Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 27
Filtrar
Mais filtros

Base de dados
País/Região como assunto
Tipo de documento
País de afiliação
Intervalo de ano de publicação
1.
J Tissue Viability ; 30(3): 418-420, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-34023159

RESUMO

Backrest elevation for a patient with a sacral-coccygeal pressure ulcer is necessary in certain situations, particularly to enable the patient to take meals. Deep pressure ulcers with undermining formations affect patients and create challenges for caregivers. The procedure of backrest elevation potentially worsens the pre-existing sacral-coccygeal pressure ulcers with undermining formations. Here, we report a Case of the clinical care of a patient using a simple approach for backrest elevation that minimizes additional injury to the existing sacral pressure ulcer covered with granulation tissue. In this case, we performed the backrest elevation in the semi-lateral position. After the backrest elevation, the patient was repositioned to the supine position to take a meal. The supine position was allowed at any time except during backrest elevation. The pressure ulcer of the patient improved rapidly using the combined treatment of our positioning approach and appropriate topical ointments. This practical approach may be effective for some patients as it potentially decreases the effect of shear force. The rationale for this approach can be explained by the mechanism of the undermining formation outlined in our experimental study using a pressure ulcer model mounted to a phantom. Although we used this position for patients with sacral-coccygeal pressure ulcers, this simple approach may also be considered for other patients based on our proposed pathogenesis of undermining formations.


Assuntos
Posicionamento do Paciente/normas , Úlcera por Pressão/prevenção & controle , Pressão/efeitos adversos , Região Sacrococcígea/irrigação sanguínea , Decúbito Dorsal/fisiologia , Humanos , Úlcera por Pressão/fisiopatologia , Região Sacrococcígea/fisiopatologia
2.
BMC Musculoskelet Disord ; 21(1): 173, 2020 Mar 16.
Artigo em Inglês | MEDLINE | ID: mdl-32178665

RESUMO

BACKGROUND: Hand osteoarthritis (OA) has a wide spectrum of clinical presentations and physical function is one of the core domains where patients suffer. The Functional Index for Hand Osteoarthritis (FIHOA) is a leading assessment tool for hand OA-related functional impairment. Our objective was to make a Japanese version of FIHOA (J-FIHOA) and validate it among Japanese hand OA patients. METHODS: Forward and backward translation processes were completed to create a culturally adapted J-FIHOA. A prospective, observational multicenter study was undertaken for the validation process. Seventeen collaborating hospitals recruited Japanese hand OA patients who met the American College of Rheumatology criteria. A medical record review and responses to the following patient-rated questionnaires were collected: J-FIHOA, Hand20, Health Assessment Questionnaire (HAQ), numerical rating scale for pain (NRS pain) and Short Form 36 Health Survey (SF-36). We explored the structure of J-FIHOA using factor analysis. Cronbach's alpha coefficients and item-total correlations were calculated. Correlations between J-FIHOA and other questionnaires were evaluated for construct validity. Participants in clinically stable conditions repeated J-FIHOA at a one- to two-week interval to assess test-retest reliability. To evaluate responsiveness, symptomatic patients who started new pharmacological treatments had a 1-month follow-up visit and completed the questionnaires twice. Effect size (ES) and standardized response mean (SRM) were calculated with pre- and post-treatment data sets. We assessed responsiveness, comparing ES and SRM of J-FIHOA with other questionnaires (construct approach). RESULTS: A total of 210 patients participated. J-FIHOA had unidimensional structure. Cronbach's alphas (0.914 among females and 0.929 among males) and item-total correlations (range, 0.508 to 0.881) revealed high internal consistency. Hand20, which measures upper extremity disability, was strongly correlated with J-FIHOA (r = 0.82) while the mental and role-social components of SF-36 showed no correlations (r = - 0.24 and - 0.26, respectively). Intraclass correlation coefficient for test-retest reliability was 0.83 and satisfactory. J-FIHOA showed the highest ES and SRM (- 0.68 and - 0.62, respectively) among all questionnaires, except for NRS pain. CONCLUSIONS: Our results showed J-FIHOA had good measurement properties to assess physical function in Japanese hand OA patients both for ambulatory follow-up in clinical practice, and clinical research and therapeutic trials.


