Knee Hurt

Category: Knee Arthritis

  • The assessment of atlantoaxial joint involvement in patients with rheumatoid arthritis is the result of an observational ‘real-life’ study

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  • CMA clarifies collaboration on combination therapies to accelerate patient access to essential treatments

    CMA clarifies collaboration on combination therapies to accelerate patient access to essential treatments

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    The Competition and Markets Authority (CMA) today issued a statement clarifying that certain types of agreements between competing pharmaceutical companies working on ‘combination therapies’ will not be prioritized for research – making it easier for pharmaceutical companies to work together to deliver essential to develop treatments for use in NS. The CMA’s statement comes in response to concerns that the CMA could intervene to stop these types of collaborations under competition law.

    Combination therapies combine two or more individual drugs into one treatment and have become increasingly important for the treatment of a range of serious conditions, most commonly cancer. They can produce better health outcomes than individual medications because, in combination, these medications can target the disease more effectively.

    These combination therapies can only be approved for use on the NHS if they are shown to be ‘cost-effective’. The Association of the British Pharmaceutical Industry (ABPI) told the CMA that since 2017, half of combination therapies for cancer treatments with branded medicines submitted for review to the National Institute for Health and Care Excellence (NICE) have withdrawn from the list . fully processed or were not assessed as cost-effective.

    In some cases, a combination will only be ‘cost-effective’ and commercially viable if there is some form of collaboration between pharmaceutical companies, and companies have expressed concerns that such collaboration could be investigated by the CMA. That’s why the CMA is playing its role in clarifying where and how competing drug manufacturers can work together to give them a better chance of meeting the cost-effectiveness threshold and bringing these essential medicines to market.

    The CMA has worked closely with the ABPI, NHS England (NHSE) and NICE to make this public statement, and has worked with relevant bodies in all four countries of Great Britain to ensure that patients can benefit where they are also located. By meeting the conditions set out in the CMA’s statement, pharmaceutical companies will be able to enter into a commercial agreement with the comfort that the CMA will not prioritize this conduct in investigations. However, the information exchanged between pharmaceutical companies must be limited to what is strictly necessary to reach a commercial agreement, and pharmaceutical companies cannot share the confidential price of their individual medicines.

    Ann Pope, CMA Senior Director of Antitrust, said:

    Tens of thousands of NHS patients are missing out on innovative combination therapies. Competing pharmaceutical companies’ concerns that they will fall foul of competition law if they work together are not the only reason why more of these therapies are unavailable to NHS patients, but the CMA is playing its role in explaining how companies can negotiation and avoidance are explored.


    Our statement is intended to provide clarity and comfort to businesses following the rules, and ultimately aims to help more people access essential treatments. It is not a ‘free pass’ and any companies engaging in anti-competitive behavior will be thoroughly investigated by the CMA.”

    Fiona Bride, Director of Medicines Value & Access at NHS England, said:

    NHS patients are already benefiting from access to combination cancer therapies, but it is clear that industry concerns over competition law could act as a barrier to a wider range of combination treatments reaching patients who could benefit.


    This crucial step by the CMA now provides a clear position that, in specific circumstances, commercial deals involving multiple medicines approved by different companies can be struck so that NHS patients can benefit from the latest combination therapies for a range of conditions at a fair price . taxpayers.”

    Helen Knight, Director of Medicines Evaluation at NICE, said:

    NICE is seeing an increasing number of combination therapies coming through its health technology assessment pipeline, so it was important for us to support the CMA in issuing this statement.


    We believe that if companies can work together in these very specific circumstances, the opportunity for these therapies to progress through NICE evaluation will increase. This has the potential to get better treatments to patients faster.”

    As well as the benefits to patients that come from having more combination therapies available on the NHS, there are also wider benefits for growth and innovation in the pharmaceutical sector. More companies should have the confidence to invest in and bring combination therapies to market, ultimately delivering better value for money to the NHS. These targets align with the CMA’s annual plan for 2023 to 2024, which puts people, businesses and the UK economy at the heart of its work.

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  • A vegan diet containing soy significantly reduces hot flashes in postmenopausal women

    A vegan diet containing soy significantly reduces hot flashes in postmenopausal women

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    A low-fat vegan diet that includes soy promotes changes in the gut microbiome that reduce postmenopausal vasomotor symptoms, or hot flashes, by 95% overall, according to a new study from the Physicians Committee for Responsible Medicine. A vegan diet also eliminated severe hot flashes, led to a 96% reduction in moderate to severe hot flashes and reduced daytime and nighttime hot flashes by 96% and 94%, respectively. Participants also lost an average of 6.4 pounds.

    Women who want to combat hot flashes should nourish the bacteria in their gut with a vegan diet rich in fruits, vegetables, grains and beans, which also leads to weight loss and protects against heart disease and type 2 diabetes.”


    Hana Kahleova, MD, PhD, study co-author, director of clinical research at the Physicians Committee for Responsible Medicine

    The new research is a secondary analysis of the WAVS study – the Women’s Study for the Alleviation of Vasomotor Symptoms – which the Physicians Committee previously published in the journal Menopause. In the study, 84 postmenopausal women who reported two or more moderate to severe hot flashes daily were randomly assigned to the intervention group that was asked to follow a low-fat vegan diet, including half a cup of cooked soybeans per day, or to the intervention group that was asked to eat a follow a low-fat vegan diet, including half a cup of cooked soybeans per day. the control group who continued their usual diet for twelve weeks.

    For the secondary analysis, stool samples from a subgroup of 11 participants were used to perform a gut microbiome analysis at baseline and after 12 weeks on a vegan diet. Changes in the abundance of different families, genera and species of bacteria were found.

    The study is the first to show that a reduction in the abundance of Porphyromonas and Prevotella corporis is associated with the reduction of severe daytime hot flashes. Prevotella corporis has also been found in the intestines of people with rheumatoid arthritis and appears to have pro-inflammatory properties.

    The decrease in the abundance of Clostridium asparagiforme was accompanied by a decrease in the total number of severe and intense nocturnal hot flashes. Clostridium asparagiforme also appears to produce trimethylamine N-oxide, a compound associated with an increased risk of cardiovascular disease and type 2 diabetes. Reduced abundance of Clostridium asparagiforme may partially offset the beneficial effects of a plant-based diet on cardiovascular health explain and establish a possible link between hot flashes and incident cardiovascular disease.

