Acute heavy‐resistance exercise–induced pain and neuromuscular fatigue in elderly women with fibromyalgia and in healthy controls: Effects of strength training

Objective

To examine heavy‐resistance exercise–induced acute neuromuscular fatigue, blood lactate concentration, and muscle pain in elderly women with fibromyalgia (FM) and in healthy controls before and after a period of strength training.

Methods

Thirteen elderly women with FM (mean ± SD age 60 ± 2 years) and 10 healthy women (mean ± SD age 64 ± 3 years) performed a heavy‐resistance fatiguing protocol (5 sets of leg presses with 10 repetitions maximum) before and after a 21‐week strength training period. Maximal isometric force and electromyography (EMG) activity of leg extensors and blood lactate concentration were measured during the loading. Pain was assessed by visual analog scale.

Results

The strength training led to large increases in maximal force and EMG activity of the muscles and contributed to the improvement in loading performance (average load/set) at week 21. The fatiguing loading sessions typically applied in strength training before and after the experimental period caused remarkable and comparable acute decreases in maximal force and increases in blood lactate concentration in both groups. Acute exercise‐induced muscle pain increased similarly in both groups, and the pain level in women with FM was lowered after the 21‐week training period.

Conclusion

The increased strength in women with FM improved high‐load performance and also seemed to attenuate perceived pain. Acute exercise‐induced neuromuscular changes and the time course of muscle pain in women with FM were comparable with findings in healthy controls, which suggests a typical fatiguing process and a similar trainability of the muscles in elderly women with FM.

     

A home‐based two‐year strength training period in early rheumatoid arthritis led to good long‐term compliance: A five‐year followup

Objective

To evaluate the impact of a 2‐year home‐based strength‐training program on physical function in patients with early rheumatoid arthritis (RA) after a subsequent 3‐year followup.

Methods

Seventy patients with early RA were randomized to perform either strength training (experimental group [EG]) or range‐of‐motion exercises (control group [CG]). Maximal strength values were recorded by dynamometers. The Modified Disease Activity Score (DAS28), pain, Health Assessment Questionnaire (HAQ), walking speed, and stair‐climbing speed were also measured.

Results

The maximum strength of assessed muscle groups increased by 19–59% in the EG during the training period and remained at the reached level throughout the subsequent 3 years. Muscle strength improved in the CG by 1–31%, but less compared with the EG. During the 2‐year training period, DAS28 decreased by 50% and 45% and pain by 67% and 39% in the EG and CG, respectively. The differences in muscle strength, DAS28, and HAQ were significantly in favor of the EG both at the 2‐year and 5‐year followup assessments.

Conclusions

The improvements achieved during the 2‐year strength‐training period were sustained for 3 years in patients with early RA.

     

Exercise in waist‐high warm water decreases pain and improves health‐related quality of life and strength in the lower extremities in women with fibromyalgia

Objective

To evaluate the short‐ and long‐term efficacy of exercise therapy in a warm, waist‐high pool in women with fibromyalgia.

Methods

Thirty‐four women (mean ± SD tender points 17 ± 1) were randomly assigned to either an exercise group (n = 17) to perform 3 weekly sessions of training including aerobic, proprioceptive, and strengthening exercises during 12 weeks, or to a control group (n = 17). Maximal unilateral isokinetic strength was measured in the knee extensors and flexors in concentric and eccentric actions at 60°/second and 210°/second, and in the shoulder abductors and adductors in concentric contractions. Health‐related quality of life (HRQOL) was assessed using the EQ‐5D questionnaire; pain was assessed on a visual analog scale. All were measured at baseline, posttreatment, and after 6 months.

Results

The strength of the knee extensors in concentric actions increased by 20% in both limbs after the training period, and these improvements were maintained after the de‐training period in the exercise group. The strength of other muscle actions measured did not change. HRQOL improved by 93% (P = 0.007) and pain was reduced by 29% (P = 0.012) in the exercise group during the training, but pain returned close to the pretraining level during the subsequent de‐training. However, there were no changes in the control group during the entire period.

