A Longitudinal Decline in Walking Speed Is Linked with Coexisting Hypertension and Arthritis in Community-Dwelling Older Adults

Objective: The aim was to investigate the association between baseline coexistence of hypertension (HTN) and arthritis, HTN alone, or arthritis alone, and their impact on longitudinal physical function measures among community-dwelling older adults over 5 years of follow-up. Methods: Ours was a longitudinal prospective cohort study from the second wave (2010-2011) and third wave (2015-2016) of the National Social Life, Health, and Aging Project (NSHAP). Data for older adults were used. Participants were categorized based on self-reported diagnoses into four groups: coexisting HTN and arthritis, HTN only, arthritis only, or neither. Physical performance measures included walking speed using the 3-Meter Walk Test and the Five Times Sit-to-Stand Test (FTSST). Multiple generalized estimating equations with linear regression analyses were conducted, adjusting for age, sex, race, body mass index (BMI) educational level, pain severity, and baseline use of pain and hypertension medications. Results: Data for 1769 participants were analyzed. Slower walking speed was only associated with coexisting HTN and arthritis (B = -0.43, p < 0.001) after accounting for covariates. The coexisting HTN and arthritis group showed no significant association with FTSST (B = 0.80, p = 0.072) after accounting for covariates. Conclusions: The coexistence of baseline HTN and arthritis in older adults is associated with a gradual decline in only walking speed as a physical performance measure in older adults.

Role of the C-reactive Protein-to-Albumin Ratio in Assessing Disease Activity in Elderly Patients With Rheumatoid Arthritis

OBJECTIVE

Nowadays, one measure that is more helpful in assessing the level of inflammation than either C-reactive protein (CRP) or albumin alone is the C-reactive protein-to-albumin ratio (CAR). Our study set out to assess the CAR in elderly individuals with rheumatoid arthritis (RA) and its correlation with other parameters.

METHODS

Included in the research were patients who were being followed up on for RA between January 2021 and January 2024 and categorized according to their age at the time of enrolment and assigned to one of two groups: younger patients, defined as <60 years of age, and those aged ≥60 years, who were recorded as elderly patients. The clinical evaluation of the patients and laboratory data measured for each patient included age, gender, disease duration, medications, CRP, erythrocyte sedimentation rate (ESR), albumin, neutrophil-to-lymphocyte ratio (NLR), and CAR. Disease activity was assessed with the disease activity score 28 (DAS 28)-ESR. The health assessment questionnaire was used to measure the functional status.

RESULTS

Ninety-four patients (<60 years: 58 and ≥60 years: 36) were included. The mean age of the elderly patients was 65.80 ± 5.33 years. Female predominance was similar in both the RA groups (<60 years: 50 patients (86.2%) vs. ≥60 years: 31 (86.1%)). The distribution of biological and disease-modifying drugs did not significantly differ between the groups. With the exception of albumin, there was no statistically significant difference between the groups for ESR, CRP, CAR, NLR, or DAS28-ESR. Elderly patients with a DAS28-ESR of 2.6 and above had a statistically significant higher CAR than the remission group (3.44±3.73 vs. 2.71±5.73, respectively). There was no statistically significant difference in the NLR value of elderly patients with a DAS28-ESR of 2.6 and above compared to the remission group (3.06 ± 2.95 vs. 2.65 ± 1.38, respectively). In addition, CAR was positively correlated with ESR, CRP, and DAS28-ESR (r = 0.726, p < 0.001; r = 0.954, p < 0.001; r = 0.339, p = 0.043, respectively). However, there was no discernible correlation between CAR and HAQ, NLR, or disease duration.

CONCLUSION

In elderly RA patients, our study demonstrated the correlation between CAR and inflammatory biomarkers and the DAS28-ESR. According to this, CAR may prove to be a useful biomarker for assessing inflammation and disease activity in clinical settings.

CXCL10 as a biomarker of interstitial lung disease in patients with rheumatoid arthritis

INTRODUCTION

Pulmonary involvement is a frequent and serious rheumatoid arthritis (RA) manifestation that affects 60%-80% of patients. CXCL10 is an inflammatory chemokine that regulates different biological responses, such as chemotaxis, angiogenesis, and inflammation.

AIM

This study aimed to identify the role of CXCL10 as a peripheral blood marker of RA-ILD and its correlation with disease activity.

