Demirkaya, Erkan

Polat, Adem

Özçakar, Levent

English

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Western University Scholarship@Western Paediatrics Publications Paediatrics Department 7-1-2013 Musculoskeletal ultrasound for enhancing pediatric rheumatology: Comment on the article by mcalindon et al Adem Polat Gulhane Military Medical Academy Erkan Demirkaya Gulhane Military Medical Academy, erkan.demirkaya@lhsc.on.ca Levent Özçakar Hacettepe Üniversitesi Follow this and additional works at: https://ir.lib.uwo.ca/paedpub Citation of this paper: Polat, Adem; Demirkaya, Erkan; and Özçakar, Levent, "Musculoskeletal ultrasound for enhancing pediatric rheumatology: Comment on the article by mcalindon et al" (2013). Paediatrics Publications. 1128. https://ir.lib.uwo.ca/paedpub/1128 DOI 10.1002/acr.21960ReplyTo the Editor:We read the comments by Navarrete-Navarrete et al re-garding our article investigating how self-efficacy for paincontrol and pain catastrophizing are related to pain, stiff-ness, fatigue, and psychological distress in patients withSLE. Navarrete-Navarrete et al directed readers to theirimportant study regarding the role of high levels of chronicstress experienced by SLE patients in relevant SLE out-comes (1) as well as an interesting intervention trial in SLEpatients (2).Navarrete-Navarrete et al conducted a study suggestingthat high levels of daily stress, although not stressful lifeevents, were associated with an exacerbation of SLE symp-toms (1). Subsequently, the authors carried out a ran-domized controlled trial examining the efficacy of CBT forcoping with chronic stress in patients with SLE (2). In thistrial, 45 patients with SLE and high levels of daily stresswere randomized to either a group receiving 10 consecu-tive weekly sessions of CBT for coping with chronic stressor a control group. The authors examined posttreatmentoutcomes over the next year and found that participants inthe CBT intervention group reported decreased levels ofdepression, anxiety, and daily stress compared to partici-pants in the control group. Participants in the CBT stresscoping intervention group also demonstrated significantimprovements in QOL and somatic symptoms includingpain compared to the control group. No differences be-tween the groups were found for immunologic measures.Our study specifically examined how the pain copingcognitions (i.e., self-efficacy for pain control and pain cata-strophizing) of the SLE patients were related to physicalsymptoms and psychological distress in patients with SLE.We found that pain coping cognitions were related to pain,stiffness, fatigue, and mood even after controlling for age,race, and disease activity. In our article, we suggested thatshifting the treatment of SLE patients from a traditionalapproach with medication (e.g., immunosuppressive ther-apy) to a multidisciplinary approach that includes treat-ments addressing pain cognitions may have an importantand positive impact on SLE outcomes. The application ofa tailored pain coping skills training (PCST) (3) protocolthat aims to increase self-efficacy for pain control anddecrease pain catastrophizing may be particularly benefi-cial for these patients.A PCST protocol tailored for SLE patients would focuson enhancing the ability of these patients to manage theirpain and decrease their negative pain coping strategies(i.e., pain catastrophizing). We hypothesize that such aPCST protocol would result in increased self-efficacy forpain control, decreased pain catastrophizing, decreasedpain, and increased physical and psychological function-ing. The CBT stress coping protocol that targeted decreasesin daily stress that Navarrete-Navarrete et al tested pro-duced significant reductions in pain, depression, anxiety,and daily stress as well as somatic symptoms.It would be interesting to compare the efficacy of atailored PCST protocol to the CBT-based chronic stresscoping protocol proposed by Navarrete-Navarrete et al (4)in patients with SLE. Both protocols may be effective fortreating certain physical symptoms and psychological dis-tress, although the degree of improvement may vary; itremains unknown whether the CBT-based chronic stresscoping protocol would impact important pain coping cog-nitions. Another important aim of future work