scholarly journals Value of imaging detected joint inflammation in explaining fatigue in RA at diagnosis and during the disease course: a large MRI study

RMD Open ◽  
2021 ◽  
Vol 7 (2) ◽  
pp. e001599
Author(s):  
X M E Matthijssen ◽  
Fenne Wouters ◽  
Navkiran Sidhu ◽  
A H M van der Helm - van Mil
Keyword(s):  
Mixed Models ◽  
Disease Activity Score ◽  
Rating Scale ◽  
Numerical Rating Scale ◽  
Joint Inflammation ◽  
Severe Fatigue ◽  
Numerical Rating ◽  
Mri Study ◽  
Subsequent Improvement

ObjectiveFatigue in rheumatoid arthritis (RA) is hypothesised to be caused by inflammation. Still ~50% of the variance of fatigue in RA cannot be explained by the Disease Activity Score (DAS), nor by background or psychological factors. Since MRI can detect joint inflammation more sensitively than the clinical joint counts as incorporated in the DAS, we hypothesised that inflammation detected by MRI could aid in explaining fatigue in RA at diagnosis and during the follow-up.Methods526 consecutive patients with RA were followed longitudinally. Fatigue was assessed yearly on a Numerical Rating Scale. Hand and foot MRIs were performed at inclusion, after 12 and 24 months in 199 patients and were scored for inflammation (synovitis, tenosynovitis and osteitis combined). We studied whether patients with RA with more MRI-inflammation were more fatigued at diagnosis (linear regression), whether the 2-year course of MRI-inflammation associated with the course of fatigue (linear mixed models) and whether decrease in MRI-inflammation in year 1 associated with subsequent improvement in fatigue in year 2 (cross-lagged models). Similar analyses were done with DAS as inflammation measure.ResultsAt diagnosis, higher DAS scores were associated with more severe fatigue (p<0.001). However, patients with more MRI-inflammation were not more fatigued (p=0.94). During 2-year follow-up, DAS decrease associated with improvement in fatigue (p<0.001), but MRI-inflammation decrease did not (p=0.96). DAS decrease in year 1 associated with fatigue improvement in year 2 (p=0.012), as did MRI-inflammation decrease (p=0.039), with similar effect strength.ConclusionSensitive measurements of joint inflammation did not explain fatigue in RA at diagnosis and follow-up. This supports the concept that fatigue in RA is partly uncoupled from inflammation.

scholarly journals POS0438 IS IMAGING DETECTED JOINT INFLAMMATION HELPFUL IN EXPLAINING FATIGUE IN RHEUMATOID ARTHRITIS AT DIAGNOSIS AND DURING THE DISEASE COURSE? – A LARGE MRI STUDY

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 448.1-448
Author(s):  
X. Matthijssen ◽  
F. Wouters ◽  
N. Sidhu ◽  
A. van der Helm - van Mil
Keyword(s):  
Rheumatoid Arthritis ◽  
Mixed Models ◽  
Rating Scale ◽  
Numerical Rating Scale ◽  
Joint Inflammation ◽  
Severe Fatigue ◽  
Numerical Rating ◽  
Mri Study ◽  
Subsequent Improvement

Background:Fatigue in rheumatoid arthritis (RA) is hypothesized to be caused by inflammation. Still ~50% of fatigue in RA cannot be explained by the disease activity score (DAS), nor by generic or psychological factors.Objectives:Since MRI can detect joint inflammation more sensitively than DAS, we hypothesized that residual inflammation detected by MRI could aid in explaining fatigue in RA at diagnosis and during follow-up.Methods:526 consecutive RA-patients were followed longitudinally. Fatigue was assessed yearly on a numerical rating scale. Hand and foot MRIs were performed at inclusion, after 12 and 24-months in 199 patients and were scored for inflammation (synovitis, tenosynovitis and osteitis combined). We studied whether RA-patients with more MRI-inflammation were more fatigued at diagnosis (linear regression), whether the 2-year course of MRI-inflammation associated with the course of fatigue (linear mixed models) and whether decrease in MRI-inflammation in year-1 associated with subsequent improvement in fatigue in year-2 (cross-lagged models). Similar analyses were done with DAS as inflammation measure.Results:At diagnosis, higher DAS-scores were associated with more severe fatigue (p<0.001). However, patients with more MRI-inflammation were not more fatigued (p=0.94). During 2-year follow-up, DAS decrease associated with improvement in fatigue (p<0.001), but MRI-inflammation decrease did not (p=0.96). DAS decrease in year-1 associated with fatigue improvement in year-2 (p=0.012), as did MRI-inflammation decrease (p=0.039), with similar effect strength.Conclusion:Sensitive measurements of joint inflammation did not aid in explaining fatigue in RA at diagnosis and follow-up. This supports the concept that fatigue in RA is partly uncoupled from inflammation.Disclosure of Interests:None declared

scholarly journals Percutaneous Osteoplasty under Fluoroscopy and Cone-Beam CT guidance for Painful Sternal Metastases

