Top

Published in:

01-08-2019 | Polymyositis | Review Article

Physical therapy in adult inflammatory myopathy patients: a systematic review

Authors: Anna Van Thillo, Jean-Baptiste Vulsteke, Dieter Van Assche, Patrick Verschueren, Ellen De Langhe

Published in: Clinical Rheumatology | Issue 8/2019

Abstract

The safety and effect of physical therapy in adult patients with idiopathic inflammatory myopathies (IIMs) are currently unclear. Considering the muscle weakness resulting from disease activity as well as from the administered drugs, these patients could benefit from an evidence-based physical therapy program. To perform a systematic review to assess safety and effects of physical therapy on the functional outcome of patients with idiopathic inflammatory myopathies in both active and quiescent disease: Pubmed, Embase, and Cochrane. Patients with one of the following idiopathic inflammatory myopathies: polymyositis, dermatomyositis, immune-mediated necrotizing myopathy, and/or overlap myositis. The intervention included several types of rehabilitation programs, from strength and resistance training to endurance training, with a minimal duration of 1 month. Studies reporting intervention-related adverse events, disease activity, and functional outcomes were eligible. The risk of bias was assessed using the Cochrane guidelines. We included five randomized controlled and seven open-label non-randomized non-controlled trials. Data on statistical significance were extracted for all the trials. Included trials were of medium-quality evidence given the low number of patients and some risk of bias factors. Physical therapy does not have a negative effect on the disease activity of idiopathic inflammatory myopathies in quiescent disease and could improve functional outcome. The physical therapy program should minimally include endurance training. A combination with resistance training might be beneficial.

Available only for authorised users

ADL

Activities of daily living

CPK

Creatine phosphokinase

Category ratio/chronotropic reserve

CRP

C-reactive protein

Dermatomyositis

EMG

Electromyography

Emtree

Embase subject headings

ESM

Erythrocyte sedimentation rate

FEF(25-75%)

Forced expiratory flow

FEV1/FVC

Forced expiratory volume one second to forced vital capacity ratio

Functional index

FIM

Functional independence measure

FVC

Forced vital capacity

Grip strength

HAQ-DI

Health assessment questionnaire disability index

IBM

Inclusion-body myositis

IIM

Idiopathic inflammatory myopathy

IMACS

International myositis assessment and clinical studies group

IMNM

Immune-mediated necrotizing myopathy

MACTAR

McMaster Toronto arthritis patient preference disability questionnaire

MAP

Myositis activities profile

MeSH

Medical subject headings

MFASQ

Modified functional assessment screening questionnaire

MITAX

Myositis intent-to-treat activity index

MMT

Manual muscle test

MRI

Magnetic resonance imaging

NHP

Nottingham health profile

PGA

Patient’s global disease activity

PhGA

Physician’s global disease activity

PICO

Patient intervention comparison outcome

PIT

Peak isometric/isokinetic torque

Polymyositis

QCSA

Quadriceps cross-sectional area

RCP

Respiratory compensation point

RCT

Randomized controlled trial

Repetition maximum

ROM

Range of motion

SDGI

Subjective global disease impact

SF-36

Medical outcomes study 36-item short-form health survey questionnaire

TST

Timed-stands test

TUGT

Timed-up-and-go test

VAS

Visual analogue scale

VAT

Ventilatory anaerobic threshold

VRM

Voluntary repetition maximum

Walk test

ΔHRR1

Heart rhythm at the first minute after the test

ΔHRR2

Heart rhythm at the second minute after the test

Dalakas MC (2015) Inflammatory muscle diseases. N Engl J Med 372:1734–1747. https://doi.org/10.1056/NEJMra1402225 CrossRef

Dalakas MC (1991) Polymyositis, dermatomyositis and inclusion-body myositis. N Engl J Med 325:1487–1498. https://doi.org/10.1056/NEJM199111213252107 CrossRefPubMed

Dalakas MC, Hohlfeld R (2003) Polymyositis and dermatomyositis. Lancet (London, England) 362:971–982. https://doi.org/10.1016/S0140-6736(03)14368-1 CrossRef

Dalakas MC (2011) Review: an update on inflammatory and autoimmune myopathies. Neuropathol Appl Neurobiol 37:226–242. https://doi.org/10.1111/j.1365-2990.2010.01153.x CrossRefPubMed