    Changes in the abundance of other bacteria looked at in the study may play a role in relieving hot flashes by stabilizing estrogen levels, reducing inflammation and increasing satiety, among other things.

    The authors say larger randomized clinical trials are needed to further investigate these findings.

    Source:

    Physicians Committee for Responsible Medicine

    Magazine reference:

    Kahleova, H., et al. (2023). A dietary intervention for postmenopausal hot flashes: a potential role of the gut microbiome. An exploratory analysis. Complementary therapies in medicine. doi.org/10.1016/j.ctim.2023.103002.

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  • Regenerative medicine is taking a leap forward with cartilage grafts derived from nasal cartilage

    Regenerative medicine is taking a leap forward with cartilage grafts derived from nasal cartilage

    Osteoarthritis

    The Department of Biomedicine at the University of Basel and the University Hospital Basel announced today that they have delivered the first surgical procedure for the treatment of osteoarthritis in humans. The procedure called Nasal Chondrocyte Tissue-Engineered Cartilage, or N-TEC, offers an innovative alternative for healing limited knee cartilage lesions and addressing degenerative OA cases that have previously required knee joint replacements – prostheses that must be routinely performed. replaced after 15 years. 20 years.

    The team in Basel is leading the next generation of human clinical trials that will take place in multiple locations across Europe, including Switzerland, Germany, Italy, Croatia, Sweden, Austria and Poland. The Swiss government and the EU have awarded the N-TEC program $13.1 million in funding for these osteoarthritis clinical trials – and the team continues to seek additional funding to expand these trials and bring this promising regenerative osteoarthritis treatment to other joints then deliver the knees. These clinical trials are open to qualified patients from around the world, including the United States.

    According to the U.S. government, 2.5 million joint replacement surgeries take place in the United States each year, and even more patients are looking for alternatives to delay or avoid a prosthesis. Chondrocytes are the cell building blocks for cartilage and the team at the University of Basel uses them to grow new cartilage. Implantation of this tissue-engineered cartilage graft in cartilage defects of the knee could be an alternative for all patients who need more than simple pain relief, but do not want a prosthesis. N-TEC is not suitable for the treatment of rheumatoid arthritis. N-TEC’s current studies will focus exclusively on patellafemeral osteoarthritis, rather than complete knee osteoarthritis.

    The N-TEC procedure was developed by an interdisciplinary research team led by biomedical engineer Professor Ivan Martin, PhD, director of the Department of Biomedicine, and Dr. Marcus Mumme, MD, senior orthopedic physician at the University Children’s Hospital Basel.

    Regenerative medicine is really in the clinic today

    N-TEC goes beyond laboratory and animal testing and has already taken regenerative medicine in the treatment of cartilage damage from a laboratory concept to real clinical success in humans. The University of Basel team is leading an international clinical trial with five centers in Europe and has successfully treated more than 100 patients for focal lesions – 2 to 8 cm2 dimensions – in the knee since 2012, and these patients have already returned to robust sporting activities, including skiing and running half marathons. Six years ago, the University of Basel team reached beyond focal lesions and treated two patients with advanced knee osteoarthritis – patients who had planned knee joint replacement. These patients, treated with N-TEC and correction of the leg axis, have reported favorable results (standardized, self-assessed questionnaires) and are still able to perform daily activities six years after surgery, without the need to resort to artificial joint replacement.

    To tackle osteoarthritis and cartilage defects in other joints, the University of Basel team is conducting human clinical trials targeting patella-femoral osteoarthritis (PFOA) in the knee and cartilage lesions in the ankle and shoulder joints. They will start trials in the elbow joint in 2024.

    “I have always been a very active and sporty person,” says 56-year-old Marlies Ruckstuhl from Basel, Switzerland. “A fall on ice damaged the cartilage in my left knee and left me with significant knee pain – and a reduced quality of life. Exercise was out of the question – and even sitting in my office chair was torture. I was told I needed a knee replacement In May 2017 I underwent the N-TEC procedure, after a year of structured physiotherapy I was able to run again and in the winter of 2018 I started skiing. Today I am back to my old self, pain free and unlimited – enjoying half marathons and trail running. Life is pure enjoyment again. Many thanks to the Basel – Bravo team!”

    Nasal cartilage – extracting, growing and attributes

    N-TEC is an autologous procedure that uses cartilage cells from each patient’s own body to grow new cartilage grafts that are surgically implanted to repair damaged cartilage in the patient’s joints. The team extracts a 7×7 mm segment of cartilage from the patient’s nasal septum, isolates and expands the cells, and then grows the cells on a collagen membrane in the laboratory to create a newly developed nasal cartilage graft of up to 40 cm.2. It takes four weeks to grow the cartilage grafts in the laboratory. The cartilage harvested from the nasal septum does not damage the patient’s nose.

    Importantly, the nasal cartilage is made up of cells derived from the neural crest – the type of cells that create better functioning organs, such as the brain and eyes. These cells are superior to cells from other parts of the body in terms of regenerative capacity and so-called environmental plasticity – namely the ability to adapt to different environments and conditions. In particular, nasal chondrocytes, even from older donors, can be reproducibly used to develop N-TEC cartilage patches that possess structural and mechanical properties typical of articular cartilage tissue.

    Although replacing damaged cartilage in a joint is remarkable, it is not sufficient to repair degenerative joint conditions such as osteoarthritis. Osteoarthritis is associated with wear and tear on the joint, as well as a significant amount of inflammation in damaged joints. This inflammation is a risk factor for the breakdown of new cartilage, just like with the original cartilage. Laboratory and animal experiments have shown that N-TEC nasal cartilage possesses anti-inflammatory properties that resist harmful inflammation in repaired joints. N-TEC has also proven its durability in the treatment of osteoarthritis knee cartilage, which was performed six years ago.

    Surgical procedure

    The N-TEC graft is placed in the joint during open surgery – and the team tailors the new cartilage graft in the operating room to the shape and size of the cartilage defect. The surgeons attach the graft to the surrounding cartilage tissue. The cartilage then integrates with the surrounding cartilage and subchondral bone. Patients are hospitalized for three to five days and the leg is immobilized for the first week after surgery. The patients then walk with crutches for another six weeks, during which the leg is mobilized and freedom of movement is increased. After another week, patients put their full weight on the leg and continue physical therapy to strengthen the leg. The patient can return to light sports (non-impact sports), such as swimming and cycling, after three months, and return to full robust exercise, including sports, after a year.

