Knee osteoarthritis management therapies

Knee osteoarthritis (OA) is a common cause of pain and long-term disability in the elderly, and the incidence among middle-aged adults is considerable. Well-recognized risk factors associated with knee OA include age, women, being overweight or obese, major knee injury, and occupational overuse of the knee. Although loss of articular cartilage represents the pathological hallmark of knee OA, changes in subchondral bone and soft tissue are major features. Because knee OA is chronic and progressive, it is paramount that patients and health care professionals work together to manage symptoms, and to prevent and minimize deleterious consequences. Patient education, exercise, weight reduction, thermal modalities, assistive devices, medications, and neutraceuticals are important components of therapy. This article reviews common nonpharmacological and pharmacological therapies essential for the effective management of knee OA.

Polymyalgia rheumatica and temporal arteritis: a case presentation

Polymyalgia rheumatica (PMA) and temporal arteritis (TA) are common clinical syndromes that affect the elderly population. Both syndromes may include similar constitutional complaints, an increase in acute phase reactants, a rapid response to corticosteroids, and the presence of anteritis giant cells upon temporal artery biopsy. Differential diagnosis is one of exclusion. A case presentation is included to assist practitioners in recognizing presenting symptoms, identifying diagnostic testing, and proceeding with appropriate therapy and follow-up.

Issues in the nursing management of osteoporosis

As new interventions are developed to improve the care of patients with osteoporosis, nurses will play an important role in improving patients' quality of life, reducing their fear, and assisting in maintaining their independence throughout the adult life span. This article examines key issues involved in the management of patients at risk for, or diagnosed with, osteoporosis.

Medium-sized business employees speak out about smoking

A health promotion study, funded by a state health department to meet objectives 3.4 and 3.11 of Healthy People 2000, was designed to: (1) identify tobacco use; (2) assess employees' beliefs on one's health and family member's health; and (3) assess the type of smoking policies favored. Using the Health Belief Model, it was hypothesized that there were differences in the health beliefs of tobacco users, former users, and never users. A 34-item questionnaire was administered to 1090 employees with a return rate of 603 (55%).

RESULTS

tobacco users perceived weight control and reduction of tension as benefits; they accepted warning label as hazardous but reported smokeless not as harmful; they perceived heart disease and cancer as related to tobacco use; and 62% had tried to quit smoking. Former and never users wanted "total ban policies" while, tobacco users wanted "designated areas" for smoking. All perceived their smoking and environmental tobacco smoke hazardous to their health and the health of family.

Osteoporosis: implications for risk reduction in the college setting

Osteoporosis is often considered a chronic disease of older adulthood. As with many chronic diseases, lifestyle behaviors adopted during young adulthood are important risk factors for future development of osteoporosis. The college student population represents the age group in which optimal bone development is likely to occur and certain lifestyle behaviors are reinforced. Therefore, risk factors for osteoporosis, including nutritional insufficiency of calcium and vitamin D, smoking, alcohol abuse, excessive exercise, use of steroids, and high-protein diets, have special relevance for this target population. The authors examine risk factors for osteoporosis that are especially relevant to the college health setting and offer intervention strategies for college health professionals.

Hyaluronic acid treatment for osteoarthritis of the knee

Osteoarthritis of the knee is a leading cause of chronic disability in the United States. It is a heterogeneous condition that causes pathogenic changes that are presumably irreversible. In many cases, knee pain is often progressive and leads the patient to seek medical attention. Pharmacologic and nonmedicinal treatments are, in most cases, only modestly successful in relieving pain. Hyaluronic acid (HA) functions as the backbone of the proteoglycan aggregates necessary for the functional integrity of articular cartilage of the knee. Two drugs made up of HA derivatives have recently become available for patients in whom simple analgesics and conservative non-pharmacologic therapy have failed. This article reviews the epidemiology, pathogenesis, diagnosis, and medical management of osteoarthritis of the knee, with an emphasis on the physiologic and pharmacologic mechanisms of HA. Health care providers may administer HA via intra-articular injection in primary care, rheumatologic or orthopedic settings, or they may refer their patients to specialists for consultation.

