Degenerative Joint Diseases: Osteoarthritis of the Knee and Cervical Spondylosis Purpose - Essay Example

Degenerative Joint Diseases: Osteoarthritis of the Knee and Cervical Spondylosis Purpose/Rationale By definition Degenerative Joint Disease is a degeneration or ‘wear and tear’ of articular cartilage usually accompanied by an overgrowth of bone (osteophytes), narrowing of the joint space, sclerosis or hardening of bone at the joint surface, and deformity in joints (Druginfonet.com, 2003). Osteoarthritis of the Knee and Cervical Spondylosis both fall into this category. This paper analysis the epidemiology, morbidity and costs linked with these degenerative diseases. The paper also looks into the impact of conventional health care particularly the side effects and the after effects of common drugs used. Osteoarthritis (OA) of the knee is generally caused by excess stress on the joint and causes pain, swelling, and a decrease in knee motion. A common symptom is morning stiffness that decreases with use. The knee may also pop of click, or even lock up at times (Quinn, 2006). OA Knee usually occurs in knees that have experienced trauma, infection or injury. A smooth, slippery, fibrous connective tissue called articular cartilage acts as a protective cushion between bones. Arthritis develops as the cartilage begins to deteriorate. As the articular cartilage is lost, the joint space between the bones narrows resulting in osteoarthritis (American Academy of Orthopaedic Surgeons, 2003). Cervical Spondylosis is the most common disorder of the cervical spine. It is caused by degenerative changes in the vertebrae and intervertebral discs that occur as a result of ageing or due to injury or rheumatoid disease (Virtual Medical Centre, 2006). Neck pain and stiffness that gets progressively worse may be an indication of cervical spondylosis. Bones in the neck (cervical spine) progressively degenerate as age progresses. Arthritis of the neck (cervical spondylosis) may result from bony spurs and problems with ligaments and disks. The spinal canal may narrow (stenosis) and compress the spinal cord and nerves to the arms. Injuries can also cause spinal cord compression. The pain that results may range from mild discomfort to severe, crippling dysfunction (American Academy of Orthopaedic Surgeons, 2001). Epidemiology, Morbidity and Costs Osteoarthritis of knee is one of the most common disorders, and is responsible for higher morbidity, particularly in the old age or the second half of human life. Therefore, there is a burden on health from both morbidity and cost (Qing-yu, et al, 2006). According to the Bone and Joint Decade 2000-2010, which is endorsed by the United Nations and supported by more than 750 organizations and institutions, 40% of people over 70 suffer from osteoarthritis of the knee around the world. 80% of patients with osteoarthritis have some degree of limitation of movement, and 25% cannot perform their major daily activities of life. Evidence suggests that women have a higher incidence of osteoarthritis than men across all age groups, and overall have an incidence of 2.95 per 1000 population, compared with 1.71 per 1000 population in men. Despite problems of defining the global burden of disease, the WHO Scientific Group on the Burden of Musculoskeletal Conditions and The Bone and Joint Decade estimate that 10% of the world’s population who are 60 years or older have significant clinical problems that can be attributed to osteoarthritis (Bone and Joint Decade, 2000). In the case of Cervical spondylosis, the course of cervical spondylosis may be slow and prolonged, and patients may either remain asymptomatic or have mild cervical pain. Long periods of non-progressive disability are typical, and in a few cases, the patients condition progressively deteriorates. Morbidity ranges from chronic neck pain, radicular pain, diminished cervical range of motion (ROM), headache, myelopathy leading to weakness, and impaired fine motor coordination to quadriparesis and/or sphincteric dysfunction (for example, difficulty with bowel or bladder control) in advanced cases. The patient may be eventually chair-bound or bedridden and is also responsible for significant socioeconomic costs (WebMD, 2005). Impact of conventional health care Many medications are available for relieving the symptoms of osteoarthritis. However treatment of OA depends upon multiple factors including patient age, activities, medical condition, and x-ray findings. Patients with mild to moderate osteoarthritis of weight-bearing joints (hips and knees) may benefit from a supervised exercise program such as walking. A first line of simple treatment include the use of acetaminophen (Tylenol) which is effective and has less side effects than other non-steroidal anti-inflammatory drugs (NSAIDS) such as ibuprofen, naproxen, or aspirin. Glucosamine-chondroitin sulfate may be prescribed