1
|
Leerling AT, Niesters M, Flendrie M, Tel M, Appelman-Dijkstra NM, Dekkers OM, Winter EM. Neuropathic and Nociplastic Pain Profiles are Common in Adult Chronic Nonbacterial Osteitis (CNO). Calcif Tissue Int 2024; 114:603-613. [PMID: 38627292 PMCID: PMC11090977 DOI: 10.1007/s00223-024-01214-3] [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: 01/22/2024] [Accepted: 03/28/2024] [Indexed: 05/14/2024]
Abstract
Chronic nonbacterial osteitis (CNO) is a rare musculoskeletal disease causing chronic bone pain. It is known that chronic musculoskeletal pain may involve other mechanisms than nociceptive pain only. We investigate the prevalence of neuropathic and nociplastic pain in adult CNO and their association with clinical characteristics and treatment outcomes. Survey study among the Dutch adult CNO cohort (n = 84/195 participated), including PAIN-detect for neuropathic pain, and the Central Sensitization Inventory (CSI), Fibromyalgia Rapid Screening Tool (FiRST), and ACTTION-APS Pain Taxonomy (AAPT) for nociplastic pain. Clinical characteristics and CNO-related bone pain scores were compared between patients with exclusive nociceptive pain and those with nociceptive pain plus neuropathic and/or nociplastic pain (mixed pain). 31% (95% CI 21-41) of patients classified as likely having neuropathic pain according to PAIN-detect. 53% (41-64) of patients displayed central sensitization on CSI, 61% (50-72) screened positive for fibromyalgia on FiRST and 14% (7-23) of patients fulfilled the AAPT criteria, all indicative of nociplastic pain. Mixed pain was associated with longer diagnostic delay (mean difference 2.8 years, 95% CI 0.4-5.2, p = 0.023), lower educational level (72% versus 20%, p < 0.001), and opioid use (37% versus 13%, p = 0.036). Despite comparable disease severity and extent, patients with mixed pain reported significantly higher CNO-related bone pain scores. This study demonstrates the high prevalence of mixed pain in adult CNO, in which neuropathic and nociplastic pain exist alongside nociceptive inflammatory bone pain. Disease burden in CNO may extend beyond inflammatory activity, highlighting the need for a multifaceted management approach.
Collapse
Affiliation(s)
- Anne T Leerling
- Division of Endocrinology, Department of Internal Medicine, Leiden University Medical Center, Leiden, The Netherlands
- Center for Bone Quality, Leiden University Medical Center, Albinusdreef 2, 2333, ZA, Leiden, The Netherlands
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Marieke Niesters
- Department of Anesthesiology and Pain Medicine, Leiden University Medical Center, Leiden, The Netherlands
| | - Marcel Flendrie
- Department of Rheumatology, Sint Maartenskliniek, Nijmegen, The Netherlands
| | - Marije Tel
- Division of Endocrinology, Department of Internal Medicine, Leiden University Medical Center, Leiden, The Netherlands
- Center for Bone Quality, Leiden University Medical Center, Albinusdreef 2, 2333, ZA, Leiden, The Netherlands
| | - Natasha M Appelman-Dijkstra
- Division of Endocrinology, Department of Internal Medicine, Leiden University Medical Center, Leiden, The Netherlands
- Center for Bone Quality, Leiden University Medical Center, Albinusdreef 2, 2333, ZA, Leiden, The Netherlands
| | - Olaf M Dekkers
- Division of Endocrinology, Department of Internal Medicine, Leiden University Medical Center, Leiden, The Netherlands
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Elizabeth M Winter
- Division of Endocrinology, Department of Internal Medicine, Leiden University Medical Center, Leiden, The Netherlands.
- Center for Bone Quality, Leiden University Medical Center, Albinusdreef 2, 2333, ZA, Leiden, The Netherlands.
| |
Collapse
|
2
|
Huang F, Shi Y, Ding L, Huang J, Zhang Z. Learned Helplessness and Associated Factors Among Patients with Lung Cancer. Patient Prefer Adherence 2024; 18:467-474. [PMID: 38410772 PMCID: PMC10895993 DOI: 10.2147/ppa.s446523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Accepted: 01/11/2024] [Indexed: 02/28/2024] Open
Abstract
Purpose Learned helplessness (LH) is the psychological state in which an individual experiences multiple failures and setbacks and experiences a sense of loss when facing the current situation. It is a significant burden for lung cancer patients that can impair quality of life and lead to physical, social, and psychological difficulties. Thus, this study aimed to determine the level of LH among patients with lung cancer and identify factors associated with LH. Patients and Methods From August 2022 to March 2023, 237 patients with lung cancer from Chongqing University Cancer Hospital were selected for this study. A general information questionnaire, the LH scale, the Brief Illness Perception questionnaire, the Strategies Used by People to Promote Health questionnaire, the Medical Coping Modes questionnaire, and the Self-esteem scale were used for the investigation. Multiple linear regression was employed to identify influencing factors for LH in patients with lung cancer. Results The total LH score of patients with lung cancer was 52.19±11.20. Multiple linear regression analysis showed that illness perception (β=0.249, P=0.001), self-efficacy (β=-0.194, P=0.017), and resignation coping mode (β=0.267, P<0.001) were the main influencing factors of LH (P<0.05), which explained 42.0% of the total variance. Conclusion The score of LH in patients with lung cancer was at a moderate level in this study. Illness perception, self-efficacy, and resignation coping mode have been found to impact LH among patients with lung cancer. Healthcare professionals should implement effective interventions, such as promoting self-efficacy, encouraging positive coping, and reducing illness perception, to alleviate LH.
