Effects of exercise in patients with connective tissue disease receiving high-dose glucocorticoids: A pilot prospective cohort study.

PURPOSE: High doses of glucocorticoids induce skeletal muscle weakness. The aim of this study was to evaluate the effects of exercise therapy on skeletal muscle strength, mass, and exercise capacity in patients with connective tissue disease treated with high doses of glucocorticoids. METHODS: This prospective, observational, single-center, cohort study included 35 patients aged ≥ 15 years diagnosed with connective tissue disease who received high-dose glucocorticoids and physical training. Exercise therapy, including moderate aerobic and strength training, was performed five times a week. Knee extension strength, skeletal muscle mass, anaerobic threshold, and peak oxygen consumption were measured at the beginning of exercise therapy and at discharge. RESULTS: After 6 weeks of aerobic and strength exercises, skeletal muscle mass significantly decreased by 5.5%, right knee extension decreased by 11.6%, and left knee extension decreased by 9.7%. The anaerobic threshold and peak oxygen consumption significantly increased by 13.0% and 9.0%, respectively. The increase in glucocorticoid dose was inversely correlated with changes in knee extension strength. CONCLUSION: In patients with connective tissue disease being treated with high-dose glucocorticoids, exercise therapy might attenuate the decrease in skeletal muscle mass and strength and increase the anaerobic threshold and peak oxygen consumption, thus moderating the side effects of high-dose glucocorticoid treatment. Trial registration The trial is registered with UMIN (University Hospital Medical Information Network), ID number UMIN000038836.

Practical management strategies for benign hypermobility syndromes.

PURPOSE OF REVIEW: Patients with symptomatic hypermobility syndrome such as hypermobile Ehlers-Danlos syndromes (hEDS) and hypermobility spectrum disorders (HSD) commonly present to rheumatologists with joint pain and functional disability. Providers often have difficulty with diagnosis due to a lack of knowledge on the range of associated manifestations and the available therapeutic modalities. This review will discuss recent updates on diagnostic measures and treatment options for rheumatologists to help patients navigate hEDS/HSD. RECENT FINDINGS: This article describes newer diagnostic measures and assessment of hEDS/HSD manifestations. Evidence supporting physical therapy and occupational therapy is provided, as well as recent updates on assistive devices, compressive garments, orthoses, and surgical interventions. Given patient heterogeneity specific guidance about the amount and type of therapies required to produce a beneficial effect is lacking. Treatment should be individualized, and many of the studies focus on regional joint complaints rather than a whole-body approach. SUMMARY: Physical therapy and occupational therapy remain the cornerstone of treatment.

Assessment of rehabilitation potential in patients with vascular dysfunction caused by undifferentiated connective tissue dysplasia.

INTRODUCTION: Degradation of collagen, inherent to undifferentiated connective tissue dysplasia (UCTD) syndrome, also influences the changes in the structure of vascular walls. This contributes to the development of configured vascular anomalies, which are an independent predictor of vascular accident risk. Such diversity of UCTD manifestations requires development of prognostic criteria for rehabilitation potential, correction of which may contribute to recovery process in case of development of vascular catastrophe. Study aim is to evaluate the rehabilitation potential in patients with vascular dysfunction and underlying UCTD. MATERIALS AND METHODS: The study involved 150 male patients with confirmed diagnosis of UCTD (average age - 26.4 ± 0.6 years). All patients had a complex clinical and instrumental examination. Phenotypic and UCTD visceral stigmas, UCTD biochemical markers were analyzed, followed by statistical processing of the results by method of variotional statistics. RESULTS: We revealed the high degree of direct correlation between the presence of vascular dysfunction and myxomatous degeneration of the mitral valve (r = + 0.76, p.

GENERAL HEALTH STATUS AMONG FIREFIGHTERS AND RESCUE OPERATIONS WORKERS.

Research objective - to study the state of health of staff of service of fire extinguishing and accident rescue services department for definition of the priority directions of rendering the treatment-and-prophylactic help and rehabilitation of employees. By means of an information and analytical method the retrospective analysis of reports about the registered diseases, their result and the reasons of temporary disability of staff of service of fire extinguishing and accident rescue services department of Department on emergency situations of Almaty in 2011-2016 has been carried out. Statistical processing of the received results of research is carried out by means of Student's t-criterion. The conducted research showed that the high level of primary incidence is characteristic of the staff of service of fire extinguishing and accident rescue services department, at the same time the most significant are diseases of respiratory organs, traumas, poisoning and some other consequences of influence of the external reasons, diseases of bone and muscular system and connecting tissue, blood circulatory system illness. Studying of the state of health of staff of service of fire extinguishing and rescue services allowed to establish the priority directions of rendering the treatment-and-prophylactic help and rehabilitation. Their contents are defined by need of concentration of efforts on prevention, treatment and rehabilitation of the most widespread diseases causing the maximum damage to health.

