ABSTRACT
BACKGROUND: Identification of modifiable risk factors and treatments for osteoarthritis (OA) are needed. Warfarin, a vitamin K antagonist, causes fetal and animal model skeletal abnormalities. Vitamin K insufficiency has been associated with OA, but whether warfarin is also detrimental to OA is not known. METHODS: We conducted a nested case-control study using a UK general practitioner electronic medical records database. We identified cases of knee or hip replacement (KR or HR) from among adults with atrial fibrillation newly prescribed either warfarin or direct oral anticoagulants (DOACs). Cases were matched with four controls by age and sex. We assessed the relation of warfarin compared with DOAC use to risk of joint replacement using conditional logistic regression. We also evaluated different durations of warfarin use. RESULTS: We identified 857 subjects with KR or HR (cases), of whom 64.6% were warfarin users, and 3428 matched controls, of whom 56.1% were warfarin users (mean age 75, 47% female). Warfarin users had a 1.59 times higher risk of joint replacement than DOAC users (adjusted OR 1.59, 95% CI 1.31 to 1.92). Longer duration of warfarin use was associated with higher risk of joint replacement in comparison with <1 year of warfarin use. CONCLUSION: Warfarin, a vitamin K antagonist, was associated with greater risk of KR and HR (an indicator for end-stage knee OA) than DOAC use, supporting the importance of adequate vitamin K functioning in limiting OA progression.
Subject(s)
Anticoagulants/adverse effects , Arthroplasty, Replacement, Hip/statistics & numerical data , Arthroplasty, Replacement, Knee/statistics & numerical data , Osteoarthritis/surgery , Warfarin/adverse effects , Aged , Case-Control Studies , Databases, Factual , Female , Humans , Male , Middle Aged , Osteoarthritis/chemically induced , Risk Factors , Vitamin K/antagonists & inhibitorsABSTRACT
Presentation of scrub typhus associated with brachial neuritis is extremely rare with only a few cases reported so far. Here, we report a case of a 45-year-old female who presented with fever and right shoulder pain. Laboratory parameters showed leucocytosis with ELISA and PCR for scrub typhus positive. Electromyography (EMG) and Nerve Conduction Velocity (NCV) study was suggestive of brachial neuritis. She was given doxycycline therapy for 10 days following which her shoulder pain resolved.
