The aim of this study is to compare four forms of axial spondyloarthritis (axSpA): non-radiographic axial spondyloarthritis (nr-axSpA), ankylosing spondylitis (AS), non-radiographic axial psoriatic ...arthritis (nr-axPsA) and radiographic axial psoriatic arthritis (r-axPsA). In a cross-sectional retrospective study, gender difference, human leukocyte antigen (HLA) typing, laboratory C-reactive protein (CRP) and erythrocyte sedimentation (SE) values, and radiographic and magnetic resonance scans were analyzed. One hundred and thirty-seven patients were included in the study: 45 AS, 51 nr-axSpA, 32 r-axPsA and 9 nr-axPsA; 74 women and 63 men. Most of the gender, laboratory and radiological findings confirmed the results of previously conducted studies about each group of the investigated axSpA. The key findings of our study are the newly detected findings of HLA typing beyond HLA-27 positivity: HLA-DR16 in AS, HLA-DR11 in nr-axSpA, HLA-B13, HLA-B57, HLA-Cw12 and HLA-DR7 in r-axPsA, and HLA-B18 in nr-axPsA. Our study also confirmed some of the results of previously conducted studies on predominant genes of HLA typing in axSpA: HLA-B27 in AS, HLA-B39 and HLA-Cw6 in r-axPsA, and HLA-Cw7 in nr-axPsA. Important conclusions about the nr-axPsA group cannot be drawn because of the very small number of subjects included in this group of axSpA. Our results suggest that the newly detected HLA typing findings beyond HLA-B27 positivity could be possible biomarkers of early detection of axSpA, but further studies on larger samples are needed.
Cilj: Prikaz slučaja bolesnice s fibromialgijom koja se inicijalno prezentirala kroničnom proširenom boli te je proveden dijagnostičko-terapijski postupak. Prikaz slučaja: Bolesnica u dobi od 61 ...godine liječena je pri Zavodu za fizikalnu i rehabilitacijsku medicinu s reumatologijom zbog jakih kroničnih bolova u zglobovima i mišićima. Bolesnica dodatno opisuje poteškoće sa spavanjem, tegobe depresije i anksioznosti. Boluje od hipotireoze, a prethodno su na magnetskoj rezonanciji utvrđene degenerativne promjene kralježnice. Opsežnom je dijagnostičkom obradom isključena upalna reumatska bolest, neurološka bolest, paraneoplastični sindrom, neregulirana hipotireoza te kronična infekcija. Dijagnostički upitnik za fibromialgiju potvrdio je sumnju da bolesnica boluje od fibromialgije temeljem rezultata upitnika (Widespread pain index (WPI) 15; symptom severity scale (SSS) 9). Procjena umora kronične bolesti dala je izrazito loš rezultat (The Functional Assessment of Chronic Illness Therapy (FACIT-F) 15/52), što je ukazalo na lošu kvalitetu života. Provedeno je nefarmakološko liječenje koje se sastojalo od edukacije, individulane kineziterapije i fizikalno-terapijskih procedura te multimodalno farmakološko liječenje. Izborom lijekova djelovalo se na nociceptivnu i neuropatsku vrstu boli, kao i na anksioznost bolesnice s povoljnim terapijskim odgovorom. Navedenim pristupom liječenja postignuto je značajno poboljšanje tegoba sindroma fibromialgije u naše bolesnice. Zaključak: U bolesnika s proširenom kroničnom boli, kroničnim umorom i poremećajima mentalnog stanja treba posumnjati na fibromialgiju. Dijagnostičkom je obradom potrebno isključiti drugu ozbiljnu bolest. Za postavljanje dijagnoze fibromialgije koriste se dijagnostički kriteriji iz 2016. godine – American College of Rheumatology (ACR). Ovim prikazom bolesnice željeli smo podignuti svijest o ovoj bolesti koja je u svijetu prepoznata kao ozbiljan zdravstveni problem iako ponekad zanemaren i nepriznat.
