[Lumbar spinal stenosis: diagnosis and conservative treatment].

Lumbar Spinal Stenosis is a typical disease of the elderly patient that mainly originates in degenerative multisegmental changes of the lumbar vertebral column. The classical symptom of pain irradiation into the legs whilst walking and relief with standing is similar to peripheral arterial disease presentation but differs in the sense that symptoms can be triggered through lumbar extension and relieved with lumbar flexion whereas arterial disease is correlated with pathological arteriovascular findings. Diagnosis is usually confirmed through magnetic resonance imaging (MRI) and response to conservative treatment (analgetics, physiotherapy, epidural injections) is usually good in the majority of cases.

Topical diclofenac and its role in pain and inflammation: an evidence-based review.

Objective: Topical diclofenac is widely used in the treatment of pain and inflammation. This comprehensive review assesses the safety and efficacy of topical diclofenac in a range of painful and inflammatory disorders.

Methods: Double-blind, randomized, placebo- or active-controlled trials (RCT) evaluating topical diclofenac in soft-tissue injuries, soft-tissue rheumatic disorders and osteoarthritis were identified through detailed literature searches.

Clinical trial: the effects of adding ranitidine at night to twice daily omeprazole therapy on nocturnal acid breakthrough and acid reflux in patients with systemic sclerosis--a randomized controlled, cross-over trial.

Background: Gastro-oesophageal reflux disease (GERD) is an important problem in systemic sclerosis due to impaired salivation and oesophageal function.

Aim: To determine the efficacy of adding ranitidine at bedtime to control nocturnal acid breakthrough (NAB) and GERD in patients with systemic sclerosis already prescribed high-dose omeprazole.

Methods: Patients with systemic sclerosis and GERD symptoms (n = 14) were treated with omeprazole 20 mg b.

Outcome of patients with arthritis and parvovirus B19 DNA in synovial membranes.

To investigate the follow-up of the 17 patients during the period of 1995-2001 of the outpatient Clinic for Rheumatology at the University Hospital of Zurich with arthritis and the presence of parvovirus B19 DNA demonstrated by PCR in synovial biopsies. Seventeen patients of 163 with arthritis, which were routinely examined by needle arthroscopy during 1995-2001 with a positive parvovirus B19 DNA by PCR of synovial biopsy were reevaluated. Investigations included medical history, clinical examination and blood tests.

Short-term treatment with topical diclofenac epolamine plaster in patients with symptomatic knee osteoarthritis: pooled analysis of two randomised clinical studies.

Background: Data from two randomised, double-blind, placebo-controlled studies were considered in order to investigate the efficacy and safety of a bio-adhesive plaster for topical administration containing diclofenac epolamine (DHEP) in patients with symptomatic knee osteoarthritis (OA).

Methods: Patients with radiologically confirmed symptomatic knee OA were included. The 14-day treatment consisted of two daily applications of either DHEP or placebo plaster.

[History and clinical examination in rheumatology--key to diagnosis and prognosis].

History and clinical examination are key to diagnosis and prognosis in rheumatology. In the area of soft tissue rheumatism, there is no other diagnostic possibility which could replace clinical examination. Clinical examination also plays a very important role in the diagnosis of the other rheumatic disorders.

Overall tolerability and analgesic activity of intra-articular sodium hyaluronate in the treatment of knee osteoarthritis.

Objective: Viscosupplementation with intra-articular hyaluronic acid (HA) is an alternative to the treatment of symptomatic knee osteoarthritis (OA) with pain relieving drugs. Sinovial, is a sterile, non-pyrogenic 0.8% solution of highly purified sodium hyaluronate for intra-articular application.

[The role of PCR for the diagnosis of Lyme arthritis].

Objective, Patients And Methods: We studied retrospectively four patients with Lyme arthritis of the knee, the role of PCR for the detection of B. burgdorferi DNA and its influence on further therapeutic decisions.

Results: All four patients with Lyme arthritis suffered from knee pain and effusions.

MRI for diagnosis and monitoring of patients with eosinophilic fasciitis.

Objective: The objective of this study was to describe MRI findings in patients with eosinophilic fasciitis (EF) and to correlate clinical and laboratory findings with the MRI findings.

Materials And Methods: Six patients with histologically proven EF underwent MRI at the time of diagnosis and after therapy (15 MRI examinations). Unenhanced T1-weighted, T2-weighted, and STIR sequences were performed using a 1.

Pseudocystic degeneration of the lumbar ligamentum flavum: a little known entity.

Objective: The objective of this work was to investigate the clinical and histologic features of patients with pseudocystic lesions of the ligamentum flavum in the lumbar region of the spinal canal and ascertain the existence of genuine ligamentum flavum pseudocysts.

Methods: Retrospective chart and histologic study of a patient cohort with lumbar radiculopathy due to a cystic intraspinal lesion and who had undergone decompressive surgery was conducted. Intraoperatively, the stenosing process had been found to be different from common etiologic entities and had been submitted for histologic examination.

Assessment of heart involvement.

Cardiac involvement frequently occurs in systemic sclerosis (SSc), contributing to the occurrence of symptoms, namely dyspnoea, fatigue, palpitations, and in some instances to the clinical evolution and prognosis of the disease. A thorough baseline screening of heart functioning and appropriate follow-up monitoring is therefore mandatory in all SSc patients. This consists of various simple, non-invasive ambulatory diagnostic procedures (visit, electrocardiogram, chest X-ray, Doppler-bidimensional echocardiogram), which provide information on the presence of rhythm and conduction disturbances, cardiac morphology and function, as well as on the possible presence of pulmonary hypertension (PH).

