Comparison of health-related quality of life in rheumatoid arthritis, psoriatic arthritis and psoriasis and effects of etanercept treatment Targeting motivation and self-regulation to increase physical activity among patients with rheumatoid arthritis: a randomised controlled trial Systematic literature review of domains assessed in psoriatic arthritis to inform the update of the psoriatic arthritis core domain set Engagement and satisfaction with an Internet-based physical activity intervention in patients with rheumatoid arthritis. Discriminant validity, responsiveness and reliability of the arthritis-specific Work Productivity Survey assessing workplace and household productivity within and outside the home in patients with axial spondyloarthritis, including nonradiographic axial spondyloarthritis and ankylosing spondylitis Infliximab improves health related quality of life and physical function in patients with psoriatic arthritis Active Treatment for Idiopathic Adolescent Scoliosis (ACTIvATeS): a feasibility study. A patient-initiated DMARD self-monitoring service for people with rheumatoid or psoriatic arthritis on methotrexate: a randomised controlled trial Development of a digital Childhood Health Assessment Questionnaire for systematic monitoring of disease activity in daily practice. Patient-reported outcomes better discriminate active treatment from placebo in randomized controlled trials in rheumatoid arthritis. Using internet technology to deliver a home-based physical activity intervention for patients with rheumatoid arthritis: A randomized controlled trial. A tailored-guided internet-based cognitive-behavioral intervention for patients with rheumatoid arthritis as an adjunct to standard rheumatological care: results of a randomized controlled trial Feasibility and preliminary efficacy of a physical activity counseling intervention using Fitbit in people with knee osteoarthritis: the TRACK-OA study protocol A web-based physical activity intervention benefits persons with low self-efficacy in COPD: results from a randomized controlled trial Effectiveness of a Web-Based Physical Activity Intervention in Patients With Knee and/or Hip Osteoarthritis: Randomized Controlled Trial Policy‐Into‐Practice for Rheumatoid Arthritis: Randomized Controlled Trial and Cohort Study of E‐Learning Targeting Improved Physiotherapy Management Psoriatic arthritis (PA): a clinical, immunological and radiological study of 180 patients.
Objectives To compare health-related quality of life ( HRQoL ) before and after treatment with etanercept in patients with moderate to severe rheumatoid arthritis ( RA ) , psoriatic arthritis ( PsA ) and psoriasis using spydergram representations . Methods Data from r and omised , controlled trials of etanercept in patients with RA , PsA and psoriasis were analysed . HRQoL was assessed by the medical outcomes survey short form 36 ( SF-36 ) physical ( PCS ) and mental ( MCS ) component summary and domain scores . Baseline comparisons with age and gender-matched norms and treatment-associated changes in domain scores were quantified using spydergrams and the health utility SF-6D measure . Results Mean baseline PCS scores were lower than age and gender-matched norms in patients with RA and PsA , but near normative values in patients with psoriasis ; MCS scores at baseline were near normal in PsA and psoriasis but low in RA . Treatment with etanercept result ed in improvements in PCS and MCS scores as well as individual SF-36 domains across all indications . Mean baseline SF-6D scores were higher in psoriasis than in RA or PsA ; clinical ly meaningful improvements in SF-6D were observed in all three patient population s following treatment with etanercept . Conclusions Patients with RA , PsA and psoriasis demonstrated unique HRQoL profiles at baseline . Treatment with etanercept was associated with improvements in PCS and MCS scores as well as individual domain scores in patients with RA , PsA and psoriasis The purpose of this study is to evaluate the effects of targeting both the motivation and action phases of behaviour change in a 5-week intervention to increase physical activity ( PA )  among patients with rheumatoid arthritis ( RA ) not meeting current PA recommendations . In a r and omised controlled trial , a control group — which received a group-based patient education session led by a physical therapist — was compared to a treatment group which received the education session plus a motivational interview from a physical therapist and two self-regulation coaching