Clinical Medicine Insights. Arthritis and Musculoskeletal Disorders最新文献

We report a case of calcium pyrophosphate dihydrate crystal deposition (CPPD) disease presenting as acute arthritis of the left wrist. A 66-year-old woman with no significant family history was admitted with a 7-day history of swelling, persistent pain, and limitation of motion in her left wrist. She reported no recent trauma, surgery, or severe illness, and had no known comorbidities other than mild hypertension treated with low-dose thiazide diuretics. She was not on chronic glucocorticoids or other immunosuppressive drugs. Plain radiographs of her wrist, obtained during the initial days of arthritis, showed chondrocalcinosis in her left wrist. A diagnosis of pseudogout was made. After 30 days, a repeat X-ray demonstrated the disappearance of the chondrocalcinosis border in the left wrist; however, follow-up radiography revealed chondrocalcinosis in asymptomatic joint areas, such as the pubic symphysis and knees. With this case report, we highlight the important role of radiographs in the early diagnosis of CPPD disease. Radiographic detection of crystal deposition can occasionally be transient, and its disappearance may lead to diagnostic confusion. Identifying such changes early can help avoid misdiagnosis and inappropriate management.

Introduction: Internet and social media are widely available tools for several purposes, including search of health information. This study aims to describe the usage patterns, the trust generated, and the influence of such information on decision-making by patients diagnosed with systemic lupus erythematosus and rheumatoid arthritis.

Methods: A cross-sectional study was conducted, administering a survey to patients with rheumatic diseases at multiple centers in Latin America, virtually or on paper. Three domains were evaluated: access/patterns of use, perception, and confidence generated by the health information found. Subgroup analysis based on key characteristics was performed.

Results: In total, 244 surveys were analyzed, identifying 96.7 % respondents as regular internet users, mainly through smartphones (79.5%). About 86.5% used social media regularly, around 15.2 % used it for finding health information. YouTube was the most frequently used (67.6%). 64.3 % perceive searching information as straightforward and 65.6% as not frustrating; academic institutions were the most and "influencers" were the least trusted. Most expressed high confidence in the ability to use information and perceive it as beneficial. Different patterns of use, perception, and confidence were identified according to disease, age, educational level, country of origin and survey method of collection.

Conclusions: This study illustrates the high prevalence of Internet and social media access in Latin America, primarily through mobile devices, which represents an opportunity to develop educational strategies for the population that have access to these tools. These strategies can be tailored according to specific use patterns and differential characteristics of distinct subgroups of patients.

Objective: The objective was to determine whether oral non-steroidal anti-inflammatory drugs (NSAIDs) affect the efficacy of dextrose prolotherapy (DPT) in patients with knee osteoarthritis, and if the combination of these treatments is safe and well-tolerated.

Methods: Five patients with symptomatic knee osteoarthritis were included in this prospective case series. Participants underwent a series of three DPT injections at four-week intervals in their symptomatic knee(s) and were immediately prescribed a seven-day course of Ibuprofen after each injection. The main outcome measures included changes in the Knee Injury in Osteoarthritis (KOOS) questionnaire subscales (pain, symptoms, quality of life, sports and recreation function, and activities of daily living) and the Numeric Pain Rating Scale (NPRS).

Results: There was a statistically significant improvement in the KOOS subscales of pain (P < 0.0001), Symptoms (P = 0.01), and Quality of Life (P = 0.001) after 12 weeks. The KOOS subscales for Sports and Recreation function (P = 0.06) and Activities of Daily Living (P = 0.10) showed numerical improvement over time that fell short of statistical significance. There was a statistically significant improvement in the NPRS scores compared with baseline NPRS scores after 12 weeks (P < 0.0001). In addition, NPRS scores were significantly lower at one-week follow-up after each DPT injection (P = 0.01); (P = 0.025); (P < 0.0001). There were no reported adverse events.

Conclusions: Concomitant use of NSAIDS with dextrose prolotherapy injections is safe and well-tolerated with no adverse events and results in improvements in pain, symptoms, and overall quality of life associated with chronic knee OA. Controlled trials of this treatment are warranted.

Background: Complex Regional Pain Syndrome (CRPS) is a chronic condition characterized by persistent pain and local autonomic dysfunction. Its exact cause remains unclear, making diagnosis and treatment challenging.

