Rheumatoid Arthritis: Ryan S

Oliver S, Ryan S. · · Nurs Stand. · Pubmed #15384306 No free full text.

Abstract: In this article, the authors examine pain management options for patients with osteoarthritis and rheumatoid arthritis.

Ryan S. · Staffordshire Rheumatology Centre, Stoke on Trent. · Prof Nurse. · Pubmed #10347533 No free full text.

Abstract: Arthritis can affect physical, psychological, social, sexual and role function. Nurses need to enter into a therapeutic relationship with patients to address coping strategies. Care must be placed within the context of the patient's and family's life for it to be meaningful and relevant.

Ryan S, Hill J, Thwaites C, Dawes P. · Haywood Hospital, Stoke-on-Trent. · Nurs Stand. · Pubmed #18828292 No free full text.

Abstract: AIMS: The primary aim of this study was to investigate whether a questionnaire developed for patients with rheumatoid arthritis (RA) could also be used with patients who have fibromyalgia. A secondary aim was to assess the impact of fibromyalgia on sexuality. METHOD: In the first of two phases the face and content validity of a sexuality questionnaire already being used in patients with RA were assessed in a qualitative, audio-taped, interview study of five patients with fibromyalgia. The second phase consisted of a self-report questionnaire distributed to 60 patients with fibromyalgia. FINDINGS: The interview data confirmed that the content of the RA sexuality questionnaire was relevant to patients with fibromyalgia. A total of 43 (72%) questionnaires were returned and, of these, 41 (95%) were usable. Patients reported that fibromyalgia had altered their sexual relationship. They cited pain, stiffness, fatigue, reduced sexual drive and the impact of drug therapy as the main reasons. CONCLUSION: The symptoms associated with fibromyalgia had a negative effect on sexual enjoyment. The questionnaire appears to be useful in addressing sexuality in patients with fibromyalgia.

Oliver S, Bosworth A, Airoldi M, Bunyan H, Callum A, Dixon J, Home D, Lax I, O'Brien A, Redmond A, Ryan S, Scott DG, Steuer A, Tanner L. · Litchdon Medical Centre, Devon, UK. · Musculoskeletal Care. · Pubmed #18785194 No free full text.

Abstract: OBJECTIVE: Consumers of healthcare can reveal important insights into the personal challenges they experience when negotiating their health needs. The National Rheumatoid Arthritis Society (NRAS) wanted to explore the experiences of those with rheumatoid arthritis (RA) in order to understand the impact on the individual and on healthcare resources and benchmark care against published standards and guidelines. METHODS: A project was designed to explore the experiences of individuals with sero-positive RA who had been diagnosed for three years or less. Qualitative semi-structured interviews were used and combined with process mapping to explore the experiences of a purposeful sample of individuals with RA. The information generated was mapped and variances explored. Ethical approval was not required as the data were collected outside the National Health Service. RESULTS: Twenty-two participants' stories were mapped. Fifty per cent of participants sought a medical opinion within three weeks of symptom onset and the majority received a disease-modifying anti-rheumatic drug within six months from first presenting symptoms. Work-related issues were highlighted by 13 participants, and seven of these experienced job losses directly attributed to their diagnosis. CONCLUSIONS: This unique mapping approach used qualitative research and process mapping to compare patient experiences against recognized standards and guidelines. These twenty-two stories reveal important insights into the challenges experienced in negotiating these healthcare journeys and the impact upon the individual as a result of variances in standards of care received. The participants in this study were chiefly self-motivated, informed and articulate, and did not reflect the broad ethnic, social or cultural diversity in the UK. Limitations must also be considered in relation to perceptions and recall of participants over a three-year period, as these may have altered over time and illness experience.

Neuhausen SL, Steele L, Ryan S, Mousavi M, Pinto M, Osann KE, Flodman P, Zone JJ. · Department of Epidemiology, University of California Irvine, 224 Irvine Hall, Irvine, CA 92697-7550, USA. · J Autoimmun. · Pubmed #18692362 No free full text.

Abstract: The occurrence of other autoimmune diseases in celiac disease families has not been previously reported in a North American population. We investigated the familial aggregation of rheumatoid arthritis (RA), juvenile rheumatoid arthritis/juvenile idiopathic arthritis (JRA/JIA), hypothyroidism, insulin dependent diabetes mellitus (IDDM), and alopecia areata (AA) among individuals in families with celiac disease (CD). Family history information, obtained from questionnaires from the University of California Irvine Celiac Disease study, was reviewed for reports of RA, JRA/JIA, hypothyroidism, IDDM, and AA in celiac disease cases and their first-degree relatives. Reports of disease were compared with prevalence data from the literature and analyzed by calculating the standardized ratio (SR) with 95% confidence limits. We analyzed: (1) subjects with confirmed celiac disease or dermatitis herpetiformis (205 probands and 203 affected first-degree relatives) and (2) first-degree relatives of celiac disease cases (n=1272). We found a significantly increased number of cases, relative to the expected number, of IDDM in both groups and hypothyroidism among subjects with celiac disease. JRA/JIA was increased among first-degree relatives of celiacs. These results indicate that the presence of IDDM within our celiac disease families may be due to shared genetic susceptibility predisposing to these diseases or autoimmune diseases in general.

