Background
Pain remains a prevalent symptom for rheumatoid arthritis (RA) patients despite a wide therapeutic choice. The objective of this study was to provide a multidimensional evaluation of pain.
...Methods
A total of 295 RA patients from 7 French rheumatology centres were enrolled in a cross‐sectional study. Patients completed a chronic pain assessment questionnaire approved by the French National Authority for Health, the health assessment questionnaire (HAQ) as well as depression and anxiety scales (HAD, Beck Depression Inventory, STAI). Disease activity (DAS28) and ESR were recorded. A multivariate descriptive analysis was undertaken using principal component analysis (PCA).
Results
38.4% of patients had a pain score > 40 mm/100, although 83% were on biological treatment and 38.7% were in remission based on the RA activity score. The PCA analysis found four axes representing 70% of total variance. The axes, per cent of variance and variables represented were as follows: (a) axis 1, 41% variance, anxiety and depression scores, sensory and affective qualifier score, HAQ and pain impact on daily life; (b) axis 2, 13% variance, disease activity score (DAS28) and pain relief with current treatment; (c) axis 3, 9% of variance, RA duration and radiographic score and (d) axis 4, 6% of variance, DAS28 and ESR. Moderate to severe pain was significantly associated with axes 1 and 2.
Conclusions
Despite a high proportion of patients on biological treatments, 38.4% of patients continue to experience moderate to severe pain. Pain is associated with the RA activity score, but also with the depression and anxiety scores.
Significance
Substantial proportion of rheumatoid arthritis (RA) patients still experiences relevant pain, although more than 80% on biological treatment. Pain is primarily associated with anxiety and depression scores and with disease activity score. These findings highlight the need to assess patients’ mental well‐being alongside. Clinical measures of disease activity to better manage pain and guide treatment decisions.
Active discopathy is associated with a specific phenotype of chronic low back pain (LBP). Local inflammation has a role in active discopathy-associated symptoms.
To assess the efficacy of a single ...glucocorticoid intradiscal injection (GC IDI) in patients with chronic LBP with active discopathy.
Prospective, parallel-group, double-blind, randomized, controlled study. (ClinicalTrials.gov: NCT00804531).
3 tertiary care centers in France.
135 patients with chronic LBP with active discopathy on magnetic resonance imaging (MRI).
A single GC IDI (25 mg prednisolone acetate) during discography (n = 67) or discography alone (n = 68).
The primary outcome was the percentage of patients with LBP intensity less than 40 on an 11-point numerical rating scale (0 no pain to 100 maximum pain in 10-point increments) in the previous 48 hours at 1 month after the intervention. The main secondary outcomes were LBP intensity and persistent active discopathy on MRI at 12 months and spine-specific limitations in activities, health-related quality of life, anxiety and depression, employment status, and use of analgesics and nonsteroidal anti-inflammatory drugs at 1 and 12 months.
All randomly assigned patients were included in the primary efficacy analysis. At 1 month after the intervention, the percentage of responders (LBP intensity <40) was higher in the GC IDI group (36 of 65 55.4%) than the control group (21 of 63 33.3%) (absolute risk difference, 22.1 percentage points 95% CI, 5.5 to 38.7 percentage points; P = 0.009). The groups did not differ in LBP intensity at 12 months and in most secondary outcomes at 1 and 12 months.
Tertiary care setting.
In chronic LBP associated with active discopathy, a single GC IDI reduces LBP at 1 month but not at 12 months.
French Ministry of Health.
Objectives
The aims of this preliminary study were to demonstrate the feasibility of in vivo diffusion tensor imaging (DTI) and fibre tracking (FT) of the lumbar nerve roots, and to assess potential ...differences in the DTI parameters of the lumbar nerves between healthy volunteers and patients suffering from disc herniation.
Methods
Nineteen patients with unilateral sciatica related to posterolateral or foraminal disc herniation and 19 healthy volunteers were enrolled in this study. DTI with tractography of the L5 or S1 nerves was performed. Mean fractional anisotropy (FA) and mean diffusivity (MD) values were calculated from tractography images.
Results
FA and MD values could be obtained from DTI-FT images in all controls and patients. The mean FA value of the compressed lumbar nerve roots was significantly lower than the FA of the contralateral nerve roots (
p
= 0.0001) and of the nerve roots of volunteers (
p
= 0.0001). MD was significantly higher in compressed nerve roots than in the contralateral nerve root (
p
= 0.0002) and in the nerve roots of volunteers (
p
= 0.04).
Conclusion
DTI with tractography of the lumbar nerves is possible. Significant changes in diffusion parameters were found in the compressed lumbar nerves.
Le syndrome douloureux régional complexe de type I, SDRC I du pied et de la cheville, anciennement appelé algodystrophie, est une affection douloureuse polymorphe articulaire et périarticulaire ...pouvant atteindre le pied et la cheville. Les symptômes cliniques se caractérisent par une douleur souvent mal systématisée, accompagnée de troubles de la sensibilité, vasomoteur, sudoromoteur, musculaire et trophique locaux, à extension possible régionale, survenant dans les suites d’un traumatisme, même mineur, ou spontanément. Malgré les avancées dans sa compréhension, la physiopathologie demeure partiellement élucidée, suggérant des altérations complexes au niveau du système nerveux sympathique, du système nerveux central ainsi que des phénomènes inflammatoires locaux. L’évolution est imprévisible dans le temps, et peut entraîner un handicap fonctionnel parfois sévère ainsi qu’une altération de la qualité de vie. Le diagnostic est avant tout clinique. Il existe un consensus pour utiliser les critères de Budapest pour le diagnostic de SDRC I permettant d’uniformiser la pratique clinique quotidienne. Le traitement repose avant tout sur la réadaptation fonctionnelle. D’autres options thérapeutiques, notamment l’administration de bisphosphonates par perfusion, sont envisageables selon les cas, en prenant en compte les différents symptômes, la sévérité du handicap fonctionnel et les contraintes spécifiques de prise en charge.
