ABSTRACT Background It is known that the knee is divided into 3 compartments: medial, lateral and... more ABSTRACT Background It is known that the knee is divided into 3 compartments: medial, lateral and femuro-patelar. The medial compartment is more exposed to stress due to the knee biomechanics where the weight of load is in biggest proportion. The hemi-paretic patient supports modified forces in the knee-joint due to the muscle spasticity, fact which determines a redistribution of forces, so that through quadriceps failure and gastrocnemian muscle spasticity it would generate genu recurvatum, with modified biomechanics and redistributed areasof taking weight, making a vicious circle. Objectives We propose to prevent the formation of genu recurvatum at patients who suffered a stroke with hemi-paresis and reduce the changes at those who have already developed these modifications. Methods There were 26 patients selected for this study (14 women and 12 men, all over 45 years old) with a 2-year-old stroke, with secondary developed knee osteoarthritis at hemi-paretic lower limb. The patients were evaluated both through muscular and joint tests as well as knee front and profile X-rays. These patients were divided in 2 study groups. Both groups followed a rehabilitation program – physiotherapy, peripheral magnetic stimulation on the muscle motor points -18 days, when we followed the toning of the failing muscles to correct the knee muscle balance: quadriceps and tibialis anterioris muscles – to counteract the gastrocnemianus muscle spasticity, correcting position of genu recurvatum and ankle orthotic. The patients of the Study Group A followed this program while being hospitalized – 18 days, repeated and adjusted at 3 months. The patients of Study Group B of followed this program for 6 months with adjustedkineticprogram, the magnetic stimulation being applied 10 days/month. The evaluation was also initially made at 6 months with joint testing scale, and VAS pain scale, the 6MWD (6 Minute Walking Distance test), the WOMAC (Western Ontario and McMaster Universities Arthritis Index), and Ashworth spasticity testing scale (from 0 to 5). Results Group A did not obtain any improvement at the joint testing. The pain in the knee was reduced from 70.2 to 51.4 mm on VAS scale. The 6 MWD test made by moving with crutch recorded an average improvement of 15.6 m. The WOMAC scale recorded a score drop from 74.2 to 41.4. The Ashworth scale dropped from 3.5 to 3. Group B presented better results, a reduction of genu recurvatum observed and proved by the improvement with 5 degrees at the joint testing for extension. The VAS scale improved from 71.3 to 34.5. The 6 MWD test proved a growth in the walking capacity with 23.4 m. The WOMAC scale recorded a significant drop from 78.4 to 32.3, and Ashworth scale dropped from 3.6 to 2.7. Conclusions Sustained physical therapy correctly executed with periodical adjustment of the program as well as the repetitive magnetic stimulation peripherally applied on the failing muscle groups prove that the invalidity induced by genu recurvatum at this special category ofpatients is reduced functional as well as by objective assessment through evaluation tests. Disclosure of Interest None Declared
ABSTRACT Background More than 90% of people with rheumatoid arthritis (RA) develop symptoms in th... more ABSTRACT Background More than 90% of people with rheumatoid arthritis (RA) develop symptoms in the foot and ankle over the course of the disease. While each individual deformity is common, it is the combination of deformities that compounds the problem.(1) Objectives The objective of our study is to evaluate the predictive factors for forefoot impairments in different stages of rheumatoid arthritis (RA) patients. Methods We followed for 3 years 34 patients with RA. The patients were assessed twice: to the beginning of study and after 1 year. We evaluated the morning stiffness (minutes), the PJN, SJN-number of painful and swollen of the metatarsophalangeal (MTP) joints and, the level of pain (with VAS 100mm), the Health Assessment Questionnaire-walking subscale. The results were analyzed with the statistics programme SPSS. Results Pain and swelling MTP joint was present in 68% of patients (the average pain on VAS-6.89). The walking disability was present in 47% of patients. We also found an important correlation between the level of pain, swelling and walking disability (HAQ) (R 0.698, R2 0.551). Conclusions The significant correlation between the parameters analyzed in our study enables the supporting of the necessity for paying a considerable attention to forefoot assessment in RA patients because of important influence of walking disabilities in active life and participation in work, social and self-care activities. References Disclosure of Interest None declared DOI 10.1136/annrheumdis-2014-eular.5106
Chronic peripheral obstructive arteriopathies (CPOA), together with their determinations, play an... more Chronic peripheral obstructive arteriopathies (CPOA), together with their determinations, play an important role in the elderly pathology and represent one of the most frequent causes of disability, thus having a negative impact on the patient's quality of life. Therefore, in this clinical randomized trial we proposed to study the efficiency of several treatment methods based on physical exercise together with other therapeutical approaches specific to physical medicine such as galvanic baths. We formed a group of 111 patients diagnosed with peripheral arterial disease in inferior limbs randomized into three groups: the control group (drug treatment and hygiene-dietary), the exercise group (12 weeks supervised exercises program, followed by another 12 weeks home unsupervised exercises) and the exercise and procedure group (kinesitherapy and galvanic baths). All the subjects performed the exercise treadmill test, according to the Gardner protocol, at the beginning of the study, a...
