Objective. To determine whether the occurrence of seizures is correlated with the presence of serum antiphospholipid antibodies (aPL) in systemic lupus erythematosus (SLE) patients.Methods. The study included 221 unselected patients with SLE. Of these, 21 patients with epileptic seizures not attributed to any cause other than SLE were identified. Epilepsy was diagnosed by clinical history and electroencephalography. Blood samples were tested for the presence of antibodies to cardiolipin (aCL, IgG and IgM isotypes) and lupus anticoagulant (LAC).Results. LAC was detected in 43.8% of the patients with epilepsy and in 20.8% of controls (P = 0.057). A statistically significant association was found between moderate-to-high titers of IgG aCL and the presence of seizures (P = 0.02). Brain computed tomography and/or magnetic resonance imaging scanning was performed in 14 patients. All patients with abnormal features found on these tests had positive aPL (P = 0.03). Nine patients (42.9%) had at least 1 of the classic features associated with the aPL syndrome. Conclusion. We confirmed that epilepsy as a primary neuropsychiatric event is significantly associated with moderate-to-high titers of IgG aCL in SLE

BackgroundRecent clinical recommendations still propose active exercises (AE) for CNSLBP. However, acceptance of exercises by patients may be limited by pain-related manifestations. Current evidences suggest that manual therapy (MT) induces an immediate analgesic effect through neurophysiologic mechanisms at peripheral, spinal and cortical levels. The aim of this pilot study was first, to assess whether MT has an immediate analgesic effect, and second, to compare the lasting effect on functional disability of MT plus AE to sham therapy (ST) plus AE.MethodsForty-two CNSLBP patients without co-morbidities, randomly distributed into 2 treatment groups, received either spinal manipulation/mobilization (first intervention) plus AE (MT group; n = 22), or detuned ultrasound (first intervention) plus AE (ST group; n = 20). Eight therapeutic sessions were delivered over 4 to 8 weeks. Immediate analgesic effect was obtained by measuring pain intensity (Visual Analogue Scale) before and immediately after the first intervention of each therapeutic session. Pain intensity, disability (Oswestry Disability Index), fear-avoidance beliefs (Fear-Avoidance Beliefs Questionnaire), erector spinae and abdominal muscles endurance (Sorensen and Shirado tests) were assessed before treatment, after the 8th therapeutic session, and at 3- and 6-month follow-ups.ResultsThirty-seven subjects completed the study. MT intervention induced a better immediate analgesic effect that was independent from the therapeutic session (VAS mean difference between interventions: -0.8; 95% CI: -1.2 to −0.3). Independently from time after treatment, MT + AE induced lower disability (ODI mean group difference: -7.1; 95% CI: -12.8 to −1.5) and a trend to lower pain (VAS mean group difference: -1.2; 95% CI: -2.4 to −0.30). Six months after treatment, Shirado test was better for the ST group (Shirado mean group difference: -61.6; 95% CI: -117.5 to −5.7). Insufficient evidence for group differences was found in remaining outcomes.ConclusionsThis study confirmed the immediate analgesic effect of MT over ST. Followed by specific active exercises, it reduces significantly functional disability and tends to induce a larger decrease in pain intensity, compared to a control group. These results confirm the clinical relevance of MT as an appropriate treatment for CNSLBP. Its neurophysiologic mechanisms at cortical level should be investigated more thoroughly.Trial registrationTrial registration number: NCT01496144

The INTERMED identifies complex patients during vocational rehabilitation after orthopaedic trauma and is a good predictor of poor outcome 1 year after discharge.

Our study identified a multitude of ICF categories that describe functioning domains and which represent the complexity of VR. Such a comprehensive approach in assessing patients in VR may help to understand and customize the process of VR in the clinical setting and to enhance multidisciplinary communication.

Objective-To establish if computed tomography (CT) imaging, which has proved helpful in detecting intra-articular tophi in gout, can also be used to document gouty enthesopathy and tendinopathy. Methods In this study of three patients with tophaceous gout, the ability of CT to identify monosodium urate deposits in clinically involved tendons (Achilles tendon in two patients, patellar tendon in one patient) was assessed.Case reports PATIENT 1 A 70 year old man was admitted with acute arthritis of the left ankle joint. He had been suffering from gout for 10 years, and had a history of excessive alcohol consumption and of irregular medication consisting of nonsteroidal anti-inflammatory drugs and allopurinol.Upon admission, the patient was overweight (body mass index 32.8 kg m-', normal < 25), and he had an effusion of the left knee, signs of acute arthritis of the left ankle, and nodules of both Achilles tendons, which were slightly tender on palpation; he also had nodules next to the olecranon processes. The arteries of both feet were pulsatile; blood pressure was 170/80 mm Hg. Synovial fluid aspirated from the left knee contained 1000 leucocytes mm-3 with intracellular negatively birefringent crystals. Serum uric acid was 455 jmol litre-1 (normal < 416); creatinine 80 jmol litre-' (normal < 106); fasting blood sugar 7.0 mmol litre-1; and cholesterol 4.2 mmol litre-1 (normal < 5.2).