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Arthritis, general [keywords]
- [Analyses of risk factors for deep vein thrombosis in lower extremities]. [English Abstract, Journal Article]
- Zhonghua Yi Xue Za Zhi 2013 Aug 6; 93(29):2279-82.
To explore the risk factors of deep vein thrombosis (DVT) in lower extremities.Retrospective data analyses were performed for a total of 1264 DVT patients at our department from January 2010 to December 2012.Among them, 984 cases (77.85%) were over 40 years old, no overt cause was found for 642 cases (50.79%), 142 cases (11.23%) had a clear history of trauma before onset (without surgery). Among 316 recurrent postoperative cases, there were the surgical histories of orthopedics (n = 142, 11.23%), gynecology (n = 90, 7.12%), general practice (n = 42, 3.32%), vascular (n = 23, 1.82%), urological (n = 12, 0.94%) and others (n = 7, 0.55%). Ten cases (0.79%) occurred after suffering bedridden chronic diseases. And 20 cases (1.58%) were caused by conditions during pregnancy or postpartum period.had Malignant tumors were found in 25 (1.98%) patients. After long-term uses of hormones, 10 patients (0.79%) of rheumatoid arthritis had a recurrence.Owing to varicose veins, 27 patients (2.14%) recurred. Eight patients (0.63%) had a history of drug abuse, 2 cases (0.16%) suffered depression and 62 cases (4.9%) were recurrent.There are many causative factors of DVT so that prevention is of great importance. We should pay more attention to the prevention and treatment of high-risk DVT patients.
- Improving osteoporosis management following minimal trauma fracture in a regional setting: The Coffs Fracture Card Project. [Journal Article]
- Aust J Rural Health 2013 Dec; 21(6):343-9.
To improve osteoporosis (OSP) management following minimal trauma fracture (MTF) with few additional resources.Population intervention with serial cross-sectional analysis.Regional setting involving primary care, base hospital and private hospital.Patients with MTF.A 'Fracture Card' prompting OSP management was provided to all patients post-MTF. Patients were encouraged to attend their general practitioner (GP) with this to discuss bone health issues. The 2-year intervention was supported by a public health education campaign.Number of (i) serum 25-OH vitamin D assays, (ii) dual-energy X-ray absorptiometry (DXA) scans, and (iii) new Pharmaceutical Benefits Scheme (PBS)-subsidised prescriptions for bone protective therapy (bisphosphonates, raloxifene, strontium, teriparatide, denosumab).The number of serum 25-OH vitamin D assays ordered in Coffs Harbour increased from 329 ± 15 per month (July 2009-June 2010) to 568 ± 21 (July 2010-June 2012; P < 0.001). The number of DXA scans performed per month increased from 192 ± 14 (July 2009-June 2010) to 296 ± 12 (July 2010-June 2012; P < 0.001). There was no difference in the number of new PBS-subsidised prescriptions for bone protective therapy in the Coffs statistical subdivision over that time (176 ± 3.8 per month, July 2009-June 2010 versus 180 ± 3.5, July 2010-June 2012, P > 0.05).The intervention was associated with an increased number of 25-OH vitamin D assays and DXA scans but not with more prescriptions for bone protective therapy. This suggests that a public health education campaign and provision of a 'prompt' for GPs was only partially successful at improving OSP management post-MTF. This has driven establishment of a Fracture Liaison Service.
- Rheumatoid Arthritis among Periodontitis Patients in Baddi Industrial Estate of Himachal Pradesh, India: A Cross Sectional Study. [JOURNAL ARTICLE]
- J Clin Diagn Res 2013 Oct; 7(10):2334-2337.
Aim: To determine whether there is a relationship between periodontal disease and rheumatoid arthritis. Methods: A total of 1520 (852 - periodontal group; 668 - general group) individuals of 30-70 years age group and residents of Baddi industrial estate in Himachal Pradesh, India, were assessed for the prevalence of rheumatoid arthritis and Periodontal Disease (PD). The prevalence and severity of periodontitis were determined by recording the Community Periodontal Index (CPI) with loss of attachment, based on WHO guidelines (1997). The criteria considered for diagnosis of rheumatoid arthritis were as those given by American Rheumatism Association -1988. Frequency distributions for bivariate analysis and logistic regression for multivariate analysis were used for assessment of statistical association between variables. Results: In patients referred for periodontal treatment, the prevalence of rheumatoid arthritis was 4.4%. Females (3.2%) and subjects aged above 50 years (3.5%) showed a significantly higher prevalence in comparison to their counterparts (p<0.001). The odds of rheumatoid arthritis in females were nearly three times (OR=2.813) higher than those in males, which was also statistically significant (p<0.05). Conclusion: The findings provide evidence of a relationship, suggesting that individuals with moderate to severe periodontal disease are at higher risk of suffering from rheumatoid arthritis and vice versa.