    N-TEC has shown overwhelming success in human clinical trials to date. Thanks to generous government funding and collaboration with other excellent teams, we will now expand clinical trials to investigate N-TEC under more challenging conditions so that it may one day become a regular bedside procedure for many patients suffering from joint pain caused by cartilage loss. .”


    Ivan Martin, PhD, professor of tissue engineering at the Department of Biomedicine, University of Basel and University Hospital Basel

    “The amazing N-TEC procedure is funded by grants from the Swiss National Science Foundation and the European Union – and private donors can step up to donate and accelerate N-TEC’s path to the bedside,” said Steve O Keeffe, founder of Angry @Arthritis, a nonprofit organization focused on attacking and eliminating osteoarthritis, headquartered in Alexandria, Virginia, in the United States. “When the doctor told me I had arthritis, it felt like my life, as I knew it, was over. The team at the University of Basel is giving new hope to people like us. They actually inspired me to start Angry@Arthritis – and begin my journey to finding and financing treatments for osteoarthritis.”

    Listen to Professor Ivan Martin’s story about N-TEC on the Angry@Arthritis podcast – https://www.angryarthritis.org/podcasts/. Also available on the major streaming platforms – Spotify, Apple, etc. You can donate to expand N-TEC’s clinical trials at https://www.angryatarthritis.org/.

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  • Patients with autoimmune rheumatic diseases benefit significantly from the fourth dose of COVID-19 vaccine

    Patients with autoimmune rheumatic diseases benefit significantly from the fourth dose of COVID-19 vaccine

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    Patients with autoimmune rheumatic diseases, including rheumatoid arthritis and other chronic conditions that cause inflammation, are at increased risk for SARS-CoV-2 infection and death from severe COVID-19. Many patients receive disease-modifying antirheumatic drugs (DMARDs) to treat these conditions, but this treatment has been associated with a blunted response to COVID-19 vaccines. The U.S. Centers for Disease Control and Prevention recommends that patients receiving DMARDs receive a fourth dose of the mRNA vaccine in addition to the primary three-dose series to protect against COVID-19. A new study led by researchers at Mass General Brigham suggests that this recommendation saved lives and reduced hospitalizations among patients in this risk group. Results are published in The Lancet Rheumatology.

    To conduct their study, the researchers used observational data from Mass General Brigham’s health care system to compare rheumatic patients who took DMARDs and received a fourth dose of the mRNA vaccine with those who did not. The study included data from 4,305 patients. They found that patients who received the fourth dose had a 41 percent reduction in risk of infection and a 65 percent reduction in admission/death compared to those who did not.

    A fourth dose of COVID-19 mRNA vaccine provides significant protection against any SARS-CoV-2 infection and severe COVID-19 in patients with systemic autoimmune rheumatic diseases taking DMARDs. These patients should be encouraged to remain current on COVID-19 mRNA vaccines, including boosters after the primary vaccination series.”


    Zachary Wallace, MD, MSc, co-corresponding author of the Division of Rheumatology, Immunology and Allergy at Massachusetts General Hospital (MGH), a founding member of the Mass General Brigham health care system

    Since the start of the pandemic, researchers from across Brigham and Women’s Hospital (BWH) and MGH have been working together to pay special attention to this group of patients to uncover insights that can help inform their treatment and the care of broader patient populations. .

    “At the very beginning of the pandemic, we joined forces to identify every rheumatic patient with COVID we see in our institutions so we could monitor their clinical course and collect examination and blood data,” said co-corresponding author Jeffrey Sparks, MD, MMSc, ​​of the Division of Rheumatology, Inflammation and Immunity at BWH. “Working together, we will find important clues that can help better protect patients against infections and serious diseases.”

    Source:

    Magazine reference:

    Hanberg, J.S. et al. (2023) Effectiveness of a fourth dose of COVID-19 mRNA vaccine in patients with systemic autoimmune rheumatic diseases taking disease-modifying antirheumatic drugs: an emulated target study. The Lancet Rheumatology. doi.org/10.1016/S2665-9913(23)00272-2.

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  • New research suggests that cannabis shows promise in relieving endometriosis pain

    New research suggests that cannabis shows promise in relieving endometriosis pain

    From a recent study published in the Journal of Clinical Medicineresearchers examined the available literature on cannabis as a self-management strategy in the treatment of pain due to endometriosis. They further investigated the mechanisms by which cannabis interacts with the endocannabinoid system (ECS) and the interactions of gut microbiota and ECS in the treatment of the condition. Their findings show that cannabis-derived endocannabinoids have a protective effect on the intestines, reducing intestinal inflammation and improving its permeability. This in turn suppresses bloating, the most common symptom of endometriosis. Cannabinoids also inherently suppress pain receptors and serve as a natural painkiller. These results highlight the gut microbiota and ECS as future clinical trial targets in the fight against endometriosis.

    Study: Cannabis and endometriosis: the role of the gut microbiota and the endocannabinoid system. Image credits: Rapeepat Pornsipak / ShutterstockStudy: Cannabis and endometriosis: the role of the gut microbiota and the endocannabinoid system. Image credits: Rapeepat Pornsipak / Shutterstock

    Endometriosis and the benefits of cannabis

    Endometriosis is a disease of sexually mature women (between the first menstrual period and up to menopause) characterized by endometrial tissue-like tissue growing beyond the boundaries of the uterus. It is a common condition, estimated to affect 10% of all women, with symptoms including severe pelvic pain and outcomes including difficulty conceiving.

    In addition to the immediate results, endometriosis-related chronic pelvic pain (CPP) has been associated with several comorbidities, including irritable bowel syndrome (IBS), psoriasis, rheumatoid arthritis, mental health problems (depression and anxiety), and chronic fatigue syndrome. The annual economic loss due to the disease is estimated at between US$1,459 and US$20,239 per woman, highlighting the socio-economic burden of the disease alone and not its treatment.

    Research has shown that progesterone is a common feature of endometriosis patients, suggesting that hormonal imbalances then cause inflammation due to the local infiltration of immune cells. These cells establish new cells that have been found to activate pathways related to invasion, proliferation, metastasis and angiogenesis. Because most hormone resistances arise due to imbalances in the gut microbial system, resulting in changes in the expression levels of estrogen-metabolizing enzymes, recent studies have focused on the associations between the gut microbiome and the disease.

