The purpose of the study was to examine whether rheumatoid arthritis (RA) patients have higher prevalence of metabolic syndrome (MetS) than osteoarthritis (OA) patients in association with a higher ...level of chronic systemic inflammation in rheumatoid arthritis. A total of 583 RA and 344 OA outpatients were analyzed in this multicentric study. Metabolic syndrome was defined using the National Cholesterol Education Program Adult Treatment Panel III criteria. A 1.6-fold higher prevalence of MetS was found in patients with OA compared with the RA patients. Among the parameters of MetS, patients with OA had significantly higher levels of waist circumference, systolic blood pressure, fasting blood glucose and triglycerides, whereas HDL cholesterol and diastolic blood pressure values were similar in both groups of patients. Higher values of inflammatory markers C-reactive protein (CRP), erythrocyte sedimentation rate (ESR) in MetS than in non-MetS patients and higher prevalence of MetS in patients with CRP level ≥5 mg/L in both RA and OA patients were found. In multivariate logistic regression analysis, significant predictors of MetS were type of arthritis (OA vs. RA; OR 2.5 95 % CI 1.82–3.43), age (OR 1.04 95 % CI 1.03–1.06) and ESR (OR 1.01; 95 % CI 1.00–1.01). The significant association between OA and MetS was maintained in the regression model that controlled for body mass index (OR 1.87 95 % CI 1.34–2.61). The present analysis suggests that OA is associated with an increased risk of MetS, which may be due to a common underlying pathogenic mechanism.
Knee osteoarthritis (KOA), the most common type of osteoarthritis (OA), is associated with pain and inflammation of the joint capsule, impaired muscular stabilization, reduced range of motion and ...functional disability. High-intensity laser therapy (HILT) involves higher-intensity laser radiation and causes minor and slow light absorption by chromophores. Light stimulation of the deep structures, due to high intensity laser therapy, activates cell metabolism through photochemical effect. The transmissions of pain stimulus are slowed down and result in a quick achievement of pain relief. The aim of our research was to investigate the prompt analgesic effect of HILT on patients with KOA. Knee radiographs were performed on all patients and consequently graded using the Kellgren-Lawrence grading scale (K/L). A group of 96 patients (75 female, 21 male, mean age 59.2) with K/L 2 and 3 were submitted to HILT therapy. Pain intensity was evaluated with visual analogue scale (VAS) before and after the treatment. HILT consisted in one daily application, over a period of ten days, using protocol wavelength, frequency and duration. The results showed statistically significant decrease in VAS after the treatment (p < 0.001). Considering these results, HILT enables prompt analgesic effects in KOA treatment. Therefore HILT is a reliable option in KOA physical therapy.
In this study, we compare the prevalence of arterial hypertension (HT) in rheumatoid arthritis (RA) and osteoarthritis (OA) patients, exposed to high- and low-grade chronic inflammation, ...respectively, to assess the possible association between chronic inflammation and HT. A total of consecutive 627 RA and 352 OA patients were enrolled in this multicentric study. HT was defined as a systolic blood pressure (BP) ≥ 140 and/or diastolic BP ≥ 90 mmHg or current use of any antihypertensive drug. Overweight/obesity was defined as body mass index (BMI) ≥ 25, and patients ≥65 years were considered elderly. The prevalence of HT was higher in the OA group than in the RA group 73.3 % (95 % CI, 68.4, 77.7) and 59.5 % (95 % CI, 55.6, 68.4) P < 0.001, respectively. When the results were adjusted for age and BMI, the HT prevalence was similar in both groups RA 59 % (95 % CI, 55.1, 63.8) OA 60 % (95 % CI, 58.4, 65.0). In both groups, the prevalence of HT was higher in the elderly and those who were overweight than in the younger patients and those with a BMI < 25. Overweight (BMI ≥ 25) and age ≥65 were independent predictors of HT in multivariate logistic regression model, which showed no association between HT and the disease (RA or OA). The results indicate a robust association of age and BMI with HT prevalence in both RA and OA. The difference in HT prevalence between RA and OA is due rather to age and BMI than to the features of the disease, putting into question specific association of HT with RA.