Collapse
Affiliation(s)
- Fengmei Huang
- Department of Medical Oncology, Chongqing University Cancer Hospital, Chongqing, 400030, People's Republic of China
| | - Yumei Shi
- Department of Medical Oncology, Chongqing University Cancer Hospital, Chongqing, 400030, People's Republic of China
| | - Li Ding
- Nursing Department, Chongqing University Cancer Hospital, Chongqing, 400030, People's Republic of China
| | - Jingui Huang
- Department of Medical Oncology, Chongqing University Cancer Hospital, Chongqing, 400030, People's Republic of China
| | - Zhaoli Zhang
- Nursing Department, Chongqing University Cancer Hospital, Chongqing, 400030, People's Republic of China
| |
Collapse
|
3
|
DeShazo JM, Kouwijzer I, de Groot S, Post MWM, Valent LJM, van Leeuwen CMC, Wen H, Cowan RE. Effect of Training for an Athletic Challenge on Illness Cognition in Individuals with Chronic Disability: A Prospective Cohort Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 21:58. [PMID: 38248523 PMCID: PMC10815898 DOI: 10.3390/ijerph21010058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/07/2023] [Revised: 12/19/2023] [Accepted: 12/25/2023] [Indexed: 01/23/2024]
Abstract
Illness cognitions (IC) influence how a patient adapts to a chronic disease. The aim was (1) to determine if training for a handcycling mountain time trial (HandbikeBattle) improves IC and (2) to identify factors associated with IC change scores. Persons with a chronic disability (N = 220; including N = 151 with spinal cord disorder) trained 5 months and participated in the time trial. The IC Questionnaire measured helplessness, acceptance, perceived benefits and was assessed before training (T1), after training (T2), and four months after the event (T3). Age, sex, body mass index (BMI), time since injury (TSI), disability characteristics, self-efficacy, mental health (MH) and musculoskeletal pain were obtained at T1. Multilevel regression analyses showed that helplessness decreased (from 11.96 to 11.28, p < 0.01) and perceived benefits increased (from 16.91 to 17.58, p < 0.01) from T1 to T2. For helplessness this decrease persisted during follow-up (11.16 at T3). Changes in helplessness were associated with self-efficacy (p = 0.02), MH (p = 0.02) and lesion completeness (p = 0.02), and were independent of disability type (p = 0.66), lesion level (p = 0.30) and demographics such as sex (p = 0.29) and age (p = 0.67). Training with peers may improve helplessness and perceived benefits in individuals with a chronic disability. Especially individuals with MH problems might benefit from training for an athletic challenge with peers to improve illness cognitions, and ultimately, quality of life.
Collapse
Affiliation(s)
- Joy M. DeShazo
- Department of Physical Medicine and Rehabilitation, University of Alabama at Birmingham, Birmingham, AL 35294, USA; (J.M.D.); (H.W.); (R.E.C.)
| | - Ingrid Kouwijzer
- Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Amsterdam Movement Sciences, Vrije Universiteit Amsterdam, 1081 BT Amsterdam, The Netherlands;
- Amsterdam Rehabilitation Research Center|Reade, 1054 HW Amsterdam, The Netherlands
| | - Sonja de Groot
- Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Amsterdam Movement Sciences, Vrije Universiteit Amsterdam, 1081 BT Amsterdam, The Netherlands;
- Amsterdam Rehabilitation Research Center|Reade, 1054 HW Amsterdam, The Netherlands
| | - Marcel W. M. Post
- Center of Excellence for Rehabilitation Medicine, UMCU Brain Center, University Medical Center Utrecht and De Hoogstraat Rehabilitation, 3583 TM Utrecht, The Netherlands; (M.W.M.P.); (C.M.C.v.L.)
- Center for Rehabilitation, University Medical Center Groningen, University of Groningen, 9713 GZ Groningen, The Netherlands
| | - Linda J. M. Valent
- Research and Development, Heliomare Rehabilitation Center, 1949 EC Wijk aan Zee, The Netherlands;
| | - Christel M. C. van Leeuwen
- Center of Excellence for Rehabilitation Medicine, UMCU Brain Center, University Medical Center Utrecht and De Hoogstraat Rehabilitation, 3583 TM Utrecht, The Netherlands; (M.W.M.P.); (C.M.C.v.L.)
| | - Huacong Wen
- Department of Physical Medicine and Rehabilitation, University of Alabama at Birmingham, Birmingham, AL 35294, USA; (J.M.D.); (H.W.); (R.E.C.)
| | - Rachel E. Cowan
- Department of Physical Medicine and Rehabilitation, University of Alabama at Birmingham, Birmingham, AL 35294, USA; (J.M.D.); (H.W.); (R.E.C.)
