Hydrotherapy versus conventional land-based exercise for the management of patients with osteoarthritis of the knee: a randomized clinical trial.

BACKGROUND AND PURPOSE: This study was designed to evaluate the effectiveness of hydrotherapy in subjects with osteoarthritis (OA) of the knee compared with subjects with OA of the knee who performed land-based exercises. SUBJECTS AND METHODS: Sixty-four subjects with OA of the knee were randomly assigned to 1 of 2 groups that performed exercises for 18 weeks: a water-based exercise group and a land-based exercise group. The outcome measures included a visual analog scale (VAS) for pain in the previous week, the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), pain during gait assessed by a VAS at rest and immediately following a 50-foot (15.24-m) walk test (50FWT), walking time measured at fast and comfortable paces during the 50FWT, and the Lequesne Index. Measurements were recorded by a blinded investigator at baseline and at 9 and 18 weeks after initiating the intervention. RESULTS: The 2 groups were homogenous regarding all parameters at baseline. Reductions in pain and improvements in WOMAC and Lequesne index scores were similar between groups. Pain before and after the 50FWT decreased significantly over time in both groups. However, the water-based exercise group experienced a significantly greater decrease in pain than the land-based exercise group before and after the 50FWT at the week-18 follow-up. DISCUSSION AND CONCLUSION: Both water-based and land-based exercises reduced knee pain and increased knee function in participants with OA of the knee. Hydrotherapy was superior to land-based exercise in relieving pain before and after walking during the last follow-up. Water-based exercises are a suitable and effective alternative for the management of OA of the knee.

[Monitoring the functional capacity of patients with rheumatoid arthritis for three years]. / Acompanhamento da capacidade funcional de pacientes com artrite reumatoide por três anos.

OBJECTIVE: To quantify modification of functional capacity in a three year period in a group of patients with rheumatoid arthritis (RA) using HAQ and EPM-ROM inventories. METHODS: Forty patients with RA on methotrexate (MTX) as disease-modifying anti rheumatic drug (DMARD) were followed for up to three years. The functional status was assessed at the beginning and end of the period by HAQ and EPM-ROM. RESULTS: Thirty two patients were retrieved, with initial HAQ score of 1.14±0.49 (mean±SD) and EPM-ROM score of 5.8±2.75. After an average period of three years, the HAQ score was 1.13±0.49 and EPM-ROM score, 6.81±3.66. In the subgroup of seven patients submitted to orthopedic surgery, HAQ score decreased from 0.84±0.72 to 1.64±0.56 and the EPM-ROM score, from 5.8±1.80 to 8.3±0.74. In the subgroup of non-operated patients, HAQ score varied from of 1.2±0.45 to 1.07±0.70 and EPM-ROM score, from 5.7±3.06 to 6.4±3.90. CONCLUSION: In a group of RA patients in use of only MTX as DMARD, there was little change on HAQ score and EPM-ROM scores over the average period of three years. Worsening functional capacity was observed in the group of operated patients in comparison to the not operated ones. This fact alerts us to the need for use of broader therapeutic regimens availability of musculoskeletal surgeries in a timely manner in patients with RA.

Acompanhamento da capacidade funcional de pacientes com artrite reumatoide por três anos / Monitoring the functional capacity of patients with rheumatoid arthritis for three years

Objetivo Quantificar a modificação da capacidade funcional em um período de três anos em um grupo de pacientes com artrite reumatoide (AR), utilizando os inventários HAQ e EPM-ROM. Métodos Quarenta pacientes com AR em tratamento com metotrexato (MTX) como fármaco antirreumático modificador da doença (DMARD) foram acompanhados por até três anos. O estado funcional foi avaliado no início e no final do período por HAQ e EPM-ROM. Resultados Trinta e dois pacientes foram recuperados, com escore HAQ inicial de 1,14 ± 0,49 (média ± DP) e EPM-ROM de 5,8 ± 2,75. Após um período médio de três anos, o HAQ foi de 1,13 ± 0,49 e EPM-ROM em 6,81 ± 3,66. No subgrupo de sete pacientes submetidos a cirurgia ortopédica, o HAQ diminuiu de 0,84 ± 0,72 para 1,64 ± 0,56; e o EPM-ROM, de 5,8 ± 1,80 para 8,3 ± 0,74. No subgrupo de pacientes não operados, o HAQ variou de 1,2 ± 0,45 para 1,07 ± 0,70; e o EPM-ROM, de 5,7 ± 3,06 para 6,4 ± 3,90. Conclusão Em um grupo de pacientes com AR medicados apenas com MTX como DMARD, houve pouca mudança nas pontuações HAQ e EPM-ROM durante o período médio de três anos. Observou-se agravamento da capacidade funcional no grupo de pacientes operados, em comparação com os não operados. Este fato nos alerta para a necessidade do uso de esquemas terapêuticos mais abrangentes e de maior disponibilidade de cirurgias musculoesqueléticas, em tempo hábil, em pacientes com AR. .

