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Background-Analgesics could be used to manage painful symptoms during and after COVID-19. Materials and methods-Persistence of painful symptoms was assessed during and after COVID-19 in a sample of patients admitted to a post-acute COVID-19 outpatient service in Rome, Italy. Data on type and frequency of use of first-line analgesics were collected. Pain severity was evaluated with a numeric rating scale (NRS) from 0 to 10. Results-Mean age of 696 participants was 57.1 ± 20.3 years and 61.7% were women. During COVID-19, the most prevalent symptoms were fever, fatigue, arthralgia, myalgia and headache. Acetaminophen was used by 40% of the sample. Only 6.7% needed to continue analgesic therapy after COVID-19. Frequent causes of analgesics consumption were persistent arthralgia and myalgia. The most common analgesics used amongst those who continued taking analgesics in the post-acute phase of COVID-19 were the following: acetaminophen (31%), ibuprofen (31%) and other non-steroidal anti-inflammatory drug (NSAID) (29.5%); in older subjects the most common analgesic used was acetaminophen (54%). Most of the subjects in this group said there was an improvement in pain perception after taking analgesic therapy (84%). Conclusions-Use of analgesics in the post-acute COVID-19 is common in subjects with persistent arthralgia and myalgia, and common analgesics were acetaminophen and ibuprofen. Further research on the safety and efficacy of those medications in COVID-19 is warranted.

A relationship between carbon monoxide (CO) and hydrogen sulfide (H2S) has been described in different pathological conditions, but their interaction in modulating joint pain has not yet been investigated. In young female mice with monosodium acetate-induced joint degeneration and pain, we assessed: (1) the effects of CORM-2 (tricarbonyldichlororuthenium(II)dimer), a CO-releasing molecule, and CoPP (cobalt protoporphyrin IX), an inducer of heme oxygenase 1 (HO-1), administered alone and combined with low doses of two slow-releasing H2S donors, DADS (diallyl disulfide) and GYY4137 (morpholin-4-ium 4-methoxyphenyl(morpholino) phosphinodithioate dichloromethane complex) on the mechanical allodynia and loss of grip strength provoked by joint degeneration; (2) the role of Nrf2, NAD(P)H: quinone oxidoreductase 1 (NQO1) and HO-1 in the antinociceptive actions of H2S donors; (3) the impact of DADS and GYY4137 treatment on the expression of Nrf2 and several antioxidant proteins in dorsal root ganglia (DRG) and periaqueductal gray matter (PAG). Our data showed that treatment with H2S donors inhibited allodynia and functional deficits, while CORM-2 and CoPP only prevented allodynia. The Nrf2 pathway is implicated in the analgesic actions of DADS and GYY4137 during joint degeneration. Moreover, the co-administration of low doses of CORM-2 or CoPP with DADS or GYY4137 produced higher antiallodynic effects and greater recovery of grip strength deficits than those produced by each of these compounds alone. The activation of the antioxidant system caused by H2S donors in DRG and/or PAG might explain the enhancement of antinociceptive effects. These data reveal a positive interaction between H2S and CO in modulating joint pain in female mice.

To investigate a 6-month intervention with an olive leaf extract (OLE) on knee functionality and biomarkers of bone/cartilage metabolism and inflammation. This randomized, double-blind, placebo-controlled, multi-centric trial included 124 subjects with knee pain or mobility issues. Subjects received twice a day one capsule of placebo or 125 mg OLE (Bonolive, an OLE containing 50 mg of oleuropein) for 6 months. The co-primary endpoints were Knee injury and Osteoarthritis Outcome Score (KOOS) and serum Coll2-1NO2. The secondary endpoints were the subscales of the KOOS, knee pain VAS at rest and at walking, OARSI core set of performance-based tests and multiple inflammatory and bone or cartilage remodeling serum biomarkers and concentration of oleuropein's metabolites in urine. At 6 months, OLE group was not efficient on global KOOS score, changes of inflammatory and cartilage remodeling biomarkers compared to placebo. analyses demonstrated a large and significant treatment effect of OLE in a sub-group of subjects with high walking pain at baseline ( = 0.03). This was observed at 6 months for the global KOOS score, and each different subscale and for pain at walking ( = 0.02). OLE treatment was well tolerated. OLE was not effective on joint discomfort excepted in a sub-group of subjects with high pain at treatment initiation. As oleuropein is well tolerated, OLE can be used to relieve knee joint pain and enhance mobility in subjects with articular pain.

Higher body mass and obesity are associated with bodily pain, and rates of chronic pain increase among older adults. Most past studies are cross-sectional, precluding determination of the temporal relationship between body mass and pain. A longitudinal study of body mass and pain among middle-aged adults found that higher body mass index (BMI) led to greater lower back pain. No longitudinal study of BMI and pain has been conducted among adults older than 70 years. This study used dual change score models to determine the directional relationship between BMI and bodily pain in a sample of middle-aged and older adults. Participants (n = 1889) from the Swedish Twin Registry (baseline age range 40-93 years) completed at least 1 nurse assessment of BMI and self-report ratings of pain interference and joint pain. Pain interference was not associated with BMI, but joint pain was analyzed in univariate and bivariate models, with dual change score models modeling the relationship of BMI and joint pain across age, both independently and as part of bivariate relationships. The results indicated a reciprocal relationship between BMI and joint pain, but joint pain generally led to changes in BMI. In addition, the relationship changed with age, until approximately age 80 years, increasing joint pain contributed to higher BMI, but after that time increasing joint pain contributed to lower BMI. In addition, sex differences in the relationship between BMI and pain appeared after age 70 years. Thus, joint pain contributes to changes in BMI among middle-aged and older adults, but the relationship may change by age and sex., Copyright © 2022 International Association for the Study of Pain

Higher body mass and obesity are associated with bodily pain, and rates of chronic pain increase among older adults. Most past studies are cross-sectional, precluding determination of the temporal relationship between body mass and pain. A longitudinal study of body mass and pain among middle-aged adults found that higher body mass index (BMI) led to greater lower back pain. No longitudinal study of BMI and pain has been conducted among adults older than 70 years. This study used dual change score models to determine the directional relationship between BMI and bodily pain in a sample of middle-aged and older adults. Participants (n = 1889) from the Swedish Twin Registry (baseline age range 40-93 years) completed at least 1 nurse assessment of BMI and self-report ratings of pain interference and joint pain. Pain interference was not associated with BMI, but joint pain was analyzed in univariate and bivariate models, with dual change score models modeling the relationship of BMI and joint pain across age, both independently and as part of bivariate relationships. The results indicated a reciprocal relationship between BMI and joint pain, but joint pain generally led to changes in BMI. In addition, the relationship changed with age, until approximately age 80 years, increasing joint pain contributed to higher BMI, but after that time increasing joint pain contributed to lower BMI. In addition, sex differences in the relationship between BMI and pain appeared after age 70 years. Thus, joint pain contributes to changes in BMI among middle-aged and older adults, but the relationship may change by age and sex.

In middle-aged and elderly patients, different types of bodily conditions begin to manifest themselves, which, at times, are in a medical challenge to find the origin. Joint pain, gastrointestinal conditions, weight loss is part of the symptoms of old age but sometimes these symptoms are related to treatable or curable diseases that with an accurate and early diagnosis can improve the quality of life of patients. This is a qualitative, bibliographic research in which the scientific publications available regarding "Whipple's disease" and "deep venous thromboses" are sought, seeking to find a relationship between the clinical manifestations of thrombosis as an indication of the presence of the disease. by Whipple. Finding a relationship between the two conditions would be part of a specific case since, statistically, both diseases can occur after 40 years of age, but in the case of deep vein thrombosis it usually occurs mostly in female people, while the disease of Whipple in males. In this case, it would be logical to refer to the clinical manifestations of both diseases to find an expeditious path towards a timely diagnosis.For deep vein thrombosis, the Wells scale can help and in the case of Whipple's disease, identify not only joint pain but also pain. weight loss that is usually the most frequent sign of the presence of bacteria in the affected person. Considering what is known of both diseases, it can be identified that having joint pain in common, especially in the lower ones, but it is not exclusive, therefore there are no findings in the research that indicate that a diagnosis of deep vein thrombosis is the initial path to discover Whipple's Disease., En pacientes de mediana y avanzada edad se empiezan a manifestar distintos tipos de afecciones corporales que, en ocasiones, se convierten en un reto medico conseguir el origen. Los dolores articulares, las afecciones gastrointestinales, perdida de peso es parte de los síntomas de la vejez, pero en ocasiones estos síntomas están relacionados a enfermedades tratables o curables que con un diagnostico certero y temprano pueden mejorar la calidad de vida de los pacientes. Se trata de una investigación bibliográfica, cualitativa en donde se buscan las publicaciones científicas disponibles respecto a la “enfermedad de Whipple” y las “trombosis venosas profundas” pretendiendo encontrar relación entre las manifestaciones clínicas de las trombosis como un indicio de la presencia de la Enfermedad de Whipple. Encontrar una relación entre ambas afecciones seria parte de un caso específico pues, estadísticamente ambas enfermedades se pueden presentar luego de los 40 años de edad, pero en el caso de la trombosis venosa profunda suele presentarse mayormente en personas de sexo femenino, mientras que la enfermedad de Whipple en personas de sexo masculino. Sería lógico en dado caso remitirse a las manifestaciones clínicas de ambas enfermedades para encontrar un camino expedito hacia el diagnóstico oportuno, para la trombosis venosa profunda la escala de Wells puede ayudar y en caso de la enfermedad de Whipple identificar no solo el dolor articular sino la perdida de peso que suele ser la muestra mas frecuente de la presencia bacteriana en el afectado. Considerando lo conocido de ambas enfermedades se puede identificar que poseen en común el dolor en las articulaciones, sobre todo en las inferiores, pero no es excluyente, por tanto, no se encuentran hallazgos en la investigación que indique que un diagnóstico de trombosis venosa profunda sea el camino inicial para descubrir la Enfermedad de Whipple.

In middle-aged and elderly patients, different types of bodily conditions begin to manifest themselves, which, at times, are in a medical challenge to find the origin. Joint pain, gastrointestinal conditions, weight loss is part of the symptoms of old age but sometimes these symptoms are related to treatable or curable diseases that with an accurate and early diagnosis can improve the quality of life of patients. This is a qualitative, bibliographic research in which the scientific publications available regarding "Whipple's disease" and "deep venous thromboses" are sought, seeking to find a relationship between the clinical manifestations of thrombosis as an indication of the presence of the disease. by Whipple. Finding a relationship between the two conditions would be part of a specific case since, statistically, both diseases can occur after 40 years of age, but in the case of deep vein thrombosis it usually occurs mostly in female people, while the disease of Whipple in males. In this case, it would be logical to refer to the clinical manifestations of both diseases to find an expeditious path towards a timely diagnosis.For deep vein thrombosis, the Wells scale can help and in the case of Whipple's disease, identify not only joint pain but also pain. weight loss that is usually the most frequent sign of the presence of bacteria in the affected person. Considering what is known of both diseases, it can be identified that having joint pain in common, especially in the lower ones, but it is not exclusive, therefore there are no findings in the research that indicate that a diagnosis of deep vein thrombosis is the initial path to discover Whipple's Disease., En pacientes de mediana y avanzada edad se empiezan a manifestar distintos tipos de afecciones corporales que, en ocasiones, se convierten en un reto medico conseguir el origen. Los dolores articulares, las afecciones gastrointestinales, perdida de peso es parte de los síntomas de la vejez, pero en ocasiones estos síntomas están relacionados a enfermedades tratables o curables que con un diagnostico certero y temprano pueden mejorar la calidad de vida de los pacientes. Se trata de una investigación bibliográfica, cualitativa en donde se buscan las publicaciones científicas disponibles respecto a la “enfermedad de Whipple” y las “trombosis venosas profundas” pretendiendo encontrar relación entre las manifestaciones clínicas de las trombosis como un indicio de la presencia de la Enfermedad de Whipple. Encontrar una relación entre ambas afecciones seria parte de un caso específico pues, estadísticamente ambas enfermedades se pueden presentar luego de los 40 años de edad, pero en el caso de la trombosis venosa profunda suele presentarse mayormente en personas de sexo femenino, mientras que la enfermedad de Whipple en personas de sexo masculino. Sería lógico en dado caso remitirse a las manifestaciones clínicas de ambas enfermedades para encontrar un camino expedito hacia el diagnóstico oportuno, para la trombosis venosa profunda la escala de Wells puede ayudar y en caso de la enfermedad de Whipple identificar no solo el dolor articular sino la perdida de peso que suele ser la muestra mas frecuente de la presencia bacteriana en el afectado. Considerando lo conocido de ambas enfermedades se puede identificar que poseen en común el dolor en las articulaciones, sobre todo en las inferiores, pero no es excluyente, por tanto, no se encuentran hallazgos en la investigación que indique que un diagnóstico de trombosis venosa profunda sea el camino inicial para descubrir la Enfermedad de Whipple.

