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Pavel Horak - One of the best experts on this subject based on the ideXlab platform.
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op0305 psychological profile of scleroderma patients described by multidimensional minnesota multiphasic personality inventory mmpi ii and beck depression inventory tests bdi ii
Annals of the Rheumatic Diseases, 2016Co-Authors: A Smržova, L Hubackova, S Kreiselova, M Schubertova, Martina Skacelova, Anna Petrackova, Eva Kriegova, Z Heřmanova, Frantisek Mrazek, Pavel HorakAbstract:Background Scleroderma is a systemic multiorgan autoimmune disease with high mortality and morbidity rates. In serious disease with organ manifestation, quality of life and perception of health is deeply influenced in these patients. The face changes and fibrosis of skin, digital ulceration contribute to the psychological trauma of these patients. Only little is known about the objective evaluation of systemic scleroderma psychological impact. Objectives The aim of study is detection of psychological profile and manifestation of depression in scleroderma patients. Methods From March 2015 to January 2016 we examined 42 patients with scleroderma Patients were evaluated by MMPI-II (The Minnesota Multiphasic Personality Inventory test, standardized psychometric test of adult personality and psychopathology) and BDI-II tests (Beck Depression Inventory test of depression). The data obtained from the multidimensional pachological testing were correlated with the clinical and laboratory pheonotype of the disease (smoking status, BMI, arterial hypertension, diabetes, lipid profile, family history of cardiovascular event, lung manifestation, pulmonary hypertension, digital ulceration, damage of gastrointestinal tract, myositis, renal crisis, autoantibody profile, and presence of cardiovascular events) Statistical tests (descriptive statistic, Student t-test, Spearman test, ANOVA) were performed and p-value ≤0.05 was considered as significant. Results In this study42 patient were included (6 men, 36 women. mean of age – 57,8±9.4y., duration of disease 8,6±8.2y. duration of Raynauds Phenomenon 13,4±11,2y.), 12 patient have diffuse form and 30 patient limited form of scleroderma. Subjective perceived depression detected by BDI II test was present in 16 patients (32.1%, mild 7, moderate 7 and 2 severe). BDI-II correlated with anticentromer antibodies (p=0.05), total cholesterol (p=0.008), LDL (p=0.05) and, gastrointestinal manifestation (p=0.002). Scale L, F and K in MMPI-II test in typical sequence for depressive score was detected in 38 patients (90%). The main scales of MMPI-II test were detected in followed percentage values: – Hypochondria (54.7%), Depression (33.3%), Converse hysteria (28.6%), Psychopathic (14.3%), Masculinity/Felinity (7.1%), Paranoia (9.5%), Psychastenia (26.2%), Schizophrenia (21.4%), Hypomania (11.9%) and Social introverse (33.3%). Conclusions The limitation of these data is fact, that these tests showed some of trends of symptoms typical for psychological and personal manifestation; they could not be regarded as a diagnostic test. Patients with scleroderma have high prevalention of subjective perceived depression. In this study we detected high prevalence of depression, social introversion and trend toward somatisation. It will be very useful to be aware of this subjective perception of scleroderma patient and cooperated with psychologist or psychiatrist to improve quality of life and sometimes also morbidity of these seriously ill patients. Acknowledgement Grant support: MZ CR VES15–28659A Disclosure of Interest None declared
P Butler - One of the best experts on this subject based on the ideXlab platform.