Topical diclofenac patch in patients with knee osteoarthritis: a randomized, double-blind, controlled clinical trial.

Objective: To assess the efficacy and safety of a diclofenac hydroxyethylpyrrolidine (DHEP) patch in the treatment of symptomatic osteoarthritis (OA) of the knee joint.

Methods: A double-blind, randomised, placebo-controlled trial was carried out on 103 outpatients for 2 weeks. The main efficacy parameters were spontaneous pain and Lequesne's Index.

Angiogenic and angiostatic factors in systemic sclerosis: increased levels of vascular endothelial growth factor are a feature of the earliest disease stages and are associated with the absence of fingertip ulcers.

To examine whether the lack of sufficient neoangiogenesis in systemic sclerosis (SSc) is caused by a decrease in angiogenic factors and/or an increase in angiostatic factors, the potent proangiogenic molecules vascular endothelial growth factor (VEGF) and basic fibroblast growth factor, and the angiostatic factor endostatin were determined in patients with SSc and in healthy controls. Forty-three patients with established SSc and nine patients with pre-SSc were included in the study. Serum levels of VEGF, basic fibroblast growth factor and endostatin were measured by ELISA.

Prevalence of TTV DNA and GBV-C RNA in patients with systemic sclerosis, rheumatoid arthritis, and osteoarthritis does not differ from that in healthy blood donors.

Objective: To determine the prevalence of GB virus-C (GBV-C) RNA and TT virus (TTV) DNA in patients with systemic sclerosis (SSc), rheumatoid arthritis (RA), and osteoarthritis (OA) as well as to compare the autoantibody pattern in patients with SSc with and without evidence of viral infection.

Patients And Methods: The study included 168 patients (84 SSc, 41 RA, and 43 OA) diagnosed according to the American College of Rheumatology criteria and 122 volunteer blood donors. The presence of GBV-C RNA and TTV DNA in serum was assessed by nested reverse transcriptase-polymerase chain reaction (RT-PCR) and semi-nested PCR, respectively.

European multicentre study to define disease activity criteria for systemic sclerosis. II. Identification of disease activity variables and development of preliminary activity indexes.

Objective: To develop criteria for disease activity in systemic sclerosis (SSc) that are valid, reliable, and easy to use.

Methods: Investigators from 19 European centres completed a standardised clinical chart for a consecutive number of patients with SSc. Three protocol management members blindly evaluated each chart and assigned a disease activity score on a semiquantitative scale of 0-10.

Osteoarthritis of the scaphoidtrapezium joint: an early sign of calcium pyrophosphate dihydrate disease.

The aim of this study was to determine the value of scaphoidtrapezium osteoarthritis (ST osteoarthritis) as an early sign of calcium pyrophosphate dihydrate disease (CPDD) in a cohort of patients undergoing surgery for osteoarthritis of the first carpometacarpal joint. We examined whether patients with cartilage calcification of the wrist at the time of operation had ST osteoarthritis, indicating CPDD at an earlier time (retrospective study), and whether patients with ST osteoarthritis but without cartilage calcification at the time of surgery develop radiological or clinical signs of CPDD at a later time (prospective study). From 1 January 1989 to 31 December 1995 a total of 169 patients (from an orthopaedic clinic) with a diagnosis of osteoarthritis of the first carpometacarpal joint were included in the study; 167 underwent surgery and two were treated without.

Altered diurnal rhythm of prolactin in systemic sclerosis.

Objective: Mild hyperprolactinemia has been reported in systemic lupus erythematosus (SLE) and systemic sclerosis (SSc). We investigated whether the elevated serum level of prolactin (Prl) detected in SSc is due to a sustained increase over 24 h and/or a shift in the diurnal rhythm, and whether Prl autoantibodies--originally described in SLE--may interfere in the assay.

Methods: The serum level of Prl was measured by ELISA and compared between 73 patients with SSc and 73 age and sex matched controls (78% women, age 56 +/- 11 years).

Effects of creatine supplementation on muscle weakness in patients with rheumatoid arthritis.

Background And Objectives: Patients with rheumatoid arthritis (RA) frequently suffer from muscle weakness. Oral administration of creatine has been shown to improve muscle strength in healthy subjects. The objective of this study was to examine the effect of oral creatine supplementation on muscle weakness, disease activity and activities of daily living in patients with RA.

Haemophilic; arthropathy: assessment of quality of life after total knee arthroplasty.

The goal of this study was to examine how the known effects of total knee arthroplasty (TKA) on clinical outcome parameters translate into improved quality of life, as measured with validated condition-specific and generic questionnaires (Knee Society Score, WOMAC, SF-12, transition questions), addressing physical, mental and social health. Eleven patients (13 knees) undergoing TKA from 1986 to 1994, with the diagnosis of severe haemophilic arthropathy of the knee, were followed-up over a 4-year period on average. TKA was found to reduce the burden of disease to levels similar to patients with osteoarthritis undergoing hip arthroplasty.

Development and validation of a self-administered systemic sclerosis questionnaire (SySQ).

Objective: To develop a self-administered systemic sclerosis questionnaire (SySQ) covering condition-specific functional limitation and symptoms. METHODS An initial item pool was generated by open patient interviews. A preliminary questionnaire was devised using 62 systemic sclerosis (SSc; scleroderma) patients.

Lymphatic microangiopathy of the skin in systemic sclerosis.

Methods: The cutaneous capillary lymphatic system in patients with systemic sclerosis was investigated using fluorescence microlymphography. The distal upper limbs of 16 healthy controls (mean age 62.3+/-13.