Annals for Educators - 1 December 2020
Authors: Christine Laine
Journal: Annals of Internal Medicine (2020)

Web Exclusives1 December 2020Annals for Educators - 1 December 2020FREEChristine Laine, MD, MPHChristine Laine, MD, MPHSearch for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/AWED202012010 SectionsAboutVisual AbstractPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Clinical Practice PointsEffectiveness of Curcuma longa Extract for the Treatment of Symptoms and Effusion–Synovitis of Knee Osteoarthritis. A Randomized TrialCurcuma longa (turmeric) extract, an Ayurvedic and Chinese traditional medicine, has anti-inflammatory and analgesic properties. This trial examined its efficacy for treating patients with symptomatic knee osteoarthritis and evidence of knee effusion or synovitis.Use this study to:Start a teaching session with a multiple-choice question. We've provided one below!Ask your learners what therapies they typically offer to patients with knee osteoarthritis.Do they routinely ask patients with new osteoarthritis if they use alternative therapies? If so, what alternative therapies do their patients report using?Have your learners heard of Curcuma longa extract as a therapy for knee osteoarthritis?Ask your learners if they would suggest Curcuma longa extract for patients with symptomatic knee osteoarthritis after reading this article.Should This Patient Be Screened for Pancreatic Cancer? Grand Rounds Discussion From Beth Israel Deaconess Medical CenterIn 2019, the U.S. Preventive Services Task Force confirmed its 2004 recommendation against routine screening for pancreatic cancer in average-risk persons. Here, 2 experts review the guideline and recent evidence and discuss whether a patient with a family history of pancreatic cancer should be screened.Use this article to:Watch the video of the patient discussed in this article and ask your learners whether they would screen him for pancreatic cancer. Discuss the potential benefits and harms of screening such a patient for pancreatic cancer.Have your learners read the article or watch the grand rounds video and then review what you have learned by taking this quiz. Public HealthContact Settings and Risk for Transmission in 3410 Close Contacts of Patients With COVID-19 in Guangzhou, China. A Prospective Cohort StudyThis study evaluated the risk for transmission of SARS-CoV-2 among a prospective cohort of 3410 close contacts in China exposed to 391 persons with COVID-19 infection according to different exposure settings.Use this study to:Ask your learners about the types of exposures in the community that present a high risk for SARS-CoV-2 transmission.Discuss the contact tracing strategies that are used in various countries.Ask your learners what contact tracing strategies they would find acceptable. Would they be willing to enable an app that would allow their mobile phones to track their location for the purposes of SARS-CoV-2 contact tracing?Health Professionals, Violence, and Social ChangeThis article aims to help readers answer 4 questions: What do I know about disparities and violence? How am I part of the problem? How can I become part of the solution? How can I help others do the same?Use this article to:Ask your learners to share examples of patients they have cared for who have been victims of violence.Discuss whether physicians should routinely ask about violence when taking a social history.A physician is concerned that a patient who presents frequently with vague complaints might be the victim of domestic violence. Role-play a conversation in which the physician explores this concern with the patient.Invite a social worker to share information about resources within your health system or the surrounding community for patients affected by violence.Hearing LossThis practical review addresses the prevention, diagnosis, and care of patients with hearing loss.Use this article to:Discuss the etiology of hearing loss. When should physicians be concerned that it is not simply related to the aging process?Ask your learners to share their experiences caring for patients with hearing loss. Do they have strategies they find helpful when communicating with patients who have difficulty hearing?Ask an audiologist to provide your learners with a short overview of available devices to assist patients with hearing loss.MKSAP 18 QuestionA 38-year-old woman seeks advice regarding preventative measures for developing osteoarthritis. One year ago, she started an exercise regimen of running approximately 20 miles per week. She has no joint pain when running. History is significant for polycystic ovary syndrome. Family history is notable for both parents having knee replacements for osteoarthritis. Her only medication is an oral contraceptive.On physical examination, vital signs are normal. BMI is 31. Musculoskeletal examination is normal.Which of the following is the most appropriate preventive measure for this patient?A. Begin chondroitin sulfate supplementsB. Begin vitamin DC. Recommend weight lossD. Stop runningCorrect AnswerC. Recommend weight lossEducational ObjectivePrevent osteoarthritis with weight loss.CritiqueRecommending weight loss in order to lower the likelihood that she will develop osteoarthritis (OA) is the most appropriate choice. Obesity is the strongest modifiable risk factor for OA incidence. Multiple studies have shown that higher BMI categories have proportionally higher risk of developing radiographic and symptomatic knee OA. A recent randomized clinical trial showed that a reduction of ≥5 kg or 5% of body weight over a 30-month period reduces the risk for the onset of radiographic knee OA in middle-aged overweight and obese women. Another recent study of obese and overweight patients found that subjects who lost weight over 48 months showed significantly lower knee cartilage degeneration, as assessed with MRI, compared with those whose weight was stable.Chondroitin sulfate supplementation has not been studied to lower the risk for developing incident OA. There are promising but inconclusive data on whether chondroitin sulfate has a salutary effect on the progression of structural changes in established knee OA.Limited studies have examined the association of vitamin D with incident OA, and available data thus far have not shown that low vitamin D confers a greater risk of incident OA. There is no evidence that vitamin D supplementation reduces the incidence of OA.Suggesting that running will increase her risk of knee OA is not appropriate. Although not completely conclusive, the medical literature generally supports the idea that running does not contribute to the degeneration of articular cartilage in joints that are neuroanatomically normal. Some studies using advanced MRI techniques showed that moderate exercise in subjects at high risk for OA may be associated with favorable joint composition changes, which could have chondroprotective effects on the knee. Additionally, some studies suggest that quadriceps muscle weakness may be a risk for knee OA incidence. Nonetheless, there is a clear association with knee OA and antecedent knee injury, such as meniscal or cruciate ligament tears, so while stopping running may not be a beneficial recommendation, taking precaution to avoid injury would be prudent.Key PointObesity is the strongest modifiable risk factor for osteoarthritis incidence; weight loss can lower the risk for developing the disease.BibliographyRoos EM, Arden NK. Strategies for the prevention of knee osteoarthritis. Nat Rev Rheumatol. 2016;12:92-101. doi:10.1038/nrrheum.2015.135Do you like reading Annals for Educators? Receive it direct to your inbox. Sign up for the Annals for Educators alert today. Comments0 CommentsSign In to Submit A Comment Author, Article, and Disclosure InformationAffiliations: PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics 1 December 2020Volume 173, Issue 11Page: ED11KeywordsCOVID-19HearingKneesOsteoarthritisOverweightPancreatic cancerRunningSulfatesVitamin DWeight loss ePublished: 1 December 2020 Issue Published: 1 December 2020 Copyright & PermissionsCopyright © 2020 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...