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Advances in Therapy Apr 2020The purpose of this study is to review the current literature on the use of hyaluronic acid (HA) specifically applied to the treatment of osteoarthritis (OA) secondary...
The purpose of this study is to review the current literature on the use of hyaluronic acid (HA) specifically applied to the treatment of osteoarthritis (OA) secondary to primary inflammatory rheumatic diseases. Osteoarthritis should be carefully considered because it has potentially devastating effects on health-related quality of life. Locally injected HA seems to be an effective treatment for OA but it is not clear how to place this treatment in the context of inflammatory rheumatic disorders. To retrieve relevant articles, we conducted the search through MEDLINE, EMBASE and Cochrane Databases performing the PICO strategy. We finally selected four randomized clinical trials and six observational studies and grouped them in accordance with its main objective within three focuses: the clinical effect of HA therapy in joints without any signs of inflammation, the clinical effects of HA therapy in joints with active synovitis, and the involvement and changes of synovial fluid in the treatment of secondary OA. Our qualitative analysis clearly showed that the current literature is marked by high levels of heterogeneity and therefore difficult to interpret. Therefore, our hypothesis that viscosupplementation should be considered as a treatment for chronic moderate symptomatic OA secondary to inflammatory rheumatic diseases, and not for flares with joint swelling, cannot be definitely supported. Well-designed studies are necessary to definitively clarify the range of application of intra-articular HA injections in the treatment of inflammatory rheumatic disorders.
Topics: Humans; Hyaluronic Acid; Inflammation; Injections, Intra-Articular; Osteoarthritis; Quality of Life; Rheumatic Diseases; Synovial Fluid; Synovitis; Treatment Outcome; Viscosupplements
PubMed: 32141016
DOI: 10.1007/s12325-020-01256-7 -
Seminars in Arthritis and Rheumatism Aug 2020Although calcium pyrophosphate deposition (CPPD) is common, there are no validated outcome domains and/or measurements for CPPD studies. The aim of this work was to...
INTRODUCTION
Although calcium pyrophosphate deposition (CPPD) is common, there are no validated outcome domains and/or measurements for CPPD studies. The aim of this work was to identify domains that have been reported in prior clinical studies in CPPD, to inform the development of a core set of domains for CPPD studies.
METHODS
We performed a scoping literature review for clinical studies in CPPD, searching in Medline (via PubMed), EMBASE, and Cochrane Central Register of Controlled Trials (CENTRAL) databases; published from January 1, 1946 to January 7, 2020. All reported outcomes and study design data were extracted and mapped to the core areas and domains as defined by the OMERACT Filter 2.1.The protocol was registered on PROSPERO (CRD: 42019137075; 09-07-2019).
FINDINGS
There were 112 papers identified, comprising of 109 observational studies and three randomized controlled trials. Most studies reported clinical presentations of OA with CPPD or acute CPP crystal arthritis. Outcomes that mapped to 22 domains were identified; the most frequently reported measures mapped to the following domains/sub-domains: imaging (joint damage on imaging tests - 59 studies; joint calcification on imaging tests - 28 studies), joint pain (26 studies), response to treatment (23 studies), side effects of treatment (15 studies), inflammation in the joint fluid or blood (ESR or C-reactive protein - 12 studies; synovial fluid markers - 4 studies; other blood markers - 2 studies), overall function (14 studies), joint swelling (12 studies) and range of joint movement (10 studies). Very few studies mapped to domains related to life impact, societal/resource use or longevity.
CONCLUSION
There is substantial variability in outcomes reported in CPPD studies. Outcomes that map to imaging manifestations, joint pain and response to treatment domains are most often reported.
Topics: Calcinosis; Calcium Pyrophosphate; Chondrocalcinosis; Female; Humans; Male; Observational Studies as Topic; Synovial Fluid
PubMed: 32521326
DOI: 10.1016/j.semarthrit.2020.05.015 -
Le Infezioni in Medicina Mar 2020There are still many unknowns regarding the potential application of Procalcitonin (PCT) as an adjunct to aid the diagnosis of Prosthetic Joint Infection. A systematic...
There are still many unknowns regarding the potential application of Procalcitonin (PCT) as an adjunct to aid the diagnosis of Prosthetic Joint Infection. A systematic review searching scientific articles was performed with keywords "Procalcitonin", "Total Hip Replacement", and "Total Knee Replacement" (n=123). After review of the abstract and full text for relevance, ten articles were included (n=10). Serum PCT levels for chronic Total Hip Replacement (THR) and Total Knee Replacement (TKR) have a range of mean values from 1.5 ng/ml to 14.2 ng/ml. Specificity ranges from 0.27 to 0.98, while sensitivity is from 0.33 to 0.9. On primary THR/TKR with confirmation of non-infected status, serum PCT peaks between 1-3 days post-operatively, with peak levels varying from 0.12 - 0.79 ng/ml. Based on this review, serum PCT is not a good adjunct in diagnosing Prosthetic Joint Infection (PJI). Synovial fluid PCT fluid may add better clinical support but requires further studies. There were several limitations with this review: the studies are small and heterogeneous, there was a variable definition of PJI, and there was a wide range of mean values, sensitivity and specificity.
Topics: Arthroplasty, Replacement, Hip; Arthroplasty, Replacement, Knee; Biomarkers; Humans; Procalcitonin; Prosthesis-Related Infections; Reference Values; Sensitivity and Specificity; Synovial Fluid
PubMed: 32172255
DOI: No ID Found