Rotator cuff degeneration in the rheumatoid shoulder : 'the issue is soft tissue'

We hypothesized that shoulder pain, caused by rheumatoid arthritis (RA), can lead to disuse of the affected shoulder joint. In addition to the structural changes caused by rotator cuff tears, tendonitis or synovitis disuse may play an important role in the aetiology of fatty degeneration (FD) of the rotator cuff muscles. This FD may induce proximal migration due to shoulder muscle force imbalance, causing even more pain due to subacromial impingement. FD is thought irreversible, even when the underlying pathology was treated. Early referral and treatment of shoulder involvement of rheumatoid disease may protect the rheumatoid shoulder from this downward spiral. It is of great importance to screen rheumatoid arthritis patients for shoulder joint involvement at an early stage. The use of the Upward migration Index to assess proximal migration can be used reliably to screen for the presence of rotator degeneration. In order to quantify fatty degeneration we advocate using the Mean Muscle Density measured on CT-images. We underline the importance of these measurements as they were strongly correlated to shoulder pain and functional loss. Measurement of proximal migration in an early stage can therefore play an important role in the initiation of functional and medicinal treatment of RA and may present patients with better possible outcome providing that shoulder surgery is indicated.AnnaFonds Dutch Arthritis Association Nederlandse Orthopaedische Vereniging(NOV) Nederlandse vereniging voor Arthroscopie(NVA) Bauerfeind BV BBraun BV Biomet BV DePuy/Mitec J&J BV Endocare BV Implantcast BV KCI Medical BV Mathys Orthopaedics BV Oldelft BV Plus Orthopaedics BV Schering-Plough BV Somas BV Smith & Nephew BV Stryker BV Synthes BV Tornier BV Toshiba Medical BV Wyeth BV Zimmer BVUBL - phd migration 201

ASO author reflections: towards patient-tailored management of extremity soft tissue sarcoma

Orthopaedics, Trauma Surgery and Rehabilitatio

Treatment strategies for metastatic soft tissue sarcomas

Biological, physical and clinical aspects of cancer treatment with ionising radiatio

Regression of fibrous dysplasia in response to denosumab therapy: a report of two cases

We present two patients with fibrous dysplasia who showed a decrease in lesional size and activity after denosumab therapy. Both patients also experienced a reduction in pain and bone turnover markers, which had not been accomplished during previous bisphosphonate therapy. These cases highlight the potential of denosumab to decrease lesional size in fibrous dysplasia. This finding has been reported in mice, but not in humans. Denosumab may be considered when bisphosphonates are not tolerated or not effective (enough), or in severe cases as neoadjuvant therapy to improve surgical possibilities and outcome. In addition, these results show that Na[F-18]F PET-CT is suitable for detecting change in each fibrous dysplasia lesion distinctively.Imaging- and therapeutic targets in neoplastic and musculoskeletal inflammatory diseas

Characterization of denosumab treatment response in giant cell tumors of bone with dynamic contrast-enhanced MRI

Rationale and objectivesDenosumab is a monoclonal antibody used neo-adjuvantly in giant cell tumor of bone (GCTB) to facilitate surgery, or long term for axial tumors where surgery comes with high morbidity. Time intervals for treatment effects to occur are unclear and monitoring tools are limited, complicating optimal drug dose titration. We assessed changes in time intensity curve (TIC) - derived perfusion features on DCE-MRI in GCTB during denosumab treatment and evaluated the duration of treatment effects on tumor perfusion.Materials and methodsPatients with GCTB who underwent dynamic contrast enhanced (DCE) MRI before (t = 0) and after 3 (t = 3), 6 (t = 6) or 12 (t = 12) months of denosumab treatment were retrospectively included in a single center. Regions of interest were placed on tumor compartments with visually most intense enhancement and TICs were created. Time-to-enhancement (TTE), wash-in rate (WIR), maximal relative enhancement (MRE), and area-under-the-curve (AUC) were calculated. Differences in perfusion features were calculated with the Wilcoxon signed-rank test.ResultsIn all 24 patients decreased perfusion on DCE-MRI after start of denosumab treatment was seen. TTE increased between t = 0 and t = 3 (p ConclusionMRI perfusion significantly changed in GCTB within 3 months of denosumab treatment compared to baseline. No further significant change occurred between 3 and 6, and 6 and 12 months of treatment. These findings suggest that evaluation of treatment response and subsequent consideration of maintenance with lower doses of denosumab, may already be indicated after 3 months. In cases where long term denosumab is the preferred therapy, monitoring change in tumor characteristics on DCE-MRI may aid optimal drug dose titration, minimizing side effects.Experimentele farmacotherapi

The association of metastasis pattern and management of metastatic disease with oncological outcomes in patients with malignant peripheral nerve sheath tumors: a multicenter cohort study

