Clinical Medicine Insights. Arthritis and Musculoskeletal Disorders最新文献

{"title":"Successful Treatment of Urticarial Vasculitis in a Patient With Systemic Lupus Erythematosus With Rituximab.","authors":"Samar Alharbi,&nbsp;Jorge Sanchez-Guerrero","doi":"10.1177/1179544120967374","DOIUrl":"https://doi.org/10.1177/1179544120967374","url":null,"abstract":"<p><p>Urticarial vasculitis is an eruption of erythematous wheals that clinically resemble urticaria but histologically show changes of leukocytoklastic vasculitis. In association with connective tissue disease it is most commonly seen complicating Systemic lupus erythematous (SLE) and, less often, Sjogren's syndrome. Here, we report a 25-year-old woman who developed SLE in 1998. In May 2013 she presented with urticarial vasculitis; her skin biopsy was consistent with leukocytoclastic vasculitis. She also developed bilateral uveitis. She had most of the clinical and laboratory characteristics of hypocomplementic urticarial vasculitis syndrome (HUVS) which is difficult to be differentiated from SLE. She was treated with high-dose prednisone, Mycophenolate Mofetil (MMF), colchicine, and Dapsone but failed. We decided to give her Rituximab (RTX), her urticarial vasculitis and uveitis symptoms improved significantly. Unfortunately, later on she presented with severe discoid lupus. We started her on thalidomide and responded well. Our case highlights that Rituximab is a good option for severe refractory urticarial vasculitis and thalidomide is effective in treatment of discoid lupus erythematosus (DLE), and can be used safely in specialist rheumatological practice.</p>","PeriodicalId":10443,"journal":{"name":"Clinical Medicine Insights. Arthritis and Musculoskeletal Disorders","volume":"13 ","pages":"1179544120967374"},"PeriodicalIF":2.6,"publicationDate":"2020-10-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1179544120967374","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38612398","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":"The Efficacy and Safety of Highly-Bioavailable Curcumin for Treating Knee Osteoarthritis: A 6-Month Open-Labeled Prospective Study.","authors":"Yasuaki Nakagawa,&nbsp;Shogo Mukai,&nbsp;Shigeru Yamada,&nbsp;Satoru Murata,&nbsp;Hiromitsu Yabumoto,&nbsp;Takahiro Maeda,&nbsp;Shota Akamatsu","doi":"10.1177/1179544120948471","DOIUrl":"https://doi.org/10.1177/1179544120948471","url":null,"abstract":"<p><strong>Background: </strong>We previously developed a surface-controlled water-dispersible form of curcumin that we called Theracurmin^®. The area under the blood concentration-time curve (AUC) of Theracurmin in humans was 27-fold higher than that of curcumin powder. Previously, we reported on the anti-inflammatory effects of Theracurmin for knee osteoarthritis.</p><p><strong>Hypothesis/purpose: </strong>We determined the clinical effects of orally administered Theracurmin in patients with knee osteoarthritis over a 6-month period.</p><p><strong>Study design: </strong>Open prospective study.</p><p><strong>Methods: </strong>Fifty patients Kellgren-Lawrence grade II, III, or IV knee osteoarthritis who were above 40 years old were enrolled in this clinical study. Theracurmin containing 180 mg/day of curcumin was administered orally every day for 6 months. To monitor for adverse events, blood biochemistry analyses were performed before and after 6 months of each intervention. The patients' knee symptoms were evaluated at 0, 1, 2, 3, 4, 5, and 6 months based on the Japanese Knee Osteoarthritis Measure, the knee pain visual analog scale, and the knee scoring system of the Japanese Orthopedic Association.</p><p><strong>Results: </strong>Five cases dropped out during the study, but no cases dropped out because of major problems. No major side effects were observed with Theracurmin treatment, including the blood biochemistry analysis results. The effective group included 34 cases (75.6%), while the not-effective group included 11 cases.</p><p><strong>Conclusion: </strong>This study demonstrates the safety and good efficacy of Theracurmin for various types of knee osteoarthritis. Theracurmin shows great potential for the treatment of human knee osteoarthritis.