Chronic Joint Pain Research Articles

Efficacy of Tui-na for Treatment of Osteoarthritis: A Systematic Review and Meta-analysis

Osteoarthritis (OA) is one of the most common causes for chronic joint pain in canine patients. The objective of this systematic review and meta-analysis study was to determine whether Tui-na can be an effective treatment for osteoarthritis when performed alone or part of a multi-modal approach. All studies using Tui-na as a treatment for OA published in peer-reviewed journals were considered in initial search results. To be included in the meta-analysis, the study must have reported statistical results associated with one of the following endpoints: 1) relief of pain; 2) improvement of mobility; 3) improved quality of life. There were 10 articles in experimental OA animal models and 18 in human clinical studies that met inclusion criteria. Overall p-value on experimental OA animal model studies was 4.47×10-11, suggesting that Tui-na treatments were significantly effective when compared to model control animals not receiving treatments. Overall p-value on human studies was 6.74×10-13, also suggesting that Tui-na treatments can be effective for treating OA-related diseases in human patients. With treatment effective rate available in 14 human studies, meta-analysis performed with effect size model revealed a significant overall group effect (p = 6.72×10-10), suggesting patients treated with Tui-na can have a higher effective rate than those treated without receiving Tui-na. The positive results on experimental model and human clinical studies indicate that Tui-na treatments have potential to be an effective treatment option for veterinary patients with OA conditions.

Anti-Inflammatory and Analgesic Properties of the Cannabis Terpene Myrcene in Rat Adjuvant Monoarthritis.

Cannabis-based terpenes are believed to modulate physiological responses to disease and alter the efficacy of cannabinoids in the so-called “entourage effect”. The monoterpene myrcene can reduce nociception produced by noxious thermal and mechanical stimuli as well as reducing acute inflammation. The current study examined the role of myrcene and cannabidiol (CBD) in controlling chronic joint inflammation and pain. Chronic arthritis was induced in male Wistar rats by intra-articular injection of Freund’s complete adjuvant into the right knee. On days 7 and 21 after arthritis induction, joint pain (von Frey hair algesiometry), inflammation (intravital microscopy, laser speckle contrast analysis) and joint histopathology were assessed. Local application of myrcene (1 and 5 mg/kg s.c.) reduced joint pain and inflammation via a cannabinoid receptor mechanism. The combination of myrcene and CBD (200 μg) was not significantly different from myrcene alone. Repeated myrcene treatment had no effect on joint damage or inflammatory cytokine production. These data suggest that topical myrcene has the potential to reduce chronic arthritis pain and inflammation; however, it has no synergistic effect with CBD.

Selective Sensory Denervation by Means of Radiofrequency (RF) Ablation: a Novel Non-surgical Treatment Approach in Chronic Joint Pain: a Narrative Review on Its Application on Knee Hip and Shoulder

Selective Sensory Denervation by Means of Radiofrequency (RF) Ablation: a Novel Non-surgical Treatment Approach in Chronic Joint Pain: a Narrative Review on Its Application on Knee Hip and Shoulder

The Interaction between Carbon Monoxide and Hydrogen Sulfide during Chronic Joint Pain in Young Female Mice.

A relationship between carbon monoxide (CO) and hydrogen sulfide (H2S) has been described in different pathological conditions, but their interaction in modulating joint pain has not yet been investigated. In young female mice with monosodium acetate-induced joint degeneration and pain, we assessed: (1) the effects of CORM-2 (tricarbonyldichlororuthenium(II)dimer), a CO-releasing molecule, and CoPP (cobalt protoporphyrin IX), an inducer of heme oxygenase 1 (HO-1), administered alone and combined with low doses of two slow-releasing H2S donors, DADS (diallyl disulfide) and GYY4137 (morpholin-4-ium 4-methoxyphenyl(morpholino) phosphinodithioate dichloromethane complex) on the mechanical allodynia and loss of grip strength provoked by joint degeneration; (2) the role of Nrf2, NAD(P)H: quinone oxidoreductase 1 (NQO1) and HO-1 in the antinociceptive actions of H2S donors; (3) the impact of DADS and GYY4137 treatment on the expression of Nrf2 and several antioxidant proteins in dorsal root ganglia (DRG) and periaqueductal gray matter (PAG). Our data showed that treatment with H2S donors inhibited allodynia and functional deficits, while CORM-2 and CoPP only prevented allodynia. The Nrf2 pathway is implicated in the analgesic actions of DADS and GYY4137 during joint degeneration. Moreover, the co-administration of low doses of CORM-2 or CoPP with DADS or GYY4137 produced higher antiallodynic effects and greater recovery of grip strength deficits than those produced by each of these compounds alone. The activation of the antioxidant system caused by H2S donors in DRG and/or PAG might explain the enhancement of antinociceptive effects. These data reveal a positive interaction between H2S and CO in modulating joint pain in female mice.

