Bulletin of the Hospital for Joint Disease (2013)
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Bull Hosp Jt Dis (2013) · Jan 2013
Case ReportsInjury to the superior gluteal artery during intramedullary fixation of an atypical subtrochanteric stress fracture - a case report.
Iatrogenic vascular injury during hip fracture surgery is a rare complication, with infrequent reports of injury during the procedure of cepahalomedullary nailing. We describe a case report of injury to the superior gluteal artery which occurred during insertion of a nail for prophylactic fixation of an incomplete femur fracture secondary to alendronate use. We describe the anatomy of the arterial branches, the postoperative course, and the management strategy and hope this will increase awareness of these rare injuries.
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Bull Hosp Jt Dis (2013) · Jan 2013
ReviewThe role of concomitant methotrexate in biologic therapy for rheumatoid arthritis.
From the first use of biologic therapy for the management of rheumatoid arthritis, methotrexate (MTX) has been commonly used as co-therapy. There are a number of mechanistic reasons why MTX may improve the efficacy of biologics, including reduced antigenicity as well as reduced clearance of the biologic agent. ⋯ One exception may be the interleukin-6 receptor antibody tocilizumab, for which there is some data to suggest that monotherapy may be as effective as combined therapy with MTX. Post-marketing registry data also supports the concomitant use of MTX with biologics, with evidence for greater efficacy and longer persistence on treatment when compared with monotherapy.
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Bull Hosp Jt Dis (2013) · Jan 2013
ReviewTotal hip arthroplasty periprosthetic femoral fractures: a review of classification and current treatment.
Periprosthetic fractures of the femur after total hip replacement can present some unique challenges to the treating reconstructive orthopedic surgeon. Treatment may differ depending on fracture location, bone condition, implant stability, patient characteristics, and surgeon experience. ⋯ The patient's final outcome is dependent on fracture union, implant stability, early functional recovery, and return to pre-injury independence. This review presents an overview of the current diagnostic and treatment approaches, with the goal of providing a template for optimal decision-making when dealing with these complex injuries.
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Bull Hosp Jt Dis (2013) · Jan 2013
ReviewParenteral methotrexate for the treatment of rheumatoid arthritis.
Methotrexate (MTX) is the anchor treatment for rheumatoid arthritis (RA) and has been very thoroughly studied in many different patient populations, as monotherapy and in combination with various other disease modifying antirheumatic drugs and biologic agents, as they became available. It has a well-established safety and efficacy profile and is the preferred first line agent for RA treatment. ⋯ Several shortages of drug availability in a parenteral form have been possibly one of the reasons for this low level of use. Several studies have looked at the role of parenteral MTX in RA treatment, and these overall demonstrate better tolerability, bioavailability, and possible efficacy of MTX compared with PO preparation.
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Bull Hosp Jt Dis (2013) · Jan 2013
ReviewEfficacy and safety of methotrexate in combination with other non-biologic disease-modifying antirheumatic drugs (DMARDs) in treatment of rheumatoid arthritis.
Methotrexate (MTX) is well-established as the "anchor drug" for patients with rheumatoid arthritis (RA), to be used early and aggressively, with higher long-term effectiveness, tolerability, and safety than any other disease-modifying antirheumatic drug (DMARD). However, about 20% to 40% of patients experience incomplete responses to MTX and require further therapy, with options including other non- biologic DMARDs, low dose glucocorticoids, and biologic agents. Non-biologic DMARDs in combination with MTX may provide similar efficacy to a biologic agent in clinical trials, with fewer adverse events and lower costs. This re- view presents a summary of 21 clinical trials documenting the efficacy and safety of MTX in combination with other non-biologic DMARDs.