BackgroundCo-morbid symptoms (for example, chronic pain, depression, anxiety, and fatigue) are particularly common in military fighters returning from the current conflicts, who have experienced physical and/or psychological trauma. These overlapping conditions cut across the boundaries of mind, brain and body, resulting in a common symptomatic and functional spectrum of physical, cognitive, psychological and behavioral effects referred to as the ‘Trauma Spectrum Response’ (TSR). While acupuncture has been shown to treat some of these components effectively, the current literature is often difficult to interpret, inconsistent or of variable quality. Thus, to gauge comprehensively the effectiveness of acupuncture across TSR components, a systematic review of reviews was conducted using the Samueli Institute’s Rapid Evidence Assessment of the Literature (REAL©) methodology.MethodsPubMed/MEDLINE, the Cochrane Database of Systematic Reviews, EMBASE, CINAHL, and PsycInfo were searched from inception to September 2011 for systematic reviews/meta-analyses. Quality assessment was rigorously performed using the Scottish Intercollegiate Guidelines Network (SIGN 50) checklist and the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) methodology. Adherence to the Standards for Reporting Interventions in Clinical Trials in Acupuncture (STRICTA) criteria was also assessed.ResultsOf the 1,480 citations identified by our searches, 52 systematic reviews/meta-analyses, all high quality except for one, met inclusion criteria for each TSR component except post-traumatic stress disorder (PTSD) and sexual function. The majority of reviews addressed most STRICTA components, but did not describe safety.ConclusionsBased on the results of our review, acupuncture appears to be effective for treating headaches and, although more research is needed, seems to be a promising treatment option for anxiety, sleep disturbances, depression and chronic pain. It does not, however, demonstrate any substantial treatment benefit for substance abuse. Because there were no reviews on PTSD or sexual function that met our pre-defined inclusion criteria, we cannot comment on acupuncture’s effectiveness in treating these conditions. More quality data are also needed to determine whether acupuncture is appropriate for treating fatigue or cognitive difficulties. Further, while acupuncture has been shown to be generally safe, safety was not described in the majority of studies, making it difficult to provide any strong recommendations. Future research should address safety reporting in detail in order to increase our confidence in acupuncture’s efficacy across the identified TSR components.

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The term "sympathetic synovial effusion" refers to a transudative, noninflammatory effusion occurring in a synovial-lined space contiguous to another inflamed joint, bursa, or other tissue space, presumably occurring as a reactive phenomenon in response to the inflammation (1). Sympathetic effusions have received little attention in the rheumatoiogic literature, and a general discussion of their characteristics and natural history has been lacking. We present here a case report and discussion of sympathetic effusions associated with infectious arthritis and bursitis, and a review of the available literature.Case report. A 29-year-old white woman was admitted to the hospital, with fever and left knee swelling and pain, which she had had for 6 days.Medical history included hypertension and brittle insulin-dependent diabetes mellitus, complicated by nephropathy, retinopathy, and peripheral neuropathy. Pertinent findings from the physical examination included an oral temperature of 38°C. There was diffuse

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