Effect of Lifestyle Counselling via a Mobile Application on Disease Activity Control in Inflammatory Arthritis: A Single-Blinded, Randomized Controlled Study.

BACKGROUND: Mobile applications (apps) are a resource for information on lifestyle and nutrition which are associated to improved outcomes in inflammatory arthritis. OBJECTIVE: The aim of this study was to explore whether targeted lifestyle counselling via an app improves disease activity in arthritis patients. METHODS: Patients with rheumatoid arthritis (RA), spondyloarthritis (SpA), psoriatic arthritis (PsA) were randomized to 12 weeks of lifestyle counselling via an app (Mida, Midaia GmbH, Germany) pertaining to a healthy Mediterranean Diet, physical activity, and mental health. Disease activity was measured with specific instruments by a blinded physician and categorized (remission, low, moderate, high). Dietary adherence was assessed by the Mediterranean Diet Adherence Screener (MEDAS). Mixed effects logistic regression adjusted to baseline disease activity, age, and sex were calculated. RESULTS: Of 158 patients included (73% female, 53.3 ± 11.7 years), 74 were in the active counselling group (ACG). All showed improvement in low disease activity or remission. ACG patients had an odds ratio (OR) of 2.8 (95%-CI 1.1-7.2, p = 0.035), while OR in the control group was not significant OR = 2.1 (0.9-5.0, p = 0.097). The control group was less likely to reach a MEDAS >= 4 (OR = 0.16 (0.03-0.77), p = 0.02), while this was not seen in the ACG (OR = 0.54 (0.06-4.63), p = 0.6). Patients in the ACG showed a tendency towards improved adhesion to a Mediterranean Diet (MEDAS) (ß = 0.35 (-0.05-0.74), p = 0.086). This tendency was not observed in the control group (ß = 0.09 (-0.29-0.46), p = 0.64). CONCLUSIONS: Individualized lifestyle and dietary counselling via app may help to improve disease control in inflammatory arthritis patients.

Dietary fruits and arthritis.

Arthritis is a global health concern affecting a significant proportion of the population and associated with reduced quality of life. Among the different forms of arthritis, osteoarthritis (OA) and rheumatoid arthritis (RA) are the most common and lacking a definite cure in the affected individuals. Fruits, such as berries and pomegranates are rich sources of a variety of dietary bioactive compounds, especially the polyphenolic flavonoids that have been associated with antioxidant, anti-inflammatory and analgesic effects. Emerging research demonstrates a protective role of fruits and their polyphenols in pre-clinical, clinical and epidemiological studies of OA and RA. In this context, commonly available fruits, such as blueberries, raspberries and strawberries, and pomegranates have shown promising results in reducing pain and inflammation in experimental models and in human clinical studies of arthritis. There is also some evidence on the role of specific fruit polyphenols, such as quercetin and citrus flavonoids in alleviating RA symptoms. These emerging data deserve further investigation in rigorous scientific studies to determine the mechanisms, dosing and selection of fruits and fruit extracts in arthritis management.

Impact of Diet and/or Exercise Intervention on Infrapatellar Fat Pad Morphology: Secondary Analysis from the Intensive Diet and Exercise for Arthritis (IDEA) Trial.

OBJECTIVES: The infrapatellar fat pad (IPFP) represents intra-articular adipose tissue that may contribute to intra-articular inflammation and pain by secretion of proinflammatory cytokines. Here we examined the impact of weight loss by diet and/or exercise interventions on the IPFP volume. METHODS: Intensive Diet and Exercise for Arthritis (IDEA) was a single-blinded, single-center, 18-month, prospective, randomized controlled trial that enrolled 454 overweight and obese older adults with knee pain and radiographic osteoarthritis. Participants were randomized to 1 of 3 groups: exercise-only control (E), diet-induced weight loss (D), and diet-induced weight loss + exercise (D+E). In a subsample (n = 106; E: n = 36, D: n = 35, and D+E: n = 35), magnetic resonance images were acquired at baseline and at the 18-month follow-up, from which we analyzed IPFP volume, surface areas, and thickness in this secondary analysis. RESULTS: The average weight loss amounted to 1.0% in the E group, 10.5% in the D group, and 13.0% in the D+E group. A significant (p < 0.01) reduction in IPFP volume was observed in the E (2.1%), D (4.0%), and D+E (5.2%) groups. The IPFP volume loss in the D+E group was significantly greater than that in the E group (p < 0.05) when not adjusting for parallel comparisons. Across intervention groups, there were significant correlations between IPFP volume change, individual weight loss (r = 0.40), and change in total body fat mass (dual-energy X-ray absorptiometry; r = 0.44, n = 88) and in subcutaneous thigh fat area (computed tomography; r = 0.32, n = 82). CONCLUSIONS: As a potential link between obesity and knee osteoarthritis, the IPFP was sensitive to intervention by diet and/or exercise, and its reduction was correlated with changes in weight and body fat.

