强直性脊柱炎患者睡眠状态问卷研究

目的研究强直性脊柱炎(AS)患者睡眠状态,探讨睡眠障碍、疼痛之间的性别差异。方法57例男性和23例女性AS患者,进行睡眠状态问卷调查,并与临床资料进行比较。结果74%的女性和46%的男性AS患者有睡眠障碍(P<0.05),造成睡眠障碍的主要原因是疼痛。睡眠障碍和疼痛、晨僵及BathAS活动指数(BASDAI)评分之间存在相关性。结论睡眠障碍是AS的常见问题,与疼痛、病情活动相关,男性女性AS患者之间主观睡眠障碍、疼痛差异存在统计学意义。     

Effects of isosorbide dinitrate on rheumatic and non-rheumatic mitral regurgitation

Isosorbide dinitrate was given to seven patients with isolated mitral regurgitation (three cases of rheumatic origin, four non-rheumatic) to assess its hemodynamic effects. The pulmonary capillary pressure, left ventricular end-diastolic pressure, left ventricular end-diastolic volume index, and the aortic pressure were all significantly reduced. The heart rate was significantly increased, while the systemic vascular resistance and the left ventricular contractility index were unchanged. The regurgitant flow increased by an average of 72.2% in the rheumatic group, but decreased by an average of 4.8% in the non-rheumatic group (p < 0.05). The forward cardiac output decreased slightly in both groups, but the difference was not significant (NS). It appears that isosorbide dinitrate has a more detrimental effect on cases of mitral regurgitation of rheumatic origin than on those of non-rheumatic origin. We suggest the difference in the responses is a consequence of the dynamic nature of the regurgitant orifice in the non-rheumatic group and the static nature of the orifice in the rheumatic group.     

Sleep disturbances in outpatients with ankylosing spondylitisa questionnaire study with gender implications

OBJECTIVE: To study the sleep pattern in ankylosing spondylitis, and to investigate gender differences in sleep, pain, and fatigue. METHODS: Forty-three male and 27 female patients with ankylosing spondylitis completed a sleep questionnaire and the results were compared with earlier findings in 3,558 persons randomly selected from the general population. RESULTS: Too little sleep was reported by 80.8% of the female and 50.0% of the male patients, compared to 28.8% and 21.8% respectively in the reference group (p<0.0001). The main reason was pain in the pre-sleep and sleep-periods (p<0.0001). Daytime fatigue was a major problem (p<0.0001). Higher correlation was found between pain and daytime fatigue than between sleep disturbance and daytime fatigue. CONCLUSION: Sleep disturbance is a significant problem in ankylosing spondylitis. The disturbance is closely related to pain at bedtime and during the night. Gender differences exist in the subjective sleep disturbance, fatigue, and pain.     

Pain and fatigue in patients with rheumatic disorders

Summary The purpose of the study was to investigate whether fibromyalgia patients (n=50) differed from patients with rheumatoid arthritis (n=22) and ankylosing spondylitis (n=31) with respect to pain experience, pain coping and fatigue. A high general pain intensity level was recorded by the McGill Pain Questionnaire (p<0.01) and the visual analogue scale (p<0.01) in the fibromyalgia group compared to the other groups. The pain was of continuous duration in the fibromyalgia patients while the rheumatoid arthritis and ankylosing spondylitis patients experienced intermittent pain. A high correlation between sensory and affective pain rating indexes was determined in all patient groups (p<0.01). No statistically significant difference between the groups in pain coping was recorded. A high frequency of reported gastrointestinal problems (p<0.01) and high intensity of fatigue (p<0.01) were seen in the fibromyalgia group compared to the other groups. In the fibromyalgia group there was no correlation between the sleep problems and fatigue intensity. Thus, the fibromyalgia patients differed from the other groups in reporting frequently shoulder and upper arm pain, continuous pain, higher levels of fatigue and pain intensities as well as high frequency of gastrointestinal problems.     

