Objective. To determine the diagnostic value of sonography in patients with suspected carpal tunnel syndrome (CTS).Methods. We conducted a prospective study of 110 wrists in 74 consecutive patients with suspected CTS who had been referred to a tertiary care center. We determined the largest cross-sectional area of the median nerve at the carpal tunnel. Because of the lack of a universally accepted reference standard, we first examined the association of sonography with nerve conduction. Then, we compared sonography with a reference standard based on the combination of nerve conduction studies and signs and symptoms. Sonography and reference standard tests were performed independently and interpreted under blinded conditions. Based on a fitted receiver operating characteristic curve, we estimated likelihood ratios (LRs) and posttest probabilities for different cutoffs.Results. There was a high concordance between sonography and nerve conduction. Based on the combined reference standard, a cutoff of 10 mm 2 resulted in approximately equal sensitivity and specificity, but only moderate LRs. A cutoff of <8 mm 2 had satisfactory power to rule out CTS: the fitted-negative LR was 0.13. Conversely, a cutoff of >12 mm 2 had excellent power to rule in CTS, with a fitted-positive LR of 19.9. For nerves >12 mm 2 and a pretest probability of 70% expected in patients with suspected CTS in tertiary care, we found a posttest probability of CTS of 98%.Conclusion. Depending on setting and purpose, different cutoff values for the largest cross-sectional area may be used to accurately rule in or rule out CTS. Using sonography as a first-line test may cost-effectively reduce the number of nerve conduction studies in patients with suspected CTS. A large-scale, randomized controlled trial is required to determine the effects of sonography on clinical outcomes, the number of nerve conduction studies performed, and the total cost.

Objective. To compare the efficacy and safety of intraarticular hylan and 2 hyaluronic acids (HAs) in osteoarthritis (OA) of the knee.Methods. This was a multicenter, patient-blind, randomized controlled trial in 660 patients with symptomatic knee OA. Patients were randomly assigned to Conclusion. We found no evidence for a difference in efficacy between hylan and HAs. In view of its higher costs and potential for more local adverse events, we see no rationale for the continued use of hylan in patients with knee OA.In patients with osteoarthritis (OA), synovial hyaluronic acid (HA) is depolymerized and cleared at higher rates than in normal individuals, resulting in a ISRCTN: 51421587.

Objective. Tumor necrosis factor (TNF) inhibitors have revolutionized the treatment of severe rheumatoid arthritis (RA), yet drug discontinuation is common. The aim of this study was to compare treatment retention rates and specific causes of anti-TNF discontinuation in a population-based RA cohort. Conclusion. In this population, infliximab was associated with higher overall discontinuation rates compared with etanercept and adalimumab, which is mainly due to an increased risk of infusion or allergic reactions.

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