Abstract:
:Pain is a leading cause of morbidity worldwide, with published data showing its prevalence as high as 50% for chronic pain in the European population. This prevalence is likely to continue to rise, particularly in elderly people with comorbid conditions and complex aetiologies of pain. There is thus a rapidly growing demand for safe and effective pain management. Management of mild-to-moderate pain has traditionally been based upon the use of non-steroidal anti-inflammatory drugs (NSAIDs) and the synthetic non-opioid analgesic paracetamol (acetaminophen), the latter of which acts centrally, inhibiting brain cyclo-oxygenase (COX) and nitric oxide synthase. Both the NSAIDs and paracetamol are effective for mild-to-moderate pain and are widely recommended and used. However, NSAIDs may not be tolerated due to gastrointestinal (GI) symptoms and can result in potentially fatal peptic ulceration and bleeding. Selective COX-2 inhibitors were developed to reduce the GI side effects and complications, but large-scale studies have highlighted another serious potential effect of anti-inflammatory drugs: cardiovascular events. Both the European Medicines Agency (EMEA) and the Food and Drugs Administration (FDA) in the US have issued advice to apply cautions and restrictions when prescribing COX-2 inhibitors, particularly for patients at increased cardiovascular risk and for long-term use. The FDA also applied cardiovascular warnings with regard to nonselective NSAIDs. Both the EMEA and the FDA have recommended using the lowest effective dose for the shortest duration. These concerns and warnings have left physicians seeking safe alternatives to anti-inflammatory drugs for both short- and long-term uses in many patients. These developments have generated a climate of uncertainty in the absence of official guidance on the selection of alternative analgesic regimens. Amongst the possible strategies, combinations of drugs that provide analgesic efficacy at reduced individual doses may confer the optimal risk-benefit ratio for pain management in the long term or in patients at increased cardiovascular risk. Weak opioids devoid of serious organ-damaging effects combined with paracetamol may well be safer for long-term therapy. Fixed-dose combinations of paracetamol with weak opioids, such as codeine, dextropropoxyphene or tramadol are currently available. Paracetamol plus tramadol is an effective and safe multimodal analgesic regimen for the management of both acute and chronic moderate-to-severe pain. Re-evaluating the role of weak opioids, such as tramadol, and combinations in pain management may prove a valuable option for prescribers seeking alternatives to anti-inflammatory drugs.
journal_name
Clin Rheumatoljournal_title
Clinical rheumatologyauthors
Langford RMdoi
10.1007/s10067-006-0311-5subject
Has Abstractpub_date
2006-01-01 00:00:00pages
S2-8eissn
0770-3198issn
1434-9949journal_volume
25 Suppl 1pub_type
杂志文章,评审abstract:OBJECTIVE:To determine clinical course and outcomes in rheumatic disease patients with coronavirus disease 2019 (COVID-19) and compare results to uninfected patients. METHODS:We conducted a case cohort study of autoimmune disease patients with COVID-19 (confirmed by severe acute respiratory syndrome coronavirus 2 PCR)...
journal_title:Clinical rheumatology
pub_type: 杂志文章
doi:10.1007/s10067-021-05578-x
更新日期:2021-01-09 00:00:00
abstract::Eighty patients with Reiter's syndrome (RS) were studied retrospectively. A comparison was made between patients with the complete syndrome and patients with the incomplete syndrome. A comparison was also made between patients with and without HLA-B27. There were no major differences in severity and duration of the ar...
journal_title:Clinical rheumatology
pub_type: 杂志文章
doi:10.1007/BF02030971
更新日期:1986-01-01 00:00:00
abstract::In order to study the function of polymorphonuclear leukocytes in patients suffering from psoriatic and rheumatoid arthritis and psoriasis vulgaris the release of beta-glucuronidase, elastase and cytoplasmic lactate dehydrogenase was investigated. The life of polymorphonuclear leukocytes in rheumatoid and psoriatic ar...