Objective To quantify modification of functional capacity in a three-year period in a group of patients with rheumatoid arthritis (RA) using HAQ and EPM-ROM inventories. Methods Forty patients with RA on methotrexate (MTX) as disease-modifying antirheumatic drug (DMARD) were followed for up to three years. The functional status was assessed at the beginning and end of the period by HAQ and EPM-ROM. Results Thirty-two patients were retrieved, with initial HAQ score of 1.14 ± 0.49 (mean ± SD) and EPM-ROM score of 5.8 ± 2.75. After an average period of three years, the HAQ score was 1.13 ± 0.49 and EPM-ROM score, 6.81 ± 3.66. In the subgroup of seven patients submitted to orthopedic surgery, HAQ score decreased from 0.84 ± 0.72 to 1.64 ± 0.56 and the EPM-ROM score, from 5.8 ± 1.80 to 8.3 ± 0.74. In the subgroup of non-operated patients, HAQ score varied from 1.2 ± 0.45 to 1.07 ± 0.70 and EPM-ROM score, from 5.7 ± 3.06 to 6.4 ± 3.90. Conclusion In a group of RA patients in use of only MTX as DMARD, there was little change on HAQ score and EPM-ROM scores over the average period of three years. Worsening functional capacity was observed in the group of operated patients in comparison to the not operated ones. This fact alerts us to the need for use of broader therapeutic regimens availability of musculoskeletal surgeries in a timely manner in patients with RA. .

Development of a tool for early referral of children and adolescents with signs and symptoms suggestive of chronic arthropathy to pediatric rheumatology centers.

OBJECTIVE: To develop an easy, time-efficient tool to identify children and adolescents with signs and symptoms suggestive of chronic arthropathies, and to evaluate its interobserver reproducibility and reliability. METHODS: The instrument used standardized techniques as required for the development of health-related instruments, targeting parents of apparently healthy children and adolescents ages 1-16 years. A multidisciplinary team was involved in the design of the instrument. RESULTS: Each health professional generated 10-15 questions addressing musculoskeletal complaints that they considered to be the most relevant. A total of 60 questions were listed. During the reduction step, each health professional scored questions from 1 to 4 according to the question's relevance. The tool comprised 12 questions and was administered to the parents of 3 groups: patients with juvenile idiopathic arthritis (JIA; n = 48), children with diffuse musculoskeletal pain (n = 39), and a healthy control group (n = 42). The JIA group achieved the highest scores, followed by the diffuse musculoskeletal pain group and the control group. Nine (18.7%) of 48 patients with JIA and 2 (5.1%) of 39 children with musculoskeletal pain had a score of 5. The interobserver reproducibility was confirmed. All 12 questions were included in the final version of the instrument. We determined that children and adolescents with a score > or =5 should be referred for a rheumatologic evaluation (cluster analysis and logistic regression). CONCLUSION: Our questionnaire seems to be a useful tool for the early detection of musculoskeletal problems in children that may need a referral for a rheumatologic evaluation.

Polyarticular corticosteroid injection versus systemic administration in treatment of rheumatoid arthritis patients: a randomized controlled study.

