祛湿除痹复方对急性痛风性关节炎模型大鼠关节症状的作用及其机制

目的: 探讨祛湿除痹复方对大鼠急性痛风性关节炎的可能作用机制,验证急性痛风性关节炎的湿热痹阻病机。方法: 将40只Wistar大鼠随机分5组,每组8只,即空白组、模型组、秋水仙碱组、中药低剂量组和中药高剂量组。采用尿酸单钠晶体溶液踝关节注射法建立急性痛风性关节炎模型。以祛湿除痹复方与秋水仙碱对比治疗,观察祛湿除痹复方对大鼠关节各种症状(炎症、肿胀度及活动障碍)及大鼠关节组织内白细胞介素1β(IL-1β)、白细胞介素1受体(IL-1R)和髓样分化因子88(MyD88)表达水平的影响。结果: 灌胃给药7 d后秋水仙碱组和中药各剂量组与模型组比较,大鼠关节肿胀程度差异显著(P<0.01), 秋水仙碱组和中药高剂量组比较差异有统计学意义(P<0.05)。各组大鼠关节炎症指数及功能障碍指数积分比较,模型组积分最高。造模后8和72 h各组积分均降低(P<0.05),模型组与各用药组比较差异显著 (P<0.05)。关节软组织内IL-1β、IL-1R及MyD88的平均吸光度以模型组为最高,中药低剂量组和秋水仙碱组比较无明显差异(P>0.05),而与中药高剂量组比较有显著差异(P<0.05)。结论: 祛湿除痹复方能有效抑制实验性急性痛风性关节炎大鼠关节组织内炎症因子的表达,从而改善模型大鼠各种关节症状。     

The effect of colchicine treatment on sperm production and function: a review

Colchicine is used for the treatment of various diseases including gouty arthritis, familial Mediterranean fever (FMF) and Behcet's disease. As a modulator of the microtubules at the cytoskeleton level, it arrests cell division at metaphase and inhibits microtubular- dependent cell motility. Controversy exists as to the adverse effect of colchicine on sperm production and function in healthy subjects as well as in gout, FMF and Behcet's patients. Sperm analysis shows a spectrum of pathology, from oligo- and azoospermia to normospermia with disturbances in sperm motility. These inconsistent sperm pathologies can be explained in part by the variability of the pathophysiology of the underlying disease. Thus, it seems that colchicine by itself may not have a significant direct adverse effect on sperm production and function.      

Treatment of acute gouty arthritis with the 5-hydroxytryptamine antagonist ondansetron

We report on a 28-year-old man with hematemesis, renal dysfunction, and arterial hypertension who suffered from an acute gouty attack presenting as podagra. Because of the accompanying symptoms conventional treatment of the gouty attack with colchicine or nonsteroidal anti-inflammatory drugs was contraindicated. We treated the pain of acute arthritis with the specific 5-hydroxytryptamine subtype 3 receptor antagonist ondansetron. Within 30 min after intravenous injection of this drug a substantial degree of pain relief had occurred. Unwanted side effects due to treatment were not observed. It is suggested that the 5-hydroxytryptamine released during a gouty attack induces pain via activation of 5-hydroxytryptamine subtype 3 receptors on nociceptive afferent nerve fibers. 5-Hydroxytryptamine subtype 3 receptor antagonists may therefore be a novel class of drugs for the effective treatment of acute gouty attacks when conventional treatment is contraindicated.Abbreviation 5-HT 5-hydroxytryptamine Correspondence to: H. Schworer     

