2022 EULAR points to consider for remote care in rheumatic and musculoskeletal diseases

Background: Remote care and telehealth have the potential to expand healthcare access, and the COVID-19 pandemic has called for alternative solutions to conventional face-to-face follow-up and monitoring. However, guidance is needed on the integration of telehealth into clinical care of people with rheumatic and musculoskeletal diseases (RMD).  Objective: To develop EULAR points to consider (PtC) for the development, prioritisation and implementation of telehealth for people with RMD.  Methods: A multidisciplinary EULAR task force (TF) of 30 members from 14 European countries was established, and the EULAR standardised operating procedures for development of PtC were followed. A systematic literature review was conducted to support the TF in formulating the PtC. The level of agreement among the TF was established by anonymous online voting.  Results: Four overarching principles and nine PtC were formulated. The use of telehealth should be tailored to patient's needs and preferences. The healthcare team should have adequate equipment and training and have telecommunication skills. Telehealth can be used in screening for RMD as preassessment in the referral process, for disease monitoring and regulation of medication dosages and in some non-pharmacological interventions. People with RMD should be offered training in using telehealth, and barriers should be resolved whenever possible. The level of agreement to each statement ranged from 8.5 to 9.8/10.  Conclusion :The PtC have identified areas where telehealth could improve quality of care and increase healthcare access. Knowing about drivers and barriers of telehealth is a prerequisite to successfully establish remote care approaches in rheumatologic clinical practice

The Effects of Age and Fasting Models on Blood Pressure, Insulin/Glucose Profile, and Expression of Longevity Proteins in Male Rats

Intermittent fasting can be effective in reducing metabolic disorders and age-related diseases. However, there remain questions about the effects of fasting with respect to the age in which fasting begins, the fasting models, and the mechanisms involved. We investigated the effects of age of beginning fasting and chronic mild and severe fasting models on blood pressure (BP), insulin/glucose profile, and expression of klotho, sirtuin1 (SIRT1), and sirtuin3 (SIRT3) in male Wistar rats. Young (3 months), middle-aged (12 months), and old (22 months) animals were randomly divided into three subgroups and fed as ad libitum (AL), AL with fasting 1 day per week (FW), and AL with fasting every other day (EOD), respectively, for 3 months. The FW reduced the weight gain in young animals (p < 0.001 vs. AL), whereas EOD induced weight loss in all three age categories (p < 0.001). Aging was associated with high BP, high glucose, and insulin levels. Both FW and EOD feedings decreased BP and blood glucose level (p < 0.001) and EOD decreased insulin level (p < 0.05 vs. AL) in old animals. Parallel to aging, the expression of SIRT1 and klotho significantly decreased in plasma and EOD feeding recovered this defect. Both FW and EOD feedings increased the expression of SIRT3 in middle-aged and old rats. Age is a determining factor for the effectiveness of fasting and old animals respond more desirably to fasting. The effect of EOD fasting is more effective than FW fasting in improving the metabolic factors, partly through the recovery of SIRT1 and klotho. © Copyright 2020, Mary Ann Liebert, Inc., publishers 2020

The effect of oral ascorbic acid pretreatment on feeding changes following injection in nucleus accumbens shell in adult male rats

