Chronic Musculoskeletal Symptoms Research Articles

Tick-Borne Disease Infections and Chronic Musculoskeletal Pain

Tick-borne diseases (TBDs) other than Lyme disease, such as spotted fever group rickettsiosis, ehrlichiosis, and galactose-α-1,3-galactose (α-gal) syndrome, are an emerging public health issue. Long-term sequelae secondary to Ehrlichia or Rickettsia infection are uncommon; however, musculoskeletal symptoms are often attributed to prior tick exposure. To evaluate the potential associations between prior exposure to TBDs and musculoskeletal symptoms, including radiographic osteoarthritis. This cross-sectional study analyzed serum samples from the fourth visit (2017-2018) of the Johnston County Osteoarthritis (JoCo OA) project, an ongoing longitudinal, population-based study in Johnston County, North Carolina. Biospecimen testing and analysis were performed between May 2022 and November 2023. Participants in the JoCo OA project are noninstitutionalized White and Black Johnston County residents 45 years or older. The primary outcome was seropositivity with Ehrlichia IgG, Rickettsia IgG, and/or α-gal IgE and musculoskeletal symptoms. Secondary outcomes included risk factors associated with elevated α-gal IgE and weighted population point prevalence rates. Participants completed questionnaires, underwent physical assessments, and provided biospecimens for serological testing. Multivariable models were used to estimate associations of interest. Of the 605 participants who completed the fourth visit of the JoCo OA project, 488 (80.7%) had serum samples available for testing. The 488 participants had a median (IQR) age of 72 (68-78) years and included 336 females (68.9%) and 161 Black (33.0%) and 327 White (67.0%) individuals. The overall weighted point prevalence was 8.6% (95% CI, 5.9%-11.3%) for Ehrlichia IgG, 17.1% (95% CI, 12.6%-21.5%) for Rickettsia IgG, and 19.6% (95% CI, 15.3%-23.8%) for α-gal IgE level greater than 0.1 IU/mL. Only α-gal IgE was associated with knee pain, aching or stiffness (mean ratio, 1.30; 95% CI, 1.09-1.56). Antibodies to Rickettsia, Ehrlichia, and α-gal were not associated with symptomatic radiographic knee osteoarthritis. Male sex (odds ratio [OR], 2.63; 95% CI, 1.55-4.47), current smoker status (OR, 3.55; 95% CI, 1.38-9.18), and an attached tick bite in the past 5 years (OR, 3.99; 95% CI, 2.22-7.15) were all risk factors that were associated with α-gal IgE level greater than 0.1 IU/mL. Despite only 84 individuals (17.2%) recalling a tick bite in the past 5 years, 178 (36.5%) had evidence of prior tick-borne exposure, suggesting frequent human-tick interactions. Results of this cross-sectional study indicate no association between Ehrlichia or Rickettsia seropositivity and chronic musculoskeletal symptoms or osteoarthritis. Further investigation is needed into the pathogenesis of α-gal syndrome and interventions to reduce human-tick interactions.

Risk of COVID-19 Diagnosis and Hospitalisation in Patients with Osteoarthritis or Back Pain Treated with Ibuprofen Compared to Other NSAIDs or Paracetamol: A Network Cohort Study.

