Rheumatoid arthritis occurs two to three times more often in women than in men and it has been less studied in men. The results of gender influence on clinical course of the disease are ...contradictory. The aim of this study is to determine the difference in handgrip strength between female and male RA patients in comparison to healthy individuals. The study included 100 RA patients and 100 healthy individuals (50% were male in both groups). Handgrip strength was measured in both hands using a dynamometer. A two-way ANCOVA was used to analyse the data and age was included in the study as covariate. The results show that both male and female RA patients have lower handgrip strength compared to healthy individuals. The analysis of gender and disease interaction has shown that male RA patients have lower handgrip strength than female RA patients in comparison with the healthy group, age adjusted. This interaction is evident and statistically significant in both right hand (
F
1, 195) = 14.62;
p
< 0.01) and left hand (
F
1, 195) = 20.54;
p
< 0.01). The common-language effect size has shown that there is 92% (right hand) and 93% (left hand) chance that male individual will have stronger handgrip than his female counterpart. In RA patients, there is 77% chance for both hands that male will have stronger handgrip. Men and women with RA have significantly lower handgrip strength compared to healthy individuals and the difference is more pronounced in men which was not previously observed in the literature.
Full text
Available for:
EMUNI, FIS, FZAB, GEOZS, GIS, IJS, IMTLJ, KILJ, KISLJ, MFDPS, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, SBMB, SBNM, UKNU, UL, UM, UPUK, VKSCE, ZAGLJ
Osteoporoza i osteoporotični prijelomi predstavljaju značajan javnozdravstveni problem u zapadnim zemljama jer uzrokuju bol, nesposobnost te povećani morbiditet i mortalitet. Porast životne dobi ...jedan je od najvećih rizika za osteoporozu. Prema brojnim epidemiološkim studijama može se zaključiti da će 50 % žena i 20 % muškaraca u dobi iznad 50 godina doživjeti barem jedan osteoporotični prijelom, tako da su prevencija i racionalna dijagnostička obrada osnova liječenja i sprečavanja invalidnosti. Svaki bolesnik zahtijeva individualni pristup jer je neophodno razmotriti čimbenike rizika za nastanak osteoporoze i osteoporotičnih prijeloma. Čimbenici rizika na koje ne možemo utjecati su visoka životna dob, ženski spol i genska predispozicija. Cilj racionalnog probira je identificirati osobe s povećanim rizikom od prijeloma na malu traumu kojima bi pravodobna intervencija minimalizirala taj rizik. Pristupi probiru mineralne gustoće kostiju (BMD) razlikuju se od zemlje do zemlje, dijelom zbog troškova i pitanja u vezi s učinkovitošću politike probira široke populacije. Procjena mineralne gustoće kosti kod premenopauzalnih žena ne radi se rutinski iako je potrebno prepoznati žene s rizičnim faktorima te spriječiti osteoporotične prijelome.
Metotreksat (MTX) strukturni je analog folne kiseline koji se u peroralnom ili parenteralnom obliku rabi ponajprije u liječenju upalnih reumatskih bolesti. Učinkovitost MTX-a u liječenju reumatoidnog ...artritisa dokazana je u više randomiziranih kliničkih studija te je potvrđena u metaanalizama. Danas je MTX zlatni standard u liječenju reumatoidnog artritisa, a liječenje se započinje dozama od 7,5 do 15 mg na tjedan s mogućnošću povišenja doze ovisno o aktivnosti bolesti. Pažljivo monitoriranje bolesnika snižava rizik od hepatotoksičnosti i drugih nuspojava te čini ovaj lijek prvim izborom u liječenju reumatoidnog i psorijatičnog artritisa.