- Treatment of displaced talar neck fractures using delayed procedures of plate fixation through dual approaches. [JOURNAL ARTICLE]
- Int Orthop 2013 Dec 3.
Treatment of talar neck fractures is challenging. Various surgical approaches and fixation methods have been documented. Clinical outcomes are often dissatisfying due to inadequate reduction and fixation with high rates of complications. Obtaining satisfactory clinical outcomes with minimum complications remains a hard task for orthopaedic surgeons.In the period from May 2007 to September 2010, a total of 31 cases with closed displaced talar neck fractures were treated surgically in our department. Injuries were classified according to the Hawkins classification modified by Canale and Kelly. Under general anaesthesia with sufficient muscle relaxation, urgent closed reduction was initiated once the patients were admitted; if the procedure failed, open reduction and provisional stabilisation with Kirschner wires through an anteromedial approach with tibiometatarsal external fixation were performed. When the soft tissue had recovered, definitive fixation was performed with plate and screws through dual approaches. The final follow-up examination included radiological analysis, clinical evaluation and functional outcomes which were carried out according to the Ankle-Hindfoot Scale of the American Orthopaedic Foot and Ankle Society (AOFAS), patient satisfaction and SF-36.Twenty-eight patients were followed up for an average of 25 months (range 18-50 months) after the injury. Only two patients had soft tissue complications, and recovery was satisfactory with conservative treatment. All of the fractures healed anatomically without malunion and nonunion, and the average union time was 14 weeks (range 12-24 weeks). Post-traumatic arthritis developed in ten cases, while six patients suffered from avascular necrosis of the talus. Secondary procedures included three cases of subtalar arthrodesis, one case of ankle arthrodesis and one case of total ankle replacement. The mean AOFAS hindfoot score was 78 (range 65-91). According to the SF-36, the average score of the physical component summary was 68 (range 59-81), and the average score of the mental component summary was 74 (range 63-85).Talar neck fractures are associated with a high incidence of long-term disability and complications. Urgent reduction of the fracture-dislocation and delayed plate fixation through a dual approach when the soft tissue has recovered may minimise the complications and provide good clinical outcomes.
- Who uses Australian chiropractic services? [JOURNAL ARTICLE]
- Chiropr Man Therap 2013; 21(1):31.
The use of chiropractic services is widespread, however, little is known about the characteristics of people who seek chiropractic care in Australia. This study compared the characteristics of users and non-users of chiropractic services from a cohort of patients sourced from general medical practice in Victoria, Australia.This is a secondary analysis of baseline screening data from a prospective adult cohort study beginning in 2005. Thirty randomly selected Australian general medical practices mailed out surveys to 17,780 of their patients. Differences were examined between chiropractic users and others, and between chiropractic users who reported a back problem to those who did not.Of 7,519 respondents, 15% indicated they had visited a chiropractor in the last 12 months. Chiropractic users were more likely to have their GP located in a rural location and to be born in Australia; they were less likely to be in the older age group (55-76), to be unemployed or to have a pension/benefit as their main source of income. Chiropractic users were more likely to: have a back problem; use complementary or alternative medication; visit another type of complementary health practitioner or a physiotherapist. They were less likely to take medication for certain health problems (e.g. for high blood pressure, high cholesterol or asthma). No important differences were seen between chiropractic users and non-users for other health problems. People who visited a chiropractor and reported a back problem were more likely to: be a current smoker; have a number of other chronic conditions, including arthritis, hypertension, chronic sinusitis, asthma, dermatitis, depression and anxiety; report taking medications, including antidepressants, analgesics (painkillers and arthritis medication) and complementary or alternative medications.This large cross-sectional study of general medical practice attendees suggests that chiropractors are the most commonly consulted complementary health profession. Chiropractors should ensure they are aware of their patients' health conditions other than musculoskeletal problems and should ensure they are appropriately managed.
