Degenerative Rheumatic Diseases Research Articles

Uso y prescripción de cannabis medicinal por reumatólogos en Argentina

The use and prescription of cannabis and its derivatives in Rheumatology is still under discussion. The cannabis law was enacted near 3 years ago, although the regulation is just beginning. The objective of this study was to know how rheumatologists positions themselves about the use of cannabis in the framework of his medical practice. Through a survey conducted during the 2019 Argentine Congress of Rheumatology, 314 doctors answered questions about the use, recommendations and opinions regarding the indication and use of cannabinoids in their daily practice. 78.3% (246) knew of the existence of a national law. 51.6% (162) disagreed with the use of cannabinoids by their patients, while 36.6% (115) agreed, 3.2% (10) reported to strongly agree, and 8.6% (27) strongly disagreed. For patients with autoimmune rheumatic diseases, 94.6% (297) reported that they never prescribed cannabinoids, 4.1% (13) prescribed them rarely, and 1.3% (4) sometimes. For degenerative rheumatic diseases, 90.4% (284) never prescribed cannabinoids, 6.7% (21) did it rarely, and 2.9% (9) did so sometimes. For fibromyalgia, 84.4% (265) never prescribed cannabinoids, 8.3% (26) prescribed them rarely, 6.4% (20) sometimes. The main obstacle to prescribing (more than one answer allowed) was not having enough scientific information (50.3%, 158), 47.5% (149) were uncertain about the cannabis preparation, 47.1% (148) had no knowledge about doses or posology, 41.4% (130) didn´t trust the producers, 38.9% (122) were no convince by the trials in the field . There were no significant differences between the variables age, gender, years in the specialty or workplace and the responses described. Conclusion: According to specialists in Argentina, the use of cannabis in rheumatology requires more scientific and pharmaceutical data to prescribe cannabinoids in a safer framework.

STW1 and Its Versatile Pharmacological and Clinical Effects in Rheumatic Disorders: A Comprehensive Report.

Aim To review the published and unpublished experimental and clinical studies about the efficacy and tolerability of STW1 and to compare the results to the efficacy and tolerability of investigated NSAIDs in parallel. Content. STW1 (Phytodolor®) contains a fixed combination of extracts from aspen leaves and bark (Populus tremula), common ash bark (Fraxinus excelsior), and goldenrod herb (Solidago virgaurea). It belongs to the group of anti-inflammatory and antirheumatic drugs, and it is authorized for the treatment of painful disorders of degenerative and inflammatory rheumatic diseases. The individual components have complementary effects. Its multifocal mode of action includes antiphlogistic, analgesic, antiexudative, antioxidative, antipyretic, and antiproliferative properties. The effects of both STW1 and its components have been verified in comprehensive pharmacological investigations. Open and randomized, placebo- and verum-controlled, and single-blind (sb) or double-blind (db) clinical trials, performed in different subtypes of rheumatic diseases confirm the pharmacological evidence. Its efficacy is comparable to a range of standard nonsteroidal anti-inflammatory drugs (NSAIDs) studied in parallel, but it has a superior safety profile. Conclusion STW1 is a reasonable alternative to NSAIDs with comparable efficacy and a superior safety profile. It is also suitable to reduce the intake of NSAIDs.

A Review of Heat Therapy in African Traditional Medicine

Heat therapy – also known as thermotherapy or thermal therapy – is the transfer of heat or thermal energy in and out of the human body especially at the joints, using towels, ice packs, wax, hot/warm water, steam, etc within a given temperature range. The objective is the expansion of blood capillaries and increased blood flow to the affected area for healing. The principle is the application of the heat or cold to change the cutaneous, intraarticular or core temperature of soft tissues to improve symptoms of certain conditions. Categories of heat therapy include: diathermia (<41°C), hyperthermia (41°C - 45°C), and thermal ablation (>45°C). Heat therapy is classified on the bases of contact of heat, mode of transfer, type of heat, penetration of heat, and use of heat. Examples include: steam inhalation, hot fomentations, hot foot bath, Seitz bath (hip bath and half-bath), hot and cold contrast bath, and sun therapy. Heat therapy has several benefits in African traditional medicine and has also been used extensively for treating various diseases including: sickle cell disease, primary dysmenorrhea, skeletomuscular pain, trauma, inflammatory and degenerative rheumatic diseases, osteoarthritis, acute and non-specific chronic low back pain, fibromyalgia, cutaneous leishmaniasis, tumours, musculoskeletal injuries, diabetic kidney disease, etc.