    Current treatment for endometriosis involves a combination of surgery and hormone treatment. Antineuropathic agents, including gabapentin, pregabalin, and amitriptyline, are used to reduce pain and allow normal daily functioning. Unfortunately, these interventions are medically suboptimal given the reduced access of women in developing and underdeveloped countries to surgery and the greatly reduced efficacy of antineuropathic agents in controlling pain in endometriosis patients. Research has shown that endometriosis patients are four times more likely to overuse painkillers, causing dependence and abuse.

    Metabolites from the Hemp gender received extensive attention in the 1990s, resulting in the discovery of the endocannabinoid system (ECS), a complex signaling system consisting of G protein-coupled cannabinoid receptors, ion channel transient receptor potential vanilloid 1, and a cohort of enzymes responsible for endocannabinoid synthesis and catabolism. Cannabidiol (CBD) and tetrahydrocannabinol (THC), the two main active ingredients derived from cannabis consumption, have intrinsic pain-suppressing properties and have been used in other medical research.

    Given its relative cheapness and ease of access, cannabis consumption has become a popular self-medication for endometriosis pain, despite ample research into the pathways and mechanisms through which it can affect the ECG, positively or negatively altering endometriosis outcomes.

    Findings of the study

    The current study is a descriptive review of current scientific knowledge on endometriosis, focusing on the impact of endocannabinoids on disease outcomes and the associations between ECS, gut microbiota and endometriosis. Although no publication screening methodologies were reported, the citation list suggests that more than 140 scientific articles were reviewed during the synthesis of this work.

    Research has shown that the ECS is mainly involved in pain modulation and inflammation suppression. Endocannabinoids or exogenous cannabinoids have been shown to activate the CB1 and C.B2 receptors, critical components of the G protein-coupled system, suppressing nociceptive processing and inducing analgesia.

    “In a prospective randomized, placebo-controlled trial, smoked cannabis (3.56% delta-9-tetrahydrocannabinol (THC) – participants smoked three cigarettes per day for a four-day period) reduced the daily pain experienced by adults with HIV-associated sensory neuropathy .”

    ECS is further hypothesized to play a central role in the pathology of endometriosis, with some researchers calling the disease an “endocannabinoid deficiency.” Strong correlations have been observed between circulating plasma endocannabinoid levels and the severity of endometriosis, with lower levels of endocannabinoids being associated with increased pain. However, other studies have suggested that endometriosis and the ECS may have complex associations with the onset of the former, initiating a feedback loop in the latter. This indicates that the role of ECS in endometriosis may extend beyond inflammation and pain suppression and warrants further investigation into the mechanisms underlining these interactions.

    Can external cannabis consumption help?

    The role of cannabis derivatives in endometriosis, especially regarding their pain-suppressing properties, has led to investigations into cannabis use as a potential natural alternative to current anti-neuropathic therapies. An ongoing clinical trial is testing the efficacy of CBD isolate oil and vaporized THC in pain modulation in women admitted to hospitals and clinics reporting severe endometrial pain. In vivo mouse models have paved the way for these types of studies, given the positive effects of CBD against not only endometrial pain, but also the observed growth-inhibitory effects on the surface of endometrial implants.

    These promising findings highlight the potential therapeutic benefits of CBD and THC for endometriosis-associated pain, justifying the need for human studies.

    What about the gut microbiota?

    The intestines are part of the ECS, and enzymes secreted by the intestines have been shown to significantly alter ECS hormones, potentially having a regulatory effect on endometriosis. However, research in this area is still in its infancy. So far, the findings suggest a bidirectional relationship between the gut microbiota, the ECS and endometriosis, influencing both the risk and severity of the disease.

    “Endocannabinoids and exogenous cannabinoids have opposite effects on intestinal permeability. For example, in research on decreased permeability due to inflammation, it was shown that 2-AG and AEA increased permeability, while THC and CBD decreased permeability.”

    Although research on the direct effects of cannabinoids on endometriosis remains scarce, preclinical models have demonstrated the positive impact of the former on the comorbidities of the latter, especially irritable bowel disorder (IBD). Interestingly, the gut microbiota has been implicated in these associations Lactobacillus acidophilus intestinal inoculations in mice were shown to result in endogenous upregulation of the CB2 expression in intestinal cells, resulting in analgesic effects and reduced visceral pain in the mice. Additionally, research in athletes has linked cannabinoids to pain suppression, anti-inflammatory effects, and improved intestinal absorption.

    “Studies have also examined the relationship between the ECS and microbial metabolites in the gut. For example, endocannabinoids have been found to mediate the anti-inflammatory effects of SCFAs. This association was observed in an exercise intervention where an increase in SCFAs (including butyrate) and SCFA-producing bacteria (such as Bifidobacterium) was correlated with a decrease in pro-inflammatory cytokines TNF-α and IL-6.”

    Conclusions

    The current study compiles currently available information on research on cannabinoids, the ECS, the gut microbiota and their collective (potentially bidirectional) association with endometriosis. The findings are largely positive, with research confirming the beneficial effects of cannabinoids, both endogenous and exogenous, on endometriosis outcomes and comorbidities of the disease. However, further research is needed to assess the safety of THC and CBD administrations in the treatment of endometriosis and the mechanisms underlying these preclinically observed benefits. Fortunately, at least one clinical trial is already underway to achieve this.

    Magazine reference:

    • Farooqi, T., Bhuyan, D.J., Low, M., Sinclair, J., Leonardi, M., & Armor, M. (2022). Cannabis and endometriosis: the role of the gut microbiota and the endocannabinoid system. Journal of Clinical Medicine, 12(22), 7071, DOI – https://doi.org/10.3390/jcm12227071, https://www.mdpi.com/2077-0383/12/22/7071

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  • One in five people taking nirmatrelvir-ritonavir treatment were found to experience rebound COVID

    One in five people taking nirmatrelvir-ritonavir treatment were found to experience rebound COVID

    Arthritis

    A new study by researchers at Mass General Brigham found that one in five people taking Nirmatrelvir-ritonavir treatment, commonly known as Paxlovid, to treat severe symptoms of COVID-19 experienced a positive test result and excretion of live and potentially contagious virus after initial recovery and negative test; a phenomenon known as virological rebound. In contrast, people who didn’t take Paxlovid experienced a rebound only about 2 percent of the time. Results are published in Annals of Internal Medicine.