| | | |
Collapse
|
4
|
Čepukienė V, Puzerienė E. Examining pain severity in women with rheumatoid arthritis: the impact of pain self-efficacy and perceived partner's emotional support. HEALTH PSYCHOLOGY REPORT 2023; 12:14-25. [PMID: 38425891 PMCID: PMC10900974 DOI: 10.5114/hpr/167803] [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: 07/27/2022] [Revised: 05/15/2023] [Accepted: 06/09/2023] [Indexed: 03/02/2024] Open
Abstract
BACKGROUND Empirical data suggest that psychosocial factors, such as pain self-efficacy (PSE) and emotional support from a partner, may alleviate the suffering caused by rheumatoid arthritis (RA) pain. However, the data are ambiguous and warrant a more comprehensive investigation into the effect of these factors on the severity of RA pain. The objective of the present study was to assess the significance of PSE and emotional support from a partner in relation to pain severity among women with RA. PARTICIPANTS AND PROCEDURE The study included a sample of 196 women diagnosed with RA with the mean age of 41.54. The study employed the following measures: Rheumatoid Arthritis Pain Scale, Pain Self-efficacy Questionnaire, and Communication Based Emotional Support Scale. RESULTS The analysis revealed that higher PSE emerged as the strongest predictor for lower pain severity across all components of RA pain. However, the impact of the partner's emotional support on pain severity was not as evident and varied depending on the specific pain component. Furthermore, the use of pain medications significantly predicted three out of four pain components. Mediation analysis revealed that perceived emotional support from a partner directly affected women's RA pain intensity, as well as indirectly through the PSE as a mediator. Moderated mediation analysis demonstrated that the association between PSE and pain severity weakened as the duration of RA increased. CONCLUSIONS Enhancing women's PSE and providing appropriate training for their partners to offer effective emotional support may play a crucial role in the treatment of RA.
Collapse
Affiliation(s)
| | - Erika Puzerienė
- Department of Psychology, Vytautas Magnus University, Kaunas, Lithuania
| |
Collapse
|
5
|
Mena-Vázquez N, Lisbona-Montañez JM, Redondo-Rodriguez R, Mucientes A, Manrique-Arija S, Rioja J, Garcia-Studer A, Ortiz-Márquez F, Cano-García L, Fernández-Nebro A. Inflammatory profile of incident cases of late-onset compared with young-onset rheumatoid arthritis: A nested cohort study. Front Med (Lausanne) 2022; 9:1016159. [PMID: 36425102 PMCID: PMC9679221 DOI: 10.3389/fmed.2022.1016159] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 10/25/2022] [Indexed: 08/27/2023] Open
Abstract
Objectives To describe the characteristics of patients between late-onset rheumatoid arthritis (LORA) with young-onset (YORA), and analyze their association with cumulative inflammatory burden. Methods We performed a nested cohort study in a prospective cohort comprising 110 patients with rheumatoid arthritis (RA) and 110 age- and sex-matched controls. The main variable was cumulative inflammatory activity according to the 28-joint Disease Activity Score with erythrocyte sedimentation rate (DAS28-ESR). High activity was defined as DAS28 ≥ 3.2 and low activity as DAS28 < 3.2. The other variables recorded were inflammatory cytokines, physical function, and comorbid conditions. Two multivariate models were run to identify factors associated with cumulative inflammatory activity. Results A total of 22/110 patients (20%) met the criteria for LORA (≥ 60 years). Patients with LORA more frequently had comorbid conditions than patients with YORA and controls. Compared with YORA patients, more LORA patients had cumulative high inflammatory activity from onset [13 (59%) vs. 28 (31%); p = 0.018] and high values for CRP (p = 0.039) and IL-6 (p = 0.045). Cumulative high inflammatory activity in patients with RA was associated with LORA [OR (95% CI) 4.69 (1.49-10.71); p = 0.008], smoking [OR (95% CI) 2.07 (1.13-3.78); p = 0.017], anti-citrullinated peptide antibody [OR (95% CI) 3.24 (1.15-9.13); p = 0.025], average Health Assessment Questionnaire (HAQ) score [OR (95% CI) 2.09 (1.03-14.23); p = 0.034], and physical activity [OR (95% CI) 0.99 (0.99-0.99); p = 0.010]. The second model revealed similar associations with inflammatory activity in patients with LORA. Conclusion Control of inflammation after diagnosis is poorer and comorbidity more frequent in patients with LORA than in YORA patients and healthy controls.
Collapse
Affiliation(s)
- Natalia Mena-Vázquez
- Instituto de Investigación Biomédica de Málaga (IBIMA)-Plataforma Bionand, Málaga, Spain
- Unidad de Gestión Clínica (UGC) de Reumatología, Hospital Regional Universitario de Málaga, Málaga, Spain
| | - Jose Manuel Lisbona-Montañez
- Instituto de Investigación Biomédica de Málaga (IBIMA)-Plataforma Bionand, Málaga, Spain
- Unidad de Gestión Clínica (UGC) de Reumatología, Hospital Regional Universitario de Málaga, Málaga, Spain
- Departamento de Medicina y Dermatología, Universidad de Málaga, Málaga, Spain
| | - Rocío Redondo-Rodriguez
- Instituto de Investigación Biomédica de Málaga (IBIMA)-Plataforma Bionand, Málaga, Spain
- Unidad de Gestión Clínica (UGC) de Reumatología, Hospital Regional Universitario de Málaga, Málaga, Spain
- Departamento de Medicina y Dermatología, Universidad de Málaga, Málaga, Spain
| | - Arkaitz Mucientes
- Instituto de Investigación Biomédica de Málaga (IBIMA)-Plataforma Bionand, Málaga, Spain
- Unidad de Gestión Clínica (UGC) de Reumatología, Hospital Regional Universitario de Málaga, Málaga, Spain
| | - Sara Manrique-Arija
- Instituto de Investigación Biomédica de Málaga (IBIMA)-Plataforma Bionand, Málaga, Spain
- Unidad de Gestión Clínica (UGC) de Reumatología, Hospital Regional Universitario de Málaga, Málaga, Spain
