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March 14, 2017

Rheumatoid arthritis (RA) is a long-term autoimmune disorder of the joints and it is characterized by stiffness, acute swelling and pain in the joints. The International Osteoporosis Foundation (IOF) Chronic Inflammation and Bone Structure (CIBS) Working Group has published its review of bone loss in RA and the role of biologics in bone outcomes - bone mineral density (BMD), bone turnover markers, and fragility fractures. They concluded that early and aggressive treatment with biologics disease-modifying anti-rheumatic drugs (bDMARDs) is crucial to avoid progressive bone loss in patients with RA.

International Osteoporosis Foundation
12min read    
March 14, 2017

Pain after surgery is common and often requires proper management to resolve it. Several factors may help determine the severity the pain and ideal approaches to manage it. For example, different types of surgeries and surgical cuts causes different types of pain. A longer invasive surgery causes more severe painas compared to short non-invasive surgeries. To be comfortable, pain control can help to speed up the recovery and may reduce you’re the risk of developing certain post-surgical complications such as pneumonia and blood clots.

Eur J Pain. 2016 Oct 13.
7min read    
March 14, 2017

A recent study from Loyola University in Chicago has revealed that arthritis drug Celecoxib boosted the effectiveness of antidepressant medication in severely depressed patients. However,  it does not treat depression on its own. Over a span of eight weeks, researchers studied 55 bipolar adults aged between 18 and 65 years. All participants were experiencing the disease’s depressive phase and had not benefited from an antidepressant drug. Patients were randomized to receive either escitalopram+celecoxib (n=31) or escitalopram+placebo (n=24).

Loyola University Health System
6min read    
March 14, 2017

A new study by Mayo Clinic probed on why some rheumatoid arthritis (RA) patients respond poorly when treated with tumor necrosis factor (TNF) inhibitors, that belongs to biologics. According to reserachers, it happens due to body protein in the body responsible for inflammation. So, in an attempt to eliminate “trial and error” prescribing of medications, a new step has been put forward for better personalizing RA treatment. The findings were presented at the American College of Rheumatology annual meeting in San Francisco.

Mayo Clinic
8min read    
March 14, 2017

Facet joints or joints with “small faces” provide the joint about 20% of the torsional stability in the neck and low back. These joints  can be found at every spinal level. The vertebrae of the chest area permit a small amount of forward/backward and some side bending with very little twisting. The facet joints are paired diarthrodial articulations between the posterior elements of the adjacent vertebrae. Facet joint motion can be disturbed by trauma or injury. Stiffness in the joint restricting motion is called as hypomobility, while excessive joint motion is known as hypermobility.

Eur J Pain. 2016 Oct 10
9min read    

A 79-year-old Caucasian retired physician presented to the clinic with a severe complaint of bilateral hip pain that had been persisting since last 2 years with unbearable episodes of pain over the previous three months. His pain was dull and achy, and started anteriorly in both the hips with occasional radiation to the groin. The pain ratings at its most severe point were 7 and 5 on a ten-point scale in the left and the right hip, respectively. The pain was most severe in the morning, when the patient woke up and in the evening after completion of all day to day activities. Acetaminophen 650mg bid as well as tid was no longer effective in relieving his pain. However, Ibuprofen 400 mg tid did show some improvement. The patient was unwilling to begin NSAIDs because of the fear of having gastrointestinal (GI) adverse events. Tramadol, hydrocodone, and oxycodone in the past lead to troublesome lightheadedness.

What will most likely explain the symptoms reported by the patient in this case?

  • Bilateral Hip Osteoarthritis
  • Spinal Stenosis
  • Greater Trochanteric Bursitis
  • Osteonecrosis

23min read    
Key Take-Away:
  • New drug levetiracetam shows comparable efficacy to currently used drugs such as valproate in migraine prophylaxis

  • Levetiracetam significantly reduces headache frequency in patients with migraine

Migraine is a common neurological disorder. It is categorized as migraine with aura (classic migraine) and migraine without aura (common migraine). Pharmacological treatment of migraine consists of prophylactic (preventive) treatment and symptomatic (abortive) treatment.

