Continuing Education Activity

Olecranon bursitis is presented as a frequent source of swelling and discomfort at the back of the elbow, arising from inflammation of the olecranon bursa. The condition develops from repetitive mechanical irritation, direct trauma, infection, or systemic inflammatory disorders. Olecranon bursitis can present in either an aseptic or a septic form, and distinguishing between the 2 is essential for safe and effective management. Accurate recognition depends on understanding the bursa’s anatomy, the mechanisms that drive inflammation, and the typical clinical features seen on examination. Diagnostic evaluation emphasizes careful history-taking, targeted physical examination, and, when appropriate, aspiration with fluid analysis to exclude infection. Management spans conservative measures such as rest, compression, and protective padding; antibiotic therapy for septic presentations; and selective use of aspiration, corticosteroid injection, or surgery, while avoiding unnecessary procedures that increase risk.

The course enables participants to promptly identify olecranon bursitis, apply evidence-based diagnostic reasoning, and select treatment strategies that balance effectiveness with safety. Clinical decision-making becomes more precise as the learner recognizes when conservative care is sufficient and when escalation to procedural or surgical intervention is justified. Collaboration within an interprofessional team, integrating primary care expertise, orthopedic evaluation, infectious disease insight, physical therapy support, and nursing observation, enhances patient outcomes by ensuring thorough assessment, coordinated treatment, and early identification and management of complications. This shared approach promotes continuity, reduces recurrence, and supports a smoother recovery trajectory across the entire episode of care.

Objectives:

• Identify the clinical features that distinguish septic from aseptic olecranon bursitis based on history and physical examination.
• Differentiate evidence-based management approaches for septic versus aseptic bursitis to avoid unnecessary invasive procedures.
• Implement strategies to minimize complications such as secondary infection, abscess formation, and osteomyelitis.
• Collaborate with interprofessional team members, including nurses, pharmacists, and orthopedic specialists, to coordinate comprehensive patient care.

Introduction

Olecranon bursitis is inflammation of the olecranon bursa, a synovial-lined sac located over the dorsal aspect of the proximal ulna (olecranon process) at the elbow. This bursae is one of the most common type to become inflamed, presenting as swelling, pain, and sometimes erythema over the posterior elbow.[1][2] Olecranon bursitis has long been recognized as a frequent cause of elbow swelling, especially in individuals with repetitive elbow trauma or pressure, such as manual laborers and athletes. The condition can be acute or chronic, and is classified as either septic (infectious) or aseptic (noninfectious).[1][3] Septic cases are most often caused by Staphylococcus aureus and are associated with trauma or skin breaks.[3][4] The annual incidence is estimated at 10 to 29 per 100,000, with higher rates in populations exposed to repetitive elbow trauma, such as military recruits.[3][5]

The olecranon bursa is a thin, fluid-filled sac situated between the skin and the olecranon process of the ulna. The bursa's primary function is to reduce friction between the skin and the underlying bone during elbow movement.[6] The bursa is superficial, making it susceptible to direct trauma and infection. Olecranon bursitis most commonly results from microtrauma or repetitive pressure on the elbow, leading to inflammation and fluid accumulation.[5][7][8] Other mechanisms include acute trauma, infection (septic bursitis), crystal deposition (eg, gout), hemorrhage, and systemic inflammatory conditions.[9] Risk factors include men, older age, elevated body mass index, hyperlipidemia, and smoking.[8] Septic bursitis typically follows a skin break, allowing bacteria to enter the bursa, whereas aseptic bursitis is usually related to mechanical irritation or underlying systemic disease.[1][3][4]

Etiology

The etiology of olecranon bursitis is multifactorial, with causes broadly categorized as traumatic (microtrauma or acute trauma), infectious (septic), and systemic/inflammatory. The most common cause is chronic microtrauma—repetitive pressure or friction on the olecranon, such as from leaning on the elbows or from occupational activities (eg, manual labor, military training).[5][7][10][11] Acute trauma, such as a direct blow, can also precipitate bursitis.[10][11] Septic olecranon bursitis occurs when bacteria, most commonly Staphylococcus aureus, enter the bursa, often through a skin break or following trauma.[1][3][4][10][12] Septic cases account for about one-third of presentations and are more common in settings with skin injury or compromised local defenses.[3][4][11]

