Clinical Medicine Insights. Arthritis and Musculoskeletal Disorders最新文献

{"title":"Delay to TKA and Costs Associated with Knee Osteoarthritis Care Using Intra-Articular Hyaluronic Acid: Analysis of an Administrative Database.","authors":"Andrew Concoff, Faizan Niazi, Forough Farrokhyar, Akram Alyass, Jeffrey Rosen, Mathew Nicholls","doi":"10.1177/1179544121994092","DOIUrl":"https://doi.org/10.1177/1179544121994092","url":null,"abstract":"<p><strong>Background: </strong>Total knee arthroplasty (TKA) is a surgical treatment for patients with knee osteoarthritis (KOA) that no longer experience symptom relief from non-operative or pharmacologic treatments. Non-operative KOA management aims to address patient symptoms and improve function, as well as forestall or mitigate the large costs associated with TKA. The primary objective of this study was to examine the relationship between intra-articular hyaluronic acid (IA-HA) treatment and delaying TKA in patients with KOA compared to patients not receiving IA-HA, as well as to identify differences in KOA-related costs incurred among patients who received or did not receive IA-HA.</p><p><strong>Methods: </strong>This was a retrospective analysis of an administrative claims database from October 1st, 2010 through September 30th, 2015. Kaplan-Meier survival analysis was conducted to determine the TKA-free survival of patients who received IA-HA, stratified by the number of injection courses received versus those who did not receive any IA-HA. Median KOA-related costs per year were calculated for 2 comparisons: (1) patients who received IA-HA versus patients who did not receive IA-HA, among patients who eventually had TKA, and (2) patients who received IA-HA versus patients who did not receive IA-HA, among patients who did not have TKA.</p><p><strong>Results: </strong>A total of 744 734 patients were included in the analysis. A delay to TKA was observed after IA-HA treatment for patients treated with IA-HA compared to those who did not receive IA-HA. At 1 year, the TKA-free survival was 85.8% (95% CI: 85.6%-86.0%) for patients who received IA-HA and 74.1% (95% CI: 74.0%-74.3%) for those who did not receive IA-HA. At 2 years, the TKA free survival was 70.8% (70.5%-71.1%) and 63.7% (63.5%-63.9%) in the 2 groups, respectively. Patients treated with multiple courses of IA-HA demonstrated an incremental increase in delay to TKA with more courses of IA-HA, suggesting that the risk of TKA over the study time period is reduced with additional IA-HA courses. The hazard ratio for the need of TKA was 0.85 (95% CI 0.84-0.86) for a single course and 0.27 (95% CI 0.25-0.28) for ⩾5 courses, both compared to the no IA-HA group. In patients that eventually had TKA, the median KOA-related costs were lower among those who received IA-HA before their TKA ($860.24, 95% CI: 446.65-1722.20), compared to those who did not receive IA-HA ($2659.49, 95% CI: 891.04-7480.38). For patients who did not have TKA, the median and interquartile range (IQR) KOA-related costs per year were similar for patients who received IA-HA compared with those who did not.</p><p><strong>Conclusion: </strong>These results demonstrate that within a large cohort of KOA patients, individuals who received multiple courses of IA-HA had a progressively greater delay to TKA compared to patients who did not receive IA-HA treatment. Also, for patients who progressed to TKA, IA-HA treatment was assoc","PeriodicalId":10443,"journal":{"name":"Clinical Medicine Insights. Arthritis and Musculoskeletal Disorders","volume":"14 ","pages":"1179544121994092"},"PeriodicalIF":2.6,"publicationDate":"2021-03-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1179544121994092","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"25557529","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Can Medical Cannabis Therapies be Cost-Effective in the Non-Surgical Management of Chronic Knee Pain?","authors":"Christopher Vannabouathong,&nbsp;Meng Zhu,&nbsp;Yaping Chang,&nbsp;Mohit Bhandari","doi":"10.1177/11795441211002492","DOIUrl":"https://doi.org/10.1177/11795441211002492","url":null,"abstract":"<p><strong>Introduction: </strong>Chronic knee pain is a common musculoskeletal condition, which usually leads to decreased quality of life and a substantial financial burden. Various non-surgical treatments have been developed to relieve pain, restore function and delay surgical intervention. Research on the benefits of medical cannabis (MC) is emerging supporting its use for chronic pain conditions. The purpose of this study was to evaluate the cost-effectiveness of MC compared to current non-surgical therapies for chronic knee pain conditions.