Improvement In Morning Stiffness Research Articles

The Effect of Shock Wave Therapy as a New Modality for Treatment of Primary Knee Osteoarthritis

Background: osteoarthritis, the most common form of arthritis, is a chronic disease characterized by slow degradation of cartilage, pain, and increasing disability. Objective: to study the effect of shock wave therapy in treatment of primary knee osteoarthritis. Patients and Methods: thirty patients with primary knee osteoarthritis were classified equally into 2 groups according to the line of treatment; Group I received extra-corporeal shock wave therapy and Group II received continuous ultrasonic waves. Patients were evaluated for pain using visual analogue scale, active range of motion, and physical and functional assessment. Bilateral anteroposterior weight bearing radiographs were done for all patients before treatment and degree of osteoarthritis was assessed by Kallgren and Lawrence Radiographic criteria. Results: there was significant improvement in group I more than group II (as regard to pain assessed by visual analogue scale (VAS) after treatment (p=0.039) and in follow up (p <0.001). There was significant improvement in morning stiffness in both groups with insignificant difference between both them. Regarding active range of motion (ROM), there was significant improvement in flexion in both groups with significant difference between both groups before and after treatment (p =0.001) and in follow up (p <0.001). Regarding chair stand test, there was significant improvement in both groups with in significant difference between them. Regarding stair climb test (SCT), there was significant improvement in both groups with insignificant difference between them. Conclusions: shock wave had an effect in treatment of primary knee OA as a new modality for improving clinical and functional performance.

Efficacy of 99Tc-MDP combined with calcium and vitamin D3 for treating secondary osteoporosis in patients with rheumatoid arthritis

Objective To observe the efficacy of 99Tc-methylene diphosphonate (MDP) combined with calcium and vitamin D3 in the treatment of rheumatoid arthritis (RA) and secondary osteoporosis. Methods Fifty patients (19 males, 31 females, average age: (56.21±18.32) years) with RA and secondary osteoporosis from January 2015 to December 2016 were selected as observation group. All of them were treated with 99Tc-MDP, calcium and vitamin D3. Another 39 patients with RA and secondary osteoporosis were randomly selected as control group, including 16 males and 23 females (average age: (60.37±12.56) years), and all were treated with methotrexate, calcium and vitamin D3. Curative effects before and after (3, 6, 12 months) the treatment were observed and compared. Two-sample t test was used for data analysis. Results Both of the 2 groups showed good response, and there was no statistical significance in improvement of morning stiffness, reducing joint tenderness and swelling (t values: 0.3-0.6, all P>0.05). The bone mineral density (BMD) of L2-L4 vertebral bodies and femoral neck were (0.64±0.05) and (0.59±0.06) g/cm2 6 months after treatment, and were (0.81±0.04) and (0.79±0.06) g/cm2 12 months after treatment in the observation group, which were all higher than those in the control group ((0.51±0.04), (0.50±0.05), (0.59±0.03), (0.52±0.05) g/cm2;t values: 8.3-9.9, all P<0.05). Conclusion 99Tc-MDP combined with calcium and vitamin D3 for RA and RA osteoporosis may achieve good curative effect. Key words: Arthritis, rheumatoid; Osteoporosis; Cholecalciferol; Technetium Tc 99m medronate; Treatment outcome

Impact of Tocilizumab Monotherapy on Clinical and Patient-Reported Quality-of-Life Outcomes in Patients with Rheumatoid Arthritis.

