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1.
Orthop Clin North Am ; 51(2): 227-233, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32138860

RESUMO

Ulnar abutment (ulnocarpal impaction) syndrome may be a source of ulnar-sided wrist pain in the athlete. This condition results from excessive load transfer across the triangular fibrocartilage complex and ulnocarpal joints with characteristic degenerative changes. It frequently occurs in patients with either static or dynamic ulnar positive variance. Treatment is tailored to the athlete and their sporting demands. Surgical treatment focuses on addressing ulnar variance to unload the ulnocarpal joint, with multiple surgical options, including the metaphyseal closing wedge osteotomy achieving this goal. This review focuses on the presentation, biomechanics, and treatment options for ulnar abutment syndrome in the athlete.


Assuntos
Artralgia/terapia , Traumatismos em Atletas/terapia , Mau Alinhamento Ósseo/terapia , Ulna/lesões , Traumatismos do Punho/terapia , Artralgia/complicações , Artralgia/cirurgia , Traumatismos em Atletas/complicações , Traumatismos em Atletas/cirurgia , Mau Alinhamento Ósseo/complicações , Mau Alinhamento Ósseo/cirurgia , Humanos , Osteotomia , Ulna/cirurgia , Traumatismos do Punho/complicações , Traumatismos do Punho/cirurgia
2.
BMC Musculoskelet Disord ; 20(1): 432, 2019 Sep 14.
Artigo em Inglês | MEDLINE | ID: mdl-31521142

RESUMO

BACKGROUND: Due to advances in hip arthroscopy, the number of surgical procedures has increased dramatically. The diagnostic challenge in patients with longstanding hip and groin pain, as well as the increasing number of hip arthroscopies, may lead to a higher number of patients referred to tertiary care for consideration for surgery. Therefore, the aims were: 1) to describe the prevalence of hip-related groin pain in patients referred to tertiary care due to longstanding hip and groin pain; and 2) to compare patient characteristics and patient-reported outcomes for patients categorized as having hip-related groin pain and those with non-hip-related groin pain. METHODS: Eighty-one patients referred to the Department of Orthopedics at Skåne University Hospital for longstanding hip and groin pain were consecutively included and categorized into hip-related groin pain or non-hip-related groin pain using diagnostic criteria based on current best evidence (clinical examination, radiological examination and intra-articular block injection). Patient characteristics (gender (%), age (years), BMI (kg/m2)), results from the Hip Sports Activity Scale (HSAS), the SF-36, the Copenhagen Hip and Groin Outcome Score (HAGOS), and pain distribution (pain manikin) were collected. Parametric and non-parametric statistics were used as appropriate for between-group analysis. RESULTS: Thirty-three (47%) patients, (30% women, 70% men, p < 0.01), were categorized as having hip-related groin pain. The hip-related groin pain group had a higher activity level during adolescence (p = 0.013), and a higher pre-injury activity level (p = 0.034), compared to the non-hip-related groin pain group. No differences (mean difference (95% CI)) between hip-related groin pain and non-hip-related groin pain were observed for age (0 (- 4; 4)), BMI (- 1.75 (- 3.61; 0.12)), any HAGOS subscales (p ≥ 0.318), any SF-36 subscales (p ≥ 0.142) or pain distribution (p ≥ 0.201). CONCLUSIONS: Only half of the patients referred to tertiary care for long-standing hip and groin pain, who were predominantly men with a high activity level, had hip-related groin pain. Self-reported pain localization and distribution did not differ between patients with hip-related groin pain and those with non-hip-related groin pain, and both patient groups had poor perceived general health, and hip-related symptoms and function.


Assuntos
Artralgia/complicações , Impacto Femoroacetabular/epidemiologia , Virilha , Dor Musculoesquelética/epidemiologia , Medidas de Resultados Relatados pelo Paciente , Adulto , Artralgia/terapia , Estudos Transversais , Feminino , Impacto Femoroacetabular/diagnóstico , Impacto Femoroacetabular/etiologia , Articulação do Quadril , Humanos , Masculino , Pessoa de Meia-Idade , Dor Musculoesquelética/diagnóstico , Dor Musculoesquelética/etiologia , Exame Físico , Prevalência , Autorrelato/estatística & dados numéricos , Atenção Terciária à Saúde/estatística & dados numéricos , Fatores de Tempo
3.
Ulus Travma Acil Cerrahi Derg ; 25(5): 514-519, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31475328

