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Journal of Infection and Public Health 2016The diagnosis and management of prosthetic joint infections (PJI) with negative cultures remains an enigma without clear definitions and guidelines for its management.... (Review)
Review
The diagnosis and management of prosthetic joint infections (PJI) with negative cultures remains an enigma without clear definitions and guidelines for its management. In contrast, the literature offers guidelines to the diagnosis and management of culture positive prosthetic joint infections as noted in both the infectious disease literature and the orthopedic literature. This paper outlines the current state of knowledge of PJI with negative cultures and summarizes the recommendations for the work up and management of this condition. In addition, we propose a simple algorithm that clinicians may find useful for the management of PJI with negative cultures. This algorithm has not been validated with data at this point, but can be applied to practice to help direct the management and diagnosis of prosthetic joint infections in the absence of positive cultures.
Topics: Bacteria; Bacterial Infections; Humans; Joint Diseases; Joint Prosthesis; Mycoses; Prosthesis-Related Infections
PubMed: 26829893
DOI: 10.1016/j.jiph.2015.12.001 -
Revista de Gastroenterologia de Mexico... 2024Inflammatory bowel disease (IBD) has a high economic burden due to its chronicity. Treatment has evolved, thanks to the understanding of IBD pathogenesis and the advent...
INTRODUCTION AND AIMS
Inflammatory bowel disease (IBD) has a high economic burden due to its chronicity. Treatment has evolved, thanks to the understanding of IBD pathogenesis and the advent of biologic therapy, albeit the latter increases direct costs. The aim of the present study was to calculate the total cost and cost per patient/year of biologic therapy for IBD and IBD-associated arthropathy in Colombia.
METHODS
A descriptive study was conducted. The data were obtained from the Comprehensive Social Protection Information System of the Department of Health for the year 2019, utilizing the medical diagnosis codes of the International Classification of Diseases related to IBD and IBD-associated arthropathy as keywords.
RESULTS
The prevalence of IBD and IBD-associated arthropathy was 61 cases per 100,000 inhabitants, with a female-to-male ratio of 1.5:1. Joint involvement was 3%, and 6.3% of the persons with IBD and IBD-associated arthropathy received biologic therapy. Adalimumab was the most widely prescribed biologic drug (49.2%). Biologic therapy had a cost of $15,926,302 USD and the mean cost per patient/year was $18,428 USD. Adalimumab had the highest impact on healthcare resource utilization, with a total cost of $7,672,320 USD. According to subtype, ulcerative colitis had the highest cost ($10,932,489 USD).
CONCLUSION
Biologic therapy is expensive, but its annual cost in Colombia is lower than that of other countries due to the government's regulation of high-cost medications.
Topics: Humans; Colombia; Male; Female; Adult; Inflammatory Bowel Diseases; Middle Aged; Biological Therapy; Adalimumab; Health Care Costs; Young Adult; Joint Diseases; Aged; Adolescent; Prevalence; Biological Products
PubMed: 37208212
DOI: 10.1016/j.rgmxen.2023.05.001 -
British Medical Journal Aug 1969
Topics: Adolescent; Bursitis; Elbow Joint; Female; Humans; Joint Diseases; Male; Middle Aged; Osteochondritis; Physical Examination; Radiography; Rest; Rheumatoid Nodule; Synovitis; Tendinopathy; Ulnar Nerve; Elbow Injuries
PubMed: 5797785
DOI: 10.1136/bmj.3.5667.399 -
American Family Physician Feb 2008Chronic shoulder pain is a common problem in the primary care physician's office. Effective treatment depends on an accurate diagnosis of the more common etiologies:... (Review)
Review
Chronic shoulder pain is a common problem in the primary care physician's office. Effective treatment depends on an accurate diagnosis of the more common etiologies: rotator cuff disorders, adhesive capsulitis, acromioclavicular osteoarthritis, glenohumeral osteoarthritis, and instability. Activity modification and analgesic medications comprise the initial treatment in most cases. If this does not lead to improvement, or if the initial presentation is of sufficient severity, a trial of physical therapy that focuses on the specific diagnosis is indicated. Combined steroid and local anesthetic injections can be used alone or as an adjuvant to the physical therapy. The site of the injection (subacromial, acromioclavicular joint, or intra-articular) depends on the diagnosis. Injections into the glenohumeral joint should be done under fluoroscopic guidance. Symptoms that persist or worsen after six to 12 weeks of directed treatment should be referred to an orthopedic specialist.
