Rheumatic diseases clinics of North America
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Although total knee replacement is an excellent treatment of end-stage osteoarthritis of the knee in the older (>65 years) population, many patients with less severe disease are significantly impacted by their symptoms and have failed to respond to less invasive treatment alternatives. For this group, there are several less invasive surgical alternatives, including arthroscopic meniscectomy, grafting of symptomatic areas of bone marrow lesions, unloading osteotomy, and unicompartmental knee replacement. Current total knee arthroplasty designs can be expected to survive 20 years or more in the older, less active population. New materials may extend that survivorship.
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Rheum. Dis. Clin. North Am. · Aug 2012
ReviewImaging in axial spondyloarthritis: diagnostic problems and pitfalls.
Magnetic Structural changes in axial Spondyloarthritis (axSpA) are best identified by conventional radiographs, while magnetic resonance imaging (MRI) is considered the gold standard for assessment of inflammatory changes. Imaging of the axial skeleton is crucial for the diagnosis but also for classification to non-radiographic axSpA according to the 2009 ASAS classification criteria. Despite the existing definitions for a positive MRI for the sacroiliac joints and the spine, these predefined lesions can also be seen in other conditions, representing pitfalls and false-positive conclusions in patients with similar clinical symptoms who do not have SpA. Diagnosis of SpA should result from the combination of clinical, laboratory and imaging findings.
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Inflammatory back pain (IBP) is a concept, which elements characterize the spinal involvement of patients with ankylosing spondylitis (AS) and axial spondyloarthritis (axSpA). The identification of patients with IBP depends on the clinical setting and the diagnostic value of several IBP criteria. IBP differentiation from non-inflammatory, mechanical chronic back might be sometimes difficult, but the role of IBP diagnosis in the early stage of axSpA and AS leads to a better treatment.
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Rheum. Dis. Clin. North Am. · May 2011
ReviewMetabolic myopathies: clinical features and diagnostic approach.
The rheumatologist is frequently called on to evaluate patients with complaints of myalgia, muscle cramps, and fatigue. The evaluation of these patients presents a diagnostic challenge given the nonspecific and intermittent nature of their complaints, often leading to inappropriate diagnostic testing. When these symptoms are associated with physical exertion, a metabolic myopathy should be suspected Although inflammatory myopathies may present with similar features, such a pattern should prompt a thorough evaluation for an underlying metabolic myopathy. This review discusses the most common causes of metabolic myopathies and reviews the current diagnostic options available to the clinician.
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Tai chi is a complex multicomponent mind-body exercise. Many studies have provided evidence that tai chi benefits patients with a variety of chronic disorders. ⋯ Thus, despite certain limitations in the evidence, tai chi can be recommended to patients with osteoarthritis, rheumatoid arthritis, and fibromyalgia as a complementary and alternative medical approach. This article overviews the current knowledge about tai chi to better inform clinical decision making for rheumatic patients.