Associations Between Adiponectin and the Development of Diabetes in Rheumatoid Arthritis.

PURPOSE: We evaluated associations between adiponectin and the risk of diabetes among patients with rheumatoid arthritis (RA), a systemic inflammatory disease associated with metabolic disturbance. METHODS: This prospective cohort study included adults with RA from the Veterans Affairs Rheumatoid Arthritis Registry. Adiponectin and inflammatory cytokines/chemokines were measured at enrollment on stored serum samples. Adiponectin levels were categorized, and clinical variables were described across categories (<10 µg/mL; 10-40 µg/mL; >40 µg/mL). Multivariable Cox proportional hazard models evaluated associations between adiponectin and incident diabetes adjusting for age, sex, race, smoking status, body mass index (BMI), disease-modifying therapy use, calendar year, and comorbidity. Testing for modification of effect in the context of elevated cytokines/chemokines was performed. RESULTS: Among 2595 patients included in the analysis, those with adiponectin levels >40 µg/mL (N = 379; 15%) were older and had lower BMI. There were 125 new cases of diabetes among 1689 patients without prevalent disease at enrollment. There was an inverse association between adiponectin and incident diabetes; however, the association was positive among patients with adiponectin levels >40 µg/mL. Patients with levels >40 µg/mL were at higher risk compared to those with levels 10-40 µg/mL (HR: 1.70 [1.34, 2.16] P < .001). Those with adiponectin levels >40 µg/mL had significantly higher levels of inflammatory cytokines with evidence of a modified effect of adiponectin on diabetes risk in the setting of inflammation. CONCLUSION: The relationship between adiponectin and incident diabetes risk is U-shaped in RA. Patients with very high adiponectin levels have greater systemic inflammation and an altered relationship between adiponectin and diabetes risk.

Changes in physical function over time in rheumatoid arthritis patients: A cohort study.

INTRODUCTION: Self-reported disability is potentially influenced by many factors in patients with rheumatoid arthritis (RA). In this sense, we evaluated the association between self-reported disability and (1) clinical features, (2) muscle strength and (3) physical performance over time among patients with RA from two distinct patient cohorts. MATERIALS AND METHODS: Two independent prospective RA cohorts were analyzed. The Health Assessment Questionnaire (HAQ), Disease Activity Score in 28 Joints (DAS28), handgrip test, chair stand test, timed-up-and-go (TUG) test and Short Physical Performance Battery (SPPB) were performed at baseline and in follow-up. T test for independent samples, Mann-Whitney U test, Spearman correlation coefficients and linear regression with generalized estimating equations were performed to assess associations between individual constructs at baseline and over time. RESULTS: A total of 205 total RA patients were included [North American Cohort (n = 115); Brazilian Cohort (n = 90)]. At enrollment, Brazilian men had better HAQ than North American men (p<0.001). Brazilian patients overall had lower muscle strength than North American patients (p<0.05). HAQ was associated with DAS28, handgrip test, chair stand test, TUG and SPPB (p<0.001) in both cohorts. Worsening of the DAS28 and chair stand test were each associated with worsening in HAQ in longitudinal analysis over time. Worsening of handgrip was also associated in with worsening HAQ in both cohorts (p<0.05). A worse TUG test was associated with worsening in HAQ in Brazilian cohort (p<0.05) and a worse SPPB was associated with worsening in HAQ in North American cohort (p<0.05). CONCLUSION: Greater disability measured by HAQ is closely associated with disease activity, pain, muscle strength, and physical performance among RA. Worsening in self-reported disability correlate with worsening clinical factors including objectively-observed physical function.

Sarcopenia in Immune-Mediated Rheumatic Diseases-Review.

