1,721,028 research outputs found
The discrepancy between clinical and ultrasonographic remission in rheumatoid arthritis is not related to therapy or autoantibody status.
No full textTo evaluate the clinical remission by means of power Doppler ultrasonographic (PDUS) monitoring in a group of patients with rheumatoid arthritis (RA) in clinical remission (DAS28 < 2.6). The study included 54 patients with RA in therapy with DMARDS, anti-TNF, or no therapy in clinical remission according to ACR criteria and DAS 28 < 2.6 for at least 6 months. All patients had active wrist or hand inflammation in the past. US examination evaluated the presence of active synovitis, power Doppler signal, and synovial hypertrophy on the following bilateral joints: metacarpophalangeal-proximal interphalangeal joints-flexor tendons (on 2°-3° fingers) and wrist (radiocarpal and midcarpal joints). In 19 patients, there was an agreement between clinical and US parameters. However, 35 patients with clinical remission showed a positive ultrasonographic assessment and at least an active parameter. No statistic correlation was found between US examination and antibody assessment (anti-CCP and/or RF). Patients in therapy with anti-TNF or other therapies showed similar US assessment without significant statistical differences. Among eleven patients that presented swollen and tender joints at the latest physical examination, which preceded US exam, just 5 patients had an US confirmation too. In the other patients, the PDUS did not confirm the presence of inflammation in the corresponding swollen and tender joints or showed a positive ultrasonographic assessment in other locations. The remission state is a great therapy target and not only through the biological therapy. Synovial inflammation could persist independently from type of therapy or autoantibody statu
Impegno cardiaco nella sclerosi sistemica
No full textL'impegno cardiaco in corso di sclerosi sistemia consta di uno spettro variabile di manifestazioni cliniche conseguenti ad alterazioni di natura microangiopatica, elettrica e/o emodinamica. In danno ischemico e/o flogistico autoimmune del miocardio producono, in ultima analisi, il quadro istopatologico caratteristico della 'necrosi a bande' con deposizione di tessuto fibroso, responsabile della riduzione di elasticità e della capacità contrattile muscolare. ...
IS THERE A DISSOCIATION BETWEEN CLINICAL REMISSION AND ULTRASONOGRAPHIC ASSESSMENT IN RHEUMATOID ARTHRITIS?
No full textBackground: Achieving remission is the aim of treatment in RA. Modern joint imaging improves the accuracy of remission measurement in RA; In particular Power Doppler Ultrasonographic (PDUS) findings may have a predictive value in disease activity and radiologic outcome.Objectives: To Evaluate and to confirm the clinical remission and the absence of synovial inflammation by means PDUS monitoring.Rheumatology Unit of Modena was the promoter of the URAR study (Ultrasound evaluation in RA patients with clinical remission) national group that aims to this target.Methods: The patients were recruited in the Rheumatology Unit of Modena and they were chosen sequentially in the rheumatologic out-patient's department dedicated to arthritis.The study included 54 patients (10 men, 44 women) with RA in therapy with DMARDS, anti-TNF or no therapy in clinical remission according to ACR criteria and DAS 28 < 2.6. All patients had active wrist or hand inflammation in the past. US examination evaluated the presence of active Synovitis (ACD), Power Doppler (PD) signal and Sinovial Hypertrophy (SH) on the following bilateral joints: Metacarpophalangeal – Proximal Interphalangeal joints – Flexor tendons (on 2°-3° fingers) and Wrist (radiocarpal and midcarpal joints). Scores and scales have been chosen according to the literature (1)Results: 19 patients (35.2%) displayed a negative US evaluation in the meaning of an agreement between clinical and US parameters. However 35 patients (64,1%) with clinical remission showed a positive ultrasonographic assessment and at least an active parameter (ACD, PD, SH). No correlation was found between US examination and antibody assessment (anti-CCP and RF): according to the statistic function "Half-Normal Plot" parameters are completely independent. Small differences were also found between patients in therapy with anti-TNF or other therapies (DMARDS, corticosteroids): they showed similar US assessment so that there is no statistical significance in the comparison between the two groups. Among eleven patients that presented swollen and tender joints at the latest physical examination which preceded US exam just 5 patients had a correspondence at the US: positive joints at the clinical evaluation showed a US confirmation too. Otherwise the other patients had a mismatch between clinical assessment and the PDUS: it did not confirm the presence of inflammation in the corresponding swollen – tender joints or showed a positive ultrasonographic assessment in other locations.Conclusion: The remission state is a great therapy target and its attainment seems to be possible and not only through the biological therapy.Clinical remission is not always confirmed by US evaluation, therefore it is not possible to exclude a complete absence of synovial inflammation just on the base of DAS 28 value. It seems particularly interesting the mismatch between clinical assessment and PDUS: according to this finding an integration between clinical and US results seems to be useful to guide clinical procedure and disease monitoring
Procedural pain management in the treatment of scleroderma digital ulcers