Conclusion

The therapy relieved pain and improved HRQOL and muscle strength in the lower limbs at low velocity in patients with initial low muscle strength and high number of tender points. Most of these improvements were maintained long term.

     

Muscle mass,muscle strength,functional performance,and physical impairment in women with the hypermobility type of Ehlers‐Danlos syndrome

Objective

To investigate lower extremity muscle mass, muscle strength, functional performance, and physical impairment in women with the Ehlers‐Danlos syndrome hypermobility type (EDS‐HT).

Methods

Forty‐three women with EDS‐HT and 43 sex‐ and age‐matched healthy control subjects participated. Muscle mass was determined by dual x‐ray absorptiometry. Muscle strength and muscle strength endurance were measured with isokinetic dynamometry at angular velocities of 60, 180, and 240°/second. Static muscle endurance during posture maintenance was also assessed. Pain and fatigue were simultaneously evaluated by visual analog scale and the Borg scale, respectively. In addition, the chair rise test for assessment of functional performance and the Arthritis Impact Measurement Scales (AIMS) for physical impairment evaluation were used.

Results

Compared to control subjects, EDS‐HT patients showed substantial lower extremity muscle weakness, reflected by significantly reduced knee extensor and flexor muscle strength and endurance parameters, with differences ranging from ?30% to ?49%; reduced static muscle endurance time; and diminished functional performance. Lower extremity muscle mass was similar in both groups and unlikely to affect the muscle strength results. By contrast, pain and fatigue were omnipresent and increased remarkably due to the tests. Furthermore, the EDS‐HT group was physically impaired, especially in the AIMS domain walking and bending.

Conclusion

This study demonstrates severely reduced quantitative muscle function and impairment in physical function in patients with EDS‐HT compared to age‐ and sex‐matched controls. The muscle weakness may be due to muscle dysfunction rather than reduced muscle mass. Whether muscle strength and endurance can be improved by appropriate exercise programs needs evaluation in further studies.

     

Frequency of osteopenia in children and young adults with childhood‐onset systemic lupus erythematosus

Objective

To determine the frequency of osteopenia in patients with childhood‐onset systemic lupus erythematosus (SLE) compared with that in healthy matched controls, and to evaluate the relationship between disease‐related variables and bone mineral mass.

Methods

Bone mineral density (BMD) and bone mineral content (BMC) were measured in a cohort of 70 patients with childhood‐onset SLE (mean ± SD disease duration 10.8 ± 8.3 years, mean ± SD age 26.4 ± 9.9 years) and 70 age‐ and sex‐matched healthy controls. BMD and BMC of the femoral neck, lumbar spine, total body, and distal one‐third of the radius were measured by dual x‐ray absorptiometry. We investigated the relationship between BMC and the following disease variables: cumulative dose of corticosteroids, organ damage, current use of corticosteroids, use of cyclophosphamide, age at disease onset, and disease activity at the time of diagnosis. Biochemical markers of bone metabolism were also measured.

Results

BMD values for the lumbar spine and femoral neck were significantly lower in patients than in healthy controls. The reduction in BMD of the lumbar spine was significantly greater than that of the total body. In multiple linear regression analyses, a higher cumulative corticosteroid dose was significantly associated with lower BMC of the lumbar spine and femoral neck. Decreased lumbar spine BMC was also related to male sex.

Conclusion

The frequency of osteopenia was higher in patients with childhood‐onset SLE than in matched controls. The lumbar spine was the most seriously affected skeletal site, followed by the femoral neck. The cumulative dose of corticosteroids was shown to be an important explanatory variable for BMC values in the lumbar spine and femoral neck.

     

Effects of dynamic strength training on physical function,Valpar 9 work sample test,and working capacity in patients with recent‐onset rheumatoid arthritis

Objective

To study the impact of 24 months of strength training on the physical function of patients with early rheumatoid arthritis (RA).