would beto examine how pretreatment individual factors (e.g., age,disease severity, pain levels, and daily stressors) moderatethe impact of such intervention protocols on importantoutcomes. For instance, SLE patients who have high levelsof pain and/or pain catastrophizing but limited levels ofdaily stress may benefit most from a PCST protocol, whileSLE patients with low levels of pain catastrophizing buthigh levels of daily stress may benefit from a CBT-basedprotocol focused on coping with chronic stress. In anotherinstance, patients with moderate levels of both pain cata-strophizing and daily stress may benefit from a combina-tion of these intervention protocols.We appreciate the interest by Navarrete-Navarrete et alin our work and their comments. We plan to move forwardby examining CBT-based pain interventions in patientswith SLE and will certainly use their findings to informand advance our future work.Tamara J. Somers, PhDPreethi C. Kurakula, MDLisa Criscione-Schreiber, MDFrancis J. Keefe, PhDMegan E. B. Clowse, MD, MPHDuke University Medical CenterDurham, NC1. Peralta-Ramirez MI, Jimenez-Alonso J, Godoy-Garcia JF,Perez-Garcia M, for the Group Lupus Virgen de las Nieves. Theeffects of daily stress and stressful life events on the clinicalsymptomatology of patients with lupus erythematosus. Psy-chosom Med 2004;66:788–94.2. Navarrete-Navarrete N, Peralta-Ramirez MI, Sabio-Sanchez JM,Coin MA, Robles-Ortega H, Hidalgo-Tenorio C, et al. Efficacy ofcognitive behavioural therapy for the treatment of chronicstress in patients with lupus erythematosus: a randomizedcontrolled trial. Psychother Psychosom 2010;79:107–15.3. Keefe FJ, Caldwell DS, Williams DA, Gil KM, Mitchell D,Robertson C, et al. Pain coping skills training in the manage-ment of osteoarthritic knee pain: a comparative study. BehavTher 1990;21:49–62.4. Navarrete-Navarrete N, Peralta-Ramirez MI, Sabio JM,Martinez-Egea I, Santos-Ruiz A, Jimenez-Alonso J. Quality-of-life predictor factors in patients with SLE and their modifi-cation after cognitive behavioural therapy. Lupus 2010;19:1632–9.DOI 10.1002/acr.21972Musculoskeletal ultrasound for enhancingpediatric rheumatology: comment on thearticle by McAlindon et alTo the Editor:We read with great interest the article by McAlindon etal published recently in Arthritis Care & Research (1). Theuse of musculoskeletal ultrasound (US) has tremendouslyLetters 1205enhanced the field of rheumatology in the past 2 decades(1). Particularly, musculoskeletal US is paramount forthe early diagnosis of various rheumatic diseases and forthe close followup of patients (mainly as an objectivemeans of outcome assessment) during their lengthy treat-ment periods (2). Furthermore, musculoskeletal US haseven been included in the diagnostic criteria for rheuma-toid arthritis, ankylosing spondylitis, and polymyalgiarheumatica (3–5).Musculoskeletal US has some very well-known advan-tages; it is convenient and inexpensive, it does not containradiation, and it readily provides comparative and dy-namic imaging with great comfort for the patient and thephysician alike. Additionally, with techniques such assonopalpation or sonoauscultation, the role of musculo-skeletal US as an extension of the physical examination(its use in musculoskeletal assessment is much like howthe stethoscope is used in a physical examination) has alsobeen noted (6–8). Also noteworthy is that musculoskeletalUS can provide immediate guidance once the need for anytype of intervention (aspiration/injection) has been deter-mined (9).In this regard, especially when considering its advan-tages in terms of radiation exposure (there is none) anddynamic imaging (the extra procedures required for mag-netic resonance imaging in pediatric patients are unneces-sary), one would expect musculoskeletal US to be muchmore commonly used in pediatric rheumatology; however,pertinent studies in the literature suggest the contrary (10–12). In general, the 2 important barriers against the use ofmusculoskeletal US by nonradiologists seem to be the lackof a device to administer musculoskeletal US and the lackof education on how to perform it (13). However, based onour experience organizing the musculoskeletal US work-shops in the previous 2 PRES (Pediatric RheumatologyEuropean Society) fellowship courses