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NEWS - Rheumatology

The clinical and cost-effectiveness of corticosteroid injection versus night splints for carpal tunnel syndrome (INSTINCTS trial): an open-label, parallel group, randomised controlled trial – The Lancet (free)

Invited Commentary: Steroid injection or wrist splint for first-time carpal tunnel syndrome? (free)

“A single corticosteroid injection shows superior clinical effectiveness at 6 weeks compared with night-resting splints, making it the treatment of choice for rapid symptom response in mild or moderate carpal tunnel syndrome presenting in primary care.”

 


Effect of Early Surgery vs Physical Therapy on Knee Function Among Patients With Nonobstructive Meniscal Tears: The ESCAPE Randomized Clinical Trial – JAMA (free for a limited period)

Commentary: PT an Alternative to Surgery for Some Meniscal Tears – Physician’s First Watch (free)

Related: Adverse Outcomes After Arthroscopic Partial Meniscectomy (free study, commentary and guideline on the subject)

“Our Dutch multi center RCT demonstrates noninferiority of physical therapy compared with early surgery with arthroscopic partial meniscectomy for improving self-reported knee function in patients with nonobstructive meniscal tears.” (via @RudolfPoolman see Tweet)

 


Guideline for the management of hip and knee osteoarthritis – Royal Australian College of General Practitioners (free PDF)

News Release: Updated osteoarthritis guideline designed to reduce unnecessary imaging and surgery (free)

Commentary: Australia hopes to reduce unnecessary imaging, surgery with updated osteoarthritis guidelines – Health Imaging (free)

““The Guideline for the management of knee and hip osteoarthritis,” offer up exercise and weight loss as a first line defense, and warn against costly treatments using glucosamine, opioids and arthroscopic surgery, said David Hunter, co-chair of the RACGP group responsible for the update.” (from Health Imaging)

 


Percutaneous vertebroplasty for osteoporotic vertebral compression fracture – Cochrane Library (link to abstract – $ for full-text)

Summary: Featured Review: Vertebroplasty for treating spinal fractures due to osteoporosis – Cochrane Library (free)

High quality evidence shows that vertebroplasty does not provide more clinically important benefits than placebo but may cause people harm”.

 


Seven-year tolerability profile of glucocorticoids use in early rheumatoid arthritis: data from the ESPOIR cohort – Annals of Rheumatic Diseases (free)

Commentaries: Long-Term Safety of Glucocorticoids in Patients with Early Rheumatoid Arthritis – Journal Watch (free) AND Long-term Low-dose Steroids OK in Early RA – MedPage Today (free registration required)

“Long-Term Safety of Glucocorticoids in Early Rheumatoid Arthritis. Stopping steroids completely is difficult in patients whose disease flares with tapering, but low-dose levels are relatively safe” (RT @JWatch see Tweet)

 


Corticosteroid or Nonsteroidal Antiinflammatory Drugs for the Treatment of Acute Gout: A Systematic Review of Randomized Controlled Trials – The Journal of Rheumatology (free)

Source: EvidenceAlerts

Corticosteroids and NSAIDs did not have different effects on pain scores, but there was a higher risk of indigestion, nausea and vomiting with NSAIDs.

 


Osteoarthritis of the Knee Clical Care Standard – Australian Commission on Safety and Quality in Health Care (PDF Guideline and other resources)

Source: Research Review Australia (free resource to find articles of interest)

 


Long-Term Effects of Repeated Injections of Local Anesthetic With or Without Corticosteroid for Lumbar Spinal Stenosis: A Randomized Trial – Archives of Physical Medicine and Rehabilitation (free)

Source: ACP Journal Wise ($)

“Epidural injections of corticosteroid plus lidocaine offered no benefits from 6 weeks to 12 months beyond that of injections of lidocaine alone”

 


Incidence of and risk factors for nephrolithiasis in patients with gout and the general population, a cohort study – Arthritis Research & Therapy (free)

Commentaries: Gout Patients Run Higher Risk of Kidney Stones – MedPage Today (free registration required) AND Gout associated with elevated risk for kidney stones – MedWire News (free)

“60% increased risk of first-time nephrolithiasis versus general population, with little protection from allopurinol” (from MedPage Today)

 


A comprehensive guide to the new science of treating lower back pain – VOX (free)

“Mainstream medicine has failed people with chronic back pain”

 


New National Guideline Clearinghouse (NGC) Summaries in Low back, Cervical and Thoracic Spine Disorders with focus on occupational health.

Low Back Disorders – American College of Occupational and Environmental Medicine (free summary from NGC – $ see original guideline in ACOEM website)

Cervical and thoracic spine disorders – American College of Occupational and Environmental Medicine (free summary from NGC – $ see original guideline in ACOEM website)

 


Effectiveness of non-steroidal anti-inflammatory drugs for the treatment of pain in knee and hip osteoarthritis: a network meta-analysis – The Lancet (link to abstract – $ for full-text)

Diclofenac 150 mg/day is the most effective NSAID available at present (are the cardiac and renal risks worth it?) and Paracetamol does not seem to work for this condition.

 


Is cyclobenzaprine useful for pain? – Therapeutics Initiative (free)

“…cyclobenzaprine is a long-acting sedative, not a muscle relaxant, and questioning whether any potential benefits are worth the side effects”. (from TI Newsletter). “If prescribed, a dose of 5 mg at bedtime should be tried first.  Evidence suggests titration based on response and tolerability to a maximum dose of 15 mg/day, for no longer than one week”.

 


Clinical characteristics and outcomes of diffuse alveolar hemorrhage in patients with systemic lupus erythematosus – Seminars in Arthritis & Rheumatism (link to abstract – $ for full-text)

Commentary: Prompt Evaluation of Lung Bleeds Needed in Lupus – MedPage Today (free registration required)

“Low hemoglobin, low C4 and hypoxia are features of poor outcome” (from MedPage Today)

 



What I Wish I’d Known About My Knees – The New York Times (10 articles per month are free)

Related guideline: Arthroscopic surgery for degenerative knee arthritis and meniscal tears: a clinical practice guideline – The BMJ (free)

“There’s little evidence to support many of the procedures people undergo in the hopes of avoiding a knee replacement”. (RT @NYTHealth see Tweet)

 


Prevalence of Axial Spondyloarthritis Among Patients With Fibromyalgia: A Magnetic Resonance Imaging Study With Application of the Assessment of SpondyloArthritis International Society Classification Criteria – Arthritis Care & Research (link to abstract – $ for full-text)

Commentary: Does Fibromyalgia Mask Spondyloarthritis? – MedPage Today (free registration required)

Small study (99 patients) showed some patients diagnosed with fibromyalgia have imaging changes suggestive of axial Spondyloarthritis, suggesting that Fibromyalgia may mask an underlying Spondyloarthropathy.

 


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