Category Archives: Osteoarthritis

Osteoarthritis-a disease of cartilage

Bitter Kola boosts libido and beats osteoarthritis

Results of a study published in African Journal of Pharmacy and Pharmacology have confirmed that bitter kola possesses sexual enhancing effects on male rats as evidenced by the increased mounting (MF) and intromission (IF) frequencies with increased number of subsequent ejaculations over the 20 min observation period.bitter-kola

The study is titled “Effects of ethanolic extract of Garcinia kola on sexual behaviour and sperm parameters in male Wistar rats.”

Another study published in Journal of Orthopaedic Surgery and Research by medical doctors, pharmacists and nurses at Obafemi Awolowo University Teaching Hospital (OAUTH) concluded: “Garcinia kola appeared to have clinically significant analgesic/anti-inflammatory effects in knee osteoarthritis patients. Garcinia kola is a potential osteoarthritis disease activity modifier with good mid term outcome. Further studies are required for standardization of dosages and to determine long-term effects.”

The study is titled “Clinical effects of Garcinia kola in knee osteoarthritis.”

Comment: Whoa…, I think I need this.

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What are my options for shoulder pain?

The shoulder has the honor of being is the largest, most complex, and most mobile joint in the body.  And it is this reason that makes it the most vulnerable to overuse.

The shoulder consists of three bones: the humerus (upper arm bone), clavicle (collarbone), and scapula (shoulder blade).

The rotator cuff muscles and tendons are responsible for movement and stabilization of the shoulder.

In addition, there are other muscles and a complex array of ligaments that also serve to ensure stability.

Another tendon, the biceps tendon, originates from the glenoid (the cup of the shoulder blade where the humerus sits) and extends down the humerus.  It is responsible for certain arm and shoulder movements.

The ironic fact is that a patient who complains of shoulder pain may have nothing wrong with the shoulder!shoulder-pain

For example, many medical conditions such as gall bladder disease, pneumonia, and ectopic pregnancies can present with shoulder pain.  Also, neck conditions often cause referred pain to the shoulder.  Patients with heart disease who are experiencing a heart attack may complain of pain in the left shoulder and arm.

Shoulder ailments fall into three major groups.  The first is trauma.  An example may be a skier who falls on an extended arm.  The impact can drive the head of the arm bone into the socket and cause damage to the cartilage, the bone, as well as the rotator cuff tendons. If the ligaments are stretched or torn, the shoulder can dislocate.  While the shoulder can be “relocated”, once dislocation occurs, the patient is at increased risk for another dislocation. Significant impact can cause damage to the cartilage that cushions the head of the femur as well as the “cup” of the scapula.  This cup is referred to as the glenoid.  The glenoid also has a lip of tougher cartilage that can be torn with impact injuries.

Trauma, if significant enough, can cause dislocation of the joint joining the collar bone to the shoulder blade. The common term for this is a “separated shoulder.”

A related but different type of ailment is wear and tear.  Because so many of the structures that permit shoulder movement and provide stability are made of connective tissue, it stands to reason that over time, they can begin to wear out.  And that is exactly what happens.  Tendons- the ropes that connect muscles to bone-, ligaments, and bursae (fluid filled sacks that cushion joint movement) all are prone to injury as a result of overuse.

When this occurs, conditions such as tendinopathy (previously known as tendonitis), bursitis, and ligament strain ensue.

While inflammation may be present, the overwhelming problem is tissue breakdown.

The last ailment that affects the shoulder is arthritis.  The three bones that make up the shoulder interact with each other at two specific points.  At these two points, there is a joint where two bones whose ends are covered with cartilage articulate.  The two joints are the glenohumeral joint- the joint that joins the shoulder blade and the humerus and the acromioclavicular joint that joins the collarbone to the shoulder blade.

Arthritis at these two areas can develop as a result of systemic disease such as rheumatoid arthritis or as a result of wear and tear- osteoarthritis.

