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Dinas PC, Moe RH, Boström C, Kosti RI, Kitas GD, Metsios GS. Combined Effects of Diet and Physical Activity on Inflammatory Joint Disease: A Systematic Review and Meta-Analysis. Healthcare (Basel) 2023; 11:healthcare11101427. [PMID: 37239713 DOI: 10.3390/healthcare11101427] [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: 03/29/2023] [Revised: 05/09/2023] [Accepted: 05/11/2023] [Indexed: 05/28/2023] Open
Abstract
Research evidence suggests that, individually, diet and physical activity are effective interventions for reducing levels of inflammation in inflammatory joint diseases (IJD), however little is known about their combined use. This systematic review and meta-analysis aimed to examine the effects and/or associations of combined diet and physical activity interventions in IJD, specifically rheumatoid arthritis (RA) and the spondyloarthropathies (SpA) (PROSPERO registration number: CRD42022370993). Ten out of 11 eligible studies examined RA patients. We found that a combination of diet/nutrition and physical activity/exercise improved Health Assessment Questionnaire score (standardized mean difference = -1.36, confidence interval (CI) = (-2.43)-(-0.30), I2 = 90%, Z = 2.5, p = 0.01), while surprisingly they increased erythrocyte sedimentation rate (mean difference = 0.20, CI = 0.09-0.31, I2 = 0%, Z = 3.45, p < 0.01). No effects were found on C-reactive protein or weight (p > 0.05) of RA patients. We did not find studies in other IJDs that provided sufficient data for a meta-analysis. The narrative data synthesis provided limited evidence to address our research question. No firm conclusions can be made as to whether the combination of diet/nutrition and physical activity/exercise affects inflammatory load in IJDs. The results of this study can only be used as a means of highlighting the low-quality evidence in this field of investigation and the need for further and better-quality research.
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Affiliation(s)
- Petros C Dinas
- Department of Nutrition and Dietetics, School of Physical Education, Sport Science and Dietetics, University of Thessaly, 42130 Trikala, Greece
- FAME Laboratory, School of Physical Education, Sport Science and Dietetics, University of Thessaly, 42131 Trikala, Greece
| | - Rikke Helene Moe
- National Resource Centre for Rehabilitation in Rheumatology, Department of Rheumatology, Diakonhjemmet Hospital, 0370 Oslo, Norway
| | - Carina Boström
- Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, 14183 Huddinge, Sweden
| | - Rena I Kosti
- Department of Nutrition and Dietetics, School of Physical Education, Sport Science and Dietetics, University of Thessaly, 42130 Trikala, Greece
| | - George D Kitas
- Dudley Group of Hospitals NHS Foundation Trust, Department of Rheumatology, Russells Hall Hospital, Dudley DY1 2HQ, UK
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham B15 2SQ, UK
| | - George S Metsios
- Department of Nutrition and Dietetics, School of Physical Education, Sport Science and Dietetics, University of Thessaly, 42130 Trikala, Greece
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Efthymiou E, Grammatikopoulou MG, Gkiouras K, Efthymiou G, Zafiriou E, Goulis DG, Sakkas LI, Bogdanos DP. Time to Deal with Rheumatoid Cachexia: Prevalence, Diagnostic Criteria, Treatment Effects and Evidence for Management. Mediterr J Rheumatol 2022; 33:271-290. [PMID: 36531417 PMCID: PMC9727471 DOI: 10.31138/mjr.33.3.271] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 06/25/2022] [Accepted: 07/15/2022] [Indexed: 11/27/2022] Open
Abstract
Cachexia is an early result of rheumatoid arthritis (RA) (rheumatoid cachexia, RC), characterised mainly by involuntary loss of fat-free mass. RC is apparent in 1-67% of patients with RA, depending on the diagnostic criteria applied and the method used for the assessment of body composition. RC is associated with increased inflammation and disability, lower health perception, and greater mortality risk. These changes in body composition are driven by the inflammation process, the low levels of physical activity, the underlying testosterone deficiency and hypogonadism, and the pharmacotherapy required for RA. Chronic inflammation enhances resting energy expenditure as a response to stress, inducing an energy deficit, further propelling protein turnover. The use of corticosteroids and tumour necrosis factor α (TNF-α) inhibitors tend to increase fat accumulation, whereas other disease-modifying antirheumatic drugs (DMARDs) appear to induce increments in fat-free mass. The present review presents all information regarding the prevalence of RC, diagnostic criteria, and comorbidities, as well as the effects of pharmacotherapy and medical nutrition therapy on body composition of patients with RA.
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Affiliation(s)
- Elisavet Efthymiou
- Department of Nutritional Sciences & Dietetics, Faculty of Health Sciences, International Hellenic University, Alexander Campus, Sindos, Thessaloniki, Greece
| | - Maria G. Grammatikopoulou
- Department of Rheumatology and Clinical Immunology, Faculty of Medicine, University General Hospital of Larissa, School of Health Sciences, University of Thessaly, Larissa, Greece
| | - Konstantinos Gkiouras
- Department of Rheumatology and Clinical Immunology, Faculty of Medicine, University General Hospital of Larissa, School of Health Sciences, University of Thessaly, Larissa, Greece
| | - Georgios Efthymiou
- Department of Rheumatology and Clinical Immunology, Faculty of Medicine, University General Hospital of Larissa, School of Health Sciences, University of Thessaly, Larissa, Greece
| | - Efterpi Zafiriou
- Department of Dermatology, Faculty of Medicine, School of Health Sciences, University of Thessaly, Biopolis, Larissa, Greece
| | - Dimitrios G. Goulis
- Unit of Reproductive Endocrinology, 1st Department of Obstetrics and Gynecology, Medical School, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Lazaros I. Sakkas
- Department of Rheumatology and Clinical Immunology, Faculty of Medicine, University General Hospital of Larissa, School of Health Sciences, University of Thessaly, Larissa, Greece
| | - Dimitrios P. Bogdanos
- Department of Rheumatology and Clinical Immunology, Faculty of Medicine, University General Hospital of Larissa, School of Health Sciences, University of Thessaly, Larissa, Greece
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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.
