Chronic Rheumatic Patients Research Articles

Outpatient Care Aspects of Rheumatic Patients in Latvia: Real Life Data in the Context of the First Month of the COVID-19 Pandemic

Abstract The aim of this study was to analyse the rheumatic disease profile and treatment aspects of the patients consulted in the outpatient department of Pauls Stradiņš Clinical University Hospital during the first month of the COVID-19 pandemic from 2020 March 13 till April 14. A total of 457 (76.04%) remote and 144 (23.96%) face-to-face consultations were analysed, totalling 601 patients: 434 (72.21%) females and 167 (27.79%) males with mean age 51.40 ± 14.73 years. Rheumatoid arthritis (223 (37.10%)), psoriatic arthritis (93 (15.47%)) and ankylosing spondylitis (80 (13.31%)) were the most frequently consulted conditions. Disease modifying antirheumatic drugs (DMARDs) or immunosuppressants (IS) were taken by 515 (85.69%) patients. These included synthetic DMARD (242 (46.99%)), mainly methotrexate; and biologic DMARD (156 (30.29%)), mainly tumour necrosis factor inhibitor. More than one-half of the cohort (427 (71.05%)) was not taking a glucocorticoid (GC). NSAIDs were used in 391 (65.08%) patients, mainly on demand (354 (90.54%)). Most patients (401 (66.72%)) had no comorbidities (hypertension, diabetes, malignancy and/or chronic respiratory disease). The profile of patients consulted in the outpatient department consisted mainly of middle-age females with autoimmune inflammatory arthritis treated by DMARD. Most of the patients did not use GCs, they did not regularly use NSAIDs and did not have comorbidities. Telemedicine is an acceptable way of care delivery for chronic rheumatic patients with previously known disease and treatment, especially during a pandemic.

A Limited Systemic Scleroderma Patient with Social Behavior Change and Role of Gut Microbiome: a Case Report

The role of the gut microbiome in influencing immune function and homeostasis is being investigated. A 56-years-old female patient was referred due to nightmares, insomnia, pain, and redness in all her fingers. At first, Zolpidem was prescribed by a psychiatrist, but it induced a stuffy nose, change in behavior, drugged feeling, and tiredness. Previously she had been referred to a rheumatologist, and after some visits, atypical scleroderma had been diagnosed. She received psychiatric treatment with quetiapine and melatonin and was prescribed a probiotic diet. The patient was followed up and showed an excellent therapeutic response after augmentation with diet therapy. The treatment based on gut or fecal microbiome transplantation (FMT) may affect the patient's behavior and sleep disturbance. Thus the key point is the role of gut microbiota and FMT-based therapy in chronic rheumatic patients with resistance and refractory psychiatric symptoms, which improves the quality of life and acceptance of treatment.

AB0879-HPR MOTIVATION OF HEALTHCARE PROVIDERS DURING COVID19 PANDEMIC OUTBREAK

Background:Since the beginning of 2020, the medical staff caring for patients with rheumatic disorders has been exposed to considerable emotional and physical stress due to the COVID19 pandemic outbreak. Newly-designed circuits were imposed to better manage chronic patient admissions.Objectives:To assess the level of motivation in healthcare personnel caring for patients with rheumatic disorders and identify determinants that lead to dissatisfaction during the COVID19 spread.Methods:A 15-item questionnaire was distributed among medical and paramedical staff looking after chronic rheumatic patients. Motivation factors were included in questions having five preset answers, ranging from “not al all”, “to a small extent”, “moderately”, “to a large extent” and “to a very large extent”. The final item was an open-type question, favoring personal suggestions and potential changes in local management.Results:Out of a total of a 124 responders, 82 were doctors with various degrees in training (fellow trainees, specialists in Rheumatology, Head of Department), 37 medical assistants, 3 nurses, a physical therapist, one clinical psychologist. Mean age in the group was 38.3 years old with a strikingly female dominance (87.6%). Within the responders, the financial factor represented by monthly salary or bonuses had no or little impact on work motivation during the pandemic since more than 70% answered with “not al all / to a small extent / moderately”. Regarding motivation through working hours, 26.7% responded either “not at all” or “to a small extent”, 32.4% were moderately motivated while only 12.4% were more enthusiastic. More than half (53.4%) of the staff stated that motivation was not entirely affected by working conditions in the hospital. Answers were relatively equally divided referring to motivation by safety at their workplace (almost 20% for each statement), and 40.9% suffered some extent of demotivation due to risk of contamination while caring for COVID19 positive patients. 42% of the staff was only moderately motivated by hospital’s measure to limit the spread of COVID throughout the personnel. Almost 75% of the healthcare workers were not motivated by news media. Around 54% said that personal motivation was not influenced by a larger work volume and 43% were very much motivated by work relationships with colleagues. 41% of the staff is only moderately satisfied with their work during the COVID outbreak while 18% are not at all satisfied. Finally, the last open-question confirmed that for some the pandemic period was a time to bring healthcare professionals together to a stronger bond. Other responders felt that chronic rheumatic patients were left aside, while caring mostly for COVID19 patients and only limited admissions for life-threatening conditions. Moreover, medical staff suggested that the lack of a more frequent testing throughout the personnel to avoid contamination was demotivating, while still living with families or relatives.Conclusion:Motivation of the personnel is a process with great economic and social impact. This study challenged the level of healthcare staff in difficult times caused by medical crisis. Results of the enquiry showed that financial benefits had no impact on motivation. Harsher working conditions or larger volume did not negatively impact motivation of staff, but the fear of contamination was considerable. Apparently the media influence was not a motivator for medical staff during the outbreak. Medical teams should find their stamina until the end of pandemia.

