AimWe aimed to explore the meaning of obesity in elderly persons with knee osteoarthritis (KO) and to determine the factors that encourage or discourage weight loss.BackgroundVarious studies have demonstrated that body mass index is related to KO and that weight loss improves symptoms and functional capacity. However, dietary habits are difficult to modify and most education programs are ineffective.DesignA phenomenological qualitative study was conducted. Intentional sampling was performed in ten older persons with KO who had lost weight and improved their health-related quality of life after participating in a health education program. A thematic content analysis was conducted following the stages proposed by Miles and Huberman.FindingsParticipants understood obesity as a risk factor for health problems and stigma. They believed that the cause of obesity was multifactorial and criticized health professionals for labeling them as “obese” and for assigning a moral value to slimness and diet. The factors identified as contributing to the effectiveness of the program were a tolerant attitude among health professionals, group education that encouraged motivation, quantitative dietary recommendations, and a meaningful learning model based on social learning theories.ConclusionDietary self-management without prohibitions helped participants to make changes in the quantity and timing of some food intake and to lose weight without sacrificing some foods that were deeply rooted in their culture and preferences. Dietary education programs should focus on health-related quality of life and include scientific knowledge but should also consider affective factors and the problems perceived as priorities by patients.
Background:Since the publication of 2010 ACR/ELUAR classification criteria for Rheumatoid Arthritis (RA), identification of patients with RA at early stages of the disease has improved. Nevertheless, up to 56% of patients are diagnosed with undifferentiated arthritis (UA) at the first visit to Rheumatology Departments, of which about 20-30% will progress to RA. For this reason, Early Arthritis Clinics (EAC) have been progressively implemented in Rheumatology departments in order to identify and have a tight follow-up of these patients.Objectives:a) To analyze the progression rate from UA to RA in a cohort of EAC. b) To identify differences in clinical features at baseline that characterize the progression to RA of these patients.Methods:Prospective study from a cohort of EAC between 2010 and 2018. Patients diagnosed with UA at first consultation were included and with a follow-up of 2-years. Final diagnosis was assessed at the end of study period defining two groups: RA progression (RA-group) vs no progression (non-RA-group).Baseline characteristics were recorded for both groups: sex, age, smoking habit, duration of symptoms, morning stiffness, tender joint count (TJC), swollen joint count (SJC), Rheumatoid Factor (RF), Anti-Citrullinated-Peptide-Antibodies (ACPA), DAS-28, erythrocyte sedimentation rate (ESR), C-Reactive Protein (CRP), Pain visual analogue scale (VAS). Differences in sociodemographic, clinical and serological features between groups were analyzed using T-test, chi-square test and U-Mann Whitney depending on the nature of variables.Results:A total of 228 patients with UA were included, of which 54 (23,3%) progressed to RA (patients characteristics are shown in table 1). Regarding serological characterization, we found that in our cohort, 44.4% of patients who developed RA had FR and ACPA positivity, 13% RF positive, 7.4% ACPA positive. In contrast 35% patients were seronegative. From non-RA group, 73% of patients were seronegative, 18% RF positive, 4.5% ACPA positive and 4.5% double positive.Table 1.VariableTotal (n=228)RA (n=54)Non-RA (n=174)p-valueFemale sex n(%)165 (71.7)42 (77.8)121 (69.5)0.31*Age (mean SD)51.47 (16.46)52.9 (16.15)51.26 (16.61)0.53§Smoking habit n (%)0.12*-smokers49 (21.2)14 (25.9)33 (19)-exsmokers52 (22.5)15 (27.8)37 (21.3)-non-smokers113 (48.9)19 (35.2)93 (53.4)Duration of symptoms (weeks) (median IQR)8 (4-19)12 (8-24)8 (4-16)0.006¶Morning stiffnes >60min n (%)53 (22.9)15 (27.8)38 (21.8)0.26*Patient health assessment (meadian IQR)39 (16-68)58 (22-75)34 (14-64)0.01¶Pain (VAS) (median IQR)45 (18-68.2)54 (30-71)39 (14.5-67.5)0.02¶Tender Joint Count (median IQR)2 (1-6)4 (1-9)2 (1-6)0.04¶Swollen Joint Count (median IQR)2 (1-4)3 (1-6)2 (1-4)0.01¶Baseline DAS28 (mean SD)3.97 (1.39)4.44 (1.54)3.82 (1.33)0.006§HAQ (median IQR)0.75 (0.25-1.5)1.12 (0.37-1.56)0.62 (0.12-1.37)0.06¶CRP(mean SD)2.2 (8.01)1.39 (3.25)2.3 (8.9)0.44§ESR (mean SD)23.74 (19.5)24.62 (16.22)22.8 (19.3)0.54§RF n (%)70 (30.3)31 (57.4)39 (22.4)<0.001*ACPA n (%)44 (19)28 (51.9)16 (9.2)<0.001*No differences between age at onset, sex an smoking habit were found. Duration of symptoms until first visit to Rheumatology Department was longer RA-group. Regarding joint involvement, TCJ and SCJ were higher in RA-group at baseline and also VAS pain and patients´global health assessment.Conclusion:One out of four patients diagnosed with early UA are at risk of RA development within the following 2 years. This fact implies that these patients benefit from EAC in order to have a tight control of the disease and have the chance of starting treatment as soon as possible.References:Combe B et al. 2016 update of the EULAR recommendations for the management of early arthritis. Ann Rheum Dis 2017;76:948-959.van Steenbergen HW et al. Preventing progression from arthralgia to arthritis: targeting the right patients. Nat Rev Rheumatol. 2018 Jan;14(1):32-41.Disclosure of Interests:None declared
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