SciCombinator

Discover the most talked about and latest scientific content & concepts.

Journal: Joint, bone, spine : revue du rhumatisme

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In the majority of cases, Lyme disease responds well to antibiotic treatment. Nevertheless, some patients may suffer from chronic nonspecific symptoms such as musculoskeletal pain and fatigue, termed as a post-treatment Lyme disease syndrome (PTLDS). Proper understanding and management of PTLDS may prevent from the incorrect diagnosis of patients with autoimmune, neuromuscular or other somatic disorders, where identical symptoms are equally prevalent. We report a 37-year-old female with systemic lupus erythematosus (SLE) who was repeatedly misdiagnosed for a chronic Lyme disease and treated with tetracycline antibiotics before she developed an acute exacerbation of SLE and finally died due to multi-organ failure. The internet encourages patients to ask physicians for serology testing for Lyme disease and to demand further antibiotic treatment. However, there is clear evidence that positive serology does not indicate infection with B.burgdorferi and most importantly, antibiotic therapy for PTLDS is potentially harmful for patients. It is crucial to follow the recent guidelines for diagnosis and treatment of Lyme disease and PTLDS to avoid the repetition of antibiotic regimens and misdiagnosing patients.

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Cow’s milk is often severely criticized as a cause of multiple health problems, including an increased risk of fractures. A close look at the scientific literature shows a striking contradiction. On the one hand, experimental studies of surrogate markers (e.g., bone turnover markers and bone mineral density [BMD]) usually indicate benefits from drinking cow’s milk. On the other, the findings from epidemiological studies are conflicting and disconcerting. In all age groups, including children and postmenopausal women, consuming cow’s milk, powdered milk supplements, or whey protein is associated with a slower bone turnover and unchanged or higher BMD values. These benefits are particularly marked in populations where calcium deficiency is prevalent, for instance in Asian countries. No interventional studies have addressed the fracture risk potentially associated with drinking cow’s milk. The only available data come from epidemiological observational studies, whose results are conflicting, with a lower fracture risk in some cases and no difference or a higher risk in others. Several hypotheses have been offered to explain these findings, such as a deleterious effect of D-galactose, lactose intolerance, and acid overload. Epidemiological studies face many obstacles when seeking to detect effects of a single food, particularly the multiplicity of interactions among foods. Furthermore, reliable dietary intake data must be collected over prolonged periods, often long before the occurrence of a fracture, and defective recall may therefore introduce a major yet often unrecognized bias, particularly in populations where calcium deficiency is uncommon. To date, there is no conclusive evidence that we should modify our currently high level of consumption of cow’s milk.

Concepts: Scientific method, Osteoporosis, Bone, Epidemiology, Milk, Calcium, Lactose intolerance, Cheese

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Rheumatoid arthritis (RA) is the most common chronic inflammatory joint disease and is associated with an excess risk of cardiovascular disease. For the general population, the World Health Organization has issued detailed recommendations on the type of physical activity appropriate for decreasing the cardiovascular risk. The objective of this work is to review available data on the effects of physical activity in patients with RA.

Concepts: Medicine, Cardiovascular disease, Rheumatoid arthritis, Rheumatology, Osteoarthritis, Arthritis, World Health Organization, Psoriatic arthritis

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Drug-induced tendon toxicity is rare but often underestimated. To date, four main drug classes have been incriminated in tendinopathies. Quinolones and long-term glucocorticoids are the most widely known, but statins and aromatase inhibitors can also induce tendon damage. The specific pathophysiological mechanisms responsible for drug-induced tendinopathies remain unknown. Proven risk factors have been identified, such as age older than 60years, pre-existing tendinopathy, and potentiation of toxic effects when several drug classes are used in combination. Mean time to symptom onset varies from a few days with quinolones to several months with statins and several years for long-term glucocorticoid therapy. The most common sites of involvement are the lower limb tendons, most notably the body of the Achilles tendon. The first part of this review discusses tendon anatomy and the pathophysiology and radiological manifestations of tendinopathies. The second part provides details on the main characteristics of each of the drugs classes associated with tendon toxicity.

Concepts: Drug, Glucocorticoid, Drugs, Drug addiction, Toxicity, Tendon, Achilles tendon, Tendons

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To investigate the prevalence of the ultrasound findings indicative of monosodium urate crystal deposits at the hip joint in patients with gout and to explore the association between the ultrasound findings and the clinical and serological features.

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To evaluate the geoepidemiology of Sjögren’s syndrome (SS) in Latin America.

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Parotidomegaly is a criterion of the EULAR Primary Sjögren Syndrome Disease Activity Index (ESSDAI). The cut-off value was set at 3 cm in length for the parotid gland, 2 cm for the submandibular glands. However, clinical appreciation of salivary glands size remains hazardous. The objective is to evaluate inter-observer reproducibility of parotid gland measurement by palpation, and to secondary evaluate its reliability compared to US assessment.

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Osteogenesis imperfecta (OI) is a genetic disease whose clinical phenotype and severity vary considerably. The increased risk of fractures due to bone fragility persists in adulthood, notably after 40 years of age, albeit at a lower level than during growth. Adults with OI require periodic evaluations of the other manifestations of OI including hearing loss, respiratory impairments, ocular and dental abnormalities, and cardiovascular disease. Follow-up should therefore be provided by a multidisciplinary team, at intervals tailored to disease severity. Currently used treatments for OI have not been proven to decrease the fracture risk but are consistently effective in increasing bone mineral density. Specific orthopedic expertise is often required to treat fractures in patients with OI. A combination of periodic evaluations, chronic pain control, and disability management is necessary to improve quality of life.

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In the absence of previous studies, our objective was to assess whether gout was associated with an increase or decrease in the risk of Sjogren’s Syndrome (SS) in older adults, 65 years or older.

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a) to describe the self-reported adherence to disease modifying drugs (DMARDs) (methotrexate and biological DMARDs) among patients with chronic inflammatory rheumatic diseases (CIRDs); b) to assess factors associated with non-adherence.