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Jomo Rogers, a naturally talented athlete, starts taking performance enhancing drugs in order to be an even better high school football player, but finds his life spinning out of control as his game improves.

Objectives: To investigate whether somatosensory amplification - a heightened sensitivity to normal bodily sensations - affects the clinical response to corticosteroid injection in shoulder impingement syndrome (SIS) patients who did not respond to conservative treatment. Methods: This prospective observational study included 70 patients with SIS and persistent pain despite at least four weeks of physical therapy and non-steroidal anti-inflammatory drugs (NSAIDs). All patients received a standardized corticosteroid injection into the subacromial space under ultrasound guidance. Pain intensity was measured using the Visual Analog Scale (VAS) at rest (VAS-rest) and during movement (VAS-movement), while shoulder-related disability was assessed with the Shoulder Pain and Disability Index (SPADI) at baseline and one month after the injection. Somatosensory amplification - referring to increased sensitivity to normal bodily sensations—was evaluated using the Somatosensory Amplification Scale (SSAS), a brief self-report questionnaire administered at the one-month follow-up by a psychiatrist blinded to clinical outcomes. Treatment response was defined as a ≥30% reduction in VAS-movement, based on the minimal clinically important difference (MCID). Patients were categorized as responders or non-responders accordingly. Results: Thirty (42.9%) patients were classified as responders and 40 (57.1%) as non-responders. At 1-month, non-responders had significantly higher SSAS scores than responders (30.7 [27.4-32.6] vs. 21.5 [19.4-23.4], P<0.001). Compared to non-responders, the responder group demonstrated more significant improvements in VAS-rest, VAS-movement, and SPADI scores (P<0.001 for all). Spearman correlation analysis revealed strong positive correlations between SAS and VAS-rest (r=0.732), VAS-movement (r=0.748), and SPADI (r=0.734); P<0.001 for all. Conclusions: Higher levels of somatosensory amplification were linked to a lower likelihood of benefiting from subacromial injection in SIS. These findings support the importance of including psychosomatic assessment in routine care to improve treatment outcomes and guide more personalized management.

Abstract Disclosure: A. Goel: None. S. Shekhar: None. J. Priest: None. S.B. Seminara: None. L. Plummer: None. W.F. Crowley: None. A. Delaney: None. J.E. Hall: None. Introduction: Isolated hypogonadotropic hypogonadism (IHH) is a syndrome characterized by a deficiency in GnRH secretion. We evaluated non-reproductive phenotypes and genetic architecture in subjects with IHH. Methods: 94 IHH subjects (58 males; mean age (±SD) 24.3 ± 9.3 yrs) were evaluated with a detailed history and physical examination, olfactory, audiology and ophthalmic testing, renal and pelvic/testicular ultrasounds, DXA, skeletal X-rays, 12 hours of every 10-minute blood sampling for LH and hormonal testing. Phenotypic differences were categorized by olfactory status and pulsatile LH secretion. Phenotypic clusters were identified using K-means clustering and stratified by sex. Exome sequencing in 56 IHH genes was used to identify rare sequence variants (RSVs, moderate- to high-impact, minor allele frequency <1%). Pathogenic/likely pathogenic (P/LP) RSVs were defined by ClinVar annotation and/or >80% deleteriousness in in silico prediction models. Results: Hyposomia (including anosmia) and LH pulses were noted in 77 (82%) and 25 (27%) subjects, respectively. Neurologic (27%), psychiatric (23%), and endocrine-metabolic (endo-met, 25%) were the most prevalent non-reproductive anomalies. FGFR1 had the most frequent P/LP RSVs (14%) among 98 IHH RSVs across 37 genes. DXA Z-scores for whole body (r=0.42), AP spine (r=0.49), hip (r=0.32), and femur (r=0.33) correlated with post-infancy sex steroid exposure duration (ster-exp) (all p<0.01). Hyposmic subjects had a greater frequency of bimanual synkinesia (p=0.04), renal anomalies (p=0.04), short metacarpals (p = 0.04), and lower AP spine Z-scores (mean difference: -0.73 ± 0.39 p=0.04). Compared to subjects with apulsatile LH secretion, those with LH pulses had more thoracic spinal anomalies (p=0.02) and higher DXA Z-scores in whole body (p=0.02) and hip (p=0.03) regions without differences in ster-exp. Among three phenotypic clusters in all subjects, cluster 3 (n=20) was the largest, consisting of olfactory, ocular, endo-met and palmoplantar anomalies. Sex-stratified analysis revealed two male clusters, with Cluster 2 (n=23) dominating with a high prevalence of ocular, craniofacial and dental anomalies. Among three female clusters, cluster 3 (n=13) dominated, with ocular, craniofacial, endo-met and palmoplantar anomalies. Conclusion: In those with IHH, neurologic and psychiatric anomalies were common. There were significant differences in non-reproductive phenotypic features based on olfactory and pulsatile LH secretory status, and bone density correlated with post-infancy sex steroid exposure duration. The presence of distinct phenotypic clusters suggests certain features often co-occur in IHH patients, which may facilitate clinical screening. Additional analyses will determine whether genotype-phenotype correlations can inform genetic screening. Presentation: Monday, July 14, 2025