Shoulder calcific lesions of the rotator cuff are a common problem in physiatric and orthopedic practice. The lesions are mostly located in the supraspinatus tendon, close to the insertion area in ...the critical zone. Patients are usually treated conservatively by nonsteroid antiinflammatory drugs, analgesic drugs, local injections, physiotherapy and rarely by applying surgical procedures. Painful shoulder gives rise to functional disabilities and may sometimes lead to pharmacological overuse. In the last twenty years, extracorporeal shock wave therapy (ESWT) has been frequently used in the treatment of calcific tendinopathies. We have evaluated the effectiveness of radial ESWT on the group of 30 patients, aged between 28 and 58 years, with calcific tendinitis of the shoulder. Criotherapy, medical exercises and radial ESWT were applied. We used the radial ESWT device (BTL-5000 SWT, Columbia, USA), 3 bars pressure, 10 Hz frequency, 2000 shocks. Patients were examined before the beginning of the treatment, immediately after the treatment, and 6 months later. The treatment included measurement of the range of motion (ROM), measurement of voluntary isometric contraction of shoulder muscles with manual muscle test (MMT), and subjective assessment of pain intensity with visual analogue scale (VAS). X-ray was done before and 6 month after treatment. The study has shown the efficiency of the treatment with radial ESWT. The level of statistical significance was determined with student t-test. Radial ESWT applied to patients with shoulder calcific lesions of the rotator cuff resulted in pain relief increase in the range of motion and increase in the muscular strength. As shown by X-ray, these results were followed by the decrease in the size of the rotator cuff calcifications.
Low-dose oral steroid therapies are very effective in active rheumatoid arthritis (RA), reducing disease activity in acute crisis either while waiting for disease-modifying antirheumatic drugs ...(DMARDs) to take effect or if it was slow in response to DMARDs. However, long-term steroid therapies are associated with serious side effects, such as osteoporotic reduction of bone mass and frequent fractures. This paper reports a female patient who has suffered RA treated with low-dose oral steroid therapy in a long-term period. Suddenly, she developed severe pain and oedema of forefeet during home distance level walking, with no history of trauma. The diagnosis of spontaneous serial fractures of the 2nd to 4th metatarsal (MT) bone bilaterally was performed by feet radiography. Furthermore, in widening the diagnostic approaches the authors had performed diagnostic musculoskeletal ultrasound to exclude metatarsophalangeal joint effusion and exacerbation of RA. They also made a static analysis of feet on the electronic baropodometer system in order to register biomechanical changes in bipedal standing. One year after, the same diagnostic procedures were done, on which occasion the healing of fractures were verified, with better results in biomechanical static analysis of the feet but without complete regression of static disbalance. This could lead to further disturbances during level walking and daily activities. This paper reports a unique case of the RA patient on long-term low-dose steroid therapy with previously unreported sites of spontaneous metatarsal fractures of feet which causes further static disbalance; consequently the patient might experience problems in every-day life activities.
Tuberkuloza (TBC ) je prepoznata kao važna oportunistička infekcija koja se javlja u bolesnika s upalnim reumatskim bolestima. Rezultati svjetskih registara pokazuju da se rizik od reaktivacije ...latentne TBC ili nastanka nove TBC - infekcije povećava u bolesnika liječenih inhibitorima faktora tumorske nekroze (TNFi). Dok rezultati randomiziranih kliničkih studija i malobrojni podatci iz svakodnevne prakse pokazuju da ciljani sintetski antireumatski lijekovi koji modificiraju bolest (eng. targeted synthetic disease-modifying anti-rheumatic drugs; tsDMARD ), kao što su apremilast
te inhibitori janus-kinaza (JAK -i), imaju niži rizik za aktivaciju TBC -a u usporedbi s TNFi. U ovom članku prikazati ćemo bolesnika u kojega je dugi niz godina psorijaza kože prethodila razvoju zglobnih tegoba i postavljanju dijagnoze psorijatičnog artritisa (PsA). Liječen je konvencionalnim sintetskim antireumatskim lijekovima koji modificiraju bolest (eng. conventional synthetic disease-modifying anti-rheumatic drugs; csDMARD )
metotreksatom i sulfasalazinom, te potom i tsDMARD -ovima apremilastom i tofacitinibom, uz prethodno utvrđene negativne nalaze hepatitis markera i kvantiferonskog testa na latentnu tuberkulozu. S obzirom na intenzivnu bolnost lumbosakralnog segmenta kralježnice uz febrilitet i alteraciju upalnih laboratorijskih parametara, učini se dijagnostička obrada kojom se utvrdi postojanje tuberkuloznog spondilodiscitisa L5-S1, epiduralnog apscesa i apscesa desnog mišića psoasa. Ukine se specifična terapija te se učini kirurška evakuacija apscesa, mikrodiscektomija i vertebrosinteza L5-S1 te započne antituberkulotska terapija u ukupnom trajanju od 12 mjeseci. Zaključno, ovo je prvi prikaz u literaturi tuberkuloznog spondilodiscitisa u bolesnika sa PsA liječenog tofacitinibom. Pacijent je godinu dana ranije bio liječen apremilastom tri mjeseca, ali ga ne možemo povezati s razvojem ekstrapulmonalne tuberkuloze. Potrebno je prikupiti rezultate iz nacionalnih registara s obzirom na to da randomizirane kontrolirane studije faze III nisu registrirale niti jedan slučaj TBC -a u pacijenata s PsA liječenih tofacitinibom. Kod pojave simptoma koji se ne uklapaju u kliničku sliku PsA, treba razmišljati o mogućnosti razvoja pulmonalne ili ekstrapulmonalne manifestacije tuberkuloze iako se bolesnik liječi tsDMARD -om.
