Prevalence of remission in patients with rheumatoid arthritis in daily clinical practice: long-term data from a tertiary care centre.

OBJECTIVES: We aimed to study remission rates in patients with RA in a tertiary care centre over a long-term observation period. METHODS: In a monocentric cohort study with a prospective and a retrospective part, adult RA patients were included. Patient's characteristics and outcome parameters were documented prospectively (clinical visit). Data of the initial visit (index visit) and date of first occurrence of remission were taken retrospectively from the hospital information system. Remission was defined as DAS28 <2.6 and sustained remission (SR) was defined as remission lasting >6 months. Logistic regression analysis was used to analyse factors associated with remission and SR. RESULTS: A total of 136 RA patients were included with retrospective data available over a period of 47.9 (18.9) months. One third already had erosions and severe limitations in physical function at baseline. The vast majority (n=109) of patients achieved a state of remission at least once over time (80.1%). At the clinical visit, 40 patients (29.4%) were in remission. Remission was achieved 14.9 months (13.8) after the index visit and by 54.1%, 23.9%, 13.8%, and 8.3% of patients within the first, second, third, and fourth year, respectively. SR was achieved by 65 patients (47.8%) within the observation period. CONCLUSIONS: Most patients achieved remission at least once within the observation period and almost 50% of patients also achieved SR. This study shows that the target of achieving remission should be constantly pursued, as we were able to show that even in the fourth year of treatment, patients still achieved remission.

Does adding exercise or physical activity to pharmacological osteoporosis therapy in patients with increased fracture risk improve bone mineral density and lower fracture risk? A systematic review and meta-analysis.

This prospectively registered systematic review and meta-analysis examines whether exercise (EX) training has an additive effect to osteoanabolic and/or antiresorptive pharmacological therapy (PT) in people with osteoporosis on bone mineral density (BMD), bone turnover markers (BTMs), fracture healing, and fractures. Four databases (inception to 6 May 2022), 5 trial registries, and reference lists were searched. Included were randomized controlled trials comparing the effect of EX + PT vs. PT with regard to BMD, BTM, fracture healing, and fractures. Risk of bias was assessed using the Cochrane RoB2 and certainty of evidence by the GRADE approach. Random-effects meta-analysis with Hartung-Knapp-Sidik-Jonkman adjustment was used to estimate standardized mean differences and 95% confidence intervals. Out of 2593 records, five RCTs with 530 participants were included. Meta-analysis showed with very low certainty evidence and wide confidence intervals that EX + PT compared to PT had larger effect sizes for BMD at 12 months at the hip (SMD [95%CI]: 0.18 [- 1.71; 2.06], n = 3 studies), tibia (0.25 [- 4.85; 5.34], n = 2), lumbar spine (0.20 [- 1.15; 1.55], n = 4), and forearm (0.05 [- 0.35; 0.46], n = 3), but not femoral neck (- 0.03 [- 1.80; 1.75], n = 3). Furthermore, no improvement was revealed for BTM such as bone ALP (- 0.68 [- 5.88; 4.53], n = 3), PINP (- 0.74 [- 10.42; 8.93], n = 2), and CTX-I (- 0.69 [- 9.61; 8.23], n = 2), but with very wide confidence intervals. Three potentially relevant ongoing trials were identified via registries. No data were found for fracture healing or fracture outcomes. It remains unclear whether EX has an additive impact to PT in people with osteoporosis. High-quality, adequately powered, targetted RCTs are required. PROTOCOL REGISTRATION: PROSPERO CRD42022336132.

Changes of immunosuppressive medication because of COVID-19 by patients with chronic inflammatory rheumatic diseases: anxiety was not a major driver.

