Objectives: 1) Evaluate the risk of atherosclerosis in rheumatic disease compared to healthy controls; 2) Assess the lipid profile of children with systemic lupus erythematosus (SLE) at presentation before treatment with corticosteroids; 3) Compare the lipid profiles of children with juvenile dermatomyositis (JDM), systemic juvenile idiopathic arthritis (SJIA), and SLE; 4) Evaluate the extent of early atherosclerosis in children with JDM, SJIA, and SLE; 5) Investigate the progression of early markers of atherosclerosis in children with SLE. Methods. The methods include a systematic review, a cross sectional study of serum lipid levels of a cohort of children with SLE, an analysis of the first time point of a prospective study of cardiovascular disease risk factors and vascular function measures of a cohort of children with JDM, and SJIA, and SLE and a longitudinal study of vascular function measures of a prospective study of a cohort of children with SLE. Results. Our systematic review demonstrated that carotid intima media thickness (CIMT), a surrogate marker of early atherosclerosis, was significantly increased in rheumatic disease populations. We found that newly diagnosed children with SLE before corticosteroid treatment exhibited a pattern of dyslipoproteinemia of increased triglycerides and depressed HDL-cholesterol. When we measured the lipid profiles in children with the rheumatic diseases of JDM, SJIA, and SLE, one third of children had at least one abnormal lipid value. The most common abnormalities were found for total cholesterol and triglyceride levels and most often in children with JDM. One quarter of all patients were found to have insulin resistance. Lastly, when we considered the effects of treatment in children with SLE, we found that improvement in CIMT was possible and it correlated with a higher cumulative dose of prednisone over the study period. Conclusions. Early markers of atherosclerosis in pediatric rheumatic disease are important for determining the risk of these children in developing heart disease as young adults. Chronic inflammation plays a significant role and should be considered an important predictor of premature atherosclerosis.

Objectives: 1) Evaluate the risk of atherosclerosis in rheumatic disease compared to healthy controls; 2) Assess the lipid profile of children with systemic lupus erythematosus (SLE) at presentation before treatment with corticosteroids; 3) Compare the lipid profiles of children with juvenile dermatomyositis (JDM), systemic juvenile idiopathic arthritis (SJIA), and SLE; 4) Evaluate the extent of early atherosclerosis in children with JDM, SJIA, and SLE; 5) Investigate the progression of early markers of atherosclerosis in children with SLE. Methods. The methods include a systematic review, a cross sectional study of serum lipid levels of a cohort of children with SLE, an analysis of the first time point of a prospective study of cardiovascular disease risk factors and vascular function measures of a cohort of children with JDM, and SJIA, and SLE and a longitudinal study of vascular function measures of a prospective study of a cohort of children with SLE. Results. Our systematic review demonstrated that carotid intima media thickness (CIMT), a surrogate marker of early atherosclerosis, was significantly increased in rheumatic disease populations. We found that newly diagnosed children with SLE before corticosteroid treatment exhibited a pattern of dyslipoproteinemia of increased triglycerides and depressed HDL-cholesterol. When we measured the lipid profiles in children with the rheumatic diseases of JDM, SJIA, and SLE, one third of children had at least one abnormal lipid value. The most common abnormalities were found for total cholesterol and triglyceride levels and most often in children with JDM. One quarter of all patients were found to have insulin resistance. Lastly, when we considered the effects of treatment in children with SLE, we found that improvement in CIMT was possible and it correlated with a higher cumulative dose of prednisone over the study period. Conclusions. Early markers of atherosclerosis in pediatric rheumatic disease are important for determining the risk of these children in developing heart disease as young adults. Chronic inflammation plays a significant role and should be considered an important predictor of premature atherosclerosis.

