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Picotti S, Forte L, Serrentino J. A pre-market interventional, single-arm clinical investigation of a new topical lotion based on hyaluronic acid and peptides, EGYFIL TM, for the treatment of pain and stiffness in soft tissues. BMC Musculoskelet Disord 2023; 24:777. [PMID: 37784053 PMCID: PMC10544473 DOI: 10.1186/s12891-023-06903-y] [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: 02/13/2023] [Accepted: 09/21/2023] [Indexed: 10/04/2023] Open
Abstract
BACKGROUND Muscle pain and stiffness are strictly interconnected. Injuries frequently occur during sport activities, causing muscle pain, with or without stiffness, and require effective as well as fast-acting treatments. Topical products can be ideal for the treatment of such physical alterations as they are convenient and simple to use. In this study, it was investigated the application of a novel topical formulation, EGYFIL™, for the treatment of pain and stiffness due to muscle contracture, trauma, and/or overtraining. The lotion is composed of hyaluronic acid, a well-known ingredient for the pain alleviation, mixed with skin conditioning SH-Polypeptide-6 and SH-Oligopeptide-1, embedded in it. METHODS Twenty-six patients with pain and/or stiffness were enrolled. After a screening visit (Time 0, t0), patients were treated for the first time with the IP. The treatment consisted of topical application of the pain lotion. Level of pain and stiffness were measured with Numerical Rating Scale (NRS). Patients' pain and/or stiffness were evaluated at t0 (prior to using the product), after three hours (t1), and after three days (t2) of treatment. Participants were free to apply and re-apply the product ad libitum over the course of the study period (3 days). Potential adverse events (AE) and tolerance were evaluated during each visit. RESULTS There was a 22% decrease in pain in the first three hours (p < 0.001), followed by an additional 20% decrease after three days (p=0.0873). Overall, there was a 42% decrease in pain over the three days of the study (p =0.001). Furthermore, a 24% reduction in stiffness in the first three hours (p=0.025) and a 38% decrease in stiffness over three days (p < 0.001) were observed. Reduction in pain and stiffness were neither age, nor sex dependent. No adverse effects were reported during the study. CONCLUSION EGYFIL™ is safe and seems to reduce pain and stiffness in patients during the 3 days of treatment, already after 3 h from the first application. TRIAL REGISTRATION ClinicalTrials.gov ID: NCT05711953. This trial was registered on 03/02/2023.
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Affiliation(s)
| | - Luca Forte
- Contrad Swiss SA, Via Ferruccio Pelli 2, Lugano, 6900, Switzerland.
| | - Jo Serrentino
- International Institute of Clinical Ecology (IICE), Quebec, Canada
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Küçükdeveci AA, Elhan AH, Erdoğan BD, Kutlay Ş, Gökmen D, Ateş C, Yüksel S, Lundgren-Nilsson A, Escorpizo R, Stucki G, Tennant A, Conaghan PG. Use and detailed metric properties of patient-reported outcome measures for rheumatoid arthritis: a systematic review covering two decades. RMD Open 2021; 7:rmdopen-2021-001707. [PMID: 34376556 PMCID: PMC8356163 DOI: 10.1136/rmdopen-2021-001707] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 07/26/2021] [Indexed: 11/08/2022] Open
Abstract
Introduction The importance of patient-reported outcome measures (PROMs) for rheumatoid arthritis (RA) clinical studies has been recognised for many years. The current study aims to describe the RA PROMs used over the past 20 years, and their performance metrics, to underpin appropriate tool selection. Methods The study included a systematic search for PROMs that have been in use over the period 2000–2019, with detailed documentation of their psychometric properties, and a user-friendly presentation of the extensive evidence base. Results 125 PROMs were identified with psychometric evidence available. The domains of pain, fatigue, emotional functions, mobility, physical functioning and work dominated, with self-efficacy and coping as personal factors. Domains such as stiffness and sleep were poorly served. The most frequently used PROMs included the Health Assessment Questionnaire Disability Index (HAQ), the Short Form 36 (SF-36), the EuroQoL and the Modified HAQ which, between them, appeared in more than 3500 papers. Strong psychometric evidence was found for the HAQ, and the SF-36 Physical Functioning and Vitality (fatigue) domains. Otherwise, all domains except stiffness, sleep, education and health utility, had at least one PROM with moderate level of psychometric evidence. Conclusion There is a broad range of PROMs for measuring RA outcomes, but the quality of psychometric evidence varies widely. This work identifies gaps in key RA domains according to the biopsychosocial model.
