Stretching exercises for costochondritis pain.

The term costochondritis (ChC) indicates a painful and persistent inflammation at the costochondral or costosternal junction. The usual conservative treatment (NSAIDs), local splinting, local heat) and sometimes disappointing. The aim of this study is to evaluate the effect of stretching exercises in a group of patients affected with ChC. This retrospective open study involved 51 outpatients with diagnosis of ChC: thirty four consecutive patients were treated with stretching exercises, 34 patients matched for age, pain and disease duration constituted the control group. All the patients had spontaneous pain at least in the one of the costochondral junctions at the third to seventh rib. The intensity of spontaneous pain was measured by means of the visual analogic scale of Scott-Huskisson. The homogeneity of the two groups at the beginning of the study was checked for VAS, for disease duration and age by means of Mann-Whitney test for non-parametric measures. The statistical analysis of pain was done by Friedman analysis of variance and Student-Newman-Keuls multiple comparisons tests. The results showed a progressive significant amelioration in patients treated with stretching exercises as respect as the control group (p<0.001). The goal of therapy of costochondritis is to reduce inflammation and the pain. The NSAIDs, local injection of anaesthetic or steroid has insufficient effectiveness. The possibility to improve the pain by means of simple stretching exercises can supply a useful instrument in order to treat the condition of these patients.

Sonographic assessment of soft tissue alterations in osteoarthritis of the knee.

Osteoarthritis (OA) is the most common joint disorder to affect the knee, and the single most important cause of disability in aged elderly people. Radiological criteria for knee OA (focal loss of cartilage, osteophytosis, subchondral cysts and subchondral sclerosis) reflect late manifestations and significant joint damage only. Ultrasound examination is useful in revealing disruption of the periarticular tissue that contributes to symptoms and disability in advanced disease. Nevertheless, ultrasound examination is very important in early OA of the knee when it can give information about soft tissues and cartilage involvement also in absence of clinical symptoms.

HLA-DRB1alleles and osteoarthritis in a group of patients living in Liguria-Italy.

AIM: Osteoarthritis (OA), a degenerative arthro-pathy, produces damage and cartilage loss in one or more joints. Genetic factors contribute substantially to the risk of OA. The nature of the genetic influence in OA is speculative and may involve both a structural defect (i.e. collagen), alterations in cartilage or bone metabolism. Analyses of the frequencies of HLA antigens in various OA populations showed different RESULTS: The aim of this study was to verify the prevalence of HLA-DRB1 haplotypes in 92 outpatients of the Rheumatological Center of Genoa University. METHODS: Ninety-two outpatients (69 females, 23 males) affected by OA were enrolled and divided into a group with OA of the hands and a group with different joints localizations. Both groups have been compared with a control group, represented by 150 Italian marrow donors, to detect a typology of second class HLA alleles that, if present, may represent a risk factor of disease. The statistical significance between the groups were assessed by means of the contingency table to compare frequencies (P<0.05 was considered as significant). RESULTS: The results obtained showed that the frequency of DRB1*12 and *10 alleles families, not present in the second study group, has been compared only between the first study group and the control group. Haplotypes *07 e *04 are more frequent in the second group than in the first group and in the control group and haplotype *13 is the most represented in the first and second group. Haplotypes *11 and *13 are more significantly represented in the control group. CONCLUSIONS: The results obtained with the study of HLA-DRB1 locus in patients affected by OA and living in Liguria may suggest a research on a larger number of OA patients to confirm the data obtained in this study and to define DRB1 haplotypes as more frequent markers both in OA of the hand and in OA of other joints.

Analgesic efficacy of a lecithin-vehiculated diclofenac epolamine gel in shoulder periarthritis and lateral epicondylitis: a placebo-controlled, multicenter, randomized, double-blind clinical trial.

