Spa Group Research Articles

The Effectiveness of Physical Activity Intervention at School on BMI and Body Composition in Overweight Children: A Pilot Study

(1) Background: Overweight children usually have lower levels of physical activity (PA) than their normal-weight peers. Low PA predisposes to an increase in body fat mass. The aim of this study was to evaluate the effectiveness of school-based PA intervention on the anthropometric indicators and body composition of overweight and obese children during a two-year observation period, from the age of 10 to 12. (2) Materials and methods: The research included 148 children with overweight or obesity who were born in 2007. There were two groups of children with standard and elevated PA at school (SPA and EPA; 4 and 10 h of physical education lessons a week, respectively). Anthropometric and body composition measurements were carried out. Body mass index (BMI), fat mass (FM), fat-free mass (FFM), skeletal muscle mass (SMM), and total body water (TBW) were estimated. In total, five measurements were conducted at intervals of 5–6 months. (3) Results: In EPA group, the percentage of obese children decreased from 46% to 35.25%, and in SPA group, this percentage increased from 42.75% to 46%. Only 3.33% of children in the standard PA group (one child) and 17.2% in the elevated PA group (six children) changed their BMI and FM categories from overweight to normal body mass. In EPA children, FM decreased from 28.65% to 26.41%, and in SPA children, it increased from 30.31% to 31.75%. The highest increase in FFM was in EPA boys, while SPA boys recorded the highest decrease. In SPA children, SMM increased by 0.43% from 38.85% to 39.28%, and in EPA children, it increased by 2.51% from 40.27% to 42.78%. In EPA children, TBW slightly increased from 53.26% to 53.59%, and in SPA children, it decreased from 50.70% to 49.93%. (4) Conclusions: Elevated PA at school has a positive effect on the BMI and body composition of children who are overweight or obese. Increasing the mandatory number of physical education lessons in school curricula is an efficient strategy for reducing obesity in school-aged children.

Differences In The Effect Of Baby Massage And Baby Spa On The Growth And Motoric Development Of Infants Aged 3 - 6 Months At Pmb Cakung Kelurahan, Jakarta Timur

Background : The age of infants and toddlers is the golden age of the period of growth and development of a human being. To stimulate the growth and development of the baby, it is necessary to stimulate the baby. Baby massage and spa are activities to optimize the growth and development of babies. Research objective : to determine the effect of baby massage and baby spa on the growth and motoric development of babies aged 3 to 6 months. Research Methods : This study used a quasi-experimental and pretest and post-test design with a control group. The number of samples of infants aged 3-6 months was 60 babies, 20 babies for the baby massage group, 20 babies for the baby spa group (solus per aqua) and 20 babies who were not treated because their parents refused. The instruments used in this study were baby scales, tape measure and DDST II. Data analysis in this study was the Wilcoxon and Mann Whitney tests. The results of the study: There is an influence of baby massage and baby spa interventions on the growth and motor development of infants aged 3-6 months with p-Value = 0.000 (<0.05). The Mann Whitney test results obtained a p-value of 0.000 (p-value <0.05 at α = 5%), so that it can be concluded that there are differences in the growth and motor development of infants aged 3 to 6 months between the control group and the intervention group (who get baby massage and baby spa). Conclusions and suggestions : It is hoped that baby massage and baby spa can optimize baby growth and development. There is a difference in the effect of giving baby massage and baby spa on the growth and motoric development of infants aged 3-6 months. So that giving actions like this can be routinely carried out to maximize the growth and development of the baby.