Factors influencing the quality of life of people with rheumatic disease

Aim Several factors affect everyday life of people with chronic rheumatic illness. A systematic study has been conducted to investigate the most severe problems aggravating the quality of life of these patients, and the role of support and assistance from their family members/acquaintances. An analysis of the characteristics of economic situation influencing everyday life of a risk group of the Estonian society is also presented. Materials and methods A national sociological survey called ‘Chronic Rheumatic Patients 2006’ was carried out by the Rheumatic Association of Tallinn with support from the Ministry of Social Affairs of Estonia. Data were collected from 808 respondents using a questionnaire. The quality of life data was analyzed and compared to results of the population survey ‘Estonia 2008’. Results The respondents indicated their state of health and shortage of money as their most severe problems, followed by dysfunctional family relations, poor living conditions, etc. The problems were more severe for those who lived alone and had been coping with illness for over 10 years. In most cases, occasional assistance was received from family members or acquaintances to cope with daily life. On an average, every tenth respondent did not have anyone to turn to for assistance. The respondents have also reported the lack of sufficient information on the nature of the illness, effect of medication, options for obtaining assistive devices and rehabilitation. Conclusion Need for attention during the initial period of the development of the illness and to increase awareness in the society to provide better conditions for the affected are highlighted based on the results.

AB1159-HPR Do Our Chronic Rheumatic Patients Receive Less Support from Their Life Partners than the Acute Patients?

BackgroundReceiving a diagnosis of chronic rheumatic disease has a profound impact not only on patients, but also on their spouse (life partner). These might be affected because of fear and...

AB1156-HPR Do Rheumatic Patients under Biological Therapy Receive More Attention from Their Doctors Compared with Those Who do not Receive Such Therapy?

BackgroundChronic rheumatic patients come in contact with health system more often than regular people that give them the opportunity to better identify both the strengths and weakness of this system....

AB1140-HPR Senior Rheumatologysts, Junior Rheumatologysts, Nurse Specialists and Patients with Similar Diseases – Four Sources of Information for Rheumatic Patient not Equally Valued, not Equally Used

BackgroundChronic rheumatic patients have to face various needs of communication throughout their illness. Their doctors, nurses and fellows suffering from similar diseases are the main oral sources of information. Based...

Negative affect in systemic sclerosis

Negative affect appears frequently in rheumatic diseases, but studies about their importance and prevalence in systemic sclerosis patients are scarce, and the results are inconclusive separately. We conducted a comprehensive search on April 2013 of PubMed, Medline, and PsycINFO databases to identify original research studies published. A total of 48 studies were included in this systematic review. We found negative emotions have very high levels in these patients, compared to both healthy population other chronic rheumatic patients assessed with the same instruments and cutoffs. Depression has been, of the three negative emotions that we approach to in this review, the most widely studied in systemic sclerosis, followed by anxiety. Despite the fact that anger is a common emotion in these diseases is poorly studied. Methodologic issues limited the ability to draw strong conclusions from studies of predictors. Disease-specific symptoms (swollen joints, gastrointestinal and respiratory symptoms and digital ulcers) and factors related to physical appearance were associated with negative emotions. Interdisciplinary care and biopsychosocial approach would have a great benefit in the clinical management of these patients.

Disease-related social and family life: people coping with rheumatoid arthritis in Estonia

Objective: The aim of the article is to investigate the most severe problems aggravating the quality of life of people with rheumatism and to outline the role of support and assistance people with rheumatism receive from their family members/acquaintances in order to cope with their daily life. Methods: The article is based on the data and findings of the national sociological survey ‘Chronic Rheumatic Patients 2006’ carried out by the Rheumatic Association of Tallinn in the years 2005–2006 with the support from the Ministry of Social Affairs of Estonia. Data were collected via a questionnaire from 808 respondents. Results: The respondents indicated their state of health and shortage of money as their most severe problems, followed by dysfunctional family relations, poor living conditions, loneliness, etc. The problems are more severe for the respondents who live alone and have been coping with illness for over 10 years. The assistance received from relatives/acquaintances to cope with daily life is more varied and thorough than that received from children. Assistance is mostly received occasionally. On average, every tenth respondent does not have anyone to turn to for assistance. Conclusion: Severe problems and stress symptoms display a cumulative effect–the occurrence of one aspect often triggers others. To break this vicious circle, people with rheumatism need assistance and support from the state as well as from their immediate environment.

Analysis of mucin composition in gastric juices of chronic rheumatic patients with upper gastrointestinal damage

Assessment of the mucin subclasses in the gastric juices of severe chronic rheumatoid arthritis (RA) patients was compared with non-RA cases which received the eradication treatment of Helicobacter pylori (H. pylori). Gastric juice samples were obtained from 8 RA patients (5 for H. pylori-negative and 3 for H. pylori-positive) and 5 control subjects in which we confirmed the successful eradication of H. pylori. The gastric luminal mucins were extracted and isolated by the ethanol precipitation method. These mucin solutions were digested with chymotrypsin, dialyzed, lyophilized, and redissolved. The obtained specimen was applied to an ion exchange column containing DEAE-Sepharose CL-6B and eluted with a discontinuous salt gradient in three salt steps. The gastric luminal mucins were divided into three fractions based on the distinctive sialic acid content. The proportion of acidic mucin rich in sialic acid from the gastric juice of RA patients without the H. pylori infection was significantly lower than those RA patients with H. pylori or the control subjects. A decrease in the acidic mucin content after eradication of H. pylori was commonly observed in all the control subjects. Our investigation raises the possibility that the gastric mucosae of RA patients have resistance against H. pylori infection. And the analysis of the composition in the gastric luminal mucin may be a very useful tool for the evaluation of gastric homeostasis in RA patients.