Atrial fibrillation is the most common sustained arrhythmia; however, its mechanism is not well understood. Several conditions such as valvular disease, heart failure, and hypertension predispose to atrial fibrillation. Identifying the electrophysiological substrate in these clinical conditions would yield insight into the mechanism of atrial fibrillation and aid in developing strategies to prevent or cure it. Rheumatic mitral stenosis is associated with high prevalence of atrial fibrillation. While atrial stretch itself may be adequate to explain the occurrence of atrial fibrillation in this population, it is not known if the disease process would remodel the atria so as to increase its propensity. Chapters 2 and 3 present the results of the studies evaluating the substrate for atrial fibrillation in both the left and right atria in rheumatic mitral stenosis. These studies have demonstrated extensive conduction abnormalities both regional and site specific associated with low voltage area and scar. Despite the prolonged atrial refractoriness, the propensity for atrial fibrillation was increased; lending support to the theory that structural remodelling associated with conduction abnormalities plays a greater role in the substrate predisposing to atrial fibrillation. Chapters 4 and 5 present the results of the studies evaluating the immediate effects of chronic atrial stretch reversal on the atrial electrical remodelling. These studies demonstrated that immediately after percutaneous mitral commissurotomy there was decrease in P wave duration, improvement in site specific conduction delay and conduction velocity associated with increase in the voltage. However, there was no change in atrial refractoriness. Chapter 6 studies the substrate long-term after reduction of stretch. There was further increase in conduction velocity and voltage associated with decrease in atrial refractoriness and conduction delay across the crista terminalis. These observations suggest that strategies aimed at reducing atrial stretch in different disease conditions would potentially decrease the burden or prevent atrial fibrillation. There is mounting evidence of the effect of stretch on the atria; however, the effect of stretch on the triggers of atrial fibrillation has not been evaluated before. Chapter 7 and 8 present the results of the study examining the effect of acute and chronic stretch on human pulmonary veins. Simultaneous pacing of the right ventricle and pulmonary vein induced acute stretch. The effect of chronic stretch was evaluated in patients with mitral stenosis. The atrial refractoriness was abbreviated in acute stretch while it was prolonged in the chronic form. Nevertheless, both resulted in marked pulmonary vein conduction abnormalities that were pronounced with chronic stretch and extra-stimuli. Additionally, structural remodelling was seen with chronic stretch. These abnormalities implicate stretch in the milieu for re-entry and pulmonary vein arrhythmogenesis in conditions predisposed to atrial fibrillation. In summary, this thesis has evaluated the effects of stretch on the substrate and triggers of atrial fibrillation. It provides evidence for the importance of structural changes and the associated abnormalities in conduction in predisposing to atrial fibrillation. These observations may be important in the development of tools to treat, cure and prevent atrial fibrillation. / Thesis (Ph.D.) -- University of Adelaide, School of Medicine, 2008

Orientador: Claudia Saad Magalhães / Banca: Nelson Itiro Miyague / Banca: José Roberto Fioretto / Resumo: Objetivo: Avaliar os índices de saúde e bem-estar físico e psico-social, por meio de questionários auto-aplicáveis, em pacientes com Febre Reumática (FR). Métodos: Os itens e escalas do Childhood Health Assessment Questionnaire (CHAQ) e Child Health Questionnaire (CHQ-PF-50) foram compilados em um estudo transversal, durante a fase ativa ou inativa da FR; comparados com valores normativos populacionais, e de acordo com o estado de atividade ou inatividade da doença. Resultados: Cento e sete questionários foram analisados. Dezessete casos foram avaliados durante a fase aguda, seja durante o primeiro surto ou recorrência, e 90 em inatividade. A média de idade e duração média de doença na avaliação foram de 14,4 l 3,9 e 0,7l1,7 anos para casos em atividade e 12, 5l 4,3 e 5,5l4,1 anos para casos em inatividade, respectivamente. Todos os domínios e o índice de incapacidade física do CHAQ, os índices Físico e o Psico-social do CHQ-PF-50, assim como as escalas de dor e bem-estar global, apresentaram diferença significante na pontuação quando comparados com a da população de referência. A comparação destes índices e escalas, entre os casos de FR em atividade e inatividade, também apresentou diferença significante, resultando em maior incapacidade e pior avaliação do estado de saúde, com exceção da escala de dor e do Indice Psicosocial. Conclusões: A FR tem impacto nos índices de saúde física e psico-social, comparados