Diclofenac epolamine (2-hydroxyethyl-pyrrolidine) (DHEP) is a diclofenac salt endowed with enhanced cutaneous permeation. To optimize its absorption after topical application, a lecithin-enriched DHEP 1.3% gel has been developed (DHEP lecithin gel) and investigated in patients with shoulder periarthritis and lateral epicondylitis in a placebo-controlled, multicenter double-blind clinical trial. One hundred fifty-eight patients were randomized to a 10-day treatment with DHEP lecithin gel or placebo (5 g t.i.d. applied on the painful area). The efficacy criteria were pain measured by visual analog scale (VAS) while performing a specific standardized movement, intake of rescue medication (paracetamol), and the disabilities of the arm, shoulder and hand (DASH) questionnaire. VAS scores indicated a consistently higher analgesic activity of DHEP lecithin gel. At day 3, pain was reduced by -20.1 +/- 20.2 and -9.9 +/- 12.7 mm in the DHEP lecithin gel- and placebo-treated patients, respectively (p < 0.001); at day 6 of treatment, DHEP lecithin gel induced a pain reduction of -33.2 +/- 26.1 mm, while the reduction achieved with placebo was only -21.2 +/- 18.8 mm (p < 0.001). The mean changes in DASH questionnaire indicated that DHEP lecithin gel was more effective than placebo in improving patient well-being and reducing difficulties in performing the activities most severely impaired by rheumatism, while no difference was observed between the two treatments in consumption of rescue medication. In conclusion, these results indicate that DHEP lecithin gel is a topically effective analgesic product in patients with shoulder periarthritis or lateral epicondylitis and provide further evidence on the use of topical nonsteroidal anti-inflammatory drugs as an optimal approach to the treatment of localized musculoskeletal disorders.

Prevalence of DRB1*01 and DRB1*04 alleles in a group of patients with rheumatoid arthritis living in Liguria.

A major component of genetic susceptibility to rheumatoid arthritis (RA) appears to be explained by inheritance of HLA-DRB1 alleles. Multiple HLA-DRB1 alleles (DRB1*0401, *0404, *0405, *0408, *0101, *102, *1001 and *1402) encoding a shared epitope at amino acid positions 70-74 are associated with susceptibility to RA. There is ethnic variation in the clinical expression of RA and in both the frequency and type of HLA-DRB1 alleles carrying the shared epitope. We evaluated the prevalence of the alleles of HLA-DRB1 locus encoding for SE in 42 outpatients with RA attending the Rheumatology Center of the University of Genoa, Bruzzone Institute, and living in Liguria. A control group was composed of Italian marrow donors. DNA genotyping was performed using a low-resolution polymerase chain reaction technique for characterization of the families of HLA-DRB1 alleles for each of the 42 patients studied. Subsequently, subjects with *01 and *04 haplotype were tested with high-resolution HLA-DRB 1 typing to characterize the *01 and *04 alleles. No statistically significant differences were found in the prevalence of RA-associated single alleles *01 and *04 in the study group or in the control group. In contrast, the sum of susceptibility *04 alleles studied by resolution typing was strongly related to RA in the study group in comparison with the control group.

Role of T cells and tumour necrosis factor in antitumour activity and toxicity of flavone acetic acid.

To investigate the importance of natural killer (NK) and T cells in the inhibition of tumour growth by flavone acetic acid (FAA), colon 26 murine carcinoma was grafted subcutaneously in euthymic and athymic mice. FAA was active in euthymic but not in athymic mice (ratio between tumour weight in treated vs. control animals [T/C %], 27% and 92%, respectively). NK cell activity was increased in both mouse strains, indicating a lack of major involvement of this lymphocyte population in FAA efficacy. In euthymic mice tumour-specific T cells were activated, and after in vivo depletion of lymphocyte subpopulations (L3T4 and Lyt2), tumour inhibition by FAA was abrogated (T/C %, 88%). Antitumour efficacy of FAA was also reduced when the treatment was followed by injection of antitumour necrosis factor alpha (TNF alpha) antibodies. FAA toxicity depended on tumour weight at the time of treatment: 200 mg/kg caused 0 and 100% mortality in mice bearing tumour nodules under 50 and over 300 mg, respectively. When anti-TNF alpha antibodies were given after FAA treatment, the toxicity was greatly reduced (3/14 mice died compared with 10/15).

Effects of gonadotrophin-releasing hormone agonist on uterine fibroids and bone density.

Bone density (BD) was evaluated by single photon absorptiometry (SPA) in 18 women treated with Buserelin a gonadotrophin-releasing hormone (LHRH) analogue, for uterine fibroids. Buserelin was administered for a period of 6 mth. Amenorrhoea and oestradiol levels in the follicular-phase range were recorded in all patients during treatment. Fibroid volume was evaluated by means of ultrasound. SPA was performed at the 1/3 proximal radius and at the 1/10 distal radius sites before starting therapy and every 2 mth subsequently for 12 mth. BD was also measured in a control group of 18 normally-menstruating premenopausal women, matched for age and body mass index. No significant changes in BD at the proximal or distal radius sites were observed in either the cases or the controls during the study. Moreover, comparison of the data on the cases and the controls revealed no differences in BD at 0, 6 or 12 mth. Thus, although LHRH analogue treatment proved effective in reducing fibroids, it did not cause any significant changes in BD.