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fri0287 the use of a dorsal approach for the injection of botulinum toxin a in the treatment of Raynauds Phenomenon secondary to scleroderma
Annals of the Rheumatic Diseases, 2016Co-Authors: K Dhaliwal, M Griffin, S Salinas, Kevin Howell, Christopher P Denton, P ButlerAbstract:Background Raynaud9s Phenomenon (RP) is common in scleroderma patients and causes pain, paraesthesia, ulceration, and gangrene. Botulinum toxin A (Btx-A), injected via a palmar approach, has been shown to be effective in the treatment of severe RP. However, hand weakness is a common complication, with rates as high as 27% and can last for up to 6 months (1–5). Objectives This study aimed to determine the effect of Btx-A injected via a dorsal approach, on hand function and improvement in symptoms, in patients with RP secondary to Scleroderma. Methods Twenty one patients diagnosed with RP secondary to scleroderma were included. All patients met the criteria for systemic sclerosis of the American College of Rheumatology. They were treated with 10 units of Btx-A, injected into the hand via a dorsal approach. Each patient had a baseline hand assessment and thermographic image (FLIR E60bx). Hand assessment included pinch and power grip strength measurements (Jammar plus digital pinch gauge and dynameter), range of movement of each joint in the hands using a goniometer, Kapandji thumb opposition test and a pain score using the 0–10 visual analogue scale. Patients were asked to report any symptoms of pain, colour change, cold intolerance and complete a Disabilities of the Arm, Shoulder and Hand (DASH) score. Post injection, the hand assessment and thermography was performed at 15 minutes and at 6 weeks in a temperature controlled room at 23.7±2°C. Patients were followed up for 6 weeks and filled out a daily Raynaud9s attack diary. Results 89% of patient reported an overall improvement in symptoms. There was a reduction in the overall number and severity of Raynaud9s attacks. There was a significant improvement in both the DASH score value (P=0.008) and Kapandji score value (p=0.007). Pain score decreased by 1 point on average, from 4.9 to 3.9. No patients reported hand weakness as a complication. One patient reported pain at the site of injection for 3 days and 1 patient reported itching for the first 2 days. The effect on range of movement and blood flow was variable. Conclusions Btx-A injected via a dorsal approach improves symptoms reduces number of attacks in patients with RP secondary to scleroderma. This approach has lower rates of Btx-A related complications compared to the palmar approach. References Sycha T, et al. European Journal of Clinical Investigation. 2004;34(4):312–3. Neumeister MW et al. Plastic and reconstructive surgery. 2009;124(1):191–201. Uppal L, et al. Journal of Hand Surgery (European Volume). 2013:1753193413516242. Fregene A, et al. Journal of Hand Surgery-American Volume. 2009;34A(3):446–52. Van Beek AL, et al. Plastic and reconstructive surgery. 2007;119(1):217–26. Acknowledgement We would like to thank Rebecca Canny for her contribution to this project. Disclosure of Interest None declared
S Sriram - One of the best experts on this subject based on the ideXlab platform.
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ab0725 role and efficacy of botulinum toxin type a in the management of Raynauds Phenomenon secondary to systemic connective tissue disorders
Annals of the Rheumatic Diseases, 2015Co-Authors: S SriramAbstract:Background Raynauds Phenomenon is an episodic vasospastic disorder, which manifests as triphasic colour change in response to stress or cold. The exact pathophysiology of Raynauds Phenomenon is incompletely understood. As a result, targeting the underlying cause in pathogenesis of Raynauds Phenomenon has proved challenging, driving the focus of pharmacological and surgical management options towards the crux of the issue. Most pharmacologic therapies target arterial vasoconstriction and consist of direct or indirect vasodilators, sympatholytics, Prostaglandins and anticoagulants. However, their effects are inconsistent and transient. Surgical options like sympathectomies have variable outcomes with inherent morbidities. Botulinum toxin type A, a neurotoxin has been tried with a good success in previous reports. We report the results of treatment of recalcitrant Raynauds Phenomenon with Botulinum toxin type A in our Institution. Objectives To study the role and efficacy of Botulinum toxin type A in the management of Raynauds Phenomenon and healing of chronic digital ulcers that are recalcitrant to conventional pharmacological agents. Methods 50 patients attending Rheumatology outpatient department of our institution with recalcitrant Raynauds Phenomenon (frequent attacks, worsening pain, discolouration, non healing digital ulcers) secondary