com a população saudável. As propriedades psicométricas de ambos os instrumentos, CHAQ e CHQ-PF50, foram consideradas adequadas revelando validade de face e discriminativa. / Abstract: Objetive: The purpose of this study was to assess self-reported measures of physical and psychosocial well-being in Rheumatic Fever patients (RF). Methods: The Childhood Health Assessment Questionnaire (CHAQ) and the Child Health Questionnaire (CHQ-PF-50) itens and scales were compiled in clinic for a cross sectional study, during RF active and inactive phases, and compared to population normative values, as well as according to disease activity status. Results: One hundred and seven questionnaires were analysed. Seventeen cases were assessed during active phase, either during the first attack or relapse, and 90 during inactive phase. Mean age and mean disease duration at completion was 14,4 l 3,9 and 0,7l1,7 years for active cases and 12, 5l 4,3 and 5,5+4,1 years for inactive cases, respectively. The CHAQ and CHQ domains scoring, CHAQ-Disability Index, CHQPhysical - Psychosocial scores, and both pain and overall well-being scales, presented significant difference in patients with rheumatic fever compared to population normative values. The active and inactive RF cases values were compared as well, resulting in worse function and health, during active phase compared to inactive, except for pain-VAS and CHQ- Psychosocial Scores. Conclusions: RF causes impact on physical and psychosocial health scoring compared to the general population. Both tools, CHAQ and CHQ-PF50 have shown good psychometric properties with proper face and discriminant validity. / Mestre

No description available.

Made available in DSpace on 2014-06-11T19:28:01Z (GMT). No. of bitstreams: 0 Previous issue date: 2007-02-01Bitstream added on 2014-06-13T18:32:27Z : No. of bitstreams: 1 bandeira_m_me_botfm.pdf: 879545 bytes, checksum: 26ce92fbb416c74cf983b2d5f3a4a09e (MD5) / Objetivo: Avaliar os índices de saúde e bem-estar físico e psico-social, por meio de questionários auto-aplicáveis, em pacientes com Febre Reumática (FR). Métodos: Os itens e escalas do Childhood Health Assessment Questionnaire (CHAQ) e Child Health Questionnaire (CHQ-PF-50) foram compilados em um estudo transversal, durante a fase ativa ou inativa da FR; comparados com valores normativos populacionais, e de acordo com o estado de atividade ou inatividade da doença. Resultados: Cento e sete questionários foram analisados. Dezessete casos foram avaliados durante a fase aguda, seja durante o primeiro surto ou recorrência, e 90 em inatividade. A média de idade e duração média de doença na avaliação foram de 14,4 l 3,9 e 0,7l1,7 anos para casos em atividade e 12, 5l 4,3 e 5,5l4,1 anos para casos em inatividade, respectivamente. Todos os domínios e o índice de incapacidade física do CHAQ, os índices Físico e o Psico-social do CHQ-PF-50, assim como as escalas de dor e bem-estar global, apresentaram diferença significante na pontuação quando comparados com a da população de referência. A comparação destes índices e escalas, entre os casos de FR em atividade e inatividade, também apresentou diferença significante, resultando em maior incapacidade e pior avaliação do estado de saúde, com exceção da escala de dor e do Indice Psicosocial. Conclusões: A FR tem impacto nos índices de saúde física e psico-social, comparados com a população saudável. As propriedades psicométricas de ambos os instrumentos, CHAQ e CHQ-PF50, foram consideradas adequadas revelando validade de face e discriminativa. / Objetive: The purpose of this study was to assess self-reported measures of physical and psychosocial well-being in Rheumatic Fever patients (RF). Methods: The Childhood Health Assessment Questionnaire (CHAQ) and the Child Health Questionnaire (CHQ-PF-50) itens and scales were compiled in clinic for a cross sectional study, during RF active and inactive phases, and compared to population normative values, as well as according to disease activity status. Results: One hundred and seven questionnaires were analysed. Seventeen cases were assessed during active phase, either during the first attack or relapse, and 90 during inactive phase. Mean age and mean disease duration at completion was 14,4 l 3,9 and 0,7l1,7 years for active cases and 12, 5l 4,3 and 5,5+4,1 years for inactive cases, respectively. The CHAQ and CHQ domains scoring, CHAQ-Disability Index, CHQPhysical - Psychosocial scores, and both pain and overall well-being scales, presented significant difference in patients with rheumatic fever compared to population normative values. The active and inactive RF cases values were compared as well, resulting in worse function and health, during active phase compared to inactive, except for pain-VAS and CHQ- Psychosocial Scores. Conclusions: RF causes impact on physical and psychosocial health scoring compared to the general population. Both tools, CHAQ and CHQ-PF50 have shown good psychometric properties with proper face and discriminant validity.

