Santa Maria Nuova, Italy
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News Article | April 25, 2017
Site: www.eurekalert.org

Patients who suffer a first broken bone due to underlying osteoporosis are at two- to threefold risk of subsequent fractures -- which can lead to a host of serious outcomes such as pain, disability, loss of quality of life and even premature death. Given this danger, medical guidelines consistently recommend that fracture patients aged 50 or over, receive intervention that includes assessment of bone status and evaluation of fracture risk. However, despite clear medical recommendations, studies have shown that only approximately 20% of fracture patients are offered adequate post-fracture assessment and care. Would it be more effective to empower the patients themselves to demand testing and care? This question was asked by investigators from Lyon, France who set up a multicenter, randomized controlled trial (PREVOST) to evaluate the impact of a post-fracture care program with a dedicated case manager who interacts with the patients. The trial enrolled 436 women, aged 50-85 years, who had attended hospital for treatment of a fragility fracture of the wrist or upper arm. While the control group received the usual care offered by the hospital or clinic, the intervention group also received repeated oral and written information about fragility fractures and osteoporosis management by a case manager. The case manager prompted the patients to visit their primary care physicians to ask for BMD testing and management. Within six months, 53% of the women in the intervention group initiated post-fracture care versus 33% in the control group. The intervention resulted in BMD prescription for 50% of the women, with 41% following through with testing, versus 33% and 25% respectively for the control group. There was only a slight improvement in treatment prescription (13% in the intervention group versus 9%). Only 46% of the women with a low BMD for which treatment would be advised according to French guidelines, actually received treatment prescription -- reflecting the care gap in secondary prevention of osteoporosis that exists in France and worldwide. Lead author Dr Blandine Merle of the Rheumatology Service, University of Lyon, stated: "In France as elsewhere, osteoporosis is underdiagnosed and undertreated -- including in high-risk fracture patients. Our randomized trial demonstrates that directly informing and involving patients in their post-fracture care follow-up, through the intervention of a case manager, can substantially improve the rate of BMD assessment. This type of intervention is easy to set up, relatively inexpensive, and may reach a large number of patients. Although more needs to be done to increase treatment rates and close the care gap, empowering patients to ask for BMD testing is an important first step. " Post-fracture care: do we need to educate patients rather than doctors? The PREVOST randomized controlled trial. Merle, B., Chapurlat, R., Vignot, E., Thomas, T., Haesebaert, J., Schott, AM., Osteoporos Int (2017) 28: 1549. doi:10.1007/s00198-017-3953-z https:/


News Article | April 25, 2017
Site: www.sciencedaily.com

Patients who suffer a first broken bone due to underlying osteoporosis are at two- to threefold risk of subsequent fractures -- which can lead to a host of serious outcomes such as pain, disability, loss of quality of life and even premature death. Given this danger, medical guidelines consistently recommend that fracture patients aged 50 or over, receive intervention that includes assessment of bone status and evaluation of fracture risk. However, despite clear medical recommendations, studies have shown that only approximately 20% of fracture patients are offered adequate post-fracture assessment and care. Would it be more effective to empower the patients themselves to demand testing and care? This question was asked by investigators from Lyon, France who set up a multicenter, randomized controlled trial (PREVOST) to evaluate the impact of a post-fracture care program with a dedicated case manager who interacts with the patients. The trial enrolled 436 women, aged 50-85 years, who had attended hospital for treatment of a fragility fracture of the wrist or upper arm. While the control group received the usual care offered by the hospital or clinic, the intervention group also received repeated oral and written information about fragility fractures and osteoporosis management by a case manager. The case manager prompted the patients to visit their primary care physicians to ask for BMD testing and management. Within six months, 53% of the women in the intervention group initiated post-fracture care versus 33% in the control group. The intervention resulted in BMD prescription for 50% of the women, with 41% following through with testing, versus 33% and 25% respectively for the control group. There was only a slight improvement in treatment prescription (13% in the intervention group versus 9%). Only 46% of the women with a low BMD for which treatment would be advised according to French guidelines, actually received treatment prescription -- reflecting the care gap in secondary prevention of osteoporosis that exists in France and worldwide. Lead author Dr Blandine Merle of the Rheumatology Service, University of Lyon, stated: "In France as elsewhere, osteoporosis is underdiagnosed and undertreated -- including in high-risk fracture patients. Our randomized trial demonstrates that directly informing and involving patients in their post-fracture care follow-up, through the intervention of a case manager, can substantially improve the rate of BMD assessment. This type of intervention is easy to set up, relatively inexpensive, and may reach a large number of patients. Although more needs to be done to increase treatment rates and close the care gap, empowering patients to ask for BMD testing is an important first step. "


