Rheumatic diseases

Originally published as © Vasquez A. Microbial Origins of Fibromyalgia. Naturopathic Doctor News and Reviews 2016 Apr ndnr.com/pain-medicine/microbial-origins-of-fibromyalgia derived from Inflammation Mastery, 4th Edition excerpted as Pain Revolution (full-color) and Brain Inflammation (discounted grayscale printing). Copyright © 2014-present by Dr Alex Vasquez https://www.InflammationMastery.com/fibromyalgia 
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A large quantity of research concerning issues of patient compliance with medications has been produced in recent years. The assumption in much of this work is that patients have little option but to comply with the advice and instructions they receive. Studies have shown, however, that between one third and one half of all patients are non-compliant, but different authors cite different reasons for this high level of non-compliance. In this paper, the concept of compliance is questioned. It is shown to be largely irrelevant to patients who carry out a 'cost-benefit' analysis of each treatment, weighing up the costs/risks of each treatment against the benefits as they perceive them. Their perceptions and the personal and social circumstances within which they live are shown to be crucial to their decision-making. Thus an apparently irrational act of non-compliance (from the doctor's point of view) may be a very rational action when seen from the patient's point of view. The solution to the waste of resources inherent in non-compliance lies not in attempting to increase patient compliance per se, but in the development of more open, co-operative doctor-patient relationships.

Worldwide, osteoarthritis (OA) is estimated to be the fourth leading cause of disability. Most of this disability burden is attributable to the involvement of the hips or the knees. OA is strongly associated with ageing and the Asian region is ageing rapidly. Further, OA has been associated with heavy physical occupational activity, a required livelihood for many people living in rural communities in developing countries. Unfortunately, joint replacement surgery, an effective intervention for people with severe OA involving the hips or knees, is inaccessible to most people in these regions. On the other hand, obesity, another major risk factor, may be less prevalent, although it is on the increase. Determining region-specific OA prevalence and risk factor profiles will provide important information for planning future cost-effective preventive strategies and health care services. An update of what is currently known about the prevalence of hip and knee OA from population-based studies conducted in the Asian region is presented in this review. Many of the recent studies have conducted comparisons between urban and rural areas and poor and affluent communities. The results of Asian-based studies evaluating risk factors from population-based cohorts or case-control studies, and the current evidence on OA morbidity burden in Asia is also outlined.

Ethnopharmacological relevance: From the 16th up into the 18th century botanical and medicinal knowledge in Europe was documented and spread in magnificently illustrated herbals. For the most part modern science has neglected this source of knowledge and old remedies have not been systematically evaluated pharmacologically. Aim of the study: Rheumatic disorders and chronic inflammatory and degenerative diseases of the musculoskeletal system were chosen in an attempt to discuss remedies described in the old herbals in the viewpoint of modern science. Materials and methods: Five of the most important European herbals of the 16th and 17th century were searched for terms related to rheumatic diseases, and plants and recipes described for their treatment. An extensive search of the scientific data banks Medline and SciFinder scholar was done to find recent results concerning the phytochemistry and possible antiphlogistic activities of the plants.

Background: Osteoarthritis (OA) is a cartilage degenerative process, involving the immune system, producing local inflammatory reactions, with production of pro-inflammatory cytokines and metalloproteinases. No treatment is still available to improve or reverse the process. Stem cell therapy opened new horizons for treatment of many incurable diseases. Mesenchymal stem cells (MSCs) due to their multi-lineage potential, immunosuppressive activities, limited immunogenicity and relative ease of growth in culture, have attracted attentions for clinical use.

Arthritis is the leading cause of chronic illness in the United States. Seventy-two percent of the adults aged 55 years and older with arthritis report sleep difficulties. This review discusses sleep disorders associated with rheumatoid arthritis, juvenile rheumatoid arthritis, Sjogren's syndrome, systemic lupus erythematosus, scleroderma, Behcet's disease, seronegative spondyloarthropathies, osteoarthritis, sarcoidosis, and fibromyalgia. We describe the inter-relationship between sleep complaints, disease activity, depression, sleep deprivation, and cytokines. An algorithm for evaluation and treatment of sleep disorders associated with rheumatologic diseases is proposed.