Assuntos
Comparação Transcultural , Articulação da Mão/patologia , Osteoartrite/diagnóstico , Osteoartrite/etnologia , Inquéritos e Questionários/normas , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Seguimentos , Humanos , Japão/etnologia , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Reprodutibilidade dos Testes
3.
J Tissue Viability ; 29(2): 130-134, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32165036

RESUMO

Undermining is an important issue in the treatment and care of deep pressure ulcers. The frequency of the undermining over different bony prominences varies. In particular, deep pressure ulcers over the sacrum exhibit undermining more frequently than those occurring over the heel. Although shear force has been suggested as a critical factor in undermining, the exact mechanism remains unclear due to ethical and technical reasons in clinical practice. To clarify this issue, a deformable model was constructed to recreate the physical and morphological properties of a pressure ulcer with persistent undermining. The model was constructed using urethane to recreate the physical properties of a pressure ulcer. To examine the clinical relevance of the model, mechanical properties of the skin and the model were measured using a durometer. The model was further mounted onto a phantom that was laid on a bed. Backrest elevation of the bed induced deformities in the urethane model, suggesting a mechanism of persistent undermining of the sacral pressure ulcer. Moreover, a simple palpation examination in elderly volunteers revealed that the skin over the sacrum was more mobile than the skin over the heel. Therefore, persistent undermining is likely caused by specific external forces and the characteristic skin mobility of the sacral region. These two different factors explain the frequent undermining that occurs in sacral pressure ulcers.


Assuntos
Movimento/fisiologia , Úlcera por Pressão/classificação , Sacro/lesões , Pele/fisiopatologia , Adulto , Feminino , Humanos , Masculino , Úlcera por Pressão/fisiopatologia , Sacro/anormalidades , Sacro/fisiopatologia , Pele/anatomia & histologia
4.
J Tissue Viability ; 26(1): 75-78, 2017 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-27568824

RESUMO

AIM: A pressure ulcer is localized injury to the skin and/or underlying tissue usually over a bony prominence, as a result of pressure, or pressure in combination with shear. Although the external forces and bony prominences differ depending on ulcer location, the way in which these anatomical differences affect pressure ulcer development is not well studied. METHODS: To clarify the location-dependent factors for pressure ulcer development, we focused on superficial injuries that develop over an undermining lesion, which we have termed them bilayer pressure ulcers. Because it is thought that a deep pressure ulcer is caused by ischemia at the deep lesion and a shallow pressure ulcer is caused by shear force to the superficial skin, a bilayer pressure ulcer can be considered a mixed phenotype, induced by both pressure and shear force. We retrospectively examined the frequency of bilayer pressure ulcers by location in a total of 568 pressure ulcers. RESULTS: The ratio of bilayer pressure ulcers to deep pressure ulcers staged III or more was significantly larger for pressure ulcers over the sacrum. CONCLUSION: A new concept, the relative position between the external force and bony prominence, could explain the frequency and developmental mechanism of bilayer pressure ulcers. The external forces, shape of the bony prominence, and mobility of the soft tissue may be responsible for this concept.


Assuntos
Úlcera por Pressão/etiologia , Pele/lesões , Idoso , Idoso de 80 Anos ou mais , Fenômenos Biomecânicos , Extremidades , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Úlcera por Pressão/classificação , Úlcera por Pressão/fisiopatologia , Estudos Retrospectivos , Sacro , Índice de Gravidade de Doença
5.
Mod Rheumatol ; 27(6): 990-994, 2017 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-28333570

