THE OFFICIAL PATIENT’S SOURCEBOOK
on
OSTEOARTHRITIS J AMES N. P ARKER , M.D. AND P HILIP M. P ARKER , P H .D., E DITORS
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ICON Health Publications ICON Group International, Inc. 4370 La Jolla Village Drive, 4th Floor San Diego, CA 92122 USA Copyright Ó2003 by ICON Group International, Inc. Copyright Ó2003 by ICON Group International, Inc. All rights reserved. This book is protected by copyright. No part of it may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, without written permission from the publisher. Printed in the United States of America. Last digit indicates print number: 10 9 8 7 6 4 5 3 2 1
Publisher, Health Care: Tiffany LaRochelle Editor(s): James Parker, M.D., Philip Parker, Ph.D. Publisher's note: The ideas, procedures, and suggestions contained in this book are not intended as a substitute for consultation with your physician. All matters regarding your health require medical supervision. As new medical or scientific information becomes available from academic and clinical research, recommended treatments and drug therapies may undergo changes. The authors, editors, and publisher have attempted to make the information in this book up to date and accurate in accord with accepted standards at the time of publication. The authors, editors, and publisher are not responsible for errors or omissions or for consequences from application of the book, and make no warranty, expressed or implied, in regard to the contents of this book. Any practice described in this book should be applied by the reader in accordance with professional standards of care used in regard to the unique circumstances that may apply in each situation, in close consultation with a qualified physician. The reader is advised to always check product information (package inserts) for changes and new information regarding dose and contraindications before taking any drug or pharmacological product. Caution is especially urged when using new or infrequently ordered drugs, herbal remedies, vitamins and supplements, alternative therapies, complementary therapies and medicines, and integrative medical treatments. Cataloging-in-Publication Data Parker, James N., 1961Parker, Philip M., 1960The Official Patient’s Sourcebook on Osteoarthritis: A Revised and Updated Directory for the Internet Age/James N. Parker and Philip M. Parker, editors p. cm. Includes bibliographical references, glossary and index. ISBN: 0-597-83543-8 1. Osteoarthritis-Popular works. I. Title.
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Disclaimer This publication is not intended to be used for the diagnosis or treatment of a health problem or as a substitute for consultation with licensed medical professionals. It is sold with the understanding that the publisher, editors, and authors are not engaging in the rendering of medical, psychological, financial, legal, or other professional services. References to any entity, product, service, or source of information that may be contained in this publication should not be considered an endorsement, either direct or implied, by the publisher, editors or authors. ICON Group International, Inc., the editors, or the authors are not responsible for the content of any Web pages or publications referenced in this publication.
Copyright Notice If a physician wishes to copy limited passages from this sourcebook for patient use, this right is automatically granted without written permission from ICON Group International, Inc. (ICON Group). However, all of ICON Group publications are copyrighted. With exception to the above, copying our publications in whole or in part, for whatever reason, is a violation of copyright laws and can lead to penalties and fines. Should you want to copy tables, graphs or other materials, please contact us to request permission (e-mail:
[email protected]). ICON Group often grants permission for very limited reproduction of our publications for internal use, press releases, and academic research. Such reproduction requires confirmed permission from ICON Group International Inc. The disclaimer above must accompany all reproductions, in whole or in part, of this sourcebook.
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Dedication To the healthcare professionals dedicating their time and efforts to the study of osteoarthritis.
Acknowledgements The collective knowledge generated from academic and applied research summarized in various references has been critical in the creation of this sourcebook which is best viewed as a comprehensive compilation and collection of information prepared by various official agencies which directly or indirectly are dedicated to osteoarthritis. All of the Official Patient’s Sourcebooks draw from various agencies and institutions associated with the United States Department of Health and Human Services, and in particular, the Office of the Secretary of Health and Human Services (OS), the Administration for Children and Families (ACF), the Administration on Aging (AOA), the Agency for Healthcare Research and Quality (AHRQ), the Agency for Toxic Substances and Disease Registry (ATSDR), the Centers for Disease Control and Prevention (CDC), the Food and Drug Administration (FDA), the Healthcare Financing Administration (HCFA), the Health Resources and Services Administration (HRSA), the Indian Health Service (IHS), the institutions of the National Institutes of Health (NIH), the Program Support Center (PSC), and the Substance Abuse and Mental Health Services Administration (SAMHSA). In addition to these sources, information gathered from the National Library of Medicine, the United States Patent Office, the European Union, and their related organizations has been invaluable in the creation of this sourcebook. Some of the work represented was financially supported by the Research and Development Committee at INSEAD. This support is gratefully acknowledged. Finally, special thanks are owed to Tiffany LaRochelle for her excellent editorial support.
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About the Editors James N. Parker, M.D. Dr. James N. Parker received his Bachelor of Science degree in Psychobiology from the University of California, Riverside and his M.D. from the University of California, San Diego. In addition to authoring numerous research publications, he has lectured at various academic institutions. Dr. Parker is the medical editor for the Official Patient’s Sourcebook series published by ICON Health Publications.
Philip M. Parker, Ph.D. Philip M. Parker is the Eli Lilly Chair Professor of Innovation, Business and Society at INSEAD (Fontainebleau, France and Singapore). Dr. Parker has also been Professor at the University of California, San Diego and has taught courses at Harvard University, the Hong Kong University of Science and Technology, the Massachusetts Institute of Technology, Stanford University, and UCLA. Dr. Parker is the associate editor for the Official Patient’s Sourcebook series published by ICON Health Publications.
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About ICON Health Publications In addition to osteoarthritis, Official Patient’s Sourcebooks are available for the following related topics: ·
The Official Patient's Sourcebook on Arthritis of the Knee
·
The Official Patient's Sourcebook on Arthritis of the Shoulder
·
The Official Patient's Sourcebook on Fibromyalgia
·
The Official Patient's Sourcebook on Gout
·
The Official Patient's Sourcebook on Juvenile Rheumatoid Arthritis
·
The Official Patient's Sourcebook on Lupus
·
The Official Patient's Sourcebook on Polymyalgia Rheumatica
·
The Official Patient's Sourcebook on Reiter's Syndrome
·
The Official Patient's Sourcebook on Rheumatoid Arthritis
To discover more about ICON Health Publications, simply check with your preferred online booksellers, including Barnes & Noble.com and Amazon.com which currently carry all of our titles. Or, feel free to contact us directly for bulk purchases or institutional discounts: ICON Group International, Inc. 4370 La Jolla Village Drive, Fourth Floor San Diego, CA 92122 USA Fax: 858-546-4341 Web site: www.icongrouponline.com/health
Contents vii
Table of Contents INTRODUCTION...................................................................................... 1
Overview............................................................................................................... 1 Organization......................................................................................................... 3 Scope ..................................................................................................................... 3 Moving Forward................................................................................................... 4
PART I: THE ESSENTIALS ................................................. 7 CHAPTER 1. THE ESSENTIALS ON OSTEOARTHRITIS: GUIDELINES ...... 9
Overview............................................................................................................... 9 What Is Osteoarthritis? ...................................................................................... 10 Who Is Affected by Osteoarthritis? .................................................................... 11 Osteoarthritis Basics: The Joint and Its Parts .................................................... 12 Cartilage: The Key to Healthy Joints .................................................................. 13 How Do You Know If You Have Osteoarthritis? .............................................. 13 The Warning Signs of Osteoarthritis ................................................................. 14 How Do Doctors Diagnose Osteoarthritis? ....................................................... 15 How Is Osteoarthritis Treated?.......................................................................... 16 Medicines............................................................................................................ 19 Non-Traditional Approaches .............................................................................. 21 Health Professionals Who Treat Osteoarthritis.................................................. 22 Be a Winner! Practice Self-Care and Keep a Good-Health Attitude .................. 23 Current Research ................................................................................................ 25 Comprehensive Treatment Strategies................................................................. 26 Using NSAIDs ................................................................................................... 27 Drugs to Prevent Joint Damage ......................................................................... 27 Acupuncture....................................................................................................... 27 Nutritional Supplements.................................................................................... 28 Hyaluronic Acid ................................................................................................. 28 Estrogen .............................................................................................................. 29 Tissue Engineering............................................................................................. 29 Enzyme Engineering .......................................................................................... 29 Cartilage Cell Replacement................................................................................. 29 Stem Cell Transplantation ................................................................................. 29 Hope for the Future............................................................................................. 30 Additional Resources .......................................................................................... 30 More Guideline Sources ..................................................................................... 31 Vocabulary Builder............................................................................................. 44
CHAPTER 2. SEEKING GUIDANCE ....................................................... 49
Overview............................................................................................................. 49 Associations and Osteoarthritis ......................................................................... 49 Finding More Associations................................................................................. 51 Finding Doctors.................................................................................................. 53
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Finding a Rheumatologist .................................................................................. 54 Selecting Your Doctor ........................................................................................ 55 Working with Your Doctor ................................................................................ 55 Broader Health-Related Resources ..................................................................... 57
CHAPTER 3. CLINICAL TRIALS AND OSTEOARTHRITIS ....................... 59
Overview............................................................................................................. 59 Recent Trials on Osteoarthritis .......................................................................... 62 Benefits and Risks............................................................................................... 73 Keeping Current on Clinical Trials.................................................................... 76 General References.............................................................................................. 77 Vocabulary Builder............................................................................................. 78
PART II: ADDITIONAL RESOURCES AND ADVANCED MATERIAL.................................................. 79 CHAPTER 4. STUDIES ON OSTEOARTHRITIS ........................................ 81
Overview............................................................................................................. 81 The Combined Health Information Database ..................................................... 81 Federally Funded Research on Osteoarthritis .................................................... 90 E-Journals: PubMed Central ............................................................................ 107 The National Library of Medicine: PubMed .................................................... 109 Vocabulary Builder........................................................................................... 128
CHAPTER 5. PATENTS ON OSTEOARTHRITIS ..................................... 133
Overview........................................................................................................... 133 Patents on Osteoarthritis.................................................................................. 134 Patent Applications on Osteoarthritis.............................................................. 145 Keeping Current ............................................................................................... 156 Vocabulary Builder........................................................................................... 157
CHAPTER 6. BOOKS ON OSTEOARTHRITIS ........................................ 161
Overview........................................................................................................... 161 Book Summaries: Federal Agencies .................................................................. 161 Book Summaries: Online Booksellers ............................................................... 163 The National Library of Medicine Book Index ................................................. 167 Chapters on Osteoarthritis ............................................................................... 169 General Home References ................................................................................. 176 Vocabulary Builder........................................................................................... 176
CHAPTER 7. MULTIMEDIA ON OSTEOARTHRITIS .............................. 179
Overview........................................................................................................... 179 Video Recordings .............................................................................................. 179 Bibliography: Multimedia on Osteoarthritis .................................................... 180
CHAPTER 8. PERIODICALS AND NEWS ON OSTEOARTHRITIS ........... 183
Overview........................................................................................................... 183 News Services & Press Releases ....................................................................... 183 Newsletters on Osteoarthritis........................................................................... 193
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Newsletter Articles ........................................................................................... 195 Academic Periodicals covering Osteoarthritis.................................................. 198 Vocabulary Builder........................................................................................... 200
CHAPTER 9. PHYSICIAN GUIDELINES AND DATABASES ................... 201
Overview........................................................................................................... 201 NIH Guidelines................................................................................................. 201 NIH Databases.................................................................................................. 202 Other Commercial Databases ........................................................................... 214 The Genome Project and Osteoarthritis ........................................................... 214 Specialized References....................................................................................... 218 Vocabulary Builder........................................................................................... 220
CHAPTER 10. DISSERTATIONS ON OSTEOARTHRITIS ........................ 221
Overview........................................................................................................... 221 Dissertations on Osteoarthritis ........................................................................ 221 Keeping Current ............................................................................................... 222 Vocabulary Builder........................................................................................... 223
PART III. APPENDICES .................................................. 225 APPENDIX A. RESEARCHING YOUR MEDICATIONS.......................... 227
Overview........................................................................................................... 227 Your Medications: The Basics .......................................................................... 227 Learning More about Your Medications .......................................................... 229 Commercial Databases...................................................................................... 231 Contraindications and Interactions (Hidden Dangers) ................................... 232 A Final Warning .............................................................................................. 233 General References............................................................................................ 233
APPENDIX B. RESEARCHING ALTERNATIVE MEDICINE ................... 235
Overview........................................................................................................... 235 What Is CAM? ................................................................................................. 235 What Are the Domains of Alternative Medicine?............................................ 236 Can Alternatives Affect My Treatment? ......................................................... 239 Finding CAM References on Osteoarthritis..................................................... 240 Additional Web Resources................................................................................ 251 General References............................................................................................ 268 Vocabulary Builder........................................................................................... 269
APPENDIX C. RESEARCHING NUTRITION ......................................... 271
Overview........................................................................................................... 271 Food and Nutrition: General Principles........................................................... 271 Finding Studies on Osteoarthritis.................................................................... 276 Federal Resources on Nutrition........................................................................ 279 Additional Web Resources................................................................................ 280 Vocabulary Builder........................................................................................... 286
APPENDIX D. FINDING MEDICAL LIBRARIES.................................... 289
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Overview........................................................................................................... 289 Preparation ....................................................................................................... 289 Finding a Local Medical Library ...................................................................... 290 Medical Libraries Open to the Public............................................................... 290
APPENDIX E. QUESTIONS AND ANSWERS ABOUT ARTHRITIS PAIN . 297
Overview........................................................................................................... 297 What Is Arthritis? ............................................................................................ 297 What Is Pain? ................................................................................................... 298 What Causes Arthritis Pain? Why Is It So Variable? ..................................... 298 How Do Doctors Measure Arthritis Pain? ...................................................... 299 What Will Happen When You First Visit a Doctor for Your Arthritis Pain? 299 Who Can Treat Arthritis Pain?........................................................................ 300 How Is Arthritis Pain Treated? ....................................................................... 300 Short-Term Relief ............................................................................................. 300 Long-Term Relief .............................................................................................. 301 What Alternative Therapies May Relieve Arthritis Pain? .............................. 303 How Can You Cope with Arthritis Pain? ........................................................ 303 What Research Is Being Conducted on Arthritis Pain?................................... 304 Where Can You Find More Information on Arthritis Pain? ........................... 306
APPENDIX F. MORE ON RHEUMATIC DISEASES AND ARTHRITIS ..... 309
Overview........................................................................................................... 309 What Are Rheumatic Diseases and What Is Arthritis? ................................... 309 Examples of Rheumatic Diseases...................................................................... 310 What Causes Rheumatic Disease?.................................................................... 312 Who Is Affected by Arthritis and Rheumatic Conditions? .............................. 313 What Are the Symptoms of Arthritis? ............................................................. 314 How Are Rheumatic Diseases Diagnosed? ...................................................... 314 Medical History ................................................................................................ 314 Physical Examination....................................................................................... 315 Common Laboratory Tests................................................................................ 315 Work with Your Doctor to Limit Your Pain .................................................... 317 X-Rays and Other Imaging Procedures ........................................................... 318 What Are the Treatments? ............................................................................... 318 Myths about Treating Arthritis ....................................................................... 322 What Can Be Done to Help? ............................................................................ 323 What Is Some of the Current Research Being Done on Arthritis? .................. 323 Where Can I Find More Information about Arthritis? .................................... 326
APPENDIX G. NIH CONSENSUS STATEMENT ON TOTAL HIP REPLACEMENT ................................................................................... 327
Overview........................................................................................................... 327 What Is Total Hip Replacement? ..................................................................... 329 What Are the Current Indications for Total Hip Replacement?...................... 330 What Are the Design and Surgical Considerations Relating to a Replacement Prosthesis? ........................................................................................................ 331
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What Are the Responses of the Biological Environment? ................................ 335 What Are the Expected Outcomes?.................................................................. 337 What Are the Accepted Approaches and Outcomes for Revision of a Total Hip Replacement?.................................................................................................... 340 What Are the Most Productive Directions for Future Research?.................... 342
ONLINE GLOSSARIES.................................................... 345 Online Dictionary Directories.......................................................................... 349
OSTEOARTHRITIS GLOSSARY................................... 351 General Dictionaries and Glossaries ................................................................ 369
INDEX................................................................................... 371
Introduction
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INTRODUCTION Overview Dr. C. Everett Koop, former U.S. Surgeon General, once said, “The best prescription is knowledge.”1 The Agency for Healthcare Research and Quality (AHRQ) of the National Institutes of Health (NIH) echoes this view and recommends that every patient incorporate education into the treatment process. According to the AHRQ: Finding out more about your condition is a good place to start. By contacting groups that support your condition, visiting your local library, and searching on the Internet, you can find good information to help guide your treatment decisions. Some information may be hard to find—especially if you don't know where to look.2 As the AHRQ mentions, finding the right information is not an obvious task. Though many physicians and public officials had thought that the emergence of the Internet would do much to assist patients in obtaining reliable information, in March 2001 the National Institutes of Health issued the following warning: The number of Web sites offering health-related resources grows every day. Many sites provide valuable information, while others may have information that is unreliable or misleading.3
Quotation from http://www.drkoop.com. The Agency for Healthcare Research and Quality (AHRQ): http://www.ahcpr.gov/consumer/diaginfo.htm. 3 From the NIH, National Cancer Institute (NCI): http://cancertrials.nci.nih.gov/beyond/evaluating.html. 1 2
2
Osteoarthritis
Since the late 1990s, physicians have seen a general increase in patient Internet usage rates. Patients frequently enter their doctor's offices with printed Web pages of home remedies in the guise of latest medical research. This scenario is so common that doctors often spend more time dispelling misleading information than guiding patients through sound therapies. The Official Patient’s Sourcebook on Osteoarthritis has been created for patients who have decided to make education and research an integral part of the treatment process. The pages that follow will tell you where and how to look for information covering virtually all topics related to osteoarthritis, from the essentials to the most advanced areas of research. The title of this book includes the word “official.” This reflects the fact that the sourcebook draws from public, academic, government, and peerreviewed research. Selected readings from various agencies are reproduced to give you some of the latest official information available to date on osteoarthritis. Given patients’ increasing sophistication in using the Internet, abundant references to reliable Internet-based resources are provided throughout this sourcebook. Where possible, guidance is provided on how to obtain free-ofcharge, primary research results as well as more detailed information via the Internet. E-book and electronic versions of this sourcebook are fully interactive with each of the Internet sites mentioned (clicking on a hyperlink automatically opens your browser to the site indicated). Hard copy users of this sourcebook can type cited Web addresses directly into their browsers to obtain access to the corresponding sites. Since we are working with ICON Health Publications, hard copy Sourcebooks are frequently updated and printed on demand to ensure that the information provided is current. In addition to extensive references accessible via the Internet, every chapter presents a “Vocabulary Builder.” Many health guides offer glossaries of technical or uncommon terms in an appendix. In editing this sourcebook, we have decided to place a smaller glossary within each chapter that covers terms used in that chapter. Given the technical nature of some chapters, you may need to revisit many sections. Building one’s vocabulary of medical terms in such a gradual manner has been shown to improve the learning process. We must emphasize that no sourcebook on osteoarthritis should affirm that a specific diagnostic procedure or treatment discussed in a research study, patent, or doctoral dissertation is “correct” or your best option. This sourcebook is no exception. Each patient is unique. Deciding on appropriate
Introduction
3
options is always up to the patient in consultation with their physician and healthcare providers.
Organization This sourcebook is organized into three parts. Part I explores basic techniques to researching osteoarthritis (e.g. finding guidelines on diagnosis, treatments, and prognosis), followed by a number of topics, including information on how to get in touch with organizations, associations, or other patient networks dedicated to osteoarthritis. It also gives you sources of information that can help you find a doctor in your local area specializing in treating osteoarthritis. Collectively, the material presented in Part I is a complete primer on basic research topics for patients with osteoarthritis. Part II moves on to advanced research dedicated to osteoarthritis. Part II is intended for those willing to invest many hours of hard work and study. It is here that we direct you to the latest scientific and applied research on osteoarthritis. When possible, contact names, links via the Internet, and summaries are provided. It is in Part II where the vocabulary process becomes important as authors publishing advanced research frequently use highly specialized language. In general, every attempt is made to recommend “free-to-use” options. Part III provides appendices of useful background reading for all patients with osteoarthritis or related disorders. The appendices are dedicated to more pragmatic issues faced by many patients with osteoarthritis. Accessing materials via medical libraries may be the only option for some readers, so a guide is provided for finding local medical libraries which are open to the public. Part III, therefore, focuses on advice that goes beyond the biological and scientific issues facing patients with osteoarthritis.
Scope While this sourcebook covers osteoarthritis, your doctor, research publications, and specialists may refer to your condition using a variety of terms. Therefore, you should understand that osteoarthritis is often considered a synonym or a condition closely related to the following: ·
Arthrosis
·
Degenerative Joint Disease
·
Hypertrophic Osteoarthritis
4
Osteoarthritis
·
Osteoarthrosis
In addition to synonyms and related conditions, physicians may refer to osteoarthritis using certain coding systems. The International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) is the most commonly used system of classification for the world's illnesses. Your physician may use this coding system as an administrative or tracking tool. The following classification is commonly used for osteoarthritis:4 ·
715 osteoarthrosis and allied disorders
·
715.0 osteoarthrosis, generalized
·
715.1 osteoarthrosis, localized, primary
·
715.2 osteoarthrosis, localized, secondary
·
715.3 osteoarthrosis, localized, not specified whether primary or secondary
·
715.8 osteoarthrosis involving, or with mention of more than one site, but not specified as generalized
·
715.9 osteoarthrosis, unspecified whether generalized or localized
For the purposes of this sourcebook, we have attempted to be as inclusive as possible, looking for official information for all of the synonyms relevant to osteoarthritis. You may find it useful to refer to synonyms when accessing databases or interacting with healthcare professionals and medical librarians.
Moving Forward Since the 1980s, the world has seen a proliferation of healthcare guides covering most illnesses. Some are written by patients or their family members. These generally take a layperson's approach to understanding and coping with an illness or disorder. They can be uplifting, encouraging, and highly supportive. Other guides are authored by physicians or other healthcare providers who have a more clinical outlook. Each of these two styles of guide has its purpose and can be quite useful.
This list is based on the official version of the World Health Organization's 9th Revision, International Classification of Diseases (ICD-9). According to the National Technical Information Service, “ICD-9CM extensions, interpretations, modifications, addenda, or errata other than those approved by the U.S. Public Health Service and the Health Care Financing Administration are not to be considered official and should not be utilized. Continuous maintenance of the ICD-9-CM is the responsibility of the federal government.”
4
Introduction
5
As editors, we have chosen a third route. We have chosen to expose you to as many sources of official and peer-reviewed information as practical, for the purpose of educating you about basic and advanced knowledge as recognized by medical science today. You can think of this sourcebook as your personal Internet age reference librarian. Why “Internet age”? All too often, patients diagnosed with osteoarthritis will log on to the Internet, type words into a search engine, and receive several Web site listings which are mostly irrelevant or redundant. These patients are left to wonder where the relevant information is, and how to obtain it. Since only the smallest fraction of information dealing with osteoarthritis is even indexed in search engines, a non-systematic approach often leads to frustration and disappointment. With this sourcebook, we hope to direct you to the information you need that you would not likely find using popular Web directories. Beyond Web listings, in many cases we will reproduce brief summaries or abstracts of available reference materials. These abstracts often contain distilled information on topics of discussion. While we focus on the more scientific aspects of osteoarthritis, there is, of course, the emotional side to consider. Later in the sourcebook, we provide a chapter dedicated to helping you find peer groups and associations that can provide additional support beyond research produced by medical science. We hope that the choices we have made give you the most options available in moving forward. In this way, we wish you the best in your efforts to incorporate this educational approach into your treatment plan. The Editors
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PART I: THE ESSENTIALS
ABOUT PART I Part I has been edited to give you access to what we feel are “the essentials” on osteoarthritis. The essentials of a disease typically include the definition or description of the disease, a discussion of who it affects, the signs or symptoms associated with the disease, tests or diagnostic procedures that might be specific to the disease, and treatments for the disease. Your doctor or healthcare provider may have already explained the essentials of osteoarthritis to you or even given you a pamphlet or brochure describing osteoarthritis. Now you are searching for more in-depth information. As editors, we have decided, nevertheless, to include a discussion on where to find essential information that can complement what your doctor has already told you. In this section we recommend a process, not a particular Web site or reference book. The process ensures that, as you search the Web, you gain background information in such a way as to maximize your understanding.
Guidelines
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CHAPTER 1. THE ESSENTIALS ON OSTEOARTHRITIS: GUIDELINES Overview Official agencies, as well as federally funded institutions supported by national grants, frequently publish a variety of guidelines on osteoarthritis. These are typically called “Fact Sheets” or “Guidelines.” They can take the form of a brochure, information kit, pamphlet, or flyer. Often they are only a few pages in length. The great advantage of guidelines over other sources is that they are often written with the patient in mind. Since new guidelines on osteoarthritis can appear at any moment and be published by a number of sources, the best approach to finding guidelines is to systematically scan the Internet-based services that post them.
The National Institutes of Health (NIH)5 The National Institutes of Health (NIH) is the first place to search for relatively current patient guidelines and fact sheets on osteoarthritis. Originally founded in 1887, the NIH is one of the world's foremost medical research centers and the federal focal point for medical research in the United States. At any given time, the NIH supports some 35,000 research grants at universities, medical schools, and other research and training institutions, both nationally and internationally. The rosters of those who have conducted research or who have received NIH support over the years include the world's most illustrious scientists and physicians. Among them are 97 scientists who have won the Nobel Prize for achievement in medicine.
5
Adapted from the NIH: http://www.nih.gov/about/NIHoverview.html.
10 Osteoarthritis
There is no guarantee that any one Institute will have a guideline on a specific disease, though the National Institutes of Health collectively publish over 600 guidelines for both common and rare diseases. The best way to access NIH guidelines is via the Internet. Although the NIH is organized into many different Institutes and Offices, the following is a list of key Web sites where you are most likely to find NIH clinical guidelines and publications dealing with osteoarthritis and associated conditions: ·
Office of the Director (OD); guidelines consolidated across agencies available at http://www.nih.gov/health/consumer/conkey.htm
·
National Library of Medicine (NLM); extensive encyclopedia (A.D.A.M., Inc. ) with guidelines available at http://www.nlm.nih.gov/medlineplus/healthtopics.html
·
National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS); fact sheets and guidelines at http://www.nih.gov/niams/healthinfo/
Among those listed above, the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) is especially noteworthy. The mission of NIAMS, a part of the National Institutes of Health (NIH), is to support research into the causes, treatment, and prevention of arthritis and musculoskeletal and skin diseases, the training of basic and clinical scientists to carry out this research, and the dissemination of information on research progress in these diseases. The National Institute of Arthritis and Musculoskeletal and Skin Diseases Information Clearinghouse is a public service sponsored by the NIAMS that provides health information and information sources. The NIAMS provides the following guideline concerning osteoarthritis.6
What Is Osteoarthritis?7 Osteoarthritis (AH-stee-oh-ar-THREYE-tis) is the most common type of arthritis, especially among older people. Sometimes it is called degenerative joint disease or osteoarthrosis. Osteoarthritis is a joint disease that mostly affects the cartilage (KAR-til-uj). Cartilage is the slippery tissue that covers the ends of bones in a joint. 6This
and other passages are adapted from the NIH and NIAMS (http://www.niams.nih.gov/hi/index.htm). “Adapted” signifies that the text is reproduced with attribution, with some or no editorial adjustments. 7 Adapted from The National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS): http://www.niams.nih.gov/hi/topics/arthritis/oahandout.htm.
Guidelines 11
Healthy cartilage allows bones to glide over one another. It also absorbs energy from the shock of physical movement. In osteoarthritis, the surface layer of cartilage breaks down and wears away. This allows bones under the cartilage to rub together, causing pain, swelling, and loss of motion of the joint. Over time, the joint may lose its normal shape. Also, bone spurs--small growths called osteophytes--may grow on the edges of the joint. Bits of bone or cartilage can break off and float inside the joint space. This causes more pain and damage. People with osteoarthritis usually have joint pain and limited movement. Unlike some other forms of arthritis, osteoarthritis only affects joints, and not internal organs. For example, rheumatoid arthritis--the second most common form of arthritis--affects other parts of the body besides the joints. It begins earlier than osteoarthritis, causes inflammation, and may make people feel sick, tired, and sometimes feverish.
Who Is Affected by Osteoarthritis? Osteoarthritis is one of the most frequent causes of physical disability among adults. More than 20 million people in the United States probably have the disease. Some younger people get osteoarthritis from a joint injury, but osteoarthritis most often occurs in older people. In fact, by age 65, more than half of the population has x-ray evidence of osteoarthritis in at least one joint. Since the number of older Americans is increasing, so is the number of people with osteoarthritis. Both men and women have the disease. Before age 45, more men have it, while after age 45 osteoarthritis is more common in women.
How Does Osteoarthritis Affect People? Osteoarthritis affects each person differently. In some people, it progresses more quickly; in others, the symptoms are more serious. Scientists do not yet know what causes the disease, but they suspect a combination of factors in the body and in the environment. Also, diet, weight, and stresses on the joints from certain jobs affect the disease and how a person reacts to it. Osteoarthritis hurts people in more than their joints--their finances and lifestyles are also affected. Financial effects include: ·
The cost of treatment
12 Osteoarthritis
·
Wages lost because of disability.
Lifestyle effects include: ·
Depression
·
Anxiety
·
Feelings of helplessness
·
Limits on daily activities
·
Job limitations
·
Loss of everyday family joys and responsibilities.
Despite these challenges, most people with osteoarthritis can lead active and productive lives. They succeed by using osteoarthritis treatment strategies such as: ·
Pain relief medications
·
Rest and exercise
·
Patient education and support programs
·
Learning self-care and having a “good-health attitude.”
Osteoarthritis Basics: The Joint and Its Parts Most joints--the place where two moving bones come together--are designed to protect bone ends from wearing away and to absorb shock from movements like walking or repetitive movements. The joint includes: ·
Cartilage. A hard but slippery coating on the end of each bone. Cartilage, which breaks down and wears away in osteoarthritis, is described in more detail in the box below.
·
Joint capsule. A tough membrane sac that holds all the bones and other joint parts together.
·
Synovium (sin-O-vee-um). A thin membrane inside the joint capsule.
·
Synovial fluid. A fluid that lubricates the joint and keeps the cartilage smooth and healthy.
·
Muscles, ligaments, and tendons. Together, muscles and connective tissues keep the bones stable and allow the joint to bend and move. Ligaments are tough, cord-like tissues that connect one bone to another. Tendons are tough, fibrous cords that connect muscles to bones.
Guidelines 13
Cartilage: The Key to Healthy Joints Cartilage is 65 to 80 percent water. Three other substances make up the rest of cartilage tissue: collagen, proteoglycans, and chondrocytes. ·
Collagen (KAHL-uh-jen). A fibrous protein. Collagen is also the building block of skin, tendon, bone, and other connective tissues.
·
Proteoglycans (PRO-tee-uh-GLY-kanz). A combination of proteins and sugars. Strands of proteoglycans and collagen weave together and form a mesh-like tissue. This allows cartilage to flex and absorb physical shock.
·
Chondrocytes (KAHN-druh-sytz). Cells that grow all through the cartilage. They mainly help cartilage stay healthy and grow. Sometimes, however, they release substances called enzymes that destroy collagen and other proteins. Researchers are trying to learn more about chondrocytes.
How Do You Know If You Have Osteoarthritis? Usually, osteoarthritis comes on slowly. Early in the disease, joints may ache after physical work or exercise. Osteoarthritis can occur in any joint. Most often it occurs at the hands, hips, knees, or spine.
Hands Osteoarthritis of the fingers is the one type of the disease that seems to be hereditary; that is, it runs in families. More women than men have it, especially after menopause. Small, bony knobs appear on the end joints of the fingers. They are called Heberden's nodes. Similar knobs (called Bouchard's [boo-SHARDZ] nodes) can appear on the middle joints of the fingers. Fingers can become enlarged and gnarled, and may ache or be stiff and numb. The base of the thumb joint is also commonly affected by osteoarthritis. This kind of osteoarthritis can be helped by medications, splints, or heat treatment.
14 Osteoarthritis
Knees The knees are the body's primary weight-bearing joints. For this reason, they are among the joints most commonly affected by osteoarthritis. They may be stiff, swollen, and painful, making it hard to walk, climb, get in and out of chairs, and use bathtubs. If not treated, osteoarthritis in the knees can lead to disability. Medications, losing weight, exercise, and walking aids can reduce pain and disability. In severe cases, knee replacement surgery may be helpful.
Hips Osteoarthritis in the hip can cause pain, stiffness, and severe disability. People may feel the pain in their hips, or in their groin, inner thigh, or knees. Walking aids such as canes or walkers can reduce stress on the hip. Osteoarthritis in the hip may limit moving and bending. This can make daily activities such as dressing and foot care a challenge. Walking aids, medication, and exercise can help relieve pain and improve motion. The doctor may recommend hip replacement if the pain is severe and not helped by other methods.
Spine Stiffness and pain in the neck or in the lower back can result from osteoarthritis of the spine. Weakness or numbness of the arms or legs can also result. Some people feel better when they sleep on a firm mattress or sit using back support pillows. Others find help from heat treatment or an exercise program to strengthen the back and abdominal muscles. In severe cases, the doctor may suggest surgery to reduce pain and help restore function.
The Warning Signs of Osteoarthritis ·
Steady or intermittent pain in a joint
·
Stiffness after getting out of bed
·
Joint swelling or tenderness in one or more joints
·
A crunching feeling or sound of bone rubbing on bone
Guidelines 15
·
Hot, red, or tender? Probably not osteoarthritis. Check with your doctor about other causes, such as rheumatoid arthritis.
·
Not always pain. Not everyone with osteoarthritis feels pain. In fact, only a third of people with osteoarthritis in their X-rays report pain or other symptoms.
How Do Doctors Diagnose Osteoarthritis? No single test can diagnose osteoarthritis. Most doctors use a combination of the following methods to diagnose the disease and rule out other conditions.
Clinical History The doctor begins by asking the patient to describe the symptoms, and when and how the condition started. Good doctor-patient communication is important. The doctor can give a better assessment if the patient gives a good description of pain, stiffness, and joint function, and how they changed over time. It is also important for the doctor to know how the condition is affecting the patient's work and daily life. Finally, the doctor also needs to know about other medical conditions and whether the patient is taking any medicines.
Physical Examination The doctor will check the patient's general health. Joints bothering the patient will be examined, including checking reflexes and muscle strength. The doctor will also observe the patient's ability to walk, bend, and carry out activities of daily living.
X-Rays Doctors take x rays to see how much joint damage has been done. X rays of the affected joint can show such things as cartilage loss, bone damage, and bone spurs. But there is often a big difference between the severity of osteoarthritis that the x ray shows and the degree of pain and disability the patient has. And x rays may not show early osteoarthritis damage (before much cartilage loss has taken place).
16 Osteoarthritis
Other Tests The doctor may order blood tests to determine the cause of symptoms. Another common test includes “joint aspiration,” where fluid is drawn from the joint for examination. It is usually not difficult to tell if a patient has osteoarthritis. It is more difficult to tell if the disease is causing the patient's symptoms. Osteoarthritis is so common, especially in older people, that other conditions may play a role in the symptoms. The doctor will try to find out what is causing the symptoms, ruling out other disorders and identifying conditions that may make the symptoms worse. The severity of symptoms in osteoarthritis is greatly influenced by the patient's attitudes, anxiety, depression, or daily activity level.
How Is Osteoarthritis Treated? Most successful treatment programs involve a combination of treatments tailored to the patient's needs, lifestyle, and health. Osteoarthritis treatment has four general goals: ·
Control pain through drugs and other measures.
·
Improve joint care through rest and exercise.
·
Maintain an acceptable body weight.
·
Achieve a healthy lifestyle.
Osteoarthritis treatment plans often include ways to manage pain and improve function. Such plans can involve exercise, rest and joint care, pain relief, weight control, medications, surgery, and nontraditional treatment approaches. Treatment approaches to osteoarthritis include: ·
Exercise
·
Rest and joint care
·
Surgery
·
Pain relief techniques
·
Weight control
Guidelines 17
·
Medicines
·
Alternative therapies
Exercise Research shows that one of the best treatments for osteoarthritis is exercise. This activity can improve mood and outlook, decrease pain, increase flexibility, improve the heart and blood flow, maintain weight, and promote general physical fitness. It is also inexpensive and, if done correctly, has few negative side effects. The amount and form of exercise will depend on which joints are involved, how stable the joints are, and whether a joint replacement has already been done. You can use exercises to keep strong and limber, extend your range of movement, and reduce weight. Ask your doctor or physical therapist what exercises are best for you. ·
Strength: Exercise bands are inexpensive devices that add resistance.
·
Aerobics: Activities that keep your lungs and circulation systems in shape.
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Range of Motion: These activities keep the joints limber.
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Agility: Many of these exercises help you to maintain daily living skills.
·
Neck and Back Strength: Don't forget to keep your spine strong and limber.
Ask your doctor or physical therapist what exercises are best for you. Ask for guidelines on exercising when a joint is sore or if swelling is present. Also, check if you should (1) use drugs such as analgesics or anti-inflammatories (NSAIDs) to make exercising easier, or (2) use ice afterwards.
Rest and Joint Care Treatment plans include regularly scheduled rest. Patients must learn to recognize the body's signals, and know when to stop or slow down. This prevents pain caused by overexercising. Some patients find that relaxation techniques, stress reduction, and biofeedback help. Some use canes and splints to protect joints and take pressure off them. Splints or braces provide extra support for weakened joints. They also keep the joint in proper position during sleep or activity. Splints must be used for limited periods because
18 Osteoarthritis
joints and muscles need to be exercised to prevent stiffness and weakness. An occupational therapist or a doctor can help the patient get a properly fitting splint. Surgery For some people, surgery helps relieve the pain and disability of osteoarthritis. Surgery may be performed to: ·
Resurface (smooth out) bones.
·
Reposition bones.
·
Replace joints. Surgeons may replace affected joints with artificial joints called prostheses. These joints can be made from metal alloys, highdensity plastic, and ceramic material, and can be joined to bone surfaces by special cements. Artificial joints can last from 10 to 15 years or more. About 10 percent may need revision. Surgeons choose the design and components of prostheses according to their patient's weight, sex, age, activity level, and other medical conditions.
·
Remove loose pieces of bone or cartilage from the joint to improve joint function.
The decision to use surgery depends on several things. Both surgeon and patient consider the patient's level of disability, intensity of pain, interference with lifestyle, age, and occupation. Currently, more than 80 percent of osteoarthritis surgery cases involve replacing the hip or knee joint. After surgery and rehabilitation, the patient usually feels less pain and swelling, and can move more easily.
Pain Relief People with osteoarthritis may have nonmedical ways to relieve pain. Patients can use warm towels, hot packs, or a warm bath or shower to apply moist heat to the joint. This can relieve pain and stiffness. In some cases, cold packs (a bag of ice or frozen vegetables wrapped in a towel) can relieve pain or numb the sore area. (Check with a doctor or physical therapist to find out if heat or cold is the best treatment.) Water therapy in a heated pool or whirlpool may also relieve pain and stiffness. For osteoarthritis in the knee, patients may wear insoles or cushioned shoes to redistribute weight and reduce joint stress.
Guidelines 19
Weight Control Osteoarthritis patients who are overweight or obese need to lose weight. Weight loss can reduce stress on weight-bearing joints and limit further injury. A dietician can help patients develop healthy eating habits. A healthy diet and regular exercise help reduce weight.
Medicines Doctors use medicines to eliminate or reduce pain and to improve functioning. Doctors consider a number of factors when choosing medicines for their patients with osteoarthritis. Two important factors are the nature of the pain and potential drug side effects. Patients must use medicines carefully and tell doctors about any changes that occur. The following types of medicines are commonly used in treating osteoarthritis.
NSAIDs (Nonsteroidal Anti-Inflammatory Drugs) Many NSAIDs are used to treat osteoarthritis. Patients can buy some over the counter (for example, aspirin, Advil®8, Motrin® IB, Aleve®, ketoprofen). Others need a prescription. These drugs work in a similar way: they fight inflammation or swelling and relieve pain. However, each NSAID is a different chemical, and has slightly different effects in the body. Side effects of NSAIDs include: ·
NSAIDs can cause stomach irritation or affect kidney function. The longer a person uses NSAIDs, the more likely he or she is to have side effects, and the more serious those effects can be.
·
Many other drugs cannot be taken with NSAIDs, because NSAIDs alter the way the body uses or gets rid of these drugs.
·
NSAIDs are associated with serious gastrointestinal problems, including ulcers, bleeding, and perforation. They should be used with caution in
Brand names included in this booklet are provided as examples only. Their inclusion does not mean they are endorsed by the National Institutes of Health or any other Government agency. Also, if a certain brand name is not mentioned, this does not mean or imply that the product is unsatisfactory.
8
20 Osteoarthritis
people over 65 and in those with any history of ulcers or gastrointestinal bleeding.
COX-2 Inhibitors Two new NSAIDs, Celebrex® and Vioxx®, from a class of drugs known as COX-2 inhibitors, are now being used against osteoarthritis. These medicines reduce inflammation like traditional NSAIDs, but cause fewer gastrointestinal side effects.
Acetaminophen A non-anti-inflammatory pain reliever (for example, Tylenol®). This drug does not irritate the stomach and is less likely than NSAIDs to cause longterm side effects. Research has shown that in many patients with osteoarthritis, acetaminophen relieves pain as effectively as NSAIDs.9
Other Medicines Doctors may prescribe several other medicines for osteoarthritis. They include: ·
Topical pain-relieving creams, rubs, and sprays (for example, capsaicin cream) applied directly to the skin.
·
Mild narcotic painkillers, which--while very effective--are addictive and rarely used.
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Corticosteroids, powerful anti-inflammatory hormones made naturally in the body or man made for use as drugs. Corticosteroids are typically injected into affected joints to relieve pain temporarily. This is a shortterm measure, not recommended for more than two or three times per year.
·
Hyaluronic acid, a new medicine for joint injection, used to treat osteoarthritis of the knee. This substance is a normal component of the joint, involved in joint lubrication and nutrition. Many patients experience pain relief after a series of three to five injections.
Warning: Patients with liver disease, heavy alcohol drinkers, and those on blood-thinning medicines should use acetaminophen with caution.
9
Guidelines 21
Questions to Ask Your Doctor or Pharmacist about Medicines ·
How often should I take this medicine?
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Should I take this medicine with food or between meals?
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What side effects can I expect?
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Should I take this medicine with other prescription medicines I take?
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Should I take this medicine with the over-the-counter medicines I take?
Side Effects Most medicines used to treat osteoarthritis have side effects. So it is important for patients to learn about the drugs they are taking. Even nonprescription drugs should be checked. Several groups of patients are at high risk for side effects. Those patients are people with a history of peptic ulcers or digestive tract bleeding, those taking oral corticosteroids or anticoagulants (blood thinners), those who smoke, and those who consume alcohol. Some patients may be able to help reduce side effects by taking some drugs with food. Others should avoid stomach irritants such as alcohol, tobacco, and caffeine. Some patients take other medicines to try to protect their stomachs by coating the stomach or blocking stomach acids. These measures help, but are not always completely effective.
Non-Traditional Approaches Among the alternative therapies for treating osteoarthritis are: ·
Acupuncture
·
Folk remedies
Acupuncture Some people have found pain relief using acupuncture (the use of fine needles inserted at specific points on the skin). Preliminary research shows that acupuncture may be a useful component in an osteoarthritis treatment plan for some patients.
22 Osteoarthritis
Folk Remedies Some patients seek alternative therapies for their pain and disability. Some of these alternative therapies have included wearing copper bracelets, drinking herbal teas, and taking mud baths. While these practices are not harmful, some can be expensive. They also cause delays in seeking medical treatment. To date, no scientific research shows these approaches to be helpful in treating osteoarthritis.
Health Professionals Who Treat Osteoarthritis Many types of health professionals care for people with osteoarthritis: ·
Rheumatologists. Doctors who specialize in treating arthritis and related conditions that affect joints, muscles, and bones.
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Orthopaedists. Doctors who specialize in treatment of and surgery for bone diseases.
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Physical therapists. Health professionals who work with patients to improve joint function.
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Occupational therapists. Health professionals who teach ways to protect joints, minimize pain, and conserve energy.
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Dietitians. Health professionals who teach ways to use a good diet to improve health and maintain a healthy weight.
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Nurse educators. Nurses who specialize in helping patients understand their overall condition and implement their treatment plans.
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Physiatrists (rehabilitation specialists). Doctors who help patients make the most of their physical potential.
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Licensed acupuncture therapists. Health professionals who reduce pain and improve physical functioning by inserting fine needles into the skin at various points on the body.
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Psychologists. Health professionals who help patients cope with difficulties in the home and workplace resulting from their conditions.
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Social workers. Professionals who assist patients with social challenges caused by disability, unemployment, financial hardships, home health care, and other needs resulting from their conditions.
Guidelines 23
Be a Winner! Practice Self-Care and Keep a Good-Health Attitude People with osteoarthritis can enjoy good health despite having the disease. How? By learning self-care skills and developing a good-health attitude. Self-care is central to successfully managing the pain and disability of osteoarthritis. Patients have a much better chance for a rewarding lifestyle when they educate themselves about the disease and take part in their own care. Working actively with a team of health care providers enables people with the disease to minimize pain, share in decision-making about treatment, and feel a sense of control over their lives. Research shows that patients who take part in their own care report less pain and make fewer doctor visits. They also enjoy a better quality of life. Self-Management Programs People with osteoarthritis find that self-management programs help them: ·
Understand the disease
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Reduce pain while remaining active
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Cope physically, emotionally, and mentally
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Have greater control over the disease
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Build confidence in their ability to live an active, independent life.
Self-Help and Education Programs Three kinds of programs help people learn about osteoarthritis, learn selfcare, and improve their good-health attitude. These programs are: ·
Patient education programs
·
Arthritis self-management programs
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Arthritis support groups.
These programs teach about osteoarthritis, its treatments, exercise and relaxation, patient/health care provider communication, and problem solving. Research has shown that these programs have clear and long-lasting benefits.
24 Osteoarthritis
Enjoy a Good-Health Attitude ·
Focus on your abilities instead of disabilities.
·
Focus on your strengths instead of weaknesses.
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Break down activities into small tasks that you can manage.
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Incorporate fitness and nutrition into daily routines.
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Develop methods to minimize and manage stress.
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Balance rest with activity.
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Develop a support system of family, friends, and health professionals.
Exercise Regular physical activity plays a key role in self-care and wellness. Two types of exercise are important in osteoarthritis management. Therapeutic exercises keep joints working as well as possible. Aerobic conditioning exercises improve strength and fitness, and control weight. Patients should be realistic when they start exercising. They should learn how to exercise correctly, because exercising incorrectly can actually cause problems. Most people with osteoarthritis exercise best when pain is least severe. Start with an adequate warmup and begin exercising slowly. Resting frequently ensures a good workout. It also reduces the risk of injury. A physical therapist can evaluate how a patient's muscles are working. This information helps the therapist develop a safe, personalized exercise program to increase strength and flexibility. Many people enjoy sports or other activities in their exercise program. Good activities include swimming and aquatic exercise, walking, running, biking, cross-country skiing, and using exercise machines and exercise videotapes. People with osteoarthritis should check with their doctor or physical therapist before embarking on an exercise program. Health care providers will suggest what exercises are best for you, how to warm up safely, and when to avoid exercising a joint affected by arthritis. Pain medications and ice applications may make exercising easier.
Guidelines 25
Body, Mind, Spirit Making the most of good health requires careful attention to the body, mind, and spirit. People with osteoarthritis must plan and develop daily routines that maximize their quality of life and minimize disability. They also need to evaluate these routines periodically to make sure they are working well. Good health also requires a positive attitude. People must decide to make the most of things when faced with the challenges of osteoarthritis. This attitude--a good-health mindset--doesn't just happen. It takes work, every day. And with the right attitude, you will enjoy it.
Current Research The leading role in osteoarthritis research is played by the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), within the National Institutes of Health (NIH). The NIAMS funds many researchers across the United States to study osteoarthritis. It has established a Specialized Center of Research devoted to osteoarthritis. Also, a large number of researchers study arthritis at the NIAMS Multipurpose Arthritis and Musculoskeletal Disease Centers. These centers conduct basic, laboratory, and clinical research aimed at understanding the causes, treatment options, and prevention of arthritis and musculoskeletal diseases. Center researchers also study professional, patient, and public education; epidemiology; and health services. For years, scientists thought that osteoarthritis was simply a disease of “wear and tear” that occurred in joints as people got older. In the last decade, however, research has shown that there is more to the disorder than aging alone. The production, maintenance, and breakdown of cartilage, as well as bone changes in osteoarthritis, are now seen as a series or “cascade” of events. Many researchers are trying to discover where in that cascade of events things go wrong. By understanding what goes wrong, they hope to find new ways to prevent or treat osteoarthritis. Some key areas of research are described below.
Animal Models Animals help researchers understand how diseases work and why they occur. In osteoarthritis, animal models help researchers learn many things about osteoarthritis. They help reveal what happens to cartilage, how
26 Osteoarthritis
treatment strategies might work, and what might prevent the disease. Animal models also help scientists study osteoarthritis in very early stages, before it causes joint damage. Diagnostic Tools Some scientists want to find ways to detect osteoarthritis at earlier stages so that they can treat it earlier. They seek specific abnormalities in the blood, joint fluid, or urine of people with the disease. Other scientists use new technologies to analyze differences in cartilage from different joints. For example, many people have osteoarthritis in the knees or hips, but few have it in their ankles. Can ankle cartilage be different? Does it age differently? Answering these questions will help us understand the disease better.
Genetic Studies Researchers suspect that inheritance plays a role in 25 to 30 percent of osteoarthritis cases. Scientists have identified a mutation (a gene defect) affecting collagen, an important part of cartilage in patients with an inherited kind of osteoarthritis that starts at an early age. The mutation weakens collagen protein, which may break or tear more easily under stress. Scientists are looking for other mutations in osteoarthritis. In the future, a test to determine who carries the genetic defect (or defects) could help people reduce their risk for osteoarthritis with lifestyle adjustments.
Comprehensive Treatment Strategies Effective treatment for osteoarthritis takes more than drugs or surgery. Getting help from a variety of care professionals can often improve patient treatment and self-care. Research shows that adding patient education and social support is a low-cost, effective way to decrease pain and reduce the amount of medicine used. Exercise plays a key part in comprehensive treatment. Researchers are studying exercise in greater detail, finding out just how to use it in treating or preventing osteoarthritis. For example, several scientists have looked at knee osteoarthritis and exercise. They have found that
Guidelines 27
·
The level of muscle strength in the thigh muscle (quadriceps) is very important. Strengthening this muscle can relieve symptoms and prevent more damage.
·
Walking can result in better functioning and increased walking distance.
·
People with knee osteoarthritis who were active in an exercise program feel less pain. They also function better.
Research has shown that losing extra weight can help people with osteoarthritis. Most important, weight loss may reduce the risk of developing osteoarthritis of the knee in overweight or obese people.
Using NSAIDs Many patients have pain that persists despite the use of simple pain relievers like acetaminophen. Some of these patients use NSAIDs instead. Health care providers are concerned about long-term NSAID use because dangerous side effects can result. Scientists are working to design and test new, safer NSAIDs. One example currently available is a class of drugs called COX-2 inhibitors. These medicines relieve symptoms and are less likely to produce serious side effects such as stomach ulcers and bleeding, which are associated with long-term NSAID use.
Drugs to Prevent Joint Damage No treatment actually prevents osteoarthritis or reverses or blocks the disease process once it begins. Present treatments just relieve the symptoms. Researchers are looking for drugs that would prevent, slow down, or reverse joint damage. One experimental antibiotic drug, doxycycline, may stop certain enzymes from damaging cartilage. The drug has responded well in clinical studies, but more studies are needed. Researchers are also studying growth factors or other natural chemical messengers. These potential medicines may be able to stimulate cartilage growth or repair.
Acupuncture Licensed acupuncture therapists insert very fine needles into the skin at various points on the body. Scientists think that the needles stimulate the release of natural, pain-relieving chemicals produced by the brain or the
28 Osteoarthritis
nervous system. Researchers are looking at acupuncture treatment of patients who have knee osteoarthritis. Early findings suggest that traditional Chinese acupuncture is effective in some patients as an additional therapy for osteoarthritis, reducing pain and improving function.
Nutritional Supplements Nutritional supplements are often reported as helpful in treating osteoarthritis. Such reports should be viewed with caution, however, since very few studies have carefully evaluated the role of nutritional supplements in osteoarthritis.
Glucosamine and Chondroitin Sulfate Both of these nutrients are found in small quantities in food and are components of normal cartilage. Scientific studies on these two nutritional supplements have not yet shown that they affect the disease. They may relieve symptoms in some patients, however. The National Center for Complementary and Alternative Medicine at NIH is supporting a clinical trial to test whether either glucosamine or chondroitin sulfate alone, or in combination with each other, reduces pain and improves function. Patients using this therapy should do so only under the supervision of their doctor, as part of an overall treatment program with exercise, relaxation, and pain relief.
Vitamins D and C Progression of the disease appears to be less in patients with high levels of vitamin D or C intake. More studies are needed to confirm these reports.
Hyaluronic Acid Injecting this substance into the knee joint provides long-term pain relief for some people with osteoarthritis. Hyaluronic acid is a natural component of cartilage and joint fluid. It lubricates and absorbs shock in the joint. The Food and Drug Administration (FDA) recently approved this therapy for patients with osteoarthritis of the knee if they do not get relief from exercise, physical
Guidelines 29
therapy, or simple analgesics. Researchers are testing whether hyaluronic acid can slow down the progression of osteoarthritis.
Estrogen In studies of older women, scientists found a lower risk of osteoarthritis in women who had used oral estrogens for hormone replacement therapy. The researchers suspect that low estrogen levels could increase risk for the disease. Further studies are needed to answer this question.
Tissue Engineering This technology involves removing cells from the body and replacing them to improve certain body functions. NIAMS researchers are exploring three types of tissue engineering for use in treating osteoarthritis.
Enzyme Engineering Certain body chemicals called enzymes may help cartilage break down. Scientists are working to genetically engineer cells that would inhibit these enzymes and prevent the damage they cause. Cells are removed from the body, genetically changed, and then injected back into the affected joint. They live in the joint and protect it from damaging enzymes.
Cartilage Cell Replacement Researchers remove cartilage cells from the patient's own joint, clone or grow new cells using tissue culture and other laboratory techniques, and inject the newly grown cells into the patient's joint. Patients with cartilage cell replacement have decreased osteoarthritis symptoms. Actual cartilage repair is limited, however.
Stem Cell Transplantation Stem cells are primitive cells that can transform into other kinds of cells, such as muscle or bone cells. They are usually taken from bone marrow. In the
30 Osteoarthritis
future, researchers hope to insert stem cells into cartilage where they will make new cartilage. If successful, this process could be used to repair damaged cartilage and avoid the need for surgical joint replacements with metal or plastics.
Hope for the Future Research is opening up new avenues of treatment for people with osteoarthritis. A balanced, comprehensive approach is still the key to staying active and healthy with the disease. People with osteoarthritis should combine exercise, relaxation education, social support, and medicines in their treatment strategies. Meanwhile, as scientists unravel the complexities of the disease, new treatments and prevention methods should appear. They will improve the quality of life for people with osteoarthritis and their families.
Additional Resources National Institute of Arthritis and Musculoskeletal and Skin Diseases Information Clearinghouse National Institutes of Health 1 AMS Circle Bethesda, MD 20892-3675 (301) 495-4484 or (877) 22-NIAMS (toll free) TTY: (301) 565-2966 Fax: (301) 718-6366 NIAMS Fast Facts-For health information that is available by fax 24 hours a day, call (301) 881-2731 from a fax machine telephone. http://www.niams.nih.gov/ This clearinghouse, a public service sponsored by the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), provides information about various forms of arthritis and rheumatic diseases. The clearinghouse distributes patient and professional education materials and also refers people to other sources of information.
Guidelines 31
Arthritis Foundation 1330 West Peachtree Street Atlanta, GA 30309 (404) 872-7100 (800) 283-7800, or call your local chapter (listed in the telephone directory) http://www.arthritis.org/ This is the main voluntary organization devoted to arthritis. The foundation publishes a free pamphlet on osteoarthritis and a magazine for members on arthritis and related conditions. It also provides up-todate information on research and treatment, nutrition, alternative therapies, and self-management strategies. Chapters nationwide offer exercise programs, classes, support groups, physician referral services, and free literature. American College of Rheumatology 1800 Century Place, Suite 250 Atlanta, GA 30345 (404) 633-3777 Fax: (404) 633-1870 http://www.rheumatology.org/ This association provides referrals to rheumatologists and physical and occupational therapists who have experience working with people who have osteoarthritis. The organization also provides educational materials and guidelines.
More Guideline Sources The guideline above on osteoarthritis is only one example of the kind of material that you can find online and free of charge. The remainder of this chapter will direct you to other sources which either publish or can help you find additional guidelines on topics related to osteoarthritis. Many of the guidelines listed below address topics that may be of particular relevance to your specific situation or of special interest to only some patients with osteoarthritis. Due to space limitations these sources are listed in a concise manner. Do not hesitate to consult the following sources by either using the Internet hyperlink provided, or, in cases where the contact information is provided, contacting the publisher or author directly.
32 Osteoarthritis
Topic Pages: MEDLINEplus For patients wishing to go beyond guidelines published by specific Institutes of the NIH, the National Library of Medicine has created a vast and patientoriented healthcare information portal called MEDLINEplus. Within this Internet-based system are “health topic pages.” You can think of a health topic page as a guide to patient guides. To access this system, log on to http://www.nlm.nih.gov/medlineplus/healthtopics.html. From there you can either search using the alphabetical index or browse by broad topic areas. Recently, MEDLINEplus listed the following as being relevant to osteoarthritis: ·
Guides on Osteoarthritis Osteoarthritis http://www.nlm.nih.gov/medlineplus/osteoarthritis.html Osteoarthritis http://www.nlm.nih.gov/medlineplus/tutorials/osteoarthritisloade r.html
·
Other Guides Arthritis http://www.nlm.nih.gov/medlineplus/arthritis.html Hip Injuries and Disorders http://www.nlm.nih.gov/medlineplus/hipinjuriesanddisorders.htm l Juvenile Rheumatoid Arthritis http://www.nlm.nih.gov/medlineplus/juvenilerheumatoidarthritis. html Knee Injuries and Disorders http://www.nlm.nih.gov/medlineplus/kneeinjuriesanddisorders.ht ml Rheumatoid Arthritis http://www.nlm.nih.gov/medlineplus/rheumatoidarthritis.html
Guidelines 33
Within the health topic page dedicated to osteoarthritis, the following was recently recommended to patients: ·
General/Overviews Osteoarthritis Source: Arthritis Foundation http://www.arthritis.org/conditions/DiseaseCenter/oa.asp Osteoarthritis Source: Patient Education Institute http://www.nlm.nih.gov/medlineplus/tutorials/osteoarthritisloade r.html
·
Diagnosis/Symptoms Bone Radiography Source: American College of Radiology, Radiological Society of North America http://www.radiologyinfo.org/content/bone_radiography.htm
·
Treatment 2003 Drug Guide Source: Arthritis Foundation http://www.arthritis.org/conditions/DrugGuide/default.asp Arthritic Disorders and Treatments Source: American College of Foot and Ankle Surgeons http://www.acfas.org/brarthdis.html Arthritis: Timely Treatments for an Ageless Disease Source: Food and Drug Administration http://www.fda.gov/fdac/features/2000/300_arth.html FDA Approves New Indication and Label Changes for the Arthritis Drug, Vioxx Source: Food and Drug Administration http://www.fda.gov/bbs/topics/ANSWERS/2002/ANS01145.html
34 Osteoarthritis
Help Your Arthritis Treatment Work Source: img src='/medlineplus/images/easyread.gif' width='79' height='17' border=0 alt='Easy-to-Read'> (Food and Drug Administration http://www.fda.gov/opacom/lowlit/arthrtis.html Injections (for Pain Control) Source: Mayo Foundation for Medical Education and Research http://www.mayoclinic.com/invoke.cfm?id=PN00046 New Arthritis Drugs for Rheumatoid Arthritis and Osteoarthritis Source: National Institute of Arthritis and Musculoskeletal and Skin Diseases http://www.niams.nih.gov/hi/topics/arthritis/arthrdrugs.htm Osteoarthritis of the Knee: Hyaluronic Acid Injections Source: American Academy of Family Physicians http://familydoctor.org/handouts/616.html Types of Surgery Source: Arthritis Foundation http://www.arthritis.org/conditions/surgerycenter/types.asp Viscosupplementation Treatment for Arthritis Source: American Academy of Orthopaedic Surgeons http://orthoinfo.aaos.org/fact/thr_report.cfm?Thread_ID=245&topc ategory=Knee ·
Alternative Therapy Acupuncture Source: Arthritis Foundation http://www.arthritis.org/resources/arthritistoday/2000_archives/2 000_05_06_acupuncture.asp Ayurvedic Herbs Source: Arthritis Foundation http://www.arthritis.org/resources/arthritistoday/1999_archives/1 999_05_06explorations.asp
Guidelines 35
Glucosamine and Chondroitin Sulfate Source: Arthritis Foundation http://www.arthritis.org/conditions/alttherapies/glucosamine.asp Homeopathy Source: Arthritis Foundation http://www.arthritis.org/resources/arthritistoday/2000_archives/2 000_03_04_homeopathy.asp Meditation Source: Arthritis Foundation http://www.arthritis.org/resources/arthritistoday/2001_archives/2 001_01_02_meditation.asp Nontraditional Arthritis Treatments: Some May Help, But Be Wary Source: Mayo Foundation for Medical Education and Research http://www.mayoclinic.com/invoke.cfm?id=HQ01121 Tai Chi Source: Arthritis Foundation http://www.arthritis.org/resources/arthritistoday/2000_archives/2 000_07_08_taichi.asp ·
Specific Conditions/Aspects Arthritis of the Foot and Ankle Source: American Orthopaedic Foot and Ankle Society http://www.aofas.org/arthritis.asp Arthritis of the Knee Source: American Academy of Orthopaedic Surgeons http://orthoinfo.aaos.org/fact/thr_report.cfm?Thread_ID=177&topc ategory=Arthritis Arthritis of the Thumb Source: American Academy of Orthopaedic Surgeons http://orthoinfo.aaos.org/fact/thr_report.cfm?Thread_ID=138&topc ategory=Arthritis
36 Osteoarthritis
Arthritis Patients Receive Effective Care in Nurse-led Clinics Source: American College of Rheumatology http://www.rheumatology.org/press/am2002/pr4.asp Bone Spurs (Osteophytes) Source: Mayo Foundation for Medical Education and Research http://www.mayoclinic.com/invoke.cfm?objectid=B153EB20-02EF4D54-A1B1FC6DB1C67499 Degenerative Changes in the Spine Source: Mayo Foundation for Medical Education and Research http://www.mayoclinic.com/invoke.cfm?id=AN00124 JAMA Patient Page: Osteoarthritis of the Knee Source: American Medical Association http://www.amaassn.org/public/journals/patient/archive/jpg022603.htm Managing Housework with Arthritis Source: Mayo Foundation for Medical Education and Research http://www.mayoclinic.com/invoke.cfm?id=AR00010 Osteoarthritis of the Hip Source: American Academy of Orthopaedic Surgeons http://orthoinfo.aaos.org/fact/thr_report.cfm?Thread_ID=208&topc ategory=Arthritis Overuse Injuries Associated with Hobbies Source: Mayo Foundation for Medical Education and Research http://www.mayoclinic.com/invoke.cfm?id=AR00020 Questions and Answers about Arthritis and Exercise Source: National Institute of Arthritis and Musculoskeletal and Skin Diseases http://www.niams.nih.gov/hi/topics/arthritis/arthexfs.htm Questions and Answers about Arthritis Pain Source: National Institute of Arthritis and Musculoskeletal and Skin Diseases http://www.niams.nih.gov/hi/topics/arthritis/arthpain.htm
Guidelines 37
Traveling with Arthritis: Plan, Pack and Enjoy Source: Mayo Foundation for Medical Education and Research http://www.mayoclinic.com/invoke.cfm?id=HQ01554 ·
From the National Institutes of Health Arthritis Advice Source: National Institute on Aging http://www.nia.nih.gov/health/agepages/arthritis.htm Do I Have Arthritis? http://www.niams.nih.gov/hi/topics/arthritis/tengo/english.htm Glucosamine/Chondroitin Arthritis Intervention Trial Begins Patient Recruitment Source: National Center for Complementary and Alternative Medicine http://nccam.nih.gov/news/19972000/121100/index.htm Handout on Health: Osteoarthritis Source: National Institute of Arthritis and Musculoskeletal and Skin Diseases http://www.niams.nih.gov/hi/topics/arthritis/oahandout.htm Questions and Answers about Arthritis and Rheumatic Disease Source: National Institute of Arthritis and Musculoskeletal and Skin Diseases http://www.niams.nih.gov/hi/topics/arthritis/artrheu.htm
·
Organizations American College of Rheumatology http://www.rheumatology.org/ Arthritis Foundation http://www.arthritis.org/ National Institute of Arthritis and Musculoskeletal and Skin Diseases http://www.niams.nih.gov/
38 Osteoarthritis
·
Prevention/Screening 10 Ways You Can Protect Your Joints Source: Arthritis Foundation http://www.arthritis.org/conditions/tips_jointprotection.asp
·
Research Genetic Regions Linked to Inherited Hand Osteoarthritis Source: National Institute of Arthritis and Musculoskeletal and Skin Diseases http://www.niams.nih.gov/ne/highlights/spotlight/2002/hand.ht m Major Review Reveals That Osteoarthritis is a Complex Disease with New Solutions Source: National Institute of Arthritis and Musculoskeletal and Skin Diseases http://www.niams.nih.gov/ne/press/2001/01_05.htm Progress and Opportunities in Osteoarthritis Source: Arthritis Foundation http://www.arthritis.org/research/research_program/Osteoarthritis /default.asp
If you do not find topics of interest when browsing health topic pages, then you can choose to use the advanced search utility of MEDLINEplus at http://www.nlm.nih.gov/medlineplus/advancedsearch.html. This utility is similar to the NIH Search Utility, with the exception that it only includes material linked within the MEDLINEplus system (mostly patient-oriented information). It also has the disadvantage of generating unstructured results. We recommend, therefore, that you use this method only if you have a very targeted search.
The Combined Health Information Database (CHID) CHID Online is a reference tool that maintains a database directory of thousands of journal articles and patient education guidelines on osteoarthritis and related conditions. One of the advantages of CHID over other sources is that it offers summaries that describe the guidelines available, including contact information and pricing. CHID’s general Web site is http://chid.nih.gov/. To search this database, go to
Guidelines 39
http://chid.nih.gov/detail/detail.html. In particular, you can use the advanced search options to look up pamphlets, reports, brochures, and information kits. The following was recently posted in this archive: ·
Questions and Answers About Arthritis and Rheumatic Diseases Source: Bethesda, MD: National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) Information Clearinghouse. 2002. 40 p. Contact: Available from National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) Information Clearinghouse. 1 AMS Circle, Bethesda, MD 20892-3675. (877) 226-4267 or (301) 495-4484. Fax (301) 718-6366. TTY (301) 565-2966. E-mail:
[email protected]. Website: www.niams.nih.gov. PRICE: 1 to 25 copies free. Order Number: AR-27 QA (booklet), or AR-27L QA (large print). Summary: This booklet uses a question and answer format to provide people who have arthritis and other rheumatic diseases with information on their causes, symptoms, diagnosis, and treatment. Rheumatic diseases cause pain, stiffness, and swelling in joints and other supporting structures of the body. Although many people use arthritis to refer to all rheumatic diseases, the many types of arthritis comprise only a portion of the rheumatic diseases. Examples of rheumatic diseases include osteoarthritis (OA), rheumatic arthritis (RA), fibromyalgia, systemic lupus erythematosus, scleroderma, juvenile rheumatoid arthritis, ankylosing spondylitis, gout, infectious arthritis, reactive arthritis, psoriatic arthritis, bursitis, and tendinitis. The causes of rheumatic disease depend on the type of disease, and the causes of most rheumatic diseases are still being investigated. Common symptoms of arthritis include joint swelling, pain, and stiffness. Diagnosis of rheumatic diseases involves obtaining a medical history, performing a physical examination, and obtaining laboratory tests and X rays or other imaging tests. Common laboratory tests include various blood tests, arthrocentesis, and urinalysis. Treatment options for arthritis include rest and relaxation; exercise; proper diet; medications such as analgesics, nonsteroidal anti-inflammatory drugs, acetaminophen, and corticosteroids; heat and cold therapies; hydrotherapy; mobilization therapy; relaxation therapy; orthotic devices; and surgery. The National Institute of Arthritis and Musculoskeletal and Skin Diseases currently supports research efforts in RA, OA, lupus, and scleroderma. The fact sheet includes a list of additional sources of information and a list of key words to help readers understand the terms used in the fact sheet.
40 Osteoarthritis
·
An Inside Look at Osteoarthritis Source: South Deerfield, MA: Channing L. Bete Co., Inc. 2000. 16 p. Contact: Available from Channing L. Bete Co., Inc. 200 State Road, South Deerfield, MA 01373-0200. (800) 628-7733. Fax (800) 499-6464. E-mail:
[email protected]. PRICE: Contact company for pricing information; available in bulk. Order Number 75324A-02-00. Summary: This illustrated booklet provides people who have osteoarthritis (OA) with an overview of this common degenerative form of arthritis. OA causes morning joint stiffness; joint pain during or after use; a crackling sound or grating sensation during use; and joint tenderness, redness, or swelling. Risk factors for OA include age, heredity, overuse, excess weight, and a previous injury to a bone or joint. Joints commonly affected by OA include the hand, spine, hip, knee, and foot. The booklet describes the anatomy of a normal joint and explains how OA slowly damages joints. Other topics include taking various prescription and nonprescription medications to relieve pain; using heat or cold, massage, relaxation techniques, and complementary therapies to ease pain and stiffness; and undergoing surgery to repair joints. In addition, the booklet discusses the importance of exercise in managing OA, provides examples of good body mechanics to help protect joints, and identifies supportive devices and tools.
·
Osteoarthritis Source: San Bruno, CA: StayWell Company. 1998. 8 p. Contact: Available from StayWell Company. 1100 Grundy Lane, San Bruno, CA 94066-3030. (800) 333-3032. Website: www.staywell.com. PRICE: Call or write for current pricing on single and bulk orders. Summary: This booklet provides people who have osteoarthritis (OA) with information on this degenerative form of arthritis. Although its cause is not completely known, OA is associated with the breakdown of the articular cartilage. Symptoms of OA vary greatly among people. The booklet explains the basic anatomy of the normal, movable joint, focusing on the articular cartilage, the synovial membrane, and the joint capsule. OA occurs when the articular cartilage begins to break down and the smooth sliding surfaces of the bones become pitted and irregular. Sites include the neck, fingers, lower back, hip, and knee. Diagnosis requires a medical history, a physical examination, and laboratory and diagnostic imaging studies. Medical treatment may include taking aspirin, nonsteroidal anti-inflammatory drugs, and corticosteroids, as well as losing excess weight. Physical therapy, including exercise and heat treatments, may also be used to treat OA. Exercises can be performed to
Guidelines 41
increase joint flexibility and strengthen muscles. In addition, surgical treatment, such as hip and knee replacement, may be used for pain that does not respond to conventional treatment and physical therapy. ·
Living With Osteoarthritis: Controlling Joint Pain Source: San Bruno, CA: StayWell Company. 1998. 6 p. Contact: Available from StayWell Company. 1100 Grundy Lane, San Bruno, CA 94066-3030. (800) 333-3032. Website: www.staywell.com. PRICE: Call or write for current pricing on single and bulk orders. Summary: This brochure provides people who have osteoarthritis (OA) with information on controlling joint pain. OA causes the cartilage in the joints to break down. Symptoms include joint pain and stiffness, weak muscles and wobbly joints, and loss of normal joint shape and motion. These symptoms can be controlled by exercising, losing weight and maintaining weight loss, and using special tools and aids to reduce strain and protect joints. Medications may help relieve pain and stiffness. The brochure provides tips on obtaining the best results from medications and comments on the use of surgery to decrease pain and improve movement.
·
Facts About Osteoporosis, Arthritis, and Osteoarthritis Source: Washington, DC: National Osteoporosis Foundation (NOF). 1997. 6 p. Contact: Available from National Osteoporosis Foundation. 1150 17th Street, NW, Suite 500, Washington, DC 20036-4603. (202) 223-2226. Fax (202) 223-2237. Website: www.nof.org. PRICE: Single copy free; bulk orders available at cost. Summary: This pamphlet provides people who have osteoporosis, arthritis, and osteoarthritis with information on these painful chronic diseases. Osteoporosis is characterized by a loss of bone mass and by poor bone quality, which lead to reduced bone strength and increased risk of fractures. The pamphlet lists the risk factors for osteoporosis and highlights prevention and treatment strategies. Osteoarthritis (OA), the most common form of arthritis, is a degenerative joint disease that leads to the thinning or destruction of the cartilage. The pamphlet presents the features of OA, identifies risk factors, and comments on diagnosis and treatment. Rheumatoid arthritis (RA) is an inflammatory disease of the lining of the joints that has no known cause. The pamphlet presents the warning signs of RA and provides information on diagnosis, treatment, and outcomes.
42 Osteoarthritis
The National Guideline Clearinghouse™ The National Guideline Clearinghouse™ offers hundreds of evidence-based clinical practice guidelines published in the United States and other countries. You can search their site located at http://www.guideline.gov by using the keyword “osteoarthritis” or synonyms. The following was recently posted: ·
Exercise prescription for older adults with osteoarthritis pain: consensus practice recommendations. Source: American Geriatrics Society.; 2001 June; 16 pages http://www.guideline.gov/FRAMESETS/guideline_fs.asp?guideline=00 2414&sSearch_string=osteoarthritis
·
Recommendations for the medical management of osteoarthritis of the hip and knee: 2000 update. Source: American College of Rheumatology.; 2000 September; 11 pages http://www.guideline.gov/FRAMESETS/guideline_fs.asp?guideline=00 2161&sSearch_string=Arthrosis
Healthfinder™ Healthfinder™ is an additional source sponsored by the U.S. Department of Health and Human Services which offers links to hundreds of other sites that contain healthcare information. This Web site is located at http://www.healthfinder.gov. Again, keyword searches can be used to find guidelines. The following was recently found in this database: ·
Arthritis of the Knee Summary: Three basic types of arthritis may affect the knee joint. Osteoarthritis (OA) is the most common form of knee arthritis.
1.
Source: American Academy of Orthopaedic Surgeons http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&R ecordID=7231
Guidelines 43
·
Celebrex Summary: Celebrex is used to relieve the signs and symptoms of osteoarthritis and rheumatoid arthritis in adults. Source: Center for Drug Evaluation and Research, U.S. Food and Drug Administration http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&R ecordID=6975
·
Celebrex Summary: Celebrex is used to relieve the signs and symptoms of osteoarthritis and rheumatoid arthritis in adults. Source: Center for Drug Evaluation and Research, U.S. Food and Drug Administration http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&R ecordID=6975
·
Handout on Health: Osteoarthritis Summary: This guide discusses osteoarthritis -- the most common type of arthritis, especially among older individuals. Source: National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&R ecordID=5983
·
New Arthritis Drugs for Rheumatoid Arthritis and Osteoarthritis Summary: This fact sheet discusses arthritis drug by category, including biological response modifiers, disease-modifying antirheumatic drugs, and nonsteroidal anti-inflammatory drugs. Source: National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&R ecordID=6691
44 Osteoarthritis
The NIH Search Utility After browsing the references listed at the beginning of this chapter, you may want to explore the NIH Search Utility. This allows you to search for documents on over 100 selected Web sites that comprise the NIH-WEBSPACE. Each of these servers is “crawled” and indexed on an ongoing basis. Your search will produce a list of various documents, all of which will relate in some way to osteoarthritis. The drawbacks of this approach are that the information is not organized by theme and that the references are often a mix of information for professionals and patients. Nevertheless, a large number of the listed Web sites provide useful background information. We can only recommend this route, therefore, for relatively rare or specific disorders, or when using highly targeted searches. To use the NIH search utility, visit the following Web page: http://search.nih.gov/index.html.