Sleep disturbance in Moroccan patients with ankylosing spondylitis: Prevalence and relationships with disease-specific variables, psychological status and quality of life

Sleep disturbance is often reported by the patients with ankylosing spondylitis (AS), with awakenings produced by inflammatory pain. There are limited studies about sleep disturbance on these patients, and especially its association with psychological state and quality of life to examine the prevalence of sleep disturbance and to assess its association with disease-specific variables, psychological status and quality of life. One hundred and ten patients were included in this cross-sectional study according to the modified New York criteria for AS. Clinical and biological parameters were evaluated. Sleep disturbance was assessed by the fourth item of Hamilton Anxiety Scale. Psychological status was assessed by The Hospital Anxiety and Depression Scale including depression subscale and anxiety subscale. The quality of life was evaluated by the short form-36 (SF-36). Sleep disturbance was found in 64.5 %, depression in 55.5 % and anxiety in 60.9 % amongst our patients. Significantly, worse pain, higher disease activity and functional disability were present in patients with sleep disturbance. Likewise, sleep problems were significantly higher in patients with depression, anxiety and in patients with low scores of the SF36. Multivariate logistic regression analysis revealed that the pain (OR = 1.019) and depression (OR = 1.304) were independent risk factors that influenced sleep disturbance. Sleep problems are prevalent amongst Moroccan patients with AS. Our findings suggest that pain and depression were the independent risk factors that influenced the sleep disturbance and hence, the need for evaluation and optimal management of pain and depression to improve sleep quality in AS patients.     

In-hospital and Readmission Outcomes With Percutaneous Balloon Mitral Valvuloplasty

Percutaneous balloon mitral valvuloplasty (PBMV) is primarily performed for rheumatic mitral stenosis (MS). Therefore, limited data exist on PBMV in countries with a low incidence of rheumatic disease. Using the Nationwide Readmission Database, we examined trends in in-hospital mortality and 30-day readmission among patients who received PBMV for rheumatic and non-rheumatic MS. We also examined the change in 90-day hospitalization rate before vs after PBMV. Between 2016 and 2019, there were 1109 hospitalizations in which patients received PBMV for rheumatic (n = 955, 86.1%) vs non-rheumatic MS (n = 154, 13.9%). The all-cause in-hospital mortality for rheumatic and non-rheumatic MS did not change over time (0.9% → 2.0%, P = 0.94, and 5.9% → 9.5%, P = 0.09 respectively). Similarly, the 30-day readmission for patients with rheumatic and non-rheumatic MS did not change over time (12.4% → 9.9%, P = 0.26, and 4.4% → 10.5%, P = 0.30, respectively). The 90-day all-cause hospitalization rate remained the same before vs after PBMV for rheumatic and non-rheumatic MS (25.5% → 21.8%; P = 0.14, and 24.0% → 33.7%; P = 0.19, respectively). Although no statistically significant change was noted over time for trends in in-hospital mortality, 30-day readmission, or even in the change in 90-day all-cause hospitalizations before and after PBMV for both types of MS, among those with non-rheumatic MS, there was a signal of an increase in the in-hospital mortality, and 30-day readmission, even more, there was 29% relative increase in 90-day hospitalizations after PBMV. Future studies are needed to examine the role of PBMV in patients with non-rheumatic MS.     

Management of atrial fibrillation in rheumatic valvular heart disease

PURPOSE OF REVIEW: Atrial fibrillation in patients with rheumatic valvular heart disease results in significant morbidity and possibly mortality. RECENT DEVELOPMENTS: The recent advances in treatment options for non-rheumatic atrial fibrillation have widened its scope of management. These treatment modalities have not been extensively validated in rheumatic valvular heart disease. SUMMARY: A review and comparison of the available data in atrial fibrillation and rheumatic valvular heart disease vis-à-vis non-rheumatic atrial fibrillation is presented.     

