the pelvis and lumbar spine. Although the spondyloarthropathies are grouped together, they display distinct clinical features. It is likely that an interplay among genetic, environmental, and immunologic factors is responsible for the various clinical manifestations of these diseases. Infection with an unknown organism or exposure to an unknown antigen in a genetically susceptible patient (HLA-...

This clinical content conforms to AAFP criteria for evidence-based continuing medical education (EB CME). EB CME is clinical content presented with practice recommendations supported by evidence that has been systematically reviewed by an AAFP-approved source. P rimary dysmenorrhea, which is defined as painful menses in women with normal pelvic anatomy, usually begins during adolescence. It is ...

N onsteroidal anti-inflammatory drugs (NSAIDs) are commonly used to treat inflammation, pain, and fever by decreasing prostaglandin synthesis through blockage of the cyclooxygenase (COX) enzyme. Table 1 lists NSAID dosages and monthly costs. There is little evidence to support differences in effectiveness for pain treatment when comparing all NSAIDs. Aspirin is used for primary and secondary pr...

T he number of adults in North America who have congenital heart disease (CHD) has steadily increased over the past 30 years. Although this increase is partly because of the growth of the adult population, it may be more attributable to improvements in surgical management, which have resulted in a greater than 90 percent 10-year survival rate in persons with CHD. Between 1979 and 1997, mortalit...

A ccurate diagnosis of the generalized rash can be difficult because of the nonspecific appearance of many rashes. If the diagnosis is not obvious, the physician must resist the common tendency to prematurely close the diagnostic process and instead generate an inclusive differential diagnosis. Part I of this two-part article discusses the common, uncommon, and rare causes of generalized rashes...

Several clinical studies have shown that valerian is effective in the treatment of insomnia, most often by reducing sleep latency. A double-blind, placebo-controlled trial compared a 400-mg aqueous extract of valerian and a commercial valerian/hops preparation with placebo of encapsulated brown sugar. A total of 128 volunteers completed a subjective study evaluating the effects of single doses ...