Systemic inflammatory conditions, such as gout, rheumatoid arthritis, and other crystal arthropathies, can cause or predispose one to bursitis through deposition of crystals or immune-mediated inflammation.[9][10][13] These cases are less common but important to recognize, especially in patients with known rheumatologic disease. Epidemiologic studies identify older age, elevated body mass index (BMI), hyperlipidemia, and smoking as significant risk factors.[5][7][8][11] Occupations or activities involving frequent elbow trauma or pressure (eg, military recruits, athletes) are at higher risk.[3][5] Hyperlipidemia and smoking have been shown to independently increase risk, particularly in older individuals and those with higher BMI.[8]

Epidemiology

Olecranon bursitis is relatively common. There is no mortality associated with this condition. Pain in the posterior elbow causes morbidity, with a limitation of activities. Olcranon bursitis typically affects men aged 30 to 60.

• Two-thirds of cases are nonseptic and occur when repeated trauma or sports injuries lead to bleeding into the bursa or release of inflammatory mediators.
• There is no predisposition to sex or race.
• Olecranon bursitis occurs in both children and adults.
• Long-term hemodialysis treatment, uremia, or mechanical factors can cause inflammation.
• Technicians who crawl on their knees in tight spaces and lean on their elbows are very susceptible.

Inflammation may also be due to a systemic inflammatory process, such as rheumatoid arthritis, or to a crystal deposition disease, such as gout or pseudogout. This condition may be a side effect of sunitinib, which is used to treat renal cell carcinoma.

Pathophysiology

The most common clinical findings of olecranon bursitis are localized swelling over the posterior elbow, tenderness, warmth, and erythema. Septic bursitis is more likely to present with marked tenderness (88%), erythema/cellulitis (83%), warmth (84%), and fever (38%), whereas aseptic cases typically show less pronounced inflammatory signs.[1] The swelling is usually fluctuant and may be painless in chronic or noninfectious cases.

Histopathology

The histopathological features of olecranon bursitis typically include bursal wall thickening, synovial cell hyperplasia, and infiltration of inflammatory cells. Regardless of etiology, macrophages and some T cells often predominate in the bursal tissue, along with increased expression of proinflammatory cytokines such as interleukin-6, interleukin-1β, and tumor necrosis factor alpha.[13] In chronic or uremic cases, the bursal wall may show hyalinized collagenous tissue and infiltration by histiocytes and lymphocytes, reflecting ongoing inflammation and possible fibrosis.[14]

In septic bursitis, histology reveals dense neutrophilic infiltration, possible purulent exudate, and destruction of the synovial lining, while aseptic bursitis is more likely to show chronic inflammatory changes without significant neutrophil predominance.[13][14] Crystal-induced bursitis (eg, gout) may demonstrate crystal deposits within the bursal tissue, surrounded by a granulomatous inflammatory response. Overall, the most common histopathological findings are synovial hyperplasia, inflammatory cell infiltration (macrophages, lymphocytes, and neutrophils in septic cases), and increased proinflammatory cytokine expression.[13][14]

History and Physical

Typical findings in the history of olecranon bursitis include recent or repetitive trauma to the elbow, prolonged pressure (eg, leaning on hard surfaces), or a history of infection or systemic inflammatory disease. However, most patients whose bursitis was induced by trauma have forgotten the minor or repetitive trauma that ever occurred by the time the symptoms manifest.[7] Patients often report swelling over the posterior elbow, which may be painless or mild; pain is usually more pronounced in septic cases. Fever and constitutional symptoms are uncommon in aseptic bursitis but may be present in septic cases.[1][4]

On physical examination, the most common findings are localized swelling over the olecranon, which is often fluctuant and may be tender. Septic bursitis more often presents with erythema, warmth, and cellulitis than aseptic bursitis. Tenderness is reported in 88% of septic cases, compared with 36% in aseptic cases. Similarly, erythema or cellulitis occurs in 83% of septic cases compared with 27% of aseptic cases, and local warmth is observed in 84% versus 56%, respectively. Fever is also more common in septic bursitis, occurring in 38% of cases, whereas it is absent in aseptic bursitis. These findings indicate that pronounced redness, warmth, tenderness, and systemic symptoms are strong indicators of septic bursitis.[1] 

The overlying skin may show evidence of trauma or a lesion, and range of motion is typically preserved unless significant pain or infection is present. Joint involvement is rare and helps distinguish bursitis from septic arthritis.[4] The hallmark findings of olecranon bursitis are posterior elbow swelling, with tenderness, erythema, and warmth suggesting a septic process, while painless or mildly painful swelling is more typical of aseptic bursitis.[1][4][10]

Evaluation

Recommended diagnostic evaluation for olecranon bursitis focuses on distinguishing septic from aseptic bursitis and ruling out other causes of elbow pain. 

