The effects of exercise on cardiovascular disease risk factors and cardiovascular physiology in rheumatoid arthritis

© 2019, Springer-Verlag GmbH Germany, part of Springer Nature. Cardiovascular disease (CVD) morbidity and mortality is highly prevalent in patients with rheumatoid arthritis (RA) with debilitating effects for the individual as well as significant healthcare impact. Current evidence demonstrates that engaging in aerobic and resistance exercise (i.e. structured physical activity) can significantly improve patient-reported and clinical index-assessed outcomes in RA. In addition to this, engagement in exercise programmes improves, in a dose-dependent manner, the risk of developing CVD as well as CVD symptoms and outcomes. The present narrative review uses evidence from systematic reviews and meta-analyses as well as controlled trials, to synthesize the current state-of-the-art on the potential effects of aerobic and resistance exercise on CVD risk factors as well as on cardiac and vascular function and structure in people with RA. Where there is a lack of evidence in RA to explain potential mechanisms, relevant studies from the general population are also discussed and linked to RA.Published versio

Educational readiness among health professionals in rheumatology: low awareness of EULAR offerings and unfamiliarity with the course content as major barriers: results of a EULAR-funded European survey

Background: Ongoing education of health professionals in rheumatology (HPR) is critical for high-quality care. An essential factor is education readiness and a high quality of educational offerings. We explored which factors contributed to education readiness and investigated currently offered postgraduate education, including the European Alliance of Associations for Rheumatology (EULAR) offerings. Methods and participants: We developed an online questionnaire, translated it into 24 languages and distributed it in 30 European countries. We used natural language processing and the Latent Dirichlet Allocation to analyse the qualitative experiences of the participants as well as descriptive statistics and multiple logistic regression to determine factors influencing postgraduate educational readiness. Reporting followed the Checklist for Reporting Results of Internet E-Surveys guideline. Results: The questionnaire was accessed 3589 times, and 667 complete responses from 34 European countries were recorded. The highest educational needs were 'professional development', 'prevention and lifestyle intervention'. Older age, more working experience in rheumatology and higher education levels were positively associated with higher postgraduate educational readiness. While more than half of the HPR were familiar with EULAR as an association and the respondents reported an increased interest in the content of the educational offerings, the courses and the annual congress were poorly attended due to a lack of awareness, comparatively high costs and language barriers. Conclusions: To promote the uptake of EULAR educational offerings, attention is needed to increase awareness among national organisations, offer accessible participation costs, and address language barriers.Orthopaedics, Trauma Surgery and Rehabilitatio

Treatment strategies in axial spondyloarthritis: What, when and how?

There have been major advances in the management of axial spondyloarthritis (axSpA) with the introduction of effective biologic agents targeting TNF and IL-17A. Clinicians now have more choice but, despite treatment recommendations, are still faced with significant uncertainty when deciding on the optimal treatment strategy for an individual patient in clinical practice. Management of axSpA typically requires both non-pharmacological and pharmacological interventions. NSAIDs remain the first line drug therapies for axSpA with proven efficacy for symptomatic management but uncertainty remains regarding their optimal long-term use relating to radiographic progression and safety in axSpA. To-date there are no head-to-head trials of biologics in axSpA. Clinicians need to consider other factors, including extra-articular manifestations, comorbidities, safety and radiographic progression when deciding on which biologic to recommend for an individual patient. This article will explore the evidence relating to these factors and highlight areas of unmet need. © 2020 The Author(s) 2020. Published by Oxford University Press on behalf of the British Society for Rheumatology

Established rheumatoid arthritis – Redefining the concept

During the last few years, there has been a shift of focus in rheumatoid arthritis (RA) research towards earlier disease states. The terms early and established RA are inseparable, and having a clear definition of these two terms is crucial in conducting research and trying to understand the immunopathological mechanisms behind these different disease states. Established RA has been connected to chronic inflammation and a high burden of long-standing disease, with joint damage and comorbidities as a consequence of chronic inflammation. A chronological definition does not ensure us clear differentiation between early and established disease, because diagnosis can be delayed significantly. Similarly, a radiological definition does not ensure a clear differentiation either, as there is significant heterogeneity in the RA patient population, with some patients never developing structural damage, even after many years of disease. As the focus is now more on the early stages of disease, we propose to use the term established RA from the time of a definite clinical diagnosis of RA, irrespective of the symptoms’ duration or the presence of irreversible damage, to distinguish established disease to a stage of undifferentiated arthritis (UA) or risk for developing RA, which might never progress to RA. © 2019 Elsevier Lt

Lung cancer in rheumatoid arthritis. Is there a need for better risk assessment and screening?

