split, Croatia / zavod za fizikalnu medicinu i rehabilitaciju s reumatologijom, klinički bolnički centar split, split, Hrvatska 2 department of rehabilitation and Physical medicine, school of medicine, university of split, split, Croatia / katedra za rehabilitacijsku i fizikalnu medicinu, medicinski fakultet split, sveučilište u splitu, split, Hrvatska corresponding author / Adresa autora za dopisivanje: Prof. dr. sc. Tonko Vlak, prim. dr. med. institute of Physical medicine, rehabilitation and rheumatology / zavod za fizikalnu medicinu i rehabilitaciju s reumatologijom Clinical Hospital Centre split / klinički bolnički centar split šoltanska 1, 21000 split Croatia / Hrvatska Phone /

The aim of this study was to evaluate body composition, handgrip strength, quality of life, disease duration and activity and lifestyle habits in patients with rheumatoid arthritis (RA) and to evaluate possible associations between all of the abovementioned factors. Seventy-five stable RA patients were included. Data on sociodemographic data, disease activity, quality of life, nutritional risk, body mass composition, anthropometric parameters, and clinical and laboratory parameters were collected for each study participant. The results showed that the mean score of the disease activity score (DAS28) was 5.4, the mean score of the health assessment questionnaire-disability index (HAQ-DI) was 1.19, and the mean disease duration in our population was 13.9 years. Our studied population had a long disease duration and high disease activity. Positive predictors of muscle mass in RA patients were daily caloric intake, fat-free mass, bone mass, basal metabolic rate, total body water, weight, body mass index (BMI), height, and muscle strength. There were no significant negative predictors. Positive predictors of muscle strength in RA patients were daily caloric intake, basal metabolic rate, predicted muscle mass, fat-free mass, bone mass, weight, total body water, metabolic age, hemoglobin, BMI, and number of exercises per week. In contrast, negative predictors of muscle strength were number of comorbidities, number of swollen joints, DAS, number of tender joints, erythrocyte sedimentation rate (ESR), and duration of RA. An association was also found between bone mineral density and both muscle mass and muscle strength. A structured nutritional approach in terms of multidisciplinary collaboration between rheumatologist, dietitian and physical medicine specialist is needed in the Dalmatian RA population.

Non-pharmacological treatment is undeniably a significant part of painful shoulder syndrome treatment. Medical exercises are its most important segment, according to the results of evidence-based medicine. Due to the fact that exercises are rarely used as monotherapy, we were particularly interested in the data regarding other non-pharmacological methods of treatment found in the Cochrane library and PEDro database (Physiotherapy Evidence Database). Simultaneously, we conducted a research study of painful shoulder syndrome treatment with conventional methods of physical therapy. The study included 157 patients, which allowed us to compare our preliminary results with data found in the previously mentioned databases.The majority of quality studies that can be found in the literature database involve the use of modern technology, such as extracorporeal shock wave therapy and high-intensity laser therapy, because they have proven to be very effective in the reduction of pain intensity and the increase of functional capacity of the painful shoulder. These methods of treatment have shown to be effective even in patients with calcific tendinitis, a more severe form of the disease, as well as in patients who had no calcifications. Conventional methods of treatment, often referred to as standard physical therapy (low-level laser therapy, electrotherapy, therapeutic ultrasound) have proven to be effective, but less effective compared to the aforementioned methods. The results of our research also corroborate the previously mentioned fact, thus confirming that the use of conventional methods of physical medicine (therapeutic ultrasound, diclofenac sonophoresis, interferential current therapy, low-level laser therapy, cryotherapy) has been successful in reducing pain intensity and increasing the functional capacity of the painful shoulder. Among the conventional methods of treatment, electrotherapy (interferential current therapy) turned out to be the most efficient one.Non-pharmacological treatment have to be an integral part of all painful shoulder syndrome treatment protocols, and in the future, the use of modern technology in addition to conventional methods of treatment should be encouraged.