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Bharti A, Kumar S, Omar B, Prakash S. Evaluating the Efficacy of Antibiotic Therapy in Non-responsive Sacroiliitis: A Comparative Study. Cureus 2024; 16:e57372. [PMID: 38694628 PMCID: PMC11061771 DOI: 10.7759/cureus.57372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/31/2024] [Indexed: 05/04/2024] Open
Abstract
BACKGROUND Sacroiliitis, characterized by inflammation of the sacroiliac joints, poses significant challenges in management, especially in patients unresponsive to standard therapies like non-steroidal anti-inflammatory drugs (NSAIDs) and physical therapy. This study aimed to evaluate the efficacy of antibiotic therapy in such patients, addressing a critical gap in the current treatment approach. METHODS A total of 360 patients with lower back pain who presented to the outpatient department (OPD) of the Department of Orthopedics of a medical college in Northern India for six months were included in this study. With meticulous history taking, clinical examination, and radiological evaluation, 59 patients were diagnosed with sacroiliitis, out of which 31 were males and 28 were females, aged between 20 and 40 years, and were enrolled in this cross-sectional comparative study. Patients were divided into two groups: a control group (21 patients) receiving conventional treatment without antibiotics and a study group (38 patients) receiving conventional treatment plus antibiotics (who gave consent for treatment with antibiotics). The primary outcome was assessed using the Japanese Orthopaedic Association (JOA) score, with evaluations conducted at baseline, one month, and three months. Recovery rates were also calculated. SPSS trial software version 27 (IBM Corp., Armonk, NY) was used for statistical analysis. RESULTS Both groups exhibited improvement in JOA scores over time. At the one-month and three-month follow-ups, the mean JOA scores and recovery rates showed no statistically significant difference between the control and study groups (p-values > 0.05). Adverse effects related to antibiotic use were not significant. CONCLUSION The study concludes that the addition of antibiotics to the conventional treatment regimen for sacroiliitis does not provide significant benefit in terms of functional recovery or pain relief in patients non-responsive to NSAIDs and/or physical therapy. These findings underscore the importance of a targeted treatment approach based on the specific etiology of sacroiliitis and caution against unnecessary antibiotic use.
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Affiliation(s)
- Ajay Bharti
- Orthopedics, All India Institute of Medical Sciences, Gorakhpur, Gorakhpur, IND
| | - Sanjay Kumar
- Orthopedics and Trauma, Ganesh Shankar Vidyarthi Memorial (GSVM) Medical College, Kanpur, IND
| | - Balram Omar
- Microbiology, All India Institute of Medical Sciences, Rishikesh, Rishikesh, IND
| | - Shashank Prakash
- Orthopedics, All India Institute of Medical Sciences, Gorakhpur, Gorakhpur, IND
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Fu Y, Chiarotto A, Enthoven W, Skou ST, Koes B. The influence of comorbidities on outcomes for older people with back pain: BACE-D cohort study. Ann Phys Rehabil Med 2023; 66:101754. [PMID: 37276834 DOI: 10.1016/j.rehab.2023.101754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 02/11/2023] [Accepted: 02/24/2023] [Indexed: 06/07/2023]
Abstract
BACKGROUND Comorbidities are common in older people with back pain but little is known about the influence of comorbidities on outcomes. OBJECTIVES To explore the influence of the most prevalent comorbidities, and the number of comorbidities, on short (at 3 months) and long-term (at 12 months) outcomes of back pain in older people. METHODS We analyzed data from the 'Back Complaints in the Elders' Dutch study cohort (BACE-D) and included participants aged >55 years. We used the modified Self-Administered Comorbidities Questionnaire (SCQ), the Numeric Rating Scale (NRS) and the Roland-Morris Disability Questionnaire (RMDQ) to assess the number of comorbidities, pain intensity and back-related physical functioning, respectively. We conducted separate linear regression models to analyze the association between comorbidities and outcomes including potential confounders of age, sex, body mass index, smoking and alcoholic drinking status, back pain history, and baseline NRS and RMDQ scores. RESULTS Our study included 669 participants with a mean age of 66.5 (SD 7.7) years of whom 394 were female. More comorbidities were positively associated with higher pain intensity (3-month regression coefficient (β) =0.27, 95% CI 0.14-0.39; 12-month β = 0.31, 95% CI 0.17-0.45) and worse physical functioning (3-month β = 0.54, 95% CI 0.31-0.77; 12-month β = 0.64, 95% CI 0.37-0.92). Four of the 5 commonest comorbidities were musculoskeletal problems. Older participants with musculoskeletal comorbidities had higher pain intensity (3-month β = 0.89 95% CI 0.41-1.37; 12-month β = 1.17, 95% CI 0.65-1.69), and worse physical functioning (3-month β = 1.61, 95% CI 0.71-2.52; 12-month β = 1.85, 95% CI 0.82-2.89, P-value < 0.001) compared to participants without musculoskeletal comorbidities. CONCLUSIONS More comorbidities are associated with worse back pain outcomes in older adults. Participants with musculoskeletal comorbidities had worse back pain outcomes than those without.