2021 ◽  
Author(s):  
Xun-wei Liu ◽  
Zhi-guo Wang ◽  
Jin Peng ◽  
Gang Sun
Keyword(s):  
Rating Scale ◽  
Numerical Rating Scale ◽  
Cone Beam Ct ◽  
Tumor Location ◽  
Cone Beam ◽  
Ct Guidance ◽  
Numerical Rating ◽  
Cement Distribution ◽  
Painful Bone Metastases

Abstract Background: Although percutaneous osteoplasty (POP) has been widely accepted and is now being performed for the treatment of painful bone metastases outside the spine, there are only scarced reports regarding osteoplasty in painful sternal metastases.Case presentation: The paper reported four patients with painful sternal metastasis who underwent POP under fluoroscopic and cone-beam CT guidance. The patients were three men and one woman (mean age, 66.25 years). Primary tumor location in lung is 3 cases, in thyroid is 1 case. In these cases, Pain was measured using a numerical rating scale (NRS), with scores ranging from 0 (no pain) to 10 (worst pain imaginable). The scores on the NRS in the four patients before POP were 9, 8, 8, and 9. After POP, the NRS scores decreased to 2, 3, 2, and 2, respectively, in follow-up at 6 months. Conclusions: POP is a safe and effective treatment for pain caused by metastatic bone tumors in the sternum. However, care and at tention should be paid to the insertion of a needle and cement distribution for better treatment effect

scholarly journals The Role of Testosterone Supplemental Therapy in Opioid-Induced Hypogonadism: A Retrospective Pilot Analysis

2016 ◽  
Vol 11 (4) ◽  
pp. 1208-1213 ◽  
Author(s):  
Omer A. Raheem ◽  
Sunil H. Patel ◽  
David Sisul ◽  
Tim J. Furnish ◽  
Tung-Chin Hsieh
Keyword(s):  
Chronic Pain ◽  
Rating Scale ◽  
Numerical Rating Scale ◽  
Opioid Therapy ◽  
Total Testosterone ◽  
Chronic Noncancer Pain ◽  
Numerical Rating ◽  
Noncancer Pain ◽  
Supplemental Therapy

Chronic opioid therapy for pain management is known to induce several endocrine changes. The authors examined the effect of testosterone supplemental therapy (TST) in patients with chronic, noncancer pain undergoing opioid therapy. It was hypothesized that treatment of opioid-induced hypogonadism (OIH) can reduce opioid requirements in patients suffering from chronic pain and approve their quality of life. Over 18 months period, patients with OIH were identified in a tertiary referral pain center, Numerical Rating Scale (NRS) pain scores and daily morphine equivalent dose (MED) were the primary outcomes measured. Data were collected and comparative analysis performed between men undergoing TST versus nontreatment group. Twenty-seven OIH patients (total testosterone <300 ng/dL) were identified during the study period. TST group consists of 11 patients, while non-TST group consists of 16 patients as control cohort. Mean patient age (55 and 54.4, p = .4) and basic metabolic index (28.5 and 31.9, p = .07) in TST and non-TST groups, respectively. Mean follow-up total testosterone (ng/dL) was significantly higher after TST compared with the non-TST group (497.5 vs. 242.4 ng/dL, p = .03). Median follow-up NRS was 0 and 2 in the TST and non-TST groups ( p = .02). Mean MED (mg) decreased by 21 mg in TST group and increased by 2.5 mg in non-TST group ( p < .05). This study reports that treatment of OIH with TST can reduce opioid requirements in men with chronic pain as quantified by MED. It also confirms previous reports on the potential effects of OIH and that TST is effective in correcting opioid-induced endocrine abnormalities.

scholarly journals Effect of Complex Korean Medicine Treatment on Sacral Insufficiency Fracture: A Case Report

2020 ◽  
Vol 37 (3) ◽  
pp. 187-192
Author(s):  
Ga Hyeon Jung ◽  
Hyun Lee ◽  
Hwa Yeon Ryu ◽  
Jae Hui Kang
Keyword(s):  
Rating Scale ◽  
Numerical Rating Scale ◽  
Insufficiency Fracture ◽  
Sacral Insufficiency Fracture ◽  
Korean Medicine ◽  
Numerical Rating ◽  
Numerical Rating Scale Score ◽  
History Of ◽  
Sacral Insufficiency Fractures

