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Annals of the Rheumatic Diseases Oct 2021To establish evidence-based recommendations to guide health professionals using intra-articular therapies (IAT) in adult patients with peripheral arthropathies.
OBJECTIVES
To establish evidence-based recommendations to guide health professionals using intra-articular therapies (IAT) in adult patients with peripheral arthropathies.
METHODS
A multidisciplinary international task force established the objectives, users and scope and the need for background information, including systematic literature reviews) and two surveys addressed to healthcare providers and patients throughout Europe. The evidence was discussed in a face-to-face meeting, recommendations were formulated and subsequently voted for anonymously in a three-round Delphi process to obtain the final agreement. The level of evidence was assigned to each recommendation with the Oxford levels of evidence.
RESULTS
Recommendations focus on practical aspects to guide health professionals before, during and after IAT in adult patients with peripheral arthropathies. Five overarching principles and 11 recommendations were established, addressing issues related to patient information, procedure and setting, accuracy, routine and special aseptic care, safety issues and precautions to be addressed in special populations, efficacy and safety of repeated joint injections, use of local anaesthetics and aftercare.
CONCLUSION
We have developed the first evidence and expert opinion-based recommendations to guide health professionals using IAT. We hope that these recommendations will be included in different educational programmes, used by patient associations and put into practice via scientific societies to help improve uniformity and quality of care when performing IAT in peripheral adult joints.
Topics: Antirheumatic Agents; Drainage; Europe; Glucocorticoids; Gout; Hand Joints; Humans; Hyaluronic Acid; Injections, Intra-Articular; Joint Diseases; Osteoarthritis; Osteoarthritis, Knee; Rheumatology; Societies, Medical; Viscosupplements
PubMed: 34035002
DOI: 10.1136/annrheumdis-2021-220266 -
Radiologic Clinics of North America Jul 2022Crystal arthropathies are a group of joint disorders due to deposition of crystals in and around joints that lead to joint destruction and soft tissue masses. Clinical... (Review)
Review
Imaging of Crystal Disorders:: Calcium Pyrophosphate Dihydrate Crystal Deposition Disease, Calcium Hydroxyapatite Crystal Deposition Disease and Gout Pathophysiology, Imaging, and Diagnosis.
Crystal arthropathies are a group of joint disorders due to deposition of crystals in and around joints that lead to joint destruction and soft tissue masses. Clinical presentation is variable and diagnosis might be challenging. In this article the pathophysiology is addressed, the preferred deposition of crystal arthropathies and imaging findings. Case studies of calcium pyrophosphate dihydrate crystal deposition disease, hydroxyapatite crystal deposition disease, and gout are shown. Guidelines for the use of dual-energy computed tomography are given to enable the diagnosis and follow-up of gout.
Topics: Calcium Pyrophosphate; Chondrocalcinosis; Crystal Arthropathies; Durapatite; Gout; Humans
PubMed: 35672096
DOI: 10.1016/j.rcl.2022.03.007 -
Dermatology Online Journal Nov 2010A 69-year-old woman presented with a 30-year history of lower back and large joint pain of the hips and shoulders. On examination blue-grey, pigmented macules were...
A 69-year-old woman presented with a 30-year history of lower back and large joint pain of the hips and shoulders. On examination blue-grey, pigmented macules were present over the cartilaginous portions of the ears and on the sclera. Past medical history included aortic stenosis. Urine homogentisic acid level was elevated, which is diagnostic for alkaptonuria. Alkaptonuria is an autosomal recessive disorder that results in deficiency of homogentisic acid oxidase and in the accumulation of homogentisic acid in connective tissue. Disease can result in blue-grey pigmentation of the cartilage, sclerae, face, and hands as well as severe arthropathy and cardiac valve disease. Treatment is limited at this time. Promising early reports of the use of nitisinone have prompted ongoing trials of this therapeutic agent.