Aim: To present a case of a patient with fibromyalgia who initially presented with chronic widespread pain and a diagnostic-therapeutic procedure. Case report: A 61-year-old patient was treated at the Department of physical and rehabilitation medicine with rheumatology for severe chronic joint and muscle pain. The patient additionally describes difficulty of sleeping, depression, and anxiety. She suffers from hypothyroidism and degenerative changes of the spine have been previously determined on magnetic resonance imaging. Extensive diagnostic treatment ruled out inflammatory rheumatic disease, neurological disease, paraneoplastic syndrome, unregulated hypothyroidism, and chronic infection. The Fibromyalgia Diagnostic Questionnaire confirmed the suspicion that the patient was suffering from fibromyalgia based on the results of the questionnaire Widespread pain index (WPI) 15 and symptom severity scale (SSS) 9. The Functional Assessment of Chronic Illness Therapy-fatigue (FACIT-F) gave an extremely poor result, 15 points. Non-pharmacologic treatment was conducted, consisted of education, individual exercise, physical therapy procedures and multimodal pharmacological therapy, with the choice of drugs affected the nociceptive and neuropathic type of pain, as well as the anxiety of the patient with a favorable therapeutic response. This approach to treatment has achieved a significant improvement in the symptoms of fibromyalgia syndrome in our patient. Conclusion: Fibromyalgia should be suspected in patients with widespread chronic pain, chronic fatigue, and mental disorders. It is necessary to exclude another serious disease by diagnostic processing. The 2016 American College of Rheumatology (ACR) diagnostic criteria are used to diagnose fibromyalgia. With this presentation of the patient, we wanted to raise awareness about this disease, which is recognized in the world as a serious health problem, although sometimes neglected and unrecognized.
Cilj: Neurorehabilitacija bolesnika nakon moždanog udara predstavlja velik izazov, a robotski sustavi kao nadogradnja konvencionalne rehabilitacije predmet su brojnih istraživanja. Tako je pri Zavodu ...za fizikalnu i rehabilitacijsku medicinu KBC-a Rijeka provedeno istraživanje u kojem je korišten robotski uređaj Armeo Spring® (Hocoma, Švicarska) s ciljem procjene učinkovitosti njegove primjene. Ispitanici i metode: U istraživanje je uključeno 40 bolesnika koji su zadobili moždani udar s posljedičnom hemiparezom, a uključeni su u neurorehabilitaciju u subakutnoj fazi, prosječno 47,31 (± SD = 24,74) dana nakon moždanog udara. Bolesnici su podijeljeni u dvije skupine, od po 20 bolesnika i obje skupine provodile su vježbe dva puta dnevno. Ispitivana skupina bolesnika provela je konvencionalne postupke fizioterapije po Bobath konceptu uz dodatnu robotsku terapiju na uređaju Armeo Spring® (Hocoma, Švicarska), a dvadeset bolesnika kontrolne skupine provodilo je konvencionalnu fizioterapiju po Bobath konceptu dva puta dnevno. Procjena učinkovitosti mjerena je funkcijskim indeksom onesposobljenosti (engl. Functional Independent Measurement; FIM) i ocjenskom ljestvicom motoričke procjene (engl. Motor Assessment Scale; MAS), a procjena je vršena prije i poslije provedene neurorehabilitacije. Rezultati: Praćenjem triju varijabli, cjelokupni FIM test, cjelokupni MAS test (MAS U) te MAS test za funkciju ruke (engl. Motor Assessment Scale za funkciju ruke; MAS FR), uočena je statistički značajna razlika (P < 0,05) između ispitivane i kontrolne skupine. Zaključak: Istraživanje je pokazalo da pokreti potpomognuti uređajem Armeo Spring® poboljšavaju ishod rehabilitacije i nadopunjuju konvencionalnu terapiju. Posebno je ohrabrujući podatak da smo svoje rezultate postigli kod bolesnika u subakutnoj fazi rehabilitacije nakon moždanog udara.
