{"title":"Effect of Vitamin B12 Supplementation in Pregnancy on Perinatal Outcomes.","authors":"Victoria A Sullivan, Russell S Blackwelder","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":7713,"journal":{"name":"American family physician","volume":"110 5","pages":"online"},"PeriodicalIF":3.8,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142666886","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Rheumatoid arthritis (RA) is a chronic inflammatory autoimmune disease that causes joint inflammation, erosion, and deformity. The prevalence of RA in North America is 0.5% to 1%. RA is associated with significant morbidity and disability and an increased mortality rate. The disease should be suspected in patients who present with joint inflammation, especially those who have polyarthritis. Additional characteristic features include symmetrical small joint polyarthritis, morning stiffness, and constitutional symptoms. Extra-articular manifestations are common and may affect multiple body systems. Application of a decision tool, such as the Leiden clinical prediction rule for undifferentiated arthritis, may facilitate early diagnosis of RA. Useful diagnostic tests include inflammatory markers such as C-reactive protein, rheumatoid factor, and anti-cyclic citrullinated peptide antibody. Initial therapy routinely includes oral methotrexate. The American College of Rheumatology and European Alliance of Associations for Rheumatology recommend a treat-to-target approach, including rapid interventions to reduce disease activity and achieve remission. Although RA remains incurable, patient quality of life has improved dramatically with biologic disease-modifying antirheumatic drugs (DMARDs) and targeted synthetic DMARDs. All DMARDs increase the risk of infection; therefore, routine vaccinations should be up to date in patients taking these drugs. Because patients with RA have increased risk of cardiovascular disease, addressing other cardiovascular risk factors may reduce morbidity and mortality.
{"title":"Rheumatoid Arthritis: Diagnosis and Management for the Family Physician.","authors":"Emily Peterson, Mary K Gallagher, Jason Wilbur","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Rheumatoid arthritis (RA) is a chronic inflammatory autoimmune disease that causes joint inflammation, erosion, and deformity. The prevalence of RA in North America is 0.5% to 1%. RA is associated with significant morbidity and disability and an increased mortality rate. The disease should be suspected in patients who present with joint inflammation, especially those who have polyarthritis. Additional characteristic features include symmetrical small joint polyarthritis, morning stiffness, and constitutional symptoms. Extra-articular manifestations are common and may affect multiple body systems. Application of a decision tool, such as the Leiden clinical prediction rule for undifferentiated arthritis, may facilitate early diagnosis of RA. Useful diagnostic tests include inflammatory markers such as C-reactive protein, rheumatoid factor, and anti-cyclic citrullinated peptide antibody. Initial therapy routinely includes oral methotrexate. The American College of Rheumatology and European Alliance of Associations for Rheumatology recommend a treat-to-target approach, including rapid interventions to reduce disease activity and achieve remission. Although RA remains incurable, patient quality of life has improved dramatically with biologic disease-modifying antirheumatic drugs (DMARDs) and targeted synthetic DMARDs. All DMARDs increase the risk of infection; therefore, routine vaccinations should be up to date in patients taking these drugs. Because patients with RA have increased risk of cardiovascular disease, addressing other cardiovascular risk factors may reduce morbidity and mortality.</p>","PeriodicalId":7713,"journal":{"name":"American family physician","volume":"110 5","pages":"515-526"},"PeriodicalIF":3.8,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142666896","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Mindfulness-Enhanced Parenting Programs Improve the Psychosocial Outcomes of Children up to 18 Years and Their Parents.","authors":"Dustin K Smith, Hailey A Murray, Janet M West","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":7713,"journal":{"name":"American family physician","volume":"110 5","pages":"465-466"},"PeriodicalIF":3.8,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142666890","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"UTI: Low Rates of Renal Scarring in Children; No Link to Long-Term Consequences.","authors":"Henry C Barry","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":7713,"journal":{"name":"American family physician","volume":"110 5","pages":"542"},"PeriodicalIF":3.8,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142666902","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Alcohol Use Disorder and Expectation-Based Medicines.","authors":"Alain Braillon","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":7713,"journal":{"name":"American family physician","volume":"110 5","pages":"452"},"PeriodicalIF":3.8,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142666839","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Prostate cancer is the most diagnosed noncutaneous malignancy and the second most common cause of cancer death among men in the United States. Risk factors include older age, family history of prostate cancer, and Black race. Screening via prostate-specific antigen testing may lead to a small reduction in prostate cancer-specific mortality, with no reduction in all-cause mortality, but it can cause significant harms related to false-positive test results, unnecessary biopsies, overdiagnosis, and overtreatment. Shared decision-making is strongly recommended by all national guidelines before initiating screening. Most guidelines recommend screening every 2 to 4 years in men 55 to 69 years of age at average risk. After a positive prostate-specific antigen test result (more than 4 ng/mL), the test should be repeated. If the prostate-specific antigen level is still elevated, next steps include multiparametric magnetic resonance imaging, assessment of urine or blood biomarkers, and referral to urology. Active surveillance is increasingly accepted as the preferred standard of care for patients with newly diagnosed low-risk prostate cancer, because it is associated with similar long-term survival and better quality of life than curative treatment. The primary intent of screening is to identify patients with clinically significant prostate cancer who may benefit from curative treatment while minimizing the detection of clinically insignificant cancer.
{"title":"Prostate Cancer Screening: Common Questions and Answers.","authors":"Jinping Xu, Samantha McPharlin, Elie Mulhem","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Prostate cancer is the most diagnosed noncutaneous malignancy and the second most common cause of cancer death among men in the United States. Risk factors include older age, family history of prostate cancer, and Black race. Screening via prostate-specific antigen testing may lead to a small reduction in prostate cancer-specific mortality, with no reduction in all-cause mortality, but it can cause significant harms related to false-positive test results, unnecessary biopsies, overdiagnosis, and overtreatment. Shared decision-making is strongly recommended by all national guidelines before initiating screening. Most guidelines recommend screening every 2 to 4 years in men 55 to 69 years of age at average risk. After a positive prostate-specific antigen test result (more than 4 ng/mL), the test should be repeated. If the prostate-specific antigen level is still elevated, next steps include multiparametric magnetic resonance imaging, assessment of urine or blood biomarkers, and referral to urology. Active surveillance is increasingly accepted as the preferred standard of care for patients with newly diagnosed low-risk prostate cancer, because it is associated with similar long-term survival and better quality of life than curative treatment. The primary intent of screening is to identify patients with clinically significant prostate cancer who may benefit from curative treatment while minimizing the detection of clinically insignificant cancer.</p>","PeriodicalId":7713,"journal":{"name":"American family physician","volume":"110 5","pages":"493-499"},"PeriodicalIF":3.8,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142666894","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Regular Multivitamin Use Is Not Associated With a Mortality Benefit.","authors":"David C Slawson","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":7713,"journal":{"name":"American family physician","volume":"110 5","pages":"543"},"PeriodicalIF":3.8,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142666895","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Anaphylaxis: Guidelines From the Joint Task Force on Allergy-Immunology Practice Parameters.","authors":"Stacy Rubin, Joanna Drowos, Charles H Hennekens","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":7713,"journal":{"name":"American family physician","volume":"110 5","pages":"544-546"},"PeriodicalIF":3.8,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142666855","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Should I Get Screened for Prostate Cancer?","authors":"","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":7713,"journal":{"name":"American family physician","volume":"110 5","pages":"online"},"PeriodicalIF":3.8,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142666898","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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