Neck pain patterns and subgrouping based on weekly SMS-derived trajectories.

BACKGROUND: Neck and low back pain represent dynamic conditions that change over time, often with an initial improvement after the onset of a new episode, followed by flare-ups or variations in intensity. Pain trajectories were previously defined based on longitudinal studies of temporal patterns and pain intensity of individuals with low back pain. In this study, we aimed to 1) investigate if the defined patterns and subgroups for low back pain were applicable to neck pain patients in chiropractic practice, 2) explore the robustness of the defined patterns, and 3) investigate if patients within the various patterns differ concerning characteristics and clinical findings. METHODS: Prospective cohort study including 1208 neck pain patients from chiropractic practice. Patients responded to weekly SMS-questions about pain intensity and frequency over 43 weeks. We categorized individual responses into four main patterns based on number of days with pain and variations in pain intensity, and subdivided each into four subgroups based on pain intensity, resulting in 16 trajectory subgroups. We compared baseline characteristics and clinical findings between patterns and between Persistent fluctuating and Episodic subgroups. RESULTS: All but two patients could be classified into one of the 16 subgroups, with 94% in the Persistent fluctuating or Episodic patterns. In the largest subgroup, "Mild Persistent fluctuating" (25%), mean (SD) pain intensity was 3.4 (0.6) and mean days with pain 130. Patients grouped as "Moderate Episodic" (24%) reported a mean pain intensity of 2.7 (0.6) and 39 days with pain. Eight of the 16 subgroups each contained less than 1% of the cohort. Patients in the Persistent fluctuating pattern scored higher than the other patterns in terms of reduced function and psychosocial factors. CONCLUSIONS: The same subgroups seem to fit neck and low back pain patients, with pain that typically persists and varies in intensity or is episodic. Patients in a Persistent fluctuating pattern are more bothered by their pain than those in other patterns. The low back pain definitions can be used on patients with neck pain, but with the majority of patients classified into 8 subgroups, there seems to be a redundancy in the original model.

Mental health among people with psoriasis undergoing patient education in climate therapy.

This study investigated the mental health of people with psoriasis undergoing patient education in climate therapy. A prospective design included a baseline assessment and two follow-ups after a 3-week patient education program. Participants were 254 adults. Positive mental health was measured by the mental health continuum short form (0-70), and negative mental health by the emotional distress subscale (1-4) of the health education impact questionnaire. Paired-samples t-tests were used to evaluate changes in mental health from baseline to follow-up. Multiple linear regression was used to analyse the ability of socio-demographic and clinical variables and emotional distress to predict changes in positive mental health. To predict change in negative mental health we repeated the same analysis but with a change in negative mental health as a dependent variable and positive mental health as an independent variable. The results show that positive mental health and health-related emotional distress improved significantly from before to after the intervention by 7.1 points, p < 0.001 and 0.21 points, p < 0.001) respectively. At the second follow-up, health-related emotional distress remained significantly improved compared with baseline levels by 0.11 points, p = 0.004. The longer participants had lived with psoriasis ( ß = 146, p = 0.027), and the presence of co-morbid health problems (ß  =  111, p = 0.051) the greater the improvement in the positive mental health immediately after the intervention. No predictors were identified for negative mental health. This study indicates that the promotion of positive mental health needs to be integrated into the climate therapy program, and sustained in their home context.

Osteoarthritis: the peripheral joints.

UNDERSTANDING OF OSTEOARTHRITIS HAS INCREASED: the simplistic "wear and tear" concept no longer holds and this has positive clinical implications. A parallel development has taken place in treatment techniques: there is increasing expertise in the use of physical measures and in new orthopedic reconstructive surgical approaches to multiple joints. This gives the physician alternative approaches to the patient with painful and disabling osteoarthritis. The timing of these treatment options and some considerations which lead to orthopedic referral are considered in this general discussion.

Evaluation of a province-wide physiotherapy monitoring service in an arthritis control program.

We evaluated our rheumatoid arthritis patient follow-up service in British Columbia in a 1 yr prospective study. The follow-up by 45 specially trained Arthritis Society physiotherapists involved contact of 1,701 patients; 1,081 were assessed and 440 were judged to need therapy or physician services; 279 required further physiotherapy, 191 had functional problems needing occupational therapy and 108 had medical problems requiring return to the family doctor. Within 2 months 72% of patients requiring physiotherapy and 84% of patients requiring occupational therapy had received their therapy. The study underlines the value of physiotherapy follow-up monitoring of rheumatoid patients.