Hewlett S, Carr M, Ryan S, Kirwan J, Richards P, Carr A, Hughes R. · Academic Rheumatology Unit, University of Bristol. · Musculoskeletal Care. · Pubmed #17042002 No free full text.

Abstract: BACKGROUND: It has been shown previously that patients with rheumatoid arthritis (RA) can generate a wide range of outcomes that they consider important in treatment. It is not known if these outcomes are generally important in the wider RA patient community. OBJECTIVES: (1) To examine whether recent patient-generated outcomes are generalizable within a wider RA population; (2) to assess the relative importance of each outcome; and(3) to explore whether any important outcomes have been omitted. METHODS: A questionnaire, listing 23 outcomes previously generated by RA patients, was distributed through three rheumatology centres in the UK. Patients gave an importance score to each outcome (0-3), selected their top three most important outcomes, and then listed any outcomes of personal importance that were missing. RESULTS: 323 questionnaires were returned (65%). All outcomes were deemed important. Independence, pain, and mobility were most frequently selected by patients in their top three outcomes but were not chosen by 61-66% of patients. The next most commonly chosen outcomes related to feeling well and fatigue. Factor analysis revealed six reasonably distinct groupings: general well-being (11.9% explained variance), day-to-day functioning(10.6%), emotional and psychological well-being (10.6%), social role and confidence (10%), physical symptoms (9.5%) and medication issues (7.9%). CONCLUSION: Outcomes generated by patients as important in RA, are generalizable and inclusive. The most important (independence, pain and mobility) are routinely treated and measured. The next most important (feeling well, fatigue) are infrequently addressed and deserve urgent consideration for measurement, treatment and research.

Ryan S, Wylie E. · Haywood Hospital, High Lane, Burslem, Stoke-on-Trent, UK. · Musculoskeletal Care. · Pubmed #17041993 No free full text.

Abstract: BACKGROUND: Rheumatoid arthritis (RA) is a chronic progressive inflammatory condition primarily affecting the joints. It is characterized by pain, stiffness and fatigue. Research has demonstrated that the symptoms of RA can negatively impact on a patient's sexuality and patients would welcome the opportunity to discuss their sexual needs with a health professional. AIMS: To identify current perceived practice, skills, and knowledge of rheumatology nurses in addressing the sexuality of patients with RA. METHODS: A postal questionnaire was sent to 132 rheumatology nurses identified from the British Health Professionals in Rheumatology Handbook. The questionnaire sought to identify the nurse's role in the assessment and management of RA patients' sexuality. RESULTS: Seventy six questionnaires were returned (response rate of 57.5%). Sixty nine respondents stated that sexuality should be included within the nursing assessment. The main factors that influenced whether sexuality was discussed was privacy, the level of knowledge and skills and time. Nurses felt that while contraceptive advice for patients treated with cytotoxic drugs was discussed in depth, the patient's sexual relationship was not discussed at all. The majority of respondents (83%) had never received any training in this area and would undergo training if they had the opportunity. CONCLUSION: While rheumatology nurses acknowledge the importance of including sexuality in the care management of patients with RA, in practice the impact of the condition on a patient's sexuality is only discussed briefly. Rheumatology nurses have identified the need for further training in this complex area.

Hooper H, Ryan S, Hassell A. · Primary Care Sciences Research Centre, Keele University, Stoke-on-Trent, UK. · Musculoskeletal Care. · Pubmed #17041983 No free full text.

Abstract: OBJECTIVE: This study aimed to explore the effects of participants' perceptions of support, ways of coping and feelings of control, on their accounts of well-being. METHODS: Semi-structured interviews were conducted with 10 patients with rheumatoid arthritis (RA) and explored the dynamics of participants' accounts of coping with their everyday lives. RESULTS: Four categories of coping mechanisms were evident in all participants' accounts: support during the medical consultation, nurse support, social support, and comparative strategies. This paper focuses on just one of the themes that emerged from our analysis. Further insight into coping mechanisms was provided by the prevalence of comparative coping strategies. A comparison with previous disease states was used by every participant. This comparison enhanced their sense of control and fostered a sense of well-being. Social comparison was used by seven participants to show themselves how fortunate they were in relation to others with RA. CONCLUSION: Comparative coping has been identified as an important strategy adopted by these participants that could be explored in further intervention-based studies of coping.

