Search Results (2,564)

Background/Objectives: Fibromyalgia is a painful syndrome with biopsychosocial components that predominantly affects middle-aged women. This study aimed to evaluate changes in sleep quality and quality of life following intravenous (IV) lidocaine treatment in patients with fibromyalgia (FM). Methods: This retrospective observational study included patients diagnosed with fibromyalgia who underwent intravenous lidocaine treatment at a tertiary pain clinic between June 2023 and June 2024 and had a Pittsburgh Sleep Quality Index (PSQI) score > 5. The patients’ demographic data, Fibromyalgia Impact Questionnaire (FIQ) scores at baseline and at 1 and 3 months post-treatment, Numerical Rating Scale (NRS-11) scores, Short Form-12 (SF-12) mental and physical component scores (MCS-12, PCS-12), and PSQI scores were recorded. Results: Overall, 51 patients were included. 92.2% of the patients were women, with a mean age of 41.6 ± 9.5 years. Statistically significant reductions in NRS-11, FIQ, and PSQI scores and increases in SF-12 component scores were observed at 1 and 3 months compared with baseline (p < 0.001). Negative correlations were found between NRS-11 and PCS-12 and MCS-12, and a positive correlation was found between FIQ and PSQI. Sleep quality showed a marked improvement at 1 month; however, attenuation of this benefit was observed at the 3-month follow-up. Conclusions: Sleep quality appeared to be associated with short-term functional outcomes, whereas pain intensity was associated with mid-term clinical status in patients with fibromyalgia. Prospective randomized controlled trials are required to confirm these findings and to determine optimal dosing and treatment schedules. Full article

Background/Objectives: Oxidative stress plays an important role in the pathophysiology of endometriosis, contributing to inflammation, immune dysregulation, and lesion progression. This has led to growing interest in antioxidant-based strategies as potential supportive interventions. Methods: A literature search was conducted using PubMed, Scopus, and Web of Science databases, covering studies published from database inception until the end of January 2026. The review focused on clinically relevant endpoints, including pain intensity, markers of inflammation and oxidative stress, reproductive parameters, and quality of life. Results: Among the analyzed interventions, the most consistent clinical effects were observed with melatonin, with randomized controlled trials indicating a moderate reduction in pain. N-acetylcysteine shows potentially beneficial effects; however, the available clinical data remain limited and heterogeneous. For other supplements, the evidence is inconsistent or insufficient to support clear clinical conclusions, and in many cases relies on indirect or mechanistic findings rather than well-established clinical outcomes. Conclusions: Current evidence does not support the use of non-mineral antioxidant supplements as standalone therapy for endometriosis. They may be considered as adjunctive strategies, although their clinical effectiveness remains uncertain and requires confirmation in well-designed randomized clinical trials. Full article

Ixora chinensis Lam. has traditionally been used to treat conditions such as acne, high blood pressure, bleeding, tuberculosis, and rheumatism. This study aimed to investigate the methanolic extract of I. chinensis leaves to determine their bioactive compounds and evaluate their effects on both central and peripheral pain using in vivo and in silico approaches. The GC-MS analysis revealed 41 phytochemicals, including 14 phenolics, 4 esters, 12 terpenoids, 8 alkaloids, and 3 sulfur-containing compounds. In the glucose tolerance test, both the chloroform-soluble fraction (CF) and n-hexane fraction (NHF) exhibited p < 0.05 reductions in blood glucose levels at a dosage of 400 mg/kg with decreases of 51.94% and 46.63%, respectively, compared to the positive control (64.02%). The central analgesic evaluation showed significant (p < 0.001) enhancements in tail-flick latency for the fraction (184.94%) and CF (170.51%) following 90 min. In the pain relief assay, NHF showed inhibition (64.33%, p < 0.001) followed by an aqueous fraction (57.35%). These pharmacological findings were supported by in silico analysis. Concerning activity, 5-(dimethylamino)-1- acid phenyl ester (−8.9 kcal/mol) and 9,9-dimethyl-9H-fluoren-3-ol (−8.4 kcal/mol) displayed the strongest binding affinity to AMPK. Additionally, 2,3-diphenyl-2-cyclopropen-1-one exhibited favorable interactions with α-amylase (−8.0 kcal/mol) and α-glucosidase (−8.3 kcal/mol). Similarly, the central analgesic effect correlated with the strong μ-opioid receptor affinity of s-Triazine, 2-amino-4-(piperidinomethyl)-4-piperidino (−8.8 kcal/mol). N-Methyl-N-(4-toluenesulfonyl)-benzamide (−8.6 kcal/mol) and s-Triazine derivative (−8.9 kcal/mol) demonstrated notable COX-1 and COX-2 inhibition potential. Overall, the findings indicate I. chinensis leaves as a promising source of bioactive compounds with significant antihyperglycemic and analgesic properties. Full article