Sleep disturbances in clinic patients with functional bowel disorders

OBJECTIVE: Sleep deprivation can lower visceral perception thresholds and nonregenerative sleep has been implicated as an etiological factor in chronic hyperalgesia syndromes. The aims of our study were to quantify the self-reported prevalence and type of sleep disturbances in patients with different functional bowel disorders (FBD) and to determine if this prevalence is related to involvement of the upper or lower gastrointestinal (GI) tract, perceived disease severity, or psychological comorbidity. METHODS: We enrolled 505 new FBD patients from an academic referral center specializing in functional GI disorders and 247 community based healthy controls. All patients and controls were prospectively evaluated by validated bowel symptom and sleep questionnaires. A psychological profile was obtained by SCL-90R. RESULTS: We found that 68% of functional dyspepsia (FD), 71.2% of irritable bowel syndrome (IBS)+FD, 50.2% of IBS, and 55.1% of the normal subjects reported having sleep disturbances. Waking up repeatedly during the night and waking up in the morning feeling tired or not rested were the most commonly reported sleep patterns; 57.2% of the patients reported that their abdominal ache awakened them from sleep during the night. Self-reported sleep disturbance was directly related to the perceived intensity of GI symptoms. Self-reported sleep disturbances were equally common in both male (57%) and female (58.4%) FBD patients. There was no significant difference between the mean anxiety and depression scores between patients with and without sleep dysfunction. CONCLUSIONS: FD patients, but not IBS patients, reported sleep disturbances more frequently than healthy control subjects. Abdominal pain or discomfort that awaken FBD patients from sleep during the night were common, and thus a poor discriminating factor between organic and functional disorders.     

Assessment of pain, fatigue, sleep and quality of life (QoL) in elderly hospitalized cancer patients

As the proportion of older adults in the population continues to grow, the number of patients with cancer is expected to increase proportionally. In the previously conducted studies, data on elderly cancer patients were generally compared with the QoL scores of elderly patient group and with the data of non-cancer individuals. The purpose of this study was to examine differences in reported pain, fatigue, sleep problems and QoL between middle-aged and elderly hospitalized patients with cancer. We included 53 middle-aged (between 18 and 50 years) hospitalized cancer patients and 47 elderly (>60 years) hospitalized cancer patients in this study. Pain (visual analog scale = VAS, verbal pain rating), fatigue (brief fatigue inventory = BFI), sleep problems, QoL (Short Form 36 = SF36), and European Organization for Research and Treatment of Cancer (EORTC)-QoL-C30 data were gathered using standardized measures. In the elderly group, no significant difference was detected in terms of VAS, verbal pain rating, fatigue, fatigue type, sleep problems and QoL scores (p > 0.05). When the two age groups were compared, BFI scores were found to be significantly high among the elderly patients (p < 0.05). A significant relationship was observed in both age groups between the scores of pain, fatigue and sleep problems, and QoL (p < 0.05). Elderly hospitalized cancer patients did not demonstrate a distinctive difference in terms of pain, sleep and QoL compared to the younger group. The relationship between pain, fatigue, sleep and QoL should be definitely kept in mind in clinical practice.     

Sleep disturbance and its correlates among elderly Japanese

Although sleep disturbance is a major public health problem in the elderly, few studies have examined the association between sleep disturbance and other related factors in Japan. We examined correlates of sleep disturbance among Japanese elderly. Participants in this cross-sectional study (255 men and 263 women) were those enrolled in a population-based health examination for 65 year-old residents in N City, Japan in 1996 and 1997. Epidemiological data were collected by a self-administered questionnaire. Sleep disturbances were assessed by three common symptoms: difficulty in falling asleep, frequent awakening at night and not feeling rested in the morning. The mean sleep duration was longer in men than in women (7.2 vs 6.8 h, P<0.01), and women reported difficulty in falling asleep more frequently than men (22.4 vs 15.3%, P<0.05). Sleep disturbances were associated with low educational attainment, retirement from work, higher body mass index (BMI), irregular bedtime, history of cardiovascular disease, arthritis or joint pain and prostatic hypertrophy, and lower subjective well-being in men, and the use of sleeping pills and depression in both genders, but not with marital status, residential status, smoking habits, exercise, limited instrumental activity of daily living, and past episode of such chronic diseases as hypertension and stroke. Our study suggests a close association of sleep disturbances among elderly Japanese with several medical/psychiatric health problems that are usually more prevalent in such an age group. Our findings emphasize the realistic need for clinicians to take underlying health problems into consideration when their patients complain of sleep-related symptoms.     

