京都大学 / 0048 / 新制・論文博士 / 博士(医学) / 乙第13195号 / 論医博第2159号 / 新制||医||1030(附属図書館) / (主査)教授 松田 秀一, 教授 三森 経世, 教授 妻木 範行 / 学位規則第4条第2項該当 / Doctor of Medical Science / Kyoto University / DFAM

ABSTRACT: THE EFFECT OF A COMPREHENSIVE OCCUPATIONAL THERAPY INTERVENTION PROGRAMME ON THE OCCUPATIONAL PERFORMANCE OF PEOPLE WITH RHEUMATOID ARTHRITIS, LIVING IN SOWETO. C Dreijer du Plessis Post-graduate student, University of the Witwatersrand, Johannesburg, South Africa Introduction: Rheumatoid Arthritis (RA) is a chronic disabling joint disease. Empowering patients with RA to self manage the disease can lead to changes in behaviour, pain or physical health and psychosocial health status. Limited evidence exists for the efficacy of comprehensive Occupational Therapy (OT) intervention for patients with RA in improving functional ability. Objective: The primary objective of the study was to evaluate the impact of comprehensive OT intervention on patients with RA in producing a sustained improvement in patients' functional ability. Methods: A prospective randomized control study over 4 months in which patients with moderately disabling RA, following a week of in-patient rehabilitation care, received either home visits and focus group care (group 1) or standard care (group 2). Primary outcome measures included the modified Health Assessment Questionnaire Disability Index (HAQ-DI), Disease activity score (DAS28) and SF- 36 scores. Results: There were 29 and 22 patients in each group, respectively. The HAQ-DI improved significantly in both groups following the 1 week in-patient care (p<0.05) and there was a clinically significant difference between the groups at the 4 months follow-up visit. The SF-36 scores did not change significantly for group 1 while group 2 showed significant improvements in 5 of the 8 domains at four months. However, group 2, had significantly worse SF-36 scores at baseline compared to group 1. There was a significant improvement in disease activity with the experimental group having 25% fewer tender joints. During the focus groups,the two main themes of "behavior and self management" and "problems that interfere with occupational performance" emerged. Conclusion: A comprehensive in-patient occupational therapy programme does lead to sustained significant improvement in functional ability and Health related quality of life (HR-QOL). Focus groups and home based intervention appears to have a clinically significant impact on disease activity. Key words: Rheumatoid Arthritis, Comprehensive Occupational Therapy intervention, Home based intervention, Occupational Performance.

京都大学 / 新制・課程博士 / 博士(医学) / 甲第24128号 / 医博第4868号 / 新制||医||1059(附属図書館) / 京都大学大学院医学研究科医学専攻 / (主査)教授 松田 秀一, 教授 杉田 昌彦, 教授 金子 新 / 学位規則第4条第1項該当 / Doctor of Medical Science / Kyoto University / DFAM

Introduction: Patient education is an important part of the management of rheumatic and musculoskeletal diseases. Given that patients with diverse diseases do not have the same needs, it is crucial to assess the educational requirements of targeted groups to provide tailored educational interventions. The aim of our study was to assess educational needs of a large cohort of patients with different rheumatic and musculoskeletal diseases attending a health facility in Austria. Methods: We assessed educational needs, via an online survey of patients with fibromyalgia (FMS), rheumatoid arthritis (RA), and ankylosing spondylitis (AS) recruited from an Austrian health-care facility, using the Austrian version of the Educational Needs Assessment Tool (OENAT). Results: For our sample of 603 patients, AS (62%), RA (15%), and FMS (24%), there were no educational need differences for the domains of movements, disease process, and self-help measures. Patients with FMS had less need for pain management education and greater need for education about feelings, than other disease groups. Patients with RA had a greater need for education related to treatments than other groups, and patients with AS had a greater need for treatment education than patients with FMS. Patients with AS reported greater need for support system education than other patient groups. Conclusion: Educational needs vary by disease groups, suggesting that health-care professionals should assess disease-specific needs for education to provide optimal assistance in disease management for patients.

Abstarct Analysis of the Therapy in Patients with Juvenile Idiopathic Arthritis Author: Martina Procházková Tutor: PharmDr. Josef Malý, Ph.D. Department of Social and Clinical Pharmacy, Faculty of Pharmacy in Hradec Králové, Charles University Introduction and aims: Methotrexate (MTX) is an effective and safe drug used for the treatment of juvenile idiopathic arthritis (JIA) and is well-known like a golden standart in the treatment of this serious illness. The aim of this study was analysis of therapy in patients with JIA focusing on MTX and faktors affecting its intolerance. Methods: The study was undertaken from January 2017 to February 2018 at the Department of Paediatrics and Adolescent Medicine, 1st Faculty of Medicine, Charles University in Prague. Patients younger than 18 years old, who have become ill with JIA for the first time or repeatedly between years 2015-2017 and were treated by MTX were included in this study. The prevalence of MTX intolerance was measured by "Methotrexate Intolerance Severity Score" questionaire every 3 months during regular rheumatological examinations. Simultaneously, medical records were reviewed. Data analysis was performed by means of descriptive statistics, correlation dependence and statistical signifikance of dependence was assessed with statistical two-choice...