Optimisation of the Treatment of Acute Gout

Most of the drugs prescribed to treat acute gouty attacks were used before the introduction of modern clinical trials. Thus, there are few well-designed studies available to evaluate these drugs. Nevertheless, worldwide clinical experience supports the use of most nonsteroidal anti-inflammatory drugs (NSAIDs), colchicine and corticosteroids in the treatment of acute gout. Colchicine has been widely used but toxicity, especially gastrointestinal adverse effects, are a major concern. Therapeutic regimens involving hourly or 2-hourly administration were based on the short initial half-life of colchicine in plasma. Other therapy schedules, such as early 8-hourly administration, may be equally effective and have fewer adverse effects. Unfortunately, comparative studies to investigate this have not been performed. Colchicine should not be prescribed to patients with either severe renal insufficiency or combined hepatic-renal insufficiency. Doses should be halved in patients with moderate renal function impairment. NSAIDs are the most widely prescribed drugs in the treatment of acute gout. Few comparative data are available, but any of the most potent NSAIDs are probably useful in the control of pain and inflammatory signs of acute gouty arthritis. Pharmacokinetic properties should be taken into account when selecting an NSAID for the treatment of gout, as rapid absorption and a short half-life may help to avoid accumulation in patients with subclinical renal function impairment. Comorbidities should always be kept in mind when prescribing NSAIDs. Patients with previous or recent gastrointestinal bleeding, those receiving anticoagulant therapy or with haemorrhage diathesis, and those with renal insufficiency are at risk of developing severe adverse effects from NSAID administration. Corticosteroids are probably a reasonable choice for patients in whom colchicine and NSAIDs may be hazardous or for those with a history of previous intolerance to these drugs. Few trials using prednisone, prednisolone or triamcinolone acetonide are available, and dosages are prescribed following empirical data. Corticotropin has also been used to treat acute gout. Although it has been proven to be as effective as other corticosteroids or indomethacin, the need for multiple doses, parenteral administration and the high cost are major limitations for its use. Currently, the choice of a drug for the treatment of acute gout will depend on the balance between its efficacy and the potential adverse effects in a particular patient.     

黑骨藤抗急性痛风性关节炎的实验研究

目的:探讨黑骨藤在急性痛风性关节炎中的治疗效果。方法:健康雄性SD 大鼠60 只,随机等分为空白对照组(NC 组)、模型组(M 组)、秋水仙碱组(C 组)、黑骨藤高剂量组(HD 组)、黑骨藤中剂量组(MD 组)和黑骨藤低剂量组(LD组)。除空白对照组外,其余大鼠均采用尿酸钠制备大鼠痛风性关节炎模型,用秋水仙碱(阳性对照)和不同剂量的黑骨藤灌胃给药治疗。治疗3、5、7 d 后观察各组大鼠关节肿胀情况。治疗7 d 后处死大鼠,取踝关节组织进行病理学检查,应用ELISA检测各组大鼠外周血中IL-1、IL-6、IL-8 及TNF-α的表达。结果:黑骨藤干预组大鼠踝关节肿胀程度明显低于模型组,且治疗7 d 后黑骨藤高剂量组疗效显著高于低剂量组(P<0.05);与模型组相比,黑骨藤治疗组均有较少的炎细胞浸润,且黑骨藤高剂量组趋于正常对照组;黑骨藤干预组炎症因子IL-1、IL-6、IL-8 及TNF-α水平显著低于模型组,呈剂量依赖性。结论:黑骨藤在大鼠急性痛风性关节炎中具有很好的治疗效果,且呈剂量依赖性,其机制可能与黑骨藤降低急性痛风性关节炎大鼠血清炎症因子表达有关。     

Colchicine in avian sodium urate and calcium pyrophosphate microcrystal arthritis

The effect of single doses of colchicine on the acute arthritis elicited by the injection of microcrystalline sodium urate, calcium pyrophosphate or talcum into one intertarsal joint of chickens was functionally assessed. Colchicine was significantly active against the urate challenge. The arthritic inflammation induced by calcium pyrophosphate or talcum was reduced to a lesser degree. Colchicine may thus particularly affect inflammatory processes related to urate.     

Colchicine derivatives inhibit neopterin production in human peripheral blood mononuclear cells (PBMC)

Colchicine is a microtubule disrupting agent, mostly used as treatment in various kinds of inflammatory diseases such as acute familial Mediterranean fever and Behcet's disease, as well as gout. In patients with familial Mediterranean fever treatment with colchicine induces a decline of urinary neopterin concentrations which indicates a decrease of cell-mediated immune activation. In this study, we investigated a potential effect of colchicine on the T cell/macrophage system in vitro. The human myelomonocytic cell line THP-1 and PBMC were treated with colchicine or the colchicine derivative, colcemide, in the presence or absence of 250 U/ml interferon-gamma (IFN-γ) or 10 μg/ml lipopolysaccharide (LPS) for 48 h or 96 h. Colchicine and colcemide increased neopterin/protein production in unstimulated THP-1 cells, but no such effect was apparent in cells stimulated with IFN-γ. By contrast, when PBMC were treated with colchicine or colcemide a significant reduction in neopterin formation was evident in cells without and with prestimulation by IFN-γ or LPS. In parallel, reduced production of IFN-γ was observed in PBMC. These data suggest that colchicine and colcemide are able to inhibit T cell activation within the cellular immune response.     