Documento SER de consenso sobre el uso de terapias biológicas en la espondilitis anquilosante y otras espondiloartritis, excepto la artritis psoriásica información del artículo Historia del artículo: Recibido el 23 de noviembre de 2010 Aceptado el 10 de diciembre de 2010

Chronic inflammation is a common feature shared by several autoimmune rheumatic diseases, such as rheumatoid arthritis, systemic lupus erythematosus, idiopathic inflammatory myopathies, systemic sclerosis, and ankylosing spondylitis. Therefore, blocking or reducing inflammation is one of the major treatment strategies in these diseases. In this context, exercise training has emerged as a potential therapeutic tool in counteracting systemic inflammation, thereby leading to better clinical outcomes. The aims of this review are i) to provide a summary of the clinical effects of exercise training in selected autoimmune rheumatic diseases; and ii) to discuss the potential anti-inflammatory role of exercise training in autoimmune rheumatic diseases, stressing the gaps in literature and the clinical and scientific perspectives in the field.

Sarcoidosis is a systemic, clinically heterogeneous disease characterized by the development of granulomas. Any organ system can be involved, and patients may present with any number of rheumatologic symptoms. There are no U.S. Food and Drug Administration-approved therapies for the treatment of sarcoidosis. Diagnosing sarcoidosis becomes challenging, particularly when its complications cause patients' symptoms to mimic other conditions, including polymyositis, Sjögren syndrome, or vasculitis. This review presents an overview of the etiology of and biomarkers associated with sarcoidosis. We then provide a detailed description of the rheumatologic manifestations of sarcoidosis and present a treatment algorithm based on current clinical evidence for patients with sarcoid arthritis. The discussion will focus on characteristic findings in patients with sarcoid arthritis, osseous involvement in sarcoidosis, and sarcoid myopathy. Arthritic conditions that sometimes coexist with sarcoidosis are described as well. We present two cases of sarcoidosis with rheumatologic manifestations. Our intent is to encourage a multidisciplinary, translational approach to meet the challenges and difficulties in understanding and treating sarcoidosis.

Inflammatory bowel disease (IBD) is associated with a variety of extraintestinal manifestations (EIMs) that may produce greater morbidity than the underlying intestinal disease and may even be the initial presenting symptoms of the IBD. As many as 36% of patients with IBD have at least one EIM. Some are more common related to active colitis (joint, skin, ocular, and oral manifestations). Others are especially seen with small bowel dysfunction (cholelithiasis, nephrolithiasis, and obstructive uropathy), and some are nonspecific disorders (osteoporosis, hepatobiliary disease, and amyloidosis). Patients with perianal Crohn's disease are at higher risk for developing EIMs than other IBD patients. Also the presence of one EIM appears to confer a higher likelihood of developing other manifestations than would be expected by chance alone. The identified pathogenetic autoimmune mechanisms include genetic susceptibility antigenic display of autoantigen, aberrant self-recognition, and immunopathogenetic autoantibodies against organ-specific cellular antigen(s) shared by colon and extra-colonic organs. Microbes may play an important role, probably by molecular mimicry. Early recognition of these extraintestinal manifestations should help guide therapy that will reduce overall morbidity in affected patients. This paper reviews the diagnosis, therapy and management of the more common EIMs.

To develop components of a multidimensional Health Assessment Questionnaire (MDHAQ) through the addition of new items in the "patient-friendly" HAQ format, including advanced activities of daily living (ADL), designed to overcome "floor effects" of the HAQ and modified HAQ (MHAQ) in which patients may report normal scores although they experience meaningful functional limitations, and psychological items, designed to screen efficiently for psychological distress in routine care.