sessions from a rheumatology nurse . Outcomes included  leisure-time PA , days per week with at least 30 min of moderate-intensity PA , self-efficacy and autonomous motivation ( cognitions which predict PA initiation and maintenance ) , disease activity , functional status , depressive symptoms and fatigue . Effects were assessed using mixed models repeated measures . Of the 78 patients r and omised , 76 and 67 completed the post-treatment and follow-up assessment s , respectively . Significant treatment effects were found for leisure-time PA  ( p = 0.022 ) , active days/week ( p = 0.016 ) , self-efficacy ( p = 0.008 ) and autonomous motivation ( p = 0.001 ) . At post-treatment and 6-months follow-up , significantly more treated patients than controls met current PA recommendations . No significant effects were found for disease activity , functional status , depressive symptoms or fatigue . Combining motivation- and action-focused intervention approaches improved PA-related cognitions and led to improved uptake and maintenance of leisure-time PA . However , further research is necessary to identify ways of helping patients with RA transition to— and maintain — more intensive forms of PA which are more likely to improve disease activity and functional status The objectives of this systematic literature review ( SLR ) were to identify domains and outcome measures used in psoriatic arthritis ( PsA ) studies in the past 5 years , and to compare the measurement of the Outcome Measures in Rheumatology ( OMERACT ) 2006 PsA Core Domain Set in studies published in 2010–2015 vs those published in 2006–2010 . We performed a systematic literature search in two data bases , PubMed and Embase , to identify r and omised controlled trials ( RCTs ) in PsA. We also identified PsA longitudinal observational studies ( LOS ) . Three patient research partners provided input into study conception , and data collection and interpretation . We identified 41 studies representing 22 unique RCTs , 27 LOS and 12 registries . Across all studies , we identified 24 domains and 169 outcome measures . In addition to the PsA Core Domain Set ( 6 domains ) , the following domains were also assessed in more than 30 % of RCTs : acute phase reactants , dactylitis , enthesitis , fatigue and work productivity . We identified a range of 1–15 outcome measures per domain with a mean ( SD ) of 7 ( 4.7 ) per domain . The complete PsA Core Domain Set was assessed in 59 % of RCTs in 2010–2015 compared to 23.5 % RCTs in 2006–2010 . There has been increased measurement of the PsA Core Domain Set in RCTs and LOS in the past 5 years . Numerous additional outcomes were also measured . The PsA Core Domain Set needs an up date to st and ardise PsA outcome assessment s. This SLR will inform the development of an up date d PsA Core Domain Set with patient research partner input OBJECTIVE To assess the engagement in and satisfaction with an Internet-mediated physical activity intervention with individual supervision in patients with rheumatoid arthritis ( RA ) . METHODS The intervention studied was one of the two strategies aim ed at enhancing physical activity in RA patients that were being compared in a r and omized controlled trial . A total of 82 patients , all experienced in using Internet and e-mail and registered at three different rheumatology out-patient clinics , were r and omly allocated to the Internet-mediated individualized intervention ( 52 weeks ) . They had access to personal physical activity schedules and received individual supervision by a physical therapist by means of weekly e-mail feedback . In addition , telephone contacts , an online discussion forum , six face-to-face group meetings and electronic newsletters were offered . Besides registration of returned physical activity schedules , engagement and satisfaction were measured through question naires . RESULTS The median physical activity schedule return rate of the 82 participants was 55 % . The mean number of patients logging into the website at least once a week was 53 ( 70 % ) over 12 months . Of all patients , 69 returned the question naires ( response 84 % ) . Telephone contacts were used by 38/67 patients ( 57 % ) , the mean ( SD ) number of attended group meetings was 3.1 ( 1.5 ) and the discussion forum comprised 15 posted messages . Overall , the proportions of patients being ( very ) satisfied with the amount of e-mail contacts , telephone contacts , usefulness of website information , physical activity schedules , group meetings and website layout were > /=85 % . A smaller proportion of patients were satisfied with the links to other websites ( 68 % ) , the newsletters ( 55 % ) and the online discussion forum ( 32 % ) . CONCLUSION Physical activity schedules with weekly feedback by e-mail , telephone contacts and a limited number of group meetings were frequently used website tools and modes of communication of an Internet-based physical activity intervention , with high-satisfaction rates from RA patients . Discussion forum and newsletters were less used and appreciated . Caution should be taken when extrapolating the results found to groups of patients who are not experienced Internet and e-mail users or patients with more severe physical disabilities Introduction The arthritis-specific Work Productivity Survey ( WPS ) was developed to evaluate productivity limitations associated with arthritis within and outside the home . There is an unmet need for an instrument assessing similar productivity limitations in axial spondyloarthritis ( axSpA ) , including nonradiographic axSpA and ankylosing spondylitis . Following its validation in rheumatoid and psoriatic arthritis , we aim ed to assess psychometric properties of WPS in adult-onset active axSpA in this analysis . Methods Psychometric properties were assessed using data from the RAPID-axSpA trial ( NCT01087762 ) in which research ers investigated certolizumab pegol efficacy and safety in axSpA. WPS was completed at baseline and every 4 weeks until week 24 . Validity was evaluated at study baseline via known-groups defined by the first and third quartile cutoffs of patient scores to Ankylosing Spondylitis Disease Activity Score ( ASDAS ) , Bath Ankylosing Spondylitis Disease Activity Index ( BASDAI ) , back pain , Bath Ankylosing Spondylitis Functional Index ( BASFI ) , Short Form 36 health survey ( SF-36 ) and Ankylosing Spondylitis Quality of Life Scale ( ASQoL ) . Responsiveness and reliability were assessed by comparing WPS mean changes in ASAS 20 % improvement criteria ( ASAS20 ) , BASDAI50 , ASDAS clinical ly important improvement/major improvement ( CII/MI ) and BASFI minimum clinical ly important difference ( MCID ) responders versus nonresponders at week 12 . All comparisons were conducted on observed cases in the r and omized set using a nonparametric bootstrap-t method . Results The results confirmed the psychometric properties of WPS . AxSpA patients with a worse health state had significantly more days of household work lost , household work with reduced productivity , social activities missed and outside help hired , as well as a higher interference rate of arthritis , than patients with a better health state . Similarly , employed patients with a worse health state had significantly more work days lost or with productivity reduced , and a higher interference of arthritis on work productivity . Similar findings were also observed in the nonradiographic ( nr ) axSpA and AS sub population s. The WPS was responsive to clinical changes , with responders reporting larger improvements at week 12 in WPS scores versus nonresponders . Effect sizes in responders were generally moderate to large ( st and ardized response mean > 0.5 ) . Conclusions These analyses demonstrate that WPS is a valid , responsive and reliable instrument for the measurement of productivity within and outside the home in adult-onset axSpA , as well as the in sub population s of AS and Objectives : To evaluate the effect of infliximab on health related quality of life ( HRQoL ) and physical function in patients with active psoriatic arthritis ( PsA ) in the IMPACT 2 trial . Methods : 200 patients with PsA unresponsive to conventional treatment were r and omised to intravenous infusions of infliximab 5 mg/kg or placebo at weeks 0 , 2 , 6 , 14 , and 22 ; patients with inadequate response entered early escape at week 16 .  HRQoL was assessed using the Short Form-36 ( SF-36 ) at weeks 0 , 14 , and 24 . Functional disability was assessed using the Health Assessment Question naire ( HAQ ) at every visit through week 24 . Associations between changes in quality of life ( SF-36 ) and articular ( American College of Rheumatology ( ACR ) ) and dermatological ( Psoriasis Area and Severity Index ( PASI ) ) responses were examined . Results : Mean percentage improvement from baseline in HAQ was 48.6 % in the infliximab group compared with worsening of 18.4 % in the placebo group at week 14 ( p<0.001 ) . Furthermore , 58.6 % and 19.4 % of infliximab and placebo treated patients , respectively , achieved a clinical ly