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Having More Tender Than Swollen Joints Worsens Outcomes in Early Rheumatoid Arthritis
TOPLINE:
Having more tender than swollen joints is linked to worse patient-reported outcomes (PROs), particularly in pain interference, social participation, and fatigue, in patients with rheumatoid arthritis (RA).
METHODOLOGY:
- In early RA, understanding the impact of tender-swollen joint differences (TSJDs) on PROs across multiple domains of health-related quality of life is important to customize personalized therapeutic strategies.
- This study evaluated the impact of TSJDs on PROs over 1 year in 547 patients (mean age, 56 years; 70% women; mean symptom duration, 5.3 months) with early RA across 18 centers in Canada between January 2016 and August 2022.
- TSJDs were assessed for 28 joints (six large and 22 small) at baseline and at 3-, 6-, and 12-month visits using the PRO Measurement Information System (PROMIS-29), covering seven domains of health. Higher PROMIS T-scores indicated better health outcomes.
TAKEAWAY:
- A one-point increase of TSJD was significantly associated with worse PROMIS T-scores in physical function (adjusted regression coefficient [β], −0.27; 95% CI, −0.39 to −0.15) and social participation (β, −0.34; 95% CI, −0.50 to −0.19).
- A one-point increase in TSJD was also linked to worsened PROMIS symptoms in pain interference (β, 0.49), fatigue (β, 0.34), sleep problems (β, 0.29), anxiety (β, 0.23), and depression (β, 0.20).
- Large-joint TSJD was particularly associated with worse PROs than small-joint TSJD.
- The sensitivity analysis validated the reliability of the primary findings regarding the association between joint counts and PROs evaluated by PROMIS-29, even when accounting for C-reactive protein levels in various scenarios or assumptions.
IN PRACTICE:
“Patients with more tender than swollen joints may experience worsening of all seven domains of health, especially pain interference, social participation, and fatigue. Rheumatologists should be alerted to their patients with early RA having more tender than swollen joints, particularly in large joints,” the authors wrote.
SOURCE:
The study was led by Charis F. Meng, MD, Division of Rheumatology, Hospital for Special Surgery, New York. It was published online on May 1, 2024, in Journal of Clinical Rheumatology.
LIMITATIONS:
The study was observational with missing data, which could have impacted the reliability of the results. Most participants were women and White individuals, which could restrict the generalizability of results. The absence of ultrasound for synovitis limited the clinical assessment of patients with RA for information beyond physical examination alone.
DISCLOSURES:
The study was supported and funded by the Inflammatory Arthritis Center and Division of Rheumatology at the Hospital for Special Surgery, New York. One author reported receiving funding from the National Institutes of Health.
A version of this article appeared on Medscape.com.
TOPLINE:
Having more tender than swollen joints is linked to worse patient-reported outcomes (PROs), particularly in pain interference, social participation, and fatigue, in patients with rheumatoid arthritis (RA).
METHODOLOGY:
- In early RA, understanding the impact of tender-swollen joint differences (TSJDs) on PROs across multiple domains of health-related quality of life is important to customize personalized therapeutic strategies.
- This study evaluated the impact of TSJDs on PROs over 1 year in 547 patients (mean age, 56 years; 70% women; mean symptom duration, 5.3 months) with early RA across 18 centers in Canada between January 2016 and August 2022.
- TSJDs were assessed for 28 joints (six large and 22 small) at baseline and at 3-, 6-, and 12-month visits using the PRO Measurement Information System (PROMIS-29), covering seven domains of health. Higher PROMIS T-scores indicated better health outcomes.
TAKEAWAY:
- A one-point increase of TSJD was significantly associated with worse PROMIS T-scores in physical function (adjusted regression coefficient [β], −0.27; 95% CI, −0.39 to −0.15) and social participation (β, −0.34; 95% CI, −0.50 to −0.19).
- A one-point increase in TSJD was also linked to worsened PROMIS symptoms in pain interference (β, 0.49), fatigue (β, 0.34), sleep problems (β, 0.29), anxiety (β, 0.23), and depression (β, 0.20).
- Large-joint TSJD was particularly associated with worse PROs than small-joint TSJD.
- The sensitivity analysis validated the reliability of the primary findings regarding the association between joint counts and PROs evaluated by PROMIS-29, even when accounting for C-reactive protein levels in various scenarios or assumptions.
