Clinical Briefs By Louis Kuritzky, MD
Clinical Briefs
By Louis Kuritzky, MD, Clinical Assistant Professor, University of Florida, Gainesville. Dr. Kuritzky is a consultant for Abbott, AstraZeneca, Boehringer Ingelheim, Daiichi, Sankyo, Forest Pharmaceuticals, Lilly, Novo Nordisk, Takeda.
Tai chi for fibromyalgia
Source: Wang C, et al. A randomized trial of tai chi for fibromyalgia. N Engl J Med 2010;363:743-754.
FDA-approved pharmacologic treatments for fibromyalgia (FIB) include duloxetine, milnacipran, and pregabalin. Although each of these agents has shown both statistically significant and clinically relevant impact, few patients are relieved of all problematic symptoms. Hence, additional treatment paths for FIB are sought.
Exercise has long been recognized as having a favorable impact on FIB, although it has been uncertain which type of exercise should be preferred. For a variety of reasons, some patients will not readily embrace strenuous or aerobic exercise programs, leaving a therapeutic gap in activity programs that can be relied upon to improve FIB symptoms and functionality.
Wang et al enrolled FIB patients (n = 66) into a 12-week program comparing tai chi to a stretching + wellness education component. For the physical activities, both groups participated in two 60-minute sessions per week for 12 weeks. Fibromyalgia patients were diagnosed using the American College of Rheumatology criteria.
At the conclusion of the study, Fibromyalgia Impact Questionnaire and SF-36 physical component scores were superior in the tai chi group as compared to the stretching group. Discontinuation of medications used to treat FIB was seen in both active treatment groups, with a trend favoring tai chi.
Tai chi instruction was provided by a single tai chi master to all of the subjects in that group. Generalizability whether clinicians can anticipate similar efficacy when tai chi is taught by others remains to be confirmed.
When to initiate dialysis? Early vs late GFR threshold
Source: Cooper BA, et al. A randomized, controlled trial of early versus late initiation of dialysis. N Engl J Med 2010;363:609-619.
The number of individuals requiring renal replacement therapy (dialysis) continues to grow. Because dialysis is an expensive, time-intensive, and intrusive intervention, it is wise to try to refine an optimum threshold for initiation of dialysis. Intuition might suggest that earlier is better than later, but few data to support this notion are in evidence.
Cooper et al performed a study of adults (n = 828) who qualified for dialysis. Study subjects were randomized to either early (GFR = 10-15 mL/min/1.73 m2) or late (GFR = 5-7 mL/min/1.73 m2) dialysis. The primary outcome of the trial was all-cause mortality.
Over an 8-year interval, 828 diabetic subjects with Stage V CKD (GFR < 15 mL/min/1.73 m2) were randomized to initiate dialysis at either the early or late GFR threshold. The mean time to dialysis initiation in the early group was 1.8 months vs 7.4 months in the late group, but this difference might be expanded further, since more than 75% of the late start group actually initiated dialysis because of symptoms before reaching a GFR of 7.
Overall mortality during 3.6 years of follow-up was not significantly different between the two groups. There does not appear to be any mortality detriment associated with delaying dialysis until GFR is 7 mL/min/1.73 m2 or less, although many patients may require earlier dialysis due to symptoms.
Can vitamins stop photoaging of the skin?
Source: Zussman J, et al. Vitamins and photoaging: Do scientific data support their uses? J Am Acad Derm 2010;63: 507-525.
UV light is responsible for some of the skin changes associated with aging, which is known as photoaging (PHA). Expenditures in the United States for so-called "cosmeceuticals" is anticipated to reach more than $6 billion this year, although only a few components of commonly applied topical agents have any clearly demonstrated benefit.
Vitamin A derivatives, particularly the prescription retinoids such as tretinoin cream and tazarotene, are FDA-approved for aging-related fine line wrinkles, skin roughness, and mottled hyperpigmentation. OTC vitamin A derivatives have less convincing evidence, but of these, retinol should be the preferred agent according to Zussman et al.
Amelioration of PHA has been seen in several topical vitamin C trials using L-ascorbic acid; chemically related compounds (e.g., ascorbyl palmitate, ascorbyl tetraiopalmitate) provide greater vitamin C stability, but do not have sufficient clinical trial outcomes data to advocate for them.
Topical formulations of vitamin E, although widely touted for antioxidant potential, do not have data to support their use in management of PHA. Limited data on topical niacin suggest promise.
The best method to address photoaging is overall good nutrition and an appropriate combination of sunscreen and sun avoidance.
FDA-approved pharmacologic treatments for fibromyalgia (FIB) include duloxetine, milnacipran, and pregabalin. Although each of these agents has shown both statistically significant and clinically relevant impact, few patients are relieved of all problematic symptoms. Hence, additional treatment paths for FIB are sought.Subscribe Now for Access
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