The document discusses the challenges of treating patients with early arthritis. It emphasizes the importance of early diagnosis and treatment to prevent long-term joint damage. Within 12 weeks, patients can be classified as having self-limiting or persistent arthritis. For those at risk of persistent disease, treat-to-target strategies using disease-modifying antirheumatic drugs (DMARDs) like methotrexate aim to achieve remission and prevent disability. Prognostic markers help determine who needs long-term treatment. The goal is recognizing and treating erosive arthritis early to optimize outcomes.
This document discusses rheumatoid arthritis (RA), a chronic inflammatory disease characterized by joint inflammation and damage. The clinical presentation of RA involves symmetric joint pain, swelling, and morning stiffness. The pathogenesis involves an immune response involving T cells, B cells, and cytokines like TNF-alpha that promote inflammation. Disease activity is the main driver of joint damage and disability in RA. Treatment involves conventional disease-modifying antirheumatic drugs (DMARDs) and biologic agents to reduce inflammation, prevent further joint destruction, and improve function.
A 28-year-old male patient with pemphigus vulgaris was given 7 pulses of dexamethasone therapy. He later developed avascular necrosis of the head of the femur in both hips, confirmed by x-ray and MRI. Long-term corticosteroid use is a known risk factor for avascular necrosis. The patient's condition was assessed as a severe adverse drug reaction likely caused by the dexamethasone therapy based on standardized causality scales. MRI is an important tool for early diagnosis of avascular necrosis to prevent complications.
Rheumatoid arthritis is an autoimmune disease that causes inflammation and destruction of joints. Early diagnosis through laboratory tests like rheumatoid factor, anti-CCP antibodies, erythrocyte sedimentation rate, and C-reactive protein is important so aggressive treatment can be started to control symptoms and prevent joint damage. The 2010 ACR/EULAR classification criteria uses scores based on the number and type of joints involved, serology results, markers of inflammation, and duration of symptoms to classify a patient as having rheumatoid arthritis.
This document provides guidelines for the diagnosis and treatment of postmenopausal osteoporosis from the American Association of Clinical Endocrinologists and the American College of Endocrinology. It outlines key updates to the 2020 guidelines, including stratifying patient risk and the inclusion of new drugs. The guidelines are organized by questions and provide recommendations, such as using FRAX to assess fracture risk, monitoring vitamin D levels, initiating pharmacologic therapy based on risk level, and using follow-up DXA scans and bone turnover markers to monitor treatment response. The overall goal is to reduce fractures and increase or maintain bone mineral density through lifestyle changes and pharmacologic interventions.
This study evaluated the long-term clinical and radiological outcomes of 126 patients with 239 osteoporotic vertebral fractures treated with balloon kyphoplasty compared to a conservatively treated control group. Patients undergoing kyphoplasty had significantly reduced pain scores and improved disability scores that were maintained at the 2-year follow-up, while the control group showed no significant changes. Kyphoplasty also significantly restored vertebral height and alignment, while conservative treatment did not significantly impact radiographic measures. This study demonstrates the long-term benefits of balloon kyphoplasty over conservative care for osteoporotic vertebral fractures.
This document contains abstracts from presentations at the 29th Annual Northeast Regional Scientific Meeting. The abstracts describe several studies involving nuclear imaging techniques:
1. A study evaluating the reproducibility of quantitative measurements from FDG PET and gallium scans in distinguishing between interstitial nephritis and acute tubular necrosis in rats. It found the measurements to be highly reproducible.
2. A case report describing how SPECT/CT imaging with indium-111 labeled white blood cells revealed unsuspected pulmonary septic emboli in a patient with infected hemodialysis access.
3. A case report where bone SPECT/CT identified an acute pelvic fracture that was missed on other imaging in a patient
This document discusses rheumatoid arthritis (RA), a chronic inflammatory disease characterized by joint inflammation and damage. The clinical presentation of RA involves symmetric joint pain, swelling, and morning stiffness. The pathogenesis involves an immune response involving T cells, B cells, and cytokines like TNF-alpha that promote inflammation. Disease activity is the main driver of joint damage and disability in RA. Treatment involves conventional disease-modifying antirheumatic drugs (DMARDs) and biologic agents to reduce inflammation, prevent further joint destruction, and improve function.
A 28-year-old male patient with pemphigus vulgaris was given 7 pulses of dexamethasone therapy. He later developed avascular necrosis of the head of the femur in both hips, confirmed by x-ray and MRI. Long-term corticosteroid use is a known risk factor for avascular necrosis. The patient's condition was assessed as a severe adverse drug reaction likely caused by the dexamethasone therapy based on standardized causality scales. MRI is an important tool for early diagnosis of avascular necrosis to prevent complications.
Rheumatoid arthritis is an autoimmune disease that causes inflammation and destruction of joints. Early diagnosis through laboratory tests like rheumatoid factor, anti-CCP antibodies, erythrocyte sedimentation rate, and C-reactive protein is important so aggressive treatment can be started to control symptoms and prevent joint damage. The 2010 ACR/EULAR classification criteria uses scores based on the number and type of joints involved, serology results, markers of inflammation, and duration of symptoms to classify a patient as having rheumatoid arthritis.
This document provides guidelines for the diagnosis and treatment of postmenopausal osteoporosis from the American Association of Clinical Endocrinologists and the American College of Endocrinology. It outlines key updates to the 2020 guidelines, including stratifying patient risk and the inclusion of new drugs. The guidelines are organized by questions and provide recommendations, such as using FRAX to assess fracture risk, monitoring vitamin D levels, initiating pharmacologic therapy based on risk level, and using follow-up DXA scans and bone turnover markers to monitor treatment response. The overall goal is to reduce fractures and increase or maintain bone mineral density through lifestyle changes and pharmacologic interventions.
This study evaluated the long-term clinical and radiological outcomes of 126 patients with 239 osteoporotic vertebral fractures treated with balloon kyphoplasty compared to a conservatively treated control group. Patients undergoing kyphoplasty had significantly reduced pain scores and improved disability scores that were maintained at the 2-year follow-up, while the control group showed no significant changes. Kyphoplasty also significantly restored vertebral height and alignment, while conservative treatment did not significantly impact radiographic measures. This study demonstrates the long-term benefits of balloon kyphoplasty over conservative care for osteoporotic vertebral fractures.
