Symptoms Of Rheumatic Diseases Research Articles

Patient Perception of Depressive Symptoms in Rheumatic Diseases: A Cross-sectional Survey.

The presented study aimed to explore the presence and the self-identification of depressive symptoms among patients with rheumatic musculoskeletal diseases (RMDs) through the use of the Patient Health Questionnaire (PHQ-9). Between June and October 2019, patients from the regional association for people with RMDs in Lombardy, Italy (ALOMAR), were invited to participate in a cross-sectional online survey. Participants completed PHQ-9 along with a survey about their perception of depressive symptoms. Patients were stratified according to PHQ-9 score as follows: not depressed (<4), subclinical or mild depression (5-9), moderate depression (10-14), moderately severe depression (10-14), and severe depression (20-27). Descriptive statistics and analyses of variance were used to explore data. Of the 192 RMD patients who completed PHQ-9, 35 (18.2%) were not depressed, 68 (35.4%) had subclinical or mild depression, 42 (21.9%) had moderate depression, 30 (15.6%) had moderately severe depression, and 17 (8.9%) had severe depression. Contrary to the above findings, only 16 respondents (8.3%) reported that they experienced depressive symptoms, and only 7 of the 16 were being followed by a psychiatrist. Respondents with higher PHQ-9 scores tended to have concomitant fibromyalgia, to be younger, and to be overweight. The current results indicate the overall burden of depressive symptoms in RMD patients. While clinical depression (PHQ-9 >10) was detected in 41.2% of respondents, only 8.3% reported that they experience depressive symptoms. Routine screening of RMD patients for depression is therefore critical.

Headache in rheumatic diseases

Headaches are a common, but under-recognized symptom of rheumatic diseases. They can result from intracranial (inflammation, thrombosis, etc.) or extracranial pathology, such as irritation, or degeneration of anatomically related structures such as the eyes, neck, and sinuses. In addition, patients with rheumatologic disorders have the same tendencies as the general population to develop primary headaches. While the latter are benign in nature, the former type of headaches may signal disease manifestation, progression, or complication. Information on headache syndromes related to rheumatologic disorders as well as understanding of underlying disease processes and mechanisms is important. This will help to improve diagnostics and treatment of rheumatic diseases.

Metabolomic analysis of biochemical changes in the tissue and urine of proteoglycan-induced spondylitis in mice after treatment with moxibustion

BackgroundMoxibustion is widely used in East Asian countries to manage the symptom of rheumatic diseases. The aim of this study was to identify potential metabolic profiles of moxibustion on relieving ankylosing spondylitis (AS) mice through UHPLC-Q-TOF/MS metabolomic study. MethodsThirty-two female Balb/c mice were randomized into healthy control (HC), AS model, moxibustion at acupuncture points (MA) in AS model, and moxibustion at non-acupuncture points (MNA) AS model groups. Moxibustion was administered daily at GV4, bilateral BL23 and bilateral ST36 acupuncture points for four weeks in the MA group. The overall health status, the thickness of hind paws and the tissue concentrations of IL-1β, PGE2, IL-6 and TNF-α were assessed. The UHPLC-Q-TOF/MS was used to explore the perturbations of endogenous metabolites in tissue and urine of AS model mice intervened by moxibustion. ResultsCompared with the AS group, the overall health status was significantly improved after 4-week moxibustion intervention (p<0.05). The results also showed that MA significantly reduced the levels of paw thickness and decreased the levels of four cytokines in the tissue (p<0.01). Thirty-seven endogenous metabolites identified by the OPLS-DA were considered to be contributing to therapeutic effects of moxibustion. Moreover, metabolic pathway analysis further revealed that the identified metabolites were mainly involved in TCA cycle, Lipid metabolism, Amino Acid metabolism, Intestinal flora metabolism and Purine metabolism. ConclusionsUHPLC-Q-TOF/MS based metabolomics approach, as a novel and powerful tool, can help us to gain the insights into potential mechanisms of action of moxibustion for AS.

Pain without inflammation in rheumatic diseases.