ABSTRACT Background It is known that the knee is divided into 3 compartments: medial, lateral and... more ABSTRACT Background It is known that the knee is divided into 3 compartments: medial, lateral and femuro-patelar. The medial compartment is more exposed to stress due to the knee biomechanics where the weight of load is in biggest proportion. The hemi-paretic patient supports modified forces in the knee-joint due to the muscle spasticity, fact which determines a redistribution of forces, so that through quadriceps failure and gastrocnemian muscle spasticity it would generate genu recurvatum, with modified biomechanics and redistributed areasof taking weight, making a vicious circle. Objectives We propose to prevent the formation of genu recurvatum at patients who suffered a stroke with hemi-paresis and reduce the changes at those who have already developed these modifications. Methods There were 26 patients selected for this study (14 women and 12 men, all over 45 years old) with a 2-year-old stroke, with secondary developed knee osteoarthritis at hemi-paretic lower limb. The patients were evaluated both through muscular and joint tests as well as knee front and profile X-rays. These patients were divided in 2 study groups. Both groups followed a rehabilitation program – physiotherapy, peripheral magnetic stimulation on the muscle motor points -18 days, when we followed the toning of the failing muscles to correct the knee muscle balance: quadriceps and tibialis anterioris muscles – to counteract the gastrocnemianus muscle spasticity, correcting position of genu recurvatum and ankle orthotic. The patients of the Study Group A followed this program while being hospitalized – 18 days, repeated and adjusted at 3 months. The patients of Study Group B of followed this program for 6 months with adjustedkineticprogram, the magnetic stimulation being applied 10 days/month. The evaluation was also initially made at 6 months with joint testing scale, and VAS pain scale, the 6MWD (6 Minute Walking Distance test), the WOMAC (Western Ontario and McMaster Universities Arthritis Index), and Ashworth spasticity testing scale (from 0 to 5). Results Group A did not obtain any improvement at the joint testing. The pain in the knee was reduced from 70.2 to 51.4 mm on VAS scale. The 6 MWD test made by moving with crutch recorded an average improvement of 15.6 m. The WOMAC scale recorded a score drop from 74.2 to 41.4. The Ashworth scale dropped from 3.5 to 3. Group B presented better results, a reduction of genu recurvatum observed and proved by the improvement with 5 degrees at the joint testing for extension. The VAS scale improved from 71.3 to 34.5. The 6 MWD test proved a growth in the walking capacity with 23.4 m. The WOMAC scale recorded a significant drop from 78.4 to 32.3, and Ashworth scale dropped from 3.6 to 2.7. Conclusions Sustained physical therapy correctly executed with periodical adjustment of the program as well as the repetitive magnetic stimulation peripherally applied on the failing muscle groups prove that the invalidity induced by genu recurvatum at this special category ofpatients is reduced functional as well as by objective assessment through evaluation tests. Disclosure of Interest None Declared
ABSTRACT Background More than 90% of people with rheumatoid arthritis (RA) develop symptoms in th... more ABSTRACT Background More than 90% of people with rheumatoid arthritis (RA) develop symptoms in the foot and ankle over the course of the disease. While each individual deformity is common, it is the combination of deformities that compounds the problem.(1) Objectives The objective of our study is to evaluate the predictive factors for forefoot impairments in different stages of rheumatoid arthritis (RA) patients. Methods We followed for 3 years 34 patients with RA. The patients were assessed twice: to the beginning of study and after 1 year. We evaluated the morning stiffness (minutes), the PJN, SJN-number of painful and swollen of the metatarsophalangeal (MTP) joints and, the level of pain (with VAS 100mm), the Health Assessment Questionnaire-walking subscale. The results were analyzed with the statistics programme SPSS. Results Pain and swelling MTP joint was present in 68% of patients (the average pain on VAS-6.89). The walking disability was present in 47% of patients. We also found an important correlation between the level of pain, swelling and walking disability (HAQ) (R 0.698, R2 0.551). Conclusions The significant correlation between the parameters analyzed in our study enables the supporting of the necessity for paying a considerable attention to forefoot assessment in RA patients because of important influence of walking disabilities in active life and participation in work, social and self-care activities. References Disclosure of Interest None declared DOI 10.1136/annrheumdis-2014-eular.5106