Association between Anti-inflammatory Drug and Dementia in Patients with Gout: A Nationwide,Population-Based Nested Case-Control Study

Introduction: The interaction between hyperuricemia and the cognitive system is still under debate, with studies presenting somewhat conflicting results.Objectives: This study aimed to investigate the risk of dementia in patients with gout who are administered anti-inflammatory drug treatment.Methods: Gouty arthritis patients aged 50 years and older, who received at least one of the background therapy drugs (colchicine, corticosteroids, or nonsteroidal anti-inflammatory drugs for 6 months), were divided into the following groups and compared: patients who had dementia over a period of 5 years (n = 2,292) and matched patients without dementia (n = 2,292).Results: We found that the most significant risk factors for dementia were stroke (OR, 2.66; 95% C.I., 2.33-3.03; AOR, 2.39; 95% C.I., 2.08-2.75) and depression (OR, 3.72; 95% C.I., 3.01-4.6; AOR, 3.25; 95% C.I., 2.60-4.05). The results of anti-gout drug administration, which impacted the dementia risk among patients of all ages (but especially in 50-64-year-old patients), demonstrated a higher risk ratio after 90 days of corticosteroid use (OR, 3.39; 95% C.I., 1.15-9.99), which was further increased after 180 days (OR, 3.61; 95% C.I., 1.31-9.94). We revealed that female patients experienced a significant increase in dementia risk after 90 days of corticosteroid administration, whereas male patients experienced a significant increase only after 180 days (OR, 1.52; 95% C.I., 1.06-2.17).Conclusion: We had identified that > 90-day corticosteroid administration is a significant dementia risk factor in both female and male patients of all ages, especially in the 50-60-year-old group.     

Mechanism of action of colchicine

Colchicine suppressed the development of urate crystal-induced canine synovitis only at a dose (0.25 mg/kg) that produced a peripheral leukopenia; half that amount produced neither leukopenia nor inhibition of the inflammatory response. Colchicine in the lower dose range still had no antiinflammatory effect when the time of pretreatment was increased from 15 min to 5 h before the inflammatory challenge, and when an additional dose was given 24 h beforehand. Lower doses of Colchicine were not antiinflammatory when the drug was introduced directly into the joint, either along with the urate crystals or when the inflammatory response was present and increasing. Lumicolchicine (0.25 mg/kg) neither suppressed inflammation nor induced leukopenia. The canine model differs from human gouty inflammation and from urate crystal-induced human inflammation, both of which processes respond to small, nonleukopenic doses of colchicine.This work was supported in part by grants from the USPHS (AM-10493, AM-5639) and from the Arthritis Foundation. Dr. Malawista is the recipient of a Research Career Development Award of the NIH (AM-19864).     

Application of a Novel Diagnostic Rule in the Differential Diagnosis between Acute Gouty Arthritis and Septic Arthritis

Septic arthritis and gout are major diseases that should be suspected in patients with acute monoarthritis. These two diseases are clinically similar and often indistinguishable without the help of synovial fluid analysis. Recently, a novel diagnostic rule for gout without synovial fluid analysis was developed and showed relevant performances. This study aimed to determine whether this diagnostic rule could perform well in distinguishing gout from septic arthritis. The diagnostic rule comprises 7 clinical and laboratory variables, each of which is given a specified score. The probability of gout is classified into 3 groups according to the sum of the scores: high (≥ 8), intermediate (> 4 to < 8) and low probability (≤ 4). In this retrospective study, we applied this diagnostic rule to 136 patients who presented as acute monoarthritis and were subsequently diagnosed as acute gout (n = 82) and septic arthritis (n = 54) based on synovial fluid analysis. The mean sum of scores of acute gout patients was significantly higher than that of those with septic arthritis (8.6 ± 0.2 vs. 3.6 ± 0.32, P < 0.001). Patients with acute gout had significantly more ''high'', and less ''low'' probabilities compared to those with septic arthritis (Eta[η]: 0.776). The prevalence of acute gouty arthritis, as confirmed by the presence of monosodium crystal, was 95.5% (61/64), 57.5% (19/33), and 5.1% (2/39) in high, intermediate and low probability group, respectively. The recently introduced diagnostic rule properly discriminates acute gout from septic arthritis. It may help physicians diagnose gout in cases difficult to be differentiated from septic arthritis.

