Current pain and headache reports
-
Curr Pain Headache Rep · Dec 2008
ReviewThe treatment of psoriatic arthritis and inflammatory spondylitis.
NSAIDs still remain the initial therapeutic modality for psoriatic arthritis and inflammatory spondylitis. Disease-modifying antirheumatic drugs have only been proven to be useful in peripheral arthritis, without efficacy in axial inflammatory spondylitis. In recent years, the introduction of tumor necrosis alpha inhibitors into clinical practice has produced a substantial impact in both peripheral and axial disease, with improvement in pain, function, and quality of life. Factors such as cost-effectiveness and safety will need to be better characterized over time.
-
Hormonal and nonhormonal factors play a role in the pathophysiology of menstrual migraine, but estrogen withdrawal appears to be the most potent of these factors. It is postulated that estrogen withdrawal directly enhances excitability of trigeminal afferents, modulates the synthesis of neuropeptides, activates/deactivates specific neurotransmitter systems, and influences the function of microglia. ⋯ Three new theories are advanced in this article to explain the pathophysiology of menstrual migraine. Only through an understanding of the mechanisms involved in menstrual migraine can we gain insight into the management of this severe and debilitating form of migraine headache.
-
Gout is currently the most common form of inflammatory arthritis in men. The overall incidence of gout has increased rapidly in the past 20 years. Clinicians in all fields are likely to experience a patient with acute gout in their career. ⋯ Fortunately, these diseases can be readily treated and long-term sequelae can be prevented. Recent advances in understanding the role of the innate immune system in acute gout have provided new treatment options. This article addresses the epidemiology, inflammatory pathophysiology, pain management techniques (including recent advances), and treatment of the underlying disease itself.