- Departamento de Medicina y Dermatología, Universidad de Málaga, Málaga, Spain
| | - José Rioja
- Instituto de Investigación Biomédica de Málaga (IBIMA)-Plataforma Bionand, Málaga, Spain
- Departamento de Medicina y Dermatología, Universidad de Málaga, Málaga, Spain
| | - Aimara Garcia-Studer
- Instituto de Investigación Biomédica de Málaga (IBIMA)-Plataforma Bionand, Málaga, Spain
- Unidad de Gestión Clínica (UGC) de Reumatología, Hospital Regional Universitario de Málaga, Málaga, Spain
| | - Fernando Ortiz-Márquez
- Instituto de Investigación Biomédica de Málaga (IBIMA)-Plataforma Bionand, Málaga, Spain
- Unidad de Gestión Clínica (UGC) de Reumatología, Hospital Regional Universitario de Málaga, Málaga, Spain
| | - Laura Cano-García
- Instituto de Investigación Biomédica de Málaga (IBIMA)-Plataforma Bionand, Málaga, Spain
- Unidad de Gestión Clínica (UGC) de Reumatología, Hospital Regional Universitario de Málaga, Málaga, Spain
| | - Antonio Fernández-Nebro
- Instituto de Investigación Biomédica de Málaga (IBIMA)-Plataforma Bionand, Málaga, Spain
- Unidad de Gestión Clínica (UGC) de Reumatología, Hospital Regional Universitario de Málaga, Málaga, Spain
- Departamento de Medicina y Dermatología, Universidad de Málaga, Málaga, Spain
| |
Collapse
|
6
|
Munk A, Jacobsen HB, Reme SE. Coping Expectancies and Disability across the New ICD-11 Chronic Pain Categories: A Large-Scale Registry Study. Eur J Pain 2022; 26:1510-1522. [PMID: 35603479 PMCID: PMC9543422 DOI: 10.1002/ejp.1979] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 04/21/2022] [Accepted: 05/16/2022] [Indexed: 11/09/2022]
Abstract
BACKGROUND Recently a new classification system for chronic pain was included in the 11th edition of the International Classification of Diseases (ICD-11). This study aims to investigate how expectancies of coping, i.e. pain catastrophizing and general self-efficacy, are associated with ICD-11 chronic pain categories in a large pain clinic population. Further, we investigate how coping expectancies are associated with pain-related disability, cross-sectionally and longitudinally across the novel pain classifications. METHODS The sample was retrieved from the Oslo University Hospital Pain Registry and included baseline data from 2875 chronic pain patients and 12-months follow up data for 920 patients. Demographic and clinical variables were compared across the ICD-11 chronic pain categories through ANOVA. Multiple regression models were carried out to investigate cross-sectional and longitudinal associations. RESULTS With the exception of age, our data showed no significant differences across the ICD-11 chronic pain categories. Coping expectancies were associated with disability at baseline. At 12-months follow up, coping expectancies did not predict pain-related disability when controlling for baseline levels of disability, pain intensity and pain duration. Pain classification (primary versus secondary) did not contribute significantly to the models. Helplessness had the strongest simple relationship to disability, compared with global pain catastrophizing and its additional subscales, both cross-sectionally and longitudinally. CONCLUSION Coping expectancies, pain intensity and pain-related disability appear similar across the novel chronic pain classifications, indicating that all pain patients may benefit from targeting these variables. Consistent with recent developments in stress theory, helplessness and self-efficacy were cross-sectionally associated with negative pain outcomes.
Collapse
Affiliation(s)
- Alice Munk
- The Mind-Body Lab, Department of Psychology, Faculty of Social Sciences, University of Oslo, Oslo, Norway
| | - Henrik Børsting Jacobsen
- The Mind-Body Lab, Department of Psychology, Faculty of Social Sciences, University of Oslo, Oslo, Norway.,Department of Pain Management and Research, Oslo University Hospital, Oslo, Norway
| | - Silje Endresen Reme
- The Mind-Body Lab, Department of Psychology, Faculty of Social Sciences, University of Oslo, Oslo, Norway.,Department of Pain Management and Research, Oslo University Hospital, Oslo, Norway
| |
Collapse
|
7
|
Health, Psychological and Demographic Predictors of Depression in People with Fibromyalgia and Osteoarthritis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19063413. [PMID: 35329109 PMCID: PMC8950397 DOI: 10.3390/ijerph19063413] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 03/09/2022] [Accepted: 03/10/2022] [Indexed: 02/04/2023]
Abstract
Depression is common in people with fibromyalgia (FM) and osteoarthritis (OA) and has been linked to adverse health outcomes in these conditions. The purpose of this study was to examine differences in predictors of depression among individuals with FM and OA using a range of health, demographic, and psychological variables. Of the total 963 participants, 600 were diagnosed with FM, and 363 with OA. The Quality of Well-Being Scale (QWB) was used to assess health status. The Fibromyalgia Impact Questionnaire (FIQ) and the Arthritis Impact Measurement Scale (AIMS) were used to measure disease-specific impact. Additionally, participants completed self-efficacy and helplessness assessments. Depression was measured using the Center for Epidemiological Studies Scale (CES-D). The results of a moderated linear regression showed that higher depression scores were associated with lower health status and a greater condition impact, especially in the FM group. Self-efficacy and helplessness predicted depression in both groups, but more strongly in FM. White participants with OA were more depressed than their non-White counterparts, while the opposite was true for FM. These findings indicate that improving health status and psychological well-being might alleviate depression in both FM and OA.
