Procjena funkcije šake elektoničkim dinamometrom u bolesnika s reumatoidnim artritisom [Evaluation of the hand function using an electronic dynamometer in patients with rheumatoid arthritis]

Objectives. In order to more detailed assessment of grip strength an innovative electronic dynamometer system is produced and a new dynamic parameters of hand grip are derived. The aim of this study was to determine the connection between the new evaluation parameters of hand grip with measures of functional ability and disease activity in patients with rheumatoid arthritis (RA). Patients and methods. The study included 43 consecutive RA patients and 45 healthy participants. The main outcomes were the dynamometric parameters of the handgrip: strength, velocity, endurance (fatigue) and functional capacity. DAS28 (CRP) is used in the assessment of disease activity, and functional ability is assessed by modified HAQDI and ABILHAND-RA questionnaires. Based on the hand radiogram Steinbrocker score was calculated, and the JAM scale was used to estimate deformities. Results. A positive correlation was shown between the ABILHAND-RA and dynamometric parameters. Measures of disease activity (PhGA, PtGA, tender joint count, morning stiffness) were associated with grip force and functional potential (DAS28, PhGA, tender joint count, morning stiffness). There was no association between grip velocity and measures of functional ability and disease activity. Conclusion. Evaluation of hand function with a new electronic dynamometer is useful in assessment of patients with RA

Balneotherapy/hydrotherapy in patients with rheumatoid arthritis, ankylosing spondylitis and psoriatic arthritis – a descriptive overview

Balneoterapija/hidroterapija neizostavni je dio rehabilitacije bolesnika s upalnim reumatskim bolestima. Kako se njena učinkovitost često dovodi u pitanje, cilj ovog rada je bio pretražiti literaturu koja govori o učinkovitosti balneoterapije/hidroterapije kod reumatoidnog artritisa, ankilozantnog spondilitisa i psorijatičnog artritisa. Računalnim putem pretražene su najpoznatije baze stručnih časopisa iz područja biomedicine (PubMed, Scopus, Ovid) u razdoblju od 1993. do 2013. s ključnim riječima „balneoterapija“ (engl. balneotherapy, spa-therapy) i „hidroterapija“ (engl. hydrotherapy) za navedene tri upalne reumatske bolesti. Također je korištena sva dostupna pisana medicinska literatura. Rad donosi deskriptivni pregled osnovnih principa djelovanja i dobrobiti balneoterapije/hidrokineziterapije te njezin značaj kod triju najčešćih upalnih reumatskih bolesti.Balneotherapy/hydrotherapy is an essential part of the rehabilitation in patients with inflammatory rheumatic diseases. Its effectiveness is often called into question, and for that reason the aim of this study was to summarize the literature about the effectiveness of balneotherapy/hydrotherapy in rheumatoid arthritis, ankylosing spondylitis and psoriatic arthritis. The best known journal datebases in the field of biomedicine (PubMed, Scopus, Ovid) were computer searched in the period from 1993 to 2013 by keywords “balneotherapy”, “spa therapy” and “hydrotherapy” for these three inflammatory rheumatic diseases. All the available written medical literature was also used. This article brings a descriptive overview of the basic principles of effect and the welfare of balneotherapy/hydrotherapy and its significance in the three most common inflammatory rheumatic diseases

SYSTEMIC PHARMACOLOGICAL TREATMENT OF PAIN IN RHEUMATIC DISEASE

Bol je kardinalni simptom reumatskih bolesti i najčešći razlog traženja medicinske pomoći. Olakšanje boli donosi brojne dobrobiti i preduvjet je funkcionalnog oporavka. U liječenju boli u reumatskim bolestima rabe se različiti lijekovi. Oni obično uključuju paracetamol, nesteroidne antireumatike i opioide (uglavnom slabe). Antidepresivi i antikonvulzantni lijekovi mogu se rabiti u slučajevima dominantne neuropatske sastavnice boli. U ovome deskriptivnom pregledu predstavljamo ažurirane rezultate istraživanja sa sustavnim analgeticima u reumatskim bolestima, uključujući inhibitore čimbenika rasta živca i simptomatske sporodjelujuće lijekove za osteoartritis.Pain is a cardinal symptom of rheumatic diseases and the most common reason for seeking medical help. Pain relief has many benefi cial eff ects and is necessary for the functional recovery. A variety of drugs are used for the treatment of pain in rheumatic diseases. Th ey usually include acetaminophen, nonsteroidal anti-rheumatic drugs, and opioids (mostly weak opioids). Antidepressants and anticonvulsants can be used in cases with a predominant neuropathic component. In this descriptive review we present up-to-date results of trials with systemic analgesic drugs in rheumatic diseases, including nerve growth factor inhibitors and symptomatic slow-acting drugs for osteoarthritis

