Musculoskeletal (MSK) diseases are expected to have a growing impact worldwide.
To analyse the worldwide burden of MSK diseases from 2000 to 2015.
Disability-adjusted life years (DALYs), which ...combines the years of life lost (YLLs) and the years lived with disability (YLDs), were extracted for 183 countries from the WHO Global Health Estimates Database. We analysed the median proportion of DALYS, YLLs and YLDs for MSK diseases (ICD-10: M00-M99) among the 23 WHO categories of diseases. Mixed models were built to assess temporal changes.
Worldwide, the total number of MSK DALYs increased significantly from 80,225,634.6 in 2000 to 107,885,832.6 in 2015 (p < 0.001), with the total number of MSK YLDs increasing from 77,377,709.4 to 103,817,908.4 (p = 0.0008) and MSK diseases being the second cause of YLDs worldwide. YLLs due to MSK diseases increased from 2,847,925.2 to 4,067,924.2 (p = 0.03). In 2015, the median proportion of DALYs attributed to MSK diseases was 6.66% (IQR: 5.30 - 7.88) in Europe versus 4.66% (3.98 - 5.59) in the Americas (p < 0.0001 vs Europe), 4.17% (3.14 - 6.25) in Asia (p < 0.0001), 4.14% (2.65 - 5.57) in Oceania (p = 0.0008) and 1.33% (1.03 - 1.92) in Africa (p < 0.0001). We observed a significant correlation (r = 0.85, p < 0.0001) between the proportion of MSK DALYs and the gross domestic product per capita for the year 2015.
The burden of MSK diseases increased significantly between 2000 and 2015 and is high in Europe. These results are crucial to health professionals and policy makers to implement future health plan adjustments for MSK diseases.
Systemic lupus erythematosus (SLE) is an immune-mediated multi-systemic disease characterized by a wide variability of clinical manifestations and a course frequently subject to unpredictable flares. ...Despite significant advances in the understanding of the pathophysiology and optimization of medical care, patients with SLE still have significant mortality and carry a risk of progressive organ damage accrual and reduced health-related quality of life. New tools allow earlier classification of SLE, whereas tailored early intervention and treatment strategies targeted to clinical remission or low disease activity could offer the opportunity to reduce damage, thus improving long-term outcomes. Nevertheless, the early diagnosis of SLE is still an unmet need for many patients. Further disentangling the SLE susceptibility and complex pathogenesis will allow to identify more accurate biomarkers and implement new ways to measure disease activity. This could represent a major step forward to find new trials modalities for developing new drugs, optimizing the use of currently available therapeutics and minimizing glucocorticoids. Preventing and treating comorbidities in SLE, improving the management of hard-to-treat manifestations including management of SLE during pregnancy are among the remaining major unmet needs. This review provides insights and a research agenda for the main challenges in SLE.
SLE is a chronic autoimmune rheumatic disorder of high heterogeneity in clinical presentation, treatment response and prognosis. Long-term outcomes in SLE have been dramatically improved over the ...past decades, however, increased morbidity and mortality, especially among young individuals, still exists. Unmet needs include residual disease activity and frequent flares, glucocorticoid treatment dependency and toxicity, comorbidity burden, reduced health-related quality of life, health disparities and damage. The main determinants of long-term outcomes in SLE are age, sex, race/ethnicity, genetic profile, environmental factors including smoking, disease activity, major organ involvement such as lupus nephritis and CNS involvement, comorbidities including cardiovascular disease and serious infections, coexistence with APS, treatment adherence, socio-economic factors and access to care. In this review we discuss trends in long-term outcomes in SLE over the years and major contributors such as genetic, disease-related, treatment, comorbidity, socio-economic and other factors.