Spondyloarthropathy refers to any joint disease of the vertebral column, but the term is mainly used for a specific group of disorders called seronegative spondyloarthropathies (SpAs). The axial ...skeletal involvement, peripheral and extra-articular manifestations and an association with the major histocompatibility complex class I human leukocyte antigen-B27 (HLA B27) are commonly shared features of SpAs. Klippel–Feil syndrome (KFS) is a rare congenital disorder characterized by the fusion of one or more cervical vertebrae, accompanied by various skeletal and extra-skeletal anomalies. We report a case of an adult male patient with HLA B27 positivity presenting with chronic cervical spine pain accompanied by morning stiffness and periodic night pain, with radiologically confirmed ankylosis and fusion of several cervical segments. His medical history included urogenital abnormalities operated in childhood and mild mitral prolapse. Initially suspected diagnosis of an early axial form of SpA was rejected after thorough workup. Instead, the nature of vertebral defects along with the past medical history of urogenital and cardiac abnormalities pointed towards the diagnosis of KFS. HLA B27 presence can be a confounder in patients presenting with spinal pain and that is why the differential diagnosis of CSD-s and SpA can be challenging in some patients.
Full text
Available for:
EMUNI, FIS, FZAB, GEOZS, GIS, IJS, IMTLJ, KILJ, KISLJ, MFDPS, NLZOH, NUK, OBVAL, OILJ, PNG, SAZU, SBCE, SBJE, SBMB, SBNM, UKNU, UL, UM, UPUK, VKSCE, ZAGLJ
Calcific shoulder tendinitis (CST) is characterized by hydroxyapatite crystals deposition in the rotator cuff tendons. Therapeutic exercises have been the mainstay of CST treatment, and evidence for ...therapeutic ultrasound (T-US) utilization and efficacy is lacking.
This study aimed to determine whether 4500 J T-US combined with therapeutic exercises is superior to therapeutic exercises alone regarding calcification size reduction and symptom improvement in chronic symptomatic CST.
This is a double-blind, placebo-controlled study.
This study was conducted at a University Department for Rheumatic Diseases and Rehabilitation of a University Hospital.
Patients with chronic CST were analyzed.
After eligibility allocation, 46 patients with sonographically confirmed CST were divided into two groups (56 shoulders, 26 per group). Both groups performed the same therapeutic exercises for half an hour under physiotherapist supervision. In the treatment group T-US (4500 J, 10 minutes per session at a frequency of 1 MHz and an intensity of 1.5 W/cm
), and in the placebo group, sham T-US was applied for 4 weeks. Patients were assessed for: calcification size, shoulder pain, global health (GH), shoulder mobility (ROM), handgrip strength, Health Assessment Questionnaire Disability Index (HAQ-DI), Shoulder Pain and Disability Index (SPADI), and overall rehabilitation satisfaction.
All assessed variables improved in both groups. A significantly greater reduction in calcification size was recorded in the treatment group compared to placebo: -10.92% (IQR 4.61% to 19.38%) versus -5.04% (2.30% to 7.22%), P=0.008. There was a significantly greater decrease in HAQ-DI, reduction of VAS GH, and an increase in hand grip strength in the treatment group, while no significant differences were observed for other parameters between the groups.
Our results showed that adding the 4500 J T-US to therapeutic exercises in chronic symptomatic CST therapy resulted in greater calcification size reduction immediately following the treatment, as well as hand grip strength, HAQ-DI, and VAS GH improvement.
4500 J T-US combined with therapeutic exercises is more effective in reducing calcification size than therapeutic exercises alone in the treatment of chronic symptomatic CST.
Rheumatoid arthritis (RA) is a chronic, autoimmune and disabling disease that significantly affects the quality of life. Additionally, significant number of patients with RA suffer from depressive ...disorders, which are commonly underrecognised and undertreated. We aimed to estimate the prevalence of depressive symptoms in Croatian RA patients and to assess the relationship between them and clinical correlates.
Fifty-four RA patients treated at the Clinic for Rheumatic Diseases and Rehabilitation at the University Hospital Centre Zagreb were prospectively enrolled in the study and evaluated for functional status using the Disease Activity Score 28 (DAS-28), Health Assessment Questionnaire (HAQ), Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-F) and Visual Analogue Scale (VAS) for pain and health related quality of life (HRQL) measurement. The depressive symptoms were assessed using the Beck Depression Inventory-II (BDI-II) questionnaire.