PubMed | Pfizer, National Autonomous University of Mexico, Rheumatology Service, Hospital Clinic Of Barcelona and 2 more.
Type: Journal Article | Journal: Pain medicine (Malden, Mass.) | Year: 2016

To assess the transcultural equivalency of the Spanish version of the Fibromyalgia Rapid Screening Tool (FiRST) and its discriminatory ability in different Latin American samples.Validation study.Departments of Rheumatology in general hospitals and private centers; fibromyalgia unit in a university hospital.350 chronic pain patients from Spain, Argentina, Mexico, Peru, and Ecuador.The cultural relevance of the Spanish version of the FiRST was evaluated. The ability of the FiRST as a screening tool for fibromyalgia was assessed by logistic regression analysis. To determine the degree to which potential confounders, such as differences in demographics, pain, affective distress, catastrophizing, and disability, might affect the discriminatory ability, the tool was reassessed by hierarchical multivariate logistic regression.Slightly different versions of the FiRST were recommended for use in each Latin American subsample. The FiRST showed acceptable criterion validity and was able to discriminate between fibromyalgia and non-fibromyalgia patients even after controlling for the effect of potential confounders. However, low specificities were observed in samples from Spain and Mexico.The Spanish version of the FiRST may be used as a screening tool for fibromyalgia in several Latin American subsamples, even in those patients with high scores on potential confounders. In Spain and Mexico, the low specificity of the FiRST suggests, however, that it would be best used to support a suspected diagnosis of fibromyalgia, rather than to exclude the diagnosis.


Mateo L.,Rheumatology Service | Massuet A.,Magnetic Resonance | Sola M.,Nuclear Medicine Service | Perez Andres R.,Radiology | And 2 more authors.
Clinical Rheumatology | Year: 2011

Brown tumors (BT) are benign focal bone lesions that may appear in the context of primary and secondary hyperparathyroidism (HPT). Involvement of the spine is exceedingly rare. We present a case of brown tumor involving the cervical spine, the third reported in the literature. In the literature review (until August 2010), we found nine cases of spinal BT in primary HPT and 14 cases in secondary HPT. Fifteen patients (65%) had evidence of spinal cord compression. A 34-year-old woman on long-term hemodialysis, with secondary HPT, presented with a 9-month history of persistent neck pain. Radiographs of the cervical spine revealed an expansive osteolytic lesion in the posterior arch of the second cervical vertebra. MR imaging revealed an expansive mass on C2 affecting the vertebral body, odontoid process, right pedicle, laminas, and spinous process; there were no signs of spinal edema. A CT-guided needle biopsy of the lesion showed destruction of trabecular bone, infiltration of the fibroblastic cells, and abundant osteoclast-like multinucleated giant cells with hemorrhage and hemosiderin pigment, and the diagnosis of brown tumor was made. Cervical pain disappeared within a few days of parathyroidectomy, and rapid remineralization of C2 was evident within a few months. BT must always be considered in the context of hyperparathyroidism and osteolytic lesions. Vertebral BT can be particularly devastating due to medullar compression symptoms. Regression or complete disappearance of these lesions after parathyroidectomy is common, but prompt surgical decompression is necessary in case of medullar compression symptoms. © 2010 Clinical Rheumatology.


Schestatsky P.,Neurology Service | Felix-Torres V.,Neurology Service | Fagundes Chaves M.L.,Neurology Service | Camara-Ehlers B.,Neurology Service | And 4 more authors.
Pain Medicine | Year: 2011

Background. Neuropathic pain (NP) is a very frequent and unrecognized condition in clinical practice. Therefore, it is important to have a reliable instrument to assess pain subtypes in various cultures. The Leeds Assessment of Neuropathic Symptoms and Signs (LANSS) has been widely used and validated in many countries. Up to now, there has been no reliability study of this instrument in Brazil. Methods. The scores of the Brazilian Portuguese version of the LANSS were studied in a sample of 90 chronic pain outpatients from southern Brazil. LANSS was translated into Portuguese and then back translated to English. Intraclass correlation coefficient (ICC) and internal consistency (IC) were estimated. The intensity of pain complaints, other demographic data, and LANSS scores distribution according to pain subtypes (nociceptive, neuropathic, and mixed) were also evaluated. Results. The Brazilian Portuguese version of the LANSS showed good ICC (r=0.97) and IC (Cronbach's α=0.67 for total LANSS score). Patients with NP provided significant higher LANSS scores (19.1±3.3) in comparison with those with nociceptive (7.3±4.5) and mixed (13.9±3.7) types of pain. Conclusions. This LANSS version was found to be a reliable instrument for the evaluation of pain complaints due to a variety of causes. The profile of pain scores was similar to that observed in other countries. Wiley Periodicals, Inc.


