1
|
Leerling AT, Ueckert DA, Van der Giesen FJ, Vliet-Vlieland T, Winter EM. Role of physical therapy in adult chronic non-bacterial osteitis: patients' and therapists' perspectives. Scand J Rheumatol 2024:1-10. [PMID: 38832471 DOI: 10.1080/03009742.2024.2352965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Accepted: 05/06/2024] [Indexed: 06/05/2024]
Abstract
OBJECTIVES Chronic nonbacterial osteitis (CNO) is a rare bone disease causing pain and functional impairment. We aimed to explore the application of physical therapy (PT) for adult CNO from the patients' and primary care therapists' perspective. METHOD Cross-sectional study among the Dutch adult CNO cohort (1992-present). A survey on PT-use for axial spondylarthritis was adapted for CNO. Patients using PT in the past 2 years (recent PT-users) were asked about modalities, perceived effects, satisfaction, and preferences for provision. Their current physical therapists were invited to complete a self-developed survey covering therapy details and educational preferences. RESULTS 80/199 invited patients and 14/16 invited therapists completed the survey respectively. 41 (51%) patients used PT for CNO in the preceding 2 years, 14 (18%) used PT >2 years back, and 25 (31%) never used PT. Recent PT-users (n=41) reported diverse treatment modalities, involving massage (61%), joint mobilizations (44%), breathing exercises (49%), muscle strengthening (32%) and counselling through of home-exercises (46%) and pain education (32%). 64% of all patients desired greater emphasis from physicians regarding the role of PT. Most therapists would appreciate referral letters with CNO-specific information (93%), and consultations with specialized therapists (86%). CONCLUSIONS In this study, two-third of adult CNO patients had -ever or recently- used PT, which involved variable therapeutic modalities. Most patients were receptive to a larger role of PT in CNO-management and most therapists preferred CNO-specific information to optimize their care. These findings provide a foundation for the development and systematic evaluation of CNO-specific PT.
Collapse
Affiliation(s)
- A T Leerling
- Department of Internal Medicine, Division of Endocrinology, Leiden University Medical Center, Leiden, The Netherlands
- Center for Bone Quality, Leiden University Medical Center, Leiden, The Netherlands
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
| | - D A Ueckert
- Department of Physical Therapy, Leiden University Medical Center, Leiden, The Netherlands
| | - F J Van der Giesen
- Department of Rheumatology, Zuyderland Ziekenhuis, Heerlen, The Netherlands
| | - Tpm Vliet-Vlieland
- Department of Orthopaedics, Rehabilitation and Physical Therapy, Leiden University Medical Center, Leiden, The Netherlands
| | - E M Winter
- Department of Internal Medicine, Division of Endocrinology, Leiden University Medical Center, Leiden, The Netherlands
- Center for Bone Quality, Leiden University Medical Center, Leiden, The Netherlands
| |
Collapse
|
2
|
Peyronnel C, Kessler J, Bobillier-Chaumont Devaux S, Houdayer C, Tournier M, Chouk M, Wendling D, Martin H, Totoson P, Demougeot C. A treadmill exercise reduced cardiac fibrosis, inflammation and vulnerability to ischemia-reperfusion in rat pristane-induced arthritis. Life Sci 2024; 341:122503. [PMID: 38354974 DOI: 10.1016/j.lfs.2024.122503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Revised: 01/24/2024] [Accepted: 02/11/2024] [Indexed: 02/16/2024]
Abstract
AIMS To explore cardiac structural and functional parameters and myocardial sensitivity to ischemia in a rat model of chronic arthritis, pristane-induced arthritis (PIA), and to investigate the effects of a running exercise protocol on cardiac disorders related to rheumatoid arthritis (RA). MAIN METHODS 3 groups of male Dark Agouti rats were formed: Controls, PIA and PIA-Exercise. The PIA-Exercise group was subjected to an individualized treadmill running protocol during the remission phase. At acute and chronic phases of PIA, cardiac structure was analyzed by histology. Cardiac function was explored in isolated hearts to measure left ventricular developed pressure (LVDP), cardiac compliance and infarct size before and after ischemia/reperfusion. Cardiac inflammation was evaluated through VCAM-1 mRNA expression by RT-qPCR. Plasma irisin levels were measured by ELISA. KEY FINDINGS PIA rats exhibited myocardial hypertrophy fibrosis and inflammation at the 2 inflammatory phases of the model. At chronic phase only, LVDP and cardiac compliance were lower in PIA compared to controls. As compared to sedentary PIA, exercise did not change cardiac function but reduced fibrosis, inflammation, infarct size, and arthritis severity and increased irisin levels. Cardiac inflammation positively correlated with fibrosis, while irisin levels negatively correlated with cardiac inflammation and fibrosis. SIGNIFICANCE In the PIA model that recapitulated most cardiac disorders of RA, a daily program of treadmill running alleviated cardiac fibrosis and inflammation and improved resistance to ischemia. These data provide arguments to promote the practice of exercise in RA patients for cardiac diseases prevention.
Collapse
Affiliation(s)
- C Peyronnel
- Université de Franche-Comté, EFS, INSERM, UMR RIGHT 1098, F-25000 Besançon, France
| | - J Kessler
- Université de Franche-Comté, EFS, INSERM, UMR RIGHT 1098, F-25000 Besançon, France; Service de Rhumatologie, Centre Hospitalier Louis Pasteur, F-39100 Dole, France
| | | | - C Houdayer
- Université de Franche-Comté, INSERM, UMR LINC 1322, DImaCell, Dispositif d'Imagerie Cellulaire, Besançon F-25030, France
| | - M Tournier
- Université de Franche-Comté, EFS, INSERM, UMR RIGHT 1098, F-25000 Besançon, France
| | - M Chouk
- Université de Franche-Comté, EFS, INSERM, UMR RIGHT 1098, F-25000 Besançon, France; Service de Rhumatologie, CHU Jean Minjoz, F-25000 Besançon, France
| | - D Wendling
- Service de Rhumatologie, CHU Jean Minjoz, F-25000 Besançon, France; Université de Franche-Comté, EPILAB, F-25000 Besançon, France
| | - H Martin
- Université de Franche-Comté, EFS, INSERM, UMR RIGHT 1098, F-25000 Besançon, France
| | - P Totoson
- Université de Franche-Comté, EFS, INSERM, UMR RIGHT 1098, F-25000 Besançon, France.
| | - C Demougeot
- Université de Franche-Comté, EFS, INSERM, UMR RIGHT 1098, F-25000 Besançon, France
| |
Collapse
|
3
|
Belau MH, Flaßkamp F, Becher H, Hajek A, König HH, Baumbach L. Physical activity in adults with and without rheumatoid arthritis: cross-sectional results from the Survey of Health, Ageing and Retirement in Europe (SHARE). Scand J Rheumatol 2024; 53:112-117. [PMID: 37905337 DOI: 10.1080/03009742.2023.2269672] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Accepted: 10/09/2023] [Indexed: 11/02/2023]
Abstract
OBJECTIVE Studies examining habitual physical activity levels and patterns in adults with rheumatoid arthritis (RA) using raw data from modern accelerometers are lacking. We aimed (i) to examine physical activity levels and patterns in adults with RA in their familiar environment, and (ii) to investigate whether physical activity levels differ throughout the day. METHOD Data were taken from Wave 8 of the Survey of Health, Ageing and Retirement in Europe, including N = 607 men and women who wore a triaxial accelerometer and had adequate information for RA and accelerometry data summarized as Euclidean norm minus one (ENMO, mg). Growth-curve models and simple contrast analysis were used to examine the effect of RA on daily patterns of physical activity levels, including mean total ENMO in mg, mean minutes of light-intensity physical activity (ENMO values ≥ 25 mg and ≤ 75 mg), and moderate-to-vigorous-intensity physical activity (ENMO values > 75 mg). RESULTS Total physical activity averaged throughout the day was 25.0 and 28.6 mg for respondents with and without RA, respectively. Respondents with RA spent more time in light-intensity physical activity throughout the day (p < 0.001), but less time in moderate-to-vigorous-intensity physical activity between 4 am and 11 pm (p < 0.001) than respondents without RA. CONCLUSION Adults with RA were less physically active than adults without RA. However, there were no diurnal differences in physical activity.
Collapse
Affiliation(s)
- M H Belau
- Institute of Medical Biometry and Epidemiology, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - F Flaßkamp
- Institute of Medical Biometry and Epidemiology, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - H Becher
- Heidelberg Institute of Global Health, Heidelberg University Hospital, Heidelberg, Germany
| | - A Hajek
- Department of Health Economics and Health Services Research, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - H-H König
- Department of Health Economics and Health Services Research, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - L Baumbach
- Department of Health Economics and Health Services Research, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| |
Collapse
|
4
|
Tuomi AK, Rebane K, Arnstad ED, Berntson L, Fasth A, Glerup M, Herlin T, Kautiainen H, Nordal E, Peltoniemi S, Rygg M, Rypdal V, Zak M, Aalto K. Body mass index is associated with health-related quality of life and disease characteristics in young adults with juvenile idiopathic arthritis. Pediatr Rheumatol Online J 2024; 22:25. [PMID: 38308280 PMCID: PMC10837959 DOI: 10.1186/s12969-023-00931-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 11/15/2023] [Indexed: 02/04/2024] Open
Abstract
BACKGROUND There is a growing interest concerning the relationship between obesity and several medical conditions and inflammation. Nevertheless, there is a lack of studies regarding body mass index (BMI) among patients with juvenile idiopathic arthritis (JIA). Our aim was to investigate the impact of BMI on health-related quality of life (HRQoL) measured with a 36-Item Short Form Survey (SF-36), disease activity, and disability in young adults with JIA. METHODS This study is a part of the population-based Nordic JIA cohort study. All newly diagnosed patients with JIA were recruited consecutively between 1997-2000 in specific regions in the Nordic countries. Patients in this sub-study were enrolled from 434 patients who attended their 18-year follow-up visit. Patients were classified according to the World Health Organization (WHO) into four groups based on their BMI. HRQoL, disease characteristics, disability, fatigue, sleep quality, physical activity, pain, comorbidities, and social status were assessed. RESULTS Three hundred fifty-five patients from the original study cohort were enrolled in this study and 72% of them were female. Mean age was 23.9 (± SD 4.4) years. A significant relationship was found between the JIA categories and BMI groups (p = 0.014). A significant relationship was also found between BMI and disease activity scores (DAS28) (p = 0.028), disability (p < 0.001), pain (p = 0.013), fatigue (p = 0.035), and sleep quality (p = 0.044). Moreover, a significant relationship between BMI and HRQoL regarding bodily pain (p = 0.010) and general health (p = 0.048) was revealed when adjusted for sex, age, and JIA subtype. CONCLUSION We discovered that BMI was significantly related to HRQoL, disease activity, and disability. BMI deserves more attention considering the treatment options and outcome of JIA in young adults.
Collapse
Affiliation(s)
- Anna-Kaisa Tuomi
- Pediatric Research Center, New Children's Hospital, University of Helsinki and Helsinki University Hospital, Stenbackinkatu 9, P.O. Box 347, FIN-00029 HUS, 00290, Helsinki, Finland.
| | - Katariina Rebane
- Pediatric Research Center, New Children's Hospital, University of Helsinki and Helsinki University Hospital, Stenbackinkatu 9, P.O. Box 347, FIN-00029 HUS, 00290, Helsinki, Finland
| | - Ellen Dalen Arnstad
- Department of Pediatrics, Levanger Hospital, Nord-Trøndelag Hospital Trust, Levanger, Norway
- Department of Clinical and Molecular Medicine, NTNU - Norwegian University of Science and Technology, Trondheim, Norway
| | - Lillemor Berntson
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Anders Fasth
- Department of Pediatrics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Mia Glerup
- Department of Pediatrics, Aarhus University Hospital, Aarhus, Denmark
| | - Troels Herlin
- Department of Pediatrics, Aarhus University Hospital, Aarhus, Denmark
| | - Hannu Kautiainen
- Kuopio University Hospital, Primary Health Care Unit Kuopio, Pohjois-Savo, Finland
- Folkhälsan Research Center, Helsinki, Finland
| | - Ellen Nordal
- Department of Pediatrics, University Hospital of North Norway and Pediatric Research Group, Tromsø, Norway
- Department of Clinical Medicine, UIT the Arctic University of Norway, Tromsø, Norway
| | - Suvi Peltoniemi
- Helsinki University Central Hospital, HUS Inflammation Center, Rheumatology and University of Helsinki, Helsinki, Finland
| | - Marite Rygg
- Department of Clinical and Molecular Medicine, NTNU - Norwegian University of Science and Technology, Trondheim, Norway
- Department of Pediatrics, St. Olavs University Hospital, Trondheim, Norway
| | - Veronika Rypdal
- Department of Pediatrics, University Hospital of North Norway and Pediatric Research Group, Tromsø, Norway
| | - Marek Zak
- Department of Pediatrics, Rigshospitalet Copenhagen University Hospital, Copenhagen, Denmark
| | - Kristiina Aalto
- Pediatric Research Center, New Children's Hospital, University of Helsinki and Helsinki University Hospital, Stenbackinkatu 9, P.O. Box 347, FIN-00029 HUS, 00290, Helsinki, Finland
| |
Collapse
|
5
|
Thomsen T, Aadahl M, Hetland ML, Esbensen BA. Physical activity guidance in the rheumatology clinic-what matters for patients with rheumatoid arthritis? A qualitative study. Rheumatol Int 2024; 44:181-189. [PMID: 37787914 PMCID: PMC10766747 DOI: 10.1007/s00296-023-05466-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 09/09/2023] [Indexed: 10/04/2023]
Abstract
Higher proportions of patients with rheumatoid arthritis (RA) are physically inactive compared to the general population. A barrier to engaging in physical activity (PA) may be lack of consistent PA guidance from health professionals (HPRs). This qualitative study aimed to explore daily PA levels and the patients' perspectives on current and future PA guidance from HPRs. We recruited 20 participants from five rheumatology departments in Denmark. The participants differed in socio-demography and clinical characteristics based on results from an earlier cross-sectional study. The interviews were conducted by telephone, online platforms or face-to-face. Data analysis was based on reflexive thematic analysis. Thirteen participants were female and mean age was 55 years. We generated four themes; (1) Acceptance of the arthritis is a process, which attributed to acknowledging RA as part of life before fully engagement in PA and exercise. (2) Daily physical activity-motivation, barriers and benefits, reflecting the participants' preferred types of activities and motivations and barriers to PA. (3) Physical activity guidance-your own responsibility? This theme reflected how participants missed more comprehensive discussions with HPRs about PA. (4) It is essential how, when and where physical activity guidance is provided, referring to participants' preferences for future PA guidance in the rheumatology clinic. The study emphasizes that an integrated focus on PA should be part of the rheumatology clinic. However, HPRs may need adequate training in how to guide and motivate patients with RA towards increased PA.
Collapse
Affiliation(s)
- Tanja Thomsen
- Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Centre for Head and Orthopaedics, Rigshospitalet, Copenhagen, Denmark.
- Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, Frederiksberg, Denmark.
| | - Mette Aadahl
- Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, Frederiksberg, Denmark
- Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Merete Lund Hetland
- Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Centre for Head and Orthopaedics, Rigshospitalet, Copenhagen, Denmark
- The DANBIO Registry, Center for Rheumatology and Spine Diseases, Centre for Head and Orthopaedics, Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Bente Appel Esbensen
- Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Centre for Head and Orthopaedics, Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| |
Collapse
|
6
|
Drake Af Hagelsrum K, Mogard E, Bremander A, Lindqvist E, Larsson I. Healthcare professionals' perceptions of working on lifestyle management for patients with early rheumatoid arthritis - a qualitative study. Int J Qual Stud Health Well-being 2023; 18:2241225. [PMID: 37499140 PMCID: PMC10375922 DOI: 10.1080/17482631.2023.2241225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Accepted: 07/22/2023] [Indexed: 07/29/2023] Open
Abstract
AIM To explore HPs' perceptions of working on lifestyle management for patients with early rheumatoid arthritis (RA). METHODS In this qualitative study, individual interviews were conducted with 20 HPs. Qualitative content analysis was used, and three categories and six subcategories were identified. RESULTS HPs' perceptions of working on lifestyle management for patients with early RA revealed a need for commitment from different levels. This included commitment from healthcare managers and organizations prioritizing work on lifestyle management and providing competence development for HPs. Commitment within the team regarding coordination of interdisciplinary teamwork and development of a structured lifestyle management approach, and commitment to involving patients in lifestyle management, by facilitating patient engagement and a person-centred approach. CONCLUSIONS HPs' perceptions of working on lifestyle management for patients with early RA revealed that commitment from healthcare managers, organizations, and the interdisciplinary team was essential to facilitate collaboration, patient involvement, and a person-centred approach.