Thirty RA patients (55.6%) had some sort of mood disorder, with 10 (18.5%) patients accounting as depressed. Positive correlation was found between depressive symptoms, higher disease activity and disablity during daily activities (τb=0.385, p=0.001 and τb=0.282, p=0.024 respectively). We found no significant association between depression and disease activity in the whole sample of RA patients, but for postmenopausal patients, the disease activity correlated with postmenopausal patients accounting as depressed (BDI-II score moderate or severe; τb=0.363, p=0.021). The use of biologic therapy correlated negatively with the disease acitivity, pain intensity and worse health related quality of life score (τb=-0.360, p=0.06; τb=-0.310, p=0.07; τb=-0.380, p=0.01 respectively).
Considering the high prevalence of depressive sympoms in RA patients and the effect on functional disability and quality of life, we wanted to emphasize the importance of recognizing and optimizing depression treatment through multidisciplinary approach in RA patients.
Alfakalcidol Bielen, Luka; Žagar, Iva
Medicus (Zagreb, Croatia : 1992),
11/2015, Volume:
24, Issue:
2 ASK niske doze
Journal Article
Peer reviewed
Open access
Vitamin D označava skupinu spojeva topljivih u mastima čiju osnovu strukture čine četiri prstena kolesterola. Budući da vrlo malen broj namirnica prirodno sadržava vitamin D, glavnina tog vitamina u ...ljudskom organizmu potječe iz endogene sinteze u dermisu pod utjecajem ultraljubičastog zračenja. Vitamin D nastao sintezom u dermisu i onaj unijet hranom biološki su neaktivni, a aktiviraju se u jetri i bubrezima hidroksilacijom. Normalna razina vitamina D bitna je za metabolizam kosti i održavanje homeostaze kalcija i fosfata. Nadalje, gen za receptor vitamina D posvuda je eksprimiran u živim stanicama te je oko 3% ljudskoga genoma pod kontrolom vitamina D. Time se objaš- njavaju brojni izvanskeletni učinci vitamina D, poput utjecaja na skeletne mišiće, imunosni sustav, kardiovaskularni sustav te razvoj malignih bolesti i dijabetesa. Razina vitamina D procjenjuje se mjerenjem serumske koncentracije kalcidiola, glavnoga cirkulirajućeg oblika vitamina D. Prema novijim istraživanjima, prevalencija manjka vitamina D u odrasloj je populaciji visoka i u nekim sredinama prelazi 50%. Rizični faktori uključuju dojenačku i stariju životnu dob, malapsorpciju masti, oštećenje funkcije jetre ili bubrega, život u krajevima s manjkom sunčeve svjetlosti, nošenje odjeće koja prekriva veći dio tijela itd. Nadoknada vitamina D može se provoditi različitim oblicima vitamina D i njegovim analozima, među koje se ubraja i alfakalcidol. Radi se o 1-hidroksikolekalciferolu, obliku vitamina D koji se aktivira hidroksilacijom u jetri, pri čemu se hidroksilacija u bubrezima zaobilazi. Karakterizira ga brz početak djelovanja, a izostanak hidroksilacije u bubregu povoljna je karakteristika kod bolesnika s oštećenjem bubrežne funkcije i onih na dijalizi.
BACKGROUNDThe main benefits of cryotherapy in rheumatoid arthritis (RA) are in reducing inflammation and swelling and in relieving joint pain. This study aimed to compare the short-term effects of ...cold air therapy vs. ice massage, on pain and handgrip strength (HGS) in patients with RA. SUBJECTS AND METHODSThe study is a non-randomized clinical trial. Patients were recruited if they had disease activity score (DAS28) ≥3.2 with at least 2 swollen joints on the dominant hand and were consecutively divided into two groups of 15 patients. There was no statistically significant difference in DAS28 score between groups. The first group received cold air therapy at -30°C and the second ice massage of the hands. The pain (visual analogue scale, 0-10), and HGS (kg) were measured immediately prior and after cryotherapy, and 30 and 60 minutes after cryotherapy. Descriptive statistics, Independent Samples T-test, and Paired Samples T-test were used for statistical analysis. RESULTSPain intensities for cold air therapy were as follows: 5.33 (±2.44), 3.13 (±2.67), 2.87 (±2.56), 2.80 (±2.73), and for ice massage were: 5.20 (±2.37), 2.87 (±2.42), 2.60 (±2.23), 2.67 (±2.28). In both groups pain was significantly lower immediately after, 30 and 60 minutes after the treatment compared to the baseline (p=0.001). There was no significant difference in pain alleviation between the groups regarding the used method of cryotherapy on all three measured time points. Nonsignificant improvement in HGS occurred after both methods of cryotherapy. There was no significant correlation between pain intensity and HGS. CONCLUSIONSA single application of cold air therapy and ice massage equally provides immediate and significant pain alleviation in patients with active RA, which is maintained for one hour. There is scientific evidence that HGS is influenced greatly by the disease activity. A single application of cryotherapy could not reduce disease activity explaining recorded nonsignificant effect on HGS.