In middle-aged and elderly patients, different types of bodily conditions begin to manifest themselves, which, at times, are in a medical challenge to find the origin. Joint pain, gastrointestinal conditions, weight loss is part of the symptoms of old age but sometimes these symptoms are related to treatable or curable diseases that with an accurate and early diagnosis can improve the quality of life of patients. This is a qualitative, bibliographic research in which the scientific publications available regarding "Whipple's disease" and "deep venous thromboses" are sought, seeking to find a relationship between the clinical manifestations of thrombosis as an indication of the presence of the disease. by Whipple. Finding a relationship between the two conditions would be part of a specific case since, statistically, both diseases can occur after 40 years of age, but in the case of deep vein thrombosis it usually occurs mostly in female people, while the disease of Whipple in males. In this case, it would be logical to refer to the clinical manifestations of both diseases to find an expeditious path towards a timely diagnosis.For deep vein thrombosis, the Wells scale can help and in the case of Whipple's disease, identify not only joint pain but also pain. weight loss that is usually the most frequent sign of the presence of bacteria in the affected person. Considering what is known of both diseases, it can be identified that having joint pain in common, especially in the lower ones, but it is not exclusive, therefore there are no findings in the research that indicate that a diagnosis of deep vein thrombosis is the initial path to discover Whipple's Disease., En pacientes de mediana y avanzada edad se empiezan a manifestar distintos tipos de afecciones corporales que, en ocasiones, se convierten en un reto medico conseguir el origen. Los dolores articulares, las afecciones gastrointestinales, perdida de peso es parte de los síntomas de la vejez, pero en ocasiones estos síntomas están relacionados a enfermedades tratables o curables que con un diagnostico certero y temprano pueden mejorar la calidad de vida de los pacientes. Se trata de una investigación bibliográfica, cualitativa en donde se buscan las publicaciones científicas disponibles respecto a la “enfermedad de Whipple” y las “trombosis venosas profundas” pretendiendo encontrar relación entre las manifestaciones clínicas de las trombosis como un indicio de la presencia de la Enfermedad de Whipple. Encontrar una relación entre ambas afecciones seria parte de un caso específico pues, estadísticamente ambas enfermedades se pueden presentar luego de los 40 años de edad, pero en el caso de la trombosis venosa profunda suele presentarse mayormente en personas de sexo femenino, mientras que la enfermedad de Whipple en personas de sexo masculino. Sería lógico en dado caso remitirse a las manifestaciones clínicas de ambas enfermedades para encontrar un camino expedito hacia el diagnóstico oportuno, para la trombosis venosa profunda la escala de Wells puede ayudar y en caso de la enfermedad de Whipple identificar no solo el dolor articular sino la perdida de peso que suele ser la muestra mas frecuente de la presencia bacteriana en el afectado. Considerando lo conocido de ambas enfermedades se puede identificar que poseen en común el dolor en las articulaciones, sobre todo en las inferiores, pero no es excluyente, por tanto, no se encuentran hallazgos en la investigación que indique que un diagnóstico de trombosis venosa profunda sea el camino inicial para descubrir la Enfermedad de Whipple.

In middle-aged and elderly patients, different types of bodily conditions begin to manifest themselves, which, at times, are in a medical challenge to find the origin. Joint pain, gastrointestinal conditions, weight loss is part of the symptoms of old age but sometimes these symptoms are related to treatable or curable diseases that with an accurate and early diagnosis can improve the quality of life of patients. This is a qualitative, bibliographic research in which the scientific publications available regarding "Whipple's disease" and "deep venous thromboses" are sought, seeking to find a relationship between the clinical manifestations of thrombosis as an indication of the presence of the disease. by Whipple. Finding a relationship between the two conditions would be part of a specific case since, statistically, both diseases can occur after 40 years of age, but in the case of deep vein thrombosis it usually occurs mostly in female people, while the disease of Whipple in males. In this case, it would be logical to refer to the clinical manifestations of both diseases to find an expeditious path towards a timely diagnosis.For deep vein thrombosis, the Wells scale can help and in the case of Whipple's disease, identify not only joint pain but also pain. weight loss that is usually the most frequent sign of the presence of bacteria in the affected person. Considering what is known of both diseases, it can be identified that having joint pain in common, especially in the lower ones, but it is not exclusive, therefore there are no findings in the research that indicate that a diagnosis of deep vein thrombosis is the initial path to discover Whipple's Disease., En pacientes de mediana y avanzada edad se empiezan a manifestar distintos tipos de afecciones corporales que, en ocasiones, se convierten en un reto medico conseguir el origen. Los dolores articulares, las afecciones gastrointestinales, perdida de peso es parte de los síntomas de la vejez, pero en ocasiones estos síntomas están relacionados a enfermedades tratables o curables que con un diagnostico certero y temprano pueden mejorar la calidad de vida de los pacientes. Se trata de una investigación bibliográfica, cualitativa en donde se buscan las publicaciones científicas disponibles respecto a la “enfermedad de Whipple” y las “trombosis venosas profundas” pretendiendo encontrar relación entre las manifestaciones clínicas de las trombosis como un indicio de la presencia de la Enfermedad de Whipple. Encontrar una relación entre ambas afecciones seria parte de un caso específico pues, estadísticamente ambas enfermedades se pueden presentar luego de los 40 años de edad, pero en el caso de la trombosis venosa profunda suele presentarse mayormente en personas de sexo femenino, mientras que la enfermedad de Whipple en personas de sexo masculino. Sería lógico en dado caso remitirse a las manifestaciones clínicas de ambas enfermedades para encontrar un camino expedito hacia el diagnóstico oportuno, para la trombosis venosa profunda la escala de Wells puede ayudar y en caso de la enfermedad de Whipple identificar no solo el dolor articular sino la perdida de peso que suele ser la muestra mas frecuente de la presencia bacteriana en el afectado. Considerando lo conocido de ambas enfermedades se puede identificar que poseen en común el dolor en las articulaciones, sobre todo en las inferiores, pero no es excluyente, por tanto, no se encuentran hallazgos en la investigación que indique que un diagnóstico de trombosis venosa profunda sea el camino inicial para descubrir la Enfermedad de Whipple.

In middle-aged and elderly patients, different types of bodily conditions begin to manifest themselves, which, at times, are in a medical challenge to find the origin. Joint pain, gastrointestinal conditions, weight loss is part of the symptoms of old age but sometimes these symptoms are related to treatable or curable diseases that with an accurate and early diagnosis can improve the quality of life of patients. This is a qualitative, bibliographic research in which the scientific publications available regarding "Whipple's disease" and "deep venous thromboses" are sought, seeking to find a relationship between the clinical manifestations of thrombosis as an indication of the presence of the disease. by Whipple. Finding a relationship between the two conditions would be part of a specific case since, statistically, both diseases can occur after 40 years of age, but in the case of deep vein thrombosis it usually occurs mostly in female people, while the disease of Whipple in males. In this case, it would be logical to refer to the clinical manifestations of both diseases to find an expeditious path towards a timely diagnosis.For deep vein thrombosis, the Wells scale can help and in the case of Whipple's disease, identify not only joint pain but also pain. weight loss that is usually the most frequent sign of the presence of bacteria in the affected person. Considering what is known of both diseases, it can be identified that having joint pain in common, especially in the lower ones, but it is not exclusive, therefore there are no findings in the research that indicate that a diagnosis of deep vein thrombosis is the initial path to discover Whipple's Disease., En pacientes de mediana y avanzada edad se empiezan a manifestar distintos tipos de afecciones corporales que, en ocasiones, se convierten en un reto medico conseguir el origen. Los dolores articulares, las afecciones gastrointestinales, perdida de peso es parte de los síntomas de la vejez, pero en ocasiones estos síntomas están relacionados a enfermedades tratables o curables que con un diagnostico certero y temprano pueden mejorar la calidad de vida de los pacientes. Se trata de una investigación bibliográfica, cualitativa en donde se buscan las publicaciones científicas disponibles respecto a la “enfermedad de Whipple” y las “trombosis venosas profundas” pretendiendo encontrar relación entre las manifestaciones clínicas de las trombosis como un indicio de la presencia de la Enfermedad de Whipple. Encontrar una relación entre ambas afecciones seria parte de un caso específico pues, estadísticamente ambas enfermedades se pueden presentar luego de los 40 años de edad, pero en el caso de la trombosis venosa profunda suele presentarse mayormente en personas de sexo femenino, mientras que la enfermedad de Whipple en personas de sexo masculino. Sería lógico en dado caso remitirse a las manifestaciones clínicas de ambas enfermedades para encontrar un camino expedito hacia el diagnóstico oportuno, para la trombosis venosa profunda la escala de Wells puede ayudar y en caso de la enfermedad de Whipple identificar no solo el dolor articular sino la perdida de peso que suele ser la muestra mas frecuente de la presencia bacteriana en el afectado. Considerando lo conocido de ambas enfermedades se puede identificar que poseen en común el dolor en las articulaciones, sobre todo en las inferiores, pero no es excluyente, por tanto, no se encuentran hallazgos en la investigación que indique que un diagnóstico de trombosis venosa profunda sea el camino inicial para descubrir la Enfermedad de Whipple.

