Rheum Round-up: Depression Worsens QoL in RA, Vitamin D Combo Reduces Fracture Risk, and more

Here are the top stories recently covered by DocWire News in the Rheumatology section. In this edition, read about the effect of depression on quality of life in rheumatoid arthritis patients, the usefulness of vitamin D combined with calcium, factors linked to work disability due to chronic pain, and craniosacral therapy for chronic pain. Also: a new blog post about when you should see a rheumatologist for joint pain.

Rheumatoid arthritis (RA) patients may suffer from worse quality of life if they have depression, according to a new systematic review and meta-analysis. Seven eligible studies encompassing 1,078 total RA patients were included in the study. Patients with depression, compared to those without, had a significantly higher total Disease Activity Score in 28 joints (standardized mean difference [SMD]=0.47; 95% confidence interval [CI], 0.10-0.85; P=0.01). Patients with depression also had lower scores in all measured Short Form-36 questionnaire dimensions: physical function, role physical function, emotional role function, vitality, mental health, social function, body pain, general health, physical component scale, and mental component scale. However, there were no significant between-group differences regarding pain (SMD=0.57; 95% CI, –0.03 to 1.17; P=0.06) and functional disability (SMD=0.48; 95% CI, –0.03 to 0.99; P=0.43).

Although ineffective on its own, a daily regimen of vitamin D paired with calcium may reduce the risk of fracture. The observational studies meta-analysis included 11 studies with 39,141 total participants, 6,278 fractures and 2,367 hip fractures. For every 10.0 ng/mL-increase in 25-hydroxyvitamin D (25[OH]D) concentration, the adjusted risk ratio (RR) for any fracture was 0.93 (95% confidence interval [CI], 0.89-0.96), while the adjusted RR for hip fracture was 0.80 (95% CI, 0.75-0.86). The meta-analysis of randomized controlled trials (RCTs) of vitamin D supplementation alone (daily or intermittent dose of 400-30,000 IU) included 11 trials encompassing 34,243 total participants, 2,843 fractures, and 740 hip fractures. In this analysis, no risk reduction was observed in any fracture (RR=1.06; 95% CI, 0.98-1.14) or hip fracture (RR=1.14; 95% CI, 0.98-1.32), but the authors noted that “these trials were constrained by infrequent intermittent dosing, low daily doses of vitamin D, or an inadequate number of participants.” A different meta-analysis of RCTs included six trials encompassing 49,282 total participants, 5,449 fractures, and 730 hip fractures. These trials assessed combined vitamin D and calcium supplementation; in this analysis, the authors observed a 6% reduction in risk for any fracture (RR=0.94; 95% CI, 0.89-0.99) and 16% reduction in risk for hip fracture (RR=0.84; 95% CI, 0.72-0.97).

A new study explored demographic, health, and psychosocial work environment factors that may be correlated with future work disability and unemployment among workers with low back pain (LBP) and/or neck shoulder pain (NSP). The current analysis included 5,556 participants, who were followed up for work disability (sick leave >90 days or a disability pension) and unemployment (>180 days in a year) through Dec. 31, 2013. Most of the study sample (60.5%) was female, 48.7% was aged between 38 and 47 years, and 45.3% only had NSP. Incident sick leave (>90 days) or disability pension was observed in 13.7% of participants; 10.8% were unemployed for more than 90 days during a one-year period. Women were more likely than men to experience sick leave/disability pension or unemployment. The youngest age group, compared to the oldest, was more likely to have unemployment but less likely to have sick leave/disability pension. When assessing the study sample as a whole, participants with a higher education were less likely than those with secondary education to have sick leave/disability pension, but the researchers posited that this was due to familial factors.

Patients who suffer from chronic pain may benefit from Craniosacral Therapy (CST), according to a new systematic review and meta-analysis. Final analysis included ten RCTs encompassing 681 total patients with neck and back pain, migraine, headache, fibromyalgia, epicondylitis, and pelvic girdle pain. CST was associated with more significant effects, compared to treatment as usual, on pain intensity (standardized mean difference [SMD]=–0.32; 95% confidence interval [CI], –0.61 to –0.02) and disability (SMD=–0.58; 95% CI, –0.92 to –0.24). Compared to manual/non-manual sham, CST was more effective in reducing pain intensity (SMD=–0.63; 95% CI, –0.90 to –0.37) and disability (SMD=–0.54; 95% CI, –0.81 to –0.28). When compared to active manual treatments, CST was more effective in reducing pain intensity (SMD=–0.53; 95% CI, –0.89 to –0.16) and disability (SMD=–0.58; 95% CI, –0.95 to –0.21). After six months, CST was more effective than sham in reducing pain intensity (SMD=–0.59; 95% CI, –0.99 to –0.19) and disability (SMD=–0.53; 95% CI, –0.87 to –0.19). All secondary outcomes favored CST, with the exception of six-month mental quality of life when compared to sham. No serious adverse events (AEs) were reported in the five RCTs that analyzed safety data, and minor AEs did not largely differ between the groups.

We all experience joint pain from time-to-time. In fact, in some cases (especially during flu season), aches and pains are actually a sign that your immune system is properly functioning and warding off infection. However, when pain in your muscles, and joints persist for more than a few days, you should consider seeing a doctor – specifically, one specializes in rheumatology. Rheumatic diseases, such as rheumatoid arthritis (RA) are often challenging to identify in their initial states, so it’s paramount to heed a few early warning signs that may indicate that your joint pain is more than more than routine.

Did you miss DocWire’s 2019 rheumatology in review? Click here to read our top stories in the rheumatology section in 2019.