Orientador: Claudia Saad Magalhães / Banca: Sáskia Maria Wiegerinck Fekete / Banca: Maria Odete Esteves Hilário / Resumo: A febre reumática (FR) é uma doença pós-infecciosa, causada pelo Streptococus β hemolítico do Grupo A de Lancefield, de mecanismo auto-imune. As suas manifestações clínicas principais são denominadas sinais maiores, incluindo a artrite, cardite, coréia, nódulos subcutâneos e eritema marginado. Entre as manifestações denominadas sinais menores estão o aumento do intervalo P-R no eletrocardiograma, febre, provas de fase aguda positivas, como a VHS e a proteína C reativa. A comprovação de infecção recente pelo estreptococo é considerada um critério essencial. A FR é ainda prevalente nos países em desenvolvimento e emergentes, tendo como complicações crônica o dano valvular causado pela cardite. A sua prevenção é realizada com a erradicação do estreptococo na orofaringe, por meio da profilaxia primária com penicilina benzatina e a profilaxia secundária com a manutenção da penicilina benzatina em intervalos de 21 dias, de acordo com a recomendação da OMS. Como a FR pode apresentar seqüelas, impacto social e na qualidade de vida, justifica-se a avaliação do desfecho clínico e as suas manifestações em longo prazo. Examinar a epidemiologia, as características clínicas e o desfecho da FR em uma série de casos, nos últimos 20 anos em uma unidade acadêmica dedicada à reumatologia pediátrica (HC-FMB-UNESP). 178 casos foram identificados no período de 1986 a 2007 e destes, 134 foram revisados de acordo com um protocolo listando as manifestações clínicas e laboratoriais, o uso de medicação, o período de acompanhamento e os episódios de recorrência durante o seguimento para vigilância da profilaxia secundária. Os dados demográficos, assim como as manifestações clínicas, laboratoriais e de desfecho são apresentados por meio de freqüência para os dados categóricos e pela estatística descritiva para variáveis contínuas. A probabilidade... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: Rheumatic Fever (RF) is a post-infectious disease caused by group A Streptococcus, with autoimmune mechanism. The main clinical features are named major signs as arthritis, carditis, chorea, subcutaneous nodules and erythema marginatum. Among other features, there are the minor signs as increased P-R interval on electrocardiogram (ECG), fever and acute phase reaction measured by erythrocyte sedimentation rate (ESR) or C-reactive protein (CRP). Evidence of previous streptococcal infection is considered a core criteria. RF is highly prevalent in developing countries, where the main complication is damaged heart valves due to carditis. Prophylaxis is called primary when long-acting benzyl penicilin is administered for the first time after diagnosis and it is called secondary prophylaxis for maintenance treatment with long-acting benzyl penicilin every 3 weeks, according to the WHO guidelines. As RF may result in heart damage with both quality of life and social impact, it is valuable to assess its long term outcome. To examine epidemiology , clinical features and outcome of RF in a paediatric case series, seen in an academic unit dedicated to paediatric rheumatology (HC-FMB-UNESP) during the last 20 years. 178 cases were identified from 1986 to 2007, of those 134 were fully revised according to a standardized protocol checking for clinical and laboratorial features, treatment, follow up and acute RF relapse during follow up for prophylaxis surveillance. Demographics, clinical and laboratorial features as well as outcome data are reported by frequency for categorical variables. Continuous variables are presented by descriptive statistics. The probability of carditis, valve damage and RF relapses were examined by survival analysis with actuarial survival plots. Of 134 revised cases, age at onset was from 4 to 13.8 years, follow up duration was from 1.1 to 16.9 years mean 6.8 SD (3.6) and median... (Complete abstract click electronic access below) / Mestre