Laboratory tests:

• Bursal aspiration is indicated if infection is suspected. Analysis should include Gram stain, culture, cell count, and crystal analysis. Septic bursitis is suggested by a purulent aspirate, white blood cell count >3000/μL, >50% polymorphonuclear cells, positive Gram stain/culture, and a fluid-to-serum glucose ratio <50%.[1][11][12] Bursal fluid analysis, especially cell count, Gram stain, culture, and crystal analysis, provides high diagnostic utility for distinguishing septic from aseptic olecranon bursitis and is recommended by national and international guidelines when infection is suspected.[15]
• Cell count: A bursal fluid white blood cell count >3000 cells/μL, especially with >50% polymorphonuclear cells, strongly suggests septic bursitis, though overlap exists, and lower counts do not exclude infection.[1][11][16] Reported ranges in septic cases are broad (1000–165,000 cells/μL), so interpretation should be in the clinical context.[16]
• Gram stain and culture: Positive Gram stain and culture are definitive for septic bursitis, with Staphylococcus aureus being the most common pathogen.[4][11][12][16][17][18] The Infectious Diseases Society of America and American Society for Microbiology recommend Gram stain and aerobic bacterial culture of bursal fluid as the gold standard for diagnosis.[17] However, up to 20% of clinically suspected septic cases may have sterile cultures, so negative results do not fully exclude infection.[12]
• Crystal analysis: Identification of monosodium urate or calcium pyrophosphate crystals in aspirated fluid supports a diagnosis of crystal-induced (gout or pseudogout) bursitis, which is typically aseptic.[10][15] Crystal analysis is recommended in patients with risk factors for gout or other crystal arthropathies.[15]
• Other findings: Purulent aspirate, fluid-to-serum glucose ratio <50%, and low bursal fluid glucose further support the diagnosis of septic bursitis.[11][16]
• Blood tests (complete blood count, erythrocyte sedimentation rate, C-reactive protein) may be supportive but are not specific; they can help assess systemic involvement.[1][2] 

Radiographic and imaging studies:

• Plain radiographs are recommended as the initial imaging modality to exclude fractures, dislocations, or other bony pathology in patients with acute elbow pain.[19]
• Ultrasound can help differentiate bursal fluid from other soft tissue masses and guide aspiration if needed.[20]
• Advanced imaging (magnetic resonance imaging and computed tomography) is rarely required but may be considered if there is suspicion of deep infection, osteomyelitis, or an atypical presentation.[20][21]

Guideline recommendations:

• The American College of Occupational and Environmental Medicine (ACOEM) recommends aspiration and diagnostic studies for infection and crystals in potentially infectious effusions.[15]
• The American College of Radiology recommends radiography as the first-line imaging modality for acute elbow pain, with ultrasound for further soft-tissue assessment.[19][20]

Treatment / Management

The general approach to olecranon bursitis depends on whether the condition is aseptic or septic, with most cases managed conservatively and surgery reserved for refractory or complicated disease. Aseptic olecranon bursitis is best managed with conservative measures of rest, ice, compression, soft padding, and avoidance of direct pressure on the elbow. Nonsteroidal anti-inflammatory drugs (NSAIDs) may be used for pain and inflammation, but the ACOEM does not specifically recommend NSAIDs or glucocorticoid injections for aseptic cases.[15] Evidence from randomized trials' results shows that compression plus NSAIDs, aspiration, and aspiration with steroid injection have similar efficacy, but steroid injections are associated with higher complication rates and should be used cautiously, if at all.[22][23]