Ann Indian Acad Neurol. 2015 Jan-Mar; 18(1): 45–48
12min read    
Key Take-Away:

This study puts light on how high-frequency rTMS on the contralateral primary motor cortex of traumatic amputees induced a clinically significant pain reduction up to 15 days after treatment without any major secondary effect.

Land mines, one of the world’s most disabling public health hazards, results in approximately 15,000 to 25,000 victims each year.

The Journal of Pain 2016;17 (8): 911-918
24min read    
Key Take-Away:

The study revealed that adult patients with osteoporosis had a considerably greater risk of developing subsequent migraine compared to the patients without osteoporosis.

Both osteoporosis and migraine are common conditions that can affect quality of life and can impose large social and economic burdens. The National Institutes of Health Consensus Development Conference Statement defines osteoporosis as a skeletal disorder characterized by diminished bone strength resulting in increased fracture risk.

SpringerPlus20165:1378
16min read    

A 17-year old male athlete participating in a fall league ice hockey game reported that he and an opponent, who had the puck, skated towards each other at high speed. The athlete tripped over a teammate's stick, fell forward, and the top of his helmet forcefully impacted the opponent’s leg at approximately mid-thigh.

39min read    
Education

Fibromyalgia syndrome is a common disorder characterized by multiple tender points, widespread deep muscle pain, sleep disturbance, fatigue and depression.

14min read    
Education

Gout involves problem with the purine metabolism. In this disease, the uric acid levels are increased (hyperuricemia) and urate crystals accumulates in joints and tissues of the body.

NICE
6 min read    
Education

Syndesmotic injuries at the ankle joint are injuries to the ligaments that connect the tibia and fibula.

NICE
10 min read    
Education

Fibromyalgia is a syndrome which is indicated by chronic widespread pain.

ACSAP
10 min read    
Education

This guideline is an updated version on the drug treatment options for post-shingles pain. It was based on the review of the recent litrature and the modified by the author.

The Shingles Support Society
3min read    
March 14, 2017

Rheumatoid arthritis (RA) is a long-term autoimmune disorder of the joints and it is characterized by stiffness, acute swelling and pain in the joints. The International Osteoporosis Foundation (IOF) Chronic Inflammation and Bone Structure (CIBS) Working Group has published its review of bone loss in RA and the role of biologics in bone outcomes - bone mineral density (BMD), bone turnover markers, and fragility fractures. They concluded that early and aggressive treatment with biologics disease-modifying anti-rheumatic drugs (bDMARDs) is crucial to avoid progressive bone loss in patients with RA.

International Osteoporosis Foundation

A 79-year-old Caucasian retired physician presented to the clinic with a severe complaint of bilateral hip pain that had been persisting since last 2 years with unbearable episodes of pain over the previous three months. His pain was dull and achy, and started anteriorly in both the hips with occasional radiation to the groin. The pain ratings at its most severe point were 7 and 5 on a ten-point scale in the left and the right hip, respectively. The pain was most severe in the morning, when the patient woke up and in the evening after completion of all day to day activities. Acetaminophen 650mg bid as well as tid was no longer effective in relieving his pain. However, Ibuprofen 400 mg tid did show some improvement. The patient was unwilling to begin NSAIDs because of the fear of having gastrointestinal (GI) adverse events. Tramadol, hydrocodone, and oxycodone in the past lead to troublesome lightheadedness.

What will most likely explain the symptoms reported by the patient in this case?

  • Bilateral Hip Osteoarthritis
  • Spinal Stenosis
  • Greater Trochanteric Bursitis
  • Osteonecrosis

23min read    
Education

Fibromyalgia syndrome is a common disorder characterized by multiple tender points, widespread deep muscle pain, sleep disturbance, fatigue and depression. The cause and cure for fibromyalgia is unknown, but medications and other treatments can helps to reduce the symptoms. Although, people experience pain and tenderness all over the body, they are often diagnosed by the doctors based on the tender spots or points in certain places of the body.

What are tender points?

14min read