Health-related quality of life of US adults with arthritis: analysis of data from the behavioral risk factor surveillance system, 2003, 2005, and 2007

Follow-up of health-related quality of life and pain in a cohort of patients with rheumatoid arthritis before and after COVID-19

BACKGROUND

The foot is one of the anatomical structures of the body most affected in rheumatoid arthritis (RA), associated with the disability of patients, even more during COVID-19. The aim of this study was to analyse whether the period of physical inactivity during COVID-19 is an influential factor on health-related quality of life and foot pain in patients with RA.

METHODS

162 patients with foot pain and RA, recruited from the Hospital Virgen de las Nieves, Granada (Spain) were included. Data was collected during two different periods: January - December 2018 in person and June - September 2021 by phone. Patients were asked to complete the Spanish adapted version of the 12-Item Short Form Survey (SF-12) and the Visual Analogue Scale (VAS).

RESULTS

The results from the SF-12 questionnaires were divided between its two subscales (i.e., mental, and physical component). The physical component shows an improvement between 2018 and 2021, from 32.05 in 2018-35.18 in 2021 (p < 0.05). The opposite happened with the mental component, showing a deterioration, from 39.69 in 2018-34.48 in 2021 (p < 0.05). Regarding pain, VAS shows higher levels of pain with statistically significant differences, both in general pain (from 6 in 2018-7 in 2012) and in foot pain (from 5 to 7), (p < 0.05).

CONCLUSION

Mental quality of life and pain, both general and foot pain, are influenced by the period of physical inactivity during COVID-19.

LEVEL OF EVIDENCE

Level II.

Global Burden of Disease Study 2019: an opportunity to understand the growing prevalence and impact of hip, knee, hand and other osteoarthritis in Australia

BACKGROUND

Understanding population-level trends in osteoarthritis (OA) is critical for planning health services and disease prevention initiatives.

AIM

To examine trends in the burden of hip, knee, hand and other OA related conditions in Australia from 1990 to 2019 and consider the OA burden in the context of other common conditions associated with older age.

METHODS

Global Burden of Disease Study 2019 data for Australia on OA prevalence, OA-related years lived with disability (YLDs) and OA-related YLDs attributable to high body mass index (BMI) were sourced for 1990-2019. Age-standardised YLD data for ischaemic heart disease, stroke, dementia, type 2 diabetes and chronic obstructive pulmonary disease were obtained for comparison.

RESULTS

Overall, 3.20 million Australians were estimated to have OA in 2019, with substantial growth in the prevalence of hip (+171%), knee (+126%), hand (+110%) and other types of OA (+130%) from 1990 to 2019. Age-standardised prevalence rates reflect the contribution of population ageing. Concomitant growth in OA-related YLDs was also evident; knee OA and hand OA demonstrated the highest disease burden in 2019 (59 684 and 41 893 YLDs respectively). The proportion of knee OA burden attributable to high BMI was 36% in 2019. In 2019, age-standardised YLD rates were higher for OA (313 per 100 000 population) than other common conditions (range: 47 per 100 000 (ischaemic heart disease) to 284 per 100 000 (type 2 diabetes)).

CONCLUSIONS

OA is an increasingly prevalent, impactful condition with a high non-fatal disease burden relative to other health conditions. Growth in OA populations and OA-related disability underscore the need for enhanced investment in prevention and management.

Static Foot Disturbances and the Quality of Life of Older Person with Rheumatoid Arthritis

Disturbed static foot function is one of the main causes of impaired quality of life, which may be related to the frailty syndrome of older adult patients with Rheumatoid Arthitis (RA). The aim of the study was to evaluate the relationship between parameters of static foot function disturbances and quality of life of older adult patients with RA. The study was performed among 102 patients with RA diagnosed according to the American College of Rheumatology (ACR) and EULAR 2010 criteria. Patients were divided into four subgroups depending on radiological evaluation according to the Steinbrocker classification. Plantoconturography examination was conducted using a podoscope with a 3D scanner and software for computer foot examination CQ ST2K. Quality of life of patients with RA was evaluated using the Arthritis Impact Measurement Scales-2 (AIMS-2). A statistically significant relationship between AIMS-2 and parameters of static foot function disturbances was observed. The study revealed correlations between parameters of disturbed static foot function and RA severity in comparison to disease duration. Our results indicate a relationship between static foot function disturbances and quality of life of patients with RA, not only in the area of physical activity, but also in the social an emotional domain. Study results indicate that plantoconturography and assessment of quality of life using AIMS-2 could be useful as a diagnostic and prognostic tool in RA.

Indoor solid fuel use and incident arthritis among middle-aged and older adults in rural China: A nationwide population-based cohort study

BACKGROUND

Many households in developing countries, including China, rely on the traditional use of solid fuels for cooking and heating. Arthritis is highly prevalent in middle-aged and older adults and is a major cause of disability. However, evidence linking indoor solid fuel use with arthritis is scarce in this age group (≥45 years) in developing countries.

OBJECTIVES

To investigate whether exposure to indoor solid fuel for cooking and heating is associated with arthritis in middle-aged and older adults in rural China.

METHODS

Data for the present study were extracted from the China Health and Retirement Longitudinal Study (CHARLS), a longitudinal national prospective study of adults aged 45 years and older enrolled in 2010 and followed up through 2015. We included 7807 rural participants without arthritis at baseline, of whom 1548 living in a central heating area in winter were included in the heating analysis (taking the Qinling-Huaihe line as the heating boundary). Cox proportional hazards models were used to examine the association between indoor solid fuel use and arthritis, controlling for age, sex, education, marital status, smoking status, drinking status, self-reported socioeconomic status, BMI, sleep time, napping time, independent cooking, hypertension, diabetes, dyslipidemia, heart problems and stroke. We also investigated the effect of switching primary fuels and using solid fuels for both cooking and heating on arthritis risk.

RESULTS

The mean (SD) age of the study participants was 59.2 (10.0) years old, and 48.0% of participants were women. A total of 64.8% and 63.0% of the participants reported primarily using solid fuel for cooking and heating, respectively. Arthritis incidence rates were lower among clean fuel users than solid fuel users. Compared to those using clean fuels, cooking and heating solid fuel users had a higher risk of arthritis, with hazard ratios (HRs) of 1.22 (95% confidence interval (CI): 1.01, 1.49) and 1.76 (95% CI: 1.07, 2.89), respectively. Switching from clean fuels to solid fuels for heating (HR: 3.28, 95% CI: 1.21, 7.91) and using solid fuels for both cooking and heating (HR, 1.71, 95% CI, 1.01-2.79) increased the risk of arthritis.

CONCLUSIONS

Long-term solid fuel use for indoor cooking and heating is associated with an increased risk of arthritis events among adults aged 45 years and older in rural China. The potential benefits of reducing indoor solid fuel use in groups at high risk for arthritis merit further exploration.

Number of Physically Inactive Adults With Arthritis in the United States Who Could Improve Physical Function and Pain Control by Exercising

We estimated the number of physically inactive US adults with arthritis by state and nationally who could improve their physical function and pain control by participating in an exercise program. Our calculations were based on number-needed-to-treat, arthritis prevalence, physical inactivity, and 2010 US Census data. Estimates were lowest in the District of Columbia (physical function, n = 4,412; pain, n = 2,451) and highest in Texas (physical function, n = 325,504; pain, n = 180,835). Overall estimates were 4,119,792 for physical function and 2,288,771 for pain control. State-level estimates are important for allocating resources, public health program planning, and future research.

Effects of extracorporeal shock wave therapy in patients with knee osteoarthritis: A cohort study protocol

BACKGROUND

Osteoarthritis is the most common form of arthritis, and is a major cause of disability and chronic pain in adults. However, there is very limited evidence in the scientific literature to support the effectiveness of extracorporeal shockwave therapy (ESWT) in human knee osteoarthritis. This retrospective study aimed to compare the efficacy of ESWT treatment with sham-ESWT on pain, walking speed, physical function, and adverse effects in knee osteoarthritis.

METHODS

This study will be performed and reported in accordance with the Strengthening the Reporting of Observational studies in Epidemiology checklist. We reviewed patients diagnosed with knee osteoarthritis at our academic center from 2016 to 2017. This retrospective cohort study was approved by the institutional review board in Ruijin Hospital. The primary outcome measure was pain on movement measured by a 100-cm visual analog scale. The secondary outcome measures included the Western Ontario and McMaster University Osteoarthritis Index, range of motion, and adverse effects. Statistical analysis was performed using Statistical Package for Social Sciences version 20.0 (IBM Corporation, Armonk, NY). A P-value of <.05 was defined as statistical significance.