In middle-aged and elderly patients, different types of bodily conditions begin to manifest themselves, which, at times, are in a medical challenge to find the origin. Joint pain, gastrointestinal conditions, weight loss is part of the symptoms of old age but sometimes these symptoms are related to treatable or curable diseases that with an accurate and early diagnosis can improve the quality of life of patients. This is a qualitative, bibliographic research in which the scientific publications available regarding "Whipple's disease" and "deep venous thromboses" are sought, seeking to find a relationship between the clinical manifestations of thrombosis as an indication of the presence of the disease. by Whipple. Finding a relationship between the two conditions would be part of a specific case since, statistically, both diseases can occur after 40 years of age, but in the case of deep vein thrombosis it usually occurs mostly in female people, while the disease of Whipple in males. In this case, it would be logical to refer to the clinical manifestations of both diseases to find an expeditious path towards a timely diagnosis.For deep vein thrombosis, the Wells scale can help and in the case of Whipple's disease, identify not only joint pain but also pain. weight loss that is usually the most frequent sign of the presence of bacteria in the affected person. Considering what is known of both diseases, it can be identified that having joint pain in common, especially in the lower ones, but it is not exclusive, therefore there are no findings in the research that indicate that a diagnosis of deep vein thrombosis is the initial path to discover Whipple's Disease., En pacientes de mediana y avanzada edad se empiezan a manifestar distintos tipos de afecciones corporales que, en ocasiones, se convierten en un reto medico conseguir el origen. Los dolores articulares, las afecciones gastrointestinales, perdida de peso es parte de los síntomas de la vejez, pero en ocasiones estos síntomas están relacionados a enfermedades tratables o curables que con un diagnostico certero y temprano pueden mejorar la calidad de vida de los pacientes. Se trata de una investigación bibliográfica, cualitativa en donde se buscan las publicaciones científicas disponibles respecto a la “enfermedad de Whipple” y las “trombosis venosas profundas” pretendiendo encontrar relación entre las manifestaciones clínicas de las trombosis como un indicio de la presencia de la Enfermedad de Whipple. Encontrar una relación entre ambas afecciones seria parte de un caso específico pues, estadísticamente ambas enfermedades se pueden presentar luego de los 40 años de edad, pero en el caso de la trombosis venosa profunda suele presentarse mayormente en personas de sexo femenino, mientras que la enfermedad de Whipple en personas de sexo masculino. Sería lógico en dado caso remitirse a las manifestaciones clínicas de ambas enfermedades para encontrar un camino expedito hacia el diagnóstico oportuno, para la trombosis venosa profunda la escala de Wells puede ayudar y en caso de la enfermedad de Whipple identificar no solo el dolor articular sino la perdida de peso que suele ser la muestra mas frecuente de la presencia bacteriana en el afectado. Considerando lo conocido de ambas enfermedades se puede identificar que poseen en común el dolor en las articulaciones, sobre todo en las inferiores, pero no es excluyente, por tanto, no se encuentran hallazgos en la investigación que indique que un diagnóstico de trombosis venosa profunda sea el camino inicial para descubrir la Enfermedad de Whipple.

Background: Joint pain is a common cause of functional limitation and increased health expenditure among older people. The ageing population is increasing the prevalence of joint pain and the demand for care. Joint pain is prevalent globally, one in three individuals experience joint pain, and in South Africa, 24.48% of primary health care clinics patients experience joint pain. In adults over 65 years old in a rural context, 29.7% reported experiencing joint pain. Physiotherapists working in a primary health care context are required to treat many patients with joint pain in the absence of clear guidelines. In urban and peri-urban contexts, health education and exercise programmes have been shown to improve pain, quality of life and self-efficacy of individuals with joint pain. The study aimed to determine and compare the impact of six-week education and exercise intervention programme on female patients 50 - 70 years old living with weight-bearing joint pain for three months or longer in the Maluti-a-Phofung health sub-district receiving care at PHC Clinics. Method: A single-blind randomised controlled trial was conducted using convenience sampling. Following baseline measurement, participants were randomised into the intervention, workbook, and usual care groups. Data was collected using interviewer administered outcome measures and physical performance task battery. Demographic data was collected using a self-developed demographics questionnaire. Pain severity and pain interference data were collected using the brief pain Inventory short from. Self-efficacy data was collected using the chronic diseases self-efficacy scale. Quality of life data was collected using the EQ-5D-3L, and physical function data was collected using Physical Performance Task Battery. Data was collected at baseline and six weeks. A self-developed acceptability questionnaire to collect acceptability data for the intervention group was used at six weeks. Results: Forty-seven participants enr

In middle-aged and elderly patients, different types of bodily conditions begin to manifest themselves, which, at times, are in a medical challenge to find the origin. Joint pain, gastrointestinal conditions, weight loss is part of the symptoms of old age but sometimes these symptoms are related to treatable or curable diseases that with an accurate and early diagnosis can improve the quality of life of patients. This is a qualitative, bibliographic research in which the scientific publications available regarding "Whipple's disease" and "deep venous thromboses" are sought, seeking to find a relationship between the clinical manifestations of thrombosis as an indication of the presence of the disease. by Whipple. Finding a relationship between the two conditions would be part of a specific case since, statistically, both diseases can occur after 40 years of age, but in the case of deep vein thrombosis it usually occurs mostly in female people, while the disease of Whipple in males. In this case, it would be logical to refer to the clinical manifestations of both diseases to find an expeditious path towards a timely diagnosis.For deep vein thrombosis, the Wells scale can help and in the case of Whipple's disease, identify not only joint pain but also pain. weight loss that is usually the most frequent sign of the presence of bacteria in the affected person. Considering what is known of both diseases, it can be identified that having joint pain in common, especially in the lower ones, but it is not exclusive, therefore there are no findings in the research that indicate that a diagnosis of deep vein thrombosis is the initial path to discover Whipple's Disease., En pacientes de mediana y avanzada edad se empiezan a manifestar distintos tipos de afecciones corporales que, en ocasiones, se convierten en un reto medico conseguir el origen. Los dolores articulares, las afecciones gastrointestinales, perdida de peso es parte de los síntomas de la vejez, pero en ocasiones estos síntomas están relacionados a enfermedades tratables o curables que con un diagnostico certero y temprano pueden mejorar la calidad de vida de los pacientes. Se trata de una investigación bibliográfica, cualitativa en donde se buscan las publicaciones científicas disponibles respecto a la “enfermedad de Whipple” y las “trombosis venosas profundas” pretendiendo encontrar relación entre las manifestaciones clínicas de las trombosis como un indicio de la presencia de la Enfermedad de Whipple. Encontrar una relación entre ambas afecciones seria parte de un caso específico pues, estadísticamente ambas enfermedades se pueden presentar luego de los 40 años de edad, pero en el caso de la trombosis venosa profunda suele presentarse mayormente en personas de sexo femenino, mientras que la enfermedad de Whipple en personas de sexo masculino. Sería lógico en dado caso remitirse a las manifestaciones clínicas de ambas enfermedades para encontrar un camino expedito hacia el diagnóstico oportuno, para la trombosis venosa profunda la escala de Wells puede ayudar y en caso de la enfermedad de Whipple identificar no solo el dolor articular sino la perdida de peso que suele ser la muestra mas frecuente de la presencia bacteriana en el afectado. Considerando lo conocido de ambas enfermedades se puede identificar que poseen en común el dolor en las articulaciones, sobre todo en las inferiores, pero no es excluyente, por tanto, no se encuentran hallazgos en la investigación que indique que un diagnóstico de trombosis venosa profunda sea el camino inicial para descubrir la Enfermedad de Whipple.

In middle-aged and elderly patients, different types of bodily conditions begin to manifest themselves, which, at times, are in a medical challenge to find the origin. Joint pain, gastrointestinal conditions, weight loss is part of the symptoms of old age but sometimes these symptoms are related to treatable or curable diseases that with an accurate and early diagnosis can improve the quality of life of patients. This is a qualitative, bibliographic research in which the scientific publications available regarding "Whipple's disease" and "deep venous thromboses" are sought, seeking to find a relationship between the clinical manifestations of thrombosis as an indication of the presence of the disease. by Whipple. Finding a relationship between the two conditions would be part of a specific case since, statistically, both diseases can occur after 40 years of age, but in the case of deep vein thrombosis it usually occurs mostly in female people, while the disease of Whipple in males. In this case, it would be logical to refer to the clinical manifestations of both diseases to find an expeditious path towards a timely diagnosis.For deep vein thrombosis, the Wells scale can help and in the case of Whipple's disease, identify not only joint pain but also pain. weight loss that is usually the most frequent sign of the presence of bacteria in the affected person. Considering what is known of both diseases, it can be identified that having joint pain in common, especially in the lower ones, but it is not exclusive, therefore there are no findings in the research that indicate that a diagnosis of deep vein thrombosis is the initial path to discover Whipple's Disease., En pacientes de mediana y avanzada edad se empiezan a manifestar distintos tipos de afecciones corporales que, en ocasiones, se convierten en un reto medico conseguir el origen. Los dolores articulares, las afecciones gastrointestinales, perdida de peso es parte de los síntomas de la vejez, pero en ocasiones estos síntomas están relacionados a enfermedades tratables o curables que con un diagnostico certero y temprano pueden mejorar la calidad de vida de los pacientes. Se trata de una investigación bibliográfica, cualitativa en donde se buscan las publicaciones científicas disponibles respecto a la “enfermedad de Whipple” y las “trombosis venosas profundas” pretendiendo encontrar relación entre las manifestaciones clínicas de las trombosis como un indicio de la presencia de la Enfermedad de Whipple. Encontrar una relación entre ambas afecciones seria parte de un caso específico pues, estadísticamente ambas enfermedades se pueden presentar luego de los 40 años de edad, pero en el caso de la trombosis venosa profunda suele presentarse mayormente en personas de sexo femenino, mientras que la enfermedad de Whipple en personas de sexo masculino. Sería lógico en dado caso remitirse a las manifestaciones clínicas de ambas enfermedades para encontrar un camino expedito hacia el diagnóstico oportuno, para la trombosis venosa profunda la escala de Wells puede ayudar y en caso de la enfermedad de Whipple identificar no solo el dolor articular sino la perdida de peso que suele ser la muestra mas frecuente de la presencia bacteriana en el afectado. Considerando lo conocido de ambas enfermedades se puede identificar que poseen en común el dolor en las articulaciones, sobre todo en las inferiores, pero no es excluyente, por tanto, no se encuentran hallazgos en la investigación que indique que un diagnóstico de trombosis venosa profunda sea el camino inicial para descubrir la Enfermedad de Whipple.

In middle-aged and elderly patients, different types of bodily conditions begin to manifest themselves, which, at times, are in a medical challenge to find the origin. Joint pain, gastrointestinal conditions, weight loss is part of the symptoms of old age but sometimes these symptoms are related to treatable or curable diseases that with an accurate and early diagnosis can improve the quality of life of patients. This is a qualitative, bibliographic research in which the scientific publications available regarding "Whipple's disease" and "deep venous thromboses" are sought, seeking to find a relationship between the clinical manifestations of thrombosis as an indication of the presence of the disease. by Whipple. Finding a relationship between the two conditions would be part of a specific case since, statistically, both diseases can occur after 40 years of age, but in the case of deep vein thrombosis it usually occurs mostly in female people, while the disease of Whipple in males. In this case, it would be logical to refer to the clinical manifestations of both diseases to find an expeditious path towards a timely diagnosis.For deep vein thrombosis, the Wells scale can help and in the case of Whipple's disease, identify not only joint pain but also pain. weight loss that is usually the most frequent sign of the presence of bacteria in the affected person. Considering what is known of both diseases, it can be identified that having joint pain in common, especially in the lower ones, but it is not exclusive, therefore there are no findings in the research that indicate that a diagnosis of deep vein thrombosis is the initial path to discover Whipple's Disease., En pacientes de mediana y avanzada edad se empiezan a manifestar distintos tipos de afecciones corporales que, en ocasiones, se convierten en un reto medico conseguir el origen. Los dolores articulares, las afecciones gastrointestinales, perdida de peso es parte de los síntomas de la vejez, pero en ocasiones estos síntomas están relacionados a enfermedades tratables o curables que con un diagnostico certero y temprano pueden mejorar la calidad de vida de los pacientes. Se trata de una investigación bibliográfica, cualitativa en donde se buscan las publicaciones científicas disponibles respecto a la “enfermedad de Whipple” y las “trombosis venosas profundas” pretendiendo encontrar relación entre las manifestaciones clínicas de las trombosis como un indicio de la presencia de la Enfermedad de Whipple. Encontrar una relación entre ambas afecciones seria parte de un caso específico pues, estadísticamente ambas enfermedades se pueden presentar luego de los 40 años de edad, pero en el caso de la trombosis venosa profunda suele presentarse mayormente en personas de sexo femenino, mientras que la enfermedad de Whipple en personas de sexo masculino. Sería lógico en dado caso remitirse a las manifestaciones clínicas de ambas enfermedades para encontrar un camino expedito hacia el diagnóstico oportuno, para la trombosis venosa profunda la escala de Wells puede ayudar y en caso de la enfermedad de Whipple identificar no solo el dolor articular sino la perdida de peso que suele ser la muestra mas frecuente de la presencia bacteriana en el afectado. Considerando lo conocido de ambas enfermedades se puede identificar que poseen en común el dolor en las articulaciones, sobre todo en las inferiores, pero no es excluyente, por tanto, no se encuentran hallazgos en la investigación que indique que un diagnóstico de trombosis venosa profunda sea el camino inicial para descubrir la Enfermedad de Whipple.

