Cachexia in rheumatoid arthritis is not explained by decreased growth hormone secretion.

OBJECTIVE: Patients with rheumatoid arthritis (RA) lose body cell mass (BCM) by unknown mechanisms. Since the loss of BCM in normal aging individuals parallels the characteristic age-related decline in growth hormone (GH) secretion, this study was carried out to determine whether further decreased GH secretion plays a role in the pathogenesis of this loss of BCM in RA patients, termed "rheumatoid cachexia." METHODS: GH secretory kinetics were determined by deconvolution analysis in 16 patients with RA and 17 healthy controls matched for age (mean +/- SD 45.4 +/- 13.2 years and 47.1 +/- 14.6 years, respectively), sex, race, and body mass index. Blood samples were obtained every 20 minutes for 24 hours. Body composition was ascertained using total-body potassium (TBK) as a measure of BCM and dual x-ray absorptiometry to determine fat mass. RESULTS: BCM was reduced in patients with RA compared with healthy controls (mean +/- SD gm TBK 79.5 +/- 9.5 versus 94.9 +/- 11.9; P < 0.0005), but there was no difference in fat mass. GH kinetic parameters in patients with RA did not differ from those in controls. CONCLUSION: These findings suggest that GH kinetics are unaltered in RA patients compared with healthy subjects; thus, GH deficiency does not account for rheumatoid cachexia.

Lack of multidisciplinary collaboration is a barrier to outcomes research.

OBJECTIVES: To identify and describe methods of collaboration used by dietitians to conduct outcomes research and to identify perceived barriers to participation in outcomes research. DESIGN: A questionnaire was mailed to dietitians to obtain descriptive information about outcomes research involvement. Details of collaborative research experiences were collected in follow-up telephone interviews. SUBJECTS: Subjects were a regional sample of 300 dietitians from the Clinical Nutrition Managers practice group of The American Dietetic Association. One hundred fifty-three subjects (51%) responded to the questionnaire and 25 of 42 eligible respondents were interviewed. ANALYSIS: Frequency counts on questionnaire and closed-ended interview data were analyzed. Chi2 tests were used to identify significant associations between participation in outcomes research and demographic variables. Content analysis of open-ended interview data was used to detect emergence of recurrent themes. RESULTS: Forty-two (27%) respondents had conducted outcomes research. Although all respondents collaborated on at least 1 project, half collaborated only with other dietitians, and 27 of 42 (64%) did not report research findings outside their facility. Interview data suggest that collaboration, especially between disciplines, enhances the entire research process and generates benefits beyond the specific project. The most frequently cited barriers among respondents who had not conducted outcomes research (n=111) were lack of research skills (65%) and lack of time or staff (41%). APPLICATIONS: These findings support the assertion that lack of multidisciplinary involvement is a barrier to generating evidence of nutrition therapy effectiveness. Educators, health care professionals, and dietitians must model and encourage multidisciplinary, collaborative outcomes research in diverse practice settings.