Pain, disability and catastrophizing in individuals with knee osteoarthritis / Dor, incapacidade e catastrofização em indivíduos com osteoartrite do joelho

ABSTRACT BACKGROUND AND OBJECTIVES: Knee osteoarthritis is among the leading sources of chronic disability and may lead to depression, anxiety and pain catastrophizing, enhancing perceived pain. This study aimed at investigating the influence of pain catastrophizing on attitudes and perception of pain, and in the functionality of individuals with knee osteoarthritis. METHODS: This observational study involved 18 patients, who were assessed for weight and height, and completed the Pain-related Catastrophizing Thoughts Scale (PCTS), Survey of Pain Attitudes (SPA), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and the visual analog scale (VAS). Symptoms and disability were assessed by the Lequesne Index, functional mobility was evaluated by the Timed Up and Go (TUG) test. Pressure pain tolerance thresholds (PPT) were assessed by a digital algometer. RESULTS: Mean body mass index of the sample was classified as obese (32,2±4,3). When split by the median of PCTS, differences were observed in most domains of SPA. Patients with more catastrophic thoughts took longer to perform TUG and presented more pain, joint stiffness and worse functionality (WOMAC). Despite the tendency to report more pain (VAS) in patients above the median score of PCTS, no differences were observed between groups with higher or lower catastrophizing regarding PPT. Positive and significant associations between the Rumination factor of PCTS and WOMAC outcomes were observed, as well as between the Hopelessness factor and TUG, Lequesne and WOMAC. CONCLUSION: The higher the presence of catastrophic thoughts, the worse the attitudes towards pain and the physical functionality of knee osteoarthritis patients.

RESUMO JUSTIFICATIVA E OBJETIVOS: A osteoartrite do joelho está entre as principais causas de incapacidade crônica e pode levar à depressão, ansiedade e catastrofização, intensificando a percepção da dor. Este estudo teve como objetivo investigar a influência da catastrofização da dor nas atitudes e na percepção da dor e a funcionalidade de indivíduos com osteoartrite do joelho. MÉTODOS: Dezoito pacientes foram avaliados quanto ao peso e à estatura, e completaram a Escala de Pensamentos Catastróficos Sobre a Dor (EPCD), Inventário de Atitudes frente à Dor (IAD), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) e escala analógica visual (EAV). Os sintomas e a incapacidade foram avaliados pelo Índice de Lequesne, a mobilidade funcional foi avaliada pelo teste Timed Up and Go (TUG). Os limiares de tolerância à dor à pressão (LTDP) foram avaliados por um algômetro digital. RESULTADOS: A média do índice de massa corporal da amostra foi classificado como obesa (32,2±4,3). Quando divididas pela mediana do EPCD, foram observadas diferenças na maioria dos domínios do IAD. Pacientes com pensamentos mais catastróficos demoraram mais para realizar o TUG e apresentaram mais dor, rigidez articular e pior funcionalidade (WOMAC). Apesar da tendência de relatar mais dor (EAV) em pacientes acima do escore mediano do EPCD, não foram observadas diferenças entre os grupos com maior ou menor catastrofização em relação aos LTDP. Foram observadas associações positivas e significantes entre o fator ruminação da EPCD e o WOMAC, bem como entre o fator Desesperança e TUG, Lequesne e WOMAC. CONCLUSÃO: Quanto maior a presença de pensamentos catastróficos, piores as atitudes em relação à dor e funcionalidade física dos pacientes com osteoartrite do joelho.

Cutaneous temperature and pressure pain threshold in individuals with knee osteoarthritis.

INTRODUCTION: Osteoarthritis is a common disease in which skin temperature may be included among the pathophysiological factors. Thermography allows the mapping of cutaneous temperature and may be employed in the investigation of osteoarthritis. OBJECTIVES: To evaluate cutaneous temperature of the lower limbs, as well as to verify its association with pressure pain thresholds in individuals with knee osteoarthritis. MATERIAL AND METHODS: This case series study was conducted with individuals of both genders aged 48-77 years with unilateral knee osteoarthritis. Volunteers underwent thermographic evaluation by an infrared sensor (FLIR T650SC). The anterior region of the thigh and leg and the knee area were evaluated. Pressure pain thresholds (PPT) were evaluated by algometry (Pain Diagnostics, Great Neck, USA) at the vastus medialis, vastus lateralis, rectus femoris, and patellar tendon. Data analysis was conducted with the statistical package SPSS v.24 for Windows. Comparisons between affected and unaffected sides were made by paired Student's t-test or the Mann-Whitney U test, and associations between variables were assessed by Pearson or Spearman's correlation coefficient. In all cases, the significance level was set at p ≤ 0.05. RESULTS: Eleven volunteers (63.1 ±9.5 years) participated in this study. When comparing cutaneous temperature, only the region of the knee showed a significant difference between sides (p = 0.02). There were no differences between affected and unaffected knees regarding pain tolerance (PPT) at all sites evaluated. There were also no significant associations between the study variables. CONCLUSIONS: Individuals with knee osteoarthritis presented a higher temperature of the affected knee, but this was not associated with pressure pain thresholds.

Geotherapy combined with kinesiotherapy is efficient in reducing pain in patients with osteoarthritis.

