scholarly journals Do NSAIDs Take Us Away From Treatment Goals in Axial Spondyloarthritis: A Story About Dysbiosis or Just a Matter of Bias?

2021 ◽  
Vol 8 ◽  
Author(s):  
Rubén Queiro-Silva ◽  
Andrea García-Valle ◽  
Sara Alonso-Castro ◽  
Mercedes Alperi-López
Keyword(s):  
Barrier Function ◽  
Symptomatic Relief ◽  
Term Treatment ◽  
Treat To Target ◽  
Treatment Goals ◽  
Long Term Treatment ◽  
Gut Mucosa ◽  
Spa Treatment ◽  
Inflammatory Drugs ◽  
Type 3

Non-steroidal anti-inflammatory drugs (NSAIDs) remain the mainstay of treatment for spondyloarthritides (SpA), a group of entities with common clinical and pathophysiological aspects, but also with differential features. Although NSAIDs provide significant symptomatic relief, especially for joint pain and morning stiffness, their role in achieving and maintaining the treatment goals advocated by the treat to target strategy in SpA is not entirely clear. These agents can induce changes in the composition of the intestinal microbiota, also favoring an alteration of the barrier function in the gut epithelium. All of this, favored by a pre-disposing genetic background, could activate a specific type of aberrant immune response in the gut lamina propria, also known as type-3 immunity. This article offers a perspective on how NSAIDs, despite their undeniable value in the short-term SpA treatment, could hinder the achievement of medium and long-term treatment goals by compromising the barrier function of the gut mucosa and potentially altering the composition of the gut microbiota.

scholarly journals Bilateral Intra-Articular Radiofrequency Ablation for Cervicogenic Headache

2017 ◽  
Vol 2017 ◽  
pp. 1-6 ◽  
Author(s):  
Charles A. Odonkor ◽  
Teresa Tang ◽  
David Taftian ◽  
Akhil Chhatre
Keyword(s):  
Radiofrequency Ablation ◽  
Pain Relief ◽  
Symptomatic Relief ◽  
Cervicogenic Headache ◽  
Term Treatment ◽  
Medial Branch ◽  
Neck Stiffness ◽  
Intervertebral Disks ◽  
Long Term Treatment ◽  
Improved Function

Introduction. Cervicogenic headache is characterized by unilateral neck or face pain referred from various structures such as the cervical joints and intervertebral disks. A recent study of patients with cervical pain showed significant pain relief after cervical medial branch neurotomy but excluded patients with C1-2 joint pain. It remains unclear whether targeting this joint has potential for symptomatic relief. To address this issue, we present a case report of C1-2 joint ablation with positive outcomes. Case Presentation. A 27-year-old female presented with worsening cervicogenic headache. Her pain was 9/10 by visual analog scale (VAS) and described as cramping and aching. Pain was localized suboccipitally with radiation to her jaw and posterior neck, worse on the right. Associated symptoms included clicking of her temporomandibular joint, neck stiffness, bilateral headaches with periorbital pain, numbness, and tingling. History, physical exam, and diagnostic studies indicated localization to the C1-2 joint with 80% decrease in pain after C1-2 diagnostic blocks. She underwent bilateral intra-articular radiofrequency ablation of the C1-C2 joint. Follow-up at 2, 4, 8, and 12 weeks showed improved function and pain relief with peak results at 12 weeks. Conclusion. Clinicians may consider C1-C2 joint ablation as a viable long-term treatment option for cervicogenic headaches.

scholarly journals Cardiovascular and cerebrovascular risk with nonsteroidal anti-inflammatory drugs and cyclooxygenase 2 inhibitors: latest evidence and clinical implications

2017 ◽  
Vol 8 (6) ◽  
pp. 173-182 ◽  
Author(s):  
Andrea Fanelli ◽  
Daniela Ghisi ◽  
Pierangelo Lora Aprile ◽  
Francesco Lapi
Keyword(s):  
Term Treatment ◽  
Cyclooxygenase 2 ◽  
Thrombotic Risk ◽  
Long Term Treatment ◽  
Pressure Development ◽  
Inflammatory Drugs ◽  
Anti Inflammatory ◽  
High Doses ◽  
The Right ◽  
Meta Analyses

Observational studies and meta-analyses have shown that the administration of nonsteroidal anti-inflammatory drugs (NSAIDs), especially when prescribed at high doses for long periods of time, can potentially increase the risk of cardiovascular diseases. The increased thrombotic risk related to the use of NSAIDs is mainly due to their cyclooxygenase 2 selectivity. The dosage use, the formulation selected and the duration of the therapy are other factors that can significantly impact on the cardiovascular risk. In order to minimize the risk, prescription of the right drug based on the patient’s features and the different safety profiles of several NSAIDs that are available on the market is key for their appropriate administration. Despite the baseline cardiovascular and gastrointestinal risk of each patient, monitoring of patients is suggested for increases in blood pressure, development of edema, deterioration of renal function, or gastrointestinal bleeding during long-term treatment with NSAIDs.