Orientador: Orlando Petrucci Junior / Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-18T18:24:11Z (GMT). No. of bitstreams: 1 Severino_ElaineSorayaBarbosadeOliveira_D.pdf: 8406293 bytes, checksum: bc2a25ec83eb02498875fd5f899eb087 (MD5) Previous issue date: 2011 / Resumo: Introdução: A doença cardíaca reumática é a principal causa de doença valvar mitral no Brasil. A superioridade da plastia mitral na regurgitação mitral de etiologia degenerativa já tem sido demonstrada por vários estudos, mas ainda há poucos avaliando os resultados da plastia mitral na doença reumática. Objetivo: O objetivo foi avaliar fatores preditivos de risco para reoperação e mortalidade tardia em população de pacientes reumáticos submetidos à plastia da valva mitral. Material e Método: Este é um estudo retrospectivo. Variáveis clínicas, ecocardiográficas e técnicas cirúrgicas foram anotadas. Foram avaliados apenas pacientes submetidos a reparo da valva mitral exclusivamente, ou em conjunto com plastia da valva tricuspide. Para a análise de reoperação e sobrevida foram utilizadas curvas de Kaplan-Meier. Para a análise univariada das variáveis contínuas foi utilizado o teste t de Student ou Mann-Whitney dependendo do tipo de distribuição da amostra. Para as variáveis discretas foi utilizado o teste do Qui-quadrado. Resultados: Um total de 116 pacientes foram incluídos. O tempo de seguimento médio foi de 58,02 ± 45,33 meses. A idade média dos pacientes foi de 31,19 ± 12,72 anos. No pré-operatório 54,8% dos pacientes estavam em classe funcional I, 24,7% em classe II, 17,2% III e 3,2% em classe funcional IV. Não houve reoperação por sangramento na primeira cirurgia. A taxa de reoperação tardia foi de 12,9% (15 pacientes). A mortalidade cardíaca foi de 5,2% e a geral de 7,8% durante o seguimento tardio. A hipertensão pulmonar no pós-operatório esteve associada ao óbito (P<0,01). Na análise univariada os fatores preditivos de reoperação no pré-operatório foram: medida do átrio esquerdo (P=0,03) e o diâmetro diastólico do ventrículo esquerdo (P=0,01). Durante o seguimento os fatores preditivos de reoperação foram: medida do átrio esquerdo (P<0,01), diâmetro diastólico do ventrículo esquerdo (P<0,01) e a pressão sistólica da artéria pulmonar (P=0,02). Na análise de Kaplan-Meier a variável pré-operatório preditiva de reoperação foi o diâmetro diastólico do ventrículo esquerdo (P=0,01). No seguimento as variáveis preditivas de reoperação foram: a presença de hipertensão pulmonar (P=0,02), presença de insuficiência cardíaca (P<0,01) e a insuficiência mitral (P<0,01). Quanto às técnicas de plastia utilizadas a anuloplastia mitral exclusiva e a anuloplastia tricuspide mostraram maior ocorrência de reoperação (P<0,01 para ambas). A ocorrência de reoperação não esteve associada a menor probabilidade de sobrevida. Conclusão: Os pacientes submetidos a reparo da valva mitral tem fatores preditivos de reoperação no pré e no pós-operatório. Estes pacientes devem ser seguidos de forma mais cautelosa. O reparo da valva mitral e seguro em pacientes reumáticos e com boa sobrevida a longo prazo / Abstract: Introduction: Rheumatic heart valve disease is the most frequent cause of mitral valve disease in Brazil. The advantage of mitral valve repair over mitral valve replacement in degenerative mitral regurgitation has already been demonstrated by several studies, but there are few studies evaluating the early and late outcomes of in rheumatic mitral valve repair . Objective: Our aim was to assess predictive risk factors for mitral reoperation and late mortality in a population of rheumatic patients who underwent mitral valve repair. Methods: This is a retrospective study. Clinical, echocardiographic and surgical techniques were noted. For the analysis of reoperation and survival rates were used Kaplan-Meier curve. For the univariate analysis of continuous variables the Student t test or Mann-Whitney test were used where appropriated. For discrete variables the chisquare test was used. Results: One hundred and sixteen patients were included. The average follow-up was 