RESUMEN
Chikungunya can result in debilitating arthralgia, often presenting as acute, self-limited pain, but occasionally manifesting chronically. Little is known about differences in chikungunya-associated arthralgia comparing children to adults over time. To characterize long-term chikungunya-associated arthralgia, we recruited 770 patients (105 0-4 years old [y/o], 200 5-9 y/o, 307 10-15 y/o, and 158 16+ y/o) with symptomatic chikungunya virus infections in Managua, Nicaragua, during two consecutive chikungunya epidemics (2014-2015). Participants were assessed at ~15 days and 1, 3, 6, 12, and 18 months post-fever onset. Following clinical guidelines, we defined participants by their last reported instance of arthralgia as acute (≤10 days post-fever onset), interim (>10 and <90 days), or chronic (≥90 days) cases. We observed a high prevalence of arthralgia (80-95%) across all ages over the study period. Overall, the odds of acute arthralgia increased in an age-dependent manner, with the lowest odds of arthralgia in the 0-4 y/o group (odds ratio [OR]: 0.27, 95% confidence interval [CI]: 0.14-0.51) and the highest odds of arthralgia in the 16+ y/o participants (OR: 4.91, 95% CI: 1.42-30.95) relative to 10-15 y/o participants. Females had higher odds of acute arthralgia than males (OR: 1.63, 95% CI: 1.01-2.65) across all ages. We found that 23-36% of pediatric and 53% of adult participants reported an instance of post-acute arthralgia. Children exhibited the highest prevalence of post-acute polyarthralgia in their legs, followed by the hands and torso - a pattern not seen among adult participants. Further, we observed pediatric chikungunya presenting in two distinct phases: the acute phase and the subsequent interim/chronic phases. Thus, differences in the presentation of arthralgia were observed across age, sex, and disease phase in this longitudinal chikungunya cohort. Our results elucidate the long-term burden of chikungunya-associated arthralgia among pediatric and adult populations.
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Fiebre Chikungunya , Virus Chikungunya , Adulto , Masculino , Femenino , Humanos , Niño , Fiebre Chikungunya/complicaciones , Fiebre Chikungunya/epidemiología , Estudios Prospectivos , Nicaragua/epidemiología , Artralgia/etiología , Artralgia/complicaciones , Fiebre/complicacionesRESUMEN
INTRODUCTION: Four species of the Mansonella genus infect millions of people across sub-Saharan Africa and Central and South America. Most infections are asymptomatic, but mansonellosis can be associated with nonspecific clinical manifestations such as fever, headache, arthralgia, and ocular lesions (M. ozzardi); pruritus, arthralgia, abdominal pain, angioedema, skin rash, and fatigue (M. perstans and perhaps Mansonella sp. 'DEUX'); and pruritic dermatitis and chronic lymphadenitis (M. perstans). AREAS COVERED: We searched the PubMed and SciELO databases for publications on mansonelliasis in English, Spanish, Portuguese, or French that appeared until 1 May 2023. Literature data show that anthelmintics - single-dose ivermectin for M. ozzardi, repeated doses of mebendazole alone or in combination with diethylcarbamazine (DEC) for M. perstans, and DEC alone for M. streptocerca - are effective against microfilariae. Antibiotics that target Wolbachia endosymbionts, such as doxycycline, are likely to kill adult worms of most, if not all, Mansonella species, but the currently recommended 6-week regimen is relatively impractical. New anthelmintics and shorter antibiotic regimens (e.g. with rifampin) have shown promise in experimental filarial infections and may proceed to clinical trials. EXPERT OPINION: We recommend that human infections with Mansonella species be treated, regardless of any apparent clinical manifestations. We argue that mansonellosis, despite being widely considered a benign infection, may represent a direct or indirect cause of significant morbidity that remains poorly characterized at present.