PATIENTS AND METHODS

This cross-sectional study included 73 patients with RA (33 with ILD and 40 without ILD). Pulmonary function tests and high-resolution computed tomography were performed. Blood samples were taken for complete blood count and blood chemistry analysis, and human interferon-inducible protein 10 (IP-10/CXCL10) level. Statistical Package for the Social Sciences (version 22) was used for all statistical calculations.

RESULTS

The serum CXCL10 level and patient age (r=.393, p=.024), disease duration (r=.756, p<0.001), erythrocyte sedimentation rate (r=.516, p=.002), C-reactive protein (r=.539, p=.001), and rheumatoid factor (r=.663, p<.001) revealed a significant positive correlation. Furthermore, the Modified Health Assessment Questionnaire (r=-.418, p=.015) revealed a significant negative correlation. Patients with RA-ILD show significantly higher CXCL10 than those without ILD (p<.001).

CONCLUSION

CXCL10 is a useful RA disease activity biomarker and is an RA-ILD-sensitive biomarker, also CXCL10 is a significant predictor for development of RA-ILD.

Changes in physical function over time in rheumatoid arthritis patients: A cohort study

INTRODUCTION

Self-reported disability is potentially influenced by many factors in patients with rheumatoid arthritis (RA). In this sense, we evaluated the association between self-reported disability and (1) clinical features, (2) muscle strength and (3) physical performance over time among patients with RA from two distinct patient cohorts.

MATERIALS AND METHODS

Two independent prospective RA cohorts were analyzed. The Health Assessment Questionnaire (HAQ), Disease Activity Score in 28 Joints (DAS28), handgrip test, chair stand test, timed-up-and-go (TUG) test and Short Physical Performance Battery (SPPB) were performed at baseline and in follow-up. T test for independent samples, Mann-Whitney U test, Spearman correlation coefficients and linear regression with generalized estimating equations were performed to assess associations between individual constructs at baseline and over time.

RESULTS

A total of 205 total RA patients were included [North American Cohort (n = 115); Brazilian Cohort (n = 90)]. At enrollment, Brazilian men had better HAQ than North American men (p<0.001). Brazilian patients overall had lower muscle strength than North American patients (p<0.05). HAQ was associated with DAS28, handgrip test, chair stand test, TUG and SPPB (p<0.001) in both cohorts. Worsening of the DAS28 and chair stand test were each associated with worsening in HAQ in longitudinal analysis over time. Worsening of handgrip was also associated in with worsening HAQ in both cohorts (p<0.05). A worse TUG test was associated with worsening in HAQ in Brazilian cohort (p<0.05) and a worse SPPB was associated with worsening in HAQ in North American cohort (p<0.05).

CONCLUSION

Greater disability measured by HAQ is closely associated with disease activity, pain, muscle strength, and physical performance among RA. Worsening in self-reported disability correlate with worsening clinical factors including objectively-observed physical function.

Smartphone Pedometer Sensor Application for Evaluating Disease Activity and Predicting Comorbidities in Patients with Rheumatoid Arthritis: A Validation Study

Smartphone-based pedometer sensor telemedicine applications could be useful for measuring disease activity and predicting the risk of developing comorbidities, such as pulmonary or cardiovascular disease, in patients with rheumatoid arthritis (RA), but the sensors have not been validated in this patient population. The aim of this study was to validate step counting with an activity-tracking application running the inbuilt Android smartphone pedometer virtual sensor in patients with RA. Two Android-based smartphones were tested in a treadmill test-bed setup at six walking speeds and compared to manual step counting as the gold standard. Guided by a facilitator, the participants walked 100 steps at each test speed, from 2.5 km/h to 5 km/h, wearing both devices simultaneously in a stomach pouch. A computer automatically recorded both the manually observed and the sensor step count. The overall difference in device step counts versus the observed was 5.9% mean absolute percentage error. Highest mean error was at the 2.5 km/h speed tests, where the mean error of the two devices was 18.5%. Both speed and cadence were negatively correlated to the absolute percentage error, which indicates that the greater the speed and cadence, the lower the resulting step counting error rate. There was no correlation between clinical parameters and absolute percentage error. In conclusion, the activity-tracking application using the inbuilt Android smartphone pedometer virtual sensor is valid for step counting in patients with RA. However, walking at very low speed and cadence may represent a challenge.

