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1.
MMWR Morb Mortal Wkly Rep ; 70(42): 1466-1471, 2021 Oct 22.
Artigo em Inglês | MEDLINE | ID: mdl-34673750

RESUMO

Arthritis is a highly prevalent and disabling condition among U.S. adults (1); arthritis-attributable functional limitations and severe joint pain affect many aspects of health and quality of life (2). Self-management education (self-management) and physical activity can reduce pain and improve the health status and quality of life of adults with arthritis; however, in 2014, only 11.4% and 61.0% of arthritis patients reported engaging in each, respectively. To assess self-reported self-management class attendance and health care provider physical activity counseling among adults with doctor-diagnosed arthritis, CDC analyzed 2019 Behavioral Risk Factor Surveillance System (BRFSS) data. In 2019, an age-standardized state median of one in six (16.2%) adults with arthritis reported ever attending a self-management class, and 69.3% reported ever receiving health care provider counselling to be physically active. Prevalences of both differed by state and sociodemographic characteristics; decreased with lower educational attainment, joint pain severity, and urbanicity; and were lower in men than in women. Health care providers can play an important role in promoting self-management class attendance and physical activity by counseling arthritis patients about their benefits and referring patients to evidence-based programs (3).


Assuntos
Artrite/terapia , Aconselhamento/estatística & dados numéricos , Exercício Físico , Pessoal de Saúde/psicologia , Educação de Pacientes como Assunto/estatística & dados numéricos , Relações Médico-Paciente , Autogestão/educação , Adolescente , Adulto , Idoso , Artrite/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estados Unidos/epidemiologia , Adulto Jovem
2.
MMWR Morb Mortal Wkly Rep ; 70(40): 1408-1414, 2021 Oct 08.
Artigo em Inglês | MEDLINE | ID: mdl-34618794

RESUMO

The numerous health benefits of physical activity include reduced risk for chronic disease and improved mental health and quality of life (1). Physical activity can improve physical function and reduce pain and fall risk among adults with arthritis, a group of approximately 100 conditions affecting joints and surrounding tissues (most commonly osteoarthritis, fibromyalgia, gout, rheumatoid arthritis, and lupus) (1). Despite these benefits, the 54.6 million U.S. adults currently living with arthritis are generally less active than adults without arthritis, and only 36.2% of adults with arthritis are aerobically active (i.e., meet aerobic physical activity guidelines*) (2). Little is known about which physical activities adults with arthritis engage in. CDC analyzed 2019 Behavioral Risk Factor Surveillance System (BRFSS) data to examine the most common nonwork-related physical activities among adults with arthritis who reported any physical activity during the past month, nationally and by state. In 2019, 67.2% of adults with arthritis reported engaging in physical activity in the past month; among these persons, the most commonly reported activities were walking (70.8%), gardening (13.3%), and weightlifting (7.3%). In 45 U.S. states, at least two thirds of adults with arthritis who engaged in physical activity reported walking. Health care providers can help inactive adults with arthritis become active and, by encouraging physical activity and referring these persons to evidence-based physical activity programs, improve their health and quality of life.


Assuntos
Artrite/epidemiologia , Exercício Físico , Caminhada/estatística & dados numéricos , Adolescente , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estados Unidos/epidemiologia , Adulto Jovem
3.
MMWR Morb Mortal Wkly Rep ; 70(40): 1401-1407, 2021 Oct 08.
Artigo em Inglês | MEDLINE | ID: mdl-34618800

RESUMO

Arthritis has been the most frequently reported main cause of disability among U.S. adults for >15 years (1), was responsible for >$300 billion in arthritis-attributable direct and indirect annual costs in the U.S. during 2013 (2), is linked to disproportionately high levels of anxiety and depression (3), and is projected to increase 49% in prevalence from 2010-2012 to 2040 (4). To update national prevalence estimates for arthritis and arthritis-attributable activity limitation (AAAL) among U.S. adults, CDC analyzed combined National Health Interview Survey (NHIS) data from 2016-2018. An estimated 58.5 million adults aged ≥18 years (23.7%) reported arthritis; 25.7 million (10.4% overall; 43.9% among those with arthritis) reported AAAL. Prevalence of both arthritis and AAAL was highest among adults with physical limitations, few economic opportunities, and poor overall health. Arthritis was reported by more than one half of respondents aged ≥65 years (50.4%), adults who were unable to work or disabled* (52.3%), or adults with fair/poor self-rated health (51.2%), joint symptoms in the past 30 days (52.2%), activities of daily living (ADL)† disability (54.8%), or instrumental activities of daily living (IADL)§ disability (55.9%). More widespread dissemination of existing, evidence-based, community-delivered interventions, along with clinical coordination and attention to social determinants of health (e.g., improved social, economic, and mental health opportunities), can help reduce widespread arthritis prevalence and its adverse effects.


