Clin Exp Rheumatol
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Viscosupplementation with hyaluronic acid (HA) or its derivatives for the symptomatic relief of osteoarthritis (OA) of the hip joint has never been studied in placebo-controlled, double-blinded trials and conflicting results have been obtained from the published open trials. The aim of this study was to review the literature on viscosupplementation as a symptomatic treatment of hip OA. ⋯ To date, in the absence of placebo-controlled studies, the efficacy of IA injections of HA or its derivatives in the symptomatic treatment of hip OA cannot be determined conclusively. Nevertheless the published data suggest that viscosupplementation may be effective. Double-blind, controlled studies are required to confirm these data, before viscosupplementation should be included into the treatment paradigm for patients with hip osteoarthritis.
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This is a literature review on the efficacy and toxicity of low dose weekly methotrexate treatment in rheumatoid arthritis. Personal recommendations on dosing and monitoring (of) the drug are given.
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Analgesic therapy that combines individual agents with different mechanisms of action has potential advantages for the management of mild-to-moderate pain in the outpatient setting. Theoretically, this approach can lead to greater efficacy and fewer adverse events. ⋯ Several controlled clinical studies among patients with musculoskeletal conditions, dental pain, or postoperative pain have shown that combinations of acetaminophen and NSAIDs provide additive pain-relieving activity, thereby leading to dose-sparing effects and improved safety. Further studies are warranted to determine the clinical utility and safety of acetaminophen/NSAID combinations as analgesic therapy for common conditions associated with mild-to-moderate pain.
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Review Comparative Study
Guidelines for clinical studies assessing the efficacy of drugs for the management of acute low back pain.
In this paper we propose guidelines for clinical trials aimed at assessing the efficacy of drugs for acute non-specific low back pain (LBP) with or without radicular pain, preliminary to their approval and registration. To this end, consensus statements were obtained from a group of experts in the fields of rheumatology, clinical medicine, public health and epidemiology. EBM resources were systematically used as references. ⋯ Adverse events (AE) should be monitored systematically using a methodology that reflects the mode of action of the tested drug. With the application of these guidelines, LBP could serve as an appropriate disease for testing analgesic drugs. Rigorous evaluation may also help to improve the management of acute LBP.
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Ankylosing spondylitis (AS) is a common (prevalence 0.2-0.9%) chronic inflammatory disease that mainly affects young males and is characterised by inflammatory back pain with sacroiliitis and often arthritis of the peripheral joints. The disease can lead to deformities of the vertebral column, joints and extra-spinal structures, e.g. the eye (uveitis). ⋯ In placebo controlled trials, sulfasalazine showed some improvement of disease activity, especially in spondyloarthropathy patients with peripheral arthritis. Altogether the number of therapeutic options for AS is limited and other drugs, such as leflunomide or thalidomide, should be explored further in placebo-controlled trials.