Functional exercise capacity in rheumatoid arthritis unrelated to lung injury: A comparison of women with and without rheumatoid disease

BACKGROUND

Rheumatoid arthritis (RA) mainly affects the joints of the upper and lower limbs, so evaluating functional exercise capacity in individuals with RA via dynamic tests of the locomotor system is essential.

OBJECTIVES

To compare functional exercise capacity using the Glittre-activities of daily living (ADL) test (G-AT) in women with and without RA in the absence of RA pulmonary disease (RA-PD) and to correlate the findings with hand functioning, physical functioning, handgrip strength (HGS), and quadriceps strength (QS).

METHODS

This cross-sectional pilot study evaluated 35 women with RA and 25 healthy controls by assessing hand functioning using the Cochin Hand Functional Scale (CHFS), physical functioning with the Health Assessment Questionnaire Disability Index (HAQ-DI), muscle functioning using HGS and QS, and G-AT results.

RESULTS

Compared to the women in the control group, the women with RA presented higher scores for the CHFS (p< 0.0001) and HAQ-DI (p< 0.0001) and lower HGS (p< 0.0001) and QS (p= 0.013) values. The median G-AT time was higher in the RA patients than in the healthy controls [300 (295-420) vs. 180 (155-203) s], p< 0.0001), and the greatest difficulty reported by patients after the G-AT was squatting to perform the shelving tasks. G-AT time was positively correlated with the HAQ-DI (rs= 0.668, p< 0.0001) and CHFS (rs= 0.586, p= 0.0007) and negatively correlated with QS (rs=-0.429, p= 0.037). There was no significant correlation between the G-AT time and HGS.

CONCLUSIONS

Women with RA take longer to perform G-AT tasks. Moreover, G-AT time was associated with hand functioning, physical functioning and QS, but not with HGS.

Reliability of activity monitors for physical activity assessment in patients with musculoskeletal disorders: A systematic review

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.

Serum progranulin level is associated with disease activity following orthopedic surgery in rheumatoid arthritis patients

Background

Few studies have focused on the ability of progranulin to predict postoperative disease activity in rheumatoid arthritis (RA) patients who have undergone surgery. This study evaluated serum progranulin levels in active RA patients and analyzed its relationship with postoperative disease activity.

Methods

One hundred thirty-two patients with active RA and 72 healthy subjects were included in this study. Serum progranulin was measured, and clinical data were collected. The postoperative 1-year Disease Activity Score in 28 joints calculated with C-reactive protein (DAS28-CRP) scores was evaluated as an indicator of disease activity. The predictive value of progranulin in postoperative 1-year disease activity in RA patients was also analyzed.

Results

Serum progranulin was significantly associated with the postoperative 1-year RA disease activity. The mean serum progranulin level in patients with a high disease activity was significantly higher than that of RA patients with low-to-moderate disease activity (54.2 ± 10.6 ng/mL vs. 46.7 ± 8.8 ng/mL). Serum progranulin was also evaluated as an independent predictive factor for postoperative 1-year RA disease activity in multivariate analysis (odds ratio [OR], 2.21; 95% confidence interval [CI], 1.02–8.85).

Conclusions

Serum progranulin levels may be a promising indicator of postoperative disease activity in RA patients who underwent orthopedic surgery.

Predictors of functional capacity as measured by the Glittre activities of daily living test in women with rheumatoid arthritis

Although pulmonary involvement is the most common extra-articular manifestation of rheumatoid arthritis (RA), traditional pulmonary function tests (PFTs) do not show a good correlation with the field tests usually performed in these patients. In recent decades, measurement of ventilation distribution heterogeneity through the nitrogen single-breath washout (N₂SBW) test and evaluation of functional capacity during exercise using the Glittre activities of daily living test (GA-T) have been increasingly used. Therefore, the objective of this study was to evaluate predictors of GA-T outcomes in women with RA considering demographic, anthropometric, clinical, functional variables, and chest computed tomography (CT) findings. Forty-three women with RA underwent the GA-T, the N₂SBW test, spirometry, measurement of the diffusing capacity for carbon monoxide (DLco), measurement of respiratory muscle strength, and evaluation of physical function of the lower and upper limbs through the Health Assessment Questionnaire Disability Index (HAQ-DI). Chest CT scans were analyzed retrospectively. The GA-T time showed significant correlations with the DLco (r_s=-0.397, P=0.008), forced vital capacity/DLco (r_s=0.307, P=0.044), phase III slope of the N₂SBW test (SIIIN₂, r_s=0.644, P<0.0001), and the HAQ-DI (r_s=0.482, P=0.001). Disease extent as assessed by chest CT was associated with the GA-T time. On multiple regression analysis, the SIIIN₂ and HAQ-DI were the only predictors of the GA-T time, explaining 40% of its variability. Thus, ventilation distribution heterogeneity and worse physical function substantially explain the variability in GA-T time in women with RA and varying extents of disease on chest CT.

