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The global elderly population is growing exponentially; with that comes the burden of mental health disorders and the associated comorbidities that these elderly suffer from. Psychological interventions have been proposed to offload that burden and decrease the severity or incidence of mental health disorders. The purpose of this study is to systematically evaluate the current literature on psychological interventions for mental health disorders. The current literature suggests sufficient evidence backed by extensive literature supporting psychological interventions in older adults. This aspect of care should be investigated and incorporated into treatment plans for mental health disorders as well as a form of prevention of other organic diseases that could lead to mental health disorders.

Sarcoidosis is a systemic granulomatous inflammatory condition characterized by varied clinical manifestations, with a higher prevalence observed in individuals aged 25 to 40 and women over 50. Typical presentations involve symmetric involvement of hilar and mediastinal lymph nodes, followed by lung involvement. While initial stages are often asymptomatic, the disease can impact various organs. Cutaneous involvement, observed in up to a quarter of patients, includes lupus pernio, papules, plaques, erythema nodosum, and occasionally subcutaneous nodules. Subcutaneous sarcoidosis, once considered rare, is now increasingly recognized. We present a case of Darier-Roussy sarcoidosis in a middle-aged man, demonstrating multiple painless subcutaneous nodules confirmed through biopsy. Our findings suggest that Darier-Roussy sarcoidosis typically manifests early in the disease course, indicating non-severe systemic involvement. Additionally, our patient responded well to hydroxychloroquine treatment, suggesting a positive outcome.

The global rise in the elderly population accentuates the importance of addressing challenges associated with aging, including comorbidities and declining physical function. Variability in the aging process emphasizes the potential for evidence-based biomedical innovations. Robust trials for anti-aging interventions become vital as public interest grows. Despite promising biomedical innovations, practical implementation encounters social and ethical challenges. Ensuring credibility in anti-aging research requires collaboration with biogerontology-focused journals and peer reviewers. This opinion piece delves into the unique aspects and challenges of anti-aging research and the pivotal role of adherence to reporting standards in advancing healthy aging initiatives.

Rheumatic and musculoskeletal diseases (RMDs) have far-reaching impacts on individuals and society, marked by chronic pain and functional limitations. While early diagnosis and treatments enhance RMD prognosis, comprehensive management demands multidisciplinary rehabilitation. Goals include pain management, joint function preservation, mobility sustenance, and active participation facilitation. Interdisciplinary teams craft patient-specific rehabilitation plans. Rheumatologists must guide discussions on tailored rehabilitation strategies for RMDs, particularly osteoarthritis, rheumatoid arthritis, and axial spondylarthritis, aligning with international guidelines. This review discusses evolving rehabilitation trends in rheumatic diseases, exploring challenges and opportunities for improved patient outcomes and quality of life.

The role of immunity in the pathogenesis of various pulmonary diseases, particularly interstitial lung diseases (ILDs), is being increasingly appreciated as mechanistic discoveries advance our knowledge in the field. Immune-mediated lung diseases demonstrate clinical and immunological heterogeneity and can be etiologically categorized into connective tissue disease (CTD)-associated, exposure-related, idiopathic, and other miscellaneous lung diseases including sarcoidosis, and post-lung transplant ILD. The immunopathogenesis of many of these diseases remains poorly defined and possibly involves either immune dysregulation, abnormal healing, chronic inflammation, or a combination of these, often in a background of genetic susceptibility. The heterogeneity and complex immunopathogenesis of ILDs complicate management, and thus a collaborative treatment team should work toward an individualized approach to address the unique needs of each patient. Current management of immune-mediated lung diseases is challenging; the choice of therapy is etiology-driven and includes corticosteroids, immunomodulatory drugs such as methotrexate, cyclophosphamide and mycophenolate mofetil, rituximab, or other measures such as discontinuation or avoidance of the inciting agent in exposure-related ILDs. Antifibrotic therapy is approved for some of the ILDs (e.g., idiopathic pulmonary fibrosis) and is being investigated for many others and has shown promising preliminary results. A dire need for advances in the management of immune-mediated lung disease persists in the absence of standardized management guidelines.

