Psychological care over patients with lymphoma and lymphoma survivors

Lymphomas are characterized by a relatively favorable prognosis and a good five-year survival rate, but they are associated with increased psychosocial distress. There is insufficient evidence on the efficacy of psychological interventions for lymphoma patients. This review aimed to present the research findings on currently used psychological interventions for (non-) Hodgkin lymphoma patients and survivors. A literature search on English language peer-reviewed original publications on psychological interventions for lymphoma patients published prior to December 2021 was performed in PubMed, Medline, Web of Science, Scopus and ResearchGate. Titles and abstracts were screened for the relevant terms including psychological intervention and psychological management along with (non-) Hodgkin lymphoma. The retrieved articles were evaluated by independent reviewers, the lists of eligible publications were compared, and disagreements were resolved by discussion. Of the 50 publications sought for retrieval, 8 articles were shortlisted based on their content. The papers were classified according to their content and the methodology employed. Research themes including "promoting resilience in lymphoma survivors", "web-based self-management interventions for patients with lymphoma", "addressing unmet needs whilst undergoing chemotherapy", and "mind-body interactive exercise" were identified and presented in this review. As the number of lymphoma survivors is increasing, future research on evidence-based interventions addressing patients' and survivors' unmet psychological needs is warranted.

Application of Eye-tracking in research on the theory of mind in ASD

Autism spectrum disorder (ASD) is a broad diagnostic category describing a group of neurodevelopmental disorders which includes the autistic disorder. Failure to develop normal social relationships is a hallmark of autism. An inability to understand and cope with the social environment can occur regardless of IQ. One of the hypotheses of the appearance of ASD symptoms is associated with the theory of mind (TOM). ASD patients do not have the ability to attribute the full range of mental states (goal states and epistemic states) to themselves and to others. Eye-tracking allows for observation of early signs of TOM in ASD individuals, even before they are 1 year old, without the need of developed motor and language skills. This provides a window for looking at the very basics of mindreading - detecting intentionality and eyes in our environment. Studies show that ASD children fail to recognize biological motion, while being highly sensitive to physical contingency within the random movement. Their perception of faces seems disorganized and undirected, while object recognition is intact. Evidence suggests that this orientation of attention following gaze cues is diminished in ASD patients. Available data also show deficits in emotion recognition, that cannot be accounted for by impairments in face processing or visual modality alone. Such observations provide an insight into disturbances of information processing and offer an explanation for poor social functioning of ASD patients. When combined with other methods, Eye-tracking has the potential to reveal differences in processing information on a neural circuitry level. Thus, it may help in understanding the complexity of TOM mechanisms, and their role in social functioning.

Pain as a mediator in the temperament-alexithymia relationship in individuals suffering from rheumatoid arthritis

OBJECTIVE

The study aims to establish a relationship between temperament traits, symptoms of alexithymia, and pain intensity in rheumatoid arthritis. Despite the significant progress seen in the area of RA treatment, pain, often life-long, remains the predominant symptom. This constant pain and progressing disability, as well as dependence upon other people cause RA patients to experience psychological stress that can be modified by individual patient traits. Recently, several authors have underlined the need to relate personality and temperament constructs to neurobiological processes that may underlie individual differences. It seems then that patient characteristics may play a significant role in the course of the disease.

PATIENTS AND METHODS

The study was performed on a group of patients (N=317) with rheumatoid arthritis diagnosed according to the current criteria of the American-European Consensus of 2010. All patients expressed voluntary consent to participate, and the study protocol was approved by the Local Ethics Committee. This was a survey-based study. It involved the application of the adult version of the Buss and Plomin EAS Temperament Questionnaire (EAS-D), which tests 3 main temperament domains: sociability, activity, and emotionality. The pain was measured on the Visual Analogue Scale (VAS). VAS is used to measure pain intensity. The level of alexithymia was tested using the Toronto Alexithymia Scale-20. The scale consists of 20 statements and includes 3 subscales that measure difficulty in describing feelings/emotions, difficulty in identifying feelings/emotions, and operational externally oriented thinking.

RESULTS

The analysis revealed that alexithymia is positively correlated only with one dimension of temperament, i.e., emotionality, and with pain intensity. Moreover, high emotionality was positively correlated with pain. A simple mediation analysis revealed that pain intensity functioned as a mediator in the emotionality-alexithymia relationship.

CONCLUSIONS

The observed correlations indicate that RA patients with a high level of emotionality exhibit high alexithymia as they perceive pain related to the disease symptoms more intensely. The observed mediation is partial, meaning that there are also other mediating factors in this relationship.

Who is happier: smoker or non-smoker? Smoking in medical students from the perspective of positive psychology

OBJECTIVE

The aim of this study was to analyze the correlation of nicotine dependence with perceived happiness and experienced emotions in three groups, namely non-smokers, smokers, and those who quitted smoking.

PATIENTS AND METHODS

The total of 552 Poznan University of Medical Sciences students aged 21.84 ± 3.95 (women: 83.3%, men: 16.7%) participated in this study. They were asked to fill out 4 questionnaires. Two were originally designed by the authors of this paper - one asked about some demographic information and the other described cigarette smoking. Happiness and its dimensions were measured using Fordyce's Happiness Measure and the Positive and Negative Affect Schedule (PANAS).

RESULTS

The obtained results point out some significant differences between smokers, non-smokers, and those who quitted smoking as to the levels of negative affect with respects to its two dimensions: Unpleasant and Frustrated. Smokers were characterized by a higher level of a negative affect than non-smokers, as well as higher scores for the Unpleasant and Frustrated dimensions compared to non-smokers and those who quitted smoking. As far as the positive affect of smokers and those who quitted smoking is concerned, a significant difference was observed for 5 dimensions: Interested, Inspired, Attentive, Determined and Active.