Topics: Analgesics; Drug Therapy, Combination; Humans; Joint Diseases; Referral and Consultation; Shoulder Pain; Treatment Outcome
PubMed: 18326169
DOI: No ID Found -
International Journal of Environmental... Jun 2022Arthropathy refers to the notion of joint diseases [...].
Arthropathy refers to the notion of joint diseases [...].
Topics: Gait; Gait Analysis; Humans; Joint Diseases; Lower Extremity; Walking
PubMed: 35682370
DOI: 10.3390/ijerph19116785 -
Respiratory Medicine Apr 2018Pain, commonly localized to the trunk in individuals with COPD, may be due to osteoporosis-related vertebral deformity and chest wall hyper-expansion causing... (Comparative Study)
Comparative Study
BACKGROUND
Pain, commonly localized to the trunk in individuals with COPD, may be due to osteoporosis-related vertebral deformity and chest wall hyper-expansion causing misalignment of joints between the ribs and vertebrae. The purpose of this study was to determine if thoracic vertebral deformity and arthropathy were independent contributors to trunk pain in COPD patients compared to people with a significant smoking history.
METHOD
Participants completed the Brief Pain Inventory (BPI) on the same day as chest CT scans and spirometry. Current and ex-smokers were separated into COPD (n = 91) or non-COPD (n = 80) groups based on spirometry. Subsequently, CT images were assessed for thoracic vertebral deformity, bone attenuation values, and arthropathy of thoracic vertebral joints.
RESULTS
The trunk area was the most common pain location in both COPD and non-COPD groups. Thoracic vertebral deformity and costotransverse joint arthropathy were independent contributors to trunk pain in COPD patients (adjusted OR = 3.55 and 1.30, respectively) whereas alcohol consumption contributed to trunk pain in the non-COPD group (adjusted OR = 0.35 in occasional alcohol drinkers; 0.08 in non-alcohol drinkers). The spinal deformity index and the number of narrowed disc spaces were significantly positively related to the BPI intensity, interference, and total scores significantly in COPD patients.
CONCLUSION
Trunk pain, at least in part, is caused by thoracic vertebral deformity, and costotransverse and intervertebral arthropathy in patients living with COPD. The results of this study provided the foundation for the management of pain, which requires further exploration.
Topics: Aged; Canada; Congenital Abnormalities; Cross-Sectional Studies; Female; Humans; Joint Diseases; Male; Middle Aged; Observer Variation; Osteoporosis; Outcome Assessment, Health Care; Pain; Pain Perception; Prevalence; Pulmonary Disease, Chronic Obstructive; Smoking; Thoracic Vertebrae; Tomography, X-Ray Computed
PubMed: 29605193
DOI: 10.1016/j.rmed.2018.03.007 -
British Journal of Haematology May 1998
Review
Topics: Adolescent; Adult; Blood Component Transfusion; Child; Child, Preschool; Factor VIII; Follow-Up Studies; Hemophilia A; Humans; Infant; Joint Diseases
PubMed: 9609513
DOI: 10.1046/j.1365-2141.1998.00707.x -
Pediatric Rheumatology Online Journal Jun 2022Juvenile idiopathic arthritis is the most common chronic rheumatic disease of childhood. The term JIA encompasses a heterogenous group of diseases. The variability in...
BACKGROUND
Juvenile idiopathic arthritis is the most common chronic rheumatic disease of childhood. The term JIA encompasses a heterogenous group of diseases. The variability in phenotype of patients affected by the disease means it is not uncommon for mimics of JIA to be misdiagnosed.
CASE PRESENTATION
We present four cases who were treated in single tertiary rheumatology centre for JIA who were subsequently diagnosed with a rare monogenic disease. All four patients shared the unifying features of presenting in early childhood and subsequently suffered with refractory disease, not amenable to usual standards of treatment. Multicentric Carpotarsal Osteolysis Syndrome and Camptodactyly-arthropathy-coxa vara-pericarditis syndrome are non-inflammatory conditions and patients typically present with arthropathy, normal inflammatory markers and atypical radiological features. Blau syndrome is an autosomal dominant condition and patients will typically have symmetrical joint involvement with a strong family history of arthritis, signifying the genetic aetiology.
