Joint, bone, spine : revue du rhumatisme
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Little is known about the risk factors for procedural pain during spinal and joint injections. ⋯ Procedural pain is common, but mild, in patients undergoing musculoskeletal injections. Instantaneous procedural pain and its recall 48 hours later depend principally on the level of underlying pain and anxiety, regardless of the injection site and the analgesic procedure performed.
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Comparative Study Clinical Trial
Comparison of daily, weekly or monthly pain assessments in hip and knee osteoarthritis. A 29-day prospective study.
To compare the accuracy of daily and recalled pain measurements in hip and knee osteoarthritis (OA). ⋯ In hip and knee OA, prospective daily pain assessment can be performed either by assessing 'usual pain' or 'worst pain' of the day. When recalled over one and four weeks, recall pain intensity is well correlated with calculated mean of prospective daily pain assessments during the same period, but correlations are weaker as the length of period increases. Either for 1 and 4 weeks, retrospective assessments are influenced by current pain intensity at the end of the period.
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TNF-α antagonist therapy is associated with a risk of severe, extrapulmonary, disseminated tuberculosis, which is fatal in 10% of cases. The risk of tuberculosis is increased four-fold in patients on TNF-α antagonist therapy. The main risk factors are a history of untreated or inadequately treated primary tuberculosis, recent contact with a tuberculosis patient, and residence in or travel to a high-endemicity region. ⋯ However, the accuracy of IGRAs for diagnosing latent tuberculosis remains unknown, because no reference standard is available. In addition, patients taking immunosuppressant agents to treat systemic disease may exhibit anergia, which complicates the interpretation of IGRAs. Until additional data become available, caution requires that IGRAs be used only when a positive or negative result, as assessed on a case-by-case basis, will help to decide whether tuberculosis chemoprophylaxis is in order.
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Review Case Reports
Paradoxical exacerbation of tuberculosis after TNFα antagonist discontinuation: beware of immune reconstitution inflammatory syndrome.
Paradoxical worsening of tuberculosis associated with immune reconstitution during antiretroviral therapy in patients with HIV infection is known as the immune reconstitution inflammatory syndrome (IRIS). Here, we report a case of paradoxical worsening of IFN-alpha induced tuberculosis in a patient experiencing reconstitution of pathogen-specific immune responses after discontinuing TNFα antagonist therapy. This case serves to alert clinicians that complications such as tuberculosis may worsen after TNFα antagonist discontinuation. This situation may paradoxically require readministration of the immunosuppressive drug in some patients.