High-intensity cardiorespiratory and strength exercises reduced emotional distress and fatigue in patients with axial spondyloarthritis: a randomized controlled pilot study.

OBJECTIVE: To investigate the effect of high-intensity exercise on emotional distress, fatigue, and ability to do a full day's activities in patients with axial spondyloarthritis (axSpA). METHOD: A total of 28 physically inactive axSpA patients were randomized to either an exercise group (EG), which performed 12 weeks of cardiorespiratory and strength exercises, or a control group (CG), which received treatment as usual. The outcomes reported in this paper are secondary outcomes in the trial and included emotional distress (General Health Questionnaire-12, 0-36, 36 = worst), fatigue [numeric rating scale (NRS), 0-10, 10 = worst], and ability to do a full day's activities (NRS, 0-10, 10 = worst). Post-intervention differences were assessed by analysis of covariance with baseline values as covariates. RESULTS: Twenty-four patients were included in the analyses. All patients in the EG followed the exercise protocol. The EG had a statistically significant beneficial effect [mean group differences (95% confidence interval)] on emotional distress [-5.8, (-9.7, -1.9), p < 0.01], fatigue [-2.4, (-4.3, -0.4), p = 0.02], and ability to do a full day's work [-2.2, (-3.9, -0.4), p = 0.02] compared to the CG. CONCLUSION: This pilot study showed promising effects of cardiorespiratory and strength exercises on emotional distress, fatigue, and ability to do a full day's activities in patients with axSpA. The findings need to be confirmed in a larger trial.

Presence of multiple spondyloarthritis (SpA) features is important but not sufficient for a diagnosis of axial spondyloarthritis: data from the SPondyloArthritis Caught Early (SPACE) cohort.

OBJECTIVES: Concerns have been raised about overdiagnosis of axial spondyloarthritis (axSpA). We investigated whether patients with chronic back pain (CBP) of short duration and multiple SpA features are always diagnosed with axSpA by the rheumatologist, and to what extent fulfilment of the Assessment of SpondyloArthritis International Society (ASAS) axSpA criteria is associated with an axSpA diagnosis. METHODS: Baseline data from 500 patients from the SPondyloArthritis Caught Early cohort which includes patients with CBP (≥3 months, ≤2 years, onset <45 years) were analysed. All patients underwent full diagnostic workup including MRI of the sacroiliac joints (MRI-SI) and radiograph of sacroiliac joints (X-SI). For each patient, the total number of SpA features excluding sacroiliac imaging and human leucocyte antigen B27 (HLA-B27) status was calculated. RESULTS: Before sacroiliac imaging and HLA-B27 testing, 32% of patients had ≤1 SpA feature, 29% had 2 SpA features, 16% had 3 SpA features and 24% had ≥4 SpA features. A diagnosis of axSpA was made in 250 (50%) of the patients: 24% with ≤1 SpA feature, 43% with 2 SpA features, 62% with 3 SpA features and 85% with ≥4 SpA features. Of the 230 patients with a positive ASAS classification 40 (17.4%) did not have a diagnosis of axSpA. HLA-B27 positivity (OR 5.6; 95% CI 3.7 to 8.3) and any (MRI-SI and/or X-SI) positive imaging (OR 34.3; 95% CI 17.3 to 67.7) were strong determinants of an axSpA diagnosis. CONCLUSIONS: In this cohort of patients with CBP, neither the presence of numerous SpA features nor fulfilment of the ASAS classification criteria did automatically lead to a diagnosis axSpA. Positive imaging was considered particularly important in making a diagnosis of axSpA.

Circulating levels of inflammatory cytokines and cytokine receptors in patients with ankylosing spondylitis: a cross-sectional comparative study.

OBJECTIVES: Insight into the most important inflammatory pathways in ankylosing spondylitis (AS) could be of importance in risk stratification and the development of treatment strategies. Therefore, we aimed to compare circulating levels of inflammatory biomarkers between AS patients and controls, and explore associations between these biomarkers and clinical measures of disease activity. METHOD: In a cross-sectional study, 143 AS patients were compared with 124 population controls. Blood samples were analysed by immunoassays for interleukin (IL)-6, IL-17a, IL-23, soluble tumour necrosis factor receptor 1 (sTNF-R1) and 2 (sTNF-R2), and osteoprotegerin (OPG). Disease activity was measured by the AS Disease Activity Score (ASDAS) and the Bath AS Disease Activity Index (BASDAI). RESULTS: Analysis of covariance (ANCOVA) demonstrated elevated plasma levels of sTNF-R1 [geometrical mean 0.94 (95% CI 0.88-1.00) vs. 0.83 (95% CI 0.78-0.89) ng/mL, p < 0.01] and OPG (2.3, 95% CI 2.1-2.4 vs. 2.0, 95% CI 1.9-2.2 ng/mL, p = 0.02) and, although not significant, of IL-23 (122, 95% CI 108-139 vs. 106, 95% CI 93-120 pg/mL, p = 0.07) in AS patients vs. CONTROLS: More AS patients had a high level of sTNF-R2 than controls (22 vs. 1, p < 0.01). No differences between the groups were seen for IL-6 and IL-17a. In patients, no significant associations were seen between inflammatory markers and disease activity measures after adjusting for personal characteristics. CONCLUSION: Significantly higher plasma levels of sTNF-R1, sTNF-R2, and OPG and numerically but non-significantly higher levels of IL-23 were found in AS patients compared to controls, indicating that these cytokines and cytokine receptors are important inflammatory pathways. Clinical measures of disease activity were not significantly correlated with circulating inflammatory markers.

