Academic literature on the topic 'J (Locomotive)'

Background:Rheumatoid arthritis (RA) patients have a high frequency of sarcopenia, and they commonly have reduced physical function. We previously reported that the prevalence of sarcopenia was 28%, that of frailty was 18.9%, and that of pre-frailty was 38.9% in RA patients1,2, and 13.2% of RA patients developed sarcopenia within a year 3.Objectives:To investigate the risk factors for new onset of sarcopenia, locomotive syndrome, and frailty in patients with RA and the course of each disease.Methods:Two-year follow-up data from the rural group of the prospective, observational CHIKARA study were used. Sarcopenia was diagnosed using the criteria of the Asian Working Group for Sarcopenia 2014, locomotive syndrome was diagnosed using locomotive 5, and frailty was diagnosed using the basic checklist. New onset of the disease over the 2-year follow-up period was studied, excluding cases that had the disease at baseline. Improvement was defined as cases with disease at baseline that no longer met the diagnostic criteria after 2 years. Differences in the characteristics of each disease were tested using the Chi-squared test and the paired t-test.Results:The 81 patients with RA (82.7% female) had mean age 66.9±11.5 years, mean DAS28-ESR 2.9±1.2, methotrexate use in 81.5% (with a dose of 9.9±2.7 mg/week), and glucocorticoid (GC) use in 22.2% (with a dose of 3.1±1.7 mg/week). The baseline prevalence was 44.4% for sarcopenia, 35.8% for locomotive syndrome, and 25.9% for frailty, and the new onset rate was 4.4% for sarcopenia, 15.4% for locomotive syndrome, and 13.3% for frailty. Of the patients with each disease at baseline, 36.1% had sarcopenia, 20.7% had locomotive syndrome, and 33.3% had frailty, and of those with each disease at 2 years, 36.1% had sarcopenia, 20.7% had locomotive syndrome, and 33.3% had frailty. The new onset sarcopenia and locomotive syndrome groups had significantly higher rates of GC use (p=0.036, p=0.007, paired t-test) and significantly higher doses (p=0.01, p=0.001, paired t-test) than the groups without new onset sarcopenia and locomotive syndrome. High baseline disease activity was an independent predictor of new onset of locomotive syndrome on multivariate logistic regression analysis (OR=3.21, p=0.015).Conclusion:The new onset rates at 2 years were 4.4% for sarcopenia, 15.4% for locomotive syndrome, and 13.3% for frailty. In the new onset sarcopenia and locomotive syndrome groups, both GC use and dosage were significantly higher.References:[1]Tada M, et al. Matrix metalloprotease 3 is associated with sarcopenia in rheumatoid arthritis - results from the CHIKARA study. Int J Rheum Dis. 2018 Nov;21(11):1962-1969.[2]Tada M, et al. Correlation between frailty and disease activity in patients with rheumatoid arthritis: Data from the CHIKARA study. Geriatr Gerontol Int. 2019 Dec;19(12):1220-1225.[3]Yamada Y, et al. Glucocorticoid use is an independent risk factor for developing sarcopenia in patients with rheumatoid arthritis: from the CHIKARA study. Clin Rheumatol. 2020 Jun;39(6):1757-1764.Disclosure of Interests:None declared

Background:Locomotive syndrome is a condition in which activities of daily living are affected by impairment of the motor organs, most often due to rheumatoid arthritis (RA). Locomo25 is a new index developed for the early detection of locomotive syndrome. It consists of 25 items associated with pain, physical activity, and subjective state of health, with a score of 7 points or higher classed as Grade 1 locomotive syndrome and a score of 16 points or higher as Grade 2. In RA, joint impairment causes the appearance of problems affecting motor organs as a whole, as well as progressive functional impairment. As functional impairment progresses, it causes increasing immobility, which raises the risk of osteoporosis.Objectives:Locomo25 was used to investigate functional impairment and its association with RA disease activity and osteoporosis indicators.Methods:The subjects were 105 patients with RA (24 men and 81 women) with a mean age of 68.7 (28–91) years. In terms of staging, 25 were Stage I, 22 Stage II, 17 Stage III, and 41 Stage IV, and their motor disability was Steinbrocker Class 1 in 68 cases, Class 2 in 27, Class 3 in 9, and Class 4 in 1. Disease activity according to the Disease Activity Score 28 with erythrocyte sedimentation rate (DAS28 ESR) was assessed as remission in 44 cases, low disease activity in 24, moderate in 33, and high in 4. The associations between the Locomo25 score and disease activity indices, bone mineral density (BMD), and bone turnover markers (TRACP-5b, NTX, urinary DPD, BAP, total P1NP, and 25(OH)D) were investigated.Results:Locomo25 grade was 0 in 37 cases (35.2%), 1 in 24 (22.9%), and 2 in 44 (41.9%). Locomo25 grade was significantly associated with Steinbrocker class (r= 0.4299, Spearman’s rank correlation coefficient,p< 0.0001). DAS28 ESR and Health Assessment Questionnaire scores increased as locomotive syndrome progressed. There was no significant difference in eGFR between groups, but bone resorption markers (TRACP-5b, NTX, and urinary DPD) and a bone quality marker (pentosidine) decreased significantly as locomotive syndrome progressed. There were no significant differences in BMD or other bone turnover markers.Conclusion:The Locomo25 score was useful for evaluating functional impairment in RA. The prevalence of Grade 2 locomotive syndrome in the general population is reported to be around 25%, and many patients with RA had advanced locomotive syndrome. Although there was no significant difference in BMD, elevated bone resorption and deteriorating bone quality were associated with progressive functional impairment, suggesting that RA patients with advanced locomotive syndrome may be at risk of increasingly severe osteoporosis as a result of immobility.References:[1]Yoshimura Y, Ishijima M, Ishibashi M, Liu L, Arikawa-Hirasawa E, Machida S, Naito H, Hamada C, Kominami E. J Orthop Sci. 2019 Nov;24(6):1094-1104. doi: 10.1016/j.jos.2019.08.009. Epub 2019 Sep 3.[2]Siu PPY, Cheung PWH, Cheung JPY. J Orthop Sci. 2019 Nov;24(6):1110-1117. doi: 10.1016/j.jos.2019.07.012. Epub 2019 Aug 14.Disclosure of Interests:None declared

Résumé Dans Charles Guérin, roman de P.-J.-O. Chauveau dont l'action débute en 1830, plusieurs figures de médecins sont à l'oeuvre. Exploitant une juxtaposition du texte romanesque et de l'histoire de la médecine au Québec, l'auteur examine la science, les savoirs, la locomotive, le livre, les pratiques de la médecine, ses agents et, en particulier, le désarroi commun devant l'épidémie de choléra morbus qui s'abat sur le Canada en 1832.