Clin Med Insights Arthritis Musculoskelet Disord
· 2014 · PMID 24596471
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We retrospectively evaluated the effectiveness of prolotherapy in resolving pain, stiffness, and crepitus, and improving physical activity in consecutive chondromalacia patients from February 2008 to September 2009. Sixt...We retrospectively evaluated the effectiveness of prolotherapy in resolving pain, stiffness, and crepitus, and improving physical activity in consecutive chondromalacia patients from February 2008 to September 2009. Sixty-nine knees that received prolotherapy in 61 patients (33 female and 36 male) who were 18-82 years old (average, 47.2 years) were enrolled. Patients received 24 prolotherapy injections (15% dextrose, 0.1% procaine, and 10% sarapin) with a total of 40 cc in the anterior knee. At least 6 weeks after their last prolotherapy session, patients provided self-evaluation of knee pain upon rest, activities of daily living (ADL) and exercise, range of motion (ROM), stiffness, and crepitus. Symptom severity, sustained improvement of symptoms, number of pain pills needed, and patient satisfaction before treatment and improvement after treatment were recorded. Following prolotherapy, patients experienced statistically significant decreases in pain at rest, during ADL, and exercise. Stiffness and crepitus decreased after prolotherapy, and ROM increased. Patients reported improved walking ability and exercise ability after prolotherapy. For daily pain level, ROM, daily stiffness, crepitus, and walking and exercise ability, sustained improvement of over 75% was reported by 85% of patients. Fewer patients required pain medication. No side effects of prolotherapy were noted. The average length of time from last prolotherapy session was 14.7 months (range, 6 months to 8 years). Only 3 of 16 knees were still recommended for surgery after prolotherapy. Prolotherapy ameliorates chondromalacia patella symptoms and improves physical ability. Patients experience long-term improvement without requiring pain medications. Prolotherapy should be considered a first-line, conservative therapy for chondromalacia patella.
Fahlman L, Sangeorzan E, Chheda N
… +1 more, Lambright D
Clin Med Insights Arthritis Musculoskelet Disord
· 2014 Jan · PMID 24453501
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This study describes knee alignment and active knee range of motion (ROM) in a community-based group of 78-year old adults (n = 143) who did not have radiographic evidence of knee osteoarthritis in either knee (KL < 2)....This study describes knee alignment and active knee range of motion (ROM) in a community-based group of 78-year old adults (n = 143) who did not have radiographic evidence of knee osteoarthritis in either knee (KL < 2). Although knee malalignment is a risk factor for knee osteoarthritis, most women and men had either valgus or varus alignments. Notably, no men were valgus in both knees. Women with both knees valgus had significantly greater body mass index (P > 0.001) than women with varus or straight knees. Men and women with valgus or varus knee alignments had generally lower ROM than individuals with both knees straight. In summary, this study highlights the complex relationships among knee alignment, ROM, body mass index, and gender in elderly adults without radiographic knee osteoarthritis.
Clarson LE, Nicholl BI, Bishop A
… +3 more, Edwards JJ, Daniel R, Mallen CD
Clin Med Insights Arthritis Musculoskelet Disord
· 2013 · PMID 24324351
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BACKGROUND: Despite being a highly prevalent chronic condition managed predominantly in primary care and unlike other chronic conditions, osteoarthritis (OA) care is delivered on an ad hoc basis rather than through routi...BACKGROUND: Despite being a highly prevalent chronic condition managed predominantly in primary care and unlike other chronic conditions, osteoarthritis (OA) care is delivered on an ad hoc basis rather than through routine structured review. Evidence suggests current levels of OA care are suboptimal, but little is known about what general practitioners' (GPs) consider important in OA care, and, thus, the scope to improve inconsistency or poor practice is, at present, limited. OBJECTIVES: We investigated GPs' views on and practice of monitoring OA. METHODS: This was a cross-sectional postal survey of 2500 practicing UK GPs randomly selected from the Binley's database. Respondents were asked if monitoring OA patients was important and how monitoring should be undertaken. RESULTS: Responses were received from 768 GPs of whom 70.8% were male and 89.5% were principals within their practices. Despite 55.4% (n = 405) indicating monitoring patients with OA was important and 78.3% (n = 596) considering GPs the appropriate professionals to monitor OA, only 15.2% (n = 114) did so routinely, and 45% (n = 337) did not monitor any OA patients at all. In total, 61.4% (n = 463) reported that patients should self-monitor. Respondents favored monitoring physical function, pain, and analgesia use over monitoring measures of BMI, self management plans, and exercise advice. CONCLUSIONS: The majority of respondents felt that monitoring OA was important, but this was not reflected in their reported current practice. Much of what they favored for monitoring was in line with published guidance, suggesting provision of suboptimal care does not result from lack of knowledge and interventions to improve OA care must address barriers to GPs engaging in optimal care provision.
