Arthritis Chronicle

This Article/abstract is taken from the American journal for Cardiology. It is written by j Gaziano and C Gibson. they work at Harvard and Boston.

Millions of individuals in the United States take low-dose aspirin for cardioprotection. Physicians face a clinical dilemma when those same patients also have pain from arthritis or another condition. Nonsteroidal anti-inflammatory drugs may increase the risk of gastrointestinal complications when used in conjunction with aspirin. In addition, Nonsteroidal anti-inflammatory drugs particularly ibuprofen, may interfere with the antithrombotic benefits of aspirin through competitive interaction with platelet cyclooxygenase-1 (COX-1).

Evidence suggests that naproxen has antithrombotic effects; however, as with other nonsteroidal anti-inflammatory drugs, it poses a risk of gastrotoxicity. Selective COX-2 inhibitors reduce the risk of gastrointestinal side effects, and although they inhibit platelet COX-1, it is to a far lesser extent than COX-2. However, it is unclear to what degree COX-2 inhibitors remain gastroprotective in the presence of aspirin. In addition, recent long-term trials have raised concerns about adverse cardiovascular events with prolonged use of both traditional and selective nonsteroidal anti-inflammatory drugs. Conversely, acetaminophen is well tolerated, has not been shown to contribute to gastrotoxicity when taken with aspirin, and has not been shown to interfere with the inhibition of platelet aggregation produced by aspirin. Acetaminophen is considered a first-line therapy for patients with mild-to-moderate joint pain.

The full article can be found via pubmed using the ID 16675319. It is in the May 2006 edition number 8;97, starting on page 23.

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This article comes fro Der Radiologe and is by G Linng and C Schorn from the central Rontgen institute in bad Kreuznach

QUESTION TO ANSWER: Which imaging modalities are appropriate for the Differential diagnosis of Rheumatic diseases.

METHODS AND RESULTS: MRI has far most the highest sensitivity and is unequaled in its brilliant presentation of Anatomy and Pathology. But it is sometimes forgotten, that this is at least in part the result of carefully selected sequences, dedicated to the exspected result.In a method totally independent of any result, this should not be the case. In contrary this method should be highly standardised and regardless what will be the findings. This is true for Plain X-ray. It will be shown, that already the outer sihouette of the soft parts with different features of swelling, and differences in density and even more - defects or appositions of the bony silhouette in the majority of cases at least will allow to classify the patient for a group of diseases and in many cases will lead to a definite diagnosis. Differential diagnoses like Rheumatoid Arthritis versus Psoriatic Arthritis or simply but not always simple - inflammatory Arthritis versus degenerative disease - are allowed to be answered definitely, not always so in MRI. The condition of the subchondral bone can give hints, how advanced and how active the disease is at present.

CONCLUSION: Plain X-ray offers high specifity in the differential diagnoses of rheumatic diseases, it is well standardised and it is a device, to use independent from any suspected findings.So it is the method of choice for questions of differential diagnosis. This is even more true, thinking of the possibility, to investigate all clinically involved regions with not to much extended efforts, wheras MRI and CT are used normally for only one region.

The full abstract and links to the original german article can be found using pubmed, Identifier number is 16673141 and the issue is from May 2006.

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This abstract was written by S reed and coleagues from the university of Washington in rainy Seattle in the USA. Objective: To determine whether rheumatoid arthritis is associated with increased adverse obstetric or neonatal outcomes. Study design and setting: Washington State birth records and hospital discharge data between 1987 and 2001 identified a cohort of women with rheumatoid arthritis and a comparison group of women without rheumatoid arthritis. Pregnancy and neonatal outcomes were compared using general linear models for common outcomes, calculating approximate relative risks and 95% confidence intervals.

Results: There were 243 women with rheumatoid arthritis and 2559 controls. Infants of women with rheumatoid arthritis had increased risk of cesarean delivery (adjusted approximate relative risk, aRR=1.66, 95% CI (1.22, 2.26)), prematurity (aRR=1.78, 95% CI (1.21, 2.60)), and longer birth hospitalization (aRR=1.86, 95% CI (1.32, 2.60)) compared to those born to women without rheumatoid arthritis.

Conclusions: We speculate that the increased risks for cesarean delivery, prematurity, and longer hospitalization at birth among infants born to women with rheumatoid arthritis may be due to the pathophysiologic changes associated with rheumatoid arthritis or medications used to treat the disease.
This abstract comes from the April the 29th edition of maternity and child health Journal. the pubmed identifier is 16649008.

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