Radiofrequency Ablation as an Effective Long-Term Treatment for Chronic Sacroiliac Joint Pain: A Systematic Review of Randomized Controlled Trials.

Radiofrequency ablation (RFA) has emerged as a popular intervention for chronic pain management, including pain originating in the sacroiliac joint. It offers a less invasive option than surgery but with better results than the previous standard treatment with steroid and anesthetic injections. Procedure volumes have enjoyed significant growth in the market in recent years. The evidence supporting this intervention, in the form of randomized controlled trials, however, is both thin and mixed. The purpose of this systematic review is to evaluate the body of randomized controlled trials (RCTs) to determine the quality of support for and against the use of radiofrequency ablation to treat sacroiliac joint (SIJ) pain. Several important new papers have emerged since previous systematic reviews with similar objectives were published. The review was conducted according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, and three databases were used: PubMed, Google Scholar, and Scopus. Only RCTs were sought, and no other filters, such as a historical timeline cut-off, were used. Among 95 publications that returned in response to the query, 16 were ultimately accepted as meeting the inclusion/exclusion criteria. The Cochrane risk-of-bias tool was utilized as a quality assessment measure, and the GRADE (Grading of Recommendations, Assessment, Development, and Evaluations) framework was used to assess the certainty of the evidence. Among the included publications, 15 out of 16 publications featured positive results and conclusions that supported the use of RFA in treating chronic sacroiliac joint pain. The single negative study was also the largest trial (n=681), but it was identified as “High Risk” using the Cochrane risk-of-bias tool. It included several design flaws including neither operator nor patient blinding, missing information, use of inconsistent treatment modalities across groups, and disproportionate drop-out rates. Despite its flaws, we have included this study in the present review because of its sheer size. Taken in aggregate, the total body of research included in this review supports this intervention. Questions continue to exist around whether there are clinically significant benefits associated with different RFA modalities (for example, unipolar vs. bipolar), with convincing evidence supporting each of them. Finally, it can be concluded that while the benefits are reasonably and justifiably supported in this patient population for up to one year, there is a dearth of evidence beyond a 12-month post-intervention follow-up.

Long-term chronic joint pain after sleeve gastrectomy and its influence on clinical and psychological outcomes

IntroductionBariatric surgery (BS) is effective in improving chronic joint pain (CJP). However, the long-term effects on this comorbidity are poorly understood. ObjectivesTo determine the prevalence of CJP in a sample of patients who had undergone BS with a minimum follow-up of 18 months. To determine whether or not there was any relationship between CJP and clinical or psychological outcomes after BS. Material and methodsCross-sectional study. The Lattinen index (LI) was used to evaluate CJP, using the cut-off point of 10 to define significant CJP (SCJP). ResultsOf the 110 subjects assessed, 31.2% (35/110) had SCJP. The patients with SCJP were older (57.4±13 vs 47.8±11.6 years; p<0.0001) and more time had elapsed since their BS (105.6±54.3 vs 78.5±39 months; p=0.023). The last BMI was higher in subjects with SCJP (35±5 vs 33.3±6.9kg/m2; p=0.05) and the percentage of patients who took significant regular exercise was lower (2.9% vs 68%; p<0.0001). Trauma problems after BS were more common in subjects with SCJP (61.8% vs 22.7%; p<0.0001). More patients with SCJP met depression criteria (47.1% vs 5.3%; p<0.0001) and/or were treated with antidepressants (38.2% vs 17.3%; p=0.003). Patients with SCJP reported fewer hours of sleep (6±1.4 vs 6.8±1.2h; p=0.003). ConclusionsSCJP is highly prevalent in patients who have had BS once they reach the weight plateau phase. There is an association between having SCJP and worse psychological and functional status, with potential detrimental metabolic effects.

