THE COGNITIVE IMPPAIRMENT AND ITS RELATED FACTORS AMONG FACTORS AMONG ELDERLY HYPERTENSIVE IN TWO RURAL DISTRICTS AREAS, MALAYSIA

As cognition declines with age, cognitive impairment rates are expected to increase ranging from 100% to 300% in this region. It could be higher among elderly who had any chronic diseases. The aim of the present work was to determine the prevalence and associated factors of cognitive impairment among elderly with hypertension. A clinic-based, cross-sectional study was conducted at several community clinics in Sabak Bernam and Hilir Perak districts from July to December 2015. A total of 480 patients were recruited. The prevalence of cognitive impairment was 13.13% (95%CI: 13.11, 13.15). Factors associated with cognitive impairment among elderly hypertensive were no formal educational level [OR: 3.95 (95%CI: 1.80, 8.67)]; history of high cholesterol [OR: 3.24 (95%CI: 1.15, 9.16)]; underweight [adj. OR: 4.88 (95%CI: 1.34, 17.67)]; and increasing age [OR: 1.03 (95%CI: 1.01, 1.06)]. Public health policy makers and geriatric practitioners should emphasise on early cognitive function assessment among elderlies who are hypertensive, unemployed, poor educational background, males, high cholesterol level and underweight to enhance the quality of geriatric services. Earlier establishment of diagnosis may prevent from greater rate of decline in cognitive functioning among this vulnerable group.

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Preoperative assessment of cognitive function and risk assessment of cognitive impairment in elderly patients with orthopedics: A cross-sectional study.

10.21203/rs.3.rs-21415/v1 ◽

2020 ◽

Author(s):

Shuyuan Gan ◽

Yang Yu ◽

Jiateng Wu ◽

Xiaodong Tang ◽

Yueying Zheng ◽

...

Keyword(s):

Risk Factors ◽

Cognitive Impairment ◽

Elderly Patients ◽

Cross Sectional Study ◽

Sectional Study ◽

High Cholesterol ◽

Multivariate Logistic Regression ◽

Cross Sectional ◽

Subjective Sleep ◽

High Cholesterol Level

Abstract Background Preexisting cognitive impairment is emerging as a predictor of poor postoperative outcomes in seniors. Nevertheless, cognitive impairment in a large proportion of geriatric patients has not been well identified and diagnosed.Methods This is a cross-sectional study. Mini-mental state examination scale was used to assess cognitive function of elderly patients aged ≥ 65 years undergoing orthopedic surgery preoperatively. The baseline, living habits and laboratory examination results of the two groups were compared, and multivariate Logistic regression model was used to identify independent predictors of preoperative cognitive impairment.Results A total of 374 elderly patients with orthopedics met the inclusion criteria, and 28.61% with preoperative cognitive impairment. Multivariate Logistic regression analysis showed that age (OR=1.089, P<0.001), subjective sleep disorders (OR=1.996, P=0.021), atherosclerosis (OR=2.367, P=0.017), high cholesterol level (OR=1.373, P=0.028) were independent risk factors for preoperative cognitive impairment, while high education level performed as a protective factor (Compared with illiterate group, primary school group: OR=-0.885, P=0.009; middle school or above group: OR=-2.118, P<0.001).Conclusions The prevalence of preoperative cognitive dysfunction in geriatric elective orthopedic surgical patients was high. Our study identified venerable age, low level of education, subjective sleep disorders, atherosclerosis, high cholesterol level as risk factors for preoperative cognitive impairment in these patients. Understanding these risk factors contribute to assist in prevention and directed interventions for the high-risk population.

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The prevalence and risk factors of musculoskeletal disorders among subcontracted hospital cleaners in Thailand

Journal of Health Research ◽

10.1108/jhr-01-2021-0040 ◽

2021 ◽

Vol ahead-of-print (ahead-of-print) ◽

Author(s):

Thanaphum Laithaisong ◽

Wichai Aekplakorn ◽

Paibul Suriyawongpaisal ◽

Chanunporn Tupthai ◽

Chathaya Wongrathanandha

Keyword(s):

