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Shamsalinia A, Hosseini SR, Bijani A, Ghadimi R, Kordbageri MR, Saadati K, Ghaffari F. Effects of Frailty Syndrome on Osteoporosis, Focusing on the Mediating Effect of Muscle Strength and Balance in Community-Dwelling Older Adults (≥60 years) in Iran: Results From the Amirkola Health and Aging Project Cohort Study. Geriatr Orthop Surg Rehabil 2024; 15:21514593241264647. [PMID: 39070931 PMCID: PMC11273585 DOI: 10.1177/21514593241264647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Revised: 05/21/2024] [Accepted: 06/09/2024] [Indexed: 07/30/2024] Open
Abstract
Introduction For older adults, maintaining muscle strength and balance is crucial to preserve an upright posture and independently manage their basic activities of daily living (ADL). This study aimed to examine whether muscle strength and balance mediate the relationship between frailty syndrome (FS) and osteoporosis in a large sample of community-dwelling older adults. Material and Methods This cross-sectional study is part of the second phase (2016-2017) of the Amirkola Health and Ageing Project (AHAP), a cohort study conducted on all elderly aged 60 and over in Amirkola, Northern Iran, since 2011. Data from 2018 older adults were collected by a trained person using bone mineral density (BMD), frailty index, activities of daily living (ADL), instrumental activities of daily living (IADL), handgrip strength (HGS), quadriceps muscle strength (QMS), Berg Balance Scale (BBS), and Timed Up and Go test (TUG test) and analyzed using analysis of variance, chi-square, and path analysis tests. Results The mean indices of femoral neck BMD and lumbar spine BMD, HGS, QMS, BBS, ADL, and IADL were lower in the frail older adults than in the pre-frail and non-frail older adults. In addition, the mean TUG test level was higher in the frail older adults than in the non-frail and pre-frail older adults. The results of the present study have indicated that frailty is significantly related to osteoporosis, and that balance and muscle strength can predict osteoporosis; these variables play a mediating role in the relationship between frailty and osteoporosis. Conclusion From the results of the present study, it can be concluded that frailty may increase the odds of osteoporosis. The results of the current study have indicated that balance (BBS and TUG test) and muscle strength (HGS and QMS) are associated with osteoporosis and these variables play a mediating role in the relationship between frailty and osteoporosis.
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Affiliation(s)
- Abbas Shamsalinia
- Nursing Care Research Center, Health Research Institute, Babol University of Medical Science, Babol, Iran
| | - Seyed Reza Hosseini
- Social Determinants of Health (SDH) Research Centre, Health Research Institute, Babol University of Medical Science, Babol, Iran
| | - Ali Bijani
- Social Determinants of Health (SDH) Research Centre, Health Research Institute, Babol University of Medical Science, Babol, Iran
| | - Reza Ghadimi
- Social Determinants of Health (SDH) Research Centre, Health Research Institute, Babol University of Medical Science, Babol, Iran
| | | | - Kiyana Saadati
- Student Research Committee, Ramsar Campus, Mazandaran University of Medical Sciences, Ramsar, Iran
| | - Fatemeh Ghaffari
- Nursing Care Research Center, Health Research Institute, Babol University of Medical Science, Babol, Iran
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Loecker CN, Schmaderer MS, Wysham KD, Pozehl B, Zimmerman L, England BR. Psychometric Properties of Frailty Instruments in Adults With Rheumatoid Arthritis: A Systematic Review. ACR Open Rheumatol 2024; 6:91-102. [PMID: 38083820 PMCID: PMC10867294 DOI: 10.1002/acr2.11640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 11/09/2023] [Accepted: 11/15/2023] [Indexed: 02/16/2024] Open
Abstract
OBJECTIVE Examine psychometric properties of frailty instruments used in adults with rheumatoid arthritis (RA) to inform selection of frailty instruments for clinical and research use. METHODS A systematic review was registered in PROSPERO. Studies measuring frailty in adults with RA published before May 25, 2022, were searched in six electronic databases. Level of evidence of psychometric properties were synthesized and graded for each frailty instrument using Consensus-Based Standards for the Selection of Health Measurement Instruments methodology. RESULTS There were 22 articles included in the review, and psychometric properties of 16 frailty instruments were examined. RA cohorts were predominantly female with moderate RA disease activity, mean age was 60.1 years, and frailty prevalence ranged widely from 10% to 85%. Construct validity was the only psychometric property routinely examined for frailty instruments in RA, and nearly all (14/16) performed favorably in this domain. Frailty correlated most frequently with older age, higher RA disease activity, and worse physical function. Internal consistency, measurement error, and content validity were examined infrequently. Reliability and responsiveness data were not reported. Six frailty instruments were rated highest in adults with RA: three adaptations of Fried's Criteria, 32-Item and 45-Item Frailty Indexes, and the Comprehensive Rheumatologic Assessment of Frailty. CONCLUSION Six frailty instruments possessed the highest-rated psychometric properties in RA. These instruments demonstrated construct validity of frailty with important outcomes in RA. Frailty assessment shows promise to inform risk stratification in RA, but studies are needed to evaluate reliability, responsiveness, and validity to support accuracy of frailty measurement in adults with RA who may have disease-related features that differentially impact outcomes.
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Affiliation(s)
| | | | - Katherine D. Wysham
- US Department of Veterans Affairs Puget Sound Health Care System and University of WashingtonSeattle
| | - Bunny Pozehl
- University of Nebraska Medical Center College of NursingOmaha
| | - Lani Zimmerman
- University of Nebraska Medical Center College of NursingLincoln
| | - Bryant R. England
- US Department of Veterans Affairs Nebraska‐Western Iowa Health Care System and University of Nebraska Medical CenterOmaha
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Mendoza-Pinto C, Etchegaray-Morales I, Munguía-Realpozo P, Méndez-Martínez S, Ayón-Aguilar J, Arellano-Avendaño F, Montel-Jarquín ÁJ, García-Carrasco M. SLICC-Frailty Index and Its Association with Low Bone Mineral Density and Vertebral Fractures in Women with Systemic Lupus Erythematosus. Calcif Tissue Int 2023; 113:475-480. [PMID: 37481761 PMCID: PMC10618373 DOI: 10.1007/s00223-023-01117-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 07/10/2023] [Indexed: 07/25/2023]
Abstract
The Systemic Lupus International Clinics (SLICC)-Frailty Index (FI) is associated with adverse outcomes in systemic lupus erythematosus (SLE). However, to our knowledge, its association with bone mineral density (BMD) and vertebral fractures (VF), has not been investigated using a standardized methods. Our aim was to evaluate the relationship between frailty assessed by SLICC-FI, and BMD and VF in Mestizo women with SLE. Adult women were included in this cross-sectional study. Information concerning the risk factors for VF and BMD in the lumbar spine and total hip was acquired. SLICC-FI was assessed at baseline. A semi-quantitative method was utilized to evaluate the prevalence of VF on lateral thoracolumbar radiographs. Univariate and multivariate regression analyses were performed adjusting for age, body mass index (BMI), SLE duration, cumulative glucocorticoid dose, bisphosphonate use, and BMD measurements. We included 202 women with SLE (mean age [SD] = 43.3 [13.6] years). The mean (SD) SLICC-FI value was 0.14 (0.09). Eleven (5.4%) patients were categorized as robust, 62 (30.7%) as relatively less fit, 84 (41.6%) as least fit, and 45 (22.3%) as frail. Both univariate and multivariate models showed associations between frailty (defined as SLICC-FI > 0.21) and prevalent VF in the entire population (OR 5.76, 95% CI 2.53-13.12; P < 0.001) and in the premenopausal group (OR 4.29, 95% CI; P = 0.047). We also found an association between the SLICC-FI and low BMD. In conclusion, frailty assessed by SLICC-FI might be associated with VF and low BMD in mestizo females with SLE.
