Introduktion: Medicinering av personer med reumatoid artrit (RA) har blivit bättre men samtidigt kvarstår många besvär som gruppen behöver lära sig leva med, ett sätt att angripa detta kan vara genom patientutbildning för att lära sig hantera kvarstående symtom. Arbetsterapeutiska interventioner innehåller ofta utbildning. Syfte: Syftet var att beskriva hur arbetsterapeuter använder sig av patientundervisning som intervention för personer med RA. Metod: Scoping review användes för databassökningar, databaserna som användes var Cinahl, Medline och Scopus. Under artikelsökning exkluderades artiklar som var rena litteraturstudier och resulterade i 15 artiklar som svarade på studiens syfte och frågeställningar. Resultatet granskades och analyserades numerisk och tematiskt. Resultat: Forskningsfrågorna användes som teman och resultatet besvarade vad patientundervisning syftar till, exempelvis på att stärka self-efficacy och self-management och minimera sjukdomens inverkan på aktivitet och delaktighet. Det baseras exempelvis på kognitiv beteendeterapi (KBT), olika pedagogiska teorier och motivationshöjande metoder. Det genomförs bland annat genom gruppinterventioner och individuella möten med arbetsterapeut i olika miljöer och med olika fokus. Slutsats: I interventioner uppskattades kontakten med arbetsterapeuten av patienterna. De vanligaste strategierna inom området var olika self-managementmetoder, pedagogiska teorier och motivationshöjande metoder. Med hjälp av utbildning kunde aktivitetsbarriärer minskas. / Patient-education for people with RA within Occupational therapy Abstract Introduction: The medical treatment has been effective for people with Rheumatoid Arthritis (RA). But many of the RA symptoms still remains, to learn to cope with the symptoms, patinent-education can be used. Occupational therapy often includes education. Aim: The aim was to describe how occupational therapists use patient-education as intervention for people with RA. Method: A scoping review was used for databasesearches in Cinahl, Medline and Scopus. Literature studies were excluded during the process. The search resulted in 15 studies which answered the aim and research questions for this study. The results were reviewed and analyzed numerically and thematically. Results: The research questions were used as themes and the results answered what patient-education seeks to, the purpose could be to strengthen self-efficacy, self-management and reduce the activity and participation limitations. For example educational interventions were based on cognitive behavioral therapy and different self-management strategies. It was implemented in groups or by individual meetings with an occupational therapist in different environments and with different focus. Conclusions: Patients appreciated the contact with occupational therapist during the interventions. The most frequent strategies within the area were self-management, educational theories and motivational measures. With help of education activity barriers could be reduced.

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Bakgrund: Reumatoid artrit (RA) är en kronisk autoimmun sjukdom som drabbar ungefär 0,3 – 1 % av världens population. Sjukdomen orsakar stort lidande och minskad livskvalitet hos den enskilde individen. Att synliggöra individens livserfarenheter av RA ger vårdpersonal bättre förutsättningar till att ge en god personcentrerad vård. Syfte: Att belysa personers erfarenheter av att leva med reumatoid artrit.  Metod: Kvalitativ litteraturstudie. För att identifiera relevanta artiklar har databaserna Cinahl och PubMed använts. Studien baseras på 11 artiklar som analyserades med hjälp av Fribergs femstegsmodell.   Resultat: Fyra kategorier med 11 subkategorier identifierades (1) Att uppleva livsbegräsningar, (2) Att hitta sig själv, (3) Att finna mening och balans i livet och (4) Att möta andra – privat och offentligt.   Konklusion: Resultatet belyser vilka djupgående effekter diagnosen RA har på individens alla aspekter i livet. RA tvingar individen till självreflektion, försöka återfå mening och balans i tillvaron samt till att omdefiniera sociala roller både privat och offentligt. Studiens resultat kan bli ett viktigt redskap i den personcentrerade vården. Framtida studier inom ämnesområdet kan utgå från sjuksköterskans perspektiv i mötet med individen med RA. / Background: Rheumatoid arthritis is a chronic autoimmune disease affecting 0,3 - 1 % of the world's population and causes great suffering and reduced quality of life. By recognizing the experiences of individuals affected by RA, healthcare professionals can provide an effective personalised approach.  Aim: To enlighten people's experiences of living with rheumatoid arthritis.  Methods: A qualitative literature study. We used a systematic search of two electronic databases Cinahl and PubMed. The study is based on 11 articles that were analysed using Friberg's five-step model.  Results: We identified four categories, with 11 subcategories, (1) To experience life limitations (2) To redefine yourself (3) Finding meaning and balance in life and (4) To meet others – in private and public.  Conclusion: The result highlights the effect that rheumatoid arthritis has on all aspects of the individual's life. RA forces the individual to self-reflect, to regain a sense of purpose and to redefine social roles. The result of the study can be an important tool in the personalised approach. Future studies could focus on the nurse's perspective in their encounters with individuals affected by RA.

