The pathway to consultation for rheumatoid arthritis: exploring anticipated actions between the onset of symptoms and face-to-face encounter with a healthcare professional

The Pharmacological Potential of Resveratrol in Reducing Soft Tissue Damage in Osteoarthritis Patients

Osteoarthritis is a degenerative joint disease that causes the cartilage and bone underneath the joint to break down. This causes pain and stiffness. Resveratrol, a polyphenolic compound found in various vegetables, fruits, and red wine, has been studied for its beneficial effects on osteoarthritis. Resveratrol has been shown to target a variety of pathways, including the NF-κB, PI3K/Akt, MAPK/ERK, and AMPK pathways. In particular, resveratrol has been studied for its potential use in treating osteoarthritis, and it has been shown to reduce inflammation, reduce cartilage degradation, and improve joint function. In this review, we discuss the evidence for the pharmacological use of resveratrol in minimizing soft tissue damage associated with osteoarthritis. We summarize the studies on how resveratrol has anti-inflammatory, anti-oxidant, and anti-apoptotic effects, as well as effects on cartilage degradation, osteoblast and synoviocyte proliferation, and cytokine production. We also discuss the possible mechanisms of action of resveratrol in osteoarthritis and its potential as a therapeutic agent. Finally, we discuss the potential risks and adverse effects of long-term resveratrol supplementation. Overall, resveratrol has been found to be a possible treatment for osteoarthritis because of its anti-inflammatory, anti-oxidant, and anti-apoptotic properties, and its ability to control the production of enzymes that break down cartilage, osteoblasts, and synoviocytes. Although numerous clinical studies have demonstrated resveratrol's efficacy as an osteoarthritis management agent, further long-term studies are needed to better understand the safety and potential benefits of using resveratrol for osteoarthritis management.

Discitis-osteomyelitis: optimizing results of percutaneous sampling

Vertebral discitis-osteomyelitis is an infection of the spine that involves the intervertebral disc and the adjacent vertebral body but may also extend into the paraspinal and epidural soft tissues. If blood cultures and other culture data fail to identify a causative microorganism, percutaneous sampling is indicated to help guide targeted antimicrobial therapy. Despite limited supporting evidence, withholding antimicrobial therapy for up to 2 weeks is recommended to maximize microbiological yield, although literature supporting this recommendation is limited. During the procedure, technical factors that may improve yield include targeting of paraspinal fluid collections or soft tissue abnormalities for sampling, acquiring multiple core samples if possible, and use of larger gauge needles when available. Repeat sampling may be indicated if initial percutaneous biopsy is negative but should be performed no sooner than 72 h after the initial percutaneous biopsy to ensure adequate time for culture results to return.

Toward Earlier Diagnosis Using Combined eHealth Tools in Rheumatology: The Joint Pain Assessment Scoring Tool (JPAST) Project

Outcomes of patients with inflammatory rheumatic diseases have significantly improved over the last three decades, mainly due to therapeutic innovations, more timely treatment, and a recognition of the need to monitor response to treatment and to titrate treatments accordingly. Diagnostic delay remains a major challenge for all stakeholders. The combination of electronic health (eHealth) and serologic and genetic markers holds great promise to improve the current management of patients with inflammatory rheumatic diseases by speeding up access to appropriate care. The Joint Pain Assessment Scoring Tool (JPAST) project, funded by the European Union (EU) European Institute of Innovation and Technology (EIT) Health program, is a unique European project aiming to enable and accelerate personalized precision medicine for early treatment in rheumatology, ultimately also enabling prevention. The aim of the project is to facilitate these goals while at the same time, reducing cost for society and patients.

The perspective of patients with early rheumatoid arthritis on the journey from symptom onset until referral to a rheumatologist

Objective

Timely treatment of patients with early RA (ERA) favours a beneficial disease outcome. However, individuals often delay their contact with a health-care professional (HCP) after ERA-related symptom onset. The aim of this study was to investigate the perspective of patients on the journey of a patient from RA symptom onset until referral to a specialist.

Methods

A subgroup of patients with ERA from the Care in ERA (CareRA) trial were interviewed retrospectively to discuss their initial ERA-related experiences preceding diagnosis, using a bespoke assessment form. The first section of the form focused on initial symptoms and help-seeking behaviour by the patients. The second part probed the actions of the HCPs consulted. Additional notes derived from the patient stories were analysed thematically.

Results

Among 94 patients, pain (97%), swelling (73%) and stiffness (52%), typically in multiple joints, were reported as initial ERA symptoms. The general practitioner (GP) was generally the first HCP to be contacted (87%). Frequently reported reasons to visit an HCP were intense pain (90.4%) and difficulties in performing daily activities (69%). In 44.1% of patients, the HCP suspected ERA at the first visit. Approximately 25% of patients needed more than five visits before detection of ERA. GPs mainly referred patients to rheumatologists (71%). Thematic analysis uncovered that multiple HCPs were often involved in the journey to RA detection and referral.

Conclusion

Pain is the most commonly reported initial symptom of ERA and the main reason to visit an HCP, usually a GP. These GPs play a pivotal role in early detection and correct referral. Furthermore, the journey of a patient seems complex, often with multiple HCPs being involved.

Searching for a prodrome for rheumatoid arthritis in the primary care record: A case-control study in the clinical practice research datalink

BACKGROUND

Rheumatoid arthritis (RA) has articular and non-articular manifestations. Early, intensive treatment has substantial benefit for both. This requires patients be identified as soon as symptoms develop.

OBJECTIVES

To determine whether selected signs and symptoms can be identified in the primary care records of patients prior to a formal diagnosis of RA being made and, if so, how early they can be identified.

METHODS

A case-control study was constructed within the UK Clinical Practice Research Datalink (CPRD). 3577 individuals with 'definite' RA, were matched to 14,287 individuals without inflammatory arthritis. An index date was established (i.e., date general practitioner (GP) first appeared to suspect RA). Rates of consultation and consultations for suspected early RA symptoms were compared in cases and controls in the two years prior to the index date using conditional logistic regression, adjusted for number of consultations.

RESULTS

The mean (standard deviation) age of participants was 58.8 (14.5) years and 66.8% were female. Rates of any consultation were significantly higher in RA cases than in controls for at least two years prior to the index date. Cases were more likely to have a pre-diagnosis coded consultation for joint, and particularly hand symptoms (aOR 11.44 (9.60, 13.63)), morning stiffness (8.10 (3.54, 18.5)), carpal tunnel syndrome (4.57 (3.54, 5.88)) and other non-articular features.

CONCLUSIONS

In patients who develop RA, GP consultation rates are higher for at least two years prior to the first recorded suspicion of RA. This study highlights symptoms that should raise a GP's index of suspicion for RA.