Péter Bálint

Hydrotherapy, balneotherapy, and spa treatment in pain management

The use of water for medical treatment is probably as old as mankind. Until the middle of the last century, spa treatment, including hydrotherapy and balneotherapy, remained popular but went into decline especially in the Anglo-Saxon world with the development of effective analgesics. However, no analgesic, regardless of its potency, is capable of eliminating pain, and reports of life-threatening adverse reactions to the use of these drugs led to renewed interest in spa therapy. Because of methodologic difficulties and lack of research funding, the effects of ‘water treatments’ in the relief of pain have rarely been subjected to rigorous assessment by randomised, controlled trials. It is our opinion that the three therapeutic modalities must be considered separately, and this was done in the present paper. In addition, we review the research on the mechanism of action and cost effectiveness of such treatments and examine what research might be useful in the future.

Comparison of the Psoriatic Arthritis Quality of Life (PsAQoL) questionnaire, the functional status (HAQ) and utility (EQ-5D) measures in psoriatic arthritis: results from a cross-sectional survey

Objectives: To compare the Psoriatic Arthritis Quality of Life (PsAQoL) instrument, the Health Assessment Questionnaire (HAQ) as a measure of functional status, and the generic health status (utility) measure the EuroQoL (EQ-5D) in terms of ability to assess disease severity in psoriatic arthritis (PsA). Methods: The differences between known groups and correlations of the PsAQoL, the HAQ and the EQ-5D with clinical measures were analysed in a sample of 183 PsA patients. Results: Different severities of PsA determined by known groups were distinguished well by all three questionnaires; more severe disease was associated with significantly worse values of the instruments. The correlations revealed a strong relationship between each of the measures, and with the patients’ pain on the visual analogue scale (VAS), the patient global VAS, and the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), and a weak relationship with the disease duration and the Psoriasis Area Severity Index (PASI). The PsAQoL also correlated strongly with the 28-joint Disease Activity Score (DAS28). Conclusions: The PsAQoL, the HAQ, and the EQ-5D are able to distinguish well across levels of PsA severity.

Ultrasound-guided aspiration in suspected sepsis of resection arthroplasty of the hip joint

SummaryThe authors described 17 patients who had had resection arthroplasty of the hip and who were suspected of having an infection. The resection arthroplasties had been performed for previous infection. All the patients were studied by ultrasonography to detect effusion in the pseudoarticular space. Thirteen of the 17 patients were found to have an effusion by ultrasonography. Fluid was obtained in 9 of the 13 patients by ultrasonographic-guided aspiration. The mean aspirated volume was 3 ml (range 1–25 ml). Five of the 9 aspirates proved to be septic. The echopattern in all but one of those five with sepsis was nonechofree. Of four other patients in whom it was not possible to aspirate fluid lavage of the pseudoarticular space one yielded a positive culture. The role of ultrasonography in the diagnosis and management of patients who have undergone resection arthroplasty of the hip and who are suspected of having an infected pseudoarticular space is discussed.

Ex Vivo Soft-Laser Treatment Inhibits the Synovial Expression of Vimentin and α-Enolase, Potential Autoantigens in Rheumatoid Arthritis

Background Soft-laser therapy has been used to treat rheumatic diseases for decades. The major effects of laser treatment may be dependent not on thermal mechanisms but rather on cellular, photochemical mechanisms. However, the exact cellular and molecular mechanisms of action have not been elucidated. Objective The aim of this study was to investigate the ex vivo effects of low-level laser treatment (with physical parameters similar to those applied previously) on protein expression in the synovial membrane in rheumatoid arthritis (RA). Design Synovial tissues were laser irradiated, and protein expression was analyzed. Methods Synovial membrane samples obtained from 5 people who had RA and were undergoing knee surgery were irradiated with a near-infrared diode laser at a dose of 25 J/cm2 (a dose used in clinical practice). Untreated synovial membrane samples obtained from the same people served as controls. Synovial protein expression was assessed with 2-dimensional polyacrylamide gel electrophoresis followed by mass spectrometry. Results The expression of 12 proteins after laser irradiation was different from that in untreated controls. Laser treatment resulted in the decreased expression of α-enolase in 2 samples and of vimentin and precursors of haptoglobin and complement component 3 in 4 samples. The expression of other proteins, including 70-kDa heat shock protein, 96-kDa heat shock protein, lumican, osteoglycin, and ferritin, increased after laser therapy. Limitations The relatively small sample size was a limitation of the study. Conclusions Laser irradiation (with physical parameters similar to those used previously) resulted in decreases in both α-enolase and vimentin expression in the synovial membrane in RA. Both proteins have been considered to be important autoantigens that are readily citrullinated and drive autoimmunity in RA. Other proteins that are expressed differently also may be implicated in the pathogenesis of RA. Our results raise the possibility that low-level laser treatment of joints affected with RA may be effective, at least in part, by suppressing the expression of autoantigens. Further studies are needed.

Polymyalgia rheumatica: 125 years of epidemiological progress?

Objectives On the 125th anniversary of the first recognised publication on polymyalgia rheumatica, a review of the literature was undertaken to assess what progress has been made from the point of view of the epidemiology of this disease and whether such studies have advanced our knowledge of its aetiopathogenesis and management. Methods The authors searched Medline and PubMed using the search terms ‘polymyalgia rheumatica’, ‘giant cell arteritis’ and ‘temporal arteritis’. As much as possible, efforts were made to focus on studies where polymyalgia and giant cell arteritis were treated as separate entities. The selection of articles was influenced by the authors’ bias that polymyalgia rheumatica is a separate clinical condition from giant cell arteritis and that, as yet, the diagnosis is a clinical one. Results This review has shown that, following the recognition of polymyalgia as a distinct clinical problem of the elderly, the results of a considerable amount of research efforts investigating the populations susceptible, the geographic distribution of these affected populations and the associated sociological and genetic elements that might contribute to its occurrence, polymyalgia rheumatica remains a difficult problem for the public health services of the developed world. Conclusions Polymyalgia rheumatica remains a clinical enigma and its relationship to giant cell arteritis is no clearer now than it has been for the past 125 years. Diagnosing this disease is still almost exclusively dependent on the clinical acumen of a patient’s medical attendant. Until an objective method of identifying it clearly in the clinical setting is available, uncovering the aetiology is still unlikely. Until then, clear guidelines on the future incidence and prevalence of polymyalgia rheumatica and the public health problems of the disease and its management, especially in relation to the use of long term corticosteroids, will be difficult to provide.

[The use of physiotherapy tools in medical treatment. The use of heat, light, electric, magnetic, ultrasound and shock wave therapy as well as medical massage in Hungarian medical practice].

The authors overview the possible use of different modalities of passive physiotherapy in the Hungarian medical practice. These modalities can be used in most of the medical specialities as well as family practice, not only in the treatment of the musculoskeletal disorders and medical rehabilitation.