Quality of life in Mexican patients with primary neurological or musculoskeletal disabilities.

BACKGROUND: As the population with a disability increases both in number and life expectancy, so does its demand for health services. Very little original research has been done in Mexican populations regarding the effect of disability on quality of life. OBJECTIVES: 1) Assessing the subjective quality of life of patients with neuromusculoskeletal and movement-related function disabilities and, 2) Analyzing the possible effect of the medical condition (diseases of the nervous system vs. diseases of the musculoskeletal system and connective tissue) and its interaction with sex and age. METHODS: In a cross-sectional design 330 participants were recruited from a public institution in Mexico providing specialized outpatient rehabilitation. After signing informed consent they responded a brief sociodemographic questionnaire and the WHOQOL-BREF scale. RESULTS: In general quality of life levels were satisfactory. Female and elderly patients with diseases of the nervous system were particularly affected in the physical and psychological dimensions. Women with diseases of the nervous system also showed a negatively affected social quality of life. Elderly with diseases of the musculoskeletal system and connective tissue scored the lowest in general health perception. CONCLUSIONS: Even though most patients were quite satisfied with their quality of life, not all aspects or cases have such positive perceptions; both the physical and psychological dimensions were particularly negative in female and elderly patients with nervous system diseases. Clinicians would do well to thoughtfully assess patients in these groups and adjust treatment to achieve the greatest possible rehabilitation.

Maxillofacial prosthetic rehabilitation for esophageal and laryngeal laxity due to the hypermobility syndrome: A clinical report.

Laryngeal and esophageal laxity resulting from a connective tissue disease can lead to severe pain and functional impairment. This clinical report describes a patient with such significant neck pain that it prevented her from speaking; it also caused pain with deglutition. Maxillofacial prosthetic rehabilitation with an external laryngeal and esophageal support significantly reduced the patient's pain and restored normal speaking and deglutition functions. This clinical report describes the design and fabrication of a support to stabilize the patient's laryngeal and esophageal structures to her midline.

[Oral rehabilitation with metalloceramic restorations in patients with non-differentiated systemic connective tissue dysplasia].

False formation of connective tissues have a great influence on structure and function of organs and tissues of the human body. In prosthodontics, the changes in connective tissues greatly occur during clinical stages of preparing metal ceramic dentures. The algorithm of treatment patients with connective tissue dysplasia during metal ceramic dentures was developed and introduced into practical dentistry based on studying the morphology and functionality of dentition and clinical experience.

Physiological demands of therapeutic horseback riding in children with moderate to severe motor impairments: an exploratory study.

PURPOSE: To examine energy expenditure at rest and during a single therapeutic horseback riding (THR) session in children with moderate to severe motor impairments. METHODS: Heart rate (HR), oxygen uptake (.VO2), and minute ventilation (.VE) were measured continuously during a 10-minute rest period and during a typical THR session. RESULTS: Seven children (4 males, mean age 12.3 ± 3.5 years) completed the protocol. Significant increases from rest were seen for mean HR, .VO2, .VE, and energy expenditure. Based on .VO2, 43.3 ± 24.3% of the THR session consisted of sedentary, 44.4 ± 13.4% of light, and 12.3 ± 21.8% of moderate to vigorous activity intensity, with large interindividual differences. CONCLUSIONS: The physiological demands of THR in children with moderate to severe motor impairments are moderate. However, considering the short duration of maintaining moderate to vigorous exercise activity during THR in combination with the low training frequency, group data indicate that it is unlikely that THR will improve cardiopulmonary fitness in these children.

Exercise training in pulmonary arterial hypertension associated with connective tissue diseases.

