Patient Management Strategies in Arthritis - PowerPoint PPT Presentation

1 / 39
About This Presentation
Title:

Patient Management Strategies in Arthritis

Description:

genetic predisposition (genetically obese mice are susceptible ... Massage - lavender, tiger balm & chamomile oils. Herbs. Black cohosh. Wild yam. Willow bark ... – PowerPoint PPT presentation

Number of Views:93
Avg rating:3.0/5.0
Slides: 40
Provided by: annama8
Category:

less

Transcript and Presenter's Notes

Title: Patient Management Strategies in Arthritis


1
Patient Management Strategies in Arthritis
  • Anna Mae Smith, MPAS, PA-C
  • Lock Haven University of PA
  • Physician Assistant Program

2
(No Transcript)
3
DJD/Osteoarthritis
  • Obesity
  • increase in body mass
  • altered biodynamics of gait
  • genetic predisposition (genetically obese mice
    are susceptible to osteoarthritis)
  • altered metabolism (e.g., estrogens)

4
Risk Factors
  • Occupational

5
Treatment
  • Physical measures may be subdivided into..
  • Exercise
  • Supportive devices
  • Alterations in activities of daily living
  • Thermal modalities

6
Exercise
  • Associated with reduced pain improved function.
  • Passive range of motion
  • Rest periods
  • Active range of motion, isometric, isotonic,
    isokinetic

7
  • Improved muscle tone reduces muscle spasm and
    prevents contractures. It is theorized that
    improved muscle support of the joint will retard
    the progression of osteoarthritis.

8
Which Exercises
  • Swimming
  • Biking (Stationary)
  • Walking

9
Support Devices Orhotics
  • Devices such as canes, forearm crutches,
    crutches, and walkers can improve balance and
    decrease pain.

10
  • The total length of a properly measured cane
    should be equal to the distance between the upper
    border of the greater trochanter of the femur and
    the bottom of the heel of the shoe. This should
    result in elbow flexion of about 20.

11
  • The cane should be held in the hand contralateral
    to and moved together with the affected limb. The
    healthier limb should precede the affected limb
    when climbing up stairs when climbing down
    stairs, the cane and the affected limb should be
    advanced first. The cane can unload the affected
    hip by 60.

12
Modified activities of daily living
  • Proper positioning and support when sitting,
    sleeping or driving a car
  • Adjusting ways of performing such activities as
    getting dressed, etc.
  • Adjusting furnishings around the house or at work
    (e.g., raising the level of a chair or toilet
    seat)

13
Thermal modalities
  • Superficial heat (e.g., hot packs, paraffin
    baths)
  • Deep heat (e.g., ultrasound)
  • Cold applications (e.g., cold packs, vapocoolant
    sprays)

14
HEAT
  • The therapeutic value of applying heat includes
    decreasing joint stiffness, alleviating pain,
    relieving muscle spasm, and preventing
    contractures.
  • The use of heat is contraindicated over tissues
    with inadequate vascular supply, bleeding, or
    cancer. Heat should also be avoided in areas
    close to the testicles or near developing
    fetuses.

15
Miscellaneous
  • Pulsed electromagnetic fields
  • TENS
  • Acupuncture
  • Chiropractic
  • Spa, massage, and yoga therapy

16
Short acting drugs
  • Nonsteroidal anti-inflammatory agents
  • Nonantiinflammatory analgesics (opioids,
    nonopioids)
  • Antispasmodics

17
Long Acting Agents
  • Intra-articular depocorticosteroids
  • Intra-articular hyaluronic acid
  • S-adenosylmethionine (SAM)
  • Oral chondroitin sulfate
  • Glucosamine sulfate (Dona)
  • Intra-articular orgotein
  • Diacerhein
  • Avocado/soy nonsaponifiables

18
Capsaicin
  • Capsaicin is derived mainly from capsicum, the
    common pepper plant
  • Nonprescription drug and available in two
    strengths to be applied from two to four times
    per day
  • Interferes with substance P-mediated pain
    transmission.

