For Scoliosis, Immobilize. For Knee OA, Keep Mobile


Randomized trials document the benefit of bracing for adolescent scoliosis and the value of specific exercises for lower-limb osteoarthritis. Also in the non-rheumatology journals: An immunomodulator for cutaneous sarcoidosis.

Last week's articles on rheumatology topics in the major non-rheumatology journals.

Effects of Bracing in Adolescents with Idiopathic ScoliosisNew England Journal of Medicine, September 19, 2013

Editorial: Spinal Bracing in Adolescent Idiopathic ScoliosisNew England Journal of Medicine, September 19, 2013

Bracing significantly decreased the progression to surgery for high-risk patients with adolescent idiopathic sclerosis in a 116-subject randomized trial of bracing versus observation. Because too few families were willing to be randomized, the study added a preference group of 126 patients who chose between bracing and observation (71% chose bracing). After bracing 72% met the primary outcome (progression to ≥50°), which only 48% achieved after observation alone. Results improved strongly with increased duration of brace wear. A commentary observes that in the study nearly half of growing children with adolescent idiopathic scoliosis did fine with no treatment. The challenge is to identify those most likely to benefit from bracing. This study as designed was unable to address that question.

Exercise for lower limb osteoarthritis: systematic review incorporating trial sequential analysis and network meta-analysisBMJ. 20 September 2013

A systematic review documents yet again that exercise significantly improves pain and function in patients with lower-limb osteoarthritis. An approach that combines exercises to increase strength, flexibility, and aerobic capacity is likely to be most effective. The evidence is largely from knee osteoarthritis. Previous meta-analyses used pairwise comparisons of different exercise interventions within individual trials. This study uses network meta-analysis, comparing different exercises among different trials.

Oral Antimycobacterial Therapy in Chronic Cutaneous Sarcoidosis: A Randomized, Single-Masked, Placebo-Controlled StudyJAMA Dermatology, September 2013

Oral antimycobacterial therapy significantly reduced the effects of chronic cutaneous sarcoidosis in a randomized tria. It documents the immunomodulatory effects of antimicrobial drugs on sarcoidosis lesions, which have been shown to contain mycobacterial DNA and proteins. In the Phase I trial, 30 patients were randomized to oral concomitant levofloxacin, ethambutol, azithromycin, and rifampin (CLEAR) or placebo for eight weeks with a 180-day followup. Compared to placebo, the treatment group had reduced lesion diameters and granuloma burden (the two main outcomes) as well as less severe lesions and significantly improved symptoms. 

Paraneoplastic Autoimmune Multiorgan Syndrome in a Patient With Li Fraumeni SyndromeJAMA Dermatology, September 2013

This case study of a 30-year-old African American woman with Li-Fraumeni syndrome might be of interest because of its reference to paraneoplastic autoimmune multiorgan syndrome (PAMS). An invasive thymoma was found and removed, but did not improve control of extensive and painful lesions in her mouth. She was treated with prednisone, 60 mg/d, then cyclosoporine, 100 mg/d. Over one year, the prednisone was tapered and discontinued.

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