Pharmacological Modalities Research Articles

Comparative Study of Efficacy and Safety of Diacerein versus Acelofenac in Patient with Knee Osteoarthritis

Introduction: There are different pharmacological modalities currently in practice for the treatment of osteoarthritis knee. Broadly these are divided into anti-inflammatory drugs such as NSAIDs and symptomatic slow-acting drugs in osteoarthritis (SYSADOA). Diacerein, an anthraquinone derivative inhibits IL-1b and has been shown to significantly decrease the symptoms.Methods: This is open label, prospective comparative study. Total 40 patients were divided into two groups: group A (diacerein) and group B (aceclofenac) by alternate method. In group A diacerein was given 50mg orally for 1 week followed by 50 mg orally twice a day for 3 weeks. In group B aceclofenac 200 mg sustained release tablet was given orally once a day for 4 weeks. Outcomes were measured at the end of the treatment period i.e. at four weeks and after two weeks of discontinuation of treatment i.e. at 6 weeks.Results: Improvement is observed in both treatment groups in their baseline value in terms of efficacy parameters. Results of VAS and WOMAC scores were better in group B (aceclofenac). However intra-group analysis showed VAS scores and WOMAC scores significantly decreased in patients receiving diacerein as well. (p<0.05).Conclusion: Though not superior to the control drug, diacerein showed efficacy in terms of measurement by patient self-reported WOMAC and VAS scores for the treatment of Osteoarthritis knee.

An insight to pharmacological modalities for Covid-19: rationale and recommendations

The recent outbreak of COVID-19 pandemic has caused a havoc worldwide leading to high morbidity and mortality. A very high transmission rates and limited data available on the pathophysiology of the virus, poses a big challenge in the development of effective treatment options for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The purpose of this article is to provide a short and crisp review of the rationalia and recommendations on the use of multiple therapeutic options available at different scenarios of the disease development and progression. The treatment options approved by the USFDA and CDSCO are being discussed to be used in specific population set and disease severity. Furthermore, drugs authorized as EUA but not as standard treatment of care such as monoclonal antibodies are also discussed in the article. The future of the global pandemic depends on adequacy of the treatments options for all population groups in a cost-effective manner to minimize the mortality associated with the disease.

RNA-Targeting Splicing Modifiers: Drug Development and Screening Assays.

RNA splicing is an essential step in producing mature messenger RNA (mRNA) and other RNA species. Harnessing RNA splicing modifiers as a new pharmacological modality is promising for the treatment of diseases caused by aberrant splicing. This drug modality can be used for infectious diseases by disrupting the splicing of essential pathogenic genes. Several antisense oligonucleotide splicing modifiers were approved by the U.S. Food and Drug Administration (FDA) for the treatment of spinal muscular atrophy (SMA) and Duchenne muscular dystrophy (DMD). Recently, a small-molecule splicing modifier, risdiplam, was also approved for the treatment of SMA, highlighting small molecules as important warheads in the arsenal for regulating RNA splicing. The cellular targets of these approved drugs are all mRNA precursors (pre-mRNAs) in human cells. The development of novel RNA-targeting splicing modifiers can not only expand the scope of drug targets to include many previously considered “undruggable” genes but also enrich the chemical-genetic toolbox for basic biomedical research. In this review, we summarized known splicing modifiers, screening methods for novel splicing modifiers, and the chemical space occupied by the small-molecule splicing modifiers.

Atrial fibrillation during pregnancy: a9-month period with limited options.

Pregnancy is aphysiological condition with reversible hemodynamic, neurohormonal and coagulation changes to the maternal body during this 9‑month period. The occurrence of atrial fibrillation (AF) is altogether rare among pregnant women, but necessitates immediate treatment und further work-up. Despite numerous pharmacological and invasive therapeutic modalities for AF in non-pregnant patients, very few options are considered safe enough for the fetus and the mother during pregnancy. Commonly used medications such as beta blockers, calcium channel antagonists, antiarrhythmic drugs and anticoagulation therapy must be carefully individualized according to the week of gestation and possible underlying comorbidities of the mother, thus highlighting the importance of an interdisciplinary evaluation by acardiologist and agynecologist. The current review summarizes the existing knowledge and treatment options for AF in pregnancy and suggests asimplified algorithm for this clinical constellation.