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Antihelmínticos , Mansoneliasis , Adulto , Animales , Humanos , Mansoneliasis/complicaciones , Mansoneliasis/tratamiento farmacológico , Mansonella , Ivermectina/uso terapéutico , Antibacterianos/uso terapéutico , Antihelmínticos/uso terapéutico , Artralgia/complicaciones , Artralgia/tratamiento farmacológicoRESUMEN
BACKGROUND: Persistent rheumatic symptoms and its impact on health-related quality of life (QoL), induced by the Indian Ocean Lineage (IOL) chikungunya virus (CHIKV) genotype have been widely studied. In 2014, a major CHIKV outbreak of the Asian genotype occurred in Curaçao, after which we established a longitudinal cohort in 2015, to follow the long-term CHIKV sequalae. Currently, the long-term clinical manifestations and its impact on QoL induced by the Asian CHIKV genotype, followed prospectively through time, and the association of age and comorbidities with rheumatic symptoms persistence, 60 months (M60) after disease onset is unknown. METHODS: The cohort of 304 laboratory confirmed patients were followed prospectively in time at 3-16 months (M3-16), 30 months (M30), and M60 after disease onset. Demographic and clinical characteristics, and the 36-item short-form survey (SF-36) QoL status were collected through questionnaires. At M60, QoL scores were compared to general population (CHIK-) norms. RESULTS: A total of 169 (56%) patients participated (74.6% female, mean age 56.1 years) at all time points, 107 (63%) were classified as recovered and 62 (37%) as affected. The affected patients reported an increase in the prevalence of arthralgia (P .001) and arthralgia in the lower extremities (P < .001), at M30 compared to M3-16. At M60, in comparison to recovered patients, affected patients reported a higher prevalence of recurrent rheumatic symptoms of moderate to severe pain, irrespective of age and comorbidities, and a higher prevalence of non-rheumatic symptoms (P < .001). Arthralgia in the upper (odds ratio (OR): 4.79; confidence interval (CI): 2.01-11.44; P < .001) and lower (OR: 8.68; CI: 3.47-21.69; P < .001) extremities, and headache (OR: 3.85; CI: 1.40-10.54; P = .009) were associated with being affected. The SF-36 QoL scores of the recovered patients were less impaired over time compared to the QoL scores of the affected patients. At M60, the QoL scores of the recovered patients were comparable to the CHIK- QoL scores. CONCLUSIONS: Rheumatic and non-rheumatic symptoms, and QoL impairment may persist, 60 months following infection with the Asian CHIKV genotype, similar to the IOL genotype disease sequelae. Further research is needed to follow the clinical manifestations and QoL impact of each CHIKV genotype.
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Fiebre Chikungunya , Virus Chikungunya , Humanos , Femenino , Persona de Mediana Edad , Masculino , Fiebre Chikungunya/epidemiología , Fiebre Chikungunya/complicaciones , Calidad de Vida , Curazao , Estudios Prospectivos , Virus Chikungunya/genética , Artralgia/epidemiología , Artralgia/complicaciones , Brotes de EnfermedadesRESUMEN
OBJECTIVES: To determine the role of central obesity (CO) in the onset and severity of joint pain and in predicting cardiovascular disease (CVD) in subjects affected with osteoarthritis (OA). DESIGN: Retrospective analysis on the onset of OA joint pain and CO. Waist circumference (WC), Waist-to-height ratio andwaist-to-hip ratio (WHR) were measured at the interview and defined according to the WHO criteria. Cross-sectional analyses on the association of comorbidities, including CVD, pain severity (number of joints and pain score) and CO. SETTINGS AND PARTICIPANTS: Medical records and interviews of a hospital cohort study of 609 patients with OA. Analyses included analysis of variance, mean differences (MDs), SE and logistic regression. Areas under the receiver operating characteristic curve (AUROC) compared the predictive value of the sex-specific CVD models. OUTCOME MEASURES: Onset of OA joint pain (years) and severity according to body mass index (BMI) and WC categories. Predictive value of WC for CVD by sex. Education level, disability, smoking and alcohol use were used to adjust the analysis. RESULTS: Subjects with OA and CO by WHR started 2 years earlier with pain symptoms and had more joints affected than those without CO (MD=1.96 years, SE=0.95, p=0.04 and MD=0.32, SE=0.15 and p=0.04, respectively). Age and hypertension were associated with CVD in both genders, and NSAIDs use only in males. In addition, respiratory disease, hypercholesterolaemia, stairs difficulty, a wider WC and obesity were significant risk factors in females, improving 12.7% in the prediction of CVD cases, compared with only age and BMI (AUROCC=0.793 and 0.666, respectively, p=0.03 for the difference between AUROCs). CONCLUSION: CO is associated with the onset of joint pain, and all pain analysed variables. CO has a role in CVD in women affected with OA and might help predict CVD cases.
