Therapeutic Advances in Musculoskeletal Disease最新文献

{"title":"Early knee OA definition-what do we know at this stage? An imaging perspective.","authors":"Xiaojuan Li, Frank W Roemer, Flavia Cicuttini, Jamie W MacKay, Tom Turmezei, Thomas M Link","doi":"10.1177/1759720X231158204","DOIUrl":"10.1177/1759720X231158204","url":null,"abstract":"<p><p>While criteria for early-stage knee osteoarthritis (OA) in a primary care setting have been proposed, the role of imaging has been limited to radiography using the standard Kellgren-Lawrence classification. Standardized imaging and interpretation are critical with radiographs, yet studies have also shown that even early stages of radiographic OA already demonstrate advanced damage to knee joint tissues such as cartilage, menisci, and bone marrow. Morphological magnetic resonance imaging (MRI) shows degenerative damage earlier than radiographs and definitions for OA using MRI have been published though no accepted definition of early OA based on MRI is currently available. The clinical significance of structural abnormalities has also not been well defined, and the differentiation between normal aging and structural OA development remains a challenge. Compositional MRI of cartilage provides information on biochemical, degenerative changes within the cartilage matrix before cartilage defects occur and when cartilage damage is potentially reversible. Studies have shown that cartilage composition can predict cartilage loss and radiographic OA. However, while this technology is most promising for characterizing early OA it has currently limited clinical application. Better standardization of compositional MRI is required, which is currently work in progress. Finally, there has been renewed interest in computed tomography (CT) for assessing early knee OA as new techniques such as weight bearing and spectral CT are available, which may provide information on joint loading, cartilage, and bone and potentially have a role in better characterizing early OA. In conclusion, while imaging may have a limited role in diagnosing early OA in a primary care setting, there are advanced imaging technologies available, which detect early degeneration and may thus significantly alter management as new therapeutic modalities evolve.</p>","PeriodicalId":23056,"journal":{"name":"Therapeutic Advances in Musculoskeletal Disease","volume":"15 ","pages":"1759720X231158204"},"PeriodicalIF":3.4,"publicationDate":"2023-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/f9/22/10.1177_1759720X231158204.PMC10017942.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9146237","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association between baseline cardiovascular risk and incidence rates of major adverse cardiovascular events and malignancies in patients with psoriatic arthritis and psoriasis receiving tofacitinib.","authors":"Lars E Kristensen, Bruce Strober, Denis Poddubnyy, Ying-Ying Leung, Hyejin Jo, Kenneth Kwok, Ivana Vranic, Dona L Fleishaker, Lara Fallon, Arne Yndestad, Dafna D Gladman","doi":"10.1177/1759720X221149965","DOIUrl":"10.1177/1759720X221149965","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Tofacitinib is a Janus kinase inhibitor for the treatment of psoriatic arthritis (PsA) and has been investigated for psoriasis (PsO).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objectives: &lt;/strong&gt;This &lt;i&gt;post hoc&lt;/i&gt; analysis examined baseline cardiovascular (CV) disease risk and its association with the occurrence of major adverse cardiovascular events (MACE) and malignancies in tofacitinib-treated patients with PsA and PsO.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Design: &lt;/strong&gt;Included three phase III/long-term extension (LTE) PsA trials and seven phase II/phase III/LTE PsO trials of patients receiving ⩾ 1 dose of tofacitinib.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Incidence rates (IRs: patients with events/100 patient-years) for MACE and malignancies (excluding non-melanoma skin cancer) were determined in subgroups according to history of atherosclerotic CV disease (ASCVD), baseline 10-year risk of ASCVD (in patients without history of ASCVD), and baseline metabolic syndrome (MetS).