Review Article - International Journal of Clinical Rheumatology (2023) Volume 18, Issue 6

Critical analysis and systematic examination of rheumatic transitional care programmes

Kiyoshi Sekiya*

Paediatric Rheumatology Unit, Hospital Infantile Universitario Niño Jesús, Madrid, japan

*Corresponding Author:
Kiyoshi Sekiya
Paediatric Rheumatology Unit, Hospital Infantile Universitario Niño Jesús, Madrid, japan

Received: 01-June-2023, Manuscript No. FMIJCR-23- 103063; Editor assigned: 03-June- 2023, Pre-QC No. FMIJCR-23- 103063 (PQ); Reviewed: 17-June-2023, QC No. FMIJCR-23- 103063; Revised: 23-June-2023, Manuscript No. FMIJCR-23- 103063 (R); Published: 30-June-2023, DOI: 10.37532/1758- 4272.2023.18(6).142-145




Identify current transitional care models for rheumatic and musculoskeletal illnesses (RMD), analyse their benefits and drawbacks, and promote a consensus initiative to provide transitional care guidelines.


To find papers describing transition programmes in RMD, a systematic review was done. For inclusion, a thorough description of the programme was necessary. Descriptive data was gathered, including the country of the project, the target diseases and patient ages, the resources, the transition process's components, and, when specified, the outcomes and quality measures. The following criteria were used to evaluate the programmes' quality: level of definition, program's evidence base, accessibility of quality indicators, and efficacy evidence.


In total, 27 papers from 8 programmes in 6 countries were found and analysed. Of these, 4 covered all RMDs, 3 were tailored specifically for patients with juvenile idiopathic arthritis (JIA), and 1 plan was general for chronic diseases and modified for RMD. A written transition policy, patientindividualized

planning and flexible transitional care, the designation of a transition coordinator role, the acquisition of knowledge and skills in self-management of care, decision-making, shared care, and communication between teams of paediatric and adult health care providers, and a planned transfer to adult rheumatology were all essential components of these transition programmes. Only two demonstrated effectiveness based on the predetermined outcome metrics.


RMD transitional care plans vary in terms of their organisational setup, personnel, and operational procedures. There are no established metrics for effectiveness or outcome. This data offers crucial perceptions and methods for creating transitional care in RMD.


Autoimmune disease • Primary immunodeficiency • Systemic lupus erythematosus • Antibodies deficiency


Osteoarthritis (OA), defined by cartilage breakdown and bone variations, is a habitual complaint affecting 8 – 15 of the populations of developed countries. The presence of synovitis is generally considered as a secondary event caused by phagocytosis of cartilage breakdown products but synovitis may also initiate, and contribute to, chondral lesions.

Glamorous resonance imaging (MRI) has revealed little about the frequence of synovial abnormalities in knee OA as utmost studies have been performed usingnon-injected images, especially FS T2- weighted images which don't distinguish inflamed synovium from adipose towel. Nonetheless, these studies have shown the frequence of synovitis to be high, particularly in end- stage disease6. Differ agents allow for good characterization of synovium in seditious conditions as well as in OA9. In knee OA, two recent semi-quantitative scoring studies performed with post-injected T1 images verified the presence of active synovitis. Synovial necropsies performed in only one study showed good correlations between MRI scores and macroscopic and bitsy data [1].

In seditious conditions, synovial membrane volume (SMV) is largely identified with original clinical signs of inflammation and histopathologic parameters incross-sectional as well as longitudinal studies. SM inflammation can also be measured by the speed of improvement after discrepancy agent administration. The ultimate is generally performed on a preselected single sagittal slice, with fast sequences (total accession time lower than 20 s) repeated over 10 min, which allows the speed of improvement of the SM at the ROI to be calculated. Results attained with this system have shown excellent correlation with bitsy seditious parameters15 but are weakly reproducible [2].

Then, we report the use of a new MRI fashion that combines SMV dimension and speed of improvement of synovial towel at 186 s in 15 cases suffering from colorful stages of knee OA. The volume of synovium is determined with low, intermediate and high- speed improvement and the results are compared with SMV and asemi-quantitative score “the MRI synovitis score”. The ideal of the work is to study synovial membrane (SM) inflammation with different MRI approaches performed using a T1- fitted sequence in knee OA, and to compare MRI results with macroscopic, bitsy and clinical findings [3].

