J.J. Veldhuijzen van Zanten

Negative affectivity predicts decreased pain tolerance during low-grade inflammation in healthy women

INTRODUCTION Experimental animal studies provided evidence for a synergistic effect of immunological and psychological stressors on subsequent sickness behaviours. Up to now, little corroborating evidence for such synergy exists for humans, in whom it may provide a mechanism leading to the expression of functional somatic symptoms. The aim of the present study was to determine an interaction between stress(-vulnerability) and an immunological activation on experimental pain sensitivity, i.e., pressure pain threshold and tolerance in healthy humans. METHODS In healthy female participants (n=25, mean age 22.3 years), negative affectivity (NA) and experienced stress were assessed by questionnaire before receiving a Salmonella typhi vaccine or saline control in a randomized blinded cross-over design. Pressure pain threshold was assessed at the lower back and calves and pain tolerance was assessed at the thumbnail, before and six hours after each injection. RESULTS Vaccination induced leukocytosis (+100%) and increased serum IL-6 (+670%). NA predicted decreased pain tolerance after vaccination (β=-.57, p=.007), but not after placebo (β=.25, p=.26). Post-hoc analyses also demonstrated an association with administration order. DISCUSSION NA moderated the effects of inflammation on pain tolerance. This finding is consistent with a synergistic model whereby inflammation may lower the threshold for pain reporting in individuals with increased vulnerability for somatic symptom reporting.

Feelings of competence and relatedness during physical activity are related to well-being in rheumatoid arthritis patients: preliminary findings from a randomized control trial

Background Rheumatoid arthritis (RA) is a chronic inflammatory disease that causes joint pain, swelling and stiffness with eventual structural damage leading to physical dysfunction. Consequently, people with RA tend to experience fatigue and psychological distress. As proposed by Self-determination Theory (SDT), feelings of ownership, competence and relatedness (basic human psychological needs) during physical activity (PA) are predicted to alleviate such disease-related symptoms and improve psychological well-being in RA patients. Objectives To examine whether a Self-determination Theory-based intervention fosters basic need satisfaction. In addition, to examine the relationships between need satisfaction and indicators of psychological well-being and disease related symptoms (i.e., fatigue, depression and subjective vitality) in patients with RA following a 3 month exercise programme. Methods A RCT compared two 3 month exercise programmes. The control arm participants received a standard exercise referral programme. Patients in the experimental arm received an additional psychological intervention that aimed to foster basic need satisfaction through contacts with a SDT trained PA advisor. Participants completed the following validated measures at the end of the 3 month exercise programme; Psychological Need Satisfaction in Exercise Scale, Multidimensional Assessment of Fatigue Scale, Hospital Anxiety and Depressions Scales, and Subjective Vitality Scale. Results Preliminary analyses (N = 41 patients; Mage = 55.4 yrs) indicated that the intervention arm patients (N = 22) reported significantly greater competence need satisfaction [F (1,39) = 6.9, p = .01] than the control arm. Differences between arms for autonomy [F (1,39) = 3.63, p = .06] and relatedness [F (1,39) = .88, p = .36] favoured the intervention. Pearson correlation coefficients from all data revealed feelings of competence and relatedness after the exercise programme were significantly and negatively related to depressive symptoms (r = -.43, p = .006 and r = -.39, p = .02 respectively). Competence also demonstrated a significant positive relationship with subjective vitality (r = .42, p = .01) and a negative relationship with fatigue (r = -.49, p = .002) at the end of the 3 month exercise programme. Conclusions Results suggest that a SDT-grounded PA intervention promotes need satisfaction during exercise. In addition, need satisfaction is associated with reductions in fatigue and enhancements in psychological well-being in patients with RA. Subsequent work will examine follow-up effects at 6 and 12 months. Disclosure of Interest None Declared

FRI0723 Temporal patterns of sedentary behaviour and physical activity in patients with rheumatoid arthritis

