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osteoarthritis

Intra-articular Corticosteroids in Osteoarthritis

Intra-articular Corticosteroids in Osteoarthritis

Teaser: 

Sunita Paudyal, MD, Department of Medical Education, Providence Portland Medical Center, Portland, OR, USA.
Stephen M. Campbell, MD, Department of Medical Education, Providence Portland Medical Center, Portland, OR, USA.

Osteoarthritis is a major cause of disability among older adults. Treatment of the symptoms involves multiple modalities, including exercise, physical measures such as braces or canes, analgesics, and sometimes surgery. Many studies have demonstrated the utility of intra-articular corticosteroids in the knee, but data on their use in other joints are lacking. Intra-articular corticosteroids alleviate pain in the short term but have little effect on long-term function. Overall, they are quite safe, with relatively few contraindications or complications. Intra-articular corticosteroids are a temporizing measure rather than definitive therapy and are most useful in the treatment of acute exacerbations of osteoarthritis pain, to alleviate symptoms as other therapies are instituted, and to tide patients over as they await surgery.
Key words: osteoarthritis, corticosteroids, intra-articular, injections, therapy.

How to Make Sure Your Patient with Osteoarthritis Gets the Best Care

How to Make Sure Your Patient with Osteoarthritis Gets the Best Care

Teaser: 

Cornelia M. Borkhoff, PhD, Postdoctoral Research Fellow, Centre for Global Health, University of Ottawa, Ottawa, ON; Canadian Osteoarthritis Research Program, Women’s College Hospital, Toronto, ON.
Gillian A. Hawker, MD, MSc, FRCPC, Chief of Medicine, Women’s College Hospital;
F.M. Hill Chair in Academic Women’s Medicine, University of Toronto; Arthritis Society of Canada Senior Distinguished Rheumatology Investigator, Toronto, ON.

Although total joint arthroplasty (TJA) is a highly effective treatment for individuals with moderate to severe osteoarthritis who have not responded to medical therapy, disparities in TJA utilization based on gender, race/ethnicity, and socioeconomic status are well documented. These disparities may be due in part to patient-level factors such as perceptions of, and willingness to consider, TJA. Another possible explanation is that subtle or overt biases may inappropriately influence physicians’ treatment recommendations regarding this procedure. Because of the potential for an increased quality of life among TJA recipients, disparity in rates of use of TJA among individuals with an identified need represents inadequate care. In this article, we make recommendations about how to make sure your patient gets the best care.
Key words: quality of care, osteoarthritis, joint arthroplasty, disparities.

Alcohol and Prescription Drug Interactions Among Aging Adults

Alcohol and Prescription Drug Interactions Among Aging Adults

Teaser: 


Kristine E. Pringle, Ph.D., Health Care Consultant, First Health Services Corporation/PAPACE, Harrisburg, PA, USA.
Frank M. Ahern, Ph.D., Senior Research Associate, Department of Biobehavioral Health, Pennsylvania State University, University Park, PA, USA.
Debra A. Heller, Ph.D., Senior Health Care Consultant, First Health Services Corporation/PA-PACE, Harrisburg, PA, USA.

Many medications have the potential to interact with alcohol, and older patients may be at greater risk of experiencing adverse effects due to issues of comorbidity and polypharmacy. Even small amounts of alcohol consumed by an older person who is taking multiple medications can have serious consequences. A retrospective analysis linked prescription claim records with self-reported alcohol use. Results showed that 77% of older adults used at least one alcohol-interactive medication, and 19% of alcohol-interactive drug users reported concomitant alcohol use. Because many individuals are unaware of the risks posed by alcohol and medications, it is important for clinicians to warn patients about potential interactions.
Keywords: older adults, alcohol, prescription drug use, alcohol-drug interactions, concomitant use of alcohol and prescription drugs.

Physical Therapy and Exercise for Arthritis: Do They Work?

Physical Therapy and Exercise for Arthritis: Do They Work?

Teaser: 

Marie D.Westby, BSc(PT), PhD Candidate, Mary Pack Arthritis Program,Vancouver Coastal Health, School of Rehabilitation Sciences, University of British Columbia,Vancouver, BC.
Linda Li, BSc(PT), PhD, Harold Robinson/Arthritis Society Chair, Assistant Professor, School of Rehabilitation Sciences, University of British Columbia,Vancouver, BC.