Risk Factors ◽

Musculoskeletal Disorders ◽

Teaching Hospital ◽

Stress Test ◽

Cross Sectional Study ◽

Related Factors ◽

Cross Sectional ◽

Middle Income ◽

Content Type ◽

History Of

PurposeThis research aimed to explore the prevalence of musculoskeletal disorders (MSDs) and related factors among subcontracted cleaners in a teaching hospital in Thailand.Design/methodology/approachA cross-sectional study was conducted of 393 subcontracted cleaners in a teaching hospital, from May to June 2020. Face-to-face interviews were carried out using a standard questionnaire, consisting of four parts: (1) participant characteristics, (2) stress test, (3) work characteristics and (4) standardized Nordic questionnaire, Thai version, for MSDs outcome. Multiple logistic regression analyses were performed to determine the association between MSDs and related factors.FindingsThe prevalence of MSDs was 81.9%, involving mostly the lower back (57.7%), followed by the shoulder (52.6%). Factors significantly associated with MSDs were as follows: male gender (OR = 3.06, 95% CI [1.19, 7.87]), severe stress (OR = 2.72, 95% CI [1.13, 6.54]), history of injuries (OR = 4.37, 95% CI [1.27, 15.11]), mopping posture (OR = 2.81, 95% CI [1.43, 5.50]) and task duration (OR = 1.90, 95% CI [1.01, 3.57] for 2–4 h and OR = 3.39, 95% CI [1.17, 9.86] for more than 4 h). Sick leave due to MSDs was associated with history of injuries, Thai nationality and having another part-time job.Originality/valueThe study findings about MSDs in terms of prevalence and related factors contributed to limited pool of the knowledge among subcontracted hospital cleaners in Thailand and middle-income country settings. With growing popularity in outsourcing cleaning services among hospitals in these countries, the study findings could raise a concern and inform policymakers and hospital administrators the importance of the magnitude and risk factors for MSDs necessitating design of preventive strategies.

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PENGARUH PENYAKIT KRONIS DAN GAYA HIDUP TERHADAP KINERJA VERBAL FLUENCY KATEGORIK PADA LANSIA

Majalah Kedokteran Neurosains Perhimpunan Dokter Spesialis Saraf Indonesia ◽

10.52386/neurona.v37i1.97 ◽

2019 ◽

Vol 37 (1) ◽

Author(s):

Jessica Alysia ◽

Yvonne Suzy Handajani ◽

Nelly Tina Widjaja ◽

Yuda Turana

Keyword(s):