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Ajeganova S, Andersson MLE, Frostegård J, Hafström I. Higher levels of anti-phosphorylcholine autoantibodies in early rheumatoid arthritis indicate lower risk of incident cardiovascular events. Arthritis Res Ther 2021; 23:201. [PMID: 34311770 PMCID: PMC8314464 DOI: 10.1186/s13075-021-02581-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Accepted: 07/15/2021] [Indexed: 12/21/2022] Open
Abstract
Background The increased risk of cardiovascular events (CVE) in rheumatoid arthritis (RA) is not fully explained by traditional risk factors. Immuno-inflammatory mechanisms and autoantibodies could be involved in the pathogenesis of atherosclerotic disease. It has been suggested that anti-phosphorylcholine antibodies (anti-PC) of the IgM subclass may have atheroprotective effects. Here, we aimed to investigate the association between levels of IgM anti-PC antibodies with CVE in patients with early RA. Methods The study population was derived from the BARFOT early RA cohort, recruited in 1994–1999. The outcome of incident CVE (AMI, angina pectoris, coronary intervention, ischemic stroke, TIA) was tracked through the Swedish Hospital Discharge and the National Cause of Death Registries. Sera collected at inclusion and the 2-year visit were analyzed with ELISA to determine levels of anti-PC IgM. The Kaplan-Meier estimates and Cox proportional hazards regression models were used to compare CV outcome in the groups categorized by baseline median level of IgM anti-PC. Results In all, 653 patients with early RA, 68% women, mean (SD) age 54.8 (14.7) years, DAS28 5.2 (1.3), 68% seropositive, and without prevalent CVD, were included. During the follow-up of mean 11.7 years, 141 incident CVE were recorded. Baseline IgM anti-PC above median was associated with a reduction in risk of incident CVE in patients aged below 55 years at inclusion, HR 0.360 (95% CI, 0.142–0.916); in males, HR 0.558 (0.325–0.958); in patients with BMI above 30 kg/m2, HR 0.235 (0.065–0.842); and in those who did not achieve DAS28 remission at 1 year, HR 0.592 (0.379–0.924). The pattern of associations was confirmed in the models with AUC IgM anti-PC over 2 years. Conclusion Protective effects of higher levels of innate IgM anti-PC autoantibodies on CVE were detected in younger patients with RA and those at high risk of CVE: males, presence of obesity, and non-remission at 1 year.
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Affiliation(s)
- Sofia Ajeganova
- Division of Gastroenterology and Rheumatology, Department of Medicine Huddinge, Karolinska Institutet, 171 77, Stockholm, Sweden. .,Department of Clinical Sciences, Rheumatology Division, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium.
| | - Maria L E Andersson
- Faculty of Medicine, Department of Rheumatology, Lund University, Lund and Spenshult Research and Development Centre, Halmstad, Sweden
| | - Johan Frostegård
- Section of Immunology and Chronic disease, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Ingiäld Hafström
- Division of Gastroenterology and Rheumatology, Department of Medicine Huddinge, Karolinska Institutet, 171 77, Stockholm, Sweden.,Rheumatology Unit, Karolinska University Hospital, Stockholm, Sweden
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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] [Grants] [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.
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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
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Gavilán-Carrera B, Acosta-Manzano P, Soriano-Maldonado A, Borges-Cosic M, Aparicio VA, Delgado-Fernández M, Segura-Jiménez V. Sedentary Time, Physical Activity, and Sleep Duration: Associations with Body Composition in Fibromyalgia. The Al-Andalus Project. J Clin Med 2019; 8:jcm8081260. [PMID: 31434259 PMCID: PMC6722714 DOI: 10.3390/jcm8081260] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Revised: 08/14/2019] [Accepted: 08/16/2019] [Indexed: 12/16/2022] Open
Abstract
To explore the individual–independent relationships of sedentary time (ST) and physical activity (PA) (light and moderate-to-vigorous intensity (MVPA)), with sleep duration and body composition (waist circumference, body mass index (BMI), body fat percentage, and muscle mass index) in women with fibromyalgia, and to determine whether these associations are independent of physical fitness. This cross-sectional study involved 385 women with fibromyalgia. ST and PA were assessed by triaxial accelerometry, sleep duration was self-reported. Waist circumference was measured using an anthropometric tape, and body weight, body fat percentage, and muscle mass were estimated using a bio-impedance analyzer. In individual regression models, ST and sleep were directly associated with waist circumference, BMI, and body fat percentage (β between 0.10 and 0.25; all p < 0.05). Light PA and MVPA were inversely associated with waist circumference, BMI, and body fat percentage (β between −0.23 and −0.12; all p < 0.05). In multiple linear regression models, ST (β between 0.17 and 0.23), light PA (β between −0.16 and −0.21), and sleep duration (β between 0.11 and 0.14) were independently associated with waist circumference, BMI, and body fat percentage (all p < 0.05). MVPA was associated with waist circumference independent of light physical activity (LPA) and sleep duration (β = −0.11; p < 0.05). Except for MVPA, these associations were independent of physical fitness. These results suggest that longer ST and sleep duration, and lower PA levels (especially light intensity PA), are independently associated with greater adiposity, but not muscle mass, in women with fibromyalgia. These associations are, overall, independent of physical fitness.
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Affiliation(s)
- Blanca Gavilán-Carrera
- PA-HELP "Physical Activity for Health Promotion, CTS-1018" Research Group, Department of Physical Education and Sports, Faculty of Sport Sciences, University of Granada, 18011 Granada, Spain.
- Sport and Health University Research Institute, University of Granada, 18016 Granada, Spain.
| | - Pedro Acosta-Manzano
- PA-HELP "Physical Activity for Health Promotion, CTS-1018" Research Group, Department of Physical Education and Sports, Faculty of Sport Sciences, University of Granada, 18011 Granada, Spain.