Graphical Abstract

相似文献   

中西医结合治疗急性痛风性关节炎疗效观察

目的:观察中西医结合治疗急性痛风性关节炎的临床疗效。方法:60例急性痛风性关节炎患者,按随机数字表法分为两组,每组各30例。对照组在一般性治疗的同时用碳酸氢纳片、依托考昔片口服治疗;观察组在对照组基础上,外敷金黄膏、口服加味四妙汤治疗。观察2个疗程(14天)后两组临床疗效、疼痛缓解时间以及药物不良反应,采用常规生化方法测定治疗前后两组血尿酸(UA)和C反应蛋白(CRP)水平变化;随访治疗有效患者半年内复发情况。结果:2个疗程结束后,观察组总有效率(93.33%)优于对照组(70.00%)(P0.05);疼痛缓解时间短于对照组(P0.01);两组治疗后血UA、CRP与治疗前比较,均有显著下降(P0.01),且观察组较对照组降低更明显(P0.05);观察组复发率低于对照组(P0.05);两组均未见严重不良反应。结论:中西医结合治疗急性痛风性关节炎能提高疗效,降低复发率。     

Improved Growth and Colchicine Concentration in Gloriosa Superba on Mycorrhizal Inoculation Supplemented with Phosphorus-Fertilizer

Background

Gloriosa superba produces an array of alkaloids including colchicine, a compound of interest in the treatment of various diseases. The tuber of Gloriosa superba is a rich source of colchicine which has shown anti-gout, anti-inflammatory, and anti-tumor activity. However, this promising compound remains expensive and Gloriosa superba is such a good source in global scale. Increase in yield of naturally occurring colchicine is an important area of investigation.

Materials and Methods

The effects of inoculation by four arbuscular mycorrhizal (AM), fungi, Glomus mossae, Glomus fasciculatum, Gigaspora margarita and Gigaspora gilmorei either alone or supplemented with P-fertilizer, on colchicine concentration in Gloriosa superba were studied. The concentration of colchicine was determined by high-performance thin layer chromatography.

Results

The four fungi significantly increased concentration of colchicine in the herb. Although there was significant increase in concentration of colchicine in non-mycorrhizal P-fertilized plants as compared to control, the extent of the increase was less compared to mycorrhizal plants grown with or without P-fertilization. This suggests that the increase in colchicine concentration may not be entirely attributed to enhanced P-nutrition and improved growth. Among the four AM fungi Glomus mossae was found to be best. The total colchicine content of plant (mg / plant) was significantly high in plants inoculated with Glomus mossae and 25 mg kg⁻¹phosphorus fertilizer (348.9 mg /plant) while the control contain least colchicine (177.87 mg / plant).

Conclusion

The study suggests a potential role of AM fungi in improving the concentration of colchicine in Gloriosa superba tuber.     

不同浓度尿酸钠对大鼠滑膜细胞炎性因子的影响

背景：利用尿酸钠刺激滑膜细胞制备体外急性痛风性关节炎滑膜模型,在评价治疗这类疾病药物作用机制方面有重要意义。 目的：通过不同浓度尿酸钠体外直接刺激滑膜细胞后滑膜细胞细胞因子的浓度变化,探讨急性痛风性关节炎滑膜模型制备条件。 方法：培养大鼠滑膜细胞,分别添加终浓度为0(空白组),50,125,250,500,1 000 μmol/L的尿酸钠进行干预,于培养24,48 h后测定细胞活力及培养液中细胞因子白细胞介素1β、白细胞介素8、肿瘤坏死因子α的浓度。 结果与结论：各组在24,48 h内药物对细胞活力无影响。与空白组比较,尿酸钠干预组在24,48 h培养液中细胞因子白细胞介素1β、白细胞介素8、肿瘤坏死因子α浓度均提高,尿酸钠浓度为500 μmol/L,给药时间为24 h,培养液中各细胞因子浓度最高。说明利用一定浓度尿酸钠和刺激时间,便于筛选理想的急性痛风性关节炎体外模型。     