Assuntos
Artrite/epidemiologia , Artrite/fisiopatologia , Limitação da Mobilidade , Adolescente , Adulto , Idoso , Feminino , Inquéritos Epidemiológicos , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Estados Unidos/epidemiologia , Adulto Jovem
4.
J Phys Act Health ; 18(S1): S53-S63, 2021 08 01.
Artigo em Inglês | MEDLINE | ID: mdl-34465653

RESUMO

BACKGROUND: Physical activity is central to the management and control of many chronic health conditions. The authors examined trends during the past 2 decades in the prevalence of US adults with and without select chronic health conditions who met the minimal aerobic physical activity guideline. METHODS: The 1998-2018 National Health Interview Survey data were analyzed. Prevalence of meeting the minimal aerobic physical activity guideline among adults with and without 6 chronic health conditions was estimated across 3-year intervals. Linear and higher-order trends were assessed overall and by age group. RESULTS: During the past 2 decades, prevalence of meeting the aerobic guideline increased among adults with diabetes, hypertension, coronary heart disease, stroke, cancer, and arthritis. However, the absolute increase in prevalence was lower among adults with hypertension, coronary heart disease, and arthritis compared to counterparts without each condition, respectively. Prevalence was persistently lower among those with most chronic health conditions, except cancer, and among older adults compared to their counterparts. CONCLUSIONS: Although rising trends in physical activity levels among adults with chronic health conditions are encouraging for improving chronic disease management, current prevalence remains low, particularly among older adults. Increasing physical activity should remain a priority for chronic disease management and control.


Assuntos
Artrite , Comportamentos Relacionados com a Saúde , Idoso , Artrite/epidemiologia , Artrite/terapia , Doença Crônica , Exercício Físico , Humanos , Prevalência , Estados Unidos/epidemiologia
5.
PLoS One ; 16(9): e0249442, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34478449

RESUMO

We previously demonstrated that exposure of adult mice to environmental levels of cadmium (Cd) alters immune cell development and function with increases in anti-streptococcal antibody levels, as well as decreases in splenic natural regulatory T cells (nTreg) in the adult female offspring. Based on these data, we hypothesized that prenatal Cd exposure could predispose an individual to developing autoimmunity as adults. To test this hypothesis, the effects of prenatal Cd on the development of autoimmune diabetes and arthritis were investigated. Non-obese diabetic (NOD) mice were exposed to Cd in a manner identical to our previous studies, and the onset of diabetes was assessed in the offspring. Our results showed a similar time-to-onset and severity of disease to historical data, and there were no statistical differences between Cd-exposed and control offspring. Numerous other immune parameters were measured and none of these parameters showed biologically-relevant differences between Cd-exposed and control animals. To test whether prenatal Cd-exposure affected development of autoimmune arthritis, we used SKG mice. While the levels of arthritis were similar between Cd-exposed and control offspring of both sexes, the pathology of arthritis determined by micro-computed tomography (µCT) between Cd-exposed and control animals, showed some statistically different values, especially in the female offspring. However, the differences were small and thus, the biological significance of these changes is open to speculation. Overall, based on the results from two autoimmune models, we conclude that prenatal exposure to Cd did not lead to a measurable propensity to develop autoimmune disease later in life.