OBJECTIVE: To study the effectiveness and side effects of polyarticular corticosteroid injection compared to systemic administration in patients with rheumatoid arthritis (RA), and to examine the differential response to injection among joints. METHODS: Sixty-nine RA patients presenting with 6-12 swollen joints were enrolled to participate in a randomized trial consisting of polyarticular injection in 6-8 swollen joints of intraarticular (IA) triamcinolone hexacetonide (IA group) or intramuscular (IM) mini-pulse therapy with triamcinolone acetonide in equivalent doses (IM group). Blind examination at baseline (T0), Weeks 1 (T1), 4 (T4), 12 (T12), and 24 (T24) postintervention included American College of Rheumatology improvement criteria ACR20%, 50% and 70%, visual analog scale for articular pain, pain on movement, joint count, range of motion, morning stiffness, quality of life (Medical Outcome Study Short Form-36), use of nonsteroidal antiinflammatory drugs and oral corticosteroid, blood pressure, adverse effects, calls to the physician, and hospital visits. RESULTS: Significantly better results were observed for IA compared to IM patients as follows: ACR20% (61.7% vs 28.5% at T1; 73.5% vs 42.8% at T4), ACR50% (29.4% vs 5.7% at T1; 44.1% vs 20% at T4), ACR70% (11.7% vs 0% at T1), patient's evaluation of disease activity, lower tender joint count, lower blood pressure, lower number of adverse effects, calls to the physician, and hospital visits (p < 0.05). Less significant adrenocorticotropic hormone reduction was observed for IA group at T4 and T12 (p < 0.05). Elbows and metacarpophalangeal joints had the best response to corticosteroid injection. CONCLUSION: In the short term, polyarticular IA injection was better than IM corticosteroid, as shown by ACR improvement criteria and number of adverse effects.

Evaluation of pulmonary function and quality of life in women with osteoporosis.

Osteoporotic vertebral fractures generally result in an increased kyphotic angle, which in turn may lead to disturbances in pulmonary function. The objective of the present study was to evaluate pulmonary function and quality of life in a group of osteoporotic patients. Fifteen women with osteoporosis and thoracic vertebral fractures (group 1), 20 women with osteoporosis without vertebral fracture (group 2) and 20 control women (group 3) were submitted to spirometry using a Vitatrace-130 SL spirometer and to an SF-36 quality of life questionnaire. Women with osteoporosis and vertebral fractures showed an increased kyphotic angle (median=60 degrees) and decreased forced vital capacity (group 1 vs. group 2, P =0.020; group 1 vs. group 3, P =0.039) and forced expiratory volume in 1 s (group 1 vs. group 2, P =0.008; group 1 vs. group 3, P =0.014) when compared with women without vertebral fractures or osteoporosis. A negative correlation was observed between thoracic kyphosis and the predicted value of expiratory forced volume in 1 s ( r =-0.713, P =0.003). No differences in the quality of life were detected between the three groups studied. We conclude that women with thoracic vertebral fractures have an increased kyphotic angle and present a decrease in lung volume.

Evaluation of physical capacity and quality of life in osteoporotic women.

INTRODUCTION: Osteoporotic vertebral fractures result in increased kyphosis angle, an alteration that may lead to disturbance in physical capacity. OBJECTIVE: We sought to evaluate physical capacity and disability in a group of osteoporotic patients. MATERIAL AND METHODS: Fifteen women with osteoporosis and vertebral fractures (G1), 20 women with osteoporosis without vertebral fractures (G2), and 20 control women (G3) were selected. The variables of physical capacity were measured using a treadmill. The patients spent 4 min standing quietly, 4 min walking at 3 km/h, and 10 min walking at 4 km/h. The SF-36 questionnaire was also applied. RESULTS: The results showed that women with osteoporosis and vertebral fractures (G1) had increased kyphosis angle (median 60 degrees ), while the angle was 43.5 degrees for G2 and 37 degrees for G3. Oxygen consumption (VO(2) (kg)), METS (metabolic equivalent), and energy expenditure (kcal/h) during the standing period were higher in G1 than in G2 (G1 vs G2, p=0.016, p=0.017, and p=0.012, respectively), whereas no difference in these parameters was observed between groups during the walking period. The energy expenditure during walking at 3 km/h and at 4 km/h showed a correlation with thoracic kyphosis in G1 (p=0.01 and p=0.017, respectively). No difference in SF-36 scores was observed between the three groups. CONCLUSION: Energy expenditure showed a correlation with the angle of thoracic kyphosis. Patients with or without osteoporosis showed the same energy expenditure during the walking period. The SF-36 score was similar for the three groups.