CONCLUSIONS

The findings of this paper can help us understand better the nicotine-dependent population in the context of positive psychology, and provide us with some basic information helpful in designing preventive programmes for nicotine addicts.

Neurophysiological Assessment of the Electrostimulation Procedures Used in Stroke Patients during Rehabilitation

The aim of this study was to evaluate the effectiveness of the associated electrotherapeutical and kinesiotherapeutical treatment in patients after ischemic stroke (N=24), mainly by means of neurophysiological tests. All patients underwent the same 20 days of neurorehabilitation procedures. Particular attention was paid to three-stage modified electrotherapy procedures such as: oververtebral functional electrical stimulation (FES), transcutaneous electrical nerve stimulation (TENS) and the alternate neuromuscular functional electrical stimulation (NMFES) of antagonistic muscles of the wrist and the ankle (N=16). Electrotherapy was supplemented with kinesiotherapeutic (mainly PNF) procedures acting as an amplifier. Clinical assessment included muscle tension (Ashworth's scale), muscle force (Lovett's scale) and reflex scoring at wrist and ankle. However, the effectiveness of the procedures was measured by the assessment of results in complex and repetitive, bilaterally performed global electromyography (EMG) and electroneurography (ENG; M-wave studies). The statistical analysis obtained from results in clinical and neurophysiological examinations suggested that the dorsiflexion of wrist and ankle was improved in the majority of patients who took part in this study. EMG and ENG examinations showed that 20 days of therapy improved both activity in muscle motor units on the more paralyzed side (mainly within upper extremities) and to a lesser degree in the transmission of efferent impulses within motor fibers of nerves. The results obtained suggest that patients after ischemic strokes never show an isolated unilateral disability in motor functions.

No definite similarities between the results of clinical and neurophysiological studies were found, which may suggest greater accuracy of the neurophysiological evaluation.

Dielectric study of interaction of water with normal and osteoarthritis femoral condyle cartilage

The main goal of this paper is the in vitro study of healthy and osteoarthritis (OA) human cartilage using the dielectric spectroscopy in the alpha-dispersion region of the electric field and in the temperatures from 25 to 140°C. The activation energy of conductivity needed to break the bonds formed by water in the extracellular matrix takes the average values of 61kJ/mol and 44kJ/mol for the control and OA cartilages, respectively. At 28°C, the small difference appears in the permittivity decrement between the control and OA cartilages, while the conductivity increment is about 2 times higher for the control tissue than that for the OA tissue. At 75°C, the conductivity increment for both of these samples is 8 times higher than their respective permittivity decrement. In addition, at 140°C the values of these both parameters for the OA tissue decrease by 8 times as compared to those recorded for the control sample. The relaxation frequency of about 10kHz is similar for both of these samples. The knowledge on dielectric properties of healthy and OA cartilage may prove relevant to tissue engineering focused on the repair of cartilage lesions via the layered structure designing.

Correlation between depression and burden observed in informal caregivers of people suffering from dementia with time spent on caregiving and dementia severity

OBJECTIVE

The aim of the study is to compare data on the examined population of informal caregivers of people suffering from dementia with previous studies, as well as to assess the correlation between (i) depression determined on the basis of the Center for Epidemiologic Studies Depression Scale and (ii) caregiver burden measured by means of the Zarit Caregiver Burden Scale and some chosen parameters, such as total time devoted to caregiving, time of caregiving in hours per week and level of dementia severity measured by Global Deterioration Scale.

PATIENTS AND METHODS

41 informal caregivers of people suffering from dementia from different backgrounds were evaluated using the Zarit Caregiver Burden Scale and the Center for Epidemiologic Studies Depression Scale. Demographic data about the time devoted to caregiving and the number of hours spend on caregiving weekly were gathered. The type of dementia and its stage were registered using the Global Deterioration Scale (GDS). With the aid of the Statistica StatSoft program, mutual correlations between the parameters were measured. The study was conducted within the framework of AAL UnderstAID--a platform that supports and helps to understand and assist caregivers in the care of a relative with dementia. The international project is co-founded by the Joint Programme Ambient Assisted Living (Grant code: ESR-aal 2012 5 107).

RESULTS

No significant correlations between the level of depression severity evaluated in caregivers and the total time of taking care of a demented person or time of caregiving in hours per week were observed. Similarly, no significant correlation between depression severity level and dementia severity level measured on the GDS scale were noted. There was also no significant correlation between Zarit Caregiver Burden Scale scores and the above-mentioned parameters.

CONCLUSIONS

The level of depression among caregivers do not depend on socio-demographic factors.

Do urban and rural residents living in Poland differ in their ways of coping with chronic diseases?

OBJECTIVE

Chronic disease is a critical life event which demands significant psychological adjustment. Coping strategies and resources such as sense of coherence, self-efficacy, etc. remain factors affecting stress response.

PATIENTS AND METHODS

The examined group included patients with ischemic heart disease (n = 134), type 1 diabetes mellitus (n = 109) or rheumatoid arthritis (n = 92). 159 patients came from urban area whereas 176 came from rural setting. All patients filled up inventories of life satisfaction, severity of depression, coping strategies, self-efficacy, social support and sense of coherence.

RESULTS

The analysis showed that patients from rural areas had higher levels of well-being, i.e., were characterized by lower severity of depression. The predictors of satisfaction with life included two types of resources i.e. self-efficacy, social support and two coping strategies i.e. turning to religion and self-distraction (R2 = 0.39; F = 26.87**). Life satisfaction was determined by social support, sense of coherence and positive reappraisal (R2 = 0.36; F = 29.11**).

