Are radiologic changes in the thoracic and lumbar spine of adolescents risk factors for low back pain in adults? A 25-year prospective cohort study of 640 school children.

STUDY DESIGN: This report was based on a 25-year prospective cohort study and designed as a self-administered questionnaire with low back pain as the main topic. OBJECTIVE: To identify whether radiologic changes in the thoracic and lumbar spine and a history of low back pain in the adolescent period represent risk factors for low back pain in adults. SUMMARY OF BACKGROUND DATA: Six-hundred-forty 14-year-old school children were examined with x-rays of the thoracic and lumbar spine and registered by the school doctor regarding a history of low back pain. METHODS: All of the x-rays and the short journals from the school doctor's registration were reviewed. This primary information was the basis of the investigation 25 years later. RESULTS: Eleven percent of the cohort had a history of low back pain in adolescence, and the results showed an 84% lifetime prevalence of low back pain in these subjects as adults and an increased frequency of low back pain the last month and week before they answered the questionnaire, compared with the rest of the cohort. These problems were associated with increased morbidity and decreased working capacity. Thirteen percent had radiologic abnormalities, mainly Scheuermann changes, in the thoracic and lumbar spine as adolescents, with no positive correlation to low back pain in this period. Unlike other reports, our results did not confirm a positive correlation between x-ray changes in the lower spine in adolescents and a higher prevalence of low back pain in adults. Stepwise logistic regression analyses showed that low back pain in the growth period and familial occurrence of back disease are important risk factors for low back pain later in life, with an observed probability of 88% if both factors are present. CONCLUSION: This study suggests that low back pain in the growth period is "a real problem," with a trend toward aggravation as time passes. Thus, implementing preventive measures in schools may be very important.

[Intraspinal tumor--a rare cause of low back pain in school children]. / Intraspinal tumor--en sjaelden årsag til laendesmerter hos skolebørn.

On the background of two cases, characteristic features of intraspinal tumours in school children are discussed with the purpose of early detection of this and other serious back diseases in the large group of school children with non-specific low back pain. Special attention should be paid to children with recurrent or persistent low back pain. MRI scanning is preferable to CT, when a spinal tumour is suspected.

[Intravenous immunoglobulin administration to a patient with systemic lupus erythematosus and pneumococcal septicemia]. / Intravenøst immunglobulin til en patient med systemisk lupus erythematosus og pneumokoksepsis.

A case history is presented of a woman with systemic lupus erythematosus, sepsis and pneumonia caused by Streptococcus pneumoniae. Conventional treatment was supplemented with intravenous human immunoglobulin with remarkable effect. The treatment is discussed.

[Are low back pain and radiological changes during puberty risk factors for low back pain in adult age? A 25-year prospective cohort study of 640 school children]. / Giver laendesmerter og radiologiske forandringer i puberteten risikofaktorer for senere laendesmerter? En 25 års prospektiv kohorteundersøgelse af 640 skoleelever.

Recent reports have stated that low back pain (LBP) among children is a common problem comparable with that in adults. This 25-year prospective cohort study confirms that 11% of the cohort have had a history of LBP in adolescence with an 84% lifetime prevalence of LBP in these subjects as adults compared with 70% in the rest of the cohort. LBP was associated with increased morbidity and decreased working capacity. Thirteen percent of the cohort had radiological abnormalities, mainly Scheuermann changes, in the thoracic and lumbar spine as adolescents, with no positive correlation to LBP in this period. Unlike other reports our results did not show any association between X-ray changes in the lower spine in adolescents and a higher prevalence of LBP in adults. Stepwise logistic regression analyses showed that LBP in the growth period and familial occurrence of back disease are important risk factors for LBP later in life, with an observed probability of 88% if both factors are present. Preventive measures in the school period seem to be of great importance.

[The importance of early exercise therapy in the treatment of Colles' fracture. A clinically controlled study]. / Betydningen af tidlig ergoterapi ved behandling af Colles-fraktur. En klinisk kontrolleret undersøgelse.

Forty patients participated in a study of the importance of early occupational therapy for the prognosis in stable Colles' fractures. Seventeen patients were treated by an occupational therapist 1-3 days after the injury, and the need for appliances and home-care was estimated. Twenty-three patients completed the usual treatment. Five weeks after the injury, we found significantly (p less than 0.05) better function of the hand in the 17 patients with early occupational therapy. This difference in function could not be found after 13 weeks. The rate of complications was the same in the two groups. The results indicate that contact with the occupational therapist shortly after the injury is valuable in patients with stable Colles' fractures.