</p>","PeriodicalId":10443,"journal":{"name":"Clinical Medicine Insights. Arthritis and Musculoskeletal Disorders","volume":"13 ","pages":"1179544120948471"},"PeriodicalIF":2.6,"publicationDate":"2020-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1179544120948471","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38311895","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":"Diagnostic Accuracy of Magnetic Resonance Images and Weight-Bearing Radiographs in Patients With Arthroscopic-Proven Medial Osteoarthritis of the Knee.","authors":"Nuria Muñoz-García,&nbsp;José Cordero-Ampuero,&nbsp;Rosario Madero-Jarabo","doi":"10.1177/1179544120938369","DOIUrl":"https://doi.org/10.1177/1179544120938369","url":null,"abstract":"<p><strong>Aims: </strong>The aim of this study is to analyze the diagnostic value of weight-bearing radiographs, magnetic resonance images (MRI), and the combination of both in osteoarthritic knees when using arthroscopic findings as the \"gold standard\" to compare with.</p><p><strong>Methods: </strong>A total of 59 patients were studied because of chronic pain in 1 of their knees. Radiographs were classified according to Kellgren-Lawrence scale. Magnetic resonance images were classified according to Vallotton, and arthroscopic findings according to Outerbridge criteria.</p><p><strong>Results: </strong>Sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were, respectively, 75.0%, 60.0%, 56.2%, 77.8%, and 66.1% for weight-bearing radiographs, and 70.8%, 88.6%, 81.0%, 81.6%, and 81.4% for MRI. Logistic regression analysis showed that a weight-bearing radiograph added to MRI offered no additional diagnostic value compared with MRI alone (<i>P</i> < .001).</p><p><strong>Conclusions: </strong>Magnetic resonance images presented higher specificity, positive and negative predictive values, and accuracy than weight-bearing radiographs for knee osteoarthritis. The combination of radiographs and MRI did not improve the diagnostic accuracy, compared with MRI alone.</p>","PeriodicalId":10443,"journal":{"name":"Clinical Medicine Insights. Arthritis and Musculoskeletal Disorders","volume":"13 ","pages":"1179544120938369"},"PeriodicalIF":2.6,"publicationDate":"2020-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1179544120938369","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38403313","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":"Expert Opinion on the Extensive Use of Prescription Crystalline Glucosamine Sulfate in the Multimodal Treatment of Osteoarthritis in Ukraine, Kazakhstan, Uzbekistan, and Armenia.","authors":"Andriy M Gnylorybov,&nbsp;Semen K Ter-Vartanian,&nbsp;Irina Y Golovach,&nbsp;Oleg E Vyrva,&nbsp;Oleksandr A Burianov,&nbsp;Gulnara S Yesirkepova,&nbsp;Murodjon E Irismetov,&nbsp;Mashkhura Z Rizamuhamedova,&nbsp;Valentina S Vardanyan,&nbsp;Knarik V Ginosyan","doi":"10.1177/1179544120946743","DOIUrl":"https://doi.org/10.1177/1179544120946743","url":null,"abstract":"<p><strong>Objective: </strong>The present work was led by a multidisciplinary panel of experts and proposes an extensive review on the use of prescription crystalline glucosamine sulfate (pCGS) in the multimodal treatment of osteoarthritis (OA) applicable in Ukraine and other Commonwealth of Independent States (CIS) countries.</p><p><strong>Methods: </strong>A panel of rheumatologists, orthopedic surgeons, and field experts from Ukraine and CIS regions discussed the management of OA. Literature was systematically searched using Medline, EMBASE, CIHNAL, and Cochrane Library databases. The 2-day meeting critically reviewed the available literature, treatment algorithms, pharmacoeconomic aspects, and real-world instances to form a multimodal approach based both on real-life clinical practice and systematic literature research for the management of OA in Ukraine and CIS countries.</p><p><strong>Expert opinion: </strong>pCGS plays a pivotal role in the stepwise approach to OA treatment. If it is necessary (step 1), the combined use of pCGS with paracetamol and topical nonsteroidal anti-inflammatory drugs (NSAIDs) has been recommended. If symptoms persist, oral NSAIDs and intra-articular (IA) hyaluronic acid or corticosteroids are added to the therapy (step 2) of pCGS in the patients. In case of insufficient relief and severe OA (step 3), pCGS along with oral NSAIDs, IA corticosteroids, and duloxetine have been recommended. Patient stratification with regular monitoring and careful alterations in treatment were advocated.