Perceived Influence of Weather Conditions on Rheumatic Pain in Romania

The main objective of this study was to analyze the perception of the influence of various weather conditions on patients with rheumatic pathology. A group of 394 patients, aged between 39 and 87 years and diagnosed with degenerative rheumatic diseases, were interviewed individually by using a questionnaire created specifically for this study. Further on, to assess the relationship between pain intensity and weather conditions, a frequency analysis based on Pearson’s correlation matrix was employed. The most important results are as follows: the great majority of the participants (more than 75%) believe that their rheumatic pain is definitely or to a great extent influenced by different weather conditions; most of the patients reported intensification of their pain with weather worsening, especially when cloudiness and humidity suddenly increase (83.8% and 82.0%, respectively), air temperature suddenly decreases (81.5%), and in fog or rain conditions (81.2%). In our research, alongside simple meteorological variables, we established that complex weather variables such as atmospheric fronts, in particular, the cold ones and winter anticyclonic conditions, greatly intensify the rheumatic pain, whereas summer anticyclonic conditions usually lead to a decrease in pain severity. In terms of relationships between pain intensity and weather conditions, we found the strongest correlations (ranging between 0.725 and 0.830) when temperature, relative humidity, and cloudiness are constantly high.

Effects of serial mud baths on inflammatory rheumatic and degenerative diseases

Mud baths have been used for a long time for the treatment of musculoskeletal diseases. In addition to a reduction of pain and improved function, serially applied mud baths lead to a reduction in the inflammatory processes, which often underlie degenerative and inflammatory rheumatic diseases. This study investigated the effects of serial mud baths on parameters of functional health, on pain perception and at the molecular level in patients with inflammatory rheumatic diseases, e.g. rheumatoid arthritis (RA) and ankylosing spondylitis (AS), and degenerative alterations, e.g. gonarthritis and/or coxarthritis. A total of 41 patients with inflammatory rheumatic (33 RA and 8 AS) and 40 patients with degenerative diseases were subdived into 2 groups by computer-assisted randomization. In each group a subgroup received 9 serial mud baths within 21 days in addition to a multimodal physical rehabilitative complex treatment (intervention groups). In the other subgroups only the physical rehabilitative treatment was carried out and no mud baths were administered (control group). The outcome parameters were assessment of the functional capacity and pain perception (HAQ, FFbH, VAS and WOMAC), diesease activity (DAS28 and BASDAI) as well as laboratory markers of inflammatory activity (CRP, BSG, IL-1 beta and IL-10) and the patient assessment. In the intervention groups after serial mud baths there was a significant improvement in the functional parameters (HAQ and FFbH, both p < 0.01) and a significant reduction in pain strength (VAS, p < 0.01) persisting for 3 months after the end of treatment. A significant reduction in disease activity (RA in DAS28 and AS in BASDAI) could be shown for the intervention groups as well as the control groups, whereby the effect strength was more pronounced in the intervention groups. In patients with gonarthritis and/or coxarthritis a significant improvement in functional limitations (WOMAC, p < 0.01) was only found in the intervention groups. A significant improvement in the proinflammatory cytokine IL-1 beta (p < 0.01) was only found in the intervention groups with a simultaneous increase in the anti-inflammatory cytokine IL-10 (p < 0.01). The CRP and BSG remained within the normal range and showed no significant changes even after serial mud baths. Mud baths applied within the framework of a physical rehabilitative complex treatment brought about an improvement of parameters of functional health for both inflammatory rheumatic and degenerative diseases. Effects at the molecular level were induced, which are possibly accompanied by osteoprotective and chondroprotective effects.

Physical therapy options in rheumatic diseases: what is evidence-based?

Rheumatic diseases usually progress towards morphological and functional deficits and thus cause impairment of physical health and function. Based on this fact, physiotherapeutic options are elementary and indispensable. This article focuses on the significance and importance of physiotherapy in inflammatory and degenerative rheumatic diseases. Furthermore, an overview is presented on the consequences of rheumatic diseases, the reality of supply of physiotherapy, the principles and therapeutic options, and the evidence.