Value of anticardiolipin antibodies for monitoring disease activity in systemic lupus erythematosus and other rheumatic diseases

Summary The prevalence of anticardiolipin antibodies in active systemic lupus erythematosus (SLE) was compared with that in inactive SLE and other rheumatic and non-rheumatic diseases to determine the value of these autoantibodies in monitoring rheumatic diseases. Pairs of IgG- and IgM-aCL were measured by ELISA in 173 consecutive hospitalised patients, including 141 with rheumatic diseases (18 active SLE, 21 inactive SLE, 19 rheumatoid arthritis, 13 reactive arthritis, 7 other spondyloarthropathies, 16 vasculitis, 47 other autoimmune diseases) and 32 non-rheumatic controls. A further 101 aCL pairs were determined during follow-up in 19 patients with SLE. Serum concentrations were analysed with respect to SLE activity and compared between the different patient groups. IgG- and IgM-aCL levels in excess of 10 GPL and 9 MPL respectively were considered positive. 30.6% of all patients (53/173) were found to be positive for IgG-aCL, as against only 9.8% (17/173) for IgM-aCL. IgG-aCL serum levels in active SLE differed significantly from all other groups, including inactive SLE (all p<0.005). Median IgM-aCL levels were below the cut off point in all groups, although measurable values were obtained almost exclusively in active SLE and RA. In this study IgM-aCL measurement was of less value in monitoring rheumatic diseases. IgG-aCL positivity in SLE was associated with a significantly higher odds ratio (OR) for active disease (OR 16.0, 95% confidence interval: 2.8–90.0). The results show that disease activity in SLE was accompanied by significantly increased IgG-aCL, whereas no elevation was found in other diseases. This parameter may therefore be useful in monitoring SLE activity.     

Sulphasalazine in ankylosing spondylitis. A radiological,clinical and laboratory assessment

Summary In a 12-month double-blind placebo-controlled trial, the effect of sulphasalazine was studied in 40 patients with ankylosing spondylitis. The treatment group showed significant improvement in pain, stiffness, sleep disturbance (p<0.05), finger/floor distance, erythrocyte sedimentation rate, C-reactive protein, orosomucoid and IgA levels (p<0.01). There was improvement in sleep disturbance (p<0.05), finger/floor distance and erythrocyte sedimentation rate (p<0.01) in the placebo group. Sulphasalazine did not retard radiological progression as measured either by plain X-ray or computerised tomographic scans. Multiple analysis of variance did not show a significant difference in disease activity indicators between the 2 groups.     

A randomized, double-blind, placebo-controlled, phase III trial of pregabalin in the treatment of patients with fibromyalgia

OBJECTIVE: To evaluate the efficacy and safety of pregabalin for symptomatic relief of pain associated with fibromyalgia (FM) and for management of FM. METHODS: This multicenter, double-blind, placebo-controlled trial randomly assigned 748 patients with FM to receive placebo or pregabalin 300, 450, or 600 mg/day (dosed twice daily) for 13 weeks. The primary outcome variable for study objective 1, symptomatic relief of pain associated with FM, was comparison of endpoint mean pain scores between each pregabalin group and placebo. The outcome variable for study objective 2, management of FM, included endpoint mean pain scores, Patient Global Impression of Change (PGIC), and Fibromyalgia Impact Questionnaire (FIQ)-Total Score. Secondary outcomes included assessments of sleep, fatigue, and mood disturbance. RESULTS: Patients in all pregabalin groups showed statistically significant improvement in endpoint mean pain score and in PGIC response compared with placebo. Improvements in FIQ-Total Score for the pregabalin groups were numerically but not significantly greater than those for the placebo group. Compared with placebo, all pregabalin treatment groups showed statistically significant improvement in assessments of sleep and in patients' impressions of their global improvement. Dizziness and somnolence were the most frequently reported adverse events. CONCLUSION: Pregabalin at 300, 450, and 600 mg/day was efficacious and safe for treatment of pain associated with FM. Pregabalin monotherapy provides clinically meaningful benefit to patients with FM.     