RESUMO

OBJECTIVES: The objective of this study is to clarify the surgical indication for rheumatoid forefoot deformity according to background characteristics and plantar pressure. METHODS: Patients with rheumatoid arthritis were divided into a non-surgical group (group N) and a surgical group (group S). The former consisted of 225 ft, and the latter consisted of 88 ft. DAS28, Japanese Society for Surgery of the Foot rheumatoid arthritis foot and ankle scale (JSSF scale) and hallux valgus angle (HVA) were evaluated as background characteristics. Distribution of peak pressure as plantar pressure was measured in nine sections. RESULTS: In groups N and S, the mean DAS28 was 3.6 and 3.0, the mean JSSF scale was 81.1 and 63.0, and the mean HVA was 19.9° and 35.3°, respectively. The mean peak pressure of group S at the first and third metatarsophalangeal joints was significantly higher compared with group N. Significant differences between the two groups were also seen in Δ pressure (the difference between the maximum and minimum peak pressure values). The cut-off values were 75.0 for JSSF scale, 24.9° for HVA and 3.94 kg/cm2 for Δ pressure. CONCLUSIONS: The combined assessment of HVA and Δ pressure was found to be useful as an indication for surgical treatment of the forefoot.


Assuntos
Artrite Reumatoide/cirurgia , Artroplastia/efeitos adversos , Deformidades Adquiridas do Pé/cirurgia , Hallux Valgus/cirurgia , Adulto , Artrite Reumatoide/complicações , Artrite Reumatoide/patologia , Artroplastia/métodos , Feminino , Deformidades Adquiridas do Pé/etiologia , Deformidades Adquiridas do Pé/patologia , Humanos , Masculino , Articulação Metatarsofalângica/cirurgia , Pessoa de Meia-Idade , Complicações Pós-Operatórias/prevenção & controle , Pressão
6.
J Phys Ther Sci ; 28(12): 3320-3324, 2016 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-28174444

RESUMO

[Purpose] The purpose of this study was to elucidate the relationship between knee muscle strength and knee pain in activities of daily living, based on consideration of the difference between extension and flexion strength (Q - H) and the hamstring:quadriceps (H:Q) ratio in patients with knee osteoarthritis. [Subjects and Methods] The participants were 78 females with knee osteoarthritis, and a total of 133 knees that had not been treated surgically were the targets of this research. The legs were divided according to dominance. Isometric knee extension and flexion muscle strength and knee pain during activities of daily living were measured. The H:Q ratio (flexion/extension muscle strength) and the difference between extension and flexion strength, (extension muscle strength/weight) minus (flexion muscle strength/weight), that is, Q - H, were calculated. The correlation between these indices and the knee pain score during activities of daily living was investigated. [Results] Greater knee pain during activities of daily living was related to lower knee extension muscle strength and Q - H in both the dominant and nondominant legs. Knee flexion muscle strength and the H:Q ratio were not significantly correlated with knee pain during any activities of daily living. [Conclusion] Knee extension muscle strength and Q - H were found to be significantly correlated with knee pain during activities of daily living, whereas the H:Q ratio was not.

7.
J Tissue Viability ; 24(1): 35-40, 2015 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-25660756

RESUMO

A pressure ulcer is defined as damage to skin and other tissues over a bony prominence caused by excess pressure. Deep pressure ulcers that develop over specific bony prominences often exhibit wound deformity, defined as a change in the 3-dimensional shape of the wound. Subsequently, the wound deformity can result in undermining formation, which is a characteristic of deep pressure ulcers. However, to date, a concept with respect to alleviating wound deformity has yet to be defined and described. To clarify the issue, we propose a new concept called "wound fixation" based on the physical properties of deep pressure ulcers with wound deformity. Wound fixation is defined here as the alleviation of wound deformity by exogenous materials. The wound fixation methods are classified as traction, anchor, and insertion based on the relation between the wound and action point by the exogenous materials. A retrospective survey of a case series showed that wound fixation was preferentially used for deep pressure ulcers at specific locations such as the sacrum, coccyx, and greater trochanter. Moreover, the methods of wound fixation were dependent on the pressure ulcer location. In conclusion, our new concept of wound fixation will be useful for the practical treatment and care of pressure ulcers. Further discussion and validation by other experts will be required to establish this concept.


