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Worldwide estimates of childhood overweight and obesity are as high as 43 million, and rates continue to increase each year. Researchers have taken interest in the childhood obesity epidemic and the impact of this condition across health domains. The consequences of childhood and adolescent obesity are extensive, including both medical and psychosocial comorbidities. The purpose of this review was to consolidate and highlight the recent literature on the comorbidities associated with childhood obesity, both nationally and internationally. PubMed and PsychINFO searches were conducted on childhood obesity and comorbidities. The initial search of the terms obesity and comorbidity yielded >5000 published articles. Limits were set to include studies on children and adolescents that were published in peer-reviewed journals from 2002 to 2012. These limits narrowed the search to 938. Review of those articles resulted in 79 that are included in this review. The major medical comorbidities associated with childhood obesity in the current literature are metabolic risk factors, asthma, and dental health issues. Major psychological comorbidities include internalizing and externalizing disorders, attention-deficit hyperactivity disorder, and sleep problems. The high prevalence rates of childhood obesity have resulted in extensive research in this area. Limitations to the current childhood obesity literature include differential definitions of weight status and cut-off levels for metabolic risk factors across studies. Additionally, some results are based on self-report of diagnoses rather than chart reviews or physician diagnosis. Even so, there is substantial support for metabolic risk factors, internalizing disorders, attention-deficit hyperactivity disorder, and decreased health-related quality of life as comorbidities to obesity in childhood. Additional investigations on other diseases and conditions that might be associated with childhood obesity are warranted and intervention research in this area is critical.

Background. We describe the case of a patient affected by long-standing psoriatic arthritis, multiple joint deformities, and erythrodermic psoriasis, who was treated with an anti-IL-23 agent as first-line therapy.   Materials and Methods. A 58-year-old patient, living below the poverty line, unemployed since the onset of joint symptoms, underweight (BMI 14.9 kg/m²), smoker (20 pack-years), with previous HBV and HCV infections, affected by chronic kidney disease (stage II) and depressive syndrome, presented to our clinic in March 2024 because of multiple joint pain and swelling, functional limitations, erythema, and desquamation involving the entire body surface. He reported that he had never been treated until then.   Results. Physical examination and clinometric evaluation showed a PASI score of 39.2 and a DAPSA score of 55.9. Laboratory tests revealed red blood cells 3,180,000/mm³, hemoglobin 9.7 g/dL, white blood cells 15,800/mm³, neutrophils 74%, lymphocytes 16%, platelets 737,000/mm³, creatinine 1.8 mg/dL, uric acid 8.3 mg/dL, ESR 120 mm/h, and CRP 7.9 mg/dL. Radiographs of the hands and feet showed multiple deformities (ankylosis, erosions, and bone proliferation). A diagnosis of long-standing polyarticular psoriatic arthritis, erythrodermic psoriasis, and probable reactive thrombocytosis was made. In April 2024, lamivudine prophylaxis was started to prevent HBV reactivation, and in June 2024, therapy with an anti-IL-23 drug was initiated. At the follow-up visit in September 2024, the patient reported improvement in osteoarticular and cutaneous symptoms; clinometric indexes showed PASI 28.6 and DAPSA 24.6. Laboratory tests revealed white blood cells 9.0 × 10³/μL, neutrophils 50.5%, lymphocytes 33.2%, red blood cells 3.13 × 10 /μL, hemoglobin 10.8 g/dL, platelets 530 × 10³/μL, creatinine 1.40 mg/dL, uric acid 6.1 mg/dL, CRP 3.6 mg/dL, and ESR 113 mm/h. During follow-up, the clinical picture remained stable, without viral reactivation, new infections, worsening of renal involvement, and with improvement in depressive symptoms.   Conclusions. The clinical case we present shows the efficacy and safety of anti-IL-23 therapy in a patient with long-standing disease and multiple comorbidities.  

