Effectiveness of functional training versus resistance exercise in patients with psoriatic arthritis: randomized controlled trial

OBJECTIVE

This study aims to evaluate the effect of functional versus resistance exercise training on the functional capacity and quality of life of psoriatic arthritis patients.

METHODS

Forty-one psoriatic arthritis patients (18 to 65 years old) were randomized into two groups: functional training group and resistance exercise group. The functional training group underwent functional exercises with elastic band and the functional training group underwent machine resistance exercise twice a week for 12 weeks. Outcome measures were: The Bath Ankylosing Spondylitis Functional Index (BASFI) and Health Assessment Questionnaire for the Spondyloarthropathies (HAQ-S) for functional capacity and functional status, one-repetition maximum test for muscle strength, the Short Form 36 health survey questionnaire (SF-36) for quality of life, and the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) and the Disease Activity Score 28 (DAS-28) for disease activity. Analyzes were performed by a blinded evaluator at baseline (T0), six (T6) and twelve (T12) weeks after the beginning of the exercise.

RESULTS

At baseline, the groups were homogeneous in the clinical and demographic characteristics. There was a statistical intra-group improvement for both groups in the BASFI, BASDAI, HAQ-s, and DAS-28. In the quality-of-life assessment, both groups showed statistical intra-group improvements for all domains except the "emotional aspect" domain in the resistance exercise group. In the muscle strength, there was a statistical improvement for all exercises in both groups, except for the "alternate biceps (bilateral)" exercise.

CONCLUSION

Functional training and resistance exercise are similarly effective in improving functional capacity, functional status, disease activity, general quality of life, and muscle strength in patients with psoriatic arthritis.

TRIAL REGISTRATION

ClinicalTrials.gov: NCT04304326. Registered 11 March 2020, https://clinicaltrials.gov/ct2/show/NCT04304326?term=NCT04304326&draw=2&rank=1 .

Higher rates of ultrasound synovial hypertrophy, bone erosion and power doppler signal in asymptomatic Brazilian elderly versus young adults: a cross-sectional study

To evaluate the prevalence of musculoskeletal ultrasonography (MSUS) abnormalities in asymptomatic elderly individuals. A cross-sectional controlled study was conducted and MSUS of 23 joints (wrist, metacarpophalangeal-MCP, proximal interphalangeal-PIP, elbow, glenohumeral, hip, knee, ankle, and metatarsophalangeal-MTP joints) was performed in healthy individuals aged 18-29 (young, n = 32) and 60-80 years-old (elderly, n = 32). Quantitative synovial hypertrophy (SH) was measured in mm and a semiquantitative scoring system (0-3) was used to grade SH, power doppler (PD) and bone erosion (BE). Young and elderly participants were 26.2 ± 3.2 and 65.9 ± 4.4 years-old, respectively. As compared to the young participants, elderly individuals had higher SH values in 35% of the joint surfaces (P < 0.05), higher rates of scores 1-3 for SH at the dorsal surface of the 3rd MCP, palmar surface of the 2nd MCP, 2nd PIP, 3rd MCP and 3rd PIP and subtalar joints (17.2 vs. 1.6%, P = 0.002; 29.7 vs. 6.3%, P = 0.001; 12.5 vs. 1.6%, P = 0.016; 21.9 vs. 6.3%, P = 0.011; 21.9 vs. 7.8%, P = 0.025; and 24.2 vs. 6.3%, P = 0.005, respectively), BE at the radiocarpal, ulnocarpal, dorsal surface of the 2nd MCP and posterior area of the glenohumeral joints (10.9 vs. 1.6%, P = 0.028; 12.5 vs. 0%, P = 0.003; 9.4 vs. 0%, P = 0.012; and 29.7 vs. 10.9%, P = 0.008, respectively) and PD at the dorsal surface of the 2nd and 3rd MCP joints (9.4 vs. 0%; P = 0.012 and 7.8 vs. 0%; P = 0.023, respectively). BE scores ≥ 1 were more frequent in the elderly (P < 0.05) in 22 (88%) of the joint surfaces evaluated. MSUS abnormalities are more frequent in asymptomatic elderly individuals as compared to young subjects.

Intra-articular injection with platelet-rich plasma compared to triamcinolone hexacetonide or saline solution in knee osteoarthritis: A double blinded randomized controlled trial with one year follow-up

OBJECTIVES

To compare the effectiveness of intra-articular injection (IAI) of Platelet-Rich Plasma (PRP) with Triamcinolone Hexacetonide (TH) and Saline Solution (SS), in patients with knee osteoarthritis (OA).

DESIGN

A randomized controlled trial, with blinded patients and assessor.

SETTING

Outpatient rheumatology service.

SUBJECTS

Patients with knee osteoarthritis grades II and III.

INTERVENTIONS

Patients received IAI with PRP, 40 mg TH, or SS.

METHODS

Patients were assessed at baseline and after 4, 8, 12 e 52 weeks with: visual analogue scale (VAS) for pain at rest and movement, WOMAC questionnaire, Timed to Up and Go test, 6-min walk test, percentage of improvement, goniometry, quality of life SF-36 questionnaire, Likert scale and Kelgreen & Lawrence (KL) radiographic scale (only at baseline and 52 weeks).

RESULTS

100 patients were studied, with a mean age of 67.13(6.56) years. The TH group was superior for: percentage of improvement (versus SS group from 4 to 52 weeks); WOMAC total and pain (versus PRP group at 4 weeks); and WOMAC stiffness (versus SS group at 12 weeks). The SS group was inferior for WOMAC function (from 8 to 52 weeks). The PRP group showed lowest radiographic progression [TH 17 (51.51%) to 24 (72.72%); SS 17 (51.51%) to 30 (90.90%); PRP 20 (58.82%) to 21 (61.76%)].

CONCLUSION

The Triamcinolone Hexacetonide group was superior for percentage of improvement and WOMAC, pain and stiffness. For the WOMAC function, the Platelet-Rich Plasma group and Triamcinolone Hexacetonide group were superior to the Saline group. The Platelet-Rich Plasma group showed the lowest radiographic progression at 52 weeks of follow-up.

Intra-articular triamcinolone hexacetonide injections in hands osteoarthritis ‒ A double-blinded randomized controlled trial with a one year follow-up

OBJECTIVE

to evaluate the effectiveness of triamcinolone Hexacetonide (TH) Intra-Articular Injection (IAI) in hand Interphalangeal Joints (IP) of Osteoarthritis (OA) patients to improve pain and joint swelling; improve function, goniometry, and grasping force, and assess IAI influence on radiographic evolution over 1-year.

METHODS

A randomized, double-blind study. 60 patients who underwent IAI at the most symptomatic IP joint were randomly assigned to receive TH+Lidocaine (LD) (TH/LD group) or just LD (LD group). Patients were assessed blindly for 1-year, at baseline and 1, 4, 8, 12, and 48 weeks. The following variables were assessed: articular pain and swelling, AUSCAN and COCHIN functional questionnaires, grip and pinch strength, goniometry, perception of improvement, acetaminophen consumption, and simple radiography. Repeated-measures ANOVA test was used to analyze the intervention response.