The complex regional pain syndrome type I, CRPS I in the foot and ankle, also known as algodystrophy, is a polymorphous pain articular and peri-articular condition. It is characterized by poorly systematized neuropathic regional pain, accompanied by sensory, vasomotor, sudomotor, muscular and trophic disorders. It is often triggered by a traumatic event (fracture, sprain, surgery). Despite advances in our understanding of its pathophysiology, it remains only partially elucidated, suggesting complex alterations in the sympathetic and central nervous systems, as well as local inflammatory phenomena. Its risk is prolonged evolution, leading to joint stiffening and functional disability. Diagnosis is primarily clinical, supported by Budapest criteria. Treatment is primarily based on rehabilitation. Analgesics are used to make rehabilitation tolerable and acceptable. Other treatment options, such as infusion of bisphosphonates, may be considered on a case-by-case basis, taking into account the stage of the disease, the severity of functional impairment and specific management constraints.
The purpose of this study was to (1) evaluate baseline characteristics of nonradiographic axial spondyloarthritis (nr-axSpA) and ankylosing spondylitis (AS) treated with tumor necrosis factor-α ...inhibitors (TNFi), (2) assess the response to first TNFi treatment, and (3) compare drug-survival duration and rates.
Inclusion criteria were patients with axSpA who initiated first TNFi treatment between April 2001 and July 2014 and were followed up for at least 3 months. Efficacy criteria were an improvement of at least 2 points (on a 0-10 scale) or a 50% improvement in the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI). Baseline characteristics, responses at 12 months, and drug survival were compared between AS and nr-axSpA.
A total of 361 patients were included in the study (AS, n = 263 and nr-axSpA, n = 98). Patients with AS were more often men (65.02% vs 45.92%, p = 0.001) and had longer symptom duration (11.71 ± 9.52 vs 7.34 ± 9.30 yrs, p < 0.001). Median levels of acute-phase reactants (C-reactive protein and erythrocyte sedimentation rate) were significantly higher in patients with AS (p < 0.001 for both). Median BASDAI scores at first TNFi initiation were not higher in patients with nr-axSpA than in patients with AS (59, 49-70 vs 60, 50-70, p = 0.73). BASDAI 20 and BASDAI 50 response rates at 12 months were not statistically different between patients with AS and patients with nr-axSpA (74.58% vs 64.58%, p = 0.19 and 61.02% vs 50.00%, p = 0.19, respectively). No statistically significant difference in terms of survival was observed between patients with AS and nr-axSpA (p = 1.00).
Treatment response and drug survival were similar in patients with AS and nr-axSpA after first TNFi initiation.
This report illustrates two rare cases of foramen magnum syndrome caused by a retro-odontoid mass in which calcium pyrophosphate dihydrate crystals were found.
To analyze the preoperative studies and ...the diagnostic criteria and to discuss the surgical treatment. The present cases will be compared with previous ones described in the literature.
Deposition of calcium pyrophosphate dihydrate crystals occurs into the fibrous and hyaline cartilage of the joints and intervertebral discs of the spine. Half of the patients known to have a chondrocalcinosis had asymptomatic calcification in the odontoid region. Ten patients were published in the literature as having a spinal cord syndrome secondary to calcium pyrophosphate dihydrate deposition in the odontoid region.
In both cases the preoperative studies were analyzed, and the retro-odontoid mass was resected and histologically examined. Both had an anterior transoral approach and have been followed for 1 year.
According to the preoperative radiographs the diagnosis was suspected and confirmed histologically. Transoral approach was done with no need in either case for a posterior stabilization.
Compression of the spinal cord by calcium pyrophosphate dihydrate deposition may occur. The preoperative diagnosis may be highly suspected after radiographic study and histologically confirmed. Transoral resection is the treatment of choice. Posterior stabilization should be considered only in cases of craniovertebral instability.
Objectives. –
To evaluate the quality of pain management in a teaching hospital rheumatology department.
Methods. –
We conducted a satisfaction survey among all the patients admitted to the ...conventional rheumatology department of our teaching hospital over a 1-month period (88 patients with a mean length of stay of 5 d). The patients were asked to complete a questionnaire on the day of discharge. The professional staff was not informed of the survey.
Results. –
The mean pain severity score at admission (visual analog scale, VAS) was 7.76 ± 1.76 and the mean score decrease with treatment was 7.27 ± 2.81. Expected pain relief and actual pain relief were correlated (
R = 0.39;
P = 0.001). Nearly all the patients (96.1%) reported have been encouraged to communicate about their pain. Information on the treatment was given to 89.3% of the patients; no significant differences in pain severity or pain relief were found between the patients who did and did not receive this information. The patients were satisfied with their management by the physicians (VAS: 8.83 ± 2.07) and nurses (VAS: 8.68 ± 1.72).
Conclusion. –
Satisfaction with pain management (a subjective criterion) was good in our patients. However, no validated tools for measuring satisfaction are available, and measurements should be repeated to look for improvements over time. Limitations to these results include the placebo effect, the influence of memory, and the effects of the behavior of hospitalized patients. A repeat survey is needed.
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