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Affiliation(s)
- Ayşe A Küçükdeveci
- Department of Physical Medicine and Rehabilitation, Ankara University, Faculty of Medicine, Ankara, Turkey
| | - Atilla H Elhan
- Department of Biostatistics, Ankara University, Faculty of Medicine, Ankara, Turkey
| | - Beyza D Erdoğan
- Department of Biostatistics, Ankara University, Faculty of Medicine, Ankara, Turkey
| | - Şehim Kutlay
- Department of Physical Medicine and Rehabilitation, Ankara University, Faculty of Medicine, Ankara, Turkey
| | - Derya Gökmen
- Department of Biostatistics, Ankara University, Faculty of Medicine, Ankara, Turkey
| | - Can Ateş
- Department of Biostatistics, Aksaray University, School of Medicine, Aksaray, Turkey
| | - Selcen Yüksel
- Department of Biostatistics, Ankara Yıldırım Beyazıt University, Faculty of Medicine, Ankara, Turkey
| | - Asa Lundgren-Nilsson
- Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Goteborg, Sweden
| | - Reuben Escorpizo
- Department of Rehabilitation and Movement Science, University of Vermont, Burlington, Vermont, USA
| | - Gerold Stucki
- Department of Health Sciences and Health Policy, University of Lucerne, Luzern, Switzerland
| | - Alan Tennant
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds and NIHR Leeds Biomedical Research Centre, Leeds, UK
| | - Philip G Conaghan
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds and NIHR Leeds Biomedical Research Centre, Leeds, UK
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Kelly A, Tymms K, Fallon K, Sumpton D, Tugwell P, Tunnicliffe D, Tong A. Qualitative Research in Rheumatology: An Overview of Methods and Contributions to Practice and Policy. J Rheumatol 2021; 48:6-15. [PMID: 32669447 DOI: 10.3899/jrheum.191368] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/26/2020] [Indexed: 12/12/2022]
Abstract
Patient-centered care is widely advocated in rheumatology. This involves collaboration among patients, caregivers, and health professionals and is particularly important in chronic rheumatic conditions because the disease and treatment can impair patients' health and well-being. Qualitative research can systematically generate insights about people's experiences, beliefs, and attitudes, which patients may not always express in clinical settings. These insights can address complex and challenging areas in rheumatology, such as treatment adherence and transition to adult healthcare services. Despite this, qualitative research comprises 1% of studies published in top-tier rheumatology journals. A better understanding about the effect and role, methods, and rigor of qualitative research is needed. This overview highlights the recent contributions of qualitative research in rheumatology, summarizes the common approaches and methods used, and outlines the key principles to guide appraisal of qualitative studies.