Adverse effects of D-penicillamine in rheumatoid arthritis.

Adverse effects to D-penicillamine were studied prospectively over 3 years in 259 patients with rheumatoid arthritis. Ninety-five percent had had gold therapy previously, yet 70% benefited from D-penicillamine therapy. Of the 275 courses given, 160 (58%) were complicated by at least one reaction, including rashes (44%), dysgeusia (20%), gastrointestinal upset (18%), stomatitis (10%), proteinuria (7%), thrombocytopenia (3%), and leukopenia (2%). Their occurrences peaked in the first 6 months of treatment, except for proteinuria and thrombocytopenia, which peaked in the second 6 months. Reactions were commoner at daily doses above 250 mg; mean daily doses for proteinuria, thrombocytopenia, and leukopenia were higher (approximately 600 mg/d) than for the others (approximately 500 mg/d). Of 114 discontinued courses, 73 (27%) were due to adverse reactions. The remaining reactions were controlled by altering dosages and symptomatic treatment. Only obliterative bronchiolitis (two cases) was irreversible; it resulted in the only death in our series, possibly attributable to penicillamine.

Crossover comparison of benoxaprofen and naproxen in rheumatoid arthritis.

This multicenter double-blind clinical trial compared the efficacy and safety of benoxaprofen and naproxen in the treatment of rheumatoid arthritis. The studies followed a crossover design which provided 6 wk therapy with each of the 2 study drugs. Benoxaprofen at a single daily dose of 600 mg compared favorably to naproxen, 750 mg, administered in 2 equally divided doses. All efficacy results indicated slightly more improvement with benoxaprofen although the difference between the 2 drugs was not significant. Side effects were generally mild and only 1 patient discontinued benoxaprofen therapy because of a reactivation of a duodenal ulcer.

Patterns of work--rheumatoid arthritis.

Fifty rheumatoid adults successfully competing in full time competitive work were interviewed to determine the factors which distinguish this group and enable their continuing work, which included physical and social barriers and aids to working full time. The data indicate that as a whole they had significant disease, most falling in functional class 2 and 3 (ARA). As a group they were well educated with occupations mirroring their educational attainments. Almost all had inside jobs and most had worked for long times in their occupations. The majority did not change occupations after disease onset and many had been in their jobs for years, often in the same firm. Promotions were few. They had stable marriage patterns. Patients were motivated for work and did what was necessary to get to work despite their disease. These workers had a low level of absenteeism, enjoyed their jobs and felt that personal desire was the most important factor in keeping at work. From consideration of the disease itself, in addition to upper and lower extremity problems, morning stiffness, fatigue and public transport difficulties were highlighted and focus attention on the need to better control these features of the disease and environment.

D-penicillamine in the treatment of rheumatoid arthritis.

Forty-four patients with definite or classic rheumatoid arthritis and failure to tolerate or respond to gold therapy were treated with D-penicillamine on a so-called go-slow, go-low regime. Seventeen patients tolerated the drug and had a 3-13 month follow-up assessment; 8 were markedly improved, 6 moderately or slightly improved, and 3 unimproved. Penicillamine had to be discontinued in 9 patients because of toxic side effects.

Functional results of excisional arthroplasty for the rheumatoid hand.

Two types of assessment were used in our evaluation of the long-term results of excisional MCP arthroplasty in the rheumatoid hand: a standard surgeon-patient assessment, and a functional test model applied to 17 rheumatoid hands before and after operation.The surgeon-patient overall assessment at the time of follow-up indicated satisfaction with the results in 15 of 17 hands, whereas the occupational therapists' objective functional testing indicated a less positive end result - improvement in 6 of the 17 hands and worsening in 8.The discrepancy need not negate the validity of either finding but would suggest that factors other than function as measured give patient satisfaction. These include such features as pain relief, ability to put on gloves again and improved appearance.

Return to work after treatment of rheumatoid arthritis.

This study reports on the prognosis for return to competitive work of men disabled by rheumatoid arthritis following an intensive in-patient rehabilitation program. Ninety-four men were followed up at a mean time of 3.5 years after discharge from the unit. Sixty-five per cent of the city dwellers and 50% of those living in small communities or rural areas were working either full-time or half-time. Other factors such as education, work background and geographical location influenced the success of return to work.In the city, 12 families (22%) were receiving welfare assistance prior to admission to the comprehensive rehabilitation program. At follow-up six of these families were off welfare and paying taxes. This group alone represented a minimum saving of $35,000 yearly to public funds.