Clinical rheumatology
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The objective of this study was to review all the published articles in the English literature about the systemic effects of intra-articular corticosteroid injection (IACI) in humans. Reports were searched through Pubmed using the terms intraarticular or intra-articular and steroids, corticosteroids, or glucocorticosteroids up and including the year 2007. Reports were also located through references of articles. ⋯ The effect on inflammatory cytokines is immediate with significant decrease within hours. IACI may induce remission also in patients with oligo-/polyarthritis and/or in patients with extra-articular manifestations. Other metabolic, hematologic, vascular, allergic, visual, psychologic, and other effects were also reported.
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Clinical rheumatology · Mar 2009
ReviewRehabilitation of chronic whiplash: treatment of cervical dysfunctions or chronic pain syndrome?
Chronic whiplash-associated disorders (WAD) remains a challenging condition for clinicians. There is substantial evidence for the presence of various cervical dysfunctions (e.g., increased cervical muscle tone and impaired cervical movement control), but their contribution to the complex clinical picture of subjects with chronic WAD seems rather limited. ⋯ The manuscript explains how our current understanding of chronic WAD can be used to steer the content of conservative interventions and how treatment of cervical dysfunctions in patients with chronic WAD should account for the processes involved in chronicity. It is recommended to prevent sensorimotor incongruence, target cognitive-emotional sensitization, and apply a cognitive behavioral therapy-guided exercise program.
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Clinical rheumatology · Apr 2008
ReviewBone marrow edema syndromes of the hip: MRI features in different hip disorders.
The objectives of this study were to describe the essential magnetic resonance imaging (MRI) features of bone marrow edema syndromes affecting the hip joint. In addition, to evaluate the role of MRI in the assessment of hip joint involvement in different clinical settings that may share similar clinical findings. Thirty-four patients who complained of hip pain were studied consecutively. ⋯ MR imaging is the modality of choice when clinical examination is suspect for hip disease and plain radiographs are normal or equivocal. Early diagnosis and treatment is important in many of the disorders. The literature is reviewed regarding bone marrow edema of the hip.
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The aim of this study was to evaluate data from controlled clinical trials testing the effectiveness of tai chi for treating osteoarthritis. Systematic searches were conducted on MEDLINE, AMED, British Nursing Index, CINAHL, EMBASE, PsycInfo, The Cochrane Library 2007, Issue 2, the UK National Research Register and ClinicalTrials.gov, Korean medical databases, the Qigong and Energy database and Chinese medical databases (until June 2007). Hand searches included conference proceedings and our own files. ⋯ In conclusion, there is some encouraging evidence suggesting that tai chi may be effective for pain control in patients with knee OA. However, the evidence is not convincing for pain reduction or improvement of physical function. Future RCTs should assess larger patient samples for longer treatment periods and use appropriate controls.
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Clinical rheumatology · Sep 2007
ReviewTranslating evidence into practice for people with osteoarthritis of the hip and knee.
There is an international focus on improving the quality of care for people with chronic conditions, including those with chronic rheumatic conditions such as osteoarthritis (OA). A number of evidence-based clinical practice guidelines exist to guide clinician management of OA of the hip and knee. ⋯ This paper reviews the role of clinical practice guidelines within the contemporary discourse and practice of information translation. This discussion paper uses an OA quality improvement case study to illustrate how evidence for effective implementation strategies can be used in conjunction with a practical implementation model to plan and implement quality improvement projects.