Efficacy of Intra-Articular Injection of 10 mg and 20 mg Triamcinolone for Rheumatoid Arthritis of the Wrist: A Prospective, Randomized, Pilot Study

2021 ◽  
Vol 26 (03) ◽  
pp. 490-493
Author(s):  
Takeshi Mochizuki ◽  
Koichiro Yano ◽  
Katsunori Ikari ◽  
Ken Okazaki
Keyword(s):  
Rheumatoid Arthritis ◽  
Pilot Study ◽  
Scale Score ◽  
Rating Scale ◽  
Numerical Rating Scale ◽  
Wrist Joint ◽  
Power Doppler ◽  
Total Study Population ◽  
Entire Study ◽  
Study Population

Background: To compare the efficacy of intra-articular injection (IA) with 10 mg and 20 mg triamcinolone for treatment of rheumatoid arthritis (RA) of the wrist joint. Methods: We enrolled 20 patients with swelling and pain in wrist due to RA in the present prospective, randomized, pilot study. Patients were randomly assigned in a 1:1 ratio to either the 20 mg or 10 mg group, and received IA of the appropriate dose of triamcinolone. Efficacy was assessed by recording Numerical Rating Scale (NRS) for pain and improvement in power doppler (PD) scale score at weeks 1, 4, and 12 of treatment compared with baseline. The shortened Disabilities of the Arm, Shoulder and Hand questionnaire (QuickDASH) was recorded at baseline and week 12. Results: The NRS was found to be significantly improved at weeks 4 (p = 0.006) and 12 (p = 0.036) among the total study population. Neither the change in NRS nor the improvement PD scale score from baseline were significantly different between the two groups at any week (NRS: week 1, p = 0.617; week 4, p = 0.727; and week 12, p = 0.878; PD scale score: week 1, p = 0.370; week 4, p = 1.000; and week 12, p = 0.179). Among the entire study population, the QuickDASH was not significantly improved at week 12 nor was the change from baseline significantly different between the two groups at week 12 (p = 0.592). Conclusions: IA of triamcinolone was effective for pain relief in context of RA in the wrist joint. However, in terms of NRS, improvement of PD scale score, and QuickDASH score, the efficacies of 10 mg and 20 mg triamcinolone were not significantly different. Thus, IA of 10 mg triamcinolone may be sufficient for the treatment of RA in the wrist joint.

scholarly journals Content and Construct Validity, Reliability, and Responsiveness of the Rheumatoid Arthritis Flare Questionnaire: OMERACT 2016 Workshop Report

2017 ◽  
Vol 44 (10) ◽  
pp. 1536-1543 ◽  
Author(s):  
Susan J. Bartlett ◽  
Skye P. Barbic ◽  
Vivian P. Bykerk ◽  
Ernest H. Choy ◽  
Rieke Alten ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Construct Validity ◽  
Rating Scale ◽  
Numerical Rating Scale ◽  
Field Testing ◽  
Sensitivity Factor ◽  
Instrument Selection ◽  
Item Functioning ◽  
Numerical Rating ◽  
The Rasch Model

Objective.The Outcome Measures in Rheumatology (OMERACT) Rheumatoid Arthritis (RA) Flare Group was established to develop a reliable way to identify and measure RA flares in randomized controlled trials (RCT). Here, we summarized the development and field testing of the RA Flare Questionnaire (RA-FQ), and the voting results at OMERACT 2016.Methods.Classic and modern psychometric methods were used to assess reliability, validity, sensitivity, factor structure, scoring, and thresholds. Interviews with patients and clinicians also assessed content validity, utility, and meaningfulness of RA-FQ scores.Results.People with RA in observational trials in Canada (n = 896) and France (n = 138), and an RCT in the Netherlands (n = 178) completed 5 items (11-point numerical rating scale) representing RA Flare core domains. There was moderate to high evidence of reliability, content and construct validity, and responsiveness. Factor analysis supported unidimensionality. Rasch analysis showed acceptable fit to the Rasch model, with items and people covering a broad measurement continuum and evidence of appropriate targeting of items to people, ordered thresholds, minimal differential item functioning by language, sex, or age. A summative score across items is defensible, yielding an interval score (0–50) where higher scores reflect worsening flare. The RA-FQ received endorsement from 88% of attendees that it passed the OMERACT Filter 2.0 “Eyeball Test” for instrument selection.Conclusion.The RA-FQ has been developed to identify and measure RA flares. Its review through OMERACT Filter 2.0 shows evidence of reliability, content and construct validity, and responsiveness. These properties merit its further validation as an outcome for clinical trials.

scholarly journals Influence of non-steroidal anti-inflammatory drugs on the inflammatory sonographic features in erosive hand osteoarthritis: an intervention study

