Acta reumatologica portuguesa最新文献

Therapeutic exercise and lifestyle changes (LS) are usually recommended for the treatment of knee osteoarthritis (OA).

Objectives: to compare the impact of an exercise program vs. exercise program plus LS education in individuals with knee OA.

Materials and methods: Single-blind randomized clinical trial with individuals of both sexes with clinical and radiological diagnosis of knee OA. Participants received the treatment 2 times/week for 8 weeks. Therapeutic exercise involved warm-up, flexibility, muscle strengthening, balance and proprioception. The exercise plus lifestyle education group (ELG) also participated in 8 sessions of lectures and discussion on disease self-management and healthy LS. Participants were assessed for pain intensity (visual analog scale), lifestyle, symptoms and physical disability (WOMAC) and pressure pain tolerance threshold (PPT).

Results: Sample consisted of 39 participants, divided into exercise group (EG, n=17) and ELG (n=22). Groups were homogeneous regarding regarding age, weight, height, initial pain perception (VAS) and gender predominance age and body mass index. After the interventions, reduction in pain perception and increase in PPT was observed in both groups. Despite the improvement in LS of both groups, only ELG exhibited a significant reduction in pain assessed by WOMAC. Therapeutic exercise programs may produce pain relief, but no improvements were observed in joint stiffness and funcionality.

Introduction: Behcet's disease (BD) is a multisystem autoimmune relapsing vasculitis with almost unknown etiology, which involves both large and small vessels. The involvement of the central nervous system (CNS) is rare, divided into two main sub-types- parenchymal nad and non-parenchymal. The peripheral nervous system is generally preserved or involved in very rare cases.

Case report: We present a rare case of neuro-Behcet's Disease (NBD) in a young 25-year-old female. The patient presented to our clinic with sudden onset complaints of general weakness, quadriparesis more prevalent for the right limbs, slurred speech, and swallowing disorders. Initially, a clinical diagnosis of cerebral infarction was made, but later the condition was defined as parenchymal Neuro-Behcet disease and the patient underwent corticosteroid and immunosuppressive treatment.

Discussion: NBD remains a difficult diagnosis to establish as other diseases and conditions may have a similar clinical presentation. The diagnosis is based on the clinical presentation and the typical lesions in brain magnetic resonance imaging (MRI). The development and disappearance of lesions at MRI in relation with disease-specific treatment may correlate with the course of clinical neurologic deficits.

Conclusions: Differential diagnosis of NBD should be considered in cerebrovascular disease, brain tumors, and demyelinating processes.

Background: Knee osteoarthritis is a disease of the elderly population. Two of the widely used treatment options for knee osteoarthritis is administration of oral atorvastatin and intra articular hyaluronic acid. This study was designed to compare the effects of oral atorvastatin and intra articular Hyaluronic acid in patients with knee osteoarthritis.

Method: This study was conducted under the approval of Mashhad University of medical sciences ethic committee. Seventy patients with knee OA were divided randomly into two groups; thirty five subjects were given intra articular Hyaluronic acid injections weekly for three weeks and 35 were given atorvastatin 40 milligrams orally daily for 6 months. WOMAC questioner was filled for each patient at the beginning of the study and every month up to 6 months. Data were analyzed with SPSS version 16.

Results: Enrolled subjects were consisted of 28 males (40%) and 42 females (60%), and their mean age was 57.9±1.1 years. Study groups were similar regarding gender and age distribution (P=0.626, P=0.710, respectively) significant difference between groups regarding sex (P=0.626). Mean age of patients was 57.9±1.1 years. Groups mean age did not differ significantly (P=0.710). According to WOMAC questionnaire, pain score in the second month after injection was significantly lower in the Hyaluronic acid group compared with atorvastatin (P<0.001). Function score in the second month after injection was significantly lower in the Hyaluronic acid group compared with atorvastatin (P<0.001). These differences were absent in the following months.

Conclusion: Compared to atorvastatin group, significant improvements in pain symptoms and physical function of knee OA patients were observed in intra articular Hyaluronic acid treatment group in the second month after treatment. But this improvement did not last through the following months.