in 2009 and 2011,we believe that the former barrier outweighs the latter. Yet,parallel courses (for pediatric rheumatologists) are orga-nized in several meetings because we are aware that, al-though the use of musculoskeletal US in pediatric rheu-matology resembles that in adult rheumatology, there areparticular differences/challenges pertaining to pediatricpatients.In short, we recommend that pediatric rheumatologists(and possibly of the whole field as well) should focus theirattention on the need to expedite the use of musculoskel-etal US in pediatric rheumatology. Aside from initial at-tempts to supply US machines to individual centers, theimmediate agenda should also comprise setting up stan-dardized international approaches to musculoskeletal UStraining and assessment for pediatric rheumatologistsonographers. If the immediate agenda is implementedthis way, we foresee that musculoskeletal US will soonenhance the actual clinical practice of pediatric rheuma-tology, from the perspective of both patients and physi-cians alike.Adem Polat, MDErkan Demirkaya, MDGülhane Military Medical Academyand FMF Arthritis Vasculitis andOrphan Disease Research CenterAnkara, TurkeyLevent Özçakar, MDHacettepe University Medical SchoolAnkara, Turkey1. McAlindon T, Kissin E, Nazarian L, Ranganath V, Prakash S,Taylor M, et al. American College of Rheumatology report onreasonable use of musculoskeletal ultrasonography in rheu-matology clinical practice. Arthritis Care Res (Hoboken) 2012;64:1625–40.2. Wakefield RJ, D’Agostino MA, Naredo E, Buch MH, IagnoccoA, Terslev L, et al. After treat-to-target: can a targeted ultra-sound initiative improve RA outcomes? Ann Rheum Dis 2012;71:799–803.3. Aletaha D, Neogi T, Silman AJ, Funovits J, Felson DT, Bing-ham CO III, et al. 2010 rheumatoid arthritis classificationcriteria: an American College of Rheumatology/EuropeanLeague Against Rheumatism collaborative initiative. ArthritisRheum 2010;62:2569–81.4. Rudwaleit M, van der Heijde D, Landewe R, Akkoc N, BrandtJ, Chou CT, et al. The Assessment of SpondyloArthritis inter-national Society classification criteria for peripheral spondy-loarthritis and for spondyloarthritis in general. Ann RheumDis 2011;70:25–31.5. Dasgupta B, Cimmino MA, Maradit Kremers H, Schmidt WA,Schirmer M, Salvarani C, et al. 2012 classification criteria forpolymyalgia rheumatica: a European League Against Rheuma-tism/American College of Rheumatology Collaborative Initia-tive. Arthritis Rheum 2012;64:943–54.6. Ozcakar L, De Muynck M, Imamura M, Vanderstraeten G.Musculoskeletal ultrasound in PRM: from EURO-MUSCULUStowards WORLD-MUSCULUS. Eur J Phys Rehabil Med 2012;48:649–50.7. Imamura M, Ozcakar L, Fregni F, Hsing WT, Battistella LR.Exploring a long-term global approach for musculoskeletalultrasound training: WORLD-MUSCULUS [letter]. J Rehabil2012;44:991–2.8. Ozcakar L, De Muynck M, Vanderstraeten G. EURO-MUSCULUS-I and -II behind and EURO-MUSCULUS-IIIahead [letter]. J Rehabil Med 2011;43:736.9. De Muynck M, Parlevliet T, De Cock K, Vanden Bossche L,Vanderstraeten G, Ozcakar L. Musculoskeletal ultrasound forinterventional physiatry. Eur J Phys Rehabil Med 2012;48:675–88.10. Tok F, Demirkaya E, Ozcakar L. Musculoskeletal ultrasoundin pediatric rheumatology. Pediatr Rheumatol Online J 2011;9:25.11. Collado P, Jousse-Joulin S, Alcalde M, Naredo E, D’AgostinoMA. Is ultrasound a validated imaging tool for the diagnosisand management of synovitis in juvenile idiopathic arthritis?A systematic literature review. Arthritis Care Res (Hoboken)2012;64:1011–9.12. Ozcakar L, Celebi A, Kara M, Turker T, Polat A, Akse-Onal V,et al. FMF Arthritis Vasculitis and Orphan Disease Researchin Paediatric Rheumatology (FAVOR). Ann Paediatr Rheuma-tol 2012;1:54–7.13. Ozcakar L, Tok F, Kesikburun S, Palamar D, Erden G, UlasliA, et al. Musculoskeletal sonography in physical and rehabil-itation medicine: results of the first worldwide survey study.Arch Phys Med Rehabil 2010;91:326–31.1206 Letters

Musculoskeletal ultrasound for enhancing pediatric rheumatology: Comment on the article by mcalindon et al

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Musculoskeletal ultrasound for enhancing pediatric rheumatology: Comment on the article by mcalindon et al

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