Clinical rheumatology
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Clinical rheumatology · Oct 2015
Retention of the second-line biologic disease-modifying antirheumatic drugs in patients with rheumatoid arthritis failing one tumor necrosis factor alpha inhibitor: data from the BioRx.si registry.
This study aimed to investigate the retention of the second-line biologic disease-modifying antirheumatic drugs (bDMARDs) in rheumatoid arthritis patients failing their first tumor necrosis factor alpha inhibitor (TNFi). Data was extracted from the Slovenian registry (BioRx.si) on December 15, 2012. Baseline patient characteristics were compared between second-line TNFi and non-TNFi, and potential confounders were identified by the means of binary logistic regression. ⋯ There appears to be a statistically significant retention advantage of the non-TNFi over the second-line TNFi (log rank test, p = 0.000). This advantage is retained even after taking into account the possible effect of confounders which was tested using the inverse probability-weighted Cox model [hazard ratio (HR) 4.39; 95 % confidence interval (CI) 2.62-8.01, p < 0.001]. After the first-line TNFi's failure, a second-line TNFi is more likely to fail earlier than non-TNFi.
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Clinical rheumatology · Aug 2015
Randomized Controlled TrialCombined glucosamine and chondroitin sulfate, once or three times daily, provides clinically relevant analgesia in knee osteoarthritis.
We compared the analgesic efficacy and safety of glucosamine sulfate (GS) and chondroitin sulfate (CS) capsules or sachet preparations with glucosamine hydrochloride (GH) and CS capsules in knee osteoarthritis (OA) patients. 1,120 subjects with radiographic knee OA (Kellgren/Lawrence 2-3) were randomized (1:1:1) at 16 centers to receive GS 500 mg/CS 400 mg three times daily capsules (GI) or once daily sachet (GII) or GH 500 mg/CS 400 mg three times daily (GIII) for a 16-week trial. Primary outcome, intention-to-treat (ITT) was change from baseline of patient reported pain intensity (0-100 mm visual analogue scale) in the affected knee and variation of Lequesne's index (LI). Monthly secondary outcomes were changes from baseline in patient reported pain and LI, patient and physician global assessments of disease activity, acetaminophen consumption, and adherence. ⋯ Patients that did not complete the study were 77 (44.8 %) for lack of adherence, 16 (9.3 %) consent withdrawal, 11 (6.4 %) adverse events, eight (4.7 %) lost to follow-up, and 17 (9.9 %) for other causes. Non-inferiority analysis found no differences among groups. This is a large study showing that GS/CS and GH/CS provide clinically meaningful and sustained analgesia in knee OA regardless of dose fractionation and capsule or sachet formulations.
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Clinical rheumatology · Aug 2015
Is it necessary to strictly diagnose fibromyalgia syndrome in patients with chronic widespread pain?
The applicability of the American College of Rheumatology (ACR) 1990 and 2010 criteria for the diagnosis of fibromyalgia syndrome (FMS) was determined in 284 patients with chronic widespread pain (CWP) including those with regional and systemic painful disorders. On the basis of initial evaluation, patients were classified into three groups. Group 1, those without any comorbid disease (N = 105), group 2, those having regional non-inflammatory painful disorders (N = 104), and group 3, those with a diagnosis of an inflammatory rheumatic disease (N = 75). ⋯ The findings of the study support the suggestion that FMS is just a continuum of CWP, rather than a distinct diagnostic entity. As treatment of FMS is usually identical with that of CWP, strict diagnosis of FMS will provide little or no significance from the viewpoint of clinical practice. We suggest that future research should be directed toward classification of CWP to provide guidance to clinicians in selecting effective therapies.
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Clinical rheumatology · Jun 2015
Observational StudyImpact of musculoskeletal pain on health-related quality of life among fishing sector workers.
This study aims to determine the impact of musculoskeletal pain (in terms of intensity of the pain, location and functional disability due to back pain) and other factors (socio-demographic, lifestyle and co-morbidity) on the health-related quality of life on a group of shellfish gatherers. This observational transversal study included 929 shellfish gatherers (18-69 years, 98.7 % women) who completed a self-administered questionnaire, including socio-demographic and lifestyle questions, co-morbidity, intensity and location of musculoskeletal pain, and Roland-Morris Disability Questionnaire (RMDQ). Health-related quality of life was assessed using the 36-item Short Form Survey (SF-36). ⋯ The sample had significantly lower values than the reference population in all of the dimensions of the SF-36. Intensity of the pain, pain in the hip-knee, lower back pain, functional disability due to back pain and number of locations with musculoskeletal pain were found to have a detrimental impact on the physical health of the workers. Depressive syndrome and greater functional disability due to back pain, in turn, predict worse mental health.
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Clinical rheumatology · Jun 2015
Randomized Controlled TrialThe effect of balneotherapy on chronic shoulder pain. A randomized, controlled, single-blind follow-up trial. A pilot study.
The effects of balneotherapy on chronic shoulder pain were studied. In this single-blind, randomized, follow-up study involving 46 patients with chronic shoulder pain, one group of patients received physiotherapy--exercise and transcutaneous electrical nerve stimulation--and the other group received balneotherapy in addition to physiotherapy for 4 weeks on 15 occasions. The following parameters were recorded before treatment (at week 0) and after treatment (at weeks 4, 7, and 13): Shoulder Pain and Disability Index (SPADI), the Short Form (36) Health Survey (SF-36) and EuroQuol-5D (EQ-5D) quality of life questionnaires, pain at rest and on movement on the visual analog scale (VAS), and active and passive range of motion. ⋯ Improvement of passive range of motion was not significant. Balneotherapy may have a beneficial effect on the clinical parameters and quality of life of patients with chronic shoulder pain. The number of patients should be increased.