The diagnosis and management of psoriatic arthritis in a professional football player presenting with a knee effusion: a case report

Mutual Influence of Psoriasis and Sport

The link between psoriasis and sport is a controversial issue. The topic has been poorly investigated, and nowadays there are many unsolved questions, dealing with the role of psoriasis in influencing the sporting habits of patients and, vice versa, the impact of sport activity on course, severity and extent of the disease, with particular regard to the indirect benefits on cardiovascular risk and metabolic syndrome. Moreover, the role of physical activity on patients’ quality of life and the potential limitations on physical activity due to joint involvement have not been well elucidated until now. In this narrative review we will try to provide answers to these queries.

Arthritis mimicking sports-related injuries

Arthritis, including inflammatory, crystal deposition, and synovial proliferative disorders, may mimic sports injury. The purpose of this article is to review the clinical and radiologic findings of arthropathies that can present in athletes and be confused with internal derangement.

Variations of lipoprotein(a) levels in the metabolic syndrome: a report from the Maracaibo City Metabolic Syndrome Prevalence Study

BACKGROUND

Lipoprotein(a) [Lp(a)] is a known risk factor for cardiovascular disease, yet its influence on metabolic syndrome (MS) is still controversial. The purpose of this study was to assess the impact generated by this diagnosis in serum Lp(a) concentrations.

MATERIALS AND METHODS

A total of 1807 subjects of both genders (55.3% women and 44.7% men) belonging to the Maracaibo City Metabolic Syndrome Prevalence Study were evaluated. Results were expressed as Mean ± SD, determining differences through Student's t-test and One-Way ANOVA test. Multiple logistic regression models were utilized for analyzing factors associated with elevated serum Lp(a) levels and MS. Total cholesterol and LDL-C were corrected according to Lp(a)-Cholesterol when necessary.

RESULTS

No differences were found in Lp(a) values between genders; P = 0,292. The association between MS and the classification of Lp(a) was statistically significant (χ (2) = 28.33; P < 0,0001), with greater levels in subjects with this diagnosis. In the univariate analysis, subjects with each of the separate diagnostic criteria showed higher serum Lp(a) concentrations, except for hyperglycemia.

CONCLUSIONS

Lp(a) values exhibit important variations regarding MS and each of its components. Impaired fasting glucose appeared as a protecting factor against elevated Lp(a) concentrations, whereas its association with LDL-C and hs-CRP suggests a potential pro-inflammatory role.

Lipoprotein(a) concentration does not differ between sexes in healthy offspring of patients with premature myocardial infarction

AIMS

Although a family history of coronary artery disease (CAD) is an established factor influencing lipoprotein(a) [Lp(a)] levels, the effect of sex on Lp(a) concentration remains unclear. A potential cause of the conflicting findings regarding the effect of sex on this novel CAD risk factor is the limited ability of the studies, to date, to adequately control for the potential confounding effect of CAD familial predisposition. Our purpose was to evaluate the influence of sex on Lp(a) concentration in healthy young individuals by controlling for family history of CAD. In order to achieve our goal, we compared Lp(a) levels in pairs of brothers and sisters with a positive parental history of premature myocardial infarction (PHPMI).

METHODS

We measured Lp(a) concentration in 77 healthy brother-sister pairs with PHPMI (mean age: brothers: 18.4 ± 6.2 years and sisters: 18.1 ± 5.8 years). Total cholesterol, low-density lipoprotein (LDL)-cholesterol and high-density lipoprotein (HDL)-cholesterol, triglycerides, apolipoprotein (Apo) A-I and B were also measured.

