Systemic Sclerosis Patients Experiencing Mindfulness-Based Stress Reduction Program: The Beneficial Effect on Their Psychological Status and Quality of Life

Psychological concerns in Systemic Sclerosis (SSc) patients represent an important issue and should be addressed through non-pharmacological treatments. Thus, the aim of the present study was to assess the effects of the Mindfulness-Based Stress Reduction (MBSR) program on psychological variables and the perspectives and experiences of patients with an SSc diagnosis. Notably, 32 SSc patients were enrolled and assigned to either the intervention (MBSR) group or the waitlist group. Inclusion criteria were (i) age ≥ 18 years, SSc diagnosis according to EULAR/ACR diagnostic criteria and informed consent. Exclusion criteria were previous participation in any Mind-Body Therapy or psychiatric diagnosis. Quantitative and qualitative outcomes were investigated through clinometric questionnaires and individual interviews. MBSR did not significantly impact outcomes such as physical functionality, anxiety, hopelessness, depression, physical health status, perceived stress, mindfulness and mental health status. For the anger evaluation, statistically significant differences are found for both controlling and expressing anger, indicating that the MBSR program had a favorable impact. As for qualitative results, more awareness of daily activities, stress reduction in terms of recognizing the causes and implementing self-strategies to prevent them, adherence to therapy, and recognition of the effect of medication on their bodies were reported. In conclusion, it is important to highlight the absence of negative or side effects of the MBSR program and the positive impact on patients' experience and perspective; thus, we suggest this approach should be taken into account for SSc patients.

Clinical significance and usefulness of rehabilitation for systemic sclerosis

Systemic sclerosis is a multisystem connective tissue disorder characterized by excessive fibrosis of the skin and internal organs. Impairments in skin, the musculoskeletal system, and respiratory system require rehabilitation therapy because they may lead to disabilities and reduce the quality of life in daily activities. Rehabilitation for systemic sclerosis mainly comprises two distinct approaches that include local and global rehabilitation. Local rehabilitation is applied to maintain and/or improve hand and face functions, while global rehabilitation includes aerobic and resistance exercises. Although few high-quality randomized clinical trials have been conducted to date, previous studies indicated the effectiveness of rehabilitation therapy for decreasing local and systemic disabilities, resulting in improved quality of life. Rehabilitation for systemic sclerosis needs to be regularly and constantly performed at home as well as in hospitals. Physicians involved in the treatment of systemic sclerosis need to consider rehabilitation, and skilled physiotherapists and occupational therapists also play a crucial role in evaluating and treating systemic sclerosis patients.

Systemic sclerosis: rehabilitation as a tool to cope with disability

In patients with systemic sclerosis (SSc), local disability of the hands and face, due to the involvement of skin, subcutaneous tissues and musculoskeletal system, is scarcely improved by pharmacological therapy, but may be treated efficaciously with rehabilitation, which can prevent and reduce local disability, thus ameliorating global disability and impaired Quality of Life, related to changes in the hands and face. In SSc, in order to be efficacious, rehabilitation should: 1. include and use both local treatments of hands and face and global rehabilitation techniques; 2. be different according to the different SSc phases and subsets; 3. include different techniques to tailor treatment to the personal needs and abilities of the patients.

Mind body therapies in rehabilitation of patients with rheumatic diseases

Mind body therapies (MBT) share a global approach involving both mental and physical dimensions, and focus on relationship between brain, mind, body and behavior and their effects on health and disease. MBT include concentration based therapies and movement based therapies, comprising traditional Oriental practices and somatic techniques. The greatest part of rheumatic diseases have a chronic course, leading to progressive damages at musculoskeletal system and causing physical problems, psychological and social concerns. Thus, rheumatic patients need to be treated with a multidisciplinary approach integrating pharmacological therapies and rehabilitation techniques, that not should only aim to reduce the progression of damages at musculoskeletal system. Thus, MBT, using an overall approach, could be useful in taking care of the overall health of the patients with chronic rheumatic diseases. This review will deal with different MBT and with their effects in the most common chronic rheumatic diseases (Rheumatoid Arthritis, Ankylosing Spondylitis, Fibromyalgia Syndrome).

Impact of hand and face disabilities on global disability and quality of life in systemic sclerosis patients

OBJECTIVES

In systemic sclerosis (SSc), the frequent involvement of hand and face leads to their disability. We aimed to assess influence of hand and face disability on global disability and Health related Quality of life (HRQoL).

