IGF-1 and IGFBP3 as indirect markers of hepatic insulin resistance and their relation to metabolic syndrome parameters in liver steatosis patients

Objective. The aim of the present study was to assess insulin-like growth factor 1 (IGF-1) and IGF-binding protein 3 (IGFBP3) as markers of insulin resistance in patients with prediabetes and type 2 diabetes mellitus (TDM2)

Is Coping Self-Efficacy Related to Psychological Distress in Early and Established Rheumatoid Arthritis Patients?

The study aimed to explore associations between coping self-efficacy and psychological distress in early and established rheumatoid arthritis (RA) patients. Two samples differing in disease duration were collected at outpatient rheumatology clinics in Eastern Slovakia. The first sample consisted of 146 established patients with disease duration of 12 years or more (age = 58.02 SD = 10.38 years; disease duration = 16.08 SD = 3.60 years; 86 % women) and the second sample consisted of 102 early RA patients with disease duration of 4 years or less (age = 53.25 SD = 12.32; disease duration = 2.8 SD = 1.23 years; 75 % women). The patients underwent a routine rheumatology check and completed questionnaires regarding functional disability, neuroticism and extraversion, coping self-efficacy and psychological distress. The data were analyzed using hierarchical linear regression models. Coping self-efficacy was significantly negatively associated with psychological distress in both samples with the strongest association with anxiety in the early RA group. These associations remained significant after controlling for sociodemographic, disease related and personality variables. Psychological distress was further associated with disease activity, functional disability, neuroticism and extraversion. However, different patterns in respect to anxiety and depression with the duration of RA was observed. Coping self-efficacy accounted for a unique variance in psychological distress even after controlling for the influence of disease activity, functional status and personality traits. The strongest association was observed with anxiety in early RA patients. As a result, management and intervention programs increasing self-efficacy for coping strategies might be beneficial for reducing anxiety and depression especially during the early phase of the disease

Social Support as a Moderator of Functional Disability's Effect on Depressive Feelings in Early Rheumatoid Arthritis:A Four-Year Prospective Study

Objective: To examine associations of depressive feelings with disease-related variables and explore the moderating effect of social support on depressive feelings in individuals with early rheumatoid arthritis (RA) prospectively over 4 years. Method: Data were collected annually over 4 years. The sample consisted of 124 individuals with diagnosed RA (85.5% women; mean age 47.9 years; mean disease duration 22.2 months). The strength of cross-sectional and prospective associations of sociodemographic, disease-related variables and the direct and moderating effects of social support on depression were tested using correlations, multilevel models, and hierarchical linear regressions. Results: The study showed that emotional support moderated the influence of functional disability on depressive feelings in individuals with RA. This was not detected for instrumental support. Further prospective associations between functional status, marital status, and depressive feelings were also found. Overall, the strongest association was found between initial depressive feelings and depressive feelings over time. Conclusions: Initial depression seemed to be a risk factor in explaining later depressive feelings, but emotional support might be prospectively beneficial, especially for individuals with higher levels of disability. Early detection of individuals at risk for depression and providing interventions aimed at the specific functions of social support might help to decrease mental health problems