CONCLUSIONS

Rural/urban differences in the use of coping strategies may be associated with environmental or lifestyle differences. Patients with IHD, T1D or RA in Polish rural areas are high risk for depression so they may need help in finding systematic contact with specialists of healthcare.

Certolizumab pegol in rheumatoid arthritis patients with low to moderate activity: the CERTAIN double-blind, randomised, placebo-controlled trial

Objectives

This 52-week, randomised, double-blind phase IIIb study assessed efficacy and safety of certolizumab pegol (CZP) as add-on therapy to non-biologic disease-modifying antirheumatic drugs (DMARDs) in rheumatoid arthritis (RA) patients with low to moderate disease activity, and stopping therapy in patients in sustained remission.

Methods

Patients were randomised 1:1 to CZP (400 mg at weeks 0, 2 and 4, then 200 mg every 2 weeks) or placebo (every 2 weeks) plus current non-biologic DMARDs. At week 24, patients who achieved the primary endpoint of Clinical Disease Activity Index (CDAI) remission at both weeks 20 and 24 stopped study treatment and continued in the study until week 52.

Results

Of 194 patients (CZP=96; placebo=98), >90% had moderate disease activity at baseline. Significantly more CZP patients met the primary endpoint than placebo patients (week 20 and 24 CDAI remission rates: 18.8% vs 6.1%; p≤0.05). At week 24, 63.0% vs 29.7% of CZP versus placebo patients (p<0.001) achieved LDA. Disease activity score (ESR) based on 28-joint count and Simplified Disease Activity Index remission rates were also significantly higher with CZP versus placebo (19.8% vs 3.1%; p≤0.01 and 14.6% vs 4.1%; p≤0.05). CZP patients reported improvements in physical function versus placebo (mean Health Assessment Questionnaire-Disability-Index change from baseline: CZP, −0.25 vs placebo, −0.03; p≤0.01). During the period following withdrawal of CZP or placebo, only 3/17 prior CZP patients and 2/6 prior placebo patients maintained CDAI remission until week 52, but CZP reinstitution allowed renewed improvement. Adverse and serious adverse event rates were comparable between CZP and placebo groups.

Conclusions

Addition of CZP to non-biologic DMARDs is an effective treatment in RA patients with predominantly moderate disease activity, allowing low-disease activity or remission to be reached in a majority of the patients. However, the data suggest that CZP cannot be withdrawn in patients achieving remission.

Trial registration number

NCT00674362.

The evaluation of selected serum mineral concentrations and their association with insulin resistance in obese adolescents

BACKGROUND

In obesity, elevated insulin resistance is observed, which may be associated with disturbances in mineral status in the body. The few studies concerning the status of minerals and their relationships with insulin resistance and body composition in adolescent populations have brought inconclusive results.

AIM

of this study is, thus, to assess serum mineral concentration in obese adolescents, and to evaluate their potential association with insulin resistance.

SUBJECTS AND METHODS

Seventy-eight obese adolescents and 20 healthy volunteers aged 12-18 years were recruited for the study. Selected anthropometrical measurements and levels of iron, zinc, copper, calcium, and magnesium were assessed in serum. Insulin resistance in the participants was evaluated according to the homeostatic model of assessment for insulin resistance (HOMA-IR) protocol. Levels of iron, zinc, copper, calcium, and magnesium were assessed in serum.

RESULTS

Obese subjects had significantly higher HOMA-IR indices than the control group. Compared to healthy subjects, the serum concentration of zinc, calcium, and magnesium was significantly lower in obese subjects. A significant inverse relation was found between HOMA-IR and zinc levels in serum.

CONCLUSIONS

Obese adolescents have a poorer mineral status (especially zinc) than adolescents of normal weight, which can contribute to insulin resistance.

Dielectric properties of hypothermic rat artery

The temperature and frequency dependencies of the dielectric parameters for the rat artery are used to analyse effects of hypothermia on this tissue. Measurements were performed over the frequency range 500 Hz to 100 kHz and at temperatures from 19 to 60°C. The artery samples contained about 12% water by mass at room temperature at a relative humidity of 70%. The frequency dependencies of the loss tangent for the control, mild hypothermic and moderate hypothermic artery exhibit two peaks at 2 kHz and 35 kHz in the α-dispersion region. The results were discussed in terms of the distribution of relaxation frequencies and the activation energy for the conduction and polarization mechanisms particularly in the elastin-water and collagen-water systems. The knowledge about dielectric behavior of the hypothermic rat artery in vitro is important due to clinical application of local and systemic hypothermia.

Implications of the alpha dispersion for studies on interaction of tobacco smoke--corneal tissue

In this work, we have carried out a dielectric study to determine the effect of tobacco smoke on the rat corneal function. Measurements were performed over the frequency range of 500 Hz-100 kHz in air and at the temperature of 35°C. The frequency dependencies of the loss tangent for both healthy and smoky cornea exhibit two peaks with different width occurring as a narrow at 2 kHz and a broad at around 16 kHz. The distribution parameter α at 2 kHz has a value of about 0.3, which increases to 0.6 at 16 kHz. The magnitude of the permittivity decrement at 2 and 16 kHz is about two and four times higher, respectively, for the smoky cornea than that for the healthy one. These dielectric studies indicate that the present method is useful in detection of the effect of tobacco smoke exposure on the corneal behavior.

Behavioral and Emotional Problems of Children with ADHD

ADHD as long term disease is diagnosed in first years of life. Ill children need complex psychotherapy and pharmacotherapy and effects sometimes are minor. The aim of the study was to estimate possible emotional disturbances, control of emotions, impulsivity, behavioral problems or psychosomatic disturbances in children with ADHD.

