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Association of Testosterone Therapy With Risk of Venous Thromboembolism Among Men With and Without Hypogonadism
https://jamanetwork.com/journals/jamainternalmedicine/article-abstract/2754091
JAMA Internal Medicine; Rob F. Walker, et al

Nov 30th, 2019 - Testosterone therapy is increasingly prescribed in patients without a diagnosis of hypogonadism. This therapy may be associated with increased risk of venous thromboembolism (VTE) through several mechanisms, including elevated hematocrit levels, which increase blood viscosity.

Fasting Triglycerides & Glucose Index: A Useful Screening Test for Assessing Insulin Resistance in Patients Diagnosed with Rheumatoid Arthritis & Systemic Lupus Erythematosus
https://dmsjournal.biomedcentral.com/articles/10.1186/s13098-019-0495-x
Diabetology & Metabolic Syndrome; Contreras-Haro B, et al

Nov 26th, 2019 - Insulin resistance (IR) is frequently observed in patients with rheumatoid arthritis (RA) or systemic lupus erythematosus (SLE). In clinical practice, IR assessment is limited to a low proportion of patients due to cost and equipment and technical expertise requirements. The surrogate index of triglycerides and glucose (TyG index) has been validated in non-rheumatic populations, showing adequat...

Efficacy and Safety of Low-Dose Colchicine after Myocardial Infarction
https://www.nejm.org/doi/full/10.1056/NEJMoa1912388?query=featured_home
New England Journal of Medicine; Tardif JC et al

Nov 16th, 2019 - Experimental and clinical evidence support the role of inflammation in atherosclerosis and its complications. Colchicine is an orally administered, potent antiinflammatory medication that is indicated for the treatment of gout and pericarditis.

FDA Approves Botox® (Onabotulinumtoxina) For Pediatric Patients With Lower Limb Spasticity, Excluding Spasticity Caused By Cerebral Palsy
https://www.allergan.com/News/Details/2019/10/FDA%20Approves%20BOTOX%20onabotulinumtoxinA%20for%20Pediatric%20Patients%20with%20Lower%20Limb%20Spasticity%20Excluding%20Sp

Oct 23rd, 2019 - Allergan plc (NYSE: AGN) today announced that the U.S. Food and Drug Administration (FDA) approved the company's supplemental Biologics License Application (sBLA) for BOTOX® for the treatment of pediatric patients (2 to 17 years of age) with lower limb spasticity, excluding spasticity caused by cerebral palsy (CP). This marks the 11th BOTOX® therapeutic indication, having been approved for pedi...

U.S. FDA Approves XARELTO® (rivaroxaban) to Help Prevent Blood Clots in Acutely Ill Medical Patients
https://www.jnj.com/u-s-fda-approves-xarelto-rivaroxaban-to-help-prevent-blood-clots-in-acutely-ill-medical-patients

Oct 13th, 2019 - he Janssen Pharmaceutical Companies of Johnson & Johnson announced today that the U.S. Food and Drug Administration (FDA) has approved XARELTO® (rivaroxaban) for the prevention of venous thromboembolism (VTE), or blood clots, in hospitalized acutely ill medical patients at risk for thromboembolic complications who are not at high risk of bleeding. With the approval of this new indication, XAREL...

Anticoagulation: Updated Guidelines for Outpatient Management
https://www.aafp.org/afp/2019/1001/p426.html
American Family Physician;

Sep 30th, 2019 - Anticoagulation therapy is recommended for preventing, treating, and reducing the recurrence of venous thromboembolism, and preventing stroke in persons with atrial fibrillation. Direct oral anticoagulants are first-line agents for eligible patients for treating venous thromboembolism and preventing stroke in those with nonvalvular atrial fibrillation. Vitamin K antagonists are recommended for ...

Sjögren’s Syndrome in Systemic Lupus Erythematosus - a Subset Characterized by a Systemic Inflammatory State
http://www.jrheum.org/content/early/2019/09/11/jrheum.190250
J Rheumatology; Ruacho G, et al

Sep 20th, 2019 - Secondary Sjögren’s syndrome (SLE-sSS) is an often-neglected subset of patients with Systemic lupus erythematosus (SLE). Furthermore, primary Sjögren’s syndrome overlaps and can be difficult to delineate from SLE. To shed light on the SLE-sSS subset, we investigated a large and well-characterized SLE cohort comparing patients with SLE-sSS versus SLE patients without SS (SLE-nonsSS) and controls.

Osteosarcoma and Malignant Fibrous Histiocytoma of Bone Treatment (PDQ®)–Health Professional Version
https://www.cancer.gov/types/bone/hp/osteosarcoma-treatment-pdq?cid=eb_govdel

Aug 21st, 2019 - Osteosarcoma and malignant fibrous histiocytoma (MFH) of bone treatment depends on site, extent of disease, and grade. Treatment options include surgery, chemotherapy, radiation therapy, and targeted therapy. Get detailed treatment information for osteosarcoma and MFH in this summary for clinicians

Unraveling the Safety Profile of Proton-Pump Inhibitors
https://www.jwatch.org/na49660/2019/08/19/unraveling-safety-profile-proton-pump-inhibitors
Journal Watch;

Aug 19th, 2019 - Proton-pump inhibitors (PPIs) provide important clinical benefits for many patients. However, observational studies have suggested an association between PPI use and a variety of adverse events, including dementia, osteoporosis, bone fractures, micronutrient deficiencies, pneumonia, spontaneous bacterial peritonitis, kidney disease, and enteric infections. We have observed that some patients wi...

Spinal muscular atrophy - Genetics Home Reference - NIH
https://ghr.nlm.nih.gov/condition/spinal-muscular-atrophy

Aug 5th, 2019 - Spinal muscular atrophy is a genetic disorder characterized by weakness and wasting (atrophy) in muscles used for movement (skeletal muscles). It is caused by a loss of specialized nerve cells, called motor neurons that control muscle movement. The weakness tends to be more severe in the muscles that are close to the center of the body (proximal) compared to muscles away from the body's center ...

Venous Thromboembolism Prophylaxis and Treatment in Patients With Cancer
https://ascopubs.org/doi/full/10.1200/JCO.19.01461

Aug 4th, 2019 - PURPOSE To provide updated recommendations about prophylaxis and treatment of venous thromboembolism (VTE) in patients with cancer. METHODS PubMed and the Cochrane Library were searched for randomized controlled trials (RCTs) and meta-analyses of RCTs published from August 1, 2014, through December 4, 2018. ASCO convened an Expert Panel to review the evidence and revise previous recommenda...