Additional Web Sources A number of Web sites that often link to government sites are available to the public. These can also point you in the direction of essential information. The following is a representative sample: ·
AOL: http://search.aol.com/cat.adp?id=168&layer=&from=subcats
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drkoop.comÒ: http://www.drkoop.com/conditions/ency/index.html
·
Family Village: http://www.familyvillage.wisc.edu/specific.htm
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Google: http://directory.google.com/Top/Health/Conditions_and_Diseases/
·
Med Help International: http://www.medhelp.org/HealthTopics/A.html
·
Open Directory Project: http://dmoz.org/Health/Conditions_and_Diseases/
·
Yahoo.com: http://dir.yahoo.com/Health/Diseases_and_Conditions/
·
WebMDÒHealth: http://my.webmd.com/health_topics
Vocabulary Builder The material in this chapter may have contained a number of unfamiliar words. The following Vocabulary Builder introduces you to terms used in this chapter that have not been covered in the previous chapter:
Guidelines 45
Acetaminophen: Analgesic antipyretic derivative of acetanilide. It has weak anti-inflammatory properties and is used as a common analgesic, but may cause liver, blood cell, and kidney damage. [NIH] Aerobic: 1. Having molecular oxygen present. 2. Growing, living, or occurring in the presence of molecular oxygen. 3. Requiring oxygen for respiration. [EU] Alloys: A mixture of metallic elements or compounds with other metallic or metalloid elements in varying proportions. [NIH] Analgesic: An agent that alleviates pain without causing loss of consciousness. [EU] Antibiotic: A chemical substance produced by a microorganism which has the capacity, in dilute solutions, to inhibit the growth of or to kill other microorganisms. Antibiotics that are sufficiently nontoxic to the host are used as chemotherapeutic agents in the treatment of infectious diseases of man, animals and plants. [EU] Anticoagulants: Agents that prevent blood clotting. Naturally occurring agents in the blood are included only when they are used as drugs. [NIH] Anxiety: The unpleasant emotional state consisting of psychophysiological responses to anticipation of unreal or imagined danger, ostensibly resulting from unrecognized intrapsychic conflict. Physiological concomitants include increased heart rate, altered respiration rate, sweating, trembling, weakness, and fatigue; psychological concomitants include feelings of impending danger, powerlessness, apprehension, and tension. [EU] Aspiration: The act of inhaling. [EU] Bursitis: Inflammation of a bursa, occasionally accompanied by a calcific deposit in the underlying supraspinatus tendon; the most common site is the subdeltoid bursa. [EU] Chondrocytes: Polymorphic cells that form cartilage. [NIH] Chronic: Persisting over a long period of time. [EU] Collagen: The protein substance of the white fibres (collagenous fibres) of skin, tendon, bone, cartilage, and all other connective tissue; composed of molecules of tropocollagen (q.v.), it is converted into gelatin by boiling. collagenous pertaining to collagen; forming or producing collagen. [EU] Collapse: 1. A state of extreme prostration and depression, with failure of circulation. 2. Abnormal falling in of the walls of any part of organ. [EU] Contracture: A condition of fixed high resistance to passive stretch of a muscle, resulting from fibrosis of the tissues supporting the muscles or the joints, or from disorders of the muscle fibers. [EU] Doxycycline:
A synthetic tetracycline derivative with a range of
46 Osteoarthritis
antimicrobial activity and mode of action similar to that of tetracycline, but more effective against many species. Animal studies suggest that it may cause less tooth staining than other tetracyclines. [NIH] Enzyme: A protein molecule that catalyses chemical reactions of other substances without itself being destroyed or altered upon completion of the reactions. Enzymes are classified according to the recommendations of the Nomenclature Committee of the International Union of Biochemistry. Each enzyme is assigned a recommended name and an Enzyme Commission (EC) number. They are divided into six main groups; oxidoreductases, transferases, hydrolases, lyases, isomerases, and ligases. [EU] Estrogens: A class of sex hormones associated with the development and maintenance of secondary female sex characteristics and control of the cyclical changes in the reproductive cycle. They are also required for pregnancy maintenance and have an anabolic effect on protein metabolism and water retention. [NIH] Gastrointestinal: Pertaining to or communicating with the stomach and intestine, as a gastrointestinal fistula. [EU] Gout: Hereditary metabolic disorder characterized by recurrent acute arthritis, hyperuricemia and deposition of sodium urate in and around the joints, sometimes with formation of uric acid calculi. [NIH] Intermittent: Occurring at separated intervals; having periods of cessation of activity. [EU] Irritants: Drugs that act locally on cutaneous or mucosal surfaces to produce inflammation; those that cause redness due to hyperemia are rubefacients; those that raise blisters are vesicants and those that penetrate sebaceous glands and cause abscesses are pustulants; tear gases and mustard gases are also irritants. [NIH] Ketoprofen: An ibuprofen-type anti-inflammatory analgesic and antipyretic. It is used in the treatment of rheumatoid arthritis and osteoarthritis. [NIH] Lupus: A form of cutaneous tuberculosis. It is seen predominantly in women and typically involves the nasal, buccal, and conjunctival mucosa. [NIH]
Membrane: A thin layer of tissue which covers a surface, lines a cavity or divides a space or organ. [EU] Osteoporosis: Reduction in the amount of bone mass, leading to fractures after minimal trauma. [EU] Peptic: Pertaining to pepsin or to digestion; related to the action of gastric juices. [EU] Proteoglycans:
Glycoproteins which have a very high polysaccharide
Guidelines 47
content. [NIH] Rheumatology: A subspecialty of internal medicine concerned with the study of inflammatory or degenerative processes and metabolic derangement of connective tissue structures which pertain to a variety of musculoskeletal disorders, such as arthritis. [NIH] Spondylitis: Inflammation of the vertebrae. [EU] Stomach: An organ of digestion situated in the left upper quadrant of the abdomen between the termination of the esophagus and the beginning of the duodenum. [NIH] Synovial: Of pertaining to, or secreting synovia. [EU] Systemic: Pertaining to or affecting the body as a whole. [EU] Tendinitis: Inflammation of tendons and of tendon-muscle attachments. [EU] Topical: Pertaining to a particular surface area, as a topical anti-infective applied to a certain area of the skin and affecting only the area to which it is applied. [EU] Ulcer: A local defect, or excavation, of the surface of an organ or tissue; which is produced by the sloughing of inflammatory necrotic tissue. [EU] Urinalysis: Examination of urine by chemical, physical, or microscopic means. Routine urinalysis usually includes performing chemical screening tests, determining specific gravity, observing any unusual color or odor, screening for bacteriuria, and examining the sediment microscopically. [NIH]
Seeking Guidance 49
CHAPTER 2. SEEKING GUIDANCE Overview Some patients are comforted by the knowledge that a number of organizations dedicate their resources to helping people with osteoarthritis. These associations can become invaluable sources of information and advice. Many associations offer aftercare support, financial assistance, and other important services. Furthermore, healthcare research has shown that support groups often help people to better cope with their conditions.10 In addition to support groups, your physician can be a valuable source of guidance and support. Therefore, finding a physician that can work with your unique situation is a very important aspect of your care. In this chapter, we direct you to resources that can help you find patient organizations and medical specialists. We begin by describing how to find associations and peer groups that can help you better understand and cope with osteoarthritis. The chapter ends with a discussion on how to find a doctor that is right for you.
Associations and Osteoarthritis As mentioned by the Agency for Healthcare Research and Quality, sometimes the emotional side of an illness can be as taxing as the physical side.11 You may have fears or feel overwhelmed by your situation. Everyone has different ways of dealing with disease or physical injury. Your attitude, your expectations, and how well you cope with your condition can all Churches, synagogues, and other houses of worship might also have groups that can offer you the social support you need. 11 This section has been adapted from http://www.ahcpr.gov/consumer/diaginf5.htm. 10
50 Osteoarthritis
influence your well-being. This is true for both minor conditions and serious illnesses. For example, a study on female breast cancer survivors revealed that women who participated in support groups lived longer and experienced better quality of life when compared with women who did not participate. In the support group, women learned coping skills and had the opportunity to share their feelings with other women in the same situation. In addition to associations or groups that your doctor might recommend, we suggest that you consider the following list (if there is a fee for an association, you may want to check with your insurance provider to find out if the cost will be covered): ·
Arthritis Foundation of Australia Address: 33 Bligh Street, Suite 902A, Sydney, New South Wales, 2000, Australia Telephone: 02 221 2456 Fax: 02 232 2538 Web Site: http://www.span.com.au/arthritis/ Background: The Arthritis Foundation of Australia is a not-for-profit organization that is committed to providing care, education, and research for people affected by arthritis and other musculoskeletal disorders. The term arthritis, meaning inflammation of the joints, may encompass several conditions or disease states, such as osteoarthritis, rheumatoid arthritis, ankylosing spondylitis, gout, and others. The Arthritis Foundation of Australia, which was founded in 1949, is dedicated to promoting research into the causes, control, and cure of arthritis; supporting the professional education and training of physicians and allied health professionals; and enhancing community awareness of the needs of those affected by arthritis. The Foundation's additional objectives include representing people with arthritis nationally and internationally, serving as national secretariat of affiliated state and territory foundations, and assisting affiliated foundations in promoting self-management programs for people with arthritis. The Arthritis Foundation of Australia currently consists of eight state and territory affiliates. These affiliated foundations offer a wide range of services to their members and represent their interests to their own state and territory governments. Each affiliated foundation may also provide the addresses of a wide network of branches and self-help groups in each state. Relevant area(s) of interest: Gout, Osteoarthritis, Reiter's Syndrome
Seeking Guidance 51
·
Back Pain Association of America, Inc. Address: P.O. Box 135, Pasadena, MD 21123-0135 Telephone: (410) 255-3633 Fax: (410) 255- 7338 Email:
[email protected] Background: The Back Pain Association of America, Inc. (BPAA) is a national nonprofit organization dedicated to providing information and support to people who are affected by back and neck pain, their family members, friends, and health care professionals. Established in 1991 and consisting of nearly 4,000 members, BPAA offers programs and information to help affected individuals learn more about their spinal disorders and ways to cope with them. The organization also has a program to help individuals prevent back injuries. BPAA publishes a self-titled quarterly newsletter that helps readers stay informed of updated information and new forms of treatment. The organization's 'Friends Across America' networking program enables affected individuals to exchange information and support via telephone. BPAA also has a physician referral service as well as an information service for physicians who treat back and neck pain. In addition, the Association also promotes research and offers a variety of fact sheets including 'The Relationship Between Nerve Damage and Leg Pain,' 'Urinary Problems and Diseases of the Spine,' 'Arachnoiditis, Questions and Answers,' and 'A Guide to Abdominal and Stretching Exercises.'. Relevant area(s) of interest: Fibromyalgia, Osteoarthritis, Reiter's Syndrome
Finding More Associations There are a number of directories that list additional medical associations that you may find useful. While not all of these directories will provide different information than what is listed above, by consulting all of them, you will have nearly exhausted all sources for patient associations.
The National Health Information Center (NHIC) The National Health Information Center (NHIC) offers a free referral service to help people find organizations that provide information about osteoarthritis. For more information, see the NHIC’s Web site at
52 Osteoarthritis
http://www.health.gov/NHIC/ or contact an information specialist by calling 1-800-336-4797.
DIRLINE A comprehensive source of information on associations is the DIRLINE database maintained by the National Library of Medicine. The database comprises some 10,000 records of organizations, research centers, and government institutes and associations which primarily focus on health and biomedicine. DIRLINE is available via the Internet at the following Web site: http://dirline.nlm.nih.gov/. Simply type in “osteoarthritis” (or a synonym) or the name of a topic, and the site will list information contained in the database on all relevant organizations.
The Combined Health Information Database Another comprehensive source of information on healthcare associations is the Combined Health Information Database. Using the “Detailed Search” option, you will need to limit your search to “Organizations” and “osteoarthritis”. Type the following hyperlink into your Web browser: http://chid.nih.gov/detail/detail.html. To find associations, use the drop boxes at the bottom of the search page where “You may refine your search by.” For publication date, select “All Years.” Then, select your preferred language and the format option “Organization Resource Sheet.” By making these selections and typing in “osteoarthritis” (or synonyms) into the “For these words:” box, you will only receive results on organizations dealing with osteoarthritis. You should check back periodically with this database since it is updated every 3 months. The National Organization for Rare Disorders, Inc. The National Organization for Rare Disorders, Inc. has prepared a Web site that provides, at no charge, lists of associations organized by specific diseases. You can access this database at the following Web site: http://www.rarediseases.org/search/orgsearch.html. Type “osteoarthritis” (or a synonym) in the search box, and click “Submit Query”.
Seeking Guidance 53
Online Support Groups In addition to support groups, commercial Internet service providers offer forums and chat rooms for people with different illnesses and conditions. WebMDÒ, for example, offers such a service at their Web site: http://boards.webmd.com/roundtable. These online self-help communities can help you connect with a network of people whose concerns are similar to yours. Online support groups are places where people can talk informally. If you read about a novel approach, consult with your doctor or other healthcare providers, as the treatments or discoveries you hear about may not be scientifically proven to be safe and effective.
Finding Doctors One of the most important aspects of your treatment will be the relationship between you and your doctor or specialist. All patients with osteoarthritis must go through the process of selecting a physician. While this process will vary from person to person, the Agency for Healthcare Research and Quality makes a number of suggestions, including the following:12 ·
If you are in a managed care plan, check the plan's list of doctors first.
·
Ask doctors or other health professionals who work with doctors, such as hospital nurses, for referrals.
·
Call a hospital’s doctor referral service, but keep in mind that these services usually refer you to doctors on staff at that particular hospital. The services do not have information on the quality of care that these doctors provide.
·
Some local medical societies offer lists of member doctors. Again, these lists do not have information on the quality of care that these doctors provide.
Additional steps you can take to locate doctors include the following: ·
Check with the associations listed earlier in this chapter.
·
Information on doctors in some states is available on the Internet at http://www.docboard.org. This Web site is run by “Administrators in Medicine,” a group of state medical board directors.
This section has been adapted from the AHRQ: http://www.ahrq.gov/consumer/qntascii/qntdr.htm.
12
54 Osteoarthritis
·
The American Board of Medical Specialties can tell you if your doctor is board certified. “Certified” means that the doctor has completed a training program in a specialty and has passed an exam, or “board,” to assess his or her knowledge, skills, and experience to provide quality patient care in that specialty. Primary care doctors may also be certified as specialists. The AMBS Web site is located at 13 http://www.abms.org/newsearch.asp. You can also contact the ABMS by phone at 1-866-ASK-ABMS.
·
You can call the American Medical Association (AMA) at 800-665-2882 for information on training, specialties, and board certification for many licensed doctors in the United States. This information also can be found in “Physician Select” at the AMA's Web site: http://www.amaassn.org/aps/amahg.htm.
Finding a Rheumatologist The American College of Rheumatology (ACR) maintains a geographic directory of member physicians called “Find a Rheumatologist.” To access this database, log on to http://www.rheumatology.org/directory/geo.asp. You will be given the option to search for a rheumatologist by name, by U.S. State, or by country. To contact the ACR, you can use the following information: American College of Rheumatology 1800 Century Place, Suite 250 Atlanta, GA 30345 Phone: (404) 633-3777 Fax: (404) 633-1870 E-mail:
[email protected] If the previous sources did not meet your needs, you may want to log on to the Web site of the National Organization for Rare Disorders (NORD) at http://www.rarediseases.org/. NORD maintains a database of doctors with expertise in various rare diseases. The Metabolic Information Network (MIN), 800-945-2188, also maintains a database of physicians with expertise in various metabolic diseases.
While board certification is a good measure of a doctor's knowledge, it is possible to receive quality care from doctors who are not board certified.
13
Seeking Guidance 55
Selecting Your Doctor14 When you have compiled a list of prospective doctors, call each of their offices. First, ask if the doctor accepts your health insurance plan and if he or she is taking new patients. If the doctor is not covered by your plan, ask yourself if you are prepared to pay the extra costs. The next step is to schedule a visit with your chosen physician. During the first visit you will have the opportunity to evaluate your doctor and to find out if you feel comfortable with him or her. Ask yourself, did the doctor: ·
Give me a chance to ask questions about osteoarthritis?
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Really listen to my questions?
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Answer in terms I understood?
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Show respect for me?
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Ask me questions?
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Make me feel comfortable?
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Address the health problem(s) I came with?
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Ask me my preferences about different kinds of treatments for osteoarthritis?
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Spend enough time with me?
Trust your instincts when deciding if the doctor is right for you. But remember, it might take time for the relationship to develop. It takes more than one visit for you and your doctor to get to know each other.
Working with Your Doctor15 Research has shown that patients who have good relationships with their doctors tend to be more satisfied with their care and have better results. Here are some tips to help you and your doctor become partners: ·
You know important things about your symptoms and your health history. Tell your doctor what you think he or she needs to know.
·
It is important to tell your doctor personal information, even if it makes you feel embarrassed or uncomfortable.
14 This
section has been adapted from the AHRQ: www.ahrq.gov/consumer/qntascii/qntdr.htm. 15 This section has been adapted from the AHRQ: www.ahrq.gov/consumer/qntascii/qntdr.htm.
56 Osteoarthritis
·
Bring a “health history” list with you (and keep it up to date).
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Always bring any medications you are currently taking with you to the appointment, or you can bring a list of your medications including dosage and frequency information. Talk about any allergies or reactions you have had to your medications.
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Tell your doctor about any natural or alternative medicines you are taking.
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Bring other medical information, such as x-ray films, test results, and medical records.
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Ask questions. If you don't, your doctor will assume that you understood everything that was said.
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Write down your questions before your visit. List the most important ones first to make sure that they are addressed.
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Consider bringing a friend with you to the appointment to help you ask questions. This person can also help you understand and/or remember the answers.
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Ask your doctor to draw pictures if you think that this would help you understand.
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Take notes. Some doctors do not mind if you bring a tape recorder to help you remember things, but always ask first.
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Let your doctor know if you need more time. If there is not time that day, perhaps you can speak to a nurse or physician assistant on staff or schedule a telephone appointment.
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Take information home. Ask for written instructions. Your doctor may also have brochures and audio and videotapes that can help you.
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After leaving the doctor's office, take responsibility for your care. If you have questions, call. If your symptoms get worse or if you have problems with your medication, call. If you had tests and do not hear from your doctor, call for your test results. If your doctor recommended that you have certain tests, schedule an appointment to get them done. If your doctor said you should see an additional specialist, make an appointment.
By following these steps, you will enhance the relationship you will have with your physician.
Seeking Guidance 57
Broader Health-Related Resources In addition to the references above, the NIH has set up guidance Web sites that can help patients find healthcare professionals. These include:16 ·
Caregivers: http://www.nlm.nih.gov/medlineplus/caregivers.html
·
Choosing a Doctor or Healthcare Service: http://www.nlm.nih.gov/medlineplus/choosingadoctororhealthcareserv ice.html
·
Hospitals and Health Facilities: http://www.nlm.nih.gov/medlineplus/healthfacilities.html
You can access this information at: http://www.nlm.nih.gov/medlineplus/healthsystem.html.
16
Clinical Trials 59
CHAPTER 3. CLINICAL TRIALS AND OSTEOARTHRITIS Overview Very few medical conditions have a single treatment. The basic treatment guidelines that your physician has discussed with you, or those that you have found using the techniques discussed in Chapter 1, may provide you with all that you will require. For some patients, current treatments can be enhanced with new or innovative techniques currently under investigation. In this chapter, we will describe how clinical trials work and show you how to keep informed of trials concerning osteoarthritis.
What Is a Clinical Trial?17 Clinical trials involve the participation of people in medical research. Most medical research begins with studies in test tubes and on animals. Treatments that show promise in these early studies may then be tried with people. The only sure way to find out whether a new treatment is safe, effective, and better than other treatments for osteoarthritis is to try it on patients in a clinical trial.
The discussion in this chapter has been adapted from the NIH and the NEI: www.nei.nih.gov/netrials/ctivr.htm.
17
60 Osteoarthritis
What Kinds of Clinical Trials Are There? Clinical trials are carried out in three phases: ·
Phase I. Researchers first conduct Phase I trials with small numbers of patients and healthy volunteers. If the new treatment is a medication, researchers also try to determine how much of it can be given safely.
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Phase II. Researchers conduct Phase II trials in small numbers of patients to find out the effect of a new treatment on osteoarthritis.
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Phase III. Finally, researchers conduct Phase III trials to find out how new treatments for osteoarthritis compare with standard treatments already being used. Phase III trials also help to determine if new treatments have any side effects. These trials--which may involve hundreds, perhaps thousands, of people--can also compare new treatments with no treatment. How Is a Clinical Trial Conducted?
Various organizations support clinical trials at medical centers, hospitals, universities, and doctors' offices across the United States. The “principal investigator” is the researcher in charge of the study at each facility participating in the clinical trial. Most clinical trial researchers are medical doctors, academic researchers, and specialists. The “clinic coordinator” knows all about how the study works and makes all the arrangements for your visits. All doctors and researchers who take part in the study on osteoarthritis carefully follow a detailed treatment plan called a protocol. This plan fully explains how the doctors will treat you in the study. The “protocol” ensures that all patients are treated in the same way, no matter where they receive care. Clinical trials are controlled. This means that researchers compare the effects of the new treatment with those of the standard treatment. In some cases, when no standard treatment exists, the new treatment is compared with no treatment. Patients who receive the new treatment are in the treatment group. Patients who receive a standard treatment or no treatment are in the “control” group. In some clinical trials, patients in the treatment group get a new medication while those in the control group get a placebo. A placebo is a harmless substance, a “dummy” pill, that has no effect on osteoarthritis. In other clinical trials, where a new surgery or device (not a medicine) is being tested, patients in the control group may receive a “sham treatment.” This treatment, like a placebo, has no effect on osteoarthritis and does not harm patients.
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Researchers assign patients “randomly” to the treatment or control group. This is like flipping a coin to decide which patients are in each group. If you choose to participate in a clinical trial, you will not know which group you will be appointed to. The chance of any patient getting the new treatment is about 50 percent. You cannot request to receive the new treatment instead of the placebo or sham treatment. Often, you will not know until the study is over whether you have been in the treatment group or the control group. This is called a “masked” study. In some trials, neither doctors nor patients know who is getting which treatment. This is called a “double masked” study. These types of trials help to ensure that the perceptions of the patients or doctors will not affect the study results. Natural History Studies Unlike clinical trials in which patient volunteers may receive new treatments, natural history studies provide important information to researchers on how osteoarthritis develops over time. A natural history study follows patient volunteers to see how factors such as age, sex, race, or family history might make some people more or less at risk for osteoarthritis. A natural history study may also tell researchers if diet, lifestyle, or occupation affects how a disease or disorder develops and progresses. Results from these studies provide information that helps answer questions such as: How fast will a disease or disorder usually progress? How bad will the condition become? Will treatment be needed? What Is Expected of Patients in a Clinical Trial? Not everyone can take part in a clinical trial for a specific disease or disorder. Each study enrolls patients with certain features or eligibility criteria. These criteria may include the type and stage of disease or disorder, as well as, the age and previous treatment history of the patient. You or your doctor can contact the sponsoring organization to find out more about specific clinical trials and their eligibility criteria. If you are interested in joining a clinical trial, your doctor must contact one of the trial's investigators and provide details about your diagnosis and medical history. If you participate in a clinical trial, you may be required to have a number of medical tests. You may also need to take medications and/or undergo surgery. Depending upon the treatment and the examination procedure, you may be required to receive inpatient hospital care. Or, you may have to
62 Osteoarthritis
return to the medical facility for follow-up examinations. These exams help find out how well the treatment is working. Follow-up studies can take months or years. However, the success of the clinical trial often depends on learning what happens to patients over a long period of time. Only patients who continue to return for follow-up examinations can provide this important long-term information.
Recent Trials on Osteoarthritis The National Institutes of Health and other organizations sponsor trials on various diseases and disorders. Because funding for research goes to the medical areas that show promising research opportunities, it is not possible for the NIH or others to sponsor clinical trials for every disease and disorder at all times. The following lists recent trials dedicated to osteoarthritis.18 If the trial listed by the NIH is still recruiting, you may be eligible. If it is no longer recruiting or has been completed, then you can contact the sponsors to learn more about the study and, if published, the results. Further information on the trial is available at the Web site indicated. Please note that some trials may no longer be recruiting patients or are otherwise closed. Before contacting sponsors of a clinical trial, consult with your physician who can help you determine if you might benefit from participation. ·
Acupuncture Safety/Efficacy in Knee Osteoarthritis Condition(s): Osteoarthritis, Knee Study Status: This study is currently recruiting patients. Sponsor(s): National Center for Complementary and Alternative Medicine (NCCAM) Purpose - Excerpt: The goal of this research is to determine the efficacy and safety of Traditional Chinese Acupuncture (TCA) in patients with osteoarthritis of the knee. A three arm randomized controlled trial (RCT) using sham TCA, true TCA, and an education/attention comparison group with a total sample of 525 is proposed. Primary hypothesis to be tested is that patients randomized to true TCA will have significantly more improvement in pain and function as measured by the Womac Pain & Function Scales and patient global assessments than patients randomized to the sham acupuncture and education/attention control groups. Secondary aims of the study are to 1) determine if improvement with TCA differs between patients below age 65 vs. those aged 65 and above, 2) to determine if improvement with TCA differs by racial/ethnic
18
These are listed at www.ClinicalTrials.gov.
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group (ie., Caucasian, Black, Hispanic), and 3) to determine if improvement with TCA differs by stage of radiographic severity of knee OA at baseline (KL grade 2, 3 or 4) Phase(s): Phase III Study Type: Interventional Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/gui/show/NCT00010946;jsessionid=46A2D C309B3A8ECA85AA147CF4449B37 ·
Aerobic Exercise Intervention for Knee Osteoarthritis Condition(s): Osteoarthritis Study Status: This study is currently recruiting patients. Sponsor(s): National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) Purpose - Excerpt: This trial will test if walking or bicycling exercise is effective as a non-surgical treatment option for patients with knee osteoarthritis. Study Type: Interventional Contact(s): Kenton R. Kaufman, Ph.D., P.E.: 507-284-2262,
[email protected]; Christine Hughes: 507-266-0985,
[email protected]; Mayo Clinic, Rochester, Minnesota, 55905, United States Web Site: http://clinicaltrials.gov/ct/gui/show/NCT00049816;jsessionid=46A2D C309B3A8ECA85AA147CF4449B37
·
Efficacy and Safety of PG-530742 in the treatment of Mild to Moderate Knee Osteoarthritis Condition(s): Osteoarthritis, Knee Study Status: This study is currently recruiting patients. Sponsor(s): Procter & Gamble Pharmaceuticals Purpose - Excerpt: Matrix metalloproteinases have been implicated in the cartilage degradation that occurs in osteoarthritis. PG-530742 inhibits some of these matrix metalloproteinases, thus potentially limiting cartilage degradation and disease progression. This study will test the efficacy and safety of PG-530742 in the treatment of mild to moderate knee osteoarthritis.
64 Osteoarthritis
Phase(s): Phase II Study Type: Interventional Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/gui/show/NCT00041756;jsessionid=46A2D C309B3A8ECA85AA147CF4449B37 ·
Efficacy of Acupuncture with Physical Therapy for Knee OsteoArthritis Condition(s): Osteoarthritis Study Status: This study is currently recruiting patients. Sponsor(s): National Center for Complementary and Alternative Medicine (NCCAM) Purpose - Excerpt: This study will examine the efficacy of acupuncture in combination with exercise physical therapy for moderate osteoarthritis (OA) of the knee. Phase(s): Phase III Study Type: Interventional Contact(s): Patricia Williams, RN-C: (215) 898-3038
[email protected]; Penn Therapy and Fitness, Philadelphia, Pennsylvania, 19104, United States. Study Chairs or Principal Investigators: John T. Farrar, MD, MSCE, Principal Investigator; University of Pennsylvania; Erin McMenamin, MSN, CRNP, Study Director; University of Pennsylvania Web Site: http://clinicaltrials.gov/ct/gui/show/NCT00035399;jsessionid=46A2D C309B3A8ECA85AA147CF4449B37
·
Glucosamine/Chondroitin Arthritis Intervention Trial (GAIT) Condition(s): knee pain; Osteoarthritis Study Status: This study is currently recruiting patients. Sponsor(s): Department of Veterans Affairs; Department of Veterans Affairs Cooperative Studies Program; National Institutes of Health (NIH); National Center for Complementary and Alternative Medicine (NCCAM) Purpose - Excerpt: This study will determine whether glucosamine, chondroitin sulfate and/or the combination of glucosamine and chondroitin sulfate are more effective than placebo and whether the
Clinical Trials 65
combination is more effective than glucosamine or chondroitin sulfate alone in the treatment of knee pain associated with osteoarthritis (OA) of the knee. These substances, marketed in the United States as nutritional supplements, have been widely touted by the lay press and by anecdotal personal experience as effective in treating OA. To date, however, only a few small studies have been published in the worldwide literature. The study proposed herein has been carefully constructed to definitively determine the efficacy of these agents. Phase(s): Phase III Study Type: Interventional Contact(s): See Web site below Web Site: http://clinicaltrials.gov/ct/gui/show/NCT00032890;jsessionid=46A2D C309B3A8ECA85AA147CF4449B37 ·
Prevention of Post-Traumatic Osteoarthritis (OA) Condition(s): Osteoarthritis Study Status: This study is currently recruiting patients. Sponsor(s): National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) Purpose - Excerpt: Joint injury and trauma dramatically increase the risk of developing osteoarthritis (OA). The purpose of this study is to determine what factors lead to decreased pain, improved joint function, and repair of the joint surface in post-traumatic OA. Study Type: Interventional Contact(s): See Web site below Web Site: http://clinicaltrials.gov/ct/gui/show/NCT00054821;jsessionid=46A2D C309B3A8ECA85AA147CF4449B37
·
Shoe Insert Study Condition(s): Osteoarthritis, Knee Study Status: This study is currently recruiting patients. Sponsor(s): National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) Purpose - Excerpt: This trial will test shoe inserts for the treatment of knee osteoarthritis, the most common form of knee arthritis. Those with disease on the inner (medial) aspect of the knee will be studied.
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Phase(s): Phase III Study Type: Interventional Contact(s): Boston University Medical Center, Boston, Massachusetts, 02118, United States; Joyce P. Goggins, M.P.H.: 617-638-4462,
[email protected]; Kristin Baker, Ph.D.: 617-638-5452,
[email protected] Principal Investigator: David T. Felson, M.D., M.P.H. Web Site: http://clinicaltrials.gov/ct/gui/show/NCT00032240;jsessionid=46A2D C309B3A8ECA85AA147CF4449B37 ·
Doxycycline and OA Progression Condition(s): Osteoarthritis Study Status: This study is no longer recruiting patients. Sponsor(s): National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS); National Institute on Aging (NIA) Purpose - Excerpt: This study will determine whether doxycycline decreases the severity or rate of progression of osteoarthritis (OA) in the knee. Nonsteroidal anti-inflammatory drugs (NSAIDs) are the most popular agents used to treat OA, but elderly women, in whom OA is especially common, are at greatest risk of developing serious side effects from NSAIDs. Our study targets overweight middle-aged women who have OA in one knee. Half of the 432 study participants will receive the treatment (doxycycline) and half will receive a placebo (inactive pill). Treatment with doxycycline (or placebo) will last 30 months, and participants and researchers will not know who is receiving doxycycline and who is receiving placebo until the end of the study. We will look for narrowing of the joint space in the knee that was not affected by OA at the start of the study. Joint space narrowing is a sign of OA. We will also use questionnaires to evaluate participants' symptoms and functioning. Phase(s): Phase III Study Type: Interventional Contact(s): See Web site below Web Site: http://clinicaltrials.gov/ct/gui/show/NCT00000403;jsessionid=46A2D C309B3A8ECA85AA147CF4449B37
·
Effects of Strength Training on Knee Osteoarthritis Condition(s): Osteoarthritis, Knee
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Study Status: This study is no longer recruiting patients. Sponsor(s): National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) Purpose - Excerpt: To understand the effects of leg strengthening exercise, we will study the effects of strength training of the legs in four groups of people: (1) osteoarthritis (OA) with knee pain; (2) OA without knee pain; (3) no OA but elderly with knee pain; and (4) normal elderly with no OA or knee pain. In each of the first three groups, we will look at whether people who do strength training have less pain and/or slower progression of x-ray signs of OA over 30 months than people who perform nonstrengthening, range-of-motion exercises. We are including the fourth group to find out whether people with OA (groups 1 & 2) have the same response to strength training as healthy elderly people, and whether those with knee pain (groups 1 & 3) have the same response to training as those without joint pain. Phase(s): Phase II Study Type: Interventional Contact(s): National Institute for Fitness and Sport, Indianapolis, Indiana, 46202, United States. Study chairs or principal investigators: Alan Mikesky, Ph.D.; Indiana University School of Medicine Web Site: http://clinicaltrials.gov/ct/gui/show/NCT00000406;jsessionid=46A2D C309B3A8ECA85AA147CF4449B37 ·
Impact of Exercise on Older Persons with Osteoarthritis Condition(s): Osteoarthritis Study Status: This study is no longer recruiting patients. Sponsor(s): National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS); National Institute on Aging (NIA) Purpose - Excerpt: Previous studies have found that exercise can reduce pain, improve endurance for physical activities, and improve cardiovascular fitness over time. However, these studies have not looked at the impact of exercise programs for older adults with osteoarthritis or at how long older adults continue exercising after a program is finished. This study will look at the long-term effects of a structured exercise program for people aged 60 or older who have osteoarthritis of the hip or knee. One goal of the exercise program is to encourage older people with osteoarthritis to continue exercising. We will randomly assign study participants to either the exercise program or a control group that does
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not do the exercise program. We will monitor participants at the start of the study, at 8 weeks, and every 3 months for 2 years after the program is completed. The exercise program lasts for 8 weeks and includes an exercise part and an educational part led by trained physical therapists. We believe that participants in the treatment (exercise) group will show higher rates of continued exercise and higher functional status over time compared to the group of people who do not participate in the exercise program. Phase(s): Phase II Study Type: Interventional Contact(s): Illinois; North Park Village, Chicago, Illinois, 60646, United States; Bernard Horwich Jewish Community Center, Chicago, Illinois, 60659, United States. Study chairs or principal investigators: Susan Hughes, Principal Investigator; Center for Research on Health and Aging Web Site: http://clinicaltrials.gov/ct/gui/show/NCT00000434;jsessionid=46A2D C309B3A8ECA85AA147CF4449B37 ·
Effects of Comprehensive Care for Knee OA Condition(s): Osteoarthritis Study Status: This study is completed. Sponsor(s): National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) Purpose - Excerpt: We will study 300 people with knee osteoarthritis (OA) who receive their medical care from a large health maintenance organization (HMO) in Indianapolis. Our study will evaluate a comprehensive plan for treatment of knee OA by primary care physicians. Primary care physicians will provide standard care for knee OA to half of the study participants (150 people), and will use the comprehensive treatment plan guidelines to treat the other half. The comprehensive plan includes careful use of medications along with nondrug approaches such as patient education, exercise, and social support. People who participate in the study will receive care for knee OA for 1 year. We will measure the results (outcomes) of treatment at the start of the study and at 3 months, 6 months, and 12 months after patients join the study. The results we will measure include joint pain, physical function, drug side effects, quality of life, satisfaction with OA care, and the cost of medical care. Phase(s): Phase II Study Type: Interventional
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Contact(s): Long Hospital, Room 545, Indianapolis, Indiana, 46202-5103, United States. Study Chairs or Principal Investigators: Steven A. Mazzuca, Ph.D.; Indiana University School of Medicine Web Site: http://clinicaltrials.gov/ct/gui/show/NCT00000404;jsessionid=46A2D C309B3A8ECA85AA147CF4449B37 ·
Genetic and Immune Studies of Rheumatoid Arthritis and Related Conditions Condition(s): Arthritis, Psoriatic; Autoimmune Diseases; Joint Diseases; Osteoarthritis; Rheumatoid Arthritis Study Status: This study is completed. Sponsor(s): National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) Purpose - Excerpt: This protocol will examine blood, synovial fluid and synovial tissue from patients with rheumatoid arthritis and other chronic inflammatory joint diseases to study genetic and immunologic factors involved in the cause, development and progression of these conditions. Synovial fluid is the lubricating fluid in joints. The synovial membrane is a delicate tissue lining the inner surface of joints, which, in arthritic conditions, thickens and becomes infiltrated with various types of cells. Patients with rheumatoid arthritis and certain patients with other forms of arthritis may be eligible for this study. Those enrolled will be followed periodically for follow-up and disease evaluation. They may undergo the following procedures: 1. Synovial fluid aspiration, when medically indicated (for example, for joint swelling and inflammation). For this procedure, an area of skin around the joint is numbed with an anesthetic, and a needle is inserted into the joint to withdraw a small fluid sample. 2. Periodic blood sampling, not to exceed 450 milliliters (15 ounces) during any 6-week period, for genetic studies of rheumatoid arthritis. The samples are usually taken at the same times that synovial fluid is withdrawn. 3. Synovial tissues, collected by needle biopsy or during surgical procedures for arthroscopy (examination of the interior of the joint and repair of the joint) or total joint replacement. For the needle biopsy, the skin over the biopsy site is washed and anesthetized. A needle is inserted and fluid is aspirated. The biopsy needle is then inserted through the outer needle and a tissue sample is suctioned. Patients who qualify for other research studies may be invited to participate. Study Type: Observational
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Contact(s): Maryland; National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), 9000 Rockville Pike, Bethesda, Maryland, 20892, United States Web Site: http://clinicaltrials.gov/ct/gui/show/NCT00001291;jsessionid=46A2D C309B3A8ECA85AA147CF4449B37 ·
Muscle Strengthening Device for Knee Osteoarthritis Condition(s): Osteoarthritis Study Status: This study is completed. Sponsor(s): National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) Purpose - Excerpt: Studies have shown that isometric strengthening helps people with osteoarthritis of the knee. Isometric strengthening is musclestrengthening exercise without movement, in which a person applies a force against a resistant object--for example, pushing against a brick wall. This study will test the effectiveness of a portable isometric exercise device for home use that guides a person through an exercise program using various forms of feedback. We will look at whether people exercising with the device achieve better outcomes (results) in pain, stiffness, strength, and functional measures compared to people who do not use the device or people exercising according to printed material from arthritis organizations. Phase(s): Phase II Study Type: Interventional Contact(s): See Web site below Web Site: http://clinicaltrials.gov/ct/gui/show/NCT00007241;jsessionid=46A2D C309B3A8ECA85AA147CF4449B37
·
Patient Education in Rheumatoid Arthritis and Osteoarthritis Condition(s): Rheumatoid Arthritis; Osteoarthritis Study Status: This study is completed. Sponsor(s): National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) Purpose - Excerpt: This project will evaluate the effectiveness and general usefulness of two arthritis patient education programs. The first, the Arthritis Self-Management Program, is a 6-week, community-based
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program taught in small groups by peer leaders. The second, the SelfManaged Arthritis Relief Therapy (SMART) Program, is a computerdriven program delivered through the mail. Participants in this project are people with rheumatoid arthritis or osteoarthritis who are taking part in the larger long-term studies being conducted by ARAMIS (the Arthritis, Rheumatism and Aging Medical Information System). Phase(s): Phase III Study Type: Interventional Contact(s): California; Stanford University, Palo Alto, California, 94305, United States; Kansas; Wichita Arthritis Center, Wichita, Kansas, United States; Pennsylvania; University of Pittsburgh, Pittsburgh, Pennsylvania, United States; Tennessee; Vanderbilt University, Nashville, Tennessee, United States; Canada, Alberta; University of Saskatoon, Edmonton, Alberta, Canada. Study Chairs or Principal Investigators: Kate R. Lorig, Dr.P.H.; Stanford University Web Site: http://clinicaltrials.gov/ct/gui/show/NCT00000414;jsessionid=46A2D C309B3A8ECA85AA147CF4449B37 ·
Prevention of Arthritis-Related Work Disability Condition(s): Rheumatoid Arthritis; Systemic Lupus Erythematosus; Osteoarthritis, Knee; Ankylosing Spondylitis Study Status: This study is completed. Sponsor(s): National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) Purpose - Excerpt: People with rheumatic disorders (arthritis) often have trouble keeping their jobs. This study will look at whether vocational rehabilitation (VR) will improve the ability of employed people with arthritis to keep their jobs. Job retention VR services target key factors that increase the risk of job loss. They aim to modify jobs to reduce barriers caused by functional limitations and disease symptoms, future career planning, and establish a partnership with a VR counselor for ongoing help. We will conduct the study among patients with rheumatic disorders recruited in eastern Massachusetts. We will give 120 study participants job retention services provided by VR counselors. We will give another 120 participants literature about employment- related resources. We will compare the outcomes of the two groups to evaluate the usefulness of job retention services in preventing job loss in people with rheumatic disorders.
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Phase(s): Phase II Study Type: Interventional Contact(s): Boston University School of Medicine, Boston, Massachusetts, 02118, United States. Study Chairs or Principal Investigators: Saralynn J. Allaire, Sc.D.; Boston University School of Medicine Web Site: http://clinicaltrials.gov/ct/gui/show/NCT00000416;jsessionid=46A2D C309B3A8ECA85AA147CF4449B37 ·
Tidal Lavage in Knee Osteoarthritis Condition(s): Osteoarthritis, Knee Study Status: This study is completed. Sponsor(s): National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) Purpose - Excerpt: This study compared the effects of tidal lavage (washing out) of the knee joint and an imitation lavage procedure in people with knee osteoarthritis. In tidal lavage, the doctor flushes out a knee joint with repeated injections of a mild salt solution, done under local anesthesia. Study participants had to meet standard criteria for diagnosis of osteoarthritis but could have low, medium, or high severity of x-ray changes indicating knee osteoarthritis. We performed the lavage procedure once, and did quarterly followups for 1 year. We permitted patients to use some other osteoarthritis treatments during the study, such as non-narcotic pain relievers, nonsteroidal anti-inflammatory drugs, and physical therapy. Phase(s): Phase II Study Type: Interventional Contact(s): Indiana; Indiana University School of Medicine, Indianapolis, Indiana, 46202, United States. Study Chairs or Principal Investigators: John D. Bradley, M.D.; Indiana University School of Medicine Web Site: http://clinicaltrials.gov/ct/gui/show/NCT00000424;jsessionid=46A2D C309B3A8ECA85AA147CF4449B37
·
Toward Better Outcomes in Osteoarthritis Condition(s): Osteoarthritis
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Study Status: This study is completed. Sponsor(s): National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) Purpose - Excerpt: This study will determine if there is a difference between commonly used nonsteroidal anti-inflammatory drugs (NSAIDs) and acetaminophen (a pain-reliever that does not prevent inflammation) for treating knee pain in osteoarthritis (OA). The two main results we will look at are disease progression according to x-rays and disability over 3.5 years. Study participants with moderate knee OA and knee pain will continue taking their NSAID or stop taking their NSAID and start taking acetaminophen. Every 6 months we will send the participants questionnaires that ask about pain, medication use, and disability. We will take x-rays of the knees at the start of the study and again at the end of the study. Phase(s): Phase III Study Type: Interventional Contact(s): San Francisco General Hospital, San Francisco, California, 94110, United States. Study Chairs or Principal Investigators: Nancy Lane, M.D., Study Director; UCSF, Division of Rheumatology, SFGH Web Site: http://clinicaltrials.gov/ct/gui/show/NCT00000425;jsessionid=46A2D C309B3A8ECA85AA147CF4449B37
Benefits and Risks19 What Are the Benefits of Participating in a Clinical Trial? If you are interested in a clinical trial, it is important to realize that your participation can bring many benefits to you and society at large: ·
A new treatment could be more effective than the current treatment for osteoarthritis. Although only half of the participants in a clinical trial receive the experimental treatment, if the new treatment is proved to be more effective and safer than the current treatment, then those patients who did not receive the new treatment during the clinical trial may be among the first to benefit from it when the study is over.
This section has been adapted from ClinicalTrials.gov, a service of the National Institutes of Health: http://www.clinicaltrials.gov/ct/gui/c/a1r/info/whatis?JServSessionIdzone_ct=9jmun6f291.
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If the treatment is effective, then it may improve health or prevent diseases or disorders.
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Clinical trial patients receive the highest quality of medical care. Experts watch them closely during the study and may continue to follow them after the study is over.
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People who take part in trials contribute to scientific discoveries that may help other people with osteoarthritis. In cases where certain diseases or disorders run in families, your participation may lead to better care or prevention for your family members. The Informed Consent
Once you agree to take part in a clinical trial, you will be asked to sign an “informed consent.” This document explains a clinical trial's risks and benefits, the researcher’s expectations of you, and your rights as a patient. What Are the Risks? Clinical trials may involve risks as well as benefits. Whether or not a new treatment will work cannot be known ahead of time. There is always a chance that a new treatment may not work better than a standard treatment. There is also the possibility that it may be harmful. The treatment you receive may cause side effects that are serious enough to require medical attention. How Is Patient Safety Protected? Clinical trials can raise fears of the unknown. Understanding the safeguards that protect patients can ease some of these fears. Before a clinical trial begins, researchers must get approval from their hospital's Institutional Review Board (IRB), an advisory group that makes sure a clinical trial is designed to protect patient safety. During a clinical trial, doctors will closely watch you to see if the treatment is working and if you are experiencing any side effects. All the results are carefully recorded and reviewed. In many cases, experts from the Data and Safety Monitoring Committee carefully monitor each clinical trial and can recommend that a study be stopped at any time. You will only be asked to take part in a clinical trial as a volunteer giving informed consent.
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What Are a Patient's Rights in a Clinical Trial? If you are eligible for a clinical trial, you will be given information to help you decide whether or not you want to participate. As a patient, you have the right to: ·
Information on all known risks and benefits of the treatments in the study.
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Know how the researchers plan to carry out the study, for how long, and where.
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Know what is expected of you.
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Know any costs involved for you or your insurance provider.
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Know before any of your medical or personal information is shared with other researchers involved in the clinical trial.
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Talk openly with doctors and ask any questions.
After you join a clinical trial, you have the right to: ·
Leave the study at any time. Participation is strictly voluntary. However, you should not enroll if you do not plan to complete the study.
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Receive any new information about the new treatment.
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Continue to ask questions and get answers.
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Maintain your privacy. Your name will not appear in any reports based on the study.
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Know whether you participated in the treatment group or the control group (once the study has been completed). What about Costs?
In some clinical trials, the research facility pays for treatment costs and other associated expenses. You or your insurance provider may have to pay for costs that are considered standard care. These things may include inpatient hospital care, laboratory and other tests, and medical procedures. You also may need to pay for travel between your home and the clinic. You should find out about costs before committing to participation in the trial. If you have health insurance, find out exactly what it will cover. If you don't have health insurance, or if your insurance company will not cover your costs, talk to the clinic staff about other options for covering the cost of your care.
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What Questions Should You Ask before Deciding to Join a Clinical Trial? Questions you should ask when thinking about joining a clinical trial include the following: ·
What is the purpose of the clinical trial?
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What are the standard treatments for osteoarthritis? Why do researchers think the new treatment may be better? What is likely to happen to me with or without the new treatment?
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What tests and treatments will I need? Will I need surgery? Medication? Hospitalization?
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How long will the treatment last? How often will I have to come back for follow-up exams?
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What are the treatment's possible benefits to my condition? What are the short- and long-term risks? What are the possible side effects?
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Will the treatment be uncomfortable? Will it make me feel sick? If so, for how long?
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How will my health be monitored?
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Where will I need to go for the clinical trial? How will I get there?
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How much will it cost to be in the study? What costs are covered by the study? How much will my health insurance cover?
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Will I be able to see my own doctor? Who will be in charge of my care?
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Will taking part in the study affect my daily life? Do I have time to participate?
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How do I feel about taking part in a clinical trial? Are there family members or friends who may benefit from my contributions to new medical knowledge?
Keeping Current on Clinical Trials Various government agencies maintain databases on trials. The U.S. National Institutes of Health, through the National Library of Medicine, has developed ClinicalTrials.gov to provide patients, family members, and physicians with current information about clinical research across the broadest number of diseases and conditions.
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The site was launched in February 2000 and currently contains approximately 5,700 clinical studies in over 59,000 locations worldwide, with most studies being conducted in the United States. ClinicalTrials.gov receives about 2 million hits per month and hosts approximately 5,400 visitors daily. To access this database, simply go to their Web site (www.clinicaltrials.gov) and search by “osteoarthritis” (or synonyms). While ClinicalTrials.gov is the most comprehensive listing of NIH-supported clinical trials available, not all trials are in the database. The database is updated regularly, so clinical trials are continually being added. The following is a list of specialty databases affiliated with the National Institutes of Health that offer additional information on trials: ·
For clinical studies at the Warren Grant Magnuson Clinical Center located in Bethesda, Maryland, visit their Web site: http://clinicalstudies.info.nih.gov/
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For clinical studies conducted at the Bayview Campus in Baltimore, Maryland, visit their Web site: http://www.jhbmc.jhu.edu/studies/index.html
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For trials on arthritis, musculoskeletal and skin diseases, visit newly revised site of the National Institute of Arthritis and Musculoskeletal and Skin Diseases of the National Institutes of Health: http://www.niams.nih.gov/hi/studies/index.htm
General References The following references describe clinical trials and experimental medical research. They have been selected to ensure that they are likely to be available from your local or online bookseller or university medical library. These references are usually written for healthcare professionals, so you may consider consulting with a librarian or bookseller who might recommend a particular reference. The following includes some of the most readily available references (sorted alphabetically by title; hyperlinks provide rankings, information and reviews at Amazon.com): ·
A Guide to Patient Recruitment : Today's Best Practices & Proven Strategies by Diana L. Anderson; Paperback - 350 pages (2001), CenterWatch, Inc.; ISBN: 1930624115; http://www.amazon.com/exec/obidos/ASIN/1930624115/icongroupinterna
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A Step-By-Step Guide to Clinical Trials by Marilyn Mulay, R.N., M.S., OCN; Spiral-bound - 143 pages Spiral edition (2001), Jones & Bartlett Pub;
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ISBN: 0763715697; http://www.amazon.com/exec/obidos/ASIN/0763715697/icongroupinterna ·
The CenterWatch Directory of Drugs in Clinical Trials by CenterWatch; Paperback - 656 pages (2000), CenterWatch, Inc.; ISBN: 0967302935; http://www.amazon.com/exec/obidos/ASIN/0967302935/icongroupinterna
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The Complete Guide to Informed Consent in Clinical Trials by Terry Hartnett (Editor); Paperback - 164 pages (2000), PharmSource Information Services, Inc.; ISBN: 0970153309; http://www.amazon.com/exec/obidos/ASIN/0970153309/icongroupinterna
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Dictionary for Clinical Trials by Simon Day; Paperback - 228 pages (1999), John Wiley & Sons; ISBN: 0471985961; http://www.amazon.com/exec/obidos/ASIN/0471985961/icongroupinterna
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Extending Medicare Reimbursement in Clinical Trials by Institute of Medicine Staff (Editor), et al; Paperback 1st edition (2000), National Academy Press; ISBN: 0309068886; http://www.amazon.com/exec/obidos/ASIN/0309068886/icongroupinterna
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Handbook of Clinical Trials by Marcus Flather (Editor); Paperback (2001), Remedica Pub Ltd; ISBN: 1901346293; http://www.amazon.com/exec/obidos/ASIN/1901346293/icongroupinterna
Vocabulary Builder The following vocabulary builder gives definitions of words used in this chapter that have not been defined in previous chapters: Anesthesia: A state characterized by loss of feeling or sensation. This depression of nerve function is usually the result of pharmacologic action and is induced to allow performance of surgery or other painful procedures. [NIH]
Arthroscopy: Endoscopic examination, therapy and surgery of the joint. [NIH] Biopsy: The removal and examination, usually microscopic, of tissue from the living body, performed to establish precise diagnosis. [EU] Cardiovascular: Pertaining to the heart and blood vessels. [EU] Gait: Manner or style of walking. [NIH]
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PART II: ADDITIONAL RESOURCES AND ADVANCED MATERIAL
ABOUT PART II In Part II, we introduce you to additional resources and advanced research on osteoarthritis. All too often, patients who conduct their own research are overwhelmed by the difficulty in finding and organizing information. The purpose of the following chapters is to provide you an organized and structured format to help you find additional information resources on osteoarthritis. In Part II, as in Part I, our objective is not to interpret the latest advances on osteoarthritis or render an opinion. Rather, our goal is to give you access to original research and to increase your awareness of sources you may not have already considered. In this way, you will come across the advanced materials often referred to in pamphlets, books, or other general works. Once again, some of this material is technical in nature, so consultation with a professional familiar with osteoarthritis is suggested.
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CHAPTER 4. STUDIES ON OSTEOARTHRITIS Overview Every year, academic studies are published on osteoarthritis or related conditions. Broadly speaking, there are two types of studies. The first are peer reviewed. Generally, the content of these studies has been reviewed by scientists or physicians. Peer-reviewed studies are typically published in scientific journals and are usually available at medical libraries. The second type of studies is non-peer reviewed. These works include summary articles that do not use or report scientific results. These often appear in the popular press, newsletters, or similar periodicals. In this chapter, we will show you how to locate peer-reviewed references and studies on osteoarthritis. We will begin by discussing research that has been summarized and is free to view by the public via the Internet. We then show you how to generate a bibliography on osteoarthritis and teach you how to keep current on new studies as they are published or undertaken by the scientific community.
The Combined Health Information Database The Combined Health Information Database summarizes studies across numerous federal agencies. To limit your investigation to research studies and osteoarthritis, you will need to use the advanced search options. First, go to http://chid.nih.gov/index.html. From there, select the “Detailed Search” option (or go directly to that page with the following hyperlink: http://chid.nih.gov/detail/detail.html). The trick in extracting studies is found in the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer, and the
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format option “Journal Article.” At the top of the search form, select the number of records you would like to see (we recommend 100) and check the box to display “whole records.” We recommend that you type in “osteoarthritis” (or synonyms) into the “For these words:” box. Consider using the option “anywhere in record” to make your search as broad as possible. If you want to limit the search to only a particular field, such as the title of the journal, then select this option in the “Search in these fields” drop box. The following is a sample of what you can expect from this type of search: ·
Osteoarthritis: Diagnosis and Therapeutic Considerations Source: American Family Physician. 65(5): 841-848. March 1, 2002. Contact: Available from American Academy of Family Physicians. 11400 Tomahawk Creek Parkway, Leawood, KS 66211-2672. (800) 274-2237 or (913) 906-6000. E-mail:
[email protected]. Website: www.aafp.org. Summary: This journal article provides health professionals with information on the diagnosis and treatment of osteoarthritis (OA). This common rheumatologic disorder affects men and women equally, but symptoms occur earlier and appear to be more severe in women. Current estimates suggest that 40 million Americans and 70 to 90 percent of persons older than 75 have OA. In addition to age, risk factors include joint injury, obesity, and mechanical stress. The pathophysiology involves a combination of mechanical, cellular, and biochemical processes. The interaction of these processes leads to changes in the composition and mechanical properties of the articular cartilage. The strong association between age and OA may be best explained by age related changes in the matrix composition and a decrease in chondrocyte function and responsiveness to stimuli. These changes can interfere with continued internal remodeling, maintenance of the tissue, and loss of cartilage. This leads to an increased risk for cartilage degradation and injury, including surface defects in the articular cartilage. The abnormal repair process leads to the formation of osteophytes and subchondral cysts as the disease progresses. Diagnosis is largely based on a detailed history and a physical examination because radiographic findings do not always correlate with symptoms. Radiographic findings consistent with OA include joint space narrowing, osteophyte formation, pseudocyst in subchondral bone, and increased density of subchondral bone. Knowledge of the etiology and pathogenesis of the disease process aids in prevention and management. The primary goals of treatment are improved function and quality of life. Acetaminophen and nonsteroidal antiinflammatory drugs remain first line drugs. Agents such as cyclooxygenase 2 inhibitors and sodium hyaluronate joint injections offer
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new treatment alternatives. Use of complementary medications has also increased. Patient education, rehabilitation, exercise, modification of activities of daily living, and surgery are also treatment modalities that should be considered. 1 figure, 6 tables, and 44 references. (AA-M).
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A Controlled Trial of Arthroscopic Surgery for Osteoarthritis of the Knee Source: New England Journal of Medicine. 347(2): 81-88. July 11, 2002. Summary: This journal article provides health professionals with information on a randomized, placebo-controlled trial that assessed the efficacy of arthroscopic surgery of the knee in relieving pain and improving function in patients with osteoarthritis (OA). The study population consisted of 180 patients with knee OA who were randomly assigned to receive arthroscopic debridement, arthroscopic lavage, or placebo surgery. Patients in the placebo group received skin incisions and underwent a simulated debridement without insertion of the arthroscope. Patients and assessors of outcome were blinded to the treatment group assignment. Outcomes were assessed at multiple points over a 24 month period with the use of five self reported scores (three on scales for pain and two on scales for function) and one objective test of walking and stair climbing. A total of 165 patients completed the trial. The study found that at no point did either of the intervention groups report less pain or better function than the placebo group. For example, there was no difference in knee pain between the placebo group and either the lavage group or the debridement group at 1 year or 2 years. Similarly, there was no significant difference in arthritis pain between the placebo group and the lavage group or the debridement group at 1 or 2 years. Furthermore, at no time point did either arthroscopic intervention group have significantly greater improvement in function than the placebo group. For example, there was no significant difference between the placebo group and either the lavage group or the debridement group in the self reported ability to walk and bend at 1 year or at 2 years. In fact, objectively measured walking and stair climbing were poorer in the debridement group than in the placebo group at 2 weeks and 1 year and showed a trend toward worse functioning at 2 years. Lacking evidence of the superiority of the arthroscopic treatments over the placebo procedure in relieving pain or improving function, researchers considered whether the 95 percent confidence intervals for the differences in outcomes between each arthroscopic procedure and the placebo procedure included clinically important differences. At almost all time points during follow up, the confidence intervals excluded the minimal
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important differences used in the study. The article concludes that the outcomes after arthroscopic lavage or arthroscopic debridement were no better than those after a placebo procedure. 2 figures, 3 tables, and 35 references. (AA-M).
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Debridement and Lavage for Osteoarthritis of the Knee Source: New England Journal of Medicine. 347(2): 132-133. July 11, 2002. Summary: This journal article provides health professionals with information on a randomized, placebo-controlled trial that assessed the efficacy of arthroscopic surgery of the knee in relieving pain and improving function in patients with osteoarthritis (OA). The study found no improvement of knee symptoms or knee related function from either arthroscopic debridement or lavage. Among the strengths of this trial are its size, its use of a sham arthroscopy control group with patients and evaluators blinded to the treatment assignment, its limited loss to follow up over a 2 year period, and its use of treatments that are essentially identical to those in widespread use. Weaknesses of the study include its use of an as yet unpublished instrument to measure knee pain, its focus on patients who completed the trial, and its use of a study population consisting mostly of men. The article concludes that the study provides insights into factors that affect and do not affect joint pain and disability over time and suggests that the effects on clinical symptoms of debris in osteoarthritic joints are negligible. 12 references.
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Determining the Efficacy of Glucosamine and Chondroitin for Osteoarthritis Source: Nurse Practitioner, The. 26(6): 44-46,49-52. June 2001. Summary: This journal article provides health professionals with information on the use of glucosamine and chondroitin in the treatment of osteoarthritis (OA). Although OA was once regarded as a simple consequence of aging and cartilage degeneration, researchers now believe that OA may be a group of overlapping diseases rather than a single disorder. The functional properties of articular cartilage are the core of OA pathogenesis. Components of articular cartilage are water, collagen, proteoglycans, chondrocytes, and other matrix components. Over time, the catabolism of proteoglycans and the increased loss of glycosaminoglycans result in the abrasion of cartilage and the formation of new bone within the joint. In healthy people, a balance of cartilage matrix turnover is maintained through synthesis and degradation. The
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failure to maintain this homeostatic balance because of reduced formation or increased catabolism is a possible explanation for OA. Treatment modalities focus on primary and secondary prevention. Primary prevention involves educating patients about joint protection, exercise, weight reduction, and the dangers of repetitive motion. Secondary prevention is mainly palliative and involves both nonpharmacologic and pharmacologic therapies to minimize pain. Glucosamine sulfate and chondroitin sulfate are being used by many patients for the treatment of OA. The article reviews human and animal studies on the use of these agents in treating OA. Despite findings in many of these studies supporting the efficacy of these agents for palliation of joint pain in patients with OA, the American College of Rheumatology Subcommittee on OA believes that it is too early to issue recommendations for use. Currently, the National Institute for Arthritis and Musculoskeletal and Skin Diseases, in collaboration with the National Center for Complementary and Alternative Medicine has begun a pivotal study to thoroughly evaluate these agents. 36 references. (AAM).
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Radiographic Assessment of Osteoarthritis Source: American Family Physician. 64(2): 279-286. July 15, 2001. Contact: American Academy of Family Physicians. 11400 Tomahawk Creek Parkway, Leawood, KS 66211-2672. (800) 274-2237 or (913) 9066000. E-mail:
[email protected]. Website: www.aafp.org. Summary: This journal article provides health professionals with information on the etiology, clinical features, radiographic findings, and disease progression of osteoarthritis (OA). Although OA is common in older adults, its pathology of asymmetric joint cartilage loss, subchondral sclerosis, and marginal osteophytes and subchondral cysts is the same in younger and older adults. OA is primarily diagnosed and assessed through a history and physical examination. The cardinal symptom is pain that worsens during activity and improves with rest. Joint instability is a common finding, especially involving the knees and first carpometacarpal joints. Early morning stiffness is common. Stiffness may also occur following periods of inactivity. Radiographic findings, including asymmetric joint space narrowing, subchondral sclerosis, osteophyte formation, subluxation, and distribution patterns of osteoarthritis changes, can be helpful when the diagnosis is in question. Although followup radiographs are not necessary to evaluate disease progression, they can be helpful if surgical intervention is planned or a fracture is suspected. The article includes guidelines on diagnosing OA of
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the knee, hand, hips, pelvis, spine, and foot. 5 figures, 2 tables, and 20 references. (AA-M).
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Use of Glucosamine and Chondroitin Sulfate in the Management of Osteoarthritis Source: Journal of the American Academy of Orthopaedic Surgeons. 9(2): 71-78. March-April 2001. Summary: This journal article provides health professionals with information on the use of glucosamine and chondroitin sulfate in the management of osteoarthritis (OA). The goals of OA therapy are to decrease pain and to maintain or improve joint function. The pharmacologic treatment of this condition has included the use of aspirin, acetaminophen, and nonsteroidal antiinflammatory drugs. More recently, numerous studies have investigated the potential role of chondroprotective agents, particularly glucosamine and chondroitin sulfate, in repairing articular cartilage and decelerating the degenerative process. Glucosamine is an aminosaccharide that takes part in the synthesis of glycosaminoglycans and proteoglycans by condrocytes. Chondroitin sulfate is a glycosaminoglycan composed of a long, unbranched polysaccharide chain of alternative residues of sulfated or unsulfated residues of glucuronic acid and N-acetylgalactosamine. The reports of limited clinical experience with these two agents, as well as the accompanying publicity in the popular media, have generated controversy. Advocates of these alternative modalities cite reports of progressive and gradual decline of joint pain and tenderness, improved mobility, sustained improvement after drug withdrawal, and a lack of significant toxicity associated with short term use of these agents. Critics point out that in the great majority of the relevant clinical trials, sample sizes were small and follow up was short term. Many unanswered questions remain surrounding the long term effects of these agents, the most effective dosage and route, and product purity. 2 tables and 34 references. (AA-M).
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When To Consider a COX-2 Inhibitor for Osteoarthritis of the Knee Source: JAAPA: Journal of the American Academy of Physician Assistants. 14(3): 13-14. March 2001. Summary: This journal article uses a case study question to provide health professionals with information on the use of cyclooxygenase-2 (COX-2) inhibitors in treating osteoarthritis (OA) of the knee. The patient
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in question is a 64 year old retired schoolteacher who has a history of OA and hypertension. She complains of tenderness and pain in her right knee. She takes nonprescription ibuprofen almost daily but complains that it causes heartburn. She asks about taking the newer COX-2 inhibitors. The article recommends that the patient be given acetaminophen first. Other options include the nonsteroidal antiinflammatory drugs (NSAIDs) etodolac or salsalate, or another agent. If the patient does not tolerate the NSAIDs or they do not relieve her symptoms, one of the COX-2 inhibitors can be considered. Celecoxib is indicated for signs and symptoms of OA, rheumatoid arthritis, and familial adenomatous polyposis, whereas rofecoxib is indicated for acute pain, OA, and primary dysmenorrhea. Although the COX-2 inhibitors have an excellent safety profile, they are quite costly in comparison with NSAIDs. The main adverse effects associated with the COX-2 inhibitors are diarrhea, dyspepsia, nausea, and edema; however, they pose less risk of gastrointestinal bleeding than standard NSAIDs. 1 table and 5 references.
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Glucosamine in the Treatment of Osteoarthritis Source: Rheumatic Disease Clinics of North America. 26(1): 1-11. February 2000. Summary: This journal article provides health professionals with information on the use of glucosamine sulfate in the treatment of osteoarthritis (OA). Glucosamine, an aminomonosaccharide, is found in articular cartilage. Despite its widespread use, little is known about its bioavailability or pharmacokinetics. Various clinical trials have investigated the efficacy of glucosamine sulfate. Available data suggest that glucosamine decreases pain and improves function in OA. Several studies have shown that glucosamine sulfate is as good as ibuprofen for treating OA of the knee. However, most of the glucosamine studies have methodological flaws or used parenteral formulations, making their data difficult to extrapolate into clinical practice. In addition, no data on the long term safety or efficacy of glucosamine are available. Better designed clinical trials of glucosamine are needed to identify its role in the pharmacology of OA. Although glucosamine is frequently sold as a combination product containing chondroitin sulfate, no clinical data are available on the efficacy of the combination. A few studies have compared chondroitin sulfate with placebo or diclofenac sodium OA therapy. Results suggest that chondroitin sulfate may be beneficial. People who chose to take glucosamine should be aware that its safety and efficacy are largely unknown. 1 table and 21 references. (AA M).
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Homeopathy and Rheumatic Disease Source: Rheumatic Disease Clinics of North America. 26(1): 117-123. February 2000. Summary: This journal article provides health professionals with information on the use of homeopathy to treat rheumatic disease. Homeopathy is one of the most frequently sought alternative therapies for treating rheumatic syndromes. Homeopathy was developed by the German physician Samuel Christian Hahnemann in the latter half of the 18th century. There are two main tenets of homeopathy. One is the principle of similars. This principle states that patients with a particular pattern of signs and symptoms can be cured if they are given a drug that produces the same pattern of signs and symptoms when given to a healthy individual. The second tenet in homeopathy is that remedies retain biological activity if they are diluted and agitated or shaken between serial dilutions. This tenet has often led scientists to reject homeopathy out of hand, without looking at evidence for its effects in clinical trials. Unfortunately, the current number of controlled clinical trials on the treatment of rheumatic syndromes with homeopathy is few, and results are mixed. Rheumatic arthritis has been the most studied, and only small studies have been done on osteoarthritis, fibromyalgia, and the myalgias. Overall, it appears that homeopathic remedies work better than a placebo in studies of rheumatic syndromes; however, there are too few studies to draw definitive conclusions about the efficacy of any one type of homeopathic treatment on any one condition. 25 references. (AAM).
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Around-the-Clock, Controlled-Release Oxycodone Therapy for Osteoarthritis-Related Pain Source: Archives of Internal Medicine. 160(6): 853-860. March 27, 2000. Summary: This journal article provides health professionals with information on a study that evaluated the effects of controlled-release oxycodone (OxyContin tablets) treatment on pain and function and its safety versus placebo and in long term use in patients who had moderate to severe osteoarthritis (OA). The study population consisted of 135 patients experiencing persistent OA related pain for at least 1 month who were randomized to double blind treatment with placebo or 10 milligrams or 20 milligrams of controlled-release oxycodone every 12 hours for 14 days. One hundred six patients enrolled in an open label, 6
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month extension trial. Treatment for an additional 12 months was optional. Results indicate that the use of 20 milligrams of controlledrelease oxycodone was superior to placebo in reducing pain intensity and the interference of pain with mood, sleep, and enjoyment of life. During long term treatment, the mean dose remained stable at approximately 40 milligrams per day after titration, and pain intensity was stable. Fiftyeight patients completed 6 months of treatment, 41 completed 12 months, and 15 completed 18 months. Common opioid side effects were reported, several of which decreased in duration as therapy continued. The article concludes that around the clock controlled-release oxycodone therapy seemed to be an effective and safe treatment modality for patients who had chronic, moderate to severe pain associated with OA. 34 references. (AA-M).
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Glucosamine and Chondroitin for Treatment of Osteoarthritis: A Systematic Quality Assessment and Meta-analysis Source: JAMA. Journal of the American Medical Association. 283(11): 1469-1475. March 15, 2000. Summary: This journal article provides health professionals with information on a study that evaluated the benefit of glucosamine and chondroitin preparations for osteoarthritis (OA) symptoms using meta analysis combined with systematic quality assessment of clinical trials of these preparations in knee or hip OA. Clinical trials of glucosamine and chondroitin compounds were identified by using electronic searches of MEDLINE and the Cochrane Controlled Trials Register. 'Osteoarthritis,' 'osteroarthrosis,' 'degenerative arthritis,' 'glucosamine,' 'chondroitin,' and 'glycosaminoglycans' were entered as medical subject heading terms and as textwords. Review articles, manuscripts, and supplements from rheumatology and OA journals were manually searched, and unpublished data were sought by contacting content experts, study authors, and manufacturers of glucosamine and chondroitin. Studies were included if they were published or unpublished double blind, randomized, placebo controlled trials of 4 or more weeks' duration that tested glucosamine or chondroitin for knee or hip OA and reported extractable data on the effect of treatment on symptoms. Fifteen of 37 studies were included in the analysis. Reviewers performed data extraction and scored each trial using a quality assessment instrument. Quality scores ranged from 12.3 percent to 55.4 percent of the maximum, with a mean of 35.5 percent. Only one study described adequate allocation concealment and two reported an intent to treat analysis. Most were supported or performed by a manufacturer. Funnel plots show
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significant asymmetry compatible with publication bias. Tests for heterogeneity were nonsignificant after removing one outlier trial. The aggregated effect sizes were 0.44 for glucosamine and 0.78 for chondroitin, but they were diminished when only high quality or large trials were considered. The effect sizes were relatively consistent for pain and functional outcomes. The article concludes that trials of glucosamine and chondroitin preparations demonstrate moderate to large effects on OA symptoms, but quality issues and likely publication bias suggest that these effects are exaggerated. Nevertheless, some degree of efficacy appears probable for these preparations. 2 figures, 2 tables, and 54 references. (AA-M).
Federally Funded Research on Osteoarthritis The U.S. Government supports a variety of research studies relating to osteoarthritis and associated conditions. These studies are tracked by the Office of Extramural Research at the National Institutes of Health.20 CRISP (Computerized Retrieval of Information on Scientific Projects) is a searchable database of federally funded biomedical research projects conducted at universities, hospitals, and other institutions. Visit the CRISP Web site at http://commons.cit.nih.gov/crisp3/Crisp_Query.Generate_Screen. You can perform targeted searches by various criteria including geography, date, as well as topics related to osteoarthritis and related conditions. For most of the studies, the agencies reporting into CRISP provide summaries or abstracts. As opposed to clinical trial research using patients, many federally funded studies use animals or simulated models to explore osteoarthritis and related conditions. In some cases, therefore, it may be difficult to understand how some basic or fundamental research could eventually translate into medical practice. The following sample is typical of the type of information found when searching the CRISP database for osteoarthritis: ·
Project Title: AEROBIC EXERCISE INTERVENTION FOR KNEE OSTEOARTHRITIS Principal Investigator & Institution: Kaufman, Kenton R.; Associate Professor; Mayo Clinic, Rochester; 200 1St St SW; Rochester, MN 55905
Healthcare projects are funded by the National Institutes of Health (NIH), Substance Abuse and Mental Health Services (SAMHSA), Health Resources and Services Administration (HRSA), Food and Drug Administration (FDA), Centers for Disease Control and Prevention (CDCP), Agency for Healthcare Research and Quality (AHRQ), and Office of Assistant Secretary of Health (OASH).