Background The prognosis of patients hospitalized with community-acquired pneumonia (CAP) with regards to intensive care unit (ICU) admission, short- and long-term mortality is correlated with patient’s comorbidities. For patients hospitalized for CAP, including P-CAP, we assessed the prognostic impact of comorbidities known as at-risk (AR) or high-risk (HR) of pneumococcal CAP (P-CAP), and of the number of combined comorbidities. Methods Data on hospitalizations for CAP among the French 50+ population were extracted from the 2014 French Information Systems Medicalization Program (PMSI), an exhaustive national hospital discharge database maintained by the French Technical Agency of Information on Hospitalization (ATIH). Their admission diagnosis, comorbidities (nature, risk type and number), other characteristics, and their subsequent hospital stays within the year following their hospitalization for CAP were analyzed. Logistic regression models were used to assess the associations between ICU transfer, short- and 1-year in-hospital mortality and all covariates. Results From 182,858 patients, 149,555 patients aged ≥ 50 years (nonagenarians 17.8%) were hospitalized for CAP in 2014, including 8270 with P-CAP. Overall, 33.8% and 90.5% had ≥ 1 HR and ≥ 1 AR comorbidity, respectively. Cardiac diseases were the most frequent AR comorbidity (all CAP: 77.4%). Transfer in ICU occurred for 5.4% of CAP patients and 19.4% for P-CAP. Short-term and 1-year in-hospital mortality rates were 10.9% and 23% of CAP patients, respectively, significantly lower for P-CAP patients: 9.2% and 19.8% (HR 0.88 [95% CI 0.84–0.93], p < .0001). Both terms of mortality increased mostly with age, and with the number of comorbidities and combination of AR and HR comorbidities, in addition of specific comorbidities. Conclusions Not only specific comorbidities, but also the number of combined comorbidities and the combination of AR and HR comorbidities may impact the outcome of hospitalized CAP and P-CAP patients.

Immunological mechanisms have come into the focus of current translational stroke research, and the modulation of neuroinflammatory pathways has been identified as a promising therapeutic approach to protect the ischemic brain. However, stroke not only induces a local neuroinflammatory response but also has a profound impact on systemic immunity. In this review, we will summarize the consequences of ischemic stroke on systemic immunity at all stages of the disease, from onset to long‐term outcome, and discuss underlying mechanisms of systemic brain‐immune communication. Furthermore, since stroke commonly occurs in patients with multiple comorbidities, we will also overview the current understanding of the potential role of systemic immunity in common stroke‐related comorbidities, such as cardiac dysfunction, atherosclerosis, diabetes, and infections. Finally, we will highlight how targeting systemic immunity after stroke could improve long‐term outcomes and alleviate comorbidities of stroke patients. Graphical Abstract This Review discusses the impact of ischemic stroke on systemic immunity, its interaction with common comorbidities, and the underlying mechanisms of systemic brain‐immune communication.

Knowledge of the impact of perimenopause on women with attention-deficit/hyperactivity disorder (ADHD) is lacking. We compared levels of perimenopausal symptoms and prevalence of severe perimenopausal symptoms among women with and without ADHD across age groups. In this cohort study, we used data from the population-based Stress-and-Gene-Analysis cohort study. ADHD diagnosis was self-reported at baseline and 5-year follow-up. At follow-up, we assessed ADHD symptoms using the Adult ADHD Self-Report Scale, perimenopausal symptoms (psychological, somatic, and urogenital) using Menopause Rating Scale (MRS), and general physical symptoms using Patient Health Questionnaire. We described mean scores and mean difference on MRS among women with and without ADHD with linear regression models and contrasted the prevalence of severe perimenopausal symptoms among women with and without ADHD, calculating prevalence ratios (PRs) with 95% confidence intervals (CIs) using modified Poisson regression models. Women with ADHD (  = 535) had higher total perimenopausal symptom scores (18.0 vs. 13.0,  < 0.01) than women without ADHD (  = 4,857). The difference was most pronounced among women aged 35-39 years (19.0 vs. 12.5,  < 0.01). The prevalence of severe perimenopausal symptoms was significantly higher among women with ADHD compared to those without, both overall (54.2% vs. 30.1%, PR = 1.80, 95% CI = 1.64-1.98) and on all subdimensions (psychological: 58.6% vs. 36.0%, PR = 1.63, 95% CI = 1.51-1.76; somatic: 30.4% vs. 13.9%, PR = 2.20, 95% CI = 1.88-2.57; uro-genital: 43.2% vs. 27.5%, PR = 1.57, 95% CI = 1.40-1.77). Women with ADHD have higher prevalence of severe perimenopausal symptoms. These symptoms present at an earlier age than among women without ADHD, indicating an earlier onset age of perimenopause in ADHD.

