Correction to: Intramuscular clodronate in erosive osteoarthritis of the hand is effective on pain and reduces serum COMP: a randomized pilot trial–The ER.O.D.E. study (ERosive Osteoarthritis and Disodium-clodronate Evaluation)

Clinical Rheumatology - One of the author names on this article was incorrectly tagged during the article mark-up; Luca Dalle Carbonare’s name has now been correctly tagged, with first name...     

Clodronate and hydroxychloroquine in erosive osteoarthritis: a 24-month open randomized pilot study

We evaluated the efficacy of clodronate for treating active erosive osteoarthritis of the hand and to compare it with hydroxychloroquine. Group A consisted of 24 patients treated for 24 months with clodronate 300 mg i.v. for 7 days, followed by clodronate i.m. 100 mg for 14 days every 3 months. Group B comprised 14 patients treated with hydroxychloroquine 400 mg daily for 30 days, followed by 200 mg daily for the next 11 months. In group A, 21/24 patients completed the trial and obtained significant pain reduction (p < 0.001), Dreiser’s score (p = 0.012), and number of tender joints (p = 0.011). Strength of right (p = 0.04) and left (p = 0.016) hands, physician’s global assessment (p ≤ 0.001), and patient’s global assessment (p = 0.021) improved. In group B, 8/14 patients completed 12 months of the study, which showed the inefficacy of hydroxychloroquine and its lack of acceptance by patients (worsening pain and patient’s global assessment). Therefore, enrolment was stopped. Differences between groups showed a pain decreasing trend for group A and a slightly increasing one for group B (p = 0.018). Physician and patient global assessments showed a strong increase in group A compared with group B (p < 0.001). Clodronate is effective in erosive osteoarthritis; hydroxychloroquine seems to be ineffective.     

Clarithromycin in adult-onset Still’s disease: a study of 6 cases

Adult-onset Still’s disease (AOSD) is a rare rheumatological condition characterized by an acute systemic involvement. There are no treatment guidelines. Glucocorticoids (GC), methotrexate (MTX), cyclosporin A and biologic agents have been successfully used, often in association. We treated six cases of AOSD with clarithromycin (CM) in combination with low-mild dose of GC and MTX. Four of them were not responsive to high-dose GC added to DMARDs, while two of them were treated with low-mild dose of GC added to CM from the beginning. CM, 500 mg b.i.d., was added to a mild-low dose of GC and to MTX. The dose of the drugs was reduced (and stopped where possible) following clinical and laboratory parameters. ACR criteria were used to assess clinical improvement. At 6 months 5 patients reached ACR 70% and could stop any therapy in 6–18 months; 1 continued chronic therapy with low-dose GC added to CM and MTX to maintain ACR 50%. CM can be a useful drug for the treatment of AOSD, even in patients not responsive to high-dose GC and DMARDs. No definitive conclusion can be drawn based on the present study.     

Bactericidal activity of various antibiotics against biofilm-producing Pseudomonas aeruginosa

Clinical isolates of Pseudomonas aeruginosa were collected from hospitals in Tehran, Iran, and identified using biochemical tests. A modified microtitre plate test was used to determine the biofilm-forming capacity of the isolates, measured with an enzyme-linked immunosorbent assay (ELISA) reader. Results showed that P. aeruginosa strain 214 was the most efficient at producing biofilm compared with the other strains. Observation of the bacterial biofilm on Teflon sheets and on a catheter using a scanning electron microscope showed greater biofilm formation on the catheter than on Teflon sheets. In this study, we investigated the bactericidal activity of fluoroquinolones, beta-lactams, macrolides and aminoglycoside. The results showed differences in the antibiotic susceptibility of planktonic and biofilm cell populations. Fluoroquinolones showed more potent activity than the other antibiotics, and biofilms were completely eradicated by treatment with 16 x the minimum inhibitory concentration (MIC) of ciprofloxacin and 64 x MIC of ofloxacin, whereas all biofilms survived 2560 microg/mL of imipenem and ceftazidime. Production of an exopolysaccharide matrix is one of the distinguishing characteristics of biofilms. It has been suggested that this matrix prevents access of antibiotics to the bacterial cells embedded in the community. In this study, we also evaluated the permeation of antibiotics through alginate of P. aeruginosa strain 214 using a sandwich cup method. Macrolides were most efficient, showing 100% penetration; fluoroquinolones and beta-lactams had a high permeation rate > 75%, whereas the rates for aminoglycosides were low (amikacin = 59%; gentamicin = 73%).     