Peak oxygen uptake and ventilatory anaerobic threshold in fibromyalgia.

OBJECTIVE: To compare maximum oxygen uptake and anaerobic threshold in patients with fibromyalgia (FM) and healthy sedentary controls matched by sex, age, weight, and body mass index. METHODS: Fifty women with FM aged 18-60 years and 50 healthy sedentary controls were studied. All were submitted to a maximum treadmill incremental test. Expired gas, ventilatory anaerobic threshold, and maximum oxygen uptake (VO2max) were evaluated. The influence of FM on quality of life was evaluated by questionnaires: the Fibromyalgia Impact Questionnaire and the Medical Outcomes Study Short-Form (SF-36). RESULTS: In patients with FM, the anaerobic threshold and peak oxygen uptake were significantly reduced. Maximum heartbeat rate was significantly lower in FM, indicating submaximum effort. Linear regression data showed a correlation between peak VO2 and the "Role-physical" domain of the SF-36. No such correlations were noted with anaerobic threshold. CONCLUSION: These results confirm the hypothesis of lower physical fitness in patients with FM. Considering that patients with FM do not achieve a maximum effort, ventilatory anaerobic threshold should be considered as a better fitness index than VO2max.

Denervação acetabular cranial e dorsal no tratamento da displasia coxofemoral em cães: 360 dias de evolução de 97 casos / Cranial and dorsal acetabular denervation technique in treatment of hip dysplasia in dogs: 360 days evaluation of 97 cases

Realizou-se a pesquisa com o intuito de avaliar os resultados clínicos da denervação acetabular cranial e dorsal por curetagem em cães com displasia coxofemoral. Foram estudados, para tanto, 97 cães, sem predileção racial ou sexual, de 1-7 anos de idade, com diagnóstico clínico e radiográfico de displasia coxofemoral. Para avaliação dos resultados da técnica cirúrgica, de curetagem das fibras nervosas do periósteo acetabular cranial e dorsal, exames clínicos foram realizados no momento pré-operatório (exame inicial), e pós-operatório, nos dias dois, sete, 14, 21, 30, 60, 180 e 360. Todos os animais foram avaliados quanto à claudicação, dor à movimentação e toque, grau de atrofia muscular, sensibilidade dolorosa ao teste de Ortolani, e qualidade de vida. A denervação reduziu a claudicação, e dor à movimentação e toque à partir de dois dias de pós-operatório, reduziu atrofia muscular aos 60 dias pós-operatórios, e melhorou a qualidade de vida dos pacientes tratados, sob a ótica dos proprietários e veterinários aos 360 dias de pós-operatório. A dener-vação acetabular dorsal é técnica factível no tratamento da dor conseqüente à displasia coxofemoral em cães, com decréscimo significativo desta após dois dias da intervenção cirúrgica, aumenta qualidade de vida e proporciona maior atividade aos pacientes com proprietários satisfeitos quanto aos resultados do procedimento. A técnica cirúrgica deve incluir a curetagem das fibras nervosas do periósteo acetabular tanto da região cranial quanto dorsal.

The aim was to evaluate the clinical results of cranial and dorsal acetabular denervation using curettage in dysplastic dogs. Ninty seven dogs without distinction of breed and sex, 1 to 7 years of age, were analyzed for diagnosis and treatment of hip dysplasia, based on physical examination, clinical signs and radiographic findings. For evaluation of results of the surgical denervation technique, clinical examinations were performed preoperatively (initial exam) and postoperatively at days 2, 7, 14, 21, 30, 60 180 and 360. All animals were evaluated for lameness, pain to movement and touch, muscular atrophy degree, pain sensivity to Ortolani's test and assessment of life quality. The surgical denervation procedure decreases lameness, pain to movement and touch after 2 days of procedure, decreases muscular atrophy after 60 days of procedure, and improves quality of life from the owner's and veterinarian's point of view even after 1 year of the treatment. Dorsal acetabular denervation is a feasible surgical technique in treatment of pain secondary to hip dysplasia in dogs, with significant decrease of pain after 2 days of treatment, improvement of quality of life, decrease of lameness, and consequently joyful animals and owners extremely satisfied with the results obtained by the proposed treatment. The surgical technique must include the curettage of nerve fibers from the cranial-dorsal and dorsal region of the acetabular periosteum.

