Can intervention modify adverse lifestyle variables in a rheumatoid population?

[Guest guest]

Can intervention modify adverse lifestyle variables in a rheumatoid

population? Results of a pilot study

M-M Gordon, E A Thomson, R Madhok and H A Capell

Centre for Rheumatic Diseases, Glasgow Royal Infirmary

Correspondence to:

Dr M-M Gordon, Centre for Rheumatic Diseases, Glasgow Royal Infirmary, 84

Castle Street, Glasgow G4 0SF, UK

ABSTRACT

Background: Rheumatoid arthritis (RA) is associated with significant excess

morbidity and mortality. Cardiovascular disease is the commonest cause of

premature death in patients with RA. In recognition of this, blood pressure,

weight, and smoking history are routinely ascertained in the clinic and

appropriate advice and treatment started.

Aims: To ascertain if attending a specialist nurse, in addition to routine

medical care, would increase the success in dealing with lifestyle variables

in a cohort of patients with RA.

Methods: Twenty two consecutive patients starting treatment with the disease

modifying antirheumatic drug (DMARD) sulfasalazine were invited to attend an

additional clinic dealing with lifestyle factors every 12 weeks over a 48

week follow up. Smoking and alcohol history, baseline demographic and

metrology assessments were determined for all patients. Body mass index

(BMI) was calculated, blood pressure recorded, function assessed by the

Health Assessment Questionnaire (HAQ), and social deprivation determined by

the Carstairs Index. Patients were advised on exercise and diet, and serum

cholesterol was measured.

Results: Twenty women and two men, with a mean age of 52 years and mean

disease duration of five years, were enrolled. Eight patients smoked and,

unfortunately, none were persuaded to discontinue. Fifteen of the cohort

were already taking regular exercise; one additional patient began swimming

regularly. At baseline, 10 patients were found to have a high cholesterol,

with a mean of 6.8 mmol/l. A 14% reduction in mean cholesterol was achieved

by dietary modification, and three patients merited statin treatment.

Obesity is a major problem in our population and 15 of the patients had

grade I obesity with a mean BMI of 30.6; five of these gained a further 4.5

kg. Six patients with previously untreated hypertension were identified, but

unfortunately five remained hypertensive and only two had received

anti-hypertensive drugs.

Conclusions: Educating patients in order to change lifestyle 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.