FDA Approves Daiichi Sankyo’s TURALIO™ (pexidartinib) for the Treatment of Select Patients with TGCT, a Rare and Debilitating Tumor
https://dsi.com/press-releases/-/article/364091/10481984

Aug 1st, 2019 - TURALIO is the first and only approved therapy for adult patients with symptomatic tenosynovial giant cell tumor (TGCT) associated with severe morbidity or functional limitations and not amenable to improvement with surgery

Acupuncture for Pain
https://www.aafp.org/afp/2019/0715/p89.html
American Family Physician; Kelly, R. et. al.

Jul 14th, 2019 - Acupuncture has been increasingly used as an integrative or complementary therapy for pain. It is well-tolerated with little risk of serious adverse effects. Traditional acupuncture and nontraditional techniques, such as electroacupuncture and dry needling, often result in reported pain improvement. Multiple factors may contribute to variability in acupuncture's therapeutic effects, including n...

Machine learning approaches to predict lupus disease activity from gene expression data
https://www.nature.com/articles/s41598-019-45989-0
Scientific Reports; Kegerreis, B. et. al.

Jul 2nd, 2019 - The integration of gene expression data to predict systemic lupus erythematosus (SLE) disease activity is a significant challenge because of the high degree of heterogeneity among patients and study cohorts, especially those collected on different microarray platforms. Here we deployed machine learning approaches to integrate gene expression data from three SLE data sets and used it to classify...

Arthritis Prevalence Statistics
https://www.rheumatology.org/Learning-Center/Statistics/Prevalence-Statistics

Jun 26th, 2019 - View overall prevalence of arthritis and rheumatic diseases as well as prevalence among specific racial and ethnic groups.

The Nature and Prevalence of Spinal Muscular Atrophy
https://www.neurologylive.com/peer-exchange/understanding-spinal-muscular-atrophy/the-nature-and-prevalence-of-spinal-muscular-atrophy

May 28th, 2019 - A panel of experts begin their discussion by reviewing the etiology and epidemiology of spinal muscular atrophy (SMA).

AveXis receives FDA approval for Zolgensma®, the first and only gene therapy for pediatric patients with spinal muscular atrophy (SMA)
https://www.avexis.com/content/pdf/press_release.pdf

May 23rd, 2019 - AveXis, a Novartis company, today announced the US Food and Drug Administration (FDA) has approved Zolgensma® (onasemnogene abeparvovec-xioi) for the treatment of pediatric patients less than 2 years of age with spinal muscular atrophy (SMA) with bi-allelic mutations in the survival motor neuron 1 (SMN1) gene. Zolgensma is designed to address the genetic root cause of SMA by providing a fun...

Time in remission and low disease activity state (LDAS) are associated with a better quality of life in patients with systemic lupus erythematosus: results from LUMINA (LXXIX), a multiethnic, multi...
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6560976/
RMD Open;

May 22nd, 2019 - Aims To determine whether the proportion of time systemic lupus erythematosus patients achieve remission/low disease activity state (LDAS) is associated with a better quality of life (QoL). Patients and methods Patients from a well-established multiethnic, multicentre US cohort were included: remission: Systemic Lupus Activity Measure (SLAM) score=0, prednisone≤5 mg/day and no immunosuppre...

Pediatric Systemic Lupus Erythematosus Workup
https://emedicine.medscape.com/article/1008066-workup

Apr 26th, 2019 - The initial laboratory evaluation should include a complete blood count (CBC) with platelets and reticulocyte count; a complete chemistry panel to evaluate electrolytes, liver, and kidney function; urine analysis; and a measure of acute phase reactants (eg, erythrocyte sedimentation rate [ESR] or C-reactive protein [CRP]).

Lupus Erythematosus - StatPearls
https://www.ncbi.nlm.nih.gov/books/NBK535405/

Apr 19th, 2019 - The acute form of systemic lupus erythematosus (SLE) differs from the chronic form. It disseminates differently, and it is highly fatal. Kaposi was the first in recognizing SLE in 1872, and then Pernet described it in 1908. Before that time SLE was considered to be a non-fatal disfiguring skin disease. It is now to be considered a chronic inflammatory disease characterized by a course of altern...

FDA Approves EVENITY™ (romosozumab-aqqg) For The Treatment Of Osteoporosis In Postmenopausal Women At High Risk For Fracture
https://wwwext.amgen.com/media/news-releases/2019/04/fda-approves-evenity-romosozumabaqqg-for-the-treatment-of-osteoporosis-in-postmenopausal-women-at-high-risk-for-fracture/

Apr 8th, 2019 - Amgen (NASDAQ: AMGN) and UCB (Euronext Brussels: UCB) today announced that the U.S. Food and Drug Administration (FDA) has approved EVENITY™ (romosozumab-aqqg) for the treatment of osteoporosis in postmenopausal women at high risk for fracture. EVENITY is the first and only bone builder with a unique dual effect that both increases bone formation and to a lesser extent reduces bone resorption (...

2019 update of the EULAR recommendations for the management of systemic lupus erythematosus
https://ard.bmj.com/content/78/6/736
Annals of the Rheumatic Diseases; Fanouriakis, A. et. al.

Mar 28th, 2019 - Our objective was to update the EULAR recommendations for the management of systemic lupus erythematosus (SLE), based on emerging new evidence. We performed a systematic literature review (01/2007–12/2017), followed by modified Delphi method, to form questions, elicit expert opinions and reach consensus. Treatment in SLE aims at remission or low disease activity and prevention of flares. Hydrox...

TRILURON™ - P180040
https://www.fda.gov/MedicalDevices/ProductsandMedicalProcedures/DeviceApprovalsandClearances/Recently-ApprovedDevices/ucm635176.htm

Mar 25th, 2019 - TRILURON™ is a single-use syringe prefilled with sodium hyaluronate. Hyaluronate is a chemical found in the body, and it is present in joint tissues and in the fluid that fills the joints. The body's own hyaluronate acts like a lubricant and a shock absorber in the joint, and it is needed for the joint to work properly. In osteoarthritis, there may not be enough hyaluronate, and there may be a ...