Chronic pain is a common symptom in rheumatic diseases, and the patient with pain and no signs of inflammation poses a challenge to the physician. Notably, all rheumatic diseases have components of non-inflammatory pain and a higher prevalence of fibromyalgia compared to the overall population. Hypothetically, a chronic pain stimulus may have stronger 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, the features of peripheral and central pain processing may be exacerbated by inflammation, and disturbed pain processing may be a feature contributing to widespread pain. We herein review and describe the prevalence of chronic pain and different pain modalities in the most common rheumatic diseases. In addition, the background mechanisms of non-inflammatory pain in rheumatic diseases are discussed. Finally, we here review the current strategies for pain management, with a special focus on non-inflammatory pain. The key message is that pain management should be individualized and based on a thorough pain analysis with investigation of the pain modality, localization and pain intensity. Other factors to consider are the underlying rheumatic disease and treatment, the patient's mental and physical health status and psychological factors.

Panniculitis: rheumatological aspects

Different types of panniculitis (Pn) can be one of the symptoms of rheumatic diseases (RDs). Pn is a group of heterogeneous inflammatory diseases that are characterized by subcutaneous adipose tissue (SAT) lesion and often occur with musculoskeletal and visceral involvements. There is no single concept of the etiology and pathogenesis of Pn. Infections, injures, hormonal and immune disorders, drug intake, pancreatic disease, malignant neoplasms, etc. can play a role in the development of Pn. The latter is associated with RDs in a fairly large group of patients. There have recently been reports of about 200 and 50 cases of only idiopathic lobular Pn in the world and Russian literature, respectively. There have also been publications on other types of Pn, such as erythema nodosum, eosinophilic fasciitis, superficial migratory thrombophlebitis, lupus Pn, dermatomyositis Pn, scleroderma systematica, gout, psoriatic arthritis, etc. There is now a need to study skin changes and SAT lesions in the context of RDs, which will be able to estimate the true clinical and prognostic value of Pn in RDs. Based on recent literature data, this review characterizes the main types of Pn, their clinical and histological signs, and diagnostic methods.

Chronic Pain in Inflammatory Arthritis: Mechanisms, Metrology, and Emerging Targets-A Focus on the JAK-STAT Pathway.

Chronic pain is nowadays considered not only the mainstay symptom of rheumatic diseases but also “a disease itself.” Pain is a multidimensional phenomenon, and in inflammatory arthritis, it derives from multiple mechanisms, involving both synovitis (release of a great number of cytokines) and peripheral and central pain-processing mechanisms (sensitization). In the last years, the JAK-STAT pathway has been recognized as a pivotal component both in the inflammatory process and in pain amplification in the central nervous system. This paper provides a summary on pain in inflammatory arthritis, from pathogenesis to clinimetric instruments and treatment, with a focus on the JAK-STAT pathway.

Diagnostic delays in rheumatic diseases with associated arthritis.

ObjectiveThe objective of this study was to determine the length of delay in diagnosis of inflammatory rheumatic diseases, and to indicate the main factors responsible for such delays.Material and methodsA retrospective multi-centre questionnaire survey carried out among 197 patients with diagnosed inflammatory rheumatic diseases or undergoing the diagnostic process.ResultsThe most common early symptoms of inflammatory rheumatic disease included joint pain (94%), joint swelling (78%), morning joint stiffness (77%), fatigue (76%), and sleep disturbed by joint pain (74%). When asked about the reasons for seeking medical help, most patients indicated intensification of the symptoms (89%) and the fact that the symptoms made them unable to perform daily activities or work (86%). Limited access to specialists (70%) and the conviction that the symptoms will resolve spontaneously (57%) had the biggest impact on delaying a visit to a doctor. Before visiting a rheumatologist, the patients consulted their symptoms with their general practitioners (GPs, 95%), orthopaedicians (43%), and neurologists (29%). Almost half of the patients (48%) consulted their symptoms with at least 2 non-rheumatologists, whereas as many as 21% of patients visited 4 or more specialists. After the onset of symptoms of rheumatic disease, 28% of patients delayed seeing any doctor for 4 months or longer. 36% of patients waited 4 months or longer for a referral to a rheumatologist. The great majority of the patients (85%) made an appointment with a rheumatologist within a month of receiving a referral. 25% of patients waited 4 months or longer to see a rheumatologist.ConclusionsDiagnostic delays result from both the level of patients’ awareness (ignoring early symptoms) and improper functioning of the health care system. In the case of the health care system, the source of delays is not only “queues to rheumatologists”, but also referring patients to non-rheumatologists.