Risk Factors ◽

Cardiovascular Disease ◽

Cognitive Impairment ◽

Chronic Illness ◽

Chronic Diseases ◽

Verbal Fluency ◽

Cross Sectional Study ◽

Education Level ◽

Cross Sectional ◽

History Of

CHRONIC DISEASES AND LIFESTYLE IMPACT TO CATEGORY VERBAL FLUENCY PERFORMANCE IN ELDERLYABSTRACTIntroduction: In recent studies, chronic illness and sedentary lifestyle were found to bea risk factors for cognitive impairment. Verbal fluency (VF) is one of the most used instruments.Aim: To determine cognitive impairment using VF and its correlation with risk factors (chronic illness and lifestyle) in elderly.Method: This cross-sectional study was conducted toward 121 elderly respondents in August–September 2017 at Pusaka, West Jakarta. Cognitive impariment was assessesed using VF. VF otherwise disturbed if the value <16.03. Heart disease and stroke were determined by anamnesis. Blood pressure was determined using Riester tensimeter. that has been calibrated. Cholesterol and blood sugar were determined using laboratory result by CHOD-PAP method. Smoking was determined by asking the history of smoking. Physical activity was determined by 24-hour activity recall. Nutrition Intake was determined by food record.Results: There were 63.6% subjects wno had VF impairment. Most respondent were over 65 years old (71.9%), female (66.1%) and education level more than 6 years (72.7%). VF had a significant assosiation with education level (p=0.020; OR=3.792), and without cardiovascular disease (p=0.023; OR=0.111).Discussion: The mayority of respondents had VF impairment, lower education was consistenly as a risk factors while no history of cardiovascular disease as a protective factors of language impairment.Keywords: Chronic diseases, cognitive impairment, lifestyle, verbal fluencyABSTRAKPendahuluan: Pada beberapa penelitian terbaru ditemukan bahwa faktor risiko seperti penyakit kronis dan gaya hidup buruk meningkatkan risiko terkena gangguan fungsi kognitif. Salah satu instrumen yang sering digunakan adalah verbal fluency (VF).Tujuan: Mengetahui gambaran fungsi kognitif dengan instrumen VF dan hubungannya dengan faktor risiko (penyakit kronis dan gaya hidup) pada lansia.Metode: Penelitian potong lintang ini dilaksanakan pada 121 responden lansia pada bulan Agustus-September 2017 di Pusaka Jakarta Barat. Gangguan fungsi kognitif dinilai menggunakan instrumen VF. Verbal fluency dikatakan terganggu dengan nilai <16,03. Penyakit jantung dan stroke didapatkan dari anamnesis. Tekanan darah dari hasil pengukuran menggunakan tensimeter yang telah dikalibrasi sebelumnya. Pengukuran kolesterol dan gula darah didapatkan dari hasil laboratorium dengan metode CHOD-PAP. Merokok didapat dari anamnesis. Aktivitas fisik dinilai dari 24-hour activity recall. Asupan nutrisi dinilai dari kuisioner food record.Hasil: Hasil penelitian ini menunjukkan subjek dengan gangguan VF sebanyak 63,6%. Mayoritas responden berusia diatas 65 tahun (71,9%), dengan jenis kelamin wanita (66,1%) dan tingkat pendidikan diatas 6 tahun (72,7%). Hasil analisis menunjukan bahwa instrumen VF memiliki hubungan bermakna dengan tingkat pendidikan rendah (p=0,020; RO=3,792), dan tidak berpenyakit jantung (p=0,023; RO=0,111).Diskusi: Mayoritas responden memiliki gangguan bahasa, pendidikan rendah diketahui secara konsisten sebagai faktor risiko sementara tidak ada riwayat penyakit jantung sebagai faktor protektif untuk gangguan fungsi bahasa.Kata kunci: Gangguan fungsi kognitif, gaya hidup, penyakit kronis, verbal fluency

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Patterns of sexual behaviors and related factors among prisoners in Iran: results from a national survey in 2015

International Journal of Prisoner Health ◽

10.1108/ijph-10-2018-0052 ◽

2019 ◽

Vol 16 (1) ◽

pp. 29-37

Author(s):

Ghobad Moradi ◽

Amjad Mohamadi-Bolbanabad ◽

Sonia Darvishi ◽

Fatemeh Azimian Zavareh ◽

Bakhtiar Piroozi ◽

...

Keyword(s):

Sexual Behaviors ◽

Risk Groups ◽

Cross Sectional Study ◽

Unsafe Sex ◽

Related Factors ◽

Cross Sectional ◽

Content Type ◽

Level Of Education ◽

Multi Stage ◽

History Of

Purpose The purpose of this paper is to determine patterns of sexual behaviors and related factors among prisoners in Iran, 2015. Design/methodology/approach This cross-sectional study was a part of a bio-behavioral surveillance survey conducted on 6,200 prisoners in 26 prisons in Iran. The subjects were selected through multi-stage sampling. Questionnaires and interviews were used to collect data on participant’s demographics and history of sexual behaviors. Using STATA-12 software, the collected data were analyzed through descriptive statistics, and crude and adjusted logistic regression. Findings A total of 5,508 prisoners with a response rate of 88.8 percent participated in this study. Of all prisoners, 55 percent (n=3,027) had a history of “unsafe sex in the lifetime” of whom 53.4 percent (n=1,549) never used condoms during unsafe sex in the lifetime. Based on the results of multivariate analysis, risk factors for “unsafe sex in lifetime” were the following: higher level of education (AOR=1.79, CI: 1.41–2.28), being single (AOR=1.32, CI: 1.18–1.47), unemployed before imprisonment (AOR=1.45, CI: 1.06–1.97), having history of previous imprisonment (AOR=1.31, CI: 1.17–1.47) and history of drug use in the lifetime (AOR=1.53, CI: 1.35–1.75). Originality/value Prisoners are high-risk groups that are prone to practice unsafe sex. Prisoners who are single, unemployed before imprisonment, a drug user, with a higher level of education and with a history of imprisonment are likely to be sexually active in their lifetime. Thus, they are a priority for receiving suitable interventions.