Insidensi Bayi Berat Lahir Rendah pada Spektrum Plasenta Akreta di Rumah Sakit Dr Hasan Sadikin Bandung

Low birth weight (LBW) babies are closely related to infant morbidity, stunted growth and cognitive development, and chronic diseases. Placenta accreta spectrum (PAS) is a condition that complicates pregnancy and is closely related to low birth weight. Objectives: To determined the incidence of LBW in mothers with SPA at the hospital Dr. Hasan Sadikin Bandung. Methods: A descriptive observational study involving 71 cases of SPA in hospitals Dr. Hasan Sadikin Bandung, period 2016-2020, which has met the inclusion and exclusion criteria. SPA cases were divided into three groups: placenta accreta, increta, and percreta. In each SPA group, the incidence of LBW was evaluated. Results: 46.5% (33/71 cases of PAS) had low birth weight, while 53.5% (38/71 cases of PAS) had normal birth weight babies. The placenta accreta and percreta groups were dominated by normal birth weight infants [(18/31 cases), (5/9 cases)], while the placenta increta group was dominated by low birth weight infants (16/31 cases). The LBW category is divided into Extremely Low Birth Weight (ELBW), Very Low Birth Weight (VLBW), and LBW. In placenta accreta, there were 2 ELBW and VLBW infants, and 9 LBW infants. In the placenta increta, there are 3 ELBW and VLBW, and 10 LBW. In the placenta percreta, there were 1 ELBW and 3 LBW, while VLBW was not found in the placenta percreta. Conclusion: The incidence of LBW is found in almost half the population of SPA cases in hospitals. DR. Hasan Sadikin in the 2016-2020 period.Keywords: low birth weight, placenta accreta spectrum

Risk Factors, Radiological and Clinical Outcomes in Subclinical and Clinical Pituitary Apoplexy.

Pituitary apoplexy (PA) can be symptomatic, namely acute apoplexy (APA), or asymptomatic or subclinical (SPA). To describe the clinical characteristics and evolution of the patients with APA compared to SPA Patients and methods: Retrospective, longitudinal database analysis. We identified 58 patients with PA, and 37 accomplished the inclusion criteria (17 men, median age 47.7 years). A total of 29 (78.4%) had APA (17 underwent surgery, and 12 were conservatively managed), and 8 (21.6%) had SPA. The presence of non-functioning pituitary adenoma (NFPA) odds ratio (OR): 29.36 (95% confidence interval (CI): 1.86-462.36) and the largest size OR 1.10 (95% CI: 1.01-1.2) elevated the risk of having surgery. Hypopituitarism developed in 35.1% without significant differences between APA and SPA. In non-surgical patients, adenoma volume shrunk spontaneously at one year magnetic resonance imaging (MRI), without statistical differences between the conservatively treated and SPA group. APA is more frequent in larger NFPAs, and this subset of patients has a higher risk of surgery. Hypopituitarism is quite frequent even in patients with SPA, and, therefore, long-term follow-up is mandatory. In the non-surgical group, the pituitary tumour shrinkage is clinically relevant after one year of PA. Consequently, surgery indication in NFPA should be delayed and reassessed if patients remain asymptomatic.

The impact of spinal anaesthesia on perioperative opioid consumption, postoperative pain and oncological outcome in radical retropubic prostatectomy—a retrospective before-and-after effectiveness study

BackgroundSpinal anaesthesia preceding general anaesthesia has been conducted for open radical retropubic prostatectomy (RRP) to decrease immediate postoperative pain for many years. Nevertheless, the effectiveness of spinal anaesthesia to reduce postoperative opioid requirements remains unknown. The aim of the present study was to determine the effect of spinal anaesthesia preceding general anaesthesia on opioid requirements, postoperative pain and biochemical cancer-free survival.MethodsThis before-and-after effectiveness study investigated effects of two different anaesthesia techniques in 636 patients with RRP. Three hundred eighteen consecutive patients in the SPA group (spinal anaesthesia preceding general anaesthesia) were compared with 318 patients in the GA group (general anaesthesia alone). The primary endpoint of the study was opioid consumption in the post-anaesthesia care unit. Secondary endpoints were intraoperative opioid consumption, postoperative pain, postoperative recovery time, the length of hospital-stay, persistence of pain 1 year after surgery and cancer-free survival. Differences between the groups were analysed by a two-sided t-test, χ2-test, Fisher’s exact test and Mann–Whitney U test and the influence of possible confounders on opioid consumption with a general linear model. Cancer-free survival was determined by Kaplan–Meier curves and group differences by log-rank tests and multivariable Cox regression analyses.ResultsThe total amount of morphine equivalent administered postoperatively was 7.5 [6.9; 8.1] mg in the SPA group and 6.0 [5.5; 6.5] mg in the GA group (mean [95% CI], p < 0.001). The amount of intraoperative sufentanil was 56.9 [55.1; 58.7] μg in the SPA group and 84.5 [82.5; 86.5] μg in the GA group (mean [95% CI], p < 0.001). There was no difference found in the postoperative pain level, length of hospital-stay and pain level 1 year after surgery. Biochemical cancer-free survival was highly related to TNM stage (p < 0.001, pT3 vs. pT2 hazard ratio 5.4 [95%CI 3.3; 9.2]) but not to the type of anaesthesia (p = 0.29).ConclusionsSpinal anaesthesia preceding general anaesthesia for RRP is associated with increased postoperative opioid consumption compared to general anaesthesia alone. Postoperative pain level and the oncological outcome are not affected by the adjunctive use of spinal anaesthesia. Thus, the addition of spinal anaesthesia to general anaesthesia has no advantage in RRP.Trial registrationClinicalTrial.gov, NCT03565705.