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;For patients with PsA (&lt;i&gt;N&lt;/i&gt; = 783) and PsO (&lt;i&gt;N&lt;/i&gt; = 3663), respectively, tofacitinib exposure was 2038 and 8950 patient-years (median duration: 3.0 and 2.4 years), and 40.9% and 32.7% had MetS. Excluding missing CV risk profile data, 51/773 (6.6%) and 144/3629 (4.0%) patients had history of ASCVD, and in patients without history of ASCVD, around 20.0% had intermediate/high baseline 10-year ASCVD risk. For PsA and PsO, IRs of MACE were greatest in those with history of ASCVD or high baseline 10-year ASCVD risk. For PsA, five of six patients with MACE had baseline MetS. Malignancy IRs in patients with PsA were greatest in those with intermediate/high baseline 10-year ASCVD risk. Of these, eight of nine patients with malignancies had baseline MetS. In the PsO cohort, IR of malignancies was notably greater with high &lt;i&gt;versus&lt;/i&gt; low/borderline/intermediate baseline 10-year ASCVD risk.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;In tofacitinib-treated patients with PsA/PsO, increased ASCVD risk and baseline MetS were associated with higher IRs for MACE and malignancies. Our results support assessing CV risk in patients with PsA/PsO and suggest enhanced cancer monitoring in those with increased ASCVD risk.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Registration clinicaltrialsgov: &lt;/strong&gt;NCT01877668/NCT01882439/NCT01976364/NCT00678210/NCT01710046/NCT01241591/NCT01186744/NCT01276639/NCT01309737/NCT01163253.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Plain language summary: &lt;/strong&gt;&lt;b&gt;People who have psoriatic arthritis or psoriasis may have more heart-related problems and cancer if they have a higher risk of cardiovascular disease: A study in people with psoriatic arthritis or psoriasis receiving tofacitinib&lt;/b&gt; &lt;b&gt;Why was this study done?&lt;/b&gt; • People with psoriatic arthritis (PsA) and psoriasis (PsO) are more likely than the general population to have a disease affecting the heart and blood vessels [cardiovascular (CV) disease].• People who are more likely to have CV disease may also be more likely to have certain type","PeriodicalId":23056,"journal":{"name":"Therapeutic Advances in Musculoskeletal Disease","volume":"15 ","pages":"1759720X221149965"},"PeriodicalIF":3.4,"publicationDate":"2023-02-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/7e/eb/10.1177_1759720X221149965.PMC9909057.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10707594","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A novel infrapatellar approach of ultrasound-guided intra-articular injection of the knee from both lateral and medial side: a case series.","authors":"King Hei Stanley Lam,&nbsp;Yung-Tsan Wu,&nbsp;Kenneth Dean Reeves,&nbsp;Admir Hadzic,&nbsp;Mario Fajardo Perez,&nbsp;Sau Nga Fu","doi":"10.1177/1759720X221149954","DOIUrl":"https://doi.org/10.1177/1759720X221149954","url":null,"abstract":"<p><p>Knee osteoarthritis (OA) is common. Ultrasound-guided intra-articular injection (UGIAI) using the superolateral approach is currently the gold standard for treating knee OA, but it is not 100% accurate, especially in patients with no knee effusion. Herein, we present a case series of chronic knee OA treated with a novel infrapatellar approach to UGIAI. Five patients with chronic grade 2-3 knee OA, who had failed on conservative treatments and had no effusion but presented with osteochondral lesions over the femoral condyle, were treated with UGIAI with different injectates using the novel infrapatellar approach. The first patient was initially treated using the traditional superolateral approach, but the injectate was not delivered intra-articularly and became trapped in the pre-femoral fat pad. The trapped injectate was aspirated in the same session due to interference with knee extension, and the injection was repeated using the novel infrapatellar approach. All patients who received the UGIAI using the infrapatellar approach had the injectates successfully delivered intra-articularly, as confirmed with dynamic ultrasound scanning. Their Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain, stiffness, and function scores significantly improved 1 and 4 weeks post-injection. UGIAI of the knee using a novel infrapatellar approach is readily learned and may improve accuracy of UGIAI, even for patients with no effusion.</p>","PeriodicalId":23056,"journal":{"name":"Therapeutic Advances in Musculoskeletal Disease","volume":"15 ","pages":"1759720X221149954"},"PeriodicalIF":4.2,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/9c/5c/10.1177_1759720X221149954.PMC9923012.