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Affiliation(s)
- Claudia Mendoza-Pinto
- Systemic Autoimmune Diseases Research Unit, Specialties Hospital UMAE- CIBIOR, Mexican Institute for Social Security, Puebla, Puebla, Mexico
- Department of Rheumatology, Medicine School, Meritorious Autonomous University of Puebla, Puebla, Mexico
| | - Ivet Etchegaray-Morales
- Department of Rheumatology, Medicine School, Meritorious Autonomous University of Puebla, Puebla, Mexico
| | - Pamela Munguía-Realpozo
- Systemic Autoimmune Diseases Research Unit, Specialties Hospital UMAE- CIBIOR, Mexican Institute for Social Security, Puebla, Puebla, Mexico.
- Department of Rheumatology, Medicine School, Meritorious Autonomous University of Puebla, Puebla, Mexico.
| | | | - Jorge Ayón-Aguilar
- Health Research Medical Coordinator, Mexican Social Security Institute, Puebla Delegation, Puebla, Mexico
| | | | | | - Mario García-Carrasco
- Department of Rheumatology, Medicine School, Meritorious Autonomous University of Puebla, Puebla, Mexico
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Overstreet DS, Strath LJ, Jordan M, Jordan IA, Hobson JM, Owens MA, Williams AC, Edwards RR, Meints SM. A Brief Overview: Sex Differences in Prevalent Chronic Musculoskeletal Conditions. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:4521. [PMID: 36901530 PMCID: PMC10001545 DOI: 10.3390/ijerph20054521] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 01/25/2023] [Accepted: 02/24/2023] [Indexed: 06/18/2023]
Abstract
Musculoskeletal (MSK) pain disorders are some of the most prevalent and disabling chronic pain conditions worldwide. These chronic conditions have a considerable impact on the quality of life of individuals, families, communities, and healthcare systems. Unfortunately, the burden of MSK pain disorders does not fall equally across the sexes. Females consistently demonstrate more prevalent and severe clinical presentations of MSK disorders, and this disparity increases in magnitude with age. The aim of the present article is to review recent studies that have examined sex differences between males and females in four of the most common MSK pain disorders: neck pain, low back pain, osteoarthritis, and rheumatoid arthritis.
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Affiliation(s)
- Demario S. Overstreet
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Woman’s Hospital, Boston, MA 02115, USA
- Harvard Medical School, Boston, MA 02115, USA
| | - Larissa J. Strath
- Department of Community Dentistry and Behavioral Science, University of Florida, Gainesville, FL 32603, USA
- Pain Research and Intervention Center of Excellence (PRICE), University of Florida, Gainesville, FL 32610, USA
| | | | - Indonesia A. Jordan
- Department of Psychology, University of Alabama at Birmingham, Birmingham, AL 35294, USA
| | - Joanna M. Hobson
- Department of Psychology, University of Alabama at Birmingham, Birmingham, AL 35294, USA
| | - Michael A. Owens
- Department of Psychiatry and Behavioral Sciences, School of Medicine, Johns Hopkins University, Baltimore, MD 21205, USA
| | - Adrian C. Williams
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Woman’s Hospital, Boston, MA 02115, USA
- Harvard Medical School, Boston, MA 02115, USA
| | - Robert R. Edwards
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Woman’s Hospital, Boston, MA 02115, USA
- Harvard Medical School, Boston, MA 02115, USA
| | - Samantha M. Meints
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Woman’s Hospital, Boston, MA 02115, USA
- Harvard Medical School, Boston, MA 02115, USA
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de Oliveira DC, Máximo RDO, Ramírez PC, de Souza AF, Luiz MM, Delinocente MLB, Steptoe A, de Oliveira C, Alexandre TDS. Does the incidence of frailty differ between men and women over time? Arch Gerontol Geriatr 2023; 106:104880. [PMID: 36493577 PMCID: PMC9868103 DOI: 10.1016/j.archger.2022.104880] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 11/24/2022] [Accepted: 11/27/2022] [Indexed: 12/03/2022]
Abstract
BACKGROUND/OBJECTIVE The mechanisms, risk factors and influence of sex on the incidence of frailty components are not fully understood. The aim of this study was to analyse sex differences in factors associated with the increase in the number of frailty components. METHODS A 12-year follow-up analysis was conducted with 1,747 participants aged ≥ 60 of the ELSA Study with no frailty at baseline. Generalised linear mixed models were used to analyse the increase in the number of frailty components stratified by sex, considering socioeconomic, behavioural, clinical and biochemical characteristics as exposure variables. RESULTS The increase in the number of frailty components in both sexes was associated with an advanced age (70 to 79 years and 80 years or older), low educational level, sedentary lifestyle, elevated depressive symptoms, joint disease, high C-reactive protein levels, perception of poor vision and uncontrolled diabetes (p < 0.05). Osteoporosis, low weight, heart disease, living with one or more people and perception of poor hearing were associated with an increase in the number of frailty components in men. High fibrinogen concentration, controlled diabetes, stroke and perception of fair vision were associated with the outcome in women (p < 0.05). Obese women and men and overweight women had a lower increase in the number of frailty components compared to those in the ideal weight range. CONCLUSIONS Socioeconomic factors, musculoskeletal disorders, heart disease and low weight seem to sustain the frailty process in men, whereas cardiovascular and neuroendocrine disorders seem to sustain the frailty process in women.
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Affiliation(s)
- Dayane Capra de Oliveira
- Postgraduate Programme in Physical Therapy, Federal University of Sao Carlos. Rodovia, Washington Luís, km 235, SP-310 Sao Carlos, Sao Paulo 13565-905, Brazil
| | - Roberta de Oliveira Máximo
- Postgraduate Programme in Physical Therapy, Federal University of Sao Carlos. Rodovia, Washington Luís, km 235, SP-310 Sao Carlos, Sao Paulo 13565-905, Brazil
| | - Paula Camila Ramírez
- Postgraduate Programme in Physical Therapy, Federal University of Sao Carlos. Rodovia, Washington Luís, km 235, SP-310 Sao Carlos, Sao Paulo 13565-905, Brazil; Escuela de Fisioterapia, Universidad Industrial de Santander. Carrera 32 Nº 29-31, Bucaramanga 680006, Colômbia
| | - Aline Fernanda de Souza
- Postgraduate Programme in Physical Therapy, Federal University of Sao Carlos. Rodovia, Washington Luís, km 235, SP-310 Sao Carlos, Sao Paulo 13565-905, Brazil
| | - Mariane Marques Luiz
- Postgraduate Programme in Physical Therapy, Federal University of Sao Carlos. Rodovia, Washington Luís, km 235, SP-310 Sao Carlos, Sao Paulo 13565-905, Brazil
| | - Maicon Luis Bicigo Delinocente
- Postgraduate Programme in Gerontology, Federal University of Sao Carlos. Rodovia, Washington Luís, km 235, SP-310, Sao Carlos, Sao Paulo 13565-905, Brazil
| | - Andrew Steptoe
- Department of Epidemiology and Public Health, University College of London (UCL). Gower Street, London WC1E 6BT, United Kingdom
| | - Cesar de Oliveira
- Department of Epidemiology and Public Health, University College of London (UCL). Gower Street, London WC1E 6BT, United Kingdom
| | - Tiago da Silva Alexandre
- Postgraduate Programme in Physical Therapy, Federal University of Sao Carlos. Rodovia, Washington Luís, km 235, SP-310 Sao Carlos, Sao Paulo 13565-905, Brazil; Postgraduate Programme in Gerontology, Federal University of Sao Carlos. Rodovia, Washington Luís, km 235, SP-310, Sao Carlos, Sao Paulo 13565-905, Brazil; Department of Epidemiology and Public Health, University College of London (UCL). Gower Street, London WC1E 6BT, United Kingdom; Gerontology Department, Federal University of Sao Carlos, Rodovia Washington Luís, km 235, SP-310, Sao Carlos, Sao Paulo 13565-905, Brazil.