ID:16078 IPG-Free PNS of the Obturator Nerve for the Treatment of Post-Traumatic Hip Arthralgia and Osteoarthritis

The obturator nerve is the biggest nerve in the anterior lumbar plexus, which is a group of nerves in the lower back region. Damage and subsequent pain of the obturator nerve can occur due to injuries to the nerve itself or to the nearby tissues and musculature. A 34-year-old varsity basketball coach (female) presented with chronic hip joint pain over the lateral aspect of the hip and anteriorly over the groin radiating down the thigh. She had 3 arthroscopies with some pain relief but continued to report constant, dull and aching pain, which worsened with increased activity such as playing sports. Alternative therapies such as ultrasound-guided injections and medication proved unsuccessful.

Ultrasound-Guided Intraarticular Electrical Stimulation, a New Intervention for Improving Physical Activity and Quality of Life in Patients with Severe Knee Osteoarthritis: Cases Report

Knee osteoarthritis is one of the diseases that cause degeneration of articular cartilage, subchondral bone, and chronic joint pain and stiffness. While there is no effective treatment for inhibiting the progression of its advancement, there are various interventions for managing symptoms of this condition in its early stages and a few treatments for advanced stages. In patients with severe knee osteoarthritis, the most recommended treatment is surgery. However, this procedure is contraindicated for many patients because of their comorbidities. In this study, a new physical intervention for managing the symptoms of advanced knee osteoarthritis in patients whose surgery is not indicated has been investigated, and its results have been reported. These data demonstrate that this method seems to be effective in Pain and stiffness reduction and improves physical activity and quality of life. More studies are needed to ensure the result of this study in the future.

Relationship Between Opioid Prescriptions and Number of Chronic Pain Conditions in Women With Interstitial Cystitis.

The aim of this study was to determine the relationship between opioid prescriptions and number of chronic pain conditions in women with interstitial cystitis (IC). This was a cross-sectional study. Women diagnosed with IC based on International Classification of Diseases, Ninth Revision/Tenth Revision codes over an 11-year period (2010-2020) were identified from electronic medical records. Data on comorbidities and ambulatory opioid prescriptions were also extracted. Univariable and multivariable logistic regressions were used to assess the relationship between opioid prescriptions and the number and type of coexisting chronic pain conditions. Of the 1,219 women with IC, 207 (17%) had received at least 1 opioid prescription. The proportions of women with opioid prescriptions for no, 1, 2, and 3 or more coexisting chronic pain conditions were 13%, 20%, 28%, and 32%, respectively. On univariable analysis, factors significantly associated with opioid use were higher body mass index ( P < 0.001), depression ( P < 0.001), sleep disorder ( P < 0.001), endometriosis ( P < 0.05), chronic pelvic pain ( P < 0.001), fibromyalgia ( P < 0.05), joint pain ( P < 0.001), and number of coexisting chronic pain diagnoses ( P < 0.001). On multivariable analysis, opioid prescriptions remained significantly associated with the number of coexisting chronic pain diagnoses: 1 diagnosis (adjusted odds ratio [aOR], 1.8; 95% confidence interval [CI], 1.3-2.7), 2 diagnoses (aOR, 2.6; 95% CI, 1.6-4.3), 3 or more diagnoses (aOR, 2.5; 95% CI, 1.1-5.5), diagnosis of chronic pelvic pain (aOR, 2.1; 95% CI, 1.3-3.5), endometriosis (aOR, 2.4; 95% CI, 1.4-4.3), chronic joint pain (aOR, 1.8; 95% CI, 1.1-2.9), and sleep disorders (aOR, 2.4; 95% CI, 1.6-3.6). The likelihood of opioid prescriptions in women with IC increases with the number and type of coexisting chronic pain conditions and sleep disorders.

Chronic pain and exercise

Problem: Worldwide, at least one in four adults do not exercise sufficiently. Inactivity is associated with an increase in disease burden and mortality, whereas exercise can contribute to a longer, healthier life. Chronic musculoskeletal pain is a significant public health concern; in Germany, approximately 15% of the adult population suffers from chronic low back pain. Based on the diagnoses of chronic back pain, chronic joint pain, and chronic widespread pain or fibromyalgia syndrome, this study will evaluate the importance of exercise in the treatment of chronic pain. Methods: Narrative review based on current treatment guidelines and scientific publications. Results: Exercise and physical activity are both preventively and therapeutically effective in the treatment of chronic musculoskeletal pain. Individualized, supervised exercise programs that take patients’ preferences and goals into account appear to be particularly effective, regardless of pain location. There is evidence that the positive biopsychosocial effects of movement are more important than the specific form of exercise. Discussion: In the treatment of chronic pain, exercise and activity should be considered primary therapeutic measures and be prescribed accordingly. Supervision and adaptation of exercise programs to patient needs are critical factors of success, regardless of the type of sport or form of exercise. Even a small dose of physical activity achieves health benefits in patients with chronic pain and contributes to symptom relief.

