Medical Intervention with the Disease of Osteoarthritis - Essay Example

You're 20 August 2006 Medical Intervention with the Disease of Osteoarthritis Introduction: The Background of Osteoarthritis Osteoarthritis is a disease of the human skeletal structure which predominantly consists of the degeneration of bone at the various joints in the skeletal frame. It destroys the bone by wearing away the cartilage caps that act as buffers where each bone meets and creates a joint. Osteoarthritis is a degenerative arthritis, a condition in which joint cartilage degenerates or breaks down, as was introduced (Brandt 1988). New tissue, which grows at the ends of bones, now has no cartilage cap to control it. Instead, this new bone forms into strange lips and spurs that grind and grate and get in the way of movement of the joint. Scientific investigations have clarified that the disease of osteoarthritis is common in older people following years of wear-and-tear that thin the cartilage and the bones (Davis 1988). Osteoarthritis can also result from diseases in which there is softening of the bone, like Puget's disease in which the long bones of the body curve like a bow, or osteoporosis with its bowing of the shoulder called "dowager's hump," or other bone degeneration (Hammerman 1989). Other forms of arthritis can also cause a secondary osteoarthritis. Despite what many have been told, osteoarthritis is not an inevitable problem of aging. Those who don't suffer from it may have their heredity and possibly the strength of their immune systems to thank. Medical science is not quite sure of all the factors that come into play in deciding who gets osteoarthritis and who doesn't. As was mentioned, osteoarthritis creates a formation of spurs of bone to form in the locations where the disease is most prevalent, often in the back of the neck, spinal column, and knees but in various other locations as well; as the research will continue to point out (Brandt 1988). This ultimately leads to restricted movement due to the destruction of the cartilage and causes inflammation and pain in the areas the disease targets. Osteoarthritis: The main Points of Concern Arthritis alone is simply medically known as a swelling or inflammation of the joints but osteoarthritis is a form of arthritis that is caused by the inflammation and the breakdown of cartilage around the joints which makes it far more complex than the basic form of arthritis itself (Hammerman 1989). Cartilage is the shock absorbing material between joints. The weight-bearing joints such as the knees, hips, and spine, as well as the hands, are the joints most often affected by osteoarthritis. These joints are under much greater stress because of additional weight and continuous use (lifting, sports, support, and movement). The concern that too much physical activity may lead to osteoarthritis is on the rise also (Davis 1988). Specialists who work with patients who have this disease now claim that too much physical activity can lead to osteoarthritis since "the continuous stress that physical activity places on the joints can result in micro trauma and degeneration of the articular cartilage" (Davis 1988). Osteoarthritis is also known as degenerative arthritis. Among the over 100 different types of arthritic conditions, osteoarthritis is the most common, affecting over 15 million people in the United States (Hammerman 1989). Before age 45, osteoarthritis occurs more frequently in males. After age 55 years, it occurs more frequently in females. Most cases of osteoarthritis have no known cause, and are called primary osteoarthritis (Brandt 1988). When the cause of the osteoarthritis is known, the condition is called secondary osteoarthritis. Primary osteoarthritis is mostly related to aging. After prolonged use of joints, the cartilage begins to degenerate by flaking or forming tiny crevasses. In advanced cases, there is a total loss of the cartilage cushion between the bones of the joints. Loss of cartilage cushion causes friction between the bones, leading to pain and minimized movement of the joint(s). Inflammation of the cartilage can also stimulate new bone outgrowths (spurs) to form around the joints (Hammerman 1989). Secondary osteoarthritis is caused by another disease or condition. Conditions that can lead to secondary osteoarthritis include obesity, repeated trauma or surgery to the joint structures, abnormal joints at birth (congenital abnormalities), gout, diabetes, and other hormone disorders (Brandt 1988). An important component of a healthy joint is articular cartilage, which is designed to reduce the friction of bones rubbing together by holding in fluids used for lubrication. It is a spongy material that releases fluids under pressure and soaks up fluids when the pressure is released. For example, when you take