RESULTS

The hypothesis was that ESWT would be an effective treatment for improving pain and physical function in knee osteoarthritis to control symptoms.

TRIAL REGISTRATION

This study protocol was registered in Research Registry (researchregistry5801).

Quality of Life and Life Satisfaction in Former Athletes: A Systematic Review and Meta-Analysis

Background

Sport participation has many physical and psychosocial benefits, but there is also an inherent risk of injury, subsequent osteoarthritis and psychological challenges that can negatively impact quality of life (QOL). Considering the multifaceted impacts of sport participation on QOL across the lifespan, there is a need to consolidate and present the evidence on QOL in former sport participants.

Objective

To evaluate QOL and life satisfaction in former sport participants, and determine what factors are associated with QOL and life satisfaction in this population.

Methods

Eight electronic databases were systematically searched in July 2018 to retrieve all articles that evaluated QOL or life satisfaction in former sport participants. Two authors independently screened titles/abstracts and full texts, extracted data, and appraised methodological quality using a modified Downs and Black Checklist. Random-effects meta-analysis estimated pooled mean and 95% confidence intervals (Cis) for Mental Component Scores (MCS) and Physical Component Scores (PCS) derived from the SF-12, SF-36, VR-12 and VR-36 measures. MCS and PCS were pooled for all former sport participants, as well as professional- and collegiate-athlete subgroups. Data that were inappropriate for meta-analysis (i.e. EQ-5D, PROMIS and life-satisfaction outcomes) were collated and reported descriptively.

Results

Seventeen articles evaluated QOL or life satisfaction in a total of 6692 former athletes [eight studies (n = 4255) former professional athletes; six studies (n = 1946) former collegiate athletes; two studies (n = 491) included both] with a mean age ranging from 21 to 66 years. Most studies were cross-sectional (15 of 17 articles) and 12 studies had a moderate risk of bias (n = 1 high-risk, n = 4 low-risk). Unpublished data were provided for five studies. Meta-analysis of seven studies resulted in a pooled PCS mean (95% CI) of 50.0 (46.6–53.3) [former professional athletes from two studies: 46.7 (42.1–51.2), former collegiate athletes from five studies: 51.2 (48.4–53.9)] and a pooled MCS of 51.4 (50.5–52.2) [former professional athletes: 52.7 (51.3–54.2), former collegiate athletes: 50.9 (50.0–51.8)]. Factors associated with worse QOL or life satisfaction in former athletes included involuntary retirement from sport (three studies), collision/high-contact sport compared with low/no-contact sport (three studies), three or more concussions compared with no/fewer concussions (two studies), increased body mass index (BMI) (worse PCS, three studies), and osteoarthritis or musculoskeletal issues (worse PCS and MCS, three studies; worse PCS but not MCS, two studies).

Conclusions

Former athletes had similar PCS and better MCS, compared to general-population norms. Former athletes with impaired PCS reported better MCS than population norms, highlighting the need to use an instrument that differentiates between physical and mental components of QOL in former sport participants. Factors associated with worse QOL that may explain between-study variation include involuntary retirement, collision/high contact sports, concussion, BMI and osteoarthritis.

PROSPERO

CRD42018104319.

Electronic supplementary material

The online version of this article (10.1007/s40279-019-01163-0) contains supplementary material, which is available to authorized users.

Doctor-Diagnosed Arthritis and Self-Reported Physical Health Function Among Middle-Aged and Older Adults With Serious Mental Illness

Arthritis is one of the most common chronic conditions in aging adults, with both physical and mental health issues and consequences. However, there is insufficient arthritis research among aging adults with serious mental illness (SMI). This study examined rates of doctor-diagnosed arthritis and its cross-sectional associations with self-reported physical health function among adults aged 50 years and older with SMI. Community-based mental health center participants (n = 176) reported clinical and sociodemographic data (e.g., physical health function, sex), whereas diagnostic information (i.e., arthritis, psychiatric, and medical diagnoses) was retrieved from medical records. Arthritis prevalence was high (43.8%) and had an independent, negative association with physical health function. Findings suggest that arthritis evaluations and intervention services need to be prioritized in middle-aged and older adults with SMI. Future research should focus on further testing arthritis self-management programs and other nonpharmacological psychosocial approaches for arthritis in aging adults with SMI.

Associations of Arthritis-Attributable Interference with Routine Life Activities: A Modifiable Source of Compromised Quality-of-Life

OBJECTIVE

Arthritis patients experience the impact of disease beyond routinely assessed clinical measures. We characterized arthritis-attributable interference in four important routine life domains: 1) recreation/leisure/hobbies; 2) household chores; 3) errands/shopping; and 4) social activities.

METHODS

Participants were from the Arthritis Conditions Health Effects Survey (2005-2006), a cross-sectional survey of noninstitutionalized US adults 45 years or older with doctor-diagnosed arthritis (n = 1793). We estimated the prevalence of "a lot" of arthritis-attributable interference and quantified the associations between sociodemographic, clinical, and psychological characteristics and "a lot" of arthritis-attributable interference (vs "a little" or "none") in each domain using prevalence ratios (PRs) in multivariable (MV)-adjusted logistic regression models.

RESULTS

An estimated 1 in 5 to 1 in 4 adults with arthritis reported "a lot" of arthritis-attributable interference in recreation/leisure/hobbies (27%), household chores (25%), errands/shopping (22%), and social activities (18%). The highest prevalence of "a lot" of arthritis-attributable interference was for those unable to work/disabled or reporting severe arthritis symptoms (pain, stiffness, fatigue), anxiety, depression, or no/low confidence in ability to manage arthritis, across domains. In MV-adjusted models, those unable to work/disabled, currently seeing a doctor, or reporting fair/poor self-rated health, severe joint pain, anxiety, or no/low confidence in ability to manage arthritis were more likely to report arthritis-attributable interference than their respective counterparts. Magnitudes varied by domain but were consistently strongest for those unable to work/disabled (MV PR range = 1.8-2.5) and with fair/poor health (MV PR range = 1.7-2.7).

CONCLUSION

Many characteristics associated with arthritis-attributable interference in routine life activities are potentially modifiable, suggesting unmet need for use of existing evidence-based interventions that address these characteristics and reduce interferences to improve quality of life.

A paradigm shift in studies based on rheumatoid arthritis clinical registries

Clinical research is the study of aspects of patient health or illness that are closely related to clinical practice. In the late 20th and early 21th century, outcomes for patients with rheumatoid arthritis (RA) improved dramatically due to breakthroughs in new drugs. Patient-reported outcome measures now play a significant role in the drug development process as study endpoints in clinical trials of new therapies, and this has led to increased interest in the patient's perspective, drug safety and treatment outcomes in clinical practice. In accordance with these needs, many prospective cohorts for RA patients and registries of biologic disease modifying anti-rheumatic drugs have been actively conducted in the United States and European and Asian countries. A gradual shift is taking place in the major outcomes of clinical research using these prospective cohorts and registries. This article will introduce representative registries for RA in each country set up in the early 2000s and will discuss future perspectives in clinical research on RA patients using such clinical registries.

The Role of Orthobiologics in the Management of Osteoarthritis and Focal Cartilage Defects

Individuals with osteoarthritis have a diminished quality of life, and the condition is a major cause of disability. Newer biologic treatments have been developed that are believed to modify disease progression. These predominantly include hyaluronic acid, platelet-rich plasma, bone marrow aspirate concentrate, and adipose-derived mesenchymal stem cells. There is conflicting evidence regarding the use of orthobiologics for osteoarthritis and for focal chondral defects, although most studies indicate that injections of biologics are safe and without significant adverse effects. [Orthopedics. 2019; 42(2):66-73.].

How do UK physiotherapists address weight loss among individuals with hip osteoarthritis? A mixed-methods study

BACKGROUND

Weight loss is recommended as a core treatment for individuals with hip osteoarthritis who are overweight or obese. Physiotherapists play an important role in managing patients with hip osteoarthritis, but little is known about how they address weight. We aimed to explore how UK-based physiotherapists currently address weight loss among individuals with hip OA.