20
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Timing: Fiscal Year 2002; Project Start 1-SEP-2002; Project End 1-MAR2006 Summary: (provided by applicant): Arthritis is one of the most common causes of functional limitation and dependency in the United States. Individuals with osteoarthritis restrict joint motion and limit activity in order to decrease their symptoms. Traditional, conservative medical treatment of osteoarthritis has been directed at improving functional status through reducing joint pain and inflammation and maintaining or restoring joint function. Exercise as an adjunct therapy in the clinical management of patients with osteoarthritis of the knee, however, is not uniformly accepted. In contrast, exercise has been shown to be effective for prevention and treatment of cardiovascular and metabolic disorders. Standard guidelines exist for aerobic exercise prescriptions. The focus of this study is to determine if these guidelines can also be applied to individuals with knee osteoarthritis. Patients with knee osteoarthritis will be randomized into a control group, a walking exercise group, and a stationary cycling exercise group. The individuals in the exercise groups will be required to exercise three times per week for one year using emerging public health recommendations for aerobic exercise in the adult and aging population. Patient outcome will be assessed using objective gait analysis measurements, knee radiographs to quantify joint space narrowing, magnetic resonance imaging, a general health status questionnaire (SF-36), a disease/site specific questionnaire (WOMAC), and a visual-analog pain scale. All subjects will be studied at 0 and 52 weeks. The central hypothesis of this work is that aerobic exercise can be successfully implemented as an effective nonsurgical option for treatment of patients with early stages of knee osteoarthritis. In order to evaluate this hypothesis, the following specific aims are proposed: Specific Aim 1: Determine the effect of aerobic exercise on patients with knee osteoarthritis. Hypothesis A: Clinical Outcome measures will be better in patients enrolled in exercise programs that in control patients. Hypothesis B: Quantitative measures of lower extremity function will not decline over time in an effective aerobic exercise program. Specific Aim 2: Determine prognostic factors that effect outcome in patients with knee osteoarthritis. Hypothesis: A effective exercise prescription for adults with degenerative joint disease is dependent on knee compartment involvement, CIA stage, BMI, and type of exercise prescribed. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
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Project Title: BIOMARKERS EPIDEMIOLOGY
OF
OSTEOARTHRITIS--THEIR
Principal Investigator & Institution: Sowers, Maryfran R.; Professor; University of Michigan at Ann Arbor; 3003 South State, Room 1040; Ann Arbor, MI 481091274 Timing: Fiscal Year 2001; Project Start 1-JAN-2001; Project End 1-DEC2002 Summary: Osteoarthritis (OA) is a highly prevalent chronic disease leading to significant functional limitations in both males and females, but particularly women. We propose to characterize the natural history of osteoarthritis (of the knee and hand) using radiographs, interviews and markers of cartilage and bone turnover as well as joint inflammation with this longitudinal study. The specific questions are: 1.Do biochemical markers of osteoarthritis (OA) provide evidence os OA earlier than radiographs.? 2.Can turnover markers be used to define natural history and progression of arthritis? 3.Are bone mineral density(BMD) loss and development/initiation of OA highly regulated? These questions can be addressed efficiently by concatenating historical data from two previously generated population-based groups. One population(Tecumseh Bone Health Study) of 573 women was 25-45 years at their 1992 baseline evaluation (R01-AR-40888--Bone Mineral Density Change and the Climacteric). Hand and knee films were taken two times four years apart (1992 and 1996) along with an annual BMD measurement. Annual urine and serum specimens were collected and are available for analysis of OA markers. The second group, from the SWAN Study (NR-04061), is a population-based group of 300 African-American and 150 Caucasian pre and perimenopausal women, aged 42-52 years at their 1996 baseline when hand and knee films were characterized and serum and urine collected. To the retrospectively available data, we propose to recontract these 1,023 women for radiographs (hand and knee) and interviews in 1998 and 2000 and add annual blood and urine collection with identification of potential markers of arthritis (including turnover on bone/collagen and inflammation). This would allow the examination of the initiation of osteoarthritis using radiographs, interviews and turnover biomarkers. This information about the natural history of osteoarthritis should allow us to consider more appropriate prevention and intervention strategies and offer the potential to identify markers prognostic of disease incidence and of processes involved in its pathobiology. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
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Project Title: TRANSGENE RESCUE OF CHONDRODYSPLASIA AND OSTEOARTHRITIS Principal Investigator & Institution: Bridgewater, Laura C.; Zoology; Brigham Young University; Provo, UT 84602 Timing: Fiscal Year 2001; Project Start 0-SEP-1999; Project End 1-OCT2002 Summary: Cartilage collagen fibrils are composed of type II, type IX and type XI collagen. Mutations in the genes for any of these collagens produce cartilage disorders, which range in severity from mild dwarfism with osteoarthritis to neonatal lethal chondrodysplasias. In addition to these syndromic cartilage disorders, a growing body of evidence suggests that cartilage collagen mutations also play a role in some of the estimated 20.7 million cases of osteoarthritis in America today. Little is currently known about the etiology of the vast majority of osteoarthritis cases. But in cases where the genetic cause is known, and the mutation is not dominant negative therapeutic expression of a healthy version of the mutant gene in the affected joint may be an effective treatment. The feasibility of such a treatment for cartilage disorders has not yet been tested, but we propose to begin testing it in this project. The chondrodysplasia (cho) mouse line provides a model system in which the rescue of both chondrodysplasia and osteoarthritis by ectopic expression of a gene can be studied. The cho mutation is a single base pair deletion in Col11a1 which leads to premature termination of its protein product, the type XI collagen subunit alpha1 (XI). Mice that are homozygous for the cho mutation have severe abnormalities of all cartilaginous structures and die at birth. Mice that are heterozygous for the mutation appear normal at birth, but develop osteoarthritis within six months. The goal of this proposal is to express a Col11a1 transgene in homozygous and heterozygous cho mice, in an effort to rescue the chondrodysplasia and osteoarthritis phenotypes. Enhancer elements which are capable of directing reporter gene expression specifically to cartilage in transgenic mice have already been characterized and tested. These elements will be used to construct a transgene vector that expresses Col11a1 specifically in cartilage and at levels that approximate the expression level of the endogenous Col11a1 gene. The vector will then be used to insert the transgene in homozygous and heterozygous cho mice. Our hypothesis is that the Col11a1 transgene will rescue or ameliorate the neonatal lethal homozygous cho phenotype, allowing mice to survive beyond birth. But whether or not the mice survive beyond birth, they will be thoroughly analyzed by skeletal preparations histology, immunofluorescence, and electron microscopy. Our hypothesis in the case of the heterozygous cho mice which develop osteoarthritis by 6 months of age, is that the Col11a1
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transgene will prevent or delay the onset of osteoarthritis. Histological and electron microscopic analyses of articular cartilage and intervertebral discs will be performed to assess the effects of the transgene on these mice. The overall goal of this proposal is to determine whether the chondrodysplasia and osteoarthritis phenotypes in cho mice can be rescued by the ectopic expression of a transgene, and to thereby shed light on the feasibility of one day using gene therapy protocols to treat similar disorders in humans. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
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Project Title: WEDGED INSOLE OSTEOARTHRITIS OF THE KNE
FOR
TREATMENT
OF
Principal Investigator & Institution: Felson, David T.; Professor and Chair; Boston University; 715 Albany St, 560; Boston, MA 02118 Timing: Fiscal Year 2001; Project Start 4-SEP-2001; Project End 1-AUG2006 Summary: Osteoarthritis is a highly prevalent and often disabling disorder and its treatment is often frustrating. Most osteoarthritis of the knee affects the medial compartment of the knee which even in an unaffected persons bears 60-70% of loading during walking. With the development of disease in the medial compartment, increased loading of the medial compartment is likely to be one source of localized pain. An operation in which realignment unloads the medial compartment provides excellent pain relief for patients with medial osteoarthritis. One way to lessen load across the medial compartment would be to insert an insole into the shoe that alters the distribution of load in the foot which, in turn, alters load in the knee. Japanese investigators have tested such a wedged insole and have suggested in an uncontrolled study that knee symptoms are improved. No randomized controlled trials of this treatment have been reported but if it is efficacious, it is likely to be safe and inexpensive. The overall objective of this project is to perform a randomized clinical trial of a wedged insole in patients with medial knee osteoarthritis to determine whether the use of these insoles alleviates pain. We will test that hypothesis, that compared to a neutral insert, the provision of a wedged shoe insert alleviates pain in medial knee osteoarthritis. The specific aims are: 1) to undertake a 16-week randomized crossover clinical trial in patients with medial knee osteoarthritis to determine whether prevision of the valgus wedged insert into the shoe leads to lower pain scores during the time of this treatment than during the use of a neutral insert made of the same material and 2) to perform an open label follow-up to track use and effectiveness of
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inserts. We are recruiting 80-90 patients from clinics at Boston Medical Center and by advertisements in the media, who meet criteria for medial joint osteoarthritis of the knee (roughly 60% of patients with osteoarthritis). Our protocol includes a pre-randomization visit at which time subjects undergo radiographs to evaluate their eligibility and then randomization to either the neutral shoe insert or the wedged insert with a total of six weeks of treatment after which there is a four week washout period followed by six weeks randomized to the other treatment. Our main outcome measure will be the WOMAC, a well validated tool for evaluating knee symptoms and knee related disability. At the end of the study we will be able to test whether provision of a valgus shoe insole relives pain when compared to a prevision of a neutral insole. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
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Project Title: EFFICACY OF ACUPUNCTURE WITH PT FOR KNEE OSTEO-ARTHRITIS Principal Investigator & Institution: Farrar, John T.; Senior Scholar; Anesthesia; University of Pennsylvania; 3451 Walnut Street; Philadelphia, PA 19104 Timing: Fiscal Year 2001; Project Start 5-JUL-2001; Project End 1-MAR2006 Summary: Acupuncture is an ancient Chinese technique of using a fine needle to stimulate points along theoretical meridians of energy to correct imbalances thought to be responsible for specific disease states. In the United States, acupuncture is often used for the treatment of painful conditions. The 1997 NIH Consensus Conference concluded that there was adequate evidence of efficacy in an acute dental pain model and in nausea. In chronic pain, most studies were too small, poorly designed, poorly executed, or improperly controlled to adequately demonstrate that needle acupuncture worked better than sham acupuncture, placebo, standard medical therapy, or even no treatment. Osteoarthritis (OA) of the knee has been proposed as a good model to test the efficacy of acupuncture in a chronic pain condition because it is an extremely common, well defined, and disabling condition with well established outcome measures for symptoms and functional status. There is clinical trial evidence of efficacy for the standard treatments of acetaminophen and NSAIDs, and exercise physical therapy (EPT), which is usually added when the patient develops functional limitations. One high quality study of acupuncture for knee OA, demonstrated moderate benefit in an unblinded comparison to a usual care control group. As such, a major question remains about whether acupuncture, used in addition to
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exercise therapy, will provide a clinically meaningful improvement in pain and function. Since pain can be the primary limiting factor in improved exercise capacity, if acupuncture has any efficacy in reducing the pain of knee OA, then the combination with an EPT program should be substantially more effective than EPT alone. Another major concern is that the effect of the acupuncture may be predominantly mediated by non- specific placebo effects rather than the specific effects of the placement of a needle. Another important component of this proposal is our use of a validated blinded placebo needle instead of sham acupuncture points. Therefore, the primary goal of this proposal is to use a properly designed randomized blinded clinical trial, using American College of Rheumatology (ACR) criteria and Food and Drug Administration (FDA) recommended outcome measures, to determine whether the addition of acupuncture to standard EPT provides an overall clinically important benefit to patients with symptomatic knee OA compared to placebo acupuncture. As a secondary goal, we will use the clinical trial data to develop prognostic and etiologic models for the patients that are most likely to respond to acupuncture. If a clinically important benefit for acupuncture is found, a broader application of this technique would be justified. However, if the results are negative, then the addition of acupuncture to EPT should be generally curtailed. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
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Project Title: HUMAN CARTILAGE BIOMECHANICS: AGING AND OSTEORTHRITIS Principal Investigator & Institution: Sah, Robert L.; Professor and ViceChairman; Scripps Research Institute; 10550 N Torrey Pines Rd; San Diego, CA 92037 Timing: Fiscal Year 2002; Project Start 1-JUL-1997; Project End 1-MAR2007 Summary: Articular cartilage normally serves as a wear resistant, low friction, load- bearing surface in diarthrodial joints. However, during aging and osteoarthritic cartilage degeneration in adult humans, biomechanical properties deteriorate. The long-term goal of this project is to elucidate the cellular and molecular basis for the biomechanical dysfunction of human articular cartilage during "aging" and "osteoarthritis", and also to develop diagnostic assays of this dysfunction. During the current grant period, we found that articular cartilage (1) has (a) compressive and tensile moduli that vary markedly with depth from the articular surface, (b) tensile properties that diminish modestly with normal aging (defined by gross morphology and histopathology) in a
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site-specific manner in adult humans, and (c) properties that appear dependent on both fixed charge and collagen network properties, (2) becomes more brittle with controlled aging by in vitro glycation, (3) has marked increases in intrinsic fluorescence during aging that needs to be accounted for in assessing DNA content, and (4)allows attachment of exogenous cells in a time-dependent manner. We now propose to further analyze the extent and mechanisms of biomechanical dysfunction in adult human articular cartilage during "aging" and "osteoarthritis". In particular, we propose the following. (1) To expand the biomechanical analysis of depth-dependent properties of human articular cartilage to osteoarthritic tissue in order to assess how both "aging" and "osteoarthritis" each contribute to altered material and structural mechanical properties, (2) To determine if distinct matrix metabolic pathways of "aging" and "osteoarthritis" are evident in human cartilage, as well as cartilage treated in vitro, and contribute to altered biomechanical properties. (3) To determine if cell density, organization, and phenotype are altered in "aging" and "osteoarthritis", as well as cartilage treated in vitro, and also contribute to altered biomechanical properties. Elucidation of depth-varying tissue-scale properties of cartilage are critical to an overall understanding of cartilage biomechanical function. Determination of the sensitivity of structural biomechanical testing in specific regions of human articular cartilage will help evaluate a diagnostic modality. Elucidation of mechanistic pathways leading to cartilage biomechanical dysfunction in aging and osteoarthritis may ultimately suggest therapeutic interventions. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
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Project Title: HUMAN RETROVIRUS-5 AND ARTHRITIS Principal Investigator & Institution: Patel, Robin; Assistant Professor of Medicine; Mayo Clinic, Rochester; 200 1St St SW; Rochester, MN 55905 Timing: Fiscal Year 2001; Project Start 30-SEP-2000; Project End 1-AUG2003 Summary: Osteoarthritis and rheumatoid arthritis are the most common joint diseases of mankind. To date, no infectious agent has been convincingly associated with rheumatoid arthritis or osteoarthritis, although preliminary data ,suggest an association with human retrovirus-5, a newly identified retrovirus. That human retrovirus-5 is associated with both rheumatoid arthritis and osteoarthritis is, on initial consideration, striking, because these diseases are felt to be epidemiologically, clinically and pathologically distinct. However, it is possible that rheumatoid arthritis and osteoarthritis are both associated
98 Osteoarthritis
with human retrovirus-5, but that the immunologic response to the infection differs in each instance. The response may depend on the genetic background of the patient. Alternatively, genetic polymorphisms amongst human retrovirus-5 isolates may account for its association with two, seemingly unrelated, disease processes. The purpose of this proposal is to establish the association of human retrovirus-5 with rheumatoid arthritis and osteoarthritis, and to further characterize human retrovirus-5 by sequencing the entire viral genome and culturing the putative retrovirus. To achieve these goals, three specific aims are proposed. Specific Aim 1: Study the association of human retrovirus-5 with rheumatoid arthritis and osteoarthritis. Specific Aim 2: Sequence the entire viral genome of human retrovirus-5. Specific Aim 3: Culture human retrovirus-5. Intraoperative synovial tissue and whole blood specimens from 50 patients with rheumatoid arthritis and 50 patients with osteoarthritis, and synovial tissue specimens from 15 patients with normal joints will be collected and tested by nested polymerase chain reaction for human retrovirus-5 proviral DNA. Positive samples will be sequenced. The frequency of detection of human retrovirus-5 proviral DNA in synovial tissues and blood from rheumatoid arthritis and osteoarthritis patients will be compared to that in patients with no known joint disease. These samples will be used as sources of human retrovirus5 in experiments to extend the known sequence of the human retrovirus5 genome and culture the novel virus. Identification of a specific infectious agent associated with these arthritides would potentially allo for the development of preventive strategies such as vaccination and novel therapeutic approaches. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
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Project Title: JOB-RELATED ARTHRITIS AND DISABILITY IN RETIREMENT Principal Investigator & Institution: Leigh, Paul; Epidemiology and Prev Medicine; University of California, Davis; Sponsored Programs, 118 Everson Hall; Davis, CA 95616 Timing: Fiscal Year 2001; Project Start 0-SEP-2000; Project End 9-SEP-2002 Summary: Two widely-shared medical views motivate the proposed study: 1) Injuries to joints at some time in life can produce osteoarthritis in those joints later in life. 2) Perhaps the best predictor of future lowback pain is prior low-back pain. For our purposes, the time dimension is important. The initial injury or pain could occur on-the-job whereas the subsequent osteoarthritis or pain could occur much later, perhaps during retirement years. These subsequent osteoarthritis and pain events will
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generate direct costs (doctor visits, hospitalizations, drugs) and indirect costs (lost productivity on-the-job and in the home). Aim 1 is to estimate the costs of job-related osteoarthritis. Current estimates of all job-related injuries and illnesses ignore these costs. Aim 2 is to investigate the connection between employment in injury-producing jobs prior to retirement and functional disability after retirement. Costs of job-related osteoarthritis and functional disability in retirement are important for at least three reasons. First, ignoring them leads to a significant underestimate of the overall costs of job-related injuries and illnesses. Second, these costs were largely borne by victims, families, and taxpayers, not by workers' compensation (WC) systems. Third, current economic evaluations of some Occupational Safety and Health (OSHA) standards, such as those pertaining to ergonomics, also ignore these costs. If these standards reduce initial disorders and injuries, then they should also reduce the subsequent costs. The implication is that current ergonomic standards may be more cost-effective than is commonly believed. Prevalence and costs of osteoarthritis will be estimated with primary data from the National Health Interview Surveys, National Center for Health Statistics, the Bureau of Labor Statistics, and the Agency for Healthcare Research and Quality and with secondary data from published studies. We will present a range of estimates under clearly- stated assumptions so readers can select the scenario they find most reasonable. The connection between employment in injuryproducing jobs and subsequent functional disability will be investigated with the National Health and Nutrition Examination Survey III (NHANES III). The NHANES III has information on the functional disability (Activities of Daily Living) of retirees, as well as information on subjects' longest held jobs prior to retirement. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
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Project Title: MIDCAREER INVESTIGATOR AWARD PATIENTORIENTED RESEARCH Principal Investigator & Institution: Lane, Nancy E.; Associate Professor; Medicine; University of California, San Francisco; 500 Parnassus Ave.; San Francisco, CA 94122 Timing: Fiscal Year 2002; Project Start 30-SEP-2002; Project End 30-JUN2007 Summary: (provided by applicant): Nancy E. Lane, MD is an Associate Professor of Medicine at the University of California, San Francisco (UCSF). She is an established clinical investigator in musculoskeletal diseases with a special emphasis on osteoporosis and osteoarthritis. She
100 Osteoarthritis
is currently an NIH-funded investigator conducting a study to determine if PTH can reverse glucocorticoid-induced osteoporosis and to determine risk factors for the development and progression of hip OA. The purpose of this K24 award is to mentor and teach clinical research in osteoporosis and osteoarthritis at UCSF by 1) Developing an interdisciplinary clinical research seminars in osteoporosis and osteoarthritis that both topical lectures and work in progress research presentations by junior investigators; 2) Meeting individually with all junior clinical investigators UCSF in the field of osteoporosis and osteoarthritis to review research progress, provide study design analysis suggestions, and to establish additional resources for the investigators; 3) Becoming a core faculty member in the Master's in Clinical Research Program at UCSF by teaching a seminar on Developing a Clinical Research Protocol and mentoring master's students on research methodology; 4) Mentoring junior investigators in clinical research with my currently funded NIH grants on glucocorticoid-osteoporosis and on the epidemiology of hip OA. The specific aims of the currently funded NIH proposal to determine if PTH can reverse glucocorticoid-induced osteoporosis are to: l) To determine the changes in BMD caused by two years of treatment with hPTH (1-34) or placebo in postmenopausal women with GC-induced osteoporosis who are taking estrogen, calcium, vitamin D and chronic low doses of GCs; 2) To determine if estrogen or alendronate will preserve the high bone mass state created by two years of hPTH (1-34) treatment; 3) To determine the association of biochemical markers of bone turnover with hPTH (1-34) both during and after treatment. Monitoring for specific aim 3 will be accomplished by obtaining serum bone specific alkaline phosphates, serum osteocalcin, and urinary deoxypyridinoline cross-links at 3-month intervals; 4) To compare, as possible, the fracture incidence between the hPTH (1-34) and placebo treatment groups. Monitoring for specific aims I and 2 will be accomplished by annual spinal and proximal femur trabecular bone mineral content by quantitative computed tomography (QCT) and semiannual dual x-ray absorptiometry (DXA) of the spine, hip, and forearm. The specific aims for the natural history of hip CA are to identify cases of new or worsening radiographic osteoarthritis (OA) of the hip by obtaining a second x-ray of the pelvis after an average of 8 years of follow-up in order to describe the natural history of radiographic hip OA and to determine the risk factors for hip OA. This Study of Osteoporotic Fractures cohort of elderly Caucasian women age - 65 have had radiographs of the pelvis obtained at baseline and after 8 years of followup in addition to bone mass measurements and other questionnaire and medication information. The data have been obtained and analyses are required. Dr. Lane has the enthusiastic support of her department of
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medicine and epidemiology at UCSF to pursue both her mentoring and continued research efforts in-patient oriented clinical research goals. She will strengthen her role senior mentor to young clinical investigators, she will teach clinical research methodology and develop a strong interdisciplinary clinical research group for musculoskeletal disease oriented research at UCSF. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
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Project Title: MOLECULAR MEDIATORS OF CHONDROCYTE FUNCTION IN AGING/OA Principal Investigator & Institution: Amiel, David; Professor of Orthopedics; Scripps Research Institute; 10550 N Torrey Pines Rd; San Diego, CA 92037 Timing: Fiscal Year 2002; Project Start 1-JUL-1997; Project End 1-MAR2007 Summary: Aging and associated age-related diseases are becoming increasingly important as the percentage of the population comprised by the elderly increases. Osteoarthritis (OA) is a chronic disease which affects diarthrodial joints predominantly in older individuals and is manifested by loss of articular cartilage which often progresses to the point of total joint destruction. Among various parameters which determine the onset and progression of osteoarthritis, age appears to be the greatest risk factor. At present, however, it is still unclear whether aging and osteoarthritis are a continuum or whether this disease is precipitated by biological factors not directly tied to aging. There remain important questions as to what defines "normal" aging, and how much of the pathogenesis of osteoarthritis results from non-age-related causative mechanisms. Studies from our laboratories and others suggest that osteoarthritis pathology is characterized by decreased cellularity and/or cell viability and increased fibrillation. These changes are regulated by molecules that mediate both catabolic and anabolic responses in chondrocytes. Employing an experimentally induced osteoarthritis model in mature rabbits, we demonstrated an up-regulation of catabolic mediators such as MMP-3, IL-1beta and nitric oxide in cartilage and meniscus. These changes correlated with the observed development of OA pathology. To date, however, a systematic correlation of specific molecular mediators with age-related OA pathology has yet to be elucidated. We propose that changes in cartilage cellularity/viability, and in expression of matrix metalloproteinases (MMPs), metabolic and apoptotic regulators (i.e. cytokines and nitric oxide), and extracellular matrix (ECM) structural molecules play a leading role in the induction
102 Osteoarthritis
and maintenance of osteoarthritis during aging. To delineate the role of these molecules in the pathology of developing OA and distinguish between age-related and non-age-related effects, we will study mature and aged rabbits in an animal model of experimentally induced OA, i.e. anterior cruciate ligament transection. In a parallel study we will document human age-related joint pathology which will help us differentiate age-related osteoarthritic changes from experimentally induced effects. We also propose to characterize the role of a specific anabolic (TGF-beta1) and a catabolic (PTHrP) mediator on chondrocyte metabolism and function in an in vivo aged-animal model of osteochondral defect repair. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
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Project Title: NMES FOR OLDER INDIVIDUALS AFTER TOTAL KNEE ARTHROPLASTY Principal Investigator & Institution: Snyder-Mackler, Lynn; Professor; Physical Therapy; University of Delaware; Newark, DE 19716 Timing: Fiscal Year 2002; Project Start 5-MAR-2002; Project End 8-FEB2007 Summary: Reduced muscle strength from illness or injuries often leads to loss of function and independence in the elderly. The recovery of muscle strength and function in disabled elderly individuals is a major challenge in rehabilitation. The etiology of the muscle weakness with injury or age is fully elucidated. Training programs designed to maximize strength gains in young individuals may not be optimal in the elderly because the cause of the weakness and the morphology of the muscle may be different for young vs. old people. The overall goal of this work is to determine if physiologically and morphologically based rehabilitation programs are more effective than traditional rehabilitation to counter changes in muscle strength and function in older individuals. Neuromuscular electrical stimulation (NMES) may be used to improve strength and function following injury or surgery. This study provides motivation for exploring the use of NMES with the elderly. We posit that using NMES to augment a traditional rehabilitation program for elderly patients with osteoarthritis following total knee arthroplasties (TKA) will result in greater strength and functional gains than using only traditional rehabilitation. Elderly patients with osteoarthritis who undergo TKAs serve as ideal subjects for testing the effectiveness of rehabilitation programs become those patients almost always exhibit marked quadriceps weakness that is resistant to traditional physical rehabilitation. More than 300,000 TKAs are performed each year in the
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United States to treat osteoarthritis of the knee in older individuals. Neuromuscular electrical stimulation (NMES) may be used to improve strength and function following injury or surgery. This study provides motivation for exploring the use of NMES with the elderly, We posit that using NMES to augment a traditional rehabilitation program for elderly patients with osteoarthritis following total knee arthroplasties (TKA) will result in greater strength and functional gains than using only traditional rehabilitation. Elderly patients with osteoarthritis who undergo TKAs serve as ideal subjects for testing the effectiveness of rehabilitation programs become those patients almost always exhibit marked quadriceps weakness that is resistant to traditional physical rehabilitation. More than 300,000 TKAs are performed each year in the United States to treat osteoarthritis of the knee in older individuals. So, the successful rehabilitation of elder patients following TKA is an important and challenging problem. The specific aims of this proposal are: 1) To assess the effectiveness of high-level neuromuscular electrical stimulation is an adjunct to ongoing intensive, early rehabilitation in restoring quadriceps strength and improving the functional outcome after primary TKA, and 2) To identify the physiological and morphological bases for improvements in quadriceps strength and functional outcome. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
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Project Title: SYMPTOMATIC HAND OA IN CHINESE AND CAUCASIANS Principal Investigator & Institution: Zhang, Yuqing; Medicine; Boston University; 715 Albany St, 560; Boston, MA 02118 Timing: Fiscal Year 2001; Project Start 1-AUG-2001; Project End 1-JUL2002 Summary: (provided by applicant): Epidemiologic studies of disease in different racial groups have frequently revealed major difference in disease occurrence. These observations often provide the first important clues to disease etiology. Over the last several decades, evidence on racial difference in the prevalence of radiographic osteoarthritis (OA) has accumulated. Several studies also found that prevalence of symptomatic OA, mainly in hip and knee joints, varies among different racial groups, yet relatively few studies have incorporated an evaluation of symptomatic disease in their design, even though symptomatic disease has public health and clinical importance. To our knowledge, no population-based study has been conducted to assess differences in symptomatic hand OA among different racial groups. The overall
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objective of this study is to compare the prevalence of symptomatic hand OA, the pattern of joint involvement, and its impact on upper extremity functional limitations using the data collected from two population-based studies, i.e., the Framingham Osteoarthritis Study and the Beijing Osteoarthritis Study. We will analyze the data collected from 1,099 subjects from the Framingham Osteoarthritis Study and 2,500 subjects from the Beijing Osteoarthritis Study. These two studies used identical protocols to obtain and read the hand radiographs, and identical questionnaire to assess hand symptoms and functional limitations. All information, including hand x-ray reading, hand symptoms, grip strength, and functional limitation, has been collected. The principal investigator has been actively involved in both studies, and played an important role in the study design, operation and data analysis. The results of this study will generate important information on the descriptive epidemiology of symptomatic hand OA among different racial groups. First, this is the first study that incorporated into its design a standardized and identical evaluation of the prevalence of symptomatic hand OA so that valid comparisons between Chinese and Caucasians can be made. Second, participants in both studies were randomly selected from the population, thus, difference in prevalence, joint involvement pattern of symptomatic hand OA are more likely attributable to genetic and/or environment factors between two racial groups rather than to sampling bias; Finally, the study will examine the association between symptomatic hand OA and upper extremity functional limitation in two racial groups so that we will be able to estimate and compare the impact of this disease on functional limitation among the elderly. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
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Project Title: THE EFFECT OF EXERCISE ON PROGRESSION OF KNEE OA Principal Investigator & Institution: Concoff, Andrew L.; Internal Medicine; University of Texas Hlth Sci Ctr; Box 20036; Houston, TX 77225 Timing: Fiscal Year 2001; Project Start 30-SEP-2001; Project End 1-AUG2006 Summary: (Taken from the applicants abstract): In order to gain the requisite skills to design and conduct clinical investigations regarding the interrelationship between exercise and osteoarthritis (OA), this application proposes that a physician with formal Rheumatology and Sports Medicine fellowship training engage in a five-year program of combining didactic lectures in Clinical Investigation with the conduction of an arthroscopically-based trial of the effect of exercise on the
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progression of knee OA. Specific emphasis will be placed upon the development of new outcome measures, large scale trial methodology and management, in addition to statistical data analysis. The proposed research study will investigate whether a weight-resistance exercise intervention yields slower progression of knee OA than a control group that receives only education regarding self-management techniques in knee osteoarthritis. A novel, arthroscopic outcome measure that assesses cartilage damage and synovial inflammation, the American College of Rheumatology Knee Arthroscopy Osteoarthritis Scale (ACR/KAOS), will serve as the primary outcome measure. A blinded observer trained in arthroscopy will score videotapes of arthroscopies performed on each patient prior to and following the assigned intervention using the ACR/KAOS. The rate of progression according to the ACR/KAOS will then be compared between those randomized to the exercise and education groups. The sensitivity to change of the ACR/KAOS will be compared to that of the gold-standard for knee OA disease progression, semiflexed (MTP) plain radiographs of the knee. The short-term goal will be to complete the courses required to achieve a Masters of Science degree in Clinical Investigation. The goals of this didactic portion of the program will be to gain knowledge of biostatistics, epidemiology, study design, and a detailed understanding of the moral and legal limitations to the inclusion of human subjects in clinical studies. In order to achieve this goal, the first year of the proposed plan would include participation in classes in the UCLA School of Public Health. Approximately 50% of the first year will be devoted to these classes, with the remaining 50% devoted to the conduction of the trial. This research plan will provide the training required to establish the principal investigator as an independent researcher in osteoarthritis. The long-term goal of the plan is to systematically apply the state of the art, aggressive training methods from sports medicine to those afflicted with OA and to monitor the impact through the use of comprehensive rheumatologic outcomes. Eventually, optimal exercise regimens will be sought for both primary and secondary prevention of OA at various joints and stages. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
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Project Title: THE ROLE CARTILAGE INTEGRITY
OF
SEDLIN
IN
MAINTAINING
Principal Investigator & Institution: Tiller, George E.; Pediatrics; Vanderbilt University; 2201 West End Ave; Nashville, TN 37240 Timing: Fiscal Year 2002; Project Start 30-SEP-2002; Project End 1-AUG2006
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Summary: (provided by applicant): Osteoarthritis is a chronic debilitating disease that affects up to 1/3 of the adult population. Growing evidence suggests that genetic factors influence its development, and a better understanding of inherited chondrodysplasias will undoubtedly shed light on the processes common to all degenerative joint disease. Spondyloepiphyseal dysplasia tarda (SEDL) is a chondrodysplasia that is characterized by disproportionate short stature, X-linked inheritance, and early-onset osteoarthritis. We have recently identified the gene responsible for this disorder, and have characterized numerous mutations responsible for the SEDL phenotype--However, the function of the SEDL gene product, "sedlin," remains to be elucidated. In order to determine the role played by the sedlin protein in maintaining cartilage integrity, the following goals are proposed: 1) to determine the biochemical structure and properties of sedlin, 2) to determine the subcellular localization of sedlin and its expression pattern throughout murine chondrogenesis, 3) to determine the proteins with which sedlin associates, 4) to establish an animal model for SEDL, and 5) to test the genes of proteins associated with sedlin as candidate osteciarthritis susceptibility genes. To fulfill these aims, we propose to 1) express native sedlin in vitro and study its structure by NMR spectroscopy and X-ray crystallography, 2) determine its subcellular localization using subcellular fractionation, Western blotting, and immunoelectron microscopy; follow its expression during murine chondrogenesis, 3) identify sedlin-associated proteins by immunoprecipitation and find polymorphisms in their genes, 4) create knockout mice for the SEDL locus and examine their histologic phenotype from embryo through senescence, and 5) test the genes identified in (3) as candidate genes for osteoarthritis susceptibility within a case-control cohort with idiopathic osteoarthritis. Elucidation of the expression pattern and function of the SEDL gene may provide clues for designing therapeutic modalities for individuals affected with SEDL. Moreover, we anticipate that these studies will yield valuable insight into the role of the sedlin pathway in maintaining cartilage integrity and its derangement in osteoarthritis. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
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Project Title: WOMEN'S FUNCTIONAL ACTIVITIES
KNEE
MOTION
PATTERNS
IN
Principal Investigator & Institution: Yu, Bing; University of North Carolina, Chapel Hill; Box 2688, 910 Raleigh Rd; Chapel Hill, NC 27515 Timing: Fiscal Year 2001
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Summary: Women have a greater prevalence rate of knee osteoarthritis than men do. Although some risk factors for knee osteoarthritis in women have been qualitatively identified, limited studies exist regarding the quantitative nature of risk factors for knee osteoarthritis. Particularly limited are the studies addressing the differences in lower extremity motion patterns between women and men in daily functional activities, and the effects of the motion patterns on the risk of knee osteoarthritis in women. Our recent studies suggest that women may have different knee motion patterns from men, and that stair climbing may be a more sensitive evaluation procedure for knee disorders. The objective of our long-term research project is to identify modifiable motion related risk factors for knee osteoarthritis in women and develop corresponding prevention strategies. The purpose of the proposed study is to obtain basic understanding of the differences in knee motion patterns between women and men in selected daily functional activities such as level walking and stair climbing, and the effects of estrogen level on women's knee motion patterns in these activities. The knee flexion angle, valgusvarus angle, internal rotation angle, flexion-extension moment, and valgus-varus moment will be used as knee motion measures. Knee static alignment angle will also be measured. The specific aims of this study are: Specific Aim l: To compare the knee motion patterns between women and men during the stance phases of level walking and stair climbing including ascending and descending. Specific Aim 2: To determine the effect of women's estrogen level on the women's knee motion patterns in level walking and stair climbing. Specific Aim 3: To compare static knee alignment angle with weight bearing between women and men. Specific Aim 4: To determine the relationship between static knee alignment angle with weight bearing and maximum knee valgus or varus angle in level walking and stair climbing. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
E-Journals: PubMed Central21 PubMed Central (PMC) is a digital archive of life sciences journal literature developed and managed by the National Center for Biotechnology Information (NCBI) at the U.S. National Library of Medicine (NLM).22 Access Adapted from the National Library of Medicine: http://www.pubmedcentral.nih.gov/about/intro.html. 22 With PubMed Central, NCBI is taking the lead in preservation and maintenance of open access to electronic literature, just as NLM has done for decades with printed biomedical literature. PubMed Central aims to become a world-class library of the digital age. 21
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to this growing archive of e-journals is free and unrestricted.23 To search, go to http://www.pubmedcentral.nih.gov/search, and type “osteoarthritis” (or synonyms) into the search box. This search gives you access to full-text articles. The following is a sample of items found for osteoarthritis in the PubMed Central database: ·
Articular cartilage and changes in Arthritis: Cell biology of osteoarthritis. by Sandell LJ, Aigner T.; 2001; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&arti d=128887
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Assessment of a genetic contribution to osteoarthritis of the hip: sibling study. by Lanyon P, Muir K, Doherty S, Doherty M.; 2000 Nov 11; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&arti d=27520
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Body mass indices in patients with disabling hip osteoarthritis. by Marks R, Allegrante JP.; 2002; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&arti d=83842
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Cardiovascular risk in rheumatoid arthritis versus osteoarthritis: acute phase response related decreased insulin sensitivity and high-density lipoprotein cholesterol as well as clustering of metabolic syndrome features in rheumatoid arthritis. by Dessein PH, Stanwix AE, Joffe BI.; 2002; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&arti d=125299
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Cellular Immunity in Osteoarthritis: Novel Concepts for an Old Disease. by Liossis SN, Tsokos GC.; 1998 Jul; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&ren dertype=external&artid=95594
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Efficacy, tolerability, and upper gastrointestinal safety of celecoxib for treatment of osteoarthritis and rheumatoid arthritis: systematic review of randomised controlled trials. by Deeks JJ, Smith LA, Bradley MD.; 2002 Sep 21; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&arti d=126301
The value of PubMed Central, in addition to its role as an archive, lies the availability of data from diverse sources stored in a common format in a single repository. Many journals already have online publishing operations, and there is a growing tendency to publish material online only, to the exclusion of print.
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Home based exercise programme for knee pain and knee osteoarthritis: randomised controlled trial. by Thomas KS, Muir KR, Doherty M, Jones AC, O'Reilly SC, Bassey EJ.; 2002 Oct 5; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&arti d=128377
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Mosaic chromosomal aberrations in synovial fibroblasts of patients with rheumatoid arthritis, osteoarthritis, and other inflammatory joint diseases. by Kinne RW, Liehr T, Beensen V, Kunisch E, Zimmermann T, Holland H, Pfeiffer R, Stahl HD, Lungershausen W, Hein G, Roth A, Emmrich F, Claussen U, Froster UG.; 2001; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&arti d=64845
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Osteoarthritis Associated with Mild Chondrodysplasia in Transgenic Mice Expressing [alpha]1(IX) Collagen Chains with a Central Deletion. by Nakata K, Ono K, Miyazaki J, Olsen BR, Muragaki Y, Adachi E, Yamamura K, Kimura T.; 1993 Apr 1; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&ren dertype=abstract&artid=46198
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Single Base Mutation in the Type II Procollagen Gene (COL2A1) as a Cause of Primary Osteoarthritis Associated with a Mild Chondrodysplasia. by Ala-Kokko L, Baldwin CT, Moskowitz RW, Prockop DJ.; 1990 Sep 1; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&ren dertype=abstract&artid=54577
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T Cells and T-Cell Cytokine Transcripts in the Synovial Membrane in Patients with Osteoarthritis. by Sakkas LI, Scanzello C, Johanson N, Burkholder J, Mitra A, Salgame P, Katsetos CD, Platsoucas CD.; 1998 Jul; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&ren dertype=external&artid=95595
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What can we do about osteoarthritis? by Lohmander LS.; 2000; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&arti d=129992
The National Library of Medicine: PubMed One of the quickest and most comprehensive ways to find academic studies in both English and other languages is to use PubMed, maintained by the National Library of Medicine. The advantage of PubMed over previously mentioned sources is that it covers a greater number of domestic and foreign
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references. It is also free to the public.24 If the publisher has a Web site that offers full text of its journals, PubMed will provide links to that site, as well as to sites offering other related data. User registration, a subscription fee, or some other type of fee may be required to access the full text of articles in some journals. To generate your own bibliography of studies dealing with osteoarthritis, simply go to the PubMed Web site at www.ncbi.nlm.nih.gov/pubmed. Type “osteoarthritis” (or synonyms) into the search box, and click “Go.” The following is the type of output you can expect from PubMed for “osteoarthritis” (hyperlinks lead to article summaries): ·
A 12-month, multicenter, prospective, open-label trial of radiographic analysis of disease progression in osteoarthritis of the knee or hip in patients receiving celecoxib. Author(s): Tindall EA, Sharp JT, Burr A, Katz TK, Wallemark CB, Verburg K, Lefkowith JB. Source: Clinical Therapeutics. 2002 December; 24(12): 2051-63. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12581544&dopt=Abstract
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A home-based pedometer-driven walking program to increase physical activity in older adults with osteoarthritis of the knee: a preliminary study. Author(s): Talbot LA, Gaines JM, Huynh TN, Metter EJ. Source: Journal of the American Geriatrics Society. 2003 March; 51(3): 387-92. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12588583&dopt=Abstract
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A hyaluronan preparation (500-730 kDa) in the treatment of osteoarthritis: a review of clinical trials with Hyalgan. Author(s): Maheu E, Ayral X, Dougados M. Source: Int J Clin Pract. 2002 December; 56(10): 804-13. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12510956&dopt=Abstract
PubMed was developed by the National Center for Biotechnology Information (NCBI) at the National Library of Medicine (NLM) at the National Institutes of Health (NIH). The PubMed database was developed in conjunction with publishers of biomedical literature as a search tool for accessing literature citations and linking to full-text journal articles at Web sites of participating publishers. Publishers that participate in PubMed supply NLM with their citations electronically prior to or at the time of publication.
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A randomized, double blind, placebo controlled trial of a topical cream containing glucosamine sulfate, chondroitin sulfate, and camphor for osteoarthritis of the knee. Author(s): Cohen M, Wolfe R, Mai T, Lewis D. Source: The Journal of Rheumatology. 2003 March; 30(3): 523-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12610812&dopt=Abstract
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A report of two cases treated with Pauwels' femoral osteotomy for advanced osteoarthritis resulting from a sequela of infectious coxitis in childhood. Author(s): Ohsawa S, Matsushita S, Norimatsu H, Ueno R. Source: Archives of Orthopaedic and Trauma Surgery. 2003 February; 123(1): 39-41. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12582795&dopt=Abstract
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Advanced glycation endproducts and osteoarthritis. Author(s): Saudek DM, Kay J. Source: Curr Rheumatol Rep. 2003 February; 5(1): 33-40. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12590883&dopt=Abstract
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Algo-functional assessment of knee osteoarthritis: comparison of the test-retest reliability and construct validity of the WOMAC and Lequesne indexes. Author(s): Faucher M, Poiraudeau S, Lefevre-Colau MM, Rannou F, Fermanian J, Revel M. Source: Osteoarthritis and Cartilage / Oars, Osteoarthritis Research Society. 2002 August; 10(8): 602-10. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12479381&dopt=Abstract
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American pain society pain questionnaire and other pain measures in the assessment of osteoarthritis pain: a pooled analysis of three celecoxib pivotal studies. Author(s): Moskowitz RW, Sunshine A, Brugger A, Lefkowith JB, Zhao WW, Geis GS.
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Source: American Journal of Therapeutics. 2003 January-February; 10(1): 12-20. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12522515&dopt=Abstract ·
Arthroscopic evaluation of potential structure-modifying drug in osteoarthritis of the knee. A multicenter, randomized, double-blind comparison of tenidap sodium vs piroxicam. Author(s): Ayral X, Mackillop N, Genant HK, Kirkpatrick J, Beaulieu A, Pippingskiold P, Will RK, Alava S, Dougados M. Source: Osteoarthritis and Cartilage / Oars, Osteoarthritis Research Society. 2003 March; 11(3): 198-207. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12623291&dopt=Abstract
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Arthroscopic lavage or debridement did not reduce pain more than placebo did in patients with osteoarthritis. Author(s): Moseley JB, O'Malley K, Petersen NJ, Menke TJ, Brody BA, Kuykendall DH, Hollingsworth JC, Ashton CM, Wray NP. Source: The Journal of Bone and Joint Surgery. American Volume. 2003 February; 85-A(2): 387. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12571329&dopt=Abstract
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Arthroscopic surgery for osteoarthritis of the knee. Author(s): Morse LJ. Source: The New England Journal of Medicine. 2002 November 21; 347(21): 1717-9; Author Reply 1717-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12448433&dopt=Abstract
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Arthroscopic surgery was not effective for relieving pain or improving function in osteoarthritis of the knee. Author(s): Gillespie WJ. Source: Acp Journal Club. 2003 March-April; 138(2): 49. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12614134&dopt=Abstract
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Arthroscopic treatment of osteoarthritis of the knee. Author(s): Wray NP, Moseley JB, O'Malley K.
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Source: The Journal of Bone and Joint Surgery. American Volume. 2003 February; 85-A(2): 381. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12571321&dopt=Abstract ·
Association of Heterozygous Hemochromatosis C282Y Gene Mutation with Hand Osteoarthritis. Author(s): Ross JM, Kowalchuk RM, Shaulinsky J, Ross L, Ryan D, Phatak PD. Source: The Journal of Rheumatology. 2003 January; 30(1): 121-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12508400&dopt=Abstract
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Balance impairments in individuals with symptomatic knee osteoarthritis: a comparison with matched controls using clinical tests. Author(s): Hinman RS, Bennell KL, Metcalf BR, Crossley KM. Source: Rheumatology (Oxford, England). 2002 December; 41(12): 138894. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12468818&dopt=Abstract
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Cancellous bone microdamage in the proximal femur: influence of age and osteoarthritis on damage morphology and regional distribution. Author(s): Fazzalari NL, Kuliwaba JS, Forwood MR. Source: Bone. 2002 December; 31(6): 697-702. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12531564&dopt=Abstract
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Cardiovascular thrombotic events and COX-2 inhibitors: results in patients with osteoarthritis receiving rofecoxib. Author(s): Bannwarth B, Dougados M. Source: The Journal of Rheumatology. 2003 February; 30(2): 421-2. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12583353&dopt=Abstract
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Coexisting chondrocalcinosis, osteoarthritis and popliteal cyst. Author(s): Zandman-Goddard G, Tal S, Levy Y, Korat A. Source: Isr Med Assoc J. 2003 January; 5(1): 74-5. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12592969&dopt=Abstract
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Comparison of a computer based method and the classical manual method for radiographic joint space width assessment in hip osteoarthritis. Author(s): Maillefert JF, Sharp JT, Aho LS, Dougados M. Source: The Journal of Rheumatology. 2002 December; 29(12): 2592-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12465158&dopt=Abstract
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Comparison of low-dose rofecoxib versus 1000 mg naproxen in patients with osteoarthritis. Results of two randomized treatment trals of six weeks duration. Author(s): Myllykangas-Luosujarvi R, Lu HS, Chen SL, Choon D, Amante C, Chow CT, Pasero G, Genti G, Sarembock B, Zerbini CA, Vrijens F, Moan A, Rodgers DB, De Tora L, Laurenzi M. Source: Scandinavian Journal of Rheumatology. 2002; 31(6): 337-44. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12492248&dopt=Abstract
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Correlation between radiographic severity of knee osteoarthritis and future disease progression. Results from a 3-year prospective, placebocontrolled study evaluating the effect of glucosamine sulfate. Author(s): Bruyere O, Honore A, Ethgen O, Rovati LC, Giacovelli G, Henrotin YE, Seidel L, Reginster JY. Source: Osteoarthritis and Cartilage / Oars, Osteoarthritis Research Society. 2003 January; 11(1): 1-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12505481&dopt=Abstract
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C-reactive protein as a biomarker of emergent osteoarthritis. Author(s): Sowers M, Jannausch M, Stein E, Jamadar D, Hochberg M, Lachance L. Source: Osteoarthritis and Cartilage / Oars, Osteoarthritis Research Society. 2002 August; 10(8): 595-601. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12479380&dopt=Abstract
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Criteria for selection and application of molecular markers for clinical studies of osteoarthritis. Author(s): Otterness IG, Swindell AC.
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Source: Osteoarthritis and Cartilage / Oars, Osteoarthritis Research Society. 2003 March; 11(3): 153-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12623286&dopt=Abstract ·
Crosslinking of fibrinogen and fibronectin by free radicals: a possible initial step in adhesion formation in osteoarthritis of the temporomandibular joint. Author(s): Dijkgraaf LC, Zardeneta G, Cordewener FW, Liem RS, Schmitz JP, de Bont LG, Milam SB. Source: Journal of Oral and Maxillofacial Surgery : Official Journal of the American Association of Oral and Maxillofacial Surgeons. 2003 January; 61(1): 101-11. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12524616&dopt=Abstract
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Delayed gadolinium-enhanced MRI of cartilage (dGEMRIC) in early knee osteoarthritis. Author(s): Tiderius CJ, Olsson LE, Leander P, Ekberg O, Dahlberg L. Source: Magnetic Resonance in Medicine : Official Journal of the Society of Magnetic Resonance in Medicine / Society of Magnetic Resonance in Medicine. 2003 March; 49(3): 488-92. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12594751&dopt=Abstract
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Detection of radiographic joint space narrowing in subjects with knee osteoarthritis: longitudinal comparison of the metatarsophalangeal and semiflexed anteroposterior views. Author(s): Mazzuca SA, Brandt KD, Buckwalter KA. Source: Arthritis and Rheumatism. 2003 February; 48(2): 385-90. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12571847&dopt=Abstract
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Do glucosamine or chondriotin cause regeneration of cartilage in osteoarthritis? Author(s): Priebe D, McDiarmid T, Mackler L, Tudiver F. Source: The Journal of Family Practice. 2003 March; 52(3): 237-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12620182&dopt=Abstract
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Does structural worsening of osteoarthritis predict clinical worsening? Author(s): Chevalier X.
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Source: Joint, Bone, Spine : Revue Du Rhumatisme. 2002 October; 69(5): 430-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12477225&dopt=Abstract ·
Economic evaluation of osteoarthritis treatment in Europe. Author(s): Gillette JA, Tarricone R. Source: Expert Opinion on Pharmacotherapy. 2003 March; 4(3): 327-41. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12614185&dopt=Abstract
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Effect of arthroscopic debridement for osteoarthritis of the knee on health-related quality of life. Author(s): Dervin GF, Stiell IG, Rody K, Grabowski J. Source: The Journal of Bone and Joint Surgery. American Volume. 2003 January; 85-A(1): 10-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12533566&dopt=Abstract
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Effectiveness and safety of strengthening, aerobic, and coordination exercises for patients with osteoarthritis. Author(s): Bischoff HA, Roos EM. Source: Current Opinion in Rheumatology. 2003 March; 15(2): 141-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12598802&dopt=Abstract
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Enhanced lipid peroxidation in synoviocytes from patients with osteoarthritis. Author(s): Grigolo B, Roseti L, Fiorini M, Facchini A. Source: The Journal of Rheumatology. 2003 February; 30(2): 345-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12563693&dopt=Abstract
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Epidemiology of osteoarthritis and enthesopathies in a European population dating back 7700 years. Author(s): Crubezy E, Goulet J, Bruzek J, Jelinek J, Rouge D, Ludes B. Source: Joint, Bone, Spine : Revue Du Rhumatisme. 2002 December; 69(6): 580-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12537266&dopt=Abstract
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Epigallocatechin-3-gallate selectively inhibits interleukin-1betainduced activation of mitogen activated protein kinase subgroup c-Jun N-terminal kinase in human osteoarthritis chondrocytes. Author(s): Singh R, Ahmed S, Malemud CJ, Goldberg VM, Haqqi TM. Source: Journal of Orthopaedic Research : Official Publication of the Orthopaedic Research Society. 2003 January; 21(1): 102-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12507586&dopt=Abstract
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Erythema annulare centrifugum and osteoarthritis treated with hyaluronic acid. Author(s): Ioannidou D, Krasagakis K, Stefanidou M, Tosca A. Source: Clinical and Experimental Dermatology. 2002 November; 27(8): 720-2. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12472560&dopt=Abstract
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Ethnic and sex differences in serum levels of cartilage oligomeric matrix protein: the Johnston County Osteoarthritis Project. Author(s): Jordan JM, Luta G, Stabler T, Renner JB, Dragomir AD, Vilim V, Hochberg MC, Helmick CG, Kraus VB. Source: Arthritis and Rheumatism. 2003 March; 48(3): 675-81. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12632420&dopt=Abstract
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Evaluation of locally induced osteoarthritis by the complete and incomplete Freund's adjuvant in mice. The application of DEXA measurements. Author(s): Wlodarski KH, Dickson GR. Source: Folia Biol (Praha). 2002; 48(5): 192-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12448767&dopt=Abstract
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Evidence for increased bone resorption in patients with progressive knee osteoarthritis: longitudinal results from the Chingford study. Author(s): Bettica P, Cline G, Hart DJ, Meyer J, Spector TD. Source: Arthritis and Rheumatism. 2002 December; 46(12): 3178-84. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12483721&dopt=Abstract
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Ex-professional association footballers have an increased prevalence of osteoarthritis of the hip compared with age matched controls despite
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not having sustained notable hip injuries. Author(s): Shepard GJ, Banks AJ, Ryan WG. Source: British Journal of Sports Medicine. 2003 February; 37(1): 80-1. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12547750&dopt=Abstract ·
Feasibility of a dyadic intervention for management of osteoarthritis: a pilot study with older patients and their spousal caregivers. Author(s): Martire LM, Schulz R, Keefe FJ, Starz TW, Osial Jr TA, Dew MA, Reynolds III CF. Source: Aging & Mental Health. 2003 February; 7(1): 53-60. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12554315&dopt=Abstract
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German short musculoskeletal function assessment questionnaire (SMFA-D): comparison with the SF-36 and WOMAC in a prospective evaluation in patients with primary osteoarthritis undergoing total knee arthroplasty. Author(s): Kirschner S, Walther M, Bohm D, Matzer M, Heesen T, Faller H, Konig A. Source: Rheumatology International. 2003 January; 23(1): 15-20. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12548437&dopt=Abstract
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Growth-related oncogene alpha induction of apoptosis in osteoarthritis chondrocytes. Author(s): Borzi RM, Mazzetti I, Magagnoli G, Paoletti S, Uguccioni M, Gatti R, Orlandini G, Cattini L, Facchini A. Source: Arthritis and Rheumatism. 2002 December; 46(12): 3201-11. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12483724&dopt=Abstract
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Hip disability and osteoarthritis outcome score. An extension of the Western Ontario and McMaster Universities Osteoarthritis Index. Author(s): Klassbo M, Larsson E, Mannevik E. Source: Scandinavian Journal of Rheumatology. 2003; 32(1): 46-51. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12635946&dopt=Abstract
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History of acute knee injury and osteoarthritis of the knee: a prospective epidemiological assessment. The Clearwater Osteoarthritis
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Study. Author(s): Wilder FV, Hall BJ, Barrett JP Jr, Lemrow NB. Source: Osteoarthritis and Cartilage / Oars, Osteoarthritis Research Society. 2002 August; 10(8): 611-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12479382&dopt=Abstract ·
HLA class II is associated with distal interphalangeal osteoarthritis. Author(s): Riyazi N, Spee J, Huizinga TW, Schreuder GM, De Vries RR, Dekker FW, Kloppenburg M. Source: Annals of the Rheumatic Diseases. 2003 March; 62(3): 227-30. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12594107&dopt=Abstract
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Hydroxypyridinium collagen crosslinks in serum, urine, synovial fluid and synovial tissue in patients with rheumatoid arthritis compared with osteoarthritis. Author(s): Kaufmann J, Mueller A, Voigt A, Carl HD, Gursche A, Zacher J, Stein G, Hein G. Source: Rheumatology (Oxford, England). 2003 February; 42(2): 314-20. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12595629&dopt=Abstract
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Hylan G-F 20 was safe and effective in knee osteoarthritis and had a relatively low cost-utility ratio. Author(s): Symmons D. Source: Acp Journal Club. 2003 January-February; 138(1): 20. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12511132&dopt=Abstract
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Idiopathic osteoarthritis of the hip: incidence, classification, and natural history of 272 cases. Author(s): Hartofilakidis G, Karachalios T. Source: Orthopedics. 2003 February; 26(2): 161-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12597220&dopt=Abstract
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Imaging and osteoarthritis: what is the predictive value? Author(s): Mazzuca SA.
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Source: Curr Rheumatol Rep. 2003 February; 5(1): 27-32. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12590882&dopt=Abstract ·
Immunologic intervention in the pathogenesis of osteoarthritis. Author(s): Yuan GH, Masuko-Hongo K, Kato T, Nishioka K. Source: Arthritis and Rheumatism. 2003 March; 48(3): 602-11. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12632410&dopt=Abstract
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Increased femoral neck cancellous bone and connectivity in coxarthrosis (hip osteoarthritis). Author(s): Jordan GR, Loveridge N, Bell KL, Power J, Dickson GR, Vedi S, Rushton N, Clarke MT, Reeve J. Source: Bone. 2003 January; 32(1): 86-95. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12584040&dopt=Abstract
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Induction of matrix metalloproteinase 1 gene expression is regulated by inflammation-responsive transcription factor SAF-1 in osteoarthritis. Author(s): Ray A, Kuroki K, Cook JL, Bal BS, Kenter K, Aust G, Ray BK. Source: Arthritis and Rheumatism. 2003 January; 48(1): 134-45. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12528113&dopt=Abstract
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Influence of preoperative factors on outcome of shoulder arthroplasty for glenohumeral osteoarthritis. Author(s): Iannotti JP, Norris TR. Source: The Journal of Bone and Joint Surgery. American Volume. 2003 February; 85-A(2): 251-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12571302&dopt=Abstract
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Interposition arthroplasty for osteoarthritis of trapezio metacarpal joint: results of a modified incision and technique of interposing with early mobilisation. Author(s): Maqsood M, Chenthil Kumar NR, Noorpuri BS.
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Source: Hand Surgery : an International Journal Devoted to Hand and Upper Limb Surgery and Related Research : Journal of the Asia-Pacific Federation of Societies for Surgery of the Hand. 2002 December; 7(2): 2016. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12596280&dopt=Abstract ·
Investigation of linkage on chromosome 2q and hand and knee osteoarthritis. Author(s): Gillaspy E, Spreckley K, Wallis G, Doherty M, Spector TD. Source: Arthritis and Rheumatism. 2002 December; 46(12): 3386-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12483746&dopt=Abstract
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Is there any rationale for prescribing hormone replacement therapy (HRT) to prevent or to treat osteoarthritis? Author(s): Reginster JY, Kvasz A, Bruyere O, Henrotin Y. Source: Osteoarthritis and Cartilage / Oars, Osteoarthritis Research Society. 2003 February; 11(2): 87-91. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12554124&dopt=Abstract
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Isometric muscle force measurement for clinicians treating patients with osteoarthritis of the knee. Author(s): Fransen M, Crosbie J, Edmonds J. Source: Arthritis and Rheumatism. 2003 February 15; 49(1): 29-35. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12579591&dopt=Abstract
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JAMA patient page. Osteoarthritis of the knee. Author(s): Parmet S, Lynm C, Glass RM. Source: Jama: the Journal of the American Medical Association. 2003 February 26; 289(8): 1068. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12597762&dopt=Abstract
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Joint distraction as an alternative for the treatment of osteoarthritis. Author(s): van Roermund PM, Marijnissen AC, Lafeber FP. Source: Foot Ankle Clin. 2002 September; 7(3): 515-27. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12512407&dopt=Abstract
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Joint irrigation as treatment for osteoarthritis. Author(s): Bradley JD. Source: Curr Rheumatol Rep. 2003 February; 5(1): 20-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12590881&dopt=Abstract
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Joint-Specific Multidimensional Assessment of Pain (J-MAP): Factor Structure, Reliability, Validity, and Responsiveness in Patients with Knee Osteoarthritis. Author(s): O'Malley KJ, Suarez-Almazor M, Aniol J, Richardson P, Kuykendall DH, Moseley JB Jr, Wray NP. Source: The Journal of Rheumatology. 2003 March; 30(3): 534-43. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12610814&dopt=Abstract
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Knee Osteoarthritis Compromises Early Mobility Function: The Women's Health and Aging Study II. Author(s): Ling SM, Fried LP, Garrett ES, Fan MY, Rantanen T, Bathon JM. Source: The Journal of Rheumatology. 2003 January; 30(1): 114-20. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12508399&dopt=Abstract
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Lack of efficacy of acetaminophen in treating symptomatic knee osteoarthritis: a randomized, double-blind, placebo-controlled comparison trial with diclofenac sodium. Author(s): Case JP, Baliunas AJ, Block JA. Source: Archives of Internal Medicine. 2003 January 27; 163(2): 169-78. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12546607&dopt=Abstract
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Laser-Doppler imaging of osteoarthritis in proximal interphalangeal joints. Author(s): Ng EY, How TJ. Source: Microvascular Research. 2003 January; 65(1): 65-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12535875&dopt=Abstract
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Mechanism of cartilage destruction in osteoarthritis. Author(s): Ishiguro N, Kojima T, Pool AR.
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Source: Nagoya J Med Sci. 2002 November; 65(3-4): 73-84. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12580533&dopt=Abstract ·
Medial opening-wedge high tibial osteotomy with use of porous hydroxyapatite to treat medial compartment osteoarthritis of the knee. Author(s): Koshino T, Murase T, Saito T. Source: The Journal of Bone and Joint Surgery. American Volume. 2003 January; 85-A(1): 78-85. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12533576&dopt=Abstract
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Medial torsion of the tibia in Japanese patients with osteoarthritis of the knee. Author(s): Nagamine R, Miyanishi K, Miura H, Urabe K, Matsuda S, Iwamoto Y. Source: Clinical Orthopaedics and Related Research. 2003 March; 408: 218-24. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12616062&dopt=Abstract
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Men's Shoes and Knee Joint Torques Relevant to the Development and Progression of Knee Osteoarthritis. Author(s): Kerrigan DC, Karvosky ME, Lelas JL, Riley PO. Source: The Journal of Rheumatology. 2003 March; 30(3): 529-33. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12610813&dopt=Abstract
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Microarray analysis reveals the involvement of beta-2 microglobulin (B2M) in human osteoarthritis. Author(s): Zhang H, Liew CC, Marshall KW. Source: Osteoarthritis and Cartilage / Oars, Osteoarthritis Research Society. 2002 December; 10(12): 950-60. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12464555&dopt=Abstract
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New directions in symptomatic therapy for patients with osteoarthritis and rheumatoid arthritis. Author(s): Hochberg MC.
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Source: Seminars in Arthritis and Rheumatism. 2002 December; 32(3 Suppl 1): 4-14. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12528069&dopt=Abstract ·
New radiographic-based surrogate outcome measures for osteoarthritis of the knee. Author(s): Duryea J, Zaim S, Genant HK. Source: Osteoarthritis and Cartilage / Oars, Osteoarthritis Research Society. 2003 February; 11(2): 102-10. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12554126&dopt=Abstract
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No loss of cartilage volume over three years in patients with knee osteoarthritis as assessed by magnetic resonance imaging. Author(s): Gandy SJ, Dieppe PA, Keen MC, Maciewicz RA, Watt I, Waterton JC. Source: Osteoarthritis and Cartilage / Oars, Osteoarthritis Research Society. 2002 December; 10(12): 929-37. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12464553&dopt=Abstract
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Nonrandom evolution of end-stage osteoarthritis of the lower limbs. Author(s): Shakoor N, Block JA, Shott S, Case JP. Source: Arthritis and Rheumatism. 2002 December; 46(12): 3185-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12483722&dopt=Abstract
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Obesity and hip osteoarthritis: the weight of the evidence is increasing. Author(s): Gelber AC. Source: The American Journal of Medicine. 2003 February 1; 114(2): 158-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12586240&dopt=Abstract
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Obesity outcomes in disease management: clinical outcomes for osteoarthritis. Author(s): Nevitt MC. Source: Obesity Research. 2002 November; 10 Suppl 1: 33S-7S. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12446856&dopt=Abstract
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Osteoarthritis of finger joints in Finns aged 30 or over: prevalence, determinants, and association with mortality. Author(s): Haara MM, Manninen P, Kroger H, Arokoski JP, Karkkainen A, Knekt P, Aromaa A, Heliovaara M. Source: Annals of the Rheumatic Diseases. 2003 February; 62(2): 151-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12525385&dopt=Abstract
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Osteoarthritis of the Hands, Hips and Knees in an Australian Twin Sample-Evidence of Association with the Aggrecan VNTR Polymorphism. Author(s): Kirk KM, Doege KJ, Hecht J, Bellamy N, Martin NG. Source: Twin Research : the Official Journal of the International Society for Twin Studies. 2003 February; 6(1): 62-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12626230&dopt=Abstract
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Osteoarthritis of the peripheral joints. Author(s): Petersson IF, Jacobsson LT. Source: Best Practice & Research. Clinical Rheumatology. 2002 December; 16(5): 741-60. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12473271&dopt=Abstract
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Osteoarthritis. Author(s): Chard J, Lohmander S, Smith C, Scott D. Source: Clin Evid. 2002 December; (8): 1212-37. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12603937&dopt=Abstract
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Osteoarthritis: biological markers for the future? Author(s): Garnero P. Source: Joint, Bone, Spine : Revue Du Rhumatisme. 2002 December; 69(6): 525-30. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12537257&dopt=Abstract
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Osteoarthritis: MR imaging findings in different stages of disease and correlation with clinical findings. Author(s): Link TM, Steinbach LS, Ghosh S, Ries M, Lu Y, Lane N, Majumdar S.
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Source: Radiology. 2003 February; 226(2): 373-81. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12563128&dopt=Abstract ·
Osteoprotegerin expression in synovial tissue from patients with rheumatoid arthritis, spondyloarthropathies and osteoarthritis and normal controls. Author(s): Haynes DR, Barg E, Crotti TN, Holding C, Weedon H, Atkins GJ, Zannetino A, Ahern MJ, Coleman M, Roberts-Thomson PJ, Kraan M, Tak PP, Smith MD. Source: Rheumatology (Oxford, England). 2003 January; 42(1): 123-34. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12509625&dopt=Abstract
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Peripheral-type benzodiazepine receptors in human mononuclear cells of patients affected by osteoarthritis, rheumatoid arthritis or psoriasic arthritis. Author(s): Bazzichi L, Betti L, Giannaccini G, Rossi A, Lucacchini A. Source: Clinical Biochemistry. 2003 January; 36(1): 57-60. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12554061&dopt=Abstract
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Pharmacologic therapy for osteoarthritis. Author(s): Goldberg SH, Von Feldt JM, Lonner JH. Source: Am J Orthop. 2002 December; 31(12): 673-80. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12498526&dopt=Abstract
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Posterior-anterior weight-bearing radiograph in 15 degrees knee flexion in medial osteoarthritis. Author(s): Yamanaka N, Takahashi T, Ichikawa N, Yamamoto H. Source: Skeletal Radiology. 2003 January; 32(1): 28-34. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12525941&dopt=Abstract
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Preoperative predictors of locomotor ability two months after total knee arthroplasty for severe osteoarthritis. Author(s): Parent E, Moffet H. Source: Arthritis and Rheumatism. 2003 February 15; 49(1): 36-50. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12579592&dopt=Abstract
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Prevention of disability in daily activities in older persons with knee osteoarthritis. Author(s): McCormack R. Source: Clinical Journal of Sport Medicine : Official Journal of the Canadian Academy of Sport Medicine. 2002 November; 12(6): 405. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12650157&dopt=Abstract
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Procollagen II C propeptide level in the synovial fluid as a predictor of radiographic progression in early knee osteoarthritis. Author(s): Sugiyama S, Itokazu M, Suzuki Y, Shimizu K. Source: Annals of the Rheumatic Diseases. 2003 January; 62(1): 27-32. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12480665&dopt=Abstract
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Protein kinase signals activate interleukin 16 encoding transcripts in rheumatoid arthritis versus osteoarthritis synovial fibroblasts. Author(s): Schuler MK, Sell S, Aicher WK. Source: Annals of the Rheumatic Diseases. 2003 February; 62(2): 182-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12525392&dopt=Abstract
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Pulsed magnetic field therapy for osteoarthritis of the knee--a doubleblind sham-controlled trial. Author(s): Nicolakis P, Kollmitzer J, Crevenna R, Bittner C, Erdogmus CB, Nicolakis J. Source: Wiener Klinische Wochenschrift. 2002 August 30; 114(15-16): 67884. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12602111&dopt=Abstract
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Quality of life after several treatments for osteoarthritis of the hip. Author(s): Kawasaki M, Hasegawa Y, Sakano S, Torii Y, Warashina H. Source: Journal of Orthopaedic Science : Official Journal of the Japanese Orthopaedic Association. 2003; 8(1): 32-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12560883&dopt=Abstract
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Quality of well-being in older people with osteoarthritis. Author(s): Groessl EJ, Kaplan RM, Cronan TA.
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Source: Arthritis and Rheumatism. 2003 February 15; 49(1): 23-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12579590&dopt=Abstract
Vocabulary Builder Acetylgalactosamine: The N-acetyl derivative of galactosamine. [NIH] Adjuvant: A substance which aids another, such as an auxiliary remedy; in immunology, nonspecific stimulator (e.g., BCG vaccine) of the immune response. [EU] Allopurinol: A xanthine oxidase inhibitor that decreases uric acid production. [NIH] Antidepressant: An agent that stimulates the mood of a depressed patient, including tricyclic antidepressants and monoamine oxidase inhibitors. [EU] Arthroplasty: Surgical reconstruction of a joint to relieve pain or restore motion. [NIH] Bioavailability: The degree to which a drug or other substance becomes available to the target tissue after administration. [EU] Biochemical: Relating to biochemistry; characterized by, produced by, or involving chemical reactions in living organisms. [EU] Catabolism: Any destructive metabolic process by which organisms convert substances into excreted compounds. [EU] Cholesterol: The principal sterol of all higher animals, distributed in body tissues, especially the brain and spinal cord, and in animal fats and oils. [NIH] Cyst: Any closed cavity or sac; normal or abnormal, lined by epithelium, and especially one that contains a liquid or semisolid material. [EU] Distal: Remote; farther from any point of reference; opposed to proximal. In dentistry, used to designate a position on the dental arch farther from the median line of the jaw. [EU] Dysmenorrhea: Painful menstruation. [NIH] Dyspepsia: Impairment of the power of function of digestion; usually applied to epigastric discomfort following meals. [EU] Edema: Excessive amount of watery fluid accumulated in the intercellular spaces, most commonly present in subcutaneous tissue. [NIH] Etodolac: A nonsteroidal anti-inflammatory agent with potent analgesic and antiarthritic properties. It has been shown to be effective in the treatment of osteoarthritis, rheumatoid arthritis, ankylosing spondylitis, and in the alleviation of postoperative pain. [NIH]
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Femur: The longest and largest bone of the skeleton, it is situated between the hip and the knee. [NIH] Fibroblasts: Connective tissue cells which secrete an extracellular matrix rich in collagen and other macromolecules. [NIH] Flexion: In gynaecology, a displacement of the uterus in which the organ is bent so far forward or backward that an acute angle forms between the fundus and the cervix. [EU] Gadolinium: An element of the rare earth family of metals. It has the atomic symbol Gd, atomic number 64, and atomic weight 157.25. Its oxide is used in the control rods of some nuclear reactors. [NIH] Glycosaminoglycans: Heteropolysaccharides which contain an Nacetylated hexosamine in a characteristic repeating disaccharide unit. The repeating structure of each disaccharide involves alternate 1,4- and 1,3linkages consisting of either N-acetylglucosamine or N-acetylgalactosamine. [NIH]
Homogeneous: Consisting of or composed of similar elements or ingredients; of a uniform quality throughout. [EU] Hypertension: Persistently high arterial blood pressure. Various criteria for its threshold have been suggested, ranging from 140 mm. Hg systolic and 90 mm. Hg diastolic to as high as 200 mm. Hg systolic and 110 mm. Hg diastolic. Hypertension may have no known cause (essential or idiopathic h.) or be associated with other primary diseases (secondary h.). [EU] Ibuprofen: A nonsteroidal anti-inflammatory agent with analgesic properties used in the therapy of rheumatism and arthritis. [NIH] Immunity: The condition of being immune; the protection against infectious disease conferred either by the immune response generated by immunization or previous infection or by other nonimmunologic factors (innate i.). [EU] Insulin: A protein hormone secreted by beta cells of the pancreas. Insulin plays a major role in the regulation of glucose metabolism, generally promoting the cellular utilization of glucose. It is also an important regulator of protein and lipid metabolism. Insulin is used as a drug to control insulindependent diabetes mellitus. [NIH] Irrigation: Washing by a stream of water or other fluid. [EU] Lipid: Any of a heterogeneous group of flats and fatlike substances characterized by being water-insoluble and being extractable by nonpolar (or fat) solvents such as alcohol, ether, chloroform, benzene, etc. All contain as a major constituent aliphatic hydrocarbons. The lipids, which are easily stored in the body, serve as a source of fuel, are an important constituent of cell structure, and serve other biological functions. Lipids may be considered to
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include fatty acids, neutral fats, waxes, and steroids. Compound lipids comprise the glycolipids, lipoproteins, and phospholipids. [EU] Lipoprotein: Any of the lipid-protein complexes in which lipids are transported in the blood; lipoprotein particles consist of a spherical hydrophobic core of triglycerides or cholesterol esters surrounded by an amphipathic monolayer of phospholipids, cholesterol, and apolipoproteins; the four principal classes are high-density, low-density, and very-lowdensity lipoproteins and chylomicrons. [EU] Naproxen: An anti-inflammatory agent with analgesic and antipyretic properties. Both the acid and its sodium salt are used in the treatment of rheumatoid arthritis and other rheumatic or musculoskeletal disorders, dysmenorrhea, and acute gout. [NIH] Orthopedics: A surgical specialty which utilizes medical, surgical, and physical methods to treat and correct deformities, diseases, and injuries to the skeletal system, its articulations, and associated structures. [NIH] Osteonecrosis: Death of a bone or part of a bone, either atraumatic or posttraumatic. [NIH] Osteotomy: The surgical cutting of a bone. [EU] Oxycodone: Semisynthetic derivative of codeine that acts as a narcotic analgesic more potent and addicting than codeine. [NIH] Palliative: 1. Affording relief, but not cure. 2. An alleviating medicine. [EU] Parenteral: Not through the alimentary canal but rather by injection through some other route, as subcutaneous, intramuscular, intraorbital, intracapsular, intraspinal, intrasternal, intravenous, etc. [EU] Pharmacokinetics: The action of drugs in the body over a period of time, including the processes of absorption, distribution, localization in tissues, biotransformation, and excretion. [EU] Piroxicam: 4-Hydroxy-2-methyl-N-2-pyridyl-2H-1,2-benzothiazine-3carboxamide 1,1-dioxide. A non-steroidal anti-inflammatory agent that is well established in the treatment of rheumatoid arthritis and osteoarthritis. Its usefulness has also been demonstrated in the treatment of musculoskeletal disorders, dysmenorrhea, and postoperative pain. Its long half-life enables it to be administered once daily. The drug has also been shown to be effective if administered rectally. Gastrointestinal complaints are the most frequently reported side effects. [NIH] Prevalence: The total number of cases of a given disease in a specified population at a designated time. It is differentiated from incidence, which refers to the number of new cases in the population at a given time. [NIH] Probenecid: The prototypical uricosuric agent. It inhibits the renal excretion of organic anions and reduces tubular reabsorption of urate. Probenecid has
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also been used to treat patients with renal impairment, and, because it reduces the renal tubular excretion of other drugs, has been used as an adjunct to antibacterial therapy. [NIH] Procollagen: A biosynthetic precursor of collagen containing additional amino acid sequences at the amino-terminal ends of the three polypeptide chains. Protocollagen, a precursor of procollagen consists of procollagen peptide chains in which proline and lysine have not yet been hydroxylated. [NIH]
Proximal: Nearest; closer to any point of reference; opposed to distal. [EU] Receptor: 1. A molecular structure within a cell or on the surface characterized by (1) selective binding of a specific substance and (2) a specific physiologic effect that accompanies the binding, e.g., cell-surface receptors for peptide hormones, neurotransmitters, antigens, complement fragments, and immunoglobulins and cytoplasmic receptors for steroid hormones. 2. A sensory nerve terminal that responds to stimuli of various kinds. [EU] Regeneration: The natural renewal of a structure, as of a lost tissue or part. [EU]
Resorption: The loss of substance through physiologic or pathologic means, such as loss of dentin and cementum of a tooth, or of the alveolar process of the mandible or maxilla. [EU] Sclerosis: A induration, or hardening; especially hardening of a part from inflammation and in diseases of the interstitial substance. The term is used chiefly for such a hardening of the nervous system due to hyperplasia of the connective tissue or to designate hardening of the blood vessels. [EU] Sequela: Any lesion or affection following or caused by an attack of disease. [EU]
Serum: 1. The clear portion of any body fluid; the clear fluid moistening serous membranes. 2. Blood serum; the clear liquid that separates from blood on clotting. 3. Immune serum; blood serum from an immunized animal used for passive immunization; an antiserum; antitoxin, or antivenin. [EU]
Sulfinpyrazone: A uricosuric drug that is used to reduce the serum urate levels in gout therapy. It lacks anti-inflammatory, analgesic, and diuretic properties. [NIH] Symptomatic: 1. Pertaining to or of the nature of a symptom. 2. Indicative (of a particular disease or disorder). 3. Exhibiting the symptoms of a particular disease but having a different cause. 4. Directed at the allying of symptoms, as symptomatic treatment. [EU] Tophus: A chalky deposit of sodium urate occurring in gout; tophi form most often around joints in cartilage, bone, bursae, and subcutaneous tissue
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and in the external ear, producing a chronic foreign-body inflammatory response. [EU] Torsion: 1. A type of mechanical stress, whereby the external forces (load) twist an object about its axis. 2. In ophthalmology any rotation of the vertical corneal meridians. [EU] Toxicity: The quality of being poisonous, especially the degree of virulence of a toxic microbe or of a poison. [EU] Uricosuric: 1. Pertaining to, characterized by, or promoting uricosuria (= the excretion of uric acid in the urine). 2. An agent that promotes uricosuria. [EU] Withdrawal: 1. A pathological retreat from interpersonal contact and social involvement, as may occur in schizophrenia, depression, or schizoid avoidant and schizotypal personality disorders. 2. (DSM III-R) A substancespecific organic brain syndrome that follows the cessation of use or reduction in intake of a psychoactive substance that had been regularly used to induce a state of intoxication. [EU]
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CHAPTER 5. PATENTS ON OSTEOARTHRITIS Overview You can learn about innovations relating to osteoarthritis by reading recent patents and patent applications. Patents can be physical innovations (e.g. chemicals, pharmaceuticals, medical equipment) or processes (e.g. treatments or diagnostic procedures). The United States Patent and Trademark Office defines a patent as a grant of a property right to the inventor, issued by the Patent and Trademark Office.25 Patents, therefore, are intellectual property. For the United States, the term of a new patent is 20 years from the date when the patent application was filed. If the inventor wishes to receive economic benefits, it is likely that the invention will become commercially available to patients with osteoarthritis within 20 years of the initial filing. It is important to understand, therefore, that an inventor’s patent does not indicate that a product or service is or will be commercially available to patients with osteoarthritis. The patent implies only that the inventor has “the right to exclude others from making, using, offering for sale, or selling” the invention in the United States. While this relates to U.S. patents, similar rules govern foreign patents. In this chapter, we show you how to locate information on patents and their inventors. If you find a patent that is particularly interesting to you, contact the inventor or the assignee for further information.
25Adapted
from The U. S. Patent and Trademark Office: http://www.uspto.gov/web/offices/pac/doc/general/whatis.htm.