Effects of complex spa therapy in patients with osteoarthritis of the spine receiving treatments in health resorts in south-eastern Poland

Management of patients with degenerative diseases commonly comprises health-resort based treatment programs, including spa therapies, balneotherapy as well as terrain therapy making use of microclimate factors. The study was designed to assess short- and long-term effects of spa therapy administered to patients with osteoarthritis of the spine who received treatment in health resorts located in Poland. The study involved 102 patients receiving treatment in health resorts, a group of subjects receiving outpatient treatment (100 patients) and a group receiving no therapy (100 patients). The assessment survey included: Pain VAS and Laitinen, LISAT-9 and HAQ-20 questionnaires. The assessments were carried out three times: at the start of the therapy program, as well as one month and six months after the end of the program. Short-term effects showed statistically significant improvement in all the outcome measures in spa group and outpatient treatment group. The long-term effects showed statistically significant improvement in all the outcome measures in spa group only. In conclusion spa therapy reduces pain, improves functional efficiency and increases the level of life satisfaction in patients with osteoarthritis of the spine. Its effects are sustained for at least six months. Spa therapy is more effective long-term, than outpatient treatment.Trial registration: The study was registered at Clinical Trials: NCT03974308. First registration: 04/06/2019.

Clinical implications of panic attack in Chinese patients with somatoform disorders

ObjectiveSomatoform disorders are frequently accompanied by panic attack and causes many clinical symptoms. This study aimed to compare clinical features between patients with and without panic attack in somatoform disorder. MethodsIn this cross-sectional study, 341 patients with somatoform disorder according to the MINI-International Neuropsychiatric Interview (M.I.N·I.) were divided into two groups depending on with or without comorbidity of a panic attack, somatoform disorder with a panic attack (SPA, n = 88) and those without panic attack (SNPA, n = 253). Patient Health Questionnaire (PHQ-15), Patient Health Questionnaire (PHQ-9) and 7-item Generalized Anxiety Disorder (GAD-7) scale was used to identify correlations between SPA group and SNPA group, respectively. Correlation analysis and multivariate regression analysis were used to determine the effects of demographic factors and psychiatric diagnoses on somatic, depressive and anxiety symptoms separately. ResultsThe SPA group's PHQ-15, PHQ-9 and GAD-7 scores were significantly higher than those of the SNPA group. Multiple linear regression analyses revealed that the associated factors for PHQ-15 were gender and panic disorder. PHQ-9 was just significantly associated with panic disorder. GAD-7 was significantly associated with education degree and panic disorder. ConclusionsOur results suggest that somatoform disorder patients with panic attack suffered more severe clinical symptoms than those without a panic attack.