Signs and symptoms of rheumatic diseases as first manifestation of pediatric cancer: diagnosis and prognosis implications

ObjectiveTo assess the prevalence and describe the clinical, laboratory and radiological findings, treatment and outcome of children with cancer initially referred to a tertiary outpatient pediatric rheumatology clinic. MethodsRetrospective analysis of medical records from patients identified in a list of 250 new patients attending the tertiary Pediatric Rheumatology Clinic, Ribeirão Preto Medical School hospital, University of São Paulo, from July 2013 to July 2015, whose final diagnosis was cancer. ResultsOf 250 patients seen during the study period, 5 (2%) had a cancer diagnosis. Among them, 80% had constitutional symptoms, especially weight loss and asthenia, and 60% had arthritis. Initially, all patients had at least one alteration in their blood count, lactate dehydrogenase was increased in 80% and a bone marrow smear was conclusive in 60% of patients. Bone and intestine biopsies were necessary for the diagnosis in 2 patients. JIA was the most common initial diagnosis. The definitive diagnosis was acute lymphoblastic leukemia (2 patients), M3 acute myeloid leukemia, lymphoma, and neuroblastoma (one case each). Of 5 patients studied, 3 (60%) are in remission and 2 (40%) died, one of them with prior use of steroids. ConclusionThe constitutional and musculoskeletal symptoms common to rheumatic and neoplastic diseases can delay the diagnosis and consequently worsen the prognosis of neoplasms. Initial blood count and bone marrow smear may be normal in the initial framework of neoplasms. Thus, the clinical follow-up of these cases becomes imperative and the treatment, mainly with corticosteroids, should be delayed until diagnostic definition.

Efficacy of radiation synovectomy (radiosynovectomy or radiosynoviorthesis) with yttrium-90 in exudative inflammation of synovial membrane of knee joints in patients with rheumatic diseases - preliminary report.

ObjectivesHypertrophic and exudative synovitis of the knee is one of the earliest symptoms in rheumatic diseases. In the case of pharmacotherapy failure, other methods which directly remove the inflamed synovial membrane are used – synovectomies. Radiosynovectomy (RSV) is the radiopharmaceutical application of colloidal solution to joint cavities. In this study, the authors assessed the efficacy of knee radiosynovectomy with yttrium-90 (Y-90) in several groups of patients divided into certain rheumatic diseases.Material and methodsThe study group consisted of 70 patients aged from 29 to 65 years with hypertrophic and exudative synovitis of the knee in rheumatic diseases such as rheumatoid arthritis, osteoarthrosis and spondyloarthropathies. Radiopharmaceutical colloid of Y-90, with a radiation dose of 185-222 MBq in a volume of 2-3 ml, was administered to joint. Then the knee joint was immobilized for 72 h. During visits V1, V2, V3 and V4, erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) were measured and ultrasound of the knee was performed. Disease activity was evaluated by the WOMAC scale, HAQ and 100-mm visual analog scale (VAS).ResultsThe most significant difference of synovial hypertrophy, before and after the procedure, was obtained in patients with rheumatoid arthritis. Variability of effusion before and after the procedure in all groups was comparable and statistically significant. The greatest improvement in variability of inflammatory parameters, before and 4 weeks after radiosynovectomy, was observed in patients with rheumatoid arthritis.ConclusionsIn the therapeutic algorithm radiosynovectomy should be located between conservative treatment and operative procedures. Radiosynovectomy does not require hospitalization or prolonged rehabilitation. Radiosynoviorthesis affects the patient's general condition, which is associated with eliminating pain and restoring joint function.

