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Internist, Rheumatologist, Sports Medicine Specialist
16 years of experience
Video profile
Accepting new patients

Education ?

Medical School Score Rankings
The University of Texas at Houston (1994)
  • Currently 3 of 4 apples
Top 50%

Awards & Distinctions ?

Awards  
Castle Connolly's Top Doctors™ (2012 - 2013)
Patients' Choice 5th Anniversary Award (2012)
Patients' Choice Award (2008 - 2012)
Compassionate Doctor Recognition (2010 - 2012)
Associations
American Board of Internal Medicine
American Board of Integrative Holistic Medicine
American Holistic Medical Association

Affiliations ?

Dr. Concoff is affiliated with 4 hospitals.

Hospital Affilations

Score

Rankings

  • Memorial Hermann Hospital
    6411 Fannin St, Houston, TX 77030
    • Currently 4 of 4 crosses
    Top 25%
  • St. Jude Medical Center *
    101 E Valencia Mesa Dr, Fullerton, CA 92835
    • Currently 3 of 4 crosses
    Top 50%
  • University of California - Ronald Reagan UCLA Medical Center
    757 Westwood Plz, Los Angeles, CA 90095
  • Mhhs Hermann Hospital
  • * This information was reported to Vitals by the doctor or doctor's office.

    Publications & Research

    Dr. Concoff has contributed to 4 publications.
    Title Validation of American College of Rheumatology Classification Criteria for Knee Osteoarthritis Using Arthroscopically Defined Cartilage Damage Scores.
    Date March 2006
    Journal Seminars in Arthritis and Rheumatism
    Excerpt

    OBJECTIVE: To validate the ability of the American College of Rheumatology (ACR) clinical classification criteria and the ACR clinical plus radiographic classification criteria for osteoarthritis of the knee to predict articular cartilage damage. METHODS: Ninety subjects with knee osteoarthritis (OA) who were enrolled in a prospective study determining the therapeutic efficacy of arthroscopic irrigation were characterized as to whether they fulfilled the ACR clinical classification criteria or the ACR clinical plus radiographic classification criteria. Ten rheumatoid arthritis (RA) patients were included as controls. Cartilage damage was defined using the ACR/Knee Arthroscopy Osteoarthritis Scale (ACR/KAOS) system, which is a validated outcome instrument for knee OA based on arthroscopic visualization. Mean values of the damage scores in each group were calculated and compared by t-test to determine statistical significance between the 3 groups. RESULTS: The mean ACR/KAOS score for the 10 RA patients was 1.8 [SD 1.22; range 0 to 4]. Of the 90 OA patients who underwent arthroscopy, only 73 patients had sufficient videotape to make an accurate assessment by the blinded assessor. The mean ACR/KAOS score for the 6 OA patients who fulfilled only the ACR clinical classification was 17.4 [SD 11.3; range 5 to 34.3] and the mean ACR/KAOS score for the 67 patients who fulfilled the ACR clinical plus radiographic classification criteria was 42.0 [SD 29.1; range 5.1 to 118.4]. These differences were statistically significant (RA versus OA clinical P=0.02; RA versus OA clinical+radiographic P<or=0.01). Nonparametric multivariate analysis did not reveal significant correlations between ACR/KAOS scores and WOMAC global scores (r=0.11, P=0.39), patient VAS (r=0.29, P=0.022), and age (r=0.29, P=0.08). CONCLUSIONS: The ACR clinical and clinical plus radiographic criteria for OA of the knee accurately predict cartilage damage as assessed by arthroscopy. Furthermore, the ACR clinical classification criteria identify OA patients with cartilage damage before any radiographic change, while the ACR clinical plus radiographic classification criteria identify OA patients with more severe cartilage damage. RELEVANCE: The ACR classification criteria correlates well with articular cartilage damage in patients with OA.