INTRODUCTION: The objective of this prospective study was to assess short- and long-term efficacy of exercise training (ET) as add-on to medical therapy in patients with connective tissue disease-associated pulmonary arterial hypertension (CTD-APAH). METHODS: Patients with invasively confirmed CTD-APAH received ET in-hospital for 3 weeks and continued at home for 12 weeks. Efficacy parameters have been evaluated at baseline and after 15 weeks by blinded-observers. Survival rate has been evaluated in a follow-up period of 2.9 ± 1.9 years. RESULTS: Twenty-one consecutive patients were included and assessed at baseline, and after 3 weeks, 14 after 15 weeks. Patients significantly improved the mean distance walked in 6 minutes compared to baseline by 67 ± 52 meters after 3 weeks (p < 0.001) and by 71 ± 35 meters after 15 weeks (p = 0.003), scores of quality of life (p < 0.05), heart rate at rest, peak oxygen consumption, oxygen saturation and maximal workload. Systolic pulmonary artery pressure and diastolic systemic blood pressure improved significantly after 3 weeks of ET. The 1- and 2-year overall-survival rates were 100%, the 3-year survival 73%. In one patient lung transplantation was performed 6 months after ET. CONCLUSION: ET as add-on to medical therapy is highly effective in patients with CTD-APAH to improve work capacity, quality of life and further prognostic relevant parameters and possibly improves the 1-, 2- and 3-year survival rate. Further randomized controlled studies are needed to confirm these results. TRIAL REGISTRATION: ClinicalTrials.gov: NCT00491309.

Disminución de la presión arterial en pacientes con arteriopatía periférica mediante el masaje reflejo del tejido conjuntivo / Decrease in blood pressure in patients with peripheral arterial disease by connective tissue reflex massage

Objetivos: Evaluar la eficacia del masaje reflejo del tejido conjuntivo en la presión arterial sistólica y diastólica en pacientes con enfermedad arterial periférica. Metodología: Participaron en el estudio 26 pacientes con enfermedad arterial periférica del Distrito Sanitario de Granada durante un período de intervención de 15 semanas. La muestra de estudio se dividió de forma aleatoria en grupo experimental y grupo control. Los criterios de exclusión fueron los siguientes: insuficiencia arterial periférica en estadios más avanzados, insuficiencia venosa periférica, insuficiencia cardíaca, renal o hepática. La variable independiente considerada ha sido la aplicación del masaje reflejo del tejido conjuntivo según el método de Elizabeth Dicke. Asimismo, la variable dependiente estudiada ha sido la evaluación de la presión arterial sistólica y diastólica en ambas extremidades superiores. Resultados: Se observan diferencias significativas entre la valoración basal y las valoraciones posbasales, entre los dos grupos de estudio, en la presión arterial diastólica derecha (basal, p<0,043; primera valoración, p<0,041; segunda valoración, p<0,047) y la presión arterial sistólica izquierda (basal, p<0,042; primera valoración, p<0,04; segunda valoración, p<0,049). Conclusiones: El masaje reflejo del tejido conjuntivo genera un descenso de la presión arterial en pacientes con enfermedad arterial periférica en estadio I(AU)

Aims: Evaluate the effectiveness of connective tissue reflex massage on systolic and diastolic blood pressure in patients with peripheral arterial disease. Methodology: Twenty-six patients with peripheral arterial disease from the Health District of Granada participated in the study during a 15-week intervention period. The study sample was randomly divided into an experimental group and a control group. Exclusion criteria were peripheral arterial insufficiency at more advanced stages, peripheral venous insufficiency, cardiac, renal or hepatic insufficiency. Application of the connective tissue reflex massage according to the method of Elizabeth Dicke was regarded as the independent variable. The dependent variable was evaluation of systolic and diastolic blood pressure in both upper limbs. Outcomes: Significant differences could be observed between the baseline and post-baseline evaluations between the two study groups in the right diastolic blood pressure (baseline, p<0.043; 1st evaluation, p<0.041; 2nd evaluation, p<0.047), and left systolic blood pressure (basal, p<0.042; 1st evaluation, p<0.04; 2nd evaluation, p<0.049). Conclusions: Connective tissue reflex massage causes a blood pressure decrease in patients with stage I peripheral arterial disease(AU)

[Influence of medical rehabilitation under conditions of sanatorium on life quality indices in adolescents with connective tissue dysplasia].

Maximal phenotypic manifestation of connective tissue dysplasia (CTD) is noticed in adolescence. But there are no clear conceptions about efficiency of rehabilitation programs for these patients. Indices of life quality (LQ) of adolescents with CTD, adolescents with CTD and concomitant pathology before and after medical rehabilitation are analyzed in the work. Indices of LQ in healthy children and adolescents with CTD are compared. Life quality is described both by its separated indices and by integral index. Assessment of influence of concomitant pathology in CTD patients on performed treatment is given. It shown that use of complex of physical factors can be considered as high effective method of treatment of young patients with various clinical variants of CTD.

[Rehabilitation of children with the connective tissue dysplasia in sport clubs and fitness complexes].

