-months of monthly urate self-monitoring reported the approach led to better gout control coupled with a less restricted lifestyle, according to recent research. These patients believed self-monitoring was a useful and convenient way to management their condition independently.

Additionally, participants learned how their behavior, such as diet and medication adherence, influenced their urate. In doing so, the cohort was more motivated to self-monitor regularly to ensure they stayed within the target urate concentration.

Innovative Treatments and Therapies

Recent studies highlight innovative, non-pharmacological interventions showing significant benefits for fibromyalgia patients, particularly those unresponsive to traditional treatments. Both repetitive transcranial magnetic stimulation (rTMS) and low-pressure hyperbaric oxygen therapy have demonstrated promising results.

Repetitive Transcranial Magnetic Stimulation Significantly Improves Cognitive, Psychiatric Function in Fibromyalgia

rTMS is a noninvasive brain stimulation technique that uses electromagnetic fields to alter activity in particular areas of the cerebral cortex. It has previously demonstrated efficacy in treating neuropathic pain and is used for the management of neurodegenerative diseases, such as Alzheimer’s and Parkinson’s, as well as in cases where pharmacological treatment has been unsuccessful. The technique is also beneficial for the management of treatment-resistant depression and obsessive-compulsive disorder (OCD).

Findings from a recent study published in Brain Sciences demonstrated patients with fibromyalgia who were treated with 20 sessions of low frequency rTMS had significantly greater improvements in cognitive and psychiatric function compared with the sham rTMS cohort for both short- and long-term follow-up

Low-Pressure Hyperbaric Oxygen Therapy May Aid Pain Management in Women with Fibromyalgia

To explore the effect of low-pressure hyperbaric oxygen therapy on psychological constructs related to pain and quality of life in women with fibromyalgia, investigators conducted a randomized controlled trial involving women diagnosed with fibromyalgia according to the 2016 American College of Rheumatology criteria.

“To the best of our knowledge, this is the first study that evaluates the effect of a non-psychological intervention, such as low-pressure hyperbaric oxygen therapy, on psychological constructs that have been proposed as major contributors to quality of life among fibromyalgia patients,” Pilar Serra-Añó, PhD, professor of physiotherapy at the University of Valencia in Spain, and colleagues wrote.

Results showed an 8-week intervention with low-pressure hyperbaric oxygen therapy led to significant improvements in self-perceived pain intensity; pain catastrophizing; mental defeat; pain acceptance; psychological flexibility; and quality of life in a cohort of women with fibromyalgia who had previously experienced no improvement with pharmacological treatment.