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Affiliation(s)
- Yanyan Fu
- Department of General Practice, Erasmus University Medical Center, Rotterdam, the Netherlands.
| | - Alessandro Chiarotto
- Department of General Practice, Erasmus University Medical Center, Rotterdam, the Netherlands
| | | | - Søren Thorgaard Skou
- Center for Muscle and Joint Health, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark; The Research Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Slagelse, Denmark
| | - Bart Koes
- Department of General Practice, Erasmus University Medical Center, Rotterdam, the Netherlands; Center for Muscle and Joint Health, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
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Zhou AF, Li ZY, Cui XJ, Sng KS, Zhu K, Wang YJ, Shu B, Zhang JP, Yao M. Cross-cultural adaptation of The Japanese Orthopaedic Association Back Pain Evaluation Questionnaire: A methodological systematic review. J Orthop Sci 2023; 28:984-991. [PMID: 36137918 DOI: 10.1016/j.jos.2022.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 07/04/2022] [Accepted: 08/08/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND The Japanese Orthopaedic Association Back Pain Evaluation Questionnaire (JOABPEQ) is a reliable and sensitive measure of disability to determine functional status and evaluate curative effects in low back pain, it has now been cross-cultural translated into many other languages and adapted for use in different countries. We aim to evaluate the translation procedures and measurement properties of cross-cultural adaptations of the JOABPEQ. METHODS Studies related to cross-cultural adaptation of the JOABPEQ in a specific language/culture were searched in PubMed, Embase, CINAHL, SciELO, PsycINFO, SinoMed, and Web of Science from their inception to March 2022. The Guidelines for the Process of Cross-Cultural Adaptation of Self-Report Measures and the Consensus-based Standards for the Selection of Health Status Measurement Instruments guideline were used for evaluation. RESULTS Nine different versions of cross-cultural JOABPEQ adaptations in 8 different languages/cultures were included. The adaptation process was not strictly performed, such as standard forward translation and expert committee review were rarely reported. Content validity (8/9), floor and ceiling effects (3/9), reliability (4/9), and interpretability (6/9) were assessed in most of the adaptations, while agreement (2/9), responsiveness (2/9), and the internal consistency (2/9) were not. JOABPEQ can replace functional and quality of life score to reduce the burden of scientific research. CONCLUSION We recommend Persian-Iranian, simplified Chinese-Chinese Mandarin, Thai and Gunaydin G's Turkish adaptations for application. The numerical pain rating scale/visual analogue scale in low back pain and lower extremities, as well as numbness in lower extremities could not be neglected in JOABPEQ adaptations.
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Affiliation(s)
- Ai-Fang Zhou
- Spine Disease Institute, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China; School of Rehabilitation, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Zhuo-Yao Li
- Spine Disease Institute, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Xue-Jun Cui
- Spine Disease Institute, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Kim Sia Sng
- Spine Disease Institute, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Ke Zhu
- Spine Disease Institute, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Yong-Jun Wang
- Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Bing Shu
- Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Jian-Ping Zhang
- Shanghai Jinshan District Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai, China
| | - Min Yao
- Spine Disease Institute, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China.
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Yamada K, Suzuki A, Takahashi S, Inui K, Koike T, Okano T, Yabu A, Hori Y, Toyoda H, Nakamura H. Risk Factors for Low Back Pain Increase in Rheumatoid Arthritis: Analysis of a 7-year Follow-up Study. Mod Rheumatol 2021; 32:1027-1034. [PMID: 34878544 DOI: 10.1093/mr/roab106] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 10/30/2021] [Accepted: 11/14/2021] [Indexed: 11/14/2022]
Abstract
OBJECTIVE Several studies have demonstrated that low back pain (LBP) is related to disease activity in patients with rheumatoid arthritis (RA). However, there is no longitudinal research. This study aimed to determine the impacts and risk factors for LBP increase in RA in a longitudinal cohort study. METHODS The study evaluated 113 patients with RA who completed the secondary survey. LBP increase was defined as ≥1 standard deviation of mean change in visual analog scale (VAS) between the baseline and secondary surveys. The impacts of LBP increase on quality of life (QOL) and psychological status were evaluated. Risk factors were assessed among patient demographic characteristics, radiological changes. RESULTS Mean change in VAS for LBP was -0.8±30.4 mm during a mean 7-year follow-up. LBP increase was defined as ≥30-mm increase in VAS for LBP. Patients with LBP increase had significantly lower QOL and worse mental status than patients without. Poor control of RA was identified as an independent risk factor for LBP increase (odds ratio, 9.82, p=0.001). CONCLUSION Patients with poor control of RA were likely to experience LBP increase in the long-term. Control of RA disease activity is important for control of LBP, QOL, and mental status.