IntroductionTocilizumab (TCZ) monotherapy has been proven as an effective treatment for rheumatoid arthritis (RA) in clinical trials. However, there are limited data available regarding the effectiveness of TCZ monotherapy in real-world clinical settings in the United States. The objective of this study was to evaluate the impact of TCZ monotherapy on disease activity and patient-reported outcomes (PROs) in a US-based observational cohort of patients with RA seen in routine clinical practice.MethodsEligible patients had active RA, no prior use of TCZ, and initiated TCZ as monotherapy. Changes in disease activity and PROs were assessed 1 year after TCZ initiation for the overall cohort and stratified by number of prior tumor necrosis factor inhibitors (TNFis; 0, 1, or ≥2). Primary outcomes were change in Clinical Disease Activity Index (CDAI); change in patient global disease activity, pain, fatigue; and the proportions of patients with improvement in modified Health Assessment Questionnaire (mHAQ), morning stiffness, and EQ-5D.ResultsOf 255 eligible TCZ monotherapy initiators, 9.4% were TNFi naive, 36.5% had one prior TNFi, and 54.1% had ≥2 prior TNFis. Clinical and PRO measures indicated that patients were substantially impacted by their disease at baseline. The median decrease in CDAI from baseline to 1 year was 9.8 and median patient global and pain scores improved by 10 mm, indicative of clinically meaningful improvement; the median fatigue score improved by 5 mm. Approximately 26% of patients reported clinically meaningful improvement in mHAQ, 54% experienced improvement in morning stiffness, and 20% to 36% experienced improvement in EQ-5D domains (walking, self-care, usual activities, pain/discomfort, and anxiety/depression). Improvements were similar across TNFi groups.ConclusionsPatients with active, refractory RA who initiated TCZ monotherapy experienced improvements in both composite disease activity scores and PROs at 1 year, regardless of prior TNFi exposure.FundingCorrona, LLC and Genentech.Electronic supplementary materialThe online version of this article (doi:10.1007/s40744-017-0081-3) contains supplementary material, which is available to authorized users.

Modified-Release Prednisone: in Patients with Rheumatoid Arthritis

Prednisone is a well-established treatment option in rheumatoid arthritis. Low-dose glucocorticoid therapy alleviates disease signs and symptoms, is better tolerated than high-dose therapy, and its addition to disease-modifying anti-rheumatic drugs (DMARDs) inhibits radiographic disease progression. A low-dose, modified-release (MR) formulation of prednisone, administered in the evening, was developed to counter the circadian rise in pro-inflammatory cytokine levels that contributes to disease activity. In a 12-week, randomized trial (CAPRA-2) in adult patients with rheumatoid arthritis who were receiving stable DMARD therapy, the addition of MR prednisone reduced disease signs and symptoms by ≥20% according to the American College of Rheumatology criteria (in 48% of patients vs. 29% with placebo; p<0.002 [primary endpoint]). In another 12-week trial (CAPRA-1), addition of evening MR prednisone to stable DMARD therapy reduced the mean duration of morning stiffness to a greater extent than addition of morning immediate-release (IR) prednisone (22.7 vs. 0.4%; p=0.045 [primary endpoint]). The improvement in morning stiffness with MR prednisone was maintained for 9-12months during the open-label extension of CAPRA-1. These findings were supported by data from observational studies in various adult populations with rheumatoid arthritis. Treatment with evening MR prednisone for up to 12months was generally well tolerated, with an overall similar tolerability profile compared with evening placebo or morning IR prednisone, and no new safety concerns. MR prednisone was estimated to be cost effective relative to IR prednisone in patients with rheumatoid arthritis in a UK pharmacoeconomic model.

Efficacy, safety and mechanism of action of modified-release prednisone in rheumatoid arthritis

Glucocorticoids (GCs) provide a powerful and widely used anti-inflammatory and disease-modifying therapy for rheumatoid arthritis (RA). However, concerns about adverse effects are driving efforts to find 'safer' GC or GC analogues. One novel approach has been to change the timing of GC delivery, targeting the early hours of the morning to suppress the observed circadian peak in interleukin-6 (IL-6). The CAPRA-1 study has shown that this produces a clinically useful beneficial improvement in morning stiffness and mechanistic studies have shown that this correlates with a strong suppression of the IL-6 early morning peak. With no obvious additional adverse reactions, this improvement in the therapeutic ratio offers additional treatment options in RA, and perhaps in other inflammatory diseases that show circadian variation in symptoms.

Evaluation of the effects of Global Postural Reeducation in patients with ankylosing spondylitis

