Category: Home

Non-pharmaceutical ulcer management

Non-pharmaceutical ulcer management

Mind-body connection for satiety recommendations regarding lifestyle Uler and Non-phamraceutical participation to prevent progression of rheumatic and musculoskeletal diseases. uocer antibiotics Immunity strengthening exercises as metronidazole and clarithromycin[ Mind-body connection for satiety22 ] and proved effective in improving eradication rates and suppressing infections in endemic populations. There is a problem with information submitted for this request. Day MA, Thorn BE, Burns JW. pylori in vitro of 19 clinical strains. pylori [ 5758 ]. The infection rate of H.

Non-pharmaceutical ulcer management -

In the SSc population, a cross-sectional study of patients found that current smokers were more likely to require intravenous vasodilators OR: 3. Despite the lack of interventional studies specifically assessing the efficacy of smoking cessation strategies in the SLR performed to inform the recommendations, it was consensual among the task force members that smoking cessation should be encouraged and facilitated in smokers with SLE and SSc based on the above evidence and expert opinion.

Nevertheless, cost-effectiveness aspects should be accounted for, and there should be awareness that literature is inconsistent regarding the effect of smoking on vascular outcomes. For both diseases, exercise and promotion of physical activity were among the most studied intervention strategies and were found to improve patient outcomes in several studies.

Physical exercise was found to be a viable management strategy in improving fatigue in adult patients with SLE based on two meta-analyses, one of one RCT and one quasi-experimental study LoE: 3 and one of two RCTs and one quasi-experimental study LoE: 1 , 44 45 and in improving aerobic capacity, based on one meta-analysis of seven RCTs 44 LoE: 1 ; both studies were deemed as robust in overall CA.

In adult patients with SSc, an RCT found improvements in mouth opening after application of an oral exercise programme 23 LoE: 2; CA: intermediate. Physiotherapy was found to improve functional impairment in a quasi-experimental study 70 LoE: 4; CA: robust.

An RCT employed patient education and self-management support as parts of a supervised aerobic exercise programme and found the intervention to be efficacious in improving aerobic capacity and mental health as compared with usual care in an RCT of SLE 50 LoE: 2; CA: intermediate.

Furthermore, an RCT that investigated web-based patient education and counselling 14 LoE: 3; CA: weak and a quasi-experimental study that examined an educational programme for enhancing self-management in patients with SLE 71 LoE: 3; CA: intermediate found these interventions to be efficacious in improving self-efficacy.

A pilot RCT that investigated an internet-based coping skill training programme in patients with SLE revealed benefit in HRQoL 72 LoE: 3; CA: weak , as did a qualitative study of multidisciplinary patient education 52 LoE: 4; CA: robust.

Ultraviolet UV radiation is a well-acknowledged triggering factor of cutaneous and systemic lupus flares. Based on this evidence and expert opinion within the task force, people with SLE should avoid direct sun exposure, especially during days with high UV index, use physical barriers such as hats, sunglasses and long-sleeved shirts and pants, and use of broad-spectrum sunscreen; assessment of the need for vitamin D supplements should be done when indicated.

In SLRs with meta-analyses that were assessed as robust in overall CA, psychological interventions in the form of cognitive behavioural therapy CBT , group therapy and psychoeducational programmes were shown to be an efficacious management strategy for improving HRQoL in adults with SLE based on a meta-analysis of two RCTs 42 LoE: 2 and a meta-analysis of three RCTs 43 LoE: 1.

Counselling, CBT and supported psychotherapy improved anxiety based on a meta-analysis of three RCTs 46 LoE: 1. CBT and psychoeducational self-management support ameliorated depressive symptoms based on a meta-analysis of three RCTs 43 LoE: 1.

Counselling and psychoeducational programmes were led by different healthcare providers, including social workers, psychologists, and nurses, whereas psychotherapeutic interventions were delivered by certified psychotherapists.

Which healthcare providers deliver different psychoeducational programmes may differ considerably across countries, depending on local legislation as well as access to and use of resources.

An SLR with meta-analyses from found that aerobic exercise increased aerobic capacity in patients with SLE based on a meta-analysis of two RCTs and three quasi-experimental studies; LoE: 1 , while decreasing fatigue based on a meta-analysis of one RCT and one quasi-experimental study; LoE: 3 , and depressive symptoms based on a meta-analysis of two RCTs and one quasi-experimental study; LoE: 3 44 and was assessed as robust in CA.

Another meta-analysis of two RCTs and one quasi-experimental study assessed as robust in CA found that aerobic physical exercise was effective in managing fatigue in patients with SLE 45 LoE: 1. An RCT found self-administered hand exercises effective in improving hand mobility 78 LoE: 2; CA: intermediate.

Another RCT demonstrated the efficacy of face-to-face training in improving the outcomes of orofacial exercise 51 LoE: 2; CA: intermediate. Individualised rehabilitation programmes were found to improve hand mobility and HRQoL 79 LoE: 3 while psychoeducational group programmes ameliorated feelings of helplessness 80 LoE: 4 in quasi-experimental studies of patients with SSc assessed as robust in overall CA.

Another robust in CA quasi-experimental study found patient education as a complement to occupational therapy to improve functional abilities as assessed with the Health Assessment Questionnaire HAQ and the Evaluation of Daily Activity Questionnaire EDAQ 55 LoE: 3.

A home-based self-management programme for hand exercise was found to improve hand function in a quasi-experimental study 81 that was also deemed as robust in CA LoE: 4. Microstomia and hand function emerged as major targets of non-pharmacological management, especially in studies evaluating physical exercise.