This document contains abstracts from presentations at the 29th Annual Northeast Regional Scientific Meeting. The abstracts describe several studies involving nuclear imaging techniques:
1. A study evaluating the reproducibility of quantitative measurements from FDG PET and gallium scans in distinguishing between interstitial nephritis and acute tubular necrosis in rats. It found the measurements to be highly reproducible.
2. A case report describing how SPECT/CT imaging with indium-111 labeled white blood cells revealed unsuspected pulmonary septic emboli in a patient with infected hemodialysis access.
3. A case report where bone SPECT/CT identified an acute pelvic fracture that was missed on other imaging in a patient
Evaluating Chronic Pain Patients Using Methods from Johns Hopkins Hospital Ph...Nelson Hendler
This article describes the use of physiological testing, instead of anatomical testing, to evaluate chronic pain. The efficacy of this approach is documented by published outcome studies.,, Patient require surgery 50%-63% of the time to improve.
This study reviewed 232 patients with low-grade (Spetzler-Martin Grade I-II) brain arteriovenous malformations (AVMs) who underwent surgical resection. The key findings were:
1) AVM resection was successful in all patients and confirmed angiographically in 94% with no residual AVMs found.
2) Overall good functional outcomes (mRS 0-1) were found in 78% at last follow-up, with 97% improved or unchanged from their preoperative status.
3) Patients with unruptured AVMs had better functional outcomes (91% good) than those with ruptured AVMs (65% good), but equivalent relative outcomes (96-98% improved
The document discusses several clinical trials evaluating the role of chemotherapy in metastatic castration-resistant prostate cancer (mCRPC). The CHAARTED trial found that for patients with high-volume mCRPC, the addition of docetaxel to androgen deprivation therapy (ADT) improved overall survival by 13.3 months compared to ADT alone. The STAMPEDE trial also found a survival benefit to adding docetaxel or zoledronic acid to standard of care. The GETUG-15 trial demonstrated a survival benefit for patients with high-volume disease receiving early docetaxel and ADT compared to ADT alone. Together these trials provide evidence supporting the use of docetaxel chemotherapy
This study evaluated the efficacy and safety of long-term intravenous immunoglobulin (IVIg) treatment for 52 weeks in patients with chronic inflammatory demyelinating polyradiculoneuropathy (CIDP). 49 patients received IVIg 1g/kg every 3 weeks for 52 weeks. The primary outcomes were a responder rate of 1 point improvement on the INCAT score at 28 weeks and relapse rate at 52 weeks. At 28 weeks, 77.6% of patients responded, higher than previous studies. The clinical remission rate was maintained at 69.4% at 52 weeks. Secondary outcomes also improved. Adverse events included cerebral infarction in 2 older patients. The study demonstrated efficacy of 52-week IVI
(October 2016) Non-operative management of medical meniscus posterior horn ro...Logan Peter
This study evaluated 52 patients with medial meniscus posterior horn root tears (MMPRTs) treated non-operatively over a mean follow-up of 5 years. The study found that 31% of patients underwent knee arthroplasty within 30 months on average. For the remaining patients, the mean subjective knee score was 61, indicating poor outcomes. Radiographic arthritis grades significantly worsened over time. Overall, 87% of patients met the criteria for treatment failure based on poor clinical or radiographic outcomes. Female patients and those with higher baseline arthritis grades had significantly worse outcomes. This study establishes that non-operative treatment of MMPRTs typically leads to poor clinical results and rapid arthritis progression.
Denosumab vs bisfosfonato en metástasis óseasMauricio Lema
This document summarizes key findings from three head-to-head clinical trials comparing denosumab to zoledronic acid for the treatment of bone metastases in solid tumors. The main points are:
1) A prespecified integrated analysis of the three trials found that denosumab was superior to zoledronic acid, reducing the risk of first skeletal-related events by 17%.
2) Denosumab provided benefits across multiple solid tumor types, reducing the risk of first skeletal-related events in breast cancer, prostate cancer, and other solid tumors compared to zoledronic acid.
3) Denosumab demonstrated efficacy in reducing both the time to first skeletal-related event and the risk of subsequent skeletal
S1PR modulators target receptors on lymphocytes, leading to lymphocyte sequestration in lymph nodes. They can also cross the blood-brain barrier and directly impact the central nervous system by signaling to neurons, microglia, oligodendrocytes, and astrocytes. This results in effects such as reduced neuroinflammation and neuronal damage, enhanced remyelination, and inhibition of astrogliosis. Clinical trials demonstrate that S1PR modulators significantly reduce brain volume loss compared to placebo or other disease-modifying therapies, as well as improve measures of disability and cognitive function in people with multiple sclerosis.
Crete to share for site epilepsy treatment alternatives to antiepileptic dr...psaltakis
This document discusses non-pharmacological treatment options for epilepsy, including epilepsy surgery, dietary treatments, and neurostimulation. It provides information on when these alternatives should be considered, the options available, and for which patients they may be suitable. Key points include: epilepsy surgery may be underused in the UK and can provide seizure freedom or reduction; the ketogenic diet has been shown to reduce seizures in about 15-30% of patients after 6 months depending on the study; and corpus callosotomy and vagus nerve stimulation are established palliative procedures for treatment-resistant generalized seizures.
This document discusses stress imaging modalities for assessing cardiac ischemia and viability. It addresses debates around which stress modality to use, whether pharmacological or exercise stress is preferred, and which stressor provides the best diagnostic accuracy. The document also discusses indications for pharmacological stress imaging if exercise is inadequate and assesses the diagnostic accuracy and prognostic value of different stress modalities. Finally, it addresses the use of stress echocardiography and nuclear imaging in evaluating patients for coronary artery disease.
1) Fingolimod is a sphingosine 1-phosphate receptor modulator approved for relapsing forms of multiple sclerosis. It works by retaining lymphocytes in lymph nodes, reducing their migration into the central nervous system.
2) Phase II clinical trial results showed fingolimod significantly reduced relapse rates and brain lesion activity compared to placebo over 5 years of follow up. It selectively retained naive and central memory T cells while sparing effector memory T cells.
