Function In Rheumatoid Arthritis Patients Research Articles

Comparison of methods for diagnosing sarcopenia in patients with rheumatoid arthritis

Background. Sarcopenia in patients with rheumatoid arthritis (RA) occurs in connection with the chronic inflammatory process, hormonal therapy, and limitation of physical activity due to pain syndrome. For RA patients, it is important to preserve muscle mass and function to reduce the risk of disability and improve quality of life. The research purposed to assess muscle mass and function in RA patients with a comparison of me­thods for determining skeletal muscle mass recommended by ­EWCSOP2. ­Materials and methods. A total of 44 persons were exa­mined, 32 were patients with RA, and 12 ones were healthy persons (the control group). The following methods were used in the study: the SARC-F questionnaire, the determination of the appendicular mass of skeletal muscles using dual-photon X-ray absorptiometry (DXA), the percentage of muscle and fat tissue using bioimpe­dancemetry, the determination of the cross-sectional area of the lumbar muscle using computer tomography (CT), physical performance tests. Patients with RA were divided into 3 groups: group A (11 persons) — questionnaire (SARC-F), assessment of skeletal muscle strength and determination of muscle mass using DXA was performed; group B (11 patients) — questionnaire (SARC-F), assessment of skeletal muscle strength and determination of muscle mass using bioimpedancemetry; group C (10 persons) — questionnaire (SARC-F), assessment of skeletal muscle strength and determination of muscle mass using CT. Results. All indices of physical performance tests and instrumental methods of assessing muscle mass were significantly worse in patients with RA compared to the control group. Sarcopenia was diagnosed in 50 % of patients with RA, 6 cases in group A (the average value of appendicular lean mass was 15.7 kg in them, in the control group — 21 kg), 5 in group B (the average values of the proportion of muscle mass were 21.2 compared to 29.3 % in the control group) and 5 in group C (the average percentage of muscle mass was 49.46 %, in the control group 58.32 %). ­Conclusions. Each of the methods of assessing the mass of skeletal muscles has proven its ability in the diagnosis of sarcopenia. Improving the efficiency of diagnosing sarcopenia in patients with RA will improve the response to the treatment of the underlying disease and improve the quality of life of patients.

Comparison between Total Contact Custom-Made Insole versus Over the Counter Insole in Rehabilitation of Rheumatoid Arthritis Patients

Objective To compare the effect of total contact custom-made foot insoles versus over-thecounter flat silicone insoles on pain and foot function in rheumatoid arthritis patients. Patients and Methods This study included 30 patients diagnosed with rheumatoid arthritis according to the 2010ACR/EULAR classification criteria. All underwent history, clinical examination of foot, plantar pressure assessment, pain assessment by visual analog scale (VAS), foot functionality, assessed by Lower Extremity Functional Scale (LEFS). Patients were randomly assigned to group (A) 15 patients which received total contact custom made insoles. And group B, 15 patients received a flat over the counter insole made of silicone, follow up was done after two weeks using VAS and LEFS scores. Results A total of 30 patients, aged 46.07 ± 10.78 years, with disease duration ranged from 2 – 18 years with Median (IQR) of 5.50, body mass index (BMI) ranged from 19.5 to 37 kg/m2 with mean ±SD of 29.01 ± 4.00. In both groups, significant difference in the VAS after using insoles, observed more in -group A with mean ± SD 22.67 ± 11.47, while mean ± SD of group B was 39.00 ± 14.04. Regarding LEFS score: significant improvement of the score ―improved lower limb functionality‖ in both groups after using the insoles, slightly higher in group B more than group A. No significant differences in functionality between the two groups (LEFS score after intervention for group A with Mean ± SD 40.13 ± 9.88, group B with Mean ± SD 43.20 ± 6.82). Conclusion The custom-made foot orthoses significantly reduced the patients’ foot pain, although they did not have significantly positive effects on disability and foot functionality compared with only cushioning.

Effects of Exercise on Body Composition and Physical Function in Rheumatoid Arthritis Patients: Scoping Review.

