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Vous regrettez l'insouciance des temps heureux ? Vous souhaitez retrouver votre joie de vivre ? Vivre mieux, en harmonie avec vous-même ? Mais comment faire pour redonner du sens à votre existence et conquérir durablement le bonheur ? Dans cet ouvrage, l'auteure livre 36 façons de (re)découvrir ses ressources et de façonner ses outils pour être bien dans sa vie, tout simplement. Car, le bien-être ça s'apprend et ça se cultive. Grâce à ses conseils et exercices pratiques qui vous aideront à poser un regard sur votre vie, pour mieux la comprendre, l'améliorer ou l'alléger, vous diminuerez votre niveau de stress, augmenterez votre quotient de sérénité et surtout adopterez les bonnes pratiques pour renouer avec le bonheur. Il est temps d'habiter votre vie, de la désencombrer, de la simplifier et de cheminer, en toute confiance, vers un changement positif.

Happiness. --- Self-realization. --- Personality development. --- Bonheur. --- Réalisation de soi.

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Background. Rheumatoid arthritis (RA) is a chronic, progressive inflammatory autoimmune disease that mainly affects the small joints. Amongst other, RA can be treated with rituximab (RTX) that works by CD20+ B cells depletion. In Belgium, we make use of the on-flare retreatment strategy, in which a disease flare is needed before retreatment with RTX is reimbursed. According to literature, it seems possible to taper RTX by prolonging the interval between cycles or by reducing the dose. Dose reduction of RTX was found to be safe and efficacious. The aim of this master thesis was to gain insights in the perception of rheumatologists on the on-flare retreatment strategy and dose reduction of RTX in RA. Methods. Belgian rheumatologists were invited via e-mail to take part in our qualitative study. By the means of purposive sampling, the invited group was sought out to be as diverse as possible. The participants filled in a short questionnaire for demographic data and partook in a semi-structured individual online interview. The interview guide contained questions about three main topics: RTX for RA, the retreatment strategy and tapering. After each interview a descriptive, methodologic and substantive report were made. Thereafter, the interviews were transcribed verbatim. The interviews were analysed following the Qualitative Analysis Guide of Leuven (QUAGOL). After this 10-step process themes and subthemes emerged from the interview data. Results. 13 Belgian rheumatologists were interviewed. RTX was found to be used in <5% of the patients with RA by most rheumatologists. Some perceived disadvantages were the route of administration, the slow working mechanism, the long-lasting action, the need for flare-up for retreatment and the infection risk. For selected patient groups, RTX was perceived to be an appropriate choice and had several advantages including efficacy, long-lasting activity, compliance, little drop-out and cost-effectiveness. Opinions on retreatment strategies varied between rheumatologists. On-flare strategy was deemed as appropriate by some, while others preferred a more systematic or fixed retreatment. Tapering of RTX was mainly done by prolonging the interval, with only a few rheumatologists applying dose-reduction in practice. In contrast, many of these rheumatologists would be open to dose reduction of RTX for themselves. A lack of experience and knowledge on dose reduction of RTX was indicated by the rheumatologists. Conclusion. Many Belgian rheumatologists still felt unacquainted regarding the use of RTX. Their opinions on the on-flare strategy were diverse, making it difficult to determine the best perceived retreatment strategy for RTX in patients with RA. Tapering of RTX has many advantages, and is efficacious and safe, but most rheumatologists renounce from reducing the dose of RTX and prefer increasing the time interval between RTX cycles, due to a lack of experience and knowledge. In the future, more studies should be done regarding the retreatment strategy and tapering of RTX. Furthermore, rheumatologists should be informed about the recent literature, such as the success of tapering RTX, to implement the best suited strategy in their practice. Ultimately, the aim for the future is to provide (re)treatment with RTX that is as safe as possible without losing efficacy, taking into account the burden on the patient and aiding the cost-effectiveness of treatment in RA.

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Introduction Rheumatoid Arthritis (RA) patients have an increased risk for osteoporosis and subsequently vertebral fractures (VFs). VFs increase the risk for future fractures. Radiography cannot be routinely used for the detection of VFs in the absence of typical symptoms due to its high radiation dose. Vertebral Fracture Assessment (VFA) could be an alternative. The aim of my thesis was determination of the clinical and subclinical VF prevalence in postmenopausal RA patients by VFA based on existing data and development of a protocol for a prospective study on the incidence of VFs. Methods Twenty-five postmenopausal RA patients from a preselected population, with a high pre-test probability for VFs and available VFA scan were included in a retrospective pilot study. Demographic and clinical information were collected using an electronic database. The VFA scans were analysed using quantitative analysis. A protocol for a prospective observational single-center study (VeFIRA study) was developed. Results The prevalence of osteoporosis and grade 2 VFs were 48% and 56%, respectively. Patients with grade 2 VFs had a lower femoral neck Bone Mineral Density (BMD) and T- score, higher fracture risk according to the FRAX tool and were older. No significant difference in lumbar BMD and T-score were detected. The combination of BMD and Trabecular Bone Score provided useful fracture risk information. The Ethical Committee approved the VeFIRA study in March 2016. Conclusion VFs are common among the included postmenopausal RA patients. This has to be investigated further prospectively with the focus on routine VF screening of the RA patients.

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Background. The assessment of disease activity in rheumatoid arthritis (RA) still remains a challenge because individual patients have different perceptions and require different needs. Both ends on the spectrum of disease activity, remission and flares, are accompanied withpersonal feelings and experiences. Rheumatologists often use different disease activity scores to assess the disease activity, but these may not be comprehensive enough as clinical signs not always represent how the patient is feeling. This may lead to patients not feeling understood because, they are, for example, experiencing a lot of discomfort and potentially a flare, while their rheumatologist thinks otherwise. In this master’s thesis, we wanted to investigate what patients with RA understand by remission and flares. Methods. In this study, patients with RA were interviewed to obtain their perceptions on remission and flares. The interviews were held based on a semi-structured interview guide. The individual face-to-face interviews were audio recorded and transcribed verbatim. Qualitative data was coded and analyzed on an ongoing basis in order to adjust the interview guide if necessary, while further interviews were being performed. The Qualitative Analysis Guide of Leuven (QUAGOL) was used to perform a thematic analysis and thereby construct concepts in the qualitative data. Results. From the analysis four major themes emerged: ‘What is a flare?’, ‘The impact of a flare’, ‘The New Normal’ and ‘Self-management’. Patients all believed they were able to determine for themselves whether they were experiencing a flare, while the duration of a flare was very variable. Patients frequently perceived that joint pain was the most recurrent complaint and was often accompanied with (morning)stiffness and swollen joints. Some patients also experienced extreme fatigue, even worse than pain, while others did not. They pointed out that these complaints were detrimental for their psychosocial well-being and stated that selfmanagement could be helpful to prevent and cope with a flare. Firstly, remission or disease control was seen as being pain-free. Participants stated they could live with other complaints, but suppression of pain was very important. Secondly ‘normality’ was mentioned frequently. Patients want to live their life as before they got RA and use this as a reference to indicate remission. Conclusion. Patients experienced flares as a worsening of symptoms. This caused social and psychological consequences and a reduced quality of life. They perceived remission mainly as being free of pain and/or normality.