Simple Summary:& nbsp;Around 40% of patients with MPNSTs develop distant metastasis (DM) within five years. Identification of MPNST patients more likely to develop DM and the identification of prognostic factors after DM diagnosis may guide clinical decision-making and may result in a better balance between quantity and quality of life. This study aimed to identify clinicopathologic and treatment-related factors associated with the development of DM and with overall survival (OS) after DM diagnosis. NF1, high grade, tumor size, triton and R2 resections were independent risk factors for the development of DM. This is the first study that reveals that NF1 status is also independently associated with worse survival after DM diagnosis with a median survival difference of more than 6 months between NF1 and no-NF1 patients.Purpose: This multicenter cohort study aimed to identify clinicopathologic and treatment-related factors associated with the development of distant metastasis (DM) and with overall survival (OS) after DM diagnosis in patients with malignant peripheral nerve sheath tumors (MPNST). Methods: All patients diagnosed with primary MPNST from 1988 to 2019 who were surgically treated for the primary tumor were included. Multivariable Cox regression analyses were performed to identify factors associated with DM and OS after DM diagnosis. Results: A total of 383 patients were included in this analysis, of which 150 developed metastatic disease. No differences in clinicopathologic characteristics and clinical outcome were found between patients with synchronous and metachronous DM. Neurofibromatosis type 1 (NF1), high grade, tumor size, triton and R2 resections were independent risk factors for the development of DM. NF1 and more than two metastasis sites were independently associated with worse OS after DM diagnosis. Metastasectomy, chemotherapy and the metastatic site category 'other' were associated with prolonged survival after DM diagnosis. Conclusions: This analysis provides important insights into clinicopathologic and treatment factors associated with outcomes in metastatic MPNST. Moreover, NF1-status is associated with a higher risk of DM; it is also independently associated with worse survival in metastatic MPNST.Orthopaedics, Trauma Surgery and Rehabilitatio

Individualized approach to the surgical management of fibrous dysplasia of the proximal femur

Orthopaedics, Trauma Surgery and Rehabilitatio

Safety of therapy with and withdrawal from denosumab in fibrous dysplasia and McCune-Albright syndrome: an observational study

Denosumab (Dmab) treatment can benefit patients with fibrous dysplasia/McCune-Albright syndrome (FD/MAS) by suppressing the receptor activator of nuclear factor kappa B ligand (RANKL)-mediated increased bone resorption. However, limited data of two pediatric cases indicate that a rebound phenomenon may occur after withdrawal. Therefore we studied the safety of Dmab discontinuation in FD/MAS. Thirty-seven patients using Dmab, mostly after unsuccessful bisphosphonate (BP) treatment, were included. Health records were screened for pain scores, side effects, and bone turnover markers (BTMs) (calcium, alkaline phosphatase [ALP], procollagen 1 N-terminal propeptide [P1NP], and beta-crosslaps [B-CTX, also termed beta-C-terminal telopeptide]) during treatment, and for BTMs and clinical rebound effects after withdrawal. BTM levels after withdrawal were compared to pretreatment values. Data were calculated as median (interquartile range [IQR]). BTMs normalized in two-thirds of patients and pain scores decreased significantly during treatment (p = 0.002). One patient (2.7%) developed osteonecrosis of the jaw. Sixteen patients discontinued Dmab treatment after a median of 1.6 years (IQR 1.0 years) because of insufficient effect on pain (n = 10, 63%), side effects (n = 4, 25%), or other reasons (n = 4, 25%). Follow-up posttreatment was 3.2 (2.8) years, wherein no fractures, pain flares, or lesion progression occurred. Calcium remained normal in all but one patient, who had a mild asymptomatic hypercalcemia (2.73 mmol/L) 5 months after discontinuation. ALP passed pretreatment levels in five of 11 patients (46%), increased most after 6 months by 18 (43) U/L, and returned to baseline levels thereafter. P1NP exceeded pretreatment levels in four of nine patients (44%), CTX in eight of nine patients (89%). P1NP rose most after 3 months and stabilized thereafter. CTX showed the highest relative elevation. Patients with high pretreatment levels responding well to Dmab seemed to have the highest rebound. These results suggest beneficial effects of Dmab on pain and BTMs, and show a biochemical but asymptomatic rebound phenomenon after withdrawal in adults with FD/MAS, mainly in case of high pretreatment levels, good response, and multiple injections. Further studies on the safety of Dmab and withdrawal are needed and ongoing. (c) 2021 The Authors. Journal of Bone and Mineral Research published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research (ASBMR).Diabetes mellitus: pathophysiological changes and therap

What Is the Role of Allogeneic Cortical Strut Grafts in the Treatment of Fibrous Dysplasia of the Proximal Femur? (vol 475, pg 786, 2017)

Bone and mineral researc

What Is the Role of Allogeneic Cortical Strut Grafts in the Treatment of Fibrous Dysplasia of the Proximal Femur?

Bone and mineral researc