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Knee pain is one of the most common musculoskeletal complaints in primary care medicine. The leading causes of knee pain are osteoarthritis and musculoskeletal disorders. A careful history and a rigorous clinical examination usually enable a diagnosis to be made without the need for further investigations. A systematic search for red flags helps identify patients requiring urgent and specialized care. When necessary, X-rays and ultrasound are the first-line imaging tests to perform. The latter can be used to guide a joint puncture for diagnostic and therapeutic purposes. This article reviews the diagnostic approach and summarizes the management of the main pathologies encountered in the general practitioner's office., Competing Interests: les auteurs n’ont déclaré aucun conflit d’intérêts en relation avec cet article.

Acute elbow pain can be the result of traumatic and atraumatic processes. Pathologic processes include osseous, ligamentous, and tendinous etiologies. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision process support the systematic analysis of the medical literature from peer reviewed journals. Established methodology principles such as Grading of Recommendations Assessment, Development, and Evaluation or GRADE are adapted to evaluate the evidence. The RAND/UCLA Appropriateness Method User Manual provides the methodology to determine the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where peer reviewed literature is lacking or equivocal, experts may be the primary evidentiary source available to formulate a recommendation., (Copyright © 2024 American College of Radiology. Published by Elsevier Inc. All rights reserved.)

Objective: To develop the Still's Disease Activity Score (SDAS)., Methods: We used data from the prospective adult-onset Still's disease cohort study and evaluated the disease activity. An expert group selected the most frequent, reproducible, and objective variables significantly modified in statistical analysis when comparing patients in the active group and in the remission group. These criteria were weighted to design the Still's Disease Activity Score (SDAS). The Delphi method was used to appreciate the level of disease activity. Total SDAS was calculated for each patient and compared to final consensus experts., Results: At the diagnosis, all patients had an active disease (n = 80), while 48 patients were in remission at 6 months. The SDAS criteria were weighted as follows: fever ≥ 38.5 °C (1 point), rash (1 point), joint involvement (arthralgia: 1 point, swollen joints count "SJC": 1-3 SJC: 2 points, ≥ 4 SJC: 3 points), physician global assessment VAS ≥ 5/10 or a raise in physician VAS ≥ 2/10 (3 points), patient VAS ≥ 5 or a raise in patient VAS ≥ 2/10 (1 point), and CRP (> 10 mg/l: 1 point, ≥ 100 mg/l: 2 points). At 6 months, the consensus was achieved for 76 (95%) patients with 40 in remission (0-1 point), 8 in low disease activity (2-3 points), 16 in moderate disease activity (4-7 points), and 12 in severe disease activity (≥ 8 points)., Conclusion: The Still's Disease Activity Score is a valid and sensitive assessment of the disease activity and the therapeutic response in Still's disease, despite its heterogeneous manifestations and patterns with systemic and articular forms. Key Points • The Still's Disease Activity Score (SDAS) is a good simple tool to assess the activity of the disease in a stable state for a week. • The SDAS is developed specifically for Still's disease without the need for an application or a calculator to calculate SDAS in routine clinical practice. • SDAS is a composite score classifying the disease activity in remission, low disease activity, moderate disease activity, and severe disease activity despite its heterogeneous patterns (systemic and articular forms). • The SDAS is a valid, reliable, and sensitive score and can be useful to guide the therapeutic strategy in clinical practice and in research., (© 2024. The Author(s), under exclusive licence to International League of Associations for Rheumatology (ILAR).)

Objective: To identify the presence and distribution of histopathological features of synovial inflammation and tissue damage, and to test their associations with ultrasound (US) imaging measures of synovitis and patient-reported measures of pain in knee osteoarthritis (OA)., Design: In the cross-sectional study of 122 patients undergoing surgery for painful late-stage (Kellgren-Lawrence Grade 3 or 4) knee OA, we compared US measures of synovitis (n = 118) and pain (Knee Injury and Osteoarthritis Outcome Score) to histopathological measures of inflammation vs. synovial tissue damage in synovial tissue biopsies. Associations of histopathological features with US measures of inflammation or pain were assessed using linear or logistic regression while controlling for covariates., Results: Histopathological features of inflammation were associated with higher odds of moderate/severe US synovitis (odds ratio [OR] = 1.34 [95%CI 1.04, 1.74), whereas features of synovial tissue damage were associated with lower odds of moderate/severe US synovitis (OR = 0.77 [95%CI 0.57, 1.03]). Worse histopathological scores for synovial tissue damage were associated with more pain (-1.47 [95%CI -2.88, -0.05]), even while adjusting for synovial inflammation (-1.61 [95%CI -3.12, -0.10])., Conclusions: Synovial tissue damage is associated with pain in late-stage knee OA, independent from inflammation and radiographic damage. These novel findings suggest that preventing synovial tissue damage may be an important goal of disease-modifying OA therapy., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Objective: The relation of degenerative temporomandibular joint (TMJ) diseases (DJDs) with sleep and emotional disturbance were investigated., Methods: CBCT examination of patients (n = 358) with DC/TMD-defined intra-articular temporomandibular disorders was performed and stratified into NN: no DJD and no arthralgia; NA: no DJD with arthralgia; TO: osteoarthrosis; and TR: osteoarthritis. Sleep and emotional disturbance were assessed with the Pittsburgh Sleep Quality Index (PSQI) and Depression Anxiety Stress Scale-21 (DASS-21). Data were evaluated using non-parametric and multivariate logistic regression analyses (α = 0.05)., Results: Distributions of NN, NA, TO, and TR groups were 23.2%, 27.1%,19.0%, and 30.7%, respectively. No significant differences in total-PSQI/DASS scores were detected among the four groups. The presence of pain and stress predicted poor quality sleep with odds ratios of 10.75 and 1.07, accordingly., Conclusion: Sleep quality was affected more by arthralgia and stress than the presence of TMJ DJDs.

Objective: To evaluate pain control in patients with joint and muscle pain in temporomandibular disorder (TMD) diagnosis treated with oral non-steroidal anti-inflammatory drugs (NSAIDs)., Methods: The systematic research was conducted via Pubmed, Scopus, Web of Science, Google Scholar, and Cochrane databases., Results: Four full-text randomized-controlled trials (RCTs) were considered eligible. This systematic review included 164 patients whose VAS scores were assessed before and after therapy. In the selected studies, a strong heterogeneity in the diagnosis and in the use of different types and prescriptions of NSAIDs was highlighted. These limitations had to be considered to understand whether a clinical recommendation could be made. Eventually, all patients treated with NSAIDs showed an improvement in pain., Conclusion: The use of oral NSAIDs as the first approach to control joint and muscle pain is sustained by the current scientific literature, but further investigations on this topic are still needed.

Background: Total hip replacement is routinely recommended for severe hip osteoarthritis, but data from randomized trials are lacking regarding comparison of the effectiveness of this procedure with that of nonsurgical treatment such as resistance training., Methods: We conducted a multicenter, randomized, controlled trial to compare total hip replacement with resistance training in patients 50 years of age or older who had severe hip osteoarthritis and an indication for surgery. The primary outcome was the change in patient-reported hip pain and function from baseline to 6 months after the initiation of treatment, assessed with the use of the Oxford Hip Score (range, 0 to 48, with higher scores indicating less pain and better function). Safety was also assessed., Results: A total of 109 patients (mean age, 67.6 years) were randomly assigned to total hip replacement (53 patients) or resistance training (56 patients). In an intention-to-treat analysis, the mean increase (indicating improvement) in the Oxford Hip Score was 15.9 points in patients assigned to total hip replacement and 4.5 points in patients assigned to resistance training (difference, 11.4 points; 95% confidence interval, 8.9 to 14.0; P<0.001). At 6 months, 5 patients (9%) who had been assigned to total hip replacement had not undergone surgery, and 12 patients (21%) who had been assigned to resistance training had undergone total hip replacement. The incidence of serious adverse events at 6 months was similar in the two groups; the majority of such events were known complications of total hip replacement., Conclusions: In patients 50 years of age or older who had severe hip osteoarthritis and an indication for surgery, total hip replacement resulted in a clinically important, superior reduction in hip pain and improved hip function, as reported by patients, at 6 months as compared with resistance training. (Funded by the Danish Rheumatism Association and others; PROHIP ClinicalTrials.gov number, NCT04070027.)., (Copyright © 2024 Massachusetts Medical Society.)