Biomarkers of cardiovascular risk across phenotypes of osteoarthritis.

BACKGROUND: The objective of this study was to explore the associations between ultrasonographic and radiographic joint scores and levels of arterial CVD risk markers in patients with osteoarthritis (OA). Secondly, to compare the levels of arterial CVD risk markers between OA phenotypes and controls. METHOD: The "Musculoskeletal pain in Ullensaker" Study (MUST) invited residents of Ullensaker municipality with self-reported OA to a medical examination. OA was defined according to the American College of Rheumatology (ACR) criteria and phenotyped based on joint distribution. Joints of the hands, hips and knees were examined by ultrasonography and conventional radiography, and scored for osteosteophytes. Hands were also scored for inflammation by grey scale (GS) synovitis and power Doppler (PD) signal. Control populations were a cohort of inhabitants of Oslo (OCP), and for external validation, a UK community-based register (UKPC).Pulse pressure augmentation index (AIx) and pulse wave velocity (PWV) were measured using the Sphygmocor apparatus (Atcor®). Ankel-brachial index (ABI) was estimated in a subset of patients. In separate adjusted regression models we explored the associations between ultrasonography and radiograph joint scores and AIx, PWV and ABI. CVD risk markers were also compared between phenotypes of OA and controls in adjusted analyses. RESULTS: Three hundred and sixty six persons with OA were included (mean age (range); 63.0 (42.0-75.0)), (females (%); 264 (72)). Of these, 155 (42.3%) had isolated hand OA, 111 (30.3%) had isolated lower limb OA and 100 (27.3%) had generalized OA. 108 persons were included in the OCP and 963 persons in the UKPC; (mean age (range); OCP: 57.2 (40.4-70.4), UKPC: 63.9 (40.0-75.0), females (%); OCP: 47 (43.5), UKPC: 543 (56.4%). Hand osteophytes were associated with AIx while GS and PD scores were not related to CVD risk markers. All OA phenotypes had higher levels of AIx compared to OCP in adjusted analyses. External validation against UKPC confirmed these findings. CONCLUSIONS: Hand osteophytes might be related to higher risk of CVD. People with OA had higher augmented central pressure compared to controls.Words 330.

Is it Useful to Repeat Magnetic Resonance Imaging of the Sacroiliac Joints After Three Months or One Year in the Diagnosis of Patients With Chronic Back Pain and Suspected Axial Spondyloarthritis?

OBJECTIVE: To investigate the value of repeated magnetic resonance imaging (MRI) of the sacroiliac (SI) joints in diagnosing chronic back pain patients in whom axial spondyloarthritis (SpA) is suspected and to examine determinants of positive MRI findings in SI joints. METHODS: Patients with chronic back pain (duration 3 months-2 years, age ≥16 years, age at onset <45 years) with ≥1 SpA feature who were included in the Spondyloarthritis Caught Early cohort underwent visits at baseline, at 3 months, and at 1 year. Visits included an evaluation of all SpA features and repeated MRI of SI joints. MRI-detected axial SpA positivity (according to the definition from the Assessment of SpondyloArthritis international Society) was evaluated by 2 or 3 well-trained readers who were blinded with regard to clinical information. The likelihood of a positive MRI finding at follow-up visits (taking into consideration contributing factors) was calculated by generalized estimating equation analysis. RESULTS: Of the 188 patients, 38.3% were male, the mean ± SD age was 31.0 ± 8.2 years, and the mean ± SD symptom duration was 13.2 ± 7.1 months. Thirty-one patients (16.5%) had positive MRI findings in the SI joints at baseline. After 3 months and after 1 year, the MRI results had changed from positive to negative in 3 of 27 patients (11.1%) and 11 of 29 patients (37.9%), respectively, which was attributable in part to the initiation of anti-tumor necrosis factor therapy. Status changes from negative to positive were seen in 5 of 116 patients (4.3%) after 3 months and in 10 of 138 patients (7.2%) after 1 year. HLA-B27 positivity and male sex were independent determinants of the likelihood of a positive MRI scan at any time point (42% in HLA-B27+ men and 6% in HLA-B27- women). If the baseline results were negative, the likelihood of a positive scan at follow-up was very low (≤7%). CONCLUSION: MRI-detected status changes in the SI joints were seen in a minority of the patients, and both male sex and HLA-B27 positivity were important predictors of MRI positivity. Our findings indicate that conducting MRI scans after 3 months or after 1 year in patients with suspected early axial SpA is not diagnostically useful.