[Risk factors for low back pain among 1.389 pupils in the 8th and 9th grade. An epidemiologic study]. / Risikofaktorer for laendesmerter hos 1.389 skoleelever i 8.- og 9.-klasse. Et epidemiologisk studie.

INTRODUCTION: The aim of this study was to investigate the frequency and severity of low back pain (LBP) in 13-16-year-old pupils in relation to selected factors, such as anthropometry, physical activity, smoking, hypermobility, and tightness of hamstring muscles. METHODS: The study was designed as a cross-sectional questionnaire-based survey and all the pupils were examined by the school doctor for height, weight, mobility of joints, and general health status. RESULTS: The lifetime prevalence of non-specific LBP was 58.9% and the one-year prevalence was 50.8% with no differences between the sexes. Recurrent/continuous LBP in a moderate to severe degree was recorded in 19.4% of the school children (182 F, 88 M). This was positively correlated to a female gender, a BMI of more than 25 kg/square meter, competitive sports for boys, poor physical fitness, daily smoking, heavy jobs in leisure time, increased use of the health system, and reduced life quality. DISCUSSION: Stepwise logistic regression analysis indicates that a female gender, daily smoking, and heavy jobs are important associated factors for severe LBP in adolescents, with an observed probability of 46% if all factors are present. We do not know yet whether these factors have any causal importance for the development of severe LBP.

Viscosity of plasma in patients with rheumatoid arthritis.

The viscosity of plasma (PV) was investigated in 27 outpatients with classical or definite rheumatoid arthritis (RA) according to the American Rheumatism Association (ARA) criteria. The measurements showed a significantly raised PV in patients with RA (p less than 10(-5)) compared with a control group. There was a positive correlation between the PV and the blood erythrocyte sedimentation rate (B-ESR), and the increase in the PV is largely explained by increased concentrations of the plasma proteins, fibrinogen, and IgG.

Epidemiological aspects and risk factors for low back pain in 38-year-old men and women: a 25-year prospective cohort study of 640 school children.

This study is based on data gathered by means of a postal questionnaire from a cohort of 640 38-year-old subjects. At the age of 14 years these subjects had been interviewed by their school doctor to ascertain whether any of them had a history of low back pain (LBP), and X-rays of the thoracic and lumbar spine were taken. The questionnaire contained related groups of questions, with LBP as the main topic. We wanted to identify probable risk factors in developing LBP. The results show a cumulative life-time prevalence of LBP of 70%, a 1-year prevalence of 63% and a point prevalence of 19%, independent of gender. Women reported a higher incidence of LBP than men during the month and week before they filled out the questionnaire, they also reported a higher incidence of sciatica and greater use of the health care system and analgestics over the previous year. Heavy manual work was associated with LBP and sciatica, and smoking (more than 16 cigarettes per day) was more common among unemployed and sick-listed subjects, Severe LBP was associated with increased morbidity, reduced work capacity, deterioration in social life, mental and sexual problems, and increased smoking. A stepwise logistic regression analysis of "early" independent variables indicated that severe LBP is positively correlated with low social class for men and with menstruation and pregnancy for women.

Low back pain and physical exercise in leisure time in 38-year-old men and women: a 25-year prospective cohort study of 640 school children.

A cohort of 38-year-old men and women were studied for leisure time physical exercise in relation to low back pain (LBP), education, work, social class and smoking by a self-administered questionnaire. At the age of 14 years, the subjects had been interviewed by their school doctor regarding history of LBP and radiographs of the thoracic and lumbar spine were taken. The results show no positive correlation between radiographic changes and LBP in the adolescent period and decreased physical activity in adulthood. Physical activity for at least 3 h/week reduces the risk of LBP measured as lifetime, 1-year and point prevalence. Eighty-five percent of the subjects who reported taking physical exercise for at least 3 h/week had participated in sports activity almost constantly since their school days and these reported being in better condition than the rest of the cohort. Otherwise they did not have a healthier mode of life. No physical exercise during leisure time was associated with a short school education, unskilled work, unemployment and sickness, low social class, divorce, living in an apartment and smoking. Sixty percent had never or not for many years been interested in participating in sports. Badminton and tennis were the most common sports practised (36%), followed by gymnastics (32%), ball games-soccer and team handball-(25%), running (20%) and swimming (18%). Gymnastics and swimming seem to reduce LBP significantly. Our results show a falling interest in participating in sports activities over time, with 68% of the subjects being members of an athletic association previously, but only 29% currently. Women were more physically inactive during leisure time, probably because of their dual role. Logistic regression analysis indicates that physical activity is related to a long school education, high social class and regular sports activity over time.