Background: Severe burn injuries are associated with prolonged consequent wound healing, substantial symptoms burden, and delayed, sometimes incomplete, functional recovery. Photobiomodulation using Multiwave Locked System (MLS) LASER therapy has been proposed as an adjunctive intervention to support tissue repair and thereby improve rehabilitation outcomes, but related clinical evidence in burn populations remains limited. Materials and Methods: This comparative study included 65 patients with severe burn injuries, of whom 35 were prospectively treated with adjunctive MLS LASER therapy, in addition to standard care, and 30 retrospectively identified patients, who received standard care alone, served as controls. The primary outcome was the time until complete epithelialization, while secondary outcomes included: reduction in wound surface, pain intensity, pruritus severity, scar quality, and functional improvements. Assessments were performed at baseline and after a standardized follow-up period of up to 20 days. Results: Patients treated with MLS LASER therapy achieved complete epithelialization significantly earlier than controls (median 40 vs. 73 days, p < 0.001) and demonstrated greater wound area reduction (median 434 vs. 137 cm², p = 0.0012). In multivariable analyses adjusted for burn extent, burn depth, age, and diabetes mellitus, considered as factors worsening evolution, MLS LASER therapy remained independently associated with shorter time to epithelialization and greater reduction in wound dimension. Significant improvements favoring the MLS group were also observed regarding pain, pruritus, scar quality, and functional outcomes, all assessed using specific evaluation tools (p < 0.001). Conclusions: Adjunctive MLS LASER therapy appears to be associated with improved wound healing dynamics and enhanced rehabilitation outcomes in patients with severe burn injuries. These findings should be interpreted with caution given the study limitations, including the non-randomized design and relatively small sample size. MLS LASER therapy may represent a promising adjunctive option in the conservative management of burn injuries; however, further prospective randomized studies are required to confirm these results and to define optimal treatment protocols. Full article

Background/Objectives: Metabolic syndrome (MetS) causes significant oral manifestations that negatively impact oral health-related quality of life (OHRQoL). This randomized controlled trial evaluated the effects of combined dental interventions and lifestyle guidance on OHRQoL in patients with MetS. Methods: In total, 82 participants with MetS were randomized into an intervention group (IG; n = 39), receiving dental treatment plus lifestyle guidance, or a control group (CG; n = 43), receiving lifestyle guidance only. OHRQoL was assessed using GOHAI and OHIP-14 at baseline, 1 month, and 3 months. Data were analyzed using repeated-measures ANOVA and multivariable ANCOVA, adjusting for age, sex, baseline OHRQoL, and waist circumference. Pearson correlations examined the relationship between metabolic changes (Δ) and OHRQoL. Results: At 3 months, the IG demonstrated significantly superior OHIP-14 scores (p = 0.020) and a large effect size in social disability (${\eta }_p^2$ = 0.148, p < 0.001) compared to the CG. Within-group analysis showed the IG achieved highly significant longitudinal improvements in pain and psychological discomfort (all p < 0.001). Subgroup analysis confirmed these gains were primarily driven by participants with missing teeth (${\eta }_p^2$ = 0.447, p < 0.001), whereas the periodontitis-only subgroup showed non-significant shifts. Multivariable analysis identified age and baseline scores as primary predictors. Notably, OHRQoL improvements significantly correlated with reductions in body weight (r = 0.355, p = 0.001) and waist circumference (r = 0.238, p = 0.031). Conclusions: Integrated dental and lifestyle interventions significantly improved OHRQoL in MetS patients by enhancing psychosocial well-being and social reintegration. Gains were functionally driven by systemic metabolic success. Addressing “nutritional barriers” through dental rehabilitation, while targeting weight loss goals, was essential for holistic MetS management. Full article