3) Phase III FREEDOMS trial of over 1200 patients found fingolimod 0.5mg reduced annualized relapse rates by 54% and risk of disability progression by 30% compared to placebo over 2 years. It established
Marchiafava-Bignami disease is a rare toxic condition caused by demyelination and necrosis of the corpus callosum, typically seen in chronic alcoholics. The document reports on two cases of Marchiafava-Bignami disease potentially caused by consumption of a locally brewed alcoholic beverage called Mahuwa Alcohol. Radiologically, the disease usually affects the corpus callosum, most commonly involving the body, genu, and splenium sequentially, though sometimes the entire corpus callosum is affected. Clinical presentation varies between cases.
1) Carotid artery stenosis is a major risk factor for stroke. While carotid endarterectomy (CEA) has been shown to reduce stroke risk in selected low-risk patients, many patients are at high surgical risk or have exclusion criteria.
2) Early trials of carotid artery stenting (CAS) showed high complication rates but technology and experience have improved outcomes over time. Recent trials show CAS may have slightly better outcomes than CEA in high-risk patients.
3) Ongoing trials are further evaluating CAS compared to CEA in both high-risk and low-risk patients. The use of distal protection devices during CAS appears important for reducing complications.
1) Plasma exchange (PE) significantly improves outcomes for patients with Guillain-Barré syndrome compared to supportive care alone based on data from multiple randomized controlled trials. PE results in greater improvement in disability and faster recovery.
2) Intravenous immunoglobulin (IVIg) is as effective as PE based on trials comparing the two treatments, with no significant differences in outcomes.
3) Combining PE and IVIg does not provide additional benefit over either treatment alone.
1. Intravenous antibiotic prophylaxis prior to skin incision is the most effective way to reduce the risk of postoperative wound infection after lumbar spine surgery.
2. For a patient undergoing knee replacement who has liver disease, the recommended venous thromboembolism prophylaxis includes use of mechanical prophylaxis like pneumatic calf compressors while in the hospital.
3. Bone morphogenetic proteins signal through serine-threonine kinase cell surface receptors.
Preliminary Evaluation of Clinical and Angiographic
Outcomes with Biodegradable Polymer Coated
Sirolimus-Eluting Stent in De Novo Coronary Artery Disease: Results of the MANIPAL-FLEX Study
Chlamydia-induced Reactive Arthritis research project. Discusses pathogenesis, symptoms, and etiology. Summarizes possible treatment plans and includes questions for further research.
Microwave ablation was used to treat epiphyseal osteoid osteomas in 7 patients. All patients experienced complete pain relief within 1 week of the procedure and had no complications, except for 1 patient who experienced back pain for 2 months. MRI scans after treatment showed ablation areas averaging 21 x 12 x 14 mm. The study demonstrated that microwave ablation can safely and effectively treat epiphyseal osteoid osteomas with a single needle insertion and without complications. However, more research with larger patient groups is still needed to validate these promising initial results.
NZSSD - Conference 2012 Poster - ESWT and DPNKenneth Craig
This case study examines the use of extracorporeal shockwave therapy (ESWT) to treat peripheral neuropathy in a 59-year old male with type 1 diabetes. ESWT was administered to one foot over 6 sessions while the other foot served as a control. Quantitative tests found improvements in sensory perception in the treated foot compared to baseline and deterioration in the control foot. This suggests ESWT may help reverse sensory deficits from diabetic peripheral neuropathy and warrants further exploration as a non-invasive treatment option.
A prospective study was conducted at a critical care department and post-anesthesia care unit of a university teaching hospital in Barcelona, Spain. The study recruited 707 patients with invasive BP and finger PPG waves over a period of 26 months. Exclusion criteria were presence of major arrhythmia, immediate death condition and disturbances in the arterial or PPG curve morphology. For each patient we automatically recorded the systolic blood pressure (SBP), mean arterial pressure (MAP), diastolic blood pressure (DBP) and PPG curve for 30 minutes. The PPG signal was further processed to obtain a set of features that were used to construct a Deep Belief Network with Gaussian Restricted Boltzmann Machine (DBN-RBM). The available dataset was split into three subsets (Training, Validation and Testing). The training and validation datasets included 85% of data and the testing dataset included 15% of the available data. The regression error was assessed through a Bland-Altman analysis and the AAMI standard. The mean prediction error were -2.98+-19.35 mmHg for SBP, -3.38+-10.35 mmHg for MAP and 3.65+-8.69 mmHg for DBP.
The results obtained are promising for the assessment of MAP and DBP with DBN-RBM. Further research and clinical validation are needed to bring this technology to standard medical practice.
Volker Diehl, M.D., Professor, University of Cologne, Germany Customization: The Treatment of Hodgkin's Disease
Presented at New Frontiers in the Management of Solid and Liquid Tumors hosted by the John Theurer Cancer Center at Hackensack University Medical Center. jtcancercenter.org/CME
This document discusses rheumatoid arthritis (RA), including its diagnosis, management, and treatment. Some key points:
1) RA is a common inflammatory joint disease that affects approximately 1% of the population. It is characterized by persistent inflammatory synovitis leading to joint damage.
2) Diagnosis is based on symptoms like morning stiffness and joint involvement patterns, along with serological markers like rheumatoid factor and anti-CCP antibodies. Disease activity is monitored through clinical exams, labs, and imaging.
3) Treatment involves a multidisciplinary approach including medications like NSAIDs, DMARDs such as methotrexate, steroids, and biologics that target cytokines like TNF-α to reduce
Rheumatoid arthritis is a chronic inflammatory disease that affects the joints and causes pain, swelling, stiffness and loss of function. It affects around 1% of the population worldwide. Recent advances in management include earlier diagnosis using classification criteria from ACR/EULAR and aggressive treatment with disease-modifying antirheumatic drugs alone or in combination with biological therapies that target cytokines like TNF-α. While DMARDs can control symptoms, biological therapies may induce remission and prevent further joint damage by acting faster than conventional treatments. Prompt diagnosis and management can now improve long-term outcomes for those suffering from rheumatoid arthritis.
Evaluating Chronic Pain Patients Using Methods from Johns Hopkins Hospital Ph...Nelson Hendler
This article describes the use of physiological testing, instead of anatomical testing, to evaluate chronic pain. The efficacy of this approach is documented by published outcome studies.,, Patient require surgery 50%-63% of the time to improve.
This study reviewed 232 patients with low-grade (Spetzler-Martin Grade I-II) brain arteriovenous malformations (AVMs) who underwent surgical resection. The key findings were:
1) AVM resection was successful in all patients and confirmed angiographically in 94% with no residual AVMs found.