</p><p><strong>Conclusions: </strong>This expert opinion article recommends a modified approach to the existing guidelines incorporating pCGS in treatment modality of OA in Ukraine and CIS countries. Extensive use of pCGS targets early symptomatic relief in OA while limiting the adverse effects due to long-term use of analgesics and NSAIDs.</p>","PeriodicalId":10443,"journal":{"name":"Clinical Medicine Insights. Arthritis and Musculoskeletal Disorders","volume":"13 ","pages":"1179544120946743"},"PeriodicalIF":2.6,"publicationDate":"2020-08-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1179544120946743","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38283492","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":"The Differences in Imaging Findings Between Painless and Painful Osteoarthritis of the Hip.","authors":"Hiroaki Kijima,&nbsp;Shin Yamada,&nbsp;Natsuo Konishi,&nbsp;Hitoshi Kubota,&nbsp;Hiroshi Tazawa,&nbsp;Takayuki Tani,&nbsp;Norio Suzuki,&nbsp;Keiji Kamo,&nbsp;Yoshihiko Okudera,&nbsp;Masashi Fujii,&nbsp;Ken Sasaki,&nbsp;Tetsuya Kawano,&nbsp;Yosuke Iwamoto,&nbsp;Itsuki Nagahata,&nbsp;Takanori Miura,&nbsp;Naohisa Miyakoshi,&nbsp;Yoichi Shimada","doi":"10.1177/1179544120946747","DOIUrl":"https://doi.org/10.1177/1179544120946747","url":null,"abstract":"<p><strong>Purpose: </strong>In osteoarthritis of the hip, the pain may be strong even if the deformity is mild, but the pain may be mild even if the deformity is severe. If the factors related to the pain can be identified on imaging, reducing such factors can alleviate the pain, and effective measures can be taken for cases where surgery cannot be performed. In addition, imaging findings related to the pain are also important information for determining the procedures and the timing of surgery. Thus, the purpose of this study was to identify the differences in features of osteoarthritis seen on imaging between painless and painful osteoarthritis of the hip.</p><p><strong>Methods: </strong>The subjects were the patients with hip osteoarthritis who visited our department in 2015 and who underwent x-ray, computed tomography (CT), and magnetic resonance imaging (MRI), a total of 29 patients (54 hip joints; mean age 63 years; 8 males and 21 females). The degree of osteoarthritis was determined using the Tönnis grade from the x-ray image. The cartilage morphology, intensity changes of bone marrow on MRI (subchondral bone marrow lesions [BMLs]), osteophytes, joint effusions, and paralabral cysts were scored based on the Hip Osteoarthritis MRI Scoring System (HOAMS). The cross-sectional area of the psoas major muscle at the level of the iliac crest was measured on CT, and the psoas index (PI; the cross-sectional area ratio of the psoas major muscle to the lumbar 4/5 intervertebral disc) was calculated to correct for the difference in physique. Then, the relationships between these and visual analog scale (VAS) scores of pains were evaluated.</p><p><strong>Results: </strong>The average VAS was 55.4 ± 39 mm. The PI and all items of HOAMS correlated with the VAS. The average VAS of Tönnis grade 3 osteoarthritis was 75.8 ± 26 mm. When investigating only Tönnis grade 3 osteoarthritis, the differences between cases with less than average pain and those with above average pain were the BML score in the central-inferior femoral head (<i>P</i> = .0213), the osteophyte score of the inferomedial femoral head (<i>P</i> = .0325), and the PI (<i>P</i> = .0292).</p><p><strong>Conclusion: </strong>Investigation of the differences between painless and painful osteoarthritis of the hip showed that the cases with more pain have BMLs of the femoral head on MRI that extend not only to the loading area, but also to the central-inferior area. Even with the same x-ray findings, the pain was stronger in patients with severe psoas atrophy. Thus, the instability due to muscle atrophy may also play a role in the pain of hip osteoarthritis.