Explore the vast range of titles available.

Rheumatoid arthritis(RA) and osteoarthritis(OA) patients showed systemic manifestations that may lead to a reduction in muscle strength, muscle mass and, consequently, to a reduction in functionality. On the other hand, moderate intensity resistance training(MIRT) and high intensity resistance training(HIRT) are able to improve muscle strength and muscle mass in RA and OA without affecting the disease course. However, due to the articular manifestations caused by these diseases, these patients may present intolerance to MIRT or HIRT. Thus, the low intensity resistance training combined with blood flow restriction(LIRTBFR) may be a new training strategy for these populations. To perform a systematic review with meta-analysis to verify the effects of LIRTBFR on muscle strength, muscle mass and functionality in RA and OA patients. A systematic review with meta-analysis of randomized clinical trials(RCTs), published in English, between 1957-2021, was conducted using MEDLINE(PubMed), Embase and Cochrane Library. The methodological quality was assessed using Physiotherapy Evidence Database scale. The risk of bias was assessed using RoB2.0. Mean difference(MD) or standardized mean difference(SMD) and 95% confidence intervals(CI) were pooled using a random-effects model. A P<0.05 was considered statistically significant. Five RCTs were included. We found no significant differences in the effects between LIRTBFR, MIRT and HIRT on muscle strength, which was assessed by tests of quadriceps strength(SMD = -0.01[-0.57, 0.54], P = 0.96; I² = 58%) and functionality measured by tests with patterns similar to walking(SMD = -0.04[-0.39, 0.31], P = 0.82; I² = 0%). Compared to HIRT, muscle mass gain after LIRTBFR was reported to be similar. When comparing LIRTBFR with low intensity resistance training without blood flow restriction(LIRT), the effect LIRTBFR was reported to be higher on muscle strength, which was evaluated by the knee extension test. LIRTBFR appears to be a promising strategy for gains in muscle strength, muscle mass and functionality in a predominant sample of RA and OA women.

Objective: This short-term prospective observational study aimed to evaluate the efficacy of vestibular rehabilitation therapy (VRT) in Patients Diagnosed with Persistent Postural-Perceptual Dizziness (PPPD). Methods: Given the exploratory design, the small sample (n = 25) and absence of a formal power calculation limit precision, findings should be interpreted as preliminary, and confirmatory trials are warranted. Patients were assessed before (T1), immediately after a five-week vestibular rehabilitation program (T2), and again three months later without continued therapy (T3). Clinical symptoms were assessed using the Dizziness Handicap Inventory (DHI). A Generalized Estimating Equations (GEE) model was used to analyze changes in dizziness-related physical, emotional, and functional impacts over time, accounting for sex and its interaction with time. Statistical significance was tested using the Wald test, with results reported as estimated means and standard errors (SEs), and a significance level set at p ≤ 0.05. Results: The mean age of participants was 44.48 ± 14.43 years, and the majority were women (84%). In the functional domain, the mean score difference was 6.69 points between T1 and T2 (p = 0.018), 7.11 points between T1 and T3 (p = 0.013), and 0.42 points between T2 and T3 (p > 0.05). In the emotional domain, the mean difference was 4.12 points between T1 and T2 (p = 0.008), 4.40 points between T1 and T3 (p = 0.005), and 0.29 points between T2 and T3 (p > 0.05). In the physical domain, the mean difference was 3.77 points between T1 and T2 (p = 0.024), 4.32 points between T1 and T3 (p = 0.009), and 0.55 points between T2 and T3 (p > 0.05). For the total score, the mean difference was 14.58 points between T1 and T2 (p = 0.005), 15.83 points between T1 and T3 (p = 0.003), and 1.25 points between T2 and T3 (p > 0.05). The moment variable had a statistically significant effect across all domains. Sex had a significant effect only in the emotional domain, with women consistently reporting higher scores than men. Conclusions: This study demonstrates that a five-week vestibular rehabilitation program significantly improves the physical, emotional, and functional impacts of dizziness in patients with PPPD, with these benefits largely sustained three months after the intervention. Emotional improvements were particularly notable among women, highlighting potential sex-related differences in response to treatment. These findings underscore the importance of addressing emotional health in PPPD management and support the long-term effectiveness of vestibular rehabilitation in improving patient outcomes.

