Prognostic factors determining long-term outcomes of conservative treatment for acute calcific periarthritis of the hand.

Acute calcific periarthritis (ACP) of the hand is an uncommon disease that is usually self-limited. Although the conservative treatment is generally considered the primary intervention, the prognostic factors associated with long-term outcomes have yet to be identified. The purposes of this study were to investigate the long-term effects of conservative treatment and identify factors associated with long-term prognosis. We retrospectively reviewed 25 patients with a mean age of 46 years who were diagnosed with ACP of the hand and followed up over more than 2 years. Pain control with nonsteroidal anti-inflammatory drugs and activity restrictions were recommended for the initial treatment. Symptom persistence was defined as a visual analogue scale of more than 1. We compared patients with and without symptom persistence regarding potential prognostic factors such as age, gender, calcification size and type (type 1, amorphous and ill-defined; type 2, homogenous and well-defined), and joints and digits involved. Factors associated with symptom persistence were examined with multivariate analysis. At 2-year follow-up, 19 patients showed complete improvement, whereas 6 reported persistent symptoms. Symptom persistence was independently associated with the thumb involvement (odds ratio (OR), 149.77; 95% confidence interval (CI), 0.61-15.98; P = 0.02) and calcification type 2 (OR, 27.68; 95% CI, 0.50-11.08; P = 0.02). In our study, most patients with ACP of the hand reported symptom improvement with conservative treatment at 2 years of follow-up. Calcification of the thumb or calcification type (homogeneous with a well-defined margin) was independently associated with symptom persistence at 2 years.

Retrospective study of therapeutic effect of Tongbi paste vs Fufangzhuifeng paste for shoulder periarthritis.

OBJECTIVE: To compare the therapeutic effects of Tongbi and Fufangzhuifeng pastes in shoulder periarthritis. METHODS: The retrospective study was conducted at the Chongqing Traditional Chinese Medicine Hospital, China, and comprised data of shoulder periarthritis patients who were treated from December 2018 to June 2019. Group A had data of patients treated with Tongbi paste and group B had data of patients treated with Fufangzhuifeng paste. The groups were compared for effect on pain, shoulder flexion, abduction and extension. Data was analysed using SPSS 22. RESULTS: Of the 81 patients, 43(53%) were in group A; 18(42%) males and 25(58%) females with an overall mean age of 54.26±12.38 years (range: 28-79 years) who were suffering from shoulder periarthritis for a mean duration of 5.08±3.07 months (range: 0.25-13 months). There were 38(47%) patients in group B; 23(60.5%) females and 15(39.5%) males with an overall mean age of 53.08±11.08 years (range: 33-76 years) who were suffering from shoulder periarthritis for a mean duration of 4.96±2.77 months (range: 1-12 months). Mean pain, shoulder flexion, abduction and extension scores after two weeks of treatment were significantly better for group A compared to group B (p<0.001), but after three weeks of treatment, intergroup differences were different but not significant (p>0.05). CONCLUSION: Tongbi and Fufangzhuifeng pastes were found to have a positive effect in the treatment of shoulder periarthritis, with the former providing faster relief.

Tuina for periarthritis of shoulder: A systematic review protocol.

BACKGROUND: Periarthritis of shoulder (PAS) symptom is one of the leading causes prompting many patients to seek treatment. Tuina is a common treatment for PAS in China. But at present, there is no systematic evaluation report on its therapeutic effectiveness and safety. This protocol aims to reveal the efficacy and safety of Tuina for treating PAS. METHODS: The following databases will be searched by electronic methods: PubMed, EBASE, WHO International Clinical Trials Registry Platform, Embase, the Chinese Biomedical Literature Database (CBM), Wan-fang Data (WANFANG), the China National Knowledge Infrastructure (CNKI), and other sources from inception to December 2019. Bias risk, subgroup analysis, data synthesis, and meta-analyses will be assessed with RevMan V.5.3 software if the data is met inclusion conditions. RESULTS: This study will present a quality evidence of Tuina for the treatment of PAS patients. CONCLUSION: The systematic review will present reliable evidence to judge whether or not Tuina is a safe and effective intervention for PAS patients. PROSPERO REGISTRATION NUMBER: CRD42019147445.

Arnica compositum, Hekla lava and Acidum Nitricum Together are Superior to Arnica compositum Alone in the Local Treatment of Symptomatic Calcific Periarthritis of the Shoulder: A Pilot Study.

