Clinical Medicine Insights. Arthritis And Musculoskeletal Disorders[JOURNAL]
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200 papers
Adult-Onset Still's Disease in an Elderly Patient Presenting as Aseptic Meningitis: A Case Report.
Risal U, Dhungana K, Ghimire M
Clin Med Insights Arthritis Musculoskelet Disord · 2023 · PMID 37641791 · Full text
Adult-onset Still's disease (AOSD) is a rare auto-inflammatory disease of unknown origin characterized mainly by fever, arthritis, and a rash. Aseptic meningitis is a rare complication of AOSD and is seen most commonly i...
Adult-onset Still's disease (AOSD) is a rare auto-inflammatory disease of unknown origin characterized mainly by fever, arthritis, and a rash. Aseptic meningitis is a rare complication of AOSD and is seen most commonly in young adults. Here, we report a case of AOSD in a 78-year female with fever and altered sensorium with lymphocyte predominant pleocytosis in the cerebrospinal fluid who was initially managed as tubercular meningitis. Adult-onset Still's disease was diagnosed as there was no response to antitubercular drugs even after 3 months and based on persistent fever, inflammatory arthritis, rash, and highly raised inflammatory markers.
Spondyloarthropathies That Mimic Ankylosing Spondylitis: A Narrative Review.
Tanios M, Brickman B, Norris J … +5 more , Ravi S, Eren E, McGarvey C, Morris DJ, Elgafy H
Clin Med Insights Arthritis Musculoskelet Disord · 2023 · PMID 37533960 · Full text
Ankylosing spondylitis is the most common type of seronegative inflammatory spondyloarthropathy often presenting with low back or neck pain, stiffness, kyphosis and fractures that are initially missed on presentation; ho...
Ankylosing spondylitis is the most common type of seronegative inflammatory spondyloarthropathy often presenting with low back or neck pain, stiffness, kyphosis and fractures that are initially missed on presentation; however, there are other spondyloarthropathies that may present similarly making it a challenge to establish the correct diagnosis. Here, we will highlight the similarities and unique features of the epidemiology, pathophysiology, presentation, radiographic findings, and management of seronegative inflammatory and metabolic spondyloarthropathies as they affect the axial skeleton and mimic ankylosing spondylitis. Seronegative inflammatory spondyloarthropathies such as psoriatic arthritis, reactive arthritis, noninflammatory spondyloarthropathies such as diffuse idiopathic skeletal hyperostosis, and ochronotic arthritis resulting from alkaptonuria can affect the axial skeleton and present with symptoms similar those of ankylosing spondylitis. These similarities can create a challenge for providers as they attempt to identify a patient's condition. However, there are characteristic radiographic findings and laboratory tests that may help in the differential diagnosis. Axial presentations of seronegative inflammatory, non-inflammatory, and metabolic spondyloarthropathies occur more often than previously thought. Identification of their associated symptoms and radiographic findings are imperative to effectively diagnose and properly manage patients with these diseases.
Relationship Between Serum Vitamin D Level and Disease Severity in Rheumatoid Arthritis.
Soltani Bajestani F, Khajavian N, Salarbashi D … +3 more , Kafili M, Ashori F, Hajavi J
Clin Med Insights Arthritis Musculoskelet Disord · 2023 · PMID 37434995 · Full text
BACKGROUND AND OBJECTIVE: Rheumatoid arthritis is an autoimmune disease that causes joint pain and reduces daily activities. The aim of this study was to evaluate the serum of vitamin D and its relationship with the seve...
BACKGROUND AND OBJECTIVE: Rheumatoid arthritis is an autoimmune disease that causes joint pain and reduces daily activities. The aim of this study was to evaluate the serum of vitamin D and its relationship with the severity of the disease in patients with rheumatoid arthritis referred to Allameh Hehlool hospital in Gonabad. DESIGN AND METHODS: This cross-sectional-analytical study was performed on 92 patients referred to the rheumatology clinic of Allameh Behlool Gonabad Hospital in 2021. After obtaining the permission of the ethics committee, the samples were selected based on the desired criteria. Serum vitamin D levels in patients were measured, and data were collected using a patient information checklist and DAS28-CRP activity questionnaire. Data were analyzed using SPSS software version 16 and using statistically appropriate tests at a significance level less than 5%. RESULTS: The mean age of the patients was 53.05 ± 12.33 years and most of them (58.7%) were women. Serum vitamin D level was sufficient in 65.2% of patients and the severity of the disease was in the remission in 48.9% of them. The results of chi-square test showed a significant relationship between serum vitamin D levels and disease severity in patients ( < .001). CONCLUSIONS: Serum vitamin D levels were inversely related to disease severity and in most patients with severe disease severity, serum vitamin D levels were inadequate. vitamin D supplementation is recommended in patients with rheumatoid arthritis.