PERBANDINGAN BUERGER ALLEN EXERCISE DENGAN FOOT SPA DIABETIC TERHADAP NILAI ANKLE BRACHIAL INDEX PADA PASIEN DIABETES MELITUS TIPE II

Hyperglycemia is one of the problems of Diabetes Mellitus patients. Hyperglycemia that is not well controlled can cause many complications, one of which is interference with the flow of peripheral blood vessels that can cause diabetic ulcers. Vascularity disorders can be prevented with Buerger Allen Exercise therapy and Diabetic Foot Spa to increase the value of ABI. The purpose of this study was to compare the effectiveness of Buerger Allen Exercise therapy and Diabetic Foot Spa to the value of ABI in patients with type II diabetes mellitus. The design of this study was Quasi Experiment Pre and post test two groups with 15 group A respondents given Buerger Allen Exercise intervention and 15 group B respondents given Diabetic Foot Spa intervention. The results showed that there was an increase in the value of ABI after intervention in both groups with the difference in the increase in the Buerger Allen Exercise group by 0.050 while the Diabetic Foot Spa group by 0.113. The conclusion of this study is that there was an increase in ABI values in both groups after the intervention but the Diabetic Foot Spa group had a higher increase. Diabetic Foot Spa can be recommended as an alternative therapy as prevention of peripheral arterial disease complications.

Genetic Relatedness and Diversity of Staphylococcus aureus from Different Reservoirs: Humans and Animals of Livestock, Poultry, Zoo, and Aquaculture.

The main aim of this study was the characterization of antibiotic resistance mechanisms in 82 Staphylococcus aureus strains isolated from humans and animals. Antibiotic susceptibility testing was performed on all S. aureus isolates accordingly, and antibiotic-resistant genes were investigated by genotypic methods. The genetic diversity of S. aureus was studied through spa, multilocus sequence typing (MLST), and agr typing methods. The majority of S. aureus from human sources were resistant to cefoxitin (and harbor the mecA gene) and fluoroquinolones, whereas only four strains of S. aureus from animal sources revealed resistance to ciprofloxacin. In the set of S. aureus isolated from humans, the most frequent spa, MLST, and agr group were t032, ST22, and I, respectively. In strains from animal origin the most common spa, MLST, and agr group found were t2383, ST398, and III/not typable, respectively. S. aureus from humans and animals were identified either in clonal complexes CC5, CC30, and CC398, suggesting that they have the same putative founder in their evolution. Considering the three CCs encompassing strains from human and animal reservoirs with different spa-types, we can hypothesize that this might reflect an adaptation to different phylogenetic lineages in those reservoirs (host species) probably associated to genetic diversification of pre-existing strains.

Metabolic Syndrome and Cardiovascular Diseases in Seronegative Spondyloarthropathy and Rheumatoid Arthritis Patients: A Comparative Study

Background: Spondyloarthritis (SpA) and rheumatoid arthritis (RA) are ones of the most rheumatic diseases with chronic inflammatory damaging processes that have a great risk for metabolic syndrome (MS) and cardiovascular diseases. Several studies have indicated higher cardiovascular disease (CVD) risk and mortality rates among these patients compared to the general population. Objective: To identify the prevalence and early detection of metabolic syndrome and cardiovascular disease in seronegative spondyloarthropathy and rheumatoid arthritis patients and their relation to disease activity. Patients and Methods: Our study was carried out on sixty rheumatoid arthritis patients (54 female and 6 males with mean age 46.7 ± 5.5 years) and sixty spondyloarthroapathy patients (27 female and 33 males with mean age 44.9 ± 5.9 years). Results: In RA group, there were 23 patients (38.3%) with metabolic syndrome and 37 patients (61.7%) without metabolic syndrome. In SPA group, there were 21 patients (35%) with metabolic syndrome and 39 patients (65%) without metabolic syndrome. There was no statistical significant difference (p-value > 0.05) between studied groups as regards metabolic syndrome prevalence. There was high statistical significant difference (p-value < 0.001) between patients with MS and patients without MS in RA group regarding age, duration, BMI, FBS, ESR, CRP and DAS28. High statistical significant difference (p-value < 0.001) was detected between patients with MS and patients without MS in SPA group as regards duration, BMI, FBS and BASDI. There was increase in cIMT in RA (0.8 ± 0.2) and SPA groups (0.7 ± 0.1) with high statistical significant difference (p-value < 0.001). Conclusion: MS prevalence increased in patients with RA and SPA, whereas the cardiovascular risks increased in RA patients. The disease activity of both were associated with metabolic syndrome, implicating the role of chronic inflammation in metabolic syndrome development.

