Safety of glucocorticoids: clinical trials

Clinical trials published over the last 5 years support the main conclusion of a comprehensive review on glucocorticoid safety published in 2006: there is little if any solid evidence to support the fear that low-dose glucocorticoids are associated with significant toxicity when used appropriately in inflammatory rheumatic diseases. In fact, most of the recent randomised-controlled research underlines the influence of the underlying inflammatory process in the occurrence of 'adverse events' such as osteoporosis, fractures, hypertension and glucose intolerance. This 'confounding by indication' is inherent to the field and questions the validity of the observational data, that seems to drive currently common concepts about low-dose glucocorticoid toxicity. Decisive conclusions cannot, in any case, be achieved at this stage because the clinical trials available are of limited duration and dimension and have not been designed specifically to address toxicity. Toxicity with low-dose glucocorticoids needs to be kept under careful clinical surveillance while we expect such trials to be produced. Meanwhile, the risks of stopping these medications, even on longstanding well controlled disease, need also to be considered, as underlined by withdrawal trials recently published

Safety of low- to medium-dose glucocorticoid treatment in rheumatoid arthritis: myths and reality over the years

Low- to medium-dose glucocorticoids have been shown to have not only anti-inflammatory but also disease-modifying properties in rheumatoid arthritis. The evidence for the benefit of its early use in combination with disease-modifying antirheumatic drugs underlines the need for a close evaluation of their risk-benefit ratio. Over time, numerous myths and fears about glucocorticoid toxicity in rheumatoid arthritis have arisen from observational studies, and many concerns have been unduly extrapolated from observations with higher-dose treatment. Furthermore, we cannot exclude the possibility of a powerful effect of bias by indication in these studies. Low- to medium-dose glucocorticoid regimens continued to be evaluated in randomized clinical trials, particularly in early disease, but these studies also have relevant methodological limitations in assessing safety, particularly due to small size and/or short duration. At present, the evidence on which to support clear recommendations about glucocorticoid toxicity remains remarkably weak. A large prospective pragmatic trial dedicated to the toxicity of low-dose glucocorticoids is dearly needed. Meanwhile, adherence to recommendations on standardized methodologies for registration and report of glucocorticoid adverse events is essential for improving our knowledge and competence in the best management of these important medications

Competencies in rheumatology: a European framework

The aims, structure, methods and educational experiences employed in the training of rheumatologists vary from one national programme to another, according to traditions, rules and resources. Mutual recognition of titles, the free movement of labour and the striving towards for high-quality standards in medical care in Europe demand that efforts and progress are made to ensure that similar competencies are achieved by different programmes. The European Rheumatology Curriculum Framework, developed by the European Board of Rheumatology, is meant to be a step towards the harmonization of rheumatology specialist training within the European Union, by providing a reference framework to the development and benchmarking of national curricula for the specialist training of rheumatologists. The European Rheumatology Curriculum Framework has now been endorsed by scientific and educational bodies in 17 member countries. It has been provided with a contextualized review of good practice in curriculum planning and development - the European Board of Rheumatology Educational Guide

Bone mechanical stimulation with piezoelectric materials

This chapter summarized explores in vivo use of a piezoelectric polymer for bone mechanical stimulatio

Piezoelectric actuators for bone mechanical stimulation: exploring the concept.

Arthroplasty is liable to cause intense changes on strain levels and distribution in the boné surrounding the implant, namely stress shielding. Several solutions have been proposed for this, namely design variations and development of controlled-stiffness implants. A new approach to this problem, with potential application to other orthopaedic problems and other medical fields, would be the development of smart implants integrating systems for bone mechanical stimulation. Ideally, the implant should presente sensing capability and the ability to maintain physiological levels of strain at the implant interface. Piezoelectric materials’ huge potential as a mean to produce direct mechanical stimulation lies on the possibility of producing stimuli at a high range of frequencies and in multiple combinations. The present in vitro and preliminary in vivo studies were a first step towards the validation of the concept

In-Vitro Assessment of the Acaricidal Properties of Artemisia annua and Zataria multiflora Essential Oils to Control Cattle Ticks

Background: The aim of this study was to investigate the ‘acaricidal effect' of Zataria multiflora and Ar­temisia annua essential oils on Rhipicephalus (Boophilus) annulatus.Methods: This study was carried out in 2009 in the Laboratory of Parasitology of the Faculty of Veteri­nary Medicine of Shahrekord University, west central Iran. Six dilutions (5, 10, 20, 40, 60 and 80 µL/cm3) of both essential oils were used against engorged female R. (Boophilus) annula­tus ticks using an in vitro immersion method. The mortality rates for each treatment were re­corded 6, 15 and 24 hours post inoculation (hpi). Mortality rate was analyzed using Repeated Meas­ures Analysis of Variance, and compari­son of means was carried out using General Linear Models Procedure.Results: The mortality rate caused by different dilutions of Z. multiflora essential oil ranged from 26.6% (using 10 µL/cm3) to 100% (using 40 µL/cm3) and for A. annua essential oil it was 33.2 to 100% (using 20 and 80 µL/cm3, respectively) by the end of the experiment (36 hpi). No mortality was recorded for the non-treated control group or for dilutions less than 5 and 10 µL/cm3 using Zataria and Artemisia essential oils, respectively. For Z. multiflora mortality peaked at 15 hpi for all concentrations other than 20 µL/cm3 and took 24 h to achieve its maximum effect while for A. an­nua the two highest concentrations needed 24 hpi to reach their full effect. In addition, essen­tial oils applied at more than 20 and 60 µL/cm3 caused 100% egg-laying failure in engorged fe­male ticks by Zataria and Artemisia, respectively while no failure was observed for the non-treated control group. The mortality rate in both botanical acaricides was dose-dependent.Conclusion: Both these medicinal plants have high potential acaricidal effects on the engorged stage of R. (Boophilus) annulatus in vitro

Selecting men for bone densitometry: performance of osteoporosis risk assessment tools in Portuguese men

Clinicians need tools to identify patients most likely to benefit from bone mineral density (BMD) testing, for which cost-effectiveness does not allow generalized screening. This study supports the utility of osteoporosis risk assessment tools in selecting men for BMD testing. Different cutoff values may be appropriate for different countries and/or ethnic origins. INTRODUCTION: Our aim was to evaluate the utility of three osteoporosis (OP) risk assessment tools in a large group of Portuguese men aged 50 or more and to determine the best cutoff value to be used for selecting men for bone densitometry. METHODS: We assessed the performance of three simple tools in 202 randomly selected men: body weight criterion (BWC), osteoporosis self-assessment tool for Asians (OSTA), and a modified version of the OSTA equation (OST). Previously published cutoff values (validated in postmenopausal women) and three additional cutoff values were tested. Sensitivity (SE), specificity (SP), predictive values, and area under the receiver operating characteristic (AUROC) curve for correctly selecting men with OP (defined by BMD testing) were determined. RESULTS: Mean age of the cohort was 63.8 years. According to the World Health Organization diagnostic categories, 16.8% had osteoporosis. The best performing cutoffs for correctly selecting men with OP for BMD testing were OST < 3 (SE = 75.5%, SP = 50.0%, AUROC = 0.632), OSTA < 3 (SE = 73.5%, SP = 58.3%, AUROC = 0.659), and BWC < 75 kg (SE = 73.5%, SP = 61.3%, AUROC = 0.674). CONCLUSIONS: OP risk assessment tools seem to be useful in men aged 50 or more. Best cutoff values are different from those recommended for postmenopausal women. Different cutoff values may be appropriate for different countries and/or ethnic origins