BACKGROUND: To evaluate the usefulness of Arnica compositum (AC) + Acidum nitricum (AN) + Hekla lava (HL) ointment in Emergency Medicine Department (EMD) as alternative nonpharmacological local treatment of patients with symptomatic calcific periarthritis of the shoulder (CPS) and to compare the effectiveness of this mixture against AC ointment alone. METHODS: A series of 41 consecutive patients (20 women, 19 men, median age 49 years, range 25-80 years) with non-traumatic painful unilateral CPS were randomly assigned to receive local treatment with AC+AN+HL ointment mixture (Group A, cases, N=21) or AC ointment alone (Group B, controls, N=20). The radiological Gartner classification of the CPS, and the quantification of pre- and post-treatment pain intensity using a Visual Analogue Scale (VAS) were obtained. The orthopedic evaluation of Shoulder Motion (SM) was also performed. The use of painkillers was reported as a number of doses needed. RESULTS: Age, gender distribution, Gartner type, main calcification size, baseline VAS (VAS-0) and degree of SM did not differ (p=NS) between Groups. After 3-day therapy, the reduction of pain in Group A (4.5±2.5) was superior to that observed in Group B (2.7±2.6) (p =0.03). The same result was observed in the improvement of SM in Group A (69.4±24.9) than in Group B (51.1±21.1) (p =0.015). No local or general adverse effects were noted. The number of doses of paracetamol was similar, but Group A patients used less ibuprofen (p =0.007). CONCLUSION: Local administration of the AC+AN+HL ointment mixture, which in our pilot study was superior to AC alone, could be safely suggested as an alternative uneventful treatment of patients with CPS.

A case report of basic calcium phosphate deposition disease mimicking septic arthritis.

We report a case of a 53-year-old man who presented with a diagnostic dilemma mimicking septic arthritis. It is important to consider the diagnosis of calcific peri-arthritis clinically and recognize the hallmarks on radiograph and magnetic resonance imaging as this disease process resolves completely with conservative management like in our patient, and does not require operative intervention.

[Local injection therapy of damage of paraarticular tissue]. / Lokal'naia in''ektsionnaia terapiia porazhenii paraartikuliarnykh tkanei.

AIM: To evaluate the potential of local injection therapy with Alflutop in management of paraarticular tissue lesions (PTL). MATERIAL AND METHODS: 44 patients with various localization of PTL were examined and exposed to treatment. RESULTS: As a result of local therapy with Alflutop, the majority of patients with PTL experienced a decrease in pain syndrome and an increase in the functional capabilities. There was no negative dynamic of symptoms. CONCLUSION: Treatment with Alflutop was well tolerated by patients, easily applied, had a small number of side effects and was accompanied by a pronounced clinical effect.

Chronic calcific periarthritis of the elbow treated by cimetidine administration: Five cases.

Calcific periarthritis or calcific tendinitis occurs most frequently in the shoulder and rarely in the elbow. Cimetidine was previously reported to be effective for chronic calcific periarthritis of the shoulder. Here, we present five patients with chronic calcific periarthritis of the elbow treated by administration of cimetidine; there were six affected elbows in these five patients. Although all patients had been treated with nonsteroidal anti-inflammatory drugs for at least 3 months, their symptoms were not relieved. All patients took oral administration of cimetidine 400 mg daily. The pain was completely relieved in an average of 1.8 months after the administration of cimetidine, and the calcification of the elbow disappeared in an average of 5.1 months. During the follow-up period, there were no symptoms suggesting a recurrence. Although the detailed mechanism of action of cimetidine on periarticular calcifications remains to be understood, cimetidine appears to be a potential therapeutic agent for chronic calcific periarthritis.

Efficacy and safety of ustekinumab in psoriatic arthritis patients with peripheral arthritis and physician-reported spondylitis: post-hoc analyses from two phase III, multicentre, double-blind, placebo-controlled studies (PSUMMIT-1/PSUMMIT-2).

OBJECTIVE: To evaluate ustekinumab efficacy and safety in psoriatic arthritis (PsA) patients with peripheral arthritis and physician-reported spondylitis (termed the 'spondylitis subset'). METHODS: Adults with active PsA (PSUMMIT-1/PSUMMIT-2, n=615/312) were randomised to ustekinumab 45 mg, 90 mg or placebo at week 0/week 4/q12 week. At week 16, patients with <5% improvement in tender and swollen joints entered blinded early escape. A subset of patients with physician-identified spondylitis was evaluated with spondylitis-specific assessments, including Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) and Ankylosing Spondylitis Disease Activity Score employing C reactive protein (ASDAS-CRP), through week 24. RESULTS: 256/927 (27.6%) PSUMMIT-1/PSUMMIT-2 patients (placebo/ustekinumab, n=92/164) comprised the evaluable spondylitis subset. At week 24, in this analysis subset, significantly more patients achieved BASDAI20/50/70 responses (54.8%/29.3%/15.3% vs 32.9%/11.4%/0%; p≤0.002), improvement in BASDAI question 2 concerning axial pain (1.85 vs 0.24; p<0.001) and mean per cent ASDAS-CRP improvements (27.8% vs 3.9%; p<0.001) for ustekinumab versus placebo recipients, respectively. Comparable to the overall study population, significant improvements were also achieved in psoriasis, peripheral arthritis, enthesitis, dactylitis, physical function and peripheral joint radiographs in the spondylitis subset. CONCLUSIONS: In this post-hoc analysis of PsA patients with baseline peripheral arthritis and physician-reported spondylitis, ustekinumab-treated patients demonstrated significant improvements in axial signs and symptoms through week 24. TRIAL REGISTRATION NUMBER: PSUMMIT-1 (NCT01009086, EudraCT 2009-012264-14) and PSUMMIT-2 (NCT01077362, EudraCT 2009-012265-60); post-study results.