Background Rheumatoid Arthritis (RA) is associated with increased risk of cardiovascular disease (CVD). Recent evidence suggests sedentary behaviour (waking behaviour ≤1.5 metabolic equivalents whilst sitting/lying) may contribute towards the progression of RA outcomes, including heightened CVD risk (1). Sedentary behaviour occupies the majority of waking hours among people with RA (1). However, the proportion of time spent sedentary is likely to fluctuate over the course of the day, with periods of high sedentarity representing more optimal opportunity for intervention, and thus potentially higher intervention efficacy. Objectives The aims of this study were; 1) to explore temporal patterns of sedentary behaviour (and physical activity) among RA patients, and 2) to examine associations between temporal sedentary patterns and predicted 10-year risk of CVD. Methods Patients with RA (N=97) wore a GT3X accelerometer for 7 days to assess habitual sedentary time (<100 counts/min) and physical activity (PA; light =100–2019, moderate-to-vigorous = ≥2020 counts/min). Accelerometer data were analysed separately for each hour (valid hour criteria; 60-minutes of data on ≥3 days, including a weekend day). To evaluate 10-year risk of CVD (Q-risk2), patients reported their medical history, provided a fasted blood sample and underwent assessments of blood pressure and body-mass index. Results Temporal patterns of sedentary time and PA are reported in Figure 1. Sedentary time declined throughout the morning (08:00–12:00). During the afternoon, sedentary time increased by 4.5 minutes (12:00–18:00; M =34.36±8.86 to M =39.06±7.91). A more marked increase in sedentary time was observed during leisure time (18:00–22:00; M =39.61±7.59 to M =47.90±6.30). Repeated measures analysis of variance (ANOVA) revealed sedentary time was significantly higher during leisure time (M =46.20±5.46) compared to the morning (M =36.88±5.61), and afternoon (M =38.50±6.07) [N =28, F(2,26)=43.48, p=<0.01]. Significant differences remained after accounting for employment status (i.e., employed vs. unemployed/student, F(2,23)=1.40, p=0.27). Patients who accumulated M = ≥45.31 sedentary minutes during their leisure time (18:00–23:00, median split), had significantly higher 10-year risk of CVD (M =22.23±13.83) compared to those accruing M=<45.31 sedentary minutes (M=8.09±7.62) [t(41)=3.92, p=<0.01]. Finally, hourly patterns for light PA were the reverse of those observed for sedentary time. Hourly MVPA engagement was consistently <3 minutes (peak MVPA at 09:00–10:00, M =2.47±4.16). Conclusions Interventions targeting leisure time sedentary behaviour (18:00–23:00), relative to more occupational sedentary behaviour (08:00–18:00), may offer the greatest potential for sedentary time reduction and associated improvements of CVD risk profile. Due to inverse patterns of engagement, replacing leisure time sedentary behaviour with light PA may offer an effective intervention approach. References Fenton SAM & Kitas GD. Rheumatoid Arthritis: Sedentary behaviour in RA – a new research agenda. Nat Rev Rheumatol 2016;12(12):698–700. Disclosure of Interest None declared

SAT0712 Self-reported sedentary behaviour is adversely associated with microvascular endothelial function in patients with rheumatoid arthritis