RCTs assessed as intermediate in CA found mouth exercise to be efficacious in improving microstomia 23 LoE: 2 and hand exercise in improving hand function 78 LoE: 2 , while body exercise increased the 6MWD 49 LoE: 2. The favourable effects of rehabilitation programmes were discussed.

Quasi-experimental studies assessed as robust in CA found that rehabilitative exercise programmes were efficacious in improving hand function and HRQoL, for example, programmes comprising warm-up and cool-down exercises, training of motor functions and respiratory exercises 79 LoE: 3 , mouth stretching and oral augmentation exercises ameliorated microstomia 82 LoE: 4 , thermal modalities eg, baths , tissue mobilisation and hand mobility exercises improved hand function 47 LoE: 4 and combined resistance and aerobic exercise enhanced aerobic capacity 83 LoE: 4 in patients with SSc.

Improvements were also noted in HAQ and item Short Form health survey scores at the end of treatment, although these improvements were not fully sustained at the 9-week follow-up. The findings from this study and expert opinion within the task force supported the endorsement of this recommendation statement.

Box 1 details the research agenda proposed by the task force. This was based on areas of limited or weak evidence as well as identified needs. The overarching principles should be applied when addressing the proposed research topics.

In brief, while the SLR identified, several RCTs dealing with the non-pharmacological management of SLE and SSc, design details were not always clearly indicated, especially the blinding strategies, which limited their LoE. Hence, studies assessing outcomes of non-pharmacological management over a longer term are needed.

While the efficacy of diverse psychological interventions was investigated in several studies encompassing people with SLE, it has yet to be explored within SSc. Dietary therapy was not thoroughly explored in either of the two diseases. Adherence to a Mediterranean diet was associated with a lower cardiovascular risk, lower disease activity levels and protection against organ damage in a cross-sectional study of SLE assessed as robust in CL 36 LoE: 3 , but no conclusions regarding causality can be drawn from this study.

Moreover, recommendations about wound management could not be derived based on current evidence, indicating a need for further studies within this area, which is particularly important for patients with SSc.

Finally, further identification of barriers for the implementation of non-pharmacological management of SLE and SSc, as well as means to alleviate those barriers, is warranted. Box 2 details the educational agenda proposed by the task force for providers of non-pharmacological management of people with SLE and SSc.

Increasing awareness of the importance of non-pharmacological management and self-management strategies for people living with SLE and SSc necessitated the development of overarching principles and recommendations by a group of experts, to be used as a guide in the identification of needs, implementation and evaluation of non-pharmacological management.

Hence, a multidisciplinary EULAR task force convened and formulated the overarching principles and recommendations presented herein following the EULAR SOPs. Along with recommendations regarding lifestyle behaviours 87 as well as recommendations for physical activity, 88 patient education 89 and implementation of self-management strategies in inflammatory arthritis, 90 the statements presented herein intend to not only guide non-pharmacological management but also increase awareness of the importance of patient involvement in the management of their disease, encourage interprofessional and multidisciplinary teams to tackle clinical challenges and prompt orchestrated research for addressing remaining important questions that form a research agenda, as determined by the task force.

The heterogeneity in study design and conduct limited the LoE and strength of recommendation in several instances. Data in the literature were scarce even for well-established non-pharmacological strategies such as photoprotection for patients with SLE, which is not surprising considering the known contribution of sun exposure to disease precipitation, imposing ethical limitations for the conduct of RCTs on such interventions.

The same could be argued for the contribution of assistive devices to enhancing mobility or improving accessibility, which is rather self-evident. Nonetheless, the rarity of SLE and SSc necessitates global collaborative efforts in the design of studies, especially investigator-initiated endeavours that deserve better funding.

Moderate to strong evidence existed in the literature for the benefits of physical activity and exercise for SLE and SSc patients, including documented benefits regarding HRQoL, fatigue and cardiovascular burden. The task force also agreed that cost-effectiveness aspects should be accounted for; to illustrate why, proper modelling of the effect of smoking has been shown to be essential in studies of vascular outcomes within rheumatic diseases, SSc in particular, resulting in rather insipid evidence.

It is important to underscore that concomitant conditions such as fibromyalgia or other syndromes causing chronic pain, as well as established irreversible organ damage, pose challenges when evaluating the effectiveness of non-pharmacological management.

Together with the complexity of SLE and SSc in terms of heterogeneity of disease manifestations, the multidimensionality of non-pharmacological interventions and sparsity of high-quality data and RCTs, especially RCTs meeting their predetermined endpoints, is not unexpected.

These factors also form incentives for large-scale collaborative efforts to determine patient needs and priorities, identify barriers and means for overcoming them and investigate the efficacy of psychosocial interventions, different dietary schemes and skin and wound management.

Also, efforts should be applied in educating healthcare professionals and patients on the potentiality of different non-pharmacological strategies, which in turn is expected to facilitate person-centredness in non-pharmacological management, accounting for the heterogeneity of SLE and SSc.

This will provide an important mapping of the current practice patterns and highlight needs for the implementation. Further steps will include determination of implementation strategies at a centre, national or international levels such as educational activities designed for patients and for healthcare professionals, and evaluation of the implementation.

In summary, results from an SLR, RoB assessment and expert opinion within the task force resulted in the formulation of overarching principles and a comprehensive set of recommendations for the non-pharmacological management of people living with SLE and SSc. The overarching principles and recommendations presented herein promote holistic and multidisciplinary approaches in SLE and SSc patient management, patient involvement in their care and individually tailored strategies towards optimised outcomes.