INTRODUCTION: Sarcopenia is a condition characterized by decreased muscle strength and muscle mass, which can impact physical function. Sarcopenia develops as a consequence of age-related decline (primary sarcopenia) and has a major impact on physical, social, and emotional well-being. In addition, patients with rheumatic diseases may suffer from sarcopenia independently of aging (secondary sarcopenia). Exercise, pharmacological treatments, and nutritional supplementation are some of the strategies used for the management of sarcopenia in the general population. The aim of this review is to summarize the evidence around the prevalence and impact of sarcopenia in patients with rheumatic diseases. CONCLUSIONS: From our review, we can state that sarcopenia is a common and prevalent condition among the rheumatic diseases. Furthermore, the impacts of sarcopenia are not well-appreciated, and the implementation of treatment strategies has not been widespread. Strategies such as exercise and some pharmacological treatments are effective in improving physical and functional impairment related to these conditions. FUTURE RESEARCH DIRECTIONS IN THE FIELD: New pharmacological treatments are being actively studied and may contribute in the future to the management of sarcopenia.

Effects of short sprint interval training on aerobic and anaerobic indices: A systematic review and meta-analysis.

The effects of short sprint interval training (sSIT) with efforts of ≤10 s on maximal oxygen consumption (V̇O2 max), aerobic and anaerobic performances remain unknown. To verify the effectiveness of sSIT in physically active adults and athletes, a systematic literature search was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). The databases PubMed/MEDLINE, ISI Web of Science, and SPORTDiscus were systematically searched on May 9, 2020, and updated on September 14, 2021. Inclusion criteria were based on PICO and included healthy athletes and active adults of any sex (≤40 years), performing supervised sSIT (≤10 s of "all-out" and non-"all-out" efforts) of at least 2 weeks, with a minimum of 6 sessions. As a comparator, a non-sSIT control group, another high-intensity interval training (HIIT) group, or a continuous training (CT) group were required. A total of 18 studies were deemed eligible. The estimated SMDs based on the random-effects model were -0.56 (95% CI: -0.79, -0.33, p < 0.001) for V̇O2 max, -0.43 (95% CI: -0.67, -0.20, p < 0.001) for aerobic performance, and -0.44 (95% CI: -0.70, -0.18, p < 0.001) for anaerobic performance after sSIT vs. no exercise/usual training. However, there were no significant differences (p > 0.05) for all outcomes when comparing sSIT vs. HIIT/CT. Our findings indicate a very high effectiveness of sSIT protocols in different exercise modes (e.g., cycling, running, paddling, and punching) to improve V̇O2 max, aerobic, and anaerobic performances in physically active young healthy adults and athletes.

Risk of Serious Infection With Low-dose Glucocorticoids in Patients With Rheumatoid Arthritis: An Instrumental Variable Analysis.

BACKGROUND: Low-dose glucocorticoids are commonly used in the treatment of rheumatoid arthritis (RA). Observational studies have found an increased risk of serious infection associated with low-dose glucocorticoids, but concerns about residual confounding remain. METHODS: We identified adults with RA on stable immunomodulatory therapy for >6 months receiving no glucocorticoids or ≤5 mg/day using Medicare data from 2006 to 2015. We used provider preference for glucocorticoids as an instrumental variable (IV) to assess associations between low-dose glucocorticoid use and the risk of infection requiring hospitalization using a cause-specific proportional hazards model. RESULTS: We identified 163,603 qualifying treatment episodes among 120,656 patients. Glucocorticoids ≤5 mg/day were used by 25,373/81,802 (31.0%) of patients seen by a rheumatologist with low provider preference for glucocorticoids and by 36,087/81,801 (44.1%) of patients seen by a rheumatologist with high provider preference for glucocorticoids (adjusted odds ratio 1.81, 95% confidence interval 1.77, 1.84 for association between provider preference and glucocorticoids). Chronic obstructive pulmonary disease, opioids, antibiotics, previous emergency department visits, hospitalizations, and infections requiring hospitalization infections were unbalanced with regard to exposure but not to the IV. The incidence of infection requiring hospitalization was 8.0/100 person-years among patients unexposed to glucocorticoids versus 11.7/100 person-years among those exposed. The association between glucocorticoids and infection requiring hospitalization from IV analysis (hazard ratio 1.26 [1.02-1.56]) was similar to results from a standard multivariable model (hazard ratio 1.24 [1.21-1.28]). CONCLUSIONS: Among patients with RA on stable immunomodulatory therapy, IV analysis based on provider preference demonstrated an increased risk of infection requiring hospitalization associated with low-dose glucocorticoids, similar to a traditional analysis.