In rheumatoid arthritis (RA) patients, an adverse change in body composition, which usually results in muscle wasting and increased fat mass, is high, contributing to increased functional disability. There are indications that resistance and dynamic exercise interventions could improve body composition and functional capacity in RA patients and should be recommended to manage RA. The scoping literature review aimed to analyze available literature about the effects of exercise on body composition in RA patients. Secondly to identify the contribution of exercise to improve physical function in RA patients, thirdly to identify gaps in the literature about physical exercises and health outcomes in RA patients, and make recommendations for future research. A scoping literature review design was employed following the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) guidelines. A systematic search of three databases (PubMed, CINAHL, and Scopus) for studies published from 2012 to 2022 was conducted. The words searched include "exercise intervention" AND "body fat" OR "muscle wasting" OR "lean body mass" AND "functional ability" OR "health assessments". The search strategy was limited to studies published in English on RA patients and exercise interventions. This search yielded 2693 studies, of which 11 met the inclusion criteria and were selected for review. The findings showed significant, positive effects of exercise interventions on RA patients' body composition and functional capacity, with exercise being highly beneficial. It is evident that high-intensity resistance exercise, as a stand-alone intervention, is feasible and safe for managing RA conditions. Physical exercises, following scientific guidelines, should be included as an integrated approach to managing RA conditions.

Correlation of rheumatoid and cardiac biomarkers with cardiac anatomy and function in rheumatoid arthritis patients without clinically overt cardiovascular diseases: A cross-sectional study.

Cardiac biomarkers have been shown to be related to cardiac abnormalities; nonetheless, few studies have confirmed the association between cardiac and rheumatoid biomarkers in rheumatoid arthritis (RA) patients. This study assessed the correlation of rheumatoid and cardiac biomarker levels with cardiac anatomy and function and explored the interaction between cardiac and rheumatoid biomarkers in RA patients without clinically overt cardiovascular diseases. A cross-sectional study was conducted among RA patients aged 18-65years without other connective tissue diseases, overlap syndrome, heart disease, or renal failure were included. Main cardiac and rheumatoid biomarkers, including high-sensitivity troponin T (hsTropT), N-terminal pro-B-type natriuretic peptide (NT-proBNP), rheumatoid factor, and anti-cyclic citrullinated peptide antibody (ACPA), were collected. Echocardiography was performed to examine cardiac anatomy and function. The mean left ventricular mass index (LVMI) was 80.8g/sqm, and the relative wall thickness was 0.4. The mean left ventricular ejection fraction was 70.3%. The hsTropT levels showed a weak positive correlation with LVMI and E/e' ratio and a very weak correlation with E/A ratio. Interaction effect between hsTropT and ACPA on LVMI was found in univariate analysis, not in multivariate analysis. Higher systolic blood pressure (SBP) and the use of non-steroidal anti-inflammatory drug (NSAID) increased the LVMI. Only age was related to the E/e' increase. The effect of hsTropT on LVMI was probably modified by ACPA in RA patients without clinically overt cardiovascular diseases. Age, SBP, and NSAID use among RA patients should be taken into account due to their relations to cardiac abnormalities.