METHODS

We carried out a mixed-methods study. A cross-sectional questionnaire was mailed to 3,126 UK-based musculoskeletal physiotherapists. Self-reported approaches to addressing weight loss among individuals with hip osteoarthritis were explored using a case vignette and associated clinical management questions. Semi-structured telephone interviews (n = 21) were completed with a purposeful sample of physiotherapists who returned the questionnaire and provided consent for further contact. Interview data were analysed thematically.

RESULTS

There was a 53% response rate to the questionnaires (n = 1,646), and 1,148 responders were eligible for analyses (based on having treated an individual with hip OA in the last 6 months). Eight-five per cent of physiotherapists reported that they would address the vignette patient's weight, usually via advice (70%). Interviews identified that advice often focused on the importance of weight loss, with some physiotherapists offering basic advice on how to achieve weight loss. Multiple factors influenced their approach, including confidence, perceived remit and patient receptiveness.

CONCLUSIONS

UK physiotherapists commonly address weight loss among patients with hip osteoarthritis, by offering advice relating to the importance of weight loss. However, provision of more specific guidance on how to achieve weight loss is variable. With additional training, physiotherapists could play an important role in supporting weight loss among patients with hip OA, thus potentially optimizing treatment outcomes.

Prevalence rates of arthritis among US older adults with varying degrees of depression: Findings from the 2011 to 2014 National Health and Nutrition Examination Survey

OBJECTIVE

Arthritis and depressive symptoms often interact and negatively influence one another to worsen mental and physical health outcomes. Better characterization of arthritis rates among older adults with different levels of depressive symptoms is an important step toward informing mental health professionals of the need to detect and respond to arthritis and related mental health complications. The primary objective is to determine arthritis rates among US older adults with varying degrees of depression.

METHODS

Using National Health and Nutrition Examination Survey 2011 to 2014 data (N = 4792), we first identified participants aged ≥50 years. Measures screened for depressive symptoms and self-reported doctor-diagnosed arthritis. Weighted logistic regression models were conducted.

RESULTS

Prevalence of arthritis was 55.0%, 62.9%, and 67.8% in participants with minor, moderate, and severe depression, respectively. In both unadjusted and adjusted regression models, a significant association between moderate depression and arthritis persisted. There were also significant associations between minor and severe depression with arthritis.

CONCLUSIONS

Arthritis is commonly reported in participants with varying degrees of depression. This study highlights the importance of screening for and treating arthritis-related pain in older adults with depressive symptoms and the need for future geriatric psychiatry research on developing integrated biopsychosocial interventions for these common conditions.

Cost-effectiveness of health coaching and financial incentives to promote physical activity after total knee replacement

OBJECTIVE

We evaluated the cost-effectiveness of Telephonic Health Coaching and Financial Incentives (THC + FI) to promote physical activity in total knee replacement recipients.

DESIGN

We used the Osteoarthritis Policy Model, a computer simulation of knee osteoarthritis, to evaluate the cost-effectiveness of THC + FI compared to usual care. We derived transition probabilities, utilities, and costs from trial data. We conducted lifetime analyses from the healthcare perspective and discounted all cost-effectiveness outcomes by 3% annually. The primary outcome was the Incremental Cost-Effectiveness Ratio (ICER), defined as the ratio of the differences in costs and Quality-Adjusted Life Years (QALYs) between strategies. We considered ICERs <$100,000/QALY to be cost-effective. We conducted one-way sensitivity analyses that varied parameters across their 95% confidence intervals (CI) and limited the efficacy of THC + FI to 1 year or to 9 months. We also conducted a probabilistic sensitivity analysis (PSA), simultaneously varying cost, utilities, and transition probabilities.

RESULTS

THC + FI had an ICER of $57,200/QALY in the base case and an ICER below $100,000/QALY in most deterministic sensitivity analyses. THC + FI cost-effectiveness depended on assumptions about long-term efficacy; when efficacy was limited to 1 year or to 9 months, the ICER was $93,300/QALY or $121,800/QALY, respectively. In the PSA, THC + FI had an ICER below $100,000/QALY in 70% of iterations.

CONCLUSIONS

Based on currently available information, THC + FI might be a cost-effective alternative to usual care. However, the uncertainty surrounding this choice is considerable, and further research to reduce this uncertainty may be economically justified.

A mixed methods exploration of physiotherapist's approaches to analgesic use among patients with hip osteoarthritis

OBJECTIVE

To explore how physiotherapists currently address analgesic use among patients with hip osteoarthritis, and their beliefs about the acceptability of prescribing for these patients.

METHODS

A cross-sectional questionnaire was mailed to 3126 UK-based physiotherapists. Approaches to analgesic use among patients with hip osteoarthritis were explored using a case vignette. Semi-structured telephone interviews were undertaken with 21 questionnaire responders and analysed thematically.

SETTING

UK.

PARTICIPANTS

Physiotherapists who had treated a patient with hip osteoarthritis in the previous 6 months.

RESULTS

Questionnaire response: 53% (n=1646). One thousand one hundred forty eight physiotherapists reported treating a patient with hip osteoarthritis in the last 6 months (applicable responses), of whom nine (1%) were non-medical prescribers. Nearly all physiotherapists (98%) reported that they would address analgesic use for the patient with hip osteoarthritis, most commonly by signposting them to their GP (83%). Fifty six percent would discuss optimal use of current medication, and 33%, would discuss use of over-the-counter medications. Interviews revealed that variations in physiotherapists' approaches to analgesic use were influenced by personal confidence, patient safety concerns, and their perceived professional remit. Whilst many recognised the benefits of analgesia prescribing for both patients and GP workload, additional responsibility for patient safety was a perceived barrier.

CONCLUSIONS

How physiotherapists currently address analgesic use with patients with hip osteoarthritis is variable. Although the potential benefits of independent prescribing were recognised, not all physiotherapist want the additional responsibility. Further guidance supporting optimisation of analgesic use among patients with hip OA may help better align care with best practice guidelines and reduce GP referrals.

Sociodemographic characteristics, health conditions, and functional impairment among older adults with serious mental illness reporting moderate-to-severe pain

OBJECTIVE

To compare adults aged ≥50 years with serious mental illness reporting moderate-to-severe pain to older adults with serious mental illness without pain with respect to sociodemographic characteristics, health conditions, and functional impairment.

METHOD

Secondary data analyses were conducted using baseline assessments of 183 participants recruited for the Helping Older People Experience Success (HOPES) study from three community mental health centers. The primary outcome was self-reported, nonexperimentally induced, moderate-to-severe pain (referent = no-to-mild pain). Predictor variables consisted of sociodemographic characteristics, health conditions, and functional impairment. We conducted univariable and multivariable logistic regression analyses to examine the associations between these variables.

RESULTS

Sixty-one participants (33.3%) from our sample reported pain. Pain was associated with all of the sociodemographic and health-related factors in univariable analyses. In the multivariable model, only older age, pain-related activity interference, and physical and emotional health-related social limitations were significantly associated with pain.

CONCLUSIONS AND IMPLICATIONS FOR PRACTICE

The presence of moderate-to-severe pain in older adults with serious mental illness is associated with pain-attributable impairment of activities and social problems above and beyond the substantial functional limitations routinely experienced by this high-risk, high-need group. Given the high rates of preexisting conditions and persistent social impairment among these older adults, our findings suggest that pain may contribute to worse overall functional outcomes. Future research and clinical interventions focused on improving outcomes should include an evaluation of pain as a contributor to decreased functioning and assess the need for early intervention, nonpharmacological pain management, or other health promotion services in psychiatric rehabilitation. (PsycINFO Database Record

Vonoprazan prevents ulcer recurrence during long-term NSAID therapy: randomised, lansoprazole-controlled non-inferiority and single-blind extension study

OBJECTIVE

To assess the non-inferiority of vonoprazan to lansoprazole for secondary prevention of non-steroidal anti-inflammatory drug (NSAID)-induced peptic ulcer (PU) and the safety of vonoprazan during extended use.

