Rheumatic diseases clinics of North America
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Rheum. Dis. Clin. North Am. · Feb 2011
ReviewEffectiveness of CAM therapy: understanding the evidence.
By definition, complementary and alternative medicine (CAM) attempts to diagnose and treat illnesses in unconventional ways. CAM has been classified as: (1) alternative medical systems (eg, traditional Chinese medicine [including acupuncture], naturopathic medicine, ayurvedic medicine, and homeopathy); (2) biologic-based therapies (eg, herbal, special dietary, and individual biologic treatments); (3) energy therapies (eg, Reiki, therapeutic touch, magnet therapy, Qi Gong, and intercessory prayer); (4) manipulative and body-based systems (eg, chiropractic, osteopathy, and massage); and (5) mind-body interventions (eg, meditation, biofeedback, hypnotherapy, and the relaxation response). This review focuses on how to assess the effectiveness of CAM therapies for chronic musculoskeletal pains, emphasizing the role of specific and nonspecific analgesic mechanisms, including placebo.
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Rheum. Dis. Clin. North Am. · Feb 2010
Changing worldwide epidemiology of systemic lupus erythematosus.
Developed countries have better systemic lupus erythematosus survival rates than developing countries, or countries with lower economic performance. This is in part because of a higher human development index, defined by standard of living (a marker for gross domestic product), literacy rates, and life expectancy, with contribution from ethnic variations within individual countries, and unique environmental factors.
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Rheum. Dis. Clin. North Am. · Nov 2009
ReviewClues on the MDHAQ to identify patients with fibromyalgia and similar chronic pain conditions.
Patients with fibromyalgia and chronic pain conditions report high levels of pain and fatigue, and multiple symptoms. These phenomena may be recorded quantitatively on a self-report multidimensional health assessment questionnaire (MDHAQ). These responses are likely to differ in people with fibromyalgia or chronic pain conditions compared with people with an inflammatory rheumatic disease, such as rheumatoid arthritis. Data from the MDHAQ provide clues to the presence of fibromyalgia/chronic pain conditions, including patients with inflammatory diseases who also have concomitant fibromyalgia/chronic pain conditions.
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Rheum. Dis. Clin. North Am. · Nov 2009
ReviewRAPID3, an index to assess and monitor patients with rheumatoid arthritis, without formal joint counts: similar results to DAS28 and CDAI in clinical trials and clinical care.
RAPID3 (routine assessment of patient index data 3) is a pooled index of the 3 patient-reported American College of Rheumatology rheumatoid arthritis (RA) Core Data Set measures: function, pain, and patient global estimate of status. Each of the 3 individual measures is scored 0 to 10, for a total of 30. Disease severity may be classified on the basis of RAPID3 scores: >12 = high; 6.1-12 = moderate; 3.1-6 = low; < or =3 = remission. ⋯ RAPID3 on a multidimensional health assessment questionnaire (MDHAQ) is scored in 5 to 10 seconds, versus 90 to 94 seconds for a formal 28-joint count, 108 seconds for a CDAI, and 114 seconds for a DAS28. An MDHAQ can be completed by each patient at each visit in the waiting room in 5 to 10 minutes, as a component of the infrastructure of routine care, with minimal effort of the rheumatologist and staff, to provide RAPID3 scores as well as additional data including a self-report joint count, fatigue, review of systems, and recent medical history. In all rheumatic diseases RAPID3 is able to provide a baseline quantitative value, and to quantitatively monitor and document improvement or worsening over time.
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Advances have occurred in the pharmacotherapy of fibromyalgia (FM) and the methodology of clinical trial design in FM in parallel with improved understanding of the underlying pathophysiologic mechanisms. Several medications have been approved for the management of FM based on their clinically meaningful and durable effect on pain in monotherapy trials and their beneficial effect on patients'global impression of change, function, and other key symptom domains such as fatigue, sleep disturbance, and cognition. Adjunctive therapy with medicines targeted to specific symptom domains such as sleep as well as treatments aimed toward common comorbid conditions such as irritable bowel syndrome or disease states such as rheumatoid arthritis should be considered for the purpose of reducing the patient's overall symptom burden.