ABSTRACT Background It is known that patients with rheumatoid arthritis have frequently associate... more ABSTRACT Background It is known that patients with rheumatoid arthritis have frequently associated osteoporosis, both within the context of the disease and due to the treatment with corticosteroids. Objectives We are to evaluate the progression of osteoporosis at patients with rheumatoid arthritis and osteoporosis - in therapy with bisphosphonates, D3 vitamin and 500mg calcium daily-at two groups of patients; one group in remissive treatment with leflunomid versus the other group in treatment with biological agents. For this evaluation we have developed a retrospective study within a 5-year period of time, 2007-2012. Methods We have analyzed a number of 48 patients split in two homogeneous groups – each with 24 patients; all the patients have been diagnosed with osteoporosis, T score in between -2,5 and -4,2 standard deviation. The A Group has received a treatment with 20 mg of leflunomid daily and non steroidal anti-inflammatory drugs. The B Group has received a treatment with biological agents: infliximab 3mg/kg in infusion at 2 months, etanercept 50mg weekly and adalimumab 40 mg once at two weeks. Both groups have received bisphosphonates in therapeutic doses being evaluated for osteoporosis. The median patients` age was of 52.1 of which only 38 patients were at the beginning of the postmenopausal study. There was evaluated the level of the disease activity by the 28 DAS score. We also mention that at 12 patients treated with leflunomid there was necessary corticosteroids therapy in doses of 16 mg per day with a diminishing level of 8 mg on a period of 2 up to 6 months; meanwhile there was necessary the pulse therapy with metilprednisolon 1 mg/kg at 6 patients for a period of 3 days. Patients in biological therapy did not need corticosteroids therapy. We evaluated a witness group of 14 patients with rheumatoid arthritis and osteopeny who received only the supplement with D3 and 500mg of Calcium per day. Results The A group of study presented the maintenance of median of T score at -3,1 standard deviation, and DAS 28 median was lowered from 4.2 to 3.6. The B Group of study presented the diminishing of the level of osteoporosis from a T score from -3.9 to 3.2; the median of 28 DAS was reduced from 4.2 to 3.1. These levels showed osteopeny a T score from -1.8 to -2.4 with a passing to osteoporosis at 6 patients who needed to receive bisphosphonates, and the DAS 28 score presented a raise from 2.9 la 3.4 Conclusions The diminishing level of osteoporosis with 0.2 standard deviations per year at the group of patients in therapy with biologic agents as compared to the group treated with leflunomid proves the fact that despite the beginning of the first group with lower values it obtained better results in both reducing the level of disease activity and the pathogenic immune inflammatory context. The witness group of patients with osteopeny proves both the role played by the patients’ age in the beginning of menopause at 4 patients as well as the presence of the immune inflammatory factor in generating osteoporosis to patients with rheumatoid arthritis. Disclosure of Interest None Declared
ABSTRACT Background It is known that the knee is divided into 3 compartments: medial, lateral and... more ABSTRACT Background It is known that the knee is divided into 3 compartments: medial, lateral and femuro-patelar. The medial compartment is more exposed to stress due to the knee biomechanics where the weight of load is in biggest proportion. The hemi-paretic patient supports modified forces in the knee-joint due to the muscle spasticity, fact which determines a redistribution of forces, so that through quadriceps failure and gastrocnemian muscle spasticity it would generate genu recurvatum, with modified biomechanics and redistributed areasof taking weight, making a vicious circle. Objectives We propose to prevent the formation of genu recurvatum at patients who suffered a stroke with hemi-paresis and reduce the changes at those who have already developed these modifications. Methods There were 26 patients selected for this study (14 women and 12 men, all over 45 years old) with a 2-year-old stroke, with secondary developed knee osteoarthritis at hemi-paretic lower limb. The patients were evaluated both through muscular and joint tests as well as knee front and profile X-rays. These patients were divided in 2 study groups. Both groups followed a rehabilitation