Casanueva-Fernandez B.,Rheumatology Service at the Specialist Clinic of Cantabria | Llorca J.,University of Cantabria | Rubio J.B.I.,Rheumatology Service | Rodero-Fernandez B.,Centro Rodero | Gonzalez-Gay M.A.,Hospital Universitario Marques Of Valdecilla
Rheumatology International | Year: 2012

The purpose of this study was to evaluate the efficacy of a multidisciplinary treatment program in patients severely affected by fibromyalgia. Thirty-four fibromyalgia patients were randomly divided into two groups. The control group: 17 women who continued their medical treatment and participated in four educational sessions and the experimental group that included 17 patients who besides the former medical treatment also underwent a weekly 1-h session program for 8 weeks including massage therapy, ischemic pressure on the 18 tender points, aerobic exercise and thermal therapy. At the beginning of the program, there were no significant differences between the two groups in any of the parameters. At the end of treatment, there was a significant improvement in the experimental group in the following items: vitality, social functioning, grip strength and the 6-min walk test. At 1 month after the end of treatment, the experimental group showed significant differences in overall health perception, social functioning, grip strength and the 6-min walk test. At that time, considering the threshold for clinical efficacy set at an improvement of 30% or above for the analyzed variables, 25% of the patients met the requirement for improvement of the following: number of symptoms: Visual Analogic Scale for fatigue, Fibromyalgia Impact Questionnaire and Beck Anxiety Inventory. In conclusion, patients with severe manifestations of fibromyalgia can obtain improvement with a short-term, low-cost and simple-delivery multidisciplinary program. However, additional studies including higher numbers of patients are needed to confirm the beneficial effect of this treatment program. © Springer-Verlag 2011.


Bono A.E.,National University of La Plata | Learreta J.A.,Argentine Society for Orthodontics | Rodriguez G.,Rheumatology Service | Marcos J.C.,Rheumatology Service | Marcos J.C.,National University of La Plata
Cranio - Journal of Craniomandibular Practice | Year: 2014

Aims: Temporomandibular joint (TMJ) and stomatognathic system involvement are usually observed during the course of rheumatoid arthritis. Methodology: This article presents the findings during examination of 190 TMJs from rheumatoid arthritis (RA) patients, and 44 TMJs from controls without RA, including a description of signs and symptoms related to the stomatognathic system, radiological findings in hands-, and TMJ, erythrocyte sedimentation rate (ESR) values, and scores obtained in the Disease Activity Score (Das 28) and the Health Assessment Questionnaire (HAQ). Results: The sample included 57.89% TMJs associated with spontaneous pain, 87.89% with signs of destruction in radiological images, and 58.94% with 20 teeth or less. Restricted mouth opening was detected in 42.1% of RA patients, from which 71% had blocked opening; headache was present in 58%, and pain in the masticatory muscles was found in 57%. TMJ erosions had a significant association with Larsen scores (r50.62), but not with the Das 28, HAQ, and ESR values. Conclusions: The early evaluation of this joint and the collaborative work of odontologists and rheumatologists are both necessary for a better management of TMJ pathologies. © W. S. Maney & Son Ltd 2014.


Colina M.,Rheumatology Service | Trotta F.,University of Ferrara
Current Rheumatology Reviews | Year: 2013

The peculiar bone involvement, represented by osteitis, is the common denominator of SAPHO syndrome. Hyperostosis and osteitis are chronic inflammatory reactions involving the cortical and trabecular bone respectively; both are characterised by increased sclerosis. Hyperostosis appears radiologically as chronic endosteal and periosteal thickening with narrowing of the medullary canal, but areas of ostelysis may also be present. Conversely, osteitis appears as increased osteosclerosis involving the trabecular infrastructure of cancellous bone. The occurrence of hyperostosis with little or no osteitis is not uncommon. SAPHO syndrome may have a prolonged course with phases of reacutization and remission; the long-term prognosis is usually fairly good, but sometimes a disabling course may occur. Our experience demonstrated that the majority of patients suffering from SAPHO syndrome experienced a chronic course, requiring continous treatment, whilst in a third of the cases the patients reported multiple remission and exacerbations of the disease with flares lasting till to 8 months. Only in a minority of cases the bone inflammation faded and never recurred. Female sex, peripheral arthritis, ACW involvement, the coexistence of more than one cutaneous symptoms, and high inflammatory indices are correlated with a chronic disease course and involvement of new osteoarticular sites. © 2013 Bentham Science Publishers.


