Royal National Hospital for Rheumatic Diseases NHS Foundation Trust

Bath, United Kingdom

Royal National Hospital for Rheumatic Diseases NHS Foundation Trust

Bath, United Kingdom
SEARCH FILTERS
Time filter
Source Type

Tansley S.,Royal National Hospital for Rheumatic Diseases NHS Foundation Trust | Gunawardena H.,Southmead Hospital
Clinical Reviews in Allergy and Immunology | Year: 2014

The idiopathic inflammatory myopathies: polymyositis (PM) and dermatomyositis (DM) have been historically defined by broad clinical and pathological criteria. These conditions affect both adults and children with clinical features including muscle weakness, skin disease and internal organ involvement. Over the last few years, it has become increasingly apparent that using a clinico-serological approach, both DM and PM can be defined into more homogeneous subsets. A large number of antibodies are directed against cytoplasmic or nuclear components involved in key regulatory intra-cellular processes including protein synthesis, translocation and gene transcription within this disease spectrum. In addition, these autoantibodies are found in patients with clinical features other than myositis, in particular ‘idiopathic’ interstitial pneumonia emphasizing that these patients may in fact be a formes-frustes of autoimmune connective tissue disease. Other important findings are the identification of specific autoantibodies in both cancer-associated dermatomyositis, clinically amyopathic dermatomyositis and juvenile dermatomyositis, which previously were classically described as antibody-negative clinical subsets. Finally, work has highlighted how target autoantigens identified in the myositis-connective tissue disease overlap share common cellular mechanisms, which provides us with further insights into disease pathogenesis. © 2013, Springer Science+Business Media New York.


Vowles K.E.,Haywood Hospital | Vowles K.E.,Keele University | Vowles K.E.,Royal National Hospital for Rheumatic Diseases NHS Foundation Trust | Vowles K.E.,University of Bath | And 5 more authors.
Behaviour Research and Therapy | Year: 2011

Recent developments in CBT emphasize the promotion of psychological flexibility to improve daily functioning for people with a wide range of health conditions. In particular, one of these approaches, Acceptance and Commitment Therapy (ACT), has been studied for treatment of chronic pain. While trials have provided good support for treatment effectiveness through follow-ups of as long as seven months, the longer-term impact is not known. The present study of 108 participants with chronic pain examined outcomes three years after treatment completion and included analyses of two key treatment processes, acceptance of pain and values-based action. Overall, results indicated significant improvements in emotional and physical functioning relative to the start of treatment, as well as good maintenance of treatment gains relative to an earlier follow-up assessment. Effect size statistics were generally medium or large. At the three-year follow-up, 64.8% of patients had reliably improved in at least one key domain. Improvements in acceptance of pain and values-based action were associated with improvements in outcome measures. A "treatment responder" analysis, using variables collected at pre-treatment and shorter term follow-up, failed to identify any salient predictors of response. This study adds to the growing literature supporting the effectiveness of ACT for chronic pain and yields evidence for both statistical and clinical significance of improvements over a three-year period. © 2011 Elsevier Ltd.


Brown S.,Royal National Hospital for Rheumatic Diseases NHS Foundation Trust
Nursing standard (Royal College of Nursing (Great Britain) : 1987) | Year: 2012

This article describes the characteristics of Raynaud's phenomenon, focusing on the role of the specialist nurse in diagnosis and management of the condition. Pharmacological and non-pharmacological treatment options are discussed, along with the importance of self-management. Advice is provided to help nurses enable patients to minimise episodes and improve symptoms. In the majority of cases, Raynaud's phenomenon is a treatable condition, and patients can learn to self-manage the disease.


Turton A.J.,University of the West of England | Palmer M.,University of the West of England | Grieve S.,Royal National Hospital for Rheumatic Diseases NHS Foundation Trust | Moss T.P.,University of the West of England | And 3 more authors.
Frontiers in Human Neuroscience | Year: 2013

Patients with Complex Regional Pain Syndrome (CRPS) experience distressing changes in body perception. However representing body perception is a challenge. A digital media tool for communicating body perception disturbances was developed. A proof of concept study evaluating the acceptability of the application for patients to communicate their body perception is reported in this methods paper. Thirteen CRPS participants admitted to a 2-week inpatient rehabilitation program used the application in a consultation with a research nurse. Audio recordings were made of the process and a structured questionnaire was administered to capture experiences of using the tool. Participants produced powerful images of disturbances in their body perception. All reported the tool acceptable for communicating their body perception. Participants described the positive impact of now seeing an image they had previously only imagined and could now convey to others. The application has provided a novel way for communicating perceptions that are otherwise difficult to convey. © 2013 Turton, Palmer, Grieve, Moss, Lewis and McCabe.


Brown S.,Royal National Hospital for Rheumatic Diseases NHS Foundation Trust
Nursing standard (Royal College of Nursing (Great Britain) : 1987) | Year: 2010

This article discusses the role of the nurse specialist in the management of patients with systemic sclerosis, focusing on helping patients to deal with the physical, psychological and social effects associated with digital ulcers.


Brown S.,Royal National Hospital for Rheumatic Diseases NHS Foundation Trust
Lupus | Year: 2013

This paper considers the experiences of people with lupus in comparison with those with diabetes, and discusses the impact of lupus specialist nurses in information-giving and education under the guise of 'just in case' vs. 'just in time'. Now recognized as a difficult condition to diagnose, lupus can lead to significant worry and distress especially during delays to diagnosis and times of high disease activity. Providing appropriate, individualized information to people with lupus is embedded in specialist nursing practice and enables individuals to use the tools of self-management approaches in gaining control over everyday symptoms.