40 children aged from 12 to 17 years have been observed. All the children have been divided into three groups. The first group consisted of children with mild severity of joint hypermobility. The second group, 12 children -with mild severity of joint hypermobility. The third group consisted of 10 healthy children, it was a control group. The article in describes in details complexes of exercises used in a complex treatment of children with joint hypermobility. The efficiency of these complexes was established. They strengthen locomotor apparatus and prevent the progression of joint hypermobility.

Tratamiento fisioterapéutico sistemático del tejido conjuntivo en el aparato musculoesquelético / Systematic physiotherapeutic treatment of the conjunctive tissue in the muscular-skeletal system

Un gran número de consultas al fisioterapeuta son debidas a lesiones en estructuras formadas principalmente por tejido conjuntivo. Ello ha motivado que los autores holandeses Van den Berg y Van Wingerden hayan dedicado sus investigaciones hacia este tipo de estructura tisular, intentando influenciarlo desde el punto de vista fisioterapéutico. Algunas de las conclusiones de estos autores al respecto han provocado un cambio paradigmático en el procedimiento fisioterapéutico. La fisioterapia de las lesiones de estructuras caracterizadas por este tipo de tejido se orientan alrededor del desarrollo cronológico del proceso de curación tisular conjuntiva. El dolor, el edema o la movilidad articular disminuida no son ya el objetivo primordial de la terapia, sino que son interpretadas dentro de un contexto natural: el de la curación o reparación tisular. Dentro de este contexto de proceso reparador preestablecido genéticamente, la misión del fisioterapeuta no es la de intentar acelerarlo, algo que parece bastante improbable para estos autores, sino el de dirigir las actuaciones terapéuticas que no lleguen a perjudicarlo. El paciente está necesariamente involucrado en el proceso terapéutico, que no termina en la clínica, sino que se extiende a todos sus actos de la vida diaria. Aun sin disponer de estudios clínicos de calidad sobre la efectividad de este proceder terapéutico, es interesante divulgar alguna de las conclusiones de estos autores, ya que por el momento no se dispone de trabajos traducidos al español que hagan mención a lo publicado por estos dos autores

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[The problems of rehabilitation of patients with musculoskeletal and connective tissue diseases]. / Serganciuju jungiamojo audinio ir skeleto raumenu sistemos ligomis reabilitacija.

According to the data of the State Committee for Social-Medical Examination we analyzed general disability during 5-year period (1997-2001). Primary disability due to musculoskeletal and connective tissue diseases in Lithuania is in the second disease place in structure of disability. This article describes the possibilities of rehabilitation of patiens with musculoskeletal and connective tissue diseases.

Rehabilitation of orthopedic and rheumatologic disorders. 2. Connective tissue diseases.

This self-directed learning module highlights assessment and therapeutic options in the rehabilitation of patients with connective tissue diseases. It is part of the chapter on rehabilitation of orthopedic and rheumatologic disorders in the Self-Directed Physiatric Education Program for practitioners and trainees in physical medicine and rehabilitation. New advances covered in this article include the management of patients who have polymyalgia rheumatica, juvenile rheumatoid arthritis, ankylosing spondylitis, rheumatoid cervical spine, and rheumatoid hand.

Rehabilitation in joint and connective tissue diseases. 1. Systemic diseases.

This self-directed learning module highlights new advances in this topic area. It is part of the chapter on rehabilitation in joint and connective tissue diseases in the Self-Directed Physiatric Education Program for practitioners and trainees in physical medicine and rehabilitation. This article discusses treatment and outcome in rheumatoid arthritis, musculoskeletal involvement in human immunodeficiency virus infection, scleroderma, systemic lupus erythematosus, and intraarticular injection of corticosteroids.

I can wear gloves again!

Diseases and surgical procedures that affect the MMS/CT can be acute or chronic conditions. The volume of patients who are referred with these conditions will continue at the present high level or increase as reimbursement for long-term care becomes a reality. Home healthcare nurses are prepared to provide, coordinate, and manage the acute and long-term home care needs of these patients and their families.

[Quality of life and functional indices in osteoarthritis]. / Les indices de qualité de vie et les indices fonctionnels dans l'arthrose.

The main Indices of Quality of Life used in rheumatology and their aims and applications are surveyed. Their use in osteoarthritis implies a few issues that are addressed in a critical manner. Indices of Quality of Life are useful to measure deficiency resulting from osteoarthritis by comparison with other rheumatic diseases, as rheumatoid arthritis, connective tissue diseases, fibromyalgia... They are sensitive enough for apraising the domains improved by a radical treatment such as joint replacement. However, their scores are only slightly changing in most of the drug trials, in which the more simple functional indices seem demonstrative enough. Last but no least, they are notably time consuming for both the patient and the physician.