a step, liquid is squeezed out of the cartilage in your knee as you bring your foot down (like pressing on a wet sponge), and then is soaked up when you pick up your foot to take another step. Osteoarthritis begins with a loss of water in the cartilage, causing it to weaken and crack. The cartilage degrades, forming grooves that eventually expose the bone. With this lack of cartilage, bones rub together, causing a lot of pain and swelling. Current Treatments for Osteoarthritis Surgical There are several different surgical methods that are sometimes utilized in the treatment of osteoarthritis but only if the case is severe and causing unbearable pain to the patient. Arthroplasty is one viable technique which has resulted in many positive patient outcomes (Segal 2006). Along with this type of surgical treatment there are also transplantations of soft tissues, high tibial osteotomies, and various other surgical methods that have alleviated many of the painful symptoms of osteoarthritis for patients. Hip replacement surgery is another method that, although considered a major surgery has become quite common place in the medical world (Segal 2006). Nurses are required to monitor the patient extensively and they are in charge of having the necessary patient testing carried out before the surgical procedure as well. This quite normally consists of routine X-rays, blood work, and other basic pre-op testing. Doctors have nurses assess the patient's ability to be able to sit, walk, lie down, and stand and gauge these activities on a related pain scale (Marks & Hermey 2002). Also, before the surgical procedure many patients meet with rehabilitative and occupational therapists as well so that they will gain an understanding of the physical therapy regimen they will undergo following their surgery. This of course is meant to educate them and teach them what they should know before they are discharged from the hospital environment. Although hip replacement surgeries normally progress smoothly there can be complications involved that can stem from excessive blood loss, blood clots in the legs, possible embolism in the lung or heart, and staph infection (Health Online 2005). Though these complications can arise there exists a 98% chance that the surgery will progress smoothly and without any complication such as the ones mentioned. It is the duty of the nurses, and the anesthesiologist too monitor the patient's bodily functions in order to keep an alert eye for any possible problem arising such as what was subsequently discussed (Health Online 2005). This allows for the surgical doctor to effectively perform the operation without having to try and monitor all other areas of the patients care. General anesthesia is the most common form of medication for an operation such as hip replacement but sometimes patients do awake to find they have received a spinal anesthesia. Even though they are awake the anesthesiologist is careful to make sure their pain is kept under control and they are cared for appropriately as do the nurses as well. Following hip replacement surgery some patients do suffer with nausea so more often than not the nurse injects the pain medication through the patient's intravenous line (Segal 2006). Not only does the nurse have a heavy responsibility to the patient following surgery but prior research has clarified that the patient care given before the surgery has been defined as having a major influence in the patient outcomes as well. There are times when some patients have to be placed on blood thinners to break up clots that might have developed in their legs. This normally is taken care of rather routinely and there are no farther complications if the treatment is carried out in a timely and appropriate manner (Segal 2006). Before release from the hospital the physical therapist and occupational therapist will make certain that the patient has been educated in the ways in which to move themselves in regards to, coming to a sitting position, then standing and walking. Physical therapy can be rough for some but here again it is something that the majority of patients tackle without any hindrance. Alternative forms of treatment for Non-surgical Cases of Osteoarthritis Years ago, Anti-inflammatory substances were the primary treatment methods administered when the joints showed inflammation. Corticosteroids, substances derived from hormones produced in the outer layer of the adrenal gland, were and sometimes still are used to reduce inflammation (Furst & Paulus 1993). Direct injection into an inflamed bursa or joint or synovial tissue helps relieve pain in traumatic arthritis and the acute stages of the inflammatory arthritides. But the side effects of steroids on the organs of the body limit their use. In children, steroids can stunt growth. Other anti-inflammatory