    We conducted this study to answer lingering questions about Paxlovid and virologic rebound in the treatment of COVID-19. We found that the virological rebound phenomenon was much more common than expected – in more than 20% of people taking Paxlovid – and that individuals shed live virus when they experience a rebound, indicating the potential for transmission after initially recovering were from the virus.”

    Mark Siedner, MD, MPH, Corresponding author, physician and infectious disease researcher at the Division of Infectious Diseases at Massachusetts General Hospital

    Paxlovid is an oral antiviral medication used to treat COVID-19. Previous studies show the drug’s effectiveness in reducing hospitalizations and deaths in cases of severe COVID-19 infection. Since the integration of Paxlovid into the treatment of COVID-19, some patients have reported a virological rebound. A previously conducted phase 3 clinical trial, known as EPIC-HR, suggested that only 1% to 2% of patients taking Paxlovid experienced a virological rebound. However, research by Siedner and colleagues shows that this phenomenon is much more common than previously suspected.

    Paxlovid remains a life-saving drug that I prescribe to high-risk patients. This study, while informative, does not change the fact that this drug is highly effective in preventing hospitalizations and death. Instead, it provides valuable insights to Paxlovid patients, helping them understand what to expect and how long they may remain contagious.”

    Jonathon Li, MD, co-senior author, infectious disease physician and investigator in the Division of Infectious Diseases at Brigham and Women’s Hospital

    Siedner, Li, and other researchers from Mass General Brigham collected data from the Post-vaccination Viral Characteristics Study (POSITIVES), an ongoing study of individuals diagnosed with acute COVID-19 infections. Between March 2022 and May 2023, 142 individuals were selected for the study based on positive COVID-19 tests, medication prescriptions or physician referrals. Sorting participants into those who followed a five-day Paxlovid regimen and those who did not, they closely monitored patients’ viral loads and symptoms, cultured virus samples and performed whole genome sequencing. Patients who tested positive for COVID-19 after previously testing negative and those who showed two consecutive increases in viral load after an initial reduction were classified as having virological rebound.

    Researchers found that 20.8% of participants taking Paxlovid experienced a virological rebound, while only 1.8% of those not taking Paxlovid had a similar rebound effect. Those with a rebound also showed prolonged virus shedding – an average of 14 days compared to less than 5 days in those who did not experience a rebound – suggesting they were potentially contagious for much longer. Importantly, Siedner’s team found no evidence of drug resistance in these patients.

    The findings should not deter doctors from prescribing the medication, the researchers noted, but they should prompt them to counsel patients taking the medication about the risk of viral rebound and spreading the virus to others. Advising patients to retest and isolate in case of a rebound should be part of that conversation, the team said.

    The original EPIC-HR study assessed patient outcomes at only two time points. When the Mass General Brigham researchers matched their data analysis to selected time points from the EPIC-HR study, they found virologic recovery in only 2.4% of participants, suggesting that the previous study did not capture the full extent of represented virological recovery.

    “In our study, we were able to closely monitor patients from the onset of COVID-19 infection through treatment and rebound,” Li explains. “Unlike the EPIC-HR study, which assessed outcomes at only two time points, we followed up with patients three times a week, sometimes for months, and performed sample collection at home. We also had both viral RNA levels as viral culture data. have allowed us to paint a more comprehensive and nuanced picture of a patient’s experience with Paxlovid.”

    This study is limited in that it was an observational study and not a randomized, controlled trial. Thus, the authors cannot be certain that the increased rebound rate observed in people taking Paxlovid was solely due to use of the drug. The team used a positive virus culture as a measure of risk of transmitting the virus, but could not formally measure how contagious someone was who experienced a virological rebound. Furthermore, the team could not explain why some people experienced a rebound and others did not. something they want to explore with future studies. They also plan to investigate the biological mechanism behind the rebound phenomenon associated with Paxlovid and determine whether changing the duration of treatment can help combat this rebound effect.

    Source:

    Magazine reference:

    Edelstein, G.E. et al. (2023) SARS-CoV-2 virological rebound with nirmatrelvir-ritonavir therapy. Annals of Internal Medicine. doi.org/10.7326/M23-1756.

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  • Food allergies may be linked to an increased risk of cardiovascular disease, research shows

    Food allergies may be linked to an increased risk of cardiovascular disease, research shows

    Sensitivity to common food allergens such as dairy and peanuts could be a major and previously unappreciated cause of heart disease, new research suggests – and the increased risk of cardiovascular disease extends to people without obvious food allergies.

    Food allergies may be linked to an increased risk of cardiovascular disease, research shows
    Dairy and common foods like peanuts may be a major and previously underappreciated cause of heart disease, new research suggests – and the increased risk of cardiovascular disease includes even people without apparent food allergies. Image credits: UVA Health

    That increased risk could equal or even exceed the risks of smoking, diabetes and rheumatoid arthritis, the researchers report.

    UVA Health scientists and their collaborators looked at thousands of adults over time and found that people who produced antibodies in response to dairy and other foods were at increased risk for cardiovascular disease. This was true even when traditional risk factors for heart disease, such as smoking, high blood pressure and diabetes, were taken into account. The strongest association was for cow’s milk, but other allergens such as peanuts and shrimp were also significant.

    The disturbing finding represents the first time that ‘IgE’ antibodies against common foods have been linked to an increased risk of cardiovascular death, the researchers report. The findings do not conclusively prove that food antibodies cause the increased risk, but the work builds on previous studies that linked allergic inflammation and heart disease.

    About 15% of adults produce IgE antibodies in response to cow’s milk, peanuts and other foods. Although these antibodies cause some people to develop severe food allergies, many adults who produce these antibodies do not have an overt food allergy. The new research found that the strongest link with cardiovascular death was in people who had the antibodies but continued to consume the food regularly – suggesting they did not have a severe food allergy.

    “What we were looking at here was the presence of IgE antibodies to food that were detected in blood samples,” says researcher Jeffrey Wilson, MD, PhD, an allergy and immunology expert at the University of Virginia School of Medicine. “We don’t think most of these subjects actually had a food allergy. So our story is more about an otherwise silent immune response to food. While these reactions may not be strong enough to cause acute allergic reactions to food, they can still cause inflammation and over time lead to problems such as heart disease.”

