scholarly journals Myopenia and Musculoskeletal Aging in Rheumatoid Arthritis

2020 ◽  
Author(s):  
Dan Xu ◽  
Jiake Xu ◽  
Lei Dai
Keyword(s):  
Rheumatoid Arthritis ◽  
Muscle Function ◽  
Inflammatory Arthritis ◽  
Muscle Wasting ◽  
Management Strategies ◽  
Chronic Inflammatory Disease ◽  
Muscular Dysfunction ◽  
Younger Age ◽  
High Prevalence

Rheumatoid arthritis (RA), the commonest inflammatory arthritis, is a debilitating disease leading to decreased functional capacity, social disability and reduced quality of life. RA affects multisystems with chronic inflammatory disease characterized by destructive synovitis and muscular dysfunction leading to premature musculoskeletal aging, which has been coined with many terms including myopenia, sarcopenia, cachexia, muscle failure and muscle wasting. Myopenia is described as the presence of clinically relevant muscle wasting due to any illness at any age, associated with impaired muscle function, increased morbidity and mortality. RA myopenia has significantly less muscle mass compared to the general population muscle loss showing preservation or slight increase in fat mass. RA myopenia is unique compared to chronic disease-related myopenia in cancer, chronic heart failure, kidney disease and chronic infection as it is rarely accompanied by a net weight loss. RA myopenia has younger-age onset compared to elderly primary sarcopenia, while higher-grade inflammation has been considered as the pathophysiology of muscle wasting. Research, however, indicates that inflammation itself cannot fully explain the high prevalence of muscle wasting in RA. This chapter aims to review the literature on the casual relationships among RA myopenia, premature musculoskeletal aging and management strategies to delay musculoskeletal aging.

scholarly journals Association between Hidradenitis Suppurativa and Inflammatory Arthritis: A Systematic Review and Meta-Analysis

Dermatology ◽  
2021 ◽  
pp. 1-8
Author(s):  
Nouf Almuhanna ◽  
Alexandra Finstad ◽  
Raed Alhusayen
Keyword(s):  
Rheumatoid Arthritis ◽  
Systematic Review ◽  
Ankylosing Spondylitis ◽  
Odds Ratio ◽  
Inflammatory Arthritis ◽  
Hidradenitis Suppurativa ◽  
Meta Analysis ◽  
Pooled Analysis ◽  
Increased Risk ◽  
High Prevalence

<b><i>Background:</i></b> Several studies report a high prevalence of inflammatory arthritis among hidradenitis suppurativa (HS) patients. <b><i>Objectives:</i></b> To study the association between HS and inflammatory arthritis. <b><i>Methods:</i></b> The systematic review and meta-analysis were performed according to the PRISMA guidelines to identify the association between HS and inflammatory arthritis, spondyloarthritis, ankylosing spondylitis (AS), and rheumatoid arthritis (RA). <b><i>Results:</i></b> Seven studies were entered in the analysis, with 200,361 HS patients and 385,599 controls. Pooled analysis illustrated a significantly increased risk of inflammatory arthritis in HS patients compared to controls (odds ratio [OR] 3.44; 95% confidence interval [CI] 1.92–6.17). There was also a statistically significant association between HS and spondyloarthritis (OR 2.10; 95% CI 1.40–3.15), and between HS and AS (OR 1.89; 95% CI 1.14–3.12). Moreover, pooled analysis showed a statistically significant association between HS and RA (OR 1.96; 95% CI 1.28–2.98). <b><i>Conclusions:</i></b> Our findings show that HS patients have a 3-fold increased risk of developing inflammatory arthritis. HS patients are specifically at a higher risk for spondyloarthritis, its subtype AS, and RA.

Comorbidity in rheumatoid arthritis

2020 ◽  
pp. 145-158
Author(s):  
Kimme Hyrich ◽  
Sarah Skeoch
Keyword(s):  
Quality Of Life ◽  
Rheumatoid Arthritis ◽  
Risk Factors ◽  
Treatment Decisions ◽  
Direct Result ◽  
High Prevalence ◽  
Impact On Treatment

A high prevalence of comorbidity is observed in patients with rheumatoid arthritis (RA) and the presence and type of comorbidity has a significant impact on mortality and quality of life in RA. Comorbidity also has an impact on treatment decisions and recognizing and managing comorbidities is an important aspect in the care of patients with RA. Some comorbidities occur as a direct result of RA or the treatments used, while others can be unrelated but have an effect on treatment and outcomes. In this chapter we describe the burden of comorbidity and the prevalence, risk factors, and management of important comorbidities seen in RA.

scholarly journals Predictors of quality of life of Pakistani women with rheumatoid arthritis: a cross-sectional study