SERVICE PROVIDER AND USER DIFFERENCES IN BELIEFS, BARRIERS AND ENABLERS TO EXERCISE INTERVENTIONS FOR HIP AND KNEE OSTEOARTHRITIS

Purpose: Implementation of exercise for hip and knee osteoarthritis (OA) is suboptimal in clinical practice, despite high quality evidence for its effectiveness. Patient perceptions are highly influenced by messaging from general practitioners (GPs) and other healthcare professionals and myths regarding the safety of exercise for chronic joint pain are prevalent. In the pursuit of implementing care according to clinical guidelines, the primary objective of this study was to determine any differences in beliefs regarding exercise for hip and knee OA among GPs, physiotherapists (PTs) and people with hip and knee OA (PwOA) in Ireland.

Algorithms for managing patients over 60 years old with chronic joint and back pain

Chronic pain syndrome is one of the most common geriatric syndromes. Chronic pain negatively affects the mobility and autonomy of the older person, reducing the quality of life and longevity. An active screening for chronic pain in the geriatric population improves the geriatric status. Treatment strategies for chronic pain in older patients include non-pharmacological measures as well as drug administration. However, advanced age is associated with high comorbidity, polypharmacy, and in some cases does not allow the active use of systemic non-steroidal anti-inflammatory drugs (NSAIDs). In this connection, the use of parenteral symptomatic slow-acting drugs, the representative of which is chondroitin sulfate (CS), becomes an alternative. The efficacy and safety of CS has been proven by the mean of clinical studies meta-analysis data of osteoarthritis treatment effectiveness with parenteral chondroitin sulfate, including patients with back pain.

Gut Mucosal Microbiome Is Perturbed in Rheumatoid Arthritis Mice and Partly Restored after TDAG8 Deficiency or Suppression by Salicylanilide Derivative.

Rheumatoid arthritis (RA), an autoimmune disease, is characterized by chronic joint inflammation and pain. We previously found that the deletion of T-cell death-associated gene 8 (TDAG8) significantly reduces disease severity and pain in RA mice. Whether it is by modulating gut microbiota remains unclear. In this study, 64 intestinal samples of feces, cecal content, and cecal mucus from the complete Freund’s adjuvant-induced arthritis mouse models were compared. The α- and β-diversity indices of the microbiome were significantly lower in RA mice. Cecal mucus showed a higher ratio of Firmicutes to Bacteroidetes in RA than healthy mice, suggesting the ratio could serve as an RA indicator. Four core genera, Eubacterium_Ventriosum, Alloprevotella, Rikenella, and Treponema, were reduced in content in both feces and mucus RA samples, and could serve microbial markers representing RA progression. TDAG8 deficiency decreased the abundance of proinflammation-related Eubacterium_Xylanophilum, Clostridia, Ruminococcus, Paraprevotella, and Rikenellaceae, which reduced local mucosal inflammation to relieve RA disease severity and pain. The pharmacological block of the TDAG8 function by a salicylanilide derivative partly restored the RA microbiome to a healthy composition. These findings provide a further understanding of specific bacteria interactions with host gut mucus in the RA model. The modulation by TDAG8 on particular bacteria can facilitate microbiota-based therapy.

