News

As reported by the Wall Street Journal, the FDA is seeking advice from a panel of medical experts on whether the antidepressant Cymbalta should be used as a treatment for chronic pain.

On July 2, 2010, CMS released the proposed changes to the Medicare Outpatient Hospital Prospective Payment System for 2011.

Interim final rules clarify the scope of internal claims and appeals procedures and external review processes under PPACA.

Shoulder pain is complex and difficult for even experienced clinicians to diagnose. This article reviews how to use history, simple physical tests, and imaging to distinguish rotator cuff disorders and osteoarthritis from osteonecrosis, adhesive capsulitis, labral tears, or acromioclavicular joint pathology.

anagement of low back pain (LBP) includes a variety of approaches. The clinician should involve patients in the discussion and encourage them to become active participants. Bed rest has many deleterious effects; remaining active is more effective for patients with acute or subacute LBP.

The immune system plays a dynamic role in physiological and pathogenic bone remodeling. Macrophage-, stromal-, and lymphocyte-derived cytokines may induce the activation or inhibition of bone cells and their precursors and cause bone deposition or bone resorption.

More than two-thirds of surveyed patients with gout described the pain of an attack as “miserable,” but one-fourth suggested that persons who do not have gout perceive them as overreacting to attacks and two-thirds think that others do not take the condition seriously.

The timing of the onset of a patient's symptoms can serve as a critical piece of the puzzle when trying to determine a diagnosis.

Inflammatory arthritis includes a variety of diseases; the most common are rheumatoid arthritis, ankylosing spondylitis, and psoriatic arthritis. A large proportion of patients seen in most rheumatology practices have inflammatory arthritis; these patients also are seen in the primary care setting, where they present initially before a diagnosis has been made. The inflammatory arthritides are chronic progressive diseases that can cause irreversible joint damage even early in the disease course.

More than 1 million total joint arthroplasties (TJAs) are performed in the United States each year, and much higher demand is projected. Most TJAs are successful, but aseptic loosening of implants remains a problem that limits long-term success. Aseptic osteolysis, an inflammatory reaction, occurs in up to 10% of patients at 10 years postsurgery.

After a trip to El Salvador, a woman experienced fever, malaise, and other symptoms. She had a history of a positive antinuclear antibodies test result, Raynaud phenomenon, and erythematous rash. The patient was hospitalized for pneumonia, and her symptoms persisted when she received antibiotics. Later her right ankle became red, swollen, and tender. Examination of the patient's extremities showed osteoarthritis changes.

A 25-year-old man was seen in the orthopedic clinic with a complaint of severe, exquisite pain at the ulnar aspect of the distal phalanx of his dominant right index finger. The pain had been present for 10 years, but he had not sought treatment.

The aging process is difficult, involving multisystem functional decline, and the pharmacokinetics of medications are altered in older persons, resulting in increased risks. Concerns are demonstrated in case reports.

ABSTRACT: Achilles tendon injuries are increasing as the population ages yet remains physically active later in life. Early diagnosis and management are important for good long-term outcome, but many injuries are missed or misdiagnosed on initial evaluation.

A new study from the Center for Studying Health System Change analyzes the positive and negative affects that EMR implementation can have on physician-patient interaction.

Some health care IT industry heavyweights have gone so far as to suggest that the iPad will be greatly utilized in the healthcare setting and revolutionize the way we do business. While I do think the iPad is incredibly shiny and is great computer replacement for your grandma, I think it's a bit of an exaggeration to suggest that it will ever be fully adopted by healthcare IT shops.

Modern medicine's technological advances now allow more people to live long enough to develop chronic diseases where the mortality is low but the morbidity high. Hyperchondriacs are acutely aware of this, and perceive great threats in their aging and the future. Hyperchondriacs have similar attributes to hypochondrial patients even as they lack the attendant "symptoms" of a physiologic illness.

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

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

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

Scientists have pinpointed and controlled a key molecular component that will keep certain stem cells associated with arthritis and osteoporosis in an extended infancy state, according to a study published online in the journal Development.

Study results published in the American Journal of Infection Control found that Twitter is often used to spread misleading or false information about key healthcare topics, with incorrect information from a single tweet able to reach hundreds of thousands of patients.

ABSTRACT: No new drug was FDA-approved for gout for close to 45 years, but new drugs are on the market now and others are in development. Established treatments often are effective, but each has limitations. In 2009, the FDA approved a nongeneric colchicine for acute gout.

ABSTRACT: Evidence of ongoing juvenile idiopathic arthritis (JIA) into adulthood has led to a shift in the treatment paradigm. Most physicians now pursue an approach of early, aggressive combination therapy.

This article describes a study of the prevalence of lateral epicondylitis or tennis elbow among patients with neck or arm pain, reviews the prevalence of concomitant cervical radiculopathy, and proposes a management plan for cases in which the conditions coincide.

ABSTRACT: A 36-year-old woman presented with Raynaud phenomenon, arthralgia, photosensitive rash, proteinuria, dry eyes and dry mouth, and alopecia.

A 45-year-old woman presented to the emergency department with a 3-day history of an acutely painful, swollen, and erythematous thumb. Ordinary x-ray was central to the correct diagnosis.

There are significant associations between the increased numbers of telangiectases in patients with scleroderma and the presence of pulmonary arterial hypertension (PAH). Cutaneous telangiectases may be a manifestation of the vasculopathy of scleroderma that could serve as a clinical biomarker for pulmonary vascular disease.

Although sleep often is disturbed in persons with chronic fatigue syndrome (CFS), activity-related exacerbation of symptoms is not related to poor sleep. In fact, persons with CFS often sleep better after engaging in exercise.

Late-onset systemic lupus erythematosus (SLE), often considered to have a benign disease course, actually involves greater disease activity and comorbidities than early-onset SLE. Differences in disease activity may be associated with an interaction between the SLE and age.