Findings from the RAFT trial support the use of cognitive behavioral therapy delivered by rheumatology teams to reduce the impact of fatigue among patients with rheumatoid arthritis.

Cherkin DC et al. JAMA . 2016; 315: 1240–1249. doi: 10.1001/jama.2016.2323

This care consisted of 18 weeks of fortnightly contacts focusing on weight management, leg muscle strengthening, and physical activity, as well as access to cognitive behavioral therapy for mood, sleep, and coping with pain.

Telephone-delivered exercise and cognitive behavioral interventions improve fatigue severity and impact versus usual care in people with inflammatory rheumatic diseases, LIFT study data show.

Cognitive behavioral therapy for insomnia could be delivered via the telephone to patients with osteoarthritis, proving useful for those unable to access in-person options, OATS trial findings suggest.

Nikiphorou and colleagues say that their guidance is centered around “empowering patients to become active partners of the team and to take a more proactive role,” and highlights the importance of education and self-management interventions including goal setting, problem solving, and cognitive behavioral therapy.

Therapies such as cognitive behavioral therapy (CBT) and antidepressants “may reduce pain and improve QOL in the short to medium term, although the effect size of the associations might not be clinically important to patients,” Vinícius Oliveira (Universidade Federal dos Vales do Jequitinhonha e Mucuri, Diamantina, Brazil) and co-authors write in JAMA Internal Medicine.

Placebo, followed by telephone-based cognitive behavioral therapy, does not meet noninferiority criteria compared with meloxicam for pain relief in patients with knee osteoarthritis, say US researchers.

Placebo, followed by telephone-based cognitive behavioral therapy, does not meet noninferiority criteria compared with meloxicam for pain relief in patients with knee osteoarthritis, say US researchers.

While previous guidelines were “based on a review of meta-analyses,” the current update involved “going back to the original randomized controlled trials from the inception of databases,” she says.This approach also resulted in new conditional recommendations in the updated guidelines, including for balance exercises, duloxetine, topical capsaicin for the knee, cognitive behavioral therapy, yoga for the knee, and Kinesio® taping for the base of the thumb and the knee.

Of note, lupus-prone mice who were depleted of microglial cells exhibited improvement in their depression-like behavioral deficit.

David Sherry discusses various pharmacologic and non-pharmacologic treatments for management of pediatric fibromyalgia, and outlines the impact of an interdisciplinary approach on physical function, mental health and pain outcomes in these patients.

Cognitive behavioral therapy Kashikar-Zuck et al have undertaken several studies on the use of cognitive behavioral therapy (CBT) for the treatment of pediatric fibromyalgia.

There are many outstanding cognitive-behavioral self-help programs with proven efficacy available online that are reasonable first lines of treatment for individuals with mild-to-moderate levels of symptoms.

This paper provides an overview of the relationship between mood disorders and rheumatoid arthritis, with a focus on potential mechanisms and possible therapeutic approaches. Summary Mood disorders, especially depression, occur with increased prevalence among patients with rheumatoid arthritis compared with the general population, with the notable exception of schizophrenia, which is less prevalent, probably due to the aberrant inflammatory cytokine profile apparent in schizophrenia. Potential mechanisms underlying the association between rheumatoid arthritis and mood disorders include those related to physical symptoms, stress, fatigue, emotional status, cognitive responses (such as pain catastrophizing) and behavioural responses, as well as a postulated role of the reward circuitry and neural processing. Social factors, including relationships with care providers, are an important consideration for mood disorders in rheumatoid arthritis and may also influence pain processing and disease activity. Existing medical treatments for rheumatoid arthritis need to be complemented with psychological interventions – such as cognitive-behavioral therapy, meditation-based approaches and self-management programmes. Work to reduce the social disconnect and stigmatization than can occur in rheumatoid arthritis, as well as interventions combining pharmacotherapy and psychotherapy, may be of importance for improving outcomes in rheumatological care. Sturgeon JA, Finan PH, & Zautra AJ.  Nat Rev Rheumatol  2016;12:532–542. doi:10.1038/nrrheum.2016.112

The team suggests: “Moving forward, it is important to consider strategies to actively promote changes in [physical activity], such as cognitive behavioral interventions and incorporation of psychosocial models for behavior change early following joint replacement.”