Bakgrund  Reumatoid artrit är en progressiv autoimmun reumatisk sjukdom som ger upphov till svullnad i personens leder. Svullnaden ger symtom så som smärta och stelhet för personen i berörda leder och den inflammatoriska aktiviteten kan ge upphov till kronisk trötthet. Inflammationen kan även ge upphov till leddestruktion, deformiteter och fysiska begränsningar. Sjuksköterskan har en central roll i att stödja personen med reumatoid artrit att hantera sin sjukdom. Syfte Syftet var att beskriva personers upplevelser av att leva med reumatoid artrit. Metod För att besvara syftet gjordes en litteraturöversikt. Efter urval och kvalitetsgranskning inkluderades tolv vetenskapliga artiklar.  Resultat Personer med reumatoid artrit beskrev upplevelser av att flera symtom var närvarande med varierande och oförutsägbar karaktär och varaktighet. Uppkomst av fysiska begränsningar för personen hade stor påverkan på det dagliga livet och på personliga relationer. Personer upplevde av sjukdomen ingav ett ökat beroende till andra vilket påverkade självbilden och emotioner. Resultatet visade att läkemedel var en betydande del i personernas liv men att personerna även använde flera egna strategier för att hantera sin sjukdom. Slutsats Personers upplevelser av att leva med reumatoid artrit omfattar såväl fysiska symtom och begränsningar som psykiska och sociala upplevelser och förändringar. Personen stod inför nya utmaningar när deras kropp var förändrad på grund av sjukdom. Personer upplevde att de inte längre kunde lita på den egna kroppen vilket var både emotionellt och gav påverkan på självbilden. För att hantera sin sjukdom användes flera strategier för att hantera sin sjukdom som innebar acceptans, anpassning, att avstå eller uthärda konsekvenser av sjukdom och symtom. Socialt stöd och att bli tagen på allvar hade stor betydelse för hantering av sjukdomen. / Background Rheumatoid arthritis is a progressive autoimmune rheumatic disease that causes swelling in the persons’ joints. The swelling causes symptoms such as pain and stiffness for the person in the affected joints and the inflammatory activity can cause chronic fatigue. The inflammation can also cause joint destruction, deformities, and physical limitations. Nurses have a central role in supporting people with rheumatoid arthritis in managing their illness. Aim This study aimed to describe persons’ experiences of living with rheumatoid arthritis. Method To answer the research question, a literature review was conducted. After selection and a conducted quality review, a total of twelve scientific articles were included. Results People with rheumatoid arthritis described experiences of several symptoms that were present with different and unpredictable character and duration. Physical limitations which emerged for the person had a major impact on daily life and on personal relationships. People experienced that the presence of the disease created an increased dependency on others impacting on self-image and with emotional responses. The results show that medications were a significant part of people's lives, but people also used several own coping strategies to manage their illness. Conclusions Persons' experiences of living with rheumatoid arthritis include both physical symptoms and limitations as well as psychological and social experiences and changes. The person faced new challenges when their body was altered due to disease. Persons experienced that they could no longer to trust their own body which was both emotional and influenced self-image. To manage their illness the use of several coping strategies was used, such as acceptance, adaptation, relinquishing or enduring the consequences of illness and symptoms. Social support and being taken seriously were of great importance in managing the disease.