Hughes-Stovin Syndrome: An Experience of Management of 3 Cases From a Tertiary Health Care Centre.
Sachdev G, Yadav S, Balakrishnan C … +1 more , Nanavati R
Clin Med Insights Arthritis Musculoskelet Disord · 2023 · PMID 37200981 · Full text
Three young males with Hugh-Stovin's syndrome presented with cough, haemoptysis, fever, raised inflammatory markers, and pulmonary artery aneurysm. Only one had recurrent oral ulcers suggestive of Behcet's disease, and n...
Three young males with Hugh-Stovin's syndrome presented with cough, haemoptysis, fever, raised inflammatory markers, and pulmonary artery aneurysm. Only one had recurrent oral ulcers suggestive of Behcet's disease, and none were HLA B51 positive. All responded well to immunosuppression but eventually needed either an endovascular procedure or surgery.
Sarcoidosis Mimicking a Malignant Metastatic Disease.
El Hasbani G, El Saghir N, Moukaddam H … +3 more , Farhat L, Shabb N, Uthman I
Clin Med Insights Arthritis Musculoskelet Disord · 2023 · PMID 37152614 · Full text
Sarcoidosis can have pulmonary and extrapulmonary clinical manifestations depending on the organ of involvement. Because multiple organs are involved by the disease, sarcoid can mimic metastatic diseases. Whenever clinic...
Sarcoidosis can have pulmonary and extrapulmonary clinical manifestations depending on the organ of involvement. Because multiple organs are involved by the disease, sarcoid can mimic metastatic diseases. Whenever clinical and radiological clues of metastasis are present, differentials other than cancer should not be missed. Herein, we present a case of a middle aged gentleman who presented to the oncology clinic for 1-month history of low back pain associated with a dry cough along with radiological findings of metastatic disease involving the lungs, liver, lymph nodes, axial spine, and adrenal gland. A biopsy of the liver lesion showed non-caseating granuloma. Elevated blood levels of angiotensin-converting enzyme confirmed the diagnosis of sarcoidosis.
Disordered Eating and Body Image Concerns in Young Adult Women With Scoliosis.
Limbers CA, Baskin A, Cohen LA
Clin Med Insights Arthritis Musculoskelet Disord · 2023 · PMID 37122586 · Full text
BACKGROUND: Researchers have called for more investigation into disordered eating behaviors in females with scoliosis. OBJECTIVE: The objective of the current study was to assess the associations between body image conce...
BACKGROUND: Researchers have called for more investigation into disordered eating behaviors in females with scoliosis. OBJECTIVE: The objective of the current study was to assess the associations between body image concerns, disease-specific indicators of scoliosis (ie, age of diagnosis, having undergone bracing treatment, being told by a physician your scoliosis required surgery, having a spinal fusion), quality of life, and disordered eating in a sample of young adult women diagnosed with idiopathic scoliosis during adolescence. DESIGN: This study was cross-sectional in design. METHODS: Participants were 177 young adult women ages 18 to 30 years diagnosed with idiopathic scoliosis by a physician who completed questionnaires online. RESULTS: Undergoing bracing treatment ( = -.440; < .001), greater age at scoliosis diagnosis ( = .563; < .001), being told scoliosis required surgery ( = -.196; < .050), annual income ( = .306; < .001), level of education ( = .228; < .010), and race/ethnicity ( = -.213; < .050) were associated with the EDE-Q Global Score. The Body Shape Questionnaire Total Score and EDE-Q Global Score ( = .848; < .001) and EDE-Q Weight Concern Score ( = .813; < .001) were associated. The strongest correlations between the EDE-Q and the SRS-22-Revised Subscales were generally evidenced on the SRS-22-Revised Mental Health Subscale (s ranged from -.200 to -.371; < .001). After controlling for annual income, highest level of education, undergoing bracing treatment, and age of scoliosis diagnosis, the Body Shape Questionnaire Total Score was significantly correlated with the EDE-Q Eating Concern Score (standardized beta coefficient = .618; < .001). CONCLUSIONS: These findings underscore the importance of assessing body image concerns in young adult women with scoliosis experiencing disordered eating as this information may provide valuable information relevant to treatment planning.
An Unforeseen Outcome of COVID-19: The Triggering of Adult-Onset Still's Disease.
