ADARRC

Is electroacupuncture safe and effective in the treatment of adults with chronic low back pain? This study found mixed results on the benefits of electroacupuncture in treating adults with chronic low back pain. Although no significant difference occurred between active and sham therapy for the primary outcome of reduced pain, a secondary outcome of reduced disability was significantly improved with active versus sham therapy. In addition, eliminating one single significant outlier from the overall analysis resulted in a significant benefit of active electroacupuncture versus sham therapy in both reducing pain and disability. Kong JT, Puetz C, Tian [...]

In patients with chronic coronary artery disease, does colchicine reduce the risk of cardiovascular events? Colchicine 0.5 mg daily significantly reduces the risk of myocardial infarction (MI) and ischemia-driven revascularization. For the compositive outcome of cardiovascular death, MI, or ischemic stroke, the number needed to treat (NNT) was 67 over 29 months. The cost is $8 per month in Canada and $65 per month in the United States. There was a worrisome signal of increased noncardiovascular mortality, but no clear pattern with regard to cause of death. Nidorf SM, Fiolet AT, Mosterd A, et al, for the [...]

Does the combination of baricitinib and remdesivir improve outcomes in patients hospitalized with COVID-19? For hospitalized patients with COVID-19 and evidence of lower respiratory tract infection, the combination of baracitinib plus remdesivir results in faster time to recovery, especially in patients who require noninvasive mechanical ventilation or high-flow oxygen. No survival benefit is seen with this combination. Kalil AC, Patterson TF, Mehta AK, et al. Baricitinib plus remdesivir for hospitalized adults with Covid-19. N Engl J Med. Published online December 11, 2020. doi: 10.1056/NEJMoa2031994.

Are repeat bone mineral density tests necessary to identify women who are susceptible to fracture? Rechecking bone mineral density (BMD) after 3 years does not add additional prognostic information. In other words, not much changes in 3 years with regard to estimating fracture risk and, presumably, need for treatment, so serial testing is not useful. Another study found similar results in older patients, and, similarly, a third study found that BMD monitoring is not necessary after starting treatment with a bisphosphonate. Crandall CJ, Larson J, Wright NC, et al. Serial bone density measurement and incident fracture risk [...]

Do common musculoskeletal surgical procedures produce better pain relief than no surgery? Sure, musculoskeletal surgery is invaluable for unintentional injury. But for conditions associated with chronic pain — such as knee, shoulder, wrist, neck, or back pain — even patients with objective changes on imaging that scream out for intervention, will not, on average, have better long-term pain relief with surgery as compared with no surgery. Most of the studies were not masked and there should have been a placebo effect to bolster a difference in pain relief between surgery and no surgery. As with any intervention, some [...]

What signs, symptoms, or laboratory values are diagnostic for giant cell (temporal) arteritis? No single laboratory test or physical finding by itself is useful to identify patients with giant cell arteritis (GCA); even the classic hallmarks of GCA were not very predictive. This study was unable to determine whether several findings taken together increase the odds. Even an erythrocyte sedimentation rate (ESR) greater than 100 mm/h only increases the odds of a positive temporal artery biopsy 3-fold, which is in the low range. However, an ESR less than 40 mm/h moderately predicts a negative biopsy. If you suspect [...]

Are older antiviral drugs beneficial for adults hospitalized with COVID-19? This large open-label randomized trial found no benefit to remdesivir, interferon, lopinavir, or hydroxychloroquine for adults hospitalized with COVID-19. The only possible benefit was seen with remdesivir in patients who required low-flow or no oxygen, but the absolute benefit, if any, was small. WHO Solidarity Trial Consortium, Pan H, Peto R, et al. Repurposed antiviral drugs for Covid-19 interim WHO Solidarity trial results. N Engl J Med. Published online December 2, 2020. doi: 10.1056/NEJMoa2023184.