Fibromyalgia syndrome: a comprehensive approach to identification and management

Fibromyalgia syndrome (FMS) is a common, chronic musculoskeletal pain disorder of unknown etiology seen predominately in women. It is recognized as an important clinical problem associated with high levels of functional disability, emotional distress, and utilization of several types of medical services. While widespread pain and the presence of multiple tender points characterize the dominating features, there are a large number of nonrheumatic symptoms and associated conditions that occur in a high frequency in this disorder. When the characteristic pattern of symptoms is recognized, FMS can be successfully managed by nurse practitioners with expectation of some improvement. The mainstays of management include patient education, medication, aerobic exercise, and physical therapy. An ongoing relationship with the patient and periodic follow-up are mandatory.

5-fluorouracil-induced erythema multiforme

Erythema multiforme is an immunologically mediated skin reaction to a foreign antigen and can occur with many drugs. We report the first two cases of erythema multiforme induced by 5-fluorouracil (5-FU). The first case was in a man with inoperable gastric carcinoma being treated by continual infusion who developed the classic rash involving the neck and upper chest, along with mouth ulceration and plantar-palmar erythrodysaesthesia. Histological confirmation was made by skin biopsy and the lesions resolved spontaneously. They recurred on restarting 5-FU. The second case was in a woman being given adjuvant bolus 5-FU and folinic acid for Duke's C colon cancer who developed the rash during the first cycle. Again, the lesions settled spontaneously but recurred more severely on the second cycle. When treatment was changed to the specific thymidylate synthase inhibitor, raltitrexed, the course was completed uneventfully.

Expression of cartilage oligomeric matrix protein by human synovium

Human synovium was analyzed for the possible expression of cartilage oligomeric matrix protein (COMP). Immunostaining with polyclonal antiserum to COMP demonstrated positive staining within the synovial cells and immediately subjacent connective tissue, with less intense staining in the deeper connective tissue. Western blot analysis using either polyclonal or monoclonal antibodies to human COMP confirmed the presence of COMP by immunoreactive bands with the same molecular mass (approximately 110 kDa) as purified articular cartilage COMP. PCR using oligonucleotides that span human COMP exons 7-13 revealed identical amplification products from cDNA prepared from either human chondrocytes or synovium. Northern blot analysis using a biotinylated-probe to human COMP, spanning exons 12-13, also reveal an identical hybridization product to either human chondrocyte or synovium total RNA. Human synovium should be considered as a potential tissue source of COMP in any investigation of biological markers of cartilage metabolism.

Assessment of body composition in the healthy adult

Information obtained from body composition assessment can provide a foundation for the development of weight-loss and exercise guidelines. The ideal method for assessing body composition in the clinical setting should be relatively inexpensive, as convenient as possible for the individual, reproducible and accurate, and helpful in evaluation considerations (Lohman, 1992). It appears that skinfold thickness measurements could have specific advantages in the clinical setting when compared to bioelectrical impedance and traditional methods of using height and weight. Ideally, body composition assessment should be an integral component of the physical examination of the healthy adult.

Sexual dimorphism and androgen effects on spinal motoneurons innervating the rat flexor digitorum brevis

The foot muscle, flexor digitorum brevis, is innervated by motoneurons in the retrodorsolateral nucleus of the lumbar spinal cord in rats. We found this muscle to be sexually dimorphic, but insensitive to the anabolic or catabolic effects of androgen manipulation in adulthood: the flexor digitorum brevis was larger in adult male rats than in females, with no decrease in mass after castration in males nor any increase in size after androgen treatment of ovariectomized females. The cross-sectional area of motoneurons innervating this muscle was also sexually dimorphic, i.e., the motoneurons were larger in males. In contrast to the absence of an androgen effect on target muscle size, however, cross-sectional area of motoneurons decreased in adult males as a result of castration, and increased in adult females after androgen treatment. The dissociation of androgen effects on muscle mass and motoneuron size suggests the possibility of steroid effects upon motoneurons independent of effects upon target musculature.

Does androgen affect axonal transport of cholera toxin HRP in spinal motoneurons?

We examined the effect of systemic androgen levels upon the rate at which lumbosacral motoneurons are labeled with cholera toxin-conjugated horseradish peroxidase (CT-HRP) injected into target muscles. CT-HRP first reaches the spinal nucleus of the bulbocavernosus between 8 and 10 h after injection into the bulbocavernosus muscle of adult male rats, but the number of motoneurons filled with CT-HRP does not differ between androgen-treated and control castrates at any of the time points examined. Thus, contrary to current speculation, we found no evidence that androgen can affect retrograde transport of CT-HRP by rat motoneurons.