Cannabinoids in the rheumatic diseases

2021 ◽  
pp. 45-51
Author(s):  
Mary-Ann Fitzcharles
Keyword(s):  
Treatment Option ◽  
Clinical Evidence ◽  
Symptom Relief ◽  
Active Role ◽  
Medical Cannabis ◽  
Short Term ◽  
Safe Patient Care ◽  
Prevalent Symptom ◽  
Present Setting

Pain is a prevalent symptom for rheumatology patients. Even when inflammatory arthritis is well controlled, remaining pain or comorbid fibromyalgia is a cause of persistent suffering. As current treatments for pain management are suboptimal, patients are increasingly exploring medical cannabis as a treatment option, with interest bolstered by legalization of both medical and recreational cannabis is many jurisdictions. This easier access to cannabis may even prompt some patients to experiment with use and self-medicate. Although the clinical evidence for effect of cannabinoids in rheumatology management is mostly lacking, rheumatologists must be sufficiently knowledgeable to provide patients with evidence-based information about effects and harms. This review will address the pharmacological properties of medical cannabis, products available, and methods of administration and will highlight considerations applicable for use in various rheumatology patient populations. Medical cannabis may provide some symptom relief for some rheumatology patients, but with caution about known short-term risks and largely unknown long-term risks. Medical cannabis may finally emerge as a treatment option for these patients. Even in the present setting of limited evidence, clinicians must understand the popular advocacy for medical cannabis and play an active role to ensure competent and safe patient care. Keywords: Rheumatic pain. Cannabinoids.

scholarly journals Position Statement: A Pragmatic Approach for Medical Cannabis and Patients with Rheumatic Diseases

2019 ◽  
Vol 46 (5) ◽  
pp. 532-538 ◽  
Author(s):  
Mary-Ann Fitzcharles ◽  
Omid Zahedi Niaki ◽  
Winfried Hauser ◽  
Glen Hazlewood ◽  
Keyword(s):  
Rheumatoid Arthritis ◽  
Patient Care ◽  
Healthcare Professionals ◽  
Symptom Relief ◽  
Position Statement ◽  
Evidence Based ◽  
Medical Cannabis ◽  
Pragmatic Approach ◽  
Short Term ◽  
Natural Treatment

Objective.Pain is one reason some rheumatology patients may consider use of medical cannabis, a product increasingly perceived as a safe and neglected natural treatment option for many conditions. Legalization of recreational cannabis in Canada will promote access to cannabis. Physicians must therefore provide patients with the best evidence-based information regarding the medicinal effects and harm of cannabis.Methods.The Canadian Rheumatology Association (CRA) mandated the development of a position statement for medical cannabis and the rheumatology patient. The current literature regarding the effects of medical cannabis for rheumatology patients was assessed, and a pragmatic position statement to facilitate patient care was developed by the Therapeutics Committee of the CRA and approved by the CRA board.Results.There are no clinical trials of medical cannabis in rheumatology patients. Evidence is insufficient about the benefit of pharmaceutical cannabinoids in fibromyalgia, osteoarthritis, rheumatoid arthritis, and back pain, but there is evidence of a high risk of harm. Extrapolating from other conditions, medical cannabis may provide some symptom relief for some patients. Short-term risks of psychomotor effects can be anticipated, but longterm risks have not been determined and are of concern.Conclusion.Despite lack of evidence for use of medical cannabis in rheumatology patients, we acknowledge the need to provide empathetic and pragmatic guidance for patient care. This position statement aims to facilitate the dialogue between patients and healthcare professionals in a mutually respectful manner to ensure harm reduction for patients and society.

scholarly journals Thumb Interphalangeal Joint Replacement as an Alternative to Joint Fusion

2020 ◽  
Vol 2020 ◽  
pp. 1-4
Author(s):  
Laurence Grüber ◽  
Georges Kohut ◽  
Théa Voser
Keyword(s):  
Range Of Motion ◽  
Treatment Option ◽  
Joint Replacement ◽  
Joint Instability ◽  
Joint Arthroplasty ◽  
Interphalangeal Joint ◽  
Viable Option ◽  
Short Term ◽  
Free Range