We aimed to investigate whether ibuprofen use, compared with other non-selective non-steroidal anti-inflammatory drugs (ns-NSAIDs), cyclooxygenase-2 inhibitors (COX-2i) or paracetamol, increases the risk of coronavirus disease 2019 (COVID-19) diagnosis or hospitalisation. A prevalent user and active comparator cohort study. Two US claims databases (Open Claims and PharMetrics Plus) mapped to the Observational Medical Outcomes Partnership Common Data Model. Insured patients with a history of osteoarthritis or back pain and receiving ibuprofen, other ns-NSAIDs, COX-2i or paracetamol between 1 November, 2019 and 31 January, 2020 (study enrolment window 1) or between 1 February, 2020 and 31 October, 2020 (study enrolment window 2). Large-scale propensity score matching and empirical calibration were used to minimise confounding. Incidence and hazard ratios of COVID-19 diagnosis and hospitalisation according to drug/s use were estimated and pooled in the same study period across data sources using a fixed-effects meta-analysis. Index treatment episode was the primary risk evaluation window, censored at the time of discontinuation. A total of 633,562 and 1,063,960 participants were included in periods 1 and 2, respectively, for the ibuprofen versus ns-NSAIDs comparison, 311,669 and 524,470 for ibuprofen versus COX-2i, and 492,002 and 878,598 for ibuprofen versus paracetamol. Meta-analyses of empirically calibrated hazard ratios revealed no significantly differential risk of COVID-19 outcomes in users of ibuprofen versus any of the other studied analgesic classes: hazard ratios were 1.13 (0.96-1.33) for the ibuprofen-ns-NSAIDs comparison, 1.03 (0.83-1.28) for the ibuprofen-COX-2i comparison and 1.13 (0.74-1.73) for ibuprofen-paracetamol comparison on COVID-19 diagnosis in the February 2020-October 2020 window. Similar hazard ratios were found on COVID-19 hospitalisation and across both study periods. In patients with osteoarthritis or back pain, we found no differential risks of incident COVID-19 diagnosis or COVID-19 hospitalisation for ibuprofen users compared with other ns-NSAIDs, COX-2i or paracetamol. Our findings support regulatory recommendations that NSAIDs, including ibuprofen, should be prescribed as indicated in the same way as before the COVID-19 pandemic, especially for those who rely on ibuprofen or NSAIDs to manage chronic arthritis or musculoskeletal pain symptoms.

Chronic musculoskeletal symptoms following COVID-19 in a cohort of Sri Lankan patients

The Journal of the Ceylon College of Physicians (JCCP) is a peer-reviewed, open access journal published bi-annually by the Ceylon College of Physicians (CCP) in the last week of June and December.The objective of the Journal is to promote good clinical practice and influence policy making across the medical world through publication of original research and peer reviewed articles on current issues and to foster responsible and balanced debate on issues that affect medicine and health care in Sri Lanka. Contributions to the JCCP reflect its national and multidisciplinary readership and include current thinking across a range of medical specialties.

Musculoskeletal symptoms and training characteristics differ between sex and playing positions: A cross-sectional study among high-performance Brazilian beach handball players

This study analysed self-reported musculoskeletal symptoms and training characteristics of high-performance Brazilian beach handball athletes. In a cross-sectional study, 28 men (mean (standard deviation), age: 23 (5) years, body mass: 81.9 (14.4) kg, height: 181.3 (8.6) cm, experience: 13.3 (5.4) years) and 27 women (mean (standard deviation), age: 28 (8) years, body mass: 65.5 (12.7) kg, height: 170.4 (4.9) cm, experience: 9.3 (3.0) years) answered an online questionnaire about anthropometric and sociodemographic aspects, musculoskeletal symptoms, and training characteristics. The results showed that the musculoskeletal symptoms are more prevalent in the knees during the previous seven days and in the shoulder during the previous 12 months. Left-wing players were more affected by musculoskeletal symptoms in the shoulder than right-wing players and central defenders during the previous seven days regardless of the sex. Problems in the elbow area presented a higher prevalence in the male players compared to the female players in the past 12-month period. The training volume was higher for men compared to women, regardless of the playing position. Moreover, beach handball athletes who reported training five days/week or 360 min/week or more were more likely to develop musculoskeletal symptoms in the elbow compared to those who had a lower frequency and duration of training. Musculoskeletal symptoms occurred most in the shoulders and knees, differing between sex and playing positions. Higher frequency and duration of training were independent risk factors for chronic musculoskeletal symptoms in the elbow compared to a lower volume of training.

