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Monday, November 23, 2015

Most Common Disease of elder: The Clinical trials and Studies edition of Musculo-Skeletal disorders(MSDs) - Osteoarthritis: Treatment in Conventional Medicine Perspective

Kyle J. Norton, Master of Nutrients
Health article writer and researcher; Over 10.000 articles and research papers have been written and published on line, including world wide health, ezine articles, article base, healthblogs, selfgrowth, best before it's news, the karate GB daily, etc.,.
Named TOP 50 MEDICAL ESSAYS FOR ARTISTS & AUTHORS TO READ by Disilgold.com Named 50 of the best health Tweeters Canada - Huffington Post
Nominated for shorty award over last 4 years
Some articles have been used as references in medical research, such as international journal Pharma and Bio science, ISSN 0975-6299.

Musculoskeletal disorders (MSDs) are medical condition mostly caused by work related occupations and working environment, affecting patients’ muscles, joints, tendons, ligaments and nerves and developing over time. A community sample of 73 females and 32 males aged 85 and over underwent a standardised examination at home. Musculoskeletal pain was reported by 57% of those interviewed(1).

Types of Musculo-Skeletal disorders in elder(2)

1. Osteoarthritis
2. Gout
3. Rheumatoid Arthritis
4. Polymalagia Arthritis
5. Cervical myleopathy and spinal canal stenosis
6. Osteoporosis
7. Low back pain
8. Fibromyalgia

The Treatment

A. In conventional medicine perspective
A.1. Physical Activity
According to the center for diseases control and prevention recommends that everyone, including those with arthritis, get 150 minutes of moderate exercise per week, including daily flexibility exercises to maintain proper joint range of motion and do balance exercises in patient with osteoarthritis(231). According to the study by University of Manitoba, 12 week lower body positive pressure-support low-load treadmill walking program in patients aged between 55 and 75 years, improved  knee joint pain, function, and thigh muscle strength in overweight patients with knee osteoarthritis (OA) and consider as a safe user-friendly mode of exercise used in management of day-to-day joint symptoms associated with knee OA(232)(233). Other studies insisted that the same program showed a significant improvements in knee joint pain and function and demonstrated significant increases in thigh muscle strength about the degenerative knee(234). Stretching gently on joints may improve flexibility, lessen stiffness and reduced pain. In a study of Low-level laser therapy (LLLT) and stretching exercises, researchers found that LLLT can be used as resource to increase the effects of physical therapy(237).

A.2. Weight management
Over weight and obesity are found to be associated to increased risk of osteoarthritis to elder. According to studies, Over weight and obesity  can lead to more severe cartilage degeneration(121)(123) as assessed by both morphological and quantitative MRI measurements(122).
According to the study by University of California San Francisco, in the study of 127 individuals with risk factors for knee OA, 62 subjects with a body mass index (BMI) decrease≥10% found to associate to a slower progression of T2 values in individuals with risk factors for OA,(235).

A.3. Medication
The aim of the treatment is to relieve symptoms of the disease
1. Acetaminophen
a. Acetaminophen such as Tylenol can help to relive the pain of Osteoarthritis. In the study to Tramadol/APAP add-on significantly improved knee OA pain which had been inadequately controlled by NSAIDs. Both tramadol/APAP and NSAIDs were effective at maintaining the pain-reduced state(238)(239).
b. According to RX(241) list side effects are not limit to
b.1. Nausea(239) and vomiting(240)
b.2. Appetite loss(241)
b.3. Itching(241)
b.4. Diarrhea
b.5. Dark urine(241)
b.6. Abdominal pain(241)
b.7. Constipation(239)
b.8. Others may include sedation, urinary retention, pruritus and/or respiratory depression(240).

2. Nonsteroidal anti-inflammatory drugs (NSAIDs).
a. The use of the medicine should be taken into account of in cost effectiveness, adverse event data and individual cardiovascular and gastrointestinal risks(242).
b. Side effects are not limit to
According to King’s College School of Medicine and Dentistry, nonsteroidal anti-inflammatory drugs may cause(243)
b.1. A nonspecific colitis (in particular, fenemates), and many patients with collagenous colitis are taking NSAIDs.
b.2. Large intestinal ulcers, bleeding, and perforation
b.3. Relapse of classic inflammatory bowel disease
b.4. Serious complications of diverticular disease (fistula and perforation)
b.5. Small intestinal perforation, ulcers, and strictures requiring surgery
b.6. Specific biochemical and subcellular organelle damage(243).
The University of Sydney insisted that the drug may also cause enteropathy(244).