Status of Renal Function in Rheumatoid Arthritis Patients

<i>Objective</i>: The aim of the present study was to assess the status of renal function in rheumatoid arthritis patients. <i>Methods</i>: A cross sectional study was conducted in the Department of Biochemistry, Dhaka Medical College, Dhaka from July 2016 to June 2017. According to selection criteria one hundred subjects were selected with the age ranging from 20-60 years and equally divided into two groups. Group-A fifty diagnosed case of rheumatoid arthritis patients attending in the OPD of Arthritis Care and Research Centre and SLE Clinic, Department of Medicine, Dhaka Medical College Hospital and Group-B fifty apparently healthy individuals. The study parameters were serum creatinine, eGFR, serum urea, BMI, RA factor and anti-citrullinated protein antibody (ACPA). The results were compared statistically between two groups. <i>Results</i>: Serum creatinine (mg/dl) (mean ± SD) level was significantly higher (p <0.032) in RA (0.85± 0.17) than normal individuals (0.78± 0.15). Level of eGFR (ml/min/1.73m2) (mean ± SD) level was significantly lower (p <0.042) in RA (84.5 ± 20.3) than normal individuals (92.7± 19.5). Serum urea (mg/dl) (mean ± SD) level was significantly higher (p <0.011) in RA (33.12 ± 9.46) than normal individuals (28.51± 8.28). RA factor (IU/ml) and anti-citrullinated protein antibody (ACPA, U/ml) (mean ± SD) level was significantly higher (p <0.001) in RA (37.4± 13.6 and 23.5± 8.3 respectively) than normal individual (11.7± 3.25 and 7.3± 1.65 respectively). The BMI (kg/m²) (mean ± SD) was significantly higher (p <0.0001) in RA (28.5 ± 4.8) than normal individuals (21.1± 3.7). <i>Conclusion</i>: Serum creatinine is positively correlated to RA factor and ACPA in both groups and eGFR is negatively correlated to RA factor and ACPA in both groups. Routine screening of renal function may be beneficial for rheumatoid arthritis patients to prevent renal complications.

Efficacy of Siwan Traditional Therapy on Erythrocyte Sedimentation Rate, Lipid Profile, and Atherogenic Index as Cardiac Risk Factors Related to Rheumatoid Arthritis.

Background and Objectives: The most frequent cause of mortality in rheumatoid arthritis (RA) patients is cardiovascular disease (CVD). Inflammation, dyslipidemia, and decreased physical activity are some of the main risk factors for CVD. Siwan sand therapy is a type of traditional therapy used in Egypt to treat RA. The approach of this therapy depends on the experience of the healers. The aim of the current study was to compare the effects of three sessions of Siwan traditional therapy to five sessions on common CVD risk factors and physical function in rheumatoid arthritis patients. Materials and Methods: Thirty patients (9 male and 21 female) were assigned into two groups of equal size: group (A) received three sessions of Siwan traditional therapy in the form of a sand bath. Group (B) received the same form of therapy for five days. Erythrocyte sedimentation rate (ESR), lipid profile, atherogenic index of plasma (AIP), and a health assessment questionnaire (HAQ) were measured before and after treatment. Results: There was a significant increase above normal within group (A) for ESR (p = 0.001), triglycerides (TG; p = 0.015), total cholesterol (Tot-Chol; p = 0.0001), and low-density lipoprotein (LDL; p = 0.0001). However, there were no considerable differences in high-density lipoprotein (HDL; p = 0.106), very low-density lipoprotein (VLDL; p = 0.213), AIP (p = 0.648), and HAQ (p = 0.875). For the second group, there were significant changes within group B only in Tot-Chol (p = 0.0001), HDL (p = 0.0001), VLDL (p = 0.0001), AIP (p = 0.008), and HAQ (p = 0.014). There was a significant difference between both groups regarding HDL (p = 0.027), LDL (p = 0.005), AIP (p = 0.029), ESR (p = 0.016), and HAQ (p = 0.036). Conclusions: For RA patients, five days of Siwan traditional therapy caused significant changes regarding inflammation, Tot-Chol, LDL, HDL, AIP, and functional activity when compared to three days of Siwan hot sand therapy.

Assessment of Left Atrium Volume and Function in Rheumatoid Arthritis Patients by Three-Dimensional Transthoracic Echocardiography

Assessment of Left Atrium Volume and Function in Rheumatoid Arthritis Patients by Three-Dimensional Transthoracic Echocardiography

Foot function in rheumatoid arthritis: Correlation between the Rheumatoid and Arthritis Outcome Score and performance-based physical tests.