Collapse
|
8
|
Mena-Vázquez N, Redondo-Rodríguez R, Rioja J, Jimenez-Nuñez FG, Manrique-Arija S, Lisbona-Montañez JM, Cano-García L, Rojas-Gimenez M, Ureña I, Valdivielso P, Fernández-Nebro A. Postprandial Hyperlipidemia: Association with Inflammation and Subclinical Atherosclerosis in Patients with Rheumatoid Arthritis. Biomedicines 2022; 10:133. [PMID: 35052812 PMCID: PMC8773280 DOI: 10.3390/biomedicines10010133] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 12/30/2021] [Accepted: 01/06/2022] [Indexed: 12/10/2022] Open
Abstract
OBJECTIVE To describe postprandial lipidemia in patients with rheumatoid arthritis (RA) and to analyze its association with subclinical atherosclerosis and inflammatory activity. METHODS Observational study of 80 cases of RA and 80 sex- and age-matched controls. We excluded individuals with dyslipidemia. Postprandial hyperlipidemia (PPHL) was defined as postprandial triglycerides >220 mg/dL and/or postprandial ApoB48 levels >75th percentile (>p75). Plasma lipids, cholesterol, triglycerides, ApoB48, and total ApoB were evaluated at baseline and after a meal. Other variables analyzed included subclinical atherosclerosis (defined as presence of carotid atheromatous plaque), inflammatory activity (disease activity score (DAS28-ESR)), cytokines, apolipoproteins, and physical activity. A multivariate analysis was performed to identify factors associated with PPHL in patients with RA. RESULTS A total of 75 patients with RA and 67 healthy controls fulfilled the inclusion criteria. PPHL was more frequent in patients with RA than controls (No. (%), 29 (38.70) vs. 15 (22.40); p = 0.036), as was subclinical atherosclerosis (No. (%), 22 (30.10) vs. 10 (14.90); p = 0.032). PPHL in patients with RA was associated with subclinical atherosclerosis (OR (95% CI) 4.69 (1.09-12.11); p = 0.037), TNF-α (OR (95% CI) 2.00 (1.00-3.98); p = 0.048), high-sensitivity C-reactive protein (OR (95% CI) 1.10 (1.01-1.19); p = 0.027), and baseline triglycerides (OR (95% CI) 1.02 (1.00-1.04); p = 0.049). CONCLUSION PPHL was more frequent in patients with RA than in controls. PPHL in patients with RA was associated with inflammation and subclinical atherosclerosis.
Collapse
Affiliation(s)
- Natalia Mena-Vázquez
- Instituto de Investigación Biomédica de Málaga (IBIMA), 29010 Malaga, Spain; (R.R.-R.); (J.R.); (F.G.J.-N.); (S.M.-A.); (L.C.-G.); (I.U.); (P.V.); (A.F.-N.)
- UGC de Reumatología, Hospital Regional Universitario de Málaga, 29009 Malaga, Spain;
- Departamento de Medicina y Dermatología, Universidad de Málaga, 29010 Malaga, Spain
| | - Rocío Redondo-Rodríguez
- Instituto de Investigación Biomédica de Málaga (IBIMA), 29010 Malaga, Spain; (R.R.-R.); (J.R.); (F.G.J.-N.); (S.M.-A.); (L.C.-G.); (I.U.); (P.V.); (A.F.-N.)
- UGC de Reumatología, Hospital Regional Universitario de Málaga, 29009 Malaga, Spain;
| | - José Rioja
- Instituto de Investigación Biomédica de Málaga (IBIMA), 29010 Malaga, Spain; (R.R.-R.); (J.R.); (F.G.J.-N.); (S.M.-A.); (L.C.-G.); (I.U.); (P.V.); (A.F.-N.)
- Departamento de Medicina y Dermatología, Universidad de Málaga, 29010 Malaga, Spain
| | - Francisco Gabriel Jimenez-Nuñez
- Instituto de Investigación Biomédica de Málaga (IBIMA), 29010 Malaga, Spain; (R.R.-R.); (J.R.); (F.G.J.-N.); (S.M.-A.); (L.C.-G.); (I.U.); (P.V.); (A.F.-N.)
- UGC de Reumatología, Hospital Regional Universitario de Málaga, 29009 Malaga, Spain;
| | - Sara Manrique-Arija
- Instituto de Investigación Biomédica de Málaga (IBIMA), 29010 Malaga, Spain; (R.R.-R.); (J.R.); (F.G.J.-N.); (S.M.-A.); (L.C.-G.); (I.U.); (P.V.); (A.F.-N.)
- UGC de Reumatología, Hospital Regional Universitario de Málaga, 29009 Malaga, Spain;
- Departamento de Medicina y Dermatología, Universidad de Málaga, 29010 Malaga, Spain
| | - Jose Manuel Lisbona-Montañez
- UGC de Reumatología, Hospital Regional Universitario de Málaga, 29009 Malaga, Spain;
- Departamento de Medicina y Dermatología, Universidad de Málaga, 29010 Malaga, Spain
| | - Laura Cano-García
- Instituto de Investigación Biomédica de Málaga (IBIMA), 29010 Malaga, Spain; (R.R.-R.); (J.R.); (F.G.J.-N.); (S.M.-A.); (L.C.-G.); (I.U.); (P.V.); (A.F.-N.)
- UGC de Reumatología, Hospital Regional Universitario de Málaga, 29009 Malaga, Spain;
| | - Marta Rojas-Gimenez
- UGC de Reumatología, Instituto Maimónides de Investigación Biomédica de Cordoba (IMIBIC), Hospital Universitario Reina Sofia, 14004 Cordoba, Spain;
| | - Inmaculada Ureña
- Instituto de Investigación Biomédica de Málaga (IBIMA), 29010 Malaga, Spain; (R.R.-R.); (J.R.); (F.G.J.-N.); (S.M.-A.); (L.C.-G.); (I.U.); (P.V.); (A.F.-N.)
