1
|
Kaur IP, Mughal MS, Aslam F, Schram J, Bansal P. Non-surgical treatment of aseptic olecranon bursitis: A systematic review. Reumatol Clin (Engl Ed) 2023; 19:482-487. [PMID: 37945181 DOI: 10.1016/j.reumae.2023.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Accepted: 02/23/2023] [Indexed: 11/12/2023]
Abstract
OBJECTIVE Olecranon bursitis (OB), characterized by inflammation and fluid collection in the olecranon bursa is a commonly encountered out-patient condition. The data is heterogeneous regarding a stepwise and standardized approach to aseptic OB treatment and the efficacy of intra-bursal corticosteroid injections (CSI). The objective of this review is to systematically evaluate the non-surgical treatment options for aseptic OB. METHODS This systematic review was conducted in accordance with PRISMA recommendations. The English and non-English literature search was performed in 5 medical databases to identify studies evaluating the treatment of OB. All included studies were evaluated for risk of bias (RoB) using the revised Cochrane RoB tool for randomized control trials (RCTs) and the Newcastle-Ottawa Scale (NOS) for case-control and cohort studies. RESULTS For the final analyses, 2 RCTs and 2 observational studies were included. The RoB for the RCTs was high and both failed to demonstrate a significant difference in terms of the resolution of OB and bursal tenderness among various invasive and non-invasive treatment options. Corticosteroid injection (CSI) was associated with a significant decline in the duration of symptoms. However, it was associated with a higher number of complications including bursal infection and skin atrophy. CONCLUSION Based on the available data, it appears that the clinical resolution of aseptic OB can occur with conservative methods if implemented earlier in the disease course. Although CSI is more effective than other treatments, it should be reserved for refractory cases because of a higher complication rate.
Collapse
Affiliation(s)
- Ikwinder Preet Kaur
- Department of Rheumatology, University of Florida College of Medicine, 653-1 8th St W, Jacksonville, FL 32209, United States
| | - Mohsin Sheraz Mughal
- Department of Cardiology, UHS Wilson Medical Center, Johnson City, NY 13790, United States
| | - Fawad Aslam
- Department of Rheumatology, Mayo Clinic - Arizona, 13400 E Shea Blvd, Scottsdale, AZ 85259, United States
| | - Jennifer Schram
- Librarian and Supervisor, Mayo Clinic Libraries - Wisconsin, Mayo Clinic Health System, 1400 Bellinger Street, Eau Claire, WI 54701, United States
| | - Pankaj Bansal
- Department of Rheumatology, Mayo Clinic Health System, 1400 Bellinger Street, Eau Claire, WI 54701, United States.
| |
Collapse
|
2
|
Vega-Morales D, Pérez-Luna IRM, Aguirre-García VA, Vázquez-Fuentes BR. Non-steroidal anti-inflammatory drugs in the elderly. Agreement with safe prescription recommendations according to cardiovascular and gastrointestinal risks. Reumatol Clin (Engl Ed) 2021; 17:499-503. [PMID: 34756310 DOI: 10.1016/j.reumae.2020.05.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Accepted: 05/27/2020] [Indexed: 06/13/2023]
Abstract
INTRODUCTION/OBJECTIVE Non-Steroidal Anti-Inflammatory Drugs are the cornerstone in the treatment of acute and chronic pain due to inflammation in musculoskeletal conditions. Even though adverse side-effects are associated, their use is common in the elderly patients. Our aim is to determine the prescription trend of NSAIDs, the evaluation for gastrointestinal (GI) and cardiovascular (CV) risks, and the level of agreement with prescription guidelines. METHODS We conducted an observation and descriptive study in a general hospital geriatrics consultation. RESULTS From the 231 patients only 59 patients had a NSAIDs prescription. The most frequently prescribed was Acetaminophen, in 29(49.1%) patients, Celecoxib was prescribed in 11(18.6%) patients, Piroxicam in 5(8.4%) patients, Acetaminophen plus Celecoxib plus Omeprazole in 4 (6.7%), Acetaminophen plus Piroxicam in 2 (0.3%) patients, and Acetaminophen plus Diclofenac plus Celecoxib in 1 patient (1.6%). In the Framingham risk classification there were 160/231 (69.3%) patients in Very High Risk and 71/231 (30.7%) patients in High Risk. There were no patients in Low Risk. GI Risk: 79 patients (34.1%) had a peptic ulcer disease history. There were 55/231 (23.8%) in the High GI Risk classification, 102/231 (44.1%) in Intermediate GI Risk and 74/231 (32%) in the Low Risk. The level of agreement between the prescribed versus recommended NSAIDs according the CV and GI risks was measured with a contingence table and the kappa statistic of 0.37 p=0.001. CONCLUSION There is a low level of agreement between prescribed and recommended NSAID in elderly population.