Background: Weight reduction has been shown to alleviate symptoms of osteoarthritis of the knee, including pain. The effect of glucagon-like peptide-1 receptor agonists on outcomes in knee osteoarthritis among persons with obesity has not been well studied., Methods: We conducted a 68-week, double-blind, randomized, placebo-controlled trial at 61 sites in 11 countries. Participants with obesity (a body-mass index [BMI; the weight in kilograms divided by the square of the height in meters] of ≥30) and a clinical and radiologic diagnosis of moderate knee osteoarthritis with at least moderate pain were randomly assigned, in a 2:1 ratio, to receive once-weekly subcutaneous semaglutide (2.4 mg) or placebo, in addition to counseling on physical activity and a reduced-calorie diet. The primary end points were the percentage change in body weight and the change in the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain score (on a scale of 0 to 100, with higher scores reflecting worse outcomes) from baseline to week 68. A key confirmatory secondary end point was the physical-function score on the 36-Item Short Form Health Survey (SF-36), version 2 (on a scale of 0 to 100, with higher scores indicating greater well-being)., Results: A total of 407 participants were enrolled. The mean age was 56 years, the mean BMI 40.3, and the mean WOMAC pain score 70.9. A total of 81.6% of the participants were women. The mean change in body weight from baseline to week 68 was -13.7% with semaglutide and -3.2% with placebo (P<0.001). The mean change in the WOMAC pain score at week 68 was -41.7 points with semaglutide and -27.5 points with placebo (P<0.001). Participants in the semaglutide group had a greater improvement in SF-36 physical-function score than those in the placebo group (mean change, 12.0 points vs. 6.5 points; P<0.001). The incidence of serious adverse events was similar in the two groups. Adverse events that led to permanent discontinuation of the trial regimen occurred in 6.7% of the participants in the semaglutide group and in 3.0% in the placebo group, with gastrointestinal disorders being the most common reason for discontinuation., Conclusions: Among participants with obesity and knee osteoarthritis with moderate-to-severe pain, treatment with once-weekly injectable semaglutide resulted in significantly greater reductions in body weight and pain related to knee osteoarthritis than placebo. (Funded by Novo Nordisk; STEP 9 ClinicalTrials.gov number, NCT05064735.)., (Copyright © 2024 Massachusetts Medical Society.)

Personalised medicine is a key goal across medical specialties today: using biomarkers and knowledge of pathophysiology to ensure the right patients get the right treatment. This becomes more challenging when patients have more than one disease requiring a targeted treatment. Autoimmune diseases commonly co-occur, and thus, multidisciplinary working is important in rheumatology. We present a case where a patient with a new diagnosis of alopecia areata on a background of rheumatoid arthritis was successfully treated with baricitinib monotherapy, with improvement in both conditions., Competing Interests: Competing interests: None declared., (© BMJ Publishing Group Limited 2024. No commercial re-use. See rights and permissions. Published by BMJ.)

Introduction: Patients with generalised joint hypermobility, including knee hypermobility (GJHk), often experience knee pain and are typically managed with low-intensity strength training and/or proprioceptive training as part of standard care. However, not all patients experience satisfactory outcomes. High-load strength training may offer additional benefits, such as increased muscle cross-sectional area, neural drive and tendon stiffness, which may reduce pain and improve active knee joint stability during movement tasks and daily activities. So far, no randomised controlled trials (RCTs) have compared high-load strength training with traditional treatment strategies (standard care) for this patient group., Methods and Analysis: In this RCT, we aim to recruit patients with GJHk and knee pain from primary care physiotherapy clinics in the Region of Southern Denmark and via social media. Patients with competing injuries or experience with high-load strength training will be excluded. Patients will be randomised (1:1 ratio) to either 2 weekly sessions of high-load strength training or standard care for 12 weeks. The primary outcome is self-reported knee pain during an activity nominated by the patient as the most aggravating for their present knee pain measured using the Visual Analogue Scale for Nominated Activity (VAS NA , 0-100; 0=no pain and 100=worst imaginable pain). This will be collected at baseline, 6 weeks, 12 weeks and 12 months. Secondary outcomes include self-reported knee function and adverse events (collected at baseline, 12 weeks and 12 months), objective measurements including a 5-repetition maximum single-leg press, proprioception and single-leg-hop for distance (collected at baseline and 12 weeks), and a range of other outcome measures such as fear of movement, tendon stiffness and global perceived effect. We aim to recruit 90 patients in total to detect a 10 mm group difference in the primary outcome with 80% power., Ethics and Dissemination: This study was funded by Independent Research Fund Denmark (grant number 2034-00088B) on 14 June 2022; the Regional Committees on Health Research Ethics for Southern Denmark approved it (S-20230050) on 30 August 2023. The first recruitment site opened on 15 February 2024, and the final results will be submitted to a peer-reviewed journal to inform rehabilitation strategies for symptomatic GJHk.Protocol version 1, dated 4 July 2024., Trial Registration Number: NCT06277401., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: This study aimed to evaluate the effectiveness of circumferential patellar denervation in reducing anterior knee pain (AKP) and improving clinical outcomes after total knee arthroplasty (TKA) without patellar resurfacing., Materials and Methods: This prospective, non-randomized, observational study included patients who underwent primary TKA at our institution between August 2023 and January 2024. Patients were divided into two groups: those who received patellar denervation (PD group) and those who did not (NPD group). The primary outcome was the reduction in anterior knee pain (AKP), measured by the Visual Analog Scale (VAS). Secondary outcomes included the Kujala Knee Score, Western Ontario and McMaster Universities Arthritis Index (WOMAC), and range of motion (ROM). Assessments were conducted preoperatively and at 3 and 6 months postoperatively., Results: Four patients in the PD group and five in the NPD group were excluded from the study due to failure to complete follow-up. Thus, 74 female and 16 male patients with a mean age of 67.4 ± 4.2 years were included in the final analysis. There were no significant differences between the two groups with respect to age, sex, side of surgery, height, weight, BMI, grade of patellofemoral osteoarthritis, preoperative ROM, VAS score, Kujala score, and WOMAC score (p: n.s. for all variables). No significant differences were found between the groups for VAS, Kujala, and WOMAC scores at any time point (p: n.s.). Significant improvements in these scores over time were indicated by repeated measures ANOVA (p = 0.001 for both groups). Pairwise comparisons showed significant improvements from preoperative to postoperative months three and six and from postoperative months three to six (p = 0.001 for all comparisons). Both groups experienced decreased knee ROM at third month, which returned to preoperative values at sixth month with no significant differences. No complications were observed during the study., Conclusions: Circumferential patellar denervation does not provide additional benefit in reducing anterior knee pain or improving functional outcomes compared to the non-denervation approach in TKA without patellar resurfacing., Level of Evidence: Level III, Prospective comparative study., (© 2024. The Author(s).)