- Sport and Health University Research Institute, University of Granada, 18016 Granada, Spain.
| | - Alberto Soriano-Maldonado
- SPORT Research Group (CTS-1024), CERNEP Research Center, University of Almería, 04120 Almería, Spain
- Department of Education, Faculty of Education Sciences, University of Almería, 04120 Almería, Spain
| | - Milkana Borges-Cosic
- PA-HELP "Physical Activity for Health Promotion, CTS-1018" Research Group, Department of Physical Education and Sports, Faculty of Sport Sciences, University of Granada, 18011 Granada, Spain
- Sport and Health University Research Institute, University of Granada, 18016 Granada, Spain
| | - Virginia A Aparicio
- Department of Physiology, Faculty of Pharmacy and Institute of Nutrition and Food Technology, University of Granada, 18011 Granada, Spain
| | - Manuel Delgado-Fernández
- PA-HELP "Physical Activity for Health Promotion, CTS-1018" Research Group, Department of Physical Education and Sports, Faculty of Sport Sciences, University of Granada, 18011 Granada, Spain
- Sport and Health University Research Institute, University of Granada, 18016 Granada, Spain
| | - Víctor Segura-Jiménez
- Department of Physical Education, Faculty of Education Sciences, University of Cádiz, 11519 Cádiz, Spain
- Biomedical Research and Innovation Institute of Cádiz (INiBICA) Research Unit, Puerta del Mar University Hospital University of Cádiz, 11009 Cádiz, Spain
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Summers G, Booth A, Brooke-Wavell K, Barami T, Clemes S. Physical activity and sedentary behavior in women with rheumatoid arthritis: a comparison of patients with low and high disease activity and healthy controls. Open Access Rheumatol 2019; 11:133-142. [PMID: 31417323 PMCID: PMC6592056 DOI: 10.2147/oarrr.s203511] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2019] [Accepted: 03/26/2019] [Indexed: 11/25/2022] Open
Abstract
Objective: In rheumatoid arthritis (RA) patients, low levels of physical activity (PA) and high levels of sedentary behavior (SB) may play a role in enhancing cardiovascular risk. We do not know how long-term control of disease activity impacts upon daily PA levels and if treated patients attain PA levels seen in healthy controls. We therefore compared habitual levels of PA and SB between female RA patients with low disease activity achieved by anti-tumor necrosis factor (TNF) therapy, those with active arthritis (aRA) and non-RA controls. Methods: We carried out a cross-sectional comparison of 40 RA patients on anti-TNF therapy for >2 years with DAS28<3.2 (tRA), 32 patients on conventional disease modifying anti-rheumatic drugs with DAS28>3.2 (aRA) and 34 healthy controls (C) with the groups matched for age and body mass index. PA was assessed using the ActiGraph accelerometer to determine step count and time spent in moderate-to-vigorous physical activity (MVPA), light activity and sedentary time. Results: Daily step count was 72% higher in tRA and 40% higher in C in comparison to aRA (p<0.01). Sedentary time (as a proportion of wear time) was 10% less in tRA than aRA (p=0.03), while light activity time was 18% higher (p=0.014). Both RA groups had 40% lower MVPA time than C (p=0.001). Only half of either RA group fulfilled current WHO guidelines for PA compared with 82% of controls. Conclusion: RA patients who had long-term disease suppression were more physically active with less SB compared to RA patients with active disease. They had similar light PA and SB to controls although lower MVPA. Behavioral change interventions are likely to be needed in order to restore moderate exercise, further reduce SB and to meet guidelines for daily PA.
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Affiliation(s)
| | - Alison Booth
- Department of Rheumatology, Royal Derby Hospital, Derby, UK
| | | | - Tharaq Barami
- Department of Rheumatology, Royal Derby Hospital, Derby, UK.,Kettering General Hospital , Kettering, UK
| | - Stacy Clemes
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
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Systemic Inflammatory Response and Atherosclerosis: The Paradigm of Chronic Inflammatory Rheumatic Diseases. Int J Mol Sci 2018; 19:ijms19071890. [PMID: 29954107 PMCID: PMC6073407 DOI: 10.3390/ijms19071890] [Citation(s) in RCA: 106] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Revised: 06/17/2018] [Accepted: 06/20/2018] [Indexed: 12/17/2022] Open
Abstract
Patients with Chronic Inflammatory Rheumatic diseases (CIRD) are at increased risk of cardiovascular disease (CVD), ascribed not only to classical risk factors, but also to the presence of chronic systemic inflammatory response. Αtherosclerosis, the cornerstone of CVD, is known to be accelerated in CIRD; rheumatoid arthritis promotes atheromatosis and associates with preclinical atherosclerosis equivalent to Diabetes Mellitus, which also seems to apply for systemic lupus erythematosus. Data on ankylosing spondylitis and psoriatic arthritis, albeit more limited, also support an increased CV risk in these patients. The association between inflammation and atherosclerosis, has been thoroughly investigated in the last three decades and the role of inflammation in the pathogenesis and progression of atherogenesis has been well established. Endothelial dysfunction, oxidative stress in vascular endothelial cells and macrophage accumulation, toll-like receptor signaling, NLPR-3 formation and subsequent pro-inflammatory cytokine production, such as TNFa, IL-1β, IL-6, and TNF-like cytokine 1A, are few of the mechanisms implicated in the atherogenic process. Moreover, there is evidence that anti-inflammatory biologic drugs, such as anti-TNF and anti-IL1β agents, can decelerate the atherogenic process, thus setting new therapeutic targets for early and effective disease control and suppression of inflammation, in addition to aggressive management of classical CV risk factors.