Does a Surgical Post-Acute Unit Help Elders With Rib Fractures? Definitely Maybe!

A surgical post-acute treatment unit (SPA) was developed for acutely injured elderly patients who no longer warranted acute care in an intensive care setting to decrease complications by focusing increased bedside attention to cognition, nutrition, respiration, and mobilization. A retrospective review was performed comparing patients 65 years and older with isolated rib fractures treated before the SPA was opened with patients treated in the SPA. The 2 populations were comparable except the SPA group had a higher mean Injury Severity Score. Nine complications occurred in the pre-SPA group, and no complications occurred in the SPA patient population. Four patients in the pre-SPA group died compared with zero deaths for the SPA group. The rates of complications and mortality between elderly patients with isolated rib fractures were not statistically different between patients treated with a traditional admission to an inpatient ward and patients admitted to the SPA, even though the SPA patients had significantly more severe chest injuries. Establishing a physical environment to support the needs of elderly trauma patients with isolated rib fractures who no longer need the intensive care unit (ICU) is effective in decreasing the complications and unplanned returns to the ICU.

The effects of inpatient versus outpatient spa therapy on pain, anxiety, and quality of life in elderly patients with generalized osteoarthritis: a pilot study.

This study aimed to investigate the effect of inpatient vs outpatient spa therapy on pain, quality of life, and anxiety in elderly patients with generalized osteoarthritis. A total of 150 patients were randomized into three groups. Group I was given medical treatment, group II was treated as outpatients, and group III was treated as inpatient spa therapy. Assessments were made using the Pain (VAS), EQ-5D-3L Scale, and State and Trait Anxiety Inventory (STAI) at the beginning of treatment (W0), at the end of treatment (W2), and at the fourth week after treatment (W6). The comparison of outpatient spa group and etodolac treatment group showed that outpatient spa group was superior to etodolac treatment group in all evaluated parameters at W2 vs W0 and W6 vs W0. The comparison of inpatient spa group and etodolac treatment group showed that inpatient spa group was superior to etodolac treatment group in all evaluated parameters at W2 vs W0 and W6 vs W0. The comparison of inpatient spa group and outpatient spa group showed that inpatient spa group was superior to outpatient spa group in all evaluated parameters except STAI-TXII at W2 vs W0 and in all evaluated parameters W6 vs W0. Spa therapy, either as an outpatient or inpatient basis, may have a positive effect on pain, anxiety, and quality of life in geriatric patients with generalized osteoarthritis. The inpatient spa therapy may be more beneficial than outpatient spa therapy. When the side effects of drug treatments are emphasized, spa therapy may be considered as an interesting option for elderly with osteoarthritis.

PENGARUH CITRA MEREK TERHADAP MINAT BELI WISATAWAN PADA KOMANEKA RESORTS &amp; SPA GROUP DI KAWASAN PARIWISATA UBUD, GIANYAR

The growth of Ubud district as famous tourist destination in Gianyar regency implies a tight competition in hotel industry at this area to capt potential markets, especially foreign tourists. To take a strategic market advantages, hotel industry in Ubud Area supposed to relies on product’s attibut function and brand image. Recently, hotel industry recognized “brand” as a very important asset that can attract potential customer’ purchase intention. Customer recognized brand as not just name, sign or symbol, but brand is a promises, prestiges, social status, or values of hotel supposed to give their customers features, benefits, and services. This study aimed to explore the impact of Brand Image on tourist’ purchase intention at Komaneka Resorts &amp; Spa group which consists of Komaneka at Monkey Forest, Komaneka at Tanggayuda, Komaneka at Bisma, and Komaneka at Rasa Sayang, Ubud. The methodology applied at this study is symple regression model with SPSS 17.00. This methodology was chosen because this study assumed “brand” influenced tourist intention to purchase.The findings of this study was there’s a significant impact of brand image on purchase intention at Komaneka Resorts &amp; Spa Group, Ubud, Gianyar with R Squared 0,616. This means 61,6 % of tourist’s purchase intention influenced by brand image, and 38,4 % influenced by others factors.This study recommend hotel managers to develop and improve their hotel’s brand image to grap strategic market position.

