Rheumatology

An Ameritox study found that of 938,586 urine toxicology tests administered to chronic pain patients over a three-year period, 11% detected major illicit drugs and 29% had a medication in their system that the patient's doctor was likely unaware of.

The precautionary recommendations for the H1N1 (swine) flu in persons with lupus currently are not different from those for the general public, according to the Lupus Foundation of America (LFA). However, because persons with lupus often are at increased risk for infections, especially if they are taking immunosuppressive agents, they should be particularly vigilant about taking the generally recommended precautions.

The seroprevalence of hepatitis is no higher in patients with recent-onset polyarthritis than in the general population. Therefore, screening patients for hepatitis B virus (HBV) and hepatitis C virus (HCV) infection when evaluating them for polyarthritis suggestive of rheumatoid arthritis (RA) is not useful.

In older persons who do not have dementia, stroke, or Parkinson disease, a lower frequency of participation in social activity is associated with more rapid motor function decline. Conversely, participation in a broad spectrum of late-life activities results in positive health outcomes.

In most patients with rheumatoid arthritis (RA), the results of common laboratory testing-rheumatoid factor (RF), erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP) level-are abnormal and may be used to support the diagnosis. However, a substantial proportion of patients with RA have normal test results.

A wider femoral neck and more medial centroid position of bone mineral in the femoral neck are associated with an increased risk of prevalent, incident, and progressive radiographic hip osteoarthritis (RHOA). These differences are detectable early in the natural history of hip OA.

The FDA is now requiring that stronger product warnings be included in the prescribing information of tumor necrosis factor-alpha blockers because of an increased risk of cancer in the children and adolescents who take them.

New research has found that patients with rheumatoid arthritis are likely to suffer from depression, which can, in turn, increase levels of pain associated with the disease.

Patients with rheumatoid arthritis who do not respond well to methotrexate may benefit from ofatumumab, preliminary results from a Phase III trial show.

Although many medications are used for the management of systemic lupus erythematosus (SLE) and its complications, only aspirin, corticosteroids, and the antimalarial drug hydroxychloroquine (HCQ) are specifically approved by the FDA.1 Most other medications used for SLE treatment are commercially available off label (Table 1), usually borrowed from cancer or transplant regimens. In some cases, medications have been approved for a specific clinical manifestation seen in both idiopathic disease and SLE, such as bosentan for pulmonary hypertension.

There have been significant advances in the management of rheumatologic disorders with the availability of newer disease-modifying drugs and biologic agents. However, cardiovascular disease (CVD) morbidity and mortality remain significantly increased in patients with rheumatologic disorders, especially rheumatoid arthritis (RA)1-4 and systemic lupus erythematosus (SLE).

An estimated 52 million Americans will have osteoporosis and low bone mass by next year, according to the National Osteoporosis Foundation (NOF), constituting what the Surgeon General 5 years ago termed "a major public health threat" with "epidemic" proportions. For 25 years, the NOF has been dedicated to preventing osteoporosis and related fractures, promoting lifelong bone health, improving the lives of those affected by the condition and-through programs of awareness, advocacy, public and health professional education, and research-finding a cure. This year, the NOF is marking its 25th anniversary by providing sets of 25 osteoporosis and bone health educational materials for patients and their physicians.

Athletes classified as having high generalized joint laxity demonstrate increased midfoot loading, according to researchers at the Sports Medicine Biodynamics Center at Cincinnati Children’s Hospital. Foss and associates1 noted that delineation of risk factors for medial collapse of the foot, including hypermobility in athletes, may help clinicians evaluate and prevent lower extremity injury.

Although low back pain (LBP) may be attributed to a variety of known vertebral disorders (eg, fractures, infections, tumors, and hernias), a definitive diagnosis often remains elusive.1 Biomechanical deficiencies of the lumbar spine may be a contributor, according to students at the University of Southern California's Musculoskeletal Biomechanics Research Laboratory (MBRL), and they are conducting research to determine what role the deficiencies may play in an effort to identify improved rehabilitation interventions.

