The editors of Arthritis Today magazine were on the scene, collecting news and information to share with readers from the American College of Rheumatology’s (ACR) Annual Meeting, November 9-13, in Atlanta. Here are a few of the many interesting and enlightening research topics they learned about.
Anti-inflammatory Diet Improves Disease
There has long been uncertainty whether diet influences disease activity in inflammatory arthritis. Two studies presented some evidence that it does. In one study, 17 patients with active rheumatoid arthritis (RA), defined as at least three tender and three swollen joints, followed an anti-inflammatory diet for two weeks. Blood tests before, during and after measured oxylipins, molecules involved in inflammation, pain and other cellular functions. The diet added turmeric, antioxidants, prebiotics and probiotics. It eliminated pro-inflammatory items, such as lactose (found in diary), gluten and red meat, and improved the ratio of omega-3 to omega-6 fatty acids. The subjects were found to have good diet adherence. After 14 days, a range of disease measures were significantly lower, and tests showed correlation with changes in blood levels of the oxylipins. The authors concluded that diet has the potential to complement medication and improve quality of life for patients with RA. –MARCY O’KOON
Depression and Resilience
Inflammation has been shown to have a role in depression, but does that make depression an inflammatory disorder? No, emphasized Andrew Miller, MD, a researcher in Emory School of Medicine’s psychiatry department. Depression may be associated with the inflammation that’s at the heart of inflammatory diseases like rheumatic and psoriatic arthritis and lupus, but it’s not associated in otherwise healthy people with depression. (Biologics that have been used to target inflammation in depression have had no effect.)
In the same session, “Mechanisms & Mediators of Psychiatric Comorbidity in Rheumatology,” Afton Hassett, a psychologist and researcher in the University of Michigan’s Chronic Fatigue and Pain Research Center, explored the role of resilience in people with arthritis and pain. People with rheumatic diseases tend to have a more negative outlook than “healthy” people do, but positive emotions – which are key to resilience – are associated with less pain, less need for medications, earlier discharge from the hospital and other positive outcomes. The good news is that resilience can be learned. Hassett described some exercises, including these three: 1) Pick a future point, such as one or five years from now, and imagine being your best self, living to your full potential, then write about it in detail. 2) Every day write down three things for which you are grateful; as time goes on, you’ll become aware of even smaller things to appreciate. 3) Pick a day this week and do five kind things for others and one kind thing for yourself. – JILL TYRER
Patient Partner Perspective: Stacy Courtnay attended this session on pain, depression and anxiety and said it really resonated with her.
“The more connections you have with people living in a similar situation as you, the better mental and emotional health you will have. Support groups are the key to managing your overall well-being.” – Stacy Courtnay
Stacy says “we need the support of each other” and being involved in the Arthritis Foundation has really helped her to make these connections since it is a big part of the mission. The Live Yes! Arthritis Network has played a huge role in helping her to get connected with people who understand her struggles.
The Problem of Sleeplessness
It’s no surprise to people with arthritis that pain interferes with sleep; research shows that the more significant correlation is that sleeplessness exacerbates pain. Anna Kratz, PhD, of the University of Michigan, and Daniel Whibley, PhD, of the University of Aberdeen in the U.K., discussed effects of poor sleep on people with arthritis and treatments in a session called “No More Counting Sheep: Evidence-Based Sleep Management.” (In fact, Whibley said, it takes 20 minutes longer to fall asleep by counting sheep than by using relaxing visualization.) He discussed the role of the circadian rhythm in different people’s sleeping patterns (“morning larks” vs. “night owls”) and the architecture of a night’s sleep (it’s normal to wake up a couple of times during the night). And he said people with rheumatic diseases typically have poor “sleep efficiency” – they spend more time lying awake relative to sleeping than other people do. Sleep deprivation leads to mental impairments as well as pain and fatigue, and people with sleep problems should be screened for the cause, such as obstructive sleep apnea or chronic insomnia – both of which are common among people with arthritis – or side effects of opioids or other medications.
Good sleep hygiene (getting regular exercise; keeping a dark, quiet bedroom; keeping a regular sleeping schedule; shutting off blue-light electronics, etc.) helps many people, but people with rheumatic disease may need more help. The American Academy of Sleep Medicine discourages the use of sleep medications and recommends cognitive behavioral therapy for insomnia (CBTi) as a first-line treatment. In the U.S., however, it’s hard to find people qualified to practice CBTi. (Whibley and Kratz suggested rheumatology practices have someone trained in CBTi.) “The most important thing is to be regular in your sleep-waking patterns, and that includes weekends,” Whibley said. If you don’t sleep well, seek help. “Don’t assume that poor sleep in part of the condition.” –JILL TYRER
Patient Partner Perspective: Cheryl Crow attended this session on sleep, which she stated was a very informative and engaging session. She was surprised by some of the information she learned when it comes to sleep and the rheumatic disease population. Cheryl said having a patient on this sleep panel sharing her story was powerful to witness as a patient herself.
“Insomnia and obstructive sleep apneas are much more common in the rheumatic disease population than in the average person, and that 37-50% have some sort of disorder. I had no idea. Makes me want to get assessed.” – Cheryl Crow
She was moved to see that so many rheumatology professionals were in the room asking questions to get the patient perspective, demonstrating that patient engagement is crucial in providing better patient care.
Standard PRO Measures Miss Younger Patients
Patient-reported outcome measures (PROMs) are routinely used by doctors as well as in research, but Erika Mosor, a researcher at the Medical University of Vienna, Austria, found that the standard measures may not get a true view of younger patients. In her session, “When You Read This, You Really Feel Old: Perspectives of Young People with Inflammatory Arthritis on Patient Reported Outcome Measures from a European Qualitative Study,” she reported that patients aged 18 to 35 said the PROMs of daily functioning and other issues “seem like they’re for old people.” They don’t address technology, childcare, social life, sex, loss of friends and other issues relevant to younger patients. Because their concerns are overlooked, results may be skewed so these patients appear to be doing better than they are; some patients said they considered marking worse scores just to get their concerns recognized. PROMs should be more tailored to patients so they can be used more effectively in shared decision-making, Mosor said. – JILL TYRER