Rheumatology
-
Review Case Reports
An embarrassment of pain perceptions? Towards an understanding of and explanation for the clinical presentation of CRPS type 1.
Complex regional pain syndrome (CRPS), a fairly common problem in rheumatological and orthopaedic practice, is an allodynic pain state of uncertain pathology often variably and unpredictably responsive to treatments. Although published diagnostic criteria are available, in the reality of clinical practice these do not appear to encompass the wide variety of symptoms that a patient may present with. This leads to scepticism on the part of the clinician and confusion for the sufferer. ⋯ With the aid of a case report we examine recent research that suggests how peripherally based symptoms and signs arise from changes within the central nervous system, with particular attention given to the control function of the motor-proprioceptive integrative system. We speculate how these changes within the central nervous system may provide the patient with CRPS the ability to access complex layers of lower level perceptions that are normally suppressed. We propose that such a system may explain some of the clinical puzzlements seen in this condition and suggest that the complexities of CRPS may provide an insight into brain development through evolution, which is a fruitful area for interdisciplinary clinical and scientific research.
-
Randomized Controlled Trial Comparative Study
Effects of a modular behavioural arthritis education programme: a pragmatic parallel-group randomized controlled trial.
Rheumatology guidelines recommend people with RA receive behavioural self-management education. This study developed a modular behavioural group programme and evaluated its longer term effects on pain, physical and psychological status. ⋯ Attending a modular behavioural education programme is effective for at least 1 yr in enabling people with RA and PsA to reduce pain, improve psychological status and self-manage their condition.
-
To evaluate costs, benefits and cost-effectiveness of anti-TNF agents in PsA patients with inadequate response to conventional treatment. ⋯ Cost-effectiveness ratios are within the commonly accepted willingness-to-pay threshold. These results need to be confirmed in larger samples of patients.
-
To map the content of the OsteoArthritis Knee and Hip Quality Of Life (OAKHQOL) scale to the International Classification of Functioning, Disability and Health (ICF). To compare the OAKHQOL with other instruments used in OA using the ICF core set for OA (OA core set). ⋯ Compared with other health status instruments commonly used in OA, the OAKHQOL covers the highest number of OA core set categories and captures specific aspects that are especially valuable to patients with knee and hip OA.