Background and objectives: Acute colicky abdominal pain, involving visceral spasms and inflammatory mechanisms, is a common complaint in everyday medical practice. Despite its widespread use, clinical evidence on the fixed-dose combination of pargeverine 10 mg plus lysine clonixinate 125 mg remains limited. The objective of this study was to describe real-world clinical outcomes, safety, and patient-reported experience associated with this combination in routine practice. Materials and methods: This multicenter, observational, non-comparative, real-world study included adult patients with acute colicky abdominal pain of gastrointestinal, urological, or gynecological origin. Pain intensity was assessed using a visual analog scale (VAS) at baseline and at 5 ± 3 days. Secondary outcomes included time to pain relief, satisfaction with treatment, and safety. Associations between pain reduction and patient-reported outcomes were explored. Results: A total of 202 patients were analyzed. Significant pain reduction was observed across all etiologies (p < 0.001), with median VAS reductions ranging from 6 to 9 points (approximately 70% to 90% from baseline). More than 95% of patients reported early improvement, and sustained relief was maintained in more than 96% throughout the study period, regardless of the pain’s origin. Adverse events were infrequent (3%), mild in intensity (primarily transient gastrointestinal symptoms), and did not lead to treatment discontinuation. Conclusions: In real-world clinical practice, the fixed-dose combination of pargeverine and lysine clonixinate was associated with early and sustained, clinically meaningful pain reduction across multiple forms of acute visceral colicky pain, with a favorable safety and tolerability profile, supporting its relevance as a short-term therapeutic option in mild to severe acute pain. Full article

Background: Meniscal tears are a common cause of knee pain and functional limitation, yet determinants of pain recovery following rehabilitation remain incompletely understood. Structural imaging findings often show limited correlation with clinical symptoms. This study aimed to evaluate longitudinal pain trajectories after rehabilitation in patients with meniscal tears and to investigate whether synovial fluid characteristics and structural joint degeneration are associated with pain improvement. Methods: This retrospective cohort study included 59 patients with meniscal tears who underwent structured rehabilitation. Structural degeneration was assessed using the Whole-Organ Magnetic Resonance Imaging Score (WORMS). Synovial fluid cytology evaluated neutrophil predominance (PNL) and erythrocyte positivity. Pain intensity was measured using the Visual Analog Scale (VAS) at 3 months, 6 months, and 1 year. Longitudinal changes were analyzed using the Friedman test, and predictors of pain improvement (ΔVAS from 3 months to 1 year) were evaluated using multivariable linear regression. Results: VAS scores decreased significantly over time (p < 0.001), indicating sustained pain reduction during follow-up. In the multivariable regression model (F(4, 54) = 2.80, p = 0.035), 17% of the variance in pain improvement was explained (R² = 0.17). Synovial erythrocyte positivity was modestly associated with greater longitudinal pain reduction (β = 0.75, 95% CI 0.15–1.36, p = 0.016). Age was also a significant predictor (β = 0.025, p = 0.043), whereas WORMS score and PNL positivity were not significantly associated with pain improvement. Conclusions: Pain recovery following rehabilitation in patients with meniscal tears appears to be influenced more by intra-articular biological characteristics than by structural imaging severity alone. Synovial erythrocyte positivity may indicate a potentially reversible inflammatory phenotype associated with higher early pain but greater subsequent improvement. These findings support a multidimensional model of knee pain and suggest that synovial characteristics may help improve clinical risk stratification during rehabilitation planning. Full article