Luo Y-B, Mastaglia FL (2015) Dermatomyositis, polymyositis and immune-mediated necrotising myopathies. Biochim Biophys Acta 1852:622–632. https://doi.org/10.1016/j.bbadis.2014.05.034 CrossRefPubMed

Rider LG, Miller FW (2011) Deciphering the clinical presentations, pathogenesis, and treatment of the idiopathic inflammatory myopathies. JAMA 305:183–190. https://doi.org/10.1001/jama.2010.1977 CrossRefPubMedPubMedCentral

Mariampillai K, Granger B, Amelin D, Guiguet M, Hachulla E, Maurier F, Meyer A, Tohmé A, Charuel JL, Musset L, Allenbach Y, Benveniste O (2018) Development of a new classification system for idiopathic inflammatory myopathies based on clinical manifestations and myositis-specific autoantibodies. JAMA Neurol 75:1528. https://doi.org/10.1001/jamaneurol.2018.2598 CrossRefPubMed

Lundberg IE, Tjarnlund A, Bottai M et al (2017) 2017 European League Against Rheumatism/American College of Rheumatology Classification Criteria for adult and juvenile idiopathic inflammatory myopathies and their major subgroups. Arthritis Rheumatol (Hoboken, NJ) 69:2271–2282. https://doi.org/10.1002/art.40320 CrossRef

Findlay AR, Goyal NA, Mozaffar T (2015) An overview of polymyositis and dermatomyositis. Muscle Nerve 51:638–656. https://doi.org/10.1002/mus.24566 CrossRefPubMed

10.

Svensson J, Arkema EV, Lundberg IE, Holmqvist M (2017) Incidence and prevalence of idiopathic inflammatory myopathies in Sweden: a nationwide population-based study. Rheumatology (Oxford) 56:802–810. https://doi.org/10.1093/rheumatology/kew503 CrossRef

11.

Rayavarapu S, Coley W, Nagaraju K (2011) An update on pathogenic mechanisms of inflammatory myopathies. Curr Opin Rheumatol 23:579–584. https://doi.org/10.1097/BOR.0b013e32834b41d2 CrossRefPubMed

12.

Dalakas MC (2011) Pathophysiology of inflammatory and autoimmune myopathies. Presse Med 40:e237–e247. https://doi.org/10.1016/j.lpm.2011.01.005 CrossRefPubMed

13.

Lundberg IE (2000) The role of cytokines, chemokines, and adhesion molecules in the pathogenesis of idiopathic inflammatory myopathies. Curr Rheumatol Rep 2:216–224CrossRefPubMed

14.

Zong M, Lundberg IE (2011) Pathogenesis, classification and treatment of inflammatory myopathies. Nat Rev Rheumatol 7:297–306. https://doi.org/10.1038/nrrheum.2011.39 CrossRefPubMed

15.

Ernste FC, Reed AM (2013) Idiopathic inflammatory myopathies: current trends in pathogenesis, clinical features, and up-to-date treatment recommendations. Mayo Clin Proc 88:83–105. https://doi.org/10.1016/j.mayocp.2012.10.017 CrossRefPubMed

16.

Casciola-Rosen L, Mammen AL (2012) Myositis autoantibodies. Curr Opin Rheumatol 24:602–608. https://doi.org/10.1097/BOR.0b013e328358bd85 CrossRefPubMed

17.

Lundberg IE, Vencovsky J, Alexanderson H (2014) Therapy of myositis: biological and physical. Curr Opin Rheumatol 26:704–711. https://doi.org/10.1097/BOR.0000000000000109 CrossRefPubMed

18.

Hengstman GJD, van den Hoogen FHJ, van Engelen BGM (2009) Treatment of the inflammatory myopathies: update and practical recommendations. Expert Opin Pharmacother 10:1183–1190. https://doi.org/10.1517/14656560902913815 CrossRefPubMed

19.

Dalakas MC (2010) Immunotherapy of myositis: issues, concerns and future prospects. Nat Rev Rheumatol 6:129–137. https://doi.org/10.1038/nrrheum.2010.2 CrossRefPubMed

20.

Oddis CV, Reed AM, Aggarwal R, Rider LG, Ascherman DP, Levesque MC, Barohn RJ, Feldman BM, Harris-Love MO, Koontz DC, Fertig N, Kelley SS, Pryber SL, Miller FW, Rockette HE, and the RIM Study Group (2013) Rituximab in the treatment of refractory adult and juvenile dermatomyositis and adult polymyositis: a randomized, placebo-phase trial. Arthritis Rheum 65:314–324. https://doi.org/10.1002/art.37754 CrossRefPubMedPubMedCentral

21.