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Affiliation(s)
- Ayano Kelly
- A. Kelly, MBBS, FRACP, College of Health and Medicine, Australian National University, Canberra, and Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, and Canberra Rheumatology, Canberra, and Department of Rheumatology, The Canberra Hospital, Canberra, Australia;
| | - Kathleen Tymms
- K. Tymms, MBBS, FRACP, College of Health and Medicine, Australian National University, and Canberra Rheumatology, and Department of Rheumatology, The Canberra Hospital, Canberra, Australia
| | - Kieran Fallon
- K. Fallon, FACSEP, College of Health and Medicine, Australian National University, and Department of Rheumatology, The Canberra Hospital, Canberra, Australia
| | - Daniel Sumpton
- D. Sumpton, MBBS, FRACP, Centre for Kidney Research, The Children's Hospital at Westmead, and Sydney School of Public Health, The University of Sydney, and Department of Rheumatology, Concord Hospital, Sydney, Australia
| | - Peter Tugwell
- P. Tugwell, MD, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - David Tunnicliffe
- D. Tunnicliffe, PhD, A. Tong, PhD, Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, and Sydney School of Public Health, The University of Sydney, Sydney, Australia
| | - Allison Tong
- D. Tunnicliffe, PhD, A. Tong, PhD, Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, and Sydney School of Public Health, The University of Sydney, Sydney, Australia
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van Mulligen E, Weel AEAM, Kuijper TM, Hazes JMW, van der Helm-van Mil AHM, de Jong PHP. The impact of a disease flare during tapering of DMARDs on the lives of rheumatoid arthritis patients. Semin Arthritis Rheum 2020; 50:423-431. [PMID: 32224045 DOI: 10.1016/j.semarthrit.2020.02.011] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Revised: 01/28/2020] [Accepted: 02/21/2020] [Indexed: 01/16/2023]
Abstract
OBJECTIVES To determine the impact of a disease flare on patient reported outcome measures (PROMs) in rheumatoid arthritis (RA) patients, who are tapering treatment. METHODS Data were used from the TARA trial; a multicenter, randomized controlled trial in which RA patients, with a well-controlled disease (DAS≤2.4 and SJC≤1) for at least 6 months, gradually tapered their DMARDs. PROMs of patients with a flare (DAS>2.4 and/or SJC>1) were compared every three months before and after a flare with their own norm values. Linear Mixed Models were used to investigate whether a disease flare influenced functional ability (HAQ-DI), fatigue (BRAF-MDQ), quality of life (EQ-5D and SF36), anxiety and depression (HADS), morning stiffness, general health (GH) and worker productivity, and if so, the duration was determined. For unemployment and sick leave we used descriptive statistics. RESULTS A flare negatively influenced GH, morning stiffness, HAQ-DI, EQ-5D, BRAF-MDQ, and the SF36 physical component scale and this effect lasted >3 months. Except for the HAQ-DI, effect sizes exceeded the minimum clinically important differences (MCIDs). For the physical outcomes effects lasted >6 months. Worker productivity was not significantly affected by a flare. CONCLUSION A disease flare influenced patients' lives, the largest effect was seen in the physical outcomes, and lasted 6 months. Although on a group level effect sizes for the separate PROMs were not always significant or larger than specific MCIDs, a disease flare can still be of great importance for individual patients.
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Affiliation(s)
- E van Mulligen
- Department of Rheumatology, Erasmus MC, Rotterdam, the Netherlands.
| | - A E A M Weel
- Department of Rheumatology, Erasmus MC, Rotterdam, the Netherlands; Department of Rheumatology, Maasstad Hospital, Rotterdam, the Netherlands
| | - T M Kuijper
- Department of Rheumatology, Maasstad Hospital, Rotterdam, the Netherlands
| | - J M W Hazes
- Department of Rheumatology, Erasmus MC, Rotterdam, the Netherlands
| | - A H M van der Helm-van Mil
- Department of Rheumatology, Erasmus MC, Rotterdam, the Netherlands; Department of Rheumatology, LUMC, Leiden, the Netherlands
| | - P H P de Jong
- Department of Rheumatology, Erasmus MC, Rotterdam, the Netherlands
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Stiffness, pain, and joint counts in chronic chikungunya disease: relevance to disability and quality of life. Clin Rheumatol 2020; 39:1679-1686. [PMID: 31916107 DOI: 10.1007/s10067-019-04919-1] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Revised: 12/20/2019] [Accepted: 12/27/2019] [Indexed: 01/05/2023]
Abstract
