Clinical rheumatology
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Clinical rheumatology · Jan 2013
Review Case ReportsProgressive disseminated histoplasmosis in systemic lupus erythematosus-an unusual presentation of acute tenosynovitis and a literature review.
Progressive disseminated histoplasmosis is a disease where Histoplasma capsulatum affects multiple organs due to the inability of host cellular immunity to control the infection. Progressive disseminated histoplasmosis mainly involves the bone marrow, liver, and lungs. ⋯ This report highlights the point that H. capsulatum may present as focal lesions and a high level of suspicion is needed to make the diagnosis, especially in SLE patients. We specifically reviewed reported cases of progressive disseminated histoplasmosis in SLE patients, and a review of the literature is presented.
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Clinical rheumatology · Jan 2013
Does Behcet's disease associate with neuropathic pain syndrome and impaired well-being?
Previously peripheral neuropathy signs have been reported in inflammatory chronic diseases but the presence of neuropathic pain syndrome (NPS) in Behcet's disease (BD) is unclear. The aim of this study was to investigate the association of BD with NPS and impaired quality of life and sleep quality. A total of 111 patients diagnosed as BD and 52 healthy controls were included. ⋯ We observed a positive correlation between LANSS and VAS (rest and activity) scores (r = 0.44, r = 0.42 respectively). The NPS seems to be associated with BD which should be taken into consideration in patients with neuropathic signs. The quality of life (QoL) and quality of sleep of the patients with BD were found to be impaired and this may be due to the presence of NPS.
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Clinical rheumatology · Jan 2013
Cross-cultural adaptation and validation of the Spanish version of the Cumberland Ankle Instability Tool (CAIT): an instrument to assess unilateral chronic ankle instability.
The Cumberland Ankle Instability Tool (CAIT) is a valid instrument to determine the presence of chronic ankle instability (CAI) and to assess its severity. Self-report test is very useful for researchers and clinical practice, and CAI is a widespread tool. Nevertheless, there is lack of measurement instruments validated into Spanish, which represents a major difficulty for research dealing with a Spanish-speaking population. ⋯ Correlation with the 36-item Short-Form Health Survey (SF-36) physical component summary score (rho = 0.241, p = 0.012) was greater than the SF-36 mental component summary score (rho = -0.162, p = 0.094). The construct validity shows three different factors in the questionnaire and good responsiveness with a mean change of -2.43 (95 % CI = -3.12 to 1.73, p < 0.0001) and a size effect of Cohen's d = 1.07. The Spanish version of the CAIT has been shown to be a valid and reliable instrument for measuring chronic ankle instability and constitutes a useful instrument for the measurement of CAI in the clinical setting in Spain.
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Clinical rheumatology · Jan 2013
Randomized Controlled Trial Multicenter StudyA multicenter, randomized, double-blind clinical trial of combination therapy with Anbainuo, a novel recombinant human TNFRII:Fc fusion protein, plus methotrexate versus methotrexate alone or Anbainuo alone in Chinese patients with moderate to severe rheumatoid arthritis.
This study aims to evaluate the clinical and radiological efficacy as well as safety profiles of Anbainuo, a recombinant human TNFRII:Fc fusion protein, combined with methotrexate (MTX) versus MTX alone or Anbainuo alone in the treatment of Chinese patients with moderate to severe rheumatoid arthritis (RA). In this 24-week, multicenter, double-blind, active comparator-controlled study, 396 RA patients were randomized into combination therapy group (Anbainuo plus MTX), Anbainuo group, or MTX group. Clinical response was assessed using the American College of Rheumatology (ACR)-N, ACR20, ACR50, ACR70, and van der Heijde modification of Sharp score, among which ACR-N and ACR20 were defined as primary major endpoints. ⋯ The combination therapy group also showed significantly less radiographic progression than the MTX group (p = 0.03). The total adverse events (AE) in the combination group (40.9 %) was significantly higher than those in the MTX group (28.8 %) (p < 0.05). Anbainuo combined with MTX therapy can effectively control the disease activity and radiographic progression of RA, while the incidence of AE also increased compared to either Anbainuo or MTX.
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Clinical rheumatology · Jan 2013
Clinical TrialDysfunctional pain inhibition in patients with chronic whiplash-associated disorders: an experimental study.
Inefficient endogenous pain inhibition, in particular impaired conditioned pain modulation (CPM), may disturb central pain processing in patients with chronic whiplash-associated disorders (WAD). Previous studies revealed that abnormal central pain processing is responsible for a wide range of symptoms in patients with chronic WAD. Hence, the present study aimed at examining the functioning of descending pain inhibitory pathways, and in particular CPM, in patients with chronic WAD. ⋯ During heterotopic noxious conditioning stimulation, TS of pressure pain was significantly depleted among healthy controls. In contrast, TS was quite similar prior to and during cuff inflation in chronic WAD, providing evidence for dysfunctional CPM in patients with chronic WAD. The present study demonstrates a lack of endogenous pain inhibitory pathways, and in particularly CPM, in patients with chronic WAD, and hence provides additional evidence for the presence of central sensitization in chronic WAD.