Efficacy of therapeutic ultrasound in the treatment of chronic calcific shoulder tendinitis: a randomized trial.

BACKGROUND: Calcific shoulder tendinitis (CST) is characterized by hydroxyapatite crystals deposition in the rotator cuff tendons. Therapeutic exercises have been the mainstay of CST treatment, and evidence for therapeutic ultrasound (T-US) utilization and efficacy is lacking. AIM: This study aimed to determine whether 4500 J T-US combined with therapeutic exercises is superior to therapeutic exercises alone regarding calcification size reduction and symptom improvement in chronic symptomatic CST. DESIGN: This is a double-blind, placebo-controlled study. SETTING: This study was conducted at a University Department for Rheumatic Diseases and Rehabilitation of a University Hospital. POPULATION: Patients with chronic CST were analyzed. METHODS: After eligibility allocation, 46 patients with sonographically confirmed CST were divided into two groups (56 shoulders, 26 per group). Both groups performed the same therapeutic exercises for half an hour under physiotherapist supervision. In the treatment group T-US (4500 J, 10 minutes per session at a frequency of 1 MHz and an intensity of 1.5 W/cm2), and in the placebo group, sham T-US was applied for 4 weeks. Patients were assessed for: calcification size, shoulder pain, global health (GH), shoulder mobility (ROM), handgrip strength, Health Assessment Questionnaire Disability Index (HAQ-DI), Shoulder Pain and Disability Index (SPADI), and overall rehabilitation satisfaction. RESULTS: All assessed variables improved in both groups. A significantly greater reduction in calcification size was recorded in the treatment group compared to placebo: -10.92% (IQR 4.61% to 19.38%) versus -5.04% (2.30% to 7.22%), P=0.008. There was a significantly greater decrease in HAQ-DI, reduction of VAS GH, and an increase in hand grip strength in the treatment group, while no significant differences were observed for other parameters between the groups. CONCLUSIONS: Our results showed that adding the 4500 J T-US to therapeutic exercises in chronic symptomatic CST therapy resulted in greater calcification size reduction immediately following the treatment, as well as hand grip strength, HAQ-DI, and VAS GH improvement. CLINICAL REHABILITATION IMPACT: 4500 J T-US combined with therapeutic exercises is more effective in reducing calcification size than therapeutic exercises alone in the treatment of chronic symptomatic CST.

The Impact of Disease Activity on Quality of Life, Fatigue, Functional Status and Physical Activity in Patients with Ankylosing Spondylitis.

BACKGROUND: Inflammatory back pain and stiffness are the leading symptoms of ankylosing spondylitis (AS). AS progression leads to substantial functional impairment and can reduce quality of life (QoL). The aim of this study was to determine the impact of disease activity on QoL, fatigue, functional status and physical activity. SUBJECTS AND METHODS: One hundred and fifty AS patients were included in the study, their body mass index (BMI) was calculated and they completed questionnaires regarding disease activity (The Bath Ankylosing Spondylitis Disease Activity Index, BASDAI) functional status (The Bath Ankylosing Spondylitis Functional Index, BASFI) spinal mobility (The Bath Ankylosing Spondylitis Metrology Index, BASMI), physical activity (the International Physical Activity Questionnaire, IPAQ), functional disability (The Health Assessment Questionnaire Disability Index, HAQ-DI), fatigue (The Functional Assessment of Chronic Illness Therapy - fatigue, FACIT-F) and QoL (The Short Form Survey-36, SF-36). RESULTS: Patients with inactive disease (BASDAI<4) had significantly better HAQ scores (p=0.001), SF-36 mental component scores - MCS (65.68±19.54 inactive vs. 46.89±21.78 active disease, p=0.001), SF-36 physical component scores - PCS (median score 56.25 inactive vs. 30.00 active disease, p=0.001) and FACIT-F scores (38.49±10.62 inactive vs. 26.21±10.81 active disease, p=0.001). There was no significant difference in patient's physical activity or BMI regarding disease activity (p=0.564 and p=0.162 respectively). Also, there was no significant difference in BASDAI, BASMI or BASFI scores regarding different BMI categories (p=0.818, p=0.474, p=0.436, respectively). CONCLUSION: AS activity increased fatigue, impaired functional ability and QoL, especially the physical component. Although more than half (61.4%) of our patients were categorized as pre-obese or obese according to BMI, this was not related to disease activity, spinal mobility or daily functioning scores. Reported physical activity level had no effect on disease activity. Disease activity influences the course of AS and QoL assessment should be implemented into regular AS evaluation in order to improve treatment outcome.

Influence of Non-pharmacological Treatment on Pain, Morning Stiffness, Fatigue, and Physical Function in Patients with Psoriatic Arthritis.

