Prevalence of self-reported peripheral joint pain and swelling in an Italian population: the Chiavari study.

OBJECTIVE: To evaluate the prevalence of self-reported joint pain and swelling in the peripheral joints of subjects from an Italian general population. To correlate the result with demographic data and physical activity. METHODS: A total of 4,456 subjects aged 16 years or more listed in four general practices were invited to participate in the study and to fill out the ARC questionnaire. The 3,294 responders were asked to report: (a) any past occurrence of joint swelling lasting more than 4 weeks and the distribution of the swollen joints on a mannequin; (b) any joint pain lasting more than 4 weeks; (c) current joint pain or swelling; (d) morning stiffness; (e) whether they had been previously told by a doctor they had arthritis; and (f) their physical activity according to a three-class scale. RESULTS: Joint pain was reported by 889 (27%) subjects and joint swelling was reported by 463 (14%) subjects. Women reported joint pain and swelling more frequently than men, except for the younger age classes. The prevalence of joint pain and swelling increased with age in both sexes until age 55-64, when a plateau was observed. Age was involved in the determination of joint pain and swelling. Physical activity was involved only marginally. CONCLUSIONS: We found high levels of prevalence of pain and swelling in the peripheral joints in a general Italian population. Prevalence was higher in Italian subjects than in subjects from China and Pakistan studied using the same questionnaire. These differences may reflect cultural and social diversity in the perception of disease, as well as true differences in the prevalence of rheumatic symptoms across the world.

Treatment of Lyme arthritis.

The efficacy of different therapeutic regimens for Lyme arthritis is reviewed. The first treatment for Lyme arthritis, intramuscular benzathine penicillin 2.4 million units weekly for 3 weeks, had a success rate of 35%. Another study employed intravenous penicillin G at a dosage of 20 million units daily for 10 days, which cured 55% of patients. Intravenous ceftriaxone has been shown to be superior to penicillin with a response rate of 94%. However, these results have been challenged in recent reports. Oral doxycycline or amoxicillin in association with probenecid seems to work equally well although neuroborreliosis was more frequent following treatment with amoxicillin. An anecdotal report indicates the usefullness of long-term benzathine penicillin for chronic Lyme arthritis. Long-term antibiotic therapy, which is recommended also for Reiter's syndrome, may be useful for eradicating the sanctuaries of Borrelia burgdorferi. Disease-modifying drugs such as hydroxychloroquine or sulphasalazine, a drug which is commonly used in reactive arthritis following enteric infections, may be of value in Lyme arthritis resistant to antibiotics but have not been tested to date. The role of intraarticular injections of steroids or synovectomy is still controversial. Antibiotic treatment is the cornerstone of Lyme arthritis treatment. Additional interventions should be studied for patients with Lyme arthritis resistant to antibiotics.