Sex-specific differences and how to handle them in early psoriatic arthritis

Objectives The prevalence of psoriatic arthritis (PsA) is the same in men and women; however, the latter experience a higher burden of disease and are affected more frequently by polyarthritis. Here, we performed an early PsA cohort analysis to assess sex-related differences in demographics, disease characteristics, and evolution over 1 year including applied treatment strategies. Methods Our study is embedded in the Dutch south-west Early Psoriatic Arthritis cohoRt. We described patient characteristics and treatment decisions. For the comparison across sexes and baseline and 1 year follow-up, appropriate tests depending on the distribution were used. Results Two hundred seventy-three men and 294 women with no significant differences in age and ethnicity were included. Women reported significantly longer duration of symptoms before diagnosis and significantly higher tender joint count, a higher disease activity, higher levels of pain, and lower functional capacity. Although minimal disease activity (MDA) rates increased over time for both sexes, MDA remained significantly more prevalent among men at 1 year (58.1% vs 35.7%, p < 0.00). Initially, treatment strategies were similar in both sexes with methotrexate being the most frequently used drug during the first year. Women received methotrexate for a shorter period [196 (93–364) vs 306 (157–365), p < 0.00] and therefore received a lower cumulative dose compared to men. Retention time was shorter for all DMARDs, and women had a delayed start on b-DMARDs. Conclusion After 1 year of standard-of-care treatment, women did not surpass their baseline disadvantages. Despite the overall improvement, they still presented higher disease activity, higher levels of pain, and lower functional capacity score than men. The nature of these findings may advocate a need for sex specific adjustment of treatment strategies and evaluation in early PsA patients.

Effectiveness of lower limb rehabilitation protocol using mobile health on quality of life, functional strength and functional capacity among knee osteoarthritis patients who were overweight and obese: A randomized controlled trial

Objective: This study aimed to investigate the effectiveness of the lower limb rehabilitation protocol (LLRP) using mobile health (mHealth) on quality of life (QoL), functional strength, and functional capacity among knee OA patients who were overweight and obese. Materials and Methods: In the current trial, 114 patients were recruited and randomized into either the rehabilitation group with mobile health (RGw-mHealth) receiving reminders by using mHealth to carry on the strengthening exercises of LLRP and instructions of daily care (IDC), the rehabilitation group without mobile health (RGwo-mHealth) following the strengthening exercises of LLRP and instructions of daily care (IDC) and control group (CG) only following the IDC for duration of 12-weeks. The reminders for using mHealth were provided two times a day for three days a week. Primary outcome measures were QoL assessed by the Western Ontario and McMaster Universities Osteoarthritis Index summary score, and functional strength by Five-Repetition Sit-To-Stand Test. Secondary outcome measure was functional capacity assessed by the Gait Speed Test. The assessments of QoL, functional strength, and functional capacity were taken at baseline and posttest after 12-weeks of intervention. Results: After 12 weeks of intervention, patients in all three groups had statistically significant improvement in QoL within groups (p < 0.05). Furthermore, patients in the RGw-mHealth and RGwo-mHealth had statistically significant improvement in functional strength and walking gait speed within groups (p < 0.05). The pairwise between-group comparisons (Bonferroni post hoc test) of the mean changes in QoL, functional strength, and functional capacity at posttest assessments revealed that patients in the RGw-mHealth had statistically significant greater mean change in QoL, functional strength and functional capacity relative to both the RGwo-mHealth and CG (p < 0.001). Conclusion: Improvement in QoL, functional strength, and functional capacity was larger among patients in the RGw-mHealth compared with the RGwo-mHealth or CG. Keywords: Osteoarthritis, knee, overweight, rehabilitation. mobile health.

Effectiveness of Physiotherapy in Patients with Ankylosing Spondylitis: A Systematic Review and Meta-Analysis

This study aimed to evaluate the safety and effectiveness of non-pharmacological interventions supervised by a physiotherapist in patients with Ankylosing Spondylitis, PROSPERO Protocol number CRD42020209453. Five databases (PubMed, PEDro, Scopus, Web of Science Core, and EMBASE) and reference lists with relevant articles were searched. Randomised controlled trials (RCTs) on the effectiveness of non-pharmacological interventions supervised by a physiotherapist were compared with usual care or home-based exercise programmes. Two investigators independently screened eligible studies. A total of 12 RCTs satisfied eligible criteria. The risk of bias ranged between medium and high. The meta-analysis results indicated that between supervised physiotherapy and usual care, the former was significantly associated with improvement in disease activity (standardised mean difference = −0.37, 95% CI, −0.64; −0.11; p < 0.001, I2 = 71.25%, n = 629), and functional capacity (standardised mean difference = −0.36, 95% CI, −0.61; −0.12, p < 0.05; n = 629). No statistically significant differences emerged when interventions were compared with home-based exercise programmes. Supervised physiotherapy is more effective than usual care in improving disease activity, functional capacity, and pain in patients with ankylosing spondylitis. No significant improvements emerged when supervised physiotherapy and home-based exercise programmes were compared. Further investigation and RCTs with larger samples are needed.

Relationship between physical activity and functional capacity change in aged cohort in São Paulo, Brazil

ABSTRACT Objectives: to evaluate the relationship between leisure-time physical activity and functional capacity change among aged people. Methods: we analyzed data of an aged cohort looking for determinants of functional capacity at follow-up. Baseline data were collected between 2007 and 2008 - average follow-up of 3,5 years. A full multivariate linear regression model was built to evaluate functional capacity at the end of the follow-up, controlling for functional capacity at baseline, sociodemographic, health and behavioral characteristics and amount of leisure-time physical activity in the period. Results: final model showed functional capacity independently correlated with age (p<0.001), body mass (p=0.013) and the number of activities of daily living compromised at baseline (p<0.001). Functional capacity improved with increased physical activity but loss statistical significance after adjustments (p=0.384). Conclusions: functional capacity decreases with increased age, increased loss of functional capacity at baseline and increased body mass. Albeit a non-significant association, leisure-time physical activity appears as an important modifiable factor.

Evaluation of the functional capacity and quality of life of children and adolescents during and after cancer treatment

ABSTRACT Objective: To evaluate the functional capacity and quality of life of children and adolescents during cancer treatment and post-treatment. Methods: Cross-sectional study of patients during cancer treatment and post-treatment, assessed by the 6-minute walk test (6MWT) and the Pediatric Quality of Life ™ questionnaire (cancer module). Results: Sixty-five patients, aged 11.2±3.5 years, mostly males (50.8%) and white (90.8%), with high incidence of hematological cancers (81.5%) participated in the study. The performance in the 6MWT was 23.1% inferior comparing the mean predicted and achieved (584.3±5 and 447.7±78.6 m, respectively). The percentage difference between the predicted and achieved 6MWT, and the different phases of cancer treatment were significantly different between patients in treatment (73.7±12.8) and post-treatment (84.5±9.1). When grouped by the different diagnoses, it was possible to observe that the distance covered by the patients with leukemia showed results closer to that predicted (80.7±11.7). Regarding the health-related quality of life questionnaire (HRQL), the child’s perception (78.0±14.56) was better than that reported by their parents (72.4±17.74). However, when we compared HRQL with the 6MWT, there was no association between them (p=0.597). Conclusions: Children and adolescents undergoing cancer treatment or post-treatment showed a 23% deficit in functional capacity. In relation to HRQL results, children’s perception was higher than that of their parents.