Rheumatology
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New treatments that inhibit the cytokines tumour necrosis factor alpha (TNFalpha) and interleukin 1 (IL-1) in the treatment of rheumatoid arthritis have proven clinical effect against placebo and methotrexate (MTX) in several clinical trials in early and late-stage disease and different severity groups. Since there are no head-to-head randomized controlled trials directly comparing the currently available treatments, etanercept, adalimumab, infliximab or anakinra, we perform a meta-analysis that adjusts for differences between study characteristics, and allows indirect comparisons between treatments. ⋯ When the outcome of interest is the probability of an ACR20 or ACR50 response at 6 months we found: (i) treatment with the IL-1 antagonist anakinra is better than placebo; (ii) for each treatment, the use of combination MTX improves the probability of response; (iii) treatment with any of the TNFalpha antagonists is better than with the IL-1 antagonist anakinra; and (iv) all drugs in the TNFalpha antagonist class are no different from each other.
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Multicenter Study
The impact of musculoskeletal hand problems in older adults: findings from the North Staffordshire Osteoarthritis Project (NorStOP).
Hand problems are common in older people, but their impact on everyday life is not clear. The aim of this study was to investigate the impact of hand problems in community-dwelling older adults and how this varies with age and gender. ⋯ Musculoskeletal hand problems are common in the population aged over 50 yrs. Most are painful, and have a significant impact on everyday life. Women and the very old appear especially vulnerable to the effect of hand problems on their daily activities.
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Illness perceptions may influence health outcomes, including pain. The objective of the study was to investigate the illness perceptions associated with health and behaviour in a population of older adults with musculoskeletal hand problems. ⋯ The results suggest that older people who consider their musculoskeletal hand problem to have negative effects on their life will be more likely to encounter difficulties that may lead them to consult, take medication or both. Understanding the illness perceptions of these individuals may identify opportunities for intervention.
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Recent studies indicate that the anti-malarial agent artemisinin and its derivatives may exert an anti-inflammatory effect. In this study, we explored the effect of artesunate, an artemisinin derivative, on tumour necrosis factor (TNF)-alpha-induced production of interleukins, IL-1beta, IL-6 and IL-8, in human rheumatoid arthritis (RA) fibroblast-like synoviocytes (FLS), and further investigated the signal mechanism by which this compound modulates those cytokines' production. ⋯ Our results indicate that artesunate exerts an anti-inflammatory effect in RA FLS and provide the evidence that artesunate may have therapeutic potential for RA.
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Randomized Controlled Trial Multicenter Study
A prospective double blind placebo-controlled randomized trial of ultrasound in the physiotherapy treatment of shoulder pain.
To compare the effectiveness of manual therapy and ultrasound (US) with manual therapy and placebo ultrasound (placebo US) in the treatment of new episodes of unilateral shoulder pain referred for physiotherapy. ⋯ The addition of US was not superior to placebo US when used as part of a package of physiotherapy in the short-term management of shoulder pain. This has important implications for physiotherapy practice.