Collapse
Affiliation(s)
- Klara Drake Af Hagelsrum
- School of Health and Welfare, Halmstad University, Halmstad, Sweden
- Department of Rheumatology, Skåne University Hospital, Lund, Sweden
| | - Elisabeth Mogard
- Department of Rheumatology, Skåne University Hospital, Lund, Sweden
- Section of Rheumatology, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
| | - Ann Bremander
- Section of Rheumatology, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
- Spenshult Research and Development Centre, Halmstad, Sweden
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
- Danish Hospital for Rheumatic Diseases, University Hospital of Southern Denmark, Sonderborg, Denmark
| | - Elisabet Lindqvist
- Department of Rheumatology, Skåne University Hospital, Lund, Sweden
- Section of Rheumatology, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
| | - Ingrid Larsson
- School of Health and Welfare, Halmstad University, Halmstad, Sweden
- Section of Rheumatology, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
- Spenshult Research and Development Centre, Halmstad, Sweden
| |
Collapse
|
7
|
Wang J, Xing F, Sheng N, Xiang Z. Association between Life's simple 7 and rheumatoid arthritis in adult Americans: data from the National Health and nutrition examination survey. Front Public Health 2023; 11:1251002. [PMID: 38094235 PMCID: PMC10716198 DOI: 10.3389/fpubh.2023.1251002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 11/06/2023] [Indexed: 12/18/2023] Open
Abstract
Objective The study aimed to investigate the relationship between Life's Simple 7 (LS7) and the risk of rheumatoid arthritis (RA) in adult Americans. Methods A total of 17,532 participants were included in this study. The association between LS7 and the risk of RA was assessed using a weighted logistic regression model, with odds ratios (ORs) and 95% confidence intervals (CIs) calculated. Moreover, the nonlinear relationship was further characterized through smooth curve fitting (SCF) and weighted generalized additive model (GAM) analysis. Results After adjusting for all covariates, the weighted logistic regression model demonstrated that the LS7 was negatively correlated with the risk of RA. Compared to quintile 1 of LS7, the OR between the risk of RA and quartile 4 of LS7 (LS7.Q4) was 0.261 (95% CI, 0.203, 0.337) in males under 50 years old, while in females of the same age group, the OR was 0.183 (95% CI, 0.142, 0.234). For females aged between 50 and 70 years old, the OR between the risk of RA and LS7.Q4 was 0.313 (95% CI, 0.264, 0.371). In females aged 70 years or older, the OR between the risk of RA and LS7.Q4 was 0.632 (95% CI, 0.486, 0.822). Conclusion This finding suggested the healthy lifestyle behaviors represented by LS7 have a negative association with RA. However, further prospective studies are needed to verify the causal relationship in the results.
Collapse
Affiliation(s)
| | | | | | - Zhou Xiang
- Department of Orthopaedics, Orthopaedic Research Institute, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| |
Collapse
|
8
|
Chen R, Chen Q, Lu G, Zhang M, Zhang M, Yang H, Qi K, Yu H, Zheng M, He Q. Sleep duration and depressive symptoms in Chinese middle-aged and older adults: The moderating effects of grip strength. J Affect Disord 2023; 339:348-354. [PMID: 37451435 DOI: 10.1016/j.jad.2023.07.059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 07/10/2023] [Accepted: 07/11/2023] [Indexed: 07/18/2023]
Abstract
BACKGROUND Evidence on the combined effect of sleep duration and grip strength on depressive symptoms is scarce. This study aimed to explore the moderating effect of grip strength on the association between sleep duration and depressive symptoms in a large cohort of middle-aged and older adults. METHOD Data were extracted from the China Health and Retirement Longitudinal Study (CHARLS) 2011-2018 wave. Grip strength and sleep duration were assessed by dynamometer and self-report, respectively. Depressive symptoms were determined by the Centre for Epidemiological Studies Depression scale (CESD-10). Multivariable cox regression model was used to explore the associations between sleep duration, and depressive symptoms, and assess moderation by grip strength. RESULTS A total of 4337 participants aged 57.0 ± 8.1 years (45.1 % females) were included in this study. During the 7-year follow up period, 1508 participants developed depressive symptoms. Short sleep duration (<6 h/d) was significantly associated with an increased risk of depressive symptoms [Hazard ratio (HR):1.24, 95 % confidence interval (CI):1.09, 1.40)]. This association remained in individuals with the low (HR:1.22, 95%CI:1.00, 1.49) and middle grip strength (HR:1.32, 95%CI: 1.07, 1.63), but attenuated in individuals with high grip strength (HR:1.11, 95%CI: 0.86, 1.43). CONCLUSIONS High grip strength mitigated the association between short sleep duration and higher risk of depressive symptoms. Thus, improving sleep duration and strengthening muscle strength are recommended to prevent depressive symptoms in middle-aged and older adults.
Collapse
Affiliation(s)
- Rui Chen
- School of Public Health, Wuhan University, Wuhan, China
| | - Qiutong Chen
- College of Language Intelligence, Sichuan International Studies University, Chongqing, China
| | - Gaolei Lu
- School of Public Health, Wuhan University, Wuhan, China
| | - Minjie Zhang
- School of Public Health, Wuhan University, Wuhan, China
| | - Minzhe Zhang
- School of Public Health, Wuhan University, Wuhan, China
| | | | - Kaijie Qi
- School of Public Health, Wuhan University, Wuhan, China
| | - Hongjie Yu
- School of Public Health, Wuhan University, Wuhan, China
| | - Miaobing Zheng
- School of Nutrition and Exercise, Deakin University, Melbourne, Australia.
| | - Qiqiang He
- School of Public Health, Wuhan University, Wuhan, China; Hubei Biomass-Resource Chemistry and Environmental Biotechnology Key Laboratory, Wuhan University, Wuhan, China.
| |
Collapse
|
9
|
Bagepally BS, Kumar SS, Sasidharan A, Haridoss M, Venkataraman K. Household catastrophic health expenditures for rheumatoid arthritis: a single centre study from South India. Sci Rep 2023; 13:15385. [PMID: 37717053 PMCID: PMC10505146 DOI: 10.1038/s41598-023-42623-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 09/12/2023] [Indexed: 09/18/2023] Open
Abstract
Rheumatoid arthritis (RA) not only has a physical and emotional toll but also has a substantial economic impact. This study aims to estimate the burden of catastrophic health expenditure (CHE) on households due to RA in Tamil Nadu, India. We conducted cross-sectional descriptive hospital-based single-centre study at a tertiary care private multispecialty hospital in Tamil Nadu, India. The study comprised 320 RA patients who visited the outpatient clinic from April to October 2022. Demographic and baseline descriptive characteristics were reported. Multivariable logistic regression analyses were performed to identify major determinants associated with CHE. We also examined the inequality in household annual income and CHE. Most study participants were females (88.1%) with a mean age (SD) of 55.57 ± 12.29 years. About 93% of RA patients were from urban areas, and 89.4% were literate. Only 8.1% of respondents reported having health insurance. Households experiencing CHE owing to RA were 51.4% (n = 162). The mean (95% CI) annual health expenditure for treating RA is ₹44,700 (₹41,710 to 47,690) with a median (IQR) of ₹39,210 (₹25,500) [$476 ($310)]. The corresponding mean (95% CI) and median (IQR) Out of pocket expenditure among RA patients per household were ₹40,698 (₹38,249 to 43,148) [$494 ($464 to $524)] and ₹36,450 (23,070) [$442 ($280)] respectively. Nearly half of the households with RA patients had a financial catastrophe due to healthcare costs being paid out-of-pocket and limited health insurance coverage. The results underscore the need for comprehensive approaches to strengthening public health policies along with financial risk protection and quality care in India.
Collapse
Affiliation(s)
- Bhavani Shankara Bagepally
- National Institute of Epidemiology (ICMR), Health Technology Assessment Resource Centre ICMR-NIE, R-127, Tamil Nadu Housing Board, Phase I and II, Ayapakkam, Chennai, 600077, India.
| | - S Sajith Kumar
- National Institute of Epidemiology (ICMR), Health Technology Assessment Resource Centre ICMR-NIE, R-127, Tamil Nadu Housing Board, Phase I and II, Ayapakkam, Chennai, 600077, India
| | - Akhil Sasidharan
- National Institute of Epidemiology (ICMR), Health Technology Assessment Resource Centre ICMR-NIE, R-127, Tamil Nadu Housing Board, Phase I and II, Ayapakkam, Chennai, 600077, India
| | - Madhumitha Haridoss
- National Institute of Epidemiology (ICMR), Health Technology Assessment Resource Centre ICMR-NIE, R-127, Tamil Nadu Housing Board, Phase I and II, Ayapakkam, Chennai, 600077, India
| | | |
Collapse
|
10
|
Pellegrini CA, Wilcox S, DeVivo KE, Jamieson S. Recruitment and Retention Strategies for Underrepresented Populations and Adults With Arthritis in Behavioral Interventions: A Scoping Review. Arthritis Care Res (Hoboken) 2023; 75:1996-2010. [PMID: 36752353 DOI: 10.1002/acr.25098] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 12/06/2022] [Accepted: 02/02/2023] [Indexed: 02/09/2023]
Abstract
OBJECTIVE To identify strategies used to recruit and retain underrepresented populations and populations with arthritis or fibromyalgia (FM) into behavioral programs targeting exercise, physical activity, or chronic disease self management. METHODS Five bibliographic databases were searched for articles published between January 2000 and May 2022. The search focused on strategies and best practices for recruiting and retaining underrepresented populations or populations with arthritis or FM into disease self-management or physical activity/exercise programs. Abstracts and full-text articles were screened for inclusion by 2 independent reviewers, and 2 reviewers extracted data from included articles. RESULTS Of the 2,800 articles, a total of 43 publications (31 interventions, 8 reviews, 4 qualitative/descriptive studies) met criteria and were included. The majority of studies focused on physical activity/exercise (n = 36) and targeted African American (n = 17), Hispanic (n = 9), or arthritis populations (n = 7). Recruitment strategies that were frequently used included having race- or community-matched team members, flyers and information sessions in areas frequented by the population, targeted emails/mailings, and word of mouth referrals. Retention strategies used included having race- or community-matched team members, incentives, being flexible, and facilitating attendance. Most studies used multiple recruitment and retention strategies. CONCLUSION This scoping review highlights the importance of a multifaceted recruitment and retention plan for underrepresented populations and populations with arthritis or FM in behavioral intervention programs targeting exercise, physical activity, or chronic disease self management. Additional research is needed to better understand the individual effects of different strategies and the costs associated with the various recruitment/retention methods in underrepresented populations and populations with arthritis.
Collapse
|
11
|
Buehring B, Mueller C, Parvaee R, Andreica I, Kiefer D, Kiltz U, Tsiami S, Pourhassan M, Westhoff T, Wirth R, Baraliakos X, Babel N, Braun J. [Frequency and severity of sarcopenia in patients with inflammatory and noninflammatory musculoskeletal diseases : Results of a monocentric study in a tertiary care center]. Z Rheumatol 2023; 82:563-572. [PMID: 36877305 DOI: 10.1007/s00393-023-01332-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/12/2023] [Indexed: 03/07/2023]
Abstract
INTRODUCTION Sarcopenia (SP) is defined as the pathological loss of muscle mass and function. This is a clinically relevant problem, especially in geriatric patients, because SP is associated with falls, frailty, loss of function, and increased mortality. People with inflammatory and degenerative rheumatic musculoskeletal disorders (RMD) are also at risk for developing SP; however, there is little research on the prevalence of this health disorder in this patient group using currently available SP criteria. OBJECTIVE To investigate the prevalence and severity of SP in patients with RMD. METHODS A total of 141 consecutive patients over 65 years of age with rheumatoid arthritis (RA), spondylarthritis (SpA), vasculitis, and noninflammatory musculoskeletal diseases were recruited in a cross-sectional study at a tertiary care center. The European Working Group on Sarcopenia in Older People (EWGSOP 1 and 2) definitions of presarcopenia, SP, and severe SP were used to determine the prevalence. Lean mass as a parameter of muscle mass and bone density were measured by dual X‑ray absorptiometry (DXA). Handgrip strength and the short physical performance battery (SPPB) were performed in a standardized manner. Furthermore, the frequency of falls and the presence of frailty were determined. Student's T-test and the χ2-test were used for statistics. RESULTS Of the patients included 73% were female, the mean age was 73 years and 80% had an inflammatory RMD. According to EWGSOP 2, 58.9% of participants probable had SP due to low muscle function. When muscle mass was added for confirmation, the prevalence of SP was 10.6%, 5.6% of whom had severe SP. The prevalence was numerically but not statistically different between inflammatory (11.5%) and noninflammatory RMD (7.1%). The prevalence of SP was highest in patients with RA (9.5%) and vasculitis (24%), and lowest in SpA (4%). Both osteoporosis (40% vs. 18.5%) and falls (15% vs. 8.6%) occurred more frequently in patients with SP than those without SP. DISCUSSION This study showed a relatively high prevalence of SP, especially in patients with RA and vasculitis. In patients at risk, measures to detect SP should routinely be performed in a standardized manner in the clinical practice. The high frequency of muscle function deficits in this study population supports the importance of measuring muscle mass in addition to bone density with DXA to confirm SP.
Collapse
Affiliation(s)
- B Buehring
- Rheumazentrum Ruhrgebiet, Ruhr-Universität Bochum, Herne, Deutschland.
- Klinik für Rheumatologie, Immunologie und Osteologie, Bergisches Rheuma - Zentrum, Klinisches Osteologisches Schwerpunktzentrum DVO, Europäisches Expertenzentrum Systemische Sklerose, Krankenhaus St. Josef, Akademisches Lehrkrankenhaus der Heinrich-Heine-Universität Düsseldorf, Bergstr. 6-12, 42105, Wuppertal, Deutschland.
| | - C Mueller
- Rheumazentrum Ruhrgebiet, Ruhr-Universität Bochum, Herne, Deutschland
| | - R Parvaee
- Rheumazentrum Ruhrgebiet, Ruhr-Universität Bochum, Herne, Deutschland
| | - I Andreica
- Rheumazentrum Ruhrgebiet, Ruhr-Universität Bochum, Herne, Deutschland
| | - D Kiefer
- Rheumazentrum Ruhrgebiet, Ruhr-Universität Bochum, Herne, Deutschland
| | - U Kiltz
- Rheumazentrum Ruhrgebiet, Ruhr-Universität Bochum, Herne, Deutschland
| | - S Tsiami
- Rheumazentrum Ruhrgebiet, Ruhr-Universität Bochum, Herne, Deutschland
| | - M Pourhassan
- Marienhospital Herne, Ruhr-Universität Bochum, Herne, Deutschland
| | - T Westhoff
- Marienhospital Herne, Ruhr-Universität Bochum, Herne, Deutschland
| | - R Wirth
- Marienhospital Herne, Ruhr-Universität Bochum, Herne, Deutschland
| | - X Baraliakos
- Rheumazentrum Ruhrgebiet, Ruhr-Universität Bochum, Herne, Deutschland
| | - N Babel
- Marienhospital Herne, Ruhr-Universität Bochum, Herne, Deutschland
| | - J Braun
- Rheumazentrum Ruhrgebiet, Ruhr-Universität Bochum, Herne, Deutschland
| |
Collapse
|
12
|
Kim C, Yun H, Kang HS, Jung J, Schlenk EA. Predicting physical activity and sarcopenia-related health outcomes in women with rheumatoid arthritis: A test of the self-determination theory. Nurs Open 2023; 10:6369-6380. [PMID: 37312650 PMCID: PMC10416004 DOI: 10.1002/nop2.1885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 05/06/2023] [Accepted: 05/29/2023] [Indexed: 06/15/2023] Open
Abstract
AIM This study aimed to examine a hypothetical model of physical activity (PA) and health outcomes related to sarcopenia in women with rheumatoid arthritis (RA) based on self-determination theory. DESIGN Cross-sectional study. METHODS This study included 214 women diagnosed with RA from the outpatient rheumatology department of a university-affiliated hospital in South Korea. Data were collected from September 2019 to August 2020 through structured questionnaires and anthropometric measurements and analysed using path analysis to test the hypothesized model. The primary health outcomes were perceived health status and sarcopenia-related health (thigh circumference, handgrip strength and sarcopenia risk). RESULTS The final model's fit indices were adequate. Physical activity was directly affected by motivation for PA, while depression, self-efficacy for PA, health care provider's autonomy support and basic psychological needs satisfaction indirectly affected PA. Physical activity directly affected perceived health status and thigh circumference, while perceived sarcopenia risk and handgrip strength were directly affected by disease activity and age. PATIENT OR PUBLIC CONTRIBUTION Patients were involved in a questionnaire-based survey.