Spa therapy together with supervised self-mobilisation improves pain, function and quality of life in patients with chronic shoulder pain: a single-blind randomised controlled trial

To determine whether spa therapy has a beneficial effect on pain and disability in patients with chronic shoulder pain, this single-blind randomised controlled clinical trial included patients with chronic shoulder pain due to miscellaneous conditions attending one of four spa centres as outpatients. Patients were randomised into two groups: spa therapy (18 days of standardised treatment combining thermal therapy together with supervised mobilisation in a thermal pool) and controls (spa therapy delayed for 6 months: ‘immediate versus delayed treatment’ paradigm). All patients continued usual treatments during the 6-month follow-up period. The main endpoint was the mean change in the French-Quick DASH (F-QD) score at 6 months. The effect size of spa therapy was calculated, and the proportion of patients reaching minimal clinically important improvement (MCII) was compared. Secondary endpoints were the mean change in SF-36, treatment use and tolerance. One hundred eighty-six patients were included (94 patients as controls, 92 in the spa group) and analysed by intention to treat. At 6 months, the mean change in the F-QD score was statistically significantly greater among spa therapy patients than controls (− 32.6 versus − 8.15%; p < 0.001) with an effect size of 1.32 (95%CI: 0.97–1.68). A significantly greater proportion of spa therapy patients reached MCII (59.3 versus 17.9%). Spa therapy was well tolerated with a significant impact on SF-36 components but not on drug intake. Spa therapy provided a statistically significant benefit on pain, function and quality of life in patients with chronic shoulder pain after 6 months compared with usual care.

Spa therapy in rheumatoid arthritis: a crossover trial

Objective: This study aims to investigate whether 2-week spa therapy, as an adjunct to usual pharmacological therapy, has any beneficial effect in patients with rheumatoid arthritis (RA). Methods: In this single-blind crossover study, 50 patients were randomly assigned in a 1:1 manner to receive usual pharmacological therapy plus 2-week spa therapy or usual pharmacological therapy alone (period 1.6 months); after a 9-month washout, patients were crossed over to the opposite assignment (period 2.6 months). Spa therapy program included a daily saline balneotherapy session at 36– 37 °C for 20 min except Sundays. The clinical outcomes were evaluated at baseline, after spa therapy (2 weeks) and 3 and 6 months after the spa therapy in both period and were pain (Visual Analogue Scale (VAS)), patient and physician global assessments (VAS), Health Assessment Questionnaire (HAQ), and Disease Activity Score (DAS28). Results: Spa therapy was superior to control therapy in improving all the assessed clinical outcomes at the end of the spa therapy. This superiority persisted significantly in physician global assessment (p = 0.010) and with a trend in favor of spa group in patient global assessment (p = 0.058), function (p = 0.092), and disease activity (p = 0.098) at 3 months. Statistically significant improvements were found in spa therapy compared to control in disease activity (p = 0.006) and patient (p = 0.020) and physician global (p = 0.011) assessments, and a trend toward improvements in pain (p = 0.069) and swollen joints (p = 0.070) at 6 months. Conclusion: A 2-week spa therapy adjunct to usual pharmacological therapy provided beneficial clinical effects compared to usual pharmacological therapy alone, in RA patients treated with traditional disease-modifying antirheumatic drugs. These beneficial effects lasted for 6 months.

Spa therapy adjunct to pharmacotherapy is beneficial in rheumatoid arthritis: a crossover randomized controlled trial.

