Zeitschrift für Rheumatologie
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This is a critical review on the influence of large multicenter studies on therapeutic decisions in rheumatology. Every prescription in rheumatology relies on such studies, because study results have to be presented for the approval of each new drug. Large randomized trials are rated highest within the evidence based medicine (EBM). ⋯ Auranofin) or is known due to clinical experience long before randomised studies were performed (i.e. MTX). Open longterm observational studies are undispensable in the field of rheumatology and may render more important knowledge than randomised studies.
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Comparative Study
[Technique and diagnostic value of musculoskelatal ultrasonography in rheumatology. Part 5: Ultrasonography of the shoulder].
Shoulder-related symptoms are very common in rheumatic diseases. For the evaluation of the diagnosis as well as for therapy and prognosis, an anatomic assignment is essential. Clinical investigations alone are often not capable to do this. ⋯ Considering the limitations of the method (obesity, frozen shoulder, no findings under bony structures) and knowing the pitfalls and errors of the method, ultrasonography is a reliable, quick and low cost method for the diagnosis of rheumatic shoulder joint pathology. Compared to computer tomography and magnetic resonance imaging, ultrasonography should be used as a screening method. The following standard scans are suggested for sonographic evaluation of the shoulder: 1) anterior transverse scan and 2) anterior longitudinal scan at the bicipal groove to detect synovitis and tenosynovitis, 3) anterior transverse scan at the coracoacromiale window in the neutral position, 4) at maximal external rotation and 5) at maximal internal rotation to evaluate the rotator cuff, bursitis, synovitis and erosions, 6) anterior longitudinal scan at 90 degrees to the coracoacomiale window at maximal internal rotation to describe these findings in an additional dimension, 7) anterior-lateral longitudinal scan at the anterior lateral acromion to tuberculum majus to evaluate the distal part of the supraspinatus muscle, 8) posterior transverse scan at the fossa infraspinata lateral under the spina scapulae, 9) axillary longitudinal scan to evaluate synovitis, synovial proliferation, erosions at the humeral head, lesions at the glenoidale labrum, 10) anterior transverse scan at the acromioclavicular joint and 11) anterior oblique scan at the sternoclavicular joint to detect synovitis, synovial proliferation, erosion, osteophytes.
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The treatment of fibromyalgia syndrome is still unsatisfactory, especially because it is in most cases impossible to achieve complete relief from pain. With regard to this issue, we investigated the satisfaction of in-patients for fibromyalgia with their therapeutic regimen. The survey comprised 96 patients (91 females, 5 males) who had participated in an interdisciplinary group treatment program of in-patient. ⋯ Psychological care, coaching patients to cope better with their illness, and instruction in relaxation techniques received especially high scores. An analysis of the factors yielded four factors that contribute to patient satisfaction: 1) general medical regimen, 2) special massage methods, 3) physician and psychologist, 4) relaxation techniques. An interdisciplinary approach in treating fibromyalgia has proved useful.