The Secure Hash Algorithm is one of the most commonly used hashing algorithms on the time being. Experts are proposing for much secured SHA-1 because of some reports and study conducted on SHA-1 collision attacks. The aim of the enhanced Secure Hash Algorithm-1 (SHA-1) is to strengthen its original version that is expected to resist possible SHA-1 collision attacks. The enhanced SHA-1 had integrated the following modification: 1) Enhancement on the preprocessing, specifically on the parsing method. 2) The message digest and the final message digest formula was enhanced by giving additional shifting, xoring and improved mathematical formula. The enhanced SHA-1 maintains its original rounds which consist of 80 rounds and message digest output of 160 bit. Based from the result, the enhanced algorithm specifically on mathematical calculation of parsing method and message digest had shown great effects on its result on the hash value despite of a very minimal time delay, the enhanced algorithm is better and more secure.

To evaluate the reliability and validity of the Brazilian version of the Pediatric Quality of Life Inventory (PedsQL 4.0) Generic Core Scales and measure the quality of life of healthy children and adolescents and patients with rheumatic diseases. We followed the translation methodology proposed by the developer of the original English version of the PedsQL 4.0. The instrument was administered by interviews in two groups: 240 apparently healthy children and adolescents from São Paulo (SP, Brazil) and 105 patients with chronic rheumatic diseases matched by age, as well as their respective parents or caregivers. The parent proxy-report was administered to the children's parents or caregivers separately on the same day. Cronbach's alpha values were between 0.6 and 0.9 for all dimensions, demonstrating adequate internal consistency. Patients with rheumatic diseases reported significantly lower PedsQL scores on all dimensions when compared to the healthy control group (p < 0.0...

Enthesopathies-that is, ''musculo-skeletal stress markers''-are frequently used to reconstruct past lifestyles and activity patterns. Relatively little attention has been paid in physical anthropology to methodological gaps implicit in this approach: almost all methods previously employed neglect current medical insights into enthesopathies and the distinction between healthy and pathological aspects has been arbitrary. This study presents a new visual method of studying fibrocartilaginous enthesopathies of the upper limb (modified from Villotte: Bull Mém Soc Anthropol Paris n.s. 18 (2006) 65-85), and application of this method to 367 males who died between the 18th and 20th centuries, from four European identified skeletal collections: the Christ Church Spitalfields Collection, the identified skeletal collection of the anthropological museum of the University of Coimbra, and the Sassari and Bologna collections of the mu-Grant sponsors: Maison des Sciences de l'Homme d'Aquitaine; Ministère de la culture, France (Projet Aires Culturelles) Synthesys Project. *Correspondence to: Sébastien Villotte, Laboratoire d'Anthropologie des Populations du Passé (LAPP, UMR 5199), in Wiley InterScience (www.interscience.wiley.com).

Ultrasound (US) is a noninvasive imaging technique that continues to gain interest among rheumatologists because of its undoubted utility for the assessment of a wide range of abnormalities in rheumatic diseases. It also has a great potential to be used at the time of consultation as an extension of the clinical examination. Current data demonstrate that the standard clinical approach could result in an insensitive assessment of some the different aspects of the various rheumatic diseases for which US has become a feasible and effective imaging modality that allows early detection of anatomical changes, careful guidance for the aspiration and/or local treatment, and short-and long-term therapy monitoring at the joint, tendon, enthesis, nail, and skin levels. The spectrum of pathological conditions for which US plays a crucial role continues to increase over time and includes rheumatoid arthritis, spondyloarthropathies, osteoarthritis, crystal-related arthropathies, connective tissue...

Objectives: To present the systematic literature review (SLR), which formed the basis for the European League Against Rheumatism (EULAR) evidence-based recommendations for vaccination in adult patients with autoimmune inflammatory rheumatic diseases (AIIRD). Methods: AIIRD, vaccines and immunomodulating drugs, as well as eight key questions were defined by the multidisciplinary expert committee commissioned by EULAR for developing the recommendations. A SLR was performed using MedLine through October 2009 and including data from meta-analyses, systematic reviews, randomized trials, and observational studies, excluding case series with ≤ 5 participants. Articles in English and regarding patients ≥ 16 years of age, were eligible. Results: Several vaccine-preventable infections (VPI) occur more often in AIIRD-patients and most vaccines are efficacious in AIIRD-patients, even when treated with immunomodulating agents, except rituximab. There does not appear to be an increase in vaccination-related harms in vaccinated patients with AIIRD in comparison with unvaccinated patients with AIIRD. However, these studies are underpowered and therefore not conclusive. Conclusion: Based on the current evidence from the literature, recommendations for vaccination in patients with AIIRD were made. However, more research is needed in particular regarding incidence of VPI, harms of vaccination and the influence of (new and established) immunomodulating agents on vaccination efficacy.