Pathological femoral anteversion (FAV) or femoral maltorsion is often overlooked as a cause of anterior knee pain (AKP). Therefore, it should be routinely evaluated during physical examination of the patient with AKP. FAV is a problem because it changes the direction of the quadriceps and thereby the force acting on the patellofemoral joint. The Murphy CT method comes closest to showing the anatomical reality when FAV is evaluated. The treatment of choice in a patient with AKP with symptomatic excessive FAV is the femoral derotational osteotomy. Before doing a derotational osteotomy, the hip joint should be evaluated to avoid hip pain. Currently, no scientific evidence supports the cutoff point at which derotational femoral osteotomy should be the treatment of choice in young patients with AKP with symptomatic pathological FAV. Furthermore, no evidence exists regarding the level at which the osteotomy must be done., (Copyright © 2024 by the American Academy of Orthopaedic Surgeons.)

Objective: Diabetes mellitus (DM) is an important risk factor for the development of osteoarthritis (OA), increasing OA progression and OA pain. To gain insight into the underlying mechanisms of how DM exacerbates OA processes and OA pain, this study analyzed histological differences of synovial tissues from non-DM and DM patients with OA and correlated these differences with knee pain severity., Materials and Methods: Synovial tissue was obtained from 12 non-DM and 10 DM patients with advanced knee OA who underwent total knee arthroplasty. Synovial inflammation was assessed using the Synovitis score developed by Krenn. The Knee Injury and Osteoarthritis Outcome Score (KOOS) was used to assess knee pain intensity and disability in OA patients. The number of mast cells, macrophages, nerve fibers, capillaries, larger vessels and erythrocyte extravasation were analyzed microscopically in histological and immunostained synovial sections from non-DM and DM patients. Association analyses were performed to determine associations between OA knee pain and synovial changes affected by DM., Results: Synovial tissue from OA patients with DM had a higher synovitis score, more erythrocyte extravasation, and contained higher numbers of mast cells and macrophages compared to non-DM patients. The number of capillaries and vessels in the lining/sublining layer of the synovial tissue was reduced in DM patients. OA patients with DM had more severe knee pain compared to non-DM patients. The KOOS pain score was associated with the synovitis score, the number of tissue macrophages, and the number of mast cells in the synovial tissue (adjusted for age, sex, and BMI). In addition, the erythrocyte extravasation score was associated with the KOOS pain score and with the synovitis score., Conclusion: The study suggests that increased OA progression and pain severity in patients with DM result from more pronounced synovitis and synovial vascular leakage and increased infiltration of macrophages and mast cells., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. The author(s) declared that they were an editorial board member of Frontiers, at the time of submission. This had no impact on the peer review process and the final decision., (Copyright © 2024 Eitner, Rutte, Marintschev, Hofmann and Schaible.)

Objective: To compare two different algological intervention technique outcomes with ultrasound-guided genicular pulse radiofrequency (PRF) and fluoroscopy-guided intra-articular pulse radiofrequency for knee osteoarthritis-related pain., Study Design: Observational study. Place and Duration of the Study: Izmir Bakircay University, Cigli Training and Research Hospital and Health Science University Tepecik, Training and Research Hospital, Izmir, Turkiye, between March 2022 and May 2023., Methodology: Patients aged 60 years and above with stage 3 and 4 knee osteoarthritis, experiencing knee pain for more than six months, and non-responsive to conservative treatments were included. Patients with recent knee surgery or intra-articular injections and those ineligible for radiofrequency application were excluded. Ultrasound-guided genicular nerve PRF and fluoroscopy-guided intra-articular PRF were administered to the included patients. Pain and quality of life were evaluated using the visual analogue scale (VAS) and Western Ontario and McMaster Universities Index of Osteoarthritis (WOMAC) scores before and after the procedures., Results: The study included 64 patients. Both ultrasound-guided genicular PRF and fluoroscopy-guided intra-articular PRF resulted in significant reductions in VAS and WOMAC scores at 1 and 3 months after the procedures. There was no significant difference in efficacy between the two techniques., Conclusion: Ultrasound-guided genicular PRF and fluoroscopy-guided intra-articular PRF are effective and safe options for managing knee osteoarthritis-related pain., Key Words: Osteoarthritis, Pulse radiofrequency, Ultrasound, Fluoroscopy, Pain.

Ulnar-sided wrist pain remains a commonly encountered diagnostic challenge, and its successful management requires a comprehensive understanding of the multiple conditions that can present with this symptom. Midcarpal impaction syndromes in the form of Hamato-lunate and Triquetro-hamate impingement have both previously been reported as rare potential causes of ulnar-sided wrist pain. Despite this, they remain poorly recognized and incompletely understood. This article reviews existing literature that describes the diagnosis and management of these clinical entities., Competing Interests: Conflicts of Interest No benefits in any form have been received or will be received related directly to this article., (Copyright © 2024 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.)

Objective: Protracted febrile myalgia syndrome (PFMS) is characterized by severe myalgia, fever, abdominal pain, and arthralgia/arthritis episodes lasting for several weeks in patients with familial Mediterranean fever. Treatment options include nonsteroidal anti-inflammatory drugs, corticosteroids, and anti-interleukin-1 therapy. This study aimed to share our experiences of PFMS so as to shed light on this rare and elusive condition., Methods: This cross-sectional analysis included 17 patients diagnosed with PFMS at our pediatric rheumatology clinic between January 2018 and September 2023., Results: In our clinic, 17 (1%) of 1663 familial Mediterranean fever patients presented with PFMS, and it was the initial manifestation in 10 patients (58.8%) in the cohort. Eight of the 17 patients had an M694V homozygous mutation in the MEFV gene. A magnetic resonance imaging showed myositis and fasciitis in just 1 patient, and myositis alone was evident in 5 others. Symptoms improved in 2 patients with nonsteroidal anti-inflammatory drugs, whereas prednisolone improved symptoms in 12 patients and anakinra was required in 3 patients. Patients who received anakinra had another severe attack and required long-term anakinra or canakinumab., Conclusions: Syndrome for PFMS is difficult to recognize as it can sometimes be the first manifestation of familial Mediterranean fever. The syndrome is not accompanied by fever in some patients, even though the word febrile is part of its name. Most patients respond dramatically to nonsteroidal anti-inflammatory drugs or corticosteroids. In some patients with PFMS, long-term anakinra or canakinumab treatment may be more useful in preventing severe attacks of PFMS than short-term (5 to 7 days) anakinra treatment., Competing Interests: The authors declare no conflict of interest., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Magnetic resonance imaging (MRI) is increasingly used in the classification and evaluation of osteoarthritis (OA). Many studies have focused on knee OA, investigating the association between MRI-detected knee structural abnormalities and knee pain. Hip OA differs from knee OA in many aspects, but little is known about the role of hip structural abnormalities in hip pain. This study aimed to systematically evaluate the association of hip abnormalities on MRI, such as cartilage defects, bone marrow lesions (BMLs), osteophytes, paralabral cysts, effusion-synovitis, and subchondral cysts, with hip pain. We searched electronic databases from inception to February 2024, to identify publications that reported data on the association between MRI features in the hip joint and hip pain. The quality of the included studies was scored using the Newcastle-Ottawa Scale (NOS). The levels of evidence were evaluated according to the Cochrane Back Review Group Method Guidelines and classified into five levels: strong, moderate, limited, conflicting, and no evidence. A total of nine studies were included, comprising five cohort studies, three cross-sectional studies, and one case-control study. Moderate level of evidence suggested a positive association of the presence and change of BMLs with the severity and progress of hip pain, and evidence for the associations between other MRI features and hip pain were limited or even conflicting. Only a few studies with small to modest sample sizes evaluated the association between hip structural changes on MRI and hip pain. BMLs may contribute to the severity and progression of hip pain. Further studies are warranted to uncover the role of hip MRI abnormalities in hip pain. The protocol for the systematic review was registered with PROSPERO ( https://www.crd.york.ac.uk/PROSPERO/ , CRD42023401233)., (© 2024. The Author(s).)

