Rheumatoid Arthritis Patients Maintained Unhealthy Habits Despite Specialist Advice

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Rheumatoid Arthritis Patients Maintained Unhealthy Habits Despite Specialist

Advice

A DGReview of : " Can intervention modify adverse lifestyle variables in a

rheumatoid population? Results of a pilot study "

ls of the Rheumatic Diseases (ARD Online)

01/14/2002

By Loshak

Interventions to modify adverse lifestyle variables in patients with rheumatoid

arthritis may have only marginal effects.

A pilot study among patients with rheumatoid arthritis in Scotland showed that

they made hardly any healthful changes to their way of life, despite

encouragement to do so by a specialist nurse.

No smokers discontinued the habit and only one patient started regular exercise.

Several obese patients gained still more weight.

" Educating patients to change habits and influence outcome is a long-term

challenge facing all healthcare workers. In our cohort, most adverse lifestyle

factors had already been recognised and discussed by the general practitioner or

at prior clinic visits. Additional advice and input led to only modest

improvement, " report rheumatologists at Glasgow Royal Infirmary, Scotland.

They noted that rheumatoid arthritis is associated with significant excess

morbidity and mortality. As cardiovascular disease is the most common cause of

premature death, blood pressure, weight and smoking history are routinely taken

in the clinic and appropriate advice and treatment are then started.

To see if a specialist nurse could further improve their lifestyle variables, 22

consecutive rheumatoid arthritis patients (f=22, m=2) starting treatment with

the disease modifying anti-rheumatic drug sulfasalazine were invited to attend

an additional clinic every 12 weeks over a 48- week follow-up. The patients had

a mean age of 52 years and mean disease duration of five years.

The rheumatologists determined their smoking and alcohol history, baseline

demographic and metrology assessments, body mass index, blood pressure and serum

cholesterol. Function was assessed by the Health Assessment Questionnaire and

social deprivation by the Carstairs Index. Patients were advised on exercise and

diet.

None of the eight patients who smoked was persuaded to discontinue. One of the

eight patients who were not already taking regular exercise began swimming

regularly.

At baseline, 10 patients were found to have a high cholesterol, with a mean of

6.8 mmol/l (262 mg/dL). Diet changes led to a 14.0 percent reduction in mean

cholesterol and three patients merited statin treatment. Of the 22 patients, 15

(68.2 percent) had grade 1 obesity, with a mean body mass index of 30.6 - a

third of these (n=5) gained 4.5 kg.

Although six patients with previously untreated hypertension were identified,

five remained hypertensive and only two had received anti-hypertensive drugs.

ls of the Rheumatic Diseases 2002;61:66-69