OBJECTIVES: To study treatment decisions of patients with chronic inflammatory rheumatic diseases (CIRD) at the beginning of the SARS- CoV-2 pandemic in relation to disease characteristics with focus on anxiety. METHODS: A total of 970 CIRD patients diagnosed with rheumatoid arthritis (RA), axial spondyloarthritis (axSpA), psoriasis arthritis (PsA) and connective tissue diseases (CTD), selected from our records who had presented to our hospital at least twice during last year, were contacted by telephone to be asked about medication changes, health status and therapy satisfaction. Standardised tools were used to assess disease activity, anxiety and depression, the latter by Hospital Anxiety and Depression Score (HADS) with a score ≥8 denoting definite anxiety and/or depression. The cut-off for RADAI was set at ≥3.2 and for BASDAI ≥4. Compliance with prevention rules and vaccination status were assessed. RESULTS: Complete interviews of 557 patients (57.4%) made between April and July 2020 were available for analysis. The median age was 55 (47-63), disease duration 9.0 (4.5-17.0) years, 61.9% females. A recent change in medication was reported by 197 patients (35.4%), 51.2% of which admitted that this decision was mainly made due to the pandemic with more changes occurring with bDMARDs (21.8%) than cDMARDs (6.6%) and corticosteroids (5.4%). There was no major difference between patients who changed because of the pandemic or self-reported inactive disease versus patients who did not change therapy regarding disease activity, depression and anxiety (41%, 17.2%, 31.3% vs. 47.5%, 22.5%, 35.0% vs. 48.9%, 27.7%, 34.1%). More than 90% of patients reported that they rigorously followed Corona prevention rules. The majority of patients were vaccinated against influenza (55.3%) and pneumococci (61.3%), respectively. CONCLUSIONS: Anxiety, depression and disease activity did not play an important role in decisions favouring change of therapy, even though many patients changed medication due to the pandemic. Patients probably protected themselves by strictly adhering to hygiene recommendations. Vaccination rates against influenza and pneumococci were better than previously reported, but still too low.

Effect of semi-recumbent vibration exercise on muscle outcomes in older adults: a pilot randomized controlled clinical trial.

BACKGROUND: Many older adults with physical limitations living in residential care apartments are unable to exercise in a standing position and are at risk for declining in muscle function leading to falls and injury. Novel approaches to achieve exercise benefits are needed. The purpose of this study was to test the effect of semi-recumbent vibration exercise on muscle outcomes in older adults living in residential care apartment complexes (RCACs). METHODS: A randomized, crossover design was used to examine the effect of semi-recumbent vibration exercise on muscle function and mass among 32 RCAC residents (mean age 87.5 years) with physical limitations. Participants received a randomized sequence of two study conditions: sham or vibration for 8 weeks each separated by a 4-week washout. Before and after the 8 weeks of vibration treatment and sham treatment, muscle mechanography was used to assess muscle function including jump power, weight-corrected jump power, and jump height. Short physical performance battery (SPPB) and handgrip strength were also used to measure muscle function. Bioelectrical impedance spectroscopy was used to estimate skeletal muscle mass. The effect of the vibration treatment on muscle outcomes was analyzed through mixed effects linear regression models. RESULTS: Vibration exercise leads to better jump height (p < .05) compared to sham exercise but also poorer chair rise performance (p = 0.012). Other muscle functions tests and muscle mass parameters showed non-significant changes. CONCLUSION: This small pilot study showed no conclusive results on the effect of semi-recumbent vibration exercise on muscle function and mass in older adults living in RCAC. However, the promising signals of improved jump performance could be used to power larger studies of longer duration with various vibration doses to determine the benefit of vibration exercise in this physically impaired, high-risk population with few exercise capabilities. TRIAL REGISTRATION: The study is registered at clinicaltrials.gov ( NCT02533063 ; date of first registration 26/08/2015).

Balance and prospective falls in patients with rheumatoid arthritis.