Background : Systemic lupus erythematosus (SLE) can result in impaired daily physical function through various mechanisms including active disease, chronic damage, and mental health symptoms that are common in the disease. However, the key drivers of reduced physical function are poorly understood, and no large-scale global studies investigating this have been conducted to date. Objectives : To investigate key factors that contribute to impaired physical function in SLE globally. Methods : SLE patients were identified from the COVAD 2 database, a global register of more than 20,000 respondents. Healthy controls (HC) were included to compare differences in physical function using the Patient Reported Outcome Measurement Information System (PROMIS) questionnaire. Demographics, medication, comorbidities, disease activity, Global Physical Health (GPH) and Global Mental Health (GMH) were collected. Multivariable regression analysis was used to identify contributing factors to favourable or poor physical function (measured by PROMIS Physical Function shortform PF-10a score). Results : 979 SLE patients and 3358 HCs were included in analysis. Patients with SLE had significantly lower PF-10a score as compared to HCs (median 42, IQR 36-47 vs median 49, IQR 45-50, p<0.0001). Determinants of physical function status in patients with SLE are summarised in Table 1. Briefly, factors associated with poor physical function included increasing age (-0.042, 95% CI -0.069 to -0.015, p=0.002) and methotrexate use (-0.928, 95% CI -1.844 to -0.012, p=0.047). Diabetes (-1.862, 95% CI -3.481 to -0.243, p=0.024) and interstitial lung disease (ILD) (-2.441, 95% CI -4.366 to -0.517, p=0.013), but not asthma or COPD, also contributed to lower PF-10a score. From a mental health perspective, anxiety (-0.970, 95% CI -1.853 to -0.087, p=0.031) but not depression contributed to a lower physical function score. Higher Pain Visual Analogue Scales (VAS) (-2.889, 95% CI -3.107 to -2.671, p<0.001) and Fatigue VAS (-1.459, 95% CI -1.974 to -0.945, p<0.001) also contributed to lower PF-10 scores. Hydroxychloroquine use (0.844, 95% CI 0.190 to 1.498, p=0.012) and higher GPH score (2.287, 95% CI 2.079 to 2.494, p<0.001) were associated with favourable physical function. Conclusion : Patients with SLE show significantly reduced physical function compared with HCs. Key contributors to poor physical function include intercurrent diabetes and ILD. Screening for, and aggressive early treatment of these conditions may confer improved long-term function. As expected, higher levels of pain and fatigue were associated with poor physical function. Methotrexate use was also identified as a contributing factor to reduced function, which could represent its use in articular manifestations that limit physical function. Importantly, use of hydroxychloroquine was associated with favourable physical function, adding to the well-recognised benefits of this drug in SLE.

