Radiocarpal and first metatarsophalangeal intraarticular injection site confirmation with fluoroscopy and review of accuracy of intraarticular injections.

The aim of this study was to determine the accuracy of radiocarpal (RC) joint and first metatarsophalangeal (MTP) joint arthrocentesis using fluoroscopy. Rheumatologists were asked to mark their usual site of arthrocentesis over fluoroscopically identified joint lines of the right RC and right first MTP joints. Ten rheumatologists with a mean of 17.9 years of clinical experience participated. The sites marked were a mean of 0.85 cm (range, 0-1.6 cm; SD, 0.5 cm) and 0.33 cm (range, 0-1.3 cm; SD, 0.4 cm) from the fluoroscopically identified RC and MTP joints, respectively. Traditional palpation-guided joint aspiration may be inaccurate. Fluoroscopic guidance has the potential to improve accuracy of arthrocentesis of small joints.

Non-surgical treatment of osteoarthritis-related pain in the elderly.

Osteoarthritis (OA), the third most common diagnosis in the elderly [1], causes significant pain leading to disability and decreased quality of life in subjects 65 years and older [2]. Traditionally, clinicians have relied heavily on the use of non-steroidal anti-inflammatory drugs (NSAIDs) to treat the pain of OA, as numerous studies have proven these agents to be effective. The cardiovascular, gastrointestinal, renal and hepatic toxicities of NSAIDs have limited their use, particularly in the elderly. Acetaminophen has been recommended as initial therapy due to relative safety. Several other topical, oral and intra-articular agents are available today, with use limited by efficacy and side effect profiles. Many non-pharmacologic approaches are available but underused, and may be attractive choices to avoid poly-pharmacy in older patients. We will attempt to highlight the evidence behind available non-surgical therapies for OA while paying specific attention to issues in geriatric patients.

Perioperative management of biologic agents used in treatment of rheumatoid arthritis.

Patients with rheumatoid arthritis, an inflammatory arthritis that can destroy joint structures, are often on multiple disease-modifying antirheumatic medications to control disease activity. These medications have significant toxicities, most notably immunosuppression leading to increased risk of infection. Furthermore, certain disease-modifying antirheumatic medications have been reported to affect the healing process. Over the course of their lifetime, patients with rheumatoid arthritis may undergo many surgical procedures, often orthopedic interventions, including total joint arthroplasty, reconstructive surgeries, or cervical stabilization. How to manage antirheumatic medications and their toxicities in the perioperative period is a challenging question, especially with regard to the biologic therapies such as antitumor necrosis factor alpha agents. We conducted a review of the available literature pertaining to the perioperative use of biologic agents used to treat rheumatoid arthritis. Although existing data directly addressing complications during specific orthopedic procedures are sparse, information on general surgical complications in rheumatic and other patient populations may be used as a basis for conservative recommendations.