58.02 ± 45.33 months. The mean age was 31.19 ± 12.72 years. At the preoperative time 54.8% of patients were in functional class I, 24.7% in class II, 17.2% class III, and 3.2% in class IV. There were no reoperations due to bleeding in the early postoperative time. The reoperation rate was 12.9% (15 patients) due to mitral valve degeneration after initial repair within the late follow-up. Cardiac mortality was 5.2% and all causes of death was 7.8% during the same period. The presence of pulmonary hypertension at the late follow-up was associated with death (P<0,01). In the univariate analysis, the risk factors for reoperation in the preoperative time were: left atrium dimension (P = 0.03) and left ventricular end diastolic diameter (P = 0.01). During the late follow-up period, predictive factors for reoperation were: left atrium dimension (P <0.01), left ventricular diastolic diameter (P <0.01) and pulmonary artery systolic pressure (P = 0.02). Kaplan-Meier curve analysis showed the left ventricular diastolic diameter (P = 0.01) associated with reoperation. During the late follow-up, the predictors for reoperation were: the presence of pulmonary hypertension (P = 0.02), congestive heart failure (P <0.01) and mitral regurgitation (P <0.01). Analyzing the techniques used in the initial mitral valve repair annuloplasty exclusively and tricuspid annuloplasty showed a higher incidence of reoperation (P <0.01 in both situations). The reoperation event did not decrease the probability of survival within the follow up period. Conclusion: There are predictors of reoperation in the pre- and postoperative time in patients who underwent rheumatic mitral valve repair. These patients should be followed more cautiously. The rheumatic mitral valve repair is safe and shows good long-term survival / Doutorado / Fisiopatologia Cirúrgica / Doutor em Ciências

Bakgrund: Reumatoid artrit och ankyloserande spondylit är reumatiska sjukdomar där smärta, stelhet och trötthet är vanliga symptom. Detta kan ge funktionsnedsättningar och påverka livskvalitén negativt hos de drabbade som ofta blir inaktiva, trots att forskning visar att fysisk aktivitet kan lindra funktionshinder orsakade av sjukdomen. Dock finns begränsat med forskning på vilken effekt en period med högfrekvent varierad träning kan ha på diagnosspecifika problem och funktionsnedsättningar hos patienter med reumatiska sjukdomar. Metod: Studien är en interventionsstudie av kvantitativ karaktär. Interventionen bestod av varierad gruppträning 3–4 pass/dag, 5 dagar/vecka i 4 veckor. Datainsamlingsmetoderna som använts i studien är generell upplevd smärta skattad med visuell analog skala (VAS), benstyrka mätt med timed stands test (TST), nackrotation mätt med myrinmätare, greppstyrka mätt med JAMAR och funktionell arbetskapacitet mätt med sex minuters gångtest (6MWT). Testerna utfördes innan och efter interventionen. För VAS redovisas medianvärde, för övriga tester redovisas medelvärde. Resultat: 232 patienter deltog i studien. På samtliga parametrar visades en signifikant förbättring. VAS förbättrades med 2,8, TST med 5,99 sekunder, JAMAR höger med 4,65 kg/vänster med 4,06 kg, 6MWT med 102,58 meter och nackrotation med 20,55°. Konklusion: Studiens deltagare visade en förbättring avseende samtliga parametrar. Mer forskning krävs för att påvisa om något specifikt träningsupplägg har bäst effekt på nämnda parametrar hos personer med reumatisk sjukdom, samt för att utvärdera effekten av kontextuella faktorer. / Background: Rheumatoid arthritis and ankylosing spondylitis are rheumatic diseases with common symptoms as pain, stiffness and fatigue. This can lead to disabilities and have a negative effect on the quality of life. Those affected often become inactive, despite research showing that physical activity can alleviate disabilities caused by the disease. However, there is limited research on what effect a period of high-frequency varied training can have on diagnosis-specific problems and disabilities in patients with rheumatic diseases. Method: This