[Memory tests in healthy elderly: age factors and norms]. / Geheugentests bij gezonde oudere mensen: leeftijdseffecten en normen.

The study aimed to assess the strength of age effects on both standard laboratory and ecological memory tests and the psychometric qualities of these tests. Furthermore, norm data are constructed. Memory performance was assessed in a random group of older adults (mean age 62 years, range 46-89) and a group of older adults having memory complaints who applied for memory training (mean age 63 years, range 45-85). Age effects were found on almost all memory tests, whether artificial laboratory or more ecological tests were used. Age effects remained generally present after correction for educational level. Retest reliabilities of the ecological memory tests did not differ systematically from those of standard laboratory tests. However, not all tests showed satisfactory retest reliabilities, this was even true for tests often used in clinical settings. For tests with retest reliabilities above r = .65 norms corrected for age and educational level were provided. The group of older adults having memory complaints performed on average better than the random group of older adults from the population. In the first group, higher performance thresholds should be employed in assessing whether memory performance is deviant.

[Suboptimal health and memory performance of elderly]. / Suboptimale gezondheid en geheugenprestaties van ouderen.

The influence of health-related incidents on memory test performance and subjective memory ratings was assessed in a) a group of healthy older adults recruited via the register of population (group 1: N = 117, mean age 62 years, range 46-89) and b) a group of healthy older subjects having memory complaints and applying for memory training (group 2: N = 111, mean age 63 years, range 45-85). The study tries to cross-validate a previous study, where the presence and frequency of health-related incidents were related to cognitive performance. The presence of 9 categories of health-related incidents (consultation of a neurologist, systemic diseases, repeated mild concussions, repeated anaesthesia, use of psychotropic medication, alcohol use, other neurotoxic factors, such as exposure to organic solvents, psychiatric disorders, birth complications or developmental problems) was assessed in a semi-structured interview. Memory performance was assessed with a battery covering different aspects of memory. Memory self-ratings were assessed with questionnaires asking for frequencies of memory failures and a general judgement of memory capacity. Health-related incidents occurred in about half of both subject groups and were not related to age or other demographic characteristics. In both subject groups, the presence, nor the number of health-related incidents was related to memory performance or memory complaints and there was no interaction with age. The results are not in agreement with the notion that health-related indices explain age differences in cognitive performance.

[Memory strategies in the elderly]. / De geheugenstrategieën van ouderen.

The frequency and preference of memory strategies were investigated in a group of independently living older adults (N = 111, 45-85 year) who were interested in memory training because of subjective and objective memory problems. Mokken scale analysis identified, besides the use of 'no strategy', four strategy scales, viz. encoding, retrieval, general, and external strategies. These five scales allowed for a differentiated analysis of strategy use. Frequency judgments showed that external strategies were used most frequently, followed by retrieval strategies. Encoding strategies were used least often. Reports on the preference of strategies in specific situations showed that subjects reported to use specific strategies in the majority of situations, although here too external strategies were used most generally. Strategy reports were more related to psychological variables (mental speed, primary memory ability, need for cognition and memory complaints) than to demographic characteristics (age, educational level and sex). The explained variances, however, were low which suggests substantial individual differences in use and preference of memory strategies.

[Memory training for remembering names: initial results in the healthy elderly]. / Geheugentraining voor het onthouden van namen: eerste resultaten bij gezonde ouderen.

In this study, a memory training program for remembering names was developed. It was assumed that names are remembered better if they have meaning. The effect of training is compared with two control conditions a) a placebo training, aimed at reducing worries about forgetfulness by giving information about memory and aging and b) a retest control group. Participants were healthy persons over 43 years old (M = 70 years) having subjective memory complaints and objective memory problems. The effect of training is evaluated with tasks for remembering names. Because the learned memory strategy can be applied to these tasks, these are called target memory tests. Other evaluation measures concerned remembering verbal information and intentions. These are called control memory tests, because the memory strategy learned cannot be applied directly. In accordance with the expectations, performance in the placebo training group (n = 10) did not improve more than in the retest control group (n = 11). The names training group (n = 13) improved more than both control groups on tests for remembering names. This improvement was maintained for at least three months after training. As expected, the improvement in performance on the target memory tests did not generalize to the control tasks, because of the specificity of the learned strategies.

[Memory strategies of elderly: training efficacy]. / Geheugenstrategieën van ouderen: te trainen?