Background: Ascorbic acid (AA) is not synthesized in the brain but it is actively transported through blood-brain barrier by SVCT2 cotransporter and it is stored in high concentrations with heterogeneous distribution in areas such as nucleus accumbens shell (AcbSh) in the mammalian brain. Previous studies have shown that Ascorbic acid injection into AcbSh decreases feeding therefore, in the present study we evaluated the effects of oral Ascorbic acid pretreatment on changes in feeding upon its injection in AcbSh in adult male rats. Methods: Sixty-three adult male rats (220-280 g) were divided into five treatment and five pretreatment groups. The treatment groups included the control (intact) group, sham-operated Ascorbic acid group that received normal saline as vehicle, and three other groups that received different doses of ascorbic acid (10, 50 and 250 µg/rat) by injection into AcbSh for four days. The pretreatment groups received Ascorbic acid (100 mg/kg) for 15 days via gastric gavage before receiving the aforementioned doses in treatment groups into intra nucleus AcbSh. Feeding measurement was repeated every 12 hours by automatic metabolic cage. Results: The results indicated that all injected doses of Ascorbic acid (10, 50 and 250 µg/rat) into nucleus accumbens shell decrease food intake (P<0.05) in rats and oral Ascorbic acid pretreatment had no effects in this regard. Conclusion: Our findings show that ascorbic acid is an effective factor in feeding regulation. Oral pretreatment seems to have no influence on the central effects of ascorbic acid in the nucleus accumbens shell

Restoration of the Renin-Angiotensin System Balance Is a Part of the Effect of Fasting on Cardiovascular Rejuvenation: Role of Age and Fasting Models

Intermittent fasting (IF) is an intervention that can be beneficial for health span and mitigate the risk of developing age-related cardiovascular diseases; however, the involved mechanisms are not well understood. The present study investigated the effects of IF regimens on the plasma level of angiotensin II (Ang II), and the expression of Ang II receptors (AT1aR and AT2R) and angiotensin-converting enzyme 2 (ACE2) in the heart and aorta of male, 3-, 12-, and 24-month-old Wistar rats fed ad libitum (AL), fed ad libitum and fasted 1 day per week (FW), or fasted every other day (EOD) for 3 months. Aging was associated with high circulating levels of Ang II, high level of AT1aR protein expression in the heart and aorta, and low level of AT2R protein expression in the heart and aorta. Both FW and EOD decreased Ang II levels (p < 0.01, p < 0.001) and AT1aR protein expression in the heart (p < 0.01, p < 0.001) and aorta (p < 0.001) of old rats. Both FW and EOD increased the expression of AT2R protein in the heart (p < 0.05 and p < 0.001, respectively). However, only EOD increased the expression of AT2R protein (p < 0.05) in the aorta. In the old group, both the FW and EOD regimens induced a significant increase in the expression of ACE2 protein in the heart (p < 0.01, p < 0.001 vs. age-matched AL group, respectively). The results suggest that a part of the recovery effect of fasting on cardiovascular system in old rats is mediated through restoration of the balance of renin-angiotensin system. © Copyright 2020, Mary Ann Liebert, Inc., publishers

2022 EULAR Points to consider for remote care in rheumatic and musculoskeletal diseases

Background: Remote care and telehealth have the potential to expand healthcare access, and the COVID-19 pandemic has called for alternative solutions to conventional face-to-face follow-up and monitoring. However, guidance is needed on the integration of telehealth into clinical care of people with rheumatic and musculoskeletal diseases (RMD). Objective: To develop EULAR points to consider (PtC) for the development, prioritisation and implementation of telehealth for people with RMD. Methods: A multidisciplinary EULAR task force (TF) of 30 members from 14 European countries was established, and the EULAR standardised operating procedures for development of PtC were followed. A systematic literature review was conducted to support the TF in formulating the PtC. The level of agreement among the TF was established by anonymous online voting. Results: Four overarching principles and nine PtC were formulated. The use of telehealth should be tailored to patient's needs and preferences. The healthcare team should have adequate equipment and training and have telecommunication skills. Telehealth can be used in screening for RMD as preassessment in the referral process, for disease monitoring and regulation of medication dosages and in some non-pharmacological interventions. People with RMD should be offered training in using telehealth, and barriers should be resolved whenever possible. The level of agreement to each statement ranged from 8.5 to 9.8/10.  Conclusion: The PtC have identified areas where telehealth could improve quality of care and increase healthcare access. Knowing about drivers and barriers of telehealth is a prerequisite to successfully establish remote care approaches in rheumatologic clinical practice