尿酸钠致急性痛风性关节炎模型大鼠与槲皮素的抗炎作用☆

背景：以往研究表明黄酮类化合物槲皮素具有抗氧化、抗炎和凋亡诱导等生物活性,但是对于尿酸钠结晶诱导的痛风性关节炎大鼠的治疗作用未见文献报道。 目的：验证槲皮素对尿酸钠结晶诱导的急性痛风性关节炎模型大鼠的治疗作用。 方法：将72只雄性SD大鼠随机等分为6组：分别每天灌胃100,200,400 mg/kg的槲皮素,3.0 mg/kg的吲哚美辛或等量蒸馏水(模型组和对照组),连续7 d。第5天给药后1 h向大鼠右后肢距小腿关节腔内注射3.0 mg尿酸钠混悬液制备痛风性关节炎模型,对照组不造模。采用缚线法测定大鼠距小腿关节周径来评定炎症反应程度。第7天给药后1 h取材。 结果与结论：结果表明,槲皮素呈剂量依赖性抑制急性痛风性关节炎模型大鼠的距小腿关节肿胀程度(P < 0.01),并且能够显著改善大鼠距小腿关节的病理改变,减轻尿酸钠结晶诱导的炎症因子白细胞介素1β、肿瘤坏死因子α、环氧化酶2、一氧化氮的水平(P < 0.05或P < 0.01),且作用与吲哚美辛相当。说明槲皮素可通过减轻炎症反应治疗急性痛风性关节炎。      

A hypothesis on the possible role of interferon in the initiation of acute gouty arthritis attack

There is some evidence that unidentified factors might play a role in the initial events of acute gouty arthritis. Serum interferon activity was found to be high in several arthritides; interferon stimulates the production of prostaglandin E, an established mediator of inflammation. It is postulated that interferon can play a role in the pathogenesis of an acute gouty arthritis.     

Characteristics of voltage-gated potassium currents in monosodium urate induced gouty arthritis in mice

Inflammation Research - To evaluate the role of K+ channels in pain following gouty arthritis. The model of acute gouty arthritis was induced by monosodium urate (MSU) in mice. The swelling degree...     

芜湖地区痛风急性发作诱因及临床生化特征初探

目的 探讨痛风性关节炎急性发作的诱因并对其临床特征进行总结。方法 对2017年11月~2018年12月就诊于皖南医学院第二附属医院内分泌科门诊及住院痛风性关节炎急性发作患者进行问卷调查并收集临床资料,将以上资料录入Excel数据库,对其急性发作诱因及临床特征进行分析。结果 50~60岁为发病年龄高峰,女性患者均为绝经后发病;88.03%的痛风患者急性发作前有诱因,高嘌呤饮食诱发的为61例（52.14%）,因饮酒诱发的为55例（47.01%）,上述两者中至少含有一项者为81例（69.23%）,同时含有两项者为32例（27.35%）;60例患者首发关节部位为足第一跖趾关节,下肢关节受累数目多于上肢关节（113例vs 14例）。发病年龄小的患者比发病年龄大的患者痛风发作频率高;病程长,有痛风石的患者易痛风发作频率高（P均＜0.05）;血尿酸水平高低与患者发作频率无关,两组其他临床生化检查比较,差异无统计学意义（P＞0.05）;年龄、BMI、血尿素氮是痛风石形成的危险因素,频发与长病程同样是痛风石形成的危险因素,差异均有统计学意义（P＜0.05）;Pearson直线相关分析发现:痛风急性发作时血尿酸水平与血尿素氮、血肌酐、胱抑素C相关（P＜0.05）;多因素Logistic分析显示年龄、频发和长病程是痛风石形成的独立危险因素（P＜0.05）。结论 痛风患者中老年居多,发病存在明显性别差异。痛风性关节炎急性发作诱因中以高嘌呤饮食和饮酒为其最常见诱因;发病年龄小,病程长,有痛风石的患者发作频率高。部分痛风性关节炎急性发作时血尿酸水平并不高。年龄偏大、频发和长病程的患者容易形成痛风石。     

Effect of Colchicine on Platelet-Platelet and Platelet-Leukocyte Interactions: a Pilot Study in Healthy Subjects

The cardioprotective mechanisms of colchicine in patients with stable ischemic heart disease remain uncertain. We tested varying concentrations of colchicine on platelet activity in vitro and a clinically relevant 1.8-mg oral loading dose administered over 1 h in 10 healthy subjects. Data are shown as median [interquartile range]. Colchicine addition in vitro decreased light transmission platelet aggregation only at supratherapeutic concentrations but decreased monocyte- (MPA) and neutrophil-platelet aggregation (NPA) at therapeutic concentrations. Administration of 1.8 mg colchicine to healthy subjects had no significant effect on light transmission platelet aggregation but decreased the extent of MPA (28 % [22–57] to 22 % [19–31], p?=?0.05) and NPA (19 % [16–59] to 15 % [11–30], p?=?0.01), platelet surface expression of PAC-1 (370 mean fluorescence intensity (MFI) [328–555] to 333 MFI [232–407], p?=?0.02) and P-selectin (351 MFI [269–492] to 279 [226–364], p?=?0.03), and platelet adhesion to collagen (10.2 % [2.5–32.6] to 2.0 % [0.2–9.5], p?=?0.09) 2 h post-administration. Thus, in clinically relevant concentrations, colchicine decreases expression of surface markers of platelet activity and inhibits leukocyte-platelet aggregation but does not inhibit homotypic platelet aggregation.     