    Unexpected findings about food allergy

    The researchers were inspired to explore the possibility that common food allergies could harm the heart after members of the UVA team previously linked an unusual form of food allergy, spread by ticks, to heart disease. That allergy, first identified by Thomas Platts-Mills, MD, PhD of UVA, is transmitted by the bite of the lone star tick, found across much of the country.

    The allergy – commonly incorrectly called the ‘red meat allergy’ – makes people sensitive to a certain sugar, alpha-gal, found in mammalian meat. The symptomatic form of the allergy, known as “alphagal syndrome,” can cause hives, stomach upset and breathing difficulties – even potentially fatal anaphylaxis – three to eight hours after affected people eat beef or pork. (Poultry and fish don’t contain the sugar, so won’t cause a reaction.)

    To see whether other food allergies might affect the heart, a team including Wilson, Platts-Mills and collaborators at UVA, as well as Corinne Keet, MD, PhD, of the University of North Carolina, reviewed data collected from 5,374 participants in the National Health and Examination Survey (NHANES) and the Wake Forest site of the Multi-Ethnic Study of Atherosclerosis (MESA). Of those people, 285 had died from cardiovascular causes.

    Among NHANES participants, IgE antibodies against at least one food were associated with a significantly higher risk of cardiovascular death, the researchers found. This was especially true for people who are sensitive to milk, a finding that also held true among the MESA participants. Additional analysis also identified peanut and shrimp sensitization as significant risk factors for cardiovascular death in individuals who ate them routinely.

    “We previously noted a link between allergic antibodies to the alpha-gal red meat allergen and heart disease,” Wilson explained. “That finding is supported by a larger study in Australia, but the current paper suggests that a link between allergic antibodies to food allergens and heart disease is not limited to alpha-gal. In some ways this is a surprising finding. On the other hand, we are not aware of anyone having looked before.”

    Allergies and the heart

    Although this is the first time that allergic antibodies to common foods have been linked to cardiovascular death, other allergic conditions – such as asthma and the itchy rash known as eczema or atopic dermatitis – have previously been identified as risk factors for cardiovascular disease.

    The researchers speculate that allergic antibodies to food may affect the heart by leading to the activation of specialized cells called mast cells. Mast cells in the skin and intestines are known to contribute to classic allergic reactions, but they are also found in cardiac blood vessels and tissue. Continued activation of mast cells can cause inflammation, contributing to the formation of harmful plaques that can cause heart attacks or other heart damage, the researchers think.

    However, the scientists emphasize that this is not yet certain. It is possible that other genetic or environmental factors play a role. It’s even possible that cardiovascular disease could increase the risk of food sensitization – meaning heart disease could increase the risk of food allergies, rather than the other way around – although the new results suggest this is unlikely.

    The researchers call for further research to better understand the implications of their findings before recommending changes in the way doctors treat or manage food allergies.

    This work raises the possibility that a blood test could help provide personalized information about a heart-healthy diet in the future. Although before that can be recommended, we still have a lot of work to do to understand these findings.”

    Jeffrey Wilson, allergy and immunology expert, University of Virginia School of Medicine

    Findings published

    The researchers published their findings in the leading allergy journal, the Journal of Allergy and Clinical Immunology. The research team consisted of Keet, Emily McGowan, David Jacobs, Wendy Post, Nathan Richards, Lisa Workman, Platts-Mills, Ani Manichaikul and Wilson. Wilson and Platts-Mills have received support from Thermo-Fisher/Phadia; a full list of the authors’ disclosures is included in the article.

    The research was supported by the National Institute of Allergy and Infectious Disease of the National Institutes of Health under grants 5U01AI125290, R37-AI20565, and R21AI151497; and by an AAAAI Foundation Faculty Development Award. A list of the funders of the MESA trial is available in the paper.

    Source:

    University of Virginia Health System

    Magazine reference:

    Keet, C., et al. (2023) IgE to common food allergens is associated with cardiovascular mortality in the National Health and Examination Survey and the Multi-Ethnic Study of Atherosclerosis. Journal of Allergy and Clinical Immunology. doi.org/10.1016/j.jaci.2023.09.038.

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  • Knee Cartilage Degeneration

    Knee Cartilage Degeneration

    Knee Cartilage Degeneration: Causes, Symptoms, and Treatment Options

    Knee cartilage degeneration is a common condition that affects millions of people worldwide. It occurs when the cartilage that cushions the knee joint begins to wear away, leading to pain, stiffness, and limited mobility. While this condition can occur at any age, it is more common in older adults and athletes who put a lot of stress on their knees.

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    Understanding Knee Cartilage Degeneration is important for anyone who wants to maintain healthy knees. The knee joint is made up of three bones: the femur, tibia, and patella. Between these bones is a layer of cartilage that acts as a shock absorber, preventing the bones from rubbing against each other. When this cartilage begins to break down, it can cause pain and inflammation in the knee joint. There are several factors that can contribute to knee cartilage degeneration, including age, genetics, obesity, and injury.

    If left untreated, knee cartilage degeneration can lead to more serious complications, such as osteoarthritis. Fortunately, there are several treatment options available to manage this condition, including physical therapy, medication, and surgery. By taking proactive steps to prevent knee cartilage degeneration and seeking prompt treatment when symptoms arise, individuals can maintain healthy knees and enjoy an active lifestyle for years to come.

    Key Takeaways

    • Knee cartilage degeneration is a common condition that affects the knee joint and can cause pain, stiffness, and limited mobility.
    • Factors that contribute to knee cartilage degeneration include age, genetics, obesity, and injury.
    • Treatment options for knee cartilage degeneration include physical therapy, medication, and surgery, and early intervention can help prevent more serious complications.

    Understanding Knee Cartilage Degeneration

    Knee cartilage degeneration is a common condition that occurs when the cartilage in the knee joint wears away. This can lead to pain, swelling, and stiffness in the knee, making it difficult to perform daily activities.

    Causes of Degeneration

    There are several factors that can contribute to knee cartilage degeneration. Osteoarthritis is a common cause, which occurs when the articular cartilage that covers the ends of the tibia and femur bones in the knee joint breaks down over time. This can be due to aging, injury, trauma, wear and tear, or genetics.