Sacral insufficiency fractures (SIF) are a common, but often underdiagnosed source of lower back pain without apparent trauma. This report presents the clinical outcome of a 75-year-old female with SIF, and an underlying medical history of osteoporosis and rheumatoid arthritis. She was treated non-operatively, in-hospital, with Korean medicine. Patient progress was assessed using the numerical rating scale and selfreported symptoms. Post-treatment, the numerical rating scale score for pain in her hip decreased from 7 to 2. At admission, the patient was unable to sit, and could only walk 3 m with assistance. At discharge, she could sit for longer than 1 hour and walk further than 200 m unassisted. On the follow-up visit, the patient was asymptomatic, and x-ray scans showed ossification of the sacral and pubic fractures. These results suggest that, Korean medicine can effectively reduce pain and aid rehabilitation in patients with SIF, without the need for surgery.

Clinical and radiological outcomes of the Ivory arthroplasty for trapeziometacarpal joint osteoarthritis with a minimum of 5 years of follow-up: a prospective single-centre cohort study

2013 ◽  
Vol 38 (8) ◽  
pp. 866-874 ◽  
Author(s):  
J. F. Goubau ◽  
C. K. Goorens ◽  
P. Van Hoonacker ◽  
B. Berghs ◽  
D. Kerckhove ◽  
...  
Keyword(s):  
Functional Outcome ◽  
Rating Scale ◽  
Numerical Rating Scale ◽  
Survival Rates ◽  
Trapeziometacarpal Joint ◽  
Term Survival ◽  
Numerical Rating ◽  
Trapeziometacarpal Joint Osteoarthritis ◽  
The Mean

We present the results of a 5 year prospective follow-up study on the functional outcome after total replacement of the trapeziometacarpal joint with the Ivory prosthesis (Memometal, Stryker Corporate, Kalamazoo, Michigan, USA) in 22 patients. The female to male ratio was 21:1 and the mean age was 66 (range 54–78) years. The mean follow-up period was 67 (range 60–77) months after operation. Patient satisfaction was high. The mobility of the operated thumb was restored to a range of motion comparable to the contralateral thumb. Key pinch and grip strength improved by 13% and 31%, respectively. Overall function, according to Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) score, improved by 59%. Pain decreased by 85% according to the numerical rating scale. Radiological evaluation revealed no loosening of the implant after 5 years except in one patient who required revision due to polythene wear with secondary joint instability. Another patient had asymptomatic polythene wear that required no revision but remains in follow-up. The 5 year overall survival of the prosthesis was 95%. These medium-term results suggest that the Ivory arthroplasty is a reliable option for treating advanced trapeziometacarpal arthritis, because it appears to give a very good functional outcome and has the potential for long-term survival rates.

Acute Cervical Radiculopathy Outcomes: Soft Disc Herniations vs Osteophytes

Pain Medicine ◽  
2020 ◽  
Author(s):  
William Jeremy Beckworth ◽  
Benjamin A Abramoff ◽  
Iain M Bailey ◽  
Sook Yoon ◽  
Monica Umpierrez ◽  
...  
Keyword(s):  
Pain Score ◽  
Rating Scale ◽  
Numerical Rating Scale ◽  
Neck Disability Index ◽  
Cervical Radiculopathy ◽  
Pain Scores ◽  
Plain Films ◽  
Numerical Rating ◽  
Disc Herniations

Abstract Objective Prospectively evaluate the clinical outcomes of acute cervical radiculopathy with respect to soft disc herniations vs osteophytes. Methods Sixty consecutive patients who had had cervical radiculopathy for ≤1 month were enrolled in the study. Inclusion criteria were radicular pain greater than axial pain and a pain score ≥4 out of 10 on a numerical rating scale. Patients had at least one positive clinical finding: motor, sensory, or reflex changes. Plain films and magnetic resonance imaging were ordered. Follow-up was at 6 weeks and 3, 6, and 12 months. Outcomes included pain scores (neck and upper limb), neck disability index, medication use, opioid use, and need for surgery. Two attending musculoskeletal radiologists reviewed imaging findings for osteophytes vs soft disc herniations at the symptomatic level. Results More than 75% reduction in pain was seen in 77% of patients with soft disc herniations and 66% of patients with osteophytes (P &gt; 0.05) at 12 months. A pain score ≤2 out of 10 within 6 to 12 months was seen in 86% of patients with soft disc herniations and 81% of patients with osteophytes (P &gt; 0.05). Moderate or marked improvement at 12 months was seen in 85% of patients with soft discs and 77% of patients with osteophytes (P &gt; 0.05). Baseline–to–12-month numerical rating scale pain scores of patients with soft discs vs osteophytes had overlapping confidence intervals at each follow-up. At 12 months, very few had undergone surgery (7% of patients with soft discs, 11% of patients with osteophytes; P &gt; 0.05) or were on opioids (7% of patients with soft discs, 9% of patients with osteophytes; P &gt; 0.05). Conclusions The majority of patients, but not all patients, with acute radiculopathies improved with time. This was seen with both soft disc herniations and osteophytes.