Clin Med Insights Arthritis Musculoskelet Disord
· 2013 · PMID 24250235
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Anatabine is a Solanaceae plant family alkaloid marketed in the United States as a dietary supplement. It has demonstrated anti-inflammatory effects in vivo and in vitro, and may be useful for musculoskeletal aches and p...Anatabine is a Solanaceae plant family alkaloid marketed in the United States as a dietary supplement. It has demonstrated anti-inflammatory effects in vivo and in vitro, and may be useful for musculoskeletal aches and pains. The purpose of this internet-based survey study was to provide more information about anatabine users who report benefits for joint pain or stiffness. Of the 282 survey respondents, 232 (82%) reported a benefit from anatabine supplementation for one or more joint pain conditions, most commonly the knee, wrists/hands/fingers, shoulder, and back, most often due to osteoarthritis or injury to the joint. Mean scores of joint pain and stiffness were significantly (P < 0.0001) reduced after starting anatabine supplementation, and for most respondents joint pain was virtually eliminated. Around 90% of all individuals rated the effect of anatabine supplementation as good or excellent for joint pain, stiffness, functionality, and overall effects. These results provide evidence that anatabine supplementation can lead to substantial improvement of musculoskeletal aches, pains, and stiffness, and can provide benefits in some individuals for various medical conditions in multiple joint locations.
Clin Med Insights Arthritis Musculoskelet Disord
· 2013 · PMID 24046512
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Regenerative therapeutic strategies for joint diseases usually employ either enriched concentrates of bone marrow-derived stem cells, chondrogenic preparations such as platelet-rich plasma, or irritant solutions such as...Regenerative therapeutic strategies for joint diseases usually employ either enriched concentrates of bone marrow-derived stem cells, chondrogenic preparations such as platelet-rich plasma, or irritant solutions such as hyperosmotic dextrose. In this case series, we describe our experience with a simple, cost-effective regenerative treatment using direct injection of unfractionated whole bone marrow (WBM) into osteoarthritic joints in combination with hyperosmotic dextrose. Seven patients with hip, knee or ankle osteoarthritis (OA) received two to seven treatments over a period of two to twelve months. Patient-reported assessments were collected in interviews and by questionnaire. All patients reported improvements with respect to pain, as well as gains in functionality and quality of life. Three patients, including two whose progress under other therapy had plateaued or reversed, achieved complete or near-complete symptomatic relief, and two additional patients achieved resumption of vigorous exercise. These preliminary findings suggest that OA treatment with WBM injection merits further investigation.
Clin Med Insights Arthritis Musculoskelet Disord
· 2013 · PMID 24027421
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We conducted a systematic review and meta-analysis of randomized saline-controlled trials to determine the safety and efficacy of US-approved intra-articular hyaluronic acid (IAHA) injections for symptomatic knee osteoar...We conducted a systematic review and meta-analysis of randomized saline-controlled trials to determine the safety and efficacy of US-approved intra-articular hyaluronic acid (IAHA) injections for symptomatic knee osteoarthritis. A total of 29 studies representing 4,866 unique subjects (IAHA: 2,673, saline: 2,193) were included. IAHA injection resulted in very large treatment effects between 4 and 26 weeks for knee pain and function compared to pre-injection values, with standardized mean difference (SMD) values ranging from 1.07-1.37 (all P < 0.001). Compared to saline controls, SMDs with IAHA ranged from 0.38-0.43 for knee pain and 0.32-0.34 for knee function (all P < 0.001). There were no statistically significant differences between IAHA and saline controls for any safety outcome, including serious adverse events (SAEs) (P = 0.12), treatment-related SAEs (P = 1.0), study withdrawal (P = 1.0), and AE-related study withdrawal (P = 0.46). We conclude that intra-articular injection of US-approved HA products is safe and efficacious in patients with symptomatic knee osteoarthritis.