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Patents on Osteoarthritis By performing a patent search focusing on osteoarthritis, you can obtain information such as the title of the invention, the names of the inventor(s), the assignee(s) or the company that owns or controls the patent, a short abstract that summarizes the patent, and a few excerpts from the description of the patent. The abstract of a patent tends to be more technical in nature, while the description is often written for the public. Full patent descriptions contain much more information than is presented here (e.g. claims, references, figures, diagrams, etc.). We will tell you how to obtain this information later in the chapter. The following is an example of the type of information that you can expect to obtain from a patent search on osteoarthritis: ·
Solution and the method of making the same for the treatment of osteoarthritis Inventor(s): Lee; Troy J. (17 Daniel Rd., Asheville, NC 28806) Assignee(s): none reported Patent Number: 6,537,590 Date filed: February 19, 2002 Abstract: A solution and the method of making the same for the treatment of osteoarthritis for treating symptoms of osteoarthritic conditions. The solution and the method of making the same for the treatment of osteoarthritis includes magnesium oxide; ethylenediaminetetraacetic acid; glycerin; and water, all of which are heated and added in a mixture which, after being cooled, is applied to the affected areas for treatment of the osteoarthritic condition. Excerpt(s): The present invention relates to osteoarthritic treatment lotions and more particularly pertains to a new solution and the method of making the same for the treatment of osteoarthritis for treating symptoms of osteoarthritic conditions. ... While these devices fulfill their respective, particular objectives and requirements, the aforementioned patents do not disclose a new solution and the method of making the same for the treatment of osteoarthritis. The prior art describes solutions and medicated products for various ailment treatments. ... The general purpose of the present invention, which will be described subsequently in greater detail, is to provide a new solution and the method of making the same for the treatment of osteoarthritis which has many of the advantages of the osteoarthritic treatment lotions mentioned heretofore and many novel features that result in a new solution and the method of making the same for the treatment of osteoarthritis which is not
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anticipated, rendered obvious, suggested, or even implied by any of the prior art osteoarthritic treatment lotions, either alone or in any combination thereof. The present invention includes magnesium oxide; ethylenediaminetetraacetic acid; glycerin; and water, all of which are heated and added in a mixture which, after being cooled, is applied to the affected areas for treatment of the osteoarthritic condition. None of the prior art uses the combination of ingredients of the present invention in the treatment of osteoarthritis. Web site: http://www.delphion.com/details?pn=US06537590__ ·
Composition for the treatment of osteoarthritis Inventor(s): Graus; Ivo Maria Franciscus (Wg Ede, NL), Smit; Hobbe Friso (As Utrecht, NL) Assignee(s): N.V. Nutricia (Zoetermeer, NL) Patent Number: 6,492,429 Date filed: September 14, 2000 Abstract: Osteoarthritis is treated by a composition containing both apocynin and an inhibitor of inducible nitric oxide synthase such as curcumin. Further components such as boswellic acids, glucosamine, acetylcysteine and boron further enhance the beneficial effect of apocynin and curcumin. Excerpt(s): The invention is concerned with compositions for the treatment of osteoarthritis and related diseases and with methods for treating osteoarthritis. ... Osteoarthritis (OA) is a degenerative joint disease, which develops by wear and tear of the joints during aging. OA mostly affects the weight-bearing joints such as spine, knees and hips, but thumb and finger joints may also be affected. Repetitive mechanical injury of the cartilage eventually results in loss of cartilage and damage to joint surfaces and adjacent bone. As a result of the tissue destruction, inflammatory cells invade the joint and the synovial membrane which is manifested by pain, swelling and stiffness of the affected joints. The repetitive mechanical injury leads to pathological changes that result in loss of proteoglycans and collagen from the cartilage matrix, which in turn leads to surface erosion and decreased loading capacity, In OA, chondro-cytes show a reduced potential to synthesize matrix constituents (proteoglycans and collagen fibers) and the expression of proteolytic enzymes (called matrix metallo-proteases, MNMP's) contributes to cartilage destruction and release of proteoglycan fragments in the synovial fluid. The inflammatory responses to the mechanical insults further contribute to cartilage destruction. The inflammatory mediator
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interleukin I (IL-1) is considered as the principal mediator of cartilage destruction. It induces a number of changes in chondrocytes, including the concurrent generation of significant amounts of NO (nitrogen oxide) and superoxide radicals by inducible NO synthase (iNOS) and NADPH oxidase, respectively. NO reacts with superoxide to form peroxynitrite, which is largely responsible for the decrease in proteoglycan synthesis induced by IL-1. The role of superoxide was further demonstrated by the ability of superoxide dismutase to reverse the decrease in proteoglycan synthesis. The prevention of peroxynitrite formation via selective inhibition of iNOS and thus NO formation in vivo resulted in a marked decrease of MMP's. In addition, intra-articular treatment of OA patients with superoxide dismutase reduces symptoms of OA for prolonged periods. These studies demonstrate that induction of catabolic enzymes (MMP's) and cartilage destruction is mediated via the formation of NO and O.sub.2.sup.- radicals by chondrocytes or inflammatory cells. While the primary cause of OA is mechanical damage, rheumatoid arthritis (RA) is mainly the result of an autoimmune response that leads to chronic inflammation in the joint. Contrary to OA, typical manifestations of RA are an increase of parameters that are associated with inflammation, such as haematocrite and white blood cell count and pannus formation or hyperplasia of the joint capsule that leads to deformed joints. This in turn leads to morning stiffness. Although the (primary) aetiology of RA and OA are different, the pathological processes at a later stage result in some manifestations that are similar such as joint pain, cartilage degradation and general joint disability. ... It was found that osteoarthritis can be effectively treated by administration of a suitable amount of apocynin or its functional and structural analogues, preferably in the form of an extract from a Picrorhiza plant, and preferably together with further components enhancing the beneficial effect of the apocynin. Thus, the invention in a first aspect provides compositions for the treatment of osteoarthritis, containing an effective amount of apocynin or its analogues. Web site: http://www.delphion.com/details?pn=US06492429__ ·
Combined use of diclofenac and tribenoside to treat osteoarthritis Inventor(s): Chayen; Joseph (Surrey, GB), Bitensky, deceased; Lucille (late of Surrey, GB), Kagan, executor; by Martin Roy (Teddington, GB) Assignee(s): KS Biomedix Ltd. (Surrey, GB) Patent Number: 6,034,122 Date filed: January 5, 1998
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Abstract: Diclofenac sodium and tribenoside, or more generally (i) a compound that acts on the chondrocytes and (ii) a compound that reduces the water content of the chondrocyte matrix, are useful in the treatment of osteoarthritis. Excerpt(s): This invention relates to compositions for use in the treatment of osteoarthritis (OA). ... Many drugs are known for the treatment of osteoarthritis, but in general their effectiveness is low, especially if sideeffects are to be avoided. A known drug of this type is diclofenac sodium. ... Compositions of this invention are suitable for use in the treatment of osteoarthritis in humans and in animals, e.g. domesticated and farm animals such as dogs, cats and horses. Web site: http://www.delphion.com/details?pn=US06034122__ ·
Method of treatment of osteoarthritis with interleuken-1 receptor antagonist Inventor(s): Pelletier; Jean-Pierre (St-Lambert, CA), Martel-Pelletier; Johanne (St-Lambert, CA) Assignee(s): Arthro Lab Inc. (Sherbrooke, CA) Patent Number: 5,972,880 Date filed: March 7, 1996 Abstract: A method and a composition for the preventative treatment of osteoarthritis comprising the periodic administration to a mammal suffering of this disease of a composition comprising an amount of Human recombinant Interleukin-1 receptor antagonist effective for reducing the progression of lesions and cartilage degradation. Excerpt(s): The invention relates to a method and a composition for the preventive treatment of osteoarthritis. More particularly the invention relates to a method and a composition for reducing the progression of lesion and cartilage degradation in osteoarthritis. ... Osteoarthritis, which is also called "degenerative joint disease", is the most common rheumatic disease and is characterized by a chronic inflammation of the articulation and a progressive depletion of articular cartilage matrix macromolecules. Together with the cartilage degeneracy, osteophytes (small abnormal body outgrowths) occur and develop on the stripped part of the articular bones. Symptoms of osteoarthritis occur in many people over the age of 65, and women are affected twice as often as men. These symptoms are pain, swelling and stiffness of the articulation. In a further stage of the disease, movement of articulations is limited and becomes painfil. ... The most commonly used drugs for the treatment of osteoarthritis are the
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nonsteroidal anti-inflammatory agents (NSAID). Even though these drugs have proved effectiveness in relieving the symptoms of osteoarthritis and in decreasing osteoarthritis cartilage catabolism, some of them, like sodium salicylate, have shown inhibiting properties of the proteoglycan synthesis which may jeopardize the cartilage repair process. Other drugs, such as tiaprofenic acid, which do not inhibit the proteoglycan synthesis and have shown in vitro that they are able to decrease osteoarthritis cartilage catabolism, (Jean-Pierre Pelletier et al. The Journal of Rheumatology 1989;16:5, 646-655), have been unable to provide any preventing effect in development of osteoarthritis when administrated to patients suffering from the latter, (Edward C. Huskisson et al. The Journal of Rheumatology 1995; 22:10-1941-1946). Doxycycline, a member of the tetracycline family, was also shown to reduce, in vivo, the severity of osteoarthritis lesions in the dog ACL model while reducing metalloprotease activity, (Yu LP Jr et al. Arthritis Rheum 35:1150-1159, 1992). Recent data suggests that the action of corticosteroids is associated with a reduction in the synthesis of stromelysin-1 by chondrocytes. (see: Pelletier et al., J Arthritis Rheum 37:414-423, 1994; and Pelletier et al., J Lab Invest 72:578-586, 1995). Web site: http://www.delphion.com/details?pn=US05972880__ ·
Methods of diagnosing a predisposition for osteoarthritis via detection of vitamin D receptor gene polymorphisms Inventor(s): Spector; Timothy David (London, GB), Keen; Richard William (London, GB) Assignee(s): Gemini International Holdings Limited (MC) Patent Number: 5,939,260 Date filed: April 21, 1997 Abstract: A method of diagnosing a disease associated with a genetic polymorphism in a vitamin D receptor gene comprises determining the genotype of said vitamin D receptor gene in an animal. The method can be used to diagnose predisposition or susceptibility to osteoarthritis. Compositions for said diagnosis are provided. Methods of treatment of osteoarthritis are provided, comprising identifying an individual having a predisposition or susceptibility to the disease and subsequently treating that individual. Excerpt(s): Osteoarthritis, or degenerative joint disease as it is also known, is one of the most common types of arthritis. It is characterised by the breakdown of the joint's cartilage, causing bone to rub against bone causing pain and loss of movement. Osteoarthritis can range from
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very mild to very severe and most commonly affects middle-aged and older people. It affects hands and weight-bearing joints, such as the knees, hips, feet and back. ... Although age is a leading risk factor, at present the aetiology and pathogenesis of this condition remain largely unknown. Many environmental factors and other independent conditions have been associated with osteoarthritis, including obesity, previous injury and/or menisectomy, knee bending occupations, smoking, sex hormones, gynaecological disorders and other metabolic factors. Obesity may lead to osteoarthritis of the knees. Also, people with injuries to the joints because of sports, repeated movements, or accidents may be at increased risk of developing osteoarthritis. ... At present accurate diagnosis of osteoarthritis is in general possible only when the disease has progressed significantly. Physicians can do little more than make a diagnosis of osteoarthritis based on a physical examination and history of symptoms. X-ray is typically used only to confirm diagnosis. Web site: http://www.delphion.com/details?pn=US05939260__ ·
Osteoarthritis-associated inducable isoform of nitric oxide synthetase Inventor(s): Amin; Ashok R. (Union, NJ), Abramson; Steven B. (Rye, NY) Assignee(s): Hospital For Joint Diseases (New York, NY) Patent Number: 5,759,836 Date filed: March 27, 1995 Abstract: An novel isoform of inducible nitric oxide synthase (OA-NOS) has been identified in osteoarthritis-affected articular cartilage. Some properties, including molecular weight, are similar to the constitutive isoform of neuronal nitric oxide synthase (ncnos) while other properties share similarity with the previously identified inducible nitric oxide (iNOS). Acetylating agents, such as aspirin and N-acetylimidazole act on both iNOS and OA-NOS by inhibiting their catalytic activities. A method is provided to screen for acetylating agents that inhibit OA-NOS, and the selective inhibition of OA-NOS by inhibitory agents is determined by comparison to a panel of different isoforms of nitric oxide synthase. Excerpt(s): The expression and function of iNOS and COX2, known to be involved in inflammatory processes in vivo (Stadler et al., J. Leukocyte Biol. 53:165-172, 1993; Vane et al., 1994, supra), are regulated by the local production of cytokines (Curran et al., J. Exp. Med. 170:1769-1774, 1989; Nussler and Billiar, J. Leukocyte. Biol. 54:171-178, 1993; Schini et al., Eur. J. Pharmacol. 216, 379-383, 1992). This is further substantiated by the observation that the upregulation of iNOS can be reduced by antiinflammatory cytokines such as IL-4, IL-8, IL-10, TGF-.beta.-1, -2, and -3,
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and macrophage deactivating factor (Nussler and Billiar, 1993, supra). COX-2 is induced in a number of cell types by EGF (Bailey et al., J. Lipid Res. 26:54-61, 1985), FGF (Goddard et al., Cytokine 4:377-384, 1992), PDGF (Lin et al., J. Biol. Chem. 264:17379-17383, 1989), IL-1 (Raz et al., Proc. Natl. Acad. Sci. USA 86:1657-1661, 1989) and TGF-.beta. (Bailey and Verma, Anal. Biochem. 196:11-18, 1991). PGE.sub.2 inhibits the production of cytokines (Ferreri et al., J. Biol. Chem. 267:9443-9449, 1992) and cytokine-induced proliferation in a number of cell types in vitro, (Albina and Henry, J. Surg. Res. 50:403-409, 1991). However, the actions of PGs in vivo are more complex, in that COX inhibitors exacerbate cartilage erosion but reduce bone loss (Willoughby et al., J. Lipid Mediators 6:298-293, 1993). Expression of COX-1 and COX-2 is influenced by IL-1 in rheumatoid synovial tissue (Crofford et al., J. Clin. Inv. 93:10951101, 1992). IL-1 is also known to modulate the activity of COX-2 in chondrocytes, and to affect chondrocyte function by inhibiting proteoglycan and collagen (Type II) synthesis and promoting matrix degradation by stimulating neutral and metalloproteases (LyonsGiordano et al., Exp. Cell Res. 206:58-62, 1993). Differing levels of NO (induced by cytokines or endotoxin) have stimulatory as well as inhibitory effects on PGE.sub.2 and the synthesis of neutral proteases in chondrocytes (Stadler et al., J. Immunol. 147:3915-3920, 1991). IL-1 has been reported to be a strong inducer of IL-6 synthesis and secretion in human chondrocytes, and has been shown to have a protective effect on extracellular matrix of human articular chondrocytes (Gunther et al., Arthritis Rheum. 37:395-405, 1994). Recently, Venn et al. (Arthritis Rheum 36:819-826, 1993) have reported elevated levels of IL-6 and TNF-.alpha. in synovial fluid of canine osteoarthritis. ... Classically, osteoarthritis (OA), unlike rheumatoid arthritis (RA), is defined as an inherently noninflammatory disorder of movable joints characterized by deterioration of articular cartilage and the formation of new bone at the joint surfaces and margins (Hough, in Arthritis and Allied Conditions, D. J. McCarty and W. J. Koopman, eds., Lea & Febiger, Philadelphia and London, 1699-1723, 1993). In contrast to RA, the synovial fluid in OA typically contains few neutrophils (<3,000/mm.sup.3) and, except for advanced disease, the synovium does not exhibit significant cellular proliferation nor infiltration by inflammatory leukocytes. The molecular pathogenesis of OA is increasingly understood by the elucidation of events within the articular cartilage. For example, altered dynamic equilibrium between matrix synthesis and degradation by human chondrocytes has recently been implicated as having a primary role in the degeneration of articular cartilage resulting in OA (Dingle, et al., Anal. Rheum. Dis. 52:292, 1993; Pelletier, et al., Sem. Arthritis Rheum. 20 (6 Suppl. 2):12-25, 1991). This includes upregulation of catabolic activities,
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such as secretion of degradative proteases, and/or downregulation of anabolic activities such as collagen and proteoglycan synthesis (Dingle, et al., 1993, supra; Pelletier, et al., 1991, supra). Cytokines such as IL-1 and TNF, which induce nitric oxide (NO) production in human chondrocytes (Palmer, et al. Biochem. Biophys. Res. Commun. 193:398-405, 1993), have also been implicated in the destruction of cartilage in OA (Pelletier, et al., 1991, supra). ... Accordingly, it is an object of the invention is to provide a novel inducible nitric oxide synthase (OA-NOS), obtainable from osteoarthritis-affected or rheumatoid-arthritis-affected articular cartilage. Web site: http://www.delphion.com/details?pn=US05759836__ ·
Use of debromohymenialdisine for treating osteoarthritis Inventor(s): Chipman; Stewart (Reading, MA), Faulkner; David J. (La Jolla, CA) Assignee(s): OsteoArthritis Sciences, Incorporated (Cambridge, MA), The Reagents of the University of California (Oakland, CA) Patent Number: 5,591,740 Date filed: June 7, 1995 Abstract: Disclosed is a method of treating osteoarthritis. The method comprises administering a therapeutic amount of debromohymenialdisine to an individual or animal with osteoarthritis. Debromohymenialdisine is able to slow the joint deterioration and cartilage degradation associated with the disease. Excerpt(s): Osteoarthritis or degenerative joint disease is a slowly progressive, irreversible, often monoarticular disease characterized by pain and loss of function (Mankin and Brandt, Pathogenesis of Osteoarthritis in "Textbook of Rheumatology", Kelly, et al., (eds.) 3rd edition, W. B. Saunders Co., Philadelphia, pp.14699-111471) and Dean, Arth. Rheum. 20 (Suppl. 2):2 (1991)). The underlying cause of the pain and debilitation is the cartilage degradation that occurs as a result of the disease. A typical end-stage clinical picture includes complete erosion of the weight-bearing articular cartilage, requiring total joint replacement. ... The pro-inflammatory cytokine interleukin-1 (IL-1) plays a major role in the cartilage matrix destructive processes observed in osteoarthritis (Pelletier, et al., Sem. Arth. Rheum., 20:12 (1991) and McDonnell, et al., Arth. Rheum., 35:799 (1992)). IL-1 has been demonstrated to upregulate the synthesis and secretion of the matrix metalloproteinases stromelysin and interstitial collagenase in a dose dependent manner (Stephenson, et al., Biochem. Biophys. Res. Comm. 144:583 (1987) and Lefebvre, et al., Biochem. Biophys. Res. Comm., 152:366 (1990). These matrix
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metalloproteinases are responsible for the damage to the proteoglycan and collagen II components of the cartilage matrix which occur in osteoarthritis (Dean, et al., J. Clin Invest., 84:678 (1989), Mort, et al., Matrix, 13:95 (1993) and Buttle, et al., Arth. Rheum., 12:1709 (1993). ... Currently, there is no therapeutic approach available that will slow the clinical progression of osteoarthritis, although steroids and non-steroidal anti-inflammatory drugs are used to ameliorate the pain and inflammation associated with the disease. Consequently, there is a need for new therapeutics which slow the joint degeneration caused by osteoarthritis. Web site: http://www.delphion.com/details?pn=US05591740__ ·
Footwear for patients of osteoarthritis of the knee Inventor(s): Kousaka; Sachiko (Sakai, JP), Kousaka; Mitsuko (Sakai, JP), Isaka; Kumiko (Izumi, JP) Assignee(s): Limited Responsibility Company Frontier (Osaka, JP) Patent Number: 5,579,591 Date filed: June 29, 1994 Abstract: Footware is made such that a thickness of a heel region from a sole upper surface to the ground is thinner at a backward portion than at a forward portion, whereby a line connecting a position on a lower surface of the sole under the head of the second metatarsus to a front end on a lower surface of the heel region of the sole is lifted at an angle with a horizontal line connecting a grounded rear, and on the lower surface of the heel region to a front end thereof in a state where a weight is loadedto the human heel, and the backward portion of the heel region comprises an impact absorbing mechanism, whereby a level of the human heel which is in contact with a foot is depressed when loaded. Thus, the footwear protects a knee joint of a patient suffering from the osteoarthritis of the knee and enables them to easily walk. Excerpt(s): The present invention relates to footwear for patients suffering from osteoarthritis of the knee and more particularly, to footwear for patients suffering from the osteoarthritis of the knee, which has a sufficient function as the footwear for the above patients but does not look strange because of that function, and which looks normal apparently and can be easily put on. ... Furthermore, although a conventional example 3 is not shown, it is generally called a rocker shoe whose sole is in form of circular arc. This kind of shoe protects an ankle part but unstable in the front-to-rear direction because a grounding point varies in the front-to-rear direction (because of shift of a supporting
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point). Thus, the shoe exerts a bad influence on the knee of the patients suffering from the osteoarthritis of the knee, who is an object of the present invention. ... Additionally, as an example of the osteoarthritis of the knee, there are varus (bandy leg) and valgus (knock knee). In order to ease or cure the above condition of the patient, there is used a method in which inclination is formed inside the sole of the shoe so that the inside (or outside) of the joint to be particularly protected is kept low. However, the osteoarthritis of the knee is not likely to be cured only by forming the inclined surface in the sole of the shoe and the troubles of the patients are not solved at the present. Web site: http://www.delphion.com/details?pn=US05579591__ ·
Assays for cartilage synthesis in osteoarthritis based on detection of type IIA mRNA Inventor(s): Sandell; Linda J. (80 S. Jackson, Seattle, WA 98104) Assignee(s): none reported Patent Number: 5,541,066 Date filed: February 18, 1994 Abstract: Assays for determining cartilage synthesis associated with osteoarthritis are presented. The assays are based on detection of collagen type IIA procollagen or propeptide, or collagen type IIA mRNA in a tissue or fluid sample from a non-neonatal individual being tested. Since type II A procollagen is not found in normal non-neonatal individuals, type IIA procollagen and the mRNA which encodes it are unique markers for osteoarthritis which exhibits neonatal like cartilage synthesis as part of the disease syndrome. Excerpt(s): The present invention relates to assays for detection of cartilage synthesis in osteoarthritis based on detection of type IIA procollagen and/or propeptide, and/or type IIA mRNA. The assays of the invention are useful as diagnostic and monitoring aids for osteoarthritis, and/or as aids in determining the effectiveness of osteoarthritic drugs and therapies. ... Osteoarthritis (OA) is characterized by the destruction of articular cartilage. Despite the ultimate degeneration of articular cartilage associated with OA, a striking phenomenon of OA cartilage is an attempt by chondrocytes to repair their matrix. This is characterized by proliferating chondrocyte clones, the development of chondroosteophytes and the synthesis of collagen. ... There is a need for cartilage markers that can provide information on collagen metabolism of diseased cartilage. Such markers are useful in estimating the pathological conditions of diseases such as OA. In this
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regard Shinmei et al ((1993) Osteoarthritis and Cartilage 1:128) have suggested that since type II collagen is a unique component of cartilage, the carboxy-terminal type II procollagen peptide (pCOL II-C) levels in joint fluids could reflect the synthetic activity of type II chondrocytes in the diseased joint, and thus could be used as a simple marker of type II collagen synthesis in articular cartilage in joint diseases. Unfortunately use of pCOL IIC as a marker for OA associated cartilage synthesis, as suggested by Shinmei et al, ((1993) Osteoarthritis and Cartilage 1:128), is not entirely satisfactory since non-diseased chondrocytes synthesize type II collagen, including type IIB collagen. Although there is evidence for increased synthesis of type II collagen at sites of pathological degradation of cartilage, use of pCOL IIC as a marker does not distinguish whether the increased synthesis is "normal" or associated with a disease state. Use of pCOL IIC also does not distinguish between type IIA or type IIB propeptide, since type IIA and IIB propeptides share the same carboxyterminal ends. Web site: http://www.delphion.com/details?pn=US05541066__ ·
Compositions and methods for detection and treatment of human osteoarthritis Inventor(s): Sandy; John D. (Tampa, FL), Flannery; Carl R. (Tampa, FL), Neame; Peter J. (Temple Terrace, FL), Lohmander; L. Stefan (Lund, SE) Assignee(s): Shriner's Hospitals for Crippled Children (Tampa, FL) Patent Number: 5,427,954 Date filed: April 29, 1992 Abstract: The subject invention concerns novel materials and methods for the detection, treatment, and prevention of human osteoarthritis. Specifically, the cleavage site where aggrecanase cleaves aggrecan has been identified. Identification of this site, as well as the nature of the enzyme, facilitates specific treatments which block or diminish the activity of the enzyme. A further aspect of the invention concerns methods for detecting evidence of osteoarthritis. Excerpt(s): Joint diseases are a major cause of disability and early retirement in the industrialized countries and are thus of great socioeconomic significance. Of the joint diseases, osteoarthritis (OA) has by far the greatest prevalence, and it has been calculated that, in the United States, OA is responsible for the consumption of up to thirty times more sick-leave days or hospital days than rheumatoid arthritis (Kramer, J. S., E. H. Yelin, W. V. Epstein [1983] Arthritis Rheum. 26:901-907). OA is a slowly progressive disease of multifactorial etiology. The rate of disease
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progress will vary greatly between different patients, depending on the underlying pathogenic factors. Consequently, progress from the very early stages to the overt, clinical stages may take anything from years to decades. ... The details of the mechanisms involved in the disease process of OA are not known. Presumably, the pathogenesis is multifactorial, with genetics, joint malalignment, joint overload or trauma, obesity, and aging as some of the known or suspected contributing factors. Even less well known is how these general factors are translated into disease mechanisms on the tissue and cell level. It may also be that the initiation and progression of OA are controlled by different factors. Since, however, changes in the properties of joint cartilage and loss of matrix components are an integral pan of the disease process, it can be argued that degradation of cartilage matrix is a key event at some time in the development of OA. During this process, matrix molecules, or fragments thereof, are released to the joint fluid and eventually to other body fluids. These molecules and fragments could be used as markers of cartilage turnover in OA and other joint diseases (Lohmander, S. [1988] Clin. Rheumatol. 2:37-62; Lohmander, L. S. [1990] "Cartilage markers in joint fluid in human osteoarthritis," In: Brandt, K., ed. Cartilage changes in osteoarthritis, Indianapolis: Indiana University School of Medicine Press (ISBN 0-914168-90-8), pp. 98-104; Lohmander, L. S. [1990] "Osteoarthritis: Man, Models, and Molecular Markers," In: Maroudas, A., K. Kuettner, eds. Methods in Cartilage Research, London: Academic Press, pp. 337340). ... The subject invention concerns novel compositions and methods for detection and treatment of aggrecan breakdown associated with human osteoarthritis. Aggrecan is a proteoglycan associated with collagen which constitutes the fibrous protein framework of cartilage. Aggrecanase is an enzyme whose activity is responsible for the pathological breakdown of aggrecan. The subject invention concerns the identification of the cleavage site where aggrecanase cleaves aggrecan. We have further characterized the breakdown products resulting from the proteolytic action of aggrecanase on aggrecan. Web site: http://www.delphion.com/details?pn=US05427954__
Patent Applications on Osteoarthritis As of December 2000, U.S. patent applications are open to public viewing.26 Applications are patent requests which have yet to be granted (the process to
26
This has been a common practice outside the United States prior to December 2000.
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achieve a patent can take several years). The following patent applications have been filed since December 2000 relating to osteoarthritis: ·
Protein tyrosine kinase inhibitors for treating osteoarthritis Inventor(s): Sharpe, Thomas R. ; (Wilmington, DE), Vasios, George W. ; (Brookline, MA), Campbell, R. Nelson ; (Bethesda, MD) Correspondence: Hamilton, Brook, Smith & Reynolds, P.C.; 530 Virginia Road; P.O. Box 9133; Concord; MA; 01742-9133; US Patent Application Number: 20030060515 Date filed: September 23, 2002 Abstract: Disclosed is a method of treating an individual or animal with osteoarthritis. The method comprises administering to the individual or animal a therapeutically effective amount of a protein tyrosine kinase inhibitor. Excerpt(s): Osteoarthritis or degenerative joint disease is a slowly progressive, irreversible, often monoarticular disease characterized by pain and loss of function (Mankin and Brandt, Pathogenesis of Osteoarthritis in "Textbook of Rheumatology", Kelly, et al., (eds.) 3rd edition, W. B. Saunders Co., Philadelphia, pp.14699-111471) and Dean, Arth. Rheum. 20 (Suppl. 2):2 (1991)). The underlying cause of the pain and debilitation is the cartilage degradation that occurs as a result of the disease. A typical end-stage clinical picture includes complete erosion of the weight-bearing articular cartilage, requiring total joint replacement. ... Z-debromohymenialdisine also slows the progression of osteoarthritis in animals. The use of hymenialdisines and analogues thereof for the treatment of osteoarthritis is disclosed in Chipman and Faulkner, U.S. Ser. No. 08/472,902 filed Jun. 7, 1995, now U.S. Pat. No. 5,591,740, issued on Jan. 7, 1997, the entire teachings of which are incorporated herein by reference. ... Currently, other than the hymenialdisines and analogues thereof, discussed above, there is no known, demonstrated therapeutic approach available that will slow the clinical progression of osteoarthritis, although steriods and non-steroidal anti-inflammatory drugs are used to ameliorate the pain and inflammation associated with the disease. Consequently, there is a need for new therapeutics which slow the joint degeneration caused by osteoarthritis. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html
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·
Anti-osteoarthritis and anti-hypothermia garment and device Inventor(s): Donaldson, Archie R. ; (Nassau, BS) Correspondence: DITTHAVONG & CARLSON, P.C.; Suite A; 10507 Braddock Road; Fairfax; VA; 22032; US Patent Application Number: 20030041364 Date filed: August 6, 2002 Abstract: A multilayered material is provided that exhibits therapeutic effects for relieving the pain and swelling of various forms of arthritis (particularly osteoarthritis), delaying the onset of osteoarthritis, or preventing hypothermia or alleviating conditions caused by hypothermia. The flexible, breathable multilayered material includes a first layer of soft and hypoallergenic material (e.g., cotton, silk, linen), a second layer of soft, heat retentive material (e.g., wool, cashmere) contacting the first layer, and a third layer of water repellent material contacting the second layer. Additionally, the multilayered material provides a thin, flexible, breathable fabric that can be used to construct various garments, devices, and gears to combat harsh weather conditions. Excerpt(s): The present application is a Continuation-In-Part of U.S. patent application Ser. No. 09/934,755 entitled "Anti-osteoarthritis and Anti-hypothermia Garment" filed on Aug. 23, 2001, the contents of which are hereby incorporated by reference. ... The present invention relates to textile fabrics, and more particularly to a multilayered material used to construct garments, gears, or devices capable of providing therapeutic effects relating to various forms of arthritis (particularly osteoarthritis) and conditions associated with hypothermia. ... These and other needs are addressed by the present invention, in which a multilayered material can be used to construct a garment, a device, or a gear for exhibiting therapeutic effects for relieving the pain and swelling of various forms of arthritis (particularly osteoarthritis), delaying the onset of osteoarthritis, or preventing hypothermia or alleviating conditions caused by hypothermia. The material is flexible, and breathable, and can retain as well as augment body temperature of the body parts covered by the material to well above that of the normal body temperature. The multilayered material can be used to avoid "tight-fitting" application to any of the body parts that are covered by the material, thereby advantageously eliminating the reduction of circulation. The multilayered material can be used to produce garments that are light-tomedium weight and provide medical benefits, physical fit, and a cosmetic appearance. The present invention advantageously permits a garment, device, or gear constructed from the multilayered material to be worn
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continuously for a prolonged period, if necessary, without any adverse effects because of its breathability. An inner layer, according to one embodiment, is soft, flexible, breathable, light-to-medium weight, and hypoallergenic (i.e., does not cause allergic reaction or skin irritation). A middle layer is soft, flexible, breathable, light-to-medium weight, heat retentive and augmentative, and can be made to meet the requirements of the particular body parts. An outer layer, according to an embodiment of the present invention, provides water-repellent characteristics to withstand various types of weather conditions, including water immersion; the outer layer is flexible, light-to-medium weight, breathable, and synthetic. The multilayered material can also be used to construct a number of devices and gear. Furthermore, the material can be further layered to accommodate more extreme weather conditions. The above arrangement advantageously provides a multilayered material that has wide applicability, enables continuous use, and exhibits therapeutic effects. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html ·
Inhibitors of spermidine synthase for the treatment of osteoarthritis and cartilage rehabilitation Inventor(s): Bar, Dganit ; (Rehovot, IL), Feinstein, Elena ; (Rehovot, IL), Segev, Orit ; (Rehovot, IL) Correspondence: Cooper & Dunham LLP; 1185 Avenue of the Americas; New York; NY; 10036; US Patent Application Number: 20020160978 Date filed: December 12, 2001 Abstract: This invention provides a method for the treatment of a subject in need of treatment for osteoarthritis comprising administering to said subject an amount of an inhibitor of spermidine biosynthesis sufficient to effect a substantial inhibition of spermidine biosynthesis. This invention also provides the use of an inhibitor of spermidine biosynthesis in the treatment of a subject in need of treatment of osteoarthritis in an amount sufficient to effect a substantial inhibition of spermidine biosynthesis. This invention further provides a method of preparing a therapeutic composition for the treatment of a subject in need of a treatment for osteoarthritis and the invention further provides a method of identifying an inhibitor of spermidine biosynthesis, whereby the inhibitor is a spermidine synthase inhibitor. Excerpt(s): The invention relates to the involvement of spermidine synthase with the development of osteoarthritis and in cartilage
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rehabilitation. More particularly, the invention relates to methods of treatment, compositions and the use of spermidine synthase inhibitors in the treatment of osteoarthritis and cartilage damage associated therewith. ... Osteoarthritis (OA) is a common, debilitating, costly, and currently incurable disease. Novel approaches to therapy are clearly required. The disease is characterized by abnormal functioning of chondrocytes, their terminal differentiation and initiation of osteogenesis within articular cartilage tissue, and breakdown of normal cartilage matrix. Genes whose products are involved in chondrogenesis and osteogenesis starting from the common progenitor cells, genes determining the terminal differentiation of chondrocytes and genes whose products trigger breakdown of the cartilaginous matrix are obvious candidates for therapeutic intervention. ... A specifically preferred embodiment relates to a method of preparing a therapeutic composition of the invention for the treatment of osteoarthritis (OA). This method comprises the steps of identifying an inhibitor of a spermidine synthase that leads to inhibition of any one of chondrocyte proliferation, chondrocyte final differentiation, angiogenesis and osteoclastogenesis and admixing said inhibitor with a pharmaceutically acceptable carrier. The identification of a suitable inhibitor involves obtaining a candidate inhibitor and evaluating the effect of the specific candidate. According to this specific embodiment, a candidate spermidine synthase inhibitor may be obtained for further evaluation, by selecting an inhibitor from the group consisting of adenosyl spermidine, AdoDATO, DCHA, trans-4methylcyclohexylamine (4MCHA), cyclohexylamine, methylglyoxal his(cyclopentylamidmohydrazone) (MGBP), 2-mercaptopropylamine, Nchlorosulfonyldicyclohexylamine, 5'-((3-aminopropyl)amino)-5'deoxyadenosine, I-aminooxyl-3-aminopropane, 5'-(isobutylthio) adenosine, 5'-(methylthio) adenosine and any functional homologs and analogs thereof. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html ·
Bone marrow edema as predictive of susceptibility to developing progressive osteoarthritis Inventor(s): Stevens, Randall Marion ; (Plainfield, NJ) Correspondence: HOFFMANN-LA ROCHE INC.; PATENT LAW DEPARTMENT; 340 KINGSLAND STREET; NUTLEY; NJ; 07110 Patent Application Number: 20020128548 Date filed: December 12, 2001
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Abstract: A method of identifying, for a patient having pain of a joint, susceptibility to developing progressive osteoarthritis or loss of joint space, by determining in such patient the presence or absence of bone marrow edema about or of the joint. A determination of the presence of bone marrow edema about or of the joint identifies the patient as susceptible to developing progressive osteoarthritis or loss of joint space. Excerpt(s): The present invention relates to a method of identifying, for a patient having pain of a joint, susceptibility to developing progressive osteoarthritis or loss of joint space (change in cartilage of the joint) by determining in such patient the presence or absence of bone marrow edema about the joint. A determination of the presence of bone marrow edema about the joint identifies the patient as susceptible to developing progressive osteoarthritis or loss in joint space. ... Osteoarthritis is the most common form of arthritis, affecting the hands, knees, hips, spine and other joints. Characteristics of osteoarthritis include a loss of cartilage, seen as a reduction in the joint space, and osteophytes (marginal lips of bone that grow at the edges of the joints). Other forms of arthritis are also characterized by joint space loss. ... Predictors of which patients will have progressive osteoarthritis, and which will have stable, non-progressive diseases is lacking, except for the use of bone scintigraphy in predicting joint space loss in the knee. However, repeated scintigraphy is not viable for following patients because of the associated repeated ionizing radiation dose. Other forms of arthritis also may have joint space loss, the prediction of which is also difficult to do or not able to be determined. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html ·
Osteoarthritis tissue derived nucleic acids, polypeptides, vectors, and cells Inventor(s): Phippard, Deborah J. ; (Chesterfield, MO), Vasanthakamur, Geetha ; (St. Louis, MO), Dotson, Stanton ; (Chesterfield, MO), Ma, XiaoJun ; (San Diego, CA) Correspondence: Rachel Polster; Patent Department Central; Monsanto/G.D. Searle; P.O. Box 5110; Chicago; IL; 60680-5110; US Patent Application Number: 20020119452 Date filed: January 18, 2001 Abstract: This invention relates to nucleic acids derived from osteoarthritis (OA) tissue as well as compounds and compositions made using these nucleic acids. A variety of nucleic acid and polypeptide compounds and compositions are described and specifically disclosed.
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The nucleic acids or polypeptides may be contained within vectors or host cells and then used to produce agents such as nucleic acids, polypeptides, fragments of polypeptides, antibodies, and variants of each. These molecules can be used to diagnose or treat osteoarthritis, or to analyze the disease-modifying activity of OA drugs. Cells containing one or more nucleic acids or polypeptides of the invention can also be used as targets in high-throughput screening methods, particularly in screening for compounds designed to identify compositions affecting osteoarthritis. Excerpt(s): This invention relates to nucleic acids derived from osteoarthritis (OA) tissue as well as compounds and compositions made using these nucleic acids. A variety of nucleic acid and polypeptide compounds and compositions are described and specifically disclosed. The nucleic acids or polypeptides may be contained within vectors or host cells and then used to produce agents such as nucleic acids, polypeptides, fragments of polypeptides, antibodies, and variants of each. These molecules can be used to diagnose or treat osteoarthritis, or to analyze the disease-modifying activity of OA drugs. Cells containing one or more nucleic acids or polypeptides of the invention can also be used as targets in high-throughput screening methods, particularly in screening for compounds designed to identify compositions affecting osteoarthritis. ... Osteoarthritis (OA) is a slowly progressing degenerative disease characterized by cartilage destruction that affects one or more joints. It is the most prevalent articular disease, and can severely impair mobility and lower extremity function (Ling and Bathon, J Am Geriatr Soc 46:216-25 (1998)). The term osteoarthritis implies an inflammatory disease. Although inflammatory cells may be present, OA is considered to be an intrinsic disease of cartilage in which biochemical and metabolic alterations result in its breakdown. Diagnosis is typically based upon radiological examination as well as clinical observations such as localized tenderness and bony or soft tissue swelling, joint function, severity of pain and the ease with which everyday functions such as climbing stairs can be performed. Characteristic radiographic findings include subchondral bone sclerosis, subchondral cysts and osteophytosis. Although joint space narrowing is considered to be a marker for articular cartilage thinning, in patients with early OA, who do not have radiographic evidence of bony changes, joint space narrowing alone does not accurately indicate the status of the articular cartilage. Similarly osteophytosis alone, in the absence of other radiographic features of OA, may be due to aging rather than OA. The correlation between the pathological severity of OA and symptoms is poor. Many individuals with radiographic changes of advanced OA have no symptoms. The risk factors for pain and disability in subjects with OA is still poorly
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understood. ... Estimating OA disease progression presents more of a challenge. The current "gold standard" measure of disease progression is the change in joint space caused by articular cartilage loss observed using plain X-rays (Mazzuca et al., Osteoarthritis and Cartilage 5:217-226 (1997)). Since changes are small (1-2 mm per year), a minimum of one year is required before sufficient changes have occurred to be detectable. An additional problem with this technique is the requirement that the joint must be in exactly the same position for each radiological examination. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html ·
Osteoarthritis Cartilage Regeneration Inventor(s): Goldberg, Victor M. (Gates Hills, OH); Caplan, Arnold I. (Clevenland Heights, OH); Barry, Francis P. (Baltimore, MD); Fink, David J. (Shaker Heights, OH); Marshak, Daniel R. (lutherville, md); Burns, James S. (Annapolis, MD) Correspondence: Raina Semionow; Carella, Byrne, Bain Gilfillan; Cecchi, Stewart & Olstein; 6 Becker Farm Road; Roseland; NJ; 07068 Patent Application Number: 20020110544 Date Filed: May 13, 1998 Abstract: For repair of cartilage damaged as part of the degenerative effects of osteoarthritis, the inventors have found that the human mesenchymal stem cell approach makes it possible to: (1) regenerate both shallow cartilage chondral defects and full thickness cartilage defects (osteochondral lesions); (2) broaden the suitable clinical population to routinely include middle-aged patients; (3) eliminate the use of autologous tissue grafts (mature cartilage and the periosteal covering) to repair an articular cartilage injury; (4) regenerate other types of injured cartilage such as patellar and spinal disk cartilage; (5) regenerate articular joint cartilage in older patients with osteoarthritis; and (6) form new cartilage and subchondral bone which fully integrate into the adjacent normal tissue. Excerpt(s): Arthritis is the most common chronic musculoskeletal disorder, affecting nearly 23 million patients or 9% of the U.S. population, with osteoarthritis (OA) comprising about 70% of that patient population. Arthritis is the leading age-related medical condition among women and ranks as the second most common such condition among men over 45 years of age. Deformities or orthopaedic joint impairment rank sixth among chronic disorders causing activity limitations. ... Hospitalizations resulting from arthritis are the second highest admissions category (8-
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10% of patients), followed by other orthopaedic impairments as the fourth leading category. Each year, approximately 1.3 million patients are admitted to U.S. hospitals for arthritis treatment, 85% of which are osteoarthritis patients. ... Of the half million arthroplasty procedures performed annually in the U.S., approximately 80% are performed on the hip and knee. Osteoarthritis is estimated to account for 50% of hip arthroplasties and over 80% of knee arthroplasties. Hip and knee osteoarthritis are the two most common forms of joint cartilage degeneration. Both forms of osteoarthritis occur most commonly in patients over 50 years old. Hip osteoarthritis is characterized by movement pain, joint stiffness and eventually deformity of the hip. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html ·
Novel methods and reagents for the treatment of osteoarthritis Inventor(s): Warman, Matthew L. (Cleveland, OH), Carpten, John D. (Gaithersburg, MD), Trent, Jeffery M. (Rockville, MD), Marcelino, Jose (South Euclid, OH) Correspondence: Peter G. Carroll; Medlen & Carroll, LLP; Suite 350; 101 Howard Street; San Francisco; CA; 94104; US Patent Application Number: 20020086824 Date filed: March 8, 2001 Abstract: Methods and compositions are described for treating osteoarthritis. Treatment is described with a new class of anti-OA drug, namely compounds that may be used as lubricants of the tissue diagnosed with OA. Additionally, the present invention provides reagents for the screening of compounds that may be used as therapeutic agents in the treatment of OA. Excerpt(s): This invention generally relates to novel compounds that may be used as lubricants of tissue and joints. Additionally, the present invention provides reagents for the screening of compounds that may be used as therapeutic agents in the treatment of osteoarthritis. ... This invention generally relates to novel compounds that may be used as lubricants of tissue and joints. Additionally, the present invention provides reagents for the screening of compounds that may be used as therapeutic agents in the treatment of Osteoarthritis. In one embodiment, the present invention contemplates the CACP protein, or portions thereof, in a preparation suitable for use as a lubricant. The present invention contemplates that such a preparation can be used in a method of treatment. In one embodiment, the method comprises a) providing: i) a subject (e.g. a human or animal), and ii) a preparation comprising the
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CACP protein, or portion thereof, and b) administering said preparation to said subject to lubricate the subjects tissue or joints. In another embodiment, the method comprises a) providing: i) a subject (e.g. a human or animal) diagnosed with arthritis, and ii) a preparation comprising the CACP protein, or portion thereof, and b) administering said preparation to said subject. In yet another embodiment, the method comprises a) providing: i) a subject (e.g. a human or animal) with symptoms of osteoarthritis, and ii) a preparation comprising the CACP protein, or portion thereof; and b) administering said preparation to said subject under conditions such that said symptoms (e.g. joint pain, loss of range of movement, joint damage, etc.) are reduced. In all of the above methods, it is contemplated that the preparation can have other ingredients. In one embodiment, said preparation further comprises a local anesthetic. Thus, the present invention contemplates a composition, comprising CACP protein, or portion thereof, in combination with an anesthetic. ... The present invention may be used as an experimental control in assays used for the screening of compounds that may act as therapeutics in the treatment of osteoarthritis. In this regard, the present invention may be used as a known standard in in vitro and in vivo assays known to those practiced in the art. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html ·
Methods for treating osteoarthritis using an estrogen agonist / antagonist Inventor(s): Littman, Bruce H. (Stonington, CT) Correspondence: Gregg C. Benson; Pfizer Inc.; Patent Department, MS 4159; Eastern Point Road; Groton; CT; 06340; US Patent Application Number: 20020049198 Date filed: September 19, 2001 Abstract: The present invention provides methods and kits for treating osteoarthritis using an estrogen agonist/antagonist. Excerpt(s): This invention relates to methods and kits for treating osteoarthritis using an estrogen agonist/antagonist. ... Osteoarthritis is the most common joint disorder and is characterized by loss of joint cartilage and hypertrophy of bone at the joint. This disorder usually begins asymtomatically in the 2nd to 3rd decade of life and is very common by age seventy. Almost all persons by age forty have some pathological change in weight-bearing joints. Men and women are equally affected, but onset is earlier in men. ... Osteoarthritis is a progressive disease. Typical symptomatic treatment includes the
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management of pain that accompanies osteoarthritis and changes in lifestyle such as diet and exercise. Examples of compounds that have been used to treat the pain associated with osteoarthritis include acetominophen and nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin, ibuprofen, naproxen, ketoprofen, nabumetone, etodolac, salsalate, sulindac, diclofenac, tolmetin, flurbiprofen, piroxicam, fenoprofen, indomethacin, meclofenamate, oxaprozin, diflunisal, and ketorolac; and selective cyclooxygenase-2 (COX-2) inhibitors such as Celebrex.RTM. and Vioxx.RTM.. Because NSAIDs can have unwanted side effects such as ulcers, NSAIDs are sometimes administered with other compounds that ameliorate the side effects of the NSAIDs. Typical compounds that are used in combination with NSAIDs include proton pump inhibitors such as omeprazole; antacids such as sucralfate; and H2 blockers such as ranitidine, cimetidine, famotidine, and nizatidine. In addition, products derived from natural substances have been used to treat osteoarthritis. Examples of natural substances include hyaluronic acid, glucosamine, chondroitin sulfate, and capsaicin. Intraarticular corticosteriods have also been used to treat osteoarthritis. Presently, there are no widely accepted treatments that reduce the progression of cartilage damage in osteoarthritis. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html ·
Treatment of glucosamine
osteoarthritis
by
administering
poly-N-acetyl-D-
Inventor(s): Sherman, William T. (Hendersonville, NC); Gracy, Robert W. (Fort Worth, TX) Correspondence: Darby & Darby P.C.; 805 Third Avenue; New York; NY; 10022; US Patent Application Number: 20010014671 Date Filed: February 9, 2001 Abstract: The methods of the present invention relate to administering to a mammal afflicted with osteoarthritis an effective amount of poly-Nacetyl-D-glucosamine (poly-NAG), partially depolimerized poly-NAG, pharmaceutically acceptable salts of poly-NAG, or mixtures thereof, to treat osteoarthritis and/or alleviate the symptoms of osteoarthritis such as pain, joint tenderness and swelling and impaired joint mobility. The present invention also comprises solid and liquid pharmaceutical dosage forms comprising poly-NAG, its pharmaceutically acceptable salts and mixtures thereof. These dosage forms may be administered orally and byinjection to treat osteoarthritis and/or alleviate the symptoms thereof.
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Excerpt(s): This invention relates to methods for treating osteoarthritis in mammals using pharmaceutical formulations comprising poly-N-acetylD-glucosamine (poly-NAG), a pharmaceutically acceptable derivative of poly-NAG, or mixtures thereof. The invention also relates to solid and liquid pharmaceutical dosage forms for oral and by-injection administration of poly-NAG and its derivatives. ... Osteoarthritis is a degenerative joint disease affecting articular cartilage developing in the fourth and fifth decades of life that was initially believed to be a disease of wear and tear due to mechanical stress on the joints. It is now known that the pathology of osteoarthrosis is not entirely mechanical and involves changes in the joint metabolism. Specifically, altered glucosamine metabolism appears to play a key role in the development of osteoarthritis. ... An effective treatment of osteoarthritis must address two types of problems: (i) pain, and joint tenderness, swelling and stiffness must be alleviated as an immediate patient's problem; and (ii) the degenerative process must be stopped preferably at its earlier stages. Treatment with anti-rheumatics and nonsteroidal anti-inflammatory drugs has not proven successful. Anti-rheumatics, although quickly effective, were recently shown to impair the very function that physicians were trying to improve, and anti-inflammatory drugs alleviate the pain but do not address the underlying degenerative disorder. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html
Keeping Current In order to stay informed about patents and patent applications dealing with osteoarthritis, you can access the U.S. Patent Office archive via the Internet at no cost to you. This archive is available at the following Web address: http://www.uspto.gov/main/patents.htm. Under “Services,” click on “Search Patents.” You will see two broad options: (1) Patent Grants, and (2) Patent Applications. To see a list of granted patents, perform the following steps: Under “Patent Grants,” click “Quick Search.” Then, type “osteoarthritis” (or synonyms) into the “Term 1” box. After clicking on the search button, scroll down to see the various patents which have been granted to date on osteoarthritis. You can also use this procedure to view pending patent applications concerning osteoarthritis. Simply go back to the following Web address: http://www.uspto.gov/main/patents.htm. Under “Services,” click on “Search Patents.” Select “Quick Search” under “Patent Applications.” Then proceed with the steps listed above.
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Vocabulary Builder Acetylcysteine: The N-acetyl derivative of cysteine. It is used as a mucolytic agent to reduce the viscosity of mucous secretions. It has also been shown to have antiviral effects in patients with HIV due to inhibition of viral stimulation by reactive oxygen intermediates. [NIH] Aetiology: Study of the causes of disease. [EU] Anabolic: Relating to, characterized by, or promoting anabolism. [EU] Biosynthesis: The building up of a chemical compound in the physiologic processes of a living organism. [EU] Boron: Boron. A trace element with the atomic symbol B, atomic number 5, and atomic weight 10.81. Boron-10, an isotope of boron, is used as a neutron absorber in boron neutron capture therapy. [NIH] Chondrogenesis: The formation of cartilage. This process is directed by chondrocytes which continually divide and lay down matrix during development. It is sometimes a precursor to osteogenesis. [NIH] Cimetidine: A histamine congener, it competitively inhibits histamine binding to H2 receptors. Cimetidine has a range of pharmacological actions. It inhibits gastric acid secretion, as well as pepsin and gastrin output. It also blocks the activity of cytochrome P-450. [NIH] Curcumin: A dye obtained from tumeric, the powdered root of Curcuma longa Linn. It is used in the preparation of curcuma paper and the detection of boron. Curcumin appears to possess a spectrum of pharmacological properties, due primarily to its inhibitory effects on metabolic enzymes. [NIH] Cytokines: Non-antibody proteins secreted by inflammatory leukocytes and some non-leukocytic cells, that act as intercellular mediators. They differ from classical hormones in that they are produced by a number of tissue or cell types rather than by specialized glands. They generally act locally in a paracrine or autocrine rather than endocrine manner. [NIH] Diflunisal: A salicylate derivative and anti-inflammatory analgesic with actions and side effects similar to those of ASPIRIN. [NIH] Diltiazem: A benzothiazepine derivative with vasodilating action due to its antagonism of the actions of the calcium ion in membrane functions. It is also teratogenic. [NIH] Extracellular: Outside a cell or cells. [EU] Extremity: A limb; an arm or leg (membrum); sometimes applied specifically to a hand or foot. [EU] Famotidine: A competitive histamine H2-receptor antagonist. Its main pharmacodynamic effect is the inhibition of gastric secretion. [NIH]
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Fenoprofen: An anti-inflammatory analgesic and antipyretic highly bound to plasma proteins. It is pharmacologically similar to aspirin, but causes less gastrointestinal bleeding. [NIH] Flurbiprofen: An anti-inflammatory analgesic and antipyretic of the phenylalkynoic acid series. It has been shown to reduce bone resorption in periodontal disease by inhibiting carbonic anhydrase. [NIH] Genotype: The genetic constitution of the individual; the characterization of the genes. [NIH] Hyperplasia: The abnormal multiplication or increase in the number of normal cells in normal arrangement in a tissue. [EU] Hypertrophy: The enlargement or overgrowth of an organ or part due to an increase in size of its constituent cells. [EU] Hypothermia: A low body temperature, as that due to exposure in cold weather or a state of low temperature of the body induced as a means of decreasing metabolism of tissues and thereby the need for oxygen, as used in various surgical procedures, especially on the heart, or in an excised organ being preserved for transplantation. [EU] Infiltration: The diffusion or accumulation in a tissue or cells of substances not normal to it or in amounts of the normal. Also, the material so accumulated. [EU] Interstitial: Pertaining to or situated between parts or in the interspaces of a tissue. [EU] Intrinsic: Situated entirely within or pertaining exclusively to a part. [EU] Lesion: Any pathological or traumatic discontinuity of tissue or loss of function of a part. [EU] Mediator: An object or substance by which something is mediated, such as (1) a structure of the nervous system that transmits impulses eliciting a specific response; (2) a chemical substance (transmitter substance) that induces activity in an excitable tissue, such as nerve or muscle; or (3) a substance released from cells as the result of the interaction of antigen with antibody or by the action of antigen with a sensitized lymphocyte. [EU] Metatarsus: The part of the foot between the tarsa and the toes. [NIH] Neonatal: Pertaining to the first four weeks after birth. [EU] Neuronal: Pertaining to a neuron or neurons (= conducting cells of the nervous system). [EU] Neutrophil: Having an affinity for neutral dyes. [EU] Nifedipine: A potent vasodilator agent with calcium antagonistic action. It is a useful anti-anginal agent that also lowers blood pressure. The use of nifedipine as a tocolytic is being investigated. [NIH]
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Nitrogen: An element with the atomic symbol N, atomic number 7, and atomic weight 14. Nitrogen exists as a diatomic gas and makes up about 78% of the earth's atmosphere by volume. It is a constituent of proteins and nucleic acids and found in all living cells. [NIH] Nizatidine: A histamine H2 receptor antagonist with low toxicity that inhibits gastric acid secretion. The drug is used for the treatment of duodenal ulcers. [NIH] Polypeptide: A peptide which on hydrolysis yields more than two amino acids; called tripeptides, tetrapeptides, etc. according to the number of amino acids contained. [EU] Predisposition: A latent susceptibility to disease which may be activated under certain conditions, as by stress. [EU] Protease: Proteinase (= any enzyme that catalyses the splitting of interior peptide bonds in a protein). [EU] Proteolytic: 1. Pertaining to, characterized by, or promoting proteolysis. 2. An enzyme that promotes proteolysis (= the splitting of proteins by hydrolysis of the peptide bonds with formation of smaller polypeptides). [EU] Reagent: A substance employed to produce a chemical reaction so as to detect, measure, produce, etc., other substances. [EU] Recombinant: A cell or an individual with a new combination of genes not found together in either parent; usually applied to linked genes. [EU] Secretion: 1. The process of elaborating a specific product as a result of the activity of a gland; this activity may range from separating a specific substance of the blood to the elaboration of a new chemical substance. 2. Any substance produced by secretion. [EU] Spermidine: A polyamine formed from putrescine. It is found in almost all tissues in association with nucleic acids. It is found as a cation at all pH values, and is thought to help stabilize some membranes and nucleic acid structures. It is a precursor of spermine. [NIH] Sucralfate: A basic aluminum complex of sulfated sucrose. It is advocated in the therapy of peptic, duodenal, and prepyloric ulcers, gastritis, reflux esophagitis, and other gastrointestinal irritations. It acts primarily at the ulcer site, where it has cytoprotective, pepsinostatic, antacid, and bile acidbinding properties. The drug is only slightly absorbed by the digestive mucosa, which explains the absence of systemic effects and toxicity. [NIH] Sulindac: A sulfinylindene derivative whose sulfinyl moiety is converted in vivo to an active anti-inflammatory analgesic that undergoes enterohepatic circulation to maintain constant blood levels without causing gastrointestinal side effects. [NIH] Synergistic: Acting together; enhancing the effect of another force or agent.
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[EU]
Synovitis: Inflammation of a synovial membrane. It is usually painful, particularly on motion, and is characterized by a fluctuating swelling due to effusion within a synovial sac. Synovitis is qualified as fibrinous, gonorrhoeal, hyperplastic, lipomatous, metritic, puerperal, rheumatic, scarlatinal, syphilitic, tuberculous, urethral, etc. [EU] Tetracycline: An antibiotic originally produced by Streptomyces viridifaciens, but used mostly in synthetic form. It is an inhibitor of aminoacyl-tRNA binding during protein synthesis. [NIH] Tolmetin: An anti-inflammatory antipyretic and analgesic similar in mode of action to indomethacin. It has been proposed as an antirheumatic agent. [NIH]
Tyrosine: A non-essential amino acid. In animals it is synthesized from phenylalanine. It is also the precursor of epinephrine, thyroid hormones, and melanin. [NIH]
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CHAPTER 6. BOOKS ON OSTEOARTHRITIS Overview This chapter provides bibliographic book references relating to osteoarthritis. You have many options to locate books on osteoarthritis. The simplest method is to go to your local bookseller and inquire about titles that they have in stock or can special order for you. Some patients, however, feel uncomfortable approaching their local booksellers and prefer online sources (e.g. http://www.amazon.com and www.bn.com). In addition to online booksellers, excellent sources for book titles on osteoarthritis include the Combined Health Information Database and the National Library of Medicine. Once you have found a title that interests you, visit your local public or medical library to see if it is available for loan.
Book Summaries: Federal Agencies The Combined Health Information Database collects various book abstracts from a variety of healthcare institutions and federal agencies. To access these summaries, go to http://chid.nih.gov/detail/detail.html. You will need to use the “Detailed Search” option. To find book summaries, use the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer. For the format option, select “Monograph/Book.” Now type “osteoarthritis” (or synonyms) into the “For these words:” box. You will only receive results on books. You should check back periodically with this database which is updated every 3 months. The following is a typical result when searching for books on osteoarthritis:
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Diagnosis and Nonsurgical Management of Osteoarthritis, Second Edition Source: Caddo, OK: Professional Communications, Inc. 2000. 304 p. Contact: Available from Professional Communications, Inc. P.O. Box 10, Caddo, OK 74729. (800) 337-9838. Fax (580) 367-9989. Price: $24.95 plus shipping and handling. ISBN 1884735576. Summary: This monograph provides health professionals with information on the diagnosis and nonsurgical management of osteoarthritis (OA). Part 1 presents general information about OA, including its definition, epidemiology (prevalence and risk factors), pathology, and pathogenesis. Part 2 deals with diagnosis, focusing on the clinical features of OA; the origins of joint pain; the pitfalls in diagnosing OA such as misinterpreting pain, the deformity, the radiographs, and the laboratory results; synovial fluid analysis; and the radiographic features of OA. Part 3 examines nonmedicinal therapy for OA pain, including aerobic exercise, range of motion and strengthening exercises, joint protection, weight loss, thermal modalities, patellar taping, tidal irrigation of the knee, use of wedged insoles, and patient education. Part 4 discusses the efficacy and adverse effects of systemic pharmacologic therapy, focusing on acetaminophen and nonspecific nonsteroidal antiinflammatory drugs (NSAIDs), NSAIDs that are specific inhibitors of cyclooxygenase-2, and opioids. Part 5 explores local therapies, including rubefacients and capsaicin cream, intraarticular injection of corticosteroids, and intraarticular injection of hyaluronic acid. Part 6 presents a rational strategy for treating OA pain. Part 7 highlights other therapies, including disease modifying drugs such as NSAIDs, heparinoids, tetracyclines, diacerhein, and glucosamine sulfate, as well as surgical intervention. 34 figures, 39 tables, 23 color plates, and numerous references.
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Living Well With Osteoarthritis: A Self-Care Handbook Source: South Deerfield, MA: Channing L. Bete Co., Inc. 1999. 32 p. Contact: Available from Channing L. Bete Co., Inc. 200 State Road, South Deerfield, MA 01373-0200. (800) 628-7733. Fax (800) 499-6464. E-mail:
[email protected]. PRICE: Contact company for pricing information; available in bulk. Order Number 97146A-07-99. Summary: This illustrated handbook provides people who have osteoarthritis (OA) with information on the diagnosis and management of this chronic condition. OA is caused by wear and tear that damages joints. The areas commonly affected include the hands, spine, hips, knees, and feet. Risk factors for OA include aging, heredity, injury to a joint,
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overuse, and excess weight. In a normal joint, cartilage protects the end of each bone, synovial fluid lubricates the joint, ligaments attach bone to bone, tendons attach muscles to the bones, and muscles move the bones. In general, OA damages joints after cartilage wears away and frays, and bones grate together where cartilage is missing. Common symptoms include joint pain, swelling, and stiffness. Diagnosis is based on the results of a physical examination, a medical history, and x rays. Various health care professionals may be involved in the care of a person who has OA, and the patient and team will develop a self management plan. Maintaining a positive outlook and staying active are important aspects of self care. Regular physical activity will help increase flexibility, strengthen muscles and tendons, build endurance, maintain or reach a healthy weight, and lift spirits. The handbook presents examples of exercises for increasing flexibility, strengthening muscles, and building endurance. The handbook also offers guidelines on using the food guide pyramid and nutrition facts labels to follow a balanced meal plan, performing daily tasks, using mobility aids and special assistive devices, and managing pain through relaxation techniques and pain medications. The handbook concludes with information on sources of information and support. ·
Osteoarthritis: Caring for Your Hands Source: Bethesda, MD: American Occupational Therapy Association, Inc. 1995. 19 p. Contact: American Occupational Therapy Association, 4720 Montgomery Lane, P.O. Box 31220, Bethesda, MD 20824-1220. (301) 652-2682. (800) 3778555 ( TDD ). (301) 652-7711 (fax). Summary: This book for individuals with osteoarthritis (OA) provides information for reducing pain and inflammation. Primary and secondary OA are described. The symptoms of and problems associated with OA of the thumb and fingers are presented. Surgical techniques for specific thumb joints are briefly explained. Steps that individuals can take to reduce pain, inflammation, and morning stiffness in the hands are outlined. Guidelines are provided for using heat and cold on the hands, protecting joints, and relieving muscle tension. A list of additional resources is also included. 1 reference, 11 figures, and 1 table.
Book Summaries: Online Booksellers Commercial Internet-based booksellers, such as Amazon.com and Barnes & Noble.com, offer summaries which have been supplied by each title’s
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publisher. Some summaries also include customer reviews. Your local bookseller may have access to in-house and commercial databases that index all published books (e.g. Books in PrintÒ). The following have been recently listed with online booksellers as relating to osteoarthritis (sorted alphabetically by title; follow the hyperlink to view more details at Amazon.com): ·
New Trends in Osteoarthritis by E. C. Huskisson (Editor), G. Katona (Editor), (1982); ISBN: 3805534876; http://www.amazon.com/exec/obidos/ASIN/3805534876/icongroupin terna
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Intraneural Injections for Rheumatoid Arthritis & Osteoarthritis & the Control of Pain in Arthritis by Paul Notrik (1984); ISBN: 0931150140; http://www.amazon.com/exec/obidos/ASIN/0931150140/icongroupin terna
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Osteoarthritis 1989); ISBN: 0969305303; http://www.amazon.com/exec/obidos/ASIN/0969305303/icongroupin terna
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Coping With Osteoarthritis by Robert H. Phillips (1989); ISBN: 0895293935; http://www.amazon.com/exec/obidos/ASIN/0895293935/icongroupin terna
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Osteoarthritis: A Step by Step Success Story to Show Others They Can Help Themselves by Fred L. Savage (1990); ISBN: 0882680862; http://www.amazon.com/exec/obidos/ASIN/0882680862/icongroupin terna
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Osteoarthritis: Current Research and Prospects for Pharmacological Intervention by P. A. Dieppe, R. G. Russell (1991); ISBN: 1852710934; http://www.amazon.com/exec/obidos/ASIN/1852710934/icongroupin terna
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Joint Destruction in Arthritis and Osteoarthritis (1993); ISBN: 3764327731; http://www.amazon.com/exec/obidos/ASIN/3764327731/icongroupin terna
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Sponyloarthropathies, Infectious Arthritis & Immune Dysfunction, Osteoarthritis & Crystal Deposition by Larry Ward (Illustrator), Muhammad A. Khan (1993); ISBN: 1859220193; http://www.amazon.com/exec/obidos/ASIN/1859220193/icongroupin terna
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Joint Destruction in Arthritis and Osteoarthritis (Agents and Actions Supplements, Vol. 39) by W.B. Van Den Berg, et al (1993); ISBN:
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0817627731; http://www.amazon.com/exec/obidos/ASIN/0817627731/icongroupin terna ·
Epidemiology of Osteoarthritis: International Workshop by Wolfhart Puhl, Kenneth D. Brandt (1994); ISBN: 0865775656; http://www.amazon.com/exec/obidos/ASIN/0865775656/icongroupin terna
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Osteoarthritis: Caring for Your Hands by Jeanne L. Melvin (1995); ISBN: 1569000212; http://www.amazon.com/exec/obidos/ASIN/1569000212/icongroupin terna
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Color Atlas and Text of Osteoarthritis by Michael Doherty M. D., M. Michael Doherty (1995); ISBN: 072341646X; http://www.amazon.com/exec/obidos/ASIN/072341646X/icongroupi nterna
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Osteoarthritic Disorders: Workshop, Monterey, California, April 1994 by Klaus E. Kuettner (Editor), et al (1995); ISBN: 0892031298; http://www.amazon.com/exec/obidos/ASIN/0892031298/icongroupin terna
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Stop Osteoarthritis Now: Halting the Baby Boomers' Disease by Harris H. McIlwain (Preface), Debra Fulghum Bruce (1996); ISBN: 0684814390; http://www.amazon.com/exec/obidos/ASIN/0684814390/icongroupin terna
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Arthritis: About Osteoarthritis and Rheumatoid Disease, Including Rheumatoid Arthritis by Anthony Di Fabio, Gus J. Prosch (1997); ISBN: 0961543736; http://www.amazon.com/exec/obidos/ASIN/0961543736/icongroupin terna
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Osteoarthritis: Public Health Implications for an Aging Population by David Hamerman (Editor), M. David Hamerman (1997); ISBN: 0801855616; http://www.amazon.com/exec/obidos/ASIN/0801855616/icongroupin terna
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The Arthritis Cure: The Medical Miracle That Can Halt, Reverse, and May Even Cure Osteoarthritis by Jason Theodosakis, et al (1997); ISBN: 0312190298; http://www.amazon.com/exec/obidos/ASIN/0312190298/icongroupin terna
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Maximizing the Arthritis Cure: A Step-By-Step Program to Faster, Stronger Healing During Any Stage of the Cure by Jason Theodosakis,
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MD, et al (1998); ISBN: 0312181345; http://www.amazon.com/exec/obidos/ASIN/0312181345/icongroupin terna ·
Arthritis of the Hip and Knee: The Active Person's Guide to Taking Charge by Ronald J. Allen, et al (1998); ISBN: 1561451495; http://www.amazon.com/exec/obidos/ASIN/1561451495/icongroupin terna
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Osteoarthritis (Oxford Medical Publications) by Kenneth D. Brandt (Editor), et al (1998); ISBN: 019262735X; http://www.amazon.com/exec/obidos/ASIN/019262735X/icongroupi nterna
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The Sam-E Solution by Deborah Mitchell (1999); ISBN: 0446676373; http://www.amazon.com/exec/obidos/ASIN/0446676373/icongroupin terna
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Mechanobiology: Osteoarthritis and Skeletal Regeneration, and Osteoporosis and Bone Functional Adaptation by Tamara T. Sowell (Editor) (2000); ISBN: 0756705908; http://www.amazon.com/exec/obidos/ASIN/0756705908/icongroupin terna
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The Arthritis Foundation's Guide to Good Living with Osteoarthritis (2000); ISBN: 0912423250; http://www.amazon.com/exec/obidos/ASIN/0912423250/icongroupin terna
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Clinician's Manual on Osteoarthritis by DL Scott Brooks (2001); ISBN: 1858739233; http://www.amazon.com/exec/obidos/ASIN/1858739233/icongroupin terna
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Coping With Osteoarthritis: Sound, Compassionate Advice for People Dealing With the Challenge of Osteoarthritis (Coping With...) by Robert H. Phillips, Ph.D. (2001); ISBN: 1583330909; http://www.amazon.com/exec/obidos/ASIN/1583330909/icongroupin terna
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Arthritis Survival: The Holistic Medical Treatment Program for Osteoarthritis by Robert S. Ivker, D.O., et al (2001); ISBN: 1585420972; http://www.amazon.com/exec/obidos/ASIN/1585420972/icongroupin terna
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Osteoarthritis (Natural Health Guide) by Zoltan P. Rona (2002); ISBN: 1553120132; http://www.amazon.com/exec/obidos/ASIN/1553120132/icongroupin terna
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Osteoarthritis: Your Questions Answered by John Dickson (2003); ISBN: 0443073465; http://www.amazon.com/exec/obidos/ASIN/0443073465/icongroupin terna
The National Library of Medicine Book Index The National Library of Medicine at the National Institutes of Health has a massive database of books published on healthcare and biomedicine. Go to the following Internet site, http://locatorplus.gov/, and then select “Search LOCATORplus.” Once you are in the search area, simply type “osteoarthritis” (or synonyms) into the search box, and select “books only.” From there, results can be sorted by publication date, author, or relevance. The following was recently catalogued by the National Library of Medicine:27 ·
Aetiopathogenesis of osteoarthrosis. Author: ed. by George Nuki; Year: 1980; Kent: Pitman Medical, 1980; ISBN: 0272794341 http://www.amazon.com/exec/obidos/ASIN/0272794341/icongroupin terna
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Biology of degenerative joint disease. Author: Sokoloff, Leon; Year: 1969; Chicago, Univ. of Chicago Press [1969]
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Biology of the articular cartilage in health and disease: proceedings of the Second Munich Symposium on Biology of Connective Tissue, Munich, July 23-24, 1979. Author: editor, H. Gastpar; Year: 1980; Stuttgart; New York: Schattauer, 1980.; ISBN: 3794507738
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Biomechanics of the knee: with application to the pathogenesis and the surgical treatment of osteoarthritis. Author: Paul G. J. Maquet; Year: 1976; Berlin; New York: Springer-Verlag, c1976.; ISBN: 3387078827
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Buster Crabbe's arthritis exercise book. Author: by Buster Crabbe with Raphael Cilento; Year: 1980; New York: Simon and Schuster, c1980.; ISBN: 0671240196
In addition to LOCATORPlus, in collaboration with authors and publishers, the National Center for Biotechnology Information (NCBI) is adapting biomedical books for the Web. The books may be accessed in two ways: (1) by searching directly using any search term or phrase (in the same way as the bibliographic database PubMed), or (2) by following the links to PubMed abstracts. Each PubMed abstract has a “Books” button that displays a facsimile of the abstract in which some phrases are hypertext links. These phrases are also found in the books available at NCBI. Click on hyperlinked results in the list of books in which the phrase is found. Currently, the majority of the links are between the books and PubMed. In the future, more links will be created between the books and other types of information, such as gene and protein sequences and macromolecular structures. See http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Books.
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http://www.amazon.com/exec/obidos/ASIN/0671240196/icongroupin terna ·
Development of outcome criteria and standards to assess the quality of care for patients with osteoarthrosis. Author: Sheldon Greenfield ... [et al.]; Year: 1977; Santa Monica, Calif.: Rand Corp., 1977.
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Effect of high tibial and double osteotomy on osteoarthritic and rheumatoid deformity of the knee. Author: Vratislav Rybka; Year: 1979; Praha: Univerzita Karlova, 1979.
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Enzymes and articular destruction in rheumatoid arthritis and osteoarthrosis. Author: Leena Peltonen; Year: 1978; Oulu: Univ. of Oulu, 1978.; ISBN: 9514205596
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Intertrochanteric osteotomy of the femur for oeteoarthritis of the hip joint. Author: by Sven S. Olsson; Year: 1974; Göteborg, Sweden: [s.n.], 1974
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Joint space in normal and osteoarthrotic knees: a roentgen photogrammetric study on autopsy specimens. Author: by Manhar V. Patel; Year: 1973; Stockholm: [s.n.], 1973; ISBN: 9185112011
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Management of degenerative joint diseases: Stockholm, August 28, 1980. Author: editor, Anders Bjelle; Year: 1982; Stockholm, Sweden: Almqvist & Wiksell, [1982]
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Osteoarthritis and body measurements; the relationship of osteoarthritis to body measurements as shown in data from the Health Examination Survey, 1960-1962. Author: National Center for Health Statistics (U.S.); Year: 1968; Washington [For sale by the Supt. of Docs., U. S. Govt. Print. Off.] 1968.
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Osteoarthritis in lumbar synovial joints: a morphologic study. Author: by Thord Lewin; Year: 1964; Göteborg: [s.n.], 1964.
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Osteoarthritis of the hip: pathogenesis and consequent therapy. Author: Renato Bombelli; Year: 1976; Berlin; New York: Springer-Verlag, 1976.; ISBN: 3540078428
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Osteoarthritis of the hip, not including orthopaedic and surgical treatment. Author: Françon, François, 1888-; Year: 1959; Basle, Geigy, 1959.
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Osteoarthritis of the hip; with special reference to treatment by vitallium mould arthroplasty. Author: Law, William Alexander; Year: 1952; London, Butterworth, 1952.
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Osteo-arthritis of the hip-joint. Author: Crowe, Henry Warren; Year: 1948; [London] Pulman [1948?]
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Osteoarthritis, diagnosis and management. Author: [edited by] Roland W. Moskowitz ... [et al.]; Year: 1984; Philadelphia: Saunders, 1984.; ISBN: 0721665713 http://www.amazon.com/exec/obidos/ASIN/0721665713/icongroupin terna
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Osteoarthritis; a handbook for patients. Author: Canadian Arthritis and Rheumatism Society; Year: 1957; Toronto, 1957]
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Pulsed signal therapy and the treatment of osteoarthritis. Author: prepared by Alicia Framarin; Year: 2001; Montréal, Québec: Agence d'évaluation des technologies et des modes d'intervention en santé, c2001.; ISBN: 2550384415
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Reflections of an arthritic. Author: Orme, Eve, pseud; Year: 1956; London, Faber and Faber [1956]
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Results after intertrochanteric osteotomy in osteoarthritis of the hip: a prospective study with special reference to weight-bearing capacity. Author: by Sven Collert; Year: 1974; Stockholm: [s.n.], 1974
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Subchondral bone of the medial tibial condyle in the normal state: osteoarthritis and rheumatoid arthritis: a biomechanical, biochemical, morphologic and enzymatic study. Author: by Paul Lereim; Year: 1975; Göteborg, [Sweden: s.n.], 1975
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Surgical management of degenerative arthritis of the lower limb. Author: Editors, Richard L. Cruess, Nelson S. Mitchell; Year: 1975; Philadelphia: Lea & Febiger, 1975.; ISBN: 0812104978 http://www.amazon.com/exec/obidos/ASIN/0812104978/icongroupin terna
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Symposium on Osteoarthritis, Chicago, Illinois, October, 1974. Author: [sponsored by the] American Academy of Orthopaedic Surgeons; Year: 1976; St. Louis: Mosby, 1976.; ISBN: 0801600243 http://www.amazon.com/exec/obidos/ASIN/0801600243/icongroupin terna
Chapters on Osteoarthritis Frequently, osteoarthritis will be discussed within a book, perhaps within a specific chapter. In order to find chapters that are specifically dealing with osteoarthritis, an excellent source of abstracts is the Combined Health Information Database. You will need to limit your search to book chapters and osteoarthritis using the “Detailed Search” option. Go directly to the following hyperlink: http://chid.nih.gov/detail/detail.html. To find book chapters, use the drop boxes at the bottom of the search page where “You
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may refine your search by.” Select the dates and language you prefer, and the format option “Book Chapter.” By making these selections and typing in “osteoarthritis” (or synonyms) into the “For these words:” box, you will only receive results on chapters in books. The following is a typical result when searching for book chapters on osteoarthritis: ·
Chapter 8-A: Musculoskeletal Signs and Symptoms: Monoarticular Joint Disease Source: in Klippel, J.H., et al., eds. Primer on the Rheumatic Diseases. 12th ed. Atlanta, GA: Arthritis Foundation. 2001. p. 157-160. Contact: Available from Arthritis Foundation. P.O. Box 1616, Alpharetta, GA 30009-1616. (800) 207-8633. Fax (credit card orders only) (770) 4429742. Website: www.arthritis.org. PRICE: $69.95 plus shipping and handling. ISBN: 0912423293. Summary: This chapter provides health professionals with information on the diagnosis and treatment of monarticular joint disease. The causes of monarthritis are divided into inflammatory diseases and mechanical or infiltrative disorders. Diagnosis is based on the medical history; the physical examination; and the results of diagnostic tests such as synovial fluid analysis, laboratory tests, radiographs, and synovial biopsy. Treatment decisions must often be made before all test results are available, so antibiotics or nonsteroidal antiinflammatory drugs may be prescribed as an initial step in treating monarthritis. The chapter describes specific types of monarthritis, including infection, crystal induced arthritis, osteoarthritis (OA), osteonecrosis, trauma, foreign body reactions, hemarthrosis, systemic rheumatic diseases, and monarthritis of undetermined cause. The majority of nongonoccocal bacterial infections are monarticular. The most common agents are gram positive aerobes. Neisseria gonorrhoeae is probably still the most common cause of infectious arthritis. Gout, a crystal induced arthritis, is the most common type of inflammatory monarthritis. OA is a chronic and slowly progressive disease. Trauma to a joint can lead to monarticular disease. Hemarthrosis is caused by clotting abnormalities due to anticoagulant therapy or congenital disorders such as hemophilia. Many systemic diseases may begin as acute monarticular arthritis. In many patients, the cause of monarthritis cannot be determined. 2 tables and 15 references.
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Chapter 8-B: Musculoskeletal Signs and Symptoms: Polyarticular Joint Disease Source: in Klippel, J.H., et al., eds. Primer on the Rheumatic Diseases. 12th ed. Atlanta, GA: Arthritis Foundation. 2001. p. 160-165.
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Contact: Available from Arthritis Foundation. P.O. Box 1616, Alpharetta, GA 30009-1616. (800) 207-8633. Fax (credit card orders only) (770) 4429742. Website: www.arthritis.org. PRICE: $69.95 plus shipping and handling. ISBN: 0912423293. Summary: This chapter provides health professionals with information on polyarticular joint disease. The age, gender, and race of a patient may provide helpful information in the differential diagnosis of polyarthritis. The most important diagnostic tools in the evaluation of polyarticular joint complaints are a thorough history and physical examination. Useful laboratory studies include standard hematologic and biochemical tests, nonspecific indicators of inflammation or dysproteinemia, antibody tests for exposure to pathogens, and autoantibodies that may be associated with a single condition or limited group of illnesses. Other tests that may be useful if the diagnosis is uncertain after history, physical examination, and results of standard laboratory tests are evaluated include synovial fluid analysis, imaging studies, and biopsy of the synovium or other tissues. The main categories of polyarticular joint disease are inflammatory and noninflammatory. Inflammatory conditions that may manifest with polyarthritis include rheumatic fever, septic arthritis, gonococcal and meningococcal arthritis, Lyme disease, bacterial endocarditis, mycobacterial or fungal arthritis, viral diseases, human immunodeficiency virus infection, crystal induced arthritis, palindromic rheumatism, familial Mediterranean fever, acute leukemia, and acute sarcoid arthritis. Diseases that may present with subacute and chronic inflammatory polyarthritis include rheumatoid arthritis, ankylosing spondylitis, psoriatic arthritis, reactive arthritis, juvenile chronic polyarthritis, Still's disease, Whipple's disease, systemic lupus erythematosus, drug induced lupus, systemic rheumatic illnesses, Behcet's disease, and relapsing polychondritis. Osteoarthritis is characterized by noninflammatory polyarthropathy. Other systemic illnesses that may cause noninflammatory arthropathy include amyloidosis, hypertrophic pulmonary osteoarthropathy, hemophilia, and Sickle cell disease. 2 tables and 6 references. ·
Chapter 8-C: Musculoskeletal Signs and Symptoms: Disorders of the Low Back and Neck Source: in Klippel, J.H., et al., eds. Primer on the Rheumatic Diseases. 12th ed. Atlanta, GA: Arthritis Foundation. 2001. p. 165-173. Contact: Available from Arthritis Foundation. P.O. Box 1616, Alpharetta, GA 30009-1616. (800) 207-8633. Fax (credit card orders only) (770) 4429742. Website: www.arthritis.org. PRICE: $69.95 plus shipping and handling. ISBN: 0912423293.
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Summary: This chapter provides health professionals with information on disorders of the low back and neck. Axial skeletal pain is associated with various mechanical and medical disorders. Mechanical disorders are caused by overuse, trauma, or physical deformity of an anatomic structure. Medical disorders responsible for spinal pain are associated with constitutional symptoms, disease in other organ systems, and inflammatory or infiltrative disease of the axial skeleton. Most people who have low back or neck pain have a mechanical reason for their pain. The initial evaluation of patients with spinal pain focuses on separating people with mechanical disorders from those with systemic illnesses. The initial diagnostic evaluation includes taking a medical history and performing physical and neurologic examinations. Plain radiographs and laboratory tests are usually not needed for most patients. Symptoms that help identify systemic illnesses in people who have spinal pain include fever or weight loss, pain with recumbency, morning stiffness, localized bone pain, or visceral pain. Mechanical disorders of the lumbosacral spine are the most common causes of low back pain. These disorders include muscle strain, herniated nucleus pulposus, osteoarthritis, lumbar spinal stenosis, spondylolisthesis, and adult scoliosis. Mechanical disorders of the cervical spine are less common than lumbar spine disorders and tend to be less debilitating. Causes of cervical spine pain include neck strain, cervical disc herniation, cervical spondylosis, myelopathy, and whiplash. The chapter describes the clinical features, diagnosis, and treatment of these mechanical causes of back and neck pain. 3 figures, 5 tables, and 27 references. ·
Chapter 50: Osteoarthritis Source: in Berkow, R., ed.; The Merck Manual of Medical Information: Home Edition (online version). Rahway, NJ: Merck and Company, Inc. 2000. 3 p. Contact: Available online from Merck and Company, Inc. (800) 819-9456. Website: www.merck.com/pubs/mmanual_home/contents.htm. Also available from your local book store. PRICE: $29.95 plus shipping. Summary: This chapter provides the general public and people who have osteoarthritis with information on the causes, symptoms, and treatment of this chronic joint disorder, which is characterized by degeneration of joint cartilage and adjacent bone. Osteoarthritis, the most common joint disorder, occurs in many people by age 70 and affects men and women equally. Osteoarthritis is classified as primary when the cause is not known and secondary when the cause is another disease. Symptoms usually develop gradually and at first affect only one or a few joints. Commonly affected joints are those of the fingers, base of the thumbs,
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neck, lower back, big toes, hips, and knees. Pain is usually the first symptom. Back pain is the most common symptom of osteoarthritis of the spine. Osteoarthritis of the neck or lower back can cause numbness, odd sensations, pain, and weakness in an arm or leg if bone overgrowth presses on nerves. Stiffness may occur after sleep or some inactivity. As the damage from osteoarthritis worsens, the joint may become less movable. Stretching, strengthening, and postural exercises help maintain healthy cartilage, increase the range of motion, and strengthen surrounding muscles. Physical therapy, often with heat, may be helpful. Orthotic devices can protect joints during painful activities. Massage, traction, and deep heat may be useful for certain types of osteoarthritis of the neck. Drugs are the least important aspect of the treatment program. Useful drugs include analgesics and nonsteroidal antiinflammatory drugs. Joint replacement may be considered when function becomes limited. ·
Osteoarthritis and Paget 's Disease Source: in A Patient's Guide to Paget 's Disease of Bone. New York, NY: The Paget 's Disease Foundation, Inc. 1994. p. 23-24. Contact: Paget Foundation For Paget 's Disease of Bone and Related Disorders. 200 Varick Street, Suite 1004, New York, NY 10014-4810. (212) 229-1582 or FAX (212) 229-1502. PRICE: Free. Summary: Paget 's disease ( PD ) can cause osteoarthritis by changing the bone around the joint; the resulting pain is very common in people with PD . Treatment involves a multifaceted program of physical and medicinal measures that include exercise, weight control, devices to alter joint pressures, anti-inflammatory agents, and drugs to reduce muscle spasms. Occasionally, surgical consultation is required. The author cautions that for any treatment to be effective, the person with PD must have an understanding of his or her disease or diseases, the therapy or therapies available, and what can or cannot be expected.