Assuntos
Autoimunidade/efeitos dos fármacos , Cádmio/toxicidade , Diabetes Mellitus Tipo 1/etiologia , Efeitos Tardios da Exposição Pré-Natal , Animais , Artrite/diagnóstico por imagem , Artrite/epidemiologia , Artrite/etiologia , Autoimunidade/fisiologia , Citocinas/metabolismo , Diabetes Mellitus Tipo 1/induzido quimicamente , Diabetes Mellitus Tipo 1/epidemiologia , Feminino , Fêmur/diagnóstico por imagem , Incidência , Masculino , Camundongos Endogâmicos NOD , Gravidez , Baço/citologia , Microtomografia por Raio-X
6.
BMC Public Health ; 21(1): 1564, 2021 08 18.
Artigo em Inglês | MEDLINE | ID: mdl-34407795

RESUMO

BACKGROUND: Among U.S. adults with physician-diagnosed arthritis, we examined the association of 1) participant race/ethnicity with meeting physical activity guidelines and arthritis symptoms, and 2) the association of receipt of a physician exercise recommendation with physical activity levels and arthritis symptoms, and whether race/ethnicity moderates these associations. METHODS: Retrospective, cross-sectional study of National Health Interview Survey pooled data from 2002, 2006, 2009, and 2014 from 27,887 U.S. adults aged ≥18 years with arthritis. Outcomes were meeting aerobic (yes/no) and strengthening guidelines (yes/no), arthritis-associated activity limitations (yes/no) and arthritis-related pain (0-10; higher score = more pain). Predictors were race/ethnicity (White, African American, Latino, and Asian) and receipt of physician recommendation for exercise (yes/no). Covariates included demographic and health characteristics. RESULTS: Adjusting for covariates, African Americans were more likely (AOR = 1.27; 95% CI 1.12, 1.43) and Asians were less likely (AOR = 0.75; 95% CI 0.61, 0.92) than Whites to meet muscle strengthening activity guidelines. Compared to Whites, African Americans (B = 0.48; 95% CI 0.24, 0.72) and Latinos (B = 0.44; 95% CI 0.15, 0.72) reported more severe, while Asians reported less severe (B = -0.68; 95% CI -1.22, - 0.14) joint pain. Controlling for covariates, physician exercise recommendation was associated with meeting aerobic (AOR = 1.20; 95% CI 1.11, 1.30) and strengthening (AOR = 1.21; 95% CI 1.11, 1.33) guidelines, regardless of race/ethnicity except for a weak negative association with meeting strengthening guidelines (AOR = 0.85; CI 0.74-0.99) among Latinos. CONCLUSIONS: Disparities in pain exist for African Americans and Latinos with arthritis. Physician exercise recommendation is critical among patients with arthritis to relieve symptom burden.


Assuntos
Artrite , Médicos , Adolescente , Adulto , Artrite/epidemiologia , Artrite/terapia , Estudos Transversais , Grupos Étnicos , Exercício Físico , Hispano-Americanos , Humanos , Estudos Retrospectivos
7.
Front Immunol ; 12: 677984, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34354702

RESUMO

Background: HIV infection has been associated with a non-erosive inflammatory arthritis in children, although few published reports exist. This study describes the clinical, laboratory and imaging features of this noncommunicable disease in a series of HIV-infected children in South Africa. Methods: A database search was conducted to identify HIV-infected children enrolled in a Paediatric Rheumatology service in Cape Town, South Africa between 1 January 2010 and 31 December 2020. Retrospective data were collected from individuals classified with HIV arthropathy, based on a predefined checklist. Demographic, clinical, laboratory, sonographic, therapeutic, and outcomes data were extracted by chart review. Descriptive statistical analysis was performed using R (v4.0.3). Results: Eleven cases of HIV arthropathy were included in the analysis. Cases predominantly presented in older boys with low CD4+ counts. Median age at arthritis onset was 10.3 years (IQR 6.9 - 11.6) and the male-female ratio was 3.0. The median absolute CD4+ count was 389 cells/uL (IQR 322 - 449). The clinical presentation was variable, with both oligoarthritis and polyarthritis being common. Elevated acute phase reactants were the most consistent laboratory feature, with a median ESR of 126 mL/h (IQR 67 - 136) and median CRP of 36 mg/L (IQR 25 - 68). Ultrasonography demonstrated joint effusions and synovial hypertrophy. Response to therapy was slower than has generally been described in adults, with almost all cases requiring more than one immunosuppressive agent. Five children were discharged in established remission after discontinuing immunotherapy, however outcomes data were incomplete for the remaining six cases. Conclusions: In this case series, HIV arthropathy was associated with advanced immunosuppression. Therapeutic modalities included immunomodulators and antiretroviral therapy, which consistently induced disease remission although data were limited by a high rate of attrition. Prospective studies are needed to define and understand this HIV-associated noncommunicable disease.