Methods

Seventy patients were assigned to either the strength training (experimental) group (n = 35) or the control group (n = 35). Patients in the experimental group performed strength training for 24 months, and control patients were instructed to perform range of motion exercises. Maximal strength of the knee extensors, trunk flexors, and extensors, as well as grip strength were recorded with dynamometers. Disease activity was assessed by the erythrocyte sedimentation rate and Ritchie's articular index, joint damage was determined by the Larsen x‐ray index, and functional capacity was assessed using the Valpar 9 test and the Stanford Health Assessment Questionnaire (HAQ). The employment status of each patient was recorded.

Results

In the experimental group, strength training led to significant increases (19–59%) in maximal strength of the trained muscles. Such increases in the control group varied from 1% to 31%. There was a clear training effect on muscular strength in favor of the experimental group, but significant improvements in the HAQ indices as well as in the Valpar 9 test were seen also in control patients. Results of the Valpar 9 and the HAQ were statistically significantly better in patients who remained gainfully employed compared with patients who retired preterm during followup. However, compared with patients who remained in the work force, patients who retired were older, and their work was physically more demanding.

Conclusion

As expected, strength training led to increased muscle strength, but this increase did not correlate with improved physical function as assessed by the Valpar 9 work sample test. The increased muscle performance did not prevent a substantial proportion of patients from retiring preterm. The 2 items from the Valpar 9 test that were applied were not sensitive enough to differentiate the patients according to their working status.

     

Anaerobic exercise capacity in patients with juvenile‐onset idiopathic inflammatory myopathies

Objective

To 1) report the feasibility of an “all‐out” 30‐second cycling exercise test (Wingate Anaerobic Exercise Test [WAnT]) in juvenile‐onset idiopathic inflammatory myopathy (JIIM) patients, 2) describe the anaerobic exercise capacity in juvenile dermatomyositis patients, and 3) determine if the anaerobic exercise capacity could be related to disease duration or disease phase.

Methods

Twenty patients (age 14.13 ± 5.4 years) with JIIM participated in this study. All patients were able to perform the WAnT without adverse events.

Results

Comparison with healthy controls revealed a ?29.3 ± 26.58% (P = 0.001) and ?27.6 ± 25.7% (P = 0.002) impairment in mean power and peak power on the WAnT, respectively. The WAnT correlated with disease phase and with knee extensor muscle strength.

Conclusion

The WAnT might be a valuable adjunct next to other assessment tools in the followup of JIIM patients.

     

Slowing of bone loss in patients with rheumatoid arthritis by long‐term high‐intensity exercise: Results of a randomized,controlled trial

Objective

Patients with rheumatoid arthritis (RA) are more at risk for the development of osteoporosis and osteoporotic fractures than are their healthy peers. In this randomized, controlled, multicenter trial, the effectiveness of a 2‐year high‐intensity weight‐bearing exercise program (the Rheumatoid‐Arthritis‐Patients‐In‐Training [RAPIT] program) on bone mineral density (BMD) was compared with usual care physical therapy, and the exercise modalities associated with changes in BMD were determined.

Methods

Three hundred nine patients with RA were assigned to an intervention group, either the RAPIT program or usual care physical therapy. The primary end points were BMD of the hip and spine. The exercise modalities examined were aerobic fitness, muscle strength, and, as a surrogate for those effects not directly measured by the RAPIT program, attendance rate.

Results

The data on the 136 RAPIT participants and 145 usual care participants who completed the study were analyzed. The mean rate of decrease in hip BMD, but not in lumbar spine BMD, was smaller in patients participating in the RAPIT program when compared with that in the usual care group, with a mean decrease of 1.6% (95% confidence interval [95% CI] 0.8–2.5) over the first year and 0.5% (95% CI 1.1–2.0) over the second year. The change in hip BMD was significantly and independently associated with changes in both muscle strength (multivariate odds ratio [OR] 1.75, 95% CI 1.07–2.86) and aerobic fitness (OR 1.79, 95% CI 1.10–2.90), but not with the attendance rate (OR 1.00, 95% CI 0.99–1.00).