The treatment of shoulder disorders depends upon both the underlying problem as well as the amount of patient discomfort and the impact on quality of life.

For traumatic disorder where there is obvious tissue disruption, surgery is usually required.  The type of surgery will be up to both the surgeon as well as to the individual who has the problem. The shoulder is a complex joint so it’s important to ensure whoever works on the shoulder is an expert.

For most wear and tear problems, non-steroidal anti-inflammatory medicines (NSAIDS) are sometimes, but not always, helpful. Ice and rest also can be useful.

Patients may require a steroid injection. For people who don’t respond to medicines, injections, and physical therapy, surgery may be an option. Ultrasound guidance is important.

Regenerative medicine techniques can be used for shoulder issues.  An example would be a procedure called percutaneous needle tenotomy which can be used to treat rotator cuff tendinopathy and tears.

In this procedure, a small needle is introduced using local anesthetic and ultrasound guidance. The needle is used to irritate the tendons of the rotator cuff and induce inflammation. Then, platelet-rich plasma, obtained from the patient’s whole blood is injected into the area where the tendons have been irritated. Ultrasound guidance here is mandatory. Platelets are cells in the blood that contain many growth and healing factors. This stimulates the production of new strong tendon tissue.

Another example of a regenerative medicine technique is the use of autologous stem cells (a patient’s own stem cells) for glenohumeral arthritis.

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Prevention is the best treatment for osteoarthritis?

A work group called the Osteoarthritis Management Initiative (COAMI) met in 2012 to discuss osteoarthritis management and what could be improved.  The thrust of the meeting was aimed at developing new strategies for prevention of the disease.osteoarthritis-knee-2

Risk factors for osteoarthritis include obesity, aging, genetics, family history, major injury or surgery to the joint, and misalignment of the joint.

According to Dr. Rowland Chang, professor of medicine at the Northwestern University School of Medicine, rheumatology is where cardiology was in the 1950′s.  More attention should be placed on disease prevention.  That includes lifestyle changes. He states, “If we could wipe out obesity, … we might be able to prevent about one-third of all the knee osteoarthritis we have in the world.”

My comment is this: It’s an admirable undertaking but making people change their lifestyle is going to be difficult.  However, with the aging Baby Boomer population, it’s certainly worth a try.

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Patients over 70 do well after minimally invasive spinal stenosis surgery

Rosemary Frei writing in Pain Management News reported on a study led by Raja Rampersand, MD at the Spinal Program of the Toronto Western Hospital and the University of Toronto. Analysis of data from 2008 to 2011 compared patients aged 40 to 69 with patients past the age of 70 who underwent surgical decompression for lumbar spinal stenosis.  There were no differences in adverse events between the two groups, although patients in both groups took longer to recover if a fusion accompanied the decompression. lumbar-spinal-stenosis-old-man

Comment: Spinal stenosis is one of the most common low back syndromes seen in rheumatology practice.  Although epidural steroid injections and physical therapy can be effective for many patients, many people with this malady go on to have surgery. This study provides encouraging news for patients with spinal stenosis.

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“Ooohhh, My Aching Knee!” Insider Secrets on How You Can Get Relief Quickly and Easily!

When your knee hurts, getting relief is all that’s on your mind. Getting the right relief, though, depends on knowing what’s wrong. The correct diagnosis will lead to the correct treatment.

Know Your Knee!knee-arthritis

The knee is the largest joint in the body. It’s also one of the most complicated. The knee joint is made up of four bones that are connected by muscles, ligaments, and tendons. The femur (large thigh bone) interacts with the two shin bones, the tibia (the larger one) located towards the inside and the fibula (the smaller one) located towards the outside. Where the femur meets the tibia is termed the joint line. The patella, (the knee cap) is the bone that sits in the front of the knee. It slides up and down in a groove in the lower part of the femur (the femoral groove) as the knee bends and straightens.

