Outcome of an education and home-based exercise programme for patients with ankylosing spondylitis: a nationwide randomized study.

OBJECTIVES: This study aims to assess the impact of a structured education and home exercise programme in daily practice patients with ankylosing spondylitis. METHODS: A total of 756 patients with ankylosing spondylitis (72% males, mean age 45 years) participated in a 6-month prospective multicentre controlled study, 381 of whom were randomised to an education intervention (a 2-hour informative session about the disease and the implementation of a non-supervised physical activity programme at home) and 375 to standard care (controls). Main outcome measures included Bath Ankylosing Spondylitis Disease Activity and Functional Index (BASDAI, BASFI). Secondary outcome measures were 0-10 cm visual analog scale (VAS) for total pain, nocturnal pain and global disease activity and quality of life (ASQoL), knowledge of disease (self-evaluation ordinal scale) and daily exercise (diary card). RESULTS: At 6 months, the adjusted mean difference between control and educational groups for BASDAI was 0.32, 95% confidence interval (CI) 0.10-0.54, p=0.005, and for BASFI 0.31, 95%CI 0.12-0.51, p=0.002. Significant differences were found also in VAS for total pain, patient´s global assessment and in ASQoL. Patients in the education group increased their knowledge about the disease and its treatments significantly (p<0.001) and practised more regular exercise than controls (p<0.001). CONCLUSIONS: A structured education and home exercise programme for patients with ankylosing spondylitis in daily practice was feasible and helped to increase knowledge and exercise. Although statistically significant, the magnitudes of the clinical benefits in terms of disease activity and physical function were poor.

Herpes zoster motor neuropathy in a patient with previous motor paresis secondary to Vogt-Koyanagi-Harada disease.

Motor involvement in herpes zoster is very infrequent, occurring in 3%-5% of cases, and it is caused by extension of the inflammatory process to the anterior horn motor neurons, with the subsequent development of segmental motor paralysis. The authors report a 37-yr-old woman with history of paresis in both lower limbs secondary to spinal cord atrophy associated with Vogt-Koyanagi-Harada disease and immunosuppression caused by chronic corticosteroid and azathioprine treatment of ulcerative colitis, who developed worsening of her baseline residual muscle strength in the right lower limb shortly after herpes zoster eruption. Electromyography revealed acute denervation in territories corresponding to L3-L4 and moderate widespread axonal polyneuropathy affecting both lower limbs. The patient recovered her baseline muscle strength after this event. To the best of the authors' knowledge, this is the first reported case of herpes zoster motor neuropathy in a patient with a previous motor sequel.

The prognostic value of catastrophizing for predicting the clinical evolution of low back pain patients: a study in routine clinical practice within the Spanish National Health Service.

BACKGROUND CONTEXT: Experimental studies suggest that catastrophizing may worsen the prognosis of low back pain (LBP) and LBP-related disability and increase the risk of chronicity. PURPOSE: To assess the prognostic value of baseline catastrophizing for predicting the clinical evolution of LBP patients in routine clinical practice and the association between the evolution of pain and catastrophizing. STUDY DESIGN/SETTING: Prospective study in routine clinical practice of the Spanish National Health Service. PATIENT SAMPLE: One thousand four hundred twenty-two acute and chronic adult LBP patients treated in primary and hospital care. OUTCOME MEASURES: Pain, disability, and catastrophizing measured through validated instruments. METHODS: Patients were managed according to routine clinical practice. Outcome measures were assessed at baseline and 3 months later. Logistic regression models were developed to estimate the association between baseline catastrophizing score and the improvement of LBP and disability, adjusting for baseline LBP and leg pain (LP) severity, disability, duration of the pain episode, workers' compensation coverage, radiological findings, failed back surgery, and diagnostic procedures and treatments undertaken throughout the study. Another model was developed to estimate the association between the evolution of LBP and the change in catastrophizing, adjusting for the same possible confounders plus the evolution of LP and disability. Models were repeated excluding the treatments undergone after the baseline assessment. RESULTS: Regression models showed that the degree of baseline catastrophizing does not predict the evolution of LBP and disability. Conversely, as the degree of pain improvement increases, so does the odds ratio for improvement in catastrophizing, ranging from three (95% confidence interval [95% CI], 2.00-4.50; p<.001) for improvements in pain between 1.1 and 4 visual analog scale (VAS) points, to 7.3 (95% CI, 3.49-15.36; p<.001) for improvements in pain more than 6.1 VAS points. Similar results were obtained when treatments were excluded from the models. CONCLUSIONS: In routine practice, assessing the baseline score for catastrophizing does not help clinicians to predict the evolution of LBP and disability at 3 months.

Diagnóstico y tratamiento del dolor neuropático / Diagnosis and treatment of the neuropathic pain

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Tesis doctorales sobre reumatología presentadas en España entre 1976 y 1997. Estudio bibliométrico / Doctoral thesis on rheumatology presented in Spain from 1976 to 1997. A bibliometric study

Objetivos: Conocer el número de tesis doctorales sobre reumatología, los temas y enfoques del estudio. Material y método: La base de datos electrónica TESEO accesible en http://www.mec.es/teseo recoge los resúmenes desde 1976 de las tesis doctorales aprobadas en la Universidad española. Hemos utilizado para la búsqueda los términos truncados, de gran uso en la bibliografía sobre reumatología, artr*, reuma*, osteopat*, miosit*, tend*. Con la presencia de cualquiera de ellos en cada registro y la valoración de su contenido por un autor reumatólogo, obtuvimos 312 tesis doctorales. De éstas se han considerado sus aspectos más importantes, principalmente el tema de estudio y su enfoque. El período de estudio comprende desde 1976 a 1997, ambos inclusive. Resultados y discusión: Las 312 tesis fueron presentadas por 108 mujeres (34,5 por ciento) y 204 varones (65,3 por ciento), perteneciendo 91 personas al listado de los 1.010 socios de la Sociedad Española de Reumatología que residían en España a finales de 1998. La artritis reumatoide fue el tema más estudiado con 64 tesis (20,5 por ciento). Le siguieron las enfermedades reumáticas en un sentido general con 41 tesis (13,1 por ciento) y la osteoporosis con 24 (7,6 por ciento). Por articulaciones, la rodilla con 15 (4,8 por ciento) fue la más estudiada, seguida por la columna con 14 (4,6 por ciento). Los enfoques de estudio más frecuentes fueron el inmunológico con 62 tesis (19,8 por ciento), el terapéutico con 38 (12,1 por ciento) y el anatomopatológico con 37 (12 por ciento). Las universidades que más tesis aprobaron fueron la Complutense de Madrid (13,7 por ciento), la de Barcelona (11,8 por ciento), la de Sevilla (8,6 por ciento) y la de Granada (8,0 por ciento). Desde el curso 1989-1990 se aprecia un incremento progresivo, coincidiendo con el de artículos científicos españoles sobre reumatología en revistas internacionales especializadas. Hemos encontrado muy pocas tesis sobre enfermedades tan prevalentes como fibromialgia, la artrosis o el dolor de espalda, con gran impacto social y posibilidad de dotación de fondos económicos europeos de ayuda a la investigación. (AU)