Foot function is usually assessed using self-reported outcome measures which remain subjective in patients with rheumatoid arthritis (RA). Physical performance tests were recommended for functional assessment in lower limb osteoarthritis. However, foot function assessment's guidelines in RA are lacking. We aimed to investigate the correlation between a self-reported outcome measure and two performance-based physical tests for assessing foot function in RA patients. A cross-sectional study was performed over 7months' period including RA patients. We used Rheumatoid and Arthritis Outcome score (RAOS) as a self-reported functional tool. Physical performance tests were 4-min walk test (4-MWT) and Timed up and go test (TUGT). Fifty RA patients were included with 96% females and a mean age of 54.7±10.4years. Foot involvement occurred since the diagnosis of RA in 36% of patients. Foot pain was reported by 68% of patients (48% forefoot), and foot stiffness in 46% of patients. Skin lesions of the feet were found in 78% of patients, 90% had foot deformities and 56% had inflammatory disorders of feet. Radiographic lesions were found in 94% of patients. The most impaired RAOS subscales were Sports and Recreation and Quality of life. Poor physical-based performance was found in 34% of RA patients according to 4-MWT, in 42% of RA patients according TUGT, and in 46% of patients based on at least one performance test. RAOS was negatively correlated to the 4-MWT and positively correlated in the subscales pain, other symptoms, activities of daily living, and Sport/Rec of the RAOS. Poor performance-based physical tests were significantly associated with advanced age, sedentary lifestyle, higher disease activity score and impaired functional status. Foot-related parameters significantly associated with poor performance-based physical tests were: foot pain, foot deformity and inflammatory disorders. Multivariate analysis identified foot deformities and higher functional impairment as predictive factors for lower gait speed (4-MWT) and older age and higher functional impairment for higher duration of TUGT. RAOS was significantly associated with performance-based physical function. In the era of connected technologies, these results encourage the regular assessment of rheumatoid foot function by the RAOS score through a connected programme using wearable trackers.

Sexual function assessment in women with rheumatoid arthritis

Background: Rheumatoid arthritis (RA) is a common disabling joint disease affecting both males and females. Sexual dysfunction (SD) is a common association with RA. Aim and objectives: The aim of this study was to assess the frequency rates of sexual problems and associated factors in a cohort of married females with Rheumatoid arthritis (RA), and to investigate the correlation between hormonal profile (serum testosterone level, estrogen and progesterone level) and female sexual function in RA patients. Subjects and methods: This cross-sectional analytical study included 100 female RA patients and 80 age matched healthy control female from Rheumatology and Rehabilitation Clinic in Qena University Hospital. Results: there were a highly statistically significant negative correlation between Female Sexual Function Index (FSFI) and each of DAS, VAS, MHAQ, HAM-A and Testosterone level while it showed statistically significant positive correlation between Female Sexual Function Index (FSFI) and each of Estrogen and Progesterone. Conclusion: Our study suggests that rheumatoid arthritis has a negative impact on patients' sexuality. Age of patients and partners, pain, and tender joints appear to be the main factors influencing sexual function.

Study of thyroid function in rheumatoid arthritis patients presenting at Phulo Jhano Medical College

Study of thyroid function in rheumatoid arthritis patients presenting at Phulo Jhano Medical College

4 Early diagnosis of subclinical left ventricular dysfunction in postmenopausal women with rheumatoid arthritis

Abstract Aims The most frequent cause of death among patients affected by rheumatoid arthritis (RA) is heart failure, its high prevalence is independent by cardiovascular risk factors. An early diagnosis of heart failure risk may be done assessing left ventricular diastolic dysfunction (LVDD) by Doppler echocardiography. Our study aimed to estimate the LV diastolic function in RA patients. Methods and results We enrolled 207 consecutive postmenopausal women (PMW) with normal electrocardiography, physical examination, and confirmed diagnosis of RA for over a year and 200 PMW free from RA as control group (CG). All women underwent to M-mode, two-dimensional Doppler echocardiography. Seventy-two women were affected by LVDD among 207 women with RA (34.8%), 46 among 200 women on CG (23%), Chi-squared 6.8, odds ratio 1.8, confidence interval (CI) 95%, P &amp;lt; 0.0088. In our population of PMW the chance to be affected by LVDD is almost one and a half times. There were 70 women affected by LVDD among 72 hypertensive women with RA (97.2%), 32 women were affected by LVDD among 98 hypertensive women on CG (32.7%), Chi-squared 72.1, odds ratio 7.2, CI 95%, P &amp;lt; 0.0088, Table II. Among hypertensive PMW of our population the chance to be affected by LVDD is more than triple. All LVDD subjects had abnormal diastole for all different degrees of severity. Conclusions We assess that PMW affected by RA have a significantly high incidence of LV diastolic dysfunction without clinical evidence of heart disease, the incidence is even higher if they are hypertensive, so we recommend a Doppler echocardiography examination for all women with a diagnosis of RA.