INTRODUCTION/OBJECTIVES To characterize the importance of musculoskeletal stiffness in a cohort of chikungunya patients with chronic joint symptoms. METHOD Eighty-two patients were followed up 3 years after chikungunya infection. Tender and swollen joint counts, a pain intensity scale, Health Assessment Questionnaire-Disability Index (HAQ-DI), and the EuroQol EQ-5D quality of life instrument were completed. A musculoskeletal stiffness questionnaire provided scores for overall stiffness and its components: stiffness severity, physical impact, and psychosocial impact. RESULTS Patients had a mean age 51 ± 14 years. Sixty-seven patients were still experiencing chronic arthralgia. Musculoskeletal stiffness was reported by 43/67 patients with arthralgia and 3/15 patients without arthralgia. A physical impact of stiffness was reported by 87% patients and psychosocial impact by 71% patients. Mean tender joint count in patients reporting arthralgia was 6 ± 7, mean pain intensity 65 ± 20 out of 100, mean HAQ-DI was 0.54 ± 0.52, and mean EQ-VAS global health perception was 68 ± 62 out of 100. Stiffness severity was correlated with tender joint counts (ρ = 0.46) and pain intensity (ρ = 0.40). All three measures were equally well correlated with the EuroQol-VAS global health perception. Pain and tender joints were better correlated with the HAQ-DI (ρ = 0.68 and ρ = 0.63), but stiffness was more strongly correlated with several quality of life domains, including mobility. Swollen joints were a poor predictor of outcomes. CONCLUSIONS Musculoskeletal stiffness following chikungunya infection is distinct from arthralgia. It does not always occur in the same patients or with a corresponding intensity. Joint pain and stiffness may be independently associated with disability and quality of life assessments.
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Jagpal A, O’Beirne R, Morris MS, Johnson B, Willig J, Yun H, Cherrington AL, Fraenkel L, Curtis JR, Safford MM, Navarro-Millán I. Which patient reported outcome domains are important to the rheumatologists while assessing patients with rheumatoid arthritis? BMC Rheumatol 2019; 3:36. [PMID: 31517249 PMCID: PMC6727422 DOI: 10.1186/s41927-019-0087-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Accepted: 08/25/2019] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Patient-reported outcomes (PROs) aid in rheumatoid arthritis (RA) management, but it is not well understood which measures would be most relevant to the rheumatologists for making treatment decisions. METHODS We recruited rheumatologists nationally to participate in moderated structured group teleconference discussions using the nominal group technique. Participants in each group generated lists of the elements from patient's history and signs that they use to make treatment recommendations for RA. Each participant then selected the three most important elements from the generated list. The results of each group were then combined and summarized. RESULTS Twenty-five rheumatologists participated in 4 groups (group size ranged from 4 to 8) and 150 available ranking votes across all groups. The statements generated across the 4 groups were categorized into 13 topics (including symptoms, physical function, comorbidities, social aspects, physical findings, response to treatment, treatment adherence, pain management, side effects, tests, access to care, contraception, and organ involvement), 10 of which received ranking votes. Symptoms received the highest ranking (46% of votes), followed by physical function (16%), and physical findings (13%). Among the unranked topics, social aspects had the highest number of statements (8 statements). CONCLUSION Rheumatologists highly valued patient-reported RA symptoms and physical function to inform their treatment decisions, even above objective data such as physical findings and test results. These results can guide the selection of validated PRO measures to assess these domains to inform the clinical care of patients with rheumatoid arthritis.
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Affiliation(s)
| | | | | | | | - James Willig
- University of Alabama at Birmingham, Birmingham, AL USA
| | - Huifeng Yun
- University of Alabama at Birmingham, Birmingham, AL USA
| | | | | | | | - Monika M. Safford
- Division of General Internal Medicine, Weill Cornell Medicine, 420 E 70th St., LH-363, New York, NY 10021 USA
| | - Iris Navarro-Millán
- Division of General Internal Medicine, Weill Cornell Medicine, 420 E 70th St., LH-363, New York, NY 10021 USA
- Division of Rheumatology, Hospital for Special Surgery, 420 E 70th St., LH-363, New York, NY 10021 USA
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