2) Overall good functional outcomes (mRS 0-1) were found in 78% at last follow-up, with 97% improved or unchanged from their preoperative status.
3) Patients with unruptured AVMs had better functional outcomes (91% good) than those with ruptured AVMs (65% good), but equivalent relative outcomes (96-98% improved
The document discusses several clinical trials evaluating the role of chemotherapy in metastatic castration-resistant prostate cancer (mCRPC). The CHAARTED trial found that for patients with high-volume mCRPC, the addition of docetaxel to androgen deprivation therapy (ADT) improved overall survival by 13.3 months compared to ADT alone. The STAMPEDE trial also found a survival benefit to adding docetaxel or zoledronic acid to standard of care. The GETUG-15 trial demonstrated a survival benefit for patients with high-volume disease receiving early docetaxel and ADT compared to ADT alone. Together these trials provide evidence supporting the use of docetaxel chemotherapy
This study evaluated the efficacy and safety of long-term intravenous immunoglobulin (IVIg) treatment for 52 weeks in patients with chronic inflammatory demyelinating polyradiculoneuropathy (CIDP). 49 patients received IVIg 1g/kg every 3 weeks for 52 weeks. The primary outcomes were a responder rate of 1 point improvement on the INCAT score at 28 weeks and relapse rate at 52 weeks. At 28 weeks, 77.6% of patients responded, higher than previous studies. The clinical remission rate was maintained at 69.4% at 52 weeks. Secondary outcomes also improved. Adverse events included cerebral infarction in 2 older patients. The study demonstrated efficacy of 52-week IVI
(October 2016) Non-operative management of medical meniscus posterior horn ro...Logan Peter
This study evaluated 52 patients with medial meniscus posterior horn root tears (MMPRTs) treated non-operatively over a mean follow-up of 5 years. The study found that 31% of patients underwent knee arthroplasty within 30 months on average. For the remaining patients, the mean subjective knee score was 61, indicating poor outcomes. Radiographic arthritis grades significantly worsened over time. Overall, 87% of patients met the criteria for treatment failure based on poor clinical or radiographic outcomes. Female patients and those with higher baseline arthritis grades had significantly worse outcomes. This study establishes that non-operative treatment of MMPRTs typically leads to poor clinical results and rapid arthritis progression.
Denosumab vs bisfosfonato en metástasis óseasMauricio Lema
This document summarizes key findings from three head-to-head clinical trials comparing denosumab to zoledronic acid for the treatment of bone metastases in solid tumors. The main points are:
1) A prespecified integrated analysis of the three trials found that denosumab was superior to zoledronic acid, reducing the risk of first skeletal-related events by 17%.
2) Denosumab provided benefits across multiple solid tumor types, reducing the risk of first skeletal-related events in breast cancer, prostate cancer, and other solid tumors compared to zoledronic acid.
3) Denosumab demonstrated efficacy in reducing both the time to first skeletal-related event and the risk of subsequent skeletal
S1PR modulators target receptors on lymphocytes, leading to lymphocyte sequestration in lymph nodes. They can also cross the blood-brain barrier and directly impact the central nervous system by signaling to neurons, microglia, oligodendrocytes, and astrocytes. This results in effects such as reduced neuroinflammation and neuronal damage, enhanced remyelination, and inhibition of astrogliosis. Clinical trials demonstrate that S1PR modulators significantly reduce brain volume loss compared to placebo or other disease-modifying therapies, as well as improve measures of disability and cognitive function in people with multiple sclerosis.
Crete to share for site epilepsy treatment alternatives to antiepileptic dr...psaltakis
This document discusses non-pharmacological treatment options for epilepsy, including epilepsy surgery, dietary treatments, and neurostimulation. It provides information on when these alternatives should be considered, the options available, and for which patients they may be suitable. Key points include: epilepsy surgery may be underused in the UK and can provide seizure freedom or reduction; the ketogenic diet has been shown to reduce seizures in about 15-30% of patients after 6 months depending on the study; and corpus callosotomy and vagus nerve stimulation are established palliative procedures for treatment-resistant generalized seizures.
This document discusses stress imaging modalities for assessing cardiac ischemia and viability. It addresses debates around which stress modality to use, whether pharmacological or exercise stress is preferred, and which stressor provides the best diagnostic accuracy. The document also discusses indications for pharmacological stress imaging if exercise is inadequate and assesses the diagnostic accuracy and prognostic value of different stress modalities. Finally, it addresses the use of stress echocardiography and nuclear imaging in evaluating patients for coronary artery disease.
1) Fingolimod is a sphingosine 1-phosphate receptor modulator approved for relapsing forms of multiple sclerosis. It works by retaining lymphocytes in lymph nodes, reducing their migration into the central nervous system.
2) Phase II clinical trial results showed fingolimod significantly reduced relapse rates and brain lesion activity compared to placebo over 5 years of follow up. It selectively retained naive and central memory T cells while sparing effector memory T cells.
3) Phase III FREEDOMS trial of over 1200 patients found fingolimod 0.5mg reduced annualized relapse rates by 54% and risk of disability progression by 30% compared to placebo over 2 years. It established
Marchiafava-Bignami disease is a rare toxic condition caused by demyelination and necrosis of the corpus callosum, typically seen in chronic alcoholics. The document reports on two cases of Marchiafava-Bignami disease potentially caused by consumption of a locally brewed alcoholic beverage called Mahuwa Alcohol. Radiologically, the disease usually affects the corpus callosum, most commonly involving the body, genu, and splenium sequentially, though sometimes the entire corpus callosum is affected. Clinical presentation varies between cases.
1) Carotid artery stenosis is a major risk factor for stroke. While carotid endarterectomy (CEA) has been shown to reduce stroke risk in selected low-risk patients, many patients are at high surgical risk or have exclusion criteria.
2) Early trials of carotid artery stenting (CAS) showed high complication rates but technology and experience have improved outcomes over time. Recent trials show CAS may have slightly better outcomes than CEA in high-risk patients.
3) Ongoing trials are further evaluating CAS compared to CEA in both high-risk and low-risk patients. The use of distal protection devices during CAS appears important for reducing complications.
1) Plasma exchange (PE) significantly improves outcomes for patients with Guillain-Barré syndrome compared to supportive care alone based on data from multiple randomized controlled trials. PE results in greater improvement in disability and faster recovery.