Evaluating the Use of Hydroxychloroquine in Treating Patients With Rheumatoid Arthritis.

Rheumatoid Arthritis (RA) is one of the most common autoimmune diseases present today. Although treatment options may differ among clinicians, a commonly prescribed treatment is hydroxychloroquine (HCQ), alone or in combination with other medications. HCQ has been studied for its immunomodulatory effects as well as its role in treating adverse conditions associated with RA. This systematic review examined the use of HCQ therapy in RA patients. A systematic search for relevant literature through PubMed, National Institute of Informatics, Japan (CiNii), and Science Direct databases were carried out in August 2021. Literature directly related to HCQ therapy for RA patients, RA-associated chronic kidney disease, and cardiovascular disease (including lipid profile) was considered relevant. HCQ associated retinopathic adverse effects were also selected for this review. Thirty-eight articles were found to be relevant, passed quality assessment, and were included in this review. Nine articles discussed HCQ therapy in comparison with other therapies (mainly methotrexate and sulfasalazine), but were contradictory in their outcomes, as were the seven papers that reviewed kidney function in RA patients with and without HCQ. Five articles credited better cardiovascular outcomes to RA patients taking HCQ. Sixteen articles studied the relationship between HCQ and retinal toxicity, providing insights into the risks associated with HCQ therapy. HCQ therapy was found not only to be beneficial in slowing the disease progression in RA patients but enhanced the effects of methotrexate in treating RA as well. Data strongly associates HCQ therapy with the mitigation of RA-related cardiovascular and kidney conditions. However, if HCQ is prescribed, it is imperative to be aware of the possible (although rare) retinopathic adverse effects associated with this therapy.

The Effect of Orally Administering Forkhead Box P3 Recombinant Lactobacillus plantarum on Regulatory T-cell Functionality in a Humanized Mouse Model for Rheumatoid Arthritis: A Research Protocol

Introduction: Inflammation and joint stiffening are common symptoms of rheumatoid arthritis (RA), an autoimmune inflammatory disease. Previous treatments of RA have focused on decreasing symptomatic effects but have limited effects on disease progression. In RA, an influx of pro-inflammatory cytokines occurs at the synovium, which is the soft tissue surrounding the joints. The production of pro-inflammatory cytokines is controlled by regulatory T-cells, which have a deficit in function in RA patients. Regulatory T-cell development and function is regulated by the forkhead box P3 (FOXP3). The FOXP3 gene is a viable therapeutic target to restore regulatory T-cell functionality because FOXP3 is underexpressed in RA patients. Therefore, this study ventures to treat RA regulatory T-cell functionality by increasing FOXP3 gene expression through FOXP3 recombinant Lactobacillus plantarum bactofection. We hypothesize that bactofection will lead to a decrease in RA progression by restoring normal function in regulatory T-cells, thus decreasing inflammation. Methods: We propose a study using severe combined immunodeficient mouse models engrafted with human RA synovium. The mice will be given either no treatment (control group) or a 2×109 CFU/g dose of recombinant Lactobacillus plantarum strain. The mice will be sacrificed after 0 days, 10 days, 20 days, and 30 days (control group and treatment groups respectively). Synovial tissue samples will be obtained from the hip joints. Through immunofluorescence and western blotting, the prevalence of FOXP3, regulatory T-cells and pro-inflammatory cytokines such as tumor necrosis factor-alpha, Interleukin-1 and Interleukin-6 will be compared between the control and treatment groups. For statistical analysis, a one-way MANOVA test, Levene’s test, and a Shapiro-Wilk test will be performed using GraphPad Prism. Results: As a result of bactofection, there will be an increase in FOXP3 and regulatory T-cells, resulting in a decrease of pro-inflammatory cytokines. Discussion: Analysis of mice treated with recombinant Lactobacillus plantarum compared to mice with no treatment will set a correlation between FOXP3, regulatory T-cells, and pro-inflammatory cytokines prevalence and RA progression after treatment. Conclusion: The findings of this study will provide evidence that bactofection is a viable treatment for RA, and may be more effective than conventional treatments.