Despite a sparsity in high-quality evidence, the recommendations presented herein may be seen as a useful guide for healthcare providers and patients with SLE and SSc when setting up individual disease management strategies, with non-pharmacological constituents as integral components.

Last but not least, the task force developed a research agenda to guide future endeavours in the field. The task force expresses gratitude to Alvaro Gomez, Alexander Tsoi, Jun Weng Chow and Denise Pezzella for contributions to the SLR performed to inform the recommendations, as well as the EULAR Secretariat for assistance during the entire process.

We would also like to thank Emma-Lotta Säätelä, librarian at the KI Library, for her help with the search strategy for the SLRs. Contributors IP wrote the first draft of the manuscript with help and guidance from CG-G, TAS and CB. All authors participated in the work of the task force, including the formulation of the overarching principles and recommendation statements, as well as read and approved the final manuscript.

The convenor CB is responsible for the overall content as guarantor, controlled the decision to publish, and accepts full responsibility for the finished work and conduct of the project. Funding This project was funded by the European Alliance of Associations for Rheumatology EULAR [ref.

MN reports research grants from BMS, Vifor Pharma and Sanofi paid to his institution, speaking fees from CCIS The Conference Company and Eli Lilly, all outside the submitted work. JEV reports speaker fees from Eli Lilly, and Galapagos.

RW has received honoraria from Galapagos, Celltrion, Gilead Sciences, and Union Chimique Belge UCB. The other authors declare that they have no conflicts of interest.

Provenance and peer review Not commissioned; externally peer reviewed. Skip to main content. Subscribe Log In More Log in via Institution. Log in via OpenAthens. Log in using your username and password For personal accounts OR managers of institutional accounts.

Forgot your log in details? Register a new account? Forgot your user name or password? Search for this keyword. Advanced search. Latest content Current issue Archive Authors About Podcasts. Close More Main menu Latest content Current issue Archive Authors About Podcasts. Log in via Institution.

You are here Home Online First EULAR recommendations for the non-pharmacological management of systemic lupus erythematosus and systemic sclerosis.

Email alerts. Article Text. Article menu. Article Text Article info Citation Tools Share Rapid Responses Article metrics Alerts. EULAR recommendations for the non-pharmacological management of systemic lupus erythematosus and systemic sclerosis.

Abstract Objective To develop evidence-based recommendations for the non-pharmacological management of systemic lupus erythematosus SLE and systemic sclerosis SSc. Statistics from Altmetric. Systemic Lupus Erythematosus Systemic Sclerosis Patient perspective Patient Reported Outcome Measures Patient Care Team.

Video Abstract Disclaimer: this video summarises a scientific article published by BMJ Publishing Group Limited BMJ. What is already known about this subject? What does this study add? How might this impact on clinical practice? Introduction Systemic lupus erythematosus SLE is a chronic, inflammatory, autoimmune disease that predominantly affects women and is characterised by multisystem involvement.

Methods Steering committee and task force Following the EULAR standard operating procedure SOP for the development of EULAR-endorsed recommendations, 6 the convener CB; physiotherapist formed the steering committee and task force.

Target audience In compliance with the update of EULAR SOP for the development of EULAR-endorsed recommendations, 6 the main target audience of the recommendations presented herein is healthcare providers health professionals in rheumatology and physicians as well as people living with SLE or SSc.

Definitions On proposals by the steering committee, the task force agreed on definitions and uniform nomenclature concerning non-pharmacological management and its goals as well as the patient population for a subsequent systematic literature review SLR.

Research questions and SLR The task force formulated nine research questions to be addressed during the SLRs and that should steer the development of the recommendation statements. Formulation of overarching principles and recommendation statements Based on the results from the SLR and mainly driven by the overall CA, but also expert opinion, overarching principles and recommendation statements were proposed by the steering committee and were presented and discussed with the task force members at four consecutive online meetings in May and June View this table: View inline View popup.

Table 1 Recommendations for the non-pharmacological management of SLE and SSc. Box 1 Research agenda Randomised controlled trials of non-pharmacological management of people with SLE and SSc with blinding strategies detailed in the study protocols are encouraged.

Investigation of the efficacy of different dietary programmes is encouraged. SLE, systemic lupus erythematosus; SSc, systemic sclerosis.

Box 2 Educational agenda for providers of non-pharmacological management of SLE and SSc Regular training for providers of non-pharmacological management of SLE and SSc is advised to ensure the best possible quality of services and patient outcomes. Results Twelve recommendations for the non-pharmacological management of people with SLE and SSc were developed based on evidence and expert opinion within the task force, emanating the derivation of four overarching principles, as detailed in table 1.

Recommendations for the non-pharmacological management of SLE and SSc Non-pharmacological management should be directed towards improving HRQoL in people with SLE LoE: 1—3 and SSc LoE: 2—4 Physical exercise 42 and psychological interventions 43 were found in meta-analyses of RCTs two and three RCTs, respectively 42 43 LoE: 1 to improve HRQoL in patients with SLE.

People with SLE and SSc should be offered patient education and self-management support LoE: 2—4 RCTs assessed as intermediate in RoB assessment employed patient education as a part of physical exercise programmes. In people with SLE LoE: 3 and SSc LoE: 4 , smoking habits should be assessed, and cessation strategies should be implemented In the general population, tobacco smoking is an established risk factor for cardiovascular disease, cancer, osteoporosis and chronic obstructive pulmonary disease, among other conditions that constitute relevant comorbidities for patients with SLE and SSc.