scholarly journals A Case Report on Chronic Intestinal Pseudo-obstruction Presenting as Unspecified Abdominal Pain in an Adult

2021 ◽  
Vol 42 (5) ◽  
pp. 1094-1101
Author(s):  
Yu-bin Ha ◽  
Han-sol Jang ◽  
Gil-cho Shin
Keyword(s):  
Abdominal Pain ◽  
Rating Scale ◽  
Numerical Rating Scale ◽  
The Body ◽  
X Rays ◽  
Treatment Progress ◽  
Numerical Rating ◽  
Intestinal Pseudo Obstruction ◽  
Fluid Levels

Objectives: This study examined a case of chronic intestinal pseudo-obstruction (CIPO) in an adult with unspecified abdominal pain.Methods: The patient was treated with herbal medicine, acupuncture, and moxa. Treatment progress was evaluated by follow-up monitoring of the intensity, frequency, and duration (in hours) of abdominal pain and body weight.Results: The average abdominal pain level on the Numerical Rating Scale (NRS) and its incidence decreased. The duration of pain was 15 hours maximum and 2.5 hours minimum. The body weight repeatedly increased and decreased but increased overall. Despite no remarkable findings from X-rays, air-fluid levels and coil-shaped folds of the small bowel were observed.Conclusions: Korean medical treatment based on a dialectic effectively relieved chronic abdominal pain and suspected CIPO-a disease that requires continuous management and therapeutic intervention.

scholarly journals Real-Time Ultrasound-Guided Stellate Ganglion Block for Migraine: An Observational Study

2021 ◽  
Author(s):  
Jiawei Hou ◽  
Shaofeng Pu ◽  
Junzhen Wu ◽  
Zhiqiang Lu ◽  
Xingguo Xu
Keyword(s):  
Side Effects ◽  
Rating Scale ◽  
Numerical Rating Scale ◽  
Stellate Ganglion ◽  
Stellate Ganglion Block ◽  
Ultrasound Guided ◽  
Ganglion Block ◽  
Numerical Rating

Abstract Objective. To observe whether ultrasound-guided stellate ganglion block (SGB) can effectively relieve migraine pain and improve the quality of migraine patients’ life.Methods. 81 patients with migraines were enrolled in this trial. The patients received SGB with 6 ml of 0.15% ropivacaine once every week for four times. Migraine was assessed with the Migraine Disability Assessment Scale (MIDAS) at baseline and three-months follow-up (Tm). The numerical rating scale (NRS) score at baseline, one day after treatment (Td) and Tm, the frequency of analgesic use in 3 months and the side effects were also recorded at the same time.Results. The NRS score of migraine subjects decreased significantly from 7.0 (2.0) to 3.0 (1.0) at Td and 2.0 (2.0) at Tm (vs baseline, P<0.01). The MIDAS total scores were 14.0 (10.5) at baseline and 7.0 (4.5) at Tm (P<0.001). During the three months, the frequency of analgesic consumption was decreased from 6.2 ± 2.8 to 1.9±1.8. There were no serious side effects. Conclusions. This study confirmed that ultrasound-guided SGB is an effective method to treat migraines. This technique can reduce pain and disability and then improve the quality of life of patients with migraines.

scholarly journals Neuromodulation for Chronic Pelvic Pain: A Single-Institution Experience With a Collaborative Team

Neurosurgery ◽  
2020 ◽  
Author(s):  
Cheyanne Bridger ◽  
Tarun Prabhala ◽  
Rachael Dawson ◽  
Olga Khazen ◽  
Jacquelyn MacDonell ◽  
...  
Keyword(s):  
Neuropathic Pain ◽  
Pelvic Pain ◽  
Chronic Pelvic Pain ◽  
Rating Scale ◽  
Numerical Rating Scale ◽  
Pain Catastrophizing ◽  
Pain Catastrophizing Scale ◽  
Pain Disability ◽  
Numerical Rating

