Obesity is a modifiable major cause of morbidity and mortality in the general population, but little is known about the association of obesity and quality of life in patients with rheumatoid arthritis (RA). Thus, we set out a study to test the hypothesis that obesity is independently associated with lower quality of life in patients with RA. Three hundred and fifty nine patients with RA underwent an interview, physical exam, and all clinical charts were reviewed. Based on body mass index (BMI), patients were classified as normal (BMI < 25 kg/m(2)), overweight (BMI = 25-29.9 kg/m(2)), and obese (BMI > or = 30 kg/m(2)). Quality of life was quantified with the Medical Outcomes Study Short Form 36 (SF-36). Data obtained included demographic variables, extra-articular disease, comorbidities, presence of X-ray erosions, rheumatoid factor, and depression. The association between obesity and quality of life was examined with the use of multiple lineal regression models. One hundred and seventy-two patients (47.9%) had normal BMI, 126 (35.1%) were overweight, and 61 patients (17%) were obese. Obese patients had lower quality of life (30.8 +/- 18.1) than overweight patients (43.3 +/- 20.1) and patients with normal weight (43.8 +/- 22.2), P < 0.001. The association between obesity and impaired quality of life was confirmed with a linear regression model (Coef = -12.9, P < 0.001) and remained significant after adjustment for age, sex, disease activity, extra-articular disease, comorbidities, X-ray erosions, presence of rheumatoid factor, depression, education, and disease duration (Coef = -5.3, P = 0.039). In conclusion, obesity is independently associated with the impaired quality of life in patients with rheumatoid arthritis.
Objective In this paper, we aim to define factors associated with health-related quality of life (HRQoL) in Mestizo patients with systemic lupus erythematosus (SLE). Methods We evaluated patients with SLE from Peru's two largest hospitals between October 2012 and July 2015 to ascertain HRQoL. Using a standard protocol, we incorporated demographic characteristics, clinical manifestations and treatment in our analysis. HRQoL was measured with the LupusQoL, disease activity was ascertained with the Systemic Lupus Erythematosus Disease Activity Index (SLEDAI), and damage was appraised with the Systemic Lupus International Collaborating Clinics (SLICC)/American College of Rheumatology (ACR) damage index (SDI). The associations between the LupusQoL and these variables were examined using linear regression models. Model selection was based on backward elimination. Results A total of 277 patients fit the inclusion criterion. Of these, 254 (91.7%) were female, the median (interquartile range, IQR) age at diagnosis was 41.5 (33.8-51.8) years, disease duration was 6.5 (2.7-11.3) years. The HRQoL domains most affected were the following: burden to others, fatigue, and intimate relationships. Through multivariate analysis, we determined that older age at diagnosis, higher disease activity, damage, and immunosuppressive drug use were negatively associated with HRQoL. Further, we found that higher socioeconomic status, disease duration, and antimalarial use were positively associated with HRQoL. Conclusion Age at diagnosis, disease activity, damage, and use of immunosuppressive drugs were negatively associated with HRQoL; high socioeconomic status, disease duration, and use of antimalarials were positively associated with HRQoL.
Infliximab es un medicamento efectivo en el tratamiento de pacientes con espondilitis anquilosante (EA) activa. Sin embargo, debido a su alto costo, su uso indiscriminado es prohibitivo. Objetivo: Evaluar si un régimen de inducción con infliximab es efectivo en pacientes con EA activa. Diseño: Sólo expuestos. Lugar: Servicio de Reumatología del Hospital Nacional Edgardo Rebagliati. Participantes: Pacientes con espondilitis anquilosante activa refractaria. Intervenciones: infliximab a las 0, 2 y 6 semanas. Un paciente recibió dosis de 3 mg/kg y los restantes 5 mg/kg de infliximab. Todos los pacientes continuaron recibiendo sulfasalazina. Principales medidas de resultados: Se determinó la proporción de pacientes que alcanzaron mejoría de acuerdo a los criterios ASAS 20, ASAS 40 y BASDAI 50, en la última evaluación (mediana de 55 semanas). Resultados: En la última evaluación, cinco pacientes (71,4%) presentaban respuesta ASAS 20 sostenida. Cuatro (57%) y tres (43%) de los pacientes alcanzaron BASDAI 50 y ASAS 40, respectivamente. Tres pacientes (43%) recayeron en un tiempo promedio de 26,6 semanas. No se observó efectos adversos serios. Conclusiones: La infusión de tres dosis de infliximab es efectiva para controlar la actividad de la enfermedad de los pacientes con EA refractaria a AINEs y en algunos pacientes controla la enfermedad por periodos prolongados de tiempo.
Objetivo: Evaluar la terapia con pamidronato, en pacientes con espondilitis anquilosante (EA) activa, con respuesta subóptima o falla a los antiinflamatorios no-esteroideos (AINES) y sulfasalazina. Diseño: Estudio clínico comparativo. Lugar: Hospital Nacional Edgardo Rebagliati Martins, EsSalud, Lima, Perú. Participantes: Pacientes con espondilitis anquilosante. Intervenciones. Se incluyó 9 pacientes con EA (6 varones), con enfermedad activa (BASDAI ≥4), actividad axial y falta de respuesta a los Aines y sulfasalazina a dosis de 3g/d. Todos los pacientes recibieron 60 mg de pamidronato mensual, en infusión endovenosa, durante 6 meses, y continuaron tomando AINES y sulfasalazina. La mejoría clínica fue evaluada usando el Asas 20. En forma secundaria se evaluó el ASAS 40, BASDAI 50, BASDAI, BASFI Y BASMI, a las 24 y 48 semanas (32 a 86 semanas). La diferencia entre el índice de pre y postratamiento fue evaluada usando la prueba de Wilcoxon. Principales medidas de resultados: Evaluación del ASAS 20. Resultados. El 67% alcanzó un Asas 20 a las 24 semanas y 78% a las 48 semanas; 33,3% y 55,6% tuvieron ASAS 40 y 33,3%; y 44,4% alcanzó BASDAI 50 a las 24 y 48 semanas, respectivamente. Un paciente recayó a la semana 20. Tres pacientes (33,3%) permanecieron sin cambios. A las 24 y 48 semanas, la media de BASDAI disminuyó en 45,1% (p=0,007) y en 52,1% (p=0,01), la media de BASFI en 38,2% (p=0,007) y en 52,3% (p=0,007), y la media de BASMI en 39,2% (p=0,01) y 39,2% (p=0,01), respectivamente. Los eventos adversos no fueron importantes con esta terapia. Conclusiones. El tratamiento con pamidronato demostró ser efectivo en este grupo de pacientes con EA, refractaria a AINES y a sulfasalazina.
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