</p>","PeriodicalId":10443,"journal":{"name":"Clinical Medicine Insights. Arthritis and Musculoskeletal Disorders","volume":"13 ","pages":"1179544120946747"},"PeriodicalIF":2.6,"publicationDate":"2020-08-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1179544120946747","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38283493","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":"Patient-Reported Outcomes After Platelet-Rich Plasma, Bone Marrow Aspirate, and Adipose-Derived Mesenchymal Stem Cell Injections for Symptomatic Knee Osteoarthritis.","authors":"Esteban Estrada,&nbsp;Jose L Décima,&nbsp;Marcelo Rodríguez,&nbsp;Marianela Di Tomaso,&nbsp;Javier Roberti","doi":"10.1177/1179544120931086","DOIUrl":"https://doi.org/10.1177/1179544120931086","url":null,"abstract":"<p><strong>Objective: </strong>The objective of this study was to compare platelet-rich plasma (PRP), bone marrow aspirate concentrate (BMAC), and adipose-derived mesenchymal stem cell (MSC) injections in the treatment of osteoarthritis (OA) of the knee using functional scores.</p><p><strong>Methods: </strong>A total of 89 patients with painful knee OA were included in this study. Patients were assigned to one of the 3 treatments according to severity of OA as indicated by symptoms and radiography to PRP (stage I), BMAC (stage II), or adipose-derived MSC (stage III). Clinical assessment was performed using the Knee Society Score, which combines the Knee Score, based on the clinical parameters, and the Functional Score, and IKDC score. Surveys were completed at preoperative and at 90, 180, and 265 days postoperative. The follow-up responses were compared with baseline and between treatment groups.</p><p><strong>Results: </strong>Treatment with PRP, BMAC, and adipose-derived MSC included 29 (32.6%), 27 (30.3%), and 33 (37.1%) patients, respectively. For the total group, median age was 61 years (range: 22-84 years). Score values were comparable among treatment groups at baseline. Statistically significant improvement was observed in the 3 groups according to the 3 scores at all time points during follow-up compared with baseline. No difference was found among treatment type.</p><p><strong>Conclusions: </strong>Our findings support previous reports and encourage further research on the use of these cost-effective treatments for OA of the knee.</p>","PeriodicalId":10443,"journal":{"name":"Clinical Medicine Insights. Arthritis and Musculoskeletal Disorders","volume":"13 ","pages":"1179544120931086"},"PeriodicalIF":2.6,"publicationDate":"2020-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1179544120931086","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38156432","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":"Atlantoaxial Rotatory Subluxation in a 10-Year-Old Boy.","authors":"Eric Chun Pu Chu,&nbsp;Divya Midhun Chakkaravarthy,&nbsp;Fa Sain Lo,&nbsp;Amiya Bhaumik","doi":"10.1177/1179544120939069","DOIUrl":"https://doi.org/10.1177/1179544120939069","url":null,"abstract":"<p><p>Atlantoaxial rotatory subluxation (AARS) is the loss of normal alignment and stability of the first (atlas) and second (axis) cervical vertebrae with respect to each other. We describe the clinical challenges of managing a 10-year-old boy who presented with repetitive episodes of torticollis. Open-mouth odontoid radiograph and computed tomographic (CT) scan gave a diagnosis in ARRS, based on its characteristic imaging findings. The child was admitted multiple times for continuous halter traction in the first 6 months after symptom onset. He also experienced a temporary complication from an overcorrection with correcting neck bracing. Seven months after symptom onset, this case was discussed by a multidisciplinary spine team and referred to chiropractic clinic. Despite persistent radiographic evidence of atlantoaxial instability, after 5 months of chiropractic treatment, the child was asymptomatic with nearly full range of neck movement. He also weaned off acetaminophen he had been taking over the past year. Incidentally, bilateral gynecomastia was discovered at the surveillance after treatment. The incidental finding of innocent gynecomastia, even if common in preteen boys, brings up the topic of acetaminophen's effects on the regulation of sex hormones that was previously overlooked.