Al Kaissi A, Ben Chehida F, Kenis V
… +5 more, Ganger R, Radler C, Hofstaetter JG, Klaushofer K, Grill F
Clin Med Insights Arthritis Musculoskelet Disord
· 2013 · PMID 24023524
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PURPOSE: Cleidocranial dysplasia is an autosomal dominant disorder characterized by defective ossification of the intramembraneous ossification (primarily the clavicles, cranium, and pelvis), and it is caused by mutation...PURPOSE: Cleidocranial dysplasia is an autosomal dominant disorder characterized by defective ossification of the intramembraneous ossification (primarily the clavicles, cranium, and pelvis), and it is caused by mutations in the RUNX2 gene that is responsible for osteoblast differentiation. Spine deformities were of progressive nature and considered to be the major orthopedic abnormalities encountered in our practice in patients with cleidocranial dysplasia. We aimed to further delineate the underlying spine pathology and its etiological understanding. Extraspinal deformities were dealt with respectively. MATERIAL AND METHODS: In this paper, we describe 7 patients who were consistent with the phenotypic and the genotypic characterization of cleidocranial dysplasia. Reformatted computed tomography (CT) scans have been applied in several instances to further understand the underlying pathology of progressive spine tilting. Radiographs were sufficient to illustrate other skeletal malformations. RESULTS: Anatomical survey demonstrates that a broad spectrum of frequently unrecognized orthopedic aberrations were encountered. We believe that torticollis has evolved in connection with the persistence of synchondrosis of the skull base and the upper cervical spine and these are strongly correlated to the well-known pathology of posterior occipital synchondrosis. Similarly, scoliosis and kyphoscoliosis resulted from the pathologic aberration of the cartilaginous stage of disrupted embryological development. All our results are discussed for the first time. Coxa vara, patellar dysplasia, and genu valgum were observed as extraspinal deformities. CONCLUSION: This paper includes for the first time the anatomical analysis of the malformation complex of the craniocervical and the entire spine in patients with cleidocranial dysplasia. Reformatted CT scan was the modality of choice. We were able to illustrate that the persistence of skull base and the cervical spine synchondrosis were correlated with the pathological mechanism of the posterior occipital synchondrosis. Therefore, injuries to the craniocervical region in these patients might lead to a wide range of dreadful complications, ranging from complete atlanto-occipital or atlanto-axial dislocation to nondisplaced occipital condyle avulsion fractures with the possibility of morbid and or mortal outcome. On the other hand, the persistence of a cartilaginous spine was the reason behind the progressive spine tilting. This pathological form can be considered as a notoriously unpredictable malformation complex. The value of presenting these patients is to demonsterate that the genotype is not a precise index to assess the severity and the natural history of the phenotype.
Clin Med Insights Arthritis Musculoskelet Disord
· 2013 · PMID 23997576
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Drugs form the mainstay of therapy in rheumatoid arthritis (RA). Five main classes of drugs are currently used: analgesics, non-steroidal anti-inflammatories (NSAIDs), glucocorticoids, nonbiologic and biologic disease-mo...Drugs form the mainstay of therapy in rheumatoid arthritis (RA). Five main classes of drugs are currently used: analgesics, non-steroidal anti-inflammatories (NSAIDs), glucocorticoids, nonbiologic and biologic disease-modifying antirheumatic drugs. Current clinical practice guidelines recommend that clinicians start biologic agents if patients have suboptimal response or intolerant to one or two traditional disease modifying agents (DMARDs). Methotrexate, sulfasalazine, leflunomide and hydroxychloroquine are the commonly used DMARDs. Currently, anti-TNF is the commonly used first line biologic worldwide followed by abatacept and it is usually combined with MTX. There is some evidence that tocilizumab is the most effective biologic as a monotherapy agent. Rituximab is generally not used as a first line biologic therapy due to safety issues but still as effective as anti-TNF. The long term data for the newer oral small molecule biologics such as tofacitinib is not available and hence used only as a last resort.