RESULTS

Sixty patients completed the follow-up. There were nine missed assessments. 97% were women; mean age of 61-years (SD = 8.2), and approximately 5-years of disease (SD = 3.6). Half of the patients present radiographic classification Kellgren and Lawrence (KL) grades I and II, and the other half grades III and IV. The two groups evolved similarly at 48-weeks. TH/LD group had a better evaluation in joint swelling and acetaminophen consumption (p = 0.04 and p < 0.001, respectively) at 48-weeks. Radiographically there was no statistical difference between groups (KL, p = 0.564; erosive OA, p = 0.999; worsening, p = 0.573).

CONCLUSION

The IAI IP hands OA is effective for the improvement of joint swelling and decrease of analgesic consumption and does not influence the radiographic evolution of the injected joint.

Is There a Difference Between the Joint Ultrasounds of Healthy Women and Men? A Study With Small, Medium, and Large Joints

To compare joint ultrasound measurements between the sexes in healthy volunteers. A cross-sectional study compared the joint ultrasound measurements between the sexes in healthy volunteers. Quantitative (synovial hypertrophy and perpendicular measurement in the largest synovial recess) and semiquantitative (synovial hypertrophy, power Doppler, and bone erosion; score 0-3) ultrasound measurements were performed. Forty-six articular recesses were evaluated and compared between group 1 (100 females) and group 2 (60 males) who were matched by age and BMI. For the quantitative measurements, 7360 recesses were studied. For the semiquantitative measurements, 22,720 recesses were evaluated. Higher values (p < .05) were found in females for the quantitative measurements of synovial hypertrophy for the following: radiocarpal, distal radioulnar and ulnocarpal, second/third dorsal and second/third palmar interphalangeal, second palmar metacarpophalangeal, glenohumeral, hip, talocrural, talonavicular, and talocalcaneal recesses; the highest difference was found for the hip (6.21 ± 1.35 vs. 4.81 ± 2.40) and distal radioulnar (1.46 ± 0.40 vs. 1.07 ± 0.70) recesses. For the semiquantitative measurements, significant differences were found. For synovial hypertrophy, higher measurements for females in the second/third palmar metacarpophalangeal, second palmar proximal interphalangeal, hip, tibiotalar, talonavicular, talocalcaneal, and second metatarsophalangeal recesses (highest difference for second palmar metacarpophalangeal [44 (22.0%) vs. 5 (4.2%)]). For power Doppler, there were higher values for females in the talonavicular recesses and higher values for males in the first/second/fifth metatarsophalangeal recesses (highest difference for fifth [9 (7.5%) vs. 2 (1.0%)]). For bone erosion, there were higher measurements for females in the radiocarpal recesses (10 [5.0%] vs. 0 [0.0%]) and higher values for males in the talonavicular recesses (4 [3.3%] vs. 0 [0.0%]). Higher quantitative and semiquantitative ultrasound measurements of synovial hypertrophy were typically found in females.

Effects of a progressive resistance exercise program in patients with hand osteoarthritis: A randomized, controlled trial with a blinded assessor

OBJECTIVE

To assess the effectiveness of a progressive resistance strength program on pain, function and strength in hand osteoarthritis patients.

DESIGN

Randomized controlled trial.

SETTINGS

Outpatients, University Hospital.

SUBJECTS

Sixty hand osteoarthritis patients were randomly allocated to exercise group (n = 30) or control group (n = 30).

INTERVENTION

The exercise group performed a progressive resistance strength program for hand muscles over 12 weeks. Both groups had a single education session.

MAIN MEASURES

The primary outcome was pain intensity (numeric pain scale). The secondary outcomes were - AUSCAN Hand Osteoarthritis Index, Cochin Hand Functional Scale for function and grip and pinch strength. A blinded evaluator performed the evaluations at baseline, 6 and 12 weeks.

RESULTS

The mean age were 68.9 (8.8) and 64.7 (8.9) for control and exercise groups, respectively. No significant differences between-group was observed for pain after 12 weeks (mean difference between groups was -1.30 (-0.02 to 2.62) for dominant hand and -1.33 (0.01-2.65) for non-dominant hand at T12, with P = 0.085 and 0.295, respectively). Regarding secondary outcomes, statistically significant differences between groups were found in exercise group: AUSCAN index - total score (P = 0.005), pain (P = 0.006), function (P = 0.047), and Cochin scale (P = 0.042) with the following mean difference between groups: -9.9 (4.07-15.73), -3.26 (1.06-5.46), -5.03 (1.20-8.86), and -6.27 (0.18-12.36), respectively.

CONCLUSION

No difference was observed for pain (numerical pain scale) after the progressive resistance exercise program performed, however in exercise group, an improvement was observed on secondary outcomes such as pain during activities and function for patients with hand osteoarthritis.

LEVEL OF EVIDENCE

1b.

Surgical treatment for lumbar spinal stenosis: a single-blinded randomized controlled trial

OBJECTIVE

To evaluate the effectiveness of surgery for the management of patients with symptomatic lumbar spinal stenosis.

METHODS

Sixty-three patients with lumbar canal stenosis were randomized into two groups: the intervention group (IG) and control group (CG). IG patients underwent surgery and both groups participated in the same physical therapy program twice a week for a period of 12 weeks and were followed up at 1 year. The primary endpoint was visual analogue scale for pain, and the secondary endpoints were function (6-min walk test, Roland Morris and Oswestry questionnaires), quality of life (SF-36 questionnaire) and satisfaction with treatment (Likert scale).

RESULTS

No significant difference between groups was observed for pain over time (p = 0.145). Significant differences between groups, in favor of the IG, were observed for the Oswestry score (p = 0.006) and vitality domain score of the SF-36 (p = 0.047). Function in the Roland Morris and 6-min walk test and the role of the physical domain of SF-36 also showed significant differences between the groups; however, these differences occurred due to a worsening of the IG in the short term, and the medium-term. The Likert scale demonstrated greater satisfaction with the IG treatment compared to control group.

CONCLUSIONS

Lumbar stenosis surgery did not improve pain in short and medium terms. Function and vitality were better in the group that underwent surgery in the medium term, and patients were more satisfied with the surgical treatment.

TRIAL REGISTRATION

Clinicaltrials.gov ( NCT02879461 ).

Strengthening exercises using swiss ball improve pain, health status, quality of life and muscle strength in patients with fibromyalgia: a randomized controlled trial

The aim was to evaluate the effectiveness of strengthening exercises using the Swiss ball in patients with fibromyalgia through a randomized controlled trial with intention to treat analyses. A total of 60 patients with fibromyalgia met the inclusion criteria and were randomly allocated to either the Swiss ball exercise group (n=30) or a stretching group (n=30). All patients participated in 40-minute training sessions 3 times per week for 12 weeks. Pain (Visual Analogue Scale 0-100); muscle strength (One Repetition Maximum test); health status (Fibromyalgia Impact Questionnaire Revised); quality of life (Short Form-36 questionnaire) were evaluated at baseline, and after 6 and 12 weeks of training. The Swiss ball group showed a statistically significant improvement in VAS (0-100) (p<0.001), SF-36 (p<0.05) and Fibromyalgia Impact Questionnaire (p<0.001) compared with the stretching group. The results of this study proved that the treatment for fibromyalgia with strengthening exercises and the use of the Swiss ball led to improvement of pain, quality of life, muscle strength and decreased the need for medications for this disease compared to stretching exercises, without negative effects.