This study aims to investigate whether 2-week spa therapy, as an adjunct to usual pharmacological therapy, has any beneficial effect in patients with rheumatoid arthritis (RA). In this single-blind crossover study, 50 patients were randomly assigned in a 1:1 manner to receive usual pharmacological therapy plus 2-week spa therapy or usual pharmacological therapy alone (period 1.6months); after a 9-month washout, patients were crossed over to the opposite assignment (period 2.6months). Spa therapy program included a daily saline balneotherapy session at 36-37°C for 20min except Sundays. The clinical outcomes were evaluated at baseline, after spa therapy (2weeks) and 3 and 6months after the spa therapy in both period and were pain (Visual Analogue Scale (VAS)), patient and physician global assessments (VAS), Health Assessment Questionnaire (HAQ), and Disease Activity Score (DAS28). Spa therapy was superior to control therapy in improving all the assessed clinical outcomes at the end of the spa therapy. This superiority persisted significantly in physician global assessment (p=0.010) and with a trend in favor of spa group in patient global assessment (p=0.058), function (p=0.092), and disease activity (p=0.098) at 3months. Statistically significant improvements were found in spa therapy compared to control in disease activity (p=0.006) and patient (p=0.020) and physician global (p=0.011) assessments, and a trend toward improvements in pain (p=0.069) and swollen joints (p=0.070) at 6months. A 2-week spa therapy adjunct to usual pharmacological therapy provided beneficial clinical effects compared to usual pharmacological therapy alone, in RA patients treated with traditional disease-modifying antirheumatic drugs. These beneficial effects may last for 6months.

Performance and agreement between classification criteria and rheumatologist's diagnosis of the most widely used SpA classification criteria in a Colombian group of patients with chronic low back pain

Abstract Objective To evaluate the performance of the most widely used SpA classification criteria in a Colombian group of patients with chronic low back pain. Methods We assessed the ASAS and the European Spondyloarthropathy Study Group (ESSG) classification criteria in a group of 133 patients who attended consecutively over a period of six months at outpatient clinic of low back pain. All the patients were evaluated with the same protocol. The patients were divided into two groups according to the diagnosis. The diagnosis was compared with the diagnosis made by a expert rheumatologist blinded to patient information. Results 81 patients with SpA and 52 with other diagnoses were included. There were no differences in age and age of onset of symptoms between the two groups. The SpA group included 55 males and more common clinical findings were: enthesitis, arthritis, sacroiliitis, HLA-B27-positive, previous infection, and dactylitis. The sensitivity and specificity of criteria were: ASAS criteria 96% of sensibility and 80% of specificity, and ESSG criteria 95% and 100% respectively. The agreement between the classification criteria and the diagnosis established by the rheumatologist showed a Cohen's kappa index of 0.938 for ESSG criteria (95% CI: 0.877–0.998) and 0.790 for the ASAS criteria (95% CI: 0.682–0.898). Conclusion In a Colombian group of SpA patients, the new ASAS classification criteria have a good concordance with clinical diagnosis but are not superior to the ESSG criteria.

Performance and agreement between classification criteria and rheumatologist's diagnosis of the most widely used SpA classification criteria in a Colombian group of patients with chronic low back pain

ObjectiveTo evaluate the performance of the most widely used SpA classification criteria in a Colombian group of patients with chronic low back pain. MethodsWe assessed the ASAS and the European Spondyloarthropathy Study Group (ESSG) classification criteria in a group of 133 patients who attended consecutively over a period of six months at outpatient clinic of low back pain. All the patients were evaluated with the same protocol. The patients were divided into two groups according to the diagnosis. The diagnosis was compared with the diagnosis made by a expert rheumatologist blinded to patient information. Results81 patients with SpA and 52 with other diagnoses were included. There were no differences in age and age of onset of symptoms between the two groups. The SpA group included 55 males and more common clinical findings were: enthesitis, arthritis, sacroiliitis, HLA-B27-positive, previous infection, and dactylitis. The sensitivity and specificity of criteria were: ASAS criteria 96% of sensibility and 80% of specificity, and ESSG criteria 95% and 100% respectively.The agreement between the classification criteria and the diagnosis established by the rheumatologist showed a Cohen's kappa index of 0.938 for ESSG criteria (95% CI: 0.877–0.998) and 0.790 for the ASAS criteria (95% CI: 0.682–0.898). ConclusionIn a Colombian group of SpA patients, the new ASAS classification criteria have a good concordance with clinical diagnosis but are not superior to the ESSG criteria.