BACKGROUND: Postural control is associated with fall risk. Patients with rheumatoid arthritis (RA) have a higher risk to fall than healthy subjects. The objective of this study was to identify associations between variables of postural control with prospective falls in patients with RA. METHODS: For the baseline, the balance performance of 289 men and women with RA, ages 24-85 years, was evaluated by SPPB, FICSIT-4 and Romberg tests. Postural sway for Romberg, semitandem, tandem and one-leg stands were measured with the Leonardo Mechanograph®. Self-reported disability was assessed using the Health Assessment Questionnaire (HAQ) and the Activity-specific Balance Confidence Scale (ABC-scale). Falls were reported in quarterly reports over a year. Univariate and multiple logistic regression analysis were used to explore any associations with falling. Receiver-operating characteristics were determined, and the area under the curve is reported. RESULTS: A total of 238 subjects completed the 1-year follow-up, 48 (20.2%) experienced at least one fall during the observational period. Age (OR = 1.04, CI 1.01-1.07), HAQ (OR = 1.62, 1.1-2.38), FICSIT-4 scoring 0-4 (OR = 2.38, 1.13-5.0), and one-leg standing (OR = 2.14, 1.06-4.31) showed significant associations with falls. With regard to the SPPB and ABC-scale, no statistically significant associations with falls were found. The quartiles containing the worst results of medio-lateral sway of Romberg (OR = 2.63, CI 1.03-6.69), total sway of semitandem (OR = 3.07, CI 1.10-8.57) and tandem (OR = 2.86, CI 1.06-7.69), and area of sway of semitandem (OR = 2.80, CI 1.11-7.08) stands were associated with falls. CONCLUSIONS: The assessment of a one-leg stand seems to be a good screening tool to discriminate between high and low risk of falls in RA patients in clinical practice. A low FICSIT-4 score and several sway parameters are important predictors of falls. TRIAL REGISTRATION: The study has been registered at the German Clinical Trials Register and the WHO International Clinical Trials Registry Platform (ICTRP) since 16 March 2017 ( DRKS00011873 ).

Effects of secukinumab on bone mineral density and bone turnover biomarkers in patients with ankylosing spondylitis: 2-year data from a phase 3 study, MEASURE 1.

BACKGROUND: Axial spondyloarthritis including ankylosing spondylitis (AS) is characterized by chronic inflammation and new bone formation in the axial skeleton. On the other hand, bone loss, osteoporosis and an increased risk of vertebral fractures is known to frequently occur in AS. In the MEASURE 1 study, the clinically efficacious interleukin-17A inhibitor secukinumab was shown to have limited radiographic progression through 4 years in patients with active AS. Here we present a post hoc analysis to evaluate the effect of secukinumab on bone mineral density (BMD) and bone turnover biomarkers over 2 years in this study. METHODS: BMD was measured by dual-energy X-ray absorptiometry at the lumbar spine, total hip, and femoral neck. Spinal radiographs performed at baseline and Week 104 were assessed by modified Stoke Ankylosing Spondylitis Spinal Score (mSASSS) and analyzed in relation to BMD change, considering baseline syndesmophytes. Bone turnover biomarkers were assessed at baseline and at Weeks 52 or 104. RESULTS: Among 104 patients included in this analysis, 66% were male, with a mean (SD) age of 40.4 (12.3) years. In postmenopausal women and men ≥50 years of age (T-score), the proportion of patients having normal BMD at baseline and Week 104 were 54.5%/54.5% (lumbar spine), 31.6%/55.6% (total hip), and 42.1%/44.4% (femoral neck). Similarly, at baseline, the proportion of patients with osteopenia/osteoporosis was 31.8%/13.6% (lumbar spine), 57.9%/10.5% (total hip), 42.1%/15.8% (femoral neck), and 36.4%/9.1% (lumbar spine), 44.4%/0% (total hip) and 55.6%/0% (femoral neck) at Week 104, respectively. In premenopausal women and men < 50 years of age (Z-score), the proportion of patients having BMD below the expected range for age at baseline and Week 104 were 25.0%/21.2% (lumbar spine), 11.3%/17.8% (total hip), and 9.9%/8.9% (femoral neck). In relation to mSASSS change scores ≥2 over 2 years, the increase in lumbar spine BMD was not related to radiographic progression and syndesmophyte formation. No significant changes were observed in the bone turnover markers over time. CONCLUSION: The high proportion of AS patients with diminished BMD was confirmed in this study. An increase of BMD in the lumbar spine after 2 years of secukinumab treatment in patients with AS was found that was probably unrelated to radiographic progression. No relevant effects of secukinumab on bone turnover biomarkers were documented. TRIAL REGISTRATION: MEASURE 1 (post hoc analysis) Clinicaltrials.gov, NCT01358175 ; Registered, 23 May 2011.

Association between sarcopenia, physical performance and falls in patients with rheumatoid arthritis: a 1-year prospective study.

