Association between sarcopenia, physical performance and falls in patients with rheumatoid arthritis: a 1-year prospective study

Background: Patients with rheumatoid arthritis (RA) are at increased risk of falls and fractures. Sarcopenia occurs more frequently in RA patients due to the inflammatory processes. Early diagnosis and prevention programmes are essential to avoid serious complications. The present study aims to identify risk factors for falls related to sarcopenia and physical performance. Methods: In a 1-year prospective study, a total of 289 patients with RA, ages 24-85 years, were followed using quarterly fall diaries to report falls. At the baseline, medical data such as RA disease duration and Disease Activity Score (DAS28(CRP)) were collected. Self-reported disability was assessed using the Health Assessment Questionnaire (HAQ). Appendicular skeletal mass was determined by Dual X-ray-Absorptiometry (DXA). Physical performance was evaluated by handgrip strength, gait speed, chair rise test, Short Physical Performance Battery, and FICSIT-4. Muscle mechanography was measured with the Leonardo Mechanograph (R). Sarcopenia was assessed according to established definitions by the European Working Group on Sarcopenia in Older People (EWGSOP2) and The Foundation for the National Institutes of Health (FNIH). Univariate and multiple logistic regression analysis were used to explore associations with falling. Receiver-operating characteristics (ROC) were performed, and the area under the curve is reported. Results: A total of 238 subjects with RA completed the 1-year follow-up, 48 (20.2%) experienced at least one fall during the observational period. No association was found between sarcopenia and prospective falls. Age (OR = 1.04, CI 1.01-1.07), HAQ (OR = 1.62, 1.1-2.38), and low FICSIT-4 score (OR = 2.38, 1.13-5.0) showed significant associations with falls. Conclusions: In clinical practice, a fall assessment including age, self-reported activities of daily life and a physical performance measure can identify RA patients at risk of falling

Bodenreaktionskräfte bei Kindern mit Cerebralparese vor und nach selektiver dorsaler Rhizotomie