The pillars of scientific progress in rheumatology are experimentation and observation, followed by the publication of reliable and credible results. These data must then be independently verified, validated, and replicated. Peer and journal-specific technical and statistical reviews are paramount to improving rigor and reproducibility. In addition, research integrity, ethics, and responsible conduct training can help to reduce research misconduct and improve scientific evidence. As the number of published articles in rheumatology grows, the field has become critical for determining reproducibility. Prospective, longitudinal, randomized controlled clinical trials are the gold standard for evaluating clinical intervention efficacy and safety in this space. However, their applicability to larger, more representative patient populations with rheumatological disorders worldwide could be limited due to time, technical, and cost constraints involved with large-scale clinical trials. Accordingly, analysis of real-world, patient-centered clinical data retrieved from established healthcare inventories, such as electronic health records, medical billing reports, and disease registries, are increasingly used to report patient outcomes. Unfortunately, it is unknown whether this clinical research paradigm in rheumatology could be deployed in medically underserved regions.

AimTo investigate the extent of complementary medicine (CM) use and the most common therapies utilized by Jordanian patients with musculoskeletal (MSK) diseases.MethodsA semi-structured questionnaire was used to conduct a cross-sectional survey of outpatient orthopedic and rheumatology patients at an academic medical center in Amman, Jordan between January and September 2020.ResultsA convenience sample of 1001 patients was interviewed (82% females). Pearson's chi-square comparisons showed that nutritional CM was used by 43.4% of patients, while 29.8% used physical CM, and 16% used both. Almost all used the nutritional or physical CM in addition to their prescribed treatment. Nutritional form use was significantly higher among females, older age groups, married people, and those who worked (p < .05). Physical form use was statistically more prevalent in older age groups and those with a higher level of education (p < .05). Family income and urban residence were not significantly associated with the use of either form of CM therapy. Olive oil was the most frequently reported nutritional type (22.9%), and cupping was the most reported physical type (41.6%). Recommendations to use CM came primarily from family members or friends (64% of nutritional CM users and 59% of physical CM users). A physician or pharmacist was cited more frequently with physical CM (24% versus 8% for the nutritional form). In contrast, media sources were cited more for nutritional than physical form (28% versus 7%). Over half of the patients believed they received the desired effect from CM. Surprisingly, only 9.5% of the patients admitted to discussing their CM use with their physician.ConclusionCM use is prevalent among Jordanian patients with MSK disorders. Most patients rely on family and friends for recommendations, and they rarely inform their physician of the CM use. Physicians should routinely inquire about CM to provide patients with information regarding their benefits and risks.

Patients with autoimmune inflammatory rheumatic diseases (AIIRDs) are at increased risk for severe infections. Vaccine responses and safety profiles may differ between AIIRD patients and the general population. While patients with autoimmune inflammatory rheumatic diseases (AIIRDs) often experience diminished humoral responses and reduced vaccine efficacy, factors such as the type of immunosuppressant medications used and the specific vaccine employed contribute to these outcomes. Notably, individuals undergoing B cell depletion therapy tend to have poor vaccine immunogenicity. However, despite these considerations, vaccine responses are generally considered clinically sufficient. Ideally, immunosuppressed AIIRD patients should receive vaccinations at least two weeks before commencing immunosuppressive treatment. However, it is common for many patients to already be on immunosuppressants during the immunization process. Vaccination rarely triggers flares in AIIRDs; if flares occur, they are typically mild. Despite the heightened infection risk, including COVID-19, among AIIRD patients with rheumatoid arthritis, systemic lupus erythematosus, sarcoidosis, and other diseases on immunosuppressants, the vaccination rates remain suboptimal. The future directions of vaccination in the era of immunosuppression will likely involve customized vaccines with enhanced adjuvants and alternative delivery methods. By addressing the unique challenges faced by immunosuppressed individuals, we may improve vaccine efficacy, reduce the risk of infections, and ultimately enhance the health outcomes. Additionally, clinical trials to evaluate the safety and efficacy of temporarily discontinuing immunosuppressants during vaccination in various AIIRDs are crucial.

Abstract Background Patellofemoral pain is a common condition. The Kujala score is a well-established scoring system to assess anterior knee pain and has been translated into many languages including Arabic. The purpose of this cross-sectional study is to culturally adapt the Arabic version of the Kujala score and determine its validity. Methods The Kujala score is composed of 13 multiple-choice questions. We modified two questions in the score; running and squatting, and were replaced with questions related to walking on different terrain and prostration, each with the same number of answer choices as the original questions so as not to affect the final score. These modifications were written in Arabic by the same group who translated and validated the original score into Arabic. The original and modified Kujala scores was printed and given to patients complaining of patellofemoral pain to be filled during their visit to the orthopedic outpatient clinics. Final scores for the original and modified questionnaires were calculated. Data was analyzed using SPSS statistics version 21.0 measuring Cronbach’s alpha, intraclass correlation coefficient, and Pearson correlation. Results Ninety-four patients were included in the study, 28 (29.8%) men and 66 (70.2%) women. The mean age for the included patients was 43.67 (± 14.46) years. The mean score for the modified initial questionnaire was 63.91 (± 16.32), and the mean score for the modified re-test questionnaire was 66.52 (± 17.50). There was a statistically significant difference between the mean scores (p = 0.041), with a mean difference of 1.97 (95% CI 0.08 to 3.856). We found a significant strong correlation between the score before and after changing the questions with a p value of < 0.001. Conclusions The culturally modified Arabic Kujala questionnaire is shown to be a valid, well-designed tool and an appropriate method of measuring patellofemoral pain.

Pseudoxanthoma Elasticum (PXE) is a rare genetic disorder caused by an autosomal recessive mutation in the ABCC6 gene. It manifests with distinctive clinical symptoms impacting the skin, eyes, and cardiovascular system, along with an elevated risk of cardiovascular diseases. We present a case of a 34-year-old male patient who was initially referred to the rheumatology clinic for evaluation due to suspected large vessel vasculitis. The patient's primary complaint was severe hemifacial pain radiating to the neck and upper limb. Radiological imaging studies unveiled substantial vascular narrowing and collateral vessel formation, prompting further investigation to exclude systemic vasculitis. Intriguingly, the patient also exhibited cutaneous manifestations, which were later confirmed via skin biopsy as consistent with PXE. An ophthalmological examination further revealed the presence of the classic PXE findings of angioid streaks. Given the rarity of PXE and its multifaceted clinical presentation, it can be particularly challenging to diagnose and manage. As such, cases like the one presented here may necessitate a referral to a rheumatologist for evaluation of potential systemic involvement. To provide a comprehensive perspective on PXE, we conducted a systematic review of case reports published in the past decade in English, collected from PubMed, Scopus, and the Directory of Open Access databases. The analysis of these cases will be discussed to shed light on the diversity of PXE's clinical features and the diagnostic and management dilemmas it poses and to facilitate ongoing exploration and research into this intricate condition, ultimately leading to improved care for individuals affected by PXE. [ABSTRACT FROM AUTHOR]

Idiopathic Granulomatous Mastitis (IGM) is an infrequent, benign breast disease that primarily affects women during their childbearing years and can be mistaken for breast cancer. This study aimed to review the clinical, radiological, and histopathological findings of patients with IGM in addition to management and outcome. Retrospective cross-sectional study of biopsy-confirmed IGM at an academic medical center and a private hospital in Amman, Jordan. Fifty-four patients were included, with a mean age of 37.0 ± 9.04 years, mostly presenting with a breast lump (n = 52, 96.3%) and breast pain (n = 45 patients, 84.9%). Approximately half of the patients (51.9%) were parous, and 50% had breastfed for an average duration of 30.37 ± 22.38 months. Most of the patients had either solitary or multiple abscesses on breast ultrasound. Histopathological analysis (n = 35) showed mostly either moderate inflammation (n = 16, 45.7%) or severe inflammation (n = 14, 40%). Two-thirds of the patients underwent surgical interventions at the time of diagnosis, mostly incision and drainage (n = 16, 29%) or surgical excision (n = 7, 13%), and no mastectomies were performed. The most common medical treatment included a combination of antibiotics, corticosteroids, and methotrexate (n = 21, 38.8%). After follow-up, 31 patients remained in remission, 3 experienced relapses, and 3 had a chronic course. The use of corticosteroids was significantly associated with remission (p = 0.035). The presentation and demographics of IGM patients in Jordan were consistent with the existing literature. Prospective research is needed to explore different treatment options and disease outcomes. [ABSTRACT FROM AUTHOR]

Patients with autoimmune inflammatory rheumatic diseases (AIIRDs) are at increased risk for severe infections. Vaccine responses and safety profiles may differ between AIIRD patients and the general population. While patients with autoimmune inflammatory rheumatic diseases (AIIRDs) often experience diminished humoral responses and reduced vaccine efficacy, factors such as the type of immunosuppressant medications used and the specific vaccine employed contribute to these outcomes. Notably, individuals undergoing B cell depletion therapy tend to have poor vaccine immunogenicity. However, despite these considerations, vaccine responses are generally considered clinically sufficient. Ideally, immunosuppressed AIIRD patients should receive vaccinations at least two weeks before commencing immunosuppressive treatment. However, it is common for many patients to already be on immunosuppressants during the immunization process. Vaccination rarely triggers flares in AIIRDs; if flares occur, they are typically mild. Despite the heightened infection risk, including COVID-19, among AIIRD patients with rheumatoid arthritis, systemic lupus erythematosus, sarcoidosis, and other diseases on immunosuppressants, the vaccination rates remain suboptimal. The future directions of vaccination in the era of immunosuppression will likely involve customized vaccines with enhanced adjuvants and alternative delivery methods. By addressing the unique challenges faced by immunosuppressed individuals, we may improve vaccine efficacy, reduce the risk of infections, and ultimately enhance the health outcomes. Additionally, clinical trials to evaluate the safety and efficacy of temporarily discontinuing immunosuppressants during vaccination in various AIIRDs are crucial. [ABSTRACT FROM AUTHOR]

Aim: To investigate the extent of complementary medicine (CM) use and the most common therapies utilized by Jordanian patients with musculoskeletal (MSK) diseases. Methods: A semi-structured questionnaire was used to conduct a cross-sectional survey of outpatient orthopedic and rheumatology patients at an academic medical center in Amman, Jordan between January and September 2020. Results: A convenience sample of 1001 patients was interviewed (82% females). Pearson's chi-square comparisons showed that nutritional CM was used by 43.4% of patients, while 29.8% used physical CM, and 16% used both. Almost all used the nutritional or physical CM in addition to their prescribed treatment. Nutritional form use was significantly higher among females, older age groups, married people, and those who worked (p <.05). Physical form use was statistically more prevalent in older age groups and those with a higher level of education (p <.05). Family income and urban residence were not significantly associated with the use of either form of CM therapy. Olive oil was the most frequently reported nutritional type (22.9%), and cupping was the most reported physical type (41.6%). Recommendations to use CM came primarily from family members or friends (64% of nutritional CM users and 59% of physical CM users). A physician or pharmacist was cited more frequently with physical CM (24% versus 8% for the nutritional form). In contrast, media sources were cited more for nutritional than physical form (28% versus 7%). Over half of the patients believed they received the desired effect from CM. Surprisingly, only 9.5% of the patients admitted to discussing their CM use with their physician. Conclusion: CM use is prevalent among Jordanian patients with MSK disorders. Most patients rely on family and friends for recommendations, and they rarely inform their physician of the CM use. Physicians should routinely inquire about CM to provide patients with information regarding their benefits and risks. [ABSTRACT FROM AUTHOR]

Temporal artery biopsy (TAB) is one of the diagnostic tools to confirm the diagnosis of giant cell arteritis (GCA). We aim to evaluate the clinical and technical determinants of a positive biopsy. Demographics, clinical, technical, and laboratory data of all TAB's performed between 2007 and 2019 at a single academic medical center. 107 biopsies performed for 103 patients were included; 72.9% were female, and 27.1% were male. The mean age at the time of biopsy was 67.1 ± 9.3 years. One biopsy was excluded for lack of arterial tissue content. Of the remaining 106, 19.6% were positive. The length of the biopsy and the number of arterial cross-sections were not significantly associated with its result. A positive biopsy was seen more in patients with low albumin (p = 0.010) and hypothyroidism (p = 0.017) but less in those with prior glucocorticoids treatment (p = 0.028). Predictors of a positive biopsy included male gender [OR 4.029, 95% CI (1.330–12.209), p = 0.014]; elevated ESR [OR 3.998, 95% CI (1.908–6.787), p = 0.023]; polymyalgia rheumatica (PMR) symptoms [OR 5.121, 95% CI (2.094–9.872), p = 0.001]; and advancing in age (6.5% per every additional year), [OR 1.065, 95% CI (1.005–1.130), p = 0.033]. 53.7% of the patients were eventually diagnosed with GCA; 39.2% of them were based on positive biopsy. In conclusion, old age, male gender, elevated ESR, and PMR symptoms increase the odds of positive TAB. Technical factors, such as biopsy length and the number of cross-sections, did not influence eventual biopsy results, highlighting the pivotal role of the clinical presentation of the patients in selecting patients for TAB. [ABSTRACT FROM AUTHOR]

Background: Patellofemoral pain is a common condition. The Kujala score is a well-established scoring system to assess anterior knee pain and has been translated into many languages including Arabic. The purpose of this cross-sectional study is to culturally adapt the Arabic version of the Kujala score and determine its validity. Methods: The Kujala score is composed of 13 multiple-choice questions. We modified two questions in the score; running and squatting, and were replaced with questions related to walking on different terrain and prostration, each with the same number of answer choices as the original questions so as not to affect the final score. These modifications were written in Arabic by the same group who translated and validated the original score into Arabic. The original and modified Kujala scores was printed and given to patients complaining of patellofemoral pain to be filled during their visit to the orthopedic outpatient clinics. Final scores for the original and modified questionnaires were calculated. Data was analyzed using SPSS statistics version 21.0 measuring Cronbach's alpha, intraclass correlation coefficient, and Pearson correlation. Results: Ninety-four patients were included in the study, 28 (29.8%) men and 66 (70.2%) women. The mean age for the included patients was 43.67 (± 14.46) years. The mean score for the modified initial questionnaire was 63.91 (± 16.32), and the mean score for the modified re-test questionnaire was 66.52 (± 17.50). There was a statistically significant difference between the mean scores (p = 0.041), with a mean difference of 1.97 (95% CI 0.08 to 3.856). We found a significant strong correlation between the score before and after changing the questions with a p value of < 0.001. Conclusions: The culturally modified Arabic Kujala questionnaire is shown to be a valid, well-designed tool and an appropriate method of measuring patellofemoral pain. [ABSTRACT FROM AUTHOR]

aimat,3 Lubna Khreesha,4 Fadi Al Hadidi,5 Qussay Al-Sabbagh11Division of Neurosurgery & Spine Unit, Special Surgery Department, University of Jordan, Amman, Jordan; 2School of Medicine, University of Jordan, Amman, Jordan; 3Internal Medicine Department, University of Jordan, Amman, Jordan; 4Special Surgery Department, University of Jordan, Amman, Jordan; 5Division of Orthopedic Surgery & Spine Unit, Special Surgery Department, University of Jordan, Amman, JordanCorrespondence: Tareq KanaanDivision of Neurosurgery & Spine Unit, Special Surgery Department, University of Jordan, Queen Rania St, Amman 11942, JordanTel +962 799731700Email tkanaan@web.de Background: Selective nerve root block (SNRB) is a procedure that can be used as a diagnostic or a therapeutic method. SNRB can be used in multiple sites, including cervical and lumbar. Our study aims to investigate the clinical effectiveness of the use of fluoroscopically guided therapeutic selective nerve root block as a non-surgical symptom management of lumbar radiculopathy. Patients and Methods: This is a prospective study of therapeutic nerve root block in 76 patients with low back pain and/or sciatica at Jordan University Hospital. Data was collected by independent clinical interviewers, and visual analogue score (VAS) was used to measure pain severity. Results: A total of 76 patients, 25 (32.8%) males and 51 (67.2%) females, underwent SNRB. 69 (90.7%) patients improved immediately after the procedure. Out of the total, 22 (28.9%) patients showed a long-term relief of symptoms and did not experience any recurrence during the three months of follow-up, while 47 (61.8%) experienced a recurrence of pain. In patients experiencing recurrence of symptoms, 35 needed surgery. Conclusion: Therapeutic SNRB is an important procedure in the pain management of patients with lumbar radiculopathy caused by lumbar disc prolapse and foraminal stenosis. Our study showed that avoidance of surgery was achieved in up to 54% of patients; pain relief for at least 6 months was achieved in up to 29% of patients after a single SNRB. This makes it a very good second line of management after conservative treatment and a possible method to delay, and sometimes cease, the need for surgery. [ABSTRACT FROM AUTHOR]

Objectives: This study aims to evaluate the clinical phenotypic features of sarcoidosis in a single-center academic hospital in Jordan. Patients and methods: A retrospective file review was performed at an academic medical center in Jordan that included all patients diagnosed with sarcoidosis between January 2000 and December 2018. A total of 150 patients with sarcoidosis (38 males, 112 females; mean age 47.8±11.7 years; range, 17 to 79 years) were evaluated. Clinical data extracted from the files included the sex of the patient, the age at time of diagnosis, diagnosis date, the season during which the diagnosis was established, and smoking history. Biopsy histopathology, spirometry, nerve conduction, echocardiography, and imaging reports including plain radiographs, ultrasonographic, magnetic resonance and computed tomography reports were reviewed. Data including laboratory values, medication usage, clinical outcomes, and morbidity/mortality were collected. Pulmonary function tests including spirometry and lung volumes along with the diffusing capacity for carbon monoxide were reviewed for the presence of restriction, obstruction or reduction in the diffusion capacity of carbon monoxide. Identification of extra-thoracic organ involvement was determined in each patient in accordance with the criteria suggested by the updated World Association of Sarcoidosis and Other Granulomatous Disorders. Results: A total of 77.3% of the patients were diagnosed by biopsy. One case of Lofgren's syndrome was identified. Of the patients, 18.0% had isolated pulmonary sarcoidosis, 75.3% had pulmonary and extra-pulmonary sarcoidosis and 6.7% had isolated extra-pulmonary sarcoidosis while 81.3% had respiratory symptoms, mostly shortness of breath and cough. Extra-thoracic organ involvement mostly involved the musculoskeletal system (33%) followed by the skin (20%). Female patients had more extra-thoracic involvement but the sex difference was only statistically significant for cutaneous involvement. Of the patients, 84% received treatment while 20% had disease remission during the first two years after diagnosis and 70% required treatment beyond two years after diagnosis. Conclusion: Various sarcoidosis clinical phenotypes are seen among Jordanian patients. Jordanian females are more affected by the disease and have more extra-thoracic involvement compared to male patients. A large number of the study patients received treatment. [ABSTRACT FROM AUTHOR]