Collapse
Affiliation(s)
- David Vega-Morales
- Rheumatology Service, Department of Internal Medicine, University Hospital "Dr. José Eleuterio González", Autonomous University of Nuevo Leon, Monterrey, Mexico; Hospital General de Zona No 17, Mexican Institute of Social Security, Nuevo Leon, Mexico.
| | | | - Virginia Alejandra Aguirre-García
- Rheumatology Service, Department of Internal Medicine, University Hospital "Dr. José Eleuterio González", Autonomous University of Nuevo Leon, Monterrey, Mexico
| | - Brenda Roxana Vázquez-Fuentes
- Rheumatology Service, Department of Internal Medicine, University Hospital "Dr. José Eleuterio González", Autonomous University of Nuevo Leon, Monterrey, Mexico
| |
Collapse
|
3
|
Moreno M, Arévalo M, Zamora M, Pontes C, Oliva JC, Gratacós J. Comparison of disease activity in patients with ankylosing spondylitis under TNFi or NSAID treatment, is there any difference? An observational study. Reumatol Clin (Engl Ed) 2021; 17:192-196. [PMID: 31558361 DOI: 10.1016/j.reuma.2019.07.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Revised: 07/11/2019] [Accepted: 07/20/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVE To assess whether there are any real-life differences between ankylosing spondylitis (AS) patients treated with NSAID or TNF inhibitors (TNFi) regarding disease activity. METHODS This is an observational transversal unicentric study with retrospective retrieval of data from clinical records of all AS patients attended in our hospital. We compared clinical activity measured by Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) scores between patients treated with NSAID and those treated with TNFi, in terms of low disease activity defined as BASDAI<4, and inactivity when BASDAI≤2. As secondary variables, we also collected epidemiological, clinical and radiological data from all those patients. RESULTS A total of 152 AS patients (81% male), with an average age of 49.45±12.38 years and a disease duration of 13.5±9.79 years were included in the study. Eighty-nine patients (58.6%) were treated with NSAID and 63 (41.4%) with TNFi. The proportion of patients with low disease activity and inactive disease was significantly higher in the TNFi treatment group compared to the NSAID group (81 vs. 47, P=.0001) and (44 vs. 24, P=.007), respectively. Patients treated with NSAIDs also showed significantly more global pain and night pain than those under TNFi therapy. The BASFI score and especially the type of treatment (NSAID or TNFI) were the only variables independently associated with low disease activity or inactive disease. CONCLUSION In real world practice, AS patients under TNFi treatment show a better control of clinical symptoms than those under NSAIDs.