Alzuhaily H, Mohamad S, Alsalloum L … +1 more , Al-Sayed S
Clin Med Insights Arthritis Musculoskelet Disord · 2023 · PMID 37021087 · Full text
BACKGROUND: Adult-onset Still's disease (AOSD) is a rare auto-inflammatory disorder with unknown etiology by which an infectious trigger is usually responsible for the onset of the disease. It is diagnosed by exclusion w...
BACKGROUND: Adult-onset Still's disease (AOSD) is a rare auto-inflammatory disorder with unknown etiology by which an infectious trigger is usually responsible for the onset of the disease. It is diagnosed by exclusion when certain clinical, biochemical, and radiological criteria are met after excluding all other potential causes. Besides, SARS‑CoV‑2 infection is increasingly being reported to have autoimmune complications. In the literature, 3 AOSD cases have been reported to be triggered by SARS‑CoV‑2 infection and here we report the fourth. CASE PRESENTATION: A 24-year-old female doctor suffered from fever, sore throat, and mild cough a few days after a shift in the COVID-19 ward. A week later, she developed polyarthritis, salmon-colored rash, and high-grade fever, and the laboratory findings were indicating an inflammatory syndrome. COVID-19 IgM antibodies were positive indicating recent infection. After running a battery of tests, infectious, neoplastic, and rheumatic causes of these symptoms that persisted for about 50 days were excluded which led to a diagnosis of AOSD after fulfilling its criteria with subsequent treatment with methylprednisolone. Drastic improvement was achieved with no recurrence until the date of reporting. CONCLUSION: This case presents a new consequence of COVID-19 and adds to the emerging cumulative experiences with this disease. We encourage health care professionals to report such cases to further understand the nature of this infection and its possible outcomes.
SAPHO Syndrome Presenting With Atlo-Epistrophic Synovitis and Left Vocal Cord Paresis: A Challenging Diagnosis.
Maranini B, Ciancio G, Rinaldi R … +3 more , Borrelli M, Pugliatti M, Govoni M
Clin Med Insights Arthritis Musculoskelet Disord · 2022 · PMID 36090594 · Full text
SAPHO (synovitis, acne, pustulosis, hyperostosis, and osteitis) is a rare syndrome mainly characterized by cutaneous and osteoarticular manifestations. The most typical osteoarticular manifestations are localized to the...
SAPHO (synovitis, acne, pustulosis, hyperostosis, and osteitis) is a rare syndrome mainly characterized by cutaneous and osteoarticular manifestations. The most typical osteoarticular manifestations are localized to the anterior chest wall and include a usually noninfectious osteitis, hyperostosis, and synovitis of the sternoclavicular joints. However, clinical presentation of SAPHO syndrome can be quite heterogeneous. Several clinical and radiological features are shared with other well-defined pathological entities, and clinical signs and symptoms often occur at different timepoints. Mainly due to this complexity and its rarity, there are currently no validated diagnostic criteria for SAPHO syndrome. Inflammation of the soft tissues around the bones and possible nerve compression could contribute to dysphagia, hypophonia, or obstruction of the airways. Neurologic manifestations could therefore be part of this multiorgan involvement. Here, we present a case of SAPHO syndrome with atypical onset symptoms, characterized by left vocal cord paralysis, acute neck pain due to osteolytic atlantoepistrophic lesion, and an unusual cutaneous manifestation, diagnosed as mid-dermal elastolysis. The latest two, to the best of our knowledge, have been here first described in a case of SAPHO syndrome.
Radiologically Guided Versus Blinded Intra-articular Injection in Patients With Hip Osteoarthritis: A Retrospective Comparative Study.
Aksoy A, Gulcu A, Tuna MM … +1 more , Aslan A
Clin Med Insights Arthritis Musculoskelet Disord · 2022 · PMID 36032389 · Full text
OBJECTIVES: The aim of this study was to present the clinical results of patients with Kellgren-Lawrence (KL) stage 2-4 hip osteoarthritis who were administered intra-articular corticosteroid (CS) or hyaluronic acid (HA)...
