[Physical activity, exercise and nutrition in rheumatism : Adjuvant treatment options for inflammatory-rheumatic diseases]. / Körperliche Aktivität, Training und Ernährung bei Rheuma : Adjuvante Behandlungsoptionen bei entzündlich-rheumatischen Erkrankungsbildern.

BACKGROUND AND OBJECTIVES: The positive effects of physical activity, physical training and an adaptation of diet on health have been scientifically proven for many diseases. Focusing on inflammatory rheumatic diseases and their potential comorbidities, positive effects are assumed from these two adjuvant treatment opportunities, which are examined in more detail in this review. MATERIAL AND METHODS: Based on a literature search, randomized controlled trials (RCTs), non-RCT studies, reviews and recommendations from professional societies were included. RESULTS: Physical activity and training show positive effects on the disease itself and also on its comorbidities with existing certainty. In addition, the exercise and training recommendations of the American College of Sports Medicine (ACSM) and the American Heart Association (AHA) provide recommendations, which were adapted by the European League Against Rheumatism (EULAR) to control intensity, duration and training extent. Nutritional medical approaches also provide preventive and rehabilitative beneficial possibilities. DISCUSSION: The increase of physical activity, regular physical training and the adaptation of diet should be a basic additive component of the treatment of inflammatory rheumatic diseases. In individual sub-aspects, the study situation is very heterogeneous and requires further research.

[Experiences and results from Rheuma-VOR]. / Erfahrungen und Ergebnisse aus Rheuma-VOR.

Rheumatoid arthritis, psoriatic arthritis and axial spondylarthritis are the most common chronic autoimmune rheumatic diseases. For all three diseases an early diagnosis and initiation of treatment is crucial. The proof of concept network study "Rheuma-VOR" is a further developed version of the predecessor project ADAPTHERA and was extended to several federal states. The aim of this prospective study is to improve the early diagnosis of rheumatoid arthritis, psoriatic arthritis and axial spondylarthritis and thus positively impact the quality of care for patients with the help of multidisciplinary coordinating centers. To date 3710 disease-specific questionnaires from patients with the suspected diagnosis of rheumatoid arthritis, psoriatic arthritis or axial spondylarthritis from 1298 different primary care providers were registered in the multidisciplinary coordination centers. A total of 1958 appointments were made with 1 of the 53 participating rheumatology specialists. In 876 patients, 1 of the 3 rheumatic diseases was diagnosed in an early stage. The waiting period was on average 42.5 days depending on the federal state, which is well below the nationwide average. It should also be noted that the coordinated cooperation and risk stratification of the Rheuma-VOR coordination centers relieved the capacity of rheumatology specialists by 1281 appointments (34.5%). In addition, the 2­week Rheuma Bus Tour and the accompanying initiatives in Rhineland-Palatinate (Rheuma-VOR screening app and the triage consultation) are showing first promising positive results.

[ADAPTHERA-Statewide cross-sectoral care network for patients with early rheumatoid arthritis shows sustained remission in standard care]. / ADAPTHERA ­ Landesweit transsektorales Versorgungsnetzwerk für Patienten mit früher rheumatoider Arthritis zeigt anhaltende Remissionen in der Regelversorgung.

BACKGROUND/OBJECTIVE: The majority of patients in Germany miss out on the necessity of early diagnosis and initiation of therapy for rheumatoid arthritis (RA) caused by considerable structural deficits in the health care system. The challenge is to reconcile the individual demand for the best possible therapy result with a sustainable expenditure of resources. METHODS: The cross-sectoral regional care network ADAPTHERA aims to improve early RA diagnosis and treatment in Rhineland-Palatinate. The retrospective triage analyses of suspected early onset RA patients was performed by tracing the selection process of all available enquiries (n = 1045). For analysis of the clinical course of the disease, a subset comprising 143 patients with a minimum observation time of 12 months (5 consecutive visits) was available. Clinical and laboratory parameters were collected quarter yearly, self-administered questionnaires were filled out and the treatment was adapted if necessary. RESULTS: A total of 454 patients were included. The mean waiting time was 23.9 (SD = 18) days. The mean observation period in the subcohort was 29.2 (SD = 12.7) months, with about 50% of the patients presenting within 3 months. Almost 75% of the patients were in remission after 2 years. A sustained remission could be described for 74.8% (6 months) and 53.5% (12 months), respectively. Especially patients with rapid remission induction benefited in terms of longer remissions (p = 0.03). A very early stage of the disease (VERA) was associated with a rarely necessary biologic therapy (p = 0.022). DISCUSSION: The approach of a supply network is not a panacea, but it might improve healthcare for patients with early onset RA. In order to minimize resource utilization, a pinpoint referral and accurate triage of potential cases are crucial.