MMPs Regulate Neuronal Substance P After a Painful Equibiaxial Stretch in a Co-Culture Collagen Gel Model Simulating Injury of an Innervated Ligament

Chronic joint pain is a major health problem that can result from abnormal loading of the innervated ligamentous capsule that surrounds synovial joints. The matrix metalloproteinases-1 (MMP-1) and MMP-9 are hypothesized pain mediators from stretch-induced injuries since they increase in pathologic joint tissues and are implicated in biomechanical and nociceptive pathways that underlay painful joint injuries. There is also emerging evidence that MMP-1 and MMP-9 have mechanistic interactions with the nociceptive neuropeptide substance P. Yet, how a ligament stretch induces painful responses during sub-failure loading and whether MMP-1 or MMP-9 modulates nociception via substance P are unknown. We used a neuron–fibroblast co-culture collagen gel model of the capsular ligament to test whether a sub-failure equibiaxial stretch above the magnitude for initiating nociceptive responses in neurons also regulates MMP-1 and MMP-9. Pre-stretch treatment with the MMP inhibitor ilomastat also tested whether inhibiting MMPs attenuates the stretch-induced nociceptive responses. Because of the role of MMPs in collagen remodeling, collagen microstructural kinematics were measured in all tests. Co-culture gels were incubated for one week in either normal conditions, with five days of ilomastat treatment, or with five days of a vehicle control solution before a planar equibiaxial stretch that imposed strains at magnitudes that induce pain in vivo and increase nociceptive modulators in vitro. Force, displacement, and strain were measured, and polarized light imaging captured collagen fiber kinematics during loading. At 24 h after stretch, immunolabeling quantified substance P, MMP-1, and MMP-9 protein expression. The same sub-failure equibiaxial stretch was imposed on all co-cultures, inducing a significant re-organization of collagen fibers (p ≤ 0.031) indicative of fiber realignment. Stretch induces a doubling of substance P expression in normal and vehicle-treated co-cultures (p = 0.038) that is prevented with ilomastat treatment (p = 0.114). Although MMP-1 and MMP-9 expression are unaffected by the stretch in all co-culture groups, ilomastat treatment abolishes the correlative relationships between MMP-1 and substance P (p = 0.002; R2 = 0.13) and between MMP-1 and MMP-9 (p = 0.007; R2 = 0.11) that are detected without an inhibitor. Collectively, these findings implicate MMPs in a painful ligamentous injury and contribute to a growing body of work linking MMPs to nociceptive-related signaling pathways and/or pain.

Pancoast tumor presenting with multiple joint pains: a case report

BackgroundPancoast tumors represent a unique subset of lung cancers wherein a primary neoplasm arises in the lung’s apex and invades the surrounding soft tissues. One of the main challenges in the diagnosis and treatment of these apical lung cancers is that they are usually not visualized on initial chest x-ray and, by the time the patient presents with symptoms, the tumor has almost always invaded nearby structures.Case presentationHerein we report a case of a 58-year-old nonsmoking African American male who presented to the neurology clinic with a history of multiple chronic joint pains. The patient complained of shoulder pain that traveled into his right arm and right finger and had worsened over the past 9 months. The patient also reported decreased right proximal strength and swelling of his right hand. Magnetic resonance imaging of the shoulder and cervical region showed mild cervical spondylosis and a questionable right apical mass. A subsequent high-resolution computed tomography scan of the chest revealed a large right apical lung mass, with chest wall invasion and erosion of the adjacent ribs. Biopsy of the mass confirmed poorly differentiated non-small cell lung cancer. Radiation therapy was initiated, and the patient’s pain improved significantly. Given the size of the tumor, chemotherapy was recommended by the oncology team. The patient decided against chemotherapy.ConclusionThis case highlights the importance of early diagnosis by expanding the differential diagnosis in patients presenting with weakness, sensory loss, and shoulder pain beyond radiculopathy or joint-related diseases. A comprehensive history and careful examination may lead to an earlier diagnosis, more appropriate treatment, and better outcome in cases of Pancoast tumor presenting with neuropathic or musculoskeletal pain.

Clinical and Preclinical Evidence for Roles of Soluble Epoxide Hydrolase in Osteoarthritis Knee Pain.

