Rheumatoid Arthritis and Biomarkers

The provided assignment is a collection of research articles and papers related to rheumatoid arthritis. It includes various topics such as the role of cytokines in the disease, mechanisms leading from systemic autoimmunity to joint-specific disease, MRP8/14 serum levels as predictors of response to biological treatments, prevention of cardiovascular disease in patients with rheumatoid arthritis, and more. The papers are from reputable sources like Nature Reviews Rheumatology, Annals of the Rheumatic Diseases, and others.

Evidence based
Practise and research
methods

Table of Contents
INTRODUCTION ..........................................................................................................................1
MAIN BODY ..................................................................................................................................1
A. Research Processes ................................................................................................................1
B. Methodology ..........................................................................................................................2
C. Types of research....................................................................................................................3
D. Journal/ Author analysis ........................................................................................................5
CONCLUSION................................................................................................................................7
.........................................................................................................................................................8
REFERENCES................................................................................................................................9

INTRODUCTION
There are several studies which describes the functional changes and common structural
in the foot affected by a disease known as rheumatoid arthritis(Zampeli, Vlachoyiannopoulos,
and Tzioufas, 2015). The people suffering from this have some form of foot pathology. This is a
report that discusses about the study that is done for exploring the experience of patients
suffering from foot problems that are related to rheumatoid arthritis. A qualitative design is used
in this study with an interpretive phenomenological approach to the data analysis and collection.
This report will help to analyse the effect of foot systems in relation to diagnosis of rheumatoid
arthritis.
MAIN BODY
A. Research Processes
The research process involves various processes such as identifying, locating, assessing
and analysing the information that is required by the researcher for conducting the research.
These all steps help in the development and expressing of the new ideas and plans for the
research. There are seven steps which are included in the research process like topic selection,
collection of background information, organisation of information and citations, evaluation of
information and research questions, draft writing, editing and correcting data and finally
preparation of final draft and cited references.
Topic selection: The topic selected by the researcher for the conduction of research is to
explore the personal experience of patients who are suffering from rheumatoid arthritis
associated with foot problems from the onset of foot symptoms through to their management.
The researcher used this as the aim of the study because the need of foot health management it is
suggested that people with rheumatoid arthritis have access to foot health services and a
specialist podiatrist (Turner, and Filer, 2015). This impacted badly on individuals and there is no
perspective of the individuals therefore, this aim is chosen for the research.
Collection of background information: The researcher collected data by focus group.
There were twenty two participants and the focus group comprised of one with eight participants
and two with seven in each and this group has males as well as females. All the focus groups
were conducted by an experienced researcher with an independent observer that took field notes.
1

Organisation of information and citations: The focus group members are encouraged
to contribute when a specific issue was raised to ensure that the experiences revealed are not of
one or two participants.
Evaluation of information and research questions: All the participants have access
professional foot care for the nails and skin (Szekanecz and Koch, 2016). Participants were
chosen who were suffering from foot problem. The evaluation of the information indicated that
the foot problem and the needs of patients are ignored by the general practitioners. The global
theme was supported by five themes that involve the significance of foot symptoms in
accordance with the diagnosis of rheumatoid arthritis and description of foot symptoms. This
includes accessing foot health intervention and effectiveness of this for improvement in this
intervention. The evaluation of the information indicated that the foot problem and the needs of
patients are sometimes ignored by the practitioners from before the diagnosis of rheumatoid
arthritis through to the management of foot problems. This global theme was supported by five
themes including the significance of foot symptoms in relation to the diagnosis of rheumatoid
arthritis knowledge and explanation of foot symptoms, accessing foot health interventions,
effectiveness of foot health interventions and improvement to foot health interventions.
B. Methodology
A research methodology is defined as a systematic plan for the conduction of a successful
research. There are different kind of research methods like quantitative and qualitative methods.
Qualitative methods aims to provide a complete, detailed description of observations that
involves the context of situations and circumstances. Some of them are listed below-
The Experiment- An experiment is a research method used for investigating cause and
effect under some conditions. The research is done by testing a hypothesis. A hypothesis is
termed as the statement of how variables are associated with other. The experimental group is a
group of individuals who are bare to independent variables.
Survey Research- A survey research method is on in which the subject respond to a
series of questions or statements (Lee, and et. al., 2015). This research method includes a target
population and these individuals are the focus of research. The sample of population is asked a
series of questions by conducting a survey. This includes a questionnaire or interview. The
questionnaire is a series of written questions or statements. The questionnaires and interviews
consists of open ended and close ended questions.
2