meaningful improvement in HAQ ( that is , ⩾0.3 unit decrease ) at week 14 ( p<0.001 ) . Increases in physical and mental component summary ( PCS and MCS ) scores and all eight scales of the SF-36 in the infliximab group were greater than those in the placebo group at week 14 ( p⩽0.001 ) . These benefits were sustained through week 24 . Patients achieving ACR20 and PASI75 responses had the greatest improvements in PCS and MCS scores . Conclusions : In patients with PsA  , infliximab 5 mg/kg significantly improved HRQoL and physical function compared with placebo through 24 weeks BACKGROUND The feasibility of conducting a definitive r and omised controlled trial ( RCT ) evaluating the clinical effectiveness and cost-effectiveness of scoliosis-specific exercises ( SSEs ) for adolescent idiopathic scoliosis ( AIS ) is uncertain . OBJECTIVES The aim of this study was to assess the feasibility of conducting a large , multicentre trial of SSE treatment for patients with AIS , in comparison with st and ard care , and to refine elements of the study design . The objectives were to ( 1 ) up date a systematic review of controlled trials evaluating the efficacy of SSE in AIS ; ( 2 ) survey UK orthopaedic surgeons and physiotherapists to determine current practice , patient population s and equipoise ; ( 3 ) r and omise 50 adolescents to a feasibility trial of either usual care or SSE interventions across a range of sites ; ( 4 ) develop , document and assess acceptability and adherence of interventions ; ( 5 ) assess and describe training requirements of physiotherapists ; and ( 6 ) gain user input in all relevant stages of treatment and protocol design . DESIGN Multicomponent feasibility study including UK clinician survey , systematic literature review and a r and omised feasibility trial . SETTING The r and omised feasibility study involved four secondary care NHS trusts providing specialist care for patients with AIS . PARTICIPANTS The r and omised feasibility study recruited people aged 10 - 16 years with mild AIS ( Cobb angle of < 50 ° ) . INTERVENTIONS The r and omised study allocated participants to st and ard practice of advice and education or a physiotherapy SSE programme supported by a home exercise plan . Our choice of intervention was informed by a systematic review of exercise interventions for AIS . MAIN OUTCOME MEASURES The main outcome was feasibility of recruitment to the r and omised study . Other elements were to inform choice of outcomes for a definitive trial and included curve severity , quality of life , requirement for surgery/brace , adverse events , psychological symptoms , costs and health utilities . RESULTS A UK survey of orthopaedic consultants and physiotherapists indicated a wide variation in current provision of exercise therapy through physiotherapy services . It also found that clinicians from at least 15 centres would be willing to have their patients involved in a full study . A systematic review up date found five new studies that were generally of low quality but showed some promise of effectiveness of SSE . The r and omised study recruited 58 patients from four NHS trusts over 11 months and exceeded the pre-specified target recruitment rate of 1.4 participants per centre per month , with acceptable 6-month follow-up ( currently 73 % ) . Adherence to treatment was variable ( 56 % of participants completed treatment offered ) . The qualitative study found the exercise programme to be highly acceptable . We learnt important lessons from patient and public involvement during the study in terms of study and intervention presentation , as well as practical elements such as scheduling of intervention sessions . CONCLUSIONS A definitive RCT evaluating clinical effectiveness and cost-effectiveness of SSE for idiopathic scoliosis is warranted and feasible . Such a RCT is a priority for future work in the area . There is a sufficiently large patient base , combined with willingness to be r and omised within specialist UK centres . Interventions developed during the feasibility study were acceptable to patients , families and physiotherapists and can be given within the affordability envelope of current levels of physiotherapy commissioning . TRIAL REGISTRATION Current Controlled Trials IS RCT N90480705 . FUNDING This project was funded by the NIHR Health Technology Assessment programme and will be published in full in Health Technology Assessment ; Vol . 