Saturday, 2 January 2016

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

Kyle J. Norton (Scholar)
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 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. A major restriction of joint movement range was frequent in the shoulder but uncommon in other joints(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


Osteoarthritis (OA), a form of arthritis, is defined as a condition of as a result of aging causes of wear and tear on a joint, affecting over 25 million people in the United States in alone. University of Porto Medical School indicated that one must understand the differences in prevalence and incidence estimates of osteoarthritis (OA), according to case definition, in knee, hip and hand joints(3).


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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(231) Physical Activity and Arthritis Overview(CDC)
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(264) Tests and Procedures, Cortisone shots(Mayo Clinic)
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(266) Arthroscopy(NHS choice)
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(269) Knee Osteotomy(The Knee Society)
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