J Rheumatol
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Review Meta Analysis
Medicinal and injection therapies for mechanical neck disorders: a Cochrane systematic review.
To systematically review randomized trials on medicines and injections used to improve pain, function/disability, and patient satisfaction in adults with mechanical neck disorders (MND) with or without associated headache or radicular findings. ⋯ Intramuscular injection of lidocaine for chronic MND and intravenous injection of methylprednisolone for acute whiplash were effective treatments. There was limited evidence of effectiveness of epidural injection of methylprednisolone and lidocaine for chronic MND with radicular findings. Muscle relaxants and nonsteroidal antiinflammatory drugs have unclear benefits. There was moderate evidence that Botox-A intramuscular injections for chronic MND were not better than saline.
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Review Meta Analysis
Is sulfasalazine effective in ankylosing spondylitis? A systematic review of randomized controlled trials.
To evaluate the efficacy and toxicity of sulfasalazine (SSZ) for the treatment of ankylosing spondylitis (AS). ⋯ Across all patients with AS, SSZ showed some benefit in reducing ESR and easing spinal stiffness, but no evidence of benefit in physical function, pain, spinal mobility, enthesitis, or patient and physician global assessment. Patients at an early stage of disease, with higher level of ESR (or active disease) and peripheral arthritis, might benefit from SSZ.
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Review Meta Analysis
Pennsaid therapy for osteoarthritis of the knee: a systematic review and metaanalysis of randomized controlled trials.
To systematically review published randomized controlled trials (RCT) evaluating a new topical diclofenac solution (Pennsaid) in patients with osteoarthritis (OA) of the knee. ⋯ Pennsaid is an effective topical NSAID in patients with OA of the knee. Apart from minor localized skin reactions, Pennsaid was as safe as VCP. It is not known whether the favorable results of Pennsaid can be extrapolated to other topical NSAID preparations. Pennsaid deserves further consideration when the existing treatment guidelines for OA of the knee are updated.
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The diagnostic value of tests for antimyeloperoxidase antibodies (anti-MPO) for systemic vasculitis is less established than that for cytoplasmic antineutrophil cytoplasmic antibody (cANCA)/antiproteinase 3 antibodies (anti-PR3). Controversy exists regarding the optimal utilization of indirect immunofluorescence (IIF) ANCA testing versus antigen-specific ANCA testing. To summarize the pertinent data, we conducted a metaanalysis examining the diagnostic value of ANCA testing systems that include assays for anti-MPO. ⋯ These results suggest that while anti-MPO is relatively specific for the diagnosis of systemic vasculitis, the combination system of immunoassays for anti-MPO and IIF for pANCA is highly specific and both tests should be used together given the high diagnostic precision required for these conditions. Because patients with ANCA associated vasculitis have either anti-MPO with pANCA or anti-PR3 with cANCA, and rarely both, a combined ANCA testing system including anti-PR3/cANCA and anti-MPO/pANCA is recommended to optimize the diagnostic performance of ANCA testing.
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To review the effectiveness of common interventions for the prevention of nonsteroidal antiinflammatory drug (NSAID) induced upper gastrointestinal (GI) toxicity. ⋯ Misoprostol, PPI, and double dose H2RA are effective in preventing chronic NSAID related endoscopic gastric and duodenal ulcers. Lower doses of misoprostol are less effective and are still associated with diarrhea. Only misoprostol 800 microg/day has been directly shown to reduce the risk of ulcer complications.