The precautionary recommendations for the H1N1 (swine) flu in persons with lupus currently are not different from those for the general public, according to the Lupus Foundation of America (LFA). However, because persons with lupus often are at increased risk for infections, especially if they are taking immunosuppressive agents, they should be particularly vigilant about taking the generally recommended precautions.
Although many medications are used for the management of systemic lupus erythematosus (SLE) and its complications, only aspirin, corticosteroids, and the antimalarial drug hydroxychloroquine (HCQ) are specifically approved by the FDA.1 Most other medications used for SLE treatment are commercially available off label (Table 1), usually borrowed from cancer or transplant regimens. In some cases, medications have been approved for a specific clinical manifestation seen in both idiopathic disease and SLE, such as bosentan for pulmonary hypertension.
The name and identifying features derive from what happens to the skin: it becomes thickened and swollen from deposition of excessive amounts of collagen.
The impact of biomechanical factors on rheumatoid arthritis (RA) has gained increased attention from researchers, as evidenced by studies reported in Clinical Biomechanics. For example, reevaluating knee kinematics over time is important in patients with RA who wear a mobile-bearing total knee prosthesis, according to investigators at the Biomechanics and Imaging Group, Department of Orthopaedics, Leiden University Medical Center, Leiden, the Netherlands.
ABSTRACT: Pay for performance (P4P) is causing physicians to examine how they provide care individually and collectively within local health systems. It is the most recent attempt by Medicare and commercial payers to reduce the cost and improve the outcomes of health care. Understanding P4P and deciding how to manage the multiple programs being implemented by payers will challenge physicians' ethics and practice resources. Improving health care for musculoskeletal diseases will require cooperation among the specialties that share responsibility for this care and improved methods for coordinating and documenting it. (J Musculoskel Med. 2009;26:207-212)
Shoulder pain has many causes: tendinopathy, impingement, rotator cuff tear, adhesive capsulitis ("frozen shoulder"), and arthritis. This review describes tests that can help narrow the differential diagnosis.
A new clinical practice guideline for low back pain (LBP) favors the use of noninvasive treatments over interventional procedures and suggests shared decision making between physicians and patients for better outcomes. Issued by the American Pain Society (APS), the guideline provides clinicians with several recommendations to help determine the best approaches to treating patients with LBP.
Pundits, analysts, and other industry observers have been weighing in with their thoughts on what the President's proposals will call for, what effect they may have on the nation's healthcare system, their chances of being enacted, and how we're going to pay for it all.
As a consequence of playing the role of the weekend warrior, recreational athletes often present with knee or leg pain. Generally, these patients can be categorized in 1 of 3 age-related groups (although, paradoxically, the injuries are not necessarily age-dependent):
Clinicians caring for patients with musculoskeletal disorders may see patients who have underlying conditions that typically are evaluated and managed by allergy and immunology specialists. Although diagnosis of these conditions may be challenging, new insights into their pathogenesis have led to advances in diagnosis and therapy.
Researchers and clinicians often point to biomechanical elements, particularly aberrant biomechanical forces and pathological responses to them, as key factors in osteoarthritis (OA) disease progression.
Ultrasound may be a helpful tool for diagnosing and treating rheumatoid arthritis, a new study has found.
Personal health records, designed to help patients keep all of their medical records in one place and make it easier for doctors to access patient files, may actually lead to inaccurate information and, as a result, improper treatment, some doctors fear.
This young woman sustained a hip fracture while running the Chicago Marathon. The case review suggests that training error was a critical factor. Be alert: Runners may experience stress fractures and ignore the pain.
Once a diagnosis of systemic lupus erythematosus (SLE) has been made, numerous neurological and psychiatric manifestations may be found to accompany the disease.
Heel pain (calcaneodynia) is most commonly due to plantar fasciitis, but has many other causes including nerve entrapment, stress fracture, and sciatica. This review describes an overall approach to diagnosis, discusses conservative treatments and highlights the most prevalent surgical procedures.
The features of systemic lupus erythematosus (SLE) are common in the lifetime course of rheumatoid arthritis (RA) and are significantly associated with an increased mortality risk, even after adjusting for well-described RA-specific predictors of mortality. For some SLE features, the increased risk may be as high as 6-fold.