- Effect of Biologic Treatments on Growth in Children with Juvenile Idiopathic Arthritis. [JOURNAL ARTICLE]
- J Rheumatol 2013 Dec 1.
Growth retardation is a frequent complication of severe juvenile idiopathic arthritis (JIA). Biologic treatments may improve growth velocity by controlling systemic inflammation and reducing corticosteroids. Our goals were to compare growth velocity before and after the onset of biologic therapy and to determine whether the JIA subtype, the use of steroids, the requirement of one or several biologic agents, or the disease activity influenced growth velocity.We retrospectively analyzed the growth of children with JIA who never received growth hormone treatment, who started biologic treatment before puberty, and who were followed for at least 6 months afterward.We included 100 children (33 boys). Median patient age was 7.1 years (range: 1.6-15.7) at the onset of biologic treatment and 11.0 years (range: 2.3-19.5) at the latest followup. Forty-six patients had received corticosteroid and 34 had received more than 1 biologic agent. Patient median height expressed as SD score (SDS) was 0.31 (range: -2.47 to 5.46) at disease onset, -0.24 (-3.63 to 2.90) at biologic therapy onset (p < 0.0001), and -0.15 (-4.95 to 3.52) at the latest followup (p = 0.171 compared to biologic treatment onset). Patients who required several biologics and systemic patients had a significantly lower growth velocity after the onset of biologic treatment. At the latest followup, 18% of our study group had low growth velocities and 19% were below -2SD or shorter than genetically programmed.In a subset of patients, particularly systemic JIA patients and patients who required more than 1 biologic, biologic therapy may be insufficient to restore normal growth velocity.
- A preliminary study on the characterization of follicular helper T (Tfh) cells in rheumatoid arthritis synovium. [JOURNAL ARTICLE]
- Acta Histochem 2013 Nov 25.
Rheumatoid arthritis (RA) is a chronic and systematic autoimmune inflammatory disease. Recently, a novel T cell subset, follicular helper CD4 T cell (Tfh cells) was found in relation to the pathogenesis and progression of RA, and increased numbers of circulating Tfh cells were found in RA patients. However, there is little evidence regarding the localization of Tfh cells in synovium tissues from RA patients, owing to the lack of an available method to characterize their localization in tissue. The aim of our present study was to characterize the Tfh cells in rheumatoid synovium tissues from RA patients by using immunohistochemistry and triple-fluorescence immunostaining methods. Our results showed that specific staining of CD4, CXCR5 and ICOS could be found on infiltrating immune cells in rheumatoid synovium tissues. The use of triple-fluorescence immunostaining and confocal laser scanning showed immunolocalization of CD4(+)CXCR5(+)ICOS(+)T cells (Tfh cells) in the rheumatoid synovium tissues, whereas these signals were absent in osteoarthritis (OA) synovium and in normal synovium tissues. Thus the data from our present preliminary study support the notion that CD4(+)CXCR5(+)ICOS(+)Tfh cells could be found in rheumatoid synovium tissues from RA patients, indicating the possibility that this T cell subset in synovium tissues may have important roles in the pathogenesis and progression of RA.
- Arterial hypertension assessed "out-of-office" in a contemporary cohort of rheumatoid arthritis patients free of cardiovascular disease is characterized by high prevalence, low awareness, poor control and increased vascular damage-associated "white coat" phenomenon. [Journal Article]
- Arthritis Res Ther 2013; 15(5):R142.
