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Query: UMLS:C0030193 (pain)
 261,466 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The literature reports that 70% of the cases of sinus tarsi syndrome are post-traumatic, following an inversion sprain, and that 30% result from inflammatory disorders, such as rheumatoid arthritis, ankylosing spondylitis, and gouty arthritis. However, in the case presented, talipes equinovarus deformity and sinus tarsi syndrome coexisted. One of the corrective goals in the management of the talipes equinovarus deformity is the realignment of the articulation between the medial plantarly deviated talar head and the anteromedial segment of the calcaneus. The calcaneus must be rotated from a plantarflexed position into a dorsiflexed position. The posterior tubercle will be moved down and in, with the anterior process moved up and out away from the talar head. By correcting the plantarflexed varus attitude of the calcaneus, it is put in a valgus position that often closes down the sinus tarsi upon weightbearing. This compression may result in pain over the lateral aspect of the midfoot with hindfoot instability, as seen in the case presented. As a result of the abnormal anatomical relationship of the talus and calcaneus, the patient developed severe pain in the sinus tarsi. Based on the medical history and present postoperative results, the authors find a long-term sequela of talipes equinovarus deformity to be sinus tarsi syndrome.
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PMID:Sinus tarsi syndrome in a patient with talipes equinovarus. 232 75

The cauda equina syndrome is an uncommon and poorly understood complication of ankylosing spondylitis. The clinical and radiologic findings in five patients with this syndrome are described. Typical findings include cutaneous sensory impairment of the lower limbs and perineum with sphincter disturbances. Motor impairment occurs less frequently, and associated pain is an inconstant feature. Enlargement of the caudal sac and dorsal arachnoid diverticula that erode the lamina and spinous processes are characteristic myelographic and computed tomographic findings. The pathogenesis of the cauda equina syndrome in ankylosing spondylitis remains unknown but may be due to demyelination, post-irradiation ischemia, or compression from spinal arachnoiditis.
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PMID:Cauda equina syndrome complicating ankylosing spondylitis. 232 76

Nerves of the synovial membrane and of the capsule of the hip have been studied with the usual techniques of optical neuropathology. We studied 52 hips from 46 patients: 13 hips of post-fracture states of the femoral neck, 13 hips of idiopathic osteonecrosis, 6 hips of rheumatoid arthritis, 6 hips of ankylosing spondylitis and 14 hips of osteoarthrosis. Small capsular and synovial nerves mainly located close to blood vessels are modified by the lesions of the surrounding tissue (inflammatory, vascular, traumatic and mechanical disturbances). The degree of involvement is related to the disease and its evolution. The peri- and endoneurium is thickened and demyelination is mostly observed. Nerve lesions begin focally and for some time are segmental. The final lesions correspond to a complete fibrous transformation of the nerve with loss of axons. We suggest a correlation between nerve lesions and the existence or absence of pain in the hip.
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PMID:Pathology of the capsular and synovial hip nerves in chronic hip diseases. 234

We reviewed the results of forty-two total hip replacements that had been done with the self-locking Autophor ceramic total hip prosthesis in thirty-four patients. The patients ranged in age from twenty-five to sixty-seven years (average, forty-eight years). The diagnoses were avascular necrosis (eight patients), degenerative arthritis (nineteen patients), ankylosing spondylitis (one patient), post-traumatic arthritis (two patients), and rheumatoid arthritis (four patients). Seven procedures were revisions: five, of a loose cemented total hip prosthesis and two, of a loose noncemented endoprosthesis. No revision was done for infection. The length of follow-up ranged from twenty-seven to sixty-six months (average, fifty-one months). The patients were evaluated by physical examination, serial radiographs, and questionnaires. The hips were rated with the modified Harris hip score. At the time of follow-up, eleven of the twenty-seven patients who had had a primary hip replacement complained of at least moderate pain that limited activities; however, only three patients had to have a revision. The femoral components had a notable tendency to subside more than five millimeters, and in fifteen hips there was radiographic evidence of progressive loosening. Our experience with the self-locking Autophor ceramic total hip prosthesis has been disappointing. We no longer use it.
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PMID:Unsatisfactory results with a ceramic total hip prosthesis. 187 79

The role played by simple analgesics in the treatment of ankylosing spondylitis (AS) is not clear. A questionnaire survey of AS patients and rheumatologists revealed that a majority (78%) of patients took NSAIDs and a substantial proportion (34%) took simple analgesics. A majority of rheumatologists (65%) considered simple analgesics worth prescribing for AS patients. Rheumatologists tended to prescribe NSAIDs more often initially than simple analgesics while the reverse was true for general practitioners. Over half the patients (57%) considered pain relief as their first priority for drug treatment. Other objectives such as prevention of deformities and relief of stiffness were less important. A sizeable proportion of patients (15%) bought over-the-counter drugs. Prescribing habits of doctors can be improved by listing over-the-counter drugs in the British National Formulary and Data Sheet Compendium.
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PMID:Use of simple analgesics in the treatment of ankylosing spondylitis. 243 89

A 41-year-old male with a 20-year history of classical ankylosing spondylitis, psoriasis and seropositive, nodular erosive rheumatoid arthritis presented with a 12-month history of thoracolumbar junction pain following minor trauma. A pseudoarthrosis was noted at the T11/12 level on plain radiographs and tomograms. A gallium scan showed no increased isotope uptake, and a computed tomogram (CT) revealed no evidence of a paraspinal collection. Conservative management including cast immobilisation and local radiotherapy was ineffective, and spinal fusion was required. A typical Andersson lesion was found at operation. The diagnostic and therapeutic problems of such discovertebral lesions are discussed.
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PMID:A destructive discovertebral lesion: septic discitis, ankylosing spondylitis, or rheumatoid arthritis? 252 9

Pain threshold was measured using a pressure algometer in 126 subjects, of whom 54 were females and 72 males. These subjects included 18 males and 18 females with rheumatoid arthritis, 18 males and 18 females with osteoarthritis, 18 males with ankylosing spondylitis, and 18 male and 18 female healthy control volunteers. Six points were studied on each side of the body: 2 cm above the eyebrow on the forehead, lateral aspect of the arm at the insertion of the deltoid muscle, midpoint of the ulna, hypothenar eminence in the palm, midpoint of the quadriceps muscle, and midpoint of the antero-medial aspect of the tibia. None of these points corresponded to the "trigger" points in fibromyalgia. The pain threshold was statistically significantly higher in patients with ankylosing spondylitis than in patients with osteoarthritis, and these in turn were statistically higher than in the normal subjects. Patients with rheumatoid arthritis had significantly lower pain thresholds than the normal subjects. No laterality in pain threshold was identified, but females had in general a lower pain threshold.
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PMID:Measurement of pain threshold in patients with rheumatoid arthritis, osteoarthritis, ankylosing spondylitis, and healthy controls. 208 92

The pharmacology, pharmacokinetics, clinical efficacy, adverse effects, and dosage of diclofenac sodium are reviewed. Diclofenac, the first nonsteroidal anti-inflammatory agent (NSAID) to be approved that is a phenylacetic acid derivative, competes with arachidonic acid for binding to cyclo-oxygenase, resulting in decreased formation of prostaglandins. The drug has both analgesic and antipyretic activities. Diclofenac is efficiently absorbed from the gastrointestinal tract; peak plasma concentrations occur 1.5 to 2.0 hours after ingestion in fasting subjects. Even though diclofenac has a relatively short elimination half-life in plasma (1.5 hours), it persists in synovial fluid. The drug is metabolized in the liver and is eliminated by urinary and biliary excretion. In clinical trials, diclofenac was as effective as aspirin, diflunisal, indomethacin, sulindac, ibuprofen, ketoprofen, and naproxen in improving function and reducing pain in patients with rheumatoid arthritis. For treatment of osteoarthritis, diclofenac was equivalent in efficacy to aspirin, diflunisal, indomethacin, sulindac, ibuprofen, ketoprofen, naproxen, flurbiprofen, mefenamic acid, and piroxicam. Diclofenac was as effective as indomethacin or sulindac in treating ankylosing spondylitis. The most frequent adverse effects reported for diclofenac were gastrointestinal, but these effects were fewer and less serious than occurred with aspirin or indomethacin; in addition, diclofenac caused fewer central nervous system reactions than indomethacin. Diclofenac is administered in divided doses with meals. The recommended total daily dosage is 100 to 150 mg (osteoarthritis and ankylosing spondylitis) or 150 to 200 mg (rheumatoid arthritis). Diclofenac is effective, but no more so than other NSAIDs. It is structurally distinct and offers another choice in the treatment of rheumatological conditions.
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PMID:Diclofenac sodium. 267 Mar 97

Rheumatism in its many forms has affected mankind since ancient times. Numerous examples exist of the powerful and the famous who suffered these afflictions. In some cases the disease process in thought to have, through the sufferers, altered the course of history itself. Throughout history, the arts have served as a means by which man expressed life's broad range of emotions: love, beauty, despair, loneliness. But the works of several prominent artists also reflect the pain and frustration of arthritis. Examples of common diseases include low back pain and sciatica, which disabled Aneas of Greek mythology, Jacob of Biblical times, Sister Catherine and Jefferson. Lincoln and Paganini are both thought to have suffered from Marfan's syndrome. Ankylosing spondylitis affected Cosimo de Medici and the poet Scarron, while the disability of Columbus is thought to be more compatible with Reiter's Syndrome. Without even considering the numerous examples of famous personnages who had gout, one can find multiple historical and artistic figures who suffered from chronic polyarthritis. A brief list would include the Emperor Constantine, Rubens, Mary Queen of Scots, Madison, Renoir, Verlaine, and Dufy. Since these disorders can also be found in historical references, one wonders if, having affected the lives and temperaments of the eminent, the powerful, or an entire population, they may have in some circumstances exerted some influence on the course of world history, or, through artistic talents, contributed to the intellectual enrichment of society.
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PMID:The past: a gallery of arthritics. 269 46

Serum alkaline phosphatase isoenzymes were determined quantitatively by electrophoresis on cellulose acetate in 168 patients with rheumatic diseases subgrouped for disease activity. Median values of total alkaline phosphatase and bone isoenzyme activity, as well as frequency of patients showing pathological values, increased gradually and significantly corresponding to disease activity in rheumatoid arthritis and ankylosing spondylitis, from 0% in inactive to 90% in very active forms. Bone isoenzyme was much more sensitive than total alkaline phosphatase in moderate disease activity and was also correlated to the number of involved extravertebral joints and pain in ankylosing spondylitis. No correlation was found with stage or duration of disease, age, sex, and erythrocyte sedimentation rate. Additional to bone isoenzyme, liver isoenzymes were elevated in some patients, but with only a weak correlation with disease activity. The intestinal isoenzymes were always normal. We conclude that quantitative determination of serum alkaline phosphatase bone isoenzyme activity is a major indicator for the assessment of disease activity and therapeutic monitoring in rheumatoid arthritis and ankylosing spondylitis.
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PMID:Alkaline phosphatase isoenzymes in rheumatic diseases. 272 Sep 63


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