</p><p><strong>Methods: </strong>We conducted a cost-utility analysis from a Canadian, single payer perspective and compared various MC therapies (oils, soft gels and dried flowers at different daily doses) to bracing, glucosamine, pharmaceutical-grade chondroitin oral non-steroidal anti-inflammatory drugs (NSAIDs), and opioids. We estimated the quality-adjusted life years (QALYs) gained with each treatment over 1 year and calculated incremental cost-utility ratios (ICURs) using both the mean and median estimates for costs and utilities gained across the range of reported values. The final ICURs were compared to willingness-to-pay (WTP) thresholds of $66 714, $133 428 and $200 141 Canadian dollars (CAD) per QALY gained.</p><p><strong>Results: </strong>Regardless of the estimates used (mean or median), both MC oils and soft gels at both the minimal and maximal recommended daily doses were cost-effective compared to all current knee pain therapies at the lowest WTP threshold. Dried flowers were only cost-effective up to a certain dosage (0.75 and 1 g/day based on mean and median estimates, respectively), but all dosages were cost-effective when the WTP was increased to $133 428/QALY gained.</p><p><strong>Conclusion: </strong>Our study showed that MC may be a cost-effective strategy in the management of chronic knee pain; however, the evidence on the medical use of cannabis is limited and predominantly low-quality. Additional trials on MC are definitely needed, specifically in patients with chronic knee pain.</p>","PeriodicalId":10443,"journal":{"name":"Clinical Medicine Insights. Arthritis and Musculoskeletal Disorders","volume":"14 ","pages":"11795441211002492"},"PeriodicalIF":2.6,"publicationDate":"2021-03-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/11795441211002492","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"25551143","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Therapeutic Effectiveness of AxioBionics Wearable Therapy Pain Management System in Patients with Chronic Lower Back Pain.","authors":"Philip Muccio,&nbsp;Josh Schueller,&nbsp;Miriam van Emde Boas,&nbsp;Norm Howe,&nbsp;Edward Dabrowski,&nbsp;David Durrant","doi":"10.1177/1179544121993778","DOIUrl":"https://doi.org/10.1177/1179544121993778","url":null,"abstract":"<p><p>Chronic lower back pain is one of the most common medical conditions leading to a significant decrease in quality of life. This study retrospectively analyzed whether the AxioBionics Wearable Therapy Pain Management (WTPM) System, a customized and wearable electrical stimulation device, alleviated chronic lower back pain, and improved muscular function. This study assessed self-reported pain levels using the visual analog scale before and during the use of the AxioBionics WTPM System when performing normal activities such as sitting, standing, and walking (n = 69). Results showed that both at-rest and activity-related pain were significantly reduced during treatment with the AxioBionics WTPM System (% reduction in pain: 64% and 60%, respectively; <i>P</i> < .05). Thus, this study suggests that the AxioBionics WTPM System is efficacious in treating chronic lower back pain even when other therapies have failed to sufficiently decrease reported pain levels.