Systematic Review and Meta-analysis: Mindfulness-Based Interventions for Rheumatoid Arthritis

The aim of this study was to determine the association of perceived stress with incident inflammatory arthritis (IA) defined as having at least 1 joint consistent with rheumatoid arthritis (RA)-like synovitis based on examination. Methods. We conducted a prospective cohort study in the Studies of the Etiologies of Rheumatoid Arthritis cohort. Participants without IA were recruited if they were a first-degree relative of an RA proband or screened positive for anti-cyclic citrullinated peptide. Perceived stress was measured using the Perceived Stress Scale-14 (PSS-14), in which scores can range from 0 to 56, and a higher score indicates greater perceived stress. The total PSS-14 score, as well as 2 subscores indicative of perceived distress and self-efficacy, were averaged across all study visits until development of IA or the last follow-up. Hazard ratios (HRs) and 95% confidence intervals (95% CIs) of IA associated with average PSS-14 scores were obtained using Cox proportional hazards models. Results. The mean total PSS-14 score was 20.4. We found that a 1-point increase in the perceived distress score was significantly associated with a 10-percent increase in the risk of IA (adjusted HR 1.10 [95% CI 1.02-1.19]). Total PSS-14 and self-efficacy were not associated with IA risk (adjusted HR 1.05 [95% CI 0.99-1.10] and 1.04 [95% CI 0.91-1.18], respectively). Conclusion. An association between perceived distress and incident IA was observed in this at-risk cohort. Replication of this finding in other preclinical and at-risk RA populations is needed.

Primary Sjögren’s syndrome (pSS) patients identify fatigue as their most important symptom and the one most difficult to cope with, but there are still many challenges and few solutions to manage this debilitating symptom. Promising pharmacological treatments, such as rituximab, have failed in more stringent tests including randomized controlled trials (RCTs) and meta-analysis. While non-pharmacological interventions may be safer, less costly, and address other common comorbidities, to date only aerobic exercise seems to be effective at reducing fatigue in pSS. All interventions, pharmacological or not, need to be tested in high-quality RCTs. The aim of this review is to provide an overview of fatigue management in pSS and discuss potential opportunities for future research.

Introduction / objectives Management of anxiety and depression in rheumatoid arthritis (RA) patients is vital. Previous studies investigating this topic are conflicting, and this topic still has not been thoroughly investigated. This study aimed to clarify the association of disease activity with anxiety and depression after controlling for physical disability, pain, and treatment.Method We conducted a cross-sectional study of RA patients from the Kyoto University Rheumatoid Arthritis Management Alliance cohort. For assessments, we used the Disease Activity Score (DAS28), Health Assessment Questionnaire Disability Index (HAQ-DI), and Hospital Anxiety Depression Scale.Depression and anxiety were defined by a Hospital Anxiety Depression Scale score ≥8. We then performed multivariable logistic regression analyses. ResultsOf 517 participants, 17.9% had anxiety, and 28.2% had depression. The multivariable logistic regression analyses showed patients with DAS28-based non-remission had low association with anxiety (odds ratio [OR] [95% confidence interval {CI}], 0.93 [0.48-1.78]: p = 0.82) but slight association with depression (OR [95% CI], 1.45 [0.81-2.61]: p = 0.22). However, severity of the patient's global assessment (PtGA) on DAS28 was associated with anxiety (OR [95% CI], 1.15 [1.02-1.29]; p = 0.03) and depression (OR [95% CI], 1.21 [1.09-1.35]; p < 0.01). Additionally, HAQ-DI-based non-remission was associated with anxiety (OR [95% CI], 3.51 [1.85-6.64]; p < 0.01) and depression (OR [95% CI], 2.65 [1.56-4.50]; p < 0.01). Younger patients (OR [95% CI], 0.83 [0.68-1.01]; p = 0.07) and patients not treated with methotrexate (OR [95% CI], 0.67 [0 .40-1.13]; p = 0.13) tended to suffer from anxiety. Patients using steroids had a closer association with depression than those not using them (OR [95% CI], 1.66 [1.03-2.67]; p = 0.04).Conclusions Assessment of disease activity, PtGA, and HAQ-DI are important for assessing anxiety and depression in RA patients. Attention should be paid to improving PtGA and physical function.