Background: Cerebral palsy (CP) results from an infant brain damage and displays one of the most common reasons for physical impairment in children. It is therefore of major importance for the daily mobility and overall quality of life of these children, to continuously optimize current treatment options that improve motor function. Selective dorsal rhizotomy (SDR) is an invasive neurosurgical approach aiming to reduce spasticity of the lower extremities through the selective sectioning of afferent sensory spinal nerve rootlets. In order to detect gait pathologies and validate therapeutic outcomes, instrumented gait analysis has been proven to be a renowned tool. However, the influence of SDR on ground reaction forces (GRF), examining force curves over time during forward movement, has not been evaluated in CP children yet. Patients and methods: Within prospective 3D gait analysis force platform data of 24 ambulatory children with bilateral spastic CP (15 female, 9 male; mean age at SDR 6.4 ± 1.4 years, GMFCS Level I-III) were collected preoperatively and 12 months post SDR. Analysis of data was performed retrospectively. Besides, we assessed an age-matched lab standard of 11 typically developing children (TDC; 6 female, 5 male; mean age 6.4 ± 1.8 years). Results: CP children showed significant changes in GRF parameters 12 months post SDR. The first peak of the vertical GRF (Fz1) occurred significantly later in % stance phase post SDR (p=0.027). In the anterior-posterior (a.p.) direction, the decelerating (p=0.007) and accelerating (p=0.049) peak forces as well as the decelerating impulse (p=0.001) increased, comparing pre- to postoperative values. The a.p. net impulse decreased towards zero (p=0.034) post SDR. In addition, the postoperative results of the CP children tended to approach the results of TDC. Conclusion: In conclusion, this study shows a positive influence of SDR on several vertical and a.p. GRF parameters in CP children 12 months post SDR. These changes indicate improvements in gait stability and control as well as a more efficient forward movement.Hintergrund: Die infantile Cerebralparese (CP) basiert auf einer frühkindlichen Hirnschädigung und stellt eine der häufigsten Ursachen für körperliche Behinderung im Kindesalter dar. Die Optimierung der vielfältigen Therapieansätze zur Verbesserung der motorischen Funktion ist von großer Bedeutung für die Mobilität und Lebensqualität der Kinder. Die selektive dorsale Rhizotomie (SDR) ist ein neurochirurgisches Verfahren, bei welchem durch selektive Durchtrennung afferenter sensorischer Nervenfasern die funktionseinschränkende Spastik reduziert wird. Die instrumentierte 3D-Ganganalyse eignet sich einerseits zur Objektivierung von Gangpathologien, andererseits zur Überprüfung der Wirksamkeit von therapeutischen Interventionen auf das Gangbild. Ein potentieller Effekt der SDR bei Kindern mit CP auf die Bodenreaktionskräfte, die eine Aussage über den Kraft-Zeit-Verlauf während der Vorwärtsbewegung erlauben, wurde bislang noch nicht untersucht. Patienten und Methoden: In einer Kohorte von 24 gehfähigen Kindern mit bilateral spastischer CP (15 weiblich, 9 männlich, mittleres Alter zum Zeitpunkt der SDR 6,4 ± 1,4 Jahre, GMFCS Level I-III) wurden mittels 3D-Ganganalyse die Bodenreaktionskräfte präoperativ und 12 Monate post-SDR untersucht. Die Datenerhebung erfolgte prospektiv, die Datenauswertung retrospektiv. Zur Etablierung eines Laborstandards wurden 11 typisch entwickelte Kinder (TDC, 6 weiblich, 5 männlich, mittleres Alter 6,4 ± 1,8 Jahre) untersucht. Ergebnisse: Die Kinder mit CP zeigten 12 Monate post-SDR signifikante Änderungen der Bodenreaktionskräfte. Der erste Ausschlag der vertikalen Bodenreaktionskraft (Fz1) trat in der Standphase zeitlich später auf als prä-SDR (p=0,027). In anterior-posteriorer (a.p.) Richtung nahmen die maximale Brems- (p=0,007) und Propulsionskraft (p=0,049), sowie der Bremsimpuls (p=0,001) im prä- zum postoperativen Vergleich zu. Der a.p. Netto-Impuls verschob sich postoperativ in Richtung Null (p=0,034). Zudem kam es post-SDR tendenziell zu einer Annäherung der Werte an den Laborstandard der TDC. Schlussfolgerung: Zusammenfassend zeigte sich bei Kindern mit CP 12 Monate post-SDR ein positiver Einfluss auf verschiedene Bodenreaktionskraft-Parameter in der vertikalen und a.p. Richtung. Diese Veränderungen sprechen für eine verbesserte Gangstabilität und -kontrolle sowie eine effizientere Vorwärtsbewegung

Balance and prospective falls in patients with rheumatoid arthritis

Background Postural control is associated with fall risk. Patients with rheumatoid arthritis (RA) have a higher risk to fall than healthy subjects. The objective of this study was to identify associations between variables of postural control with prospective falls in patients with RA. Methods For the baseline, the balance performance of 289 men and women with RA, ages 24–85 years, was evaluated by SPPB, FICSIT-4 and Romberg tests. Postural sway for Romberg, semitandem, tandem and one-leg stands were measured with the Leonardo Mechanograph®. Self-reported disability was assessed using the Health Assessment Questionnaire (HAQ) and the Activity-specific Balance Confidence Scale (ABC-scale). Falls were reported in quarterly reports over a year. Univariate and multiple logistic regression analysis were used to explore any associations with falling. Receiver-operating characteristics were determined, and the area under the curve is reported. Results A total of 238 subjects completed the 1-year follow-up, 48 (20.2%) experienced at least one fall during the observational period. Age (OR = 1.04, CI 1.01–1.07), HAQ (OR = 1.62, 1.1–2.38), FICSIT-4 scoring 0–4 (OR = 2.38, 1.13–5.0), and one-leg standing (OR = 2.14, 1.06–4.31) showed significant associations with falls. With regard to the SPPB and ABC-scale, no statistically significant associations with falls were found. The quartiles containing the worst results of medio-lateral sway of Romberg (OR = 2.63, CI 1.03–6.69), total sway of semitandem (OR = 3.07, CI 1.10–8.57) and tandem (OR = 2.86, CI 1.06–7.69), and area of sway of semitandem (OR = 2.80, CI 1.11–7.08) stands were associated with falls. Conclusions The assessment of a one-leg stand seems to be a good screening tool to discriminate between high and low risk of falls in RA patients in clinical practice. A low FICSIT-4 score and several sway parameters are important predictors of falls