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10736038","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"New insights in lower limb reconstruction strategies.","authors":"Giuseppe Toro,&nbsp;Antonio Benedetto Cecere,&nbsp;Adriano Braile,&nbsp;Annalisa De Cicco,&nbsp;Sara Liguori,&nbsp;Umberto Tarantino,&nbsp;Giovanni Iolascon","doi":"10.1177/1759720X231189008","DOIUrl":"https://doi.org/10.1177/1759720X231189008","url":null,"abstract":"<p><p>High Energy Musculoskeletal Traumas (HEMTs) represent a relevant problem for healthcare systems, considering the high social costs, and both the high morbidity and mortality. The poor outcomes associated with HEMT are related to the high incidence of complications, including bone infection, fracture malunion and non-union. The treatment of each of these complications could be extremely difficult. Limb reconstruction often needs multiple procedures, rising some questions on the opportunity in perseverate to try to save the affected limb. In fact, theoretically, amputation may guarantee better function and lower complications. However, amputation is not free of complication, and a high long-term social cost has been reported. A comprehensive literature review was performed to suggest possible ways to optimize the limb preservation surgeries of HEMT's complications in order to ameliorate their management.</p>","PeriodicalId":23056,"journal":{"name":"Therapeutic Advances in Musculoskeletal Disease","volume":"15 ","pages":"1759720X231189008"},"PeriodicalIF":4.2,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/f1/34/10.1177_1759720X231189008.PMC10387789.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9917120","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Myths and truths on biophysics-based approach in rehabilitation of musculoskeletal disorders.","authors":"Alessandro de Sire,&nbsp;Lorenzo Lippi,&nbsp;Nicola Marotta,&nbsp;Martina Ferrillo,&nbsp;Arianna Folli,&nbsp;Alessio Turco,&nbsp;Antonio Ammendolia,&nbsp;Marco Invernizzi","doi":"10.1177/1759720X231183867","DOIUrl":"https://doi.org/10.1177/1759720X231183867","url":null,"abstract":"<p><p>Musculoskeletal disorders (MSD) are a crucial issue in current literature due to their impact on physical function, social, and economic costs. Rehabilitation plays a pivotal role in the therapeutic management of these disabling conditions with growing evidence underlining positive effects in improving functional outcomes. However, to date, several questions are still open about the mechanisms underpinning functional improvements while recent research is now focusing on a deeper understanding of the biophysical processes underpinning the macroscopical effects of these treatments. Thus, this narrative review aims at providing a comprehensive overview about the state of the art of biophysical dimensions of currently available treatments for MSD. PubMed, Scopus, CENTRAL, PEDro, and Web of Science were searched between March 2022 and October 2022 for <i>in vitro</i> and <i>in vivo</i> studies, clinical trials, systematic reviews, and meta-analysis addressing the issue of biophysics-based approach in rehabilitation of MSD. Our findings showed that a biophysical approach might be integrated into regenerative rehabilitation, aiming at enhancing regenerative processes by mechanical and biophysical stimuli. In addition, a biophysical-based approach has been proposed to improve knowledge about several instrumental physical therapies, including shock wave therapies, low-level laser therapy, ultrasound, short-wave diathermy, electrical stimulation, pulsed electromagnetic field, and vibration therapy. In accordance, emerging research is now focusing on the biophysical properties of several medical procedures to improve pain management in patients with MSD. Taken together, our results showed promising results of the integration of a biophysical-based approach in rehabilitation, albeit several limitations currently limit its implementation in routine clinical setting. Unfortunately, the state of the art is still inconclusive, and the low quality of clinical studies based on the biophysical approach did not provide clear treatment protocols. Further studies are needed to promote a precise rehabilitation approach targeting biological modification and enhancing the functional improvement of patients with MSDs.</p>","PeriodicalId":23056,"journal":{"name":"Therapeutic Advances in Musculoskeletal Disease","volume":"15 ","pages":"1759720X231183867"},"PeriodicalIF":4.2,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/48/30/10.1177_1759720X231183867.PMC10359654.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10222614","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Utilising a non-surgical intervention in the knee osteoarthritis care pathway: a 6-year retrospective audit on NHS patients.","authors":"Robyn Benn,&nbsp;Lewis Rawson,&nbsp;Amanda Phillips","doi":"10.1177/1759720X231187190","DOIUrl":"https://doi.org/10.1177/1759720X231187190","url":null,"abstract":"<p><strong>Background: </strong>Knee osteoarthritis (OA) is a chronic, debilitating, musculoskeletal condition that affects millions. The increase in prevalence and its economic impact on healthcare and society raise the need for additional non-surgical interventions.