The objective of this study is to assess the effects of Global Postural Reeducation (GPR) in patients with ankylosing spondylitis and compare GPR with group conventional segmental self-stretching and breathing exercises. This is a controlled interventional study of 38 patients divided into 2 groups: a GPR group (n = 22) and a control group (n = 16). Both groups were treated for more than 4 months. With the GPR group patients, positions that stretched the shortened muscle chains were used. With the control group patients, conventional segmental self-stretching and breathing exercises were performed. The variables analyzed were pain intensity, morning stiffness, spine mobility, chest expansion, functional capacity (Health Assessment Questionnaire-Spondyloarthropathies-HAQ-S), quality of life (Medical Outcome Study Short Form 36 Healthy Survey-SF-36), and disease activity (Bath Ankylosing Spondylitis Disease Activity Index-BASDAI). Statistical analysis was used with a significance level of P < 0.05. There was a statistically significant improvement for all the parameters analyzed between pre-and post-treatment in both groups. In the intergroup comparison, the GPR group showed a significantly greater improvement in morning stiffness (P = 0.013), spine mobility parameters, except finger-floor distance (P = 0.118), in chest expansion (P = 0.028), and in the physical aspect component of the SF-36 (P = 0.001). The results of this study showed that individual treatment with GPR (overall stretching) seems to have better clinical outcomes than group treatment with conventional segmental self-stretching and breathing exercises for patients with ankylosing spondylitis.

Short-term infliximab therapy improves symptoms of psoriatic arthritis and decreases concentrations of cartilage oligomeric matrix protein

The aim of the current study was to evaluate the short-term effects of anti-tumour necrosis factor alpha (infliximab) therapy on serum cartilage oligomeric matrix protein (COMP) levels, a possible biomarker of cartilage destruction. Nine consecutive patients with active psoriatic arthritis (PsA) were treated with infliximab for 6 weeks. Serum COMP levels were measured and correlated to pre-established disease activity outcome variables: pain as assessed by the patient, using the 100 mm visual analogue scale (VAS), duration of morning stiffness (MGST), swollen joint count (SJC), tender joint count (TJC), erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP). Significant improvements in MGST, VAS, SJC and TJC values were observed after 6 weeks of therapy. Similar significant improvements were demonstrated in the ACR response rate and in eight (89%) patients the ACR20 was achieved. ESR and CRP decreased significantly over 6 weeks. Serum COMP levels also decreased significantly after 6 weeks of treatment (12.99 +/- 1.71 baseline, 10.22 +/- 1.1 after 6 weeks, P < 0.008). The results of our study suggest that short-term therapy with infliximab leads to decreased COMP levels in patients with PsA. COMP seems to be a good candidate for a biomarker reflecting cartilage response to this treatment in PsA patients.

Bromocriptine in rheumatic and autoimmune diseases

Background and Objectives: Multiple lines of evidence support the concept that the anterior pituitary hormone prolactin has a pathogenic role in rheumatic and autoimmune diseases including, but not limited to, rheumatoid arthritis (RA), systemic lupus erythematosus (SLE), Reiter's syndrome, psoriatic arthritis, and uveitis. Conversely, the dopaminergic agonist bromocriptine appears to have therapeutic effects through suppression of pituitary prolactin secretion and, perhaps, through actions on peripheral dopamine receptors. This article reviews the experimental and clinical data supporting the therapeutic use of bromocriptine as a nonstandard or adjunctive therapy in rheumatic and autoimmune diseases. Methods: Data addressing the potential therapeutic role of bromocriptine in rheumatic and autoimmune diseases, as well as frequently associated comorbidities, was accumulated from the author's work, online literature search of the National Library of Medicine, and references from these identified publications. Results: There have been a number of clinical therapeutic trials using 2.5 to 30 mg of bromocriptine per day in a single or divided dose, which have shown efficacy with minimal side effects in the treatment of rheumatic and autoimmune diseases. In RA, bromocriptine administration has induced immunosuppression of several immune parameters and has been associated with improvements in morning stiffness, grip strength, numbers of swollen/painful joints, and the Health Assessment Questionnaire disability index. In two blinded studies, bromocriptine reduced the number of SLE flares and was as effective as hydroxychloroquine in reducing lupus disease activity indices, respectively. In case reports, bromocriptine has been used successfully in the treatment of Reiter's syndrome enthesopathy and psoriatic arthritis. The potential efficacy of bromocriptine in the treatment of uveitis and multiple sclerosis is suggested but remains to be verified. Conclusions: Double-blind, placebo-controlled studies are limited, but clinical observations and trials support the use of bromocriptine as a nonstandard primary or adjunctive therapy in the treatment of recalcitrant RA, SLE, Reiter's syndrome, and psoriatic arthritis and associated conditions unresponsive to traditional approaches. Additional investigation is needed to verify this conclusion and extend preliminary results. Relevance:In patients with rheumatic and autoimmune diseases, bromocriptine may be a relatively safe and efficacious alternative therapy. Semin Arthritis Rheum 31:21-32. Copyright © 2001 by W.B. Saunders Company

Evaluation of a filtration lymphocytapheresis (LCP) device for use in the treatment of patients with rheumatoid arthritis. 1991.

