A cross-sectional study of sleep and depression in a rheumatoid arthritis population.

OBJECTIVES: To assess the prevalence of impaired sleep quality and depression in a rheumatoid arthritis population and determine their correlation with Disease Activity Score (DAS) and its components. METHODS: In this single-centre observational cross-sectional study, data was collected by the assessing clinician for DAS28, age and gender in various treatment groups according to use of csDMARDs, biologics and long-term steroids. Presence of impaired sleep quality and depression was assessed by the Pittsburgh Sleep Quality Index (PSQI) and Public Health Questionnaire 9 (PHQ 9). Correlation for DAS and its components with the outcomes was determined by Pearson's correlation coefficient. Multivariate analysis was performed by logistic regression. RESULTS: Two hundred patients were included. The prevalence across all subgroups of poor sleep quality and depression were 86.5% and 30%, respectively, with a correlation coefficient of 0.69 between the two and poor sleep quality amongst all RA patients with comorbid depression. Multivariate analysis found only subjective DAS components, tender joint count (TJC) and patient global health visual analogue score (VAS) to significantly correlate with both outcomes. Age inversely correlated with depression. Long-term steroid use was associated with poorer sleep quality, but there was no significant effect of csDMARDs or biologics. There was no significant difference in prevalence of depression amongst treatment subgroups. CONCLUSION: Poor sleep quality and to a lesser extent depression are prevalent in the general rheumatoid arthritis population. Patients would benefit from clinicians measuring these outcomes routinely as they constitute a significant non-inflammatory burden of living with rheumatoid disease. Key Points • Subjective components of DAS independently correlate with sleep quality and depression, while objective components do not. • Poor sleep quality is highly prevalent in RA and present in all those with comorbid depression. • Poor sleep quality and depression incidence in RA are much lower when DAS is low or remission.

T2 relaxometry in the extremely-preterm brain at adolescence.

Survival following very preterm birth is associated with cognitive and behavioral sequelae, which may have identifiable neural correlates. Many survivors of modern neonatal care in the 1990s are now young adults and the evolution of MRI findings into adult life has rarely been evaluated. We have investigated a cohort of 19-year-old adolescents without severe impairments born between 22 and 26weeks of gestation in 1995 (extremely preterm: EP). Using T2 data derived from magnetic resonance imaging we investigate differences between the brains of 46 EP participants (n=46) and the brains of a group of term-born controls (n=20). Despite EP adolescents having significantly reduced gray and white matter volumes, the composition of these tissues, assessed by both single and multi-component relaxometry, appears to be unrelated to either preterm status or gender. This may represent either insensitivity of the imaging technique or reflect that there are only subtle differences between EP subjects and their term-born peers.

Probiotics and allergy: Current understanding and application for the PCCP (Primary Care Chiropractic Physician).

The exceptional growth of allergies in recent years has been attributed to an increase in hygienic conditions which is linked to an under development of the immune system. This can be counteracted by the use of beneficial bacterial cultures (probiotics) which can provide a safe alternative for immune development.