Opportunistic Salpingectomy as a Strategy for Epithelial Ovarian Cancer Prevention
https://www.acog.org/Clinical-Guidance-and-Publications/Committee-Opinions/Committee-on-Gynecologic-Practice/Opportunistic-Salpingectomy-as-a-Strategy-for-Epithelial-Ovarian-Cancer-Prevention

Mar 25th, 2019 - Opportunistic salpingectomy may offer obstetrician–gynecologists and other health care providers the opportunity to decrease the risk of ovarian cancer in their patients who are already undergoing pelvic surgery for benign disease. By performing salpingectomy when patients undergo an operation during which the fallopian tubes could be removed in addition to the primary surgical procedure (eg, h.

Osteoporosis (Secondary) - StatPearls
https://www.ncbi.nlm.nih.gov/books/NBK470166/
Ganesan, K. et. al.

Mar 1st, 2019 - Osteoporosis is a bone disorder which is characterized by a decrease in bone strength, resulting from reduced bone mineral density, microarchitectural disruption, and skeletal fragility, thereby causing an increased risk of fracture. Secondary osteoporosis, which occurs due to the presence of underlying disease or medications, can also lead to low bone mass, resulting in increased risk of fract...

Apixaban to Prevent Venous Thromboembolism in Patients with Cancer
https://www.nejm.org/doi/10.1056/NEJMoa1814468
The New England Journal of Medicine; Carrier, M. et. al.

Feb 20th, 2019 - Patients with active cancer have an increased risk of venous thromboembolism, which results in substantial morbidity, mortality, and health care expenditures. The Khorana score (range, 0 to 6, with higher scores indicating a higher risk of venous thromboembolism) has been validated to identify patients with cancer at elevated risk for this complication and may help select those who could benefi...

Rivaroxaban for Thromboprophylaxis in High-Risk Ambulatory Patients with Cancer
https://doi.org/10.1056/NEJMoa1814630
Khorana. A., et al

Feb 20th, 2019 - Ambulatory patients receiving systemic cancer therapy are at varying risk for venous thromboembolism. However, the benefit of thromboprophylaxis in these patients is uncertain. In high-risk ambulatory patients with cancer, treatment with rivaroxaban did not result in a significantly lower incidence of venous thromboembolism or death due to venous thromboembolism in the 180-day trial period. Dur...

Triassic Cancer—Osteosarcoma in a 240-Million-Year-Old Stem-Turtle
https://jamanetwork.com/journals/jamaoncology/fullarticle/2723578
Hairdy, Y. et. al.

Feb 6th, 2019 - Paleopathology, the study of ancient disease, is a vital way by which we understand the evolution of pathogens, immune systems, healing physiology, and ultimately the environment. Cancer research has focused on its prevalence in various organisms and has found that although some animals have a high propensity for cancer,1 others seem to be resistant.2 The prevalence of cancer in the tree of lif...

Gout Activity Score has predictive validity and is sensitive to change: results from the Nottingham Gout Treatment Trial (Phase II)
https://academic.oup.com/rheumatology/advance-article/doi/10.1093/rheumatology/key446/5306645
Chinchilla, S. et. al.

Feb 3rd, 2019 - Objectives To examine the predictive validity of the Gout Activity Score (GAS), its correlation with the Gout Impact Scale (GIS) and their sensitivity to change. Methods Data from a clinical trial in which participants with one or more gout flares in the previous year were recruited from primary care and randomized to nurse-led or continuing usual care were used in this study. GAS and GIS were ...

Prevalence, symptom burden, and natural history of deep vein thrombosis in people with advanced cancer in specialist palliative care units (HIDDen): a prospective longitudinal observational study
https://www.thelancet.com/journals/lanhae/article/PIIS2352-3026(18)30215-1/fulltext
White, C. et. al.

Jan 31st, 2019 - The prevalence of deep venous thrombosis in patients with advanced cancer is unconfirmed and it is unknown whether current international thromboprophylaxis guidance is applicable to this population. We aimed to determine prevalence and predictors of femoral deep vein thrombosis in patients admitted to specialist palliative care units (SPCUs).

Intra-articular corticosteroids and the risk of knee osteoarthritis progression: results from the Osteoarthritis Initiative
https://www.oarsijournal.com/article/S1063-4584(19)30033-0/fulltext
Zeng, C. et. al.

Jan 27th, 2019 - Objective A recent randomized clinical trial reported that repeated intra-articular corticosteroids (IACs) were associated with a greater cartilage loss. This study aimed to examine the relation of IACs to knee radiographic osteoarthritis (ROA) progression in a real-world setting. Design A cohort that initiated IACs and a comparison cohort without IACs from participants with mild to moderate kn...

The association between diet and glucocorticoid treatment in patients with SLE
https://lupus.bmj.com/content/3/1/e000135
Lupus Science & Medicine; Lourdudoss, C. et. al.

Jan 18th, 2019 - Background Some studies suggest that the risk for and severity of systemic lupus erythematosus (SLE) can be modified by certain nutrients. The aim of this study was to investigate the association between diet and glucocorticoid (GC) treatment, as a proxy for disease activity, in patients with SLE. Methods We included 111 patients with SLE from the SLE Vascular Impact Cohort (SLEVIC). Dietary...

Correlation between Xerostomia index, Clinical Oral Dryness Scale, and ESSPRI with different hyposalivation tests
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6324613/
Open Access Rheumatology; Hijjaw, O. et. al.

Jan 3rd, 2019 - Xerostomia is a subjective measure of dry mouth, while hyposalivation is an objective measure of reduced saliva flow rate. In this study, we aim to assess the association between commonly used xerostomia scoring systems, with different hyposalivation measures among Sjogren Syndrome (SS) patients.

Spinal Muscular Atrophy - NORD (National Organization for Rare Disorders)
https://rarediseases.org/rare-diseases/spinal-muscular-atrophy/

Dec 12th, 2018 - Spinal muscular atrophy (SMA) is a group of inherited disorders characterized by a loss of certain nerve cells in the spinal cord called motor neurons or anterior horn cells. Motor neurons receive the nerve impulses transmitted from the brain to the spinal cord (brainstem) and, in turn, transmit the impulses to the muscle via the peripheral nerves. The loss of motor neurons leads to progressive...

American Society of Hematology 2018 guidelines for management of venous thromboembolism: opt...
http://www.bloodadvances.org/content/2/22/3257
Witt, D.