RESUMO

BACKGROUND: High-energy traumas are common occurrences worldwide. The rate of overlooked neck fractures in polytrauma cases is also high. Previous studies have shown that articular hip pathologies, particularly neck fractures, are associated with fractures of the femoral shaft. This study sets out to describe cases of intra-articular hip pathology following traumatic femoral shaft fracture. Thus, the present study aims to investigate the relationship between ipsilateral hip pain and femoral shaft fractures. METHODS: Patients who were diagnosed with a fracture of the femur shaft and who were operated on (intramedullary fixation or plate) were included in this study. Patients with pathologic fractures, femoral neck fractures, femoral intertrochanteric fractures, or pelvic fractures were excluded. Patients with at least six months of follow-up and who were capable of independent walking without support were grouped according to AO/OTA fracture classification. Patients were questioned for deep anterior groin pain, and physical examination tests and hip imaging (X-ray and MR arthrography) were performed by calling patients with the indicated complaints. RESULTS: The presence of labral tears were noted in two patients. The incidence of osseous bump of the femoral neck identified by MR arthrography (MRA) was found in three of 16 hips. Assessment of the presence of gluteal tendinosis or tear and herniation pit identified three of 16 hips. The presence of osteophytes was noted in one patient. MRA identified three of 16 hips with more than one type of intra-articular pathology. Two patients with an osseous bump of the femoral neck were also diagnosed with additional hip pathology as herniation pit. CONCLUSION: Anterior groin pain in patients with a history of femoral shaft fracture is not always related to implants. Orthopedic surgeons should become suspicious in cases of intra-articular hip pathology in patients who have persistent hip pain after severe lower extremity trauma.


Assuntos
Artralgia , Fraturas do Colo Femoral , Lesões do Quadril , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Artralgia/complicações , Artralgia/epidemiologia , Feminino , Fraturas do Colo Femoral/complicações , Fraturas do Colo Femoral/epidemiologia , Lesões do Quadril/complicações , Lesões do Quadril/epidemiologia , Articulação do Quadril/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Traumatismo Múltiplo , Estudos Retrospectivos , Adulto Jovem
5.
BMJ Case Rep ; 12(7)2019 Jul 10.
Artigo em Inglês | MEDLINE | ID: mdl-31296627

RESUMO

We present a case of transient osteoporosis of the hip in a 38-year-old recreational trail runner. Shortly after a trail running competition, he developed acute hip pain, functional disability and an antalgic gait. Diagnosis was made with MRI showing bone marrow oedema, plain radiographs demonstrating osseous demineralisation and bone scintigraphy showing uniform radioactive uptake. Treatment included off-loading of the anatomical site for 6 months until symptom resolution, analgaesia, Vitamin D, bisphosphonates and pulsed electromagnetic field therapy. He recovered fully and returned to running activities 8 months after initial presentation. Transient osteoporosis of the hip is rare but benign, self-limiting condition; however, awareness and exact diagnosis are important as runners often present with hip pain and other more serious pathologies such as avascular necrosis or stress fractures need to be excluded.


Assuntos
Dor Aguda/complicações , Artralgia/complicações , Osteoporose/complicações , Osteoporose/diagnóstico por imagem , Corrida , Dor Aguda/terapia , Adulto , Analgesia , Artralgia/terapia , Conservadores da Densidade Óssea/uso terapêutico , Doenças da Medula Óssea/complicações , Doenças da Medula Óssea/diagnóstico por imagem , Doenças da Medula Óssea/terapia , Ácido Clodrônico/uso terapêutico , Edema/complicações , Edema/diagnóstico por imagem , Edema/terapia , Radiação Eletromagnética , Articulação do Quadril/diagnóstico por imagem , Humanos , Imagem por Ressonância Magnética , Masculino , Osteoporose/terapia , Radiografia , Cintilografia , Vitamina D/uso terapêutico
6.
J Pak Med Assoc ; 69(6): 823-827, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31189289