Changes in the etiology of valvular heart disease in the rapidly aging Korean population

Background

The aim of this study is to assess the changes in the causes of valvular heart disease between 2006 and 2011 in Korea.

Methods

Data were collected from the Korean National Health Insurance Service from 2006 through 2011. These data consisted of primary diagnoses related to valvular heart disease regardless of other conditions. Valvular heart disease included non-rheumatic mitral valve disorders, non-rheumatic aortic valve disorders, rheumatic mitral valve disorders, and rheumatic aortic valve disorders.

Results

Overall, the age-standardized cumulative prevalence of non-rheumatic valvular heart disease was 70.6 per 100,000 persons in 2006 and 110.3 in 2011. This represented an increase from 42.2 to 65.2 in women and from 28.4 to 45.1 in men. In particular, there was a greater increase in prevalence in patients aged 65 years or older compared with groups aged 20–44 years or 45–64 years for both genders. The age-standardized cumulative prevalence of rheumatic valve disease did not change dramatically between 2006 and 2011.

Conclusions

The overall age-standardized cumulative prevalence of non-rheumatic valvular heart diseases increased between 2006 and 2011, especially in individuals older than 65 years. These changes should be considered in future designs of cardiovascular healthcare services in countries with a rapidly aging population.     

A review of 50 children with obstructive sleep apnea syndrome

Fifty children and adolescents with obstructive sleep apnea syndrome and related breathing disorders during sleep are reviewed. Subjects were subdivided according to whether their breathing irregularity was secondary to a medical problem (group I) or was the primary complaint (group II). The most common presenting complaint was excessive daytime somnolence; hyperactivity and antisocial behavior also were cited frequently. In 20% of cases, substantial personality changes were reported. Clinical symptoms included failure to thrive, abnormal weight for age, acute cardiac or cardiorespiratory failure, hypertension, and frequent upper airway infections. Continuous, heavy snoring was reported in all cases; disrupted nocturnal sleep, sleep walking, nightmares, and enuresis were common. All subjects, and 22 control patients, were monitored polygraphically during sleep for at least one night. Nocturnal sleep in the reported population was severely disrupted. A complete disappearance of stage 3 NREM sleep was noted in 86% of cases; REM sleep was decreased less. The management of these cases is reviewed. Eight patients received permanent tracheostomies. Thirty children had tonsillectomy and/or adenoidectomy (three later required tracheostomy). Non-surgical approaches also were used, particularly in group 1. Follow-up on these cases to date is presented.     

Measurement of shoulder related disability: results of a validation study.

OBJECTIVE--To develop and validate a questionnaire to quantify disability associated with shoulder symptoms. METHODS--A set of questions relevant to shoulder symptoms from a general disability interview was developed and the questionnaire applied to a cross-sectional population survey and a prospective study of general practice attenders. Subjects included adults who reported current shoulder pain in a population survey and patients from three general practices who attended with shoulder symptoms during a six month period. The main outcome measures were: frequency of problems with daily living related to shoulder symptoms, total score on 22-item disability questionnaire, and measures of shoulder movement. RESULTS--A higher proportion (80%) of patients attending their general practitioner with shoulder symptoms had five or more disabilities compared with subjects reporting shoulder pain in a community survey (34%). The ranked frequency with which each disability was reported was similar in the two groups, although sleep disturbance was the most common problem in consulters. Self-reported disability is correlated with measures of restricted shoulder movement. CONCLUSION--This disability questionnaire was simple to complete and should prove useful for both general practice and population-based studies of shoulder pain.     

