Steven Rimbaut

Impairment and impact of pain in female patients with Ehlers‐Danlos syndrome: A comparative study with fibromyalgia and rheumatoid arthritis

OBJECTIVE The purpose of this study was to investigate functional impairment and the impact of pain in patients with Ehlers-Danlos syndrome, hypermobility type (EDS-HT), and to compare the burden of disease with that in women with fibromyalgia (FM) and rheumatoid arthritis (RA). METHODS A total of 206 female patients were compared (72 with EDS-HT, 69 with FM, and 65 with RA). Functional impairment was assessed with the Sickness Impact Profile (SIP), and the psychosocial impact of chronic pain was quantified with the Multidimensional Pain Inventory (MPI). Data on symptoms were collected. RESULTS SIP results showed clinically relevant health-related dysfunction in all groups. Significantly poorer physical, psychosocial, and overall function was found in the EDS-HT group compared with the RA group. In comparison with the FM group, the EDS-HT group reported similar physical and overall function, but better psychosocial function. T scores from the MPI revealed significantly higher levels of pain severity and life interference due to pain, and a lower level of perceived life control, in the EDS-HT group compared to the RA group. In contrast, the EDS-HT group showed significantly lower levels of pain severity, life interference, and affective distress in comparison with the FM group. Social support for help in coping with pain was similar between the 3 groups. CONCLUSION EDS-HT is associated with a consistent burden of disease, similar to that of FM and worse than that of RA, as well as a broad impact of chronic pain on daily life, which needs to be addressed in the health care system.

Treatment of Skeletal Muscle Injury: A Review

Skeletal muscle injuries are the most common sports-related injuries and present a challenge in primary care and sports medicine. Most types of muscle injuries would follow three stages: the acute inflammatory and degenerative phase, the repair phase and the remodeling phase. Present conservative treatment includes RICE (rest, ice, compression, elevation), nonsteroidal anti-inflammatory drugs (NSAIDs) and physical therapy. However, if use improper, NSAIDs may suppress an essential inflammatory phase in the healing of injured skeletal muscle. Furthermore, it remains controversial whether or not they have adverse effects on the healing process or on the tensile strength. However, several growth factors might promote the regeneration of injured skeletal muscle, many novel treatments have involved on enhancing complete functional recovery. Exogenous growth factors have been shown to regulate satellite cell proliferation, differentiation and fusion in myotubes in vivo and in vitro, TGF-β1 antagonists behave as inhibitors of TGF-β1. They prevent collagen deposition and block formation of muscle fibrosis, so that a complete functional recovery can be achieved.

Autonomic symptom burden in the hypermobility type of Ehlers–Danlos syndrome: A comparative study with two other EDS types, fibromyalgia, and healthy controls

AIM This study provides insight into the profile and importance of autonomic symptoms in the hypermobility type (HT) of Ehlers-Danlos syndrome (EDS). The impact of these symptoms is put into perspective by comparing with fibromyalgia (FM) and two other EDS types. METHODS Overall, 80 patients with EDS-HT participated, as well as 11 with classical EDS (cEDS), seven with vascular EDS (vEDS), 38 with FM, and 43 healthy controls. All participants filled out the autonomic symptom profile (ASP). Furthermore, they were inquired about quality of life (QOL, SF-36) and factors contributing to the EDS disease burden, e.g., hypermobility (5-point questionnaire, GHQ), fatigue (checklist individual strength, CIS), pain (pain detect questionnaire, PDQ), affective distress (hospital anxiety and depression scale, HADS), and physical activity (Baecke). RESULTS The total autonomic symptom burden was higher in EDS-HT (57.9 ± 21.57) than in controls (11.3 ± 19.22), cEDS (32.3 ± 19.47), and vEDS (29.1 ± 19.18), but comparable to FM (53.8 ± 19.85). Especially orthostatic and gastrointestinal complaints were prevalent. The importance of autonomic symptoms in EDS-HT was emphasized by the correlation with lowered QOL (r = -0.402), fatigue (r = 0.304), and pain severity (r = 0.370). Although affective distress and decreased physical activity are often suggested as possible causes for dysautonomia, the ASP did not correlate with the HADS and Baecke score. By contrast, the correlation of the GHQ (r = 0.298) and PDQ (r = 0.413) with the ASP supports the hypothesis that joint hypermobility and neuropathy may play a role in the development of autonomic symptoms. CONCLUSION Autonomic symptoms, especially orthostatic and gastrointestinal complaints, are frequent extraarticular manifestations of EDS-HT and contribute to the disease burden.

Urinary retention after hysterectomy for benign disease: extended diagnostic evaluation and treatment with sacral nerve stimulation

The problem of urinary retention after hysterectomy for benign disease is extensively evaluated by authors from Ghent. Their interesting results show that it is associated with the de‐afferentiation of the bladder wall and with Fowlers syndrome. These findings help our understanding of a troublesome condition.

Free radical scavengers versus methylprednisolone in the prevention of experimentally induced heterotopic ossification

The etiology of heterotopic ossification (HO) is still obscure, it is difficult to devise an effective preventive or therapeutic approach. The options for the prevention of HO are still limited. The prophylactic effect of nonsteroidal anti‐inflammatory drugs (NSAIDs) is insufficient. Moreover, NSAIDs increase the risk of nonunion and loosening in patients with multiple joint injuries. The present experimental study was designed to compare methylprednisolone with free radical scavengers for the prevention of HO. The model of Michelsson et al. was used to induce HO in the hind legs of 30 female New Zealand albino rabbits, weighing approx. 4 kg. The animals were randomized into three groups of 10 animals each, and received daily either placebo, a free radical scavenger cocktail [allopurinol and N‐acetylcysteine (A/A)], or methylprednisolone in a randomized, double‐blind fashion. Every four days, X‐rays were obtained to measure the thickness and the length of new bone formation at the thigh. A statistically significant difference in thickness and length of newly formed bone was found between the three groups. In the placebo group HO increased from day 16 toward a medium length of 6 mm and a median thickness of 1.5 mm. In the A/A group, no signs of HO were found. In the methylprednisolone group, only one animal presented minor HO from day 32. Both free radical scavengers and methylprednisolone were found to inhibit HO, and may be considered effective measures for the prevention of heterotopic bone formation. However, it could not be demonstrated which of the two had the strongest inhibitory effect.