A preliminary study on the evaluation of left atrial function of rheumatoid arthritis by two dimensional speckle tracking imaging

To evaluate the changes of left atrial (LA) geometry and function in patients with rheumatoid arthritis (RA) by conventional echocardiography and two-dimensional speckle tracking imaging (2D-STI). We enrolled 46 RA patients with a duration of < 5 years as Group I, 40 RA patients with a duration of ≥ 5 years as Group II, and 40 normal subjects as the control group. Conventional echocardiography was conducted to measure traditional parameters. The LA strain during reservoir phase (LASr), LA strain during conduit phase (LAScd), LA strain during contraction phase (LASct), and LA global longitudinal strain (LAGLS) were obtained from 2D-STI. Related ultrasound results were compared. The LASct was significantly higher in Group I than in control group (P < 0.05). The LASr, LAScd, and LAGLS were significantly lower in Group I than in control group (all P < 0.05). The LASr, LAScd, LASct, and LAGLS were significantly lower in Group II than in control group and Group I (all P < 0.05). The function of LA impaired in RA patients, and the impairment aggravated with the clinical course of RA patients. 2D-STI technology can early and accurately evaluate the LA function of RA patients by evaluating LASr, LAScd, LASct, and LAGLS.

Morphological Parameters in Quadriceps Muscle Were Associated with Clinical Features and Muscle Strength of Women with Rheumatoid Arthritis: A Cross-Sectional Study.

Background: Rheumatoid arthritis (RA) is an autoimmune, inflammatory and chronic disease that may lead to loss of muscle mass, muscle strength and decreased functionality. Our objectives are to assess the quadriceps muscle morphology by ultrasound (MU) and verify its associations with clinical features, muscle strength and physical function in RA patients. Methods: In this cross-sectional study, RA women (≥18 years) were included. Morphological parameters in quadriceps muscle consisted of the muscle thickness and pennation angle of rectus femoris (RF), vastus intermedius (VI) and vastus lateralis (VL). RA activity was measured by a 28-joint disease activity score (DAS28), muscle strength by handgrip and chair stand tests, and physical function by health assessment questionnaire (HAQ), timed-up-and-go (TUG) test and short physical performance battery (SPPB). Results: Fifty-five patients were included (age: 56.73 ± 9.46 years; DAS28: 3.08 ± 1.29). Muscle thickness in RF, VI and VL were negatively associated with age (RF, p < 0.001; VI, p = 0.013; VL, p = 0.002) and disease duration (RF, p < 0.001; VI, p = 0.005; VL, p = 0.001), and were positively associated with handgrip strength (RF, p = 0.015; VI, p = 0.022; VL, p = 0.013). In addition, decreased muscle thickness in VI (p = 0.035) and a smaller pennation angle in RF (p = 0.030) were associated with higher DAS-28 scores. Conclusion: Quadriceps muscle morphology by ultrasound appears to be affected by age, disease duration, disease activity and muscle strength in patients with RA. MU can be a useful method to evaluate the impact of the disease on skeletal muscle.