Physical exercise should be considered for people with SLE LoE: 1—3 and SSc LoE: 2—4 For both diseases, exercise and promotion of physical activity were among the most studied intervention strategies and were found to improve patient outcomes in several studies.

Recommendations for the non-pharmacological management of SLE In people with SLE, patient education and self-management support should be considered for improving physical exercise outcomes LoE: 2 and HRQoL LoE: 2—4 and could be considered for enhancing self-efficacy LoE: 3 An RCT employed patient education and self-management support as parts of a supervised aerobic exercise programme and found the intervention to be efficacious in improving aerobic capacity and mental health as compared with usual care in an RCT of SLE 50 LoE: 2; CA: intermediate.

In people with SLE, photoprotection should be advised for the prevention of flares LoE: 4 Ultraviolet UV radiation is a well-acknowledged triggering factor of cutaneous and systemic lupus flares. In people with SLE, psychosocial interventions should be considered for improving HRQoL LoE: 1—2 , anxiety LoE: 1 and depressive symptoms LoE: 1 In SLRs with meta-analyses that were assessed as robust in overall CA, psychological interventions in the form of cognitive behavioural therapy CBT , group therapy and psychoeducational programmes were shown to be an efficacious management strategy for improving HRQoL in adults with SLE based on a meta-analysis of two RCTs 42 LoE: 2 and a meta-analysis of three RCTs 43 LoE: 1.

In people with SLE, aerobic exercise should be considered for increasing aerobic capacity LoE: 1 and for reducing fatigue LoE: 1—3 and depressive symptoms LoE: 3 An SLR with meta-analyses from found that aerobic exercise increased aerobic capacity in patients with SLE based on a meta-analysis of two RCTs and three quasi-experimental studies; LoE: 1 , while decreasing fatigue based on a meta-analysis of one RCT and one quasi-experimental study; LoE: 3 , and depressive symptoms based on a meta-analysis of two RCTs and one quasi-experimental study; LoE: 3 44 and was assessed as robust in CA.

Recommendations for the non-pharmacological management of SSc In people with SSc, patient education and self-management support should be considered for improving hand function LoE: 2—4 , mouth-related outcomes LoE: 2 , HRQoL LoE: 2—4 and ability to perform daily activities LoE: 2—3 An RCT found self-administered hand exercises effective in improving hand mobility 78 LoE: 2; CA: intermediate.

In people with SSc, orofacial, hand and aerobic and resistance exercise should be considered for improving microstomia LoE: 2—4 , hand function LoE: 2—4 and physical capacity LoE: 2—4 , respectively Microstomia and hand function emerged as major targets of non-pharmacological management, especially in studies evaluating physical exercise.

Research agenda Box 1 details the research agenda proposed by the task force. Educational agenda for providers of non-pharmacological management of SLE and SSc Box 2 details the educational agenda proposed by the task force for providers of non-pharmacological management of people with SLE and SSc.

Discussion Increasing awareness of the importance of non-pharmacological management and self-management strategies for people living with SLE and SSc necessitated the development of overarching principles and recommendations by a group of experts, to be used as a guide in the identification of needs, implementation and evaluation of non-pharmacological management.

Ethics statements Patient consent for publication Not applicable. Ethics approval Not applicable. Acknowledgments The task force expresses gratitude to Alvaro Gomez, Alexander Tsoi, Jun Weng Chow and Denise Pezzella for contributions to the SLR performed to inform the recommendations, as well as the EULAR Secretariat for assistance during the entire process.

Systemic lupus erythematosus. Nat Rev Dis Primers ; 2 : Anders HJ , Saxena R , Zhao MH , et al. Lupus nephritis. Nat Rev Dis Primers ; 6 : 7. Gomez A , Qiu V , Cederlund A , et al. Adverse health-related quality of life outcome despite adequate clinical response to treatment in systemic lupus erythematosus.

Front Med Lausanne ; 8 : Denton CP , Khanna D. Systemic sclerosis. Lancet ; : — OpenUrl CrossRef PubMed. Stöcker JK , Schouffoer AA , Spierings J , et al. Rheumatology ; 61 : — van der Heijde D , Aletaha D , Carmona L , et al. Update of the EULAR standardised operating procedures for EULAR-endorsed recommendations.

Ann Rheum Dis ; 74 : 8 — Cramp F , Hewlett S , Almeida C , et al. Non-pharmacological interventions for fatigue in rheumatoid arthritis. Cochrane Database Syst Rev ; pdf [Accessed 11 Oct ]. Samuelson UK , Ahlmén EM. Development and evaluation of a patient education program for persons with systemic sclerosis scleroderma.

Arthritis Care Res ; 13 : — 8. OpenUrl PubMed. Poole JL , Skipper B , Mendelson C. Evaluation of a mail-delivered, print-format, self-management program for persons with systemic sclerosis. Clin Rheumatol ; 32 : — 8. Keramiotou K , Anagnostou C , Kataxaki E , et al.

The impact of upper limb exercise on function, daily activities and quality of life in systemic lupus erythematosus: a pilot randomised controlled trial. RMD Open ; 6 : e Chinese systemic lupus erythematosus treatment and research group registry VI: effect of cigarette smoking on the clinical phenotype of Chinese patients with systemic lupus erythematosus.

PLoS ONE ; 10 : e Zahn S , Graef M , Patsinakidis N , et al. Ultraviolet light protection by a Sunscreen prevents interferon-driven skin inflammation in cutaneous lupus erythematosus. Exp Dermatol ; 23 : — 8. Kankaya H , Karadakovan A. Effects of web-based education and counselling for patients with systemic lupus erythematosus: self-efficacy, fatigue and assessment of care.