No full textObjective: Digital ulcers (DU) may develop in half of systemic sclerosis (SSc) patients; they are often resistant to treatments. Deep wound debridement is crucial for DU healing, but very difficult to carry out without adequate procedural pain management. Here, we report the results of our experience on procedural pain management in scleroderma DU. Methods: The study included 51 DU observed in 32 consecutive SSc patients; procedural pain was treated following a definite schedule: local lidocaine and prilocaine (25 mg of either agent per gram of cream, EMLA 5%) were initially used in all cases, followed by local and oral morphine, according to the severity of pain scored on a 10 cm visual analogue scale (VAS). Results: At baseline, higher pain VAS was recorded in more severe (p=0.0001) and/or infected DU (p=0.0001). Good compliance to DU debridement was observed in patients with mild pain (VAS ≤4) treated with only EMLA, and in 5 cases with moderate-severe pain (VAS >4) at baseline. While, the majority of DU with moderate-severe pain (34/39) needed a combined therapy with EMLA and local morphine (8/34) or with EMLA, local and oral morphine (26/34). On the whole, pain management during DU debridement required only EMLA application in 33% of cases, EMLA plus local morphine in 16%, while combined EMLA, local and oral morphine were necessary in 51%, generally with more severe and/or infected lesions. Conclusion: The present study showed valuable control of procedural pain during DU debridement with sequential, combined analgesic treatment
DANCE CLASS DEDICATED TO SCLERODERMA PATIENTS: JOINT EVALUATION, FUNCTIONAL AND QUALITY OF LIFE BEFORE AND AFTER TREATMENT – CLINICAL TRIAL
No full textBackground: Systemic sclerosis (SSc) is a complex and multi systemic disorder of connective tissue, characterized by progressive thickening and fibrosis of the skin and internal organs, as well as by widespread microvascular damage. A number of studies have described in these patients a high prevalence of depressive symptoms, pain, and body image dissatisfaction. Physical and occupational therapy showed to be useful in preserving mobility in patients with scleroderma but no specific study was found that investigated exactly what kind of activity could improve disability, encourage participation and improve mood.
Objectives: Dance (as a work of stretching, coordination, strength, aerobic, rhythmic, and recreational activity) could lead not just to accept and reconnect the patients with their bodies, enhance self-expression, address feelings of isolation and depression, but also to improve joint width, functionality, and autonomy. The study aims to compare the effects of dance/movement therapy and standard care with standard care alone in patients with systemic sclerosis.
Methods: 15 female patients diagnosed with SSc were divided into an experimental group -A-(5 patients enrolled spontaneously, considering that not all are willing to participate) and in a control group-C- (10 patients). The group A followed a dance routine devotedly for 4 months (1 hour twice a week). at T0 and after 4 months were evaluated: Subjective Functionality upper limb (QUICK DASH), Autonomy of daily living (SHAQ Scleroderma- Health Assessment Questionnaire), mood ( CES-D), Fatigue (FS Scale) Objective- Six Minutes Walking Test (6MWT), ROM of the shoulder and hip. In both groups, the changes in the outcome measures between the baseline and 16-week assessments were assessed with a paired t-test.
Results: There has been a statistically significant improvement in the group A in the objective evaluation: joint ROM of flexion of the hip and shoulder, meters walked in 6MWT(p< 0.03), test Borg dyspnea before the 6MWT is reduced from 0.6 to 0 and after the 6MWT is reduced from 2 to 0.8, while in the control group both remain unchanged (from 0.8 to 1 and 2.1 to 2.2). The self-assessment questionnaires show in the dancer group an improvement in the perception of fatigue (p <0.02) and of mood (p <0.01). No improvement was recorded in HAQ (0.58 to 0.65) and in the functionality of the upper limb (Quick Dash) due to worsening in work items (from 21.9 to 46.2) and a marked improvement in the free time items (from 40.6 to 21.5) probably attributable to awareness of disease. The results of the objective and subjective tests at time 0 and after 4 months were unchanged in the control group.
Conclusions: The results should be interpreted with caution given the small sample. However, it can be said that the experimental dance program has brought a gain in aerobic performance, perception of fatigue, mood as well as hip and shoulder joints flexibility. The patients indicated that they liked the course and continued to dance even at the end of the trial outside of the dance schoo
From Raynaud Phenomenon to Systemic Sclerosis in COVID-19: A Case Report
No full textABSTRACT: In 2019, the novel SARS-CoV-2 infection emerged, causing the disease called COVID-19, which primarily affects the respiratory tract and lung at alveolar and interstitial levels. Systemic sclerosis (SSc) is an autoimmune connective disease characterized by vascular abnormalities and diffuse and progressive fibrosis of the skin and internal organs. Raynaud phenomenon (RP) occurs in virtually all patients affected by SSc and, in most cases, is an onset symptom of the disease; that is, RP may appear several years before overt illness. Although the exact pathophysiologic pathways leading to RP and SSc are still unknown, several infectious agents, especially viruses, have been suggested as possible triggering factors. Here, the authors describe the first case of RP secondary to SSc following SARS-CoV-2 infection
DIGITAL NECROSIS IN SYSTEMIC SCLEROSIS NOT ONLY A MICROVASCULAR DISEASE: A CASE REPORT
No full textnot availabl
Going Beyond Counting First Authors in Author Co-citation Analysis
Full text linkThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
- …