[Topical gel formulation of ibuprofen in the treatment of acute and chronic joint and soft tissue pain. Results of a non-interventional observational trial]. / Topisches Ibuprofen bei akuten und chronischen Gelenk- und Weichteilschmerzen. Ergebnisse einer nicht-interventionellen Studie.

BACKGROUND: Pain, inflammation or swelling of soft tissues orjoints is often treated with oral or topical formulation of lbuprofen. METHOD: Thetherapeutic effect of a topical gel formulation of Ibuprofen (doc Ibuprofen Schmerzgel) was investigated in an observational trial. A total of 170 patients suffering either from pain, inflammation or swelling of soft tissues or joints or having experienced a blunt trauma were enrolled into this study. Physicians and patients evaluated typical symptoms at study entry and after 1 week at the final visit. Further, the patients were asked and instructed to monitor their symptoms in a daily diary over this week. RESULTS: Patientssufferingfromacute trauma (group A (symptoms existent up to 48 hours) as well as patients with chronic symptoms (group B) experienced a fast and prominent improvement of symptoms. In group A total reduction of all symptoms after one week was recorded to amount to considerably more than 80%, in group B a reduction of more than 50% compared to the initial scores could be seen. Evaluation done by physicians and patients were extremely concordant with regard to timecourse and final outcome of the treatment. After first use on day one group A noted a reduction of pain symptoms after approximately 25 minutes, while in group B a considerable relief of pain was reported after approximately 37 minutes. During this one-week treatment period no adverse-effects were reported.Tolerability and applicability were classified as good to excellent. CONCLUSIONS: The results of this study confirm findings from existing clinical trials data. In acute traumata a faster symptom relief is found, in chronic conditions the product leads to symptom reduction in case seven where pretreatment has shown insufficient results. Thus this topical treatment provides a treatment option either alone or in combination with orally taken NSAIDS.

[Analysis of clinical efficacy of combination therapy of small needle knife and Daqinjiu Tang in treatment of periarthritis of shoulder].

In order to explore the clinical effect of combination therapy of small needle knife and Daqinjiu Tang in treatment of periarthritis of shoulder, 118 patients with periarthritis of shoulder were divided into control group (59) and experimental group (59) evenly and randomly. Control group received treatment of small needle knife while experimental group received combination therapy of small needle knife and Daqinjiu Tang. Clinical efficacy, shoulder pain and shoulder function were assessed and analyzed between groups before and after treatments. It was showed that the total therapeutic efficacy of experimental group was significantly higher than that of control group (P < 0.05, chi2 = 6.781); Shoulder pain and function were improved after treatments for all patients (P < 0.05), but more significantly in experimental group than in treatment group (P < 0.05). It is suggested that there is confirmed therapeutic effects of combination therapy of small needle knife and Daqingjiu Tang in treatment of periarthritis of shoulder, better than utilizing small needle knife therapy alone.

[The analysis of the efficacy of the local treatment of patients with different course of humeroscapular periarthrosis].

The efficacy of the local treatment (anesthetic and hormonal blockades) in patients with different types of the course of humeroscapular periarthrosis (HP) has been analyzed. The examination of patients with HP (mean age 57±11,9 years) included the assessment of pain with the VAS, palpation and resistive tests, biomechanical parameters of movement volume in the shoulder joint; the 1,5 year follow-up of 58 patients. Forty patients underwent MRI of the shoulder joint. Four types of HP course have been singled out: remitting, partly regradient, regradient and stagnating. The complete or partial remission was observed in 48,2% of patients. No significant between-group differences in tomographic parameters were found that indicated the low value of MRI in the prediction of local treatment outcome. The major factors of stagnating type of HP course were the long duration of the primary exacerbation and non-maintenance of the treatment-prevention regime by patients. Differential criteria of remitting HP course were revealed: the low subjective pain perception in a large number of "painful dots", mild biomechanical disturbances and the presence of less than 6 findings in the MRI of the shoulder joint. In these patients, the use of local treatment is not effective.

Can clodronate be effective in the treatment of disabling hydroxyapatite crystal-deposition disease? A report of two cases.