Abstract: Guest Editor's Introduction: Cell adhesion on a material is caused by the interaction between them and related to the material characteristics including chemical structure, surface charge, wettability, smoothness, and microstructure such as microdomain structure. In addition, Nishimura of Asahi Medical Co. found that the size of the material is important particularly in the case of lymphocyte adhesion. Based upon this result Asahi Medical Co. developed lymphocyte removal filters by use of ultra fine fibers having a diameter of 1.7 μm. The filter was first used for leukocyte filters for blood transfusion, and then applied for therapeutic use in the treatment of patients with various hematological and autoimmune diseases. This paper describes the specification of the filter and clinical application for the treatment of rheumatoid arthritis. This paper was printed in Artificial Organs, vol. 15, page 180–188 (1991) and reprinted here with permission.A practical on‐line lymphocytapheresis (LCP) system using a leukapheresis filter (Cellsorba, Asahi Medical Co.) was evaluated in six patients with refractory rheumatoid arthritis. This filter consists of nonwoven fine polyester fiber wound around a porous cylinder. The blood was passed through the polyester fiber at a flow rate of 50 ml/min for 60 min. LCP was carried out once a week in the first month and biweekly in the next 2 months. An average of 98% of the leukocytes that entered the filter (1.27 × 1010 cells) and 100% of the lymphocytes that entered the filter (3.66 × 109 cells) were removed in the first LCP. A total of 96.6% of the platelets and 2.7% of the erythrocytes that entered the filter were also removed. All of the patients showed clinical improvement in morning stiffness, Lansbury articular index, and functional capacity, with no adverse reaction. The number of circulating lymphocytes erythrocytes, and platelets and the concentration of various serum components showed no significant change during the treatments. This LCP system required no fresh frozen plasma, albumin, or other blood transfusion. The number of circulating lymphocytes decreased to 65–70% of the pretreatment circulating lymphocyte count at the last procedure, with a decrease in the ratio of Leu3a positive cells to Leu2a positive cells. The proliferative response to phytohemagglutinin and concanavalin A was improved. These data suggest that LCP to remove ∼3 × 109 lymphocytes once a week or biweekly has an immunomodulatory effect.

One-year clinical results with actarit—a preliminary report

The effectiveness and safety of 1-year treatment with actarit were evaluated in patients with rheumatoid arthritis. Treatment was continued for 1 year or longer in 18 of the 34 patients. Early improvement in morning stiffness, grip strength, joint score and the Lansbury’s index were observed. Improvement in 1-h eythrocyte sedimentation rate was observed at the 12-month assessment. IgG was decreased at the 12-month assessment. Obvious improvement in C-reactive protein was not seen through the trial. No abnormal findings were noted in routine blood tests. Adverse reactions of special note were skin eruption in one patient and digestive symptom in one patient. However, no serious adverse reactions were observed.

One-year clinical results with actarit—a preliminary report

The effectiveness and safety of 1-year treatment with actarit were evaluated in patients with rheumatoid arthritis. Treatment was continued for 1 year or longer in 18 of the 34 patients. Early improvement in morning stiffness, grip strength, joint score and the Lansbury’s index were observed. Improvement in 1-h eythrocyte sedimentation rate was observed at the 12-month assessment. IgG was decreased at the 12-month assessment. Obvious improvement in C-reactive protein was not seen through the trial. No abnormal findings were noted in routine blood tests. Adverse reactions of special note were skin eruption in one patient and digestive symptom in one patient. However, no serious adverse reactions were observed.

Effects of modulation of inflammatory and immune parameters in patients with rheumatic and inflammatory disease receiving dietary supplementation of n-3 and n-6 fatty acids.

To describe the rationale and status of n-3 and n-6 fatty acid dietary supplementation in patients with inflammatory disease. The most recent literature is reviewed with a focus on rheumatoid arthritis (RA) as most investigations have described the use of n-3 supplements in this disease entity. Investigations from Europe, the United States, and Australia have described consistent improvement in tender joint scores with many investigators also observing improvements in morning stiffness. A meta analysis has confirmed the predictable improvement in tender joints. Recent studies also suggest that some patients with RA are able to discontinue nonsteroidal antiinflammatory drugs (NSAIDs) while receiving n-3 fatty acids. A large number of peer reviewed publications from around the world have established the utility of dietary supplementation with n-3 fatty acids in reducing tender joint counts and morning stiffness in patients with RA. Some patients are also able to discontinue NSAIDs while on these supplements.