Objective: The objective was to investigate the clinical characteristics of CRPS patients and identify risk factors influencing its onset.

Design: Retrospective analysis of medical records from 28 CRPS patients, examining variables such as demographics, comorbidities, triggering events, pain duration and location, previous examinations and treatments, clinical findings, auxiliary tests, initial and follow-up treatment outcomes, symptom relief time, and degree.

Methods: Statistical methods were used to analyze the clinical data of 28 CRPS patients, assessing general characteristics and risk factors associated with the disease.

Results: Females accounted for 57.14% of the cases, with an average patient age of 57.89 years. About 82.14% of patients experienced a triggering event prior to the onset of pain. The median time to diagnosis was 4.5 months, with a maximum duration of up to 7 years. Misdiagnosis occurred in 46.43% of patients. Laboratory tests showed that 77.78% (7 of 9) had abnormal bone metabolism; among those who underwent bone density scans, 66.67% (6 of 9) had osteoporosis, whereas 11.11% (1 of 9) had reduced bone mass. X-rays of 25 patients revealed that 44% (11 of 25) had either reduced bone mass or osteoporosis, with 2 showing more severe osteoporosis on the affected side compared with the healthy side. Rheumatoid arthritis was observed in 7.14% of patients. Post-treatment, significant pain relief was noted in 26 patients.

Conclusion: This study helps clinicians more accurately identify and manage CRPS, reducing misdiagnosis and delayed diagnosis. In addition, the data suggest that osteoporosis and rheumatoid arthritis may be potential risk factors for CRPS.

Background: Lung ultrasound (LUS) has been recently proposed as a convenient and radiation-free imaging modality for the evaluation of systemic sclerosis-related interstitial lung disease.

Objectives: The current study evaluates the relation between LUS and both high-resolution computed tomography (HRCT) and capillaroscopy findings in patients with systemic sclerosis.

Design: This cross-sectional study included 32 patients with systemic sclerosis.

Methods: Besides clinical evaluation, all participants underwent LUS, HRCT, pulmonary function tests (PFT), and nailfold video-capillaroscopy (NVC). All participants' data were compared and correlated.

Results: There is an excellent agreement between number of B-lines and HRCT score (interclass correlation = 0.864, P-value < .001). A significant positive correlation exists between number of B-lines and disease duration (r = 0.459, P-value = .008). Conversely, the number of B-lines is negatively correlated with capillary density (r = -0.687, P-value < .001), forced expiratory volume in the first second (FEV1) (r = -0.886, P-value < .001), and forced vital capacity (FVC) (r = -0.898, P-value < .001). Patients with either neoangiogenesis or previous/current digital ulcers had significantly higher number of B-lines than those without (P-value < .001, .016, respectively).

Conclusion: The number of B-lines parallels the HRCT score and the extent of digital vascular damage as indicated by NVC and clinical digital ulcers. Lung ultrasound has proven to be a reliable radiation-free modality for screening of systemic sclerosis-related interstitial lung disease and detecting its extent.

Parsonage-Turner syndrome (PTS) and ankylosing spondylitis (AS) are distinct clinical entities with unique pathogenic mechanisms. The coexistence of these conditions in a single patient is rare and presents diagnostic and management challenges especially in adolescent patient. In this case report, we present a unique and intriguing case of an 18-year-old boy presented with acute onset shoulder pain and weakness, consistent with PTS. However, further evaluation revealed additional features suggestive of AS, including chronic low back pain and morning stiffness. Diagnostic workup, including imaging studies and laboratory investigations, confirmed the presence of both PTS and AS. The management approach involved a multidisciplinary approach, including physical therapy, analgesics, and corticosteroids. This case report underscores the significance of considering the possibility of concurrent PTS and AS in patients presenting with atypical symptoms or overlapping clinical features. Clinicians should be aware of the potential overlap between PTS and AS to guide optimal treatment strategies and improve patient outcomes.

Objectives: To identify gaps in knowledge, attitude, and practice regarding the use of corticosteroids and nonsteroidal anti-inflammatory drugs (NSAIDs) among patients with chronic rheumatic diseases.