DESIGN

A phase 3, 24-week, multicenter, randomised, double-blind (DB), active-controlled study, followed by a phase 3, ≥28 week, multicenter, single-blind, parallel-group extension study (EXT) in outpatients (n=642) receiving long-term NSAID therapy who are at risk of PU recurrence. The patients received vonoprazan (10 mg or 20 mg) or lansoprazole 15 mg once daily. For DB, non-inferiority of the proportion of patients with recurrent PU within 24 weeks was analysed by Farrington and Manning test (significance level 2.5%, non-inferiority margin 8.3%; primary endpoint), recurrent PU within 12 weeks, bleeding and time-to-event of PU (secondary endpoint) and treatment-emergent adverse events (TEAEs). For EXT, TEAEs (primary endpoint), recurrent PU and safety (secondary) were assessed up to 104 weeks for patients in the extension study.

RESULTS

The non-inferiority of vonoprazan 10 mg and 20 mg to lansoprazole 15 mg was verified (percentage difference -2.2%,95% CI -6.2% to 1.8%, p<0.001; -2.1%,95% CI -6.1% to 2.0%, p<0.001, respectively). The proportion of patients with endoscopically confirmed recurrent PU within 24 weeks was 3.3%, 3.4% and 5.5%, for vonoprazan 10 mg, 20 mg and lansoprazole 15 mg, respectively. No significant safety concerns were identified.

CONCLUSION

The non-inferiority of vonoprazan (10 and 20 mg) was verified in patients receiving long-term NSAIDs in DB; it was effective and well tolerated in EXT for longer than 1 year, with a safety profile similar to lansoprazole (15 mg).

TRIAL REGISTRATION NUMBERS

NCT01452750, NCT01456260; Results.

Association between the Great China Famine exposure in early life and risk of arthritis in adulthood

BACKGROUND

The association between famine exposure in early life and risk of arthritis (combination of osteoarthritis and inflammatory arthritis) in adulthood is unclear. The aim of this study is to explore the association.

METHODS

A total of 4124 subjects were selected from the national data of the China Health and Retirement Longitudinal Study in 2011-2012. Doctor-diagnosed arthritis was self-reported in participants' questionnaire. Birthdates were used to categorise participants into famine-exposed and non-exposed groups. Logistic regression model was used to explore the association of famine exposure in early life with the risk of arthritis in adulthood.

RESULTS

The prevalence of arthritis in both infant-exposed and preschool-exposed groups was significantly higher than those in the non-exposed group (35.0% and 30.6% vs 27.3%; p<0.05). Compared with the non-exposed group, the infant-exposed group showed a significantly elevated risk of arthritis in adulthood after adjusting for confounding factors (OR=1.65; 95% CI 1.29 to 2.11; p<0.001). In the stratified analysis, we found that participants who lived in severely affected areas (OR=1.91; 95% CI 1.41 to 2.59; p<0.001), who are female (OR=2.21; 95% CI 1.57 to 3.11; p<0.001) and those with a body mass index ≥24.0 kg/m² (OR=2.46; 95% CI 1.70 to 3.55; p<0.001) in the infant-exposed group had increased risk of arthritis in adulthood. Similar results were additionally observed when age-balanced control group was used.

CONCLUSION

Great China Famine exposure in infancy may be associated with an elevated risk of arthritis in adulthood, particularly in women and participants with adiposity. These findings suggest nutrition intervention in infancy and weight control in later life may reduce the risk of arthritis in adulthood.

Health-Related Quality of Life in Patients with Arthritis: A Cross-Sectional Survey among Middle-Aged Adults in Chongqing, China

Background: Arthritis is a common disease in China, but few studies have been conducted to explore the associated health-related quality of life (HRQoL) and its influencing factors in Chongqing, China. This study aimed to explore the association of arthritis and HRQoL and probe factors affecting HRQoL among arthritis patients. Methods: A cross-sectional survey was conducted in Chongqing, China. A total of 1224 adults were included in the analysis. Medical Outcomes Study Short Form 36 Health Survey (SF-36) was used to measure HRQoL. Multiple linear regression models (stepwise) and covariance analysis models were used to examine the association of arthritis with HRQoL and analyze factors associated with HRQoL among arthritis patients. Results: Participants with arthritis had poorer HRQoL than those without. Among arthritis patients, the female was associated with a poorer state of physical functioning (p < 0.05); unemployed patients had a poorer state of role-physical than employed patients (p < 0.05); low average monthly income was associated with a poorer state of physical functioning (p < 0.01); childhood non-breastfeeding history was associated with a poorer state of social functioning (p < 0.01); average or dissatisfied attitude to current living conditions was associated with a poorer state of vitality and mental health (p < 0.05 for all); moreover, poor or general appetite was associated with a poorer state of role-physical, general health, social functioning, bodily pain, and role-emotional (p < 0.01 for all). Conclusions: Arthritis patients have worse HRQoL than those without in the Chinese population. Female, low socioeconomic status, childhood non-breastfeeding history, average or dissatisfied attitude to current living conditions and poor or general appetite were associated with poorer state of HRQoL among Chinese arthritis patients.

Geographic Variations in Arthritis Prevalence, Health-Related Characteristics, and Management - United States, 2015

Problem/Condition

Doctor-diagnosed arthritis is a common chronic condition affecting an estimated 23% (54 million) of adults in the United States, greatly influencing quality of life and costing approximately $300 billion annually. The geographic variations in arthritis prevalence, health-related characteristics, and management among states and territories are unknown. Therefore, public health professionals need to understand arthritis in their areas to target dissemination of evidence-based interventions that reduce arthritis morbidity.

Reporting Period

2015.

Description of System

The Behavioral Risk Factor Surveillance System is an annual, random-digit–dialed landline and cellular telephone survey of noninstitutionalized adults aged ≥18 years residing in the United States. Self-reported data are collected from the 50 states, the District of Columbia, Guam, and Puerto Rico. Unadjusted and age-standardized prevalences of arthritis, arthritis health-related characteristics, and arthritis management were calculated. County-level estimates were calculated using a validated statistical modeling method.

Results

In 2015, in the 50 states and the District of Columbia, median age-standardized prevalence of arthritis was 23.0% (range: 17.2%–33.6%). Modeled prevalence of arthritis varied considerably by county (range: 11.2%–42.7%). In 13 states that administered the arthritis management module, among adults with arthritis, the age-standardized median percentage of participation in a self-management education course was 14.5% (range: 9.1%–19.0%), being told by a health care provider to engage in physical activity or exercise was 58.5% (range: 52.3%–61.9%), and being told to lose weight to manage arthritis symptoms (if overweight or obese) was 44.5% (range: 35.1%–53.2%). Respondents with arthritis who lived in the quartile of states with the highest prevalences of arthritis had the highest percentages of negative health-related characteristics (i.e., arthritis-attributable activity limitations, arthritis-attributable severe joint pain, and arthritis-attributable social participation restriction; ≥14 physically unhealthy days during the past 30 days; ≥14 mentally unhealthy days during the past 30 days; obesity; and leisure-time physical inactivity) and the lowest percentage of leisure-time walking.

Interpretation

The prevalence, health-related characteristics, and management of arthritis varied substantially across states. The modeled prevalence of arthritis varied considerably by county.

Public Health Action

The findings highlight notable geographic variability in prevalence, health-related characteristics, and management of arthritis. Targeted use of evidence-based interventions that focus on physical activity and self-management education can reduce pain and improve function and quality of life for adults with arthritis and thus might reduce these geographic disparities.

Comorbid Arthritis Is Associated With Lower Health-Related Quality of Life in Older Adults With Other Chronic Conditions, United States, 2013-2014

Introduction

Arthritis is related to poor health-related quality of life (HRQoL) in adults aged 18 years or older. We sought to determine whether this relationship persisted in an older population using claims-based arthritis diagnoses and whether people who also had arthritis and at least 1 of 5 other chronic conditions had lower HRQoL.

Methods

We identified adults aged 65 years or older with Medicare Advantage coverage in November or December 2014 who responded to an HRQoL survey (Healthy Days). For respondents with and without arthritis, we used linear regression to compare mean physically, mentally, and total unhealthy days, overall and in 5 comorbidity subgroups (coronary artery disease, congestive heart failure, chronic obstructive pulmonary disease, diabetes, and hypertension), accounting for age, sex, dual Medicaid/Medicare eligibility, rural/urban commuting area, and Charlson Comorbidity Index.

Results

Of the 58,975 survey respondents, 44% had arthritis diagnosed through claims. Respondents with arthritis reported significantly more adjusted mean physically, mentally, and total unhealthy days than those without arthritis (P < .001). Older adults with arthritis and either congestive heart failure, chronic obstructive pulmonary disease, diabetes, or hypertension reported significantly more adjusted physically, mentally, and total unhealthy days than older adults without arthritis but with the same chronic conditions.

