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