scholarly journals Part of pain labelled neuropathic in rheumatic disease might be rather nociplastic

RMD Open ◽  
2020 ◽  
Vol 6 (2) ◽  
pp. e001326
Author(s):  
Florian Bailly ◽  
Alain Cantagrel ◽  
Philippe Bertin ◽  
Serge Perrot ◽  
Thierry Thomas ◽  
...  
Keyword(s):  
Neuropathic Pain ◽  
Rheumatic Diseases ◽  
Clinical Signs ◽  
Central Sensitisation ◽  
Small Fibre Neuropathy ◽  
Inflammatory Mechanism ◽  
Small Fibre ◽  
Inflammatory Drugs ◽  
The Right ◽  
Symptoms And Signs

Pain in rheumatic diseases is primarily due to mechanical or inflammatory mechanism, but neuropathic pain (NP) component is also occurring in many conditions and is probably underdiagnosed. The purpose of this article is to provide an overview of prevalence, pathophysiological and currently available treatment of NP in rheumatic diseases. When associated with clinical evaluation assessing neurological clinical signs and neuroanatomical distribution, Douleur Neuropathique 4 Questions, painDETECT, Leeds assessment of neuropathic symptoms and signs and Neuropathic Pain Questionnaire can detect NP component. Inflammatory or connective diseases, osteoarthritis, back pain or persistent pain after surgery are aetiologies that all may have a neuropathic component. Unlike nociceptive pain, NP does not respond to usual analgesics such as paracetamol and non-steroidal anti-inflammatory drugs. Entrapment neuropathy, peripheral neuropathy or small-fibre neuropathy are different aetiologies that can lead to NP. A part of the pain labelled neuropathic is rather nociplastic, secondary to a central sensitisation mechanism. Identifying the right component of pain (nociceptive vs neuropathic or nociplastic) could help to better manage pain in rheumatic diseases with pharmacological and non-pharmacological treatments.

scholarly journals PATHOGENESIS OF FIBROMYALGIA IN PATIENTS WITH AUTOIMMUNE DISEASES: SCOPING REVIEW FOR HYPOTHESIS GENERATION

2020 ◽  
Vol 1 (1) ◽  
pp. 43-54
Author(s):  
Sakir Ahmed ◽  
Able Lawrence
Keyword(s):  
Rheumatic Diseases ◽  
Scoping Review ◽  
Sleep Disturbances ◽  
Unmet Needs ◽  
Social Defeat ◽  
Hypothesis Generation ◽  
Small Fibre Neuropathy ◽  
Small Fibre ◽  
The Common

Introduction: Fibromyalgia (FM) prevalence is much higher in patients with other rheumatic diseases than in the general population. This leads to increase in the perceived disease activity scores and prevents patients from reaching remission. Elucidating the pathogenesis of such “secondary” FM can help alleviate some unmet needs in these diseases. Methods: MEDLINE and Scopus databases were searched for a scoping review for hypothesis generation regarding the genesis of secondary FM. Results: FM has been postulated to be due to cytokine dysfunction, neurogenic neuroinflammation, stress, including social defeat, sleep disturbances, sympathetic overactivity, and small fibre neuropathy. These factors increase in most autoimmune and autoinflammatory diseases. Further the evidence for the role of these factors in the pathogenesis of FM is seems strong. Metabolic syndrome and mitochondrial dysfunction are also associated with FM, but it is difficult to distinguish between cause and effect. Conclusion: FM is the common phenotype arising from the amalgamation of various aetiologies. Recruitment or amplification of the above 6 factors by various rheumatic diseases may thus lead precipitation of secondary FM in susceptible individuals.

scholarly journals AB0717 PREVALENCE OF MIGRAINE AND NEUROPATHIC PAIN AMONG PATIENTS WITH RHEUMATIC DISEASES

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 1390.1-1390
Author(s):  
S. Miladi ◽  
M. Yasmine ◽  
A. Fazaa ◽  
S. Mariem ◽  
K. Ouenniche ◽  
...  
Keyword(s):  
Neuropathic Pain ◽  
Rheumatic Diseases ◽  
Disease Duration ◽  
Self Assessment ◽  
Factors Associated ◽  
Sociodemographic Data ◽  
Inflammatory Mechanism ◽  
High Prevalence ◽  
The Mean ◽  
Interview Questionnaire