Assuntos
Úlcera por Pressão/terapia , Humanos , Fixação de Tecidos
8.
J Orthop Traumatol ; 15(4): 271-4, 2014 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-24942842

RESUMO

BACKGROUND: Double-tiered subchondral support (DSS) procedure is two-row fixation in which proximal screws support the dorsal subchondral bone, whereas distal screws support the volar central subchondral bone, using the volar variable-angle locking plate to achieve better anatomical reduction. We examined whether DSS improves clinical outcome, complication rate, and loss of correction for dorsally displaced Arbeitsgemeinschaft für Osteosynthesefragen (AO) type C3 distal radius fractures. MATERIALS AND METHODS: We reviewed dorsally displaced intra-articular AO C3-type distal radius fractures treated at our institutions with a variable-angle volar locking plate. We assessed 49 patients (27 DSS; 22 non-DSS) treated with volar locking plates, with a mean age of 59.9 years and average follow-up of 20.2 months (range 12-56 months). We evaluated differences in functional outcome, complication rates, and loss of correction between groups using radiographic parameters. RESULT: There were no differences in clinical outcome and complications. Final volar tilt and ulnar variance were better maintained in the DSS group (P = 0.01 and 0.03). Change in volar tilt of the non-DSS group was more than that of the DSS group (P = 0.00). CONCLUSION: Though there were no significant differences in clinical outcomes, we identified a significant reduction in final volar tilt, ulnar variance, and change in volar tilt. DSS procedure is useful to avoid correction loss when treating unstable C3 distal radius fractures and thus would reduce posttraumatic arthrosis. LEVEL OF EVIDENCE: Level IV.


Assuntos
Placas Ósseas , Fixação Interna de Fraturas/instrumentação , Fixação Interna de Fraturas/métodos , Fraturas Intra-Articulares/cirurgia , Fraturas do Rádio/cirurgia , Amplitude de Movimento Articular/fisiologia , Alicerces Teciduais , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Feminino , Seguimentos , Consolidação da Fratura/fisiologia , Força da Mão , Humanos , Escala de Gravidade do Ferimento , Fraturas Intra-Articulares/diagnóstico por imagem , Instabilidade Articular/prevenção & controle , Masculino , Pessoa de Meia-Idade , Radiografia , Fraturas do Rádio/diagnóstico por imagem , Estudos Retrospectivos , Resultado do Tratamento , Traumatismos do Punho/diagnóstico por imagem , Traumatismos do Punho/cirurgia , Adulto Jovem
9.
J Tissue Viability ; 22(3): 63-7, 2013 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-23764355

RESUMO

AIM OF THE STUDY: We examined the location-specific properties of pressure ulcers, focusing on depth and undermining formation, which are often unfavorable factors for ulcer healing. METHODS: We conducted a retrospective observational study of 2 independent databases on pressure ulcers. Databases from a 200-bed hospital (database A) and a 300-bed hospital (database B) were collected during different time periods. Relationships between ulcer location, ulcer depth, and undermining formation were analyzed. All pressure ulcers were accurately diagnosed and classified according to their locations. RESULTS: A total of 282 pressure ulcers in 189 patients from database A and 232 pressure ulcers in 154 patients from database B were analyzed. It was found that pressure ulcers primarily developed over the sacrum. Ratio of stages III and IV pressure ulcers was high in pressure ulcers of the foot, ankle, and crus on the lower leg. Among the deep pressure ulcers, undermining formation was frequently observed on the greater trochanter, ilium, and sacrum. In contrast, pressure ulcers of the foot, ankle, and crus did not exhibit undermining formation. CONCLUSION: Our results revealed marked differences in pressure ulcer properties depending on their location. Factors affecting depth and undermining of pressure ulcers appear to be related to anatomical and physical properties of the bone and subcutaneous tissue.