Physical Therapy in Elderly Suffering from Degenerative Diseases.

Introduction:Osteoarthritis of the joints (osteoarthritis or arthritis) represents the largest group of rheumatic diseases. Within rheumatic diseases 50% are degenerative rheumatic diseases, 10% inflammatory and 40% extra-articular.Goal:To determine the modalities of physical therapy for elderly with degenerative diseases.Material and methods:The study is retrospective-prospective and descriptive. The survey conducted included 25 patients with degenerative diseases of the musculoskeletal and nervous systems in Gerontology Center in Sarajevo, from May 1, 2014- April 30, 2015. As research instruments were used: Questionnaire for users of physical therapy in Gerontology Center in Sarajevo, self-developed, visual-analog scale to assess pain and patient records.Results:Of the total number of patients with degenerative diseases (25), 10 (40%) were male and 15 (60%) were female. The most common degenerative disease is knee osteoarthritis which had 11 patients (29%), 3 males and 8 females. From physical therapy modalities in the treatment of degenerative diseases at the Gerontology Center in Sarajevo, kinetic therapy was administered to all patients, followed by manual massage and TENS in 15 cases (60%). From twenty-two patients, who completed a questionnaire, 11 (50%, 2 male and 9 female) rated their health as poor. Seven patients (32%, 3 male and 4 female) assessed their health as good. Three patients (14%, 2 male and 1 female) rated their health as very poor, and one patient (4%, 1 male) rated its health as very good.Conclusion:The Research Physical therapy in elderly with degenerative diseases is a pilot project, which highlights the need for: Conducting research for a longer time period, with a larger sample; Quality of keeping health records; Implementation of a continuous evaluation of functional status and; Stricter control for optimal effectiveness of physical therapy in order to improve the quality of life of elderly patients.

Use of medicinal plants in rheumatology

Objective: The use of medicinal plants by patients in the treatment of chronic diseases (diabetes mellitus, hypertension) is common in Morocco. Rheumatic diseases do not except from this informal and yet unknown therapeutic way. The objective of this work is to study the prevalence of the use of herbal medicines in rheumatology and the factors associated with this practice in the population of the region of Marrakech. Patients and methods: This is a prospective study, 200 patients attending to two hospitals in Marrakech, for various inflammatory and degenerative rheumatic diseases were included, between August 2010 and March 2011. Hetero-administered questionnaire was used, including demographic data, type of plants used and the terms of their uses. Results: Patients were represented by 163 women and 37 men. The use of medicinal plants was found in 78 patients (39%), including 60 women and 18 men, with a mean age of 50 years. We identified 49 different plants. Most used ones were the Olea Europaea L . Nigella sativa L. Lavandula angustifolia Mill . The information on these plants was given by friends and neighbours in most cases, the main expected effect was analgesic and the efficacy of these products was reported in 47.4% of cases. Plants were prepared by the patients themselves in 73% of cases, without prior instruction or knowledge of the terms of use. Adverse events were noted in 24.4% of cases. The use of plants was significantly higher in elderly patients, with more children out of school and having a major pain in the visual analogue scale (VAS). Conclusion: The use of medicinal plants is quite common in rheumatology. However, we did not find an association between this practice and educational, social or economical levels of patients.

Značaj laseroterapije u fizikalnoj terapiji starih osoba

The ageing process involves a gradual loosening of the physiological functions of the body. The most common difficulties the elderly experience are: weakened peripheral and central circulation, respiratory diseases, permanently reducing the function of the cardiovascular system, degenerative diseases of the musculoskeletal system, difficulty in movement, lack of coordination, failure of the genitourinary system, chronic pain, depressed, dementia etc. Laser therapy is a relatively new physical procedure. In physical medicine, for instance, low power lasers, that generate analgetic, anti-inflammatory and antiedemous simulative effect, are often used in order to treat many conditions and diseases of the elderly. What's more, in many cases, those conditions and diseases which are common for the elderly, indicate themselves the necessity of laser treatment. Discussion: In degenerative rheumatic diseases laser therapy reduces pain, increases joint mobility, which improves the mobility of the elderly, reducing the risk of falls, and also improving the quality of life of the elderly. In inflammatory rheumatic diseases, the effect of laser beams reduces the inflammation of the joints, swelling and soreness as well as allowing us to keep the disease under control. On the other side, the amount of medications older people take on daily basis, is reduced this way, as well. Diabetic polyneuropathy is often accompanied by severe pain in the legs, disturbances of sensibility, mobility problems all of which can lead to falls and significantly affects quality of life. Laser therapy is considered curtail in treating this sort of a disease. Laser acupuncture is also important in medical treatment after a stroke; can be used as an aid in the treatment of diseases of the cardiovascular system, respiratory system, diseases of the endocrine system. Conclusion: Laser therapy is easily applied; the treatment itself is painless and relatively of short duration. However, and it is the main problem, it often implies an upfront financial investment, due to the expensive laser therapy apparatus.