Objectives: The aim of this systematic review was to assess the oral-health-related quality of life (OHRQoL) of adult patients with rheumatic diseases. Material and Methods: A systematic literature search was performed, including clinical studies on adults (aged at least 18 years) with a verified diagnosis of rheumatic disease. Results: 26 out of 41 clinical studies including rheumatoid arthritis (RA, seven studies), systemic sclerosis (SSc, five), Sjögren syndrome (SS, eight), Behcet disease (BD, four), systemic lupus erythematosus (SLE, one) and ankylosing spondylitis (AS, one) were found. In 15 studies, a healthy control group was recruited. The short form of the Oral Health Impact Profile (OHIP 14) was most frequently applied. The majority of studies (14/15) reported worse OHRQoL in patients with rheumatic disease compared to healthy individuals. In particular, patients with SS (salivary flow and composition) or BD (oral ulcers) showed a relation between OHRQoL and disease-specific oral manifestations. Most studies investigating subscales of OHRQoL (5/6) found the subscale physical disability to be predominantly affected in patients with rheumatic diseases. About half of the studies reported impaired psychosocial aspects. Conclusion: Patients with rheumatic diseases exhibit reduced OHRQoL, especially in diseases with oral manifestations like SS and BD. Physical affections due to oral diseases and psychosocial impairments caused by disease-related parameters must be recognized within patient-centered dental care.

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BACKGROUND: Spondyloarthritis is a subset of inflammatory rheumatic diseases that includes ankylosing spondyloarthritis, psoriatic arthritis, undifferentiated spondyloarthritis, and arthritis related to inflammatory bowel. The IL-23 cytokine has been implicated in the pathogenesis of spondyloarthritis. B10.RIII mice hydrodynamically injected with IL-23 minicircle overexpress the IL-23 cytokine, which leads to the development of spondyloarthritis-like disease. It is important to note that B10.RIII is a major histocompatibility complex (MHC) congenic mouse strain that is susceptible to autoimmune and autoinflammatory diseases where the background strain, C57BL/10 (B10), or the MHC donor strain, RIIIS/J, is resistant. For instance, the B10.RIII strain of mice is susceptible to IL-23-induced arthritis, while the B10 background strain is not. Large contaminating RIII-derived regions outside of the selected congenic interval on chromosome 17 were identified on chromosomes 10, 14, 15, and 17. Genetic variations in these intervals may contribute to the susceptibility of the B10.RIII mice to arthritis induced by IL-23 minicircle. OBJECTIVE: This study aimed to interrogate the arthritis phenotype after IL-23 minicircle injection in Chr17 subcongenic B10.RIII mice. In addition, chromosome 17 RIII-derived Ilrun gene and its role in regulating the Interferon signaling pathway between the B10.RIII and B10 mice were investigated. METHOD: Chromosome 17 subcongenic mice were generated by crossing B10.RIII mice with B10 mice and backcrossing the offspring to the B10.RIII mice. Offspring heterozygous b/r for the Chr17 region were then intercrossed to generate B10.RIII mice that are identical to the B10.RIII mice, except at chromosome 17, where they had the genotypes Chr17b/b, Chr17b/r, or Chr17r/r. These mice were then hydrodynamically injected with IL-23 minicircle DNA, and disease development was monitored every other day for two weeks using two parameters: clinical arthritis score and paw swelling. Bone marrow-derived macrophages were differentiated in vitro from B10.RIII and B10 mice. Cells were stimulated with TLR agonists (Pam3CSK4, Poly (I:C), LPS) that induce either the Ilrun-regulated Interferon signaling pathway or the NF-kB signaling pathway. Gene expression changes of NF-kB and Interferon-induced genes were measured using real-time quantitative PCR. TNF protein concentration in the supernatant was measured by ELISA. RESULTS: Upon IL-23 minicircle injection, Chr17r/r and Chr17b/r B10.RIII mice developed arthritis while Chr17b/b B10.RIII mice did not. In addition, the disease severity increased with the number of r alleles as the Chr17r/r B10.RIII mice had a higher clinical score and paw swelling when compared to the heterozygote Chr17b/r mice. Gene expression analysis of NF-kB and Interferon response genes revealed that there was no difference in the induction of NF-kB and Interferon response genes in bone marrow-derived macrophages from B10.RIII and B10 mice. In addition, there was also no difference in the induction of the Ilrun gene in bone marrow-derived macrophages from B10.RIII and B10 mice. CONCLUSION: The B10.RIII(71NS)/Sn strain contains three major RIII/WySn-derived regions outside of the congenic MHC region. The chromosome 17 cluster appears to play a role in susceptibility to IL-23 minicircle-induced arthritis. In vitro studies with bone marrow-derived macrophages failed to show functional differences in Ilrun between the B10.RIII and B10 mice. Future studies will interrogate chromosome 17 RIII-derived regions in arthritis development in more detail and investigate the role of Ilrun in immune responses using Ilrun knock-out mice. / 2025-02-28T00:00:00Z