Marie I, Hachulla E, Hatron PY et al (2001) Polymyositis and dermatomyositis: short term and longterm outcome, and predictive factors of prognosis. J Rheumatol 28:2230–2237PubMed

22.

Ponyi A, Borgulya G, Constantin T et al (2005) Functional outcome and quality of life in adult patients with idiopathic inflammatory myositis. Rheumatology (Oxford) 44:83–88. https://doi.org/10.1093/rheumatology/keh404 CrossRef

23.

Sultan SM, Ioannou Y, Moss K, Isenberg DA (2002) Outcome in patients with idiopathic inflammatory myositis: morbidity and mortality. Rheumatology (Oxford) 41:22–26CrossRef

24.

Clarke AE, Bloch DA, Medsger TAJ, Oddis CV (1995) A longitudinal study of functional disability in a national cohort of patients with polymyositis/dermatomyositis. Arthritis Rheum 38:1218–1224CrossRefPubMed

25.

Bronner IM, van der Meulen MFG, de Visser M, Kalmijn S, van Venrooij WJ, Voskuyl AE, Dinant HJ, Linssen WHJP, Wokke JHJ, Hoogendijk JE (2006) Long-term outcome in polymyositis and dermatomyositis. Ann Rheum Dis 65:1456–1461. https://doi.org/10.1136/ard.2005.045690 CrossRefPubMedPubMedCentral

26.

Hicks JE, Miller F, Plotz P et al (1993) Isometric exercise increases strength and does not produce sustained creatinine phosphokinase increases in a patient with polymyositis. J Rheumatol 20:1399–1401PubMed

27.

Jorgensen AN, Aagaard P, Nielsen JL et al (2016) Effects of blood-flow-restricted resistance training on muscle function in a 74-year-old male with sporadic inclusion body myositis: a case report. Clin Physiol Funct Imaging 36:504–509CrossRefPubMed

28.

Hejazi SMA, Engkasan JP, Qomi MSM (2012) Intensive exercise and a patient in acute phase of polymyositis. J Back Musculoskelet Rehabil 25:231–234. https://doi.org/10.3233/BMR-2012-0340 CrossRefPubMed

29.

Nader GA, Lundberg IE (2009) Exercise as an anti-inflammatory intervention to combat inflammatory diseases of muscle. Curr Opin Rheumatol 21:599–603. https://doi.org/10.1097/BOR.0b013e3283319d53 CrossRefPubMed

30.

Johnson LG, Collier KE, Edwards DJ, Philippe DL, Eastwood PR, Walters SE, Thickbroom GW, Mastaglia FL (2009) Improvement in aerobic capacity after an exercise program in sporadic inclusion body myositis. J Clin Neuromuscul Dis 10:178–184. https://doi.org/10.1097/CND.0b013e3181a23c86 CrossRefPubMed

31.

Alexanderson H (2009) Exercise effects in patients with adult idiopathic inflammatory myopathies. Curr Opin Rheumatol 21:158–163. https://doi.org/10.1097/BOR.0b013e328324e700 CrossRefPubMed

32.

de Salles Painelli V, Gualano B, Artioli GG, de Sá Pinto AL, Bonfá E, Lancha Junior AH, Lima FR (2009) The possible role of physical exercise on the treatment of idiopathic inflammatory myopathies. Autoimmun Rev 8:355–359. https://doi.org/10.1016/j.autrev.2008.11.008 CrossRefPubMed

33.

Habers GEA, Takken T (2011) Safety and efficacy of exercise training in patients with an idiopathic inflammatory myopathy--a systematic review. Rheumatology (Oxford) 50:2113–2124. https://doi.org/10.1093/rheumatology/ker292 CrossRef

34.

Alexanderson H, Lundberg IE (2012) Exercise as a therapeutic modality in patients with idiopathic inflammatory myopathies. Curr Opin Rheumatol 24:201–207. https://doi.org/10.1097/BOR.0b013e32834f19f5 CrossRefPubMed

35.

Alemo Munters L, Alexanderson H, Crofford LJ, Lundberg IE (2014) New insights into the benefits of exercise for muscle health in patients with idiopathic inflammatory myositis. Curr Rheumatol Rep 16(429):429. https://doi.org/10.1007/s11926-014-0429-4 CrossRefPubMed

36.