The synovitis of acute gouty arthritis. A light and electron microscopic study

The synovium participates in the inflammatory process of acute gouty arthritis with intense polymorphonuclear leukocyte infiltration, but many chronic inflammatory cells are also seen even during the acute attack. Crystals in the synovial membrane were found in three patients and then only in well defined tophi. Tophus structure was consistent with crystal deposition in a collagen and amorphous matrix with little adjacent inflammatory reaction. Microtophi were superficial and thinly encapsulated, suggesting that crystals from these tophi might easily rupture into the joint space to initiate the inflammatory reaction. Crystals were seen in detached lining cells and other macrophages as well as in polymorphonuclear leukocytes in the synovial fluid. Clinically satisfactory doses of colchicine produced no detectable morphologic changes in microtubules or other structures.     

A Web-Based Program Improves Physical Activity Outcomes in a Primary Care Angina Population: Randomized Controlled Trial

Background

Angina affects more than 50 million people worldwide. Secondary prevention interventions such as cardiac rehabilitation are not widely available for this population. An Internet-based version could offer a feasible alternative.

Objective

Our aim was to examine the effectiveness of a Web-based cardiac rehabilitation program for those with angina.

Methods

We conducted a randomized controlled trial, recruiting those diagnosed with angina from general practitioners (GPs) in primary care to an intervention or control group. Intervention group participants were offered a 6-week Web-based rehabilitation program (“ActivateYourHeart”). The program was introduced during a face-to-face appointment and then delivered via the Internet (no further face-to-face contact). The program contained information about the secondary prevention of coronary heart disease (CHD) and set each user goals around physical activity, diet, managing emotions, and smoking. Performance against goals was reviewed throughout the program and goals were then reset/modified. Participants completed an online exercise diary and communicated with rehabilitation specialists through an email link/synchronized chat room. Participants in the control group continued with GP treatment as usual, which consisted of being placed on a CHD register and attending an annual review. Outcomes were measured at 6-week and 6-month follow-ups during face-to-face assessments. The primary outcome measure was change in daily steps at 6 weeks, measured using an accelerometer. Secondary outcome measures were energy expenditure (EE), duration of sedentary activity (DSA), duration of moderate activity (DMA), weight, diastolic/systolic blood pressure, and body fat percentage. Self-assessed questionnaire outcomes included fat/fiber intake, anxiety/depression, self-efficacy, and quality of life (QOL).

Results

A total of 94 participants were recruited and randomized to the intervention (n=48) or the usual care (n=46) group; 84 and 73 participants completed the 6-week and 6-month follow-ups, respectively. The mean number of log-ins to the program was 18.68 (SD 13.13, range 1-51), an average of 3 log-ins per week per participant. Change in daily steps walked at the 6-week follow-up was +497 (SD 2171) in the intervention group and –861 (SD 2534) in the control group (95% CI 263-2451, P=.02). Significant intervention effects were observed at the 6-week follow-up in EE (+43.94 kcal, 95% CI 43.93-309.98, P=.01), DSA (–7.79 minutes, 95% CI –55.01 to –7.01, P=.01), DMA (+6.31 minutes, 95% CI 6.01-51.20, P=.01), weight (–0.56 kg, 95% CI –1.78 to –0.15, P=.02), self-efficacy (95% CI 0.30-4.79, P=.03), emotional QOL score (95% CI 0.01-0.54, P=.04), and angina frequency (95% CI 8.57-35.05, P=.002). Significant benefits in angina frequency (95% CI 1.89-29.41, P=.02) and social QOL score (95% CI 0.05-0.54, P=.02) were also observed at the 6-month follow-up.

Conclusions

An Internet-based secondary prevention intervention could be offered to those with angina. A larger pragmatic trial is required to provide definitive evidence of effectiveness and cost-effectiveness.

Trial Registration

International Standard Randomized Controlled Trial Number (ISRCTN): 90110503; http://www.controlled-trials.com/ISRCTN90110503/ISRCTN90110503 (Archived by WebCite at http://www.webcitation.org/6RYVOQFKM).