Objective: To study factors associated with health-enhancing physical activity in people with rheumatoid arthritis (RA), stratified by physical function.

Method: In 2017, a survey was sent to 1543 patients with RA in the BARFOT (Better Anti-Rheumatic Pharmacotherapy) cohort, and 69% of patients responded. The survey included questions on physical function, pain, fatigue, self-reported disease activity, physical activity level, health-related quality of life, empowerment, comorbidities, and antirheumatic treatment. The patients were stratified based on physical function according to the Health Assessment Questionnaire (median value as cut off) into groups with worse vs. better physical function and further dichotomized to whether or not they met the World Health Organisation recommended level of health-enhancing physical activity (≥ 150 min/week). The Mann-Whitney U test or chi-squared test was used to analyse group differences. A logistic regression model adjusted for age and sex was used to study factors associated with health-enhancing physical activity.

Results: In total, 1047 patients had available data on physical function, mean age 67 years (SD 13), 72% women. Younger age, non-obesity, less pain, less fatigue, and lower disease activity were associated with health-enhancing physical activity, irrespective of physical function level. In the group with worse physical function, better health-related quality of life and empowerment were also associated with health-enhancing physical activity.

Conclusion: The results indicate a complex relationship between various factors that can affect the level of physical activity in individuals with RA. Strengthening empowerment could be a key when supporting improvement in physical activity in patients with RA with impaired physical function. Key Points • The importance of empowerment in managing rheumatoid arthritis. • The role of physical activity in improving physical function. • Strategies for integrating physical activity into daily life for those with rheumatoid arthritis.

© 2025. The Author(s).

Background incl. Aims: Patients newly diagnosed with rheumatoid arthritis (RA) require frequent visits to a rheumatology specialist clinic for swift and targeted pharmacological treatment (Citation1). Genuine person-centred care, as recommended by national and international guidelines and the Swedish national integrated care pathways (Citation2, Citation3), emphasizes holistic treatment. To facilitate early and holistic care for patients with early RA, a tight-control and treat-to-target clinic (Tight control and Intervention in Newly Diagnosed RA; TINDRA) was introduced in 2021 at the department of Rheumatology at Skåne University Hospital in Lund, Sweden. To gain a deeper understanding of patients’ experiences of participating in a very tight control early RA clinic (TINDRA), a qualitative interview study was conducted.

Aim: To explore how patients experienced care in a very tight control early RA clinic

Methods: This study adopted an exploratory qualitative design with an inductive approach. TINDRA was designed for very tight control with high continuity over 24 months, including regular follow-ups every three months with a rheumatologist and interim visits with a rheumatology nurse. Other healthcare professionals (occupational therapists, physiotherapists, and social workers) meet with patients 8–12 weeks after diagnosis. Nurse-led follow-ups alternate between phone and in-person consultations every other week for the first three months, then occur monthly or as needed during the first years. These follow-ups are conducted in close collaboration with the rheumatologist, aiming for remission. The initial focus of follow-ups is on treatment response, understanding and managing the chronic disease, and thereafter gradually shifts towards facilitating increased self-management and empowerment.

Individual interviews were conducted with 13 patients diagnosed with early RA (11 women, 2 men, median age 59 years (range 22-77 years) after 12 months of treatment at the very tight control early RA clinic (TINDRA), between April and November 2024. The interviews were analyzed using qualitative content analysis, resulting in six sub-categories grouped into three categories, which together formed an overarching theme (Table 1).

Results: The patients’ experiences of the very tight control early RA clinic were described as ‘fostering a sense of security’, which encompassed three categories: ‘contributing to competence’, ‘providing support’, and ‘building relationships’. The very tight control early RA clinic contributed to competence by promoting self-management and empowerment, enabling patients to develop independence and confidence in managing the disease. Participating in the structured early RA clinic provided a sense of support through continuity and accessibility, characterized by tight control and easy access to healthcare professionals. This accessibility and continuity helped alleviate anxiety and reinforced a sense of security. Additionally, the very tight control early RA clinic fostered the building of relationships, described by patients as feeling seen, heard and actively participating in their care through interactions with the interdisciplinary team.

Conclusions: A very tight control and treat-to-target early RA clinic fosters a sense of security in patients with newly diagnosed RA. The results align with recommendations for person-centered and integrated care pathways and highlight the importance of implementing very tight control early RA clinics within specialized rheumatology care.

Background: Pain and fatigue are prevalent symptoms in patients with rheumatoid arthritis (RA) and are associated with a high prevalence of fear-avoidance beliefs. A healthy lifestyle plays an important role in managing RA, and may help to improve symptoms, ease disease impact and consequently improve quality of life. It is well-known that the level of physical activity (PA) is negatively associated with fear-avoidance towards PA, while empowerment and level of PA has a positive association. There is lack of information concerning the impact of additional lifestyle factors (overweight, smoking and alcohol consumption) on fear-avoidance beliefs.