Nader GA, Dastmalchi M, Alexanderson H, Grundtman C, Gernapudi R, Esbjörnsson M, Wang Z, Rönnelid J, Hoffman EP, Nagaraju K, Lundberg IE (2010) A longitudinal, integrated, clinical, histological and mRNA profiling study of resistance exercise in myositis. Mol Med 16:455–464. https://doi.org/10.2119/molmed.2010.00016 CrossRefPubMedPubMedCentral

37.

Bohan A, Peter JB (1975) Polymyositis and dermatomyositis (first of two parts). N Engl J Med 292:344–347. https://doi.org/10.1056/NEJM197502132920706 CrossRefPubMed

38.

Bohan A, Peter JB (1975) Polymyositis and dermatomyositis (second of two parts). N Engl J Med 292:403–407. https://doi.org/10.1056/NEJM197502202920807 CrossRef

39.

Isenberg DA, Allen E, Farewell V, Ehrenstein MR, Hanna MG, Lundberg IE, Oddis C, Pilkington C, Plotz P, Scott D, Vencovsky J, Cooper R, Rider L, Miller F (2004) International consensus outcome measures for patients with idiopathic inflammatory myopathies. Development and initial validation of myositis activity and damage indices in patients with adult onset disease. Rheumatology (Oxford) 43:49–54. https://doi.org/10.1093/rheumatology/keg427 CrossRef

40.

Alexanderson H, Lundberg IE, Stenstrom CH (2002) Development of the myositis activities profile--validity and reliability of a self-administered questionnaire to assess activity limitations in patients with polymyositis/dermatomyositis. J Rheumatol 29:2386–2392PubMed

41.

Seltzer GB, Granger CV, Wineberg DE (1982) Functional assessment: bridge between family and rehabilitation medicine within an ambulatory practice. Arch Phys Med Rehabil 63:453–457PubMed

42.

Millard RW (1989) The functional assessment screening questionnaire: application for evaluating pain-related disability. Arch Phys Med Rehabil 70:303–307PubMed

43.

Alemo Munters L, van Vollenhoven RF, Alexanderson H (2011) Patient preference assessment reveals disease aspects not covered by recommended outcomes in polymyositis and dermatomyositis. ISRN Rheumatol 2011:463124. https://doi.org/10.5402/2011/463124, 1, 5

44.

Keith RA, Granger CV, Hamilton BB, Sherwin FS (1987) The functional independence measure: a new tool for rehabilitation. Adv Clin Rehabil 1:6–18PubMed

45.

Gandek B, Sinclair SJ, Kosinski M, Ware JEJ (2004) Psychometric evaluation of the SF-36 health survey in Medicare managed care. Health Care Financ Rev 25:5–25PubMedPubMedCentral

46.

Grimby A, Wiklund I (1994) Health-related quality of life in old age. A study among 76-year-old Swedish urban citizens. Scand J Soc Med 22:7–14CrossRefPubMed

47.

Tiffreau V, Ledoux I, Eymard B, Thévenon A, Hogrel JY (2007) Isokinetic muscle testing for weak patients suffering from neuromuscular disorders: a reliability study. Neuromuscul Disord 17:524–531. https://doi.org/10.1016/j.nmd.2007.03.014 CrossRefPubMed

48.

Backman E (1988) Methods for measurement of muscle function. Methodological aspects, reference values for children, and clinical applications. Scand J Rehabil Med Suppl 20:9–95PubMed

49.

Stoll T, Bruhlmann P, Stucki G et al (1995) Muscle strength assessment in polymyositis and dermatomyositis evaluation of the reliability and clinical use of a new, quantitative, easily applicable method. J Rheumatol 22:473–477PubMed

50.

Josefson A, Romanus E, Carlsson J (1996) A functional index in myositis. J Rheumatol 23:1380–1384PubMed

51.

Brooks D, Solway S, Gibbons WJ (2003) ATS statement on six-minute walk test. Am J Respir Crit Care Med 167:1287CrossRefPubMed

52.

Newcomer KL, Krug HE, Mahowald ML (1993) Validity and reliability of the timed-stands test for patients with rheumatoid arthritis and other chronic diseases. J Rheumatol 20:21–27PubMed

53.

Podsiadlo D, Richardson S (1991) The timed “up & go”: a test of basic functional mobility for frail elderly persons. J Am Geriatr Soc 39:142–148CrossRefPubMed

54.

Nordenskiold UM, Grimby G (1993) Grip force in patients with rheumatoid arthritis and fibromyalgia and in healthy subjects. A study with the Grippit instrument. Scand J Rheumatol 22:14–19CrossRefPubMed

55.