INTRODUCTION: Patients with osteoarthritis (OA) suffer from a degenerative disease that causes several physical disabilities and pain. Despite the few studies involving exercise combined with geotherapy (a therapy using poultices made from earth materials such as clay or mud) for patients with OA, this subject is still under debate, as effect of the earth material remains unclear. The aim of this study was to compare pain, joint stiffness and disability in patients who underwent kinesiotherapy (K) or geotherapy combined with kinesiotherapy (GK). METHOD: This was a clinical randomized single-blinded prospective study, in which 48 individuals participated. Volunteers were evaluated for pain perception, pressure pain tolerance thresholds, and responded to questionnaires about pain, joint stiffness and physical disability (WOMAC) and about symptoms and disability (Lequesne Algofunctional Index). Patients in K group underwent 15 twice-weekly sessions of kinesiotherapy consisting of stretching and strengthening exercises for lower limbs. GK patients received a poultice of powder dolomite mixed with hot water on the knees for 25 min before each of the 15 sessions of the same kinesiotherapy program. RESULTS: Both interventions were effective in reducing pain, joint stiffness and physical disability (p < 0.001), and in increasing pressure pain thresholds (p < 0.05); however, patients who underwent GK presented a more pronounced reduction in pain perception (p = 0.006) than those in K group. They also exhibited more tolerance to pain in all sites evaluated. CONCLUSION: Both interventions were effective in reducing pain, joint stiffness and physical disability, but GK produced significantly better results in pain perception.

Discordance between radiographic findings, pain, and superficial temperature in knee osteoarthritis.

INTRODUCTION: Knee pain is an imprecise marker of radiographic evidence of osteoarthritis (OA). These patients are more likely to develop central sensitisation to pain, a risk factor for chronic pain. OBJECTIVES: The aim of this study was to examine the associations among radiographic evidence of OA, self-reported pain, pressure pain thresholds (PPT), and superficial knee temperature in individuals with knee OA. MATERIAL AND METHODS: This cross-sectional study enrolled 25 patients with knee OA with clinic and radiographic diagnosis of bilateral OA (Kellgren-Lawrence grading scale 1-4 in X-ray images), but symptoms of pain and discomfort in only one of the knees, with pain perception in the symptomatic knee equal to or above 4 in a visual analogue scale. Volunteers underwent an evaluation including demographic data, superficial knee temperature (infrared thermography, mean superficial temperature of the region of the knee) and PPT (digital algometry at longus adductor, vastus lateralis, vastus medialis and tibialis anterior muscles, patellar tendon, and centre of the patella). RESULTS: Comparisons between symptomatic and asymptomatic knees revealed no differences regarding Kellgren-Lawrence classification, knee superficial temperature, or PPT. Significant weak and moderate associations were found between radiographic classification of OA and PPT of both knees in almost all sites evaluated. Nonetheless, superficial temperature of the knee was not associated with PPT or Kellgren-Lawrence grading scale. CONCLUSIONS: Patients with bilateral knee OA presented no differences in symptomatic and asymptomatic knees regarding radiographic evidence, knee temperature, and PPT, indicating that central sensitisation may be present in them. Radiographic classification of OA was significantly associated with PPT in both knees.

Estudo da segurança e eficácia do exercício aeróbico em pacientes com esclerose sistêmica / Study of safety and efficacy of aerobic exercise in systemic sclerosis patients

OBJETIVO: Diversos estudos demonstraram que pacientes com Esclerose Sistêmica possuem capacidade aeróbia reduzida. É relevante avaliar se o exercício aeróbio é seguro e eficaz para estes pacientes. MÉTODO: Sete pacientes com Esclerose Sistêmica e sete controles saudáveis participaram de um programa de oito semanas, que consistiu em atividade aeróbia de intensidade moderada duas vezes por semana. RESULTADOS: Pacientes e controles apresentaram aumento significativo no pico de consumo de oxigênio, e foram capazes de executar uma intensidade de exercício significativamente maior em relação ao pré-teste. O grupo Esclerose Sistêmica demonstrou aumento na saturação de oxigênio no pico do exercício. O escore de Rodnan foi similar antes e após a intervenção, e as úlceras digitais e o fenômeno de Raynaud permaneceram estáveis. CONCLUSÃO: O exercício aeróbio foi seguro e eficaz para pacientes com Esclerose Sistêmica, portanto, aumentar a capacidade aeróbia é uma meta possível no tratamento desta doença.

OBJECTIVES: Several studies have established that Systemic Sclerosis patients have a reduced exercise capacity. It is relevant to evaluate whether aerobic exercise consists in a safe and effective intervention for these patients. METHODS: Seven Systemic Sclerosis patients and seven healthy sedentary controls were enrolled in an eight-week program consisting of moderate intensity aerobic exercise twice a week. RESULTS: Systemic Sclerosis patients and controls had a significant improvement in their peak oxygen consumption and were able to perform a significantly higher exercise intensity when compared to baseline. Systemic sclerosis group improved peak exercise oxygen saturation. Rodnan score was similar before and after the intervention. Digital ulcers and Raynauds phenomenon remained stable. CONCLUSIONS: Aerobic exercise was safe and effective in patients with Systemic Sclerosis, therefore increasing aerobic capacity is a feasible goal in the management of this disease.