journal_title:Clinical rheumatology
pub_type: 杂志文章
doi:10.1007/BF02031274
更新日期:1984-12-01 00:00:00
abstract::Hyperuricemia is not only a risk factor for gout but also an independent determinant of hypertension, diabetes, and chronic kidney diseases. Although the incidence of gout in Korean adults is increasing, epidemiologic studies on hyperuricemia in the general Korean population are limited. Thus, this study aimed at eval...
journal_title:Clinical rheumatology
pub_type: 杂志文章
doi:10.1007/s10067-018-4130-2
更新日期:2018-09-01 00:00:00
abstract::This study shows that N-acetyl-galactosamine and N-acetyl-glucosamine can diminish the production of superoxide anion from cytochalasin-B treated PMNs stimulated with FMLP. Inhibition ranged from 80.9% to 1.8%. N-acetyl-galactosamine was superior to N-acetyl-glucosamine, but both showed their action in a dose-related ...
journal_title:Clinical rheumatology
pub_type: 杂志文章
doi:10.1007/BF02207968
更新日期:1992-06-01 00:00:00
abstract::Chronic pediatric musculoskeletal (MSK) conditions are a major cause of morbidity. The burden of pediatric rheumatic diseases in East Africa is largely unknown. The purposes of this study were to estimate frequencies and assess the spectrum of MSK-related diagnoses using ICD-10 diagnostic codes among outpatients at a ...
journal_title:Clinical rheumatology
pub_type: 杂志文章
doi:10.1007/s10067-018-4376-8
更新日期:2019-04-01 00:00:00
abstract::If rheumatoid arthritis (RA) patients with a mild disease course could be identified early in the phase of the disease, therapy with less aggressive and probably less toxic antirheumatic drugs seems to be rational. The aim of this study was to investigate which factors at baseline could predict a clinical response (Am...
journal_title:Clinical rheumatology
pub_type: 临床试验,杂志文章,多中心研究
doi:10.1007/s100670050121
更新日期:1999-01-01 00:00:00
abstract::Monovariate and multivariate analyses including logistic regression were performed to determine associations among predicting variables [age, gender, immunofluorescence pattern, and anti-nuclear antibody (ANA) titer] and anti-extractable nuclear antigen (ENA) and -dsDNA antibodies (Abs) in 1089 patients with positive ...
journal_title:Clinical rheumatology
pub_type: 杂志文章
doi:10.1007/s10067-004-0937-0
更新日期:2004-12-01 00:00:00
abstract::The Revised Fibromyalgia Impact Questionnaire (FIQR) attempts to address the limitations of the Fibromyalgia Impact Questionnaire (FIQ). As there is no Turkish version of the FIQR available, we aimed to investigate the validity and reliability of a Turkish translation of the FIQR in Turkish female fibromyalgia (FM) pa...
journal_title:Clinical rheumatology
pub_type: 杂志文章
doi:10.1007/s10067-010-1546-8
更新日期:2011-03-01 00:00:00
abstract::The objectives of this study are to assess the levels of serum Interleukin-35 (IL-35) in patients with idiopathic inflammatory myopathies (IIMs) and to evaluate the association between IL-35 levels and IIM-related features. Serum IL-35 was detected in 76 patients with dermatomyositis (DM), 28 patients with polymyositi...
journal_title:Clinical rheumatology
pub_type: 杂志文章
doi:10.1007/s10067-016-3347-1
更新日期:2016-11-01 00:00:00
abstract::Very recently, several studies have convincingly demonstrated the role of infection in the development of the antiphospholipid syndrome. Cross antibody-mediated reactivity due to molecular mimicry between endothelial glycoproteins and microbial products was considered as an important pathogenic mechanism. However, ano...
journal_title:Clinical rheumatology
pub_type: 杂志文章,评审
doi:10.1007/s10067-006-0352-9
更新日期:2007-03-01 00:00:00
abstract::Interferon regulatory factor 5 (IRF5) is a member of IRF family which induce signaling pathways and are involved in modulation of cell growth, differentiation, apoptosis, and immune system activity. Juvenile idiopathic arthritis (JIA) is an auto-inflammatory syndrome where the inflammatory markers are believed to play...
