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When assessing the relationship between metabolite levels and high PsA disease activity, a significant direct correlation was found between alanine and leucine levels and DAPSA score, which is a validated composite outcome measure based on the number of swollen and tender joints, CRP levels, and the patients assessment of the pain and activity related to the disorder 58

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Overall, the evidence supports the view that anabolicandrogenic steroid misuse represents a complex endocrinemetabolic and public-health issue rather than an isolated doping-related practice

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