Material and Method


The medical records of 70 cases appertained to Saiseikai Kanazawa Hospital between June and December 2006 were collected and reviewed retrospectively. All cases had a cough of at least 8 week's duration. Their referrals were made not only by primary care croakers but also by respiratory specialists. The following information was collected from the medical records name, date of birth, gender, source of referral, duration of symptoms, antedating acute upper respiratory tract infection( UTRI), smoking habits, and results of fungal culture attained from nebulized hypertonic saline- convinced foam that was collected from the cases at their first visit [4].

The cause of habitual cough in each case was diagnosed grounded on a questionnaire, blood examination findings, casket and sinusX-rays, convinced- foam examination, pulmonary function tests, 11 test for cough kickback perceptivity to gobbled capsaicin, 12 bronchial reversibility in response to bronchodilators, bronchial responsiveness to methacholine, 13 and the efficacity of individual cause-specific treatments [5].

Capsaicin cough threshold was measured as an indicator of airway cough kickback perceptivity according to the system reported by the authors.12 The capsaicin cough threshold was defined as the smallest attention of gobbled capsaicin inspiring five or further coughs. Positive bronchial reversibility was defined as chance increase in FEV1> 12 and absolute increase in FEV1> 200 mL. Thenon-specific bronchial responsiveness to methacholine was assessed according to the system described by Cockcroft etal. 13 The results were expressed as the provocation attention (mg/ mL) needed to beget a 20 or further fall from the birth FEV1 (respiratory threshold of methacholine; RT- Meth). The examinations were performed in agreement with the individual criteria for each cause, as recommended by the Japanese Cough Research Society1 and Japanese Respiratory Society [6].

Individual criteria of habitual cough

The clinical features of atopic cough( AC) were considered to be as follows habitual bronchodilator- resistant nonproductive cough with “ pierce ” in the throat lasting for further than eight weeks; absence of gasping, dyspnea, haemoptysis, or pleurisy, and no accidental lung sounds on physical examination presence of one or further global atopic findings, including once history and/ or complication of antipathetic conditions except for bronchial asthma, family history of antipathetic conditions, supplemental blood eosinophilia, elevated total IgE position in the serum, positive specific IgE antibody to common aeroallergens, and positive allergen skin test; presence of eosinophils in hypertonic salineconvinced foam and/ or submucosal of biopsied trachea and/ or bronchi normal limits of forced expiratory volume in 1 s (FEV1), forced vital capacity( FVC), and FEV1/ FVC rate; no bronchial reversibility defined as lower than a 5 increase in FEV1 after inhalation of 300 μg salbutamol following 250 mg aminophylline injection bronchial responsiveness within normal limits;( 8) increased airway cough kickback perceptivity; and complete relief of the cough upon treatment with histamine H1 antagonists, gobbled corticosteroid remedy and/ or oral corticosteroid remedy [7]. The case was diagnosed with cough- predominant asthma when the following criteria were satisfied habitual cough as a sole incarnation no history of gasping or dyspnea attacks suggestive of asthma no accidental lung sounds on lung auscultation relief from cough on bronchodilator remedy; an presence of one or further of the following findings that are specific to bronchial asthma( i) positive bronchial reversibility in response to beta- 2 agonists defined as increases in FEV1 of> 12 and> 200 mL following inhalation of 300 μg salbutamol Sulfate and( ii) increased quotidian variation of peak inflow rate. Some experimenters may diagnose similar conditions as cough- variant asthma whereas others, as bronchial asthma [8].

Sino bronchial pattern (SBS) 18 was diagnosed according to the following individual criteria productive cough without gasping lasting for eight weeks or more one or further of the following findings( i) symptoms similar as postnasal drip( PND) and throat clearing;( ii) signs similar as mucus or mucopurulent stashing in the upper and middle pharynx, and cobble gravestone appearance of the mucosa;( iii) fluid retention or mucosal thickening on sinusX-ray or reckoned tomographic (CT) checkup; and( iv) increased neutrophils without eosinophils in nasal concealment and robotic foam no atopic findings; no bronchial reversibility; (5) bronchial responsiveness within normal limits; (6) normal limits of cough kickback perceptivity; and (7) relief of cough on treatment with 14- or 15- member macrolides. The efficacity of the treatment was estimated at 2 months after the launch of treatment and was judged as effective when the productive cough lowered to half or lower. When all criteria were satisfied, a definite opinion of SBS was made [9].