    Other factors that can contribute to knee cartilage degeneration include joint damage, physical activity, and obesity. In some cases, there may be no obvious cause for the degeneration.

    Symptoms and Diagnosis

    The symptoms of knee cartilage degeneration can vary depending on the severity of the condition. Common symptoms include knee pain, swelling, stiffness, and limited range of motion. In some cases, there may be a clicking or popping sound when the knee is moved.

    Diagnosis of knee cartilage degeneration typically involves a physical exam, medical history, and diagnostic tests such as x-rays and magnetic resonance imaging (MRI). These tests can help to identify the extent of the damage and determine the best course of treatment.

    Overall, understanding the causes and symptoms of knee cartilage degeneration is important for managing the condition and preventing further damage to the knee joint. If you are experiencing knee pain or other symptoms, it is important to seek medical attention and discuss your treatment options with your healthcare provider.

    Risk Factors and Complications

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    Knee cartilage degeneration can be caused by several risk factors that increase the likelihood of developing the condition. In this section, we will discuss identifying risk factors and potential complications associated with knee cartilage degeneration.

    Identifying Risk Factors

    The following factors may increase the risk of knee cartilage degeneration:

    • Age: Cartilage naturally wears down over time, making older adults more susceptible to the condition.
    • Gender: Women are more likely than men to develop knee cartilage degeneration.
    • Obesity: Excess weight puts additional pressure on the knees, which can lead to cartilage damage.
    • Previous injury: A history of knee injuries can increase the risk of developing knee cartilage degeneration.
    • Occupation: Jobs that require repetitive knee movements, such as construction work, can increase the risk of developing the condition.

    Potential Complications

    Knee cartilage degeneration can lead to several complications, including:

    • Joint damage: As cartilage wears down, bones in the knee may rub against each other, causing joint damage.
    • Disability: Severe cases of knee cartilage degeneration can limit mobility and lead to disability.
    • Instability: As cartilage wears down, the knee joint may become unstable, making it more difficult to walk or stand.
    • Medical conditions: Knee cartilage degeneration can increase the risk of developing other medical conditions, such as diabetes and fever.
    • Deformities: In some cases, knee cartilage degeneration can cause the knee joint to become misaligned or deformed.

    Overall, understanding the risk factors and potential complications associated with knee cartilage degeneration is important for early detection and treatment of the condition.

    Treatment and Management

    When it comes to knee cartilage degeneration, there are a variety of treatment options available. The best course of action will depend on the severity of the condition, as well as the individual needs and goals of the patient.

    Non-Surgical Treatments

    For those with mild to moderate knee cartilage degeneration, non-surgical treatments may be effective. These can include:

    • Physical therapy: This can help improve mobility and flexibility, as well as strengthen the muscles around the knee joint.
    • Medications: Anti-inflammatory drugs such as NSAIDs or corticosteroids can help reduce inflammation and pain.
    • Injections: Platelet-rich plasma (PRP) or hyaluronic acid injections may be used to promote healing and reduce pain.
    • Braces: Knee braces can help stabilize the joint and reduce pain during physical activity.

    Surgical Treatments

    In more severe cases of knee cartilage degeneration, surgical treatments may be necessary. These can include:

    • Arthroscopy: This minimally invasive procedure involves inserting a small camera into the knee joint to remove damaged tissue or bone spurs.
    • Autologous chondrocyte implantation: This procedure involves removing healthy cartilage cells from the patient’s knee, growing them in a lab, and then implanting them back into the knee joint to promote healing.
    • Joint replacement surgery: This involves removing the damaged knee joint and replacing it with an artificial joint.

    It’s important to note that surgery is generally considered a last resort, and conservative treatment options should be exhausted before considering surgical intervention.

    If you are experiencing knee pain, redness, or swelling, or if you are having difficulty with mobility or flexibility in your knee joint, it’s important to see a doctor. They can help diagnose the underlying cause of your symptoms and recommend appropriate treatment options.

    Prevention is also key when it comes to knee cartilage degeneration. Maintaining a healthy weight, avoiding repetitive stress on the knee joint, and engaging in regular exercise can all help prevent degenerative joint disease from developing.

    Frequently Asked Questions

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    What are the early symptoms of knee arthritis?

    The early symptoms of knee arthritis include pain, stiffness, and swelling in the knee joint. You may also experience a decrease in range of motion and difficulty walking. If you are experiencing any of these symptoms, it is recommended that you see a doctor for an evaluation.

    What are some new treatments for osteoarthritis of the knee?

    There are several new treatments for osteoarthritis of the knee, including stem cell therapy, platelet-rich plasma (PRP) therapy, and hyaluronic acid injections. These treatments can help to reduce pain, inflammation, and promote healing of damaged cartilage.

    What causes degeneration of cartilage?

    Degeneration of cartilage can be caused by a variety of factors, including aging, injury, and genetics. Other factors that can contribute to cartilage degeneration include obesity, repetitive stress on the joints, and certain medical conditions such as rheumatoid arthritis.

    Can knee arthritis pain radiate down the leg?

    Yes, knee arthritis pain can radiate down the leg. This is because the nerves that supply sensation to the knee joint also supply sensation to other parts of the leg, such as the thigh and calf.

    What are the symptoms of having no cartilage in the knee?

    The symptoms of having no cartilage in the knee include pain, swelling, stiffness, and a decrease in range of motion. You may also experience a grinding or popping sensation when you move your knee.

    How can knee cartilage damage be treated effectively?

    Knee cartilage damage can be treated effectively through a variety of treatments, including physical therapy, medications, and surgery. The type of treatment that is recommended will depend on the severity of the damage and the underlying cause of the damage. It is important to work closely with your doctor to determine the best course of treatment for you.

  • Knee Swelling

    Knee Swelling

    Knee Swelling: Causes, Symptoms, and Treatment

    Knee swelling is a common problem that can occur due to various reasons. It can be caused by an injury, inflammation, or an underlying medical condition. Swelling in the knee can lead to discomfort, pain, and difficulty in movement. In this article, we will discuss knee swelling in detail, including its causes, diagnosis, and treatment options.

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    Understanding Knee Swelling:

    Knee swelling is a condition in which the knee joint becomes enlarged due to the accumulation of fluid in or around the joint. It can be caused by a variety of factors, such as injury, arthritis, or infection. The swelling can range from mild to severe, and it can affect one or both knees. Knee swelling can also lead to other symptoms, such as stiffness, pain, and difficulty in bending or straightening the knee.