19 , No. 55 . See the NIHR Journals Library website for further project information Objective To determine the effectiveness of a patient-initiated disease-modifying antirheumatic drugs ( DMARD ) self-monitoring service for people with rheumatoid ( RA ) or psoriatic arthritis ( PsA ) on methotrexate .  Methods A two-arm , single-centre , r and omised controlled trial assessing superiority in relation to healthcare use , clinical and psychosocial outcomes . Participants were 100 adults with either RA or PsA on a stable dose of methotrexate , r and omly assigned to usual care or the patient-initiated service .  Intervention participants were trained how to underst and and interpret their blood tests and use this information to initiate care from their clinical nurse specialist ( CNS ) . The primary outcome was the number of outpatient visits to the CNS during the trial period . Differences between groups were analysed using Poisson regression models . Secondary outcomes were collected at baseline and after the third and sixth blood tests . Disease activity was measured using either the Disease Activity Score in 28 joints or Psoriatic Arthritis Response Criteria ( PsARC ) , pain and fatigue using a visual numeric scale and the Health Assessment Question -II , Hospital Anxiety and Depression Scale and SF12 were completed to assess disability , mood and quality of life , respectively . Differences between groups over time on secondary outcomes were analysed using multilevel models . Results The patient-initiated DMARD self-monitoring service was associated with 54.55 % fewer visits to the CNS ( p<0.0001 ) , 6.80 % fewer visits to the rheumatologist ( p=0.23 ) and 38.80 % fewer visits to the general practitioner ( p=0.07 ) , compared with control participants . There was no association between trial arm and any of the clinical or psychosocial outcomes . Conclusions The results suggest that a patient-initiated service that incorporates patients ’ self-monitoring DMARD therapy can lead to significant reductions in healthcare use , while maintaining clinical and psychosocial well-being . Trial registration number IS RCT N21613721 OBJECTIVE To develop a reliable and user-friendly digital Childhood HAQ ( CHAQ ) to facilitate systematic monitoring of disease activity at the outpatient clinic in juvenile idiopathic arthritis ( JIA ) patients . METHODS The digital CHAQ was tested with patients who visited the outpatient paediatric rheumatology clinic of the Erasmus MC Sophia Children 's Hospital . These patients completed in a r and omized order the paper form and digital CHAQ while being observed . Validity was tested by comparing outcomes with the paper form CHAQ .  User-friendliness was evaluated through a short question naire . RESULTS A digital CHAQ was developed and revised several times according to our observations . Outcome is automatically calculated and can be printed . Fifty-one patients completed both the digital and paper form CHAQ . Correlation coefficient between both outcomes of the CHAQ Disability Index was 0.974 . No statistically significantly differences in median outcome were found in visual analogue scale ( VAS ) pain ( 25.6 vs 25.9 mm ) and VAS well-being ( 20.1 vs 19.5 mm ) . Although the mean time ( 5.06 min ) to complete the digital CHAQ was significantly longer than the mean time ( 3.75 min ) to complete the paper form , the majority of patients ( 75 % ) preferred the digital version . User-friendliness received maximum positive score . CONCLUSION We developed a reliable and user-friendly digital CHAQ , which can be easily and systematic ally completed during routine clinic visits . Such digitalization of question naires can be applied in any field to make systematic monitoring of disease activity in daily practice possible BACKGROUND Recent r and omized controlled trials ( RCTs ) in rheumatoid arthritis ( RA ) have used patient- and physician-reported outcomes , ESR and /or CRP as components of ACR response criteria to assess efficacy . OBJECTIVES Mean changes from baseline in patient- and physician-reported outcome measures , ESR and CRP were compared in two RCTs in patients with active RA . Comparisons between active and placebo treatment used mean percentage improvements and st and ard effect sizes ( SESs ) . RESULTS In both protocol s , patient-reported assessment s of disease activity , pain and physical function reflected little or no improvement with placebo , best discriminating between active and placebo therapy , as did ESR and CRP . CONCLUSION Improvements in signs and symptoms of active RA in placebo RCTs appear to be best reflected by patient-reported measures of physical