Chronic fatigue syndrome - an update.

Background: Chronic fatigue syndrome is a widespread condition with a huge impact not only on a patient’s life, but also on society as evidenced by substantial losses of productivity, informal costs, and medical expenses. The high prevalence rates (0.2–6.4%) and the low employment rates (27–41%) are responsible for the enormous burden imposed on society, with loss of productivity representing the highest cost. The objective of this review is to systematically review the recent literature on chronic fatigue syndrome/myalgic encephalomyelitis. Methods: The published literature between 1 January 1990 and 1 April 2015 was searched using the MEDLINE, Cochrane Library, and Web of Sciences databases. The reference lists of the selected articles were screened for other relevant articles. Results and conclusions: Despite extensive research, none of the proposed etiological factors have shown strong, reproducible scientific evidence. Over the years, the biopsychosocial model integrating many of the proposed hypotheses has been gaining popularity over the biomedical model, where the focus is on one physical cause. Since the etiological mechanism underlying chronic fatigue syndrome is currently unknown, disease-specific treatments do not exist. Various treatments have been investigated but only cognitive behavior therapy (CBT) and graded exercise therapy (GET) have shown moderate effectiveness.

A multidisciplinary network for the care of abnormal fatigue and chronic fatigue syndrome in the provinces of East and West Flanders in Belgium

Abstract The organization of care for patients with the chronic fatigue syndrome (CFS) in tertiary care referral centres from 2002 onwards, was negatively evaluated by the Belgian Health Care Knowledge Centre on the endpoint of socio-professional reintegration. Subsequently, the federal health authorities asked for the elaboration of a new and innovative model of stepped care, aiming at improved integration of diagnosis and treatment into primary care and between levels of health care for patients with CFS. The reference centre of the University Hospital Ghent took the initiative of recruiting partners in the Belgian provinces of East and West Flanders to guarantee the care for patients with medically unexplained symptoms, in particular abnormal fatigue and CFS. A new and innovative care model, in which general practitioners play a central role, emphasizes the importance of early recognition of the patient ‘at risk’, correct diagnosis and timely referral. Early detection and intervention is essential in order to avoid or minimize illness progression towards chronicity, to safeguard opportunities for significant health improvement as well as to enhance successful socio-professional reintegration. This approach covers both the large sample of patients developing somatic complaints without obvious disease in an early phase as well as the more limited group of patients with chronic illness, including CFS. Cognitive behavioural therapy and graded exposure/exercise therapy are the evidence based main components of therapy in the latter. A biopsychosocial model underlies the proposed path of care.

Effect of whole body vibration on intracompartmental pressure in the lower leg

BackgroundWhole body vibration has important effects on neuromuscular functions. It seems to be a promising tool in the conservative treatment and rehabilitation of compartment syndrome. In the present study we investigated the effect of whole body vibration on intracompartmental pressure in the lower leg during a strenuous static exercise program.MethodsWe conducted a cross-over pilot study in which fifteen healthy male subjects participated. They twice performed a 20.5-min static exercise program on the Fitvibe Medical whole body vibration device, once with 27 Hz vibrations and once without. The intracompartmental pressure was measured by two examiners at the superficial posterior compartment of the left and right lower leg, at rest and during the exercise programs.ResultsA general linear model for repeated measures showed a significant difference between the exercise program with vibrations and that without (P = 0.001) and a significant difference in intracompartmental pressure for the factor time of measurement (P < 0.001). Mean intracompartmental pressure was at any point in time lower in the vibrating than in the non-vibrating exercise conditions, though not always significant. In the program with vibrations the exercise pressures showed a non-significant trend to decrease (from 23.5 mmHg to 21.3 mmHg) as the program advanced, while in the non-vibration program, there was a trend to increase (from 24.1 to 27.9 mmHg).ConclusionsThe mean intracompartmental pressure was lower when whole body vibration at 27 Hz was superimposed. Therefore, whole body vibration seems to be a possible tool to lower intracompartmental pressure. Further research is needed to confirm whether these findings are also applicable in patients, athletes, and in dynamic exercises.

What is the Role for Preoperative Physical Training and Respiratory Kinesitherapy in Obese Surgical Patients

The role of exercise and physical therapy in the treatment of obesity remains debatable. Those who believe in respiratory kinesitherapy believe that this intervention may prevent or reduce the impact of anesthesia and surgery on the respiratory muscles and on postoperative pulmonary complications. Exercise (especially when combined with diet) has a positive effect on body weight and cardiovascular disease risk factors in overweight and obese patients. If physical fitness can be linked to surgical outcome, then improving fitness by means of physical training as an intervention should theoretically improve postoperative outcome. There is evidence that less fit patients do have a greater risk of complications and death and prehabilitation does improve health-related quality of life and fitness levels. Although there is a paucity of studies on this topic, this chapter will try to address some questions, including “Can preoperative training improve fitness in morbidly obese patients and does this translate to better outcome?” and “What are the key elements of such a preoperative training: modality, frequency, duration, intensity and pattern?”.