Self-reported disability is potentially influenced by many factors in patients with rheumatoid arthritis (RA). In this sense, we evaluated the association between self-reported disability and (1) clinical features, (2) muscle strength and (3) physical performance over time among patients with RA from two distinct patient cohorts. Two independent prospective RA cohorts were analyzed. The Health Assessment Questionnaire (HAQ), Disease Activity Score in 28 Joints (DAS28), handgrip test, chair stand test, timed-up-and-go (TUG) test and Short Physical Performance Battery (SPPB) were performed at baseline and in follow-up. T test for independent samples, Mann-Whitney U test, Spearman correlation coefficients and linear regression with generalized estimating equations were performed to assess associations between individual constructs at baseline and over time. A total of 205 total RA patients were included [North American Cohort (n = 115); Brazilian Cohort (n = 90)]. At enrollment, Brazilian men had better HAQ than North American men (p<0.001). Brazilian patients overall had lower muscle strength than North American patients (p<0.05). HAQ was associated with DAS28, handgrip test, chair stand test, TUG and SPPB (p<0.001) in both cohorts. Worsening of the DAS28 and chair stand test were each associated with worsening in HAQ in longitudinal analysis over time. Worsening of handgrip was also associated in with worsening HAQ in both cohorts (p<0.05). A worse TUG test was associated with worsening in HAQ in Brazilian cohort (p<0.05) and a worse SPPB was associated with worsening in HAQ in North American cohort (p<0.05). Greater disability measured by HAQ is closely associated with disease activity, pain, muscle strength, and physical performance among RA. Worsening in self-reported disability correlate with worsening clinical factors including objectively-observed physical function.

ObjectivesTo assess the prevalence of sarcopenia and examine its association with clinical features, health-related quality of life (HRQoL), muscle-specific strength and body composition in patients with systemic lupus erythematosus (SLE).MethodsIn this cross-sectional multicentre study, women with SLE (18–50 years old) were included. Data collected included clinical features and HRQoL. Muscle strength was assessed using the handgrip test (kg), appendicular skeletal muscle mass index (ASMI, kg/m²) was measured using dual-energy X-ray absorptiometry. Physical performance was assessed using the timed-up-and-go test (TUG, seconds). Sarcopenia was defined by the European Working Group on Sarcopenia in Older People-2 criteria. The muscle-specific strength was evaluated by dividing their arm strength by their lean arm mass. Pearson’s or Spearman’s correlation coefficients were performed (accepted at p<0.05).ResultsSeventy-three SLE women were included, with median (IQR) age and disease duration of 37 (30–44) years old and 10.0 (4.0–16.8) years, respectively. Most of the patients (83.5%) had inactive or low disease activity and 31.0% presented a disease damage index score ≥1. Mean (±SD) handgrip strength, ASMI and muscle-specific strength was 25.58±8.31 kg, 6.62±0.97 kg/m² and 6.6±2.3, respectively. Median TUG was 6.9 (6.1–8.2) s. The prevalence of probable sarcopenia was 11.1%, and sarcopenia was 2.7%. Lower muscle strength, lower muscle-specific strength and lower physical performance, as well as sarcopenia, were correlated with worse HRQoL (p<0.05).ConclusionIn Brazilian patients with SLE with inactive or low disease activity, the prevalence of sarcopenia was low. However, low muscle strength, low muscle-specific strength and low physical performance were correlated with worse HRQoL, emphasising the need for muscle strength assessments in SLE management.

Background: Rheumatoid arthritis (RA) is an autoimmune, inflammatory and chronic disease that may lead to loss of muscle mass, muscle strength and decreased functionality. Our objectives are to assess the quadriceps muscle morphology by ultrasound (MU) and verify its associations with clinical features, muscle strength and physical function in RA patients. Methods: In this cross-sectional study, RA women (≥18 years) were included. Morphological parameters in quadriceps muscle consisted of the muscle thickness and pennation angle of rectus femoris (RF), vastus intermedius (VI) and vastus lateralis (VL). RA activity was measured by a 28-joint disease activity score (DAS28), muscle strength by handgrip and chair stand tests, and physical function by health assessment questionnaire (HAQ), timed-up-and-go (TUG) test and short physical performance battery (SPPB). Results: Fifty-five patients were included (age: 56.73 ± 9.46 years; DAS28: 3.08 ± 1.29). Muscle thickness in RF, VI and VL were negatively associated with age (RF, p < 0.001; VI, p = 0.013; VL, p = 0.002) and disease duration (RF, p < 0.001; VI, p = 0.005; VL, p = 0.001), and were positively associated with handgrip strength (RF, p = 0.015; VI, p = 0.022; VL, p = 0.013). In addition, decreased muscle thickness in VI (p = 0.035) and a smaller pennation angle in RF (p = 0.030) were associated with higher DAS-28 scores. Conclusion: Quadriceps muscle morphology by ultrasound appears to be affected by age, disease duration, disease activity and muscle strength in patients with RA. MU can be a useful method to evaluate the impact of the disease on skeletal muscle.

