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Bakgrund: JIA (juvenil idiopatisk artrit) är den vanligast förekommande reumatiska sjukdomen bland barn. Fysisk träning en viktig del av behandlingen där fysioterapeuten har huvudansvar. Tidigare forskning tyder på att barn med JIA inte är lika fysiskt aktiva som sina friska jämnåriga och att det i dagsläget saknas fördjupad kunskap om faktorer som påverkar fysisk aktivitet hos dessa barn.  Syfte: Syftet med arbetet var för vårdnadshavare för barn med JIA, utforska upplevelser och erfarenheter kring faktorer som påverkar barnets fysiska aktivitet.  Metod: Kvalitativ metod genom fem semistrukturerade intervjuer som genomfördes med vårdnadshavare till barn med JIA. Bekvämlighetsurval användes för att hitta deltagare. Materialet bearbetades genom en kvalitativ innehållsanalys.  Resultat: I analysen framkom fem kategorier med faktorer som påverkar fysisk aktivitet: hitta rätt – medicineringens roll i främjandet av fysisk aktivitet, upplevt ansvar att hitta och förmedla information, anpassningar i skolmiljö, uppmuntran och integration – vikten av normalitet i livet med JIA och önskemål kring utökade vårdinsatser.  Konklusion: Vårdnadshavare till barn med JIA erfarande att en adekvat medicinering var en faktor som främjade fysisk aktivitet. Vidare upplevde informanterna att de har ett stort ansvar att söka information om sjukdomen, samt att förmedla denna till berörda parter såsom skola och idrottsorganisationer för att främja sitt barns fysiska aktivitet. Otillräcklig kunskap om sjukdomen i samhället anses vara en hindrande faktor till att barnen kan vara fysiskt aktiva, medan lyhördhet och anpassningar i skola och idrottssammanhang var underlättande faktorer. Informanterna framförde önskemål om förbättrad kontinuitet i vården för att effektivisera behandlingen. / Background: JIA (juvenile idiopathic arthritis) is the most common rheumatic disease among children. Exercise is an important part of the treatment, and physiotherapists have primary responsibility for the treatment plan. Previous research suggests that children with JIA are not as physically active as their healthy peers, and currently, there is a lack of in-depth knowledge about factors that affect physical activity in children with JIA.  Objectives: The aim of this study was to explore the experiences of factors influencing a child's physical activity for guardians of children with JIA.  Method: A qualitative design was conducted through five semi-structured interviews with guardians of children with JIA. Convenience sampling was used to identify participants. The data was processed through qualitative content analysis.  Result: The analysis revealed five categories of factors that influence physical activity: the role of medication in promoting physical activity, guardians’ responsibility to find and convey information, adaptations in school environment, the importance of normalcy in life with JIA and preferences for expanded healthcare interventions.  Conclusion: Guardians of children with JIA experienced that adequate medication was a factor that facilitated physical activity. Moreover, the guardians of children with JIA felt that they had a responsibility to seek information about the disease and convey it to relevant parties such as schools and sports organizations to promote their child's physical activity. Insufficient knowledge about the disease in society was considered a hindering factor for children to be physically active, while awareness and adaptations in school and sports settings were facilitating factors. The informants expressed a desire for improved continuity in healthcare to streamline treatment.

Rheumatoid arthritis (RA) is a chronic disease characterized by cycles of inflammation and resolution. Previously, it was believed that the resolution of inflammation is simply dissipation of pro-inflammatory signals, although current research indicates that resolution is an active process. Acute inflammation follows defined phases of induction, inflammation and resolution, and resolution occurs by an active process that requires COX-2 activity. This study aims to address whether this paradigm extends to a recognized model of chronic inflammation. We demonstrated in murine collageninduced arthritis that chronic inflammation follows the same sequential course. While there is the normal production of pro-inflammatory cytokines during inflammation and anti-inflammatory mediators such as 15-deoxyΔ12,14PGJ2 (15d-PGJ2) during resolution, interestingly there is sustained production of both COX-2 and the presumably proinflammatory PGE2 during both phases. Blocking COX-2 activity and therefore production of PGE2 during the resolution phase perpetuated instead of attenuated inflammation. Repletion with PGE2 analogs restored homeostasis, and this function is mediated by the pro-resolving lipoxygenase metabolite, lipoxin A4 (LXA4), which is a potent stop signal. Thus, the study provided in vivo evidence for a natural, endogenous link between the cyclooxygenase-lipoxygenase pathways and showed that PGE2 serves as a feedback inhibitor essential for limiting chronic inflammation in autoimmune arthritis. These findings may explain the enigma regarding why COX-2 inhibitors are palliative rather than curative in humans because blocking resolution may mitigate the benefit of preventing induction. / Microbiology and Immunology

Bacterial infection within a joint, septic arthritis, is a serious condition in horses that can lead to long-term joint disease if the infection is not resolved quickly. Equine septic arthritis is diagnosed primarily based on clinical signs and synovial fluid cytology. Septic synovial fluid is characterized by significant elevations in total protein (TP) and total nucleated cell count (TNCC). However, in some cases it can be difficult to distinguish between septic arthritis and non-septic joint inflammation (synovitis) based on clinical signs and synovial fluid cytology alone. A rapid assay to help confirm septic arthritis would be advantageous. A new assay to quantify the major equine acute phase protein, serum amyloid A (SAA) may fulfill this need. Serum amyloid A increases in the body in response to injury, infection, and inflammation and shows promise as a useful tool in confirming a diagnosis of sepsis, as inflammation causes mild increases in SAA and infection causes marked elevations. In our study, serial serum and synovial fluid samples were collected from horses with experimental models of synovitis and septic arthritis, synovial fluid cytology was performed, and serum and synovial fluid SAA were quantified. Synovial fluid TNCC and TP concentrations increased significantly following induction of both models. Serum and synovial fluid SAA concentrations remained normal in synovitis horses and increased significantly in septic arthritis horses. Any elevation in serum or synovial fluid SAA above normal values may be supportive of synovial sepsis since synovial inflammation alone did not result in SAA elevations in our model. / Master of Science

