Hand, osteoarthritis

Urinary tract Diacerein is a drug used in osteoarthritis that elicits and inhibitory effect on interleukin-1 and metal-loproteases. The efficacy of diacerein in hand osteoarthritis was studied in a double-blind, randomized, placebo-controlled study among 86 Korean patients that were enrolled to receive diacerein (50 mg twice daily) or placebo for 12 weeks. The efficacy was similar between both groups, as was the safety profile. However, frequent discolouration of the urine - which disappeared spontaneously - occurred more often in the diacerein group (88%) than in the placebo group (20%) [48 j. 

Shin K, Kim JW, Moon KW, Yang JA, Lee EY, Song YW, et al. The efficacy of diacerein in hand osteoarthritis a double-blind, randomized, placebo-controlled study. Clin Ther April 2013 35(4) 431-9. 

Radiographic changes lypical of rheumatoid arthritis on posteroanterior hand and wrist x-rays, which must include erosions or unequivocal bony decalcification localized to or most marked adjacent to tire involved joints (osteoarthritis changes alone do not qualify). 

Osteoarthritis proves to be a more complex disease than autoimmune disease, with multiple variable manifestations like knee, hip, hand, DIP, elbow, shoulder, and spinal joints OA, which have different risk factors. The etiology of OA is multifactorial with inflammatory, metabolic and mechanical causes. A number of personal and environmental risk factors, such as obesity, occupation, and trauma, may initiate various pathological pathways. OA comprises degeneration of articular cartilage together with changes in subchondral bone of the joint margins and mild intraarticular inflammation. 

Intraaraticular injections of cortisone are used to alleviate the pain from osteoarthritis, especially in the knee, elbow and hands. 

Drugs are applied to the mucous membranes of the conjunctiva, nasopharynx, and vagina to achieve local effects. On the other hand, the antidiuretic hormone lypressin (Diapid) is given by nasal spray, but the intention is to produce systemic effects. For the treatment of meningeal leukemia, cytosine arabinoside is injected directly into the spinal subarachnoid space. In osteoarthritis, corticosteroids are given by intra-articular injection. 

Osteoarthritis is a chronic disease which is characterised by pain and stiffness in the joints. It is not simply a disease caused by wear and tear, many factors can be involved. There is a loss of cartilage and a loss of joint space. There may be bony overgrowths at joint margins. The joints most commonly affected are those of the hands, the knees, hips and spine. 

The term therapeutic touch is used to mean a particular hands-on therapy, as well as the entire realm of hands-on techniques, such as Reiki, Touch for Health, Jin Shin Jyutsu, and some forms of Reconnective Healing. In addition to reducing stress and anxiety, therapeutic touch has been shown to have positive effects on many conditions linked to acidity in the body, including osteoarthritis, cancer, irritable bowel syndrome, and Alzheimer s-type dementia.10 It can provide an increased sense of comfort and well-being, reduce pain, and in some cases improve symptoms and the condition itself. More study is required to validate the power of therapeutic touch as a treatment, either stand-alone or in combination with other healing therapies and medical treatments. But because therapeutic touch has no side effects and can help reduce stress, it is a welcome addition to the Kick Acid program, should you choose to incorporate it. 

Osteoarthritis (OA) is the most common form of joint disease and is a leading cause of disability in the elderly. The disease commonly affects the hands, spine, knees, and hips. Multiple joints may be affected in any one individual. The disorder is strongly associated with increasing age, and has been estimated to affect 2 to 10% of aU adults. It is responsible for approximately 68 million work-loss days/year, and for more than 5% of the annual retirement rate. Furthermore, OA is the most frequent reason for joint replacement, a cost to the community of billions of dollars per year. 

The client with osteoarthritis of the hands is prescribed capsaicin (Capsin) cream, a nonopioid topical analgesic. Which intervention should the nurse discuss with the client concerning this medication ... 

The topical cream should be kept in place at least 30 minutes after application because it is being administered for osteoarthritis of the hands. If not being applied for hands, the cream should be washed off immediately. 

Fig. 3.4 The X-ray image of the hand of an osteoarthritis patient. The arrow shows directly contacting bone surfaces. (Authors own work and copyright-free picture)...

Park JS, Choi MA, Kim BS, Han IS, Kurata T, Yu R (2000) Capsaicin protects against ethanol-induced oxidative injury in the gastric mucosa of rats. Life Sci 67 3087-3093 Deal CL (1991) Effect of topical capsaicin a double blind trial. Clin Ther 13 383-395 McCarthy GM, McCarthy DJ (1991) Effect of topical capsaicin in the therapy of painful osteoarthritis of the hand. J Rheumatol 19 604-607... 

Diclofenac gel is indicated for the relief of the pain of osteoarthritis of the joints amenable to topical treatments such as the knees and those of the hands. Diclofenac patch is indicated for the topical treatment of acute pain due to minor strains, sprains and contusions [2,3]. In controlled trials during the premarketing development approximately 600 patients with minor sprains, strains, and contusions were treated safely with diclofenac patch for up to 2 weeks [4j. A randomized, double-blind, placebo-controlled, trial evaluated the efficacy and tolerability of diclofenac patch, self-administered every 12 h to injury site, in 384 patients aged 18-65 years with minor soft tissue injury and moderate to severe pain intensity >5 (0-10 scale). The most common injuries were contusion (42.6%), strain (31.1%), and sprain (24.4%) most common sites were ankle, shoulder, knee, and foot (67.3%). Patients treated with diclofenac patch experienced improved mean pain scores (40.4% of baseline score) vs. patients using placebo (47.4%, P < 0.05) with an overall pain reduction of 14.8% (Figure 52.3). Patients treated with the patch reached pain resolution 3 days sooner than those in the placebo group (median 10.0 vs. 13.5 days, P = 0.01). Patient response to treatment was rated good to excellent 57.8% for the diclofenac patch vs. 48.4% placebo (P < 0.01). 

Postmen, O., Forsskahl, B., Markhind, M. (1988) Local glycosaminoglycan polysulphate injection therapy in osteoarthritis of the hand. A placebo controlled double-blind clinical study. Scandinavian Journal of Rheumatology, 17,197-202. 

Rheumatoid arthritis and osteoarthritis may involve the joints of the wrist and hand. Psoriatic arthritis and gouty arthritis may also affect this area. Many of the findings and specific deformities were mentioned previously. In the arthriti-des, the small accessory motions of the joint are lost first. The osteopathic physician must articulate all joints once the acute inflammation has subsided. Placing traction on the joint as it is articulated decreases the discomfort for the patient. The patient should be encouraged to exercise the joints gently to maintain mobility. 

Examination She is moderately obese, 90 kg, and has osteoarthritis affecting the wrists. There is decreased sensitivity to pinprick and touch in the median nerve distribution of both hands, i.e., the lateral half of the palm and the ventral thumb, and index and middle fingers. TineTs and Phalen s are positive. There is moderate weakness of the oppo-nens and flexor muscles of the both thumbs. There was no weakness proximal to the wrists or in the lower Umbs. Tendon reflexes were normal, plantar reflexes were flexor. 

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