From rheumatologyadvisor.com
The theme for World Arthritis Day 2025 is “power of dreams,” which embodies the goals and hopes that drive individuals with arthritis to forge ahead
With its establishment in 1996, World Arthritis Day was intended to raise global awareness of arthritis as a public health issue. Organizations such as the Arthritis Foundation offer patient resources and information on the impact of arthritis while also celebrating the strength and resilience of affected families and individuals. International rheumatology organizations — including the European Alliance of Associations for Rheumatology (EULAR) — host campaigns to help achieve their goal of advocacy for rheumatic and musculoskeletal diseases. Their theme for World Arthritis Day 2025 is “power of dreams,” which embodies the goals, hopes, and visions of individuals with arthritis. World Arthritis Day is an integral part of furthering scientific research, medical education, and disease awareness.
To gain further insight on the role of providers in enhancing care, as well as promoting awareness and understanding of how patients can prioritize and be empowered to take charge of their bone and joint health, we spoke with experts Melanie Smith, MD, PhD, and Francis Keefe, PhD. Dr Smith is an attending physician in the Division of Rheumatology at the Hospital for Special Surgery (HSS) and an assistant professor of medicine at Weill Cornell Medicine, New York. Dr Keefe is a professor in psychiatry and behavioural sciences, psychology and neuroscience, medicine, and anesthesiology and a member of the Duke Cancer Institute at Duke University in Durham, North Carolina.
How can clinical practices, by addressing barriers in rheumatology, play a role in guiding patients towards seeking early care for their symptoms, which has been associated with better outcomes, lower health care costs, and higher quality of life?
MS: One of the issues we have in rheumatology is overall awareness of rheumatologic conditions and the role of the rheumatologist, such as educating the general population, partnering with primary care providers (PCPs), and offering referrals to other specialties. Because autoimmunity may have a genetic component, families should be educated about symptoms that need evaluation in the future. In addition to these factors, misinformation leads to a delayed diagnosis. It is important for providers to dispel myths to encourage patients to seek early care and enhance their quality of life.
FK: Rheumatology is a tertiary care discipline. A significant time may have passed by the time a patient with arthritis visits a rheumatologist. Patients often work with their PCP and see a rheumatologist only for a consultation, once or twice a year. Rheumatology evaluations and assessments need to be focused on the disease process while simultaneously understanding how symptoms are affecting patients’ lives. Although pharmacotherapy has been the mainstay of arthritis treatment, the risk for medication side effects must be considered. Even with optimal medical management, patients still face challenges. In addition, management of pain — by both providers and patients — is important for achieving optimal quality of life.
What should clinicians consider in terms of screening practices to ensure timely diagnosis and appropriate management?
MS: We discuss with PCPs about their role in referring patients in a timely manner or encouraging patients to seek care and get a second opinion from a rheumatologist. For inflammatory arthritis (IA), it is important to refer a patient with joint swelling that lasts for more than 2 days and morning stiffness for at least 60 minutes. It has been observed that PCPs often emphasize laboratory values, but many of our patients have normal values for erythrocyte sedimentation rate and C-reactive protein, negative rheumatoid factor, and negative cyclic citrullinated peptide, and still have IA. This results in a delayed diagnosis. Clinical diagnoses for rheumatic conditions, such as rheumatoid arthritis and ankylosing spondylitis, are dependent on joint examinations and other factors, not only on blood tests.
FK: If we think about a patient population that often doesn’t get referred to a rheumatologist until later in their disease trajectory, it is those with social determinants of health (eg, low income or living in a rural areas) that increase the risk for delayed treatment. Because of costs, some individuals with osteoarthritis may wait until the pain is intolerable and only then seek referral to specialists.
Persistent pain and other arthritis symptoms also tend to affect psychologic well-being. Screening questionnaires can help [clinicians] identify problems and understand the impact of symptoms on quality of life. Many PCPs already use pain and depression screening tools not only to get a sense of disease severity, but also to understand the impact of a disease on quality of life. Rheumatologists also need to incorporate these tools in their practice to understand the disproportionate impact of pain on daily life to improve and encourage self-management.
While pharmacotherapy is the mainstay of arthritis treatment, the addition of lifestyle interventions is shown to be effective for patients with rheumatic disease. Are patients routinely counselled on incorporating lifestyle changes? Is there evidence for their effectiveness?