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Affiliation(s)
- Kentaro Yamada
- Department of Orthopaedic Surgery, PL Hospital, Tondabayashi City, Osaka, Japan.,Department of Orthopaedic Surgery, Osaka City University, Osaka City, Osaka, Japan
| | - Akinobu Suzuki
- Department of Orthopaedic Surgery, Osaka City University, Osaka City, Osaka, Japan
| | - Shinji Takahashi
- Department of Orthopaedic Surgery, Osaka City University, Osaka City, Osaka, Japan
| | - Kentaro Inui
- Department of Orthopaedic Surgery, Osaka City University, Osaka City, Osaka, Japan
| | - Tatsuya Koike
- Center for Senile Degenerative Disorders (CSDD), Osaka City University, Osaka City, Osaka, Japan
| | - Tadashi Okano
- Department of Orthopaedic Surgery, Osaka City University, Osaka City, Osaka, Japan
| | - Akito Yabu
- Department of Orthopaedic Surgery, Osaka City University, Osaka City, Osaka, Japan
| | - Yusuke Hori
- Department of Orthopaedic Surgery, Osaka City University, Osaka City, Osaka, Japan
| | - Hiromitsu Toyoda
- Department of Orthopaedic Surgery, Osaka City University, Osaka City, Osaka, Japan
| | - Hiroaki Nakamura
- Department of Orthopaedic Surgery, Osaka City University, Osaka City, Osaka, Japan
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Dao T, Kirk B, Phu S, Vogrin S, Duque G. Prevalence of Sarcopenia and its Association with Antirheumatic Drugs in Middle-Aged and Older Adults with Rheumatoid Arthritis: A Systematic Review and Meta-analysis. Calcif Tissue Int 2021; 109:475-489. [PMID: 34132852 DOI: 10.1007/s00223-021-00873-w] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Accepted: 06/03/2021] [Indexed: 12/28/2022]
Abstract
To examine the prevalence of sarcopenia and its association with antirheumatic drugs in adults with rheumatoid arthritis (RA). This review was registered on PROSPERO and followed PRISMA guidelines. Electronic databases were searched for studies reporting on the prevalence of sarcopenia in adults with RA using any muscle index (muscle mass, strength and/or physical performance) and cutpoints as recommended by established criteria (EWGSOP1/2, AWGS, FNIH, SDOC). The secondary objective was to investigate the relationship between RA, antirheumatic drugs, and sarcopenia. Among 2240 middle-aged and older adults with RA (mean age: 47.7 ± 5.5 to 75.0 ± 6.2 years, 83.8% women), the pooled prevalence of low muscle mass/sarcopenia was 30.2% [95% confidence interval (CI) 24.2-36.2%; 16 studies; I2: 89.2%]. Sub-group analysis showed a non-significant higher prevalence of low muscle mass alone (32.6%, 95% CI 25.0-40.3%; I2: 87.9%) versus consensus definitions of sarcopenia (25.4%, 95% CI 15.4-35.3%; I2: 91.2%, p = 0.255). In adults with RA, corticosteroid use was positively associated with sarcopenia [odds ratio (OR) 1.46, 95% CI 0.94-2.29, 7 studies; I2: 47.5%] while conventional synthetic disease-modifying antirheumatic drugs (csDMARDs) was inversely associated (OR 0.70, 95% CI 0.52-0.94; 6 studies: I2: 0.00%) with this muscle disease. No association was found for biological/targeted synthetic disease-modifying antirheumatic drugs (b/tsDMARDs) (OR 0.83, 95% CI 0.54-1.30; 6 studies: I2: 47.6%). Sarcopenia is a common comorbidity of RA, and as such, clinicians should screen for this muscle disease in adults with RA. Further longitudinal studies are needed to understand the role of antirheumatic drugs (particularly type, dosing, and duration) in the development of sarcopenia.
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Affiliation(s)
- Thang Dao
- Department of Medicine-Western Health, Melbourne Medical School, University of Melbourne, St Albans, Melbourne, VIC, Australia
- Australian Institute for Musculoskeletal Science (AIMSS), University of Melbourne and Western Health, 176 Furlong Road, St. Albans, VIC, 3121, Australia
| | - Ben Kirk
- Department of Medicine-Western Health, Melbourne Medical School, University of Melbourne, St Albans, Melbourne, VIC, Australia
- Australian Institute for Musculoskeletal Science (AIMSS), University of Melbourne and Western Health, 176 Furlong Road, St. Albans, VIC, 3121, Australia
| | - Steven Phu
- Australian Institute for Musculoskeletal Science (AIMSS), University of Melbourne and Western Health, 176 Furlong Road, St. Albans, VIC, 3121, Australia
- Falls, Balance and Injury Research Centre, Neuroscience Research Australia, University of New South Wales, Sydney, NSW, Australia
| | - Sara Vogrin
- Department of Medicine-Western Health, Melbourne Medical School, University of Melbourne, St Albans, Melbourne, VIC, Australia
- Australian Institute for Musculoskeletal Science (AIMSS), University of Melbourne and Western Health, 176 Furlong Road, St. Albans, VIC, 3121, Australia
| | - Gustavo Duque
- Department of Medicine-Western Health, Melbourne Medical School, University of Melbourne, St Albans, Melbourne, VIC, Australia.
