Efficacy, tolerability and safety of cannabinoids in chronic pain associated with rheumatic diseases (fibromyalgia syndrome, back pain, osteoarthritis, rheumatoid arthritis)

Der Schmerz ◽  
2016 ◽  
Vol 30 (1) ◽  
pp. 47-61 ◽  
Author(s):  
M.-A. Fitzcharles ◽  
C. Baerwald ◽  
J. Ablin ◽  
W. Häuser
Keyword(s):  
Rheumatoid Arthritis ◽  
Chronic Pain ◽  
Back Pain ◽  
Rheumatic Diseases ◽  
Fibromyalgia Syndrome

Ankylosing spondylitis, other spondyloarthritides, and related conditions

2010 ◽  
pp. 3603-3616 ◽  
Author(s):  
J. Braun ◽  
J. Sieper
Keyword(s):  
Rheumatoid Arthritis ◽  
Back Pain ◽  
Ankylosing Spondylitis ◽  
Gastrointestinal Tract ◽  
Rheumatic Diseases ◽  
Skin Lesions ◽  
Inflammatory Back Pain ◽  
Psoriatic Skin ◽  
Inflammatory Rheumatic Diseases ◽  
History Of

The spondyloarthritides are a group of inflammatory rheumatic diseases with predominant involvement of axial and peripheral joints and entheses, together with other characteristic clinical features, including inflammatory back pain, sacroiliitis, peripheral arthritis (mainly in the legs), enthesitis, dactylitis, preceding infection of the urogenital/gastrointestinal tract, psoriatic skin lesions, Crohn-like gut lesions, anterior uveitis, and a family history of Spondyloarthritis. They are the second most frequent inflammatory rheumatic diseases after rheumatoid arthritis....

scholarly journals Burden of Rheumatic Diseases in A Rural Community of Bangladesh

2014 ◽  
Vol 15 (2) ◽  
pp. 125-130 ◽  
Author(s):  
Moniruzzaman Ahmed ◽  
Syed Atiqul Haq ◽  
Md. Nazrul Islam ◽  
Sree Krisna Banik ◽  
Mohammad Noor Alam
Keyword(s):  
Rheumatoid Arthritis ◽  
Low Back Pain ◽  
Back Pain ◽  
Rural Community ◽  
Rheumatic Diseases ◽  
Burden Of Illness ◽  
Adult Population ◽  
Inflammatory Rheumatic Diseases ◽  
Low Back ◽  
Osteoarthritis Of Knee

Objective: To estimate the magnitude, burden of illness and help-seeking behavior of patients with musculoskeletal complaints and to provide incidence of osteoarthritis, low back pain, fibromyalgia, rheumatoid arthritis, gout, and other inflammatory and non-inflammatory rheumatic diseases in a rural community of Bangladesh. Methods: The study was conducted in a few villages near Dhaka city which were considered to be a fairly representative sample of Bangladeshi rural population. Data were collected with the help of modified Community Oriented Program for Control of Rheumatic Diseases (COPCORD) questionnaire and a diagnosis using American College of Rheumatology (ACR) criteria was established. Results: During the 18 months study period, 2685 adults (15 years and above) were included. A total of 441 (M=163, F=278) developed new musculoskeletal (MSK) pain. The incidence rates were 10.9/100 person-years (PY) for the whole population, 8.2/100 PY for males and 13.6/100 PY for females. Nonspecific low back pain (NSLBP), fibromyalgia and osteoarthritis of knee were common MSK problems. A total of 302 patients had complaints of low back pain, of them 204 persons had noninflammatory low back pain; 262 respondents had complaints of knee pain, 38 had satisfied the criteria of knee OA; a total of 116 respondents suffered from fibromyalgia during the study period. Of the respondents (M=17, F=24) 41 had inflammatory arthropathy. Among the incidences of inflammatory arthritis, rheumatoid arthritis 120 (M=101, F=147), spondyloarthropathies 150 (M=252, F=49), ankylosing spondylitis 75 (M=151, F=0), reactive arthritis 50 (M=101, F=0), and psoriatic arthritis 256 (M=0, F=49) per 100,000 / PY respectively were observed, Conclusions: Rheumatic diseases are common in the rural community of Bangladesh, affecting nearly a quarter of adult population. Non-specific low back pain (NSLBP), fibromyalgia and osteoarthritis of knee joints are common joint disorders; point prevalence estimates of most common diagnoses were similar to other community surveys using COPCORD methodology.DOI: http://dx.doi.org/10.3329/jom.v15i2.20685 J MEDICINE 2014; 15 : 125-130