Conclusions

In older adults, having arthritis is associated with lower HRQoL and even lower HRQoL among those with at least 1 of 5 other common chronic conditions. Because arthritis is so common among older adults, improving HRQoL depends on managing both underlying chronic conditions and any accompanying arthritis.

Mindfulness is associated with psychological health and moderates pain in knee osteoarthritis

OBJECTIVE

Previous studies suggest that higher mindfulness is associated with less pain and depression. However, the role of mindfulness has never been studied in knee osteoarthritis (OA). We evaluate the relationships between mindfulness and pain, psychological symptoms, and quality of life in knee OA.

METHOD

We performed a secondary analysis of baseline data from our randomized comparative trial in participants with knee OA. Mindfulness was assessed using the Five Facet Mindfulness Questionnaire (FFMQ). We measured pain, physical function, quality of life, depression, stress, and self-efficacy with commonly-used patient-reported measures. Simple and multivariable regression models were utilized to assess associations between mindfulness and health outcomes. We further tested whether mindfulness moderated the pain-psychological outcome associations.

RESULTS

Eighty patients were enrolled (60.3 ± 10.3 years; 76.3% female, body mass index: 33.0 ± 7.1 kg/m²). Total mindfulness score was associated with mental (beta = 1.31, 95% CI: 0.68, 1.95) and physical (beta = 0.69, 95% CI:0.06, 1.31) component quality of life, self-efficacy (beta = 0.22, 95% CI:0.07, 0.37), depression (beta = -1.15, 95% CI:-1.77, -0.54), and stress (beta = -1.07, 95% CI:-1.53, -0.60). Of the five facets, the Describing, Acting-with-Awareness, and Non-judging mindfulness facets had the most associations with psychological health. No significant association was found between mindfulness and pain or function (P = 0.08-0.24). However, we found that mindfulness moderated the effect of pain on stress (P = 0.02).

CONCLUSION

Mindfulness is associated with depression, stress, self-efficacy, and quality of life among knee OA patients. Mindfulness also moderates the influence of pain on stress, which suggests that mindfulness may alter the way one copes with pain. Future studies examining the benefits of mind-body therapy, designed to increase mindfulness, for patients with OA are warranted.

Dietary intake of fibre and risk of knee osteoarthritis in two US prospective cohorts

Objectives

Dietary fibre reduces body weight and inflammation both of which are linked with knee osteoarthritis (OA). We examined the association between fibre intake and risk of knee OA.

Methods

We used data from the Osteoarthritis Initiative (OAI) of 4796 participants and Framingham Offspring Osteoarthritis Study (Framingham) of 1268 persons. Dietary intake of fibre was estimated at baseline, and incident radiographic OA (ROA) and symptomatic OA (SxOA) were followed annually until 48 months in OAI and assessed 9 years later in Framingham. Knee pain worsening was also examined in OAI. Generalised estimating equations were applied in multivariable regression models.

Results

In OAI, we identified 869 knees with SxOA, 152 knees with ROA and 1964 knees with pain worsening among 4051 subjects with valid dietary intake (baseline mean age: 61.2 years; mean body mass index (BMI): 28.6). In Framingham, 143 knees with SxOA and 176 knees with ROA among 971 such subjects (baseline mean age: 53.9 years; mean BMI: 27.0) were identified. In both cohorts, dietary total fibre was inversely associated with risk of SxOA (p trend <0.03) with significantly lower risk at the highest versus lowest quartile (OR (95% CI): 0.70 (0.52, 0.94) for OAI and 0.39 (0.17, 0.88) for Framingham). Furthermore, dietary total and cereal fibre were significantly inversely associated with knee pain worsening in OAI (p trend <0.02). No apparent association was found with ROA.

Conclusions

Findings from two longitudinal studies consistently showed that higher total fibre intake was related to a lower risk of SxOA, while the relation to ROA was unclear.

Diet quality of individuals with rheumatoid arthritis using the Healthy Eating Index (HEI)-2010

BACKGROUND

Rheumatoid arthritis (RA) afflicts approximately 1.5 million American adults and is a major cause of disability. As disease severity worsens, individuals with RA may experience functional decline that can impact dietary intake.

OBJECTIVE

The objective of this study is to assess the diet quality of individuals with RA using the Healthy Eating Index (HEI)-2010 and examine associations between diet quality and disease activity and functional status.

METHODS

This cross-sectional study assessed diet quality and disease activity and functional status in adults with RA. Participants completed seven-day weighed food records, which were scored using the HEI-2010. Participants had a fasting blood draw and completed the Multidimensional Health Assessment Questionnaire to determine disease activity and functional status.

RESULTS

The mean age of individuals with RA ( N = 84) was 53 ± 14 years, and 86.9% were female. The mean HEI-2010 total score was 58.7 ± 15.9, with 7.1% of participants scoring "good", 58.3% "fair", and 34.5% "poor". Most participants did not adhere to recommended intakes of total fruit, total vegetables, whole grains, fatty acids, refined grains, sodium, and empty calories. An unadjusted multiple linear regression model found duration of morning stiffness and C-reactive protein concentration to be significant variables to inversely predict HEI-2010 total score.

CONCLUSIONS

The diet quality of many individuals with RA needs improvement and may be related to functional disability associated with RA. Healthcare providers should encourage individuals with RA to meet dietary guidelines and maintain a healthy diet. Moreover, healthcare providers should be aware of the potential impacts of functional disability on diet quality in individuals with RA.

Biological Knee Reconstruction With Concomitant Autologous Chondrocyte Implantation and Meniscal Allograft Transplantation: Mid- to Long-term Outcomes

BACKGROUND

Treating articular cartilage defects and meniscal deficiency is challenging. Although some short- to mid-term follow-up studies report good clinical outcomes after concurrent autologous chondrocyte implantation (ACI) and meniscal allograft transplantation (MAT), longer follow-up is needed.

PURPOSE

To evaluate mid- to long-term outcomes after combined ACI with MAT.

STUDY DESIGN

Case series; Level of evidence, 4.

METHODS

We performed a retrospective review of prospectively gathered data from patients who had undergone ACI with MAT between 1999 and 2013. A single surgeon treated 18 patients for symptomatic full-thickness chondral defects with meniscal deficiency. One patient was lost to follow-up. Thus, 17 patients (18 knees; mean age, 31.7 years) were evaluated over a mean 7.9-year follow-up (range, 2-16 years). A mean 1.8 lesions per knee were treated over a total surface area of 7.6 cm² (range, 2.3-21 cm²) per knee. Seventeen lateral and 1 medial MATs were performed. Survival was analyzed using the Kaplan-Meier method. The modified Cincinnati Knee Rating Scale, Western Ontario and McMaster Universities Osteoarthritis Index, visual analog scale, and Short Form-36 were used to evaluate clinical outcomes. Patients also self-reported knee function and satisfaction. Standard radiographs were scored for Kellgren-Lawrence (K-L) grade.

RESULTS

Both 5- and 10-year survival rates were 75%. Outcomes for 6 knees were considered failures. Of the 6 failures, 4 knees were converted to arthroplasty and the other 2 knees underwent biological revision surgery. Of the 12 successfully operated knees, all clinical measures significantly improved postoperatively. Ten patients representing 11 of the 12 knees rated outcomes for their knees as good or excellent, and 1 rated their outcome as fair. Eight patients representing 9 of the 12 knees were satisfied with the procedure. There was no significant osteoarthritis progression based on K-L grading from preoperatively to a mean 5.9 years after surgery. Seven of the 12 knees (58%) required subsequent surgical procedures (5 arthroscopic alone, 2 both arthroscopic and open).

CONCLUSION

Combined ACI with MAT provided significant improvement in 65% of the operated knees over a mid- to long-term follow-up. This procedure can allow patients to retain their biological knees, delay or prevent rapid degeneration to osteoarthritis, and could be recognized as a bridge procedure before artificial knee replacement. However, careful discussion between the patient and surgeon is necessary before surgery to ensure realistic expectations.

Polypharmacy and Health-Related Quality of Life Among US Adults With Arthritis, Medical Expenditure Panel Survey, 2010-2012

INTRODUCTION

Our objective was to determine the relationship between polypharmacy (treatment with prescription drugs from 6 or more drug classes concurrently) and health-related quality of life (HRQoL) among US adults with arthritis.