PRESCRIPTION PATTERN AND FACTORS ASSOCIATED WITH THE CONTROL OF BLOOD PRESSURE AMONG HYPERTENSIVE PATIENTS RECEIVING CARE IN A NIGERIAN TERTIARY HOSPITAL

Objective: Despite the numerous Pharmacological and non-Pharmacological modalities available for the management of Hypertension, majority of the patients. The study aimed to identify the factors associated with the control of blood pressure among hypertensive patients receiving care in a Nigerian Tertiary Hospital. Design and method: The study was a retrospective cross sectional study carried out at the University of Nigeria Teaching Hospital Ituku/Ozalla, Enugu State Nigeria. A well Structured Pro-forma was used to extract variables from patient folders. These variables include Age, gender, marital status, religion, state of origin, educational level, occupation, age at first dose of antihypertensive, co-morbidities (diabetes, CKD), antihypertensive(s) used, duration of therapy, reasons for stopping (if stopped). Quantitative data was managed using Microsoft office excel and statistical product and services solution (SPSS) for windows. Continuous variables were expressed as mean ± SD and categorical variables as percentages with 95% confidence intervals. The students’t-test and the paired sample t-test were used to compare continuous variables while the pearson chi square test and fishers exact test will be used to compare categorical variables. All statistical test will be considered significant when the 2- sided p-value is <0.05. Results: Three hundred and Ninety patient Folders were used for the study. About 174 (42.4%) of the patients were male while 216 (52.7%) were female with a mean age of 62 years. Amlodipine with a frequency of 182 (64%) was the most prescribed antihypertensive in this study followed by losartan 182 (46.43%) and the least being atenolol and nebivolol with frequency of 4 (1.03%) each. 302 (94.4%) patients had hypertension and an existing comorbidity while 88(22.6%) had no comorbidities. The most common comorbidities were diabetes mellitus and chronic kidney disease. About 197 (50.3%) of the patients had their blood pressure under control while 193(49.7%) had uncontrolled blood pressure. Age, Monthly income, educational status and presence of comorbidity were the major predictors of uncontrolled blood pressure. Conclusions: Amlodipine was the most frequently prescribed antihypertensive. About half of the patient had their blood pressure uncontrolled. Age and monthly income were associated with uncontrolled blood pressure.

Special Considerations to Improve Clinical Outcomes in Patients with Osteoporosis Undergoing Spine Surgery.

Osteoporosis is a condition that is commonly encountered, with increasing diagnosis by the medical community with the aging population. Osteoporosis leaves patients susceptible to fragility fractures in the vertebrae and is also associated with degenerative changes, both of which may require intervention from a spine surgeon. The goal of this review is to concisely outline special nonoperative adjuncts, as well as preoperative, intraoperative, and postoperative considerations of osteoporotic patients undergoing spine intervention. A literature analysis was completed for this narrative review. A database search of PubMed and Google Scholar was conducted using "osteoporosis" combined with "spine," "spine surgery," and "spinal fusion" without exclusion based on publication date. Articles were screened to exclude duplicate articles and screened for their full text and English language availability. The database search yielded recent publications from which the narrative review was completed. Preoperatively, screening is traditionally completed with dual-energy x-ray absorptiometry (DEXA). Pharmacological therapy modalities currently include teriparatide, raloxifene, denosumab, bisphosphonates, and calcitonin. In order to prevent operative complications associated with osteoporosis, surgeons have found success in increasing the diameter and the length of pedicle screws, limiting pedicle tapping, achieving bicortical or even tricortical purchase, augmenting with polymethyl methacrylate, using iliosacral stabilization, preventing positive sagittal balance, and using adequate fusion products when necessary. Postoperatively, it is important to implant a care plan that includes adequate pain control and necessary care, and to understand risks associated with falls may increase risk of postoperative fragility fractures as well as instrumentation displacement. At this time there are no recommendations in regard to bracing in the postoperative setting. This review article outlines the most current evidence-based medicine with regard to considerations in spine surgery of the osteoporotic patient, and aims to bring about new questions to be investigated in that paradigm.

Control of Hemodynamic Responses and Perioperative Outcomes in Transsphenoidal Pituitary Surgery: A Qualitative Systematic Review of the Available Evidence.