Assuntos
Artrite/epidemiologia , Artrite/imunologia , Infecções por HIV/epidemiologia , Infecções por HIV/imunologia , HIV , Fármacos Anti-HIV/uso terapêutico , Anti-Inflamatórios não Esteroides/uso terapêutico , Antirreumáticos/uso terapêutico , Artrite/tratamento farmacológico , Contagem de Linfócito CD4 , Criança , Cloroquina/uso terapêutico , Comorbidade , Feminino , Glucocorticoides/uso terapêutico , Infecções por HIV/tratamento farmacológico , Humanos , Masculino , Metotrexato/uso terapêutico , Prednisona/uso terapêutico , Prevalência , Estudos Retrospectivos , África do Sul/epidemiologia , Resultado do Tratamento
9.
Intern Med J ; 51(5): 788-792, 2021 05.
Artigo em Inglês | MEDLINE | ID: mdl-34047040

RESUMO

Community restrictions due to COVID-19 have changed healthcare, including increased telehealth use. During the early pandemic phase, a cohort of Australian patients with inflammatory arthritis was surveyed. Self-reported access to healthcare was maintained and physical health was more likely to be self-rated poorly than mental health. There was a high level of support for telehealth during and after the pandemic.


Assuntos
Artrite , COVID-19 , Telemedicina , Artrite/epidemiologia , Atitude , Austrália/epidemiologia , Humanos , Pandemias , SARS-CoV-2
11.
Knee ; 29: 557-563, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33774589

RESUMO

BACKGROUND: Magnetic resonance imaging (MRI) is one of the most widely used investigations for knee pain as it provides detailed assessment of the bone and soft tissues. The aim of this study is to report the frequency of each diagnosis identified on MRI scans of the knee and explore the relationship between MRI results and onward treatment. METHODS: Consecutive MRI reports from a large NHS trust performed in 2017 were included in this study. The hospital electronic system was consulted to identify whether a patient underwent x-ray prior to the MRI, attended an outpatient appointment or underwent surgery. RESULTS: 4466 MRI knees were performed in 2017 with 71.2% requested in primary care and 28.1% requested in secondary care. The most common diagnosis was signs of arthritis (55.2%), followed by meniscal tears (42.8%) and ACL tears (8.3%). 49.4% of patients who had an MRI attended outpatients and 15.6% underwent surgery. The rate of knee surgery was significantly higher for patients who had their scans requested in secondary care (32.9% vs 8.9%, p < 0.001). CONCLUSION: The rate of surgical intervention following MRI is low and given these results it seems unlikely that the scan changes practice in most cases. The rate of surgery and outpatient follow up was significantly higher in scans requested by secondary care. We urge clinicians avoid wasteful use of MRI and recommend the use of plain radiography prior to MRI where arthritis may be present.


Assuntos
Artrite/diagnóstico por imagem , Traumatismos do Joelho/diagnóstico por imagem , Joelho/diagnóstico por imagem , Adulto , Idoso , Lesões do Ligamento Cruzado Anterior/diagnóstico por imagem , Lesões do Ligamento Cruzado Anterior/epidemiologia , Lesões do Ligamento Cruzado Anterior/cirurgia , Artrite/epidemiologia , Feminino , Humanos , Joelho/cirurgia , Traumatismos do Joelho/epidemiologia , Traumatismos do Joelho/cirurgia , Imageamento por Ressonância Magnética/métodos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Medicina Estatal/estatística & dados numéricos , Reino Unido
12.
Clin Interv Aging ; 16: 335-343, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33654390