Lewis J.S.,McGill University | Lewis J.S.,Royal National Hospital for Rheumatic Diseases NHS Foundation Trust | Schweinhardt P.,McGill University
European Journal of Pain (United Kingdom) | Year: 2012

Background: Disturbances in body perception are increasingly acknowledged as a feature of complex regional pain syndrome (CRPS). Conventional treatments have limited success particularly among those with long-standing disease. Understanding the relationship between body perception disturbance, pain and tactile acuity might provide insight into alternative avenues for treatment. The aim of this study was to test the hypotheses that (1) body perception disturbance is positively related to pain and (2) decreased tactile acuity is related to increased body perception disturbance. Methods: A controlled observational design was used to measure these features among those with CRPS of one arm. The extent of body perception disturbance was assessed using the Bath CRPS body perception disturbance scale and pain was measured using the neuropathic pain symptom inventory. Two-point discrimination threshold testing was performed as a measure of tactile acuity. Results: Findings confirmed both hypotheses. Body perception disturbance was found to positively correlate with pain such that those in greater pain had more extensive body perception disturbance (r = 0.57, p < 0.01). Furthermore, a positive correlation was revealed between body perception disturbance and two-point discrimination thresholds (r = 0.5, p < 0.025) so those with greater body perception disturbance had worse tactile acuity. Interestingly, those with longer disease duration had significantly greater body perception disturbance (r = 0.66, p < 0.001). Conclusion: Aberrant central processing is suggested as the neural correlate of body perception disturbance and tactile impairment. The exact relationship between body perception disturbance, pain and tactile acuity and how they may be modulated for pain relief requires further exploration. © 2012 European Federation of International Association for the Study of Pain Chapters.


PubMed | University of Bristol and Royal National Hospital for Rheumatic Diseases NHS Foundation Trust
Type: Journal Article | Journal: Clinical child psychology and psychiatry | Year: 2015

Chronic fatigue syndrome or myalgic encephalomyelitis (CFS/ME) is a disabling condition known to have a negative impact on all aspects of a childs life. However, little is understood about the impact of CFS/ME on siblings. A total of 34 siblings completed questionnaires measuring depression (Hospital Anxiety and Depression Scale (HADS)), anxiety (HADS and Spence Childrens Anxiety Scale (SCAS)) and European Quality-of-life-Youth (EQ-5D-Y). These scores were compared with scores from normative samples. Siblings had higher levels of anxiety on the SCAS than adolescents of the same age recruited from a normative sample; however, depression and quality-of-life were similar. Interviews were undertaken with nine siblings of children with CFS/ME who returned questionnaires. Interview data were analysed using a framework approach to thematic analysis. Siblings identified restrictions on family life, not knowing and lack of communication as negative impacts on their family, and change of role/focus, emotional reactions and social stigma as negative impacts on themselves. They also described positive communication, social support and extra activities as protective factors. Paediatric services should be aware of the impact of CFS/ME on the siblings of children with CFS/ME, understand the importance of assessing paediatric CFS/ME patients within the context of their family and consider providing information for siblings about CFS/ME.


Vowles K.E.,The Interdisciplinary Center | McCracken L.M.,Royal National Hospital for Rheumatic Diseases NHS Foundation Trust
Behaviour Research and Therapy | Year: 2010

Psychologically-based interventions for chronic pain traditionally include a mix of methods, including physical conditioning, training in relaxation or attention control, strategies to decrease irrational or dysfunctional thinking patterns, and activity management training. Recent developments suggest additional methods to promote acceptance, mindfulness, values-based action, and cognitive defusion (a cognitive process entailing change in the influences exerted by thoughts without necessarily changing their form or frequency). Collectively, these processes entail what is referred to as psychological flexibility. This study examined how changes in traditionally conceived methods of coping compare to changes in psychological flexibility in relation to improvements in functioning over the course of an interdisciplinary treatment program. Participants were 114 chronic pain sufferers. Results indicated that changes in the traditionally conceived methods were essentially unrelated to treatment improvements, while changes in psychological flexibility were consistently and significantly related to these improvements. We suggest that psychological flexibility appears highly relevant to the study of chronic pain and to future treatment developments. The utility of more traditionally conceived pain management strategies, on the other hand, may require a reappraisal. © 2009 Elsevier Ltd. All rights reserved.


Vermaak E.,Royal National Hospital for Rheumatic Diseases NHS Foundation Trust | McHugh N.,Royal National Hospital for Rheumatic Diseases NHS Foundation Trust
International Journal of Clinical Rheumatology | Year: 2012

Dermatomyositis (DM) is a rare chronic autoimmune condition characterized by proximal muscle weakness, characteristic skin lesions and frequently, specific autoantibodies. Involvement of other organ systems, particularly the lungs, is usual and the condition is associated with malignancy in a significant proportion. The morbidity and mortality associated with DM remains high, despite the availability of a large number of therapeutic agents. Over the recent years, considerable progress has been made in the diagnosis and classification of these patients, particularly in the area of myositis-specific antibodies, which has provided further insight into the etiopathogenesis of this complex disease. Advances made in imaging techniques, especially MRI, have enhanced the diagnostic pathway in DM and provided novel means of monitoring disease activity and response to treatment. Although a number of exciting therapeutic trials are underway, the evidence base for the treatment of DM is found wanting. The aim of this review is to give an update on the approach to management of DM. © 2012 Future Medicine Ltd.

Loading Royal National Hospital for Rheumatic Diseases NHS Foundation Trust collaborators
Loading Royal National Hospital for Rheumatic Diseases NHS Foundation Trust collaborators