program – physiotherapy, peripheral magnetic stimulation on the muscle motor points -18 days, when we followed the toning of the failing muscles to correct the knee muscle balance: quadriceps and tibialis anterioris muscles – to counteract the gastrocnemianus muscle spasticity, correcting position of genu recurvatum and ankle orthotic. The patients of the Study Group A followed this program while being hospitalized – 18 days, repeated and adjusted at 3 months. The patients of Study Group B of followed this program for 6 months with adjustedkineticprogram, the magnetic stimulation being applied 10 days/month. The evaluation was also initially made at 6 months with joint testing scale, and VAS pain scale, the 6MWD (6 Minute Walking Distance test), the WOMAC (Western Ontario and McMaster Universities Arthritis Index), and Ashworth spasticity testing scale (from 0 to 5). Results Group A did not obtain any improvement at the joint testing. The pain in the knee was reduced from 70.2 to 51.4 mm on VAS scale. The 6 MWD test made by moving with crutch recorded an average improvement of 15.6 m. The WOMAC scale recorded a score drop from 74.2 to 41.4. The Ashworth scale dropped from 3.5 to 3. Group B presented better results, a reduction of genu recurvatum observed and proved by the improvement with 5 degrees at the joint testing for extension. The VAS scale improved from 71.3 to 34.5. The 6 MWD test proved a growth in the walking capacity with 23.4 m. The WOMAC scale recorded a significant drop from 78.4 to 32.3, and Ashworth scale dropped from 3.6 to 2.7. Conclusions Sustained physical therapy correctly executed with periodical adjustment of the program as well as the repetitive magnetic stimulation peripherally applied on the failing muscle groups prove that the invalidity induced by genu recurvatum at this special category ofpatients is reduced functional as well as by objective assessment through evaluation tests. Disclosure of Interest None Declared
ABSTRACT Background More than 90% of people with rheumatoid arthritis (RA) develop symptoms in th... more ABSTRACT Background More than 90% of people with rheumatoid arthritis (RA) develop symptoms in the foot and ankle over the course of the disease. While each individual deformity is common, it is the combination of deformities that compounds the problem.(1) Objectives The objective of our study is to evaluate the predictive factors for forefoot impairments in different stages of rheumatoid arthritis (RA) patients. Methods We followed for 3 years 34 patients with RA. The patients were assessed twice: to the beginning of study and after 1 year. We evaluated the morning stiffness (minutes), the PJN, SJN-number of painful and swollen of the metatarsophalangeal (MTP) joints and, the level of pain (with VAS 100mm), the Health Assessment Questionnaire-walking subscale. The results were analyzed with the statistics programme SPSS. Results Pain and swelling MTP joint was present in 68% of patients (the average pain on VAS-6.89). The walking disability was present in 47% of patients. We also found an important correlation between the level of pain, swelling and walking disability (HAQ) (R 0.698, R2 0.551). Conclusions The significant correlation between the parameters analyzed in our study enables the supporting of the necessity for paying a considerable attention to forefoot assessment in RA patients because of important influence of walking disabilities in active life and participation in work, social and self-care activities. References Disclosure of Interest None declared DOI 10.1136/annrheumdis-2014-eular.5106
Chronic peripheral obstructive arteriopathies (CPOA), together with their determinations, play an... more Chronic peripheral obstructive arteriopathies (CPOA), together with their determinations, play an important role in the elderly pathology and represent one of the most frequent causes of disability, thus having a negative impact on the patient's quality of life. Therefore, in this clinical randomized trial we proposed to study the efficiency of several treatment methods based on physical exercise together with other therapeutical approaches specific to physical medicine such as galvanic baths. We formed a group of 111 patients diagnosed with peripheral arterial disease in inferior limbs randomized into three groups: the control group (drug treatment and hygiene-dietary), the exercise group (12 weeks supervised exercises program, followed by another 12 weeks home unsupervised exercises) and the exercise and procedure group (kinesitherapy and galvanic baths). All the subjects performed the exercise treadmill test, according to the Gardner protocol, at the beginning of the study, a...