RESUMO

OBJECTIVE: To investigate the relationships of pain beliefs with clinical/functional status and kinesiophobia in patients with knee osteoarthritis. Methods: The descriptive cross-sectional study was conducted at the Department of Physical Therapy and Rehabilitation, Acibadem Hospitals Group, Istanbul, Turkey, between May 2015 and April 2016, and comprised chronic patients who were either overweight or obese. Patients were evaluated using visual analogue scale, Western Ontario and McMaster University Osteoarthritis Index, Lequesne Index (LI), Tampa Scale for Kinesiophobia and the Pain Beliefs Questionnaire. Statistical analysis was done using SPSS 15. . RESULTS: Of the 78 patients, there were 10(13%) males, 68(87%) females with an overall mean age of 56.09}11.79 years and mean body mass index of 29.3}4.91. There were moderate positive correlations among kinesiophobia, pain and functional scores, while organic pain beliefs had a moderate positive correlation with body mass index scores and positive weak correlations with clinical/functional status scores and kinesiophobia (p<0.05 each). There were no associations between the organic subscale and psychological subscale of the Pain Beliefs Questionnaire (p>0.05).. CONCLUSIONS: Possible fear of movement and pain belief should be taken into consideration in the management of patients with knee osteoarthritis.


Assuntos
Artralgia , Osteoartrite do Joelho , Transtornos Fóbicos , Adulto , Idoso , Artralgia/complicações , Artralgia/epidemiologia , Artralgia/fisiopatologia , Artralgia/psicologia , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Osteoartrite do Joelho/complicações , Osteoartrite do Joelho/epidemiologia , Osteoartrite do Joelho/fisiopatologia , Osteoartrite do Joelho/psicologia , Transtornos Fóbicos/complicações , Transtornos Fóbicos/epidemiologia , Turquia/epidemiologia
7.
BMC Infect Dis ; 19(1): 439, 2019 May 20.
Artigo em Inglês | MEDLINE | ID: mdl-31109292

RESUMO

BACKGROUND: Brucellosis has extensive clinical spectrum, clinicians have insufficient understanding of the disease, and the misdiagnosis rate is still high. By collecting and analyzing the clinical characteristics of patients with brucellosis in Heilongjiang Province to provide guidance and reference for clinicians to make timely diagnosis and treatment. METHODS: The demographic and epidemiological characteristics, clinical features, complications, laboratory findings were retrospectively evaluated in 850 brucellosis patients admitted in the Department of Infectious Diseases of the First Affiliated Hospital of Harbin Medical University and the Second Hospital of Daqing from 2012 to 2017. RESULTS: Of the 850 patients, the most common clinical manifestations were fever (93.3%), joint pain (69.8%), sweating (45.2%), fatigue (38.6%), and splenomegaly (34.0%). Peripheral arthritis, spondylitis and epididymal-orchitis were the common complications. Of the 398 patients who were followed up and completed treatment, 22 (5.5%) had relapse. CONCLUSIONS: Brucellosis is a multisystem disease with diverse clinical manifestations. In areas where brucellosis is endemic, the possibility of the disease should be considered in patients with unexplained fever and joints pain. In addition, the high rate of relapse is mainly due to the misdiagnosis of complications, so local CT or MRI examination is necessary for patients with joint pain and low back pain. Timely diagnosis, early detection of complications are essential to improve the prognosis and reduce relapse.


Assuntos
Brucelose/diagnóstico , Adolescente , Adulto , Idoso , Artralgia/complicações , Brucelose/complicações , Brucelose/epidemiologia , Criança , Pré-Escolar , China/epidemiologia , Fadiga/complicações , Feminino , Febre/complicações , Humanos , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Recidiva , Estudos Retrospectivos , Esplenomegalia/complicações , Adulto Jovem
8.
Clin Liver Dis ; 23(2): 247-261, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30947875

RESUMO

A variety of rheumatologic disorders may affect the liver. There is a significant epidemiologic, genetic, and immunologic overlap between immune-mediated rheumatologic disorders and autoimmune liver diseases. There is an increased frequency of autoimmune liver diseases, such as primary biliary cholangitis, autoimmune hepatitis, primary sclerosing cholangitis, or overlap syndrome, in patients with systemic lupus erythematosus, rheumatoid arthritis, Sjögren syndrome, systemic sclerosis, vasculitis, and other immune-related diseases. Non-immune-mediated rheumatologic diseases such as gouty arthritis may also have hepatic manifestations. Furthermore, medications used to treat rheumatologic diseases occasionally cause liver dysfunction. Conversely, primary immune-mediated and non-immune-mediated liver disorders may present with rheumatologic manifestations.