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Hanlon P, Morrison H, Morton F, Jani BD, Siebert S, Lewsey J, McAllister D, Mair FS. Frailty in people with rheumatoid arthritis: a systematic review of observational studies. Wellcome Open Res 2022; 6:244. [PMID: 37746318 PMCID: PMC10511856 DOI: 10.12688/wellcomeopenres.17208.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/02/2022] [Indexed: 09/26/2023] Open
Abstract
Background: Frailty, an age-related decline in physiological reserve, is an increasingly important concept in the management of chronic diseases. The implications of frailty in people with rheumatoid arthritis are not well understood. We undertook a systematic review to assess prevalence of frailty in people with rheumatoid arthritis, and the relationship between frailty and disease activity or clinical outcomes. Methods: We searched four electronic databases (January 2001 to April 2021) for observational studies assessing the prevalence of frailty (any frailty measure) in adults (≥18 years) with rheumatoid arthritis, or analysing the relationship between frailty and disease activity or clinical outcomes (e.g. quality of life, hospitalisation or mortality) in people with rheumatoid arthritis. Study quality was assessed using an adapted Newcastle-Ottawa Scale. Screening, quality assessment and data extraction were performed independently by two reviewers. We used narrative synthesis. Results: We identified 17 analyses, from 14 different populations. 15/17 were cross-sectional. Studies used 11 different measures of frailty. Frailty prevalence ranged from 10% (frailty phenotype) to 36% (comprehensive rheumatologic assessment of frailty) in general adult populations with rheumatoid arthritis. In younger populations (<60 or <65 years) prevalence ranged from 2.4% (frailty phenotype) to 19.9% (Kihon checklist) while in older populations (>60 or >65) prevalence ranged from 31.2% (Kihon checklist) to 55% (Geriatric 8 tool). Frailty was cross-sectionally associated with higher disease activity (10/10 studies), lower physical function (7/7 studies) and longer disease duration (2/5 studies), and with hospitalization and osteoporotic fractures (1/1 study, 3.7 years follow-up). Conclusion: Frailty is common in rheumatoid arthritis, including those aged <65 years, and is associated with a range of adverse features. However, these is heterogeneity in how frailty is measured. We found few longitudinal studies making the impact of frailty on clinical outcomes over time and the extent to which frailty is caused by rheumatoid arthritis unclear.
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Affiliation(s)
- Peter Hanlon
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Holly Morrison
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Fraser Morton
- Institute of Infection, Immunity & Inflammation, University of Glasgow, Glasgow, UK
| | - Bhautesh D Jani
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Stefan Siebert
- Institute of Infection, Immunity & Inflammation, University of Glasgow, Glasgow, UK
| | - Jim Lewsey
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - David McAllister
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Frances S Mair
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
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Hanlon P, Morrison H, Morton F, Jani BD, Siebert S, Lewsey J, McAllister D, Mair FS. Frailty in people with rheumatoid arthritis: a systematic review of observational studies. Wellcome Open Res 2022; 6:244. [PMID: 37746318 PMCID: PMC10511856 DOI: 10.12688/wellcomeopenres.17208.1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/02/2022] [Indexed: 07/15/2024] Open
Abstract
Background: Frailty, an age-related decline in physiological reserve, is an increasingly important concept in the management of chronic diseases. The implications of frailty in people with rheumatoid arthritis are not well understood. We undertook a systematic review to assess prevalence of frailty in people with rheumatoid arthritis, and the relationship between frailty and disease activity or clinical outcomes. Methods: We searched four electronic databases (January 2001 to April 2021) for observational studies assessing the prevalence of frailty (any frailty measure) in adults (≥18 years) with rheumatoid arthritis, or analysing the relationship between frailty and disease activity or clinical outcomes (e.g. quality of life, hospitalisation or mortality) in people with rheumatoid arthritis. Study quality was assessed using an adapted Newcastle-Ottawa Scale. Screening, quality assessment and data extraction were performed independently by two reviewers. We used narrative synthesis. Results: We identified 17 analyses, from 14 different populations. 15/17 were cross-sectional. Studies used 11 different measures of frailty. Frailty prevalence ranged from 10% (frailty phenotype) to 36% (comprehensive rheumatologic assessment of frailty) in general adult populations with rheumatoid arthritis. In younger populations (<60 or <65 years) prevalence ranged from 2.4% (frailty phenotype) to 19.9% (Kihon checklist) while in older populations (>60 or >65) prevalence ranged from 31.2% (Kihon checklist) to 55% (Geriatric 8 tool). Frailty was cross-sectionally associated with higher disease activity (10/10 studies), lower physical function (7/7 studies) and longer disease duration (2/5 studies), and with hospitalization and osteoporotic fractures (1/1 study, 3.7 years follow-up). Conclusion: Frailty is common in rheumatoid arthritis, including those aged <65 years, and is associated with a range of adverse features. However, these is heterogeneity in how frailty is measured. We found few longitudinal studies making the impact of frailty on clinical outcomes over time and the extent to which frailty is caused by rheumatoid arthritis unclear.