A patient pathway is the patient experience from the first symptom through the initial referral for diagnosis, treatment and follow-up, and includes diverse aspects of disease management, such as ...holistic support and prevention of complications. Among the most significant challenges in systemic lupus erythematosus (SLE)1 are the excessive diagnosis delay and the lack of coordinated care. At our national reference center in Strasbourg (France), we have conducted a series of focus groups with healthcare professionals and SLE patients. Based on the collected data, the most impactful disruption points in SLE patient pathways were identified.2 A novel framework to improve individual patient pathways in SLE was developed, discussed and validated during a consensus meeting with representative stakeholders. Six main disruptions in optimal SLE patient pathways were identified: (1) appropriate and timely referral strategy for SLE diagnosis; (2) the need for a dedicated consultation during which the diagnosis of SLE would be communicated, and following which clarifications and psychological support offered; (3) individualized patient pathways with coordinated care based on organ involvement, disease severity and patient preference; (4) improved therapeutic patient education; (5) prevention of complications such as infections, osteoporosis and cancer; (6) and additional patient support. These disruption points are valuable knowledge, which may be used to improve individual patient pathways in SLE. These data may be of valuable interest to patients with SLE, their physicians, health organizations and policy makers. Felten R, et al. 10 most important contemporary challenges in the management of SLE. Lupus Sci Med. 2019 Jan 10;6(1):e000303. doi: 10.1136/lupus-2018-000303. Schlencker A, et al. Improving patient pathways for systemic lupus erythematosus: a multistakeholder pathway optimisation study. Lupus Sci Med. 2022 May;9(1):e000700. doi: 10.1136/lupus-2022-000700. Learning Objectives Explain the key concept of patient pathways Describe how patient pathways can be mapped in systemic lupus Identify the main disruption points in lupus patient pathways Describe how to improve lupus patient pathways
► Four parameters influencing mechanical properties of hemp concretes are studied. ► The curing conditions can strongly affect the mechanical behavior of the material. ► The mechanical behavior of a ...hemp concrete is related to a large extent to its age. ► The binder content hugely influences the setting and hardening of the material. ► The use of small particles leads to reduce the setting process of hemp concrete.
Hemp concrete is a multifunctional ecological material used in buildings. Due to its high porosity (about 80% in volume), it presents an “atypical” mechanical behavior and its thermal and acoustic properties are particularly interesting. It is today possible to design this material according to the required use. This paper focuses on the mechanical properties of hemp concrete. It is shown that extreme curing conditions (30%, 75% and 98% RH) are prejudicial to the mechanical setting of the hydraulic binders whereas only high relative humidity disrupts the one of the air lime-based binder. It is also established that the binder content hugely influences the setting and hardening of the material. Finally, according to the hemp particle size, it appears that small particles (about 3
mm in length) lead to reduce the porosity and consequently the setting process of hemp concrete as compared to concrete manufactured with large particles (about 9
mm).
Abstract
Beside the commonly described pulmonary expression of the coronavirus disease 2019 (COVID-19), major vascular events have been reported. The objective of this study was to investigate ...whether increased levels of circulating endothelial cells (CECs) might be associated with severe forms of COVID-19. Ninety-nine patients with COVID-19 were enrolled in this retrospective study. Patients in the intensive care units (ICU) had significantly higher CEC counts than non-ICU patients and the extent of endothelial injury was correlated with putative markers of disease severity and inflammatory cytokines. Together, these data provide in vivo evidence that endothelial injury is a key feature of COVID-19.
Fatigue is one of the most common symptoms in those with systemic lupus erythematosus (SLE), and may impair daily activities, decrease health-related quality of life and lead to employment ...disability. In SLE, significant fatigue is reported by two-third of patients and rated as severe by one-third. Due to the highly multifactorial nature of fatigue, its assessment and treatment remains a major challenge in SLE. A careful assessment of its determinants is therefore key for an efficient and individualised management in SLE. First, common causes of fatigue unrelated to SLE such as sideropenic anemia, sleep apnea or adrenal failure should be ruled out based on a thorough medical history as well as targeted clinical and laboratory examinations. Then, disease activity and organ damage due to SLE should be assessed. The relationship between fatigue and disease activity remains very controversial in SLE. In those with active disease, remission is the most appropriate therapeutic target and may improve fatigue. Significant damage such as renal or cardiac failure is also associated with high levels of fatigue in SLE, and symptomatic treatment may also improve fatigue levels. In patients with inactive disease and no significant damage, anxiety and depression are common and independent predictors of fatigue. This requires dedicated assessment and care, including psychological counseling and pharmacological intervention if needed. Besides psychological support, lifestyle changes including physical activity should be incorporated in the management of fatigue in SLE.Learning ObjectivesExplain why fatigue is one of the most common symptoms in SLE and highlight the importance of facing this challenging unmet need in SLEDescribe why the common causes of fatigue unrelated to SLE (e.g. sideropenic anemia, sleep apnoea, etc…) should systematically be ruled outDiscuss the controversial relationship between fatigue and disease activity, and explain the importance of minimising the significant damage commonly associated with high levels of fatigue in SLEExplain why anxiety and depression are common in SLE and act as independent predictors of fatigueExplain why lifestyle changes including physical activity should be incorporated in the management of fatigue in SLE
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