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Iversen MD, Frits M, von Heideken J, Cui J, Weinblatt M, Shadick NA. Physical Activity and Correlates of Physical Activity Participation Over Three Years in Adults With Rheumatoid Arthritis. Arthritis Care Res (Hoboken) 2017; 69:1535-1545. [PMID: 27863147 DOI: 10.1002/acr.23156] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Revised: 10/26/2016] [Accepted: 11/15/2016] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To characterize physical activity participation (moderate-to-vigorous physical activity [MVPA], ≥150 minutes of moderate physical activity or 75 minutes of vigorous physical activity per week), to examine associations between disease activity and MVPA, and to identify MVPA correlates in adults with rheumatoid arthritis (RA) over 3 years. METHODS This study included 573 RA patients (94% white, 83% female, mean age 61 years, mean RA duration 19.5 years) with ≥1 annual registry visit and who completed the physical activity questionnaire. Baseline and annual measures included demographics/medical history, self-efficacy for disease management, quality of life, patient/physician global assessment, physical function, and self-reported physical activity. A logistic repeated-measures model using the generalized estimating equation examined the relationship between disease activity and MVPA. RESULTS Average disease activity (from the 3-variable Disease Activity Score in 28 joints using the C-reactive protein level) was mean ± SD 3.1 ± 1.4, 36% were physically inactive, and 29% met MVPA recommendations. There was a negative borderline association with disease activity (odds ratio [OR] 0.89 [95% confidence interval (95% CI) 0.79-1.00]). Correlates of meeting MVPA recommendations, adjusting for disease activity, were being white (OR 2.95 [95% CI 1.29-6.75]), older age (ages >69 years OR 0.58 [95% CI 0.36-0.92]), poor mental health (OR 0.63 [95% CI 0.41-0.95]), poor physical function (OR 0.59 [95% CI 0.34-1.01]), overweight/obese (body mass index [BMI] >25-30 OR 0.69 [95% CI 0.50-0.95], BMI >30-39.9 OR 0.60 [95% CI 0.41-0.88], and BMI ≤40 OR 0.24 [95% CI 0.08-0.74]), and patient global assessment (≥10-20 OR 0.57 [95% CI 0.39-0.83]). CONCLUSION A small proportion of patients met MVPA recommendations despite well-controlled disease. Disease activity was negatively associated with physical activity over time. Physical activity correlates were linked to lifestyle, mental health, and patient perceptions of disease, suggesting physical activity interventions that address patient perspectives may facilitate RA management.
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Affiliation(s)
- Maura D Iversen
- Northeastern University, Brigham and Women's Hospital, and Harvard Medical School, Boston, Massachusetts, and Karolinska Institutet, Stockholm, Sweden
| | | | | | - Jing Cui
- Brigham and Women's Hospital, Boston, Massachusetts
| | - Michael Weinblatt
- Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Nancy A Shadick
- Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
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11
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Pinto AJ, Roschel H, de Sá Pinto AL, Lima FR, Pereira RMR, Silva CA, Bonfá E, Gualano B. Physical inactivity and sedentary behavior: Overlooked risk factors in autoimmune rheumatic diseases? Autoimmun Rev 2017; 16:667-674. [PMID: 28479487 DOI: 10.1016/j.autrev.2017.05.001] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2017] [Accepted: 03/15/2017] [Indexed: 12/17/2022]
Abstract
This review aims to (1) summarize the estimates of physical inactivity and sedentary behavior in autoimmune rheumatic diseases; (2) describe the relationship between physical (in)activity levels and disease-related outcomes; (3) contextualize the estimates and impact of physical inactivity and sedentary behavior in autoimmune diseases compared to other rheumatic diseases and chronic conditions; and (4) discuss scientific perspectives around this theme and potential clinical interventions to attenuate these preventable risk factors. We compiled evidence to show that estimates of physical inactivity and sedentary behavior in autoimmune rheumatic diseases are generally comparable to other rheumatic diseases as well as to other chronic conditions (e.g., type 2 diabetes, cardiovascular diseases, and obesity), in which a lack of physical activity and excess of sedentary behavior are well-known predictors of morbimortality. In addition, we also showed evidence that both physical inactivity and sedentary behavior may be associated with poor health-related outcomes (e.g., worse disease symptoms and low functionality) in autoimmune rheumatic diseases. Thus, putting into practice interventions to make the patients "sit less and move more", particularly light-intensity activities and/or breaking-up sedentary time, is a simple and prudent therapeutic approach to minimize physical inactivity and sedentary behavior, which are overlooked yet modifiable risk factors in the field of autoimmune rheumatic diseases.
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Affiliation(s)
- Ana Jéssica Pinto
- Applied Physiology and Nutrition Research Group, Universidade de Sao Paulo, Av. Professor Mello Moraes, 65 - Cidade Universitaria, Sao Paulo/SP 05508-030, Brazil; Rheumatology Division, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Rua Dr. Ovídio Pires de Campos, 225 - Cerqueira Cesar, Sao Paulo/SP 05403-010, Brazil.
| | - Hamilton Roschel
- Applied Physiology and Nutrition Research Group, Universidade de Sao Paulo, Av. Professor Mello Moraes, 65 - Cidade Universitaria, Sao Paulo/SP 05508-030, Brazil; Rheumatology Division, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Rua Dr. Ovídio Pires de Campos, 225 - Cerqueira Cesar, Sao Paulo/SP 05403-010, Brazil.
| | - Ana Lúcia de Sá Pinto
- Rheumatology Division, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Rua Dr. Ovídio Pires de Campos, 225 - Cerqueira Cesar, Sao Paulo/SP 05403-010, Brazil.
| | - Fernanda Rodrigues Lima
- Rheumatology Division, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Rua Dr. Ovídio Pires de Campos, 225 - Cerqueira Cesar, Sao Paulo/SP 05403-010, Brazil.
| | - Rosa Maria Rodrigues Pereira
- Rheumatology Division, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Rua Dr. Ovídio Pires de Campos, 225 - Cerqueira Cesar, Sao Paulo/SP 05403-010, Brazil.
| | - Clovis Artur Silva
- Rheumatology Division, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Rua Dr. Ovídio Pires de Campos, 225 - Cerqueira Cesar, Sao Paulo/SP 05403-010, Brazil.
| | - Eloisa Bonfá
- Rheumatology Division, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Rua Dr. Ovídio Pires de Campos, 225 - Cerqueira Cesar, Sao Paulo/SP 05403-010, Brazil.
| | - Bruno Gualano
- Applied Physiology and Nutrition Research Group, Universidade de Sao Paulo, Av. Professor Mello Moraes, 65 - Cidade Universitaria, Sao Paulo/SP 05508-030, Brazil; Rheumatology Division, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Rua Dr. Ovídio Pires de Campos, 225 - Cerqueira Cesar, Sao Paulo/SP 05403-010, Brazil.