Background:Patients afflicted with rheumatoid arthritis (RA) face an elevated risk of cardiovascular diseases (CVD). Previous studies have indicated that high levels of gamma-glutamyl transpeptidase (GGT) in the blood are associated with an increased risk of CVD. This investigation seeks to assess whether DAS28-GGT can serve as a predictor for cardiovascular risk in RA patients.Objectives:This study aims to explore the potential of DAS28-GGT as a predictor for cardiovascular risk in rheumatoid arthritis patients, contributing valuable insights into the relationship between disease activity, GGT levels, and cardiovascular health.Methods:We conducted a descriptive cross-sectional study involving RA patients (according to ACR/EULAR 2010 criteria) who were monitored for a minimum of 1 year. Sociodemographic parameters and RA characteristics, including DAS28-CRP activity score, GGT levels, and cardiovascular risk (CVR) assessed by the Framingham cardiovascular risk score, were evaluated. DAS28-GGT was calculated at baseline using the formula: 0.56VNSD-28 + 0.28VNSG-28 + 2*|n(yGT)+0.014*VAS.Results:A total of 100 patients, with an average age of 51±11 years, were included. The mean disease duration was 7.67±6.8 years. Rheumatoid factors and ACPAs were positive in 51% and 56% of patients, respectively. The mean DAS28-CRP was 4.2±1.75. GGT levels ranged from 9 to 279 U/L, with a mean value of 34±21 U/L, and the average DAS28-GGT was 7.45±2.06. In our cohort, 28% of patients exhibited a high CV risk, defined by a Framingham cardiovascular risk score exceeding 10%. Additionally, DAS28-GGT showed a significant correlation with patient age (r=0.61; p<0.001) and Framingham risk score (r=0.52, p<0.001).Conclusion:This study underscores the importance of assessing cardiovascular comorbidities in RA patients and suggests the potential utility of DAS28-GGT as a predictor for cardiovascular risk.REFERENCES:NIL.Acknowledgements:NIL.Disclosure of Interests:None declared.

Background:Psoriatic arthritis (PsA) disease activity in one area may still be present even after controlling for disease activity in another, leading to a treatment strategy change.Objectives:This study evaluated patients’ frequency and contributing factors with potential ‘difficult-to-treat PsA (D2TPsA), similar to the European Alliance of Associations for Rheumatology definition of D2T Romatoid Arthritis [1].Methods:A retrospective study was conducted at two tertiary centers to define potential D2TPsA, which was described as failure of ≥ 1 csDMARD and ≥ 2 b/tsDMARDs with different mechanisms of action.Results:Of the 171 patients included in the study, 74 (67.3%) were women; the average age was 48.16 (±11.23). D2TPsA was detected in 33 patients (19.3%). This group exhibited a longer disease duration, higher disease burden (median number of tender and swollen joints, patient and physician global evaluation, morning stiffness, erythrocyte sedimentation rate and C-reactive protein, Disease Activity Score for Psoriatic Arthritis), HLAB27 positivity, and higher prevalence of polyarticular involvement (Table 1). Secukinumab use and glucocorticosteroids (GCs) dosage were significantly higher in the D2TPsA group. Comorbidities such as Fibromyalgia (FM) and diabetes mellitus (DM) and the median number of comorbidities were significantly higher in D2T PsA. In multivariate analysis, current treatment with secukinumab, FM, DM, and polyarticular disease was independently associated with D2T PsA (Table 2).Conclusion:This study underscores the impact of comorbidities on disease activity in PsA. It emphasizes the need for more comprehensive studies to differentiate between treatment goals hindered by comorbidities and truly treatment-resistant patients.REFERENCES:[1] Nagy G, Roodenrijs NMT, Welsing PMJ, Kedves M, Hamar A, Van Der Goes MC, et al. EULAR definition of difficult-to-treat rheumatoid arthritis. Ann Rheum Dis. 2021 Jan 1;80(1):31–5.Table 