Seminars in arthritis and rheumatism
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Semin. Arthritis Rheum. · Oct 2007
Comparative StudyThe impact of psychological functioning upon systemic sclerosis patients' quality of life.
To access health-related quality of life (HRQOL) in systemic sclerosis (SSc) patients using the World Health Organization Quality of Life Instrument, Short-Form (WHOQOL-BREF), and to identify the association between clinical, psychopathological, and personality parameters and SSc patients' HRQOL. ⋯ Impaired psychological functioning is associated with diminished HRQOL in SSc, and consequently, treatment of depressive symptoms should be considered a priority. Moreover, assessment of HRQOL should only be used in conjunction with specific psychological distress measurements, to detect the influence of psychopathology on HRQOL.
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Semin. Arthritis Rheum. · Oct 2007
Clinical TrialResponse-driven combination therapy with conventional disease-modifying antirheumatic drugs can achieve high response rates in early rheumatoid arthritis with minimal glucocorticoid and nonsteroidal anti-inflammatory drug use.
To assess the safety and efficacy of combination therapy in recent-onset rheumatoid arthritis (RA), with dose adjustments determined by response, in a clinic setting over 3 years. ⋯ This implementation study demonstrates the feasibility, safety, and efficacy of combination therapy with inexpensive DMARDs, fish oil, and minimal glucocorticoid use, in routine clinical practice using predefined rules for dosage adjustment.
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Semin. Arthritis Rheum. · Aug 2007
ReviewPercutaneous laser disc decompression for the treatment of lumbar disc herniation: a review.
Discontinuation of the marketing of chymodactin has reawakened interest in other percutaneous techniques for treating lumbar disc herniation. Developed in the 1980s, the concept of laser disc decompression is based on the percutaneous introduction of an optical fiber into the intervertebral disc and administering laser energy. The procedure allows for the vaporization of a small amount of the nucleus pulposus and hence a reduction in the intradisc pressure and relief of radicular pain. ⋯ Although the concept of laser disc nucleotomy is appealing, this treatment cannot be considered validated for disc herniation-associated radiculopathy resistant to medical treatment.
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Fibromyalgia (FM) is a syndrome characterized by chronic widespread pain, fatigue, disrupted sleep, depression, and physical deconditioning. In this article, we review the literature on the normal activity of the hypothalamic-pituitary-growth hormone-insulin-like growth factor-1 (HP-GH-IGF-1) axis and its perturbations in FM subjects. ⋯ These studies suggest that pituitary function is normal in FM and that reported changes in the HP-GH-IGF-1 axis are most likely hypothalamic in origin. The therapeutic efficacy of supplemental GH therapy in FM requires further study before any solid recommendations can be made.
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Semin. Arthritis Rheum. · Jun 2007
Case ReportsChurg-Strauss syndrome revealed by granulomatous acute pericarditis: two case reports and a review of the literature.
Churg-Strauss syndrome (CSS) is a necrotizing systemic vasculitis with extravascular granulomas and eosinophilic infiltrates of small vessels. CSS is usually revealed by nonspecific signs of necrotizing vasculitis in a context of late-onset asthma and blood eosinophilia. It is considered a systemic vasculitis with the highest prevalence of cardiac involvement and can lead to rapid-onset heart failure due to specific cardiomyopathy. Pericardial effusion may also occur during CSS and is usually well tolerated. ⋯ CSS may present as isolated cardiac tamponade. Whereas pericarditis with myocardial injury warrants immunosuppressive therapy, isolated pericarditis without other visceral involvement of poor prognosis only requires corticosteroid therapy.