Assuntos
Antirreumáticos/efeitos adversos , Hepatopatias/etiologia , Doenças Reumáticas/complicações , Doenças Reumáticas/tratamento farmacológico , Acetaminofen/efeitos adversos , Anti-Inflamatórios não Esteroides/efeitos adversos , Artralgia/complicações , Produtos Biológicos/efeitos adversos , Doença Hepática Induzida por Substâncias e Drogas/etiologia , Glucocorticoides/efeitos adversos , Humanos , Hepatopatias/complicações , Doenças Reumáticas/etiologia
10.
Int J Rheum Dis ; 22(4): 592-598, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30729702

RESUMO

OBJECTIVE: To assess the impact of direct acting anti-viral (DAA) therapy for hepatitis C virus (HCV) infection on changes in pain intensity and prescription opioid use among Veterans. METHODS: We conducted a retrospective cohort study of Veterans with HCV who were seen in a rheumatology clinic at least once while receiving DAA therapy between January 1, 2010 and December 31st 2016. Demographic characteristics, HCV status, HCV treatment characteristics, numeric rating scale (NRS) pain scores and opioid prescription data were extracted from the electronic medical record. Pain scores were averaged over 6 months prior to HCV treatment and 6 months after completion of treatment. Prescription opioid dose was converted to a morphine equivalent daily dose (MEDD) and averaged across the two 6-month intervals. Generalized estimating equations were used to model the change in average pain and MEDD from pre- to post-HCV treatment. Effect size was assessed using Cohen's d. RESULTS: A total of 121 Veterans, 91% male with average age of 59 were included. Average pre-treatment pain was 4.4 (SD 2.4). The average reduction in pain scores was 0.6 points (P = 0.02, Cohen's d = 0.22) after treatment. Among 67 patients prescribed chronic opioid therapy at baseline, average pre-treatment MEDD was 52.4 mg (SD = 62.5 mg) and post-DAA treatment average MEDD was 49.5 mg (SD = 69.3 mg), representing a decrease by 2.9 mg (P < 0.01, Cohen's d = 0.14). Opioid dose reduction was seen in 43/67 patients and 12 patients discontinued opioids entirely. CONCLUSION: Among US Veterans, subjective pain scores had modest improvement and opioid prescriptions were mildly reduced following treatment with DAA.


Assuntos
Analgésicos Opioides/administração & dosagem , Antivirais/uso terapêutico , Artralgia/tratamento farmacológico , Artrite Reumatoide/tratamento farmacológico , Hepatite C/tratamento farmacológico , Idoso , Analgésicos Opioides/efeitos adversos , Antivirais/efeitos adversos , Artralgia/complicações , Artralgia/diagnóstico , Artrite Reumatoide/complicações , Artrite Reumatoide/diagnóstico , Prescrições de Medicamentos , Registros Eletrônicos de Saúde , Feminino , Hepatite C/complicações , Hepatite C/diagnóstico , Humanos , Masculino , Pessoa de Meia-Idade , Medição da Dor , Estudos Retrospectivos , Índice de Gravidade de Doença , Fatores de Tempo , Resultado do Tratamento , Saúde dos Veteranos
11.
Intern Med ; 58(12): 1781-1785, 2019 Jun 15.
Artigo em Inglês | MEDLINE | ID: mdl-30713308

RESUMO

A 53-year-old man with recurrent episodes of large joint pain and a low-grade fever at irregular intervals for 16 years developed right knee and ankle arthralgia, watery diarrhea, and abdominal pain. Following an ileum and colon biopsy, he was diagnosed with gastrointestinal amyloidosis. We suspected familial Mediterranean fever (FMF) based on his history and administered colchicine; his symptoms subsequently improved. Thus, he was diagnosed with atypical FMF. After tocilizumab administration, the amyloid deposits disappeared. This case suggests that physicians should consider FMF even in cases with atypical symptoms in order to prevent the progression of amyloidosis and that amyloid deposits can be eliminated by interleukin (IL)-6 inhibition.