Cytokine and prostaglandin production by monocytes of volunteers and rheumatoid arthritis patients treated with dietary supplements of blackcurrant seed oil.

In this study, dietary supplements of blackcurrant seed oil (BCO) rich in the n-6 polyunsaturated fatty acid (PUFA) gamma-linolenic acid were fed to both RA patients and healthy volunteers with sunflower seed oil being fed to control subjects. A significant improvement in morning stiffness was noted in the RA patients receiving BCO. Monocytes were isolated from all subjects and cultured in the presence of lipopolysaccharide. It was observed that the production from the cultured monocytes of the cytokines IL-1 beta, TNF alpha and IL-6 as well as the prostaglandin PGE2 was markedly altered in those subjects given BCO. The results suggest that the numerous beneficial effects of PUFAs in inflammatory diseases such as RA may be due to a reduction in the secretion of the inflammatory cytokines IL-1 beta and TNF-alpha via redirection of eicosanoid metabolism although the possibility cannot be excluded that the PUFAs may be altering cytokine release directly through an effect on monocyte membranes.

Evaluation of a Filtration Lymphocytapheresis (LCP) Device for Use in the Treatment of Patients with Rheumatoid Arthritis

A practical on-line lymphocytapheresis (LCP) system using a leukapheresis filter (Cellsorba, Asahi Medical Co.) was evaluated in six patients with refractory rheumatoid arthritis. This filter consists of nonwoven fine polyester fiber wound around a porous cylinder. The blood was passed through the polyester fiber at a flow rate of 50 ml/min for 60 min. LCP was carried out once a week in the first month and biweekly in the next 2 months. An average of 98% of the leukocytes that entered the filter (1.27 x 10(10) cells) and 100% of the lymphocytes that entered the filter (3.66 x 10(9) cells) were removed in the first LCP. A total of 96.6% of the platelets and 2.7% of the erythrocytes that entered the filter were also removed. All of the patients showed clinical improvement in morning stiffness, Lansbury articular index, and functional capacity, with no adverse reaction. The number of circulating erythrocytes and platelets and the concentration of various serum components showed no significant change during the treatments. This LCP system required no fresh frozen plasma, albumin, or other blood transfusion. The number of circulating lymphocytes decreased to 65-70% of the pretreatment circulating lymphocyte count at the last procedure, with a decrease in the ratio of Leu3a positive cells to Leu2a positive cells. The proliferative response to phytohemagglutinin and concanavalin A was improved. These data suggest that LCP to remove approximately 3 x 10(9) lymphocytes once a week or biweekly has an immunomodulatory effect.

Therapeutic trial of cryofiltration in patients with rheumatoid arthritis

Cryofiltration, a new technique for on-line plasma separation and its treatment by cold filtration, enables the selective removal of immune complexes and eliminates the need for replacement proteins. Fifteen patients with rheumatoid arthritis were treated for nine to 10 consecutive sessions over a three- to five-week period. Circulating immune complexes decreased by an average of 78 percent and rheumatoid factor by 32 percent. This was accompanied by significant clinical improvement in morning stiffness, articular index, 50-foot walking time, grip strength, and target joint circumference. Cryofiltration might thus be beneficial for a subgroup of rheumatoid arthritis patients in whom conventional therapy has failed.

Stretch gloves. A study of objective and subjective effectiveness in arthritis of the hands.

AbstractThe effect of stretch gloves in treatment of arthritis affecting the hands was evaluated in 9 hospitalized and 14 ambulatory patients. Eighteen patients had rheumatoid arthritis, 2 had other forms of connective tissue disease, and 3 had degenerative joint disease. No statistically significant improvement in ring size, range of motion or grip strength was noted. Moderate or marked subjective improvement in morning stiffness and/or night pain was observed in 5 of 9 hospitalized patients, and in 7 of 14 ambulatory patients. It is suggested that stretch gloves provide a safe addition to the management of arthritis of the hands which will be effective to some degree in a majority of patients.