Subjective and Objective Measures of Dryness Symptoms in Primary Sjögren's Syndrome: Capturing the Discrepancy

Objective

To develop a novel method for capturing the discrepancy between objective tests and subjective dryness symptoms (a sensitivity scale) and to explore predictors of dryness sensitivity.

Methods

Archive data from the UK Primary Sjögren's Syndrome Registry (n = 688) were used. Patients were classified on a scale from ?5 (stoical) to +5 (sensitive) depending on the degree of discrepancy between their objective and subjective symptoms classes. Sensitivity scores were correlated with demographic variables, disease‐related factors, and symptoms of pain, fatigue, anxiety, and depression.

Results

Patients were on average relatively stoical for both types of dryness symptoms (mean ± SD ocular dryness ?0.42 ± 2.2 and ?1.24 ± 1.6 oral dryness). Twenty‐seven percent of patients were classified as sensitive to ocular dryness and 9% to oral dryness. Hierarchical regression analyses identified the strongest predictor of ocular dryness sensitivity to be self‐reported pain and that of oral dryness sensitivity to be self‐reported fatigue.

Conclusion

Ocular and oral dryness sensitivity can be classified on a continuous scale. The 2 symptom types are predicted by different variables. A large number of factors remain to be explored that may impact symptom sensitivity in primary Sjögren?s syndrome, and the proposed method could be used to identify relatively sensitive and stoical patients for future studies.

     

Changes underlying the dynamic contrast-enhanced MRI response to treatment in rheumatoid arthritis

Objective Dynamic contrast-enhanced MRI of patients with rheumatoid arthritis has shown a decrease in the early enhancement rate (EER) of synovitis after treatment. The purpose of this work was to investigate the underlying changes. Methods 3D dynamic contrast-enhanced images were acquired from 13 patients before and 1–2 weeks after anti-TNFα treatment. The EER of the inflamed synovium was measured. The T₁ relaxation time of the synovitis was calculated from images at different flip angles. The time course of the arrival of gadolinium at the radial artery was determined. The gadolinium enhancement of the inflamed synovium was modeled to calculate the fractional plasma volume (v_p), the fractional extravascular, extracellular fluid volume (v_e), and the volume transfer constant (K^trans). Pre- and post-treatment values were compared and the dependence of the EER on each parameter was assessed. Results There was a decrease in the EER measured over 26 s after treatment (29%, p = 0.002). Reductions in T₁ (12%, p = 0.001), K^trans (31%, p = 0.002), and v_p (43%, p = 0.01) contributed to this; however, the EER was relatively insensitive to changes in v_e. Conclusions The decrease in EER after anti-TNFα treatment is largely caused by reductions in the volume transfer constant K^trans, the fractional plasma volume v_p, and the T₁ relaxation time. Only the contributions from K^trans and v_p directly reflect synovial vascularity.     

常用抗高血压药物对血压的时间生物学特征的影响

目的 :探讨 3类常用抗高血压药物对非杓型的高血压病患者BP的时间生物学特征的影响。方法 :共入选非杓型BP分布的高血压病患者 16 1例 ,将其随机分为 3组 ,分别给予赖诺普利 (10mg·d-1) ,非洛地平 (2 5mg·d-1) ,或氢氯噻嗪 (5 0mg·d-1) ,并于治疗前后行 2 4h动态BP监测。采用余弦拟合方法分析治疗前后患者BP时间生物学特征的改变。结果 :赖诺普利组与非洛地平组治疗后 2 4hBP均值明显降低 ,但其振幅、峰值相位无变化 ;氢氯噻嗪治疗降压效果不甚理想 ,但显著增加了患者BP的夜间降低幅度 ,使患者BP由非杓型转变为杓型分布。结论 :氢氯噻嗪治疗可能使非杓型分布的高血压病患者的BP转变为杓型分布 ,从而有助于降低患者相关并发症的发生率。     

Effets du repas précompétitif sur la perception de l'effort et sur la glycémie lors d'un exercice de pédalage

The first purpose of the present study was to investigate the effect of three different preexercise meals on perceived exertion and glycaemia during a one-hour bicycle exercise at 80% VO₂ max. The second purpose of this study was to determine the relationship between glycaemia and perceived exertion. Eight athletes (age: 24.6 ± 2.7 years, weight: 78.0 ±6.8 kg, height: 182.6 ± 9.9 cm) completed three assessment sessions, each being preceeded by one of the following meals, ingested 3 h before exercise: 400 mL of water, 400 mL of water and 75 g of glucose, and 100 mL of water and 375 g of potatoes. The subjects 'perceived exertion were measured at times 6, 15, 30, 45, 60 min and glycaemia at 0, 30, 60 min of the exercise. The results showed that perceived exertion (RPE and ETL) of each meal increased as a function of time (P <- 0.05) whereas glycaemia did not differ except for the glucose meal between 30 min and 1 h(P < 0.02). There was no significant difference in ratings of perceived exertion among any meal whereas glycaemia was different between the three conditions only at the beginning and the middle of the exercises (P < 0.04 and P < 0.02, respectively). Moreover, the vectorial angles between the variables ofperceived exertion and the glycaemia are close to 90 °. These results would suggest that perceived exertion does not seem to be affected by the three preexercise meals used in our study. Perceived exertion is not correlated to glycaemia changes during one-hour high intensity exercise. The results would, therefore, suggest that glycaemia is not a contributor signal of perceived exertion in this study. It seems that physiological factors other than glycaemia may have mediated the perceptual intensity at exhaustion. The respiratory-metabolic signals of exertion which are most pronounced at high relative exercise intensity are suggested to influence the perceptual signal of exertion.