In view of the method of diagnosing sarcopenia being complex and considered to be difficult to introduce into routine practice, the European Working Group on Sarcopenia in Older People (EWGSOP) recommends the use of the SARC-F questionnaire as a way to introduce assessment and treatment of sarcopenia into clinical practice. Only recently, some studies have turned their attention to the presence of sarcopenia in systemic sclerosis (SSc).There is no data about performance of SARC-F and other screening tests for sarcopenia in this population. To compare the accuracy of SARC-F, SARC-CalF, SARC-F+EBM, and Ishii test as screening tools for sarcopenia in patients with SSc. Cross-sectional study of 94 patients with SSc assessed by clinical and physical evaluation. Sarcopenia was defined according to the revised 2019 EWGSOP diagnostic criteria (EWGSOP2) with assessments of dual-energy X-ray absorptiometry, handgrip strength, and short physical performance battery (SPPB). As case finding tools, SARC-F, SARC-CalF, SARC-F+EBM and Ishii test were applied, including data on calf circumference, body mass index, limitations in strength, walking ability, rising from a chair, stair climbing, and self reported number of falls in the last year. The screening tests were evaluated through receiver operating characteristic (ROC) curves. Standard measures of diagnostic accuracy were computed using the EWGSOP2 criteria as the gold standard for diagnosis of sarcopenia. Sarcopenia was identified in 15 (15.9%) patients with SSc by the EWGSOP2 criteria. Area under the ROC curve of SARC-F screening for sarcopenia was 0.588 (95% confidence interval (CI) 0.420-0.756, p = 0.283). The results of sensitivity, specificity, positive likelihood ratio (+LR), negative likelihood ratio (-LR) and diagnostic Odds Ratio (DOR) with the EWGSOP2 criteria as the gold standard were 40.0% (95% CI, 19.8-64.2), 81.0% (95% CI, 71.0-88.1), 2.11 (95% CI, 0.98-4.55), 0.74 (95% CI, 0.48-1.13) and 2.84 (95% CI, 0.88-9.22), respectively. SARC-CalF and SARC-F+EBM showed better sensitivity (53.3%, 95% CI 30.1-75.2 and 60.0%, 95% CI 35.7-80.2, respectively) and specificity (84.8%, 95% CI 75.3-91.1 and 86.1%, 95% CI 76.8-92.0, respectively) compared with SARC-F. The best sensitivity was obtained with the Ishii test (86.7%, 95% CI 62.1-96.3), at the expense of a small loss of specificity (73.4%, 95% CI 62.7-81.9). Comparing the ROC curves, SARC-F performed worse than SARC-CalF, SARC-F+EBM and Ishii test as a sarcopenia screening tool in this population (AUCs 0.588 vs. 0.718, 0.832, and 0.862, respectively). Direct comparisons between tests revealed differences only between SARC-F and Ishii test for sensitivity (p = 0.013) and AUC (p = 0.031). SARC-CalF, SARC-F+EBM, and Ishii test performed better than SARC-F alone as screening tools for sarcopenia in patients with SSc. Considering diagnostic accuracy and feasibility aspects, SARC-F+EBM seems to be the most suitable screening tool to be adopted in routine care of patients with SSc.

To perform a systematic review with meta-analysis to verify muscle strength, muscle mass, and physical function of patients with systemic lupus erythematosus (SLE) and compare then with healthy individuals and patients with rheumatoid arthritis (RA). A systematic review with meta-analysis of observational studies published in English up to 2022 was performed using MEDLINE (via PubMed) and other relevant sources. Search strategies were based on pre-defined keywords and medical subject headings. The methodological quality of the studies was assessed using the Newcastle–Ottawa Scale. Mean difference (MD) or standardized mean difference (SMD) and 95% confidence intervals (CI) were combined using a random-effects model. Sensitivity analyses were performed when necessary. The significance level was set at p < 0.05. The systematic review included 19 studies and the meta-analysis included 11 studies. SLE patients appear to have less muscle strength assessed by handgrip than healthy controls (SLE = 21.74 kg; healthy controls = 29.34 kg; p < 0.05). SLE patients seem to have greater strength than patients with RA, but this difference was not statistically significant (RA = 17.24 kg; p = 0.210). However, in the sensitivity analysis, SLE group without deforming arthropathy showed higher muscle strength than the RA (p = 0.0001). SLE patients with deforming arthropathy have lower muscle strength compared to SLE patients without deforming arthropathy (p < 0.01). Muscle mass was similar in SLE patients compared to the RA group and healthy controls (p > 0.05). However, RA patients have a higher BMI than the two groups (p < 0.05). Patients with SLE have regular physical function. Muscle strength is affected in SLE patients. SLE patients with deforming arthropathy have less muscle strength than patients without deforming arthropathies.