</p>","PeriodicalId":10443,"journal":{"name":"Clinical Medicine Insights. Arthritis and Musculoskeletal Disorders","volume":"14 ","pages":"1179544121993778"},"PeriodicalIF":2.6,"publicationDate":"2021-02-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1179544121993778","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"25500518","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Assessment of Adipokines, CXCL16 Chemokine Levels in Patients With Rheumatoid Arthritis Combined With Metabolic Syndrome.","authors":"Lyudmila Gennadyevna Turgunova,&nbsp;Anna Andreevna Shalygina,&nbsp;Janis Pavlovich Zalkalns,&nbsp;Dmitriy Anatolyevich Klyuyev,&nbsp;Lyudmila Leonidovna Akhmaltdinova,&nbsp;Raushan Sultanovna Dosmagambetova","doi":"10.1177/1179544120985860","DOIUrl":"https://doi.org/10.1177/1179544120985860","url":null,"abstract":"<p><strong>Objective: </strong>Rheumatoid arthritis (RA), which is a chronic systemic inflammatory disease, is associated with accelerated atherosclerosis and an increased risk of cardiovascular disease (CVD), but the causal factors have yet to be completely elucidated. The studies show that the prevalence of metabolic syndrome (MtS) was significantly higher in RA patients compared to the population. In RA and MetS inflammation and atherosclerosis are closely linked. The level of chemokines and adipokines, which may play a role in the development of atherogenesis in RA with MetS patients is currently unknown. In this study, we investigated the level of chemokine C-X-C motif chemokine ligand 16 (CXCL16) and adipokine in RA with MetS patients and assessed the association of biomarkers with clinical and biochemical activity scores of RA and components of MetS.</p><p><strong>Methods: </strong>Blood serum of 298 people (48-patients with RA and MetS, 82-with RA without MetS, 105-with MetS, 63-control group without both RA and MetS) was tested for (CXCL16), Resistin, Leptin and Fibroblast Growth Factor 21 (FGF21) levels by fluorescent antibody technique. Statistical analysis was performed using SPSS version 18.0.</p><p><strong>Results: </strong>The biomarker study showed the highest level in the RA with MetS patient group; but as compared with the RA group the differences were insignificant. CXCL16 (Me = 426.2 pg/ml (Q_25-75 250.5-527.6), resistin (Me = 8685.4 pg/ml (Q_25-75 6480.8-13 629.1), and FGF21 (Me = 443.6 pg/ml (Q_25-75 772.9-916.3) proved to be significantly augmented in RA with MetS patients group, and in RA without MetS patients group (Me = 312.7 (Q_25-75 199.4-517.7) pg/ml; Me = 8265.3 (Q_25-75 5779.7-13 340.5) pg/ml; Me = 412.4 (Q_25-75 300.4-497.4) pg/ml, respectively) as compared with MetS patients group (Me = 189.4 (Q_25-75 130.3-280.6) pg/ml; Me = 5364.8 (Q_25-75 2368.9-10 160.9) pg/ml; Me = 133.2 (Q_25-75 76.2-268.6) pg/ml, respectively; <i>P</i> = <.001). Leptin level in all groups was higher than in the control group, but there were no differences between groups. The correlation analysis found a positive relationship between the leptin level and the waist circumference (rs = 0.39; <i>P</i> = .007) in the RA with MetS patients, the association of biomarkers with DAS28 score and ESR did not have any statistical significance. Conclusions: The augmented chemokine, resistin and FGF21 in the RA with MetS patients proves the systemic inflammation which is the basis of RA; the augmented leptin is linked to the abdominal obesity. These data are somewhat of an explanation of the increased risk of the CVD development in RA with MetS people. A differentiated specification can be useful to assess the cardiovascular risk of patients and justify prompt personalized treatment.</p>","PeriodicalId":10443,"journal":{"name":"Clinical Medicine Insights. Arthritis and Musculoskeletal Disorders","volume":"14 ","pages":"1179544120985860"},"PeriodicalIF":2.6,"publicationDate":"2021-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1179544120985860","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"25390327","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prevalence of Musculoskeletal Pain Among Academic Staff of Mekelle University, Ethiopia.","authors":"Habtamu Meaza,&nbsp;Melaku Hailu Temesgen,&nbsp;Getachew Redae,&nbsp;Teklehaimanot Tekle Hailemariam,&nbsp;Abayneh Alamer","doi":"10.1177/1179544120974671","DOIUrl":"https://doi.org/10.1177/1179544120974671","url":null,"abstract":"<p><strong>Background: </strong>Musculoskeletal pain is a leading cause of morbidity, low productivity. Thus; not only affecting the individual's quality of life; it also creates a burden in the health system and affects the productivity of their institution and the country at large. The prevalence of musculoskeletal pain among academic staff in developed countries ranges from 47% to 85%. However, there was a scarce of studies in developing country, particularly in the study area.