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Enfermedades Cardiovasculares , Osteoartritis , Humanos , Femenino , Masculino , Enfermedades Cardiovasculares/complicaciones , Enfermedades Cardiovasculares/epidemiología , Obesidad Abdominal/complicaciones , Obesidad Abdominal/epidemiología , Estudios Retrospectivos , Estudios de Cohortes , Estudios Transversales , Obesidad/complicaciones , Obesidad/epidemiología , Obesidad/diagnóstico , Factores de Riesgo , Índice de Masa Corporal , Circunferencia de la Cintura , Dolor/complicaciones , Artralgia/complicaciones , Osteoartritis/complicaciones , Osteoartritis/epidemiología , Relación Cintura-CaderaRESUMEN
BACKGROUND: The severity of nail disease, the presence of arthralgia and fatigue are predictors of development of psoriatic arthritis (PsA) in patients with psoriasis (Pso). In children, little is known about the musculoskeletal (MSK) impairment in patients with Pso and its effect on health-related quality of life (HRQoL). OBJECTIVES: To determine the frequencies of pain and MSK inflammation (i.e., arthritis, enthesitis, and sacroiliitis) among children and adolescents with Pso and its relationship to HRQoL and fatigue. METHODS: Pediatric patients with Pso underwent a rheumatologic physical examination to evaluate synovitis, enthesalgia, sacroiliac joint (SIJ) pain and tender points of fibromyalgia. The core set of domains recommended by the GRAPPA - OMERACT to be measured in PsA studies was assessed. Ultrasound (US) was performed in clinical cases of enthesitis, and magnetic resonance imaging (MRI) was performed in cases of SIJ pain. RESULTS: Forty-three participants (10 ± 2.9 years old) were evaluated. Pain on palpation of the entheses was observed in 10 (23.2%) patients and pain on SIJ palpation was observed in 3 (7%). No patient presented with synovitis; one presented with enthesitis on US, but MRI did not confirm sacroiliitis in any case. Patients with MSK pain had greater skin disease severity (PASI 5.4 vs. 2, p < 0.01), worse fatigue, and lower HRQoL scores on all instruments used. The estimated risk of HRQoL impairment was eight times higher in the presence of MSK pain, which was an independent predictive factor. With a NAPSI greater than 30, the probability of pain was greater than 80%. CONCLUSION: MSK pain is frequent among children with Pso, related to the severity of skin and nail disease, and negatively affects HRQoL. The typically used complementary exams might not detect the inflammatory process caused by Pso.
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Enfermedades Musculoesqueléticas/complicaciones , Psoriasis/complicaciones , Calidad de Vida , Adolescente , Artralgia/complicaciones , Artralgia/diagnóstico , Artralgia/epidemiología , Artritis/diagnóstico por imagen , Artritis Psoriásica/etiología , Niño , Preescolar , Estudios Transversales , Entesopatía/diagnóstico por imagen , Fatiga/complicaciones , Femenino , Fibromialgia/diagnóstico , Humanos , Imagen por Resonancia Magnética , Masculino , Enfermedades Musculoesqueléticas/diagnóstico , Enfermedades Musculoesqueléticas/epidemiología , Dolor Musculoesquelético/diagnóstico , Enfermedades de la Uña/complicaciones , Enfermedades de la Uña/diagnóstico , Palpación , Sacroileítis/diagnóstico por imagen , Índice de Severidad de la Enfermedad , UltrasonografíaRESUMEN
Objective: (1) To investigate differences in pain severity and its distribution between patients with and without diabetes mellitus (DM) in a population with advanced osteoarthritis (OA). (2) To explore the role of medication used for diabetes in these associations. Research design and methods: This is a hospital-based cohort study of patients with advanced OA requiring total joint arthroplasty. Interviews and electronic records included: age, gender, occupation, DM (including medication and duration), analgesics used, anthropometry, joints affected by pain and disease duration. Joint pain was scored by the patients using numerical rating scale. Pain severity score was calculated by adding the number of joints affected by pain and the maximum pain score. All analyses were adjusted and/or stratified by gender, age and body mass index. Results: In total, 489 patients with painful OA were included. From those, 139 patients had DM (30% males and 28% females, p=0.03). Pain severity, principally the number of joints affected by pain, and analgesic consumption, was higher in males with diabetes compared with males without diabetes (p=0.012 and OR=3.03; 95% CI 1.24 to 7.36, p=0.015, respectively). These associations were not significant in females (p=0.41 and p=0.66). Pain was more severe in males using insulin versus those who did not (p=0.025). Male subjects with diabetes had higher odds of hand pain or knee and hand pain compared with males without diabetes (OR=3.7, 95% CI 1.15 to 12; p=0.028 and OR=5.54; 95% CI 1.43 to 21.5, p=0.013, respectively). Conclusions: Males with diabetes, especially those who require insulin, have more severe joint pain and consume more analgesics than males without diabetes or those who have DM and use other DM medication.
