Efficacy and safety of opioids for osteoarthritis: a meta-analysis of randomized controlled trials

SummaryObjectivesTo determine the analgesic effectiveness, the effect on physical function and the safety of opioids in patients with osteoarthritis (OA).Search strategyA systematic literature search was performed in electronic databases up to October 2006. A hand search of references was also performed.Selection criteriaAll randomized controlled trials evaluating the efficacy and/or the safety of opioids vs placebo or non-opioid analgesics in patients with OA were selected.Data collection and analysisData were collected using a predetermined form. Statistical analysis determined in each trial the effect size to assess the magnitude of treatment effect and the number needed to harm (NNH) to evaluate opioids safety.Main resultsEighteen randomized placebo-controlled trials were analyzed, i.e., a total of 3244 participants who received opioids and 1612 who received placebo. The mean trial duration was 13±18 weeks. The pooled effect sizes of all opioids vs placebo for pain intensity and physical function were −0.79 (95% confidence interval, CI, −0.98 to −0.59) and −0.31 (95% CI −0.39 to −0.24), respectively. The NNH was calculated to be 5 vs placebo. The number of studies (n=4) that compared opioids with non-opioid analgesics (paracetamol and non-steroidal anti-inflammatory drugs) was too limited to provide robust data.ConclusionsOpioids significantly decrease pain intensity and have small benefits on function compared with placebo in patients with OA. Adverse events, although reversible and not life threatening, often cause participants to stop taking the medication and could limit opioid usefulness. Moreover, the long-term efficacy and safety of these drugs for OA is yet to be determined due to the short mean trial duration

Psoriasis Area and Severity Index response in moderate-severe psoriatic patients switched to adalimumab: results from the OPPSA study

Background: Few studies have compared the efficacy of switching to adalimumab in the real-life setting in plaque psoriasis patients. Objective: To evaluate the effect of adalimumab in psoriasis patients previously treated with other biologics. Methods: In this multicentre study, psoriasis patients (N = 262) treated with an anti-TNF-alpha agent, ustekinumab or naïve to biologics then switched to adalimumab were included. Disease severity was assessed by the Psoriasis Area and Severity Index (PASI) at baseline and after 3, 6, 12, 24 and 36 months. The association between clinical risk factors and achievement of PASI response was evaluated by logistic regression. Results: Adalimumab treatment resulted in a decrease in PASI (15.1 ± 6.2 at baseline vs. 2.7 ± 4.8 at 6 months, P < 0.0001), regardless of previous biologic treatment. Furthermore, adalimumab allowed 92.5%, 79% and 56% of patients to achieve PASI response (PASI 50, 75 and 90, respectively) and complete remission (PASI 100 response) in 48.4% of patients, by 6 months and maintained over 3 years, independent of prior biologic treatment. The absence of metabolic syndrome, dyslipidemia, hypertension and lower PASI and lower age at baseline was associated with achievement of PASI response at 3, 6 and 12 months, whereas at later time points (24 and 36 months), PASI 90 and PASI 100 response was associated with diagnosis of psoriasis/psoriatic arthritis. Conclusion: Adalimumab was effective at reducing PASI score over 3 years, irrespective of whether patients were biologic naïve or previously treated with a TNF-alpha or IL-12/23 inhibitor

Interregional migration of human creative capital:The case of "Bohemian graduates"

The human capital endowment has long been perceived to be of paramount importance to regional growth and development. In recent years, there also has been a widely held belief that creativity, going hand in hand with innovation and knowledge creation, readily translates into regional competitiveness. Attracting quality human capital and cultivating creative industry/class have been given an unprecedented level of significance in regional policies. As a result of this, understanding the factors determining the migration behaviour of graduates – and especially graduates in creative disciplines – has clear implications for policy makers. In addressing these issues and advancing our understanding of the relationship between creativity and mobility in human capital, this study provides the first empirical analysis of the role played by graduates' subject background (i.e. creative vs. non-creative subjects) in influencing their migration choice in the UK. Our data employed in this paper primarily draw on the Destinations of Lea-vers from Higher Education Survey (DLHE) 2006/2007, collected by the UK's Higher Education Statistic Agency. Graduates are classified into five migration categories based on their migration choices from domicile to university and then onto workplace. Our results show that graduates from disciplines such as business/management and more importantly engineering/technology are more migratory and more likely to be repeat migrants and land higher paid jobs, while graduates from creative arts, education or law are less mobile and, on average, earn less

The controversy of using PGA to define remission in RA

Abstract not provided for this lette

Impact of Symptoms on Daily Life in People at Risk of Rheumatoid Arthritis

Objectives: To explore the impact on daily life of symptoms experienced by those with systemic autoimmunity associated with rheumatoid arthritis (RA). Methods: Fifteen people took part in focus groups to explore the impact of symptoms on daily life. Results: Core themes included: 1) physical impact of limited hand function and mobility; 2) psychological distress experienced included a fear of symptoms progressing into RA, uncertainty about the future, feelings of despair, shame and frustration. Conclusion: People with arthralgia at risk of developing RA experienced considerable physical and psychological impact of symptoms. Greater consideration should be given to the needs of people at risk of developing RA

Myths and lessons of liberal intervention: The British campaign for the abolition of the Atlantic slave trade to Brazil

This is the Pre-print version of the Article. The official published version can be accessed from the link below - Copyright @ 2012 Martinus NijhoffThis article takes issue with recent references to the British nineteenth century campaign for the abolition of the trans-Atlantic slave trade to Brazil that serve to bolster interventionist or imperialist agendas. In particular, such accounts reproduce two and a half myths about the campaign: that it can serve as a model for the present age; that the success of the campaign can be explained through the actions of the intervening party alone (with a corresponding neglect of those of the ‘target’ state); and the half-myth that the campaign’s success was due to military action (at the expense of institutional (legal) and normative factors and the capacity of the target state). I argue instead that this case – and interventions more generally – would benefit from an analysis that considers the role of force in relation to a series of residual institutional and cultural constraints within the liberal state and to political conditions in the target state. In light of the complexities and contingencies that these factors present the underlying lesson is that military force should be used sparingly, if at all