CONCLUSIONS
We share our learning from these cases to add to the growing portfolio of JIA mimics and to highlight when to consider an alternative diagnosis. In cases of refractory disease and diagnostic uncertainty further imaging and genetic testing can play a crucial role in establishing the aetiology. In all of these cases the correct diagnosis was made due to careful, longitudinal clinical phenotyping and a close working relationship between rheumatology, radiology and clinical genetics; highlighting the importance of the multidisciplinary team in managing complex patients.
Topics: Arthritis, Juvenile; Arthropathy, Neurogenic; Child, Preschool; Coxa Vara; Humans; Joint Diseases; Synovitis
PubMed: 35717242
DOI: 10.1186/s12969-022-00700-y -
Folia Medica Cracoviensia Jun 2022Authors, mostly specialists on rehabilitation and orthopedic surgery prove that arthrofibrosis is a commonly overlooked phenomenon, which may lead to serious limitation...
Authors, mostly specialists on rehabilitation and orthopedic surgery prove that arthrofibrosis is a commonly overlooked phenomenon, which may lead to serious limitation in the range of movement, leading to limitation in patients quality of functioning. The main goal of this article is to emphasize the importance of understanding a such complex condition. Non typical patomechanism, lack of biomarkers dedicated to this dysfunction and general lack of understanding in this pathology causes that risk factors and the most effective strategies remain vastly unknown. Pathophysiology of the arthrofibrosis in the joints is definitely multifactorial, but intense production of collagen seems to be the main factor. Most modern pharmacological methods concentrate on the regulation of collagen fiber production and reducing the inflammation. Inflammation from joint contractures stimulates the proliferation of activated cells that results in the production of extracellular matrix macromolecules to form fibrotic tissue that is deposited into the capsule, thereby resulting in fibrosis. Lack of unified classification scale is caused by relatively high variation of the functions fulfilled by particular joints and each treatment plan should be constructed individually. Quality of surgical treatment and physical therapy play a major role in both prevention and treatment of such complex condition as arthrofibrosis. Both iatrogenic mistakes and overly aggressive manual therapy are some of main factors increasing the risk of this pathological condition. Introducing properly conducted physical therapy treatment in the early stage is crucial to main the range of movement and preventing this significant problem.
Topics: Collagen; Fibrosis; Humans; Inflammation; Joint Diseases; Physical Therapy Modalities
PubMed: 36088593
DOI: 10.24425/fmc.2022.141691 -
Haemophilia : the Official Journal of... Nov 2016Joint haemorrhage is the principal clinical manifestation of haemophilia frequently leading to advanced arthropathy and arthrofibrosis, resulting in severe disability....
INTRODUCTION
Joint haemorrhage is the principal clinical manifestation of haemophilia frequently leading to advanced arthropathy and arthrofibrosis, resulting in severe disability. The degree and prevalence of arthrofibrosis in hemophilic arthropathy is more severe than in other forms of arthropathy. Expression of connective tissue growth factor (CTGF) has been linked to many fibrotic diseases, but has not been studied in the context of haemophilic arthropathy.
AIM
We aim to compare synovial tissues histologically from haemophilia and osteoarthritis patients with advanced arthropathy in order to compare expression of proteins that are possibly aetiologic in the development of arthrofibrosis.
METHODS
Human synovial tissues were obtained from 10 haemophilia and 10 osteoarthritis patients undergoing joint surgery and processed for histology and immunohistochemistry.
RESULTS
All samples from haemophilia patients had synovitis with hypertrophy and hyperplasia of synovial villi. Histologically, synovial tissues contained hyperplastic villi with increased cellularity and abundant haemosiderin- and ferritin-pigmented macrophage-like cells (HMCs), with a perivascular localization in the sub-surface layer. CTGF staining was observed in the surface layer and sub-surface layer in all haemophilia patients, exclusively co-localizing with HMCs. Quantification showed that the extent of CTGF-positive areas was correlated with the degree of detection of HMCs. CTGF was not observed in any of the samples from osteoarthritis patients.
CONCLUSION
Using histological analysis, we showed that CTGF expression is elevated in haemophilia patients with arthrofibrosis and absent in patients with osteoarthritis. Additionally, we found that CTGF is always associated with haemosiderin-pigmented macrophage-like cells, which suggests that CTGF is produced by synovial A cells following the uptake of blood breakdown products.
Topics: Adult; Connective Tissue Growth Factor; Female; Hemarthrosis; Hemophilia A; Humans; Joint Diseases; Male; Middle Aged; Young Adult
PubMed: 27704689
DOI: 10.1111/hae.13049