News in brief: Knee OA benefits of diet and exercise maintained after five years; Inflammatory arthritis linked to male infertility; The most important genetic risk factor for RA-ILD

Thursday, 12 Aug 2021

Knee OA benefits of diet and exercise maintained after five years

Diet and exercise have long term beneficial effects for older adults with knee osteoarthritis, even if patients regain the weight lost during an initial intervention, a US study has shown.

Benefits on knee OA pain were seen up to five years after people started a 1.5 year Intensive Diet and Exercise in Arthritis (IDEA) trial, according to a follow up study of the 399 participants.

The participants were over the age of 55, overweight and obese adults with knee OA, of whom 91% achieved 5% weight loss after diet and exercise and 80% achieved a 5% weight loss after a diet-only intervention.

When followed up at five years, body weight had increased in the diet and exercise group by an average of 5.9 kg and by 3.1 kg (in the diet group.

Nevertheless, compared to baseline, WOMAC pain scores were lower in all participant groups at 5-year follow-up: -1.2 for diet and exercise; -1.2 for diet only group.

The study authors said the findings showed that diet and exercise interventions could reverse the usual trajectory of weight gain in older people with knee OA and deliver clinically meaningful benefits in pain and function that were maintained over subsequent years

The findings are published in Arthritis Care and Research.

Inflammatory arthritis linked to male fertility issues

Inflammatory arthritis (IA) can negatively impact male fertility, with biological mechanisms, pharmacological treatment and psychosocial factors all potentially inhibiting factors, a study has found.

Research led by Dr Luis Fernando Perez-Garcia, a rheumatologist at the Erasmus Medical Centre in The Netherlands, discovered that men who were diagnosed with IA before or during the peak of their reproductive age had a lower fertility rate and also a higher rate of childlessness.

The multi-centre, cross-sectional study, published in the Annals of Rheumatic Diseases surveyed 628 men with IA aged 40 years or older who considered their family size to be complete.

Men who were diagnosed at age 30 years or younger were found to have a significantly lower mean number of children than those diagnosed between 31 and 40 years of age and 41 years or older (1.32 versus 1.60 and 1.88, respectively).

Significantly higher proportions of men diagnosed with IA before and during the peak of their reproductive years were involuntarily childless compared to men diagnosed from 41 years old (12% and 10% vs 4%, respectively).

It was also found that these age groups were twice as likely to be evaluated for fertility problems than the group diagnosed at 41 years and above (20.7% and 20.6% vs 11%, respectively), and that those diagnosed at 30 years and 31-40 years were more likely to have abnormal sperm quality compared to the general adult male population (8% and 6.5% vs 2%, respectively).

The authors noted that inflammation and pharmacological treatment could be contributing to impaired fertility in men with IA, as well as psychosocial factors and co-morbidities associated with the condition. However, they also highlight that basic, translational and epidemiological studies are needed in order to better understand their impact.

“The diagnosis of IA before or during the peak of reproductive age can result in impaired male fertility,” the authors conclude. “Rheumatologists should be aware of this novel association and approach their patients accordingly.”

The most important genetic risk factor for RA-ILD

One in six patients with rheumatoid arthritis (RA) is carrying the MUC5B mutation and developing RA-related interstitial lung disease (ILD) by the age of 80, according to key findings of a US study .

Using FinnGen, a collection of prospective epidemiological and disease-based cohorts, as well as hospital biobank samples, the researchers determined that the lifetime risk of ILD in RA for those with the MUC5B promoter variant was 16.8% – compared to 6.1% for non MUC5B carriers and 4.4% for the general population – and that this seemed to specifically emerge after age of 65 years.

Also, while men with RA were found to have a higher lifetime risk of ILD than women with the disease, lifetime risk for RA-ILD among those carrying the MUC5B promoter variant “was quite high for both men (20.9%) and women (14.5%)”, the authors noted in their paper published in the Annals of the Rheumatic Diseases.

According to lead author Dr Jeffrey Sparks, the MUC5B promoter variant has clearly emerged as the “single most important genetic risk factor for RA-ILD” and any model of RA-ILD pathogenesis, particularly usual interstitial pneumonia (UIP), needed to incorporate the variant into its framework.

However, he added that while the findings “have clear research importance for the field of RA-ILD” its “clinical application is not yet determined” and that certain study limitations need to be considered.

For one, data on cigarette smoking, which likely mediates the relationships between MUC5B, RA, and RA-ILD, was not included in the analysis, nor were other factors that might impact the risk such as RA-related autoantibody levels, disease activity and medications.



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