RESUMO

Purpose: The Timed Up and Go (TUG) test is used to assess a person's mobility and balance. We aimed to provide updated reference values for TUG performance for the community-dwelling older population according to age and sex, and according to the presence of arthritis and non-communicable diseases (NCDs). Participants and Methods: Cross-sectional data from the seventh wave (2015-2016) of the population-based Norwegian Tromsø Study counting 5400 community-dwelling people (53% women), aged 60-84 years were used. Reference values were presented as percentiles and means for men and women by age at five-year intervals. Results: Median TUG score was stable during age 60-65 years, and after age 65 years median TUG score increased significantly with age (increase by 0.14 sec per 1 year higher age in both men and women, p<0.001). At the youngest ages (<65 years), in both men and women, there were no differences in TUG performance for those with NCD or arthritis compared to those without these diseases. After age 65 however, those without these diseases performed significantly better (p<0.05) in both men and women. Conclusion: The present study provided percentile reference values for TUG performance in community-dwelling older adults in Norway by age and sex, and in subgroups of those having arthritis and NCDs. TUG scores increased with age, and performance was significantly poorer among participants with arthritis or NCDs after age 65 years. The findings may guide clinical interventions for individuals with mobility and balance disabilities.


Assuntos
Artrite , Vida Independente/estatística & dados numéricos , Desempenho Físico Funcional , Equilíbrio Postural , Idoso , Artrite/diagnóstico , Artrite/epidemiologia , Artrite/fisiopatologia , Estudos Transversais , Feminino , Avaliação Geriátrica/métodos , Avaliação Geriátrica/estatística & dados numéricos , Humanos , Masculino , Doenças não Transmissíveis/epidemiologia , Noruega/epidemiologia , Valores de Referência
13.
RMD Open ; 7(1)2021 02.
Artigo em Inglês | MEDLINE | ID: mdl-33542048

RESUMO

OBJECTIVE: To summarise the methodological aspects in studies with work participation (WP) as outcome domain in inflammatory arthritis (IA) and other chronic diseases. METHODS: Two systematic literature reviews (SLRs) were conducted in key electronic databases (2014-2019): search 1 focused on longitudinal prospective studies in IA and search 2 on SLRs in other chronic diseases. Two reviewers independently identified eligible studies and extracted data covering pre-defined methodological areas. RESULTS: In total, 58 studies in IA (22 randomised controlled trials, 36 longitudinal observational studies) and 24 SLRs in other chronic diseases were included. WP was the primary outcome in 26/58 (45%) studies. The methodological aspects least accounted for in IA studies were as follows (proportions of studies positively adhering to the topic are shown): aligning the studied population (16/58 (28%)) and sample size calculation (8/58 (14%)) with the work-related study objective; attribution of WP to overall health (28/58 (48%)); accounting for skewness of presenteeism/sick leave (10/52 (19%)); accounting for work-related contextual factors (25/58 (43%)); reporting attrition and its reasons (1/58 (2%)); reporting both aggregated results and proportions of individuals reaching predefined meaningful change or state (11/58 (16%)). SLRs in other chronic diseases confirmed heterogeneity and methodological flaws identified in IA studies without identifying new issues. CONCLUSION: High methodological heterogeneity was observed in studies with WP as outcome domain. Consensus around various methodological aspects specific to WP studies is needed to improve quality of future studies. This review informs the EULAR Points to Consider for conducting and reporting studies with WP as an outcome in IA.


Assuntos
Artrite , Artrite/epidemiologia , Doença Crônica , Humanos , Estudos Prospectivos
15.
Sci Total Environ ; 772: 145395, 2021 Jun 10.
Artigo em Inglês | MEDLINE | ID: mdl-33578144

RESUMO

BACKGROUND: Many households in developing countries, including China, rely on the traditional use of solid fuels for cooking and heating. Arthritis is highly prevalent in middle-aged and older adults and is a major cause of disability. However, evidence linking indoor solid fuel use with arthritis is scarce in this age group (≥45 years) in developing countries. OBJECTIVES: To investigate whether exposure to indoor solid fuel for cooking and heating is associated with arthritis in middle-aged and older adults in rural China. METHODS: Data for the present study were extracted from the China Health and Retirement Longitudinal Study (CHARLS), a longitudinal national prospective study of adults aged 45 years and older enrolled in 2010 and followed up through 2015. We included 7807 rural participants without arthritis at baseline, of whom 1548 living in a central heating area in winter were included in the heating analysis (taking the Qinling-Huaihe line as the heating boundary). Cox proportional hazards models were used to examine the association between indoor solid fuel use and arthritis, controlling for age, sex, education, marital status, smoking status, drinking status, self-reported socioeconomic status, BMI, sleep time, napping time, independent cooking, hypertension, diabetes, dyslipidemia, heart problems and stroke. We also investigated the effect of switching primary fuels and using solid fuels for both cooking and heating on arthritis risk. RESULTS: The mean (SD) age of the study participants was 59.2 (10.0) years old, and 48.0% of participants were women. A total of 64.8% and 63.0% of the participants reported primarily using solid fuel for cooking and heating, respectively. Arthritis incidence rates were lower among clean fuel users than solid fuel users. Compared to those using clean fuels, cooking and heating solid fuel users had a higher risk of arthritis, with hazard ratios (HRs) of 1.22 (95% confidence interval (CI): 1.01, 1.49) and 1.76 (95% CI: 1.07, 2.89), respectively. Switching from clean fuels to solid fuels for heating (HR: 3.28, 95% CI: 1.21, 7.91) and using solid fuels for both cooking and heating (HR, 1.71, 95% CI, 1.01-2.79) increased the risk of arthritis. CONCLUSIONS: Long-term solid fuel use for indoor cooking and heating is associated with an increased risk of arthritis events among adults aged 45 years and older in rural China. The potential benefits of reducing indoor solid fuel use in groups at high risk for arthritis merit further exploration.