Collapse
Affiliation(s)
- Chun‐Ja Kim
- College of Nursing and Research Institute of Nursing ScienceAjou UniversitySuwonSouth Korea
| | - Hye‐Won Yun
- Department of NursingCatholic Sangji CollegeAndongSouth Korea
| | - Hee Sun Kang
- Red Cross College of NursingChung‐Ang UniversitySeoulSouth Korea
| | - Ju‐Yang Jung
- Department of RheumatologyAjou University School of MedicineSuwonSouth Korea
| | | |
Collapse
|
13
|
Cerasola D, Argano C, Chiovaro V, Trivic T, Scepanovic T, Drid P, Corrao S. Physical Exercise and Occupational Therapy at Home to Improve the Quality of Life in Subjects Affected by Rheumatoid Arthritis: A Randomized Controlled Trial. Healthcare (Basel) 2023; 11:2123. [PMID: 37570365 PMCID: PMC10419087 DOI: 10.3390/healthcare11152123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Revised: 07/12/2023] [Accepted: 07/16/2023] [Indexed: 08/13/2023] Open
Abstract
BACKGROUND Rheumatoid arthritis (RA) is a chronic autoimmune inflammatory disease that affects synovial membranes and typically causes joint pain and swelling. The resulting disability of RA is due to the erosion of cartilage and bone from the inflamed synovial tissue. Occupational therapy is a strategy and technique to minimize the joints' fatigue and effort. At the same time, physical exercise reduces the impact of systemic manifestations and improves symptoms in RA. This study investigates the role of a 30-day joint economy intervention (integration of physical exercise and occupational therapy) at home on the quality of life of subjects with RA. METHODS One hundred and sixty outpatients with RA were enrolled in a single-center trial with PROBE design and were divided into the intervention group (IG), which combined joint protection movements and physical exercise to maintain muscle tone at home, and the control group (CG). Both groups included 80 patients. In all patients, data from the disease activity score (DAS 28), health assessment questionnaire (HAQ), and short-form health survey (SF-12) "Italian version" were collected. In addition, to IG, a brochure was distributed, and the joint economy was explained, while to CG, the brochure only was distributed. The comparison between groups was made using Fisher's exact test for contingency tables and the z-test for the comparison of proportions. The non-parametric Mann-Whitney U test was used to compare quantitative variables between groups. The Wilcoxon signed-ranked test was used for post-intervention versus baseline comparisons. RESULTS Among the recruited patients, 54% were female. The mean age was 58.0 (42.4-74.7) for the CG and 54.0 (39.7-68.3) for the IG. Patients included in the IG had a higher cumulative illness rating scale for the evaluation of severity and comorbidity index (2.81 vs. 2.58; 2.91 vs. 2.59, respectively), as well as morning stiffness (33.8 vs. 25.0), even if not significant compared with CG patients. Our results indicate that, after 30 days of joint economy intervention at home, the DAS28 erythrocyte sedimentation rate (esr) and DAS28 C-reactive protein (crp), HAQ, and SF-12 mental component score were significantly improved (p = 0.005, p = 0.004, p = 0.009, and p = 0.010, respectively). CONCLUSIONS Our findings show that the combination of physical exercise and occupational therapy positively affects patients' quality of life with RA considering disease activity, global health status, and mental health.
Collapse
Affiliation(s)
- Dario Cerasola
- Department of Psychology, Educational Science and Human Movement, University of Palermo, 90128 Palermo, Italy;
| | - Christiano Argano
- Department of Internal Medicine IGR, National Relevance and High Specialization Hospital Trust ARNAS Civico, Di Cristina, Benfratelli, 90127 Palermo, Italy; (V.C.); (S.C.)
| | - Valeria Chiovaro
- Department of Internal Medicine IGR, National Relevance and High Specialization Hospital Trust ARNAS Civico, Di Cristina, Benfratelli, 90127 Palermo, Italy; (V.C.); (S.C.)
| | - Tatjana Trivic
- Faculty of Sport and Physical Education, University of Novi Sad, 21000 Novi Sad, Serbia; (T.T.); (T.S.); (P.D.)
| | - Tijana Scepanovic
- Faculty of Sport and Physical Education, University of Novi Sad, 21000 Novi Sad, Serbia; (T.T.); (T.S.); (P.D.)
| | - Patrik Drid
- Faculty of Sport and Physical Education, University of Novi Sad, 21000 Novi Sad, Serbia; (T.T.); (T.S.); (P.D.)
| | - Salvatore Corrao
- Department of Internal Medicine IGR, National Relevance and High Specialization Hospital Trust ARNAS Civico, Di Cristina, Benfratelli, 90127 Palermo, Italy; (V.C.); (S.C.)
- Dipartimento di Promozione della Salute, Materno Infantile, Medicina Interna e Specialistica di Eccellenza “G. D’Alessandro” (PROMISE), University of Palermo, 90127 Palermo, Italy
| |
Collapse
|
14
|
Yekini A, Grace JM. Effects of Exercise on Body Composition and Physical Function in Rheumatoid Arthritis Patients: Scoping Review. Open Access Rheumatol 2023; 15:113-123. [PMID: 37521003 PMCID: PMC10378614 DOI: 10.2147/oarrr.s412942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 05/25/2023] [Indexed: 08/01/2023] Open
Abstract
Background In rheumatoid arthritis (RA) patients, an adverse change in body composition, which usually results in muscle wasting and increased fat mass, is high, contributing to increased functional disability. There are indications that resistance and dynamic exercise interventions could improve body composition and functional capacity in RA patients and should be recommended to manage RA. Purpose The scoping literature review aimed to analyze available literature about the effects of exercise on body composition in RA patients. Secondly to identify the contribution of exercise to improve physical function in RA patients, thirdly to identify gaps in the literature about physical exercises and health outcomes in RA patients, and make recommendations for future research. Methods A scoping literature review design was employed following the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) guidelines. A systematic search of three databases (PubMed, CINAHL, and Scopus) for studies published from 2012 to 2022 was conducted. The words searched include "exercise intervention" AND "body fat" OR "muscle wasting" OR "lean body mass" AND "functional ability" OR "health assessments". The search strategy was limited to studies published in English on RA patients and exercise interventions. Results This search yielded 2693 studies, of which 11 met the inclusion criteria and were selected for review. The findings showed significant, positive effects of exercise interventions on RA patients' body composition and functional capacity, with exercise being highly beneficial. It is evident that high-intensity resistance exercise, as a stand-alone intervention, is feasible and safe for managing RA conditions. Conclusion Physical exercises, following scientific guidelines, should be included as an integrated approach to managing RA conditions.
Collapse
Affiliation(s)
- Amidu Yekini
- Discipline of Biokinetics, Exercise and Leisure science, College of Health Sciences, University of Kwazulu-Natal, Durban, South Africa
| | - Jeanne Martin Grace
- Discipline of Biokinetics, Exercise and Leisure science, College of Health Sciences, University of Kwazulu-Natal, Durban, South Africa
| |
Collapse
|
15
|
Desai S, Wu J, Horkeby K, Norgård M, Ohlsson C, Windahl SH, Engdahl C. A COX-2 Inhibitor Does Not Interfere With the Bone-Protective Effects of Loading in Male Mice With Arthritis. JBMR Plus 2023; 7:e10751. [PMID: 37457879 PMCID: PMC10339087 DOI: 10.1002/jbm4.10751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 03/03/2023] [Accepted: 04/11/2023] [Indexed: 07/18/2023] Open
Abstract
Mechanical loading enhances bone strength and counteracts arthritis-induced inflammation-mediated bone loss in female mice. It is unknown whether nonsteroidal anti-inflammatory drugs (NSAIDs; eg, COX-2 inhibitors) can reduce inflammation without affecting the loading-associated bone formation in male mice. The aim of this study was to investigate if loading combined with a COX-2 inhibitor (NS-398) could prevent arthritis-induced bone loss and inflammation in male mice. Four-month-old male C57BL/6J mice were subjected to axial tibial mechanical loading three times/week for 2 weeks. Local mono-arthritis was induced with a systemic injection of methylated bovine serum albumin on the first day of loading, followed by a local injection in one knee 1 week later. The arthritis induction, knee swelling, bone architecture, and osteoclast number were evaluated in the hind limbs. C-terminal cross-links as a marker for osteoclast activity was measured in serum. Compared with loading and arthritis alone, loading of the arthritic joint enhanced swelling that was partly counteracted by NS-398. Loading of the arthritic joint enhanced synovitis and articular cartilage damage compared with loading alone. Loading increased cortical bone and counteracted the arthritis-induced decrease in epiphyseal bone. NS-398 did not alter the bone-protective effects of loading. C-terminal cross-links, a bone resorption marker, was increased by arthritis but not loading. In conclusion, loading prevented arthritis-induced epiphyseal and metaphyseal bone loss, and NS-398 reduced knee swelling without affecting the bone-protective effects of loading. If our results can be extrapolated to the human situation, specific COX-2 inhibitors could be used in combination with loading exercise to prevent pain and swelling of the joint without influencing the bone-protective effects of loading. © 2023 The Authors. JBMR Plus published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research.
Collapse
Affiliation(s)
- Suchita Desai
- Department of Laboratory Medicine, Division of Pathology, Karolinska InstitutetKarolinska University HospitalHuddingeSweden
| | - Jianyao Wu
- Sahlgrenska Osteoporosis Centre, Centre for Bone and Arthritis Research, Department of Internal Medicine and Clinical NutritionInstitute of Medicine, Sahlgrenska Academy, University of GothenburgGothenburgSweden
| | - Karin Horkeby
- Sahlgrenska Osteoporosis Centre, Centre for Bone and Arthritis Research, Department of Internal Medicine and Clinical NutritionInstitute of Medicine, Sahlgrenska Academy, University of GothenburgGothenburgSweden
| | - Maria Norgård
- Department of Laboratory Medicine, Division of Pathology, Karolinska InstitutetKarolinska University HospitalHuddingeSweden
| | - Claes Ohlsson
- Sahlgrenska Osteoporosis Centre, Centre for Bone and Arthritis Research, Department of Internal Medicine and Clinical NutritionInstitute of Medicine, Sahlgrenska Academy, University of GothenburgGothenburgSweden
| | - Sara H Windahl
- Department of Laboratory Medicine, Division of Pathology, Karolinska InstitutetKarolinska University HospitalHuddingeSweden
| | - Cecilia Engdahl
- Sahlgrenska Osteoporosis Centre, Centre for Bone and Arthritis Research, Department of Internal Medicine and Clinical NutritionInstitute of Medicine, Sahlgrenska Academy, University of GothenburgGothenburgSweden
- Centre for Bone and Arthritis Research, Department of Rheumatology and Inflammation ResearchInstitute of Medicine, Sahlgrenska Academy, University of GothenburgGothenburgSweden
| |
Collapse
|
16
|
Farrell K, Comis LE, Casimir MM, Hodsdon B, Jiménez-Silva R, Dunigan T, Bhattacharyya T, Jha S. Occupational engagement, fatigue, and upper and lower extremity abilities in persons with melorheostosis. PM R 2023; 15:587-595. [PMID: 35403375 PMCID: PMC9548523 DOI: 10.1002/pmrj.12817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 03/14/2022] [Accepted: 03/30/2022] [Indexed: 11/09/2022]
Abstract
INTRODUCTION Melorheostosis is a rare bone disorder with limited literature that describes the effect of this disease on functional and motor abilities. As part of a natural history study, four outcome measures were administered to better understand the burden this disease has on a person's ability to engage in basic and instrumental activities of daily living. OBJECTIVE To investigate the relationship between functional engagement, fatigue, and motor ability in patients with melorheostosis. DESIGN Cross-sectional data gathered from a longitudinal natural history observational study. SETTING Rehabilitation department within a single institution. PARTICIPANTS Forty-seven adult volunteers with melorheostosis were enrolled. Two participants were removed for failure to meet diagnosis eligibility. Thirty patients had lower extremity (LE) osteosclerotic bone lesions, 14 had upper extremity (UE) lesions, and one had lesions in both UEs and LEs. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Activity Card Sort, Second Edition (ACS); Multi-Dimensional Fatigue Inventory; Lower Extremity Functional Scale; Upper Extremity Functional Index. RESULTS On the ACS, high-demand leisure (HDL) activities were the least retained (p < .001). Of the activities rated most important, HDL activities were the most likely to have been given up (27%). General fatigue (μ = 11.8) and physical fatigue (μ = 11.0) were the two most limiting fatigue constructs. There were moderate negative correlations with HDL activities compared to physical fatigue (r = -0.524, p < .001) and reduced activity fatigue (r = -0.58, p = .001). LE lesions had a large effect on completing LE tasks (d = 0.95) and UE lesions had a medium effect on completing tasks involving the UE (d = 0.69). CONCLUSIONS Patients with melorheostosis experience fatigue and low engagement in HDL activities. The results of this study underscore the importance of acknowledging activity domain, fatigue constructs, and lesion location to support and provide targeted evidence-based rehabilitative therapy. CLINICAL TRIAL REGISTRATION NUMBER NCT02504879.
Collapse
Affiliation(s)
- Kathleen Farrell
- Rehabilitation Medicine Department, Clinical Center, National Institutes of Health, Bethesda, Maryland, USA
| | - Leora E. Comis
- Rehabilitation Medicine Department, Clinical Center, National Institutes of Health, Bethesda, Maryland, USA
| | - Morgan M. Casimir
- Rehabilitation Medicine Department, Clinical Center, National Institutes of Health, Bethesda, Maryland, USA
| | - Bonnie Hodsdon
- Rehabilitation Medicine Department, Clinical Center, National Institutes of Health, Bethesda, Maryland, USA
| | - Rafael Jiménez-Silva
- Rehabilitation Medicine Department, Clinical Center, National Institutes of Health, Bethesda, Maryland, USA
| | - Tiara Dunigan
- Rehabilitation Medicine Department, Clinical Center, National Institutes of Health, Bethesda, Maryland, USA
| | - Timothy Bhattacharyya
- Clinical and Investigative Orthopedics Unit, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | - Smita Jha
- Clinical and Investigative Orthopedics Unit, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, Maryland, USA
- Section on Congenital Disorders, Clinical Center, National Institutes of Health, Bethesda, Maryland, USA
| |
Collapse
|
17
|
Schäfer C, Keyßer G. Lifestyle Factors and Their Influence on Rheumatoid Arthritis: A Narrative Review. J Clin Med 2022; 11:jcm11237179. [PMID: 36498754 PMCID: PMC9736780 DOI: 10.3390/jcm11237179] [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: 10/06/2022] [Revised: 11/23/2022] [Accepted: 11/30/2022] [Indexed: 12/12/2022] Open
Abstract
In recent years, a possible association of lifestyle factors with rheumatoid arthritis (RA) has attracted increasing public interest. The aim of this review is to provide an overview of the extent and the limitations of current evidence regarding lifestyle factors and RA. The PubMed medical database was screened for epidemiological and prospective studies investigating the contribution of lifestyle factors to the development and the course of the disease. Large epidemiological studies have identified smoking, unhealthy diet and adiposity, as well as a low educational level and low socioeconomic status, as factors that increase the incidence of RA. In addition, several lifestyle habits influence the response of RA to antirheumatic drugs. Among others, smoking, obesity and poor physical activity are associated with a worse treatment outcome. Methodological problems often impair firm conclusions with respect to the causal role of these factors in the risk and the course of RA. However, current evidence is sufficient to recommend a healthy diet, the prevention of obesity, the cessation of smoking and the maintenance of a high level of physical activity to support the effectivity of modern antirheumatic medication.