The 24-hour Movement Behaviour (24-h MovBeh) paradigm, encompassing physical activity (PA), sedentary behaviour (SB) and sleep patterns, is recognised as a holistic approach to adolescent health. It emphasises promoting PA, reducing SB and ensuring sufficient sleep, especially in school environments. Understanding the links between lifestyle factors and health outcomes is crucial for clinical and public health, informing interventions for lifestyle changes among adolescents. This study aims to assess adherence to 24-h MovBeh among Lithuanian adolescents, examining the patterns, inter-relationships and impacts on socio-demographic status, 24-h MovBeh, health-related fitness, blood pressure, body composition, dietary patterns, health-related quality of life, mental health, physical and exercise motivation, other lifestyles and health indicators, and academic performance. The 24-h MovBeh study is a prospective cohort study beginning in 2025 with baseline data collected in schools. It will recruit 500 primary and secondary school adolescents (11–14 years old) from Klaipeda and Kaunas, Lithuania. The study will evaluate 11 main categories: Socio-demographic status, 24-h MovBeh, health-related fitness, blood pressure, body composition, dietary patterns, health-related quality of life, mental health, physical and exercise motivation, other lifestyles and health indicators, and academic performance. Statistical analysis will estimate adherence to 24-h MovBeh and its inter-relationships with individual and environmental factors and health outcomes. The 24-h MovBeh study will be a crucial step towards establishing a monitoring system for health and lifestyle outcomes, benefiting researchers, policymakers, adolescents, and parents, while laying the groundwork for future intervention studies.

Metabolomic analysis provides a wealth of information that can be predictive of distinctive phenotypes of pathogenic processes and has been applied to better understand disease development. Rheumatoid arthritis (RA) is an autoimmune disease with the establishment of chronic synovial inflammation that affects joints and peripheral tissues such as skeletal muscle and bone. There is a lack of useful disease biomarkers to track disease activity, drug response and follow-up in RA. In this review, we describe potential metabolic biomarkers that might be helpful in the study of RA pathogenesis, drug response and risk of comorbidities. TMAO (choline and trimethylamine oxide) and TCA (tricarboxylic acid) cycle products have been suggested to modulate metabolic profiles during the early stages of RA and are present systemically, which is a relevant characteristic for biomarkers. Moreover, the analysis of lipids such as cholesterol, FFAs and PUFAs may provide important information before disease onset to predict disease activity and treatment response. Regarding therapeutics, TNF inhibitors may increase the levels of tryptophan, valine, lysine, creatinine and alanine, whereas JAK/STAT inhibitors may modulate exclusively fatty acids. These observations indicate that different disease modifying antirheumatic drugs have specific metabolic profiles and can reveal differences between responders and non-responders. In terms of comorbidities, physical impairment represented by higher fatigue scores and muscle wasting has been associated with an increase in urea cycle, FFAs, tocopherols and BCAAs. In conclusion, synovial fluid, blood and urine samples from RA patients seem to provide critical information about the metabolic profile related to drug response, disease activity and comorbidities.

ObjectiveHandgrip strength (HGS) is a simple, non-invasive measure associated with disability, frailty and disease activity in chronic conditions such as rheumatoid arthritis (RA). However, longitudinal changes in HGS and their implications in RA remain underexplored. This study aimed to systematically review changes in HGS over time and its associations with disease status and follow-up duration in patients with RA.DesignSystematic review and meta-analysis.Data sourcesA search of PUBMED, EMBASE and WEB OF SCIENCE were searched for cohort studies up to July 2025.Eligibility criteriaStudies including RA patients, assessing HGS and employing an observational design.ResultsFrom 4301 studies (including 737 identified through citation tracking), 27 met the inclusion criteria, comprising 2742 individuals (mostly women (1784; 65.1%)), aged 19–87 years, with disease duration ranging from 2 months to 47 years. Participants generally had low to moderate disease activity and moderate to severe physical disability. Overall, HGS slightly increased over time (standardised mean difference; SMD 0.25; 95% CI 0.07 to 0.43). Greater improvements were observed in early RA (SMD 0.46; 95% CI 0.30 to 0.61), while no significant changes were found in established RA. HGS increased in patients followed for ≤1 year (SMD 0.25; 95% CI 0.07 to 0.43) and >1–5 years (SMD 0.43; 95% CI 0.05 to 0.81), but not beyond 5 years.ConclusionPatients with early RA tend to improve HGS over time, whereas those with longer disease duration show stable strength levels. HGS may serve as a useful marker for monitoring function and guiding personalised care in RA.PROSPERO registration numberCRD42023473416.