a b s t r a c tObjective: To describe the main indications and the technical steps to perform ultrasound guided procedures in patients with rheumatic diseases. To access procedures accuracy, safety and effectiveness. Materials and methods: 27 patients with pain related to articular complications of rheumatic diseases and according to previous radiographic or US exam were submitted to several US-guided procedures. 42% of patients (n = 11) had rheumatoid arthritis, 11% (n = 3) spondyloarthropathies, 18% (n = 5) psoriatic arthritis, 15% (n = 4) undifferentiated arthritis, 3% (n = 1) Sjögren syndrome and 11% (n = 3) had gout.Described procedures are synovial biopsies, intra-articular injections of corticosteroids, radiation synovectomy and synovial cysts drainage procedures. When a therapeutical procedure was made, patients were evaluated by 2 rheumatologists.Corticosteroids used were Prednisolone and Triamcinolone. Yttrium-90 was used for synovectomy. Results: In all cases success was achieved with correct needle placement inside the joint. After injection/aspiration symptoms successfully solved with all patients improving their health status. No complications were recorded during follow-up period. Conclusions: US-guidance is very reliable to afford a safety procedure always checking the injection, biopsy or aspiration. Guided-biopsy has high success rates obtaining several samples. Thus is also possible to use more powerful/long acting therapeutic drugs aggressive to extra-articular structures avoiding complications.
Introduction Pain is the most common symptom in rheumatic diseases. In its pathophysiology there is usually a disturbance in nociceptive perception by tissue damage, that evolve often to features of central pain, with characteristics of neuropathic pain (NP). Neuropathic pain in rheumatic diseases is a topic rarely addressed in the literature. Objectives Determine, in a cohort of patients with rheumatoid arthritis (RA), osteoarthritis (OA) axial (a-SpA) and peripheral (p-SpA) spondylarthritis, the prevalence of DN, correlations between NP and activity and disease duration. Compare the prevalence of DN with control group. Materials and Methods Cross-sectional study. Variables analysed: sex, age, duration of illness, medication. All patients answered VAS of pain, DN4 and EQol-5D. In patients with RA and p-SpA we determined DAS28, BASDAI and BASFI in a-SpA and WOMAC in OA. Control group of healthy subjects randomised with patients in age and sex responded DN4. Statistical analysis using SPSS 18. Results 216 patients enrolled (80RA, 48p-SpA, 46a-SpA, 42OA), 85 men and 131 women, with mean age 55.27 ± 14.62 years, mean disease duration 10 ± 11.87years. 48patients had ≥4 DN4, only 3 were on medication to NP. The NP prevalence was 40.47% in OA (p < 0.01), 18.75% RA, 23.91% a-SpA and 10:42% p-SpA. The prevalence of DN was higher in patients compared with controls, in OA (OR = 23.12% CI 95 (2.88–185.41) and SPA´s (OR = 8.62 CI 95% (1.1–67.25). Despite the increasing prevalence of DN with duration of disease, this difference was not statistically significant. Regarding disease activity, we found that DN increases with BASDAI (p < 0:02) in a-SpA and DAS28 in RA (p < 0.02). Higher values of VAS were found in patients with DN4 ≥4 (p < 0.001). Conclusion This study reveals an important neuropathic component in our cohort of patients. The disease with the highest prevalence of DN was OA, which meets the data found in the literature. This discrepancy in prevalence, lower in inflammatory conditions, though chronic, certainly needs further study, placing the use of more aggressive therapy in these patients, like DMARD's, as a plausible hypothesis. This study demonstrates the need for a better understanding of the mechanisms and types of pain in rheumatic patients, with nociceptive pain only part of the spectrum of pain. Additional studies are needed to investigate the importance of neuropathic pain in rheumatic diseases, and its relation with the evolution of the underlying disease.
Psoriatic arthritis (PsA) has a strong negative impact on the quality of life of patients. The Psoriatic Arthritis Quality of Life (PsAQoL) questionnaire is a disease-specific instrument developed to measure the quality of life in patients with PsA. The aims of this study were to culturally adapt the questionnaire for Portugal and evaluate its reliability and validity in patients with PsA. The original UK English version of the PsAQoL was translated into Portuguese by a bilingual and lay panel. Structured cognitive debriefing interviews were conducted with ten PsA patients. The Portuguese PsAQoL was subsequently applied to PsA patients followed at the Rheumatology Department of Centro Hospitalar do Baixo Vouga, E.P.E. To assess reproducibility, 30 patients with PsA completed the Portuguese PsAQoL on two occasions, 2 weeks apart. A larger sample was recruited to determine internal consistency and construct validity. The Nottingham Health Profile (NHP) was used as a comparator instrument. Translation and adaptation were successful. Cronbach´s alpha for the Portuguese version of the PsAQoL was 0.91 and the test-retest reliability was 0.93. The PsAQoL could distinguish between groups of patients defined by self-reported general health status, self-reported severity of PsA and flare of arthritis. There was a positive correlation between the total score of the PsAQoL and each of the sections of the NHP. The Portuguese version of the PsAQoL was found to be relevant, understandable and easy to complete, reliable and valid.