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12
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Biomarkers associated with sedentary behaviour in older adults: A systematic review. Ageing Res Rev 2017; 35:87-111. [PMID: 28025174 DOI: 10.1016/j.arr.2016.12.002] [Citation(s) in RCA: 61] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2016] [Revised: 10/30/2016] [Accepted: 12/12/2016] [Indexed: 01/13/2023]
Abstract
OBJECTIVE Pathomechanisms of sedentary behaviour (SB) are unclear. We conducted a systematic review to investigate the associations between SB and various biomarkers in older adults. METHODS Electronic databases were searched (MEDLINE, EMBASE, CINAHL, AMED) up to July 2015 to identify studies with objective or subjective measures of SB, sample size ≥50, mean age ≥60years and accelerometer wear time ≥3days. Methodological quality was appraised with the CASP tool. The protocol was pre-specified (PROSPERO CRD42015023731). RESULTS 12701 abstracts were retrieved, 275 full text articles further explored, from which 249 were excluded. In the final sample (26 articles) a total of 63 biomarkers were detected. Most investigated markers were: body mass index (BMI, n=15), waist circumference (WC, n=15), blood pressure (n=11), triglycerides (n=12) and high density lipoprotein (HDL, n=15). Some inflammation markers were identified such as interleukin-6, C-reactive protein or tumor necrosis factor alpha. There was a lack of renal, muscle or bone biomarkers. Randomized controlled trials found a positive correlation for SB with BMI, neck circumference, fat mass, HbA1C, cholesterol and insulin levels, cohort studies additionally for WC, leptin, C-peptide, ApoA1 and Low density lipoprotein and a negative correlation for HDL. CONCLUSION Most studied biomarkers associated with SB were of cardiovascular or metabolic origin. There is a suggestion of a negative impact of SB on biomarkers but still a paucity of high quality investigations exist. Longitudinal studies with objectively measured SB are needed to further elucidate the pathophysiological pathways and possible associations of unexplored biomarkers.
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Pope JE, Nevskaya T, Barra L, Parraga G. Carotid Artery Atherosclerosis in Patients with Active Rheumatoid Arthritis: Predictors of Plaque Occurrence and Progression Over 24 Weeks. Open Rheumatol J 2016; 10:49-59. [PMID: 27857821 PMCID: PMC5093864 DOI: 10.2174/1874312901610010049] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2016] [Revised: 08/30/2016] [Accepted: 09/04/2016] [Indexed: 01/16/2023] Open
Abstract
Introduction: This study evaluated the prevalence and progression of subclinical carotid artery atherosclerosis in active rheumatoid arthritis (RA). Methods: Carotid arteries of RA patients were scanned using 3D ultrasound at baseline and 24 weeks for total plaque area, vessel wall volume, and intima-media thickness (IMT), as well as arterial stiffness measured using pulse wave velocity. Variables related to inflammation, lipids and cardiovascular (CV) risk were assessed for associations with plaque progression. Of 195 screened patients, 31 met inclusion criteria (66 Swollen joint count (SJC) plus 68 Tender joint count (TJC)≥8 OR SJC plus TJC≥4 with elevated acute phase reactants) and were enrolled (27 female; mean age 59.3±9.8years). Patients using lipid lowering drugs and uncontrolled comorbidities were excluded. Results: Atherosclerotic plaque occurred in 35% and arterial wall hypertrophy (IMT≥0.6mm) in 86% of patients. Most (68%) had an abnormal lipid profile characterized by reduced HDL and/or increased total cholesterol/HDL index, which was adversely affected by disease activity. Stepwise binary logistic regression analysis showed that Framingham risk score (OR=1.155, 95%CI:1.002-1.332, p=0.046) and ESR (OR=1.148, 95%CI:1.015-1.299, p=0.028) predicted plaque burden most strongly. Plaque progression was significantly associated with baseline higher hsCRP, ESR, and heavy smoking, but only hsCRP predicted plaque growth in multivariate regression analysis (p=0.004); and hsCRP was related to higher disease activity (r=0.443, p=0.016), LDL (r=0.544, p=0.007), and smoking (r=0.384, p=0.04). Conclusion: RA-related inflammation contributed to augmented CV burden in RA and might mediate its effect on atherosclerosis through hsCRP and modulation of the traditional CV risk factors, such as dyslipidemia.