Assuntos
Amiloidose/complicações , Artralgia/complicações , Diarreia/complicações , Febre Familiar do Mediterrâneo/complicações , Gastroenteropatias/complicações , Dor Abdominal/etiologia , Amiloidose/tratamento farmacológico , Anticorpos Monoclonais Humanizados/uso terapêutico , Artralgia/tratamento farmacológico , Colchicina/uso terapêutico , Febre Familiar do Mediterrâneo/diagnóstico , Febre Familiar do Mediterrâneo/tratamento farmacológico , Febre/complicações , Supressores da Gota/uso terapêutico , Humanos , Masculino , Pessoa de Meia-Idade
12.
J Orthop Sci ; 24(4): 636-642, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30606647

RESUMO

BACKGROUND: There are few clinical studies evaluating the relationship between lunate cysts and symptomatic ulnar impaction syndrome (UIS). The purpose of this study was to investigate the prevalence and relationship between lunate cysts and UIS by comparing data from patients with UIS against those without. MATERIALS AND METHODS: From March 2012 to January 2015, 375 patients who had undergone MRI or CT for reasons other than ulnar-sided wrist pain were classified into the 'asymptomatic group' (Group I). Thirty three patients who had been diagnosed with UIS were classified in the 'UIS group' (Group II). We determined whether any differences were present between the two groups and evaluated prognostic factors for lunate cysts. RESULTS: The prevalence of lunate cysts was significantly higher in Group II but only reached just above 50% (10.4% vs. 57.6%, p < 0.001]. Dorsal-side lunate cysts were more frequent than palmar side in Group I, while Group II had more cysts on the palmar side (74.4% vs. 52.6%, p = 0.001). Logistic regression analysis revealed that UIS and patient age was a significant factor for the presence of lunate cysts (odds ratio: 11.692, p < 0.001; odds ratio: 1.063, p < 0.001, respectively). However, positive ulnar variance or duration of symptom in Group II was not a predisposing factor for lunate cysts (odds ratio: 1.035, p = 0.598; odds ratio: 1.007, p = 0.877, respectively). CONCLUSION: Since positive ulnar variance or duration of symptom did not affect the formation of the lunate cyst and only slightly more than 50% (57.6%) of patients with UIS had a lunate cyst, it seems unlikely that these cysts are a pathognomonic finding. Surgeons can obtain some evidence from lunate cysts on radiographic exams, but care must be taken that this diagnosis is not made hastily or without due consideration.


Assuntos
Artralgia/complicações , Artralgia/diagnóstico por imagem , Cistos Ósseos/epidemiologia , Osso Semilunar , Articulação do Punho , Adulto , Idoso , Cistos Ósseos/diagnóstico por imagem , Feminino , Humanos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Prevalência , Estudos Retrospectivos , Tomografia Computadorizada por Raios X , Adulto Jovem
13.
J Ultrasound Med ; 38(6): 1411-1423, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30239017

RESUMO

OBJECTIVE: The aim of this cross-sectional correlational study was to determine the association of pain with morphologic and inflammatory sonographic findings in patients with knee osteoarthritis. METHODS: A total of 113 participants with knee osteoarthritis were assessed using visual analog scale pain score and sonography. Ultrasound evaluation included morphologic changes (ie, articular cartilage degeneration, medial and lateral meniscal protrusion, and presence of osteophytes on the joint margins) and inflammatory changes (ie suprapatellar effusion and/or synovitis, Baker cyst, superficial and deep infrapatellar effusion, pes anserine tendinopathy, and Hoffa panniculitis). RESULTS: Cluster analysis via Ward's method grouped patients with minimal pain (visual analog scale score, 0-4) and with substantial pain (visual analog scale score, 5-10). Stepwise logistic regression yielded 5 variables that significantly explained the variation in the probability of perceived substantial pain at 10% level of significance: lateral cartilage clarity (LCC; P = .025), medial cartilage clarity (MCC; P = .20), medial cartilage thickness (MCT; P = .041), medial meniscus protrusion (MMP) (P = .029), and osteophytes at medial femoral margin (P = .082), with 63% overall prediction accuracy. When age and sex were added, 4 variables remained significant at a 10% level of significance: LCC, MCC, MCT, and MMP, with 65% overall prediction accuracy. The receiver operating characteristic curve of this model was 0.667. CONCLUSION: The study was able to demonstrate that morphologic abnormalities in the ultrasound parameters for LCC, MCC, MCT, and MMP were able to predict significant joint pain in knee osteoarthritis. There were no inflammatory changes that contributed to significant joint pain in this study.