Uçar D, Em S, Bozkurt M
… +5 more, Oktayoglu P, Yüksel HK, Caglayan M, Gezer O, Nas K
Clin Med Insights Arthritis Musculoskelet Disord
· 2013 · PMID 23966806
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The aim of the present study was to emphasize the collagen turnover in 2 of the most common chronic inflammatory rheumatic diseases by evaluating serum prolidase activity (SPA) in ankylosing spondylitis (AS) and rheumato...The aim of the present study was to emphasize the collagen turnover in 2 of the most common chronic inflammatory rheumatic diseases by evaluating serum prolidase activity (SPA) in ankylosing spondylitis (AS) and rheumatoid arthritis (RA). 30 patients who met the modified New York Criteria for the classification of AS, 29 patients who met the 2010 Rheumatoid Arthritis Classification Criteria for the classification of RA, and 31 healthy controls were enrolled in the study. Serum samples of the patients and the controls were collected and SPA was measured by a spectrophotometric method. The comparison of the SPA in these 3 groups was statistically examined. In both patient groups, the SPA was lower than in the control group. SPA in patients with AS was statistically significantly lower than in the control and RA groups (P < 0.001/P = 0.002). No statistically significant difference was found between the RA and the control groups (P = 0.891). In conclusion, lower SPA is presumably associated with decreased collagen turnover and fibrosis, leading to decreased physical functions in both chronic inflammatory musculoskeletal diseases.
Clin Med Insights Arthritis Musculoskelet Disord
· 2013 · PMID 23761985
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The purpose of this study was to (1) evaluate joint pain and function in knee osteoarthritis (OA) patients treated with a joint-sparing, extracapsular implant and (2) identify patient characteristics that influenced clin...The purpose of this study was to (1) evaluate joint pain and function in knee osteoarthritis (OA) patients treated with a joint-sparing, extracapsular implant and (2) identify patient characteristics that influenced clinical outcomes. This study included 99 patients with symptomatic medial knee OA refractory to conservative care who were treated with the KineSpring Knee Implant System and followed for a mean of 17 months (range, 1.5 to 48 months). All devices were successfully implanted and activated with no intraoperative complications. Statistically significant mean improvements of 56%, 50%, and 38% were observed for Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) Pain, Function, and Stiffness scales, respectively (all P < 0.001). Regardless of gender, age group, body mass index classification, or disease severity, all WOMAC domain scores significantly improved during the postoperative follow-up period. WOMAC clinical success rates were 77.8% for Pain, 77.8% for Function, and 68.7% for Stiffness. Neither gender, age group, body mass index classification, nor disease severity predicted clinical success in any WOMAC domain. In conclusion, the KineSpring System yields clinically meaningful improvements in joint pain and function in patients with medial knee OA. Additionally, unlike joint-altering procedures such as knee arthroplasty or high tibial osteotomy, patient characteristics had little association with postoperative clinical outcomes.
Al-Bishri J, Attar S, Bassuni N
… +4 more, Al-Nofaiey Y, Qutbuddeen H, Al-Harthi S, Subahi S
Clin Med Insights Arthritis Musculoskelet Disord
· 2013 · PMID 23645988
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Comorbid conditions play a pivotal role in rheumatoid arthritis management and outcomes. We estimated the percentage of comorbid illness among rheumatoid arthritis patients and explored the relationship between this como...Comorbid conditions play a pivotal role in rheumatoid arthritis management and outcomes. We estimated the percentage of comorbid illness among rheumatoid arthritis patients and explored the relationship between this comorbidity and different prescriptions. A cross-sectional study of patients with rheumatoid arthritis in three centers in Saudi Arabia was carried out. Comorbidity and antirheumatoid medication regimens prescribed were recorded on a specially designed Performa. The association between comorbidity and different drugs was analyzed. A total of 340 patients were included. The most comorbidities were hypertension 122 (35.9%), diabetes 105 (30.9%), osteoporosis 88 (25.8%), and dyslipidemia in 66 (19.4). The most common drug prescribed was prednisolone in 275 (80.8%) patients followed by methotrexate in 253 (74.4%) and biological therapy in 142 (41.5%) patients. Glucocorticoids were prescribed considerably more frequently in hypertensive and diabetic patients as well as in patients with osteoporosis and dyslipidemia. Most patients with rheumatoid arthritis suffered from comorbid diseases.