Conclusion

A long‐term high‐intensity weight‐bearing exercise program for RA patients is effective in slowing down the loss of BMD at the hip. The exercise modalities associated with this effect are muscle strength and aerobic fitness.

     

Muscle strength,functional performance,and self‐reported outcomes four years after arthroscopic partial meniscectomy in middle‐aged patients

Objective

To examine thigh muscle strength, functional performance, and self‐reported outcome in patients with nontraumatic meniscus tears 4 years after operation, and to study the impact of a strength deficit on self‐reported outcome and evaluate the feasibility of 3 performance tests in this patient group.

Methods

The study group comprised 45 patients (36% women, mean age 46.7) who had an arthroscopic partial meniscectomy a mean of 4 years (range 1–6 years) previously. Main outcome measures included isokinetic strength of knee extensors and flexors, functional performance (1‐leg hop, 1‐leg rising, and square‐hop tests), and a self‐reported questionnaire (Knee Injury and Osteoarthritis Outcome Score).

Results

We found lower knee extensor strength and worse 1‐leg rising capacity in the operated leg, but no difference between operated and nonoperated leg for knee flexors (P ≤ 0.004 and P > 0.3, respectively). Patients with a stronger quadriceps of the operated leg compared with the nonoperated leg had less pain and better function and quality of life (r = 0.4–0.6, P ≤ 0.010). We found the 1‐leg rising and 1‐leg hop tests to be suitable performance tests in middle‐aged meniscectomy patients.

Conclusion

Quadriceps strength is reduced in the meniscectomized leg compared with the nonoperated leg 4 years after surgery. This relative quadriceps weakness significantly affects objective and self‐reported knee function, pain, and quality of life, indicating the importance of restoring muscle function after meniscectomy in middle‐aged patients.

     

A comparison of strength training,self‐management,and the combination for early osteoarthritis of the knee

Objective

To assess the relative effectiveness of combining self‐management and strength training for improving functional outcomes in patients with early knee osteoarthritis.

Methods

We conducted a randomized intervention trial lasting 24 months at an academic medical center. Community‐dwelling middle‐aged adults (n = 273) ages 35–64 years with knee osteoarthritis, pain, and self‐reported physical disability completed a strength training program, a self‐management program, or a combined program. Outcomes included 5 physical function tests (leg press, range of motion, work capacity, balance, and stair climbing) and 2 self‐reported measures of pain and disability.

Results

A total of 201 participants (73.6%) completed the 2‐year trial. Overall, compliance was modest for the strength training (55.8%), self‐management (69.1%), and combined (59.6%) programs. The 3 groups showed a significant and large increase from pre‐ to posttreatment in all of the physical functioning measures, including leg press (d = 0.85), range of motion (d = 1.00), work capacity (d = 0.60), balance (d = 0.59), and stair climbing (d = 0.59). Additionally, all 3 groups showed decreased self‐reported pain (d = ?0.51) and disability (d = ?0.55). There were no significant differences among the groups.

Conclusion

Middle‐aged, sedentary persons with mild early knee osteoarthritis benefited from strength training, self‐management, and the combination program. These results suggest that both strength training and self‐management are suitable treatments for the early onset of knee osteoarthritis in middle‐aged adults. Self‐management alone may offer the least burdensome treatment for early osteoarthritis.

     

Change in bone mineral density in patients with rheumatoid arthritis during the first decade of the disease

Objective

Rheumatoid arthritis (RA) has been reported to be associated with bone loss during the first years of the disease. The magnitude of this problem after the initial years has not yet been evaluated. In the present study, the change in bone mineral density (BMD) in patients with recent‐onset RA as well as the effects of inflammation, mobility, and the use of prednisone on this change were studied in the first decade of the disease.

Methods

BMD was measured twice in 76 RA patients with mean disease durations of 2.35 years at the first BMD measurement and 8.90 years at the second BMD measurement. BMD was measured in both hips using dual x‐ray absorptiometry. Results were expressed as mean ± SEM Z scores (using age‐ and sex‐matched reference values) and as mean ± SEM percent change in BMD (in gm/cm²) per year. The effects of inflammation, mobility, and the use of prednisone on change in BMD were evaluated using multiple linear regression analyses.