Background Patients with Rheumatoid Arthritis (RA) are at increased risk for cardiovascular disease (CVD). Research suggests impaired vascular function contributes to this heightened risk. At present, little is known regarding factors associated with vascular function in RA. Epidemiological evidence demonstrates sedentary behaviour (i.e., waking behaviour ≤1.5 metabolic equivalents whilst sitting or lying), to be adversely linked to CVD risk in the general population. Whilst the biological processes underlying this relationship are not understood, vascular dysfunction may play a role (1, 2). However, research is yet to examine the association between sedentary behaviour and vascular function in healthy adults and/or clinical populations. Studies investigating this relationship in RA, will help to determine the extent to which sedentary behaviour may represent a modifiable risk factor for CVD in these patients. Objectives To investigate the cross-sectional associations between sedentary behaviour and microvascular and large vessel endothelial function among patients with RA. Methods Fifty-three patients with RA participated in the study (M age=52.9±12.8, 72% female). Laser Doppler imaging with iontophoresis was used to assess microvascular endothelium-dependent (acetylcholine, ACh) and endothelium-independent (sodium nitroprusside, SNP) function. Large vessel endothelium-dependent and endothelium-independent functions were measured via flow-mediated dilation (FMD) and glyceryl trinitrate dilation (GTN), respectively. Sedentary behaviour was self-reported via the International Physical Activity Questionnaire (hours/week sitting). Data were analysed using multiple linear regressions adjusted for traditional CVD risk factors; age, gender, total cholesterol, smoking status, family history of CVD, hypertension and body-mass-index. Results Sitting time (hours/week, M =39.2±17.9) was significantly negatively related to % increase in perfusion in response to ACh (β=−0.30, p<0.05) and SNP (β=−0.37, p<0.01) after adjustment for traditional CVD risk factors. Sitting time accounted for 8% and 12% of the variance in microvascular endothelium-dependent function (ACh) and endothelium-independent function (SNP), respectively (traditional CVD risk factors, R2=0.3). No significant associations were observed between self-reported sitting time and large vessel endothelium-dependent vasodilation (FMD, β=0.16, p=0.29) or independent vasodilation (GTN, β=−0.08, p=0.55). Conclusions Sedentary behaviour appears to adversely affect microvascular endothelial function, but not large vessel function in patients with RA. It may therefore represent a modifiable risk factor for CVD in this population. Experimental studies employing objective measures of sedentary behaviour are necessary to confirm these findings, and to determine the utility of sedentary behaviour interventions for improving vascular function and reducing CVD risk in RA. References Thosar SS, Bielko SL, Mather KJ, et al. Effect of Prolonged Sitting and Breaks in Sitting Time on Endothelial Function. Med Sci Sports Exerc 2015:47(4);843–9. Fenton SAM & Kitas GD. Rheumatoid Arthritis: Sedentary behaviour in RA – a new research agenda. Nat Rev Rheumatol 2016:12(12):698–700. Disclosure of Interest None declared

ASSOCIATIONS BETWEEN OBJECTIVE AND SELF-REPORTED PHYSICAL ACTIVITY DATA IN RHEUMATOID ARTHRITIS PATIENTS

Background Rheumatoid arthritis (RA) patients suffer from periodic flare-ups causing joint swelling, pain and potential bone destruction. In addition, RA patient are at greater risk of cardiovascular disease. Therefore, physical activity (PA) has been identified as an important component of a holistic treatment programme [1]. However, research suggests that RA patients fail to reach the recommended PA levels to gain the associated benefits [2]. PA is typically assessed in the exercise literature with self-report measures or via accelerometery. To our knowledge, little is known about the associations between self-reported and objective PA measures in RA patients. Objectives To describe and compare the self-reported and objectively measured physical activity profiles of RA patients. Secondly, to investigate the associations between self-reported and objectively measured PA levels in RA patients. Methods 68 participants (42 female, 4 missing) wore an accelerometer (Actigraph) for an average of 6±1 days. The International Physical Activity Questionnaire (IPAQ) was also completed in reference to the same targeted time period. The associations between objective/self-reported PA levels were examined on sedentary time/total sitting time, light PA/walking, and moderate, vigorous PA and moderate-to-vigorous PA (MVPA) from both meassurements. Results Self-reported time spent sitting (M=343±141 minutes) was significantly less than objectively measured sedentary time (M=583±98; t=-13.12, p<0.01). Participants reported significantly more moderate intensity PA behaviour (M=86±83 minutes) than was objectively recorded (M=19±17 minutes; t=6.65, p<0.01), and more vigorous PA (M=10±37 minutes) than that revealed via accelerometry (M≤1 minute; t=2.14, p<0.01). Objective sedentary time was positively correlated with self-reported levels of sitting (r=0.29, p<0.05). Objective light PA was positively associated with self-reported MVPA (r=0.27, p<0.05). Objective moderate PA was also positively correlated to subjective walking time (r=0.28, p<0.05) and reported moderate PA (r=0.30, p<0.05). Conclusions Patients with RA reported engagement in significantly less sedentary time and significantly more physical activity than was objectively revealed via accelerometry. Despite the over-estimation of subjective PA and under-estimation of obejctive sedentary behaviour, the observed moderate significant associations provide some evidence of convergent validity for the IPAQ echoing findings from previous research [3]. The significant moderate correlation between self-reported MVPA and objective light PA suggests that RA patients may perceive PA to require more exertion. Therefore, the PA intensity guidelines may need to be re-considered for RA patients. References Feinglass J, Thompson JA, et al. Effect of physical activity on functional status among older middle-age adults with arthritis. Arthritis & Rheumatism 2005;53(6):879-885. Fontaine KR, Heo M, & Bathon J. Are US adults with arthritis meeting public health recommendations for physical activity? Arthritism & Rheumatis 2004;50(2):624-628. Boon RM, Hamlin MJ, Steel GD, & Ross JJ. Validation of the New Zealand Physical Activity Questionnaire (NZPAQ-LF) and the International Physical Activity Questionnaire (IPAQ-LF) with accelerometry. British Journal of Sports Medicine 2008;44(10):741-746 Acknowledgements Medical Research Council and NPRI. Disclosure of Interest : None declared DOI 10.1136/annrheumdis-2014-eular.5529