Cachexia in patients with rheumatoid arthritis: a cohort study.

BACKGROUND: Rheumatoid arthritis (RA) is an inflammatory disease that leads to altered body composition. The loss of lean mass with a preservation or increase in fat mass has been termed rheumatoid cachexia (RC), to contrast with classic cachexia, which is characterized by severe weight loss. There are limited data on the prevalence and progression of cachexia in RA over time, as well as on associated factors. Our aim was to determine the prevalence of cachexia and to determine associations with potential factors. METHODS: This prospective cohort study recruited consecutively patients diagnosed with RA and followed for 1 year. The assessments were performed: clinical features, body composition, and physical function. RC and classic cachexia were assessed by several established diagnostic criteria. The pairwise Student's t test, Chi-square test, and GEE were performed (accepted at p ≤ 0.05). RESULTS: Of 90 patients recruited, 81 completed the study. Most patients were women (88.9%), and the mean age was 56.5 ± 7.3 years. At baseline, the median DAS28-CRP was 3.0 (IQR, 1.0-3.0), 13.3-30.0% of the included patients had RC, while none met criteria for classic cachexia. The prevalence of cachexia did not change after 12 months. Disease activity status and treatment with biologic disease-modifying antirheumatic drugs were significantly associated with changes on body composition and physical function (p < 0.05). CONCLUSIONS: In this cohort, RC was common, while classic cachexia was absent. Disease activity and use of biologic therapies were associated with changes on body composition and physical function, underscoring the importance of aiming for remission when treating RA.

Perceived Discrimination and Cardiometabolic Risk Among US Hispanics/Latinos in the HCHS/SOL Sociocultural Ancillary Study.

BACKGROUND: Metabolic syndrome (MetS) is a group of cardiovascular risk factors including elevated blood pressure, elevated triglycerides, decreased high-density lipoprotein cholesterol, impaired fasting glucose, and abdominal obesity, which disproportionately affects Hispanics/Latinos. The present study examined associations between perceived discrimination and MetS in Hispanic/Latino adults from various background groups (i.e., Dominican, Central American, Cuban, Mexican, Puerto Rican, South American). METHODS: Data were obtained from 5174 Hispanics/Latinos who participated in the Hispanic Community Health Study/Study of Latinos (HCHS/SOL) Sociocultural Ancillary Study. MetS components and covariates were measured at a baseline examination, and perceived discrimination was assessed within 9 months of baseline. Path analysis modeled associations of perceived discrimination with MetS prevalence and each of the six components of MetS, controlling for age, sex, income, acculturation, physical activity, diet, smoking, and alcohol use. RESULTS: Among the full cohort, perceived discrimination was not associated with MetS prevalence in any of the models evaluated. Higher perceived discrimination at work/school was associated with larger waist circumference. When examining background groups separately, higher perceived ethnicity-associated threat was related to increased MetS prevalence only among individuals of Central American background. Differential patterns of association between perceived discrimination and MetS components were found for different background groups. CONCLUSIONS: Overall results suggested that perceived discrimination was not strongly or consistently associated with MetS among Hispanics/Latinos.

Psychological Distress Predicts HbA1c Trajectories among Type 1 Diabetic Adolescents / El estrés psicológico predice las trayectorias de HbA1c en adolescentes diabéticos tipo 1

Abstract Diabetic adolescents have poor metabolic control. We aimed to characterize the longitudinal association between the stress-related domains of emotional burden (EB), physician related-distress (PD), regimen-related distress (RD), diabetes-related interpersonal distress (ID), and hemoglobin glycosylated (HbA1c) trajectories among Type 1 diabetics Chilean adolescents. Thirty-two Type 1 diabetic adolescents (Mage=15.97; SD=3.45) were followed for one year. HbA1c was assessed at three time points, and a stress measure was obtained. Using a longitudinal growth curve modeling, a marginal overall negative linear trend was found in HbA1c (b = -0.23, p = 0.096). There was an interaction between time and PD (b = -0.33, p < 0.05), and a main effect of EB, RD, and ID on HbA1c. Psychological stress domains predict metabolic control trajectories. Monitoring diabetes specific stress may be a useful tool to identify adolescents at risk for poor control, and interventions that reduce such stress might lead to better management of diabetes in adolescents.

