Management of osteoarthritis of the hip and knee

Article Abstract:

It is estimated that 15.8 million adults in the US have symptoms and signs of osteoarthritis. The disorder causes pain in affected joins and interferes with normal movement. Since many joints affected by osteoarthritis are inflamed, physicians have been quick to prescribe nonsteroidal anti-inflammatory drugs (NSAIDs). This practice is not supported by clinical evidence, however, and a recent study has found that these drugs provide no additional benefit when compared with plain analgesics, which do nothing except reduce the pain. Presenting their results in the July 11, 1991 issue of The New England Journal of Medicine, the researchers show that ibuprofen, an NSAID, is no more effective than acetaminophen, an analgesic. (Acetaminophen is sold over-the-counter drug as Tylenol.) Clinicians should be aware, however, that the publication of this study is not the final word on the usefulness of NSAIDs in the treatment of osteoarthritis. Several questions remain unanswered. Might other NSAIDs besides ibuprofen yield different results and perhaps provide additional benefits? Might the long-term results achieved using NSAIDs be better than those using acetaminophen? The treatment of osteoarthritis is a complicated affair. The diagnosis is not straightforward, since many conditions may cause joint pain. Furthermore, the prescription of a pain killer is not the full treatment. Patients may gain tremendously from careful instruction in the proper use of a cane, which, contrary to popular opinion, is not obvious and requires practice. Patients can also benefit from instruction in many movements of everyday life, and mechanical devices which provide a bit of help can improve tremendously the ease of movement of the patient. New treatments may also make inroads; there is some indication that therapy with ultrasonic sound waves may provide benefit, and some investigators have reported that the electrical stimulation of nerves through the skin can help. Benefit may also be obtained by tidal irrigation, in which debris is washed from the joint space. Until a cure for osteoarthritis becomes available, researchers must study the development and progression of the disease, and clinicians must carefully evaluate the many treatment options. (Consumer Summary produced by Reliance Medical Information, Inc.)

Joint diseases, editorial

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Techniques to Improve Physicians' Use of Diagnostic Tests: A New Conceptual Framework

Article Abstract:

Several different methods may be needed to encourage physicians to order diagnostic tests only when appropriate. These methods include education, practice guidelines, utilization audits, and financial incentives. Researchers analyzed 49 studies that evaluated different methods for changing physician behavior. In 76% of the studies, the method studied successfully changed physician behavior. Eighty-six percent of the studies that targeted several behavioral factors were successful, compared to 62% of the studies that targeted only one.

Usage, Practice, Physicians, Medical professions, Diagnosis, Laboratory, Laboratory diagnosis

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An aggrecanase and osteoarthritis

Article Abstract:

Three enzymes capable of degrading aggrecan are identified that include ADAMTS 1, ADAMTS 4 and ADAMTS 5. The results revealed that the inactivation of either enzyme did not affect skeletal development or the integrity of articular cartilage in unchallenged mice.

United Kingdom, Analysis, Risk factors, Articular cartilage

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