Social participation in early and established rheumatoid arthritis patients

Purpose: The aim of the study was to examine whether rheumatoid arthritis (RA) patients with different levels of restriction in social participation differ in disease related as well as psychosocial variables and whether a similar pattern can be found among early and established RA patients. Method: Two samples of RA patients with early (n = 97; age = 53 ± 12.3 years; disease duration = 2.8 ± 1.2 years; 76% women) and established (n = 143; age = 58 ± 10.3 years; disease duration = 16.1 ± 3.6 years; 86% women) were collected. The pattern of differences for the patients with different level of participation restriction (no restriction, mild, moderate or high restriction) was explored by the Jonckheere–Terpstra test. Results: Significant differences were found between patients with different levels of social participation restrictions in both samples in pain, fatigue, functional disability, anxiety, depression and mastery. Generally, it was found that patients with higher restrictions experienced more pain and fatigue, more anxiety and depression and reported lower mastery. Similar pattern of differences concerning disease activity and self-esteem was found mainly in the established group. Conclusions: The study shows that the level of perceived restrictions in social participation are highly relevant regarding the disease related variables such as pain, fatigue and functional disability as well as psychological status and personal resources in both early and established RA. Implications for Rehabilitation Supporting involvement and participation of individuals with rheumatoid arthritis is important for decreasing the impact of RA symptoms on everyday life. Recognition and empowerment of individual resources such a mastery and self-esteem of RA patients could be beneficial for overcoming restrictions in participation. Keywords: Anxiety, depression, functional disability, participation, rheumatoid arthriti

Social support and psychological distress in rheumatoid arthritis: a 4-year prospective study

Introduction: The objective of the study was to investigate the course of psychological distress in early rheumatoid arthritis patients and to explore the strength of its associations with disease-related variables over time. A further aim focused specifically on the associations between social support and psychological distress. Methods: The study had a longitudinal design, with four annual measurements over consecutive years. The course and stability of psychological distress on the individual level were investigated via test-retest correlation coefficients and changes over time were studied using the Friedman test for repeated measurements. Hierarchical regression analysis was performed to analyze the multilinear associations of disease activity, functional disability, joint tenderness, pain and social support with psychological distress. Results: Significant cross-sectional associations were found among functional disability, joint tenderness, pain, emotional support, instrumental support and psychological distress. However, after controlling for the erratic pattern of the disease and the relevant variables, only initial psychological distress and emotional support retained a significant relationship with psychological distress. The final regression model, in which functional disability, pain, emotional support and initial psychological distress were significant variables, explained 36% of the variance in psychological distress. Conclusion: The study stresses the importance of initial psychological distress, which was found to have the highest correlation with psychological distress experienced 4 years later. In addition, higher emotional support and lower pain were found to be the only variables independently associated with lower levels of psychological distress after controlling for the relevant variables

Social Participation and Health Related Quality of Life in Early and Established Rheumatoid Arthritis Patients

Social participation has been recognized as one of the key variables to be addressed in disability research yet few studies addressed the association between restriction in participation and quality of life in the context of rheumatoid arthritis. The aim of this study was to explore the associations between restrictions in social participation and health related quality of life (HRQoL) in early and established group of rheumatoid arthritis (RA) patients. Two samples with early (n = 97; age = 53 +/- 12.3 years; disease duration = 2.8 +/- 1.2 years; 76 % women) and established (n = 143; age = 58 +/- 10.3 years; disease duration = 16.1 +/- 3.6 years; 86 % women) RA patients were collected. Respondents completed questionnaires on pain (NHP), fatigue (VAS), functional disability (HAQ), depression (HADS), social participation restrictions (Participation scale) and health related quality of life (SF-36). Data were analyzed using stepwise regression models controlling for the relevant variables. Perceived social participation restrictions in the group of early patients were found to be negatively associated with the mental health component of the HRQoL (beta = -0.192; p a parts per thousand currency sign 0.05) and in the established RA group with the physical health component of the HRQoL (beta = -0.271; p a parts per thousand currency sign 0.001). These results generally suggest the importance of social participation with regard to HRQoL in RA

A Combination of CD28 (rs1980422) and IRF5 (rs10488631) Polymorphisms Is Associated with Seropositivity in Rheumatoid Arthritis: A Case Control Study.