Arthrodesis is the generally accepted treatment for symptomatic osteoarthritis of the interphalangeal (IP) joint of the thumb. For 7 thumbs in 5 patients, an IP joint replacement was offered as a pain alleviating and motion conserving treatment option for osteoarthritis. In these cases, an offlabel use of the SR-PIP prosthesis was performed. All patients did well postoperatively with reasonable pain-free range of motion of the interphalangeal joint except one patient who required further surgeries for recurring joint instability. Radiologically, though, an osteolysis around the stems that could lead to loosening of the prosthesis and progressing periarticular ossifications that might cause a blockage of the joint were observed. IP joint arthroplasty represents a viable option on the short term; however, further studies should be conducted to ensure their long-term sustainability.

scholarly journals OnabotulinumtoxinA in the treatment of patients with chronic migraine: clinical evidence and experience

2017 ◽  
Vol 10 (12) ◽  
pp. 397-406 ◽  
Author(s):  
Chia-Chun Chiang ◽  
Amaal J. Starling
Keyword(s):  
Chronic Migraine ◽  
Clinical Evidence ◽  
Migraine Prophylaxis ◽  
Phase Iii ◽  
Short Term ◽  
Double Blind ◽  
The Us ◽  
Injection Protocol ◽  
Prophylaxis Therapy

Chronic migraine is a debilitating neurobiological disorder that affects approximately 1.4–2.2% of the population worldwide. Patients with chronic migraine have 15 or more headache days per month, with at least 8 days per month that meet the criteria for migraine. Injection of onabotulinumtoxinA, using a standardized injection protocol, was approved by the US Food and Drug Administration in 2010 for the treatment of chronic migraine. The approval was made based on results from two large, randomized, double-blind placebo-controlled trials: the Phase III Research Evaluating Migraine Prophylaxis Therapy (PREEMPT) trials. Since then, numerous studies have been performed investigating the short-term and long-term benefits, risks and complications of the use of onabotulinumtoxinA injections for the treatment of chronic migraine. The purpose of this narrative review is to describe the currently available clinical evidence for the use of onabotulinumtoxinA injections for treating patients with chronic migraine.

scholarly journals Marine litter from beach-based sources: Case study of an Eastern Mediterranean coastal town

2018 ◽  
Author(s):  
Michelle E. Portman ◽  
Ruth E Brennan
Keyword(s):  
Eastern Mediterranean ◽  
Institutional Context ◽  
Active Role ◽  
Short Term ◽  
Policy Makers ◽  
Marine Litter ◽  
Management Intervention ◽  
Survey Results

Marine litter has been a serious and growing problem for some decades now. Yet, there is still much speculation among researchers, policy makers and planners about how to tackle marine litter from land-based sources. This paper provides insights into approaches for managing marine litter by reporting and analyzing survey results of litter dispersal and makeup from three areas along an Arab-Israeli coastal town in view of other recent studies conducted around the Mediterranean Sea. Based on our results and analysis, we posit that bathing beach activities should be a high priority for waste managers as a point of intervention and beach-goers must be encouraged to take a more active role in keeping beaches clean. Further, plastic fragments on the beach should be targeted as a first priority for prevention (and cleanup) of marine litter with plastic bottle caps being a high priority to be targeted among plastics. More survey research is needed on non-plastic litter composition for which amounts and geographic dispersal in the region vary greatly from place to place along Mediterranean shores. In general, findings of this study lead us to recommend exploring persuasive beach trash can design coupled with greater enforcement for short term waste management intervention while considering the local socio-economic and institutional context further for long-term efforts.

scholarly journals Delayed Calcium Normalization after Successful Parathyroidectomy in Primary Hyperparathyroidism