40 mothers of children fulfilled the questionnaire of Achenbach and questionnaire of authors' concept. Children aged 6-18 yrs of age were estimated by mothers. The results show the most often problems underlined were low control of emotions 50%, impulsivity 25%, aggressiveness - 10%. Parents also show tendency of appearance of psychosomatic problems as headaches, sleep disturbances, eating disturbances. They connected these problems to school adaptations problems.

There was correlation between level of intelligence (IQ) and frequency of appearance of sleep disturbances. The lower level of IQ the sleep disturbances reveal more often.

In conclusion: Children with ADHD need also complex care, also psychotherapy and there is a need of psychological counseling for the families.

Psychotherapy, Pharmacotherapy and Rehabilitation of a Child with Cerebral Palsy

Cerebral palsy (CP) is one of the most often non-progressive encephalopaties. among clinical symptoms the mobility and posture disturbances are predominantly observed, most typically neurologic and motor disturbances, showing up as spasticity, disturbances in muscle tension, ataxia or somatosensoric problems. CP and its coexisting symptoms, encompassing mental impairment are most severe causes of handicap in children and constitute an important factor deteriorating the fulfilment of developmental tasks. the improvement of the functional status depends on systematic training based on learning processes. Following training, as effect of learning, stable plastic alterations in brain occurs, based on the previously described feature of making new synaptic connections and synaptic stabilization due to apoptosis of some other neural connections. Neverless pharmacotherapy, though it cannot remove the source of the disturbances and acts mainly symptomatically, is a important element of the complex rehabilitation. However, taking into consideration the chronic and stable character of the pathologic process, it should be remembered that the pharmacologic substances used should be characterized by:

•

The most frequently used drug groups in the cerebral palsy are:

•

Rational use of relatively wide spectrum of drugs, relaxant, sedative, anxiolytic, toning up, improving cerebral perfusion, anticonvulsory and reducing muscle tonus makes diagnostics, functional psychotherapy, kinesis therapy, ergotherapy, manual therapy, physical therapy, as well as social and occupational rehabilitation easier to a very high extent.

Obesity and its Connections to Some Personality Traits, Locus of Health Control in Adolescents

The substantial health enhancing potential of physical and psychological activity can be realized by incorporation of physical activity in everyday style of life. Health can be understood as an aim of activities but also adolescents may not take into consideration activities toward health improvement.

The aim of the study was to estimate differences in psychological functioning locus of health control in adolescents with obesity.

The method were: The Scale MHLC - Multidimensional Scale of Health Control Localization. CISS - questionnaire of coping with stress.

60 persons growing with obesity (over 90 percentile) participated in investigations in age of 12-18 years. 100 healthy persons well-chosen made up the group of the reference under in relation to age, sex, educations. The results were important on the level 0,05.

Results show that the locus of health control was internal in both groups, but internal locus in healthy group has appeared more often. Children with obesity had lower abilities of coping with stress in comparison to healthy ones.

Body posture in women after mastectomy and its changes as a result of rehabilitation

PURPOSE

The aim of the study is: 1) to analyse selected features of body posture in women after mastectomy, 2) to compare them with body posture of healthy women, 3) to determine the effect of rehabilitation physical exercises on the changes in body posture in women after mastectomy.

MATERIAL AND METHODS

The research material consisted of 85 women after mastectomy examined once, including 40 of them who were additionally examined twice at six-monthly intervals. Moreover, a group of 20 women was isolated who regularly attended rehabilitation classes for a period of one year in question. A comparative group was a group of 85 healthy women. The examinations were performed using photogrametric assessment of body posture.

RESULTS

Distinct adverse changes in body posture of women after mastectomy in comparison with healthy women were found, manifested mainly in asymmetry of trunk and shoulder girdle and greater forward leaning of the trunk. Significant relationship was indicated between the operation of mastectomy and the asymmetry of position of scapulas.

CONCLUSIONS

When comparing the changes in the features of body posture in the group of women who exercised regularly with other women for the period of one year it was found that a positive effect of regular rehabilitation was keeping the angle of body inclination on the same level and improvement in trunk symmetry, position of scapulas and shoulder girdle.

Alterations of lymphocyte subpopulations in choroidal melanoma patients undergoing surgery

PURPOSE

The alterations of lymphocyte subpopulations assessment after surgery in choroidal melanoma patients compared to cataract patients.

MATERIAL AND METHODS

12 patients with malignant melanoma of the choroid, 10 patients subjected to surgery due to cataract. Methods--flow cytometric measurement of absolute lymphocyte count, the number of all T cells (CD3+), T helper lymphocytes (CD3+ CD4+), T cytotoxic lymphocytes (CD3+CD8+), B lymphocytes (CD19+), NK cells (CD3-CD16+) and T cells (CD3+) cells with gammasigma TCR, on the day of surgery and two days after it.

RESULTS

Comparable numbers of cells were observed in both groups prior to surgery, but the behavior of some populations differed: CD3+, CD3+CD4+ cells increased in melanoma patients whereas they decreased in reference group, the number of T lymphocytes with gammasigma TCR was significantly higher in melanoma patients before surgery and it did not differ after it.

CONCLUSIONS

Though there were no significant differences in lymphocyte subpopulations between melanoma patients and the reference group, it seems that the presence of tumour influences the reactivity of the immune system to the trauma (surgery).

Acute phase proteins serum concentrations in children are related to urinary iodine excretion

PURPOSE

The paper presents links between iodine provision and selected acute phase proteins' (APP) serum concentrations as well as their glycosylations profiles (investigated with the use of affinity immunoelectrophoresis with Concanavalin A as ligand) in children.

