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Treatment Options for Osteoarthritis

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Injected into the joint capsule to reduce friction and improves articulation ... Bulletin of the Hospital for Joint Diseases. 2005; 63(1&2): 31-36. ... – PowerPoint PPT presentation

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Title: Treatment Options for Osteoarthritis


1
Treatment Options for Osteoarthritis
  • Adam Bastin
  • Prof. Powdrill
  • March 27, 2008

2
Arthritis
  • Rheumatoid Arthritis
  • Autoimmune
  • Symmetrical
  • Joint pain, swelling, stiffness, fatigue
  • Better once joint is used
  • Osteoarthritis
  • Asymmetrical
  • Joint pain, stiffness
  • Pain is worse with use
  • Boney enlargement
  • Weight bearing joints
  • Joint space narrowing

3
Osteoarthritis
  • Most common joint disorder worldwide
  • Diagnosed on clinical presentation and supported
    by radiography.
  • Risk Factors
  • Older age, female sex, obesity, trauma,
    quadriceps weakness, and nutritional deficiencies

4
Osteoarthritis
5
Osteoarthritis Measurement Scales
  • Western Ontario and McMaster Osteoarthritis Index
    (WOMAC)
  • Questionnaire with twenty four questions about
    pain, function, and stiffness
  • Visual Analogue Scale
  • 100 mm long line with descriptive words (no pain
    / worst pain ever felt) on either side
  • Lequesne Index
  • Questionnaire 11 questions that ask about the
    patients symptoms and functional ability

6
Review of Literature
  • Exercise Related Therapy
  • Pharmaceutical therapy
  • Various procedures performed to relieve symptoms

7
Exercise Therapy
  • Indicated for mild to moderate osteoarthritis
  • Water therapy Very effective
  • Good for elderly patients
  • Exercise training Effective
  • Improvements in both knee and hip patients
  • Weight loss Effective
  • Weight loss groups improved over weight stable
    group
  • (All studies had statistically significant
    results on the scales discussed earlier)

8
Pharmaceutical therapy
  • Indicated for mild, moderate, and severe
  • NSAIDS Very common
  • Transdermal Fentanyl
  • Indicated when NSAIDS, weak opiods dont work
  • Glucosamine
  • Improves repair process and formation of
    cartilage
  • (All studies had statistically significant
    results on the scales discussed earlier)

9
Various Procedures
  • Hyaluronic acids
  • Injected into the joint capsule to reduce
    friction and improves articulation (act as
    synovial fluid)

10
Various Procedures
  • Joint Replacement Surgery
  • Improved pain and overall patient well being

11
Various Procedures
  • Acupuncture
  • No difference seen in patients who exercised and
    advice when compared to patients who exercised,
    had advice, and acupuncture.

12
Treatment Overview
13
Conclusion
  • Treatment is different with every individual
  • Think about severity of osteoarthritis symptoms
    when considering treatment options
  • Consider patients goal for treatment (pain free
    vs. being able to perform activities)

14
References
  • Arthritis Foundation, Disease Center
    Osteoarthritis, Available at http//ww2.arthritis
    .org/conditions/DiseaseCenter/OA/oa_epidemiology.a
    sp, November 23, 2007
  • Cochrane T, Davey RC, Matthes Edwards SM.
    Randomised controlled trial of the
    cost-effectiveness of water-based therapy for
    lower limb osteoarthritis. Health Technology
    Assessment. 2005 Aug 9(31).
  • Dawson J, Linsell L, Doll H, Zondervan K, Rose P,
    et al. Assessment of the Lequesne index of
    severity for osteoarthritis of the hip in an
    elderly population. Osteoarthritis and Cartilage.
    2005 13(10) 854-60.
  • de Jong ORW, Hopman-Rock M, Tak ECPM, Klazinga
    NS. An implementation study of two evidence-based
    exercise and health education programmes for
    older adults with osteoarthritis of the knee and
    hip. Health Education Research. 2004 19(3)
    316-25.
  • Foster NE, Thomas E, Barlas P, Hill JC, Young J,
    Mason E, et al. Acupuncture as an adjunct to
    exercise based physiotherapy for osteoarthritis
    of the knee randomised controlled trial. BMJ.
    2007 335 436-48 originally published online 15
    Aug 2007.
  • Fregly BJ, Reinbolt JA, Rooney KL, Mitchell KH,
    Chmielewski TL. Design of patient-specific gait
    modifications for knee osteoarthritis
    rehabilitation. IEEE Transactions on Biomedical
    Engineering. 2007 Sep 54(9) 1687-95.
  • Gould D, Kelly D, Goldstone L, Gammon J.
    Examining the validity of pressure ulcer risk
    assessment scales developing and using
    illustrated patient simulations to collect the
    data. Journal of Clinical Nursing. 2001
    10697-706.
  • Hunter DJ, Felson DT. Osteoarthritis. BMJ. 2006
    Mar 18(332) 639-42.
  • Jordan KM, Arden NK, Doherty M, Bannwarth B,
    Bijlsma JWJ, Dieppe P, et al. EULAR
    Recommendations 2003 an evidence based approach
    to the management of knee osteoarthritis Report
    of a Task Force of the Standing Committee for
    International Clinical Studies Including
    Therapeutic Trials (ESCISIT). Ann Rheum Dis.
    2003 62 114555.
  • Juni P, Reichenbach S,Trelle S, Tschannen B,
    Wandel S, Jordi B, et al. Efficacy and safety of
    intraarticular hylan or hyaluronic acids for
    osteoarthritis of the knee. Arthritis
    Rheumatism. 2007 Nov 56(11) 3610-19.
  • Langford R, McKenna F, Ratcliffe S, Vojtassak J,
    Richarz U. Transdermal Fentanyl for Improvement
    of Pain and Functioning in Osteoarthritis A
    Randomized, Placebo-Controlled Trial. Arthritis
    Rheumatism. 2006 Jun 54(6) 1829-37.
  • Loyd M, Rublee D, Jacobs P. An economic model of
    long-term use of celecoxib in patients with
  • osteoarthritis. BMC Gastroenterology. 2007
    7(25).
  • Mikesky AE, Mazzuca SA, Brandt KD, Perkins SM,
    Damush T, Land KA. Effects of Strength Training
    on the Incidence and Progression of Knee
    Osteoarthritis. Arthritis Rheumatism (Arthritis
    Care Research). 2006 Oct 15 55(5) 690-99.
  • Miller GD, Nicklas BJ, Davis C, Loeser RF,
    Lenchik L, Messier SP. Intensive Weight Loss
    Program Improves Physical Function in Older Obese
    Adults with Knee Osteoarthritis. Obesity. 2006
    Jul 14(7) 1219-30.
  • Orthoteers Organization, WOMAC, Available at
    http//www.orthoteers.org/(S(qmyfg0ribj51evba5wm1y
    1z2))/content/contentnoframeset.aspx?article367c
    1, February 16, 2008
  • Reginster JY, Bruyere O, Fraikin G, Henrotin Y.
    Current Concepts in the Therapeutic Management of
    Osteoarthritis with Glucosamine. Bulletin of the
    Hospital for Joint Diseases. 2005 63(12)
    31-36.
  • Rowe, PJ, Myles CM, Nutton R. The effect of total
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