ISSN:1040-8711    

出版商:OVID    

年代:1998

数据来源: OVID

ISSN:1040-8711    

出版商:OVID    

年代:1998

数据来源: OVID

ISSN:1040-8711    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

Epidemiologic studies continue to provide evidence that fibromyalgia is part of a spectrum of chronic widespread pain. The prevalence of chronic widespread pain is several times higher than fibromyalgia as defined by the 1990 American College of Rheumatology guidelines. There is now compelling evidence of a familial clustering of fibromyalgia cases in female sufferers; whether this clustering results from nature or nurture remains to be elucidated. A wide spectrum of fibromyalgia associated symptomatology and syndromes continues to be described. During the past year the association with interstitial cystitis has been explored, and neurally mediated hypotension has been documented in both fibromyalgia and chronic fatigue syndrome. Abnormalities of the growth hormone-insulin-like growth factor-1 axis have been also documented in both fibromyalgia and chronic fatigue syndrome. The commonly reported but anecdotal association of fibromyalgia with whiplash-type neck trauma was validated in a report from Israel. However, unlike North America, 100% of Israeli patients with posttraumatic fibromyalgia returned to work. Basic research in fibromyalgia continues to pinpoint abnormal sensory processing as being integral to understanding fibromyalgia pain. Drugs such as ketamine, which block N-methyl- D-aspartate receptors (which are often upregulated in central pain states) were shown to benefit fibromyalgia pain in an experimental setting. The combination of fluoxetine and amitriptyline was reported to be more beneficial than either drug alone in patients with fibromyalgia. A high prevalence of autoantibodies to cytoskeletal and nuclear envelope proteins was found in chronic fatigue syndrome, and an increased prevalence of antipolymer antibodies was found in symptomatic silicone breast implant recipients who often have fibromyalgia

ISSN:1040-8711    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

Low-income populations have a lower prevalence of low back pain than high-income populations. Pathologic processes affecting the intervertebral disc are affected by genetic factors and degeneration of annular fibers. Historical and physical findings are not helpful in identifying damaged tissues in patients with nonspecific low back pain. Agency for Health Care Policy and Research guidelines for plain radiographs in the evaluation of low back pain are too sensitive and expose patients unnecessarily to ionizing radiation. Clinical entities reviewed in the literature include septic sacroiliitis, prognosis of metastatic spinal tumors, and low back pain in health care professionals. Epidural corticosteroid injections are useful for leg pain and sensory deficits early in the course of sciatica secondary to a herniated nucleus pulposus. Poor nutritional state increases the risk for postoperative infections for spinal fusion patients

ISSN:1040-8711    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

Recent research of disorders of the neck has concentrated on the efficacy of manual and other conservative therapies for neck pain and whiplash. Systematic reviews paint a poor picture of the quality of literature upon which many conventional, conservative therapies are based. Conclusive scientific data are lacking. Despite its unsavory reputation, whiplash has attracted considerable scientific inquiry. Multiple studies have brought data to bear that indicate that chronic neck pain after whiplash is not psychogenic, and that psychologic distress is secondary to the pain. Strong studies have shown that cervical zygapophysial joint pain is the most common basis for chronic neck pain after whiplash but that this condition cannot be diagnosed other than by using controlled diagnostic blocks. Surgical treatment of cervical zygapophysial joint pain has been proven to be effective in a double-blind controlled trial.

ISSN:1040-8711    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

Numerous reconstructive procedures have been used to address the manifestations of rheumatoid arthritis in the foot and ankle. Clinical studies have documented that these procedures relieve pain, however they often sacrifice motion essential to the normal function of the foot. In the forefoot, metatarsophalangeal joint resection arthroplasty shortens the lever arm of the foot, defunctionalizes the toes, and disables the plantar plate and fat pad. Arthrodesis of the ankle and hindfoot alters gait and the effective transmission of weight-bearing stresses through the foot and ankle. These ablative procedures may provoke the deterioration of adjacent joints and may cripple the long-term function of the lower extremity. The introduction of reconstructive procedures designed to preserve motion in joints essential to function and the recognition and treatment of muscle imbalances associated with bone and joint deformities are recent advances in the surgical management of the rheumatoid foot and ankle

ISSN:1040-8711    

出版商:OVID    

年代:1998

数据来源: OVID

ISSN:1040-8711    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

Therapeutic trials in rheumatoid arthritis (RA), osteoarthritis, seronegative spondylarthopathies, back pain, systemic lupus erythematosus, and systemic sclerosis are reviewed. For RA, minocycline has been proven effective in some subsets of RA, whereas tumor necrosis factor receptor IgG fusion protein appears quite effective for treating the symptoms of RA in a more resistant group. The latter trial illustrates the importance of tumor necrosis factor in RA. Also, the triple combination of hydroxychloroquine, sulfasalazine, and methotrexate is very effective even in resistant RA. In osteoarthritis, the effects of nonsteroidal anti-inflammatory drugs, intra-articular steroids, and biologies are reviewed, with generally nondifferentiable nonsteroidal anti-inflammatory drug effects and some short-term intra-articular effects of new biologies. Sulfasalazine is moderately effective for ankylosing spondylitis and psoriatic arthritis, although the large placebo response in the latter makes it more difficult to show responses. Trials in the treatment of back pain are beginning to be published, with a large cohort study over 1 year favoring surgery for early relief of pain in both sciatica and lumbar stenosis, but not showing a clear advantage in functional outcome at 1 year. Finally, early reports show the ability of dihydroepiandrosterone to decrease steroid use in systemic lupus erythematosus, whereas Relaxin appears to be effective in decreasing skin involvement in systemic sclerosis. These trials demonstrate in numerous ways the need to consider the elements of good trial design when testing therapeutic modalities in the rheumatic diseases

ISSN:1040-8711    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

The epidemiology of early synovitis syndromes in the community remains of interest. Attempts to identify those cases likely to progress to erosive rheumatoid arthritis have yielded some prognostic features that may be clinically applicable. The incidence of juvenile rheumatoid arthritis appears to fluctuate in a cyclic pattern, suggesting microbial or other environmental factors contributing to its occurrence. In the United States, the frequency of scleroderma varies among racial groups with rising rates noted especially among African-American women. A very high prevalence of scleroderma among Oklahoma Choctaws is providing an opportunity to study interactions of environmental and genetic risk factors. Excess weight in middle-aged women and possibly low intake of antioxidents contribute to the progression of established osteoarthritis of the knee

ISSN:1040-8711    

出版商:OVID    

年代:1998

数据来源: OVID