Results

At the first BMD measurement, RA patients had lower BMD compared with the reference values (Z score −0.42 ± 0.11, 95% confidence interval [95% CI] –0.64, –0.20). Between the 2 measurements, we observed a small decrease in BMD of −0.28 ± 0.11%/year (95% CI –0.07 to –0.49). However, the rate of bone loss was smaller than expected. The Z score increased by 0.13 ± 0.05 between the 2 BMD measurements (95% CI 0.02, 0.23). Only the use of prednisone was significantly associated with increased bone loss. In a separate analysis that included only postmenopausal women, increased physical activity and longer time since menopause were both associated with decreased bone loss. In this subgroup of patients, the use of prednisone was significantly associated with increased bone loss as well. A high erythrocyte sedimentation rate was associated with increased bone loss, but this did not reach statistical significance.

Conclusion

After the initial years of the disease, bone loss in RA patients is lower than expected compared with age‐ and sex‐matched reference values. Postmenopausal RA patients with low levels of physical activity are at increased risk of losing bone. Use of prednisone was the only variable consistently associated with reduction in BMD in RA patients.

     

sE‐selectin for stratifying outcome in rheumatoid arthritis

Objectives

To determine the usefulness of sE‐selectin as a marker for early diagnosis and stratification of rheumatoid arthritis.

Methods

We investigated several markers of disease activity, including circulating adhesion molecules and other standard laboratory tests, in a 2–3 year followup analysis of patients with rheumatoid arthritis.

Results

The mean ± SD levels of sE‐selectin (91.68 ± 31.8 ng/ml versus 49.83 ± 14.76 ng/ml) and rheumatoid factor (375.7 ± 394.4 U versus 44.66 ± 37.63 U) were strongly elevated in severe (n = 15) versus mild (n = 7) courses of disease. Statistical calculation of mean and standard deviation revealed that sE‐selectin represents a highly significant marker for the presence of persistent and aggressive disease over time, regardless of therapeutic intervention and observation time points (P = 0.0004). Notably, regression analysis identified constant values for all parameters analyzed and, therefore, a stable course of the disease could be predicted from the beginning.

Conclusion

sE‐selectin appears to be a powerful marker to predict the severity of rheumatoid arthritis.

     

Antibody levels correlate with creatine kinase levels and strength in anti–3‐hydroxy‐3‐methylglutaryl‐coenzyme A reductase–associated autoimmune myopathy

Objective

Autoantibodies recognizing 3‐hydroxy‐3‐methylglutaryl‐coenzyme A reductase (HMGCR) are found in patients with statin‐associated immune‐mediated necrotizing myopathy and, less commonly, in statin‐unexposed patients with autoimmune myopathy. The main objective of this study was to define the association of anti‐HMGCR antibody levels with disease activity.

Methods

Anti‐HMGCR levels, creatine kinase (CK) levels, and strength were assessed in anti‐HMGCR–positive patients. Associations of antibody level with CK level and strength at visit 1 were analyzed in 55 patients, 40 of whom were exposed to statins. In 12 statin‐exposed and 5 statin‐unexposed patients with serum from 5 serial visits, the evolution of antibody levels, CK levels, and strength was investigated.

Results

Antibody levels were associated with CK levels (P < 0.001), arm strength (P < 0.05), and leg strength (P < 0.05) at visit 1, but these associations were only significant among statin‐exposed patients in stratified analyses. With immunosuppressive treatment over 26.2 ± 12.6 months (mean ± SD), antibody levels declined (P < 0.05) and arm abduction strength improved (P < 0.05) in the 17 patients followed up longitudinally. The separate analysis showed that statin‐exposed patients developed decreased antibody levels (P < 0.01), decreased CK levels (P < 0.001), improved arm strength (P < 0.05), and improved hip flexion strength (P < 0.05) with treatment. Anti‐HMGCR antibody levels did not normalize in any patient.