Les manifestations rhumatologiques de l'hépatite chronique C sont nombreuses : arthralgies, myalgies, arthrites, vascularités, syndromes secs… La présence d'arthralgies est la manifestation extrahépatique la plus fréquente de cette infection et révèle parfois une cryoglobulinémie mixte. Les arthralgies peuvent également être induites par le traitement de l'hépatite par interféron. Les arthrites vraies non liées à une cryoglobulinémie sont en revanche plus rares. Elles sont considérées par plusieurs auteurs comme une entité indépendante et peuvent mimer une polyarthrite rhumatoïde ce d'autant plus que le facteur rhumatoïde est présent dans 50 à 80 % des cas. Les anticorps antipeptides cycliques citrullinés sont le plus souvent négatifs et pourraient aider à distinguer les deux pathologies. Le traitement des arthrites liées au virus C reste empirique et mal codifié. Les corticoïdes à faibles doses, l'hydroxychloroquine et le méthotrexate ont été utilisés avec succès dans plusieurs observations mais il n'existe que peu de données sur leur tolérance hépatique. Les arthrites secondaires à une cryoglobulinémie répondent habituellement au traitement antiviral. Les syndromes secs sont fréquents chez les patients atteints d'hépatite C chronique et en raison des similitudes avec le syndrome de Gougerot-Sjögren primitif, un groupe de travail a récemment proposé d'inclure le virus de l'hépatite C dans les causes secondaires de ce syndrome. Les vascularités décrites en association avec l'hépatite C sont le plus souvent secondaires à une cryoglobulinémie, mais quelques observations de vascularités touchant les vaisseaux de moyen calibre, de type périartérite noueuse ont été rapportées. D'autres associations pathologiques ont également été décrites : fibromyalgies, lupus érythémateux systémiques, syndromes des antiphospholipides, ostéoscléroses.

Objective. The Outcome Measures in Rheumatology (OMERACT) initiative works to develop core sets of outcome measures for trials and observational studies in rheumatology. At the OMERACT 11 meeting, substantial time was devoted to discussing a conceptual framework and a proposal for a more explicit working process to develop what we now propose to term core outcome measurement sets, collectively termed "OMERACT Filter 2.0." Methods. Preconference work included a literature review, and discussion of preliminary proposals through face-to-face discussions and Internet-based surveys with people within and outside rheumatology. At the conference, 5 interactive sessions comprising plenary and small-group discussions reflected on the proposals from the viewpoint of previous and ongoing OMERACT work. These considerations were brought together in a final OMERACT presentation seeking consensus agreement for the Filter 2.0 framework.

Stress resilience factors, and interventions to ease stress and enhance resilience, are gaining increasing attention for the treatment of rheumatic conditions. This Review presents a digest of empirical work on the factors that determine the risk of adapting poorly to a rheumatic condition, and on the resilience factors that counteract such risks. We consider the types of stress-management and resilience

Objective. The Patient Health Questionnaire 9 (PHQ-9) was developed to screen for depressive disorders in community, primary care, and medical settings. We aimed to estimate its diagnostic accuracy, internal consistency, reliability, and convergent validity in diagnosing major depressive disorder (MDD) in Greek patients with rheumatologic disorders. Methods. In a 2-phase sampling design study, we recruited 475 patients with established rheumatologic disorders. One of 2 of the high scorers (PHQ-9 score >9, n ‫؍‬ 85) and 1 of 3 of the low scorers (PHQ-9 score 0 -8, n ‫؍‬ 128) were interviewed using the Mini International Neuropsychiatric Interview to confirm MDD. A receiver operator characteristic curve analysis was performed to confirm the optimum threshold value. The scale's dimensional structure was tested with factor analysis, and internal consistency reliability was assessed with Cronbach's alpha.