Objectives: To characterize the expression profiles of two nuclear-encoded mitochondrial genes previously associated with chronic pain, the translocator protein (TSPO) and family with sequence similarity 173B (FAM173B), in different knee compartments from patients with painful knee OA. Also, to examine their association with the joint expression of inflammatory cytokines/chemokines and clinical symptoms. Methods: The study was performed on 40 knee OA patients and 19 postmortem (PM) controls from which we collected the knee tissues: articular cartilage (AC), synovial membrane (SM) and subchondral bone (SB). Quantitative real-time polymerase chain reaction was used to determine the relative mRNA levels of TSPO, FAM173B, and inflammatory mediators IL6, IL8, IL10, IL12, MCP1, CCL11 and CCL17. OA patients rated their pain intensity (visual analogue scale), severity of knee-related outcomes (KOOS) and pain sensitivity assessed by pressure algometry. Results: The gene expression of TSPO in SM was elevated in OA patients compared with control subjects while there were no group differences in AC and SB. Expression of FAM173B was reduced in SM but elevated in SB in OA patients compared with controls. The expression of TSPO and FAM173B in SM and SB was associated with the expression of inflammatory substances, but not in AC. Synovial expression of TSPO correlated with lower pain intensity and FAM173B with increased pressure pain sensitivity in OA. Conclusion: Our results suggest that altered expression of TSPO and FAM173B is associated with joint expression of inflammatory mediators and with clinical symptoms indicating the relevance for the pathophysiology of knee OA.

Objectives: To characterize the expression profiles of two nuclear-encoded mitochondrial genes previously associated with chronic pain, the translocator protein (TSPO) and family with sequence similarity 173B (FAM173B), in different knee compartments from patients with painful knee OA. Also, to examine their association with the joint expression of inflammatory cytokines/chemokines and clinical symptoms. Methods: The study was performed on 40 knee OA patients and 19 postmortem (PM) controls from which we collected the knee tissues: articular cartilage (AC), synovial membrane (SM) and subchondral bone (SB). Quantitative real-time polymerase chain reaction was used to determine the relative mRNA levels of TSPO, FAM173B, and inflammatory mediators IL6, IL8, IL10, IL12, MCP1, CCL11 and CCL17. OA patients rated their pain intensity (visual analogue scale), severity of knee-related outcomes (KOOS) and pain sensitivity assessed by pressure algometry. Results: The gene expression of TSPO in SM was elevated in OA patients compared with control subjects while there were no group differences in AC and SB. Expression of FAM173B was reduced in SM but elevated in SB in OA patients compared with controls. The expression of TSPO and FAM173B in SM and SB was associated with the expression of inflammatory substances, but not in AC. Synovial expression of TSPO correlated with lower pain intensity and FAM173B with increased pressure pain sensitivity in OA. Conclusion: Our results suggest that altered expression of TSPO and FAM173B is associated with joint expression of inflammatory mediators and with clinical symptoms indicating the relevance for the pathophysiology of knee OA.

Objectives: To characterize the expression profiles of two nuclear-encoded mitochondrial genes previously associated with chronic pain, the translocator protein (TSPO) and family with sequence similarity 173B (FAM173B), in different knee compartments from patients with painful knee OA. Also, to examine their association with the joint expression of inflammatory cytokines/chemokines and clinical symptoms. Methods: The study was performed on 40 knee OA patients and 19 postmortem (PM) controls from which we collected the knee tissues: articular cartilage (AC), synovial membrane (SM) and subchondral bone (SB). Quantitative real-time polymerase chain reaction was used to determine the relative mRNA levels of TSPO, FAM173B, and inflammatory mediators IL6, IL8, IL10, IL12, MCP1, CCL11 and CCL17. OA patients rated their pain intensity (visual analogue scale), severity of knee-related outcomes (KOOS) and pain sensitivity assessed by pressure algometry. Results: The gene expression of TSPO in SM was elevated in OA patients compared with control subjects while there were no group differences in AC and SB. Expression of FAM173B was reduced in SM but elevated in SB in OA patients compared with controls. The expression of TSPO and FAM173B in SM and SB was associated with the expression of inflammatory substances, but not in AC. Synovial expression of TSPO correlated with lower pain intensity and FAM173B with increased pressure pain sensitivity in OA. Conclusion: Our results suggest that altered expression of TSPO and FAM173B is associated with joint expression of inflammatory mediators and with clinical symptoms indicating the relevance for the pathophysiology of knee OA.

Objectives: To characterize the expression profiles of two nuclear-encoded mitochondrial genes previously associated with chronic pain, the translocator protein (TSPO) and family with sequence similarity 173B (FAM173B), in different knee compartments from patients with painful knee OA. Also, to examine their association with the joint expression of inflammatory cytokines/chemokines and clinical symptoms. Methods: The study was performed on 40 knee OA patients and 19 postmortem (PM) controls from which we collected the knee tissues: articular cartilage (AC), synovial membrane (SM) and subchondral bone (SB). Quantitative real-time polymerase chain reaction was used to determine the relative mRNA levels of TSPO, FAM173B, and inflammatory mediators IL6, IL8, IL10, IL12, MCP1, CCL11 and CCL17. OA patients rated their pain intensity (visual analogue scale), severity of knee-related outcomes (KOOS) and pain sensitivity assessed by pressure algometry. Results: The gene expression of TSPO in SM was elevated in OA patients compared with control subjects while there were no group differences in AC and SB. Expression of FAM173B was reduced in SM but elevated in SB in OA patients compared with controls. The expression of TSPO and FAM173B in SM and SB was associated with the expression of inflammatory substances, but not in AC. Synovial expression of TSPO correlated with lower pain intensity and FAM173B with increased pressure pain sensitivity in OA. Conclusion: Our results suggest that altered expression of TSPO and FAM173B is associated with joint expression of inflammatory mediators and with clinical symptoms indicating the relevance for the pathophysiology of knee OA.

In middle-aged and elderly patients, different types of bodily conditions begin to manifest themselves, which, at times, are in a medical challenge to find the origin. Joint pain, gastrointestinal conditions, weight loss is part of the symptoms of old age but sometimes these symptoms are related to treatable or curable diseases that with an accurate and early diagnosis can improve the quality of life of patients. This is a qualitative, bibliographic research in which the scientific publications available regarding "Whipple's disease" and "deep venous thromboses" are sought, seeking to find a relationship between the clinical manifestations of thrombosis as an indication of the presence of the disease. by Whipple. Finding a relationship between the two conditions would be part of a specific case since, statistically, both diseases can occur after 40 years of age, but in the case of deep vein thrombosis it usually occurs mostly in female people, while the disease of Whipple in males. In this case, it would be logical to refer to the clinical manifestations of both diseases to find an expeditious path towards a timely diagnosis.For deep vein thrombosis, the Wells scale can help and in the case of Whipple's disease, identify not only joint pain but also pain. weight loss that is usually the most frequent sign of the presence of bacteria in the affected person. Considering what is known of both diseases, it can be identified that having joint pain in common, especially in the lower ones, but it is not exclusive, therefore there are no findings in the research that indicate that a diagnosis of deep vein thrombosis is the initial path to discover Whipple's Disease., En pacientes de mediana y avanzada edad se empiezan a manifestar distintos tipos de afecciones corporales que, en ocasiones, se convierten en un reto medico conseguir el origen. Los dolores articulares, las afecciones gastrointestinales, perdida de peso es parte de los síntomas de la vejez, pero en ocasiones estos síntomas están relacionados a enfermedades tratables o curables que con un diagnostico certero y temprano pueden mejorar la calidad de vida de los pacientes. Se trata de una investigación bibliográfica, cualitativa en donde se buscan las publicaciones científicas disponibles respecto a la “enfermedad de Whipple” y las “trombosis venosas profundas” pretendiendo encontrar relación entre las manifestaciones clínicas de las trombosis como un indicio de la presencia de la Enfermedad de Whipple. Encontrar una relación entre ambas afecciones seria parte de un caso específico pues, estadísticamente ambas enfermedades se pueden presentar luego de los 40 años de edad, pero en el caso de la trombosis venosa profunda suele presentarse mayormente en personas de sexo femenino, mientras que la enfermedad de Whipple en personas de sexo masculino. Sería lógico en dado caso remitirse a las manifestaciones clínicas de ambas enfermedades para encontrar un camino expedito hacia el diagnóstico oportuno, para la trombosis venosa profunda la escala de Wells puede ayudar y en caso de la enfermedad de Whipple identificar no solo el dolor articular sino la perdida de peso que suele ser la muestra mas frecuente de la presencia bacteriana en el afectado. Considerando lo conocido de ambas enfermedades se puede identificar que poseen en común el dolor en las articulaciones, sobre todo en las inferiores, pero no es excluyente, por tanto, no se encuentran hallazgos en la investigación que indique que un diagnóstico de trombosis venosa profunda sea el camino inicial para descubrir la Enfermedad de Whipple.

In middle-aged and elderly patients, different types of bodily conditions begin to manifest themselves, which, at times, are in a medical challenge to find the origin. Joint pain, gastrointestinal conditions, weight loss is part of the symptoms of old age but sometimes these symptoms are related to treatable or curable diseases that with an accurate and early diagnosis can improve the quality of life of patients. This is a qualitative, bibliographic research in which the scientific publications available regarding "Whipple's disease" and "deep venous thromboses" are sought, seeking to find a relationship between the clinical manifestations of thrombosis as an indication of the presence of the disease. by Whipple. Finding a relationship between the two conditions would be part of a specific case since, statistically, both diseases can occur after 40 years of age, but in the case of deep vein thrombosis it usually occurs mostly in female people, while the disease of Whipple in males. In this case, it would be logical to refer to the clinical manifestations of both diseases to find an expeditious path towards a timely diagnosis.For deep vein thrombosis, the Wells scale can help and in the case of Whipple's disease, identify not only joint pain but also pain. weight loss that is usually the most frequent sign of the presence of bacteria in the affected person. Considering what is known of both diseases, it can be identified that having joint pain in common, especially in the lower ones, but it is not exclusive, therefore there are no findings in the research that indicate that a diagnosis of deep vein thrombosis is the initial path to discover Whipple's Disease., En pacientes de mediana y avanzada edad se empiezan a manifestar distintos tipos de afecciones corporales que, en ocasiones, se convierten en un reto medico conseguir el origen. Los dolores articulares, las afecciones gastrointestinales, perdida de peso es parte de los síntomas de la vejez, pero en ocasiones estos síntomas están relacionados a enfermedades tratables o curables que con un diagnostico certero y temprano pueden mejorar la calidad de vida de los pacientes. Se trata de una investigación bibliográfica, cualitativa en donde se buscan las publicaciones científicas disponibles respecto a la “enfermedad de Whipple” y las “trombosis venosas profundas” pretendiendo encontrar relación entre las manifestaciones clínicas de las trombosis como un indicio de la presencia de la Enfermedad de Whipple. Encontrar una relación entre ambas afecciones seria parte de un caso específico pues, estadísticamente ambas enfermedades se pueden presentar luego de los 40 años de edad, pero en el caso de la trombosis venosa profunda suele presentarse mayormente en personas de sexo femenino, mientras que la enfermedad de Whipple en personas de sexo masculino. Sería lógico en dado caso remitirse a las manifestaciones clínicas de ambas enfermedades para encontrar un camino expedito hacia el diagnóstico oportuno, para la trombosis venosa profunda la escala de Wells puede ayudar y en caso de la enfermedad de Whipple identificar no solo el dolor articular sino la perdida de peso que suele ser la muestra mas frecuente de la presencia bacteriana en el afectado. Considerando lo conocido de ambas enfermedades se puede identificar que poseen en común el dolor en las articulaciones, sobre todo en las inferiores, pero no es excluyente, por tanto, no se encuentran hallazgos en la investigación que indique que un diagnóstico de trombosis venosa profunda sea el camino inicial para descubrir la Enfermedad de Whipple.

