The focus of this month’s edition of Geriatrics & Aging is musculoskeletal disease. This heterogeneous collection of disorders is the biggest factor in quality of life for old and frail adults who are surveyed in the community. It is easy to understand why. If every step causes pain, or if sleeping is impossible because of hip disease, life can be very unpleasant indeed. Yet arthritis (and by extension those physicians who are interested in caring for patients with arthritis) never seems to get the amount of attention it deserves. Making life pain-free and more enjoyable seems less of a public and medical concern than saving lives.

The study and management of musculoskeletal disease has been revolutionized in recent times by the advent of magnetic resonance imaging (MRI). At times, however, the pictures are better than the science of what to do with those pictures. Spinal stenosis is a good example of how our diagnostic ability has forged ahead of our therapeutic knowledge. However, this is now an active area of investigation, and Drs. David Snyder, David Doggett, and Charles Turkelson tackle the issue in their article, “Lumbar Spinal Stenosis: Evidence for Treatment.” Dr. Arto Herno discusses an issue that is ubiquitous in older adults (and often younger ones as well) in his article entitled “The Evaluation and Treatment of Low Back Pain in Older Adults.” Although not as common as osteoarthritis, inflammatory conditions can be devastating in the older population. Dr. Jerry Tenenbaum reviews this topic in his article, “Inflammatory Musculoskeletal Conditions in Older Adults.”

As well, we have our usual assortment of geriatric articles. Drs. Kristopher Cunningham, Sharmi Shafi, Mellitta Mezony, Molly Thangaroopan, and Jagdish Butany outline the “Diagnosis and Treatment of Pericarditis in the Aged.” This can be a difficult and often overlooked diagnosis. Drs. Nages Nagaratnam and Kujan Nagaratnam review the topic of “Screaming in Dementia,” an issue which is very distressing for family and caregivers. Our Medical Director of CME, Dr. D’Arcy Little, reviews the topic of “Skin Manifestations of Internal Disease,” while Drs. Andrew Kertesz and David Munoz discuss “Frontotemporal Disease,” also known as Pick’s Disease, for our Drugs & Aging column. In our Lung Disease column, Drs. Max Huang and Lianne Singer review “Surgical Interventions for COPD.”

It’s not too much of a stretch of the imagination to realize that telemedicine will soon be a common way for patients to access a health professional. To this end, our Technology in Medicine column, entitled “Getting into Telemedicine: Information for Physicians” and written by Drs. Peter McCracken and Darryl Rolfson, is a valuable overview of the advantages of telemedicine for physicians and barriers to its application.

Finally, Dr. Paul Arnold provides an enjoyable and practical review of a recently published book, “The Medical Professional’s Guide to Handheld Computing.”

Enjoy this issue,
Barry Goldlist

Arthur Bookman, MD, FRCPC, Senior Staff Physician, University Health Centre, Coordinator, Core Residency Rheumatology Program, University of Toronto, Toronto, ON.

Pain in the older adult is of diagnostic significance. The pattern of distribution reflects the dermatome of the same spinal root that supplies the irritated deep structure. The timing helps differentiate inflammatory and infiltrative from mechanical pathology. Certain diseases of the musculoskeletal system are seen in the older adult. These include osteoarthritis, pseudogout, gout, spontaneous osteonecrosis of the knee and polymyalgia rheumatica. Diagnosis is key to effective treatment. Although the patients in this age group are often “boxed in” by a series of relative contraindications to treatment, with care and perseverence, it is often possible to break open the box and find an effective therapeutic regimen.
Key words: musculoskeletal pain, arthritis, diagnosis, spinal disease, older adults.