IN PRACTICE:
“Patients with more tender than swollen joints may experience worsening of all seven domains of health, especially pain interference, social participation, and fatigue. Rheumatologists should be alerted to their patients with early RA having more tender than swollen joints, particularly in large joints,” the authors wrote.
SOURCE:
The study was led by Charis F. Meng, MD, Division of Rheumatology, Hospital for Special Surgery, New York. It was published online on May 1, 2024, in Journal of Clinical Rheumatology.
LIMITATIONS:
The study was observational with missing data, which could have impacted the reliability of the results. Most participants were women and White individuals, which could restrict the generalizability of results. The absence of ultrasound for synovitis limited the clinical assessment of patients with RA for information beyond physical examination alone.
DISCLOSURES:
The study was supported and funded by the Inflammatory Arthritis Center and Division of Rheumatology at the Hospital for Special Surgery, New York. One author reported receiving funding from the National Institutes of Health.
A version of this article appeared on Medscape.com.
TOPLINE:
Having more tender than swollen joints is linked to worse patient-reported outcomes (PROs), particularly in pain interference, social participation, and fatigue, in patients with rheumatoid arthritis (RA).
METHODOLOGY:
- In early RA, understanding the impact of tender-swollen joint differences (TSJDs) on PROs across multiple domains of health-related quality of life is important to customize personalized therapeutic strategies.
- This study evaluated the impact of TSJDs on PROs over 1 year in 547 patients (mean age, 56 years; 70% women; mean symptom duration, 5.3 months) with early RA across 18 centers in Canada between January 2016 and August 2022.
- TSJDs were assessed for 28 joints (six large and 22 small) at baseline and at 3-, 6-, and 12-month visits using the PRO Measurement Information System (PROMIS-29), covering seven domains of health. Higher PROMIS T-scores indicated better health outcomes.
TAKEAWAY:
- A one-point increase of TSJD was significantly associated with worse PROMIS T-scores in physical function (adjusted regression coefficient [β], −0.27; 95% CI, −0.39 to −0.15) and social participation (β, −0.34; 95% CI, −0.50 to −0.19).
- A one-point increase in TSJD was also linked to worsened PROMIS symptoms in pain interference (β, 0.49), fatigue (β, 0.34), sleep problems (β, 0.29), anxiety (β, 0.23), and depression (β, 0.20).
- Large-joint TSJD was particularly associated with worse PROs than small-joint TSJD.
- The sensitivity analysis validated the reliability of the primary findings regarding the association between joint counts and PROs evaluated by PROMIS-29, even when accounting for C-reactive protein levels in various scenarios or assumptions.
IN PRACTICE:
“Patients with more tender than swollen joints may experience worsening of all seven domains of health, especially pain interference, social participation, and fatigue. Rheumatologists should be alerted to their patients with early RA having more tender than swollen joints, particularly in large joints,” the authors wrote.
SOURCE:
The study was led by Charis F. Meng, MD, Division of Rheumatology, Hospital for Special Surgery, New York. It was published online on May 1, 2024, in Journal of Clinical Rheumatology.
LIMITATIONS:
The study was observational with missing data, which could have impacted the reliability of the results. Most participants were women and White individuals, which could restrict the generalizability of results. The absence of ultrasound for synovitis limited the clinical assessment of patients with RA for information beyond physical examination alone.
DISCLOSURES:
The study was supported and funded by the Inflammatory Arthritis Center and Division of Rheumatology at the Hospital for Special Surgery, New York. One author reported receiving funding from the National Institutes of Health.
A version of this article appeared on Medscape.com.
Eating More Vegetables Improves Glucose Tolerance
TOPLINE:
A diet rich in green, leafy, cruciferous, and colorful vegetables may improve glucose tolerance and insulin sensitivity, whereas a high intake of potato fries or chips may worsen these outcomes, an Australian study shows.
METHODOLOGY:
- Researchers assessed the association between the intake of vegetables and potatoes with markers of type 2 diabetes (T2D) in 8009 participants (median age, 52 years; 55% women) from the Australian Diabetes, Obesity, and Lifestyle Study.
- A self-administered 74-item food frequency questionnaire was used to assess participants’ eating habits over 12 months prior to baseline.
- Participants were categorized into four quartiles of vegetable intake, from the highest intake (Q4) to the lowest intake (Q1).