In middle-aged and elderly patients, different types of bodily conditions begin to manifest themselves, which, at times, are in a medical challenge to find the origin. Joint pain, gastrointestinal conditions, weight loss is part of the symptoms of old age but sometimes these symptoms are related to treatable or curable diseases that with an accurate and early diagnosis can improve the quality of life of patients. This is a qualitative, bibliographic research in which the scientific publications available regarding "Whipple's disease" and "deep venous thromboses" are sought, seeking to find a relationship between the clinical manifestations of thrombosis as an indication of the presence of the disease. by Whipple. Finding a relationship between the two conditions would be part of a specific case since, statistically, both diseases can occur after 40 years of age, but in the case of deep vein thrombosis it usually occurs mostly in female people, while the disease of Whipple in males. In this case, it would be logical to refer to the clinical manifestations of both diseases to find an expeditious path towards a timely diagnosis.For deep vein thrombosis, the Wells scale can help and in the case of Whipple's disease, identify not only joint pain but also pain. weight loss that is usually the most frequent sign of the presence of bacteria in the affected person. Considering what is known of both diseases, it can be identified that having joint pain in common, especially in the lower ones, but it is not exclusive, therefore there are no findings in the research that indicate that a diagnosis of deep vein thrombosis is the initial path to discover Whipple's Disease., En pacientes de mediana y avanzada edad se empiezan a manifestar distintos tipos de afecciones corporales que, en ocasiones, se convierten en un reto medico conseguir el origen. Los dolores articulares, las afecciones gastrointestinales, perdida de peso es parte de los síntomas de la vejez, pero en ocasiones estos síntomas están relacionados a enfermedades tratables o curables que con un diagnostico certero y temprano pueden mejorar la calidad de vida de los pacientes. Se trata de una investigación bibliográfica, cualitativa en donde se buscan las publicaciones científicas disponibles respecto a la “enfermedad de Whipple” y las “trombosis venosas profundas” pretendiendo encontrar relación entre las manifestaciones clínicas de las trombosis como un indicio de la presencia de la Enfermedad de Whipple. Encontrar una relación entre ambas afecciones seria parte de un caso específico pues, estadísticamente ambas enfermedades se pueden presentar luego de los 40 años de edad, pero en el caso de la trombosis venosa profunda suele presentarse mayormente en personas de sexo femenino, mientras que la enfermedad de Whipple en personas de sexo masculino. Sería lógico en dado caso remitirse a las manifestaciones clínicas de ambas enfermedades para encontrar un camino expedito hacia el diagnóstico oportuno, para la trombosis venosa profunda la escala de Wells puede ayudar y en caso de la enfermedad de Whipple identificar no solo el dolor articular sino la perdida de peso que suele ser la muestra mas frecuente de la presencia bacteriana en el afectado. Considerando lo conocido de ambas enfermedades se puede identificar que poseen en común el dolor en las articulaciones, sobre todo en las inferiores, pero no es excluyente, por tanto, no se encuentran hallazgos en la investigación que indique que un diagnóstico de trombosis venosa profunda sea el camino inicial para descubrir la Enfermedad de Whipple.

In middle-aged and elderly patients, different types of bodily conditions begin to manifest themselves, which, at times, are in a medical challenge to find the origin. Joint pain, gastrointestinal conditions, weight loss is part of the symptoms of old age but sometimes these symptoms are related to treatable or curable diseases that with an accurate and early diagnosis can improve the quality of life of patients. This is a qualitative, bibliographic research in which the scientific publications available regarding "Whipple's disease" and "deep venous thromboses" are sought, seeking to find a relationship between the clinical manifestations of thrombosis as an indication of the presence of the disease. by Whipple. Finding a relationship between the two conditions would be part of a specific case since, statistically, both diseases can occur after 40 years of age, but in the case of deep vein thrombosis it usually occurs mostly in female people, while the disease of Whipple in males. In this case, it would be logical to refer to the clinical manifestations of both diseases to find an expeditious path towards a timely diagnosis.For deep vein thrombosis, the Wells scale can help and in the case of Whipple's disease, identify not only joint pain but also pain. weight loss that is usually the most frequent sign of the presence of bacteria in the affected person. Considering what is known of both diseases, it can be identified that having joint pain in common, especially in the lower ones, but it is not exclusive, therefore there are no findings in the research that indicate that a diagnosis of deep vein thrombosis is the initial path to discover Whipple's Disease., En pacientes de mediana y avanzada edad se empiezan a manifestar distintos tipos de afecciones corporales que, en ocasiones, se convierten en un reto medico conseguir el origen. Los dolores articulares, las afecciones gastrointestinales, perdida de peso es parte de los síntomas de la vejez, pero en ocasiones estos síntomas están relacionados a enfermedades tratables o curables que con un diagnostico certero y temprano pueden mejorar la calidad de vida de los pacientes. Se trata de una investigación bibliográfica, cualitativa en donde se buscan las publicaciones científicas disponibles respecto a la “enfermedad de Whipple” y las “trombosis venosas profundas” pretendiendo encontrar relación entre las manifestaciones clínicas de las trombosis como un indicio de la presencia de la Enfermedad de Whipple. Encontrar una relación entre ambas afecciones seria parte de un caso específico pues, estadísticamente ambas enfermedades se pueden presentar luego de los 40 años de edad, pero en el caso de la trombosis venosa profunda suele presentarse mayormente en personas de sexo femenino, mientras que la enfermedad de Whipple en personas de sexo masculino. Sería lógico en dado caso remitirse a las manifestaciones clínicas de ambas enfermedades para encontrar un camino expedito hacia el diagnóstico oportuno, para la trombosis venosa profunda la escala de Wells puede ayudar y en caso de la enfermedad de Whipple identificar no solo el dolor articular sino la perdida de peso que suele ser la muestra mas frecuente de la presencia bacteriana en el afectado. Considerando lo conocido de ambas enfermedades se puede identificar que poseen en común el dolor en las articulaciones, sobre todo en las inferiores, pero no es excluyente, por tanto, no se encuentran hallazgos en la investigación que indique que un diagnóstico de trombosis venosa profunda sea el camino inicial para descubrir la Enfermedad de Whipple.

Objectives: To characterize the expression profiles of two nuclear-encoded mitochondrial genes previously associated with chronic pain, the translocator protein (TSPO) and family with sequence similarity 173B (FAM173B), in different knee compartments from patients with painful knee OA. Also, to examine their association with the joint expression of inflammatory cytokines/chemokines and clinical symptoms. Methods: The study was performed on 40 knee OA patients and 19 postmortem (PM) controls from which we collected the knee tissues: articular cartilage (AC), synovial membrane (SM) and subchondral bone (SB). Quantitative real-time polymerase chain reaction was used to determine the relative mRNA levels of TSPO, FAM173B, and inflammatory mediators IL6, IL8, IL10, IL12, MCP1, CCL11 and CCL17. OA patients rated their pain intensity (visual analogue scale), severity of knee-related outcomes (KOOS) and pain sensitivity assessed by pressure algometry. Results: The gene expression of TSPO in SM was elevated in OA patients compared with control subjects while there were no group differences in AC and SB. Expression of FAM173B was reduced in SM but elevated in SB in OA patients compared with controls. The expression of TSPO and FAM173B in SM and SB was associated with the expression of inflammatory substances, but not in AC. Synovial expression of TSPO correlated with lower pain intensity and FAM173B with increased pressure pain sensitivity in OA. Conclusion: Our results suggest that altered expression of TSPO and FAM173B is associated with joint expression of inflammatory mediators and with clinical symptoms indicating the relevance for the pathophysiology of knee OA.

In middle-aged and elderly patients, different types of bodily conditions begin to manifest themselves, which, at times, are in a medical challenge to find the origin. Joint pain, gastrointestinal conditions, weight loss is part of the symptoms of old age but sometimes these symptoms are related to treatable or curable diseases that with an accurate and early diagnosis can improve the quality of life of patients. This is a qualitative, bibliographic research in which the scientific publications available regarding "Whipple's disease" and "deep venous thromboses" are sought, seeking to find a relationship between the clinical manifestations of thrombosis as an indication of the presence of the disease. by Whipple. Finding a relationship between the two conditions would be part of a specific case since, statistically, both diseases can occur after 40 years of age, but in the case of deep vein thrombosis it usually occurs mostly in female people, while the disease of Whipple in males. In this case, it would be logical to refer to the clinical manifestations of both diseases to find an expeditious path towards a timely diagnosis.For deep vein thrombosis, the Wells scale can help and in the case of Whipple's disease, identify not only joint pain but also pain. weight loss that is usually the most frequent sign of the presence of bacteria in the affected person. Considering what is known of both diseases, it can be identified that having joint pain in common, especially in the lower ones, but it is not exclusive, therefore there are no findings in the research that indicate that a diagnosis of deep vein thrombosis is the initial path to discover Whipple's Disease., En pacientes de mediana y avanzada edad se empiezan a manifestar distintos tipos de afecciones corporales que, en ocasiones, se convierten en un reto medico conseguir el origen. Los dolores articulares, las afecciones gastrointestinales, perdida de peso es parte de los síntomas de la vejez, pero en ocasiones estos síntomas están relacionados a enfermedades tratables o curables que con un diagnostico certero y temprano pueden mejorar la calidad de vida de los pacientes. Se trata de una investigación bibliográfica, cualitativa en donde se buscan las publicaciones científicas disponibles respecto a la “enfermedad de Whipple” y las “trombosis venosas profundas” pretendiendo encontrar relación entre las manifestaciones clínicas de las trombosis como un indicio de la presencia de la Enfermedad de Whipple. Encontrar una relación entre ambas afecciones seria parte de un caso específico pues, estadísticamente ambas enfermedades se pueden presentar luego de los 40 años de edad, pero en el caso de la trombosis venosa profunda suele presentarse mayormente en personas de sexo femenino, mientras que la enfermedad de Whipple en personas de sexo masculino. Sería lógico en dado caso remitirse a las manifestaciones clínicas de ambas enfermedades para encontrar un camino expedito hacia el diagnóstico oportuno, para la trombosis venosa profunda la escala de Wells puede ayudar y en caso de la enfermedad de Whipple identificar no solo el dolor articular sino la perdida de peso que suele ser la muestra mas frecuente de la presencia bacteriana en el afectado. Considerando lo conocido de ambas enfermedades se puede identificar que poseen en común el dolor en las articulaciones, sobre todo en las inferiores, pero no es excluyente, por tanto, no se encuentran hallazgos en la investigación que indique que un diagnóstico de trombosis venosa profunda sea el camino inicial para descubrir la Enfermedad de Whipple.