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Affiliation(s)
- Peter Hanlon
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Holly Morrison
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Fraser Morton
- Institute of Infection, Immunity & Inflammation, University of Glasgow, Glasgow, UK
| | - Bhautesh D Jani
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Stefan Siebert
- Institute of Infection, Immunity & Inflammation, University of Glasgow, Glasgow, UK
| | - Jim Lewsey
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - David McAllister
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Frances S Mair
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
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Hax V, Tessari J, Pena E, Santo RCDE, dos Santos LP, Gasparin AA, Bredemeier M, Fighera TM, Spritzer PM, Xavier RM, Chakr RMDS. Physical frailty in patients with systemic sclerosis. Semin Arthritis Rheum 2022; 56:152077. [DOI: 10.1016/j.semarthrit.2022.152077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 07/12/2022] [Accepted: 07/25/2022] [Indexed: 10/16/2022]
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Hanlon P, Morton F, Siebert S, Jani BD, Nicholl BI, Lewsey J, McAllister D, Mair FS. Frailty in rheumatoidrmdopen-2021-002111 arthritis and its relationship with disease activity, hospitalisation and mortality: a longitudinal analysis of the Scottish Early Rheumatoid Arthritis cohort and UK Biobank. RMD Open 2022; 8:e002111. [PMID: 35292529 PMCID: PMC8928366 DOI: 10.1136/rmdopen-2021-002111] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 02/17/2022] [Indexed: 01/17/2023] Open
Abstract
OBJECTIVE To assess the prevalence of frailty in rheumatoid arthritis (RA) and its association with baseline and longitudinal disease activity, all-cause mortality and hospitalisation. PARTICIPANTS People with RA identified from the Scottish Early Rheumatoid Arthritis (SERA) inception cohort (newly diagnosed, mean age 58.2 years) and UK Biobank (established disease identified using diagnostic codes, mean age 59 years). Frailty was quantified using the frailty index (both datasets) and frailty phenotype (UK Biobank only). Disease activity was assessed using Disease Activity Score in 28 joints (DAS28) in SERA. Associations between baseline frailty and all-cause mortality and hospitalisation was estimated after adjusting for age, sex, socioeconomic status, smoking and alcohol, plus DAS28 in SERA. RESULTS Based on the frailty index, frailty was common in SERA (12% moderate, 0.2% severe) and UK Biobank (20% moderate, 3% severe). In UK Biobank, 23% were frail using frailty phenotype. Frailty index was associated with DAS28 in SERA, as well as age and female sex in both cohorts. In SERA, as DAS28 lessened over time with treatment, mean frailty index also decreased. The frailty index was associated with all-cause mortality (HR moderate/severe frailty vs robust 4.14 (95% CI 1.49 to 11.51) SERA, 1.68 (95% CI 1.26 to 2.13) UK Biobank) and unscheduled hospitalisation (incidence rate ratio 2.27 (95% CI 1.45 to 3.57) SERA 2.74 (95% CI 2.29 to 3.29) UK Biobank). In UK Biobank, frailty phenotype also associated with mortality and hospitalisation. CONCLUSION Frailty is common in early and established RA and associated with hospitalisation and mortality. Frailty in RA is dynamic and, for some, may be ameliorated through controlling disease activity in early disease.
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Affiliation(s)
- Peter Hanlon
- General Practice and Primary Care, University of Glasgow Institute of Health and Wellbeing, Glasgow, UK
| | - Fraser Morton
- Institute of Infection, Immunity & Inflammation, University of Glasgow, Glasgow, UK
| | - Stefan Siebert
- Institute of Infection, Immunity & Inflammation, University of Glasgow, Glasgow, UK
| | - Bhautesh D Jani
- General Practice and Primary Care, University of Glasgow Institute of Health and Wellbeing, Glasgow, UK
| | - Barbara I Nicholl
- General Practice and Primary Care, University of Glasgow Institute of Health and Wellbeing, Glasgow, UK
| | - Jim Lewsey
- Health Economics and Health Technology Assessment, University of Glasgow Institute of Health and Wellbeing, Glasgow, UK
| | - David McAllister
- Public Health, University of Glasgow Institute of Health and Wellbeing, Glasgow, UK
| | - Frances S Mair
- General Practice and Primary Care, University of Glasgow Institute of Health and Wellbeing, Glasgow, UK
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Gao RC, Zhen-Gang W, Zhen-Zhen W, Hao M, Guo-Cui W. Frailty in rheumatoid arthritis: a systematic review and meta-analysis. Joint Bone Spine 2022; 89:105343. [PMID: 35033680 DOI: 10.1016/j.jbspin.2022.105343] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Revised: 12/07/2021] [Accepted: 12/29/2021] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Rheumatoid arthritis (RA) may cause damage to multiple organs and may further restrict the patient's physical, psychological and social functions. This meta-analysis aimed to explore the prevalence of frailty and prefrailty and the influential factors in RA patients. METHODS PubMed, Web of Science, Cochrane, Embase, and CNKI were searched to identify related articles. Articles published before July 23rd, 2021 that assessed frailty in patients with RA qualified for the systematic review and meta-analysis. A quality appraisal of the studies was performed using the Agency for Healthcare Research and Quality and Newcastle-Ottawa Scales. The pooled results were displayed as odds ratios or standardized mean differences (ORs/SMDs) and 95% confidence intervals (CIs). RESULTS The article search generated 2,273 articles, of which 16 satisfied the inclusion criteria and were merged in the final review. A total of 8,556 RA patients were finally included. The pooled prevalence of frailty in the patients with RA was 33.5% (95% CI: 25.2-41.7%), and the pooled prevalence of prefrailty was 39.9% (95% CI: 29.4-50.3%). Subgroup analyses showed that frailty was more prevalent in females (24.7%) than in males (19.1%). The prevalence of prefrailty in females was similar to that in males among the RA patients. Frailty in RA was associated with the female sex (OR: 1.47, 95% CI: 1.04-2.07) and disease activity (OR: 1.47, 95% CI: 1.03-2.09). CONCLUSION Frailty is prevalent in RA patients. Female gender and disease activity are associated with the prevalence of frailty in RA patients.
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Affiliation(s)
- Rui-Chen Gao
- School of Nursing, Anhui Medical University, Hefei, 230032, Anhui, China
| | - Wu Zhen-Gang
- School of Nursing, Anhui Medical University, Hefei, 230032, Anhui, China
| | - Wu Zhen-Zhen
- School of Nursing, Anhui Medical University, Hefei, 230032, Anhui, China
| | - Min Hao
- Department of Rheumatology, The First Affiliated Hospital of Anhui Medical University, Hefei, 230022, Anhui, China
| | - Wu Guo-Cui
- School of Nursing, Anhui Medical University, Hefei, 230032, Anhui, China.
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Abstract
The gold standard for diagnosis of osteoporosis is measurement of an individual's bone mineral density on dual-energy x-ray absorptiometry scan. If this value is less than or equal to 2.5 standard deviations less than that of an adult female reference population, a person is said to have osteoporosis, with this risk increasing as a person ages. Female gender is a large risk factor in developing osteoporosis, regardless of ethnic or racial group. Frailty is another key factor in determining likelihood to develop osteoporotic fractures. Bisphosphonates are the first line agents for treatment of osteoporosis.
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Affiliation(s)
- Ivy Akid
- Department of Medicine, Division of General Internal Medicine, Section of Palliative Medicine, JHUSOM, Johns Hopkins Hospital, 600 North Wolfe Street Blalock 371, Baltimore, MD 21287, USA.