Association between Inflammatory Cytokines and Liver Functions in Rheumatoid Arthritis Patients

Background: Rheumatoid arthritis (RA) is associated with abnormal liver tests, and the medications used for RA are often hepatotoxic. Therefore, this study aimed to investigate an association between pro-inflammatory and anti-inflammatory cytokines and liver function tests in RA patients.&#x0D; Methods: In this descriptive cross-sectional study, 88 RA patients were included, 84 of them were women and 4 men, aged 21–81 years. Serum interleukin-10 (IL-10), interleukin-17 (IL-17), Osteopontin (OPN) were measured and liver function tests were conducted.&#x0D; Results: The frequency of RA was higher among adults aged &gt;41 years (72 [81.8%]) than young adults aged ≤41 years (16 [18.2%]). RA was more common in women (84 [95.5%]) than in men (4 [4.5%]) – approximately 21:1-fold. Young adults had higher abnormal IL-10 than adult RA patients (OR = 3.72, p-value 0.044). Abnormal IL-17 (OR = 5.67, p-value 0.034) was found to be increased in young-adult RA patients. No association was observed between age and OPN and between the duration of disease and IL-10, IL-17, and OPN. Similarly, no association was noted between the types of treatment and IL-10, IL-17, and OPN, nor between IL-10, IL-17, OPN and liver parameters (AST, ALT, ALP, ALB, TP, and GGT).&#x0D; Conclusion: Pro-inflammatory and anti-inflammatory cytokines are not associated with abnormal liver functions, as has been demonstrated in RA patients.

Factors contributing to discrepant estimated glomerular filtration values measured by creatinine and cystatin C in patients with rheumatoid arthritis

This study aimed to clarify the factors underlying the discrepancy that has been noted between estimated glomerular filtration ratio (eGFR) measured using serum creatinine (Cr) and eGFR using serum cystatin C (CysC) in patients with rheumatoid arthritis (RA) and to identify those patients whose renal function should be evaluated using CysC. We retrospectively evaluated clinical features, disease activity, Steinbrocker radiological staging, and co-morbidities (diabetes mellitus, hypertension, dyslipidemia) in 238 RA patients. eGFR using serum creatinine (eGFR-Cr) and eGFR using serum cystatin C (eGFR-CysC) were calculated using the new Japanese coefficient-modified Modification of Diet in Renal Disease study equation. To clarify the cause(s) of differences of 20% or more between the two eGFRs, we divided our RA patients into Group A (eGFR-Cr/eGFR-CysC ≥ 1.2) and Group B (eGFR-Cr/eGFR-CysC < 1.2), and searched for factors independently related to Group A. Forty-five patients (18.9%) were assigned to Group A, and 193 (81.1%) to Group B. BMI (Odds Ratio [OR] 0.820, 95% confidence interval [CI] 0.675–0.996), Hb (OR 0.633, 95% CI 0.433–0.926), CK (OR 0.773 per 10 units, 95% CI 0.644–0.933), NSAID use (OR 0.099, 95% CI 0.020–0.494), diabetes mellitus (OR 6.024, 95% CI 1.508–24.390) and stage 4 Steinbrocker radiological stage (OR 10.309, 95% CI 2.994–35.714) were identified as independent relevant factors for Group A by a multifactorial analysis. Renal function in RA patients with low BMI, diabetes, anemia and low CK may be overestimated using eGFR-Cr alone, and such patients need to be evaluated using eGFR-CysC.

Foot Pain and Morphofunctional Foot Disorders in Patients with Rheumatoid Arthritis: A Multicenter Cross-Sectional Study.

Foot problems are highly prevalent in people with rheumatoid arthritis. This study aims to explore the foot morphology, pain and function in rheumatoid arthritis patients and the relation with the time of disease debut. A cross-sectional study was designed. Footprint, the Foot Posture Index, the hallux valgus prevalence, foot pain and function in 66 rheumatoid arthritis patients and the association with time since diagnosis, were recorded. The Foot Function Index, the Manchester Foot Pain and Disability Index, the Visual Analogic Scale, and the Manchester Scale for hallux valgus were administered and analyzed in two groups, with less and more than 10 years of diagnosis of the disease. A high prevalence of pronated (right 36.8% and left 38.6%) and highly pronated (right 15.8% and left 15.8%) feet was observed, as well as an elevated percentage of low arched footprints (right 68.4 and left 66.7%) and hallux valgus (right 59.6% and left 54.4%). Hallux valgus prevalence, toe deformities and Foot Function Index (Functional limitation) factors were significantly associated with the time since RA diagnosed adjusted for the other factors. The adjusted odds ratio of Hallux valgus prevalence was 4.9 (1.2–19.7). In addition, the foot function was diminished, and foot pain was present in most participants. In conclusion, rheumatoid arthritis patients’ feet showed altered morphology and function, and with longer rheumatoid arthritis history, metatarsophalangical stability and foot function, but not pain and global foot posture, were likely to deteriorate.