A normal serum urate (SU) level at presentation does not exclude an acute gouty attack. A normal level should be considered below 6.8 mg/dL rather than 8 mg/dL as is accepted and reported by several laboratories.

For patients who have comorbid depression and musculoskeletal pain, optimized antidepressant therapy combined with pain self-management may result in substantial improvements in both conditions. However, additional interventions may be needed to achieve bigger improvements in pain and higher depression response and remission rates.

Hip bone mineral density (BMD) correlates with erosion scores in postmenopausal women who have rheumatoid arthritis (RA), although the relationship is not statistically significant after adjustment for clinical factors. BMD and erosions appear to be more strongly correlated in patients with early RA. Solomon and coworkers studied 163 postmenopausal women being treated for RA but not for osteoporosis.

Balloon kyphoplasty results in more and faster improvements in quality of life and disability measures and reduction of back pain than nonsurgical treatment for patients with acute painful vertebral fracture. However, the differences in improvement diminish by 1 year after treatment for most outcome measures, probably because of natural fracture healing.

Bennett RM, Bushmakin AG, Cappelleri JC, et al, Oregon Health and Science University, Portland, and other centers. Minimal clinically important difference in the fibromyalgia impact questionnaire. J Rheumatol. 2009;36:1304-1311.

The name and identifying features derive from what happens to the skin: it becomes thickened and swollen from deposition of excessive amounts of collagen.

Metatarsalgia, fractures, plantar fasciitis, neuromas, blisters, black toenail-easily preventable or inherent, readily manageable or hard to heal, acute or chronic, these are just a few of the maladies that make runners ask, "Why does my foot hurt?" Both runners and researchers seeking answers are taking a close look at barefoot running.

The impact of biomechanical factors on rheumatoid arthritis (RA) has gained increased attention from researchers, as evidenced by studies reported in Clinical Biomechanics. For example, reevaluating knee kinematics over time is important in patients with RA who wear a mobile-bearing total knee prosthesis, according to investigators at the Biomechanics and Imaging Group, Department of Orthopaedics, Leiden University Medical Center, Leiden, the Netherlands.

A proposal that would limit the maximum over-the-counter dose of Tylenol and ban the narcotic painkillers Vicodin and Percocet is currently under consideration by the Food and Drug Administration.

A patient’s expectations for recovery from a whiplash-associated disorder (WAD), measured in the first 6 weeks after a traffic-related WAD, predict actual recovery. Pain recovery and resolution of pain-related limitations show a similar pattern.

Persons in consistently good musculoskeletal health-those who do not report musculoskeletal pain-often demonstrate low levels of psychosocial problems, such as depression, anxiety, sleep disturbance, traumatic experiences, and somatization.

Functional limitations are greater and health-related quality of life (HRQOL) is poorer in persons who have spondyloarthritis (SpA) than in those who do not, even after adjustment for age, sociodemographics, and comorbidities. Many factors are modifiable (eg, severity and duration of disease, response to current therapy, treatment-related adverse effects, medical comorbidity, socioeconomic factors), and targeted interventions may improve function and HRQOL in patients with SpA.

For patients with early rheumatoid arthritis (RA), starting therapy with a combination of disease-modifying antirheumatic drugs (DMARDs) improves long-term outcomes without an increase in adverse events. The combination of methotrexate, sulfasalazine, and hydroxychloroquine plus prednisolone is satisfactory for most patients.

Acupuncture-like treatments significantly improve function in persons with chronic low back pain compared with usual care. However, the beneficial and persisting effects of real acupuncture needling may be no greater than those of noninsertive stimulation.

New research from the Imperial College London may lead to the ability to turn off an immune system signaling molecule that can contribute to the chronic joint inflammation of rheumatoid arthritis.

Ever since the Surgeon General warned of the dangers associated with smoking nearly 50 years ago, special interest groups have pressed Congress to grant the FDA authority to regulate or ban tobacco products.