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Musculoskeletal Health Source: in Physical Activity for Health and Fitness. Jackson, A.W.; Morrow, J.R., Jr.; Hill, D.W.; Dishman, R.K. Champaign, IL, Human Kinetics, pp. 193-226, 1999. Contact: Human Kinetics, P.O. Box 5076, Champaign, IL 61825-5076. (800) 747-4457. INTERNET/EMAIL:
[email protected]. Summary: Musculoskeletal Health, a chapter in Physical Activity for Health and Fitness, presents information on how physical activity impacts musculoskeletal health, discussing the structure and function of
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healthy joints and looking at the overall effects of physical activity on musculoskeletal health. The chapter discusses (1) the effects of physical activity on muscle and bone; and (2) risk factors for musculoskeletal injuries, which include aging, structural faults in the musculoskeletal system, excessive body weight, and previous musculoskeletal injuries. It discusses the structure and function of healthy joints, explaining the joints (diarthrodial and synovial) and the two types of cartilage that contribute to joint function (hyaline and fibrocartilage). It also discusses the function of ligaments and the importance of flexibility. The chapter then focuses on joint disease, examining osteoarthritis and rheumatoid arthritis. Soft tissue injuries are considered, including (1) ligament injuries, (2) muscle injuries, (3) bursa injuries, (4) tendon injuries, (5) overuse injuries, (6) treatment of soft tissue injuries, and (7) physical activity and soft tissue injuries. Exercise-associated injuries to the skeletal system are less frequent than soft tissue injuries. Stress fractures come from overtraining rather than acute trauma. Risk factors for developing osteoporosis and the effect of physical activity on osteoporosis are discussed. The chapter discusses low back pain, including the structure and function of the back, causes of back pain, preventing back pain, and treating back pain. This chapter contains health checks (brief questions with immediate answers), highlighted key points, and a laboratory to reinforce its information. The laboratory experience focuses on determining the risks of developing osteoporosis and back pain, and learning back exercises. ·
Physical Activity and Musculoskeletal Disease Source: in Aging, Physical Activity, and Health. Shephard, R.J. Champaign, IL, Human Kinetics, pp. 243-261, 1997. Contact: Human Kinetics, P.O. Box 5076, Champaign, IL 61825-5076. (800) 747-4457. INTERNET/EMAIL: http://www.humankinetics.com/;
[email protected]. Summary: Physical Activity and Musculoskeletal Disease, a chapter in Aging, Physical Activity, and Health, addresses the effect of physical activity on muscle wasting (sarcopenia), specific muscular dystrophies, rheumatoid arthritis, osteoarthritis, and osteoporosis. Muscle wasting is caused by a cycle of inadequate diet and lack of strength that leads to further inactivity and accelerating loss of muscle. Despite normal muscle aging, the active elderly person participating in resistance training maintains much more muscle mass and remains much stronger than sedentary elderly persons even in the final years of life. The most common neuromuscular disease in elderly persons is amyotrophic lateral sclerosis (ALS). Management of ALS is based on maximizing residual
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function. A sedentary lifestyle does lead to further decreases in function. Rheumatoid arthritis, an autoimmune disease, impairs normal physical activity, such as walking. Since little is known about the etiology of the disease, prevention is not possible. Physical activity is, nevertheless, a helpful component of tertiary treatment. Osteoarthritis, the most common form of arthritis (also called degenerative joint disease), makes physical activity painful. Prevention of osteoarthritis includes avoidance of power sports, such as football, when younger. Physical training does appear to improve function and quality of life in persons with osteoarthritis, but joint replacement may be inevitable. Osteoporosis is an important factor in both quality of life and longevity. Prevalence increases progressively with age. Adults who participate in regular weight-bearing exercise have higher bone density than sedentary adults. This also appears to be true for adults in late middle age and in elderly adults. An adequate calcium intake and a physical activity program that applies substantial force to the bones may help prevent osteoporosis. ·
Osteoarthrosis/Osteoarthritis Source: in Zarb, G.A., et al. Temporomandibular Joint and Masticatory Muscle Disorders. Copenhagen, Denmark: Munksgaard. 1994. p. 298-314. Contact: Available from Munksgaard. 35 Norre Sogade, P.O. Box 2148, DK 1016 Copenhagen K, Denmark. Phone Number: 45 33 12 70 30; Fax: 45 33 12 93 87. PRICE: DDK1456.00. Contact publisher directly for current price in U.S. Dollars. ISBN: 8716106377. Summary: This chapter on degenerative joint disease (osteoarthrosis and osteoarthritis, or OA) is from a comprehensive textbook that addresses temporomandibular joint disorders (TMD) and masticatory muscle disorders. Topics include definitions and general features, the prevalence of OA, etiology, pathogenesis, diagnostic considerations, and treatment. OA is defined as a primarily non-inflammatory pattern of reaction of movable joints to injury. The disease process is characterized by deterioration and abrasion of articular cartilage and soft tissue surfaces, and the occurrence of thickening and remodelling of the underlying bone and formation of marginal spurs and subarticular 'cysts.' The temporomandibular (TMJ) is one joint that can be affected by OA. The authors note that non-drug treatment strives to reduce joint overload so that healing can occur; consequently, rest and exercise are regarded as an important part of a self care strategy. Reversible dental interventions such as appliance therapy or restoration of posterior occlusal support may produce long-range benefits, although this has not yet been conclusively shown in clinical trials. The clinical long-term prognosis of
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TMJ OA is usually extremely favorable in spite of regularly observed severe radiographic changes. 5 figures. 2 tables. 40 references. (AA-M).
General Home References In addition to references for osteoarthritis, you may want a general home medical guide that spans all aspects of home healthcare. The following list is a recent sample of such guides (sorted alphabetically by title; hyperlinks provide rankings, information, and reviews at Amazon.com): · All About Joints by Irwin M. Siegel; Paperback - 224 pages 1st edition (December 15, 2001), Demos Medical Publishing; ISBN: 1888799560; http://www.amazon.com/exec/obidos/ASIN/1888799560/icongroupinterna · Arthritis Sourcebook : Basic Consumer Health Information About Specific Forms of Arthrits and Related Disorders by Allan R. Cook (Editor); Hardcover - 600 pages 1 edition (October 1998), Omnigraphics, Inc.; ISBN: 0780802012; http://www.amazon.com/exec/obidos/ASIN/0780802012/icongroupinterna · Primer on the Rheumatic Diseases by John H. Klippel, et al; Paperback 700 pages, 12th edition (December 2001), National Book Network; ISBN: 0912423293; http://www.amazon.com/exec/obidos/ASIN/0912423293/icongroupinterna
Vocabulary Builder Antibiotics: Substances produced by microorganisms that can inhibit or suppress the growth of other microorganisms. [NIH] Antibody: An immunoglobulin molecule that has a specific amino acid sequence by virtue of which it interacts only with the antigen that induced its synthesis in cells of the lymphoid series (especially plasma cells), or with antigen closely related to it. Antibodies are classified according to their ode of action as agglutinins, bacteriolysins, haemolysins, opsonins, precipitins, etc. [EU] Arteritis: Inflammation of an artery. [NIH] Cervical: Pertaining to the neck, or to the neck of any organ or structure. [EU] Constitutional: 1. Affecting the whole constitution of the body; not local. 2. Pertaining to the constitution. [EU] Dystrophy:
Any disorder arising from defective or faulty nutrition,
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especially the muscular dystrophies. [EU] Endocarditis: Exudative and proliferative inflammatory alterations of the endocardium, characterized by the presence of vegetations on the surface of the endocardium or in the endocardium itself, and most commonly involving a heart valve, but sometimes affecting the inner lining of the cardiac chambers or the endocardium elsewhere. It may occur as a primary disorder or as a complication of or in association with another disease. [EU] Hemarthrosis: Bleeding into the joints. It may arise from trauma or spontaneously in patients with hemophilia. [NIH] Hyperostosis: Hypertrophy of bone; exostosis. [EU] Lumbar: Pertaining to the loins, the part of the back between the thorax and the pelvis. [EU] Masticatory: 1. Subserving or pertaining to mastication; affecting the muscles of mastication. 2. A remedy to be chewed but not swallowed. [EU] Methionine: A sulfur containing essential amino acid that is important in many body functions. It is a chelating agent for heavy metals. [NIH] Neisseria: A genus of gram-negative, aerobic, coccoid bacteria whose organisms are part of the normal flora of the oropharynx, nasopharynx, and genitourinary tract. Some species are primary pathogens for humans. [NIH] Neurologic: Pertaining to neurology or to the nervous system. [EU] Neuromuscular: Pertaining to muscles and nerves. [EU] Osteomalacia: A condition marked by softening of the bones (due to impaired mineralization, with excess accumulation of osteoid), with pain, tenderness, muscular weakness, anorexia, and loss of weight, resulting from deficiency of vitamin D and calcium. [EU] Osteomyelitis: Inflammation of bone caused by a pyogenic organism. It may remain localized or may spread through the bone to involve the marrow, cortex, cancellous tissue, and periosteum. [EU] Osteopetrosis: Excessive formation of dense trabecular bone leading to pathological fractures, osteitis, splenomegaly with infarct, anemia, and extramedullary hemopoiesis. [NIH] Polyarthritis: An inflammation of several joints together. [EU] Rickets: A condition caused by deficiency of vitamin D, especially in infancy and childhood, with disturbance of normal ossification. The disease is marked by bending and distortion of the bones under muscular action, by the formation of nodular enlargements on the ends and sides of the bones, by delayed closure of the fontanelles, pain in the muscles, and sweating of the head. Vitamin D and sunlight together with an adequate diet are curative, provided that the parathyroid glands are functioning properly. [EU]
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Septic: Produced by or due to decomposition by microorganisms; putrefactive. [EU] Spondylolisthesis: Forward displacement of one vertebra over another. [NIH] Stenosis: Narrowing or stricture of a duct or canal. [EU] Subacute: Somewhat acute; between acute and chronic. [EU] Tenosynovitis: Inflammation of a tendon sheath. [EU] Thermal: Pertaining to or characterized by heat. [EU] Thrombosis: The formation, development, or presence of a thrombus. [EU] Venous: Of or pertaining to the veins. [EU] Viral: Pertaining to, caused by, or of the nature of virus. [EU] Visceral: Pertaining to a viscus. [EU] Vitallium: An alloy of 60% cobalt, 20% chromium, 5% molybdenum, and traces of other substances. It is used in dentures, certain surgical appliances, prostheses, implants, and instruments. [NIH]
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CHAPTER 7. MULTIMEDIA ON OSTEOARTHRITIS Overview Information on osteoarthritis can come in a variety of formats. Among multimedia sources, video productions, slides, audiotapes, and computer databases are often available. In this chapter, we show you how to keep current on multimedia sources of information on osteoarthritis. We start with sources that have been summarized by federal agencies, and then show you how to find bibliographic information catalogued by the National Library of Medicine. If you see an interesting item, visit your local medical library to check on the availability of the title.
Video Recordings Most diseases do not have a video dedicated to them. If they do, they are often rather technical in nature. An excellent source of multimedia information on osteoarthritis is the Combined Health Information Database. You will need to limit your search to “video recording” and “osteoarthritis” using the “Detailed Search” option. Go directly to the following hyperlink: http://chid.nih.gov/detail/detail.html. To find video productions, use the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer, and the format option “Videorecording (videotape, videocassette, etc.).” By making these selections and typing “osteoarthritis” (or synonyms) into the “For these words:” box, you will only receive results on video productions. The following is a typical result when searching for video recordings on osteoarthritis: ·
Arthritis (Osteoarthritis) Source: New York, NY: Patient Education Media, Inc. 1996.
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Contact: Available from Patient Education Media, Inc./Time Life Medical, 1271 6th Avenue, New York, NY 10020. (212) 522-8089. (212) 522-8092 (fax). (800) 588-9959. PRICE: $19.95. Summary: This videotape for individuals with arthritis and their families provides up-to-date medical information on arthritis. The information in the videotape is presented in a news magazine-style and is divided into four reports. These reports use computer animation to help viewers understand what is going on inside the body and how a diagnosis is made; explain what happens after the diagnosis is made; address practical issues concerning the types of health care professionals involved in managing arthritis and osteoarthritis and how the lifestyle changes that patients may find helpful; explore options for treating and managing arthritis and osteoarthritis, including using medications, exercising, reducing weight, and, in some cases, undergoing joint replacement surgery; and use an in-studio question-and-answer session to consider issues that frequently arise about arthritis and osteoarthritis. The videotape is accompanied by a patient workbook that includes program highlights, a glossary, a resource guide, and a personal journal.
Bibliography: Multimedia on Osteoarthritis The National Library of Medicine is a rich source of information on healthcare-related multimedia productions including slides, computer software, and databases. To access the multimedia database, go to the following Web site: http://locatorplus.gov/. Select “Search LOCATORplus.” Once in the search area, simply type in osteoarthritis (or synonyms). Then, in the option box provided below the search box, select “Audiovisuals and Computer Files.” From there, you can choose to sort results by publication date, author, or relevance. The following multimedia has been indexed on osteoarthritis. For more information, follow the hyperlink indicated: ·
Arthritis. Source: Marshfield Medical Foundation, in cooperation with Marshfield Clinic & St. Joseph's Hospital; Year: 1983; Format: Videorecording; Marshfield, WI: Marshfield Regional Video Network, 1983.
·
Arthritis. Source: Time Life Medical; produced in association with Sonalysts Studio; Year: 1996; Format: Videorecording; New York, NY: Patient Education Media, c1996.
·
Arthroscopic ankle arthrodesis. Source: American Academy of Orthopaedic Surgeons; Year: 1995; Format: Videorecording; [Rosemont, Ill.]: AAOS, c1995.
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·
Arthroscopy and maquet osteotomy for degenerative arthritis of the knee. Source: produced by the Office of Educational Resources; Year: 1981; Format: Videorecording; [San Antonio, Tex.]: UTHSCSA, c1981.
·
Current management of osteoarthritis. Source: [presented by] the American Academy of Family Physicians and its Commission on Continuing Medical Education, Subcommittee on CME Production and Development; produced by Gardiner-Caldwell SynerMed, i; Year: 1989; Format: Videorecording; Kansas City, Mo.: The Academy, c1989.
·
Degenerative arthritis of the hip joint. Source: McMaster University, Health Sciences; Year: 1977; Format: Slide; [Hamilton, Ont.]: The University, c1977.
·
Degenerative joint disease: etiologic factors and pathophysiology. Source: presented by Department of Medicine, Emory University, School of Medicine; Year: 1984; Format: Videorecording; Atlanta, Ga.: Emory Medical Television Network, 1984.
·
Degenerative joint disease. Source: [American Academy of Orthopaedic Surgeons]; Year: 1972; Format: Slide; [Chicago, Ill.]: The Academy, [1972]
·
Degenerative tears of the medial meniscus with degenerative arthritis. Source: David Shneider; Year: 1983; Format: Videorecording; Okemos, Mich.: Arthroscopy Video Journal, c1983.
·
Flexible fitness : the arthritis workout. Source: Advil Forum on Health Education [and] the National Council on the Aging, Inc; Year: 1995; Format: Videorecording; New York, NY: The Forum, [1995]
·
High tibial osteotomy for osteoarthritis of the knee using Yokohama blade plate. Source: the American Academy of Orthopaedic Surgeons; Year: 1986; Format: Videorecording; [Park Ridge, Ill.]: The Academy, [1986]
·
New insights on pathogenesis of osteoarthritis. Source: presented by MSD, Merck Sharp & Dohme; produced by Medi-Cine, ltd; Year: 1978; Format: Motion picture; West Point, PA.: Merck, c1978.
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New perspectives in arthritis management. Source: presented by the Laurence A. Grossman Medical Learning Center, Saint Thomas Hospital; Year: 1988; Format: Videorecording; Nashville, Tenn.: The Hospital, c1988.
·
Osteoarthritis: current clinical concepts. Source: Roland W. Moskowitz, Victor M. Goldberg; Year: 1974; Format: Slide; New York: Medcom, c1974.
·
Osteoarthritis. Source: Marshfield Medical Foundation, in cooperation with Marshfield Clinic and St. Joseph's Hospital; [presented by]
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Marshfield Video Network; Year: 1985; Format: Videorecording; Marshfield, WI: The Foundation, 1985. ·
Osteoarthritis. Source: [presented by] Medical Video Library; coproduced by IMS, Faculty of Medicine, University of Toronto and Medical Productions and Associates; Year: 1989; Format: Videorecording; Toronto, Ont.: IMS, [1989]
·
Pathophysiology of osteoarthritis. Source: presented by the Department of Medicine, Emory University, School of Medicine; Year: 1985; Format: Videorecording; Atlanta, Ga.: The University, 1985.
·
Physical activity recommendations for people living with knee joint arthritis. Source: produced by MSTL Television, School of Medicine, University of North Carolina at Chapel Hill; Year: 1996; Format: Videorecording; Chapel Hill, N.C.: Medical Sciences Teaching Labs, School of Medicine, University of North Carolina at Chapel Hill, c1996.
·
Postero-lateral approach to total hip replacement. Source: Harold K. Dunn; produced and edited by Ralph Lorange; Year: 1973; Format: Motion picture; Warsaw, Ind.: Zimmer; [Danbury, Conn.: for loan by Davis and Geck, 1973]
·
Proximal tibial osteotomy: surgical technique and survival analysis. Source: [presented by] Hughston Sports Medicine Foundation; Year: 1993; Format: Videorecording; Rosemont, Ill.: American Academy of Orthopaedic Surgeons, [1993]
·
Radiological evaluation of patients with arthritis. Source: by Donald Resnick; Year: 1982; Format: Videorecording; West Conshohocken, PA: Videolearning Systems, [1982]
·
Surgical treatment of cubital tunnel syndrome caused by osteoarthritis of the elbow joint. Source: [produced by ¯Osaka Abikku Igaku Bideo Sent¯a]; Year: 1988; Format: Videorecording; [S.l.: s.n., 1988]
·
Trapezium implant (silicone) arthroplasty for arthritis of the thumb. Source: Alfred B. Swanson; Year: 1977; Format: Videorecording; [Chicago, Ill.]: American Academy of Orthopaedic Surgeons, [1977]
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Valgus-producing proximal tibial osteotomy (Slocum). Source: produced by James L. Baldwin; Year: 1988; Format: Videorecording; Portland, Or.: Providence Medical Center, 1988.
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CHAPTER 8. PERIODICALS OSTEOARTHRITIS
AND
NEWS
ON
Overview Keeping up on the news relating to osteoarthritis can be challenging. Subscribing to targeted periodicals can be an effective way to stay abreast of recent developments on osteoarthritis. Periodicals include newsletters, magazines, and academic journals. In this chapter, we suggest a number of news sources and present various periodicals that cover osteoarthritis beyond and including those which are published by patient associations mentioned earlier. We will first focus on news services, and then on periodicals. News services, press releases, and newsletters generally use more accessible language, so if you do chose to subscribe to one of the more technical periodicals, make sure that it uses language you can easily follow.
News Services & Press Releases Well before articles show up in newsletters or the popular press, they may appear in the form of a press release or a public relations announcement. One of the simplest ways of tracking press releases on osteoarthritis is to search the news wires. News wires are used by professional journalists, and have existed since the invention of the telegraph. Today, there are several major “wires” that are used by companies, universities, and other organizations to announce new medical breakthroughs. In the following sample of sources, we will briefly describe how to access each service. These services only post recent news intended for public viewing.
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PR Newswire Perhaps the broadest of the wires is PR Newswire Association, Inc. To access this archive, simply go to http://www.prnewswire.com. Below the search box, select the option “The last 30 days.” In the search box, type “osteoarthritis” or synonyms. The search results are shown by order of relevance. When reading these press releases, do not forget that the sponsor of the release may be a company or organization that is trying to sell a particular product or therapy. Their views, therefore, may be biased. The following is typical of press releases that can be found on PR Newswire: ·
Health Canada approves new osteoarthritis treatment Summary: Toronto, March 31 /PRNewswire-FirstCall/ - Specialty pharmaceutical developer, Dimethaid Research Inc., (TSX: DMX) has received final Health Canada approval for PENNSAID(R), a topically applied, nonsteroidal anti- inflammatory drug (NSAID). The approval gives physicians a new option for treating the pain, stiffness and physical impairment that result from osteoarthritis (OA) of the knee. "This is an historic achievement, the first drug of its kind in Canada," says Rebecca Keeler, Dimethaid's president and CEO. "PENNSAID is the country's one and only topical, prescription OA therapy, and Dimethaid is the first-ever Canadian, public company to get regulatory approval for a drug it has conceived, developed and manufactured on its own." More than three million Canadians suffer from OA and because incidence of the disease increases among seniors, both market size and sales volumes are expected to rise as the population ages. According to IMS Health, the Canadian NSAID market is worth an estimated $500 million. Datamonitor, another industry intelligence source, projects that the worldwide market for arthritis products will grow 4.8 percent annually, from its current $16.4 billion to $21 billion by 2008. Dimethaid's new drug will be marketed as an alternative to oral NSAIDs, such as ibuprofen and naproxen, which have been linked to serious side effects including gastrointestinal bleeding, kidney and liver disease. "We expect PENNSAID will be widely prescribed because it fills an obvious gap," says Dimethaid's medical director, Dr. Zev Shainhouse. "There are many patients who don't need, don't want, or can't take oral NSAIDs."
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A 1998 paper published in the Journal of Rheumatology reports that up to 30 percent of patients taking traditional NSAIDs develop persistent GI symptoms, and more than 10 percent discontinue treatment. The Arthritis Society also estimates that up to 1,900 Canadians die every year from complications related to oral NSAID use. PENNSAID has been designed to decrease the likelihood of serious side effects. Based on Dimethaid's patented technology, the treatment combines a chemical carrier with diclofenac sodium, a proven antiarthritic, and delivers active drug through the skin directly to the site of disease. This more targeted approach introduces only negligible amounts of NSAID into the bloodstream -- up to 150 times lower than levels reported for comparable oral medication. Clinical trial data, reviewed by Health Canada, has repeatedly demonstrated the product's ability to relieve symptoms without provoking serious GI or other systemic side effects. Following PENNSAID application, the most frequently reported adverse event has been a localized patch of dry or irritated skin. During the past year, Dimethaid medical sales representatives have been meeting regularly with physicians, gathering information about the challenges of managing osteoarthritis. "The medical community has been waiting for this product," says Danny Dean, director, national sales and marketing. "Patients clearly need better treatment choices and with this approval, we expect to begin distribution to pharmacies across Canada, shortly." PENNSAID will be manufactured at Dimethaid's 26,000-sq-ft plant in Varennes, Quebec. The facility has been licensed by Health Canada in recognition of compliance with Good Manufacturing Practices (GMP). About Dimethaid Research Inc. Dimethaid Research Inc. is a publicly traded, Canadian, specialty pharmaceutical company headquartered in Markham, Ontario, with manufacturing facilities in Varennes, Quebec and Wanzleben, Germany. The company develops and commercializes targeted therapeutic drugs designed to produce minimal side effects. Dimethaid's two technology platforms focus on transcellular drug delivery and immune system regulation. Products have potential applications in such areas as osteoarthritis, onychomycosis and HIV/AIDS. For more information, please visit http://www.dimethaid.com.
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This release may contain forward-looking statements, subject to risks and uncertainties beyond management's control. Actual results could differ materially from those expressed here. Risk factors are discussed in the Company's annual information form filed with the securities commissions in each of the provinces of Canada. The Company undertakes no obligation to revise forward-looking statements in light of future events. Reuters The Reuters' Medical News database can be very useful in exploring news archives relating to osteoarthritis. While some of the listed articles are free to view, others can be purchased for a nominal fee. To access this archive, go to http://www.reutershealth.com/frame2/arch.html and search by “osteoarthritis” (or synonyms). The following was recently listed in this archive for osteoarthritis: ·
Long-term intraarticular steroid injection safe for knee osteoarthritis Source: Reuters Industry Breifing Date: February 28, 2003 http://www.reuters.gov/archive/2003/02/28/business/links/20030228 clin004.html
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Acetaminophen found ineffective in treating knee osteoarthritis Source: Reuters Industry Breifing Date: February 06, 2003 http://www.reuters.gov/archive/2003/02/06/business/links/20030206 clin008.html
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Osteoarthritis in finger joints linked to increased mortality risk Source: Reuters Medical News Date: January 15, 2003 http://www.reuters.gov/archive/2003/01/15/professional/links/20030 115epid006.html
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Early joint replacement for osteoarthritis tied to improved functional outcomes Source: Reuters Medical News Date: December 26, 2002 http://www.reuters.gov/archive/2002/12/26/professional/links/20021 226clin015.html
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New markers may help predict damage with knee osteoarthritis Source: Reuters Medical News Date: November 15, 2002 http://www.reuters.gov/archive/2002/11/15/professional/links/20021 115clin012.html
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Therapeutic exercise reduces pain of osteoarthritis of the knee Source: Reuters Medical News Date: September 03, 2002 http://www.reuters.gov/archive/2002/09/03/professional/links/20020 903clin011.html
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Extended-release oxymorphone effective for osteoarthritis pain Source: Reuters Medical News Date: August 22, 2002 http://www.reuters.gov/archive/2002/08/22/professional/links/20020 822drgd004.html
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Endo's oxymorphone demonstrates efficacy in osteoarthritis pain study Source: Reuters Industry Breifing Date: August 22, 2002 http://www.reuters.gov/archive/2002/08/22/business/links/20020822 drgd005.html
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Muscle weakness important in progression to disability due to knee osteoarthritis Source: Reuters Medical News Date: August 15, 2002 http://www.reuters.gov/archive/2002/08/15/professional/links/20020 815clin009.html
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Hip abductor activation increased in unilateral hip osteoarthritis Source: Reuters Medical News Date: August 01, 2002 http://www.reuters.gov/archive/2002/08/01/professional/links/20020 801clin013.html
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Measurement of adduction moment predicts progression in knee osteoarthritis Source: Reuters Medical News Date: July 12, 2002 http://www.reuters.gov/archive/2002/07/12/professional/links/20020 712clin026.html
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·
Arthroscopic surgery no better than placebo for osteoarthritis of the knee Source: Reuters Medical News Date: July 10, 2002 http://www.reuters.gov/archive/2002/07/10/professional/links/20020 710clin011.html
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Valdecoxib safe, effective for knee osteoarthritis Source: Reuters Industry Breifing Date: July 02, 2002 http://www.reuters.gov/archive/2002/07/02/business/links/20020702 clin011.html
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NSAID use for treatment of osteoarthritis has declined in US Source: Reuters Industry Breifing Date: June 28, 2002 http://www.reuters.gov/archive/2002/06/28/business/links/20020628 prof001.html
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Dimethaid drops Provalis as marketer of osteoarthritis drug Source: Reuters Industry Breifing Date: June 14, 2002 http://www.reuters.gov/archive/2002/06/14/business/links/20020614 inds003.html
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Pain reduction improves quadriceps strength in patients with knee osteoarthritis Source: Reuters Medical News Date: May 27, 2002 http://www.reuters.gov/archive/2002/05/27/professional/links/20020 527clin003.html
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Avocado/soybean derivative does not have major effect in hip osteoarthritis Source: Reuters Medical News Date: March 26, 2002 http://www.reuters.gov/archive/2002/03/26/professional/links/20020 326clin003.html
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Hip osteoarthritis not linked to increased bone mineral density Source: Reuters Medical News Date: February 18, 2002 http://www.reuters.gov/archive/2002/02/18/professional/links/20020 218clin002.html
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·
Benefit of tidal irrigation for knee osteoarthritis attributed to placebo effect Source: Reuters Medical News Date: February 12, 2002 http://www.reuters.gov/archive/2002/02/12/professional/links/20020 212clin002.html
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Radiographic abnormalities predict progression in osteoarthritis patients Source: Reuters Medical News Date: February 07, 2002 http://www.reuters.gov/archive/2002/02/07/professional/links/20020 207clin004.html
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Vitamin E doesn't prevent osteoarthritis pain Source: Reuters Health eLine Date: October 26, 2001 http://www.reuters.gov/archive/2001/10/26/eline/links/20011026elin 010.html
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Glucosamine sulfate treats osteoarthritis in postmenopausal women Source: Reuters Industry Breifing Date: October 09, 2001 http://www.reuters.gov/archive/2001/10/09/business/links/20011009 clin020.html
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Leeches appear to relieve osteoarthritis knee pain Source: Reuters Industry Breifing Date: September 19, 2001 http://www.reuters.gov/archive/2001/09/19/business/links/20010919 clin011.html
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Balance tests important for patients with knee osteoarthritis Source: Reuters Medical News Date: August 31, 2001 http://www.reuters.gov/archive/2001/08/31/professional/links/20010 831clin002.html
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Nimesulide more cost-effective than diclofenac for osteoarthritis Source: Reuters Industry Breifing Date: August 21, 2001 http://www.reuters.gov/archive/2001/08/21/business/links/20010821 econ002.html
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Significant costs of job-related osteoarthritis not born by businesses responsible Source: Reuters Medical News Date: August 14, 2001 http://www.reuters.gov/archive/2001/08/14/professional/links/20010 814econ001.html
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Incyte, British hospital aim to find gene-based therapies, tests for osteoarthritis Source: Reuters Industry Breifing Date: August 14, 2001 http://www.reuters.gov/archive/2001/08/14/business/links/20010814 inds009.html
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Arthrotec superior to acetaminophen in some osteoarthritis patients Source: Reuters Industry Breifing Date: August 03, 2001 http://www.reuters.gov/archive/2001/08/03/business/links/20010803 clin009.html
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Physical activity not linked to knee osteoarthritis Source: Reuters Health eLine Date: July 20, 2001 http://www.reuters.gov/archive/2001/07/20/eline/links/20010720elin 022.html
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Physical activity not linked to future knee osteoarthritis Source: Reuters Medical News Date: July 20, 2001 http://www.reuters.gov/archive/2001/07/20/professional/links/20010 720clin019.html
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NIH and drug firms join forces in osteoarthritis study Source: Reuters Medical News Date: July 18, 2001 http://www.reuters.gov/archive/2001/07/18/professional/links/20010 718inds012.html
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Knee alignment linked to progression of knee osteoarthritis Source: Reuters Medical News Date: July 11, 2001 http://www.reuters.gov/archive/2001/07/11/professional/links/20010 711clin012.html
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Glucosamine tops ibuprofen in treatment of TMJ osteoarthritis Source: Reuters Industry Breifing Date: June 20, 2001 http://www.reuters.gov/archive/2001/06/20/business/links/20010620 clin011.html
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Ibuprofen, acetaminophen equally effective for severe osteoarthritis knee pain Source: Reuters Industry Breifing Date: June 13, 2001 http://www.reuters.gov/archive/2001/06/13/business/links/20010613 clin005.html
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Posture control impaired in patients with knee osteoarthritis Source: Reuters Medical News Date: May 30, 2001 http://www.reuters.gov/archive/2001/05/30/professional/links/20010 530clin001.html
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Q-Med wins European approval for osteoarthritis treatment Source: Reuters Industry Breifing Date: May 08, 2001 http://www.reuters.gov/archive/2001/05/08/business/links/20010508 rglt005.html
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Osteoarthritis treatment approved for marketing in Europe Source: Reuters Medical News Date: May 08, 2001 http://www.reuters.gov/archive/2001/05/08/professional/links/20010 508rglt012.html
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Controlled-release oxycodone effective for osteoarthritis pain Source: Reuters Industry Breifing Date: April 24, 2001 http://www.reuters.gov/archive/2001/04/24/business/links/20010424 clin023.html
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Wide base, high-heeled shoes may lead to knee osteoarthritis Source: Reuters Medical News Date: April 09, 2001 http://www.reuters.gov/archive/2001/04/09/professional/links/20010 409clin025.html
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Bone marrow lesions associated with pain in knee osteoarthritis Source: Reuters Medical News Date: April 05, 2001 http://www.reuters.gov/archive/2001/04/05/professional/links/20010 405clin007.html
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HRT may prevent knee osteoarthritis in postmenopausal women Source: Reuters Industry Breifing Date: March 13, 2001 http://www.reuters.gov/archive/2001/03/13/business/links/20010313 clin016.html
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Topical solution for osteoarthritis may challenge COX-2 inhibitors Source: Reuters Medical News Date: March 01, 2001 http://www.reuters.gov/archive/2001/03/01/professional/links/20010 301inds024.html
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Arthroscopic surgery for knee osteoarthritis no more effective than sham surgery Source: Reuters Industry Breifing Date: March 01, 2001 http://www.reuters.gov/archive/2001/03/01/business/links/20010301 clin001.html
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Smith Nephew's injectable osteoarthritis treatment wins FDA approval Source: Reuters Industry Breifing Date: January 30, 2001 http://www.reuters.gov/archive/2001/01/30/business/links/20010130 rglt005.html The NIH
Within MEDLINEplus, the NIH has made an agreement with the New York Times Syndicate, the AP News Service, and Reuters to deliver news that can be browsed by the public. Search news releases at http://www.nlm.nih.gov/medlineplus/alphanews_a.html. MEDLINEplus allows you to browse across an alphabetical index. Or you can search by date at http://www.nlm.nih.gov/medlineplus/newsbydate.html. Often, news items are indexed by MEDLINEplus within their search engine.
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Business Wire Business Wire is similar to PR Newswire. To access this archive, simply go to http://www.businesswire.com. You can scan the news by industry category or company name.
Internet Wire Internet Wire is more focused on technology than the other wires. To access this site, go to http://www.internetwire.com and use the “Search Archive” option. Type in “osteoarthritis” (or synonyms). As this service is oriented to technology, you may wish to search for press releases covering diagnostic procedures or tests that you may have read about.
Search Engines Free-to-view news can also be found in the news section of your favorite search engines (see the health news page at Yahoo: http://dir.yahoo.com/Health/News_and_Media/, or use this Web site’s general news search page http://news.yahoo.com/. Type in “osteoarthritis” (or synonyms). If you know the name of a company that is relevant to osteoarthritis, you can go to any stock trading Web site (such as www.etrade.com) and search for the company name there. News items across various news sources are reported on indicated hyperlinks. BBC Covering news from a more European perspective, the British Broadcasting Corporation (BBC) allows the public free access to their news archive located at http://www.bbc.co.uk/. Search by “osteoarthritis” (or synonyms).
Newsletters on Osteoarthritis Given their focus on current and relevant developments, newsletters are often more useful to patients than academic articles. You can find newsletters using the Combined Health Information Database (CHID). You will need to use the “Detailed Search” option. To access CHID, go directly to the following hyperlink: http://chid.nih.gov/detail/detail.html. Your investigation must limit the search to “Newsletter” and “osteoarthritis.” Go
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to the bottom of the search page where “You may refine your search by.” Select the dates and language that you prefer. For the format option, select “Newsletter.” By making these selections and typing in “osteoarthritis” or synonyms into the “For these words:” box, you will only receive results on newsletters. The following list was generated using the options described above: ·
Sports, Exercise, and Arthritis Source: Bulletin on the Rheumatic Diseases. 50(6): 1-4. 2001. Contact: Available from Arthritis Foundation. 1330 West Peachtree Street, Atlanta, GA 30309. (800) 268-6942 or (404) 872-7100. Fax (404) 872-9559. Website: www.arthritis.org. Summary: This newsletter provides health professionals with information on the impact of exercise and sports on the musculoskeletal system. Some observations from animal studies suggest a link between the physical stress of exercise and osteoarthritis (OA). The article reviews human studies on the relationship between vigorous exercise and OA and between physical activity and OA of the knee, as well as the beneficial effects of exercise in patients with either inflammatory or degenerative arthritis. Evidence suggesting that sports participation and exercise contribute over time to degenerative arthritis is fragmentary and difficult to substantiate consistently. However, there is much evidence, even if anecdotal, to support the many benefits of exercise in health and disease. For example, one study found that a dynamic, individually tailored strength training program can be beneficial for people who have inflammatory arthritis by minimizing the effects of disease, inactivity, or both on the neuromuscular system. 22 references.
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Glucosamine and Chondroitin for Osteoarthritis? Source: Bulletin on the Rheumatic Diseases. 50(7): 1-4. 2001. Contact: Available from Arthritis Foundation. 1330 West Peachtree Street, Atlanta, GA 30309. (800) 268-6942 or (404) 872-7100. Fax (404) 872-9559. Website: www.arthritis.org. Summary: This newsletter provides health professionals and people who have osteoarthritis (OA) with information on the therapeutic effects of glucosamine and chondroitin. The article reviews laboratory studies, placebo controlled clinical trials, comparator trials, and human disease modification studies of glucosamine and chondroitin. Evidence currently supports a modest efficacy for glucosamine and chondroitin in the treatment of OA. The products are safe and could have a role in the management of this disorder. However, further independent studies are
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needed to confirm findings on efficacy and to determine the clinical applicability of these compounds. In addition, preliminary findings support the idea that glucosamine and chondroitin might have disease modifying effects in OA. Research is needed to confirm these findings and to evaluate the impact of glucosamine and chondroitin on all aspects of OA progression. 1 table and 16 references.
Newsletter Articles If you choose not to subscribe to a newsletter, you can nevertheless find references to newsletter articles. We recommend that you use the Combined Health Information Database, while limiting your search criteria to “newsletter articles.” Again, you will need to use the “Detailed Search” option. Go to the following hyperlink: http://chid.nih.gov/detail/detail.html. Go to the bottom of the search page where “You may refine your search by.” Select the dates and language that you prefer. For the format option, select “Newsletter Article.” By making these selections, and typing in “osteoarthritis” (or synonyms) into the “For these words:” box, you will only receive results on newsletter articles. You should check back periodically with this database as it is updated every 3 months. The following is a typical result when searching for newsletter articles on osteoarthritis: ·
Hyaluronate and Knee OA [Osteoarthritis] Source: Arthritis Self-Management. 2(7): 6. July 2001. Contact: Available from Arthritis Self-Management. Customer Service, P.O. Box 56051, Boulder, CO 80322-6051. (800) 234-0923. Summary: This newsletter article provides people who have arthritis with information on the use of hyaluronate to treat osteoarthritis (OA) of the knee. Hyaluronate is a normal constituent of the joint fluid that lubricates and cushions the joints. The osteoarthritic joint is less capable of producing and maintaining healthy levels of hyaluronate in the synovial fluid, so the joint becomes stiff and painful. Replacing hyaluronate via injection directly into the knee joint can improve joint function and reduce pain. This procedure is known as viscosupplementation. Hyalgan, Synvisc, and Supartz are the hyaluronate compounds currently approved by the Food and Drug Administration for the treatment of OA of the knee. People who do not respond adequately to nondrug treatments such as weight loss and exercise and those who respond poorly to acetaminophen or to
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nonsteroidal antiinflammatory drugs may be candidates for viscosupplementation. The article explains how the procedure is performed, identifies potential side effects, and reports on its efficacy. The article also lists sources of additional information. ·
Supplements: Glucosamine for Osteoarthritis Source: Harvard Women's Health Watch. 7(9): 5. May 2000. Contact: Available from Harvard Women's Health Watch. Department SR, P.O. Box 380, Boston, MA 02117. (800) 829-5921. E-mail:
[email protected]. Summary: This newsletter article provides women who have arthritis with information on the supplement glucosamine. This popular nutritional supplement, which is derived from the shells of lobster, shrimp, and crabs, is being promoted for treating osteoarthritis (OA) naturally. Glucosamine occurs naturally in the body and encourages cartilage cells to produce glycosaminoglycans and proteoglycans. Mild and moderate OA cases have generally been treated with nonsteroidal antiinflammatory drugs, but long term use of these medications can cause serious gastrointestinal side effects. Thus, people who have OA are looking for gentler, less expensive ways to treat their pain. Numerous studies conducted in Europe and Asia suggest that glucosamine has promise as a pain reliever. The National Institutes of Health awarded the University of Utah School of Medicine a $6.6 million grant to coordinate the first multicenter, randomized, double blind clinical trial of glucosamine and chondroitin, a companion supplement, in patients with OA of the knee. The 1,000 patients participating in the study will take either glucosamine, chondroitin, a combination of both, or a placebo for 16 weeks and be evaluated monthly for improvement of pain. The article offers suggestions on taking glucosamine safely.
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New Osteoarthritis Treatments: Will Revolutionary Drugs Bring Relief? Source: Mayo Clinic Women's HealthSource. 3(3): 1-2. March 1999. Summary: This newsletter article provides people who have osteoarthritis with information on new drugs available for treating this chronic condition. Although there is little evidence of inflammation with osteoarthritis, pain-relieving nonsteroidal anti-inflammatory drugs (NSAIDs) have been the treatment of choice. In 1971, researchers found the NSAIDs worked by inhibiting the enzyme cyclooxygenase, or Cox. Cox-2 enzymes promote the inflammation and pain of arthritis. Most NSAIDs inhibit both Cox-1 and Cox-2 molecules, however, this then
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leaves the stomach lining vulnerable to ulcers and bleeding. The Cox-2 inhibitors appear to provide pain relief equal to other NSAIDs with much less chance of gastrointestinal upset. Two other new treatments for osteoarthritis, hyaluronan and hylan G-F20, are injectable drugs that help relieve pain. Hyaluronan is administered in a series of five injections into the knee joint, and relief may last up to 12 months. Hylan G-F20 is similar to hyaluronan, and it is administered in three injections. This drug may produce relief for up to 6 months or longer. Both of these drugs are currently available, and the Cox-2 inhibitor Celebrex is expected to be available some time in 1999. The article also comments on the use of the nutritional supplements, glucosamine and chondroitin sulfate, to treat osteoarthritis. ·
Alternative Treatments and Rheumatic Diseases Source: Bulletin on the Rheumatic Diseases. 48(7): 1-4. 1999. Contact: Available from Arthritis Foundation. 1330 West Peachtree Street, Atlanta, GA 30309. (404) 872-7100. Fax (404) 872-9559. Summary: This newsletter article provides health professionals with information on the most popular alternative treatments for arthritis, including glucosamine and chrondroitin, herbal treatments, and special diets. Each treatment is discussed in terms of the claims made, the research supporting the claims, and reasons to be cautious. Glucosamine and chondroitin are two of the most popular dietary supplements available. Treatment with these supplements is based on the hypothesis that ingesting them might increase the formative and regenerative effects on cartilage promoted by naturally occurring glucosamine and chondroitin. Studies have demonstrated that the supplements appear to relieve pain and improve function in people who have osteoarthritis (OA). In addition, they appear to be well tolerated. However, they are not regulated by the Food and Drug Administration, so there is no way to know whether the quantity of ingredients stated on the label is accurate or what other substances or impurities may be present. Herbal treatments are the most commonly used of all alternative treatments. Herbal preparations may or may not contain measurable quantities of the herb promoted on the label, and the quantity of active ingredient may vary. Herbal preparations and supplements have also been shown to contain various contaminants. Because of these problems, there are few reliable, valid clinical studies that have examined the claims about the effect of herbal medicines on various diseases. Studies have investigated the effect of Ayurvedic plant and mineral preparations, Tripterygium wilfordii, Sadenosylmethionine (SAM-e), and hydroxy-methoxy-plenyl-33. Although rheumatologists have maintained that there are no special diets
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that alter the course of rheumatoid arthritis or OA, studies have examined the effects of omega 3 fatty acids, nightshade foods, and food allergies on arthritis. 22 references. ·
Nonmedical Therapies for Osteoarthritis Source: Bulletin on the Rheumatic Diseases. 47(2): 5-7. 1998. Contact: Available from Arthritis Foundation. 1330 West Peachtree Street, Atlanta, GA 30309. (404) 872-7100. Fax (404) 872-9559. Summary: This newsletter article provides people who have osteoarthritis (OA) with information on the efficacy and usefulness of common nonmedicinal therapies for OA, including exercise, weight loss, physical modalities, and other treatments for painful conditions. OA, which is a degenerative joint disease, is the most common form of arthritis. Evidence suggests that muscle strengthening and aerobic conditioning may be promising treatments. Despite this evidence, patient adherence to recommended programs of exercise is often poor. Thus, various tactics are necessary to enhance adherence. In addition, the issue of which types of exercise should be recommended is unresolved. Studies have shown that weight change over time has an effect on a person's risk of developing OA. People who experience weight gain increase their risk, whereas people who experience weight loss decrease their risk. Although few clinical trials have examined the efficacy of weight loss as a treatment for OA of the knee or hip, one uncontrolled study demonstrated that weight loss was an effective nonmedicinal therapy for the pain and disability of knee OA. Research has also shown that some types of biomechanical alterations, such as elastic knee supports and canes and crutches, may be effective treatment options. Other analgesic treatments, including transcutaneous electrical nerve stimulation, electromagnetic stimulation, pulsed electrical stimulation, and educational interventions, may also be useful. 10 references.
Academic Periodicals covering Osteoarthritis Academic periodicals can be a highly technical yet valuable source of information on osteoarthritis. We have compiled the following list of periodicals known to publish articles relating to osteoarthritis and which are currently indexed within the National Library of Medicine's PubMed database (follow hyperlinks to view more information, summaries, etc., for each). In addition to these sources, to keep current on articles written on osteoarthritis published by any of the periodicals listed below, you can simply follow the hyperlink indicated or go to the following Web site:
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www.ncbi.nlm.nih.gov/pubmed. Type the periodical's name into the search box to find the latest studies published. If you want complete details about the historical contents of a periodical, visit the Web site: http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi. Here, type in the name of the journal or its abbreviation, and you will receive an index of published articles. At http://locatorplus.gov/ you can retrieve more indexing information on medical periodicals (e.g. the name of the publisher). Select the button “Search LOCATORplus.” Then type in the name of the journal and select the advanced search option “Journal Title Search.” The following is a sample of periodicals which publish articles on osteoarthritis: ·
Aging & Mental Health. (Aging Ment Health) http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi?field=0®exp=Ag ing+&+Mental+Health&dispmax=20&dispstart=0
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American Family Physician. (Am Fam Physician) http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi?field=0®exp=A merican+Family+Physician&dispmax=20&dispstart=0
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Archives of Internal Medicine. (Arch Intern Med) http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi?field=0®exp=Ar chives+of+Internal+Medicine&dispmax=20&dispstart=0
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Arthritis and Rheumatism. (Arthritis Rheum) http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi?field=0®exp=Ar thritis+and+Rheumatism&dispmax=20&dispstart=0
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Best Practice & Research. Clinical Rheumatology. (Best Pract Res Clin Rheumatol) http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi?field=0®exp=Be st+Practice+&+Research.+Clinical+Rheumatology&dispmax=20&dispsta rt=0
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Bmj (Clinical Research Ed. . (BMJ) http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi?field=0®exp=B mj+(Clinical+Research+Ed.+&dispmax=20&dispstart=0
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Clinical Biochemistry. (Clin Biochem) http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi?field=0®exp=Cli nical+Biochemistry&dispmax=20&dispstart=0
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Clinical Rheumatology. (Clin Rheumatol) http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi?field=0®exp=Cli nical+Rheumatology&dispmax=20&dispstart=0
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Scandinavian Journal of Public Health. (Scand J Public Health) http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi?field=0®exp=Sc andinavian+Journal+of+Public+Health&dispmax=20&dispstart=0
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Scandinavian Journal of Rheumatology. (Scand J Rheumatol) http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi?field=0®exp=Sc andinavian+Journal+of+Rheumatology&dispmax=20&dispstart=0
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Social Science & Medicine (1982). (Soc Sci Med) http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi?field=0®exp=So cial+Science+&+Medicine+(1982)&dispmax=20&dispstart=0
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The Journal of Rheumatology. (J Rheumatol) http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi?field=0®exp=Th e+Journal+of+Rheumatology&dispmax=20&dispstart=0
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Wiener Klinische Wochenschrift. (Wien Klin Wochenschr) http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi?field=0®exp=Wi ener+Klinische+Wochenschrift&dispmax=20&dispstart=0
Vocabulary Builder Neuropathy: A general term denoting functional disturbances and/or pathological changes in the peripheral nervous system. The etiology may be known e.g. arsenical n., diabetic n., ischemic n., traumatic n.) or unknown. Encephalopathy and myelopathy are corresponding terms relating to involvement of the brain and spinal cord, respectively. The term is also used to designate noninflammatory lesions in the peripheral nervous system, in contrast to inflammatory lesions (neuritis). [EU]
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CHAPTER 9. PHYSICIAN GUIDELINES AND DATABASES Overview Doctors and medical researchers rely on a number of information sources to help patients with their conditions. Many will subscribe to journals or newsletters published by their professional associations or refer to specialized textbooks or clinical guides published for the medical profession. In this chapter, we focus on databases and Internet-based guidelines created or written for this professional audience.
NIH Guidelines For the more common diseases, The National Institutes of Health publish guidelines that are frequently consulted by physicians. Publications are typically written by one or more of the various NIH Institutes. For physician guidelines, commonly referred to as “clinical” or “professional” guidelines, you can visit the following Institutes: ·
Office of the Director (OD); guidelines consolidated across agencies available at http://www.nih.gov/health/consumer/conkey.htm
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National Institute of General Medical Sciences (NIGMS); fact sheets available at http://www.nigms.nih.gov/news/facts/
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National Library of Medicine (NLM); extensive encyclopedia (A.D.A.M., Inc.) with guidelines: http://www.nlm.nih.gov/medlineplus/healthtopics.html
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National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS); fact sheets and guidelines available at http://www.nih.gov/niams/healthinfo/
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NIH Databases In addition to the various Institutes of Health that publish professional guidelines, the NIH has designed a number of databases for professionals.28 Physician-oriented resources provide a wide variety of information related to the biomedical and health sciences, both past and present. The format of these resources varies. Searchable databases, bibliographic citations, full text articles (when available), archival collections, and images are all available. The following are referenced by the National Library of Medicine:29 ·
Bioethics: Access to published literature on the ethical, legal and public policy issues surrounding healthcare and biomedical research. This information is provided in conjunction with the Kennedy Institute of Ethics located at Georgetown University, Washington, D.C.: http://www.nlm.nih.gov/databases/databases_bioethics.html
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HIV/AIDS Resources: Describes various links and databases dedicated to HIV/AIDS research: http://www.nlm.nih.gov/pubs/factsheets/aidsinfs.html
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NLM Online Exhibitions: Describes “Exhibitions in the History of Medicine”: http://www.nlm.nih.gov/exhibition/exhibition.html. Additional resources for historical scholarship in medicine: http://www.nlm.nih.gov/hmd/hmd.html
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Biotechnology Information: Access to public databases. The National Center for Biotechnology Information conducts research in computational biology, develops software tools for analyzing genome data, and disseminates biomedical information for the better understanding of molecular processes affecting human health and disease: http://www.ncbi.nlm.nih.gov/
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Population Information: The National Library of Medicine provides access to worldwide coverage of population, family planning, and related health issues, including family planning technology and programs, fertility, and population law and policy: http://www.nlm.nih.gov/databases/databases_population.html
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Cancer Information: Access to caner-oriented databases: http://www.nlm.nih.gov/databases/databases_cancer.html
Remember, for the general public, the National Library of Medicine recommends the databases referenced in MEDLINEplus (http://medlineplus.gov/ or http://www.nlm.nih.gov/medlineplus/databases.html). 29 See http://www.nlm.nih.gov/databases/databases.html. 28
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Profiles in Science: Offering the archival collections of prominent twentieth-century biomedical scientists to the public through modern digital technology: http://www.profiles.nlm.nih.gov/
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Chemical Information: Provides links to various chemical databases and references: http://sis.nlm.nih.gov/Chem/ChemMain.html
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Clinical Alerts: Reports the release of findings from the NIH-funded clinical trials where such release could significantly affect morbidity and mortality: http://www.nlm.nih.gov/databases/alerts/clinical_alerts.html
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Space Life Sciences: Provides links and information to space-based research (including NASA): http://www.nlm.nih.gov/databases/databases_space.html
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MEDLINE: Bibliographic database covering the fields of medicine, nursing, dentistry, veterinary medicine, the healthcare system, and the pre-clinical sciences: http://www.nlm.nih.gov/databases/databases_medline.html
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Toxicology and Environmental Health Information (TOXNET): Databases covering toxicology and environmental health: http://sis.nlm.nih.gov/Tox/ToxMain.html
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Visible Human Interface: Anatomically detailed, three-dimensional representations of normal male and female human bodies: http://www.nlm.nih.gov/research/visible/visible_human.html
While all of the above references may be of interest to physicians who study and treat osteoarthritis, the following are particularly noteworthy.
The Combined Health Information Database A comprehensive source of information on clinical guidelines written for professionals is the Combined Health Information Database. You will need to limit your search to “Brochure/Pamphlet,” “Fact Sheet,” or “Information Package” and osteoarthritis using the “Detailed Search” option. Go directly to the following hyperlink: http://chid.nih.gov/detail/detail.html. To find associations, use the drop boxes at the bottom of the search page where “You may refine your search by.” For the publication date, select “All Years,” select your preferred language, and the format option “Fact Sheet.” By making these selections and typing “osteoarthritis” (or synonyms) into the “For these words:” box above, you will only receive results on fact sheets dealing with osteoarthritis. The following is a sample result:
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·
Osteoarthritis of the Knee: A Special Report Source: Physician and Sportsmedicine. Special Report. May 2000. Contact: Available from McGraw-Hill Healthcare Information. 4530 West 77th Street, Floor 3, Minneapolis, MN 55435. (800) 525-5003 or (609) 4267070 (for subscriptions) or (952) 835-3222 (for back issues). Summary: This special report presents a series of articles that provide health professionals with information on osteoarthritis (OA) of the knee. The first article reviews the pathophysiological characteristics of OA and discusses its etiology, diagnosis, and evaluation. OA is caused by multiple factors, including genetic, metabolic, biochemical, enzymatic, biomechanical, and environmental factors. The history, physical examination, and radiographic examination help establish the diagnosis. The second article offers an overview of the nonoperative management of OA of the knee. Nonoperative techniques can be effective in relieving pain and improving functional ability. Nonpharmacologic treatment options include decreasing physical activity, exercising, losing weight, using supports and braces, and undergoing physiotherapy. Topical treatments include nonsteroidal anti-inflammatory drugs (NSAIDs) and capsaicin. Systemic therapies include nonnarcotic and narcotic analgesics, antidepressants, NSAIDs, chondroitin, and glucosamine. Intra-articular therapies include corticosteroids and viscosupplementation. The third article discusses operative treatment for the arthritic knee, focusing on the role of arthroscopy, the indications for joint replacement, and the new area of articular cartilage restoration and resurfacing. The choice of procedure is based on the patient's age, the extent of disease, and the desired level of physical activity. The fourth article presents case reports of active patients with arthritis who underwent viscosupplementation. The fifth article uses a question and answer format to provide health professionals with information on traditional and innovative treatments for OA of the knee. The final article is a continuing medical education activity. 5 tables and 95 references.
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Osteoarthritis: New Insights: Part 1: The Disease and Its Risk Factors Source: Annals of Internal Medicine. 133(8): 635-646. October 17, 2000. Summary: This journal article, the first of a two part summary of a National Institutes of Health conference on osteoarthritis (OA), provides health professionals with information on what OA is and on risk factors that predispose to it. The conference brought together experts on OA from diverse backgrounds and provided a multidisciplinary and comprehensive summary of recent advances in the prevention of OA onset, progression, and disability. OA is the most common form of
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arthritis, affecting millions of people in the United States. It is a complex disease whose etiology bridges biomechanics and biochemistry. Evidence is growing for the role of systemic factors such as ethnicity, genetics, dietary intake, estrogen use, and bone density, as well as local biomechanical factors such as muscle weakness, obesity, and joint laxity, in the development of OA. These risk factors are particularly important in weight bearing joints, and modifying them may present opportunities for prevention of pain and disability. The article discusses these systemic and biomechanical risk factors and examines the impact of OA on disability. 3 figures, 3 tables, and 120 references. (AA-M). ·
Osteoarthritis: New Insights: Part 2: Treatment Approaches Source: Annals of Internal Medicine. 133(9): 726-737. November 7, 2000. Summary: This journal article, the second of a two part summary of a National Institutes of Health conference on osteoarthritis (OA), provides health professionals with information on treatment approaches. The conference brought together experts on OA from diverse backgrounds and provided a multidisciplinary and comprehensive summary of recent advances in the prevention of OA onset, progression, and disability. The article reviews evidence for the efficacy of commonly used oral therapies, including nonopioid analgesics, nonsteroidal antiinflammatory drugs, opioid analgesics, and glucosamine and chondroitin. This is followed by a discussion of biomechanical interventions, such as exercise and bracing, and behavioral interventions, such as individualized telephone based interventions and group programs directed toward enhancing self management. The article then reports on the use of acupuncture in the treatment of OA. In addition, the article describes current surgical approaches. Four categories of nonbiological procedures are considered surgical management: osteotomy, arthroscopy, arthrodesis, and arthroplasty. The article concludes with suggestions on probable future biotechnology oriented approaches to treatment, including cartilage transplantation and tissue engineering of biologically active cells, signal molecules, and a biomatrix to assemble functional tissues and organs. 2 figures, 1 table, and 135 references. (AA-M).
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51 Ways To Be Good to Your Joints Source: Atlanta, GA: Arthritis Foundation. 2002. 8 p. Contact: Available from Arthritis Foundation. 1330 West Peachtree Street, Atlanta, GA 30309. (800) 268-6942 or (404) 872-7100. Fax (404) 872-9559. Website: www.arthritis.org.
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Summary: This booklet provides the general public and people who have arthritis with information on ways to keep joints healthy. The booklet begins with a 12 question quiz that readers can use to help them assess their own joint health. This is followed by 51 tips for keeping joints healthy. Tips on losing weight, eating well, exercising, working smarter, and relieving stress and pain are presented. In addition, the booklet reports on the lives of a mother and daughter who both have osteoarthritis. ·
Tengo Artritis? [Do I Have Arthritis?] Source: Bethesda, MD: National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) Information Clearinghouse. 2001. 32 p. Contact: Available from National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) Information Clearinghouse. 1 AMS Circle, Bethesda, MD 20892-3675. (877) 226-4267 toll-free or (301) 495-4484. Fax (301) 718-6366. TTY (301) 565-2966. E-mail:
[email protected]. Website: www.niams.nih.gov. PRICE: 1 to 25 copies free. Order Number: AR-209. Summary: This booklet, written in both English and Spanish, uses a question and answer format to provide people who have arthritis with information on the symptoms, diagnosis, and treatment of this disease, which causes pain and swelling in the joints. The most common types of arthritis are osteoarthritis (OA) and rheumatoid arthritis (RA). OA usually occurs with age and most frequently affects the fingers, knees, and hips. RA occurs when the body's immune system does not work properly. Symptoms of arthritis include pain in the joints, fever, weight loss, breathing difficulties, and a rash or itch. Diagnosis is based on medical history, physical examination, and diagnostic tests. Various medications can be taken to help with the pain, stiffness, and inflammation caused by arthritis. Other ways to relieve pain include applying creams to the affected joints, taking a warm shower, doing some gentle stretching exercises, using an ice pack on the sore area, and resting the sore joint. The booklet includes a list of organizations that can provide information on arthritis and musculoskeletal and skin diseases. 9 figures.
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Shoulder Replacement Surgery: Relieving Your Shoulder Pain Source: San Bruno, CA: StayWell Company. 2000. 16 p. Contact: Available from StayWell Company. 1100 Grundy Lane, San Bruno, CA 94066-3030. (800) 333-3032. Website: www.staywell.com. PRICE: Call or write for current pricing on single and bulk orders.
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Summary: This illustrated booklet provides people who have shoulder replacement surgery with information on undergoing and recovering from this surgical procedure. The booklet describes the anatomy of the healthy shoulder and identifies problems that can cause pain and stiffness, such as osteoarthritis, rheumatoid arthritis, fracture, avascular necrosis, and rotator cuff tear. This is followed by a discussion of the orthopedic evaluation to assess the shoulder, focusing on the medical history, the physical examination, and diagnostic tests such as x rays, computed tomography, and magnetic resonance imaging. The booklet then outlines the steps involved in preparing for surgery, that is, having a general physical and dental examination, storing blood, informing the surgeon about any medications being taken, and planning ahead to make home recovery go more smoothly. In addition, the booklet discusses preparations in the days before surgery, describes the surgical technique for replacing part or all of the shoulder, and offers guidelines on recovering in the hospital and at home. The booklet includes a surgical checklist to help readers remember what to do before and after surgery. 11 figures. ·
Total Hip Replacement: Returning to Movement Source: San Bruno, CA: StayWell Company. 2000. 16 p. Contact: Available from StayWell Company. 1100 Grundy Lane, San Bruno, CA 94066-3030. (800) 333-3032. Website: www.staywell.com. PRICE: Call or write for current pricing on single and bulk orders. Summary: This illustrated booklet, which is available in both English and Spanish, provides people who have total hip replacement with information on this procedure. The booklet describes the anatomy of a healthy hip and one damaged by osteoarthritis, rheumatoid arthritis, a fracture, or necrosis. This is followed by a discussion of the orthopedic evaluation to determine whether surgery is the best treatment option, focusing on the medical history, the physical examination, and diagnostic tests such as x rays. The booklet highlights the benefits of hip replacement and outlines the steps involved in preparing for surgery, such as planning ahead to make home recovery go more smoothly, receiving training on the use of special equipment, donating blood, undergoing a general physical examination, discussing medication usage with the surgeon, and finishing dental work. In addition, the booklet explains the steps involved in performing a hip replacement and identifies risks and complications. Other topics include recovering in the hospital and at home. The booklet concludes with guidelines on managing pain and protecting the hip when walking, sitting, and
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dressing. The booklet also contains a surgical checklist to help readers remember what to do before and after surgery. Numerous figures. ·
Glucosamine and Chondroitin Sulfate Source: Atlanta, GA: Arthritis Foundation. 1999. 8 p. Contact: Available from Arthritis Foundation. P.O. Box 1616, Alpharetta, GA 30009-1616. (800) 207-8633. Fax (credit card orders only) (770) 4429742. Website: www.arthritis.org. PRICE: Single copy free from local Arthritis Foundation chapter (call (800) 283-7800 for closest local chapter); bulk orders may be purchased from address above. Summary: This pamphlet uses a question and answer format to provide people who have arthritis with information on glucosamine and chondroitin sulfate. These substances, which are found naturally in the body, are sold as dietary or nutritional supplements. They have been used in Europe to treat osteoarthritis since the 1980s. Studies conducted primarily in Europe have shown that some people with mild to moderate osteoarthritis who took either substance experienced pain relief at a level similar to that of nonsteroidal anti-inflammatory drugs. Glucosamine and chondroitin are unregulated, so the quality and content may vary widely. A person choosing to take these supplements should consult his or her physician to make sure that osteoarthritis is the cause of pain and should choose products sold by large, well established companies. Recommended dosages are 1,500 milligrams (mg) per day for glucosamine and 1,200 mg per day for chondroitin. Common side effects are increased intestinal gas and softened stools. There are some people who need to be especially careful when considering the use of these supplements.
·
Celecoxib (Celebrex) Source: Atlanta, GA: Arthritis Foundation. 1999. 6 p. Contact: Available from Arthritis Foundation. P.O. Box 1616, Alpharetta, GA 30009-1616. (800) 207-8633. Fax (credit card orders only) (770) 4429742. Website: www.arthritis.org. PRICE: Single copy free from local Arthritis Foundation chapter (call (800) 283-7800 for closest local chapter); bulk orders may be purchased from address above. Summary: This pamphlet uses a question and answer format to provide people who have arthritis with information on celecoxib. This cyclooxygenase-2 (COX-2) inhibitor is a new type of nonsteroidal antiinflammatory drug (NSAID) that has been approved for use to relieve the symptoms of osteoarthritis or rheumatoid arthritis. NSAIDs work by blocking prostaglandins that are involved in the inflammatory process.
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Celecoxib helps relieve pain and inflammation by targeting prostaglandins involved in inflammation without affecting the ones that help protect the stomach. In theory, the drug will be safer on the stomach than traditional NSAIDs. Celexoxib can be taken with other arthritis medications, but people with known allergies to celecoxib or allergic type reactions to sulfonamides should not take the drug. Possible side effects include stomach ulcers. ·
Knee Owner's Manual: A Guide to the Treatment of Knee Problems Source: San Bruno, CA: StayWell Company. 1999. 16 p. Contact: Available from StayWell Company. 1100 Grundy Lane, San Bruno, CA 94066-3030. (800) 333-3032. Website: www.staywell.com. PRICE: Call or write for current pricing on single and bulk orders. Summary: This booklet, which is available in both English and Spanish, provides people who have knee problems with information on common knee problems and their treatment. The structures of the knee comprise bones, cartilage, ligaments, muscles, tendons, and bursae. Common symptoms associated with knee problems include pain, swelling, locking or giving way, limited movement or stiffness, and grinding or cracking. Diagnosing a knee problem requires a medical history, a physical examination, and laboratory and diagnostic imaging studies. The article describes common knee problems and outlines possible ways of treating them. Knee problems involving wear and tear include osteoarthritis, bursitis, and runner's knee. Problems involving tears and sprains include meniscus tears, mild to moderate sprains, and torn ligaments. Bone problems include fractures, a dislocated kneecap, and Osgood-Schlatter disease. Physical therapy can be used to help relieve pain and swelling and strengthen the knee. Treatment modalities include bracing, putting ice on the knee to reduce swelling, compressing the knee to keep fluid from collecting there, keeping the leg raised above the heart, using electrical stimulation or ultrasound to reduce pain, taking medications, massaging the knee, and exercising. Preventing future knee problems involves maintaining strength and flexibility by exercising and protecting the knee by losing excess weight, using an elastic bandage to support the knee during activities, and stopping an activity that causes pain. The booklet presents both gentle and strenuous knee exercises and offers suggestions on keeping knees healthy.
·
Managing Your Arthritis [Information Package] Source: Shawnee Mission, KS: Searle, The Movement for Motion Program. 1999. [packet of 8 booklets].
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Contact: Available from Searle, The Movement for Motion Program. P.O. Box 29278, Shawnee Mission, KS 66201-9686. (877) 732-7531 ext. 108. Website: www.arthritisconnection.com. PRICE: Single copy free. Summary: This information packet, which consists of numerous booklets, provides people who have arthritis with information on comfortably performing daily activities, developing a strong working relationship with their doctor and other health care professionals, being active in their own treatment, and maintaining good interpersonal relationships. Booklets that focus on living more comfortably with arthritis help people learn about various tools and techniques they can use to help make living with arthritis easier, including good body mechanics to conserve energy and use joints wisely. It is also important to be efficient, use assistive devices, and get adequate sleep and exercise. The booklet on developing a good doctor patient relationship offers tips on how to make each office visit valuable and presents a reproducible form that can be taken to each office visit so the patient remembers topics he or she would like to discuss. The booklets on self care provide guidelines on healthy eating, exercising, and making the most of arthritis care resources. The booklet dealing with interpersonal relations explains how to educate loved ones and others about arthritis and to interact with others. A final booklet describes the differences between osteoarthritis and rheumatoid arthritis and discusses the use of medications, diet, and exercise to manage arthritis. ·
Thinking About Managing Your Arthritis Source: Midland, MI: Health Enhancement Systems. 1999. 4 p. Contact: Available from Health Enhancement Systems. P.O. Box 1035, Midland, MI 48641-1035. (800) 326-2317. Fax (517) 839-0025. PRICE: Bulk prices starting at $0.68 each for 10-50, plus shipping and handling. Item No. HESAR-1. Summary: This brochure guides people through the process of thinking about managing their arthritis. The brochure begins by describing the features of osteoarthritis and rheumatoid arthritis and explaining what arthritis management means. This is followed by a series of questions that help readers think about arthritis management. The brochure also includes a list of helpful organizations.
·
The Benefits of Managing Arthritis Source: Midland, MI: Health Enhancement Systems. 1999. 8 p. Contact: Available from Health Enhancement Systems. P.O. Box 1035, Midland, MI 48641-1035. (800) 326-2317. Fax (517) 839-0025. PRICE: Bulk
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prices starting at $0.98 each for 10-50, plus shipping and handling. Item No. HESAR-2. Summary: This brochure provides people who have arthritis with information on the benefits of arthritis management. The brochure begins by identifying the risk factors that people can and cannot control and describing the features of osteoarthritis and rheumatoid arthritis. This is followed by information on the advantages of managing arthritis and the benefits of keeping a record of arthritis symptoms. In addition, the brochure presents several scenes that readers can reflect upon to help them manage their arthritis, provides sample questions that readers can answer to learn about their arthritis and how to control it, and explains the importance of finding supportive people. The brochure also includes a list of helpful organizations. ·
Total Knee Replacement: Improving Movement Source: San Bruno, CA: StayWell Company. 1999. 16 p. Contact: Available from StayWell Company. 1100 Grundy Lane, San Bruno, CA 94066-3030. (800) 333-3032. Website: www.staywell.com. PRICE: Call or write for current pricing on single and bulk orders. Summary: This illustrated booklet, which is available in both English and Spanish, provides people who have total knee replacement with information on this procedure. The booklet describes the anatomy of a healthy knee and one damaged by osteoarthritis, rheumatoid arthritis, or injury. This is followed by a discussion of the orthopedic evaluation to determine whether surgery is the best treatment option, focusing on the medical history, the physical examination, and diagnostic tests such as x rays. The booklet highlights the benefits of knee replacement and outlines the steps involved in preparing for surgery, such as planning ahead to make home recovery go more smoothly, arranging for in home help, undergoing a general physical examination, discussing medication usage with the surgeon, finishing dental work, and donating blood. In addition, the booklet explains the steps involved in performing a knee replacement and identifies risks and complications. Other topics include recovering in the hospital and at home. The booklet concludes with guidelines on managing pain and building muscle strength, improving joint motion, and returning to activity. The booklet also contains a surgical checklist to help readers remember what to do before and after surgery. Numerous figures.
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The NLM Gateway30 The NLM (National Library of Medicine) Gateway is a Web-based system that lets users search simultaneously in multiple retrieval systems at the U.S. National Library of Medicine (NLM). It allows users of NLM services to initiate searches from one Web interface, providing “one-stop searching” for many of NLM's information resources or databases.31 One target audience for the Gateway is the Internet user who is new to NLM's online resources and does not know what information is available or how best to search for it. This audience may include physicians and other healthcare providers, researchers, librarians, students, and, increasingly, patients, their families, and the public.32 To use the NLM Gateway, simply go to the search site at http://gateway.nlm.nih.gov/gw/Cmd. Type “osteoarthritis” (or synonyms) into the search box and click “Search.” The results will be presented in a tabular form, indicating the number of references in each database category.
Results Summary Category Items Found Journal Articles 25734 Books / Periodicals / Audio Visual 312 Consumer Health 58 Meeting Abstracts 56 Other Collections 15 Total 26175
Adapted from NLM: http://gateway.nlm.nih.gov/gw/Cmd?Overview.x. The NLM Gateway is currently being developed by the Lister Hill National Center for Biomedical Communications (LHNCBC) at the National Library of Medicine (NLM) of the National Institutes of Health (NIH). 32 Other users may find the Gateway useful for an overall search of NLM's information resources. Some searchers may locate what they need immediately, while others will utilize the Gateway as an adjunct tool to other NLM search services such as PubMed® and MEDLINEplus®. The Gateway connects users with multiple NLM retrieval systems while also providing a search interface for its own collections. These collections include various types of information that do not logically belong in PubMed, LOCATORplus, or other established NLM retrieval systems (e.g., meeting announcements and pre-1966 journal citations). The Gateway will provide access to the information found in an increasing number of NLM retrieval systems in several phases. 30 31
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HSTAT33 HSTAT is a free, Web-based resource that provides access to full-text documents used in healthcare decision-making.34 HSTAT's audience includes healthcare providers, health service researchers, policy makers, insurance companies, consumers, and the information professionals who serve these groups. HSTAT provides access to a wide variety of publications, including clinical practice guidelines, quick-reference guides for clinicians, consumer health brochures, evidence reports and technology assessments from the Agency for Healthcare Research and Quality (AHRQ), as well as AHRQ's Put Prevention Into Practice.35 Simply search by “osteoarthritis” (or synonyms) at the following Web site: http://text.nlm.nih.gov.
Coffee Break: Tutorials for Biologists36 Some patients may wish to have access to a general healthcare site that takes a scientific view of the news and covers recent breakthroughs in biology that may one day assist physicians in developing treatments. To this end, we recommend “Coffee Break,” a collection of short reports on recent biological discoveries. Each report incorporates interactive tutorials that demonstrate how bioinformatics tools are used as a part of the research process. Currently, all Coffee Breaks are written by NCBI staff.37 Each report is about 400 words and is usually based on a discovery reported in one or more articles from recently published, peer-reviewed literature.38 This site has new Adapted from HSTAT: http://www.nlm.nih.gov/pubs/factsheets/hstat.html. The HSTAT URL is http://hstat.nlm.nih.gov/. 35 Other important documents in HSTAT include: the National Institutes of Health (NIH) Consensus Conference Reports and Technology Assessment Reports; the HIV/AIDS Treatment Information Service (ATIS) resource documents; the Substance Abuse and Mental Health Services Administration's Center for Substance Abuse Treatment (SAMHSA/CSAT) Treatment Improvement Protocols (TIP) and Center for Substance Abuse Prevention (SAMHSA/CSAP) Prevention Enhancement Protocols System (PEPS); the Public Health Service (PHS) Preventive Services Task Force's Guide to Clinical Preventive Services; the independent, nonfederal Task Force on Community Services Guide to Community Preventive Services; and the Health Technology Advisory Committee (HTAC) of the Minnesota Health Care Commission (MHCC) health technology evaluations. 36 Adapted from http://www.ncbi.nlm.nih.gov/Coffeebreak/Archive/FAQ.html. 37 The figure that accompanies each article is frequently supplied by an expert external to NCBI, in which case the source of the figure is cited. The result is an interactive tutorial that tells a biological story. 38 After a brief introduction that sets the work described into a broader context, the report focuses on how a molecular understanding can provide explanations of observed biology and lead to therapies for diseases. Each vignette is accompanied by a figure and hypertext links that lead to a series of pages that interactively show how NCBI tools and resources are used in the research process. 33 34
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articles every few weeks, so it can be considered an online magazine of sorts, and intended for general background information. You can access the Coffee Break Web site at http://www.ncbi.nlm.nih.gov/Coffeebreak/.
Other Commercial Databases In addition to resources maintained by official agencies, other databases exist that are commercial ventures addressing medical professionals. Here are a few examples that may interest you: ·
CliniWeb International: Index and table of contents to selected clinical information on the Internet; see http://www.ohsu.edu/cliniweb/.
·
Image Engine: Multimedia electronic medical record system that integrates a wide range of digitized clinical images with textual data stored in the University of Pittsburgh Medical Center's MARS electronic medical record system; see the following Web site: http://www.cml.upmc.edu/cml/imageengine/imageEngine.html.
·
Medical World Search: Searches full text from thousands of selected medical sites on the Internet; see http://www.mwsearch.com/.
·
MedWeaver: Prototype system that allows users to search differential diagnoses for any list of signs and symptoms, to search medical literature, and to explore relevant Web sites; see http://www.med.virginia.edu/~wmd4n/medweaver.html.
·
Metaphrase: Middleware component intended for use by both caregivers and medical records personnel. It converts the informal language generally used by caregivers into terms from formal, controlled vocabularies; see http://www.lexical.com/Metaphrase.html.
The Genome Project and Osteoarthritis With all the discussion in the press about the Human Genome Project, it is only natural that physicians, researchers, and patients want to know about how human genes relate to osteoarthritis. In the following section, we will discuss databases and references used by physicians and scientists who work in this area.