京都大学 / 新制・論文博士 / 博士(人間健康科学) / 乙第13504号 / 論人健博第11号 / 新制||人健||7(附属図書館) / 京都大学大学院医学研究科人間健康科学系専攻 / (主査)教授 田村 恵子, 教授 若村 智子, 教授 森信 暁雄 / 学位規則第4条第2項該当 / Doctor of Human Health Sciences / Kyoto University / DFAM

In this longitudinal pilot study, magnetic resonance imaging (MRI) and Early Erosions in Rheumatoid Arthritis (EERA) software were used to quantify bone erosive damage in the metacarpophalangeal (MCP) 2-5 joints of the worst-affected hand (i.e. greatest swelling and tenderness at baseline) of patients with rheumatoid arthritis (n=35). Firstly, Spearman’s rho (rs) was used to evaluate the correlation between total change in sum erosive damage and change in functional ability, as well as the correlation between rate of change in sum erosive damage and change in functional ability. The rs (p-value) for total change and rate of change in sum erosive damage was 0.099 (0.585) and 0.104 (0.565), respectively. Therefore, the null hypothesis that neither variable was associated with change in functional ability could not be rejected. Participants were also classified into three groups based on total change in sum erosive damage (improvement, stable or progression) and were examined for possible differences in a variety of measures using an exploratory, non-statistical approach. Most notably, participants in the improvement group had more than five times the mean sum erosive damage at baseline compared to the progression group and also appeared to be the least aggresively medicated of the three cohorts. This study is the first to apply EERA in a way that helps to address clinically important questions related to change in erosive damage and functional ability. Future studies should use the ideas and concepts generated in this pilot study to further explore the use of this highly reproducible erosion quantification software, with the ultimate goal of expanding the applications of EERA in both the research and clinical settings. / Thesis / Master of Science (MSc) / In this study, the hands of patients with rheumatoid arthritis (RA) were assessed using magnetic resonance imaging (MRI) to investigate how erosive damage to the bone changes over time. Specialized computer software entitled Early Erosions in Rheumatoid Arthritis (EERA) was used to perform this analysis. Firstly, change in erosive damage was not found to be related to change in functional ability (e.g. eating, grip, etc.). Secondly, it appeared that individuals who demonstrated improvement in bone damage over time had significant damage at the beginning of the study period. Overall, this study provides new information for researchers and clinicians in terms of how this unique software can be used to enhance our understanding of RA. Future studies will continue to explore ways in which this software can be applied to address questions that are important to RA patients.

Bakgrund: Reumatoid artrit är en obotlig sjukdom som påverkar kroppens leder. Diagnostiserade patienter kommer att handskas med bland annat smärtor, trötthet och stelhet som försvårar deras liv. Som sjuksköterska ansvarar man för patienters omvårdnad och främjar deras hälsa. Syfte: Syftet var att beskriva vuxna patienters upplevelser av att leva med reumatoid artrit. Metod: En litteraturöversikt med nio kvalitativa artiklar och en artikel med mixad metod av kvalitativ och kvantitativ. Sökningen gjordes på CINAHL Complete och PubMed. Resultat: I resultatet framträdde tre huvudteman; Patienters vardag med reumatoid artrit, Den psykiska påfrestningen av reumatoid artrit och Strategier för att hantera reumatoid artrit. Resultatet visar att reumatoid artrit påverkar patienters liv utifrån flera aspekter med smärta i fokus. Det framkom även vikten av vårdpersonalens förståelse och stöd för patienterna. Sammanfattning: Smärta är en stor faktor för patienters försämrade livskvalité. Medan stöd från omgivning påverkar patienters välbefinnande positivt. Vad för hjälp som patienterna behöver kan skilja mycket. Därför skall sjuksköterskans möte med patienter utgå utifrån personcentrerad vård. / Background: Rheumatoid arthritis is an incurable disease that affects the body’s joints. Diagnosed patients will deal with pains, fatigue and stiffness that will affect their lives. It is the registered nurse’s responsibility to take care of the patients and promote their health.  Aim: The aim was to describe adult patients experiences of living with rheumatoid arthritis. Method: A literature review was done with ten qualitative articles and one article with mixed method qualitative and quantitative. The article search was done on CINAHL Complete and PubMed. Results: In the results, three main themes appeared; Patients everyday life with rheumatoid arthritis, The physiological impact of rheumatoid arthritis and Different strategies to deal with rheumatoid arthritis. The results show that rheumatoid arthritis affects patients’ lives in many aspects with mainly pain in focus. It was also noted the importance of health care workers understanding and support for the patients.  Summary: Pain is a big factor for patient’s decreased life quality. While support from their surroundings affect patients’ wellbeing positively. The type of help the patients need varies. That is why the registered nurse should proceed every meeting according to person centered care.