1.Comparison of demographic, and clinical characteristics of non-D2T and D2T PsA patientsVariablesOverall N:171Non-D2T N= 138D2T N = 33p-valueGender, (female), n (%)116 (67.8)94 (68.1)22 (66.7)0.878Age, year, mean±SD48.5±11.548.4±11.948.8±9.50.072BMI (kg/m2), mean±SD29.2±528.9±4.930.6±5.10.150PsA duration, year, median(IQR)4 (10)4 (9)9.5 (9)0.019Psoriasis duration, year, median(IQR)13 (20)13(20)16.5 (14)<0.001PsA typesAxial involvement, n (%)Polyarticular involvement, n(%)Oligoarticular, n(%)Distal interphalangeal predominant, n (%)Arthritis mutilans, n (%)31 (18.1)72 (42.1)57 (33.3)10 (5.8)1(0.7)29 (21)52 (37.7)46 (33.3)10 (7.2)1 (0.6)2 (6.1)20 (60.6)11 (33.3)0(0)0(0)0.055Polyarticular involvement, n(%)68(39.8)49 (35.5)19(57.6)0.020Peripheral involvement, ever,n (%)142 (83)110 (79.7)32 (97)0.018HLAB27 positivity, n (%) N:8414 (16.7)8 (11.8)6 (37.5)0.023Number of comorbidities, median(IQR)1 (2)1 (1)1(2)0.047Diabetes mellitus, n (%)30 (17.5)16 (11.6)14 (42.4)<0.001Fibromyalgia, n (%)20 (11.8)13 (9.4)7 (21.9)0.049CRP, mg/dl, median (IQR)4.8 (7.9)3.8 (6.4)9.4 (7)<0.001DAPSA, mean±SD17.9 (14.4)11.5 (13.6)24.6 (21.1)<0.001BSA, median (IQR)1 (2)1(2)0 (1)0.038GCs dosage, mg/day, mean± SD2.31(2.2)1.98(0.23)3.14(0.5)0.009Biological therapy, n (%)90 (52.6)57 (41.3)33(100)<0.001Secukinumab, n (%)25 (14.6)10 (7.2)15 (45.5)<0.001≥ 2 biological use, n (%)65 (38)32 (23.2)33(100)<0.001BMI, body mass index; RF, Rheumatoid factor; PsA, Psoriatic arthritis; SD standard deviation. N, number. BSA, Body surface area; CRP, C-reactive protein; DAPSA, Disease Activity Score for Psoriatic Arthritis; GCs, Glucocorticoids; N, number of patients; TNFi, TNF alpha inhibitors.Table 2.Evaluation of factors associated with D2T PsA in multivariate analysisVariablesO.R%95 C. I lower%95 C. I upperP valuesPoliarticular involment9.3531.69051.766.010HLAB27 positivity5.016.79931.476.085Presence of diabetes mellitus15.4342.016118.133.008Presence of fibromyalgia9.2401.26868.065.028Current treatment withsecukinumab17.5942.936105.444.002CI, confidence interval. O.R., odds ratio.Acknowledgements:NIL.Disclosure of Interests:None declared.

Background : Idiopathic inflammatory myopathies (IIM) encompass a group of disorders characterized by muscle inflammation, weakness, and varying levels of systemic involvement. These conditions profoundly impact patients’ quality of life (QoL) due to their chronic nature, physical impairments, and accompanying mental health challenges. Recent literature has highlighted the prevalence of comorbidities in IIM, with cardiovascular damage and depression being particularly prominent and significantly influencing on patient’s QoL. Objectives : This study aims to explore the influence of mental health disorders (MHDs) on the QoL of in patients with IIM. Methods : We examined the prevalence of MHDs in IIM adult patients using the COVAD-2 data. Mental Health Multimorbidity (MHM) was defined as the presence of ≥2 MHDs. PROMIS global physical health (PGP), mental health (PMH), fatigue 4a (F4a), and physical function (SF10) were analyzed using descriptive statistics and linear regression. Hierarchical Clustering on Principal Components was performed to delineate the grouping of IIM patients. Results : Of the 10,740 COVAD participants, 1,523 reported a diagnosis of IIM. The IIM cohort included 470 (30.8%) patients with dermatomyositis (DM), 217 (14.2%) with polymyositis (PM), 375 (24.6%) with Inclusion body inclusion myositis (IBM), 103 (6.7%) with antisynthetase syndrome (ASS), 96 (6.3%) with immune-mediated necrotizing myopathy (IMNM), and 239 (15.6%) with overlap myositis (OM), while the remaining patients were considered “unclassified myositis.” The demographics and characteristics of the study cohort are shown in Table 1A. MHD was present in 34% of the IIM patients, predominantly manifesting as anxiety, with no significant difference across subgroups, except for insomnia, which was notably more prevalent