| | - Danielle J Doberman
- Department of Medicine, Division of General Internal Medicine, Section of Palliative Medicine, Palliative Medicine Program, JHUSOM, Johns Hopkins Hospital, 600 North Wolfe Street Blalock 371, Baltimore, MD 21287, USA
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Furuya T, Oh K, Ikari K, Inoue E, Tanaka E, Yamanaka H, Harigai M. Factors associated with frailty in Japanese patients with rheumatoid arthritis: results from the Institute of Rheumatology Rheumatoid Arthritis cohort study. Clin Rheumatol 2021; 41:405-410. [PMID: 34586516 DOI: 10.1007/s10067-021-05938-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2021] [Revised: 09/17/2021] [Accepted: 09/22/2021] [Indexed: 12/01/2022]
Abstract
This study aimed to evaluate the prevalence of, and the factors associated with, frailty in Japanese patients with rheumatoid arthritis (RA). Patients with RA enrolled in the Institute of Rheumatology Rheumatoid Arthritis (IORRA) cohort completed self-administered questionnaires, which included the 5-item frailty screening index. Patients were classified as frail, prefrail, or robust based on the 5 components of the frailty screening index. Logistic regression analyses were used to evaluate associations between clinical variables and frailty. Among 3,290 Japanese patients with RA (86.7% female, mean age 62.4 years) who participated this frailty study, 549 (16.7%) patients were categorized as frailty, 2,063 (62.7%) as prefrailty, and 678 (20.6%) as robust. In multivariable models, body mass index (BMI) ≥ 25 kg/m2 (odds ratio [OR] 1.87, 95% confidence interval [CI] 1.41 to 2.47), BMI < 18.5 kg/m2 (OR 1.31, 95% CI 1.00 to 1.71), disease activity scores in 28 joints (DAS28) (OR 1.32, 95% CI 1.18 to 1.47), Japanese version of Health Assessment Questionnaire disability index (J-HAQ) (OR 1.26, 95% CI 1.04 to 1.52), the European Quality of Life-5 Dimensions (EQ-5D) (OR 0.80, 95% CI 0.74 to 0.85), non-steroidal anti-inflammatory drug (NSAID) use (OR 1.59, 95% CI 1.23 to 1.98), and methotrexate (MTX) use (OR 0.75, 95% CI 0.60 to 0.94) were significantly (P < 0.05) associated with frailty. BMI (both overweight and underweight), DAS28, J-HAQ, EQ-5D, NSAID use, and MTX nonuse appear to be associated with frailty in Japanese patients with RA. Key Points • This is the largest study showing the prevalence and the associated factors of frailty in patients with RA. • Maintaining normal BMI appears to be important for preventing frailty in patients with RA. • We confirmed the significant associations of frailty with high disease activity, high degree of disability, and poor health related QOL in Japanese patients with RA. • NSAID use and MTX nonuse were associated with the frailty in Japanese patients with RA, which could be explained by patients' background.
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Affiliation(s)
- Takefumi Furuya
- Division of Rheumatology, Department of Internal Medicine, Tokyo Women's Medical University School of Medicine, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan. .,Institute of Rheumatology, Tokyo Women's Medical University Hospital, Tokyo, Japan.
| | - Koei Oh
- Institute of Rheumatology, Tokyo Women's Medical University Hospital, Tokyo, Japan.,Department of Orthopedics, Tokyo Women's Medical University School of Medicine, Tokyo, Japan
| | - Katsunori Ikari
- Institute of Rheumatology, Tokyo Women's Medical University Hospital, Tokyo, Japan.,Department of Orthopedics, Tokyo Women's Medical University School of Medicine, Tokyo, Japan
| | - Eisuke Inoue
- Division of Rheumatology, Department of Internal Medicine, Tokyo Women's Medical University School of Medicine, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan.,Showa University Research Administration Center, Showa University, Tokyo, Japan
| | - Eiichi Tanaka
- Division of Rheumatology, Department of Internal Medicine, Tokyo Women's Medical University School of Medicine, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan.,Institute of Rheumatology, Tokyo Women's Medical University Hospital, Tokyo, Japan
| | - Hisashi Yamanaka
- Division of Rheumatology, Department of Internal Medicine, Tokyo Women's Medical University School of Medicine, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan.,Institute of Rheumatology, Tokyo Women's Medical University Hospital, Tokyo, Japan.,Rheumatology, Sanno Medical Center, Tokyo, Japan
| | - Masayoshi Harigai
- Division of Rheumatology, Department of Internal Medicine, Tokyo Women's Medical University School of Medicine, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan.,Institute of Rheumatology, Tokyo Women's Medical University Hospital, Tokyo, Japan
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13
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Lieber SB, Nahid M, Paget S, Berman JR, Barbhaiya M, Sammaritano LR, Kirou K, Carrino JA, Rajan M, Sheira D, Mandl LA. Evaluation of a Patient-reported Frailty Tool in Women With Systemic Lupus Erythematosus. J Rheumatol 2021; 49:60-67. [PMID: 34470795 DOI: 10.3899/jrheum.201466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/17/2021] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Frailty is associated with mortality in systemic lupus erythematosus (SLE), but how best to measure frailty is unclear. We aimed to compare 2 frailty metrics, the self-reported Fatigue, Resistance, Ambulation, Illnesses, and Loss of weight (FRAIL) scale (FS) and the Fried phenotype (FP), in SLE to evaluate differences between frail and nonfrail women and whether frailty is associated with self-reported disability. METHODS Adult women aged < 70 years with validated SLE and mild/moderate disease enrolled in this cross-sectional study between August 2018 and October 2019. Correlation and agreement between the FS and the FP were determined. Differences in sociodemographic and disease characteristics, patient-reported outcome measures (PROMs), and biomarkers between frail and nonfrail participants were evaluated, as well as the association of frailty with Valued Life Activities disability. RESULTS Of 67 participants, 27% and 18% were frail according to the FS and the FP, respectively. Correlation (r = 0.51; P < 0.0001) and agreement (κ = 0.46; P = 0.0004) between the FS and the FP were significant. Frail women had greater disease damage, high-sensitivity C-reactive protein, and interleukin 6, and worse PROMs according to both frailty definitions. Both frailty measures were associated with self-reported disability after adjustment for age, comorbidity, and disease activity and damage; this relationship was attenuated for the FP. CONCLUSION Frailty prevalence was high in this cohort of women with SLE using both frailty definitions, suggesting that frailty may be accelerated in women with SLE, particularly when based exclusively on self-report. Frailty remained associated with self-reported disability in adjusted analyses. The FS may be an informative point-of-care tool to identify frail women with SLE.