Dietary supplementation is more prevalent among adults with arthritis in the United States population.

OBJECTIVES: Sparse data are available to describe the prevalence of dietary supplementation among individuals with arthritis. Using a nationally representative sample, this investigation assessed the prevalence of dietary supplement use among Americans self-reporting arthritis. SETTING AND DESIGN: Data from 4606 participants of the 2011-2012 National Health and Nutrition Examination Survey were analyzed, including from 1170 participants self-reporting arthritis. Participants reported dietary supplementation over the past 30days. RESULTS: Approximately 62.5% of adults with arthritis reported taking at least one dietary supplement, which was greater than the 49.0% among individuals without arthritis (P<0.001). Arthritis was not independently associated with higher odds of supplement use (odds ratio=1.12, 95% confidence interval [CI]=0.88-1.42) in a multivariate logistic regression model. Among individuals with arthritis, supplement use was more prevalent in older adults (≥50 years), non-Hispanic whites, those with greater education, and those with health insurance. Among 721 participants with arthritis that were taking at least one supplement, 15.1% (95% CI=12.8-17.8%) indicated at least one of their supplements was 'for healthy joints, arthritis', compared to only 7.7% (95% CI=6.4-9.3%) of participants without arthritis (P<0.001). Glucosamine and/or chondroitin were the most common types of supplements used to improve joint health in arthritis. CONCLUSIONS: Given that roughly three out of five individuals with arthritis regularly use dietary supplements, health practitioners should be prepared to discuss potential benefits and risks of supplementation for the management of pain and function in arthritis.

How the Mediterranean diet and some of its components modulate inflammatory pathways in arthritis.

Arthritis encompasses a heterogeneous group of diseases characterised by inflammation that leads not only to joint damage, bone erosion, severe pain and disability, but also affects other organs of the body, resulting in increased morbidity and mortality. Although the mechanisms underlying the pathogenesis of joint diseases are for the most part unknown, a number of nutrient and non-nutrient components of food have been shown to affect the inflammatory process and, in particular, to influence clinical disease progression. The Mediterranean diet model has already been linked to a number of beneficial health effects: both fat and non-fat components of the Mediterranean dietary pattern have been shown to exert important anti-inflammatory activities by affecting the arachidonic acid cascade, the expression of some proinflammatory genes, and the activity of immune cells. N-3 polyunsaturated fatty acids, in particular, have been shown to affect lymphocyte and monocyte functions, crucially involved in adaptive and innate immunity. Although some aspects concerning the mechanisms of action through which the Mediterranean diet pattern exerts its beneficial effects remain to be elucidated, arthritis patients may potentially benefit from it in view of their increased cardiovascular risk and the treatment they require which may have side effects.

The steps to health randomized trial for arthritis: a self-directed exercise versus nutrition control program.