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Artralgia/complicaciones , Artralgia/patología , Diabetes Mellitus Tipo 2/complicaciones , Diabetes Mellitus Tipo 2/tratamiento farmacológico , Hipoglucemiantes/uso terapéutico , Osteoartritis de la Rodilla/complicaciones , Anciano , Artralgia/epidemiología , Estudios de Cohortes , Diabetes Mellitus Tipo 2/epidemiología , Femenino , Articulación de la Cadera , Humanos , Articulación de la Rodilla , Masculino , Persona de Mediana Edad , Osteoartritis de la Rodilla/epidemiología , Osteoartritis de la Rodilla/patología , Dimensión del Dolor , Factores de Riesgo , Índice de Severidad de la Enfermedad , Caracteres Sexuales , Factores SexualesRESUMEN
BACKGROUND: Chikungunya virus (CHIKV) emerged in Aruba for the first time in 2014. We studied the clinical presentation of acute CHIKV infection and the contribution of serologic and molecular assays to its diagnosis. In a cohort of confirmed CHIKV cases, we analysed the frequency, duration and predictors of post-chikungunya chronic polyarthralgia (pCHIK-CPA), defined as joint pains lasting longer than 6 weeks or longer than 1 year. METHODOLOGY: Patient sera obtained within 10 days of symptom onset were tested for CHIKV, using an indirect immunofluorescence test for the detection of CHIKV-specific Immunoglobulin M (IgM) and post-hoc, by reverse-transcription polymerase chain reaction (RT-PCR). CHIKV was isolated from selected samples and genotyped. For confirmed CHIKV cases, clinical data from chart review were complemented by a Telephone survey, conducted 18-24 months after diagnosis. When joint pain was reported, the duration, presence of inflammatory signs, type and number of joints affected, were recorded. Joint involvement was scored according to the 2010 'American College of Rheumatology/ European League Against Rheumatism' criteria for seronegative rheumatoid arthritis (ACR-score). Risk factors for pCHIK-CPA were identified by logistic regression. PRINCIPAL FINDINGS: Acute CHIKV infection was diagnosed in 269 of 498 sera, by detection of IgM (n = 105), by RT-PCR (n = 59), or by both methods (n = 105). Asian genotype was confirmed in 7 samples. Clinical data were complete for 171 of 248 (69.0%) patients, aged 15 years or older (median 49.4 [35.0-59.6]). The female-to-male ratio was 2.2. The main acute symptoms were arthralgia (94%), fever (85%), myalgia (85%), headache (73%) and rash (63%). In patients with arthralgia (n = 160), pCHIK-CPA longer than 6 weeks was reported by 44% and longer than 1 year by 26% of cases. Inflammatory signs, stiffness, edema and redness were frequent (71%, 39% and 21%, respectively). Joints involved were knees (66%), ankles (50%), fingers (52%), feet (46%), shoulders (36%), elbows (34%), wrists (35%), hips (31%), toes (28.1%) and spine (28.1%). Independent predictors of pCHIK-CPA longer than 1 year were female gender (OR 5.9, 95%-CI [2.1-19.6]); high ACR-score (7.4, [2.7-23.3]), and detection of CHIKV-RNA in serum beyond 7 days of symptom onset (6.4, [1.4-34.1]. CONCLUSIONS: We identified 269 CHIKV patients after the first outbreak of Asian genotype CHIKV in Aruba in 2014-2015. RT-PCR yielded 59 (28%) additional CHIKV diagnoses compared to IgM antibody detection alone. Arthralgia, fever and skin rash were the dominant acute phase symptoms. pCHIK-CPA longer than 1 year affected 26% of cases and was predicted by female gender, high ACR-score and CHIKV-RNA detection beyond 7 days of symptom onset.
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Artralgia/virología , Fiebre Chikungunya/complicaciones , Virus Chikungunya/genética , Adolescente , Adulto , Anticuerpos Antivirales/sangre , Artralgia/complicaciones , Artralgia/epidemiología , Aruba , Fiebre Chikungunya/epidemiología , Enfermedad Crónica , Estudios de Cohortes , Femenino , Técnica del Anticuerpo Fluorescente Indirecta , Genotipo , Humanos , Inmunoglobulina G/sangre , Articulaciones/patología , Masculino , Persona de Mediana Edad , Factores de Riesgo , Encuestas y Cuestionarios , Resultado del Tratamiento , Adulto JovenRESUMEN
The most frequent extra-intestinal manifestation in ulcerative colitis (UC) around the world is joint involvement. There are no previous data in Latin America that is about this aspect of disease; hence, the aim of this study was to determine the frequency and factors associated to joint involvement in Mexican patients with UC. A total of 295 patients with histological diagnosis of UC were studied, divided into two groups: (1) 154 cases with at least one joint affection (arthralgia, peripheral, or axial arthropathy (sacroilitis (SI) or ankylosing spondylitis (AS))) and (2) 141 controls that had never presented any joint involvement during the clinical course of UC. Demographic, clinical, and laboratory variables were collected from the clinical records, at the time of presentation of the joint involvement for the cases and with the last information available for controls. A total of 52.2% of the patients had joint involvement, which was also the most frequent extra-intestinal manifestation (EIM). The frequency of peripheral arthralgia was 46.8% and of axial arthropathy was 5.4% (2.7% AS, 2.4% SI, and 0.3% both). The female gender (P = 0.01, OR = 3.061 95% CI: 1.311-7.15), elevated erythrocyte sedimentation rate (ESR) (P = 0.07, OR = 8.04 95% CI: 1.759-36.764), and moderate disease activity by Truelove and Witts criteria (P = 0.024, OR = 4.37 95% CI: 1.211-15.78) were factors associated at the time of presentation of the joint affection. Joint involvement is the most frequent EIM in Mexican patients with UC. The female gender, elevated ESR, and disease activity are factors associated with its presentation.
