Osteoarthritis, An Issue of Clinics in Geriatric Medicine

David J. Hunter

Description

This issue of Clinics in Geriatric Medicine, Guest Edited by David Hunter, MD, will feature such article topics as: Epidemiology of Osteoarthritis; Age-Related Changes in the Musculoskeletal System and the Development of Osteoarthritis; The Contribution of Osteoarthritis to Disability; Etiology and Assessment of Disability in Older Adults; Quality of Osteoarthritis Care for Community-Dwelling Older Adults; Contextualizing Osteoarthritis Care and the Reasons for the Gap Between Evidence and Practice; Transforming Osteoarthritis Care in an Era of Health Care Reform; Strength Training in Older Adults: the Benefits for Osteoarthritis, Diet and Exercise in Older Obese Adults with Osteoarthritis; Device Use: Braces, Walking aids and orthotics; Pharmacologic Intervention for Osteoarthritis in Older Adults; Surgery in Older Adults with Osteoarthritis.

Sujets

• Médecine
• Spécialités médicales
• Medical
• Geriatrics

Informations

• Publié par: Saunders
• Date de parution: 28 novembre 2010
• Nombre de lectures: 1
• EAN13: 9781455700332
• Langue: English
• Poids de l'ouvrage: 1 Mo

Extrait

Clinics in Geriatric Medicine , Vol. 26, No. 3, August 2010
ISSN: 0749-0690
doi: 10.1016/S0749-0690(10)00060-1

Contributors
Clinics in Geriatric Medicine
Osteoarthritis
David J. Hunter
Rheumatology Department, Level 4, Block 4, Royal North Shore Hospital, St Leonards 2065, New South Wales, Australia
ISSN  0749-0690
Volume 26 • Number 3 • August 2010

Contents
Cover
Contributors
Forthcoming Issues
Preface
Epidemiology of Osteoarthritis
Age-Related Changes in the Musculoskeletal System and the Development of Osteoarthritis
The Contribution of Osteoarthritis to Functional Limitations and Disability
Quality of Osteoarthritis Care for Community-Dwelling Older Adults
Contextualizing Osteoarthritis Care and the Reasons for the Gap Between Evidence and Practice
Transforming Osteoarthritis Care in an Era of Health Care Reform
Strength Training in Older Adults: The Benefits for Osteoarthritis
Diet and Exercise for Obese Adults with Knee Osteoarthritis
Device Use: Walking Aids, Braces, and Orthoses for Symptomatic Knee Osteoarthritis
Pharmacologic Intervention for Osteoarthritis in Older Adults
Total Joint Replacement in the Elderly Patient
Index
Clinics in Geriatric Medicine , Vol. 26, No. 3, August 2010
ISSN: 0749-0690
doi: 10.1016/S0749-0690(10)00062-5

Forthcoming Issues
Clinics in Geriatric Medicine , Vol. 26, No. 3, August 2010
ISSN: 0749-0690
doi: 10.1016/j.cger.2010.06.001

Preface
Osteoarthritis

David J. Hunter, MBBS, PhD, FRACP
Department of Rheumatology, Northern Clinical School, University of Sydney, 2065, Sydney, Australia, Division of Research, New England Baptist Hospital, 125 Parker Hill Avenue, Boston, MA 02120, USA Rheumatology Department, Level 4, Block 4, Royal North Shore Hospital, St Leonards 2065 New South Wales, Australia
E-mail address: [e-mail]