OBJECTIVES: The aim of this study was to present the clinical results of patients with Kellgren-Lawrence (KL) stage 2-4 hip osteoarthritis who were administered intra-articular corticosteroid (CS) or hyaluronic acid (HA), with or without fluoroscopy. METHODS: This retrospective comparative study was conducted in the clinics where the authors worked between 2010 and 2018. Patients with stage 2-4 hip osteoarthritis according to KL criteria were included in the study. Age, body mass index, American Society of Anesthesiologists stages, and Western Ontario and McMaster Universities Arthritis Index (WOMAC) scores (3rd, 6th, and 12th months) were recorded. Two groups were created as patients who underwent injection with or without fluoroscopy guidance. In group 1, CS (triamnisolone) was administered, and in group 2, sodium hyaluronate 88 mg/4 mL was administered. Obtained parameters were compared. RESULTS: The WOMAC scores at 3 months of both the CS and HA groups were statistically significantly better than before the application, with the improvement in the CS group found to be significantly better than in the HA group ( = .047). At 6 months, the mean WOMAC scores of the CS and HA groups were better than prior to the application, and there was a statistically significant difference ( < .001). No significant difference was found in either the CS or HA group in the comparison of 12-month WOMAC scores with the baseline scores ( = .744 and = .054). CONCLUSION: In symptomatic hip OA patients, intra-articular administration of CS and HA was seen to be effective at 3 and 6 months after administration. However, the effectiveness was determined to have disappeared within 1 year. Furthermore, in hip OA intra-articular drug applications, it was determined that the blinded technique without radiological guidance performed in the outpatient clinic is as effective and safe as the radiologically guided technique administered in the operating room.
The Impact of Metabolic Syndrome on Quality of Life Among Individuals With Knee Osteoarthritis Living in Egypt.
Samaan SF, Taha SI
Clin Med Insights Arthritis Musculoskelet Disord · 2022 · PMID 35645586 · Full text
BACKGROUND: Several studies have linked metabolic syndrome (MetS) to osteoarthritis (OA), but they have not looked into how MetS can affect the health-related quality of life (HRQOL) of OA individuals. OBJECTIVES: We aim...
BACKGROUND: Several studies have linked metabolic syndrome (MetS) to osteoarthritis (OA), but they have not looked into how MetS can affect the health-related quality of life (HRQOL) of OA individuals. OBJECTIVES: We aimed to assess the association of MetS and its components, including obesity, hypertension, hyperglycemia, and dyslipidemia, with HRQOL among Egyptians with knee OA. METHODS: This cross-sectional study comprised 116 adult Egyptian participants with knee OA. They were divided into 2 groups based on whether or not they had the MetS. All participants were subjected to a thorough medical history taking and a detailed medical examination. The Kellgren and Lawrence (K/L) scale evaluated OA in all individuals using anteroposterior knee radiographs. The Health Assessment Questionnaire-Disability Index (HAQ-DI) and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) were used to assess participants' HRQOL; their higher scores indicate more disability. Spearman rank and Pearson's correlation analyses were used to assess the association between variables. RESULTS: Diabetes, hypertension, dyslipidemia, and obesity were significantly associated with the OA + MetS group with a prevalence of 77.6%, 82.8%, 77.6%, and 50.0%, respectively. According to the K/L scale, 70.7% of the OA + MetS group had grade IV knee affection. The HAQ-DI and WOMAC scores were significantly ( < .001) higher among the OA + MetS individuals compared with the OA individuals. Interleukin (IL)-6 serum levels were also significantly higher in the OA + MetS group ( = .036) and increased significantly with the more serious radiological damage and functional disability. We found significant positive correlations between HAQ-DI and WOMAC with waist circumference ( = .004, .001), as well as triglycerides ( = .006, .008), cholesterol ( = .041, .048), fasting blood sugar ( < .001, < .001) and significant negative correlations with high-density lipoprotein levels ( = .628, .002). CONCLUSIONS: Individuals with knee OA with MetS showed more significant radiological damage, severe functional disability, and poor HRQOL. They also had higher levels of IL-6, which correlated significantly with the degree of disability, promoting it as a significant therapeutic target.
Representation Rate and Management of Gout for Patients Discharged From Emergency Departments in Illawarra Shoalhaven Local Health District.
Loganathan A, Raman A, Berlinski N … +1 more , Riordan J
Clin Med Insights Arthritis Musculoskelet Disord · 2022 · PMID 35645585 · Full text
INTRODUCTION: The estimated prevalence of gout in Western societies is 2.7% to 6.7%. In Australia, there have been increasing rates of hospitalisations for gout flares. Urate-lowering therapy (ULT) is effective in reduci...
INTRODUCTION: The estimated prevalence of gout in Western societies is 2.7% to 6.7%. In Australia, there have been increasing rates of hospitalisations for gout flares. Urate-lowering therapy (ULT) is effective in reducing urate burden, which can prevent gout flares and destructive arthropathy. This study assessed the representation rate of patients presenting to the Emergency Department (ED) with crystal arthropathy and the utilisation of ULT in the community for patients with a pre-existing history of gout. METHODS: A retrospective review of electronic records of patients presenting to the ED from the Illawarra Shoalhaven Local Health District was performed. Patients included were coded as per the 10th revision of the International Classification of Diseases coding for crystal arthropathy. RESULTS: In all, 18.8% of all crystal arthropathy encounters to the ED were repeat presentations. Of the 70% of patients with a history of gout, only 30.8% were on ULT. DISCUSSION: Despite evidence-based recommendations for a 'treat-to-target' approach, most patients with a previous history of gout were not on ULT. One in five encounters were re-presentations for crystal arthropathy. Effective adherence to treatment guidelines may reduce the number of repeat encounters for gout flare in the ED.