3. Narcotics
Narcotics are natural opioid drugs derived from the Asian poppy may provide relief from more severe osteoarthritis pain(245), with additive effect(246).
b. According to NIH, the side effects(247) are not limit to
b.1. Risk of dependence
b.2. Dizziness and drowsiness
b.3. Nausea and vomiting
b.4. Headache and fatigue
b.5. Others include
Yawning, insomnia, restlessness, mood swings, diarrhea(247)


A.4.. Non medication therapy
Non medication therapies such as
1. Physical therapy or physiotherapy
Physical therapy is the form of medical rehabilitation for develop, maintain and restore maximum movement and functional ability for patients caused by injure, aging and other external factors such as diseases(250). In knee osteoarthritis, according to The University of Melbourne, more research may be needed to support the claim, physiotherapy interventions has shown to reduce pain and improve function in those with knee OA(249). But according to the joint study by the University of Melbourne, University of Otago and Monash University, physical therapy dose not result in greater improvement in pain or function than other treatment such as sham treatment in patients with hip osteoarthritis(248).

2. Occupational Therapy 
According to the Canadian Association of Occupation Therapists, Occupational therapy is the form of treatment involved evaluating and improving a persons functional abilities of a specific age group or disability such as arthritis, developmental coordination disorder, mental illness, or spinal cord injury, etc...(251). But some research suggested that patient should be encouraged to change of lifestyle to achieve a optimal self-managing the effects and symptoms of OA(252).
Unfortunately, according to the University of Alberta, the implication for Rehabilitation Pain gasp has not been focused in training programs in occupational therapy education even it is a prevalent condition in all age groups(253). Some research in regarded to occupation therapy in treatment of hand exercise in osteoarthritis, insisted that high-quality studies are necessary to establish a strong and sound of evidences in concerning functional assessment and the effect of hand exercises in hand osteoarthritis(254).

In need, depending to the individual needs, including patients education and self-management programs. Weight loss may be necessary if the osteoarthritic patient is overweight(255); physical therapy may also be needed for muscle strengthening with aerobic conditioning(256)(257) and tai chi exercise(258) with improving pain and function in people with OA, depending to the disease severities(258), etc.

Exercise therapy may be beneficiary for treatment of pain in patients with OA(259), but when it is used in conjunctions with other forms of therapies such as strength training and exercise with additional passive manual mobilisation, the combination has found to achieve better pain relief in patients with knee osteoarthritis(260), according to the study by Maastricht University

Manual therapy on the other hand, is more effective than exercise for those with hip OA in the short and long-term(261). Unfortunately, in the  investigate the addition of manual therapy to exercise therapy for the reduction of pain and increase of physical function in people with knee osteoarthritis (OA), researchers at the showed that combined strategy of exercise therapy plus manual therapy with booster sessions was not superior to exercise therapy alone in patients with knee osteoarthritis(262).

A.5. Surgery
Surgery only necessary if symptoms persist, depending on several factors, including the location and severity of OA damage, patient characteristics and risk factors.(265).
1. Arthrocentesis plus corticosteroid
Arthrocentesis is a medical procedure to remove joint fluid with a sterile needle for analysis through injection of corticosteroids into the joints to relieve pain, swelling, and inflammation. According to Regions Hospital, there is a reluctance of surgeon to perform such operation in patient who are receiving anticoagulation at therapeutic levels(263).
According to the Mayo clinic, cortisone shots overdoses can cause joint damage(264).

2. Arthroscopy
Arthroscopy is a minimally invasive surgical procedure to examine and treat the abnormalities of and damage to the cartilage and ligaments through the arthroscope. It is considered as one of the standard interventions with low potential for complications for patient with knee osteoarthritis(265) and ankles, shoulders, elbows, wrists and hips osteoarthritis(266).