In middle-aged and elderly patients, different types of bodily conditions begin to manifest themselves, which, at times, are in a medical challenge to find the origin. Joint pain, gastrointestinal conditions, weight loss is part of the symptoms of old age but sometimes these symptoms are related to treatable or curable diseases that with an accurate and early diagnosis can improve the quality of life of patients. This is a qualitative, bibliographic research in which the scientific publications available regarding "Whipple's disease" and "deep venous thromboses" are sought, seeking to find a relationship between the clinical manifestations of thrombosis as an indication of the presence of the disease. by Whipple. Finding a relationship between the two conditions would be part of a specific case since, statistically, both diseases can occur after 40 years of age, but in the case of deep vein thrombosis it usually occurs mostly in female people, while the disease of Whipple in males. In this case, it would be logical to refer to the clinical manifestations of both diseases to find an expeditious path towards a timely diagnosis.For deep vein thrombosis, the Wells scale can help and in the case of Whipple's disease, identify not only joint pain but also pain. weight loss that is usually the most frequent sign of the presence of bacteria in the affected person. Considering what is known of both diseases, it can be identified that having joint pain in common, especially in the lower ones, but it is not exclusive, therefore there are no findings in the research that indicate that a diagnosis of deep vein thrombosis is the initial path to discover Whipple's Disease., En pacientes de mediana y avanzada edad se empiezan a manifestar distintos tipos de afecciones corporales que, en ocasiones, se convierten en un reto medico conseguir el origen. Los dolores articulares, las afecciones gastrointestinales, perdida de peso es parte de los síntomas de la vejez, pero en ocasiones estos síntomas están relacionados a enfermedades tratables o curables que con un diagnostico certero y temprano pueden mejorar la calidad de vida de los pacientes. Se trata de una investigación bibliográfica, cualitativa en donde se buscan las publicaciones científicas disponibles respecto a la “enfermedad de Whipple” y las “trombosis venosas profundas” pretendiendo encontrar relación entre las manifestaciones clínicas de las trombosis como un indicio de la presencia de la Enfermedad de Whipple. Encontrar una relación entre ambas afecciones seria parte de un caso específico pues, estadísticamente ambas enfermedades se pueden presentar luego de los 40 años de edad, pero en el caso de la trombosis venosa profunda suele presentarse mayormente en personas de sexo femenino, mientras que la enfermedad de Whipple en personas de sexo masculino. Sería lógico en dado caso remitirse a las manifestaciones clínicas de ambas enfermedades para encontrar un camino expedito hacia el diagnóstico oportuno, para la trombosis venosa profunda la escala de Wells puede ayudar y en caso de la enfermedad de Whipple identificar no solo el dolor articular sino la perdida de peso que suele ser la muestra mas frecuente de la presencia bacteriana en el afectado. Considerando lo conocido de ambas enfermedades se puede identificar que poseen en común el dolor en las articulaciones, sobre todo en las inferiores, pero no es excluyente, por tanto, no se encuentran hallazgos en la investigación que indique que un diagnóstico de trombosis venosa profunda sea el camino inicial para descubrir la Enfermedad de Whipple.

In middle-aged and elderly patients, different types of bodily conditions begin to manifest themselves, which, at times, are in a medical challenge to find the origin. Joint pain, gastrointestinal conditions, weight loss is part of the symptoms of old age but sometimes these symptoms are related to treatable or curable diseases that with an accurate and early diagnosis can improve the quality of life of patients. This is a qualitative, bibliographic research in which the scientific publications available regarding "Whipple's disease" and "deep venous thromboses" are sought, seeking to find a relationship between the clinical manifestations of thrombosis as an indication of the presence of the disease. by Whipple. Finding a relationship between the two conditions would be part of a specific case since, statistically, both diseases can occur after 40 years of age, but in the case of deep vein thrombosis it usually occurs mostly in female people, while the disease of Whipple in males. In this case, it would be logical to refer to the clinical manifestations of both diseases to find an expeditious path towards a timely diagnosis.For deep vein thrombosis, the Wells scale can help and in the case of Whipple's disease, identify not only joint pain but also pain. weight loss that is usually the most frequent sign of the presence of bacteria in the affected person. Considering what is known of both diseases, it can be identified that having joint pain in common, especially in the lower ones, but it is not exclusive, therefore there are no findings in the research that indicate that a diagnosis of deep vein thrombosis is the initial path to discover Whipple's Disease., En pacientes de mediana y avanzada edad se empiezan a manifestar distintos tipos de afecciones corporales que, en ocasiones, se convierten en un reto medico conseguir el origen. Los dolores articulares, las afecciones gastrointestinales, perdida de peso es parte de los síntomas de la vejez, pero en ocasiones estos síntomas están relacionados a enfermedades tratables o curables que con un diagnostico certero y temprano pueden mejorar la calidad de vida de los pacientes. Se trata de una investigación bibliográfica, cualitativa en donde se buscan las publicaciones científicas disponibles respecto a la “enfermedad de Whipple” y las “trombosis venosas profundas” pretendiendo encontrar relación entre las manifestaciones clínicas de las trombosis como un indicio de la presencia de la Enfermedad de Whipple. Encontrar una relación entre ambas afecciones seria parte de un caso específico pues, estadísticamente ambas enfermedades se pueden presentar luego de los 40 años de edad, pero en el caso de la trombosis venosa profunda suele presentarse mayormente en personas de sexo femenino, mientras que la enfermedad de Whipple en personas de sexo masculino. Sería lógico en dado caso remitirse a las manifestaciones clínicas de ambas enfermedades para encontrar un camino expedito hacia el diagnóstico oportuno, para la trombosis venosa profunda la escala de Wells puede ayudar y en caso de la enfermedad de Whipple identificar no solo el dolor articular sino la perdida de peso que suele ser la muestra mas frecuente de la presencia bacteriana en el afectado. Considerando lo conocido de ambas enfermedades se puede identificar que poseen en común el dolor en las articulaciones, sobre todo en las inferiores, pero no es excluyente, por tanto, no se encuentran hallazgos en la investigación que indique que un diagnóstico de trombosis venosa profunda sea el camino inicial para descubrir la Enfermedad de Whipple.

In middle-aged and elderly patients, different types of bodily conditions begin to manifest themselves, which, at times, are in a medical challenge to find the origin. Joint pain, gastrointestinal conditions, weight loss is part of the symptoms of old age but sometimes these symptoms are related to treatable or curable diseases that with an accurate and early diagnosis can improve the quality of life of patients. This is a qualitative, bibliographic research in which the scientific publications available regarding "Whipple's disease" and "deep venous thromboses" are sought, seeking to find a relationship between the clinical manifestations of thrombosis as an indication of the presence of the disease. by Whipple. Finding a relationship between the two conditions would be part of a specific case since, statistically, both diseases can occur after 40 years of age, but in the case of deep vein thrombosis it usually occurs mostly in female people, while the disease of Whipple in males. In this case, it would be logical to refer to the clinical manifestations of both diseases to find an expeditious path towards a timely diagnosis.For deep vein thrombosis, the Wells scale can help and in the case of Whipple's disease, identify not only joint pain but also pain. weight loss that is usually the most frequent sign of the presence of bacteria in the affected person. Considering what is known of both diseases, it can be identified that having joint pain in common, especially in the lower ones, but it is not exclusive, therefore there are no findings in the research that indicate that a diagnosis of deep vein thrombosis is the initial path to discover Whipple's Disease., En pacientes de mediana y avanzada edad se empiezan a manifestar distintos tipos de afecciones corporales que, en ocasiones, se convierten en un reto medico conseguir el origen. Los dolores articulares, las afecciones gastrointestinales, perdida de peso es parte de los síntomas de la vejez, pero en ocasiones estos síntomas están relacionados a enfermedades tratables o curables que con un diagnostico certero y temprano pueden mejorar la calidad de vida de los pacientes. Se trata de una investigación bibliográfica, cualitativa en donde se buscan las publicaciones científicas disponibles respecto a la “enfermedad de Whipple” y las “trombosis venosas profundas” pretendiendo encontrar relación entre las manifestaciones clínicas de las trombosis como un indicio de la presencia de la Enfermedad de Whipple. Encontrar una relación entre ambas afecciones seria parte de un caso específico pues, estadísticamente ambas enfermedades se pueden presentar luego de los 40 años de edad, pero en el caso de la trombosis venosa profunda suele presentarse mayormente en personas de sexo femenino, mientras que la enfermedad de Whipple en personas de sexo masculino. Sería lógico en dado caso remitirse a las manifestaciones clínicas de ambas enfermedades para encontrar un camino expedito hacia el diagnóstico oportuno, para la trombosis venosa profunda la escala de Wells puede ayudar y en caso de la enfermedad de Whipple identificar no solo el dolor articular sino la perdida de peso que suele ser la muestra mas frecuente de la presencia bacteriana en el afectado. Considerando lo conocido de ambas enfermedades se puede identificar que poseen en común el dolor en las articulaciones, sobre todo en las inferiores, pero no es excluyente, por tanto, no se encuentran hallazgos en la investigación que indique que un diagnóstico de trombosis venosa profunda sea el camino inicial para descubrir la Enfermedad de Whipple.

Monoarticular joint pain is commonly encountered in the emergency department (ED) with a broad differential diagnosis. Septic arthritis represents a “can’t miss” diagnosis while gout represents a chronic, painful arthropathy. Traditionally these diagnoses are made with arthrocentesis in addition to history, physical exam, imaging and laboratory studies. Ultrasound (US) represents a novel modality that may aid in the diagnosis of gout without requiring arthrocentesis. Furthermore, the sonographic features of gout may exclude the diagnosis of septic arthritis. Additional research is required in the ED setting to better clarify the role of US in these two disease states.

Background: Tissue compression and partial vascular occlusion using band flossing results in reperfusion of blood to the muscle tissue that may ultimately reduce joint pain and increase range of motion, enhancing prevention from or rehabilitation of injury. However, the extent of research examining the effect of tissue flossing in an athletic setting is currently very limited, and the effects of band flossing on knee pain and jump performance have not yet been investigated and remain unclear. Purpose: To investigate the effect of band flossing on perceived knee pain and vertical jump performance in recreational athletes with knee pain. Methods: Five young male recreational athletes with previously reported knee pain took part in this study (age 22±0.5; height 184±6.8cm; weight 79±1.5kg; BMI 23.34±1.2 kg/m2). Participants performed a number of tests pre and post intervention, with the application of a floss band on the knee joint. The experimental protocol consisted in the performance of countermovement jump (CMJ) tests (without occlusion, with occlusion, and after occlusion). Pre and Post intervention measures included a perceived knee pain -by visual analogue scale (VAS)- and CMJ performance -by force platform-. Results: The application of flossing bands in knee joint resulted in enhancements in all test measures pre to post intervention (10% jump height; 4.5% time in the air; 5% jump velocity; 13% jump power; 7.5% jump force). Participants reported a 3.5-point pain enhancement in AVS during performance of CMJ tests. Conclusion: Flossing bands caused a reduction in perceived knee pain and improved vertical jump performance in young male recreational athletes.

Monoarticular joint pain is commonly encountered in the emergency department (ED) with a broad differential diagnosis. Septic arthritis represents a “can’t miss” diagnosis while gout represents a chronic, painful arthropathy. Traditionally these diagnoses are made with arthrocentesis in addition to history, physical exam, imaging and laboratory studies. Ultrasound (US) represents a novel modality that may aid in the diagnosis of gout without requiring arthrocentesis. Furthermore, the sonographic features of gout may exclude the diagnosis of septic arthritis. Additional research is required in the ED setting to better clarify the role of US in these two disease states.