A Retrospective Observational Cohort Study of Periprosthetic Hip Infection Treated by one-stage Method Including Cases With Bone Graft Reconstruction.
Unfried RI, Krause LMF, Cezimbra HM … +3 more , Pacheco LS, Larangeira JA, Ribeiro TA
Clin Med Insights Arthritis Musculoskelet Disord · 2022 · PMID 35547099 · Full text
PURPOSE: Prosthetic joint infection (PJI) is a devastating complication that can affect hip arthroplasty. Its treatment is extremely difficult, and issues regarding the optimal treatment remain unanswered. This study int...
PURPOSE: Prosthetic joint infection (PJI) is a devastating complication that can affect hip arthroplasty. Its treatment is extremely difficult, and issues regarding the optimal treatment remain unanswered. This study intended to show the effectiveness of the one-stage treatment of PJI. MATERIALS AND METHODS: A retrospective observational cohort study performed from July 2014- August 2018. All patients with suspected PJI were included. Major and minor criteria developed by the International Consensus on Periprosthetic Joint Infection (ICPJI) was used to define infection. Laboratory tests and image exams were performed, and all patients were followed for at least 2 years. OUTCOMES: Success rate (2018 ICPJI definition to success) in treatment of PJI using one-stage revision method. Clinical and functional outcomes defined by Harris Hip Score (HHS). RESULTS: Thirty-one patients were screened and 18 analyzed. 69.85 ± 9.76 years was the mean age. Mean follow-up time was 63.84 ± 18.55 months. Ten patients had acetabular defects and required bone graft reconstruction. Sixteen patients were classified as Tier 1, 1 as Tier 3D, and as 1 Tier 3E. Almost 90% of patients submitted to one-stage revision with acetabulum graft reconstruction were free of infection. The overall infection survival rate was 78.31±6.34 months. and sinus tract were statistically significant in univariate Cox's analysis. The predictor of one-stage revision surgery failure that remained final Cox's regression model was (hazard ratio [HR]: 4.47). CONCLUSION: Treatment through one-stage revision surgery associated with 6 months of antimicrobial is a viable option with acceptable results even when bone graft reconstruction is necessary. was a strong predictor of failure in this cohort.
Can Complete Blood Count Picture Tell Us More About the Activity of Rheumatological Diseases?
Taha SI, Samaan SF, Ibrahim RA … +3 more , Moustafa NM, El-Sehsah EM, Youssef MK
Clin Med Insights Arthritis Musculoskelet Disord · 2022 · PMID 35481333 · Full text
BACKGROUND: In clinical practice, distinguishing disease activity in patients with rheumatological illnesses is challenging. OBJECTIVES: We aimed to investigate clinical associations of hemogram-derived indices, namely:...
BACKGROUND: In clinical practice, distinguishing disease activity in patients with rheumatological illnesses is challenging. OBJECTIVES: We aimed to investigate clinical associations of hemogram-derived indices, namely: red cell distribution width (RDW), mean platelet volume (MPV), neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), lymphocyte-to-monocyte ratio (LMR), and systemic immune-inflammation index (SII) with disease activity in patients with rheumatoid arthritis (RA), systemic lupus erythematosus (SLE), and ankylosing spondylitis (AS). METHODS: In 250 patients with rheumatological disease and 100 healthy age-matched controls, we investigated disease activity scores and indicators and evaluated their association with hemogram-derived indices values. RESULTS: Compared with the control group, RDW, MPV, and PLR significantly increased ( < .001) in the three studied disorders (RA, SLE, and AS), but LMR dramatically decreased. SII was considerably higher in RA and AS patients compared with controls but not in SLE patients. On the other hand, NLR rose dramatically in SLE patients compared with controls ( = .043), but did not change much in RA and AS patients ( > .05). RDW and MPV showed significant changes ( < .001) in the three studied diseases (RA, SLE, and AS) according to disease activity. They significantly increased across worsening activity scores. Only in the SLE group, PLR was significantly increased with disease activity ( < .001), while LMR showed a significant decrease ( = .016). CONCLUSIONS: Clinicians must pay close attention to complete blood count (CBC) analysis and its various derived ratios to better characterize the activity of rheumatological disorders and anticipate the disease course and prognosis.