CHARACTERISTICS OF CORONARY ATHEROSCLEROSIS IN PATIENTS WITH RHEUMATOID ARTHRITIS

Purpose of this study was examination of the features of coronary vessels in patients with rheumatoid arthritis (RA) using CT angiography. Materials and Methods: results of CT angiographic studies of 60 patients with varying degrees of coronary vessels pathology were retrospectively analyzed. 27 of them had a history of RA. The control group included 33 patients who had no medical history and clinical symptoms of rheumatic disease. The degree of calcification of the coronary arteries was calculated according to the Agatston degree. Processing of the results was carried out on Excel and Statistica 6.0. Results: The study found that coronary calcification in the control group patients averaged 289, and in patients with RA 305 HU (p <0.05). In addition, the dependence of the Agatston degree, patient's age, smoking and diabetes history was revealed. Conclusions: comparing to the control group coronary calcification was higher in patients with rheumatoid arthritis. A direct correlation between the value of the calcification index and RA activity, as well as risk factors such as age, smoking, and diabetes was revealed.

Computer aided erosions and osteophytes detection based on hand radiographs

In this paper we present a computer system to detect erosions and osteophytes from hand radiographs, the most common symptoms of rheumatic diseases. The designed, implemented and verified algorithm uses techniques of image processing, image analysis and pattern recognition. In the stages of image processing and image analysis, the locations of metacarpal bones, the outlines of finger bones, the locations and outlines of joints and finally the borders of joint surfaces are identified. In the pattern recognition stage, a shape description language is used for each border of the joint surface to detect the locations of erosions and osteophytes on hand radiographs. The presented algorithm expands on those known from the literature, because besides erosions it also detects osteophytes. Moreover, in contrast to previous systems, it analyses proximal interphalangeal joints and distal interphalangeal joints. The obtained results are satisfactory and very promising. The joints are successfully located in 98.3% of cases. The average mean distance between the borders pointed out by radiologists and obtained from the system varies between 0.094mm and 0.157mm, while the sensitivity and the specificity equal around 70% in most of the cases. Therefore, it can become a basis for the diagnosis of certain diseases.

ASSESSMENT OF RISK FOR GASTROINTESTINAL AND CARDIOVASCULAR COMPLICATIONS ASSOCIATED WITH THE USE OF NONSTEROIDAL ANTI-INFLAMMATORY DRUGS IN THE CIS POPULATION: PRELIMINARY DATA OF THE CORONA-2 EPIDEMIOLOGICAL SURVEY

Nonsteroidal anti-inflammatory drugs (NSAIDs) are able to effectively control the major symptoms of rheumatic diseases and widely used in real clinical practice. However, they may cause serious gastrointestinal (GI) and cardiovascular (CV) events. The prevention of these events is based on the estimation of whether risk factors (RFs) are present. Objective: to estimate the presence of RFs in patients needing NSAIDs. Subjects and methods . A cross-sectional epidemiological survey was performed, during which 2021 physicians from 9 CIS countries questioned for 2 weeks at least 10 patients needing NSAIDs. The inclusion criterion was severe musculoskeletal pain (>40 mm on a 100-mm visual analogue scale (VAS)) or use of NSAIDs at the examination. Data were obtained on 21,185 patients (57.5% women and 42.5% men) (mean age 50.5±14.1 years) who had predominantly dorsalgia (56.6%) and osteoarthritis (23.5%). The mean pain value was 62.2±25.2 mm. Results. 1.7, 11.3, and 25.3% of patients had history of gastrointestinal bleeding, ulcer, or dyspepsia, respectively; people over 65 years of age constituted 16.8%; those who took low-dose aspirin (LDA) – 20.0%. The total number of patients at high risk for GI events was 29.0%. There were also common CV RFs: myocardial infarction or stroke (7.8%), coronary heart disease (17.8%), hypertension (37.7%), and diabetes mellitus (8.1%). The total number of patients at high risk for CV events (without SCOR assessment) was 23.0%. Many high-risk patients who has already used NSAIDs received no effective prevention. Thus, 62.2% of the patients at high GI risk took gastroprotective drugs; 53.2% of those at high CV risk used LDA. Conclusion. A large number of patients needing active analgesic therapy have a serious risk for drug-induced complications. This limits the possibility of using NSAIDs and determines the need for effective prevention or use of alternative methods for analgesia.

