Anxiety and depression in primary care patients suffering of rheumatoid diseases.

Rheumatic diseases are chronic debilitating conditions with a known association with anxiety and depression. Individuals with rheumatic diseases experience more psychological distress as these conditions mostly follows a painful, progressively disabling course. The aim of this study was to assess the levels and explore factors associated with anxiety and depression experienced by Greek patients with rheumatic diseases. The sample consisted of 108 patients with rheumatic diseases who visited a rheumatology outpatient clinic. Data collection was conducted using a questionnaire which included patients' characteristics and the Zung Self-Rating Depression Scale (SDS) and Anxiety Scale (SAS). Of the 108 patients in the current study, 44.6% and 41.5% were assessed with depression and anxiety, respectively. Among patients exhibiting depression, 13% had severe depression, with the rest having moderate (12%) and mild (19.6%) severity of depression. Among patients exhibiting anxiety, the majority (20.2%) exhibited mild anxiety, whereas 17% of patients exhibited moderate and 4.3% severe anxiety. Higher levels of depression were experienced by those who experienced severe pain (p=0.001), those who were relapsed (p=0.008), those who had quitted their job due to health limitations (p=0.021), those who had the experience of a miscarriage (p=0.021) and those who used antidepressant or antianxiety medication (p<0.001). Higher levels of anxiety were experienced by female (p=0.011), the unemployed (p=0.047), those who experienced severe pain (p<0.001), those who were relapsed (p=0.015) and those who used antidepressant or antianxiety medication (p<0.001). Individuals with rheumatic diseases should be monitored for accompanying anxiety or depression during follow-up. Given their high prevalence, their profound impact on quality of life, and the range of effective treatments available, health care providers should be encouraged to screen all patients for both anxiety and depression. It is important to assess patients' characteristics when implementing strategies to confront with psychiatric disorders in this vulnerable population group.

Hyperbaric oxygen as salvage treatment for idiopathic sudden sensorineural hearing loss.

OBJECTIVE: To investigate the efficacy of hyperbaric oxygen therapy as a salvage treatment for patients with sudden sensorineural hearing loss (SSHL). MATERIALS AND METHODS: Fifteen patients affected by sudden hearing loss and treated with hyperbaric oxygen after steroid and vasodilator therapy failed constituted the study group. A control group of 30 patients who were treated with steroids and vasodilator alone was also included. Hyperbaric oxygen was administered once daily for 15 sessions at a constant pressure of 2.2 atmospheres. Pure-tone hearing thresholds were obtained for both groups before and after each treatment and frequency-specific thresholds 3 months after the end of hyperbaric oxygen therapy. RESULTS: Salvage hyperbaric oxygen therapy was performed with a mean delay of 24 days from the onset of SSHL. The overall rate of hearing improvement was higher in the study group (7/15 cases, 46.6%) compared with the control group (4/30 cases, 13.3%). The mean pure-tone hearing average thresholds after salvage treatment in the study group was 53.4 dB HL (mean gain, 12.1 dB HL), which was significantly lower than that in the control group of 67.9 dB HL (mean gain, 2.7 dB HL). Hearing recovery was found to be better at low frequencies (250-500 Hz). CONCLUSION: Hyperbaric oxygen therapy should be suggested to all patients for whom initial conventional medical treatment for SSHL has failed.

Clinical expression and course in patients with late onset systemic lupus erythematosus.

BACKGROUND: To analyze the pattern of clinical expression and the 5-year disease course in Caucasian patients with late onset of systemic lupus erythematosus (SLE) and to compare the findings with an early onset SLE group. METHODS: Medical records of 551 patients who presented with SLE at hospitals of the region of Thessaloniki between 1989 and 2007 were studied. Patients who developed SLE at or after the age of 50 years were classified as the late onset group, while younger patients served as the early onset group. Data on clinical manifestations and damage accrual at disease onset and at 5 years was obtained and compared between the two groups. RESULTS: In 121 patients, the disease started after the age of 50 years. Elderly patients showed less pronounced female predominance and less often presented with malar rash, nephropathy, fever and lymphadenopathy, while lung involvement, pericarditis and sicca syndrome were more frequent. Damage accrual was similar in both groups. The main causes of damage at 5 years differed, with the elderly exhibiting more cardiovascular damage. They also had a higher incidence of hypertension and osteoporosis at 5 years. CONCLUSIONS: Caucasian SLE patients with late onset of the disease present with different clinical manifestations, suggesting that age affects the expression of SLE. Damage accrual at 5 years is similar in the elderly and the younger patients. However, the causes of this damage and the occurrence of other comorbidities follow a different pattern, possibly reflecting the disease process and the effects of aging.

Clinical expression and morbidity of systemic lupus erythematosus during a post-diagnostic 5-year follow-up: a male:female comparison.

The aim of this study was to analyse the prevalence of the most relevant clinical features of the diagnosis of systemic lupus erythematosus (SLE) in a sample of male patients with lupus as well as the incidence of the main causes of morbidity in a 5-year period after the diagnosis. A further aim of this study was to investigate the impact of gender on expression and morbidity of SLE. Data were collected from the medical records of 59 male and 535 female patients with SLE who were diagnosed at the hospitals in the region of Thessaloniki. Several differences in the expression and morbidity of the disease were found in relation to the gender of the patient. Male patients had a higher prevalence of thromboses, nephropathy, strokes, gastrointestinal tract symptoms and antiphospholipid syndrome when compared with female patients, but tended to present less often with arthralgia, hair loss, Raynaud's phenomenon and photosensitivity as the initial clinical manifestations. During the 5-year follow-up, positive associations have been found between male gender and the incidence of tendonitis, myositis, nephropathy and infections, particularly of the respiratory tract. In conclusion, this study has provided information regarding the features of clinical expression and morbidity in male patients, and has shown that gender is a possible factor that can influence the clinical expression of SLE.