Phone App Helps Cut Pain, Aid Functioning With Osteoarthritis
A physical therapy app that offers a self-managed exercise and education program helps to improve pain and physical function for patients with osteoarthritis, according to a study published in PLOS ONE. Researchers used data from patients with hip and knee osteoarthritis participating in a digital self-management program (0 to 24 weeks: 499 patients; 0 to 48 weeks: 138 patients). For the 24-week group, pain numeric rating scale scores (0 to 10) decreased monthly by −0.43 units (mean knee pain, 5.6 to 3.1; mean hip pain, 5.9 to 3.8) and 30-second chair stand test repetitions increased monthly by 0.76 repetitions (mean for knee, 10.0 to 14.3 repetitions; mean for hip, 10.9 to 14.8). For the group with 48-week adherence, pain decreased monthly by −0.39 units (mean knee pain, 5.7 to 3.2; mean hip pain, 5.8 to 3.8) and repetitions increased by 0.72 repetitions (mean repetitions for knee, 10.3 to 14.4; mean for hip, 11.1 to 14.9). “We expected patients to see an improvement, but these results exceeded our expectations,” a coauthor said in a statement. “This demonstrates that using digital tools when treating chronic illnesses such as osteoarthritis can work very well.”


Factors ID’d in Quitting Smoking for Rheumatoid Arthritis Patients
Certain factors are tied to an increased likelihood of quitting smoking in patients with rheumatoid arthritis (RA), according to a study published in Arthritis Care & Research. For the study, electronic health record data from two health systems were used to identify 3,577 patients with at least two ICD codes for RA between 2005 and 2016. Patient- and healthcare-level predictors of smoking cessation in patients with RA were evaluated. At baseline, 507 patients smoked, 29% of whom quit during a median of 4.75 years. Baseline smokers were significantly more likely to be male, aged 40 to 59 years, of black race, and be Medicaid beneficiaries; however, none of these factors predicted cessation. Patients were more likely to quit if they were new to rheumatology care (adjusted odds ratio [aOR], 1.60) or were treated in a rural community health system (aOR, 1.66). Seropositive patients were less likely to quit smoking (aOR, 0.57). “[Our findings] highlight the need to engage seropositive patients who smoke and are at risk for worse rheumatoid arthritis and cardiopulmonary diseases, which we know are leading causes of death in rheumatoid arthritis,” a coauthor said in a statement.

Cumulative Dose of Oral Steroids Associated With HTN Incidence
For adults with any of six chronic inflammatory diseases, a cumulative dose of oral glucocorticoids is associated with an increased incidence of hypertension, according to a study published in CMAJ, the journal of the Canadian Medical Association. Study investigators analyzed electronic health records from 389 practices during 1998 to 2017 for adults diagnosed with any of six chronic inflammatory diseases and with no history of hypertension. The effect of oral glucocorticoids on the incidence of hypertension was examined. During a median follow-up of 6.6 years, 34.8% of the 71,642 patients in the cohort developed hypertension. Hypertension had an incidence rate of 46.7 per 1,000 person-years. With a higher cumulative glucocorticoid prednisolone-equivalent dose, the incidence rates increased, from 44.4 to 45.3 to 49.3 to 55.6 per 1,000 person-years in periods of nonuse versus periods with >0.0 to 959.9 mg, 960 to 3,054.9 mg, and ≥3,055 mg, respectively (hazard ratios, 1.14, 1.20, and 1.30, respectively). For the six diseases studied, cumulative effects were seen, but the dose-response effects were not observed for daily dose. “We suggest that blood pressure be closely monitored for early identification and management of hypertension in patients with diseases treated with long-term glucocorticoids,” the authors write. “Given that glucocorticoids are widely prescribed, the associated health burden could be high.”

Asthma, COPD Linked to Higher Risk for Rheumatoid Arthritis
Asthma and chronic obstructive pulmonary disease (COPD) are associated with an increased risk for rheumatoid arthritis (RA), according to a study published in Arthritis & Rheumatology. Researchers performed a prospective cohort study involving 205,153 women in the Nurses’ Health Study (NHS) and NHSII to examine whether asthma or COPD were associated with RA. During 4,384,471 person-years of follow-up, the study team identified 15,148 women with confirmed asthma, 3,573 with confirmed COPD, and 1,060 incident RA cases. Compared with no asthma/COPD, after adjustment for covariates—including smoking pack-years/status—asthma was associated with increased RA risk (hazard ratio [HR], 1.53). Among never-smokers only, asthma remained associated with increased RA risk (HR, 1.53). COPD was also associated with elevated RA risk (HR, 1.89). In the subgroup of ever-smokers aged >55 years, the associations of COPD with RA were most pronounced (HR, 2.20). “These novel findings further implicate chronic airway inflammation in the pathogenesis of RA, and they identify populations at-risk for RA for the purposes of research as well as informing clinical care,” the authors