BACKGROUND: Despite the established benefits of exercise for adults with arthritis, participation is low. Safe, evidence-based, self-directed programs, which have the potential for high reach at a low cost, are needed. PURPOSE: To test a 12-week, self-directed, multicomponent exercise program for adults with arthritis. DESIGN: Randomized controlled trial. Data were collected from 2010 to 2012. Data were analyzed in 2013 and 2014. SETTING/PARTICIPANTS: Adults with arthritis (N=401, aged 56.3 [10.7] years, 85.8% women, 63.8% white, 35.2% African American, BMI of 33.0 [8.2]) completed measures at a university research center and participated in a self-directed exercise intervention (First Step to Active Health(®)) or nutrition control program (Steps to Healthy Eating). INTERVENTION: Intervention participants received a self-directed multicomponent exercise program and returned self-monitoring logs for 12 weeks. MAIN OUTCOME MEASURES: Self-reported physical activity, functional performance measures, and disease-specific outcomes (arthritis symptoms and self-efficacy) assessed at baseline, 12 weeks, and 9 months. RESULTS: Participants in the exercise condition showed greater increases in physical activity than those in the nutrition control group (p=0.01). Significant improvements, irrespective of condition, were seen in lower body strength, functional exercise capacity, lower body flexibility, pain, fatigue, stiffness, and arthritis management self-efficacy (p values<0.0001). More adverse events occurred in the exercise than nutrition control condition, but only one was severe and most were expected with increased physical activity. CONCLUSIONS: The exercise program improves physical activity, and both programs improve functional and psychosocial outcomes. Potential reasons for improvements in the nutrition control condition are discussed. These interventions have the potential for large-scale dissemination. This study is registered at Clinicaltrials.gov NCT01172327.

Insufficient colostrum ingestion is a risk factor for polyarthritis and/or phlegmon in hand-reared reticulated giraffes (Giraffa camelopardalis reticulata): 7 cases (2003-2012).

Seven reticulated giraffes were hand-reared at Nogeyama Zoological Gardens, because the dam had agalactia. Six of the 7 calves exhibited polyarthritis and/or phlegmon in the lower legs. However, the cause of the disorder was unclear. The present study reviewed the clinical records of the 7 giraffes, including the type and amount of colostrum ingested during the first 72 hr. The disorder involved the fetlocks and carpal and tarsal joints in 6 of the 7 calves within an average of 8 days of birth. The average amount of fed bovine or powdered colostrum was 0-2.4 l in the first 24 hr and 2.0-6.2 l during the first 72 hr. Insufficient colostrum quantity might be a factor in polyarthritis and/or phlegmon.

Monitoring healthy people 2010 arthritis management objectives: education and clinician counseling for weight loss and exercise.

PURPOSE: Our goal was to monitor the progress of 3 Healthy People 2010 (HP2010) objectives encouraging self-management education and clinician counseling for weight loss and physical activity among adults with doctor-diagnosed arthritis. METHODS: Using the national 2002 and 2006 National Health Interview Survey (NHIS) and state-based 2003 and 2007 Behavioral Risk Factor Surveillance System (BRFSS), we estimated the change in proportion of persons counseled for each objective, overall and by selected characteristics. RESULTS: Nationally, the proportion of overweight and obese adults with doctor-diagnosed arthritis who were counseled by their clinician to lose weight to lessen their arthritis symptoms increased significantly from 35.0% (95% confidence interval [CI], 32.8%-37.2%) in 2002 to 41.3% (95% CI, 38.7%-44.0%) in 2006 but have yet to reach the 2010 target of 46%. There was no change in the proportion of adults with doctor-diagnosed arthritis who had ever taken a self-management education class (approximately 11%) or who had been counseled to engage in physical activity (approximately 52%), whose targets for 2010 are 13% and 67%, respectively. States had variable findings. CONCLUSIONS: Nationally, significant progress has been made by clinicians for weight counseling of overweight and obese adults with doctor-diagnosed arthritis but not for the other 2 arthritis management objectives. Because clinician counseling can have important effects on the latter, this discrepancy suggests a need to focus on barriers to physician counseling for these outcomes.

Effect of feeding status on adjuvant arthritis severity, cachexia, and insulin sensitivity in male Lewis rats.

We studied the effect of food restriction, overfeeding, and normofeeding on cachexia, inflammatory and metabolic parameters, and insulin sensitivity in chronic adjuvant arthritis (AA) in rats. Food restriction during AA increased circulating ghrelin, corticosterone, decreased leptin, and ameliorated arthrogram score and systemic inflammation compared to normofeeding. Overfeeding worsened arthrogram score and systemic inflammation, and led to lipid accumulation in the liver, but not to alterations of adipokine and ghrelin plasma levels relative to normofeeding. Independently of feeding status, AA induced cachexia, in which modulation of mRNA expressions for appetite-regulating neuropeptides (NPY, AgRP, POMC, CART) in the arcuate nucleus (ARC) does not play a primary role. The overexpression of IL-1ß mRNA in the ARC suggests its role in the mechanisms of impaired energy balance during AA under all feeding conditions. Normal HOMA index in all arthritic groups does not indicate the development of insulin resistance by feeding interventions in these rats.

