CDM talk on updates in the diagnosis and management of ED arthritis

Welcome, readers from Clinical Decision Making. You've got a PowerPoint version of my talk on your USB drives; here's the link to today's Prezi.

I frequently mentioned Chris Carpenter's excellent 2011 systematic review of ED septic arthritis; Margaretten's Systematic Review for JAMA is also worth a look.

Other references from my talk:

• EPMonthly and EMPractice (new Rosen's chapter is not yet published)

• Terkeltaub's trial that changed colchicine regimens for gout
• Kesselheim and Solomon in NEJM 2010 on the Curious Case of Colchicine

• Piper on the risks of local anesthetics on cartilage
• Fitch 2008 on IA lidocaine for shoulder reduction in the ED

• Barthel 2010 on topical diclofenac
• Lynch 2011 on cannabinoids
• Richards 2012 on capsaicin

I encountered a bit of resistance to this when I presented it at Ponte Vedra: not too many do IA injections, but those who do said things like, "aw, come on, please, my patients love this"

I think I'll borrow a page from the Newman playbook and recommend shared decision-making with the patient - "while no studies have shown this dose or a one-time exposure in humans is dangerous, and the majority of patients who get pump infusions have no detectable adverse reaction years later, there is a risk and the benefit is just a few hours of relief, sooner"