Collapse
|
18
|
Özlü A, Akdeniz Leblebicier M. Does remission in rheumatoid arthritis bring kinesiophobia, quality of life, fatigue, and physical activity closer to normal? Arch Rheumatol 2022; 37:603-612. [PMID: 36879575 PMCID: PMC9985370 DOI: 10.46497/archrheumatol.2022.9552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 08/19/2022] [Indexed: 03/08/2023] Open
Abstract
Objectives This study aimed to compare kinesiophobia, fatigue, physical activity, and quality of life (QoL) between the patients with rheumatoid arthritis (RA) in remission and a healthy population. Patients and methods The prospective controlled study included 45 female patients (mean age: 54.22±8.2 year; range, 37 to 67 year) with a diagnosis of RA determined to be in remission according to the Disease Activity Score in 28 Joints (DAS28) being ≤2.6 between January 2022 and February 2022. As a control group, 45 female healthy volunteers (mean age: 52.2±8.2 year; range, 34 to 70 year) of similar age were evaluated. The QoL, disease activity, pain, kinesiophobia, fatigue severity, and physical activity were assessed using the Health Assessment Questionnaire, DAS28, Visual Analog Scale, Tampa Scale of Kinesiophobia, Fatigue Severity Scale, and International Physical Activity Questionnaire, respectively. Results There was no significant difference between the groups in demographic data. A statistically significant difference was found between the groups in terms of pain, C-reactive protein level, fatigue, kinesiophobia, QoL, and total, high, and moderate physical activity scores (p<0.001). Among the RA patients in remission, there was a significant correlation between kinesiophobia and moderate physical activity and QoL, as well as between fatigue and high physical activity (p<0.05). Conclusion Patient education and multidisciplinary approach strategies should be developed to increase the QoL and physical activity and reduce kinesiophobia in RA patients in remission since there may be a decrease in physical activity due to kinesiophobia, fatigue, and fear of movement in this patient group compared to the healthy population, impairing their QoL.
Collapse
Affiliation(s)
- Aysun Özlü
- Department of Physical Medicine and Rehabilitation, Kütahya Health Sciences University, Kütahya, Türkiye
| | - Merve Akdeniz Leblebicier
- Department of Physical Medicine and Rehabilitation, Kütahya Health Sciences University, Kütahya, Türkiye
| |
Collapse
|
19
|
O’Brien CM, Duda JL, Kitas GD, Veldhuijzen van Zanten JJCS, Metsios GS, Fenton SAM. Autonomous motivation to reduce sedentary behaviour is associated with less sedentary time and improved health outcomes in rheumatoid arthritis: a longitudinal study. BMC Rheumatol 2022; 6:58. [PMID: 36210469 PMCID: PMC9549664 DOI: 10.1186/s41927-022-00289-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Accepted: 06/08/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
This longitudinal study investigated whether changes in autonomous and controlled motivation to reduce sedentary behaviour were associated with variability in sedentary, standing and stepping time and, in turn, disease activity, systemic inflammation, pain and fatigue in rheumatoid arthritis (RA).
Methods
People with RA undertook assessments at baseline (T1, n = 104) and 6 months follow-up (T2, n = 54) to determine autonomous and controlled motivation to reduce sedentary behaviour (Behavioural Regulation in Exercise Questionnaire-2), free-living sedentary, standing and stepping time (7 days activPAL3μ wear), Disease Activity Score-28 (DAS-28), systemic inflammation (c-reactive protein [CRP]), pain (McGill Pain Questionnaire) and fatigue (Multidimensional Assessment of Fatigue Scale). N = 52 participants provided complete data at T1 and T2. Statistical analyses: In a series of models (A and B), path analyses examined sequential associations between autonomous and controlled motivation to reduce sedentary behaviour with activPAL3μ-assessed behaviours and, in turn, RA outcomes.
Results
Models demonstrated good fit to the data. Model A (sedentary and stepping time): autonomous motivation was significantly negatively associated with sedentary time and significantly positively related to stepping time. In turn, sedentary time was significantly positively associated with CRP and pain. Stepping time was not significantly associated with any health outcomes. Model B (standing time): autonomous motivation was significantly positively associated with standing time. In turn, standing time was significantly negatively related to CRP, pain and fatigue.
Conclusions
Autonomous motivation to reduce sedentary behaviour is associated with sedentary and standing time in RA which may, in turn, hold implications for health outcomes.
Collapse
|
20
|
Öztürk Ö, Feyzioğlu Ö, Sarıtaş F. Inflammatory Arthritis Facilitators and Barriers (IFAB) for physical activity questionnaire: cross-cultural adaptation into Turkish and evaluation of its psychometric properties. Disabil Rehabil 2022:1-8. [PMID: 35914576 DOI: 10.1080/09638288.2022.2104940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
PURPOSE We aimed to conduct the translation and cross-cultural adaptation of the Inflammatory arthritis Facilitators and Barriers (IFAB) questionnaire into Turkish language for patients with axial spondyloarthritis (axSpA) and analyze the psychometric properties of the IFAB-Turkish version (IFAB-Tr). METHODS Data from ninety-three patients with axSpA were analyzed who completed the IFAB-Tr, Health Assessment Questionnaire (HAQ), Hospital Anxiety and Depression Scale (HADS) and Bath Ankylosing Spondylitis Functional Index (BASFI). Internal consistency, test-retest reliability, convergent validity, floor and ceiling effect, measurement error were examined. Exploratory factor analysis (EFA) and confirmatory factor analysis were conducted. RESULTS Small modification was needed in the translation and cultural adaptation process. Internal consistency of the IFAB-Tr total score was 0.71 and test-retest reliability was excellent for IFAB-Tr (ICC = 0.90). A moderate negative correlation was found between IFAB-Tr total score and HAQ, HADS, BASFI scores. No floor and ceiling effect was detected. Minimal detectable change was 10.34 points. EFA revealed two factors which accounted for 55% of the variance. CONCLUSIONS The IFAB was successfully translated into the Turkish language and seems suitable for evaluating barriers and facilitators for physical activity in rheumatic diseases and could be used in clinical settings before designing a physical activity intervention.IMPLICATIONS FOR REHABILITATIONThe Turkish version of the Inflammatory arthritis FAcilitators and Barriers (IFAB) is a valid and reliable tool to assess barriers and facilitators to physical activity for patients with axial spondyloarthritis.More work is needed to assess all psychometric properties of the IFAB questionnaire in other inflammatory rheumatic disorders.The Inflammatory arthritis FAcilitators and Barriers questionnaire in Turkish is an easy and quick way to determine potential barriers to physical activity in clinical and research settings.
Collapse
Affiliation(s)
- Özgül Öztürk
- Department of Physiotherapy and Rehabilitation, Acıbadem Mehmet Ali Aydınlar University, Istanbul, Turkey
| | - Özlem Feyzioğlu
- Department of Physiotherapy and Rehabilitation, Acıbadem Mehmet Ali Aydınlar University, Istanbul, Turkey
| | - Fatih Sarıtaş
- Department of Rheumatology, University of Health Sciences, Haydarpaşa Numune Research and Training Hospital, Istanbul, Turkey
| |
Collapse
|
21
|
Correlates of physical activity in adults with spondyloarthritis and rheumatoid arthritis: a systematic review. Rheumatol Int 2022; 42:1693-1713. [PMID: 35672508 PMCID: PMC9439989 DOI: 10.1007/s00296-022-05142-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 04/30/2022] [Indexed: 11/25/2022]
Abstract
Physical activity (PA) is a primary non-pharmacological treatment option for those living with rheumatoid arthritis (RA) and spondyloarthritis (SpA). The aim of this systematic literature review was to summarize and present an updated synthesis of the factors associated with PA in the RA and SpA populations. A tailored search of PubMed (inc. Medline), Web of Science, Embase, APA PsycNET, and Scopus was conducted for research published between 2004 and June 2019. Methodological quality was assessed using The National Institutes of Health (NIH) Quality Assessment Tools for Observational Cohort and Cross-sectional Studies, Case–Control Studies, and Controlled Intervention Studies. Forty RA and eleven SpA articles met the inclusion criteria. Methodological quality was generally fair to good, with two RA studies rated as poor. Correlates are discussed in the sociodemographic, physical, psychological, social, and environmental categories. Environmental factors were not measured in any RA study. In individuals living with RA, consistent positive associations were found between PA and high-density lipoprotein, self-efficacy, and motivation. Consistent negative associations were found for functional disability and fatigue. In individuals with SpA, consistent positive associations were found between PA and quality of life, and consistent negative associations with functional disability. Physical and psychological factors are most consistently related with PA parameters in those living with RA and SpA. Many variables were inconsistently studied and showed indeterminant associations. Studies with prospective designs are needed to further understand the factors associated with PA in these populations, especially in those living with SpA.
Collapse
|
22
|
Ye H, Weng H, Xu Y, Wang L, Wang Q, Xu G. Effectiveness and safety of aerobic exercise for rheumatoid arthritis: a systematic review and meta-analysis of randomized controlled trials. BMC Sports Sci Med Rehabil 2022; 14:17. [PMID: 35123568 PMCID: PMC8818158 DOI: 10.1186/s13102-022-00408-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Accepted: 01/27/2022] [Indexed: 11/15/2022]
Abstract
Background Rheumatoid arthritis (RA) can cause severe physical impairment and a reduced quality of life, and there is limited evidence for any effective intervention. Aerobic exercise may be beneficial for improving symptoms. Therefore, the purpose of this meta-analysis was to evaluate the effectiveness and safety of aerobic exercise for rheumatoid arthritis patients. Methods PubMed, The Cochrane Library, Web of Science, EMBASE, CNKI, WanFang Data and VIP databases were searched. Randomized controlled trials of the effectiveness and safety of aerobic exercise for rheumatoid arthritis were included. Risks of bias were assessed by two independent reviewers using the methods described in the RevMan 5.3, GRADEpro and the Cochrane Handbook. Meta-analyses were performed to investigate the effects of aerobic exercise on rheumatoid arthritis. Results A total of 13 RCTs were included, including 967 rheumatoid arthritis patients. The Meta-analysis results showed that aerobic exercise can improve functional ability [MD = − 0.25, 95% CI (− 0.38, − 0.11), P = 0.0002], relieve pain [SMD = − 0.46, 95% CI (− 0.90, − 0.01), P = 0.04], increase aerobic capacity [MD = 2.41, 95% CI (1.36, 3.45), P < 0.00001] and improve the Sit to Stand test score[MD = 1.60, 95% CI (0.07, 3.13), P = 0.04] with statistically significant differences. Conclusion Generally, aerobic exercise is beneficial and safe for RA patients and has a certain alleviating effect on the disease, such as functional ability improvement, pain relief and aerobic capacity increase. Limited by the quantity and quality of the included studies, future research with higher-quality studies needs to be conducted to verify the above conclusions. Trial registration: PROPERO registration number: CRD42021242953.
Collapse
Affiliation(s)
- Hui Ye
- School of Nursing, Nanjing University of Chinese Medicine, No. 138, Xianlin St., Box 064, Nanjing, 210023, People's Republic of China
| | - Heng Weng
- School of Nursing, Nanjing University of Chinese Medicine, No. 138, Xianlin St., Box 064, Nanjing, 210023, People's Republic of China
| | - Yue Xu
- School of Nursing, Nanjing University of Chinese Medicine, No. 138, Xianlin St., Box 064, Nanjing, 210023, People's Republic of China
| | - Lulu Wang
- School of Nursing, Nanjing University of Chinese Medicine, No. 138, Xianlin St., Box 064, Nanjing, 210023, People's Republic of China
| | - Qing Wang
- School of Nursing, Nanjing University of Chinese Medicine, No. 138, Xianlin St., Box 064, Nanjing, 210023, People's Republic of China.
| | - Guihua Xu
- School of Nursing, Nanjing University of Chinese Medicine, No. 138, Xianlin St., Box 064, Nanjing, 210023, People's Republic of China.
| |
Collapse
|
23
|
Baysalhan Öztürk İ, Garip Y, Sivas F, Parlak Özden M, Bodur H. Kinesiophobia in rheumatoid arthritis patients: Relationship with quadriceps muscle strength, fear of falling, functional status, disease activity, and quality of life. Arch Rheumatol 2021; 36:427-434. [PMID: 34870175 PMCID: PMC8612492 DOI: 10.46497/archrheumatol.2021.8535] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Accepted: 01/16/2021] [Indexed: 12/21/2022] Open
Abstract
Objectives
This study aims to determine the frequency of kinesiophobia in rheumatoid arthritis (RA) patients and to evaluate the relation of kinesiophobia with the knee range of motion (ROM), quadriceps muscle strength, fear of falling, functional status, disease activity, depression, and quality of life. Patients and methods
Between September 2018 and September 2019, a total of 100 RA patients (25 males, 75 females; mean age: 56.1±9.3 years; range, 32 to 69 years) and 50 healthy controls (14 males, 36 females; mean age: 54.6±9.8 years; range, 30 to 69 years) were included. Disease activity was evaluated using the Disease Activity Score 28 (DAS28), and functional status using the Health Assessment Questionnaire (HAQ). Pain severity was measured using the Visual Analog Scale (VAS). Tampa Kinesiophobia Scale (TKS) was used to evaluate kinesiophobia. Quadriceps muscle strength and knee ROM measurements of two extremities were recorded. Depression was evaluated using the Beck Depression Inventory (BDI), fear of falling by Falls Efficacy Scale (FES) and quality of life using the Short Form-36 (SF-36). Results
The rate of kinesiophobia was 70% in RA patients and 12% in controls, indicating a higher rate in RA patients, compared to controls (odds ratio [OR] = 44.861, 95% confidence interval [CI]: 42.571-49.052; p<0.05). This rate was 76% in females and 52% in males. Regression analysis revealed that the number of swollen and tender joints, DAS28, VAS-pain, and HAQ scores were positively associated with the TKS scores (p<0.05). Quadriceps muscle strength and knee flexion were negatively associated with the TKS scores (p<0.05). The TKS was significantly correlated with FES and BDI (p<0.05). The TKS was negatively correlated with SF-36 subscales (p<0.05). Conclusion
Kinesiophobia is common in RA patients. Our study is the first to evaluate the frequency of kinesiophobia in RA patients and to show pain level, disease activity, functional status, knee flexion ROM, and quadriceps muscle strength are effective on kinesiophobia. Kinesiophobia is also associated with fear of falling and depression, negatively affecting the quality of life in terms of physical, emotional, social and mental functions. Therefore, evaluating kinesiophobia and developing targeted treatment approaches seem to be useful in increasing the quality of life in RA.