- UGC de Reumatología, Hospital Regional Universitario de Málaga, 29009 Malaga, Spain;
| | - Pedro Valdivielso
- Instituto de Investigación Biomédica de Málaga (IBIMA), 29010 Malaga, Spain; (R.R.-R.); (J.R.); (F.G.J.-N.); (S.M.-A.); (L.C.-G.); (I.U.); (P.V.); (A.F.-N.)
- Departamento de Medicina y Dermatología, Universidad de Málaga, 29010 Malaga, Spain
- UGC de Medicina Interna, Hospital Universitario Virgen de la Victoria, 29010 Malaga, Spain
| | - Antonio Fernández-Nebro
- Instituto de Investigación Biomédica de Málaga (IBIMA), 29010 Malaga, Spain; (R.R.-R.); (J.R.); (F.G.J.-N.); (S.M.-A.); (L.C.-G.); (I.U.); (P.V.); (A.F.-N.)
- UGC de Reumatología, Hospital Regional Universitario de Málaga, 29009 Malaga, Spain;
- Departamento de Medicina y Dermatología, Universidad de Málaga, 29010 Malaga, Spain
| |
Collapse
|
9
|
Lin C, Tu R, Bier B, Tu P. Uncovering the Imprints of Chronic Disease on Patients' Lives and Self-Perceptions. J Pers Med 2021; 11:jpm11080807. [PMID: 34442451 PMCID: PMC8399677 DOI: 10.3390/jpm11080807] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Revised: 08/10/2021] [Accepted: 08/16/2021] [Indexed: 02/06/2023] Open
Abstract
Rheumatoid arthritis (RA) patients face psychological hardship due to physical discomfort, disabilities, and anxieties. Previous research indicated a bidirectional relationship and patient desire for emotional support from providers. This study examined lesser-understood RA experiences across the psychological and social contexts in relation to self-perception through the patients' expression of their struggles with these burdens. We conducted four semistructured focus groups and eleven interviews (total n = 31). A codebook was developed and refined through iterative transcript coding via NVivo-12. Four emerging themes were identified by inductive, thematic analysis: (1) the patients' healthy appearances were a myth, with subthemes revealing a conflict between an inclination to hide the disease and a desire for validation, while feeling embarrassed by symptom manifestations and disappointment at withdrawal from social interactions; (2) an identity crisis due to diminished functionality, autonomy, and sense of self; (3) RA constantly occupied the mind, as its unpredictability dictated daily schedules and altered plans; and (4) the disease's chronic nature influenced personal outlook to worry about or accept the uncertainty. Even with effective treatment, the invisibility of the disease, the fear and anticipation of flare-ups, and identity clashes caused emotional distress. The insights offer a different perspective on personalized medicine, complementing clinical treatments based on genetic or biomarker profile. For patient-centered holistic care, education is needed to prompt both patients and providers to discuss psychological issues for more customized, integrated interventions. The findings can help inform healthcare teams and families in recognizing and supporting these physical-psychological intertwined experiences, thereby ameliorating patients' wellbeing.
Collapse
Affiliation(s)
- Cheryl Lin
- Policy and Organizational Management Program, Duke University, Durham, NC 27705, USA; (C.L.); (B.B.)
| | - Rungting Tu
- College of Management, Shenzhen University, Shenzhen 518060, China;
| | - Brooke Bier
- Policy and Organizational Management Program, Duke University, Durham, NC 27705, USA; (C.L.); (B.B.)
| | - Pikuei Tu
- Policy and Organizational Management Program, Duke University, Durham, NC 27705, USA; (C.L.); (B.B.)
- Correspondence:
| |
Collapse
|
10
|
Manrique-Arija S, Mena-Vazquez N, Ureña I, Rioja J, Valdivielso P, Ginel-Mendoza L, Abad-Sánchez S, Jiménez-Núñez FG, Oliver-Martos B, Fernandez-Nebro A. Cumulative inflammatory burden and obesity as determinants of insulin resistance in patients with established rheumatoid arthritis: cross-sectional study. BMJ Open 2021; 11:e044749. [PMID: 33563625 PMCID: PMC7875272 DOI: 10.1136/bmjopen-2020-044749] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 12/29/2020] [Accepted: 01/13/2021] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVES To describe the prevalence of insulin resistance (IR) in patients with established rheumatoid arthritis (RA) and to analyse the contribution of cumulative inflammatory burden and other factors to its development. DESIGN Observational cross-sectional study. PARTICIPANTS Patients with RA and controls matched for age, sex and Body Mass Index. We excluded patients with diabetes. SETTINGS Patients from an RA inception cohort at Hospital Regional Universitario de Málaga, Spain, were recruited between September 2016 and May 2018. PRIMARY AND SECONDARY OUTCOME MEASURES IR was evaluated using the homeostasis model assessment for IR and beta-cell function and the quantitative insulin sensitivity check index. Other variables included the cumulative 28-Joint Disease Activity Score (DAS28) with C reactive protein (CRP) body composition and cytokines. Two logistic regression models were constructed to identify factors associated with IR in patients with RA. RESULTS Eighty-nine patients with RA and 80 controls were included. The prevalence of IR was similar in both cases and controls. Inflammatory activity was controlled appropriately in patients during follow-up (mean DAS28 3.1 (0.8)). The presence of IR in patients with RA was associated with obesity (OR 6.01, 95% CI 1.9 to 8.7), higher cumulative DAS28-CRP values during follow-up (OR 2.8, 95% CI 1.3 to 6.0), and higher interleukin-1β levels (OR 1.6, 95% CI 1.1 to 2.4). The second model showed that the risk of IR increased by 10% for each kilogram of excess body fat. CONCLUSION In patients with well-controlled, established RA, IR is associated mainly with poorer control of inflammation from diagnosis and with obesity, specifically total fat mass.