INTRODUCTION:The aim of the study was to analyse genetic architecture of RA by utilizing multiparametric statistical methods such as linear discriminant analysis (LDA) and redundancy analysis (RDA). METHODS:A total of 1393 volunteers, 499 patients with RA and 894 healthy controls were included in the study. The presence of shared epitope (SE) in HLA-DRB1 and 11 SNPs (PTPN22 C/T (rs2476601), STAT4 G/T (rs7574865), CTLA4 A/G (rs3087243), TRAF1/C5 A/G (rs3761847), IRF5 T/C (rs10488631), TNFAIP3 C/T (rs5029937), AFF3 A/T (rs11676922), PADI4 C/T (rs2240340), CD28 T/C (rs1980422), CSK G/A (rs34933034) and FCGR3A A/C (rs396991), rheumatoid factor (RF), anti-citrullinated protein antibodies (ACPA) and clinical status was analysed using the LDA and RDA. RESULTS:HLA-DRB1, PTPN22, STAT4, IRF5 and PADI4 significantly discriminated between RA patients and healthy controls in LDA. The correlation between RA diagnosis and the explanatory variables in the model was 0.328 (Trace = 0.107; F = 13.715; P = 0.0002). The risk variants of IRF5 and CD28 genes were found to be common determinants for seropositivity in RDA, while positivity of RF alone was associated with the CTLA4 risk variant in heterozygous form. The correlation between serologic status and genetic determinants on the 1st ordinal axis was 0.468, and 0.145 on the 2nd one (Trace = 0.179; F = 6.135; P = 0.001). The risk alleles in AFF3 gene together with the presence of ACPA were associated with higher clinical severity of RA. CONCLUSIONS:The association among multiple risk variants related to T cell receptor signalling with seropositivity may play an important role in distinct clinical phenotypes of RA. Our study demonstrates that multiparametric analyses represent a powerful tool for investigation of mutual relationships of potential risk factors in complex diseases such as RA

SNPs associated with seropositivity in RA.

<p>Redundancy discrimination analysis plot showing that IRF5, CD28 and CTLA4 are associated with seropositivity in RA patients. RF+–rheumatoid factor positive RA patients; RF-–rheumatoid factor negative RA patients; ACPA+–anti-citrullinated peptides antibodies positive RA patients; ACPA-–anti-citrullinated peptides antibodies negative RA patients; SE (0,1,2)—number of shared epitope coding alleles in HLA-DRB1 gene (✧); IRF5 (CC, CT, TT)—genotypes in IRF5 gene (C risk allele) (▷); CD28 (CC, CT, TT)–genotypes in CD28 gene (C risk allele) (◁); CTLA4 (AG, GG, AA)–genotypes in CTLA4 gene (G risk allele) (◊). Diagram reading clue: Symbols are genetic factors. Large bold symbols represent genotypes significantly influencing the presence of RF and ACPA. Small empty symbols represent other genotypes of selected genes. Direction of arrow indicates which serologic status is associated with the genetic parameters and the length of the arrow indicates the magnitude of the association.</p

The challenge of implementing Less is More medicine: A European perspective

The concept of Less is More medicine emerged in North America in 2010. It aims to serve as an invitation to recognize the potential risks of overuse of medical care that may result in harm rather than in better health, tackling the erroneous assumption that more care is always better. In response, several medical societies across the world launched quality-driven campaigns ("Choosing Wisely") and published "top-five lists" of low-value medical interventions that should be used to help make wise decisions in each clinical domain, by engaging patients in conversations about unnecessary tests, treatments and procedures. However, barriers and challenges for the implementation of Less is More medicine have been identified in several European countries, where overuse is rooted in the culture and demanded by a society that requests certainty at almost any cost. Patients' high expectations, physician's behavior, lack of monitoring and pernicious financial incentives have all indirect negative consequences for medical overuse. Multiple interventions and quality-measurement efforts are necessary to widely implement Less is More recommendations. These also consist of a top-five list of actions: (1) a novel cultural approach starting from medical graduation courses, up to (2) patient and society education, (3) physician behavior change with data feedback, (4) communication training and (5) policy maker interventions. In contrast with the prevailing maximization of care, the optimization of care promoted by Less is More medicine can be an intellectual challenge but also a real opportunity to promote sustainable medicine. This project will constitute part of the future agenda of the European Federation of Internal Medicine