Assuntos
Artralgia/complicações , Artralgia/fisiopatologia , Articulação do Joelho/diagnóstico por imagem , Articulação do Joelho/fisiopatologia , Osteoartrite do Joelho/complicações , Osteoartrite do Joelho/fisiopatologia , Idoso , Artralgia/diagnóstico , Protocolos Clínicos , Análise por Conglomerados , Estudos Transversais , Feminino , Humanos , Inflamação/complicações , Inflamação/diagnóstico por imagem , Inflamação/fisiopatologia , Masculino , Pessoa de Meia-Idade , Filipinas , Reprodutibilidade dos Testes , Índice de Gravidade de Doença , Ultrassonografia/métodos
14.
Pain Med ; 20(1): 191-194, 2019 01 01.
Artigo em Inglês | MEDLINE | ID: mdl-29912452

RESUMO

Objective: To evaluate the associations between polymorphisms in two genes, catechol-O-methyltransferase and T-cell leukemia/lymphoma 1 A, and acupuncture-mediated pain reduction among breast cancer survivors with aromatase inhibitor-associated arthralgia. Design, Setting, and Subjects: Biospecimens were obtained from 38 patients enrolled in a clinical trial of acupuncture for aromatase inhibitor-associated arthralgia in postmenopausal hormone receptor-positive breast cancer survivors. Methods: We used polymerase chain reaction to genotype the rs4680 (Val158Met) and rs4633 (His62His) variants in the catechol-O-methyltransferase gene and rs2369049 (A > G) and rs7158782 (A > G) variants in the T-cell leukemia/lymphoma 1 A gene. Response to acupuncture was defined by 30% reduction in end-of-treatment average pain, measured by the Brief Pain Inventory. We used Fisher exact tests to evaluate associations between genotype and treatment response. Results: Among participants, all six (15.8%) subjects who expressed AA in locus rs4680 responded to acupuncture. In a combined analysis, the 18 (47.4%) subjects with the responder genotype at either rs4680 (AA) or rs2369049 (GG or AG) were significantly more likely to respond to acupuncture than those without (77.8% vs 45.0%, P = 0.039). Conclusions: Specific genetic variations at loci rs4680 and rs2369049 are associated with response to acupuncture-type intervention for management of arthralgia. These results serve as a proof of concept for applying a precision medicine framework to the study of cancer pain management.


Assuntos
Terapia por Acupuntura , Inibidores da Aromatase/efeitos adversos , Neoplasias da Mama/genética , Neoplasias da Mama/terapia , Terapia por Acupuntura/métodos , Idoso , Artralgia/complicações , Artralgia/genética , Neoplasias da Mama/complicações , Sobreviventes de Câncer/estatística & dados numéricos , Catecol O-Metiltransferase/genética , Feminino , Humanos , Pessoa de Meia-Idade , Medição da Dor , Resultado do Tratamento
15.
J Oral Rehabil ; 46(1): 5-13, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30240024

RESUMO

BACKGROUND: Temporomandibular joint (TMJ) arthralgia is a painful condition assumed to be associated with local inflammation. OBJECTIVE: The objective of the present study was to determine the efficacy for reducing pain of a single-dose intra-articular (IA) injection of methylprednisolone to the TMJ. The hypothesis was that methylprednisolone would effectively reduce TMJ pain. METHODS: This randomised, double-blind, parallel-group, multicentre, controlled study included visits for enrolment, treatment and 4-week follow-up. The study included patients 18 years and older who had been diagnosed with unilateral TMJ arthralgia. All participants were randomly assigned to receive 1 mL IA injections of methylprednisolone or saline. The primary outcome was change in recorded pain intensity on a visual analogue scale (VAS) at maximum jaw opening, analysed in the per protocol population. RESULTS: In total, 54 patients were randomly assigned to single-dose IA injections with methylprednisolone (n = 27) or saline (n = 27). Between baseline and the 4-week follow-up, VAS-rated pain intensity at maximum jaw opening decreased from a mean of 61.0 (95% confidence interval [CI]: 50.1; 70.7) to 33.9 (95% CI: 21.6; 46.2) in the methylprednisolone group and from 59.6 (95% CI: 50.7; 65.9) to 33.9 (95% CI: 23.8; 43.9) in the saline group. The between-group difference was not significant (P = 0.812). Treatment-related adverse events were doubled in the methylprednisolone group. CONCLUSION: Methylprednisolone provided no additional benefit for reducing pain, but caused more harm compared with saline following a single-dose IA injection in patients with TMJ arthralgia.