ISHOD I TIJEK BOLESTI COVID-19 KOD BOLESNIKA S UPALNIM REUMATSKIM BOLESTIMA KOJI SU NA BIOLOŠKOJ ILI CILJANOJ SINTETSKOJ MODIFICIRAJUĆOJ TERAPIJI – REZULTATI JEDNOGA REUMATOLOŠKOG CENTRA

The aim of this study was to investigate the course and outcome of COVID in patients with inflammatory rheumatic diseases (IRD) who are on biological disease-modifying antirheumatic drugs (bDMARDs) or targeted synthetic disease-modifying antirheumatic drugs (tsDMARDs). In this study, we used the data of patients with rheumatoid arthritis (RA), psoriatic arthritis (PsA) and axial spondyloarthritis (axSpA) who had been treated at the Department of Rheumatology, Physical and Rehabilitation Medicine of the Sestre milosrdnice University Hospital in Zagreb (Croatia) and in whose case the SARS-CoV-2 infection was proven in the period from February 2020 until the end of July 2021. In order to analyse this data, we have used the methods of descriptive statistics. Out of a total of 28 patients, 6 had a severe or critical case of COVID-19, but only one subject was hospitalized. All 6 patients were treated with bDMARDs before the onset of infection. Most of them (4/6) had moderate to high disease activity of IRD, as well as multiple comorbidities. No deaths were recorded in this cohort of patients. The results of this study suggest that the course of COVID-19 is associated with the disease activity of IRD and accompanying comorbidities, whereas the use of specific biological drugs might be associated with a more favourable outcome of the infection. Therefore, a better follow-up process and management of disease activity in patients with IRD should be implemented during the period of this pandemic, as well as the modification of specific therapy.Cilj ovog istraživanja bio je istražiti tijek i ishod bolesti COVID-19 kod ispitanika s upalnim reumatskim bolestima koji su liječeni biološkim lijekovima koji mijenjaju tijek bolesti (engl. biologic disease modifying antirheumatic drugs, skr. bDMARDs) i ciljanim sintetskim lijekovima koji mijenjaju tijek bolesti (engl. targeted synthetic disease difying antitheumatic drugs, skr. tsDMARDs). U istraživanju smo analizirali podatke bolesnika s reumatoidnim artritisom (RA), psorijatičnim artritisom (PsA) i aksijalnim spondiloartritisom (axSpA) koji su se kontrolirali na Klinici za reumatologiju, fizikalnu medicinu i rehabilitaciju Kliničkoga bolničkog centra Sestre milosrdnice u Zagrebu i koji su imali dokazanu infekciju virusom SARS-CoV-2 u razdoblju od veljače 2020. do kraja srpnja 2021. godine. Od ukupno 28 bolesnika njih šestoro je imalo teški ili kritični oblik bolesti COVID-19, a samo jedna osoba je bila hospitalizirana. Svih tih šest bolesnika bilo je liječeno bDMARDs-ima. Većina bolesnika (4 od 6) s teškim i kritičnim oblikom bolesti COVID-19 imali su umjereni do visoki stupanj aktivnosti upalne reumatske bolesti, kao i više komorbiditeta. Smrtnog ishoda u ovoj kohorti bolesnika nije bilo. Rezultati ovog istraživanja sugeriraju da je tijek bolesti COVID-19 povezan sa stupnjem aktivnosti upalne reumatske bolesti i popratnim komorbiditetima, a mogući povoljniji ishod s upotrebom specifične biološke terapije. Stoga je u ovo doba pandemije potrebna bolja kontrola aktivnosti upalne reumatske bolesti, kao i modifikacija specifične terapije

VAGAL NERVE STIMULATION IN THE TREATMENT OF PATIENTS WITH RHEUMATOID ARTHRITIS – RESULTS THROUGH DAY 84 OBTAINED AT THE CROATIAN CENTER OF AN INTERNATIONAL PILOT STUDY