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Affiliation(s)
- Sarah B Lieber
- This work was supported by a Scientist Development Award from the Rheumatology Research Foundation and a Michael D. Lockshin Fellowship from the Barbara Volcker Center for Women and Rheumatic Diseases at Hospital for Special Surgery. Research reported in this publication was supported by the National Center For Advancing Translational Sciences of the National Institutes of Health (NIH) under Award Number UL1TR002384. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH. S.B. Lieber, MD, MS, Assistant Professor, S. Paget, MD, Professor, J.R. Berman, MD, Associate Professor, M. Barbhaiya, MD, MPH, Assistant Professor, L.R. Sammaritano, MD, Professor, K. Kirou, MD, Associate Professor, J.A. Carrino, MD, MPH, Professor, L.A. Mandl, MD, MPH, Assistant Research Professor, Hospital for Special Surgery, and Weill Cornell Medicine, New York, New York; M. Nahid, MSc, M. Rajan, MBA, Research Associate, Weill Cornell Medicine, New York, New York; 3D. Sheira, BA, Stanford School of Medicine, Palo Alto, California, USA. JAC declares the following conflicts of interest: Covera Health, Image Analysis Group, Image Biopsy Lab, Pfizer, Simplify Medical, and the Arthritis & Rheumatology and Osteoarthritis Imaging journals. LAM declares the following conflicts of interest: Regeneron Pharmaceuticals. All other authors declare no conflicts of interest relevant to this article. Address correspondence to Dr. S.B. Lieber, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA. . Accepted for publication August 17, 2021
| | - Musarrat Nahid
- This work was supported by a Scientist Development Award from the Rheumatology Research Foundation and a Michael D. Lockshin Fellowship from the Barbara Volcker Center for Women and Rheumatic Diseases at Hospital for Special Surgery. Research reported in this publication was supported by the National Center For Advancing Translational Sciences of the National Institutes of Health (NIH) under Award Number UL1TR002384. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH. S.B. Lieber, MD, MS, Assistant Professor, S. Paget, MD, Professor, J.R. Berman, MD, Associate Professor, M. Barbhaiya, MD, MPH, Assistant Professor, L.R. Sammaritano, MD, Professor, K. Kirou, MD, Associate Professor, J.A. Carrino, MD, MPH, Professor, L.A. Mandl, MD, MPH, Assistant Research Professor, Hospital for Special Surgery, and Weill Cornell Medicine, New York, New York; M. Nahid, MSc, M. Rajan, MBA, Research Associate, Weill Cornell Medicine, New York, New York; 3D. Sheira, BA, Stanford School of Medicine, Palo Alto, California, USA. JAC declares the following conflicts of interest: Covera Health, Image Analysis Group, Image Biopsy Lab, Pfizer, Simplify Medical, and the Arthritis & Rheumatology and Osteoarthritis Imaging journals. LAM declares the following conflicts of interest: Regeneron Pharmaceuticals. All other authors declare no conflicts of interest relevant to this article. Address correspondence to Dr. S.B. Lieber, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA. . Accepted for publication August 17, 2021
| | - Stephen Paget
- This work was supported by a Scientist Development Award from the Rheumatology Research Foundation and a Michael D. Lockshin Fellowship from the Barbara Volcker Center for Women and Rheumatic Diseases at Hospital for Special Surgery. Research reported in this publication was supported by the National Center For Advancing Translational Sciences of the National Institutes of Health (NIH) under Award Number UL1TR002384. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH. S.B. Lieber, MD, MS, Assistant Professor, S. Paget, MD, Professor, J.R. Berman, MD, Associate Professor, M. Barbhaiya, MD, MPH, Assistant Professor, L.R. Sammaritano, MD, Professor, K. Kirou, MD, Associate Professor, J.A. Carrino, MD, MPH, Professor, L.A. Mandl, MD, MPH, Assistant Research Professor, Hospital for Special Surgery, and Weill Cornell Medicine, New York, New York; M. Nahid, MSc, M. Rajan, MBA, Research Associate, Weill Cornell Medicine, New York, New York; 3D. Sheira, BA, Stanford School of Medicine, Palo Alto, California, USA. JAC declares the following conflicts of interest: Covera Health, Image Analysis Group, Image Biopsy Lab, Pfizer, Simplify Medical, and the Arthritis & Rheumatology and Osteoarthritis Imaging journals. LAM declares the following conflicts of interest: Regeneron Pharmaceuticals. All other authors declare no conflicts of interest relevant to this article. Address correspondence to Dr. S.B. Lieber, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA. . Accepted for publication August 17, 2021
| | - Jessica R Berman
- This work was supported by a Scientist Development Award from the Rheumatology Research Foundation and a Michael D. Lockshin Fellowship from the Barbara Volcker Center for Women and Rheumatic Diseases at Hospital for Special Surgery. Research reported in this publication was supported by the National Center For Advancing Translational Sciences of the National Institutes of Health (NIH) under Award Number UL1TR002384. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH. S.B. Lieber, MD, MS, Assistant Professor, S. Paget, MD, Professor, J.R. Berman, MD, Associate Professor, M. Barbhaiya, MD, MPH, Assistant Professor, L.R. Sammaritano, MD, Professor, K. Kirou, MD, Associate Professor, J.A. Carrino, MD, MPH, Professor, L.A. Mandl, MD, MPH, Assistant Research Professor, Hospital for Special Surgery, and Weill Cornell Medicine, New York, New York; M. Nahid, MSc, M. Rajan, MBA, Research Associate, Weill Cornell Medicine, New York, New York; 3D. Sheira, BA, Stanford School of Medicine, Palo Alto, California, USA. JAC declares the following conflicts of interest: Covera Health, Image Analysis Group, Image Biopsy Lab, Pfizer, Simplify Medical, and the Arthritis & Rheumatology and Osteoarthritis Imaging journals. LAM declares the following conflicts of interest: Regeneron Pharmaceuticals. All other authors declare no conflicts of interest relevant to this article. Address correspondence to Dr. S.B. Lieber, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA. . Accepted for publication August 17, 2021
| | - Medha Barbhaiya
- This work was supported by a Scientist Development Award from the Rheumatology Research Foundation and a Michael D. Lockshin Fellowship from the Barbara Volcker Center for Women and Rheumatic Diseases at Hospital for Special Surgery. Research reported in this publication was supported by the National Center For Advancing Translational Sciences of the National Institutes of Health (NIH) under Award Number UL1TR002384. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH. S.B. Lieber, MD, MS, Assistant Professor, S. Paget, MD, Professor, J.R. Berman, MD, Associate Professor, M. Barbhaiya, MD, MPH, Assistant Professor, L.R. Sammaritano, MD, Professor, K. Kirou, MD, Associate Professor, J.A. Carrino, MD, MPH, Professor, L.A. Mandl, MD, MPH, Assistant Research Professor, Hospital for Special Surgery, and Weill Cornell Medicine, New York, New York; M. Nahid, MSc, M. Rajan, MBA, Research Associate, Weill Cornell Medicine, New York, New York; 3D. Sheira, BA, Stanford School of Medicine, Palo Alto, California, USA. JAC declares the following conflicts of interest: Covera Health, Image Analysis Group, Image Biopsy Lab, Pfizer, Simplify Medical, and the Arthritis & Rheumatology and Osteoarthritis Imaging journals. LAM declares the following conflicts of interest: Regeneron Pharmaceuticals. All other authors declare no conflicts of interest relevant to this article. Address correspondence to Dr. S.B. Lieber, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA. . Accepted for publication August 17, 2021
| | - Lisa R Sammaritano
- This work was supported by a Scientist Development Award from the Rheumatology Research Foundation and a Michael D. Lockshin Fellowship from the Barbara Volcker Center for Women and Rheumatic Diseases at Hospital for Special Surgery. Research reported in this publication was supported by the National Center For Advancing Translational Sciences of the National Institutes of Health (NIH) under Award Number UL1TR002384. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH. S.B. Lieber, MD, MS, Assistant Professor, S. Paget, MD, Professor, J.R. Berman, MD, Associate Professor, M. Barbhaiya, MD, MPH, Assistant Professor, L.R. Sammaritano, MD, Professor, K. Kirou, MD, Associate Professor, J.A. Carrino, MD, MPH, Professor, L.A. Mandl, MD, MPH, Assistant Research Professor, Hospital for Special Surgery, and Weill Cornell Medicine, New York, New York; M. Nahid, MSc, M. Rajan, MBA, Research Associate, Weill Cornell Medicine, New York, New York; 3D. Sheira, BA, Stanford School of Medicine, Palo Alto, California, USA. JAC declares the following conflicts of interest: Covera Health, Image Analysis Group, Image Biopsy Lab, Pfizer, Simplify Medical, and the Arthritis & Rheumatology and Osteoarthritis Imaging journals. LAM declares the following conflicts of interest: Regeneron Pharmaceuticals. All other authors declare no conflicts of interest relevant to this article. Address correspondence to Dr. S.B. Lieber, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA. . Accepted for publication August 17, 2021