METHODS

We conducted a retrospective cohort study that used 2-year longitudinal data from the Medical Expenditure Panel Survey to analyze a cohort of 6,132 adults aged over 21 years with arthritis. Measures of HRQoL were the summary scores from the mental component summary (MCS) and physical component summary (PCS) of the 12-item short-form health survey. Unadjusted and adjusted regression models were used to evaluate the association between polypharmacy and HRQoL measures. We used SAS, version 9.4, (SAS Institute Inc) to conduct all analyses.

RESULTS

In unadjusted analyses, adults with arthritis taking prescription drugs from 6 or more drug classes concurrently had significantly lower MCS and PCS scores (β, -3.11, P < .001 and β, -10.26, P < .001, respectively) than adults taking prescription drugs from fewer than 6. After controlling for the demographic characteristics, number of mental and physical chronic conditions, and baseline MCS and PCS scores, adults taking prescription drugs from 6 or more drug classes concurrently had significantly lower PCS scores (β, -1.68, P < .001), than those taking prescription drugs from fewer than 6. However, no significant difference in MCS scores was found between adults taking prescription drugs from 6 or more drug classes concurrently and those taking prescription drugs from fewer than 6 (β, -0.27, P = .46).

CONCLUSION

Polypharmacy is significantly associated with lower PCS scores among adults with arthritis. Because polypharmacy can lead to drug-drug and drug-disease interactions, health care providers need to consider the risk and adopt a cautious approach in prescribing multiple drugs to manage chronic conditions and in choosing therapies to improve HRQoL among adults with arthritis.

State of the evidence

PURPOSE OF REVIEW

This review focuses on recent studies of osteoarthritis epidemiology, including research on prevalence, incidence, and a broad array of potential risk factors at the person level and joint level.

RECENT FINDINGS

Studies continue to illustrate the high impact of osteoarthritis worldwide, with increasing incidence. Person-level risk factors with strong evidence regarding osteoarthritis incidence and/or progression include age, sex, socioeconomic status, family history, and obesity. Joint-level risk factors with strong evidence for incident osteoarthritis risk include injury and occupational joint loading; the associations of injury and joint alignment with osteoarthritis progression are compelling. Moderate levels of physical activity have not been linked to increased osteoarthritis risk. Some topics of high recent interest or emerging evidence for association with osteoarthritis include metabolic pathways, vitamins, joint shape, bone density, limb length inequality, muscle strength and mass, and early structural damage.

SUMMARY

Osteoarthritis is a complex, multifactorial disease, and there is still much to learn regarding mechanisms underlying incidence and progression. However, there are several known modifiable and preventable risk factors, including obesity and joint injury; efforts to mitigate these risks can help to lessen the impact of osteoarthritis.

Arthritis has an impact on the daily lives of Canadians young and old: results from a population-based survey

Background

There is a perception that the impacts of arthritis are greatest among older adults. However, the effect of age on health-related outcomes in individuals with arthritis has not been explicitly studied. This study examined whether the physical and mental health impacts of arthritis are greater in older (75+ years) versus younger (20–44, 45–64 and 65–74 years) Canadian adults.

Methods

Data were from the arthritis component of the 2009 Survey on Living with Chronic Diseases in Canada. The responses were weighted to be representative of Canadians (≥20 years) with arthritis. Associations between age and the prevalence of severe/frequent joint pain, severe/frequent fatigue, sleep limitations, instrumental activities of daily living (IADLs) limitations, high levels of stress, suboptimal general and suboptimal mental health, were examined descriptively prior to conducting multivariate log-binomial regression analyses.

Results

A total of 4565 respondents completed the survey (78 % response rate). Individuals with arthritis were mostly female (63 %), of working age (57 %) and overweight or obese (67 %). Upon adjusting for covariates, younger (20–44 years) and/or middle aged (45–64 years) adults were more likely than those older (75+ years) to report severe/frequent joint pain, sleep limitations, high levels of stress and suboptimal mental health. After adjusting for covariates, age was not associated with IADL limitations, severe/frequent fatigue or suboptimal general health.

Conclusions

Contrary to the belief that older adults with arthritis experience more severe physical and mental health outcomes, we found that older adults were less likely to report worse outcomes than younger adults. In light of these findings, public health messaging should stress that arthritis does not just affect the elderly and emphasize the importance of timely diagnosis and management at all ages in order to prevent or, minimize arthritis-related impairment.

Baby boomer caregiver and dementia caregiving: findings from the National Study of Caregiving

BACKGROUND

Previous studies have well documented the characteristics of baby boomers but less is known about the experiences of boomer caregivers (CGs) of people with dementia.

OBJECTIVE

The purpose of this study was to compare the characteristics of boomer CGs of people with dementia with those of boomer CGs for people without dementia and to ascertain factors associated with outcomes.

DESIGN

We selected baby boomer CGs from the National Study of Caregiving (NSOC) with 650 primary boomer CGs (138 CGs of people with dementia and 512 CGs of people without dementia).

METHODS

The Stress Process Model (SPM) was used to examine the effects of resources (the use of paid help and informal support) and stressors (primary: level of CG care activities and interrupted sleep; secondary: strain of caregiving on work, other care and social activities) on CGs' down, depressed or hopeless feelings and self-perceived general health. T-tests and chi-square tests were used to compare SPM domain differences and ordinary least-square multiple regression analysis was used to investigate predictors of CGs' outcomes.

RESULTS

High blood pressure and arthritis were the most prevalent chronic diseases in both groups. Boomer CGs of people with dementia reported providing more help with daily activities, higher level of caregiving and social activity conflict, experiencing more interrupted sleep and more down, depressed or hopeless feelings than CGs of people without dementia. Different factors predicted boomer CGs' outcomes.

CONCLUSION

The current results yield important information about the considerable differences between two baby boomer CG groups within the caregiving experiences. The findings highlight the need to provide tailored interventions to boomer CGs to help them cope with caregiving stress to improve their physical and mental health.

Prevalence and risk factors of arthritis in a middle-aged and older Chinese population: the China health and retirement longitudinal study

OBJECTIVES

The aims of this study were to estimate the prevalence of arthritis and to identify risk factors of arthritis in a middle-aged and older Chinese adult population.

METHODS

The China Health and Retirement Longitudinal Study (CHARLS) national survey data were used to estimate overall arthritis prevalence and prevalence by age and gender groups taking into account the complex survey design and response rate. The PROC SURVEYLOGISTIC procedure (SAS 9.3; SAS Institute, Cary, NC, USA) was applied to identify factors associated with arthritis using the CHARLS national survey data. Significant factors were further evaluated in the longitudinal CHARLS pilot study.

RESULTS

The overall prevalence of arthritis among middle-aged and older Chinese adults was 31.4% (95% CI 30.3, 32.4). Prevalence increased with age. Females had a higher prevalence of arthritis than males in each age group. In the cross-sectional analysis, age, gender, education, BMI, sleep duration, vigorous physical activity and self-reported doctor-diagnosed chronic lung disease, hypertension, chronic liver disease, cardiovascular disease, stroke, chronic kidney disease and chronic digestive disease were associated with arthritis. Age, gender, vigorous physical activity and cardiovascular disease were confirmed to be risk factors of arthritis in the longitudinal analysis. Participants with cardiovascular disease were 1.67 times (95% CI 1.02, 2.74) more likely to have self-reported arthritis in a 4-year period of follow-up in the CHARLS pilot study.

CONCLUSION

Middle-aged and older Chinese adults had a high prevalence of arthritis. Cardiovascular disease is a novel risk factor for arthritis in this population.

Health-related quality of life among people aged ≥65 years with self-reported visual impairment: findings from the 2006-2010 behavioral risk factor surveillance system

PURPOSE

To examine the association between health-related quality of life (HRQoL) and visual impairment among people aged ≥65 years.

METHODS

We used cross-sectional data from the 2006-2010 Behavioral Risk Factor Surveillance System to examine six HRQoL measures: self-reported health, physically unhealthy days, mentally unhealthy days, activity limitation days, life satisfaction, and disability. Visual impairment was categorized as no, a little, and moderate/severe. We examined the association between self-reported visual impairment and HRQoL using logistic regression accounting for the survey's complex design.