The crystal arthropathies

2013 ◽  
Vol 6 (11) ◽  
pp. 681-687 ◽  
Author(s):  
Robert A Jones ◽  
Brian Quilty
Keyword(s):  
Quality Of Life ◽  
Risk Factors ◽  
Inflammatory Arthritis ◽  
Term Treatment ◽  
Routine Practice ◽  
Treatment Goals ◽  
Crystal Arthropathies ◽  
Long Term Treatment

Unlike many other forms of inflammatory arthritis, the crystal arthropathies are routinely diagnosed and managed in primary care. Gout, in particular, is relatively commonplace and rates of other types of crystal-related arthritis are predicted to increase. These are, therefore, conditions that GPs and trainees will regularly encounter during routine practice. While the clinical features and pathophysiology of gout and pseudo-gout are well described, the long-term treatment goals and options of management are often less well understood, and opportunities to assess for associated co-morbidities can easily be missed. GPs can be central in optimising management by promptly and appropriately addressing acute symptoms, preventing recurrent attacks, minimising disability and work absences, reducing cardiovascular risk factors, improving general health and enhancing quality of life.

Ptosis following botulinum toxin injection in hemifacial spasm

2020 ◽  
Author(s):  
Mansooreh Jamshidian-Tehrani ◽  
Hadi Z. Mehrjardi ◽  
Abolfazl Kasaee ◽  
Samira Yadegari
Keyword(s):  
Botulinum Toxin ◽  
Hemifacial Spasm ◽  
Botulinum Toxin Injection ◽  
Symptomatic Relief ◽  
Symptom Relief ◽  
Spontaneous Remission ◽  
Cataract Extraction ◽  
Glaucoma Surgery ◽  
Term Treatment ◽  
Long Term Treatment

Hemifacial spasm (HFS) is characterized by irregular involuntary tonic or clonic contractions of muscles innervated by the seventh cranial nerve. Patients usually need long-term treatment, as spontaneous remission is infrequent. Repeated botulinum toxin injection has been shown as a safe and successful treatment for symptomatic relief in patients with HFS.1 Side effects are usually mild and transient. Ptosis has been reported in about 24% of patients with HFS probably due to diffusion of toxin to levator palpebrae superioris muscle.2 However, the frequency of ptosis in patients with HFS has not been addressed yet, due to causes other than botulinum toxin side effect. Herein, we present a case of HFS who presented to our clinic with complaint of complete ptosis and progressive pain early after botulinum toxin injection. Despite initial negative evaluations, further work up revealed a compressive lesion. A 75-year-old man presented with left severe ptosis since 3 weeks ago (Figure 1). He was known case of left HFS since 4 years ago, and botulinum toxin had been regularly injected for his symptom relief in orbicularis oculi, corrugator, and procerus muscles.   Figure 1. Left Blepharoptosis one week after botulinum toxin injection   The patient stated that this new ptosis had begun within a week after his last Dysport (Ipsen, Ltd., Slough, Berkshire, UK) injection while he had no ptosis in his previous injections. In past medical history, he had ischemic heart disease, hypertension, cataract extraction of both eyes, and glaucoma surgery on his right eye. He had been admitted to the neurology ward of a general hospital.

scholarly journals Hypertension in Acromegaly in Relationship to Biochemical Control and Mortality: Global ACROSTUDY Outcomes

2020 ◽  
Vol 11 ◽  
Author(s):  
Greisa Vila ◽  
Anton Luger ◽  
Aart Jan van der Lely ◽  
Sebastian J. C. M. M. Neggers ◽  
Susan M. Webb ◽  
...  
Keyword(s):  
Term Treatment ◽  
Stepwise Logistic Regression ◽  
Treatment Goals ◽  
Biochemical Control ◽  
Total Cohort ◽  
Kaplan Meier ◽  
Long Term Treatment ◽  
Igf I ◽  
Surgical Cure