function , as long as reported changes in global assessment s of disease activity and /or pain reflect similar benefit . Patient-reported outcome measures should be considered objective ; treatment-associated changes are congruent with measures of inflammation , and appear less susceptible to the placebo response OBJECTIVE To compare the effectiveness of 2 Internet-based physical activity interventions for patients with rheumatoid arthritis ( RA ) . METHODS A total of 160 physically inactive patients with RA who had a computer with Internet access were r and omly assigned to an Internet-based physical activity program with individual guidance , a bicycle ergometer , and group contacts ( individualized training [ IT ] group ; n = 82 ) or to an Internet-based program providing only general information on exercises and physical activity ( general training [ GT ] group ; n = 78 ) . Outcome measures included quantity of physical activity ( question naire and activity monitor ) , functional ability , quality of life , and disease activity ( baseline , 3 , 6 , 9 , and 12 months ) . RESULTS The proportion of physically active patients was significantly greater in the IT than in the GT group at 6 ( 38 % versus 22 % ) and 9 months ( 35 % versus 11 % ; both P < 0.05 ) regarding a moderate intensity level for 30 minutes in succession on at least 5 days a week , and at 6 ( 35 % versus 13 % ) , 9 ( 40 % versus 14 % ) , and 12 months ( 34 % versus 10 % ; all P < 0.005 ) regarding a vigorous intensity level for 20 minutes in succession on at least 3 days a week . In general , there were no statistically significant differences regarding changes in physical activity as measured with an activity monitor , functional ability , quality of life , or disease activity . CONCLUSION An Internet-based physical activity intervention with individually tailored supervision , exercise equipment , and group contacts is more effective with respect to the proportion of patients who report meeting physical activity recommendations than an Internet-based program without these additional elements in patients with RA . No differences were found regarding the total amount of physical activity measured with an activity monitor Abstract For patients with chronic pain conditions such as rheumatoid arthritis ( RA ) , who experience elevated levels of distress , tailored-guided internet-based cognitive-behavioral treatment may be effective in improving psychological and physical functioning , and reducing the impact of RA on daily life . A multicenter , r and omized controlled trial was conducted for RA patients with elevated levels of distress as assessed by a disease-specific measure . The control group ( n = 71 ) received st and ard care and the intervention group ( n = 62 ) additionally received an internet-based tailored cognitive-behavioral intervention . Main analyses were performed using a linear mixed model estimating differences between the intervention and control groups in scores of psychological functioning , physical functioning , and impact of RA on daily life at preassesment and post assessment , and at 3 , 6 , 9 , and 12 months . Patients who received the internet-based intervention reported a larger improvement in psychological functioning compared with the control group , indicating less depressed mood ( P < 0.001 , d = 0.54 ) , negative mood ( P = 0.01 , d = 0.38 ) , and anxiety ( P < 0.001 , d = 0.48 ) during the course of the 1-year follow-up period . Regarding physical functioning , a trend was found for the intervention group reporting less fatigue than the control group ( P = 0.06 , d = 0.24 ) , whereas no effect was found on pain . No effects were found for the impact of RA on daily life , except for the intervention group experiencing fewer role limitations due to emotional problems ( P < 0.001 , d = 0.53 ) . Offering guided internet-based cognitive-behavioral therapy is a promising development to aid patients with psychological distress particularly in improving psychological functioning . Further research on adherence and specific intervention ingredients is warranted Background Physical activity ( PA ) reduces pain and improves functioning in people with knee osteoarthritis ( OA ) , but few people with the condition meet recommended PA guidelines . Successful intervention strategies to increase PA include goal setting , action planning , self-monitoring , and follow-up feedback from a healthcare professional . Recently developed consumer wearable activity trackers allow users to set activity goals , self-monitor daily goal -progress , and provide feedback on goal attainment . It is hypothesized that a multi-component physiotherapist-led intervention that includes a short ( 40-min ) education module , guided goal - setting and action planning , the use of a wristb and activity tracker , and weekly follow-up phone calls will lead to increased PA outcomes . Methods / design Thirty-six participants will be recruited from the community for a two-group pilot r and omized controlled trial with a stepped-wedge design using an intention-to-treat analysis . Computer-generated block r and omization will be performed using varying block sizes and a 1:1 allocation ratio . The 4-week intervention will be delivered immediately ( immediate-intervention group ) or after a 5-week delay ( delayed-intervention group ) . Outcome measures of pain and disability ( Knee Injury and OA Outcome Score ) , disease self-management ability ( Partners in Health Scale ) , and objective bouted moderate-to-vigorous PA and sedentary time ( BodyMedia SenseWear Mini Armb and ) will be collected at baseline ( week 0 ) and two follow-ups ( weeks 5 and 10 ) , for a total study duration of 11 weeks . Feasibility data relating to process , re source , management , and scientific elements of the trial will be collected . Outcome measure and feasibility data will be summarized , and an estimate of intervention efficacy will be obtained by regression model with planned comparisons . The trial began recruiting in February 2015 . To date , 34 subjects have been recruited . Discussion This study will evaluate the feasibility and preliminary efficacy of a novel intervention to promote  PA in people living with knee OA . The results will provide valuable information to inform a larger r and omized trial to assess intervention effectiveness . Trial registration Clinical Trials.gov Identifier : NCT02313506 ( registration date 8 December 2014 ) . First participant r and omized 20 February 2015 Promoting  physical activity ( PA ) is of top priority in chronic obstructive pulmonary disease ( COPD ) . This study examines the influence of an internet-delivered intervention on the relationship between exercise self-efficacy and changes in PA , physical health , and exercise capacity in COPD . 112 U.S. Veterans with COPD were r and omized to either a comparison ( pedometer alone ) or an intervention group ( pedometer plus access to an internet-mediated PA intervention ) . There was a significant interaction between baseline exercise self-efficacy and r and omization group on change in PA . In the comparison group , there was a significant relationship between higher baseline exercise self-efficacy and greater change in PA , whereas in the intervention group , improvements in PA were independent of level of baseline self-efficacy . Similar patterns were found with physical health and exercise capacity as outcomes . The use of an internet-mediated intervention significantly benefited persons with COPD who had low baseline self-efficacy to increase PA  and  physical health . Clinical trial registration The r and omized clinical trial was registered on Clinical Trials.gov ( NCT01772082 ) Background Patients with knee and /or hip osteoarthritis ( OA ) are less physically active than the general population , while the benefits of physical activity ( PA ) have been well documented . Based on the behavioral grade d activity treatment , we developed a Web-based intervention to improve PA levels in patients with knee and /or hip OA , entitled “ Join2move ” . The Join2move intervention is a self-paced 9-week PA program in which the patient ’s favorite recreational activity is gradually increased in a time-contingent way . Objective The aim of the study was to investigate whether a fully automated Web-based PA intervention in patients with knee and /or hip OA would result in improved levels of PA , physical function , and self-perceived effect compared with a waiting list control group . Methods The study design was a two-armed r and omized controlled trial which was not blinded . Volunteers were recruited via articles in newspapers and health-related websites . Eligibility criteria for participants were : ( 1 ) aged 50 - 75 years , ( 2 ) self-reported knee and /or hip OA , ( 3 ) self-reported inactivity ( 30 minutes of moderate PA , 5 times or less per week ) , ( 4 ) no face-to-face consultation with a health care provider other than general practitioners , for OA in the last 6 months , ( 5 ) ability to access the Internet weekly , and ( 6 ) no