Collapse
Affiliation(s)
- İlkay Baysalhan Öztürk
- Department of Physical Medicine and Rehabilitation, Ankara Bilkent City Hospital Physical Therapy and Rehabilitation Hospital, Ankara, Turkey
| | - Yeşim Garip
- Pediatric Brain Injury Rehabilitation Clinic, Ankara Bilkent City Hospital Physical Therapy and Rehabilitation Hospital, Ankara, Turkey
| | - Filiz Sivas
- Brain Injury Rehabilitation Clinic, Ankara Bilkent City Hospital Physical Therapy and Rehabilitation Hospital, Ankara, Turkey
| | - Merve Parlak Özden
- Kahramankazan District Health Directorate, Public Health, Ankara, Turkey
| | - Hatice Bodur
- Ankara Bilkent City Hospital Physical Therapy and Rehabilitation Hospital, Rheumatology, Orthopedic Rehabilitation and Pain, Ankara, Turkey
| |
Collapse
|
24
|
Negrini F, de Sire A, Lazzarini SG, Pennestrì F, Sorce S, Arienti C, Vitale JA. Reliability of activity monitors for physical activity assessment in patients with musculoskeletal disorders: A systematic review. J Back Musculoskelet Rehabil 2021; 34:915-923. [PMID: 33935067 DOI: 10.3233/bmr-200348] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Activity monitors have been introduced in the last years to objectively measure physical activity to help physicians in the management of musculoskeletal patients. OBJECTIVE This systematic review aimed at describing the assessment of physical activity by commercially available portable activity monitors in patients with musculoskeletal disorders. METHODS PubMed, Embase, PEDro, Web of Science, Scopus and CENTRAL databases were systematically searched from inception to June 11th, 2020. We considered as eligible observational studies with: musculoskeletal patients; physical activity measured by wearable sensors based on inertial measurement units; comparisons performed with other tools; outcomes consisting of number of steps/day, activity/inactivity time, or activity counts/day. RESULTS Out of 595 records, after removing duplicates, title/abstract and full text screening, 10 articles were included. We noticed a wide heterogeneity in the wearable devices, that resulted to be 10 different types. Patients included suffered from rheumatoid arthritis, osteoarthritis, juvenile idiopathic arthritis, polymyalgia rheumatica, and fibromyalgia. Only 3 studies compared portable activity trackers with objective measurement tools. CONCLUSIONS Taken together, this systematic review showed that activity monitors might be considered as useful to assess physical activity in patients with musculoskeletal disorders, albeit, to date, the high device heterogeneity and the different algorithms still prevent their standardization.
Collapse
Affiliation(s)
| | - Alessandro de Sire
- Department of Medical and Surgical Sciences, University of Catanzaro "Magna Graecia", Catanzaro, Italy
| | | | | | | | | | | |
Collapse
|
25
|
Kin-Hoo Koo K, Chinoy H, Creaney L, Hayton M. Inflammatory Arthropathy in the Elite Sports Athlete. Curr Sports Med Rep 2021; 20:577-583. [PMID: 34752430 DOI: 10.1249/jsr.0000000000000903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
ABSTRACT Elite athletes commonly present with joint pains that are attributed to overuse injuries though on occasion it can be due to an inflammatory arthropathy. The diagnostic challenge is that presenting symptoms of benign injuries are similar to inflammatory arthropathies. A holistic review of the athlete can provide clues suggestive of inflammatory arthropathy, before requesting further investigations to confirm the diagnosis. Current imaging modalities are not specific in differentiating inflammatory arthritis with other causes of joint inflammation. Prompt treatment is required to restore the athlete to an optimum level of activity and prevent career ending disability, all in adherence to the regulations of the sporting governing bodies. This review aims to highlight the importance of inflammatory arthropathy in the differentials for an athlete presenting with joint pains.
Collapse
Affiliation(s)
- Kenneth Kin-Hoo Koo
- Department of Trauma and Orthopaedics, Salford Royal NHS Foundation Trust, Salford, UNITED KINGDOM
| | - Hector Chinoy
- National Institute for Health Research Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, The University of Manchester, Manchester, UNITED KINGDOM
| | - Leon Creaney
- Manchester Institute of Health & Performance (MIHP), Manchester, UNITED KINGDOM
| | - Mike Hayton
- Upper Limb Unit, Wrightington Hospital, Hall Lane, Appley Bridge, Wrightington, Wigan, UNITED KINGDOM
| |
Collapse
|
26
|
Mizoguchi Y, Tanaka S, Matsumoto Y, Urakawa T, Kurabayashi H, Akasaka K, Hall T. Quality of life and life-space mobility after total knee arthroplasty in patients with rheumatoid arthritis: a pilot case-controlled study. J Phys Ther Sci 2021; 33:660-667. [PMID: 34539070 PMCID: PMC8436044 DOI: 10.1589/jpts.33.660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 06/06/2021] [Indexed: 11/24/2022] Open
Abstract
[Purpose] The purpose of this study was to identify factors inhibiting improvement in the quality of life after total knee arthroplasty in patients with rheumatoid arthritis. [Participants and Methods] This was a pilot case-control study. The sample comprised of five participants with rheumatoid arthritis and 11 participants with osteoarthritis, who underwent total knee arthroplasty. We compared the groups in terms of physical function, walking ability, Japanese Knee Osteoarthritis Measure, and Life-Space Assessment. Measurements were taken before surgery and at four weeks and five months post-surgery. All patients underwent rehabilitation for five months postoperatively, first as inpatients, and then as outpatients after discharge. [Results] In the period from 4 weeks to 5 months post-surgery, physical function improved similarly in both groups in terms of muscle strength and walking ability. Despite the patients with rheumatoid arthritis being younger, their self-health assessment score by the Japanese Knee Osteoarthritis Measure and measures of life-space mobility by Life-Space Assessment were lower. [Conclusion] It is important to consider exercise therapy, and gait instruction to alleviate anxiety about health status and improve the quality of life and life-space mobility in patients with rheumatoid arthritis who undergo total knee arthroplasty.
Collapse
Affiliation(s)
- Yasuaki Mizoguchi
- Department of Rehabilitation, Saitama Medical University Hospital: 38 Morohongo, Moroyama, Iruma, Saitama 350-0495, Japan
| | - Shinya Tanaka
- Department of Orthopedic Surgery, Saitama Medical University Hospital, Japan
| | - Yukihiro Matsumoto
- Department of Rehabilitation, Saitama Medical University Hospital: 38 Morohongo, Moroyama, Iruma, Saitama 350-0495, Japan
| | - Tsukasa Urakawa
- Department of Rehabilitation, Saitama Medical University Hospital: 38 Morohongo, Moroyama, Iruma, Saitama 350-0495, Japan
| | - Hitoshi Kurabayashi
- Department of Rehabilitation, Saitama Medical University Hospital: 38 Morohongo, Moroyama, Iruma, Saitama 350-0495, Japan
| | - Kiyokazu Akasaka
- Master's and Doctoral Program of Physical Therapy, Saitama Medical University Graduate School of Medicine, Japan
| | - Toby Hall
- School of Physiotherapy and Exercise Science, Curtin University, Australia.,Manual Concept, Australia
| |
Collapse
|
27
|
Baday-Keskin D, Ekinci B. The relationship between kinesiophobia and health-related quality of life in patients with rheumatoid arthritis: A controlled cross-sectional study. Joint Bone Spine 2021; 89:105275. [PMID: 34536623 DOI: 10.1016/j.jbspin.2021.105275] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Accepted: 09/02/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To evaluate the kinesiophobia and kinesiophobia-related factors in patients with rheumatoid arthritis (RA) and provide a better perspective on the relationship between kinesiophobia and patients' health-related quality of life (HRQoL). METHODS A total of 88 patients (67 females, 21 males) with RA and 93 healthy volunteers (67 females, 26 males) were included in the study between March 2020 and July 2020. Kinesiophobia was evaluated using the Tampa Scale of Kinesiophobia (TSK) and HRQoL was evaluated using the 36-item Short-Form Health Survey (SF-36). The Fatigue Severity Scale (FSS), Beck Depression Inventory (BDI), Health Assessment Questionnaire Disability Index (HAQ-DI), International Physical Activity Questionnaire (IPAQ) (Short Form) were completed by all participants. RESULTS The median age was 52.0 (IQR, 45.0-58.0) years in the RA group and 50.0 (IQR, 41.5-56.0) years in the control group. Age and sex were not significantly different between the groups. The median TSK score was 45.0 (IQR, 39.0-49.75) in the RA group, 39.0 (IQR, 37.0-43.0) in the control group (P<0.001). The median FSS, BDI, and HAQ-DI scores were higher and the median HRQoL domains were lower in the RA group than in the control group (P<0.05). Multivariate linear regression analysis including age, sex, education level, body mass index (BMI), morning stiffness duration, Disease Activity Score in 28 joints, FSS, BDI, visual analog scale and IPAQ scores variables showed that FSS scores (B=1.07, P<0.05), BDI scores (B=0.24, P<0.05), and BMI (B=0.22, P<0.05) were independent variables for kinesiophobia in patients with RA (R2=0.32). TSK was a predictive variable for HAQ-DI (B=0.03, P<0.001), the physical functioning domain of the HRQoL (B=-1.18, P<0.001), the bodily pain domain of the HRQoL (B=-0.78, P<0.05), respectively. CONCLUSION Physicians should have awareness of kinesiophobia in patients with RA. Educating patients about kinesiophobia, developing strategies for avoiding kinesiophobia, and specific treatment strategies with a multidisciplinary approach may improve HRQoL and disability.
Collapse
Affiliation(s)
- Dilek Baday-Keskin
- Department of Physical Medicine and Rehabilitation, Erzincan Binali Yildirim University Mengucek Gazi Training and Research Hospital, Erzincan, Turkey.
| | - Bilge Ekinci
- Department of Physical Medicine and Rehabilitation, Erzincan Binali Yildirim University Mengucek Gazi Training and Research Hospital, Erzincan, Turkey
| |
Collapse
|
28
|
Wang C, Qin Y, Xu J, Li G, Lei J, Zhang C, Deng H. Correlation of Ultrasound Synovitis Joint Count with Disease Activity and Its Longitudinal Variation with Treatment Response to Etanercept in Rheumatoid Arthritis. ULTRASOUND IN MEDICINE & BIOLOGY 2021; 47:2543-2549. [PMID: 34175145 DOI: 10.1016/j.ultrasmedbio.2021.05.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 04/26/2021] [Accepted: 05/06/2021] [Indexed: 06/13/2023]
Abstract
More research is needed into rheumatoid arthritis (RA), and ultrasound (US) synovitis is a promising factor for assisting in the management of RA; however, related research is extremely limited. The goal of this study was to evaluate the correlation of US synovitis joint count with clinical features, and its longitudinal changes with treatment response to etanercept in RA. We consecutively enrolled 117 people with active RA being treated with etanercept. US synovitis joint count was evaluated in 28 joints at baseline (W0), week 4 (W4), week 12 (W12) and week 24 (W24) after initiation of etanercept treatment. The mean (±standard deviation), median, inter-quartile range, and total range of the US synovitis joint count at W0 were 9.3 ± 4.0, 9.0, 7.0-11.0 and 2.0-21.0, respectively. US synovitis joint count was positively associated with tenderness joint count, swollen joint count, erythrocyte sedimentation rate, 28-joint Disease Activity Score based on erythrocyte sedimentation rate and Health Assessment Questionnaire-Disability Index score. Then participants were categorized into response and non-response groups according to their response status at W24. Further analyses showed that US synovitis joint count gradually decreased from W0 to W24, and displayed a more notable declining trend in the response group compared with the non-response group. In addition, US synovitis joint count at W0 and W4 was similar between groups, but at W12 and W24 it was markedly decreased in the response group compared with the non-response group. In conclusion, US synovitis joint count correlates with disease activity, and its longitudinal decrease is associated with treatment response to etanercept in RA.
Collapse
Affiliation(s)
- Chaojun Wang
- Department of Ultrasound, Lishui People's Hospital, Lishui, China
| | - Yong Qin
- Department of General Surgery, Lishui People's Hospital, Lishui, China
| | - Jinghua Xu
- Department of Ultrasound, Lishui People's Hospital, Lishui, China
| | - Gang Li
- Department of Ultrasound, Lishui People's Hospital, Lishui, China
| | - Jianming Lei
- Department of Ultrasound, Lishui People's Hospital, Lishui, China
| | - Chunlai Zhang
- Department of Ultrasound, Lishui People's Hospital, Lishui, China
| | - Huadong Deng
- Department of Ultrasound, Lishui People's Hospital, Lishui, China.
| |
Collapse
|
29
|
Li Y, Gu C, Liu G, Yu Y, Xu J. Polarization of rheumatoid macrophages is regulated by the CDKN2B-AS1/ MIR497/TXNIP axis. Immunol Lett 2021; 239:23-31. [PMID: 34418490 DOI: 10.1016/j.imlet.2021.08.001] [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: 03/26/2021] [Revised: 07/09/2021] [Accepted: 08/12/2021] [Indexed: 12/24/2022]
Abstract
The polarization of macrophages plays a critical role in the pathophysiology of rheumatoid arthritis. The macrophages can have pro-inflammatory M1 polarization and various types of alternative anti-inflammatory M2 polarization. Our preliminary results showed that the CDKN2B-AS1/MIR497/TXNIP axis might regulate macrophages of rheumatoid arthritis patients. Therefore, we hypothesized that this axis regulated the polarization of rheumatoid macrophages. Flow cytometry was used to determine the surface polarization markers in M1 or M2 macrophages from healthy donors and rheumatoid arthritis patients. The QPCR and Western Blotting were used to compare the expression of the CDKN2B-AS1/MIR497/TXNIP axis in these macrophages. We Knocked down and overexpressed the axis in the macrophage cell line MD to test its roles in macrophage polarization. Compared to cells from healthy donors, cells from rheumatoid arthritis patients expressed higher levels of CD40 and CD80 and lower levels of CD16, CD163, CD206, and CD200R after polarization, they also expressed higher CDKN2B-AS1, lower MIR497, and higher TXNIP. In macrophages from healthy donors, there was no correlation among CDKN2B-AS1, MIR497, and TXNIP. But in macrophages from patients, there were significant correlations. The CDKN2B-AS1 knockdown, MIR497 mimics suppressed the M1 polarization but promoted the M2 polarization in MD cells, while the MIR497 knockdown and the TXNIP overexpression did the opposite. This study demonstrated that elevated CDKN2B-AS1 in macrophages promotes the M1 polarization and inhibited the M2 polarization of macrophages by the CDKN2B-AS1/ MIR497/TXNIP axis.
Collapse
Affiliation(s)
- Yu Li
- Hospital of Zhengzhou University, Zhengzhou, China
| | - Chenxi Gu
- Hospital of Zhengzhou University, Zhengzhou, China
| | - Guanlei Liu
- Hospital of Zhengzhou University, Zhengzhou, China
| | - Yang Yu
- Hospital of Zhengzhou University, Zhengzhou, China
| | - Jianzhong Xu
- Hospital of Zhengzhou University, Zhengzhou, China.
| |
Collapse
|
30
|
Thomsen T, Aadahl M, Aabo MR, Beyer N, Hetland ML, Bente A, Esbensen. Participant evaluation of a behavioral intervention targeting reduction of sedentary behavior in patients with rheumatoid arthritis: a mixed methods study. Disabil Rehabil 2021; 44:6382-6393. [PMID: 34415207 DOI: 10.1080/09638288.2021.1966676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Purpose: The "Joint Resources - Sedentary Behavior Study" (JR-SB) revealed significant behavioral and cardio-metabolic effects of reducing daily sedentary behavior replaced by light-intensity physical activity in patients with rheumatoid arthritis. This study explores the participant perception and experiences of the intervention and impact on the participants' health, family and physical activity behavior.Materials and Methods: A mixed-methods study design, including quantitative and qualitative data, was applied. Quantitative data were collected post-intervention using a questionnaire (n = 69) evaluating experiences of participation in the intervention. By maximum variation sampling, 18 participants were recruited to three focus group interviews with discussions of intervention elements. Data from the two sub-studies were collected and analyzed separately, although integrated at the interpretation and reporting level.Results: Based on four overarching themes, results indicated participant satisfaction with the individually tailored, behavioral approach and the focus on light-intensity physical activity rather than higher intensities. Study participation had an additional positive impact on the behaviors of family and social relations. Conversely, the family motivated the participants to achieve their physical activity goals.Conclusions: The study results support the use of individually tailored and behavioral approaches to reduce sedentary behavior, increase light-intensity physical activity and improve physical abilities in patients with rheumatoid arthritis. IMPLICATIONS FOR REHABILITATIONThis paper presents positive participant perception and motivation for an individually tailored, behavioural intervention that aimed to reduce sedentary behaviour replaced by light-intensity physical activity in patients with rheumatoid arthritis.The results indicate that especially the focus on light-intensity physical activity, a consistent focus on the individual's everyday life and continuous support from health professionals motivated the participants to reduce their daily sedentary behaviour - also in the long term.Involvement of participants' family members seems to have influence on their own physical activity behavior as well as on the participants' motivation for changing physical activity behavior.Together with earlier evidence, the results underpin the use of behavioural strategies to support patients with rheumatoid arthritis in achieving their physical activity goals and in improving the abilities needed to manage their everyday lives.