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COVID-19 and Cognitive Impairment: A Cross-Sectional Clinic Based Study

10.21203/rs.3.rs-1178928/v1 ◽

2021 ◽

Author(s):

Amira Siddig ◽

Khabab Abbasher Hussien Mohamed Ahmed ◽

Ahmed Abdelrahman ◽

AlHussien Abbasher ◽

Abubaker Alsedig Abbasher ◽

...

Keyword(s):

Cognitive Impairment ◽

Cognitive Functions ◽

Age Distribution ◽

Clinical Manifestations ◽

Cross Sectional Study ◽

Cross Sectional ◽

Senior Consultant ◽

Presenting Symptoms ◽

Phonemic Fluency ◽

History Of

Abstract Background: Patients with dementia are more prone to acquire COVID-19 infection. Patients with COVID-19 showed a tendency to develop cognitive impairment. Objectives: We aimed to study the clinical manifestations of COVID-19 infection among adult Sudanese demented patients and the prevalence of cognitive impairment among adult Sudanese non demented patients. Methodology: This is a descriptive cross-sectional study which took place in Sudan, Khartoum state in the period (September-December 2021) in a private neurology/psychiatry clinic. 135 adult Sudanese patients were included in this study and were divided into two groups. The first group consists of 100 patients with a known history of dementia that got infected recently with COVID-19, while the second group consists of 35 patients who developed some sort of cognitive impairment after recovering from COVID-19 infection. Regarding the second group, cognitive functions were assessed by senior consultant neurologist and senior consultant psychiatrist using a well validated neuropsychological measure. Results: Out of 100 patients in the first group, females were 60 and males were 40. Age distribution is between 63 -98. The common presenting symptoms of COVID-19 among this group were: Cough and fever (90 patients), diarrhea and vomiting (5 patients), breathlessness (4 patients), coughing of blood (5 patients), convulsions (1 patient), paraplegia (1 patient) and hemiplegia (1 patient). Regarding the second group, Age distribution varied from 30 to 80 years. Cognitive functions impairment was noticed as follows: Memory recall (22%), memory recognition (23%), memory encoding (24%), processing speed (16%), executive functioning (19%), phonemic fluency (17%) and category fluency (17%). Conclusion: Patients with dementia are more susceptible to develop COVID-19 infection. Patients with COVID-19 Infection are at risk of developing some sort of cognitive impairment after recovery.

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Health literacy levels and related factors of patients admitted to an outpatient clinic in Malatya

European Journal of Public Health ◽

10.1093/eurpub/ckaa166.361 ◽

2020 ◽

Vol 30 (Supplement_5) ◽

Author(s):

E Pehlivan ◽

K Ozdemir

Keyword(s):

Health Literacy ◽

Outpatient Clinic ◽

Educational Background ◽

Cross Sectional Study ◽

Related Factor ◽

Related Factors ◽

Cross Sectional ◽

Factors Affecting ◽

Average Value ◽

Health Literacy Level

Abstract Background This study was conducted to determine the health literacy levels and related factors of the patients who applied to a health unit. Methods The population of this cross-sectional study was the patients who applied to a district outpatient clinic in the center of Malatya. Power 80% and in the 95% confidence interval based on the mean of health literacy scale of Turkey (29.5 ± 5.7) the sample size was determined as 317. In the first three months of 2019 outpatients and 384 randomized patients who agreed to participate in the study, developed by the Ministry of Health Literacy Turkey Health Questionnaire-32 (THLQ) was applied. The score obtained from the scale is considered to be insufficient of 25 and below, limited to > 25-33 points and a score of < 33 and above is sufficient. In the analysis of the data, Kolmogorov Smirnov, Mann Whitney U, Kruskal Wallis and Chi-Kare tests were used and p < 0.05 was chosen as the level of error. Results 49.9% of the participants were male and 50.1% were female. The average age is 35.94 ± 13.8. While 24% of the participants have secondary or lower education, 40.6% are graduates of higher education. In this study,the health literacy scale mean score of the participants is 15.85 ± 11.07. According to the results of THLQ-32, 78.1% of the participants were in the “insufficient” health literacy category, 14.0% in the “limited” category, only 7.9% in the “sufficient” category. Gender, age, educational background, frequency of applying to the health institution were determined as factors affecting the level of health literacy (p < 0.05). However, the presence of a disease causing regular drug use was not identified as a related factor (p > 0.05). Conclusions In this study, although of have a high education level of the participants were found to be inadequate of health literacy levels according to Turkey average value reflects the general. Key messages According to these results, it may be difficult for the groups that are insufficient in terms of health literacy to benefit from health services. Raising the health literacy level of the society can be an important component of health promotion.