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Artralgia/complicaciones , Colitis Ulcerosa/complicaciones , Sacroileítis/complicaciones , Espondilitis Anquilosante/complicaciones , Adulto , Estudios de Casos y Controles , Bases de Datos Factuales , Femenino , Humanos , Masculino , México , Persona de Mediana Edad , Estudios Retrospectivos , Factores SexualesRESUMEN
OBJECTIVE: In order to establish a relationship between bruxism and temporomandibular disorders (TMDs), a systematic review was performed. MATERIALS AND METHODS: A systematic research was performed based on PubMed, Cochrane Library, Medline, Embase, BIREME, Lilacs and Scielo data bases, between 2003 and 2014 including all languages. Descriptive clinical cases were identified. Two independent authors selected the articles. PICO format was used to analyse the studies and the Newcastle-Ottawa Scale (NOS) was used to verify the quality of the evidence. RESULTS: Thirty-nine studies (n = 39) were analysed in this review. According to bruxism diagnosis, articles were grouped as follows: polysomnographic diagnosis (PSG) (n = 7), clinical diagnosis (n = 11) and survey/self-report (n = 21). Thirty-three articles (n = 33) established a positive relation between bruxism and TMD and six (n = 6) did not. Quality of evidence was low to moderate. In general, the most part of the studies showed shortcomings on their design with bias risk, and also had a low sensitivity on bruxism diagnosis. CONCLUSIONS: The evidence based on PSG was not as conclusive as the studies that used surveys and clinical exam to diagnosis bruxism, when bruxism was related to TMD. Sleep bruxism could be associated with myofascial pain, arthralgia and joint pathology as disc displacement and joint noises. Although the evidence at present is inconclusive and does not provide information according to the type of bruxism (bruxism sleep and wakefulness), it is possible to suggest that bruxism would be associated with TMD.
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Bruxismo/complicaciones , Bruxismo del Sueño/complicaciones , Trastornos de la Articulación Temporomandibular/complicaciones , Artralgia/complicaciones , Humanos , Luxaciones Articulares/complicaciones , Síndrome de la Disfunción de Articulación Temporomandibular/complicacionesRESUMEN
Protein-free guar gum (DGG) was oxidized (DGGOX) or sulfated (DGGSU) by insertion of new groups in C-6 (manose) and C-6 (galactose), for DGGOX and DGGSU, respectively. Rats were subjected to anterior cruciate ligament transection (ACLT) of the knee, joint pain recorded using the articular incapacitation test, and the analgesic effect of intraarticular 100µg DGG, DGGOX or DGGSU solutions at days 4-7 was evaluated. Other groups received DGG or saline weekly, from days 7 to 70 and joint damage assessed using histology and biochemistry as the chondroitin sulfate (CS) content of cartilage. The molar mass of CS samples was obtained by comparing their relative electrophoretic mobility to standard CS. DGG but not DGGOX or DGGSU significantly inhibited joint pain. DGG significantly reversed the increase in CS, its reduced electrophoretic mobility, and histological changes following ACLT, as compared to vehicle. Structural integrity accounts for DGG benefits in experimental osteoarthritis.
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Galactanos/química , Galactanos/farmacología , Mananos/química , Mananos/farmacología , Osteoartritis/tratamiento farmacológico , Gomas de Plantas/química , Gomas de Plantas/farmacología , Animales , Artralgia/complicaciones , Artralgia/tratamiento farmacológico , Cartílago Articular/efectos de los fármacos , Cartílago Articular/patología , Modelos Animales de Enfermedad , Galactanos/uso terapéutico , Masculino , Mananos/uso terapéutico , Osteoartritis/complicaciones , Osteoartritis/patología , Oxidación-Reducción , Gomas de Plantas/uso terapéutico , Ratas , Ratas Wistar , Relación Estructura-Actividad , Sulfatos/química , ViscosidadRESUMEN
Temporomandibular joint (TMJ) disorders are divided by the American Academy of Orofacial Pain into five categories. The most common ones are joint pain, as arthralgia and joint disorders, as disc displacements. An important clinical presentation of arthralgia is the painful tenderness to manual palpation or decreased pressure pain threshold (PPT). The authors conducted a study to determine the appropriate PPT value to discriminate asymptomatic TMJ individuals from those with moderate to severe arthralgia. Forty-nine individuals was evaluated and divided into groups: TMJ arthralgia, asymptomatic disc displacement and control group. Magnetic resonance images were obtained for all the groups, and algometry was performed on the TMJ lateral pole. Patients with arthralgia filled out a visual analogue scale (VAS). anova test with 1% of significance analysed the data. Specificity, sensitivity and ROC curve were also determined. Arthralgia group had significant lower PPT (mean of 1.07 kgf cm(-2) ) than the others. Asymptomatic disc displacement group (mean of 1.64 kgf cm(-2) ) has shown significant lower PPT than the control (mean of 2.35 kgf cm(-2) ). 89.66% of specificity and 70% of sensitivity were obtained when 1.36 kgf cm(-2) was applied to the TMJ (ROC area = 0.90). This value was considered to be the most appropriate to detected moderate to severe TMJ arthralgia. Indeed, the presence of disc displacement seems to significantly decrease PPT levels in asymptomatic subjects. The PPT value of 1.36 kgf cm(-2) can be used in the calibration procedures of the professionals involved with temporomandibular disorders and orofacial pain.