Collapse
Affiliation(s)
- Mireia Moreno
- Rheumatology Department, University Hospital Parc Taulí, I3PT Universitat Autònoma de Barcelona, Sabadell (Barcelona), Spain
| | - Marta Arévalo
- Rheumatology Department, University Hospital Parc Taulí, I3PT Universitat Autònoma de Barcelona, Sabadell (Barcelona), Spain.
| | - Marc Zamora
- Universitat Autònoma de Barcelona (UAB), Spain
| | - Caridad Pontes
- Clinical Pharmacology Unit, Universitat Autònoma de Barcelona, Sabadell (Barcelona), Spain
| | - Juan Carlos Oliva
- Statistics Department, University Hospital Parc Taulí, I3PT Universitat Autònoma de Barcelona, Sabadell (Barcelona), Spain
| | - Jordi Gratacós
- Rheumatology Department, University Hospital Parc Taulí, I3PT Universitat Autònoma de Barcelona, Sabadell (Barcelona), Spain
| |
Collapse
|
4
|
Ma J, Peng M, Wang F, Chen L, Zhang ZZ, Wang YL. [Effect of pre-administered flurbiprofen axetil on the EC50 of propofol during anesthesia in unstimulated patients: a randomized clinical trial]. Rev Bras Anestesiol 2020; 70:605-612. [PMID: 33223005 DOI: 10.1016/j.bjan.2020.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Revised: 08/04/2020] [Accepted: 08/08/2020] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Preoperative use of flurbiprofen axetil (FA) is extensively adopted to modulate the effects of analgesia. However, the relationship between FA and sedation agents remains unclear. In this study, we aimed to investigate the effects of different doses of FA on the median Effective Concentration (EC50) of propofol. METHODS Ninety-six patients (ASA I or II, aged 18-65 years) were randomly assigned into one of four groups in a 1:1:1:1 ratio. Group A (control group) received 10 mL of Intralipid, and groups B, C and D received 0.5 mg.kg-1, 0.75 mg.kg-1 and 1 mg.kg-1 of FA, respectively, 10 minutes before induction. The depth of anesthesia was measured by the Bispectral Index (BIS). The "up-and-down" method was used to calculate the EC50 of propofol. During the equilibration period, if BIS ≤ 50 (or BIS > 50), the next patient would receive a 0.5 μg.mL-1-lower (or-higher) propofol Target-Controlled Infusion (TCI) concentration. The hemodynamic data were recorded at baseline, 10 minutes after FA administration, after induction, after intubation, and 15 minutes after intubation. RESULTS The EC50 of propofol was lower in Group C (2.32 μg.mL-1, 95% Confidence Interval [95% CI] 1.85-2.75) and D (2.39 μg.mL-1, 95% CI 1.91-2.67) than in Group A (2.96 μg.mL-1, 95% CI 2.55-3.33) (p = 0.023, p = 0.048, respectively). There were no significant differences in the EC50 between Group B (2.53 μg.mL-1, 95% CI 2.33-2.71) and Group A (p ˃ 0.05). There were no significant differences in Heart Rate (HR) among groups A, B and C. The HR was significantly lower in Group D than in Group A after intubation (66 ± 6 vs. 80 ± 10 bpm, p < 0.01) and 15 minutes after intubation (61 ± 4 vs. 70 ± 8 bpm, p < 0.01). There were no significant differences among the four groups in Mean Arterial Pressure (MAP) at any time point. The MAP of the four groups was significantly lower after induction, after intubation, and 15 minutes after intubation than at baseline (p < 0.05). CONCLUSION High-dose FA (0.75 mg.kg-1 or 1 mg.kg-1) reduces the EC50 of propofol, and 1 mg.kg-1 FA reduces the HR for adequate anesthesia in unstimulated patients. Although this result should be investigated in cases of surgical stimulation, we suggest that FA pre-administration may reduce the propofol requirement when the depth of anesthesia is measured by BIS.