Physiotherapy aims to prevent physical impairment and restore functional ability through the use of exercise, education, and physical modalities. While there is solid evidence supporting physical activities in the management of arthritis, inactivity continues to be a problem among both younger and older patients with arthritis as compared to the general population. Current evidence supports the effectiveness and safety of moderate- to highintensity aerobic and strengthening exercises for osteoarthritis and stable rheumatoid arthritis. Participation in recreational activities does not replace the need for therapeutic exercises. Physicians and health professionals should be equipped with strategies to overcome barriers and facilitate treatment adherence when prescribing exercise.
Keywords: osteoarthritis, rheumatoid arthritis, physical therapy, exercise, physical activity.

Total Hip Arthroplasty in the Older Population

Total Hip Arthroplasty in the Older Population

Teaser: 

Peter G. Passias, MD, 4th year resident, Tufts Affiliated Hospitals Orthopedic Surgery Residency Program, Medford, MA, USA.
James V. Bono, MD, Clinical Professor of Orthopedics, Tufts University School of Medicine; Director of Education, New England Baptist Hospital, Medford, MA, USA.

Total hip arthroplasty (THA) is one of the most commonly performed and successful operations in orthopedic surgery in terms of clinical outcome, implant survivorship, and cost-effectiveness. The average age for a patient undergoing a THA is 66 years. As life expectancy continues to increase in developed nations and the percentage of the population that is older than 65 years rises, THA surgery will be more frequently performed. This change in demographics is clinically relevant as the indications, risks involved, and outcomes are not identical to those of younger THA candidates. Osteoarthritis is by far the most common diagnosis among patients undergoing primary elective THA. Other common diagnoses include rheumatoid arthritis, other types of inflammatory arthritis, post-traumatic arthritis, and osteonecrosis of the femoral head. Patients that are candidates for THA have radiographic evidence of hip joint degeneration together with the clinical symptoms of disabling pain and functional limitation despite adequate nonsurgical management. The following article attempts to summarize some of the key issues regarding THA in an older population.
Key words: total hip arthroplasty, osteoarthritis, avascular necrosis, hip fracture, older population.

Yoga as a Complementary Therapy

Yoga as a Complementary Therapy

Teaser: 


Marian Garfinkel, EdD, Medical Researcher and Adjunct Professor, Temple University, College of Health Professions, Department of Kinesiology; Medical Researcher, University of Pennsylvania, School of Medicine, Department of Rheumatology; Veterans Administration Hospital, Department of Rheumatology; Director, BKS Iyengar Yoga Studio of Philadelphia, Philadelphia, PA, USA.

By broadening yoga’s application beyond stress-related ailments to include preventative and curative therapies, physicians today have an advantage in treating patients’ illnesses and disorders. Specifically, yoga therapy complements patients’ traditional medical treatment of osteoarthritis and other bone and joint disorders. Following anatomical guidelines, yoga teachers can adapt postures (asanas) to ensure patients’ organs, joints, and bones are aligned to achieve physiologic changes. Recent studies performed by this author assessing the effect of yoga therapy on rheumatic diseases, such as osteoarthritis, and repetitive strain injuries, such as carpal tunnel syndrome, showed that yoga therapy caused physiologic changes, relieved pain, and improved motion.
Key words: osteoarthritis, yoga, Iyengar, exercise, repetitive strain injuries.

Inflammatory Musculoskeletal Conditions in Older Adults

Inflammatory Musculoskeletal Conditions in Older Adults

Teaser: 


The accredited CME learning activity based on this article is offered under the auspices of the CE department of the University of Toronto. Participating physicians are entitled to one (1) MAINPRO-M1 credit by completing this program, found online at www.geriatricsandaging.ca/cme.htm

Jerry Tenenbaum, MD, FRCPC, Professor of Medicine, University of Toronto; Consultant in Rheumatology, Mount Sinai Hospital, University Health Network, Baycrest Geriatric Centre, Toronto, ON.

