Jing Song

Objective: This study examined the association between positive affect and physical function in individuals with early rheumatoid arthritis (RA). Methods: We analyzed baseline data from 129 adults with early RA (persistent joint symptoms for ≤24 months) and active disease enrolled in the Central Pain in RA 2 (CPIRA‐2) study. Patient‐reported outcome measures assessed positive affect (using the positive affect subscale of the Positive and Negative Affect Schedule), physical function, pain intensity, and other psychological factors. We constructed linear regression models to estimate unadjusted and adjusted cross‐sectional associations between positive affect and physical function. Adjusted models controlled for age, sex, body mass index, swollen joint count, symptom duration, pain intensity, and depression. Further analyses were conducted to evaluate whether pain intensity modified the relationship between positive affect and physical function. Results: Greater self‐reported positive affect (β for every five‐unit increase = 1.4, P = 0.002) was associated with better physical function independent of pain intensity and depressive symptoms. In additional analyses, pain intensity significantly modified this relationship (interaction β = −0.5, P = 0.001), and the positive association between positive affect and physical function weakened as pain intensity increased. Findings remained consistent when controlling for alternative negative affect measures (pain catastrophizing and anxiety) in place of depression. Conclusion: Positive affect was independently associated with self‐reported physical function in early RA, suggesting that resilience‐related psychological processes may contribute to functional outcomes during the early stages of disease. Interventions targeting positive emotional well‐being may complement RA treatment approaches aimed at preserving and improving physical function.

Objective: Nonarticular pain (NAP) may contribute to patient global assessment (PtGA), confound disease activity assessment, and influence treatment decisions. Our aims were to (1) evaluate the association between NAP and PtGA in adults with active rheumatoid arthritis (RA) starting a new disease‐modifying antirheumatic drug (DMARD) and (2) determine the extent to which this relationship is mediated by pain intensity. Methods: We enrolled adults with active RA initiating a new DMARD. Participants indicated NAP on a body pain diagram (0–19 sites) and completed assessments of PtGA and pain intensity. To evaluate the association between NAP and PtGA, adjusted multivariable linear regression was performed. Mediation analyses using linear regression models examined whether this association was mediated by pain intensity at baseline and at three months separately. All models were adjusted for potential confounders. Results: The 197 participants were mostly female (83.8%), with a mean age of 55.1 (SD 14.4) years, a mean disease duration of 10.6 (SD 12.6) years, and a mean Clinical Disease Activity Index score of 23.9 (SD 14.6). NAP was reported by 92.9% at baseline and by 84.8% at three months. At baseline, each site of NAP (0–19) was associated with a 0.20‐point higher PtGA (β = 0.20, 95% confidence interval 0.12–0.28). Pain intensity mediated 61.8% of this association. Similar findings were observed at three months. Conclusion: There was a significant linear relationship between NAP and PtGA, most of which could be explained by pain intensity. These findings raise awareness of NAP and its added burden of worse perceived health status in RA. This may help prevent unnecessary DMARD treatment changes and increase specificity in treatment of different pain types. image

Background: Physical activity (PA) is associated with improved health outcomes among cancer survivors (CS), yet PA participation and access to PA programs in cancer care are low. Mobile health (mHealth) technologies such as wearable activity trackers and smartphone lifestyle applications are promising strategies to promote PA among CS. However, CS's adoption patterns and willingness to share resulting mHealth data with healthcare providers are underexplored. Aims: This study examined mHealth technology ownership and usage as well as willingness to share wearable data with healthcare providers among CS and identified demographic and health‐related correlates. Methods: Self‐reported data were collected from post treatment CS ( n = 518; M _age = 56.5 (SD = 14.5); 54.6% female) from a large healthcare system. Univariate logistic regression models examined associations between demographic (age, sex, race/ethnicity, education, income, marital status, employment status, health status, BMI) and disease (time since diagnosis, treatment received, disease stage) characteristics and meeting PA guidelines (i.e., 150 min/week of moderate to vigorous PA) and activity tracker ownership, lifestyle app usage, and willingness to share wearable data with healthcare providers. Results: Nearly all CS (97.5%) owned a smartphone. Over half (52.9%) owned an activity tracker, and one‐third (32.4%) used a lifestyle app. Most (64.3%) were willing to share wearable data with healthcare providers. Participants with a college degree or higher income, those who met PA guidelines, and those who were obese were more likely to own a wearable activity tracker. Along with those factors, younger age (< 65) and full‐time employment were also associated with a higher likelihood of using a lifestyle app ( p < 0.05). Being employed full‐time was significantly associated with willingness to share data with a healthcare provider. No other relationships were significant. Conclusions: Many CS use or are open to using mHealth technologies. However, differences in adoption by demographic characteristics and unclear demographic and disease correlates of willingness to share data highlight the need for targeted, inclusive, and evidence‐based strategies to integrate these tools into survivorship care. Understanding who adopts mHealth technologies is essential to optimizing their potential to improve long‐term cancer outcomes.