Mesenchymal Stromal Cells: Updates and Therapeutic Outlook in Rheumatic Diseases.

Multipotent mesenchymal stromal cells or mesenchymal stem cells (MSCs) are adult stem cells exhibiting functional properties that have opened the way for cell-based clinical therapies. MSCs have been reported to exhibit immunosuppressive as well as healing properties, improving angiogenesis and preventing apoptosis or fibrosis through the secretion of paracrine mediators. This review summarizes recent progress on the clinical application of stem cells therapy in some inflammatory and degenerative rheumatic diseases. To date, most of the available data have been obtained in preclinical models and clinical efficacy needs to be evaluated through controlled randomized double-blind trials.

One-year-survey with multicenter data of more than 4,500 patients with degenerative rheumatic diseases treated with therapeutic nuclear magnetic resonance

Nuclear magnetic resonance (NMR) has been shown to stimulate repair processes and cartilage and to influence pain signalling. It represents an alternative therapy for patients suffering from osteoarthritis (OA). To prove the clinical success of this new therapeutical method, validated measuring parameters are important that are convincing for pain and function in a one-year-follow-up. During the course of its application over the last 10 years, over 4,500 protocols of a one-year-follow-up have been collected to record the outcome of NMR therapy. This report reflects the outcome of NMR therapy on patients with the following degenerative rheumatic diseases: OA of the knee (n = 2.770), OA of the hip (n = 673), OA of the ankle joint (n = 420) and chronic low back pain (n = 655). Data were collected at baseline, 6–8 weeks and 6 and 12 months following NMR treatment. Pain was reduced significantly 6 weeks after NMR treatment in the cases of all four examined indications and stayed measurably reduced up to 6 and 12 months. The improvements in all three forms of pain (pain on load, pain on motion, pain at rest) following NMR treatment were around 21–50% on average. Following therapy with NMR, patients with OA of all four types experienced a distinct improvement in their ability in functional parameters. Overall, the 10 years of a one-year-survey with multicenter data gathered on the effect of NMR therapy on patients verifiably proved its efficacy amongst patients with degenerative rheumatic diseases.

Measures in Musculoskeletal Ultrasound. What are Valid?

The attempt to measure and quantify changes related to inflammation and structural damage lesions represents one of the most interesting topics in the field of musculoskeletal ultrasound in rheumatology. Different scoring systems have been used over the recent years to measure inflammation and structural damage lesions in patients affected by inflammatory and degenerative rheumatic diseases. In the last years quantitative and semiquantitative methods in several studies have been applied, with promising results. In the present review we reported the main studies about this topic. However, more studies are needed to address some technical issues and quantify ultrasonography-detected abnormalities.

La thérapie cellulaire du cartilage : bases cellulaires et moléculaires

The destruction of articular cartilage represents the outcome of most inflammatory and degenerative rheumatic diseases and leads to severe disability. Articular cartilage being unable to repair spontaneously, alterations of the joint surface often results in end-stage osteoarthritis, requiring surgical intervention and total joint replacement. This makes damaged tissues repair a major challenge in our aging society. Cartilage harbors only one cell type, the chondrocyte, which synthesizes and secretes specific matrix proteins such as type II collagen and high molecular weight proteoglycans. Matrix proteins are responsible for the conservation of the chondrocyte phenotype and the maintenance of the mechanical functions of cartilage. Development of therapeutic strategies for cartilage repair should thus comprise not only the replacement of lost cartilage cells but also that of extracellular matrix with cartilage-like properties. Different protocols are under investigation. The most commonly employed materials include transplantation of autologous osteochondral tissue. More recently, cell-based therapies using autologous mature chondrocytes or pre-chondrogenic stem cells have drawn particular attention. Tissue-engineering procedures represent the actual trend in cartilage repair. This approach combines biodegradable polymeric three-dimensional matrixes and isolated prechondrogenic stem cells. The cells are seeded within the biocompatible matrix and then implanted into the joint. Numerous non-degradable and degradable polymers, which efficiently "mimic" the natural surroundings of cartilage cells, are currently under investigation.

