J Rheumatol
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In a previous retrospective study, we had found that shoulder radiographs were overused in the initial evaluation of patients presenting to the emergency department with shoulder pain. Our objective was to prospectively define clinical criteria that identify patients who have a low risk of radiographic findings that influence the management of the initial evaluation of shoulder pain in the emergency department. ⋯ Our findings suggest that specific clinical criteria are able to identify patients who do not need radiographs as part of the initial management of shoulder pain. Prospective validation of these criteria are needed to confirm that these low risk patients can be safely evaluated without radiographs.
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Randomized Controlled Trial Clinical Trial
Topical diclofenac versus placebo: a double blind, randomized clinical trial in patients with osteoarthritis of the knee.
To assess the efficacy and safety of a topical formulation of 2% diclofenac in lecithin organogel in the treatment of pain associated with mild to moderate osteoarthritis (OA) of the knee. ⋯ A topical formulation of 2% diclofenac in a lecithin organogel appears to have therapeutic value in patients with mild to moderate OA of the knee as determined by responses from the WOMAC (VA3.0) osteoarthritis health status measure.
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To examine the effect of the bisphosphonate NE- 10035 on bone histomorphometry and bone dynamics in dogs after transection of the anterior cruciate ligament (ACL), and to determine, in a placebo controlled trial, whether treatment modified the severity of pathologic changes of osteoarthritis (OA) in the unstable joint. ⋯ The antiresorptive agent employed in this study effectively reduced turnover of subchondral bone in the OA joint, consistent with the coupling of bone formation to bone resorption at that site. Nonetheless, over the 12 week period of the study it had no effect on osteophyte formation, in which bone formation occurs via enchondral ossification and is not linked to bone resorption, and, despite the clear inhibition of bone turnover in the OA knee of the active treatment group, did not affect the severity of cartilage changes of OA. It should be noted, however, that although treatment with this antiresorptive agent did not affect the level of chondropathy, the cartilage changes in both treatment groups were relatively mild and the sample size relatively small. Additional studies with a larger number of animals and a longer period of observation (to increase the severity of pathology) are warranted to determine whether the inhibition of bone turnover and the decrease in proteoglycan concentration that resulted from therapy will affect articular cartilage degeneration in the OA joint.