Nov 26th, 2018 - Background: Clinicians confront numerous practical issues in optimizing the use of anticoagulants to treat venous thromboembolism (VTE). Objective: These evidence-based guidelines of the American Society of Hematology (ASH) are intended to support patients, clinicians and other health care professionals in their decisions about the use of anticoagulants in the management of VTE.

American Society of Hematology 2018 Guidelines for management of venous thromboembolism: tre...
http://www.bloodadvances.org/content/2/22/3292
Monagle, P.

Nov 26th, 2018 - Background: Despite an increasing incidence of venous thromboembolism (VTE) in pediatric patients in tertiary care settings, relatively few pediatric physicians have experience with antithrombotic interventions. Objective: These guidelines of the American Society of Hematology (ASH), based on the best available evidence, are intended to support patients, clinicians, and other health care profes.

American Society of Hematology 2018 guidelines for management of venous thromboembolism: dia...
http://www.bloodadvances.org/content/2/22/3226
Lim, W.

Nov 26th, 2018 - Background: Modern diagnostic strategies for venous thromboembolism (VTE) incorporate pretest probability (PTP; prevalence) assessment. The ability of diagnostic tests to correctly identify or exclude VTE is influenced by VTE prevalence and test accuracy characteristics.

American Society of Hematology 2018 guidelines for management of venous thromboembolism: hep...
http://www.bloodadvances.org/content/2/22/3360
Cuker, A.

Nov 26th, 2018 - Background: Heparin-induced thrombocytopenia (HIT) is an adverse drug reaction mediated by platelet-activating antibodies that target complexes of platelet factor 4 and heparin. Patients are at markedly increased risk of thromboembolism.

American Society of Hematology 2018 guidelines for management of venous thromboembolism: pro...
http://www.bloodadvances.org/content/2/22/3198
Schünemann, H.

Nov 26th, 2018 - Background: Venous thromboembolism (VTE) is the third most common vascular disease. Medical inpatients, long-term care residents, persons with minor injuries, and long-distance travelers are at increased risk.

American Society of Hematology 2018 guidelines for management of venous thromboembolism: ven...
http://www.bloodadvances.org/content/2/22/3317
Bates, S.

Nov 26th, 2018 - Background: Venous thromboembolism (VTE) complicates ?1. 2 of every 1000 deliveries.

Significance and impact of dietary factors on systemic lupus erythematosus pathogenesis
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6327661/
Experimental and Therapeutic Medicine;

Nov 15th, 2018 - Systemic lupus erythematosus (SLE) is an autoimmune disease of unknown etiology, although its mechanisms involve genetic, epigenetic and environmental risk factors. Considering that SLE pathogenesis is yet to be explored, recent studies aimed to investigate the impact of diet, in terms of triggering or altering the course of the disease. To study the impact of diet on SLE pathogenesis, we condu...

Osteoporosis - StatPearls
https://www.ncbi.nlm.nih.gov/books/NBK441901/
Porter, J. et. al.

Nov 14th, 2018 - Osteoporosis is defined as low bone mineral density caused by altered bone microstructure ultimately predisposing patients to low-impact, fragility fractures. Osteoporotic fractures lead to a significant decrease in quality of life, with an increased morbidity, mortality, and disability.[1] Over 50% of postmenopausal Caucasian women will have an osteoporotic-related fracture. Only 33% of senior...

Joint Clinical Consensus Statement of the American College of Foot and Ankle Surgeons® and t...
https://www.jfas.org/article/S1067-2516(18)30356-9/fulltext
Mirmiran, R.,et al.

Oct 31st, 2018 - Gout is a condition that commonly affects the foot and ankle, and practitioners who treat these structures should be aware of the methods to diagnose and treat this form of arthritis. Practitioners also need to recognize extra-articular manifestations of the disease.

NCCN Guidelines Insights: Cancer-Associated Venous Thromboembolic Disease, Version 2.2018
http://www.jnccn.org/content/16/11/1289.full
Streiff, M.

Oct 31st, 2018 - Venous thromboembolism (VTE) is common in patients with cancer and increases morbidity and mortality. VTE prevention and treatment are more complex in patients with cancer.

Evidence in focus: Nusinersen use in spinalmuscular atrophy
http://n.neurology.org/content/neurology/early/2018/10/12/WNL.0000000000006502.full.pdf
Michelson, D.

Oct 11th, 2018 - Objective: To identify the level of evidence for use of nusinersen to treat spinal muscular atrophy (SMA)and review clinical considerations regarding use Keywords: Neurology, spinal muscular atrophy, nusinersen, musculoskeletal diseases, spinal muscular atrophy type 3, spinal muscular atrophy type 4.

Psoriatic arthritis – new perspectives
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6524178/
Archives of Medical Science; Krakowski, P.

Aug 22nd, 2018 - Psoriatic arthritis (PsA) is a seronegative arthropathy with many clinical manifestations, and it may affect nearly a half of patients with psoriasis. PsA should be diagnosed as early as possible to slow down joint damage and progression of disability. To improve the diagnosis of PsA, physicians should look for peripheral inflammatory pain, axial inflammatory pain, dactylitis, and buttock and s...

Spinal Muscular Atrophy: Epidemiology and Genetics
https://hcp.smanewstoday.com/spinal-muscular-atrophy-epidemiology-and-genetics/

Aug 14th, 2018 - With an estimated incidence of approximately 1 in 10,00-11,00 live births, Spinal Muscular Atrophy (SMA) is the second most common autosomal recessive cause of death in children in the United States; incidence in European countries may be higher.1-3 The estimated prevalence of SMA in the United States, Europe, and Australia is less than 9,000 patients.2 SMA presents in five different forms, SMA...

Advanced Practice Provider Corner: Imminent Fracture Risk
https://www.nof.org/advanced-practice-provider-corner-imminent-fracture-risk/
E. Michael Lewiecki

Aug 6th, 2018 - A previous fracture increases the risk of subsequent fractures [1], even when the previous fracture is considered to be “traumatic” [2]. Since the correlation between prior fracture and future fractures is robust and at least partially independent of bone mineral density (BMD), a previous fracture is one of the clinical risk factors included in the FRAX algorithm to estimate the 10-year risk of.