Coelho S, Amarelo M, Ryan S, Reddy M, Sibbald RG. · Dermatology Day Care and Wound Healing Clinic, Women's College Ambulatory Care Centre, Sunnybrook and Women's College Health Sciences Centre, Toronto, Ontario, Canada. · Int Wound J. · Pubmed #16722900 No free full text.

Abstract: Patients with rheumatoid arthritis may develop leg ulcers of varied aetiologies, including venous disease, infection and inflammation (vasculitis or pyoderma gangrenosum). The leg ulcers in rheumatoid arthritis patients may involve several of these aetiological factors and are often difficult to heal. Both the ulcers and the treatments are often painful, and these ulcers may be present for years. A new oxidised regenerated cellulose and collagen dressing has been developed for slow-to-heal wounds and may have a role in the management of superficial inflammation that may persist in many of these ulcers, although clinically it is difficult to distinguish this from critical colonisation or frank infection. Venous disease requires compression therapy. Deep compartment infection should be treated with systemic antimicrobials, and inflammatory processes extending beyond the superficial wound base require disease-specific systemic anti-inflammatory agents. Four patients with recalcitrant wounds resistant to best practice were treated successfully with this new dressing combined with a strategy to control bacterial burden.

Almeida C, Clarke B, O'Brien A, Hammond A, Ryan S, Kay L, Hewlett S. · Academic Rheumatology, University of Bristol, Bristol, UK. · Rheumatology (Oxford). · Pubmed #16449368 links to  free full text

Abstract: OBJECTIVES: Rheumatological conditions are common and all health professionals (HPs) therefore need sufficient knowledge and skills to manage patients safely and effectively. The aim of this study was to examine current undergraduate education in rheumatology for HPs in the UK. METHODS: A questionnaire was sent to curriculum organizers and clinical placement officers for all undergraduate courses in adult nursing, occupational therapy (OT) and physiotherapy (PT) in the UK to ascertain the nature and amount of rheumatology theory and clinical exposure provided. RESULTS: Of the 47 adult nursing, 26 OT and 30 PT undergraduate courses surveyed, 85-90% responded. Overall, rheumatology teaching is 5-10 h over 3 yr. Nursing students receive moderate/in-depth teaching on rheumatoid arthritis (RA) in only 52% of courses (OT 91%, PT 96%) and on osteoarthritis (OA) in 63% (OT 91%, PT 92%). Clinical experience of RA is probably/definitely available in only 56% of nursing courses (OT 72%, PT 88%), with similar results in OA. Overall, nursing students receive the least rheumatology exposure, particularly in psychosocial issues and symptom management, while PT students receive the most. OT students have limited opportunities for clinical exposure to psychosocial and joint protection issues. Use of local rheumatology clinical HP experts is variable (18-93%) and cross-disciplinary exposure is limited (0-36%). Many educators consider their rheumatology training to be insufficient (nursing 50%, PT 42%, OT 24%). CONCLUSIONS: Rheumatology training for undergraduate HPs is limited in key areas and often fails to take advantage of local clinical expertise, with nursing students particularly restricted. Clinical HP experts should consider novel methods of addressing these shortfalls within the limited curriculum time available.

Ryan S, Hassell AB, Lewis M, Farrell A. · Staffordshire Rheumatology Centre, Haywood Hospital, Stoke on Trent, UK. · J Adv Nurs. · Pubmed #16441532 No free full text.

Abstract: AIM: This paper reports a study to test the hypothesis that consultation with a clinical nurse specialist in a drug monitor clinic has a measurable impact on the well-being of patients with rheumatoid arthritis. METHOD: A single blinded randomized controlled trial was carried out with 71 patients with rheumatoid arthritis who were starting new disease-modifying anti-rheumatic therapy at a district general hospital. Patients were randomized into two groups over a 3-year recruitment period. Intervention group patients were monitored by a rheumatology clinical nurse specialist using Pendelton's framework to assess patient needs alongside safety monitoring. Control group patients were seen by an outpatient staff nurse for safety monitoring only over a 1-year period. The primary outcome measures were the Arthritis Impact Measurement Scales and the Rheumatology Attitude Index. Data were also collected on the Disease Activity Score, number of consultations with healthcare professionals and changes in drug therapy. Data were collected at baseline, 3, 7 and 12 months between 1999 and 2002. RESULTS: The Intervention group had greater change scores than the Control group for the Arthritis Impact Scale, with statistical significance shown at 7 months (P = 0.03). At 12 months the Rheumatology Attitude Index had improved by a mean of 1.8 in the Intervention group and deteriorated by 0.3 in the Control group. Changes in the Disease Activity Score were greater in the Intervention group at all time points, with statistical significance at 12 months (P = 0.048). There was little difference in the number of consultations or changes in drug therapy between the two groups. CONCLUSION: Consultation with an expert rheumatology nurse in a drug monitor clinic may add value in terms of improving patients' perceived ability to cope with the arthritis.