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Affiliation(s)
- Janet E Pope
- Schulich School of Medicine & Dentistry, Western University, Rheumatology, St. Joseph's Hospital 268 Grosvenor Street London, Ontario, N6A 4V2, Canada
| | - Tatiana Nevskaya
- Schulich School of Medicine & Dentistry, Western University, Rheumatology, St. Joseph's Hospital 268 Grosvenor Street London, Ontario, N6A 4V2, Canada
| | - Lillian Barra
- Schulich School of Medicine & Dentistry, Western University, Rheumatology, St. Joseph's Hospital 268 Grosvenor Street London, Ontario, N6A 4V2, Canada
| | - Grace Parraga
- Schulich School of Medicine & Dentistry, Western University, Robarts Research Institute,1151 Richmond St. N., London, Ontario, N6A 5B7, Canada
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14
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Hernández-Hernández MV, Díaz-González F. Role of physical activity in the management and assessment of rheumatoid arthritis patients. ACTA ACUST UNITED AC 2016; 13:214-220. [PMID: 27263964 DOI: 10.1016/j.reuma.2016.04.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2015] [Revised: 03/18/2016] [Accepted: 04/04/2016] [Indexed: 12/19/2022]
Abstract
OBJECTIVES Rheumatoid arthritis (RA) is a chronic inflammatory disease affecting diarthrodial joints, in which patients tend to perform less physical activity (PA) than recommended. This review focuses on the existing evidence about the relationship of PA and RA, specifically how the former influences joint inflammation, disability, quality of life and pain in RA patients, and also how disease activity potentially impacts PA in these patients. METHODS A literature search of EMBASE and MEDLINE databases from January 2000 to January 2015. RESULTS The evidence indicating that PA in RA patients is safe and the benefits from regularly performing, both aerobic and resistance exercises, in these patients include improvement in: quality of life, functionality, pain and number of swollen joints. Interestingly, recent studies suggest that changes in disease activity in RA patients inversely correlate with variations in PA, as assessed by accelerometry. CONCLUSIONS The regular monitoring of PA in RA patients might facilitate a more objective evaluation of variations in disease activity, helping physicians to make general and therapeutic recommendations that will improve both the health status and the joint functionality of these patients.
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Affiliation(s)
| | - Federico Díaz-González
- Servicio de Reumatología, Hospital Universitario de Canarias, La Laguna, Spain; Departamento de Medicina Interna, Facultad de Medicina, Universidad de La Laguna, La Laguna, Spain.
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15
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Manrique-Arija S, Ureña I, Valdivielso P, Rioja J, Jiménez-Núñez FG, Irigoyen MV, Fernández-Nebro A. Insulin resistance and levels of adipokines in patients with untreated early rheumatoid arthritis. Clin Rheumatol 2015; 35:43-53. [PMID: 26526677 PMCID: PMC4710654 DOI: 10.1007/s10067-015-3106-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2015] [Revised: 10/03/2015] [Accepted: 10/21/2015] [Indexed: 01/02/2023]
Abstract
The aim of this study is to investigate the presence of insulin resistance (IR) in patients with untreated early rheumatoid arthritis (ERA) and its relationship with adipokines, inflammatory cytokines, and treatment. In this prospective study, we enrolled 46 ERA patients with a disease duration of <1 year, and 45 sex-, age-, race-, and body mass index (BMI)-matched controls. Patients and controls with diabetes or a history of glucocorticoid (GC) or disease-modifying antirheumatic drugs (DMARDs) use were excluded. Patients were assessed at the time of diagnosis (visit 1) and after 6 months of treatment (visit 2). The main outcomes were homeostatic model assessment of IR (HOMA-IR) and β-cell function (HOMA-β) and quantitative insulin sensitivity check index (QUICKI). A multivariate regression analysis was performed to analyze IR adjusting according to lipids, body composition, physical activity, nutrition, and inflammatory cytokine and adipokine levels. The baseline HOMA-IR, HOMA-β, and QUICKI values were similar in both groups. However, patients showed lower levels of physical activity, total cholesterol, and high-density lipoprotein. Moreover, the inflammatory cytokines and resistin concentrations were higher in patients than controls. Multivariate analysis indicated that BMI and baseline rheumatoid factor levels were positively associated with HOMA-IR and HOMA-β, and negatively with QUICKI. After DMARD treatment, patients showed improvements in inflammatory parameters and lipids whereas IR remained stable. Furthermore, adiponectin and resistin concentrations decreased slightly. Our data suggest that IR is not present in ERA patients either at diagnosis or at 6 months after treatment. However, symptom duration and fat mass appear to be related.
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Affiliation(s)
- Sara Manrique-Arija
- UGC de Reumatología, Instituto de Investigación Biomédica de Málaga (IBIMA), Hospital Regional Universitario de Málaga, Universidad de Málaga, Málaga, Spain
| | - Inmaculada Ureña
- UGC de Reumatología, Instituto de Investigación Biomédica de Málaga (IBIMA), Hospital Regional Universitario de Málaga, Universidad de Málaga, Málaga, Spain
| | - Pedro Valdivielso
- UGC de Medicina Interna, Instituto de Investigación Biomédica de Málaga (IBIMA), Hospital Universitario Virgen de la Victoria, Universidad de Málaga, Málaga, Spain
| | - José Rioja
- Departamento de Medicina y Dermatología, Instituto de Investigación Biomédica de Málaga (IBIMA), Universidad de Málaga, Málaga, Spain
| | - Francisco G Jiménez-Núñez
- UGC de Reumatología, Instituto de Investigación Biomédica de Málaga (IBIMA), Hospital Regional Universitario de Málaga, Universidad de Málaga, Málaga, Spain
| | - María V Irigoyen
- UGC de Reumatología, Instituto de Investigación Biomédica de Málaga (IBIMA), Hospital Regional Universitario de Málaga, Universidad de Málaga, Málaga, Spain
| | - Antonio Fernández-Nebro
- UGC de Reumatología, Instituto de Investigación Biomédica de Málaga (IBIMA), Hospital Regional Universitario de Málaga, Universidad de Málaga, Málaga, Spain.
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Cachexia and adiposity in rheumatoid arthritis. Relevance for disease management and clinical outcomes. Joint Bone Spine 2015; 83:127-33. [PMID: 26184539 DOI: 10.1016/j.jbspin.2015.04.010] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2015] [Accepted: 04/19/2015] [Indexed: 12/18/2022]
Abstract
Altered body composition is a frequent finding in rheumatoid arthritis and is associated with the two major outcomes of the disease: disability and cardiovascular mortality. It is estimated that up to two thirds of patients may be affected by loss of lean mass, the so-called rheumatoid cachexia. Hence, body weight being equal, the relative amount of lean mass is lower and that of body fat is higher in rheumatoid arthritis patients vs. healthy controls. Both disease-related factors and other factors, like drug treatments, physical activity and nutrition contribute to modify body composition in rheumatoid arthritis. The effect of pharmacological treatments, and notably of anti-TNF drugs, on body composition is controversial. Conversely, training programs to stimulate muscle growth can restore lean mass and reduce adiposity. There is good evidence that amelioration of body composition ameliorates function and reduces disability. Currently, there is no evidence that interventions that modify body composition can reduce cardiovascular morbidity and mortality in rheumatoid arthritis.