Densitometric evaluation might prevent failure of knee artroplasty for aseptic loosening: An 8-year observational controlled study

Objectives:

To study the correlation between quantitative ultrasound (QUS) expressed as stiffness index (SI) and the risk of aseptic loosening of knee arthroplasty.

Methods:

An observational retrospective controlled study was performed on 85 female patients (mean age: 73.3 years) divided into 2 groups from January 2007 to March 2015 and carried out at the Orthopedic Rehabilitation Unit, Casa di Cura Eremo, Arco, Trento, Italy. Group A included 42 patients who had undergone a revision of knee prosthesis for aseptic-loosening, and group B included 43 age-matched patients who underwent primary replacement of the knee without following aseptic loosening. Patients in both groups were evaluated for SI with Achilles - QUS system at the same side of the surgery.

Results:

In group A, 20/42 patients (47.6%) had an SI T-score below -2.5. In group B, 14/43 (32.5%) patients had a SI T-score below -2.5. The difference between the 2 groups was statistically significant (p=0.015).

Conclusion:

Stiffness index appears to be an important predictor of aseptic loosening of the knee prosthesis. Therefore, densitometric evaluation, including SI, may be recommended before surgical knee replacement.Periprosthetic bone loss is the most common complication of arthroplasty. Some degree of bone loss is present in every failed total knee arthroplasty.1 There are several factors leading to bone loss including wear debris and stress shielding. The implantation of exogenous material into the organism causes foreign body reactions characterized by the activation of macrophages and consequent release of a myriad of bio reactive agents (reactive oxygen intermediates, degradative enzymes and acids). The reaction ends in the formation of foreign body giant cells at the material interface and the consequences can be devastating. Biomaterial surface properties play an important role in the development of the reaction. One of the primary causes of damage is the production of particulate wear debris, which is the consequence of the articular motion. Wear debris is able to induce inflammation at the interface between implants and bone, and osteolysis is the final result.2 Extremely high blood metal ion levels have been found in patients after arthroplasty, even in asymptomatic patients with a stable prosthesis, but the ion levels were significantly higher in patients with severe bone loss.3 Another factor is represented by the stress shielding: in a healthy person the bone will remodel in response to the loads it is placed under, therefore, the absence of the load causes bone loss. In addition to prosthetic shapes and sizes, implant fixation methods (including surface treatments), clinical installation, interface micromotions, and periprosthetic high hydraulic pressure can play a role in the mobilization of the prosthesis.4 Previous osteoporosis may be an important cause of failure of prosthetic implants: it has been demonstrated that low systemic bone mineral density (BMD) evaluated with dual x-ray absorptiometry (DXA) increases migration, and delays osseointegration of cementless femoral stems in women who had underwent cementless total hip arthroplasty.5,6 Quantitative ultrasound (QUS) is a recent developed technique that can assess both bone mass and architecture densitometry.7 Frediani et al8 in 2006 compared QUS (Achilles Express) and DXA for the evaluation of vertebral fracture risk: 764 post-menopausal women with non-traumatic vertebral fractures versus 770 post-menopausal women with normal morphometry were evaluated. The authors concluded that both QUS and DXA were able to discriminate women with from women without fracture and were independent predictors of fracture. Moreover, BMD and stiffness were both able to indicate the risk of fracture.8 The aim of this study is to investigate the correlation between bone mass evaluated with practicable QUS, and the risk of aseptic loosening of knee arthroplasty.     