Ligaments are the strong rope-like structures that help connect bones and provide stability. In the knee, there are four major ligaments. On the inner (medial) aspect of the knee is the medial collateral ligament (MCL) and on the outer (lateral) aspect of the knee is the lateral collateral ligament (LCL). The other two main ligaments are found in the center of the knee. These ligaments are called the anterior cruciate ligament (ACL) and the posterior cruciate ligament (PCL). They are called cruciate ligaments because the ACL crosses in front of the PCL. Other smaller ligaments help hold the patella in place in the center of the femoral groove.

Two structures called menisci sit between the femur and the tibia. These structures act as cushions or shock absorbers. They also help provide stability for the knee. The menisci are made of a tough material called fibrocartilage. There is a medial meniscus and a lateral meniscus. When either meniscus is damaged it is called a “torn cartilage”.

There is another type of cartilage in the knee called hyaline cartilage. This cartilage is a smooth shiny material that covers the bones in the knee joint. In the knee, hyaline cartilage covers the ends of the femur, the femoral groove, the top of the tibia and the underside of the patella. Hyaline cartilage allows the knee bones to move easily as the knee bends and straightens.

Tendons connect muscles to bone. The large quadriceps muscles on the front of the thigh attach to the top of the patella via the quadriceps tendon. This tendon inserts on the patella and then continues down to form the rope-like patellar tendon. The patellar tendon in turn, attaches to the front of the tibia. The hamstring muscles on the back of the thigh attach to the tibia at the back of the knee. The quadriceps muscles are the muscles that straighten the knee. The hamstring muscles are the main muscles that bend the knee.

Bursae are small fluid filled sacs that decrease the friction between two tissues. Bursae also protect bony structures. There are many different bursae around the knee but the ones that are most important are the prepatellar bursa in front of the knee cap, the infrapatellar bursa just below the kneecap, the anserine bursa, just below the joint line and to the inner side of the tibia, and the semimembranous bursa in the back of the knee. Normally, a bursa has very little fluid in it but if it becomes irritated it can fill with fluid and become very large.

Is it bursitis… or tendonitis…or arthritis?

Tendonitis generally affects either the quadriceps tendon or patellar tendon. Repetitive jumping or trauma may set off tendonitis. The pain is felt in the front of the knee and there is tenderness as well as swelling involving the tendon. With patellar tendonitis, the infrapatellar bursa will often be inflamed also. Treatment involves rest, ice, and anti-inflammatory medication. Injections are rarely used. Physical therapy with ultrasound and iontopheresis may help.

Bursitis pain is common. The prepatellar bursa may become inflamed particularly in patients who spend a lot of time on their knees (carpet layers). The bursa will become swollen. The major concern here is to make sure the bursa is not infected. The bursa should be aspirated (fluid withdrawn by needle) by a specialist. The fluid should be cultured. If there is no infection, the bursitis may be treated with anti-jnflammatory medicines, ice, and physical therapy. Knee pads should be worn to prevent a recurrence once the initial bursitis is cleared up.

Anserine bursitis often occurs in overweight people who also have osteoarthritis of the knee. Pain and some swelling is noted in the anserine bursa. Treatment consists of steroid injection, ice, physical therapy, and weight loss.

The semimembranous bursa can be affected when a patient has fluid in the knee (a knee effusion). The fluid will push backwards and the bursa will become filled with fluid and cause a sensation of fullness and tightness in the back of the knee. This is called a Baker’s cyst. If the bursa ruptures, the fluid will dissect down into the calf. The danger here is that it may look like a blood clot in the calf. A venogram and ultrasound test will help differentiate a ruptured Baker’s cyst from a blood clot. The Baker’s cyst is treated with aspiration of the fluid from the knee along with steroid injection, ice, and elevation of the leg.

Knock out knee arthritis… simple steps you can take!

