May 15, 2013

DynaMed EBM Journal Volume 8, Issue 20

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Physicians: .25 AMA PRA Category ICreditsTM

Family Physicians: .25 Prescribed credits

Nurse Practitioners: .25 Contact hours

Release Date: May 15, 2013

Expiration Date: May 15, 2014

Estimated Completion Time: 15 minutes

There is no fee for this activity.

To Receive Credit

In order to receive your certificate of participation, you should read the information about this activity, including the disclosure statements, review the entire activity, take the post-test, and complete the evaluation form. You may then follow the directions to print your certificate of participation. To begin, click the CME icon at the end of the article.

Program Overview

Learning Objectives

Upon successful completion of this educational program, the reader should be able to:
1. Discuss the significance of this article as it relates to your clinical practice.
2. Be able to apply this knowledge to your patient's diagnosis, treatment and management.

Faculty Information

Alan Ehrlich, MD - Assistant Professor in Family Medicine, University of Massachusetts Medical School, Worcester, Massachusetts, USA; Senior Deputy Editor, DynaMed, Ipswich, Massachusetts, USA

Michael Fleming, MD, FAAFP - Assistant Clinical Professor of Family Medicine and Comprehensive Care, LSU Health Science Center School of Medicine, Shreveport, Louisiana, USA; Assistant Clinical Professor of Family Medicine, Department of Family and Community Medicine, Tulane University Medical School, New Orleans, Louisiana, USA; Chief Medical Officer, Amedisys, Inc. & Antidote Education Company

James McLellan, PhD - Senior Medical Writer, DynaMed, Ipswich, Massachusetts, USA


Dr. Ehrlich, Dr. Fleming, Dr. McLellan, DynaMed Editorial Team members, and the staff of Antidote Education Company have disclosed that they have no relevant financial relationships or conflicts of interest with commercial interests related directly or indirectly to this educational activity.

No commercial support has been received for this activity.

Accreditation Statements

ACCME: This activity has been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education through the joint sponsorship of Antidote Education Company and EBSCO Publishing. Antidote is accredited by the ACCME to provide continuing medical education for physicians. Antidote Education Company designates this enduring activity for a maximum of 0.25 AMA PRA Category 1 CreditsTM. Physicians should only claim credit commensurate with the extent of their participation in the activity.

AAFP: This enduring material activity, DynaMed EBM Focus Volume 8, has been reviewed and is acceptable for up to 13 Prescribed credits by the American Academy of Family Physicians. AAFP certification begins March 6, 2013. Term of approval is for one year from this date with the option of yearly renewal. Each weekly updated is approved for 0.25 Prescribed credits. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

AANP: This program is approved for 0.25 contact hour of continuing education by the American Academy of Nurse Practitioners.

Program ID: 1304158B


Last week 765 journal articles were evaluated via DynaMed's Systematic Literature Surveillance and summaries of 339 articles were added to DynaMed content.

Based on criteria for selecting "articles most likely to change clinical practice," one article of significant interest was selected by the DynaMed Editorial Team.

Severity Of Symptoms and Presence of Effusion May Predict Response to Intra-Articular Corticosteroid Injection for Knee Osteoarthritis
Reference: Rheumatology (Oxford) 2013 June;52(6):1022

Intra-articular steroid injections are a common treatment for osteoarthritis of the knee, and are recommended by the American College of Rheumatology for initial management and strongly recommended for patients without satisfactory clinical response to full-dose acetaminophen (Arthritis Care Res (Hoboken) 2012 Apr;64(4):465). However, the magnitude and duration of benefit from steroid injections varies widely across patients. A recent systematic review of 11 studies assessing the efficacy of steroid injections sought to identify factors associated with good response in 624 patients with knee osteoarthritis.

Factors associated with response were identified primarily through post hoc analyses in the original articles, and no meta-analysis could be performed due to differences in outcome measures and criteria for symptom change. Dichotomous factors predictive of good response in at least one study included presence of effusion, withdrawal of fluid from the knee, absence of synovitis, and use of ultrasound guidance for injection delivery. Increasing efficacy was also associated with increasing severity of radiographic degeneration and increasing severity of pain, stiffness, and loss of function. Duration of symptoms was not associated with response. Although it would be ideal to have these findings validated in a prospective study, this information may help guide patient selection when intra-articular steroids are being considered.

For more information, see the Degenerative joint disease of the knee topic in DynaMed.

Earn CME Credit for reading this e-Newsletter.
For more information on this educational activity, see the CME sidebar.

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