Conclusion

In the entire cohort, initial anti‐HMGCR levels correlated with indicators of disease activity; with immunosuppressive treatment, antibody levels declined and arm strength improved. Statin‐exposed patients had significant improvements in CK levels and strength whereas statin‐unexposed patients did not, suggesting a phenotypic difference between statin‐exposed and statin‐unexposed anti‐HMGCR–positive patients.

     

Complete and sustained remission of juvenile dermatomyositis resulting from aggressive treatment

Objective

To assess the time needed to achieve sustained, medication‐free remission in a cohort of patients with juvenile dermatomyositis (DM) receiving a stepwise, aggressive treatment protocol.

Methods

Between 1994 and 2004, a cohort of 49 children with juvenile DM who were followed up at a single tertiary care children's hospital using disease activity measures according to a specific protocol received standardized therapy with steroids and methotrexate. If a patient's strength or muscle enzyme levels did not normalize with this initial therapy, additional medications were added in rapid succession to the treatment regimen. The primary outcome measure was time to complete remission. Additional outcome measures were onset of calcinosis, effect of treatment on height, and complications resulting from medications.

Results

Forty‐nine patients were followed up for a mean ± SD of 48 ± 30 months. All but 1 patient received 2 or more medications simultaneously. Transient localized calcifications occurred in 4 patients (8%), and 2 additional patients (4%) had persistent calcinosis. Despite the aggressive therapy, complications associated with treatment were mild and were primarily attributable to steroids. No persistent effect on longitudinal growth was observed. A complete, medication‐free remission was achieved in 28 patients; the median time to achievement of complete remission was 38 months (95% confidence interval 32–44 months). None of these patients experienced a disease flare that required resumption of medications during the subsequent period of observation (mean ± SD 36 ± 19.7 months).

Conclusion

Our findings suggest that aggressive treatment of juvenile DM aimed at achieving rapid, complete control of muscle weakness and inflammation improves outcomes and reduces disease‐related complications. In more than one‐half of the children whose disease was treated in this manner (28 of 49), a prolonged, medication‐free remission was attained within a median of 38 months from the time of diagnosis.

     

Bone mineral density in juvenile dermatomyositis: Assessment using dual x‐ray absorptiometry

Objective

To determine the bone mineral density (BMD) status of our juvenile dermatomyositis (DM) population and to compare the frequency of osteopenia in patients with active disease requiring corticosteroids with that in patients with inactive disease who are not receiving corticosteroids.

Methods

Medical charts of all children diagnosed as having juvenile DM at our institution between 1989 and 1999 were reviewed for demographic and clinical data, including disease activity and duration of corticosteroid therapy. BMD measurements of the lumbar spine (L1–L4) were performed using dual x‐ray absorptiometry (DXA). Z scores were calculated from the BMD data for comparison with published normative data.

Results

A total of 15 patients were assessed: 10 with active disease, and 5 with inactive disease who had not taken corticosteroids for an average of 6.0 years (range 3.4–8.1 years). Baseline BMD measurements demonstrated osteopenia or frank osteoporosis in the majority of patients, including 6 of the 10 patients with active disease and 4 of the 5 patients whose disease was in remission. Fourteen patients had serial BMD measurements. Persistent or worsening osteopenia was documented in all patients who had ongoing active disease, except for 3 patients who had been treated with bisphosphonates because of vertebral compression fractures.

Conclusion

Osteopenia is common in patients with juvenile DM, and it usually worsens with ongoing disease. It can persist for many years after the disease enters remission. Bisphosphonates appeared to beneficially affect bone mineralization in our patients. Treatment to prevent the long‐term complications of osteoporosis in patients with juvenile DM should be considered and requires further study.

     

Spirituality,well‐being,and quality of life in people with rheumatoid arthritis

Objective

To evaluate spirituality, well‐being, and quality of life (QOL) among people with rheumatoid arthritis (RA).