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Online Mendelian Inheritance in Man (OMIM) The Online Mendelian Inheritance in Man (OMIM) database is a catalog of human genes and genetic disorders authored and edited by Dr. Victor A. McKusick and his colleagues at Johns Hopkins and elsewhere. OMIM was developed for the World Wide Web by the National Center for Biotechnology Information (NCBI).39 The database contains textual information, pictures, and reference information. It also contains copious links to NCBI's Entrez database of MEDLINE articles and sequence information. Go to http://www.ncbi.nlm.nih.gov/Omim/searchomim.html to search the database,. Type “osteoarthritis” (or synonyms) in the search box, and click “Submit Search.” If too many results appear, you can narrow the search by adding the word “clinical.” Each report will have additional links to related research and databases. By following these links, especially the link titled “Database Links,” you will be exposed to numerous specialized databases that are largely used by the scientific community. These databases are overly technical and seldom used by the general public, but offer an abundance of information. The following is an example of the results you can obtain from the OMIM for osteoarthritis: ·
Osteoarthritis Web site: http://www.ncbi.nlm.nih.gov/htbinpost/Omim/dispmim?165720
·
Osteoarthritis of Distal Interphalangeal Joints Web site: http://www.ncbi.nlm.nih.gov/htbinpost/Omim/dispmim?140600
·
Osteoarthritis with Mild Chondrodysplasia Web site: http://www.ncbi.nlm.nih.gov/htbinpost/Omim/dispmim?604864
Genes and Disease (NCBI - Map) The Genes and Disease database is produced by the National Center for Biotechnology Information of the National Library of Medicine at the National Institutes of Health. This Web site categorizes each disorder by the Adapted from http://www.ncbi.nlm.nih.gov/. Established in 1988 as a national resource for molecular biology information, NCBI creates public databases, conducts research in computational biology, develops software tools for analyzing genome data, and disseminates biomedical information--all for the better understanding of molecular processes affecting human health and disease.
39
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system of the body. Go to http://www.ncbi.nlm.nih.gov/disease/, and browse the system pages to have a full view of important conditions linked to human genes. Since this site is regularly updated, you may wish to re-visit it from time to time. The following systems and associated disorders are addressed: ·
Muscle and Bone: Movement and growth. Examples: Duchenne muscular dystrophy, Ellis-van Creveld syndrome, Marfan syndrome, myotonic dystrophy, spinal muscular atrophy. Web site: http://www.ncbi.nlm.nih.gov/disease/Muscle.html
·
Nervous System: Mind and body. Examples: Alzheimer disease, Amyotrophic lateral sclerosis, Angelman syndrome, Charcot-Marie-Tooth disease, epilepsy, essential tremor, Fragile X syndrome, Friedreich's ataxia, Huntington disease, NiemannPick disease, Parkinson disease, Prader-Willi syndrome, Rett syndrome, Spinocerebellar atrophy, Williams syndrome. Web site: http://www.ncbi.nlm.nih.gov/disease/Brain.html
·
Signals: Cellular messages. Examples: Ataxia telangiectasia, Baldness, Cockayne syndrome, Glaucoma, SRY: sex determination, Tuberous sclerosis, Waardenburg syndrome, Werner syndrome. Web site: http://www.ncbi.nlm.nih.gov/disease/Signals.html
Entrez Entrez is a search and retrieval system that integrates several linked databases at the National Center for Biotechnology Information (NCBI). These databases include nucleotide sequences, protein sequences, macromolecular structures, whole genomes, and MEDLINE through PubMed. Entrez provides access to the following databases: ·
PubMed: Biomedical literature (PubMed), Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed
·
Nucleotide Sequence Database (Genbank): Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Nucleotide
·
Protein Sequence Database: Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Protein
·
Structure: Three-dimensional macromolecular structures, Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Structure
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·
Genome: Complete genome assemblies, Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Genome
·
PopSet: Population study data sets, Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Popset
·
OMIM: Online Mendelian Inheritance in Man, Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=OMIM
·
Taxonomy: Organisms in GenBank, Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Taxonomy
·
Books: Online books, Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=books
·
ProbeSet: Gene Expression Omnibus (GEO), Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=geo
·
3D Domains: Domains from Entrez Structure, Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=geo
·
NCBI's Protein Sequence Information Survey Results: Web site: http://www.ncbi.nlm.nih.gov/About/proteinsurvey/
To access the Entrez system at the NCBI, go to http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?CMD=search&DB=genom e, and then select the database that you would like to search. The databases available are listed in the drop box next to “Search.” In the box next to “for,” enter “osteoarthritis” (or synonyms) and click “Go.” Jablonski's Multiple Congenital Anomaly/Mental Retardation (MCA/MR) Syndromes Database40 This online resource can be quite useful. It has been developed to facilitate the identification and differentiation of syndromic entities. Special attention is given to the type of information that is usually limited or completely omitted in existing reference sources due to space limitations of the printed form. At http://www.nlm.nih.gov/mesh/jablonski/syndrome_toc/toc_a.html you can search across syndromes using an alphabetical index. Search by keywords at http://www.nlm.nih.gov/mesh/jablonski/syndrome_db.html. Adapted from the National Library of Medicine: http://www.nlm.nih.gov/mesh/jablonski/about_syndrome.html.
40
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The Genome Database41 Established at Johns Hopkins University in Baltimore, Maryland in 1990, the Genome Database (GDB) is the official central repository for genomic mapping data resulting from the Human Genome Initiative. In the spring of 1999, the Bioinformatics Supercomputing Centre (BiSC) at the Hospital for Sick Children in Toronto, Ontario assumed the management of GDB. The Human Genome Initiative is a worldwide research effort focusing on structural analysis of human DNA to determine the location and sequence of the estimated 100,000 human genes. In support of this project, GDB stores and curates data generated by researchers worldwide who are engaged in the mapping effort of the Human Genome Project (HGP). GDB's mission is to provide scientists with an encyclopedia of the human genome which is continually revised and updated to reflect the current state of scientific knowledge. Although GDB has historically focused on gene mapping, its focus will broaden as the Genome Project moves from mapping to sequence, and finally, to functional analysis. To access the GDB, simply go to the following hyperlink: http://www.gdb.org/. Search “All Biological Data” by “Keyword.” Type “osteoarthritis” (or synonyms) into the search box, and review the results. If more than one word is used in the search box, then separate each one with the word “and” or “or” (using “or” might be useful when using synonyms). This database is extremely technical as it was created for specialists. The articles are the results which are the most accessible to non-professionals and often listed under the heading “Citations.” The contact names are also accessible to non-professionals.
Specialized References The following books are specialized references written for professionals interested in osteoarthritis (sorted alphabetically by title, hyperlinks provide rankings, information, and reviews at Amazon.com): · Atlas of Rheumatology by Gene G. Hunder (Editor); Hardcover, 2nd edition (June 2001), Current Medicine; ISBN: 1573401714; http://www.amazon.com/exec/obidos/ASIN/1573401714/icongroupinterna
Adapted from the Genome Database: http://gdbwww.gdb.org/gdb/aboutGDB.html#mission.
41
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· Clinical Problems in Rheumatology by Dudley; Paperback, 3rd edition (May 2001), Dunitz Martin Ltd; ISBN: 1853175722; http://www.amazon.com/exec/obidos/ASIN/1853175722/icongroupinterna · Diagnosis and Treatment of Movement Impairment Syndromes by Shirley Sahrmann; Hardcover - 384 pages, 1st edition (September 4, 2001), Mosby, Inc.; ISBN: 0801672058; http://www.amazon.com/exec/obidos/ASIN/0801672058/icongroupinterna · Diagnosis of Bone and Joint Disorders (5-Volume Set) by Donald Resnick; Hardcover - 5472 pages, 4th edition (March 8, 2002); W B Saunders Co.; ISBN: 0721689213; http://www.amazon.com/exec/obidos/ASIN/0721689213/icongroupinterna · Kelley's Textbook of Rheumatology (2-Volume Set) by Shaun Ruddy (Editor), et al; Hardcover - 1788 pages, 6th edition (January 15, 2001), W B Saunders Co.; ISBN: 0721680089; http://www.amazon.com/exec/obidos/ASIN/0721680089/icongroupinterna · Kelley's Textbook of Rheumatology CD-ROM by Shaun Ruddy (Editor), et al; 6th edition (July 15, 2001), W B Saunders Co.; ISBN: 0721690327; http://www.amazon.com/exec/obidos/ASIN/0721690327/icongroupinterna · Mechanical Loading of Bones and Joints by Hideaki Takahashi (Editor); Hardcover - 324 pages, 1st edition (July 15, 1999), Springer Verlag; ISBN: 4431702423; http://www.amazon.com/exec/obidos/ASIN/4431702423/icongroupinterna · Modern Therapeutics in Rheumatic Diseases by George C. Tsokos (Editor), Steffen Gay (Editor); Hardcover - 655 pages, 1st edition (January 15, 2002), Humana Press; ISBN: 0896039161; http://www.amazon.com/exec/obidos/ASIN/0896039161/icongroupinterna · Oxford Handbook of Rheumatology by Alan Hakim (Editor), Gavin Clunie (Editor); Paperback, 1st edition (March 15, 2002); Oxford University Press; ISBN: 0192630547; http://www.amazon.com/exec/obidos/ASIN/0192630547/icongroupinterna · Pathology and Pathobiology of Rheumatic Diseases by H. G. Fassbender; Hardcover (September 2001), Springer Verlag; ISBN: 3540629424; http://www.amazon.com/exec/obidos/ASIN/3540629424/icongroupint erna · Rehabilitation Techniques in Rheumatology by Clarke; Hardcover, 2nd edition (March 15, 2001), Dunitz Martin Ltd.; ISBN: 1853171204; http://www.amazon.com/exec/obidos/ASIN/1853171204/icongroupinterna · Rheumatology Secrets by Sterling G. West, M.D.; Paperback, 2nd edition (February 15, 2002), Lippincott, Williams & Wilkins Publishers; ISBN:
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1560534745; http://www.amazon.com/exec/obidos/ASIN/1560534745/icongroupinterna · Treatment of the Rheumatic Diseases: Companion to Kelley's Textbook of Rheumatology by Michael H. Weisman, et al; Hardcover - 563 pages, 2nd edition (January 15, 2001), W B Saunders Co.; ISBN: 0721684645; http://www.amazon.com/exec/obidos/ASIN/0721684645/icongroupinterna
Vocabulary Builder Cholestasis: Impairment of biliary flow at any level from the hepatocyte to Vater's ampulla. [NIH] Prostaglandins: A group of compounds derived from unsaturated 20carbon fatty acids, primarily arachidonic acid, via the cyclooxygenase pathway. They are extremely potent mediators of a diverse group of physiological processes. [NIH] Sciatica: A syndrome characterized by pain radiating from the back into the buttock and into the lower extremity along its posterior or lateral aspect, and most commonly caused by prolapse of the intervertebral disk; the term is also used to refer to pain anywhere along the course of the sciatic nerve. [EU] Tomography: The recording of internal body images at a predetermined plane by means of the tomograph; called also body section roentgenography. [EU]
Dissertations 221
CHAPTER 10. DISSERTATIONS ON OSTEOARTHRITIS Overview University researchers are active in studying almost all known diseases. The result of research is often published in the form of Doctoral or Master's dissertations. You should understand, therefore, that applied diagnostic procedures and/or therapies can take many years to develop after the thesis that proposed the new technique or approach was written. In this chapter, we will give you a bibliography on recent dissertations relating to osteoarthritis. You can read about these in more detail using the Internet or your local medical library. We will also provide you with information on how to use the Internet to stay current on dissertations.
Dissertations on Osteoarthritis ProQuest Digital Dissertations is the largest archive of academic dissertations available. From this archive, we have compiled the following list covering dissertations devoted to osteoarthritis. You will see that the information provided includes the dissertation’s title, its author, and the author’s institution. To read more about the following, simply use the Internet address indicated. The following covers recent dissertations dealing with osteoarthritis: ·
Appraisal and Coping in Older Persons with Osteoarthritis by Regan, Catherine A., Ph.D., from Stanford University, 1990, 178 pages http://wwwlib.umi.com/dissertations/fullcit/9017917
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·
Central Processing of Pressure Stimulation in Patients with Osteoarthritis of the Knee by Kersh, Brian Christopher; Ph.D., from the University of Alabama, 2002, 67 pages http://wwwlib.umi.com/dissertations/fullcit/3067289
·
Connective Tissue Adaptation and Changes in Functional Ability of Individuals with Osteoarthritis of the Knee in Response to an Exercise Program by Bautch, Judith Catherine, Ph.D., from the University of Wisconsin - Madison, 1992, 126 pages http://wwwlib.umi.com/dissertations/fullcit/9224140
·
Degenerative Joint Disease in a Medieval Nubian Population (Sudan) by Kilgore, Lynn, Ph.D., from University of Colorado at Boulder, 1984, 242 pages http://wwwlib.umi.com/dissertations/fullcit/8508954
·
Impact of a Supervised Walking and Education Program on Functional Status: Results from a Randomized Controlled Trial in Patients with Osteoarthritis of the Knee by Kovar, Pamela Ann, EDD, from Columbia University Teachers College, 1991, 229 pages http://wwwlib.umi.com/dissertations/fullcit/9136404
·
Magnetic Resonance Relaxation Studies of Osteoarthritis and Tumor Response to Chemotherapy by Duvvuri, Umamaheswar; Ph.D., from University of Pennsylvania, 2002, 135 pages http://wwwlib.umi.com/dissertations/fullcit/3043866
·
Measuring the Family Helper Costs of Disabling Osteoarthritis of the Hip or Knee in Older Persons (Arthritis, Cost Analysis) by Werkner, Janet Elaine, Ph.D., from Case Western Reserve University, 1990, 287 pages http://wwwlib.umi.com/dissertations/fullcit/9035315
·
Hexosaminidase Inhibitors As New Drug Candidates for the Therapy of Osteoarthritis by Liu, Junjie; Ph.D., from the Scripps Research Institute, 2002, 228 pages http://wwwlib.umi.com/dissertations/fullcit/3045858
Keeping Current As previously mentioned, an effective way to stay current on dissertations dedicated to osteoarthritis is to use the database called ProQuest Digital Dissertations via the Internet, located at the following Web address: http://wwwlib.umi.com/dissertations. The site allows you to freely access the last two years of citations and abstracts. Ask your medical librarian if the library has full and unlimited access to this database. From the library, you
Dissertations 223
should be able to do more complete searches than with the limited 2-year access available to the general public.
Vocabulary Builder Exogenous: Developed or originating outside the organism, as exogenous disease. [EU] Neuropeptides: Peptides released by neurons as intercellular messengers. Many neuropeptides are also hormones released by non-neuronal cells. [NIH]
225
PART III. APPENDICES
ABOUT PART III Part III is a collection of appendices on general medical topics which may be of interest to patients with osteoarthritis and related conditions.
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APPENDIX A. RESEARCHING YOUR MEDICATIONS Overview There are a number of sources available on new or existing medications which could be prescribed to patients with osteoarthritis. While a number of hard copy or CD-Rom resources are available to patients and physicians for research purposes, a more flexible method is to use Internet-based databases. In this chapter, we will begin with a general overview of medications. We will then proceed to outline official recommendations on how you should view your medications. You may also want to research medications that you are currently taking for other conditions as they may interact with medications for osteoarthritis. Research can give you information on the side effects, interactions, and limitations of prescription drugs used in the treatment of osteoarthritis. Broadly speaking, there are two sources of information on approved medications: public sources and private sources. We will emphasize free-to-use public sources.
Your Medications: The Basics42 The Agency for Health Care Research and Quality has published extremely useful guidelines on how you can best participate in the medication aspects of osteoarthritis. Taking medicines is not always as simple as swallowing a pill. It can involve many steps and decisions each day. The AHCRQ recommends that patients with osteoarthritis take part in treatment decisions. Do not be afraid to ask questions and talk about your concerns. By taking a moment to ask questions early, you may avoid problems later. Here are some points to cover each time a new medicine is prescribed: 42
This section is adapted from AHCRQ: http://www.ahcpr.gov/consumer/ncpiebro.htm.
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·
Ask about all parts of your treatment, including diet changes, exercise, and medicines.
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Ask about the risks and benefits of each medicine or other treatment you might receive.
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Ask how often you or your doctor will check for side effects from a given medication.
Do not hesitate to ask what is important to you about your medicines. You may want a medicine with the fewest side effects, or the fewest doses to take each day. You may care most about cost, or how the medicine might affect how you live or work. Or, you may want the medicine your doctor believes will work the best. Telling your doctor will help him or her select the best treatment for you. Do not be afraid to “bother” your doctor with your concerns and questions about medications for osteoarthritis. You can also talk to a nurse or a pharmacist. They can help you better understand your treatment plan. Feel free to bring a friend or family member with you when you visit your doctor. Talking over your options with someone you trust can help you make better choices, especially if you are not feeling well. Specifically, ask your doctor the following: ·
The name of the medicine and what it is supposed to do.
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How and when to take the medicine, how much to take, and for how long.
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What food, drinks, other medicines, or activities you should avoid while taking the medicine.
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What side effects the medicine may have, and what to do if they occur.
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If you can get a refill, and how often.
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About any terms or directions you do not understand.
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What to do if you miss a dose.
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If there is written information you can take home (most pharmacies have information sheets on your prescription medicines; some even offer large-print or Spanish versions).
Do not forget to tell your doctor about all the medicines you are currently taking (not just those for osteoarthritis). This includes prescription medicines and the medicines that you buy over the counter. Then your doctor can avoid giving you a new medicine that may not work well with the medications you take now. When talking to your doctor, you may wish to
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prepare a list of medicines you currently take, the reason you take them, and how you take them. Be sure to include the following information for each: ·
Name of medicine
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Reason taken
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Dosage
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Time(s) of day
Also include any over-the-counter medicines, such as: ·
Laxatives
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Diet pills
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Vitamins
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Cold medicine
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Aspirin or other pain, headache, or fever medicine
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Cough medicine
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Allergy relief medicine
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Antacids
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Sleeping pills
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Others (include names)
Learning More about Your Medications Because of historical investments by various organizations and the emergence of the Internet, it has become rather simple to learn about the medications your doctor has recommended for osteoarthritis. One such source is the United States Pharmacopeia. In 1820, eleven physicians met in Washington, D.C. to establish the first compendium of standard drugs for the United States. They called this compendium the “U.S. Pharmacopeia (USP).” Today, the USP is a non-profit organization consisting of 800 volunteer scientists, eleven elected officials, and 400 representatives of state associations and colleges of medicine and pharmacy. The USP is located in Rockville, Maryland, and its home page is located at www.usp.org. The USP currently provides standards for over 3,700 medications. The resulting USP DIÒ Advice for the PatientÒ can be accessed through the National Library of Medicine of the National Institutes of Health. The database is partially
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derived from lists of federally approved medications in the Food and Drug Administration's (FDA) Drug Approvals database.43 While the FDA database is rather large and difficult to navigate, the Phamacopeia is both user-friendly and free to use. It covers more than 9,000 prescription and over-the-counter medications. To access this database, simply type the following hyperlink into your Web browser: http://www.nlm.nih.gov/medlineplus/druginformation.html. To view examples of a given medication (brand names, category, description, preparation, proper use, precautions, side effects, etc.), simply follow the hyperlinks indicated within the United States Pharmacopeia (USP). It is important to read the disclaimer by the USP before using the information provided. Of course, we as editors cannot be certain as to what medications you are taking. Therefore, we have compiled a list of medications associated with the treatment of osteoarthritis. Once again, due to space limitations, we only list a sample of medications and provide hyperlinks to ample documentation (e.g. typical dosage, side effects, drug-interaction risks, etc.). The following drugs have been mentioned in the Pharmacopeia and other sources as being potentially applicable to osteoarthritis: Capsaicin ·
Topical - U.S. Brands: Zostrix; Zostrix-HP http://www.nlm.nih.gov/medlineplus/druginfo/capsaicintopical 202626.html
Hyaluronate Sodium ·
Systemic - U.S. Brands: Hyalgan http://www.nlm.nih.gov/medlineplus/druginfo/hyaluronatesodi umsystemic203531.html
Hyaluronate Sodium Derivative ·
Systemic - U.S. Brands: Synvisc http://www.nlm.nih.gov/medlineplus/druginfo/hyaluronatesodi umderivativesys203582.html
Though cumbersome, the FDA database can be freely browsed at the following site: www.fda.gov/cder/da/da.htm.
43
Researching Your Medications 231
Meloxicam ·
Systemic - U.S. Brands: Mobic http://www.nlm.nih.gov/medlineplus/druginfo/meloxicamsyste mic500131.html
Rofecoxib ·
Systemic - U.S. Brands: Vioxx http://www.nlm.nih.gov/medlineplus/druginfo/rofecoxibsystem ic203782.html
Commercial Databases In addition to the medications listed in the USP above, a number of commercial sites are available by subscription to physicians and their institutions. You may be able to access these sources from your local medical library or your doctor's office. Reuters Health Drug Database The Reuters Health Drug Database can be searched by keyword at the hyperlink: http://www.reutershealth.com/frame2/drug.html.
Mosby's GenRx Mosby's GenRx database (also available on CD-Rom and book format) covers 45,000 drug products including generics and international brands. It provides prescribing information, drug interactions, and patient information. Information can be obtained at the following hyperlink: http://www.genrx.com/Mosby/PhyGenRx/group.html. Physicians Desk Reference The Physicians Desk Reference database (also available in CD-Rom and book format) is a full-text drug database. The database is searchable by brand name, generic name or by indication. It features multiple drug interactions reports. Information can be obtained at the following hyperlink: http://physician.pdr.net/physician/templates/en/acl/psuser_t.htm.
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Other Web Sites A number of additional Web sites discuss drug information. As an example, you may like to look at www.drugs.com which reproduces the information in the Pharmacopeia as well as commercial information. You may also want to consider the Web site of the Medical Letter, Inc. which allows users to download articles on various drugs and therapeutics for a nominal fee: http://www.medletter.com/.
Contraindications and Interactions (Hidden Dangers) Some of the medications mentioned in the previous discussions can be problematic for patients with osteoarthritis--not because they are used in the treatment process, but because of contraindications, or side effects. Medications with contraindications are those that could react with drugs used to treat osteoarthritis or potentially create deleterious side effects in patients with osteoarthritis. You should ask your physician about any contraindications, especially as these might apply to other medications that you may be taking for common ailments. Drug-drug interactions occur when two or more drugs react with each other. This drug-drug interaction may cause you to experience an unexpected side effect. Drug interactions may make your medications less effective, cause unexpected side effects, or increase the action of a particular drug. Some drug interactions can even be harmful to you. Be sure to read the label every time you use a nonprescription or prescription drug, and take the time to learn about drug interactions. These precautions may be critical to your health. You can reduce the risk of potentially harmful drug interactions and side effects with a little bit of knowledge and common sense. Drug labels contain important information about ingredients, uses, warnings, and directions which you should take the time to read and understand. Labels also include warnings about possible drug interactions. Further, drug labels may change as new information becomes available. This is why it's especially important to read the label every time you use a medication. When your doctor prescribes a new drug, discuss all over-thecounter and prescription medications, dietary supplements, vitamins, botanicals, minerals and herbals you take as well as the foods you eat. Ask your pharmacist for the package insert for each prescription drug you take.
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The package insert provides more information about potential drug interactions.
A Final Warning At some point, you may hear of alternative medications from friends, relatives, or in the news media. Advertisements may suggest that certain alternative drugs can produce positive results for patients with osteoarthritis. Exercise caution--some of these drugs may have fraudulent claims, and others may actually hurt you. The Food and Drug Administration (FDA) is the official U.S. agency charged with discovering which medications are likely to improve the health of patients with osteoarthritis. The FDA warns patients to watch out for44: ·
Secret formulas (real scientists share what they know)
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Amazing breakthroughs or miracle cures (real breakthroughs don't happen very often; when they do, real scientists do not call them amazing or miracles)
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Quick, painless, or guaranteed cures
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If it sounds too good to be true, it probably isn't true.
If you have any questions about any kind of medical treatment, the FDA may have an office near you. Look for their number in the blue pages of the phone book. You can also contact the FDA through its toll-free number, 1888-INFO-FDA (1-888-463-6332), or on the World Wide Web at www.fda.gov.
General References In addition to the resources provided earlier in this chapter, the following general references describe medications (sorted alphabetically by title; hyperlinks provide rankings, information and reviews at Amazon.com): ·
Complete Guide to Prescription and Nonprescription Drugs 2001 (Complete Guide to Prescription and Nonprescription Drugs, 2001) by H. Winter Griffith, Paperback 16th edition (2001), Medical Surveillance; ISBN: 0942447417; http://www.amazon.com/exec/obidos/ASIN/039952634X/icongroupintern a
44
This section has been adapted from http://www.fda.gov/opacom/lowlit/medfraud.html.
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·
The Essential Guide to Prescription Drugs, 2001 by James J. Rybacki, James W. Long; Paperback - 1274 pages (2001), Harper Resource; ISBN: 0060958162; http://www.amazon.com/exec/obidos/ASIN/0060958162/icongroupinterna
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Handbook of Commonly Prescribed Drugs by G. John Digregorio, Edward J. Barbieri; Paperback 16th edition (2001), Medical Surveillance; ISBN: 0942447417; http://www.amazon.com/exec/obidos/ASIN/0942447417/icongroupinterna
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Johns Hopkins Complete Home Encyclopedia of Drugs 2nd ed. by Simeon Margolis (Ed.), Johns Hopkins; Hardcover - 835 pages (2000), Rebus; ISBN: 0929661583; http://www.amazon.com/exec/obidos/ASIN/0929661583/icongroupinterna
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Medical Pocket Reference: Drugs 2002 by Springhouse Paperback 1st edition (2001), Lippincott Williams & Wilkins Publishers; ISBN: 1582550964; http://www.amazon.com/exec/obidos/ASIN/1582550964/icongroupinterna
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PDR by Medical Economics Staff, Medical Economics Staff Hardcover 3506 pages 55th edition (2000), Medical Economics Company; ISBN: 1563633752; http://www.amazon.com/exec/obidos/ASIN/1563633752/icongroupinterna
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Pharmacy Simplified: A Glossary of Terms by James Grogan; Paperback 432 pages, 1st edition (2001), Delmar Publishers; ISBN: 0766828581; http://www.amazon.com/exec/obidos/ASIN/0766828581/icongroupinterna
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Physician Federal Desk Reference by Christine B. Fraizer; Paperback 2nd edition (2001), Medicode Inc; ISBN: 1563373971; http://www.amazon.com/exec/obidos/ASIN/1563373971/icongroupinterna
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Physician's Desk Reference Supplements Paperback - 300 pages, 53 edition (1999), ISBN: 1563632950; http://www.amazon.com/exec/obidos/ASIN/1563632950/icongroupinterna
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APPENDIX B. RESEARCHING ALTERNATIVE MEDICINE Overview Complementary and alternative medicine (CAM) is one of the most contentious aspects of modern medical practice. You may have heard of these treatments on the radio or on television. Maybe you have seen articles written about these treatments in magazines, newspapers, or books. Perhaps your friends or doctor have mentioned alternatives. In this chapter, we will begin by giving you a broad perspective on complementary and alternative therapies. Next, we will introduce you to official information sources on CAM relating to osteoarthritis. Finally, at the conclusion of this chapter, we will provide a list of readings on osteoarthritis from various authors. We will begin, however, with the National Center for Complementary and Alternative Medicine's (NCCAM) overview of complementary and alternative medicine.
What Is CAM?45 Complementary and alternative medicine (CAM) covers a broad range of healing philosophies, approaches, and therapies. Generally, it is defined as those treatments and healthcare practices which are not taught in medical schools, used in hospitals, or reimbursed by medical insurance companies. Many CAM therapies are termed “holistic,” which generally means that the healthcare practitioner considers the whole person, including physical, mental, emotional, and spiritual health. Some of these therapies are also known as “preventive,” which means that the practitioner educates and 45
Adapted from the NCCAM: http://nccam.nih.gov/nccam/fcp/faq/index.html#what-is.
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treats the person to prevent health problems from arising, rather than treating symptoms after problems have occurred. People use CAM treatments and therapies in a variety of ways. Therapies are used alone (often referred to as alternative), in combination with other alternative therapies, or in addition to conventional treatment (sometimes referred to as complementary). Complementary and alternative medicine, or “integrative medicine,” includes a broad range of healing philosophies, approaches, and therapies. Some approaches are consistent with physiological principles of Western medicine, while others constitute healing systems with non-Western origins. While some therapies are far outside the realm of accepted Western medical theory and practice, others are becoming established in mainstream medicine. Complementary and alternative therapies are used in an effort to prevent illness, reduce stress, prevent or reduce side effects and symptoms, or control or cure disease. Some commonly used methods of complementary or alternative therapy include mind/body control interventions such as visualization and relaxation, manual healing including acupressure and massage, homeopathy, vitamins or herbal products, and acupuncture.
What Are the Domains of Alternative Medicine?46 The list of CAM practices changes continually. The reason being is that these new practices and therapies are often proved to be safe and effective, and therefore become generally accepted as “mainstream” healthcare practices. Today, CAM practices may be grouped within five major domains: (1) alternative medical systems, (2) mind-body interventions, (3) biologicallybased treatments, (4) manipulative and body-based methods, and (5) energy therapies. The individual systems and treatments comprising these categories are too numerous to list in this sourcebook. Thus, only limited examples are provided within each. Alternative Medical Systems Alternative medical systems involve complete systems of theory and practice that have evolved independent of, and often prior to, conventional biomedical approaches. Many are traditional systems of medicine that are
46
Adapted from the NCCAM: http://nccam.nih.gov/nccam/fcp/classify/index.html.
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practiced by individual cultures throughout the world, including a number of venerable Asian approaches. Traditional oriental medicine emphasizes the balance or disturbances of qi (pronounced chi) or vital energy in health and disease, respectively. Traditional oriental medicine consists of a group of techniques and methods including acupuncture, herbal medicine, oriental massage, and qi gong (a form of energy therapy). Acupuncture involves stimulating specific anatomic points in the body for therapeutic purposes, usually by puncturing the skin with a thin needle. Ayurveda is India's traditional system of medicine. Ayurvedic medicine (meaning “science of life”) is a comprehensive system of medicine that places equal emphasis on body, mind, and spirit. Ayurveda strives to restore the innate harmony of the individual. Some of the primary Ayurvedic treatments include diet, exercise, meditation, herbs, massage, exposure to sunlight, and controlled breathing. Other traditional healing systems have been developed by the world’s indigenous populations. These populations include Native American, Aboriginal, African, Middle Eastern, Tibetan, and Central and South American cultures. Homeopathy and naturopathy are also examples of complete alternative medicine systems. Homeopathic medicine is an unconventional Western system that is based on the principle that “like cures like,” i.e., that the same substance that in large doses produces the symptoms of an illness, in very minute doses cures it. Homeopathic health practitioners believe that the more dilute the remedy, the greater its potency. Therefore, they use small doses of specially prepared plant extracts and minerals to stimulate the body's defense mechanisms and healing processes in order to treat illness. Naturopathic medicine is based on the theory that disease is a manifestation of alterations in the processes by which the body naturally heals itself and emphasizes health restoration rather than disease treatment. Naturopathic physicians employ an array of healing practices, including the following: diet and clinical nutrition, homeopathy, acupuncture, herbal medicine, hydrotherapy (the use of water in a range of temperatures and methods of applications), spinal and soft-tissue manipulation, physical therapies (such as those involving electrical currents, ultrasound, and light), therapeutic counseling, and pharmacology.
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Mind-Body Interventions Mind-body interventions employ a variety of techniques designed to facilitate the mind's capacity to affect bodily function and symptoms. Only a select group of mind-body interventions having well-documented theoretical foundations are considered CAM. For example, patient education and cognitive-behavioral approaches are now considered “mainstream.” On the other hand, complementary and alternative medicine includes meditation, certain uses of hypnosis, dance, music, and art therapy, as well as prayer and mental healing.
Biological-Based Therapies This category of CAM includes natural and biological-based practices, interventions, and products, many of which overlap with conventional medicine's use of dietary supplements. This category includes herbal, special dietary, orthomolecular, and individual biological therapies. Herbal therapy employs an individual herb or a mixture of herbs for healing purposes. An herb is a plant or plant part that produces and contains chemical substances that act upon the body. Special diet therapies, such as those proposed by Drs. Atkins, Ornish, Pritikin, and Weil, are believed to prevent and/or control illness as well as promote health. Orthomolecular therapies aim to treat disease with varying concentrations of chemicals such as magnesium, melatonin, and mega-doses of vitamins. Biological therapies include, for example, the use of laetrile and shark cartilage to treat cancer and the use of bee pollen to treat autoimmune and inflammatory diseases.
Manipulative and Body-Based Methods This category includes methods that are based on manipulation and/or movement of the body. For example, chiropractors focus on the relationship between structure and function, primarily pertaining to the spine, and how that relationship affects the preservation and restoration of health. Chiropractors use manipulative therapy as an integral treatment tool. In contrast, osteopaths place particular emphasis on the musculoskeletal system and practice osteopathic manipulation. Osteopaths believe that all of the body's systems work together and that disturbances in one system may have an impact upon function elsewhere in the body. Massage therapists manipulate the soft tissues of the body to normalize those tissues.
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Energy Therapies Energy therapies focus on energy fields originating within the body (biofields) or those from other sources (electromagnetic fields). Biofield therapies are intended to affect energy fields (the existence of which is not yet experimentally proven) that surround and penetrate the human body. Some forms of energy therapy manipulate biofields by applying pressure and/or manipulating the body by placing the hands in or through these fields. Examples include Qi gong, Reiki and Therapeutic Touch. Qi gong is a component of traditional oriental medicine that combines movement, meditation, and regulation of breathing to enhance the flow of vital energy (qi) in the body, improve blood circulation, and enhance immune function. Reiki, the Japanese word representing Universal Life Energy, is based on the belief that, by channeling spiritual energy through the practitioner, the spirit is healed and, in turn, heals the physical body. Therapeutic Touch is derived from the ancient technique of “laying-on of hands.” It is based on the premises that the therapist’s healing force affects the patient's recovery and that healing is promoted when the body's energies are in balance. By passing their hands over the patient, these healers identify energy imbalances. Bioelectromagnetic-based therapies involve the unconventional use of electromagnetic fields to treat illnesses or manage pain. These therapies are often used to treat asthma, cancer, and migraine headaches. Types of electromagnetic fields which are manipulated in these therapies include pulsed fields, magnetic fields, and alternating current or direct current fields.
Can Alternatives Affect My Treatment? A critical issue in pursuing complementary alternatives mentioned thus far is the risk that these might have undesirable interactions with your medical treatment. It becomes all the more important to speak with your doctor who can offer advice on the use of alternatives. Official sources confirm this view. Though written for women, we find that the National Women’s Health Information Center’s advice on pursuing alternative medicine is appropriate for patients of both genders and all ages.47
47
Adapted from http://www.4woman.gov/faq/alternative.htm.
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Is It Okay to Want Both Traditional and Alternative or Complementary Medicine? Should you wish to explore non-traditional types of treatment, be sure to discuss all issues concerning treatments and therapies with your healthcare provider, whether a physician or practitioner of complementary and alternative medicine. Competent healthcare management requires knowledge of both conventional and alternative therapies you are taking for the practitioner to have a complete picture of your treatment plan. The decision to use complementary and alternative treatments is an important one. Consider before selecting an alternative therapy, the safety and effectiveness of the therapy or treatment, the expertise and qualifications of the healthcare practitioner, and the quality of delivery. These topics should be considered when selecting any practitioner or therapy.
Finding CAM References on Osteoarthritis Having read the previous discussion, you may be wondering which complementary or alternative treatments might be appropriate for osteoarthritis. For the remainder of this chapter, we will direct you to a number of official sources which can assist you in researching studies and publications. Some of these articles are rather technical, so some patience may be required.
The Combined Health Information Database For a targeted search, The Combined Health Information Database is a bibliographic database produced by health-related agencies of the Federal Government (mostly from the National Institutes of Health). This database is updated four times a year at the end of January, April, July, and October. Check the titles, summaries, and availability of CAM-related information by using the “Simple Search” option at the following Web site: http://chid.nih.gov/simple/simple.html. In the drop box at the top, select “Complementary and Alternative Medicine.” Then type “osteoarthritis” (or synonyms) in the second search box. We recommend that you select 100 “documents per page” and to check the “whole records” options. The following was extracted using this technique:
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·
Questions & Answers: NIH Glucosamine/Chondroitin Arthritis Intervention Trial (GAIT) Source: Gaithersburg, MD: National Center for Complementary and Alternative Medicine. 2002. 5 p. Contact: Available from National Center for Complementary and Alternative Medicine Clearinghouse. P.O. Box 7923, Gaithersburg, MD 20898. (888) 644-6226; INTERNATIONAL PHONE: (301) 519-3153; TTY: (866) 464-3615; FAX: (866) 464-3616; E-MAIL:
[email protected]. PRICE: Free. Publication Number: D147. Summary: This National Institutes of Health fact sheet provides information about the Glucosamine/Chondroitin Arthritis Intervention Trial in a question and answer format. It discusses the overall purpose of the trial as well as the circumstances that prompted the NIH to study glucosamine and chondroitin for osteoarthritis. It describes the basic design of the study and includes information about the number of patients included, who is eligible to take part, and how people can sign up to participate in the study. The fact sheet provides general facts about osteoarthritis and the dietary supplements glucosamine and chondroitin, which are being tested to treat the condition.
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S-Adenosyl-L-Methionine for Treatment of Depression, Osteoarthritis, and Liver Disease Source: Rockville, MD: Agency for Healthcare Research and Quality. 2002. 6 p. Contact: Available from National Center for Complementary and Alternative Medicine Clearinghouse. P.O. Box 7923, Gaithersburg, MD 20898. (888) 644-6226; INTERNATIONAL PHONE: (301) 519-3153; TTY: (866) 464-3615; FAX: (866) 464-3616; E-MAIL:
[email protected]. PRICE: Free. Publication Number: D175. Summary: This evidence report/technology assessment summary from the Agency for Healthcare Research and Quality (AHRQ) provides a review of the published literature on the use of S-adenosyl-L-methionine (SAMe) for the treatment of osteoarthritis, depression, and liver disease (cholestasis of pregnancy). The literature review is used to evaluate evidence for the efficacy of SAMe. The summary includes a description of the methodology, including the search strategy; selection criteria; and data collection and analysis. The findings are then discussed followed by an overview of future research on the topic. Information is also given on when and where the full report will be available. 1 reference.
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·
NIH Consensus Conference: Acupuncture Source: JAMA. Journal of the American Medical Association. 280(17): 1518-1524. November 4, 1998. Summary: This journal article presents the findings of the consensus conference on acupuncture, sponsored by the Office of Alternative Medicine and the Office of Medical Applications of Research, National Institutes of Health. The purpose of the conference was to provide clinicians, patients, and the general public with a reliable assessment of the use and effectiveness of acupuncture for a variety of conditions. A multidisciplinary panel evaluated evidence presented by experts and in the scientific literature, and developed a consensus statement addressing five issues: the efficacy of acupuncture compared with placebo or sham acupuncture, the place of acupuncture in clinical practice, the biological effects of acupuncture, the integration of acupuncture into the health care system, and directions for future research. The panel concluded that many of the efficacy studies of acupuncture provide equivocal results because of design, sample size, and other factors. The issue is further complicated by inherent difficulties in the use of appropriate controls. However, promising results have emerged showing the efficacy of acupuncture for adult postoperative and chemotherapy nausea and vomiting, and in postoperative dental pain. In other conditions such as addiction, stroke rehabilitation, headache, menstrual cramps, fibromyalgia, myofascial pain, osteoarthritis, tennis elbow, low back pain, carpal tunnel syndrome, and asthma, acupuncture may be useful as an adjunct treatment, an acceptable alternative, or part of a comprehensive management plan. This article has 66 references.
National Center for Complementary and Alternative Medicine The National Center for Complementary and Alternative Medicine (NCCAM) of the National Institutes of Health (http://nccam.nih.gov) has created a link to the National Library of Medicine's databases to allow patients to search for articles that specifically relate to osteoarthritis and complementary medicine. To search the database, go to the following Web site: www.nlm.nih.gov/nccam/camonpubmed.html. Select “CAM on PubMed.” Enter “osteoarthritis” (or synonyms) into the search box. Click “Go.” The following references provide information on particular aspects of complementary and alternative medicine (CAM) that are related to osteoarthritis: ·
A 57-year-old man with osteoarthritis of the knee. Author(s): Lonner JH.
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Source: Jama : the Journal of the American Medical Association. 2003 February 26; 289(8): 1016-25. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12597755&dopt=Abstract ·
A comparative study of diazepam and acupuncture in patients with osteoarthritis pain: a placebo controlled study. Author(s): Thomas M, Eriksson SV, Lundeberg T. Source: Am J Chin Med. 1991; 19(2): 95-100. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=1816730&dopt=Abstract
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A comparison of acupuncture with advice and exercises on the symptomatic treatment of osteoarthritis of the hip--a randomised controlled trial. Author(s): Haslam R. Source: Acupunct Med. 2001 June; 19(1): 19-26. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11471578&dopt=Abstract
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A comparison of the clinical features of hospital out-patients with rheumatoid disease and osteoarthritis in Pakistan and England. Author(s): Hameed K, Gibson T. Source: British Journal of Rheumatology. 1996 October; 35(10): 994-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=8883439&dopt=Abstract
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A pilot study to evaluate the effects of floatation spa treatment on patients with osteoarthritis. Author(s): Hill S, Eckett MJ, Paterson C, Harkness EF. Source: Complementary Therapies in Medicine. 1999 December; 7(4): 2358. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=10709308&dopt=Abstract
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A randomized controlled trial comparing topical piroxicam gel with a homeopathic gel in osteoarthritis of the knee. Author(s): van Haselen RA, Fisher PA. Source: Rheumatology (Oxford, England). 2000 July; 39(7): 714-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=10908688&dopt=Abstract
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·
A randomized trial of acupuncture as an adjunctive therapy in osteoarthritis of the knee. Author(s): Berman BM, Singh BB, Lao L, Langenberg P, Li H, Hadhazy V, Bareta J, Hochberg M. Source: Rheumatology (Oxford, England). 1999 April; 38(4): 346-54. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=10378713&dopt=Abstract
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A randomized, double-blind, placebo-controlled trial of glucosamine sulphate as an analgesic in osteoarthritis of the knee. Author(s): Hughes R, Carr A. Source: Rheumatology (Oxford, England). 2002 March; 41(3): 279-84. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11934964&dopt=Abstract
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A randomized, placebo-controlled, cross-over study of ginger extracts and ibuprofen in osteoarthritis. Author(s): Bliddal H, Rosetzsky A, Schlichting P, Weidner MS, Andersen LA, Ibfelt HH, Christensen K, Jensen ON, Barslev J. Source: Osteoarthritis and Cartilage / Oars, Osteoarthritis Research Society. 2000 January; 8(1): 9-12. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=10607493&dopt=Abstract
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A specific electrotherapy technique in the treatment of osteoarthritis of the knee: three case reports. Author(s): Singh BB, Zarow FM, Traina A, Scaringe J. Source: Alternative Therapies in Health and Medicine. 2000 September; 6(5): 112, 110-1. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11012282&dopt=Abstract
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Acupuncture as a symptomatic treatment of osteoarthritis. A systematic review. Author(s): Ernst E. Source: Scandinavian Journal of Rheumatology. 1997; 26(6): 444-7. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=9433405&dopt=Abstract
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Acupuncture for osteoarthritis of the knee: a systematic review. Author(s): Ezzo J, Hadhazy V, Birch S, Lao L, Kaplan G, Hochberg M, Berman B. Source: Arthritis and Rheumatism. 2001 April; 44(4): 819-25. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11315921&dopt=Abstract
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Acupuncture-like stimulation with codetron for rehabilitation of patients with chronic pain syndrome and osteoarthritis. Author(s): Fargas-Babjak AM, Pomeranz B, Rooney PJ. Source: Acupuncture & Electro-Therapeutics Research. 1992; 17(2): 95105. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=1353654&dopt=Abstract
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Alternative therapies for traditional disease states: osteoarthritis. Author(s): Morelli V, Naquin C, Weaver V. Source: American Family Physician. 2003 January 15; 67(2): 339-44. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12562155&dopt=Abstract
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An investigation of the effectiveness of exercise and manual therapy in treating symptoms of TMJ osteoarthritis. Author(s): Nicolakis P, Burak EC, Kollmitzer J, Kopf A, Piehslinger E, Wiesinger GF, Fialka-Moser V. Source: Cranio. 2001 January; 19(1): 26-32. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11842837&dopt=Abstract
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Are psychosocial factors related to response to acupuncture among patients with knee osteoarthritis? Author(s): Creamer P, Singh BB, Hochberg MC, Berman BM. Source: Alternative Therapies in Health and Medicine. 1999 July; 5(4): 726. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=10394677&dopt=Abstract
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Argument against use of food additives for osteoarthritis of the hip. Author(s): Callaghan JJ, Buckwalter JA, Schenck RC Jr.
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Source: Clinical Orthopaedics and Related Research. 2000 December; (381): 88-90. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11127674&dopt=Abstract ·
Arnica montana gel in osteoarthritis of the knee: an open, multicenter clinical trial. Author(s): Knuesel O, Weber M, Suter A. Source: Adv Ther. 2002 September-October; 19(5): 209-18. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12539881&dopt=Abstract
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Balneotherapy at the Dead Sea area for knee osteoarthritis. Author(s): Sukenik S, Flusser D, Codish S, Abu-Shakra M. Source: Isr Med Assoc J. 1999 October; 1(2): 83-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=10731301&dopt=Abstract
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Balneotherapy for rheumatoid arthritis and osteoarthritis. Author(s): Verhagen AP, de Vet HC, de Bie RA, Kessels AG, Boers M, Knipschild PG. Source: Cochrane Database Syst Rev. 2000; (2): Cd000518. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=10796385&dopt=Abstract
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Clinical decisions in the use of acupuncture as an adjunctive therapy for osteoarthritis of the knee. Author(s): Singh BB, Berman BM, Hadhazy V, Bareta J, Lao L, Zarow FM, Hochberg M. Source: Alternative Therapies in Health and Medicine. 2001 July-August; 7(4): 58-65. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11452568&dopt=Abstract
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Clinical effect of acupuncture treatment in 109 cases of knee osteoarthritis. Author(s): Jiang A, Zhang L, Zhao C, Yang F. Source: J Tradit Chin Med. 2001 December; 21(4): 282-5. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12014131&dopt=Abstract
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Conservative management of spinal osteoarthritis with glucosamine sulfate and chiropractic treatment. Author(s): Gottlieb MS. Source: Journal of Manipulative and Physiological Therapeutics. 1997 July-August; 20(6): 400-14. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=9272473&dopt=Abstract
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Decreasing osteoarthritis pain. A psychological case report with followup data. Author(s): Rice JM. Source: The Clinical Journal of Pain. 1989 June; 5(2): 183-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=2520401&dopt=Abstract
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Determining the efficacy of glucosamine and chondroitin for osteoarthritis. Author(s): O'Rourke M. Source: The Nurse Practitioner. 2001 June; 26(6): 44-6, 49-52. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11416939&dopt=Abstract
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Dietary habits, weight history, and vitamin supplement use in elderly osteoarthritis patients. Author(s): White-O'Connor B, Sobal J, Muncie HL Jr. Source: Journal of the American Dietetic Association. 1989 March; 89(3): 378-82. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=2921444&dopt=Abstract
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Differential effectiveness of psychological interventions for reducing osteoarthritis pain: a comparison of Erikson [correction of Erickson] hypnosis and Jacobson relaxation. Author(s): Gay MC, Philippot P, Luminet O. Source: European Journal of Pain (London, England). 2002; 6(1): 1-16. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11888223&dopt=Abstract
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Double-blind evaluation of implants of gold wire at acupuncture points in the dog as a treatment for osteoarthritis induced by hip dysplasia.
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Author(s): Hielm-Bjorkman A, Raekallio M, Kuusela E, Saarto E, Markkola A, Tulamo RM. Source: The Veterinary Record. 2001 October 13; 149(15): 452-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11688748&dopt=Abstract ·
Effect of acupuncture on knee function in advanced osteoarthritis of the knee: a prospective, non-randomised controlled study. Author(s): Tillu A, Tillu S, Vowler S. Source: Acupunct Med. 2002 March; 20(1): 19-21. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11926599&dopt=Abstract
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Effect of SKI 306X, a new herbal anti-arthritic agent, in patients with osteoarthritis of the knee: a double-blind placebo controlled study. Author(s): Jung YB, Roh KJ, Jung JA, Jung K, Yoo H, Cho YB, Kwak WJ, Kim DK, Kim KH, Han CK. Source: Am J Chin Med. 2001; 29(3-4): 485-91. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11789591&dopt=Abstract
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Effect of spa therapy in Tiberias on patients with rheumatoid arthritis and osteoarthritis. Author(s): Elkayam O, Wigler I, Tishler M, Rosenblum I, Caspi D, Segal R, Fishel B, Yaron M. Source: The Journal of Rheumatology. 1991 December; 18(12): 1799-803. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=1795315&dopt=Abstract
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Effect of sulfur baths on antioxidative defense systems, peroxide concentrations and lipid levels in patients with degenerative osteoarthritis. Author(s): Ekmekcioglu C, Strauss-Blasche G, Holzer F, Marktl W. Source: Forschende Komplementarmedizin Und Klassische Naturheilkunde = Research in Complementary and Natural Classical Medicine. 2002 August; 9(4): 216-20. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12232493&dopt=Abstract
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Effect on osteoarthritis of spa therapy at Bourbonne-les-Bains. Author(s): Guillemin F, Virion JM, Escudier P, De Talance N, Weryha G.
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Source: Joint, Bone, Spine : Revue Du Rhumatisme. 2001 December; 68(6): 499-503. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11808987&dopt=Abstract ·
Effectiveness of devil's claw for osteoarthritis. Author(s): Chrubasik S, Pollak S, Black A. Source: Rheumatology (Oxford, England). 2002 November; 41(11): 1332-3; Author Reply 1333. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12422011&dopt=Abstract
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Effects of a ginger extract on knee pain in patients with osteoarthritis. Author(s): Altman RD, Marcussen KC. Source: Arthritis and Rheumatism. 2001 November; 44(11): 2531-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11710709&dopt=Abstract
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Effects of a milk-based bioactive micronutrient beverage on pain symptoms and activity of adults with osteoarthritis: a double-blind, placebo-controlled clinical evaluation. Author(s): Colker CM, Swain M, Lynch L, Gingerich DA. Source: Nutrition (Burbank, Los Angeles County, Calif.). 2002 May; 18(5): 388-92. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11985942&dopt=Abstract
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Effects of T'ai Chi training on function and quality of life indicators in older adults with osteoarthritis. Author(s): Hartman CA, Manos TM, Winter C, Hartman DM, Li B, Smith JC. Source: Journal of the American Geriatrics Society. 2000 December; 48(12): 1553-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11129742&dopt=Abstract
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Efficacy and safety of avocado/soybean unsaponifiables in the treatment of symptomatic osteoarthritis of the knee and hip. A prospective, multicenter, three-month, randomized, double-blind, placebo-controlled trial. Author(s): Blotman F, Maheu E, Wulwik A, Caspard H, Lopez A.
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Source: Rev Rhum Engl Ed. 1997 December; 64(12): 825-34. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=9476272&dopt=Abstract ·
Efficacy and tolerability of a standardized willow bark extract in patients with osteoarthritis: randomized placebo-controlled, double blind clinical trial. Author(s): Schmid B, Ludtke R, Selbmann HK, Kotter I, Tschirdewahn B, Schaffner W, Heide L. Source: Phytotherapy Research : Ptr. 2001 June; 15(4): 344-50. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11406860&dopt=Abstract
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Efficacy and tolerability of Boswellia serrata extract in treatment of osteoarthritis of knee--a randomized double blind placebo controlled trial. Author(s): Kimmatkar N, Thawani V, Hingorani L, Khiyani R. Source: Phytomedicine : International Journal of Phytotherapy and Phytopharmacology. 2003 January; 10(1): 3-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12622457&dopt=Abstract
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Efficacy and tolerance of Harpagophytum procumbens versus diacerhein in treatment of osteoarthritis. Author(s): Chantre P, Cappelaere A, Leblan D, Guedon D, Vandermander J, Fournie B. Source: Phytomedicine : International Journal of Phytotherapy and Phytopharmacology. 2000 June; 7(3): 177-83. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11185727&dopt=Abstract
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Efficacy of traditional Chinese acupuncture in the treatment of symptomatic knee osteoarthritis: a pilot study. Author(s): Berman BM, Lao L, Greene M, Anderson RW, Wong RH, Langenberg P, Hochberg MC. Source: Osteoarthritis and Cartilage / Oars, Osteoarthritis Research Society. 1995 June; 3(2): 139-42. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=7584319&dopt=Abstract
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Electroacupuncture and exercise in body weight reduction and their application in rehabilitating patients with knee osteoarthritis. Author(s): Shafshak TS. Source: Am J Chin Med. 1995; 23(1): 15-25. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=7598088&dopt=Abstract
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Electroacupuncture versus Diclofenac in symptomatic treatment of Osteoarthritis of the knee: a randomized controlled trial. Author(s): Sangdee C, Teekachunhatean S, Sananpanich K, Sugandhavesa N, Chiewchantanakit S, Pojchamarnwiputh S, Jayasvasti S. Source: Bmc Complementary and Alternative Medicine [electronic Resource]. 2002 March 21; 2(1): 3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11914160&dopt=Abstract
Additional Web Resources A number of additional Web sites offer encyclopedic information covering CAM and related topics. The following is a representative sample: ·
Alternative Medicine Foundation, Inc.: http://www.herbmed.org/
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AOL: http://search.aol.com/cat.adp?id=169&layer=&from=subcats
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Chinese Medicine: http://www.newcenturynutrition.com/
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drkoop.comÒ: http://www.drkoop.com/InteractiveMedicine/IndexC.html
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Family Village: http://www.familyvillage.wisc.edu/med_altn.htm
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Google: http://directory.google.com/Top/Health/Alternative/
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Healthnotes: http://www.thedacare.org/healthnotes/
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Open Directory Project: http://dmoz.org/Health/Alternative/
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TPN.com: http://www.tnp.com/
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Yahoo.com: http://dir.yahoo.com/Health/Alternative_Medicine/
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WebMDÒHealth: http://my.webmd.com/drugs_and_herbs
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WellNet: http://www.wellnet.ca/herbsa-c.htm
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WholeHealthMD.com: http://www.wholehealthmd.com/reflib/0,1529,,00.html
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The following is a specific Web list relating to osteoarthritis; please note that any particular subject below may indicate either a therapeutic use, or a contraindication (potential danger), and does not reflect an official recommendation: ·
General Overview Arthritis, OsteoSource: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Ost eoarthritiscc.html Bone Loss Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Ost eoporosiscc.html Indigestion, Heartburn, and Low Stomach Acidity Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Indigestion.htm Obesity Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Obe sitycc.html Osteoarthritis Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Osteoarthritis.htm
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Osteoarthritis Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/InteractiveMedicine/ConsLookups/Uses/ osteoarthritis.html Osteoarthritis Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Ost eoarthritiscc.html Osteoarthritis Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000264.html Osteoporosis Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Ost eoporosiscc.html Pain Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Pain.htm Rheumatoid Arthritis Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Rheumatoid_Arth ritis.htm Temporomandibular Joint Dysfunction Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Tem pomandibularJointDysfunctioncc.html
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TMJ Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Tem pomandibularJointDysfunctioncc.html ·
Alternative Therapy Acupuncture Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsModalities/Acu puncturecm.html Apitherapy Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525, 669,00.html Ayurveda Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525, 672,00.html Chiropractic Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsModalities/Chir opracticcm.html Homeopathy Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsModalities/Ho meopathycm.html
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Light therapy Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525, 713,00.html Massage therapy Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525, 716,00.html Qigong Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525, 729,00.html Tai Chi Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsModalities/TaiC hicm.html Therapeutic touch Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525, 739,00.html Yoga Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsModalities/Yog acm.html Yoga Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525, 746,00.html
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·
Homeopathy Aconitum napellus Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Homeo_Homeoix/Aconitu m_napellus.htm Actaea racemosa Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Homeo_Homeoix/Actaea_r acemosa.htm Apis mellifica Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Homeo_Homeoix/Apis_me llifica.htm Arnica Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Homeo_Homeoix/Arnica.ht m Belladonna Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Homeo_Homeoix/Belladon na.htm Bryonia Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Homeo_Homeoix/Bryonia. htm
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Calcarea carbonica Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Homeo_Homeoix/Calcarea _carbonica.htm Calcarea fluorica Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Homeo_Homeoix/Calcarea _fluorica.htm Calcarea phosphorica Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Homeo_Homeoix/Calcarea _phosphorica.htm Cimicifuga Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Homeo_Homeoix/Cimicifu ga.htm Dulcamara Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Homeo_Homeoix/Dulcama ra.htm Kali carbonicum Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Homeo_Homeoix/Kali_carb onicum.htm Kalmia latifolia Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Homeo_Homeoix/Kalmia_l atifolia.htm
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Ledum palustre Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Homeo_Homeoix/Ledum_ palustre.htm Pulsatilla Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Homeo_Homeoix/Pulsatilla .htm Rhus toxicodendron Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Homeo_Homeoix/Rhus_tox icodendron.htm Ruta graveolens Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Homeo_Homeoix/Ruta_gra veolens.htm ·
Herbs and Supplements Amino Acids Overview Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Supp/Amino_Acids.htm Ananas comosus Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsSupplements/Br omelaincs.html Ashwagandha Alternative names: Withania somniferum Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Herb/Ashwagandha.htm
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Beta-Carotene Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000104.html Boswellia Alternative names: Boswellia serrata Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Herb/Boswellia.htm Boswellia Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000115.html Boswellia Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525, 759,00.html Bromelain Alternative names: Ananas comosus, Bromelainum Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsSupplements/Br omelaincs.html Bromelain Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000117.html Bromelainum Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsSupplements/Br omelaincs.html
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Calciferol Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsSupplements/Vi taminDcs.html Calcitrol Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsSupplements/Vi taminDcs.html Cat’s Claw Alternative names: Uncaria tomentosa Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Herb/Cats_Claw.htm Cat's Claw Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000122.html Cayenne Alternative names: Capsicum annuum, Capsicum frutescens Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Herb/Cayenne.htm Celecoxib Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Drug/Celecoxib.htm Cetyl Myristoleate Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Supp/Cetyl_Myristoleate.ht m
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Cherry fruit extract Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525, 10015,00.html Cholecalciferol Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsSupplements/Vi taminDcs.html Devil’s Claw Alternative names: Harpagophytum procumbens Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Herb/Devils_Claw.htm Devil's Claw Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000145.html Diclofenac Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Drug/Diclofenac.htm DMSO Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Supp/DMSO.htm Docosahexaenoic Acid Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Supp/DHA.htm Eicosapentaenoic Acid (EPA) Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsSupplements/Ei cosapentaenoicAcidEPAcs.html
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EPA Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsSupplements/Ei cosapentaenoicAcidEPAcs.html Erocalciferol Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsSupplements/Vi taminDcs.html Etodolac Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Drug/Etodolac.htm Flurbiprofen Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Drug/Flurbiprofen.htm Ginger Alternative names: Zingiber officinale Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Herb/Ginger.htm Glucosamine Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Supp/Glucosamine.htm Glucosamine Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsSupplements/Gl ucosaminecs.html
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Glucosamine Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000168.html Glucosamine Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525, 790,00.html Glutathione Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525, 854,00.html Green tea Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525, 10032,00.html Green-Lipped Mussel Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Supp/Green_Lipped_Muss el.htm Horsetail Alternative names: Equisetum arvense Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Herb/Horsetail.htm Ibuprofen Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Drug/Ibuprofen.htm Indomethacin Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Drug/Indomethacin.htm
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Ketoprofen Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Drug/Ketoprofen.htm Meadowsweet Alternative names: Filipendula ulmaria Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Herb/Meadowsweet.htm Methylsulfonylmethane Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Supp/MSM.htm MSM Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525, 807,00.html Nabumetone Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Drug/Nabumetone.htm N-Acetyl-Glucosamine Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Supp/N_Acetyl_Glucosami ne.htm Nettle Alternative names: Urtica dioica Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Herb/Nettle.htm Non-steroidal Anti-Inflammatory Drugs Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Drug/NSAIDs.htm
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Oxaprozin Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Drug/Oxaprozin.htm Phenylalanine Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Supp/Phenylalanine.htm Phenylalanine Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsSupplements/P henylalaninecs.html Phenylalanine Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000141.html Phosphorus Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsSupplements/P hosphoruscs.html Piroxicam Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Drug/Piroxicam.htm Pregnenolone Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Supp/Pregnenolone.htm Rofecoxib Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Drug/Rofecoxib.htm
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S-Adenosylmethionine (SAMe) Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsSupplements/S AdenosylmethionineSAMecs.html Salsalate Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Drug/Salsalate.htm SAMe Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Supp/SAMe.htm SAMe Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsSupplements/S AdenosylmethionineSAMecs.html SAMe (S-Adenosylmethionine) Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000090.html SAMe (S-adenosylmethionine) Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525, 818,00.html Sulindac Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Drug/Sulindac.htm
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Turmeric Alternative names: Curcuma longa Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Herb/Turmeric.htm Turmeric Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000243.html White Willow Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000247.html Willow Alternative names: Salix alba Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Herb/White_Willow.htm Willow Bark Alternative names: There are several species of willow includingSalix alba, Salix nigra, Salix fragilis, Salix purpurea, Salix babylonica, White Willow, European Willow, Black Willow, Pussy Willow, Crack Willow, Purple Willow, Weeping Willow, Liu-zhi Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsHerbs/WillowB arkch.html Yucca Alternative names: Yucca schidigera , Yucca spp. Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Herb/Yucca.htm Yucca Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000252.html
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General References A good place to find general background information on CAM is the National Library of Medicine. It has prepared within the MEDLINEplus system an information topic page dedicated to complementary and alternative medicine. To access this page, go to the MEDLINEplus site at: www.nlm.nih.gov/medlineplus/alternativemedicine.html. This Web site provides a general overview of various topics and can lead to a number of general sources. The following additional references describe, in broad terms, alternative and complementary medicine (sorted alphabetically by title; hyperlinks provide rankings, information, and reviews at Amazon.com): · The Arthritis Bible: A Comprehensive Guide to Alternative Therapies and Conventional Treatments for Arthritic Diseases by Leonid Gordin, Craig Weatherby; Paperback - 244 pages, 1st edition (April 15, 1999), Inner Traditions Int’l Ltd.; ISBN: 0892818255; http://www.amazon.com/exec/obidos/ASIN/0892818255/icongroupinterna · Healing Joint Pain Naturally : Safe and Effective Ways to Treat Arthritis, Fibromyalgia, and Other Joint Diseases by Ellen Hodgson Brown; Paperback - 262 pages (June 2001), Broadway Books; ISBN: 076790561X; http://www.amazon.com/exec/obidos/ASIN/076790561X/icongroupintern a · Healthy Bones & Joints: A Natural Approach to Treating Arthritis, Osteoporosis, Tendinitis, Myalgia & Bursitis by David Hoffmann; Paperback - 128 pages (July 15, 2000), Storey Books; ISBN: 1580172539; http://www.amazon.com/exec/obidos/ASIN/1580172539/icongroupinterna · Joint Pains: A Guide to Successful Herbal Remedies by Penelope Ody; Paperback - 172 pages (April 2002), Souvenir Press Ltd; ISBN: 0285636227; http://www.amazon.com/exec/obidos/ASIN/0285636227/icongroupinterna · Living Life Free from Pain: Treating Arthritis, Joint Pain, Muscle Pain, and Fibromyalgia with Maharishi Vedic Medicine by Kumuda Reddy, et al; Paperback - 350 pages (August 2001), Lantern Books; ISBN: 1930051549; http://www.amazon.com/exec/obidos/ASIN/1930051549/icongroupint erna · The Posture Prescription : A Doctor's Rx for Eliminating Back, Muscle, and Joint Pain, Achieving Optimum Strength and Mobility, Living a Life of Fitne by Arthur White, MD, et al; Paperback - 256 pages, 1st edition (January 8, 2002), Three Rivers Pr; ISBN: 0609806319; http://www.amazon.com/exec/obidos/ASIN/0609806319/icongroupinterna
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For additional information on complementary and alternative medicine, ask your doctor or write to: National Center for Complementary and Alternative Medicine Clearinghouse National Institutes of Health P. O. Box 8218 Silver Spring, MD 20907-8218
Vocabulary Builder The following vocabulary builder gives definitions of words used in this chapter that have not been defined in previous chapters: Acidity: The quality of being acid or sour; containing acid (hydrogen ions). [EU]
Capsicum: A genus of Solanaceous shrubs that yield capsaicin. Several varieties have sweet or pungent edible fruits that are used as vegetables when fresh and spices when the pods are dried. [NIH] Carotene: The general name for a group of pigments found in green, yellow, and leafy vegetables, and yellow fruits. The pigments are fat-soluble, unsaturated aliphatic hydrocarbons functioning as provitamins and are converted to vitamin A through enzymatic processes in the intestinal wall. [NIH]
Cholecalciferol: An antirachitic oil-soluble vitamin. [NIH] Equisetum: A genus of plants closely related to ferns. Some species have medicinal use and some are poisonous. [NIH] Histamine: 1H-Imidazole-4-ethanamine. A depressor amine derived by enzymatic decarboxylation of histidine. It is a powerful stimulant of gastric secretion, a constrictor of bronchial smooth muscle, a vasodilator, and also a centrally acting neurotransmitter. [NIH] Phenylalanine: An aromatic amino acid that is essential in the animal diet. It is a precursor of melanin, dopamine, noradrenalin, and thyroxine. [NIH] Sulfur: An element that is a member of the chalcogen family. It has an atomic symbol S, atomic number 16, and atomic weight 32.066. It is found in the amino acids cysteine and methionine. [NIH] Virion: The infective system of a virus, composed of the viral genome, a protein core, and a protein coat called a capsid, which may be naked or enclosed in a lipoprotein envelope called the peplos. [NIH]
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APPENDIX C. RESEARCHING NUTRITION Overview Since the time of Hippocrates, doctors have understood the importance of diet and nutrition to patients’ health and well-being. Since then, they have accumulated an impressive archive of studies and knowledge dedicated to this subject. Based on their experience, doctors and healthcare providers may recommend particular dietary supplements to patients with osteoarthritis. Any dietary recommendation is based on a patient's age, body mass, gender, lifestyle, eating habits, food preferences, and health condition. It is therefore likely that different patients with osteoarthritis may be given different recommendations. Some recommendations may be directly related to osteoarthritis, while others may be more related to the patient's general health. These recommendations, themselves, may differ from what official sources recommend for the average person. In this chapter we will begin by briefly reviewing the essentials of diet and nutrition that will broadly frame more detailed discussions of osteoarthritis. We will then show you how to find studies dedicated specifically to nutrition and osteoarthritis.
Food and Nutrition: General Principles What Are Essential Foods? Food is generally viewed by official sources as consisting of six basic elements: (1) fluids, (2) carbohydrates, (3) protein, (4) fats, (5) vitamins, and (6) minerals. Consuming a combination of these elements is considered to be a healthy diet:
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·
Fluids are essential to human life as 80-percent of the body is composed of water. Water is lost via urination, sweating, diarrhea, vomiting, diuretics (drugs that increase urination), caffeine, and physical exertion.
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Carbohydrates are the main source for human energy (thermoregulation) and the bulk of typical diets. They are mostly classified as being either simple or complex. Simple carbohydrates include sugars which are often consumed in the form of cookies, candies, or cakes. Complex carbohydrates consist of starches and dietary fibers. Starches are consumed in the form of pastas, breads, potatoes, rice, and other foods. Soluble fibers can be eaten in the form of certain vegetables, fruits, oats, and legumes. Insoluble fibers include brown rice, whole grains, certain fruits, wheat bran and legumes.
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Proteins are eaten to build and repair human tissues. Some foods that are high in protein are also high in fat and calories. Food sources for protein include nuts, meat, fish, cheese, and other dairy products.
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Fats are consumed for both energy and the absorption of certain vitamins. There are many types of fats, with many general publications recommending the intake of unsaturated fats or those low in cholesterol.
Vitamins and minerals are fundamental to human health, growth, and, in some cases, disease prevention. Most are consumed in your diet (exceptions being vitamins K and D which are produced by intestinal bacteria and sunlight on the skin, respectively). Each vitamin and mineral plays a different role in health. The following outlines essential vitamins: ·
Vitamin A is important to the health of your eyes, hair, bones, and skin; sources of vitamin A include foods such as eggs, carrots, and cantaloupe.
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Vitamin B1, also known as thiamine, is important for your nervous system and energy production; food sources for thiamine include meat, peas, fortified cereals, bread, and whole grains.
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Vitamin B2, also known as riboflavin, is important for your nervous system and muscles, but is also involved in the release of proteins from nutrients; food sources for riboflavin include dairy products, leafy vegetables, meat, and eggs.
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Vitamin B3, also known as niacin, is important for healthy skin and helps the body use energy; food sources for niacin include peas, peanuts, fish, and whole grains
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Vitamin B6, also known as pyridoxine, is important for the regulation of cells in the nervous system and is vital for blood formation; food sources for pyridoxine include bananas, whole grains, meat, and fish.
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Vitamin B12 is vital for a healthy nervous system and for the growth of red blood cells in bone marrow; food sources for vitamin B12 include yeast, milk, fish, eggs, and meat.
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Vitamin C allows the body's immune system to fight various diseases, strengthens body tissue, and improves the body's use of iron; food sources for vitamin C include a wide variety of fruits and vegetables.
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Vitamin D helps the body absorb calcium which strengthens bones and teeth; food sources for vitamin D include oily fish and dairy products.
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Vitamin E can help protect certain organs and tissues from various degenerative diseases; food sources for vitamin E include margarine, vegetables, eggs, and fish.
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Vitamin K is essential for bone formation and blood clotting; common food sources for vitamin K include leafy green vegetables.
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Folic Acid maintains healthy cells and blood and, when taken by a pregnant woman, can prevent her fetus from developing neural tube defects; food sources for folic acid include nuts, fortified breads, leafy green vegetables, and whole grains.
It should be noted that one can overdose on certain vitamins which become toxic if consumed in excess (e.g. vitamin A, D, E and K). Like vitamins, minerals are chemicals that are required by the body to remain in good health. Because the human body does not manufacture these chemicals internally, we obtain them from food and other dietary sources. The more important minerals include: ·
Calcium is needed for healthy bones, teeth, and muscles, but also helps the nervous system function; food sources for calcium include dry beans, peas, eggs, and dairy products.
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Chromium is helpful in regulating sugar levels in blood; food sources for chromium include egg yolks, raw sugar, cheese, nuts, beets, whole grains, and meat.
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Fluoride is used by the body to help prevent tooth decay and to reinforce bone strength; sources of fluoride include drinking water and certain brands of toothpaste.
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Iodine helps regulate the body's use of energy by synthesizing into the hormone thyroxine; food sources include leafy green vegetables, nuts, egg yolks, and red meat.
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Iron helps maintain muscles and the formation of red blood cells and certain proteins; food sources for iron include meat, dairy products, eggs, and leafy green vegetables.
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Magnesium is important for the production of DNA, as well as for healthy teeth, bones, muscles, and nerves; food sources for magnesium include dried fruit, dark green vegetables, nuts, and seafood.
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Phosphorous is used by the body to work with calcium to form bones and teeth; food sources for phosphorous include eggs, meat, cereals, and dairy products.
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Selenium primarily helps maintain normal heart and liver functions; food sources for selenium include wholegrain cereals, fish, meat, and dairy products.
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Zinc helps wounds heal, the formation of sperm, and encourage rapid growth and energy; food sources include dried beans, shellfish, eggs, and nuts.
The United States government periodically publishes recommended diets and consumption levels of the various elements of food. Again, your doctor may encourage deviations from the average official recommendation based on your specific condition. To learn more about basic dietary guidelines, visit the Web site: http://www.health.gov/dietaryguidelines/. Based on these guidelines, many foods are required to list the nutrition levels on the food’s packaging. Labeling Requirements are listed at the following site maintained by the Food and Drug Administration: http://www.cfsan.fda.gov/~dms/labcons.html. When interpreting these requirements, the government recommends that consumers become familiar with the following abbreviations before reading FDA literature:48 ·
DVs (Daily Values): A new dietary reference term that will appear on the food label. It is made up of two sets of references, DRVs and RDIs.
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DRVs (Daily Reference Values): A set of dietary references that applies to fat, saturated fat, cholesterol, carbohydrate, protein, fiber, sodium, and potassium.
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RDIs (Reference Daily Intakes): A set of dietary references based on the Recommended Dietary Allowances for essential vitamins and minerals and, in selected groups, protein. The name “RDI” replaces the term “U.S. RDA.”
48
Adapted from the FDA: http://www.fda.gov/fdac/special/foodlabel/dvs.html.
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·
RDAs (Recommended Dietary Allowances): A set of estimated nutrient allowances established by the National Academy of Sciences. It is updated periodically to reflect current scientific knowledge. What Are Dietary Supplements?49
Dietary supplements are widely available through many commercial sources, including health food stores, grocery stores, pharmacies, and by mail. Dietary supplements are provided in many forms including tablets, capsules, powders, gel-tabs, extracts, and liquids. Historically in the United States, the most prevalent type of dietary supplement was a multivitamin/mineral tablet or capsule that was available in pharmacies, either by prescription or “over the counter.” Supplements containing strictly herbal preparations were less widely available. Currently in the United States, a wide array of supplement products are available, including vitamin, mineral, other nutrients, and botanical supplements as well as ingredients and extracts of animal and plant origin. The Office of Dietary Supplements (ODS) of the National Institutes of Health is the official agency of the United States which has the expressed goal of acquiring “new knowledge to help prevent, detect, diagnose, and treat disease and disability, from the rarest genetic disorder to the common cold.”50 According to the ODS, dietary supplements can have an important impact on the prevention and management of disease and on the maintenance of health.51 The ODS notes that considerable research on the effects of dietary supplements has been conducted in Asia and Europe where the use of plant products, in particular, has a long tradition. However, the overwhelming majority of supplements have not been studied scientifically. To explore the role of dietary supplements in the improvement of health care, the ODS plans, organizes, and supports conferences, workshops, and symposia on scientific topics related to dietary supplements. The ODS often works in conjunction with other NIH Institutes and Centers, other This discussion has been adapted from the NIH: http://ods.od.nih.gov/whatare/whatare.html. 50 Contact: The Office of Dietary Supplements, National Institutes of Health, Building 31, Room 1B29, 31 Center Drive, MSC 2086, Bethesda, Maryland 20892-2086, Tel: (301) 435-2920, Fax: (301) 480-1845, E-mail:
[email protected]. 51 Adapted from http://ods.od.nih.gov/about/about.html. The Dietary Supplement Health and Education Act defines dietary supplements as “a product (other than tobacco) intended to supplement the diet that bears or contains one or more of the following dietary ingredients: a vitamin, mineral, amino acid, herb or other botanical; or a dietary substance for use to supplement the diet by increasing the total dietary intake; or a concentrate, metabolite, constituent, extract, or combination of any ingredient described above; and intended for ingestion in the form of a capsule, powder, softgel, or gelcap, and not represented as a conventional food or as a sole item of a meal or the diet.” 49
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government agencies, professional organizations, and public advocacy groups. To learn more about official information on dietary supplements, visit the ODS site at http://ods.od.nih.gov/whatare/whatare.html. Or contact: The Office of Dietary Supplements National Institutes of Health Building 31, Room 1B29 31 Center Drive, MSC 2086 Bethesda, Maryland 20892-2086 Tel: (301) 435-2920 Fax: (301) 480-1845 E-mail:
[email protected]
Finding Studies on Osteoarthritis The NIH maintains an office dedicated to patient nutrition and diet. The National Institutes of Health’s Office of Dietary Supplements (ODS) offers a searchable bibliographic database called the IBIDS (International Bibliographic Information on Dietary Supplements). The IBIDS contains over 460,000 scientific citations and summaries about dietary supplements and nutrition as well as references to published international, scientific literature on dietary supplements such as vitamins, minerals, and botanicals.52 IBIDS is available to the public free of charge through the ODS Internet page: http://ods.od.nih.gov/databases/ibids.html. After entering the search area, you have three choices: (1) IBIDS Consumer Database, (2) Full IBIDS Database, or (3) Peer Reviewed Citations Only. We recommend that you start with the Consumer Database. While you may not find references for the topics that are of most interest to you, check back periodically as this database is frequently updated. More studies can be found by searching the Full IBIDS Database. Healthcare professionals and researchers generally use the third option, which lists peer-reviewed citations. In all cases, we suggest that you take advantage of the “Advanced Search” option that allows you to retrieve up to 100 fully explained references in a comprehensive format. Type “osteoarthritis” (or synonyms) Adapted from http://ods.od.nih.gov. IBIDS is produced by the Office of Dietary Supplements (ODS) at the National Institutes of Health to assist the public, healthcare providers, educators, and researchers in locating credible, scientific information on dietary supplements. IBIDS was developed and will be maintained through an interagency partnership with the Food and Nutrition Information Center of the National Agricultural Library, U.S. Department of Agriculture.
52
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into the search box. To narrow the search, you can also select the “Title” field. The following is a typical result when searching for recently indexed consumer information on osteoarthritis: ·
A “natural” approach to treating osteoarthritis. Author(s): Arthritis Foundation, Atlanta, USA. Source: Klippel, J Health-News. 2000 May; 6(5): 1-2 1081-5880
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Supplements. Glucosamine for osteoarthritis. Source: Anonymous Harv-Womens-Health-Watch. 2000 May; 7(9): 5-6 1070-910X
The following information is typical of that found when using the “Full IBIDS Database” when searching using “osteoarthritis” (or a synonym): ·
A nutritional approach to osteoarthritis. Source: Jones, W.E. J-equine-vet-sci. WildoMarch, Calif. : William E. Jones, DVM. Mar 2000. Volume 20 (3), page 160, 162-163, 217-218. 07370806
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Alternative therapies for osteoarthritis. Author(s): California State University in Sacramento, USA.
[email protected] Source: Parkman, C A Case-Manager. 2001 May-June; 12(3): 34-6 10619259
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Can ischemic hip disease cause rapidly destructive hip osteoarthritis? A case report. Author(s): Rheumatology department, CHU Rangueil, Toulouse, France. Source: Laroche, Michel Moineuse, Christine Durroux, Regine Mazieres, Bernard Puget, Jean Joint-Bone-Spine. 2002 January; 69(1): 76-80 1297319X
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Can one substance treat both osteoarthritis and depression. Source: Tufts-Univ-health-nutr-lett. New York, NY : Tufts University Health & Nutrition Letter, c1997-. November 1999. volume 17 (9) page 3.
