Rheum Round-up: Arthritis and Mental Health, Do Men and Women Report OA Pain Differently?, and More

Here are the top stories covered by DocWire News this week in the Rheumatology section. In this edition, read about the link between arthritis and anxiety, how different patients report pain, the link between muscle mass and mortality, and the impact of diet on frailty.

Patients with rheumatoid arthritis (RA) may have an increased risk for anxiety, according to a meta-analysis. The researchers queried several databases, including PubMed, EMBASE, and Web of Science. Articles published through July 23, 2018, were included, and researchers used an odds ratio (OR) with 95% confidence interval (CI) to determine the association. “The random-effects model played a crucial role in calculating the pooled odds ratio, while subgroup analyses and sensitivity analyses were also performed,” wrote the authors. The final analysis included 10 studies encompassing 139,875 patients and 6,201 cases of anxiety. All patients did not have anxiety at baseline. Follow-up spanned from one year to 9.2 years. “Overall, the quantitative meta-analysis suggested that subjects with RA were associated with a significantly increased risk of anxiety incidence (OR, 1.20; 95% CI, 1.03–1.39) than those without,” the researchers found. Based on their findings, the authors concluded that RA patients may be more likely to develop anxiety. They recommended that, looking ahead, studies should “explore whether clinical manifestations of RA are modifiable risk factors for anxiety.”

A new study compared expression of pain in patients with osteoarthritis (OA) of the hip or knee scheduled for joint arthroplasty based on age and sex. Younger patients had less radiographically advanced OA than the older cohort, but they used more affective words (POM) and words with higher affective intensity (median scores: < 65 years, 8 [3–39] vs. ≥ 65 years, 5.5 [2–27]), and they reported more symptoms per the Knee Injury and Osteoarthritis Outcome Score (KOOS) or Hip Disability and Osteoarthritis Outcome Score (HOOS). Visual analog scale (VAS) and KOOS/HOOS pain outcomes did not significantly differ between the age groups. The use of analgesics was higher among women (45.7%) compared to men (26.5%), and women also rated their pain higher (mean POM-VAS: women, 42 [SD 24] vs. men, 31 [SD 19]). There were no between-group differences in sensory or affective POM-Words, or radiographic OA grade.

Older adults may benefit from dual-energy X-ray absorptiometry (DXA) scanning, according to a study, which linked low muscle mass (LMM) to increased mortality in adults aged ≥ 65 years. The researchers assessed body composition in older community-dwelling adults, including an evaluation of total fat mass, visceral adipose tissue (VAT), appendicular lean mass (ALM), and different definitions of LMM. When evaluating the male patients, in adjusted analyses, there was a significantly increased all-cause mortality risk associated with LMM (odds ratio [OR], 11.36; 95% confidence interval [CI], 2.21–58.37; P = 0.004) and VAT (OR, 1.99; 95% CI, 1.38–2.87; P < 0.001, for each 100‐g increase). However, total fat was correlated with a decreased mortality risk (OR, 0.48; 95% CI, 0.33–0.71; P < 0.001). When looking at cardiovascular mortality, the results were similar. In women, the only predictor of mortality was LMM, but the association was significant for both all-cause (OR, 62.88, 95% CI, 22.59 to 175.0, P < 0.001) and cardiovascular (OR, 74.54, 95% CI, 9.72 to 571.46, P < 0.001) mortality.

A healthy diet may reduce the risk of frailty in older adults, a study has found. The final analysis included 2,154 participants (mean age at baseline, 74.5 years; 51.5% were female), who were classified as robust (n = 1,020) or pre-frail (n = 1,134) at baseline. In the total cohort, most patients had a medium Healthy Eating Index score (72.9%), while 6.5% scored “poor” and 20.6% scored “good.” All patients were followed for a mean 3.5 years, during which time 277 patients developed frailty. In adjusted analyses, poor-quality diets was associated with a 92% higher frailty incidence compared to good-quality diets; in medium-quality diets, the incidence was 40% greater. When looking at the robust cohort, which had a mean 2.7 years of follow-up, 629 out of 1,020 patients developed frailty or pre-frailty. The study authors observed in this cohort, “The associations of overall diet quality with incident pre‐frailty or frailty were in the same direction as for frailty, but not statistically significant. A 10‐g lower vegetable protein intake was associated with a 20% higher incidence of pre‐frailty or frailty. No associations were observed with energy intake, total protein intake, or animal protein intake.”