| | - Kyriakos Kirou
- This work was supported by a Scientist Development Award from the Rheumatology Research Foundation and a Michael D. Lockshin Fellowship from the Barbara Volcker Center for Women and Rheumatic Diseases at Hospital for Special Surgery. Research reported in this publication was supported by the National Center For Advancing Translational Sciences of the National Institutes of Health (NIH) under Award Number UL1TR002384. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH. S.B. Lieber, MD, MS, Assistant Professor, S. Paget, MD, Professor, J.R. Berman, MD, Associate Professor, M. Barbhaiya, MD, MPH, Assistant Professor, L.R. Sammaritano, MD, Professor, K. Kirou, MD, Associate Professor, J.A. Carrino, MD, MPH, Professor, L.A. Mandl, MD, MPH, Assistant Research Professor, Hospital for Special Surgery, and Weill Cornell Medicine, New York, New York; M. Nahid, MSc, M. Rajan, MBA, Research Associate, Weill Cornell Medicine, New York, New York; 3D. Sheira, BA, Stanford School of Medicine, Palo Alto, California, USA. JAC declares the following conflicts of interest: Covera Health, Image Analysis Group, Image Biopsy Lab, Pfizer, Simplify Medical, and the Arthritis & Rheumatology and Osteoarthritis Imaging journals. LAM declares the following conflicts of interest: Regeneron Pharmaceuticals. All other authors declare no conflicts of interest relevant to this article. Address correspondence to Dr. S.B. Lieber, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA. . Accepted for publication August 17, 2021
| | - John A Carrino
- This work was supported by a Scientist Development Award from the Rheumatology Research Foundation and a Michael D. Lockshin Fellowship from the Barbara Volcker Center for Women and Rheumatic Diseases at Hospital for Special Surgery. Research reported in this publication was supported by the National Center For Advancing Translational Sciences of the National Institutes of Health (NIH) under Award Number UL1TR002384. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH. S.B. Lieber, MD, MS, Assistant Professor, S. Paget, MD, Professor, J.R. Berman, MD, Associate Professor, M. Barbhaiya, MD, MPH, Assistant Professor, L.R. Sammaritano, MD, Professor, K. Kirou, MD, Associate Professor, J.A. Carrino, MD, MPH, Professor, L.A. Mandl, MD, MPH, Assistant Research Professor, Hospital for Special Surgery, and Weill Cornell Medicine, New York, New York; M. Nahid, MSc, M. Rajan, MBA, Research Associate, Weill Cornell Medicine, New York, New York; 3D. Sheira, BA, Stanford School of Medicine, Palo Alto, California, USA. JAC declares the following conflicts of interest: Covera Health, Image Analysis Group, Image Biopsy Lab, Pfizer, Simplify Medical, and the Arthritis & Rheumatology and Osteoarthritis Imaging journals. LAM declares the following conflicts of interest: Regeneron Pharmaceuticals. All other authors declare no conflicts of interest relevant to this article. Address correspondence to Dr. S.B. Lieber, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA. . Accepted for publication August 17, 2021
| | - Mangala Rajan
- This work was supported by a Scientist Development Award from the Rheumatology Research Foundation and a Michael D. Lockshin Fellowship from the Barbara Volcker Center for Women and Rheumatic Diseases at Hospital for Special Surgery. Research reported in this publication was supported by the National Center For Advancing Translational Sciences of the National Institutes of Health (NIH) under Award Number UL1TR002384. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH. S.B. Lieber, MD, MS, Assistant Professor, S. Paget, MD, Professor, J.R. Berman, MD, Associate Professor, M. Barbhaiya, MD, MPH, Assistant Professor, L.R. Sammaritano, MD, Professor, K. Kirou, MD, Associate Professor, J.A. Carrino, MD, MPH, Professor, L.A. Mandl, MD, MPH, Assistant Research Professor, Hospital for Special Surgery, and Weill Cornell Medicine, New York, New York; M. Nahid, MSc, M. Rajan, MBA, Research Associate, Weill Cornell Medicine, New York, New York; 3D. Sheira, BA, Stanford School of Medicine, Palo Alto, California, USA. JAC declares the following conflicts of interest: Covera Health, Image Analysis Group, Image Biopsy Lab, Pfizer, Simplify Medical, and the Arthritis & Rheumatology and Osteoarthritis Imaging journals. LAM declares the following conflicts of interest: Regeneron Pharmaceuticals. All other authors declare no conflicts of interest relevant to this article. Address correspondence to Dr. S.B. Lieber, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA. . Accepted for publication August 17, 2021
| | - Dina Sheira
- This work was supported by a Scientist Development Award from the Rheumatology Research Foundation and a Michael D. Lockshin Fellowship from the Barbara Volcker Center for Women and Rheumatic Diseases at Hospital for Special Surgery. Research reported in this publication was supported by the National Center For Advancing Translational Sciences of the National Institutes of Health (NIH) under Award Number UL1TR002384. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH. S.B. Lieber, MD, MS, Assistant Professor, S. Paget, MD, Professor, J.R. Berman, MD, Associate Professor, M. Barbhaiya, MD, MPH, Assistant Professor, L.R. Sammaritano, MD, Professor, K. Kirou, MD, Associate Professor, J.A. Carrino, MD, MPH, Professor, L.A. Mandl, MD, MPH, Assistant Research Professor, Hospital for Special Surgery, and Weill Cornell Medicine, New York, New York; M. Nahid, MSc, M. Rajan, MBA, Research Associate, Weill Cornell Medicine, New York, New York; 3D. Sheira, BA, Stanford School of Medicine, Palo Alto, California, USA. JAC declares the following conflicts of interest: Covera Health, Image Analysis Group, Image Biopsy Lab, Pfizer, Simplify Medical, and the Arthritis & Rheumatology and Osteoarthritis Imaging journals. LAM declares the following conflicts of interest: Regeneron Pharmaceuticals. All other authors declare no conflicts of interest relevant to this article. Address correspondence to Dr. S.B. Lieber, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA. . Accepted for publication August 17, 2021
| | - Lisa A Mandl
- This work was supported by a Scientist Development Award from the Rheumatology Research Foundation and a Michael D. Lockshin Fellowship from the Barbara Volcker Center for Women and Rheumatic Diseases at Hospital for Special Surgery. Research reported in this publication was supported by the National Center For Advancing Translational Sciences of the National Institutes of Health (NIH) under Award Number UL1TR002384. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH. S.B. Lieber, MD, MS, Assistant Professor, S. Paget, MD, Professor, J.R. Berman, MD, Associate Professor, M. Barbhaiya, MD, MPH, Assistant Professor, L.R. Sammaritano, MD, Professor, K. Kirou, MD, Associate Professor, J.A. Carrino, MD, MPH, Professor, L.A. Mandl, MD, MPH, Assistant Research Professor, Hospital for Special Surgery, and Weill Cornell Medicine, New York, New York; M. Nahid, MSc, M. Rajan, MBA, Research Associate, Weill Cornell Medicine, New York, New York; 3D. Sheira, BA, Stanford School of Medicine, Palo Alto, California, USA. JAC declares the following conflicts of interest: Covera Health, Image Analysis Group, Image Biopsy Lab, Pfizer, Simplify Medical, and the Arthritis & Rheumatology and Osteoarthritis Imaging journals. LAM declares the following conflicts of interest: Regeneron Pharmaceuticals. All other authors declare no conflicts of interest relevant to this article. Address correspondence to Dr. S.B. Lieber, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA. . Accepted for publication August 17, 2021
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Abstract
PURPOSE OF REVIEW Rheumatoid arthritis (RA) is associated with increased risk for osteoporotic fracture. We highlight RA-specific risk factors for bone mineral density (BMD) loss and fractures and considerations regarding the diagnosis and treatment of osteoporosis in patients with RA. RECENT FINDINGS Anticitrullinated protein antibody (ACPA) positivity, although associated with low BMD in early RA, is not associated with accelerated BMD loss over time when compared to ACPA negative individuals. Studies have found reduced BMD in individuals on low doses of glucocorticoids (GCs). Poor functional status and frailty are additional important risk factors for low BMD and fractures. Heightened fracture risk in RA may be mitigated by tight disease control, and biologic therapies are associated with more stable BMD compared to nonbiologic therapies. Evidence-based guidelines specific for treating osteoporosis in patients with RA do not exist. Thus, treatment decisions are based on general osteoporosis guidelines, taking into account additional RA-specific risk factors. SUMMARY Recent studies have advanced knowledge of RA-specific risk factors for BMD loss and fractures. Future studies applying these findings to modify established fracture risk algorithms as well as evaluating osteoporosis treatments in RA cohorts are needed to reduce the risk of disabling fractures in these patients.