scholarly journals AB0165 CENTRAL SENSITIZATION IN RHEUMATOID ARTHRITIS

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 1109.2-1109
Author(s):  
E. Filatova ◽  
E. Pogozheva ◽  
V. Amirdzhanova ◽  
A. Karateev ◽  
A. Lila
Keyword(s):  
Quality Of Life ◽  
Rheumatoid Arthritis ◽  
Chronic Pain ◽  
Disease Activity ◽  
Rheumatic Diseases ◽  
Central Sensitization ◽  
Nociceptive Pain ◽  
The Central Nervous System ◽  
Clinically Significant

Background:Central Sensitization (CS) is a proposed physiological phenomenon in which dysregulation in the central nervous system causes neuronal dysregulation and hyperexcitability, resulting in hypersensitivity to both noxious and non-noxious stimuli. The term Central Sensitivity Syndrome (CSS) describes a group of medically indistinct (or nonspecific) disorders, such as fibromyalgia (FM) (1, 2).The prevalence of FM has been estimated at 2-7% in general population, but 10-30% patients with several rheumatic diseases fulfill the FM criteria, which suggests that they have not only nociceptive pain, but signs of CS or nocyplastic pain. (3)Objectives:to identify the signs of central sensitization (CS) in patients with rheumatoid arthritis (RA) with the central sensitization inventory (CSI).Methods:We examined 43 RA patients (mean age 45.5 [29.0; 53.0] years) with chronic pain. The patients underwent rheumatological examinations; CS was diagnosed using the CSI(4).; inflammation severity (DAS28 index), pain intensity (VAS), affective disorders (HADS), and quality of life (EQ-5D) were assessed.Results:We recruited 36 women and 7 men, mostly with moderate and high disease activity according to the DAS28 index.Using the CSI subclinical CS was found in 9 patients (20.9%), mild in 7 (16.3%), moderate in 8 (18.6%), severe in 16 (37.2%), and extremely severe sensitization in 3 (6.7%). Thus, 62.5% of patients with RA had had clinically significant CS (CS>40 points according to the CSI questionnaire).Patients with the presence of CS were characterized by more severe anxiety (10.0 [7.0; 11.0] vs 5.0 [3.0; 6.0], p=0.001) and lower quality of life (0.52 [-0.02; 0.52] vs 0.52 [0.52; 0.69], p= 0.02).The CSI tests not only pain but also other diseases associated with CS. Comorbid disorders associated with CS were found in patients with RA: 34.9% had cognitive impairment, 39.5% had signs of depression.Conclusion:Central sensitization was detected in 62.5% of patients with RA using the CSI questionnaire. CS is associated with anxiety and depression and negatively affects the patients’ quality of life. Chronic pain in RA can be of a mixed nature: nociceptive and neoplastic, which must be taken into account in the selection of personalized therapy.References:[1]Wolfe F. Fibromyalgianess. Arthritis Rheum. 2009; 61: 715-6.[2]Martins Rocha T, Pimenta S, Bernardo A, et al. Determinants of non-nociceptive pain in Rheumatoid Arthritis. Acta Reumatol Port. 2018 Oct-Dec;43(4):291-303.[3]Halioglu S, Carlioglu A., Akdeniz D., Karaaslan Y., Kosar A. Fibromyalgia in patients user rheumatic patients with several rheumatic diseases: prevalence and relationship with disease activity. Reumatol. Int. 2014 Sep; 34(90:1275-80 doi:10.1007/s00296-014-2972.Disclosure of Interests:None declared

Time-trends in Opioid Use Disorder Hospitalizations in Gout, Rheumatoid arthritis, Fibromyalgia, Osteoarthritis, and Low Back Pain