Care of adults with neurofibromatosis type 1
http://www.acmg.net/PDFLibrary/Adult-Neurofibromatosis-Type-1.pdf
Stewart, D.,e t al

Jun 30th, 2018 - Neurofibromatosis type 1 (NF1) is an autosomaldominant disorder that is caused by a heterozygous loss-offunctionvariant in the tumor suppressor gene NF1; it affects~ 1/1,900–1/3,500 people worldwide. The disorder is associatedwith an 8–15-year reduction in average life expectancy in both menand women, primarily due to malignant neoplasms and cardiovascularcauses.

Aromatase Inhibitors in Gynecologic Practice
https://www.acog.org/Clinical-Guidance-and-Publications/Committee-Opinions/Committee-on-Gynecologic-Practice/Aromatase-Inhibitors-in-Gynecologic-Practice
Committee on Gynecologic Practice

Jun 29th, 2018 - Aromatase inhibitors have been used for the treatment of breast cancer, ovulation induction, endometriosis, and other estrogen-modulated conditions. For women with breast cancer, bone mineral density screening is recommended with long-term aromatase inhibitor use because of the risk of osteoporosis due to estrogen deficiency.

NIH Fact Sheets - Lupus
https://report.nih.gov/nihfactsheets/ViewFactSheet.aspx?csid=47

Jun 28th, 2018 - Lupus statistics (systemic lupus erythematosus) is a serious and potentially fatal disease that mainly affects young women. The cause of the disease is not known, but it is believed to be an autoimmune disease (an illness that occurs when the body mistakenly detects its own tissue as foreign and attacks itself).The disease often starts between the ages of 15 and 44. The manifestations of lupus ...

Osteoporosis to Prevent Fractures: Screening
https://www.uspreventiveservicestaskforce.org/Page/Document/UpdateSummaryFinal/osteoporosis-screening1
US Preventive Services Task Force

May 31st, 2018 - The USPSTF recommends screening for osteoporosis with bone measurement testing to prevent osteoporotic fractures in women 65 years and older. The USPSTF recommends screening for osteoporosis with bone measurement testing to prevent osteoporotic fractures in postmenopausal women younger than 65 years who are at increased risk of osteoporosis, as determined by a formal clinical risk assessment tool.

Diagnosis and management of Duchenne muscular dystrophy, part 3: primary care, emergency man...
https://linkinghub.elsevier.com/retrieve/pii/S1474442218300267

Apr 30th, 2018 - Improvements in the function, quality of life, and longevity of patients with Duchenne muscular dystrophy (DMD) have been achieved through a multidisciplinary approach to management across a range of health-care specialties. In part 3 of this update of the DMD care considerations, we focus on primary care, emergency management, psychosocial care, and transitions of care across the lifespan.

Clinical Policy: Critical Issues in the Evaluation and Management of Adult Patients Presenti...
https://linkinghub.elsevier.com/retrieve/pii/S0196064418302245
Wolf, S.

Apr 30th, 2018 - This clinical policy from the American College of Emergency Physicians addresses key issues in the evaluation and management of adult patients with suspected venous thromboembolism. A writing subcommittee conducted a systematic review of the literature to derive evidence-based recommendations to answer the following clinical questions: (1) In adult patients with suspected acute pulmonary emboli.

Diagnosis and management of Duchenne muscular dystrophy, part 2: respiratory, cardiac, bone ...
https://linkinghub.elsevier.com/retrieve/pii/S1474442218300255

Mar 31st, 2018 - A coordinated, multidisciplinary approach to care is essential for optimum management of the primary manifestations and secondary complications of Duchenne muscular dystrophy (DMD). Contemporary care has been shaped by the availability of more sensitive diagnostic techniques and the earlier use of therapeutic interventions, which have the potential to improve patients' duration and quality of l.

Diagnosis and management of Duchenne muscular dystrophy, part 1: diagnosis, and neuromuscula...
https://linkinghub.elsevier.com/retrieve/pii/S1474442218300243

Feb 28th, 2018 - Since the publication of the Duchenne muscular dystrophy (DMD) care considerations in 2010, multidisciplinary care of this severe, progressive neuromuscular disease has evolved. In conjunction with improved patient survival, a shift to more anticipatory diagnostic and therapeutic strategies has occurred, with a renewed focus on patient quality of life.

Duchenne Muscular Dystrophy (DMD)
https://www.mda.org/disease/duchenne-muscular-dystrophy/medical-management
Muscular Dystrophy Association (USA)

Jan 22nd, 2018 - Thanks to advances in many areas of medicine, such as cardiology and pulmonology, people with Duchenne muscular dystrophy in the 21st century are living longer than in previous decades, often well into adulthood. The use of available treatments can help maintain comfort and function and prolong life.

Adolescent Idiopathic Scoliosis: Screening
https://www.uspreventiveservicestaskforce.org/Page/Document/UpdateSummaryFinal/adolescent-idiopathic-scoliosis-screening1
US Preventive Services Task Force

Dec 31st, 2017 - The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening for adolescent idiopathic scoliosis in children and adolescents aged 10 to 18 years.

Systemic lupus erythematosus images | DermNet NZ
https://www.dermnetnz.org/topics/systemic-lupus-erythematosus-images/

Dec 30th, 2017 - Systemic lupus erythematosus images. SLE. Authoritative facts about the skin from DermNet New Zealand Trust.

AAHKS Position Statement on CDC Guideline: Post-Operative Prophylactic Antibiotics
http://www.aahks.org/aahks-news/welcome-to-the-aahks-newsroom/position-statement-on-cdc-guideline-post-operative-prophylactic-antibiotics/
Denise Smith Rodd

Nov 16th, 2017 - The Centers for Disease Control and Prevention (CDC) released their 2017 Guideline for the Prevention of Surgical Site Infection, which recommends against the use of post-operative prophylactic antibiotics – including patients undergoing total joint arthroplasty (TJA). At this time, we do not agree with this recommendation vis a vis TJA in that it contradicts current international standards of.

ACR Appropriateness Criteria ® Imaging After Total Knee Arthroplasty
https://linkinghub.elsevier.com/retrieve/pii/S1546144017310918
Hochman, M.

Oct 31st, 2017 - Total knee arthroplasty (TKA) is the most commonly performed joint replacement procedure in the United States and annual demand for primary TKA is expected to grow by 673% by 2030. The first part provides an overview of imaging modalities (radiographs, CT, MRI, ultrasound, and various nuclear medicine studies) and discusses their usefulness in the imaging evaluation of TKA.

