The use of complementary and alternative medicine (CAM) is high and increasing worldwide. Patients usually use CAM in addition to conventional medicine, mainly to treat pain. In a large number of ...cases, people use CAM for chronic musculoskeletal pain as in osteoarthritis, back pain, neck pain, or fibromyalgia. Herewith, a review is presented of CAM efficacy in treating musculoskeletal pain for which, however, no scientific research has so far provided evidence solid enough. In some rare cases where adequate pain control cannot be achieved, CAM might be considered in rational and individual approach based on the first general rule in medicine "not to harm" and on the utility theory of each intervention, i.e. according to the presumed mechanism of painful stimulus and with close monitoring of the patient's response. Further high quality studies are warranted to elucidate the efficacy and side effects of CAM methods. Therefore, conventional medicine remains the main mode of treatment for patients with musculoskeletal painful conditions.
The aim of the study was testing the hypothesis that body height has a moderating effect on the association of weight and chronic low back pain (LBP) induced disability, and that this moderating ...effect is different in women and men. We performed a nested cross-sectional analysis using data collected at baseline in a prospective cohort study conducted in 2008-2009 at a special hospital for medical rehabilitation in Croatia. The outcome was the Roland-Morris Disability Questionnaire (RMDQ) score. The independent variable was body weight. The focal moderators were body height and sex. The moderation analysis was adjusted for seven sociodemographic and clinical covariates. We analyzed data on 72 patients with a median (interquartile range) age of 50 (43-55) years, 36 (50%) of whom were women, treated for nonspecific, chronic LBP. The interaction of sex, body weight and height was a significant predictor of the RMDQ score after adjustments for all covariates (increase of R2=0.13; p=0.001; false discovery rate <5%). In both sexes, the correlation between body weight and the RMDQ score was significantly moderated by body height but in opposite ways. In conclusion, the effects of body weight on physical disability are moderated by body height, but this moderation effect differs between women and men. Key words: Low back pain; Body weight; Body height; Physical disability; Sex Cilj je bio testirati hipotezu da tjelesna visina ima moderatorski ucinak na povezanost te?ine i onesposobljenosti uzrokovane kronicnim bolovima u kri?ima (KBK) te da se taj moderatorski ucinak razlikuje kod ?ena i mu?karaca. Proveli smo ugnije?denu presjecnu analizu koristeci podatke prikupljene na pocetku prospektivne kohortne studije provedene 2008.-2009. godine u specijalnoj bolnici za medicinsku rehabilitaciju u Hrvatskoj. Ishod je bio rezultat Roland-Morrisova upitnika onesposobljenosti (RMDQ). Neovisna varijabla bila je tjelesna masa. Ciljani moderatori bili su tjelesna visina i spol. Analiza moderacije prilagodena je za sedam sociodemografskih i klinickih kovarijata. Analizirali smo podatke za 72 bolesnika s medijanom (IQR) dobi 50 (43-55) godina, od kojih su 36 (50%) bile ?ene, lijecenih zbog nespecificne KBK. Interakcija spola, tjelesne mase i visine bila je znacajan prediktor rezultata RMDQ nakon prilagodbi za sve kovarijate (porast R.sup.2=0,13; p=0,001; stopa la?nih otkrica <5%). U oba spola je korelacija izmedu tjelesne mase i rezultata RMDQ znacajno moderirana tjelesnom visinom, ali u suprotnim smjerovima. U zakljucku, ucinci tjelesne mase na tjelesnu onesposobljenost moderirani su tjelesnom visinom, ali taj se moderatorski ucinak razlikuje kod ?ena i mu?karaca. Kljucne rijeci: Bolovi u kri?ima; Tjelesna te?ina; Tjelesna visina; Tjelesna onesposobljenost; Spol
Routine assessment of patient index data 3 (RAPID3) is a simple, valid and reliable tool designed to measure disease activity in patients with rheumatoid arthritis (RA). RA causes significant ...disability and diminishes health-related quality of life (HR-QoL). The aim of this study was to investigate how RAPID3 is related to HR-QoL in patients with RA. In this cross-sectional study performed at the tertiary outpatient clinic 68 consecutive patients (58 females, and 10 males) with established RA were enrolled. RAPID3 and EuroQoL-5D-3L (EQ-5D-3L) were used to measure disease activity and quality of life, respectively. Alongside, demographic and clinical data were obtained, as well as HAQ-DI as a measure of physical function, and Steinbrocker’s score for radiographic damage. To test the relationships among RAPID3 and study variables we used the Pearson product–moment correlation coefficient, with the significance was set at