2) Intravenous immunoglobulin (IVIg) is as effective as PE based on trials comparing the two treatments, with no significant differences in outcomes.
3) Combining PE and IVIg does not provide additional benefit over either treatment alone.
1. Intravenous antibiotic prophylaxis prior to skin incision is the most effective way to reduce the risk of postoperative wound infection after lumbar spine surgery.
2. For a patient undergoing knee replacement who has liver disease, the recommended venous thromboembolism prophylaxis includes use of mechanical prophylaxis like pneumatic calf compressors while in the hospital.
3. Bone morphogenetic proteins signal through serine-threonine kinase cell surface receptors.
Preliminary Evaluation of Clinical and Angiographic
Outcomes with Biodegradable Polymer Coated
Sirolimus-Eluting Stent in De Novo Coronary Artery Disease: Results of the MANIPAL-FLEX Study
Chlamydia-induced Reactive Arthritis research project. Discusses pathogenesis, symptoms, and etiology. Summarizes possible treatment plans and includes questions for further research.
Microwave ablation was used to treat epiphyseal osteoid osteomas in 7 patients. All patients experienced complete pain relief within 1 week of the procedure and had no complications, except for 1 patient who experienced back pain for 2 months. MRI scans after treatment showed ablation areas averaging 21 x 12 x 14 mm. The study demonstrated that microwave ablation can safely and effectively treat epiphyseal osteoid osteomas with a single needle insertion and without complications. However, more research with larger patient groups is still needed to validate these promising initial results.
NZSSD - Conference 2012 Poster - ESWT and DPNKenneth Craig
This case study examines the use of extracorporeal shockwave therapy (ESWT) to treat peripheral neuropathy in a 59-year old male with type 1 diabetes. ESWT was administered to one foot over 6 sessions while the other foot served as a control. Quantitative tests found improvements in sensory perception in the treated foot compared to baseline and deterioration in the control foot. This suggests ESWT may help reverse sensory deficits from diabetic peripheral neuropathy and warrants further exploration as a non-invasive treatment option.
A prospective study was conducted at a critical care department and post-anesthesia care unit of a university teaching hospital in Barcelona, Spain. The study recruited 707 patients with invasive BP and finger PPG waves over a period of 26 months. Exclusion criteria were presence of major arrhythmia, immediate death condition and disturbances in the arterial or PPG curve morphology. For each patient we automatically recorded the systolic blood pressure (SBP), mean arterial pressure (MAP), diastolic blood pressure (DBP) and PPG curve for 30 minutes. The PPG signal was further processed to obtain a set of features that were used to construct a Deep Belief Network with Gaussian Restricted Boltzmann Machine (DBN-RBM). The available dataset was split into three subsets (Training, Validation and Testing). The training and validation datasets included 85% of data and the testing dataset included 15% of the available data. The regression error was assessed through a Bland-Altman analysis and the AAMI standard. The mean prediction error were -2.98+-19.35 mmHg for SBP, -3.38+-10.35 mmHg for MAP and 3.65+-8.69 mmHg for DBP.
The results obtained are promising for the assessment of MAP and DBP with DBN-RBM. Further research and clinical validation are needed to bring this technology to standard medical practice.
Volker Diehl, M.D., Professor, University of Cologne, Germany Customization: The Treatment of Hodgkin's Disease
Presented at New Frontiers in the Management of Solid and Liquid Tumors hosted by the John Theurer Cancer Center at Hackensack University Medical Center. jtcancercenter.org/CME
This document discusses rheumatoid arthritis (RA), including its diagnosis, management, and treatment. Some key points:
1) RA is a common inflammatory joint disease that affects approximately 1% of the population. It is characterized by persistent inflammatory synovitis leading to joint damage.
2) Diagnosis is based on symptoms like morning stiffness and joint involvement patterns, along with serological markers like rheumatoid factor and anti-CCP antibodies. Disease activity is monitored through clinical exams, labs, and imaging.
3) Treatment involves a multidisciplinary approach including medications like NSAIDs, DMARDs such as methotrexate, steroids, and biologics that target cytokines like TNF-α to reduce
Rheumatoid arthritis is a chronic inflammatory disease that affects the joints and causes pain, swelling, stiffness and loss of function. It affects around 1% of the population worldwide. Recent advances in management include earlier diagnosis using classification criteria from ACR/EULAR and aggressive treatment with disease-modifying antirheumatic drugs alone or in combination with biological therapies that target cytokines like TNF-α. While DMARDs can control symptoms, biological therapies may induce remission and prevent further joint damage by acting faster than conventional treatments. Prompt diagnosis and management can now improve long-term outcomes for those suffering from rheumatoid arthritis.
This document discusses rheumatoid arthritis (RA), including its etiology, classification criteria, clinical features, diagnostic testing, complications, and treatment approaches. RA is a chronic inflammatory disorder that primarily involves synovial joints, with symmetric involvement of hands/feet typically seen. Diagnosis relies on clinical exam showing inflamed joints and laboratory tests like rheumatoid factor and anti-CCP antibodies. If left untreated, RA can cause long-term joint damage and functional disability. Treatment involves medications like NSAIDs, DMARDs, steroids, and biologics to reduce inflammation and prevent structural damage.
Rheumatoid arthritis (RA) is a progressive inflammatory disorder characterized by symmetric synovitis and joint erosions. Approximately 1% of adults are affected. RA results in significant costs, morbidity, and mortality. The pathogenesis involves genetic and immunological factors. Early diagnosis and treatment can slow structural damage. Disease-modifying antirheumatic drugs (DMARDs) such as methotrexate are first-line treatments, with the goal of controlling disease activity and slowing progression. Combination DMARD therapy may provide superior outcomes to single agents. New therapies are still needed to further improve safety profiles and disease control.
Rheumatoid arthritis (RA) is a chronic inflammatory autoimmune disease that primarily affects the joints, causing swelling and stiffness. It results from an immune response targeting the synovial membrane and joint structures. RA is more common in women and usually presents between the ages of 40-50. Symptoms include pain, swelling and stiffness in small joints of hands and feet. If left untreated, RA can cause joint deformities and disability. Treatment involves medications to reduce inflammation and prevent joint damage, with the goal of achieving remission. Tight control of the disease and early use of disease-modifying antirheumatic drugs (DMARDs) can help improve long-term outcomes of patients with RA.