Transnasal transsphenoidal (TNTS) pituitary surgery is associated with short-lived but intense nociceptive stimuli which cause substantial hemodynamic perturbations that may increase blood loss and impair visualization of the surgical field. This systematic review aimed to critically appraise the clinical evidence for the efficacy and safety of various anesthetic techniques, other pharmacological modalities, and supplementary interventions by assessing intraoperative systemic hemodynamics, use of adjunct medications, quality of the surgical field, intraoperative blood loss, and recovery profiles in patients undergoing TNTS pituitary surgery. Relevant randomized clinical trials and observational studies were identified in a systematic literature search; 16 studies (13 randomized clinical trials, 3 observational studies) enrolling a total of 907 patients were identified for inclusion in this review. Propofol provided more potent hemodynamic control compared with volatile anesthetics with a sparing effect on the need for additional drugs to blunt hemodynamic responses. Recovery profiles between propofol and sevoflurane were either equivalent or favored sevoflurane, but both agents were superior to isoflurane. Regarding intraoperative analgesia, remifentanil was associated with superior hemodynamic control and recovery profiles than fentanyl. Dexmedetomidine had beneficial effects on hemodynamics, surgical field quality, recovery characteristics, and nociceptive properties compared with placebo. Although there was no clear-cut superiority of other adjunct pharmacological modalities on hemodynamic responses during surgery, regional blocks were associated with beneficial impacts on both primary and secondary outcomes. In summary, short-acting anesthetics, analgesics and dexmedetomidine seem to improve intraoperative hemodynamics, blood loss, and recovery qualities during TNTS pituitary surgery. However, definitive conclusions cannot be drawn because of methodological heterogeneity in the identified studies.

111 - The Gastrointestinal Complexities of GvHD in the Pediatric HSCT Patient: A Case Study Discussing Pharmacologic and Nonpharmacologic Treatment Modalities

111 - The Gastrointestinal Complexities of GvHD in the Pediatric HSCT Patient: A Case Study Discussing Pharmacologic and Nonpharmacologic Treatment Modalities

Approach to psychotherapy in generalized anxiety disorder in the primary health care

Although medications have shown great efficacies in managing generalized anxiety disorder (GAD), recent evidence shows that patients tend to psychotherapy as their first-line of management due to the frequency of side effects resulting from the prolonged use of these medications. Psychotherapy is defined as the using certain and defined psychological modalities for the management of an emotional or mental illness on the condition that the aim and deadline of the therapy have been pre-determined. In this review, we present a brief about the psychological management of patients with GAD. We have identified three psychological modalities for the management of GAD as previous studies have compared them to the usual care by pharmacological modalities or a placebo. These include cognitive-behavioral (CBT), interpersonal, and supportive therapies. We found that management of GAD using CBT, interpersonal or supportive therapies is significantly efficacious in reducing GAD symptoms and increase the possibilities of recovery in addition to reducing the recovery or relapse rates. By doing this, we expect that the managed patient’s quality of life would be improved. We also recommend that the management approach should be case-sensitive for each patient depending on the patient’s status, the severity of the disease, and the responsiveness of the patient.

Targeted pharmacotherapy of irritable bowel syndrome.

Irritable bowel syndrome (IBS) is a highly prevalent functional gastrointestinal (GI) disorder with negative impact on quality of life and it represents a substantial economic burden on healthcare cost. The medical management of IBS is symptom directed. This review provides an update related to clinical trial data for novel treatment modalities in IBS targeting the gut epithelium secretagogue receptors and channels. The new Rome IV criteria define functional gastrointestinal disorders (FGID) as disorders of the gut-brain interaction. Pharmacological treatment modalities for IBS target gastrointestinal receptors and ion channels, peripheral opioid receptor, gut serotonin receptors, and the gut microbiome. New targeted pharmacotherapies have shown efficacy and safety in the treatment of patients with IBS. Diagnostic criteria for FGID, including IBS, have been revised in Rome IV and are defined as gut-brain disorders. Newly approved pharmacotherapy options with proven efficacy and acceptable side-effect profiles are available for the symptom-based management of IBS.