2017 American College of Rheumatology Guideline for the Prevention and Treatment of Glucocor...
https://www.rheumatology.org/Portals/0/Files/Guideline-for-the-Prevention-and-Treatment-of-GIOP.pdf
Lenore Buckley

Aug 29th, 2017 - This guideline provides direction for clinicians and patients making treatment decisions. Clinicians and patients should use a shared decisionmaking process that accounts for patients’ values, preferences, and comorbidities.

2017 American College of Rheumatology/American Association of Hip and Knee Surgeons Guidelin...
https://www.rheumatology.org/Portals/0/Files/ACR-AAHKS-Perioperative-Management-Guideline.pdf
Goodman, S.,et al

Jul 31st, 2017 - This collaboration between the American College of Rheumatology and the American Association of Hip and Knee Surgeons developed an evidence-based guideline for the perioperative management of antirheumatic drug therapy for adults with rheumatoid arthritis (RA), spondyloarthritis (SpA) including ankylosing spondylitis and psoriatic arthritis, juvenile idiopathic arthritis (JIA), or systemic lupu.

Treatment of Low Bone Density or Osteoporosis to Prevent Fractures in Men and Women: A Clini...
http://annals.org/aim/fullarticle/2625385/treatment-low-bone-density-osteoporosis-prevent-fractures-men-women-clinical
Amir Qaseem

Jun 5th, 2017 - This guideline updates the 2008 American College of Physicians (ACP) recommendations on treatment of low bone density and osteoporosis to prevent fractures in men and women. This guideline is endorsed by the American Academy of Family Physicians.

ACR Appropriateness Criteria Acute Chest Pain—Suspected Pulmonary Embolism
https://www.jacr.org/article/S1546-1440(17)30207-7/fulltext
Kirsch, J.

Apr 30th, 2017 - Pulmonary embolism (PE) remains a common and important clinical condition that cannot be accurately diagnosed on the basis of signs, symptoms, and history alone. The diagnosis of PE has been facilitated by technical advancements and multidetector CT pulmonary angiography, which is the major diagnostic modality currently used.

ACR Appropriateness Criteria Suspected Osteomyelitis, Septic Arthritis, or Soft Tissue Infec...
https://www.jacr.org/article/S1546-1440(17)30185-0/fulltext
Beaman, F.

Apr 30th, 2017 - Infection of the musculoskeletal system is a common clinical problem. Differentiating soft tissue from osseous infection often determines the appropriate clinical therapeutic course.

ACR Appropriateness Criteria Stress (Fatigue/Insufficiency) Fracture, Including Sacrum, Excl...
https://www.jacr.org/article/S1546-1440(17)30218-1/fulltext
Bencardino, J.

Apr 30th, 2017 - Stress fractures, including both fatigue and insufficiency types, are frequently encountered in clinical practice as a source of pain in both athletes and patients with predisposing conditions. Radiography is the imaging modality of choice for baseline diagnosis.

ACR Appropriateness Criteria ® Osteoporosis and Bone Mineral Density
https://linkinghub.elsevier.com/retrieve/pii/S1546144017301989
Ward, R.

Apr 30th, 2017 - Osteoporosis is a considerable public health risk, with 50% of women and 20% of men >50 years of age experiencing fracture, with mortality rates of 20% within the first year. Dual x-ray absorptiometry (DXA) is the primary diagnostic modality by which to screen women >65 years of age and men >70 years of age for osteoporosis.

An update on diet and nutritional factors in systemic lupus erythematosus management
https://www.cambridge.org/core/journals/nutrition-research-reviews/article/an-update-on-diet-and-nutritional-factors-in-systemic-lupus-erythematosus-management/992C22937FC53A6B1D3D30BC97B331E9
Nutrition Research Reviews; Aparicio-Soto, M. et. al.

Mar 14th, 2017 - Systemic lupus erythematosus (SLE) is a chronic inflammatory and autoimmune disease characterised by multiple organ involvement and a large number of complications. SLE management remains complicated owing to the biological heterogeneity between patients and the lack of safe and specific targeted therapies. There is evidence that dietary factors can contribute to the geoepidemiology of autoimmu...

MANAGEMENT OF OSTEOARTHRITIS OF THE HIP: EVIDENCE-BASED CLINICAL PRACTICE GUIDELINE
https://www.aaos.org/uploadedFiles/PreProduction/Quality/Guidelines_and_Reviews/OA%20Hip%20CPG_11.1.17.pdf

Mar 12th, 2017 - This clinical practice guideline is based on a systematic review of peer-reviewed articles published from January 1, 1990 to April 15th, 2016 with regard to the management of osteoarthritis of the hip in patients over the age of 18 years.

Lupus: Using Diet and Nutrition to Improve Symptoms and Outcomes
https://www.rheumatologyadvisor.com/home/topics/systemic-lupus-erythematosus/lupus-using-diet-and-nutrition-to-improve-symptoms-and-outcomes/
Rodriguez, T.

Mar 5th, 2017 - A healthy diet is important in general, but perhaps even more so for the roughly 1 million Americans and 3 million people worldwide who suffer from systemic lupus erythematosus (SLE).1 Because of the multifaceted challenges presented by the disease, consuming adequate amounts of the right nutrients — and limiting others — can help relieve symptoms and improve outcomes

VTE Prophylaxis for Laparoscopic Surgery Guidelines: An Update
https://www.sages.org/publications/guidelines/guidelines-for-deep-venous-thrombosis-prophylaxis-during-laparoscopic-surgery/
William S. Richardson

Feb 28th, 2017 - All general surgical patients should be assessed for risk of VTE because of the potential for fatal consequences. Our endorsement of the ACCP guidelines comes with several caveats.

Get the Facts: Sugar-Sweetened Beverages and Consumption
https://www.cdc.gov/nutrition/data-statistics/sugar-sweetened-beverages-intake.html

Feb 26th, 2017 - Sugar-sweetened beverages (SSBs) or sugary drinks are leading sources of added sugars in the American diet. Frequently drinking sugar-sweetened beverages is associated with weight gain/obesity, type 2 diabetes, heart disease, kidney diseases, non-alcoholic liver disease, tooth decay and cavities, and gout, a type of arthritis.1-4 Limiting the amount of SSB intake can help individuals maintain a...