contra-indications to exercise without supervision . Baseline , 3-month , and 12-month follow-up data were collected through online question naires . Primary outcomes were PA , physical function , and self-perceived effect . In a subgroup of participants , PA was measured objective ly using accelerometers . Secondary outcomes were pain , fatigue , anxiety , depression , symptoms , quality of life , self-efficacy , pain coping , and locus of control . Results Of the 581 interested respondents , 199 eligible participants were r and omly assigned to the intervention ( n=100 ) or waiting list control group ( n=99 ) . Response rates of question naires were 84.4 % ( 168/199 ) after 3 months and 75.4 % ( 150/199 ) after 12 months . In this study , 94.0 % ( 94/100 ) of participants actually started the program , and 46.0 % ( 46/100 ) reached the adherence threshold of 6 out of 9 modules completed . At 3 months , participants in the intervention group reported a significantly improved physical function status ( difference=6.5 points , 95 % CI 1.8 - 11.2 ) and a positive self-perceived effect ( OR 10.7 , 95 % CI 4.3 - 26.4 ) compared with the control group . No effect was found for self-reported PA . After 12 months , the intervention group showed higher levels of subjective ( difference=21.2 points , 95 % CI 3.6 - 38.9 ) and objective PA ( difference=24 minutes , 95 % CI 0.5 - 46.8 ) compared with the control group . After 12 months , no effect was found for physical function ( difference=5 points , 95 % CI −1.0 to 11.0 ) and self-perceived effect ( OR 1.2 , 95 % CI 0.6 - 2.4 ) . For several secondary endpoints , the intervention group demonstrated improvements in favor of the intervention group . Conclusions Join2move result ed in changes in the desired direction for several primary and secondary outcomes . Given the benefits and its self-help format , Join2move could be a component in the effort to enhance PA in sedentary patients with knee and /or hip OA . Trial Registration The Netherl and s National Trial Register : NTR2483 ; http://www.trialregister.nl/trialreg/admin/ rct view.asp?TC=2483 ( Archived by WebCite at http://www.webcitation.org/67NqS6Beq ) To examine the effectiveness of a physiotherapy‐specific , web‐based e‐learning platform , “ RAP‐el , ” in best‐ practice management of rheumatoid arthritis ( RA ) using a single‐blind , r and omized controlled trial ( RCT ) and prospect i ve cohort study We carried out a prospect i ve study of the clinical , laboratory and radiological features of 180 patients with psoriatic arthritis . We initially classified our patients into five groups as described in the publications of Moll and Wright . Thirty-seven per cent had oligoarthritis , 36 % polyarthritis , 23 % spondarthritis ( sacroiliitis and /or spondylitis ) and 4 % had the mutilans form . The distal joint arthritis type did not exist as an entity and the distal interphalangeal ( DIP ) joints were affected in all groups . The spondarthritis form includes patients with exclusively axial manifestations and also those who in addition have peripheral arthritis ( oligoarthritis , polyarthritis , DIP arthritis ) . Only 53 % of our patients had nail involvement . We found an increase of IgA levels in patients with axial disease . This suggests a relationship between ankylosing spondylitis and psoriatic spondylitis . The HLA-B17/Cw6 association increased in the oligoarticular form . The increase of antigen B17 correlated with the spondarthritic and oligoarthritis forms whereas Cw6 was more important in the oligoarthritis form . An increase of the HLA-B27/Cw1 association and the spondarthritic form was also found . Moreover , we detected a greater incidence of the HLA-B27 antigen in patients with bilateral sacroiliitis ( 85 % ) than in patients with unilateral sacroiliitis ( 22 % ) . Our work revealed that PA is not a harmless disease ; 57 % of our patients had erosive arthritis while 19 % had ARA class III or IV functional impairment
There is very limited evidence for the effectiveness of IDIs on PA and HRQoL in RA and JIA and no evidence for their effectiveness in PsA or AS
The aim of this systematic review was to evaluate the evidence from r and omised controlled trials ( RCTs ) evaluating the effectiveness of interactive digital interventions ( IDIs ) for physical activity ( PA )  and  health related quality of life ( HRQoL )  in people with Inflammatory Arthritis [ rheumatoid arthritis ( RA ) , juvenile idiopathic arthritis ( JIA ) axial Spondyloarthritis ( AS ) and psoriatic arthritis ( PsA ) ] .