Outcome of Cholecalciferol Supplementation on Bone Mineral metabolism in End Stage Renal Disease Patients in Comparison with Placebo- Randomized Control Trial

Objectives: This study was conducted to evaluate the impact of oral cholecalciferol intake on Bone Mineral Metabolism [i.e. levels of 25-hydroxyvitamin-D, alkaline phosphatase (ALP), intact parathyroid hormone (iPTH), calcium (Ca), phosphorus (P), calcium-phosphorus product (CaxP)] and to ascertain its effects on markers of inflammation [i.e. C-reactive protein (CRP), white blood cell count (WBC)] and chronic musculoskeletal symptoms (musculoskeletal pain or fatigue) Study Design: Double blind randomized controlled trial. Place and Duration of Study: Shaikh Zayed Hospital, Lahore, over a period of 2 months from November 2015 to Jan 2016. Methods: 70 patients on maintenance hemodialysis in Shaikh Zayed Hospital Lahore, fulfilling inclusion criteria received weekly doses of cholecalciferol or placebo according to 25-hydroxyvitamin-D levels. All patients were evaluated at 0 month and 2 months after supplementation. Level of 25-hydroxyvitamin-D, hemoglobin, white blood cell count, intact PTH, alkaline phosphatase, calcium, phosphorus, calcium phosphorus product, C reactive protein, albumin and scale of chronic pain/fatigue with visual analog scale was compared at day 0 and after 2 months of treatment. Results: There was substantial increment in 25 OH vitamin D levels after cholecalciferol intake whereas there was reduction in vitamin D levels in patients receiving placebo. In the cholcalciferol group only 14% achieved therapeutic levels of >30 pg/dl while 60% had levels >25 pg/dl. There was minor change in iPTH, calcium, phosphorus, calcium phosphorus product and alkaline phosphate levels in cholcalciferol group as compared to placebo (p value = 0.484, 0.067, 0.359, 0.061, 0.12 respectively). There was significant improvement of chronic musculoskeletal pain (p value=0.00) and CRP (p value=0.005) with cholecalciferol supplementation compared to placebo. Hemoglobin, white blood cell count, albumin level had no significant difference in both the groups. Conclusion: Cholecalciferol supplementation was effective in reduction of chronic musculoskeletal symptoms and marker of inflammation like CRP but does not show difference in term of iPTH, calcium, phosphorus calcium phosphorus product, alkaline phosphate, hemoglobin, albumin level and WBC count. Keywords: ESRD, Vitamin D3, 25 hydoxyvitamin D, Metabolic Bone disease

Risk factors of sociodemographic and work environment that related to musculoskeletal symptoms among SME workers in Vietnam

According the limited resources and capacity, SMEs are more prine to occupational hazards and risk. This research aimed to determine the socio-demographic and work environment risk factors related to musculoskeletal symptoms among SME workers in Vietnam, especially in the food processing and garment industries. The respondents were 530 SME workers 281 from the garment industry; 249 from the food processing industry). The instruments used were a self-devised questionnaires including lifestyle and work environment factors. The Standardized Nordic Questionnaire (SNQ) used to see the musculo-skeletal symptoms. The results showed 45.1% of respondents had chronic MSDs, and 40.2% had experienced acute MSDs. The socio-demographic factors, such as work status, shifts and trip duration to the workplace, significantly influenced the chronic and acute musculo-skeletal symptoms. The symptoms were also induced by work environment factors, especially noise, lighting, heat and humidity, handling loads more than 20 kg, mostly sitting on the floor or mostly standing while working and slippery floors in the workplace. It is crucial to improve the work environment and comply with the standard even SME industries, as well. Moreover, the work posture and load for manual handling need a correction to reduce musculo-skeletal symptoms.

Psychological stress perceived with respect to general health among urban Indian women

