Scandinavian Journal of Rheumatology最新文献

Objective: Many people with rheumatoid arthritis (RA) or axial spondyloarthritis (axSpA) face limitations in societal participation, including work. Supervised exercise therapy improves symptoms and physical functioning, but its impact on work outcomes is unclear. This systematic review aims to examine the reporting of and effects on work outcomes in exercise therapy trials.

Method: Eight databases were searched up to February 2024 for randomized controlled trials (RCTs) evaluating the (cost-)effectiveness of supervised exercise therapy interventions in adults with RA/axSpA. The reporting of work and other social participation outcomes, the content of the exercise therapy intervention, and their effects on work outcomes were extracted. Within- and between-group results on work outcomes were summarized.

Results: In total, 41 (22 RA, 19 axSpA) RCTs on supervised exercise therapy were included, none of which was specifically targeted at work. Two RCTs in people with RA included work outcomes (absenteeism and employment hours). None of the RCTs in axSpA reported work outcomes. A work-related item or subscale was reported in 6/22 of the RA and 7/19 of the axSpA trials. Outcomes on societal participation (including work) were reported in 13/22 of the RA and 18/19 of the axSpA trials. Effects on work were reported on different outcomes and results were inconclusive.

Conclusion: Work outcomes are rarely reported in exercise therapy trials in people with RA/axSpA. To determine the effects of supervised exercise therapy on work, future studies should include work outcomes. International consensus on which outcome to use could increase the comparability of results.

Objective: Although gout is the most common inflammatory arthritis, there are few tools to monitor disease activity and predict complications in gout patients. The neutrophil-to-lymphocyte ratio (NLR) and monocyte-to-lymphocyte ratio (MLR) are associated with disease activity in various diseases and the NLR has been shown to predict coronary artery disease severity, a common comorbid condition with gout. Thus, we evaluated the use of NLR and MLR as novel biomarkers to measure disease activity and predict cardiovascular disease (CVD) risk in gout patients.

Method: Data were collected from 38 gout patients. Disease activity, including total number of acute gout attacks, and 10 year risk of cardiovascular morbidity, were assessed at the patient's visit. Calprotectin, cell counts, and uric acid levels were measured from patients' blood.

Results: Levels of the neutrophil activation marker calprotectin correlated with NLR (r = 0.56, p = 0.0004). MLR correlated with total number of gout attacks as well (r = 0.39, p = 0.02). NLR and MLR, but not absolute monocyte or neutrophil counts, were significantly correlated with body mass index and significantly increased in gout patients with high CVD risk (p < 0.05). Using logistic regression analysis, patients with high NLR or MLR (defined as the upper quartile of patients) had increased odds of developing high CVD risk (odds ratio 7.5, 95% confidence interval 1.7-33.0).

Conclusion: NLR and MLR are potential biomarkers to predict gout flare risk. An increase in either may indicate an increased risk of CVD morbidity.

Objective: Diabetic cheiroarthropathy (DCA) is one of the musculoskeletal manifestations of diabetes mellitus. It is clinically diagnosed using the prayer and tabletop signs. The clinical appearance, however, mimics autoimmune-mediated polyarthritis of the hands and fingers. It is therefore crucial to positively identify DCA patients.

Method: We used high-frequency B-mode ultrasound to investigate 14 patients with DCA and seven non-DCA diabetics with anti-cyclic citrullinated peptide antibody-positive rheumatoid arthritis (RA). We recorded the frequency of synovitis in radiocarpal, metacarpophalangeal, and proximal interphalangeal joints, the presence of tenosynovitis of the finger flexor tendons, echogenicity of the synovia and the flexor tendon sheaths, and soft tissue alterations in the digits. We compared our findings between groups to determine sonographic characteristics of DCA.

Results: A low rate of small finger joint involvement in the presence of a high rate of finger flexor tendinopathy showed a high association with DCA in correlation (p = 0.002) and regression analysis (p < 0.001). Tendon sheaths were significantly more often hyperechoic and proliferative in DCA compared to RA (p = 0.008), and hypoechoic soft tissue alterations were almost exclusively seen in DCA patients (p = 0.003). Radiocarpal joint involvement and its echogenicity did not differ between groups.

Conclusion: Ultrasonography shows typical features in DCA, and is capable of discriminating DCA from non-DCA patients with RA and diabetes.

Objectives: To assess the longitudinal association between physical activity and global functioning in patients with axial spondyloarthritis (axSpA), and to identify the subtype of physical activity that is longitudinally related to global functioning.

Method: Physical activity was measured using Global Physical Activity Questionnaire. Global functioning was assessed using the Assessment of SpondyloArthritis international Society Health Index (ASAS HI). The amount and subtype (work, transport, and recreation) of physical activity, disease activity, and ASAS HI were assessed at baseline, and at 1 and 2 year follow-up. Physical activity levels were categorized as low, moderate, or high. The longitudinal association between physical activity and ASAS HI scores was analysed using a generalized estimating equation.

Results: The study evaluated 160 patients. Univariate analysis identified physical activity at moderate level and higher, Ankylosing Spondylitis Disease Activity Score (ASDAS), and syndesmophyte number as being longitudinally associated with ASAS HI over 2 years. Multivariate analysis identified physical activity at moderate level and higher as being longitudinally associated with ASAS HI. Physical activity above moderate levels was associated independently with good global functioning. In the analysis stratified by radiographic axSpA and non-radiographic axSpA, a positive association between physical activity and global functioning was observed in both groups. Only recreational activity, but not work- and transport-related activity, showed an independent longitudinal relationship with the ASAS HI score.

Conclusions: Physical activity at moderate level and higher was associated independently with global functioning in axSpA. Therefore, patients should maintain physical activity above moderate levels to preserve global function.