Demographic, clinical and antibody characteristics of patients with digital ulcers in systemic sclerosis: data from the DUO Registry

OBJECTIVES: The Digital Ulcers Outcome (DUO) Registry was designed to describe the clinical and antibody characteristics, disease course and outcomes of patients with digital ulcers associated with systemic sclerosis (SSc). METHODS: The DUO Registry is a European, prospective, multicentre, observational, registry of SSc patients with ongoing digital ulcer disease, irrespective of treatment regimen. Data collected included demographics, SSc duration, SSc subset, internal organ manifestations, autoantibodies, previous and ongoing interventions and complications related to digital ulcers. RESULTS: Up to 19 November 2010 a total of 2439 patients had enrolled into the registry. Most were classified as either limited cutaneous SSc (lcSSc; 52.2%) or diffuse cutaneous SSc (dcSSc; 36.9%). Digital ulcers developed earlier in patients with dcSSc compared with lcSSc. Almost all patients (95.7%) tested positive for antinuclear antibodies, 45.2% for anti-scleroderma-70 and 43.6% for anticentromere antibodies (ACA). The first digital ulcer in the anti-scleroderma-70-positive patient cohort occurred approximately 5 years earlier than the ACA-positive patient group. CONCLUSIONS: This study provides data from a large cohort of SSc patients with a history of digital ulcers. The early occurrence and high frequency of digital ulcer complications are especially seen in patients with dcSSc and/or anti-scleroderma-70 antibodies

Psychosocial interventions for back pain in elite sport

$\textbf {Psychosocial interventions}$ for back pain patients are well established elements of treatment regimens and numerous reviews support their effectiveness. Research is sparse regarding the specific case of elite athletes suffering from back pain(BP), and the effects of psychological treatments in this population. $\textbf {Therefore}$, based on a biopsychosocial paradigm, this article describes four intervention approaches with a specific orientation towards athletes’ 1) pain perception and pain management, 2) body experience and body concept, 3) motivation and self-regulation, and 4) stress management and recovery. $\textbf {For each of these four topics}$, a short overview of the key research and existing interventions is given. Based on the overviews of these four topics, specific treatments that have been developed by the authors are described. These treatments particularly aim 1) to gradually increase physical and social activity while reducing BP and disability, 2) to concentrate on positive aspects of body experience, 3) to enhance patients’ self-efficacy and intrinsic motivation for rehabilitation and 4) to promote and monitor individual recovery activities,and relaxation techniques. Evidence concerning the effects and feasibility of these developments is expected from current intervention studies. $\textbf {Future studies}$ are encouraged to examine whether the developed interventions are also effective when offered by trained physiotherapists or physicians in primary care.$\textbf {Psychosoziale Interventionen}$ haben sich im Rahmen der Behandlung von Rückenschmerzen als ein fester Bestandteil etabliert und eine Vielzahl von Literaturübersichten zeigt ihre Effektivität. In Bezug auf die speziellen Aspekte von Leistungssportlern und -sportlerinnen mit Rückenschmerzen und die Effektivität von psychosozialen Maßnahmen im Rahmen ihrer Behandlung ist die Forschungslage jedoch schwach. $\textbf {Daher beschreibt}$ der vorliegende Beitrag auf Basis eines biopsychosozialen Paradigmas vier Interventionsansätze mit spezifischer Ausrichtung auf 1) die Schmerzbewältigung und das Schmerzmanagement, 2) die Körpererfahrung und das Körperkonzept, 3) die Motivation und die Selbstregulation und 4) das Stressmanagement und die Erholung von Sportlern und Sportlerinnen. $\textbf {Für jede der vier Ausrichtungen}$ wird eine kurze Übersicht über die Forschung und bestehende Interventionsansätze gegeben. Basierend auf diesen Übersichten werden spezifische Interventionsansätze dargestellt, die von den Autorinnen und Autoren entwickelt wurden. Diese Interventionsansätze zielen insbesondere darauf ab 1) die körperliche und soziale Aktivität zu erhöhen während Schmerzen und Einschränkungen verringert werden, 2) die Konzentration auf positive Aspekte der Körpererfahrung zu lenken, 3) die Selbstwirksamkeitserwartung und intrinsische Motivation für die Rehabilitation zu erhöhen und 4) individuelle Erholungsmaßnahmen sowie Entspannungstechniken zu fördern und zu begleiten. Belege hinsichtlich der Effekte und Umsetzbarkeit dieser Interventionsansätze werden von aktuell laufenden Studien erwartet. Zukünftige Studiensollen darüber hinaus zeigen, ob die Interventionen auch effektiv sind, wenn sie durch ausgebildete Therapeutinnen und Therapeuten eingesetzt werden

Elucidating the burden of recurrent and chronic digital ulcers in systemic sclerosis: long-term results from the DUO Registry

Objectives Digital ulcers (DUs) occur in up to half of patients with systemic sclerosis (SSc) and may lead to infection, gangrene and amputation with functional disability and reduced quality of life. This study has elucidated the burden of SSc-associated DUs through identification of four patient categories based on the pattern of DU recurrence over a 2-year observation period.Methods Patients with SSc-associated DUs enrolled in the Digital Ulcers Outcome Registry between 1 April 2008 and 19 November 2013, and with 2years of observation and 3 follow-up visits during the observation period were analysed. Incident DU-associated complications were recorded during follow-up. Work and daily activity impairment were measured using a functional assessment questionnaire completed by patients after the observation period. Potential factors that could predict incident complications were identified in patients with chronic DUs.Results From 1459 patients, four DU occurrence categories were identified: 33.2% no-DU; 9.4% episodic; 46.2% recurrent; 11.2% chronic. During the observation period, patients from the chronic category had the highest rate of incident complications, highest work impairment and greatest need for help compared with the other categories. Independent factors associated with incident complications included gastrointestinal manifestations (OR 3.73, p=0.03) and previous soft tissue infection (OR 5.86, p=0.01).Conclusions This proposed novel categorisation of patients with SSc-associated DUs based on the occurrence of DUs over time may help to identify patients in the clinic with a heavier DU burden who could benefit from more complex management to improve their functioning and quality of life