Fotokontrolisani PROTAC molekuli - struktura i mehanizam dejstva

Traditional drug discovery strategies are usually focused on occupancy of binding sites that directly affect functions of proteins. Hence, proteins that lack such binding sites are generally considered pharmacologically intractable. Modulators of protein activity, especially inhibitors, must be applied in appropriate dosage regimens that often lead to high systemic drug exposures in order to maintain sufficient protein inhibition in vivo. Consequently, there is a risk of undesirable off-target drug binding and side effects. Recently, PROteolysis TArgeting Chimera (PROTAC) technology has emerged as a new pharmacological modality that exploits PROTAC molecules for induced protein degradation. PROTAC molecule is a heterobifunctional structure consisting of a ligand that binds a protein of interest (POI), a ligand for recruiting an E3 ubiquitin ligase (an enzyme involved in the POI ubiquitination) and a linker that connects these two. After POI-PROTAC-E3 ubiquitin ligase ternary complex formation, the POI undergoes ubiquitination (an enzymatic post-translational modification in which ubiquitin is attached to the POI) and degradation. By merging the principles of photopharmacology and PROTAC technology, photocontrollable PROTACs for spatiotemporal control of induced protein degradation have recently emerged. The main advantage of photocontrollable over conventional PROTACs is the possible prevention of off-target toxicity thanks to local photoactivation.

COVID-19 treatment in children: A systematic review and meta-analysis.

Background:Exact information about the efficacy of various medications proposed by regulatory bodies in children with COVID-19 is limited due to the lack of controlled trials in the existing literature.Methods:Different electronic databases (MEDLINE, EMBASE, Web of Science, COCHRANE CENTRAL, LitCovid, medRxiv, and bioRxiv) were searched for articles describing the management of COVID-19 cases in children with 18 shortlisted medications. Prospective/retrospective studies/case series (with at least 20 cases) reporting COVID-19 in patients aged ≤14 years were searched to collect information regarding clinical details and severity of participants, medications used, and outcome. The pooled estimate of these parameters across studies was performed using a random-effect or fixed-effect meta-analysis depending on the degree of heterogeneity.Results:From a total of 5794 records, 97 studies/case series (8243 patients) fulfilled the eligibility criteria and were included in this systematic review. A total of 21% children received at least one medication specifically used for COVID-19. While antivirals were used in 15.3% of children, remedesivir was the most commonly used antiviral drug in 6.2% of included children without many reports of serious adverse effects. There was a more prevalent use of anti-inflammatory medications including corticosteroids (27.8%, P = 0.01). Total 91% of severe cases described in literature in children received some anti-inflammatory medications. Among them, corticosteroids (17%) and Intravenous immune globulin (IVIG) (17.5%) were the most predominant followed by interferon (4.2%), tocilizumab (1.5%), and anakinra (0.8%). The most predominant therapy among multisystem inflammatory syndrome in children (MIS-C) cases were IVIG (81%), followed by aspirin (67%), corticosteroids (64%), inotropes (62%), and anticoagulation (56%, mostly low molecular weight heparin, LMWH). Overall mortality was only 1.3%, but when we analyzed separately including only cases with moderate and severe disease, the mortality rate was 4.6%.Conclusion:Among pharmacological modalities, anti-inflammatory agents like corticosteroids and antivirals like remdesivir have the most promising evidence for severe cases of pediatric COVID-19. Intravenous immunoglobulin and other anti-inflammatory/immunomodulatory agents like anakinra, aspirin, and anticoagulants have important therapeutic role in cases with MIS-C. Most of the mild cases recover with conservative treatment only.

Funkcionalna dinamika proizvodnje biomarkera oštećenja miokarda tokom akutnog tretmana izoprenalinom kod pacova

Introduction: Isoprenaline or isoproterenol (1-(3,4-dihydroxyphenyl)-2-isopropylaminoethanolhydrochloride; ISO), a synthetic b-adrenergic agonist, can be used to establish myocardial ischemia, cardiotoxicity, necrosis and/or an experimental model of infarction in rats. Aim: Determination of the dynamics of myocardial injury biomarkers production of aspartate transaminase (AST), lactate dehydrogenase (LDH), creatine kinase (CK), and high-sensitive troponin T (hsTnT), with changes on electrocardiogram (ECG) parameters during the subcutaneous aplication of ISO in male Wistar rats. Material and methods: All animals (n = 23) were divided into two groups: control group (n = 11) treated with a saline solution, during two consecutive days (0,2 ml/kg b.m. daily, sc); and the ISO group (n = 12) treated with isoprenaline, during two consecutive days (85 mg/kg b.m. daily, sc). Blood was drawn from the rat tail vein in both groups, in order to determine serum activity levels of myocardial injury biomarkers, and an ECG (n = 6) was registered prior to the application, as well as 48h following the first dose of of saline solution or isoprenaline. Results: In comparison to the control group, in which no significant enzyme activities elevation (p > 0.05) nor ECG changes were registered, ISO group presented a significant rise of two clinically significant biomarkers of acute myocardial injury/myocardial infarction (AMI), CK (p = 0.05) and hsTnT (p < 0.01), as well as an ST segment elevation, with a patognomonic ECG change. Conclusion: Obtained results support previous studies, proving that isoprenaline represents an adequate experimental model for myocardial injury/AMI induction, and a "golden standard" for evaluating potential cardioprotective effects of pharmacological and non-pharmacological therapeutic modalities, with the ultimate goal of lowering the degree of lesions and improving post-infarction myocardium function.