MS: Most patients with IA report benefit from being active; so, exercise is commonly recommended at my practice. To improve adherence to exercise regimens, providers and patients together can discuss the form of activity that patients enjoy and increase the frequency. If patients do not engage in regular physical activity but have their joint inflammation under control with medications, we refer them to physical therapists to start a weight training or cardiovascular fitness program to avoid risk for injury. Another consideration is the important role of a healthy diet and supplementation with calcium and vitamin D for optimal bone and joint health.
What steps can health care providers take to empower patients to be proactive in their joint health?
FK: Living with arthritis means accepting that pain and other symptoms will persist but realizing you can still have a meaningful life. Providers should discuss important patient values and preferences and build achievable goals around them. This value-based approach can potentially encourage patients to engage in meaningful activities, which can improve the impact of the care they receive.
MS: The most important way to empower patients in this regard is enabling them to stay active by recommending regular exercise and healthy sleep habits. Patients with IA should be counselled on a case-by-case basis regarding improving their joint health. Another important aspect is getting patients the help they need; for example, referrals to physical therapists for an exercise program or to address disease-related postural issues. I believe that helping patients with their psychologic health could make them empowered to take control of their arthritis symptoms as well.
Can you highlight the role of collaboration with different specialties (eg, psychiatry/psychology) and other stakeholders (eg, patient advocacy organizations) in enhancing care and achieving optimal patient outcomes?
FK: Arthritis self-management can be thought of as occurring along a spectrum. At one end is a self-directed approach in which, through experience, patients learn a variety of strategies they can use to manage their arthritis symptoms. At the other end of the continuum is formal self-management training programs, often led by professionals (eg, nurses and psychologists) that systematically teach patients coping strategies for managing arthritis symptoms, such as relaxation, goal setting, mindfulness-based meditation, and problem solving. Training in self-management is widely available through community groups, self-management classes, arthritis programs designed for patients and peers, books, handouts, and other community-based resources.
Apart from this, many rheumatologists provide education about self-management when they give interactive talks in the community about arthritis, such as at nursing homes and communities of older adults. Further, referral for formal training in self-management becomes critical when patients have severe depression or pain, which significantly affects their quality of life. Embedding psychologists into primary care settings where providers are being trained to identify symptoms and provide timely referrals for formal training in self-management is increasingly being seen as valuable to health care systems. Specialists in self-management have developed collaborations with organizations, like the Arthritis Foundation, and this collaboration has been instrumental in increasing access to accurate and timely self-management materials for patients. Educating patients about the importance of a comprehensive care model that combines specialist care with self-management is beneficial.
MS: Many of the conditions of IA co-occur with other systemic diseases. For example, some patients with IA have comorbid inflammatory bowel disease or psoriasis, with rheumatologists working closely with gastroenterologists or dermatologists. Some patients have other organ involvement and then we work closely with those specialists, like pulmonologists or nephrologists. We also work with mental health professionals, based on patients’ symptoms. Rheumatology is multidisciplinary, and as rheumatologists we must be team players to get the best care for our patients. Advocacy organizations play an important role in education. At HSS, we have social work departments with various support groups for patients with a new diagnosis or established RA. We encourage patients to connect with this network.
With women forming a major part of the rheumatic disease population, how can their care be more informed in terms of creating awareness and offering resources?
FK: Research shows pain severity differences between men and women. Our team has worked with women with arthritis and their pain, and related coping mechanisms. We found that women vs men are more active in their coping strategies, are more likely to prefer involving others in their coping efforts (ie, as “communal copers”), and adopt a greater variety of approaches. It may be important to explore the social context here, such as asking women about family responsibilities, self-care techniques, and social activities — all of which are very important and help to avoid setbacks.
MS: There are specific considerations for patients who are women. One is for patients with childbearing potential or who are interested in being pregnant — a situation which changes the way providers think about contraception, treatment, and disease management. We have discussions with patients about their preferences and care plans. In the disease diagnosis stage, some women with arthritis symptoms during postpartum or [when] entering menopause have misdiagnosis of their condition because of overlapping symptoms. Further, new mothers may not necessarily put their health first and ignore symptoms (it is a common time in a woman’s life to have an autoimmune disease). Another important aspect is that IA is a risk factor for osteoporosis, which especially affects postmenopausal women. Providers should advise patients to receive bone density scans for preventable fractures.
https://www.rheumatologyadvisor.com/features/world-arthritis-day-2025-interview-with-experts/
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