People with rheumatoid arthritis have an increased risk of developing diseases such as osteoporosis, diabetes and cardiovascular disease. New research now shows how this risk can be reduced relatively easily.
People with rheumatoid arthritis often struggle with other health problems. They have an increased risk of developing cardiovascular disease, osteoporosis and diabetes. The risk of illness is further exacerbated by the fact that people with rheumatoid arthritis are more likely to be sedentary than the general population.
However, new research shows that a relatively simple intervention can get people with rheumatoid arthritis to become more physically active and improve their overall health and thus indirectly contribute to reducing the risk of further illness.
“People with rheumatoid arthritis are often sedentary. They are less active because of the challenges of performing various types of physical activity, which increases their risk of various comorbid conditions. We wanted to determine whether the widespread sedentary behaviour of people with rheumatoid arthritis can be reduced. Surprisingly, we could get people to reduce the time they were sedentary by more than two hours per day by using relatively simple methods. The intervention also improved their cholesterol and blood glucose levels, which may help reduce the risk of additional diseases such as cardiovascular disease and diabetes,” explains Bente Appel Esbensen, Professor and Senior Researcher, Copenhagen Center for Arthritis Research (COPECARE), Rigshospitalet, Glostrup.
The research has been published in both Annals of the Rheumatic Diseases and Arthritis Care & Research. Postdoctoral fellow Tanja Thomsen led the research as a PhD student.
Individualised interventions for 150 people
The trial involved 150 people with rheumatoid arthritis averaging 60 years old, 80% women and had rheumatoid arthritis for an average of 11 years.
These participants were randomised to two groups of 75 who either received the intervention or continued their lives as usual.
The intervention was individualised and comprised three interviews with each participant to determine where including more physical activity in their daily lives made sense.
For example, this could mean using the stairs instead of an elevator; bicycling to go shopping instead of driving a car; getting up off the couch every time there were commercials on TV; or getting up from the couch to make a cup of coffee in the kitchen instead of making a whole jug and putting it on the living-room table.
“A nurse or occupational therapist conducted these interviews, collaborating with the participants to determine how they could increase their activity level during the day. The participants decided their own goals, and then a communication expert formulated them in motivational language. Subsequently, for example, the participants received a text message reminding them about their goal of going for a walk or the like. All messages were individually tailored to the lives and needs of the participants,” says Bente Appel Esbensen.
Monitoring participants’ activity
The trial lasted 16 weeks, and the participants were examined four times – at the start, after 16 weeks, after 10 months and after 22 months.
Each participant was equipped with an accelerometer, which measured over 7 days the time they sat down, stood and walked.
The participants also completed questionnaires about their well-being, symptoms, physical functioning and how they perceived their own illness. The researchers took blood samples and analysed them for long-term blood glucose and lipids.
“We hoped that participants in the intervention group would become more physically active and that this would improve their symptoms, mood and health,” explains Bente Appel Esbensen.
Effects continued 18 months later
The research clearly showed that the intervention had a major effect on the participants.
First, they were considerably more active during the 16-week intervention period. On average, the intervention participants were active up to 2 hours more per day than the control participants.
The intervention continued to have an affect 18 months after it ended. The intervention participants continued to be physically active up to 2 hours more per day than the control participants and had significantly reduced long-term blood glucose and lipids compared with the control participants.
Thus, the intervention improved their health and reduced their risk of developing diabetes and cardiovascular disease.
“The people in the intervention group also reported less pain, less fatigue and higher quality of life. This means that a relatively simple intervention can improve both the physical and mental health of people with rheumatoid arthritis,” says Bente Appel Esbensen.
The researchers used the results to analyse the economic aspects of the health benefits. The analysis is not finished yet, but Bente Appel Esbensen says that the positive results have made the researchers consider whether the intervention should be offered to everyone with rheumatoid arthritis.
Tanja Thomsen has also received a grant to carry out an implementation project, which will integrate these positive results into rheumatology clinical practice and hopefully benefit more people.