Resumen Los adolescentes diabéticos tienen un pobre control metabólico. El propósito de este estudio fue caracterizar la asociación longitudinal entre el estrés emocional (EB), estrés con el médico (PD), estrés con el tratamiento (RD) y estrés interpersonal (ID), con trayectorias de hemoglobinas glicosiladas (HbA1c) en adolescentes diabéticos tipo 1 (DM1). Treinta y dos adolescentes DM1 (Medad = 15.97, DE = 3.45) fueron seguidos un año. Se obtuvo la HbA1c tres veces en el año, más un auto-reporte de estrés. Análisis de curvas de crecimiento predijeron una tendencia lineal negativa en la trayectoria de HbA1c (b = -0.23, p = 0.096). Hubo una interacción entre el tiempo y PD (b = -0.33, p ≤ 0.05) y los efectos principales de EB, RD, e ID en HbA1c. Se concluye que el estrés psicológico predice trayectorias de HbA1c. Monitorear dominios específicos de estrés podría ser útil para identificar adolescentes con riesgo de tener pobre HbA1c, e intervenciones que reduzcan el estrés podrían ayudar a manejar la diabetes en adolescentes.

Language Trajectories of Children Born Very Preterm and Full Term from Early to Late Childhood.

OBJECTIVE: To identify distinct language trajectories of children born very preterm and full term from 2 to 13 years of age and examine predictors for the identified trajectories. STUDY DESIGN: A cohort of 224 children born very preterm and 77 full term controls recruited at birth were followed up at ages 2, 5, 7, and 13 years. The number of distinct language trajectories was examined using latent growth mixture modeling allowing for linear and quadratic time trends. Potential predictors in the neonatal period (eg, birth group, sex, and medical risk) and at 2 years (ie, social risk and use of allied health services) for the language trajectories were tested using multinomial logistic regression. RESULTS: Five distinct language trajectories were identified across childhood: stable normal (32% of study cohort), resilient development showing catch-up (36%), precocious language skills (7%), stable low (17%), and high-risk (5%) development. The very preterm group was 8 times more likely to have a language trajectory that represented poorer language development compared with full term controls (very preterm, 40%; full term, 6%). Greater social risk and use of allied health services were associated with poorer language development. CONCLUSIONS: Variable language trajectories were observed, with a substantial proportion of children born very preterm exhibiting adverse language development. These findings highlight the need for monitoring language skills in children born very preterm before school entry and across middle childhood.

Estimating large carnivore populations at global scale based on spatial predictions of density and distribution - Application to the jaguar (Panthera onca).

Broad scale population estimates of declining species are desired for conservation efforts. However, for many secretive species including large carnivores, such estimates are often difficult. Based on published density estimates obtained through camera trapping, presence/absence data, and globally available predictive variables derived from satellite imagery, we modelled density and occurrence of a large carnivore, the jaguar, across the species' entire range. We then combined these models in a hierarchical framework to estimate the total population. Our models indicate that potential jaguar density is best predicted by measures of primary productivity, with the highest densities in the most productive tropical habitats and a clear declining gradient with distance from the equator. Jaguar distribution, in contrast, is determined by the combined effects of human impacts and environmental factors: probability of jaguar occurrence increased with forest cover, mean temperature, and annual precipitation and declined with increases in human foot print index and human density. Probability of occurrence was also significantly higher for protected areas than outside of them. We estimated the world's jaguar population at 173,000 (95% CI: 138,000-208,000) individuals, mostly concentrated in the Amazon Basin; elsewhere, populations tend to be small and fragmented. The high number of jaguars results from the large total area still occupied (almost 9 million km2) and low human densities (< 1 person/km2) coinciding with high primary productivity in the core area of jaguar range. Our results show the importance of protected areas for jaguar persistence. We conclude that combining modelling of density and distribution can reveal ecological patterns and processes at global scales, can provide robust estimates for use in species assessments, and can guide broad-scale conservation actions.