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Affiliation(s)
- Katherine D Wysham
- Rheumatology Section, VA Puget Sound Healthcare System, Division of Rheumatology, University of Washington, Seattle, Washington
| | - Joshua F Baker
- Rheumatology and Epidemiology, Corporal Michael J. Crescenz VA Medical Center, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Dolores M Shoback
- Endocrine Research Unit, SFVAMC, UCSF, UCSF Training Program in Diabetes, Endocrinology and Metabolism, San Francisco, California, USA
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Campos DES, de Araújo Ferreira Muniz I, de Souza Villarim NL, Ribeiro ILA, Batista AUD, Bonan PRF, de Sales MAO. Is there an association between rheumatoid arthritis and bone changes in the temporomandibular joint diagnosed by cone-beam computed tomography? A systematic review and meta-analysis. Clin Oral Investig 2021; 25:2449-2459. [PMID: 33547580 DOI: 10.1007/s00784-021-03817-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Accepted: 01/27/2021] [Indexed: 12/23/2022]
Abstract
OBJECTIVES Evaluate the relation of rheumatoid arthritis (RA) and bone changes in the temporomandibular joint diagnosed by cone-beam computed tomography (CBCT). MATERIALS AND METHODS This systematic review and meta-analysis were recorded in the PROSPERO database, using the CRD42020153246 protocol. The electronic searches were performed in the following databases: Pubmed, Scopus, Web of Science, Lilacs, Cochrane, and Open Grey. Cross-sectional studies that evaluated patients with RA with bone changes in the temporomandibular joint diagnosed by CBCT, without language restriction or publication date, were included. Meta-analysis was performed in Stata Software (StataCorp, TX, USA, version 12.0), using the metan, and a random effects model, and the risk of different bone alterations occurring in adults with and without arthritis was estimated using odds ratios (ORs) as a pooled measure of effect. Forest plots were used to present the isolated and the pooled effects (ORs and 95% CI). RESULTS Six studies were used for qualitative synthesis and 2 studies for quantitative synthesis. All studies diagnosed higher prevalence changes in the bone structures of the TMJ of RA patients, described as erosion, flattening, sclerosis, and osteophytes. Meta-analysis showed that the chance of bone changes occurring in components of the TMJ is greater in individuals who have RA. CONCLUSION There is an association between RA and bone changes in TMJ structures diagnosed through CBCT, as RA patients were more likely to have osteoarthritic changes in this joint. CLINICAL RELEVANCE Understanding the existence of an association between bone alterations in TMJ and RA can assist in the management of patients.
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Affiliation(s)
- Débora E Silva Campos
- Post Graduate Program in Dentistry, Federal University of Paraíba, João Pessoa, Paraíba, Brazil.
| | | | | | - Isabella Lima Arrais Ribeiro
- Department of Social Medicine. Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
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Bissias C, Kaspiris A, Kalogeropoulos A, Papoutsis K, Natsioulas N, Barbagiannis K, Papagelopoulos PJ, Savvidou OD. Factors affecting the incidence of postoperative periprosthetic fractures following primary and revision hip arthroplasty: a systematic review and meta-analysis. J Orthop Surg Res 2021; 16:15. [PMID: 33407704 PMCID: PMC7788804 DOI: 10.1186/s13018-020-02152-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Accepted: 12/09/2020] [Indexed: 11/24/2022] Open
Abstract
Objectives The increasing number of hip arthroplasties (HA), due to the growing elderly population, is associated with the risk of femoral periprosthetic fractures (FPFs). The purpose of this study was to identify potential risk factors for the development of FPFs after HA. Methods A systematic review was conducted in five data bases (Medline, Embase, Cochrane, Cinahl, ICTRP) according to the Preferred Reporting Items for Systematic reviews and Meta-analysis (PRISMA) guidelines up to May 2019, using the key words “risk factor,” “periprosthetic fracture,” and “hip replacement or arthroplasty.” Meta-analysis of the clinical outcomes of HA and subgroup analysis based on the factors that were implicated in FPFs was performed. Results Sixteen studies were included (sample size: 599,551 HA patients, 4253 FPFs, incidence 0.71%). Risk factors statistically associated with increased incidence of FPFs were female gender (+ 40%), previous revision arthroplasty surgery (× 3 times), and the presence of rheumatoid arthritis (× 2.1 times), while osteoarthritis (− 57%), cement application (− 59%), and insertion of Biomet (− 68%) or Thompson’s prosthesis (− 75%) were correlated with low prevalence of FPFs. Obesity, cardiac diseases, advanced age, bad general health (ASA grade ≥ 3), and use of Exeter or Lubinus prosthesis were not linked to the appearance of FPFs. Conclusion This meta-analysis suggested that female gender, rheumatoid arthritis, and revision arthroplasty are major risk factors for the development of FPFs after a HA. In those patients, frequent follow-ups should be planned. Further prospective studies are necessary to clarify all the risk factors contributing to the appearance of FPFs after HA. Supplementary Information The online version contains supplementary material available at 10.1186/s13018-020-02152-0.
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Affiliation(s)
- Christos Bissias
- Department of Orthopaedic Surgery, Naval Hospital of Athens, Deinokratous 70, 115 21, Athens, Greece.
| | - Angelos Kaspiris
- Laboratory of Molecular Pharmacology/Division for Orthopaedic Research, School of Health Sciences, University of Patras, 26504, Patras, Greece
| | | | - Konstantinos Papoutsis
- Department of Orthopaedic Surgery, Naval Hospital of Athens, Deinokratous 70, 115 21, Athens, Greece
| | - Nikolaos Natsioulas
- Department of Orthopaedic Surgery, Naval Hospital of Athens, Deinokratous 70, 115 21, Athens, Greece
| | - Konstantinos Barbagiannis
- Department of Orthopaedic Surgery, Naval Hospital of Athens, Deinokratous 70, 115 21, Athens, Greece
| | - Panayiotis J Papagelopoulos
- 1st Department of Orthopaedic Surgery, School of Medicine, National and Kapodistrian University of Athens, "ATTIKON" University General Hospital, 124 62, Athens, Greece
| | - Olga D Savvidou
- 1st Department of Orthopaedic Surgery, School of Medicine, National and Kapodistrian University of Athens, "ATTIKON" University General Hospital, 124 62, Athens, Greece
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