Rutinska procjena bolesnikova indeksa 3 (engl. Routine Assessment of Patient Index Data 3 – RAPID3) jest indeks aktivnosti bolesti koji se izračunava na temelju jednostavnih i kratkih pitanja, a ...konstruiran je tako da ga bolesnik lako i brzo ispuni bez pomoći liječnika. On procjenjuje učinak upale zgloba na funkciju u aktivnostima svakodnevnog života. Originalno je dizajniran za bolesnike s reumatoidnim artritisom (RA), ali se može primjenjivati i u psorijatičnom artritisu (PsA). Indeks dokazano točno mjeri aktivnost bolesti i osjetljiv je na promjenu. Dio indeksa sadržava dijelove upitnika procjene bolesnikova zdravlja (engl. Health Assessment Questionnaire – HAQ), a mnogi radovi potvrđuju njegovu korelaciju s indeksom aktivnosti bolesti 28 (engl. Disease Activity Score 28 – DAS 28). S obzirom na činjenicu da je to indeks koji bolesnici ispunjavaju samostalno, važno je imati na umu stupanj edukacije bolesnika i međukulturne razlike što bi mogle utjecati na rezultate pozitivne korelacije opisane u literaturi. Stoga su ciljevi našeg istraživanja bili usporediti vrijednosti aktivnosti bolesti prema indeksu RAPID3, koji bolesnici ispunjavaju samo stalno, u odnosu prema indeksu DAS 28 i upitniku HAQ što ga ispunjavaju u interakciji bolesnik–liječnik te utvrditi koreli raju li i u našoj populaciji ti indeksi. U istraživanje je uključeno ukupno 57 bolesnika, 49 s RA i 8 sa PsA kod kojih smo pratili povezanost aktivnosti bolesti prema indeksu RAPID3 u usporedbi s upitnikom HAQ i indeksom DAS 28. Povezanost numeričkih i ordinalnih vrijednosti indeksa RAPID3 s HAQ-om i DAS 28 vrlo je jaka (uglavnom > 0,7 / > 0,6) i statistički značajna (statistička značajnost gubi se u skupini PsA zbog malenog broja bolesnika), što znači da su navedeni rezultati usporedivi te vrijednosti indeksa RAPID3 odgovaraju vrijednostima HAQ-a i DAS 28. Zaključno, u svojih smo bolesnika dokazali korelaciju vrijednosti među ispitivanim indeksima te da indeks RAPID3 može biti prihvatljiv alat za brzo mjerenje aktivnosti bolesti bolesnika s RA u reumatološkim ambulantama u Hrvatskoj.
The PROMO (preference for once monthly bisphosphonate) Study, conducted in seven hospital centres in Croatia between June 2007 and June 2008, was designed to analyse patient preference for weekly and ...monthly bisphosphonates in everyday clinical practice where the significant proportion of patients are not completely satisfied with the current osteoporosis treatment. Eligible participants were women with postmenopausal osteoporosis taking weekly bisphosphonates for the last 6 months. Those who agreed to be enrolled were transferred from weekly to monthly ibandronate for the next 6 months. There was no washout period between the two treatment regimens. At the baseline, patients expressed their satisfaction with the weekly treatment. At the end of the study, all patients were asked to complete the five-question survey specially designed for this study. Study population comprised 258 participants. Among 248 patients who completed the study, 244 (98.4%) declared their preference for one of the regimens or they had no preference. Once-monthly regimen was preferred by 231 patients (94.7%), whereas once-weekly regimen was preferred by five patients (2.0%). Eight patients (3.3%) indicated no preference. Furthermore, 93.0% of patients thought that monthly dosing was more convenient. Compared to weekly regimen, monthly dosing was associated with significantly higher satisfaction with the treatment and with significantly less adverse events. In line with these data, 85.9% of patients stated improved quality of life with monthly ibandronate. In summary, the PROMO Study demonstrated strong patient preference for monthly over weekly dosing which is expected to improve suboptimal adherence to weekly bisphosphonates.