2021 ◽  
Vol 2021 ◽  
pp. 1-4
Author(s):  
Iván Emilio de la Cruz Rodríguez ◽  
Elsy Sarahí García Montesinos ◽  
María Fernanda Rodríguez-Delgado ◽  
Guadalupe Vargas Ortega ◽  
Lourdes Balcázar Hernández ◽  
...  
Keyword(s):  
Case Report ◽  
Primary Hyperparathyroidism ◽  
Treatment Option ◽  
Serum Calcium ◽  
Curative Treatment ◽  
Long Term Outcomes ◽  
Medium Term ◽  
Short Term ◽  
Preoperative Serum

Introduction. Parathyroidectomy is the curative treatment option in primary hyperparathyroidism (PHPT). The decrease of parathormone (PTH) by 50% or more from levels prior to surgery after excision predicts successful parathyroidectomy. Serum calcium is expected to return to normal within 24–72 hours after the surgery; however, nearly 10% have transient, persistent postoperative hypercalcemia. We present a case report of delayed calcium normalization after successful parathyroidectomy in a 38-year-old patient with PHPT. Methods. Parathyroidectomy was performed, with evidence of a decrease in PTH levels of more than 50% in the first 24 hours postoperatively compared to presurgical PTH; however, despite curative parathyroidectomy, a delayed calcium normalization was evidenced, with hypercalcemia persistence up to 120 hours postoperatively. Results. After the first month postoperatively, serum calcium remained normal. In conclusion, approximately 10% of patients with curative parathyroidectomy have transient, persistent postoperative hypercalcemia, which is more likely to occur in patients with higher preoperative serum calcium and PTH levels. Conclusion. Persistent hypercalcemia after the first month postoperatively is related with persistent PHPT, highlighting the importance of calcium monitoring after parathyroidectomy to predict short-term, medium-term, and long-term outcomes and prognosis.

Drug Withdrawal in Male and Female Chronic Schizophrenics

1969 ◽  
Vol 115 (525) ◽  
pp. 961-962 ◽  
Author(s):  
M. H. Abenson
Keyword(s):  
Social Adjustment ◽  
Symptom Relief ◽  
Chronic Schizophrenia ◽  
Control Group ◽  
Control Groups ◽  
Short Term ◽  
Chronic Schizophrenics ◽  
Long Term Follow Up

Although the value of phenothiazines is without question in the treatment of acute schizophrenia, their value in chronic schizophrenia is questionable. Cawley (1) states that social and environmental factors become more prominent for symptom relief and social adjustment with increasing chronicity. Both Ekblom and Lassenius (2) and Simon et al. (7), who did long-term follow-up studies on drug-treated schizophrenics, found only slight improvement when compared with control groups. Letemendia and Harris (4) found no significant improvement on phenothiazine treatment of previously untreated chronic schizophrenics when compared with a control group. On the other hand Kelly and Sargant (3) found a distinct improvement after two years in a group of phenothiazine-treated patients, who were compared with earlier admissions to the same hospital before the introduction of drugs. However, whilst Pritchard (6) found the short term prognosis was better for phenothiazine-treated schizophrenics when compared with patients admitted prior to introduction of these drugs, he found the three-year follow-up produced little difference.

Conceptual short-term memory (CSTM) supports core claims of Christiansen and Chater

2016 ◽  
Vol 39 ◽  
Author(s):  
Mary C. Potter
Keyword(s):  
Working Memory ◽  
Rapid Serial Visual Presentation ◽  
Language Comprehension ◽  
Short Term Memory ◽  
Visual Presentation ◽  
Long Term Memory ◽  
Short Term ◽  
Term Memory ◽  
Use Of Knowledge

AbstractRapid serial visual presentation (RSVP) of words or pictured scenes provides evidence for a large-capacity conceptual short-term memory (CSTM) that momentarily provides rich associated material from long-term memory, permitting rapid chunking (Potter 1993; 2009; 2012). In perception of scenes as well as language comprehension, we make use of knowledge that briefly exceeds the supposed limits of working memory.