David J. Hunter, MBBS, PhD, FRACP Guest Editor
Osteoarthritis (OA) is the leading cause of disability among older adults. It is already an incredibly prevalent condition and one that is becoming even more prevalent with the combined effects of an aging and increasingly obese society. In this context, this issue of Clinics in Geriatric Medicine is timely, as we envision this increasingly prevalent disabling condition in an era when health care expenditure is increasingly scrutinized.
With these societal trends, new insights are developing into the pervasive disease we know as OA. Consideration of the impact of this condition in our society requires an understanding of the incidence and prevalence of this disease. Drs Zhang and Jordan provide a thoughtful appraisal of the epidemiology of OA, illuminating us on how we define OA (both radiographically and symptomatically), the prevalence and incidence of OA, and risk factors for OA.
Dr Loeser provides a thoughtful review of the biology of OA and the relationship between aging and the development of OA. We now conceptualize OA as a disease of the whole joint organ. Critically, the disease is no longer viewed as a passive, degenerative disorder but rather an active disease process driven primarily by mechanical factors. In addition, an inflammatory component to OA that includes increased activity of a number of cytokines and chemokines in joint tissues drives production of matrix-degrading enzymes. Rather than directly causing OA, aging changes in the musculoskeletal system contribute to the development of OA by making the joint more susceptible to the effects of other OA risk factors that include abnormal biomechanics, joint injury, genetics, and obesity.
As the leading cause of disability in older adults, it is critical that we consider the genesis of this disability. Within the disablement model conceptual framework, Drs McDonough and Jette review the significant contribution of OA to the onset and progression of functional limitations and disability. With respect to important risk factors for the development of functional limitations and disability among those with OA, there is strong support for the role of physical impairments along with other predisposing and intraindividual factors, such as age, body mass index, obesity, lack of exercise, comorbid conditions, depression, and depressive symptoms.
Sir William Osler, considered the “Father of Modern Medicine,” once said, “When an arthritis patient walks in the front door, I feel like leaving by the back door.” For many clinicians this attitude still holds true; however, there is much the interested clinician can do rather than nihilistic waiting. I provide a narrative review that outlines the management of the patient with OA, how standard clinical practice diverges from what is recommended, and some key challenges facing clinicians with regard to optimizing quality-of-care delivery in OA.
No one denies that the management of OA is a challenge and the frequency with which expert groups develop recommendations both highlights this challenge and at times further complicates it. Unfortunately, despite what many guidelines would make you believe, there is not one size or prescription that fits all. OA management needs to be individualized and patient centered. Drs Doherty and Dieppe review the gap between evidence and practice and provide reasons for this separation. Their thoughtful review provides stimulation to clinicians to improve their care of older people with OA.
The challenge facing clinicians is dwarfed by the experience that persons with OA have to face. Any person with a chronic illness faces a personal daily battle with the condition itself that, in the case of OA, is further compounded by a nihilistic “broken” health care system. I have had the distinct pleasure of coauthoring a review with Dr William Gruber on the current state of OA management in our health care system and progressive steps that can be taken in this era of health care reform.
For the practicing clinician, arming themselves with evidence for disease management is critical and the ensuing articles, particularly those on strength training, obesity management, and device use, are critical, as these are far too frequently overlooked in clinical practice. It is important that symptomatic improvement serve the purpose of increasing tolerance for functional activity. Ultimately, an efficacious treatment for any progressive disorder should also control the factors and forces that drive disease progression. These sections highlight this need.
Drs Latham and Liu summarize the findings of randomized controlled trials of progressive resistance strength training by older people with OA. Their results suggest that strength training has particularly strong functional benefits for older adults with OA. They go on to discuss how older adults with OA will benefit from a strength training program and how clinicians should encourage and prescribe participation in exercise training programs.
The impact of, and mechanisms by which, obesity affects OA are of great concern at both societal and individual levels. Dr Messier, a master in this field, reviews the physiologic and mechanical consequences of obesity on older adults with OA: the effects of long-term exercise and weight-loss interventions, the most effective nonpharmacologic treatments for obesity; and the usefulness, practicality, and feasibility of prescribing these in clinical practice.
The goal of many noninvasive devices for OA is to alter joint biomechanics in such a way as to limit regional exposure to potentially damaging and provocative mechanical stresses. Because of their targeted intention, optimal prescription of most noninvasive devices requires that we first specify which mechanical stresses we wish to reduce. Dr Gross lends his expertise and reviews several of the most important devices currently used in the treatment of OA.
Ultimately many patients seek assistance for pain relief in the form of pharmacologic intervention. Dr Harvey and I review the current trends and controversies related to pharmacologic management, including the use of oral, topical, and injectable agents. Before recommending any pharmacologic intervention, it is important to reconcile the delicate balance between effectiveness and toxicity.
Failing prior interventions, OA surgery may become necessary. Although the indications for arthroscopy have narrowed, joint replacement continues to play a pivotal role in disease management. Drs Talmo, Robbins, and Bono review the role and indications for joint replacement in older adults. They highlight the perioperative issues, including monitoring, preventative measures, and complications, that are critical to consider in adequately managing joint replacement in older adults.
Looking forward we are reminded by the late Sir Henry Tizard that “The secret of science is to ask the right question, and it is the choice of problem more than anything else that marks the man of genius in the scientific world.” We have been afforded an opportunity to study a much maligned disease that is rapidly evolving. Let us learn from the insights our research is providing to focus even more on important modifiable risk factors, such as mechanics and obesity, as we develop the therapeutic armamentarium of the twenty-first century. Assuming we maintain a meaningful motivation with the patient at the forefront of our minds, we have an opportunity to make a difference in millions of people's lives. I look forward to the evolution ahead.
I would sincerely like to thank my friends and colleagues for their valuable contributions to this issue. They were a pleasure to work with and I am sure you will see from the contents that their respective manuscripts reflect wonderful insight and appraisal of a complex and developing field.

Dr Hunter is funded by an Australian Research Council Future Fellowship.
Clinics in Geriatric Medicine , Vol. 26, No. 3, August 2010
ISSN: 0749-0690
doi: 10.1016/j.cger.2010.03.001

Epidemiology o