BACKGROUNDEarly diagnosis is the key to successful treatment of inflammatory rheumatic diseases and the use of conventional disease-modifying antirheumatic drugs (csDMARD) and biologic ...disease-modifying antirheumatic drugs (bDMARD) or biologics have substantially contributed to better disease control. Biological drugs have been approved for the treatment of rheumatoid arthritis (RA), juvenile arthritis (JIA), ankylosing spondylitis (AS) and psoriatic arthritis (PsA). SUBJECTS AND METHODSThe study involved 79 adult patients with rheumatoid arthritis (RA) and ankylosing spondylitis (AS), psoriatic arthritis (PsA) or undifferentiated spondyloarthropathy (USpA) - the last three clinical entities belong to a common group called spondyloarthropathies (SpA); receiving anti-TNF therapy at the department of Rheumatology and Rehabilitation, Clinical Hospital Center Zagreb. The duration of therapy was a minimum of 1 month, with the mean duration of 32.0±24.0 months. The infections recorded were infections that appeared during treatment or soon after the treatment was stopped. RESULTSDuring the course of therapy 17 patients (21.5%) experienced an infection, with the total number of 21 infections. This resulted in an overall incidence rate (IR) of 9.9/100 patient-years. Of the patients with RA 76.5% developed an infection, which was significantly higher than for patients with SpA (p<0.001). The IR/100 patient-years for all infections in RA patients was 23.7 compared to 2.8 in patients with SpA. Female gender was associated with a significantly higher infection rate (70.6%, p=0.005). There were 8 infections that were considered serious, yielding an IR of 3.8/100 patient-years. There was only one malignancy case in our study. CONCLUSIONEvery fifth patient developed an infection during the course of anti-TNF therapy, and more than one third of all infections were serious. RA and female gender was associated with a significantly increased number of infections.
Ankylosing spondylitis (AS) is a chronic inflammatory rheumatic disease which primarily affects the axial spine and sacroiliac joints. Over the past several years Vitamin D has been recognized as a ...hormone with significant immunomodulatory effect due to the fact that it inhibits T-cell proliferation and decreases the production of interleukin-2, interferon-γ, and tumor necrosis factor-α. Therefore, vitamin D may play a role in the development and progression of inflammatory diseases. Our aim was to estimate and evaluate the correspondence of vitamin D status with functional scores, spinal mobility and disease activity among patients with AS in Croatia.
One hundred and fifty (150) AS patients were prospectively enrolled and assessed for disease activity, spinal mobility and functional disability. Blood samples were obtained from all patients and 25(OH)D concentration and inflammatory markers were determined. All patients underwent bone mineral density measurement at the lumbar spine (L1-L4) and proximal femur (total hip and femoral neck) with dual-energy x-ray absorptiometry.
The prevalence of 25(OH)D inadequacy considering cut-offs of 75, 50 and 30 nmol/L was 80, 46.7 and 16.7% respectively. The mean 25(OH)D serum concentration was 52.63±23.45 nmol/L. There was no significant difference in mean 25(OH)D concentration regarding patient's age, sex, smoking status, season change, disease activity, spinal mobility or functional scores. However, there was a trend towards lower 25(OH)D concentration in patients with higher disease activity, worse spinal mobility and worse functional scores.
Our results showed that there is no significant association between serum 25(OH)D concentration and activity of AS. Given that significant proportion of our patients had inadequate vitamin D status, the role of vitamin D in pathophysiology of AS still remains to be elucidated.
PDF