2021 ◽  
Vol 8 (10) ◽  
pp. 4742
Author(s):  
Sucheta Sharma ◽  
Srilatha Eapi ◽  
Abdul Muqtadir ◽  
Ammar Bokhari ◽  
Mehak Zulfiqar ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Rheumatoid Arthritis ◽  
Disease Activity ◽  
Severe Disease ◽  
Cross Sectional Study ◽  
Chronic Inflammatory Disease ◽  
Sectional Study ◽  
Emotional Wellbeing ◽  
Cross Sectional

Background: Rheumatoid arthritis (RA) is characterized as a chronic inflammatory disease indicated by stiffness, pain, inflammation, and impaired mobility. This results in joint impairment, poor workability, productivity, and afterward, it curtails the quality and expectancy of life of an individual. The aim of this research is to assess the quality of life of Pakistan women with RA and assess various factors affecting it.Methods: It was a cross-sectional study conducted in the Orthopedics department of the Indus Hospital and Health Network, Karachi Pakistan, where we assessed quality of life in sample of women with RA. A consecutive sampling technique was used to enrol women with rheumatoid arthritis who were seen in the Orthopedics outpatient clinic during the study period (February to May 2021).Results: Of the 134 women with RA, 72.39% of women were unemployed, 54.48% of women had family monthly income of 16000 PKR or more and 44.03% of women reported at least one comorbidity other than RA. According to linear regression analyses, women having RA with severe disease activity tended to have tended to have low physical functioning, vitality, emotional wellbeing, social functioning, pain and general health as compared to patients with remission, low disease and moderate disease activity. Absence of family support in disease management can impact vitality and emotional wellbeing with decrease in scores of -85.20 and -120.66 respectively.Conclusions: Guidelines need to developed and implemented for assessing psychological domains of these patients for assessment of quality of life. This will help in maintaining and improving QoL of women with RA. 

scholarly journals Biomarkers to Personalize the Treatment of Rheumatoid Arthritis: Focus on Autoantibodies and Pharmacogenetics

Biomolecules ◽  
2020 ◽  
Vol 10 (12) ◽  
pp. 1672
Author(s):  
Valeria Conti ◽  
Graziamaria Corbi ◽  
Maria Costantino ◽  
Emanuela De Bellis ◽  
Valentina Manzo ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Chronic Inflammatory Disease ◽  
New Drugs ◽  
Magic Bullet ◽  
Predictive Capacity ◽  
Predictors Of Response ◽  
Specific Factors ◽  
Treatment Predictors ◽  
Background Models

Rheumatoid arthritis (RA) is a chronic inflammatory disease that is very complex and heterogeneous. If not adequately treated, RA patients are likely to manifest excess of morbidity and disability with an important impact on the quality of life. Pharmacological treatment is based on the administration of the disease-modifying antirheumatic drugs (DMARDs), subdivided into conventional synthetic (csDMARDs), targeted synthetic (tsDMARDs), and biological (bDMARDs). bDMARDs are now frequently administered in patients, both as alternative treatment and together with csDMARDs. Unfortunately, there is a therapeutic response variability both to old and new drugs. Therefore, to identify pre-therapeutic and on-treatment predictors of response is a priority. This review aims to summarize recent advances in understanding the causes of the variability in treatment response in RA, with particular attention to predictive potential of autoantibodies and DMARD pharmacogenetics. In recent years, several biomarkers have been proposed to personalize the therapy. Unfortunately, a magic bullet does not exist, as many factors concur to disease susceptibility and treatment outcomes, acting around the patient’s congenital background. Models integrating demographic, clinical, biochemical, and genetic data are needed to enhance the predictive capacity of specific factors singularly considered to optimize RA treatment in light of multidisciplinary patient management.

scholarly journals Research of Pathogenesis and Novel Therapeutics in Arthritis

2019 ◽  
Vol 20 (7) ◽  
pp. 1646 ◽  
Author(s):  
Chih-Hsin Tang
Keyword(s):  
Rheumatoid Arthritis ◽  
Psoriatic Arthritis ◽  
Side Effects ◽  
Inflammatory Arthritis ◽  
Current Understanding ◽  
Special Issue ◽  
Novel Therapeutics ◽  
High Prevalence ◽  
Exact Etiology ◽  
Inflammatory Drugs

Arthritis has a high prevalence globally and includes over 100 types, the most common of which are rheumatoid arthritis, osteoarthritis, psoriatic arthritis and inflammatory arthritis. The exact etiology of arthritis remains unclear and no cure exists. Anti-inflammatory drugs are commonly used in the treatment of arthritis, but are associated with significant side effects. Novel modes of therapy and additional prognostic biomarkers are urgently needed for these patients. In this editorial, the twenty articles published in the Special Issue Research of Pathogenesis and Novel Therapeutics in Arthritis 2019 are summarized and discussed as part of the global picture of the current understanding of arthritis.