Arabic translation, cross-cultural adaptation, and psychometric properties of the low back pain knowledge questionnaire

Background: Low Back Pain Knowledge Questionnaire (LBP_KQ) was originally developed and validated for English speakers but not yet available for Arabic speakers.Purpose: To translate, cross-culturally adapt, and test the psychometric properties of the Arabic version of the LBP_KQ.Methods: Translation and cross-cultural adaptation were performed according to recommended guidelines. Construct validity was assessed through principal component analysis, and contrasted groups including physical therapists, nurses, and patients with low back pain. Concurrent validity was assessed by the correlation of LBP_KQ with the fear avoidance-belief questionnaire and depression, anxiety, and stress scale. Reliability was assessed using internal consistency (Cronbach's α) and test-retest reliability using intra-class correlation coefficient (ICC) and Bland-Altman analyses. Sensitivity to change was measured by comparing an educational intervention group (IG) and a control group (CG).Results: The questionnaire has four components. Physical therapists had significantly (p < .001) higher LBP_KQ scores than nurses and patients indicating good construct validity. There was a significant correlation between LBP_KQ and fear avoidance-belief questionnaire total score (r = 0.200, p = .04), depression score (r = -0.219, p = .024), anxiety score (r = -0.251, p < .01), stress score (r = -0.199, p < .041). Cronbach's α was 0.662, and ICC _(2,1) was 0.760 which reflects good reliability. There was a significant difference in LBP_KQ scores between IG and CG (p < .001) indicating sensitivity to change.Conclusion: The Arabic version of LBP_KQ is valid, reliable, and sensitive to change.

Effectiveness of Nighttime Orthoses in Controlling Pain for Women With Hand Osteoarthritis: A Randomized Controlled Trial

IMPORTANCE

Hand osteoarthritis is a musculoskeletal problem that is associated with hand pain, stiffness, functional limitation, decreased grip strength, and reduced quality of life.

OBJECTIVE

To evaluate the effectiveness of nighttime orthoses on the second or third finger of the dominant hand in controlling pain in women with symptomatic osteoarthritis (OA) in the interphalangeal joint.

DESIGN

Randomized controlled trial.

SETTING

Outpatient clinic.

PARTICIPANTS

Fifty-two women with symptomatic OA and presence of Heberden's and Bouchard's nodes, allocated randomly to the intervention group or the control group.

INTERVENTION

The intervention group used a nighttime orthosis on the second or third finger of the dominant hand. Both groups participated in an educational session.

OUTCOMES AND MEASURES

The following parameters were measured: pain (numerical rating scale, Australian/Canadian Osteoarthritis Hand Index), grip and pinch strength, function (Cochin Hand Functional Scale), and manual performance (Moberg Pick Up Test).

RESULTS

The intervention group showed a statistically significant improvement in pain (p < .001) and hand function. The improvement in pain correlated with Cochin Hand Functional Scale scores and the absence of Bouchard's nodes in the third finger, which are predictors of the best prognosis for treatment with a nighttime orthosis.

CONCLUSIONS AND RELEVANCE

This study demonstrates that nighttime orthoses are effective in reducing pain and lead to improvement in hand function in women with hand OA. They are therefore specifically recommended for nonpharmacological treatment of hand OA.

WHAT THIS ARTICLE ADDS

Orthoses can be considered, together with manual exercises and joint protection, as an intervention to reduce symptoms and improve hand function in people with hand OA. This study is an important step in empowering occupational therapists to determine appropriate and effective intervention for clients with OA.

Effectiveness of customized insoles in patients with Morton's neuroma: a randomized, controlled, double-blind clinical trial

OBJECTIVE

To assess the effectiveness of customized insole in patients with Morton's neuroma.

DESIGN

Double-blind randomized controlled trial with intent-to-treat analysis.

SETTING

Outpatients, University Hospital.

SUBJECTS

A total of 72 patients with Morton's neuroma met the inclusion criteria and were randomly allocated to either the study group (n = 36) or the control group (n = 36).

INTERVENTIONS

The study group was assigned to use a customized insole with metatarsal and arch support made of ethyl vinyl acetate and the control group received a flat insole of the same material, color, and density.

MAIN MEASURES

The primary outcome measure was walking pain intensity measured by the visual analogue scale. The secondary outcomes were as follows: pain at rest, palpation, and paresthesia (visual analogue scale); functional disability (6-minute walk test, Foot Function Index, and Foot Health Status Questionnaire); quality of life (Health Survey Short Form-36 (SF-36)); and foot pressure (AM Cube FootWalk Pro program).

RESULTS

In the comparison between the groups over time, a statistically significant difference, with improvement in favor of the experimental group, was found for pain during walking (P = 0.048); in the general health domains (P < 0.001) and physical activity (P = 0.025) of the Foot Health Status Questionnaire; in the general Foot Function Index score (P = 0.012); and in the functional capacity domain of the SF-36 questionnaire (P = 0.046). For the other parameters, no difference was found between groups.

CONCLUSION

The study demonstrated that customized insole with metatarsal and arch support relieved walking pain and improved patient-reported measures of function in patients with Morton's neuroma.

Influence of isostretching on patients with chronic low back pain. A randomized controlled trial

Objective: This study investigated the influence of isostretching on patients with chronic low back pain. Methods: It was a randomized, controlled trial with concealed allocation, intention-to-treat analysis, and blind assessment. Fifty-four patients with chronic low back pain were randomized to an experimental group and a control group. The experimental group performed isostretching twice a week for 45 days, while the control group remained on the waiting list for physical therapy. Patients were submitted to evaluations at baseline, after 20 and 45 days of treatment with regard to pain, quality of life, functional capacity, and satisfaction. Results: The experimental group exhibited statistically significant improvements in comparison to the control group with regard to pain (p = .003), functional capacity (p = .026), patient satisfaction (p < .001), and quality of life as determined by the functional capacity (p = .012), physical aspects (p = .011) and pain (p = .006) subscales of the SF-36. The experimental group used a significantly lesser amount of pain medication than the control group (p = .03). Conclusion: Isostretching was effective in reducing pain and in improving function, patient satisfaction and some aspects of quality of life in patients with chronic low back pain.

Translation to Brazilian Portuguese, cultural adaptation and psychometric properties of 8-item ArthritisSelf-Efficacy Scale (ASES-8)

BACKGROUND

Self-efficacy refers to one's belief in one's ability to organize, perform actions and face challenges in order to achieve goals and motivation. High self-efficacy improves disease coping and adherence to treatment among patients with rheumatoid arthritis. The objective of this study was to translate, culturally adapt and test the reproducibility of the 8-item Arthritis Self-Efficacy Scale (ASES-8) questionnaire for use in Brazil.

DESIGN AND SETTING

Validation study conducted in university outpatient clinics.

METHODS

The questionnaire was translated into Brazilian Portuguese and then back-translated into English. The final version in Portuguese was tested on 30 patients with rheumatoid arthritis and was shown to be understandable and culturally adapted. A further 32 patients with rheumatoid arthritis were evaluated three times using the questionnaire. On the first occasion, two evaluators applied the questionnaire to check inter-evaluator reproducibility. After 15 days, one of the evaluators reassessed the patients to verify intra-evaluator reproducibility. At the first assessment, to test the construct validity of ASES-8, the Numerical Pain Scale, Health Assessment Questionnaire, Beck Depression Inventory and Short Form-36 questionnaire were also applied to all the patients.

