Seminars in arthritis and rheumatism
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Semin. Arthritis Rheum. · Aug 2005
ReviewRole of the growth hormone/insulin-like growth factor-1 paracrine axis in rheumatic diseases.
Hypothalamic-pituitary axis abnormalities have been associated with systemic disturbances in several rheumatic diseases. Longitudinal analysis of erythrocyte, serum, urinary and synovial fluid growth hormone (GH), insulin-like growth factor-1 (IGF-1), and somatostatin levels could provide important surrogate measures of disease activity in rheumatic diseases. ⋯ The results of these analyses support the view that some rheumatic diseases such as OA and diffuse idiopathic skeletal hyperostosis, heretofore considered to be purely focal and degenerative, could be reclassified as systemic metabolic disturbances. We propose that serum GH, IGF-1, and somatostatin levels be monitored on a longitudinal basis during the course of medical therapy of rheumatic diseases to determine the extent to which changes in clinical symptoms (exemplified by reduced pain and inflammation and improved range of joint motion) are accompanied by changes in the basal concentration of these hypothalamic/pituitary-related hormones.
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Semin. Arthritis Rheum. · Aug 2005
Multicenter StudyDo physicians treat symptomatic osteoarthritis patients properly? Results of the AMICA experience.
The main objective of the AMICA project was to photograph the Italian scenario of osteoarthritis (OA) and its treatment in general and specialty practice. The study was designed to evaluate their prescription modalities to determine whether they matched the recently proposed treatment guidelines for OA (ACR 2000; EULAR 2000; APS 2002). ⋯ The published guidelines appear to be properly used by most of the physicians in terms of the pharmacological approach; however, the increased use of Coxibs has not reduced the amount of prescribed gastroprotection. No specific precautions were observed in the treatment of patients with hypertension or cardiac problems. Nonpharmacological treatments are mainly used in conjunction with medications and did not take into account the findings of evidence-based medicine. Continuing education of GPs and specialists caring for OA patients is essential.
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Semin. Arthritis Rheum. · Aug 2005
Multicenter StudyClinical presentation of osteoarthritis in general practice: determinants of pain in Italian patients in the AMICA study.
To assess the clinical characteristics and determinants of pain observed by general practitioners (GPs) in Italian patients with osteoarthritis (OA) of the hand, hip, and knee. ⋯ The results of this study underscore the major impact of OA on care in general practice, the high frequency of OA-associated comorbidities, and the role of different risk factors in OA pain.
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Semin. Arthritis Rheum. · Aug 2005
Multicenter StudyThe characteristics of symptomatic osteoarthritis in general and specialist practice in Italy: design and methods of the AMICA Study.
The diagnostic and clinical approach to osteoarthritis (OA) of the hand, knee, and hip in general practice and specialist practice in Italy as determined by the AMICA project. ⋯ This large data set reveals the attitudes of Italian GPs and specialists toward the diagnosis and treatment of OA of the hand, knee, and hip.
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Semin. Arthritis Rheum. · Aug 2005
Comorbid conditions in the AMICA study patients: effects on the quality of life and drug prescriptions by general practitioners and specialists.
Osteoarthritis (OA) has been identified as the disease with the highest rate of comorbidities, which may increase the likelihood of disability. The AMICA study evaluated how the presence of a coexistent disease and/or its chronic pharmacological treatment influenced the prescription of pharmacological and nonpharmacological therapy in patients with OA. ⋯ Comorbidities decrease the quality of life and worsen the joint function in OA patients. Comorbidities and their treatment generally do not influence the physician's choice of OA treatment, with the exception of peptic ulcer and anticoagulant therapy, both of which were associated with a reduction in the prescription of antiinflammatory drugs. There was a preferential use of Coxibs in patients with peptic ulcer, and an underuse of gastroprotective measures in OA patients treated with NSAIDs.