The Effects of Hyperbaric Oxygen on Rheumatoid Arthritis: A Pilot Study.

BACKGROUND/OBJECTIVE: This case series pilot study assessed the effects of hyperbaric oxygen therapy (HBO2) for treating rheumatoid arthritis (RA). METHODS: Ten RA subjects received 30 HBO2 treatments over 6 to 10 weeks. Serial rheumatologic evaluations (ie, the Disease Activity Scale [DAS28], the Routine Assessment of Patient Index Data 3, and the Pain and Sleep Quality Questionnaire) were completed at baseline, throughout the course of the study, and at the 6-month follow-up. RESULTS: There was a statistically significant effect of HBO2 therapy over time on the DAS28-Global Health (p = 0.01), the DAS28-C-reactive protein (p = 0.002), and the DAS28-erythrocyte sedimentation rate (p = 0.008) measures; these analyses excluded 2 patients who were in clinical remission at baseline. Selected post hoc comparisons showed significantly lower DAS28-Global Health, DAS28-C-reactive protein, and DAS28-erythrocyte sedimentation rate scores at 3 and 6 months relative to baseline. In addition, statistically significant decreases in pain as measured by the Routine Assessment of Patient Index Data 3 and Pain and Sleep Quality Questionnaire were observed at the end of HBO2 relative to baseline. CONCLUSIONS: Hyperbaric oxygen therapy is effective for joint pain in patients with RA based on data from multiple, validated clinical measures. Further research with more subjects and the use of a control group is necessary.

Pain improvement in rheumatoid arthritis with hyperbaric oxygen: report of three cases.

Rheumatoid arthritis (RA) is a chronic, erosive, symmetrical inflammatory disease that can progress to synovial destruction, severe disability and premature mortality. Immunotherapies, while beneficial, can cause significant adverse events. Three patients with RA treated in our facility with hyperbaric oxygen (HBO2) for unrelated diagnoses all reported significant but unanticipated improvement in RA-related pain, increased activity and improved sleeping patterns. Two improved while continuing traditional RA medications; the other patient had all RA meds held due to cancer and postoperative wound healing problems. The significant symptomatic improvement in these three patients led us to hypothesize that HBO2 for patients with RA may result in decreased joint pain, increased activity level, improvement in sleeping patterns and possibly a decreased need for standard rheumatologic medications, effectively reducing or avoiding the effects of immunosuppression. A clinical trial is planned to objectively assess these findings.

Does starting allopurinol prolong acute treated gout? A randomized clinical trial.

BACKGROUND: Traditionally, allopurinol is not initiated during an acute gout attack to avoid prolonging the painful arthritis. The 2012 American College of Rheumatology Guidelines for the Management of Gout suggest that urate-lowering therapy can be started during an acute attack, based on "consensus opinion of experts, case studies, or standard of care." OBJECTIVE: The aim of this study was to determine whether initiating allopurinol will adversely affect the resolution of acute, treated gout. METHODS: We conducted a 28-day, placebo-controlled, double-blind study of allopurinol initiation in patients with acute gout. Patients with crystal-proven gout by arthrocentesis were enrolled if they presented to the rheumatology clinic with an acute gout attack within 72 hours from initial therapy. The patients were also required to meet at least 1 additional criterion for urate-lowering therapy including (1) the presence of gouty tophi, (2) more than 1 acute gout attack per year, (3) a history of nephrolithiasis, or (4) urate overproduction (>1000 mg in 24-hour urine collection). Patients were excluded from the study if they had a glomerular filtration rate of less than 50 or liver function test of greater than 1.25 times the upper limit of normal. The treating physician determined therapy for the acute gout attack. Standard prophylaxis, with colchicine or nonsteroidal anti-inflammatory drugs, was prescribed. Allopurinol or placebo was initiated at 100 mg daily for the first 14 days and then increased to 200 mg daily for the next 14 days. The primary end point was protocol defined days to resolution of acute gout, incorporating patient-rated joint pain and physician examination. Secondary measures included Physician Global Assessment, patient-rated pain, adverse effects of therapy, and serum uric acid. RESULTS: Thirty-one patients (17 on placebo, 14 on allopurinol) completed the study. Both intent-to-treat and completer analyses showed only a statistically insignificant difference in days to resolution (15.4 days in the allopurinol group completers vs 13.4 days in the placebo group; P = 0.5). The secondary measures revealed that the acute phase of pain rapidly improved in both groups. CONCLUSIONS: We initiated allopurinol at low doses during an acute gout attack in patients who met criteria for starting urate-lowering therapy and did not have abnormal kidney or liver function. In this cohort, allopurinol did not prolong the acute, treated attack.

Non-popliteal synovial rupture.

The ruptured popliteal synovial cyst is a common complication of chronic knee arthritis. In contrast, non-popliteal synovial rupture is less well recognized and may present a diagnostic dilemma. We report an 81-year-old woman who presented with chest wall pain and ecchymosis. Ultrasonography of the shoulder region readily diagnosed a dissecting parasynovial cyst. She developed the unusual complication of contralateral recurrence. Literature review revealed a small but important set of non-popliteal synovial ruptures in the regions of the shoulder, elbow, wrist, spine, hip, knee, and ankle. Local swelling, inflammation, ecchymosis, and nerve impingement may mimic other conditions. Awareness of the clinical presentations and a high index of suspicion are required to avoid diagnostic confusion. Management data are limited to case reports of arthrocentesis, injection, and very rarely, surgery.

Common rheumatic diseases of the Middle East.

OBJECTIVE: The objective of this article is to educate military physicians and providers about rare, endemic rheumatic diseases that may be encountered in deployments to the Middle East region, specifically Familial Mediterranean Fever (FMF), Behcet's disease (BD), and tumor necrosis factor-associated periodic syndrome (TRAPS). METHODS: We found review articles using MDConsult and Ovid. RESULTS: Suitable articles were employed to describe the characteristics of each disease. CONCLUSIONS: Although these diseases are considered rare, they can be endemic to current areas of deployment. Awareness of these conditions may prevent unnecessary and invasive treatment as well as make the clinician aware of possible disease complications.