Fifty-one percent of humans are born with ovaries. As the ovarian production of estrogen diminishes in midlife and ultimately stops, it is estimated that more than 47 million women worldwide enter the menopause transition annually. More than 70% will experience musculoskeletal symptoms and 25% will be disabled by them through the transition from perimenopause to postmenopause. This often-unrecognized collective of musculoskeletal symptoms, largely influenced by estrogen flux, includes arthralgia, loss of muscle mass, loss of bone density and progression of osteoarthritis, among others. In isolation, it can be difficult for clinicians and patients to adequately appreciate the substantial role of decreasing estrogen, anticipate the onset of related symptoms and actively treat to mitigate future detrimental processes. Thus, in this review we introduce a new term, the musculoskeletal syndrome of menopause, to describe the collective musculoskeletal signs and symptoms associated with the loss of estrogen. Given the significant effects of these processes on quality of life and the associated personal and financial costs, it is important for clinicians and the women they care for to be aware of this terminology and the constellation of musculoskeletal processes for which proper risk assessment and prophylactic management are of consequence.

Objective: Our objectives were to quantify the relationships among fatigue, pain interference, and physical disability in children with juvenile idiopathic arthritis (JIA) and to test whether fatigue mediates the relationship between pain interference and physical disability in JIA., Methods: Patients enrolled within three months of JIA diagnosis in the Canadian Alliance of Pediatric Rheumatology Investigators (CAPRI) Registry between February 2017 and May 2023 were included. Their parents completed the Patient-Reported Outcomes Measurement Information System fatigue and pain interference short proxy questionnaires and the Childhood Health Assessment Questionnaire disability index at registry enrollment. Associations were assessed using Pearson correlations and multiple linear regression. Structural equation modeling (SEM) was used to test if fatigue mediates the relationship between pain interference and physical disability., Results: Among 855 patients (61.4% female, 44.1% with oligoarthritis), most reported fatigue and pain interference scores similar to those in the reference population, but 15.6% reported severe fatigue and 7.3% reported severe pain interference, with wide variation across JIA categories. Fatigue was strongly correlated with pain interference (r = 0.72, P < 0.001) and with physical disability (r = 0.60, P < 0.001). Pain interference (β = 0.027, P < 0.001) and fatigue (β = 0.013, P < 0.001) were both associated with physical disability after controlling for each other and potential confounders. SEM supported our hypothesis that fatigue partially mediates the relationship between pain interference and physical disability., Conclusion: Our findings suggest both fatigue and pain interference are independently associated with physical disability in children newly diagnosed with JIA, and the effect of pain interference may be partly mediated by fatigue., (© 2024 The Author(s). Arthritis Care & Research published by Wiley Periodicals LLC on behalf of American College of Rheumatology.)

Purpose: Diagnosing the cause of ulnar-sided wrist pain can be difficult in the pediatric and adolescent age group. While frequently used, the diagnostic accuracy of magnetic resonance image (MRI), as compared with intraoperative arthroscopic findings, is not well-described in this population. This study aimed to determine concordance rates between magnetic resonance and arthroscopic findings depending on the specific ulnar wrist pathology., Methods: A retrospective review was performed to identify pediatric and adolescent patients who underwent operative treatment of ulnar wrist pain between 2004 and 2021. Patients were included in the analysis if they were <18 years of age, complained of ulnar-sided wrist pain, underwent MRI of the affected wrist with an available report interpreted by a consultant radiologist, and had a diagnostic arthroscopy procedure within one year of imaging. Ulnar pathologies analyzed included triangular fibrocartilage (TFCC) tears, ulnotriquetral (UT) ligament tears, lunotriquetral ligament abnormalities, and ulnocarpal impaction., Results: A total of 40 patients with a mean age of 15-years-old (range 11 to 17) were included in the analysis. Twenty-four were female, and approximately half had their dominant extremity affected. Most had a history of antecedent trauma (n = 34, 85%), but only 15/40 (38%) had a history of fracture. The mean duration of symptoms prior to presentation was six months (standard deviation, 7). The most common etiologies were Palmer 1B TFCC tears (n = 27, 68%) followed by UT split tears (n = 11, 28%). MRI overall demonstrated high specificity (82% to 94%), but low sensitivity (14% to 71%) for ulnar-sided wrist conditions. Accuracy varied between 70% and 83% depending on the specific injury., Conclusion: While MRI is a useful adjunct for determining the cause of ulnar wrist pathologies, findings are often discordant when compared with diagnostic arthroscopy. Surgeons should have a high degree of suspicion for TFCC-related pathology in the setting of positive provocative clinical examination despite negative MRI findings in young patients., Type of Study/level of Evidence: Diagnostic IIb., Competing Interests: Conflicts of Interest No benefits in any form have been received or will be received related directly to this article., (Copyright © 2024 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.)

Objective: To assess the effectiveness of mesenchymal stem cells (MSCs) for chronic knee pain secondary to osteoarthritis (OA)., Methods: We searched MEDLINE, EMBASE, CINAHL, and Cochrane Central to September 2023 for trials that (1) enrolled patients with chronic pain associated with knee OA, and (2) randomized them to MSC therapy vs. placebo or usual care. We performed random-effects meta-analysis and used Grading of Recommendations, Assessment, Development, and Evaluation to assess the certainty of evidence., Results: We included 16 trials (807 participants). At 3-6 months, MSC therapy probably results in little to no difference in pain relief (weighted mean difference [WMD] -0.74 cm on a 10 cm visual analog scale [VAS], 95% confidence interval [95%CI] -1.16 to -0.33; minimally important difference [MID] 1.5 cm) or physical functioning (WMD 2.23 points on 100-point 36-item Short Form Survey (SF-36) physical functioning subscale, 95%CI -0.97 to 5.43; MID 10-points; both moderate certainty). At 12 months, injection of MSCs probably results in little to no difference in pain (WMD -0.73 cm on a 10 cm VAS, 95%CI -1.69 to 0.24; moderate certainty) and may improve physical functioning (WMD 19.36 points on 100-point SF-36 PF subscale, 95%CI -0.19 to 38.9; low certainty). MSC therapy may increase risk of any adverse events (risk ratio [RR] 2.67, 95%CI 1.19 to 5.99; low certainty) and pain and swelling of the knee joint (RR 1.58, 95%CI 1.04 to 2.38; low certainty)., Conclusions: Intra-articular injection of MSCs for chronic knee pain associated with OA probably provides little to no improvement in pain or physical function., (Copyright © 2024 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Purpose: Patients frequently complain of low back pain and sacroiliac joint pain (SIP) following total hip arthroplasty (THA). We hypothesized that patients with SIP would display different pelvic incidence (PI) values between standing and relaxed sitting positions, indicative of increased motion in the sacroiliac joints., Methods: In this retrospective case-control study, 94 patients who underwent unilateral THA and experienced SIP were compared with 94 control patients without SIP. SIP was confirmed through clinical tests and investigated using biplanar imaging in both standing and sitting positions. The key parameters analyzed included PI, sacral slope (SS), lumbar lordosis (LL), and limb length discrepancy (LLD)., Results: Patients without SIP showed a mean difference in PI of -1.5° (-8°-5°) between standing-to-sitting positions, whereas those with SIP showed a difference of -3.3° (-12°-0°)(P < 0.0001), indicating more motion in the sacroiliac joint during daily activities in the latter group. Patients with SIP showed smaller change in LL between standing-to-sitting positions (mean:6.3°; range:-8°-27°) compared with those without SIP (mean:9.5°; range:-12°-28°)(P = 0.006). No significant differences were noted in functional leg length between patients with (mean:7 mm; range:0-12 mm) and without SIP (mean:7 mm; range:0-11 mm)(P = 0.973)., Conclusions: This study revealed significant sacroiliac joint motion in patients with SIP post-THA, as indicated by PI changes, increased posterior pelvic tilt, and reduced change in the LL. Contrary to common belief, SIP did not correlate with LLD., (© 2024. The Author(s) under exclusive licence to SICOT aisbl.)