by the doctor. This medication, when taken over a period of months, may reduce pain and symptoms by restoring or replenishing nutrition to diseased cartilage cells. It tends to be more effective in earlier stages of OA. Patients who fail to improve on acetaminophen or glucosamine are further treated with salicylates and other oral anti-inflammatories ( NSAIDs). Intra-articular (within the joint) injections of steroids may also be helpful, although the duration and amount of pain relief is often unpredictable, especially in more advanced stages of OA. Alternative injections of hyaluronic acid peparations (sodium hyaluronate) are also available in the treatment of OA. Surgery may be dramatically effective for patients with severe osteoarthritis of the weight-bearing joints. Total knee replacement or unicompartmental (partial) knee replacement can be extremely effective (Druginfonet.com, 2003). A major analysis indicated that drug therapy is generally more effective than non-drug treatments (surgery, acupuncture). Drugs such as Acetaminophen are inexpensive and generally safe. It poses far less of a risk for gastrointestinal problems than NSAIDs and does not appear to increase the risk for miscarriage (as NSAIDs do), even when used regularly. It does have some adverse effects, however, and the daily dose should not exceed 4 grams (4,000 mg). Patients who take high doses of this drug for long periods are at risk for liver damage, particularly if they drink alcohol and do not eat regularly. A 2004 review, published in the British Medical Journal, suggested that long-term use of NSAIDs does not actually reduce osteoarthritis pain and may increase patients risk of experiencing side effects. High dosages of NSAIDs can cause heart problems (such as increased blood pressure), kidney problems, and stomach bleeding (A.D.A.M. Quality, N.D.). In the case of mild cervical spondylosis, no treatment is required. Symptoms from cervical spondylosis usually stabilize or regress with simple, conservative therapy including a cervical collar (neck brace) to restrict motion and non-steroidal anti-inflammatory medications (NSAIDs). Cortisone injections to specific areas of irritation may also be helpful. In these cases also the side effects remain the same as that of osteoarthritis. Rarely, intermittent neck traction may be recommended instead of, or in addition to, a cervical collar. This usually consists of a halter-like device placed on the head and neck and attached to pulleys and weights. For severe cases, hospitalization with complete bed rest and traction for 1 or 2 weeks may be needed. Narcotic medicine or muscle relaxants may help to reduce pain. Surgical decompression of the spinal cord in the neck may be recommended for severe pain or for significant loss of movement, sensation, or function. Surgical procedures may involve removal of bone and disc tissue impinging on the nerves of the spinal cord and stabilization of the neck by fusing the cervical vertebrae (drugs.com, 2006). In conclusion, both the degenerative disease can be diagnosed and treated effectively through exercises and mild medications. However it is essential to identify the condition and look for an early intervention. This will not only reduce the cost of the treatment but also the patient undergoes less trauma. References A.D.A.M. Quality, (N.D.) Osteoarthritis, Retrieved October 12, 2006, from http://adam.about.com/reports/000035_9.htm American Academy of Orthopaedic Surgeons, (2003) Frequently Asked Questions about Osteoarthritis of the Knee, Retrieved October 12, 2006, from http://orthoinfo.aaos.org/fact/thr_report.cfm?Thread_ID=418&topcategory=Knee American Academy of Orthopaedic Surgeons, (2001) Cervical Spondylosis, Retrieved October 12, 2006, from http://orthoinfo.aaos.org/fact/thr_report.cfm?Thread_ID=304&topcategory=Neck Bone and Joint Decade, (2000) The Global Economic and Healthcare Burden of Musculoskeletal Disease, Retrieved October 12, 2006, from http://www.ota.org/downloads/bjdExecSum.pdf drugs.com, (2006) Cervical spondylosis, Retrieved October 12, 2006, from http://www.drugs.com/enc/cervical_spondylosis.html Druginfonet.com, (2003) Health Encyclopedia - Diseases and Conditions: Degenerative Joint Disease, Drug Infonet, Inc. Retrieved October 12, 2006, from http://www.healthscout.com/ency/416/577/main.html Qing-yu, Z. et al, (2006) Associated risk factors of knee osteoarthritis: a population survey in Taiyuan, China, Chin Med J 2006; 119 (18):1522-1527. Quinn, E. (2006) Osteoarthritis of the Knee, About, Inc., Retrieved October 12, 2006, from http://sportsmedicine.about.com/cs/knee_injuries/a/knee4.htm Virtual Medical Centre, (2006) Cervical Spondylosis, Retrieved October 12, 2006, from http://www.virtualbonecentre.com/diseases.asp?did=505 WebMD, (2005) Cervical Spondylosis, Retrieved October 12, 2006, from http://www.emedicine.com/PMR/topic27.htm Read More