Arthritis and degenerative joint disease

Rheumatoid arthritis is an autoimmune disease. The antigen that stimulates the initial autoimmune response and the genetic mechanism that promotes its development are unknown. Once the disease process is under way, antigen-antibody complexes presumably activate the complement and elicit the release of various mediators, causing inflammation. The treatment of rheumatoid arthritis is aimed at reducing this inflammation, thereby decreasing the pain and attempting to slow the joint destruction. 

In the management of arthritic conditions, drugs are chosen on an empirical basis, usually trying the least toxic 

First choice— nonsteroidal antiinflammatory agents Aspirin 

Second choice—disease-modifying agents Gold salts P-Penicillamine Hydroxychloroquine 

Nonsalicylate Nonsteroidal Antiinflammatory Drugs for the Treatment of Rheumatoid Arthritis and Allied Degenerative Joint Diseases 

---

Arthritis and degenerative joint disease treatment of Asthma treatment of Autonomic receptors Benzodiazepines uses of Beta-adrenergic-receptor-blocking agents Bioavailabihty of drugs factors influencing Botuhnum toxin A uses of... 

Table 4. Preformed precipitating gelatin-reactive antibodies in sera of normal human subjects and patients with rheumatoid arthritis and degenerative Joint diseases. (Maurer 1960)...

Serious skin reactions (Stevens-Johnson syndrome and Lyell s syndrome) caused temporary withdrawal of isoxi-cam in several countries, even though an analysis of 1800 patients with rheumatoid arthritis or degenerative joint disease failed to confirm an increased risk (2). 

The maintenance of the normal, anomalous viscosity index of synovial fluid is essential for its proper function as a lubricant between joint surfaces. The concentration and the degree of polymerization of hyaluronic acid in synovial fluids of patients with rheumatoid arthritis and other degenerative joint diseases have been the subjects of widespread investigation. Ragan and Meyer (R1) ascribed the changes in synovial fluid in... 

HA is a major molecule in joint fluid, and plays a major role in that tissue in joint motion and maintenance of normal joint homeostasis. In inflammatory diseases of the joint such as rheumatoid arthritis (RA), and in degenerative joint disease such as osteoarthritis (OA), the levels and average molecular size of HA chains are much reduced. Expressions of both HASl and 2 are decreased, while the hyaluronidases are increased in the various forms of arthritis, compared to control, with a concomitant decrease in average molecular sizes [112]. 

Phenylbutazone is indicated in relieving the symptoms of acute gouty arthritis, active rheumatoid arthritis, and active ankylosing spondylitis, acnte attacks of degenerative joint disease of the hips and knees, and painfnl shoulder (peritendinitis, capsnlitis, bnrsitis, and acnte arthritis of that joint). However, becanse of the risk of agranulocytosis and aplastic anemia, it shonld be nsed only when other nonsteroidal antiinflammatory snbstances have proven unsatisfactory. 

J16. Johansen, P. E., and Sylvest, O., Synovial fluid changes in degenerative joint disease, rheumatoid arthritis, and traumatic arthritis. Acta Rheumatol. Scand. 7, 240-248 (1961),... 

Sokoloff defines degenerative joint disease as an extremely common, noninflammatory, progressive disorder of movable joints, particularly weight-bearing joints, characterized pathologically by deterioration of articular cartilage and by formation of new bone in the sub-chondral areas and at the margins of the joinf [46]. As mentioned, osteoarthritis or osteoarthrosis is sometimes referred to as the wear and tear form of arthritis but, wear itself is rarely a simple process even in weU-defined systems. 

Sokoloff, L. Davis, W.H., and Lee, S.L. Boundary lubricating ability of synovial fluid in degenerative joint disease. Arthritis Rheumatism 21, 754—760,1978. 

OSTEOARTHRITIS (DEGENERATIVE JOINT DISEASE, OR HYPERTROPHIC ARTHRITIS). Osteoarthritis, which is the most common type of arthritis, results from the wear and tear on the joints. Most persons over 50 years of age have osteoarthritis to some degree for this reason it is often called old-age rheumatism. However, it... 

Histologic Considerations 150 Normal US Anatomy and Scanning Technique 153 Pathologic Changes 156 Joint Effusion 156 Rheumatoid Arthritis and Other Inflammatory Arthropathies 158 Septic Arthritis 162 Traumatic Injuries 163 Degenerative Joint Disease (Osteoarthritis) 166 Deposition Diseases 169 Postoperative Complications 173... 

Psoriasis generally appears at the joints, limbs and scalp but may appear anywhere on the body. At least 10% those with psoriasis develop psoriatic arthritis, a degenerative disease of the joints and connective tissue. Approximately 1 million people in the U.S. have psoriatic arthritis. Psoriatic arthritis usually develops between the ages of 30 and 50 but can develop without the lesions characteristic of psoriasis (Natl Psoriasis Foundation, 2005, Specific forms of psoriasis, psoriasis.org). Of those with psoriatic arthritis, about 20% will develop spinal involvement. The inflammation associated with spinal involvement can lead to vertebral fusion as in alkylosing spondylitis. 

Arthritis causing inflammatory and degenerative changes around joints affects 43 million in the United States, and CDC projects that this will rise to 60 million by 2020. It can be caused by more than 100 different diseases, but the commonest are osteoarthritis and rheumatoid arthritis. New medications, such as the anti-tumor necrotic factor a-blockers, raise fresh challenges to clinical study methodology because of limitations on nonclinical toxicity predictors and the application of biologic measurements on a traditional drug appraisal system. 

---