Borg GA (1982) Psychophysical bases of perceived exertion. Med Sci Sports Exerc 14:377–381

56.

Tiffreau V, Rannou F, Kopciuch F, Hachulla E, Mouthon L, Thoumie P, Sibilia J, Drumez E, Thevenon A (2017) Postrehabilitation functional improvements in patients with inflammatory myopathies: the results of a randomized controlled trial. Arch Phys Med Rehabil 98:227–234. https://doi.org/10.1016/j.apmr.2016.09.125 CrossRefPubMed

57.

Alexanderson H, Munters LA, Dastmalchi M, Loell I, Heimbürger M, Opava CH, Lundberg IE (2014) Resistive home exercise in patients with recent-onset polymyositis and dermatomyositis -- a randomized controlled single-blinded study with a 2-year followup. J Rheumatol 41:1124–1132. https://doi.org/10.3899/jrheum.131145 CrossRefPubMed

58.

Alemo Munters L, Dastmalchi M, Katz A, Esbjörnsson M, Loell I, Hanna B, Lidén M, Westerblad H, Lundberg IE, Alexanderson H (2013) Improved exercise performance and increased aerobic capacity after endurance training of patients with stable polymyositis and dermatomyositis. Arthritis Res Ther 15:R83. https://doi.org/10.1186/ar4263 CrossRefPubMedPubMedCentral

59.

Alemo Munters L, Dastmalchi M, Andgren V, Emilson C, Bergegård J, Regardt M, Johansson A, Orefelt Tholander I, Hanna B, Lidén M, Esbjörnsson M, Alexanderson H (2013) Improvement in health and possible reduction in disease activity using endurance exercise in patients with established polymyositis and dermatomyositis: a multicenter randomized controlled trial with a 1-year open extension followup. Arthritis Care Res (Hoboken) 65:1959–1968. https://doi.org/10.1002/acr.22068 CrossRef

60.

Wiesinger GF, Quittan M, Aringer M, Seeber A, Volc-Platzer B, Smolen J, Graninger W (1998) Improvement of physical fitness and muscle strength in polymyositis/dermatomyositis patients by a training programme. Br J Rheumatol 37:196–200CrossRefPubMed

61.

Wiesinger GF, Quittan M, Graninger M et al (1998) Benefit of 6 months long-term physical training in polymyositis/dermatomyositis patients. Br J Rheumatol 37:1338–1342CrossRefPubMed

62.

Mattar MA, Gualano B, Perandini LA, Shinjo SK, Lima FR, Sá-Pinto AL, Roschel H (2014) Safety and possible effects of low-intensity resistance training associated with partial blood flow restriction in polymyositis and dermatomyositis. Arthritis Res Ther 16(473). https://doi.org/10.1186/s13075-014-0473-5

63.

Mattar MA, Gualano B, Roschel H, Perandini LA, Dassouki T, Lima FR, Shinjo SK, de Sá Pinto AL (2014) Exercise as an adjuvant treatment in persistent active polymyositis. J Clin Rheumatol 20:11–15. https://doi.org/10.1097/RHU.0000000000000056 CrossRefPubMed

64.

Alexanderson H, Dastmalchi M, Esbjornsson-Liljedahl M et al (2007) Benefits of intensive resistance training in patients with chronic polymyositis or dermatomyositis. Arthritis Rheum 57:768–777. https://doi.org/10.1002/art.22780 CrossRefPubMed

65.

Varju C, Petho E, Kutas R, Czirjak L (2003) The effect of physical exercise following acute disease exacerbation in patients with dermato/polymyositis. Clin Rehabil 17:83–87. https://doi.org/10.1191/0269215503cr572oa CrossRefPubMed

66.

Alexanderson H, Stenstrom CH, Jenner G, Lundberg I (2000) The safety of a resistive home exercise program in patients with recent onset active polymyositis or dermatomyositis. Scand J Rheumatol 29:295–301CrossRefPubMed

67.

Alexanderson H, Stenstrom CH, Lundberg I (1999) Safety of a home exercise programme in patients with polymyositis and dermatomyositis: a pilot study. Rheumatology (Oxford) 38:608–611CrossRef

68.