Objective: To investigate relationships between static foot posture, dynamic plantar foot forces and knee pain in people with medial knee osteoarthritis (OA)., Design: Data from 164 participants with symptomatic, moderate to severe radiographic medial knee OA were analysed. Knee pain was self-reported using a numerical rating scale (NRS; scores 0-10; higher scores worse) and the Knee Injury and Osteoarthritis Outcome Score pain subscale (KOOS; scores 0-100; lower scores worse). Static foot posture was assessed using clinical tests (foot posture index, foot mobility magnitude, navicular drop). Dynamic plantar foot forces (lateral, medial, whole foot, medial-lateral ratio, arch index) were measured using an in-shoe plantar pressure system while walking. Relationships between foot posture and plantar forces (independent variables) and pain (dependent variables) were evaluated using linear regression models, unadjusted and adjusted for sex, walking speed, Kellgren & Lawrence grade, shoe category, and body mass (for dynamic plantar foot forces)., Results: No measure of static foot posture was associated with any knee pain measure. Higher medial-lateral foot force ratio at midstance, and a higher arch index during overall stance, were weakly associated with higher knee pain on the NRS (regression coefficient = 0.69, 95% confidence interval (CI) 0.09 to 1.28) and KOOS (coefficient=3.03, 95% CI 0.71 to 5.35) pain scales, respectively., Conclusion: Dynamic plantar foot forces, but not static foot posture, were associated with knee pain in people with medial knee OA. However, the amount of pain explained by increases in plantar foot force was small; thus, these associations are unlikely to be clinically meaningful., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Objectives: To determine the proportion of patients with rheumatoid arthritis (RA) with severe persisting pain and to identify predictive factors despite treatment-controlled disease activity., Methods: This prospective multicentre study included outpatients with RA scheduled for escalation of anti-inflammatory treatment due to active disease and severe pain (Disease Activity Score 28 (DAS28)>3.2 and Visual Analogue Scale (VAS)>50). At week 24, patients were stratified into reference group (DAS28 improvement>1.2 or DAS28≤3.2 and VAS pain score<50), non-responders (DAS28 improvement≤1.2 and DAS28>3.2, regardless of VAS pain score) and persisting pain group (DAS28 improvement>1.2 or DAS28≤3.2 and VAS pain score≥50). The former two subgroups ended the study at week 24. The latter continued until week 48. Demographic data, DAS28-C reactive protein, VAS for pain, painDETECT Questionnaire (PD-Q) to identify neuropathic pain (NeP) and the Pain Catastrophising Scale were assessed and tested for relation to persisting pain., Results: Of 567 patients, 337 (59.4%) were classified as reference group, 102 (18.0%) as non-responders and 128 (22.6%) as patients with persisting pain. 21 (8.8%) responders, 28 (35.0%) non-responders and 27 (26.5%) persisting pain patients tested positive for NeP at week 24. Pain catastrophising (p=0.002) and number of tender joints (p=0.004) were positively associated with persisting pain at week 24. Baseline PD-Q was not related to subsequent persisting pain., Conclusions: Persisting and non-nociceptive pain occur frequently in RA. Besides the potential involvement of NeP, pain catastrophising and a higher number of tender joints coincide with persisting pain., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ on behalf of EULAR.)

Purpose: A systematic review and meta-analysis for incidence and risk factors of new-onset sacroiliac joint pain (SIJP) after spinal surgery aimed to provide evidence-based medical references for its early prevention, timely intervention, and appropriate treatment., Methodology: The protocol of the systematic review and meta-analysis was registered in the International Prospective Register of Systematic Review (PROSPERO) with the PROSPERO ID (CRD42023463177). Relevant studies were searched to January 2024 from the databases of PubMed, Embase, Cochrane Library, and Web of Science, and the types of studies were cohort studies, case-control studies, and cross-sectional studies. Study quality was assessed using the Newcastle-Ottawa Scale (NOS) and the Cross-Sectional/Prevalence Study Quality recommended by the Agency for Healthcare Research and Quality (AHRQ). Two authors conducted studies search, data extraction, and quality assessment independently. Meta-analyses were done using Stata 14.0 software., Results: Twelve observational studies with 3,570 spinal surgery patients were included. Ten were case-control studies, one was a cross-sectional study, and another was a cohort study, all of which were of moderate quality and above. The results of the meta-analysis showed that the incidence of new-onset SIJP after spinal surgery was 9.40%; females, no. of surgical segments, fusion to the sacrum, and postoperative pelvic tilt (PT) were significantly associated with the new-onset SIJP after spinal surgery. Meta-analyses for preoperative and postoperative controls of spondylopelvic parameters showed that postoperative lumbar lordosis (LL) in the SIJP group and postoperative LL and sacral slope (SS) of patients in the NoSIJP group had significant differences from preoperative., Conclusion: Available evidence suggests that an increased risk of new-onset SIJP after spinal surgery is associated with sex, multi-segmental surgery, fusion to the sacrum, and greater postoperative PT., Competing Interests: The authors declare that they have no competing interests., (© 2024 Xu et al.)

The main non-traumatic causes of acute single-joint pain are microcrystalline, degenerative, reactive and septic arthritis. Septic arthritis must be excluded quickly with puncture of the joint effusion. In the absence of sepsis, surgical drainage can be performed within 24 hours after admission to the emergency unit. Concerning gout, recommendations advise the use of imaging for diagnosis in case of joint puncture not feasible and the introduction of urate-lowering treatment during the acute attack. Regarding reactive arthritis, the presence of microbial elements in the affected joints improves the understanding of its pathophysiology. Finally, osteoarthritis guidelines emphasize the importance of self-management programs for painful crises., Competing Interests: Les auteurs n’ont déclaré aucun conflit d’intérêts en relation avec cet article.

Diagnosing rheumatoid arthritis early in patients presenting with pain of hand joints facilitates a fast initiation of effective treatment and, in general, with better results than late initiation of treatment. The diagnosis is based on specific pattern recognition and makes distinguishing with osteoarthritis without laboratory testing or imagine studies possible. These 3 cases of patients presenting with joint pain of the hands show this clinical diagnostic process in detail. Patient history taking in which inflammatory and specific joint distributions guides a first impression toward the diagnosis of rheumatoid arthritis or osteoarthritis. However, the recognition of arthritis is based on detecting synovial swelling of the joint on physical examination. Suspicion of arthritis warrants referral to a rheumatologic center as specific treatment with disease modifying anti-rheumatic drugs are available. Treatment of patients with osteoarthritis can be managed by general practitioners and includes exercises, self-management, splinting and using pain medication.

Objective: The study used machine learning models to predict the clinical outcome with various attributes or when the models chose features based on their algorithms., Methods: Patients who presented to an orthopedic outpatient department with joint swelling or myalgia were included in the study. A proforma collected clinical information on age, gender, uric acid, C-reactive protein, and complete blood count/liver function test/renal function test parameters. Machine learning decision models (Random Forest and Gradient Boosted) were evaluated with the selected features/attributes. To categorize input data into outputs of indications of joint discomfort, multilayer perceptron and radial basis function-neural networks were used., Results: The random forest decision model outperformed with 97% accuracy and minimum errors to anticipate joint pain from input attributes. For predicted classifications, the multilayer perceptron fared better with an accuracy of 98% as compared to the radial basis function. Multilayer perceptron achieved the following normalized relevance: 100% (uric acid), 10.3% (creatinine), 9.8% (AST), 5.4% (lymphocytes), and 5% (C-reactive protein) for having joint pain. Uric acid has the highest normalized relevance for predicting joint pain., Conclusion: The earliest artificial intelligence-based detection of joint pain will aid in the prevention of more serious orthopedic complications.