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Artralgia/diagnóstico , Dolor Facial/diagnóstico , Umbral del Dolor , Trastornos de la Articulación Temporomandibular/diagnóstico , Adolescente , Adulto , Análisis de Varianza , Artralgia/complicaciones , Artralgia/fisiopatología , Brasil , Calibración , Dolor Facial/etiología , Dolor Facial/fisiopatología , Femenino , Humanos , Imagen por Resonancia Magnética , Persona de Mediana Edad , Palpación , Valor Predictivo de las Pruebas , Presión , Curva ROC , Rango del Movimiento Articular , Reproducibilidad de los Resultados , Sensibilidad y Especificidad , Índice de Severidad de la Enfermedad , Trastornos de la Articulación Temporomandibular/complicaciones , Trastornos de la Articulación Temporomandibular/fisiopatologíaRESUMEN
Objetivo Determinar las concentraciones de aluminio en suero de pacientes con terapia de reemplazo renal crónico con hemodiálisis y las concentraciones en agua de redes de distribución y diálisis en dos unidades renales en Bogotá. Material y Métodos Estudio descriptivo en 63 pacientes en hemodiálisis y 20 individuos sanos. Las concentraciones de aluminio se determinaron por espectrofotometría de absorción atómica horno de grafito con corrección de lámpara de deuterio. Resultados El promedio de las concentraciones de aluminio en suero de los pacientes fue de 26,5 µg/L (11,2 a 49,2 µg/L, DE=8,03), en individuos sanos de 8,05 µg/L (menor al Límite de Detección a 17,2 µg/L, DE=4,31), en agua de diálisis fue menor a 2 µg/L y en agua de las redes de distribución menor a 200 µg/L. Conclusiones Las concentraciones de aluminio en el agua de la red de distribución y diálisis estudiadas se encontraron por debajo de los valores establecidos internacionalmente indicando un adecuado tratamiento de las mismas. Igualmente las concentraciones de aluminio pre-HD y post-HD observadas en los pacientes se encontraron por debajo de las reportadas en la literatura. El consumo de hidróxido de aluminio aumenta significativamente la concentración de aluminio en suero. Variables como edad, género, estado civil y situación laboral no son factores de riesgo que alteren significativamente las concentraciones de aluminio en suero.
Objective Determining aluminium concentrations in the serum of patients undergoing chronic renal replacement therapy with haemodialysis and concentration in distribution network water and dialysis in two renal units in Bogotá. Material and Methods This was a descriptive study of 63 haemodialysed patients and 20 healthy subjects. Aluminium concentration was determined in water and serum using graphite furnace atomic absorption spectrometry with deuterium lamp background corrector. Results Average aluminium concentration was 26.5 µg/L in patients (ranging from 11.2 to 49.2 µg/L; 8.03 standard deviation) and 8.05 µg/L in healthy individuals (ranging from undetectable to 17.2 µg/L; 4.31 standard deviation). Aluminium concentration in dialysis water and distribution network water was below 2 µg/L and 200 µg/L, respectively. Conclusions Aluminium concentration in water and serum in this study was below international standard values, thereby indicating appropriate treatment. Additionally, aluminium concentration in pre-HD and post-HD sera was below that reported previously. Aluminium hydroxide uptake increases aluminium concentration in serum. Personal situation regarding age, gender, civil and work status were not risk factors determining aluminium concentrations in serum.
