Developing a group intervention to manage fatigue in rheumatoid arthritis through modifying physical activity.

BACKGROUND: Fatigue is a major symptom of rheumatoid arthritis (RA). There is some evidence that physical activity (PA) may be effective in reducing RA fatigue. However, few PA interventions have been designed to manage fatigue and there is limited evidence of end-user input into intervention development. The aim of this research was to co-design an intervention to support self-management of RA fatigue through modifying PA. METHODS: A series of studies used mixed methodological approaches to co-design a fatigue management intervention focused on modifying PA based on UK Medical Research Council guidance, and informed by the Behaviour Change Wheel theoretical framework. Development was based on existing evidence, preferences of RA patients and rheumatology healthcare professionals, and practical issues regarding intervention format, content and implementation. RESULTS: The resulting group-based intervention consists of seven sessions delivered by a physiotherapist over 12 weeks. Each session includes an education and discussion session followed by supervised PA chosen by the participant. The intervention is designed to support modification and maintenance of PA as a means of managing fatigue. This is underpinned by evidence-based behaviour change techniques that might support changes in PA behaviour. Intervention delivery is interactive and aims to enhance capability, opportunity and motivation for PA. CONCLUSION: This study outlines stages in the systematic development of a theory-based intervention designed through consultation with RA patients and healthcare professionals to reduce the impact of RA fatigue. The feasibility of future evaluation of the intervention should now be determined.

The peptide carrier Pep-1 forms biologically efficient nanoparticle complexes.

Cell-penetrating peptides (CPPs) constitute a family of peptides whose unique characteristic is their ability to insert into and cross biological membranes. Cell-penetrating peptide carriers of the Pep family are amphipathic peptides which have been shown to deliver peptides and proteins into a wide variety of cells through formation of non-covalent complexes with their cargo. In this study, we have investigated the morphological features of different Pep-1/cargo complexes by scanning electron microscopy and light scattering measurements. We provide first-time evidence that biologically efficient complexes of Pep-1/p27Kip tumour suppressor physically exist in the form of discrete nanoparticles. Moreover, we have characterized the relationship between the Pep-1/cargo ratio, the size and homogeneity of the nanoparticles formed, and their efficiency in delivering the cargo into cells, and report that particle size and homogeneity is both directly dependent on the ratio of Pep-1/cargo formulations, and responsible for their biological efficiency.