Ultrastructural investigations of MDL 19,660-induced effects on the canine platelet and megakaryocyte

1990 ◽  
Vol 48 (3) ◽  
pp. 374-375
Author(s):  
D.E. Loudy ◽  
J. Sprinkle-Cavallo ◽  
J.T. Yarrington ◽  
F.Y. Thompson ◽  
J.P. Gibson
Keyword(s):  
Antidepressant Drug ◽  
Beagle Dogs ◽  
Long Term Effects ◽  
Short Term ◽  
Platelet Counts ◽  
Toxicological Studies ◽  
Induced Aggregation ◽  
Internal Architecture

Previous short term toxicological studies of one to two weeks duration have demonstrated that MDL 19,660 (5-(4-chlorophenyl)-2,4-dihydro-2,4-dimethyl-3Hl, 2,4-triazole-3-thione), an antidepressant drug, causes a dose-related thrombocytopenia in dogs. Platelet counts started to decline after two days of dosing with 30 mg/kg/day and continued to decrease to their lowest levels by 5-7 days. The loss in platelets was primarily of the small discoid subpopulation. In vitro studies have also indicated that MDL 19,660: does not spontaneously aggregate canine platelets and has moderate antiaggregating properties by inhibiting ADP-induced aggregation. The objectives of the present investigation of MDL 19,660 were to evaluate ultrastructurally long term effects on platelet internal architecture and changes in subpopulations of platelets and megakaryocytes.Nine male and nine female beagle dogs were divided equally into three groups and were administered orally 0, 15, or 30 mg/kg/day of MDL 19,660 for three months. Compared to a control platelet range of 353,000- 452,000/μl, a doserelated thrombocytopenia reached a maximum severity of an average of 135,000/μl for the 15 mg/kg/day dogs after two weeks and 81,000/μl for the 30 mg/kg/day dogs after one week.

Comparison of Auditory, Language, Memory, and Attention Abilities in Children With and Without Listening Difficulties

2020 ◽  
Vol 29 (4) ◽  
pp. 710-727
Author(s):  
Beula M. Magimairaj ◽  
Naveen K. Nagaraj ◽  
Alexander V. Sergeev ◽  
Natalie J. Benafield
Keyword(s):  
Auditory Processing ◽  
Short Term Memory ◽  
Group Differences ◽  
Long Term Memory ◽  
Short Term ◽  
Significant Group ◽  
Term Memory ◽  
Memory And Attention ◽  
Speed And Accuracy

Objectives School-age children with and without parent-reported listening difficulties (LiD) were compared on auditory processing, language, memory, and attention abilities. The objective was to extend what is known so far in the literature about children with LiD by using multiple measures and selective novel measures across the above areas. Design Twenty-six children who were reported by their parents as having LiD and 26 age-matched typically developing children completed clinical tests of auditory processing and multiple measures of language, attention, and memory. All children had normal-range pure-tone hearing thresholds bilaterally. Group differences were examined. Results In addition to significantly poorer speech-perception-in-noise scores, children with LiD had reduced speed and accuracy of word retrieval from long-term memory, poorer short-term memory, sentence recall, and inferencing ability. Statistically significant group differences were of moderate effect size; however, standard test scores of children with LiD were not clinically poor. No statistically significant group differences were observed in attention, working memory capacity, vocabulary, and nonverbal IQ. Conclusions Mild signal-to-noise ratio loss, as reflected by the group mean of children with LiD, supported the children's functional listening problems. In addition, children's relative weakness in select areas of language performance, short-term memory, and long-term memory lexical retrieval speed and accuracy added to previous research on evidence-based areas that need to be evaluated in children with LiD who almost always have heterogenous profiles. Importantly, the functional difficulties faced by children with LiD in relation to their test results indicated, to some extent, that commonly used assessments may not be adequately capturing the children's listening challenges. Supplemental Material https://doi.org/10.23641/asha.12808607

Sign in / Sign up

Export Citation Format

Share Document