Clin Exp Rheumatol
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Editorial Review
Reconstructing the pyramid in rheumatoid arthritis. An urgent need.
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Cervicogenic headache is a relatively common pain syndrome related to functional and/or degenerative alterations of the cervical spine tract. Administration of steroid represents an effective therapy for this headache, due to the anti-inflammatory effects combined with its direct analgesic effects on the C fibers. The epidural injection of steroids, while requesting skilled personnel for its execution, gives short term (2-month) pain relief with few risks or side effects. Moreover, epidural steroids allow reduction of analgesic drug consumption.
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The concept that headache might stem from the neck is old. The term "cervicogenic headache" was coined in 1983. A new content was then given to this concept: cervicogenic headache (CEH) is in principle a unilateral headache, generally starting in the neck and "spreading" forwards. ⋯ These special features of CEH cannot be emphasised strongly enough. There are signs pertaining to the neck, such as reduced range of motion in the neck, mechanical precipitation mechanisms and ipsilateral shoulder/arm sensation (or even pain). Migraine without aura symptoms are less prominent than in migraine.
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Endogenous or exogenous glucocorticoids play a key role in the control of the immune and inflammatory network. Regulation of the effects of the glucocorticoids depends on changes in therapeutic levels, but also, as recently discovered, on modifications of the binding characteristics of the glucocorticoid receptors of target cells. ⋯ Finally, glucocorticoids are also capable of switching CD4 cells from a Th-1 to a Th-2 pattern. A decreased affinity of lymphocyte glucocorticoid receptors could hinder such a switch, with obvious clinical implications.