Cervical spine injuries are common in athletes, particularly those engaged in contact sports.
Soft tissue musculoskeletal conditions are common causes of pelvic and lower extremity pain.
Hemochromatosis is a disorder of iron metabolism that may lead to abnormalities in multiple organ systems.
The main predictor of adherence to a multimodal treatment program for patients with fibromyalgia syndrome (FMS) is barriers, such as lack of time, too much effort, stressful events, and fatigue. Because barriers are important for adherence and adherence is related to outcomes, using a questionnaire about barriers is recommended as a basis for discussing them with patients.
ABSTRACT: High ankle sprains are not as common as low anklesprains, but they are a significant injury, and the diagnosis may bechallenging. The primary role of the syndesmosis is to maintain therelationship of the talus to the tibia under physiological loads.Toaccomplish this, the distal tibiofibular joint must maintain its stability.The syndesmosis is injured most often with external rotation at theankle joint while the foot is dorsiflexed and pronated. On physicalexamination, tenderness is located in the area of the anterior syndesmosis.There are several special tests for syndesmosis injuries.Radiographic assessment is helpful. The usefulness of classificationsystems is not well defined. The optimal rehabilitation programis unknown. Rehabilitation generally is divided into phases.(J Musculoskel Med. 2008;25:564-569)
The signs and symptoms can be controlled with early diagnosis and treatment.
Molecular imaging reveals fibromyalgia symptoms related to functional brain abnormalities.
Muscle strains are most common in the hamstring, gastrocnemius, soleus, and quadriceps strains, as well as the lumbar and thigh adductor. This image-rich review covers imaging, treatment, and prevention.
Knee pain is a common complaint in older patients, andosteoarthritis is the leading cause.We prospectively evaluated the diagnosticpatterns of nonorthopedic physicians in 100 consecutive patientsolder than 60 years who had knee pain. Our study shows thatthere is a lack of consensus about the use radiographic studies for diagnosisof knee pain in older patients.Weight-bearing radiographs areideal for evaluating knee pain. MRI frequently is overly sensitive in detectingpathology and often underestimates joint-space narrowingand arthrosis. MRI also represents a much larger cost and burden onthe health care system. MRI is indicated when the cause of knee painis not readily apparent after careful physical and radiographic evaluation.(J Musculoskel Med. 2008;25:500-504)
Vitamin C intake in men is inversely associated with serum uric acid (UA) concentrations. Therefore, vitamin C has a potential role in the prevention of hyperuricemia and gout.
ABSTRACT: Osteoarthritis (OA) is the leading cause of chronicdisability in older adults. A multitude of factors can contribute to thedisease process. Only a portion of patients who have radiographicevidence of OA have associated pain. Several conditions can mimicOA. Laboratory tests often contribute little to the diagnosis.Treatmentshould be tailored to individual patients. Exercises and joint protectiontechniques are the mainstays of treatment. Patient educationmay be beneficial. Acetaminophen and NSAIDs are effective in manypatients. Cyclooxygenase-2 inhibitors are associated with improvedGI tolerability. Glucosamine and chondroitin sulfate may produceimprovements in pain and function and may be associated with adecrease in the radiographic progression of OA. Corticosteroids canprovide symptomatic relief. Surgery is an option for advanceddisease. (J Musculoskel Med. 2008;25:476-480)
Differentiation between low and high ankle sprains iscritical to delivering appropriate care.The classic mechanism for a lowankle sprain is inversion and plantar flexion. A history of ankle ligamentinjury predisposes to recurring sprains. The ankle anterior drawertest may be used to evaluate ligamentous instability. Plain radiographsof the foot and ankle may be indicated in a patient who has an acuteankle injury. Clinicians often use the Ottawa ankle rules to determinethe need for radiographs. In the acute phase, the goals of treatment areto alleviate pain, reduce swelling, and protect the ankle from furtherinjury. NSAIDs and rehabilitation are important components of management.Primary prevention may be possible with strengthening andbalance programs. (J Musculoskel Med. 2008;25:438-443)
The "logical plan" for patient care includes sparing use of medications, providingpain relief, and quick resumption of work.