Depression, Diagnostic Criteria, Explanatory Theories and Current Treatment Efficacy Compared

In the present, the nosological characterization of depression is approached, as an entity susceptible to clinical diagnosis, the semiotics of its symptomatological manifestations and pathognomonic signs are described, according to standardized criteria, to then illustrate the underlying processes that, according to different models explanatory, cognitive, and behavioral, account; of the genesis, development, and feedback mechanisms and maintenance of depressive clinical symptoms. Finally, a screening of controlled clinical trials is carried out, with treatment and control groups, where the variable to be measured was the differences or not, in the therapeutic results between cognitive and pharmacological treatment modalities of depression, regarding the prolongation of the effect, relapses and comparative improvement rates.

Intelligent Deep Brain Stimulation Systems: A General Review

Brain Stimulation is now becoming the preferred approach where pharmacological treatment is ineffective in neurological conditions such as Parkinson’s Disease (PD), Tourette Syndrome, Addiction disorder, Depression, and Anxiety. The brain can be stimulated by electrical current, light, and sound energy, invasively or non-invasively. The article comprises of pathophysiology in Parkinson’s, current pharmacological modalities used for the treatment (along with limitations), and deep brain stimulation as the last resort. The article also provides a comprehensive analysis of intelligent Deep Brain Stimulation methods (procedure, architecture, and type) from the studies and research conducted in the last five years. In the end, research gaps and associated challenges are discussed.

Ultrasound-guided radiofrequency ablation in a patient with resistant intercostal neuralgia secondary to chronic osteomyelitis of anterior end of ribs

Intercostal neuralgia is a complex painful disorder characterized by intense, sharp shooting, or burning pain, along the distribution of intercostal nerve. It is difficult to treat condition in which pharmacological modalities of treatment often fail. We report a case of a 56-year-old female with postoperative sternal wound infection, following coronary artery bypass grafting, involving the left costochondral junction and left anterior ends of 7th, 8th, and 9th ribs. She presented with severe excruciating pain over left T7, T8, and T9 dermatomes for 3 months. Conservative management failed to provide significant improvement in pain relief. Hence, intercostal nerve block was performed and it provided good pain relief for 3 weeks. It was then followed by radiofrequency ablation (RFA) that provided good symptomatic pain relief at 9-month follow-up. Thus, ultrasound-guided RFA can be effectively and safely used in patients suffering from resistant intercostal neuralgia for providing quick and long-term pain relief.

Cancer-related Fatigue in Patients with Oncological Diseases: Causes, Prevalence, Guidelines for Assessment and Management.

Fatigue and exhaustion are considered to be the most common complaints of patients with cancer during treatment and upon its completion. The manifestations of fatigue can be physical, cognitive, and emotional. The exact determinants of fatigue, however, are yet unknown. An initial literature review was conducted. Four reference databases were searched (MEDLINE, ELSEVIER - Science Direct, ELSEVIER - SCOPUS, Springer). The initial search yielded 430 articles. We included references consistent with the study design, pub-lished between 1993 and 2017, and written in English or German. The 48 remaining articles were assessed for relevance to the area by visually examining their titles for keywords: cancer-related fatigue, assesment, management. Cancer-related fatigue in cancer patients during treatment and in survivors is estimated to have a prevalence in the range of 58% to 90%. This report is a review of the literature relevant to the problem of fatigue in patients with oncological diseases - causes, prevalence, and impact on the lives of affected patients, proposing guidelines for assessment and management. A set of reliable tools have been presented for assessment and measurement of the burden of fatigue. The management strategies include a number of non-pharmacological methods: physically based therapies, psycho-educational and mind-body interventions, methods of managing sleep disorders, methods of increasing physical activity, and pharmacological modalities. Clarification of the causes for fatigue, its detection, a reliable assessment of its severity, the application of appropriate interventions for treatment and the necessary care could support the application of a differentiated approach.