Vitamin D is known for its role in calcium homeostasis for optimal skeletal health. It was previously believed that only elderly or hospitalized patients were at risk for vitamin D insufficiency, but many people in the general US population have insufficient levels of 25-hydroxyvitamin D (25[OH]D). According to the Third National Health and Nutrition Examination Survey, 61% of white and 91% of black Americans suffer from vitamin D insufficiency (25[OH]D < 32 ng/mL). Recent studies have demonstrated that a minimum 25(OH)D level of 32 ng/mL is necessary for optimal protection from fracture and intestinal absorption of calcium. Recently, vitamin D has been recognized as important for extraskeletal functions such as immune function, cancer prevention, and hypertension prevention. We review the role of vitamin D in skeletal health and present data on vitamin D in other extraskeletal diseases, with special emphasis on the rheumatology patient.

Background: Various modifi cations of the Erythrocyte Sedimentation Rate (ESR) determination have been suggested since the original Westergren procedure that has been adopted as the gold standard by the International Council for Standardization in Haematology (ICSH). Recently, an automated method, (Alifax Test 1), based on a technique completely different from Westergren, has been introduced. Material and methods: In this comparative study, ESR of blood from 680 patients with various rheumatic diseases was determined on both Test 1 and the StaRRsed automated ESR analyser which performs measurements in accordance with ICSH specifi cations. Furthermore the robustness of the new technique was evaluated. Results: Direct correlation of Test 1 and StaRRsed measurements confi rmed the results of previous studies: an overall correlation coeffi cient of R ϭ 0.90. However, further statistical analysis showed that, depending on the instrument that was used, in 78 samples (i.e. 11.5%) the results could lead to different treatment suggestions. Furthermore it appeared that several procedural factors could infl uence the fi nal Test 1 outcome. Conclusions: Due to its sensitivity for procedural variations, Test 1 measurements should be carried out under strictly standardized conditions. Especially at the higher ESR levels the Test 1 technique is, however, not a reliable alternative for the ICSH approved 'Westergren' method.

Enthesopathies, in the guise of musculoskeletal skeletal stress markers (MSM), have been widely used to reconstruct activity levels in human skeletal populations. In general, studies have focused on their presence in the upper limb, which is used in the majority of daily activities. The aim of this study was to use some of the attachment sites on the humerus to explore the relationship between enthesopathy formation, activity, and the ageing process. The skeletal sample used in this study comprised male adult skeletons with known age-at-death and known occupations from the late-19th and early-20th century cemeteries in Portugal. The enthesopathies were recorded as either present or absent. Statistical analysis using Fishers exact tests and logistic regression was undertaken to determine whether associations could be found between specific activities or socioeconomic status (manual or nonmanual workers), and age and enthesopathy presence. Left and right sides were analyzed separately. Fisher's exact tests were used to determine the relationship between activity and enthesopathy, and they demonstrated no association between activity and enthesopathies (P > 0.01). The results of the logistic regression established that age was the single most significant factor in enthesopathy formation (P > 0.05). This study found that, in these samples, age-at-death, and therefore age-related degeneration rather than degeneration caused by activities, was the primary cause of enthesopathy formation. Considering the difficulties of reliably ageing adult human skeletal remains, this is a major issue for studies of activity using enthesopathies. Am J Phys Anthropol, 2010. © 2009 Wiley-Liss, Inc.

Although many may think of rheumatology as the study of arthritis, occurring predominantly in older patients, many autoimmune and connective tissue diseases are actually diseases of young and middle-aged women. This article reviews common rheumatic diseases that most frequently occur in women, including fibromyalgia, rheumatoid arthritis (RA), Sjogren's syndrome, systemic lupus erythematosus (SLE), and the antiphospholipid antibody syndrome (APLS). In this group of patients, many women are of childbearing potential, and special considerations for pregnancy can and often do arise; these are discussed as well. In addition, rheumatic conditions that more frequently affect older women, such as osteoarthritis (OA), polymyalgia rheumatica (PMR), and temporal arthritis, are discussed. Osteoporosis, which has been recognized as a significant women's health issue, is reviewed.