Assuntos
Calcanhar/patologia , Úlcera por Pressão/etiologia , Úlcera por Pressão/patologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Braço/patologia , Dorso/patologia , Bases de Dados Factuais , Feminino , Humanos , Perna (Membro)/patologia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
10.
Clin Calcium ; 23(7): 943-50, 2013 Jul.
Artigo em Japonês | MEDLINE | ID: mdl-23811581

RESUMO

Understanding bone strength scientifically requires knowledge of the material strength of a bone fragment, and understanding the bone strength of a specific part of a bone requires a destruction test using a cadaver bone. Since these tests cannot be used clinically, bone strength evaluation with the advanced medical technology of "predictive estimation of bone strength based on a finite element method using quantitative CT" has been developed to estimate bone strength with consideration of anatomical bone structure of the proximal femur. Today this method has come to be clinically applicable with actual patients. Investigations in our hospital have also led to the finding that while the proximal femur is strong enough for a standing load in daily life, it does not readily withstand the load from falls in accidents, and has a structure such that fractures may be predicted to occur at about one-third that size.


Assuntos
Envelhecimento , Densidade Óssea/efeitos dos fármacos , Fêmur/patologia , Fraturas Ósseas/fisiopatologia , Acidentes por Quedas , Densidade Óssea/fisiologia , Fêmur/fisiopatologia , Fraturas Ósseas/etiologia , Humanos , Modelos Anatômicos
12.
Nagoya J Med Sci ; 84(2): 418-432, 2022 May.
Artigo em Inglês | MEDLINE | ID: mdl-35967955

RESUMO

As older people become frail, they tend to fall more easily. Moreover, women have a higher rate of falls than men. However, effective strategies to avoid elderly women falling are lacking. The Timed Up and Go test is a well-known indicator of falling tendency. This study clarifies the motor elements related to the Timed Up and Go test according to the degree of weakness in older outpatients to specify exercise intervention to improve weakness and prevent falls. Participants were 145 female outpatients who visited the Locomo-Frail outpatient clinic, classified into three groups (robust, prefrail, and frail, according to the definition of the Japanese Cardiovascular Health Study. Vertical ground reaction force parameters were measured for all participants when they stood up from a chair, walking speed, and the Timed Up and Go test. Results showed that walking speed is related to the Timed Up and Go test in the robust group; balance ability is related to the Timed Up and Go test in the prefrail group; and instantaneous force is related to the Timed Up and Go test in the frail group. These results suggest that weakness can be improved by performing exercise interventions of balance and instantaneous force elements in the prefrail and frail groups, respectively.


Assuntos
Fragilidade , Acidentes por Quedas/prevenção & controle , Idoso , Feminino , Idoso Fragilizado , Fragilidade/diagnóstico , Humanos , Masculino , Equilíbrio Postural , Estudos de Tempo e Movimento
13.
J Hand Surg Asian Pac Vol ; 27(6): 1021-1025, 2022 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-36550085

RESUMO

Background: Carpal tunnel syndrome is occasionally associated with basal joint arthritis and is more common in postmenopausal women than in the general population. Currently, more evidence is needed to describe changes in the carpal tunnel after basal joint arthroplasty (BJA) of the thumb and to determine whether it is better to combine the release of the flexor retinaculum. The purpose of this study was to clarify the changes in the carpal tunnel cross-sectional area and carpal tunnel shape after complete removal of the trapezium during BJA of the thumb, according to computed tomography (CT) findings. Methods: We retrospectively investigated the carpal tunnel cross-sectional area with CT findings obtained pre- and postoperatively in 20 postmenopausal women who underwent BJA of the thumb. Results: The average horizontal plane area of the carpal tunnel was 1.11 ± 0.19 cm2 preoperatively and increased to 1.23 ± 0.2 cm2 at 3 months postoperatively (p = 0.0411). The ratio of the longitudinal diameter to the horizontal diameter was significantly increased from 0.6 ± 0.13 preoperatively to 1.23 ± 0.2 postoperatively (p = 0.0439). Conclusions: The increase in the carpal tunnel cross-sectional area was confirmed after BJA of the thumb. This increased carpal tunnel cross-sectional area changed as the longitudinal diameter increased, without changes in the horizontal diameter. Level of Evidence: Level IV (Therapeutic).