Tradução, adaptação e validação Non-Communicating Children´s Pain Checklist / Translation, adaptation and validation Non-Communicating Children´s Checklist

O objetivo deste estudo foi traduzir adaptar e validar o questionário Non-Communicating Children´s Pain Checklist Revised para o português. Foi utilizada a metodologia proposta por GUILLEMIN, BOMBARDIER, BEATON (7). Encontrou-se forte associação (p<0,01) entre todas as medidas aplicadas dentro do instrumento para a primeira e segunda avaliação. Encontrou-se também forte associação (p<0,01) para coeficiente de correlação de Pearson entre a escala de Barthell e o Non-Communicating Children´s Pain Checklist-Revised (NC-CPC-R). Concluiu-se que o Brasil-Non-Communicating Children´s Pain Checklist-Revised foi traduzido e adaptado com sucesso para aplicação em pacientes brasileiros sem comunicação verbal ou suplementar alternativa

Artrite reumatóide juvenil: importância das escalas de dor / Juvenile rheumatoid arthritis: importance of pain scales

Objetivo: Avaliar a confiabilidade de três tipos de escalas de dor (numérica, de faces e verbal) na avaliaçao da dor sentida por crianças brasileiras com artrite reumatóide juvenil (ARJ). Métodos: As escalas de dor foram administradas a 53 crianças com a doença e aos seus pais. Foram avaliadas a reprodutibilidade e a validade construída. Resultados: Foi observada correlaçao satisfatória (coeficiente de correlaçao de Pearson) entre os escores das escalas de dor e os valores obtidos de outros parâmetros clínicos utilizados por reumatologistas pediátricos: atividade da doença, número de articulaçoes acometidas, classe funcional do American College of Rheumatology, duraçao da rigidez matinal, questionário Child-HAQ e velocidade de hemossedimentaçao. Conclusao: Nossos resultados comprovam a confiabilidade das escalas de dor na avaliaçao da dor de crianças com ARJ

Escala EPM-ROM Pediátrica: uma escala reduzida para avaliação da amplitude de movimento articular de pacientes com artrite reumatóide juvenil / Pediatric EPM-ROM scale: a reduced scale to be used in the daily juvenile rheumatoid arthritis practice and in clinical trials

Objetivo: Desenvolver um instrumento específico para a avaliação da amplitude de movimento articular de crianças e adolescentes com artrite reumatóide juvenil (ARJ) e avaliar as suas propriedades de medida. Casuística e métodos: os 10 movimentos da escala Escola Paulista de medicina - Range of Motion (EPM-ROM) Pediátrica originaram-se de 25 movimentos iniciais. A seleção foi baseada em dois critérios: 1 )consenso entre três reumatologistas pediátricos, um fisioterapêuta e um terapeuta ocupacional e 2 )resultados e um estudo piloto envolvendo pacientes com ARJ. A nota obtida em cada movimento articular variou de zero (movimento total) a três (limitação grave) e os ângulos de corte para os movimentos foram obtidos, de modo geral, de acordo com a falta de capacidade em realizar algumas atividades comuns do dia a dia. Foram avaliadas a reprodutibilidade intra-observador (teste-reteste) e a interobservadores. A validade construída foi estudada através da correlação dos valores de alguns parâmetros clínicos rotineiramente utilizados em pacientes com ARJ com as notas da escala EPM-ROM Pediátrica. Resultados: A escala foi aplicada em 34 pacientes com ARJ (11 com tipo de início sistêmico, 11 poliarticular e 12 pauciarticular). A nota obtida (média) foi de 0,57 (0 a 2,05). A reprodutibilidade foi satisfatória. Os coeficientes de correlação de Pearson obtidos entre as notas da escala e os valores dos outros parâmetros (childhood Health Assessment Questionaire, classe funcional do American College of Rheumatology e número de articulações acometidos) variaram entre 0,55 e 0,65 (p<0,05). Conclusão: A escala EPM-ROM Pediátrica é um instrumento válido e reprodutível e é útil na avaliação de pacientes com ARJ