</p>","PeriodicalId":10443,"journal":{"name":"Clinical Medicine Insights. Arthritis and Musculoskeletal Disorders","volume":"13 ","pages":"1179544120939069"},"PeriodicalIF":2.6,"publicationDate":"2020-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1179544120939069","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38150708","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":"Shoulder Double Crush Syndrome: A Retrospective Study of Patients With Concomitant Suprascapular Neuropathy and Cervical Radiculopathy.","authors":"Yoshihiro Katsuura,&nbsp;Katherine Yao,&nbsp;Eric Chang,&nbsp;Tareck A Kadrie,&nbsp;John A Dorizas","doi":"10.1177/1179544120921854","DOIUrl":"https://doi.org/10.1177/1179544120921854","url":null,"abstract":"<p><strong>Purpose: </strong>While the double crush phenomena (compression along two points on a nerve) has been established between median neuropathy and cervical radiculopathy, combined suprascapular neuropathy (SSN) and cervical C5/C6 radiculopathy-so-called shoulder double crush syndrome-has not been well examined. We aim to identify the incidence of shoulder double crush syndrome in patients undergoing arthroscopic suprascapular nerve release for SSN.</p><p><strong>Methods: </strong>One hundred consecutive patients >18 years of age who were positive for SSN on electromyography and motor nerve conduction studies (EMG/NCS) and underwent a suprascapular nerve release were included. Patients with evidence of shoulder double crush syndrome were identified based on x ray, cervical spine magnetic resonance imaging (MRI) and examination findings. Demographics, electrodiagnostics results, treatment courses, and clinical outcomes (visual analog scores and rotator cuff strength) following arthroscopic suprascapular nerve release were compared between patients with double crush syndrome versus isolated SSN.</p><p><strong>Results: </strong>Thirty one percent of patients had evidence of shoulder crush syndrome. Two significant electrophysiologic differences were noted in shoulder double crush patients compared to isolated SSN patients. Patients with double crush had an increased incidence of median neuropathy (51% vs 30%, <i>P</i> = .04). Double crush patients had less supraspinatus motor amplitude difference between the affected side and non-affected side compared to isolated SSN patients (2.62 mV vs 3.44 mV, <i>P</i> = .03). In general, most double crush patients were treated conservatively with regard to their cervical spine pathology.</p><p><strong>Conclusion: </strong>A significant percentage of patients with SSN have evidence of shoulder double crush syndrome. Patients with SSN and concomitant median neuropathy should have a detailed neck examination performed.</p>","PeriodicalId":10443,"journal":{"name":"Clinical Medicine Insights. Arthritis and Musculoskeletal Disorders","volume":"13 ","pages":"1179544120921854"},"PeriodicalIF":2.6,"publicationDate":"2020-06-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1179544120921854","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38110180","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":"Midfoot Arthritis in Children: Is There Any Relation With Malignancy?","authors":"Reza Shiari,&nbsp;Nargess Salar,&nbsp;Vadood Javadi Parvneh,&nbsp;Khosro Rahmani,&nbsp;Mehrnoush Hassas Yeganeh,&nbsp;Sara Shiari","doi":"10.1177/1179544120924643","DOIUrl":"https://doi.org/10.1177/1179544120924643","url":null,"abstract":"<p><strong>Background: </strong>Musculoskeletal symptoms are a presenting manifestation in a number of lymphoproliferative disorders including leukemia, especially in children. Among these primary symptoms, midfoot arthritis seems to be an important alarm for malignancy in children. The aim of this study is evaluation association of midfoot arthritis with malignancy in children.</p><p><strong>Method: </strong>In this cross-sectional study, all medical records of patients with arthritis were identified and reviewed. All clinical and laboratory data were recorded in the information form and data were analyzed by SPSS 25 software.</p><p><strong>Results: </strong>A total of 557 cases of arthritis were evaluated, of which 18 (3.2%) cases have primary symptoms of midfoot arthritis. Four of 18 patients (22.2%) had B-cell precursor acute lymphoblastic leukemia, that midfoot arthritis was their first manifestation. Also, their laboratory findings confirmed that platelet, lactic acid dehydrogenesis, and uric acid values were significantly higher in these children. Based on statistical evaluation, there was no significant difference between age and sex in these patients.</p><p><strong>Conclusion: </strong>According to the findings of the present study, it can be concluded that \"midfoot arthritis\" may be the first manifestation of leukemia in children even with a near-normal hematologic values.