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Clinical evidence for osteoarthritis as an inflammatory disease. Author(s): Division of Rheumatology, Vanderbilt University Medical Center, 203 Oxford House, Box 5, Nashville, TN 37232-4500, USA. Source: Pincus, T Curr-Rheumatol-Repage 2001 December; 3(6): 524-34 1523-3774
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Combination of glycosaminoglycans and acetylsalicylic acid in knee osteoarthrosis. Author(s): Department of Medicine, J. M. Ramos Mejia Hospital, Buenos Aires, Argentina.
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Source: Kerzberg, E M Roldan, E J Castelli, G Huberman, E D Scand-JRheumatol. 1987; 16(5): 377-80 0300-9742 ·
Degenerative joint disease. Part I: Diagnosis and management considerations. Author(s): Department of Oral Biology, University of Florida, College of Dentistry, Gainesville 32610. Source: Bates, R E Gremillion, H A Stewart, C M Cranio. 1993 October; 11(4): 284-90 0886-9634
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Diacerein as a disease-modulating agent in osteoarthritis. Author(s): Rene Descartes University, Cochin Hospital, Rheumatology B Department, 27 rue du Faubourg Saint Jacques, 75014 Paris, France. Source: Falgarone, G Dougados, M Curr-Rheumatol-Repage 2001 December; 3(6): 479-83 1523-3774
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Double-blind comparison of etodolac SR and diclofenac SR in the treatment of patients with degenerative joint disease of the knee. Author(s): Bridgend General Hospital, Newport, Wales. Source: Khan, F M Williams, P I Curr-Med-Res-Opin. 1992; 13(1): 1-12 0300-7995
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Effect of hydration on signal intensity of gelatin phantoms using lowfield magnetic resonance imaging: possible application in osteoarthritis. Source: Baird, D.K. Kincaid, S.A. Hathcock, J.T. Rumph, P.F. Kammerman, J. Visco, D.M. Vet-radiol-ultrasound. Raleigh, NC : American College of Veterinary Radiology. Jan/February 1999. volume 40 (1) page 27-35. 1058-8183
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Effects of body mass and genotype on avian degenerative joint disease pathology and articular cartilage proteoglycan distribution. Author(s): Department of Biochemistry, University of Edinburgh, U.K. Source: Anderson MacKenzie, J M Hulmes, D J Thorp, B H Clin-ExpRheumatol. 1998 Jul-August; 16(4): 403-8 0392-856X
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Efficacy and tolerability of etodolac in aged patients affected by degenerative joint disease (osteoarthritis) in its active phase. Author(s): Division of Rheumatology, University of Padua, Italy. Source: Todesco, S Del Ross, T Marigliano, V Ariani, A Int-J-ClinPharmacol-Res. 1994; 14(1): 11-26 0251-1649
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Enhanced synovial production of hyaluronic acid may explain rapid clinical response to high-dose glucosamine in osteoarthritis. Author(s): Nutrition 21, San Diego, CA 92109, USA. Source: McCarty, M F Med-Hypotheses. 1998 June; 50(6): 507-10 03069877
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Erosive osteoarthritis: presentation, clinical pearls, and therapy. Author(s): University of Pennsylvania School of Medicine; One Independence Place #1101, 241 South Sixth Street, Philadelphia, PA 19106-3731, USA.
[email protected] Source: Ehrlich, G E Curr-Rheumatol-Repage 2001 December; 3(6): 484-8 1523-3774
Federal Resources on Nutrition In addition to the IBIDS, the United States Department of Health and Human Services (HHS) and the United States Department of Agriculture (USDA) provide many sources of information on general nutrition and health. Recommended resources include: ·
healthfinder®, HHS's gateway to health information, including diet and nutrition: http://www.healthfinder.gov/scripts/SearchContext.asp?topic=238&pag e=0
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The United States Department of Agriculture's Web site dedicated to nutrition information: www.nutrition.gov
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The Food and Drug Administration's Web site for federal food safety information: www.foodsafety.gov
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The National Action Plan on Overweight and Obesity sponsored by the United States Surgeon General: http://www.surgeongeneral.gov/topics/obesity/
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The Center for Food Safety and Applied Nutrition has an Internet site sponsored by the Food and Drug Administration and the Department of Health and Human Services: http://vm.cfsan.fda.gov/
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Center for Nutrition Policy and Promotion sponsored by the United States Department of Agriculture: http://www.usda.gov/cnpp/
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Food and Nutrition Information Center, National Agricultural Library sponsored by the United States Department of Agriculture: http://www.nal.usda.gov/fnic/
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Food and Nutrition Service sponsored by the United States Department of Agriculture: http://www.fns.usda.gov/fns/
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Additional Web Resources A number of additional Web sites offer encyclopedic information covering food and nutrition. The following is a representative sample: ·
AOL: http://search.aol.com/cat.adp?id=174&layer=&from=subcats
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Family Village: http://www.familyvillage.wisc.edu/med_nutrition.html
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Google: http://directory.google.com/Top/Health/Nutrition/
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Healthnotes: http://www.thedacare.org/healthnotes/
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Open Directory Project: http://dmoz.org/Health/Nutrition/
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Yahoo.com: http://dir.yahoo.com/Health/Nutrition/
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WebMDÒHealth: http://my.webmd.com/nutrition
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WholeHealthMD.com: http://www.wholehealthmd.com/reflib/0,1529,,00.html
The following is a specific Web list relating to osteoarthritis; please note that any particular subject below may indicate either a therapeutic use, or a contraindication (potential danger), and does not reflect an official recommendation: ·
Vitamins Niacin Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsSupplements/Vi taminB3Niacincs.html Niacin Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525, 892,00.html Vitamin B3 Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Supp/Vitamin_B3.htm
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Vitamin B3 Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000188.html Vitamin B3 (Niacin) Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsSupplements/Vi taminB3Niacincs.html Vitamin C Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000098.html Vitamin D Alternative names: Calciferol, Calcitrol, Cholecalciferol, Erocalciferol Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsSupplements/Vi taminDcs.html Vitamin D Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525, 905,00.html Vitamin E Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Supp/Vitamin_E.htm Vitamin E Alternative names: Alpha-Tocopherol, Beta-Tocopherol, D-AlphaTocopherol, Delta-Tocopherol, Gamma-Tocopherol Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsSupplements/Vi taminEcs.html
282 Osteoarthritis
Vitamin E Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000092.html ·
Minerals Alpha-Tocopherol Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsSupplements/Vi taminEcs.html Beta-Tocopherol Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsSupplements/Vi taminEcs.html Boron Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Supp/Boron.htm Boron Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000114.html Chondroitin Alternative names: chondroitin sulfate, sodium chondroitin sulfate Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsSupplements/C hondroitincs.html Chondroitin Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/InteractiveMedicine/ConsSupplements/In teractions/Chondroitincs.html
Researching Nutrition 283
Chondroitin Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000130.html Chondroitin Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525, 10017,00.html Copper Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000138.html D-Alpha-Tocopherol Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsSupplements/Vi taminEcs.html Delta-Tocopherol Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsSupplements/Vi taminEcs.html Folate Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000161.html Gamma-Tocopherol Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsSupplements/Vi taminEcs.html
284 Osteoarthritis
Glucosamine/Chondroitin Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Supp/Glucosamine_Chondr oitin.htm Manganese Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsSupplements/M anganesecs.html Naproxen/Naproxen Sodium Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Drug/Naproxen.htm Retinol Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsSupplements/Vi taminARetinolcs.html Selenium Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000233.html Vitamin A (Retinol) Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsSupplements/Vi taminARetinolcs.html Zinc Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Supp/Zinc.htm
Researching Nutrition 285
·
Food and Diet Cartilage Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000116.html Cartilage (Bovine and Shark) Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Supp/Cartilage.htm Chondroitin Sulfate Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Supp/Chondroitin_Sulfate. htm Eggplant Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Food_Guide/Eggplant.htm Low Back Pain Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Low_Back_Pain.ht m Omega-3 Fatty Acids Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsSupplements/O mega3FattyAcidscs.html Potatoes Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Food_Guide/Potatoes.htm
286 Osteoarthritis
Sweet Peppers Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Food_Guide/Sweet_Pepper s.htm Tomatoes Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Food_Guide/Tomatoes.htm Weight Loss and Obesity Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Weight_Loss.htm
Vocabulary Builder The following vocabulary builder defines words used in the references in this chapter that have not been defined in previous chapters: Capsules: Hard or soft soluble containers used for the oral administration of medicine. [NIH] Carbohydrate: An aldehyde or ketone derivative of a polyhydric alcohol, particularly of the pentahydric and hexahydric alcohols. They are so named because the hydrogen and oxygen are usually in the proportion to form water, (CH2O)n. The most important carbohydrates are the starches, sugars, celluloses, and gums. They are classified into mono-, di-, tri-, poly- and heterosaccharides. [EU] Estradiol: The most potent mammalian estrogenic hormone. It is produced in the ovary, placenta, testis, and possibly the adrenal cortex. [NIH] Gelatin: A product formed from skin, white connective tissue, or bone collagen. It is used as a protein food adjuvant, plasma substitute, hemostatic, suspending agent in pharmaceutical preparations, and in the manufacturing of capsules and suppositories. [NIH] Hydration: The condition of being combined with water. [EU] Iodine: A nonmetallic element of the halogen group that is represented by the atomic symbol I, atomic number 53, and atomic weight of 126.90. It is a nutritionally essential element, especially important in thyroid hormone synthesis. In solution, it has anti-infective properties and is used topically. [NIH]
Researching Nutrition 287
Niacin: Water-soluble vitamin of the B complex occurring in various animal and plant tissues. Required by the body for the formation of coenzymes NAD and NADP. Has pellagra-curative, vasodilating, and antilipemic properties. [NIH] Overdose: 1. To administer an excessive dose. 2. An excessive dose. [EU] Potassium: An element that is in the alkali group of metals. It has an atomic symbol K, atomic number 19, and atomic weight 39.10. It is the chief cation in the intracellular fluid of muscle and other cells. Potassium ion is a strong electrolyte and it plays a significant role in the regulation of fluid volume and maintenance of the water-electrolyte balance. [NIH] Riboflavin: Nutritional factor found in milk, eggs, malted barley, liver, kidney, heart, and leafy vegetables. The richest natural source is yeast. It occurs in the free form only in the retina of the eye, in whey, and in urine; its principal forms in tissues and cells are as FMN and FAD. [NIH] Selenium: An element with the atomic symbol Se, atomic number 34, and atomic weight 78.96. It is an essential micronutrient for mammals and other animals but is toxic in large amounts. Selenium protects intracellular structures against oxidative damage. It is an essential component of glutathione peroxidase. [NIH] Thermoregulation: Heat regulation. [EU] Thyroxine: An amino acid of the thyroid gland which exerts a stimulating effect on thyroid metabolism. [NIH]
Finding Medical Libraries 289
APPENDIX D. FINDING MEDICAL LIBRARIES Overview At a medical library you can find medical texts and reference books, consumer health publications, specialty newspapers and magazines, as well as medical journals. In this Appendix, we show you how to quickly find a medical library in your area.
Preparation Before going to the library, highlight the references mentioned in this sourcebook that you find interesting. Focus on those items that are not available via the Internet, and ask the reference librarian for help with your search. He or she may know of additional resources that could be helpful to you. Most importantly, your local public library and medical libraries have Interlibrary Loan programs with the National Library of Medicine (NLM), one of the largest medical collections in the world. According to the NLM, most of the literature in the general and historical collections of the National Library of Medicine is available on interlibrary loan to any library. NLM's interlibrary loan services are only available to libraries. If you would like to access NLM medical literature, then visit a library in your area that can request the publications for you.53
53
Adapted from the NLM: http://www.nlm.nih.gov/psd/cas/interlibrary.html.
290 Osteoarthritis
Finding a Local Medical Library The quickest method to locate medical libraries is to use the Internet-based directory published by the National Network of Libraries of Medicine (NN/LM). This network includes 4626 members and affiliates that provide many services to librarians, health professionals, and the public. To find a library in your area, simply visit http://nnlm.gov/members/adv.html or call 1-800-338-7657.
Medical Libraries Open to the Public In addition to the NN/LM, the National Library of Medicine (NLM) lists a number of libraries that are generally open to the public and have reference facilities. The following is the NLM’s list plus hyperlinks to each library Web site. These Web pages can provide information on hours of operation and other restrictions. The list below is a small sample of libraries recommended by the National Library of Medicine (sorted alphabetically by name of the U.S. state or Canadian province where the library is located):54 ·
Alabama: Health InfoNet of Jefferson County (Jefferson County Library Cooperative, Lister Hill Library of the Health Sciences), http://www.uab.edu/infonet/
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Alabama: Richard M. Scrushy Library (American Sports Medicine Institute), http://www.asmi.org/LIBRARY.HTM
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Arizona: Samaritan Regional Medical Center: The Learning Center (Samaritan Health System, Phoenix, Arizona), http://www.samaritan.edu/library/bannerlibs.htm
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California: Kris Kelly Health Information Center (St. Joseph Health System), http://www.humboldt1.com/~kkhic/index.html
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California: Community Health Library of Los Gatos (Community Health Library of Los Gatos), http://www.healthlib.org/orgresources.html
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California: Consumer Health Program and Services (CHIPS) (County of Los Angeles Public Library, Los Angeles County Harbor-UCLA Medical Center Library) - Carson, CA, http://www.colapublib.org/services/chips.html
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California: Gateway Health Library (Sutter Gould Medical Foundation)
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California: Health Library (Stanford University Medical Center), http://www-med.stanford.edu/healthlibrary/
54
Abstracted from http://www.nlm.nih.gov/medlineplus/libraries.html.
Finding Medical Libraries 291
·
California: Patient Education Resource Center - Health Information and Resources (University of California, San Francisco), http://sfghdean.ucsf.edu/barnett/PERC/default.asp
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California: Redwood Health Library (Petaluma Health Care District), http://www.phcd.org/rdwdlib.html
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California: San José PlaneTree Health Library, http://planetreesanjose.org/
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California: Sutter Resource Library (Sutter Hospitals Foundation), http://go.sutterhealth.org/comm/resc-library/sac-resources.html
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California: University of California, Davis. Health Sciences Libraries
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California: ValleyCare Health Library & Ryan Comer Cancer Resource Center (ValleyCare Health System), http://www.valleycare.com/library.html
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California: Washington Community Health Resource Library (Washington Community Health Resource Library), http://www.healthlibrary.org/
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Colorado: William V. Gervasini Memorial Library (Exempla Healthcare), http://www.exempla.org/conslib.htm
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Connecticut: Hartford Hospital Health Science Libraries (Hartford Hospital), http://www.harthosp.org/library/
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Connecticut: Healthnet: Connecticut Consumer Health Information Center (University of Connecticut Health Center, Lyman Maynard Stowe Library), http://library.uchc.edu/departm/hnet/
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Connecticut: Waterbury Hospital Health Center Library (Waterbury Hospital), http://www.waterburyhospital.com/library/consumer.shtml
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Delaware: Consumer Health Library (Christiana Care Health System, Eugene du Pont Preventive Medicine & Rehabilitation Institute), http://www.christianacare.org/health_guide/health_guide_pmri_health _info.cfm
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Delaware: Lewis B. Flinn Library (Delaware Academy of Medicine), http://www.delamed.org/chls.html
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Georgia: Family Resource Library (Medical College of Georgia), http://cmc.mcg.edu/kids_families/fam_resources/fam_res_lib/frl.htm
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Georgia: Health Resource Center (Medical Center of Central Georgia), http://www.mccg.org/hrc/hrchome.asp
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Hawaii: Hawaii Medical Library: Consumer Health Information Service (Hawaii Medical Library), http://hml.org/CHIS/
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·
Idaho: DeArmond Consumer Health Library (Kootenai Medical Center), http://www.nicon.org/DeArmond/index.htm
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Illinois: Health Learning Center of Northwestern Memorial Hospital (Northwestern Memorial Hospital, Health Learning Center), http://www.nmh.org/health_info/hlc.html
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Illinois: Medical Library (OSF Saint Francis Medical Center), http://www.osfsaintfrancis.org/general/library/
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Kentucky: Medical Library - Services for Patients, Families, Students & the Public (Central Baptist Hospital), http://www.centralbap.com/education/community/library.htm
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Kentucky: University of Kentucky - Health Information Library (University of Kentucky, Chandler Medical Center, Health Information Library), http://www.mc.uky.edu/PatientEd/
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Louisiana: Alton Ochsner Medical Foundation Library (Alton Ochsner Medical Foundation), http://www.ochsner.org/library/
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Louisiana: Louisiana State University Health Sciences Center Medical Library-Shreveport, http://lib-sh.lsuhsc.edu/
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Maine: Franklin Memorial Hospital Medical Library (Franklin Memorial Hospital), http://www.fchn.org/fmh/lib.htm
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Maine: Gerrish-True Health Sciences Library (Central Maine Medical Center), http://www.cmmc.org/library/library.html
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Maine: Hadley Parrot Health Science Library (Eastern Maine Healthcare), http://www.emh.org/hll/hpl/guide.htm
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Maine: Maine Medical Center Library (Maine Medical Center), http://www.mmc.org/library/
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Maine: Parkview Hospital, http://www.parkviewhospital.org/communit.htm#Library
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Maine: Southern Maine Medical Center Health Sciences Library (Southern Maine Medical Center), http://www.smmc.org/services/service.php3?choice=10
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Maine: Stephens Memorial Hospital Health Information Library (Western Maine Health), http://www.wmhcc.com/hil_frame.html
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Manitoba, Canada: Consumer & Patient Health Information Service (University of Manitoba Libraries), http://www.umanitoba.ca/libraries/units/health/reference/chis.html
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Manitoba, Canada: J.W. Crane Memorial Library (Deer Lodge Centre), http://www.deerlodge.mb.ca/library/libraryservices.shtml
Finding Medical Libraries 293
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Maryland: Health Information Center at the Wheaton Regional Library (Montgomery County, Md., Dept. of Public Libraries, Wheaton Regional Library), http://www.mont.lib.md.us/healthinfo/hic.asp
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Massachusetts: Baystate Medical Center Library (Baystate Health System), http://www.baystatehealth.com/1024/
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Massachusetts: Boston University Medical Center Alumni Medical Library (Boston University Medical Center), http://medlibwww.bu.edu/library/lib.html
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Massachusetts: Lowell General Hospital Health Sciences Library (Lowell General Hospital), http://www.lowellgeneral.org/library/HomePageLinks/WWW.htm
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Massachusetts: Paul E. Woodard Health Sciences Library (New England Baptist Hospital), http://www.nebh.org/health_lib.asp
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Massachusetts: St. Luke's Hospital Health Sciences Library (St. Luke's Hospital), http://www.southcoast.org/library/
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Massachusetts: Treadwell Library Consumer Health Reference Center (Massachusetts General Hospital), http://www.mgh.harvard.edu/library/chrcindex.html
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Massachusetts: UMass HealthNet (University of Massachusetts Medical School), http://healthnet.umassmed.edu/
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Michigan: Botsford General Hospital Library - Consumer Health (Botsford General Hospital, Library & Internet Services), http://www.botsfordlibrary.org/consumer.htm
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Michigan: Helen DeRoy Medical Library (Providence Hospital and Medical Centers), http://www.providence-hospital.org/library/
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Michigan: Marquette General Hospital - Consumer Health Library (Marquette General Hospital, Health Information Center), http://www.mgh.org/center.html
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Michigan: Patient Education Resouce Center - University of Michigan Cancer Center (University of Michigan Comprehensive Cancer Center), http://www.cancer.med.umich.edu/learn/leares.htm
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Michigan: Sladen Library & Center for Health Information Resources Consumer Health Information, http://www.sladen.hfhs.org/library/consumer/index.html
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Montana: Center for Health Information (St. Patrick Hospital and Health Sciences Center), http://www.saintpatrick.org/chi/librarydetail.php3?ID=41
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·
National: Consumer Health Library Directory (Medical Library Association, Consumer and Patient Health Information Section), http://caphis.mlanet.org/directory/index.html
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National: National Network of Libraries of Medicine (National Library of Medicine) - provides library services for health professionals in the United States who do not have access to a medical library, http://nnlm.gov/
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National: NN/LM List of Libraries Serving the Public (National Network of Libraries of Medicine), http://nnlm.gov/members/
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Nevada: Health Science Library, West Charleston Library (Las Vegas Clark County Library District), http://www.lvccld.org/special_collections/medical/index.htm
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New Hampshire: Dartmouth Biomedical Libraries (Dartmouth College Library), http://www.dartmouth.edu/~biomed/resources.htmld/conshealth.htmld /
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New Jersey: Consumer Health Library (Rahway Hospital), http://www.rahwayhospital.com/library.htm
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New Jersey: Dr. Walter Phillips Health Sciences Library (Englewood Hospital and Medical Center), http://www.englewoodhospital.com/links/index.htm
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New Jersey: Meland Foundation (Englewood Hospital and Medical Center), http://www.geocities.com/ResearchTriangle/9360/
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New York: Choices in Health Information (New York Public Library) NLM Consumer Pilot Project participant, http://www.nypl.org/branch/health/links.html
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New York: Health Information Center (Upstate Medical University, State University of New York), http://www.upstate.edu/library/hic/
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New York: Health Sciences Library (Long Island Jewish Medical Center), http://www.lij.edu/library/library.html
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New York: ViaHealth Medical Library (Rochester General Hospital), http://www.nyam.org/library/
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Ohio: Consumer Health Library (Akron General Medical Center, Medical & Consumer Health Library), http://www.akrongeneral.org/hwlibrary.htm
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Oklahoma: Saint Francis Health System Patient/Family Resource Center (Saint Francis Health System), http://www.sfhtulsa.com/patientfamilycenter/default.asp
Finding Medical Libraries 295
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Oregon: Planetree Health Resource Center (Mid-Columbia Medical Center), http://www.mcmc.net/phrc/
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Pennsylvania: Community Health Information Library (Milton S. Hershey Medical Center), http://www.hmc.psu.edu/commhealth/
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Pennsylvania: Community Health Resource Library (Geisinger Medical Center), http://www.geisinger.edu/education/commlib.shtml
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Pennsylvania: HealthInfo Library (Moses Taylor Hospital), http://www.mth.org/healthwellness.html
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Pennsylvania: Hopwood Library (University of Pittsburgh, Health Sciences Library System), http://www.hsls.pitt.edu/chi/hhrcinfo.html
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Pennsylvania: Koop Community Health Information Center (College of Physicians of Philadelphia), http://www.collphyphil.org/kooppg1.shtml
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Pennsylvania: Learning Resources Center - Medical Library (Susquehanna Health System), http://www.shscares.org/services/lrc/index.asp
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Pennsylvania: Medical Library (UPMC Health System), http://www.upmc.edu/passavant/library.htm
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Quebec, Canada: Medical Library (Montreal General Hospital), http://ww2.mcgill.ca/mghlib/
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South Dakota: Rapid City Regional Hospital - Health Information Center (Rapid City Regional Hospital, Health Information Center), http://www.rcrh.org/education/LibraryResourcesConsumers.htm
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Texas: Houston HealthWays (Houston Academy of Medicine-Texas Medical Center Library), http://hhw.library.tmc.edu/
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Texas: Matustik Family Resource Center (Cook Children's Health Care System), http://www.cookchildrens.com/Matustik_Library.html
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Washington: Community Health Library (Kittitas Valley Community Hospital), http://www.kvch.com/
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Washington: Southwest Washington Medical Center Library (Southwest Washington Medical Center), http://www.swmedctr.com/Home/
Questions and Answers about Arthritis Pain 297
APPENDIX E. QUESTIONS ARTHRITIS PAIN
AND
ANSWERS
ABOUT
Overview Chronic pain is a major health problem in the United States and is one of the most weakening effects of arthritis. More than 40 million Americans are affected by some form of arthritis, and many have chronic pain that limits daily activity. Osteoarthritis is by far the most common form of arthritis, affecting over 20 million Americans, while rheumatoid arthritis, which affects about 2.1 million Americans, is the most disabling form of the disease. This appendix reproduces a document prepared by the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) describing issues relating to arthritis pain.55
What Is Arthritis? The word arthritis literally means joint inflammation, but it is often used to refer to a group of more than 100 rheumatic diseases that can cause pain, stiffness, and swelling in the joints. These diseases may affect not only the joints but also other parts of the body, including important supporting structures such as muscles, bones, tendons, and ligaments, as well as some internal organs. This appendix focuses on pain caused by two of the most common forms of arthritis--osteoarthritis and rheumatoid arthritis.
55
Adapted from the NIAMS: http://www.niams.nih.gov/hi/topics/arthritis/arthpain.htm.
298 Osteoarthritis
What Is Pain? Pain is the body's warning system, alerting you that something is wrong. The International Association for the Study of Pain defines it as an unpleasant experience associated with actual or potential tissue damage to a person's body. Specialized nervous system cells (neurons) that transmit pain signals are found throughout the skin and other body tissues. These cells respond to things such as injury or tissue damage. For example, when a harmful agent such as a sharp knife comes in contact with your skin, chemical signals travel from neurons in the skin through nerves in the spinal cord to your brain, where they are interpreted as pain. Most forms of arthritis are associated with pain that can be divided into two general categories: acute and chronic. Acute pain is temporary. It can last a few seconds or longer but wanes as healing occurs. Some examples of things that cause acute pain include burns, cuts, and fractures. Chronic pain, such as that seen in people with osteoarthritis and rheumatoid arthritis, ranges from mild to severe and can last weeks, months, and years to a lifetime.
What Causes Arthritis Pain? Why Is It So Variable? The pain of arthritis may come from different sources. These may include inflammation of the synovial membrane (tissue that lines the joints), the tendons, or the ligaments; muscle strain; and fatigue. A combination of these factors contributes to the intensity of the pain. The pain of arthritis varies greatly from person to person, for reasons that doctors do not yet understand completely. Factors that contribute to the pain include swelling within the joint, the amount of heat or redness present, or damage that has occurred within the joint. In addition, activities affect pain differently so that some patients note pain in their joints after first getting out of bed in the morning, whereas others develop pain after prolonged use of the joint. Each individual has a different threshold and tolerance for pain, often affected by both physical and emotional factors. These can include depression, anxiety, and even hypersensitivity at the affected sites due to inflammation and tissue injury. This increased sensitivity appears to affect the amount of pain perceived by the individual. Social support networks can make an important contribution to pain management.
Questions and Answers about Arthritis Pain 299
How Do Doctors Measure Arthritis Pain? Pain is a private, unique experience that cannot be seen. The most common way to measure pain is for the doctor to ask you, the patient, about your difficulties. For example, the doctor may ask you to describe the level of pain you feel on a scale of 1 to 10. You may use words like aching, burning, stinging, or throbbing. These words will give the doctor a clearer picture of the pain you are experiencing. Since doctors rely on your description of pain to help guide treatment, you may want to keep a pain diary to record your pain sensations. You can begin a week or two before your visit to the doctor. On a daily basis, you can describe the situations that cause or alter the intensity of your pain, the sensations and severity of your pain, and your reactions to the pain. For example: “On Monday night, sharp pains in my knees produced by housework interfered with my sleep; on Tuesday morning, because of the pain, I had a hard time getting out bed. However, I coped with the pain by taking my medication and applying ice to my knees.” The diary will give the doctor some insight into your pain and may play a critical role in the management of your disease.
What Will Happen When You First Visit a Doctor for Your Arthritis Pain? The doctor will usually do the following: ·
Take your medical history and ask questions such as: How long have you been experiencing pain? How intense is the pain? How often does it occur? What causes it to get worse? What causes it to get better?
·
Review the medications you are using
·
Conduct a physical examination to determine causes of pain and how this pain is affecting your ability to function
·
Take blood and/or urine samples and request necessary laboratory work
·
Ask you to get x rays taken or undergo other imaging procedures such as a CAT scan (computerized axial tomography) or MRI (magnetic resonance imaging) to see how much joint damage has been done.
Once the doctor has done these things and reviewed the results of any tests or procedures, he or she will discuss the findings with you and design a
300 Osteoarthritis
comprehensive management approach for the pain caused by your osteoarthritis or rheumatoid arthritis.
Who Can Treat Arthritis Pain? A number of different specialists may be involved in the care of a patient with arthritis--often a team approach is used. The team may include doctors who treat people with arthritis (rheumatologists), surgeons (orthopaedists), and physical and occupational therapists. Their goal is to treat all aspects of arthritis pain and help you learn to manage your pain. The physician, other health care professionals, and you, the patient, all play an active role in the management of arthritis pain.
How Is Arthritis Pain Treated? There is no single treatment that applies to everyone with arthritis, but rather the doctor will develop a management plan designed to minimize your specific pain and improve the function of your joints.
Short-Term Relief Medications Because people with osteoarthritis have very little inflammation, pain relievers such as acetaminophen (Tylenol) may be effective. Patients with rheumatoid arthritis generally have pain caused by inflammation and often benefit from aspirin or other nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (Motrin or Advil).
Heat and Cold The decision to use either heat or cold for arthritis pain depends on the type of arthritis and should be discussed with your doctor or physical therapist. Moist heat, such as a warm bath or shower, or dry heat, such as a heating pad, placed on the painful area of the joint for about 15 minutes may relieve the pain. An ice pack (or a bag of frozen vegetables) wrapped in a towel and placed on the sore area for about 15 minutes may help to reduce swelling and stop the pain. If you have poor circulation, do not use cold packs.
Questions and Answers about Arthritis Pain 301
Joint Protection Using a splint or a brace to allow joints to rest and protect them from injury can be helpful. Your physician or physical therapist can make recommendations.
Transcutaneous Electrical Nerve Stimulation (TENS) A small TENS device that directs mild electric pulses to nerve endings that lie beneath the skin in the painful area may relieve some arthritis pain. TENS seems to work by blocking pain messages to the brain and by modifying pain perception. Massage--In this pain-relief approach, a massage therapist will lightly stroke and/or knead the painful muscle. This may increase blood flow and bring warmth to a stressed area. However, arthritis-stressed joints are very sensitive, so the therapist must be familiar with the problems of the disease.
Long-Term Relief Osteoarthritis and rheumatoid arthritis are chronic diseases that may last a lifetime. Learning how to manage your pain over the long term is an important factor in controlling the disease and maintaining a good quality of life. Following are some sources of long-term pain relief. Medications Some of the medications used to treat arthritis pain include the following: ·
Biological response modifiers--These new drugs used for the treatment of rheumatoid arthritis reduce inflammation in the joints by blocking the reaction of a substance called tumor necrosis factor, an immune system protein involved in immune system response. These drugs include Enbrel and Remicade.
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Nonsteroidal anti-inflammatory drugs (NSAIDs)--These are a class of drugs including aspirin and ibuprofen that are used to reduce pain and inflammation and may be used for both short-term and long-term relief in people with osteoarthritis and rheumatoid arthritis. NSAIDs also
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include Celebrex and Vioxx, so-called COX-2 inhibitors that block an enzyme known to cause an inflammatory response. ·
Disease-modifying antirheumatic drugs (DMARDs)--These are drugs used to treat people with rheumatoid arthritis who have not responded to NSAIDs. Some of these include the new drug Arava and methotrexate, hydroxychloroquine, penicillamine, and gold injections. These drugs are thought to influence and correct abnormalities of the immune system responsible for a disease like rheumatoid arthritis. Treatment with these medications requires careful monitoring by the physician to avoid side effects.
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Corticosteroids--These are hormones that are very effective in treating arthritis but cause many side effects. Corticosteroids can be taken by mouth or given by injection. Prednisone is the corticosteroid most often given by mouth to reduce the inflammation of rheumatoid arthritis. In both rheumatoid arthritis and osteoarthritis, the doctor also may inject a corticosteroid into the affected joint to stop pain. Because frequent injections may cause damage to the cartilage, they should be done only once or twice a year. Other Products
Hyaluronic acid products like Hyalgan and Synvisc mimic a naturally occurring body substance that lubricates the knee joint and permits flexible joint movement without pain. A blood-filtering device called the Prosorba Column is used in some health care facilities for filtering out harmful antibodies in people with severe rheumatoid arthritis.
Weight Reduction Excess pounds put extra stress on weight-bearing joints such as the knees or hips. Studies have shown that overweight women who lost an average of 11 pounds substantially reduced the development of osteoarthritis in their knees. In addition, if osteoarthritis has already affected one knee, weight reduction will reduce the chance of it occurring in the other knee.
Exercise Swimming, walking, low-impact aerobic exercise, and range-of-motion exercises may reduce joint pain and stiffness. In addition, stretching
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exercises are helpful. A physical therapist can help plan an exercise program that will give you the most benefit.
Surgery In select patients with arthritis, surgery may be necessary. The surgeon may perform an operation to remove the synovium (synovectomy), realign the joint (osteotomy), or in advanced cases replace the damaged joint with an artificial one (arthroplasty). Total joint replacement has provided not only dramatic relief from pain but also improvement in motion for many people with arthritis.
What Alternative Therapies May Relieve Arthritis Pain? Many people seek other ways of treating their disease, such as special diets or supplements. Although these methods may not be harmful in and of themselves, no research to date shows that they help. Some people have tried acupuncture, in which thin needles are inserted at specific points in the body. Others have tried glucosamine and chondroitin sulfate, two natural substances found in and around cartilage cells, for osteoarthritis of the knee. Some alternative or complementary approaches may help you to cope with or reduce some of the stress of living with a chronic illness. It is important to inform your doctor if you are using alternative therapies. If the doctor feels the approach has value and will not harm you, it can be incorporated into your treatment plan. However, it is important not to neglect your regular health care or treatment of serious symptoms.
How Can You Cope with Arthritis Pain? The long-term goal of pain management is to help you cope with a chronic, often disabling disease. You may be caught in a cycle of pain, depression, and stress. To break out of this cycle, you need to be an active participant with the doctor and other health care professionals in managing your pain. This may include physical therapy, cognitive-behavioral therapy, occupational therapy, biofeedback, relaxation techniques (for example, deep breathing and meditation), and family counseling therapy.
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The Multipurpose Arthritis and Musculoskeletal Diseases Center at Stanford University, supported by the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), has developed an Arthritis Self-Help Course that teaches people with arthritis how to take a more active part in their arthritis care. The Arthritis Self-Help Course is taught by the Arthritis Foundation and consists of a 12- to 15-hour program that includes lectures on osteoarthritis and rheumatoid arthritis, exercise, pain management, nutrition, medication, doctor-patient relationships, and nontraditional treatment. Things you can do to manage arthritis pain: ·
Eat a healthy diet.
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Get 8 to 10 hours of sleep at night.
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Keep a daily diary of pain and mood changes to share with your physician.
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Choose a caring physician.
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Join a support group.
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Stay informed about new research on managing arthritis pain.
You may want to contact some of the organizations listed at the end of this appendix for additional information on the Arthritis Self-Help Course and on coping with pain, as well as for information on support groups in your area.
What Research Is Being Conducted on Arthritis Pain? The NIAMS, part of the National Institutes of Health, is sponsoring research that will increase understanding of the specific ways to diagnose, treat, and possibly prevent arthritis pain. As part of its commitment to pain research, the Institute joined with many other NIH institutes and offices in 1998 in a special announcement to encourage more studies on pain. At the Specialized Center of Research in Osteoarthritis at Rush-PresbyterianSt. Luke's Medical Center in Chicago, Illinois, researchers are studying the human knee and analyzing how injury in one joint may affect other joints. In addition, they are analyzing the effect of pain and analgesics on gait (walking) and comparing pain and gait before and after surgical treatment for knee osteoarthritis.
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At the University of Maryland Pain Center in Baltimore, NIAMS researchers are evaluating the use of acupuncture on patients with osteoarthritis of the knee. Preliminary findings suggest that traditional Chinese acupuncture is both safe and effective as an additional therapy for osteoarthritis, and it significantly reduces pain and improves physical function. At Duke University in Durham, North Carolina, NIAMS researchers have developed cognitive-behavioral therapy (CBT) involving both patients and their spouses. The goal of CBT for arthritis pain is to help patients cope more effectively with the long-term demands of a chronic and potentially disabling disease. Researchers are studying whether aerobic fitness, coping abilities, and spousal responses to pain behaviors diminish the patient's pain and disability. NIAMS-supported research on arthritis pain also includes projects in the Institute's Multipurpose Arthritis and Musculoskeletal Diseases Centers. At the University of California at San Francisco, researchers are studying stress factors, including pain, that are associated with rheumatoid arthritis. Findings from this study will be used to develop patient education programs that will improve a person's ability to deal with rheumatoid arthritis and enhance quality of life. At the Indiana University School of Medicine in Indianapolis, health care professionals are looking at the causes of pain and joint disability in patients with osteoarthritis. The goal of the project is to improve doctor-patient communication about pain management and increase patient satisfaction. The list of pain studies continues. A NIAMS-funded project at Stanford University in California is evaluating the effects of a patient education program that uses a book and videotape to control chronic pain. At Indiana University in Indianapolis, Institute-supported scientists are determining whether strength training can diminish the risk of severe pain from knee osteoarthritis. And a multicenter study funded by the National Center for Complementary and Alternative Medicine and NIAMS, and coordinated by the University of Utah School of Medicine, is investigating the effects of the dietary supplements glucosamine and chondroitin sulfate for knee osteoarthritis.
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Where Can You Find More Information on Arthritis Pain? National Institute of Arthritis and Musculoskeletal and Skin Diseases Information Clearinghouse National Institutes of Health 1 AMS Circle Bethesda, MD 20892-3675 Phone: 301-495-4484 or 877-22-NIAMS (226-4267) (free of charge) TTY: 301-565-2966 Fax: 301-718-6366 http://www.niams.nih.gov/ The clearinghouse provides information about various forms of arthritis and rheumatic disease and bone, muscle, and skin diseases. It distributes patient and professional education materials and refers people to other sources of information. Additional information and updates can also be found on the NIAMS Web site. American Academy of Orthopaedic Surgeons P.O. Box 2058 Des Plaines, IL 60017 Phone: 800-824-BONE (2663) (free of charge) www.aaos.org This academy publishes brochures on arthritis and other subjects. Single copies of a brochure are available free of charge by sending a selfaddressed, stamped (business-size) envelope to (name of brochure) at the address above. American College of Rheumatology 1800 Century Place, Suite 250 Atlanta, GA 30345 Phone: 404-633-3777 Fax: 404-633-1870 www.rheumatology.org This association provides referrals to doctors and health professionals who work on arthritis, rheumatic diseases, and related conditions. It also provides educational materials and guidelines.
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American Physical Therapy Association 1111 North Fairfax Street Alexandria, VA 22314-1488 Phone: 703-684-2782 or 800-999-2782, ext. 3395 (free of charge) www.apta.org This association is a national professional organization representing physical therapists, allied personnel, and students. Its objectives are to improve research, public understanding, and education in the physical therapies. Arthritis Foundation 1330 West Peachtree Street Atlanta, GA 30309 Phone: 404-872-7100 or 800-283-7800 (free of charge) or call your local chapter (listed in the telephone directory) www.arthritis.org This is the major voluntary organization devoted to arthritis. The foundation publishes a free brochure, Coping With Pain, and a monthly magazine for members that provides up-to-date information on all forms of arthritis. The foundation also can provide addresses and phone numbers for local chapters and physician and clinic referrals. American Chronic Pain Association P.O. Box 850 Rocklin, CA 95677 Phone: 916-632-0922 www.theacpa.org This association provides information on positive ways to deal with chronic pain and can provide guidelines on selecting a pain management center. American Pain Society 4700 West Lake Avenue Glenview, IL 60025-1485 Phone: 847-375-4715 www.ampainsoc.org This society provides general information to the public and maintains a directory of resources, including referrals to pain centers.
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National Chronic Pain Outreach Association, Inc. 7979 Old Georgetown Road, Suite 100 Bethesda, MD 20814-2429 Phone: 301-652-4948 Fax: 301-907-0745 neurosurgery.mgh.harvard.edu/ncpainoa.htm This association operates an information clearinghouse offering publications and cassette tapes for people with pain. It also publishes a newsletter that includes information on pain management techniques, coping strategies, book reviews, and support groups.
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APPENDIX F. MORE ON RHEUMATIC DISEASES AND ARTHRITIS Overview There are more than 100 rheumatic diseases. These diseases may cause pain, stiffness, and swelling in joints and other supporting structures of the body such as muscles, tendons, ligaments, and bones. Some rheumatic diseases can also affect other parts of the body, including various internal organs. The following discussion was prepared by the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS). It covers the basics of rheumatic diseases and arthritis.
What Are Rheumatic Diseases and What Is Arthritis?56 Many people use the word “arthritis” to refer to all rheumatic diseases. However, the word literally means joint inflammation; that is, swelling, redness, heat, and pain caused by tissue injury or disease in the joint. The many different kinds of arthritis comprise just a portion of the rheumatic diseases. Some rheumatic diseases are described as connective tissue diseases because they affect the body’s connective tissue—the supporting framework of the body and its internal organs. Others are known as autoimmune diseases because they are caused by a problem in which the immune system harms the body’s own healthy tissues. Examples of some rheumatic diseasesinclude:
Adapted from the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS): http://www.niams.nih.gov/hi/topics/arthritis/artrheu.htm.
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Examples of Rheumatic Diseases Osteoarthritis Also known as degenerative joint disease, osteoarthritis is the most common type of arthritis, affecting an estimated 20.7 million adults in the United States. Osteoarthritis primarily affects cartilage, which is the tissue that cushions the ends of bones within the joint. Osteoarthritis occurs when cartilage begins to fray, wear, and decay. In extreme cases, the cartilage may wear away entirely, leaving a bone-on-bone joint. Bony spurs (pointy bulges of bone) may form at the edges of the joint. Osteoarthritis can cause joint pain, reduced joint motion, loss of function, and disability. Disability results most often when the disease affects the spine and the weight-bearing joints (the knees and hips).
Rheumatoid Arthritis Rheumatoid arthritis is an inflammatory disease of the synovium, or lining of the joint, that results in pain, stiffness, swelling, deformity, and loss of function in the joints. Inflammation most often affects joints of the hands and feet and tends to be symmetrical (occurring equally on both sides of the body). This symmetry helps distinguish rheumatoid arthritis from other types of arthritis. About 1 percent of the U.S. population (about 2.1 million people) has rheumatoid arthritis.
Fibromyalgia Fibromyalgia is a chronic disorder that causes pain and stiffness throughout the tissues that support and move the bones and joints. Pain and localized tender points occur in the muscles and tendons, particularly those of the neck, spine, shoulders, and hips. Patients may experience widespread pain, fatigue, and sleep disturbances.
Systemic Lupus Erythematosus Systemic lupus erythematosus (also known as lupus and SLE) is an autoimmune disease in which the immune system harms the body’s own healthy cells and tissues. In SLE, this can result in inflammation of and damage to the joints, skin, kidneys, heart, lungs, blood vessels, and brain.
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Scleroderma Also known as systemic sclerosis, the word scleroderma means “hard skin.” It refers to several diseases that almost always affect the skin, blood vessels, and joints. A more serious form also affects internal organs such as the lungs and kidneys. In scleroderma, there is an abnormal and excessive production of collagen (a fiber-like protein) in the skin or internal organs.
Juvenile Rheumatoid Arthritis This is the most common form of arthritis in childhood, causing pain, stiffness, swelling, and loss of function in the joints. The arthritis may be associated with rashes or fevers, or may affect other parts of the body.
Ankylosing Spondylitis This type of arthritis primarily affects the spine, but may also cause arthritis in the hips, shoulders, and knees. The tendons and ligaments around the bones and joints in the spine become inflamed, resulting in pain and stiffness, especially in the lower back. Ankylosing spondylitis tends to affect people in late adolescence or early adulthood.
Gout This type of arthritis results from deposits of needle-like crystals of uric acid in the connective tissue, joint spaces, or both. Uric acid is a normal breakdown product of purines, which are present in body tissues and in many foods. Usually, uric acid passes through the kidney into urine and is eliminated. If the concentration of uric acid in the blood rises above normal levels, sodium urate crystals may form in the tendons, ligaments, and cartilage of the joints. These needle-like crystals cause inflammation, swelling, and pain in the affected joint. The joint most commonly affected is the big toe.
Infectious Arthritis This is a general term used to describe forms of arthritis that are caused by infectious agents, such as bacteria or viruses. Parvovirus arthritis, gonococcal
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arthritis, and Lyme disease are examples of infectious arthritis. In those cases caused by bacteria, early diagnosis and treatment with antibiotics relieve the arthritis symptoms and cure the disease. Reactive Arthritis This form of arthritis develops after an infection involving the lower urinary tract, bowel, or other organs. It is commonly associated with eye problems, skin rashes, and mouth sores. Reiter’s syndrome is an example of reactive arthritis.
Psoriatic Arthritis This form of arthritis occurs in some patients with psoriasis, a common scaling skin disorder. Psoriatic arthritis often affects the joints at the ends of the fingers and is accompanied by changes in the fingernails and toenails. Some people also have spinal involvement.
Bursitis This condition involves inflammation of the bursae, small, fluid-filled sacs that help reduce friction between bones and other moving structures in the joints. The inflammation may result from arthritis in the joint or injury or infection of the bursae. Bursitis produces pain and tenderness and may limit the movement of nearby joints.
Tendinitis (Tendonitis) This refers to inflammation of tendons (tough cords of tissue that connect muscle to bone) caused by overuse, injury, or related rheumatic conditions. Tendinitis produces pain and tenderness and may restrict movement of nearby joints.
What Causes Rheumatic Disease? The causes of rheumatic diseases vary depending on the type of disease. Researchers have pinpointed the cause or causes of some rheumatic diseases, such as infectious arthritis and gout.
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The causes of most rheumatic diseases are still under investigation. In osteoarthritis, excessive stress on the joint, from repeated injury or inherited cartilage weakness, may play a role. In lupus, rheumatoid arthritis, and scleroderma, the combination of genetic factors that determine susceptibility, the influence of certain hormones, and environmental triggers are believed to be important. Scientists are also studying the risk factors that determine why some people develop rheumatic diseases and others do not. For example, being overweight increases the likelihood that a person will develop osteoarthritis. The chance of developing osteoarthritis also increases with age. Genes and family history play a role in many rheumatic diseases including gout, rheumatoid arthritis, lupus, ankylosing spondylitis, scleroderma, and some others. Certain rheumatic conditions, such as lupus, rheumatoid arthritis, scleroderma, and fibromyalgia, are more common among women. This indicates that hormones or other male-female differences play a role in the development of these conditions.
Who Is Affected by Arthritis and Rheumatic Conditions? An estimated 40 million people in the United States have arthritis or other rheumatic conditions. By the year 2020, this number is expected to reach 59 million. Rheumatic diseases are the leading cause of disability among adults age 65 and older. Rheumatic diseases affect people of all races and ages. Some rheumatic conditions are more common among certain populations. For example: ·
Rheumatoid arthritis occurs two to three times more often in women than in men.
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Scleroderma is more common in women than in men.
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Nine out of 10 people who have lupus are women.
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Nine out of 10 people who have fibromyalgia are women.
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Gout is more common in men than in women.
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Lupus is three times more common in African-American women than in Caucasian women.
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Ankylosing spondylitis is more common in men than in women.
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What Are the Symptoms of Arthritis? Different types of arthritis have different symptoms. In general, people who have arthritis have pain and stiffness in the joints. Some of the more common symptoms are listed below. Early diagnosis and treatment help decrease further joint damage and help control symptoms of arthritis and many other rheumatic diseases. Common symptoms of arthritis include: ·
Swelling in one or more joints
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Stiffness around the joints that lasts for at least 1 hour in the early morning
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Constant or recurring pain or tenderness in a joint
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Difficulty using or moving a joint normally
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Warmth and redness in a joint
How Are Rheumatic Diseases Diagnosed? Diagnosing rheumatic diseases can be difficult because some symptoms and signs are common to many different diseases. A general practitioner or family doctor may be able to evaluate a patient or refer him or her to a rheumatologist: a doctor who specializes in treating arthritis and other rheumatic diseases. The doctor will review the patient’s medical history, conduct a physical examination, and obtain laboratory tests and X rays or other imaging tests. The doctor may need to see the patient more than once to make an accurate diagnosis.
Medical History It is vital for people with joint pain to give the doctor a complete medical history. Answers to the following questions will help the doctor make an accurate diagnosis: ·
Is the pain in one or more joints?
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When does the pain occur?
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How long does the pain last?
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When did you first notice the pain?
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What were you doing when you first noticed the pain?
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Does activity make the pain better or worse?
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Have you had any illnesses or accidents that may account for the pain?
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Is there a family history of any arthritis or rheumatic diseases?
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What medicine(s) are you taking?
It may be helpful for people to keep a daily journal that describes the pain. Patients should write down what the affected joint looks like, how it feels, how long the pain lasts, and what they were doing when the pain started.
Physical Examination The doctor will examine all of the patient’s joints for redness, warmth, deformity, ease of movement, and tenderness. Because some forms of arthritis, such as lupus, may affect other organs, a complete physical examination including the heart, lungs, abdomen, nervous system, and eyes, ears, and throat may be necessary. The doctor may order some laboratory tests to help confirm a diagnosis.
Common Laboratory Tests The following are some examples of laboratory tests which are often used in the diagnosis of osteoarthritis.
Antinuclear Antibody (ANA) This test checks blood levels of antibodies that are often present in people who have connective tissue diseases or other autoimmune disorders, such as lupus. Since the antibodies react with material in the cell’s nucleus (control center), they are referred to as antinuclear antibodies. There are also tests for individual types of ANA’s that may be more specific to people with certain autoimmune disorders. ANA’s are also sometimes found in healthy people. Therefore, having ANA’s in the blood does not necessarily mean that a person has a disease.
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Arthrocentesis Arthrocentesis or joint aspiration is done to obtain a sample of synovial fluid. The doctor injects a local anesthetic, inserts a thin, hollow needle into the joint, and removes the synovial fluid into a syringe. The test provides important diagnostic information. For example, the test allows the doctor to see whether crystals (found in patients with gout or other types of crystalinduced arthritis) or bacteria or viruses (found in patients with infectious arthritis) are present in the joint.
Complement This test measures the level of complement, a group of proteins in the blood. Complement helps destroy foreign substances, such as germs, that enter the body. A low blood level of complement is common in people who have active lupus.
Complete Blood Count (CBC) This test determines the number of white blood cells, red blood cells, and platelets present in a sample of blood. Some rheumatic conditions or drugs used to treat arthritis are associated with a low white blood count (leukopenia), low red blood count (anemia), or low platelet count (thrombocytopenia). When doctors prescribe medications that affect the CBC, they periodically test the patient’s blood.
Creatinine This blood test is commonly ordered in patients who have rheumatic diseases to monitor for underlying kidney disease.
Erythrocyte Sedimentation Rate (SED Rate) This blood test is used to detect inflammation in the body. Higher sed rates indicate the presence of inflammation and are typical of many forms of arthritis, such as rheumatoid arthritis and ankylosing spondylitis, and many of the connective tissue diseases.
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Hematocrit (PCV, Packed Cell Volume) This test and the test for hemoglobin (a substance in the red blood cells that carries oxygen through the body) measure the number of red blood cells present in a sample of blood. A decrease in the number of red blood cells (anemia) is common in people with inflammatory arthritis and rheumatic diseases.
Rheumatoid Factor This test determines whether rheumatoid factor is present in the blood. Rheumatoid factor is an antibody found in the blood of most (but not all) people who have rheumatoid arthritis. Rheumatoid factor may be found in many other diseases besides rheumatoid arthritis, and sometimes in normal, healthy people.
Urinalysis In this test, a urine sample is studied for protein, red blood cells, white blood cells, or casts. These abnormalities indicate kidney disease, which may be seen in several rheumatic diseases such as lupus or vasculitis. Some medications used to treat arthritis can also cause abnormal findings on urinalysis.
White Blood Cell Count (WBC) This test determines the number of white blood cells present in a sample of blood. The number may increase as a result of infection or decrease in response to certain medications, or with certain diseases, such as lupus. Low numbers of white blood cells increase a person’s risk of infections.
Work with Your Doctor to Limit Your Pain The role you play in developing your treatment plan is very important. It is vital for you to have a good relationship with your doctor so that you can work together. You should not be afraid to ask questions about your condition or treatment. You must understand the treatment plan and tell the
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doctor whether or not it is helping you. Studies have shown that patients who are well informed and participate actively in their own care experience less pain and make fewer visits to the doctor than other patients do.
X-Rays and Other Imaging Procedures To see what the joint looks like inside, the doctor may order X-rays or other imaging procedures. X-rays provide an image of the bones, but they do not show the cartilage, muscles, and ligaments. Other noninvasive imaging methods such as computed tomography (CT or CAT), magnetic resonance imaging (MRI), and arthrography (joint X ray) show the whole joint. The doctor may also use an arthroscope (a small, flexible tube that transmits the image of the inside of a joint to a video screen) to examine damage to a joint. The arthroscope is inserted into the affected joint through a very small incision in the skin. This procedure, called arthroscopy, allows the doctor to see inside the joint. Doctors also use arthroscopy to perform surgery for some types of joint injury.
What Are the Treatments? Treatments for arthritis include rest and relaxation, exercise, proper diet, medication, and instruction about the proper use of joints and ways to conserve energy. Other treatments include the use of pain relief methods and assistive devices, such as splints or braces. In severe cases, surgery may be necessary. The doctor and the patient work together to develop a treatment plan that helps the patient maintain or improve his or her lifestyle. Treatment plans usually combine several types of treatment and vary depending on the rheumatic condition and the patient.
Rest, Exercise, and Diet People who have a rheumatic disease should develop a comfortable balance between rest and activity. One sign of many rheumatic conditions is fatigue. Patients must pay attention to signals from their bodies. For example, when experiencing pain or fatigue, it is important to take a break and rest. Too much rest, however, may cause muscles and joints to become stiff. Physical exercise can reduce joint pain and stiffness and increase flexibility, muscle strength, and endurance. It also helps with weight reduction and contributes to an improved sense of well-being. Before starting any exercise
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program, people with arthritis should talk with their doctor. People with arthritis can participate in a variety of sports and exercise programs. Exercises that doctors often recommend include: ·
Range-of-motion exercises to help maintain normal joint movement, maintain or increase flexibility, and relieve stiffness.
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Strengthening exercises to maintain or increase muscle strength. Strong muscles help support and protect joints affected by arthritis.
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Aerobic or endurance exercises to improve cardiovascular fitness, help control weight, and improve overall well-being. Studies show that aerobic exercise can also reduce inflammation in some joints.
Another important part of a treatment program is a well-balanced diet. Along with exercise, a well-balanced diet helps people manage their body weight and stay healthy. Weight control is important to people who have arthritis because extra weight puts extra pressure on some joints and can aggravate many types of arthritis. Diet is especially important for people who have gout. People with gout should avoid alcohol and foods that are high in purines, such as organ meats (liver, kidney), sardines, anchovies, and gravy.
Medications A variety of medications are used to treat rheumatic diseases. The type of medication depends on the rheumatic disease and on the individual patient. At this time, the medications used to treat most rheumatic diseases do not provide a cure, but rather limit the symptoms of the disease. The one exception is treatments for infectious arthritis. If caught early enough, arthritis associated with an infection (such as Lyme disease) can usually be cured with antibiotics. Medications commonly used to treat rheumatic diseases provide relief from pain and inflammation. In some cases, the medication may slow the course of the disease and prevent further damage to joints or other parts of the body. This fact sheet describes the medications most commonly used to treat pain and inflammation. The doctor may delay using medications until a definite diagnosis is made, because medications can hide important symptoms (such as fever and swelling) and thereby interfere with diagnosis. Patients taking any medication, either prescription or over-the-counter, should always follow the doctor’s instructions. The doctor should be notified immediately if the
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medicine is making the symptoms worse or causing other problems, such as an upset stomach, nausea, or headache. The doctor may be able to change the dosage or medicine to reduce these side effects. Analgesics (pain relievers) such as aspirin; other nonsteroidal antiinflammatory drugs (NSAID’s) such as ibuprofen (Motrin,¹ Advil, Nuprin); and acetaminophen (Tylenol) are used to reduce the pain caused by many rheumatic conditions. Aspirin and NSAID’s have the added benefit of decreasing the inflammation associated with arthritis. Certain analgesics, such as aspirin and NSAID’s, can have side effects, such as stomach irritation, that can be reduced by changing the dosage or the medication. The dosage will vary depending on the particular illness and the overall health of the patient. The doctor and patient must work together to determine which analgesic to use and the appropriate amount. If analgesics do not ease the pain, the doctor may use other medications, depending on the diagnosis. Corticosteroids, such as prednisone, cortisone, solumedrol, and hydrocortisone, are used to treat many rheumatic conditions because they decrease inflammation and suppress the immune system. The dosage of these medications will vary depending on the diagnosis and the patient; again, the patient and doctor must work together to determine what dose is best for the patient. Corticosteroids can be given by mouth, in creams applied to the skin, or by injection. Short-term side effects of corticosteroids include swelling, increased appetite, weight gain, and emotional ups and downs. These side effects generally stop when the drug is stopped. It can be dangerous to stop taking corticosteroids suddenly, so it is very important that the doctor and patient work together when changing the corticosteroid dose. Side effects that may occur after long-term use of corticosteroids include stretch marks, excessive hair growth, osteoporosis, high blood pressure, damage to the arteries, high blood sugar, infections, and cataracts. Although some rheumatic diseases respond to analgesics and corticosteroids, others may not. Rheumatoid arthritis, gout, lupus, scleroderma, and fibromyalgia are some of the rheumatic diseases that routinely require other medications; these are prescribed to slow the course of the disease or to treat disease-specific symptoms.
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Heat and Cold Therapies Heat and cold can both be used to reduce the pain and inflammation of arthritis. Both therapies come in different forms, and the patient and doctor can determine which form works best. Studies have shown heat and cold therapies to be equally effective in reducing pain, although they are usually avoided in acute gout. Heat therapy increases blood flow, tolerance for pain, and flexibility. Heat therapy can involve treatment with paraffin wax, microwaves, ultrasound, or moist heat. Physical therapists are needed to apply paraffin wax, or use microwave or ultrasound therapy, but patients can apply moist heat themselves. Some ways to apply moist heat include placing warm towels or hot packs on the inflamed joint or taking a warm bath or shower. Cold therapy numbs the nerves around the joint (which reduces pain) and relieves inflammation and muscle spasms. Cold therapy can involve cold packs, ice massage, soaking in cold water, or over-the-counter sprays and ointments that cool the skin and joints.
Hydrotherapy, Mobilization Therapy, and Relaxation Therapy Hydrotherapy involves exercising or relaxing in warm water, which helps relax tense muscles and relieve pain. Exercising in a large pool is easier because water takes some weight off painful joints. This type of exercise improves muscle strength and joint movement. Mobilization therapies include traction (gentle, steady pulling), massage, and manipulation (using the hands to restore normal movement to stiff joints). When done by a trained professional, these methods can help control pain, increase joint motion, and improve muscle and tendon flexibility. Relaxation therapy helps reduce pain by teaching people various ways to release muscle tension throughout the body. In one method of relaxation therapy, known as progressive relaxation, the patient tightens a muscle group and then slowly releases the tension. Doctors and physical therapists can teach patients progressive relaxation and other relaxation techniques.
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Assistive Devices The most common assistive devices for treating arthritis pain are splints and braces, which are used to support weakened joints or allow them to rest. Some of these devices prevent the joint from moving; others allow some movement. A splint or brace should be used only when recommended by a doctor or therapist, who will show the patient the correct way to put the device on, ensure that it fits properly, and explain when and for how long it should be worn. The incorrect use of a splint or brace can cause joint damage, stiffness, and pain. A person with arthritis can use other kinds of devices to ease the pain. For example, the use of a cane when walking can reduce some of the weight placed on an arthritic knee or hip. A shoe insert (orthotic) can ease the pain of walking caused by arthritis of the foot or knee.
Surgery Surgery may be required to repair damage to a joint after trauma (a torn meniscus, for example) or to restore function or relieve pain in a joint damaged by arthritis. The doctor may recommend arthroscopic surgery, bone fusion (surgery in which bones in the joint are fused or joined together), or arthroplasty (also known as total joint replacement, in which the damaged joint is removed and replaced with an artificial one).
Myths about Treating Arthritis At this time, the only type of arthritis that can be cured is that caused by infections. Although symptoms of other types of arthritis can be effectively managed with rest, exercise, and medication, there are no cures. Some people claim to have been cured by treatment with herbs, oils, chemicals, special diets, radiation, or other products. However, there is no scientific evidence that such treatments are helpful in patients with arthritis and, moreover, they may actually cause harm with the development of side effects. Patients should talk to their doctor before using any therapy that has not been prescribed or recommended by the health care team caring for the patient.
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What Can Be Done to Help? Studies show that an estimated 18 percent of Americans who have arthritis or other rheumatic conditions believe that their condition limits their activities. People with arthritis may find that they can no longer participate in some of their favorite activities, which can affect their overall well-being. Even when arthritis impairs only one joint, a person may have to change many daily activities to protect that joint from further damage and reduce pain. When arthritis affects the entire body, as it does in people with rheumatoid arthritis or fibromyalgia, many daily activities have to be changed to deal with pain, fatigue, and other symptoms. Changes in the home may help a person with chronic arthritis continue to live safely, productively, and with less pain. People with arthritis may become weak, lose their balance, or fall in the bathroom. Installing grab bars in the tub or shower and by the toilet, placing a secure seat in the tub, and raising the height of the toilet seat can help. Special kitchen utensils can accommodate arthritic hands to make meal preparation easier. An occupational therapist can help people who have rheumatic conditions identify and make adjustments in their homes to create a safer, less painful, and more efficient environment. Friends and family can help a patient with a rheumatic condition by learning about that condition and understanding how it affects the patient’s life. Friends and family can provide emotional and physical assistance. Their support, as well as support from other people who have the same disease, can make it easier to cope. The Arthritis Foundation (see the list of resources at the end of this fact sheet) has a wealth of information to help people with arthritis.
What Is Some of the Current Research Being Done on Arthritis? The National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), a part of the National Institutes of Health (NIH), leads the Federal medical research effort in arthritis and rheumatic diseases. The NIAMS sponsors research and research training on the NIH campus in Bethesda, Maryland, and at universities and medical centers throughout the United States.
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The NIAMS supports three types of centers: Multipurpose Arthritis and Musculoskeletal Diseases Centers (MAMDC’s), Specialized Centers of Research (SCOR’s), and Core Centers. The MAMDC’s foster a multidisciplinary approach to the many problems of arthritis and musculoskeletal diseases and develop new capabilities for research into other diseases. Centers develop and carry out research in basic or laboratory and clinical science, professional and patient education, and epidemiology and health services. Each SCOR focuses on a single disease: currently, rheumatoid arthritis, systemic lupus erythematosus, osteoarthritis, osteoporosis, and scleroderma. By doing laboratory and clinical studies under one roof, these centers aim to speed up basic research on the causes of these diseases and to hasten transfer of advances from the laboratory to the bedside and improve patient care. Core Centers promote interdisciplinary collaborative efforts among scientists engaged in high-quality research related to a common theme. By providing funding for facilities, pilot and feasibility studies, and program enrichment activities at the Core Center, the Institute reinforces and amplifies investigations already ongoing in NIAMS program areas. Core Centers are currently targeted for skin diseases (Skin Disease Research Core Centers) and for musculoskeletal disorders (Core Centers for Musculoskeletal Disorders). Some current NIAMS research efforts in rheumatoid arthritis, osteoarthritis, lupus, and scleroderma are outlined below.
Rheumatoid Arthritis Researchers are trying to identify the causes of rheumatoid arthritis in the hope that understanding the cause will lead to new treatments. They are examining the role that the endocrine (hormonal), nervous, and immune systems play, and the ways in which these systems interact with environmental and genetic factors in the development of rheumatoid arthritis. Some scientists are trying to determine whether an infectious agent triggers rheumatoid arthritis. Others are studying the role of certain enzymes (specialized proteins in the body that carry out biochemical reactions) in breaking down cartilage. Researchers are also trying to identify the genetic factors that place some people at higher risk than others for developing rheumatoid arthritis.
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Moreover, scientists are looking at new ways to treat rheumatoid arthritis. They are experimenting with new drugs and “biologic agents” that selectively block certain immune system activities associated with inflammation. Recent studies suggest that these represent promising approaches to treatment. Other investigators have shown that minocycline and doxycycline, two antibiotic medications in the tetracycline family, have a modest benefit for people with rheumatoid arthritis. Osteoarthritis Researchers are working to understand what role certain enzymes play in the breakdown of joint cartilage in osteoarthritis and are testing drugs that block the action of these enzymes. In addition, a gene that may be linked to an inherited form of osteoarthritis has recently been discovered.
Systemic Lupus Erythematosus Researchers are looking at how genetic, environmental, and hormonal factors influence the development of systemic lupus erythematosus. They are trying to find out why lupus is more common in certain populations. There has been very promising progress in identifying the genes that may be responsible for lupus. Promising areas of treatment research include biologic agents; newer, more selective drugs that suppress the immune system; and efforts to correct immune abnormalities with bone marrow transplantation. Clinical studies are underway to determine the safety of estrogens for hormone replacement therapy and birth control in women with lupus. Contrary to the widely held belief that estrogens can make the disease worse, recent data suggest that these drugs may be safe for some women with lupus. Scleroderma Current studies on scleroderma are focusing on three areas of the disease: overproduction of collagen, blood vessel injury, and abnormal immune system activity. Researchers hope to discover how these three elements interact with each other to cause and promote scleroderma. In one recent study, researchers found evidence of fetal cells within the blood and skin lesions of women who had been pregnant years before developing scleroderma. The study suggests that fetal cells may play a role in
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scleroderma by maturing immune cells that promote the overproduction of collagen. Scientists are continuing to study the implications of this finding.
Where Can I Find More Information about Arthritis? For more information, contact: Arthritis Foundation 1330 West Peachtree Street Atlanta, GA 30309 404/872–7100 800/283–7800, or call your local chapter (listed in the telephone directory) http://www.arthritis.org/ This is the main voluntary organization devoted to arthritis. The foundation publishes free pamphlets on many types of arthritis and a monthly magazine for members that provides up-to-date information on arthritis. The foundation also can provide physician and clinic referrals. American College of Rheumatology/Association of Rheumatology Health Professionals 1800 Century Place, Suite 250 Atlanta, GA 30345–4300 404/633–3777 Fax: 404/633–1870 World Wide Web address: http://www.rheumatology.org/ This association provides referrals to rheumatologists and physical and occupational therapists who have experience working with people who have rheumatic diseases. The organization also provides educational materials and guidelines about many different rheumatic diseases. National Arthritis and Musculoskeletal and Skin Diseases Information Clearinghouse (NAMSIC) National Institutes of Health 1 AMS Circle Bethesda, Maryland 20892–3675 301/495–4484 TTY: 301/565–2966 Fax: 301/718–6366 http://www.niams.nih.gov This clearinghouse, a public service sponsored by the NIAMS, provides information about various forms of arthritis and rheumatic disease. The clearinghouse distributes patient and professional education materials and also refers people to other sources of information.
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APPENDIX G. NIH CONSENSUS STATEMENT ON TOTAL HIP REPLACEMENT Overview NIH Consensus Development Conferences are convened to evaluate available scientific information and resolve safety and efficacy issues related to biomedical technology. The resultant NIH Consensus Statements are intended to advance understanding of the technology or issue in question and to be useful to health professionals and the public.57 Each NIH consensus statement is the product of an independent, non-Federal panel of experts and is based on the panel's assessment of medical knowledge available at the time the statement was written. Therefore, a consensus statement provides a “snapshot in time” of the state of knowledge of the conference topic. The NIH makes the following caveat: “When reading or downloading NIH consensus statements, keep in mind that new knowledge is inevitably accumulating through medical research. Nevertheless, each NIH consensus statement is retained on this website in its original form as a record of the NIH Consensus Development Program.”58 The following concensus statement was posted on the NIH site and not indicated as “out of date” in March 2002. It was originally published, however, in September 1994.59
This paragraph is adapted from the NIH: http://odp.od.nih.gov/consensus/cons/cons.htm. 58 Adapted from the NIH: http://odp.od.nih.gov/consensus/cons/consdate.htm. 59 Total Hip Replacement. NIH Consens Statement Online 1994 September 12-14 [cited 2002 February 21]; 12(5): 1-31: http://consensus.nih.gov/cons/098/098_statement.htm. 57
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Objective To provide physicians with a current consensus on total hip replacement.
Participants A non-Federal, nonadvocate, 13-member consensus panel representing the fields of orthopedic surgery, rehabilitation and physical medicine, biomechanics and biomaterials, internal medicine, public health, geriatrics and biostatistics, and a public representative. In addition, 27 experts in orthopedic surgery, rehabilitation and physical medicine, biomechanics and biomaterials, rheumatology, geriatrics, and epidemiology presented data to the consensus panel and a conference audience of 425.
Evidence The literature was searched through Medline and an extensive bibliography of references was provided to the panel and the conference audience. Experts prepared abstracts with relevant citations from the literature. Scientific evidence was given precedence over clinical anecdotal experience.
Consensus The panel, answering predefined consensus questions, developed their conclusions based on the scientific evidence presented in open forum and the scientific literature. Consensus Statement The panel composed a draft statement that was read in its entirety and circulated to the experts and the audience for comment. Thereafter, the panel resolved conflicting recommendations and released a revised statement at the end of the conference. The panel finalized the revisions within a few weeks after the conference.
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Conclusions Total hip replacement is an option for nearly all patients with diseases of the hip that cause chronic discomfort and significant functional impairment. Most patients have an excellent prognosis for long-term improvement in symptoms and physical function. At this time, a cemented femoral component using modern cementing techniques, paired with a porouscoated acetabular component, can give excellent long-term results. Revision of a total hip replacement is indicated when mechanical failure occurs. Continued periodic follow-up is necessary to identify early evidence of impending failure so as to permit remedial action before a catastrophic event.
What Is Total Hip Replacement? More than 120,000 artificial hip joints are being implanted annually in the United States. Successful replacement of deteriorated, arthritic, and severely injured hips has contributed to enhanced mobility and comfortable, independent living for many people who would otherwise be substantially disabled. New technology involving prosthetic devices for replacement of the hip, along with advances in surgical techniques, has diminished the risks associated with the operation and improved the immediate and long-term outcome of hip replacement surgery. Questions remain, however, concerning which prosthetic designs and materials are most effective for specific groups of patients and which surgical techniques and rehabilitation approaches yield the best long-term outcomes. Issues also exist regarding the best indications and approaches for revision surgery. As a follow-up to the National Institutes of Health (NIH) Consensus Development Conference (CDC) on Total Hip Joint Replacement held in 1982, the National Institute of Arthritis and Musculoskeletal and Skin Diseases, together with the Office of Medical Applications of Research of the NIH, convened a second CDC on Total Hip Replacement on September 1214, 1994. The conference was cosponsored by the National Institute on Aging, the National Institute of Child Health and Human Development, and the Office of Research on Women's Health. After 1-1/2 days of presentations by experts in the relevant fields and discussion by a knowledgeable audience, an independent, non-Federal consensus panel composed of specialists from the fields of orthopedic surgery, epidemiology, rehabilitation and physical medicine, biomechanics and biomaterials,
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geriatrics, rheumatology, as well as a public representative, weighed the scientific evidence and formulated a consensus statement in response to the following six previously stated questions: ·
What are the current indications for total hip replacement?
·
What are the design and surgical considerations relating to a replacement prosthesis?
·
What are the responses of the biological environment?
·
What are the expected outcomes?
·
What are the accepted approaches and outcomes for revision of a total hip replacement?
·
What are the most productive directions for future research?
This consensus statement reflects a synthesis of generally accepted observations and recommendations derived from the scientific presentations as well as a general review of current literature by the consensus panel. This panel also identified areas of limited information where further research would be most productive.
What Are the Current Indications for Total Hip Replacement? Primary total hip replacement (THR) is most commonly used for hip joint failure caused by osteoarthritis; other indications include, but are not limited to, rheumatoid arthritis, avascular necrosis, traumatic arthritis, certain hip fractures, benign and malignant bone tumors, the arthritis associated with Paget's disease, ankylosing spondylitis, and juvenile rheumatoid arthritis. The aims of THR are relief of pain and improvement in function. Candidates for elective THR should have radiographic evidence of joint damage and moderate to severe persistent pain or disability, or both, that is not substantially relieved by an extended course of nonsurgical management. These measures usually include trials of analgesic and nonsteroidal antiinflammatory drugs (NSAIDs), physical therapy, the use of walking aids, and reduction in physical activities that provoke discomfort. In certain conditions such as rheumatoid arthritis and Paget's disease, additional disease-specific therapies may be appropriate. The patient's goals and expectations should be ascertained prior to THR to determine whether they are realistic and attainable by the recommended therapeutic approach. Any discrepancies between the patient's expectations and the likely outcome should be discussed in detail with the patient and family members before surgery.
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In the past, patients between 60 and 75 years of age were considered to be among the best candidates for THR. Over the last decade, however, the age range has been broadened to include more elderly patients, many of whom have a higher level of comorbidities, as well as younger patients, whose implants may be exposed to greater mechanical stresses over an extended time course. In patients less than 55 years of age, alternative surgical procedures such as fusion and osteotomy deserve consideration. However, there are no data showing that the outcomes of these procedures are as good or better than those from THR when performed for similar indications. Advanced age alone is not a contraindication for THR; poor outcomes appear to be related to comorbidities rather than to age. There are few contraindications to THR other than active local or systemic infection and other medical conditions that substantially increase the risk of serious perioperative complications or death. Obesity has been considered a relative contraindication because of a reported higher mechanical failure rate in heavier patients; however, the prospect of substantial long-term reduction in pain and disability for heavier patients appears to be similar to that for the population in general. Thus, although the clinical conditions and circumstances leading to THR are broadly defined, several issues regarding indications remained unresolved. For example, data are insufficient on the associations between potential risk factors (e.g., age, weight, smoking, medications) and outcomes to guide treatment of the individual patient. Moreover, indications are not clear for use of the various surgical approaches and types of prostheses in individual patients. Finally, standardized instruments to measure levels of pain, physical disability, and quality of life as perceived by the patient need to be used to guide clinical decision making and choice of surgery.
What Are the Design and Surgical Considerations Relating to a Replacement Prosthesis? At the NIH CDC on Total Hip Joint Replacement held in 1982, aseptic loosening was identified as a major problem with THR. It was especially prevalent in young, active patients and after revision surgery. Because it appeared with increasing frequency over time, it was feared that a much larger problem would emerge. Newer fixation (cement and cementless) techniques had been introduced, but their long-term efficacy was unknown. Cobalt-, titanium-, and iron-based alloys, higher molecular weight
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polyethylene, and autocuring polymethylmethacrylate (PMMA) bone cement were the materials used in most implants. Chemical modifications and altered processing of the alloys had been introduced to deal with the problem of fractured stems. As of 1994, state of the art pertaining to THR has changed substantially. For example, changes have been made in fixation (cement and cementless), device designs, and some materials. Concerns remain about the in vivo durability of femoral and acetabular components of the implants, but the procedure has a more predictable outcome. The newer cementing techniques have proven to be more successful than the original ones on the femoral side. Improved techniques include the use of a medullary plug, a cement gun, lavage of the canal, pressurization, centralization of the stem, and reduction in porosity in the cement. However, the optimum cement-metal interface has yet to be identified. These newer procedures minimize defects and localized stress concentrations in the cement. Their current success indicates that previously observed aseptic loosening within the first 10 years following implantation was primarily a mechanical process and that steps to reduce stresses in the materials and improve strength of the interfaces are reasonable to reduce loosening. Further optimization of the bone implant interface constitutes an important opportunity for future research. Another important change in fixation has been the introduction and widespread use of noncemented components that rely on bone growth into porous or onto roughened surfaces for fixation. In the femur, selected cementless components have exhibited clinical success, although with shorter follow-up, similar to that of cemented components installed with the newer cementing techniques. There is evidence that bone changes (osteolysis or bone resorption) can occur as well with some of the cementless components. Numerous reports document resorption, and although it has not usually become symptomatic during early stages of follow-up, concerns nevertheless exist about progressive osteolysis and consequent aseptic loosening or fracture. On the acetabular side, the cementless components have demonstrated less aseptic loosening compared with the cemented components over the short term, although long-term results are not yet available. The prospective and retrospective studies conducted have been specific to device design and technique, and any general comparison of cemented and noncemented systems should be viewed with caution. The implants themselves have undergone multiple changes. As a result of improved alloys and designs, fracture of femoral stems is no longer a
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significant problem. Stem cross-sections have been rounded to avoid high stresses in the cement. There is still controversy over the appropriate length of uncemented stems and the extent and location of porous or roughened regions. Metal backing of cemented acetabular components has not been associated with a high degree of success and is now used infrequently. Metal-backed acetabular components with porous coatings have demonstrated good to excellent results in regard to loosening noted at 5- to 7-year follow-up and continue to be followed. Modular components have been introduced and are widely used, but it is recognized that in vivo disassembly, fretting and corrosion, and wear between components can be a source of debris and may contribute to osteolysis and isolated implant fractures. Given the potential problems, routine use of modular components needs to be evaluated specific to particular applications. There appears to be little justification for modularity or customization of femoral stems below the head-neck junction in primary THR, although the modular stem components for revisions may be useful. Revision rates for cemented femoral components, using modern techniques, have been reported to be less than 5 percent at 10-year follow-up; revision rates for uncemented acetabular components are approximately 2 percent at 5-year follow-up. To be deemed efficacious, new design features should be shown to have a mechanical failure rate equal to or lower than these figures. As in 1982, the primary implant materials are cobalt- and titanium-based alloys, PMMA bone cement, and ultrahigh molecular weight polyethylene. These continue to demonstrate biocompatibility in bulk, but particles of these materials, particularly the polyethylene, are suspected to have a role in bone resorption and potential implant loosening. Osteolysis that can occur with both cemented and cementless components on both the femoral and acetabular sides is thought to be due to an inflammatory process brought on by particulate matter. The articulating surfaces between the femoral and acetabular components are now recognized as a major source of debris, which has been shown to be important in this pathologic tissue response. Most components for femoral heads have polished cobalt alloy, which articulates with polyethylene sockets. Longitudinal research continues on smoothness and ion implantation of the articulating surfaces, ceramicpolymer, ceramic-ceramic, and alloy-alloy components, although the in vivo data remain limited at this time. Efforts to alter or replace the polyethylene are underway, but no new materials with reduced clinical wear rates are routinely available. Several factors have been suggested to minimize the production of wear debris. Polyethylene acetabular cups with minimum wall thickness of 6 mm
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and femoral heads with diameters of 28 mm are important design considerations associated with reduced wear. Where metallic shells are used to contain the polyethylene cup, the interior of the shell should be smooth with a minimum number of openings for screws, and the polyethylene liner should be highly conforming and mechanically stable. Polyethylene of the highest quality is strongly advised for the manufacture of the components. Femoral heads with highly polished cobalt alloy, or polished ceramics as some data suggest, maybe advantageous to minimize effects of wear on the polyethylene surface. Studies also continue on surface modifications of implants to provide direct attachment to bone. For example, several types of calcium phosphate ceramics (CPC) (often called hydroxylapatite) have been added as coatings to THR surfaces to enhance fixation of noningrowth implants to bone. Concerns have been expressed about the longer term in vivo fatigue strengths of the substrate to coating interfaces, biodegradation, and the potential for generating ceramic particulates, although so far data addressing implant performance are comparable to those from other device designs at the same follow-up times. Research and development on the enhancement of bone growth into porous biomaterials using CPC has also shown promise, although longitudinal data are incomplete at this time. Long-term data are needed on the benefit-to-risk ratio of clinical outcomes for these types of surface modifications. Although there are in vitro tests for evaluating implant design features and material characteristics, as well as animal testing regimens, the relevance of these tests to in vivo human performance are often unknown and additional approaches are necessary. Long-term clinical studies are the only accepted method for evaluating the efficacy of the design and materials in human use, particularly with regard to patient-defined outcome measures. Since these take many years and are very expensive, few implant design features are supported by well-designed studies. Adaptive bone remodeling around the prosthesis continues to be a concern, but there is little evidence that it is a significant clinical problem during the first 10 years of follow-up. Joint forces are known with better confidence than in 1982, but it is still unknown which elements of force, magnitude, and time are relevant to implant failures. Detailed analysis of stress distribution is still limited by imprecise data on joint forces, viscoelastic properties, and failure modes of the materials and tissues. In 1994, the main problems of concern related to implant design are longterm fixation of the acetabular component, osteolysis due to particulate
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materials, biologic response to particles of implant materials, and the less favorable results of revision surgery.