Escalante A, Miller L, Beardmore TD (1993) Resistive exercise in the rehabilitation of polymyositis/dermatomyositis. J Rheumatol 20:1340–1344PubMed

Title: Physical therapy in adult inflammatory myopathy patients: a systematic review
Authors: Anna Van Thillo
Jean-Baptiste Vulsteke
Dieter Van Assche
Patrick Verschueren
Ellen De Langhe
Publication date: 01-08-2019
Publisher: Springer London
Keywords: Polymyositis
Diseases of the neuromuscular synapses and muscles
Polymyositis
Physical Therapy
Dermatomyositis
Myopathy
Published in: Clinical Rheumatology / Issue 8/2019
Print ISSN: 0770-3198
Electronic ISSN: 1434-9949
DOI: https://doi.org/10.1007/s10067-019-04571-9

Live Webinar | 27-06-2024 | 18:00 (CEST)

Keynote webinar | Spotlight on medication adherence

Reserve your place

Live: Thursday 27th June 2024, 18:00-19:30 (CEST)

WHO estimates that half of all patients worldwide are non-adherent to their prescribed medication. The consequences of poor adherence can be catastrophic, on both the individual and population level.

Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.

Prof. Kevin Dolgin

Prof. Florian Limbourg

Prof. Anoop Chauhan

Developed by: Springer Medicine

Obesity Clinical Trial Summary

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.

Developed by: Springer Medicine

Highlights from the ACC 2024 Congress

Year in Review: Pediatric cardiology

Pediatric Cardiology Video

Watch Dr. Anne Marie Valente present the last year's highlights in pediatric and congenital heart disease in the official ACC.24 Year in Review session.

Year in Review: Pulmonary vascular disease

Cardiopulmonary Comorbidity Video

The last year's highlights in pulmonary vascular disease are presented by Dr. Jane Leopold in this official video from ACC.24.

Year in Review: Valvular heart disease

Valvular Heart Disease Video

Watch Prof. William Zoghbi present the last year's highlights in valvular heart disease from the official ACC.24 Year in Review session.

Year in Review: Heart failure and cardiomyopathies

Heart Failure Video

Watch this official video from ACC.24. Dr. Biykem Bozkurt discusses last year's major advances in heart failure and cardiomyopathies.

ACC 2024 Congress Coverage

Year in Review: Heart failure and cardiomyopathies

Heart Failure Video

Watch this official video from ACC.24. Dr. Biykem Bozkurt discusses last year's major advances in heart failure and cardiomyopathies.

Watch now

Semaglutide benefits people with type 2 diabetes and obesity-related heart failure

16-04-2024 Type 2 Diabetes News

Incentivised to exercise

11-04-2024 Lifestyle Modifications News

New intervention for STEMI-related cardiogenic shock

10-04-2024 Myocardial Infarction News

» View more highlights on the ACC 2024 congress hub page

Image Credits

Illustration of figure on mountain summit/© Orapun / Stock.adobe.com, STEP AAG HeroTeaserCollection image/© Tarek / Generated with AI / Stock.adobe.com, ACC 2024 Pediatric and Congenital Heart Disease: Year in Review/© 2024 American College of Cardiology, ACC 2024 Pulmonary Vascular Disease: Year in Review/© 2024 American College of Cardiology, ACC 2024 Valvular Heart Disease: Year in Review/© 2024 American College of Cardiology, ACC 2024 HF and Cardiomyopathies: Year in Review/© 2024 American College of Cardiology, Woman out walking/© Seventyfour / stock.adobe.com (symbolic image with model), Woman checking smartwatch /© saltdium / stock.adobe.com (symbolic image with model), Cardiac catheterization/© Damian / stock.adobe.com

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Please log in to get access to this content

Other articles of this Issue 8/2019

Patients with early-stage knee osteoarthritis and knee pain have decreased hip abductor muscle strength while descending stairs

Ankylosing spondylitis is associated with aberrant DNA methylation of IFN regulatory factor 8 gene promoter region

Serum KL-6 is associated with the severity of interstitial lung disease in Chinese patients with polymyositis and dermatomyositis

Efficacy and safety profile of intravenous tocilizumab versus intravenous abatacept in treating female Saudi Arabian patients with active moderate-to-severe rheumatoid arthritis

Burden of comorbidities in South Africans with systemic lupus erythematosus

Changing rate of serious infections in biologic-exposed rheumatoid arthritis patients. Data from South American registries BIOBADABRASIL and BIOBADASAR

Live: Thursday 27th June 2024, 18:00-19:30 (CEST)

Highlights from the ACC 2024 Congress

ACC 2024 Congress Coverage