Objective. To assess objective and subjective evidence of sleep disturbances in patients with rheumatoid arthritis (RA) and to examine correlations between parameters of inflammatory activity and sleep pathology. Methods. Nineteen RA patients and 19 age‐matched healthy control subjects underwent all‐night polysomnography on 2 consecutive nights. RA patients were also evaluated for daytime sleepiness by mean sleep latency test and responded to a self‐report questionnaire on their first night. Results. Whereas normal sleep architecture is conserved in RA, we confirmed former findings of severe sleep fragmentation and an enhanced presence of primary sleep disorders. No correlation exists between RA activity and the sleep disorders. Subjective assessment was not consistent with the objective evidence of sleep disruption, unlike the findings in patients with fibrositis. Conclusion. Sleep is severly disturbed in patients with RA, regardless of the inflammatory disease activity. the specificity of the sleep disorders assessed needs confirmation, as does specific sleep therapy for these patients.

Background Childhood obesity is associated with early cardiometabolic risk (CMR), increased risk of adulthood obesity, and worse health outcomes. Leg fat mass (LFM) is protective beyond total fat mass (TFM) in adults. However, the limited evidence in children remains controversial. Objective We investigated the relationship between LFM and CMR factors in youth. Subjects A total of 203 overweight/obese children, 7–17‐yr‐old, followed in the Pediatric Clinic, Luxembourg. Methods TFM and LFM by dual energy x‐ray absorptiometry and a detailed set of CMR markers were analyzed. Results After TFM, age, sex, body mass index (BMI) Z‐score, sexual maturity status, and physical activity adjustments, negative significant partial correlations were shown between LFM and homeostasis model assessment of insulin resistance (HOMA) (variance explained: 6.05% by LFM*; 7.18% by TFM**), fasting insulin (variance explained: 5.71% by LFM*; 6.97% by TFM**), triglycerides (variance explained: 3.96% by LFM*; 2.76% by TFM*), systolic blood pressure (variance explained: 2.68% by LFM*; 4.33% by TFM*), C‐reactive protein (variance explained: 2.31% by LFM*; 4.28% by TFM*), and resistin (variance explained: 2.16% by LFM*; 3.57% by TFM*). Significant positive partial correlations were observed between LFM and high‐density lipoprotein (HDL) cholesterol (variance explained: 4.16% by LFM*) and adiponectin (variance explained: 3.09% by LFM*) (*p‐value < 0.05 and **p‐value < 0.001). In order to adjust for multiple testing, Benjamini–Hochberg method was applied and the adjusted significance level was determined for each analysis. LFM remained significant in the aforementioned models predicting HOMA, fasting insulin, triglycerides, and HDL cholesterol (Benjamini and Hochberg corrected p‐value < 0.01). Conclusions LFM is protective against CMR in children, at least in terms of insulin resistance and adverse blood lipid profiles.

BackgroundPaediatric research analysing the relationship between the easy-to-use anthropometric measures for adiposity and cardiometabolic risk factors remains highly controversial in youth. Several studies suggest that only body mass index (BMI), a measure of relative weight, constitutes an accurate predictor, whereas others highlight the potential role of waist-to-hip ratio (WHR), waist circumference (Waist C), and waist-to-height ratio (WHtR). In this study, we examined the effectiveness of adding anthropometric measures of body fat distribution (Waist C Z Score, WHR Z Score and/or WHtR) to BMI Z Score to predict cardiometabolic risk factors in overweight and obese youth. We also examined the consistency of these associations with the “total fat mass + trunk/legs fat mass” and/or the “total fat mass + trunk fat mass” combinations, as assessed by dual energy X-ray absorptiometry (DXA), the gold standard measurement of body composition.MethodsAnthropometric and DXA measurements of total and regional adiposity, as well as a comprehensive assessment of cardiometabolic, inflammatory and adipokines profiles were performed in 203 overweight and obese 7–17 year-old youths from the Paediatrics Clinic, Centre Hospitalier de Luxembourg.ResultsAdding only one anthropometric surrogate of regional fat to BMI Z Score improved the prediction of insulin resistance (WHR Z Score, R2: 45.9 %. Waist C Z Score, R2: 45.5 %), HDL-cholesterol (WHR Z Score, R2: 9.6 %. Waist C Z Score, R2: 10.8 %. WHtR, R2: 6.5 %), triglycerides (WHR Z Score, R2: 11.7 %. Waist C Z Score, R2: 12.2 %), adiponectin (WHR Z Score, R2: 14.3 %. Waist C Z Score, R2: 17.7 %), CRP (WHR Z Score, R2: 18.2 %. WHtR, R2: 23.3 %), systolic (WHtR, R2: 22.4 %), diastolic blood pressure (WHtR, R2: 20 %) and fibrinogen (WHtR, R2: 21.8 %). Moreover, WHR Z Score, Waist C Z Score and/or WHtR showed an independent significant contribution according to these models. These results were in line with the DXA findings.ConclusionsAdding anthropometric measures of regional adiposity to BMI Z Score improves the prediction of cardiometabolic, inflammatory and adipokines profiles in youth.

ObjectivesTo describe and explore differences in formal regulations around sick leave and work disability (WD) for patients with rheumatoid arthritis (RA), as well as perceptions by rheumatologists and patients on the system’s performance, across European countries.MethodsWe conducted three cross-sectional surveys in 50 European countries: one on work (re-)integration and social security (SS) system arrangements in case of sick leave and long-term WD due to RA (one rheumatologist per country), and two among approximately 15 rheumatologists and 15 patients per country on perceptions regarding SS arrangements on work participation. Differences in regulations and perceptions were compared across categories defined by gross domestic product (GDP), type of social welfare regime, European Union (EU) membership and country RA WD rates.ResultsForty-four (88%) countries provided data on regulations, 33 (75%) on perceptions of rheumatologists (n=539) and 34 (77%) on perceptions of patients (n=719). While large variation was observed across all regulations across countries, no relationship was found between most of regulations or income compensation and GDP, type of SS system or rates of WD. Regarding perceptions, rheumatologists in high GDP and EU-member countries felt less confident in their role in the decision process towards WD (β=−0.5 (95% CI −0.9 to −0.2) and β=−0.5 (95% CI −1.0 to −0.1), respectively). The Scandinavian and Bismarckian system scored best on patients’ and rheumatologists’ perceptions of regulations and system performance.ConclusionsThere is large heterogeneity in rules and regulations of SS systems across Europe in relation to WD of patients with RA, and it cannot be explained by existing welfare regimes, EU membership or country’s wealth.