Participant Observation- The qualitative data is collected from the participant
observation. Participant observation is a research method in which investigators observes people
and helping them in doing routine work (Zhang, and et. al., 2015). The fieldwork makes
participant observation descriptive and exploratory and it has less rules. This is a lengthy process
and researcher has to stay in field for weeks and months.
Focus groups- A focus group involves a gathering of deliberately selected individuals
who participate in a planned discussion and this discussion is related to the research topic. There
is presence of a diverse group of people whose reactions are analysed for the research. These
groups are a collective on purpose. These groups allow members of a group to interact and
influence each other during the group discussion and consider new ideas and perspectives of
different individuals. The focus group methods helps in alternative ways of obtaining
information from people without conducting a survey. These have a flexible design and they
capitalise on the ability of decision makers to discuss with people.
In the conduction of this research, a qualitative methodology and phenomenological
approach is adopted for the data collection and data analysis. This approach considers the
experience of the participants and acknowledges the previous experiences of the researcher. This
leads to the fusion of horizons and increases the understanding. The focus groups that are chosen
in this study are useful for the collection of data. This method has different features like group
dynamics, social interaction and group synergy and this helps in creation of richness of data
(Lerner and Matthias, 2015). The focus group is chosen for completing the analysis of the study.
The participants of the study are recruited from the Salford Ethics Committee. The criteria for
participants was adults who are above 18 years of age and who are able to read and speak
English language. These individuals are chosen as participant if they have a positive diagnosis of
rheumatoid arthritis and foot problems. There were around twenty five people who fall under
this criteria and they were chosen for data collection for accomplishing the study.
C. Types of research
The research methods are defined as the systematic and scientific procedure of data
compilation, collection, interpretation, analysis and implication that pertains to any business
problem. The research methods can be classified into several categories on the basis of nature
and purpose of the study (Jiang, Li and Li, 2015). There are basically two types of research
methods used by the investigator and researcher such as quantitative and qualitative research.
3

Quantitative research- The quantitative methods focuses on objective measurements
and the statistical. This research includes mathematical or numerical analysis of data collected by
questionnaires, polls, surveys, etc. This data is also obtained by manipulation of pre existing
statistical data using the computational techniques. This research emphasises on collecting
numerical data and generalising it over the group of individuals.
Qualitative Research- The qualitative research is an exploratory research and it used for
gaining the understanding of opinion. This gives an insights into different problems and helps in
developing ideas and hypothesis for conducting a potential quantitative research (Hollan, and et.
al., 2015). The methods of data collection in qualitative method are categorised on unstructured
and semi structured techniques. Some of the common methods or techniques in qualitative
research includes focus groups, individual interviews and observations. A sample size is chosen
in this research by which data is collected for evaluating the aim of the study.
Difference between quantitative and qualitative research
Attributes Qualitative Research
Methods
Quantitative Research
Methods
Analytical objectives This research method focuses
on describing an experience
and beliefs of an individual.
This research method focuses
on describing the
characteristics of a population.
Types of questions asked Open ended questions. Closed ended questions
Data collection instrument This research method uses
semi-structured method like
in-depth interviews, participant
observations and focus groups
(Brouwer and et. al. , 2015).
Quantitative research uses
highly structured methods like
structured observation using
surveys and questionnaires.
Form of the data produced This is a descriptive data. This is a numerical data.
Degree of flexibility The participant responses
affect how and which
questions researcher asks next.
The responses of participant
does not influence or
determine how and which
questions researchers ask next.
4