What Are the Responses of the Biological Environment? Since the NIH CDC on Total Hip Joint Replacement held in 1982, bone resorption, or osteolysis, has emerged as the major concern with regard to the long-term survival of total hip arthroplasty. Significant resorption and massive osteolysis as well as more limited areas of bone destruction had been associated with cemented components and attributed to cement debris. Subsequent findings confirm that similar problems can be associated with cementless prosthetic implants, and some degree of osteolysis may be present in up to 30-40 percent of cases within 10 years of surgery. Both acetabular and femoral components may be affected. Components may remain well fixed in the presence of significant bone loss, but indications are that once osteolysis appears it tends to progress and may ultimately lead to implant failure. This bone loss is now considered to be a reaction to particulate matter derived from the implanted prosthetic components as well as the cement when used. Because osteolysis is an important contributor to failure of hip arthroplasties and may occur in the absence of clinical symptoms, it is important that patients with implants be followed and evaluated at regular intervals throughout life to ensure timely operative intervention, if necessary. Quantitatively, the material causing the most tissue reaction appears to be particulate polyethylene. These particles have been recovered in significant quantities from periprosthetic tissues, including sites remote from the source. Particle size varies, but the majority recovered are approximately 0.5 micron, with 90 percent less than 1.0 micron. It has been estimated that the average rate of wear for cobalt alloy-to-polyethylene interface is 0.1-0.2 mm/year. The volume of wear debris may increase with larger femoral head size. Metallic debris has also been identified in significant quantities. The source may be related to stem-bone fretting, particularly in loose prostheses and in more distal portions of proximally fixed prostheses where significant motion between stem and bone may persist. With the use of modular prostheses, corrosion and/or fretting have been identified in up to 35 percent of some retrieved specimens, and these connections could serve as a source of metallic particles. Fretting and corrosion are not limited to the interface between dissimilar alloys. Interactions have also been identified with cobalt-
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cobalt and titanium-titanium as well as titanium-cobalt alloy junctions. Reactions at the head-neck junctions have been studied in depth. Corrosion and wear debris products can also form at the interfaces between screws and acetabular shells and at modular collars for adapting proximal femoral stems. Some of the metallic particles generated may be larger than the polyethylene debris. The major effect of these larger metallic debris may relate to promoting third body wear of the polyethylene, with the derivative polyethylene particles of submicron size triggering the cellular response. However, smaller metal particles and ions have been demonstrated to be active in direct stimulation of biologic processes. The leading hypothesis to explain the development of massive osteolysisis that particulate matter derived from prosthetic components and cement stimulates an inflammatory response. Phagocytosis of the particles by macrophage and foreign-body giant cells (arising from the macrophage) appears to be the initial biologic response to particulate matter. The presence of intracellular particles is associated with the release of cytokines and other mediators of inflammation. These factors initiate a focal bone resorptive process largely mediated by osteoclasts. These osteoclasts do not contain debris particles. Thus, the long-term threat to component failure from a biologic standpoint appears to be wear-debris-associated periprosthetic osteolysis as a result of osteoclastic activity. This is stimulated by cytokines such as tumor necrosis factor, interleukins, and prostaglandins released by macrophages and possibly other cells including fibroblasts. The critical initiating sequence involves the interaction between small particulate materials and responding cells. The process is affected by the number, size, distribution, and type of particulate material, as well as responsiveness of the ingesting cells. The debris may be distributed beyond the hip joint. Material has been identified in distant lymph nodes, but no systemic consequences are documented up to this time. Since it is now recognized that both cobalt- and titanium-based alloys release soluble products in patients, long-term surveillance to assess possible systemic and remote side effects after THR is advisable. Adaptive bone remodeling occurs in the proximal femur in response to an altered mechanical environment following hip replacement. This process is commonly referred to as “stress shielding” or stress transfer. Stem rigidity or elasticity plays a major role. Bone resorption in unstressed areas is a common observation, but it has not been shown to be related to loosening.
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Nevertheless, it presents an important concern in terms of long-term stability and effect on revision surgery. Factors influencing adaptive bone remodeling have been considered in determining the location and extent of porous coating on uncemented stems. Finite element analysis suggests that proximally coated porous stems are associated with less cortical bone stress shielding than fully coated stems, but the extent of coating on most currently used prosthetic stems is still greater than that calculated necessary to significantly reduce the stressshielding effect on the proximal femur. Decreasing porous coating to reduce stress shielding must be weighed against providing sufficient coating to ensure fixation. Efforts to reduce stem stiffness have been shown to lessen proximal cortical atrophy under experimental conditions.
What Are the Expected Outcomes? The success of THR in most patients is strongly supported by nearly 30 years of follow-up data. There appears to be immediate and substantial improvement in the patient's pain, functional status, and overall healthrelated quality of life. Promising data suggest that these immediate improvements persist in the long term. Over the last two decades, complications associated with THR have declined significantly. Prophylactic antibiotic therapy has helped to prevent infection. Use of anticoagulants in the perioperative period has reduced deep venous thrombosis and pulmonary emboli. The incidence of mechanical loosening has decreased with the introduction of improved fixation techniques. More than 90 percent of all artificial joints are never revised. Rates of revision are decreasing with improved surgical techniques. The important questions of today are not whether THR is effective compared with no treatment but rather which technology and methodology used for THR are best for a particular patient. For example, the various total hip designs, fixation methods, and surgical techniques need to be rigorously compared with one another. Surgeon's experience and hospital environment should be investigated for possible independent effects. Various rehabilitation interventions, including long-term therapeutic exercise, should be evaluated for effectiveness. Similarly, little is known about patient-level predictors of outcome, e.g., patient expectations, quality of the individual patient's bone stock, demographic characteristics, comorbidities, obesity, and activity level.
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Since length of acute hospital stay has become progressively shorter, more emphasis must be given to determining the role of preadmission educational programs, appropriate physical therapy, and rehabilitation during the acute stay and following discharge. Home health programs when indicated may be more effective than prolonged hospitalization. The benefits of a long-term therapeutic exercise program for patients who have undergone THR have not been clearly demonstrated to improve mobility or hip stability. There appears to be insufficient appreciation for the role of exercise in THR rehabilitation; however, there is evidence that hip weakness persists up to 2 years after surgery in the presence of a normal gait. Multiple studies have demonstrated that weakness in the lower extremities is a major risk factor for falls in the geriatric age group. Thus, further studies are needed to assess the relationship between muscle function following THR, mobility, and risk for falls, as well as the role of therapeutic exercise in improving muscle function with enhancement of mobility and stability. Outcome assessment in THR has been limited by the lack of standardized terminology and by the use of various scales that have traditionally relied on the surgeon's assessment of the patient's pain, range of motion, muscle strength, and mobility. Most of these measures have not been adequately characterized in terms of validity, reliability, and responsiveness to change. The traditional assessments have not included patient-oriented evaluation of function or satisfaction. There is no consensus on the standard definitions of endpoints with respect to prosthesis failure. The American Academy of Orthopaedic Surgeons has developed recommendations for data to be collected, and this approach should be endorsed for use in clinical practice. The patient's functional status should be further assessed in follow-up by standardized, patient-reported, disease-specific measures and by at least one global outcome measure. Finally, the radiographic and clinical criteria for prosthesis failure should be defined. Long-term follow-up is essential to determining outcomes and pathological processes (e.g., failures related to osteolysis and particulate debris). These complications were not emphasized in the 1982 CDC on Total Hip Joint Replacement. The problems have been identified only by long-term followup of patients. Methodological issues that have limited THR outcomes assessment include lack of randomized trials and other well-controlled studies, lack of wellcharacterized patient cohorts for prospective observational studies, and insufficient sample sizes followed for prolonged periods of time.
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THR is performed more than 120,000 times per year in the United States. This represents a 64-percent increase in the number of THR procedures per year in the United States since the 1982 CDC. Analysis of Medicare claims data demonstrates significant variations in the rates of performance of THR with respect to geography, age, gender, and race. The highest rates of THR are in the Midwest and Northwest and the lowest rates in the South and East. A fourfold difference exists between the State with the highest rate of THR (Utah) and the State with the lowest rate (Wyoming). A previous study demonstrated a 50-percent higher rate of THR in Boston, Massachusetts, compared with New Haven, Connecticut. Other procedures such as hip fracture repair have very low variation from one geographical area to another. In today's era of cost-containment and outcomes research, it is important to understand the factors contributing to these wide area variations as well as which rate of THR is most appropriate. Sixty-two percent of all THR procedures in the United States are performed in women. Furthermore, women have significantly worse preoperative functional status than do men and are 35 percent more likely to report the use of a walking aid at the time of surgery. These differences persist even after adjustment for other demographic and clinical characteristics. These data suggest that, compared with men, women are being operated on at a more advanced stage of the disease. Two-thirds of all THR procedures are performed in individuals who are older than 65 years of age. The rate of THR increases for 3patients up to 75 years of age and then declines. The highest age-specific incidence rates of THR are between 65 and 74 years of age for men and 75 and 84 years of age for women. Recent comparisons of rates of THR reveal that more are being done in the young and in the oldest patients. Among the older patients, there has been an increase in THR in patients with more comorbidities. Most THR procedures are performed in whites. The prevalence rate of hip implants (fixation devices and artificial joints) was 4.2 per 1,000 in whites compared with 1.7 per 1,000 in African-Americans. The disparity by race increases markedly with age. These findings were confirmed by an analysis of Medicare claims data that focused solely on THR. Observed differences in the rate of THR by race may reflect a disparity in access or referral for care for African-Americans. Additionally, individuals with higher income were 22 percent more likely to undergo THR than were individuals with low income. Health care providers and patients must be cognizant of the variations in the THR rate. It is important to carefully consider the potential influence of access to care, treatment selection biases, and patient knowledge and preferences on these variations in rates.
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In this era of cost-containment and managed care, the ultimate selection of a THR system should be based on individualized patient needs, safety, and efficacy. There is consensus that the THR patient requires periodic follow-up including appropriate x-ray examination throughout life. Periodic follow-up, perhaps at 5-year intervals after the first 5 years, could allow identification of osteolysis and other indicators of impending failure in their earliest forms and permits institution of treatment before catastrophic failure.
What Are the Accepted Approaches and Outcomes for Revision of a Total Hip Replacement? As more primary THRs occur on a cumulative basis, as indications extend to more conditions and to older and younger individuals, and as the population ages, the absolute number of revision hip replacements will increase, even if the frequency of failures in primary procedures continues to decrease. Revision surgery is highly complex and costly and requires considerable scientific and technical expertise, an array of expensive technological options, a supportive health care environment, and a skilled health care team. Consequently, issues such as the surgeon's experience, the hospital characteristics, the related health care costs, and appropriateness of current hospital reimbursements associated with revision should be carefully examined. Currently, the results of revision THR are inferior to those of primary procedures. It remains important to refine the indications for revision and to do so on the basis of the best available outcome data. Not all “failed” primary THRs require revision. The decision to revise, as is true of decisions regarding primary procedures, must consider such circumstances as the presence of disabling pain, stiffness, and functional impairment unrelieved by appropriate medical management and lifestyle changes. In addition, radiographic evidence of bone loss or loosening of one or both components should be present. Indeed, evidence of progressive bone loss alone provides sufficient reason to consider revision in advance of catastrophic failure. Fracture, dislocation, malposition of components, and infection involving the implant are other reasons to consider revision. A number of options must be considered in planning a revision operation. The selection of specific technology is currently a judgment of the surgeon and depends on the amount and quality of the bone stock, the age and functional demands of the patient, and the reason for failure of the primary procedure.
NIH Consensus Statement on Total Hip Replacement 341
The weight of clinical experience suggests that a loose acetabular component, either cemented or porous coated, can be reliably replaced by a porous-coated component in the presence of adequate bone stock. In one study using this approach, 91 percent of implants were radiographically stable and 9 percent required re-revision (for dislocation and infection rather than aseptic loosening) between 8 and 11 years after revision. In elderly patients with lower functional demands and those with osteogenic bone, cemented implants have also provided satisfactory results. To achieve prosthetic stability in the absence of sufficient bone stock, deficits can be filled with morselized or structural bone grafts (either autografts or allografts obtained from accredited tissue banks), customized metal components, or, under some circumstances, bone cement. The approach to revision of the femoral component must be based on the nature of the remaining bone stock in the proximal femur, and clinical judgment usually takes into account the age and functional demands of the patient. Under many circumstances, revision of the femoral component with a cemented stem is possible using modern cementing techniques. The rerevision rate for this approach is between 10 and 18 percent at 10- to 11-year follow-up. An acceptable alternative approach to revision of femoral components when there is substantial residual bone stock has been the use of noncemented implants, particularly the extensively coated components. This approach has resulted in 90-percent stem survivorship at a 9-year follow-up. Morselized bone graft can be used successfully to fill defects in the femoral canal with or without the use of bone cement, and cortical bone can be augmented with only grafts as necessary. Under exceptional circumstances, it may be necessary to use large structural allografts when the proximal femoral bone stock deficiency is substantial. If this is done, the implant should be cemented into the graft. Both the diagnosis and the treatment of infected implants remain challenging. The infection rates of the past have been dramatically reduced. Current infection rates of less than 1 percent at 1 year after primary THR are now being reported. Nonetheless, infection remains a devastating complication, and treatment alternatives remain controversial. Recovery of the infecting organism is essential to the selection of appropriate antibiotics and the planning of surgical approaches. For organisms highly susceptible to multiple antibiotics, one-stage surgical approaches that combine extensive debridement and an ensuing exchange of implants are associated with a 77-
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to 94-percent success rate. Two-stage revisions that include at least 4 weeks of appropriate antibiotic treatment following implant removal and wound debridement and a variable period of time before reinsertion determined by the characteristics of the organism have resulted in a success rate greater than 80 percent. In young people, there may be value to a third, intermediate stage in which the bone stock is augmented in anticipation of later reimplantation.
What Are the Most Productive Directions for Future Research? THR is acknowledged as a highly successful procedure that has provided relief of pain, increased mobility, and improved tolerance for activity for thousands of people. Despite the advances made in the past decade, obvious deficiencies in knowledge remain regarding treatment alternatives, patient characteristics, and environmental issues. To address these concerns most effectively, it is important to identify those avenues of investigation that will lead to decreased morbidity and enhanced quality of life for the population at large affected by debilitating hip disease. Standardized instruments for assessing outcomes need to be developed, validated, and introduced into clinical use. These may also be useful in developing guidelines for surgery and in making physicians aware of their patients' physical capabilities and expectations. The issues of age, sex, weight, activity level, and comorbidities have been implicated for their effects on the outcome of THR and need to be studied in relation to the indications for surgery and timing of the procedure. Serious questions have been raised concerning the disparate rates for THR between racial groups and geographic locations that seem to have no direct relationship to incidence of disease. Indepth analysis of rate differential can lead to an identification of underlying reasons. In this way, the benefits of THR can be extended to an appropriate segment of the population that appears to have limited access. Materials currently used for the manufacture of THR implants have been improved with regard to design and finish. Wear debris, however, remains a factor that affects the durability of the implants and their fixation. Research is ongoing and support is needed to expand investigations of new materials and to create a better understanding of wear processes that can prolong the life of the implant and reduce the wear and wear products.
NIH Consensus Statement on Total Hip Replacement 343
One of the necessary approaches for evaluating implant failure modes is an organized, ongoing analysis of in situ prostheses retrieved from cadavers. Such a program should be national in scope and supported by grant monies. As part of this effort, it is anticipated that significant data could be obtained concerning wear processes involving the articular surfaces under circumstances where the implant did not fail. At the same time, this avenue of research would further clarify the device and tissue interactions that are characteristic of the cemented and noncemented types of devices. Randomized clinical trials are needed to determine the efficacy of implant designs and surgical approaches, including the effect of coatings that encourage appositional or interpositional bone growth for fixation. The contribution of prehospital, inhospital, and posthospital education and rehabilitation programs to the eventual outcome of the surgical procedure deserves an organized, in-depth study to determine optimum regimen, duration of treatment, and expected outcomes. Clinical data suggest that potential capabilities of the patients are not being fully developed. The biologic interface between the implant and the host bone has been recognized as a source of potential failure. Basic research efforts into the mechanisms by which these changes occur are providing some clues, but much more needs to be known about specific cellular mechanisms associated with osteolysis, suggested immunologic or inflammatory responses, and the reactions to varying stresses encountered by the bone. In addition, further investigation should be encouraged into the ways by which the local inflammatory response to particulate matter could be modified by regional or systemic interventions. As the indications for THR are extended into the younger age group, patients with THR will be exposed to more rigorous environmental demands, both occupational and recreational. Investigations are needed into the environmental modifications, activity limitations, or types of physical effort that contribute to extended prosthesis survival. Physical conditioning activities--muscle development, improvement in coordination, and exercises that enhance bone integrity without affecting fixation--need to be studied as they relate to the anticipated lifestyle and occupational objectives of the patient. Outcomes of revision hip surgery are less reliable and satisfactory than those of primary procedures. Those biologic, biomechanical, and rehabilitation
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factors that influence these results need to be explored and solutions developed. Regional or national registries should be established to capture a minimum data set on all THR and revision procedures. The goals of this registry should be to better define the natural history and epidemiology of THR in the U.S. population as a whole and to identify risk factors for poor outcomes that relate to the implant, procedure, and patient characteristics. Conclusions: ·
HR is an option for nearly all patients with diseases of the hip that cause chronic discomfort and significant functional impairment.
·
In the aggregate, THR is a highly successful treatment for pain and disability. Most patients have an excellent prognosis for long-term improvement in symptoms and physical function.
·
Perioperative complications such as infection and deep venous thrombosis have been significantly reduced because of use of prophylactic antibiotics and anticoagulants and early mobilization.
·
The predominant mode of long-term prosthetic failure appears to be related to generation of particulate matter, which in turn causes an inflammatory reaction and subsequent bone resorption around the prosthesis.
·
Revision of THR is indicated when mechanical failure occurs. The surgery is technically more difficult and the long-term prognosis is generally not as good as for primary THR. The optimal surgical techniques for THR revision vary considerably depending on the conditions encountered. Continued periodic follow-up is necessary to identify early evidence of impending failure so as to permit remedial actions before a catastrophic event.
·
Improved methods for evaluating existing technology should be developed and implemented, especially with respect to patient-defined outcomes.
·
Future research should focus on refining indications for surgery; defining reasons for differences in procedure rates by age, race, gender, and geographic region; developing surgical techniques, materials, and designs that will be clearly superior to current practices; understanding the inflammatory response to particulate material and how to modify it; determining optimal short- and long-term rehabilitation strategies; and elucidating risk factors that may lead to accelerated prosthetic failure.
Online Glossaries 345
ONLINE GLOSSARIES The Internet provides access to a number of free-to-use medical dictionaries and glossaries. The National Library of Medicine has compiled the following list of online dictionaries: ·
ADAM Medical Encyclopedia (A.D.A.M., Inc.), comprehensive medical reference: http://www.nlm.nih.gov/medlineplus/encyclopedia.html
·
MedicineNet.com Medical Dictionary (MedicineNet, Inc.): http://www.medterms.com/Script/Main/hp.asp
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Merriam-Webster Medical Dictionary (Inteli-Health, Inc.): http://www.intelihealth.com/IH/
·
Multilingual Glossary of Technical and Popular Medical Terms in Eight European Languages (European Commission) - Danish, Dutch, English, French, German, Italian, Portuguese, and Spanish: http://allserv.rug.ac.be/~rvdstich/eugloss/welcome.html
·
On-line Medical Dictionary (CancerWEB): http://www.graylab.ac.uk/omd/
·
Technology Glossary (National Library of Medicine) - Health Care Technology: http://www.nlm.nih.gov/nichsr/ta101/ta10108.htm
·
Terms and Definitions (Office of Rare Diseases): http://rarediseases.info.nih.gov/ord/glossary_a-e.html
Beyond these, MEDLINEplus contains a very user-friendly encyclopedia covering every aspect of medicine (licensed from A.D.A.M., Inc.). The ADAM Medical Encyclopedia Web site address is http://www.nlm.nih.gov/medlineplus/encyclopedia.html. ADAM is also available on commercial Web sites such as Web MD (http://my.webmd.com/adam/asset/adam_disease_articles/a_to_z/a) and drkoop.com (http://www.drkoop.com/). Topics of interest can be researched by using keywords before continuing elsewhere, as these basic definitions and concepts will be useful in more advanced areas of research. You may choose to print various pages specifically relating to osteoarthritis and keep them on file. The NIH, in particular, suggests that patients with osteoarthritis visit the following Web sites in the ADAM Medical Encyclopedia:
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·
Basic Guidelines for Osteoarthritis Bursitis Web site: http://www.nlm.nih.gov/medlineplus/ency/article/000419.htm Osteoarthritis Web site: http://www.nlm.nih.gov/medlineplus/ency/article/000423.htm Osteoarthrosis Web site: http://www.nlm.nih.gov/medlineplus/ency/article/000423.htm
·
Signs & Symptoms for Osteoarthritis Crepitus Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003286.htm Joint pain Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003261.htm Joint swelling Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003262.htm Limited range of motion Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003173.htm Obesity Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003101.htm Overweight Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003101.htm
Online Glossaries 347
Stress Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003211.htm Swelling Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003103.htm Weight loss Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003107.htm ·
Diagnostics and Tests for Osteoarthritis ANA Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003535.htm CBC Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003642.htm ESR Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003638.htm Rheumatoid factor Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003548.htm X-ray Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003337.htm
·
Surgery and Procedures for Osteoarthritis Arthrodesis Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002968.htm
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Hip arthroplasty Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002975.htm Knee arthroplasty Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002974.htm ·
Background Topics for Osteoarthritis Arthritis - support group Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002183.htm Chronic Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002312.htm Exercise Web site: http://www.nlm.nih.gov/medlineplus/ency/article/001941.htm Incidence Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002387.htm Relieved by Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002288.htm Support group Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002150.htm Systemic Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002294.htm Weight control Web site: http://www.nlm.nih.gov/medlineplus/ency/article/001943.htm
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Weight reduction Web site: http://www.nlm.nih.gov/medlineplus/ency/article/001940.htm
Online Dictionary Directories The following are additional online directories compiled by the National Library of Medicine, including a number of specialized medical dictionaries and glossaries: ·
Medical Dictionaries: Medical & Biological (World Health Organization): http://www.who.int/hlt/virtuallibrary/English/diction.htm#Medical
·
MEL-Michigan Electronic Library List of Online Health and Medical Dictionaries (Michigan Electronic Library): http://mel.lib.mi.us/health/health-dictionaries.html
·
Patient Education: Glossaries (DMOZ Open Directory Project): http://dmoz.org/Health/Education/Patient_Education/Glossaries/
·
Web of Online Dictionaries (Bucknell University): http://www.yourdictionary.com/diction5.html#medicine
Glossary 351
OSTEOARTHRITIS GLOSSARY The following is a complete glossary of terms used in this sourcebook. The definitions are derived from official public sources including the National Institutes of Health [NIH] and the European Union [EU]. After this glossary, we list a number of additional hardbound and electronic glossaries and dictionaries that you may wish to consult. Acetaminophen: Analgesic antipyretic derivative of acetanilide. It has weak anti-inflammatory properties and is used as a common analgesic, but may cause liver, blood cell, and kidney damage. [NIH] Acetylcysteine: The N-acetyl derivative of cysteine. It is used as a mucolytic agent to reduce the viscosity of mucous secretions. It has also been shown to have antiviral effects in patients with HIV due to inhibition of viral stimulation by reactive oxygen intermediates. [NIH] Acetylgalactosamine: The N-acetyl derivative of galactosamine. [NIH] Adjuvant: A substance which aids another, such as an auxiliary remedy; in immunology, nonspecific stimulator (e.g., BCG vaccine) of the immune response. [EU] Aerobic: 1. Having molecular oxygen present. 2. Growing, living, or occurring in the presence of molecular oxygen. 3. Requiring oxygen for respiration. [EU] Aetiology: Study of the causes of disease. [EU] Allopurinol: A xanthine oxidase inhibitor that decreases uric acid production. [NIH] Alloys: A mixture of metallic elements or compounds with other metallic or metalloid elements in varying proportions. [NIH] Anabolic: Relating to, characterized by, or promoting anabolism. [EU] Analgesic: An agent that alleviates pain without causing loss of consciousness. [EU] Anemia: A reduction in the number of circulating erythrocytes or in the quantity of hemoglobin. [NIH] Anesthesia: A state characterized by loss of feeling or sensation. This depression of nerve function is usually the result of pharmacologic action and is induced to allow performance of surgery or other painful procedures. [NIH]
Antibiotic: A chemical substance produced by a microorganism which has the capacity, in dilute solutions, to inhibit the growth of or to kill other
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microorganisms. Antibiotics that are sufficiently nontoxic to the host are used as chemotherapeutic agents in the treatment of infectious diseases of man, animals and plants. [EU] Antibody: An immunoglobulin molecule that has a specific amino acid sequence by virtue of which it interacts only with the antigen that induced its synthesis in cells of the lymphoid series (especially plasma cells), or with antigen closely related to it. Antibodies are classified according to their ode of action as agglutinins, bacteriolysins, haemolysins, opsonins, precipitins, etc. [EU] Anticoagulants: Agents that prevent blood clotting. Naturally occurring agents in the blood are included only when they are used as drugs. [NIH] Antidepressant: An agent that stimulates the mood of a depressed patient, including tricyclic antidepressants and monoamine oxidase inhibitors. [EU] Anxiety: The unpleasant emotional state consisting of psychophysiological responses to anticipation of unreal or imagined danger, ostensibly resulting from unrecognized intrapsychic conflict. Physiological concomitants include increased heart rate, altered respiration rate, sweating, trembling, weakness, and fatigue; psychological concomitants include feelings of impending danger, powerlessness, apprehension, and tension. [EU] Arteries: The vessels carrying blood away from the heart. [NIH] Arteritis: Inflammation of an artery. [NIH] Arthrography: Roentgenography of a joint, usually after injection of either positive or negative contrast medium. [NIH] Arthroplasty: Surgical reconstruction of a joint to relieve pain or restore motion. [NIH] Arthroscopy: Endoscopic examination, therapy and surgery of the joint. [NIH] Aseptic: Free from infection or septic material; sterile. [EU] Aspiration: The act of inhaling. [EU] Benign: Not malignant; not recurrent; favourable for recovery. [EU] Bioavailability: The degree to which a drug or other substance becomes available to the target tissue after administration. [EU] Biopsy: The removal and examination, usually microscopic, of tissue from the living body, performed to establish precise diagnosis. [EU] Biosynthesis: The building up of a chemical compound in the physiologic processes of a living organism. [EU] Boron: A trace element with the atomic symbol B, atomic number 5, and atomic weight 10.81. Boron-10, an isotope of boron, is used as a neutron absorber in boron neutron capture therapy. [NIH]
Glossary 353
Bursitis: Inflammation of a bursa, occasionally accompanied by a calcific deposit in the underlying supraspinatus tendon; the most common site is the subdeltoid bursa. [EU] Capsicum: A genus of Solanaceous shrubs that yield capsaicin. Several varieties have sweet or pungent edible fruits that are used as vegetables when fresh and spices when the pods are dried. [NIH] Carbohydrate: An aldehyde or ketone derivative of a polyhydric alcohol, particularly of the pentahydric and hexahydric alcohols. They are so named because the hydrogen and oxygen are usually in the proportion to form water, (CH2O)n. The most important carbohydrates are the starches, sugars, celluloses, and gums. They are classified into mono-, di-, tri-, poly- and heterosaccharides. [EU] Cardiovascular: Pertaining to the heart and blood vessels. [EU] Carotene: The general name for a group of pigments found in green, yellow, and leafy vegetables, and yellow fruits. The pigments are fat-soluble, unsaturated aliphatic hydrocarbons functioning as provitamins and are converted to vitamin A through enzymatic processes in the intestinal wall. [NIH]
Catabolism: Any destructive metabolic process by which organisms convert substances into excreted compounds. [EU] Cataract: An opacity, partial or complete, of one or both eyes, on or in the lens or capsule, especially an opacity impairing vision or causing blindness. The many kinds of cataract are classified by their morphology (size, shape, location) or etiology (cause and time of occurrence). [EU] Cervical: Pertaining to the neck, or to the neck of any organ or structure. [EU] Chemotherapy: The treatment of disease by means of chemicals that have a specific toxic effect upon the disease - producing microorganisms or that selectively destroy cancerous tissue. [EU] Cholecalciferol: An antirachitic oil-soluble vitamin. [NIH] Cholestasis: Impairment of biliary flow at any level from the hepatocyte to Vater's ampulla. [NIH] Cholesterol: The principal sterol of all higher animals, distributed in body tissues, especially the brain and spinal cord, and in animal fats and oils. [NIH] Chondrocytes: Polymorphic cells that form cartilage. [NIH] Chondrogenesis: The formation of cartilage. This process is directed by chondrocytes which continually divide and lay down matrix during development. It is sometimes a precursor to osteogenesis. [NIH] Chronic: Persisting over a long period of time. [EU] Cimetidine:
A histamine congener, it competitively inhibits histamine
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binding to H2 receptors. Cimetidine has a range of pharmacological actions. It inhibits gastric acid secretion, as well as pepsin and gastrin output. It also blocks the activity of cytochrome P-450. [NIH] Cobalt: A trace element that is a component of vitamin B12. It has the atomic symbol Co, atomic number 27, and atomic weight 58.93. It is used in nuclear weapons, alloys, and pigments. Deficiency in animals leads to anemia; its excess in humans can lead to erythrocytosis. [NIH] Collagen: The protein substance of the white fibres (collagenous fibres) of skin, tendon, bone, cartilage, and all other connective tissue; composed of molecules of tropocollagen (q.v.), it is converted into gelatin by boiling. collagenous pertaining to collagen; forming or producing collagen. [EU] Collapse: 1. A state of extreme prostration and depression, with failure of circulation. 2. Abnormal falling in of the walls of any part of organ. [EU] Constitutional: 1. Affecting the whole constitution of the body; not local. 2. Pertaining to the constitution. [EU] Contracture: A condition of fixed high resistance to passive stretch of a muscle, resulting from fibrosis of the tissues supporting the muscles or the joints, or from disorders of the muscle fibres. [EU] Cortical: Pertaining to or of the nature of a cortex or bark. [EU] Curcumin: A dye obtained from tumeric, the powdered root of Curcuma longa Linn. It is used in the preparation of curcuma paper and the detection of boron. Curcumin appears to possess a spectrum of pharmacological properties, due primarily to its inhibitory effects on metabolic enzymes. [NIH] Cyst: Any closed cavity or sac; normal or abnormal, lined by epithelium, and especially one that contains a liquid or semisolid material. [EU] Cytokines: Non-antibody proteins secreted by inflammatory leukocytes and some non-leukocytic cells, that act as intercellular mediators. They differ from classical hormones in that they are produced by a number of tissue or cell types rather than by specialized glands. They generally act locally in a paracrine or autocrine rather than endocrine manner. [NIH] Diflunisal: A salicylate derivative and anti-inflammatory analgesic with actions and side effects similar to those of aspirin. [NIH] Diltiazem: A benzothiazepine derivative with vasodilating action due to its antagonism of the actions of the calcium ion in membrane functions. It is also teratogenic. [NIH] Dislocation: The displacement of any part, more especially of a bone. Called also luxation. [EU] Distal: Remote; farther from any point of reference; opposed to proximal. In dentistry, used to designate a position on the dental arch farther from the
Glossary 355
median line of the jaw. [EU] Doxycycline: A synthetic tetracycline derivative with a range of antimicrobial activity and mode of action similar to that of tetracycline, but more effective against many species. Animal studies suggest that it may cause less tooth staining than other tetracyclines. [NIH] Dysmenorrhea: Painful menstruation. [NIH] Dyspepsia: Impairment of the power of function of digestion; usually applied to epigastric discomfort following meals. [EU] Dystrophy: Any disorder arising from defective or faulty nutrition, especially the muscular dystrophies. [EU] Edema: Excessive amount of watery fluid accumulated in the intercellular spaces, most commonly present in subcutaneous tissue. [NIH] Endocarditis: Exudative and proliferative inflammatory alterations of the endocardium, characterized by the presence of vegetations on the surface of the endocardium or in the endocardium itself, and most commonly involving a heart valve, but sometimes affecting the inner lining of the cardiac chambers or the endocardium elsewhere. It may occur as a primary disorder or as a complication of or in association with another disease. [EU] Enzyme: A protein molecule that catalyses chemical reactions of other substances without itself being destroyed or altered upon completion of the reactions. Enzymes are classified according to the recommendations of the Nomenclature Committee of the International Union of Biochemistry. Each enzyme is assigned a recommended name and an Enzyme Commission (EC) number. They are divided into six main groups; oxidoreductases, transferases, hydrolases, lyases, isomerases, and ligases. [EU] Equisetum: A genus of plants closely related to ferns. Some species have medicinal use and some are poisonous. [NIH] Estradiol: The most potent mammalian estrogenic hormone. It is produced in the ovary, placenta, testis, and possibly the adrenal cortex. [NIH] Estrogens: A class of sex hormones associated with the development and maintenance of secondary female sex characteristics and control of the cyclical changes in the reproductive cycle. They are also required for pregnancy maintenance and have an anabolic effect on protein metabolism and water retention. [NIH] Etodolac: A nonsteroidal anti-inflammatory agent with potent analgesic and antiarthritic properties. It has been shown to be effective in the treatment of osteoarthritis, rheumatoid arthritis, ankylosing spondylitis, and in the alleviation of postoperative pain. [NIH] Exogenous: Developed or originating outside the organism, as exogenous disease. [EU]
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Extracellular: Outside a cell or cells. [EU] Extraction: The process or act of pulling or drawing out. [EU] Famotidine: A competitive histamine H2-receptor antagonist. Its main pharmacodynamic effect is the inhibition of gastric secretion. [NIH] Fenoprofen: An anti-inflammatory analgesic and antipyretic highly bound to plasma proteins. It is pharmacologically similar to ASPIRIN, but causes less gastrointestinal bleeding. [NIH] Fibroblasts: Connective tissue cells which secrete an extracellular matrix rich in collagen and other macromolecules. [NIH] Flexion: In gynaecology, a displacement of the uterus in which the organ is bent so far forward or backward that an acute angle forms between the fundus and the cervix. [EU] Flurbiprofen: An anti-inflammatory analgesic and antipyretic of the phenylalkynoic acid series. It has been shown to reduce bone resorption in periodontal disease by inhibiting carbonic anhydrase. [NIH] Gadolinium: Gadolinium. An element of the rare earth family of metals. It has the atomic symbol Gd, atomic number 64, and atomic weight 157.25. Its oxide is used in the control rods of some nuclear reactors. [NIH] Gait: Manner or style of walking. [NIH] Gastrointestinal: Pertaining to or communicating with the stomach and intestine, as a gastrointestinal fistula. [EU] Gelatin: A product formed from skin, white connective tissue, or bone collagen. It is used as a protein food adjuvant, plasma substitute, hemostatic, suspending agent in pharmaceutical preparations, and in the manufacturing of capsules and suppositories. [NIH] Genotype: The genetic constitution of the individual; the characterization of the genes. [NIH] Glycosaminoglycans: Heteropolysaccharides which contain an Nacetylated hexosamine in a characteristic repeating disaccharide unit. The repeating structure of each disaccharide involves alternate 1,4- and 1,3linkages consisting of either N-acetylglucosamine or N-acetylgalactosamine. [NIH]
Gout: Hereditary metabolic disorder characterized by recurrent acute arthritis, hyperuricemia and deposition of sodium urate in and around the joints, sometimes with formation of uric acid calculi. [NIH] Hemarthrosis: Bleeding into the joints. It may arise from trauma or spontaneously in patients with hemophilia. [NIH] Hematocrit: Measurement of the volume of packed red cells in a blood specimen by centrifugation. The procedure is performed using a tube with
Glossary 357
graduated markings or with automated blood cell counters. It is used as an indicator of erythrocyte status in disease. For example, anemia shows a low hematocrit, polycythemia, high values. [NIH] Histamine: 1H-Imidazole-4-ethanamine. A depressor amine derived by enzymatic decarboxylation of histidine. It is a powerful stimulant of gastric secretion, a constrictor of bronchial smooth muscle, a vasodilator, and also a centrally acting neurotransmitter. [NIH] Homogeneous: Consisting of or composed of similar elements or ingredients; of a uniform quality throughout. [EU] Hormones: Chemical substances having a specific regulatory effect on the activity of a certain organ or organs. The term was originally applied to substances secreted by various endocrine glands and transported in the bloodstream to the target organs. It is sometimes extended to include those substances that are not produced by the endocrine glands but that have similar effects. [NIH] Hydrocortisone: The main glucocorticoid secreted by the adrenal cortex. Its synthetic counterpart is used, either as an injection or topically, in the treatment of inflammation, allergy, collagen diseases, asthma, adrenocortical deficiency, shock, and some neoplastic conditions. [NIH] Hyperostosis: Hypertrophy of bone; exostosis. [EU] Hyperplasia: The abnormal multiplication or increase in the number of normal cells in normal arrangement in a tissue. [EU] Hypersensitivity: A state of altered reactivity in which the body reacts with an exaggerated immune response to a foreign substance. Hypersensitivity reactions are classified as immediate or delayed, types I and IV, respectively, in the Gell and Coombs classification (q.v.) of immune responses. [EU] Hypertension: Persistently high arterial blood pressure. Various criteria for its threshold have been suggested, ranging from 140 mm. Hg systolic and 90 mm. Hg diastolic to as high as 200 mm. Hg systolic and 110 mm. Hg diastolic. Hypertension may have no known cause (essential or idiopathic h.) or be associated with other primary diseases (secondary h.). [EU] Hypertrophy: The enlargement or overgrowth of an organ or part due to an increase in size of its constituent cells. [EU] Hypothermia: A low body temperature, as that due to exposure in cold weather or a state of low temperature of the body induced as a means of decreasing metabolism of tissues and thereby the need for oxygen, as used in various surgical procedures, especially on the heart, or in an excised organ being preserved for transplantation. [EU] Ibuprofen: A nonsteroidal anti-inflammatory agent with analgesic properties used in the therapy of rheumatism and arthritis. [NIH]
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Immersion: The placing of a body or a part thereof into a liquid. [NIH] Immunity: The condition of being immune; the protection against infectious disease conferred either by the immune response generated by immunization or previous infection or by other nonimmunologic factors (innate i.). [EU] Implantation: The insertion or grafting into the body of biological, living, inert, or radioactive material. [EU] Incision: 1. Cleft, cut, gash. 2. An act or action of incising. [EU] Induction: The act or process of inducing or causing to occur, especially the production of a specific morphogenetic effect in the developing embryo through the influence of evocators or organizers, or the production of anaesthesia or unconsciousness by use of appropriate agents. [EU] Infiltration: The diffusion or accumulation in a tissue or cells of substances not normal to it or in amounts of the normal. Also, the material so accumulated. [EU] Inflammation: A pathological process characterized by injury or destruction of tissues caused by a variety of cytologic and chemical reactions. It is usually manifested by typical signs of pain, heat, redness, swelling, and loss of function. [NIH] Insulin: A protein hormone secreted by beta cells of the pancreas. Insulin plays a major role in the regulation of glucose metabolism, generally promoting the cellular utilization of glucose. It is also an important regulator of protein and lipid metabolism. Insulin is used as a drug to control insulindependent diabetes mellitus. [NIH] Interleukins: Soluble factors which stimulate growth-related activities of leukocytes as well as other cell types. They enhance cell proliferation and differentiation, DNA synthesis, secretion of other biologically active molecules and responses to immune and inflammatory stimuli. [NIH] Intermittent: Occurring at separated intervals; having periods of cessation of activity. [EU] Interstitial: Pertaining to or situated between parts or in the interspaces of a tissue. [EU] Intrinsic: Situated entirely within or pertaining exclusively to a part. [EU] Iodine: A nonmetallic element of the halogen group that is represented by the atomic symbol I, atomic number 53, and atomic weight of 126.90. It is a nutritionally essential element, especially important in thyroid hormone synthesis. In solution, it has anti-infective properties and is used topically. [NIH]
Irrigation: Washing by a stream of water or other fluid. [EU] Irritants: Drugs that act locally on cutaneous or mucosal surfaces to produce
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inflammation; those that cause redness due to hyperemia are rubefacients; those that raise blisters are vesicants and those that penetrate sebaceous glands and cause abscesses are pustulants; tear gases and mustard gases are also irritants. [NIH] Ketoprofen: An ibuprofen-type anti-inflammatory analgesic and antipyretic. It is used in the treatment of rheumatoid arthritis and osteoarthritis. [NIH] Lesion: Any pathological or traumatic discontinuity of tissue or loss of function of a part. [EU] Ligament: A band of fibrous tissue that connects bones or cartilages, serving to support and strengthen joints. [EU] Lipid: Any of a heterogeneous group of flats and fatlike substances characterized by being water-insoluble and being extractable by nonpolar (or fat) solvents such as alcohol, ether, chloroform, benzene, etc. All contain as a major constituent aliphatic hydrocarbons. The lipids, which are easily stored in the body, serve as a source of fuel, are an important constituent of cell structure, and serve other biological functions. Lipids may be considered to include fatty acids, neutral fats, waxes, and steroids. Compound lipids comprise the glycolipids, lipoproteins, and phospholipids. [EU] Lipoprotein: Any of the lipid-protein complexes in which lipids are transported in the blood; lipoprotein particles consist of a spherical hydrophobic core of triglycerides or cholesterol esters surrounded by an amphipathic monolayer of phospholipids, cholesterol, and apolipoproteins; the four principal classes are high-density, low-density, and very-lowdensity lipoproteins and chylomicrons. [EU] Lumbar: Pertaining to the loins, the part of the back between the thorax and the pelvis. [EU] Lupus: A form of cutaneous tuberculosis. It is seen predominantly in women and typically involves the nasal, buccal, and conjunctival mucosa. [NIH]
Malignant: Tending to become progressively worse and to result in death. Having the properties of anaplasia, invasion, and metastasis; said of tumours. [EU] Masticatory: 1. Subserving or pertaining to mastication; affecting the muscles of mastication. 2. A remedy to be chewed but not swallowed. [EU] Mediator: An object or substance by which something is mediated, such as (1) a structure of the nervous system that transmits impulses eliciting a specific response; (2) a chemical substance (transmitter substance) that induces activity in an excitable tissue, such as nerve or muscle; or (3) a substance released from cells as the result of the interaction of antigen with antibody or by the action of antigen with a sensitized lymphocyte. [EU]
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Medullary: Pertaining to the marrow or to any medulla; resembling marrow. [EU] Membrane: A thin layer of tissue which covers a surface, lines a cavity or divides a space or organ. [EU] Menopause: Cessation of menstruation in the human female, occurring usually around the age of 50. [EU] Metatarsus: The part of the foot between the tarsa and the TOES. [NIH] Methionine: A sulfur containing essential amino acid that is important in many body functions. It is a chelating agent for heavy metals. [NIH] Methotrexate: An antineoplastic antimetabolite with immunosuppressant properties. It is an inhibitor of dihydrofolate reductase and prevents the formation of tetrahydrofolate, necessary for synthesis of thymidylate, an essential component of DNA. [NIH] Minocycline: A semisynthetic antibiotic effective against tetracyclineresistant staphylococcus infections. [NIH] Mobilization: The process of making a fixed part or stored substance mobile, as by separating a part from surrounding structures to make it accessible for an operative procedure or by causing release into the circulation for body use of a substance stored in the body. [EU] Naproxen: An anti-inflammatory agent with analgesic and antipyretic properties. Both the acid and its sodium salt are used in the treatment of rheumatoid arthritis and other rheumatic or musculoskeletal disorders, dysmenorrhea, and acute gout. [NIH] Narcotic: 1. Pertaining to or producing narcosis. 2. An agent that produces insensibility or stupor, applied especially to the opioids, i.e. to any natural or synthetic drug that has morphine-like actions. [EU] Neisseria: A genus of gram-negative, aerobic, coccoid bacteria whose organisms are part of the normal flora of the oropharynx, nasopharynx, and genitourinary tract. Some species are primary pathogens for humans. [NIH] Neonatal: Pertaining to the first four weeks after birth. [EU] Neurologic: Pertaining to neurology or to the nervous system. [EU] Neuromuscular: Pertaining to muscles and nerves. [EU] Neuronal: Pertaining to a neuron or neurons (= conducting cells of the nervous system). [EU] Neurons: The basic cellular units of nervous tissue. Each neuron consists of a body, an axon, and dendrites. Their purpose is to receive, conduct, and transmit impulses in the nervous system. [NIH] Neuropathy: A general term denoting functional disturbances and/or pathological changes in the peripheral nervous system. The etiology may be
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known e.g. arsenical n., diabetic n., ischemic n., traumatic n.) or unknown. Encephalopathy and myelopathy are corresponding terms relating to involvement of the brain and spinal cord, respectively. The term is also used to designate noninflammatory lesions in the peripheral nervous system, in contrast to inflammatory lesions (neuritis). [EU] Neuropeptides: Peptides released by neurons as intercellular messengers. Many neuropeptides are also hormones released by non-neuronal cells. [NIH] Neurosurgery: A surgical specialty concerned with the treatment of diseases and disorders of the brain, spinal cord, and peripheral and sympathetic nervous system. [NIH] Neutrophil: Having an affinity for neutral dyes. [EU] Niacin: Water-soluble vitamin of the B complex occurring in various animal and plant tissues. Required by the body for the formation of coenzymes NAD and NADP. Has pellagra-curative, vasodilating, and antilipemic properties. [NIH] Nifedipine: A potent vasodilator agent with calcium antagonistic action. It is a useful anti-anginal agent that also lowers blood pressure. The use of nifedipine as a tocolytic is being investigated. [NIH] Nitrogen: An element with the atomic symbol N, atomic number 7, and atomic weight 14. Nitrogen exists as a diatomic gas and makes up about 78% of the earth's atmosphere by volume. It is a constituent of proteins and nucleic acids and found in all living cells. [NIH] Nizatidine: A histamine H2 receptor antagonist with low toxicity that inhibits gastric acid secretion. The drug is used for the treatment of duodenal ulcers. [NIH] Ointments: Semisolid preparations used topically for protective emollient effects or as a vehicle for local administration of medications. Ointment bases are various mixtures of fats, waxes, animal and plant oils and solid and liquid hydrocarbons. [NIH] Orthopedics: A surgical specialty which utilizes medical, surgical, and physical methods to treat and correct deformities, diseases, and injuries to the skeletal system, its articulations, and associated structures. [NIH] Osteoclasts: A large multinuclear cell associated with the absorption and removal of bone. An odontoclast, also called cementoclast, is cytomorphologically the same as an osteoclast and is involved in cementum resorption. [NIH] Osteolysis: Dissolution of bone; applied especially to the removal or loss of the calcium of bone. [EU] Osteomalacia: A condition marked by softening of the bones (due to impaired mineralization, with excess accumulation of osteoid), with pain,
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tenderness, muscular weakness, anorexia, and loss of weight, resulting from deficiency of vitamin D and calcium. [EU] Osteomyelitis: Inflammation of bone caused by a pyogenic organism. It may remain localized or may spread through the bone to involve the marrow, cortex, cancellous tissue, and periosteum. [EU] Osteonecrosis: Death of a bone or part of a bone, either atraumatic or posttraumatic. [NIH] Osteopetrosis: Excessive formation of dense trabecular bone leading to pathological fractures, osteitis, splenomegaly with infarct, anemia, and extramedullary hemopoiesis. [NIH] Osteoporosis: Reduction in the amount of bone mass, leading to fractures after minimal trauma. [EU] Osteotomy: The surgical cutting of a bone. [EU] Oxycodone: Semisynthetic derivative of codeine that acts as a narcotic analgesic more potent and addicting than codeine. [NIH] Palliative: 1. Affording relief, but not cure. 2. An alleviating medicine. [EU] Paraffin: A mixture of solid hydrocarbons obtained from petroleum. It has a wide range of uses including as a stiffening agent in ointments, as a lubricant, and as a topical anti-inflammatory. It is also commonly used as an embedding material in histology. [NIH] Parenteral: Not through the alimentary canal but rather by injection through some other route, as subcutaneous, intramuscular, intraorbital, intracapsular, intraspinal, intrasternal, intravenous, etc. [EU] Parvovirus: A genus of the family Parvoviridae, subfamily Parvovirinae, infecting a variety of vertebrates including humans. Parvoviruses are responsible for a number of important diseases but also can be nonpathogenic in certain hosts. The type species is mice minute virus. [NIH] Penicillamine: 3-Mercapto-D-valine. The most characteristic degradation product of the penicillin antibiotics. It is used as an antirheumatic and as a chelating agent in Wilson's disease. [NIH] Peptic: Pertaining to pepsin or to digestion; related to the action of gastric juices. [EU] Perforation: 1. The act of boring or piercing through a part. 2. A hole made through a part or substance. [EU] Perioperative: Pertaining to the period extending from the time of hospitalization for surgery to the time of discharge. [EU] Phagocytosis: Endocytosis of particulate material, such as microorganisms or cell fragments. The material is taken into the cell in membrane-bound vesicles (phagosomes) that originate as pinched off invaginations of the
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plasma membrane. Phagosomes fuse with lysosomes, forming phagolysosomes in which the engulfed material is killed and digested. [EU] Pharmacokinetics: The action of drugs in the body over a period of time, including the processes of absorption, distribution, localization in tissues, biotransformation, and excretion. [EU] Phenylalanine: An aromatic amino acid that is essential in the animal diet. It is a precursor of melanin, dopamine, noradrenalin, and thyroxine. [NIH] Piroxicam: 4-Hydroxy-2-methyl-N-2-pyridyl-2H-1,2-benzothiazine-3carboxamide 1,1-dioxide. A non-steroidal anti-inflammatory agent that is well established in the treatment of rheumatoid arthritis and osteoarthritis. Its usefulness has also been demonstrated in the treatment of musculoskeletal disorders, dysmenorrhea, and postoperative pain. Its long half-life enables it to be administered once daily. The drug has also been shown to be effective if administered rectally. Gastrointestinal complaints are the most frequently reported side effects. [NIH] Polyarthritis: An inflammation of several joints together. [EU] Polyethylene: A vinyl polymer made from ethylene. It can be branched or linear. Branched or low-density polyethylene is tough and pliable but not to the same degree as linear polyethylene. Linear or high-density polyethylene has a greater hardness and tensile strength. Polyethylene is used in a variety of products, including implants and prostheses. [NIH] Polypeptide: A peptide which on hydrolysis yields more than two amino acids; called tripeptides, tetrapeptides, etc. according to the number of amino acids contained. [EU] Porosity: Condition of having pores or open spaces. This often refers to bones, bone implants, or bone cements, but can refer to the porous state of any solid substance. [NIH] Potassium: An element that is in the alkali group of metals. It has an atomic symbol K, atomic number 19, and atomic weight 39.10. It is the chief cation in the intracellular fluid of muscle and other cells. Potassium ion is a strong electrolyte and it plays a significant role in the regulation of fluid volume and maintenance of the water-electrolyte balance. [NIH] Predisposition: A latent susceptibility to disease which may be activated under certain conditions, as by stress. [EU] Prednisone: A synthetic anti-inflammatory glucocorticoid derived from cortisone. It is biologically inert and converted to prednisolone in the liver. [NIH]
Prevalence: The total number of cases of a given disease in a specified population at a designated time. It is differentiated from incidence, which refers to the number of new cases in the population at a given time. [NIH]
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Probenecid: The prototypical uricosuric agent. It inhibits the renal excretion of organic anions and reduces tubular reabsorption of urate. Probenecid has also been used to treat patients with renal impairment, and, because it reduces the renal tubular excretion of other drugs, has been used as an adjunct to antibacterial therapy. [NIH] Procollagen: A biosynthetic precursor of collagen containing additional amino acid sequences at the amino-terminal ends of the three polypeptide chains. Protocollagen, a precursor of procollagen consists of procollagen peptide chains in which proline and lysine have not yet been hydroxylated. [NIH]
Prostaglandins: A group of compounds derived from unsaturated 20carbon fatty acids, primarily arachidonic acid, via the cyclooxygenase pathway. They are extremely potent mediators of a diverse group of physiological processes. [NIH] Prosthesis: An artificial substitute for a missing body part, such as an arm or leg, eye or tooth, used for functional or cosmetic reasons, or both. [EU] Protease: Proteinase (= any enzyme that catalyses the splitting of interior peptide bonds in a protein). [EU] Proteins: Polymers of amino acids linked by peptide bonds. The specific sequence of amino acids determines the shape and function of the protein. [NIH]
Proteoglycans: content. [NIH]
Glycoproteins which have a very high polysaccharide
Proteolytic: 1. Pertaining to, characterized by, or promoting proteolysis. 2. An enzyme that promotes proteolysis (= the splitting of proteins by hydrolysis of the peptide bonds with formation of smaller polypeptides). [EU] Proximal: Nearest; closer to any point of reference; opposed to distal. [EU] Psoriasis: A common genetically determined, chronic, inflammatory skin disease characterized by rounded erythematous, dry, scaling patches. The lesions have a predilection for nails, scalp, genitalia, extensor surfaces, and the lumbosacral region. Accelerated epidermopoiesis is considered to be the fundamental pathologic feature in psoriasis. [NIH] Purines: A series of heterocyclic compounds that are variously substituted in nature and are known also as purine bases. They include adenine and guanine, constituents of nucleic acids, as well as many alkaloids such as caffeine and theophylline. Uric acid is the metabolic end product of purine metabolism. [NIH] Reagent: A substance employed to produce a chemical reaction so as to detect, measure, produce, etc., other substances. [EU] Receptor:
1. A molecular structure within a cell or on the surface
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characterized by (1) selective binding of a specific substance and (2) a specific physiologic effect that accompanies the binding, e.g., cell-surface receptors for peptide hormones, neurotransmitters, antigens, complement fragments, and immunoglobulins and cytoplasmic receptors for steroid hormones. 2. A sensory nerve terminal that responds to stimuli of various kinds. [EU] Recombinant: A cell or an individual with a new combination of genes not found together in either parent; usually applied to linked genes. [EU] Regeneration: The natural renewal of a structure, as of a lost tissue or part. [EU]
Resorption: The loss of substance through physiologic or pathologic means, such as loss of dentin and cementum of a tooth, or of the alveolar process of the mandible or maxilla. [EU] Rheumatoid: Resembling rheumatism. [EU] Rheumatology: A subspecialty of internal medicine concerned with the study of inflammatory or degenerative processes and metabolic derangement of connective tissue structures which pertain to a variety of musculoskeletal disorders, such as arthritis. [NIH] Riboflavin: Nutritional factor found in milk, eggs, malted barley, liver, kidney, heart, and leafy vegetables. The richest natural source is yeast. It occurs in the free form only in the retina of the eye, in whey, and in urine; its principal forms in tissues and cells are as FMN and FAD. [NIH] Rickets: A condition caused by deficiency of vitamin D, especially in infancy and childhood, with disturbance of normal ossification. The disease is marked by bending and distortion of the bones under muscular action, by the formation of nodular enlargements on the ends and sides of the bones, by delayed closure of the fontanelles, pain in the muscles, and sweating of the head. Vitamin D and sunlight together with an adequate diet are curative, provided that the parathyroid glands are functioning properly. [EU] Rigidity: Stiffness or inflexibility, chiefly that which is abnormal or morbid; rigor. [EU] Sciatica: A syndrome characterized by pain radiating from the back into the buttock and into the lower extremity along its posterior or lateral aspect, and most commonly caused by prolapse of the intervertebral disk; the term is also used to refer to pain anywhere along the course of the sciatic nerve. [EU] Sclerosis: A induration, or hardening; especially hardening of a part from inflammation and in diseases of the interstitial substance. The term is used chiefly for such a hardening of the nervous system due to hyperplasia of the connective tissue or to designate hardening of the blood vessels. [EU] Secretion: 1. The process of elaborating a specific product as a result of the
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activity of a gland; this activity may range from separating a specific substance of the blood to the elaboration of a new chemical substance. 2. Any substance produced by secretion. [EU] Sedimentation: The act of causing the deposit of sediment, especially by the use of a centrifugal machine. [EU] Selenium: An element with the atomic symbol Se, atomic number 34, and atomic weight 78.96. It is an essential micronutrient for mammals and other animals but is toxic in large amounts. Selenium protects intracellular structures against oxidative damage. It is an essential component of glutathione peroxidase. [NIH] Septic: Produced by or due to decomposition by microorganisms; putrefactive. [EU] Sequela: Any lesion or affection following or caused by an attack of disease. [EU]
Serum: 1. The clear portion of any body fluid; the clear fluid moistening serous membranes. 2. Blood serum; the clear liquid that separates from blood on clotting. 3. Immune serum; blood serum from an immunized animal used for passive immunization; an antiserum; antitoxin, or antivenin. [EU]
Spermidine: A polyamine formed from putrescine. It is found in almost all tissues in association with nucleic acids. It is found as a cation at all pH values, and is thought to help stabilize some membranes and nucleic acid structures. It is a precursor of spermine. [NIH] Spondylitis: Inflammation of the vertebrae. [EU] Spondylolisthesis: Forward displacement of one vertebra over another. [NIH] Stenosis: Narrowing or stricture of a duct or canal. [EU] Subacute: Somewhat acute; between acute and chronic. [EU] Substrate: A substance upon which an enzyme acts. [EU] Sucralfate: A basic aluminum complex of sulfated sucrose. It is advocated in the therapy of peptic, duodenal, and prepyloric ulcers, gastritis, reflux esophagitis, and other gastrointestinal irritations. It acts primarily at the ulcer site, where it has cytoprotective, pepsinostatic, antacid, and bile acidbinding properties. The drug is only slightly absorbed by the digestive mucosa, which explains the absence of systemic effects and toxicity. [NIH] Sulfinpyrazone: A uricosuric drug that is used to reduce the serum urate levels in gout therapy. It lacks anti-inflammatory, analgesic, and diuretic properties. [NIH] Sulfur: An element that is a member of the chalcogen family. It has an atomic symbol S, atomic number 16, and atomic weight 32.066. It is found in the amino acids cysteine and methionine. [NIH]
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Sulindac: A sulfinylindene derivative whose sulfinyl moiety is converted in vivo to an active anti-inflammatory analgesic that undergoes enterohepatic circulation to maintain constant blood levels without causing gastrointestinal side effects. [NIH] Symptomatic: 1. Pertaining to or of the nature of a symptom. 2. Indicative (of a particular disease or disorder). 3. Exhibiting the symptoms of a particular disease but having a different cause. 4. Directed at the allying of symptoms, as symptomatic treatment. [EU] Synergistic: Acting together; enhancing the effect of another force or agent. [EU]
Synovitis: Inflammation of a synovial membrane. It is usually painful, particularly on motion, and is characterized by a fluctuating swelling due to effusion within a synovial sac. Synovitis is qualified as fibrinous, gonorrhoeal, hyperplastic, lipomatous, metritic, puerperal, rheumatic, scarlatinal, syphilitic, tuberculous, urethral, etc. [EU] Systemic: Pertaining to or affecting the body as a whole. [EU] Tendinitis: Inflammation of tendons and of tendon-muscle attachments. [EU] Tenosynovitis: Inflammation of a tendon sheath. [EU] Tetracycline: An antibiotic originally produced by Streptomyces viridifaciens, but used mostly in synthetic form. It is an inhibitor of aminoacyl-tRNA binding during protein synthesis. [NIH] Thermal: Pertaining to or characterized by heat. [EU] Thermoregulation: Heat regulation. [EU] Thrombocytopenia: Decrease in the number of blood platelets. [EU] Thrombosis: The formation, development, or presence of a thrombus. [EU] Thyroxine: An amino acid of the thyroid gland which exerts a stimulating effect on thyroid metabolism. [NIH] Tolerance: 1. The ability to endure unusually large doses of a drug or toxin. 2. Acquired drug tolerance; a decreasing response to repeated constant doses of a drug or the need for increasing doses to maintain a constant response. [EU]
Tolmetin: An anti-inflammatory antipyretic and analgesic similar in mode of action to indomethacin. It has been proposed as an antirheumatic agent. [NIH]
Tomography: The recording of internal body images at a predetermined plane by means of the tomograph; called also body section roentgenography. [EU]
Tophus: A chalky deposit of sodium urate occurring in gout; tophi form most often around joints in cartilage, bone, bursae, and subcutaneous tissue and in the external ear, producing a chronic foreign-body inflammatory
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response. [EU] Topical: Pertaining to a particular surface area, as a topical anti-infective applied to a certain area of the skin and affecting only the area to which it is applied. [EU] Torsion: 1. A type of mechanical stress, whereby the external forces (load) twist an object about its axis. 2. In ophthalmology any rotation of the vertical corneal meridians. [EU] Toxicity: The quality of being poisonous, especially the degree of virulence of a toxic microbe or of a poison. [EU] Transcutaneous: Transdermal. [EU] Transplantation: The grafting of tissues taken from the patient's own body or from another. [EU] Tyrosine: A non-essential amino acid. In animals it is synthesized from phenylalanine. It is also the precursor of epinephrine, thyroid hormones, and melanin. [NIH] Ulcer: A local defect, or excavation, of the surface of an organ or tissue; which is produced by the sloughing of inflammatory necrotic tissue. [EU] Uricosuric: 1. Pertaining to, characterized by, or promoting uricosuria (= the excretion of uric acid in the urine). 2. An agent that promotes uricosuria. [EU] Urinalysis: Examination of urine by chemical, physical, or microscopic means. Routine urinalysis usually includes performing chemical screening tests, determining specific gravity, observing any unusual color or odor, screening for bacteriuria, and examining the sediment microscopically. [NIH] Vasculitis: Inflammation of a vessel, angiitis. [EU] Virion: The infective system of a virus, composed of the viral genome, a protein core, and a protein coat called a capsid, which may be naked or enclosed in a lipoprotein envelope called the peplos. [NIH] Viruses: Minute infectious agents whose genomes are composed of DNA or RNA, but not both. They are characterized by a lack of independent metabolism and the inability to replicate outside living host cells. [NIH] Visceral: Pertaining to a viscus. [EU] Vitallium: An alloy of 60% cobalt, 20% chromium, 5% molybdenum, and traces of other substances. It is used in dentures, certain surgical appliances, prostheses, implants, and instruments. [NIH] Withdrawal: 1. A pathological retreat from interpersonal contact and social involvement, as may occur in schizophrenia, depression, or schizoid avoidant and schizotypal personality disorders. 2. (DSM III-R) A substancespecific organic brain syndrome that follows the cessation of use or reduction in intake of a psychoactive substance that had been regularly used
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to induce a state of intoxication. [EU]
General Dictionaries and Glossaries While the above glossary is essentially complete, the dictionaries listed here cover virtually all aspects of medicine, from basic words and phrases to more advanced terms (sorted alphabetically by title; hyperlinks provide rankings, information and reviews at Amazon.com): ·
Dictionary of Medical Acronymns & Abbreviations by Stanley Jablonski (Editor), Paperback, 4th edition (2001), Lippincott Williams & Wilkins Publishers, ISBN: 1560534605, http://www.amazon.com/exec/obidos/ASIN/1560534605/icongroupinterna
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Dictionary of Medical Terms : For the Nonmedical Person (Dictionary of Medical Terms for the Nonmedical Person, Ed 4) by Mikel A. Rothenberg, M.D, et al, Paperback - 544 pages, 4th edition (2000), Barrons Educational Series, ISBN: 0764112015, http://www.amazon.com/exec/obidos/ASIN/0764112015/icongroupinterna
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A Dictionary of the History of Medicine by A. Sebastian, CD-Rom edition (2001), CRC Press-Parthenon Publishers, ISBN: 185070368X, http://www.amazon.com/exec/obidos/ASIN/185070368X/icongroupintern a
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Dorland's Illustrated Medical Dictionary (Standard Version) by Dorland, et al, Hardcover - 2088 pages, 29th edition (2000), W B Saunders Co, ISBN: 0721662544, http://www.amazon.com/exec/obidos/ASIN/0721662544/icongroupinterna
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Dorland's Electronic Medical Dictionary by Dorland, et al, Software, 29th Book & CD-Rom edition (2000), Harcourt Health Sciences, ISBN: 0721694934, http://www.amazon.com/exec/obidos/ASIN/0721694934/icongroupinterna
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Dorland's Pocket Medical Dictionary (Dorland's Pocket Medical Dictionary, 26th Ed) Hardcover - 912 pages, 26th edition (2001), W B Saunders Co, ISBN: 0721682812, http://www.amazon.com/exec/obidos/ASIN/0721682812/icongroupinterna /103-4193558-7304618
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Melloni's Illustrated Medical Dictionary (Melloni's Illustrated Medical Dictionary, 4th Ed) by Melloni, Hardcover, 4th edition (2001), CRC PressParthenon Publishers, ISBN: 85070094X, http://www.amazon.com/exec/obidos/ASIN/85070094X/icongroupinterna
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·
Stedman's Electronic Medical Dictionary Version 5.0 (CD-ROM for Windows and Macintosh, Individual) by Stedmans, CD-ROM edition (2000), Lippincott Williams & Wilkins Publishers, ISBN: 0781726328, http://www.amazon.com/exec/obidos/ASIN/0781726328/icongroupinterna
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Stedman's Medical Dictionary by Thomas Lathrop Stedman, Hardcover 2098 pages, 27th edition (2000), Lippincott, Williams & Wilkins, ISBN: 068340007X, http://www.amazon.com/exec/obidos/ASIN/068340007X/icongroupintern a
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Tabers Cyclopedic Medical Dictionary (Thumb Index) by Donald Venes (Editor), et al, Hardcover - 2439 pages, 19th edition (2001), F A Davis Co, ISBN: 0803606540, http://www.amazon.com/exec/obidos/ASIN/0803606540/icongroupinterna
Index 371
INDEX A Abdomen .......................................47, 315 Abdominal..............................................14 Abrasion ........................................84, 175 Acetaminophen................................20, 27 Acetylcysteine......................................135 Acetylgalactosamine..............86, 129, 356 Adjuvant...............................117, 286, 356 Adolescence ........................................311 Aerobic .......116, 162, 177, 198, 302, 305, 319, 360 Aetiology......................................136, 139 Alloys .....18, 331, 332, 333, 335, 336, 354 Anabolic .................................46, 141, 355 Anemia ........177, 316, 317, 354, 357, 362 Anesthesia.............................................72 Ankle......................................26, 142, 180 Antibiotic ...... 27, 160, 325, 337, 342, 360, 367 Antibody......157, 158, 171, 315, 317, 354, 359 Anticoagulants .......................21, 337, 344 Anxiety...........................................16, 298 Arteries ................................................320 Arthrography........................................318 Arthroplasty .......118, 120, 126, 153, 168, 182, 205, 303, 322, 335, 348 Arthroscopy .............69, 84, 204, 205, 318 Aseptic .................................331, 332, 341 Aspiration.................................16, 69, 316 Autopsy................................................168 B Baths .............................................22, 248 Benign .................................................330 Bioavailability.........................................87 Biochemical ...... 82, 151, 169, 171, 204, 324 Biodegradation ....................................334 Biosynthesis ........................................148 Boron ...........................135, 157, 352, 354 Bursitis ...........................................39, 209 C Capsules..............................275, 286, 356 Carbohydrate.......................................274 Cardiovascular...............................67, 319 Catabolism.....................................84, 138 Cataract ...............................................353 Cervical................................................172 Chemotherapy .....................................242 Cholestasis ..........................................241 Cholesterol ..........108, 130, 272, 274, 359
Chondrocytes. 13, 84, 117, 118, 136, 137, 138, 140, 143, 149 Chondrogenesis.................................. 149 Chromosomal ..................................... 109 Cimetidine ........................................... 155 Cobalt.......... 178, 333, 334, 335, 336, 368 Collagen.......................................... 13, 26 Constitutional ...................................... 172 Cortical........................................ 337, 341 Crabs .................................................. 196 Curcumin............................................. 135 Cyst..................................................... 113 Cytokines .................................... 139, 336 D Degenerative ........................................ 10 Diarrhea ........................................ 87, 272 Diflunisal ............................................. 155 Dislocation .................................. 340, 341 Distal ........................... 119, 131, 335, 364 Doxycycline............................. 27, 66, 325 Dysmenorrhea .............. 87, 130, 360, 363 Dyspepsia ............................................. 87 Dystrophy............................................ 216 E Edema................................... 87, 149, 150 Elastic ......................................... 198, 209 Elasticity.............................................. 336 Endocarditis ........................................ 171 Enzyme ...... 46, 144, 145, 159, 196, 302, 355, 364, 366 Epidemiological................................... 118 Estrogens...................................... 29, 325 Etodolac ................................ 87, 155, 278 Exogenous .................................. 223, 355 Extracellular ........................ 129, 140, 356 Extraction .............................................. 89 Extremity ............................. 151, 220, 365 F Famotidine .......................................... 155 Fatigue ..... 45, 298, 310, 318, 323, 334, 352 Femoral...... 111, 120, 329, 332, 333, 334, 335, 336, 341 Femur.......... 113, 168, 332, 336, 337, 341 Fenoprofen.......................................... 155 Fibroblasts .......................... 109, 127, 336 Flexion ................................................ 126 Flurbiprofen......................................... 155 Friction ................................................ 312 G Gadolinium.......................................... 115
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Gait ..............................................304, 338 Gastrointestinal....... 19, 20, 46, 87, 108, 158, 159, 184, 196, 197, 356, 366, 367 Gelatin ...................................45, 278, 354 Genotype .....................................138, 278 Glycosaminoglycans...... 84, 86, 89, 196, 277 Groin ......................................................14 Gynaecological ....................................139 H Heartburn...............................................87 Hemarthrosis .......................................170 Hematocrit ...........................................357 Heredity .........................................40, 162 Histamine.............157, 159, 353, 356, 361 Hormonal .....................................324, 325 Hormones .......20, 46, 131, 139, 157, 223, 302, 313, 354, 355, 361, 365 Hydration .............................................278 Hydrocortisone ....................................320 Hyperplasia..........................131, 136, 365 Hypersensitivity ...................................298 Hypertension .........................................87 Hypertrophy .........................................154 Hypothermia ........................................147 I Ibuprofen ......87, 155, 184, 191, 244, 300, 301, 320 Immersion............................................148 Implantation .................................332, 333 Incision ........................................120, 318 Induction ......................................118, 136 Infiltration .............................................140 Inflammation ..............................11, 19, 20 Insulin ..................................108, 129, 358 Interleukins ..........................................336 Intermittent.............................................14 Interstitial .............................131, 141, 365 Intrinsic ................................................151 Irrigation...............................122, 162, 189 Irritants.....................................21, 46, 359 K Ketoprofen .....................................19, 155 L Ligament..............................................174 Lipid .............116, 129, 130, 248, 358, 359 Lipoprotein...........108, 130, 269, 359, 368 Locomotor............................................126 Lubrication .............................................20 Lumbar ........................................168, 172 Lupus ....39, 171, 310, 313, 315, 316, 317, 320, 324, 325 M Malignant .....................................330, 352 Masticatory ..........................................175 Mediator...............................................135
Medullary ............................................ 332 Membrane....... 12, 40, 69, 135, 157, 160, 298, 354, 362, 367 Menopause ........................................... 13 Metatarsus .......................................... 142 Methionine .......................... 241, 269, 366 Methotrexate ....................................... 302 Minocycline ......................................... 325 Mobility...... 86, 151, 155, 163, 329, 338, 342 Mobilization ................................... 39, 344 Molecular ..... 45, 114, 131, 139, 140, 202, 213, 215, 331, 333, 351, 364 N Naproxen ............................ 114, 155, 184 Narcotic................... 20, 72, 130, 204, 362 Nausea.................................. 87, 242, 320 Neonatal.............................................. 143 Neurologic........................................... 172 Neuromuscular ........................... 174, 194 Neuronal ............................. 139, 223, 361 Neurons .............. 158, 223, 298, 360, 361 Neuropeptides ............................ 223, 361 Neurosurgery ...................................... 308 Niacin .................................................. 272 Nifedipine .................................... 158, 361 Nizatidine ............................................ 155 O Ointments.................................... 321, 362 Oral ......... 21, 29, 156, 184, 185, 205, 286 Orthopaedic ................................ 152, 168 Osteoarthritis ... 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31 Osteoclasts ......................................... 336 Osteolysis .. 332, 333, 334, 335, 336, 338, 340, 343 Osteonecrosis ..................................... 170 Osteoporosis................. 41, 174, 320, 324 Osteotomy.. 111, 123, 168, 169, 181, 182, 205, 303, 331 Overdose ............................................ 273 Oxycodone.................................... 88, 191 P Palliative................................................ 85 Paraffin................................................ 321 Parenteral ............................................. 87 Penicillamine....................................... 302 Peptic .................................... 21, 159, 366 Perforation ............................................ 19 Perioperative............................... 331, 337 Pharmacokinetics ................................. 87 Piroxicam ............................ 112, 155, 243 Polyarthritis ......................................... 171 Polyethylene ..... 332, 333, 334, 335, 336, 363
Index 373
Polypeptide..................131, 150, 151, 364 Porosity................................................332 Postmenopausal..........................189, 192 Postural ...............................................173 Potassium............................................274 Predisposition ......................................138 Prednisone ..........................................320 Preoperative ................................120, 339 Prevalence...... 117, 125, 144, 162, 175, 339 Procollagen..........................131, 143, 364 Progressive...86, 117, 137, 141, 144, 146, 149, 150, 154, 170, 321, 332, 340 Prostaglandins.............................208, 336 Prosthesis ............330, 334, 338, 343, 344 Proteins ....... 13, 157, 158, 159, 272, 274, 316, 324, 354, 356, 361, 364 Proteoglycans............13, 84, 86, 135, 196 Proteolytic ....................................135, 145 Proximal......113, 122, 128, 182, 336, 337, 341, 354 Psoriasis ......................................312, 364 Pulmonary ...................................171, 337 Purines ........................................311, 319 R Receptor ......137, 138, 157, 159, 356, 361 Recombinant .......................................137 Regeneration .......................................115 Registries.............................................344 Resorption ....... 117, 158, 332, 333, 335, 336, 344, 356, 361 Rheumatoid .....................................11, 15 Rheumatology ......31, 36, 37, 54, 89, 306, 326, 328, 330 Riboflavin.............................................272 Rigidity.................................................336 S Sclerosis ................85, 151, 174, 216, 311 Secretion ....140, 141, 157, 159, 269, 354, 356, 357, 358, 361, 366 Sedentary ............................................174 Selenium..............................................274 Septic...........................................171, 352 Sequela ...............................................111
Serum ......................... 117, 119, 131, 366 Spermidine.......................................... 148 Spondylitis...... 39, 50, 128, 171, 311, 313, 316, 330, 355 Spondylolisthesis ................................ 172 Stenosis .............................................. 172 Stomach....... 19, 20, 21, 27, 46, 197, 209, 320, 356 Subacute............................................. 171 Substrate............................................. 334 Sucralfate............................................ 155 Sulfur................................... 177, 248, 360 Sulindac .............................................. 155 Symptomatic ...... 113, 122, 123, 131, 154, 243, 244, 249, 250, 251, 332, 367 T Tendinitis............................................... 39 Tetracycline........... 46, 138, 325, 355, 360 Thermal............................................... 162 Thermoregulation................................ 272 Thrombocytopenia .............................. 316 Thrombosis ................................. 337, 344 Thyroxine ............................................ 273 Tolerance ............ 250, 298, 321, 342, 367 Tolmetin .............................................. 155 Tomography........................ 207, 299, 318 Topical .......... 47, 111, 184, 243, 362, 368 Toxicity.......................... 86, 159, 361, 366 Transcutaneous .................................. 198 Transplantation ........... 158, 205, 325, 357 Tyrosine .............................................. 146 U Ulcer............................................ 159, 366 Uricosuric .................... 130, 131, 364, 366 Urinalysis ........................ 39, 47, 317, 368 V Vasculitis............................................. 317 Venous........................................ 337, 344 Viral..................... 157, 171, 269, 351, 368 Viruses ........................................ 311, 316 Visceral ............................................... 172 Vitallium .............................................. 168 W Withdrawal ............................................ 86
374 Osteoarthritis
Index 375
376 Osteoarthritis