2020 ◽  
Vol 4 (1) ◽  
Author(s):  
Qun Xia Xu ◽  
Ruth Wittoek
Keyword(s):  
Rating Scale ◽  
Numerical Rating Scale ◽  
Randomized Study ◽  
Power Doppler ◽  
Doppler Signal ◽  
Control Group ◽  
Hand Osteoarthritis ◽  
Synovial Proliferation ◽  
Numerical Rating ◽  
Power Doppler Signal

Abstract Objective The aim was to examine whether inflammatory US features in erosive hand OA patients change when discontinuing intake of NSAIDs before US examination in a non-randomized study. Methods Patients (n = 99) were allocated to the NSAIDs or control group according to their intake at baseline. US was performed at baseline (T0) and 2 weeks after discontinuation of NSAIDs (T1). Inflammatory features (i.e. synovial proliferation, effusion and power Doppler signal) were scored using a semi-quantitative scale (from zero to three). Pain levels were scored on a numerical rating scale. Binomial mixed models were fitted for US features, and odds ratios of having a US score of at least two vs at most one for synovial proliferation and effusion, and zero vs at least one for power Doppler were calculated. Results At baseline, both groups [NSAIDs group (n = 47) vs control group (n = 52)] were comparable for numerical rating scale pain, disease duration, number of radiographically affected joints, BMI and US baseline data, but not for age (P = 0.005). At T1, more synovial proliferation and power Doppler signal was seen compared with T0 in the NSAIDs group (P = 0.018 and 0.031, respectively). However, the interaction term time*NSAIDs was not found to be significant for any variable. The numerical rating scale pain at T1 was higher compared with baseline, although statistically non-significant. Conclusion No significant changes in inflammatory US features were seen in patients with erosive hand OA after withdrawal of NSAIDs for 2 weeks. This study suggests that an NSAID-free period is not necessary before assessing inflammatory disease activity in erosive hand OA.

scholarly journals Vivostat Platelet-Rich Fibrin® for Complicated or Chronic Wounds—A Pilot Study

Biomedicines ◽  
2020 ◽  
Vol 8 (8) ◽  
pp. 276
Author(s):  
Andreas Bayer ◽  
Gesa Höntsch ◽  
Mark Kaschwich ◽  
Annika Dell ◽  
Markus Siggelkow ◽  
...  
Keyword(s):  
Wound Healing ◽  
Pilot Study ◽  
Clinical Efficacy ◽  
Chronic Wounds ◽  
Local Treatment ◽  
Entire Study ◽  
Platelet Rich Fibrin ◽  
Arterial Blood ◽  
Autologous Platelet Concentrate ◽  
Study Population

Vivostat Platelet-Rich Fibrin® (PRF) is an autologous platelet concentrate used for the local treatment of chronic or complicated wounds. Still, its application for this indication is not evidence-based. Therefore, we performed this monocentric retrospective pilot study investigating the clinical outcome of a local treatment of chronic or complicated wounds in 35 patients (23 male, 12 female, mean age 68.7 years) treated with Vivostat PRF®. This study population is the largest among published studies analyzing the clinical efficacy of Vivostat PRF® on chronic wounds so far. Using the perpendicular method we divided the wounds into three sizes (<10, 10–30, and >30 cm2). The clinical efficacy of the Vivostat PRF treatment was the primary endpoint and was divided into three groups of increasing degrees of wound improvement: (1) no improvement of the wound (wound area was not reduced > 10% under Vivostat PRF® treatment), (2) improvement of the wound (reduced area > 10% under Vivostat PRF® treatment) and (3) complete epithelialization (wounds that were completely re-epithelialized after Vivostat PRF® treatment). We included patients’ diagnosis and concomitant diseases (peripheral arterial occlusive disease (PAOD)), chronic venous insufficiency (CVI)), diabetic foot syndrome (DFS)) in our data analysis in order to investigate their potential impact on the wound healing capacity of Vivostat PRF®. Our results show that in the entire study population, 13 out of 35 (37.1%) patients experienced wound improvement and 14 out of 35 (40%) patients showed complete epithelialization of their wound under Vivostat PRF® treatment. In summary, 77.1% of the treated patients benefited from the Vivostat PRF® therapy. These positive wound healing effects were all observed within the first three to six Vivostat PRF® applications. Subgroup analyses showed that Vivostat PRF® appeared to be more efficient in patients without CVI in comparison to patients with CVI (p = 0.02). Moreover, Vivostat PRF® treatment seems to be particularly efficient in PAOD-related wounds with a reduced crural arterial blood supply (p = 0.01). Additionally, we performed an experimental human in vivo study on ten male students where we artificially generated bilateral gluteal wounds and analyzed the influence of the Vivostat PRF® treatment on the expression of two genes (human beta Defensin-2, ((hBD-2) and human beta-Defensin-3 (hBD-3)) in keratinocytes of resected wound specimens that are induced during wound healing. Interestingly, this analysis revealed that only seven of out ten individuals showed a relevant hBD-2 and hBD-3 gene induction after Vivostat PRF® treatment. This led to the novel “key-lock-hypothesis”. With the goal of an individualized precision medicine approach with optimized wound treatment strategies in the future, this is an important observation that demands further experimental and clinical studies.

