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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.

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.

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.

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.

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.

IntroductionSystemic sclerosis (SSc) often leads to decreased muscle strength and mass, impairing physical performance and causing disability. Interventions with resistance exercise (RE) is an effective non-pharmacological approach to mitigate these issues. This systematic review aims to evaluate the effects of interventions with RE on muscle strength, muscle mass, physical performance, physical disability, and quality of life (QOL) in SSc patients, as well as to assess its adherence and safety.MethodsA systematic review and meta-analysis were conducted based on a PICOS framework: Patient = Systemic Sclerosis; Intervention = Resistance exercise; Study design = Randomized clinical trials. Searches were performed across MEDLINE (PubMed), PMC, Web of Science, Cochrane Library, LILACS, and EMBASE up to January 2025.ResultsTen randomized clinical trials, including 422 participants (~85% female), were eligible for analysis. Participants’ ages ranged from 42 to 64 years, with body mass indices between 22.5 and 28.0 kg/m2. The intervention period was standardized to 12 weeks. Interventions with RE significantly improved muscle strength (SMD = 2.76 kg; 95% CI, 1.32 to 4.20; p = 0.0002) and functional disability (SMD = −0.47; 95% CI, −0.93 to −0.00; p = 0.05) compared to controls. Interventions with RE also showed superiority in the physical component of QOL (SMD = 0.42; 95% CI, 0.04 to 0.81; p = 0.03). Although enhanced physical performance was observed, statistical pooling was not possible due to limited data. Interventions with RE had a low incidence of adverse events, but data on disease progression and adherence were insufficient.ConclusionInterventions with RE benefits muscle strength, physical function, and QOL in SSc patients, though optimal protocols and adherence strategies need further investigation. More robust studies are required to refine training methods and enhance clinical trial designs.

Background Rheumatoid arthritis (RA) is a systemic autoimmune disease with articular and extra-articular manifestations. Chronic inflammation may contribute to sarcopenia independently of age. While cross-sectional studies report sarcopenia in 24–30% of RA patients, longitudinal data remain limited. This study aimed to assess long-term changes in sarcopenia and body composition in RA patients and explore their associations with clinical features and health outcomes. Methods In this prospective cohort study, 90 RA patients were followed for a median of 6.4 years (IQR: 5.8–7.0). Clinical features, falls, fragility fractures, and mortality were recorded. Body composition (BMI, appendicular lean mass index [ALMI], fat mass index [FMI]) was assessed using dual-energy X-ray absorptiometry; grip strength by JAMAR dynamometer; and physical performance by the Timed Up and Go test. Sarcopenia was defined using EWGSOP2 criteria. Statistical analyses included ANOVA, Kruskal–Wallis, chi-squared tests, generalized estimating equations, Kaplan–Meier curves, and regression models. Results At baseline, mean age was 56.5 ± 7.3 years, median disease duration 8.5 years (IQR:3.0–18.0), median DAS28-CRP 3.0 (IQR:1.0–3.0), and mean HAQ-DI 1.1 ± 0.9. Seven patients (7.7%) had sarcopenia, including one severe case. Most participants were overweight with elevated FMI. Sarcopenia prevalence and clinical characteristics remained stable, with no new sarcopenia cases during follow-up. ALMI increases were associated with FMI increases ( p  = 0.005). Baseline sarcopenia was not associated with falls, fractures, or mortality. Low muscle mass and poor physical performance were not linked to mortality, but low muscle strength showed a trend toward higher mortality risk (HR = 4.35, 95% CI: 0.51–37.25). After adjusting for age, disease duration, glucocorticoid dose, and DMARD use, low muscle strength was significantly associated with falls (B = 3.92,95% CI:1.03–15.02; p  = 0.046). No associations were found for low muscle mass, low physical performance, or sarcopenia with these outcomes. Conclusion In RA patients receiving regular care, sarcopenia prevalence remained high and stable. Low muscle strength was associated with falls and showed a trend toward increased mortality risk, possibly due to limited sample size, highlighting its potential prognostic value. However, the absence of a control group limits interpretation, as observed changes may reflect normal aging rather than disease-specific effects. Clinical trial number Not applicable.

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.

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.

Objective To compare the responses of velocities, ventilatory thresholds and maximum oxygen uptake (VO 2 max) through a maximum incremental test with blood flow restriction (Tmax-BFR) and without restriction (Tmax-TRAD) in active young people. Methods This is a crossover study. Eight active young men (25 ± 4 years, 173 ± 0.07 cm, 77.19 ± 7.5 kg) were submitted to cardiopulmonary exercise test performed with or without vascular occlusion and evaluated in the entire test by ergospirometry. The first and second ventilatory threshold (VT1 and VT2), VO 2 max and the speeds to reach the thresholds were analyzed, as well as the exhaustion time for each condition was analyzed. Results VT1, VT2 and VO 2 max are similar in both conditions. However, to reach VT2 and VO 2 max the speeds in the Tmax-BFR condition were significantly lower than in the Tmax-TRAD condition: 11.06 ± 1.56; 14.25 ± 1.03 km/h, p  = 0.0002; 13.06 ± 2.04; 16.62 ± 1.30 km/h, p  = 0.001. To reach VT1, there was a tendency to reduce the Tmax-BFR condition compared to Tmax-TRAD: 7.81 ± 0.92; 9 ± 1.36 km/h, p  = 0.0645 d : 1024. Still, the exhaustion time was significantly shorter for the Tmax-BFR condition compared to Tmax-TRAD: 11:16 ± 0.10 min; 15:02 ± 0.05 min (Table 2 ) p  = 0.007. Conclusion We identified reductions in velocities at ventilatory thresholds and VO 2 max when performed with occlusion. These data suggest the possible contribution of this resource to clinical practice, highlighting the achievement by individuals who do not tolerate high speeds on the treadmill or athletes who need to reduce speeds without decreasing exercise intensities.