Ryan S, Hassell A, Dawes P, Kendall S. · Haywood Hospital, Stoke on Trent. · Nurs Times. · Pubmed #12715557 No free full text.

Abstract: Forty patients with rheumatoid arthritis were randomly recruited from an outpatient population for an in-depth, qualitative interview. The aim was to identify factors that influence whether patients feel they have any control over their condition. The data were analysed using Colaizzi's procedural steps. Four major categories that positively influence perceptions of control were identified. These were the reduction of physical symptoms, the matching of social support with perceived need, the provision of information, and the nature of the clinical consultation.

Carr A, Hewlett S, Hughes R, Mitchell H, Ryan S, Carr M, Kirwan J. · Academic Rheumatology, University of Nottingham, Nottingham, UK. · J Rheumatol. · Pubmed #12672221 No free full text.

Abstract: Our aim was to explore the patient's perspective of outcomes in rheumatoid arthritis (RA) to identify which outcomes are important to patients and how patients calibrate what constitutes a meaningful change in those outcomes. A qualitative study was performed using focus groups in 5 clinical centers in different geographical locations in the UK. Each group contained 6 to 9 patients with RA who were purposefully sampled to include men and women with a range of age, disease duration, functional disability, work disability, and current disease activity. Each focus group lasted around 1 h and addressed 3 questions: What outcomes from treatment are important to RA patients? What makes patients satisfied or dissatisfied with a treatment? How do patients decide that a treatment is working? Patients identified as important not only physical outcomes such as pain and disability, but also fatigue and a general feeling of wellness. The relative importance of these outcomes depended on the stage of disease and on specific situations, such as a disease flare. Satisfaction was influenced by communication, access to treatment, and treatment efficacy. Treatment efficacy was related to symptom reduction, with the magnitude of reduction necessary for efficacy dependent on the stage of disease. For example, large changes were deemed necessary with disease of long duration, while in early disease, even small changes could be important. Our data support existing knowledge of the importance of pain and mobility as treatment outcomes, but raise new and important issues: Some outcomes of importance to patients are not currently measured and there are no measures available to capture them. Existing measures need to be calibrated to take account of the differing importance of outcomes at different stages of disease and variations in the magnitude of change within the same outcome that indicate treatment efficacy.

Ryan S, Hassell A, Dawes P, Kendall S. · Staffordshire Rheumatology Centre, The Haywood Hospital, High Lane, Burslem, Stoke-on-Trent ST6 7AG, UK. · Rheumatology (Oxford). · Pubmed #12509626 links to  free full text

Abstract: OBJECTIVE: To identify factors that patients perceive as influencing control in living with the symptoms of rheumatoid arthritis (RA). METHOD: A sample of 40 patients with RA were recruited randomly from an out-patient population. The participants of the sample were interviewed in depth by one researcher to identify perceptions of control. They also completed two self-administered questionnaires, the Health Assessment Questionnaire and the Rheumatology Attitude Index. RESULTS: Four major categories were identified that positively influenced perceptions of control in patients living with the consequences of RA. These included: (i) the reduction of physical symptoms; (ii) social support matching perceived need; (iii) the provision of information; and (iv) the medical consultation. Components of the consultation included patient involvement, provision of information, feedback and reassurance, empathy and access to an expert. CONCLUSION: The categories identified can be influenced by health-care professionals in the management of the patient, and if the medical consultation is utilized to its full potential it can play a major role in enabling patients with RA to manage the daily symptoms of their condition.

Edwards J, Mulherin D, Ryan S, Jester R. · Cannock Chase Hospital, Staffordshire, UK. · Arthritis Rheum. · Pubmed #11308053 links to  free full text

Abstract: OBJECTIVE: To describe the experiences of patients with rheumatoid arthritis (RA) when admitted to hospital. METHODS: A selected sample of 9 women with RA of at least 3 years duration, who had experienced at least 5 days of inpatient care within the previous 2 years, underwent unstructured interviews in this qualitative, phenomenological study. Information from the interviews was analyzed using Colaizzi's 6 procedural steps. RESULTS: Five major themes emerged from the study: uncertainty during the first admission to hospital; the process of becoming an experienced patient on subsequent admissions; the evident experience and knowledge of staff; the effect, both positive and negative, of other patients; and the loss of privacy. CONCLUSION: These findings throw important new light on the experience of patients with RA receiving inpatient rheumatologic care and have the potential to significantly advance nursing practice within rheumatology.