agents are drugs like ibuprofen, indomethacin, and gold (Furst & Paulus 1993). Instead of trying to turn salt into gold, today's alchemists turn gold into a salt form and use it as an anti-inflammatory agent in early rheumatoid arthritis and some cases of lupus and osteoarthritis. Of course, the first consideration in every arthritis is to relieve pain. The most common pain reliever is and has for years been aspirin (Bradley et al 1991). Another method is heat which is meant to alleviate a great deal of the pain associated with osteoarthritis. However, most arthritides have no cure, and in those cases therapy is directed toward making the patient more comfortable and more functional, thereby allowing room for surgical methods to be considered as well. There is however a typical treatment that has become more pronounced over the past few years other than surgery since some patients want to avoid a surgical treatment at all costs. Recently osteoarthritis treatments have relied heavily on no steroidal anti-inflammatory drugs (NSAIDs) (Furst & Paulus 1993). A few examples of NSAIDs, which can most likely be found in the medicine cabinet, include aspirin and ibuprofen, with aspirin as a treatment method having been mentioned previously. These drugs may relieve the symptoms, but they do not slow the progression of the disease. In addition, there is evidence that long-term use of NSAIDs damages the joints and accelerates the progression of osteoarthritis, so prolonged usage is a big no-no according to the specialists who deal with these types of bone illnesses (Bradley et al 1991). Furthermore, NSAIDs have a number of adverse side effects, including ulcers and damage to the liver or kidneys. With this type of information it leaves many doctors and scientists asking where glucosamine sulfate comes into play Glucosamine is a building block for the strength and durability of joint structures (Bradley et al 1991). When sufficient levels of glucosamine are present, cartilage keeps its ability to hold water and act as a shock absorber. Glucosamine is a simple molecule that can be naturally produced in the body. As some people age, they lose the ability to make sufficient levels of glucosamine, such as those with osteoarthritis and other arthritic conditions. The result is that cartilage loses its ability to act as a shock absorber (Brandt 1988). Conclusion Although there are numerous methods utilized to treat osteoarthritis and other arthritic diseases it is believed that glucosamine sulfate is the best choice with the minimal amount of adverse side affects. A surgical methodology would be the only other logical means to try and alleviate a patient's pain and bring back an improved quality of life. Medical experts and specialists claim that glucosamine sulfate is an ideal supplement to use in order to effectively treat osteoarthritis if a surgical method is not being considered. There are many sound experiments to back the quality and effectiveness of glucosamine sulfate, thus making it a safe choice for joint sufferers. Not only does glucosamine rid the patient of pain and swelling of the affected joints, it also works at the source of the problem, which is joint degradation. Unlike NSAIDs, which can cause negative side effects, glucosamine works only to the benefit of the user. With numerous studies backing the power of glucosamine sulfate, I believe it will become the number one supplement used for joint problems (osteoarthritis), thus replacing the conventional methods such as surgery, and therefore giving hope towards the attempts to reduce the amount of pain that patients experience with these forms of bone diseases. References Brandt, K. D. (1988). "Osteoarthritis." Journal of Clinical Geriatric Medicine 4, 279-293. Bradley, JD & Brandt, KD & Katz, BP & Kalasinki, LA. (1991). "Comparison of an Anti-inflammatory Dose of Ibuprofen, an Analgesic Dose of Ibuprofen, and Acetaminophen in the Treatment of Patients with Osteoarthritis of the Knee. New England Journal of Medicine 325, 87-91. Davis, M. A. (1988). "Epidemiology of Osteoarthritis." Clinical Journal of Geriatric Medicine 4, 241-255. Furst, D. E. & Paulus, H. E. (1993). Aspirin and other Nonsterodial Anti-inflammatory Drugs: Arthritis and Allied Conditions 12th Edition. Philadelphia: Lea & Febiger Publishing. Hammerman, D. (1989). "The Biology of Osteoarthritis." New England Journal of Medicine 320, 1322-1330. Health Online. (2005). "Hip Replacement Surgery." Available online from: http://www.health.com/wynks/HipReplacementWYNK2000-MAL/ Marks, Sandy & Hermey, Donna. (2002). The Structure and Development of Bone, Dept. of Cell Biology. Worcester: University Press of Massachusetts. Seagel, N. A. (2006). "Other Surgical Techniques for Osteoarthritis." Journal of Clinical Rheumatology 1, 155-176. Read More