Background and Objectives: Distal radius fractures (DRFs) are among the most common upper-extremity injuries in the elderly, with malunion leading to long-term pain and disability. This study aimed to compare the discriminative performance of the Cast Index (CI), Gap Index (GI), and Three-Point Index (TPI) for predicting malunion during follow-up after closed reduction and casting in elderly patients with dorsally displaced DRFs. Materials and Methods: This study retrospectively analyzed 274 patients aged ≥65 years (mean 73.6 ± 6.5 years) with dorsally displaced Arbeitsgemeinschaft für Osteosynthesefragen/Orthopaedic Trauma Association (AO/OTA) 2R3A fractures treated conservatively between 2018 and 2023. Standard posteroanterior and lateral radiographs were evaluated immediately post-reduction, at 7–10 days, and at 4 weeks. Cast, Gap, and Three-Point Indices were measured independently by two observers, and the mean values were analyzed. Receiver operating characteristic (ROC) analysis was used to evaluate discriminative performance for the detection of malunion. Subgroup analyses were performed based on fracture stability according to La Fontaine criteria. Results: At the final follow-up, 136 fractures (49.6%) maintained acceptable alignment, while 138 fractures (50.4%) experienced malunion. There was no significant difference in radiographic parameters between groups immediately post-reduction or at 7–10 days. The Gap and Three-Point Indices were significantly higher in the malunion group at 7–10 days and at 4 weeks (p < 0.001), but the Cast Index showed no significant between-group difference. At 7–10 days, the Gap Index [Area Under the Curve (AUC) = 0.641; cut-off = 0.33] and the Three-Point Index (AUC = 0.640; cut-off = 1.51) demonstrated modest discriminative ability. In stable fractures, both indices were statistically significantly higher in the malunion group, whereas in unstable fractures, only the Three-Point Index was statistically significantly higher in the malunion group (p < 0.001). Conclusions: The Gap and Three-Point Indices showed greater discriminative ability than the Cast Index for malunion after conservative management of DRFs in elderly patients. Thresholds of GI ≥ 0.33 and TPI ≥ 1.51 at 7–10 days may serve as practical quantitative indicators to identify patients who may warrant closer follow-up and possible cast reassessment in conjunction with standard radiographic assessment and clinical judgment. Full article

Background: Acute primary angle closure (APAC) is an ophthalmic emergency characterized by abrupt elevation of intraocular pressure (IOP) and severe ocular pain and headache. While acute management prioritizes IOP reduction, supportive analgesic strategies during the preoperative waiting period in medically refractory cases remain insufficiently studied. We evaluated short-term changes in the pain intensity and safety of adjunctive greater occipital nerve block (GONB) in medically refractory APAC. Methods: This retrospective observational study included 34 patients with medically refractory APAC who received GONB during the preoperative waiting period. Headache intensity was measured using an 11-point Numeric Rating Scale (NRS) at baseline, 30 min, and 60 min. Longitudinal changes were analyzed using a linear mixed-effects model. Responder analyses were reported with 95% confidence intervals (Wilson method). No multivariable modeling or NNT estimation was performed in the revised analysis. Results: Baseline NRS was 7.8 ± 1.1, decreasing to 4.1 ± 1.5 at 30 min and 3.6 ± 1.3 at 60 min (both p < 0.001). The mean baseline-to-60 min change was −4.21 (95% CI, −4.88 to −3.54). Clinically meaningful pain relief (≥3-point reduction) at 60 min occurred in 79.4% (95% CI, 63.2–89.7%). In linear mixed-effects modeling, time remained a significant fixed effect (p < 0.001). Conclusions: Adjunctive GONB was associated with a rapid reduction in pain intensity in medically refractory APAC. These findings should be interpreted cautiously, given the uncontrolled design and concurrent treatment. Prospective controlled studies are warranted. Full article

Background: The Lapidus procedure has become a cornerstone in the surgical management of hallux valgus, especially in cases with associated tarsometatarsal instability. This study investigated and compared the radiographic outcomes of three distinct Lapidus constructs, aiming to provide valuable insights into the optimal fusion configurations for achieving long-term stability improvement and maintaining the intermetatarsal angle (IMA) postoperatively. Methods: In this retrospective study, the objective was to assess and compare the outcomes of three different fusion constructs used in the Lapidus procedure: group 1, transverse screw fixation; group 2, metatarsal cuneiform screw fixation; and group 3, combined transverse and metatarsal cuneiform screw fixation. The study encompassed 32 feet: 11 in group 1, 8 in group 2, and 13 in group 3. The primary focus was to evaluate postoperative stability through radiographic imaging complemented by clinical assessments and an examination of complications. Statistical analyses were used to compare outcomes across the three fixation groups immediately, 3 months, 6 months, and 1 year postoperatively. Results: Radiographic assessments demonstrated successful fusion, and patients reported improvements in pain and function and overall satisfaction with the procedure. Complication rates were within an acceptable range. The IMA in all three groups exhibited a significant reduction postoperatively compared with preoperative measurements. Group 3 demonstrated a notably stronger initial reduction in the IMA compared with groups 1 and 2, and they maintained a statistically significantly more stable IMA value and exhibited a lower recurrence rate compared with the other two groups 1 year postoperatively. Conclusions: These findings endorse the use of Lapidus fusion with these three constructs, particularly with combined transverse and metatarsal cuneiform screw fixation, as a dependable and efficacious surgical approach in addressing hallux valgus with concomitant tarsometatarsal instability. Full article

