Impact of three-phase bone scintigraphy on the diagnosis and treatment of complex regional pain syndrome type I or reflex sympathetic dystrophy

To determine the impact of three-phase bone scintigraphy [TPBS] on the diagnosis and management of complex regional pain syndrome type I [CRPSI] or reflex sympathetic dystrophy [RSD]. Twenty consecutive patients with a recent clinical evidence of CRPSI were referred for TPBS as part of their routine management plan. All patients underwent neurological examinations with special attention to the evaluation of clinical features of vasomotor, sudomotor, motor and sensory dysfunction. Patients were followed prospectively. When both the clinical and TPBS results supported the diagnosis of CRPSI, patients were started on treatment. Of the 20 patients, TPBS supported the diagnosis of RSD in 9 who were treated with steroids and physiotherapy. Complete follow-up was available for 7 of them and all had a satisfactory response to treatment. For the remaining 11 patients RSD was diagnosed clinically but not confirmed by TPBS. On follow-up there was no evidence that TPBS failed to identify RSD in these 11 patients. The results indicate that TPBS confirmed the clinical diagnosis of RSD, and, more importantly, had a significant impact on its management.

Incidence of musculoskeletal pain in adult Kuwaitis using the validated Arabic version of the WHO-ILAR COPCORD Core Questionnaire

The WHO-ILAR Community Oriented Program for Control of Rheumatic Diseases [COPCORD] primarily aims to estimate the burden of musculoskeletal symptoms/disorders. We estimated the incidence of musculoskeletal pain in the first community-based COPCORD study in Kuwait. The validated Arabic version of the WHOILAR COPCORD Core Questionnaire was used in a survey of 2500 randomly selected Kuwaiti households to assess the frequency of musculoskeletal pain, disability, and health-seeking behavior in adult Kuwaitis. Those subjects reporting no musculoskeletal pain were identified and followed-up for a period of one year by contacting them every 2 weeks. Once a respondent reported pain, an appointment to report to hospital was offered and the subject was examined by a rheumatologist using American College of Rheumatology [ACR] criteria. Of 5159 adults who were non-complainers in an earlier prevalence phase of the study, 3341 responded to phone calls [response rate of 65%]. The incidence of musculoskeletal pain was 6.6% [95%CI, 3.4%- 9.7%]. Age- and sex-adjusted incidence rates were 7.2% [95%CI, 3.4%- 10.5%] for females and 6.1% [95%CI, 3.1%-9.2%] for males. The incidence rate increased with increasing age, body mass index, and with being married. The common sites of pain were knee, low back and shoulder. The incidence of musculoskeletal pain among Kuwaiti adults is reported for the first time. Further studies adopting the same instrument in other communities are warranted to compare with our findings

Prevalence of low back pain among physical therapists in Kuwait

To determine the life and point prevalence rates and study the characteristics of work-related and non-work-related low back pain [LBP] among physical therapists in Kuwait and its effect on their regular activities. Subjects and A specially designed self-administered questionnaire was distributed to 143 physical therapists in Kuwait. The questionnaire included demographic data, history and characteristics of LBP before and after working as a physical therapist, the effect of LBP on regular activities and current LBP. A visual analogue scale was used to score the intensity of the pain. One hundred [70%] of the 143 physical therapists completed the questionnaire; mean age and standard deviation of the respondents were 35.9 +/- 8.45 years. The lifetime prevalence of work-related LBP was 70% [61.8% in males and 74.2% in females] and the point [current] prevalence rate was 57% [31.6% in males and 68.4% in females]. All the 100 therapists were college graduates who worked full-time and 82% were employed in general hospitals and rehabilitation centers. The most common areas of specialty were orthopedics [32%] and neurology [23%]. Fifty% reported that LBP affected their regular activities, 28.6% reported limitation due to pain and 11.4% changed their work settings because of LBP. The main site of pain was at low back and buttocks. Pain intensity was scored similarly among male and female physical therapists. Work-related and point prevalence rates of LBP among physical therapists in Kuwait are high and affect their daily activities, necessitating changes in work settings

Sarcoidosis mimicking localized scleroderma

We report a case of a 76 year old female who presented with Scleroderma-like thickening of the skin over both arms, forearms, the dorsum of both hands and ankles. Laboratory investigations showed a high level of Angiotensin converting enzyme and chest radiography showed bilateral hilar lymphadenopathy. The biopsy showed non-caseating granulomas in subcutaneous tissue. The above findings were compatible with the diagnosis of sarcoidosis and the patient's response to corticosteroid was satisfactory