</p><p><strong>Objective: </strong>To assess the referral rates to secondary care consultation and clinical outcomes in patients with severe knee OA treated with a home-based, non-surgical intervention.</p><p><strong>Design: </strong>This was a retrospective audit on 571 patients with knee OA who met the clinical criteria for total knee replacement (TKR) and received the service between October 2015 and March 2020.</p><p><strong>Methods: </strong>Patients were treated with a non-surgical, home-based, biomechanical intervention that aims to reduce pain and improve function, involving a foot-worn device for gait rehabilitation. The device is adjusted to the patient based on their gait patterns and clinical symptoms. Patients are advised to use the device at home or work and continue their routine. Patients are also advised to return to follow-up appointments to readjust the device and treatment plan. The primary outcome measure was the referral rates to secondary care consultation. Secondary outcomes included patient-reported outcome measures to assess pain and function and a computerised gait test. Follow-up time was between 1 and 6 years post-treatment initiation with a mean follow-up time of 1308.1 (SD = 473.4) days (i.e. 3.5 years.).</p><p><strong>Results: </strong>There were 65 (11.4%) referrals for secondary consultation with an average follow-up of 3.5 years. The mean days to referral was 480.9 (SD = 399.2) days. Of all referrals, 48% (<i>n</i> = 31) occurred during the first year of treatment, and 32% (<i>n</i> = 21) occurred during the second year. The rest were after more than 2 years of treatment.Significant improvements were seen in all clinical outcomes, including a reduction in pain and an improvement in function and gait patterns (<i>p</i> < 0.05 for all).</p><p><strong>Conclusion: </strong>Utilising this intervention as a non-surgical option for patients with knee OA who met the clinical criteria for TKR led to a significant reduction in pain and improvement in function after 3 months that was maintained for up to 3 years. Most patients (89%) did not proceed to secondary care consultation during their time in treatment for up to 6 years.</p>","PeriodicalId":23056,"journal":{"name":"Therapeutic Advances in Musculoskeletal Disease","volume":"15 ","pages":"1759720X231187190"},"PeriodicalIF":4.2,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/29/a3/10.1177_1759720X231187190.PMC10387773.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9917117","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The application of machine learning in early diagnosis of osteoarthritis: a narrative review.","authors":"Anran Xuan,&nbsp;Haowei Chen,&nbsp;Tianyu Chen,&nbsp;Jia Li,&nbsp;Shilong Lu,&nbsp;Tianxiang Fan,&nbsp;Dong Zeng,&nbsp;Zhibo Wen,&nbsp;Jianhua Ma,&nbsp;David Hunter,&nbsp;Changhai Ding,&nbsp;Zhaohua Zhu","doi":"10.1177/1759720X231158198","DOIUrl":"https://doi.org/10.1177/1759720X231158198","url":null,"abstract":"<p><p>Osteoarthritis (OA) is the commonest musculoskeletal disease worldwide, with an increasing prevalence due to aging. It causes joint pain and disability, decreased quality of life, and a huge burden on healthcare services for society. However, the current main diagnostic methods are not suitable for early diagnosing patients of OA. The use of machine learning (ML) in OA diagnosis has increased dramatically in the past few years. Hence, in this review article, we describe the research progress in the application of ML in the early diagnosis of OA, discuss the current trends and limitations of ML approaches, and propose future research priorities to apply the tools in the field of OA. Accurate ML-based predictive models with imaging techniques that are sensitive to early changes in OA ahead of the emergence of clinical features are expected to address the current dilemma. The diagnostic ability of the fusion model that combines multidimensional information makes patient-specific early diagnosis and prognosis estimation of OA possible in the future.</p>","PeriodicalId":23056,"journal":{"name":"Therapeutic Advances in Musculoskeletal Disease","volume":"15 ","pages":"1759720X231158198"},"PeriodicalIF":4.2,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/ed/cd/10.1177_1759720X231158198.PMC10017946.