The Journal of Musculoskeletal Medicine Vol 27 No 4

Diagnosing fibromyalgia: Moving away from tender points

April 12, 2010

Fibromyalgia syndrome (FMS) is not a novel entity-there has been interest in unexplained pain syndromes since antiquity (Figure 1). The earliest research focused on the symptom of “muscle hardenings,” which may be the equivalent of musculoskeletal symptoms that patients with FMS describe today.

Rational Use of Opioid Analgesics in Chronic Musculoskeletal Pain

April 11, 2010

Throughout history, various forms of morphine have been the most effective medications in relieving pain. Opioid analgesics-the natural, semisynthetic, and synthetic derivatives of morphine-are used routinely in the management of acute musculoskeletal pain. However, myths and misunderstandings about these drugs often prevent primary care physicians from prescribing them for chronic pain, such as that seen in common musculoskeletal conditions (eg, rheumatoid arthritis, osteoarthritis [OA], osteoporosis, and low back pain [LBP]). Although pain is one of the most common symptoms that bring patients to the physician’s office, those with chronic musculoskeletal or other noncancer pain all too often are undertreated.

All about osteoporosis: A comprehensive analysis

April 09, 2010

Osteoporosis is a major public health threat that affects more than half of persons older than 50 years. The most common bone disease in humans, osteoporosis is associated with pain, disability, and increased risk of mortality.

Knee surgery scores points with athletes and older patients with arthritis

April 08, 2010

Older patients with advanced knee osteoarthritis (OA) who have undergone total knee replacement (TKR) surgery experience significantly improved dynamic balance in addition to pain relief and improved function, according to a study presented at the recent American Academy of Orthopaedic Surgeons (AAOS) annual meeting in New Orleans. In another study, researchers found that patients may participate in high-impact sports activities after total knee arthroplasty (TKA) without increasing the risk of early implant failure-and may even achieve better clinical scores.

Exercise and pregnancy: What patients need to know

April 07, 2010

Virtually all health care professionals who responded to a recent survey thought that exercise is good medicine for expecting mothers. However, 60% of the physicians and 86% of the doctors of osteopathy were not familiar with current pregnancy exercise guidelines.

Fracture prediction models are sex- and site-specific

April 06, 2010

Prediction of fractures is specific for the patient’s sex and the site of bone mineral density (BMD) measurement. This finding challenges the practice of using similar models-and of measuring BMD at the hip only-to predict fracture risk for men and for women.

Low back pain recommended/actual care gap is hurting patients

April 06, 2010

Key aspects of the usual care that general practitioners provide for patients with low back pain (LBP) do not align with the care recommended in evidence-based guidelines. The likely result is less than optimal outcomes.

Vitamin D deficiency linked with osteoarthritis in older men

April 06, 2010

There is a high prevalence of 25-hydroxyvitamin D (25[OH]D) deficiency in older men who have radiographic hip osteoarthritis (OA). Because 25(OH)D plays a significant role in bone and cartilage maintenance, therapeutic interventions with vitamin D are warranted to augment their skeletal health.

Caution: MRI has low specificity for RA

April 06, 2010

MRI abnormalities that resemble rheumatoid arthritis (RA) pathologies often are found in the metacarpophalangeal and wrist joints of healthy persons. Although MRI is highly sensitive for tracking the progression of erosions, it has low specificity for RA, suggesting caution in the interpretation of joint lesions on MRI, especially in early arthritis.

Exercise training in the primary care setting reduces patients’ anxiety symptoms

April 06, 2010

Exercise training provides an effective means for reducing anxiety symptoms, with minimal risk of adverse events. Anxiety reduction is a favorable outcome of exercise interventions that were designed as a primary treatment or adjuvant for medical conditions other than anxiety.

Comorbidity patterns vary with rheumatologic disease

April 06, 2010

Separate patterns of comorbidity are identified in patients who have fibromyalgia syndrome (FMS), systemic lupus erythematosus (SLE), rheumatoid arthritis (RA), and noninflammatory rheumatic disorders (NIRD). The patterns include the type of comorbid variables reported and their associations with age and disease duration.