Background The impact of rheumatic diseases on patients’ sexuality has been, for a long time, an ignored topic. As quality of life in these patients became more valorized, sexuality, as a major aspect for the individual’s well being, arised as a subject to be considered over the last decade1. The awareness of the physicians for the problem is of great importance, since the impact in sexual life might be a major concern and still, a quite uncomfortable topic for the patient – both with healthcare professionals and partners. Objectives To analyze the approach by the healthcare service and/or partners on the patients’ perspective of the impact of the rheumatic disease in their sexual activity. Methods An anonymous questionnaire was performed, consisting in demographic data (sex, age, disease duration, civil status, professional status and educational level), and questions related to the importance attributed to sexual activity, as well as to the approach of the topic by the patient and healthcare professionals, with multiple choice questions and questions to be answered through a visual analogical scale. A descriptive study was performed. Results 95 patients with the diagnosis of spondyloarthritis were enrolled and 76 answered the questionnaire; 31 had psoriatic arthritis, 30 had ankylosing spondylitis, 9 had undifferentiated spondyloarthritis and 6 had inflammatory bowel disease spondyloarthritis; 40 were male, 35 were female and 1 unknown. Mean age was 46.08±12.08 and mean disease duration was 12.17±10.32 years. Most of patients were married (56) or common law married (8); 19 patients had completed primary school only and less than one quarter were graduate or higher. In a visual analogical scale, mean importance give to sexual capacity was 74.67±24.55. Among the 76 patients, only 35 stated they talked about the subject with their partner; however, the great majority (66 patients) said they had the partner’s understanding towards their limitations in sexual activity. The perception of conditioning in the conjugal relationship was, in a visual analogical scale, 33.68±31.56. 58 patients had never talked about it with anyone else and 65 had never been questioned by any health professional (rheumatologist, general practitioner or nurse). Conclusions This work emphasizes that the impact of spondyloarthritis on sexual activity is a topic rarely approached either by the patients, either by health professionals. Since patients valorize a lot their sexual capacity and seem not to talk about the limitations imposed by their disease, this subject might deserve a greater attention, including from rheumatologists and other healthcare professionals. References Helland Y, Kjeken I, Steen E, Kvien TK, Hauge MI, Dafinrud H. Rheumatic Diseases and Sexuality: Disease Impact and Self-Management Strategies. Arthritis Care & Res 2011;5:743–750 Disclosure of Interest None Declared
Background The impact of rheumatic diseases on patients’ sexual life has been gathering the attention of the scientific community over the last decade1. However, specific assessemnt tools are scarce and there are few existing studies, specially those related to spondyloarthritis2 and particularly to psoriatic arthritis. In fact, several factors may condition sexual function in these patients: pain, stiffness, decreased range of motion, joint swelling and extraarticular features such as fatigue, enthesopathy and, in the case of psoriatic arthritis, cutaneous lesions. Objectives To assess sexual satisfaction in a cohort of patients with spondyloarthritis; to identify the limitation imposed by different factors related to the disease in sexual activity; to search for relations between those limitation and quality of life and disease activity and function indexes. Methods An anonymous questionnaire was performed, consisting in two parts. One part consisted in a questionnaire filled by the physician with data on the disease – affected joints, extraarticular features, comorbidities, current treatment, metrology in patients with axial involvement, disease activity (BASDAI and/or DAS28) and function (BASFI and HAQ) indexes and quality of life index (ASQoL). The other part consisted in a questionnaire filled by the patient, with demographic data (sex, age, disease duration, civil status, professional status and educational level), multiple choice questions and questions to be answered through a visual analogical scale, including items approached in some validated indexes of sexual function and satisfaction assessment. Statistical treatment was performed using SPPS system, version 17.0. Results 95 patients with the diagnosis of spondyloarthritis were enrolled and 76 answered the questionnaire; 31 had psoriatic arthritis, 30 had ankylosing spondylitis, 9 had undifferentiated spondyloarthritis and 6 had inflammatory bowel disease spondyloarthritis; 40 were male, 35 were female and 1 unknown. Mean age was 46.08±12.08 and mean disease duration was 12.17±10.32 years. In a visual analogical scale, the mean sexual satisfaction level was 52.28±30.99; the perception of conditioning in the conjugal relationship was 33.68±31.56; limitation on sexual activity was 32.72±31.06; limitation by pain, joint swelling, fatigue, stiffness, decreased range of motion, decreased libido and psoriasis lesions varied from 29.17±28.51 (swelling) e 46.94±32.31 (fatigue), and there was no significant difference between sexes, diagnoses and type of involvement. A strong correlation was identified between most of these factors and ASQoL and HAQ values, but not between them and activity indexes. The presence of comorbidities did not influence the obtained values in a statistically significant way. Conclusions This work highlights the impact of spondyloarthritis on patients’ sexual function. Fatigue was mentioned as the most limiting factor in sexual activity, and the values obtained had a strong correlation with quality of life index in ankylosing spo...
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