Chronic Low Back Pain: What does and does not work (according to current evidence)

DOES WORK: Keeping moving Physical therapy or manipulation therapies Acupuncture, tai chi (clinician should emphasize possible benefits - likely enhances the placebo effect!) NSAIDs - lowest effective dose for shortest period - 1st line pharmacotherapy Can try APAP in those with NSAID contraindications, but unlikely to help Duloxetine (other SNRIs may work, but evidence lacking)… Continue reading Chronic Low Back Pain: What does and does not work (according to current evidence)

Gout – Treatment Guidelines

(BMJ)—A committee of experts w/ experience in gout agreed upon potential targets and outcomes, which was the basis for the systematic literature search. The expert group developed 9 treat-to-target recommendations: 1. Serum urate must be measured regularly and urate-lowering tx should be adjusted to attain the therapeutic target. 2. Serum urate level <6 mg/dL should… Continue reading Gout – Treatment Guidelines

Eye Manifestations of Systemic Disease – Czarnecki

Lecture notes from presentation by Dr Scott Czarnecki, 04 January 2017: WHAT IS URGENT? Acute vision loss (<24h) Painful vision loss (<24h) Globe penetration (now) Flashes and floaters (<24h) Semi-urgent:  HSV conjunctivitis, zoster ophthalmicus (24-48h) Ptosis and blown pupil (now) Random ophtho pearls: For bacterial conjunctivitis, use Ocuflox or Polytrim.  Don't use tobra or gentamicin… Continue reading Eye Manifestations of Systemic Disease – Czarnecki

Acute Monoarthritis

Most common diagnoses in primary care:  osteoarthritis, gout and trauma. Do not miss disorder:  septic arthritis.  Missed diagnosis can lead to sepsis, bacteremia, joint destruction or death. Focal bone pain or recent trauma requires X-ray imaging:  must rule out metabolic bone disease, tumor or fracture. Joint effusion with any sign of infection (redness, warmth, fever)… Continue reading Acute Monoarthritis

Urate-Lowering Therapy May Lower Cardiovascular Risk

Hyperuricemia is associated with risk for CVD, and many studies show excess risk (CVD and all-cause mortality) for men with gout. n = 40,000 2646 had gout, 55% of which were txed with urate-lowering therapy, 45% untreated Followed for mean of 6.5 years CVD- and all-cause-mortality did not differ between gout vs non-gout, but gout… Continue reading Urate-Lowering Therapy May Lower Cardiovascular Risk