Effects of Teriparatide on Joint Erosions in Rheumatoid Arthritis: A Randomized Controlled Trial.

OBJECTIVE: Articular erosions correlate with disability in rheumatoid arthritis (RA). Biologic agents reduce erosion progression in RA, but erosion healing occurs infrequently. This study was undertaken to assess the effects of the anabolic agent teriparatide on joint erosion volume in RA patients treated with a tumor necrosis factor inhibitor (TNFi). METHODS: We conducted a randomized controlled trial in 24 patients with erosive RA, osteopenia, and disease activity controlled by TNFi treatment for at least 3 months. Half were randomized to receive teriparatide for 1 year and the others constituted a wait-list control group. Subjects and primary rheumatologists were not blinded with regard to treatment assignment, but all outcomes were assessed in a blinded manner. The primary outcome measure was change in erosion volume determined by computed tomography at 6 anatomic sites. Significance within each hand and anatomic site was based on a 2-tailed test, with P values less than 0.05 considered significant. RESULTS: Baseline characteristics of the treatment groups were well balanced. After 52 weeks, the median change in erosion volume in the teriparatide group was -0.4 mm3 (interquartile range [IQR] -34.5, 29.6) and did not differ significantly from that in controls (median change +9.1 mm3 [IQR -29.6, 26.4]) (P = 0.28). No significant difference in change in erosion volume was noted at the radius, ulna, or metacarpophalangeal joints. Bone mineral density improved at the femoral neck and lumbar spine in the teriparatide group. CONCLUSION: Our findings indicate that teriparatide treatment for 1 year does not significantly reduce erosion volume in the hands or wrists of patients with established RA with disease activity controlled by TNFi treatment.

[Electroconvulsive therapy in compulsive syndromes. A case report]. / Elektrokrampftherapie bei Zwangssyndromen. Eine Kasuistik.

We report on a case of successful ECT in serious drug-resistant and psychotherapy-resistant obsessive-compulsive disorder. The 44-year old male patient had already had symptoms of this disorder for 4 years, and they completely disappeared after seven ECTs (1 bi-, 6 unilateral). After remission of the obsessions the patient underwent a behaviour therapy to consolidate the success of the ECT treatment and to prepare the patient for returning to work. He remains free of obsessions 18 months later.

[Violent patients. A problem for the therapist in psychiatric clinics?]. / Gewalttätige Patienten. Ein Problem für Therapeuten an psychiatrischen Kliniken?

At four psychiatric hospitals, 128 doctors, 50 psychologists and 55 social workers were asked to complete a questionnaire about their experience with aggressive patients. Fifty-five percent reported having been assaulted seriously during their career; physical assaults during the last year had occurred for 29%. Forty-nine percent had experienced a situation judged as fairly or very dangerous. Women were concerned less than men, social workers less than psychologists and doctors.

[High tibial barrel-vault osteotomy. A clinical study and statistical analysis of 91 long-term results]. / Die valgisierende Tibiakopfpendelosteotomie. Eine klinische Untersuchung und statistische Analyse von 91 Langzeitergebnissen.

91 high tibial valgus barrel-vault osteotomies were subject of a follow-up study from 10 to 19 years (phi 11.9) after the osteotomy. 20 of the patients rate themselves as excellent, 29 as good, 22 as poor and 22 as failed. Adipositas was a factor that mainly worsened the results. Furthermore a postoperative flexion deformity and preoperative joint-space-narrowing were negative conditions, too. A slight overcorrection, more than the physiological valgus proved to be advantageous. The results were not influenced by age, sex and preoperative radiographic stage and range of motion. In summary the osteotomy has been shown to be a successful measure to prolong the period until final destruction of the knee joint will happen.

The influence of sample age on collagen-induced platelet aggregation in whole blood.

Whole blood electrical aggregometry (WBEA) has become an accepted method to gain quick information on platelet disorders. Compared to the optical method WBEA is closer to physiology and less complicated, but on the other hand more difficult to standardize. Different approaches have been attempted in the past to improve the reliability and practicability of this technique. The influence of sample age has not been defined so far. In a first step a mathematical modelling program was established, which is able to characterize the aggregation curves obtained after collagen stimulation. In a mathematical analysis various characteristics of the curve function were calculated and their sensitivity for aging investigated. Regression was performed for each characteristic, and correction factors defined. Our results indicate, that whole blood specimen for collagen induced aggregation can be used without correction factor up to 30 minutes. Data obtained with an age exceeding half an hour have to be corrected following a quadratic regression.