Effect of dietary interventions on nutritional status in patients with rheumatoid arthritis and spondyloarthritis - A systematic review and meta-analysis

BACKGROUND & AIM

Patients with rheumatoid arthritis (RA) and spondyloarthritis (SpA) have an increased risk of developing altered body composition, such as low muscle mass, and an increased risk of developing cardiovascular diseases (CVD). Thus, investigating how to improve body composition and CVD risk factors is a relevant topic to improve management of RA and SpA. The aim of this study was to identify dietary interventions that can improve body composition, as well as reduce CVD risk factors in RA and SpA.

METHODS

We searched the databases Medline, Embase and Cochrane. Duplicates were removed using Endnote and records were screened through Rayyan. The primary outcomes were muscle mass (kg) and fat mass (kg). Secondary outcomes were body weight (kg), body mass index (BMI: kg/m2), waist circumference (cm) and lipid profile (total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), triglycerides, mmol/L).

RESULTS

A total of 4965 articles were identified, and 17 articles were included in this review, of which 15 were suitable for meta-analysis. We found a reduction in TC and LDL-C, (Mean difference, [95%CI]: -0.36, [-0.63, -0.10], I2 = 43%, and -0.20, [-0.35, -0.05], I2 = 0% respectively). Otherwise, no other significant effect was seen in either primary or secondary outcomes. The evidence was graded as moderate for TC and low for LDL-C.

CONCLUSION

Dietary interventions might reduce the levels of blood lipids, and consequently, the risk of cardiovascular diseases. However, body composition did not change significantly after a 2-4 month dietary intervention. Both short intervention period and lack of reliable methods to assess body composition are possible explanations for this finding. Further studies of longer duration are needed.

Surgical wound dressing in outpatient paediatric surgery. A randomised study

A comparison of two different wound dressings was carried out in a series of 88 paediatric patients. The patients were randomised to either Steristrip plus Cutiplast, a conventional absorbent wound dressing, or to DuoDERM, an occlusive adhesive dressing. The study, set up to show which was the most convenient dressing for minor outpatient surgery, focused on the psychological aspects of operative treatment of infants and children. The results showed that the DuoDERM group had fewer bandage changes than the Steristrip & Cutiplast group, although this was not significant. Significantly less pain was experienced on removal of the wound dressing in the DuoDERM group. When dressed with DuoDERM, children could be bathed in the immediate postoperative period without complication. In conclusion, an occlusive wound dressing (DuoDERM) seems to minimize the physical and psychological trauma to the infant or child and reduce the disruption to the child's and the parents' daily routines.

[Preoperative ultrasonic diagnosis of maldescended testis]

In 30 boys with a total of 35 maldescended testicles, the present authors found that ultrasonic examination was a useful aid in the diagnosis of maldescended testicles, including intraabdominal testicles. Ultrasonic examination is recommended preoperatively in boys with non-palpable testicles in order to provide optimal surgical intervention.