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Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Adulto Joven , Aluminio/sangre , Soluciones para Hemodiálisis/análisis , Fallo Renal Crónico/terapia , Diálisis Renal , Hidróxido de Aluminio/farmacocinética , Artralgia/sangre , Artralgia/complicaciones , Colombia , Utensilios de Comida y Culinaria/estadística & datos numéricos , Estudios Transversales , Hábitos , Fallo Renal Crónico/sangre , Fallo Renal Crónico/complicaciones , Concentración Máxima Admisible , Trastornos de la Memoria/sangre , Trastornos de la Memoria/complicaciones , Trastornos del Movimiento/sangre , Trastornos del Movimiento/complicaciones , Muestreo , Espectrofotometría Atómica , Trastornos del Habla/sangre , Trastornos del Habla/complicaciones , Agua/análisisRESUMEN
AIMS: To assess the prevalence of primary headaches (HA) in adults with temporomandibular disorders (TMD) who were assessed in a specialty orofacial pain clinic, as well as in controls without TMD. METHODS: The sample consisted of 158 individuals with TMD seen at a university-based specialty clinic, as well as 68 controls. The Research Diagnostic Criteria for TMD were used to diagnose the TMD patients. HAs were assessed using a structured interview and classified according to the Second Edition of the International Classification for Headache Disorders. Data were analyzed by chi-square tests with a significance level of 5% and odds ratio (OR) tests with a 95% confidence interval (CI). RESULTS: HAs occurred in 45.6% of the control group (30.9% had migraine and 14.7% had tension-type headache [TTH]) and in 85.5% of individuals with TMD. Among individuals with TMD, migraine was the most prevalent primary HA (55.3%), followed by TTH (30.2%); 14.5% had no HA. In contrast to controls, the odds ratio (OR) for HA in those with TMD was 7.05 (95% confidence interval [CI] = 3.65-13.61; P = .000), for migraine, the OR was 2.76 (95% CI = 1.50-5.06; P = .001), and for TTH, the OR was 2.51 (95% CI = 1.18-5.35; P = .014). Myofascial pain/arthralgia was the most common TMD diagnosis (53.2%). The presence of HA or specific HAs was not associated with the time since the onset of TMD (P = .714). However, migraine frequency was positively associated with TMD pain severity (P = .000). CONCLUSION: TMD was associated with increased primary HA prevalence rates. Migraine was the most common primary HA diagnosis in individuals with TMD.
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Trastornos Migrañosos/etiología , Trastornos de la Articulación Temporomandibular/complicaciones , Adolescente , Adulto , Anciano , Artralgia/complicaciones , Estudios de Casos y Controles , Enfermedad Crónica , Femenino , Humanos , Masculino , Persona de Mediana Edad , Dimensión del Dolor , Trastornos de la Articulación Temporomandibular/clasificación , Síndrome de la Disfunción de Articulación Temporomandibular/complicaciones , Cefalea de Tipo Tensional/etiología , Factores de Tiempo , Adulto JovenRESUMEN
OBJECTIVE: Determining aluminium concentrations in the serum of patients undergoing chronic renal replacement therapy with haemodialysis and concentration in distribution network water and dialysis in two renal units in Bogotá. MATERIAL AND METHODS: This was a descriptive study of 63 haemodialysed patients and 20 healthy subjects. Aluminium concentration was determined in water and serum using graphite furnace atomic absorption spectrometry with deuterium lamp background corrector. RESULTS: Average aluminium concentration was 26.5 µg/L in patients (ranging from 11.2 to 49.2 µg/L; 8.03 standard deviation) and 8.05 µg/L in healthy individuals (ranging from undetectable to 17.2 µg/L; 4.31 standard deviation). Aluminium concentration in dialysis water and distribution network water was below 2 µg/L and 200 µg/L, respectively. CONCLUSIONS: Aluminium concentration in water and serum in this study was below international standard values, thereby indicating appropriate treatment. Additionally, aluminium concentration in pre-HD and post-HD sera was below that reported previously. Aluminium hydroxide uptake increases aluminium concentration in serum. Personal situation regarding age, gender, civil and work status were not risk factors determining aluminium concentrations in serum.
