How to investigate: Early axial spondyloarthritis

Publication date: Available online 31 July 2019Source: Best Practice &Research Clinical RheumatologyAuthor(s): Pedro D. Carvalho, Pedro M. MachadoAbstractAxial spondyloarthritis (axSpA) is a chronic inflammatory condition of the axial skeleton that encompasses radiographic and non-radiographic axSpA and that can lead to chronic pain, structural damage, disability, and loss of quality of life. Scientific advances, including the role of MRI assessment, have led to new diagnostic insights and the creation of a new set of classification criteria for axial and peripheral SpA. New criteria allow the identification of SpA patients with early disease and their enrolment in clinical studies. In this chapter, we discuss the difference between diagnostic and classification criteria, the diagnostic approach to patients with suspected axSpA, the limitations of MRI assessment, and the importance of early identification of this condition. A practical algorithm to investigate axSpA, based on the current evidence, is also proposed. Clinical judgement should always be kept as the mainstay in the diagnosis of axSpA.
Source: Best Practice and Research Clinical Rheumatology - Category: Rheumatology Source Type: research

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‚ÄčA right-handed man presented with swelling and tenderness at the base of his thumb after an altercation. His range of motion at the metacarpal-carpal joint was limited because of pain. Not unexpectedly, his first metacarpal was broken. What can you tell this patient about his injury?You can say:This fracture has a name: Bennett's fracture.It is the most common fracture of the base of the thumb.His fracture is classic in mechanism; fist fights commonly produce this injury (by having an axial load against a partially flexed first metacarpal).His radiographs are classic in appearance—a two-piece intraarticular fractu...
Source: Lions and Tigers and Bears - Category: Emergency Medicine Tags: Blog Posts Source Type: blogs
Conclusions: Topping-off can effectively prevent the adjacent segment disease from progressing after lumbar internal fixation, which is be more effective in proximal segments. Topping-off technique was more effective in improving subjective feelings of patents rather than objective motor functions. However, no significant difference between topping-off technique and PLIF can be found in the rates of complications.
Source: Medicine - Category: Internal Medicine Tags: Research Article: Systematic Review and Meta-Analysis Source Type: research
CONCLUSIONS: It is uncertain whether Tai Chi has any effect on clinical outcomes (joint pain, activity limitation, function) in RA, and important effects cannot be confirmed or excluded, since all outcomes had very low-quality evidence. Withdrawals from study were greater in the control groups than the Tai Chi groups, based on low-quality evidence. Although the incidence of adverse events is likely to be low with Tai Chi, we are uncertain, as studies failed to explicitly report such events. Few minor adverse events (joint and muscle soreness and cramps) were described qualitatively in the narrative of two of the studies. T...
Source: Cochrane Database of Systematic Reviews - Category: General Medicine Authors: Tags: Cochrane Database Syst Rev Source Type: research
CONCLUSIONS: The lumbar lordosis index, but not the sacral horizontal angle, was significantly associated with CLBP in the subjects. PMID: 31282399 [PubMed - as supplied by publisher]
Source: Journal of Back and Musculoskeletal Rehabilitation - Category: Orthopaedics Tags: J Back Musculoskelet Rehabil Source Type: research
Authors: Khlopas H, Khlopas A, Samuel LT, Ohliger E, Sultan AA, Chughtai M, Mont MA Abstract Ankle osteoarthritis constitutes a large burden to society and is a leading cause of chronic disability in the United States. Most commonly, it is post-traumatic, occurs in younger individuals, and is associated with obesity. This entity presents similarly to osteoarthritis of the other joints, with the typical nonspecific symptoms of stiffness, swelling, and pain. Radiographic investigation includes four weight-bearing standard views: antero-posterior and lateral foot, mortise view of the ankle, and a specialized view of t...
Source: Surgical Technology International - Category: Surgery Tags: Surg Technol Int Source Type: research
Abstract Osteoarthritis (OA) is the most common form of joint disease and a major cause of pain and disability in the adult population. Interestingly, there are patients with symptomatic OA displaying pain, while patients with asymptomatic OA that do not experience pain but show radiographic signs of joint damage. Pain is a complex experience integrating sensory, affective, and cognitive processes related to several peripheral and central nociceptive factors besides inflammation. During the last years, the role of infrapatellar fat pad (IFP), other than the synovial membrane, has been investigated as a potential s...
Source: Biomed Res - Category: Research Authors: Tags: Biomed Res Int Source Type: research
Publication date: May 2019Source: Journal of the American College of Radiology, Volume 16, Issue 5, SupplementAuthor(s): Expert Panel on Neurological Imaging:, Marin A. McDonald, Claudia F.E. Kirsch, Beejal Y. Amin, Joseph M. Aulino, Angela M. Bell, R. Carter Cassidy, Santanu Chakraborty, Asim F. Choudhri, Seth Gemme, Ryan K. Lee, Michael D. Luttrull, Darlene F. Metter, Toshio Moritani, Charles Reitman, Lubdha M. Shah, Aseem Sharma, Robert Y. Shih, Laura A. Snyder, Sophia C. Symko, Ralf ThieleAbstractNontraumatic neck pain is a leading cause of disability, with nearly 50% of individuals experiencing ongoing or recurrent sy...
Source: Journal of the American College of Radiology - Category: Radiology Source Type: research
Nontraumatic neck pain is a leading cause of disability, with nearly 50% of individuals experiencing ongoing or recurrent symptoms. Radiographs are appropriate as initial imaging for cervical or neck pain in the absence of “red flag” symptoms or if there are unchanging chronic symptoms; however, spondylotic changes are commonly identified and may result in both false-positive and false-negative findings. Noncontrast CT can be complementary to radiographs for evaluation of new or changing symptoms in the setting of prior cervical spine surgery or in the assessment of extent of ossification in the posterior longitudinal ligament.
Source: Journal of the American College of Radiology : JACR - Category: Radiology Authors: Tags: Appropriate use criteria Source Type: research
Conclusion Trochlear pain (trochleodynia) is becoming recognized as a set of disorders that can present in isolation or concomitantly with co-existing migraines, tension-type headaches, or other headache disorders, possibly explaining subpar symptom control in a small but significant number of individuals globally. Trochleodynia features unilateral periocular pain that may involve the ipsilateral hemicranium. Pain exacerbation occurs with trochlear palpation and supraduction of the affected eye especially in the adducted position. Trochleodynia may respond to oral NSAIDs if symptoms are mild and of recent onset. While ora...
Source: Frontiers in Neurology - Category: Neurology Source Type: research
The objectives of this study were to define the role for surgery in the treatment of chronic low back pain (cLBP) and to develop a new classification of cLBP based on the pattern of injury.HypothesisSurgery may benefit patients with cLBP, and a new classification based on the injury pattern may be of interest.MethodA systematic literature review was performed by searching Medline, the Cochrane Library, the French public health database (Banque de Données en Santé Publique), Science Direct, and the National Guideline Clearinghouse. The main search terms were “back pain” OR “lumbar” OR &...
Source: Orthopaedics and Traumatology: Surgery and Research - Category: Orthopaedics Source Type: research
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