journal_title:Clinical rheumatology
pub_type: 杂志文章
doi:10.1007/s10067-018-4010-9
更新日期:2018-10-01 00:00:00
abstract::In addition to the debilitating fatigue, the majority of patients with chronic fatigue syndrome (CFS) experience chronic widespread pain. These pain complaints show the greatest overlap between CFS and fibromyalgia (FM). Although the literature provides evidence for central sensitization as cause for the musculoskelet...
journal_title:Clinical rheumatology
pub_type: 杂志文章,评审
doi:10.1007/s10067-006-0433-9
更新日期:2007-04-01 00:00:00
abstract::The objective of the study was to determine clinical factors associated with activity limitation and predictors of a change in activity limitation after 1 year in people with gout. Two hundred ninety-five participants with gout (disease duration < 10 years) attended a baseline assessment which included medical and dis...
journal_title:Clinical rheumatology
pub_type: 杂志文章
doi:10.1007/s10067-018-4110-6
更新日期:2018-08-01 00:00:00
abstract::Statin-induced necrotising autoimmune myopathy (NAM) is a rare but disabling complication of statin therapy. Data regarding treatment and outcomes in these patients is sparse. We retrospectively identified those patients with a diagnosis of statin-induced NAM who were managed in a single-tertiary referral centre from ...
journal_title:Clinical rheumatology
pub_type: 杂志文章
doi:10.1007/s10067-017-3831-2
更新日期:2018-02-01 00:00:00
abstract::There is an increasing concern over generalizability of trial results. We investigated eligibility criteria of knee osteoarthritis clinical trials. Eligible trials were randomized, placebo-controlled trials that were identified by searches in MEDLINE, SCOPUS, and the Cochrane Central Register of Controlled Trials. We ...
journal_title:Clinical rheumatology
pub_type: 杂志文章,评审
doi:10.1007/s10067-013-2342-z
更新日期:2013-11-01 00:00:00
abstract::The investigation concerned changes in vitamin A derivatives (retinol and retinyl) content in serum of patients suffering from two types of rheumatic diseases--rheumatoid arthritis (RA) and osteoarthrosis. Healthy women of similar age served as control. It was found that the retinol content of the serum in the group s...
journal_title:Clinical rheumatology
pub_type: 杂志文章
doi:10.1007/BF02042773
更新日期:1982-09-01 00:00:00
abstract::To demonstrate an as yet merely postulated generalized osteopathy in psoriatics, the serum calcium level, the alkaline phosphatase in the serum and the urinary excretion of hydroxyproline were evaluated in 24 patients with Ps and 24 patients with PA. Moreover, the bone bioptates from 25 patients with PA and 10 patient...
journal_title:Clinical rheumatology
pub_type: 杂志文章
doi:10.1007/BF02208026
更新日期:1991-03-01 00:00:00
abstract::A white female patient developed overlapping features of systemic lupus erythematosus (SLE) and systemic sclerosis (SSc) with severe pulmonary compromise. She was treated with steroids and azathioprine, which improved her clinical condition and spirometric status. In May 2002 she presented with continuous pain in her ...
journal_title:Clinical rheumatology
pub_type: 杂志文章
doi:10.1007/s10067-004-1048-7
更新日期:2005-08-01 00:00:00
abstract::The authors describe an atypical case of a patient having giant cell arteritis presenting only with fever, diagnosed by positron emission tomography and subsequently confirmed by temporal artery biopsy. ...
journal_title:Clinical rheumatology
pub_type: 杂志文章
doi:10.1007/s10067-007-0831-7
更新日期:2008-06-01 00:00:00
abstract::Iron-binding proteins (lactoferrin, transferrin and ferritin) and free iron were measured in synovial fluid (SF) from 30 patients with rheumatoid arthritis (RA) and 20 osteoarthritis (OA) patients. The iron-binding proteins except transferrin were significantly increased in RA SF as compared with OA SF. Similarly, fre...