MATERIAL AND METHOD

116 children (58 girls and 58 boys) were enrolled. Iodine level was measured in the morning (7:30-8:30) urine portion, using Cr-As method. According to iodine level children were divided into two groups. The first one consisted of 56 children with decreased iodine level (lower than 100 micrograms/L), second--60 children with iodine level higher than 100 micrograms/L. In serum the concentration of ferritin, beta2-microglobulin (beta2-MG), thyroxin (T4), triiodothyronin (T3), thyrotrophic hormone (TSH) were measured by radioimmunoassay (BELORIS, Belarus). Concentrations of APP: C-reactive protein (CRP), alphal-acid glycoprotein (AGP), alphal-antichymotrypsin (ACT), alphal-antitrypsin (AT), haptoglobin (Hp), alpha2-macroglobulin (A2-M), ceruloplasmin (Cp) and transferrin (Tf) were measured in sera samples by rocket immunoelectrophoresis acc. to Laurell with antibodies and standard from DakoCytomation, Denmark. Microheterogeneity of AGP, ACT and Tf was estimated using affinity immunoelectrophoresis with ConA as a ligand, acc. to Bøg-Hansen.

RESULTS

It was established, that CRP level was lower than upper limit of normal range. Levels of other investigated proteins were reliably dependent on the level of iodine. Especially for AGP lower level was observed for children of the group with low iodine level. In children with low iodine level along with the decrease of serum AGP concentration altered glycosylations profile was observed, namely decrease in the content of variant non-reactive to ConA (W0) and increase in content of weakly reactive (W1) and reactive (W2) variants content, which resulted in increase of the reactivity coefficient (AGP-RC). Similar tendency in alterations of distinctly glycosylated variants in relation to iodine level could be shown for ACT. Serum concentration of any investigated protein was not dependent on the concentration of the hormones of pituitary-thyroid system.

CONCLUSIONS

It seems that the influence of the iodine level is direct, not via thyroid hormones. It could be suggested that in euthyroid children with low iodine excretion with urine a hidden iodine deficiency is already registered by the regulatory mechanisms and a kind of acute phase reaction is started, may be in order to increase iodine uptake and storage.

Development and psychokinetic therapy of children suffering from West Syndrome--an overview

Paper presents reasons leading to the West Syndrome, disturbances occurring in the child's development and possible rehabilitation programmes. Psychological rehabilitation of a child with West Syndrome is multilateral, but its main aim is to improve the quality of life, social adaptation and optimizing of the cognitive functioning. Taking into consideration the psychokinetic retardation occurring in the West Syndrome because of prenatal, perinatal or postnatal disturbances apart from pharmacotherapy an intensive psychokinetic stimulation based on plasticity of the brain should be stressed out. Only the complex, intensive and long lasting rehabilitation of a child may secure to it the best possible development.

Open trial of mirtazapine in patients with fibromyalgia

BACKGROUND

Some positive therapeutic effects in fibromyalgia syndrome (FS) were reported with both tricyclic and new antidepressant drugs as well as serotonergic agents (5HT2 and 5HT3 receptor blockers).

METHODS

In the present study, a novel antidepressant drug mirtazapine, 15-30 mg/day, has been used in 29 patients with FS in an open trial.

RESULTS

Twenty-six patients completed the six-week study. Ten (38%) were considered responders on account of the reduction of > or =40% on pain, fatigue and sleep disturbances and remission of depressive symptoms at the end of study. Eighteen patients had at least moderate depression before mirtazapine treatment and 8 patients presented mild depressive symptoms. Reduction on main symptoms of FS after 6 weeks of mirtazapine treatment significantly correlated with the reduction in depression. However, the percentage of responders and patients with > or = 40% reduction on main symptoms of fibromyalgia was similar in high and low depression groups.

CONCLUSIONS

The results obtained suggest that mirtazapine may be promising method of FS treatment. Further double-blind placebo-controlled studies are required to confirm these results.

Effects of antidepressant mirtazapine on fibromyalgia symptoms

PURPOSE

Fibromyalgia syndrome (FS) is a form of non-articular rheumatism. The main criteria are the widespread musculoskeletal pain and tender points at multiple characteristic sites which are associated with several vegetative and functional symptoms. Depression is the most frequent psychiatric concomitant of FS. Etiology is unknown, connection between disturbances of serotonin metabolism and pathogenesis is postulated. Pharmacological therapy with analgetic and nonsteroidal antiinflammatory drugs is not very effective. Positive effects were reported in some patients treated with antidepressant drugs, especially serotonergic agents.

MATERIAL AND METHODS

In the study a novel antidepressant drug mirtazapine was used characterized by selective blockade of 5-HT2 and 5-HT3 receptors. In an open trial participated 29 patients with FS, who met 1990 ACR criteria for fibromyalgia. All were treated with mirtazapine for 6 weeks. Intensity of pain, sleep disturbances, fatigue and other symptoms were measured using visuale analogue scale, severity of depression was evaluated with HDRS and BDI.

RESULTS

An open trial completed 26 patients, the majority of them experienced a clinical improvement at the end of the study as a consequence of > or = 40% reduced intensity of fibromyalgia symptoms as well as reduced severity of depression. The significant correlation between reduction in depression after 6 weeks of mirtazapine treatment with the reduction on all four main symptoms of FS suggests a common pathophysiology of depression and symptoms of fibromyalgia. The data thus far obtained indicate the blockade of 5-HT2 and 5-HT3 receptors with mirtazapine as an effective and promising method in FS.