BACKGROUND: Patients with rheumatoid arthritis (RA) are at increased risk of falls and fractures. Sarcopenia occurs more frequently in RA patients due to the inflammatory processes. Early diagnosis and prevention programmes are essential to avoid serious complications. The present study aims to identify risk factors for falls related to sarcopenia and physical performance. METHODS: In a 1-year prospective study, a total of 289 patients with RA, ages 24-85 years, were followed using quarterly fall diaries to report falls. At the baseline, medical data such as RA disease duration and Disease Activity Score (DAS28CRP) were collected. Self-reported disability was assessed using the Health Assessment Questionnaire (HAQ). Appendicular skeletal mass was determined by Dual X-ray-Absorptiometry (DXA). Physical performance was evaluated by handgrip strength, gait speed, chair rise test, Short Physical Performance Battery, and FICSIT-4. Muscle mechanography was measured with the Leonardo Mechanograph®. Sarcopenia was assessed according to established definitions by the European Working Group on Sarcopenia in Older People (EWGSOP2) and The Foundation for the National Institutes of Health (FNIH). Univariate and multiple logistic regression analysis were used to explore associations with falling. Receiver-operating characteristics (ROC) were performed, and the area under the curve is reported. RESULTS: A total of 238 subjects with RA completed the 1-year follow-up, 48 (20.2%) experienced at least one fall during the observational period. No association was found between sarcopenia and prospective falls. Age (OR = 1.04, CI 1.01-1.07), HAQ (OR = 1.62, 1.1-2.38), and low FICSIT-4 score (OR = 2.38, 1.13-5.0) showed significant associations with falls. CONCLUSIONS: In clinical practice, a fall assessment including age, self-reported activities of daily life and a physical performance measure can identify RA patients at risk of falling. TRIAL REGISTRATION: The study has been registered at the German Clinical Trials Register and the WHO International Clinical Trials Registry Platform (ICTRP) since 16 March 2017 ( DRKS00011873 ).

Current imaging techniques in osteoporosis.

Osteoporosis is a global pandemic affecting children, men and women of all ages and ethnicities. Millions of people suffer fragility fractures each year around the world as a result of this bone disease, which can have devastating consequences for them, including permanent disability and death. Many fractures are preventable by identifying people at high risk for fracture and falls, and diagnosing those who already have osteoporosis, before they fracture. Rheumatologists commonly encounter people with fragile bones, either as an isolated entity, or a co-morbidity to their underlying rheumatic illness or treatment. Imaging in osteoporosis can be used to make a diagnosis, while measurements of bone and body tissues, most commonly bone mineral density, can be used to identify those at risk and monitor them following treatment. Modern densitometry scanners may have multiple new features including measures of hip geometry, trabecular bone score, finite element analysis, fat and muscle mass, and may have additional imaging features including vertebral fracture assessment and atypical femoral fracture screening. When used correctly, these tools provide invaluable information for the assessment of the effectiveness of interventions in clinical studies, and patient management in clinical practice. In this article we review osteoporosis imaging techniques, with an emphasis on dual-energy x-ray absorptiometry, and how to apply and interpret them in modern rheumatology practice.

Use of contrast-enhanced magnetic resonance imaging of the pelvis to describe changes at different anatomic sites which are potentially specific for polymyalgia rheumatica.

OBJECTIVES: To identify inflammatory pelvic structures of patients with polymyalgia rheumatica (PMR) by magnetic resonance imaging (MRI) in detail, searching for a disease-specific pattern. METHODS: A total of 40 contrast-enhanced pelvic MRIs of patients with a clinical diagnosis of PMR was reviewed by an experienced musculoskeletal radiologist who assessed all abnormalities semi-quantitatively, based on a predefined scoring system. RESULTS: The median (25th/75th percentiles) age of patients was 67 (55/73) years, median symptom duration 13 (6/22) weeks, 55% female, median CRP 1.9 (0.7/4) mg/dl, median ESR 30/1h (17/43). Ten patients were diagnosed with rheumatoid arthritis (25%), in addition to their leading polymyalgic symptom. Multi-locular, mostly bilateral, peritendinous enhancement of pelvic girdle tendons was found to be the hallmark of PMR in all patients. Low-grade hip synovitis was also detected frequently. In all cases, ≥4 extracapsular tendinous sites were bilaterally affected. Besides involvement of the common ischiocrural tendon and the glutaeus medius and minimus tendon (present in all cases), an enhancement of the proximal rectus femoris origin was observed in 100% and of the adductor muscles at the inferior medial pubic bone in 90% of cases. The observed MRI pattern patho-anatomically suggests inflammation of the external peritendineum. CONCLUSIONS: The uniformity of the observed pelvic inflammatory pattern detected by contrast-enhanced MRI in PMR patients suggests that it may become relevant for diagnostic purposes. The bilateral involvement of at least 4 extracapsular sites (including the origins of proximal rectus femoris or adductorial muscles) appears to be characteristic of PMR.