Impact of thumb osteoarthritis on pain, function, and quality of life: a comparative study between erosive and non-erosive hand osteoarthritis

OBJECTIVE

The study was aimed to compare the impact of thumb base osteoarthritis (TBOA) on pain, function, and quality of life in patients with erosive or non-erosive hand osteoarthritis (HOA).

METHODS

This observational retrospective study included 232 patients: 64 with erosive HOA (EHOA) and concomitant TBOA, 36 with isolated EHOA, 97 with non-erosive HOA (non-EHOA) and TBOA, and 35 with isolated non-EHOA. Hand pain by a visual analogue scale (VAS), Functional Index for Hand Osteoarthritis (FIHOA) score, Health Assessment Questionnaire (HAQ), the Medical Outcomes Study 36-Item Short Form (SF-36), and the possible correlations between VAS and FIHOA with radiological score were assessed.

RESULTS

No differences were found between EHOA with TBOA and isolated EHOA in VAS and FIHOA scores; opposite, there was a significant difference in VAS (p < 0.01) and FIHOA (p < 0.001) between subjects with non-EHOA and TBOA and patients with only non-EHOA. VAS and FIHOA values resulted slightly higher in patients with EHOA and TBOA vs non-EHOA and TBOA; they were significantly more elevated in EHOA and TBOA group compared to isolated non-EHOA (p ≤ 0.001) and in isolated EHOA vs isolated non-EHOA (p < 0.01 and p < 0.001, respectively). HAQ, SF-36 resulted significantly better in isolated non-EHOA patients compared to the other groups. Finally, we observed a significant correlation between FIHOA and all the Kallman scales in EHOA patients with TBOA and between FIHOA and Kallman's thumb score in non-EHOA-TBOA group.

CONCLUSIONS

EHOA has a more severe clinical burden than non-EHOA; the presence of TBOA appeared an important determinant of pain and disability in non-EHOA.Key Points• Each subset of HOA can have a different impact on pain and functionality, with EHOA determining more severe effects on hand symptoms and disability than non-EHOA.• The presence of TBOA appeared an important determinant of pain and disability in non-EHOA, but not in EHOA.• Our findings support the need for an individualized therapy for each phenotype of hand osteoarthritis.

Sarcopenia in osteoarthritis and rheumatoid arthritis: The association with self-reported fatigue, physical function and obesity

AIM

To determine if there is an association between sarcopenia, physical function and self-reported fatigue in osteoarthritis (OA) and rheumatoid arthritis (RA).

METHODS

A cross-sectional analysis of measurements from a cohort of 157 participants with OA or RA was performed. The relationship between muscle mass (appendicular muscle index (AMI)), physical function (timed up and go, 30-seconds sit-to-stand test, 40-meter fast-paced walk test and grip-strength) and two fatigue measures (Multidimensional Assessment of Fatigue (MAF) and a fatigue Visual Analogue Scale (VAS)) was explored using hierarchical linear regression or logistic regression with established AMI cut-offs for sarcopenia.

RESULTS

There were no significant differences for perceived fatigue-related variables between OA or RA sarcopenic or non-sarcopenic participants. Participants with OA had worse physical function (TUG; P = 0.029, STS; P = 0.004, WS; P = 0.003), but participants with RA had lower grip strength (P<0.001). The RA group had higher CRP (P = 0.006), were more likely to receive glucocorticoids (P<0.001), and experienced worse fatigue (P = 0.050). The hierarchical multiple regression showed that self-reported fatigue (VAS/MAF-distress) had a significant but weak association with AMI in RA. Participants with higher percentage body fat had a significantly stronger association with sarcopenia in both OA and RA.

CONCLUSION

Sarcopenia, when assessed by AMI, does not appear to be strongly associated with self-reported fatigue or physical function in participants with either OA or RA. Higher body fat had a moderately strong association with sarcopenia in this cross-sectional study, suggesting that body composition may be an important factor in the health of patients with longstanding OA or RA.