ABSTRACT Background It is known that the knee is divided into 3 compartments: medial, lateral and... more ABSTRACT Background It is known that the knee is divided into 3 compartments: medial, lateral and femuro-patelar. The medial compartment is more exposed to stress due to the knee biomechanics where the weight of load is in biggest proportion. The hemi-paretic patient supports modified forces in the knee-joint due to the muscle spasticity, fact which determines a redistribution of forces, so that through quadriceps failure and gastrocnemian muscle spasticity it would generate genu recurvatum, with modified biomechanics and redistributed areasof taking weight, making a vicious circle. Objectives We propose to prevent the formation of genu recurvatum at patients who suffered a stroke with hemi-paresis and reduce the changes at those who have already developed these modifications. Methods There were 26 patients selected for this study (14 women and 12 men, all over 45 years old) with a 2-year-old stroke, with secondary developed knee osteoarthritis at hemi-paretic lower limb. The patients were evaluated both through muscular and joint tests as well as knee front and profile X-rays. These patients were divided in 2 study groups. Both groups followed a rehabilitation program – physiotherapy, peripheral magnetic stimulation on the muscle motor points -18 days, when we followed the toning of the failing muscles to correct the knee muscle balance: quadriceps and tibialis anterioris muscles – to counteract the gastrocnemianus muscle spasticity, correcting position of genu recurvatum and ankle orthotic. The patients of the Study Group A followed this program while being hospitalized – 18 days, repeated and adjusted at 3 months. The patients of Study Group B of followed this program for 6 months with adjustedkineticprogram, the magnetic stimulation being applied 10 days/month. The evaluation was also initially made at 6 months with joint testing scale, and VAS pain scale, the 6MWD (6 Minute Walking Distance test), the WOMAC (Western Ontario and McMaster Universities Arthritis Index), and Ashworth spasticity testing scale (from 0 to 5). Results Group A did not obtain any improvement at the joint testing. The pain in the knee was reduced from 70.2 to 51.4 mm on VAS scale. The 6 MWD test made by moving with crutch recorded an average improvement of 15.6 m. The WOMAC scale recorded a score drop from 74.2 to 41.4. The Ashworth scale dropped from 3.5 to 3. Group B presented better results, a reduction of genu recurvatum observed and proved by the improvement with 5 degrees at the joint testing for extension. The VAS scale improved from 71.3 to 34.5. The 6 MWD test proved a growth in the walking capacity with 23.4 m. The WOMAC scale recorded a significant drop from 78.4 to 32.3, and Ashworth scale dropped from 3.6 to 2.7. Conclusions Sustained physical therapy correctly executed with periodical adjustment of the program as well as the repetitive magnetic stimulation peripherally applied on the failing muscle groups prove that the invalidity induced by genu recurvatum at this special category ofpatients is reduced functional as well as by objective assessment through evaluation tests. Disclosure of Interest None Declared
ABSTRACT Background More than 90% of people with rheumatoid arthritis (RA) develop symptoms in th... more ABSTRACT Background More than 90% of people with rheumatoid arthritis (RA) develop symptoms in the foot and ankle over the course of the disease. While each individual deformity is common, it is the combination of deformities that compounds the problem.