Collapse
Affiliation(s)
- Jing Ma
- Zhongnan Hospital of Wuhan University, Department of Anesthesiology, Wuhan, China
| | - Mian Peng
- Zhongnan Hospital of Wuhan University, Department of Anesthesiology, Wuhan, China
| | - Fei Wang
- Zhongnan Hospital of Wuhan University, Department of Anesthesiology, Wuhan, China
| | - Lei Chen
- Zhongnan Hospital of Wuhan University, Department of Anesthesiology, Wuhan, China
| | - Zong-Ze Zhang
- Zhongnan Hospital of Wuhan University, Department of Anesthesiology, Wuhan, China
| | - Yan-Lin Wang
- Zhongnan Hospital of Wuhan University, Department of Anesthesiology, Wuhan, China.
| |
Collapse
|
5
|
Del Olmo Martínez ML, Velayos Jiménez B, Almaraz-Gómez A. Hydration with Lactated Ringer's solution combined with rectal diclofenac in the prevention of pancreatitis after endoscopic retrograde cholangiopancreatography. Gastroenterol Hepatol 2020; 44:20-26. [PMID: 32674877 DOI: 10.1016/j.gastrohep.2020.03.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Revised: 02/13/2020] [Accepted: 03/13/2020] [Indexed: 12/17/2022]
Abstract
OBJECTIVE Different measures are recommended to reduce pancreatitis after endoscopic retrograde cholangiopancreatography (ERCP). We conducted a study in patients with ERCP treated with rectal diclofenac or lactated Ringer's solution, or both interventions, to assess whether there is a decrease in the number of cases of post-ERCP pancreatitis. MATERIAL AND METHODS A mixed cohort study involving 1,896 patients from 2009 to 2018. Up to June 2012 without treatment (Group I). Subsequently, 100mg of rectal diclofenac (Group II). Since 2016, lactated Ringer's solution 200ml/hour during the procedure and 4hours after it, in addition to 500ml over 30minutes when the pancreas was cannulated (Group III). Since 2017, lactated Ringer's solution plus Diclofenac (Group IV). There were 725 patients in group I, and 530, 227 and 414 patients in groups II, III and IV, respectively. Factors predisposing to post-ERCP pancreatitis and post-ERCP pancreatitis cases that were defined by consensus criteria have been collected. RESULTS There were 65 cases of post-ERCP pancreatitis (3.4%); 2.9%, 3.4%, 3.1% and 4.3% in groups I, II, III and IV, respectively (P=.640). In group I, there was 4.2% of post-ERCP pancreatitis in naïve papillae and 4%, 4.9% and 6.3% in groups II, III and IV, respectively (P=.585). The severity of post-ERCP pancreatitis and adverse effects were similar in all groups. 38.4% were high-risk patients. There were also no differences in post-ERCP pancreatitis in this group (P=.501). CONCLUSION In this work, no benefit was obtained with diclofenac plus hydration in reducing the number and severity of cases of post-ERCP pancreatitis nor with the other prophylactic measures.
Collapse
Affiliation(s)
| | - Benito Velayos Jiménez
- Servicio de Aparato Digestivo, Hospital Clínico Universitario de Valladolid, Valladolid, España
| | - Ana Almaraz-Gómez
- Departamento de Medicina Preventiva y Salud Pública, Facultad de Medicina, Universidad de Valladolid, Valladolid, España
| |
Collapse
|
6
|
Vega-Morales D, Pérez-Luna IRM, Aguirre-García VA, Vázquez-Fuentes BR. Non-Steroidal Anti-Inflammatory Drugs in the Elderly. Agreement With Safe Prescription Recommendations According to Cardiovascular and Gastrointestinal Risks. Reumatol Clin (Engl Ed) 2020; 17:S1699-258X(20)30133-9. [PMID: 32660837 DOI: 10.1016/j.reuma.2020.05.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Revised: 05/20/2020] [Accepted: 05/27/2020] [Indexed: 06/11/2023]
Abstract