scholarly journals Effect of Mirogabalin on Chemotherapy-Induced Peripheral Neuropathy Caused by Gemcitabine Plus Nab-Paclitaxel Therapy in Pancreatic Cancer Patients: A Pilot Study

2021 ◽  
Author(s):  
Yusuke Takasaki ◽  
Toshio Fujisawa ◽  
Mako Ushio ◽  
Sho Takahashi ◽  
Wataru Yamagata ◽  
...  
Keyword(s):  
Pancreatic Cancer ◽  
Peripheral Neuropathy ◽  
Pilot Study ◽  
Adverse Events ◽  
Rating Scale ◽  
Numerical Rating Scale ◽  
Sensory Neuropathy ◽  
Life Questionnaire ◽  
European Organization ◽  
Patient Reported

Abstract Purpose: Gemcitabine/nab-paclitaxel (GnP) therapy is widely used to treat pancreatic cancer (PC), but chemotherapy-induced peripheral neuropathy (CIPN) is common. Mirogabalin is a novel drug for treating peripheral neuropathy. We investigated the effects of mirogabalin on CIPN due to GnP therapy in PC patients.Methods: This was a single-center retrospective pilot study. Patients who had previously received or were currently receiving GnP for PC and had taken mirogabalin for at least 2 weeks for CIPN, were included. Patients completed a questionnaire about their symptoms before and after taking mirogabalin. The primary outcome was the change in numbness and tingling scores on the patient-reported outcomes version of the Common Terminology Criteria for Adverse Events (PRO-CTCAE). Secondary outcomes were the European Organization for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire–Chemotherapy-Induced Peripheral Neuropathy (QLQ-CIPN20) (Japanese version) score, numerical rating scale (NRS) pain score, and adverse events (AEs).Results: Increased numbness and tingling severity (1.84 vs. 1.76; P=0.63) and interference with daily life (1.42 vs. 1.44; P=0.80) were not seen in any of the 25 enrolled patients. The scores on the sensory subscale of the QLQ-CIPN improved significantly after treatment (17.5 vs. 15.7; P=0.02). AEs occurred in 22 patients (88%), but there were no serious AEs (≥ grade 3).Conclusions: Mirogabalin may control the progression of CIPN caused by GnP therapy in PC patients, and improved sensory neuropathy significantly in our patients. However, since the incidence of AEs is high, mirogabalin should be used with caution.

scholarly journals An investigation into the effects of a virtual reality system on phantom limb pain: a pilot study

2019 ◽  
Vol 14 (2) ◽  
pp. 92-97 ◽  
Author(s):  
Jai Kulkarni ◽  
Steve Pettifer ◽  
Sue Turner ◽  
Cliff Richardson
Keyword(s):  
Virtual Reality ◽  
Pilot Study ◽  
Statistical Difference ◽  
Rating Scale ◽  
Numerical Rating Scale ◽  
Phantom Limb Pain ◽  
Phantom Limb ◽  
Limb Pain ◽  
Chi Square ◽  
Numerical Rating

Background: There is no first-line treatment available for phantom limb pain (PLP). For some years, there has been interest in the use of mirrors and other techniques based on visual feedback. Unfortunately, up until now, all published studies have had methodological weaknesses with two recent systematic reviews concluding that therapies of this kind need more evidence to support their use. Aim: To evaluate the effects of a virtual reality (VR) activity on PLP. Methods: This was a prospective pilot study of upper limb amputees using questionnaires to evaluate a VR system. Eleven participants were recruited, with nine completing all three sessions of VR. Participants undertook three sessions of VR, one a month for 3 months. Outcome measures were PLP pain intensity using an 11-point numerical rating scale (NRS), number of PLP episodes and duration of the PLP episodes. All participants were also asked for their judgement of change. Open-ended questions captured the qualitative experience of all aspects of the VR experience. Results: The mean PLP pain score following three VR sessions reduced (6.11 v 3.56) but this was not a statistical difference (t = 2.1, df = 8, p = 0.07). No statistical difference was found for the number of PLP episodes (Pearson chi-square = 3.43, df = 2, p = 0.18) or the duration of each PLP episode (Pearson chi-square = 22.50, df = 16, p = 0.13). Three groups emerged: those whose pain reduced (the majority), those whose pain remained the same (small number) and one those whose pain increased slightly. Discussion: There is insufficient evidence from these results to identify an effect of VR on PLP; however, this is a small group and qualitatively most were content with the treatment and wanted a longer trial.