Ingredients of a Natural Oral Nutritional Supplement and Their Role in the Treatment of Osteoarthritis.
Bharat KT, Manhas NS, Gutcho J … +3 more , Lin J, Bhattacharyya S, Kounang R
Clin Med Insights Arthritis Musculoskelet Disord · 2022 · PMID 35360183 · Full text
Osteoarthritis is a prevalent degenerative disease affecting a large portion of the world's aging population. Currently, nonsteroidal anti-inflammatory drugs and acetaminophen are first-line medications for treating oste...
Osteoarthritis is a prevalent degenerative disease affecting a large portion of the world's aging population. Currently, nonsteroidal anti-inflammatory drugs and acetaminophen are first-line medications for treating osteoarthritis patients' pain. However, several studies have noted that while these medications control pain they do not halt progressive degeneration and tend to have an unfavorable side-effect profile with prolonged use. Recently, due to their more favorable side-effect profiles, herbal alternatives for controlling osteoarthritis symptoms and for alleviating the progression of the disease are being increasingly studied. Synogesic is a newly developed herbal supplement blend by renowned orthopedic surgeons and physiatrists consisting of turmeric, rutin, ginger root, vitamin C, vitamin D, and boswellia extracts. A study by Sharkey et al. has commented on the efficacy of the blend on the patients with knee osteoarthritis. So far, a review on the ingredients of the blend has not yet carried outbeen. By exploring prominent literature databases including PubMed and ScienceDirect, our aim is to write a narrative review to explore the individual ingredients of this blend and delve into their characteristics, as well as the most recent literature on their mechanism and efficacy in patients with osteoarthritis. Through this, we hope to inform clinicians and patients alike on relevant up-to-date research on the supplement and provide insight on the potential for this supplement for alleviating the disease course of patients with osteoarthritis.
Effect of Prophylactic Dose of Trimethoprim-Sulfamethoxazole on Serum Creatinine in Japanese Patients With Connective Tissue Diseases.
Kawato R, Rokutanda R, Okada M … +3 more , Matsushita M, Yamaji K, Tamura N
Clin Med Insights Arthritis Musculoskelet Disord · 2022 · PMID 35342315 · Full text
OBJECTIVES: At normal doses of trimethoprim-sulfamethoxazole (TMP/SMX), trimethoprim inhibits tubular creatinine secretion, leading to a rapid but reversible increase in serum creatinine (SCr). Although patients with con...
OBJECTIVES: At normal doses of trimethoprim-sulfamethoxazole (TMP/SMX), trimethoprim inhibits tubular creatinine secretion, leading to a rapid but reversible increase in serum creatinine (SCr). Although patients with connective tissue diseases are often in the state of immunosuppression and TMP/SMX is an important prophylactic drug, clinicians often have to stop or reduce the dosage due to concerns regarding its effect on renal function. This study aimed to evaluate the effect of a prophylactic dose of TMP/SMX on SCr in Japanese patients with connective tissue diseases, the extent of SCr level elevation and the independent risk factors for creatinine elevation. METHODS: A retrospective cohort study was undertaken. Participants included patients with connective tissue diseases who were treated with a prophylactic dose of TMP/SMX between 2004 and 2018. Using single and multiple regression analyses, the risk factors that affected SCr elevation were evaluated. RESULTS: A total of 262 patients, females, n = 181; age, median (range) = 59 (19-89) years, were included. The median baseline SCr level before treatment was 0.62 (0.16-2.1) mg/dL. The median SCr elevation value was 0.07 (-0.54 to 0.84) mg/dL in 4 weeks after TMP/SMX initiation. Five (2%) participants had ⩾0.3 mg/dL SCr elevation. Multiple regression analyses, including age, baseline SCr, diuretic use, nonsteroidal anti-inflammatory drug use and diabetes mellitus, indicated that baseline SCr and advanced age were independent risk factors of SCr elevation. CONCLUSIONS: These results demonstrated that baseline SCr and advanced age were associated with SCr elevation by a prophylactic dose of TMP/SMX. However, a prophylactic dose of TMP/SMX rarely elevated the SCr level significantly. Therefore, other causes can be considered if patients show an SCr elevation ⩾0.3 mg/dL.
Associations Between Physical Activity, Self-reported Joint Function, and Molecular Biomarkers in Working Age Individuals With Hip and/or Knee Osteoarthritis.
Östlind E, Eek F, Stigmar K … +3 more , Sant'Anna A, Ekvall Hansson E, Struglics A
Clin Med Insights Arthritis Musculoskelet Disord · 2022 · PMID 35342314 · Full text
OBJECTIVE: Previous research has suggested an association between physical activity (PA), joint function, and molecular biomarkers, but more studies are needed. The aim of this study was to explore the associations betwe...