(1) Background: To date, the response of patients with rheumatoid arthritis (RA) to the various biologic DMARD available cannot be predicted due to a lack of reliable biomarkers. Based on our preliminary work on tmTNF reverse signaling, we developed a whole-blood assay measuring tmTNF crosslinking-induced IL-10 production to predict the response to TNF inhibitor (TNFi) therapy. (2) Methods: This prospective study included patients with active RA. Depending on the clinical judgment of the attending rheumatologist, either therapy with a TNF or JAK inhibitor was initiated. Clinical parameters and blood samples were obtained at baseline and after 8 weeks of therapy. The blood samples were collected using a newly developed whole-blood assay based on the principle of tmTNF reverse signalling. Subsequently, IL-10 was measured via enzyme-linked immunosorbent assay (ELISA) technique. (3) Results: 63 patients with RA were enrolled. In fifteen patients, TNFi therapy was initiated, while eight patients started a JAKi treatment. The cross-sectional analysis of all patients showed a positive correlation between tmTNF crosslinking-induced IL-10 and parameters of disease activity (CRP [r = 0.4091, p = 0.0009], DAS28 [r = 0.3303, p = 0.0082]) at baseline. In the TNFi treatment study, IL-10 was found to be significantly higher in EULAR responders than in non-responders (p = 0.0033). After initiation of JAKi treatment, in contrast, IL-10 induction was not linked to response. Longitudinal analysis of the TNFi-treated patients revealed IL-10 to decrease in responders (p = 0.04), but not in non-responders after 8 weeks of therapy. Of importance, the IL-10 production at baseline correlated inversely with TNFi response determined by DDAS28 in patients with TNFi treatment (r = 0.5299, p = 0.0422) while no such link was observed under JAKi therapy (p = 0.22). Receiver operation characteristics (ROC) analysis demonstrated a high performance of tmTNF/crosslinking-induced IL-10 in predicting a TNFi therapy response according to the EULAR criteria (AUC = 0.9286, 95% Confidence interval 0.7825–1.000, p = 0.0055). (4) Conclusions: In this pilot investigation, we demonstrated the feasibility of a whole-blood assay measuring tmTNFinduced IL-10 to predict clinical response to TNF inhibitor treatment. This approach might support rheumatologists in their decision for an individually tailored RA therapy.

Background: The aim of this cross-sectional study was to investigate oral health and functional status of adolescents with juvenile idiopathic arthritis (JIA) and its possible link to disease specific parameters. Methods: Patients with JIA were recruited (November 2012–October 2014) and disease specific information was extracted from patients’ records. Oral examination included: dental findings (decayed-, missing- and filled-teeth-index (dmf-t/DMF-T)), gingival inflammation (papilla-bleeding-index (PBI)) and periodontal screening index (PSI). Functional examination followed Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD). Additionally, modified Helkimo’s Clinical Dysfunction Index and radiographic scoring were recorded. Results: 59 JIA patients were included. The mean dmf-t/DMF-T was 2.6. Only one patient showed no signs of gingival inflammation, while 57.6% had a maximum PSI of 2 or less. Positive functional findings were assessed clinically in more than half of the patients. Major diagnosis by RDC/TMD was osteoarthrosis. Patients with at least one positive anamnestic or clinical functional finding revealed significantly higher radiographic scores (CI = 0.440, p = 0.022). Patients with increased c-reactive-protein had a significantly higher PBI (Z = –2.118, p = 0.034) and increased radiographic scores (CI = 0.408, p = 0.043). Conclusions: Adolescents suffering from JIA show high levels of caries experience and gingival inflammation. Temporomandibular joint dysfunction is often seen in JIA patients. Consequently, special dental care programs would be recommendable.

No description available.