Galactosaminoglycuronoglycan sulfate (matrix) in therapy of tibiofibular osteoarthritis of the knee.

To evaluate the efficacy and tolerance of galactosaminoglycuronoglycan sulfate (Matrix vials) in the therapy of tibiofibular arthritis of the knee, forty patients suffering from this illness at radiological stages 1 and 2 undergoing concomitant therapy with NSAIDS, were randomized into two groups of twenty. The treatment group received the drug under study and the control group received placebo. Treatment was carried out in double blind. The therapy protocol comprised 25 intramuscular injections (one injection twice a week). This cycle was repeated for 6 months, for a total of 50 injections. The patients were visited on days 0, 90, 180, 240, 330 and 360. At each visit the following symptoms were evaluated: spontaneous pain, pain on loading, on passive movement and on pressure; changes in NSAIDS posology were also recorded; lastly any possible side effects were noted. Analysis of results has shown a statistically significant higher therapeutic effect on treatment with Matrix for all the symptoms taken into consideration. No important side effects were noted, either local or systemic; in two cases only in the group treated with Matrix and in the same number in the control group slight dyspeptic symptoms were found to occur, but without requiring suspension or reduction in posology. Two patients in the Matrix group and one in the control group left the study for non-compliance with the type of administration. The good clinical results obtained, together with the excellent tolerance shown by the drug, suggest that Matrix may be the drug of choice in the "basic" therapy of osteoarthritis, with its efficacy being demonstrated in an increasing number of clinical studies.

Intravenous clodronate for acute pain induced by osteoporotic vertebral fracture.

Even though newly developed drugs may in the future preserve bone mass and reduce the risk of fracture, patients with osteoporosis will continue to suffer from episodes of painful vertebral fracture for many years to come. For this reason, the treatment of acute pain induced by this pathology is still a clinically important issue. The aim of this study was to assess the effect of intravenous disodium clodronate (300 mg) on three pain conditions (at rest, on pressure and on motion) associated with recent osteoporotic vertebral fractures. The effects of disodium clodronate were compared with those of paracetamol in 30 patients during a 30-day observation period. The results showed higher pain remission rate in patients receiving disodium clodronate intravenously than in those receiving paracetamol. The rapid onset of analgesic activity produced by intravenous administration of disodium clodronate after vertebral fracture represents a definite clinical indication.

Low dose gabapentin for shoulder-hand syndrome induced by phenobarbital: a three-month study.

Both the pathogenetic interpretation and treatment of phenobarbital-induced rheumatism are uncertain. The reflex sympathetic dystrophy syndrome which complicates antiepileptic drug therapy is a problem for rheumatologists. The aim of our study was to test the effect of gabapentin as an additional therapy in patients suffering from phenobarbital-induced shoulder-hand syndrome when these patients were treated with gabapentin instead of receiving phenobarbital only. After a 3-month observation period, the pain and the movement range from the shoulder to the wrist and to the hand improved more than in the control group using acetaminophen. Further studies are required to confirm this observation.

A two-year study of chondroitin sulfate in erosive osteoarthritis of the hands: behavior of erosions, osteophytes, pain and hand dysfunction.

The aim of this study was to evaluate the effect of 800 mg/die of chondroitin sulfate (CHS) per os plus naproxen versus naproxen over 2 years in patients with erosive osteoarthritis (EOA) of the hands. Joint count for erosions, Heberden and Bouchard nodes, Dreiser's algofunctional index and physicians' and patients' global assessment of disease activity were studied. A total of 24 consecutive patients (22 women and 2 men, mean age 53.0 +/- 6) suffering from symptomatic OA with radiographic characteristics of EOA were evaluated. The patients were divided into two groups of 12 patients each. The first group took naproxen 500 mg only. The second group was treated with CHS 800 mg orally plus naproxen 500 mg. Joint counts, radiological hand examinations and assessment of disease activity were performed at baseline, at 12 months and at 24 months. In the second year the treated group showed significant worsening in erosion, Heberden, Bouchard and Dreiser scores was recorded. Physician and patient global assessments of disease activity showed no significant difference from baseline scores. The untreated group showed significant worsening in erosion, Heberden and Bouchard nodes, Dreiser index and physician and patient global assessment scores. This study confirms the partial efficacy of oral CHS in improving some aspects of EOA.