Collapse
Affiliation(s)
- Tanja Thomsen
- Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Centre for Head and Orthopaedics, Rigshospitalet, Denmark.,Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, Frederiksberg, Denmark
| | - Mette Aadahl
- Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, Frederiksberg, Denmark.,Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Maria R Aabo
- Department of Physiotherapy and Occupational Therapy, Herlev and Gentofte Hospital, Herlev, Denmark
| | - Nina Beyer
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Merete L Hetland
- Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Centre for Head and Orthopaedics, Rigshospitalet, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.,The DANBIO registry, Center for Rheumatology and Spine Diseases, Centre for Head and Orthopaedics, Rigshospitalet, Denmark
| | | | - Esbensen
- Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Centre for Head and Orthopaedics, Rigshospitalet, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| |
Collapse
|
31
|
Mathias K, Amarnani A, Pal N, Karri J, Arkfeld D, Hagedorn JM, Abd-Elsayed A. Chronic Pain in Patients with Rheumatoid Arthritis. Curr Pain Headache Rep 2021; 25:59. [PMID: 34269913 DOI: 10.1007/s11916-021-00973-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/11/2021] [Indexed: 12/27/2022]
Abstract
PURPOSE OF REVIEW Chronic pain is highly prevalent in patients with rheumatoid arthritis (RA) and can cause various physical and psychological impairments. Unfortunately, the appropriate diagnosis of chronic pain syndromes in this population can be challenging because pain may be primary to RA-specific inflammation and/or secondary to other conditions, typically osteoarthritis (OA) and fibromyalgia (FM). This disparity further poses a clinical challenge, given that chronic pain can often be discordant or undetected with standard RA-specific surveillance strategies, including serological markers and imaging studies. In this review, we provide a robust exploration of chronic pain in the RA population with emphasis on epidemiology, mechanisms, and management strategies. RECENT FINDINGS Chronic pain associated with RA typically occurs in patients with anxiety, female sex, and elevated inflammatory status. Up to 50% of these patients are thought to have chronic pain despite appropriate inflammatory suppression, typically due to peripheral and central sensitization as well as secondary OA and FM. In addition to the standard-of-care management for OA and FM, patients with RA and chronic pain benefit from behavioral and psychological treatment options. Moreover, early and multimodal therapies, including non-pharmacological, pharmacological, interventional, and surgical strategies, exist, albeit with varying efficacy, to help suppress inflammation, provide necessary analgesia, and optimize functional outcomes. Overall, chronic pain in RA is a difficult entity for both patients and providers. Early diagnosis, improved understanding of its mechanisms, and initiation of early, targeted approaches to pain control may help to improve outcomes in this population.
Collapse
Affiliation(s)
- Kristen Mathias
- Department of Internal Medicine, University of Chicago, Chicago, IL, USA
| | - Abhimanyu Amarnani
- Department of Internal Medicine, Division of Rheumatology, Los Angeles County + University of Southern California (LAC + USC) and Keck Medicine of USC, Los Angeles, CA, USA
| | - Neha Pal
- Texas A&M School of Medicine, Bryan, TX, USA
| | - Jay Karri
- Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, TX, USA
| | - Daniel Arkfeld
- Department of Internal Medicine, Division of Rheumatology, Los Angeles County + University of Southern California (LAC + USC) and Keck Medicine of USC, Los Angeles, CA, USA
| | - Jonathan M Hagedorn
- Department of Anesthesiology and Perioperative Medicine, Division of Pain Medicine, Mayo Clinic, Rochester, MN, USA
| | - Alaa Abd-Elsayed
- Department of Anesthesia, Division of Pain Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.
| |
Collapse
|
32
|
Relationship between disease activity level and physical activity in rheumatoid arthritis using a triaxial accelerometer and self-reported questionnaire. BMC Res Notes 2021; 14:242. [PMID: 34176502 PMCID: PMC8237436 DOI: 10.1186/s13104-021-05666-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Accepted: 06/18/2021] [Indexed: 11/12/2022] Open
Abstract
Objective This study evaluated the relationship between rheumatoid arthritis (RA) disease activity level and physical activity (PA) by using an accelerometer and self-reported questionnaire. Results The cross-sectional study was part of a cohort study designed to determine disease activity is associated with PA in RA patients. We classified patients with a Disease Activity Score 28-erythrocyte sedimentation rate (DAS28-ESR) of less than and higher than 3.2 into the low-disease-activity (LDA) group and moderate/high-disease-activity (MHDA) group, respectively. We measured the wear time, time of vigorous-intensity PA, moderate-intensity PA, light-intensity PA, and sedentary behavior per day using a triaxial accelerometer. 34 patients were included in the study. The accelerometer-measured moderate-to-vigorous PA (MVPA) was 17.2 min/day and 10.6 min/day in the LDA group and MHDA group (p < 0.05), respectively. There was no significant association between RA disease activity level and accelerometer-measured PA with adjustment for age and Functional Assessment of Chronic Illness Therapy-Fatigue score. There was no correlation between accelerometer-measured MVPA and self-reported MVPA in the MHDA group, but these factors were correlated in the LDA group (rs = 0.57, p < 0.05). In conclusion, no significant association was noted between RA disease activity level and accelerometer-measured PA. Supplementary Information The online version contains supplementary material available at 10.1186/s13104-021-05666-w.
Collapse
|
33
|
Comparison of frailty associated factors between older adult patients with rheumatoid arthritis and community dwellers. Arch Gerontol Geriatr 2021; 96:104455. [PMID: 34126437 DOI: 10.1016/j.archger.2021.104455] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 05/19/2021] [Accepted: 05/31/2021] [Indexed: 11/22/2022]
Abstract
PURPOSE To determine whether frailty associated factors differ between community dwellers and older adult patients with rheumatoid arthritis (RA). METHODS We used the cross-sectional data for patients with RA from the RA epidemiological quality-of-life study (n = 210, mean age 71.8 ± 3.7 years) and community dwellers from the Japan Gerontological Evaluation Study (n = 53,255, mean age 71.7 ± 4.0 years). Frailty status was assessed using the Kihon Checklist (KCL), and the primary outcome was frailty (KCL score ≥8 points). Information on predictor variables, including age, sex, marital status, educational level, body mass index (BMI), drinking and smoking status and social participation were obtained from a standardized questionnaire. We employed Poisson regression to calculate the prevalence ratio (PR) of frailty according to its predictors. RESULTS We found frailty in 37.6% of the patients with RA and 15.7% of the community dwellers. In the multivariate models, BMI and social participation were independently associated with frailty in patients with RA (BMI <18.5: PR, 1.62; 95% confidence interval [CI] 1.09-2.41. BMI ≥25.0: PR, 1.81; 95% CI 1.20-2.71. Active social participation: PR, 0.61; 95% CI 0.42-0.87) and community dwellers (BMI <18.5: PR, 1.77; 95% CI 1.67-1.88. BMI ≥25.0: PR, 1.27; 95% CI 1.22-1.33. Active social participation: PR, 0.46; 95% CI 0.44-0.48). All other predictors were significantly associated with frailty in the community dwellers. CONCLUSION Maintaining appropriate body weight and participating in social activities are important for preventing frailty in patients with RA as well as community dwellers.
Collapse
|
34
|
Hartung W, Sewerin P, Ostendorf B. [Sports and exercise therapy in inflammatory rheumatic diseases]. Z Rheumatol 2021; 80:251-262. [PMID: 33686450 DOI: 10.1007/s00393-021-00970-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/03/2021] [Indexed: 12/15/2022]
Abstract
Physical therapy has always been a pillar of the treatment of inflammatory rheumatic diseases in addition to targeted drug treatment; nevertheless, it is only established in the treatment guidelines for a few diseases. Within the last two decades the discovery of myokines has uncovered the physiological correlations of the anti-inflammatory effect of physical activity. For rheumatoid arthritis and spondylarthritis, several randomized controlled trials provide sufficient evidence to make well-founded recommendations. For connective tissue diseases (CTD) the data situation is clearly sparser but nevertheless shows that the positive effects of physical activity prevail. In the following article the authors present the most important clinical studies on sport and inflammatory rheumatic diseases and from these derive possible therapeutic recommendations.
Collapse
Affiliation(s)
- Wolfgang Hartung
- Asklepios Klinik Bad Abbach, Kaiser-Karl-V.-Allee 3, 93077, Bad Abbach, Deutschland.
| | | | | |
Collapse
|
35
|
Beider S, Flohr S, Gehlert S, Witte T, Ernst D. [Association of physical activity with fatigue and functional capacity in patients with rheumatoid arthritis]. Z Rheumatol 2021; 80:113-121. [PMID: 32588130 PMCID: PMC8426241 DOI: 10.1007/s00393-020-00830-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
BACKGROUND Patients with rheumatoid arthritis (RA) tend to be less physically active. Physical activity has been shown to have a positive impact on disease activity and quality of life and is recommended by the European League Against Rheumatism (EULAR) as an integral component of standard treatment. OBJECTIVE A cross-sectional analysis of RA patients was carried out assessing disease activity, functional capacity and fatigue associated with physical activity. MATERIAL AND METHODS Physical activity, functional capacity and the global fatigue index (GFI) were examined using standardized questionnaires: the international physical activity questionnaire short form (IPAQ-SF), the functional questionnaire Hannover (FFbH) and the multidimensional assessment of fatigue (MAF). The data were evaluated using SPSS 26 (IBM, Armonk, NY, USA). The level of significance was tested with bivariate and partial correlations and nonparametric tests. RESULTS In total 164 patients were included in the study. The majority of the patients were female (127/164; 77%) and the median age of the cohort was 58.3 years (range 21-86 years). The median duration of disease-related symptoms at inclusion was 169 months (range 0-713 months). Physical activity was low in 39%, moderate in 37% and high in 24%. Patients reporting higher levels of physical activity reported significantly lower GFI (p < 0.001), functional limitations (p < 0.001) and disease activity (p = 0.045) scores than those with less physical activity. CONCLUSION Physical activity in RA patients was significantly correlated with functional capacity and levels of fatigue. In order to reduce the proportion of patients with low physical activity, the possibilities for functional training should be expanded and the patients should be encouraged to undertake sporting activities.
Collapse
Affiliation(s)
- S Beider
- Klinik für Rheumatologie und Immunologie, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Deutschland.
- Institut für Sportwissenschaft, Universität Hildesheim, Hildesheim, Deutschland.
| | - S Flohr
- Institut für Sportwissenschaft, Universität Hildesheim, Hildesheim, Deutschland
| | - S Gehlert
- Institut für Sportwissenschaft, Universität Hildesheim, Hildesheim, Deutschland
| | - T Witte
- Klinik für Rheumatologie und Immunologie, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Deutschland
| | - D Ernst
- Klinik für Rheumatologie und Immunologie, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Deutschland
| |
Collapse
|
36
|
Cardiovascular and musculoskeletal health disorders associate with greater decreases in physical capability in older women. BMC Musculoskelet Disord 2021; 22:192. [PMID: 33593350 PMCID: PMC7888167 DOI: 10.1186/s12891-021-04056-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 01/31/2021] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Good physical capability is an important part of healthy biological ageing. Several factors influencing physical capability have previously been reported. Long-term reports on physical capability and the onset of clinical disorders and chronic diseases are lacking. Decrease in physical capacity has been shown to increase mortality. This study focuses on the prevalence of chronic diseases. The primary objective of the study was to reveal the association between physical capability and morbidity. Secondary objectives included the validity of self-reported physical capability and the association between baseline physical capability and mortality. METHODS The OSTPRE (Kuopio Osteoporosis Risk Factor and Prevention Study) prospective cohort involved all women aged 47-56 years residing in the Kuopio Province, Finland in 1989. Follow-up questionnaires were mailed at five-year intervals. Physical capability questions were first presented in 1994. From these women, we included only completely physically capable subjects at our baseline, in 1994. Physical capability was evaluated with five scale self-reports at baseline and in 2014 as follows: completely physically capable, able to walk but not run, can walk up to 1000 m, can walk up to 100 m and temporarily severely incapable. The prevalences of selected chronic diseases, with a minimum prevalence of 10% in 2014, were compared with the change in self-reported physical capability. Additionally, associations between long-term mortality and baseline physical capability of the whole 1994 study population sample were examined with logistic regression. The correlation of self-reported physical capability with functional tests was studied cross-sectionally at the baseline for a random subsample. RESULTS Our study population consisted of 6219 Finnish women with a mean baseline age of 57.0 years. Self-reported physical capability showed statistically significant correlation with functional tests. Cardiovascular diseases and musculoskeletal disorders show the greatest correlation with decrease of physical capability. Prevalence of hypertension increased from 48.7% in the full physical capability group to 74.5% in the "able to walk up to 100 metres" group (p < 0.001). Rheumatoid arthritis showed a similar increase from 2.1 to 7.4% between these groups. Higher baseline body mass index (BMI) decreases long-term capability (P < 0.001). Women reporting full physical capability at baseline had a mortality rate of 15.1%, in comparison to 48.5% in women within the "able to walk up to 100 m" group (p = 0.357). Mortality increased steadily with worsening baseline physical capability. CONCLUSIONS The results of this study show that chronic diseases, particularly cardiovascular and musculoskeletal disorders, correlate with faster degradation of physical capability in the elderly. Similar results are shown for increase in BMI. We also demonstrate that the risk of mortality over a 20-year period is higher in individuals with poor baseline physical capability.
Collapse
|
37
|
Hörnberg K, Pomeroy J, Sandberg C, Ångström L, Södergren A, Sundström B. Isotemporal Substitution of Time Between Sleep and Physical Activity: Associations With Cardiovascular Risk Factors in Early Rheumatoid Arthritis. ACR Open Rheumatol 2021; 3:138-146. [PMID: 33570840 PMCID: PMC7966882 DOI: 10.1002/acr2.11225] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Accepted: 12/31/2020] [Indexed: 11/07/2022] Open
Abstract
OBJECTIVE We aimed to determine relationships between objectively measured nightly sleep, sedentary behavior (SB), light physical activity (LPA), and moderate to vigorous physical activity (MVPA) with risk factors for cardiovascular disease (CVD) in patients with early rheumatoid arthritis (RA). Furthermore, we aimed to estimate consequences for these risk factors of theoretical displacements of 30 minutes per day in one behavior with the same duration of time in another. METHODS This cross-sectional study included 78 patients with early RA. Nightly sleep, SB, LPA, and MVPA were assessed by a combined heart rate and accelerometer monitor. Associations with risk factors for CVD were analyzed using linear regression models and consequences of reallocating time between the behaviors by isotemporal substitution modeling. RESULTS Median (Q1-Q3) nightly sleep duration was 4.6 (3.6-5.8) hours. Adjusted for monitor wear time, age, and sex, 30-minutes-longer sleep duration was associated with favorable changes in the values β (95% confidence interval [CI]) for waist circumference by -2.2 (-3.5, -0.9) cm, body mass index (BMI) by -0.9 (-1.4, -0.4) kg/m2 , body fat by -1.5 (-2.3, -0.8)%, fat-free mass by 1.6 (0.8, 2.3)%, sleeping heart rate by -0.8 (-1.5, -0.1) beats per minute, and systolic blood pressure by -2.5 (-4.0, -1.0) mm Hg. Thirty-minute decreases in SB, LPA, or MVPA replaced with increased sleep was associated with decreased android fat and lower systolic blood pressure levels. Replacement of SB or LPA with MVPA yielded lower BMIs. CONCLUSION Shorter sleep during the night is common among patients with early RA and is associated with adverse risk factors for CVD.