ContextHypertension is a major cardiovascular risk factor related to increased mortality in acromegaly. Surgical cure of acromegaly is associated with improvement in blood pressure levels, however little is known about the effect of pegvisomant (PEGV) treatment in patients with hypertension. This analysis evaluates outcomes in patients with hypertension and acromegaly included in ACROSTUDY.MethodsACROSTUDY is a global non-interventional surveillance study of long-term treatment with PEGV, monitoring its safety and efficacy. The cohort was retrospectively divided in two subgroups: patients with and without hypertension. Stepwise logistic regression and Kaplan-Meyer analyses were performed for testing predictors of mortality.ResultsThe total cohort included 2,090 patients with acromegaly treated with PEGV who were followed for a median of 6.8 years (range up to 12.1 years). In ACROSTUDY there were 1,344 patients with hypertension (52.3% males). This subgroup was older, had a higher BMI, and higher prevalence of diabetes, hyperlipidemia, and cardiovascular disease (CVD) when compared to patients without hypertension. During ACROSTUDY, 68 deaths were reported in the hypertension cohort, vs 10 in the cohort without hypertension. Both CVD (p<0.0001) and anterior pituitary deficiencies (p=0.0105) at study entry independently predicted mortality in patients with acromegaly and hypertension; Kaplan-Meier analysis confirmed that CVD significantly impairs survival.ConclusionsHypertension is common in patients with acromegaly and significantly increases mortality, especially when there is concomitant CVD. These data suggest that treatment goals should extend beyond IGF-I normalization, and include optimisation of substitution of pituitary deficiencies and scrutinous screening and treatment of CVD.

Multimodality imaging in patients with post-cardiac injury syndrome

Heart ◽  
2020 ◽  
Vol 106 (9) ◽  
pp. 639-646 ◽  
Author(s):  
Beni R Verma ◽  
Michael Chetrit ◽  
James L Gentry III ◽  
Andrew Noll ◽  
Ahmed Bafadel ◽  
...  
Keyword(s):  
Clinical Decision Making ◽  
Multimodality Imaging ◽  
Cardiac Injury ◽  
Clinical Decision ◽  
Term Treatment ◽  
Acute Pericarditis ◽  
Pericardial Diseases ◽  
Long Term Treatment ◽  
Inflammatory Drugs ◽  
Anti Inflammatory

This review article is focused on the role of echocardiography, cardiac CT and cardiac magnetic resonance (CMR) imaging in diagnosing and managing patients with post-cardiac injury syndrome (PCIS). Clinically, the spectrum of pericardial diseases under PCIS varies not only in form and severity of presentation but also in the timing varying from weeks to months, thus making it difficult to diagnose. Pericarditis developing after recent or remote myocardial infarction, cardiac surgery or ablation if left untreated or under-treated could worsen into complicated pericarditis which can lead to decreased quality of life and increased morbidity. Colchicine in combination with other anti-inflammatory agents (non-steroidal anti-inflammatory drugs) is proven to prevent and treat acute pericarditis as well as its relapses under various scenarios. Imaging modalities such as echocardiography, CT and CMR play a pivotal role in diagnosing PCIS especially in difficult cases or when clinical suspicion is low. Echocardiography is the tool of choice for emergent bedside evaluation for cardiac tamponade and to electively study the haemodynamics impact of constrictive pericarditis. CT can provide information on pericardial thickening, calcification, effusions and lead perforations. CMR can provide pericardial tissue characterisation, haemodynamics changes and guide long-term treatment course with anti-inflammatory agents. It is important to be familiar with the indications as well as findings from these multimodality imaging tools for clinical decision-making.

scholarly journals Predictive Factors for Achievement of Treatment Goals in Patients with Postmenopausal Osteoporosis Treated with Denosumab

2021 ◽  
Author(s):  
Kyosuke Hattori ◽  
Nobunori Takahashi ◽  
Toshihisa Kojima ◽  
Shiro Imagama
Keyword(s):  
Bone Mineral Density ◽  
Multivariate Analysis ◽  
Postmenopausal Osteoporosis ◽  
Predictive Factors ◽  
Term Treatment ◽  
Treatment Goals ◽  
Mineral Density ◽  
T Score ◽  
Long Term Treatment

Abstract Objectives To investigate efficacy of long-term treatment with denosumab and predictive factors for achievement of treatment goals in patients with postmenopausal osteoporosis (PMO). Methods We enrolled 111 PMO patients who had T-scores ≤ -2.5 either at the lumbar spine (L-) or femoral neck (FN-), who had never been treated for osteoporosis, and who could be followed for at least 3 years. We first evaluated changes in bone mineral density (BMD) for up to 7 years. We next defined the treatment goal as the achievement of a T-score > -2.5 at month 36 and performed multivariate analysis to identify predictive factors for achievement of the goal. Results L- and FN-BMD increased yearly for 7 years. Among 87 patients with baseline L-T-scores ≤ -2.5, better baseline L-T-scores predicted achievement of L-T-scores > -2.5 at month 36. The cut-off value for baseline L-T-score was -3.4. Among 76 patients with baseline FN-T-scores ≤ -2.5, better baseline FN-T-scores predicted achievement of FN-T-scores > -2.5 at month 36. The cut-off value for baseline FN-T-scores was -2.8. Conclusions Long-term treatment with denosumab was effective in PMO patients. As better baseline T-score predicted achievement of T-scores > -2.5, early initiation of treatment will contribute to better outcome.

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