Električna stimulacija vagusa pokazala se učinkovitom u različitim upalnim stanjima na životinjskim modelima. Cilj je bio prikazati učinak neurostimulacije vagalnog živca na kliničke i laboratorijske pokazatelje u dva bolesnika s aktivnim reumatoidnim artritisom (RA) i nedostatnim odgovorom na metotreksat. Ispitanici i metode. Istraživanje je provedeno u sklopu međunarodne pilot-studije. Bolesnicima je ugrađen sustav Cyberonics za električnu stimulaciju vagusa. Nakon prve unutarbolničke stimulacije bolesnici su započeli sa stimuliranjem kod kuće do dana 42. kada je uređaj deaktiviran. Na dan 56. stimulacije su nastavljene. Evaluirani su ovi parametri: broj bolnih zglobova, broj otečenih zglobova, liječnikova (PGA) i bolesnikova (PtGA) globalna ocjena, jačina boli, aktivnost bolesti (DAS28), funkcionalna sposobnost (HAQ), serumska vrijednost CRP-a, kao i odgovor na terapiju prema EULAR-ovim kriterijima. Rezultati. U oba je bolesnika od probirne vizite do dana 42. nastupilo poboljšanje u vrijednostima DAS28 (7,00 i 6,22 prema 4,03 i 2,13), PGA (70 i 53 prema 27 i 16), PtGA (48 i 43 prema 15 i 14), broja bolnih zglobova (26 i 28 prema 4 i 0) i broja otečenih zglobova (24 i 14 prema 8 i 2), jačine boli (72 i 87 prema 21 i 7), vrijednosti HAQ-a (2,25 i 2,25 prema 1,5 i 1,375) te razine CRP-a (23,8 i 5,58 prema 13 i 4,61). Nakon isključenja uređaja došlo je do pogoršanja DAS28 i VAS-a boli u oba pacijenta. Zaključak. Vagalna neuralna stimulacija u liječenju bolesnika s aktivnim RA i nedostatnim odgovorom na tera piju metotreksatom učinkovita je u smanjenju kliničkih simptoma i pokazatelja upale. Naši su rezultati u skladu s rezultatima dobivenim i u drugim centrima. Potrebna su istraživanja na većem broju ispitanika da bi se bolje ocijenio učinak ovoga novog pristupa liječenju bolesnika s reumatoidnim artritisom.Electrical stimulation of the vagus has proven eff ective in various infl ammatory conditions in animal models. Th e aim of this study is to show the eff ect of vagal nerve neurostimulation on clinical and laboratory parameters in two patients with active rheumatoid arthritis (RA) and an inadequate response to methotrexate. Patients and methods. Th e research was conducted as part of an international pilot study. Patients were implanted with the Cyberonics system for electrical stimulation of the vagus. Aft er an initial in-clinic stimulation, the patients performed the stimulations at home for 42 days, when the device was inactivated. On day 56 the stimulations were reinitiated. Th e following parameters were evaluated: tender and swollen joint count, physician’s (PGA) and patient’s (PtGA) global score, intensity of pain, disease activity (DAS28), functional ability (HAQ), serum CRP level, and EULAR response. Results. In the period from the screening visit to the day 42 visit, both patients experienced an improvement of DAS28 (7.00 and 6.22 vs. 4.03 and 2.13), PGA (70 and 53 vs. 27 and 16), PtGA (48 and 43 vs. 15 and 14), tender joint count (26 and 28 vs. 4 and 0), swollen joint count (24 and 14 vs. 8 and 2), intensity of pain (72 and 87 vs 21 and 7), HAQ score (2.25 and 2.25 vs. 1.5 and 1.375), and CRP levels (23.8 and 5.58 vs. 13 and 4.61). Aft er the device deactivation, DAS28 and VAS pain worsened in both patients. Conclusion. Vagal neural stimulation in the treatment of patients with active RA and an inadequate response to methotrexate is eff ective in reducing clinical symptoms and parameters of infl ammation. Our results are in accordance with the results obtained in other centers. Research on a larger number of subjects is necessary for a better evaluation of the eff ect of this new approach to the treatment of patients with rheumatoid arthritis