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)
This site is a calculator from the American Academy of Orthopedic Surgeons to help us decide which patients undergoing procedures are recommended to receive prophylactic antibiotics: Ortho Proph Abx Calc
(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
Notes on what primary docs need to know about inflammatory back pain before referring to rheumatology. From lecture by Dr Sandra Horvath-Dori, 4/5/17.
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
Dr Rebecca Morrow's SPEP/UPEP matching game! Try your hand at it - which pattern on the right matches the protein electrophoresis pattern on the left? A monoclonal pattern is suggestive of multiple myeloma or MGUS. There will be one or two "spikes" of protein present. A normal pattern is, as you would think, a normal… Continue reading SPEP and UPEP pattern matching game!
The adult-onset Still disease triad: fever, arthralgias and an evanescent rash. adult-still-disease
From Life in the Fast Lane: Drug rash with eosinophilia and systemic symptoms (DRESS syndrome) It affects approximately 1 per 1500 new users of phenytoin and carbamazepine [Reference] The mortality rate associated with DRESS syndrome is approximately 10%, the majority due to fulminant liver failure [Reference]
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
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