Tanning bed users have a significantly increased risk of melanoma, but it remains unclear how indoor tanning drives melanomagenesis. To better understand the etiology of melanoma associated with tanning bed use, we described the patterns of melanoma in patients with quantifiable tanning bed usage and performed exome sequencing of melanocytes from normal skin of a subset of these patients. Tanning bed users were more likely to have melanoma on body sites with low cumulative levels of sun damage and to have multiple melanomas. The melanocytes in skin from tanning bed users had higher mutation burdens and higher proportions of cells with pathogenic mutations—these differences were most prominent over body sites that experience comparatively less exposure to natural sunlight. We conclude that tanning bed radiation induces melanoma by increasing the mutation burden of melanocytes and by mutagenizing a broader field of melanocytes than are typically exposed to natural sunlight.

Objective: This study investigates the association between discordance in commonly collected clinical indicators of rheumatoid arthritis (RA) disease activity and abnormalities in quantitative sensory testing (QST) observed in individuals with nociplastic pain. The goal is to identify low‐burden methods of assessing nociplastic pain in rheumatology practice. Methods: Data from 225 patients with active RA were included for cross‐sectional analyses. Measures of discordance in disease activity were as follows: (1) tender–swollen joint count difference (TSJD), (2) proportion of subjective components to the total Disease Activity Score in 28 joints (DAS28‐P), and (3) patient global assessment of disease activity minus evaluator global assessment of Disease Activity (PtGA − EGA). QST measures were pressure pain thresholds (PPTs) at the trapezius, temporal summation (TS), and conditioned pain modulation. We evaluated associations between measures of discordance and QST using unadjusted and multivariable linear regression models. Results: The mean TSJD was 5.4 (SD ±8.2), and the mean DAS28‐P was 49.7% (SD ±13.3%). The mean PtGA − EGA was 0.7 (SD ±2.2). Higher TSJD was associated with lower trapezius PPT (β = −0.05; 95% confidence interval [CI] −0.08 to −0.02) and higher TS (β = 0.29; 95% CI 0.05 to 0.53). Higher DAS28‐P was associated with a lower trapezius PPT (β = −0.05; 95% CI −0.07 to −0.04) and higher TS (β = 0.21; 95% CI 0.06 to 0.35). PtGA − EGA was not associated with any QST measures. Conclusion: Two of our proposed measures of discordance (higher TSJD and DAS28‐P) were modestly associated with worse QST measures of nociplastic pain (lower trapezius PPT and higher TS), suggesting that discordance between patient‐reported and physician‐assessed measures of disease activity may reflect an element of nociplastic pain.

Objective: Falls are common after total hip arthroplasty (THA) and can cause serious complications. Understanding preoperative factors linked to falls post‐THA can inform discharge planning and management to lower fall risk. We aimed to identify preoperative factors associated with falls occurring within one year following THA in older adults.Methods: We performed a retrospective cohort study using records within a large hospital system. Adults aged ≥65 years with a recorded THA between March 2012 and March 2022 were included. The primary outcome was a fall occurrence (yes vs no) within one year post‐THA. A fall was identified through International Classification of Diseases, Ninth/Tenth Revision codes, documentation for fall‐related emergency room visit(s), or mention of a fall in the medical record. Purposeful selection of variables in logistic regression models identified preoperative factors associated with a fall.Results: Among 4,501 patients (age 72.7 ± 6.0 years), 683 (15.2%) experienced at least one fall within one year post‐THA. The strongest risk factors were a fall within one year pre‐THA (odds ratio [OR] = 2.67, 95% confidence interval [CI] = 2.22–3.22) and depression (OR = 1.95, 95% CI = 1.62–2.35). Other factors included neurologic conditions, insomnia, revision or conversion hip arthroplasty, knee pain, lumbar conditions, body mass index (BMI) 2, and older age. A BMI of 25 to 29.9 was protective against falls.Conclusion: This longitudinal cohort study identified multiple independent factors associated with fall occurrences within one year post‐THA. Findings highlight the opportunity to address modifiable factors and provide individuals with tailored discharge planning and management strategies (eg, fall prevention programs) to reduce fall risk. image