RESULTS

The inter and intra-evaluator correlation coefficients for ASES-8 were high. Cronbach's alpha was higher than 0.90 for the questionnaire, indicating excellent internal consistency. There were moderate correlations between ASES-8 and most of the instruments tested, indicating good construct validity.

CONCLUSION

ASES-8 was translated and adapted to the Portuguese language for Brazil. This instrument is valid, reproducible and reliable for evaluating self-efficacy among patients with rheumatoid arthritis.

Comparison between intra-articular Botulinum toxin type A, corticosteroid, and saline in knee osteoarthritis: a randomized controlled trial

OBJECTIVE

To compare the effectiveness of intra-articular injection (IAI) with Botulinum toxin type A (BTA), triamcinolone hexacetonide (TH), and saline in primary knee osteoarthritis.

DESIGN

A randomized controlled trial, with blinded patients and assessor.

SETTING

Outpatient rheumatology service.

SUBJECTS

Patients with knee osteoarthritis grades II and III.

INTERVENTIONS

Patients received IAI with 100 IU BTA, 40 mg TH, or isotonic saline solution (SS) 0.9%.

MAIN MEASURES

Patients were assessed at baseline and at 4, 8, and 12 weeks with the following instruments: visual analog scale for pain during movement (VASm; primary outcome) and visual analog scale for pain at rest (VASr), Western Ontario & McMaster Universities Osteoarthritis Index (WOMAC) questionnaire, 6-minute walk test, Timed Up and Go test, Short Form (SF)-36 questionnaire, range of motion of knee, and ultrasound (US) measurement of synovial hypertrophy.

RESULTS

In total, 105 patients were randomized, with 35 in each group; 96 were female (91.4%) and 9 were male (8.6%), with a mean age of 64.2 years (±6.9). At 12 weeks, the TH group showed better results only for VASm. At four weeks, the TH group showed better results than the BTA and SS groups for VASm (-68.9% (37.8) vs. -35.3% (40.3) vs. -35.9% (51.4)), WOMAC pain (-56.0% (30.7) vs. -30.8% (34.3) vs. -30.0% (39.9)), WOMAC stiffness (-53.4% (38.4) vs. -17.2% (59.3) vs. -17.3% (78.1)), WOMAC function (-48.2% (34.6) vs. 30.8% (33.6) vs. -13.6% (64.9)), WOMAC total score (-51.2% (31.0) vs. -30.9% (30.0) vs. -18.8% (54.8)), and US measurement of synovial hypertrophy (-11.6% (44.9) vs. -1.5% (47.9) vs. +28.6% (81.3)).

CONCLUSION

IAI with TH had a higher effectiveness than that with TBA or SS in the short-term assessment (four weeks) for pain in movement, WOMAC, and US measurement of synovial hypertrophy.

Gait in children and adolescents with idiopathic musculoskeletal pain

INTRODUCTION

Musculoskeletal pain is a constant complaint in pediatric practice. The pain may be related to a number of organic diseases and / or be part of the amplified musculoskeletal pain syndromes. Idiopathic musculoskeletal pain (IMSP) is defined as the presence of intermittent pain in three or more body regions for at least three months, excluding organic diseases that could explain the symptoms.

OBJECTIVE

To study the gait of children and adolescents with IMSP by dynamic baropodometry.

METHODOLOGY

Thirty-two patients with IMSP and 32 healthy controls, matched by age, sex, social class, and body mass index (BMI) were enrolled. All were evaluated for pain intensity through the visual analogue scale (VAS) and gait evaluation using dynamic baropodometry.

RESULTS

The mean age of the IMSP group was 13.6 years (SD = 2.1, range 9.8-16.9) and of the control group was 13.5 years (SD = 2.0, range 9.6-16.5). The mean pain scale was 5.4 cm in the IMSP group and 0 cm in the control group (p < 0.001). In gait, the mean right foot velocity of the IMSP group was significantly lower (p = 0.034), the time of the step of the IMSP group was significantly higher (p = 0.003) and the pace of the IMSP group was significantly lower (p = 0.001).

CONCLUSION

In our study we observed differences between the gait of children with IMSP and healthy controls according to the dynamic baropodometry. This finding indicates the need for individualized attention to the gait of children with musculoskeletal pain.

Supervised walking improves cardiorespiratory fitness, exercise tolerance, and fatigue in women with primary Sjögren's syndrome: a randomized-controlled trial

OBJECTIVE

The aim of this study was to evaluate the safety and effectiveness of a supervised walking program in women with primary Sjögren's syndrome (pSS).

METHODS

Forty-five sedentary women fulfilling the American European Consensus Criteria for pSS were randomized to a training group (TG, n = 23) or control group (CG, n = 22). Patients in the TG were submitted to supervise walking three times a week for 16 weeks. The patients of the CG were instructed to not perform any kind of regular physical exercise. Physical fitness [maximum oxygen uptake (VO_2max) and distance], EULAR Sjögren's Syndrome Disease Activity Index (ESSDAI), hematological tests, and Medical Outcomes Study 36 (SF-36) were assessed at baseline and week 16. In addition, EULAR Sjögren's Syndrome Patient Reported Index (ESSPRI), Functional Assessment of Chronic Illness Therapy Fatigue Subscale (FACIT-fatigue), and Beck Depression Inventory (BDI) were measured prior to intervention, after 8 and 16 weeks. Patient global assessment of response to therapy was completed at the final assessment. An intent-to-treat analysis was performed.

RESULTS

After 16 weeks, the mean change of VO_2max (ml/kg/min), distance, and FACIT-fatigue were higher in the TG than in the CG (p = 0.016, p = 0.043 and p = 0.030, respectively). Improved cardiorespiratory fitness was associated with improvements in fatigue scores and physical components of quality of life (SF-36). Furthermore, improved fatigue scores were associated with reduced depression and improvements in the physical and mental components of SF-36. Overall, 95.4% of patients in the TG rated themselves as clinically improved versus 62% of the patients in the CG (p = 0.049). There was no flare in disease activity and no serious adverse events with exercise.

CONCLUSIONS

This supervised walking program was demonstrated to be feasible and safe with improvements in cardiorespiratory fitness, exercise tolerance, fatigue, and patient perception of improvement in pSS patients.

TRIAL REGISTRATION

Clinical Trials.gov ID, number NCT02370225.

Ultrasound of entheses in ankylosing spondylitis patients: The importance of the calcaneal and quadriceps entheses for differentiating patients from healthy individuals

OBJECTIVES

To compare the ultrasonographic findings of entheses in ankylosing spondylitis (AS) patients with those of healthy control individuals and to assess the ability of ultrasound (US) to identify aspects related to the disease.

METHODS

A cross-sectional study involving 50 patients with AS and 30 healthy controls was performed. Clinical assessment included the use of a visual analog scale for pain, assessment of swelling of the enthesis, global assessments for patients and physician, use of a disease activity index, mobility and dysfunctional indices, erythrocyte sedimentation rate and clinical enthesitis index. US was performed for the following entheses by two experienced musculoskeletal radiologists: brachial triceps, distal quadriceps, proximal and distal patellar tendons, calcaneal tendon, and plantar fascia; the total and subitems of the Madrid Sonographic Enthesitis Index were used for evaluations.