Collapse
Affiliation(s)
| | - Jeremy Pomeroy
- Marshfield Clinic Research Institute, Marshfield, Wisconsin
| | | | | | | | | |
Collapse
|
38
|
Ren Y, Yang Q, Luo T, Lin J, Jin J, Qian W, Weng X, Feng B. Better clinical outcome of total knee arthroplasty for rheumatoid arthritis with perioperative glucocorticoids and disease-modifying anti-rheumatic drugs after an average of 11.4-year follow-up. J Orthop Surg Res 2021; 16:84. [PMID: 33504345 PMCID: PMC7839203 DOI: 10.1186/s13018-021-02232-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2020] [Accepted: 01/14/2021] [Indexed: 12/17/2022] Open
Abstract
Background Previous evidence suggested that perioperative anti-rheumatic therapy for patients receiving total knee arthroplasty (TKA) helped improve postoperative rehabilitation for rheumatoid arthritis (RA), yet long-term effects and outcomes of perioperative drug therapy in TKA presently remain unclear. This study investigated whether perioperative treatment with glucocorticoids (GC) and disease-modifying anti-rheumatic drugs (DMARDs) can improve clinical outcomes for patients with RA undergoing TKA. Methods Patients between January 2000 and December 2011 were allocated into three groups based on perioperative drug therapy: A, control group (no GC or DMARDs), B, DMARD group (DMARDs given without GC), and C, co-therapy group (DMARDs plus GC). The patients were followed up for average 11.4 years. Baseline characteristics, pre- and post-operative Hospital for Special Surgery score (HSS), laboratory parameters, and complications were recorded by follow-up. Results Fifty-six RA patients undergoing 91 TKAs were included in this study. Patients who received perioperative GC with DMARDs (group C) achieved larger/increased range of motion (ROM) (C:122.17 vs A:108.31 vs B:108.07, p = 0.001, partial eta squared (η2 p) = 0.18) at 1 year, better HSS score (C, 83.01 vs A, 79.23 vs B, 77.35, p = 0.049, η2 p = 0.067), pain relief (C, 1.09 vs A, 1.17 vs B, 1.75, p = 0.02, η2 p = 0.094), and ROM (C, 130.81 vs A, 112.82 vs B, 113.58, p = 0.001, η2p = 0.142) at latest follow-up comparing with the other treatment groups. No differences were noted in laboratory tests, blood loss, volume of transfusion, or complications among groups. Conclusions Compared with the other perioperative anti-rheumatic treatments, the combination of GC and DMARDs results in improved HSS score, better function, larger range of motion, and reduced postoperative pain for TKA patients with RA in the long term. Further investigation is warranted to look for a better understanding of more specific medication effects and strike a good balance between the benefits and complications for long-term pharmacotherapy.
Collapse
Affiliation(s)
- Yi Ren
- Department of Orthopedic Surgery, Peking Union Medical College Hospital, Peking Union Medical College, Beijing, 100730, China
| | - Qi Yang
- Department of Orthopedic Surgery, Peking Union Medical College Hospital, Peking Union Medical College, Beijing, 100730, China.,Department of Orthopedics, First Hospital of Harbin, Harbin, China
| | - Tim Luo
- Doctor of Medicine Program, University of Alberta, Edmonton, AB, Canada
| | - Jin Lin
- Department of Orthopedic Surgery, Peking Union Medical College Hospital, Peking Union Medical College, Beijing, 100730, China
| | - Jin Jin
- Department of Orthopedic Surgery, Peking Union Medical College Hospital, Peking Union Medical College, Beijing, 100730, China
| | - Wenwei Qian
- Department of Orthopedic Surgery, Peking Union Medical College Hospital, Peking Union Medical College, Beijing, 100730, China
| | - Xisheng Weng
- Department of Orthopedic Surgery, Peking Union Medical College Hospital, Peking Union Medical College, Beijing, 100730, China
| | - Bin Feng
- Department of Orthopedic Surgery, Peking Union Medical College Hospital, Peking Union Medical College, Beijing, 100730, China.
| |
Collapse
|
39
|
O’Brien CM, Ntoumanis N, Duda JL, Kitas GD, Veldhuijzen van Zanten JJCS, Metsios GS, Fenton SAM. Pain and fatigue are longitudinally and bi-directionally associated with more sedentary time and less standing time in rheumatoid arthritis. Rheumatology (Oxford) 2021; 60:4548-4557. [PMID: 33493311 PMCID: PMC8487306 DOI: 10.1093/rheumatology/keab029] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 01/04/2021] [Indexed: 02/02/2023] Open
Abstract
OBJECTIVES The aims of this study were to examine the longitudinal and bi-directional associations of pain and fatigue with sedentary, standing and stepping time in RA. METHODS People living with RA undertook identical assessments at baseline (T1, n = 104) and 6-month follow-up (T2, n = 54). Participants completed physical measures (e.g. height, weight, BMI) and routine clinical assessments to characterize RA disease activity (DAS-28). Participants also completed questionnaires to assess physical function (HAQ), pain (McGill Pain Questionnaire) and fatigue (Multidimensional Assessment of Fatigue Scale). Participants' free-living sedentary, standing and stepping time (min/day) were assessed over 7 days using the activPAL3µ™. For the statistical analysis, hierarchical regression analysis was employed to inform the construction of path models, which were subsequently used to examine bi-directional associations of pain and fatigue with sedentary, standing and stepping time. Specifically, where significant associations were observed in longitudinal regression analysis, the bi-directionality of these associations was further investigated via path analysis. For regression analysis, bootstrapping was applied to regression models to account for non-normally distributed data, with significance confirmed using 95% CIs. Where variables were normally distributed, parametric, non-bootstrapped statistics were also examined (significance confirmed via β coefficients, with P < 0.05) to ensure all plausible bi-directional associations were examined in path analysis. RESULTS Longitudinal bootstrapped regression analysis indicated that from T1 to T2, change in pain, but not fatigue, was positively associated with change in sedentary time. In addition, change in pain and fatigue were negatively related to change in standing time. Longitudinal non-bootstrapped regression analysis demonstrated a significant positive association between change in fatigue with change in sedentary time. Path analysis supported the hypothesized bi-directionality of associations between change in pain and fatigue with change in sedentary time (pain, β = 0.38; fatigue, β = 0.44) and standing time (pain, β = -0.39; fatigue, β = -0.50). CONCLUSION Findings suggest pain and fatigue are longitudinally and bi-directionally associated with sedentary and standing time in RA.
Collapse
Affiliation(s)
- Ciara M O’Brien
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham,Department of Rheumatology, Russells Hall Hospital, Dudley Group NHS Foundation Trust, West Midlands,Medical Research Council Versus Arthritis Centre for Musculoskeletal Ageing Research, University of Birmingham, Birmingham, UK
| | - Nikos Ntoumanis
- School of Psychology, Faculty of Health Sciences, Curtin University, Perth, Western Australia
| | - Joan L Duda
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham
| | - George D Kitas
- Department of Rheumatology, Russells Hall Hospital, Dudley Group NHS Foundation Trust, West Midlands
| | - Jet J C S Veldhuijzen van Zanten
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham,Department of Rheumatology, Russells Hall Hospital, Dudley Group NHS Foundation Trust, West Midlands,Medical Research Council Versus Arthritis Centre for Musculoskeletal Ageing Research, University of Birmingham, Birmingham, UK
| | - George S Metsios
- Department of Rheumatology, Russells Hall Hospital, Dudley Group NHS Foundation Trust, West Midlands,Faculty of Education, Health and Wellbeing, University of Wolverhampton, Wolverhampton, UK
| | - Sally A M Fenton
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham,Department of Rheumatology, Russells Hall Hospital, Dudley Group NHS Foundation Trust, West Midlands,Medical Research Council Versus Arthritis Centre for Musculoskeletal Ageing Research, University of Birmingham, Birmingham, UK,Correspondence to: Sally A. M. Fenton, School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK. E-mail:
| |
Collapse
|
40
|
Mal K, Kumar R, Mansoor F, Kaur N, Kumar A, Memon S, Rizwan A. Risk of Major Adverse Cardiovascular Events in Patients With Rheumatoid Arthritis. Cureus 2020; 12:e12246. [PMID: 33505813 PMCID: PMC7823064 DOI: 10.7759/cureus.12246] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Introduction Rheumatoid arthritis is a chronic, inflammatory, and multisystem disease, which, along with the joints, can involve the cardiovascular system. The treatment of rheumatoid arthritis or rheumatoid arthritis itself can lead to atherosclerosis, which is considered one of the major causes by which it can affect the cardiovascular system. In this study, we will assess the risk of cardiovascular events in patients with rheumatoid arthritis as compared to the general population. Method This case-control study was conducted from January 2018 to November 2018. Two-hundred twenty-two (222) patients with diagnosed rheumatoid arthritis were included as cases in the study. Two-hundred eleven (211) patients were included in the study as the control group (patients without rheumatoid arthritis). All the data were recorded in a self-structured questionnaire. Result Participants with rheumatoid arthritis also showed an increased risk of myocardial infarction (MI) by an odds ratio of 2.50 (95% CI; 0.77-8.14). There was also an increased risk of cardiovascular death in participants with rheumatoid arthritis by an odds ratio of 1.99 (0.58-6.71). Conclusion The study suggests that rheumatoid arthritis along with joint inflammation can also affect the cardiovascular system. Hence, a multidisciplinary team of rheumatologists and cardiologists should manage patients suffering from rheumatoid arthritis, which will improve morbidity and mortality in such patients.
Collapse
Affiliation(s)
- Kheraj Mal
- Cardiology, National Institute of Cardiovascular Diseases, Sukkur, PAK
| | - Ratan Kumar
- Cardiology, Khairpur Medical College, Nawabshah, PAK
| | - Farah Mansoor
- Internal Medicine, Jinnah Sindh Medical University, Karachi, PAK
| | - Navneet Kaur
- Internal Medicine, Adesh Institute of Medical Sciences and Research, Buchu Kalan, IND
| | - Anil Kumar
- Cardiology, National Institute of Cardiovascular Diseases, Sukkur, PAK
| | - Sidra Memon
- Internal Medicine, Jinnah Sindh Medical University, Karachi, PAK
| | - Amber Rizwan
- Family Medicine, Jinnah Post Graduate Medical Center, Karachi, PAK
| |
Collapse
|
41
|
Hu H, Xu A, Gao C, Wang Z, Wu X. The effect of physical exercise on rheumatoid arthritis: An overview of systematic reviews and meta-analysis. J Adv Nurs 2020; 77:506-522. [PMID: 33176012 DOI: 10.1111/jan.14574] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 07/24/2020] [Accepted: 08/07/2020] [Indexed: 11/29/2022]
Abstract
AIMS To determine which outcomes will be improved by different exercise interventions and the evidence quality for each intervention. DESIGN Overview of systematic reviews and meta-analysis. DATA SOURCES PubMed, Cochrane, Web of Science, CINAHL, and Embase. Published from the establishment of the database to 3 September 2019. REVIEW METHODS AMSTAR 2 and PRISMA were used to evaluate methodological and reporting quality. Evidence quality of the effect of each intervention was assessed according to GRADE guidelines. Meta-analysis of original studies was conducted for comparison of systematic reviews and to explore the effect of different exercise interventions on the same outcome. RESULTS Ten systematic reviews were included in the overview. A significant improvement was seen in: aerobic exercise for aerobic capacity; strength training for erythrocyte sedimentation rate and 50-foot walking time; aerobic exercise combined with strength training for aerobic capacity, physical function, and fatigue; hand exercise for hand function. CONCLUSIONS For the maximum benefit of rheumatoid arthritis (RA) patients, different exercise methods should be selected according to the symptoms. For RA patients, any exercise is better than no exercise, but the intensity, frequency, and period of exercise for better results are not determined. IMPACT What problem did the study address is which outcomes will be improved by different exercise interventions. For maximum benefit for RA patients, different exercise methods should be selected according to symptoms. The research summarized the evidence of exercise rehabilitation of RA and will help RA patients or their caregivers choose the appropriate type of exercise, which will play a positive role on the rehabilitation of patients with RA.
Collapse
Affiliation(s)
- Huiling Hu
- School of Nursing, Peking University, Beijing, P.R. China
| | - Anqi Xu
- School of Nursing, Peking University, Beijing, P.R. China
| | - Chao Gao
- Department of Rheumatology and Immunology, The People's Hospital of Peking University, Beijing, P.R. China
| | - Zhenqing Wang
- Department of Rheumatology and Immunology, Peking University Third Hospital, Beijing, P.R. China
| | - Xue Wu
- School of Nursing, Peking University, Beijing, P.R. China.,Health Science Centre for Evidence-Based Nursing: A Joanna Briggs Institute Centre of Excellence, Peking University, Beijing, P.R. China
| |
Collapse
|
42
|
Seppen BF, den Boer P, Wiegel J, Ter Wee MM, van der Leeden M, de Vries R, van der Esch M, Bos WH. Asynchronous mHealth Interventions in Rheumatoid Arthritis: Systematic Scoping Review. JMIR Mhealth Uhealth 2020; 8:e19260. [PMID: 33151161 PMCID: PMC7677027 DOI: 10.2196/19260] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Revised: 08/18/2020] [Accepted: 08/21/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Mobile devices such as smartphones and tablets have surged in popularity in recent years, generating numerous possibilities for their use in health care as mobile health (mHealth) tools. One advantage of mHealth is that it can be provided asynchronously, signifying that health care providers and patients are not communicating in real time. The integration of asynchronous mHealth into daily clinical practice might therefore help to make health care more efficient for patients with rheumatoid arthritis (RA). The benefits have been reviewed in various medical conditions, such as diabetes and asthma, with promising results. However, to date, it is unclear what evidence exists for the use of asynchronous mHealth in the field of RA. OBJECTIVE The objective of this study was to map the different asynchronous mHealth interventions tested in clinical trials in patients with RA and to summarize the effects of the interventions. METHODS A systematic search of Pubmed, Scopus, Cochrane, and PsycINFO was performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. Studies were initially screened and later assessed by two independent researchers. Disagreements on inclusion or exclusion of studies were resolved by discussion. RESULTS The literature search yielded 1752 abstracts. After deduplication and screening, 10 controlled intervention studies were included. All studies were assessed to be at risk for bias in at least one domain of the Cochrane risk-of-bias tool. In the 10 selected studies, 4 different types of mHealth interventions were used: SMS reminders (to increase medication adherence or physical activity; n=3), web apps (for disease monitoring and/or to provide medical information; n=5), smartphone apps (for disease monitoring; n=1), and pedometers (to increase and track steps; n=1). Measured outcomes varied widely between studies; improvements were seen in terms of medication compliance (SMS reminders), reaching rapid remission (web app), various domains of physical activity (pedometer, SMS reminders, and web apps), patient-physician interaction (web apps), and self-efficacy (smartphone app). CONCLUSIONS SMS reminders, web apps, smartphone apps, and pedometers have been evaluated in intervention studies in patients with RA. These interventions have been used to monitor patients or to support them in their health behavior. The use of asynchronous mHealth led to desirable outcomes in nearly all studies. However, since all studies were at risk of bias and methods used were very heterogeneous, high-quality research is warranted to corroborate these promising results.