Background: The aim of this cross-sectional study was to investigate potential associations between periodontal inflamed surface area (PISA) and tooth loss with disease-related parameters in patients with rheumatoid arthritis (RA) and ankylosing spondylitis (AS). Methods: Patients who attended the Department of Nephrology and Rheumatology, University Medical Centre Goettingen, Germany, were included. The oral examination comprised the detection of the number of remaining teeth and periodontal condition based on staging and grading matrix. Based on periodontal pockets with positive bleeding on probing, the periodontal inflamed surface area (PISA) was determined. Disease related parameters were extracted from the patients’ records. Results: In total, 101 (RA) and 32 participants (AS) were included. Patients with RA had 22.85 ± 4.26 and AS patients 24.34 ± 5.47 remaining teeth (p < 0.01). Periodontitis stage III and IV was present in 91% (RA) and 81.2% (AS) of patients (p = 0.04). Associations between PISA and disease-related parameters were not found in both groups (p > 0.05). In RA, a higher age (p < 0.01), C-reactive protein (p = 0.02), disease activity (p < 0.01) and prednisolone intake (p < 0.01) were associated with fewer remaining teeth. In AS, a higher age (p = 0.02) and increased Bath Ankylosing Spondylitis Metrology Index (p = 0.02) were associated with a lower number of remaining teeth. Conclusions: Tooth loss is associated with disease activity, especially in RA individuals. Dental care to prevent tooth loss might be recommendable to positively influence oral health condition and disease activity in RA and SA patients.

Background Rheumatoid arthritis, or rheumatoid joint inflammation, is the most common inflammatory joint disease, affecting 0.5–1.0 percent of the Western population. The disease develops gradually over several weeks to months, with symmetric inflammation in the hands and feet. Those affected are at risk of premature death. Aim The aim was to describe patients' experiences of living with rheumatoid arthritis. Method This literature review includes eleven original studies with the aim of describing the current state of knowledge in current research. The two electronic research databases, Cinahl Complete and PubMed, were used to gather information on rheumatoid arthritis. Findings were then thematized using Friberg's four-step model. Results The analysis resulted in four themes: Experiences of living with pain and fatigue; Experiences of a lack of social life; Support from family and healthcare; and Strategies for managing rheumatoid arthritis. The disease has a negative impact on participants' lives in several aspects, including physical, psychological, social, and economic. Summary Nurses need knowledge of how patients with rheumatoid arthritis experience living with the disease to assist them in managing their daily lives, provide information about the disease, and motivate lifestyle changes. / Bakgrund Reumatoid artrit eller ledgångsreumatism är den vanligaste av de inflammatoriska ledsjukdomar som drabbar 0,5–1,0 procent av den västerländska befolkningen. Sjukdomen utvecklas smygande från flera veckor till månader med symmetrisk inflammation i händerna och fötterna. De drabbade riskerar att dö i förtid. Syfte Syftet var att beskriva patienters upplevelser av att leva med Reumatoid artrit. Metod I denna litteraturöversikt ingår elva originalstudier med målet att beskriva kunskapsläget inom aktuell forskning. De två elektroniska forskningsdatabaserna Cinahl Complete och PubMed användes för att samla in information om Reumatoid artrit. Sedan tematiserades fynd med hjälp av Fribergs fyrstegsmodell.  Resultat Analysen resulterade i fyra teman: Upplevelser av att leva med smärta och trötthet; Upplevelser av brist på socialt liv, Stöd från familj och vården och Strategier att hantera Reumatoid artrit. Sjukdomen har en negativ inverkan på deltagarnas liv i flera aspekter både fysiskt, psykiskt, socialt och ekonomiskt.  Sammanfattning Sjuksköterskor behöver kunskap om hur patienter med RA upplever att leva med sjukdomen för att kunna hjälpa patienterna att hantera sin vardag, förmedla information om sjukdomen och motivera till livsstilsförändringar.