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Degenerative Joint Disease (Osteoarthritis)

A randomized, controlled trial of 156 individuals with knee osteoarthritis found that physical therapy was more effective at reducing pain and disability at 1 year than intra-articular glucocorticoid injections.

Crystal Deposition Arthritis

In a 2020 randomized, controlled trial in patients with CKD and a high risk of its progression, urate-lowering treatment with allopurinol did not slow the decline in eGFR when compared to placebo.

In patients with concomitant coronary artery disease, long-term colchicine use can reduce major cardiovascular events.

Despite initial concern that febuxostat was associated with more cardiovascular events than allopurinol, a large, randomized, controlled trial in 2020 showed that the two drugs have similar cardiovascular safety.

Immune-Mediated Inflammatory Myopathies

Inclusion body myositis, because of its tendency to mimic polymyositis, is a common cause of “treatment-resistant polymyositis.”

  • – In contrast to polymyositis, the typical patient with inclusion body myositis is White, male, and over the age of 50 years.

  • – The onset of inclusion body myositis is more insidious than that of polymyositis or dermatomyositis (eg, occurring over years rather than months), and the distal motor weakness is commonly asymmetric.

  • – Creatine kinase levels are often minimally elevated and are normal in 25%.

  • – Electromyography may show a mixed picture of myopathic and neurogenic abnormalities.

  • – The disease is associated with antibodies to cytoplasmic 5'-nucleotidase 1A (cN1A).

  • – Inclusion body myositis is less likely to respond to therapy.

Immune-mediated necrotizing myopathy, although similar to polymyositis, is distinct because of the presence of muscle necrosis.

  • – Autoantibodies aid in diagnosis; anti-SRP antibodies are associated with severe muscle weakness, pain, and cardiac involvement.

  • – Anti-HMGCR antibodies occur in the setting of statin use and are associated with proximal muscle weakness and marked creatine kinase elevations.

  • – Unlike statin-induced myopathy, anti-HMGCR myositis does not resolve when statins are stopped.

  • – Instead, many patients have a severe and unrelenting disease course with persistent weakness.

Granulomatosis with Polyangiitis

Plasma exchange does not reduce the incidence of end-stage kidney disease or death in severe ANCA-associated vasculitis.

Levamisole-Associated Purpura

There may be long-term sequelae of levamisole exposure, such as deforming cutaneous lesions, arthralgias, and arthritis.

Relapsing Polychondritis

Large vessel vasculitis is a frequently overlooked but potentially catastrophic complication.

Acute Pyogenic Osteomyelitis

Combined with surgical debridement, a 3-week course of antibiotics (compared to 6 weeks) may be sufficient.

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