Rheumatoid arthritis (RA) is associated with a high cardiovascular disease (CVD) risk, whereas arterial hypertension is a major modifiable CVD risk factor with still unclear prevalence in RA disease. We conducted a comprehensive study on hypertension characteristics evaluating for the first time out-of-office blood pressure (BP) in a typical contemporary RA cohort.Assessment of office and out-of-office BP (when office systolic/diastolic BP was >129/79) and vascular studies including evaluation of aortic stiffness, carotid hypertrophy/plaques and ankle-brachial index, were performed in 214 consecutive, consenting RA patients free of CVD (aged 58.4 ± 12.3 years, 82% women). As comparators regarding office hypertension measurements, data from 214 subjects (1:1 matched for age and gender with the RA patients) derived from a cohort designed to assess the prevalence of hypertension in the general population were used.The prevalence of declared known hypertension in the RA population was 44%. Of the remaining RA patients, 2 in every 5 individuals had abnormal office BP (systolic/diastolic >139/89 mmHg), contributing to almost double the prevalence of declared/office hypertension compared to the general matched population (67% vs. 34%). Out-of-office (home or ambulatory 24 hour) BP measurements revealed that: (i) a 54% prevalence of actual hypertension in RA, in other words almost 10% of the patients were unaware of having hypertension and (ii) 29% of the RA patients with known hypertension were not well controlled. Actual hypertension was positively associated with age and body mass index, and inversely with the use of biologic drugs. Overall, almost 1 out of 5 presented the 'white coat' phenomenon. An intermediately compromised vascular phenotype was evident in this "white coat" subgroup (lying between patients with sustained normotension and sustained hypertension) in terms of aortic stiffness, carotid hypertrophy and ankle-brachial index, even after adjustment for confounders.Beyond any doubt on the basis of out-of-office evaluation, arterial hypertension in RA has a high prevalence, low awareness and poor control, as well as substantial and vascular damage-associated "white coat" phenomenon. Thus, correct diagnosis and effective treatment of hypertension is of key importance in RA for CVD risk reduction.
- Drug survival on TNF inhibitors in patients with rheumatoid arthritis comparison of adalimumab, etanercept and infliximab. [JOURNAL ARTICLE]
- Ann Rheum Dis 2013 Nov 27.
To compare drug survival on adalimumab, etanercept and infliximab in patients with rheumatoid arthritis (RA).Patients with RA (n=9139; 76% women; mean age 56 years) starting their first tumour necrosis factor (TNF) inhibitor between 2003 and 2011 were identified in the Swedish Biologics Register (ARTIS). Data were collected through 31 December 2011. Drug survival over up to 5 years of follow-up was compared overall and by period of treatment start (2003-2005/2006-2009; n=3168/4184) with adjustment for age, sex, education, period, health assessment questionnaire (HAQ), disease duration, concomitant disease modifying antirheumatic drug (DMARD) treatment and general frailty (using hospitalisation history as proxy).During 20 198 person-years (mean/median 2.2/1.7 years) of follow-up, 3782 patients discontinued their first biological (19/100 person-years; 51% due to inefficacy, 36% due to adverse events). Compared with etanercept, infliximab (adjusted HR 1.63, 95% CI 1.51 to 1.77) and adalimumab initiators had higher discontinuation rates (1.26, 95% CI 1.16 to 1.37), and infliximab had a higher discontinuation rate than adalimumab (1.28, 95% CI 1.18 to 1.40). These findings were consistent across periods, but were modified by time for adalimumab versus etanercept (p<0.001; between-drug difference highest the 1st year in both periods). The discontinuation rate was higher for starters in 2006-2009 than 2003-2005 (adjusted HR 1.12, 95% CI 1.04 to 1.20). The composition of 1-year discontinuations also changed from 2003-2005 vs 2006-2009: adverse events decreased from 45% to 35%, while inefficacy increased from 43% to 53% (p<0.001).Discontinuation rates were higher for infliximab compared with adalimumab and etanercept initiators, and for adalimumab versus etanercept during the 1st year. Discontinuation rates increased with calendar period, as did the percentage discontinuations due to inefficacy.
- Pharmacokinetics of drugs in cachectic patients: a systematic review. [Journal Article]
- PLoS One 2013; 8(11):e79603.
Cachexia is a weight-loss process caused by an underlying chronic disease such as cancer, chronic heart failure, chronic obstructive pulmonary disease, or rheumatoid arthritis. It leads to changes in body structure and function that may influence the pharmacokinetics of drugs. Changes in gut function and decreased subcutaneous tissue may influence the absorption of orally and transdermally applied drugs. Altered body composition and plasma protein concentration may affect drug distribution. Changes in the expression and function of metabolic enzymes could influence the metabolism of drugs, and their renal excretion could be affected by possible reduction in kidney function. Because no general guidelines exist for drug dose adjustments in cachectic patients, we conducted a systematic search to identify articles that investigated the pharmacokinetics of drugs in cachectic patients.