The aim was to study if empowerment and lifestyle factors are associated with fear-avoidance beliefs in patients with long-term rheumatoid arthritis.

Method: This cross-sectional study involved patients from the BARFOT (Better Anti-Rheumatic PharmacOTherapy) cohort. In 2024 a survey was sent to 1159 still-living patients from the BARFOT cohort, the response rate was 47% (n = 541). The patients have a disease duration of 18-32 years. The questionnaire included validated questionnaires as Fear-Avoidance Beliefs Questionnaire related to fear-avoidance beliefs about physical activity (FABQ-PA, 0-24, best to worst), Rheumatic Disease Empowerment Scale (SWE-RES-23, 1-5, worst to best), Euroqol 5-dimensions 3 levels (EQ5D, 0-1, worst to best) and health assessment questionnaire (HAQ, 0-3, best to worst). Questions of physical activity, alcohol consumption (Audit C), smoking habits, body mass index (BMI), numeric rating scales (NRS) of fatigue, pain, and patient global health (PatGA) and self-reported 28-joint tender (TJC) and swollen (SJC) were also included in the survey.

The FABQ-PA subscale was completed by 91% (n = 490) of the respondents and constituted the studied cohort. The third of participants who reported the highest (i.e., worse) FABQ-PA scores was compared to the two-thirds who reported lower (i.e., better) scores. Physical activity was dichotomised based on whether the recommendations for physical activity were reached or not; not reaching the recommendations was classified as physical inactivity. The recommended amount of physical activity per week is at least 150 minutes at moderate intensity or at least 75 minutes at vigorous intensity. Median and interquartile range (IQR) and Mann-Whitney U test or chi-2 were used to analyse differences between groups when appropriate. A logistic regression model adjusted for age and sex was used to study factors associated with worse FABQ-PA.

Results: The patients who responded to FABQ-PA had a median age of 72 years (IQR 16), and 74% were females. When comparing those reporting worse FABQ-PA (n = 170) with those reporting better FABQ-PA (n = 320), those with worse FABQ-PA reported more swollen and tender joints, worse PatGA, more pain, more fatigue, worse function, assessed with the HAQ, worse health related quality of life (HRQoL), assessed with the EQ5D, and lower empowerment assessed with SWE-RES-23 (Table 1). Patients with worse FABQ-PA were, to a higher extent, physically inactive and a larger proportion were obese. There were no differences between the groups regarding smoking or drinking habits.

Worse FABQ-PA adjusted for age and sex were associated with more swollen and tender joints, worse PatGA, more pain, more fatigue, worse function, lower HRQoL and lower empowerment. Regarding lifestyle factors, worse fear-avoidance beliefs were associated with physical inactivity and being obese. No associations were found regarding smoking and drinking habits (Table 2).

Conclusion; This study shows that worse fear-avoidance beliefs were associated with low empowerment and poorer health outcomes in patients with rheumatoid arthritis, including increased pain, fatigue, functional limitations, and worse HRQoL. Addressing psychological factors in the clinic may ease fear-avoidance and facilitate patients’ physical activity level, disease management, and overall well-being. Longitudinal research could clarify the causal relationships between these factors and fear-avoidance beliefs, providing valuable insights for improving patient care.

Background: Rheumatoid arthritis (RA) is a chronic, systemic, inflammatory joint disease, that influences patients’ health in different ways, including physical, social, emotional, and psychological aspects. The goal of rheumatology care is to achieve optimal health and personalised care and therefore, it is essential to understand what health means for patients in the early course of RA. The aim of this study was to describe the understanding of health among patients with early RA.

Methods: The study had a descriptive qualitative design with a phenomenographic approach. Phenomenography is used to analyse, describe, and understand various ways people understand or experience a phenomenon, in this study, patients’ understandings of health. Individual semi-structured interviews were conducted with 31 patients (22 women and nine men, aged (38–80) with early RA, defined as a disease duration of < 1 year, and disease-modifying anti-rheumatic drugs (DMARDs) for 3–7 months. The phenomenographic analysis was conducted in 7 steps, and the outcome space presents the variation in understanding and the interrelation among categories. In accordance with the European Alliance of Associations for Rheumatology’s (EULAR) recommendations, a patient research partner participated in all phases of the study.

Results: The analysis revealed four main descriptive categories: ‘Health as belonging’ was described as experiencing a sense of coherence. ‘Health as happiness’ was understood as feeling joy in everyday life. ‘Health as freedom’ was understood as feeling independent. ‘Health as empowerment’ was understood as feeling capable. Essential health aspects in early RA are comprised of a sense of coherence, joy, independence, and the capability to manage everyday life.