METHODS

119 SSc patients were assessed for global disability by HAQ, HRQoL, by SF36; hand disability by HAMIS, CHFDS, fist closure and hand opening measures; face disability by MHISS and mouth opening measure.

RESULTS

Diffuse SSc (dSSc) patients present higher HAQ, lower Summary Physical Index (SPI) of SF36, major hand disability at hand (higher HAMIS, CHFDS, fist closure, lower hand opening) and face (lower mouth opening, higher MHISS) than lSSc patients (p<0.05). SPI of SF36 is negatively correlated with MHISS, CHFDS, HAMIS and positively correlated to mouth and hand opening (p<0.05). Summary Mental Index (SMI) of SF36 is negatively correlated with MHISS (p<0.05). HAQ is negatively correlated with mouth opening and positively correlated to MHISS, HAMIS, CHFDS (p<0.05). By hierarchical multiple linear regression, SPI of SF36 is significantly associated with total MHISS (B=-0.34; t=-3.78; p<0.001) and CHFDS (B=-0.27; t=-3.01; p=0.003), together, explaining 22% of SPI variance. SMI of SF36 is significantly associated only with MHISS total score (B=-0.22; t=-2.41; p=0.017), explaining 4% of its variance. HAQ is significantly associated with CHFDS score (B=0.61; t=7.90; p<0.001), explaining 36% of HAQ variance.

CONCLUSIONS

dSSc patients present higher global and local disability, and lower HRQoL in SPI than lSSc patients. Local disabilities, assessed by CHDFS and MHISS, are independently related to global disability and HRQoL.

Is an intervention with a custom-made splint and an educational program useful on pain in patients with trapeziometacarpal joint osteoarthritis in a daily clinical setting?

AIM

Custom-made splints may be useful in the conservative treatment of osteoarthritis (OA) of trapeziometacarpal (TMC) joint OA. Our aim was to evaluate usefulness of a custom-made splint and educational program in patients with symptomatic TMC joint OA in daily clinical practice.

METHODS

Fifty patients with symptomatic TMC joint OA, not treated with surgery, were enrolled in a open prospective study in a clinical day setting and treated with a 'butterfly' custom-made thermoplastic short opponens splint to be worn 16 h/day for 30 days and then when needed, for 12 months. Patients were evaluated at enrolment (T0), at the first month (T1) and at the 12th month (T2) since splint application for pain (main outcome measure) by numeric rating scale 0-10. At T0 and T1, a Jamar dynamometer (kg) was used to assess hand strength, a pinch gauge to evaluate pinch strength (kg) and Dreiser test to assess hand disability (secondary outcome measures).

RESULTS

The comparison between T0 and T1 showed a significant improvement in all the outcome measures (P < 0.0001 for pain, muscle and pinch strength; P = 0.001 for Dreiser test). Moreover, at the end of 12 months follow-up, patients maintained the reduction of pain (T2 vs. T1, P = NS) and showed a reduced consumption of analgesics (P < 0.05).

CONCLUSIONS

A custom-made thermoplastic short opponens splint for 30 consecutively days for at least 16 h/day, followed by occasional use on pain outbreak is an useful conservative treatment in symptomatic TMC joint OA.

Is an intervention with a custom-made splint and an educational program useful on pain in patients with trapeziometacarpal joint osteoarthritis in a daily clinical setting?

AIM

Custom-made splints may be useful in the conservative treatment of osteoarthritis (OA) of trapeziometacarpal (TMC) joint OA. Our aim was to evaluate usefulness of a custom-made splint and educational program in patients with symptomatic TMC joint OA in daily clinical practice.

METHODS

Fifty patients with symptomatic TMC joint OA, not treated with surgery, were enrolled in a open prospective study in a clinical day setting and treated with a 'butterfly' custom-made thermoplastic short opponens splint to be worn 16 h/day for 30 days and then when needed, for 12 months. Patients were evaluated at enrolment (T0), at the first month (T1) and at the 12th month (T2) since splint application for pain (main outcome measure) by numeric rating scale 0-10. At T0 and T1, a Jamar dynamometer (kg) was used to assess hand strength, a pinch gauge to evaluate pinch strength (kg) and Dreiser test to assess hand disability (secondary outcome measures).

RESULTS

The comparison between T0 and T1 showed a significant improvement in all the outcome measures (P < 0.0001 for pain, muscle and pinch strength; P = 0.001 for Dreiser test). Moreover, at the end of 12 months follow-up, patients maintained the reduction of pain (T2 vs. T1, P = NS) and showed a reduced consumption of analgesics (P < 0.05).