The specific treatments given before the opinion of CIC was made were as follows. Suspected CVA17 was treated in the first case with β2- agonists (a combination of oral 40 μg/ d clenbuterol and 200 μg salbutamol inhalation at bedtime and on demand). Still, treatment was stepped up according to the guidelines on the treatment of asthma, If this proved inadequate. Suspected AC, 13 i.e., bronchodilator- resistant cough( eosinophilic tracheobronchitis with cough acuity), was treated with histamine H1 antagonists and gobbled corticosteroids( a combination of 10 mg/ d cetrizine hydrochloride and 400 – 800 μg/ d fluticasone propionate). Suspected SBS18 was treated with clarithromycin (oral 200 mg/ d). Suspected GER4 was treated with a high cure of protonpump impediments. The duration of each treatment was a minimum of 3 months [10].

Mycological study

Induced- foam samples attained from the cases were invested on Sabouraud's dextrose agar (SDA) containing chloramphenicol. The morphological features of the strains were recorded by a mycological specialist by using the slide culture system (30 °C for 2 weeks) and by staining with lacto phenol cotton blue.

Statistical analysis

Statistical analysis of quantitative data (age at referral, age at onset of cough, duration of cough, and logarithmic metamorphosis of attention causing 5 coughs (log C5)) was performed using the Mann – Whitney U test. Dichotomous data (gender, former URTI, and positive result of dressed basidiomycetous BM fungi) were anatomized using a 2 test. A p value of lower than0.05 was considered to be statistically significant. The trial was approved by the institutional review boards, and informed concurrence was attained from each of the 70 cases.


Information was collected from a aggregate of 70 successive new case referrals between June and December 2006. The studied cases comprised 33 males and 37 ladies. The median age of the cases at referral was 51 times (range 22 – 80 times). The median duration of symptoms was4.5 months (range 2 – 181 months). Casket X-rays were normal for all the cases and mucosal consistence or fluid collection of maxilla glands in sinusX-rays was detected in 6 cases. Nine cases were current smokers, and 14 cases wereex-smokers.

Habitual tailwind limitation was considered present when the rate of FEV1 to FVC (FEV1/ FVC rate) was<0.7. An FEV1 of< 80 of the prognosticated value was set up in only three of the 70 cases. Cough kickback perceptivity was increased in 29 cases. Bronchial responsiveness to methacholine was exaggerated in five cases.

The bronchodilator remedy showed effectiveness in 26 cases (21 CVA cases and 5 cough- predominant asthma cases) but not in the other 44 cases. The remedy of histamine H1 antagonists and gobbled corticosteroids produced a clinical response in 17 cases with AC.


Despite expansive individual evaluation and multitudinous treatment guidelines, 1, 2, 3, 4 a number of cases remain worried by habitual and wilful cough. Though asthmatic cough, gastro- esophageal influx( GER)- associated cough, and postnasal drip( PND)- convinced cough are honored as major causes of habitual cough in western countries, 4 GER- associated cough and PND- convinced cough are veritably rare in Japan.7, 8 lately a prospective multicenter study revealed that atopic cough( AC), cough- variant asthma( CVA), and sinobronchial pattern( SBS) are major causes of habitual cough in Japan.

We've preliminarily reported cases of AC caused by a acuity to Trichosporon asahii, Pichia guilliermondii, 24 Streptomyces albums, 25 and also reported the first case of non-asthmatic foam eosinophilia caused by antipathetic response to a BM fungus( firstly mislabeled as Humicola fuscoatra) in which the increase of eosinophils in the convinced- foam was established by repeated environmental checks to be nearly related to the appearance of BM fungi in the case's house.26 likewise, we've reported several cases of AC which were acclimatized with BM fungi and successfully cancelled and treated with low- cure itraconazole27 or oral sanctification with amphotericin.

Although only a limited number of the literature has proved contagious conditions caused by BM fungi, similar as Schizophyllum village, 29 the Coprinus species, 30 important of the literature reports the possible part of basidiospores as airborne allergens.

From the results of our series of studies on cases with fungus- associated atopic cough we've concentrated on the possible part of BM as a fungal aeroallergen. originally we performed pharyngeal tar societies for the discovery of fungi in 141 cases with habitual nonproductive cough and linked Candida and BM in10.6 and6.4 of all the examined cases, independently.33 Since BM fungi are infrequently detected in the culture of pharyngeal hearties taken from on-coughers, 34 and the positive rate of the immediate subcutaneous response for BM fungi in antipathetic airway conditions similar as atopic cough( AC), cough- variant asthma( CVA), and cough- predominant asthma was significantly advanced than that innon-coughers( unpublished data), we suspected that the positive culture results weren't caused by an environmental fungal impurity. Thus, we've hypothecated that BM fungi populating in the pharynx or lower respiratory tract plays an important part in antipathetic airway diseases.

Conflict of Interest





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