INTRODUCTION:Ustekinumab (UST), an IL12/23 blocker approved for Crohn's disease, was effective in Phase 3 induction and maintenance studies of patients with moderate-severe ulcerative colitis (UC). Since discontinuation of corticosteroids (CS) is an important goal of therapy in UC, this analysis aims to further describe the CS sparing effects of ustekinumab treatment through Week 44 of the UNIFI trial.METHODS:Responders to UST IV induction entered maintenance and were randomized to UST 90 mg SC (q12wks or q8wks), or PBO. During the induction and maintenance studies, oral CS were not to be initiated or increased beyond baseline. At Week 0 of the maintenance study, a scheduled taper was recommended for all patients receiving CS. CS-free Clinical Response (CSR) and remission (CSRem) rates (at Week 44, and for >90 days prior to Week 44) were calculated for the overall population and for the subset of patients on CS at maintenance baseline. Among the subset of patients on CS at maintenance baseline, the mean prednisone-equivalent (P.Eq) CS dose (mg/day) through Week 44 were calculated as were the rates of subjects who were CS-free at Week 44 and for >90 days prior to Week 44.RESULTS:Overall 50.6% (265/523) of patients in the primary analysis population were receiving CS at maintenance baseline. The proportions of patients who were receiving concomitant CS at maintenance baseline were 52.3%, 47.7%, and 52.3% in the UST q8w, UST q12w and PBO groups, respectively. As detailed in Table 1, in the overall population, CSR and CSRem rates were significantly higher for patients who continued on UST therapy during maintenance compared with placebo. Among the patients who achieved CSR or CSRem at Week 44, the majority achieved these endpoints and eliminated CS use at or up to 90 days prior to Week 44. Similar results were observed in the subset of patients on concomitant CS at maintenance BL. In this group, the mean daily P.Eq CS dose at maintenance BL was approximately 15.0 mg/day for all treatment groups. Mean decrease in average daily P.Eq dose at Wk 44 was more pronounced and the proportion of patients who were CS-free was greater in the UST maintenance arms.CONCLUSION:UST maintenance therapy, with both q8w and q12w dosing regimens, is effective in reducing and eliminating the use of CS in patients with UC; the majority of patients (>90%) who achieved clinical response or clinical remission were able to eliminate corticosteroids.Table 1.

Background: Drug-induced hypersensitivity syndrome (DIHS) is a rare and severe systemic drug reaction characterized by skin involvement, internal organ complications, and hematologic disorders. Management of this condition is challenging due to its wide range of cutaneous manifestations and 10% mortality rate. Case Illustration: A 52-year-old male presented with widespread redness throughout his body with a prior history of regular phenytoin consumption. The rash continued to spread despite the patient’s abrupt discontinuation of the suspected medication. He was diagnosed with atypical DIHS according to J-SCAR criteria and was given high-dose corticosteroid. Drastic clinical improvement was observed after nine days of therapy, and complete resolution of the rash was achieved after 14 days. The steroid was stopped after four weeks, and no relapse was observed after four months of follow-up. Discussion: Discontinuing the suspected medication is the first crucial step in DIHS management. No specific pharmaceutical strategy has been established for this syndrome; however, systemic corticosteroids have been frequently prescribed as a first-line therapy. Steroids need to be tapered off slowly over 6–8 weeks, even upon clinical resolution, to prevent relapse. In the current case, the steroid was tapered off slowly over four weeks. The lack of relapse observed after steroid discontinuation could be due to the fact that the patient stopped consuming the suspected medication immediately. Conclusion: Education on the consequences of prescribing high-risk medications is important. Early detection and prompt cessation of offending medications are needed for better DIHS outcomes.