CONCLUSIONS

Further double-blind placebo-controlled study are required to confirm our results.

Intra-articular treatment of arthritides and activated osteoarthritis with the 5-HT3 receptor antagonist tropisetron. A double-blind study compared with methylprednisolone

BACKGROUND

Since the good effect of intra-articular injections of the 5-HT3 receptor antagonist tropisetron in patients with arthritides and activated osteoarthritis has already been demonstrated in pilot studies, the effect of tropisetron is compared with that of methylprednisolone here.

OBJECTIVES

In a double-blind study, 34 patients with gonarthritides or activated osteoarthritis (18 patients with rheumatoid arthritis, 16 patients with osteoarthritis) were treated with a single intra-articular injection of 10 mg tropisetron (18 patients) or 40 mg methylprednisolone (16 patients). Before treatment as well as one and three weeks later, the intensity of rest pain and pain following exercise was measured with the visual analog scale (VAS) for pain and the clinical findings in the knee joint were recorded.

RESULTS

By means of the intra-articular tropisetron treatment, the inflammatory joint process with arthritides and activated arthroses could be influenced in a similar way as with corticosteroid treatment. No significant differences were detected.

CONCLUSION

According to the results presented here, the intra-articular treatment with the 5-HT3 receptor antagonist tropisetron in patients with gonarthritides and activated arthroses was about equally effective as those for treatment with corticosteroids. Therefore, it can be used as an alternative in patients for whom concomitant diseases like diabetes and hypertension make it difficult to use corticosteroids. Whether increasing the tropisetron dose may further improve the results remains to be determined in future studies.

Interleukin-10 and interleukin-6 in lupus erythematosus and rheumatoid arthritis, correlations with acute phase proteins

We sought to investigate the influence of interleukin-10 (IL-10) and IL-6 on the acute phase proteins (APP) in systemic lupus erythematosus (SLE) and rheumatoid arthritis (RA). IL-10, IL-6, Creactive protein (CRP), alpha-1-acid glycoprotein (AGP), and alpha1 antichymotrypsin (ACT) serum levels were determined in one hundred-eight patients (71 with SLE, 37 with RA). Quantification of the serum IL-10 level showed increased levels in SLE and RA patients as compared to healthy controls. Serum IL-6 level was found to be elevated in SLE and RA patients. A correlation between IL-10 and IL-6 serum level was found only in SLE. CRP and AGP serum levels were increased in RA as compared to controls, whereas in SLE only AGP was found elevated. A statistically significant correlation between IL-6 serum level and CRP, AGP and ACT was found only in RA. No correlation between IL-10 and serum level of CRP, AGP and ACT was established. Since IL-10 has a potent immunosuppressive activity, we expected it to be negatively correlated with APP levels. Surprisingly, IL-10 did not correlate with APP either in SLE or RA patients. However, the elevation of IL-10 serum levels in SLE and RA and the correlation between IL-10 and IL-6 in SLE may suggest that IL-10 may play a central role in inflammatory connective tissue diseases.

[Biochemical changes in fibromyalgia]

Different changes in neurotransmitters were observed in patients with fibromyalgia. The aim of the study was to confirm the diagnosis fibromyalgia by determination of several of these substances. In 60 patients, who met the ACR classification criteria for fibromyalgia and in 20 sex and age matched controls the following estimations were made: serotonin (EIA), somatomedin C (RIA), calcitonin (RIA), prostaglandin E2 (EIA), oxytocin (RIA), ACTH (RIA), substance P (EIA), TSH (LIA), prolactin (LIA). In comparison to healthy controls, patients with fibromyalgia revealed significantly decreased levels of serotonin, somatomedin C, calcitonin, prostaglandin E2 and a significantly increased level of prolactin. No significant differences were found in the levels of ACTH, substance P and TSH. These results suggest that the diagnosis of fibromyalgia can be confirmed by various biochemical parameters, but further investigations must be carried out to value the diagnostic relevance of these findings.

The lymphocyte phenotype in patients with primary fibromyalgia

The aim of this study was to examine the lymphocyte phenotype in fibromyalgia (FB) patients. Nineteen patients [18 females, 1 male] who met the ACR classification criteria for FB were recruited into the study. The fluorescence of leukocytes was measured using Ortho Cytotron Absolute flow cytometer. Ortho-mune monoclonal antibodies [OK-Combo-Tests] were used for determination of the following antigens: CD3/CD19, CD3/HLA-DR, CD4/CD8, CD45RA/CD4. Serum IgE was established with ELISA [Merck, Germany]. There were no differences in percentage of CD3, CD19, CD4, CD8, CD3/HLA-DR and CD4/CD45RA cells as compared to healthy controls. We found a negative correlation between CD4 and CD8, CD3DR and IgE, CD8 and IgE concentration. The positive correlation between CD3 and CD3DR, CD3DR and CD8 was observed. The inhibitory effect of CD8+ cells subpopulation on B-cells and thereby on IgE production in patients afflicting for allergy has been already observed. Moreover, the symptoms to allergy has been found in about 50% of our patients. Taken together the data thus far obtained present a coexistence of symptoms of allergy and FB.

The 5-HT3 blockers in the treatment of the primary fibromyalgia syndrome: a 10-day open study with Tropisetron at a low dose

A 10-day open trial with Tropisetron, the selective serotonin type 3 receptor antagonist, in a dose of 5 mg daily was undertaken in 19 patients with the primary fibromyalgia syndrome (FB). Before and after the therapy, pain was assessed using a visual analogue scale and a pain score. All the patients were asked about the presence and intensity of vegetative and functional symptoms. Moreover, the tenderness at the 24 typical tender points at baseline and at the end of the therapy was evaluated. A statistically significant improvement of all examined parameters was observed after the therapy. The efficacy of Tropisetron in a dose of 5 mg daily was comparable with the results obtained in a previously reported trial with a dose of 10 or 15 mg per day, but the frequency of gastric troubles decreased (21% vs. 60%). The hypothesis about the existence of two subgroups of patients with FB is also discussed.