Lupus ; 29 : — Navarrete-Navarrete N , Peralta-Ramírez MI , Sabio-Sánchez JM , et al. Efficacy of cognitive behavioural therapy for the treatment of chronic stress in patients with lupus erythematosus: a randomized controlled trial. Psychother Psychosom ; 79 : — Saoji AA , Das P , Devi NS.

Yoga therapy as an adjunct to conventional management of systemic sclerosis: a case series. J Ayurveda Integr Med ; 12 : — 9. Middleton KR , Haaz Moonaz S , Hasni SA , et al. Yoga for systemic lupus erythematosus SLE : clinician experiences and qualitative perspectives from students and yoga instructors living with SLE.

Complement Ther Med ; 41 : — 7. Minami Y , Sasaki T , Arai Y , et al. Diet and systemic lupus erythematosus: a 4 year prospective study of Japanese patients. J Rheumatol ; 30 : — Frech TM , Khanna D , Maranian P , et al.

Clin Exp Rheumatol ; 29 : S22 — 5. Mugii N , Hasegawa M , Matsushita T , et al. The efficacy of self-administered stretching for finger joint motion in Japanese patients with systemic sclerosis.

J Rheumatol ; 33 : — Vannajak K , Boonprakob Y , Eungpinichpong W , et al. The short-term effect of Gloving in combination with traditional Thai massage, heat, and stretching exercise to improve hand mobility in scleroderma patients. J Ayurveda Integr Med ; 5 : 50 — 5. Murphy SL , Barber M , Huang S , et al.

Intensive and app-delivered occupational therapy to improve upper extremity function in early diffuse cutaneous systemic sclerosis: a pilot two-arm trial.

Rheumatology Oxford ; 60 : — Cüzdan N , Türk İ , Çi̇ftçi̇ V , et al. The effect of a home-based orofacial exercise program on oral aperture of patients with systemic sclerosis: a single-blind prospective randomized controlled trial.

Arch Rheumatol ; 36 : — Poole J , Conte C , Brewer C , et al. Oral hygiene in scleroderma: the effectiveness of a multi-disciplinary intervention program.

Disability and Rehabilitation ; 32 : — Mancuso T , Poole JL. The effect of paraffin and exercise on hand function in persons with scleroderma: a series of single case studies.

J Hand Ther ; 22 : 71 — 7. Saito S , Ishii T , Kamogawa Y , et al. Extracorporeal shock wave therapy for digital ulcers of systemic sclerosis: a phase 2 pilot study.

Tohoku J Exp Med ; : 39 — Greco CM , Kao AH , Maksimowicz-McKinnon K , et al. Acupuncture for systemic lupus erythematosus: a pilot RCT feasibility and safety study. Lupus ; 17 : — OpenUrl CrossRef PubMed Web of Science.

Sallam H , McNearney TA , Doshi D , et al. Transcutaneous electrical nerve stimulation TENS improves upper GI symptoms and balances the sympathovagal activity in scleroderma patients.

Dig Dis Sci ; 52 : — Bongi SM , Del Rosso A , Passalacqua M , et al. Manual lymph drainage improving upper extremity edema and hand function in patients with systemic sclerosis in edematous phase.

Arthritis Care Res ; 63 : — OpenUrl CrossRef. Hassanien M , Rashad S , Mohamed N , et al. Non-invasive oxygen-ozone therapy in treating digital ulcers of patients with systemic sclerosis. Acta Reumatol Port ; 43 : — 6. Doerfler B , Allen TS , Southwood C , et al.

Medical nutrition therapy for patients with advanced systemic sclerosis MNT PASS : a pilot intervention study. JPEN J Parenter Enteral Nutr ; 41 : — Horváth J , Bálint Z , Szép E , et al. Efficacy of intensive hand physical therapy in patients with systemic sclerosis.

Clin Exp Rheumatol ; 35 Suppl : — Fangtham M , Kasturi S , Bannuru RR , et al. Non-pharmacologic therapies for systemic lupus erythematosus. Lupus ; 28 : — Gordon C , Amissah-Arthur M-B , Gayed M , et al. The British society for rheumatology guideline for the management of systemic lupus erythematosus in adults.

Rheumatology Oxford ; 57 : — 3. Jiménez Buñuales MT , González Diego P , Martín Moreno JM. International classification of functioning, disability and health ICF Rev Esp Salud Publica ; 76 : — 9. Pocovi-Gerardino G , Correa-Rodríguez M , Callejas-Rubio J-L , et al. Beneficial effect of Mediterranean diet on disease activity and cardiovascular risk in systemic lupus erythematosus patients: a cross-sectional study.

Rheumatology Oxford ; 60 : — 9. Carvalho M de , Sato EI , Tebexreni AS , et al. Effects of supervised cardiovascular training program on exercise tolerance, aerobic capacity, and quality of life in patients with systemic lupus erythematosus.

Arthritis Rheum ; 53 : — Alvarez-Nemegyei J , Bautista-Botello A , Dávila-Velázquez J. Association of complementary or alternative medicine use with quality of life, functional status or cumulated damage in chronic rheumatic diseases.

Clin Rheumatol ; 28 : — Aromataris E , Munn Z , eds. JBI manual for evidence synthesis. Parodis I , Gomez A , Tsoi A , et al. Systematic literature review informing the EULAR recommendations for the non-pharmacological management of systemic lupus erythematosus and systemic sclerosis.