19
Capsaicin
  • Initially, its use is accompanied by a sensation
    of heat or burning in the area of the skin where
    applied. If not used continuously, the nerve
    endings will renew their sensitivity to substance
    P.

20
Hyaluronic Acid Derivatives
  • In general, they are reported to reduce pain for
    prolonged periods of time potentially to
    improve mobility

21
Hyaluronic Acid Derivatives
  • There is evidence for an anti-inflammatory effect
  • A short-term lubricant effect
  • An analgesic effect by direct buffering of
    synovial nerve endings
  • A stimulatory effect on production of normal
    hyaluronic acid by synovial lining cells

22
S-adenosylmethionine (SAM)
  • A methyl group donor and oxygen radical
    scavenger, has been used by intravenous loading
    and oral maintenance

23
Chondroitin Sulfate
  • Those receiving chondroitin sulfate consumed
    fewer NSAIDs than the controls at both the
    completion of the treatment and the
    treatment-free phase.

24
Glucosamine sulfate
  • An intermediate in mucopolysaccharide synthesis,
    has been tried both orally and intramuscularly.
    Glucosamine sulfate (400 mg) administered
    intramuscularly twice weekly for 6 weeks, reduced
    the severity of disease
  • 1500mg/day (500tid)

25
Recombinant human superoxide dismutase (rH-SOD)
  • Has been used in animal models
  • It catalyzes peroxide formation from free
    radicals, therefore limiting free radical
    concentrations and ability to inflict damage in
    the joint.

26
Intra-articular orgotein
  • A metalloproteinase with superoxide dismutase
    activity is still under investigation

27
avocado/soy nonsaponifiables
  • Have been found to potentially modulate
    chondrocyte synthetic and repair activity
  • An early report of decreased pain and stiffness
    as well as decreased analgesic use by
    osteoarthritis patients has appeared.

28
(No Transcript)
29
DIET
  • Avoid coffee, artificial additives, red meats
    processed foods
  • Limit tomatoes,potatoes,eggplants, peppers,
    simple carbohydrates(white flour refined
    sugar).
  • Fresh fruits veges, complex carbs, wheat
    germ oily fish

30
DIET
  • Vit. A 10,000iu/day
  • Vit. C 2grams/day
  • Vit. E 600iu/day
  • Vit. B6 50 mg/day

31
Rheumatoid Arthritis
32
First-line therapy
  • Anti-inflammatories
  • Aspirin
  • Nonsteroidal anti-inflammatory

33
Second Line Therapies
  • Antimalarials (chloroquine, hydroxychloroquine)
  • Sulfasalazine
  • Methotrexate
  • Gold salts
  • Auranofin
  • Parenteral gold
  • D-penicillamine

34
Second Line Therapies cond
  • Azathioprine
  • Cyclosporin A
  • Combination therapies
  • Corticosteroids
  • Systemic steroids
  • Low-dose oral
  • Parenteral pulse steroids
  • Intra-articular

35
Investigational
  • EPA (eicosapentaenoic) - anti-inflammatory effect
    of fish oil fatty acid
  • Plant seed oils particularly those extracted from
    evening primrose oil and borage seed oil that
    contain large amounts of gamma linolenic acid.

36
Light Therapy
  • Extracorporeal photochemotherapy and
    extracorporeal protein A immunoadsorption

37
Vitamins
  • Vit. C 2grams/day
  • Vit. E 600iu/day
  • B complex vitamin
  • Calcium 1200-1500/day
  • Selenium 100mg/day
  • Zinc 30mg/day

38
Hydrotherapy
  • Cold compresses when acutely inflamed followed by
    alternating hot cold
  • Massage - lavender, tiger balm chamomile oils

39
Herbs
  • Black cohosh
  • Wild yam
  • Willow bark
  • Licorice
Write a Comment
User Comments (0)
About PowerShow.com