2020 ◽  
pp. jrheum.191370
Author(s):  
Jasvinder A. Singh ◽  
John D. Cleveland
Keyword(s):  
Rheumatoid Arthritis ◽  
Low Back Pain ◽  
Back Pain ◽  
Rheumatic Diseases ◽  
Time Trends ◽  
Musculoskeletal Diseases ◽  
Opioid Use Disorder ◽  
Hospital Charges ◽  
Low Back ◽  
Opioid Use

Objective To examine opioid use disorder (OUD)-related hospitalizations and associated healthcare utilization outcomes in people with five common musculoskeletal diseases. Methods We used the U.S. National Inpatient Sample (NIS) data from 1998-2014 to examine the rates of OUD-hospitalizations (per 100,000 NIS claims overall), time-trends and outcomes in five, common rheumatic diseases, gout, rheumatoid arthritis (RA), fibromyalgia, osteoarthritis (OA), and low back pain (LBP). Results OUD-hospitalization rate per 100,000 total NIS claims in 1998-2000 versus 2015-2016 (and increase) were as follows: gout, 0.05 versus 1.88 (36-fold); OA, 0.68 versus 10.22 (14-fold); fibromyalgia, 0.53 versus 6.98 (12-fold); RA, 0.30 versus 3.16 (9.5-fold); and LBP, 1.17 versus 7.64 (5.5-fold). The median hospital charges and hospital stays for OUD-hospitalizations were: gout, $18,363 and 2.5 days; RA, $26,639 and 2.4 days; fibromyalgia, $15,772 and 2.1 days; OA, $17,398 and 2.4 days; and LBP, $22,794 and 2 days. In-hospital mortality rates ranged 0.9% for LBP versus 1.7% for gout with OUD-hospitalizations. Compared to the those without each musculoskeletal disorder, age, sex, race and insurance payer adjusted total hospital charges (inflation-adjusted) for OUD-hospitalizations with each rheumatic disease were: gout, $697 higher; OA, $4,759 lower; fibromyalgia, $2,082 lower; RA, $1,258 lower; and LBP, $4,944 lower. Conclusion OUD-hospitalizations increased in all 5 musculoskeletal diseases studied, but the rate of increase differed. Awareness of these OUD-hospitalization trends in 5 musculoskeletal diseases among providers, policy-makers and patients is important. Development and implementation of interventions, policies and practices to potentially reduce OUD-associated impact in people with rheumatic diseases is needed.

Opioid crisis in primary care? An audit of high-dose opioid prescribing at Bangholm GP Practice

2020 ◽  
Vol 70 (suppl 1) ◽  
pp. bjgp20X711581
Author(s):  
Charlotte Greene ◽  
Alice Pearson
Keyword(s):  
Chronic Pain ◽  
Back Pain ◽  
Practice Guidelines ◽  
Best Practice ◽  
Evidence Base ◽  
High Dose ◽  
Opioid Prescription ◽  
Opioid Prescribing ◽  
Best Practice Guidelines

BackgroundOpioids are effective analgesics for acute and palliative pain, but there is no evidence base for long-term pain relief. They also carry considerable risks such as overdose and dependence. Despite this, they are increasingly prescribed for chronic pain. In the UK, opioid prescribing more than doubled between 1998 and 2018.AimAn audit at Bangholm GP Practice to understand the scale of high-strength opioid prescribing. The aim of the audit was to find out if indications, length of prescription, discussion, and documentation at initial consultation and review process were consistent with best-practice guidelines.MethodA search on Scottish Therapeutics Utility for patients prescribed an average daily dose of opioid equivalent ≥50 mg morphine between 1 July 2019 and 1 October 2019, excluding methadone, cancer pain, or palliative prescriptions. The Faculty of Pain Medicine’s best-practice guidelines were used.ResultsDemographics: 60 patients (37 females), average age 62, 28% registered with repeat opioid prescription, 38% comorbid depression. Length of prescription: average 6 years, 57% >5 years, 22% >10 years. Opioid: 52% tramadol, 23% on two opioids. Indications: back pain (42%), osteoarthritis (12%), fibromyalgia (10%). Initial consultation: 7% agreed outcomes, 35% follow-up documented. Review: 56% 4-week, 70% past year.ConclusionOpioid prescribing guidelines are not followed. The significant issues are: long-term prescriptions for chronic pain, especially back pain; new patients registering with repeat prescriptions; and no outcomes of treatment agreed, a crucial message is the goal is pain management rather than relief. Changes have been introduced at the practice: a patient information sheet, compulsory 1-month review for new patients on opioids, and in-surgery pain referrals.