AB0730 Evaluation of Neuropathic Pain in A Spondyloarthritis Cohort

BackgroundPain is the most common symptom in rheumatic diseases. Its physiopathology generally involves a disturbance in nociceptive perception by tissue damage that often evolves to central pain with features of...

AB1032 The Frequency of Risk Factors of Complications Associated with Nsaids: Cross-Sectional Study

BackgroundNSAIDs are effective for control of the main symptoms of rheumatic diseases (RD) and they are widely used in clinical practice. However, NSAIDs can cause serious gastrointestinal (GI) and cardiovascular...

A7.6 Neuropathic pain in rheumatic diseases: a cross-sectional study

IntroductionPain is the most common symptom in rheumatic diseases. In its pathophysiology there is usually a disturbance in nociceptive perception by tissue damage, that evolve often to features of central...

Tactile sensitivity on the hands skin in rheumatic patients.

IntroductionClinical symptoms of rheumatic diseases can cause changes in the level of skin tactile sensitivity.AimTo determine the tactile threshold of the hands in female patients with rheumatic diseases. It also attempted to determine correlations between rheumatic patients’ tactile sensitivity and the degree of articular movement limitations, the Barthel Index (BI) and Edinburgh Handedness Inventory (EHI) results, the level of disability of the right hand and the left hand as well as age, education and eyesight.Material and methodsNinety-nine female rheumatic patients aged 19–87 years took part in the study. The control group comprised 45 healthy women aged 23–80 years. The measurement of the tactile threshold was performed using the Touch-Test™ Sensory Evaluators (Semmes-Weinstein Monofilaments Test). The tactile threshold was measured at three sites on the hand: the little finger, the index finger and the metacarpus.ResultsThe patients’ tactile sensitivity ranges were classified as normal, diminished light touch and diminished protective touch. The degree of their disability was correlated with tactile sensitivity. The patients’ tactile sensitivity worsens with age, but it is not correlated with the level of education. The lateralization was similar to that of the control group and was not correlated with tactile sensitivity. The worsening eyesight, independent of rheumatic disease, corresponds, however, with decreasing tactile sensitivity.ConclusionsThe patients represented a group with a medium level of functional disability and lower tactile sensitivity.

OP0010-PARE “life with a secret” – successful campaign designed by young rheumatics

BackgroundAn international exchange for rheumatic young people took place in Estonia in the summer of 2011 and included 50 participants from 8 countries. During the exchange, we conducted a survey...

Anti-inflammatory activities of Chinese herbal medicine sinomenine and Liang Miao San on tumor necrosis factor-α-activated human fibroblast-like synoviocytes in rheumatoid arthritis