There has been an increasing recognition of adverse short-, mid-, or long-term effects associated with the treatment as well as the disease itself that impair the health-related quality of life and functional capacity of children and adolescents with rheumatic diseases. Interestingly, cumulative evidence has suggested that exercise training may benefit patients with juvenile idiopathic arthritis, juvenile systemic lupus erythematosus, juvenile dermatomyositis and juvenile fibromyalgia, attenuating several clinical symptoms related to physical disability. Remarkably, recent evidence also suggests that exercise may have direct effects on the pathogenesis of autoimmune diseases by attenuating chronic low-grade systemic inflammation. It is also important to emphasize that no exercise-related adverse effects have been reported. This short review provides the evidence for physical training as a treatment of pediatric rheumatic diseases, introducing a novel concept that exercise is a treatment for these populations.

The concept of "enthesis organ" allows a new look at the nature of enthesis involvement in some rheumatic and nonrheumatic systemic disorders. Objectives: To describe the various presentations of enthesopathy in the course of systemic medical disorders using the available literature data. Methods: Review of relevant articles from 1996 to 2006 retrieved by a Medline search utilizing the index terms "enthesis," "enthesitis," and "tendonitis." The list of articles reviewed herein is not exhaustive, with preference given, where possible, to studies and surveys over case reports as well as the most recent literature reflecting new developments on the subject. Results: Enthesis is defined as the site of insertion of a tendon, ligament, fascia, or articular capsule into bone. Pain originating in the free nerve endings enriched entheses (enthesalgia) may represent a potential cause of chronic musculoskeletal pain in some individuals. Enthesis involvement in the disease process is well appreciated in spondyloarthropathies and in rheumatoid arthritis, though overshadowed by synovitis in the latter. Calcium deposition diseases may constitute the most significant articular cause of enthesopathies in the general population. New data may shed light on the possible pathophysiologic role of enthesopathy in the development of osteoarthritis. Various metabolic and endocrine conditions may manifest with enthesopathy features. The pathogenic mechanisms of enthesis involvement are not uniform and differ in the diverse disorders. Conclusions: The concept of enthesopathy as a variety of syndromes in the course of many rheumatic, metabolic, and endocrine disorders should be appreciated. Exercise of a high level of suspicion toward enthesopathic involvement, and greater knowledge of enthesopathy's characteristic patterns and diagnostic possibilities, may allow better management of many patients in rheumatology practice.

Damage to the mutual and delicate articular relationships of the foot may lead to functional failure. A painful foot can be the heralding sign of inflammatory, metabolic or degenerative rheumatic disease that may cause severe disability if left untreated. Healthy tendons are brilliant white in colour, are fibroelastic in texture and can withstand huge mechanical loads. Pathological tendons are characterised by changes in cellular function, rupture of collagen bundles, increased production of the proteoglycan-water matrix and neurovascular proliferation. According to the underlying disease, tendinopathies may present with pain of variable duration and intensity and with functional impairment, or they may be an asymptomatic finding on imaging techniques. Pain is the most common presenting symptom in the inflammatory rheumatic diseases of the ankle and the foot and usually precedes ultrasound or radiographic changes; pain results from inflammatory changes of the synovia and soft tissue structures including bursae, tendons, fascias and peripheral nerves. The management of tendinopathies in inflammatory and non-inflammatory rheumatic patients includes "articular economy," pharmacological treatment, foot orthotics, cryotherapy, instrumental physiotherapy, rehabilitation and physical. This review highlights the differences between tendinopathies occurring in non-inflammatory rheumatic disorders compared to those appearing in the course of inflammatory rheumatic disorders and defines a conservative management framework that non-rheumatologists (orthopaedic surgeons) and rheumatologists could adhere for the management of foot tendinopathies.