RESULTS

Comparison between groups showed a statistically significant difference with worse scores in AS patients, with bone erosion of the calcaneal enthesis and bone erosion and thickening of the plantar fascia. The odds ratio for thickening of the plantar fascia in the AS group was 3.47, according to logistic regression analysis. The AS group also had worse scores regarding the presence of calcification in the quadriceps enthesis, with a fivefold increased risk.

CONCLUSION

US analysis showed that only entheses of the foot and quadriceps were able to differentiate AS patients from healthy individuals.

Força muscular de membros inferiores em mulheres com artrite reumatoide e mulheres sem a doença: há diferença?

RESUMO A artrite reumatoide (AR) é uma doença inflamatória sistêmica, crônica, que acomete preferencialmente a membrana sinovial das articulações. Dentre as qualidades de aptidão física que podem ser reduzidas em indivíduos com AR merece destaque a força muscular, que está diretamente relacionada à capacidade de realização de todas as atividades da vida diária, desde as mais simples até as mais complexas. O objetivo deste estudo foi avaliar a força muscular de membros inferiores de mulheres com AR. Métodos: 17 voluntárias com AR (das classes funcionais I, II e III) e 17 sem a doença, com idade média de 54,7+6,63 anos, foram submetidas ao teste de uma repetição máxima para avaliar a força muscular de flexores e extensores de joelho e de abdutores e adutores de quadril. Utilizou-se o teste τ para analisar os dados, sendo considerados estatisticamente significativos os níveis de α <0,05. Em todas as avaliações o grupo de mulheres com AR apresentou valores inferiores quando comparados ao grupo sem a doença. No entanto não houve diferenças estatisticamente significativas entre os grupos. Os níveis descritivos obtidos da comparação entre a força muscular dos grupos foram: para extensores de joelho, p=0,224; flexores de joelho, p=0,467; abdutores de quadril, p=0,190; e adutores de quadril, p=0,127. A força muscular de membros inferiores não difere entre mulheres com AR (das classes funcionais I, II e III) e mulheres sem a doença.

Orthosis for rhizarthrosis: A systematic review and meta-analysis

OBJECTIVE

investigating the effectiveness of orthosis for rhizarthrosis by means of a systematic review and meta-analysis.

METHODS

A systematic review was carried out using eight electronic databases. The randomized controlled trials included were those presenting subjects using orthosis for rhizarthrosis compared with individuals without orthosis or other rehabilitation interventions, as well as studies that compared different types of orthosis. The systematic review was performed according to the Cochrane methodology. The statistical software Review Manager 5.3 was employed to analyze the data.

RESULTS

Fourteen studies were included in the review and three of them participated in the meta-analysis. The orthosis group had a reduction in pain in the long term as compared to the control group with a statistically significant difference, a medium effect size, and low-quality evidence [Effect size -0.52, Confidence Interval 95% -0.94 to -0.11, p = 0.01), I²= 50%]. The orthosis group presented improvements regarding function in the long term as compared to control group, with a statistically significant difference, a medium effect size, and moderate quality of evidence [Effect size -0.44, Confidence Interval 95% -0.72 to -0.15, p = 0.002), I²= 0%].

CONCLUSION

the orthosis for rhizarthrosis presents low-quality evidence for reducing pain in the long term and moderate evidence for an increase in function in the long term. Since imprecision and inconsistency of the data were aspects which influenced the quality of the evidence, future studies with larger samples and standardized data are needed.

Moberg Picking-Up Test in patients with hand osteoarthritis

STUDY DESIGN

Clinical measurement.

INTRODUCTION

The Moberg Pick-up Test (MPUT) was previously used to evaluate functional performance in patients with hand inflammatory disease. This is the first study using the MPUT in hand osteoarthritis (OA).

PURPOSE OF THE STUDY

Compare the functional performance (MPUT) in hand OA patients and healthy controls.

METHODS

Fifty hand OA patients and 50 controls were assessed using the MPUT, AUSCAN and Cochin questionnaires, grip and pinch strength, pain using a visual analog scale and a Likert scale regarding difficulty to perform MPUT.

RESULTS

In the MPUT evaluation, the OA group presented a statistically significant difference from the control group. The OA group spent more time executing test. The grip and pinch strength measurements showed higher values for the control group. The OA group reported a greater difficulty than the control group in performing the test.

CONCLUSION

The MPUT is a short and easy to apply test, which can be safely used to assess the functional performance of the hand OA.

LEVEL OF EVIDENCE

II.

A resistance exercise program improves functional capacity of patients with psoriatic arthritis: a randomized controlled trial

The objective of this study is to assess the effectiveness of resistance training in patients with psoriatic arthritis (PsA). The study is a randomized controlled trial with 41 patients aged between 18 and 65 years with diagnosis of psoriatic arthritis (PsA). The patients were randomized into the following: intervention group (IG) and control group (CG). The IG underwent resistance exercise twice a week, for 12 weeks. The CG remained with the conventional drug therapy. The outcome measurements were the following: BASFI and HAQ-S for functional capacity, one maximum repetition test (1RM) for muscle strength, SF-36 questionnaire for general quality of life, and BASDAI and DAS-28 for disease activity. The evaluations were done by a blinded evaluator at baseline (T0) after 6 (T6) and 12 weeks (T12). At baseline, the groups were homogeneous regarding clinical and demographic characteristics. The IG significantly improved functional capacity measured by HAQ-S and disease activity measured by BASDAI, compared to CG, at week 12. Regarding quality of life, the IG improved the domains "pain" and "general health status" compared to CG (p < 0.05). There was improvement in muscular strength in almost all exercises in IG, except in the exercise for biceps. However, there were statistical differences between groups only on exercise "leg extension" in IG compared to CG. Resistance training is effective in improving functional capacity, disease activity, and quality of life of patients with psoriatic arthritis. The clinical improvements were not coupled to significant changes in muscular strength.

Patients with juvenile idiopathic arthritis in clinical remission with positive power Doppler signal in joint ultrasonography have an increased rate of clinical flare: a prospective study

BACKGROUND

Ultrasonography (US) studies carried out on joints of juvenile idiopathic arthritis (JIA) patients in clinical remission demonstrate the presence of subclinical synovitis. The significance of subclinical synovitis and the positive power Doppler (PD) signal on US in JIA in clinical remission is not well understood. The objectives of this study were to assess whether the changes detected by US in patients with JIA in clinical remission can predict disease flare and to evaluate factors associated with flare and joint damage over 30 months of follow-up.

METHODS

A prospective study was performed with clinical and ultrasound evaluation in 34 joints of JIA patients in clinical remission. Clinical evaluation including physical exam, functional capacity and inflammatory markers was performed at baseline and every six months thereafter, for a total period of 30 months. US evaluation included presence of synovitis, PD signal and erosion at baseline and every 12 months thereafter. Subclinical synovitis was defined when there was synovitis with or without positive PD signal in US joints of patients in clinical remission. Flare was defined as any joint presenting clinical arthritis requiring therapy modification.