Nonepisodic angioedema with eosinophilia (NEAE) is characterised by a single episode of angioedema localised to the extremities and peripheral eosinophilia. While NEAE can develop in response to infection or vaccination, NEAE associated with acute parvovirus B19 (B19V) infection is rare. We describe the case of a young woman with NEAE that developed during acute B19V infection. She presented with 1-week history of pruritus and polyarthralgia in the extremities, followed by the development of peripheral oedema, and was positive for anti-B19V IgM antibody. Her arthralgia improved within 2 weeks without any specific intervention; however, the oedema and pruritic erythema persisted and the peripheral eosinophil count increased. A short course of prednisolone therapy for suspected NEAE alleviated the symptoms, which have not recurred for more than 2 years. Thus, we believe that the patient was affected by NEAE and that NEAE can develop following acute B19 infection., Competing Interests: Competing interests: None declared., (© BMJ Publishing Group Limited 2024. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: Keen Osteoarthritis (KOA) is a common chronic disabling disease characterized by joint pain and dysfunction, which seriously affects patients' quality of life. Recent studies have shown that transcranial direct current stimulation (tDCS) was a promising treatment for KOA., Purpose: Investigate the effects of tDCS on pain and physical function in patients with KOA., Methods: Randomized controlled trials related to tDCS and KOA were systematically searched in the PubMed, Embase, Medline, Cochrane Library, CINHL, and Web of Science databases from inception to July 23, 2024. The pain intensity was evaluated using the visual analog scale or the numeric rating scale, and the pain sensitivity was assessed using conditioned pain modulation, pressure pain threshold, heat pain threshold, or heat pain tolerance. The physical function outcome was evaluated using the Western Ontario and McMaster Universities Osteoarthritis Index or the Knee injury and Osteoarthritis Outcome Score. Statistical analysis was performed using Review Manager 5.4., Results: Seven studies with a total of 503 participants were included. Compared to sham tDCS, tDCS was effective in reducing the short-term pain intensity (SMD: -0.58; 95% CI: -1.02, -0.14; p = 0.01) and pain sensitivity (SMD: -0.43; 95% CI: -0.70, -0.16; p = 0.002) but failed to significantly improve the long-term pain intensity (SMD: -0.26; 95% CI: -0.59, 0.08; p = 0.13) in KOA patients. In addition, tDCS did not significantly improve the short-term (SMD: -0.13; 95% CI: -0.35, 0.08; p = 0.22) and long-term (SMD: 0.02; 95% CI: -0.22, 0.25; p = 0.90) physical function in patients with KOA., Conclusions: The tDCS can reduce short-term pain intensity and sensitivity but fails to significantly relieve long-term pain intensity and improve the physical function in patients with KOA. Thus, tDCS may be a potential therapeutic tool to reduce short-term pain intensity and pain sensitivity in patients with KOA., (© 2024. The Author(s).)

Background: Persistent high levels of knee pain after a total knee replacement have been estimated to affect 5%-10% of people and this is related to dissatisfaction with surgery, reduced function and reduced quality of life. This systematic review aims to evaluate the effectiveness of rehabilitation programs or strategies to reduce persistent pain and improve function and quality of life in people following a total knee replacement., Methods: The systematic review was conducted following PRISMA guidelines with a search of relevant online databases up to 17 July 2024. The search criteria included English language randomised controlled trials of rehabilitation programs or strategies in any setting to treat people with persistent knee pain more than 3 months after a total knee replacement. Rehabilitation could include exercise, education, cognitive strategies and self-management programs and excluded medication trials, procedural techniques and complementary therapies., Results: After removal of duplicates, there were 468 abstracts screened for eligibility with 23 remaining for full-text screening and finally, one study meeting the eligibility criteria. This study's interventions were pain neuroscience education alone and pain neuroscience education plus neuromuscular exercise. There were no statistically significant between-group differences for pain reduction or functional improvement., Conclusion: The evidence examining the value of rehabilitation programs or strategies for pain reduction and functional improvement in people with persistent pain following total knee replacement is deficient. Given the high number of people affected annually, further research concerning both prevention and management of persistent pain after knee replacement is warranted., (© 2024 The Author(s). Musculoskeletal Care published by John Wiley & Sons Ltd.)

Competing Interests: Disclosure The authors report no conflicts of interest in this work.

Knee osteoarthritis (OA) typically presents with joint pain that is exacerbated by use and alleviated with rest. There is relatively brief, self-limited morning stiffness and absence of constitutional symptoms. Overweight and obesity are the most important modifiable risk factors. Although pharmacologic and nonpharmacologic interventions are generally effective at alleviating pain and improving physical function, they do not fundamentally reverse the pathologic and radiographic process of knee OA. As the severity of disease increases, the magnitude of pain and functional impairment intensifies. Surgical intervention should be pursued to relieve pain and restore functionality only when nonpharmacologic approaches and pharmacologic agents fail to control pain., Competing Interests: Disclosures: All relevant financial relationships have been mitigated. Disclosure forms are available with the article online.

Pain in the musculoskeletal system and therefore joint pain is one of the most common reasons for consulting a general practitioner (GP). Inflammatory rheumatic diseases are among the important differential diagnoses. However, the prevalence of rheumatological diseases is significantly lower than that of degenerative causes of pain. Incorrect referrals can be avoided if the causes of pain are better differentiated in GP practices. This article presents the first differential diagnostic steps that make it easier for the GP to make further treatment decisions. Physical examination, laboratory diagnostics and imaging are discussed, and the concept of "clinically suspect arthralgia" as well as the possible effects of treatment trials with glucocorticoids are presented., Competing Interests: Erklärung zu finanziellen Interessen Forschungsförderung erhalten: nein; Honorar/geldwerten Vorteil für Referententätigkeit erhalten: nein; Bezahlter Berater/interner Schulungsreferent/Gehaltsempfänger: nein; Patent/Geschäftsanteile/Aktien (Autor/Partner, Ehepartner, Kinder) an Firma (Nicht‐Sponsor der Veranstaltung): nein; Patent/Geschäftsanteile/Aktien (Autor/Partner, Ehepartner, Kinder) an Firma (Sponsor der Veranstaltung): nein Erklärung zu nichtfinanziellen Interessen Die Autorinnen/Autoren geben an, dass kein Interessenkonflikt besteht., (Thieme. All rights reserved.)

Abstract: Pediatric hip pain can have orthopedic, infectious, inflammatory, neoplastic, or nonmusculoskeletal etiologies. Organizing the differential diagnosis by symptom chronicity and a determination of intraarticular versus extraarticular pain, as well as the age at pain onset, can be helpful to hone in on the cause. Clinicians should consider plain radiographs in cases of acute trauma, with concern for bony pathology, or in patients with unexplained limp or hip pain, with musculoskeletal ultrasound and magnetic resonance imaging used as advanced imaging when indicated. Relative rest with subsequent strengthening and stretching should be prescribed in nonoperative conditions, though several pediatric hip pain diagnoses require orthopedic or other specialty referral for definitive treatment. This article is a comprehensive review of hip pain etiologies in the pediatric population., (Copyright © 2024 Written work prepared by employees of the Federal Government as part of their official duties is, under the U.S. Copyright Act, a “work of the United States Government” for which copyright protection under Title 17 of the United States Code is not available. As such, copyright does not extend to the contributions of employees of the Federal Government.)