Methods

Questionnaires assessing positive and negative affect, depression, QOL and spirituality were completed. Disease activity was assessed by rheumatologic examination.

Results

Women (n = 62) had a mean (± SD) age of 53.0 (± 13.0) years with 12 (± 13) swollen and tender joints (STJ). Men (n = 15) were 61.9 (± 13.0) years with 7 (± 11) STJ. Disease activity was associated (P < 0.05) positively with depression (r = 0.23), pain (r = 0.26), poorer self‐ratings of health (r = 0.29) and physical role limitations (r = 0.26). Spirituality was associated directly with positive affect (r = 0.26) and higher health perceptions (r = 0.29). In multiple regression, spirituality was an independent predictor of happiness and positive health perceptions, even after controlling disease activity and physical functioning, for age and mood.

Conclusion

Spirituality may facilitate emotional adjustment and resilience in people with RA by experiencing more positive feelings and attending to positive elements of their lives.

     

Muscle strength, mass, and quality in older men and women with knee osteoarthritis

Objective

To examine the relationship between knee osteoarthritis (OA) and muscle parameters in a biracial cohort of older adults.

Methods

Participants in the Health, Aging and Body Composition Study (n = 858) were included in this cross‐sectional analysis. Computed tomography was used to measure muscle area, and quadriceps strength was measured isokinetically. Muscle quality (specific torque) was defined as strength per unit of muscle area for both the entire thigh and quadriceps. Knee OA was assessed based on radiographic features and knee pain. We compared muscle parameters between those with and without radiographic knee OA (+RKOA group and ?RKOA group, respectively) and among 4 groups defined by +RKOA and ?RKOA with and without pain.

Results

The mean ± SD age was 73.5 ± 2.9 years and the mean ± SD body mass index (BMI) was 27.9 ± 4.8 kg/m². Fifty‐eight percent of participants were women and 44% were African American. Compared to the ?RKOA participants, +RKOA participants had a higher BMI (30.2 versus 26.8 kg/m²), larger thigh muscles (117.9 versus 108.9 cm²), and a greater amount of intermuscular fat (12.5 versus 9.9 cm²; all P < 0.0001). In adjusted models, the +RKOA participants had significantly lower specific torque (P < 0.001), indicating poorer muscle quality, than ?RKOA participants, but there was no difference between groups in quadriceps specific torque. The +RKOA without pain (P < 0.05) and the +RKOA with pain (P < 0.001) participants had lower specific torque compared to the ?RKOA without pain group. There were no significant differences in quadriceps specific torque among groups.

Conclusion

Muscle quality was significantly poorer in participants with RKOA regardless of pain status. Future studies should address how lifestyle interventions might affect muscle quality and progression of knee OA.

     

Are the benefits of a high‐intensity progressive resistance training program sustained in rheumatoid arthritis patients? A 3‐year followup study

Objective

Rheumatoid arthritis (RA) patients were reassessed for body composition and physical function mean ± SD 39 ± 6 months after commencing a randomized controlled trial involving 24 weeks of either high‐intensity progressive resistance training (PRT) or low‐intensity range of movement exercise (control) to determine whether the benefits of PRT (i.e., reduced fat mass [FM], increased lean mass [LM], and improved function) were retained.

Methods

Nine PRT and 9 control subjects were reassessed for body composition (dual x‐ray absorptiometry) and function (knee extensor strength, chair test, arm curl test, 50‐foot walk) approximately 3 years after resuming normal activity following the exercise intervention.

Results

At followup, PRT subjects remained significantly leaner than control subjects (P = 0.03), who conversely had accumulated considerable FM during the study period (approximately ?1.0 kg versus +2.4 kg, PRT versus controls). PRT subjects also retained most of the improvement in walking speed gained from training (P = 0.03 versus controls at followup). In contrast, the PRT‐induced gains in LM and strength‐related function were completely lost. Data from the controls suggest that established and stable RA patients have similar rates of LM loss but elevated rates of FM accretion relative to age‐matched sedentary non‐RA controls.