Objective: Fatigue is a prevalent and debilitating symptom for patients with rheumatoid arthritis (RA). Although patients and rheumatologists often attribute fatigue to inflammation, other factors such as sleep disturbances are frequently overlooked. This study aims to explore the relationship between subjective (self‐reported) and objective (actigraphy based) sleep parameters and self‐reported fatigue in patients with RA. Methods: This cross‐sectional analysis included data from 48 adult patients with RA from a single academic rheumatology practice. Sleep data were obtained daily over 14 days with actigraphy (objective) and the Karolinska Sleep Diary (subjective). Fatigue was assessed using the Patient‐Reported Outcome Measurement Information System (PROMIS) fatigue computerized adaptive test. Spearman's correlations and linear regression analyses were used to examine associations between sleep parameters and fatigue, adjusting for swollen joint count, pain intensity, and symptoms of depression. Results: Subjective sleep parameters showed significant correlations with PROMIS fatigue. Longer total sleep time (ρ = −0.4, P < 0.01), higher sleep efficiency (ρ = −0.42, P < 0.01), and better sleep quality (ρ = −0.5, P < 0.01) were associated with lower levels of fatigue. Objective actigraphy‐based sleep parameters were not significantly associated with PROMIS fatigue. Separate linear regression models demonstrated that each subjective sleep parameter remained significantly associated with fatigue after adjusting for covariates. Conclusion: Self‐reported poor sleep duration, efficiency, and quality were significantly associated with fatigue in patients with RA, whereas objective actigraphy‐based sleep parameters were not, supporting the integration of self‐reported assessment of sleep disturbances into RA treatment plans to improve patient outcomes.

Changes in WCRF/AICR Score by experimental components, n=268 persons

Background:Interventions targeting moderate-to-vigorous physical activity (MVPA) may be a catalyst for improving other lifestyle behaviors in breast cancer survivors (BCS). We examined whether Fit2Thrive, an mHealth MVPA intervention, influenced adherence to cancer prevention recommendations.Methods:BCSs (N = 269; age, mean = 52.9; SD = 9.9) received a 12-week mHealth MVPA intervention and were randomized to “on” or “off” level of five intervention components. The World Cancer Research Fund/American Institute for Cancer Research (WCRF/AICR) score was calculated (0 = high cancer risk, 6 = low cancer risk) based on cancer prevention recommendations: sugar-sweetened beverages, fast food, fruit/vegetable intake, body mass index, alcohol consumption, and MVPA (baseline, 12 weeks, and 24 weeks). Mixed-effects models examined changes in the WCRF/AICR score and each risk factor and the effects of each intervention component (telephone support calls, Fitbit Buddy, tailored text messages, deluxe app, online gym) level on the WCRF/AICR score.Results:The WCRF/AICR total score significantly improved at 12 and 24 weeks (P values < 0.001). MVPA improved at 12 and 24 weeks (P values < 0.001). Fruit and vegetable consumption improved at 12 weeks (P = 0.01). No changes in other risk factors were observed.Conclusions:Participation in a mHealth MVPA intervention may influence cancer risk in BCS and have effects on certain untargeted behaviors (fruit and vegetable consumption) but not on other risk factors (sugar-sweetened beverages, fast food, body mass index, alcohol consumption). Future work should explore how to maximize these effects and determine if resource-efficient dietary intervention components improve cancer outcomes.Impact:Understanding the impact of an mHealth MVPA intervention on untargeted dietary behaviors may guide the development of scalable interventions targeting lifestyle behaviors.

Objective: Abnormalities in pain regulatory mechanisms are common in patients with rheumatoid arthritis (RA). We investigated whether pain sensitization changes after treatment with a disease‐modifying antirheumatic drug (DMARD) and explored associations between changes in pain sensitization and disease activity. Methods: We included 182 participants with active RA initiating/switching DMARD therapy who were observed for 12 weeks. To assess pain sensitization, participants underwent quantitative sensory testing (QST), including pressure pain thresholds (PPTs) at multiple anatomic sites, temporal summation (TS) at the wrist and forearm, and conditioned pain modulation (CPM). RA disease activity was measured using the Disease Activity Score 28 with C‐reactive protein (DAS28‐CRP) and its components. Mean changes in QST measures were examined from baseline to 12 weeks, and associations between QST and disease activity measures were explored using Pearson correlation coefficients and adjusted linear regression analyses. Results: PPTs significantly increased (improved) at multiple anatomic sites following 12 weeks of DMARD therapy. No significant changes were observed in TS or CPM. Increased PPTs at multiple anatomic sites were associated with reductions in DAS28‐CRP, swollen joint count, tender joint count, and improvements in patient global assessment. No significant associations were observed between TS, CPM, and disease activity. Conclusion: Pain sensitivity improved after 12 weeks of DMARD therapy. These improvements were associated with reductions in disease activity.