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Examination: Musculoskeletal
Published in Kate Tatham, Kinesh Patel, Complete OSCE Skills for Medical and Surgical Finals, 2018
Assess other joints for signs of arthropathy, e.g. swelling, deformity. Rheumatoid arthritis also affects:FeetAnklesKnees, hipsSpine - especially atlanto-axial joint (subluxation)
Garenoxacin
Published in M. Lindsay Grayson, Sara E. Cosgrove, Suzanne M. Crowe, M. Lindsay Grayson, William Hope, James S. McCarthy, John Mills, Johan W. Mouton, David L. Paterson, Kucers’ The Use of Antibiotics, 2017
James Owen Robinson, Keryn Christiansen
In the immature dog model, quinolones have been documented as causing blisters and erosions in the articular cartilage, producing a distinct histopathological picture (Stahlmann et al., 2000). However, garenoxacin was associated with significantly weaker articular toxicity when compared to ciprofloxacin and ofloxacin activity in this dog model (Nagai et al., 2002). This apparent lower cartilage toxicity could not be explained by the pharmacokinetic behavior of this drug, as garenoxacin has been shown to be well absorbed and drug concentrations in cartilage tended to be higher than in plasma (Kastner et al., 2004). However, the lower articular toxicity could be related to the absence of fluorine at the C-6 position or the drug’s lower affinity for magnesium, when compared to other quinolones (Nagai et al., 2002). Nevertheless, there are no current clinical data to suggest that garenoxacin can be administered safely to children. Clinical experience has revealed joint-related adverse events for patients receiving garenoxacin similar to what has been observed in participants in comparator trials (EMEA, 2007). No cases of arthropathy were reported in a review of 702 patients (Takagi et al., 2008).
Neuroendocrine disease
Published in Philip E. Harris, Pierre-Marc G. Bouloux, Endocrinology in Clinical Practice, 2014
Degenerative joint disease, affecting both the axial and the appendicular skeletons, is common. In the early stages, where there is thickening of the synovium and articular cartilage, it is potentially reversible.129 In the majority of patients, however, by the time of diagnosis, irreversible degenerative changes will have occurred. In the spine, intervertebral spaces are typically widened, with vertebral enlargement and osteophyte formation. Axial changes may be present in up to 60% of patients at the time of diagnosis. Severe morphological and structural changes can develop.130 Clinical symptoms are present in the majority of patients. Long-term uncontrolled disease can lead to severe debilitating arthropathy. Even after disease control, chronic arthropathy remains an important cause of reduced quality of life (QoL).131
Bispecific antibodies for the treatment of hemophilia A
Published in Expert Opinion on Biological Therapy, 2022
For non-inhibitor patients, the treatment options are considerably advanced by emicizumab. Subcutaneous injections can be administered at monthly intervals in early childhood, and full prophylactic treatment can commence earlier than with the current FVIII-based prophylaxis. Home treatment can be more readily introduced due to the use of much less-frequent subcutaneous injections. Consequently, greater protection from asymptomatic pathological changes in joints, and delayed onset or progress of arthropathy could be expected. Furthermore, less reliance on plasma-based FVIII replacement will minimize the development of FVIII inhibitors during the important age for healthy growth of bone and musculo-skeletal structures. Perhaps more importantly, the current prophylaxis protocols do not cover the neonatal and early toddler age groups, and emicizumab offers the important advantage of protection form ICH which is still the biggest cause of bleeding-related comorbidity in patients especially less than two years old.
Toxicity induced by ciprofloxacin and enrofloxacin: oxidative stress and metabolism
Published in Critical Reviews in Toxicology, 2021
Sara Badawy, YaQin Yang, Yanan Liu, Marawan A. Marawan, Irma Ares, María-Aránzazu Martinez, María-Rosa Martínez-Larrañaga, Xu Wang, Arturo Anadón, Marta Martínez
Adefurin et al. (2011) a systematic review about the safety of CIP in pediatrics confirmed that musculoskeletal toxicity is the most frequently reported AE with an estimated risk of one musculoskeletal AE in every 62.5 patients and a 57% increased risk of arthropathy. The arthralgia was the commonest clinical symptom of arthropathy 50% mostly affecting the knee joint. While tendon or joint disorders and reduced movement also accounted for a significant proportion of arthropathy cases (19% and 15%, respectively). The rates of musculoskeletal adverse events within 6 weeks after CIP treatment were 9.3% (31/335) (Stahlmann and Lode 2013). Also, CIP and ENR should be avoided in pregnancy as they may cause cartilage toxicity to the fetus especially in the first trimester (Franciolli et al. 2011; Ellerbrock et al. 2019, 2020). In 2016, the FDA restricted the use of FQs in children and old people ≥ 65 years. Furthermore, the safety analysis of CIP suggests the possibility of increased musculoskeletal AEs (Jackson and Schutze 2016; Michalak et al. 2017). In relation to CIP benefits in children with acute infections, its risks should be considered. In animals, quinolone-class drugs have been associated with cartilage erosions in weight-bearing joints and other forms of arthropathy in immature animals of various species. Thus, it has been advised to not use ENR either in young and growing animals or with standing cartilage development disorders or musculoskeletal injury around functionally significant joints even at therapeutic doses (Hall et al. 2011; Khazaeil et al. 2012).
Applying World Health Organization 2020 guidelines on physical activity and sedentary behavior to people with hemophilia
Published in Expert Review of Hematology, 2021
Hortensia De la Corte-Rodriguez, E. Carlos Rodriguez-Merchan, M. Teresa Alvarez-Roman, Victor Jiménez-Yuste
Thanks to advances in hematological treatments and prophylactic modalities, physical activity has been made possible for PWH, to help maintain their health [3]. Physical activity confers several benefits to the PWH such as improved muscle strength, joint stability and flexibility, decreased pain, increased bone density and prevention of falls, reduced risk of bleeding [4]. Other physical benefits include the prevention of obesity, heart disease, high blood pressure and diabetes. Physical activity also confers several mental health benefits, such as improved emotional regulation, self-efficacy and social interactions [3]. Physical inactivity is more harmful in PWH than in the general population; thus, the WHO recommendations are especially important in hemophilia [3]. Without proper treatment, people with hemophilia will suffer multiple joint and muscle bleeds. Joint bleeding (hemarthrosis) is the most frequent clinical manifestation in hemophilia. Repeated hemarthroses will lead to a process of inflammation and synovial hypertrophy, as well as progressive deterioration of the osteochondral structures, known as hemophilic arthropathy [5]. This arthropathy usually affects several joints, mainly ankles, knees and elbows. The degree of arthropathy will condition the pain, the functional deficit and the detriment in the quality of life of the patients.