Christine Blank

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The fatigue suggests tiredness and maybe sleepiness. But the fatigue experienced by many patients with an autoimmune disease is much more than that and results in complex array of problems and challenges.

In addition to making it difficult, fatigue affects a number of areas, including quality of life, pain, sleep, depression and physical functioning.

In a recent Danish study of 487 patients with rheumatoid arthritis, psoriatric arthritis and axial spondyloarthritis 

, the researchers found “significant correlations” between fatigue and work impairment, quality of life, pain, sleep, depression and physical functioning.

Patients with these disease, sometimes grouped under the term “inflammatory arthritis, say that fatigue is an issue that rheumatologists frequently overlook, so they often believe they should accept fatigue as a part of their condition,” wrote 

 of the Copenhange Centre for Arthritis Research, and her Danish colleagues.

“However, based on the complexity of fatigue as we identified, rheumatologists and other health professionals instead need not only to be aware of the impact of fatigue on the individual patient’s life, but also to focus their care specifically on the relationship of fatigue with other aspects of the patient’s everyday life,” they wrote.

In the study, patients with the three different inflammatory disorders had around the same level of fatigue. However, fatigue was more present in women, patients who had the disease for a longer period of time, and patients who changed medication in the past 12 month. It was also more common among those who were unemployed, who had less education, and who had lower household income, the researchers found.

“Low socioeconomic status is shown to be associated with obesity and unhealthy behaviors such as smoking, heavy alcohol use, and physical inactivity,” the researchers wrote. “It is important not only for rheumatologists but for all health professionals to be aware of patients with widespread fatigue and whether patients also have low socioeconomic status, because they are expected to be more vulnerable.”

Fortunately, more clinicians are recognizing the need to manage fatigue in inflammatory arthritis patients, the researchers said.

There are some ways to help address fatigue, including mindfulness, exercise, and cognitive behavioral therapy. “However,” wrote Esbensen and her colleagues “these studies have mainly focused on patients with RA (rheumatoid arthritis) and have not necessarily considered fatigue as a multidimensional symptom. Our results suggest this needs to be considered in future planning of interventions.”

Articles

Fatigue causes a complex array of problems for people with autoimmune disease.

For Autoimmune Disease Patients, Fatigue Isn't Just Another Word for Being Tired

Strict social distancing, or “shielding,” of patients with rheumatic diseases to prevent COVID-19 infection doesn’t reduce the incidence of infection and is associated with worse mental health, researchers reported.

“Shielding” is a strict form of social distancing that requires people to remain in their homes and have minimal contact with others, even members of their own household. The European League Against Rheumatism and the British Society of Rheumatology recommended shielding for patients taking immunosuppressive medications.

British researchers looked at the effects of shielding among 1,693 patients who agreed to fill out questionnaires. Half (50%) had rheumatoid arthritis; 16%, psoriatic arthritis, and 5%, ankylosing spondylitis.

When they compared the 61 patients in the group that contracted COVID-19 with the 1,632 patients who didn’t, they found that roughly the same percentage of the COVID-19 patients had shielded as those non-COVID-19 patients (24 of 61, or 40% vs. 768 of 1,632, or 47%), although the comparison did not meet the usual standard for statistical significance.

“Our study suggests that overall strict social isolation had little impact on the incidence of COVID-19 infection,” wrote Natasha Cleaton and her co-authors in the report published in the 

Cleaton also looked at the mental and physical heath effects of shielding, comparing the 722 who shielded to the 823 who did not among the patients who didn’t contract COVID-19. They found the mental and physical health of shielding patients to be significantly lower than those who didn’t shield.

“Patients are likely to require increased mental and physical support as result of the COVID pandemic,” wrote Cleaton and her co-authors, adding that further study is needed on the efficacy and effects of shielding.

Shielding means staying at home and limiting contact with members of the household. Research also calls into question on how effective it is in reducing the incidence of COVID-19.

"Shielding," An Extreme Form of Social Distancing, Hard on Mental, Physical Health

	Pediatric asthma patients realize improved health and reduced corticosteroid use when they receive integrated care that considers personal, familial, and environmental risk factors, according to the 

 published in the October 17, 2017, issue of 

	Rather than just physical factors, lead author Alyssa A. Oland, PhD, assistant professor of psychiatry at the University of Colorado School of Medicine, and colleagues found that a number of factors-lifestyle, social and psychological-affect outcomes in children with asthma. Asthma is the most common childhood illness and disproportionately affects low-income, minority children who live in urban areas, typically because children living in low-income households are more likely to experience less parental support and involvement, and to feel more of a lack of control over their environment, the authors wrote.