NCCN Guidelines Insights: Bone Cancer, Version 2.2017
http://www.jnccn.org/content/15/2/155.full
Biermann, J.,et al

Jan 31st, 2017 - The NCCN Guidelines for Bone Cancer provide interdisciplinary recommendations for treating chordoma, chondrosarcoma, giant cell tumor of bone, Ewing sarcoma, and osteosarcoma. These NCCN Guidelines Insights summarize the NCCN Bone Cancer Panel's guideline recommendations for treating Ewing sarcoma.

Diagnosis of Acute Gout: A Clinical Practice Guideline From the American College of Physicians
http://annals.org/aim/fullarticle/2578527/diagnosis-acute-gout-clinical-practice-guideline-from-american-college-physicians
Amir Qaseem

Jan 2nd, 2017 - The American College of Physicians (ACP) developed this guideline to present the evidence and provide clinical recommendations on the diagnosis of gout.

Management of Acute and Recurrent Gout: A Clinical Practice Guideline From the American Coll...
http://annals.org/aim/fullarticle/2578528/management-acute-recurrent-gout-clinical-practice-guideline-from-american-college
Amir Qaseem

Jan 2nd, 2017 - The American College of Physicians (ACP) developed this guideline to present the evidence and provide clinical recommendations on the management of gout.

Combined hormonal contraception and the risk of VTE: a guideline
https://www.asrm.org/globalassets/asrm/asrm-content/news-and-publications/practice-guidelines/for-non-members/combined_hormonal_contraception_vte-pdfnoprint.pdf
Practice Committee

Dec 31st, 2016 - While venous thromboembolism (VTE) is rare in young women of reproductive age, combined oral contraceptives increase the risk of VTE. In the patient in whom combined hormonal contraception is appropriate, it is reasonable to use any currently available preparation.

The Diabetic Foot: IDF Guideline
https://www.idf.org/our-activities/care-prevention/diabetic-foot.html
International Diabetes Federation

Dec 31st, 2016 - Diabetic foot is one of the most common, costly and severe complications of diabetes. Amputation in people with diabetes is 10 to 20 times more common than in people without diabetes and it is estimated that every 30 seconds a lower limb or part of a lower limb is lost somewhere in the world as a consequence of diabetes.

Lack of Evidence Linking Calcium With or Without Vitamin D Supplementation to Cardiovascular...
https://annals.org/aim/fullarticle/2571714/lack-evidence-linking-calcium-without-vitamin-d-supplementation-cardiovascular-disease?searchresult=1
Kopecky, S.,et al

Dec 19th, 2016 - Calcium is the dominant mineral present in bone and a shortfall nutrient in the American diet. Supplements have been recommended for persons who do not consume adequate calcium from their diet as a standard strategy for the prevention of osteoporosis and related fractures.

ASBMR Issues “Call to Action to Address the Crisis in the Treatment of Osteoporosis”: ASBMR ...
https://www.asbmr.org/Publications/News/NewsDetail.aspx?cid=451663e6-f22d-4e1f-80fa-16dd76947372#.Wm8turpFzIU
American society for bone and mineral research (ASBMR)

Sep 21st, 2016 - On Monday, September 19, 2016 at the ASBMR 2016 Annual Meeting in Atlanta, GA, USA, ASBMR and 34 other health organizations issued a “Call to Action to Address the Crisis in the Treatment of Osteoporosis” at a press conference. Leading researchers and bone health experts discussed new data on hip fractures and lack of treatment of osteoporosis patients, and issued a call to action with recommen.

American Association Of Clinical Endocrinologists And American College Of Endocrinology Clin...
https://www.aace.com/files/postmenopausal-guidelines.pdf
Pauline M. Camacho

Aug 31st, 2016 - Osteoporosis is a growing major public health problem with impacts on quality and quantity of life that cross medical, social, and economic lines. These guidelines were developed by the American Association of Clinical Endocrinologists (AACE) with hopes of reducing the risk of osteoporosis-related fractures and thereby maintaining the quality of life for people with osteoporosis.

Systemic Lupus Erythematosus: Primary Care Approach to Diagnosis and Management
https://www.aafp.org/afp/2016/0815/p284.html
American Family Physician;

Aug 14th, 2016 - Systemic lupus erythematosus is an autoimmune disease that affects many systems, including the skin, musculoskeletal, renal, neuropsychiatric, hematologic, cardiovascular, pulmonary, and reproductive systems. Family physicians should be familiar with the manifestations of lupus to aid in early diagnosis, monitoring patients with mild disease, recognizing warning signs that require referral to a...

MANAGEMENT OF CARPAL TUNNEL SYNDROME: EVIDENCE-BASED CLINICAL PRACTICE GUIDELINE
https://www.aaos.org/uploadedFiles/PreProduction/Quality/Guidelines_and_Reviews/guidelines/CTS%20CPG_4.13.2017.pdf

Feb 28th, 2016 - The following is a summary of the recommendations of the AAOS Clinical Practice Guideline on the Management of Carpal Tunnel Syndrome.

The Management of Diabetic Foot: A Clinical Practice Guideline by the Society for Vascular S...
https://www.jvascsurg.org/issue/S0741-5214%2815%29X0005-X
Hingorani, A.

Jan 31st, 2016 - Ulceration of the foot in diabetes is a common complication, can be disabling, and frequently leads to amputation of the leg. The lifetime risk for foot ulcers in people with diabetes has been estimated to be 15% to 25%.

MDA U.S. Neuromuscular Disease Registry
https://www.mda.org/services/neuromuscular-disease-registry
Muscular Dystrophy Association (USA)

Dec 31st, 2015 - In 2013, MDA launched the U. S.

Prophylaxis of Venous Thrombosis in Neurocritical Care Patients: An Evidence-Based Guideline...
http://www.learnicu.org/SiteCollectionDocuments/VTE-Prophylaxis-Neuro-Guideline.pdf
Paul Nyquist

Dec 7th, 2015 - The risk of death from venous thromboembolism (VTE) is high in intensive care unit patients with neurological diagnoses. This is due to an increased risk of venous stasis secondary to paralysis as well as an increased prevalence of underlying pathologies that cause endothelial activation and create an increased risk of embolus formation.