3. Lubrication injections
Injections of hyaluronic acid derivatives (Hyalgan, Synvisc) are recommended only to patients who have not found adequate pain relief in conservative treatment(268).
Platelet-rich plasma (PRP) contains high concentrations of autologous growth factors that originate from platelets influences the production of SZP from human joint-derived cells, has shown effectively in treatment of osteoarthritis or damage in the knee joint. or damage in the knee joint, according to the study by University of California(267).

4. Realigning bones
Osteotomy is a surgical procedure used to realign bones, cartilage and reposition the joint to reduce knee pain by shifting your body weight away from the damaged cartilage(269). Osteotomies about the hip may be used for the prevention and treatment of osteoarthrosis(270), only if the mechanical causes of the potential or established osteoarthritis is clear and the operation succeeds in reducing the pathologically excessive joint loads(271).

5. Joint replacement
Joint replacement is a surgical procedure of orthopedic surgery to relief pain and to place the damaged joint surfaces(272). Over 1 million surgical procedure have been perform in elective total knee and hip replacements annually in the United States alone(273). According to study, over 70 % of patients who received rapid mobilization of total joint replacement patients recover safely and reduced the overall length of hospital stay(274).

Joint replacement is considered as a treatment only for patients with severe joint pain or dysfunction that can not be alleviated by non  invasive treatments. But, according to Odense University Hospital, hip replacement can be postponed in patients with severe hip osteoarthritis if patients  participate in a education and supervised exercise program(275).