OBJECTIVE: Previous research has suggested an association between physical activity (PA), joint function, and molecular biomarkers, but more studies are needed. The aim of this study was to explore the associations between PA or self-reported joint function and molecular biomarkers of cartilage and inflammation in individuals with hip and/or knee osteoarthritis (OA). Specific objectives were to explore the correlations between (1) the change over 3 months in self-reported PA/joint function and the change in molecular biomarkers (2) objectively measured PA and molecular biomarkers measured at 3-month follow-up. DESIGN: Working age participants (n = 91) were recruited from a cluster randomized controlled trial. Self-reported PA, joint function, and serum samples were collected at baseline and after 3 months. Serum concentrations of the inflammatory marker C-reactive protein (CRP) and the cartilage markers Alanine-Arginine-Glycine-Serine (ARGS)-aggrecan, cartilage oligomeric matrix protein (COMP), and type II collagen C2C were analyzed by immunoassays. Objectively measured PA (steps/day) was collected during 12 weeks from activity trackers used by 53 participants. Associations were analyzed with Spearman's rank correlation. RESULTS: There was a weak negative correlation between the change in self-reported PA and the change in COMP ( = -0.256, = .040) but not for the other molecular biomarkers. There were no correlations between the change in self-reported joint function and the change in molecular biomarkers or between the average steps/day and the molecular biomarkers at follow-up ( ⩽ -0.206, ⩾ .06). CONCLUSION: In general, no or only weak associations were found between PA/joint function and molecular biomarkers. Future research recommends including participants with lower PA, extend the follow-up, and use a design that allows comparisons.
Colchicine May Interfere With the Efficacy of the Adenoviral Vector-Based Vaccine for COVID-19.
Lin CW
Clin Med Insights Arthritis Musculoskelet Disord · 2022 · PMID 35342313 · Full text
Under the ongoing COVID-19 pandemic, vaccines have become the crucial players to reduce the spread of the infection. Among them, the ChAdOx1 nCoV-19 vaccine is an adenoviral vector vaccine with an overall efficacy of 70....
Under the ongoing COVID-19 pandemic, vaccines have become the crucial players to reduce the spread of the infection. Among them, the ChAdOx1 nCoV-19 vaccine is an adenoviral vector vaccine with an overall efficacy of 70.4% in protection. The engineered adenovirus contains the SARS-CoV-2 spike protein gene and pushes its DNA into the vaccinated cell's nucleus and subsequently, the spike protein can be made. During vaccination, the genome transition of adenovirus is influenced by the architecture and dynamics of the microtubule. Colchicine can alter microtubule dynamics by suppressing microtubule dynamics at lower concentrations and inducing depolymerization of microtubules at higher concentrations. Accordingly, the delivery of the genome to the vaccinated cell's nucleus by the adenoviral vector could be hindered under the presence of colchicine. Nevertheless, colchicine is a common medication for gout therapy worldwide, and though not recommended by guidelines, colchicine has even been taken into consideration as a possible therapeutic option for COVID-19 infection. Given the above reasons and the worldwide use of colchicine, the impact of colchicine on the efficacy of the COVID-19 vaccine via adenoviral vector should be viewed cautiously.
Prevalence of Osteoporosis Among Iranian Postmenopausal Women: A Systematic Review and Meta-analysis.
Eghbali T, Abdi K, Nazari M … +2 more , Mohammadnejad E, Gheshlagh RG
Clin Med Insights Arthritis Musculoskelet Disord · 2022 · PMID 35295207 · Full text
OBJECTIVES: Osteoporosis is the most common metabolic bone disease. It is considered the silent epidemic, with high prevalence after menopause, in the current time. Different studies conducted in Iran have reported diffe...
OBJECTIVES: Osteoporosis is the most common metabolic bone disease. It is considered the silent epidemic, with high prevalence after menopause, in the current time. Different studies conducted in Iran have reported different prevalence. The present systematic review and meta-analysis aims to estimate the overall prevalence of osteoporosis in Iranian postmenopausal women. METHODS: The national scientific databases Scientific Information Database and MagIran and the international scientific databases PubMed, Web of Science, and Scopus were searched for related articles without any time limitation. The keywords osteopenia, osteoporosis, post menopause, OP, bone mineral density, and Iran along with their combinations were used in the search. The inconsistency in the data was examined using test. The data were analyzed using the meta-analysis method and the random-effects model in Stata software, version 14. RESULTS: The analysis of 26 articles with a sample size of 6735 showed that the prevalence of osteoporosis and osteopenia in Iranian postmenopausal women is, respectively, 33.70% (95% CI [confidence interval]: 22.68-44.73) and 47.60% (95% CI: 32.88-62.32). The pooled prevalence of osteoporosis in the spine and in the femur bone was 31.99% and 15.93%, respectively. Also, the prevalence of osteopenia in the spine and in the femur bone was 22.48% and 39.88%, respectively. CONCLUSION: Osteoporosis and osteopenia are highly prevalent in Iranian postmenopausal women to the extent that one-third of women suffer from osteoporosis and nearly half of them suffer from osteopenia. It seems essential to teach a healthy lifestyle to these women to reduce the prevalence of these issues.