Aim: To examine the bioavailability of Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) in elderly patients and its implications for clinical practice.NSAIDs are widely used for managing chronic pain and inflammation in elderly patients. Age-related physiological changes, including altered gastrointestinal absorption, hepatic metabolism, and renal clearance, significantly affect NSAID bioavailability and therapeutic outcomes. These changes increase the risk of adverse effects, such as gastrointestinal bleeding, renal toxicity, and cardiovascular complications, particularly in the context of polypharmacy and comorbidities. This review highlights the pharmacokinetic and pharmacodynamic variations in elderly patients and emphasizes the need for individualized dosing, regular monitoring, and the use of adjunctive therapies to optimize NSAID safety and efficacy.

Background: Adhesive capsulitis of the shoulder is a pathological process in which excessive adhesions and fibrous tissue are formed across the glenohumeral joint, resulting in gradually restricted shoulder movements, dysfunction, and pain.Aim: To analyze the efficacy of corticosteroid injection applied in cases with 1ry adhesive capsulitis and to compare the clinical results achieved with those achieved in cases given oral NSAIDs.Materials and methods: This meta-analysis was conducted on 4 investigations according to the guidelines by the Cochrane Collaboration reporting followed the PRISMA statement (Preferred Reporting Items for Systematic Reviews and Meta-analyses).Results: Two studies reported (follow up internal rotation) and all can be used. A significant heterogeneity was observed. Therefore, a random-effect model has been utilized for analysis (I² = 100%, P<0.001). The combined mean difference and 95% CIs was 1.68 (1.47 to 1.89). The combined result demonstrates highly statistically significant difference between groups regarding (follow up internal rotation) (Z = 15.65, P ˂0.001). Two studies reported (follow up external rotation) and all can be used. A non-significant heterogeneity was observed. Therefore, a random-effect model was utilized for analysis (I² = 0%, P=0.89). The combined mean difference and 95 % CIs was 1.30 (0.79 to 1.82). The combined result demonstrates highly statistically significant distinction among groups regarding (monitoring external rotation) (Z = 4.99, P ˂0.001).Conclusion: Corticosteroid injection performed results in better outcome compared with oral NSAIDs in cases with adhesive capsulitis. More high-quality well-designed trials are required.

BackgroundThere is a risk of steroid induced deterioration in patients with exacerbation of myasthenia gravis, possibly reduced if the steroid dose is increased slowly. However, there is limited evidence for this and individual practice varies. We aimed to determine if a slow steroid dose escalation reduced the risk of respiratory failure in our hospital.MethodsWe retrospectively analysed the clinical records of all patients admitted to our hospital with an exacerbation of myasthenia gravis between January 2010 and December 2014.Results69 patients were admitted with an exacerbation of myasthenia gravis. 51 patients were treated with a slowly increasing dose and 18 patients immediately with a high dose of steroids. There was a no significant increase in ITU admission in the high dose group (27.78% vs 17.65% p:0.4957) nor any difference in FVC trend, readmission rate, mortality, or treatment with IVIG or PLEX. Length of stay was longer in the patients treated with a slowly escalating dose of steroids (mean number of days 17.8 vs 15.22, p:0.1687).ConclusionWe did not find a significant deterioration in patients treated with a high dose of steroids. Given most patients are treated with an escalating steroid dose (that requires a longer hospital stay) there is need for a randomised trial to determine if this is required.

Objective: Periodic fever, aphthous stomatitis, pharyngitis, adenitis (PFAPA) is an autoinflammatory syndrome characterized by periodic fever, aphthous stomatitis, pharyngitis and adenopathy. Our country is located in a geography where Familial Mediterranean fever (FMF) is common. In this study, it was aimed to investigate the effect of MEFV mutation carrying on the clinical features and treatment of PFAPA syndrome. Methods: The files of patients with PFAPA syndrome who were followed up in the pediatric rheumatology clinic for at least 6 months between 2019 and 2021 were retrospectively reviewed. Demographic data, clinical findings, frequency and duration of attacks, MEFV gene analysis results were recorded in the prepared forms. Results: Forty-three (51.8%) of the patients were girls. The median age of symptom onset was 1.5 (0.3-7) years, the age at diagnosis was 3.5 (0.5-8) years, and the time to diagnosis was 1.5 (0-7) years. MEFV gene was analysed in 68 (82%) patients, and heterozygous mutations were detected in 25 (36%) patients. The most frequent mutation was E148Q. There was no significant difference between the two groups in terms of mean age at diagnosis, age of symptom onset, duration of attack and frequency of attacks. Conclusion: In this study, the effect of MEFV mutation carriyng, which is very common in our country, on the course of the disease and the response to colchicine could not be demonstrated. Considering that FMF is common in our country, MEFV gene analysis should be considered in patients with findings inconsistent with the clinical and course of PFAPA syndrome.