One-month follow-up of patients treated by intravenous clodronate for acute pain induced by osteoporotic vertebral fracture.

Disodium-clodronate is one of the most experimented drugs for the management of bone pain caused by vertebral fractures induced by skeletal metastases and myeloma as well as by osteoporosis. In a previous study, treatment with intravenous disodium-clodronate 300 mg/day in saline produced satisfactory relief of moderate or severe back pain in 15 patients with painful vertebral crush. The present study examines the general behavior of pain in patients suffering from vertebral crush when treated with intravenous disodium-clodronate and after discontinuation of medication. At the end of treatment, pain relief was significantly greater in patients treated with disodium-clodronate. After discontinuation of treatment the patients who had been taking disodium-clodronate for pain due to vertebral crush were generally better than those previously on acetaminophen. At the end of follow-up, no significant differences were found between the two groups. In our study, the use of disodium-clodronate was associated with a reduction in the number of days the patients experienced severe pain, which suggests that disodium-clodronate is a first-line drug in the treatment of recent vertebral crush.

Polymerase chain reaction in Lyme borreliosis.

Many bacterial and/or viral infections can affect several organs and apparatuses. Some of these infectious agents may be implicated in the pathogenesis and evolution of chronic connective and articular diseases. Such agents may trigger the start of articular chronic diseases or may play a role in maintaining the symptoms. In this study, we evaluated the sensitivity and specificity of polymerase chain reaction (PCR) in Lyme borreliosis, in patients with a confirmed diagnosis of the disease after clinical examination and standard serologic tests. There were 18 true positive results from nine samples from patients with present clinical signs, positive PCR, negative Western blot and/or enzyme-linked immunosorbent assay (ELISA) and nine samples with present clinical signs and positive ELISA and/or Western blot. The 51 true negative results were negative in all three methods used. There were 24 false positive results, positive for clinical signs, ELISA and/or Western blot but negative for PCR.

Changes in size of periarthritis calcifications in patients with painful shoulder treated with injectable disodium-clodronate.

Calcific periarticular disease is characterized by the deposition of calcium phosphate crystals in many tendons and particularly in the rotator cuff tendons. Calcifications of any size may be accompanied by painful shoulder syndrome and tendon tears. Ecographic assessment of changes in the size of calcifications may be a marker of tissue changes in evolving shoulder periarthropathies. The aim of this study was to compare variations in pain and ultrasound dimensions in the calcifications in the tendons of the rotator cuff in patients treated with disodium-clodronate compared with those treated with paracetamol and nimesulide. In all groups, pain reduction occurred over a 6-month period, but was significantly greater in patients administered disodium-clodronate than in those administered nimesulide or paracetamol. A significant reduction in the size of calcifications was also observed in all three groups, but this reduction was more marked in the disodium-clodronate group.

Evaluating pain in osteoarthritis of the hands: the effect of patient information.

The evaluation of osteoarthritis pain is principally based on a subjective rating scale. Accuracy in recording pain score is obviously important. In the present study we evaluated the effect of better standardization of information given to patients in determining the visual analog scale (VAS) score. Fifty-three consecutive male and female outpatients aged 18-65 years (40 women and 13 men) fulfilling the criteria for osteoarthritis of the hands were included in the study. Eligible patients attended the Rheumatology Center on three occasions: day 1, day 3 and day 6 of the study. Two information cards were prepared. On the first card, given to the patient at the end of the first visit, osteoarthritis of the hands was described as a less dangerous disease than rheumatoid arthritis. On the second card, given to patients at the end of the second visit, greater emphasis was placed on anatomo-pathological description of the destructive lesions. VAS score was recorded on days 1, 3 and 6 of observation. ANOVA for repeated measures demonstrated a significant reduction of VAS score between the first and the second assessment and a significant increase between the second and the third assessment. A further significant difference was found in the comparison between the first and third assessment. These results show that different standards of information given to patients may modify VAS score.

A new type of very low-power modulated laser: soft-tissue changes induced in osteoarthritic patients revealed by sonography.