Hydroxyapatite crystals are often deposited in the vicinity of joints, where they can cause a clinical periarthritis. Clodronate is a first-generation bisphosphonate that has the ability to reduce ectopic calcifications. Two women were affected by disabling calcific periarthritis of the shoulders lasting for years and resistant to any traditional drug (including glucocorticoids), infiltration and surgical treatment. We treated both patients with low-dose methylprednisolone added to intramuscular clodronate at the daily dose of 100 mg administered for 20 days every 3 months for 5 cycles (18 months). In both cases, the results were clinically evident within 1 month, showing a significant reduction in pain and disability. After 18 months, the result was furthermore radiologically evident in both cases with a great reduction in the size of calcifications. These improvements were still present at follow-up after 7 and 5 years with complete functional recovery.

[Palindromic rheumatism. Report of one case]. / Reumatismo palindrómico (Enfermedad de Hench Rosemberg). Caso clínico con respuesta a los glucocorticoides.

Palindromic rheumatism is characterized by multiple recurrent episodes of arthritis and periarthritis (mono or oligoarticular) that may last hours or days, disappearing without sequels. We report a 69-year-old male with a history of hypertension and a presumptive diagnosis of gout due to recurrent episodes of arthritis and periarthritis in the last thirty years. They involved at least two joints, lasted few days and were self limited. The patient was admitted due to arthritis and periarthritis of both wrists, knees, ankles, elbows and hands. He presented with fever (38-39 degrees C), intense articular pain and anorexia. With a presumptive diagnosis of palindromic rheumatism and the lack of response to non steroidal anti inflammatory drugs, methylprednisolone 20 mg/od per os was started, with an excellent response.

Reumatismo palindrómico (Enfermedad de Hench Rosemberg): Caso clínico con respuesta a los glucocorticoides / Palindromic rheumatism: Report of one case

Palindromic rheumatism is characterized by multiple recurrent episodes of arthritis and periarthritis (mono or oligoarticular) that may last hours or days, disappearing without sequels. We report a 69-year-old male with a history of hypertension and a presumptive diagnosis of gout due to recurrent episodes of arthritis and periarthritis in the last thirty years. They involved at least two joints, lasted few days and were self limited. The patient was admitted due to arthritis and periarthritis of both wrists, knees, ankles, elbows and hands. He presented with fever (38-39º C), intense articular pain and anorexia. With a presumptive diagnosis of palindromic rheumatism and the lack of response to non steroidal anti infammatory drugs, methylprednisolone 20 mg/od per os was started, with an excellent response.

The use of artrofoon in the therapy of disorders of the paraarticular apparatus.

In 30 patients with periarthritis of the shoulder joint, therapy with artrofoon relives pain and increases movement range; these effects were comparable with those produced by nonsteroidal antiinflammatory preparations. No changes in blood, urine, and ECG parameters were noted. No side effects requiring artrofoon withdrawal were recorded. In the control group, nonsteroidal antiinflammatory preparations were withdrawn in 3 patients, in whom symptoms of gastritis developed.

[Periarthritis of the shoulder joint: variants of the course and treatment with artrofoon].

AIM: To compare efficacy of shoulder joint periarthritis (SJP) treatment with artrofoon vs non-steroid anti-inflammatory drugs (NSAID). MATERIAL AND METHODS: SJP patients of the study group (12 males, 18 females, mean age 59.4 +/- 8.9 years, the disease duration 6.5 +/- 3.8 years) received artrofoon (1 tablet 8 times a day for 3 months, in improvement of the condition the dose was reduced to 4 tablets a day). Patients of the control group (11 males, 19 females, mean age 58.3 +/- 9.6 years, the disease duration 5.1 +/- 4.1 years) were given NSAID (primarily diclofenac in a dose 100 mg/day with subsequent dose reduction in improvement). All the patients were examined on the day of the treatment start, 2 weeks, 1 and 3 months later. The examination protocol included general examination, measurement of blood pressure, body mass, height, pain at rest and exercise, motility of the shoulder joint, subjective and objective efficacy and tolerance of the drugs. Total blood count, biochemical blood analysis, urine test, ECG, x-ray, ultrasound investigation of the joint were performed before and after therapy. RESULTS: The majority of the patients from both groups experienced nocturnal pain relief, artrofoon relived also pain at the joint movement. Significant objective and subjective responses were registered in 15 and 14, partial response--in 10 and 12 patients of the study group, respectively, no response--in 5 and 4 patients, respectively. In the controls, the above degree of the response was in 9 and 12, 18 and 16, 3 and 2 patients, respectively. Negative effects of the treatments were not seen. CONCLUSION: SJP treatment with artrofoon is effective. It relieves pain, improves motility of the joint, normalizes mental and somatic status of the patients.