Abstract BACKGROUND Secondary to the complex care, involved specialty providers, and various etiologies, chronic pelvic pain patients do not receive holistic care. OBJECTIVE To compare our general and neuromodulation cohorts based on referrals, diagnosis, and therapy and describe our neuromodulation patients. METHODS A multidisciplinary team was established at our center. The intake coordinator assessed demographics and facilitated care of enrolled patients. Outcomes were compared using minimal clinical important difference of current Numerical Rating Scale (NRS) between patients with neuropathic pain who received neuromodulation and those who did not. The neuromodulation cohort completed outcome metrics at baseline and recent follow-up, including NRS score (best, worst, and current), Oswestry Disability Index (ODI), Beck Depression Inventory, and Pain Catastrophizing Scale. RESULTS Over 7 yr, 233 patients were referred to our consortium and 153 were enrolled. A total of 55 patients had neuropathic pain and 44 of those were managed medically. Eleven underwent neuromodulation. A total of 45.5% patients of the neuromodulation cohort were classified as responders by minimal clinically important difference compared to 26.6% responders in the control cohort at most recent follow-up (median 25 and 33 mo, respectively). Outcome measures revealed improvement in NRS at worst (P = .007) and best (P = .025), ODI (P = .014), and Pain Catastrophizing Scale Rumination (P = .043). CONCLUSION Eleven percent of patients were offered neuromodulation. There were more responders in the neuromodulation cohort than the conservatively managed neuropathic pain cohort. Neuromodulation patients showed significant improvement at 29 mo in NRS best and worst pain, disability, and rumination. We share our algorithm for patient management.

scholarly journals Pengaruh Senam Rematik Terhadap Penurunan Nyeri Pada Pasien Rheumatoid Arthritis

2021 ◽  
Vol 1 ◽  
pp. 2084-2089
Author(s):  
Vanesa Tri Novana ◽  
Firman Faradisi ◽  
Nuniek Nizmah Fajriyah
Keyword(s):  
Rheumatoid Arthritis ◽  
Joint Pain ◽  
Rating Scale ◽  
Numerical Rating Scale ◽  
Alternative Therapy ◽  
Signs And Symptoms ◽  
Joint Inflammation ◽  
Pain Scale ◽  
Numerical Rating

Abstract Rheumatoid arthritis is an autoimmune disease when a person’s immune system attacks the body’s cells. Signs and symptoms of rheumatoid arthritis include joint inflammation and joint deformity. In most cases, patients with rheumatoid arthritis experience joint pain. Rheumatic Gymnastics is an alternative therapy that has been proven to reduce joint pain in rheumatic patients. The purpose of this case study is to describe the use of rheumatic exercise therapy in arthritic patients. The purpose of this case study is to examine therapeutic gymnastic in reducing pain among patients with rheumatoid arthritis. Two patients were taught to exercise therapeutic gymnastic. The research instrument is a pain scale observation sheet (Numerical Rating Scale). Two patients reported that there was a decreasing intensity of joint pain after doing exercise. This study concludes this particular exercise may reduce joint pain. Nurses are suggested to implement therapeutic gymnastics exercise in reducing pain among patients with Rheumatoid arthritis.Keywords : rheumatoid arthritis; pain; therapeutic gymnastics exercise Abstrak Rematik merupakan penyakit auto imun ketika sistem imun pada tubuh seseorang menyerang sel-sel tubuhnya sendiri. Gejala rematik yaitu inflamasi, deformitas, dan nyeri sendi yang paling dirasakan oleh penderita rematik. Senam Rematik merupakan terapi alternative yang sudah terbukti dapat menurunkan nyeri sendi pada pasien rematik. Tujuan studi kasus ini adalah untuk menggambarkan penggunaan terapi senam rematik pada pasien rematik. Metode yang digunakan adalah asuhan keperawatan dengan menerapkan terapi senam rematik. Instrumen penelitian berupa lembar observasi skala nyeri (Numerical Rating Scale). Hasil yang didapatkan pada klien 1 maupun 2 yaitu mengalami penurunan nyeri. Kesimpulan pada studi kasus ini bahwa senam rematik dapat menurunkan skala nyeri. Saran bagi perawat diharapkan dapat menerapkan tindakan senam rematik untuk menurunkan skala nyeri pada pasien rematik.Kata kunci : Rematik, nyeri, senam rematik

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