	“Recent research has underscored the importance of multidisciplinary, collaborative, integrated care for pediatric asthma patients with promising results. Such a comprehensive approach is ideal for addressing the multitude of complex, inter-related psychosocial and wellness/lifestyle factors that play a role in childhood asthma,” the authors wrote.

	Children from economically disadvantaged households may also experience less access to care and poorer quality of care. For example, it is estimated that 41% of children aged 2 to 17 years do not receive needed mental health services.

	“As such, low-income, urban minority children have increased barriers to proper asthma management, including increased exposure to environmental triggers and reduced access to appropriate treatment,” the authors wrote.

	However, it is not just income that impacts asthma morbidity and mortality rates. A variety of other risk factors include: treatment non-adherence, exposure to environmental triggers, exposure to chronic stress, child psychological problems, parental stress, family functioning, obesity, physical inactivity, and unhealthy diets, according to the study. “These risk factors often have complex interactions and inter-relationships. Comprehensive studies that explore the inter-relationships of these factors in accounting for asthma morbidity and mortality are needed and would help to inform clinical intervention.”

	While there are now a range of psychosocial interventions for children with asthma, such as educational programs, behavioral interventions, cognitive-behavioral therapy, family interventions, and/or community-based interventions, research on the efficacy of psychosocial interventions is “limited, inconclusive, and plagued by concerns regarding methodological issues,” according to the authors.

	Despite these problems, “Preliminary evidence suggests that psychosocial interventions can improve the quality of life and medical outcomes for children with asthma. Interventions that combine education with psychosocial interventions, such as behavioral, cognitive-behavioral, and/or family interventions show particular promise,” they wrote.

	Self-management training and education are also well-established and essential parts of treatment for asthma patients. Studies have shown that children with asthma taking part in these programs have improved adherence, improved asthma symptoms, reduced energy room visits, fewer school absences, and other positive benefits.

	“Similarly, education combined with family therapy resulted in benefits for children and for parents, resulting in reduced airway inflammation, improved physical health, and improved mental health,” the authors wrote.

	Integrated care programs have demonstrated significant improvements in asthma symptoms, perceived competence in asthma management, reduced corticosteroid use, and improved quality of life for caregivers and children, according to the study.

A new study reveals interesting findings about improving the health of pediatric asthma patients and integrated care programs.

Integrated care can benefit pediatric asthmatics

	While breastfeeding has been thought to decrease children’s risk of developing allergies and asthma, a 

	In the largest study of its kind, researchers with Uppsala University in Uppsala, Sweden, found that breastfeeding might increase the risk of developing hay fever and eczema. Plus, they said, breastfeeding does not have any clear effect on the risk of developing asthma, according to the article published in the 

Journal of Allergy and Clinical Immunology.

	Individuals’ risk of having asthma and allergies depends on their genes, environment and lifestyle factors, wrote Weronica Ek, lead author and researcher at Uppsala University’s Department of Immunology, Genetics and Pathology.

	However, studies on breastfeeding have shown inconsistent results. “Many studies have found breastfeeding to have a protective effect against asthma and allergy, while other studies have reported increased risk,” according to an Uppsala University 

	Meanwhile, the large Uppsala University study examined self-reported data from more than 330,000 middle-aged individuals in the United Kingdom.

	They found that increased socioeconomic status lowers the risk of asthma, while it increases the risk of developing hay fever. “These results are in line with the ‘hygiene hypothesis’, which states that growing up in a cleaner environment increases the risk of being diagnosed with allergies due to a lack of early childhood exposure to microorganisms, among other things,” Uppsala University said.

	The study also showed that a high body mass index (BMI) increases the risk for asthma, hay fever and eczema. However, the risk for developing all of the conditions decreases in individuals with higher birth weight.

	The researchers noted certain limitations to the study, including the fact that it is an observational study, which does not allow for clinical recommendations to be made. “In such studies, there may always be underlying factors that the researchers do not have information about, which are the true causes of the observed effects.”

	For example, mothers who have hay fever, asthma or eczema themselves may have been advised to breastfeed or not to breastfeed, which may affect the study’s findings.

	“It is well established that breastfeeding has a positive effect on the health of the baby. Even though we do not see a protective effect of breastfeeding on the risk of developing asthma or allergies, these results should not be used to recommend or discourage breastfeeding, since the present study only investigates the effect of breastfeeding on allergies and asthma,” Uppsala University said.

	“However, we hope that our study can give a more correct picture of the health benefits of breastfeeding,” Ek added.

While breastfeeding has been  thought to decrease children’s risk of developing allergies and asthma, a new study counters that belief.

Author | Christine Blank

Articles

For Autoimmune Disease Patients, Fatigue Isn't Just Another Word for Being Tired

"Shielding," An Extreme Form of Social Distancing, Hard on Mental, Physical Health

Integrated care can benefit pediatric asthmatics

Does breastfeeding protect children against asthma?