scholarly journals Power Doppler signal calibration in the finger joint between two models of ultrasound machine: a pilot study using a phantom and joints in patients with rheumatoid arthritis

2017 ◽  
Vol 58 (10) ◽  
pp. 1238-1244 ◽  
Author(s):  
Ryosuke Sakano ◽  
Katsumi Saito ◽  
Tamotsu Kamishima ◽  
Mutsumi Nishida ◽  
Tatsunori Horie ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Pilot Study ◽  
Power Doppler ◽  
Finger Joint ◽  
Doppler Signal ◽  
Ultrasound Machine ◽  
Power Doppler Signal

scholarly journals Pain Predicts Function One Year Later: A Comparison across Pain Measures in a Rheumatoid Arthritis Sample

2016 ◽  
Vol 2016 ◽  
pp. 1-8
Author(s):  
Vivian Santiago ◽  
Karen Raphael ◽  
Betty Chewning
Keyword(s):  
Rheumatoid Arthritis ◽  
Pain Intensity ◽  
Severe Pain ◽  
Rating Scale ◽  
Numerical Rating Scale ◽  
Functional Limitations ◽  
Measurement Scale ◽  
Impact Measurement ◽  
Patient Reported ◽  
One Year

Background. Guidance is limited on best measures and time periods to reference when measuring pain in order to predict future function. Objective. To examine how different measures of pain predict functional limitations a year later in a sample of rheumatoid arthritis patients. Methods. Logistic regression analyses were conducted using baseline and one-year data (n=262). Pain intensity in the last 24 hours was measured on a 0–10 numerical rating scale and in the last month using an item from the Arthritis Impact Measurement Scale 2 (AIMS2). AIMS2 also provided frequency of severe pain, pain composite scores, and patient-reported limitations. Physician-rated function was also examined. Results. Composite AIMS2 pain scale performed best, predicting every functional outcome with the greatest magnitude, a one-point increase in pain score predicting 21% increased odds of limitations (combined patient and physician report). However, its constituent item—frequency of severe pain in the last month—performed nearly as well (19% increased odds). Pain intensity measures in last month and last 24 hours yielded inconsistent findings. Conclusion. Although all measures of pain predicted some functional limitations, predictive consistency varied by measure. Frequency of severe pain in the last month provided a good balance of brevity and predictive power.

Testing of the OMERACT 8 Draft Validation Criteria for a Soluble Biomarker Reflecting Structural Damage in Rheumatoid Arthritis: A Systematic Literature Search on 5 Candidate Biomarkers

2009 ◽  
Vol 36 (8) ◽  
pp. 1769-1784 ◽  
Author(s):  
SILJE W. SYVERSEN ◽  
ROBERT LANDEWE ◽  
DÉSIRÉE van der HEIJDE ◽  
JOAN M. BATHON ◽  
MAARTEN BOERS ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Structural Damage ◽  
Animal Studies ◽  
Literature Search ◽  
Rating Scale ◽  
Numerical Rating Scale ◽  
Systematic Literature Search ◽  
Strength Of Evidence ◽  
Validation Criteria ◽  
Individual Criterion

Objective.To test the OMERACT 8 draft validation criteria for soluble biomarkers by assessing the strength of literature evidence in support of 5 candidate biomarkers.Methods.A systematic literature search was conducted on the 5 soluble biomarkers RANKL, osteoprotegerin (OPG), matrix metalloprotease (MMP-3), urine C-telopeptide of types I and II collagen (U-CTX-I and U CTX-II), focusing on the 14 OMERACT 8 criteria. Two electronic voting exercises were conducted to address: (1) strength of evidence for each biomarker as reflecting structural damage according to each individual criterion and the importance of each individual criterion; (2) overall strength of evidence in support of each of the 5 candidate biomarkers as reflecting structural damage endpoints in rheumatoid arthritis (RA) and identification of omissions to the criteria set.Results.The search identified 111 articles. The strength of evidence in support of these biomarkers reflecting structural damage was low for all biomarkers and was rated highest for U-CTX-II [score of 6.5 (numerical rating scale 0–10)]. The lowest scores for retention of specific criteria in the draft set went to criteria that refer to the importance of animal studies, correlations with other biomarkers reflecting damage, and an understanding of the metabolism of the biomarker.Conclusion.Evidence in support of any of the 5 tested biomarkers (MMP-3, CTX-I, CTX-II, OPG, RANKL) was inadequate to allow their substitution for radiographic endpoints in RA. Three of the criteria in the draft criteria set might not be required, but few omissions were identified.

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