RESULTS

We evaluated a total of 35 patients, 28 (80%) girls, 14 (40%) persistent oligoarticular subtype, 12 (34.3%) oligoarticular extended and 9 (25.7%) polyarticular and 26 (74.3%) in remission on medication. Twenty (57.1%) patients flared. The risk of flare was five times higher in patients with positive PD signal and 14 times higher in patients in remission on medication. Regarding the assessment of joints after 6 months and 12 months of US evaluation, 70/3162 (2.2%) joints and 80/2108 (3.8%) joints flared, respectively. Joints with subclinical synovitis with positive PD signal flared more after 6 and 12 months. Twenty five of 2108 (1.2%) joints showed erosion over time. Joints with subclinical synovitis with or without positive PD signal showed more erosion.

CONCLUSIONS

Patients in remission on medication with subclinical synovitis with positive PD signal on US have a higher risk of flare, therefore they should be monitored closely during treatment. In the same way, joints with subclinical synovitis with or without positive PD signal should be monitored due to the risk of flare and joint damage.

Articular Ultrasound in Asymptomatic Volunteers: Identification of the Worst Measures of Synovial Hypertrophy, Synovial Blood Flow and Joint Damage Among Small-, Medium- and Large-Sized Joints

Articular ultrasound of 6500 joint recesses was performed for the purpose of identifying which joint had the highest measurements among small-sized (SSJ), medium-sized (MSJ) and large-sized (LSJ) joints. Quantitative measurements of synovial hypertrophy (QSR) and semiquantitative measurements of synovial hypertrophy (SSH), power Doppler (SPD) and bone erosion (SBE) (score: 0-3) were made. Higher measurements (p < 0.01) of QSR were obtained in the second metatarsophalangeal joint (MTP), talonavicular joint, and hip. The highest SSH scores (2/3) were obtained in the second MTP, talonavicular joint, hip and knee; the highest SPD scores (1/2/3) in the first MTP, second MTP, dorsal second metacarpophalangeal (MCP) and radiocarpal recesses; and the highest SBE scores (2/3) in the radiocarpal, ulnocarpal and posterior recesses of the glenohumeral joint. In conclusion, higher measurements of synovial hypertrophy were found in the first and second MTPs (SSJ), talonavicular recess (MSJ) and hip (LSJ). Synovial blood flow was frequent in the first MTP and radiocarpal recess. Bone erosion stood out only in the glenohumeral joint.

Effectiveness of an overall progressive resistance strength program for improving the functional capacity of patients with rheumatoid arthritis: a randomized controlled trial

Objective:

To evaluate the effectiveness of overall progressive resistance training in patients with rheumatoid arthritis.

Design:

Randomized controlled clinical trial with blinded assessor and intention-to-treat analysis.

Setting:

Outpatient clinics.

Subjects:

Sixty patients with rheumatoid arthritis according to the American College of Rheumatology criteria, aged between 18 and 65 years old, under stable medication and not performing regular physical activity were randomized into two groups: intervention group (IG) and control group (CG).

Interventions:

IG performed the progressive resistance strength training, twice a week, during 12 weeks. The training consists of exercising various muscle groups using a load of 50% and 70% of one repetition maximum. The load was reassessed and adjusted after six weeks of baseline. Both groups remained in conventional drug treatment during the study.

Main measures:

Patients were evaluated at baseline and after 6, 12, and 24 weeks, using HAQ and SF-36 questionnaires and strength.

Results:

Thirty-three patients in the CG and 27 in the IG were evaluated. The groups were homogeneous at baseline. Statistical and clinical improvement were found with better results for the IG in the HAQ questionnaire ( P=0.030), functional capacity (0=0.022) and pain ( P=0.027) domains of SF-36; and muscle strength for flexors of right and left knee ( P=0.005 and p=0.14), abductors of shoulder ( P=0.041) and extensors of right and left wrists ( P=0.003 and P= 0.005).

Conclusions:

This progressive resistance strength training improves physical function as well as grip and muscular strength of knee flexors, shoulder abductors and wrist extensors in patients with RA, without adverse effects.

Swiss ball exercises improve muscle strength and walking performance in ankylosing spondylitis: a randomized controlled trial

OBJECTIVE

The purpose was to evaluate the effectiveness of a progressive muscle strengthening program using a Swiss ball for AS patients.

METHODS

Sixty patients with AS were randomized into the intervention group (IG) or the control group (CG). Eight exercises were performed by the IG patients with free weights on a Swiss ball two times per week for 16 weeks. The evaluations were performed by a blinded evaluator at baseline and after 4, 8, 12 and 16 weeks using the following instruments: the one-repetition maximum test (1 RM), BASMI, BASFI, HAQ-S, SF-36, 6-minute walk test, time up and go test, BASDAI, ASDAS, ESR and CRP dosage and Likert scale.

RESULTS

There was a statistical difference between groups for: strength (1 RM capacity) in the following exercises: abdominal, rowing, squat, triceps and reverse fly (p<0.005); 6-minute walk test (p<0.001); timed up and go test (p=0.025) and Likert scale (p<0.001), all of them with better results for the IG. No differences were observed between the groups with respect to the functional capacity evaluation using the BASFI, HAQ-S, BASMI, SF-36, TUG, ASDAS, ESR and CPR dosage.

CONCLUSIONS

Progressive muscle strengthening using a Swiss ball is effective for improving muscle strength and walking performance in patients with AS.

Interphalangeal Joint Sonography of Symptomatic Hand Osteoarthritis: Clinical and Functional Correlation

OBJECTIVES

To assess the correlation between inflammatory sonographic findings (grayscale synovial hypertrophy and power Doppler) and clinical and functional assessments in hand osteoarthritis (symptomatic interphalangeal joints) and to correlate the intraobserver and interobserver reliability of these findings.

METHODS

A prospective double-blind study of 60 interphalangeal joints was conducted. The joints were assessed 6 times per year by clinician and sonographer observers.

RESULTS

A total of 720 measurement recesses were included (360 palmar and 360 dorsal). Small correlations and a few associations were found. Proximal interphalangeal joint quantitative measurements of the dorsal recess showed a statistical correlation with joint swelling (P = .043) and pulp-to-pulp pinch strength (P = .043); in the palmar recess, statistical correlations were seen for joint swelling (P = .007), the Australian/Canadian (AUSCAN) Function Index (P = .044), and grip and finger strength (P = .037, .003, .019, and .017). In dorsal semiquantitative assessments, there were associations between sonographic findings and joint swelling (P = .010) and pinch strength (P = .027, .003, and .014); in the palmar recess, we found associations with the AUSCAN Index (P = .048) and grip and finger strength (P = .031, .006, and 0.041). No correlations or associations were found in distal interphalangeal joints. Power Doppler signals were found in only 1.7% of the sample, precluding statistical analysis. Excluding palmar semiquantitative assessments in distal interphalangeal joints (P = .623), sonographic findings were reliable (intraclass correlation coefficients, 0.474-0.857; κ = 0.390-0.673).

CONCLUSIONS

Joint swelling, grip and pinch strength, and the AUSCAN Index were weakly correlated and associated with sonographic findings in proximal interphalangeal joints. Intraobserver and interobserver sonographic assessments were reliable.