ABSTRACT Women face many sexist constraints globally, increasing the likelihood of psychological stress and related disorders. The present study explores general health constraints among urban Indian women with respect to stress. A cross-sectional study adhering to “strengthening the reporting of observational studies in epidemiology” (STROBE) guidelines was conducted in urban colonies in Delhi. A wide array of women above 18 years of age was recruited, which included students, working professional as well as housewives. General health issues and health behaviors among women were assessed through a questionnaire and stress was evaluated through Cohen’s perceived stress scale (PSS)-10. Overall 532 women were contacted, among which 306 women (mean age = 28.8 ± 7.52) years participated. There was significant difference in mean PSS-10 scores, mean±standard error = −3.3 ± 0.6 and −3.1 ± 0.6; p < .0001 for irregular periods and dysmenorrhea, respectively. Likewise, there was significant difference (Mean± SE = −8.9 ± 0.7; p < .0001) in stress scores among women with chronic respiratory, gastrointestinal, and musculoskeletal pain symptoms. Changes in eating behavior during stress; prolong sitting/standing; and lack of exercise were categorized as ‘negative health behaviors.’ One-way ANOVA showed significant differences in PSS-10 scores (Mean ±SE = −11.3 ± 0.7; p < .0001) among participants exhibiting all “negative health behaviors.” General health issues, not necessarily diagnosed medical condition can be psychological stressors among urban Indian women. Poor health behaviors adapted by urban Indian women like prolong sitting/standing, changes in eating habits during stress, and lack of exercise are associated with increased perception of stress.

Pain-Related Post-Exertional Malaise in Myalgic Encephalomyelitis/ Chronic Fatigue Syndrome (ME/CFS) and Fibromyalgia: A Systematic Review and Three-Level Meta-Analysis.

Myalgic encephalomyelitis/ chronic fatigue syndrome (ME/CFS) and fibromyalgia (FM) are two debilitating, moderately comorbid illnesses in which chronic musculoskeletal pain symptoms are prevalent. These individuals can experience post-exertional malaise (PEM), a phenomenon in which symptom severity is worsened for 24 hours or longer after physical stress, but the pain-related component of PEM is not well characterized. Systematic review and meta-analysis. Case-control studies involving adults with ME/CFS or FM and measuring pain symptoms before and after exposure to a standardized aerobic exercise test were included. Hedges' d effect sizes were aggregated with random-effects models, and potential moderators were explored with meta-regression analysis. Results were adjusted for nesting effects with three-level modeling. Forty-five effects were extracted from 15 studies involving 306 patients and 292 healthy controls. After adjusting for nesting effects, we observed a small to moderate effect indicating higher post-exercise pain in patients than in controls (Hedges' d = 0.42; 95% confidence interval [CI]: 0.16-0.67). The mean effect was significantly moderated by pain measurement time point (b = -0.19, z = -2.57, P = 0.01), such that studies measuring pain 8-72 hours after exercise showed larger effects (d = 0.71, 95% CI = 0.28-1.14) than did those measuring pain 0-2 hours after exercise (d = 0.32, 95% CI = 0.10-0.53). People with ME/CFS and FM experience small to moderate increases in pain severity after exercise, which confirms pain as a component of PEM and emphasizes its debilitating impact in ME/CFS and FM. Future directions include determining mechanisms of pain-related PEM and developing exercise prescriptions that minimize symptom exacerbation in these illnesses.

Growth Hormone (GH) and Thyroid Stimulating Hormone (TSH) Co-Secreting Pituitary Macroadenoma

Background: TSH secreting pituitary adenomas are rare and accounts for 0.5-3% of all pituitary adenomas. Only 20-25% of those adenomas co-secrete other hormones like growth hormone or prolactin. Mixed GH and TSH secreting adenomas present with symptoms from tumor growth and features of both acromegaly and hyperthyroidism. Clinical Case: A 57 years old woman with a past medical history of chronic joint pains and bilateral knee swelling presented to her PCP with complaints of chronic fatigue. Evaluation revealed a normal TSH level and MNG and patient did not have any further work-up. She reported undergoing periodic knee arthrocentesis which gave her only temporary pain relief. Two years later, patient presented with complaints of unintentional weight loss, tremors and palpitations. She also reported enlargement in the size of hands, feet and forehead and no improvement in the knee swelling after multiple arthrocentesis. Lab evaluation revealed high free T4 2.31ng/dl (0.58-1.64), high free T3 6.44pg/ml (2.50-4.30), non-suppressed TSH 1.32mU/L (0.34-5.00), elevated IGF-1 415ng/ml (47-236), GH 7.76ng/ml (0.01-3.61) and prolactin 6.69ng/mL (2.74-26.72). Neck USG showed multiple nodules and 24hr radioactive iodine uptake scan showed increased uptake at 43%. 75gm OGTT showed non-suppression of GH level. MRI of brain showed 1.8 cm pituitary macroadenoma. Patient underwent transsphenoidal pituitary resection in January 2018 and the final pathology showed positive tumor staining for GH and TSH. Following surgery, patient reported improvement in symptoms. Lab work-up from October 2018 showed normal IGF 189 ng/ml (47-236), normal GH 0.35(0.01-3.61), Free T4 0.80(0.58-1.64), Free T3 2.41(2.50-4.30), TSH 0.06(0.34-5.00) and MRI from August 2020 showed no evidence of residual pituitary tumor. Conclusion: This is a rare case of a GH and TSH co-secreting pituitary macroadenoma. This case highlights the importance of considering acromegaly early in the differential diagnosis of patients presenting with chronic musculoskeletal symptoms and to pursue work up for central hyperthyroidism in a hyperthyroid patient presenting with a non-suppressed TSH level.

