No abstract

In a study of 144 patients, with Grade 1 and 2 inversion injuries to the ankle sustained in sport, treatment with a non-steroidal anti-inflammatory was considerably superior to placebo with respect to joint tenderness, level of training and injury severity. No difference in efficacy could be determined between ibuprofen 2400 mg given in two or four equally divided daily doses. Ten patients withdrew from the study because of side effects, five from ibuprofen twice daily, three from ibuprofen four times daily and two from the placebo group. This study confirms the efficacy, flexibility and tolerability of high dose ibuprofen.

Background Juvenile Idiopathic Arthritis (JIA) is the main cause of chronic arthritis in children, and it can lead to joint damage and disability. Detecting early articular involvement in JIA is therefore of crucial importance to prevent cartilage and bone damage in these young patients. Since 2004 we have undertaken a prospective study of children with newly diagnosed JIA with knee involvement, and we noted that, not infrequently, knees deemed clinically normal had appreciable effusion on ultrasound (US). Objectives We wished to prospectively compare agreement between clinical, US and MRI assessments of the knee joints in children with JIA, and to develop an MRI scoring system that allows assessment of disease activity and progression in children with JIA and compare it with US examination. Methods Three hundred and thirty one knees from 48 children, affected by JIA with knee arthritis, were assessed clinically and ultrasonographically on the same day, using a semi-quantitative scoring system from 0 to 3 for swelling and effusion, respectively. A subgroup of these children (25) with a total of 40 knees had matching MRI scans obtained within 0 to 14 days from clinical and US examinations. For those, US and MRI scans (T2 weighted images) were scored 0-3 for effusion, synovial hypertrophy, bone oedema and bone erosions, using our newly developed knee MRI scoring system. An open 0.2 Tesla scanner without administration of gadolinium was used. Results A moderate agreement for effusion was found between the 331 knees assessed clinically and ultrasonographically (K 0.54). Out of the 260 knees without swelling, 30 (11.5%) had mild to moderate effusion on US (Table). In the subgroup of 40 knees that had matching US and MRI scans it was demonstrated a good agreement for effusion (K 0.66) and a moderate agreement for synovial hypertrophy (K 0.47) between the two methods of assessments. The inter-observer reliability for US was very good for effusion (K 0.87), and good for synovial hypertrophy (K 0.68). The intra-observer reliability for MRI was good for effusion (K 0.73) and very good for synovial hypertrophy (K 0.85). Moreover, US tends to be more sensitive than MRI at detecting joint effusion (US scored on average 0.08 higher on the scoring system than MRI), maybe due to the lower sensitivity of MRI as T2 weighted images rather than contrast with gadolinium was used. Conclusions A significant number of knee joint effusions are missed on clinical examination. Therefore US of this joint should be used as an adjunct to clinical examination to avoid under-diagnosis, especially when joint injections are being considered, when clinical examination is negative and symptoms are equivocal for active arthritis, at follow-up to assess treatment’s efficacy. We have developed a reproducible scoring system for MRI of the knee. US appeared to be more sensitive than MRI at detecting effusions, however this is probably due to the absence of using gadolinium in MRI. It does however highlight the benefits of MSUS in paediatric rheumatol...

Background: Osteoporotic fractures and falls are as heads and tails of a coin. Among the elderly, the greatest risk of fracture comes from falls, rather than osteoporosis, hence, bone mineral density measurement should not be used alone to estimate fracture risk or guide treatment decisions. Evidence shows that at least 15% of falls in older people can be prevented, with individual trials reporting relative reductions of up to 50%. We developed a model that predicts the falls risk among patients referred for bone mineral density using variables that are easily assessed in clinical practice. Methods: As part of the integrated osteoporosis and falls service, patients admitted to the hospital with low trauma fracture had their bone mineral density assessed. In addition to DXA scanning, fracture risk assessment using FRAX (before and after the occurrence of the fracture), as well as falls risk factors were analyzed. The independent predictive value of the different risk factors for the occurrence of falls was assessed using logistic regression analysis. A prediction scoring system was developed using data from a cohort of 106 patients. 102 osteoporotic patients without history of falls or fracture were also assessed as control group. The diagnostic performance of the prediction model was evaluated using the area under the curve (AUC). The developed prediction model was internally validated. Results: Falls risk was significantly higher among the osteoporotic patients who sustained fractures in comparison to the control group (P < 0.01). The risk factors significantly correlated with an increased risk of falls were: history of > 1 fall in the last 12 months (regression coefficient 2.2), slowing of the walking speed/ change of the gait (1.6), impaired vision (1.2), weak grip strength (1.1), loss of balance (1.2). Cut off point of 3.5 achieved the best sensitivity and specificity (0.918 and 0.86 respectively, PPV85.9) and was indicative of high falls risk. A score of 2.0-3.5 was indicative of moderate risk. Conclusions: The findings indicate that evaluation of falls risk based on risk factor profiles of individual patients can help physicians identify high risk osteoporotic patients and assist with decisions concerning falls prevention and patient management. Also, these results emphasize the importance of performing a falls risk assessment for all osteoporotic patients, in parallel with bone mineral density measurement, on regular basis as part of their assessment and management.