CONCLUSIONS

A custom-made thermoplastic short opponens splint for 30 consecutively days for at least 16 h/day, followed by occasional use on pain outbreak is an useful conservative treatment in symptomatic TMC joint OA.

Liver stiffness correlates with methotrexate cumulative dose in patients with rheumatoid arthritis

BACKGROUND

Liver stiffness values were recently proposed to identify patients with methotrexate-induced liver fibrosis. Aim of this study was to assess the clinical and laboratory determinants of the association between liver stiffness, measured by transient elastography, and methotrexate treatment in patients with rheumatoid arthritis in the absence of other factors contributing to liver damage and fibrosis.

METHODS

100 patients with rheumatoid arthritis, with a cumulative methotrexate dose ranging from 1530 to 13,000 mg over a mean period of 7.07±3.89 yrs, were retrospectively evaluated.

RESULTS

The average liver stiffness value in the whole population was 4.93±1.8 kPa, excluding the presence of significant fibrosis. At univariate analysis, a significant correlation was found between liver stiffness and methotrexate cumulative dose, duration of treatment, alanine transaminases levels, body mass index, gamma glutamyl-transpeptidase and the presence of steatosis. At multivariate analysis, a significant association was detected only between liver stiffness and methotrexate cumulative dose. Out of 11 patients with liver stiffness >7.0 kPa, five were subjected to liver biopsy and mild or moderate perisinusoidal fibrosis was detected in two patients with a cumulative dose >4000 mg and liver stiffness >9 kPa.

CONCLUSIONS

Chronic methotrexate treatment induces a progressive increase in liver stiffness corresponding to mild or moderate perisinusoidal fibrosis for values >9 kPa.

The Italian version of the Hand Mobility in Scleroderma (HAMIS) test: evidence for its validity and reliability

OBJECTIVES

In systemic sclerosis (SSc), hand involvement is frequent and leads to prominent disability. The Hand Mobility in Scleroderma (HAMIS) test is a hand function test for SSc patients assessing the movements included in an ordinary range of motion examination. Our aim is to validate the Italian version of HAMIS, by assessing its test-retest reliability, internal consistency and external consistency in Italian SSc patients.

METHODS

The Italian version of HAMIS was administered to 40 SSc patients. HAMIS was translated according to international procedures. Test-retest reliability was assessed by intra-class correlation coefficient (ICC), internal consistency by Cronbach's alpha and external consistency by comparison with Cochin Hand Function Scale (CHFS), fist closure, hand opening, HAQ.

RESULTS

HAMIS showed a good testretest reliability (ICCs=0.99 for right and left hand) and internal consistency (Cronbach's α=0.94 for right and 0.93 for left hand) for both hands. A good external consistency was confirmed by the correlation of right and left hand HAMIS with CHFS (p<0.0001, in both cases); fist closure of homolateral hand (p<0.0001 in both cases), opening of homolateral hand (p<0.05 and <0.005, respectively), HAQ (p<0.001 in both cases). HAMIS scores for right and left hands were 7.95±6 .68 and 7.5±6.60 (p=NS), respectively. HAMIS scores for both hands were higher in dSSc and in patients with hand arthritis and flexion contractures.

CONCLUSIONS

HAMIS is a hand function test measuring hand disability in SSc. Our results support its validity and reliability in Italian SSc patients.

[Serum beta 2-microglobulin and HLA alloantigens in primary Gougerot-Sjögren syndrome. A possible relation with HLA-DR3 specificity]

The relationships between some allo-antigens of the HLA system and beta 2-microglobulin (beta 2m) serum level were examined in a group of 24 subjects with primitive Sjögren's syndrome (pSS). While the beta 2m serum level of all the patients with pSS were higher at the limits of significance (p congruent to 0.05), compared to the values of the 14 control subjects, the division of the patients into two sub-groups of 14 and 10 subjects, according to the presence or absence of the haplotypes DR2 and/or DR3, pointed up a beta 2m serum level which was significantly higher in the first compared to the second (p less than 0.02) and to the group of normal subjects (p less than 0.01). Among the individual haplotypes studied, only the DR3 was observed with a significantly greater frequency (p less than 0.01) in the patients compared to the control group. The haplotype DR3 and also the B8, although at a lesser level, were found to be correlated with a high value of the serum beta 2m: p less than 0.004 and p less than 0.05 respectively. A similar association was not found for the DR2 and DRW52 specificities.