Assuntos
Artrite , Síndrome do Túnel Carpal , Humanos , Feminino , Síndrome do Túnel Carpal/diagnóstico por imagem , Síndrome do Túnel Carpal/cirurgia , Síndrome do Túnel Carpal/complicações , Estudos Retrospectivos , Pós-Menopausa , Artrite/cirurgia , Artroplastia/métodos
14.
BMC Res Notes ; 14(1): 242, 2021 Jun 27.
Artigo em Inglês | MEDLINE | ID: mdl-34176502

RESUMO

OBJECTIVE: This study evaluated the relationship between rheumatoid arthritis (RA) disease activity level and physical activity (PA) by using an accelerometer and self-reported questionnaire. RESULTS: The cross-sectional study was part of a cohort study designed to determine disease activity is associated with PA in RA patients. We classified patients with a Disease Activity Score 28-erythrocyte sedimentation rate (DAS28-ESR) of less than and higher than 3.2 into the low-disease-activity (LDA) group and moderate/high-disease-activity (MHDA) group, respectively. We measured the wear time, time of vigorous-intensity PA, moderate-intensity PA, light-intensity PA, and sedentary behavior per day using a triaxial accelerometer. 34 patients were included in the study. The accelerometer-measured moderate-to-vigorous PA (MVPA) was 17.2 min/day and 10.6 min/day in the LDA group and MHDA group (p < 0.05), respectively. There was no significant association between RA disease activity level and accelerometer-measured PA with adjustment for age and Functional Assessment of Chronic Illness Therapy-Fatigue score. There was no correlation between accelerometer-measured MVPA and self-reported MVPA in the MHDA group, but these factors were correlated in the LDA group (rs = 0.57, p < 0.05). In conclusion, no significant association was noted between RA disease activity level and accelerometer-measured PA.


Assuntos
Artrite Reumatoide , Exercício Físico , Acelerometria , Estudos de Coortes , Estudos Transversais , Humanos , Autorrelato , Inquéritos e Questionários
15.
Artigo em Inglês | MEDLINE | ID: mdl-34639247

RESUMO

The present study aims to evaluate changes in plantar pressure distribution after joint-preserving surgery for rheumatoid forefoot deformity. A retrospective study was performed on 26 feet of 23 patients with rheumatoid arthritis (RA) who underwent the following surgical combination: modified Mitchell's osteotomy (mMO) of the first metatarsal and shortening oblique osteotomy of the lateral four metatarsals. Plantar pressure distribution and clinical background parameters were evaluated preoperatively and one year postoperatively. A comparison of preoperative and postoperative values indicated a significant improvement in the visual analog scale, Japanese Society for Surgery of the Foot scale, and radiographic parameters, such as the hallux valgus angle. A significant increase in peak pressure was observed at the first metatarsophalangeal joint (MTPJ) (0.045 vs. 0.082 kg/cm2; p < 0.05) and a significant decrease at the second and third MTPJs (0.081 vs. 0.048 kg/cm2; p < 0.05, 0.097 vs. 0.054 kg/cm2; p < 0.05). While overloading at the lateral metatarsal heads following mMO has been reported in previous studies, no increase in peak pressure at the lateral MTPJs was observed in our study. The results of our study show that this surgical combination can be an effective and beneficial surgical combination for RA patients with mild to moderate joint deformity.


Assuntos
Artrite Reumatoide , Hallux Valgus , Artrite Reumatoide/cirurgia , Humanos , Osteotomia , Estudos Retrospectivos , Resultado do Tratamento
16.
Intern Med ; 60(9): 1359-1367, 2021 05 01.
Artigo em Inglês | MEDLINE | ID: mdl-33250460