Musculoskeletal inflammatory conditions in the older patient cover the spectrum of those conditions affecting all age groups to those that are associated with advanced age. Polymyalgia rheumatica and pseudogout are two conditions which are seen predominately in older adults. While gout occurs more often in males in younger patients, both genders may present in the older population. Myositis in an older patient is more likely to be associated with neoplasia, so a search for common tumours should comprise part of the workup of that patient. Hypertrophic pulmonary osteoarthropathy associated with malignancy should be considered in the older patient who presents with arthritis, long bone pain, and clubbing. Osteoarthritis is by far the most common arthritis in the older population. It is important to identify those patients who have clinical features of inflammation in order to provide that subgroup with appropriate anti-inflammatory treatment.

Key words: polymyalgia rheumatica, pseudogout, synovitis, osteoarthritis, myositis.

Management of the At-Risk Patient with Osteoarthritis

Management of the At-Risk Patient with Osteoarthritis

Teaser: 


Alan D. Bell, MD, Department of Family and Community Medicine, Humber River Regional Hospital, Toronto, ON.

Douglas C. Conaway, MD, Section of Rheumatology, Carolina Health Specialists, Myrtle Beach, SC, USA.

Recent disclosures of cardiovascular safety issues with medications that have become mainstays of osteoarthritis management have compelled clinicians to reconsider treatment approaches. This new information must be taken into account along with the well-known risk of gastrointestinal complications associated with nonsteroidal anti-inflammatory drugs. Consequently, clinical management of osteoarthritis pain in older patients requires careful evaluation and consideration of the individual patient’s risk factors. Co-therapy with proton pump inhibitors has demonstrated reductions in endoscopic gastropathy, but clinical outcome trials are lacking. For all treatment decisions, monitoring of patients’ responses to therapy is crucial for optimizing long-term safety and efficacy outcomes.

Key words: osteoarthritis, drug therapy, nonsteroidal anti-inflammatory drugs, cyclo-oxygenase-2 inhibitors.

Management of the Arthritic Knee in Older People

Management of the Arthritic Knee in Older People

Teaser: 

Geoffrey F. Dervin, MD, MSc, FRCS(C), Associate Professor, University of Ottawa and the Ottawa Hospital, Orthopaedic Division, Department of Surgery, Ottawa, ON.

Understanding the options for treatment of osteoarthritis of the knee will allow physicians to help their patients realize the physical and social demands of healthy life. Weight loss, physical therapy and unloading braces are clinically proven strategies in the early stages of the disease. Acetaminophen remains the analgesic of choice, while COX-2 NSAIDs are reserved for flare-ups and short-term use. Oral glucosamine and chondroitin sulfate also may be helpful. Persistently swollen knees may respond to aspiration and corticosteroid injection or viscosupplementation with hyaluronic acid derivatives. Those with acute onset of mechanical symptoms may respond to arthroscopic débridement and resection of unstable meniscal tears. Osteotomy of the tibia or femur are options for isolated unicompartmental disease in younger and more active patients. Arthroplasty of one or all compartments of the knee is the definitive procedure for end-stage arthrosis with very dependable results in most clinical settings.
Key words: osteoarthritis, knee, arthroplasty, acetaminophen, older people.

Surgical Management of Osteoarthritis of the Hand and Wrist

Surgical Management of Osteoarthritis of the Hand and Wrist

Teaser: 

Herbert P. von Schroeder, MD, MSc, FRCSC, University of Toronto Hand Program and Toronto Western Hospital, University Health Network, Toronto, ON.

Osteoarthritis is a highly prevalent and disabling condition of the hand in the geriatric population. It is commonly and effectively managed by surgical means. The interphalangeal joints and base of the thumb are most frequently involved, particularly in women, whereas post-traumatic osteoarthritis of the wrist is more common in men. Surgical procedures include simple debridement, soft tissue stabilization or osteotomies for milder cases. Joint arthroplasty, including excision procedures, and joint arthrodesis (fusion) are indicated for more severe arthritis. The type of procedure used depends on the location of the affected joint, patient age and physical demands placed on the hand. Surgery can effectively alleviate pain and improve hand function to improve an individual's quality of life.
Key words: osteoarthritis, hand, arthrodesis, arthroplasty, surgery.