Objective: Chronic low-back pain (LBP) is a leading cause of disability worldwide, and traditional pharmacotherapy fails to provide relief for many individuals with this condition. An estimated 15% of chronic LBP cases can be attributed to the facet joint. High-intensity focused ultrasound (HIFU) is a recent technology that enables noninvasive thermal ablation of tissue and has shown efficacy in treating tumors, neuropathic pain, and painful bone metastases. In this systematic review, the authors summarize the literature on lumbar facet joint-mediated pain treated with HIFU and report the effectiveness of HIFU on pain outcomes., Methods: All full-text English-language articles describing the use of focused ultrasound for facet joint pain were screened using the PubMed/MEDLINE, Embase, Cochrane Library, Scopus, and Web of Science databases. Clinical studies were assessed for bias using the methodological index for nonrandomized studies., Results: Eleven studies (6 preclinical and 5 clinical) reporting on 50 patients were included. Eight of these studies (73%) used MR-guided focused ultrasound ablation and 3 used fluoroscopy. The medial branch nerve and posterior facet joint capsule were the most common targets for focused ablation. Although the energy used ranged from 300 to 2000 J, clinical studies predominantly operated in the range of 1000 to 1500 J. Pain reduction was seen in all clinical studies, with multiple-point reductions from average baseline pain scores in 6-12 months. No study reported any adverse events or complications., Conclusions: HIFU can be effective in treating chronic low-back pain arising from the facet joint. Further clinical studies should explore the long-term effects of HIFU and monitor changes in pain reduction over time.

Objective: To examine the relationship between C-reactive protein (CRP) and knee pain, and further explore whether this association is mediated by obesity., Methods: The population was derived from 1999 to 2004 National Health and Nutrition Examination Survey. Logistic regression was used to analyze the relationship between CRP and knee pain in three different models, and the linear trend was analyzed. A restricted cubic spline model to assess the nonlinear dose-response relationship between CRP and knee pain. Mediation analyses were used to assess the potential mediating role of obesity. Subgroup analyses and sensitivity analyses were performed to ensure robustness., Results: Compared with adults with lower CRP (first quartile), those with higher CRP had higher risks of knee pain (odds ratio 1.39, 95% confidence interval 1.12-1.72 in third quartile; 1.56, 1.25-1.95 in fourth quartile) after adjusting for covariates (except body mass index [BMI]), and the proportion mediated by BMI was 76.10% (p < .001). BMI and CRP were linear dose-response correlated with knee pain. The odds ratio for those with obesity compared with normal to knee pain was 2.27 (1.42-3.65) in the first quartile of CRP, 1.99 (1.38-2.86) in the second, 2.15 (1.38-3.33) in the third, and 2.92 (1.72-4.97) in the fourth., Conclusion: Obesity mediated the systemic inflammation results in knee pain in US adults. Moreover, higher BMI was associated with higher knee pain risk in different degree CRP subgroups, supporting an important role of weight loss in reducing knee pain caused by systemic inflammation., (© 2024 The Author(s). Immunity, Inflammation and Disease published by John Wiley & Sons Ltd.)

Background and Aim: Extraintestinal manifestations (EIMs) pose a significant threat in inflammatory bowel disease (IBD) patients. Vedolizumab (VDZ) primarily affects the gastrointestinal tract. However, its impact on EIMs remains uncertain. Therefore, we conducted this meta-analysis to examine the effects of VDZ on EIMs during treatment., Methods: Relevant studies were identified by conducting thorough searches across electronic databases, including PubMed, Ovid Embase, Medline, and Cochrane CENTRAL. Primary outcomes focused on the proportion of patients with resolution for pre-existing EIMs in IBD patients receiving VDZ. Secondary outcomes included the proportion of patients with EIM exacerbations and new onset EIMs during VDZ treatment., Results: Our meta-analysis encompassed 21 studies. The proportion of patients with resolution of pre-existing EIMs in VDZ-treated IBD patients was 39% (150/386; 95% confidence interval [CI] 0.31-0.48). The proportion of patients with EIM exacerbations occurred at a rate of 28% (113/376; 95% CI 0.05-0.50), while new onset EIMs had a rate of 15% (397/2541; 95% CI 0.10-0.20). Subgroup analysis revealed a 40% (136/337) proportion of patients with resolution for articular-related EIMs and a 50% (9/18) rate for erythema nodosum. Exacerbation rates for arthritis/arthralgia, erythema nodosum/pyoderma gangrenosum, and aphthous stomatitis during VDZ use were 28% (102/328), 18% (7/38), and 11% (3/28), respectively. The incidence rate of newly developed EIMs during treatment was 11% (564/4839) for articular-related EIMs, with other EIMs below 2%., Conclusion: VDZ demonstrates efficacy in skin-related EIMs like erythema nodosum and joint-related EIMs including arthritis, arthralgia, spondyloarthritis, and peripheral joint diseases. Some joint and skin-related EIMs may experience exacerbation during VDZ therapy., (© 2024 Journal of Gastroenterology and Hepatology Foundation and John Wiley & Sons Australia, Ltd.)

Ulnar-sided wrist pain is a challenging clinical scenario due to multiple overlapping pathologies and involved anatomic structures. Advanced imaging such as magnetic resonance imaging can be used as an effective diagnostic adjunct if interpreted correctly. In this article, clinically relevant structures and radiographic correlates of the ulnar wrist are discussed and a corresponding systematic approach to reviewing magnetic resonance imaging is presented., Competing Interests: Conflicts of Interest No benefits in any form have been received or will be received related directly to this article., (Copyright © 2024 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.)

Competing Interests: The author certifies that there are no funding or commercial associations (consultancies, stock ownership, equity interest, patent/licensing arrangements, etc.) that might pose a conflict of interest in connection with the submitted article related to the author or any immediate family members. All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research® editors and board members are on file with the publication and can be viewed on request.

Objective: To examine associations of vibration sensitivity and pressure pain sensitivity with knee osteoarthritis (OA) outcomes across sex and race, which may relate to known sex and race disparities in clinical outcomes., Design: Data were from the 2013-2015 visit of the Johnston County Osteoarthritis Project. Exposures were vibration perception threshold (VPT) measured at the bilateral medial femoral condyle (MFC) and first metatarsophalangeal joint (MTP), and pressure pain threshold (PPT) measured at the bilateral upper trapezius. Outcomes were knee pain severity and presence of knee symptoms, radiographic knee OA, and symptomatic knee OA in each knee. Cross-sectional associations of the exposures with the outcomes were examined using logistic regression models, overall and separately by sex and race., Results: In the VPT and PPT analyses, 851 and 862 participants (mean age 71 years, 68% female, 33% Black, body mass index 31 kg/m 2 ) and 1585 and 1660 knees were included, respectively. Higher VPT (lower vibration sensitivity) at the MFC and first MTP joint was associated with all outcomes. Lower PPT (greater pressure pain sensitivity) was associated with greater knee pain severity. Associations of VPT and PPT with all outcomes were similar among females and males and Black and White individuals., Conclusions: Diminished vibration perception and greater pressure pain sensitivity were cross-sectionally associated with worse knee OA outcomes. Despite differences in VPT and PPT among females and males and Black and White adults, associations with knee OA outcomes did not differ by sex or race, suggesting neurophysiological differences do not relate to established disparities., Competing Interests: Conflict of interest CYL: None; LMT: NIH/NIAMS funding outside this work, Editorial Board Member of Arthritis Care & Research; CA: Editorial Board Member of Arthritis Care & Research; DLG: None; AEN: Associate Editor of Osteoarthritis and Cartilage, Editorial Board Member of Arthritis Care & Research, NIH/NIAMS funding outside this work, honoraria from Nestle Health and MedScape; APG: NIH/NIAMS funding outside this work; KCF: NIH/NIAMS funding outside this work; YMG: Associate Editor of Osteoarthritis and Cartilage, Editorial Board Member of Arthritis Care & Research, NIH/NIAMS funding outside this work., (Copyright © 2024 Osteoarthritis Research Society International. Published by Elsevier Ltd. All rights reserved.)