Assuntos
Poluição do Ar em Ambientes Fechados , Artrite , Idoso , Artrite/epidemiologia , China/epidemiologia , Carvão Mineral , Estudos de Coortes , Culinária , Feminino , Humanos , Estudos Longitudinais , Pessoa de Meia-Idade , Estudos Prospectivos
16.
Rheumatology (Oxford) ; 60(8): 3617-3627, 2021 08 02.
Artigo em Inglês | MEDLINE | ID: mdl-33484138

RESUMO

OBJECTIVES: Management of early arthritis is based upon early recognition of individuals at high risk of developing persistent arthritis. Therefore, this study investigates whether the number of risk factors for persistent disease or treatment determines the clinical course of early arthritis by comparing the chance at (sustained) DMARD-free remission ((S)DFR) after 2 years follow-up. METHODS: Data from the tREACH trial, a stratified single-blinded multicentre strategy trial with a treat-to-target approach were used. We selected all patients with ≥1 swollen joint who did not fulfil 1987 and/or 2010 criteria for RA. The number of risk factors present; autoantibody-positivity, polyarthritis (>4), erosive disease and elevated acute phase reactants, determined risk group stratification. Multivariate logistic regression analyses were performed with (S)DFR as dependent variables and baseline disease activity score (DAS), treatment, symptom duration and number of risk factors present as independent variables. RESULTS: In total, 130 early arthritis patients were included and respectively 31, 66 and 33 had 0, 1 and ≥2 risk factors present. DFR rates were respectively 74%, 48% and 45% for early arthritis patients with 0, 1 and ≥2 risk factors present. In accordance SDFR rates were 61%, 32% and 30%. In our logistic model (S)DFR was not influenced by the initial treatment strategies when stratified for risk groups. CONCLUSION: The chance at (S)DFR in early arthritis diminishes when more risk factors are present, which is irrespective of the given initial treatment. Our data point out to a stratified management approach in early arthritis based on their risk profile, but validation is needed. TRIAL REGISTRATION: ISRCTN registry: ISRCTN26791028 (http://www.isrctn.com/ISRCTN26791028).


Assuntos
Artrite/epidemiologia , Adulto , Antirreumáticos/uso terapêutico , Artrite/tratamento farmacológico , Estudos de Coortes , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Países Baixos/epidemiologia , Remissão Espontânea , Fatores de Risco
17.
J Gerontol A Biol Sci Med Sci ; 76(5): 867-875, 2021 04 30.
Artigo em Inglês | MEDLINE | ID: mdl-33449072