Open-Label Pilot Study of a Single Intra-Articular Injection of Mannitol-Modified Cross-Linked Hyaluronic Acid (HANOX-M-XL) for the Treatment of the First Metatarsophalangeal Osteoarthritis (Hallux Rigidus): The REPAR Trial.
Galois L, Coillard JY, Porterie J … +2 more , Melac-Ducamp S, Conrozier T
Clin Med Insights Arthritis Musculoskelet Disord · 2022 · PMID 35295206 · Full text
PURPOSE: The purpose of this study was to obtain information on safety and short-term efficiency of a single intra-articular injection of mannitol-modified cross-linked hyaluronic acid (HANOX-M-XL) in patients with painf...
PURPOSE: The purpose of this study was to obtain information on safety and short-term efficiency of a single intra-articular injection of mannitol-modified cross-linked hyaluronic acid (HANOX-M-XL) in patients with painful first metatarsophalangeal joint osteoarthritis (1stMTPJ-OA). METHODS: The study involved an observational, single-arm, prospective multicentre trial, with a 3-month follow-up. Inclusion criteria were patients with symptomatic 1st MTPJ-OA not relieved by analgesics and / or non-steroidal-anti-inflammatory drugs and / or foot orthotic. All patients received a single, imaging-guided intra-articular (IA) injection of 1 mL of HANOX-M-XL in the 1st MTPJ. The primary outcome was the change in pain between the date of injection and month 3. The secondary outcomes were the patient assessment of effectiveness, the decrease in painkiller use and the influence of the radiographic score on the clinical efficacy. RESULTS: Sixty-five participants (72.3% women, mean age = 60) were included in the trial. Coughlin-Shurnas radiological grade was 1 in 28 patients, 2 in 29, and 3 in 6. At baseline and month 3, the average pain (0-10) was 6.5 ± 1.8 and 2.8 ± 2.3, respectively. The change in pain score was highly significant (-3.1 ± 2.9; < .0001). At baseline there was no statistically difference in pain between the radiological stages ( = .69). At endpoint, the average pain score was 2.0 ± 1.9 in x-ray stage 1, 3.1 ± 2.3 in stage 2 and 3.3 ± 2.4 in stage 3 ( = .001). Mild to moderate adverse reactions were reported by 15 patients. All were a transient increase of the hallux pain that occurred immediately and up to 6 hours after injection and resolved in 1 to 7 days. CONCLUSION: This pilot study suggests that a single IA injection of HANOX-M-XL is safe and mainly benefits patients with mild moderate 1st MTPJ-OA. Further randomized controlled trials are necessary to confirm these preliminary encouraging results.
Problems to Consider Before Determining the Regimen of the Treatment for Juvenile Systemic Sclerosis Treatment: A Case Report Where Tocilizumab Monotherapy Succeeded Efficiently and Safely.
Funauchi M, Kinoshita K
Clin Med Insights Arthritis Musculoskelet Disord · 2022 · PMID 35250323 · Full text
Juvenile systemic sclerosis (SSc) is a rare condition that results in various disorders, including growth retardation and learning disabilities in addition to impaired quality of life due to fibrosis and microvascular di...
Juvenile systemic sclerosis (SSc) is a rare condition that results in various disorders, including growth retardation and learning disabilities in addition to impaired quality of life due to fibrosis and microvascular disorders in multiple organs. Recently, efficacies of immunosuppressants such as cyclophosphamide and mycophenolate mofetil, as well as biological agents, have been reported in adult patients with SSc. However, there has been no consensus in the treatment of juvenile SSc due to its rarity and the fact that skin sclerosis may be self-limiting in some patients. Here, we present a case of 13-year-onset SSc with growth retardation and learning disabilities, in addition to skin sclerosis, interstitial lung disease, and possible myocardial fibrosis that was successfully treated with tocilizumab monotherapy without remarkable adverse reactions. As careful case-by-case management of patient's growth and education along with standard treatment is needed, the documentation of such case is important for the evaluation of the efficient and safe therapy for juvenile SSc.
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