Relationships of the stand-up time to falls and fractures in patients with rheumatoid arthritis: Results from the CHIKARA study.

Patients with rheumatoid arthritis (RA) have a higher risk of falls and fractures due to muscle weakness and painful joints of the lower extremities. Evaluation of muscle functions is important to predict falls and fractures. The aim was to investigate the relationships of muscle functions with falls and fractures in RA patients. Stand-up muscle power, speed, and stabilizing time were evaluated by a muscle function analyzer in 90 RA patients in the CHIKARA study (UMIN000023744). The relationships of the muscle functions with falls, fractures, body composition, Disease Activity Score of 28 joints - erythrocyte sedimentation rate (DAS28-ESR), modified Health Assessment Questionnaire (mHAQ) scores, Steinbrocker class, stage, sarcopenia, and frailty were investigated in a cross-sectional study. Each parameter of muscle function was related to age, falls, frailty, and the leg muscle score. However, only stabilizing time was related with fractures (r=.217, P=.04). When stabilizing time was≥1.13 and ≥1.36seconds, the odds ratios for falls and fractures were increased 6.2-fold compared to<1.13seconds (95% CI: 1.2-20.1, P=.002) and 11.4-fold compared to <1.36seconds (95% CI: 1.7-92.5, P=.071), respectively. Sarcopenia and skeletal muscle mass were not significantly related to each muscle function. There was a negative correlation between DAS28-ESR and power. Steinbrocker class and mHAQ had negative correlations with power and speed. Sarcopenia and skeletal muscle mass were not adequate indicators of muscle functions in RA patients. Analyzing muscle functions is helpful to predict falls and fractures. Patients with extended stabilizing times should recognize the increased risk of falls and fractures.

The Effect of Anti-TNF Therapy on Cardiac Function in Rheumatoid Arthritis: An Observational Study.

Congestive heart failure (CHF) is the second most prevalent cause of death in rheumatoid arthritis (RA). The systemic inflammatory state in RA patients is deemed responsible for this finding. Anti-inflammatory treatment with anti-tumor necrosis factor (anti-TNF) therapy decreases CV risk and subsequently might improve the cardiac function by lowering the overall inflammatory state. This study investigated the effect of anti-TNF on the cardiac function in RA patients. Fifty one RA patients were included, of which thirty three completed follow-up. Included patients were >18 years, had moderate–high disease activity and no history of cardiac disease. Patients were assessed at baseline and after six months of anti-TNF treatment. Patients underwent conventional Speckle tracking and tissue Doppler echocardiography in combination with clinical and laboratory assessments at baseline and follow-up. The left ventricular ejection fraction (LVEF) and global longitudinal strain (GLS) showed no changes during follow-up, LVEF 63% (±9) to 62% (±8) p = 0.097 and GLS −20 (±4) to −20 (±3) p = 0.79, respectively. Furthermore, E/e’ nor E/A changed significantly between baseline and follow-up, respectively 8 (7–9) and 8 (7–9) p = 0.17 and 1.1 (±0.4) and 1.1 (±0.4) p = 0.94. Follow-up NT-proBNP decreased with 23%, from 89 ng/L (47–142) to 69 ng/L (42–155), p = 0.10. Regression analysis revealed no association between change in inflammatory variables and cardiac function. Echocardiography showed no effect of anti-TNF treatment on the cardiac function in RA patients with low prevalence of cardiac dysfunction. Moreover, NT-proBNP decreased, possibly indicating (subtle) improvement of the cardiac function.