Background: Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) is a bothersome condition characterized by pelvic pain and lower urinary tract symptoms (LUTS). Phytotherapy can be used to treat this challenging condition. The aim of this study was to investigate the role of an oral combination of bovine colostrum, Serenoa repens extract and other anti-inflammatory elements in the treatment of CP/CPPS patients. Methods: Our study was a prospective, observational, single-arm study that enrolled patients > 18 years with a history consistent with CP/CPPS, a Chronic Prostatitis Symptom Index (CPSI) pain domain score ≥ 5 and a Meares–Stamey microbiological test negative for bacterial infection. Pelvic or genital pain was measured via the Numeric Pain Rating Scale (NPRS) and validated questionnaires. All patients were treated with an oral combination of colostrum, Serenoa repens extract and other anti-inflammatory elements for 6 months. Follow-up visits were scheduled at 3 and 6 months. Pre- and post-treatment variables were compared by means of the Wilcoxon signed-rank nonparametric test. Results: We included 42 patients in our analysis. The median (Inter-Quartile Range, IQR) age was 42 (28–51) years. Compared with baseline, after 3 months we observed a significant reduction in pain: total CPSI score of 16 (12–21) vs. 22 (17–26), p < 0.001, −6 points (−27.3%); CPSI score of “pain” domain 7 (5–9) vs. 8 (7–11), p < 0.001, −1 point (−12.5%). Moreover, quality of life improved: CPSI “quality of life” domain 6 (4–9) vs. 8 (7–10), p < 0.001. After 6 months, a significant reduction in pain was maintained: total CPSI score 19 (10–23), p < 0.001, −3 points (−13.65%); and CPSI “pain” domain 7 (4–9), p < 0.001, −1 point (−12.5%). After 6 months, a mild reduction in urinary symptoms was also reported. During the observation period, five patients discontinued treatment, two of them because of gastrointestinal intolerance. Conclusions: The daily oral administration of bovine colostrum, Serenoa repens and other anti-inflammatory elements showed a potential in improving pain and other urinary symptoms and was generally well tolerated by patients affected by CP/CPPS. Full article

Background: Musculoskeletal pain affects an estimated 1.7 billion people worldwide and ranks among the leading causes of global disability. This review evaluates the effectiveness and safety of osteopathy in treating musculoskeletal pain across multiple body regions and conditions. Methods: A systematic literature review following PRISMA guidelines was conducted across five databases (Embase, Medline via Ovid, The Cochrane Library, PEDro, and INAHTA), yielding 964 citations. Eligible studies were RCTs published in English or German up to May 2022; conference abstracts were excluded. A hybrid design was employed: a systematic review of RCTs for neck, shoulder, knee, foot, osteoporosis, and fibromyalgia was combined with a pre-specified umbrella review component for chronic non-specific low back pain (registered in PROSPERO) to avoid duplication of an existing high-confidence evidence synthesis. From 35 critically appraised articles, the best available evidence (n = 15) was selected per body region based on a risk of bias (RoB) assessment (Cochrane Collaboration tool, version 1); the existing review was appraised with AMSTAR 2. An updated search (2022–July 2025) was performed without a RoB assessment. Data were synthesised qualitatively and reported narratively. Results: Fifteen RCTs and one systematic review were included, covering eight body regions and conditions (2408 participants). Pain improved immediately post-treatment in most regions; statistically significant between-group differences were less consistent at mid- and long-term follow-ups. Key findings: neck pain (n = four RCTs)—improvement in three of four studies immediately post-treatment; shoulder pain (n = two RCTs)—improvements across all follow-up points in one study; low back pain (n = one systematic review, 10 RCTs, 1160 participants)—pain reduced immediately and at mid-term follow-up; knee pain (n = two RCTs)—significant reduction in one study; foot pain (n = two RCTs)—improvement in both studies post-treatment and at mid-term follow-up; osteoporosis (n = one RCT)—no improvement immediately post-treatment; fibromyalgia (n = two RCTs)—significant between-group differences in one study post-treatment and at mid-term follow-up. Functional outcomes were heterogeneous across regions. Adverse events were minor and transient; no serious side effects were reported across any included study. The updated search (2022–July 2025) identified 12 additional RCTs across five regions, with findings broadly consistent with the primary analysis, though results for the neck region were marginally less favourable. Discussion: Based on current evidence, osteopathy can improve neck and low back pain for up to three months and may reduce shoulder and foot pain; evidence for other body regions remains inconclusive. RoB was unclear to high across studies, largely due to the inherent inability to blind patients and practitioners in manual therapy trials. Substantial heterogeneity in interventions, outcome measures, and study designs limits comparability. Overall certainty of evidence was low to moderate, warranting cautious interpretation. The consistent absence of serious adverse events across all included studies supports osteopathy as a safe therapeutic option. High-quality research with standardised interventions, rigorous designs, long-term follow-ups, and a focus on technique, dosage, and safety is needed to inform clinical practice and healthcare policy. This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sector. Full article

