Advanced Movement: Automobilisation für Kopfgelenke und HWS

The author describes a concept of automobilisation of the cervical spine and suboccipital joints. The well known biomechanic peculiarities of cervical spine are transformed in a therapeutic setting to allow a form of automobilisation within a closed system of head and underlying base. The so resulting new patterns of movement – the so-called “advanced movement”– differ from those usually exercised. Slow motion moving and low strength efforts are resulting in mobilisation of important vertebral and soft tissue structures.     

Bildgebende Verfahren in der Rheumatologie: Konventionelle Röntgendiagnostik bei der rheumatoiden Arthritis

Conventional radiography is still regarded the gold standard for imaging techniques in rheumatoid arthritis (RA). It is a very important tool for the diagnosis, the differential diagnosis, and the evaluation of the course and prognosis of the disease. Special advantages of conventional radiography are the worldwide availability and experience with the method over decades and the relatively low costs. Moreover, x-rays can be stored and re-evaluated over long periods of time. Joint damage caused by RA can be quantified by means of scoring methods. The amount of destruction correlates well with functional disability over time. The inhibition of damage progression seen on radiographs is the most important characteristic of a DMARD. Typical radiographic changes are part of the ACR classification criteria of RA. Technically, bone structure can be demonstrated with a high local resolution better than with all other imaging techniques, whereas only indirect conclusions can be drawn concerning soft tissue and cartilage lesions. This review includes recommendations given by the "Commission on Imaging Techniques" of the German Society of Rheumatology regarding technical and personal preconditions, costs, indication as well as practical performance of radiography in RA. In addition, radiographic changes that can be expected in RA including destruction and repair are discussed briefly.     

Immunoadsorption with tryptophan columns: A therapeutic option for the treatment of rheumatoid arthritis with septic complications

Rheumatoid arthritis (RA) is a chronic inflammatory autoimmune disease affecting multiple organs and tissues. Although there is a wide range of therapeutic applications, the coexistence of severe side effects and contraindications outlines the necessity of new therapeutic options in the treatment of severe RA. We report on the case of a 71‐year‐old patient with successful treatment of a complicated RA with tryptophan immunoadsorption combined with low‐dose steroids. Bacterial spondylitis developed in this patient during long‐term treatment with infliximab and methotrexate. Weekly immunoadsorption sessions with tryptophan columns resulted in continuous suppression of RA activity over a period of more than 5 months, as indicated by laboratory findings, the disease activity score, and the visual analog scale. This is the first report of successful treatment of a refractory and complicated RA using tryptophan immunoadsorption columns. In conclusion, immunoadsorption is a safe and effective therapeutic alternative, which should be considered to bridge infectious complications in patients with severe RA. J. Clin. Apheresis, 2009. © 2009 Wiley‐Liss, Inc.     

Thiodiglycolic acid: a major metabolite of bis(2-chloroethyl)ether.

Male rats were given a single oral dose (40 mg/kg) of bis(2-chloroethyl)ether (BCEE). Less than 2% of the dose was recovered from the expired air as the unaltered parent compound during an 8-hr collection period. Urine samples representing 48 hr of collection were analyzed by gas chromatography-mass spectrometry. Methyl ester/trimethylsilyl ether derivatives of the isolated urinary acid fraction were prepared for gas-phase analysis. Two metabolites were identified in this fraction: thiodiglycolic acid (TDGA) and 2-chloroethyl β-d-glucosiduronic acid. Quantitative analysis for TDGA gave an average (seven rats) yield for 48 hr of 33 ± 11.8 mg (± SD) of TDGA/kg from a single dose of 40 mg/kg BCEE. The glucuronide of 2-chloroethanol was synthesized using rabbit liver microsomes in an incubation mixture. The matching mass spectrum of the glucuronide prepared in vitro to that identified in the urine of the rats verified 2-chloroethyl β-d-glucosiduronic acid as a metabolite of BCEE.     

SIMBO: a Screening Instrument for Identification of Work-Related Disabilities--analyses of construct and prognostic validity

BACKGROUND: For a number of years, work-related interventions in medical rehabilitation (MBO) have been developed. Basically, these interventions concentrate on vocational problems of rehabilitees whose health disorders are strongly associated with contextual factors of the environment as well as personal factors. Previous studies showed a close relationship between the success of an intervention and identification of a specific demand. In fact there are several clinical concepts regarding specific demand. But there still is a lack of appropriate instruments for use in identification of occupational challenges. Therefore SIMBO (Screening Instrument for Identification of a Demand for Medical-Vocational Oriented Rehabilitation) has been developed recently. By using a scale for the intensity of work-related problems as well as a cut-off point, SIMBO is able to identify patients with and without a demand for work-related interventions. METHOD: Analyses relative to construct validity and predictive validity were carried out on two different samples--a multi-clinic sample (patients with musculoskeletal disorders) and a sample from the German statutory pension insurance agency DRV Westfalen (successful applications for medical rehabilitation). In this context the cut-off level discussion is very important. RESULTS: By means of the multi-clinic sample--irrespective of cut-off definition--the SIMBO-decision and the clinical identification of MBO-demand were found to agree in 74-78% of the cases. This corresponds to a maximum adjusted correlation of r=0.59 (phi coefficient). Compared to the external ratings of vocational problems given by DRV staff in handling the applications, however, only little agreement is found (64%, r=0.25). In fact, SIMBO had in 77% (r=0.50) of the cases been able to correctly predict work-related problems to be expected. So the result obtained using this instrument is far better than prediction of these problems in the external ratings by DRV staff (54%, r=0,21). Also, return to work (RTW) in good health after six months can be predicted correctly by SIMBO in 77% of the cases. This means that the probability of RTW in good health is reduced by 90% (Odds Ratio=0.1) if work-related problems had been identified by SIMBO. DISCUSSION AND CONCLUSION: Concerning its clinical as well as predictive quality, the validity of SIMBO-based ratings of work-related problems has been proven. Further, it has become obvious that SIMBO is suitable as an easy-to-handle tool for identification of a need for vocationally-focused interventions for use by the social insurance agencies which finance rehabilitation. Further interesting questions arise relative to application in different indications as well as potential uses as an outcome instrument.     

Methoden der Bildgebung und der Knochendichtemessung bei der Osteoporose im Rahmen entzündlich-rheumatischer Erkrankungen

Besides clinical history and clinical findings conventional X-ray is important in the evaluation of osteoporosis as the third diagnostic tool. Its purpose is mainly excluding other diseases and proof of fractures as well as their follow up. Also X-ray is able to demonstrate complications of osteoporosis such as insuffiency fractures and effects of therapy as for example fluorosis. For very early diagnosis bone densitometry is used. Today the improved methods deliver fracture prediction percentages of high value. As a planar measurement method DXA of the spine and of the femoral neck can be used. Volumetric tools, which can measure trabecular bone, without overlying cortical bone, are computed tomography of the spine and of the distal radius. Quantitative ultrasound is an interesting approach, but which does not really measure bone densitometry and which is net yet suited for clinical follow up. Quantitative Magnetic Resonance is far from routine clinical application.