25-Hydroxyvitamin D status,arterial stiffness and the renin–angiotensin system in healthy humans

Vitamin D deficiency is associated with increased arterial stiffness. We sought to clarify the influence of vitamin D in modulating angiotensin II-dependent arterial stiffness. Thirty-six healthy subjects (33?±?2 years, 67% female, mean 25-hydroxyvitamin D 69?±?4?nmol/L) were studied in high salt balance. Arterial stiffness, expressed as brachial pulse wave velocity (bPWV) and aortic augmentation index (AIx), was measured by tonometry at baseline and in response to angiotensin II infusion (3?ng/kg/min?×?30?min then 6?ng/kg/min?×?30?min). The primary outcome was change in bPWV after an angiotensin II challenge. Results were analyzed according to plasma 25-hydroxyvitamin D status: deficient (<50?nmol/L) and sufficient (≥50?nmol/L). There were no differences in baseline arterial stiffness between vitamin D deficient (25-hydroxyvitamin D 40?±?2?nmol/L) and sufficient (25-hydroxyvitamin D 80?±?4?nmol/L) groups. Compared with sufficient vitamin D status, vitamin D deficiency was associated with a decreased arterial response to angiotensin II challenge (Δbrachial pulse wave velocity: 0.48?±?0.44?m/s versus 1.95?±?0.22?m/s, p?=?0.004; Δaortic augmentation index: 9.4?±?3.4% versus 14.2?±?2.7%, p?=?0.3), which persisted for brachial pulse wave velocity response after adjustment for covariates (p?=?0.03). Vitamin D deficiency is associated with increased arterial stiffness in healthy humans, possibly through an angiotensin II-dependent mechanism.     

Intramuscular clodronate in erosive osteoarthritis of the hand is effective on pain and reduces serum COMP: a randomized pilot trial—The ER.O.D.E. study (ERosive Osteoarthritis and Disodium-clodronate Evaluation)

Clinical Rheumatology - We evaluated the efficacy and safety of intramuscular clodronate (CLO) for the treatment of active erosive osteoarthritis of the hand (EOA). Forty outpatients treated with...     

Can clodronate be effective in the treatment of disabling hydroxyapatite crystal-deposition disease? A report of two cases

Hydroxyapatite crystals are often deposited in the vicinity of joints, where they can cause a clinical periarthritis. Clodronate is a first-generation bisphosphonate that has the ability to reduce ectopic calcifications. Two women were affected by disabling calcific periarthritis of the shoulders lasting for years and resistant to any traditional drug (including glucocorticoids), infiltration and surgical treatment. We treated both patients with low-dose methylprednisolone added to intramuscular clodronate at the daily dose of 100 mg administered for 20 days every 3 months for 5 cycles (18 months). In both cases, the results were clinically evident within 1 month, showing a significant reduction in pain and disability. After 18 months, the result was furthermore radiologically evident in both cases with a great reduction in the size of calcifications. These improvements were still present at follow-up after 7 and 5 years with complete functional recovery.     

LV Mass Independently Predicts Mortality and Need for Future Revascularization in Patients Undergoing Diagnostic Coronary Angiography

Objectives

The goal of this study was to assess associations between left ventricular (LV) mass, all-cause mortality, and need for revascularization in patients undergoing coronary angiography.

Clarithromycin in rheumatoid arthritis: the addition to methotrexate and low-dose methylprednisolone induces a significant additive value—a 24-month single-blind pilot study

To compare the efficacy of the addition of clarithromycin (CM) to methotrexate (MTX) and methylprednisolone (MP) in active rheumatoid arthritis (RA). 32 patients with RA consecutively randomized. Control group: sixteen patients treated for 24 months with MTX 10–15 mg i.m. weekly and MP 4–6 mg daily. CM group: sixteen patients treated with MTX 10–15 mg i.m. weekly and MP 4–6 mg daily for 24 months; CM therapy added in the first month (500 mg twice a day for the first 15 days followed by 500 mg a day for the remaining 15 days). Evaluation of the improvement following ACR criteria was performed at months 1 (primary endpoint), 3 and 6. Patients were furthermore observed after 12, 18 and 24 months from the study beginning. At month 1, following ACR70 improvement criteria, we found a significant additive value in CM group (10/16 = 63 % vs 4/16 = 25 %, p = 0.033—chi-square test). After discontinuation of CM, the difference between groups was anymore evident (month 3: CM group 10/16 = 63 % vs control group 9/16 = 56 %). At month 24, 7/16 (44 %) in control group and 12/16 (75 %) in CM group completed the follow-up. The addition of CM to MTX and MP can induce the remission ACR 70 in the majority of RA patients within 4 weeks, while MTX and MP alone need about 3 months to achieve the same result.