Vaglio A.,University of Parma | Palmisano A.,University of Parma | Alberici F.,University of Parma | Maggiore U.,University of Parma | And 6 more authors.
The Lancet | Year: 2011

Glucocorticoids are the mainstay of treatment of idiopathic retroperitoneal fibrosis, but they often have substantial toxic effects. Several reports have suggested tamoxifen as an alternative to glucocorticoids. We compared the efficacy of prednisone with that of tamoxifen in maintainance of remission in patients with idiopathic retroperitoneal fibrosis. In this open-label, randomised controlled trial, we enrolled patients aged 18-85 years with newly diagnosed idiopathic retroperitoneal fibrosis at the Parma Hospital, Parma, Italy, between Oct 1, 2000, and June 30, 2006. After induction therapy with 1 mg/kg daily of prednisone for 1 month, the patients who achieved remission were randomly assigned to receive tapering prednisone (initial dose 0·5 mg/kg daily) for 8 months or tamoxifen (fixed dose 0·5 mg/kg daily) for 8 months. The sequence of randomisation (1:1), blocked in groups of two and four (with block size randomly selected), was generated by the trial statistician with a computer programme. After the end of treatment, the patients were followed up for an additional 18 months. Neither patients nor those giving interventions or analysing the data were masked to group assignment. The two radiologists who assessed CT and MRI scans were masked. The primary endpoint was the relapse rate by the end of treatment (month 8), which was analysed by intention to treat. This trial is registered with ClinicalTrials.gov, number NCT00440349. After induction therapy, 36 of the 40 enrolled patients achieved remission and were randomly assigned to treatment (18 per group). One patient (6) in the prednisone group and seven patients (39) in the tamoxifen group relapsed by the end of treatment (difference -33 [95 CI -58 to -8, p=0·0408]. The difference in relapse rate between the groups was sustained after the additional 18-month follow-up: the 26-month estimated cumulative relapse probability was 17 with prednisone and 50 with tamoxifen (difference -33 [-62 to -3, p=0·0372]). Cushingoid changes and grade 2 hypercholesterolaemia were more common in the prednisone group than in the tamoxifen group (p=0·0116 and p=0·0408, respectively). Prednisone is more effective in prevention of relapses than is tamoxifen in patients with idiopathic retroperitoneal fibrosis. Therefore, prednisone should be considered as first-line treatment for patients with newly diagnosed idiopathic retroperitoneal fibrosis. Parma University Hospital. © 2011 Elsevier Ltd.


PubMed | Rheumatology Service, University of Glasgow and National Ankylosing Spondylitis Society
Type: Journal Article | Journal: BMC musculoskeletal disorders | Year: 2016

Evidence suggests people with axial spondyloarthritis (axial SpA) should exercise up to five times per week but lack of time, symptoms, cost and distance are barriers to regular exercise in axial SpA. Personalised exercise programmes delivered via the internet might support people with axial SpA to reach these exercise targets. The aim of this study is to investigate the effect of, and adherence to, a 12month personalised web-based physiotherapy programme for people with axial SpA.Fifty people with axial SpA will be recruited to this prospective, interventional cohort study. Each participant will be assessed by a physiotherapist and an individualised exercise programme set up on www.webbasedphysio.com . Participants will be asked to complete their programme five times per week for 12months. With the exception of adherence, data will be collected at baseline, 6 and 12months.The primary outcome measure is adherence to the exercise programme over each four week cycle (20 sessions maximum per cycle) and over the 12months. Secondary measures include function (BASFI), disease activity (BASDAI), work impairment (WPAI:SpA), quality of life (ASQoL, EQ5D), attitude to exercise (EMI-2, EAQ), spinal mobility (BASMI), physical activity and the six minute walk test. Participants will also be interviewed to explore their adherence, or otherwise, to the intervention. This study will determine the adherence and key clinical outcomes of a targeted web-based physiotherapy programme for axial SpA. This data will inform clinical practice and the development and implementation of similar programmes.ClinicalTrials.gov: NCT02666313 , 20th January 2016.

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