INTRODUCTION/OBJECTIVE Non-Steroidal Anti-Inflammatory Drugs are the cornerstone in the treatment of acute and chronic pain due to inflammation in musculoskeletal conditions. Even though adverse side-effects are associated, their use is common in the elderly patients. Our aim is to determine the prescription trend of NSAIDs, the evaluation for gastrointestinal (GI) and cardiovascular (CV) risks, and the level of agreement with prescription guidelines. METHODS We conducted an observation and descriptive study in a general hospital geriatrics consultation. RESULTS From the 231 patients only 59 patients had a NSAIDs prescription. The most frequently prescribed was Acetaminophen, in 29(49.1%) patients, Celecoxib was prescribed in 11(18.6%) patients, Piroxicam in 5(8.4%) patients, Acetaminophen plus Celecoxib plus Omeprazole in 4 (6.7%), Acetaminophen plus Piroxicam in 2 (0.3%) patients, and Acetaminophen plus Diclofenac plus Celecoxib in 1 patient (1.6%). In the Framingham risk classification there were 160/231 (69.3%) patients in Very High Risk and 71/231 (30.7%) patients in High Risk. There were no patients in Low Risk. GI Risk: 79 patients (34.1%) had a peptic ulcer disease history. There were 55/231 (23.8%) in the High GI Risk classification, 102/231 (44.1%) in Intermediate GI Risk and 74/231 (32%) in the Low Risk. The level of agreement between the prescribed versus recommended NSAIDs according the CV and GI risks was measured with a contingence table and the kappa statistic of 0.37 p=0.001. CONCLUSION There is a low level of agreement between prescribed and recommended NSAID in elderly population.
Collapse
Affiliation(s)
- David Vega-Morales
- Rheumatology Service, Department of Internal Medicine, University Hospital "Dr. José Eleuterio González", Autonomous University of Nuevo Leon, Monterrey, Mexico; Hospital General de Zona No 17, Mexican Institute of Social Security, Nuevo Leon, Mexico.
| | | | - Virginia Alejandra Aguirre-García
- Rheumatology Service, Department of Internal Medicine, University Hospital "Dr. José Eleuterio González", Autonomous University of Nuevo Leon, Monterrey, Mexico
| | - Brenda Roxana Vázquez-Fuentes
- Rheumatology Service, Department of Internal Medicine, University Hospital "Dr. José Eleuterio González", Autonomous University of Nuevo Leon, Monterrey, Mexico
| |
Collapse
|
7
|
Moura LFDL, Vidor SB, Trindade AB, Mörschbächer PD, Oleskovicz N, Contesini EA. [Subarachnoid meloxicam does not inhibit the mechanical hypernociception on carrageenan test in rats]. Rev Bras Anestesiol 2015; 65:124-9. [PMID: 25740279 DOI: 10.1016/j.bjan.2013.10.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2013] [Accepted: 10/28/2013] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND AND OBJECTIVE Evaluate the antinociceptive effects of subarachnoid meloxicam on the mechanical hypernociception induced by carrageenan in rats. METHODS Randomized controlled trial. Eighteen adult male Wistar rats underwent a cannula implantation into the subarachnoid space and were randomly divided into two groups: Group I (GI) received saline solution 5μL, while Group II (GII) received meloxicam 30mg. The mechanical hypernociception was induced by intraplantar injection of carrageenan and evaluated using a digital analgesymeter every 30minutes during a 4 hour period. The results were recorded as the Δ withdrawal threshold (in g), calculated by subtracting the measurement value after RESULTS The Δ withdrawal threshold mean values were lower in the group of patients treated with meloxicam over all time points between 45 and 165minutes, however, there was no statistical significance, (p=0.835) for this difference. CONCLUSION Subarachnoid meloxicam at a dose of 30μg.animal(-1) did not suppress the mechanical hypernociception in a model of inflammatory pain induced by intraplantar administration of carrageenan in rats. The data suggest that other dosages should be investigated the drug effect is discarded.
Collapse
Affiliation(s)
| | - Silvana Bellini Vidor
- Programa de Pós-Graduação em Ciências Veterinárias, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brasil
| | - Anelise Bonilla Trindade
- Programa de Pós-Graduação em Ciências Veterinárias, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brasil
| | | | | | - Emerson Antonio Contesini
- Faculdade de Veterinária da Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brasil
| |
Collapse
|