Briefly describe a specific question, or set of related questions, about a health care test or treatment that this program should consider.

For patients with Injury-induced osteoarthritis, how can we stop the cycle of cartilage degradation, diapedesis, poly apoptosis and further cartilage degradation? Compare Ice/Ibuprofen from active suppression of inflammatory up-regulators that increase WBC infiltration.

Does your question include a comparison of different health care approaches? (If no, your topic will still be considered.)

yes

If yes, explain the specific technologies, devices, drugs, or interventions you would like to see compared:

Ice and Ibuprofen can slow and halt an "episode", as can Antibiotic courses like minocycline, azithromycin or one of the fluoroquinolone family ABX.

What patients or group(s) of patients does your question apply to? (Please include specific details such as age range, gender, coexisting diagnoses, and indications for therapy.)

This comparison might slow/halt the insidious progresssion of osteoarthritis that can take 10 years, but is never treated with anything shown to slow / stop an effusion that is associated with diapedesis. The old cycle of drain, repeat, drain is not addressing the infiltration. Prospective age ranges could be 20-60. Either Gender. Those that suffer recurring effusions secondary to joint trauma (Knee mostly?) would seem likely candidates.

Are there subgroups of patients that your question might apply to? (For example, an ethnic group, stage or severity of a disease.)

All Ethnicities. Presence of an effusion, or elevated poly count in Synovial fluid might be candidates. Injury not of infection etiology. Any stage.

Describe the health-related benefits you are interested in. (For example, improvements in patient symptoms or problems from treatment or diagnosis.)

Reduction in crippling arthritis, as well as contralateral damage from gait accomodations.

Describe any health-related risks, side effects, or harms that you are concerned about.

Systemic immune system reduction may not be desirable. Overuse of antibiotics is not desirable for a society. The downregulation of up-regulators should be accomplished with minimal collateral damage

Appropriateness for EHC Program

Does your question include a health care drug, intervention, device, or technology available (or likely to be available) in the U.S.?

yes

Which priority area(s) and population(s) does this topic apply to? (check all that apply)

EHC Priority Conditions (updated in 2008)

• Arthritis and nontraumatic joint disorders

AHRQ Priority Populations

• Low income groups
• Minority groups
• Women
• Children
• Elderly
• Individuals with special health care needs, including individuals with disabilities or who need chronic care or end-of-life health care

Federal Health Care Program

• Medicaid
• Medicare
• State Children's Health Insurance Program (SCHIP)

Importance

Describe why this topic is important.

Injury related arthritis is a preventable disease that cripples many and creates cost in our health care system. breaking this cycle can increaase productivity and reduce health care costs for millions. Understanding the innate inflammatory process would be a great thing for many other health care issues. There would be great pin action from controlling inflammation and diapedesis.

What specifically motivated you to ask this question? (For example, you are developing a clinical guideline, working with a policy with large uncertainty about the appropriate approach, costly intervention, new research you have read, items in the media you may have seen, a clinical practice dilemma you know of, etc.)

This topic borders many clinical practices... Rheumatology, Orthopaedics, Infectious diseases, and of course, the general practitioner. I personally have gone to the experts in every field, but only find frustrations with doctors restrained by an insurance form of tests that can be considered. There is no way to expand the scope of this medical issue without going to the roots of the process.

Does your question represent uncertainty for clinicians and/or policy-makers? (For example, variations in clinical care, controversy in what constitutes appropriate clinical care, or a policy decision.)

yes

If yes, please explain:

Rheumatologists Wring their hands, and suggest orthopedic solution once disease progresses and mobility is painful enough to consider a traumatic operation. Orthopaedists say to come back later when you can't walk. ID doctors advise there is no infection... but will sometimes do unnecessary tests. GP's might prescribe ABX for a peripheral issue, but cannot for the an Arthritic condition.

Potential Impact

How will an answer to your research question be used or help inform decisions for you or your group?

I might stay off the knee, take an inflammatory down regulator, or some compound to block the passage into knee, or a steroid to reduce the inflammatory response from a ROX exposure to other wise healthy cartilage bed. I might make very basic and inexpensive steps to quiet down inflammation, rather then costing tons in tests, accumulating a bunch of false-positive diagnoses from doctors that want to be paid (and thus have to offer a Dx).

Describe the timeframe in which an answer to your question is needed.

For me, personally, I have not scheduled my TKA, but have almost done so two times now. Doubtless there are many many others which would benefit from an answer. How many high school athletes had insidious arthritic joints that will get inflamed and cause them to lost mobility?

Describe any health disparities, inequities, or impact on vulnerable populations your question applies to.

This will probably not address Rheumatoid conditions, or some autoimmune diseases.

This might not be suitable for a growing body, due to the re-alignment of cytokines or other hormone-or-chemical-based processes in our body.

Nominator Information

Other Information About You: (optional)

Please choose a description that best describes your role or perspective: (you may select more than one category if appropriate)

I might stay off the knee, take an inflammatory down regulator, or some compound to block the passage into knee, or a steroid to reduce the inflammatory response from a ROX exposure to other wise healthy cartilage bed. I might make very basic and inexpensive steps to quiet down inflammation, rather then costing tons in tests, accumulating a bunch of false-positive diagnoses from doctors that want to be paid (and thus have to offer a Dx).

Are you making a suggestion as an individual or on behalf of an organization?

Individual

Please tell us how you heard about the Effective Health Care Program

Email from Stephanie Chang, MD MPH

Agency for Healthcare Research and Quality