scholarly journals AB0210 ACREULAR: AN R PACKAGE FOR THE CALCULATION AND VISUALISATION OF ACR/EULAR RELATED RHEUMATOID ARTHRITIS MEASURES

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 1405.1-1406
Author(s):  
F. Morton ◽  
J. Nijjar ◽  
C. Goodyear ◽  
D. Porter
Keyword(s):  
Rheumatoid Arthritis ◽  
Functional Status ◽  
Rheumatic Diseases ◽  
Web Application ◽  
R Package ◽  
Diagnostic Classification ◽  
Microsoft Excel ◽  
Link Type ◽  
Large Joint ◽  
Programming Skills

Background:The American College of Rheumatology (ACR) and the European League Against Rheumatism (EULAR) individually and collaboratively have produced/recommended diagnostic classification, response and functional status criteria for a range of different rheumatic diseases. While there are a number of different resources available for performing these calculations individually, currently there are no tools available that we are aware of to easily calculate these values for whole patient cohorts.Objectives:To develop a new software tool, which will enable both data analysts and also researchers and clinicians without programming skills to calculate ACR/EULAR related measures for a number of different rheumatic diseases.Methods:Criteria that had been developed by ACR and/or EULAR that had been approved for the diagnostic classification, measurement of treatment response and functional status in patients with rheumatoid arthritis were identified. Methods were created using the R programming language to allow the calculation of these criteria, which were incorporated into an R package. Additionally, an R/Shiny web application was developed to enable the calculations to be performed via a web browser using data presented as CSV or Microsoft Excel files.Results:acreular is a freely available, open source R package (downloadable fromhttps://github.com/fragla/acreular) that facilitates the calculation of ACR/EULAR related RA measures for whole patient cohorts. Measures, such as the ACR/EULAR (2010) RA classification criteria, can be determined using precalculated values for each component (small/large joint counts, duration in days, normal/abnormal acute-phase reactants, negative/low/high serology classification) or by providing “raw” data (small/large joint counts, onset/assessment dates, ESR/CRP and CCP/RF laboratory values). Other measures, including EULAR response and ACR20/50/70 response, can also be calculated by providing the required information. The accompanying web application is included as part of the R package but is also externally hosted athttps://fragla.shinyapps.io/shiny-acreular. This enables researchers and clinicians without any programming skills to easily calculate these measures by uploading either a Microsoft Excel or CSV file containing their data. Furthermore, the web application allows the incorporation of additional study covariates, enabling the automatic calculation of multigroup comparative statistics and the visualisation of the data through a number of different plots, both of which can be downloaded.Figure 1.The Data tab following the upload of data. Criteria are calculated by the selecting the appropriate checkbox.Figure 2.A density plot of DAS28 scores grouped by ACR/EULAR 2010 RA classification. Statistical analysis has been performed and shows a significant difference in DAS28 score between the two groups.Conclusion:The acreular R package facilitates the easy calculation of ACR/EULAR RA related disease measures for whole patient cohorts. Calculations can be performed either from within R or by using the accompanying web application, which also enables the graphical visualisation of data and the calculation of comparative statistics. We plan to further develop the package by adding additional RA related criteria and by adding ACR/EULAR related measures for other rheumatic disorders.Disclosure of Interests:Fraser Morton: None declared, Jagtar Nijjar Shareholder of: GlaxoSmithKline plc, Consultant of: Janssen Pharmaceuticals UK, Employee of: GlaxoSmithKline plc, Paid instructor for: Janssen Pharmaceuticals UK, Speakers bureau: Janssen Pharmaceuticals UK, AbbVie, Carl Goodyear: None declared, Duncan Porter: None declared

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