RESUMO

Objective To evaluate the effectiveness and drug retention rate of golimumab (GLM) for long-term use in daily practice for patients with rheumatoid arthritis (RA). Methods Patients with RA who started GLM therapy with a minimum follow-up period of 52 weeks were included. The patients were divided into a biologic-naïve group and switch group. The disease activity score (DAS) 28-erythrocyte sedimentation rate (ESR) (DAS28-ESR), grip power, and Japanese version of the health assessment questionnaire (J-HAQ) score were assessed. In addition, the treatment continuation rate was evaluated at the final follow-up. Patients Sixty-five patients [58 women and 7 men; median (range) age, 69 (61-74) years; median (range) disease duration, 9 (5-16) years] were included. Twenty-eight patients were biologic-naïve (naïve group), and 37 were switched to biologics (switch group). Results The median (range) follow-up period was 134 (58-162) weeks. The DAS28-ESR improved from a median (range) of 4.31 (3.52-5.25) to 2.65 (2.28-3.77) in the naïve group and from 4.27 (3.19-4.89) to 2.89 (2.49-3.88) in the switch group. The grip power improved in both groups (p<0.01); however, the J-HAQ score showed no marked improvement in either group. The continuation rates were 22/28 (78.6%) in the naïve group, and 26/37 (70.3%) in the switch group at the final follow-up. Conclusion We herein report for the first time that the long-term use of GLM improves the grip power. Improving the grip power may help prevent sarcopenia and frailty in the future. Given the efficacy and high continuation rate, we suggest that GLM would be a well-tolerated treatment option for RA.


Assuntos
Antirreumáticos , Artrite Reumatoide , Idoso , Anticorpos Monoclonais/uso terapêutico , Antirreumáticos/uso terapêutico , Artrite Reumatoide/tratamento farmacológico , Feminino , Humanos , Masculino , Resultado do Tratamento
17.
J Wrist Surg ; 9(6): 528-534, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-33282540

RESUMO

Background Scaphoid nonunion with humpback deformity and avascular necrosis (AVN) is a challenging problem. Correction of dorsal intercalated segment instability (DISI) requires grafting of a large and hard vascularized bone segment onto the volar side of the scaphoid. Purposes We have been treating the patients with one-incision vascularized bone grafting technique for scaphoid nonunion to improve blood supply and correct humpback deformity. We evaluated these cases retrospectively to the surgical efficacy of our procedure. Methods We harvested vascularized bone from the dorsal side of the radius using the method by Zaidemberg et al and inserted the cortical aspect into the scaphoid volar side using a direct lateral approach. Totally, 11 patients (nine males andtwo females) with a mean age of 40 years were recruited for this study. The mean time from fracture to treatment was 6 years and 3 months. The mean preoperative radiolunate angle was 25 degrees. All the patients showed AVN of the proximal scaphoid on T1-weighted images. An averaged follow-up period was 2 years and 3 months. Results Postoperative computed tomography revealed bony union in 10 patients (91% of union rate) with a mean modified Mayo'swrist score of 88 points (range, 75-100 points) and a mean disabilities of arm, shoulder, and hand (DASH) score of 4 points (range, 0-20 points). The mean radiolunate angle was corrected from 25 to 5 degrees. No adverse events were observed, except temporary mild paresthesia of the radial nerve territory in two patients. Conclusion This technique effectively corrected DISI in patients with scaphoid nonunion accompanied by humpback deformity and AVN.