Intra-articular injection in patients with juvenile idiopathic arthritis: factors associated with a good response

INTRODUCTION

Intra-articular injection of corticosteroids (IIC) for treatment of patients with juvenile idiopathic arthritis (JIA) is increasingly used in Pediatric Rheumatology.

OBJECTIVES

To describe the clinical course of patients undergoing IIC in our Pediatric Rheumatology Unit.

METHODS

Retrospective study of patients with JIA undergoing IIC from January 2008 to December 2012, with a minimum follow-up of six months after the injection. Good response to IIC was set as the presence of inactivity on the infiltrated joint by at least six months.

RESULTS

Eighty-eight patients underwent a total of 165 IICs. Of these, 75% were girls and 35.2% had persistent oligoarticular JIA. The mean age at diagnosis was 6.8 years, and when IIC was carried out, 12.2 years. Regarding patients, younger age at diagnosis (p=0.037) and the occurrence of uveitis in the course of the disease (p=0.015) were associated with good response to IIC. From 165 IICs, 63% had a good response and joints remained inactive for a median of 18.1 months. The type of joint injection (p=0.001), lesser values stated in the overall visual analog scale by the physician (p=0.015) and by parents/patient (p=0.01) have been associated with a good response to IIC. Nine adverse events (5.4%) were observed.

CONCLUSION

In our study, more than half of the joints showed a good response to IIC. Younger patients at diagnosis and uveitis during the course of the disease had good response to IIC. Knees, wrists and elbows were the joints that best responded to IIC. IIC proved to be a safe procedure.

A new musculoskeletal ultrasound scoring system (US10) of the hands and wrist joints for evaluation of early rheumatoid arthritis patients

OBJECTIVE

To propose a novel ultrasound scoring system for hand and wrist joints (US10) for evaluation of patients with early rheumatoid arthritis (RA) and to correlate the US10 with clinical, laboratory and functional variables.

METHODS

Forty-eight early RA patients underwent clinical and laboratory evaluations as well as blinded ultrasound (US) examinations at baseline, three, six and 12 months. The proposed US10 system involved the assessment of the wrist, second and third metacarpophalangeal and proximal interphalangeal joints. The score consisted of inflammation parameters (synovial proliferation [SP], power Doppler [PD] and tenosynovitis [TN]) and joint damage parameters (bone erosion [BE] and cartilage damage [CD]). SP, PD, BE and CD were scored qualitatively (0-1) and semi-quantitatively (grades 0-3). Tenosynovitis was scored as presence/absence. The evaluation also involved the 28-Joint Disease Activity Score (DAS28), Health Assessment Questionnaire (HAQ) and C-reactive protein level (CRP).

RESULTS

Mean duration of symptoms was 7.58±3.59 months. Significant correlations (p<0.05) were found between inflammation parameters and CRP at baseline and between the changes in these variables throughout the study. Significant correlations (p<0.05) were found between DAS28 score and both PD and TN at baseline and between the changes in DAS28 score and both SP and TN throughout the follow up. Moreover, significant correlations were found between the changes in inflammation parameter scores and HAQ score throughout the follow up.

CONCLUSION

The proposed US10 scoring system proved to be a useful tool for monitoring inflammation and joint damage in early RA patients, demonstrating significant correlations with longitudinal changes in disease activity and functional status.

Translation to Brazilian Portuguese, cultural adaptation and reproducibility of the questionnaire "Ankylosing Spondylitis: What do you know?"

CONTEXT AND OBJECTIVE:

Ankylosing spondylitis (AS) generates inflammation and pain in entheses, peripheral joints and the spine. Education regarding AS can improve patients' disability. Thus, it is important to assess patients' knowledge. There is no instrument in the literature for assessing knowledge of AS in Portuguese. The aim here was to translate to the Brazilian Portuguese language, culturally adapt and test the reliability of the questionnaire "Ankylosing Spondylitis: What do you know?" and to correlate the findings with other factors.

DESIGN AND SETTING:

Original article regarding validation of questionnaire, produced at the Federal University of Sao Paulo (Unifesp).

METHODS:

For translation and cultural adaptation, Guilleman methodology was used. After the first phase, the reliability was tested on 30 patients. Correlations between these scores and other factors were examined.

RESULTS:

In the interobserver assessment, the Pearson correlation coefficient and Cronbach's alpha were 0.831 and 0.895, respectively. In the intraobserver evaluation, the intraclass correlation coefficient and Cronbach's alpha were 0.79 and 0.883, respectively. At this stage, the score for area of knowledge A showed correlations with ethnicity and education; the score for area D, with age; the total score and scores for areas A and B with "social aspects" of SF-36; and the score for area D with "pain", "vitality" and "emotional aspects" of SF-36.

CONCLUSION:

The Brazilian version of the questionnaire "Ankylosing Spondylitis: What do you know?" was created. It is reproducible and correlates with education level, ethnicity and the SF-36 domains "social aspects" and "emotional aspects".

Intra-articular injection with triamcinolone hexacetonide in patients with rheumatoid arthritis: prospective assessment of goniometry and joint inflammation parameters

OBJECTIVES

To evaluate local joint variables after intra-articular injection with triamcinolone hexacetonide in rheumatoid arthritis patients.

METHODS

We blindly and prospectively (baseline, 1, 4, 12 and 24 weeks) evaluated metacarpophalangeal, wrist, elbow, shoulder, knee and ankle joints after triamcinolone hexacetonide intra-articular injection by the following outcome measures: visual analogue scale 0-10cm (VAS) for rest pain (VASR); VAS for movement pain (VASM); VAS for joint swelling (VASSw); flexion (FlexG) and extension (ExtG).

RESULTS

289 patients (635 joints) were studied. VASSw (p<0.001) and VASR (0.001<p<0.016) improved from T0 to T4, T12 and T24 for all joints. VASM improved from T0 to T4 (p<0.021) for all joints; T0 to T12 (p<0.023) for MCF and knee; T0 to T24 (p<0.019) only for MCF and knee. FlexG improved from T0 to T4 (p<0.001) for all joints; T0 to T12 (p<0.001) and T0 to T24 (p<0.02) only for MCF and knee. ExtG improved from T0 to T4 (p<0.001) for all joints except for elbow; T0 to T12 (p=0.003) for wrist, metacarpophalangeal and knee; and T0 to T24 (p=0.014) for MCF and knee.

CONCLUSION

VASSw responded better at short and medium term after IAI with triamcinolone hexacetonide in our sample of RA patients.

The relevance of performing exercise test before starting supervised physical exercise in asymptomatic cardiovascular patients with rheumatic diseases

OBJECTIVES

To evaluate the impact and risk factors associated with an abnormal exercise test (ET) in systemic inflammatory rheumatic disease (SIRD) patients before commencing supervised physical exercise.

METHODS

A total of 235 SIRD patients were enrolled in three controlled clinical trials, including 103 RA, 42 SLE and 57 AS patients. The control group consisted of 231 healthy, sedentary subjects matched for age, gender and BMI. All performed an ET, according to Bruce's or Ellestad's protocol. Cardiovascular disease risk factors, medications, comorbidities and details of each SIRD were assessed.