Healthcare Transition Preparation in X-Linked Hypophosphatemia

Abstract Introduction/Background: X-linked-dominant hypophosphatemia (XLH), formally known as vitamin-D-resistant rickets, is a rare, hereditary, chronic and progressive skeletal disorder, often perceived as a childhood disease only. Its estimated prevalence is 1 in 20,000. The perception that XLH does not require treatment once the growth plates fuse means that many adolescents/young adults (AYA) are lost to follow-up and then seek care for chronic musculoskeletal symptoms, including the consequences of osteomalacia (bone pain, pseudofractures, fractures) during adulthood. There is a need to improve the healthcare transition (HCT) preparation for AYA with XLH and other rare metabolic bone disorders (MBD) to facilitate consistent and effective care throughout the life span and lessen the psychosocial and economic burden associated with these disorders. Methods/Statement of the Problem: HCT timelines, milestones, and educational tools exist for some chronic conditions such as diabetes or kidney disease, but these programs do not meet the unique needs and nuances of patients with XLH and other rare MBD as they transfer to adult-focused healthcare. Consequently, specific tools and resources tailored by disease experts for these AYA are needed. Results/Proposed Solution: Detailed timelines with milestones and a description of a HCT program for AYA with XLH and other rare MBD have been adapted from best practice protocols. This program reflects the specific needs of, and complexities associated with these conditions. Furthermore, this approach describes how to facilitate better communication between adult- and pediatric-focused providers and their interdisciplinary teams. Our approach is guided by patient/caregiver input and existing models for research/clinical care, with the use of validated tools to measure HCT readiness. We identified the need for psychosocial and access-related resources for AYA emancipation from parental involvement, including a guidance document for parents on how to empower their child to take ownership of the disease as they grow. In addition, it is helpful to provide disease education, genetic counselling and guidance on family planning, to encourage patients to advocate for their healthcare (as access to specialists may be limited by geographical location), and to facilitate communication/education to patients through channels familiar to and accepted by AYA (e.g. online portals, text messages). Clear HCT preparation guidelines and treatment-related goals are defined for all stakeholders. A portfolio of supporting materials underpins optimization of outcomes as AYA with XLH and rare MBD transfer from pediatric- to adult-focused healthcare. Conclusion: Development of HCT tools/resources specific to XLH and other rare MBDs can help prevent loss to follow-up and promote continuous clinical care, thus driving better outcomes for AYA with these conditions.

Healthcare transition preparation in X-linked hypophosphatemia

X-linked hypophosphatemia (XLH) is a rare, chronic and progressive musculoskeletal disorder with an estimated prevalence of 1/20,000. Medical therapy is often stopped at the end of growth and many adolescents are lost to follow-up during the transition to adulthood-oriented care and only come to attention after developing chronic musculoskeletal symptoms (e.g. pain, fractures) or when they have a child with XLH. Preparation for healthcare transition (HCT) for XLH from pediatric- to adult-focused care should facilitate ongoing effective care throughout life to lessen the psychosocial impact and reduce economic burden associated with XLH.