scholarly journals Distress with Breathing in People with Lung Cancer: A Systematic Review

2009 ◽  
Author(s):  
Elizabeth Quast ◽  
Marie Williams
Keyword(s):  
Lung Cancer ◽  
Systematic Review ◽  
Daily Living ◽  
Search Strategy ◽  
Management Strategies ◽  
Common Symptom ◽  
Inclusion Criteria ◽  
Lung Cancer Patients ◽  
High Prevalence

While the prevalence of shortness of breath has been reported to be as frequent as pain in people with lung cancer, less attention has been paid to the distress associated with this symptom (dyspnea). This systematic review of the literature was undertaken to investigate how this symptom has been assessed and whether breathlessness in people with lung cancer is distressing. Using a pre-determined search strategy and inclusion criteria, thirty-one primary studies were identified and included in this review. A variety of outcome measures have been used to assess the experience of dyspnea with domains including intensity, distress, quality of life, qualitative sensation and prevalence. The distress associated with breathlessness appears to be variable, with some studies reporting it to be the most distressing sensation, while others report lower levels of distress. Overall the studies reflect a high prevalence of dyspnea in lung cancer patients, with subjects experiencing a moderate level of dyspnea intensity and interference with activities of daily living. Overall, the findings of this review indicate that dyspnea was a common symptom experienced by people with lung cancer with varying degrees of intensity and unpleasantness. Thus, if dyspnea and pain are both distressing sensations for people with lung cancer, this has potential implications for both clinical and academic areas, with regards to both management strategies and further research.

scholarly journals Factors associated with burnout syndrome in surgeons: a systematic review

2020 ◽  
Vol 102 (6) ◽  
pp. 401-407 ◽  
Author(s):  
R Galaiya ◽  
J Kinross ◽  
T Arulampalam
Keyword(s):  
Emotional Intelligence ◽  
Maslach Burnout Inventory ◽  
Burnout Syndrome ◽  
Junior Doctors ◽  
Physical And Mental Health ◽  
Health And Wellbeing ◽  
Younger Age ◽  
High Prevalence ◽  
Reported Data

Introduction To date, studies have shown a high prevalence of burnout in surgeons. Various factors have been found to be associated with burnout, and it has significant consequences personally and systemically. Junior doctors are increasingly placing their own health and wellbeing as the most important factor in their decisions about training. Finding ways to reduce and prevent burnout is imperative to promote surgical specialties as attractive training pathways. Methods The MEDLINE, PsychInfo and EMBASE databases were searched using the subject headings related to surgery and burnout. All full text articles that reported data related to burnout were eligible for inclusion. Articles which did not use the Maslach Burnout Inventory or included non-surgical groups were excluded; 62 articles fulfilled the criteria for inclusion. Findings Younger age and female sex tended to be associated with higher levels of burnout. Those further in training had lower levels of burnout, while residents suffered more than their seniors. Burnout is associated with a lower personal quality of life, depression and alcohol misuse. Academic work and emotional intelligence may be protective of burnout. Certain personality types are less likely to be burnt out. Mentorship may reduce levels of burnout. Conclusions Workload and work environment are areas that could be looked at to reduce job demands that lead to burnout. Intervening in certain psychological factors such as emotional intelligence, resilience and mindfulness may help to reduce burnout. Promoting physical and mental health is important in alleviating burnout, and these factors likely have a complex interplay.

scholarly journals The P. gingivalis Autocitrullinome Is Not a Target for ACPA in Early Rheumatoid Arthritis

2020 ◽  
Vol 99 (4) ◽  
pp. 456-462 ◽  
Author(s):  
E. Muñoz-Atienza ◽  
M.B. Flak ◽  
J. Sirr ◽  
N.A. Paramonov ◽  
J. Aduse-Opoku ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Inflammatory Arthritis ◽  
Strong Association ◽  
Intestinal Barrier ◽  
Joint Inflammation ◽  
Chronic Inflammatory Disease ◽  
Antibody Activity ◽  
Drug Naïve ◽  
Barrier Breakdown ◽  
Arthritic Joints