Conclusion

We found that long‐term resumption of normal activity resulted in loss of PRT‐induced improvements in LM and strength‐related function, but substantial retention of the benefits in FM reduction and walking ability. The relatively long‐term benefit of reduced adiposity, in particular, is likely to be clinically significant, as obesity is very prevalent among RA patients and is associated with their disability and exacerbated cardiovascular disease risk.

     

Aberrant IgG galactosylation precedes disease onset,correlates with disease activity,and is prevalent in autoantibodies in rheumatoid arthritis

Objective

To examine the association between aberrant IgG galactosylation and disease parameters in rheumatoid arthritis (RA).

Methods

Analysis of N‐glycan in serum samples from multiple cohorts was performed. The IgG N‐glycan content and the timing of N‐glycan aberrancy relative to disease onset were compared in healthy subjects and in patients with RA. Correlations between aberrant galactosylation and disease activity were assessed in the RA cohorts. The impact of disease activity, sex, age, anti–cyclic citrullinated peptide (anti‐CCP) antibody titer, disease duration, and C‐reactive protein level on aberrant galactosylation was determined using multivariate analysis. The N‐glycan content was also compared between epitope affinity–purified autoantibodies and the remaining IgG repertoire in RA patients.

Results

Our results confirm the aberrant galactosylation of IgG in RA patients as compared with healthy controls (mean ± SD 1.36 ± 0.43 versus 1.01 ± 0.23; P < 0.0001). We observed a significant correlation between levels of aberrant IgG galactosylation and disease activity (Spearman's ρ = 0.37, P < 0.0001). This correlation was higher in women (Spearman's ρ = 0.60, P < 0.0001) than in men (Spearman's ρ = 0.16, P = 0.10). Further, aberrant IgG galactosylation substantially predated the onset of arthritis and the diagnosis of RA (3.5 years) and resided selectively in the anticitrullinated antigen fraction.

Conclusion

Our findings identify aberrant IgG galactosylation as a dysregulated component of the humoral immune response in RA that begins prior to disease onset, associates with disease activity in a sex‐specific manner, and resides preferentially in autoantibodies.

     

Prevalent vertebral fractures among children initiating glucocorticoid therapy for the treatment of rheumatic disorders

Objective

Vertebral fractures are an under‐recognized problem in children with inflammatory disorders. We studied spine health among 134 children (87 girls) with rheumatic conditions (median age 10 years) within 30 days of initiating glucocorticoid therapy.

Methods

Children were categorized as follows: juvenile dermatomyositis (n = 30), juvenile idiopathic arthritis (n = 28), systemic lupus erythematosus and related conditions (n = 26), systemic arthritis (n = 22), systemic vasculitis (n = 16), and other conditions (n = 12). Thoracolumbar spine radiograph and dual x‐ray absorptiometry for lumbar spine (L‐spine) areal bone mineral density (BMD) were performed within 30 days of glucocorticoid initiation. Genant semiquantitative grading was used for vertebral morphometry. Second metacarpal morphometry was carried out on a hand radiograph. Clinical factors including disease and physical activity, calcium and vitamin D intake, cumulative glucocorticoid dose, underlying diagnosis, L‐spine BMD Z score, and back pain were analyzed for association with vertebral fracture.

Results

Thirteen vertebral fractures were noted in 9 children (7%). Of these, 6 patients had a single vertebral fracture and 3 had 2–3 fractures. Fractures were clustered in the mid‐thoracic region (69%). Three vertebral fractures (23%) were moderate (grade 2); the others were mild (grade 1). For the entire cohort, mean ± SD L‐spine BMD Z score was significantly different from zero (?0.55 ± 1.2, P < 0.001) despite a mean height Z score that was similar to the healthy average (0.02 ± 1.0, P = 0.825). Back pain was highly associated with increased odds for fracture (odds ratio 10.6 [95% confidence interval 2.1–53.8], P = 0.004).

Conclusion

In pediatric rheumatic conditions, vertebral fractures can be present prior to prolonged glucocorticoid exposure.