Younger people who have pain in the front of the knee have what is called patellofemoral syndrome (PFS). Two major conditions cause PFS. The first is chondromalacia patella. This is a condition where the cartilage on the underside of the knee cap softens and is particularly common in young women. Another cause of pain behind the knee cap in younger people may be a patella that doesn’t track normally in the femoral groove. For both chondromalacia as well as a poorly tracking patella, special exercises, taping, and anti-inflammatory medicines may be helpful. If the patellar tracking becomes a significant problem despite conservative measures, surgery is need.

While many types of arthritis may affect the knee, osteoarthritis is the most common. Osteoarthritis usually affects the joint between the femur and tibia in the medial (inner) compartment of the knee. Osteoarthritis may also involve the joint between the femur and tibia on the outer side of the knee as well as the joint between the femur and patella. Why osteoarthritis develops is still being scrutinized carefully. It seems to consist of a complex interaction of genetics, mechanical factors, and immune system involvement. The immune system attacks the joint through a combination of degradative enzymes and inflammatory chemical messengers called cytokines.

Patients will sometimes feel a sensation of rubbing or grinding. The knee will become stiff if the patient sits for any length of time. With local inflammation, the patient may experience pain at night and get relief from sleeping with a pillow between the knees. Occasionally, locking and clicking may be noticed. Patients with osteoarthritis may also tear the fibrocartilage cushions (menisci) in the knee more easily than people without osteoarthritis.

So how is the arthritis treated? An obvious place to start is weight reduction for patients who carry around too many pounds.

Strengthening exercises for the knee are also useful for many people. These should be done under the supervision of a physician or physical therapist.

Other therapies include ice, anti inflammatory medicines, and occasionally steroid injections. Glucosamine and chondroitin supplements may be helpful. A word of caution… make sure the preparation you buy is pure and contains what the label says it does. The supplement industry is unregulated… so buyer beware!

Injections of the knee with viscosupplements – lubricants- are particularly useful for many patients. Special braces may help to unload the part of the joint that is affected.

Arthroscopic techniques may be beneficial in special circumstances. Occasionally, a surgical procedure called an osteotomy, where a wedge of bone is removed from the tibia to “even things out,” may be recommended. Joint replacement surgery is required for end stage knee arthritis.

Research is being done to develop medicines that will slow down the rate of cartilage loss. Targets for these new therapies include the destructive enzymes and/or cytokines that degrade cartilage. It is hoped that by inhibiting these enzymes and cytokines and by boosting the ability of cartilage to repair itself, that therapies designed to actually reverse osteoarthritis may be created. These are referred to as disease-modifying osteoarthritis drugs or “DMOADs.” Genetic markers may identify high risk patients who need more aggressive therapies.

Newer compounds that are injected into the knee and provide healing as well as lubrication are also being developed. And finally, less invasive surgical techniques are also being looked at. Recent technological advances in “mini” knee replacement look very promising.

The technology that will revolutionize our approach to knee osteoarthritis is the use of mesenchymal stem cells.  These are stem cells derived from “non-blood” tissues such as fat, bone marrow, or even the lining of the joint. Studies in both animals as well as humans have shown great potential for these cells to regenerate cartilage.

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Don’t be a victim of arthritis myths… Arthritis treatment is effective!

Ashley Macha, writing in Health online, reported on four arthritis myths.  This was done as part of a May is Arthritis Awareness Month campaign, featuring Joe Montana, Hall of Fame quarterback.

1. Myth: Arthritis only affects the aging.  Reality: This is the most common misconception. Anyone, at any age can be affected, according to the Arthritis Foundation. The most common type is osteoarthritis, the kind due to wear and tear on the joints over time (which is what Montana has), but also rheumatoid arthritis, an autoimmune disease that can occur at any age, juvenile arthritis, an autoimmune disease in children, and other types.

2. Myth: Joint health is not a serious issue. Reality: The population of those with arthritis in the United States is increasing, with approximately 70 million Americans predicted to have arthritis by 2030. It is the number one cause of disability in the United States.