The aim of this study was to find a reliable set of clinical tests to predict pain and disability in patients with shoulder pain. Shoulder pain is the second most frequent musculoskeletal complaint in the primary care setting and has a great impact in work and leisure activities. Patient reported outcomes measuring pain and disability are available, but they are time-consuming, often biased by psychological and sociological factors and depend on patient collaboration. This was an observational, cross-sectional study, including patients with shoulder pain aged 18 to 70 years. Patients filled in the questionnaires Disabilities of the Arm, Shoulder and Hand outcome measure (DASH) and Shoulder Pain and Disability Index (SPADI) pain scale. A Visual Analogue Scale (VAS) for current pain was applied and sociodemographic and clinical data were collected. Physical examination included the Jobe, Neer and palm-up signs, range of motion (ROM) of shoulder abduction, flexion and rotation (internal and external), both active and passive. An independent t-test to compare differences between groups and the Spearman's coefficient for evaluation of bivariate correlation were used. Linear regression analysis was applied to relevant predictors. Tests were two-tailed and p values < 0.05 were considered significant. A total of 127 patients were included. Female patients and those with a positive Jobe, Neer or palm-up tests, complaints on dominant side, no leisure activity involving shoulder effort, a history of previous shoulder tendinopathy or taking analgesics had significantly higher DASH scores. Age and all range of motion variables significantly correlated with DASH scores. A linear regression model with six dependent variables (Palm-up test, range of motion in active flexion and external rotation, age, gender and complaints on dominant side) produced the highest correlation (R = 0.665), explaining 44% of the variance of DASH score. A model based on few physical examination items and individual objective data like age, gender and dominancy, can help predict disability and perceived pain in shoulder disorders. Palm-up test and range of motion in active flexion, abduction and external rotation showed best correlation with the outcome, but abduction was found redundant for the obtained prediction model.

Objective: To compare the effects of intra-articular injection of glucocorticoid (GC) and hyaluronic acid (HA) on pain and disability caused by hip osteoarthritis (HO).

Materials and methods: A systematic review of the literature was carried out within MEDLINE (via PubMed), Web of Science, Scopus and Cochrane Central Register of Controlled Trials (CENTRAL) databases, using the keywords (MeSH words): "hip osteoarthritis", "glucocorticoid", "corticosteroid", "corticoid", "hyaluronic acid" and "viscosupplementation". Two independent authors applied inclusion and exclusion criteria, selecting randomized clinical trials with direct comparison between intra-articular injection of GC and HA in patients with HO.

Results: 157 articles were found in the initial search. After applying the exclusion criteria, 36 articles were read, with final selection of 3 randomized clinical trials (n = 484). Two studies compared the administration of these products with placebo (saline) - and one also compared it with a fourth group of patients undergoing only physical therapy. Qvistgaard et al. demonstrated clinical superiority of GC (moderate clinical benefit) and HA (marginal clinical benefit) in pain, at 4 weeks, both compared to placebo; however, there was no statistically significant difference between GC and HA during the 12-week follow-up. Atchia et al. reported a statistically significant improvement in pain and function in patients treated with GC during 8 weeks. Spitzer et al. demonstrated an overall clinical response in patients in both groups throughout the study, with a faster response for those treated with GC. However, the authors highlight the superiority in all outcome measures of HA compared to GC in cases of moderate HO, at 26 weeks.

Discussion: Few studies directly compare the clinical effect between intra-articular injections of GC and HA in HO, showing heterogeneity in the type of population, number of administrations, formulation of HA and follow-up period. The analyzed studies had a short follow-up time. The results obtained seem to demonstrate a superiority of GC compared to HA in managing pain, namely in the speed of clinical response. However, Spitzer et al. demonstrated an overall superiority of HA in patients with moderate HO, which suggests that optimal selection of patients remains to be defined.

Over the last years, musculoskeletal ultrasound (MSUS) has been increasingly integrated by rheumatologists into clinical practice. Nowadays, it is considered an important imaging modality for the diagnosis, monitoring, and prognosis of various rheumatic diseases, along with its role in the guidance of interventional procedures. Formal training is needed to ensure a skilled and safe MSUS practice. Data regarding the use of MSUS by Portuguese rheumatologists is, however, lacking. Herein, we present a study on the current state of practice and training of MSUS in Portugal.

Hereditary angioedema (HAE) is a rare, debilitating and potentially life-threatening disease characterized by recurrent attacks of oedema. With the development of new therapies and better availability of diagnostic tools, important advances have been made. However, the disease still remains frequently misdiagnosed and inadequately treated. Familial Mediterranean fever (FMF) is an autoinflammatory syndrome comprised of serositis, fever, arthritis and skin involvement. Both diseases can cause severe abdominal pain resembling that of acute abdomen. We report a case of three family members that presented with various symptoms that could fit in a clinical picture of both diseases, only to confirm a diagnosis of HAE type II after a diagnostic delay of many years.