    Title Visually-guided Irrigation in Patients with Early Knee Osteoarthritis: a Multicenter Randomized, Controlled Trial.
    Date February 2001
    Journal Osteoarthritis and Cartilage / Oars, Osteoarthritis Research Society
    Excerpt

    OBJECTIVE: To determine if visually-guided arthroscopic irrigation is an effective therapeutic intervention in patients with early knee osteoarthritis. DESIGN: Ninety patients with knee osteoarthritis were randomized in a double-blind fashion to receive either arthroscopic irrigation with 3000 ml of saline (treatment group) or the minimal amount of irrigation (250 ml) required to perform arthroscopy (placebo group). The primary outcome variable was aggregate WOMAC score. RESULTS: The study did not demonstrate an effect of irrigation on arthritis severity as measured by aggregate WOMAC scores, the primary outcome variable; the mean change in aggregate WOMAC score at 12 months was 15.5 (95% CI 7.7, 23.4) for the full irrigation group compared to 8.9 (95% CI 4.9, 13.0) for the minimal irrigation group (P=0.10). Full irrigation did have a statistically significant effect on patients' self-reported pain as measured by the WOMAC pain subscale and by a visual analog scale (VAS) (the secondary outcome variables). Mean change in WOMAC pain scores decreased by 4.2 (95% CI -0.9, 9.4) for the full irrigation group compared with a mean decrease of 2.3 (95% CI -0.1, 4.7) in the minimal irrigation group (P=0.04). Mean VAS pain scores decreased by 1.47 (95% CI -1.2, 4.1) in the full irrigation group compared to a mean decrease of 0.12 (95% CI 0.0, 0.3) in the minimal irrigation group (P=0.02). A hypothesis-generating post-hoc analysis of the effect of positively birefrigent intraarticular crystals showed that patients with and without intraarticular crystals had statistically significant improvements in pain assessments and aggregate WOMAC scores at 12 months; patients with crystals had statistically greater improvements in pain. CONCLUSIONS: Visually-guided arthroscopic irrigation may be a useful therapeutic option for relief of pain in a subset of patients with knee OA, particularly in those who have occult intraarticular crystals.

    Title What is the Relation Between Crystals and Osteoarthritis?
    Date October 1999
    Journal Current Opinion in Rheumatology
    Excerpt

    The nature of the relation between osteoarthritis and the various forms of calcium crystals that are found within osteoarthritic joints continues to challenge and confound researchers. The most basic question is whether such crystals are directly relevant to the development of osteoarthritis, or are merely a byproduct or marker of the disease itself. The past year has produced several studies that elucidate important aspects of the molecular and cellular mechanisms of calcium pyrophosphate dihydrate and apatite crystal formation. Such studies may yield novel targets for therapeutic intervention in crystal-associated osteoarthritis. Other recent studies have provided further understanding of the mechanisms by which crystals induce inflammation. Arthroscopic assessment of patients with knee osteoarthritis refractory to traditional therapy suggests that the combined absence of chondrocalcinosis on plain films and identifiable crystals on compensated polarized light microscopy of synovial fluid from arthrocentesis may not be adequate to exclude clinically relevant crystalline deposition and inflammation. Clinical criteria are needed to identify patients with occult crystalline disease who, by virtue of crystal-induced inflammation, require more aggressive anti-inflammatory therapy than those with noninflammatory osteoarthritis.

    Title Can Physical Signs or Magnetic Resonance Imaging Substitute for Diagnostic Arthroscopy in Knee Osteoarthritis Patients with Suspected Internal Derangements?: a Pilot Study.
    Date
    Journal Journal of Clinical Rheumatology : Practical Reports on Rheumatic & Musculoskeletal Diseases
    Excerpt

    ABSTRACT: This pilot study was developed to compare the relative diagnostic accuracies of physical findings, magnetic resonance imaging (MRI) and arthroscopy for internal derangements in knee osteoarthritis (OA) patients. Nine patients with locking and/or giving way in 10 knees underwent MRI and arthroscopy; the relative diagnostic accuracies for meniscal tears were studied and compared with physical findings. Eleven meniscal and no cruciate ligament tears were noted by MRI and/ or arthroscopy. Using arthroscopy as the comparison standard, the sensitivity of MRI for meniscal tears was 33.3%, specificity was 96.6%, and diagnostic accuracy was 75.0%. No significant correlations between physical findings and MRI or arthroscopy findings were found. It seemed that participants with normal radiographs had false positive MRIs more frequently. These preliminary data suggest that physical findings may not be adequate for the diagnosis of meniscal tears in patients with associated knee OA. A larger study may be warranted to further test this hypothesis. Because the presence of a meniscal tear may change therapy toward specific physical therapy modalities and/or meniscal repair, knee OA patients with mechanical symptoms may require an MRI or arthroscopy to establish the presence of a meniscal tear. Further testing is required to confirm the suggestion from these cases that patients with normal or minimally abnormal radiographs may require a diagnostic arthroscopy rather than an MRI to demonstrate a meniscal tear.

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