Al Kaissi A, Zwettler E, Ganger R
… +3 more, Schreiner S, Klaushofer K, Grill F
Clin Med Insights Arthritis Musculoskelet Disord
· 2013 · PMID 23399831
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BACKGROUND: A leptosomic body type is tall and thin with long hands. Marfanoid features may be familial in nature or pathological, as occurs in congenital contractual arachnodactyly (Beal's syndrome) and Shprintzen-Goldb...BACKGROUND: A leptosomic body type is tall and thin with long hands. Marfanoid features may be familial in nature or pathological, as occurs in congenital contractual arachnodactyly (Beal's syndrome) and Shprintzen-Goldberg syndrome mimicking some of the changes of Marfan syndrome, although not accompanied by luxation of lens and dissecting aneurysm of aorta. METHODS: In this article we collected eight patients who were consistent with the diagnosis of Marfan syndrome via phenotypic and genotypic characterization. RESULTS: Our patients manifested a constellation of variable presentations of musculo-skeletal abnormalities ranging from developmental dysplasia of the hip, protrusio acetabuli, leg length inequality, patellar instability, scoliosis, to early onset osteoarthritis. Each abnormality has been treated accordingly. CONCLUSION: This is the first paper which includes the diagnosis and the management of the associated musculo-skeletal abnormalities in patients with Marfan syndrome, stressing that patients with Marfan syndrome are exhibiting great variability in the natural history and the severity of musculo-skeletal abnormalities.
Bhandari M, Smith J, Miller LE
… +1 more, Block JE
Clin Med Insights Arthritis Musculoskelet Disord
· 2012 · PMID 23239930
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Surgery is indicated for symptomatic knee osteoarthritis (OA) when conservative measures are unsuccessful. High tibial osteotomy (HTO), unicompartmental knee arthroplasty (UKA), and total knee arthroplasty (TKA) are surg...Surgery is indicated for symptomatic knee osteoarthritis (OA) when conservative measures are unsuccessful. High tibial osteotomy (HTO), unicompartmental knee arthroplasty (UKA), and total knee arthroplasty (TKA) are surgical options intended to relieve knee OA pain and dysfunction. The choice of surgical intervention is dependent on several factors such as disease location, patient age, comorbidities, and activity levels. Regardless of surgical treatment, complications such as infection, loosening or lysis, periprosthetic fracture, and postoperative pain are known risks and are indications for revision surgery. The clinical and economic implications for revision surgery are underappreciated. Over 55,000 revision surgeries were performed in 2010 in the US, with 48% of these revisions in patients under 65 years. Total costs associated with each revision TKA surgery have been estimated to be in excess of $49,000. The current annual economic burden of revision knee OA surgery is $2.7 billion for hospital charges alone. By 2030, assuming a 5-fold increase in the number of revision procedures, this economic burden will exceed $13 billion annually. It is appealing to envision a therapy that could delay or obviate the need for arthroplasty. From an actuarial standpoint, this would have the theoretical downstream effect of substantially reducing the number of revision procedures. Although no known therapies currently meet these criteria, such a breakthrough would have a tremendous impact in lessening the clinical and economic burden of knee OA revision surgery.
Shimojima Y, Ishii W, Matsuda M
… +1 more, Ikeda S
Clin Med Insights Arthritis Musculoskelet Disord
· 2012 · PMID 23115480
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OBJECTIVE: To investigate peripheral blood lymphocyte subpopulations, particularly helper T (Th) cells and cytokine expression before and after treatment in polymyositis (PM) and dermatomyositis (DM). PATIENTS AND METHOD...OBJECTIVE: To investigate peripheral blood lymphocyte subpopulations, particularly helper T (Th) cells and cytokine expression before and after treatment in polymyositis (PM) and dermatomyositis (DM). PATIENTS AND METHODS: Ten patients with PM and 15 with DM were enrolled in this study. As a control we used 11 age-matched healthy subjects. We analyzed peripheral blood lymphocytes using flow cytometry. Serum cytokines were determined by enzyme-linked immunosorbent assay. RESULTS: Th2/Th1 and Th2/Th17 ratios were significantly higher in both PM and DM than in controls and this Th2-predominancy is marked in DM associated with interstitial pneumonia. IL-1β, IL-6 and TGF-β were significantly higher in both PM and DM and IL-4 showed a significant increase in DM when compared to controls. There was no significant correlation between either any lymphocyte subpopulations or serum cytokines and clinical severity markers such as the manual muscle strength test, serum creatine kinase, and the total CT score. Th2/Th17 in both PM and DM, as well as Th2/Th1 in the latter, significantly decreased after clinical remission compared with before treatment. CONCLUSIONS: Th2-predominancy as shown by the increase in Th2/Th1 and Th2/Th17 ratios may suggest active disease in PM/DM but does not reflect clinical severity.