Chair and Presenter Taofeek K. Owonikoko, MD, PhD, Hossein Borghaei, DO, MS, and Anne Chiang, MD, PhD, FASCO, prepared useful Practice Aids pertaining to small cell lung cancer for this CME/MOC/AAPA activity titled “Harnessing the Power of the Latest Clinical and Research Advances in SCLC: How to Accelerate Progress and Improve Patient Outcomes With Current and Emerging Therapies.” For the full presentation, downloadable Practice Aids, and complete CME/MOC/AAPA information, and to apply for credit, please visit us at https://bit.ly/46zyU93. CME/MOC/AAPA credit will be available until January 2, 2025.
Roy H. Decker, MD, PhD, and Sarah B. Goldberg, MD, MPH, prepared useful practice aids pertaining to lung cancer for this CME activity titled "The Era of Immunotherapy in Stage III NSCLC: Exploring the Evidence and Practicalities of Integrating Checkpoint Inhibition Into the Multimodal Treatment Arsenal." For the full presentation, monograph, complete CME information, and to apply for credit, please visit us at http://bit.ly/2PU3iaZ. CME credit will be available until December 6, 2019.
Edward B. Garon, MD, MS, Jamie E. Chaft, MD, and Matthew D. Hellmann, MD, prepared useful Practice Aids pertaining to lung cancer management for this CME/MOC/CE activity titled "Improving Patient Outcomes With Cancer Immunotherapies Throughout the Lung Cancer Continuum: State of the Science and Implications for Practice." For the full presentation, monograph, complete CME/MOC/CE information, and to apply for credit, please visit us at http://bit.ly/2ATq0qp. CME/MOC/CE credit will be available until November 21, 2019.
Rheumatoid arthritis current diagnosis and treatmentAnkur Varshney
This document provides information on the diagnosis and management of rheumatoid arthritis (RA). It begins with an introduction to RA, noting that it is a chronic inflammatory joint disease affecting approximately 1% of the population. It then discusses the clinical presentation and manifestations of RA, including onset, patterns of joint involvement, and articular and extra-articular symptoms. The document reviews the diagnostic criteria for RA and covers laboratory investigations and radiographic features. It concludes with an overview of the goals and various treatment modalities for RA, including NSAIDs, corticosteroids, disease-modifying antirheumatic drugs (DMARDs), immunosuppressive therapies, and biological therapies.
The document discusses the challenges and opportunities in treating rheumatoid arthritis (RA). It notes that early diagnosis and treatment are important as joint erosions can occur early in RA. It also discusses the criteria for diagnosing RA and shows that biologic disease-modifying antirheumatic drugs (DMARDs) like etanercept and adalimumab, when combined with methotrexate, provide efficacy in reducing the signs and symptoms of RA as well as improving physical function. However, it notes there are safety considerations to monitor with biologic DMARDs such as infections, malignancies, and demyelination.
The document discusses the challenges and opportunities in treating rheumatoid arthritis (RA). It notes that early diagnosis and treatment are important as joint erosions can occur early in RA. It also discusses the criteria for diagnosing RA and shows that biologic disease-modifying antirheumatic drugs (DMARDs) like etanercept and adalimumab, when combined with methotrexate, provide efficacy in reducing the signs and symptoms of RA as well as improving physical function. However, it notes there are safety considerations to biologic DMARDs like increased risk of serious infections and potential risk of malignancies.
Treat to target in inflammatory diseases SMMI 2018SMMI2015
In conclusion, treat to target is a new paradigm that involves regular disease assessment, therapy adaptation, and consideration of patient factors. Integration into daily
The document discusses biologic therapies for rheumatological conditions. It provides information on TNF antagonists that are approved for treating diseases like rheumatoid arthritis, spondyloarthropathies, and psoriasis. It discusses the mechanisms of action, pharmacokinetics, administration, and safety monitoring of TNF inhibitors like infliximab, etanercept, and adalimumab. The document also summarizes clinical trial data on the effectiveness of TNF inhibitors for conditions like Crohn's disease and ankylosing spondylitis.
Updated summery 2021 American College of RheumatologyWafa sheikh
This document provides guidelines from the 2021 American College of Rheumatology for the treatment of rheumatoid arthritis. It discusses the diagnostic criteria and pathogenesis of rheumatoid arthritis. It recommends methotrexate monotherapy as first-line treatment for patients with moderate to high disease activity. It provides guidance on modifying or switching treatment for patients not achieving treatment targets. It also offers recommendations for treating specific patient populations and managing safety concerns.
3 evaluation and management of rheumatoid arthritisAmer
This document discusses the management of rheumatoid arthritis (RA). It provides details on:
- Key features of RA including symptoms, joint involvement, rheumatoid factor levels, and erosions.
- The typical clinical course, with most patients experiencing progressive joint damage over time.
- Treatment principles including early intervention, balancing efficacy and safety, and monitoring.
- Specific treatment options including NSAIDs, DMARDs, immunosuppressants, corticosteroids, and newer biologics.
- Potential complications of long-term RA and its treatment, including NSAID-induced gastropathy. Selective COX-2 inhibitors are presented as a potential solution to reduce gastrointestinal risks.
Arthritis is inflammation of the joints that can affect people of all ages. The joints are made of cartilage, synovial membrane, and bone. There are two main types - inflammatory arthritis like rheumatoid arthritis which causes persistent joint inflammation, and degenerative arthritis from normal wear and tear. Rheumatoid arthritis specifically affects the synovium and causes symmetrical joint pain, stiffness, and swelling. It is assessed based on symptoms, physical exam, blood tests for rheumatoid factor and anti-CCP antibodies, and x-rays. Treatment involves medications like NSAIDs for pain and swelling, DMARDs to slow disease progression, and corticosteroids for flares, with the goal of relieving symptoms and preventing long-
This document discusses a case of a 58-year-old woman presenting with recurrent eye pain and redness in both eyes. On examination, she was found to have diffuse anterior scleritis in the right eye and posterior scleritis, with a history of rheumatoid arthritis. The document then provides an overview of scleritis, including classification, pathogenesis, diagnostic approach, and treatment strategies depending on the type of scleritis and any underlying conditions. Treatment may involve NSAIDs, corticosteroids, immunosuppressants like methotrexate, or biologics, sometimes with surgical intervention for necrotizing scleritis. Non-infectious scleritis can indicate serious systemic diseases.
