Rheumatic diseases clinics of North America
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The role of surgical treatment in osteoarthritis of the knee continues to evolve. The indications for arthroscopy have narrowed. Orthopedic surgeons continue to explore options less invasive than total knee replacement for isolated unicompartmental arthritis of the knee joint. In addition to arthroscopy, this article discusses the merits and drawbacks of and indications for osteotomy, interpositional arthroscopy, patellofemoral replacements, and emerging technologies for total knee replacements.
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Recent interest in the neurobiology of the placebo effect has brought about a new awareness of its potential exploitation for patient benefit, framing it as a positive context effect with the power to influence therapy outcome. Among the different placebo effects described in clinical conditions and experimental settings, placebo analgesia is of particular relevance to the rheumatologist. Placebo analgesia is the field that has most contributed to our understanding of the multiple mechanisms underlying this phenomenon. The possible clinical applications of placebo studies range from the design of clinical trials incorporating specific recommendations and minimizing the use of placebo arms to the optimization of the context surrounding the patient so that the placebo component in any treatment is maximized.
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In rheumatic pain there is good evidence that topical nonsteroidal anti-inflammatory drugs are about as effective as oral nonsteroidal anti-inflammatory drugs, but are probably safer and more tolerable because of much less systemic absorption and lower plasma concentrations. The best information is for topical diclofenac. For topical capsaicin, evidence of efficacy is trivial. For topical rubefacients there is no evidence of efficacy.
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Rheum. Dis. Clin. North Am. · May 2008
Psychologic interventions and lifestyle modifications for arthritis pain management.
This article provides an overview of self-management interventions used to manage pain in patients who have arthritis. The article is divided in two major sections. ⋯ The second section addresses lifestyle behavioral weight loss interventions used to reduce arthritis pain. In each section, the authors briefly describe the rationale and nature of the interventions, present data on their efficacy, and highlight potential future research directions.
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Many conditions presenting with clinical hard skin and tissue fibrosis can be confused with systemic sclerosis (scleroderma). These disorders have very diverse etiologies and often an unclear pathogenetic mechanism. Distinct clinical characteristics, skin histology, and disease associations may allow one to distinguish these conditions from scleroderma and from each other. ⋯ This article highlights nephrogenic systemic fibrosis (nephrogenic fibrosing dermopathy), eosinophilic fasciitis (Shulman's syndrome), scleromyxedema, and scleredema. These often are detected in the primary care setting and referred to rheumatologists for further evaluation. Rheumatologists must be able to promptly recognize them to provide valuable prognostic information and appropriate treatment options for affected patients.