journal_title:Clinical rheumatology
pub_type: 杂志文章
doi:10.1007/BF02030347
更新日期:1989-09-01 00:00:00
abstract::Knee osteoarthritis (KOA) is a common degenerative joint disease causing pain, stiffness, reduced motion, swelling, crepitus, and disability. Several inflammatory markers and cartilage degradation products can be used as biomarkers in OA. The key factors of bone metabolism in normal joint bone, dickkopf-1 (DKK1) and o...
journal_title:Clinical rheumatology
pub_type: 杂志文章
doi:10.1007/s10067-017-3690-x
更新日期:2017-10-01 00:00:00
abstract::Dego's disease is an uncommon thrombo-occlusive vasculopathy that presented with skin rash and thrombotic complications affecting internal organs that may simulate rheumatic diseases and may be brought to the attention of rheumatologists. We present here a case of a middle-aged woman who presented with acute bowel inf...
journal_title:Clinical rheumatology
pub_type: 杂志文章
doi:10.1007/s10067-009-1164-5
更新日期:2009-07-01 00:00:00
abstract::This study aims to explore patient's concerns when discussing sexual problems caused by chronic low back pain with their healthcare provider. It also aims to identify factors influencing and limiting such communication. A cross-sectional analysis of 100 consenting chronic low back pain sexually active patients was car...
journal_title:Clinical rheumatology
pub_type: 杂志文章
doi:10.1007/s10067-013-2299-y
更新日期:2013-10-01 00:00:00
abstract::The aim of this study was to evaluate in systemic sclerosis (SSc) retrospectively the effect of Bosentan and Sildenafil and their combination on Raynaud's phenomenon (RP), function, and capillaroscopic patterns. One hundred and twenty-three SSc patients (mean age ± sd, 57.69 ± 14.07 years) were retrospectively evaluat...
journal_title:Clinical rheumatology
pub_type: 杂志文章
doi:10.1007/s10067-015-3119-3
更新日期:2016-01-01 00:00:00
abstract:BACKGROUND:Psoriatic arthritis (PsA) is an inflammatory disorder affecting the joints of psoriatic patients. Gelsolin regulated the actin assembly and disassembly. Reduction in plasma gelsolin levels was detected in tissue damages, including trauma, sepsis, and chronic inflammatory disorders. OBJECTIVES:The study aims...
journal_title:Clinical rheumatology
pub_type: 杂志文章
doi:10.1007/s10067-020-04959-y
更新日期:2020-06-01 00:00:00
abstract::Polymyositis may occur along with other manifestations of chronic graft vs host disease after allogeneic bone marrow transplantation (BMT). Donor lymphocyte infusion (DLI) could produce durable remissions in relapsed patients with chronic myelogenous leukemia (CML) but it may contribute to the development of polymyosi...
journal_title:Clinical rheumatology
pub_type: 杂志文章
doi:10.1007/s10067-006-0346-7
更新日期:2007-07-01 00:00:00
abstract::The original published version of this article contained the incorrect Table 2 and are now presented correctly in this article. ...
journal_title:Clinical rheumatology
pub_type: 杂志文章,已发布勘误
doi:10.1007/s10067-020-04926-7
更新日期:2020-04-01 00:00:00
abstract::We reviewed the records of 315 patients with rheumatoid arthritis (RA) treated with low-dose methotrexate (MTX) and evaluated the conditions contributing to thrombocytopenia. Thirteen out of 315 patients with RA presented with low platelet counts (< or = 100.000/mm3). The age of these patients (51 +/- 12.6 years) did ...
journal_title:Clinical rheumatology
pub_type: 杂志文章
doi:10.1007/BF02230334
更新日期:1996-03-01 00:00:00
abstract::Initial treatment of trapeziometacarpal osteoarthritis (TMO) often consists of intra-articular injection of corticosteroids or hyaluronic acid. Several studies have shown that ultrasound (US)-guided injections demonstrate greater precision and effectiveness when compared to blind techniques. The aim of our study was t...
journal_title:Clinical rheumatology
pub_type: 杂志文章
doi:10.1007/s10067-011-1730-5
更新日期:2011-09-01 00:00:00