Rheumatology

Heel pain (calcaneodynia) is most commonly due to plantar fasciitis, but has many other causes including nerve entrapment, stress fracture, and sciatica. This review describes an overall approach to diagnosis, discusses conservative treatments and highlights the most prevalent surgical procedures.

Greater quadriceps strength protects against cartilage loss at the lateral compartment of the patellofemoral joint in persons with knee osteoarthritis (OA), and persons with greater quadriceps strength are likely to have less knee pain and better physical function. Greater quadriceps strength has no influence on cartilage loss at the tibiofemoral joint.

A high-intensity strength and endurance exercise program has an impact on a variety of parameters of metabolic syndrome (MetS) in older women. General-purpose exercise programs primarily designed to reduce bone fracture risk also are effective in reducing coronary heart disease risk factors.

Cervical spine injuries are common in athletes, particularly those engaged in contact sports.

In patients with ankylosing spondylitis (AS), the presence of an active inflammatory lesion at the vertebral corner on MRI is associated with development of new syndesmophytes at the corresponding vertebral corner visible on plain radiography, suggesting a relationship between inflammation and ankylosis. New syndesmophytes will develop from a previous active inflammatory lesion even when the lesion has resolved on follow-up MRI after the start of anti-tumor necrosis factor a (anti–TNF–α) therapy.

An outcomes-based fibromyalgia syndrome (FMS) education program is designed to provide physicians and other health care professionals with a broad range of useful information about the disease and thus promote earlier, more accurate diagnosis.

Soft tissue musculoskeletal conditions are common causes of pelvic and lower extremity pain.

Hemochromatosis is a disorder of iron metabolism that may lead to abnormalities in multiple organ systems.

Treatment for patients who have osteoarthritis (OA) of the knee always should be tailored to individual patients after they have had discussions with their physician, according to a new American Academy of Orthopaedic Surgeons (AAOS) guideline.

The main predictor of adherence to a multimodal treatment program for patients with fibromyalgia syndrome (FMS) is barriers, such as lack of time, too much effort, stressful events, and fatigue. Because barriers are important for adherence and adherence is related to outcomes, using a questionnaire about barriers is recommended as a basis for discussing them with patients.

Electronic tools for comprehensively tracking pain are available, but will physicians and patients use them?

Researchers have found new evidence that antidepressants can reduce the severity of symptoms associated with fibromyalgia syndrome.

ABSTRACT: High ankle sprains are not as common as low anklesprains, but they are a significant injury, and the diagnosis may bechallenging. The primary role of the syndesmosis is to maintain therelationship of the talus to the tibia under physiological loads.Toaccomplish this, the distal tibiofibular joint must maintain its stability.The syndesmosis is injured most often with external rotation at theankle joint while the foot is dorsiflexed and pronated. On physicalexamination, tenderness is located in the area of the anterior syndesmosis.There are several special tests for syndesmosis injuries.Radiographic assessment is helpful. The usefulness of classificationsystems is not well defined. The optimal rehabilitation programis unknown. Rehabilitation generally is divided into phases.(J Musculoskel Med. 2008;25:564-569)

The signs and symptoms can be controlled with early diagnosis and treatment.

Links between rheumatoid arthritis (RA) and cardiovascular disease (CVD) and diabetes mellitus (DM) highlighted the research findings reported at the recent American College of Rheumatology (ACR) Annual Scientific Meeting in San Francisco.

Felson DT, Nevitt MC,Yang M, et al, Boston University School of Medicine and other centers.A new approach yields high rates of radiographic progression in knee osteoarthritis.J Rheumatol. 2008;35:2047-2054.

Molecular imaging reveals fibromyalgia symptoms related to functional brain abnormalities.

Muscle strains are most common in the hamstring, gastrocnemius, soleus, and quadriceps strains, as well as the lumbar and thigh adductor. This image-rich review covers imaging, treatment, and prevention.

This surgery is an excellent option for relieving pain and restoring function in patients with osteoarthritis.

Knee pain is a common complaint in older patients, andosteoarthritis is the leading cause.We prospectively evaluated the diagnosticpatterns of nonorthopedic physicians in 100 consecutive patientsolder than 60 years who had knee pain. Our study shows thatthere is a lack of consensus about the use radiographic studies for diagnosisof knee pain in older patients.Weight-bearing radiographs areideal for evaluating knee pain. MRI frequently is overly sensitive in detectingpathology and often underestimates joint-space narrowingand arthrosis. MRI also represents a much larger cost and burden onthe health care system. MRI is indicated when the cause of knee painis not readily apparent after careful physical and radiographic evaluation.(J Musculoskel Med. 2008;25:500-504)

The clinical presentation and outcome of heart failure differ significantly in patients who have rheumatoid arthritis (RA) and those who do not.The presentation of heart failure is more subtle in patients with RA, and mortality is significantly higher.

Pain can be intense and difficult to tolerate in the short-term, such as labor pains and kidney stone impaction, or chronic and long-term, such as low back pain.

ABSTRACT: Osteoarthritis (OA) is the leading cause of chronicdisability in older adults. A multitude of factors can contribute to thedisease process. Only a portion of patients who have radiographicevidence of OA have associated pain. Several conditions can mimicOA. Laboratory tests often contribute little to the diagnosis.Treatmentshould be tailored to individual patients. Exercises and joint protectiontechniques are the mainstays of treatment. Patient educationmay be beneficial. Acetaminophen and NSAIDs are effective in manypatients. Cyclooxygenase-2 inhibitors are associated with improvedGI tolerability. Glucosamine and chondroitin sulfate may produceimprovements in pain and function and may be associated with adecrease in the radiographic progression of OA. Corticosteroids canprovide symptomatic relief. Surgery is an option for advanceddisease. (J Musculoskel Med. 2008;25:476-480)

Complex regional pain syndrome (CRPS) can be tricky todiagnose. This review describes criteria for identifying CRPS, and gives guidance for treatment, with case studies and photographs.

Differentiation between low and high ankle sprains iscritical to delivering appropriate care.The classic mechanism for a lowankle sprain is inversion and plantar flexion. A history of ankle ligamentinjury predisposes to recurring sprains. The ankle anterior drawertest may be used to evaluate ligamentous instability. Plain radiographsof the foot and ankle may be indicated in a patient who has an acuteankle injury. Clinicians often use the Ottawa ankle rules to determinethe need for radiographs. In the acute phase, the goals of treatment areto alleviate pain, reduce swelling, and protect the ankle from furtherinjury. NSAIDs and rehabilitation are important components of management.Primary prevention may be possible with strengthening andbalance programs. (J Musculoskel Med. 2008;25:438-443)

The "logical plan" for patient care includes sparing use of medications, providingpain relief, and quick resumption of work.

This detailed review desccribes the heterogeneous idiopathic inflammatory myopathies and their mimics, with criteria for classification, an overview of cardiac, pulmonary and malignant comorbidieis, and guidance for treatment.

A 21-numbered circle visual analog scale (VAS) may be a desirable alternative to the traditional 10-cm horizontal line for pain and patient global estimate on a Multidimensional Health Assessment Questionnaire (MDHAQ).

A prediction rule for the development of rheumatoid arthritis (RA) in patients with undifferentiated arthritis (UA) has been validated. The rule accurately estimates the risk of RA in more than 75% of patients with recent-onset UA.

A study published in the Canadian Medical Association Journal reveals that PPIs for treating acid reflux elevate the risk of osteoporosis-related fractures.