Hand grip endurance moderating the effect of grip force on functional ability and disease activity in rheumatoid arthritis patients: a cross-sectional study.

To examine the effect of endurance on the relationship between grip force and measures of functional capacity and disease activity, we performed a cross-sectional study at the University Department of Rheumatology, Physical medicine and Rehabilitation from January 2017 to August 2018. Functional capacity of the hand was measured by ABILHAND-RA questionnaire and disease activity was assessed by the Disease Activity Score (DAS-28-CRP). All participants underwent dynamometric measurements of maximal grip force and hand grip endurance during repeated gripping. We analyzed the data from 34 RA patients at the median (IQR) age of 57 (51-61), 31 (91%) of them women, and 44 healthy participants at the age of 55 (50-59), 39 (89%) of them women. The moderating effect of endurance on the correlation between maximum grip force and the ABILHAND-RA score was not significant in healthy participants (b = 0.000, 95% CI - 0.005-0.004, p = 0.862), but it was in RA patients (b = 0.003, 95% CI 0.000-0.005, p = 0.027). In RA patients, the effect of maximum grip force on the ABILHAND-RA score increased with the increase in hand grip endurance. In RA patients, the interaction between endurance and grip force significantly explained the 15% more variance of the disease activity than main effects of these two measures, age, gender and body mass index alone. Hand grip endurance during repeated gripping affects the correlation between maximum grip force and the ABILHAND-RA score in a pattern that differs in RA patients and in the healthy population. In RA patients, hand grip endurance significantly moderates the correlation between maximum grip force and the DAS-28-CRP.

Association between disease activity measured by RAPID3 and health-related quality of life in patients with rheumatoid arthritis.

Routine assessment of patient index data 3 (RAPID3) is a simple, valid and reliable tool designed to measure disease activity in patients with rheumatoid arthritis (RA). RA causes significant disability and diminishes health-related quality of life (HR-QoL). The aim of this study was to investigate how RAPID3 is related to HR-QoL in patients with RA. In this cross-sectional study performed at the tertiary outpatient clinic 68 consecutive patients (58 females, and 10 males) with established RA were enrolled. RAPID3 and EuroQoL-5D-3L (EQ-5D-3L) were used to measure disease activity and quality of life, respectively. Alongside, demographic and clinical data were obtained, as well as HAQ-DI as a measure of physical function, and Steinbrocker's score for radiographic damage. To test the relationships among RAPID3 and study variables we used the Pearson product-moment correlation coefficient, with the significance was set at P < 0.05. Linear and forward stepwise regression was used to show how variables of interest contributed to RAPID3. The mean value of RAPID3 (standard deviation, SD) was 14.12 (± 5.21), while the median (IQR) value of EQ-5D-3L was 0.51 (0.62-0.23). There was a high significant correlation (r = - 0.73) between RAPID3 scores and EQ-5D-3L. Among the other variables of interest, the strongest correlation was found between RAPID3 and intensity of pain (r = 0.88), while the EQ-5D-3L and pain were moderately correlated (r = - 0.68). In evaluating the influence of variables of interest on RAPID3, a forward stepwise regression model was constructed to evaluate whether VAS pain, EQ-5D-3L and EQ-VAS predicted RAPID3. The given variables significantly explained approximately 81% of the variation in RAPID3. Based on the results of this study RAPID3, a simple and practical tool to assess disease activity, reflects well HR-QoL in patients with established RA.

[SYSTEMIC PHARMACOLOGICAL TREATMENT OF PAIN IN RHEUMATIC DISEASE].

Pain is a cardinal symptom of rheumatic diseases and the most common reason for seeking medical help. Pain relief has many benefi cial eff ects and is necessary for the functional recovery. A variety of drugs are used for the treatment of pain in rheumatic diseases. Th ey usually include acetaminophen, nonsteroidal anti-rheumatic drugs, and opioids (mostly weak opioids). Antidepressants and anticonvulsants can be used in cases with a predominant neuropathic component. In this descriptive review we present up-to-date results of trials with systemic analgesic drugs in rheumatic diseases, including nerve growth factor inhibitors and symptomatic slow-acting drugs for osteoarthritis.

[VAGAL NERVE STIMULATION IN THE TREATMENT OF PATIENTS WITH RHEUMATOID ARTHRITIS ­ RESULTS THROUGH DAY 84 OBTAINED AT THE CROATIAN CENTER OF AN INTERNATIONAL PILOT STUDY].

Objective: Electrical stimulation of the vagus has proven effective in various inflammatory conditions in animal models. The aim of this study is to show the effect of vagal nerve neurostimulation on clinical and laboratory parameters in two patients with active rheumatoid arthritis (RA) and an inadequate response to methotrexate. Patients and methods: The research was conducted as part of an international pilot study. Patients were implanted with the Cyberonics system for electrical stimulation of the vagus. After an initial in-clinic stimulation, the patients performed the stimulations at home for 42 days, when the device was inactivated. On day 56 the stimulations were reinitiated. The following parameters were evaluated: tender and swollen joint count, physician's (PGA) and patient's (PtGA) global score, intensity of pain, disease activity (DAS28), functional ability (HAQ), serum CRP level, and EULAR response. Results: In the period from the screening visit to the day 42 visit, both patients experienced an improvement of DAS28 (7.00 and 6.22 vs. 4.03 and 2.13), PGA (70 and 53 vs. 27 and 16), PtGA (48 and 43 vs. 15 and 14), tender joint count (26 and 28 vs. 4 and 0), swollen joint count (24 and 14 vs. 8 and 2), intensity of pain (72 and 87 vs 21 and 7), HAQ score (2.25 and 2.25 vs. 1.5 and 1.375), and CRP levels (23.8 and 5.58 vs. 13 and 4.61). After the device deactivation, DAS28 and VAS pain worsened in both patients. Conclusion: Vagal neural stimulation in the treatment of patients with active RA and an inadequate response to methotrexate is effective in reducing clinical symptoms and parameters of inflammation. Our results are in accordance with the results obtained in other centers. Research on a larger number of subjects is necessary for a better evaluation of the effect of this new approach to the treatment of patients with rheumatoid arthritis.

Neuroendocrine small cell carcinoma of the breast--a case report.

Neuroendocrine tumors are very rare tumors that occur most commonly in the gastrointestinal tract. The occurrence of neuroendocrine tumors outside gastrointestinal tract is very rare but not unknown. Thus, neuroendocrine tumors and their primary seat can be found in the bronchi and lungs, as well as in the testicles, ovaries, prostate, etc. The occurrence of neuroendocrine tumors as a primary seat in the breast is extremely rare phenomenon that is described in literature. We present the case of 55-year old female in where routine mammographic examination found suspicious lesions that we recommended for further processing. The patient made a breast ultrasound examination in which tumor formation was found in size 27 x 19 mm and cytological puncture found breast adenocarcinoma. Further pathohystologic and immunohistochemical analysis set the diagnosis of neuroendocrine carcinoma, small cell type, second grade. Tumor formation by ultrasound initially sized 27 x 19 mm and pathohistologic diagnosis showed tumor size 26 x 20 x 20 mm. The axillary lymph node biopsy did not found distant metastases in lymph nodes as well as gatherings in other organs. Neuroendocrine small cell carcinomas are exceedingly rare phenomena in the literature. By the year 2009 in the USA there were described only 50 cases of this extremely rare tumor of the breast.