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17
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Ormseth MJ, Stein CM. Is visceral fat the missing link in the relationship between inflammation and insulin resistance in RA? J Rheumatol 2014; 41:1906-9. [PMID: 25275092 DOI: 10.3899/jrheum.140780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
| | - C Michael Stein
- Division of Rheumatology, Department of Medicine and Division of Clinical Pharmacology, Department of Pharmacology, Vanderbilt University, Nashville, Tennessee, USA
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Demmelmaier I, Lindkvist Å, Nordgren B, Opava CH. "A gift from heaven" or "This was not for me". A mixed methods approach to describe experiences of participation in an outsourced physical activity program for persons with rheumatoid arthritis. Clin Rheumatol 2014; 34:429-39. [PMID: 24941928 DOI: 10.1007/s10067-014-2723-y] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2014] [Accepted: 06/07/2014] [Indexed: 12/27/2022]
Abstract
Most persons with rheumatoid arthritis (RA) do not perform health-enhancing physical activity (HEPA). Evaluations of innovative HEPA programs need to be complemented with descriptive and qualitative data from the users. The aim of this mixed methods study was to explore and describe how a subgroup of the RA population perceives participation during the first year of an outsourced 2-year HEPA program. Data were collected by a study-specific postal survey to 220 program participants (response rate 87%, n = 191) and by interviews with a purposefully selected subsample of 35, including completers and dropouts. The survey data were analyzed by descriptive statistics and the interviews by qualitative content analysis.The survey demonstrated increased self-reported physical activity in 165 participants (86%). After the first year of the program, participants reported having performed "regular" or "periodical" circuit training (78%) and physical activity in daily life (92%). The most valued program components were circuit training and physical activity in daily life, both rated median 5/5. Coach support, prompts by text messages, and expert lectures were rated median 4/5. Five categories emerged from the interviews describing expectations, facilitators, gains, maintenance, and obstacles/suggestions for improvement of the program. The results demonstrate that HEPA outside health care is highly appreciated by a subgroup of the RA population. Professional coaching and prompts by text messages seem to be particularly useful facilitators. Individual preferences emphasize the need to tailor settings, exercise formats, and behavioral support for HEPA even in a narrow, self-selected group with RA.
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Affiliation(s)
- Ingrid Demmelmaier
- Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden,
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19
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Uutela T, Kautiainen H, Järvenpää S, Salomaa S, Hakala M, Häkkinen A. Waist circumference based abdominal obesity may be helpful as a marker for unmet needs in patients with RA. Scand J Rheumatol 2014; 43:279-85. [PMID: 24467375 DOI: 10.3109/03009742.2013.858769] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVES To assess the impact of abdominal obesity (AO) on disease severity, cardiovascular risk factors, and patient-reported outcomes (PROs) in patients with rheumatoid arthritis (RA). METHOD Two hundred and thirty consecutive outpatients were cross-sectionally assessed. Waist circumference (WC) with a cut-off point of ≥ 102 cm in men and ≥ 88 cm in women indicated AO. Clinical assessment included joint counts, radiographs of small joints, and laboratory tests. Comorbidities and medication were verified from the patients' database. Patient questionnaires included sociodemographics, pain intensity, global disease activity, the Beck Depression Inventory (BDI), the Health Assessment Questionnaire (HAQ), physical activity level, and the 36-item Short Form Health Survey (SF-36). Metabolic syndrome (MetS) was defined according to the criteria of National Cholesterol Education Program (NCEP) Adult Treatment Panel III (ATP III). The association of AO with the 28-joint count Disease Activity Score (DAS28) and mental (MCS) and physical component scores (PCS) of the SF-36 and the HAQ was assessed by using regression models with the propensity score as a covariate. RESULTS The AO prevalence was 52% in the 200 eligible patients. In a univariate analysis, AO was associated with cardiovascular risk factors, low HAQ score, physical inactivity, disease activity parameters, impaired MCS, higher pain, and increased use of biological drugs and antidepressants. In a multivariable model, only poorer DAS28 (p = 0.018) and poorer HAQ score (p = 0.004) remained significantly associated with AO. CONCLUSIONS AO is highly prevalent in patients with RA. In addition to cardiovascular risk factors, AO is associated with higher disease activity, higher disability, physical inactivity, more patients' perception of pain, and poorer mental health. Multifaceted promotion of lifestyle habits would be beneficial for improving AO-related health outcomes in patients with RA.
