Rheumatology
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Work-related upper limb disorders (WRULD) are common and disabling complaints in industry, but a tissue diagnosis can be difficult where the pain is diffuse and variable, and this prevents effective treatment. Diffuse arm pain is frequently found in those doing rapid or strenuous repetitive work, such as factory assembly workers or keyboard operators. Similar symptoms occur in the legs in athletes, where chronic compartment syndrome (CCS) is a recognized entity, so we investigated the possibility that this might also be caused by prolonged repetitive work. ⋯ CCS is responsible for chronic peripheral neurological dysfunction in addition to muscle pain, and awareness of this diagnosis allows early identification and treatment of a currently unrecognized disorder with potential resolution of a long-lasting arm disability.
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Review Meta Analysis
A meta-analysis of the efficacy and toxicity of combining disease-modifying anti-rheumatic drugs in rheumatoid arthritis based on patient withdrawal.
Combinations of disease-modifying anti-rheumatic drugs (DMARDs) are increasingly used to treat rheumatoid arthritis (RA). Early trials showed their toxicity while recent trials suggest superior efficacy. Trials of DMARD combinations have enrolled different types of patient (early or established RA), used different designs (step-up, parallel or step-down) and utilized a range of outcome measures. We undertook a systematic review of combination DMARD therapy for RA and carried out a meta-analysis to evaluate the evidence for efficacy and toxicity. ⋯ DMARD combinations vary in their efficacy/toxicity ratio. MTX plus sulphasalazine and/or anti-malarials and MTX plus TNF inhibitors have particularly favourable benefit/risk ratios.
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Randomized Controlled Trial Multicenter Study
A multicentre randomized controlled trial of epidural corticosteroid injections for sciatica: the WEST study.
To determine the effectiveness and predictors of response to lumbar epidural corticosteroid injections (ESI) in patients with sciatica. We performed a 12-month, multicentre, double-blind, randomized, placebo-controlled, parallel-group trial in four secondary pain-care clinics in the Wessex Region. ⋯ In this pragmatic study, ESIs offered transient benefit in symptoms at 3 weeks in patients with sciatica, but no sustained benefits in terms of pain, function or need for surgery. Sciatica is a chronic condition requiring a multidisciplinary approach. To fully investigate the value of ESIs, they need to be evaluated as part of a multidisciplinary approach.
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Randomized Controlled Trial Multicenter Study Comparative Study
A cost consequences analysis of local corticosteroid injection and physiotherapy for the treatment of new episodes of unilateral shoulder pain in primary care.
Local steroid injections and community-based physiotherapy have been shown to be of similar benefit for treating shoulder pain presenting to primary care. This paper presents a cost consequences analysis of a prospective economic evaluation, conducted alongside a randomized clinical trial (RCT) of corticosteroid injections versus physiotherapy for new episodes of unilateral shoulder pain, to determine the economic implications of injection versus physiotherapy. ⋯ This study has shown, given similar clinical outcomes across the treatment groups, that corticosteroid injections were the cost-effective option for patients presenting with new episodes of unilateral shoulder pain in primary care.