Clin Med Insights Arthritis Musculoskelet Disord
· 2012 · PMID 22952417
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BACKGROUND: Dupuytren's contracture (DC) and HFE hemochromatosis occur in some of the same at-risk populations and present with similar comorbid conditions. METHODS: We estimated DC prevalence in two cohorts of white Ala...BACKGROUND: Dupuytren's contracture (DC) and HFE hemochromatosis occur in some of the same at-risk populations and present with similar comorbid conditions. METHODS: We estimated DC prevalence in two cohorts of white Alabama hemochromatosis probands (294 C282Y homozygotes, 67 C282Y/H63D compound heterozygotes) in a retrospective study. We performed logistic regressions on DC using the following independent variables: age, body mass index, heavy ethanol consumption, serum ferritin, elevated serum AST/ALT, non-alcoholic fatty liver disease, viral hepatitis, cirrhosis, and diabetes. RESULTS: One man and two women with C282Y homozygosity had DC (prevalence 1.02%; 95% CI 0.35%-2.96%). A man with C282Y/H63D had DC (prevalence 1.49%; 95% CI 0.26%-7.98%). DC occurred as an autosomal dominant trait in his kinship. In regression analyses, no single variable predicted DC. We observed no new DC cases after the diagnosis of hemochromatosis (mean follow-up 12.9 ± 7.5 years (1 SD), and 9.0 ± 5.1 years, respectively). CONCLUSIONS: Our prevalence estimates of DC in white Alabama hemochromatosis probands are similar to those found in the white US population cohorts. DC risk was unrelated to the variables we studied.
Clin Med Insights Arthritis Musculoskelet Disord
· 2012 · PMID 22837646
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In order to determine the clinical significance of Kikuchi Fujimoto Disease (histiocytic necrotizing lymhadenitis) and to review the literature available on this condition, we selected the Medicine research papers in Eng...In order to determine the clinical significance of Kikuchi Fujimoto Disease (histiocytic necrotizing lymhadenitis) and to review the literature available on this condition, we selected the Medicine research papers in English language published between the years 1972 to 2011.Kikuchi Fujimoto Disease (KFD) is an uncommon, cosmopolitan, benign and self-limiting condition with higher Japanese and Asian prevalence. Most of the sufferers of KFD are young people who seek treatment because of having acute tender cervical lymphadenopathy, low grade fever and night sweats. Coagulative necrosis with ample karyorrhetic debris in paracortical areas of the involved lymph nodes is the characteristic histologic feature of KFD. Diagnosing KFD is crucial as it can be mistaken for malignant lymphoma and SLE.KFD was put forth first time in 1972 by Dr. Masahiro Kikuchi and by Funimoto as lymphadenitis with reticular proliferation, histiocytes and abundant nuclear debris. It is a rare benign condition of lymph nodes and most of the clinicians and pathologists are unfamiliar with it. KFD is self-limiting disease (within 1 to 4 months), however, patients should be followed up regularly as it may crop up again or progress to SLE. Analgesics and antipyretics help to ameliorate the symptoms.
Koca K, Ekinci S, Ege T
… +4 more, Ozyurek S, Kurklu M, Battal B, Basbozkurt M
Clin Med Insights Arthritis Musculoskelet Disord
· 2012 · PMID 22798724
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In this paper, we report a case of a 23-year-old male patient with bilateral absence of the flexor pollicis brevis and abductor pollicis brevis muscles with an intact functioning opponens pollicis and flexor pollicis lon...In this paper, we report a case of a 23-year-old male patient with bilateral absence of the flexor pollicis brevis and abductor pollicis brevis muscles with an intact functioning opponens pollicis and flexor pollicis longus muscles with bilateral thenar atrophy due to its rarity. All physical, neurological, ultrasonographic, direct radiographic, electromyographic and MRI studies were used to confirm and document this congenital anomaly.