Phytodolor® – Effects and efficacy of a Herbal Medicine

Herbal antirheumatics are successfully used in painful inflammatory or degenerative rheumatic diseases. One of these herbal medicines is Phytodolor (STW 1), a fixed combination of extracts from aspen leaves and bark (Populus tremula), common ash bark (Fraxinus excelsior), and golden rod herb (Solidago virgaurea). Its effects as well as those of its components have been verified in experimental and human pharmacological investigations. The mode of action of STW 1 includes antiinflammatory, antioedematous, antioxidative and analgesic properties, and it is considered to be broader than that of synthetic antirheumatics. Open clinical studies and randomised, placebo- or verum-controlled double-blind trials, performed in different subtypes of rheumatic diseases, confirm the pharmacological evidence of efficacy, such as by reducing the intake of non-steroidal antiinflammatory drugs (NSAIDs). STW 1 has a high drug safety. Phytodolor (STW 1) is a reasonable alternative to NSAIDs and to cyclooxygenase(COX)-2-inhibitors such as rofecoxib.

Comparison of different stationary phases for bioanalytical studies of biologically active compounds

In this study, the chromatographic behaviour of four mixtures of compounds was tested on columns possessing various surface properties. Cocaine, dimefluron, nabumetone, and tramadol were chosen as the test compounds. Cocaine is a tropane alkaloid, which is relatively often abused as a drug. This is why many papers have already been written about its determination in human biological samples. Dimefluron, a derivative of benzo[c]fluorene, is a new perspective drug being investigated for its potential antineoplastic effects. Nabumetone is a non-steroidal anti-inflammatory prodrug used for treatment of inflammatory and degenerative rheumatic diseases. Tramadol, derived from an opioid structure is used as an anodyne for treatment of severe pain. As a medicament it is usually determined either in biological samples or in pharmaceuticals. The above-mentioned model drugs were separated using chromatographic columns with C18, C8, palmitamidopropyl, and pentafluorophenylpropyl chains. The best conditions for separation of the individual compounds and their metabolites were chosen on the basis of resolution, retention times, and peak symmetry.

Lˈassociation spondylarthropathie féminine-syndrome de Gougerot-Sjögren est-elle fortuite ? À propos de 13 cas

Objective. To determine the prevalence of Sjögrenˈs syndrome (SS) in women with spondyloarthropathy (SpA). Methods. Forty-one women with SpA manifesting as inflammatory back pain and/or peripheral arthritis were diagnosed as having ankylosing spondylitis, undifferentiated spondyloarthropathy, psoriatic arthritis, or enteropathic arthropathy. A validated questionnaire was used to look for sicca symptoms in the SpA group and in 102 controls with degenerative rheumatic diseases. Women with SpA and sicca symptoms and/or positive antinuclear antibodies (ANA) were investigated for SS by minor salivary gland biopsy. In the SpA group, the following tests were done: HLA B27; HLA DR, DQ; ENA; and serology for CMV, EBV, HIV, hepatitis B, and hepatitis C. Results. Thirteen women (31.7%) met European criteria for SS, compared to three (2.9%) of the controls. Of the 41 women with SpA, 16 (39%) were ANA-positive. ANA were detected in eight of the 16 (50%) patients with SS. HLA B27 was positive in 11 of the 13 (84.6%) SS patients. HLA DR 04.04 and DQ 03.03 seemed more common in SS patients, but the difference was not statistically significant. Conclusion. SS was far more common in the women with SpA (31.7 %) than in the controls (2.9 %), suggesting that the SpA-SS association may not be coincidental.