Background: Tissue compression and partial vascular occlusion using band flossing results in reperfusion of blood to the muscle tissue that may ultimately reduce joint pain and increase range of motion, enhancing prevention from or rehabilitation of injury. However, the extent of research examining the effect of tissue flossing in an athletic setting is currently very limited, and the effects of band flossing on knee pain and jump performance have not yet been investigated and remain unclear. Purpose: To investigate the effect of band flossing on perceived knee pain and vertical jump performance in recreational athletes with knee pain. Methods: Five young male recreational athletes with previously reported knee pain took part in this study (age 22±0.5; height 184±6.8cm; weight 79±1.5kg; BMI 23.34±1.2 kg/m2). Participants performed a number of tests pre and post intervention, with the application of a floss band on the knee joint. The experimental protocol consisted in the performance of countermovement jump (CMJ) tests (without occlusion, with occlusion, and after occlusion). Pre and Post intervention measures included a perceived knee pain -by visual analogue scale (VAS)- and CMJ performance -by force platform-. Results: The application of flossing bands in knee joint resulted in enhancements in all test measures pre to post intervention (10% jump height; 4.5% time in the air; 5% jump velocity; 13% jump power; 7.5% jump force). Participants reported a 3.5-point pain enhancement in AVS during performance of CMJ tests. Conclusion: Flossing bands caused a reduction in perceived knee pain and improved vertical jump performance in young male recreational athletes.

The article deals with the neurophysiological aspects of reflexology methods in the comprehensive therapy of post-stroke patients. The comparative clinical data of two groups of observation are given: the main (30 patients) — where, along with traditional therapy, acupuncture by the author’s method was used, and control (30 persons) — only traditional treatment. The advantages of comprehensive treatment with reflexology are shown., В статье рассмотрены нейрофизиологические аспекты методов рефлексотерапии, обосновывающие их применение в составе комплексной терапии больных после инсульта. Приведены сравнительные клинические данные двух групп наблюдения: основной (30 больных), в которой наряду с традиционной терапией применялась рефлексотерапия, в частности акупунктура по разработанной авторами методике, и контрольной (30 больных), в которой проводилось исключительно традиционное лечение. Показаны преимущества комплексного лечения с применением рефлексотерапии., У статті розглянуті нейрофізіологічні аспекти методів рефлексотерапії, що обґрунтовують їх застосування у складі комплексної терапії хворих після інсульту. Наведено порівняльні клінічні дані двох груп спостереження: основної (30 хворих), у якій поряд із традиційною терапією застосовувалась рефлексотерапія, зокрема акупунктура за розробленою авторами методикою, та контрольної (30 хворих), у якій проводилось виключно традиційне лікування. Показані переваги комплексного лікування із застосуванням рефлексотерапії.

Arthritis patients often take fish oil supplements to alleviate symptoms, but limited evidence exists regarding their efficacy. The objective was to evaluate whether marine oil supplements reduce pain and/or improve other clinical outcomes in patients with arthritis. Six databases were searched systematically (24 February 2015). We included randomized trials of oral supplements of all marine oils compared with a control in arthritis patients. The internal validity was assessed using the Cochrane Risk of Bias tool and heterogeneity was explored using restricted maximum of likelihood (REML)-based meta-regression analysis. Grading of Recommendations Assessment, Development and Evaluation (GRADE) was used to rate the overall quality of the evidence. Forty-two trials were included; 30 trials reported complete data on pain. The standardized mean difference (SMD) suggested a favorable effect (-0.24; 95% confidence interval, CI, -0.42 to -0.07; heterogeneity, I² = 63%. A significant effect was found in patients with rheumatoid arthritis (22 trials; -0.21; 95% CI, -0.42 to -0.004) and other or mixed diagnoses (3 trials; -0.63; 95% CI, -1.20 to -0.06), but not in osteoarthritis patients (5 trials; -0.17; 95% CI, -0.57-0.24). The evidence for using marine oil to alleviate pain in arthritis patients was overall of low quality, but of moderate quality in rheumatoid arthritis patients.

Arthritis patients often take fish oil supplements to alleviate symptoms, but limited evidence exists regarding their efficacy. The objective was to evaluate whether marine oil supplements reduce pain and/or improve other clinical outcomes in patients with arthritis. Six databases were searched systematically (24 February 2015). We included randomized trials of oral supplements of all marine oils compared with a control in arthritis patients. The internal validity was assessed using the Cochrane Risk of Bias tool and heterogeneity was explored using restricted maximum of likelihood (REML)-based meta-regression analysis. Grading of Recommendations Assessment, Development and Evaluation (GRADE) was used to rate the overall quality of the evidence. Forty-two trials were included; 30 trials reported complete data on pain. The standardized mean difference (SMD) suggested a favorable effect (-0.24; 95% confidence interval, CI, -0.42 to -0.07; heterogeneity, I² = 63%. A significant effect was found in patients with rheumatoid arthritis (22 trials; -0.21; 95% CI, -0.42 to -0.004) and other or mixed diagnoses (3 trials; -0.63; 95% CI, -1.20 to -0.06), but not in osteoarthritis patients (5 trials; -0.17; 95% CI, -0.57-0.24). The evidence for using marine oil to alleviate pain in arthritis patients was overall of low quality, but of moderate quality in rheumatoid arthritis patients.

Objectives: This study sought to quantify the 1-year cumulative incidence of shoulder and elbow pain among youth baseball players and identify risk factors associated with the occurrence of shoulder and elbow pain. Methods: In total, 900 youth baseball players (aged 7–11 years) were enrolled in a 1-year prospective follow-up study. One year later, subjects were asked whether they had experienced episodes of shoulder or elbow pain and the following risk factors for such pain were investigated: age, position, length of baseball experience, training hours per week, and history of shoulder or elbow pain. Data for the groups with and without shoulder or elbow pain were analyzed using multivariate logistic regression models. Results: Episodes of shoulder pain were reported by 18.3% of players and episodes of elbow pain were reported by 35.2% of players. Multivariate analysis showed that shoulder pain was associated with playing pitcher, catcher, increasing training hours per week, and history of shoulder and elbow pain, and that elbow pain was associated with increasing age, playing pitcher, catcher, increasing training hours per week, and history of elbow pain. Length of baseball experience was not associated with shoulder or elbow pain. Conclusion: History of elbow pain, playing pitcher, catcher and increasing training hours per week were associated with both types of pain. History of shoulder pain was associated with shoulder pain but not elbow pain. Increasing age was associated with elbow pain but not shoulder pain.

Arthritis patients often take fish oil supplements to alleviate symptoms, but limited evidence exists regarding their efficacy. The objective was to evaluate whether marine oil supplements reduce pain and/or improve other clinical outcomes in patients with arthritis. Six databases were searched systematically (24 February 2015). We included randomized trials of oral supplements of all marine oils compared with a control in arthritis patients. The internal validity was assessed using the Cochrane Risk of Bias tool and heterogeneity was explored using restricted maximum of likelihood (REML)-based meta-regression analysis. Grading of Recommendations Assessment, Development and Evaluation (GRADE) was used to rate the overall quality of the evidence. Forty-two trials were included; 30 trials reported complete data on pain. The standardized mean difference (SMD) suggested a favorable effect (-0.24; 95% confidence interval, CI, -0.42 to -0.07; heterogeneity, I2 = 63%. A significant effect was found in patients with rheumatoid arthritis (22 trials; -0.21; 95% CI, -0.42 to -0.004) and other or mixed diagnoses (3 trials; -0.63; 95% CI, -1.20 to -0.06), but not in osteoarthritis patients (5 trials; -0.17; 95% CI, -0.57–0.24). The evidence for using marine oil to alleviate pain in arthritis patients was overall of low quality, but of moderate quality in rheumatoid arthritis patients.

Arthritis patients often take fish oil supplements to alleviate symptoms, but limited evidence exists regarding their efficacy. The objective was to evaluate whether marine oil supplements reduce pain and/or improve other clinical outcomes in patients with arthritis. Six databases were searched systematically (24 February 2015). We included randomized trials of oral supplements of all marine oils compared with a control in arthritis patients. The internal validity was assessed using the Cochrane Risk of Bias tool and heterogeneity was explored using restricted maximum of likelihood (REML)-based meta-regression analysis. Grading of Recommendations Assessment, Development and Evaluation (GRADE) was used to rate the overall quality of the evidence. Forty-two trials were included; 30 trials reported complete data on pain. The standardized mean difference (SMD) suggested a favorable effect (-0.24; 95% confidence interval, CI, -0.42 to -0.07; heterogeneity, I2 = 63%. A significant effect was found in patients with rheumatoid arthritis (22 trials; -0.21; 95% CI, -0.42 to -0.004) and other or mixed diagnoses (3 trials; -0.63; 95% CI, -1.20 to -0.06), but not in osteoarthritis patients (5 trials; -0.17; 95% CI, -0.57–0.24). The evidence for using marine oil to alleviate pain in arthritis patients was overall of low quality, but of moderate quality in rheumatoid arthritis patients.

PURPOSE:To determine if asymmetry between hips in pain or radiographic osteoarthritis (RHOA) is associated with worse pain and joint space narrowing (JSN) at baseline and longitudinally in knees contralateral to more affected hips. METHODS:We studied 279 participants in the Osteoarthritis Initiative with baseline asymmetry between hips in pain and 483 with asymmetry in RHOA none of whom had a hip replacement for ≥4 years after baseline. RHOA assessed from pelvis radiographs was categorized as none, possible or definite and hip pain on most days of a month in the past year as present/absent. Knee pain (WOMAC scale) and JSN (fixed flexion radiographs) were categorized as none, mild and moderate-severe. We compared knees contralateral and ipsilateral to more affected hips on baseline knee pain and JSN using clustered multinomial regression and on change in knee pain and JSN over 4-5 years using generalized linear and logistic estimating equations. RESULTS:Knees contralateral to painful hips had less baseline pain ("moderate-severe" vs "none", relative risk ratio [RRR]: 0.39, 95% CI = 0.27-0.57), but greater baseline JSN ("moderate-severe" vs "none", RRR: 1.62, 95% CI = 1.09-2.38) and greater worsening of pain during follow-up (P = 0.001). Knees contralateral to hips with worse RHOA had nonsignificant trends for greater baseline JSN (P = 0.10) and JSN progression (P = 0.17). CONCLUSION:These findings provide limited support for the hypothesis that early asymmetry in hip pain and RHOA is associated with worse pain and structural outcomes in knees contralateral to the more affected hip.

PURPOSE:To determine if asymmetry between hips in pain or radiographic osteoarthritis (RHOA) is associated with worse pain and joint space narrowing (JSN) at baseline and longitudinally in knees contralateral to more affected hips. METHODS:We studied 279 participants in the Osteoarthritis Initiative with baseline asymmetry between hips in pain and 483 with asymmetry in RHOA none of whom had a hip replacement for ≥4 years after baseline. RHOA assessed from pelvis radiographs was categorized as none, possible or definite and hip pain on most days of a month in the past year as present/absent. Knee pain (WOMAC scale) and JSN (fixed flexion radiographs) were categorized as none, mild and moderate-severe. We compared knees contralateral and ipsilateral to more affected hips on baseline knee pain and JSN using clustered multinomial regression and on change in knee pain and JSN over 4-5 years using generalized linear and logistic estimating equations. RESULTS:Knees contralateral to painful hips had less baseline pain ("moderate-severe" vs "none", relative risk ratio [RRR]: 0.39, 95% CI = 0.27-0.57), but greater baseline JSN ("moderate-severe" vs "none", RRR: 1.62, 95% CI = 1.09-2.38) and greater worsening of pain during follow-up (P = 0.001). Knees contralateral to hips with worse RHOA had nonsignificant trends for greater baseline JSN (P = 0.10) and JSN progression (P = 0.17). CONCLUSION:These findings provide limited support for the hypothesis that early asymmetry in hip pain and RHOA is associated with worse pain and structural outcomes in knees contralateral to the more affected hip.