Assuntos
Anti-Inflamatórios/uso terapêutico , Artralgia/tratamento farmacológico , Metilprednisolona/uso terapêutico , Amplitude de Movimento Articular/efeitos dos fármacos , Transtornos da Articulação Temporomandibular/tratamento farmacológico , Adulto , Idoso , Artralgia/complicações , Artralgia/fisiopatologia , Método Duplo-Cego , Feminino , Seguimentos , Humanos , Injeções Intra-Articulares , Masculino , Pessoa de Meia-Idade , Manejo da Dor , Medição da Dor , Amplitude de Movimento Articular/fisiologia , Transtornos da Articulação Temporomandibular/complicações , Transtornos da Articulação Temporomandibular/fisiopatologia , Resultado do Tratamento
17.
Clin Orthop Relat Res ; 476(12): 2402-2414, 2018 12.
Artigo em Inglês | MEDLINE | ID: mdl-30334833

RESUMO

BACKGROUND: Acromioclavicular joint arthritis is a common, painful, and often missed diagnosis, and it often accompanies other shoulder conditions such as rotator cuff disease. Whether distal clavicle resection is important to perform in patients undergoing surgery for rotator cuff tears and concomitant acromioclavicular joint arthritis is controversial. QUESTIONS/PURPOSES: The purpose of this study was to perform a systematic review and meta-analysis of randomized controlled trials (RCTs) to evaluate the effect of distal clavicle resection on (1) outcome scores; (2) shoulder ROM, joint pain or tenderness, and joint instability; and (3) risk of reoperation among patients treated surgically for rotator cuff tears who had concomitant acromioclavicular joint arthritis. METHODS: We systematically searched the PubMed, EMBASE, and Cochrane databases to find RCTs that met our eligibility criteria, which, in summary, (1) compared rotator cuff repair plus distal clavicle resection with isolated rotator cuff repair for patients who sustained a full- or partial-thickness rotator cuff tear and concomitant acromioclavicular joint arthritis; and (2) the followup period was at least 2 years. Two reviewers screened the studies, extracted the data and evaluated the methodological quality, and performed data analysis. Statistical heterogeneity among studies was quantitatively evaluated with the I index. No heterogeneity was detected (I = 0%; p = 0.75) in terms of acromioclavicular joint pain or tenderness, Constant score, forward flexion, external rotation, and risk of reoperation, so fixed-effect models were used in these endpoints. Heterogeneity was moderate for the American Shoulder and Elbow Surgeons (ASES) score (I = 53%; p = 0.12) and low for the visual analog scale (VAS) score (I = 35%; p = 0.22), so random-effect models were used in these endpoints. Subgroup analysis was stratified by the symptom of acromioclavicular joint arthritis. Three RCTs with 208 patients were included. We evaluated the risk of bias using the Cochrane risk-of-bias tool; in aggregate, the three RCTs included showed low to intermediate risk, although not all parameters of the Cochrane tool could be assessed for all studies. RESULTS: There was no difference between the distal clavicle resection plus rotator cuff repair group and the isolated rotator cuff repair group in ASES score (mean difference =1.41; 95% confidence interval [CI], -3.37 to 6.18; p = 0.56) nor in terms of the VAS score and Constant score. Likewise, we found no difference in ROM of the shoulder (forward flexion, internal rotation, and external rotation) or acromioclavicular joint pain or tenderness between the groups (pooled results of acromioclavicular joint pain or tenderness: risk ratio [RR], 1.59; 95% CI, 0.67-3.78; p = 0.30). Acromioclavicular joint instability was only detected in the rotator cuff repair plus distal clavicle resection group. Finally, we found no difference in the proportion of patients undergoing repeat surgery between the study groups (pooled results of risk of reoperation for the rotator cuff repair plus distal clavicle resection and isolated rotator cuff repair: one of 52 versus two of 78; RR, 0.86; 95% CI, 0.11-6.48; p = 0.88). CONCLUSIONS: Distal clavicle resection in patients with rotator cuff tears did not result in better clinical outcome scores or shoulder ROM and was not associated with a lower risk of reoperation. Distal clavicle resection might cause acromioclavicular joint instability in patients with rotator cuff tears and concomitant asymptomatic acromioclavicular joint arthritis. Arthroscopic distal clavicle resection is not recommended in patients with rotator cuff tears and concomitant acromioclavicular joint arthritis. Additional well-designed RCTs with more participants, long-term followup, and data on patient-reported outcomes are needed. LEVEL OF EVIDENCE: Level I, therapeutic study.