Imaging of axial spondyloarthritis. New aspects and differential diagnoses.

Axial spondyloarthritis (axSpA) is a chronic rheumatic disease characterised by inflammatory back pain and several other disease manifestations and comorbidities. The 2009 ASAS classification criteria differentiate between the classical ankylosing spondylitis or radiographic axSpA and non-radiographic axSpA based on the presence or absence of definite radiographic changes in the sacroiliac joints. Importantly, back pain in patients with axSpA may well have reasons other than axial inflammation or new bone formation. There are several important differential diagnoses such as diffuse idiopathic skeletal hyperostosis and osteitis condensans. This review summarises recent publications concerning the performance of imaging modalities in the field, such as conventional radiography, magnetic resonance imaging, computed tomography and dual energy x-ray absorptiometry including the trabecular bone score.

Increased Leg Bone Mineral Density and Content During the Initial Years of College Sport.

Scerpella, JJ, Buehring, B, Hetzel, SJ, and Heiderscheit, BC. Increased leg bone mineral density and content during the initial years of college sport. J Strength Cond Res 32(4): 1123-1130, 2018-Bone mineral density (BMD) and bone mineral content (BMC) data are useful parameters for evaluating how training practices promote bone health. We used dual-energy X-ray absorptiometry (DXA) to longitudinally assess sport-specific growth in leg and total body BMD/BMC over the initial 2 years of collegiate training. Eighty-five Division 1 collegiate basketball, hockey, and soccer athletes (50 males and 35 females; age 19.0 [0.8] years) underwent annual DXA scans. Leg and total body BMD/BMC were compared within and across two 1-year intervals (periods 1 and 2) using repeated-measures analysis of variance, adjusting for age, sex, race, and sport. Leg BMD, leg BMC, and total body BMC all increased over period 1 (0.05 g·cm [p = 0.001], 0.07 kg [p = 0.002], and 0.19 kg [p < 0.001] respectively). Changes in period 2 compared with period 1 were smaller for leg BMD (p = 0.001), leg BMC (p < 0.001), leg fat mass (p = 0.028), and total BMC (p = 0.005). Leg lean mass increased more during period 2 than period 1 (p = 0.018). Sports participation was the only significant predictor of change in leg BMD. Significant increases in both leg BMD and BMC were demonstrated over both 2-year periods, with greater gains during period 1. These gains highlight the importance of attentive training procedures, capitalizing on attendant physical benefits of increased BMD/BMC. Additional research in young adults, evaluating bone mass acquisition, will optimize performance and decrease risk of bone stress injury among collegiate athletes.

Novel Approaches to the Diagnosis of Sarcopenia.

Sarcopenia is common in older people and is associated with disability, reduced mobility, hospitalization, and various comorbidities. Although it has been recognized for over a quarter of a century, we do not currently have a universally adopted definition. This limits our ability to compare results from different studies and impedes the development of novel therapies. Although sarcopenia was initially defined purely based on low muscle mass, the importance of measures of muscle function has been realized and these have been included in recent operational definitions. These continue to evolve with some including an assessment of adiposity and others adding further components of musculoskeletal health in a score-based approach. This review describes the importance of reaching a widely accepted method to define sarcopenia in both research and clinical practice. It details the ways in which the definition has changed since its initial inception and explores how it may continue to evolve in the future. The different methods by which components of sarcopenia can be measured are described, and the various advantages and disadvantages of these techniques are evaluated. Clearly, there are several other similar syndromes in older people, such as frailty and cachexia; their relationships and overlap with sarcopenia are also explored.

Dual-energy X-ray absorptiometry measured regional body composition least significant change: effect of region of interest and gender in athletes.