RESUMO

BACKGROUND: We aimed to examine the multimorbidity patterns within a representative sample of UK older adults and their association with concurrent and subsequent memory. METHODS: Our sample consisted of 11 449 respondents (mean age at baseline was 65.02) from the English Longitudinal Study of Aging (ELSA). We used 14 health conditions and immediate and delayed recall scores (IMRC and DLRC) over 7 waves (14 years of follow-up). Latent class analyses were performed to identify the multimorbidity patterns and linear mixed models were estimated to explore their association with their memory trajectories. Models were adjusted by sociodemographics, body mass index (BMI), and health behaviors. RESULTS: Results showed 8 classes: Class 1: Heart Disease/Stroke (26%), Class 2: Asthma/Lung Disease (16%), Class 3: Arthritis/Hypertension (13%), Class 4: Depression/Arthritis (12%), Class 5: Hypertension/Cataracts/Diabetes (10%), Class 6: Psychiatric Problems/Depression (10%), Class 7: Cancer (7%), and Class 8: Arthritis/Cataracts (6%). At baseline, Class 4 was found to have lower IMRC and DLRC scores and Class 5 in DLRC, compared to the no multimorbidity group (n = 6380, 55.72% of total cohort). For both tasks, in unadjusted models, we found an accelerated decline in Classes 1, 3, and 8; and, for DLRC, also in Classes 2 and 5. However, it was fully attenuated after adjustments. CONCLUSIONS: These findings suggest that individuals with certain combinations of health conditions are more likely to have lower levels of memory compared to those with no multimorbidity and their memory scores tend to differ between combinations. Sociodemographics and health behaviors have a key role to understand who is more likely to be at risk of an accelerated decline.


Assuntos
Envelhecimento , Transtornos da Memória/epidemiologia , Multimorbidade , Idoso , Artrite/epidemiologia , Asma/epidemiologia , Catarata/epidemiologia , Depressão/epidemiologia , Diabetes Mellitus/epidemiologia , Feminino , Cardiopatias/epidemiologia , Humanos , Análise de Classes Latentes , Estudos Longitudinais , Pneumopatias/epidemiologia , Masculino , Transtornos Mentais/epidemiologia , Rememoração Mental , Neoplasias/epidemiologia , Acidente Vascular Cerebral/epidemiologia , Reino Unido/epidemiologia
18.
Lupus ; 30(4): 615-619, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33461416

RESUMO

OBJECTIVES: Myositis is an infrequent feature of SLE and may often be overlooked. We aimed to estimate the incidence of myositis in SLE, and to determine demographic and clinical factors associated with it. METHODS: Within our lupus cohort, we identified potential myositis cases using the SLICC Damage Index for muscle atrophy or weakness, the SLEDAI-2K item for myositis, and annually measured serum creatinine kinase. Cases were confirmed through chart review. We performed descriptive analyses of prevalent myositis cases as of January 2000. From that point onward, we studies patients without myositis to determine risk of incident myositis, using cohort analyses adjusted for demographic variables (age, sex, race/ethnicity). RESULTS: As of January 2000, there were 5 prevalent myositis cases in our SLE cohort. Among 560 SLE patients with a study visit from January 2000 onward, with no history of myositis at baseline, 5 new cases (4 females, 1 male) were identified over an average follow-up of 8.5 years (incidence 1.05 cases per 1000 person-years). There was a higher proportion of Caucasians in the non-myositis group versus myositis group, with a trend for fewer females in the myositis cases. Arthritis, Raynaud's phenomenon, and anti-Smith antibodies were common pre-existing features, occurring in all incident myositis cases. In Cox regression analyses adjusting for age, race/ethnicity and sex, non-Caucasian patients had a markedly increased risk of developing myositis. CONCLUSION: We found a low incidence of myositis in our SLE cohort. A cluster of variables, particularly non-Caucasian race/ethnicity, arthritis, Raynaud's phenomenon, and anti-Smith antibodies were associated with risk of developing myositis in SLE. These variables may aid clinicians in identifying SLE patients at highest risk for this important complication.


Assuntos
Lúpus Eritematoso Sistêmico/complicações , Miosite/etnologia , Miosite/etiologia , Miosite/patologia , Adulto , Anticorpos Antinucleares/imunologia , Artrite/diagnóstico , Artrite/epidemiologia , Atrofia/patologia , Estudos de Coortes , Creatina Quinase/sangue , Feminino , Seguimentos , Humanos , Incidência , Lúpus Eritematoso Sistêmico/diagnóstico , Lúpus Eritematoso Sistêmico/epidemiologia , Masculino , Pessoa de Meia-Idade , Debilidade Muscular/fisiopatologia , Miosite/epidemiologia , Estudos Prospectivos , Doença de Raynaud/diagnóstico , Doença de Raynaud/epidemiologia , Análise de Regressão , Índice de Gravidade de Doença
19.
J Foot Ankle Surg ; 60(1): 21-24, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33160837