Assuntos
Artralgia/cirurgia , Artrite/cirurgia , Artroscopia/métodos , Clavícula/cirurgia , Lesões do Manguito Rotador/cirurgia , Articulação Acromioclavicular/fisiopatologia , Idoso , Artralgia/complicações , Artralgia/fisiopatologia , Artrite/complicações , Artrite/fisiopatologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Período Pós-Operatório , Amplitude de Movimento Articular , Lesões do Manguito Rotador/complicações , Lesões do Manguito Rotador/fisiopatologia , Ombro/fisiopatologia , Resultado do Tratamento
18.
Acta Dermatovenerol Alp Pannonica Adriat ; 27(3): 153-154, 2018 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-30244267

RESUMO

Behçet's disease is a rare disorder of unknown etiology that is classified as a systemic vasculitis. The prevalence of the disease is high in countries in the Far East, Mediterranean Basin, and East Asia. Thus, it is also known as the Silk Road Disease. Behçet's disease is characterized by recurrent oral aphthous ulcers, genital sores, and ocular lesions. However, it can present with severe clinical manifestations as a result of cardiovascular system, central nervous system, and gastrointestinal tract involvement. The disease causes serious complications, morbidity, and mortality, especially in male patients with early age onset. Here we present a rare case of Behçet's disease exhibiting multiple organ involvement in a 26-year-old Caucasian female.


Assuntos
Síndrome de Behçet/complicações , Inflamação/complicações , Adulto , Artralgia/complicações , Artrite/complicações , Síndrome de Behçet/diagnóstico , Feminino , Humanos , Inflamação/diagnóstico
19.
Osteoarthritis Cartilage ; 26(11): 1453-1460, 2018 11.
Artigo em Inglês | MEDLINE | ID: mdl-30092262

RESUMO

OBJECTIVE: Depressive symptoms in knee osteoarthritis (OA) are associated with increased pain severity and declines in physical performance. This study examined whether pain severity mediates the association between depressive symptoms and physical performance in persons with radiographic knee OA. METHOD: Three years of annual data from participants (n = 1,463) with radiographic knee OA in the Osteoarthritis Initiative (OAI) were analyzed. Depressive symptoms were measured using the Center for Epidemiological Studies Depression (CES-D) scale. Pain severity was evaluated with the Western Ontario and McMaster Universities Arthritis Index. Physical performance was assessed via standardized gait speed. Marginal structural models were used to assess the direct (unmediated) effects of depressive symptoms on physical performance and indirect (mediated) effects through pain severity. RESULTS: Direct and indirect effects for a difference in CES-D score of 0-1 were -0.0051 (95% confidence intervals (CI): -0.0053, -0.0049) and -0.0016 (95% CI: -0.0024, -0.0007) standard deviations in gait speed, respectively. Higher depressive symptom severity exhibited diminishing, incremental, direct and indirect effects and for a difference in CES-D score of 15-16 were -0.0045 (95% CI: -0.0047, -0.0042) and -0.0009 (95% CI: -0.0014, -0.0004) standard deviations in gait speed, respectively. Therefore, the magnitude of the mediated, indirect effect, was never larger than 24%. CONCLUSION: Pain severity mediated approximately one-fifth of the association between depressive symptoms and physical performance in persons with radiographic knee OA, and the diminishing incremental effects may explain why unimodal treatment strategies with a single disease target are often ineffective in depressed OA patients.


Assuntos
Artralgia/complicações , Depressão/etiologia , Osteoartrite do Joelho/complicações , Desempenho Físico Funcional , Idoso , Artralgia/epidemiologia , Artralgia/psicologia , Depressão/epidemiologia , Depressão/psicologia , Progressão da Doença , Feminino , Seguimentos , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Osteoartrite do Joelho/fisiopatologia , Osteoartrite do Joelho/psicologia , Medição da Dor , Estudos Retrospectivos , Fatores de Risco , Índice de Gravidade de Doença , Estados Unidos/epidemiologia
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