Objective: This retrospective, intention-to-treat real-world study, designed by the Greek Research Alliance for the Study of headache and Pain (GRASP) sought to compare the effectiveness and safety of anti-CGRP monoclonal antibodies (anti-CGRP Mabs) to topiramate in preventing migraine. Patients and methods: Patients received either fremanezumab, erenumab, galcanezumab, eptinezumab, or topiramate for at least six months. Outcomes included reductions in monthly headache days (MHDs), ≥50% and ≥75% responder rates, monthly acute medication intake (MAI), MHDs with peak headache intensity ≥5 on VAS, migraine-related disability (MIDAS, HIT-6), quality of life (EQ-VAS), discontinuation rates and safety. Results: We included 409 migraine patients (median age 45.2 years), predominantly female (80%) and mostly with long-standing disease and high baseline burden. After six months, all treatments reduced MHDs. Mean MHDs decreased by −7.8 days with anti-CGRP Mabs versus −3.8 days with topiramate (p < 0.001). Higher ≥50% and ≥75% responder rates were observed across all anti-CGRP agents, compared to topiramate. Anti-CGRP Mabs also achieved greater reductions in moderate/severe MHDs, MAI, disability metrics, and superior QOL gains. Among the CGRP-targeted therapies, slight differences in effectiveness outcomes were present, though failing to demonstrate any specific superiority. Safety was favorable for anti-CGRP Mabs, whereas topiramate showed substantially higher adverse events and discontinuations. Conclusions: Anti-CGRP Mabs were more effective, produced greater reductions in disability and higher improvements quality-of-life metrics and were better tolerated than topiramate. Differences among individual anti-CGRP agents were modest and unlikely to represent a clinically meaningful superiority, supporting a class-wide benefit vs. topiramate in migraine prevention both in terms of effectiveness and safety. Full article

Dercum’s disease (DD) is a rare chronic disorder characterized by painful subcutaneous lipomas, mostly affecting overweight or obese middle-aged women. The etiology remains unclear, and evidence for medical treatments is limited. Surgical approaches may reduce pain but are associated with frequent relapses and are difficult to implement in extensive clinical pictures. We investigated the outcomes of multiple medical and surgical therapeutic strategies. Particularly, we explored immunomodulators (methotrexate and infliximab), used alone or combined with glucagon-like peptide-1 receptor agonists (GLP-1 RAs) such as semaglutide, as well as the dual GIP (glucose-dependent insulinotropic polypeptide)/GLP-1 RAs tirzepatide. Five patients with DD were included in this retrospective single-center case series. Baseline clinical data, medical history, and longitudinal information on Dermatology Life Quality Index (DLQI), Visual Analogue Scale (VAS) for pain, and body mass index (BMI) were collected from existing medical records and scheduled follow-up visits conducted since 2021. Clinical trajectories differed across patients and regimens. Methotrexate and infliximab coincided with variable and often transient improvements in pain and quality of life. Combination regimens including GLP-1 RAs were accompanied by weight reduction and, in selected patients, by sustained improvements in pain and DLQI. In other cases, the benefit was limited or absent. Adverse events were manageable and consistent with the known safety profiles of these drugs. In this small real-world case series, therapeutic responses in DD were highly individualized, underscoring the absence of standardized medical treatment and the need for patient-tailored strategies. The observed patterns suggest that immunomodulatory and incretin-based therapies may represent exploratory options in selected patients, especially when surgery is not feasible. However, controlled studies are needed to clarify their role. Full article