Journals Watch - Osteoarthritis and osteopenia

Not had time to read the latest research? Dr Lizzie Croton brings you up to date with the journals.

Glucosamine and chondroitin were of little benefit for pain in osteoarthritis of the hip and knee (Photograph: SPL)
Glucosamine and chondroitin were of little benefit for pain in osteoarthritis of the hip and knee (Photograph: SPL)

Glucosamine and chondroitin for osteoarthritis
BMJ 2010; 341: c4675

This meta-analysis included large RCTs with more than 200 patients with osteoarthritis of the hip or knee.

The studies compared glucosamine, chondroitin and a combination of the two with placebo and had two outcome measures: pain intensity and minimal width of joint space on imaging. The authors collated data from 10 trials with a total of 3,803 patients.

Using a 10cm visual analogue scale there was no difference in pain intensity when comparing glucosamine, chondroitin or the combination with placebo.

There was also no statistically significant effect on the progression of the disease radiologically when glucosamine, chondroitin or their combination were compared with placebo. The conclusion was that these preparations were of little benefit.

Long-term outcomes of exercise in older women with osteopenia
Arch Intern Med 2010; 170(7): 1548-56

There is little long-term evidence for the effectiveness of exercise in preventing disability and fall-related fractures in older women.

This study followed up 160 women with osteopenia (aged 70-73 at baseline) for four years after an exercise trial.

The primary outcome measures were femoral neckbone mineral density, postural sway and leg strength. Secondary outcome measures were hospital-treated fractures and functional ability measures.

There was a difference between groups in favour of exercise in terms of postural sway, walking speed and Frenchay activities index score.

The bone mineral density decreased with time consistently across both groups. There were no hip fractures in the exercise group and five in the control group.

Home-based exercises and voluntary home training seems to have a long-term effect on balance and gait and may protect against hip fractures.

Effects of cat and dog ownership on eczema in atopic infants
J Pediatr 2010. doi:10.1016/j.jpeds.2010.07.026

This study aimed to ascertain risk factors for eczema at the age of four years. The authors invited 636 infants of atopic parents to have annual clinical evaluations and skin prick testing (SPT) from the age of 12 months.

Parents completed validated surveys on eczema and environmental exposures. House dust samples were also analysed for allergens.

Interestingly, not having a dog before 12 months and having positive dog SPT at 12 months to three years of age resulted in a four-fold increased risk of eczema at age four.

Among dog owners, positive dog SPT did not confer an increased eczema risk.

The reverse was seen for cat ownership with a positive cat SPT and a cat in the house before 12 months conferring an increased risk of eczema.

Among non-cat owners, positive cat SPT was not associated with increased risk.

Clinical diagnosis of toenail onychomycosis
Br J Dermatol 2010; 163(4): 743-51

Fungal toenails are commonly seen in primary care. Clinical diagnosis is often inadequate with nail clippings frequently providing inconclusive results.

This paper aimed to assess the diagnostic accuracy of clinical findings and validate a diagnostic rule. The study was a cross-sectional design using 277 patients seen by 12 dermatologists. The gold standard was the presence of dermatophytes on culture or a positive nail plate biopsy.

Helpful findings predicting the presence of fungi were: a previous diagnosis of fungal disease, abnormal plantar desquamation affecting >25 per cent of the sole, onychomycosis considered to be the most probable diagnosis and interdigital tinea.

When onychomycosis was considered the most probable diagnosis and plantar desquamation was present, the positive predictive value for fungi was 81 per cent.

When both signs were absent, the positive predictive value for absence of fungi was 71 per cent. In other cases, culture or biopsy of nails is suggested to aid diagnosis.

Management of PID in primary care
Br J Gen Pract 2010; 60(579):e395-e406

Effective and timely treatment of PID helps to prevent long-term complications. This cohort study using data from the General Practice Research Database aimed to estimate the incidence of first-episode PID cases and examine the management of cases in relation to existing guidelines.

A total of 3,797 women with first diagnosis of PID were identified over the five-year study, of which 56 per cent appeared to have been wholly managed within the practice.

Of these, 34 per cent received the recommended treatment of metronidazole, 54 per cent had a chlamydia test but only 16 per cent received both.

Women in their twenties and those later on in the study period were most likely to have been treated in line with the recommended guidelines.

Factors associated with recurrent depression
Fam Pract 2010. doi: 10.1093/fampra/cmq076

Identifying patients who are at higher risk for recurrent depression (duration longer than 12 months) allows better care and this study looked at individual variables to predict which patients were at increased risk.

The authors identified 1,094 patients aged 18-75 years. They were followed up at six and 12-month intervals and risk factors were assessed via a questionnaire.

Major depression was diagnosed in 13 per cent of patients with 28 per cent of the depressed patients having a recurrent episode 12 months later.

The factors that increased the risk of recurrent depression were history of drug abuse, experiencing discrimination or a history of childhood abuse.

  • Dr Croton is a GP in Birmingham and a member of our team who regularly review the journals
CPD IMPACT: earn more credits

These further action points may allow you to earn more credits by increasing the time spent and the impact achieved.

  • Review your protocol for prescribing glucosamine in patients with symptoms of hip or knee osteoarthritis and consider discontinuing treatment in patients with little clinical benefit.
  • Perform an audit of patients presenting with PID symptoms to ascertain if recommended guidelines are being followed.
  • Meet with your practice physiotherapists to consider offering exercise regimens for elderly patients with osteopenia.

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