Surgery, More Conservative Treatments Similar Outcomes Spinal Stenosis Patients

Which works better for spinal stenosis…. Conservative treatment or surgery… the answer next…
Surgery, More Conservative Treatments May Provide Similar Long-Term Outcomes Spinal Stenosis Patients.
Robert Preidt writing in Healthday reported that research published in Spine suggests that “surgery and more conservative treatments provide similar long-term outcomes for people with spinal stenosis.” The research “included more than 650 spinal stenosis patients who had surgery or received nonsurgical treatment such as physical therapy or medications.” Investigators found that “after eight years of follow-up, there were no significant differences between the two groups in terms of pain, functioning or disability.”
Comment: Surgery has its place but only after conservative management has failed.

Which patients should be extra cautious about getting joint replacement? Next…
Total Hip or Knee Replacement Not Recommended for Some Patients With Fibromyalgia-Like Symptoms
Rosemary Frei writing in Pain Medicine News reported total hip or knee replacement is not advisable for some patients with both severe hip or knee pain and fibromyalgia-like symptoms, according to a new analysis of predictors of pain outcomes after total knee and hip arthroplasty.
Researchers focused on the pain scores of 635 patients with fibromyalgia-like symptoms—but not necessarily a clinical diagnosis of fibromyalgia—before arthroplasty and six months after. The study indicated that a patient self-report survey for the assessment of fibromyalgia was the only statistically significant predictor of patients who had long-term postoperative pain as measured by the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain subscale and other tools.
Comment: This is a phenomenon reported by others and comes as no surprise.

Should RA patients who are in renmission go on a drug holiday? The answer might surprise you.
Study: Joint Inflammation In Patients With Early RA Still Present After Two Years Of Therapy.
Pam Harrison writing in MedPage Today reported that “MRI evidence of joint inflammation was still present in patients with early rheumatoid arthritis (RA) despite clinical remission, according to a sub-study of the Treatment of Early Aggressive Rheumatoid Arthritis (TEAR) trial.” Investigators found that “a couple years of triple therapy, or the combination of a tumor necrosis factor (TNF) inhibitor plus methotrexate, did not eliminate signs of joint inflammation, with all 118 patients in the TEAR sub-study showing evidence of residual MRI inflammation, including patients who met stringent definitions of remission at the same follow-up point.” The research was published in Arthritis Care & Research.

Comment: These are surprising and disturbing findings since remission doesn’t seem to be as good as we think it is and certainly negates the thought we ought to give a drug holiday. It would be a bad idea.

Glucosamine… the debate rages on

Glucosamine And Chondroitin May Benefit Certain Patients With Knee OA.
Nancy Walsh writing in MedPage Today reported that “evidence has been increasing in favor of the use of glucosamine and chondroitin in osteoarthritis (OA) of the knee, with a new noninferiority study” published in Annals of the Rheumatic Diseases “showing equivalent significant benefits for the supplement combination as for the COX-2 inhibitor Celebrex.” Researchers found, “in a clinical trial known as MOVES that included 606 patients with moderate-to-severe pain,” that “6 months of treatment with the dietary supplements was associated with a 50.1% decrease in pain as measured on the Western Ontario and McMaster osteoarthritis index (WOMAC), compared with a 50.2% decrease among patients given Celebrex.” Walsh pointed out that “MOVES becomes the third major trial to show a benefit for the supplement combination in OA.”

Comment: Next week, another negative study. Oh well…

A predictor for treatment success in rheumatoid arthritis

Diana Swift writing in MedPage Today reported in early rheumatoid arthritis (RA) the most important single predictor of achieving an absolute or a relative patient-perceived pain improvement (PPSI) after 6 months of treatment is baseline symmetrical arthritis, according to a Dutch study published online in the journal Rheumatology.

Comment: I’ve actually noticed the same phenomenon in my practice.

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