Naphthalanotherapy (NT) is a therapeutic procedure that uses mineral oil obtained from petroleum. The aim of this study was to investigate the influence of the duration of NT combined with an individually adjusted rehabilitation program (IARP) on pain, morning stiffness (MS), fatigue, and physical function in patients with psoriatic arthritis (PsA). A total of 29 consecutive patients with PsA were divided into two groups. Group 1 (n=17) participated in a two-week and Group 2 (n=12) in a three-week intervention program. Pain (using the Visual Analogue Scale - VAS), fatigue (VAS and Functional Assessment of Chronic Illness Therapy-Fatigue - FACIT-F), duration of MS (minutes), and physical function (Health Assessment Questionnaire - HAQ) were assessed before and after therapy. Statistical analysis was performed using SPSS version 20, with P<0.05. There was a significant improvement in VAS-pain, VAS-fatigue, MS, HAQ, and FACIT-F before vs after therapy: Group 1:5.88±1.62 vs 3.94±1.25, P=0.001; 6.59±1.73 vs 4.35±1.73, P=0.001; 35.47±31.64 vs 23.71±29.30, P=0.001; 1.43±0.78 vs 1.23±0.74, P=0.001; 25.88±10.89 vs 30.71±10.65, P=0.009; Group 2: 6.17±1.27 vs 3.92±1.44, P=0.001; 6.50±1.93 vs 3.75±1.71, P=0.001; 38.42±32.00 vs 21.25±17.31, P=0.006; 1.47±0.79 vs 0.93±0.54, P=0.008; 25.00±9.87 vs 36.83±7.20, P=0.001, respectively. Regarding the length of the therapy, significant difference was reached only in FACIT-F (P=0.009). Two-week and three-week NT combined with IARP are equally efficient in reduction of pain and MS, as well as in improving physical function in patients with PsA. The three-week program showed an additional effect on reducing fatigue assessed by the FACIT-F score.

Klippel-Feil syndrome misdiagnosed as spondyloarthropathy: case-based review.

Spondyloarthropathy refers to any joint disease of the vertebral column, but the term is mainly used for a specific group of disorders called seronegative spondyloarthropathies (SpAs). The axial skeletal involvement, peripheral and extra-articular manifestations and an association with the major histocompatibility complex class I human leukocyte antigen-B27 (HLA B27) are commonly shared features of SpAs. Klippel-Feil syndrome (KFS) is a rare congenital disorder characterized by the fusion of one or more cervical vertebrae, accompanied by various skeletal and extra-skeletal anomalies. We report a case of an adult male patient with HLA B27 positivity presenting with chronic cervical spine pain accompanied by morning stiffness and periodic night pain, with radiologically confirmed ankylosis and fusion of several cervical segments. His medical history included urogenital abnormalities operated in childhood and mild mitral prolapse. Initially suspected diagnosis of an early axial form of SpA was rejected after thorough workup. Instead, the nature of vertebral defects along with the past medical history of urogenital and cardiac abnormalities pointed towards the diagnosis of KFS. HLA B27 presence can be a confounder in patients presenting with spinal pain and that is why the differential diagnosis of CSD-s and SpA can be challenging in some patients.

Correspondence of vitamin D status with functional scores and disease activity among Croatian patients with ankylosing spondylitis: a preliminary study.

BACKGROUND: Ankylosing spondylitis (AS) is a chronic inflammatory rheumatic disease which primarily affects the axial spine and sacroiliac joints. Over the past several years Vitamin D has been recognized as a hormone with significant immunomodulatory effect due to the fact that it inhibits T-cell proliferation and decreases the production of interleukin-2, interferon-γ, and tumor necrosis factor-α. Therefore, vitamin D may play a role in the development and progression of inflammatory diseases. Our aim was to estimate and evaluate the correspondence of vitamin D status with functional scores, spinal mobility and disease activity among patients with AS in Croatia. SUBJECTS AND METHODS: One hundred and fifty (150) AS patients were prospectively enrolled and assessed for disease activity, spinal mobility and functional disability. Blood samples were obtained from all patients and 25(OH)D concentration and inflammatory markers were determined. All patients underwent bone mineral density measurement at the lumbar spine (L1-L4) and proximal femur (total hip and femoral neck) with dual-energy x-ray absorptiometry. RESULTS: The prevalence of 25(OH)D inadequacy considering cut-offs of 75, 50 and 30 nmol/L was 80, 46.7 and 16.7% respectively. The mean 25(OH)D serum concentration was 52.63±23.45 nmol/L. There was no significant difference in mean 25(OH)D concentration regarding patient's age, sex, smoking status, season change, disease activity, spinal mobility or functional scores. However, there was a trend towards lower 25(OH)D concentration in patients with higher disease activity, worse spinal mobility and worse functional scores. CONCLUSION: Our results showed that there is no significant association between serum 25(OH)D concentration and activity of AS. Given that significant proportion of our patients had inadequate vitamin D status, the role of vitamin D in pathophysiology of AS still remains to be elucidated.