Dual-energy X-ray absorptiometry (DXA) is widely used to evaluate body composition in athletes. Knowledge of measurement precision is essential for monitoring body composition changes over time. This study begins characterizing DXA body composition precision in 60 (30 males and 30 females) Division 1 athletes focusing on gender, regional, and tissue type differences. Two total body scans with repositioning between were performed on the same day. Least significant change (LSC) for the root-mean-square deviation (LSCRMSD) and the percent coefficient of variation (LSC%CV) for total, lean, and fat mass was calculated for 6 regions of interest. The effect of gender, region, tissue type, and mass on the standard deviation (SD) and percent coefficient of variation (%CV) between the 2 scans was evaluated using repeated measures regression analysis. Statistically significant effects of gender, region, tissue type, and mass on SD and %CV were noted. To generalize, a nonlinear positive relationship between LSCRMSD and mass and a nonlinear negative relationship between LSC%CV and mass were observed. In conclusion, DXA body composition LSC varies among genders, regions, tissues, and mass. As such, when evaluating serial body composition in athletes, especially if assessing regional change, knowledge of precision in individuals of similar body size and gender to the population of interest is needed.

Glucocorticoid-induced osteoporosis: an update on effects and management.

Glucocorticoids remain a cornerstone of guideline-based management of persistent asthma and allergic diseases. Glucocorticoid-induced osteoporosis (GIO) is the most common iatrogenic cause of secondary osteoporosis and an issue of concern for physicians treating patients with inhaled or oral glucocorticoids either continuously or intermittently. Patients with GIO experience fragility fractures at better dual-energy x-ray absorptiometry T-scores than those with postmenopausal or age-related osteoporosis. This might be explained, at least in part, by the effects of glucocorticoids not only on osteoclasts but also on osteoblasts and osteocytes. Effective options to detect and manage GIO exist, and a management algorithm has been published by the American College of Rheumatology to provide treatment guidance for clinicians. This review will summarize GIO epidemiology and pathophysiology and assess the role of inhaled and oral glucocorticoids in asthmatic adults and children, with particular emphasis on the effect of such therapies on bone health. Lastly, we will review the American College of Rheumatology GIO guidelines and discuss diagnostic and therapeutic strategies to mitigate the risk of GIO and fragility fractures.

Pitfalls and pearls in diagnosing inflammatory arthritis in older patients.

Given current demographic shifts, the number of older adults continues to grow, with almost half of patients over 65 being diagnosed with some form of arthritis. Rheumatic diseases pose unique diagnostic challenges in older patients due to the convergence of physiologic changes of aging, confounding difficulties to care, and atypical disease manifestations. This review summarizes the current published evidence to guide clinicians in evaluating geriatric patients with rheumatologic concerns, focusing on inflammatory arthritis. Using the background of epidemiologic data on various musculoskeletal diseases, clinical presentations, current diagnostic tests, and known physiologic changes of aging, this review highlights five diagnostic pitfalls in inflammatory polyarthritis among older patients. The pitfalls include: 1) broader differential diagnosis; 2) atypical presentations; 3) communication, cognitive, and social impairments; 4) the role of chronological vs. biological age; and 5) anchoring bias by assuming older adults are simply "older young adults". These pitfalls are discussed in the context of geriatric principles such as the "hallmarks of aging" and the expected pathophysiologic changes of organ systems. Furthermore, the review discusses the strengths and weaknesses of diagnostic tests used in arthritis and introduces some of the geriatric assessment tools that systematically evaluate multimorbidity and geriatric syndromes. With familiarity of the potential diagnostic pitfalls, knowledge of both normal and pathologic aging processes, awareness of the difference between biological and chronological age, and the ability to use geriatric assessment tools to better characterize older patients, clinicians will be better able to diagnose and manage rheumatic conditions in this population.

Three-Year Mortality of Older Hospitalized Patients with Osteosarcopenia: Data from the OsteoSys Study.

Osteosarcopenia, the concurrent presence of sarcopenia and osteopenia/osteoporosis, poses a significant health risk to older adults, yet its impact on clinical outcomes is not fully understood. The aim of this prospective, longitudinal multicentre study was to examine the impact of osteosarcopenia on 3-year mortality and unplanned hospitalizations among 572 older hospitalized patients (mean age 75.1 ± 10.8 years, 78% female). Sarcopenia and low bone mineral density (BMD) were evaluated using Dual Energy X-ray Absorptiometry and the European Working Group on Sarcopenia in Older People (EWGSOP2) and WHO criteria, respectively. Among participants, 76% had low BMD, 9% were sarcopenic, and 8% had osteosarcopenia. Individuals with osteosarcopenia experienced a significantly higher rate of mortality (46%, p < 001) and unplanned hospitalization (86%, p < 001) compared to those without this condition. Moreover, "healthy" subjects-those without sarcopenia or low BMD-showed markedly lower 3-year mortality (9%, p < 001) and less unplanned hospitalization (53%, p < 001). The presence of osteosarcopenia (p = 0.009) increased the 3-year mortality risk by 30% over sarcopenia alone and by 8% over low BMD alone, underscoring the severe health implications of concurrent muscle and bone deterioration. This study highlights the substantial impact of osteosarcopenia on mortality among older adults, emphasizing the need for targeted diagnostic and therapeutic strategies.