- The association between vegetable intake and various metabolic markers such as fasting plasma glucose (FPG), 2-hour post-load plasma glucose, updated homeostasis model assessment of beta cell function (HOMA2-%beta), HOMA2 of insulin sensitivity (HOMA2-%S), and fasting insulin were evaluated over a 12-year follow-up period.
TAKEAWAY:
- The post-load glucose was 3% lower in participants in the highest vs lowest quartile of total vegetable intake (ratio of means [RoM], 0.97; 95% CI, 0.96-0.99).
- Post-load glucose was 4% lower (RoM, 0.96; 95% CI, 0.95-0.98), HOMA2-%beta was 3% lower (RoM, 0.97; 95% CI, 0.96-0.99), and serum insulin was 5% lower (RoM, 0.95; 95% CI, 0.93-0.98) in those in the highest vs lowest quartile of green leafy vegetable intake.
- Those in the highest vs lowest quartile of potato fries or chips intake had 1% higher FPG, 3% higher HOMA2-%beta, and 8% higher serum insulin but 6% lower HOMA2-%S, revealing a negative impact on glucose tolerance and insulin sensitivity.
- The risk for T2D over 12 years was 26% and 25% lower among those in the highest and moderate quartiles of cruciferous vegetable intake, respectively, than among those in the lowest quartile of cruciferous vegetable intake.
IN PRACTICE:
The authors wrote that their study “sheds light on the physiological alterations in insulin regulation and glucose tolerance resulting from higher vegetable and subgroups of vegetable intake and supports the notion that vegetable subgroups may act differently in regulating insulin and blood glucose levels.”
SOURCE:
The study was led by Pratik Pokharel, MPH, Nutrition & Health Innovation Research Institute, School of Medical and Health Sciences, Edith Cowan University, Perth, Australia, and was published online in The Journal of Clinical Endocrinology & Metabolism.
LIMITATIONS:
The study’s observational nature precluded the inference of causality. Potential measurement errors in dietary exposures and recall bias linked to the food frequency questionnaire could have affected the findings. The overrepresentation of participants from higher education and socioeconomic subgroups and loss to follow-up could limit the generalizability of the findings.
DISCLOSURES:
The study was funded by the National Health and Medical Research Council, National Heart Foundation of Australia, and Royal Perth Hospital Medical Research Foundation. Several authors reported receiving grants from various sources during the conduct of this study. The other authors reported no conflicts of interest.
A version of this article appeared on Medscape.com.
TOPLINE:
A diet rich in green, leafy, cruciferous, and colorful vegetables may improve glucose tolerance and insulin sensitivity, whereas a high intake of potato fries or chips may worsen these outcomes, an Australian study shows.
METHODOLOGY:
- Researchers assessed the association between the intake of vegetables and potatoes with markers of type 2 diabetes (T2D) in 8009 participants (median age, 52 years; 55% women) from the Australian Diabetes, Obesity, and Lifestyle Study.
- A self-administered 74-item food frequency questionnaire was used to assess participants’ eating habits over 12 months prior to baseline.
- Participants were categorized into four quartiles of vegetable intake, from the highest intake (Q4) to the lowest intake (Q1).
- The association between vegetable intake and various metabolic markers such as fasting plasma glucose (FPG), 2-hour post-load plasma glucose, updated homeostasis model assessment of beta cell function (HOMA2-%beta), HOMA2 of insulin sensitivity (HOMA2-%S), and fasting insulin were evaluated over a 12-year follow-up period.
TAKEAWAY:
- The post-load glucose was 3% lower in participants in the highest vs lowest quartile of total vegetable intake (ratio of means [RoM], 0.97; 95% CI, 0.96-0.99).
- Post-load glucose was 4% lower (RoM, 0.96; 95% CI, 0.95-0.98), HOMA2-%beta was 3% lower (RoM, 0.97; 95% CI, 0.96-0.99), and serum insulin was 5% lower (RoM, 0.95; 95% CI, 0.93-0.98) in those in the highest vs lowest quartile of green leafy vegetable intake.
- Those in the highest vs lowest quartile of potato fries or chips intake had 1% higher FPG, 3% higher HOMA2-%beta, and 8% higher serum insulin but 6% lower HOMA2-%S, revealing a negative impact on glucose tolerance and insulin sensitivity.
- The risk for T2D over 12 years was 26% and 25% lower among those in the highest and moderate quartiles of cruciferous vegetable intake, respectively, than among those in the lowest quartile of cruciferous vegetable intake.