[Expert Meeting: Integrated Care of the COPD Patients]. / Expertentreffen COPD: Integriertes Patientenmanagement bei COPD.

Despite considerable progress concerning pharmaceutical therapeutic options, many COPD patients show a markedly reduced quality of life and increased mortality risk. This workshop aimed to identify COPD-specific factors impeding an improved mode of care for patients with COPD. Such factors are: the generally lower social and educational status of the majority of COPD patients; the stigma of COPD as a self-inflicted disease ("smoker's lung"); the strict sectoral separation within the German health care system. In the second part the workshop tried to identify ways to improve the care of COPD patients. Use of health information technology, improved communication between care givers and patients as well as between the health care sectors, integrating rehabilitation and establishing self-management education are factors within an integrated patient-centered approach. In summary, an integrated management of the individual patient with COPD including multi-professional teams should contribute to optimizing the quality of COPD care.

Effects of feeding polyphenols from pomegranate extract on health, growth, nutrient digestion, and immunocompetence of calves.

Objectives were to determine effects of feeding pomegranate extract (POMx) rich in polyphenols on performance, health, nutrient digestion, and immunocompetence of calves in the first 70 d of age. Holstein calves (n=67), at 2+/-1 d of age (d 0=birth day) were randomly assigned to 0 (control), 5 (POMx5), or 10 g/d (POMx10) of pomegranate extract containing 16.9% gallic acid equivalent (GAE) to result in intakes of 0, 850 and 1,700 mg of GAE/d or an average of approximately 0, 15, and 30 mg of GAE/kg of body weight (BW) per day. All calves received colostrum during the first 24 h, pasteurized milk thereafter until 61 d of age, and grain was fed ad libitum for the first 70 d of age. Calves were housed in individual hutches, and grain intake, attitude and fecal scores, incidence and duration of health disorders, and treatments for health problems were evaluated daily. Body weight was measured on 2 consecutive days at 2, 30, and 70 d of age and averaged for each measurement. Concentrations of glucose and 3-hydroxybutyrate were measured in plasma. Nutrient digestion was measured using total fecal collection during a 3-d period. Neutrophil phagocytic and killing activities and antibody response to immunization with ovalbumin were measured. Peripheral blood mononuclear cells were cultured and cytokine production measured. Feeding POMx had no effect on intake or BW gain in the first 30 d of age, but after 30 d of age, both grain dry matter intake and BW gain decreased with increasing addition of POMx, which resulted in calves that were 1.8 and 4.3 kg lighter at 70 d of age for POMx5 and POMx10, respectively, compared with controls. Feeding POMx did not influence dry matter, organic matter, or starch digestibility, but it reduced crude protein and fat digestion. Plasma concentrations of glucose and 3-hydroxybutyrate were similar among treatments throughout the first 70 d of age. Measures of calf health such as fecal and attitude scores, risk of fever, and rectal temperature were not altered by treatments. Similarly, neutrophil phagocytic and killing activities did not differ among treatments. On the contrary, feeding POMx increased synthesis of interferon-gamma and interleukin-4 by peripheral blood mononuclear cells and improved total immunoglobulin G responses to ovalbumin vaccination. These results suggest that feeding POMx top-dressed onto the grain suppresses intake of grain and digestibility of fat and protein, likely because of the high tannin content. Nevertheless, polyphenols from POMx enhanced mitogen-induced cytokine production and response to vaccination, which might benefit immune competence of calves and potentially health. Additional studies are warranted to minimize the effect of POMx on intake and digestibility and to better understand the mechanisms by which polyphenols improve immune response of calves.

Starch digestibility of foods: a nutritional perspective.

Dietary starch varies greatly in digestibility and its effects on the utilization of other nutrients. The variation appears to be due to differences in starch components and their crystallinity. Processing treatments, storage conditions, chemical modification, and genetic breeding influence the digestibility of starch. Cereal starches are generally more digestible than root/tuber and legume starches. Although cooking often significantly improves the digestibility of poor and intermediately digestible starches, some foods such as bananas with starches of these types are consumed uncooked. The efficient digestion of starch is especially important to specific groups of people such as infants under 6 months of age. Ruminants must also be provided with highly digestible starch to assure maximum production efficiency. Poor digestibility of starch may have negative effects on the utilization of protein and minerals but is likely to have positive effects on the availability of certain vitamins. Decreases in the rate of starch digestion may have therapeutic application. Most clinical studies have reported that starch blockers do not elicit a significant decrease in the digestion of starch in humans. Much remains to be learned, clarified, and understood about starch digestion and its effects on diabetes and weight control.