In the research given, qualitative study is used for the accomplishment of the evaluation
of study (Hazlewood, and et. al., 2016). This qualitative study is used by the researcher for
conducting this research because it is good to evaluate the study on patients of rheumatoid
arthritis by collecting data directly from them and then making findings and suggestions. Foot
problems are a common problem and these diseases must be treated effectively. In the result of
this study, there is gap between the outcomes of foot health interventions and actual meaning of
this intervention. The main limitation of this study is that the number of participants are less and
they all were from the north west of England. This study was not able to represent cross section
of the wider population of people with rheumatoid arthritis related foot problems. This research
is limited to healthcare systems and this is a cultural specificity and generalizability. This
research can result in biased results as the people have volunteered to take part in this research. If
these people have negative experiences, then biasses can occur in the results. Due to this, it
cannot be said that this study reflects the experience of wider population of people with
rheumatoid arthritis related foot problems. This study helps in knowing that foot problems are
ignored is a major concern at multiple levels, that ranges from the implications of ignoring foot
symptoms which may aid diagnosis (Chaudhari, Rizvi, and Syed, 2016). The rheumatoid arthritis
present in the initial stages in small joints of feet and people ignore this. The participants thinks
that feet were ignored when a diagnosis was made when compared with the attention given to
hands.
D. Journal/ Author analysis
The analysis was carried out with a framework that was agreed by the researcher and
observer. The researcher reviews and coded the data, discussed the themes, further coded the
data and then agreed codes were organised into themes for enhancing the credibility of the
analysis (Choi, and et. al., 2015). The exemplars were identified from the transcripts for
illuminating the true 'authentic' nature of the experience of participants and for supporting the
trustworthiness of the findings. Four participants were randomly selected for reading and
verifying that the transcripts and results reflected the experience of groups.
Result of the study
There were sixteen females and six males and the duration of this disease is 13 years. All
of the participants of study were having problem of foot pain. One of the participant diagnosed
5

with diabetes. The global theme is supported by five themes that were available in focus groups.
These are discussed below-
Theme 1- The significance of foot symptoms in relation to the diagnosis of Rheumatoid
Arthritis
Most participants reported that they have experienced problems with their feet before
diagnosis of Rheumatoid arthritis was made. Most of the participants reported that their feet were
ignored by general practitioners even when foot symptoms were mentioned during a consultation
(Catrina, and et. al., 2017). The foot symptoms are a great concern to the participants and one of
the most worrying aspect of the disease. The participants claimed that the general practitioners
did not understand the significance of the foot symptoms in relation to the possibility of
rheumatoid arthritis.
Theme 2- Knowledge of and explanation about foot symptoms
The participants claimed that they had patchy knowledge of what causes the foot
problems associated with rheumatoid arthritis. Some of the participants have been into podiatry
services. The majority of the participants expressed relief once that they had acquired knowledge
about the foot symptoms.
Theme 3- Accessing foot health interventions
When the participants were diagnosed with Rheumatoid arthritis by a rheumatologist
some claimed that they have difficulty in getting foot care with delays in both being referred and
then getting an appointment with a podiatrist. Some claimed that their feet were ignored after
accident (Brzustewicz and Bryl, 2015). The rheumatologist have to be more focused on the
medical management and other areas of the body.
Theme 4- The effectiveness of foot health interventions
It has been identified that potential effectiveness of feet orthoses was restricted by styles
of foot wear which are weared by participants. This difficulty is also often ignored. When the
foot orthoses were fitted in several styles of footwear, participation was better and foot evidence
were improved (Brzustewicz and Bryl, 2015). Some of the participants have faced evidences of
wearing specialised footwear but each have claimed that choices of clothes and femininity was
reduced. Most of them have not care their foot and its related parts like nails, corns and callus.
Whereas, they have used improper footwear products so as to become fashionable in front of
6