RESULTS

People with self-reported moderate/severe visual impairment had more frequent (≥14) physically unhealthy days, mentally unhealthy days, and activity limitation days in the last 30 days compared to those reporting a little or no visual impairment. After controlling for all covariates (age, sex, marital status, race/ethnicity, education, income, diabetes, heart disease, stroke, heart attack, body mass index, leisure time activity, smoking, and medical care cost concerns) and comparing to those with no self-reported visual impairment, people reporting a little visual impairment were more likely to have fair/poor health (odds ratio, OR, 1.2, 95% confidence interval, CI, 1.1-1.3), life dissatisfaction (OR 1.6, 95% CI 1.3-2.0), and disability (OR 1.5, 95% CI 1.3-1.6), and those with self-reported moderate/severe visual impairment had more fair/poor health (OR 1.8, 95% CI 1.6-2.0), life dissatisfaction (OR 2.3, 95% CI 1.8-2.9), and disability (OR 2.0, 95% CI 1.8-2.2). They also had more frequent physically unhealthy days (OR 1.9, 95% CI 1.7-2.1), mentally unhealthy days (OR 1.8, 95% CI 1.5-2.1), and activity limitations days (OR 1.9, 95% CI 1.6-2.2).

CONCLUSION

Poor HRQoL is strongly associated with the severity of self-reported visual impairment among people aged ≥65 years.

Osteoarthritis: A review

Disabling for nearly 27 million people, osteoarthritis is expected to double by the year 2030. Although age is a strong predictor of osteoarthritis, it is not an inevitable consequence of aging. Nurse practitioners, frequently the first healthcare providers to see patients with osteoarthritis, must be up-to-date on current treatment recommendations.

Sociodemographic Disparities in Quality of Life for Survivors of Adolescent and Young Adult Cancers in the Behavioral Risk Factor Surveillance System

Purpose: Survivors of cancer diagnosed during adolescence and young adulthood (AYA; aged 15-39) may experience quality of life (QOL) limitations; however, little is known about QOL for AYA survivors who are now middle-aged or among racial/ethnic minority survivors. We evaluated QOL outcomes for AYA cancer survivors relative to a non-cancer comparison group by gender, race/ethnicity, and current age. Methods: Using the 2009 Behavioral Risk Factor Surveillance System (BRFSS) data, we identified 8375 individuals diagnosed with cancer while aged 15-39 years old and 334,759 controls. Participants were currently ≥20 years of age. QOL was measured using four items from the Center for Disease Control's Healthy Days Measure (general health, number of days of poor physical and mental health, and activity limitation days). Multivariable regressions compared these measures for survivors and controls by gender, race/ethnicity, and age, and among survivors to determine cancer-related factors associated with poor QOL. Results: Survivors were more likely to report fair/poor general health than controls (relative risk=1.92; 95% confidence interval: 1.77-2.10; p<0.001). QOL limitations existed by gender and race/ethnicity for survivors. Approximately 30% of survivors currently in their 40s, 50s, and early 60s were in poor health, compared to less than 20% of same-aged controls (both p<0.001). Of survivors with two or more cancers, 41.0% reported poor health, compared to 26.2% with one cancer (p<0.001). Conclusion: AYA cancer survivors have worse QOL compared to the general population and these limitations persist across gender, race/ethnicity, and age. Targeted interventions are essential for improving AYA cancer survivors' health status.

The influence of vertebral fracture on the functional disability of patients with rheumatoid arthritis

The aim of the present study was to identify the influence of vertebral fracture (VF) on the functional disability in patients with rheumatoid arthritis (RA). This study consecutively enrolled 100 female patients aged 50 yr or older with RA. All participants underwent lateral imaging of the thoracolumbar spine by simple radiography to identify any VFs. They also completed questionnaires via interview regarding demographics, medical history, and disease outcomes including functional disability. We used univariate analysis to evaluate associations between functional disability and VF, and made multivariate logistic regression models to test independent effect of the presence of VF, the number of VFs, and the severity of VF on functional disability. Among the 100 RA patients, 47 had at least one VF, but 34 of them were asymptomatic that they had experienced a fracture. The multiple VFs ≥ 3 (OR, 8.95; 95% CI, 1.77-44.15, P = 0.01) and moderate or severe VF (OR, 3.38; 95% CI, 1.26-9.04, P = 0.02) were related to disability in univariate analysis. The multiple VFs ≥ 3 (OR, 6.13; 95% CI, 1.02-36.94, P = 0.048) was associated with functional disability of RA patients after adjusting various confounders and it was mainly in walking and arising. The VF might be an important factor which affects functional disability in RA patients.

Arthritides of the foot

Arthritis of the foot can be a difficult problem. It is initially managed with antiinflammatory medications and footwear modifications or bracing. However, a significant percentage of people with arthritis of the foot go on to require surgical intervention, which is most commonly arthrodesis.

Clinical evaluation of upper limb function: Patient's impairment, disability and health-related quality of life

Musculoskeletal disorders substantially impacts physical activity, mental state, and quality of life (QOL). Generally, comprehensive assessment of upper limb function requires measures of impairment or disability as well as health-related quality of life. A growing number of outcome instrument have been introduced to evaluate upper limb function and disability, and these measures can be categorized as patient- or clinician-based, and as condition specific or general health-related QOL evaluations. The upper limb outcome instruments reviewed in this article assess different aspect of upper limb conditions, and the measures are affected by differences in cultural, psychological, and gender aspect of illness perception and behavior. Therefore, physician should select/interpret the outcome instruments addressing their primary purpose of research. Information about regional instruments for upper limb condition and health-related QOL in upper limb disorder may help us in decision-making for treatment priority or in interpretation of the treatment outcomes.

A pilot study of yoga as self-care for arthritis in minority communities

BACKGROUND

While arthritis is the most common cause of disability, non-Hispanic blacks and Hispanics experience worse arthritis impact despite having the same or lower prevalence of arthritis compared to non-Hispanic whites. People with arthritis who exercise regularly have less pain, more energy, and improved sleep, yet arthritis is one of the most common reasons for limiting physical activity. Mind-body interventions, such as yoga, that teach stress management along with physical activity may be well suited for investigation in both osteoarthritis and rheumatoid arthritis. Yoga users are predominantly white, female, and college educated. There are few studies that examine yoga in minority populations; none address arthritis. This paper presents a study protocol examining the feasibility and acceptability of providing yoga to an urban, minority population with arthritis.

METHODS/DESIGN

In this ongoing pilot study, a convenience sample of 20 minority adults diagnosed with either osteoarthritis or rheumatoid arthritis undergo an 8-week program of yoga classes. It is believed that by attending yoga classes designed for patients with arthritis, with racially concordant instructors; acceptability of yoga as an adjunct to standard arthritis treatment and self-care will be enhanced. Self-care is defined as adopting behaviors that improve physical and mental well-being. This concept is quantified through collecting patient-reported outcome measures related to spiritual growth, health responsibility, interpersonal relations, and stress management. Additional measures collected during this study include: physical function, anxiety/depression, fatigue, sleep disturbance, social roles, and pain; as well as baseline demographic and clinical data. Field notes, quantitative and qualitative data regarding feasibility and acceptability are also collected. Acceptability is determined by response/retention rates, positive qualitative data, and continuing yoga practice after three months.

DISCUSSION

There are a number of challenges in recruiting and retaining participants from a community clinic serving minority populations. Adopting behaviors that improve well-being and quality of life include those that integrate mental health (mind) and physical health (body). Few studies have examined offering integrative modalities to this population. This pilot was undertaken to quantify measures of feasibility and acceptability that will be useful when evaluating future plans for expanding the study of yoga in urban, minority populations with arthritis.

TRIAL REGISTRATION

ClinicalTrials.gov: NCT01617421.

Impact of obesity and diabetes on arthritis: An update

The incidence of obesity and diabetes has been increased with alarming rate in recent years and became a common problem around the globe including developing as well as in developed countries with incalculable social costs. Obesity and type 2 diabetes are two common co-morbidities occur together. Obesity and diabetes is closely associated with many diseases, osteoarthritis, hypertension, certain form of cancer, sleep-breathing disorders and coronary heart disease. Impacts of obesity and diabetes (insulin resistance) on arthritis have been seen in patients that we associated with combination of various factors like increased availability of high- energy foods, genetic susceptibility and decreased physical activity in modern society. Arthritis is becoming pandemic around the globe and its occurrence with obesity and diabetes has been observed more common than ever. Combination of these two chronic conditions makes these diseases more vulnerable for human health. Till now very limited information is established about the pathological and mechanistic correlation among these health ailments. In this review article we aimed to survey the literature covering the influence of obesity and diabetes on arthritis pathology and tried to establish correlation with these diseases.