THE SUBJECTIVE VITALITY SCALE IS AN INDICATOR OF PHYSICAL AND PSYCHOLOGICAL HEALTH AMONGST RHEUMATOID ARTHRITIS PATIENTS

Background Rheumatoid arthritis (RA) is the most prevalent chronic inflammatory arthritis characterized by periods of remission and flares in disease activity unique to each individual. Consequently, patients with RA experience fluctuations in both physical and psychological health and well-being (1). Subjective vitality is an indicator of positive health/optimal functioning and has been conceptualised as a sense of being alive and full of energy. Therefore, if the Subjective Vitality Scale (2) demonstrates convergent validity with indicators of physical and psychological health in RA patients, it could provide a brief and clinically relevant assessment tool. Objectives To investigate the associations between subjective vitality and indicators of physical health (i.e. physical function and cardio-respiratory fitness), and psychological health (i.e. quality of life, fatigue, depression and anxiety) amongst RA patients. Methods Patients with RA (N=106, age 54.5±12.3 years, 68% women) completed a questionnaire pack and an exercise tolerance test to assess cardio-respiratory fitness (VO2max).The Subjective Vitality Scale contains five items (e.g. “I feel alive and full of vitality”). Participants responded to how much vitality, over the last two weeks, they felt, using a scale anchored by 1 (not at all true) and 7 (very true). Participants were also asked to complete the following measures: Multidimensional Assessment of Fatigue to measure physical function, (3) Hospital Anxiety and Depression Scales, (4) Health Assessment Questionnaire to measure physical function (5) and the EuroQol (6). A blood sample was provided to measure C-reactive protein, an indicator of disease activity. Results Partial correlations were conducted controlling for age, gender and disease activity. Results revealed significant (p<0.05) positive relationships between subjective vitality and two indicators of physical health (function r=0.55 and fitness r=0.22). Significant relationships, in the expected direction, were also observed between subjective vitality and indicators of psychological health (Quality of Life r=0.60, Fatigue r= -0.66, Depression r= -0.73 and anxiety r= -0.57). Conclusions The Subjective Vitality Scale is a brief self-reported questionnaire that associates with improvements in both physical and psychological health amongst patients with RA. These significant associations support the convergent validity of the instrument. Healthcare professional could use the Subjective Vitality Scale to identify RA patients experiencing compromised physical health and well-being as well as provide an additional outcome measure to assess the effectiveness of treatment programmes. References Covic T, Cumming S, Pallant J, Manolios N, Emery P, Conaghan P, et al. Depression and anxiety in patients with rheumatoid arthritis: prevalence rates based on a comparison of the Depression, Anxiety and Stress Scale (DASS) and the hospital, Anxiety and Depression Scale (HADS). BMC Psychiatry 2012;12(1):6. Ryan RM, Frederick C. On energy, personality, and health: Subjective vitality as a dynamic reflection of well-being. Journal of Personality 1997;65(3):529-65. Acknowledgements Medical Research Council and NPRI Disclosure of Interest None declared DOI 10.1136/annrheumdis-2014-eular.5037