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9146235","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cost-effectiveness of specialised manual therapy <i>versus</i> orthopaedic care for musculoskeletal disorders: long-term follow-up and health economic model.","authors":"Stina Lilje,&nbsp;Maurits van Tulder,&nbsp;Anders Wykman,&nbsp;Emmanuel Aboagye,&nbsp;Ulf Persson","doi":"10.1177/1759720X221147751","DOIUrl":"https://doi.org/10.1177/1759720X221147751","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Physiotherapy is usually the first line of treatment for musculoskeletal disorders. If pain persists, an appointment with an orthopaedic surgeon is indicated, but many disorders for which patients are placed on orthopaedic waiting lists cannot be treated in an orthopaedic clinic. Specialised manual therapy, although not mainstream, can be an effective alternative to orthopaedic care, although its cost-effectiveness beyond 12 months is unknown.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objectives: &lt;/strong&gt;To perform an 8-year follow-up of the quality of life and costs of specialised manual therapy versus standard orthopaedic care for working-age patients with common nonsurgical musculoskeletal disorders referred to orthopaedic surgeons and to develop a health economic model.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Design: &lt;/strong&gt;Cost-effectiveness study using Markov modelling.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;The index group of a previously published pragmatic randomised controlled trial received a maximum of five treatment sessions of specialised manual therapy, while the control group received orthopaedic 'care as usual'. At 3, 6, 12 and 96 months, Health-Related Quality of Life and costs were measured with Short Form Health Survey 36, Short Form Health Survey 6D and Diagnostic Related Groups. An incremental cost-effectiveness ratio was calculated, a Markov model was developed and a sensitivity analysis was performed.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Overall, 95% (&lt;i&gt;n&lt;/i&gt; = 75) of the participants completed the 8-year follow-up. Recovery rates during the first 3 months ('per protocol') in the index and control group were 69% and 58%, respectively. The index group had 0.159 more gains in quality-adjusted life years and cost 40,270 SEK (€4027) less per patient over 8 years. The sensitivity analysis results were consistent with the main results.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;Specialised manual therapy dominated standard care after 8 years. The results of this small but very first study are promising; therefore, further exploration within other health care professions, clinics and/or countries is required. Our study raises questions about the triaging of orthopaedic outpatients, cost-effectiveness and resource allocation.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Registration: &lt;/strong&gt;Not applicable per the information provided by ClinicalTrials.gov.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Plain language summary: &lt;/strong&gt;Specialised manual therapy is more cost-effective than 'care as usual' for working-age patients referred to an orthopaedist. This study provides an 8-year follow-up of the cost effects and quality of life of a previously published trial. &lt;b&gt;Why was this study conducted?&lt;/b&gt; The standard care for musculoskeletal pain consists of exercises with a physiotherapist in primary care. If the pain persists, a referral to an orthopaedic clinic is often made. Many of these referrals are inappropriate because they concern pain from muscles and joints that do not benefit from surgery or the resources available ","PeriodicalId":23056,"journal":{"name":"Therapeutic Advances in Musculoskeletal Disease","volume":"15 ","pages":"1759720X221147751"},"PeriodicalIF":4.2,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9896095/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10652567","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Efficacy and safety of abatacept in patients with rheumatoid arthritis with previous malignancy.","authors":"Yosuke Kunishita,&nbsp;Kento Ichikawa,&nbsp;Yuji Uzawa,&nbsp;Masaki Mitsuhashi,&nbsp;Yuji Yoshioka,&nbsp;Tadanobu Okubo,&nbsp;Shouhei Nagaoka","doi":"10.1177/1759720X231186874","DOIUrl":"https://doi.org/10.1177/1759720X231186874","url":null,"abstract":"<p><strong>Background: </strong>Abatacept (ABT) is known to lower infection risk than other biologics and is effective and safe in elderly patients with rheumatoid arthritis (RA). However, there were inconsistent reports on the impact of ABT on malignancies which are more common in the elderly and strongly related to prognosis.</p><p><strong>Objectives: </strong>This study aimed to evaluate the efficacy and safety of ABT in patients with RA with previous malignancy in clinical practice.</p><p><strong>Design: </strong>A multicenter, retrospective study.