This document summarizes evidence-based care of women with rheumatoid arthritis (RA). It discusses that RA is a chronic inflammatory disorder that principally affects the synovial joints. It is characterized by a proliferative response in the synovium leading to bone and cartilage destruction. The document reviews who is affected by RA, common articular features, characteristic deformities, and extra-articular manifestations. It also discusses the natural history of RA and whether there are any gender differences. Current management approaches from 2012 are presented, including early diagnosis, prompt initiation of traditional DMARDs, and appropriate use of biological DMARDs.
A 71-year-old woman presented with aching pain and stiffness in her arms, hands, knees and feet for several months. She responded well initially to steroid treatment but had difficulty tapering off the dose. Examination found symmetrical joint swelling. Tests showed elevated inflammatory markers. She was diagnosed with possible polymyalgia rheumatica or late-onset rheumatoid arthritis. Treatment with methotrexate and gradual steroid tapering was recommended.
La artritis reumatoide es una enfermedad inflamatoria crónica que destruye progresivamente las articulaciones, causa incapacidad funcional y reduce la esperanza de vida. Afecta aproximadamente al 0.5-1% de la población mundial de manera más frecuente en mujeres. El objetivo del tratamiento es aliviar los síntomas, preservar la función, prevenir el daño estructural a través de un control estricto de la actividad de la enfermedad cada 3 meses y cambios oportunos del tratamiento.
El documento proporciona una descripción general del síndrome de anticuerpos antifosfolípidos, incluyendo su definición, características clínicas, criterios de diagnóstico, posibles mecanismos patogénicos y opciones de tratamiento y prevención. El síndrome se caracteriza por trombosis vascular recurrente y/o pérdidas fetales asociadas con niveles elevados persistentes de anticuerpos contra fosfolípidos.
El documento resume las características de las espondiloartropatías seronegativas. 1) El HLA-B27 no es patognomónico de las espondiloartropatías, pero se asocia con una alta prevalencia, especialmente en la espondilitis anquilosante. 2) Las espondiloartropatías no solo afectan el esqueleto axial, también pueden causar artritis periférica y manifestaciones extraarticulares como uveítis y entesitis. La espondilitis anquilosante es la forma más com
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Este documento presenta seis casos clínicos de pacientes con diferentes síndromes dolorosos de miembros inferiores y superiores. Resume la epidemiología, etiopatogenia, hallazgos clínicos, diagnóstico y tratamiento de cada síndrome, e identifica áreas que requieren mayor investigación. El documento provee una descripción concisa pero completa de estas condiciones musculoesqueléticas comunes.
The document discusses strategies for diagnosis in rheumatology. It begins by outlining the bases of clinical reasoning, including knowledge, skills, and the establishment of mental maps by experts and novices. It then provides examples of how an expert and novice may present the case of a 54-year old man experiencing acute knee pain differently. The expert's presentation includes an impression of recurrent acute monoarthritis, while the novice's lacks structure. The document goes on to discuss a two-step approach to diagnosis involving non-analytical mental maps based on evidence and experience. It also outlines types of diagnoses and various rheumatological syndromes like regional, widespread, articular, and systemic syndromes as well as pediatric patterns.
Las espondiloartropatías seronegativas son un grupo de enfermedades inflamatorias crónicas que incluyen la espondilitis anquilosante, el síndrome de Reiter, la artritis reactiva, la artritis enteropática y la artritis psoriásica. Presentan características como dolor espinal inflamatorio, sinovitis asimétrica y alta asociación con el antígeno HLA-B27. Aunque el HLA-B27 no es patognomónico, se presenta en altas proporciones
Este documento describe el lupus eritematoso sistémico (LES), incluyendo su definición, epidemiología, manifestaciones clínicas, factores etiológicos, criterios de clasificación y tratamiento. El LES es una enfermedad autoinmune sistémica que afecta principalmente a mujeres jóvenes y se caracteriza por la producción de anticuerpos contra antígenos nucleares. Puede afectar múltiples órganos como la piel, articulaciones, riñones, pulmones y sistema nervioso central.
3. Razonamiento
• Remisión – daño
• 14% remisión espontánea
• Daño temprano
• 70% pacientes – erosiones a los 3 años
• MRI, USG
• 9 meses de retraso incrementan progresión
• >12 semanas de retraso – 1.87 HR
4. Ventana de oportunidad
• Susceptibilidad a cambio
• Inmunologicamente distinta
• 12 semanas
• Autoanticuerpos
• Marcadores de inflamacion
• Estudios de imágen
5. Retos
• 1. Evaluar tempranamente pacientes con
artritis inflamatoria
• 2. Predecir que pacientes evolucionarán a AR y
requerirán tratamiento
• 3. Determinar como tratar a dichos pacientes
7. Abordaje
• Reconocer y tratar tempranamente a
pacientes con artritis erosiva
• Regular actividad de la enfermedad, treat to
target, buscando remisión
• Excluir otras enfermedades
• Determinar riesgo de enfermedad persistente
o irreversible
• Instituir tratameinto y vigilar actividad, escalar
tratamiento
8.
9. morning stiffness lasting 30 minutes or more. Hand or foot involvement is common in inflammatory
arthropathies and is suggested by a positive metacarpophalangeal (MCP) or metatarsophalangeal
MTP) ‘squeeze test’.
Figure 2: Metacarpophalangeal squeeze test
All new patients with symptoms of an inflammatory arthritis should be referred to a rheumatologist
during the early more treatable phase of the disease. As a proportion of patients that will develop
10. Eular On-line Course on Rheumatic Diseases – module n°13
Bernard Combe, Jackie Nam, Paul Emery
Figure 3: Malar rash in a patient with systemic lupus erythematosus
Figure 4: Psoriatic plaques
V-2 Investigations
Most cases of suspected inflammatory arthritis will warrant a complete blood count, inflammatory
markers, basic serology including RF, anti-CCP antibodies and antinuclear antibodies, renal and
liver function tests and a urine analysis.
11. Eular On-line Course on Rheumatic Diseases – module n°13
Bernard Combe, Jackie Nam, Paul Emery
Figure 5: Calcification of the triangular fibrocartilage of the wrist in calcium pyrophosphate
dihydrate deposition disease
12.
13.