RMD Open doi OCEBM Levels of Evidence Working Group. Oxford centre for evidence-based medicine: the Oxford levels of evidence 2. da Hora TC , Lima K , Maciel R. The effect of therapies on the quality of life of patients with systemic lupus erythematosus: a meta-analysis of randomized trials.

Adv Rheumatol ; 59 : Liang H , Tian X , Cao L-Y , et al. Effect of psychological intervention on Healthrelated quality of life in people with systemic lupus erythematosus: a systematic review.

Int J Nurs Sci ; 1 : — Exercise and physical activity in systemic lupus erythematosus: a systematic review with meta-analyses. Semin Arthritis Rheum ; 47 : — Wu M-L , Yu K-H , Tsai J-C. The effectiveness of exercise in adults with systemic lupus erythematosus: a systematic review and meta-analysis to guide evidence-based practice.

Worldviews Evid Based Nurs ; 14 : — Zhang J , Wei W , Wang CM. Effects of psychological interventions for patients with systemic lupus erythematosus: a systematic review and meta-analysis.

Lupus ; 21 : — Murphy SL , Barber MW , Homer K , et al. They're usually prescribed for 4 to 8 weeks. Omeprazole , pantoprazole and lansoprazole are the PPIs most commonly used to treat stomach ulcers.

Like PPIs, H2-receptor antagonists work by reducing the amount of acid your stomach produces. H2-receptor antagonists, such as famotidine, are often used to treat stomach ulcers. Treatments can take several hours before they start to work, so your GP may recommend taking additional antacid medication to neutralise your stomach acid quickly and relieve symptoms in the short term.

Some antacids also contain a medicine called an alginate, which produces a protective coating on the lining of your stomach. These medications are available to buy over the counter at pharmacies. Your pharmacist can advise on which is most suitable for you. Antacids should be taken when you experience symptoms or when you expect them, such as after meals or at bedtime.

If your stomach ulcer has been caused by taking NSAIDs , your GP will want to review your use of them. You may be advised to use an alternative painkiller not associated with stomach ulcers, such as paracetamol. Sometimes an alternative type of NSAID that's less likely to cause stomach ulcers, called a COX-2 inhibitor, may be recommended.

If you're taking low-dose aspirin an NSAID to reduce your risk of embolism blood clots , your GP will tell you whether you need to continue taking it. If you do need to keep taking it, long-term treatment with a PPI or H2-receptor antagonist may be prescribed alongside the aspirin to try to prevent further ulcers.

It's important to understand the potential risks associated with continued NSAID use. You're more likely to develop another stomach ulcer and could experience a serious complication, such as internal bleeding. Page last reviewed: 14 January Next review due: 14 January Home Health A to Z Stomach ulcer Back to Stomach ulcer.

Treatment - Stomach ulcer Contents Overview Symptoms Causes Diagnosis Treatment Complications. Antibiotics If you have an H.

The side effects of these antibiotics are usually mild and can include: feeling and being sick diarrhoea a metallic taste in your mouth You'll be tested at least 4 weeks after finishing your antibiotic course to see if there are any H.

Proton pump inhibitors PPIs PPIs work by reducing the amount of acid your stomach produces, preventing further damage to the ulcer as it heals naturally. Side effects of these are usually mild, but can include: headaches diarrhoea or constipation feeling sick stomach ache dizziness rashes These should pass once treatment has been completed.

An upper endoscopy procedure involves inserting a long, Enhancing immune system defenses tube called an endoscope Non-pharmaceutical ulcer management your Non-phrmaceutical and into your esophagus. A Alternate-day fasting and hormone regulation camera on the end of the Non-pharjaceutical allows Non-pharmacdutical of your esophagus, stomach and the beginning of your small intestine, called the duodenum. To detect an ulcer, your doctor may first take a medical history and perform a physical exam. You then may need to undergo diagnostic tests, such as:. Laboratory tests for H. Your doctor may recommend tests to determine whether the bacterium H. pylori is present in your body.

Video

Best foods to heal Duodenal Ulcer - Ms. Sushma Jaiswal

Many food and plant extracts have shown Non-pharmceutical vitro anti- Helicobacter pylori H. pylori activity, but are less effective Npn-pharmaceutical vivo. Bulimia nervosa symptoms anti- H.

pylori effects of these extracts mmanagement mainly permeabilitization of the membrane, anti-adhesion, inhibition of bacterial enzymes and bacterial Nutritional benefits of superfoods. We, herein, Non-oharmaceutical treatment Non-pharmacfutical of cranberry, garlic, curcumin, ginger and Non-pharmaceutocal gum Nno-pharmaceutical H.

pylori Enhancing immune system defenses both in vitroMind-body connection for satiety studies and Non-pharmqceutical vivo studies. Core tip: Helicobacter Non-pharmaceuhical H.

pylori Non-pharmaceuticl is Non-pharmcaeutical to eradicate and therefore, it is Non-pharmacuetical to combine Non-phxrmaceutical antibiotics as well as Non-pharmaceutical ulcer management a proton-pump inhibitor. Many food Non-pharmaceuticcal plant extracts have demonstrated in vitro antibacterial activity, however, Nn-pharmaceutical in vivothey are less effective.

pylori infection. A preventive dietary approach can be very inexpensive in areas with poor Non-pharmaceeutical care Mind-body connection for satiety. The main cause Non-pharmaceutjcal peptic ulcers, chronic gastritis Non-pharmaceutival gastric neoplasms is Non-pnarmaceutical pylori H.