</p><p><strong>Purpose: </strong>the aim of the research was to assess the burden of musculoskeletal pain and associated factors among Mekelle University academic staff.</p><p><strong>Patients and methods: </strong>An institutional based cross-sectional study was enrolled on 449 participants with a response rate of 92.2%. Multistage sampling technique was deployed to select representatives. Participants under the selected schools, institutes and departments were selected using random sampling method. Data was collected through face to face interview using structured and standardized Nordic questionnaire by trained data collectors at Mekelle University. Binary logistic regression was used to assess the association between dependent and independent variables. In bivariate logistic regression variables which have <i>P</i> value of <.25 were modeled to multivariate logistic regression. Those variables with <i>P</i>-value of <.05 with 95% CI in multivariate model were taken as statistically significant.</p><p><strong>Results: </strong>This study found that burden of musculoskeletal pain among Mekelle University academic staff in the previous 12 month was 65.2%, and in the last 7 days was 29%. Neck pain (41.5%) was most prevalent followed by low back pain (40.3%). Female gender (OR = 3.02, 95% CI: 1.58-5.76), Body mass index ⩾25 (OR = 3.68, 95% CI: 1.15-11.39), working hours per day (OR = 3.1, 95% CI: 1.54-6.38), and physical inactivity (OR = 3.48, 95% CI: 1.69-7.16), were the independent factors positevly associated with musculoskeletal pain.</p><p><strong>Conclusion: </strong>The burden of musculoskeletal pain among Mekelle University academic staff was common. Female gender, being overweight and obese, working >5 hours per day, and being physically inactive increase the odds of experiencing musculoskeletal pains among academicians. Therefore the university authorities and all academicians are recommended that to take preventable measures of musculoskeletal pain.</p>","PeriodicalId":10443,"journal":{"name":"Clinical Medicine Insights. Arthritis and Musculoskeletal Disorders","volume":"13 ","pages":"1179544120974671"},"PeriodicalIF":2.6,"publicationDate":"2020-12-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1179544120974671","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38853540","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"COVID-19, Antiphospholipid Antibodies, and Catastrophic Antiphospholipid Syndrome: A Possible Association?","authors":"Georges El Hasbani, Ali T Taher, Ali Jawad, Imad Uthman","doi":"10.1177/1179544120978667","DOIUrl":"10.1177/1179544120978667","url":null,"abstract":"<p><p>Since the 2019 novel coronavirus (COVID-19) was first detected in December 2019, research on the complications and fatality of this virus has hastened. Initially, case reports drew an association between COVID-19 and abnormal coagulation parameters. Subsequently, cross-sectional studies found a high prevalence of thrombosis among ICU and non-ICU COVID-19 patients. For that reason, certain studies tried to explain the pathogenic mechanisms of thrombosis, one of which was the emergence of anti-phospholipid antibodies (aPL). Although aPL have been found positive in very few patients, their association with thrombotic events stays debatable. Given the thrombotic manifestations of COVID-19 and the potential role of aPL, the catastrophic form of APS (CAPS) might be a major fatal phenomenon. However, to date, there has been no clear association of CAPS to COVID-19. Moreover, since infections, including viral respiratory similar to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), are considered main etiologies for CAPS, it could be possible that SARS-CoV-2 can induce CAPS although no evidence is currently found. High quality studies are needed to develop a clear idea on the pathogenic role of aPL in the progression of thrombosis in COVID-19 patients, and how such patients could be fit into a thromboprophylaxis plan.</p>","PeriodicalId":10443,"journal":{"name":"Clinical Medicine Insights. Arthritis and Musculoskeletal Disorders","volume":"13 ","pages":"1179544120978667"},"PeriodicalIF":1.9,"publicationDate":"2020-12-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/49/66/10.1177_1179544120978667.PMC7720319.