Aim: Neurorehabilitation of patients after stroke is a major challenge, and robotic systems as an upgrade to conventional rehabilitation have been the subject of numerous studies. Thus, a research was conducted at the Department of Physical and Rehabilitation Medicine of the University Hospital Center Rijeka in which an Armeo Spring® (Hocoma, Switzerland) robotic device was used in order to evaluate the effectiveness of its application. Subjects and methods: The study included 40 patients after stroke with consequent hemiparesis and were involved in subacute phase neurorehabilitation, averaging 47.31 (± SD = 24.74) days after stroke. Patients were divided into two groups of 20 patients and both groups performed exercises twice a day. The examined group of patients performed conventional physiotherapy procedures according to the Bobath concept with additional robotic therapy on the Armeo Spring® device (Hocoma, Switzerland) and twenty patients of the control group performed conventional physiotherapy according to the Bobath concept twice a day. Performance assessment was measured by the Functional Independent Measurement (FIM) and the Motor Assessment Scale (MAS) and the assessment was performed before and after neurorehabilitation. Results: Monitoring three variables, the overall FIM test, the overall MAS test (MAS U) and the MAS test for upper extremity function (Motor Assessment Scale for upper extremity function; MAS UE) showed a statistically significant difference (p <0.05) between the examined and control groups. Conclusion: The research has shown that Armeo Spring®-assisted movements improve the outcome of rehabilitation and complement conventional therapy. It is especially encouraging that we achieved our results in patients in the subacute phase of rehabilitation after stroke.
SAŽETAK
Adultne deformacije kralježnice značajno pridonose morbiditetu, napose starije popupacije. Iako je spektar uzroka raznolik najčešće se radi o novonastalim deformacijama na temelju ...degenerativnih promjena kralježnice. Osim bolova, osjećaja napetosti i drugih neugodnih simptoma, adultne deformacije rezultiraju biomehaničkim poremećajima, smanjenom pokretljivosti, a ponekad i neurološkim deficitima. Sveukupno, deformacije kralježnice u odraslih osoba uzrokuju značajnu onesposobljenost i lošiju kvalitetu života (fizičku i psihičku), dok su s druge strane u svakodnevnoj kliničkoj praksi relativno zanemarena patologija odrasle dobi. Stoga u ovom radu dajemo natativni pregled najnovijih spoznaja o etiopatogenezi, kliničkoj slici, slikovnoj dijagnostici, liječenju (konzervativnom i kirurškom) i postoperativnoj rehabilitaciji bolesnika s adultnim deformacijama najčešćih uzroka.
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.
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.
Moždani udar je naglo nastali žarišni ili globalni neurološki deficit uzrokovan cerebrovaskularnim poremećajem. Simptomi ovise o veličini oštećenja i zahvaćenog područja te o vremenu proteklom od ...pojave simptoma do dijagnoze. Brzim prepoznavanjem simptoma i prijevozom pacijenta do jedinice akutnog liječenja povećava se udio pacijenata koji se mogu liječiti trombolitičkom terapijom te se na taj način smanjuje moralitet i invaliditet. Rani početak rehabilitacije u akutnoj fazi liječenja iznimno je važan. Ovisno o veličini oštećenja pacijenti se dalje zaprimaju na bolničko liječenje i specijalizirani program neurorehabilitacije, terapiju nastavljaju ambulantno ili se otpuštaju kući, na provođenje kućne rehabilitacije. Kriteriji za prijam su stabilan neurološki status, odsutnost značajnijeg komorbiditeta, prisutnost značajnijeg neuromotornog deficita u najmanje dvije od pet navedenih funkcija: pokretljivost, aktivnost samozbrinjavanja, komunikacija, kontrola stolice i mokrenja, kontrola žvakanja i gutanja. Rana rehabilitacija je ključna jer je oporavak neuroloških deficita najbolji u prva tri mjeseca nakon moždanog udara. Današnji principi neurorehabilitacije temelje se na teoriji neuroplastičnosti. Terapijski program se individualno prilagođava svakom pacijentu i uključuje medicinsku njegu, farmakološku terapiju, pacijenti prolaze specijalizirani program neurorehabilitacije, uz primjenu ortopedskih pomagala, provode se okupacijsko–radne aktivnosti, logopedske vježbe i kognitivni trening.
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.
