<p><strong>PURPOSE: </strong>Rheumatoid arthritis (RA) is associated with adverse body composition profiles, and low muscle density due to accumulation of intramuscular fat. This study assessed associations between muscle density, body composition, muscle strength, and physical functioning in patients with RA and a reference group.</p>

<p><strong>METHODS: </strong>Patients with RA, ages 18-70 years, and healthy control participants completed whole-body DXA and peripheral quantitative CT (pQCT) to quantify appendicular lean mass (ALMI, kg/m) and fat mass indices (FMI, kg/m), visceral fat area, and muscle density. Dynamometry was used to measure hand-grip strength and muscle strength at the knee and lower leg (ft-lbs). Disability and physical functioning were measured with the Health Assessment Questionnaire (HAQ) and the Short Physical Performance Battery (SPPB). Linear regression analyses assessed differences related to RA and associations between muscle density, strength, and function.</p>

<p><strong>RESULTS: </strong>The study consisted of 103 RA patients (51 men) and 428 healthy participants. Low muscle density was associated with greater disease activity, CRP, and Interleukin-6, greater total and visceral fat, lower ALMI Z-Scores, physical inactivity, and long-term use of glucocorticoids (&gt;1yr). Patients with low ALMI Z-Scores had lower muscle density Z-Score compared to reference participants with similarly low ALMI. Low muscle density was independently associated with lower muscle strength, higher HAQ, and lower SPPB after adjusting for ALMI and FMI Z-Scores.</p>

<p><strong>CONCLUSIONS: </strong>Low muscle density observed among patients with RA is observed in association with low muscle mass, excess adiposity, poor strength, and greater disability. Interventions to address poor muscle quality could potentially affect important functional outcomes. This article is protected by copyright. All rights reserved.</p>

<p><strong>OBJECTIVE: </strong>Rheumatoid arthritis (RA) is associated with muscle loss, osteoporosis, and fracture. We examined associations between skeletal muscle mass, strength, and quality and trabecular and cortical bone deficits in patients with RA and healthy controls.</p>

<p><strong>METHODS: </strong>Participants, ages 18-75 years, completed whole-body dual-energy x-ray absorptiometry and peripheral quantitative computed tomography (pQCT) of the tibia to quantify appendicular lean mass and fat mass indices (ALMI, FMI), muscle density at the lower leg, trabecular bone density, and cortical bone thickness. Age-, sex-, and race-specific Z scores were calculated based on distributions in controls. Associations between body composition and pQCT bone outcomes were assessed in patients with RA and controls. Linear regression analyses assessed differences in bone outcomes after considering differences in body mass index (BMI) and body composition.</p>

<p><strong>RESULTS: </strong>The sample consisted of 112 patients with RA (55 men) and 412 controls (194 men). Compared to controls, patients with RA had greater BMI Z score (p &lt; 0.001), lower ALMI Z score after adjustment for FMI (p = 0.02), lower muscle strength Z score (p = 0.01), and lower muscle density Z score (p &lt; 0.001). Among RA, ALMI Z scores were positively associated with trabecular density [β: 0.29 (0.062-0.52); p = 0.01] and cortical thickness [β: 0.33 (0.13-0.53; p = 0.002]. Associations were similar in controls. Bone outcomes were inferior in patients with RA after adjusting for BMI, but similar to controls when adjusting for body composition. Radiographic damage and higher adiponectin levels were independently associated with inferior bone outcomes.</p>

<p><strong>CONCLUSION: </strong>Patients with RA exhibit deficits in cortical bone structure and trabecular density at the tibia and a preserved functional muscle-bone unit. A loss of mechanical loading may contribute to bone deficits.</p>

OBJECTIVE: Unintended pregnancy is common and disproportionately occurs among low-income women. We conducted a qualitative study with low-income women to better typologize pregnancy intention, understand the relationship between pregnancy intention and contraceptive use, and identify the contextual factors that shape pregnancy intention and contraceptive behavior.

STUDY DESIGN: Semistructured interviews were conducted with low-income, African-American and white women aged 18-45 recruited from reproductive health clinics in Pittsburgh, PA, to explore factors that influence women's pregnancy-related behaviors. Narratives were analyzed using content analysis and the constant comparison method.

RESULTS: Among the 66 participants (36 African-American and 30 white), we identified several factors that may impede our public health goal of increasing the proportion of pregnancies that are consciously desired and planned. First, women do not always perceive that they have reproductive control and therefore do not necessarily formulate clear pregnancy intentions. Second, the benefits of a planned pregnancy may not be evident. Third, because preconception intention and planning do not necessarily occur, decisions about the acceptability of a pregnancy are often determined after the pregnancy has already occurred. Finally, even when women express a desire to avoid pregnancy, their contraceptive behaviors are not necessarily congruent with their desires. We also identified several clinically relevant and potentially modifiable factors that help to explain this intention-behavior discrepancy, including women's perceptions of low fecundity and their experiences with male partner contraceptive sabotage.

CONCLUSION: Our findings suggest that the current conceptual framework that views pregnancy-related behaviors from a strict planned behavior perspective may be limited, particularly among low-income populations.

IMPLICATIONS: This study identified several cognitive and interpersonal pathways to unintended pregnancy among low-income women in Pittsburgh, PA, including perceptions of low reproductive control, perceptions of low fecundity and male partner reproductive coercion.