Creatine kinase in the U.S. population: Impact of demographics, comorbidities, and body composition on the normal range.

BACKGROUND: Creatine kinase (CK) values are a critical part of the workup of suspected myopathies and are often assessed in patients that develop myalgia on statin therapy. CK elevations may influence the initiation and cessation of statin treatment, and incidentally discovered CK elevation may lead to further testing. A number of factors influence CK levels in healthy patients, but current reference ranges do not incorporate important influencers of CK such as race. Objectives of this study were to evaluate clinical factors associated with CK among healthy individuals and to develop practical reference ranges for important subgroups to improve test interpretation. METHODS: CK was evaluated in nonpregnant participants ≥20 years old from the cross-sectional National Health and Nutrition Examination Survey (NHANES) 2011-2014. Linear and logistic regression stratified by sex identified clinical factors associated with CK levels. Adjustment for anthropomorphic measures assessed whether age and race-ethnicity differences in CK were explained by differences in body composition. The 95th and 97.5th percentiles of CK in sex/race-ethnicity subgroups were calculated, excluding patients with recent strenuous exercise. RESULTS: A total of 10,096 nonpregnant adults were studied. Black race was strongly associated with CK. The odds ratio of having an abnormal CK for black women was 5.08 (95% CI 3.65-7.08) and for black men was 8.39 (95% CI 6.11-11.52). CK was substantially lower in older men. Differences in CK by age but not race-ethnicity were largely explained by body composition. Women with low body mass index were less likely to have an elevated CK, and overweight or obese men had an almost 2-fold greater odds of having an elevated CK. The 97.5th percentile of CK was 382 (95% CI 295-469) in white men, 1001 (95% CI 718-1284) in black men, 295 (95% CI 216-374) in white women, and 487 (95% CI 310-664) in black women. CONCLUSION: CK is substantially higher in men and in black patients. Differences in body size and composition are also important but do not explain racial differences in CK. The 95th and 97.5th percentiles in sex and race-ethnicity subgroups provide a practical guide for clinicians interpreting CK values.

[How stress gets under the skin]. / How stress gets under the skin o cómo el estrés psicológico se introduce bajo la piel.

How psychological stress gets under the skin and contributes to increase the odds for the onset and progression of chronic diseases has been object of abundant research. In this literature review, evidence about the role that both acute (natural phenomenon, marital conflict, a social evaluative task) and chronic stress (stress at work, and the perception of being discriminated) as well as interpersonal stress have on physical health, is examined. Behavioral (lack of physical activity, smoking, lack of adherence) and physiological (dysregulation of the hypothalamic-pituitary-adrenal axis, sympathetic-adrenal-medullary axis, immune system and inflammatory response) mechanisms through which psychological stress may contribute to the onset and progression of cardiovascular disease (altering blood pressure, heart rate reactivity, hemoconcentration and pro-coagulation function), and two key processes involved in cancer progression (angiogenesis and metastasis) are discussed. Finally, how social support may moderate the association among psychological stress and physical health is described.

How stress gets under the skin o cómo el estrés psicológico se introduce bajo la piel / How stress gets under the skin

How psychological stress gets under the skin and contributes to increase the odds for the onset and progression of chronic diseases has been object of abundant research. In this literature review, evidence about the role that both acute (natural phenomenon, marital conflict, a social evaluative task) and chronic stress (stress at work, and the perception of being discriminated) as well as interpersonal stress have on physical health, is examined. Behavioral (lack of physical activity, smoking, lack of adherence) and physiological (dysregulation of the hypothalamic-pituitary-adrenal axis, sympathetic-adrenal-medullary axis, immune system and inflammatory response) mechanisms through which psychological stress may contribute to the onset and progression of cardiovascular disease (altering blood pressure, heart rate reactivity, hemoconcentration and pro-coagulation function), and two key processes involved in cancer progression (angiogenesis and metastasis) are discussed. Finally, how social support may moderate the association among psychological stress and physical health is described.