Collapse
Affiliation(s)
- Sara Manrique-Arija
- UGC de Reumatología, Instituto de Investigación Biomédica de Málaga (IBIMA), Hospital Regional Universitario de Málaga, Málaga, Spain
| | - Natalia Mena-Vazquez
- UGC de Reumatología, Instituto de Investigación Biomédica de Málaga (IBIMA), Hospital Regional Universitario de Málaga, Málaga, Spain
| | - Inmaculada Ureña
- UGC de Reumatología, Instituto de Investigación Biomédica de Málaga (IBIMA), Hospital Regional Universitario de Málaga, Málaga, Spain
| | - José Rioja
- Departamento de Medicina y Dermatología, Instituto de Investigación Biomédica de Málaga (IBIMA), Universidad de Málaga, Málaga, Spain
| | - Pedro Valdivielso
- UGC de Medicina Interna, Instituto de InvestigaciónBiomédica de Málaga (IBIMA), Hospital Universitario Virgen de la Victoria, Universidad de Málaga, Málaga, Spain
| | | | - Salomé Abad-Sánchez
- Centro de Salud Ciudad Jardín, Distrito Sanitario Málaga-Guadalhorce, Málaga, Spain
| | - Francisco G Jiménez-Núñez
- UGC de Reumatología, Instituto de Investigación Biomédica de Málaga (IBIMA), Hospital Regional Universitario de Málaga, Málaga, Spain
| | - Begoña Oliver-Martos
- UGC Neurociencias, Instituto de Investigación Biomédica de Málaga (IBIMA), Hospital Regional Universitario de Málaga, Málaga, Spain
| | - Antonio Fernandez-Nebro
- UGC de Reumatología, Instituto de Investigación Biomédica de Málaga (IBIMA), Hospital Regional Universitario de Málaga, Málaga, Spain
| |
Collapse
|
11
|
Mena-Vázquez N, Rojas-Gimenez M, Jimenez Nuñez FG, Manrique-Arija S, Rioja J, Ruiz-Limón P, Ureña I, Castro-Cabezas M, Valdivielso P, Fernández-Nebro A. Postprandial Apolipoprotein B48 is Associated with Subclinical Atherosclerosis in Patients with Rheumatoid Arthritis. J Clin Med 2020; 9:E2483. [PMID: 32748862 PMCID: PMC7465472 DOI: 10.3390/jcm9082483] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 07/23/2020] [Accepted: 07/31/2020] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE To describe postprandial lipemia in patients with rheumatoid arthritis (RA) and to analyze its association with subclinical atherosclerosis measured as carotid intima-media thickness (cIMT). METHODS We performed an observational study of 40 patients with RA and 40 sex and age-matched controls. Patients with dyslipidemia were excluded. Pathologically increased cIMT was defined as a carotid thickness greater than the 90th percentile (>p90) for age and sex. Fasting and postprandial plasma lipids, cholesterol, triglycerides, apolipoprotein B48 (ApoB48), and total ApoB were evaluated. The other variables included were clinical and laboratory values, Framingham score, and the 28-joint Disease Activity Score (DAS28). Two multivariate models were constructed to identify factors associated with pathologic cIMT in patients with RA. RESULTS Fasting lipid values were similar in patients with RA and controls, although those of postprandial ApoB48 were higher (median (IQR), 14.4 (10.8-12.1) vs. 12.1 (2.3-9,8); p = 0.042). Pathologic cIMT was recorded in 10 patients with RA (25%) and nine controls (22.5%). In patients with RA, pathologic cIMT was associated with postprandial ApoB48 (OR (95% CI), 1.15 (1.0-1.3)) and total ApoB (OR [95% CI], 1.12 [1.1-1.2]). The second model revealed a mean increase of 0.256 mm for cIMT in patients with elevated anticitrullinated protein antibodies (ACPAs). CONCLUSION Postprandial ApoB48 levels in patients with RA are higher than in controls. Postprandial ApoB48 and total ApoB levels and markers of severity, such as ACPAs, are associated with pathologic cIMT in patients with RA. Our findings could indicate that these atherogenic particles have a negative effect on the endothelium.
Collapse
Affiliation(s)
- Natalia Mena-Vázquez
- The Institute of Biomedical Research in Malaga (IBIMA), 29010 Málaga, Spain; (N.M.-V.); (F.G.J.N.); (S.M.-A.); (J.R.); (P.R.-L.); (I.U.); (P.V.); (A.F.-N.)
- UGC de Reumatología, Hospital Regional Universitario de Málaga, 29009 Málaga, Spain
| | - Marta Rojas-Gimenez
- UGC de Reumatología, Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Hospital Universitario Reina Sofia, 14004 Córdoba, Spain
| | - Francisco Gabriel Jimenez Nuñez
- The Institute of Biomedical Research in Malaga (IBIMA), 29010 Málaga, Spain; (N.M.-V.); (F.G.J.N.); (S.M.-A.); (J.R.); (P.R.-L.); (I.U.); (P.V.); (A.F.-N.)
- UGC de Reumatología, Hospital Regional Universitario de Málaga, 29009 Málaga, Spain
| | - Sara Manrique-Arija
- The Institute of Biomedical Research in Malaga (IBIMA), 29010 Málaga, Spain; (N.M.-V.); (F.G.J.N.); (S.M.-A.); (J.R.); (P.R.-L.); (I.U.); (P.V.); (A.F.-N.)