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funcionalidad familiar y embarazo, en adolescentes que asisten a controles prenatales en centros de assbasalud ese, manizales (colombia), 2012./family functionality and pregnancy, in adolescents attending to prenatal controls in assbasalud ese centers ma

Archivos de Medicina (Manizales) ◽

10.30554/archmed.13.2.106.2013 ◽

2013 ◽

Vol 13 (2) ◽

pp. 142-159

Author(s):

José jaime Castaño castrillón ◽

Carlos mario Arias trujillo ◽

Isabel cristina Carmona serna ◽

Andrés felipe Castro torres ◽

Audrey nathalie Ferreira gonzález ◽

...

Keyword(s):

Family Functioning ◽

Family Violence ◽

Cross Sectional Study ◽

Related Factors ◽

Cross Sectional ◽

Conflict Situations ◽

The Family ◽

Induced Abortions ◽

History Of ◽

Moderate Relationship

Objetivo: Analizar la funcionalidad familiar, y factores relacionados en un grupo de adolescentes embarazadas que asisten a control prenatal en los centros de atención de ASSBASALUD ESE (Manizales, Colombia). Materiales y métodos:Estudiode corte transversal con una población de 190 adolescentes embarazadas entre los 12 y 21 años, el instrumento utilizado fue una encuesta escrita, anónima, que interrogaba sobre variables sociodemográficas, relación con sus padres, tipo de educación recibida, situaciones conflictivas en la familia y funcionalidad familiar. Resultados: Promedio de edad de 18 años, el 72,1% de la población presentó disfuncionalidad familiar de leve a severa, 46,9% tenían una relación con el padre entre ninguna y regular, 25,3% con la madre, 38,9% presentaban antecedentes de violencia familiar, 25,8% depresión, 23,2% de consumo de alcohol, 36,3% pensaban que no iban a quedar embarazadas, 26,8% deseaban tener hijos, la buena funcionalidad familiar tuvo relación significativa con no empleo de métodos anticonceptivos (p=0,000), alto número de embarazos (p=0,025), alto número de abortos (p=0,007) entre otras. Conclusiones: La población de adolescentes gestantes estudiada tiene características similares a las poblaciones de otras ciudades de Colombia, y otros países. Se demuestra que, como prácticamente en todos los ámbitos del ser humano, en este también la familia es decisiva y determinante en la presencia de embarazo precoz en estas adolescentes. Objective: To examine family functioning and related factors in a group of pregnantadolescents attending prenatal-control care in ASSBASALUD ESE centers (Manizales,Colombia). Materials and Methods: Cross-sectional study with a population of 190pregnant adolescents between 12 and 21 years, the instrument used was a writtensurvey, anonymously, which questioned about sociodemographic variables, relationshipwith parents, type of education, conflict situations in the family and family functioning.Results: Average age 18 years, 72.1% of the population had family dysfunction frommild to severe, 46.9% had none or a moderate relationship with the father and 25.3%with the mother, 38, 9% had a history of family violence, depression 25.8%, 23.2%for alcohol, 36.3% thought they would not get pregnant, 26.8% wanted children. Agood family functioning was significantly related with no presence of family violence(p=0,000), with no pregnancies < 17 years (p=0,020), no use of contraceptive methods(p = 0.000), a high number of pregnancies (p=0,025), no induced abortions (p=0,007),discussions about pregnancies and sexuality with parents (p=0,000). Conclusions: Thestudied population of pregnant teenagers has characteristics similar to the populationsof other cities of Colombia, and other countries. It is demonstrated that, as practicallyin all areas of the human being, in this the family is also crucial and decisive in thepresence of early pregnancy in these adolescents.

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Identification of Cognitive Impairment in Cardiovascular Rehabilitation: A Cross-Sectional Study Protocol

10.1101/2021.01.01.21249114 ◽

2021 ◽

Author(s):

Qutub Jamali ◽

Salman Karim ◽

Mirza Najiullah Beg ◽

Muhammad Shoaib Raja ◽

Kalpesh Solanki ◽

...