To what degree do shoulder outcome instruments reflect patients' psychologic distress?

BACKGROUND

Psychologic distress contributes to symptom severity in patients with several musculoskeletal disorders. While numerous shoulder outcome instruments are used it is unclear whether and to what degree psychologic distress contributes to the scores.

QUESTIONS/PURPOSES

We asked (1) to what degree shoulder outcome instruments reflect patients' psychologic distress, and (2) whether patients who are strongly affected by psychologic distress can be identified.

METHODS

We prospectively evaluated 119 patients with chronic shoulder pain caused by degenerative or inflammatory disorders using the Constant-Murley scale, Simple Shoulder Test (SST), and Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire. To evaluate psychologic distress, we measured depression using the Center for Epidemiologic Studies-Depression (CES-D) scale and pain anxiety using the Pain Anxiety Symptom Scale (PASS). Demographic and clinical parameters, such as pain scores, ROM, and abduction strength, also were measured. We then assessed the relative contributions made by psychologic distress and other clinical parameters to the quantitative ratings of the three shoulder outcome instruments.

RESULTS

Quantitative ratings of shoulder outcome instruments correlated differently with psychologic distress. Constant-Murley scores did not correlate with psychologic measures, whereas SST scores correlated with PASS (r = 0.32) and DASH scores correlated with PASS and CES-D (r = 0.36 and r = 0.32). Psychologic distress contributed to worsening SST and DASH scores but not to Constant-Murley scores. DASH scores were more strongly influenced by pain anxiety and depression than the other two outcome instruments.

CONCLUSIONS

Shoulder outcome measures reflected different psychologic aspects of illness behavior, and the contributions made by psychologic distress to different shoulder outcome instruments apparently differed. Physicians should select and interpret the findings of shoulder outcome instruments properly by considering their psychologic implications.

LEVEL OF EVIDENCE

Level II, prognostic study. See Instructions for Authors for a complete description of levels of evidence.

How much are upper or lower extremity disabilities associated with general health status in the elderly?

BACKGROUND

Musculoskeletal complaints influence general health status, but the relative contribution of concurrent upper and lower extremity disabilities on patient perceptions of general health is unclear.

QUESTIONS/PURPOSES

We evaluated whether two regional instruments (DASH and WOMAC) reflect a patient's perception of general health measured using the SF-36 and determined whether general health components are explained by upper and lower extremity disabilities.

METHODS

We recruited 272 randomly chosen participants 65 years or older without a history of surgery for musculoskeletal disease or trauma who participated in the Korean Longitudinal Study on Health and Aging. Upper extremity disability was determined with the DASH score and lower extremity disability with the WOMAC; as a measure of general health, we obtained SF-36 scores. Multivariate regression modeling was used to assess the relative contributions made by upper and lower extremity disabilities to general health.

RESULTS

The DASH and WOMAC each was correlated with the physical component summary (PCS) scale and with the mental component summary (MCS) scale to differing extents. Multivariate regression analyses revealed that WOMAC alone, DASH alone, and WOMAC and DASH accounted for 24%, 19%, and 26% of the variance in the PCS scale. However, only the DASH was associated with the MCS scale but accounted for only 2% of the variance.

CONCLUSIONS

We found that in a community-based elderly population, perceived general physical health is associated with upper and lower extremity disabilities, whereas perceived general mental health is associated with only upper extremity disabilities, but to a small extent.

LEVEL OF EVIDENCE

Level II, prognostic study. See Guidelines for Authors for a complete description of levels of evidence.

Effect of depressive symptoms on perceived disability in patients with chronic shoulder pain

BACKGROUND

Psychological distress may be an important determinant of perceived disability in patients with chronic musculoskeletal disorders. We evaluated the relationship between depressive symptoms and perceived disability in patients with chronic shoulder pain and quantified the contribution made by depression to perceived disability.

METHODS

In this prospective study, 109 patients with chronic shoulder pain caused by degenerative or inflammatory disorders were evaluated using the Disability of Arm, Shoulder and Hand (DASH) questionnaire and the Center for Epidemiologic Studies-Depression (CES-D) Scale to determine relationships between depressive symptoms and perceived disability in patients with chronic shoulder pain. In addition, pain scores were evaluated using a visual analog scale (VAS) during activity, and range of motion (ROM) and abduction strength (strength) measurements were measured. Multivariate analyses of variance and regression modeling were used to assess the relative contributions made by depressive symptoms (CES-D) and other clinical parameters to patient-perceived disability (DASH).

RESULTS

DASH scores were found to be moderately correlated (0.3 < r < 0.6) with ROM, strength, pain VAS and CES-D; DASH scores were more strongly correlated with CES-D scores than with pain VAS scores or range of motion (r = 0.58; p < 0.001, 0.37; p < 0.001, 0.32; p = 0.04 respectively). Multiple stepwise regression analyses revealed that gender, ROM, pain VAS and CES-D scores independently predicted DASH score and accounted for 43 % of the variance. CES-D score was found to be the strongest predictor of DASH score and accounted for 23 % of the variance.

CONCLUSIONS

Degrees of depressive symptoms were found to be significantly associated with higher symptom scores and greater disability in patients with chronic shoulder pain. Although a large proportion of perceived disability remains unexplained, perceived disability in patients with chronic shoulder pain was found to be strongly influenced by depressive symptoms.

TYPE OF STUDY/LEVEL OF EVIDENCE

Level 2, prospective cohort study, prognostic study.

Prevalence of diagnosed arthritis and arthritis-attributable activity limitation among adults with and without diagnosed diabetes: United States, 2008-2010

OBJECTIVE

To estimate the prevalence of diagnosed arthritis among U.S. adults and the proportion of arthritis-attributable activity limitation (AAAL) among those with arthritis by diagnosed diabetes mellitus (DM) status.

RESEARCH DESIGN AND METHODS

We estimated prevalences and their ratios using 2008-2010 U.S. National Health Interview Survey of noninstitutionalized U.S. adults aged ≥ 18 years. Respondents' arthritis and DM status were both based on whether they reported a diagnosis of these diseases. Other characteristics used for stratification or adjustment included age, sex, race/ethnicity, education level, BMI, and physical activity level.

RESULTS

Among adults with DM, the unadjusted prevalences of arthritis and proportion of AAAL among adults with arthritis (national estimated cases in parentheses) were 48.1% (9.6 million) and 55.0% (5.3 million), respectively. After adjusting for other characteristics, the prevalence ratios of arthritis and of AAAL among arthritic adults with versus without DM (95% CI) were 1.44 (1.35-1.52) and 1.21 (1.15-1.28), respectively. The prevalence of arthritis increased with age and BMI and was higher for women, non-Hispanic whites, and inactive adults compared with their counterparts both among adults with and without DM (all P values < 0.05). Among adults with diagnosed DM and arthritis, the proportion of AAAL was associated with being obese, but was not significantly associated with age, sex, and race/ethnicity.

CONCLUSIONS

Among U.S. adults with diagnosed DM, nearly half also have diagnosed arthritis; moreover, more than half of those with both diseases had AAAL. Arthritis can be a barrier to physical activity among adults with diagnosed DM.

Perceived versus actual factors associated with adoption and maintenance of an evidence-based physical activity program

The public health burden of arthritis requires the dissemination of evidence-based physical activity (PA) programs for arthritis. This study examined perceived vs. actual factors related to the adoption and maintenance of PA programs and Fit and Strong! Six focus groups (n = 46) were conducted in two states with potential Fit and Strong! providers. Key informant interviews (n = 18) were conducted with actual Fit and Strong! providers. Participant interest was a primary motivator for PA program adoption in both focus groups and key informant interviews. Fit and Strong's evidence base was a motivator for adoption among focus group participants. The primary perceived barrier to adopting Fit and Strong! among focus group participants was cost/resource limitations compared to scheduling among key informants. Evidence-based programs need to craft different messages to deal with barriers perceived and experienced by providers engaged in specific stages of the translation process.