others. But after sometime, they have understand differences between generalist and specialist
podiatrist and valued the specialists with multidisciplinary team.
Theme 5- Improvement to foot health interventions
Most of the people express their opinions which General Practitioners must have
awareness related to rheumatoid arthritis as well as the importance related to foot issues in its
investigation. Once a diagnosis is done then recommendation to podiatry services has to be taken
important for such people who are going through foot pain (Brown, Pratt and Isaacs, 2016). An
agreement has been done that podiatry services have to be valued more by its opinion which says
that deficiency within funds or managerial assistance result in obstacle. The relation of finding
footwear in which to accommodate both their feet and foot orthoses is a major issue of many
people. Thus, recommendation is that within the technology advancement scenario therapeutic
footwear have to be designed within contemporary style and should have perfect fit or
comfortable.
CONCLUSION
As per the above mentioned cased study, it has been analysed that, Rheumatoid arthritis
is a disease which directly affects on hand, feet or any other joints. This disease occurs only
when immune system of a person is highly week and it converted into may other diseases. Along
with this, the Rheumatoid Arthritis has various symptoms such as pain, swelling, fever,
weakness and many more. On the other hand, mostly womens suffer from this disease between
the age of 30 to 60 years. In this report, it has been examined that, people are not aware from this
disease and they ignore when they suffer from any find of joint pain. Furthermore, this is
analysed that every person has to think about their health and should do medical treatment on a
regular basis. Also, around 1.5 million people are suffering from Rheumatoid arthritis because
people do not have such kind of knowledge and ignore the health regarding issues. The
conclusions that were made after analysing this case are patients believes that foot systems is
essential for conducting examination of rheumatoid arthritis, foot syndrome have to be bring out
referral for foot health interventions involving surgery as well as foot health interventions. Along
with this, for particular health issue it is important to provide proper education to patient so that
they can do their activities in respective manner.
7

8

REFERENCES
Books and journals
Brouwer, J and et. al. , 2015. Fertility in women with rheumatoid arthritis: influence of disease
activity and medication. Annals of the rheumatic diseases. 74(10). pp.1836-1841.
Brown, P. M., Pratt, A. G. and Isaacs, J. D., 2016. Mechanism of action of methotrexate in
rheumatoid arthritis, and the search for biomarkers. Nature Reviews Rheumatology.
12(12). p.731.
Brzustewicz, E. and Bryl, E., 2015. The role of cytokines in the pathogenesis of rheumatoid
arthritis–Practical and potential application of cytokines as biomarkers and targets of
personalized therapy. Cytokine. 76(2). pp.527-536.
Catrina, A. I., Svensson, C.I., and et. al., 2017. Mechanisms leading from systemic autoimmunity
to joint-specific disease in rheumatoid arthritis. Nature Reviews Rheumatology. 13 (2).
p.79.
Chaudhari, K., Rizvi, S. and Syed, B.A., 2016. Rheumatoid arthritis: current and future trends.
Choi, I.Y., and et. al., 2015. MRP8/14 serum levels as a strong predictor of response to
biological treatments in patients with rheumatoid arthritis. Annals of the rheumatic
diseases. 74(3). pp.499-505.
Hazlewood, G. S., and et. al., 2016. Methotrexate monotherapy and methotrexate combination
therapy with traditional and biologic disease modifying anti‐rheumatic drugs for
rheumatoid arthritis: A network meta‐analysis. Cochrane Database of Systematic
Reviews. (8).
Hollan, I., and et. al., 2015. Prevention of cardiovascular disease in rheumatoid arthritis.
Autoimmunity reviews. 14(10). pp.952-969.
Jiang, P., Li, H. and Li, X., 2015. Diabetes mellitus risk factors in rheumatoid arthritis: a
systematic review and meta-analysis.
Lerner, A. and Matthias, T., 2015. Rheumatoid arthritis–celiac disease relationship: Joints get
that gut feeling. Autoimmunity reviews. 14(11). pp.1038-1047.
Zhang, W., and et. al., 2015. Comparison of Tripterygium wilfordii Hook F with methotrexate in
the treatment of active rheumatoid arthritis (TRIFRA): a randomised, controlled clinical
trial. Annals of the rheumatic diseases. 74(6). pp.1078-1086.
Lee, S.W., and et. al., 2015. HMGB1 induces angiogenesis in rheumatoid arthritis via HIF‐1α
activation. European journal of immunology. 45(4). pp.1216-1227.
Szekanecz, Z. and Koch, A. E., 2016. Successes and failures of chemokine-pathway targeting in
rheumatoid arthritis. Nature Reviews Rheumatology. 12(1). p.5.
Turner, J. D. and Filer, A., 2015. The role of the synovial fibroblast in rheumatoid arthritis
pathogenesis. Current opinion in rheumatology. 27(2). pp.175-182.
Zampeli, E., Vlachoyiannopoulos, P. G. and Tzioufas, A. G., 2015. Treatment of rheumatoid
arthritis: unraveling the conundrum. Journal of autoimmunity. 65. pp.1-18.
9