Osteoarthritis Term Paper

Pages: 7 (2570 words)  ·  Bibliography Sources: 1+  ·  Level: College Senior  ·  Topic: Disease  ·  Buy This Paper

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[. . .] Radiographs find different abnormalities in the stressed and non-stressed areas of the affected joint. In the highly stressed areas of the joint, radiographs can depict joint (capsule) space loss, as well as bony sclerosis and cyst formation. In the areas without high contact pressures, osteophytes can be detected. The net loss of cartilage appears as a reduction of the joint space on radiographs. In major weight-bearing joints, a greater loss of joint space occurs at those areas subjected to the greatest pressures. In the osteoarthritic knee, for example, one commonly observes the greatest loss of joint space in the medial femorotibial (between the femur and tibia) compartment although the lateral femorotibial compartment and patellofemoral compartment may also be affected.

Radiographs of the entire lower extremity are also useful for demonstrating bone misalignment. Axial projections are best for evaluating the patellofemoral (patella and femur) joint. When the patellofemoral compartment is involved, the lateral facet of the patella is more frequently affected than the medial facet, and lateral patellar subluxation (bone misalignment that cause pressure on the surround nerves) may be noted.

In the osteoarthritic hip, the superior aspect of the joint space is typically the most narrowed; axial and medial migration of the femoral head is less commonly seen. In the small joints of the hand, radiographs often show loss of joint space across the entire joint. In some cases, the interphalangeal joint may be asymmetrically affected, and radial or ulnar deviation is observed. Sclerosis is often the most prominent radiographic finding when osteoarthritis affects the facet joints of the spine.

Cyst formation is a fundamental radiographic finding in patients with osteoarthritis. Osteoarthritic cysts are also referred to as subchondral cysts and pseudocysts. Later in the disease, the subchondral bone weakens and compresses; bony collapse may be seen radiographically. This finding is commonly seen in advanced cases of osteoarthritis of the hip, in which flattening of the superior aspect of the femoral head typically occurs.

The primary radiographic finding in the less-stressed areas of the osteoarthritic joint is osteophytosis. Osteophytes are mushroom-shaped bony outgrowths that are generally seen at the margins of the joint. In the knee, sharpening of the tibial spines may be present. A bony prominence, known as the Parson bump, may develop just anterior to the tibial spines. Growth of osteophytes is one of the best indicators of disease progression. Fractured osteophytes result in loose bodies in the synovial fluid which are also observed as indicators of advanced osteoarthritis. (Jewell, Watt et al. 1998)

CT (Computer Tomography) is rarely used for the diagnosis of primary osteoarthritis, although it may be used for the diagnosis of misalignment of the patellofemoral joint or the foot and ankle joints. It may also be useful in evaluating the bones of the vertebral column. In patients who cannot tolerate MRI (Magnetic Resonance Imaging), CT scanning after the intra-articular injection of contrast material and air can be useful for the diagnosis of patellofemoral osteoarthritis or loose bodies in a variety of joints. CT is also well suited for the demonstration of hip joint osteoarthritis. MRI can also depict many of the same findings of osteoarthritis as those depicted on radiographs, including joint-space narrowing, subchondral bony changes, and osteophytes. MRI and CT however, remain cost-prohibitive as compared to X-rays. MRI has the advantage of depicting cartilage directly and can be used to diagnose osteoarthritis in advance before its serious symptoms occur. (Zanetti, Bruder et al. 2000)

Treatment and Intervention

Several treatment options are now available for slowing or stopping the progression of osteoarthritis. The patient is instructed to avoid placing excessive strain on the affected joint and, if necessary, to lose weight. Physical therapy may be recommended to preserve joint motion and flexibility. Acetaminophen or acetylsalicylic acid (or other nonsteroidal anti-inflammatory drugs [NSAIDs]) are often prescribed to alleviate the pain associated with the disease. Cyclo-oxygenase-2 (COX-2) inhibitors are newer medications that are useful in patients who cannot tolerate NSAIDs due to stomach irritation and other gastro-intestinal factors.

Radiologists may also by administering image-guided intra-articular injections of steroids. This procedure often provides symptomatic relief for the patient and allows laboratory evaluation of the synovial fluid. Several corticosteroids are available for intra-articular injection.

If these treatments are ineffective, surgical intervention to resurface bones, reposition bones, replace joints and remove loose pieces of bones or cartilage is an important treatment option.

Self-Care, Better Attitude and Research

People with osteoarthritis can enjoy good health despite having the disease 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.

Patients are generally encouraged to read, research and understand their affliction. Such a move keeps them involved and make for better general treatment.

Bibliography

Arthritic Foundation. (2002). Osteoarthritis (OA). September 25, 2002 http://www.arthritis.org/conditions/DiseaseCenter/oa.asp

Hammerman, D. (1989). "The biology of osteoarthritis." New England Journal of Medicine 320(20): 1322-30.

Hoaglund, F.T., A.C. Yau, et al. (1973). "Osteoarthritis of the hip and other joints in southern Chinese in Hong Kong." J. Bone Joint Surg Am 55(3): 545-57.

Hosie, G. And J. Dickson (2000). Managing Osteoarthritis in Primary Care. Malden, MA, Blackwell Science.

Howell, D.S. (1986). "Pathogenesis of osteoarthritis." Am J. Med 80(4B): 24-8.

Intellihealth (2001). HRT Prevents Osteoarthritis. March 31, 2002, September 25, 2002. http://about.arthritis.com

Jewell, F.M., I. Watt, et al. (1998). Plain radiographic features of osteoarthritis. New York, NY, Oxford University Press.

Kellgren, J.H. (1961). "Osteoarthritis in patients and populations." Br Med J. 2: 1-6.

Radin, E.L. And I.L. Paul (1971). "Response of joints to impact loading. I. In vitro wear." Arthritis Rheum 14(3): 356-62.

Roberts, J. And T.A. Baruch (1966). "Osteoarthritis prevalence in adults by age, sex, race, and geographic area." Vital Health Stat 11(15): 1-27.

Veys, E. And G. Verbruggen (1999). Evolution and prognosis of osteoarthritis.

Wildner, M. And O. Sangha (1999). Epidemiologic and Economic Aspects of Osteoarthritis. New… [END OF PREVIEW]

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