Sinomenine, an alkaloid isolated from the root of Sinomenium acutum, has been used to alleviate the symptoms of rheumatic diseases. Liang Miao San (LMS), composed of the herbs Rhizoma Atractylodis (Cangzhu) and Cotex Phellodendri (Huangbai), is another traditional Chinese medicine formula for rheumatoid arthritis (RA) treatment. Although numerous studies have demonstrated the potential anti-inflammatory activities of sinomenine and LMS, the underlying intracellular mechanisms regulating the anti-inflammatory activities of sinomenine and LMS on human primary fibroblast-like synoviocytes (FLS) from RA patients and normal control subjects have not been elucidated. We investigated the in vitro anti-inflammatory activity of sinomenine and LMS on inflammatory cytokine tumor necrosis factor (TNF)-α-mediated activation of human normal and RA-FLS. The underlying intracellular signaling molecules were analyzed quantitatively using flow cytometry. Sinomenine was found to significantly inhibit TNF-α induced cell surface expression of vascular cell adhesion molecule (VCAM)-1 and release of inflammatory cytokine and chemokine IL-6, CCL2 and CXCL8 from both normal and RA-FLS (all p<0.05). Moreover, the suppression of sinomenine on TNF-α induced VCAM-1 expression and IL-6 release of RA-FLS was significantly higher than that of normal FLS (p<0.05). LMS significantly inhibited TNF-α-induced inflammatory chemokines CXCL10 and CCL5 release from both normal and RA-FLS, with significantly higher suppression on CXCL10 secretion in RA-FLS than that of normal FLS (all p<0.05). Further investigations showed that sinomenine and LMS could significantly suppress TNF-α-induced phosphorylation of inhibitor κBα and extracellular signal-regulated protein kinase, the central signaling molecules mediating TNF-α-induced VCAM-1 expression and chemokine production. Our results therefore provide a new insight into the differential anti-inflammatory activities of sinomenine and LMS through the suppression of TNF-α-activated FLS by modulating distinct intracellular signaling pathways in RA.

Activation of Central Pain Pathways in Rheumatic Diseases: What We have Learned from Functional Neuroimaging Studies

Pain is a major symptom in rheumatic diseases. Understanding the nature of patients pain symptoms in a rheumatology setting is integral to their assessment and optimising care. In recent years we have increasingly come to appreciate that not only is pain dependent on the underlying pathological process, but is also influenced by a number of additional factors that include genetics, the environment of the individual, previous pain experience and psychological status. Although local inflammation in the joint leads to the release of pro-inflammatory mediators including prostaglandins and cytokines that activate nociceptive signals in the joint, recent work has suggested that central activation of the brain is also important in mediating chronic pain in a number of rheumatic conditions including rheumatoid arthritis, fibromyalgia, osteoarthritis and back pain. A number of imaging modalities have been utilized in recent years to gain a deeper understanding of the pathways involved in the perception of pain in the rheumatic diseases. Functional Magnetic Resonance Imaging (fMRI), has been used to assess how the brain responds to and also mediates pain in the presence of arthritic disease. Positron emission tomography (PET) and Single photon emission computed tomography (SPECT) can produce blood flow images of the brain, or with the appropriate choice of radiopharmaceutical can also be used to image metabolic activity or specific neuroreceptors. Magnetoencephalography (MEG) can map cortical brain activity with high temporal resolution. These techniques have shown altered regional cerebral blood flow in areas of the brain in rheumatoid arthritis and fibromyalgia and have been used to determine pathways implicated in the perception of pain in specific conditions including complex regional pain syndrome and fibromyalgia. The information gained from functional imaging studies has improved our understanding of pain perception in rheumatic diseases and so may aid a more effective treatment for pain as will be discussed further in this review.

Rheumatic manifestations of sleep disorders

We have long assumed that rheumatic pain causes sleep problems, fatigue, and functional disability. This paper reviews the accumulating evidence from human and animal experimental research studies that show a bidirectional relationship of disordered sleep to pain and fatigue. The studies demonstrate that both disturbances of sleep and sleep restriction result in increased sensitivity to noxious stimuli and musculoskeletal pain symptoms. The notion of central nervous system hypersensitivity affecting widespread pain in patients with fibromyalgia syndrome is the result of a reduction in neurophysiologic inhibition of perception of noxious stimuli that is provoked by disordered sleep. Clinical and epidemiological studies show that sleep disturbances directly influence musculoskeletal pain, fatigue, mood, and overall well-being. Indeed, the interrelationships of the sleeping/waking brain with cytokine and cellular immune functions have important implications for the understanding of rheumatic disease pathology and management with disease-modifying antirheumatic drugs. The determination of how disordered sleep affects musculoskeletal pain, fatigue, mood, and behavior is important in the assessment and management of patients with rheumatic illness. The high prevalence of obstructive sleep apnea and restless legs syndromes requires more research to determine whether treatments of these sleep disorders will benefit the symptoms of rheumatic diseases.