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38718711","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Isolated Neck Extensor Myopathy Associated With Cervical Spondylosis: A Case Report and Brief Review.","authors":"Eric Chun-Pu Chu,&nbsp;Arnold Yu-Lok Wong,&nbsp;Andy Fu-Chieh Lin","doi":"10.1177/1179544120977844","DOIUrl":"https://doi.org/10.1177/1179544120977844","url":null,"abstract":"<p><p>Dropped head syndrome (DHS) is manifested as the inability to maintain the head in an upright posture. It has been associated with a wide spectrum of myopathies and neurological conditions. Isolated neck extensor myopathy (INEM) is one of many potential causes of DHS. This is a case report of a 72-year-old man who presented with degenerative cervical spondylosis and DHS for 2 years. He had previously failed to achieve a positive outcome to medication, cervical collar and exercise rehabilitation. However, he was able to regain his voluntary head control after a 4-month chiropractic program. It is believed that INEM is caused by isolated myopathic changes from chronic injury and overloading of the cervical muscles. Cervical spondylosis has been attributed as the cause of DHS secondary to denervation of the cervical extensors. While INEM associated with degenerative spondylosis is not medically treatable, manipulative therapies may be adopted before considering surgical intervention.</p>","PeriodicalId":10443,"journal":{"name":"Clinical Medicine Insights. Arthritis and Musculoskeletal Disorders","volume":"13 ","pages":"1179544120977844"},"PeriodicalIF":2.6,"publicationDate":"2020-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1179544120977844","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38706061","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Efficacy and Safety of Hylan G-F 20 Versus Intra-Articular Corticosteroids in People with Knee Osteoarthritis: A Systematic Review and Network Meta-Analysis.","authors":"Xavier Chevalier,&nbsp;Brendan Sheehan,&nbsp;Craig Whittington,&nbsp;Mir-Masoud Pourrahmat,&nbsp;Lionel Duarte,&nbsp;Wilson Ngai,&nbsp;Gustavo Constantino de Campos","doi":"10.1177/1179544120967370","DOIUrl":"https://doi.org/10.1177/1179544120967370","url":null,"abstract":"<p><strong>Background: </strong>Direct injection of corticosteroids into the joint is a standard treatment for knee osteoarthritis (OA). However, the treatment is somewhat controversial with regard to the benefit of both single and repeated injections; evidence that they are beneficial comes from small studies that show only modest improvements. The aim of this study was to estimate the short- and long-term clinical efficacy and safety of hylan G-F 20 versus intra-articular corticosteroids (IACS) for the treatment of pain in knee OA using Bayesian network meta-analysis.</p><p><strong>Methods: </strong>Based on a pre-specified protocol, MEDLINE, Embase, and CENTRAL were searched from inception to June 2018 to identify randomized controlled trials. The Cochrane Collaboration's tool for assessing risk of bias in randomized trials was used to assess the included studies. Hylan G-F 20 and IACS were compared using Bayesian network meta-analysis. Efficacy was evaluated at 1, 3, and 6 months, and at the final follow-up for safety outcomes. A pain hierarchy was used to select 1 pain outcome per study.</p><p><strong>Results: </strong>Forty-two trials were included for analysis. The network meta-analysis of pain showed that hylan G-F 20 may be equivalent to IACS in the short-term, but by 6 months the benefit relative to IACS was statistically significant, standardized mean difference (95% credible interval): -0.13 (-0.26, -0.01). There were no statistical differences in adverse events.</p><p><strong>Conclusions: </strong>Hylan G-F 20 may perform better in relieving pain at 6 months post-injection compared to IACS. Both agents were relatively well tolerated, with no clear differences in safety.