Resistance exercises improve physical function in chronic Chikungunya fever patients: a randomized controlled trial

Chikungunya fever is an arboviral disease, caused by an alphavirus, the Chikungunya virus, characterized by fever and joint pain that is generally disabling in the acute phase and may last from months to years, with the potential to evolve into chronic musculoskeletal symptoms, as polyarthralgia and arthritis, which can lead to significant impairment of physical function. The non-pharmacological treatment is very important for these patients, and resistance exercises may be one rehabilitation option. This study aimed to evaluate the efficacy of a resistance exercise protocol on the physical function, pain, and quality of life of patients with chronic Chikungunya fever. A randomized, controlled, blind trial for the evaluators. Clinic-school of Physical therapy. Thirty-one patients with Chikungunya fever and musculoskeletal symptoms lasting more than three months, recruited from the Rheumatology outpatient clinic at Clinical Hospital, Federal University of Pernambuco (HC-UFPE). Patients (aged 56±10 years) were randomly assigned into one of two groups: Resistance Exercise Group (REG, N.=15) or Control Group (CG, N.=16). REG performed progressive resistance exercises with elastic bands (24 sessions over 12 weeks). CG only had their symptoms monitored through phone calls, maintaining the usual care treatment. Assessments were taken at baseline and after 6 and 12 weeks of the following: physical function (30-second Chair Stand Test (30-s CST), 4-step Stair Climb Power Test (4SCPT), 40-m Fast-paced Walk Test (40m FPWT), and Disabilities of the Arm, Shoulder, Hand (DASH) questionnaire); pain (VAS and painful joints count); quality of life (Medical Outcomes Study 36-Item Short-Form Health Survey [SF-36]); and Patient Global Impression of Change (PGIC) scale. There was a reduction of pain (P=0.01; d=-0.83) and an improvement of 30-s CST (P=0.04; d=0.85) in REG participants after 12 weeks. There was no significant change in the domains of SF-36. Nearly 70% of trained patients reported improvement on PGIC. Resistance exercises improved physical function in sitting and standing and reduced pain in patients with chronic Chikungunya fever. Resistance exercises can be considered as a treatment approach for patients with musculoskeletal disorders in the chronic stage of Chikungunya fever.

Study of delayed treatment perspective of snake bites and their long-term effects in a tertiary care hospital in balgalkot district of Karnataka

Background: Snakebite is an acute life-threatening and time limiting medical emergency. Alternative and traditional methods of cure are barriers to early treatment which results in considerable delay in coming to the hospital. This study was done to assess the clinical profile and to identify long-term perspective of snake bites in patients who presented to the hospital beyond 6 h of snake bite. Methodology: This descriptive study was conducted over 18 months that included 45 patients with alleged history of snake bite of which 15 had delayed presentation, 6 h after snake bite. A detailed history, clinical examination and investigations were monitored for any complications during treatment and follow-up to look for delayed complications. Results: The clinical profile and outcome were different among patients presenting beyond 6 h and within 6 h, cellulitis (46.66% vs. 33.33%), bleeding manifestations (46.66% vs. 50%), neurological manifestations (33.33% vs. 33.33%), AKI (33.33% vs. 16.66%), respiratory failure requiring ventilatory support (33.33% vs. 10%), and mortality (20% vs. none). Delayed complications observed in patients with delayed presentation on long-term follow-up were ulceration including knee amputation, chronic kidney disease, psychiatric disturbances, and musculoskeletal symptoms. Conclusion: The acute complications were significantly higher with delayed presentation and delayed complications that are often overlooked which contributes to significant morbidity and suffering. The general population needs to be educated regarding the available treatment strategies and significance of seeking early medical attention for better treatment outcome and to reduce morbidity and mortality both short term and long term.