is a quantitative intervention study. The intervention consisted of varied group training 3-4 sessions/day, 5 days/week for 4 weeks. Methods used for collecting data in the study are generally perceived pain estimated with visual analog scale (VAS), leg strength measured with timed stands test (TST), neck rotation measured with myrin goniometer, grip strength measured with JAMAR and functional work capacity measured with six-minute walking test (6MWT). The tests were performed pre- and postintervention. For VAS, median value is reported, for all other tests, mean value is reported. Result: 232 patients participated in the study. A significant improvement was shown on all parameters. VAS improved by 2.8, TST by 5.99 seconds, JAMAR right by 4.65 kg/left by 4.06 kg, 6MWT by 102.58 meters and neck rotation by 20.55°. Conclusion: The participants of this study showed an improvement regarding all parameters. More research is needed to show whether any specific training program has the best effect on the mentioned parameters in people with rheumatic disease, and to evaluate the effect of contextual factors.

Bakgrund: Reumatiska sjukdomar är en vanlig orsak till inaktivitet hos de drabbade, även om fysisk aktivitet och träning enligt flertalet studier påvisats ha positiva effekter för sjukdomsbilden. Fysioterapeuter arbetar mycket med att motivera dessa patienter till beteendeförändring men deras roll i arbetet med motivation är mindre utforskat.  Syfte: Att undersöka fysioterapeuters upplevelser och erfarenheter av att motivera beteendeförändring i form av träning hos patienter med reumatiska sjukdomar.  Metod: En kvalitativ intervjustudie med ett strategiskt urval av fysioterapeuter och sjukgymnaster verksamma inom öppenvården med fokus på reumatologmottagningar. Datamaterialet analyserades enligt kvalitativ innehållsanalys med induktiv ansats. Resultat: Analysen av intervjuerna resulterade i 5 kategorier och 8 underkategorier. Kategorierna var; Tillvägagångssätt för att främja beteendeförändring, Motivationens roll i beteendeförändring, Vidmakthållande av träning, Organisatoriska faktorer och Individuella faktorer   Slutsats: Fysioterapeuterna använder ett individanpassat arbetssätt där man främjar självständighet för att kunna motivera patienter med reumatiska sjukdomar till att träna. De hinder fysioterapeuter upplever som försvårande i sitt arbete med patientgruppen är framförallt smärta och fatigue vid reumatism. Gruppverksamhet är ett viktigt verktyg för att underlätta träning för både fysioterapeuterna och patienterna. / Background: Rheumatic diseases are a common cause behind/to inactivity in afflicted individuals, despite physical activity and exercise having proven positive effects to disease profile, according to several studies. Physiotherapists work a great deal with motivating these patients to behavioural change but their role in motivational work is less explored. Aim: To explore physiotherapists experiences of motivating behavioural change by way of training in patients with rheumatic diseases.  Method: A qualitative descriptive interview study with an strategic selection of physiotherapists working in outpatient departments with focus on rheumatology outpatient clinics. The collected data was analyzed according to a qualitative content analysis with an inductive approach. Result: Analysis of the interviews resulted in 5 categories and 8 subcategories. The categories were; Approaches to promote behaviour change, The role of motivation in behaviour change, Maintenance of exercise, Organizational factors and Individual factors. Conclusion: Physiotherapists should adhere to an individualized approach to work in which they promote independence, in order to motivate patients with rheumatic diseases to exercise. The barriers physiotherapists experience as a hindrance to their work with the patient group is foremost pain and fatigue associated with rheumatism. This serves as a hindrance to physiotherapists with getting patients to start and adhere to an exercise behaviour.