Elderly rheumatoid arthritis patients on steroid treatment tolerate physical training without an increase in disease activity.

The effects of physical training on elderly, fragile patients with rheumatoid arthritis (RA) who are on low-dose steroids were investigated. The controlled study included 24 patients who had been treated with low-dose steroids for 2 years. Each patient was assigned either to a treatment group receiving training or to an untrained control group. The training took place over a 3-month period and was based on a protocol using progressive interval training consisting of bicycle exercises, heel lifts, and step-climbing. The exercises were performed twice weekly for 45 minutes. Comparison of the two groups showed that disease activity did not increase in the trained group and that fewer, but not significantly fewer, swollen joints were observed in this group (p = 0.06). No significant changes were noticed in erythrocyte sedimentation rate, tender joints, or morning stiffness. The work capacity of the trained patients were doubled and the numbers of repetitions increased 76%. Individually adapted exercise programs can therefore be recommended for elderly rheumatoid arthritis patients on steroid treatment.

Retroperitoneal fibrosis treated with methylprednisolon pulse and disease-modifying antirheumatic drugs.

The conventional treatment of patients with ureteric obstruction due to retroperitoneal fibrosis (RF) is surgery in combination with long-term corticosteroids. This report describes 11 cases of RF with ureteric obstruction treated with methyl-prednisolon pulse therapy (MPPT) in combination with azathioprine or penicillamine following initial insertion of ureteral stents. The medial treatment suggested was successful in 7 patients, but only moderately effective in the last 4 patients. This principle of non-operative management of RF has not been previously reported.

Safe and effective isokinetic knee extension training in rheumatoid arthritis.

OBJECTIVE: To evaluate the safety of isokinetic knee extensor strength training, and its effectiveness with regard to knee extension, in patients with rheumatoid arthritis (RA). METHODS: Nine women with RA, all in functional stage II or III, underwent a low-intensity strengthening protocol with 48 repetitions at 50% of maximal voluntary contraction, 3 times per week for 3 weeks, using an isokinetic dynamometer. RESULTS: Five patients had knee synovitis at entry; but neither synovitis nor joint pain increased. The mean gain in strength was 21%. CONCLUSION: This training method was effective and safe in patients with RA.

Risk factors for low back pain in a cohort of 1389 Danish school children: an epidemiologic study.

This study was designed as a cross-sectional questionnaire-based survey of low back pain (LBP) in 13- to 16-year-old Danish school children. The cohort consisted of 671 boys and 718 girls in eighth and ninth grade in 46 municipal schools in three counties of Sealand. All the pupils filled in a questionnaire with LBP as the main topic and were at the same time examined by the school doctors. The first part of the questionnaire contained questions about leisure time sports activity, TV watching, PC use, job in leisure time and smoking. The second part dealt with LBP in relation to frequency and severity, influence on daily living and use of the health system. The school doctor measured body height and weight, (BMI), degree of hypermobility and the tightness of the hamstring muscles. The results showed a cumulative life-time prevalence of LBP of 58.9%, a 1-year prevalence of 50.8% and an increase in LBP prevalence of 6.4% from 14 to 15 years of age, independent of gender. Fourteen percent (141 F, 54 M) fulfilled the criteria for general hypermobility and 12.2% (45 F, 124 M) had tightness of hamstring muscles of more than 40 degrees. Recurrent/continuous LBP in a moderate to severe degree was recorded in 19.4% of children (182 F, 88 M). This was positively correlated to female gender, BMI more than 25 kg/m(2), competitive sport for boys, poor physical fitness, daily smoking, heavy jobs in leisure time, increased use of the health system and reduced life quality. Stepwise logistic regression analysis indicates that female gender, daily smoking and heavy jobs are important associated factors for severe LBP in adolescents, with an observed probability of 46% if all factors are present. We don't know yet whether these factors are of any causal importance in the development of severe LBP.