2021 EULAR recommendations regarding lifestyle behaviours and work participation to prevent progression of rheumatic and musculoskeletal diseases.

OBJECTIVES: A European League Against Rheumatism taskforce was convened to review the literature and develop recommendations on lifestyle behaviours for rheumatic and musculoskeletal diseases (RMDs). METHODS: Six lifestyle exposures (exercise, diet, weight, alcohol, smoking, work participation) and seven RMDs (osteoarthritis, rheumatoid arthritis, axial spondyloarthritis, psoriatic arthritis, systemic lupus erythematosus, systemic sclerosis, gout) were considered. The taskforce included health professionals in rheumatology, geriatricians, epidemiologists, public health experts, people with RMDs and exposure domain experts. Systematic reviews were conducted to gather available evidence, from which recommendations were developed. RESULTS: Five overarching principles and 18 specific recommendations were defined based on available evidence. The overarching principles define the importance of a healthy lifestyle, how lifestyle modifications should be implemented, and their role in relation to medical treatments. Exercise recommendations highlight the safety and benefits of exercise on pain and disability, particularly among people with osteoarthritis and axial spondyloarthritis. The diet recommendations emphasise the importance of a healthy, balanced diet for people with RMDs. People with RMDs and health professionals should work together to achieve and maintain a healthy weight. Small amounts of alcohol are unlikely to negatively affect the outcomes of people with RMDs, although people with rheumatoid arthritis and gout may be at risk of flares after moderate alcohol consumption. Smokers should be supported to quit. Work participation may have benefits on RMD outcomes and should be discussed in consultations. CONCLUSIONS: These recommendations cover a range of lifestyle behaviours and can guide shared decision making between people with RMDs and health professionals when developing and monitoring treatment plans.

Effects of physical exercise and body weight on disease-specific outcomes of people with rheumatic and musculoskeletal diseases (RMDs): systematic reviews and meta-analyses informing the 2021 EULAR recommendations for lifestyle improvements in people with RMDs.

BACKGROUND: A European League Against Rheumatism (EULAR) taskforce was convened to develop recommendations for lifestyle behaviours in rheumatic and musculoskeletal diseases (RMDs). This paper reviews the literature on the effects of physical exercise and body weight on disease-specific outcomes of people with RMDs. METHODS: Three systematic reviews were conducted to summarise evidence related to exercise and weight in seven RMDs: osteoarthritis, rheumatoid arthritis, systemic lupus erythematosus, axial spondyloarthritis (axSpA), psoriatic arthritis, systemic sclerosis and gout. Systematic reviews and original studies were included if they assessed exercise or weight in one of the above RMDs, and reported results regarding disease-specific outcomes (eg, pain, function, joint damage). Systematic reviews were only included if published between 2013-2018. Search strategies were implemented in the Medline, Embase, Cochrane Library of systematic reviews and CENTRAL databases. RESULTS: 236 articles on exercise and 181 articles on weight were included. Exercise interventions resulted in improvements in outcomes such as pain and function across all the RMDs, although the size of the effect varied by RMD and intervention. Disease activity was not influenced by exercise, other than in axSpA. Increased body weight was associated with worse outcomes for the majority of RMDs and outcomes assessed. In general, study quality was moderate for the literature on exercise and body weight in RMDs, although there was large heterogeneity between studies. CONCLUSION: The current literature supports recommending exercise and the maintenance of a healthy body weight for people with RMDs.

Complex Regional Pain Syndrome (Sudeck Atrophy) Prevention Possibility and Accelerated Recovery in Patients with Distal Radius at the Typical Site Fracture Using Polarized, Polychromatic Light Therapy.

Objective: Distal radius fracture (DRF) is one of the most frequent population fracture mostly affecting women, and frequently leading to complex regional pain syndrome (CRPS). Management of DRF and CRPS in gerontology is complex. The aim was to evaluate the use of polarized, polychromatic, low-energy light therapy combined with conventional treatment after DRF in gerontology and to follow up patients for CRPS emergence. Materials and methods: After plaster removal, female patients (n = 52) were divided into two groups. Group 1 (n = 26) was treated with exercises and cryotherapy on the wrist and dorsal hand (control). Group 2 (n = 26) was additionally treated with light therapy (Bioptron). Results: While pain decreased and supination and pronation improved in all patients after 15 days of therapy, pain reduction was accelerated and supination enhanced in the light therapy-treated group (p < 0.05). None of the patients in the light therapy-treated group developed CRPS during the 6-month follow-up, compared with four patients (15.4%) in the control group (p < 0.05). Complete hand fist-forming capacity was achieved in 19 patients (73.1%) in the light therapy-treated group compared with 16 patients (61.5%) in the control group (p > 0.05). Conclusions: Bioptron light therapy combined with conventional therapy improves patient outcome after DRF in gerontology, compared with conventional treatment alone.

Prevalence of rheumatoid arthritis in Serbia.

The aim of this study was to estimate the prevalence of rheumatoid arthritis (RA) in Serbia, using the European EULAR project methodology. In a detection phase, a previously translated and validated telephone Questionnaire was used by lay interviewers on 6,213 randomly selected telephone numbers representing urban population from four Serbian towns: Belgrade (north), Cacak, Uzice and Krusevac (south). Patients with suspected RA were called again by a rheumatologist. For patients with self-reported diagnosis and positive symptoms, patient's rheumatologist was contacted to confirm diagnosis; a complete rheumatologist examination was scheduled for those with positive symptoms only. Prevalence estimates were standardised for age and sex in relation to Serbian population (census 2002) and further to French population, according to EULAR project methodology. The response rate was 63.6 % (3,950 respondents). The rheumatologist called 571 people, among whom 23 RA cases were confirmed (21 diagnosed previously and 2 newly diagnosed during the examination). The prevalence was 0.16 % (95 % confidence interval CI 0.01-0.32) for men and 0.51 % (95 % CI 0.26-0.76) for women; a female-to-male ratio 3.18. The overall Serbian standardised prevalence was 0.35 % (95 % CI 0.18-0.52); when standardised on French population 0.34 % (95 % CI 0.17-0.51). The highest age-specific rate was in the 65-74-year age band. The EULAR prevalence study, conducted with similar methodology and design, showed that RA prevalence estimates in Serbia (0.34 %) were in accordance with France (0.31 %), but lower than in Lithuania (0.55 %).