Aspiration is generally reserved for diagnostic purposes or for significant symptomatic relief, as routine aspiration may increase the risk of infection.[10][23] Most cases resolve with conservative management; persistent or chronic cases may require surgical intervention, such as bursectomy or, more recently, hydrothermal ablation, which has shown promising results with fewer complications than open surgery.[24] Septic olecranon bursitis requires prompt antibiotic therapy targeting S aureus and Streptococcus species, with oral or intravenous antibiotics depending on severity and patient comorbidities.[1][10][12] Bursal aspiration is recommended for diagnostic confirmation (Gram stain, culture), but results from recent studies suggest that empiric antibiotics without aspiration may be reasonable in uncomplicated cases.[25][26] Surgery (incision, drainage, or bursectomy) is reserved for cases that do not respond to antibiotics, for recurrent infections, or for those with extensive cellulitis or abscess formation.[11][12][23]

National and international guidelines (ACOEM, systematic reviews, and European consensus) consistently recommend conservative management as first-line for aseptic bursitis (rest, ice, compression, padding, NSAIDs if needed).[2][10][15] Antibiotics are used first-line for septic bursitis, with aspiration for diagnosis and surgery reserved for refractory cases.[10][11][12] Steroid injections and routine aspiration are generally discouraged due to increased risk of complications, except in select cases with high occupational or athletic demands.[1][12]

In chronic olecrenon bursitis, where the bursa appears as a boggy, thick, and rubbery, surgical excision shows good to excellent results.[27] Germawi L et al showed a 12% recurrence rate (22/199 patients) after open excision. Women and those with diabetes and/or rheumatoid conditions were more likely to have revision surgery. Just over 4% (8/199) of patients had wound complications, and 2.6% (5/199) required flap reconstruction for coverage.[28] Shen et al reported no recurrence rate or wound complications after endoscopic olecrenon bursectomy in 28 patients with aseptic cases in a retrospective study. Results from a study by Meade et al showed that 14 cases of septic olecranon bursitis were treated with endoscopic bursectomy, with no wound-healing issues except 1 minor recurrence.[29] 

In 2017, Uckay et al published a randomized controlled trial evaluating staged excision for the treatment of septic olecranon bursitis. The trial involved 130 patients, who were treated either with open bursectomy in a single stage or with antibiotics followed by a delayed open bursectomy in 2 stages. The treatment failure rate for the single-stage procedure was 10%, while the 2-stage procedure had a higher failure rate of 16% and a greater incidence of wound dehiscence.[30]

Complete excision of the bursa, combined with proper wound closure and postoperative splinting, is essential to minimize the risk of recurrence. Patients with diabetes, rheumatoid arthritis, or a history of smoking should have their surgical wounds closely monitored until fully healed. Extending antibiotic therapy beyond 7 days has not been demonstrated to reduce the risk of recurrence.[31]

Differential Diagnosis

Considerations for alternative diagnoses in the differential diagnosis should include:

• Traumatic hematoma or contusion: Direct trauma to the elbow can cause localized swelling and tenderness similar to bursitis. Hematomas are often firmer and may have associated ecchymosis; imaging (ultrasound or radiograph) can help distinguish these from bursal fluid collections.[32]
• Crystal-induced arthropathy (gout or pseudogout): Acute gout or calcium pyrophosphate deposition disease can present with rapid-onset swelling, erythema, and pain. Crystal analysis of aspirated fluid is diagnostic; calcium pyrophosphate deposition disease often affects the knee and wrist, but can involve the elbow.[33]
• Rheumatoid nodule or inflammatory arthritis flare: Rheumatoid arthritis may cause subcutaneous nodules over the olecranon or joint effusion. Nodules are firm and nonfluctuant, while joint involvement is typically symmetric and associated with morning stiffness.[34][35]
• Triceps tendinopathy or partial tendon rupture: Injury to the triceps tendon can mimic bursitis, presenting with posterior elbow pain and swelling. A palpable gap, weakness in extension, and imaging findings (ultrasound, MRI) help distinguish tendon injury.[36]
• Cellulitis or superficial soft-tissue infection: Cellulitis presents with diffuse erythema, warmth, and swelling, but typically lacks a fluctuant bursal collection. Cellulitis is often more painful and poorly demarcated than bursitis; ultrasound can help differentiate an abscess from cellulitis.[37]
• Benign soft-tissue mass (synovial/ganglion cyst, lipoma): These masses are usually painless, slow-growing, and well-circumscribed. Imaging (ultrasound, MRI) is useful for characterization.[38]
• Elbow joint arthritis (degenerative or inflammatory): Elbow arthritis causes pain, stiffness, and sometimes swelling, but usually involves joint space narrowing and osteophytes on imaging.[35]