Patients with symptomatic osteoarthritis of the cervical spine were studied by ultrasound examination. The region of interest was the soft connective tissue layer above the right and the left superior trapezium that revealed a significant difference in thickness between the left and right side. The aching side was treated with a new type of very low-power, modulated laser for 3 min. Immediately after application, the sonographic examination revealed a significant symmetrization of the subcutaneous tissue.

Efficacy of disodium-clodronate in the management of joint pain in rheumatoid arthritis. Six months open study.

AIM: The aim of the study was to evaluate the effect on the articular pain of 100 mg of disodium-clodronate administered for 6 days a week by intramuscular injection in rheumatoid arthritis (RA) patients. METHODS: We studied 46 patients (38 females and 8 males middle age 57+/-6.2 years, range from 30 to 80 years) with established RA, in the II and III anatomical stage according to Steinbrocker. Therapeutic regimen was for all patients oral methotrexate 7.5 mg weekly, prednisone 7.5 mg/day and AINS. All of these patients also received disodium-clodronate 100 mg for 6 days a week for 6 months. The results of the VAS for pain, the patient global assessment and the physician global assessment on disease activity have been recorded at baseline, at the 2 months and at 6 months of therapy. RESULTS: VAS for pain and patient global assessment of disease activity values decreased significantly after 2 months of therapy (p<0.01) and in comparing basal versus final observation, but they did not change significantly from month 2 to month 6. The score of physician global assessment on disease activity was found to be significantly improved comparing the basal versus 2 months observation, and 2 months versus 6 months observations (p<0.01). CONCLUSION: Disodium-clodronate may be considered an adjunctive therapy in the pain management of RA patients.

[Parenteral disodium-clodronate in patients with rheumatoid arthritis. A two-month open clinical study]. / Disodio-clodronato parenterale nel paziente con artrite reumatoide. Studio clinico aperto a due mesi.

BACKGROUND: The aim of the study was to evaluate the effect on articular pain of 100 mg of disodium-clodronate administered daily by intramuscular injection in patients affected by rheumatoid arthritis. METHODS: We studied 24 patients with established rheumatoid arthritis, in the II and III stage according to Steinbrocker. Visual analogue pain scale, physician global assessment activity and patient global assessment activity were recorded at baseline, after 30 days and after 60 days of treatment. RESULTS: VAS significant improvement after 30 days was found. The physician and patient global assessment activity were improved after 60 days of treatment. CONCLUSIONS: Disodium-clodronate given by intramuscular injection at the dose of 100 mg/die in rheumatoid patients vas effective in relieving joint pain during a two-month observation.

[1000 osteoarthrosis patients in treatment with GGGs: an assessment of joint pain]. / 1000 pazienti osteoartrosici in trattamento con GGGs: valutazione del dolore articolare.

The analgesic activity of a chondroprotective agent--galactosamineglucuronoglycan sulphate (Condral) was evaluated in the course of an open investigation in a large number of outpatients attending the Istituto Emilio Bruzzone of Genoa or related Centres. Out of 1720 outpatients seen, 1000 were treated for 2 years with 800-1200 mg daily of GGG in one single administration (2-3 sachets or capsules of 400 mg) By the results obtained GGG was shown to have analgesic activity in a large number of cases. Tolerance of the treatment was good and no significant clinical side effects were ever observed.

Prevalence of HFE and TFR2 gene mutation in 118 Ligurian rheumatic patients.

AIM: HFE gene is associated to haemochromatosis, an inherited autosomal recessive disorder responsible of an overload of iron in intestine, liver, pancreas, heart, cutis and joints. Articular and periarticular calcifications may occur. H63D mutation may play a role in the pathogenesis of rheumatoid arthritis. METHODS: DNA of 118 consecutive patients (28 males, 90 females, mean age 58.5+/-13.44) living in Liguria and affected by different rheumatic diseases was examined to evaluate the presence of HFE mutations. RESULTS: Analysis data showed that in 45% (53/118) of patients almost one mutation of HFE gene was present and the presence of H63D mutation in the rheumatic patients was particularly elevated. Data obtained in this study have permitted to reveal that 25 patients of 53 (47.1%) with 1 of 11 HFE mutations suffered from symptomatic or silent chondrocalcinosis. CONCLUSIONS: The conclusion is drawn that this mutation may be correlated to various rheumatic diseases.