No / Agents which increase intracellular cyclic adenosine monophosphate (cAMP) may have an antagonistic effect on pro-inflammatory molecule production so that inhibitors of the cAMP degrading phosphodiesterases have been identified as promising drugs in chronic inflammatory disorders. Although many such inhibitors have been developed, their introduction in the clinic has been hampered by their narrow therapeutic window with side effects such as nausea and emesis occurring at sub-therapeutic levels. The latest generation of inhibitors selective for phosphodiesterase 4 (PDE4), such as apremilast and roflumilast, seems to have an improved therapeutic index. While roflumilast has been approved for the treatment of exacerbated chronic obstructive pulmonary disease (COPD), apremilast shows promising activity in dermatological and rheumatological conditions. Studies in psoriasis and psoriatic arthritis have demonstrated clinical activity of apremilast. Efficacy in psoriasis is probably equivalent to methotrexate but less than that of monoclonal antibody inhibitors of tumour necrosis factor (TNFi). Similarly, in psoriatic arthritis efficacy is less than that of TNF inhibitors. PDE4 inhibitors hold the promise to broaden the portfolio of anti-inflammatory therapeutic approaches in a range of chronic inflammatory diseases which may include granulomatous skin diseases, some subtypes of chronic eczema and probably cutaneous lupus erythematosus. In this review, the authors highlight the mode of action of PDE4 inhibitors on skin and joint inflammatory responses and discuss their future role in clinical practice. Current developments in the field including the development of topical applications and the development of PDE4 inhibitors which specifically target the subform PDE4B will be discussed.

Yes / Late life involves a variety of different challenges to well-being. This study extends and qualifies propositions drawn from the paradox of well-being in aging using 15-year longitudinal data on depressive symptoms from old and very old participants in the Australian Longitudinal Study of Ageing (Baseline N 2,087; Mage 78.69 years; range: 65–103 years; 49.40% women). We first examined age-related trajectories in depressive symptoms from young-old to oldest-old, taking into account (changes in) relevant correlates, pathology, and mortality; and, second, we investigated gender differences in these trajectories. Results revealed that age-related trajectories of depressive symptoms were predictive of mortality hazards. The unique predictive effects of both level of, and change in, depressive symptoms were independent of one another and held after taking into account education as well as changes in marital status, living arrangements, cognitive function, and illness burden. In addition, results indicated that depressive symptoms were elevated among participants suffering from arthritis, and increased with age more markedly in men than in women. In particular, the significant Age Gender interaction indicated that the gender gap in depressive symptoms reduced from young-old to old-old and reversed in very old age when men showed more depressive symptoms than women. Qualifying the paradox of well-being in aging, findings demonstrated that depressive symptoms increased from young-old to oldest-old and suggest that age-, pathology-, and mortality-related changes should be examined in concert to advance our understanding of individual differences in depressive symptom trajectories in late life.

No

Yes / RA patients often present with low muscle mass and decreased strength. Quantitative MRI offers a non-invasive measurement of muscle status. This study assessed whether MRI-based measurements of T2, fat fraction, diffusion tensor imaging and muscle volume can detect differences between the thigh muscles of RA patients and healthy controls, and assessed the muscle phenotype of different disease stages. Thirty-nine RA patients (13 'new RA'-newly diagnosed, treatment naïve, 13 'active RA'-persistent DAS28 >3.2 for >1 year, 13 'remission RA'-persistent DAS28 1 year) and 13 age and gender directly matched healthy controls had an MRI scan of their dominant thigh. All participants had knee extension and flexion torque and grip strength measured. MRI T2 and fat fraction were higher in the three groups of RA patients compared with healthy controls in the thigh muscles. There were no clinically meaningful differences in the mean diffusivity. The muscle volume, handgrip strength, knee extension and flexion were lower in all three groups of RA patients compared with healthy controls. Quantitative MRI and muscle strength measurements can potentially detect differences within the muscles between RA patients and healthy controls. These differences may be seen in RA patients who are yet to start treatment, those with persistent active disease, and those who were in clinical remission. This suggests that the muscles in RA patients are affected in the early stages of the disease and that signs of muscle pathology and muscle weakness are still observed in clinical remission. / National Institute for Health Research (NIHR) Leeds Biomedical Research Centre (BRC) and Health Education England

The purpose of this study was to describe the therapeutic interventions used for people with limited function of the hand due to osteoarthrtis or rheumatoid arthritis. The study was accomplished through a literature studie. Data were collected through a search of databases considering the criteras for inclusion or exclusion that were established by the authors before the search. Twelve articles were included in the study and analysed through a qualitative content analysis. Fivedifferent categories of occupational interventions were revealed through the analysis. The categories are orthotics, heat and cold treatment, information and education, strength and range of motion exercises and training in activity of daily life. The result of the analysis continued with an interpretation of OTIPM to furher iluminate the occupational focus of activity. A minority of the occupational interventions used as treatment of clients with a limited function of the hand due to osteoarthrits or rheumatoid arthritis correspond to the focus of activity described in OTIPM. / Validerat; 20110607 (anonymous)