IN PRACTICE:
The authors wrote that their study “sheds light on the physiological alterations in insulin regulation and glucose tolerance resulting from higher vegetable and subgroups of vegetable intake and supports the notion that vegetable subgroups may act differently in regulating insulin and blood glucose levels.”
SOURCE:
The study was led by Pratik Pokharel, MPH, Nutrition & Health Innovation Research Institute, School of Medical and Health Sciences, Edith Cowan University, Perth, Australia, and was published online in The Journal of Clinical Endocrinology & Metabolism.
LIMITATIONS:
The study’s observational nature precluded the inference of causality. Potential measurement errors in dietary exposures and recall bias linked to the food frequency questionnaire could have affected the findings. The overrepresentation of participants from higher education and socioeconomic subgroups and loss to follow-up could limit the generalizability of the findings.
DISCLOSURES:
The study was funded by the National Health and Medical Research Council, National Heart Foundation of Australia, and Royal Perth Hospital Medical Research Foundation. Several authors reported receiving grants from various sources during the conduct of this study. The other authors reported no conflicts of interest.
A version of this article appeared on Medscape.com.
TOPLINE:
A diet rich in green, leafy, cruciferous, and colorful vegetables may improve glucose tolerance and insulin sensitivity, whereas a high intake of potato fries or chips may worsen these outcomes, an Australian study shows.
METHODOLOGY:
- Researchers assessed the association between the intake of vegetables and potatoes with markers of type 2 diabetes (T2D) in 8009 participants (median age, 52 years; 55% women) from the Australian Diabetes, Obesity, and Lifestyle Study.
- A self-administered 74-item food frequency questionnaire was used to assess participants’ eating habits over 12 months prior to baseline.
- Participants were categorized into four quartiles of vegetable intake, from the highest intake (Q4) to the lowest intake (Q1).
- The association between vegetable intake and various metabolic markers such as fasting plasma glucose (FPG), 2-hour post-load plasma glucose, updated homeostasis model assessment of beta cell function (HOMA2-%beta), HOMA2 of insulin sensitivity (HOMA2-%S), and fasting insulin were evaluated over a 12-year follow-up period.
TAKEAWAY:
- The post-load glucose was 3% lower in participants in the highest vs lowest quartile of total vegetable intake (ratio of means [RoM], 0.97; 95% CI, 0.96-0.99).
- Post-load glucose was 4% lower (RoM, 0.96; 95% CI, 0.95-0.98), HOMA2-%beta was 3% lower (RoM, 0.97; 95% CI, 0.96-0.99), and serum insulin was 5% lower (RoM, 0.95; 95% CI, 0.93-0.98) in those in the highest vs lowest quartile of green leafy vegetable intake.
- Those in the highest vs lowest quartile of potato fries or chips intake had 1% higher FPG, 3% higher HOMA2-%beta, and 8% higher serum insulin but 6% lower HOMA2-%S, revealing a negative impact on glucose tolerance and insulin sensitivity.
- The risk for T2D over 12 years was 26% and 25% lower among those in the highest and moderate quartiles of cruciferous vegetable intake, respectively, than among those in the lowest quartile of cruciferous vegetable intake.
IN PRACTICE:
The authors wrote that their study “sheds light on the physiological alterations in insulin regulation and glucose tolerance resulting from higher vegetable and subgroups of vegetable intake and supports the notion that vegetable subgroups may act differently in regulating insulin and blood glucose levels.”
SOURCE:
The study was led by Pratik Pokharel, MPH, Nutrition & Health Innovation Research Institute, School of Medical and Health Sciences, Edith Cowan University, Perth, Australia, and was published online in The Journal of Clinical Endocrinology & Metabolism.
LIMITATIONS:
The study’s observational nature precluded the inference of causality. Potential measurement errors in dietary exposures and recall bias linked to the food frequency questionnaire could have affected the findings. The overrepresentation of participants from higher education and socioeconomic subgroups and loss to follow-up could limit the generalizability of the findings.
DISCLOSURES:
The study was funded by the National Health and Medical Research Council, National Heart Foundation of Australia, and Royal Perth Hospital Medical Research Foundation. Several authors reported receiving grants from various sources during the conduct of this study. The other authors reported no conflicts of interest.
A version of this article appeared on Medscape.com.