</p>","PeriodicalId":10443,"journal":{"name":"Clinical Medicine Insights. Arthritis and Musculoskeletal Disorders","volume":"13 ","pages":"1179544120924643"},"PeriodicalIF":2.6,"publicationDate":"2020-06-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1179544120924643","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38060131","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":"Cannabinoids in Chronic Non-Cancer Pain: A Systematic Review and Meta-Analysis.","authors":"Herman Johal,&nbsp;Tahira Devji,&nbsp;Yaping Chang,&nbsp;Jonathan Simone,&nbsp;Christopher Vannabouathong,&nbsp;Mohit Bhandari","doi":"10.1177/1179544120906461","DOIUrl":"https://doi.org/10.1177/1179544120906461","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;For patients with chronic, non-cancer pain, traditional pain-relieving medications include opioids, which have shown benefits but are associated with increased risks of addiction and adverse effects. Medical cannabis has emerged as a treatment alternative for managing these patients and there has been a rise in the number of randomized clinical trials in recent years; therefore, a systematic review of the evidence was warranted.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;To analyze the evidence surrounding the benefits and harms of medical cannabinoids in the treatment of chronic, non-cancer-related pain.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Design: &lt;/strong&gt;Systematic review with meta-analysis.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Data sources: &lt;/strong&gt;Medline, Embase, CINAHL, SCOPUS, Google Scholar, and Cochrane Databases.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Eligibility criteria: &lt;/strong&gt;English language randomized clinical trials of cannabinoids for the treatment of chronic, non-cancer-related pain.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Data extraction and synthesis: &lt;/strong&gt;Study quality was assessed using the Cochrane risk of bias tool. All stages were conducted independently by a team of 6 reviewers. Data were pooled through meta-analysis with different durations of treatment (2 weeks, 2 months, 6 months) and stratified by route of administration (smoked, oromucosal, oral), conditions, and type of cannabinoids.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Main outcomes and measures: &lt;/strong&gt;Patient-reported pain and adverse events (AEs).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Thirty-six trials (4006 participants) were included, examining smoked cannabis (4 trials), oromucosal cannabis sprays (14 trials), and oral cannabinoids (18 trials). Compared with placebo, cannabinoids showed a significant reduction in pain which was greatest with treatment duration of 2 to 8 weeks (weighted mean difference on a 0-10 pain visual analogue scale -0.68, 95% confidence interval [CI], -0.96 to -0.40, &lt;i&gt;I&lt;/i&gt; &lt;sup&gt;2&lt;/sup&gt; = 8%, &lt;i&gt;P&lt;/i&gt; &lt; .00001; n = 16 trials). When stratified by route of administration, pain condition, and type of cannabinoids, oral cannabinoids had a larger reduction in pain compared with placebo relative to oromucosal and smoked formulations but the difference was not significant (&lt;i&gt;P&lt;/i&gt;[interaction] &gt; .05 in all the 3 durations of treatment); cannabinoids had a smaller reduction in pain due to multiple sclerosis compared with placebo relative to other neuropathic pain (&lt;i&gt;P&lt;/i&gt;[interaction] = .05) within 2 weeks and the difference was not significant relative to pain due to rheumatic arthritis; nabilone had a greater reduction in pain compared with placebo relative to other types of cannabinoids longer than 2 weeks of treatment but the difference was not significant (&lt;i&gt;P&lt;/i&gt;[interaction] &gt; .05). Serious AEs were rare, and similar across the cannabinoid (74 out of 2176, 3.4%) and placebo groups (53 out of 1640, 3.2%). There was an increased risk of non-serious AEs with cannabinoids compared with placebo.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/s","PeriodicalId":10443,"journal":{"name":"Clinical Medicine Insights. Arthritis and Musculoskeletal Disorders","volume":"13 ","pages":"1179544120906461"},"PeriodicalIF":2.6,"publicationDate":"2020-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1179544120906461","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37702214","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}