Is the relationship between spondyloarthropathy and Sjögren’s syndrome in women coincidental? A study of 13 cases

Objective. To determine the prevalence of Sjögrenˈs syndrome (SS) in women with spondyloarthropathy (SpA). Methods. Forty-one women with SpA manifesting as inflammatory back pain and/or peripheral arthritis were diagnosed as having ankylosing spondylitis, undifferentiated spondyloarthropathy, psoriatic arthritis, or enteropathic arthropathy based on accepted criteria. A validated questionnaire was used to look for sicca symptoms in the SpA group and in 102 controls with degenerative rheumatic diseases. Women with SpA and sicca symptoms and/or positive antinuclear antibodies (ANA) were investigated for SS by minor salivary gland biopsy. In the SpA group, the following tests were done: HLA B27; HLA DR, DQ; ENA; and serology for CMV, EBV, HIV, hepatitis B, and hepatitis C. Results. Thirteen women (31.7%) met European criteria for SS, compared to three (2.9%) of the controls. Of the 41 women with SpA, 16 (39%) were ANA-positive. ANA were detected in eight of the 16 (50%) patients with SS. HLA B27 was present in 11 of the 13 (84.6%) SS patients. HLA DR 04.04 and DQ 03.03 seemed more common in SS patients, but the difference was not statistically significant. Conclusion. SS was far more common in the women with SpA (31.7%) than in the controls (2.9%), suggesting that the SpA-SS association may not be coincidental.

Patient and Physician Satisfaction with Aceclofenac: Results of the European Observational Cohort Study (Experience with Aceclofenac for Inflammatory Pain in Daily Practice)

SummaryA pan-European study involving 23407 patients with pain due to various inflammatory or degenerative rheumatic diseases was undertaken in Austria, Belgium, Germany and Greece, to evaluate overall pain relief and satisfaction with aceclofenac therapy.Aceclofenac was considered by patients to be a highly efficacious treatment with excellent and fast analgesic activity that was maintained throughout the study period. At the conclusion of the study, assessment of patient status, a parameter encompassing both efficacy against inflammatory pain and tolerability, by both patient and physician, was either much improved or improved in 84% of cases. These evaluations were similar irrespective of the country or whether the indication was acute (e.g. post-traumatic pain), semi-chronic (e.g. low back pain) or chronic pain (e.g. osteoarthritis). Patient satisfaction with, and compliance of, aceclofenac therapy was similarly impressive; 90% of patients were satisfied and over 90% of patients were treatment compliant.In combination with the recently published SAMM study results, the findings of the European Observational Cohort study validate aceclofenac, in everyday clinical practice, as an effective, well-tolerated and well-accepted therapy for both acute and chronic inflammatory and degenerative disease. The availability of a powerful anti-inflammatory agent with a low incidence of side-effects is of considerable value to both the patient and physician in the management of inflammatory pain. This objective has been fulfilled with aceclofenac therapy.

Psoriasis and arthritis. I. A population study.

In a population survey of 3659 persons aged 20 years or older, no association was found between psoriasis and rheumatoid arthritis. Inflammatory, degenerative and soft tissue rheumatic diseases occurred in 59% of the psoriatics and 46% of the controls. However, the mean number of rheumatological diagnoses in the psoriatics was 1.1 and in the controls 1.3. Features of psoriasis were found in 41 individuals (1.1%). Features of inflammatory arthritis (RA + past-polyarthritis) were established in 5% and 2.2% of the psoriatics and the controls respectively, but this difference is not significant. Because patients with psoriasis have complaints associated with the locomotor system more frequently than non-psoriatic people, it seems likely that the referral rate of the former to special clinics is higher.

Untersuchungen über den Einfluß von Sulindac auf den Stoffwechsel von Diabetikern mit Glibenclamid

20 diabetic patients, all of them showing a constantly good regulation of their diabetes on their respective dose of glibenclamide during the preceding two months and (all of them) suffering from various, mainly degenerative rheumatic diseases, were taken up into the study. After a three days period the patients were additionally given sulindac for a duration of 5 days. During the entire test period the blood sugar levels were measured three times daily in order to recognize a possible drug interaction.The evaluation of the data by means of a double variance analysis did not show any significant differences of the blood sugar levels during period and the period of additional sulindac medication. From these results it can be assumed that there is no clinically significant drug interaction between glibenclamide and sulindac.