Free to read Musculoskeletal health can be compromised by breast cancer treatment. In particular, bone loss and arthralgias are prevalent side effects experienced by women treated with chemotherapy and/or adjuvant endocrine therapy. Bone loss leads to osteoporosis and related fractures, while arthralgias threaten quality of life and compliance to treatment. Because the processes that lead to these musculoskeletal problems are initiated when treatment begins, early identification of women who may be at higher risk of developing problems, routine monitoring of bone density and pain at certain stages of treatment, and prudent application of therapeutic interventions are key to preventing and/or minimizing musculoskeletal sequelae. Exercise may be a particularly suitable intervention strategy because of its potential to address a number of impairments; it may slow bone loss, appears to reduce joint pain in noncancer conditions, and improves other breast cancer outcomes. Research efforts continue in the areas of etiology, measurement, and treatment of bone loss and arthralgias. The purpose of this review is to provide an overview of the current knowledge on the management and treatment of bone loss and arthralgias in breast cancer survivors and to present a framework for rehabilitation care to preserve musculoskeletal health in women treated for breast cancer.

Bisphosphonates are widely indicated, and most therapies using bisphosphonates are given long-term, which has favored the emergence of new associated adverse effects -- maxillary osteonecrosis (MON), severe pain, atypical fractures, stomatitis, and inflammatory eye disorders. The goal of this paper is to review the current safety status of these drugs, and to describe the newly emerging adverse effects. Bisphosphonates may be divided up into two types according to their chemical structure and mechanism of action, as the presence or absence of nitrogen in their molecule entails differences in power. No tests are available that allow an identification of patients at higher risk for developing MON in order to adopt appropriate preventive measures. The causal relationship of bisphosphonates with atypical fractures could not be demonstrated, but their prescription is recommended in patients recovering from recent fractures. Nor is there any evidence that bisphosphonates may induce bone, muscle, or joint pain, but consideration must be given to the fact that pain subsides on most occasions upon bisphosphonate therapy discontinuation. No definite conclusions can be drawn to establish a causal relationship between bisphosphonate use and increased risk for AF. The presence of other risk factors should be taken into account, and patients should be surveilled on an individual basis for the potential emergence of heart rhythm disturbances. The actuality of a higher risk for esophageal cancer in association with the use of bisphosphonates could not be confirmed. However, the FDA recommends that oral bisphosphonates should not be prescribed for patients with Barrett's esophagus., Existe una amplia indicación de uso y la mayoría de los tratamientos con bifosfonatos son prolongados en el tiempo, lo que ha favorecido la aparición de nuevos efectos adversos asociados a su uso: la osteonecrosis de los maxilares (ONM), el dolor grave, las fracturas atípicas, la estomatitis y los trastornos inflamatorios oculares. El objetivo de este artículo es hacer un repaso del estado actual de la seguridad de estos fármacos, describiendo la aparición de los nuevos efectos adversos. Los bifosfonatos pueden dividirse en dos tipos en función de su estructura química y mecanismo de acción, la presencia o no de nitrógeno en su molécula conlleva diferencias de potencia. No disponemos de pruebas que nos permitan identificar a los pacientes que presenten un riesgo más elevado de desarrollar ONM para tomar las medidas preventivas oportunas. No se ha podido demostrar la relación causal de los bifosfonatos con las fracturas atípicas, pero se recomienda prescribir bifosfonatos en pacientes que se recuperan de una fractura reciente. Tampoco existe evidencia de que los bifosfonatos sean los causantes del dolor óseo, muscular o articular, pero hay tener en cuenta en la mayoría de las ocasiones que el dolor desaparece al suspender el tratamiento con bifosfonatos. No se pueden establecer conclusiones definitivas para establecer una relación causal entre la utilización de bifosfonatos y el aumento del riesgo de FA. Habrá que considerar la existencia de otros factores de riesgo e individualizar, así como vigilar la posible aparición de alteraciones del ritmo cardiaco. No se ha podido confirmar la existencia de un mayor riesgo de padecer cáncer esofágico asociado a la toma de bifosfonatos. No obstante, la FDA recomienda no prescribir bifosfonatos orales a los pacientes con esófago de Barret.

Bisphosphonates are widely indicated, and most therapies using bisphosphonates are given long-term, which has favored the emergence of new associated adverse effects -- maxillary osteonecrosis (MON), severe pain, atypical fractures, stomatitis, and inflammatory eye disorders. The goal of this paper is to review the current safety status of these drugs, and to describe the newly emerging adverse effects. Bisphosphonates may be divided up into two types according to their chemical structure and mechanism of action, as the presence or absence of nitrogen in their molecule entails differences in power. No tests are available that allow an identification of patients at higher risk for developing MON in order to adopt appropriate preventive measures. The causal relationship of bisphosphonates with atypical fractures could not be demonstrated, but their prescription is recommended in patients recovering from recent fractures. Nor is there any evidence that bisphosphonates may induce bone, muscle, or joint pain, but consideration must be given to the fact that pain subsides on most occasions upon bisphosphonate therapy discontinuation. No definite conclusions can be drawn to establish a causal relationship between bisphosphonate use and increased risk for AF. The presence of other risk factors should be taken into account, and patients should be surveilled on an individual basis for the potential emergence of heart rhythm disturbances. The actuality of a higher risk for esophageal cancer in association with the use of bisphosphonates could not be confirmed. However, the FDA recommends that oral bisphosphonates should not be prescribed for patients with Barrett's esophagus., Existe una amplia indicación de uso y la mayoría de los tratamientos con bifosfonatos son prolongados en el tiempo, lo que ha favorecido la aparición de nuevos efectos adversos asociados a su uso: la osteonecrosis de los maxilares (ONM), el dolor grave, las fracturas atípicas, la estomatitis y los trastornos inflamatorios oculares. El objetivo de este artículo es hacer un repaso del estado actual de la seguridad de estos fármacos, describiendo la aparición de los nuevos efectos adversos. Los bifosfonatos pueden dividirse en dos tipos en función de su estructura química y mecanismo de acción, la presencia o no de nitrógeno en su molécula conlleva diferencias de potencia. No disponemos de pruebas que nos permitan identificar a los pacientes que presenten un riesgo más elevado de desarrollar ONM para tomar las medidas preventivas oportunas. No se ha podido demostrar la relación causal de los bifosfonatos con las fracturas atípicas, pero se recomienda prescribir bifosfonatos en pacientes que se recuperan de una fractura reciente. Tampoco existe evidencia de que los bifosfonatos sean los causantes del dolor óseo, muscular o articular, pero hay tener en cuenta en la mayoría de las ocasiones que el dolor desaparece al suspender el tratamiento con bifosfonatos. No se pueden establecer conclusiones definitivas para establecer una relación causal entre la utilización de bifosfonatos y el aumento del riesgo de FA. Habrá que considerar la existencia de otros factores de riesgo e individualizar, así como vigilar la posible aparición de alteraciones del ritmo cardiaco. No se ha podido confirmar la existencia de un mayor riesgo de padecer cáncer esofágico asociado a la toma de bifosfonatos. No obstante, la FDA recomienda no prescribir bifosfonatos orales a los pacientes con esófago de Barret.

Background: S-Adenosylmethionine (SAMe) is a dietary supplement used in the management of osteoarthritis (OA) symptoms. Studies evaluating SAMe in the management of OA have been limited to Non Steroidal Anti-inflammatory Drugs ( NSAIDs) for comparison. The present study compares the effectiveness of SAMe to a cyclooxygenase-2 (COX-2) inhibitor ( celecoxib) for pain control, functional improvement and to decrease side effects in people with osteoarthritis of the knee. Methods: A randomized double-blind cross-over study, comparing SAMe ( 1200 mg) with celecoxib ( Celebrex 200 mg) for 16 weeks to reduce pain associated with OA of the knee. Sixty-one adults diagnosed with OA of the knee were enrolled and 56 completed the study. Subjects were tested for pain, functional health, mood status, isometric joint function tests, and side effects. Results: On the first month of Phase 1, celecoxib showed significantly more reduction in pain than SAMe ( p = 0.024). By the second month of Phase 1, there was no significant difference between both groups ( p < 0.01). The duration of treatment and the interaction of duration with type of treatment were statistically significant (ps 0.029). On most functional health measures both groups showed a notable improvement from baseline, however no significant difference between SAMe and celecoxib was observed. Isometric joint function tests appeared to be steadily improving over the entire study period regardless of treatment. Conclusion: SAMe has a slower onset of action but is as effective as celecoxib in the management of symptoms of knee osteoarthritis. Longer studies are needed to evaluate the long-term effectiveness of SAMe and the optimal dose to be used.

Background: S-Adenosylmethionine (SAMe) is a dietary supplement used in the management of osteoarthritis (OA) symptoms. Studies evaluating SAMe in the management of OA have been limited to Non Steroidal Anti-inflammatory Drugs ( NSAIDs) for comparison. The present study compares the effectiveness of SAMe to a cyclooxygenase-2 (COX-2) inhibitor ( celecoxib) for pain control, functional improvement and to decrease side effects in people with osteoarthritis of the knee. Methods: A randomized double-blind cross-over study, comparing SAMe ( 1200 mg) with celecoxib ( Celebrex 200 mg) for 16 weeks to reduce pain associated with OA of the knee. Sixty-one adults diagnosed with OA of the knee were enrolled and 56 completed the study. Subjects were tested for pain, functional health, mood status, isometric joint function tests, and side effects. Results: On the first month of Phase 1, celecoxib showed significantly more reduction in pain than SAMe ( p = 0.024). By the second month of Phase 1, there was no significant difference between both groups ( p < 0.01). The duration of treatment and the interaction of duration with type of treatment were statistically significant (ps 0.029). On most functional health measures both groups showed a notable improvement from baseline, however no significant difference between SAMe and celecoxib was observed. Isometric joint function tests appeared to be steadily improving over the entire study period regardless of treatment. Conclusion: SAMe has a slower onset of action but is as effective as celecoxib in the management of symptoms of knee osteoarthritis. Longer studies are needed to evaluate the long-term effectiveness of SAMe and the optimal dose to be used.

Deep somatic pain originating from synovial joints is a major clinical problem as it is the primary reason for loss of joint mobility and function in musculoskeletal disorders. Musculoskeletal disorders, including osteoarthritis (OA), are the most prevalent cause of disability worldwide with an estimated 1 in 3 adults affected. Current therapies for the treatment of joint pain have limited effectiveness and certain drugs produce unwanted side effects, preventing their long-term use. Targeting pain at the level of the joint may have the potential to maximise treatment efficacy, whilst reducing possible non- specific side effects associated with systemic drug treatment. Identification of novel analgesic targets that inhibit peripheral mechanical sensitization during joint pain states will be critical to the development of improved analgesics for these conditions. Based on recent preclinical findings, the orphan G protein- coupled receptor GPR55 has controversially been suggested to be the novel third cannabinoid receptor and has been identified as a potential novel target for the treatment of pain. Very few studies have investigated the effects of GPR55 activation on nociceptive processing in vivo and only one at the level of the joint during acute inflammatory arthritis. The aim of this thesis was to investigate the role of GPR55 in the modulation of joint afferent mechanosensitivity in vivo, and whether this role is altered in an experimental model of OA during established pain. Electrophysiological recordings of joint afferent nociceptors, taken from the saphenous nerve, which innervates the knee joint via the medial articular nerve, were carried out in anaesthetised rats under non-pathological conditions (naïve rats) and in a model of OA following the development of pain behaviour, 14 days following knee joint injection of monosodium iodoacetate (MIA) and compared to saline control rats. Effects of peripheral administration of the putative endogenous GPR55 agonist