Extra-articular manifestations are common in rheumatoid arthritis (RA), with lung involvement being one of the commonest. Apart from interstitial lung disease which is a well-recognized manifestation, it seems that lung cancer has also increased frequency in RA. In fact, recent meta-analyses have suggested that in RA compared with the general population, lymphomas and lung malignancy are more frequent. For the latter, male gender, seropositivity for rheumatoid factor and/or anti-citrullinated protein antibody (ACPA), as well as older age, has been suggested, among others, as risk factors. Several hypotheses have been formulated to explain the increased frequency of lung cancer in RA. These include smoking and/or interstitial lung as common risk factors for both RA and lung cancer and chronic inflammation predisposing to malignant diseases. Numerous questions remain to be answered. For example, are there any risk factors (e.g., positivity for rheumatoid factor or anti-citrullinated peptide antibodies) that would predict the development of lung cancer in these patients? Are there any screening procedures appropriate for early diagnosis and therefore better outcome? Data from large registries are needed to better define the profile of these patients. © 2019, International League of Associations for Rheumatology (ILAR)

Is mizoribine a new therapeutic agent for Sjögren's syndrome?

In a multicenter, open-label study conducted in Japan between July 2004 and May 2005, Nakayamada et al. tested the safety and efficacy of mizoribine for the treatment of primary Sjögren's syndrome (pSS). Mizoribine 50 mg was administered three times a day for 16 weeks to 59 patients with pSS, 7 of whom withdrew because of adverse drug reactions; however, no serious adverse events were noted. In the 48 patients who completed the study, an increase from baseline in median salivary secretion volume, evaluated using the Saxon test, was apparent at week 8 and was significant at week 16 (P < 0.05). At 16 weeks, significant improvements from baseline were also seen in patients' assessments of dry mouth and dry eyes, physicians' assessment of oral sicca symptoms, labioangular sicca symptoms and physicians' overall assessment, all measured using a 10 cm visual analog scale. The findings suggest that mizoribine could be an effective treatment for pSS

Disease activity indices in psoriatic arthritis: current and evolving concepts

Psoriatic arthritis (PsA) is a highly heterogenous disease, with many different clinical manifestations inside or outside of the musculoskeletal system and the skin. It is often accompanied by comorbidities like cardiovascular diseases and mental health disorders. Acute phase reactants are not always elevated and specific markers for diagnosis and/or monitor the disease are lacking thus far. These characteristics possibly reflect the difficulty in agreement about a disease activity index for PsA. Many indices have been proposed over the last years, each of them considering different combinations of disease characteristics. We performed a literature search for relevant articles using PubMed and Embase. No data limits were applied. The keywords “Psoriatic arthritis” OR “PsA” AND “disease activity” AND “index” OR “indices” were used. Reference lists of relevant articles were also reviewed. Articles were also identified through searches of the authors’ own files. In this review, we comparatively present the available indices (simple or composite) used for measuring activity in PsA, highlighting their weaknesses, strengths, and disparities. We comment also on the caveats and pitfalls that are encountered in assessment of disease activity, in relation to clinical practice and research. A widely accepted index for measuring disease activity in PsA is lacking. Other parameters, mostly related to patient-reported outcomes and to novel biomarkers might be included in the future, in such indices.Key points• Disease activity in PsA is multiparametric and its assessment is challenging due to many different phenotypes.• Many different indices are currently in use of PsA disease activity assessment.• Each PsA disease activity index has specific pros and cons. © 2021, International League of Associations for Rheumatology (ILAR)