Acute phase response in rheumatoid arthritis patients treated with immunosuppressive drugs

We sought to investigate an influence of immunosuppressive drugs on acute phase response (APR) in rheumatoid arthritis (RA). Ninety-six patients (pts) were treated with methotrexate (MTX), or with cyclophosphamide (CTX) (9-intravenously, 19-orally), or with cyclosporin A (CSA). C-reactive protein (CRP), alpha-1-acid glycoprotein (AGP), and alpha-1 antichymotrypsin (ACT) serum levels were measured by rocket immunoelectrophoresis. AGP and ACT microheterogenities evaluated using immunoelectrophoresis were expressed as reactivity coefficient (RC). Clinical improvement was observed in 71.4% MTX pts, 77.8% CTX intravenously pts, 36.8% CTX orally pts, 60.0% CSA pts. The number of side effects was the highest in CTX oral group (57.9% left the study). CRP, AGP, and ACT serum levels were increased in all groups of RA pts as compared to healthy controls. CRP level decreased only after MTX and CTX intravenous treatment. Moreover, a decrease in ACT was observed in CTX intravenously treated pts. AGP-RC was lower in the initial population of RA pts as compared to healthy control. After 6 months of treatment RC became significantly higher in MTX pts only. In opposite ACT-RC in RA pts was found to be elevated as compared to controls. After the treatment it fell down. The decrease was found to be significant only in pts treated with MTX. From our study we can conclude that MTX is the safest and the most effective agent among immunosuppressive drugs applied in RA. CTX given orally causes a number of adverse reactions, which frequently make continuous and effective treatment impossible. CTX intravenously and CSA are attractive in the treatment of the patients with severe and refractory RA. A lack of clinical benefit is reflected in the absence of acute markers changes.

Do changes in clinical improvement in rheumatoid arthritis patients treated with immunosuppressive drugs reflect the changes in acute phase proteins?

We sought to investigate whether clinical improvement after immunosuppressive treatment reflects changes in acute phase response (APR) in rheumatoid arthritis (RA). Fifty-eight patients (pts) were treated with methotrexate (MTX), nineteen with intravenous cyclophosphamide (CTX), and fifteen with cyclosporin A (CSA). C-reactive protein (CRP), alpha-1-acid glycoprotein (AGP), alpha-1 antichymotrypsin (ACT), and alpha-1 antitrypsin (AT) serum levels were measured by nephelometry or rocket immunoelectrophoresis. Clinical improvement was observed in 67% MTX pts, 53% CTX pts, and 47% CSA pts. Baseline serum levels of CRP, AGP, ACT, and AT were significantly higher as compared to healthy controls. After MTX and CTX therapy CRP level significantly decreased. The decrease in serum level of ACT and AT in CTX treated patients was also observed. All analyzed acute phase proteins remained substantially elevated after CSA therapy despite a clear reduction in disease activity. We established a correlation between changes in disease activity and all acute phase proteins (APP) in MTX and CTX pts. From our study we can conclude that clinical improvement after immunosuppressive treatment correlated with quantitative changes in all APR markers in MTX and CTX treated pts, and none in CSA pts. Although measurement of APP remains the best marker for monitoring RA pts, not always they properly reflect changes in disease activity.

Comparison of microheterogeneity of alpha-1-acid-glycoprotein in serum and synovial fluid from rheumatoid arthritis patients

Microheterogeneity of alpha-1-acid glycoprotein was studied using affinity immunoelectrophoresis with concanavalin A as a ligand in the samples of serum and synovial fluid obtained at the same time from 22 patients with rheumatoid arthritis. Individuals with intercurrent infection or other illnesses were excluded from the study. The results were expressed as reactivity coefficient (RC). Disease activity was evaluated by Mallya-Mace Activity Score, Lansbury Joint Index and laboratory tests. In most of the studied samples the glycosylation pattern was similar, composed of a nonreactive variant and 2 reactive (the first and the second) with Con A variants. In seven samples of synovial fluid an extra third peak representative of the strongly reactive one with Con A fraction was observed. It was the cause of the remarkable elevation of AGP-RC. Moreover, the level of IgM and IgA RF was higher in the synovial fluid derived from these patients--with the presence of the third peak in AFF-EP with Con A--than in those without the considered fraction.

Cold-induced vasospasm in patients with fibromyalgia and chronic low back pain in comparison to healthy subjects

Using capillary videomicroscopy of the nail fold, the frequency of cold-induced vasospasm and capillary hemodynamic parameters were studied after application of cold in 50 patients with primary fibromyalgia, 50 patients with chronic low back pain, and 50 healthy controls. Cold-induced vasospasm was detected in 38% of the patients with fibromyalgia. In this group it was significantly more frequent than in the patients with chronic low back pain (20%, p < 0.05) and healthy subjects (8%, p < 0.001). In the fibromyalgia group, the magnitude of vasospasm as measured by the capillary blood flow deceleration after cold application correlated negatively with the pain intensity as measured by pain score (r = -0.3839, p < 0.01). No differences in clinical appearance were found between patients with and without cold-induced vasospasm in both the fibromyalgia and low back pain group.