Chronic pain due to osteoarthritis (OA) is a major clinical problem, and existing analgesics often have limited beneficial effects and/or adverse effects, necessitating the development of novel therapies. Epoxyeicosatrienoic acids (EETs) are endogenous antiinflammatory mediators, rapidly metabolized by soluble epoxide hydrolase (EH) to dihydroxyeicosatrienoic acids (DHETs). We undertook this study to assess whether soluble EH-driven metabolism of EETs to DHETs plays a critical role in chronic joint pain associated with OA and provides a new target for treatment. Potential associations of chronic knee pain with single-nucleotide polymorphisms (SNPs) in the gene-encoding soluble EH and with circulating levels of EETs and DHETs were investigated in human subjects. A surgically induced murine model of OA was used to determine the effects of both acute and chronic selective inhibition of soluble EH by N-[1-(1-oxopropy)-4-piperidinyl]-N'-(trifluoromethoxy)phenyl]-urea (TPPU) on weight-bearing asymmetry, hind paw withdrawal thresholds, joint histology, and circulating concentrations of EETs and DHETs. In human subjects with chronic knee pain, 3 pain measures were associated with SNPs of the soluble EH gene EPHX2, and in 2 separate cohorts of subjects, circulating levels of EETs and DHETs were also associated with 3 pain measures. In the murine OA model, systemic administration of TPPU both acutely and chronically reversed established pain behaviors and decreased circulating levels of 8,9-DHET and 14,15-DHET. EET levels were unchanged by TPPU administration. Our novel findings support a role of soluble EH in OA pain and suggest that inhibition of soluble EH and protection of endogenous EETs from catabolism represents a potential new therapeutic target for OA pain.

Circulation of Chikungunya virus East-Central-South African genotype during the 2020–21 outbreak in São Paulo State, Brazil

Chikungunya virus (CHIKV), a mosquito-borne alphavirus, has traditionally circulated in Africa and Asia, causing human febrile illness accompanied by severe, chronic joint pain. The Asian and East-Central-South African (ECSA) genotypes were introduced in Brazil in 2014, in Bahia State and Northeast region. CHIKV virus rapidly spread, causing epidemics in urban areas, and the ECSA genotype was detected also in other regions. In the last five years, more than 700,000 cases of Chikungunya fever were reported in Brazil. Nevertheless, there is limited information about the genomic epidemiology of CHIKV from surveillance studies. In São Paulo (SP), the most populous Brazilian state, until 2015 only imported cases were identified. In 2020–21, an outbreak was detected in the coastal region of SP, accounting for 98% of confirmations in SP. To better understand the disease dynamics in SP, we generated 53 nearcomplete genomes of CHIKV isolates from Baixada Santista, obtained from clinical samples. Our results demonstrate that SP-CHIKV clade belongs to a distinct clade from those previously found in Brazil, supporting the local circulation of a specific lineage in the period. None of the SP-CHIKV carry the substitutions A226V (E1 protein) and L210Q (E2 protein) associated with increased transmission in Aedes albopictus mosquitoes. The results confirm that the ECSA lineage continues to spread across the country and reinforce that genomic data can provide information about virus genetic diversity and transmission dynamics, assisting the establishment of a more effective surveillance framework.

Cooled Radiofrequency Ablation for Chronic Joint Pain Secondary to Hip and Shoulder Osteoarthritis.

Osteoarthritis (OA) of the shoulder and hip is a leading cause of physical disability and mental distress. Traditional nonsurgical management alone is often unable to completely address the associated chronic joint pain. Moreover, a large number of patients are not eligible for joint replacement surgery owing to comorbidities or cost. Radiofrequency ablation (RFA) of articular sensory nerve fibers can disrupt the transmission of nociceptive signals by neurolysis, thereby providing long-term pain relief. A subtype of RFA, cooled RFA (CRFA), utilizes internally cooled electrodes to generate larger ablative zones compared with standard RFA techniques. Given the complex variable innervation of large joints such as the glenohumeral and hip joints, a larger ablative treatment zone, such as that provided by CRFA, is desired to capture a greater number of afferent nociceptive fibers. The suprascapular, axillary, and lateral pectoral nerve articular sensory branches are targeted during CRFA of the glenohumeral joint. The obturator and femoral nerve articular sensory branches are targeted during CRFA of the hip. CRFA is a promising tool in the interventionalist's arsenal for management of OA-related pain and symptoms, particularly in patients who cannot undergo, have long wait times until, or have persistent pain following joint replacement surgery. An invited commentary by Tomasian is available online. ©RSNA, 2022.

