EPIREUMAPT PROTOCOL - PORTUGUESE EPIDEMIOLOGIC STUDY OF THE RHEUMATIC DISEASES

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Life History of Women with Fibromyalgia: Beyond the Illness

Fibromyalgia is a chronic pain syndrome, which mostly affects middle age women and whose etiological factors remain unclear. Psychosocial aspects may have a relevant role as predisposing, triggering, and/or perpetuating factors for this syndrome, raising the interest about life history of patients with fibromyalgia. In this study, we interviewed 10 women with a diagnosis of fibromyalgia, who had identified a critical or very stressful life event before the onset of the syndrome. The interview about the life history comprises the whole life, before and after the onset of the syndrome, and the narratives were analyzed with interpretative phenomenological analysis. Nine themes emerged: struggle, focus on adversities, positive overlaps the negative, scars of unhappy childhood, help others, perfectionism and desire to achieve, unsatisfactory present, perception of injustice, and keep feelings inside. A difficult life history is prevalent in these women and the themes identified are discussed in their relation with other qualitative studies and their possible role as predisposing and perpetuating factors for fibromyalgia. The ability to value the positive side of things, despite the adversities these women emphasized, is highlighted as an aspect to explore in psychological intervention, to enable a better management of this syndrome

A Tricky Diagnosis of Poncet?s Disease

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Doppler ultrasound - a valid and reliable tool to assess spondyloarthritis

Enthesitis is the hallmark of spondyloarthritis and is observed in all subtypes. Namely, a wide information on spondyloarthritis abnormalities, including synovitis, bursitis, tendinitis, enthesitis and cortical bone abnormalities (erosions and enthesophytes), can be efficiently perceived by ultrasound power Doppler. Furthermore, several studies on imaging of enthesis showed that imaging techniques are better than clinical examination to detect pathology at asymptomatic enthesis. Vascularized enthesitis detected by ultrasound power Doppler appears to be a valuable diagnostic tool to confirm spondyloarthritis diagnosis. This article focuses on the validity and reliability of ultrasound enthesitis assessment in the management of spondyloarthritis patients

A systematic literature review

Publisher Copyright: © The Author 2014. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved.Objective. The aim of this study was to systematically review outcome domains and measurement tools used in gout trials and their accordance with the preliminary OMERACT gout recommendations published in 2005.Methods. Randomized controlled trials (RCTs) and quasi-RCTs investigating any intervention for gout published up to February 2013 were included. Recruitment start dates and all measured outcomes were extracted. Risk of bias (RoB) was assessed with the Cochrane Collaboration tool. Numbers of OMERACT domains were compared for trials at low vs unclear/high RoB and for recruitment start date before 2005 or 2005 and later.Results. Of 9784 articles screened, 38 acute and 30 chronic gout trials were included. Mean (s.d.) number of OMERACT outcomes was 2.9 (1.1) (out of 5) and 2.5 (1.2) (out of 9) for acute and chronic gout trials, respectively. Health-related quality of life, participation and joint damage imaging were not assessed in any trial. Tools used to measure individual domains varied widely. There were no differences in the number of OMERACT outcomes reported in acute or chronic gout trials recruiting before 2005 vs 2005 or later [mean (s.d.): 3.0 (1.1) vs 3.5 (1.3), P = 0.859 and 2.7 (1.1) vs 2.8 (1.4), P = 0.960, respectively]. While both acute and chronic trials at low RoB reported more OMERACT domains than trials at unclear/high RoB, these differences were not significant. Industry-funded trials and trials performed by OMERACT investigators reported more OMERACT outcome domains.Conclusion. We found no appreciable impact of the OMERACT recommendations for gout trials to date.publishersversionpublishe

Efetividade de um programa de educação baseada na neurofisiologia da dor e exercício aquático em comparação com um programa de exercício aquático isolado em indivíduos com dor lombar crónica

Preprint de poster apresentado no XVII Congresso Português de Reumatologia, 7-10 de maio de 2014, Albufeira, Portuga

a nationwide population-based study

Funding Information: The present publication was funded by Fundação Ciência e Tecnologia, IP national support through CHRC (UIDP/04923/2020). The same institution supported the first author (LAG) under an individual PhD grant (SFRH/BD/145636/2019). EpiReumaPt was supported by unrestricted grants from Direção-Geral da Saúde, Fundação Calouste Gulbenkian, Fundação Champalimaud, Fundação AstraZeneca, Abbvie, Merck, Sharp & Dohme, Pfizer, Roche, Servier, Bial, D3A Medical Systems, Happybrands, Center de Medicina Laboratorial, Germano de Sousa, Clínica Médica da Praia da Vitória, CAL-Clínica, Galp Energia, Açoreana Seguros, and individual rheumatologists. Data were provided by the EpiDoC Unit - CEDOC with permission. Publisher Copyright: ©Objectives To estimate the prevalence of medical care-seeking among adults with low back pain (LBP) and to characterise and compare use of diagnostic procedures and medical management between primary and secondary care. Design Cross-sectional study. Setting Data from the EpiReumaPt, a nationwide population-based study conducted in Portugal including a representative sample of non-institutionalised adults (n=10 661) stratified by administrative territorial units was analysed. Participants Individuals who self-reported history of LBP within the previous 12 months (n=6434) and sought medical care for this problem in the same period (n=2618). Outcome measures Patients' self-reported diagnostic workup and management procedures performed by medical care for LBP collected through a structured questionnaire. Medical care procedures were stratified by level of care. Results The prevalence of medical care-seeking for LBP was 38.0% (95% CI 35.9% to 40.1%). Primary care in isolation (45.3%) was the most sought level of care. Emergency departments (25.9%) and orthopaedics (19.4%) were the most sought secondary medical specialties. Several pathoanatomical diagnoses were used, supported by laboratory or imaging tests (91.1%). Disc herniation (20.4%) and osteoarthritis (19.7%) were the most frequent diagnoses, and X-ray (63.7%) was the most frequent diagnostic procedure self-reported by individuals. Most (75.1%) reported being treated for LBP: 80.4% with oral medication and 49.9% with injectables. The mean duration of pharmacological treatment was 104.24 (SD, 266.80) days. The use of pathoanatomical diagnoses, laboratory or imaging tests, and pharmacological treatments were generally more frequent for secondary care (p<0.05). Approximately one-quarter of individuals (24.5%) reported seeking care from additional healthcare providers, physiotherapists (66.9%) were the most frequent. Conclusions Medical care for LBP is frequent and associated with high levels of pathoanatomical diagnoses, imaging and laboratory tests and pharmacological therapy in both primary and secondary care settings. Funding and delivery actions should be prioritised to assure appropriate care for LBP.publishersversionpublishe