The musculoskeletal impairment negatively impacts the quality of life of children and adolescents with psoriasis

Abstract Background The severity of nail disease, the presence of arthralgia and fatigue are predictors of development of psoriatic arthritis (PsA) in patients with psoriasis (Pso). In children, little is known about the musculoskeletal (MSK) impairment in patients with Pso and its effect on health-related quality of life (HRQoL). Objectives To determine the frequencies of pain and MSK inflammation (i.e., arthritis, enthesitis, and sacroiliitis) among children and adolescents with Pso and its relationship to HRQoL and fatigue. Methods Pediatric patients with Pso underwent a rheumatologic physical examination to evaluate synovitis, enthesalgia, sacroiliac joint (SIJ) pain and tender points of fibromyalgia. The core set of domains recommended by the GRAPPA - OMERACT to be measured in PsA studies was assessed. Ultrasound (US) was performed in clinical cases of enthesitis, and magnetic resonance imaging (MRI) was performed in cases of SIJ pain. Results Forty-three participants (10 ± 2.9 years old) were evaluated. Pain on palpation of the entheses was observed in 10 (23.2%) patients and pain on SIJ palpation was observed in 3 (7%). No patient presented with synovitis; one presented with enthesitis on US, but MRI did not confirm sacroiliitis in any case. Patients with MSK pain had greater skin disease severity (PASI 5.4 vs. 2, p < 0.01), worse fatigue, and lower HRQoL scores on all instruments used. The estimated risk of HRQoL impairment was eight times higher in the presence of MSK pain, which was an independent predictive factor. With a NAPSI greater than 30, the probability of pain was greater than 80%. Conclusion MSK pain is frequent among children with Pso, related to the severity of skin and nail disease, and negatively affects HRQoL. The typically used complementary exams might not detect the inflammatory process caused by Pso.(AU)

Duloxetina no tratamento da dor lombar inflamatória crônica em pacientes portadores de espondilite anquilosante: relato de casos / Duloxetine to treat chronic inflammatory low back pain in ankylosing spondylitis patients: case reports

JUSTIFICATIVA E OBJETIVOS: A espondilite anquilosante (EA) é uma doença inflamatória crônica de etiologia autoimune, cujo principal sintoma é a lombalgia crônica de caráter inflamatório, cujo tratamento e complicações representam um encargo considerável para a sociedade. Novas opções terapêuticas têm sido buscadas para o tratamento da dor lombar inflamatória refratárianos pacientes com EA. O objetivo foi apresentar dois pacientes portadores de EA com dor lombar refratária ao usode anti-inflamatórios não esteroides (AINES), que apresentaram importante melhora clínica com a duloxetina.RELATO DOS CASOS: Dois pacientes do sexo masculino com EA e dor lombar crônica inflamatória refratária ao uso de AINES, que usaram duloxetina (60 mg/dia) e apresentaram melhora clínica importante do quadro doloroso. CONCLUSÃO: A duloxetina se mostrou eficaz para a redução da intensidade da dor lombar crônica inflamatória em pacientes portadores de EA.

BACKGROUND AND OBJECTIVES: Ankylosing spondylitis (AS) is a chronic inflammatory autoimmune disease. Its major symptom is chronic inflammatory low back pain, which treatment and complications represent a considerable burden to society. New therapeutic options have been studied to treat refractory inflammatory low back pain in AS patients. The objective was to present two AS patients with low back pain refractory to non-steroid anti-inflammatory drugs (NSAIDs), who presented important clinical improvement with duloxetine.CASE REPORTS: Two male patients with AS and chronic inflammatory low back pain refractory to NSAIDs,who used duloxetine (60 mg/day) and presented major clinical improvement.CONCLUSION: Duloxetine was effective to decrease chronic inflammatory low back pain intensity in AS patients.

Concomitância de fibromialgia em pacientes com espondilite anquilosante / Occurrence of fibromyalgia in patients with ankylosing spondylitis

INTRODUÇÃO: A Espondilite Anquilosante (EA) é uma doença inflamatória crônica que acomete o esqueleto axial. Cursa com dor e incapacidade funcional. Para medir o impacto da EA na vida dos pacientes são utilizados questionários que avaliam a atividade da doença (BASDAI); a incapacidade funcional (BASFI); e a qualidade de vida (ASQoL). A Fibromialgia (FM) é uma das causas mais comuns de dor generalizada e pode coexistir com outras doenças; pode ser avaliada por meio do questionário de impacto da Fibromialgia (FIQ). Há poucos estudos demonstrando correlações entre FM e EA. O presente estudo obteve dados referentes ao perfil epidemiológico de pacientes com EA e FM e avaliou a prevalência de FM em portadores de EA. Avaliou-se a interferência da FM nos escores dos testes BASDAI, BASFI e ASQoL. PACIENTES E MÉTODO: Foram incluídos 71 pacientes portadores de EA diagnosticados de acordo com os critérios modificados de Nova York. Avaliação clínica, funcional e aplicação dos testes BASDAI, BASFI e ASQoL foram realizados. Os pacientes com diagnóstico de FM foram avaliados com o FIQ. RESULTADOS: Onze pacientes preencheram os critérios para FM, observando-se assim uma prevalência de 15 por cento de FM entre os pacientes com EA, sendo mais frequente entre as mulheres (3,8:1). A idade de início da doença (EA) foi de 27,5 anos. O antígeno HLA-B27 foi positivo na grande maioria (80,4 por cento). Comparando-se as médias dos testes BASDAI, BASFI e ASQoL, verificou-se que os valores são significativamente superiores (P < 0,01) entre os pacientes com FM. Concluiu-se que a coexistência da FM pode piorar os aspectos de atividade na EA, a incapacidade funcional e a qualidade de vida.

INTRODUCTION: Ankylosing spondylitis (AS) is a chronic inflammatory disease that affects the axial skeletal system, causing pain and functional incapacity. To measure the impact of AS on patient's life, questionnaires are used to assess disease activity (BASDAI); functional incapacity (BASFI); and quality of life (ASQoL). Fibromyalgia (FM) is one of the most common causes of generalized pain and can coexist with other diseases; it can be assessed by the Fibromyalgia Impact Questionnaire (FIQ). Few studies have demonstrated correlations between FM and AS. The present study obtained data regarding the epidemiologic profile of patients with AS and FM and evaluated the prevalence of FM in patients with AS. The FM influence on BASDAI, BASFI and ASQoL test scores was assessed. PATIENTS AND METHOD: A total of 71 patients with AS, diagnosed according to the modified New York criteria, were studied. Clinical and functional assessment was performed and BASDAI, BASFI and ASQoL tests were applied. Patients with a diagnosis of FM were evaluated through the FIQ. RESULTS: Eleven patients met the criteria for FM; thus a FM prevalence of 15 percent was observed among the patients with AS. FM was more prevalent among women (3.8:1). Age at disease onset (AS) was 27.5 years. The HLA-B27 antigen was positive in most of them (80.4 percent). When comparing BASDAI, BASFI and ASQoL test means, it was observed that values are significantly higher (P < 0.01) among patients with FM. We concluded that the coexistence of FM can worsen AS activity aspects, as well as functional incapacity and quality of life.