14. Persistencia individual
• Duración de la enfermedad
• RAM
• Manos
• Discapacidad
• Reactantes de fase aguda
• FR, aCCP
• Marcadores genéticos
• Tabaquismo
• Erosiones en estudios de imágen
• Densitometría de huesos de manos
• Histología
• Marcadores de destrucción articular
15. Eular On-line Course on Rheumatic Diseases – module n°13
Bernard Combe, Jackie Nam, Paul Emery
Figure 6: Conventional radiograph of the foot showing erosions of the fifth metatarsal head
Radiographic damage at baseline also represents the best predictive factor of poor structural
outcome. Irrespective of the scoring systems (e.g. Larsen or Sharp scores) used, the initial
radiographic score consistently predicts future radiographic damage[51].
16. the diagnosis of early arthritis. The advantages of US are that it is relatively inexpensive, non-invasive
and allows many joints to be assessed at any one time. The main disadvantage is its
dependency on the skills of the operator and potential problems with reproducibility.
Figure 7: Rheumatoid arthritis.
Second metacarpophalangeal joint. A. Conventional radiography shows iuxta-articular
osteoporosis. B. Sonographic examination, in the longitudinal dorsal scan, reveals proliferative
synovitis with marked intra-articular power Doppler signal. m = metacarpal bone; p = proximal
phalanx; t = extensor tendon
Further discussion on the use of MRI and US in early arthritis can be found in in-depth discussion
1.
19. Estrategia de tratamiento
• No farmacológicas
• Educación del paciente
• Farmacológicas
– Sintomáticos
– Esteroides
– DMARD (FARME)
– Monoterapia vs. terapia combinada
– Biológicos
– Inducción y mantenimiento
20. Remisión según DAS28 en estudios de ART con
biológicos + MTX a 1 año
*
*P<0.001
*
*
1 2 3 4
Dosis de infliximab: 3 mg/kg c/8 sem
MTX
1. St Clair EW et al. Arthritis Rheum 2004; 50: 3432-43.
2. Klareskog et al. Lancet 2004; 363: 675–81.
3. Breedveld FC et al. Arthritis Rheum 2006; 54: 26–37.
4. Emery P, Breedveld F, Hall S, et al. Abstract Presentation ACR 2007
21. Etanercept: Inhibición de la progresión
radiográfica del daño articular
Cambio promedio en Indice de Sharp a los 3 años a partir de la basal
*p < 0.05, E vs. MTX
†p < 0.05, combinación vs. MTX
‡p < 0.05, combinación vs. E
† ‡
3 y
*
*
*
‡
† ‡
1 y 2 y
3.25
* 0.39
†‡
-0.67
Cambio promedio desde línea basal
8
6
4
2
0
-2
MTX = 210
E = 211
E + MTX = 217
El Indice de Sharp es un método de evaluación radiográfica que
considera erosiones y disminución del espacio articular
van der Heijde D, et al. Abstract Presentation ACR 2005
22. Reducción en uso de recursos con anti-TNF
Tratamiento pre- post anti-TNF
1000
800
600
400
200
60
50
40
30
20
10
• Pacientes con anti-TNF (mar 99 a jun 00)
• 4 servicios de Reumatología en Suecia (n = 116)
• Comparación pre-post implementada a los 12 meses
857
593
332
113
0
Hospitalización
relacionada con
cirugía
Hospitalización
no quirúrgica
Número total de días
Tratamiento pre- post anti-TNF
56
22 20
28
10 8
0
Procedimientos
ortopédicos
Reemplazo
articular mayor
Cirugía de mano
Porcentaje por paciente/año
Kobelt et al. Annals of the Rheumatic Diseases 2004;63:4-10
25. Table 4 EULAR recommendations on the management of early arthritis [36]
1. Arthritis is characterised by the presence of joint swelling, associated with pain or stiffness. Patients
presenting with arthritis of more that 1 joint should be referred to, and seen by, a rheumatologist,
ideally within 6 weeks after onset of symptoms.
2. Clinical examination is the method of choice for detecting synovitis. In doubtful cases, ultrasound,
power Doppler, and MRI might be helpful to detect synovitis.
3. Exclusion of disease other than rheumatoid arthritis requires careful history taking and clinical
examination, and ought to include at least the following laboratory tests: complete blood cell count,
urinalysis, transaminases, and antinuclear antibodies.
4. In every patient presenting with early arthritis to the rheumatologist, the following factors predicting
persistent and erosive disease should be measured: number of swollen and tender joints, ESR or
CRP, level of rheumatoid factor and anti-CCP antibodies, and radiographic erosions.
5. Patients at risk of developing persistent or erosive arthritis would be started with DMARDs as early
as possible, even if they do not yet fulfil established classification criteria for inflammatory
rheumatological diseases.
6. Patient information concerning the disease and its treatment and outcome is important. Education
programmes aimed at coping with pain, disability and maintenance of work ability may be employed
as adjunct interventions.
7. NSAIDs have to be considered in symptomatic patients after evaluation of gastrointestinal, renal,
and cardiovascular status.
8. Systemic glucocorticoids reduce pain and swelling and should be considered as adjunctive
treatment (mainly temporary), as part of the DMARD strategy. Intra-articular glucocorticoids
injections should be considered for the relief of local symptoms of inflammation.
9. Among the DMARDS, Methotrexate is considered to be the anchor drug, and should be used first
in patients at risk of developing persistent disease.
10. The main goal of DMARD treatment is to achieve remission. Regular monitoring of disease activity
and adverse events should guide decisions on choice and changes in treatment strategies
(DMARDs including biological agents).
11. Non-pharmaceutical interventions such as dynamic exercises, occupational therapy, and
hydrotherapy can be applied as adjuncts to pharmaceutical interventions in patients with early
arthritis.
12. Monitoring of disease activity should include tender and swollen joint count, patient’s and
physician’s global assessments, ESR and CRP. Arthritis activity should be assessed at one to three
month intervals, for as long as remission is not achieved. Structural damage should be assessed by
radiographs of hands and feet every 6-12 months during the first few years. Functional assessment
(for example, HAQ) can be used to complement the disease activity and structural damage
monitoring.
CRP, C reactive protein; DMARD disease modifying antirheumatic drug; ESR, erythrocyte
sedimentation rate; HAQ, Health Assessment Questionnaire: MRI, magnetic resonance imaging.