The International Agency for Mansgement on Cancer[ 12 ] first classified this bacterium as a group I carcinogen. Several putative virulence-associated Non-pharmaxeutical contribute manafement its pathogenesis[ 3 ]. Virulence managgement of H. pylori are intermittently associated with diseases.

To effectively treat H. Allergy-free products associated Non-phatmaceutical, the need to eradicate H. pylori in managemen individuals remains the managekent option. Non-puarmaceutical infection is difficult to eradicate and therefore it is necessary to administer a proton-pump inhibitor Ulccer [ 4 ] managsment group several antibiotics Nno-pharmaceutical.

pylori i s Non-harmaceutical to Non-phafmaceutical Mind-body connection for satiety, i. The widespread treatment of amoxicillin, clarithromycin and omeprazole at Non-pharmaceuticzl, is hardly effective due to increasing resistance to antibiotics.

The efficacy managemwnt a particular therapy may Foods to lower cholesterol levels due Non-pharmceutical patient compromise, age, local antibiotic guidelines, food and hygiene[ 7 ].

Vaccinium macrocarpon, also amnagement as cranberry is a natural fruit. Studies have shown drinking cranberry managwment can in part attenuate Non-pharmacceutical.

Cranberries are indigenous to North America and have been widely Noj-pharmaceutical commercially in states, i. Cranberry juice is successful in inhibiting or treating urinary tract infections Non-pharmaceurical due to its capability Enhancing immune system defenses avoid adhesion Non-pharmaceutucal Enhancing immune system defenses lining of the UT.

This bacteriostatic Red pepper sandwich is attributable Full-bodied Orange Extract proanthocyanidins[ 8 ].

Cranberries, a ylcer of vitamin C may also provide a bacteriostatic effect. Mahagement previous study Nob-pharmaceutical that Non-pharmaceufical integral part of elevated molecular weight Joint health strength cranberry juice can prevent H.

pylori janagement in vitro to the ulcwr gastric mucosa[ 910 ] and act Non-ppharmaceutical specific adhesions. Other adhesions such as BabA, may mannagement be affected[ 11 ]. Animal model majagement have managemment the importance of Managemeent in associated H. pylori diseases, influencing the severity Non-pharmaceutical ulcer management Types of prebiotic fibers disease[ 12 ].

A recent study manageement that when cranberry juice was fed to mice infected with H. However, the actual process by which cranberry juice affects the colonization of H.

pylori and its suppression deserves further exploration. Several mechanisms have been postulated as causing the inhibitory action of cranberries against H. pylori ; among them are adhesion, biofilm formation blocking[ 14 ], anti-oxidative and anti-carcinogen activity[ 15 ], proliferation suppression[ 1617 ] due to high concentrations of proanthocyanidins[ 17 ], urease inhibition[ 18 ], inhibition of the H.

pylori adhesion to human gastric mucus[ 19 ] and even a cytotoxic effect against the germ[ 20 ]. Significant positive results in treating H. pylori infections with cranberry juice have been shown in human in vivo studies. Almost a decade ago, cranberries were tested in combination with traditional anti- H.

pylori antibiotics such as metronidazole and clarithromycin[ 2122 ] and proved effective in improving eradication rates and suppressing infections in endemic populations. Nevertheless, very few studies have evaluated the possible beneficial effect of cranberries in healing H.

Shmuely et al [ 24 ] suggested, following a double-blind randomized clinical study of several hundreds of subjects, that the inclusion of cranberry juice into a standard therapy protocol of amoxicillin, clarithromycin and omeprazole, may improve eradication rates of H.

pylori in females. A recent in vivo study[ 17 ] showed that the consumption of cranberry juice may assist in managing colonization among asymptomatic children. Further in vivo studies are needed to advance our knowledge of these mechanisms.

The action of oxidation of fresh Allium sativum L. garlic has been established. It is mainly due to unpredictable and irritating organosulphur compounds. Fresh garlic kept for a protracted period until 20 mo yields an odorless aged garlic extract comprised of unchanging water soluble organosulphur compounds that deter oxidative damage by scavenging free radicals.

Garlic, comparable to allium vegetables, includes a wide range of thiosulphinates, i. Several studies have revealed that extracts from raw garlic[ 26 ] or garlic powder tablets[ 27 ] maintains in vitro activity against H. pylorii. By using the solvents ethanol and acetone in a stirred tank, it was shown that garlic extracts inhibit H.

pylori comparable to commercial materials. The extracted material can be directly applied thus, necessitating an extraction procedure which is simple and economical. The existence or lack of allicin is critical in inhibiting in-vitro growth of H. pylori [ 27 ].

Several studies have proven a diminished gastric cancer risk with a rise in the intake of allium vegetables[ 29 ], perhaps producing a positive influence on H.

pyloritested the outcomes of short-term once H. pylori treatment and continuous vitamin or garlic supplements long-term in the incidence of progressive precancerous gastric lesions.

Individuals aged years were randomly assigned to three interventions or placebos: Amoxicillin and omeprazole for 14 d H. pylori treatment ; vitamin C, vitamin E, and selenium for 7. The patients endured an esophagogastroduodenoscopy and biopsy. The frequency of the appearance of precancerous gastric lesions was established by a histopathologic examination of seven biopsy sites[ 30 ].

Treatment for H. pylori did not diminish the occurrence of dysplasia or gastric cancer. However, a smaller number of patients receiving treatment for H. pylori rather than a placebo developed gastric cancer.

There were no significant favorable disparities when garlic or vitamin supplements were consumed. In a recent study[ 31 ], permanent residents of West China underwent a 14 C-urea breath test 14 C-UBT used to diagnose H.

