Diagnostic Dilemma of Reactive Arthritis Aided by Multimodality Imaging using MRI, CECT and 18F-FDG PET/CT Scans

Reactive arthritis can be an elusive diagnosis especially in the elderly. A 77-year-old lady, presented with recent history of hip pain. She had been treated for urinary tract infection caused by Chlamydia sp. and had associated weight loss. She was also investigated for possible tuberculosis and occult malignancy. CT scan abdomen/pelvis and MRI revealed peri-articular muscle inflammation. Biopsy of her hip joint failed to find the causative factor. Wholebody 18F-FDG PET/CT scan revealed increased FDG uptake at bilateral hip and shoulder joints. She recovered after an intensive course of antibiotics. Thus, she was diagnosed with reactive arthritis. Reactive arthritis is usually a diagnosis of exclusion made by a high index of suspicion and positive serology test. Molecular imaging can be an alternative investigation for joint pains in the elderly, which enables excellent anatomical and functional information to exclude more sinister conditions such as malignancy.

Pain measurement in the elderly: evaluation of psychometric properties of the Geriatric Pain Measure – Portuguese version / Mensuração da dor em idosos: avaliação das propriedades psicométricas da versão em português do Geriatric Pain Measure

ABSTRACT BACKGROUND AND OBJECTIVES: The "Geriatric Pain Measure" was developed for multidimensional pain evaluation in the elderly, being easy to apply and understand. It has already been translated and transculturally adapted to Brazil (Geriatric Pain Measure-P). This study aimed at evaluating its psychometric properties, checking whether they are adequate. METHODS: Participated in the study 70 community elderly, aged 60 years or above, of both genders, with chronic pain (three months or longer), with intensity equal to or higher than 30 mm according to the pain visual analog scale. Socio-demographic characteristics, pain duration and intensity were evaluated. For reliability and validity, two interviewers have applied the Geriatric Pain Measure and, in up to 14 days, a single interviewer has reapplied it. For validity, the Geriatric Pain Measure-P "Total Adjusted Score" and its questions related to pain intensity (Q 19 and 20) were correlated to the visual analog scale and, in a subsample, the Geriatric Pain Measure-P "Total Adjusted Score" was correlated to daily life functionality. RESULTS: Sample was made up especially of long-lived elderly females, widows, with low education and moderate to severe pain. Internal consistency was adequate (Cronbach’s alpha= 0.729) and reproducibility was satisfactory (low variability without statistically significant differences). The Geriatric Pain Measure-P "Total Adjusted Score" and the visual analog scale had low correlation but it was regular for Q19 and Q20 of the Geriatric Pain Measure-P and for the visual analog scale (19 r=45.5%, 20 r=51.9%; p<0.05). CONCLUSION: The Geriatric Pain Measure-P had its psychometric properties analyzed and adequate reliability and validity were found. It was easy to apply and understand, demanding a short period of time. .

RESUMO JUSTIFICATIVA E OBJETIVOS: O "Geriatric Pain Measure" foi desenvolvido para avaliação multidimensional da dor em idosos, sendo de fácil aplicabilidade e compreensão. Já foi traduzido e adaptado transculturalmente para o Brasil (Geriatric Pain Measure- P). O objetivo deste estudo foi estudar suas propriedades psicométricas, verificando se são adequadas. MÉTODOS: Foram avaliados 70 idosos da comunidade, com 60 anos ou mais, de ambos os gêneros, com dor crônica (três meses ou mais), de intensidade maior ou igual a 30mm segundo a escala analógica visual de dor. Foram apuradas as características sócio-demográficas, intensidade e duração da dor. Para as propriedades confiabilidade e validade, dois entrevistadores aplicaram o Geriatric Pain Measure e, em até 14 dias, apenas um entrevistador o reaplicou. Para a validade, o Geriatric Pain Measure-P "Escore Total Ajustado" e suas questões relacionadas à intensidade dolorosa (Q19 e 20) foram correlacionadas com escala analógica visual, e ainda, numa subamostra, o Geriatric Pain Measure-P "Escore Total Ajustado" foi correlacionado com funcionalidade na vida diária. RESULTADOS: amostra foi composta principalmente por idosas longevas, viúvas, de baixa escolaridade e com dor de intensidade moderada a intensa. A consistência interna foi adequada (alfa de Cronbach=0,729) e a reprodutibilidade satisfatória (variabilidade baixa e sem diferenças estatisticamente significativas). O Geriatric Pain Measure-P "Escore Total Ajustado" e a escala analógica visual apresentaram baixa correlação, mas a mesma foi regular para Q19 e Q20 do Geriatric Pain Measure-P e para a escala analógica visual (19 r=45,5%, 20 r=51,9%; p<0,05). CONCLUSÃO: O Geriatric Pain Measure-P teve propriedades psicométricas analisadas, sendo apuradas confiabilidade e validade adequadas. Foi de fácil aplicabilidade e compreensão, demandando curto período de tempo. .

Geriatric pain management, pharmacological and nonpharmacological considerations

Persistent pain is prevalent in the elderly population, although it is not an inevitable part of aging. It is important to understand how to manage pain effectively in old age, particularly because an increasing number of individuals are becoming older, or living longer. Several problems, less common in younger adults, may complicate the treatment of pain. An accurate pain assessment is required for the most efficient strategy of pain treatment. Challenges to an effective pain assessment include: pain underreporting by patients, atypical manifestations of pain in elderly, age-associated pharmacodynamic and pharmacokinetic changes to specific drugs, other general age-related changes, and misconceptions about tolerance or addiction to opioids. However, physicians are able to provide geriatric patients with appropriate analgesia by using comprehensive assessment involving a multidisciplinary approach, and the appropriate use of various treatment modalities.

The Relationship between Pain and Stress in Senior Citizens Residing in a Certain District

BACKGROUND: In spite of its high prevalence and social impact, pain in the elderly has not been managed appropriately. Understanding the multidimensional aspect of pain is crucial in its effective management. Patients with chronic pain are known to be more profoundly affected by psychological and social factors. We, therefore, classified chronic pain patients and especially focused on the relationship between pain and stress. METHODS: The subjects were 149 persons older than 60 years attending a certain geriatric college. A survey was peformed employing the Korean version of Geriatric Pain Measure (GPM-K), the Korean Version of Brief Pain Inventory (BPI-K), the Elderly Life Stress Inventory (ELSI), the Perceived Stress Scale (PSS), the Geriatric Depression Scale Short Form-Korea Version (GDSSF-K), and the Revised Chalder's Fatigue Scale (Fatigue). RESULTS: A total of 103 people, who completed both the questionnaires on pain and stress were enrolled. There was a significant correlation between GPM-K and ELSI (ELSI: r=.38, P<0.01). In chronic pain patients, not only ELSI, but also PSS was correlated with GPM-K (ELSI: r=.37, P<0.01, PSS: r=.25, P=0.04). CONCLUSION: There was a significant correlation between GPM-K and ELSI in the elderly. In chronic pain patients, it was more closely associated with GPM-K. We, therefore, believe that stress management can be useful in the management of pain, especially in the management of chronic pain patients.