Topics: Aged; Alkaptonuria; Arthritis; Cyclohexanones; Female; Homogentisic Acid; Humans; Joint Diseases; Nitrobenzoates; Ochronosis; Pigmentation Disorders
PubMed: 21163157
DOI: No ID Found -
The Journal of Bone and Joint Surgery.... Oct 2011Femoroacetabular impingement is a well-documented cause of hip pain. There is, however, increasing evidence for the presence of a previously unrecognised... (Review)
Review
Femoroacetabular impingement is a well-documented cause of hip pain. There is, however, increasing evidence for the presence of a previously unrecognised impingement-type condition around the hip - ischiofemoral impingement. This is caused by abnormal contact between the lesser trochanter of the femur and the ischium, and presents as atypical groin and/or posterior buttock pain. The symptoms are gradual in onset and may be similar to those of iliopsoas tendonitis, hamstring injury or bursitis. The presence of ischiofemoral impingement may be indicated by pain caused by a combination of hip extension, adduction and external rotation. Magnetic resonance imaging demonstrates inflammation and oedema in the ischiofemoral space and quadratus femoris, and is distinct from an acute tear. To date this has only appeared in the specialist orthopaedic literature as a problem that has developed after total hip replacement, not in the unreplaced joint.
Topics: Arthralgia; Diagnosis, Differential; Femur; Humans; Ischium; Joint Diseases; Magnetic Resonance Imaging
PubMed: 21969425
DOI: 10.1302/0301-620X.93B10.26714 -
The New England Journal of Medicine Aug 2007Effective ways to prevent arthropathy in severe hemophilia are unknown. (Comparative Study)
Comparative Study Randomized Controlled Trial
BACKGROUND
Effective ways to prevent arthropathy in severe hemophilia are unknown.
METHODS
We randomly assigned young boys with severe hemophilia A to regular infusions of recombinant factor VIII (prophylaxis) or to an enhanced episodic infusion schedule of at least three doses totaling a minimum of 80 IU of factor VIII per kilogram of body weight at the time of a joint hemorrhage. The primary outcome was the incidence of bone or cartilage damage as detected in index joints (ankles, knees, and elbows) by radiography or magnetic resonance imaging (MRI).
RESULTS
Sixty-five boys younger than 30 months of age were randomly assigned to prophylaxis (32 boys) or enhanced episodic therapy (33 boys). When the boys reached 6 years of age, 93% of those in the prophylaxis group and 55% of those in the episodic-therapy group were considered to have normal index-joint structure on MRI (P=0.006). The relative risk of MRI-detected joint damage with episodic therapy as compared with prophylaxis was 6.1 (95% confidence interval, 1.5 to 24.4). The mean annual numbers of joint and total hemorrhages were higher at study exit in the episodic-therapy group than in the prophylaxis group (P<0.001 for both comparisons). High titers of inhibitors of factor VIII developed in two boys who received prophylaxis; three boys in the episodic-therapy group had a life-threatening hemorrhage. Hospitalizations and infections associated with central-catheter placement did not differ significantly between the two groups.
CONCLUSIONS
Prophylaxis with recombinant factor VIII can prevent joint damage and decrease the frequency of joint and other hemorrhages in young boys with severe hemophilia A. (ClinicalTrials.gov number, NCT00207597 [ClinicalTrials.gov].).
Topics: Child; Child, Preschool; Drug Administration Schedule; Factor VIII; Follow-Up Studies; Hemarthrosis; Hemophilia A; Hemorrhage; Humans; Infant; Infusions, Intravenous; Joint Diseases; Male; Treatment Outcome
PubMed: 17687129
DOI: 10.1056/NEJMoa067659 -
Acta Clinica Croatica Dec 2019Bone endures a lifelong course of construction and destruction, with bone marker (BM) molecules released during this cycle. The field of measuring BM levels in synovial... (Review)
Review
Bone endures a lifelong course of construction and destruction, with bone marker (BM) molecules released during this cycle. The field of measuring BM levels in synovial fluid and peripheral blood is a cardinal part of bone research within modern clinical medicine and has developed extensively in the last years. The purpose of our work was to convey an up-to-date overview on synovial fluid and serum BMs in the most common arthropathies.
Topics: Adult; Aged; Aged, 80 and over; Biomarkers; Female; Humans; Joint Diseases; Male; Middle Aged; Synovial Fluid
PubMed: 32595257
DOI: 10.20471/acc.2019.58.04.19 -
Ugeskrift For Laeger Dec 2018In this review, function, anatomy and pathology of the sternoclavicular joint is described. Arthritis as part of a rheumatological condition is treated medically;... (Review)
Review
In this review, function, anatomy and pathology of the sternoclavicular joint is described. Arthritis as part of a rheumatological condition is treated medically; persistent synovitis can be treated by synovectomy. Infection is most often caused by Staphylococcus and is treated by debridement and antibiotics. Painful degenerative conditions can be treated by arthroscopic or open debridement, medial clavicle resection and resection of osteophytes. Instability can be traumatic or non-traumatic and is treated by a stabilising operation. Generally, results of treatment are positive.