- UGC de Reumatología, Hospital Regional Universitario de Málaga, 29009 Málaga, Spain
| | - José Rioja
- The Institute of Biomedical Research in Malaga (IBIMA), 29010 Málaga, Spain; (N.M.-V.); (F.G.J.N.); (S.M.-A.); (J.R.); (P.R.-L.); (I.U.); (P.V.); (A.F.-N.)
- Departamento de Medicina y Dermatología, Universidad de Málaga, 29010, Málaga, Spain
| | - Patricia Ruiz-Limón
- The Institute of Biomedical Research in Malaga (IBIMA), 29010 Málaga, Spain; (N.M.-V.); (F.G.J.N.); (S.M.-A.); (J.R.); (P.R.-L.); (I.U.); (P.V.); (A.F.-N.)
- Unidad de Gestión Clínica de Endocrinología y Nutrición, Hospital Clínico Virgen de la Victoria, 29010 Málaga, Spain
| | - Inmaculada Ureña
- The Institute of Biomedical Research in Malaga (IBIMA), 29010 Málaga, Spain; (N.M.-V.); (F.G.J.N.); (S.M.-A.); (J.R.); (P.R.-L.); (I.U.); (P.V.); (A.F.-N.)
- UGC de Reumatología, Hospital Regional Universitario de Málaga, 29009 Málaga, Spain
| | - Manuel Castro-Cabezas
- Department of Internal Medicine, Franciscus Gasthuis & Vlietland, Kleiweg 500, 3045 PM Rotterdam, The Netherlands;
| | - Pedro Valdivielso
- The Institute of Biomedical Research in Malaga (IBIMA), 29010 Málaga, Spain; (N.M.-V.); (F.G.J.N.); (S.M.-A.); (J.R.); (P.R.-L.); (I.U.); (P.V.); (A.F.-N.)
- Departamento de Medicina y Dermatología, Universidad de Málaga, 29010, Málaga, Spain
- UGC de Medicina Interna, Hospital Universitario Virgen de la Victoria, Universidad de Málaga, 29010 Málaga, Spain
| | - Antonio Fernández-Nebro
- The Institute of Biomedical Research in Malaga (IBIMA), 29010 Málaga, Spain; (N.M.-V.); (F.G.J.N.); (S.M.-A.); (J.R.); (P.R.-L.); (I.U.); (P.V.); (A.F.-N.)
- UGC de Reumatología, Hospital Regional Universitario de Málaga, 29009 Málaga, Spain
- Departamento de Medicina y Dermatología, Universidad de Málaga, 29010, Málaga, Spain
| |
Collapse
|
12
|
Galvez-Sánchez CM, de la Coba P, Duschek S, Reyes del Paso GA. Reliability, Factor Structure and Predictive Validity of the Widespread Pain Index and Symptom Severity Scales of the 2010 American College of Rheumatology Criteria of Fibromyalgia. J Clin Med 2020; 9:jcm9082460. [PMID: 32752048 PMCID: PMC7464133 DOI: 10.3390/jcm9082460] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 07/29/2020] [Accepted: 07/30/2020] [Indexed: 01/01/2023] Open
Abstract
Fibromyalgia syndrome (FMS) is a chronic condition of widespread pain. In 2010, the American College of Rheumatology (ACR) proposed new diagnostic criteria for FMS based on two scales: the Widespread Pain Index (WPI) and Symptoms Severity (SS) scale. This study evaluated the reliability, factor structure and predictive validity of WPI and SS. In total, 102 women with FMS and 68 women with rheumatoid arthritis (RA) completed the WPI, SS, McGill Pain Questionnaire, Trait Anxiety Inventory, Fatigue Severity Scale, Oviedo Quality of Sleep Questionnaire, and Beck Depression Inventory. Pain threshold and tolerance and a measure of central sensitization to pain were obtained by pressure algometry. Values on WPI and SS showed negative-skewed frequency distributions in FMS patients, with most of the observations concentrated at the upper end of the scale. Factor analysis did not reveal single-factor models for either scale; instead, the WPI was composed of nine pain-localization factors and the SS of four factors. The Cronbach’s α (i.e., Internal consistency) was 0.34 for the WPI,0.83 for the SS and 0.82 for the combination of WPI and SS. Scores on both scales correlated positively with measures of clinical pain, fatigue, insomnia, depression, and anxiety but were unrelated to pain threshold and tolerance or central pain sensitization. The 2010 ACR criteria showed 100% sensitivity and 81% specificity in the discrimination between FMS and RA patients, where discrimination was better for WPI than SS. In conclusion, despite their limited reliability, both scales allow for highly accurate identification and differentiation of FMS patients. The inclusion of more painful areas in the WPI and of additional symptoms in the SS may reduce ceiling effects and improve the discrimination between patients differing in disease severity. In addition, the use of higher cut-off values on both scales may increase the diagnostic specificity in Spanish samples.
Collapse
Affiliation(s)
- Carmen M. Galvez-Sánchez
- Department of Psychology, University of Jaén, 23071 Jaén, Spain; (P.d.l.C.); (G.A.R.d.P.)
- Correspondence:
| | - Pablo de la Coba
- Department of Psychology, University of Jaén, 23071 Jaén, Spain; (P.d.l.C.); (G.A.R.d.P.)
| | - Stefan Duschek
- Institute of Psychology, UMIT—University for Health Sciences, Medical Informatics and Technology, 6060 Hall in Tirol, Austria;
| | | |
Collapse
|