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    Key Takeaways:

    • Knee swelling can be caused by various factors, including injury, inflammation, or an underlying medical condition.
    • It can lead to discomfort, pain, and difficulty in movement.
    • Treatment options for knee swelling depend on the underlying cause and may include rest, ice, compression, and elevation, as well as medication and physical therapy.

    Understanding Knee Swelling

    Knee swelling is a common symptom that can be caused by a variety of factors. Swelling in the knee joint can be due to an accumulation of fluid, inflammation, or injury, among other things.

    When the knee joint is swollen, it may appear red and warm to the touch. The skin around the joint may also be stretched and appear shiny. This type of swelling is called an effusion.

    Effusions can be caused by a variety of factors, including injury, overuse, or underlying medical conditions such as arthritis. In some cases, fluid may accumulate in the joint due to an infection or other underlying medical condition.

    If you experience knee swelling, it is important to seek medical attention to determine the underlying cause. Treatment will depend on the cause of the swelling and may include rest, ice, compression, and elevation of the affected leg. In some cases, medication or physical therapy may also be recommended.

    It is important to avoid putting too much weight on a swollen knee, as this can exacerbate the swelling and delay healing. If you experience redness or warmth in addition to swelling, it may be a sign of an infection and you should seek medical attention immediately.

    In conclusion, knee swelling can be a symptom of a variety of underlying medical conditions. If you experience knee swelling, it is important to seek medical attention to determine the underlying cause and receive appropriate treatment.

    Causes and Risk Factors

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    Knee swelling can be caused by a variety of factors, including injury, medical conditions, age, and lifestyle. Understanding the causes and risk factors of knee swelling can help individuals take preventative measures to avoid future swelling.

    Injury and Overuse

    Injury and overuse are common causes of knee swelling. Sports and trauma, such as a torn ligament or anterior cruciate ligament (ACL), can cause swelling. Falls, kneeling for extended periods, and overuse from repetitive motions can also lead to knee swelling.

    Medical Conditions

    Medical conditions such as arthritis, rheumatoid arthritis, gout, and osteoarthritis can cause knee swelling. Bursitis and pseudogout are also common causes of knee swelling. Autoimmune diseases can lead to knee swelling as well.

    Age and Lifestyle

    Age and lifestyle can also contribute to knee swelling. Maintaining a healthy weight can help prevent knee swelling, as excess weight puts additional strain on the knee joint. Stress and fever can also contribute to knee swelling.

    Other Factors

    Other factors that can cause knee swelling include infections and pus. It is important to seek medical attention if knee swelling is accompanied by fever or other symptoms.

    Overall, understanding the causes and risk factors of knee swelling can help individuals take preventative measures to avoid future swelling.

    Diagnosis and Treatment

    Medical Examination

    If you are experiencing knee swelling, your doctor will begin with a thorough medical examination. They will ask about your symptoms and medical history, and may perform a physical examination of your knee. They may also order imaging tests, such as a CT or MRI, to get a better look at your knee joint.

    In some cases, your doctor may also perform arthrocentesis, which involves removing a sample of fluid from your knee joint for analysis. This can help to determine the cause of your knee swelling.

    Medications and Therapies

    Treatment for knee swelling will depend on the underlying cause. In many cases, rest, ice, and pain relievers such as acetaminophen or nonsteroidal anti-inflammatory drugs (NSAIDs) may be recommended.

    If your knee swelling is due to inflammation, your doctor may prescribe corticosteroids to help reduce swelling and inflammation. Physical therapy may also be recommended to help strengthen the muscles around your knee and improve range of motion.

    Surgery and Other Procedures

    In some cases, surgery may be necessary to treat knee swelling. This may include arthroscopy, which involves using a small camera to view the inside of your knee joint and make repairs, or knee replacement surgery if the joint is severely damaged.

    It is important to work closely with your doctor to determine the best course of treatment for your knee swelling. With proper diagnosis and treatment, many people are able to find relief from their symptoms and improve their quality of life.

    Prevention and Self-Care

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    When it comes to knee swelling, prevention and self-care are crucial. Here are some tips to help manage your knee swelling and prevent it from getting worse.

    Exercise and Weight Management

    Maintaining a healthy weight is important for reducing the stress on your knees. Exercising regularly can also help strengthen the muscles around your knees, which can help reduce knee swelling. Low-impact exercises such as swimming, cycling, and yoga are great options for those with knee problems.

    Proper Rest and Body Mechanics

    Rest is important for allowing your knee to heal and reducing inflammation. Avoid putting too much pressure on your knees, and try to keep them in a neutral position when sitting or lying down. When standing, distribute your weight evenly between both legs.

    Medications and Home Remedies

    Over-the-counter pain relievers such as ibuprofen can help reduce pain and inflammation. Applying heat or cold to your knee can also help reduce swelling. Elevating your knee above heart level and wearing an elastic bandage or brace can also help reduce swelling.

    Remember, prevention and self-care are key to managing knee swelling. By following these tips, you can help reduce pain and inflammation and prevent further damage to your knees.

    Frequently Asked Questions

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    What can cause knee swelling?

    There are many causes of knee swelling, including injury, overuse, arthritis, infections, and other medical conditions. It is important to see a doctor if you experience knee swelling to determine the underlying cause.

    What is the fastest way to get rid of fluid on the knee?

    The fastest way to get rid of fluid on the knee is to rest, elevate the leg, apply ice, and use compression. Over-the-counter pain relievers can also help. If the swelling does not improve, it is important to see a doctor.

    How do I reduce swelling in my knee?

    To reduce swelling in your knee, you should rest, elevate the leg, apply ice, and use compression. Over-the-counter pain relievers can also help. If the swelling does not improve, it is important to see a doctor.

    What causes a knee to swell without injury?

    A knee can swell without injury due to medical conditions such as arthritis, infections, and gout. It is important to see a doctor if you experience knee swelling to determine the underlying cause.

    Knee swollen for 3 weeks

    If your knee has been swollen for 3 weeks, it is important to see a doctor. The swelling could be due to a medical condition that requires treatment.

    Swollen knee in older person

    A swollen knee in an older person could be due to arthritis, infections, or other medical conditions. It is important to see a doctor to determine the underlying cause and receive appropriate treatment.