The Role of the Gut Microbiota and the Immune System in the Development of Autism.

Autism‌ ‌spectrum‌ ‌disorders‌ ‌(ASDs)‌ ‌are‌ ‌neurodevelopmental‌ ‌disorders‌ ‌that‌ ‌present‌ ‌with‌ ‌social‌ skills‌ ‌and‌ ‌communication‌ ‌challenges,‌ ‌restricted‌ ‌interest,‌ ‌and‌ ‌repetitive‌ ‌behavior.‌ ‌The‌ ‌specific‌ cause ‌of‌ ‌autism‌ ‌is‌ ‌not‌ ‌well‌ ‌understood‌ ‌yet.‌ ‌However,‌ ‌numerous‌ ‌studies‌ ‌indicated‌ ‌that‌ ‌environmental‌ ‌and‌ ‌genetic‌ ‌factors,‌ ‌dysregulated‌ ‌immune‌ ‌response,‌ ‌and‌ ‌alterations‌ ‌to‌ ‌the‌ ‌balance‌ ‌and‌ ‌content‌ ‌of‌ ‌the‌ ‌gut‌ ‌microbiota‌ ‌are‌ ‌implemented‌ ‌in‌ ‌the‌ ‌development‌ ‌of‌ ‌autism.‌ ‌Many‌ ‌non-pharmacological‌ ‌interventions‌ ‌are‌ ‌nominated‌ ‌to‌ ‌manage ‌autism,‌ ‌including‌ ‌family‌ ‌support‌ ‌services‌ ‌and‌ ‌psychoeducational‌ ‌methods‌. Moreover,‌ ‌different‌ ‌pharmacological‌ ‌therapy‌ ‌modalities‌ ‌are‌ ‌recommended‌ ‌for‌ ‌children‌ ‌with‌ ‌ASD.‌ ‌Learning‌ ‌more‌ ‌about‌ ‌the‌ ‌brain,‌ ‌immune‌ ‌system, ‌and‌ ‌gut‌ ‌connections‌ ‌could‌ ‌assist‌ ‌in early‌ ‌diagnosis‌ ‌and‌ ‌treatment‌ ‌of‌ ‌this‌ ‌devastating‌ ‌neurodevelopmental‌ ‌disorders‌ ‌as‌ ‌an‌ ‌early‌ ‌intervention‌ ‌in‌ ‌ASD‌ ‌could‌ ‌improve‌ ‌a‌ ‌child's‌ ‌overall‌ ‌development.‌ We‌ ‌gathered‌ ‌data‌ ‌from‌ ‌relevant‌ ‌previously‌ ‌published‌ ‌articles‌ ‌on‌ ‌PubMed‌ ‌to‌ ‌evaluate ‌the‌ ‌role‌ ‌of‌ ‌the‌ ‌gut‌ ‌microbiota‌ ‌and‌ ‌the‌ ‌immune‌ ‌system‌ ‌on‌ ‌the‌ ‌development‌ ‌of‌ ‌autism.‌

Charting a New Path Towards Degrading Every Protein.

Strategies to directly alter protein abundance such as small-molecule-induced targeted protein degradation (TPD) are innovative pharmacological modalities with promising clinical potential. Herein, I describe my experience with the development of the degradation tag (dTAG) system, which is a chemical biology strategy to induce rapid and precise degradation of any target protein. Open-source collaborative discovery has been critical for advancing the versatility and accessibility of the dTAG system and will be necessary to understand the benefits and limits of TPD-based strategies in the clinic.

Pain and Neuropathic Pain in Rheumatic Diseases

AbstractPain is a challenge to rheumatologists. Not only patients with active arthritis but also patients with a good therapeutic response and even in remission complain of persistent joint pain. It has been proposed that a chronic pain stimulus may have a greater impact in a chronic inflammatory state, and the process towards a pain condition may be influenced by individual predisposition for development of chronic pain. In addition, features of peripheral pain processing may be exacerbated by inflammation, and disturbed pain processing may be a feature contributing to widespread pain. Furthermore, a neuropathic component may be part of the total pain experience of our patients. There are many different strategies of pain therapy in patients with rheumatic diseases, such as pharmacological and non- pharmacological modalities.