Methods: A cross-sectional study was conducted using a questionnaire including 12 knowledge questions, 13 attitude assessment statements, 5 barrier assessment statements, and 7 practical scenarios. We counted the total numbers of correct answers in knowledge, positive attitudes, barriers, and appropriate practices and fitted using Poisson regression to examine factors associated with knowledge, attitudes, and practices.

Results: A total of 182 participants were included in this study, a large proportion of them had never heard of corticosteroids (34%) and NSAIDs (54%) before. Physicians were the source of information regarding corticosteroids and NSAIDs in 83% and 84% of the cases, respectively. Gastric ulcer was the most commonly recognized adverse drug reaction (ADR) for corticosteroids (64%) and the only ADR recognized for NSAIDs (95%), while only few patients were aware of life-threatening ADRs. The primary barrier, with a 40% agreement, was health care providers' time constraints in providing medication information to patients. Our study findings did not reveal any gaps in practice, nor did they show any correlation between patients' knowledge and attitudes to the practice of using corticosteroids and NSAIDs.

Conclusion: There were gaps in knowledge, attitudes, and barriers to information access regarding NSAIDs and corticosteroid use in Vietnamese patients with chronic rheumatic diseases. Potential solutions include allocating more time for information exchange between physicians and patients, creating new channels to provide reliable information for patients, and emphasizing the important ADRs.

Background: Complex Regional Pain Syndrome type 1 (CRPS-1) is severely debilitating and painful disease that is difficult to treat.

Objective: The objective was to evaluate the long-term residual disability of patients with CRPS-1 following parenteral neridronate treatment.

Design: This is real-life retrospective observational study.

Methods: Patients affected by CRPS-1 of the upper limb were treated with neridronate infusions (400 mg over 10 days) between February 2017 and December 2021 for whom clinical and demographic information was collected. From November 2022, patients treated ⩾1 year previously were recalled for clinical evaluation. A dedicated instrument (DASH questionnaire, Disabilities of the Arm, Shoulder and Hand) was employed to assess residual disability. Multivariate logistic regression analysis was used to investigate predictors of disability.

Results: Forty-nine patients aged 61.1 ± 11.5 years and 73.5% female with CRPS-1 of the upper limb were included. Disease duration before treatment was 9.9 ± 8.0 weeks, and the mean length of follow-up was 4 years (47.7 ± 22.0 months). The disease had fully resolved in 46 patients (93.9%) for whom the diagnostic criteria were no longer recognized. According to the DASH score, 38 patients (77.6%) resulted free of functional limitations, whereas 11 patients (22.4%) were still suffering from disability. The DASH score was positively correlated with residual visual analogue scale (VAS; Spearman's Rho = 0.61; P < .001). Predictors of residual disability were younger age (odds ratio [OR]: 0.77, 95% CI: 0.63-0.93; P = .012) and delay between disease onset and treatment (OR: 1.45, 95% CI: 1.13-1.96; P = .004).

Conclusions: In this real-life study, neridronate parenteral treatment provided a full recovery of CRPS-1 in over 3 quarters of patients, provided they are treated early.

This narrative review aims specifically to explore the relationship between tobacco exposure and systemic sclerosis (SSc), idiopathic inflammatory myositis (IIM), and systemic lupus erythematosus (SLE). Relevant articles were obtained by searching key terms such as "tobacco," "smoking," "scleroderma," "myositis," "lupus," and "Sjögren's" in PubMed and Google Scholar databases. The selected articles ranged from the years 2010 to 2023. Inclusion criteria were based on the relevance and contribution to the field of study. Systemic sclerosis is a complex condition involving multiple immune cell lines that can be influenced by tobacco. However, the existing literature does not provide sufficient evidence to support an increased risk of SSc in smokers or the impact on treatment options. Cigarette smoking does increase the risk of skin ulcerations in SSc patients. In addition, cigarette smoking has been associated with IIM through genetic and molecular mechanisms. Smokers with dermatomyositis or polymyositis are at an elevated risk of atherosclerosis and interstitial lung disease. Similarly, smoking in patients with SLE increases the risk of organ damage, thrombosis, and disease severity compared with non-smokers. Smokers with SLE also have more difficulty in controlling disease flares compared with non-smokers. Tobacco exposure can lead to secondary complications in patients with IIM and SLE, although the course of treatment may not differ significantly. No definitive conclusions can be drawn to the clear relationship between tobacco smoking and Sjögren's's syndrome.