Managing Joint Pain in Primary Care

Palmer, Trish; Toombs, James D.

doi:10.3122/jabfm.17.suppl_1.s32

Cited by 19 publications

(13 citation statements)

References 49 publications

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“…OTC pain medications, including acetaminophen and ibuprofen, are effective therapies for minor arthralgia and myalgia symptoms and are appropriate initial therapies for symptoms of acute joint pain [36]. Many women receiving AI therapy may opt for these medications in lieu of discontinuing hormonal treatment.…”

Section: Managing Ai-induced Arthralgiamentioning

confidence: 99%

Musculoskeletal Adverse Events Associated with Adjuvant Aromatase Inhibitors

Khan

O’Dea

Sharma

2010

Journal of Oncology

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Musculoskeletal symptoms including arthralgia and myalgia occur frequently in aging women, particularly during the transition to menopause, when plasma estrogens precipitously decline. In postmenopausal women (PMW) with breast cancer, third-generation aromatase inhibitors (AIs) as adjuvant hormonal therapy have proven to be more effective, and to have a more predictable side effect profile, than tamoxifen. However, AIs further reduce plasma estrogens in PMW, exacerbating musculoskeletal symptoms. Clinical trial data have shown significantly higher incidences of arthralgia and myalgia with AIs compared with women on tamoxifen or placebo. Symptoms may be severe enough to significantly affect quality of life; musculoskeletal symptoms are a frequent reason for discontinuing therapy. In many cases, symptoms can be effectively managed with oral analgesics or other strategies. Early recognition and effective management of musculoskeletal symptoms can help maximize treatment compliance, enabling patients to derive optimal benefit from therapy in terms of preventing recurrence.

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Section: Managing Ai-induced Arthralgiamentioning

confidence: 99%

Musculoskeletal Adverse Events Associated with Adjuvant Aromatase Inhibitors

Khan

O’Dea

Sharma

2010

Journal of Oncology

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“…When assessing chronic joint pain, the physician should ask about the location(s), onset, and progression of the pain as well as the presence of systemic symptoms. 61 In addition to the patient’s medical history, a family history of joint disease and rheumatic conditions should be reviewed. Physical examination involves inspection, palpation, range of motion, and other specialized tests.…”

Section: Clinical and Laboratory Assessmentmentioning

confidence: 99%

“…Blood tests such as ESR and CRP can be helpful to rule out an autoimmune disorder, but other laboratory tests such as rheumatoid factor, anti-cyclic citrullinated peptide, ANA, and other auto-antibodies are often best ordered only when there is a strong clinical suspicion of an autoimmune disorder. 6 , 29 , 61-63 Elevated ESR and CRP are also often elevated in other conditions such as systemic infections or malignancy. 64 …”

Section: Clinical and Laboratory Assessmentmentioning

confidence: 99%

A Practical Guide to Managing Patients With Systemic Symptoms and Breast Implants

McGuire¹,

Clauw

Hammer

et al. 2021

Aesthetic Surgery Journal

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Numerous studies have explored the possibility of an association between breast implants and systemic symptoms potentially linked to exposure to silicone. Some studies show no direct association while others provide insufficient scientific evidence to prove or disprove an association. Nonetheless, some patients with breast implants remain concerned about the possible role of their implants in systemic symptoms they may be experiencing. This paper provides a practical approach for plastic surgeons in managing patients with breast implants who present with systemic symptoms, including recommendations for patient counseling, clinical and laboratory assessment of symptoms, and/or referral. Integral components of patient counseling include listening attentively, providing unbiased information, and discussing the risks and benefits of options for evaluation and treatment. A thorough history and assessment of symptoms, including appropriate laboratory tests, may identify underlying conditions to expeditiously address patients’ health issues through a specialist referral. Diagnosing and treating disorders that are causing a patient’s symptoms, if unrelated to their implant, would avoid a potentially unnecessary surgery. Ultimately, better information is needed to reliably guide patients in an evidence-based fashion. Long-term follow-up of patients who are explanted to see what symptoms may or may not improve could be useful in educating patients. Control groups in studies prospectively following women with implants for development of systemic symptoms would also be useful as the symptoms reported are common in women without implants. Cases are presented to illustrate the recommendations for a practical approach toward management of women reporting systemic symptoms with breast implants.

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“…This was based on the standards of care for treating pain. [39][40][41] Ultimately if the patient outcome did not improve, that patient underwent a surgical arthroscopic procedure.…”

Section: Limitationsmentioning

confidence: 99%

Cost-Effectiveness Analysis of Needle Arthroscopy Versus Magnetic Resonance Imaging in the Diagnosis and Treatment of Meniscal Tears of the Knee

Amin

McIntyre

Carter

et al. 2019

Arthroscopy: The Journal of Arthroscopic & Related Surgery

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To determine whether needle arthroscopy (NA) compared with magnetic resonance imaging (MRI) in the diagnosis and treatment of meniscal tears is cost-effective when evaluated over a 2-year period via patient-reported outcomes. The hypothesis is that improved diagnostic accuracy with NA would lead to less costly care and similar outcomes. Methods: A Markov model/decision tree analysis was performed using TreeAge Pro 2017 software. Patients were evaluated for degenerative and traumatic damage to the lateral/medial meniscus. Assumed sensitivities and specificities were derived from the medical literature. The direct costs for care were derived from the 2017 Medicare fee schedule and from private payer reimbursement rates. Costs for care included procedures performed for false-positive findings and for care for false-negative findings. Effectiveness was examined using the global knee injury and osteoarthritis outcome score (KOOS). Patients were evaluated over 2 years for costs and outcomes, including complications. Dominance and incremental cost-effectiveness were evaluated, and 1-to 2-way sensitivity analysis was performed to determine those variables that had the greatest effect. The consolidated economics evaluation and reporting standards checklist for reporting economic evaluations was used. Results: NA was less costly and had similar KOOS versus MRI for both the medial/lateral meniscus with private pay.

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Managing Joint Pain in Primary Care

Cited by 19 publications

References 49 publications

Musculoskeletal Adverse Events Associated with Adjuvant Aromatase Inhibitors

Musculoskeletal Adverse Events Associated with Adjuvant Aromatase Inhibitors

A Practical Guide to Managing Patients With Systemic Symptoms and Breast Implants

Cost-Effectiveness Analysis of Needle Arthroscopy Versus Magnetic Resonance Imaging in the Diagnosis and Treatment of Meniscal Tears of the Knee

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