Prevalence of sarcopenia in patients with rheumatoid arthritis using the revised EWGSOP2 and the FNIH definition

Objective In rheumatoid arthritis (RA), chronic inflammation can enhance the development of sarcopenia with a depletion of muscle mass, strength and performance. Currently, a consensus definition for sarcopenia and solid results for the prevalence of sarcopenia in patients with RA are lacking. Methods In this cross-sectional study, 289 patients ≥18 years with RA were recruited. Dual X-ray absorptiometry was performed to measure appendicular lean mass. Assessment of muscle function included grip strength, gait speed and chair rise time. Prevalence of sarcopenia was defined using the updated European Working Group on Sarcopenia in Older People (EWGSOP2) and the Foundation for the National Institutes of Health (FNIH) definition. In addition, the RA study population was compared with existing data of healthy controls (n=280). Results 4.5% of patients (59.4±11.3 years) and 0.4% of controls (62.9±11.9 years) were affected by sarcopenia according to the EWGSOP2 definition. Body weight (OR 0.92, 95% CI 0.86 to 0.97), body mass index (BMI) (OR 0.70, 95% CI 0.57 to 0.87), C reactive protein (CRP) (OR 1.05, 95% CI 1.01 to 1.10), disease duration (OR 1.08, 95% CI 1.02 to 1.36), current medication with glucocorticoids (OR 5.25, 95% CI 2.14 to 24.18), cumulative dose of prednisone equivalent (OR 1.04, 95% CI 1.02 to 1.05) and Health Assessment Questionnaire (HAQ) (OR 2.50, 95% CI 1.27 to 4.86) were associated with sarcopenia in patients with RA. In contrast, the prevalence was 2.8% in patients compared with 0.7% in controls when applying the FNIH definition, and body height (OR 0.75, 95% CI 0.64 to 0.88), BMI (OR 1.20, 95% CI 1.02 to 1.41), CRP (OR 1.06, 95% CI 1.01 to 1.11) and HAQ (OR 2.77, 95% CI 1.17 to 6.59) were associated with sarcopenia. Conclusion Sarcopenia is significantly more common in patients with RA compared with controls using the EWGSOP2 criteria. The FNIH definition revealed sarcopenia in individuals with high BMI and fat mass, regardless of the presence of RA. Trial registration number It was registered at the German Clinical Trials Registry (DRKS) as well as WHO Clinical Trials Registry (ICTRP) (DRKS00011873, registered on 16 March 2017)

Impact of specific immunotherapy and sting challenge on the quality of life in patients with hymenoptera venom allergy

Background: An experienced life-threating anaphylactic reaction to hymenoptera venom can sustainably impair patients’ quality of life (QoL). Besides carrying emergency medication, venom-specific immunotherapy (VIT) exists as a causal treatment of allergy. Objective: This study aimed to examine QoL, anxiety, depression, and physical and mental health in patients allergic to hymenoptera venom before and during VIT and the impact of a tolerated sting challenge (SC). Methods: Between July 2017 and August 2017, 142 patients with venom allergy were analyzed using validated questionnaires as the: Vespid Allergy Quality for Life Questionnaire" (VQLQ-d), the "Hospital Anxiety and Depression Scale" (HADS-D) and the "Short Form 36" (SF-36). To evaluate the impact of VIT and SC on the QoL, patients were divided into 3 groups: (A) VIT and tolerated SC (n = 45), (B) VIT before carrying out SC (n = 73), and (C) therapy-naïve before VIT (n = 20). Further parameters like gender, age, insect species, and severity of the anaphylactic reaction were assessed. Results: A significant correlation between the health-related QoL and the parameters of gender and state of treatment was seen. Especially male patients, as well as patients allergic to yellow jacket venom, benefit from a SC in terms of a significant increase in their QoL. In the total study cohort, a clear trend was observed towards a higher QoL in patients under VIT who tolerated a SC. Overall, neither the patients’ age nor the insect species exerted a relevant influence on QoL, depression or anxiety. However, women showed a lower QoL combined with higher anxiety and depression scores than men. Conclusion: Immunotherapy leads to an improved QoL, which can be further increased by a SC. A tolerated SC conceivably reassures the patients by objectifying the treatment success. Female patients appear to have a stronger impaired QoL per se. Taken together, a SC can be performed during VIT to strengthen the patients’ QoL