Conclusions: This study revealed that patients’ perception of health in early RA encompasses various facets, including a sense of belonging, happiness, freedom, and empowerment. It highlighted that health is multifaceted and personal, emphasizing the importance of acknowledging this diversity in providing person-centred care. The findings can guide healthcare professionals to deepen patients’ participation in treatment goals, which may lead to better treatment adherence and health outcomes. 

 © The Author(s) 2024.

Objectives: The aim was to study the development of radiographic knee osteoarthritis (RKOA) in individuals with knee pain over 2 years, and the associations between radiographic changes and baseline variables.

Design: Longitudinal cohort study.

Participants and setting: This study is part of the Halland Osteoarthritis cohort. The included 178 individuals, aged 30-67, had knee pain, without cruciate ligament injury or radiographic findings and 67% were women. The presence of RKOA was defined as Ahlbäck score of ≥1 in ≥1 knee. (Ahlbäck grade 1: joint space narrowing in the tibiofemoral joint <3 mm). Diagnosis of clinical KOA was based on the clinical guideline from the National Institute for Health and Care Excellence (NICE). Knee injury and Osteoarthritis Outcome Score (KOOS), pain intensity, physical function, body mass index (BMI) and visceral fat area (VFA) were measured. Associations to RKOA were analysed with logistic regression (OR).

Results: In all, 13.8% (n=24) developed RKOA in 2 years whereof all had clinical KOA at baseline, as defined by NICE. Deterioration to RKOA was significantly associated with higher BMI, OR 1.119 (95% CI 1.024 to 1.223; p=0.013), and VFA, 1.008 (95% CI 1.000 to 1.016; p=0.049), worse knee pain intensity, 1.238 (95% CI 1.028 to 1.490; p=0.024), worse scores for KOOS Pain, 0.964 (95% CI 0.937 to 0.992; p=0.013) and KOOS Symptoms, 0.967 (95% CI 0.939 to 0.996; p=0.027), KOOS Activities of daily living 0.965 (95% CI 0.935 to 0.996; p=0.026) and KOOS Quality of Life 0.973 (95% CI 0.947 to 0.999; p=0.044), at baseline.

Conclusions: One out of seven individuals with clinical KOA developed RKOA in only 2 years. Baseline variables associated with RKOA after 2 years may possibly be detected early by using the NICE guideline, assessment of obesity and self-reported data of symptoms to support first-line treatment: education, exercise and weight control. © Author(s) (or their employer(s)) 2024.

Background: Healthy lifestyle habits (regular physical activity, a healthy diet, no smoking and non-hazardous alcohol consumption) alongside pharmacological treatment can lower the risk of cardiovascular diseases and improve symptoms and quality of life in patients with rheumatoid arthritis (RA). Therefore, healthcare professionals in rheumatology care are urged to discuss lifestyle habits with all patients. The aim of this study was to explore patients’ perceptions of lifestyle discussions in early rheumatology care.

Methods: Individual interviews were conducted with 20 patients with RA, 14 women and six men, aged 23 to 77 years, and with a mean disease duration of 2.4 years. All lifestyle discussions were performed during the first year with RA. A qualitative content analysis was performed.

Results: An overarching theme emerged, exploring how patients with RA perceived lifestyle discussions as facilitating self-management. Three categories illustrated this: (1) the usefulness of lifestyle discussions depended on the individual patient’s preferences and prioritization for lifestyle support; (2) the design of lifestyle discussions should be based on a person-centred approach, incorporating personalized lifestyle information and providing structured and recurrent support; (3) the outcomes of lifestyle discussions should contribute to enhanced knowledge and motivation for making healthy lifestyle changes.

Conclusion: Lifestyle discussions in early rheumatology care should, according to patients with RA, be based on a person-centred approach, be tailored to each patient’s preferences and needs, and have outcomes focusing on patient support for healthy lifestyle changes, all essential elements to facilitate self-management. The present findings can be used to guide the development and implementation of more person-centred lifestyle approaches targeted to facilitate lifestyle changes and benefit cardiovascular disease risk management in early rheumatology care.

© 2024. The Author(s).

AIM: To explore HPs' perceptions of working on lifestyle management for patients with early rheumatoid arthritis (RA). METHODS: In this qualitative study, individual interviews were conducted with 20 HPs. Qualitative content analysis was used, and three categories and six subcategories were identified. RESULTS: HPs' perceptions of working on lifestyle management for patients with early RA revealed a need for commitment from different levels. This included commitment from healthcare managers and organizations prioritizing work on lifestyle management and providing competence development for HPs. Commitment within the team regarding coordination of interdisciplinary teamwork and development of a structured lifestyle management approach, and commitment to involving patients in lifestyle management, by facilitating patient engagement and a person-centred approach. CONCLUSIONS: HPs' perceptions of working on lifestyle management for patients with early RA revealed that commitment from healthcare managers, organizations, and the interdisciplinary team was essential to facilitate collaboration, patient involvement, and a person-centred approach. © 2023 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group.