Background:Pain in rheumatic diseases (RD) is primarily due to mechanical or inflammatory mechanism, but neuropathic pain (NP) component is yet to be fully evaluated and described, with a particular attention to the distinction with nociceptive pain [1].Objectives:The aim of our study was to assess the prevalence of migraine and neuropathic pain in patients with RD and to explore factors associated with NP.Methods:Prospective study including patients with rheumatoid arthritis (RA) and spondylarthritis (SpA) were invited to complete a validated self-assessment questionnaires. Sociodemographic data as well as disease related characteristics were recorded. Migraine was diagnosed according to the IHS migraine diagnostic criteria. NP was evaluated using DN4 (Douleur Neuropathique 4 Questions) and Pain DETECT questionnaire (PDQ). Neuropathic pain was retained in case of a total score of 4 or more at DN4-interview questionnaire or a score ≥19 with the PDQ.Results:A total of 60 patients with RD were included (42 RA/18 SpA). Females outnumbered males (sex-ratio=1.7). The mean age was 51.3 ± 13.1 years [18-75] and the mean disease duration was 11.9 ±5.6 [1-23] years. The prevalence of migraine was 15%. This latter was higher among women than men and among RA patients than SpA (18% vs 9%, 16.6% vs 11.2%) with no statistically significant correlation (p=0,329, 0,581 respectively). Parameters associated with a higher prevalence of migraine were an older age (p=0,042). However, there was no correlation between the presence of migraine and the type of the RD, disease duration or the level of anxiety (p=0,059, p=0,459 respectively). Chronic pain with neuropathic characteristics was found in 21.7% with the DECT score and 16.7% with DN4 questionnaire. NP was most prevalent among patients with comorbidities (28.5% vs 6%, p=0.021) and with higher body mass index (p=0.01). Prevalence was significantly higher in the RA group (19%) than in the SpA group (11%) without a statistically significant correlation (p=0.45). Similarly, NP was not associated with Salazopyrine intake (p=0.9).Conclusion:We found a high prevalence of migraine and NP in our sample of patients with RD. It seems therefore important to check the presence of migraine or NP especially in patients with comorbidities and older ones.References:[1]Bailly F, Cantagrel A, Bertin P, et al. Part of pain labelled neuropathic in rheumatic disease might be rather nociplastic. RMD Open. 2020;6:e001326.Disclosure of Interests:None declared

scholarly journals Pyogenic arthritis of sacroiliac joint in children

2009 ◽  
Vol 137 (9-10) ◽  
pp. 554-557 ◽  
Author(s):  
Zoran Rakonjac ◽  
Radivoj Brdar ◽  
Mirko Satara
Keyword(s):  
Sacroiliac Joint ◽  
Clinical Signs ◽  
Skeletal Scintigraphy ◽  
X Ray ◽  
Pyogenic Infection ◽  
Laboratory Results ◽  
Haematogenous Spread ◽  
The Right ◽  
Pyogenic Arthritis ◽  
Symptoms And Signs

Introduction Pyogenic infection of sacroiliac joint (SIJ) is very rare in children. It is the result of haematogenous spread primarily affecting the joint. The process is usually monoarticular. By rule, sequestra are rarely formed, there are no greater bone destructions, but there is usually early bone sclerosing. Case outline Due to the pain in the lumbosacral area spreading down the right leg and positive Lazarevic's sign, a 13-yearold boy was referred to a neuropediatrician. He was suffering from lumbosciatica. In the first three sick days, laboratory tests were done as well as X-ray examination. High febrility and laboratory results indicated the existence of infection of unknown localization. Diagnostic examination: radiography of the lungs and heart, computerized tomography (CT), nuclear magnetic resonance (NMR), ultrasound (US) of hips and painful sacroiliac area and US of abdomen could not localise the infection. Radiography of SIJ (Barschoni) focused the attention on SIJ. Scintigraphy of the skeleton with 99mTc-DPD pointed to the intensified collection of radiopharmaceuticals in the area around SIJ. Localized changes, erythema and signs of abscess in the projection of SIJ appeared the fifth day since the appearance of the disease. Incision was performed as well as evacuation of purulent content, and bacterial analysis isolated Staphylococcus aureus. Therapy with antibiotics was applied according to the antibiogram three weeks parenterally (intravenously) and two weeks per os. After five weeks, clinical and laboratory results were normal. The patient has been monitored for eight months since the appearance of the disease. Conclusion In children with symptoms and signs of lumbosciatica, among other things, attention should be paid, differentially and diagnostically speaking, to pyogenic infection of SIJ. The skeletal scintigraphy helps early diagnosis of pyogenic infection of SIJ, when localized clinical signs have not been formed yet. In our patient, the infection was caused by localized spreading from a skin abrasion.