P
< 0.05. Linear and forward stepwise regression was used to show how variables of interest contributed to RAPID3. The mean value of RAPID3 (standard deviation, SD) was 14.12 (± 5.21), while the median (IQR) value of EQ-5D-3L was 0.51 (0.62–0.23). There was a high significant correlation (
r
= − 0.73) between RAPID3 scores and EQ-5D-3L. Among the other variables of interest, the strongest correlation was found between RAPID3 and intensity of pain (
r
= 0.88), while the EQ-5D-3L and pain were moderately correlated (
r
= − 0.68). In evaluating the influence of variables of interest on RAPID3, a forward stepwise regression model was constructed to evaluate whether VAS pain, EQ-5D-3L and EQ-VAS predicted RAPID3. The given variables significantly explained approximately 81% of the variation in RAPID3. Based on the results of this study RAPID3, a simple and practical tool to assess disease activity, reflects well HR-QoL in patients with established RA.
Infrared thermography is used for measuring and analyzing physiological functions and pathology related to the body’s thermal homeostasis and temperature. This review provides an overview of the ...technological advantages of infrared imaging, with the focus on new advances in and opportunities for infrared imaging, as a reliable medical diagnostic tool.
The review has four main parts. Firstly, a short history of thermography development in medicine is given. Secondly, an overview on the clinical and biomedical research results and methodological improvements in established applications of infrared thermography is provided. Thirdly, the details of published research and development results and activities of the last 3 years for time and frequency domain analysis of infrared video
thermography recordings to study some vital functions of human physiology are discussed. Analysis of infrared video thermography streams resulted in important information on microvascular (arteriolar) function of the skin and of vital organs when exposed during an operation. This new set of parameters of microvascular function enhances the assessment of the cardiovascular
system in chronic diseases e.g. in hypertension and diabetes. Infrared
thermography provides valuable information when an organ’s suitability for transplantationmust be assessed based on quantifiable parameters of organ function and viability. Fourthly, a brief overview on a separate, exciting area of infrared imaging is provided as well: the development of a touchless polygraph system. It enables the study of the psychophysiological parameters of stress, by the assessment of breathing and pulse wave patterns by noncontact
methodology, for lie detection purposes.
In conclusion, infrared imaging is a non-invasive, non-radiative, low
cost detection tool, and its application area is constantly growing, along with technical improvements and advances.
To examine the effect of endurance on the relationship between grip force and measures of functional capacity and disease activity, we performed a cross-sectional study at the University Department ...of Rheumatology, Physical medicine and Rehabilitation from January 2017 to August 2018. Functional capacity of the hand was measured by ABILHAND-RA questionnaire and disease activity was assessed by the Disease Activity Score (DAS-28-CRP). All participants underwent dynamometric measurements of maximal grip force and hand grip endurance during repeated gripping. We analyzed the data from 34 RA patients at the median (IQR) age of 57 (51–61), 31 (91%) of them women, and 44 healthy participants at the age of 55 (50–59), 39 (89%) of them women. The moderating effect of endurance on the correlation between maximum grip force and the ABILHAND-RA score was not significant in healthy participants (
b
= 0.000, 95% CI − 0.005–0.004,
p
= 0.862), but it was in RA patients (
b
= 0.003, 95% CI 0.000–0.005,
p
= 0.027). In RA patients, the effect of maximum grip force on the ABILHAND-RA score increased with the increase in hand grip endurance. In RA patients, the interaction between endurance and grip force significantly explained the 15% more variance of the disease activity than main effects of these two measures, age, gender and body mass index alone. Hand grip endurance during repeated gripping affects the correlation between maximum grip force and the ABILHAND-RA score in a pattern that differs in RA patients and in the healthy population. In RA patients, hand grip endurance significantly moderates the correlation between maximum grip force and the DAS-28-CRP.