Keyword(s):

Cognitive Impairment ◽

Cardiac Rehabilitation ◽

Cardiac Event ◽

Cross Sectional Study ◽

Adverse Cardiac Event ◽

Sectional Study ◽

Cross Sectional ◽

Memory Problems ◽

Before And After ◽

History Of

AbstractIntroductionCardiac Rehabilitation is a multidisciplinary intervention for people after an adverse cardiac event to improve their physical, psychological and social functioning. The risk factors of cardiac disease and dementia are similar. This cross sectional study aims to determine whether adding memory assessment to a cardiac rehabilitation program would improve early detection of cognitive impairment.Methods and AnalysisParticipants will undergo cognitive assessment by using Addenbrooke’s Cognitive Examination (ACE-III). The data obtained will be divided into: - 1- Participants who had a history of memory problems before and after the adverse cardiac event. 2-Participants with no history of memory problems before and currently presents with cognitive impairment. 3-Participants with no memory problems before and after the adverse cardiac event.Ethics and disseminationStudy ethical approval has been granted by Sheffield Research Ethics Committee (reference 20/YH/0146) and the NHS Health Research Authority (project reference 273763).

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Treatment Seeking Behavior for COVID-19 Symptoms and Its Related Factors Among Northern Iranian Population: A Cross-sectional Study

10.21203/rs.3.rs-112020/v1 ◽

2020 ◽

Author(s):

Farahnaz Joukar ◽

Mehrnaz Asgharnezhad ◽

Mohammadreza Naghipour ◽

Fariborz Mansour-Ghanaei ◽

Saman Maroufizadeh ◽

...

Keyword(s):

Respiratory Disease ◽

Cross Sectional Study ◽

Treatment Seeking ◽

Sectional Study ◽

Related Factors ◽

Cross Sectional ◽

Patient Reported ◽

Seeking Behavior ◽

History Of ◽

Professional Treatment

Abstract Background: This study was conducted to investigate the treatment seeking behavior for COVID-19 symptoms among northern Iranian population and its related factors.Methods: This hospital-based cross-sectional study was conducted to investigate the treatment seeking behavior for COVID-19 symptoms and its related factors in 602 confirmed COVID-19 cases for a period of 2 months between March and May 2020 in Guilan at the onset of the corona epidemic in Iran. Results: Professional treatment-seeking was observed in 18.6% of patients and most of patient reported home remedies (50.3%) and self-medication (31.1%) as first reaction to COVID-19 symptoms. The multivariate logistic regression analyses revealed that patients with breathing difficulties symptom and history of respiratory disease had greater odds professional treatment of seeking respectively (adjusted odds ratio (OR) =1.6, P=0.03, (OR) =3.3, P =0.001). Conclusions: Roughly half of symptomatic COVID-19 patient reported home remedies as first treatment-seeking behaviors and only breathing difficulties symptom and past history of respiratory disease were identified as an independent predictor of professional treatment–seeking. However, we found no more professional treatment -seeking behaviors among elderly, diabetic, hypertensive and obese patients, while there were at risk of severe illness and death from COVID-19 infections. Thus, behavior change interventions in population with underling disease (including diabetes, hypertension and obesity) and older age is crucial to improve professional treatment -seeking behaviors.

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High Cholesterol Level As A Marker of Allergic Rhinitis Severity

QJM ◽

10.1093/qjmed/hcab100.078 ◽

2021 ◽

Vol 114 (Supplement_1) ◽

Author(s):

Dina S Sheha ◽

Lobna A El-Korashi ◽

Marwa M El-Begermy ◽

Amira R Elmahdi

Keyword(s):

Allergic Rhinitis ◽

Cholesterol Level ◽

Blood Lipid ◽

Cross Sectional Study ◽

Blood Cholesterol ◽

Sectional Study ◽

High Cholesterol ◽

Blood Lipid Profile ◽

Cross Sectional ◽

High Cholesterol Level

Abstract Background There is some evidences illustrated the relation between abnormal blood lipid profile and atopy. But, the evidence about relation between allergic rhinitis (AR) and cholesterol level is conflicting. We aimed to assess correlation between Cholesterol level and severity of AR. Methods 50 AR patients were recruited in this cross-sectional study. Blood samples for blood cholesterol level were drawn from all patients. Results There was a statistically significant positive correlation between TC and visual analogue scale (VAS) score. Conclusion High cholesterol level in AR patients can be a marker of disease severity.

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