Joint, bone, spine : revue du rhumatisme
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Many patients with gouty arthritis experience frequent flares and have comorbidities that may limit their anti-inflammatory treatment options for acute flare management. For patients with contraindications to both NSAIDs and/or colchicine, treatment options are particularly limited, and there is an unmet medical need in this subgroup of patients. ⋯ Canakinumab was consistently superior to the active comparator triamcinolone acetonide and was generally well tolerated in this patient population with a high prevalence of multiple medical comorbidities. Canakinumab should therefore be considered as a treatment option in a target population of patients with frequent gouty arthritis attacks who are unable to use NSAIDs and colchicine and in whom frequent use of corticosteroids is not considered appropriate.
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Although tendinopathies constitute a heterogeneous group of conditions, they are often treated by similar combinations of local and systemic symptomatic interventions. The vast number of causes, pathophysiological mechanisms, and histological changes that characterizes tendinopathies may explain that the standard treatment fails in some patients. Platelet-rich plasma (PRP), which contains a host of soluble mediators including growth factors, has been suggested as a second-line treatment for refractory tendinopathy, with the goal of expediting tendon healing or remodeling. ⋯ Nevertheless, further studies are needed to define these potential indications and the optimal treatment protocols. A key point is that the complexity of the tendon healing process cannot be replicated simply by injecting a subset of growth factors, whose effects may occur in opposite directions over time. Topics not discussed in this review are the regulatory framework for PRP therapy, PRP nomenclature, and precautions for use, which are described in a previous article (Does platelet-rich plasma have a role in the treatment of osteoarthritis, Ornetti P, et al. [1]).
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Neutropenia is defined as a neutrophil count lower than 1.5g/L, with categorization as mild, moderate, or severe when the count is 1.5-1g/L, 1-0.5g/L, or<0.5g/L, respectively. The main complication is infection, whose risk increases with the depth and duration of the neutropenia. Comprehensive etiological investigations are mandatory to determine the best treatment strategy. ⋯ The treatment depends on the depth of the neutropenia and findings from the etiological workup. A neutrophil count below 0.5g/L, a fever, and the presence of clinical signs indicate a life-threatening condition requiring emergent treatment. In other patients, the first step is immediate discontinuation of any possibly involved drugs, simultaneously with the etiological workup.
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Randomized Controlled Trial Comparative Study
Comparative efficacy of intra-articular hyaluronic acid and corticoid injections in osteoarthritis of the first carpometacarpal joint: results of a 6-month single-masked randomized study.
The study aim was to compare the efficacy and safety of ultrasound-guided intra-articular injections of hyaluronic acid and betamethasone in the management of patients with osteoarthritis of the thumb. ⋯ Both hyaluronic acid and betamethasone were effective and well-tolerated for the management of rhizarthrosis. Hyaluronic acid was more effective over time and more efficiently improved functionality and pain in patients with more severe symptoms.