Asunto(s)
Aluminio/sangre , Soluciones para Hemodiálisis/análisis , Fallo Renal Crónico/terapia , Diálisis Renal , Adulto , Anciano , Hidróxido de Aluminio/farmacocinética , Artralgia/sangre , Artralgia/complicaciones , Colombia , Utensilios de Comida y Culinaria/estadística & datos numéricos , Estudios Transversales , Femenino , Hábitos , Humanos , Fallo Renal Crónico/sangre , Fallo Renal Crónico/complicaciones , Masculino , Concentración Máxima Admisible , Trastornos de la Memoria/sangre , Trastornos de la Memoria/complicaciones , Persona de Mediana Edad , Trastornos del Movimiento/sangre , Trastornos del Movimiento/complicaciones , Muestreo , Espectrofotometría Atómica , Trastornos del Habla/sangre , Trastornos del Habla/complicaciones , Agua/análisis , Adulto JovenRESUMEN
We estimate the prevalence and evaluate the clinical characteristics of leprosy related arthritis. One thousand, two hundred fifty-seven leprosy patients were attended at "Alfredo da Matta" outpatient clinic in the state of Amazonas, Brazil from July to October 2004. Among them, 115 patients were identified with articular pain and were referred for evaluation with rheumatologist. Blood samples were collected and radiological evaluation of the involved joints was performed. All patients with arthritis who continued to be followed up were reevaluated. One hundred fifteen leprosy patients (9.1%) were identified with articular involvement. The articular complaints were attributed to a defined rheumatic disease in 36 cases and excluded from further analysis. Twenty-four patients had arthralgia, and 55 (37 males and 18 females) had leprosy-related arthritis. The prevalence of arthritis was similar in both genders, and all patients with leprosy-related arthritis had lepromatous or borderline type. Most of patients had polyarticular and symmetrical arthritis and had completed the multidrug therapy and was under reaction treatment. The mean duration of articular symptoms at the time of study was 1.06 years (ranging from 5 days to 14 years). Ninety-one percent of patients with leprosy-related arthritis presented erythema nodosum leprosum or reversal reactions. Only five patients with arthritis had never presented reactions. Fifty percent of patients became asymptomatic during the mean 24 months of follow-up. Leprosy-related arthritis has a lower prevalence than previously reported. Most cases of leprosy-related arthritis were associated with reactional episodes, and in a large number of cases, the arthritis had a chronic course not responsive to the conventional therapy for reactions.
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Artralgia/complicaciones , Artritis Infecciosa/microbiología , Lepra/complicaciones , Adulto , Artralgia/epidemiología , Artralgia/fisiopatología , Artritis Infecciosa/epidemiología , Artritis Infecciosa/fisiopatología , Brasil/epidemiología , Comorbilidad , Femenino , Humanos , Articulaciones/fisiopatología , Lepra/epidemiología , Lepra/fisiopatología , Masculino , Mycobacterium leprae/inmunologíaRESUMEN
Osteoarthritis (OA) is a major healthcare burden of increasing prevalence. It has been demonstrated that the relationship between pain and sleep produces changes in sleep patterns and pain perception. However, electrophysiological studies in animal models of pain are limited. The current study examined the effect of chronic articular pain on sleep patterns in an experimental model of OA. Rats were implanted with electrodes for electrocorticography and electromyography. OA was induced in these rats by the intra-articular administration of monosodium iodoacetate into the left knee joint. Sleep recordings were monitored during light and dark periods lasting 12h each and were evaluated at baseline as well as on days 1, 10, 15, 20 and 28 after iodoacetate injection or assignment to sham or control groups. The pain threshold was also assessed by hot plate testing in other groups of rats at the same time points. The results demonstrated that OA significantly reduced the thermal pain threshold from day 10 until the end of experiment. OA rats exhibited reduced sleep efficiency, slow-wave sleep, paradoxical sleep and an increased number of microarousals during the light periods compared with the baseline as well as control and sham groups. These changes in sleep pattern occurred mostly between days 10 and 28. In the dark period, sleep disturbances were also characterized by decreased sleep efficiency, slow-wave sleep, and paradoxical sleep, although sleep was only initially fragmented. Thus, pain associated with the rat OA model causes alterations in sleep architecture by disrupting the sleep pattern.
Asunto(s)
Artralgia/complicaciones , Corteza Cerebral/fisiopatología , Osteoartritis/complicaciones , Trastornos del Sueño-Vigilia/etiología , Trastornos del Sueño-Vigilia/fisiopatología , Sueño/fisiología , Animales , Nivel de Alerta/fisiología , Artralgia/inducido químicamente , Modelos Animales de Enfermedad , Electroencefalografía , Electromiografía , Mediadores de Inflamación , Yodoacetatos , Masculino , Osteoartritis/inducido químicamente , Dimensión del Dolor , Umbral del Dolor , Ratas , Ratas Wistar , Trastornos del Sueño-Vigilia/diagnóstico , Sueño REM/fisiologíaAsunto(s)
Artralgia/complicaciones , Cutis Laxo/etiología , Tejido Elástico/ultraestructura , Cara , Piel/patología , Adulto , Articulación del Tobillo , Cutis Laxo/patología , Cutis Laxo/cirugía , Diagnóstico Diferencial , Humanos , Masculino , Microscopía Electrónica de Transmisión , Procedimientos de Cirugía Plástica/métodosRESUMEN
A artrite é a manifestação clínica mais freqüente, mas menos específica, da febre reumática. Alguns pacientes podem apresentar quadros articulares atípicos, diferentes da poliartrite migratória clássica descrita por Jones, o que dificulta a identificação dessa doença, principalmente quando o paciente apresenta artrite como único sinal maior.