Jamal AB, Salma AH, Wafa AS
… +2 more, Ghadah A, Roaa A
Clin Med Insights Arthritis Musculoskelet Disord
· 2012 · PMID 22798723
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OBJECTIVE: To determine the appropriateness (both indications and adequate dosage regimen via creatinine clearance estimation) of allopurinol by physicians of different specialties in a tertiary care centre. PATIENTS AND...OBJECTIVE: To determine the appropriateness (both indications and adequate dosage regimen via creatinine clearance estimation) of allopurinol by physicians of different specialties in a tertiary care centre. PATIENTS AND METHODS: In this cross sectional study computerized clinical records of 156 adult patients who were prescribed allopurinol from 12th November to 11th December, 2011 were retrieved from Al Hada Hospital Taif Saudi Arabia. Main outcome variables were approprsiate indications of allopurinol, prescribing physician's specialty, and dosage of allopurinol. The prescribed dosages were categorized into correct and incorrect dose adjustments based on creatinine clearance estimation. The SPSS version 16 was utilized for data analyses. RESULTS: The mean (±SD) age was 58.15 (±14.99) years. There were 105 (67.3%) males and 51 (32.7%) females with male to female ratio being 2:1. Allopurinol was frequently prescribed by nephrologists and family physicians in this study. Out of 156 patients, 46 (29.5%) patients received allopurinol with appropriate indications. Eighty-five (54.5%) patients were received allopurinol without dose adjustment based on their creatinine clearance estimation; among them, 21 (13.5%) received allopurinol with appropriate indications. CONCLUSION: The inappropriate use of allopurinol (both the indication and prescribed dosage) is still a major problem in a large tertiary care centre. Furthermore, the specialty of physicians is also a contributory factor in this inappropriateness.
Shimojima Y, Ishii W, Matsuda M
… +4 more, Katoh N, Tazawa K, Sekijima Y, Ikeda S
Clin Med Insights Arthritis Musculoskelet Disord
· 2012 · PMID 22442637
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OBJECTIVE: To investigate clinical effectiveness of prednisolone (PSL) and cyclosporin A (CyA), particularly continuous intravenous administration of the latter, in patients with interstitial pneumonia (IP) associated wi...OBJECTIVE: To investigate clinical effectiveness of prednisolone (PSL) and cyclosporin A (CyA), particularly continuous intravenous administration of the latter, in patients with interstitial pneumonia (IP) associated with polymyositis/dermatomyositis (PM/DM). METHODS: We reviewed the clinical findings and therapeutic outcomes of patients with PM/DM who had received PSL and CyA (PSL + CyA, n = 21 for DM and 2 for PM) or the former alone (n = 12 for DM and 7 for PM). All patients receiving PSL + CyA had active IP. RESULTS: Fifteen of the 21 DM patients receiving PSL + CyA showed favorable therapeutic outcomes of IP (recovery group), while the remaining 6 died of respiratory failure (death group). Before treatment PaO(2) in room air and %VC were significantly lower, and the total CT score was significantly higher in the death group than in the recovery one. Continuous intravenous administration of CyA was performed in 6 patients for severe IP requiring oxygen therapy, and of these 2 showed complete recovery from it. CONCLUSIONS: Coadministration of PSL and CyA, particularly continuous intravenous infusion of the latter, from the early phase of illness may be a potent therapeutic option for PM/DM patients with decreases in PaO(2) and %VC and/or a high total CT score suggestive of a poor prognosis.
Ogata A, Hirano T, Hishitani Y
… +1 more, Tanaka T
Clin Med Insights Arthritis Musculoskelet Disord
· 2012 · PMID 22438671
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Because of the pathological role of IL-6 in rheumatoid arthritis (RA), tocilizumab (TCZ), a humanized anti-IL-6 receptor monoclonal antibody, was expected to improve inflammation and joint destruction of RA. Indeed, rand...Because of the pathological role of IL-6 in rheumatoid arthritis (RA), tocilizumab (TCZ), a humanized anti-IL-6 receptor monoclonal antibody, was expected to improve inflammation and joint destruction of RA. Indeed, randomized clinical trials demonstrated the clinical efficacy of TCZ as monotherapy or combined with methotrexate (MTX) for RA patients with inadequate responses to disease-modifying antirheumatic drugs, MTX or tumor necrosis factor (TNF) inhibitors. Although long-term tolerability for TCZ is superior to that for TNF inhibitors, information regarding the potency of drug free remission of TCZ is limited at present. In terms of its safety profile, the general risk of infection when using TCZ is comparable to that of TNF inhibitors. TCZ has some advantage in RA patients who can not use MTX and are non-responders to TNF inhibitors. In conclusion, TCZ is one of the most prospective next generation biologics for the treatment of RA.