Background:Managing chronic diseases such as rheumatoid arthritis (RA) is a challenge on a daily basis for rheumatologists and convincing our patients to properly take their medication may be difficult especially with elderly. First step comes with our patients’ education and suppressing misbeliefs and misconceptions.Objectives:To study beliefs of elderly RA patients on DMARDs and see what they really think of their treatments.Methods:A cross-sectional study was conducted in a rheumatology clinic over a period of 4 months. Patients over the age of 65 having RA and being treated with conventional DMARDs or biologics were questionned about their medication. The belief about medicines questionnaire (BMQ) was used to assess different beliefs. It is a validated questionnaire of 18 items. Patients responded freely to each item using a Likert scale. The clinician later collected the data and 4 scores were calculated (concern (c), necessity (n), overuse and harm), thus classifying patients on 4 different groups as follows: accepting if n≥ 15 and c<15, ambivalent n≥ 15 and c≥15, indifferent if n< 15 and c <15 and skeptical if n<15 and c≥ 15.Results:Forty elderly patients joined the study. The median of age was 66 years. They were mostly women (82.5%) with other comorbidities in 55% of the cases. The mean of DAS 28 score was 4.65± 1.77 and the mean of the VAS pain score was 5 out of 10. Only 17.5% of the patients were on remission or low disease activity. Radiological destructions were detected in 87.2% of the patients and deformities in 60% of them. Rheumatoid factor and/or citrullinated peptide antibodies were detected in 81.6% of the cases.95% of the patients were on methotrexate (MTX), 12.5% on Sulfasalazin and 12.5% on biotherapies. Corticosteroids were prescribed in 85% of the patients. Responses to the BMQ specific and general questionnaire are showed in table.1. The mean score of concern was 15.33±3.8, the mean score of harm was 13.44±2.9, the median of the necessity score was 18 and the median of the overuse score was 13.5. Analysing patients’ beliefs, the majority of them were ambivalent towards their DMARDs (44.4%), 33.4% were accepting, 11.1% were skeptical and 11.1% were indifferent.Table 1.BMQ responsesBMQ specificDo not agree at all %Do not agree %Incertain %Agree %Agree very much %My health at present depends on my RA medicines5.622.2%27.844.40Having to take RA medication worries me5.644.4038.911.1My life would be impossible without my RA medication5.616.722.233.322.2Without my RA medication i would be very ill11.122.216.738.911.1I sometimes worry about the long-term effects of my RA medication27.811.111.144.45.6My Ra medication is a mystery to me5.633.35.6505.6My health in the future will depend on my RA medication5.616.727.8500My RA medication disrupts my life5.638.95.644.45.6I sometimes worry about becoming too dependent to my RA medication038.911.144.45.6My RA medication protects me from becoming worse016.75.661.116.7BMQ generalDoctors use too many medicines016.727.844.411.1People who take medicines should stop their treatment for a while every now and then11.144.422.222.20Most medicines are addictive05.622.261.111.1Natural remedies are safer than medicines11.111.127.822.227.8Medicines do more harm than good11.127.827.827.85.6All medicines are poisons5.622.227.822.222.2Doctors place too much trust on medicines5.616.733.327.816.7If doctors had more time with patients they would prescribe fewer medicines011.122.233.333.3Conclusion:Elderly RA patients should me more reassured about the safety of DMARDs and the importance of taking them and try to establish a better patient-doctor relationship.References:[1]Horne R, Weinman J, Hankins M. The beliefs about medicines questionnaire: The development and evaluation of a new method for assessing the cognitive representation of medication. Psychol Health 1999; 14: 1–24.[2]Aikens JE, Nease DE, Nau DP, et al. Adherence to Maintenance-Phase Antidepressant Medication as a Function of Patient Beliefs About Medication. Ann Fam Med 2005; 3: 23–30.Disclosure of Interests:None declared
Background:Epidural steroid injections are largely used in the management of osteoarthritis-related sciatica. Three possible sites of injection are possible: the caudal through the sacral hiatus, the interlaminar and the transforaminal site. The caudal technique is known to be the most simple one. However, doubts still persist about this infiltration’s efficacy.Objectives:The aim of this work was to study the short-term and mid-term efficacy of caudal epidural steroid injections in patients suffering from sciatica related to a degenerative etiology and to study the determining factors of its efficacy.Methods:A retroscpective, descriptive and monocentric study was conducted in Sahloul university hospital of Tunisia. Medical records of patients who suffered from sciatica due to disc herniation or spinal stenosis were analysed. Only patients who benefited from at least one caudal epidural steroid injection were included. Other etiologies were ruled out by CT-scan or MRI and laboratory tests. Efficacy of the injection was evaluated by the visual analog scale of pain (VAS) at the first week post infiltration, 3 months and 6 months later. The infiltration was considered effective if the difference of pain scoe by VAS was ≥50% compared to baseline‘s score. The presence of anxiety and depression was also tracked down with the hospital anxiety and depression scale. Data was collected and analysed using the statistical tool SPSS.20.Results:Twenty-five patients were included. They were 7 males and 18 females. The mean age at diagnosis was 51.88± 15.28 years. Eleven patients had another osteoarthritis site. Five patients had previous back surgery: 2 dissectomies, 1 arthrodesis, and 2 laminectomies. Median duration of sciatica was 30 months. Sciatica was bilateral in 41.7% of the cases, impulsive during efforts in 52% of the cases and with claudication in 92% of the cases. The median VAS score at baseline was 7 out of 10 (min=4; max=9). All patients had tried medical treatment using NSAIDS and painkillers, and physical therapy before prescribing the infiltration. The technique was similar in all patients: Lidocaine 1% was first injected at a median volume of 5ml, followed by corticosteroids and finally a saline solution (median volume of 20ml). The median number of epidural caudal injections was 3 injections (min=1; max=3). The caudal epidural steroid injections were effective in 60% of the patients at the first week, 56% in the cases at 3 months and 56% of the cases at 6 months. Factors associated with efficacy of the injection at the first week were greater total volume injected (p=0.001), and greater saline solution volumes (p=0.016). At 3 months, factors significantly associated with efficacy of the infiltration were having unilateral pain (p=0.05), a positive straight leg raise test sign (p=0.028), a lower anxiety score (0.014) and a lower depression (0.000) score. At 6 months, factors associated with efficacy were not having cervical osteoarthritis (p=0.03), unilateral pain (p=0.05), low anxiety (p=0.014) and low depression (p=0.001) scores and a higher number of steroid injections (p=0.05).Conclusion:Caudal epidural steroid injections seem effective on the short-term and this efficacy is maintained till the mid-term. Greater volumes may help with pain by possible adhesiolyse-like mechanisms and having unilateral pain, positive straight leg raise sign, a higher number of injections, no anxiety or depression and no other osteoarthritis sites makes the infiltration more effective.References:[1]Dincer U, Kiralp MZ, Cakar E, Yasar E, Dursan H. Caudal epidural injection versus non-steroidal anti-inflammatory drugs in the treatment of low back pain accompanied with radicular pain. Joint Bone Spine. 2007;5.Disclosure of Interests:None declared
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