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Aspray T.J.,Musculoskeletal Unit | Aspray T.J.,Northumbria University | Francis R.M.,Northumbria University
Maturitas | Year: 2012

In the past 15 years, oral bisphosphonate therapy has become the mainstay of pharmacological management in patients with osteoporosis. In the UK, alendronate is the drug of first choice, based on clinical efficacy data and cost. However, some patients are unable to take oral bisphosphonates for a number of reasons. In this article, we review the practical management of such cases, including strategies for monitoring adherence and switching to alternative oral agents (e.g. risedronate, strontium ranelate, raloxifene). In some cases, alternative parenteral agents may be considered, including intravenous bisphosphonates, parathyroid hormone therapies and denosumab. Specific concerns about safe prescribing are considered, when prescribing potent anti-resorptive medications, particularly relating to renal function and vitamin D deficiency. Finally, consideration is given to clinical risk factors, including aspects of lifestyle which may be modified to decrease fracture risk. © 2011 Elsevier Ireland Ltd. All rights reserved. Source


Abad Mateos M.A.,University of Murcia | Perez-Jara J.,Musculoskeletal Unit
Revista Espanola de Geriatria y Gerontologia | Year: 2010

Introduction: The aims of this research are to analyse prevalence and risk factors of the fear of falling in people over 65 years with recurrent dizziness. Methods: This cross-sectional study includes 109 patients sent from General or Emergency Primary Care clinics of a Health Centre from January to December 2008 in Archena (Murcia). Data collected were clinical history, medication, fear of falling using a single question and Falls Efficacy Scale as well as social and functional status using Cubrecavi (Quality of Life Short Questionnaire) and GHQ-28 (General Health Questionnaire). Results: Fear of falling is detected in 71.5% of our elderly population with recurrent dizziness, and it affects women more often than men. The variables associated with fear of falling in the multivariate analysis were, diabetes mellitus (OR: 35.15; 95%CI: 4.57-270.07; P<0,001), taking antidepressants (OR: 9.84;95%CI: 1,48-5.36; P=0.017), and frequency of social relations (OR: 0.18; 95%CI: 0.04-0.86; P=0.017); and independence for activities of daily living (OR: 0.17;95% CI: 0.04-0.76; P=0.021). Conclusion: A very high proportion of fear of falling is observed among elderly patients with frequent dizziness. This is one of the highest proportions published. Associated factors with fear of falling were, having diabetes mellitus and taking antidepressants, as risk factors; and higher frequency of social relationships and higher independence for activities of daily living as protective factors. In this population, having had a fall is not related to fear of falling. © 2009 SEGG. Source


Raftery G.,City Hospitals Sunderland NHS Trust | He J.,Northumbria University | Pearce R.,Vitality | Birchall D.,Regional Neurosciences Center | And 4 more authors.
Arthritis Research and Therapy | Year: 2012

Introduction: We hypothesised that fatigue in rheumatoid arthritis (RA) is related to TNF-alpha induced dysregulation of cerebral blood flow. Our objectives were to assess fatigue, cognitive function and cerebral blood flow before and after initiation of anti-TNF treatment.Methods: In a pilot study, 15 patients initiating treatment with adalimumab were assessed for fatigue using a visual analogue scale (FACIT-F), cognitive function using a panel of psychometric tests and regional cerebral blood flow using MR perfusion imaging.Results: Patients improved clinically after anti-TNF therapy in terms of DAS28 and FACIT-F. Furthermore significant improvements were documented in full scale, verbal and performance IQ following therapy. There was a non-significant trend towards reduced cerebral perfusion in both grey and white matter, and fatigue at 3 months correlated with cerebral blood flow in white (p = 0.014) and grey (p = 0.005) matter.Conclusions: We demonstrate for the first time a significant improvement in cognitive function following effective treatment of RA. Although we observed minor reductions in cerebral blood flow, and a correlation between cerebral blood flow and fatigue, a larger, controlled study would be required to affirm a causal relationship. © 2012 Raftery et al.; licensee BioMed Central Ltd. Source


Cooles F.A.H.,Northumbria University | Isaacs J.D.,Northumbria University | Isaacs J.D.,Musculoskeletal Unit
Current Opinion in Rheumatology | Year: 2011

Purpose of Review: To provide a summary of recent advances in the pathophysiology of rheumatoid arthritis. Recent Findings: Highlights include further elucidation of the relationship between the shared epitope, smoking and anticitrullinated protein/peptide antibody generation, including identification of putative citrullinated auto-antigens; and a hypothesis linking citrullinating oral bacteria and anticitrullinated protein/peptide antibody generation. Important work on signalling within regulatory T cells has identified sequestration of protein kinase C theta away from the immune synapse as critical for suppressive activity; TNFα exposure interferes with protein kinase C theta compartmentalisation, explaining its inhibition of regulatory T cell function. Platelet microparticles have emerged as important pro-inflammatory mediators via their stimulatory effects on fibroblast-like synoviocytes. The mechanisms by which fibroblast-like synoviocyte invade are becoming elucidated, and recent work suggests the capacity of these cells to migrate from joint to joint, potentially explaining the evolution of clinical rheumatoid arthritis. Summary: Our knowledge of rheumatoid arthritis pathogenesis continues to expand. The last year has seen some key findings, including the identification of novel, potentially tractable targets for further therapeutic research. © 2011 Wolters Kluwer Health | Lippincott Williams and Wilkins. Source


Aspray T.J.,Musculoskeletal Unit | Aspray T.J.,Northumbria University
Age and Ageing | Year: 2013

Fracture is the clinical outcome of concern in osteoporosis, a disease variably defined over the last 30 years, mostly in terms of bone mineral density (BMD). However, an 'osseocentric' view of the condition may have hampered our understanding of how best to identify patients at the greatest risk of fragility fracture. More recently, the identification of a number of clinical risk factors for fragility fracture and the creation of fracture risk assessment tools, such as FRAX®, QFracture and Garvan have helped in a move towards clinically useful definitions, using the common currency of 10-year major osteoporotic and 10-year hip fracture risks. However, there are a large number of available fracture risk assessment tools and there remain few validation studies comparing their performance. The National Institute for Health and Clinical Excellence has recently advocated the use of these methods in case finding and studies are underway in their clinical application. It seems likely that the operational definition of osteoporosis must now include fracture risk, which will never replace fracture incidence as a measure of clinical efficacy but may be used in future studies to define patient groups likely to benefit from intervention. We still need to understand more about the performance of these tools, particularly in the context of specific patient groups, such as those with vertebral osteoporosis, the frail, those who fall and patients with secondary osteoporosis. © The Author 2013. Published by Oxford University Press on behalf of the British Geriatrics Society. Source

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