RESULTS

Lp(a) levels did not differ between siblings of different sex (male vs. female sex: 0.994 ± 1.29 vs. 0.860 ± 0.82 μmol/l, P = 0.940); moreover, the prevalence of elevated (>1.071 μmol/l) Lp(a) concentrations between sexes was the same (29.9%). As expected, compared to female sex, male sex showed higher total/HDL-cholesterol ratio (3.642 ± 0.99 vs. 3.329 ± 0.89, P = 0.017) and lower HDL-cholesterol (1.221 ± 0.24 vs. 1.343 ± 0.28 mmol/l, P = 0.001), Apo A-I (1.390 ± 0.20 vs. 1.474 ± 0.23 g/l, P = 0.003) concentrations and Apo A-I/Apo B ratio (1.632 ± 0.49 vs. 1.830 ± 0.66, P = 0.016).

CONCLUSION

Our results show that healthy young men with PHPMI have a similar Lp(a) levels but worse lipid profile than women.

Injuries to kickers in American football: the National Football League experience

BACKGROUND

Very little information is available regarding the incidence, causative mechanisms, and expected duration of time lost after injuries to kickers (placekickers and punters) in American football.

HYPOTHESIS

Lower extremity musculotendinous injuries are the most common type of injury in American football kickers. The injuries related to punting differ from injuries related to placekicking.

STUDY DESIGN

Descriptive epidemiologic study.

METHODS

A retrospective review of all documented injuries to kickers in the National Football League over a 20-year period (1988-2007) was performed using the League's injury surveillance database. The data were analyzed from multiple perspectives, with emphasis on the type of kick or activity at the time of injury and the factors that affect return to play after injury.

RESULTS

There were 488 total injuries over the 20-year period: 72% involved the lower extremity, 9% involved the lumbosacral spine, and 7% involved the head. Muscle-tendon injuries (49%) were the most common, followed by ligamentous injuries (17%). There was a significantly higher risk of injury in games (17.7 per 1000) than during practice (1.91 per 1000). Most injuries (93%) did not require surgery, and the mean time to return to play was 15 days if no surgery was necessary. Kickers over 30 years of age took longer to return to play (mean, 21 days) than younger kickers (mean, 12 days) after nonsurgical injuries (P = .03). Mean return to play after injuries that required surgery was 121 days. Lumbosacral soft tissue injury, lateral ankle sprains, and shoulder injuries were more likely to occur in punters than placekickers.

CONCLUSION

Kicking athletes face a low risk of injury in professional American football. Injuries most commonly involve the lower extremities. Training and injury prevention efforts should reflect that punting is associated with different injuries than placekicking, and that older kickers take longer to recuperate than younger kickers after certain injuries.

Interrater reliability of a clinical scale to assess knee joint effusion

STUDY DESIGN

Clinical measurement.

OBJECTIVE

To determine the interrater reliability of a knee joint effusion grading scale in an outpatient orthopaedic physical therapy clinic.

BACKGROUND

Knee joint effusion may indicate joint inflammation or irritation. Therefore, objective monitoring of effusion is important to decision making regarding patient prognosis and program progression. The clinicians in the authors' clinic use a modified stroke test to assess for knee joint effusion, which is operationally based on a 5-point grading scale.

METHODS

Seventy-five patients (44 male, 31 female) receiving outpatient physical therapy for a unilateral knee problem, for whom effusion assessment was indicated, were tested. The subjects ranged from 16 to 65 years of age. Pairs of therapists graded the knee joint effusion using the clinical grading scale. A contingency table was constructed and analyzed using Cohen kappa values to establish interrater reliability. Percent agreement was also calculated.

RESULTS

The kappa value was 0.75, observed as a proportion of the maximum possible kappa, and the percent agreement was 73%. Fifty-four of 75 pairs of tests had perfect agreement. Only 5 had disagreement of 2 grades, and there were no disagreements of greater than 2 grades.

CONCLUSION

These findings provide evidence to support the proposed clinical effusion grading scale as a reliable method to assess knee joint effusion between therapists in an outpatient orthopaedic physical therapy clinic in patients with unilateral knee dysfunction. Only 5 of 75 ratings resulted in disagreement that could result in different clinical decisions being made by the therapists.