Best practice & research. Clinical rheumatology
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Best Pract Res Clin Rheumatol · Apr 2002
ReviewHow to manage patients with cardiopulmonary disease?
Systemic lupus erythematosus (SLE) is a connective tissue disease characterized by the formation of autoantibodies and immune complexes. The heart and lungs are among the organ systems commonly affected in SLE. Pericarditis, premature coronary atherosclerosis, pleuritis and pulmonary infections are the most prevalent cardiopulmonary manifestations. ⋯ Current imaging modalities may provide earlier detection of subclinical disease, which may aid in preventing these potentially fatal complications. The response to treatment varies, depending on the presentation of disease. In this chapter we address the frequency, diagnosis and monitoring, and treatment regimens of cardiac and pulmonary involvement in patients with SLE.
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Best Pract Res Clin Rheumatol · Dec 2001
ReviewNeuroendocrine mechanisms in fibromyalgia-chronic fatigue.
Fibromyalgia and chronic fatigue syndrome are poorly understood disorders that share similar demographic and clinical characteristics. Because of the clinical similarities between both disorders it was suggested that they share a common pathophysiological mechanism, namely, central nervous system dysfunction. ⋯ The possible contribution of the central nervous system dysfunction to the development and symptomatology of these conditions is discussed. The chapter concludes by reviewing the effect of current treatments and emerging therapeutic modalities in fibromyalgia and chronic fatigue syndrome.
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Patients with osteoarthritis (OA) often benefit from properly performed surgical procedures. However, the scientific database from studies investigating appropriate timing of surgery, patient morbidity, quality of life before and after the intervention, and cost utility of different procedures is insufficient. In order to allow a fair allocation of resources in future health care systems, randomized controlled trials (RCTs) with defined entry criteria, sufficient number of patients, and valid outcome measures should be performed for different surgical approaches. ⋯ Debridement by arthroscopy and arthotomy probably does not alter the natural history of OA and true clinical outcomes are difficult to determine, but it can provide transient relief of symptoms. Joint replacement has to be considered for refractory pain associated with disability and radiological deterioration. As the pre-operative functional status seems to influence the outcome not only in joint replacement but also in joint-preserving osteotomies, the indication for these procedures might be expanded in the future.
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Injections, especially of corticosteroids but also of hyaluronan, are widely used in the treatment of osteoarthritis. The various joints - knee, hip, hand - affected by OA are accessible to these local treatments. ⋯ The side-effects of corticosteroid injections are reviewed, and the potential interest in post-injection rest is discussed. Finally, the potential structure-modifying effect of hyaluronan is investigated.
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In 2000, both the American College of Rheumatology (ACR) and the European League of Associations of Rheumatology (EULAR) published recommendations for the use of pharmacological therapy in the treatment of patients with lower limb osteoarthritis. These recommendations are based on the level of evidence observed in systematic reviews and/or meta-analyses of published randomized controlled trials as well as expert opinion. Acetaminophen (paracetamol) is considered as first-line oral therapy for symptomatic lower limb osteoarthritis with mild to moderate pain because it is more efficacious than placebo and is generally considered to be safe and well tolerated. ⋯ The methodology for evaluating the possible structure-modifying effect of drugs has dramatically improved during the past decade. Two agents have demonstrated a beneficial structural effect: glucosamine sulphate in osteoarthritis of the knee, and diacerhein in osteoarthritis of the hip. The clinical relevance of such an effect needs to be further evaluated in long-term outcome studies.