Efeitos da cinesioterapia laboral nos sintomas osteomusculares crônicos de servidores universitários de um setor da Universidade Federal do Paraná

INTRODUÇÃO: Os servidores universitários passam longos períodos sentados durante a jornada de trabalho, podendo alterar a flexibilidade e desencadear sintomas de desconforto e/ou dor osteomuscular. A cinesioterapia laboral, com exercícios físicos realizados no local de trabalho, pode ser uma estratégia importante para melhorar o conforto e prevenir os sintomas a essa população. OBJETIVO: Verificar os efeitos dos exercícios de cinesioterapia laboral na amplitude de movimento e nos sintomas osteomusculares crônicos em servidores do setor universitário. CASUÍSTICA E MÉTODOS: Trata-se de um estudo de coorte de intervenção conhecida. Realizou-se avaliação da amplitude de movimento (ADM) de ombro, quadril e tronco por meio de fleximetria e para os sintomas osteomusculares, o questionário Nórdico. A cinesioterapia laboral teve duração de 20 minutos por atendimento, duas vezes por semana, durante 7 meses. RESULTADOS: Participaram do estudo 13 servidores, de ambos os sexos, com idades entre 22 e 65 anos. Observou-se aumento significativo da amplitude de movimento de 73% nas articulações avaliadas. Após 1 mês do término da cinesioterapia laboral, realizou-se nova avaliação com a fleximetria, resultando em diminuição da amplitude em 50% das articulações. O questionário Nórdico indicou que 90% dos participantes relataram problemas osteomusculares nos últimos 12 meses. CONCLUSÃO: A cinesioterapia laboral se mostrou eficaz nos distúrbios osteomusculares dos servidores, no aumento e manutenção da amplitude de movimento. Porém, a atividade física deve ser adotada como hábito de vida para que os resultados perpetuem.

Quality of life in chronic musculoskeletal symptomatic Chilean population: secondary analysis of National Health Survey 2009\u20132010

BackgroundHealth-related quality of life (HRQoL) is defined as the patient’s perception of their health status. HRQoL can be modified by illnesses, treatments or social and health policies. Chronic musculoskeletal pain is a modifying factor of HRQoL that leads to lower quality of life, elevated suffering and disability. Knowing HRQoL in subjects reporting chronic musculoskeletal symptoms (cMSS), like pain, discomfort or swollenness lasting more than 3 months, will provide information to health teams and organizations engaged in the Chilean health system. This study aim was to determine the relationship between HRQoL and musculoskeletal symptoms measured in three different Chilean groups: [1] without symptoms; [2] with acute symptoms; and [3] with cMSS.MethodsA secondary analysis of the 2009–10 Chilean National Health Survey (NHS) was executed to determine the relationship between HRQoL (measured with SF-12) in three MSS groups. The Chilean NHS considered a national, probabilistic, stratified and multistage sample of 5293 participants aged 15 and older; it was representative at the national, urban-rural and regional levels. A multivariate logistic regression model studied the relationship between cMSS and HRQoL, adjusted for age, sex, educational level and residence area as control variables (p < 0.05).ResultsOut of 5293 participants in the NHS 2009–10, 5276 subjects were included for analysis. The median age was 46 years (IQR 31–60), 59.4% women, a median of 10 years formal education (IQR 7–12) and an urban residence in 85.2% of the population of the NHS 2009–10. The observed population prevalence of people with cMSS was 42.6% (95% CI 40.4–44.9). Presence of cMSS is a risk factor for low HRQoL, exhibited both in the physical (OR 3.1 95% CI 2.7–3.5) and mental (OR 1.9 95% CI 1.6–2,) HRQoL dimensions, independent of control variables.ConclusionsPhysical and mental HRQoL are affected in people with cMSS, low educational level and advanced age. This is especially seen in women. This information will facilitate assessment and treatment of cMSS as a prevalent and multidimensional health problem.

Arboviruses related with chronic musculoskeletal symptoms.

Arboviruses (ARthropods BOrne VIRUSES) are disease-causing viruses transmitted through the bite of hematophagous arthropods, such as mosquitoes and ticks. Among these, the alphavirus, genus of the Togaviridae family, is considered the most arthritogenic species, responsible for diseases such as chikungunya fever (CHIK), O'nyong-nyong virus fever, Ross River virus disease, Barmah Forest virus disease, Sindbis virus disease, and Mayaro fever. These arboviral diseases, especially CHIK, have impacted public health in recent decades, leading to devastating epidemics, particularly in developing countries, due to their high potential for chronicity, functional impairment, and great impact on the quality of life. In a similar way, chronic musculoskeletal symptoms have been described in all alphavirus infections. However, CHIK is the best studied. The purpose of this article is to review physiopathology, clinical manifestations, diagnosis, and treatment of alphaviruses, focusing on CHIK and chronic evolution of musculoskeletal symptoms.