We aimed to compile evidence for the efficacy and safety of therapeutic options for the peripheral arthritis domain of psoriatic arthritis (PsA) for the revised 2021 Group in Research and Assessment ...of Psoriasis and Psoriatic Arthritis (GRAPPA) treatment recommendations.
A working group consisting of clinicians and patient research partners was convened. We reviewed the evidence from new randomized controlled trials (RCTs) for PsA treatment from February 19, 2013, to August 28, 2020. We used the Grading of Recommendations Assessment, Development, and Evaluation (GRADE)-informed approach to derive evidence for the classes of therapeutic options for 3 patient groups: (1) naïve to treatment, (2) inadequate response to conventional synthetic disease-modifying antirheumatic drugs (csDMARDs), and (3) inadequate response to biologic DMARDs (bDMARDs). Recommendations were derived through consensus meetings.
The evidence review included 69 RCTs. We derived GRADE evidence for each class of therapeutic options and achieved consensus for the recommendations. For patients naïve to treatment, the working group strongly recommends csDMARDs (methotrexate, sulfasalazine, leflunomide) and phosphodiesterase 4 inhibitors, and emphasizes regular assessment and early escalation to achieve treatment target. bDMARDs (tumor necrosis factor inhibitors TNFi, interleukin 17 inhibitors IL-17i, IL-12/23i, IL-23i) and Janus kinase inhibitors (JAKi) are also strongly recommended. For patients with inadequate response to csDMARDs, we strongly recommend TNFi, IL-17i, IL-12/23i, IL-23i, and JAKi. For those who had prior experience with bDMARDs, we strongly recommend a second TNFi, IL-17i, IL-23i, and JAKi. The evidence supporting nonpharmacological interventions was very low. An expert panel conditionally recommends adequate physical activity, smoking cessation, and diet to control weight gain.
Evidence supporting optimal therapy for the peripheral arthritis domain of PsA was compiled for the revised 2021 GRAPPA treatment recommendations.
Fibrodysplasia ossificans progressiva (FOP) is a rare hereditary disease caused by a mutation in the intracellular domain of the activin A receptor type I and is characterized by episodes (flare-ups) ...of progressive heterotopic endochondral ossification (HO) in the soft tissues. The mutation alone is not sufficient for the occurrence of HO since flare-ups are triggered by inflammation and activation of the innate immune system. A number of cellular and humoral mediators have been implicated in animal and in vitro models. Observations in humans support the inflammatory nature of the condition, but data on the involved mediators are variable. We hypothesize that for induction of flare-ups in patients with FOP increase in at least one of the pro-inflammatory cytokines is both essential and sufficient to trigger the entire process of the inflammatory cells influx resulting in the novel ectopic bone formation and we suggest that C–C motif ligand 5 (CCL5), a pro-inflammatory chemokine also known as Regulated on activation, normal T-cell expressed and secreted (RANTES), might be the key candidate. CCL5 is a chemoattractant for all cellular types implicated in HO and is produced by the cells of the tissue microenvironment at the sites of HO as well as by the pro-inflammatory cellular mediators. CCL5 induces ossification in cultured human pluripotent mesenchymal cells (hMSCs) and in the primary culture of monocytes from FOP patients (but not from their healthy relatives), stimulation with lipopolysaccharide induces CCL5 expression. Finally, in a pilot study we used a panel of 23 cytokines and chemokines to screen the plasma samples of three subjects: a female patient with FOP during a flare-up; a female patient with hyperostosis corticalis generalisata (van Buchem disease), another rare disease characterized by excessive bone formation at the sites where it regularly occurs that does not include inflammatory events; and a healthy woman without bone disorders. There appeared a rather clear-cut signal of a 2-fold higher level of CCL5 in the FOP patient vs. the healthy subject and the van Buchem patient. Evaluation of the hypothesis would require an international prospective study, with main motivation being the lack of a conclusive treatment as the major unmet need in FOP. A treatment targeting CCL5 receptor already exists and is used in HIV-infected patients.