Does memory strategy training improve the quantity and quality of reported strategy use of normal older adults (N = 111, mean age 63 years, range 46-85 years) in daily life? Three strategy training conditions, remembering names (N = 26), intentions (N = 20) and verbal information (N = 20) and an educational training (N = 23) were compared to a test-retest control group (N = 22). Strategy use was assessed with a Strategy Frequency Questionnaire (investigating the reported frequency of strategy use on five scales: encoding, retrieval, general, external and no strategies) and a Memory Situations Questionnaire (investigating the preference of strategies in specific situations). Three months after training, the frequency of strategy use as assessed by the scale scores had not increased more in the strategy training conditions than in the control condition. No demographic or psychological characteristics were identified that could predict which individuals were most likely to change their strategy use. When strategies were analyzed separately, only after names training a specific effect was demonstrated, indicating that subjects more frequently used the strategy for remembering names (association) at follow-up. With regard to changes in the strategies used in specific situations, subjects in the names and intention training conditions reported an increase in the use of the trained strategies on names and prospective situations respectively. Moreover, there was some evidence of a generalization of training to strategies that were not directly dealt with during training. The control group showed that repeated practice with memory tests may result in changes in strategy use in specific situations, which are not always for the better, how-ever.

[Are memory courses effective?]. / Zijn geheugencursussen effectief?

After a general overview of the many forms, aims and methods of memory courses, especially in the Netherlands, a strategy-oriented memory course for healthy elderly in a residential home is evaluated. The participants (N = 18) were compared with control subjects from the same home of comparable age, level of education and memory performance. Significant effects of the course could be demonstrated on subjective measures of memory but not on objective and 'ecologically valid' memory tests. Although one could consider subjectively experienced memory improvement as a very satisfactory result of memory courses, the authors state that adjustments to achieve objectively demonstrable progress are both necessary and possible.

[Memory and learning abilities in everyday life of the elderly]. / Geheugen en leervermogen in het dagelijks leven van ouderen.

Self-evaluations by adults (varying in age from 45-92 years) of their memory and learning abilities were investigated and related to performance on laboratory and ecological memory tasks. Hardly any association was found between subjective and objective measures. Self-evaluations were strongly influenced by (systematically varied) frames of reference: optimistic in comparisons with other people, pessimistic in comparisons with their own previous level of functioning. The most frequent problems were 'learning something new' and 'remembering names'. In contrast to external memory aids, cognitive strategies were rarely used spontaneously. Strategy training led to significant improvement of performance, that remained stable at follow-up. A further opportunity for improving performance was realized by ergonomic adaptations of computerized systems (teleshopping). Problems in learning to use such systems were strongly reduced by decreasing the load on working memory and by adapting the system to existing knowledge and skills of the users. A general observation in the different projects was that age-differences could explain only a small percentage of the variance in subjective and objective memory measures.

Relations between subjective evaluations of memory and objective memory performance.

Several explanations for the weak relations between subjective memory judgements and objective memory performance were investigated in two groups of normal older adults. Group 1 sampled a general population (mean age 61.6 yr., range 46-89), while Group 2 sampled subjects who were on a waiting list for memory training (mean age 63.0 yr., range 45-85 years). In both groups, subjective memory judgments were assessed with global ratings of memory capacity and with ratings of frequency of forgetting in specific memory situations. Memory performance was assessed with several well-known tests and with recently developed tests for domain-specific aspects of memory. Most tests concerned episodic memory. Study 1 also included measures of semantic, incidental and working memory. Study 2 further examined the influence of the domain-specificity of objective and subjective measures for remembering names, intentions, and texts. Relations between memory self-reports and performance were weak in both groups and for all kinds of tests. Against expectations, the low correlations could not be explained by differences between ecological and laboratory tests or incidentally and intentionally remembered information, or by differences between specific failures compared to global, stereotyped judgments. Surprisingly, correlations did not increase when subjective and objective measures assessed the same ability, like remembering names. Also noncognitive variables (mood and lifestyle) did not influence the relations. The (weak) relations between subjective and objective memory measures were comparable for subjects over and under 65 years of age. Furthermore, relations were comparable for the general population sample and the memory compliant group.

Spared recognition capacity in elderly and closed-head-injury subjects with clinical memory deficits.

This study describes the performance of three groups of subjects on a pictorial forced-recognition task, the Hundred Pictures Test. The aim was to determine whether subjects with memory deficits (elderly and closed-head-injured subjects) would perform as well as healthy young subjects, both on immediate and very long-term recognition. The results indicate that memory for complex meaningful pictures is spared in subjects with an otherwise impaired memory, and that despite increasing forgetting rates with increasing retention intervals (up to 27 weeks), still no differences are found between performance of these subjects and healthy young controls. It will be discussed how this result might be interpreted.