A directional preference approach for chronic pelvic pain, bladder dysfunction and concurrent musculoskeletal symptoms: a case series

ABSTRACT Background Chronic pelvic pain (CPP) with concurrent musculoskeletal and bladder symptoms is a complex and challenging problem. However, clinically the co-existence of these symptoms is not routinely questioned, and their musculoskeletal source is not investigated thoroughly. The purpose of this case series is to present the use of Mechanical Diagnosis and Therapy (MDT) principles in seven patients with concurrent chronic pelvic pain, bladder dysfunction and musculoskeletal symptoms. Case Descriptions Seven patients with coexisting pelvic health and musculoskeletal signs and symptoms were retrospectively reviewed. Most common symptoms were urinary frequency, incontinence, pelvic pain, nocturia, dyspareunia, bladder dyssynergia, and lumbar, pelvic or hip pain. All patients failed to recognize the possible interconnectedness of the two sets of symptoms. Each exhibited a directional preference (DP) and subsequent MDT provisional classification of derangement was established; the use of DP forces abolished or dramatically improved both symptoms and mobility impairments. In all cases DP was for sustained sagittal forces initially, but ultimately lateral forces and mobilization were indicated. Outcomes Changes in Pelvic Floor Impact Questionnaire, Care Connections Pelvic Floor and Lumbar spine were all clinically significant and exceeded minimally Clinical Important Differences several times. Average of 5.8 sessions per patient was noted. Follow-up at an average of 3.3 years revealed ongoing satisfaction and confidence in independent self-management. Discussion These case studies highlight the importance of ensuring expansion of intake questions for possible co-existence of symptoms in both pelvic and musculoskeletal patients, possibly suggesting a mechanical intervention is indicated. Provisional subclassification into ‘Mechanical Pelvic Syndrome’ is proposed. Level of Evidence: 4.

Injuries in female and male elite taekwondo athletes: a 10-year prospective, epidemiological study of 1466 injuries sustained during 250 000 training hours

ObjectivesWe aimed to determine the injury patterns associated with training activities in elite South Korean taekwondo athletes training for the Olympic Games.MethodsWe collected data prospectively from 2007 to 2016 at...

Presentation of SLE in UK primary care using the Clinical Practice Research Datalink

ObjectivesTo describe the presenting symptoms of SLE in primary care using the Clinical Practice Research Database (CPRD) and to calculate the time from symptom presentation to SLE diagnosis.MethodsIncident cases of...

Individuals with type 2 diabetes are at higher risk of chronic musculoskeletal pain: a study with diabetes cohort

The relationship between type 2 diabetes (T2DM) and chronic musculoskeletal complaints (cMSCs) remains largely debated. We investigated the association between T2DM and cMSCs in a cohort of 347 participants. A cross-sectional design was employed using the modified Nordic musculoskeletal questionnaire to investigate the prevalence of chronic musculoskeletal symptoms (cMSS) defined by pain and/stiffness lasting ≥3 months during the past 12 months. Multiple logistic regressions were employed to estimate the odds ratio among the diabetics compared to those without diabetes at 95 % CI. Generally, there was a high prevalence of cMSS among the cohorts, chronic low back pain being the most common complaint both among the diabetics (83; 49.7 %) and non-diabetics (70; 38.9 %).T2DM was associated with a higher prevalence of cMSS in at least one body segment and in all the nine body regions studied. cMSS was 2.5 times more likely among persons with T2DM compared to those without diabetes. Also, individuals with T2DM are 29 times at risk of cMSP of the upper back and knee compared to healthy cohorts. T2DM is associated with a higher risk of cMSP, a risk which is increased for the peripheral system much the same as centrally located musculoskeletal structure.