Collapse
Affiliation(s)
- Bart F Seppen
- Amsterdam Rheumatology and Immunology Center, Reade, Amsterdam, Netherlands
| | - Pim den Boer
- Amsterdam Rheumatology and Immunology Center, Reade, Amsterdam, Netherlands
| | - Jimmy Wiegel
- Amsterdam Rheumatology and Immunology Center, Reade, Amsterdam, Netherlands.,Department of Rheumatology, VU Medical Center, Amsterdam UMC, Amsterdam, Netherlands
| | - Marieke M Ter Wee
- Department of Rheumatology, VU Medical Center, Amsterdam UMC, Amsterdam, Netherlands.,Department of Epidemiology and Biostatistics, Amsterdam Public Health, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, Netherlands
| | - Marike van der Leeden
- Amsterdam Rheumatology and Immunology Center, Reade, Amsterdam, Netherlands.,Department of Rehabilitation Medicine, VU Medical Center, Amsterdam UMC, Amsterdam, Netherlands
| | - Ralph de Vries
- Medical Library, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Martin van der Esch
- Amsterdam Rheumatology and Immunology Center, Reade, Amsterdam, Netherlands.,Department of Rehabilitation Medicine, VU Medical Center, Amsterdam UMC, Amsterdam, Netherlands
| | - Wouter H Bos
- Amsterdam Rheumatology and Immunology Center, Reade, Amsterdam, Netherlands
| |
Collapse
|
43
|
Twelve Weeks of Strengthening Exercise for Patients with Rheumatoid Arthritis: A Prospective Intervention Study. J Clin Med 2020; 9:jcm9092792. [PMID: 32872481 PMCID: PMC7564491 DOI: 10.3390/jcm9092792] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 08/22/2020] [Accepted: 08/26/2020] [Indexed: 12/25/2022] Open
Abstract
Rheumatoid arthritis (RA) patients may benefit from exercise for several reasons. However, whole-limb strengthening exercises for such patients remain poorly studied. We hypothesized that systemic strength training that includes the upper and lower extremities would improve strength per se and enhance the quality of life. Here, we investigated the effects of 12 weeks of upper- and lower-limb strengthening exercise on the strength and quality of life of RA patients using the International Classification of Functioning, Disability, and Health model. This was a prospective, interventional controlled trial. Forty female RA patients were recruited and assigned to two groups not based on willingness to exercise, with 20 patients in the exercise group and 20 in the control group. All patients in the exercise group received once-weekly training sessions of 60 min over 12 weeks. All participants were assessed before and after the 12-week intervention period. We measured the hand grip strength and isometric quadriceps contraction, the cross-sectional area of the rectus femoris (CSA-RF) (via ultrasonography), and performed the 30 s sit-to-stand test and the 6 min walk test (6MWT). We derived the Borg scale score after the 6MWT and assessed the extent of social participation and quality of life using a Korean version of the 36-Item Short Form Health Survey (SF-36). A total of 35 subjects completed the experiment (18 in the exercise group, 17 in the control group). After the 12-week intervention period, the lower-limb strength and the CSA-RF were significantly increased in the exercise group. The activity level did not change significantly in either group. The exercise group exhibited significant improvements in the SF-36 mental health domain scores. Thus, strengthening exercise is useful for patients with RA.
Collapse
|
44
|
Physical Exercise as an Immunomodulator of Chronic Diseases in Aging. J Phys Act Health 2020; 17:662-672. [PMID: 32396868 DOI: 10.1123/jpah.2019-0237] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Revised: 02/24/2020] [Accepted: 03/20/2020] [Indexed: 11/18/2022]
Abstract
BACKGROUND The progressive dysfunction of the immune system during aging appears to be involved in the pathogenesis of several age-related disorders. However, regular physical exercise can present "antiaging" effects on several physiological systems. METHODS A narrative review of studies investigating the chronic effects of exercise and physical activity on the immune system and its association with age-related chronic diseases was carried out according to the guidelines for writing a narrative review. RESULTS There is compelling evidence suggesting that age-related immune system alterations play a key role on the pathophysiology of atherosclerosis, hypertension, chronic heart failure, type 2 diabetes, obesity, arthritis, and chronic obstructive pulmonary disease. On the other hand, the regular practice of physical activity appears to improve most of the inflammatory/immunological processes involved in these diseases. CONCLUSION Epidemiological, experimental, and clinical studies permit us to affirm that regular physical activity improves immunomodulation and may play a key role in the prevention and treatment of several age-related chronic diseases. However, further studies are needed to better describe the prophylactic and therapeutic effects of physical exercise in specific organs of older individuals, as well as the mechanisms involved in such response.
Collapse
|
45
|
Versloot O, Timmer MA, de Kleijn P, Schuuring M, van Koppenhagen CF, van der Net J, Fischer K. Sports participation and sports injuries in Dutch boys with haemophilia. Scand J Med Sci Sports 2020; 30:1256-1264. [PMID: 32246553 PMCID: PMC7317861 DOI: 10.1111/sms.13666] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Revised: 02/26/2020] [Accepted: 03/24/2020] [Indexed: 12/23/2022]
Abstract
INTRODUCTION Sports participation in children with hemophilia is generally considered to be associated with increased injury risk, which is generally considered highest in severe hemophilia. AIM To assess sports participation according to age and severity in children with hemophilia and its association with sports injuries. METHODS In a retrospective single-center study, sports participation, injuries, and bleeding data from three consecutive annual clinic visits were collected for young patients with hemophilia (PWH, aged 6-18). Sports in categories 2.5 and 3 of 3 according to the National Hemophilia Foundation classification were considered high-risk. Groups were compared using chi-square testing. RESULTS 105 PWH (median age: 13(IQR 10-14); 53% severe; bleeding rate: 1/y) were identified; three were unable to perform sports and were excluded. The majority of PWH (77%) played sports weekly, of which 80% high-risk sports. Sports participation (median 3.0x/wk), and the proportion of injured PWH was similar in severe (42%) and non-severe (33%) PWH. Sports injuries were rare (65% no injuries in 3 years, median 0/y (IQR 0-1)). Annually, PWH did not report more injuries (15%) than age-matched boys (28%). Sports injuries were not associated with frequency and type of sports. DISCUSSION This retrospective study showed high sports participation (including high-risk sports) and low injury rates. Sports participation was similar across severities and injury rates were not higher than among the general population. Injuries were not associated with frequency or type of sports. A prospective study with objective assessment of sports participation and injuries is warranted to confirm these findings and avoid recall bias.
Collapse
Affiliation(s)
- Olav Versloot
- Van Creveldkliniek, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Merel A Timmer
- Van Creveldkliniek, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Piet de Kleijn
- Van Creveldkliniek, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Marleen Schuuring
- Center for Child Development, Exercise and Physical Literacy, University Children's Hospital, University Medical Center, Utrecht, The Netherlands
| | | | - Janjaap van der Net
- Center for Child Development, Exercise and Physical Literacy, University Children's Hospital, University Medical Center, Utrecht, The Netherlands
| | - Kathelijn Fischer
- Van Creveldkliniek, University Medical Center Utrecht, Utrecht, The Netherlands
| |
Collapse
|
46
|
Paredes-Arturo Y, Aguirre-Acevedo D, Martínez Torres J. Síndrome de fragilidad y factores asociados en adulto mayor indígena de Nariño, Colombia. Semergen 2020; 46:153-160. [DOI: 10.1016/j.semerg.2019.06.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2019] [Revised: 06/20/2019] [Accepted: 06/23/2019] [Indexed: 11/28/2022]
|
47
|
Liphardt AM, Windahl SH, Sehic E, Hannemann N, Gustafsson KL, Bozec A, Schett G, Engdahl C. Changes in mechanical loading affect arthritis-induced bone loss in mice. Bone 2020; 131:115149. [PMID: 31715339 DOI: 10.1016/j.bone.2019.115149] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Revised: 11/04/2019] [Accepted: 11/06/2019] [Indexed: 12/15/2022]
Abstract
Arthritis induces bone loss by inflammation-mediated disturbance of bone homeostasis. On the other hand, pain and impaired locomotion are highly prevalent in arthritis and result in reduced general physical activity and less pronounced mechanical loading. Bone is affected by mechanical loading, directly through impact with the ground during movement and indirectly through muscular activity. Mechanical loading in its physiological range is essential for maintaining bone mass, whereas disuse leads to bone loss. The aim of this study was to investigate the impact of mechanical loading on periarticular bone as well as inflammation during arthritis. Mechanical loading was either blocked by botulinum neurotoxin A (Botox) injections before induction of arthritis, or enhanced by cyclic compressive loading, three times per week during arthritis induction. Arthritis was verified and evaluated histologically. Trabecular and cortical bone mass were investigated using micro-computed tomography (μCT), subchondral osteoclastogenesis and bone turnover was assessed by standard methods. Inhibition of mechanical loading enhanced arthritis-induced bone loss while it did not affect inflammation. In contrast, enhanced mechanical loading mitigated arthritis-induced bone loss. Furthermore, the increase in bone resorption markers by arthritis was partly blocked by mechanical loading. In conclusion, enhanced arthritic bone loss after abrogation of mechanical loading suggests that muscle forces play an essential role in preventing arthritic bone loss. In accordance, mechanical loading of the arthritic joints inhibited bone loss, emphasizing that weight bearing activities may have the potential to counteract arthritis-mediated bone loss.
Collapse
Affiliation(s)
- Anna-Maria Liphardt
- Friedrich-Alexander-University Erlangen-Nuremberg (FAU), Department of Internal Medicine 3 -Rheumatology & Immunology, University Hospital Erlangen, Erlangen, Germany; German Sport University Cologne (DSHS Köln), Institute of Biomechanics and Orthopedics, Köln, Germany
| | - Sara H Windahl
- Centre for Bone and Arthritis Research, Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Department of Laboratory Medicine, Division of Pathology, Karolinska Institutet, Karolinska University Hospital, Huddinge, Sweden
| | - Edina Sehic
- Centre for Bone and Arthritis Research, Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Centre for Bone and Arthritis Research, Department of Rheumatology and Inflammation Research, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Nicole Hannemann
- Friedrich-Alexander-University Erlangen-Nuremberg (FAU), Department of Internal Medicine 3 -Rheumatology & Immunology, University Hospital Erlangen, Erlangen, Germany
| | - Karin L Gustafsson
- Centre for Bone and Arthritis Research, Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Aline Bozec
- Friedrich-Alexander-University Erlangen-Nuremberg (FAU), Department of Internal Medicine 3 -Rheumatology & Immunology, University Hospital Erlangen, Erlangen, Germany
| | - Georg Schett
- Friedrich-Alexander-University Erlangen-Nuremberg (FAU), Department of Internal Medicine 3 -Rheumatology & Immunology, University Hospital Erlangen, Erlangen, Germany
| | - Cecilia Engdahl
- Friedrich-Alexander-University Erlangen-Nuremberg (FAU), Department of Internal Medicine 3 -Rheumatology & Immunology, University Hospital Erlangen, Erlangen, Germany; Centre for Bone and Arthritis Research, Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Centre for Bone and Arthritis Research, Department of Rheumatology and Inflammation Research, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
| |
Collapse
|
48
|
Measurement of sedentary time and physical activity in rheumatoid arthritis: an ActiGraph and activPAL™ validation study. Rheumatol Int 2020; 40:1509-1518. [PMID: 32472303 PMCID: PMC7371657 DOI: 10.1007/s00296-020-04608-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Accepted: 05/16/2020] [Indexed: 02/02/2023]
Abstract
Accurate measurement of sedentary time and physical activity (PA) is essential to establish their relationships with rheumatoid arthritis (RA) outcomes. Study objectives were to: (1) validate the GT3X+ and activPAL3μ™, and develop RA-specific accelerometer (count-based) cut-points for measuring sedentary time, light-intensity PA and moderate-intensity PA (laboratory-validation); (2) determine the accuracy of the RA-specific (vs. non-RA) cut-points, for estimating free-living sedentary time in RA (field-validation). Laboratory-validation: RA patients (n = 22) were fitted with a GT3X+, activPAL3μ™ and indirect calorimeter. Whilst being video-recorded, participants undertook 11 activities, comprising sedentary, light-intensity and moderate-intensity behaviours. Criterion standards for devices were indirect calorimetry (GT3X+) and direct observation (activPAL3μ™). Field-validation: RA patients (n = 100) wore a GT3X+ and activPAL3μ™ for 7 days. The criterion standard for sedentary time cut-points (RA-specific vs. non-RA) was the activPAL3μ™. Results of the laboratory-validation: GT3X-receiver operating characteristic curves generated RA-specific cut-points (counts/min) for: sedentary time = ≤ 244; light-intensity PA = 245-2501; moderate-intensity PA ≥ 2502 (all sensitivity ≥ 0.87 and 1-specificity ≤ 0.11). ActivPAL3μ™-Bland-Altman 95% limits of agreement (lower-upper [min]) were: sedentary = (- 0.1 to 0.2); standing = (- 0.7 to 1.1); stepping = (- 1.2 to 0.6). Results of the field-validation: compared to the activPAL3μ™, Bland-Altman 95% limits of agreement (lower-upper) for sedentary time (min/day) estimated by the RA-specific cut-point = (- 42.6 to 318.0) vs. the non-RA cut-point = (- 19.6 to 432.0). In conclusion, the activPAL3μ™ accurately quantifies sedentary, standing and stepping time in RA. The RA-specific cut-points offer a validated measure of sedentary time, light-intensity PA and moderate-intensity PA in these patients, and demonstrated superior accuracy for estimating free-living sedentary time, compared to non-RA cut-points.
Collapse
|
49
|
Hörnberg K, Pomeroy J, Sandberg C, Södergren A, Ångström L, Sundström B, Wållberg Jonsson S. Physical activity in rheumatoid arthritis: relationship to cardiovascular risk factors, subclinical atherosclerosis, and disease activity. Scand J Rheumatol 2019; 49:112-121. [DOI: 10.1080/03009742.2019.1657491] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Affiliation(s)
- K Hörnberg
- Department of Public Health and Clinical Medicine, University of Umeå, Umeå, Sweden
| | - J Pomeroy
- Clinical Research Center, Marshfield Clinic Research Institute, Marshfield Clinic Health System, Marshfield, WI, USA
| | - C Sandberg
- Department of Public Health and Clinical Medicine, University of Umeå, Umeå, Sweden
| | - A Södergren
- Department of Public Health and Clinical Medicine, University of Umeå, Umeå, Sweden
| | - L Ångström
- Department of Public Health and Clinical Medicine, University of Umeå, Umeå, Sweden
| | - B Sundström
- Department of Public Health and Clinical Medicine, University of Umeå, Umeå, Sweden
| | - S Wållberg Jonsson
- Department of Public Health and Clinical Medicine, University of Umeå, Umeå, Sweden
| |
Collapse
|
50
|
Hammam N, Ezeugwu VE, Rumsey DG, Manns PJ, Pritchard-Wiart L. Physical activity, sedentary behavior, and long-term cardiovascular risk in individuals with rheumatoid arthritis. PHYSICIAN SPORTSMED 2019; 47:463-470. [PMID: 31122104 DOI: 10.1080/00913847.2019.1623995] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Objective: Individuals with rheumatoid arthritis (RA) have increased risk of cardiovascular disease (CVD). Lifestyle factors such as prolonged sedentary behavior (SB) and reduced physical activity (PA) may heighten the risk of CVD. The objective of the study was to investigate the role of SB and PA as predictors for long-term CVD risk in RA patients.Methods: A subsample of 273 people diagnosed with RA was extracted from the 2003-2006 National Health and Nutrition Examination Survey and included in this cross-sectional study. Valid accelerometry data were categorized into sedentary behavior, very light, light, and moderate-to-vigorous physical activity. Functional limitations were assessed using a physical function questionnaire. The Framingham risk score (FRS) was used to calculate 10-year CVD risk. Regression models were used to examine the relationships between SB, PA, and 10-year CVD risk while controlling for potential confounders.Results: Participants spent an average of 9 h/day sedentary, 4 h in very light PA, 1 h in light PA, and 0.4 h in moderate-to-vigorous PA. Greater sedentary time was associated with higher 10-year CVD risk (p= 0.019). Increased daily PA, at all intensities, was inversely associated with 10-year CVD risk (p< 0.01). In the fully adjusted regression model, associations between 10-year CVD risk and SB (β = 0.31, R2 = 0.27, p< 0.01), very light PA (β = -0.19, R2 = 0.26, p< 0.01), light PA (β = -0.16, R2 = 0.25, p< 0.01), and moderate-to-vigorous PA (β = -0.15, R2 = 0.25, p< 0.01) remained significant.Conclusions: Strategies for decreasing SB and increasing PA should be explored with individuals with RA in order to decrease long-term CVD risk.
Collapse
Affiliation(s)
- Nevin Hammam
- Department of Physical Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB, Canada.,Department of Rheumatology and Rehabilitation, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Victor E Ezeugwu
- Department of Physical Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB, Canada
| | - Dax G Rumsey
- Department of Pediatrics, Stollery Children's Hospital, University of Alberta, Edmonton, AB, Canada
| | - Patricia J Manns
- Department of Physical Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB, Canada
| | - Lesley Pritchard-Wiart
- Department of Physical Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB, Canada
| |
Collapse
|