The examining clinician should pay careful attention not to miss the following critical alternative diagnoses that could result in unfavorable outcomes if not recognized and treated promptly: 

• Septic arthritis of the elbow: Presents with acute pain, swelling, fever, and limited range of motion. Synovial fluid analysis (cell count, Gram stain, culture) is essential; septic arthritis requires urgent treatment to prevent joint destruction.[39]
• Osteomyelitis of the olecranon/ulna: Suspected with deep pain, systemic symptoms, and sometimes overlying skin changes. MRI is the most sensitive imaging modality; elevated C-reactive protein and erythrocyte sedimentation rate support diagnosis.[40]
• Soft-tissue sarcoma or metastatic malignancy: Rapidly enlarging, deep, or firm masses, especially >5 cm, should prompt further evaluation. MRI with contrast and biopsy are recommended per National Comprehensive Cancer Network guidelines to rule out malignancy.[38][41]

Prognosis

The prognosis of olecranon bursitis is generally excellent, with most cases, both aseptic and septic, resolving fully with appropriate conservative or medical management. Aseptic bursitis typically resolves within a few weeks with rest, compression, and avoidance of pressure, with 65% to 85% of patients achieving resolution by 4 weeks regardless of whether they receive NSAIDs, aspiration, or a steroid injection; however, steroid injections carry higher complication risks and are not routinely recommended.[22][23]

Septic olecranon bursitis also has a high rate of resolution with empiric antibiotics, and most patients do not require surgery or hospitalization; study results report uncomplicated resolution in 88% of cases managed with antibiotics alone.[12][25][26] Surgical intervention is reserved for refractory, chronic, or recurrent cases; even then, most patients recover fully. However, open bursectomy carries higher complication rates than newer minimally invasive options, such as hydrothermal ablation.[23][24]

Factors that may delay recovery or increase recurrence include longer symptom duration before treatment, underlying systemic disease (eg, gout, rheumatoid arthritis), repeated trauma, and inadequate offloading of the elbow.[11][22][23] Chronic or recurrent cases are more likely in patients with persistent occupational or athletic elbow stress. In these cases, recurrence rates can be reduced with proper preventive measures and, if needed, minimally invasive surgical techniques.[24] Most patients with olecranon bursitis recover fully, but delayed treatment, comorbidities, and ongoing mechanical stress can prolong recovery or increase recurrence risk. Surgical intervention is rarely needed, and newer techniques offer improved outcomes for refractory cases.

Complications

Potential complications of olecranon bursitis include infection, chronic or recurrent swelling, delayed wound healing, osteomyelitis, persistent drainage, skin atrophy, and, rarely, the need for revision surgery after bursectomy. Septic bursitis can progress to cellulitis, abscess formation, or osteomyelitis if not promptly treated, and may require surgical intervention in refractory cases. Aseptic bursitis may become chronic or recurrent, especially with ongoing trauma or underlying systemic disease, and can occasionally be complicated by secondary infection, particularly after aspiration or corticosteroid injection. 

Surgical management (bursectomy) carries risks, including delayed wound healing, persistent drainage, infection, and, in rare cases, the need for flap surgery, especially in patients with comorbidities such as rheumatoid arthritis or diabetes mellitus. Corticosteroid injections are associated with increased risk of skin atrophy and other local complications without clear benefit.[4][10][23][28] Overall, most cases resolve without serious sequelae, but complications are more likely with invasive procedures, comorbid conditions, or inadequate initial management.[10][23][28]

Deterrence and Patient Education

Olecranon bursitis can be explained to patients as a swelling at the back of the elbow that develops when the olecranon bursa, a thin, fluid-filled sac that allows the skin to glide smoothly over the bone, becomes irritated or inflamed. The condition may result from repetitive pressure on the elbow, a direct impact, an underlying medical issue such as arthritis or gout, or, in some cases, an infection. Patients should be advised that swelling, warmth, redness, or soreness can occur, and discomfort tends to increase when infection is present.

Education emphasizes that most cases improve with simple measures, including resting the elbow, avoiding prolonged pressure, using ice, and protecting the area with padding or a wrap. Over-the-counter anti-inflammatory medications may help with discomfort when appropriate. When infection is suspected, antibiotic treatment becomes necessary, and recurrent or persistent cases may require procedural or surgical intervention. Preventive guidance focuses on avoiding prolonged elbow leaning, using protective padding during work or sports, and maintaining clean skin to reduce infection risk. Patients are reminded that recovery typically occurs within a few weeks, but significant pain, fever, or persistent swelling warrants prompt medical attention.