[Serotonin concentration in serum of patients with generalized tendomyopathy (fibromyalgia) and chronic polyarthritis]

The serum concentration of serotonin (S-5-HT) was measured in 31 patients with primary fibromyalgia, 21 patients with rheumatoid arthritis (RA) (15 of them with secondary fibromyalgia) and 20 healthy volunteers. Both patients with primary fibromyalgia and rheumatoid arthritis had significantly lower S-5-HT levels when compared to healthy controls, and S-5-HT concentrations in patients with secondary fibromyalgia were even significantly lower than those of RA-patients. Unlike the patients with rheumatoid arthritis, a significant correlation between S-5-HT level and the number of "tender points" as well as mean pressure tenderness at 24 different points was found in patients with primary fibromyalgia. Conversely, in patients with rheumatoid arthritis the S-5-HT level correlated significantly with erythrocyte sedimentation rate. These results suggest different pathological mechanisms of S-5-HT decrease in patients with primary fibromyalgia and rheumatoid arthritis. On the other hand, they raise the question whether secondary fibromyalgia may be a pathogenetically different syndrome mimicking symptomatically primary fibromyalgia.

Transient increase of aminotransferases in RA patients treated with methotrexate

Sixty-two patients with rheumatoid arthritis (RA) were treated with methotrexate (MTX) for 3 months. Methotrexate was given orally in a single dose of 7.5-15.0 mg/week. At the onset of the treatment increased activity of aminotransferases has been observed. Eighteen patients (29%) displayed higher enzyme activity in the first 3 weeks. Despite the continuous drug administration the activity of aminotransferase became normal at week 12 in all but one patient. In this patient MTX had to be withdrawn.

[Recording muscle spasm in the musculus erector spinae using in vivo 31P magnetic resonance spectroscopy in patients with chronic lumbalgia and generalized tendomyopathies]

Using 31P nuclear magnetic resonance, the following parameters were determined in the resting musculus erector spinae of five patients suffering from chronic low back pain, five patients with fibromyalgia, and five healthy controls: Inorganic phosphate (Pi), phosphocreatine (PCr), ATP gamma, ATP alpha, ATP beta. The intracellular pH was derived from the chemical shift of Pi referenced to the PCr resonance. In addition, the Pi-Index was calculated according to the formula: Pi/(Pi + PCr). We discovered a tendency towards a shift of the Pi resonance in the alcalic direction, which was the larger, the stronger muscle spasm was found on palpation. The pH showed the most reliable relationship to the clinical status of muscle spasm. The surprising finding that there is no acidification within the spasmed muscle indicates that generalized hypoxia does not exist in this tissue. This has already been shown with PO2 measurements. An intracellular acidification is only recorded during maximal isometric contraction. Thus, ischemia cannot be responsible for pain experienced during muscle spasm.

[Can thermal therapy of ankylosing spondylitis induce an activation of the disease?]

A randomized, open, controlled study was carried out in eight patients with spondylitis ankylosans, in a cross-over procedure including total body cryotherapy and whole spine paraffin mud packs. The effect of both therapies on clinical status and different laboratory data was investigated. No clinical changes were seen after either therapy; in contrast, in answering the spine function questionnaire patients reported an improvement after cryotherapy and a worsening after thermotherapy, but because of the small number of patients no positive conclusion was possible. The acute phase proteins (alpha-1-AGP, alpha-1-ACT, alpha-2-haptoglobin and alpha-2-coeruloplasmin) did not show any changes, only CRP increased after thermotherapy and declined after cryotherapy. Interesting changes were seen in the glycosylation profile of alpha-1-AGP: after thermotherapy an increase of bi-antennary oligosaccharides occurred, observed as appearance of a third peak in the affinity immunoelectrophoresis with con A and an increase of reactivity-coefficient of alpha-1 and glycoprotein which was also seen in the exacerbation of AS. This shows, that an activation of the inflammatory process may be possible by thermotherapy (perhaps because of an amplification of Il-6 production), but not by cryotherapy. Similar studies should be conducted in larger numbers of patients.

[Intraindividual comparison of whole body cold therapy and warm treatment with hot packs in generalized tendomyopathy]

In a cross-over study, the short-term efficacy of whole-body cold therapy and hot mud packs in patients with generalized tendomyopathy (fibromyalgia) was compared. As a pain assessment, visual analog scale and so-called pain score were measured; dolorimetry of the 24 tender points and eight control points was performed as well. Using these methods, we found that there is a significant improvement of all parameters examined during a 2-h period of measurements after cold application, and a marked improvement was also detectable 24 h after this therapy. In contrast, only pain score values showed a slight decrease immediately after hot mud-pack therapy, and no significant differences were found in visual analog scale and pressure tenderness as measured dolorimetrically. Central inhibition of nociceptors as a result of an activation of A-delta system as well as a blockade of gamma-motoneurons are discussed to be a mechanism of action of whole-body cold therapy, resulting in a decrease in muscle tonus. Long-term studies are needed to determine, if there is any enduring effect of whole-body cold therapy on pain in the patients with generalized tendomyopathy.

[Pressure point studies in generalized tendomyopathy (fibromyalgia) (comparison of various methods)]

There are different methods used for examination of tender-point pressure tenderness, which is one of the two most important criteria for diagnosis of generalised tendomypathy (fibromyalgia). When 11 of 18 tender points must be painful under the pressure of 4 kg for fulfilling the criteria of American College of Rheumatology (ACR), we require 12 of 24 points to be tender when pressed with a force less than 2 kg using dolorimeter. We have found that our method have a significantly higher specificity with about the same sensitivity, when compared with by ACR proposed method. Specificity and sensitivity depended on method used for pressure application and not on points examined. In view of our findings, we propose for scientific purposes dolorimetric measurement of pressure tenderness as being more reliable although more time-consuming method.