SURGICAL MANAGEMENT OF OSTEOARTHRITIS OF THE KNEE: EVIDENCE-BASED CLINICAL PRACTICE GUIDELINE
https://www.aaos.org/uploadedFiles/PreProduction/Quality/Guidelines_and_Reviews/guidelines/SMOAK%20CPG_4.22.2016.pdf

Dec 3rd, 2015 - The following is a summary of the recommendations of the AAOS Clinical Practice Guideline on the Surgical Management of Osteoarthritis of the Knee.

FDA Grants Breakthrough Therapy Designation for Daiichi Sankyo and Plexxikon's Investigational CSF-1R Inhibitor Pexidartinib (PLX3397) in Tenosynovial Giant Cell Tumo
https://www.prnewswire.com/news-releases/fda-grants-breakthrough-therapy-designation-for-daiichi-sankyo-and-plexxikons-investigational-csf-1r-inhibitor-pexidartinib-plx3397-in-tenosynovial-giant-cell-tumor-300169556.html

Oct 10th, 2015 - Daiichi Sankyo, Inc. and Plexxikon Inc., a member of the Daiichi Sankyo Group, today announced that the U.S. Food and Drug Administration (FDA) has granted Breakthrough Therapy Designation to its investigational oral CSF-1R inhibitor pexidartinib (formerly PLX3397) for the treatment of tenosynovial giant cell tumor (TGCT) where surgical removal of the tumor would be associated with potentially ...

2015 Infectious Diseases Society of America (IDSA) Clinical Practice Guidelines for the Diag...
https://academic.oup.com/cid/article/61/6/e26/452579
Elie F. Berbari

Sep 14th, 2015 - Native vertebral osteomyelitis (NVO) in adults is often the result of hematogenous seeding of the adjacent disc space from a distant focus, as the disc is avascular [1, 2]. The diagnosis of NVO can often be delayed several months and may initially be misdiagnosed and mismanaged as a degenerative process [3, 4].

Society for Vascular Surgery practice guidelines for atherosclerotic occlusive disease of th...
https://www.jvascsurg.org/article/S0741-5214%2814%2902284-8/fulltext
Conte, M.

Feb 28th, 2015 - Peripheral arterial disease (PAD) continues to grow in global prevalence and consumes an increasing amount of resources in the United States health care system. Overall rates of intervention for PAD have been rising steadily in recent years.

Venous Thromboembolism Prophylaxis and Treatment in Patients With Cancer Update
http://ascopubs.org/doi/full/10.1200/JCO.2014.59.7351
Gary H. Lyman

Feb 1st, 2015 - To provide current recommendations about the prophylaxis and treatment of venous thromboembolism (VTE) in patients with cancer.

Paget's Disease of Bone: An Endocrine Society Clinical Practice Guideline
https://academic.oup.com/jcem/article/99/12/4408/2833929
Frederick R. Singer

Nov 30th, 2014 - We recommend that plain radiographs be obtained of the pertinent regions of the skeleton in patients with suspected Paget's disease. If the diagnosis is confirmed, we suggest that a radionucleotide bone scan be done to determine the extent of the disease.

Anticoagulation and Antiplatelet Therapy in Urologic Practice: ICUD and AUA Review Paper
http://www.auanet.org/guidelines/anticoagulation-and-antiplatelet-therapy
Daniel J. Culkin

Sep 30th, 2014 - A common scenario in urologic practice is that of a 55-year-old male who comes to you after his primary care physician informed him about his serially rising serum prostate specific antigen (PSA) that is now 5. 8 ng/mL.

Clinician’s Guide to Prevention and Treatment of Osteoporosis
https://link.springer.com/article/10.1007%2Fs00198-014-2794-2
Cosman, F.

Sep 30th, 2014 - The Clinician’s Guide to Prevention and Treatment of Osteoporosis was developed by an expert committee of the National Osteoporosis Foundation (NOF) in collaboration with a multispecialty council of medical experts in the field of bone health convened by NOF. Readers are urged to consult current prescribing information on any drug, device, or procedure discussed in this publication.

Therapy for Osteoporosis: NAMS Guideline
http://www.menopause.org/publications/clinical-practice-materials/therapy-for-osteoporosis

Sep 30th, 2014 - Prevention and management of osteoporosis in women begins with lifestyle approaches, such as eating a balanced diet, adequate calcium and vitamin D, appropriate exercise, avoiding cigarette smoke and excessive alcohol consumption, and preventing falls. For postmenopausal women at low risk of osteoporotic fracture, lifestyle approaches may be all that is needed.

AANEM Evidence-based Guideline: Evaluation, Diagnosis, and Management of Facioscapulohumeral...
http://www.aanem.org/getmedia/00b55a9f-f743-458f-b431-e6e91cc446e8/2015-03-20-FSHD-docs.pdf
Rabi Tawil

Jul 22nd, 2014 - Objective: To develop recommendations for the evaluation, diagnosis, prognostication, and treatment of facioscapulohumeral muscular dystrophy (FSHD) from a systematic review and analysis of the evidence.

Four Strategies for Managing Opioid-Induced Side Effects in Older Adults
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4418642/
Rogers, E. et. al.

Apr 4th, 2014 - Opioid medications are considered key therapeutic interventions in the management of both acute pain and cancer-related pain among patients of all ages; however, their role in treating patients with chronic noncancer pain remains controversial. While the debate about the appropriate role of opioids in the treatment of chronic pain continues, the fact remains that many clinicians prescribe opioi...

Diagnosis and Treatment of Lumbar Disc Herniation with Radiculopathy
https://www.spine.org/Portals/0/Documents/ResearchClinicalCare/Guidelines/LumbarDiscHerniation.pdf?ver=2015-06-05-125632-840
D. Scott Kreiner

Dec 31st, 2013 - The objective of the North American Spine Society (NASS) Clinical Guideline for the Diagnosis and Treatment of Lumbar Disc Herniation with Radiculopathy is to provide evidence-based recommendations to address key clinical questions surrounding the diagnosis and treatment of lumbar disc herniation with radiculopathy. The guideline is intended to reflect contemporary treatment concepts for sympto.

TREATMENT OF OSTEOARTHRITIS OF THE KNEE: EVIDENCE-BASED GUIDELINE, 2ND EDITION
https://www.aaos.org/research/guidelines/TreatmentofOsteoarthritisoftheKneeGuideline.pdf

May 17th, 2013 - This summary of the AAOS clinical practice guideline, “Treatment of Osteoarthritis of the Knee” contains a list of the evidence based treatment recommendations and includes only less invasive alternatives to knee replacement.