Pearls and Other Issues

Key facts to keep in mind regarding olecranon bursitis include:

• Most cases are aseptic and self-limited, resolving with conservative management such as rest, ice, compression, and padding; avoid unnecessary aspiration or steroid injection due to increased complication risk.[7][15][22][23]
• Septic bursitis should be suspected with marked tenderness, erythema, warmth, fever, or overlying skin lesions; prompt antibiotics are indicated, and aspiration is reserved for diagnostic uncertainty or severe cases.[11][12]
• Distinguishing septic from aseptic bursitis can be challenging; physical findings and bursal fluid analysis (if performed) are key, but empiric antibiotics without aspiration are reasonable for uncomplicated cases.[25][26]
• Longer duration of symptoms before treatment is associated with delayed resolution; early intervention improves outcomes.[22]
• Recurrence is more likely in patients with ongoing occupational or athletic elbow stress; education and preventive measures are crucial.[11] 
• Endoscopic bursectomy offers lower wound complication rates and shorter hospital stays than open bursectomy for refractory cases.[29]

Recommended management:

• Aseptic bursitis: Outpatient management is appropriate; surgery is reserved for chronic, recurrent, or refractory cases.[15][23]
• Septic bursitis: Most can be cared for in oputatient settings with oral antibiotics if not acutely ill; admit for intravenous antibiotics if systemic symptoms, extensive cellulitis, or failed outpatient therapy.[10][12]
• Surgical referral is indicated for persistent infection, chronic drainage, or failure of medical management; minimally invasive techniques (eg, endoscopic bursectomy) have lower complication rates than open surgery.[29]

Points of caution:

• Overuse of aspiration and steroid injection in aseptic cases increases the risk of infection and skin atrophy without improving outcomes.[22][23]
• Missing septic arthritis or osteomyelitis: Always assess for joint involvement and deep infection, especially if pain is severe or the range of motion is limited.[10] 
• Premature surgical intervention: Most cases resolve without surgery; reserve for refractory or complicated presentations.[23][29]

Prevention strategies:

• Avoid repetitive trauma or pressure to the elbow (use padding, modify activities).[15] 
• Promptly treat skin injuries over the elbow to reduce the risk of infection.
• Address underlying conditions (eg, gout, rheumatoid arthritis) to prevent recurrence.[10] 

Enhancing Healthcare Team Outcomes

The prevalence and variable presentation of olecranon bursitis require a patient-centered, evidence-based approach to management, emphasizing accurate diagnosis and tailored treatment strategies to optimize outcomes and safety. Effective management relies on clinical skills and strategic decision-making. Differentiating septic from aseptic bursitis is critical and depends on careful history-taking, physical examination, and, when indicated, bursal fluid analysis. Evidence supports conservative management for most cases, with aspiration, steroid injection, and surgery reserved for specific indications, and with awareness of the risks and benefits of each intervention.

Ethical practice and professional responsibility require clinicians to provide safe, effective, and minimally invasive care. This includes avoiding unnecessary procedures that may increase complications, such as routine steroid injections for aseptic bursitis, and ensuring that treatment decisions reflect both best evidence and patient preferences through shared decision-making. Interprofessional communication and teamwork are essential for high-quality care. Clinicians, pharmacists, and other health professionals each play vital roles in assessment, treatment, education, and follow-up. Clear communication, defined responsibilities, and collaborative planning ensure that care is coordinated and responsive to patient needs.

Coordinated care and dynamic team performance enhance patient outcomes, safety, and efficiency. Guidelines from the American College of Physicians emphasize flexible team roles based on patient needs and clincian competencies, supporting seamless transitions and comprehensive care, especially in complex or refractory cases. Multidisciplinary teams improve patient satisfaction, access, and safety, with evidence showing that procedures performed in primary care settings can be as safe and effective as those in specialty care, while improving access and reducing costs.

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Disclosure: Jon Pangia declares no relevant financial relationships with ineligible companies.

Disclosure: Muhammad Taqi declares no relevant financial relationships with ineligible companies.

Disclosure: Tara Rizvi declares no relevant financial relationships with ineligible companies.