to systemic connective tissue disorders who were already on conventional drugs were recruited for the study after obtaining Institutional ethical board clearance.60 units of Botulinum type A toxin (12 sites per hand- 5 units per site) was reconstituted with 3ml of normal saline and injected along the digits, targeting the space adjacent to superficial palmar arch, common digital artery and proper digital arteries. Outcome was assessed by pain rating (visual analog scale), Quick DASH score, digital colour appearance, duration of healing of chronic digital ulcers, Colour and Power Doppler of digital arteries (resistive index, pulsatility index, peak systolic velocity, end diastolic velocity) before and after 30 days of Botulinum administration. All patients were followed up for 8 months. Results In our study, Botulinum injection reduced the warm up time after exposure to cold, improvement in the pain visual analog scale and quick DASH score, improved Doppler findings (decreased resistive and pulsatility index, increase in the peak systolic and end diastolic velocity), reduction in the duration, intensity, severity of attacks. Conclusions Hence we conclude that Botulinum administration is a relatively safe method to abort Raynauds attacks. It reduces the use of multiple drugs used in the treatment of Raynauds and its adverse effects. it also avoids cumbersome surgeries and improves the patients quality of life and activities of daily living. References Stadlmaier E, Muller T, Hermann J, Graninger W. Raynaud9s Phenomenon: Treatment with Botulinum toxin. Ann Rheum Dis 2005; 64 (supple III): 275. Sycha T, Graninger M, Auff E, Schnider P. Botulinum toxin in the treatment of Raynaud9s Phenomenon: a pilot study. Eur J Clin Invest. 2004; 34(4): 312–3. Kossintseva I, Barankin B. Improvement in both Raynaud disease and hyperhidrosis in response to botulinum toxin type A treatment. J Cutan Med Surg 2008; 12(4): 189–93. Acknowledgements NIL Disclosure of Interest None declared
I Janta - One of the best experts on this subject based on the ideXlab platform.
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121 comparison of clinical and laboratory profiles in 3575 systemic lupus erythematosus patients with and without sjogrens syndrome data from the spanish society for rheumatology lupus registry
Lupus science & medicine, 2019Co-Authors: J G Ovallesbonilla, Jose Maria Pego Reigosa, Inigo Rua Figueroa, Maria Galindo Izquierdo, J C Nieto, Julia Martinezbarrio, B Serrano, Jaime Calvoalen, Roberto Gonzalez, I JantaAbstract:Background The clinical coexistence of Systemic Lupus Erythematosus (SLE) and Sjogrens Syndrome (SS) was recognized in 1959. The prevalence of SS among patients with SLE varies considerably among the published studies (10%–30%). There is still controversy as to whether or not SLE patients with overlapping SS have a distinct and significantly milder lupus. To address the clinical and serologic features of SLE and differences from SLE that occurs in overlap with SS. Methods This is a multicenter, descriptive, cross-sectional study of 3575 patients from the Spanish Society for Rheumatology Lupus Registry (RELESSER). Unselected SLE patients from 45 Rheumatology Departments across Spain were evaluated for the presence of overlapping SS using the American-European consensus criteria. Cumulative clinical data were collected at the moment of the last assessment. Clinical and laboratory parameters in SLE patients with SS (SLEwSS) were compared with those in SLE patients without SS (SLEwoSS). Results SS was identified in 516 SLE patients (14.4%). Compared with the SLEwoSS group, patients with SLEwSS were significantly older, had a higher frequency of mucocutaneous manifestations, Raynauds Phenomenon, peripheral neuropathy, anti-Ro/SSA, anti-La/SSB, neoplasia, and older age at death, but had a significantly lower frequency of renal involvement, thrombocytopenia, anti-dsDNA, anti-2-GPI IgM and complement consumption. Both groups displayed a clinically similar presentation of lymphadenopathy, systemic vasculitis, serositis, damage accrual, mortality, musculoskeletal and CNS manifestations. Conclusions SLEwSS appears to constitute a subgroup of SLE patients with distinct clinical and serologic features, in whom SS is expressed as an overlapping entity. A particular cluster of clinical variables, namely, mucocutaneous manifestations, Raynauds Phenomenon, peripheral neuropathy, renal involvement and thrombocytopenia, was found to be important overall for discriminating SLE patients with or without SS. SLEwSS patients constitute a subgroup of patients with SLE characterized by milder lupus: older age at death, similar rates of mortality and SLICC-ACR damage index, less renal and immunological manifestations. Funding Source(s): None
A Smržova - One of the best experts on this subject based on the ideXlab platform.