(1) Objectives The objective of our study is to evaluate the predictive factors for forefoot impairments in different stages of rheumatoid arthritis (RA) patients. Methods We followed for 3 years 34 patients with RA. The patients were assessed twice: to the beginning of study and after 1 year. We evaluated the morning stiffness (minutes), the PJN, SJN-number of painful and swollen of the metatarsophalangeal (MTP) joints and, the level of pain (with VAS 100mm), the Health Assessment Questionnaire-walking subscale. The results were analyzed with the statistics programme SPSS. Results Pain and swelling MTP joint was present in 68% of patients (the average pain on VAS-6.89). The walking disability was present in 47% of patients. We also found an important correlation between the level of pain, swelling and walking disability (HAQ) (R 0.698, R2 0.551). Conclusions The significant correlation between the parameters analyzed in our study enables the supporting of the necessity for paying a considerable attention to forefoot assessment in RA patients because of important influence of walking disabilities in active life and participation in work, social and self-care activities. References Disclosure of Interest None declared DOI 10.1136/annrheumdis-2014-eular.5106
ABSTRACT Background It is known that patients with rheumatoid arthritis have frequently associate... more ABSTRACT Background It is known that patients with rheumatoid arthritis have frequently associated osteoporosis, both within the context of the disease and due to the treatment with corticosteroids. Objectives We are to evaluate the progression of osteoporosis at patients with rheumatoid arthritis and osteoporosis - in therapy with bisphosphonates, D3 vitamin and 500mg calcium daily-at two groups of patients; one group in remissive treatment with leflunomid versus the other group in treatment with biological agents. For this evaluation we have developed a retrospective study within a 5-year period of time, 2007-2012. Methods We have analyzed a number of 48 patients split in two homogeneous groups – each with 24 patients; all the patients have been diagnosed with osteoporosis, T score in between -2,5 and -4,2 standard deviation. The A Group has received a treatment with 20 mg of leflunomid daily and non steroidal anti-inflammatory drugs. The B Group has received a treatment with biological agents: infliximab 3mg/kg in infusion at 2 months, etanercept 50mg weekly and adalimumab 40 mg once at two weeks. Both groups have received bisphosphonates in therapeutic doses being evaluated for osteoporosis. The median patients` age was of 52.1 of which only 38 patients were at the beginning of the postmenopausal study. There was evaluated the level of the disease activity by the 28 DAS score. We also mention that at 12 patients treated with leflunomid there was necessary corticosteroids therapy in doses of 16 mg per day with a diminishing level of 8 mg on a period of 2 up to 6 months; meanwhile there was necessary the pulse therapy with metilprednisolon 1 mg/kg at 6 patients for a period of 3 days. Patients in biological therapy did not need corticosteroids therapy. We evaluated a witness group of 14 patients with rheumatoid arthritis and osteopeny who received only the supplement with D3 and 500mg of Calcium per day. Results The A group of study presented the maintenance of median of T score at -3,1 standard deviation, and DAS 28 median was lowered from 4.2 to 3.6. The B Group of study presented the diminishing of the level of osteoporosis from a T score from -3.9 to 3.2; the median of 28 DAS was reduced from 4.2 to 3.1. These levels showed osteopeny a T score from -1.8 to -2.4 with a passing to osteoporosis at 6 patients who needed to receive bisphosphonates, and the DAS 28 score presented a raise from 2.9 la 3.4 Conclusions The diminishing level of osteoporosis with 0.2 standard deviations per year at the group of patients in therapy with biologic agents as compared to the group treated with leflunomid proves the fact that despite the beginning of the first group with lower values it obtained better results in both reducing the level of disease activity and the pathogenic immune inflammatory context. The witness group of patients with osteopeny proves both the role played by the patients’ age in the beginning of menopause at 4 patients as well as the presence of the immune inflammatory factor in generating osteoporosis to patients with rheumatoid arthritis. Disclosure of Interest None Declared
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