Contrasting effects of n-3 and n-6 fatty acids on cyclooxygenase-2 in model systems for arthritis.

Cyclooxygenase-2 (COX-2) is intimately involved in symptoms of arthritis while dietary n-3 polyunsaturated fatty acids (PUFA) are thought to be beneficial. In these experiments, using both bovine and human in vitro systems that mimic features of arthritis, we show that the n-3 PUFA eicosapentaenoic acid (EPA) is able to reduce mRNA and protein levels of COX-2. Activity, as assessed through prostaglandin E(2) formation, was also reduced in a dose-dependent manner. These effects of EPA contrasted noticeably with the n-6 PUFA, arachidonic acid. The data provide direct evidence for a molecular mechanism by which dietary n-3 PUFA, such as EPA, can reduce inflammation and, hence, associated symptoms in arthritis.

Zinc supplementation for the treatment or prevention of disease: current status and future perspectives.

Zinc is a nutritionally essential trace element, and thus zinc deficiency may severely affect human health. Many studies were published in which the effect of nutritional zinc supplementation on the incidence or severity of a certain disease was investigated. This review summarizes the main observations and aims to evaluate the use of nutritional zinc supplementation for prevention and treatment of human disease.

[Polyarticular gout in young adults: a curable rheumatic disease]. / La goutre polyarticulaire de l'adulte jeune: un rhumatisme curable.

Juvenile chronic gout in its polyarticular deformative form has rarely been described in medical literature. We report a rare case of destructive polyarticular tophaceous gout in a 31-year-old Senegalese man. He consulted for bilateral asymmetric polyarthritis with deformities of the hands and feet that had been ongoing in recurrent episodes since the age of 18 years in association with tophus. He had received no previous medication. All laboratory investigations were normal except hyperuricemia 104 mg/l. Radiographs of affected joints demonstrated evidence of destructive polyarthritis, i.e., articular narrowing and osteo-condensation of the left great toe. The patient responded favourably to colchicine, allopurinol and diet. Gouty arthropathy must be differentiated from rheumatoid arthritis, psoriasic arthritis and distal chronic osteoarthrosis. In our case, definitive diagnosis of gouty arthropathy was based on chronic polyarthritis associated with tophus, hyperuricemia and therapeutic response to colchicine. Polyarticular gout can be suspected in case of chronic seronegative polyarthritis and diagnosis can be confirmed on the basis of plain radiographs and laboratory investigations showing uricemia. Treatment is effective, well tolerated and inexpensive.

Biological basis for the benefit of nutraceutical supplementation in arthritis.

Arthritis is a common disease in which the end-point results in joint replacement surgery. This article reviews the use of nutraceuticals as alternative treatments for pathological manifestations of arthritic disease. The efficacy of fish oils (e.g. cod liver oil) in the diet has been demonstrated in several clinical trials, animal feeding experiments and in vitro models that mimic cartilage destruction in arthritic disease. In addition, there is some evidence for beneficial effects of other nutraceuticals, such as green tea, herbal extracts, chondroitin sulphate and glucosamine. However, in most cases, there is little scientific evidence at the cellular and molecular levels to explain their mechanisms of action.

Unusual polyarthritis as a unique clinical manifestation of coeliac disease.

This report describes a patient who presented with an unusual polyarthritis accompanied by myalgia, fever and anxiety. After extensive clinical and serological evaluation, duodenal biopsy and serological tests provided evidence for the diagnosis of coeliac disease (CD). The patient was promptly put on a gluten-free diet, which led to an improvement in the clinical abnormalities.

The dietary treatment of inflammatory arthritis: case reports and review of the literature.

Two patients with seropositive inflammatory arthropathies who experienced clinical improvement on the Waianae diet are presented. The scientific literature validates the usefulness of fasting in the control of joint inflammation. Elimination diets are variably successful. Fasting followed by a vegetarian diet can produce a sustained positive response measured clinically and by laboratory variables of inflammation; the efficacy of such an approach appears to hinge on the alteration of fecal flora. Swaying the balance of dietary fats in favor of the omega 3 and omega 6 fatty acids has an antiinflammatory effect, but does not appear to correct the basic immunologic processes involved in the development of the arthropathies. Practical guidelines for the application of this information are offered.