Seroprevalence, clinical profile and knowledge, attitudes, and practices (KAPs) of brucellosis in North India in patients with pyrexia of unknown origin and chronic joint pain

Introduction: Brucellosis is a significant but lesser-known cause of pyrexia of unknown origin (PUO) in India. Studies documenting the prevalence of Brucellosis in different parts of India are sparse and few. Clinicians thus usually don’t consider it in their differential diagnosis. This study assesses its prevalence in two groups: febrile patients with unknown etiology and individuals presenting with arthritis and/or joint pains. Knowledge, Attitude, and Practices (KAP) among clinicians about the disease was evaluated.Materials and Methods: This is a prospective study conducted at a tertiary care center of North India catering to urban, semi-urban, and rural populace. Ninety-two patients with fever of unknown origin, arthralgia, or similar constitutional symptoms were recruited in this study. Detailed clinical history was elicited from all patients as per predesigned proforma and a rigorous physical examination was conducted. Following primary screening to rule out malaria, enteric fever, and leptospirosis, secondary screening for Brucellosis was done by Rapid Screen Test (PUO screen) and IgM and IgG ELISA. A predesigned survey was used for assessing KAP among clinicians about Brucellosis.Results: Brucella infection was diagnosed in 27 (29.3%) cases. The most common symptoms among the patients apart from fever were arthralgia (77.8%), fatigue (70.8%), pallor (66.1%), headache (59.2%), backache (53.8%) and cough (33.3%). PUO screen is a specific test for brucellosis but lacks sensitivity. It detects acute cases but misses chronic cases. IgM ELISA being more sensitive should be used for confirmation. Low ODs point to chronic brucellosis which was confirmed by IgG ELISA. Normal CRP levels in patients with PUO and chronic joint pains should point to brucellosis. KAP revealed that 25% to 50% of doctors considered Brucella in their differential diagnosis of acute and chronic fever respectively while 10% Orthopedics considered it in cases of arthralgia.Conclusion: Our results highlight the significance of Brucella as a cause of PUO and arthralgia. Brucellosis is an underrecognized but important cause of pyrexia of unknown origin and chronic joint pain. It should be actively suspected, diagnosed, and treated.International Journal of Human and Health Sciences Vol. 06 No. 01 January’22 Page: 80-88

Randomized comparison of proximal and distal radial access for coronary angiography and interventions

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Vascular access for coronary procedures is of paramount important not only for successful procedure but also to prevent complications. In comparison to femoral access, proximal radial artery (PRA) access at wrist is associated with decreased bleeding complications and mortality. The most important complication of PRA access is radial artery occlusion Use of the proximal radial artery (PRA) approach at wrist has several limitations: the need to supinate the hand, which can exacerbate chronic joint pain, the depth of the radial artery in large arms, which could make arterial puncture challenging even under ultrasound guidance, the risk of sporadic bleeding in the forearm, and the risk of radial artery occlusion. All above limitations can be overcome by distal radial artery (DRA) access in anatomical snuff box. Randomized Studies are lacking for the comparison between DRA and PRA approach in coronary procedures. Aims and objective To compare safety, efficacy and feasibility between PRA and DRA approach in randomized fashion. Material and methods This was single center randomized controlled trial. 320 patients were randomized in PRA and DRA groups. PRA approach was in wrist and DRA approach was in anatomical snuff box. Primary endpoint was cannulation failure (failure to achieve radial access) and transradial failure (failure to complete procedure after successful access). Secondary safety outcome includes major (compartment syndrome, need for vascular surgery, hand dysfunction, nerve palsy ,arteriovenous fistula, hematoma requiring blood transfusion, proximal radial artery occlusion) and minor (radial artery spasm, hematoma not requiring transfusion or causing compartment syndrome, ecchymosis, local edema, paresthesia, pseudoaneurysm) complications; secondary efficacy outcome were puncture attempts, cannulation time, procedure time, radiation dose, hemostasis time and quality of life endpoint was pain score . Results Each group was having 160 patients. In DRA group 73.9 % were CAG and 26.1 % were PCI; in PRA group and 75.7 were CAG and 24.3 were PCI. Cannulation failure was more in DRA group (7.5 % vs 2.5 %, P &amp;lt; 0.001) without difference in transradial failure (n = 3 vs 4, p =0.764). There were no major complications in both groups except PRAO which was significantly less in DRA group (0 % vs 5.2 %, p= 0.007). Puncture attempts, cannulation time, pain score were more in DRA (1.65 vs 1.29, P &amp;lt; 0.001;3.23 vs 2.62 minutes, p &amp;lt; 0.001;25.5 vs 21.6 minutes, p = 0.039 respectively). There was no significant difference for minor complications in both groups. Conclusion DRA approach is as safe and feasible as PRA approach and causes significantly less PRAO. DRA approach may be advocated as default approach where radial access is chosen for coronary procedures. Abstract Figure. primary outcome Abstract Figure. Procedural characteristic