</p><p><strong>Methods: </strong>Patients who received ABT for RA in two hospitals in Yokohama until May 2022 were included in this study. The patients were divided into two groups according to the presence or absence of a history of malignancy (no previous malignancy: NP group, previous malignancy: PM group). The collected parameters were compared between the groups using propensity score matching.</p><p><strong>Results: </strong>In this study, 312 patients were included, of whom 73 had previous malignancies when starting ABT. The age at ABT initiation was significantly higher in the PM group, the rate of methotrexate use was significantly lower in the PM group, and the Steinbrocker stage was significantly higher in the PM group. After matching these 3 factors, 68 patients were selected from each group. No significant differences in the ABT continuation rate, and malignancy incidence were observed between the two groups after ABT initiation. In addition to these factors, when matched for smoking history, interstitial lung disease, disease duration, sex, and inflammatory status, which are known risk factors for malignancy in RA, 40 patients were selected from each group. No significant differences in the ABT continuation rate, and malignancy incidence were observed between the two groups after ABT initiation.</p><p><strong>Conclusion: </strong>In our clinical practice, ABT was as effective and safe in patients with a history of malignancy as in those without.</p>","PeriodicalId":23056,"journal":{"name":"Therapeutic Advances in Musculoskeletal Disease","volume":"15 ","pages":"1759720X231186874"},"PeriodicalIF":4.2,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/55/f1/10.1177_1759720X231186874.PMC10395174.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10301551","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"<i>T</i>-score discordance between hip and lumbar spine: risk factors and clinical implications.","authors":"Ming-Hsiu Chiang,&nbsp;Yeu-Chai Jang,&nbsp;Yu-Pin Chen,&nbsp;Wing P Chan,&nbsp;Ying-Chin Lin,&nbsp;Shu-Wei Huang,&nbsp;Yi-Jie Kuo","doi":"10.1177/1759720X231177147","DOIUrl":"https://doi.org/10.1177/1759720X231177147","url":null,"abstract":"<p><strong>Background: </strong><i>T</i>-score discordance is common in osteoporosis diagnosis and leads to problems for clinicians formulating treatment plans.</p><p><strong>Objectives: </strong>This study investigated the potential predictors of <i>T</i>-score discordance and compared fracture risk among individuals with varying <i>T</i>-score discordance status.</p><p><strong>Design: </strong>This was a single-center cross-sectional study conducted at Wan Fang Hospital, Taipei City, between 1 February 2020 and 31 January 2022.</p><p><strong>Methods: </strong>The present study enrolled patients aged ⩾50 years who received advanced bone health examination. Participants with a history of fracture surgery or underlying musculoskeletal diseases were excluded. Bioelectrical impedance analysis and dual-energy X-ray absorptiometry were used to determine the body composition and <i>T</i>-score, respectively. Discordance was defined as different <i>T</i>-score categories between the lumbar spine and hip. The impact of discordance on an individual's fracture risk was assessed using the Fracture Risk Assessment Tool (FRAX).</p><p><strong>Results: </strong>This study enrolled 1402 participants (181 men and 1221 women). Of the 912 participants diagnosed with osteoporosis, 47 (5%) and 364 (40%) were categorized as having major and minor discordance, respectively. Multinomial logistic regression revealed that decreased walking speed was significantly correlated with major discordance but not osteoporosis in both the hip and lumbar spine (odds ratio of 0.25, <i>p</i> = 0.04). The adjusted FRAX scores for the major osteoporotic fracture risks of the major and minor discordance groups were approximately 14%, which was significantly lower than that of people having osteoporosis in both the hip and lumbar spine.</p><p><strong>Conclusions: </strong>Walking speed exhibited the most significant correlation with major discordance in patients with osteoporosis. Although adjusted major fracture risks were similar between the major and minor discordance groups, further longitudinal studies are warranted to confirm this finding.</p><p><strong>Registrations: </strong>This study was approved by the Ethics Committee of Taipei Medical University on 01/04/2022 (TMU-JIRB N202203088).</p>","PeriodicalId":23056,"journal":{"name":"Therapeutic Advances in Musculoskeletal Disease","volume":"15 ","pages":"1759720X231177147"},"PeriodicalIF":4.2,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/cf/c8/10.1177_1759720X231177147.PMC10286209.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10302683","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}