Rheumatoid arthritis (RA), a chronic inflammatory disease affecting primarily the joints, is frequently characterized by the presence of autoimmune anticitrullinated protein antibodies (ACPA) during preclinical stages of disease and accumulation of hypercitrullinated proteins in arthritic joints. A strong association has been reported between RA and periodontal disease, and Porphyromonas gingivalis, a known driver of periodontitis, has been proposed as the microbial link underlying this association. We recently demonstrated P. gingivalis–mediated gut barrier breakdown and exacerbation of joint inflammation during inflammatory arthritis. In the present study, we investigated another potential role for P. gingivalis in RA etiopathogenesis, based on the generation of ACPA through the activity of a unique P. gingivalis peptidylarginine deiminase (PPAD) produced by this bacterium, which is capable of protein citrullination. Using a novel P. gingivalis W50 PPAD mutant strain, incapable of protein citrullination, and serum from disease-modifying antirheumatic drug–naïve early arthritis patients, we assessed whether autocitrullinated proteins in the P. gingivalis proteome serve as cross-activation targets in the initiation of ACPA production. We found no evidence for patient antibody activity specific to autocitrullinated P. gingivalis proteins. Moreover, deletion of PPAD did not prevent P. gingivalis–mediated intestinal barrier breakdown and exacerbation of disease during inflammatory arthritis in a murine model. Together, these findings suggest that the enzymatic activity of PPAD is not a major virulence mechanism during early stages of inflammatory arthritis.

scholarly journals Treatment strategy for patients with rheumatoid arthritis

2020 ◽  
Vol 63 (7) ◽  
pp. 422-430
Author(s):  
Soo-Kyung Cho ◽  
Yoon-Kyoung Sung
Keyword(s):  
Quality Of Life ◽  
Rheumatoid Arthritis ◽  
Disease Activity ◽  
Targeted Therapies ◽  
Functional Disability ◽  
Joint Destruction ◽  
Joint Damage ◽  
Chronic Inflammatory Disease ◽  
Biologic Dmards

Rheumatoid arthritis (RA) is a chronic inflammatory disease affecting the joints, causing joint destruction, functional disability, and reduced quality of life in patients. The aim of RA treatment is to decrease the inflammation, prevent joint damage, and improve patientsʼ quality of life while minimizing progression of the disease. Both early detection and intervention with disease-modifying anti-rheumatic drugs (DMARDs) have been reported to improve therapeutic outcomes. Treatment with DMARDs should be started immediately after the diagnosis is established, with methotrexate as the best initial drug of choice. Disease activity should be regularly monitored. Targeted therapies can be considered in patients with persistent active disease despite methotrexate therapy. Remission or low disease activity is the preferred treatment target. There are two major classes of DMARDs: conventional synthetic DMARDs and the targeted therapies specific to pro-inflammatory cytokines including biologic DMARDs and small molecule inhibitors. Recently, the importance of shared decision making, in which patients and clinicians make decisions together, and education of the patient has been emphasized in the treatment strategies of RA. This review summarizes the effectiveness and safety of the DMARDs currently available for RA treatment. Recommendations for RA management would also be discussed in this article.

scholarly journals Clinical predictors of multiple failure to biological therapy in patients with rheumatoid arthritis

2020 ◽  
Vol 22 (1) ◽  
Author(s):  
Marta Novella-Navarro ◽  
Chamaida Plasencia ◽  
Carolina Tornero ◽  
Victoria Navarro-Compán ◽  
José L. Cabrera-Alarcón ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
University Hospital ◽  
Clinical Predictors ◽  
La Paz ◽  
Erosive Disease ◽  
Das 28 ◽  
Younger Age ◽  
Insufficient Response ◽  
Patients Experience

Abstract Background Biological therapies have improved the clinical course and quality of life of rheumatoid arthritis (RA) patients. Despite the availability and effectiveness of these treatments, some patients experience multiple failures to biologic disease-modifying antirheumatic drugs (bDMARDs), constituting a particular challenge to clinicians. Objectives This study aims to determine the percentage of rheumatoid arthritis (RA) patients who fail to respond to subsequent bDMARDs, describe their characteristics, and identify specific baseline and early features during the first bDMARD as possible predictors of consecutive multiple bDMARD failure. Methods This is a longitudinal study involving RA patients from the prospective biological cohort drawn from the La Paz University Hospital RA Registry (RA-Paz), starting a bDMARD during the years 2000 to 2019. Patients who presented insufficient response (due to primary or secondary inefficacy) to at least three bDMARDs or two bDMARDs with different mechanism of action were considered multi-refractory (MR-patients). Patients who achieved low disease activity or remission (by DAS-28) with the first bDMARD and maintained this over a follow-up period of at least 5 years were considered non-refractory (NR-patients). Results A total of 41 out of 402 (10%) patients were MR-patients and 71 (18%) NR-patients. In the multivariate analysis, the presence of erosions, younger age, higher baseline DAS-28 and mostly achieving delta-DAS < 1.2 after 6 months of the first bDMARD (OR 11.12; 95% CI 3.34–26.82) were independently associated with being MR-patients to bDMARDs. Conclusions In our cohort, 10% of patients with RA were observed to have multi-refractoriness to bDMARDs. This study supports the contention that younger patients with erosive disease and especially the early absence of clinical response to the first bDMARDs are predictors of multi-refractoriness to consecutive biologics. Hence, patients with these characteristics should be monitored more closely and may benefit from personalized treatments.

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