Thermal hypoesthesia differentiates secondary RLS due to small fibre neuropathy from primary RLS

2009 ◽  
Vol 40 (01) ◽  
Author(s):  
C Bachmann ◽  
R Rolke ◽  
M Sommer ◽  
S Happe ◽  
RD Treede ◽  
...  
Keyword(s):  
Small Fibre Neuropathy ◽  
Small Fibre

Acute abdomen in pregnancy: a retrospective study of pregnant patients hospitalised for abdominal pain

2020 ◽  
Vol 99 (3) ◽  
pp. 131-135
Keyword(s):  
Abdominal Pain ◽  
Clinical Signs ◽  
University Hospital ◽  
Diagnostic Process ◽  
Abdominal Emergency ◽  
Lower Abdominal Quadrant ◽  
Abdominal Emergencies ◽  
The Right ◽  
Abdominal Quadrant ◽  
In Pregnancy

Introduction: Abdominal emergencies occur in pregnant women with the rate of 1:500−635 pregnancies. Such conditions usually develop from full health and worsen rapidly. Symptoms are often similar to those in physiological pregnancy (abdominal pain, vomiting, constipation). The diagnostic process is thus difficult and both the mother and her child are at risk. Our aim was to evaluate the frequency of abdominal emergencies in the Department of Surgery, University Hospital in Pilsen and to consider their impact on pregnancy and on the newborn. Methods: We acquired a set of patients by retrograde collection of data. We searched for pregnant patients suspected of developing an abdominal emergency admitted to the Department of Surgery, Faculty of Medicine, Pilsen between 2004 and 2015. We evaluated a number of clinical signs to statistically describe the set. Results: The set included 121 patients; 42 of the patients underwent a surgical procedure and 79 received conservative treatment. 38 patients underwent appendectomy; 6 appendixes were with no pathologies. McBurney’s incision was an approach of choice in most cases. The most frequent symptom was pain in the right lower abdominal quadrant. The foetus has been lost in none of the cases. Conclusion: Acute appendicitis was the most frequent abdominal emergency in our set and also the most frequent reason for surgical intervention. The most specific sign was pain in the right lower abdominal quadrant. No impact of appendicitis or appendectomy on the health of the newborn has been observed. Even though abdominal emergencies in pregnancy are relatively rare, the results of the department are very good.

scholarly journals Comprehensive Review of Knee Osteoarthritis Pharmacological Treatment and the Latest Professional Societies’ Guidelines

2021 ◽  
Vol 14 (3) ◽  
pp. 205
Author(s):  
Dragan Primorac ◽  
Vilim Molnar ◽  
Vid Matišić ◽  
Damir Hudetz ◽  
Željko Jeleč ◽  
...  
Keyword(s):  
Knee Osteoarthritis ◽  
Platelet Rich Plasma ◽  
Symptom Relief ◽  
Topical Administration ◽  
Symptomatic Therapy ◽  
Therapy Options ◽  
Professional Societies ◽  
Inflammatory Drugs ◽  
The Right

Osteoarthritis is the most common musculoskeletal progressive disease, with the knee as the most commonly affected joint in the human body. While several new medications are still under research, many symptomatic therapy options, such as analgesics (opioid and non-opioid), nonsteroid anti-inflammatory drugs, symptomatic slow-acting drugs in osteoarthritis, and preparations for topical administration, are being used, with a diverse clinical response and inconsistent conclusions across various professional societies guidelines. The concept of pharmacogenomic-guided therapy, which lies on principles of the right medication for the right patient in the right dose at the right time, can significantly increase the patient’s response to symptom relief therapy in knee osteoarthritis. Corticosteroid intra-articular injections and hyaluronic acid injections provoke numerous discussions and disagreements among different guidelines, even though they are currently used in daily clinical practice. Biological options, such as platelet-rich plasma and mesenchymal stem cell injections, have shown good results in the treatment of osteoarthritis symptoms, greatly increasing the patient’s quality of life, especially when combined with other therapeutic options. Non-inclusion of the latter therapies in the guidelines, and their inconsistent stance on numerous therapy options, requires larger and well-designed studies to examine the true effects of these therapies and update the existing guidelines.

scholarly journals Ibuprofen-Induced Aseptic Meningitis in a Male Adolescent with Intracranial Hypertension and Visual Impairment: A Case Report

2021 ◽  
Vol 13 (1) ◽  
pp. 233-238
Author(s):  
Seyed Mohammad Mousavi Mirzaei ◽  
Zahra Ahmadi
Keyword(s):  
Visual Impairment ◽  
Intracranial Hypertension ◽  
Aseptic Meningitis ◽  
Rare Complication ◽  
Clinical Signs ◽  
Male Adolescent ◽  
Drug Induced ◽  
Blurred Vision ◽  
Inflammatory Drugs

Drug-induced aseptic meningitis (DIAM) is a rare complication of certain drugs, most commonly reported with ibuprofen use. The present study reports on a male adolescent with intracranial hypertension and visual impairment accompanied by DIAM. We present a 16-year-old male patient who after ibuprofen consumption displayed headache, fever, photophobia, and blurred vision following heavy exercises. Examination of cerebrospinal fluid showed a mononuclear pleocytosis and an increase in protein concentration. Other examinations had normal results. The development of common clinical signs following ibuprofen use reflected DIAM. The patient’s vision was found to improve with supportive care and stopping of the drug during follow-up. Given the widespread use of nonsteroidal anti-inflammatory drugs and the fact that these drugs are the most common cause of DIAM, the probability of occurrence of this event should be always kept in mind, and screening for autoimmune diseases in these patients is of great importance.

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