Assessment of colour flow imaging in the grading of valvular regurgitation

To assess the accuracy of colour flow imaging in the gradingof valvular regurgitation, we studied 100 consecutive patientswith angiographic mitral regurgitation (55), aortic regurgitation(35) or both (10). The etiology of valve regurgitation was rheumaticin 42 and non-rheumatic in 58 patients. For comparison, 28 subjectswith no structural cardiac disease were studied. Mitral valveregurgitation was assessed with colour flow imaging by measuringthe maximal regurgitant jet area and the maximal jet area normalizedto left atrial area; aortic valve regurgitation was assessedfrom jet area and jet width normalized to ventricular outflowtract width. The best correlation between colour flow imagingand angiography was obtained with normalized measurements forboth mitral (r = 0.82, P<0.0001) and aortic regurgitation(r = 0.94, P<0.0001). A proportion of patients and controlswithout angiographic regurgitation showed evidence of mild mitral(31% and 32%) and aortic (14% and 11%) regurgitation on colourflow imaging. There was a large overlap in the normalized colourflow measurements between angiographically mild and moderatemitral regurgitation: (43%); the overlap was greater when regurgitationwas rheumatic in origin (45% ) rather than non-rheumatic (10%)(P<0.001). There was also overlap in the normalized colourflow findings in patients with angiographic aortic regurgitation,which was greater in rheumatic vs non-rheumatic disease. Knowledgeof the etiology significantly improved the separation of allangiographic grades of aortic regurgitation using colour flowmeasurements (P = 0.006). These findings confirm the high sensitivityof colour flow imaging in the detection of valvular regurgitationand indicate that its accuracy is higher in patients with non-rheumaticthan rheumatic heart disease.     

Effect of education, occupation and some lifestyle factors on common rheumatic complaints in a Swedish group aged 50-70 years.

The relation between common rheumatic diseases such as osteoarthrosis, arthralgia without definite signs of osteoarthrosis, subacromial shoulder pain, different forms of tendinitis, low back pain and neck pain, and the level of formal education, occupational workload and some lifestyle factors were examined in 502 of 900 randomly selected subjects aged 50-70 years. The group with rheumatic complaints had a higher proportion of subjects with a lower level of formal education (less than or equal to eight years) by bivariate analysis. In multivariate analysis, the major risk factors were: a self rated heavy workload (odds ratio (OR) 6.4), sleep disturbance (OR 3.6), and advanced age (OR 2.0 per five year increase) for osteoarthrosis; a self rated heavy workload for subacromial shoulder pain (OR 5.4) and low back pain (OR 4.8); and a self rated heavy workload (OR 8.0) and female sex (OR 4.8) for neck pain. A self rated heavy workload was strongly correlated with a low level of formal education. A heavy workload (i.e. previous or present principal occupation) could only be confirmed in the groups with neck pain and low back pain on the basis of available occupational classification data. Neck pain was thus associated with occupations entailing repetitive tasks and awkward posture with respect to the neck, shoulders, and back. Low back pain was associated with occupations entailing awkward posture with respect to the neck, shoulders, and back, and occupations entailing exposure to vibration and heavy manual work. It is concluded that, in a cross sectional sample of an elderly population, a low level of formal education and self rated heavy physical work are associated with the occurrence of adult rheumatic complaints, though the self rated heavy workload could only be verified in the groups with neck pain and low back pain. There correlations between heavy work and low back pain, and especially neck pain, suggest that successful prevention would mean a substantial economic gain to the community. Whether the level of education is a marker of risk factors other than a heavy occupational workload needs further evaluation.     

Sleep related myoclonus in rheumatic pain modulation disorder (fibrositis syndrome)

Thirty-three patients with rheumatic pain modulation disorder (RPMD) were divided into 2 groups: RPMD with sleep related myoclonus (RPMD-SM) (n = 12) and RPMD only (n = 21). Both groups showed chronic nonarticular musculoskeletal pain, fatigue, tender points, and nonrestorative sleep with alpha (7.5-11 Hz) EEG sleep anomaly. RPMD-SM patients were older, had later onset of illness, showed disrupted sleep with periodic involuntary leg movements that were related to fatigue, and alpha EEG sleep related to fatigue and pain.