Topics: Humans; Joint Diseases; Sternoclavicular Joint
PubMed: 30618359
DOI: No ID Found -
Medical Sciences (Basel, Switzerland) Aug 2023Hereditary hemochromatosis (HH) is an autosomal recessive bleeding disorder characterized by tissue overload of iron. Clinical systemic manifestations in HH include... (Review)
Review
Hereditary hemochromatosis (HH) is an autosomal recessive bleeding disorder characterized by tissue overload of iron. Clinical systemic manifestations in HH include liver disease, cardiomyopathy, skin pigmentation, diabetes mellitus, erectile dysfunction, hypothyroidism, and arthropathy. Arthropathy with joint pain is frequently reported at diagnosis and mainly involves the metacarpophalangeal and ankle joints, and more rarely, the hip and knee. Symptoms in ankle joints are in most cases non-specific, and they can range from pain and swelling of the ankle to deformities and joint destruction. Furthermore, the main radiological signs do not differ from those of primary osteoarthritis (OA). Limited data are available in the literature regarding treatment; surgery seems to be the gold standard for ankle arthropathy in HH. Pharmacological treatments used to maintain iron homeostasis can also be undertaken to prevent the arthropathy, but conclusive data are not yet available. This review aimed to assess the ankle arthropathy in the context of HH, including all its aspects: epidemiology, physiopathology, clinical and imaging presentation, and all the treatments available to the current state of knowledge.
Topics: Male; Humans; Ankle; Ankle Joint; Hemochromatosis; Joint Diseases; Iron
PubMed: 37606430
DOI: 10.3390/medsci11030051 -
Journal of General Internal Medicine Sep 2018
Topics: Female; Finger Joint; Hand Deformities, Acquired; Humans; Joint Diseases; Lupus Erythematosus, Systemic; Radiography; Young Adult
PubMed: 29987749
DOI: 10.1007/s11606-018-4559-7 -
The Cochrane Database of Systematic... Nov 2022Chronic arthropathy is a potentially debilitating complication for people with haemophilia - a genetic, X-linked, recessive bleeding disorder, characterised by the... (Review)
Review
BACKGROUND
Chronic arthropathy is a potentially debilitating complication for people with haemophilia - a genetic, X-linked, recessive bleeding disorder, characterised by the absence or deficiency of a clotting factor protein. Staging classifications, such as the Arnold-Hilgartner classification for haemophilic arthropathy of the knee, radiologically reflect the extent of knee joint destruction with underlying chronic synovitis. Management of this highly morbid disease process involves intensive prophylactic measures, and chemical or radioisotope synovectomy in its early stages. However, failure of non-surgical therapy in people with progression of chronic arthropathy often prompts surgical management, including synovectomy, joint debridement, arthrodesis, and arthroplasty, depending on the type of joint and extent of the damage. To date, management of people with mild to moderate chronic arthropathy from haemophilia remains controversial; there is no agreed standard treatment. Thus, the benefits and disadvantages of non-surgical and surgical management of mild to moderate chronic arthropathy in people with haemophilia needs to be systematically reviewed. OBJECTIVES: To assess the efficacy and safety of surgery for mild to moderate chronic arthropathy in people with haemophilia A or B.
SEARCH METHODS
We searched the Cochrane Cystic Fibrosis and Genetic Disorders Group's Coagulopathies Trials Register, CENTRAL, MEDLINE, Embase, CINAHL, and two trial registers to August 2022. We also handsearched relevant journals and conference abstract books.
SELECTION CRITERIA
Randomized controlled trials (RCTs) and quasi-RCTs comparing surgery and non-surgical interventions, for any joint with chronic arthropathy, in people with haemophilia, who were at least 12 years old.
DATA COLLECTION AND ANALYSIS
The review authors did not identify any trials to include in this review.
MAIN RESULTS
The review authors did not identify any trials to include in this review.
AUTHORS' CONCLUSIONS
The review authors did not identify any trials to include in this review. Due to a lack of research in this particular area, we plan to update the literature search every two years, and will update review if any new evidence is reported. There is a need for a well-designed RCT that assesses the safety and efficacy of surgical versus non-surgical interventions for chronic arthropathy in people with haemophilia.
Topics: Child; Humans; Hemophilia A; Joint Diseases; Knee Joint; MEDLINE; Randomized Controlled Trials as Topic
PubMed: 36448638
DOI: 10.1002/14651858.CD013634.pub2