RESUMO

Arthritis of the foot is a significant cause of pain and disability. The prevalence of foot arthritis in adults aged ≥50 has been reported to be 17%. Of those, 25% are estimated to be radiographic arthritis of the first metatarsophalangeal joint. The purposes of this study were to (1) identify the prevalence of radiographic hallux rigidus (HR) in a population of patients with end-stage ankle arthritis relative to that reported in the general population and (2) identify associations between the presence of HR and demographic and clinical factors. A total of 870 feet in 809 subjects with end-stage ankle arthritis who underwent primary total ankle arthroplasty between November 2006 and November 2017 were included. Feet were stratified by patient age: <40, 40 to 59, 60 to 79, and ≥80 years. Etiology of ankle arthritis was classified as inflammatory, post-traumatic, primary, and other. The prevalence of HR in the study group was 72.9%. The prevalence of HR was slightly higher in patients with inflammatory arthritis (odds ratio 1.31, 95% confidence interval 0.73 to 2.32) and primary arthritis (odds ratio 1.18, 95% confidence interval 0.86 to 1.63). The prevalence of HR increased with age (p = .01). In conclusion, the prevalence of radiographic HR in a population with end-stage ankle arthritis was significantly higher relative to patients without documented comorbidities in the foot and ankle. Increasing age was associated with a higher prevalence of the disease.


Assuntos
Artrite , Hallux Rigidus , Articulação Metatarsofalângica , Adulto , Idoso de 80 Anos ou mais , Tornozelo , Artrite/epidemiologia , Seguimentos , Hallux Rigidus/diagnóstico por imagem , Hallux Rigidus/epidemiologia , Hallux Rigidus/cirurgia , Humanos , Prevalência , Estudos Retrospectivos , Resultado do Tratamento
20.
Anesth Analg ; 132(1): 202-209, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-31856005

RESUMO

BACKGROUND: Patients with Stickler syndrome often require emergency surgery and are often anesthetized in nonspecialist units, typically for retinal detachment repair. Despite the occurrence of cleft palate and Pierre-Robin sequence, there is little published literature on airway complications. Our aim was to describe anesthetic practice and complications in a nonselected series of Stickler syndrome cases. To our knowledge, this is the largest such series in the published literature. METHODS: We retrospectively identified patients with genetically confirmed Stickler syndrome who had undergone general anesthesia in a major teaching hospital, seeking to identify factors that predicted patients who would require more than 1 attempt to correctly site an endotracheal tube (ETT) or supraglottic airway device (SAD). Patient demographics, associated factors, and anesthetic complications were collected. Descriptive statistical analysis and logistic regression modeling were performed. RESULTS: Five hundred and twoanesthetic events were analyzed. Three hundred ninety-five (92.7%) type 1 Stickler and 63 (96.9%) type 2 Stickler patients could be managed with a single attempt of passing an ETT or SAD. Advanced airway techniques were required on 4 occasions, and we report no major complications. On logistic regression, modeling receding mandible (P = .0004) and history of cleft palate (P = .0004) were significantly associated with the need for more than 1 attempt at airway manipulation. CONCLUSIONS: The majority of Stickler patients can be anesthetized safely with standard management. If patients have a receding mandible or history of cleft, an experienced anesthetist familiar with Stickler syndrome should manage the patient. We recommend that patients identified to have a difficult airway wear an alert bracelet.


Assuntos
Manuseio das Vias Aéreas/métodos , Anestesia Geral/métodos , Artrite/epidemiologia , Artrite/cirurgia , Doenças do Tecido Conjuntivo/epidemiologia , Doenças do Tecido Conjuntivo/cirurgia , Perda Auditiva Neurossensorial/epidemiologia , Perda Auditiva Neurossensorial/cirurgia , Complicações Intraoperatórias/epidemiologia , Complicações Intraoperatórias/prevenção & controle , Descolamento Retiniano/epidemiologia , Descolamento Retiniano/cirurgia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Fissura Palatina/epidemiologia , Fissura Palatina/cirurgia , Estudos de Coortes , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Síndrome de Pierre Robin/epidemiologia , Síndrome de Pierre Robin/cirurgia , Estudos Retrospectivos , Adulto Jovem
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