Real-life experience of using conventional disease-modifying anti-rheumatic drugs (DMARDs) in psoriatic arthritis (PsA). Retrospective analysis of the efficacy of methotrexate, sulfasalazine, and leflunomide in PsA in comparison to spondyloarthritides other than PsA and literature review of the use of conventional DMARDs in PsA.

With the aim of assessing the response to treatment with conventional disease-modifying anti-rheumatic drugs (DMARDs) used in patients with psoriatic arthritis (PsA), data on methotrexate, sulfasalazine (SSZ), and leflunomide were analyzed from baseline and subsequent follow-up (FU) questionnaires completed by patients with either PsA or other spondyloarthritides (SpAs). A single-center real-life retrospective analysis was performed by obtaining clinical data via questionnaires administered before and after treatment. The indices used were erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) level, Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Bath Ankylosing Spondylitis Function Index (BASFI), wellbeing (WB), and treatment effect (TxE). The indices measured at baseline were compared with those measured on one occasion in a FU visit at least 1 year later. A total of 73 patients, 51 with PsA (mean age 49.8±12.8 years; male-to-female ratio [M:F]=18:33) and 22 with other SpAs (mean age 50.6±16 years; M:F=2:20), were studied. BASDAI, BASFI, and WB displayed consistent improvements during FU assessments in both PsA patients and controls in comparison to baseline values. SSZ exhibited better efficacy as confirmed by TxE in both PsA patients and controls. ESR and CRP displayed no differences in either the PsA or the SpA group between the cases before and after treatment. Real-life retrospective analysis of three DMARDs used in PsA (and SpAs other than PsA) demonstrated that all three DMARDs that were used brought about improvements in BASDAI, BASFI, TxE, and WB. However, the greatest improvements at FU were seen with SSZ use in both PsA and control cohorts.

Effect of spa therapy with saline balneotherapy on oxidant/antioxidant status in patients with rheumatoid arthritis: a single-blind randomized controlled trial.

Oxidative stress has been shown to play a contributory role in the pathogenesis of rheumatoid arthritis (RA). Recent studies have provided evidence for antioxidant properties of spa therapy. The purpose of this study is to investigate whether spa therapy with saline balneotherapy has any influence on the oxidant/antioxidant status in patients with RA and to assess clinical effects of spa therapy. In this investigator-blind randomized controlled trial, we randomly assigned 50 patients in a 1:1 ratio to spa therapy plus standard drug treatment (spa group) or standard drug treatment alone (control group). Spa group followed a 2-week course of spa therapy regimen consisting of a total of 12 balneotherapy sessions in a thermal mineral water pool at 36-37°C for 20min every day except Sunday. All clinical and biochemical parameters were assessed at baseline and after spa therapy (2weeks). The clinical parameters were pain intensity, patient global assessment, physician global assessment, Health Assessment Questionnaire disability index (HAQ-DI), Disease Activity Score for 28-joints based on erythrocyte sedimentation rate (DAS28-4[ESR]). Oxidative status parameters were malondialdehyde (MDA), nonenzymatic superoxide radical scavenger activity (NSSA), antioxidant potential (AOP), and superoxide dismutase (SOD). The NSSA levels were increased significantly in the spa group (p=0.003) but not in the control group (p=0.509); and there was a trend in favor of spa therapy for improvements in NSSA levels compared to control (p=0.091). Significant clinical improvement was found in the spa group compared to the control in terms of patient global assessment (p=0.011), physician global assessment (p=0.043), function (HAQ-DI) (p=0.037), disease activity (DAS28-4[ESR]) (0.044) and swollen joint count (0.009), and a trend toward improvement in pain scores (0.057). Spa therapy with saline balneotherapy exerts antioxidant effect in patients with RA as reflected by the increase in NSSA levels after spa therapy; whether this antioxidant effect contributes to the clinical improvements observed remains to be verified.