6. Etc.

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Back to Kyle J. Norton Home page http://kylejnorton.blogspot.ca p/general-health.htmlReferences
(231) Physical Activity and Arthritis Overview(CDC)
(232) Managing Knee Osteoarthritis: The Effects of Body Weight Supported Physical Activity on Joint Pain, Function, and Thigh Muscle Strength by Peeler J1, Christian M, Cooper J, Leiter J, MacDonald P.(PubMed)
(233) Lower body positive pressure: an emerging technology in the battle against knee osteoarthritis? by Takacs J1, Anderson JE, Leiter JR, MacDonald PB, Peeler JD.(PubMed)
(234) Managing Knee Osteoarthritis: The Effects of Body Weight Supported Physical Activity on Joint Pain, Function, and Thigh Muscle Strength by Peeler J1, Christian M, Cooper J, Leiter J, MacDonald P.(PubMed)
(235) Weight loss over 48 months is associated with reduced progression of cartilage T2 relaxation time values: data from the osteoarthritis initiative by Serebrakian AT1, Poulos T, Liebl H, Joseph GB, Lai A, Nevitt MC, Lynch JA, McCulloch CE, Link TM.(PubMed)
(236) Obesity versus osteoarthritis: beyond the mechanical overload.[Article in English, Portuguese] by Sartori-Cintra AR1, Aikawa P2, Cintra DE3.(PubMed)
(237) Effect of low-level laser therapy (904 nm) and static stretching in patients with knee osteoarthritis: a protocol of randomised controlled trial by Ferreira de Meneses SR1,2, Hunter DJ3, Young Docko E4, Pasqual Marques A5.(PubMed)
(238) The efficacy of tramadol/acetaminophen combination tablets (Ultracet®) as add-on and maintenance therapy in knee osteoarthritis pain inadequately controlled by nonsteroidal anti-inflammatory drug (NSAID). by Park KS1, Choi JJ, Kim WU, Min JK, Park SH, Cho CS.(PubMed)
(239) Efficacy and safety of tramadol/acetaminophen tablets (Ultracet) as add-on therapy for osteoarthritis pain in subjects receiving a COX-2 nonsteroidal antiinflammatory drug: a multicenter, randomized, double-blind, placebo-controlled trial by Emkey R1, Rosenthal N, Wu SC, Jordan D, Kamin M; CAPSS-114 Study Group.(PubMed)
(240) Effects of acetaminophen on morphine side-effects and consumption after major surgery: meta-analysis of randomized controlled trials by Remy C1, Marret E, Bonnet F.(PubMed)
(241) Tylenol Side Effects Center(RXlist)
(242) Cost effectiveness of COX 2 selective inhibitors and traditional NSAIDs alone or in combination with a proton pump inhibitor for people with osteoarthritis(The BMJ)
(243) Side effects of nonsteroidal anti-inflammatory drugs on the small and large intestine in humans by Bjarnason I1, Hayllar J, MacPherson AJ, Russell AS.(PubMed)
(244) Detection and prevention of NSAID-induced enteropathy by Davies NM1, Saleh JY, Skjodt NM.(PubMed)
(245) Patient preference and willingness to pay for knee osteoarthritis treatments. by Posnett J1, Dixit S2, Oppenheimer B2, Kili S3, Mehin N4.(PubMed)
(246) A model of additive effects of mixtures of narcotic chemicals by Shirazi MA1, Linder G.(PubMed)
(247) Pain medications - narcotics(NIH)
(248) Effect of physical therapy on pain and function in patients with hip osteoarthritis: a randomized clinical trial by Bennell KL1, Egerton T1, Martin J1, Abbott JH2, Metcalf B1, McManus F1, Sims K3, Pua YH4, Wrigley TV1, Forbes A5, Smith C5, Harris A6, Buchbinder R7.(PubMed)
(249) Physiotherapy management of knee osteoarthritis by Page CJ1, Hinman RS, Bennell KL.(PubMed)
(250) Policy statement: Description of physical therapy(World federation of physical therapy)
(251) Occupational Therapy - As defined by the Canadian Association of Occupational Therapists(Canadian Association of Occupation Therapists)
(252) Integrating lifestyle approaches into osteoarthritis care by Garver MJ1, Focht BC2, Taylor SJ3.(PubMed)
(253) Occupational therapists' pain knowledge: a national survey by Reyes AN1, Brown CA1.(PubMed)
(254) Occupational therapy-based and evidence-supported recommendations for assessment and exercises in handosteoarthritis by Kjeken I1(PubMed)
(255) Osteoarthritis, obesity and weight loss: evidence, hypotheses and horizons – a scoping review by H Bliddal,1 A R Leeds,2,3,4 and R Christensen1(PubMed)
(256) Strength cycle training: effects on muscular strength and aerobic conditioning. by Van Zant RS1, Bouillon LE.(PubMed)
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(259) Osteoarthritis(Medline Plus)
(260) Strength training alone, exercise therapy alone, and exercise therapy with passive manual mobilisation each reduce pain and disability in people with knee osteoarthritis: a systematic review. by Jansen MJ1, Viechtbauer W, Lenssen AF, Hendriks EJ, de Bie RA.(PubMed)
(261) Manual therapy for osteoarthritis of the hip or knee: a systematic review by Review published: 2011.Bibliographic details: French HP, Brennan A, White B, Cusack T. Manual therapy for osteoarthritis of the hip or knee: a systematic review. Manual Therapy 2011; 16(2): 109-117. [PubMed]
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(263) Safety of arthrocentesis and joint injection in patients receiving anticoagulation at therapeutic levels by Ahmed I1, Gertner E.(PubMed)
(264) Tests and Procedures, Cortisone shots(Mayo Clinic)
(265) [Complications of knee arthroscopy].[Article in German] by Mayr HO1, Stoehr A2.(PubMed)
(266) Arthroscopy(NHS choice)
(267) Stimulation of the superficial zone protein and lubrication in the articular cartilage by human platelet-rich plasma by Sakata R1, McNary SM1, Miyatake K1, Lee CA1, Van den Bogaerde JM1, Marder RA1, Reddi AH2.(PubMed)
(268) Non-surgical treatment of osteoarthritis-related pain in the elderl by Saulat Mushtaq,3 Rabeea Choudhary,2 and Carla R. Scanzello(PMC)
(269) Knee Osteotomy(The Knee Society)
(270) Osteotomies about the hip for the prevention and treatment of osteoarthrosis by Millis MB1, Murphy SB, Poss R.(PubMed)
(271) Osteotomies of the hip in the prevention and treatment of osteoarthritis by Millis MB, Poss R, Murphy SB.(PubMed)
(272)
(273) Parachutes and Preferences - A Trial of Knee Replacement by Katz JN1.(PubMed)
(274) Rapid mobilization decreases length-of-stay in joint replacement patients by Tayrose G, Newman D, Slover J, Jaffe F, Hunter T, Bosco J 3rd.(PubMed)

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