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Affiliation(s)
- T Uutela
- Department of Medicine, Central Hospital of Lapland , Rovaniemi , Finland
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20
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Hernandez-Hernandez V, Ferraz-Amaro I, Diaz-Gonzalez F. Influence of disease activity on the physical activity of rheumatoid arthritis patients. Rheumatology (Oxford) 2013; 53:722-31. [DOI: 10.1093/rheumatology/ket422] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Paul L, Rafferty D, Marshall-McKenna R, Gill JMR, McInnes I, Porter D, Woodburn J. Oxygen cost of walking, physical activity, and sedentary behaviours in rheumatoid arthritis. Scand J Rheumatol 2013; 43:28-34. [DOI: 10.3109/03009742.2013.802009] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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22
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Backhouse MR, Hensor EMA, White D, Keenan AM, Helliwell PS, Redmond AC. Concurrent validation of activity monitors in patients with rheumatoid arthritis. Clin Biomech (Bristol, Avon) 2013; 28:473-9. [PMID: 23522723 PMCID: PMC3677088 DOI: 10.1016/j.clinbiomech.2013.02.009] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2012] [Revised: 02/08/2013] [Accepted: 02/27/2013] [Indexed: 02/07/2023]
Abstract
BACKGROUND Physical activity is frequently reported in rheumatology but it is difficult to measure objectively outside the gait laboratory. A new generation of activity monitors offers this potential but it has not yet been evaluated in patients with rheumatoid arthritis. This study aimed to evaluate three types of activity monitors in patients with rheumatoid arthritis. METHODS The Step-N-Tune, Activ4Life Pro V3.8, and the Intelligent Device for Energy Expenditure and Activity activity monitors were tested concurrently in 12 patients with rheumatoid arthritis as well as in a healthy control group of 12 volunteers. Participants walked at a self selected speed for two minutes and were filmed for later review. Temporal and spatial gait parameters were also validated against the GAITRite walkway and the total number of steps recorded by each activity monitor was compared to a gold standard derived from half speed video replays. FINDINGS Activity monitor performance varied between devices but all showed poorer performance when used in the group with rheumatoid arthritis. Bland-Altman plots demonstrated wider 95% limits of agreement in the group with rheumatoid arthritis and a systematic decrease in agreement between activity monitors and the gold standard with decreasing functional ability. INTERPRETATION Despite some variation between devices, all the activity monitors tested performed reasonably well in healthy young volunteers. All except the Activ4Life showed a marked decrease in performance in patients with rheumatoid arthritis, suggesting Activ4Life could be the most suitable for use in this patient group. The marked between group difference in functional ability, and systematic decrease in device performance with deteriorating gait, indicate that activity monitors require specific validation in target clinical populations.
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Affiliation(s)
- Michael R Backhouse
- Institute of Rheumatic and Musculoskeletal Disease, University of Leeds, Leeds, UK.
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23
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Munsterman T, Takken T, Wittink H. Are persons with rheumatoid arthritis deconditioned? A review of physical activity and aerobic capacity. BMC Musculoskelet Disord 2012; 13:202. [PMID: 23078261 PMCID: PMC3575246 DOI: 10.1186/1471-2474-13-202] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2011] [Accepted: 10/10/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Although the general assumption is that patients with rheumatoid arthritis (RA) have decreased levels of physical activity, no review has addressed whether this assumption is correct. METHODS Our objective was to systematically review the literature for physical activity levels and aerobic capacity (VO2max). in patients with (RA), compared to healthy controls and a reference population. Studies investigating physical activity, energy expenditure or aerobic capacity in patients with RA were included. Twelve studies met our inclusion criteria. RESULTS In one study that used doubly labeled water, the gold standard measure, physical activity energy expenditure of patients with RA was significantly decreased. Five studies examined aerobic capacity. Contradictory evidence was found that patients with RA have lower VO2max than controls, but when compared to normative values, patients scored below the 10th percentile. In general, it appears that patients with RA spend more time in light and moderate activities and less in vigorous activities than controls. CONCLUSION Patients with RA appear to have significantly decreased energy expenditure, very low aerobic capacity compared to normative values and spend less time in vigorous activities than controls.
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Affiliation(s)
- Tjerk Munsterman
- Physical Therapy Center, Martini Hospital Groningen, P.O. Box 30033, 9700 RM Groningen, Netherlands
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Atherosclerosis and rheumatoid arthritis: more than a simple association. Mediators Inflamm 2012; 2012:147354. [PMID: 23024462 PMCID: PMC3449150 DOI: 10.1155/2012/147354] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2012] [Accepted: 07/10/2012] [Indexed: 11/17/2022] Open
Abstract
In the last decades a large amount of evidence linked rheumatoid arthritis (RA) to atherosclerosis. In fact, RA patients have an increased risk of cardiovascular events that is not fully explained by other classic cardiovascular risk factors. RA and atherosclerosis may share several common pathomechanisms and inflammation undoubtedly plays a primary role. The proinflammatory cytokines such as tumor necrosis factor alpha and interleukin-6, involved in the pathogenesis of RA, are also independently predictive of subsequent cardiovascular disease (CVD). In RA, inflammation alters HDL constituents and the concentration of LDL and HDL, thus facilitating atherosclerosis and CVD events. On the other hand, also the increase of oxidative processes, frequently observed in RA, induces atherosclerosis. Interestingly, some genetic polymorphisms associated with RA occurrence enhance atherosclerosis, however, other polymorphisms associated with RA susceptibility do not increase CVD risk. Several other mechanisms may influence atherosclerotic processes in RA. Moreover, atherosclerosis may be directly mediated also by underlying autoimmune processes, and indirectly by the occurrence of metabolic syndrome and impaired physical activity. Finally, the effects of RA therapies on cardiovascular system in general and on atherosclerosis in particular are really wide and different. However, the starting point of every RA treatment is that disease control, or better remission, is the best way we have for the reduction of CVD occurrence.
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Abstract
PURPOSE OF REVIEW To assess factors that promote atherogenesis and cardiovascular disease (CVD) in rheumatoid arthritis (RA). Also, to determine how control of inflammation with conventional and biological antirheumatic drugs affects cardiovascular risk. RECENT FINDINGS An excess risk of CVD occurs early in the RA disease course and indeed may predate disease onset. Inflammation is a key driver of CVD risk as it adversely affects body composition, glucose handling and lipid function, especially the atheroprotective role of high-density lipoprotein. Therapies for RA, especially hydroxychloroquine and methotrexate (MTX) have positive effects on cardiovascular risk factors such as glycaemic control and reverse cholesterol transport. MTX and antitumour necrosis factor-alpha drugs also appear to have beneficial effect on CVD event risk, although the data on MTX appears more consistently to favour such a benefit. SUMMARY Future work needs to understand which aspects of the inflammatory state contribute most to CVD risk and whether specific anti-inflammatory agents, either alone or in combination, afford maximal CVD protection in RA.
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Affiliation(s)
- Hoda Mirjafari
- Arthritis Research UK Epidemiology Unit, Manchester Academic Health Sciences Centre, The University of Manchester
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