Impact of daily physical therapy over 2 weeks on spinal mobility including objective electronic measurements and function in patients with axial spondyloarthritis.

Background: Patients with axial spondyloarthritis (axSpA) are often compromised by impaired function and mobility. The standardized 2-week inpatient program 'multimodal rheumatologic complex treatment' (MRCT) was designed for patients with axSpA. The Epionics SPINE (ES) is an objective tool validated to assess mobility. Objective: To investigate the impact of MRCT on physical function and mobility including range of motion (RoM) and kinematics (RoK). Design: Single-center interventional, observational trial. Methods: Patients with axSpA presenting with high disease activity and impaired physical function were consecutively recruited to undergo MRCT. Assessments performed before (V1) and after (V2) the intervention included Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Bath Ankylosing Spondylitis functional index (BASFI), Bath Ankylosing Spondylitis Metrology Index (BASMI), the ankylosing spondylitis physical performance index (ASPI), the Short Physical Performance Battery (SPPB), and ES measurements. Results: At baseline, the 80 patients included had: BASDAI 5.5 ± 1.5, BASFI 5.6 ± 2.0, BASMI 4.2 ± 1.8, SPPB 13.8 ± 1.8, and ASPI 37.3 ± 18.1 s. Clinically relevant improvements between V1 versus V2 were noted for BASFI, BASMI, and all other assessments (p < 0.001), and also for ES measures of RoK (all p < 0.003) and RoM (all p < 0.04), while a positive trend was seen for flexion and extension (RoM). There was no significant effect of changes in medication (all p > 0.05). Conclusion: The 2-weeks MRCT was associated with definite improvements of function and mobility. Importantly, the effect of this extensive physical activity was confirmed by using the ES as an objective tool to assess spinal mobility. The ES demonstrated for the first time that the RoK of spinal mobility can significantly improve related to an exercise intervention. Trial registration: Ethical Committee: Ruhr-Universität (reference-number: 19-6735-BR).

Clinically relevant differences in spinal mobility related to daytime performance in patients with axial spondyloarthritis.

OBJECTIVE: Patients with axial spondyloarthritis (axSpA) suffer from clinical symptoms like morning stiffness and back pain. Mobility of patients with axSpA is often impaired. The aim of this study is to compare the performance of patients with axSpA regarding mobility measures including performance-based tests and objective electronic assessments with the Epionics SPINE device (ES) at different times of the day compared with healthy controls (HC). METHODS: Observational trial, consecutive inpatients with axSpA (n=100) and 20 HCs were examined in the morning (V1: before 10:00 am) and in the afternoon (V2: after 02:00 pm) by the Bath Ankylosing Spondylitis Metrology Index (BASMI), the AS physical performance index (ASPI), the Short Physical Performance Battery (SPPB) and ES measurements, including range of motion (RoM) and range of kinematics (RoK). RESULTS: The assessments of patients with axSpA performed in the morning clearly differed from those in the afternoon, especially regarding performance-based tests. Significant improvements were seen for BASMI (4.0±3.8 to 3.8±1.9; p<0.001), ASPI (36.2±18.3 to 28.8±11.9 s; p<0.001), SPPB (10.1±1.5 to 10.7±1.4 points; p<0.001) and for ES measures of speed (RoK; p<0.018) but not for RoM, except for lateral flexion (13.3±7.4 to 14.7±8.2°; p=0.002). This time of assessment-related variability was not observed in HC. CONCLUSION: The spinal mobility of patients with axSpA was worse in the morning but significantly improved in the afternoon. This was captured best by performance-based measures and was not seen in HC. The diurnal variation of mobility has implications for clinical studies, suggesting that the time of assessments needs to be standardised.