ADARRC

Does intensive urate lowering improve outcomes in persons with erosive gout? In adults with erosive gout, intensive urate lowering is difficult to achieve, takes a lot of medications, and does not improve outcomes. Dalbeth N, Doyle AJ, Billington K, et al. Intensive serum urate lowering with oral urate-lowering therapy for erosive gout: a randomized double-blind controlled trial. Arthritis Rheumatol 2022;74(6):1059-1069.

Are platelet-rich plasma injections, either single or multiple, more effective than saline injections in adults with early symptomatic degenerative joint disease of the knee? This is yet another study — this one of higher quality than the others — that finds PRP injections, singly or serially, to be no better than saline injections in improving outcomes in adults with mild radiographically confirmed degenerative joint disease of the knee. Lewis E, Merghani K, Robertson I, et al. The effectiveness of leucocyte-poor platelet-rich plasma injections on symptomatic early osteoarthritis of the knee: the PEAK randomized controlled trial. Bone Joint [...]

What is the best dose of aspirin for secondary prevention in persons with established atherosclerotic cardiovascular disease? There is no advantage to a 325-mg dose of aspirin for patients with established atherosclerotic cardiovascular disease (ASCVD), and people taking the higher dose often switched to the lower dose (although the reason is unclear). Just stick with 81 mg. Jones WS, Mulder H, Wruck LM, et al. Comparative effectiveness of aspirin dosing in cardiovascular disease. N Engl J Med 2021;384(21):1981-1990.

How do ibuprofen, ketorolac, and diclofenac compare for the treatment of acute, nonradicular low back pain in adults? This study found no differences among ibuprofen, ketorolac, and diclofenac in the primary outcome of overall clinical improvement at 5 days in adults presenting to the emergency department with acute, nonradicular low back pain. Some of the secondary outcomes favored ketorolac, however, leaving open the possibility that ketorolac is superior to ibuprofen and/or diclofenac. As the saying goes, "Absence of proof is not proof of absence." Irizarry E, Restivo A, Salama M, et al. A randomized controlled trial of ibuprofen versus ketorolac [...]

Are platelet-rich plasma injections effective for alleviating pain and improving function in adults with symptomatic ankle osteoarthritis? This study found no evidence that supports a benefit of PRP injections compared with saline placebo injections for improving function or reducing pain in adults with symptomatic ankle osteoarthritis. Paget LDA, Reurink G, de Vos RJ, et al, for the PRIMA Study Group. Effect of platelet-rich plasma injections vs placebo on ankle symptoms and function in patients with ankle osteoarthritis. A randomized clinical trial. JAMA 2021;326(16):1595-1605.

What is the incidence and timing of recurrent herpes zoster in older adults? The incidence of recurrent herpes zoster is comparable with the incidence of a first episode zoster infection, supporting the benefit of vaccination for individuals with a history of previous herpes zoster. See the synopsis for specific recurrent incidence risks based on age, sex, and time following initial infection. Qian J, Macartney K, Heywood AE, Sheridan S, Liu B. Risk of recurrent herpes zoster in a population-based cohort study of older adults. J Am Acad Dermatol 2021;85(3):611-618.

Do muscle relaxants provide relief for nonspecific lower back pain? Stick with nonsteroidal anti-inflammatories for the treatment of low back pain. Despite being used for almost 50 years to treat low back pain, the evidence supporting benzodiazepine or non-benzodiazepine “muscle relaxants” is of low certainty. None of the treatments will produce a clinically important difference over placebo treatment. Cashin AG, Folly T, Bagg MK, et al. Efficacy, acceptability, and safety of muscle relaxants for adults with non-specific low back pain: systematic review and meta-analysis. BMJ 2021;374:n1446.

Is fluvoxamine effective in preventing hospitalizations in high-risk adults with COVID-19? In this study, compared with placebo, fluvoxamine decreased hospitalizations in high-risk symptomatic adults with COVID-19. Reis G, dos Santos Moreira-Silva EA, Silva DCM, et al, for the TOGETHER investigators. Effect of early treatment with fluvoxamine on risk of emergency care and hospitalisation among patients with COVID-19: the TOGETHER randomised, platform clinical trial. Lancet Glob Health 2021;S2214-109X(21)00448-4.

Does a booster dose provide clinical benefit against symptomatic infection and serious illness due to COVID-19 in persons 60 years and older who are fully vaccinated with the Pfizer-BioNTech vaccine? A booster (third) dose of the BNT162b2 mRNA vaccine from Pfizer-BioNTech provides significant additional protection against both infection and serious illness. (LOE = 2b) Bar-On YM, Goldberg Y, Mandel M, et al. Protection of BNT162b2 vaccine booster against Covid-19 in Israel. N Engl J Med 2021;385(15):1393-1400.

Do muscle relaxants provide relief for nonspecific lower back pain? Stick with nonsteroidal anti-inflammatories for the treatment of low back pain. Despite being used for almost 50 years to treat low back pain, the evidence supporting benzodiazepine or non-benzodiazepine “muscle relaxants” is of low certainty. None of the treatments will produce a clinically important difference over placebo treatment. Cashin AG, Folly T, Bagg MK, et al. Efficacy, acceptability, and safety of muscle relaxants for adults with non-specific low back pain: systematic review and meta-analysis. BMJ 2021;374:n1446.