- Australian Institute for Musculoskeletal Science (AIMSS), University of Melbourne and Western Health, 176 Furlong Road, St. Albans, VIC, 3121, Australia.
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Dao T, Kirk B, Phu S, Vogrin S, Duque G. Prevalence of Sarcopenia and its Association with Antirheumatic Drugs in Middle-Aged and Older Adults with Rheumatoid Arthritis: A Systematic Review and Meta-analysis. Calcif Tissue Int 2021. [PMID: 34132852 DOI: 10.1007/s00223-021-00873-w.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/29/2022]
Abstract
To examine the prevalence of sarcopenia and its association with antirheumatic drugs in adults with rheumatoid arthritis (RA). This review was registered on PROSPERO and followed PRISMA guidelines. Electronic databases were searched for studies reporting on the prevalence of sarcopenia in adults with RA using any muscle index (muscle mass, strength and/or physical performance) and cutpoints as recommended by established criteria (EWGSOP1/2, AWGS, FNIH, SDOC). The secondary objective was to investigate the relationship between RA, antirheumatic drugs, and sarcopenia. Among 2240 middle-aged and older adults with RA (mean age: 47.7 ± 5.5 to 75.0 ± 6.2 years, 83.8% women), the pooled prevalence of low muscle mass/sarcopenia was 30.2% [95% confidence interval (CI) 24.2-36.2%; 16 studies; I2: 89.2%]. Sub-group analysis showed a non-significant higher prevalence of low muscle mass alone (32.6%, 95% CI 25.0-40.3%; I2: 87.9%) versus consensus definitions of sarcopenia (25.4%, 95% CI 15.4-35.3%; I2: 91.2%, p = 0.255). In adults with RA, corticosteroid use was positively associated with sarcopenia [odds ratio (OR) 1.46, 95% CI 0.94-2.29, 7 studies; I2: 47.5%] while conventional synthetic disease-modifying antirheumatic drugs (csDMARDs) was inversely associated (OR 0.70, 95% CI 0.52-0.94; 6 studies: I2: 0.00%) with this muscle disease. No association was found for biological/targeted synthetic disease-modifying antirheumatic drugs (b/tsDMARDs) (OR 0.83, 95% CI 0.54-1.30; 6 studies: I2: 47.6%). Sarcopenia is a common comorbidity of RA, and as such, clinicians should screen for this muscle disease in adults with RA. Further longitudinal studies are needed to understand the role of antirheumatic drugs (particularly type, dosing, and duration) in the development of sarcopenia.
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Affiliation(s)
- Thang Dao
- Department of Medicine-Western Health, Melbourne Medical School, University of Melbourne, St Albans, Melbourne, VIC, Australia.,Australian Institute for Musculoskeletal Science (AIMSS), University of Melbourne and Western Health, 176 Furlong Road, St. Albans, VIC, 3121, Australia
| | - Ben Kirk
- Department of Medicine-Western Health, Melbourne Medical School, University of Melbourne, St Albans, Melbourne, VIC, Australia.,Australian Institute for Musculoskeletal Science (AIMSS), University of Melbourne and Western Health, 176 Furlong Road, St. Albans, VIC, 3121, Australia
| | - Steven Phu
- Australian Institute for Musculoskeletal Science (AIMSS), University of Melbourne and Western Health, 176 Furlong Road, St. Albans, VIC, 3121, Australia.,Falls, Balance and Injury Research Centre, Neuroscience Research Australia, University of New South Wales, Sydney, NSW, Australia
| | - Sara Vogrin
- Department of Medicine-Western Health, Melbourne Medical School, University of Melbourne, St Albans, Melbourne, VIC, Australia.,Australian Institute for Musculoskeletal Science (AIMSS), University of Melbourne and Western Health, 176 Furlong Road, St. Albans, VIC, 3121, Australia
| | - Gustavo Duque
- Department of Medicine-Western Health, Melbourne Medical School, University of Melbourne, St Albans, Melbourne, VIC, Australia. .,Australian Institute for Musculoskeletal Science (AIMSS), University of Melbourne and Western Health, 176 Furlong Road, St. Albans, VIC, 3121, Australia.
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