18.
Intern Med ; 59(16): 1963-1970, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32801270

RESUMO

Objective To investigate the clinical outcomes of rheumatoid arthritis (RA) patients who discontinued infliximab (IFX) treatment at our hospital. Methods Among 249 patients receiving IFX from 2007 to 2015, we retrospectively investigated the clinical courses of 18 who discontinued IFX after achieving the 28-joint disease activity score based on the erythrocyte sedimentation (DAS28-ESR) clinical remission (CR) and whose clinical courses were available continuously for 96 weeks after discontinuation. Results At IFX introduction, the median age was 56.9 (range 36.1-72.4) years, and the disease duration was 5.2 (0.4-25.6) years. The median duration of maintaining either CR or a low disease activity (LDA) with IFX was 37.2 (4.0-91.4) months, and the total duration of IFX therapy was 45.8 (17.1-96.9) months. After discontinuation, 8 patients (44.4%) maintained CR/LDA for 96 weeks (no-flare group), and 10 (55.6%) experienced flares (DAS28-ESR≥3.2) within 96 weeks (flare group). In the no-flare group, six patients receiving intensified conventional synthetic disease-modifying antirheumatic drug (csDMARD) therapy to prevent flare ups simultaneously either with or immediately after discontinuing IFX. In the flare group, four patients received intensified csDMARD therapy. Six patients restarted biological DMARDs (bDMARDs), and all achieved CR again. Ultimately, 12 patients (66.7%) maintained a Bio-free disease control for 96 weeks. A comparison of the clinical backgrounds between the flare and no-flare groups showed no marked difference in their disease duration, IFX dosage, duration of maintaining CR with IFX, or concomitant csDMARDs use. Conclusion Irrespective of the RA disease duration, more than half of all patients maintained a Bio-free condition for 96 weeks. Continuing LDA with IFX for a sufficiently long period of time before discontinuation and preventive intensification of csDMARD therapy may help maintain a Bio-free condition.


Assuntos
Antirreumáticos/uso terapêutico , Artrite Reumatoide/tratamento farmacológico , Desprescrições , Glucocorticoides/uso terapêutico , Infliximab/uso terapêutico , Metotrexato/uso terapêutico , Prednisolona/uso terapêutico , Inibidores do Fator de Necrose Tumoral/uso terapêutico , Adulto , Idoso , Artrite Reumatoide/fisiopatologia , Produtos Biológicos/uso terapêutico , Sedimentação Sanguínea , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Recidiva , Indução de Remissão , Estudos Retrospectivos , Resultado do Tratamento
19.
Intern Med ; 58(4): 511-519, 2019 Feb 15.
Artigo em Inglês | MEDLINE | ID: mdl-30210123

RESUMO

Objectives The present study was performed with the aim of analyzing the biological disease-modifying antirheumatic drug (bDMARD)-free (Bio-free) condition of adalimumab (ADA)-treated rheumatoid arthritis (RA) patients in a real-world setting. Methods ADA was used in the treatment of 130 (male, n=21; female, n=109 females) RA patients. Among them, 26 patients (20.0%) discontinued ADA due to a good response. We analyzed 20 patients who were followed up for more than 6 months after the discontinuation of ADA. The Disease Activity Score 28 based on C-reactive protein (DAS28-CRP) and modified health assessment questionnaires (mHAQs) were evaluated. Results The mean age of the patients was 53.4±11.1 years. The mean disease duration was 4.5±4.3 years. Sixteen patients were bDMARD-naïve, while 4 switched from bDMARDs to ADA. At 6 months after the discontinuation ADA, 19 patients had achieved a clinical remission, and 1 had achieved a low disease activity. The Bio-free period was 26.4±15.5 months. The dose of prednisolone was significantly reduced from baseline (3.45±3.17 mg/day) at 6 months after the discontinuation of ADA (2.63±2.78 mg/day). The dose of methotrexate was unchanged. The number of conventional synthetic DMARDs (csDMARDs) was significantly increased (0.8±0.6 to 1.4±1.06). The mHAQ values were significantly ameliorated by ADA and remained good in patients with a Bio-free condition. A multivariate analysis showed that the dose of methotrexate (MTX) was an important factor for achieving a Bio-free condition. Conclusion A sustainable Bio-free condition in a real clinical setting can be achieved and may be a suitable way of reducing medical costs. The dose of MTX and the additional administration of csDMARDs is therefore thought to be important for ensuring a good outcome in these patients.


Assuntos
Adalimumab/uso terapêutico , Anticorpos Monoclonais Humanizados/uso terapêutico , Antirreumáticos/uso terapêutico , Artrite Reumatoide/tratamento farmacológico , Metotrexato/uso terapêutico , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento
20.
Clin Case Rep ; 6(8): 1600-1603, 2018 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-30147913

RESUMO

For the treatment of skin necrosis with exposed tendons in rheumatoid arthritis (RA) foot, we should perform microvascular free flap surgery at an early stage without conservative treatment considering the increased risk of infection and the decreased physical activity.

SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA