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Ruim 2 miljoen Nederlanders hebben een vorm van reuma. Door de pijn en de beperkingen heeft de ziekte bij veel mensen invloed op het dagelijks leven. Behalve het bezoeken van reumatologen en orthopeden gaan mensen met reumatische aandoeningen vaak op zoek naar alternatieve behandelmethoden. Internet is voor velen een belangrijke informatiebron maar helaas niet altijd even betrouwbaar. Voor professor Hans Rasker en doctor Bart van den Bemt reden om bijna alle behandelmethoden te rubriceren en op heldere wijze te beschrijven in het nieuwe standaardwerk Reuma & Alternatieve behandelmethoden.

In this study we examine which factors are related to compliance with medication in patients suffering from rheumatoid arthritis (RA).persons suffering recently developed, active RA, who cooperated in a randomized study on the effect of patient education. We analyzed the relation between adherence to Sulphasalazine therapy and personal factors, environmental influences, demographic factors, disease-related factors, and barriers to compliance. Moreover, a logistical regression analysis was performed on these factors, consideringor = 80% a high compliance, both with compliance as dependent factor. Only self-efficacy correlated with compliance (r = 0.58; P0.001). The logistical regression analysis identified self-efficacy as the only factor determiningor = 80% adherence (P = 0.01). Self-efficacy regarding the use of prescribed medication is related to compliance with this treatment. Further study is needed to determine the test characteristics of self-efficacy as a predictor for compliance with medication.

Objective Fibromyalgia (FM) in rheumatoid arthritis (RA) can cause consternation because symptoms are seen to be out of proportion to physician and laboratory assessments, and composite RA activity scores such as the 28 joint Disease Activity Score, Clinical Disease Activity Index, and Routine Assessment of Patient Index Data 3 (RAPID-3) can yield apparently “wrong” results. We explored the effect of polysymptomatic distress (PSD), a measure of fibromyalgianess and a quantity derived from the American College of Rheumatology 2010 FM diagnostic criteria, to explain the relationship of patient to physician variables. Methods We obtained PSD scores on 300 RA patients prior to ordinary clinical care, and assessed the associations of PSD with tender and swollen joints, physician global estimate of RA activity, pain, Health Assessment Questionnaire score, and composite RA activity measures during routine clinic assessments. Results PSD scores greater than the sample mean (8.8) were associated with increased patient symptoms regardless of the presence or absence of FM, while scores below the mean were associated with better patient outcomes. PSD scores predicted all patient outcomes and less strongly predicted physician outcomes. The discrepancy between patient and physician measures was greatest at low levels of physician-estimated disease activity. Conclusion PSD rather than FM diagnosis more usefully identifies and predicts disproportionate responses. Just as there are patients who lean disproportionately toward greater severity, there are also patients who disproportionately report milder symptoms. Composite measures used to assess RA are flawed, as they confound RA inflammation and patient distress, and more consideration should be given to disaggregated assessments. PSD also appears to be influenced weakly by RA disease activity.

Piriformis syndrome is an underdiagnosed extraspinal association of sciatica. Patients usually complain of deep seated gluteal pain. In severe cases the clinical features of piriformis syndrome are primarily due to spasm of the piriformis muscle and irritation of the underlying sciatic nerve but this mysterious clinical scenario is also described in lumbar spinal canal stenosis, leg length discrepancy, piriformis myofascial pain syndrome, following vaginal delivery, and anomalous piriformis muscle or sciatic nerve. In this paper, we describe piriformis and fibromyalgia syndrome in a 30-year-old young lady, an often missed diagnosis. We also focus on management of the piriformis syndrome.

Objective. Fibromyalgia (FM) is a disorder characterised by chronic widespreadpain in soft tissues, especially in muscles. Previous research has demonstrateda higher muscle fibre conduction velocity (CV) in painful muscles of FM patients. The primary goal of this study was to investigate whether there is also a difference in CV in non-painful, non-tender point (TP) related muscles between FM patients and controls. The secondary goal was to explore associations between the CV, the number of TPs and the complaints in FM. Methods. Surface electromyography (sEMG) was performed on the biceps brachii muscle of female FM patients (13) and matched healthy controls (13). Short static contractions were applied with the arm unloaded and loaded at 5% and 10% of maximum voluntary force. The CV was derived by cross-correlation method (CV-cc) and inter-peak latency method (CV-ipl). TP score and Fibromyalgia Impact Questionnaire (FIQ) were performed in all participants. Correlations were calculated between the CVs, TP score and items of the FIQ. Results. In FM patients, the CV was higher than in the controls (CV-cc p=0.005; CV-ipl p=0.022). The CV was correlated with the number of TPs in FM patients (r=0.642 and 0.672 for CVcc and CV-ipl, respectively). No correlations were found between the CV and any aspect of health status on the FIQ. Conclusion. The results demonstrate abnormally high muscle membrane conduction velocity in FM, even in non-TP muscles. In addition, a relationship has been found between the high membrane velocity and the number of TPs.

Transient osteoporosis of the hip (TOH), also referred to as transient bone marrow edema syndrome, is most common in middle-aged men and often after trivial trauma or sport-related injuries. Diagnosis is usually made by eliminating other possible causes of hip pain. Magnetic resonance imaging (MRI) plays an important role in diagnosis and demonstrates a typical pattern of bone marrow edema (BME) in the form of diffuse low signal on T1-weighted images and high signal on T2 fat-suppressed or short T1 inversion recovery images. No consensus exists about the management of TOH, as it may progress to avascular necrosis. We describe eight cases of TOH treated with alendronate resulting in improvement of pain and function and complete resolution of BME on MRI. The literature is reviewed regarding TOH and the relationship with bone marrow edema syndrome, avascular necrosis of the hip, and regional migratory osteoporosis. To our knowledge, this is the first report describing the improvement of this condition after of alendronate with documented radiological improvement on follow-up MRI

Many crystals may be found in arthritic joints. Rheumatologists are able to diagnose, with a high degree of probability, which crystals induce arthritis in the individual case. A definite diagnosis supported by polarisation microscopy may provide a firm basis for adequate long-term treatment. Recently new insights in the inflammatory processes induced the development of targeted therapies. We review novel developments in crystal-induced arthritis and gout in particular.

This study examined the construct validity of the Dutch Life Orientation Test-Revised (LOT-R) in two samples; one sample of patients with psychiatric disorders (n=157) and one sample of patients with rheumatoid arthritis (RA, n=83). Confirmatory factor analyses showed that the LOT-R was not sufficiently unidimensional and could be better explained by two underlying factors consisting of positively and negatively worded items, respectively. This two-factor solution fitted the data significantly better than the onefactor solution in both groups, but satisfied all criteria for good model fit in the psychiatric patient sample only. One-factor models allowing correlated error terms between the positively or negatively worded items performed equally better than the original one-factor solution in both groups, indicating that the two factors may be the result of the specific wording of the items. However, the two factors were differentially associated with other relevant psychological constructs and correlation patterns differed substantially between both populations, indicating possible conceptual differences between optimism and pessimism. Overall, the findings suggest that the positively and negatively worded items of the Dutch LOT-R do not reflect a true unidimensional construct, but two underlying factors which may reflect a complex combination of methodological artefact and substantive differences. Therefore, researchers using the Dutch LOT-R are encouraged to not only rely on total scale scores, but to use additional sub-scores for optimism and pessimism to better examine possible relationships and effects in optimism research.

PURPOSE: Since about ten years a new modality for whole body hyperthermia, a compact and userfriendlyinfrared (IR) 'sauna' has become available. Patients with musculoskeletal disorders report positive effects.RELEVANCE: Until now hardly any research was done in this field. Therefore in this study the short-termphysiological and clinical effects in healthy subjects and patients with Rheumatoid Arthritis (RA) andAnkylosing Spondylitis (AS) were investigated. SUBJECTS: 17 RA patients (3 male, 14 female), 19 AS patients (12 male, 7 female) and 21 healthy subjects (11 male, 10 female) with a mean age (sd) of 47 (13), 45 (10) and 45 (7) years respectively were included in the study.METHODS AND MATERIALS: Patients with RA or AS and healthy subjects were treated with whole-body hyperthermia by means of a 30 minutes stay in a IR sauna cabin at an adjusted temperature of 55°C. Before and directly after the sauna treatment in both RA and AS patient groups pain and stiffness and were measured on a 10 centimetres Visual Analogue Scale. Besides that in all groups body weight was measured before and after treatment. Additionally during the treatment heart rate, systolic and diastolic blood pressure, skin surface and core temperature were continuously monitored. Also general wellbeing during and after treatment was investigated. RESULTS: Pain and stiffness improved significantly duringtreatment; mean between 40% and 60%. The mean weight loss during treatment due to transpiration was significant (p