RESULTS

SIRD patients had a higher percentage of abnormal ETs compared with the control group, especially exercise hypertensive behaviour, higher oxygen consumption, higher resting heart rate and heart rate at the first minute of recovery, and chronotropic incompetence (C-Inc) (P < 0.001). The disease itself was involved with higher likelihood of having an abnormal ET [Odds ratio (OR) = 12.0, 95% CI: 2.5, 56.7; P = 0.002 for SLE; OR = 13.56, 95% CI: 6.16, 29.8; P < 0.001 for RA; and OR = 4.31, 95% CI: 1.17, 15.8; P = 0.028, for AS]. Each 10-year increment of age increased the chance of having an abnormal ET by 13% (P = 0.008) in AS patients, as well as hypertension (OR = 7.14, 95% CI: 1.61, 31.6; P = 0.01). Regarding C-Inc, age played a protective role (OR = 0.88, 95% CI: 0.78, 0.99; P = 0.043) in SLE, and ASDAS-ESR was associated with a higher risk in AS (OR = 2.73, 95% CI: 0.93, 8.0; P = 0.067).

CONCLUSION

Our results showed a higher prevalence of abnormal ETs in asymptomatic cardiovascular SIRD patients, and the disease itself was associated with a higher likelihood of having an abnormal test, emphasizing the relevance and need of performing it before starting supervised physical exercise.

Effectiveness of insole use in rheumatoid feet: a randomized controlled trial

OBJECTIVES

To assess the effectiveness of foot orthoses with regard to pain, function, quality of life, and global perceived effect in patients with rheumatoid arthritis (RA).

METHOD

A double-blind randomized controlled trial (RCT) was carried out. Eighty women with RA were randomly assigned to an experimental group (EG) or a control group (CG). The EG used an insole with metatarsal and medial arch supports and the CG used a flat insole for 6 months. Evaluations performed at baseline and after 45, 90, and 180 days by a blinded assessor were: foot pain while walking and at rest, function, quality of life, and global perceived effect with treatment.

RESULTS

The groups were homogeneous for all parameters at baseline. A statistically significant improvement (p < 0.001) was found in the EG regarding pain while walking (mean difference: -2.2 for the right foot and -2.1 for the left foot) and at rest (mean difference: -0.3 for the right foot and -0.5 for the left foot) in comparison to CG. There were no differences in any other observed measures. The time of insole use correlated with foot pain and function in the EG.

CONCLUSIONS

Foot orthoses with metatarsal and medial arch supports decreases pain during walking and at rest in both feet in patients with RA. Time of insole use correlated with improvements in pain and function.

Intra-articular injection in patients with juvenile idiopathic arthritis: factors associated with a good response

INTRODUCTION

Intra-articular injection of corticosteroids (IIC) for treatment of patients with juvenile idiopathic arthritis (JIA) is increasingly used in Pediatric Rheumatology.

OBJECTIVES

To describe the clinical course of patients undergoing IIC in our Pediatric Rheumatology Unit.

METHODS

Retrospective study of patients with JIA undergoing IIC from January 2008 to December 2012, with a minimum follow-up of six months after the injection. Good response to IIC was set as the presence of inactivity on the infiltrated joint by at least six months.

RESULTS

Eighty-eight patients underwent a total of 165 IICs. Of these, 75% were girls and 35.2% had persistent oligoarticular JIA. The mean age at diagnosis was 6.8 years, and when IIC was carried out, 12.2 years. Regarding patients, younger age at diagnosis (p=0.037) and the occurrence of uveitis in the course of the disease (p=0.015) were associated with good response to IIC. From 165 IICs, 63% had a good response and joints remained inactive for a median of 18.1 months. The type of joint injection (p=0.001), lesser values stated in the overall visual analogue scale by the physician (p=0.015) and by parents/patient (p=0.01) have been associated with a good response to IIC. Nine adverse events (5.4%) were observed.

CONCLUSION

In our study, more than half of the joints showed a good response to IIC. Younger patients at diagnosis and uveitis during the course of the disease had good response to IIC. Knees, wrists and elbows were the joints that best responded to IIC. IIC proved to be a safe procedure.

Translation, cultural adaptation and reproducibility of the Oxford Shoulder Score questionnaire for Brazil, among patients with rheumatoid arthritis

CONTEXT AND OBJECTIVE Although shoulder questionnaires validated for Brazil do exist, none of them are aimed at populations with rheumatic disease. We believe that the Oxford Shoulder Score (OSS) may be useful in this population. The objective of this study was to translate the OSS, adapt it to Brazilian culture and test its reproducibility. DESIGN AND SETTING Validation study conducted in university outpatient clinics. METHODS The OSS was translated into Portuguese by two English teachers and was then retranslated into English by two native English teachers. These translations were reviewed by a committee to establish the version of OSS-Brazil to be administered to 30 patients with rheumatoid arthritis (RA) and shoulder pain, in order to test the cultural adaptation. The validity and reproducibility was tested among another 30 patients with RA and shoulder pain, of both genders and aged 18 to 65 years. The internal consistency and reproducibility were analyzed. The following instruments were evaluated: OSS-Brazil; a numerical scale for shoulder pain; DASH; HAQ and SF-36. RESULTS The internal consistency was 0.957 and the intra and inter-rater reproducibility was 0.917 and 0.861, respectively. A high level of correlation was found between OSS-Brazil and the following: HAQ (-0.663), DASH (-0.731) and the SF-36 domains of functional capacity (0.589), physical aspects (0.507), pain (0.624), general state of health (0.444), vitality (0.634) and mental health (0.578). CONCLUSION OSS-Brazil was successfully translated and adapted, and this version exhibited good internal consistency, reliability and construct validity.

Effects of Aerobic Training in Patients with Ankylosing Spondylitis

Objective.

To evaluate the effects of aerobic exercise in patients with ankylosing spondylitis (AS).

Methods.

Seventy patients classified with AS by the modified New York criteria were included. The patients were randomly assigned into 2 groups. The intervention group (IG) performed 50 min of walking followed by stretching exercises 3 times a week for 12 weeks. The control group (CG) performed only stretching exercises. The outcome measurements were the Bath indexes [Bath AS Functional Index (BASFI), Bath AS Disease Activity Index (BASDAI), and Bath AS Metrology Index (BASMI)], Health Assessment Questionnaire for the Spondyloarthropathies (HAQ-S), AS Disease Activity Score (ASDAS), the 6-min walk test (6MWT), chest expansion, and the Medical Outcomes Study Short Form-36. Aerobic capacity was assessed by ergospirometry on a treadmill. Routine laboratory techniques were used in determining lipid levels. Assessments were performed immediately before randomization and after 6, 12, and 24 weeks.

Results.

Thirty-five patients were randomized to the IG and 35 to the CG. There was significant improvement in the BASFI, HAQ-S, BASMI, BASDAI, and ASDAS in both groups (p < 0.05), but did not differ between groups. There was a significant increase in the walking distance in the 6MWT in the IG compared with CG (p < 0.001). The IG showed significant improvement in cardiopulmonary capacity compared with CG. Cholesterol and triglyceride levels did not change in either group.

Conclusion.

In patients with AS, aerobic training improved walking distance and aerobic capacity. Aerobic training did not provide additional benefits in functional capacity, mobility, disease activity, quality of life, and lipid levels when compared with stretching exercises alone.