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op0305 psychological profile of scleroderma patients described by multidimensional minnesota multiphasic personality inventory mmpi ii and beck depression inventory tests bdi ii
Annals of the Rheumatic Diseases, 2016Co-Authors: A Smržova, L Hubackova, S Kreiselova, M Schubertova, Martina Skacelova, Anna Petrackova, Eva Kriegova, Z Heřmanova, Frantisek Mrazek, Pavel HorakAbstract:Background Scleroderma is a systemic multiorgan autoimmune disease with high mortality and morbidity rates. In serious disease with organ manifestation, quality of life and perception of health is deeply influenced in these patients. The face changes and fibrosis of skin, digital ulceration contribute to the psychological trauma of these patients. Only little is known about the objective evaluation of systemic scleroderma psychological impact. Objectives The aim of study is detection of psychological profile and manifestation of depression in scleroderma patients. Methods From March 2015 to January 2016 we examined 42 patients with scleroderma Patients were evaluated by MMPI-II (The Minnesota Multiphasic Personality Inventory test, standardized psychometric test of adult personality and psychopathology) and BDI-II tests (Beck Depression Inventory test of depression). The data obtained from the multidimensional pachological testing were correlated with the clinical and laboratory pheonotype of the disease (smoking status, BMI, arterial hypertension, diabetes, lipid profile, family history of cardiovascular event, lung manifestation, pulmonary hypertension, digital ulceration, damage of gastrointestinal tract, myositis, renal crisis, autoantibody profile, and presence of cardiovascular events) Statistical tests (descriptive statistic, Student t-test, Spearman test, ANOVA) were performed and p-value ≤0.05 was considered as significant. Results In this study42 patient were included (6 men, 36 women. mean of age – 57,8±9.4y., duration of disease 8,6±8.2y. duration of Raynauds Phenomenon 13,4±11,2y.), 12 patient have diffuse form and 30 patient limited form of scleroderma. Subjective perceived depression detected by BDI II test was present in 16 patients (32.1%, mild 7, moderate 7 and 2 severe). BDI-II correlated with anticentromer antibodies (p=0.05), total cholesterol (p=0.008), LDL (p=0.05) and, gastrointestinal manifestation (p=0.002). Scale L, F and K in MMPI-II test in typical sequence for depressive score was detected in 38 patients (90%). The main scales of MMPI-II test were detected in followed percentage values: – Hypochondria (54.7%), Depression (33.3%), Converse hysteria (28.6%), Psychopathic (14.3%), Masculinity/Felinity (7.1%), Paranoia (9.5%), Psychastenia (26.2%), Schizophrenia (21.4%), Hypomania (11.9%) and Social introverse (33.3%). Conclusions The limitation of these data is fact, that these tests showed some of trends of symptoms typical for psychological and personal manifestation; they could not be regarded as a diagnostic test. Patients with scleroderma have high prevalention of subjective perceived depression. In this study we detected high prevalence of depression, social introversion and trend toward somatisation. It will be very useful to be aware of this subjective perception of scleroderma patient and cooperated with psychologist or psychiatrist to improve quality of life and sometimes also morbidity of these seriously ill patients. Acknowledgement Grant support: MZ CR VES15–28659A Disclosure of Interest None declared