3. Myth: Patients with arthritis should avoid exercise. Reality: The Arthritis Foundation recommends starting out walking or doing water workouts. Montana lifts weights to keep his muscles in shape. “When muscles are strong, it takes pressure off them [joints].” Patience White, MD, and vice president of public health for the Arthritis Foundation says resistance training can provide numerous benefits for those who suffer from arthritis. Dr. White recommends simple exercises, including hamstring and calf stretches, or weightlifting with something as simple as 16-ounce soup cans.

4. Myth: There is no treatment for arthritis. Reality: “I always thought initially that there was nothing you could do to help to ease your everyday life,” Montana said. There are medication and treatments, as well yoga moves to help ease pain, natural remedies, and new treatments are in the pipeline. Treatment also varies with the type of arthritis. There are more than 100 different kinds of arthritis and each is treated differently.

There are many other myths but the key points to remember are that arthritis, when diagnosed early is very treatable and that newer treatments such as stem cell therapy for osteoarthritis look extremely promising.

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Osteoporosis Drugs May Benefit Patients With Knee Osteoarthritis

Lynda Williams writing in Medwire reported, “Research adds weight to reports that patients with knee osteoarthritis may experience benefits in pain or progression relief from bisphosphonate treatment.”

osteoarthritis-knee-2Bisphosphonates are drugs typically used to treat osteoporosis.osteoporosis Investigators who analyzed “data from the National Institutes of Health Osteoarthritis Initiative cohort shows that patients who used bisphosphonates  for 3 or more years over a 5-year period achieved a significant reduction in rating scale pain scores at years 2 and 3 compared with nonusers, after adjusting for baseline levels of pain and analgesic use.”

The findings were published in the Annals of Rheumatic Diseases.

Comment: Killing two birds with one stone…

 

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Vitamin K Deficiency A Cause of Osteoarthritis?

Lynda Williams writing in Medwire reported, “Vitamin K deficiency may play a role in the development of osteoarthritis, suggests a study published in The American Journal of Medicine.”

green-vegetablesResearchers found that “Multicenter Osteoarthritis (MOST) Study participants with subclinical plasma levels (≤0.5 nM) of phylloquinone (vitamin K) were significantly more likely than participants with adequate vitamin K to have x-ray evidence of knee osteoarthritis.” Additionally, during “30 months of follow-up, vitamin K-deficient participants were significantly more likely to develop osteoarthritis in one or both knees than in neither knee.”

Comment: Interesting… eat your greens!

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Tipoffs to need for repeat joint surgery

Nancy Walsh writing in MedPage Today reported “Specific patient characteristics, such as depression and renal disease, can help predict which patients with knee or hip replacements are most likely to need repeat surgery joint-replacement-surgerywithin a year, a researcher reported” at an American Academy of Orthopaedic Surgeon meeting.

Investigators found that “in Medicare patients, one of the most significant independent risk factors for total knee arthroplasty revision within a year was chronic pulmonary disease, while depression was a main reason for revision total hip arthroplasty within 12 months.”

Several “factors influence outcomes in joint replacement surgery, including physician, health system, and device factors, but patient characteristics, particularly in older patients, have not been studied much, according to” Kevin Bozic, MD, “who presented results from two studies.”

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Orthopedic Knee Device Undergoes Safety Alert From FDA

joint-replacement-surgeryDebra Sherman writing for Reuters reported that the US Food and Drug Administration released  a Safety Alert, notifying healthcare providers that Johnson & Johnson’s DePuy unit has issued an urgent, Class I recall, for its LPS Diaphyseal Sleeve. The FDA said that thus far, it has received 10 reports of incidents in which fractures or looseness caused the orthopedic device, which is used for reconstructive knee surgery, to malfunction.

Fractures that occur at the taper joint of the sleeve could cause soft tissue to become compromised and result in infection, function loss, limb loss, or death, the agency cautioned in the Alert.

Another danger of knee replacement surgery.

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