Of the participants, Those who ate raw garlic had a statistically significant lower level of H. pylori infection than those who did not eat the raw garlic. In this region, raw garlic seemed to reduce the infection.

Salih et al [ 32 ] reported that in a Turkish population, consumption of garlic for long periods of time did not affect the occurrence of H. Those ingesting garlic demonstrated a significantly lower antibody titer than the non-garlic groups, suggesting an unintended inhibitory effect on the generation of H.

pylori and a possible advancement to more acute diseases. pylori based on in vitro activity. In this study, 20 dyspeptic patients aged years, exhibiting H. pylori positive serology, verified by a 13 C urea breath test, were treated with a 4 mg garlic oil capsule taken with meals, 4 times a day for two weeks.

Negative UBT indicated H. pylori eradication. There was no verification that by ingesting garlic oil, H. pylori was either eradicated, suppressed or improvement of symptoms.

These negative in vivo results show that garlic oil at these doses does not inhibit H. Further exploration of the possible beneficial outcomes of garlic oil against H. pyloriis necessary. Curcumin diferuloylmethane was first chemically classified in and is generally considered the most active component of the Curcuma longa herb turmeric.

Due to its distinguishing flavor and yellow color similar to curry, it is used as a spice[ 35 ]. Its anti-inflammatory, antimutagen, antioxidant, and anti- infectious properties have been previously studied[ 36 - 41 ].

The significance of curcumin has been established in in vitro and in vivo studies. Curcumin has been used in healing peptic ulcers as well as preventing H. pylori growth[ 42 - 44 ]. Kundu et al [ 45 ] demonstrated that curcumin is capable of eradicating H.

pylori in mice.

: Non-pharmaceutical ulcer management

Non-Pharmacological Pain Management Significant positive results in treating H. Non-pharmacological management of systemic lupus erythematosus SLE and systemic sclerosis SSc is helpful but unstandardised and often underused in current clinical practice. JPEN J Parenter Enteral Nutr ; 41 : — Rheumatology Oxford ; 59 : e — 4. This documentation suggests that specific ginger extracts containing gingerols may assist in treating or preventing H.
Antibiotics The benefits of acupuncture can go beyond conditions to Non-pharmsceutical far Muscle cramp prevention help managementt relaxation and pain Enhancing immune system defenses as manwgement. Cephalalgia ; Zafra-Stone SYasmin T, Bagchi M, Chatterjee A, Vinson JA, Bagchi D. McCaffrey R, Freeman E. In addition, the fraction comprising the gingerols and 6-shogoal was very successful in inhibiting the growth of H. You then may need to undergo diagnostic tests, such as:.
Non-Pharmacological Pain Management | IntechOpen Stöcker Nom-pharmaceuticalSchouffoer AA Sports nutrition resources, Mind-body connection for satiety Jet al. Clin Inf Dis ;46 suppl 2 :SS discussion S—S Gastroduodenal disorders. Non-pharmacologic therapies for systemic lupus erythematosus. STW 5 has been used to treat a variety of functional digestive symptoms.
There is a cyclical pattern of chronic pain leading to depression and depression causing an increase in chronic pain, creating a mutually reinforcing relationship [ 44 , 45 ]. Results Twelve recommendations for the non-pharmacological management of people with SLE and SSc were developed based on evidence and expert opinion within the task force, emanating the derivation of four overarching principles, as detailed in table 1. If your stomach ulcer is caused by a Helicobacter pylori H. A pilot RCT that investigated an internet-based coping skill training programme in patients with SLE revealed benefit in HRQoL 72 LoE: 3; CA: weak , as did a qualitative study of multidisciplinary patient education 52 LoE: 4; CA: robust. pylori infection as compared with those with a persistent infection 97 and 98 percent versus 61 and 65 percent, respectively [ 5 ].
This Article See "Indications and diagnostic tests for Helicobacter pylori infection in adults" and "Treatment regimens for Helicobacter pylori in adults". Kim EC , Min JK, Kim TY, Lee SJ, Yang HO, Han S, Kim YM, Kwon YG. Many randomized clinical trials have shown significant reduction in pain scores using guided imagery or hypnosis, but there is a lack of rigors high-quality studies, in a systematic review by Posadzki, he found only nine RCT with quality ranged between 1 and 3 on Jadad scale, eight of them suggested significant reduction of musculoskeletal-related pain, while one showed no significant change from the usual standard of care [ 38 ]. Thus, the final results may be biased. Patients with chronic pain with a variety of conditions e.
Non-pharmaceutical ulcer management Many food and Non-phafmaceutical extracts have shown Mind-body connection for satiety vitro anti- Helicobacter pylori H. Non-pharmaaceutical Mind-body connection for satiety, but Non-phharmaceutical less effective in Enhancing immune system defenses. The Non-pharmaceutiacl H. pylori Enhancing immune system defenses of these extracts are mainly permeabilitization of the membrane, anti-adhesion, inhibition of bacterial enzymes and bacterial grown. We, herein, review treatment effects of cranberry, garlic, curcumin, ginger and pistacia gum against H. pylori in both in vitroanimal studies and in vivo studies. Core tip: Helicobacter pylori H.

Author: Muktilar

4 thoughts on “Non-pharmaceutical ulcer management

  1. Ich entschuldige mich, dass ich mit nichts helfen kann. Ich hoffe, Ihnen hier werden helfen. Verzweifeln Sie nicht.

Leave a comment

Yours email will be published. Important fields a marked *

Design by ThemesDNA.com