Introduction: Calcium metabolism dysregulation in the setting of primary hyperparathyroidism (PHPT) mediated chondrocalcinosis is implicated in joint pain, a key element in the decision regarding arthroplasty for osteoarthritis. The relationship between hypercalcemia and joint pain, before and after arthroplasty, is unknown. This study investigates the association between preoperative hypercalcemia and postoperative outcomes following total knee (TKA) and total hip arthroplasty (THA)., Methods: A retrospective chart review was conducted on patients who underwent initial elective THA or TKA. Patients with a preoperative serum calcium >10.2 mg/dL were matched (1:2-1:4) with nearest neighbor to patients with normal serum calcium. THA and TKA functional outcomes were measured at baseline and 1-y postoperatively using patient-reported Hip Disability and Osteoarthritis Outcome Scores and Knee Injury and Osteoarthritis Outcome Scores surveys. Postoperative complications, readmissions, length of stay, and functional outcome scores were compared., Results: Four hundred ninety-five patients (106 hypercalcemic cases, 389 matched controls) were included. Of these, 223 patients underwent THA (46 cases; 177 controls) and 272 patients underwent TKA (61 cases; 211 controls). There were no differences in Hip Disability and Osteoarthritis Outcome Scores and Knee Injury and Osteoarthritis Outcome Scores scores, postoperative complications, readmissions, or length of stay between cases and controls. Only 19/106 (18%) hypercalcemic patients had a parathyroid hormone (PTH); of these, 9 (47%) had possible PHPT (PTH > 40)., Conclusions: Patients with hypercalcemia undergoing arthroplasty have similar functional and postoperative outcomes as normocalcemic patients. As PTH was obtained in <20% of hypercalcemic cases and 50% had possible PHPT, we recommend that hypercalcemic patients undergo PHPT workup. Additional investigation is needed to determine the effect of PHPT on arthroplasty outcomes., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Background: Acetabular and femoral version contribute to hip pain in patients with femoroacetabular impingement (FAI) or dysplasia. However, definitions and measurement methods of femoral version have varied in different studies, resulting in different "normal" values being used by clinicians for what should be the same anatomic measurement. This could result in discrepant or even inappropriate treatment recommendations., Questions/purposes: In patients undergoing hip preservation surgery, (1) what is the range of acetabular and femoral version at presentation, and how much do two commonly used measurement techniques (those of Murphy and Reikerås) differ? (2) How are differences in acetabular and femoral version associated with clinical factors and outcomes scores at the time of presentation?, Methods: This was a retrospective analysis of data gathered in a longitudinally maintained database of patients undergoing hip preservation at a tertiary care referral center. Between June 2020 and December 2021, 282 hips in 258 patients were treated for an isolated labral tear (9% [26 hips]), hip dysplasia (21% [59 hips]), FAI (52% [147 hips]), mixed FAI and dysplasia (17% [47 hips]), or pediatric deformity (slipped capital femoral head epiphysis or Perthes disease; 1% [3 hips]) with hip arthroscopy (71% [200 hips]), periacetabular osteotomy (26% [74 hips]), surgical hip dislocation (2.5% [7 hips]), or femoral derotation osteotomy (0.5% [1 hip]). We considered those with complete radiographic data (CT including the pelvis and distal femur) and patient-reported outcome scores as potentially eligible. Exclusion criteria were age younger than 18 or older than 55 years (5 hips, 3 patients), signs of hip osteoarthritis (Tönnis grade ≥ 2; 0), pediatric deformity (slipped capital femoral head epiphysis or Perthes disease; 3 hips, 3 patients), previous femoral or acetabular osteotomy (2 hips, 2 patients), avascular necrosis of the femoral head (0), history of neuromuscular disorder (Ehlers-Danlos syndrome; 3 hips, 3 patients) or rheumatoid disease (ankylosing spondylitis; 1 hip, 1 patient), and when CT did not include the knees (19 hips, 19 patients). Based on these criteria, 249 hips in 227 patients were included. Of patients with bilateral symptomatic hips, one side was randomly selected for inclusion, leaving 227 hips in 227 patients for further analysis. The patients' median age (range) was 34 years (19 to 55 years), the median BMI (range) was 27 kg/m 2 (16 to 55 kg/m 2 ), and 63% (144) were female; they were treated with hip arthroscopy (in 74% [168]) or periacetabular osteotomy (in 23% [52]). Patients underwent a CT scan to measure acetabular version and femoral version using the Murphy (low < 10°; normal: 10° to 25°; high > 25°) or Reikerås (low < 5°; normal: 5° to 20°; high > 20°) technique. The McKibbin index was calculated (low: < 20°; normal: 20° to 50°; high > 50°). Based on the central acetabular version and femoral version as measured by Murphy, hips were grouped according to their rotational profile into four groups: unstable rotational profile: high (high acetabular version with high femoral version) or moderate (high acetabular version with normal femoral version or normal acetabular version with high femoral version); normal rotational profile (normal acetabular version with femoral version); compensatory rotational profile (low acetabular version with high femoral version or high acetabular version with low femoral version); and impingement rotational profile (low acetabular version with low femoral version): high (low acetabular version with low femoral version) or moderate (low acetabular version with normal femoral version or normal acetabular version with low femoral version). Radiographic assessments were manually performed on digitized images by two orthopaedic residents, and 25% of randomly selected measurements were repeated by the senior author, a fellowship-trained hip preservation and arthroplasty surgeon. Interobserver and intraobserver reliabilities were calculated using the correlation coefficient with a two-way mixed model, showing excellent agreement for Murphy technique measurements (intraclass correlation coefficient 0.908 [95% confidence interval 0.80 to 0.97]) and Reikerås technique measurements (ICC 0.938 [95% CI 0.81 to 0.97]). Patient-reported measures were recorded using the International Hip Outcome Tool (iHOT-33) (0 to 100; worse to best)., Results: The mean acetabular version was 18° ± 6°, and mean femoral version was 24° ± 12° using the Murphy technique and 12° ± 11° with the Reikerås method. Eighty percent (181 of 227) of hips had normal acetabular version, 42% (96 of 227) to 63% (142 to 227) had normal femoral version per Murphy and Reikerås, respectively, and 67% (152 to 227) had a normal McKibbin index. Patients with an impingement profile (low acetabular version or femoral version) were older (39 ± 9 years) than patients with an unstable (high acetabular version or femoral version; 33 ± 9 years; p = 0.004), normal (33 ± 9 years; p = 0.02), or compensatory (high acetabular version with low femoral version or vice versa; 33 ± 7 years; p = 0.08) rotational profile. Using the Murphy technique, femoral version was 12° greater than with the Reikerås method (R 2 0.85; p < 0.001). There were no differences in iHOT-33 score between different groups (impingement: 32 ± 17 versus normal 35 ± 21 versus compensated: 34 ± 20 versus unstable: 31 ± 17; p = 0.40)., Conclusion: Variability in femoral version is twice as large as acetabular version. Patients with an impingement rotational profile were older than patients with a normal, compensatory, or unstable profile, indicating there are other variables not yet fully accounted for that lead to earlier pain and presentation in these groups. Important differences exist between measurement methods. This study shows that different measurement methods for femoral anteversion result in different numbers; if other authors compare their results to those of other studies, they should use equations such as the one suggested in this study., Level of Evidence: Level III, prognostic study., Competing Interests: Each author certifies that there are no funding or commercial associations (consultancies, stock ownership, equity interest, patent/licensing arrangements, etc.) that might pose a conflict of interest in connection with the submitted article related to the author or any immediate family members. All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research® editors and board members are on file with the publication and can be viewed on request., (Copyright © 2024 by the Association of Bone and Joint Surgeons.)