</p>","PeriodicalId":10443,"journal":{"name":"Clinical Medicine Insights. Arthritis and Musculoskeletal Disorders","volume":"13 ","pages":"1179544120967370"},"PeriodicalIF":2.6,"publicationDate":"2020-11-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1179544120967370","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38682295","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Efficacy and Safety of Musculoskeletal Ultrasound Guided Aspiration and Intra-Lesional Corticosteroids Injection of Ruptured Baker's Cyst: A Retrospective Observational Study.","authors":"Mohamed Mortada,&nbsp;Yomna A Amer,&nbsp;Rabab S Zaghlol","doi":"10.1177/1179544120967383","DOIUrl":"https://doi.org/10.1177/1179544120967383","url":null,"abstract":"<p><strong>Objective: </strong>The aim of the work was to demonstrate the effectiveness and safety of ultrasonographic guided aspiration performed with corticosteroid injection intra-lesional for ruptured Baker cysts (BCs).</p><p><strong>Methods: </strong>Single-center retrospective study that included 42 patients with knee joint disorder associated with ruptured BCs were treated by ultrasonographic guided aspiration of fluid from the cyst and different points from the calf then intra-lesional injection of corticosteroids once or twice, 1 week apart. Follow up were done weekly until complete resolution of symptoms. Visual analog scale (VAS) and Rauschning-Lindgren and Lysholm Knee Scoring Scales (RLC) were used for assessment.</p><p><strong>Results: </strong>Clinical parameters (VAS and RLC) improved significantly in all patients at both post injection evaluation visits (1 week and 12 weeks). Ultrasonographic features improved significantly with complete disappearance of free fluid in the calf in 35 (83.3%) cases 1 week after the injection, and in 41 (97.6%) after 12 weeks. As regards BCs only 4 (9.5%) cases showed complete disappearance after 1 week and there was recurrent BCs in 38 (90.5%) cases which required reaspiration. While after 12 weeks, BCs were completely disappeared in 23 (54.8%) cases, most of the relapsed BCs were complex BCs. No side effects were reported in all cases.</p><p><strong>Conclusion: </strong>Ultrasonographic guided aspiration followed by injection of corticosteroids intra-lesional is an efficient and safe method for managing ruptured BCs.</p>","PeriodicalId":10443,"journal":{"name":"Clinical Medicine Insights. Arthritis and Musculoskeletal Disorders","volume":"13 ","pages":"1179544120967383"},"PeriodicalIF":2.6,"publicationDate":"2020-11-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1179544120967383","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38736436","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pediatric Granulomatosis With Polyangiitis Mimicking IgA Vasculitis: A Case Report.","authors":"Vadood Javadi Parvaneh,&nbsp;Arezoo Shirzani,&nbsp;Khosro Rahmani,&nbsp;Reza Shiari","doi":"10.1177/1179544120967371","DOIUrl":"https://doi.org/10.1177/1179544120967371","url":null,"abstract":"<p><strong>Background: </strong>Granulomatosis with polyangiitis (GPA) is a systemic vasculitis of the upper and lower respiratory tract along with glomerulonephritis and is very rare in childhood. Its renal manifestations similarity with IgA vasculitis can be misleading.</p><p><strong>Case presentation: </strong>Herein, we report a 12-years-old girl with the clinical picture of IgA vasculitis and renal involvement at the time of presentation, over time, elevated cytoplasmic Anti-neutrophil Cytoplasmic Antibody (C-ANCA) and tissue biopsy confirmed GPA.</p><p><strong>Conclusion: </strong>In the case of a patient with an unusual presentation of IgA vasculitis, to some degree of suspicion, the GPA should be considered. Also, in approach to non-thrombocytopenic palpable petechia and purpura a wide range of differential diagnosis such as infections, ANCA associated vasculitis, and secondary vasculitis should be considered. Therefore, 2 effective method of GPA diagnosis, the high titer of C-ANCA test and tissue biopsy, should be considered simultaneously.</p>","PeriodicalId":10443,"journal":{"name":"Clinical Medicine Insights. Arthritis and Musculoskeletal Disorders","volume":"13 ","pages":"1179544120967371"},"PeriodicalIF":2.6,"publicationDate":"2020-11-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1179544120967371","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38640599","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}