in the OM subgroup (P=0.001).No significant differences were found in the distribution of MHM across the subgroups. It was also noted that patients with MHDs exhibited poorer physical function, as evidenced by lower PGP, PGM, and SF10 scores, and higher F4a scores (all P<0.001). Furthermore, the presence of MHM and active disease were significant predictors of all assessed PROMIS domains (all P<0.001). Age and gender were not found to be associated with physical function scores.Three distinct clusters were identified (Table 2A). Cluster 1 appears to be characterized by patients without a significant multimorbidity burden, generally healthier scores, and an older average age. Cluster 2, with the youngest average age, shows adequate health scores and fewer multimorbidities. Cluster 3, with both single and multiple morbidities, exhibits more mental health issues, poorer health scores, and a middle-range average age. In Cluster 1, DM and IBM were the most common subtypes, whereas OM was predominant in Cluster 2. In Cluster 3, the distribution was more varied, but DM and OM were relatively more common than other subtypes. Conclusion : Our study indicates that patients with a multitude of coexisting conditions and MHDs tend to report poorer outcomes in various aspects of health, such as overall physical and mental health, physical functioning, and fatigue, especially in certain demographic with DM or OM. Recognizing the complex needs of these patients, our findings suggest a need for tailored care approaches. These may encompass specialized medical services or prioritized follow-up strategies to minimize treatment delays. Additionally, we must be cognizant of the increased demand these patients may place on healthcare resources.

Background:The epidemiological characteristics of the disease determine that patients with knee osteoarthritis (OA) are associated with at least one other long-term condition, which falls under the definition of multimorbidity. This can affect joint functionality and have a potential importance for patient management.Objectives:To determine the coexisting conditions in people with OA and whether the number of comorbidities were linked with knee functional status.Methods:In a cross-sectional study, patients who fulfilled the ACR classification criteria for knee OA (1991) were recruited from the University Rehabilitation Center. Data collection included demographics, present comorbidities and how these linked with pain intensity (0–100), and joint function according to Knee Injury and Osteoarthritis Outcomes Score (KOOS) with 5 domains (Pain, Symptoms, Activity in Daily Living (ADL), Sport and recreation (Sport/rec.) and Quality of life (QoL).Results:The study included 164 consecutive patients, mean age (M±SD) of 62,2±8,76 years, 77,4% females. The clinical exam and medical history analysis reveal 22 patients with a single chronic disease (OA-Gr.1) and 142 with 2 or more long-term conditions (Gr.2 patients with multimorbidity). The level of pain was similar in both groups (62,27±14,1 vs 61,7±17,1 mm, p>0.05). The KOOS results showed a reduction of knee function in both groups Gr1. (Pain-62,6 ±15,0, Symptoms –55,9±10,47, ADL –48,8±12,2, Sport/rec.– 21,8±12,4, and QoL –42,9±24,1,%) in Gr.2 (Pain-52,9±18,7, Symptoms –58,1±19,8, ADL-40,9±18,5, Sport/rec.– 14,8±21,9, and QoL –30,3±22,7,%), although joint functionality seem to be more affected in the Gr.2 with multimorbidity, there was no statistical difference (p>0.05). However, the increase in the number of associated pathologies correlates moderately with a degradation of the ability to do heavy activities and a lower quality of life (r=-0,3, p <0,0001).Conclusion:Multimorbidity leads to physical decline, and people with more conditions experience pronounced joint impairment, which seems to increase with a rising number of long-term conditions.REFERENCES:NIL.Acknowledgements:NIL.Disclosure of Interests:None declared.